Houston Community College System

Community health workers are recognized in the Patient Protection and Affordable Care Act as important members of the health care workforce. The evidence shows that they can help improve health care access and outcomes; strengthen health care teams; and enhance quality of life for people in poor, underserved, and diverse communities. We trace how two states, Massachusetts and Minnesota, initiated comprehensive policies to foster far more utilization of community health workers and, in the case of Minnesota, to make their services reimbursable under Medicaid. We recommend that other states follow the lead of these states, further developing the workforce of community health workers, devising appropriate regulations and credentialing, and allowing the services of these workers to be reimbursed.

In their examination of ESL teachers' questions in the classroom, Long and Sato (1983) found that teachers ask significantly more display questions, which request information already known by the questioner, than referential questions. The main purpose of the study reported in this article was to determine if higher frequencies of referential questions have an effect on adult ESL classroom discourse. Four experienced ESL teachers and 24 non-native speakers (NNSs) participated. Two of the teachers were provided with training in incorporating referential questions into classroom activity; the other 2 were not provided with training. Each of the 4 teachers taught the same reading and vocabulary lesson to a group of 6 NNSs. The treatment-group teachers asked significantly more referential questions than did the control-group teachers. Student responses in the treatment-group classes were significantly longer and more syntactically complex and contained greater numbers of connective.

Wind energy is the leading form of non-hydro renewable energy source in terms of installed capacity in Turkey. It is among the most promising option for Turkey to decrease the energy dependence of external primary energy resources such as national gas and oil that diversifies the domestic share of energy sources in the national energy mix. However, offshore wind energy deployment has not gained satisfactory attention even though the country is surrounded by seas on three of its sides. Exploring Turkey's offshore wind power potential becomes an important task to serve this energy policy. This study presents a methodological framework for finding the most suitable offshore wind farm locations, meeting various multi-layer site selection criteria. The offshore wind energy resource is first assessed using the wind energy potential for 55 coastal regions where the nearshore meteorological stations are available in Turkey. Following on this analysis, a multi-criteria site selection work is carried out to identify the most suitable areas for offshore wind development. Wind Atlas Analysis and Application Program (WAsP) is then used to conduct statistical analysis to identify the most promising offshore wind farm locations. According to the pre-processing step of the framework, Bozcaada, Bandirma, Gokceada, Inebolu, and Samandag coastlines are found to be the most suitable locations for offshore wind farm development. Finally, the offshore wind energy potential of Turkey is estimated by using the micro-sitting configuration of wind turbines, considering sea depth, main wind direction, and distance to shore for the most feasible project locations. It is found that total estimated offshore wind power capacity at the specified sites is 1,629 MW.

The high cost of textbooks is of concern not only to college students but also to society as a whole. Open textbooks promise the same educational benefits as traditional textbooks; however, their efficacy remains largely untested. We report on one community college's adoption of a free online psychology textbook. During the fall semester, 2011, 690 students used this book. Compared to students using a traditional text in the spring of 2011, students who used the free online textbook scored higher on departmental final exams, had higher GPAs in the class and higher retention rates.

OBJECTIVE: We evaluated the effects of three different strategies for communicating diagnostic uncertainty on patient perceptions of physician competence and visit satisfaction. DESIGN/SETTING: Experimental vignette-based study design involving pediatric cases presented to a convenience sample of parents living in a large US city. PARTICIPANTS/INTERVENTION(S): Three vignettes were developed, each describing one of three different ways physicians communicated diagnostic uncertainty to parents-(i) explicit expression of uncertainty ('not sure' about diagnosis), (ii) implicit expression of uncertainty using broad differential diagnoses and (iii) implicit expression of uncertainty using 'most likely' diagnoses. Participants were randomly assigned to one of the three vignettes and then answered a 37-item web-based questionnaire. MAIN OUTCOME MEASURE(S): Outcome variables included parent-perceived technical competence of physician, trust and confidence, visit satisfaction and adherence to physician instructions. Differences between the three groups were compared using analysis of variance, followed by individual post hoc analyses with Bonferroni correction. RESULTS: Seventy-one participants completed the vignette questions. Demographic characteristics and scores on activation (parent activation measure [PAM]) and intolerance to uncertainty were similar across the three groups. Explicit expression of uncertainty was associated with lower perceived technical competence, less trust and confidence, and lower patient adherence as compared to the two groups with implicit communication. These latter two groups had comparable outcomes. CONCLUSION: Parents may react less negatively in terms of perceived competence, physician confidence and trust, and intention to adhere when diagnostic uncertainty is communicated using implicit strategies, such as using broad differential diagnoses or most likely diagnoses. Evidence-based strategies to communicate diagnostic uncertainty to patients need further development.

Diagnostic error research has largely focused on individual clinicians' decision making and system design, while overlooking information from patients. We analyzed a unique new data source of patient- and family-reported error narratives to explore factors that contribute to diagnostic errors. From reports of adverse medical events submitted in the period January 2010-February 2016, we identified 184 unique patient narratives of diagnostic error. Problems related to patient-physician interactions emerged as major contributors. Our analysis identified 224 instances of behavioral and interpersonal factors that reflected unprofessional clinician behavior, including ignoring patients' knowledge, disrespecting patients, failing to communicate, and manipulation or deception. Patients' perspectives can lead to a more comprehensive understanding of why diagnostic errors occur and help develop strategies for mitigation. Health systems should develop and implement formal programs to collect patients' experiences with the diagnostic process and use these data to promote an organizational culture that strives to reduce harm from diagnostic error.

The existing literature on intimate partner violence (IPV) does not paint a consistent portrait of the impact of race/ethnicity. In addition, although research has clearly demonstrated that there is a relationship between substance use and IPV, the temporal ordering of these variables is not clearly established. This article seeks to examine the temporal ordering of IPV victimization and drug use using longitudinal data with a nationally representative racially and ethnically diverse sample. Data from Wave III (2001-2002) and Wave IV (2007-2008) of the National Longitudinal Study of Adolescent Health (Add Health) will serve as Time 1 and Time 2, respectively, to answer three research questions. First, does substance use during early young adulthood (Time 1) predict IPV victimization during young adulthood (Time 2) among women? Second, does IPV victimization during early young adulthood predict substance use during young adulthood for women? Finally, do these bidirectional relationships vary by race/ethnicity (i.e., White, African American, and Latina)? Four different forms of IPV (minor violence, major violence, rape/sexual coercion, and injury) are investigated along with binge drinking, marijuana use, and other drug use. Understanding not only the temporal relationship between substance use, trauma, and IPV but also the racial and ethnic differences in these relationships is critical to developing and refining culturally sensitive trauma-informed prevention and treatment services for women.

Biobased epoxy resins, derived from lignin, phenolic acids, and vegetable oils, exhibited rapid degradation through hydrolysis in basic solution.

Abstract This study investigated the relationship between elementary pupils' attitudes toward science and their science achievement. Residualized gain scores were used to analyze the data. By using residualized gain scores, the effects of individual differences can be minimized. In addition to controlling for these differences, residualized gain scores do not possess the measurement errors that are normally associated with simple change scores. The subjects of this study were 583 intermediate elementary pupils. The average class size was 21. A pretest‐posttest design was used. To insure consistency in the teaching of the lesson, each teacher was given an identical detailed science lesson that included all the instructions and materials needed for the activity. The pupils were pre‐ and posttested. The pupils' science achievement was assessed by a test, the “Hough Pupil Process Test.” It consisted of multiple choice and fill‐in questions. The attitude instrument, the “Hough Attitude Inventory,” was given to the elementary pupils involved in this study. It was field tested and found to discern attitudes. The instrument consisted of six statements to which the subjects responded by circling either yes, I don't know, or no. The analysis revealed that there was a significant relationship between the pupils' residualized gain scores on the “Hough Pupil Process Test” and their residualized gain scores on the “Hough Attitude Inventory” ( r = 0.45).

Water production from solar thermal desalination is limited by the energy consumption of phase change. Resonant heat exchange between matched saline feed and purified distillate flow rates enables optimized recovery of vaporization energy.

BACKGROUND: Racial disparities persist in prostate cancer (CaP) treatment and survival, but disparities in androgen deprivation therapy (ADT) and the degree to which it affects racial differences in survival remains to be fully assessed. METHODS: Using the Surveillance, Epidemiology and End Results-Medicare linked data, we examined a large cohort of men (N = 64,475) diagnosed with locoregional CaP during 1992 to 1999 and followed through 2003. The effects of ADT and race on survival were analyzed using a Cox proportional hazards model. RESULTS: The receipt of ADT was significantly lower in African Americans (24%) relative to Caucasians (27%), Asians (34%), and Hispanics (28.7%) (P < .05). Compared with Caucasian race, African American race was associated with a statistically significant increased mortality (HR = 1.26, 95% CI = 1.21-1.32), which remained significant after adjusting for ADT but was substantially decreased after controlling for primary therapies such as radical prostatectomy, radiation, and watchful waiting (HR = 1.06, 95% CI = 1.01-1.10) and was no longer statistically significant after controlling for comorbidities (HR = 0.98, 95% CI = 0.94-1.03). CONCLUSIONS: There were marked racial variations in the receipt of ADT, primary therapies (namely surgery and surgery combined with radiation), and comorbidities. However, racial disparities in survival were not affected by racial variations in ADT but were explained by racial variations in primary therapies and by racial differences in comorbidities.

Delayed diagnosis of HIV is associated with a worse prognosis despite highly active antiretroviral therapy. Many persons with HIV infection are diagnosed late in the disease process. We conducted a study of 119 persons recently diagnosed with HIV infection to determine the association of health literacy and other factors with delayed diagnosis. Patients were recruited from four publicly funded facilities in Houston, Texas. Health literacy was measured with the Test of Functional Health Literacy in Adults (TOFHLA). Delayed diagnosis was assessed by CD4 cell count at diagnosis. Sixty-five percent of patients had CD4 cell counts 350 cells/mm(3) or less. Twenty-eight percent had inadequate health literacy, but literacy was not associated with CD4 cell count. Thirty-eight percent were tested because they "felt sick." In multivariable analysis, female gender (p = 0.005), reason tested other than "felt sick" (p < 0.001), and marijuana use (p = 0.004) and other illicit drug use (p = 0.01) were predictors of having a higher CD4 cell count at diagnosis. These results confirm that late diagnosis of HIV is common among users of public health care facilities. Expanded routine testing for HIV infection is needed with attention directed to men and persons who may not recognize that they are at risk for contracting HIV infection.

Bulk heterojunction organic photovoltaic (OPV) devices are multilayer organic devices that can be fabricated using low-cost and scalable solution processing methods, but current devices exhibit poor mechanical stability and degrade under deformation due to cracking and delamination. Recent approaches to improve mechanical durability involve modifying the side-chain or main-chain structures of conjugated polymers in the active layer, but in general it is difficult to simultaneously optimize electronic properties, morphology, and mechanical stability. Here, we present a general approach to improve the mechanical stability of bulk heterojunction active layers through incorporation of an internal elastic network. Network-stabilized bulk heterojunction OPVs are prepared using reactive small molecular additives that are rapidly cross-linked through thiol–ene coupling after processing the active layer. Thiol–ene reactions catalyzed by a base or initiated through short exposure to UV light produce insoluble, elastic thiol–ene networks in the active layer. We show through a combination of crack onset strain measurements, morphological analysis, and OPV device testing that network-stabilized OPVs with up to 20% thiol–ene network exhibit improved deformability with no loss in PCE, and we implement network-stabilized bulk heterojunction OPVs to produce stretchable photovoltaic devices. Here, this work represents a simple approach for improving the mechanical durability of bulk heterojunction OPVs.

Community colleges serve the most diverse student populations in higher education yet have some of the lowest levels of faculty diversity in higher education. Retaining community college student cohorts through transfer/graduation is a goal, yet attaining this goal has been elusive, particularly for underrepresented minority (URM) community college students. Few studies have explored the impact of faculty diversity on the successful retention of URM community college students. This study used archival data for 120 public community colleges from the Integrated Postsecondary Education Data System (IPEDS) to calculate a Diversity Score for each college and ranked them by their overall level of faculty racial/ethnic variance to quantify the relationship between faculty diversity and student graduation, transfer, and drop-out rates. The findings suggest that there is a significant strong positive relationship between graduation, transfer, and drop-out rates for URM students of all race/ethnic categories when there are increases in faculty diversity. Exposure to a diverse faculty produces different outcomes in URM students.

Andropause seem to be less defined than menopause. This study on older patients describes how they perceive and understand this aging process. A noninterventional, cross-sectional study was performed to determine what men report as symptoms of andropause to ascertain if memory loss was a predominant feature. The hypothesis was that androgens such as testosterone are responsible for visual-spatial and memory development. As such the aging process of andropause, which is associated with declines in testosterone levels, would lead to memory loss. A standardized questionnaire of 22 questions was administered to 302 outpatients of a medical center. Information on patient demographics, understanding of andropause, and risk factors was collected. Of the 302 patients, 71% were above 60 years and whites predominated at 87%. Memory loss was reported in 36% of the patients who felt that they had experienced andropause. It was the third most common symptom after erectile dysfunction (46%) and general weakness (41%). Twenty-two percent of the 302 patients had a history of diabetes. Among those who reported that they had undergone andropause, diabetic patients were more likely to report memory loss (p = .03, OR = 1.9. CI = 1.1-3.4). Sixty-four percent of patients reported the onset of andropause to be between 50 and 70 years (the median age being 50-60 years). This study highlights the importance of testosterone in maintaining cognitive functions. It supports studies of testosterone replacement in men undergoing andropause and who have concomitant dementia. The results parallel recent reports of the neuroprotective effects of estrogens in preventing dementia. Diabetes is associated with memory loss because of the additional insults to cognitive function of the brain secondary to ischemia.

Pancreatic ductal adenocarcinoma (PDAC) is currently the fourth leading cause of death in the United States and is expected to be ranked second in the next 10 years due to poor prognosis and a rising incidence. Distant metastatic PDAC is associated with the worst prognosis among the different phases of PDAC. The diagnostic options for PDAC are convenient and available for staging, tumor response evaluation, and management of resectable or borderline resectable PDAC. However, imaging is crucial in PDAC diagnosis, monitoring, resectability appraisal, and response evaluation. The advancement of medical technologies is evolving, hence the use of imaging in PDAC treatment options has grown as well as the utilization of ctDNA as a tumor marker. Treatment options for metastatic PDAC are minimal with the primary goal of therapy limited to symptom relief or palliation, especially in patients with low functional capacity at the point of diagnosis. Molecular profiling has shown promising potential solutions that would push the treatment boundaries for patients with PDAC. In this review, we will discuss the latest updates from evidence-based guidelines regarding diagnosis, therapy response evaluation, prognosis, and surveillance, as well as illustrating novel therapies that have been recently investigated for PDAC, in addition to discussing the molecular profiling advances in PDAC.

Purpose – This paper aims to provide a deeper understanding of the effective use of Facebook within the hotel industry. It explored which current Facebook practices are effective/persuasive using the elaboration likelihood model (ELM) as the main theoretical foundation. Design/methodology/approach – Using an experimental design, the effects of consumers’ exposure to treatments, involving different levels of elaboration and source credibility, were examined to determine whether consumer’s process information from Facebook communication through a central or peripheral route. Findings – The results of this research showed that consumer attitudes are affected by the source credibility, but not by the level of elaboration. Also, intentions to stay at the hotel and intentions to engage with the hotel brand via social media were not affected by the level of elaboration or source credibility. Research limitations/implications – This study presents an important step forward in understanding how consumer persuasion takes place in an online environment. Also, this paper provides a first-hand account of the manner in which social media adds value to a business organization. In addition, this paper provides insight on how consumers process online information. Originality/value – As this is the first conceptualization of the ELM in a social media context, this study is uniquely able to explain the concept of persuasion in the hotel industry. Such knowledge is invaluable to academics and hotel decision makers, especially because the research provides specific insights on the manner in which attitudes change in consumers.

Knowledge of the product distribution and kinetics of the secondary vapor-phase cracking of biomass tar is crucial for the design and optimization of biomass thermochemical conversion processes, such as fast pyrolysis, gasification, and combustion. In this study, we have examined the distribution of condensable tar products from the vapor-phase cracking of eugenol, a model-fuel compound representative of the lignin structural entities found in biomass. Pyrolysis experiments were investigated at different temperatures (300–900 °C) and residence times (τ = 1 and 3 s) in a non-isothermal laminar-flow reactor operated at atmospheric pressure. Tar products were analyzed using gas chromatography with mass spectrometric detection. Eugenol conversion commenced rapidly above 350 °C at τ = 3 s and above 400 °C at τ = 1 s. Complete conversion was attained at 550 and 600 °C at τ = 3 and 1 s, respectively. A numerical model incorporating laminar-flow, non-isothermal temperature profile and pseudo-unimolecular kinetics was developed to model the eugenol conversion data. The model agreed very well with the experimental data, and the derived global kinetic parameters for overall eugenol decomposition were A = 1014 s–1 and Ea = 50.7 kcal mol–1. Tar products were comprised of oxygenates and aromatic hydrocarbons. Identified oxygenates include phenols, furans, ethers, and acids. The aromatics consisted of single-ring aromatic compounds and polycyclic aromatic hydrocarbons. Oxygenates were observed as tar products in the temperature range of 350–850 °C at both τ = 1 and 3 s. Aromatic hydrocarbons were observed as tar products at temperatures above 650 °C. Most of the identified aromatic hydrocarbons showed an increase in the yield above 650 °C at both τ = 1 and 3 s. At all temperatures, yields of oxygenates and aromatics were generally higher at τ = 1 s than at τ = 3 s. Mass balance closure was not achieved above 400 and 500 °C at τ = 3 and 1 s, respectively, with discrepancies in the mass balances increasing with an increase in the temperature. The discrepancies in the mass balances can be attributed to the formation of noncondensable gas products.

To design optimal thermochemical processes for the conversion of biomass into chemicals, fuels, and electrical power, an understanding of the mechanisms for the secondary vapor-phase cracking of tar compounds is crucial. Despite the many studies examining the homogeneous secondary cracking of biomass tar existing in the literature, its thermal decomposition reaction pathways are not completely understood. Much of this lack of understanding is due to the complex, heterogeneous nature of biomass tar. A useful approach is to examine the pyrolysis of model-fuel compounds that are actual components or are representative of compounds found in biomass tar. In this study, we focus on eugenol, a model-fuel compound representative of the lignin-derived components found in biomass tar. We conduct pyrolysis experiments at temperatures of 300–900 °C and one second residence time using a non-isothermal laminar-flow reactor system. We report the variation in the experimental yield of light product gases as functions of the reactor temperature. We examine a reaction pathway for the unimolecular decomposition of eugenol with consideration of the experimental product distributions and analogous reactions based on established decomposition mechanisms of similar compounds. We examine the detailed energetics of the unimolecular decomposition route using computational chemistry calculations at the B3LYP/6-311G+(d,p) level of theory. The results presented in this study would be of relevance to the pyrolysis, gasification, and combustion of biomass.

This study uses the contingent valuation approach to examine the relationship between selected socio-economic characteristics of households and their willingness to pay for private water connection. An iterative bidding method was used to obtain survey data from 135 households randomly selected from Kanye in southern Botswana and the ordinary least-square regression technique was used to estimate the effects of selected exogenous variables on willingness to pay. The results show that household income, level of education and employment status of the head of the household and level of consumers' awareness are the principal factors influencing willingness. This suggests that any government policy that increases these factors will increase households' willingness. In addition, because consumers' income is associated with their willingness to pay, it is suggested that policies on connection and user fees recognise income inequalities when determining the amount that households should pay.