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We discussed multiple regression back in chapter 9. Recall that a multiple regression examines the correlation between two or more independent variables and a dependent variable. This chapter covers examples that have at least three independent variables, whereby the program, NORM, is used to impute missing data.

As previously explained, a multiple regression analysis is a type of test that analyzes the amount of variance explained in a dependent variable by more than one predictor variable. The variables are interval, but sometimes they may have continuous predictors, meaning they are not discrete. For example, weight is a continuous variable, since someone may weigh 125.6 pounds. Sometimes, a researcher wishes to examine the interactions between predictors, when the data are centered.

When you think of assessment, what comes to mind? Perhaps you think of a combination of quizzes, tests, problem-solving activities, explorations, creative design projects, or cumulative mathematics missions.

A structural equation model is a multivariate model that permits variables to be related in chains or paths, whose analysis allows you to find a model that fits data very well, whose lack of fit is not significant. This seems counterintuitive. Stated another way, if the model is significant, then it does not fit the data.

An ATI Analysis is an analysis of covariance with an interaction. In the previous chapter, we looked at a two or three-factor crossed ANOVA. This test involves one or more covariates, whereby one of the covariates may be an interaction between two variables. The test involves one or more fixed effects and one or more covariates. A covariate is a latent variable that may indirectly impact the significance of a model.

We discussed MANOVA in Chapter 7. Recall that a MANOVA compares the means of two or more groups across more than one dependent variable. A MANOVA may include one or more than one independent variable. This chapter discusses the usage of a MANOVA that has at least 3 groups for the independent variable and 4 dependent variables, entered as fixed effects.

Policymakers at all levels of government try to design policies to promote economic growth. Many of these policies have a goal of attracting new businesses to an area, as new businesses are considered a key driver of local economic growth. An emerging literature suggests that such policies have heterogeneous effects on economic growth, both in terms of how the effect of the same policy may vary across locations as well as how different policies spur different types of growth. In this chapter, we discuss the insights provided by the existing literature on the effect of government policy on local economic growth. We pose questions that have not been fully answered, and for which the evidence is mixed, and discuss methodologies that future work should consider utilizing in order to answer these pressing issues. We also discuss the importance of data and the ideal types of data that should be collected and analyzed in the future. Evaluating the features and outcomes of policies will continue to be an important role for regional scientists over the next several decades, as government officials seek guidance when designing policy and allocating scarce resources.

In the previous article on high-stakes testing, we looked at the origins and criticisms of standardized tests. In this article, problems with test construction and guidelines for improvement will be briefly visited.

Given the resurgence of cities as consumer centers and the importance of amenities, we revisit the differences in tipping in taxis between tourists and locals in New York City. Taxi service is an endogenous amenity; however, taxis also contribute to the demand and provision of other amenities. Using data from the New York City Taxi and Limousine Commission, we find that tourists and theatergoers tip more than locals and non-theatergoers, and tourists who are theatergoers tip even more. These differences between tourists and locals may affect the allocation of taxis throughout the city, and hence the provision of other amenities.

Some sequences are arithmetic or geometric, meaning they either change by some common difference or common ratio. An arithmetic sequence is a sequence with a common difference, d. All linear functions represent arithmetic sequences. A geometric sequence is a sequence with a common ratio, r. All exponential functions represent geometric sequences.

The concept of expected value is a mystery to many students (and many teachers, as well). Most students understand that it is an average, of some sort. Specifically stated, for one trial, the expected value is the average of possible outcomes.

Online assessments are quite prevalent in the mathematics classroom. Online assessments can take many forms, including, but not limited to teacher-created online assessments via course management systems and quiz/test creation websites, classroom response systems, online math practice, games/applets, online practice tests, online portfolios, online surveys, and so on.

As stated in Chapter 5, a one-way ANOVA compares the means of two or more groups for one dependent variable. Chapter 6 defines a factorial ANOVA as an ANOVA that includes more than one factor or independent variable. A two or three factor crossed ANOVA is different, in that the interaction of the factors is also included in the analysis. By doing so, one can see if the interaction is significant.

The concept of a derivative is a mystery to many students. Oftentimes, students memorize a sequence of steps, in order to find a derivative, but never fully understand the meaning. On the same note, students often do not understand why there is more than one way to find a derivative. The varying notations of derivatives pose great confusion for many students. This article serves as a very brief introduction to the topic of derivatives. The information provided here may be used to segue into a more in-depth study of the teaching of derivatives.

Background: Data entry at the point of collection using mobile electronic devices may make data-handling processes more efficient and cost-effective, but there is little literature to document and quantify gains, especially for longitudinal surveillance systems. Objective: To examine the potential of mobile electronic devices compared with paper-based tools in health data collection. Methods: Using data from 961 households from the Rufiji Household and Demographic Survey in Tanzania, the quality and costs of data collected on paper forms and electronic devices were compared. We also documented, using qualitative approaches, field workers, whom we called ‘enumerators’, and households’ members on the use of both methods. Existing administrative records were combined with logistics expenditure measured directly from comparison households to approximate annual costs per 1,000 households surveyed. Results: Errors were detected in 17% (166) of households for the paper records and 2% (15) for the electronic records (p

A multiple regression analysis is a type of test that analyzes the amount of variance explained in a dependent variable by more than one predictor variable.

An independent samples t-test compares the means of two groups. The data are interval for the groups. There is not an assumption of normal distribution (if the distribution of one or both groups is really unusual, the t-test will not give good results with unequal sample sizes), but there is an assumption that the two standard deviations are equal. If the sample sizes are equal or very similar in size, even that assumption is not critical.

A paired-samples t-test compares the mean of two matched groups of people or cases, or compares the mean of a single group, examined at two different points in time. If the same group is tested again, on the same measure, the t-test is called a repeated measures t-test.

The normal curve serves as a mystery for many students. Students are often shown examples of normally distributed data, in the form of a bell-shape. This curve is called “normal” or “symmetrical.” This normal distribution may show a mean other than 0.

Sigma notation indicates that you must sum terms. Sigma means “to sum.” Sigma notation indicates the starting and ending n-value (variable value), for which an expression must be evaluated. Then, each of these evaluations must be summed.

Previous studies have struggled to demonstrate that higher taxes deter business activity. We revisit this issue by estimating the effect of changes over time in cross-border differences in state tax conditions on the tendency for new establishments to favor one side of a state border over the other. Identification is enhanced by taking account of previously overlooked reciprocal agreements that require workers to pay income tax to their state of residence as opposed to their state of employment. When reciprocal agreements are in force, higher personal income tax rates lure companies from across the border, while corporate income tax and sales tax rates have the opposite effect. Where reciprocal agreements are not in place, the results are largely reversed. These patterns are amplified in heavily developed locations, and differ in anticipated ways by industry and corporate/non-corporate status of the establishment. Overall, results strengthen the view that state-level tax policies do affect the location decisions of entrepreneurs and new business activity, but not in a way that lends itself to a one-size-fits-all summary.

Review Objective: The objective of this systematic review is to analyze and synthesize best available evidence on the perspectives of patients and family members who have encountered adverse events while receiving health care. Review Question: The specific review question to be addressed is: What are the thoughts, perceptions, and experiences of patients and family members to the occurrence of adverse events while receiving health care? Inclusion Criteria: Types of Participants: This review will consider patients with diverse diagnoses and conditions experiencing an adverse health care event while receiving health care. Because family members often play an integral role in the care of patients during periods of illness and health crisis, they will be included in the review and their perspectives about the occurrence of adverse events will also be considered. There will be no age limitation for the inclusion of participants in this review and all health care settings will be considered, for example, acute, emergency, mental health, pediatric, home, and long-term care Health care providers may include, but are not limited to, nurses (RN and RPN), physicians, midwives, personal support workers, health care aides, technicians and technologists of all diagnostic areas where care occurs. Phenomenon of Interest: The phenomenon of interest is what it was like to experience an adverse health care event while receiving health care including patients and/or family members’ thoughts, perceptions, and reactions to such events. Patient perspective of an adverse event is defined for this review as the subjective thoughts/viewpoints/opinions/feelings/psychological reactions that pertain to the patient experience alone or to family members who have had the experience with a loved one.

We compared: 1) rearing mortality, 2) size at release (mean length), 3) jack, male and female sizes, and 4) jack, female, and adult returns of coho salmon (Oncorhynchus kisutch) from three consecutive brood years reared at the Nitinat River hatchery using a conventional or a semi-natural rearing method. The semi-natural method included feeding restrictions, shading of the rearing ponds, lower rearing temperature and rearing densities, exposure to a predator and a volitional release. We found no significant effects of brood year or rearing method on rearing mortality; it was significantly lower during the marking to release phase than during the other two phases (eyed-egg to ponding, ponding to marking). Conventionally reared smolts were significantly longer. Conventionally reared males were longer. As a proportion of number of smolts released, semi-natural rearing produced 86% fewer jacks, the same proportion of females and 15% more adults. Adult production trends, described as marine survival rate (returning adults • smolt-1) for Nitinat River Hatchery coho, and as ln recruits • female spawner-1 for a nearby wild coho population, were similar. Jacking rates were lower in Nitinat River hatchery coho than for the nearby wild coho population. We concluded that the semi-natural rearing methodology produces adult fish more efficiently than the conventional rearing method does, and at 73% of the cost.

Review question/objective The objective of this systematic review is to compare the use of self-assessment instruments versus an objective structured clinical examination (OSCE) to measure the competence of healthcare learners and healthcare professionals. The specific question that will guide this review is: When measuring the competence of healthcare learners and healthcare professionals is the evaluation obtained by self-assessment instruments comparable to performance on an objective structured clinical examination? Inclusion criteria Types of participants In this review all healthcare learners and healthcare professionals will be considered, including but not limited to physicians, nurses, dentists, occupational therapists, physiotherapists, social workers and respiratory therapists. Types of intervention(s)/phenomena of interest In this review studies in which participants are first administered a self-assessment (related to performance), followed by an objective structured clinical examination will be considered; the results of which will then be compared. The review will consider studies that explore the evaluation of competence by self-assessment, which is then compared with the evaluation of competence using an objective structured clinical examination. Types of outcomes In this review studies that include the following outcome measures will be considered: competence, confidence, performance, self-efficacy, knowledge and empathy as defined in the background section.

Aim This integrative study on safety in home care provides a synopsis of evidence in the Canadian and international literature. The objectives of this study were to: (i) develop/test a comprehensive search strategy to locate the literature on harmful incidents (previously called adverse events (AEs)) in the home care environment to track emerging evidence; (ii) determine what has been documented about AEs in the home care setting; and (iii) catalogue definitions of safety in home care by analysis of reported/published definitions. Methods The review was characterised by a process of mapping and categorising existing literature in practice, health services and policy literature. Methods included a thorough search strategy determined by time/scope constraints, quality assessment of study sets relevant to design and graphic/tabular representation of the synthesis. This multi-step, iterative process used an explicit search and retrieval strategy based on Cochrane and Joanna Briggs Institute methodologies. A modified Problem, Intervention, Comparison, Outcome template was used to design the search. To facilitate concept clarification, key definitions relevant to patient safety and AEs in home care were catalogued. Results Multiple runs on searches were performed for sensitivity and specificity using the Peer Review of Electronic Search Strategies methodology developed by the Canadian Agency for Drugs and Technologies in Health and additional other approaches. Ninety-two research studies published from 1993 to 2010 and representing 14 countries (the majority North American) met the inclusion criteria (i.e. addressing AEs within the context of home care). Studies varied in scope from one home healthcare agency/site to nationwide investigations that involved more than five million participants. Quantitative research methods included experimental, descriptive and retrospective designs. Qualitative research methods included focus groups, interviews and consensus workshops. The nature of AEs was categorised as types of patient injury/harm related to an AE, caregiver instigated injury/harm and organisational/services/staff injury/harm. Conclusions There is an emerging evidence base about safety in home care. A predominant theme was the lack of conceptual clarity with the terms patient safety and AEs in the home care environment. An important finding was that innovative strategies/tools appear in the grey or peer-review literature as quality initiatives with/without evaluation elements. Traditionally, we do not concentrate heavily on the grey literature, but to advance the field, it may be necessary to place more emphasis on this source. A glaring limitation was the paucity of research on the occurrence of AEs and a lack of quality of research that documents prevalence estimates/incidence rates. Interventional research to evaluate risk reduction strategies was very limited and will advance only when tracking and documentation of various AEs improves.

AIM: While continuity of care is an important component in the provision of mental health services, a universally accepted definition is missing. There is a need to identify areas of consensus and discrepancy in continuity theory and provide a foundation for advancing measurement capabilities. The purpose of this study was to systematically identify and examine scholarship on continuity in mental healthcare. METHODS: Using a focused literature review modelled on the Joanna Briggs Methodology for systematic reviews, MEDLINE, CINAHL, Embase, PsycINFO and Health STAR were searched from 1950 to 2011 for articles on the theoretical nature of continuity in mental healthcare. Included conceptualisations were subject to a theory analysis to critically examine similarities and differences. Next, a content analysis on the extracted data was used to identify a global understanding and set of theoretically defined concepts for the whole. Finally, the identified global concepts were compared with the original documents and to items identified on existing quantitative measurement tools to assess areas of consensus and discrepancy. RESULTS: Seven documents describing the conceptualisation of continuity in mental healthcare were identified. From these, a deductive theoretical summary is proposed and theoretical consensus exists to support nine global concepts of continuity in mental healthcare. These global concepts include Longitudinality, Input & Individuality, Comprehensiveness, Flexible Consistency, Stability & Relationship, Accessibility, Information & Sharing, Realities, and Responsibility/Accountability. The original theories proposed by Dr Bachrach and colleagues and Dr Joyce and colleagues, as well as the ACSS-MH measurement tool, provide the best coverage of the proposed concepts. CONCLUSIONS: Consensus exists across conceptualisations of continuity in mental healthcare, yet it is obscured by inconsistent use of language. Existing tools capture many of the associated concepts and elements, but none do so entirely. Further tool development and psychometric testing is needed. This study provides the foundational work required to advance research priorities in this area.

This study aimed to contribute to the understanding of Mycobacterium ulcerans (MU) ecology by analysing both clinical and environmental samples collected from ten communities along two major river basins (Offin and Densu) associated with Buruli ulcer (BU) at different seasons. We collected clinical samples from presumptive BU cases and environmental samples from ten communities. Following DNA extraction, clinical samples were confirmed by IS2404 PCR and environmental samples were confirmed by targeting MU-specific genes, IS2404, IS2606 and the ketoreductase (KR) using real-time PCR. Environmental samples were first analysed for IS2404; after which, IS2404-positive samples were multiplexed for the IS2606 and KR gene. Our findings indicate an overall decline in BU incidence along both river basins, although incidence at Densu outweighs that of Offin. Overall, 1600 environmental samples were screened along Densu (434, 27 %) and Offin (1166, 73 %) and MU was detected in 139 (9 %) of the combined samples. The positivity of MU along the Densu River basin was 89/434 (20.5 %), whilst that of the Offin River basin was 50/1166 (4.3 %). The DNA was detected mainly in snails (5/6, 83 %), moss (8/40, 20 %), soil (55/586, 9 %) and vegetation (55/675, 8 %). The proportion of MU positive samples recorded was higher during the months with higher rainfall levels (126/1175, 11 %) than during the dry season months (13/425, 3 %). This study indicates for the first time that there is a seasonal pattern in the presence of MU in the environment, which may be related to recent rainfall or water in the soil. Electronic supplementary material The online version of this article (doi:10.1007/s00248-017-0946-6) contains supplementary material, which is available to authorized users.

Review question/objective The objective of this review is to identify the meaningfulness of adult life experiences after heart transplantation. The following questions will guide and direct the review: 1. How is a heart recipient’s sense of self and body image altered after a heart transplant? 2. How do heart recipients cope with the loss of their own heart and how do they reach acceptance of their donor heart? Inclusion criteria Types of participants This review will consider studies that include individuals 18 years of age and older who have received a heart or heart-lung transplant or re-transplant Phenomena of interest This review will consider studies that investigate the individual’s sense of self, the experience of transformation and adjustment following the loss of their own heart and the receiving of a new heart or heart and lungs. The context of this review is the community of those individuals living with another’s heart following heart transplantation

Review question/objective How is patient safety culture measured/monitored/described in a rural hospital setting? Inclusion criteria Types of participants This review will include as participants any healthcare worker including but not limited to nurses, physicians, physiotherapists, pharmacists, diagnostic technicians and/or occupational therapists respirologists, social workers, psychologists, that are part of the patient safety culture in a rural hospital. Types of intervention(s)/phenomena of interest The review will consider studies that measure, monitor and describe patient safety culture in rural hospitals. Types of outcomes This systematic review will consider outcomes that include measurement, monitoring and description of patient safety culture in rural hospitals. The specific outcomes may include but not limited to monitoring strategies, descriptions, current standards and expectation of patient safety culture in rural hospitals.

Background: Malaria elimination is unlikely to occur if vector control efforts focus entirely on transmission occurring\ud indoors without addressing vectors that bite outdoors and outside sleeping hours. Additional control tools such as\ud spatial repellents may provide the personal protection required to fill this gap. However, since repellents do not kill\ud mosquitoes it is unclear if vectors will be diverted from households that use spatial repellents to those that do not.\ud Methods: A crossover study was performed over 24 weeks in Kilombero, Tanzania. The density of resting and bloodengorged\ud mosquitoes and human blood index (HBI) of malaria vector species per household was measured among\ud 90 households using or not using 0.03 % transfluthrin coils burned outdoors under three coverage scenarios: (i) no\ud coverage (blank coils); (ii) complete coverage of repellent coils; and (iii) incomplete coverage of repellent and blank\ud coils. Mosquitoes were collected three days a week for 24 weeks from the inside and outside of all participating\ud households using mosquito aspirators. Paired indoor and outdoor human landing collections were performed in three\ud random households for six consecutive nights to confirm repellent efficacy of the coils and local vector biting times.\ud Results: The main vectors were Anopheles arabiensis and Anopheles funestus (sensu stricto), which fed outdoors, outside\ud sleeping hours, on humans as well as animals. Anopheles arabiensis landings were reduced by 80 % by the spatial\ud repellent although household densities were not reduced. The HBI for An. arabiensis was significantly higher among\ud households without repellents in the incomplete coverage scenario compared to houses in the no coverage scenario\ud (Odds ratio 1.71; 95 % CI: 1.04–2.83; P = 0.03). This indicated that An. arabiensis mosquitoes seeking a human blood\ud meal were diverted from repellent users to non-users. The repellent coils did not affect An. funestus densities or HBI.\ud Conclusions: Substantial malaria vector activity is occurring outside sleeping hours in the Kilombero valley. Repellent\ud coils provided some protection against local An. arabiensis but did not protect against local (and potentially\ud pyrethroid-resistant) An. funestus. Pyrethroid-based spatial repellents may offer a degree of personal protection,\ud however the overall public health benefit is doubtful and potentially iniquitous as their use may divert malaria\ud vectors to those who do not use them.

The importance of dendritic cells (DCs) for the initiation and regulation of immune responses not only to foreign organisms but also to the self has raised considerable interest in the qualitative and quantitative analysis of these cells in various human diseases.Plasmodium falciparum malaria is characterized by the poor induction of long-lasting protective immune responses. This study, therefore, investigated the percentage of peripheral blood DCs as lineage marker–negative and HLA-DR+ or CD83+cells in healthy children and in children suffering from acute malaria in Kilifi, Kenya. Comparable percentages of CD83+ DCs were found in peripheral blood of healthy children and children with malaria. However, the percentage of HLA-DR+ peripheral blood DCs was significantly reduced in children with malaria. The results suggest that a proportion of peripheral blood DCs may be functionally impaired due to the low expression of HLA-DR on their surface.

The pathogenesis of the neurological complications of Plasmodium falciparum malaria is unclear. We meas- ured proteins and amino acids in paired plasma and cerebrospinal fluid (CSF) samples in children with severe falciparum malaria, to assess the integrity of the blood brain barrier (BBB), and look for evidence of intrathecal synthesis of immu- noglobulins, excitotoxins and brain damage. Methods: Proteins of different molecular sizes and immunoglobulins were measured in paired CSF and plasma samples in children with falciparum malaria and either impaired consciousness, prostrate, or seizures. Results: The ratio of CSF to plasma albumin (Qalb) exceeded the reference values in 42 (51%) children. The CSF concen- trations of the excitotoxic amino acid aspartate and many non-polar amino acids, except alanine, were above the reference value, despite normal plasma concentrations. IgM concentrations were elevated in 21 (46%) and the IgM index was raised in 22 (52%). Identical IgG oligoclonal bands were found in 9 (35%), but only one patient had an increase in the CSF IgG without a concomitant increase in plasma indicating intrathecal synthesis of IgG. Conclusions: This study indicates that the BBB is mildly impaired in some children with severe falciparum malaria, and this impairment is not confined to cerebral malaria, but also occurs in children with prostrate malaria and to a lesser extent the children with malaria and seizures. There is evidence of intrathecal synthesis of immunoglobulins in children with ma- laria, but this requires further investigation. This finding, together with raised level of excitotoxic amino acid aspartate could contribute to the pathogenesis of neurological complications in malaria.

Background: Large reductions in malaria transmission and mortality have been achieved over the last decade, and this has mainly been attributed to the scale-up of long-lasting insecticidal bed nets and indoor residual spraying with insecticides. Despite these gains considerable residual, spatially heterogeneous, transmission remains. To reduce transmission in these foci, researchers need to consider the local demographical, environmental and social context, and design an appropriate set of interventions. Exploring spatially variable risk factors for malaria can give insight into which human and environmental characteristics play important roles in sustaining malaria transmission. Methods: On Rusinga Island, western Kenya, malaria infection was tested by rapid diagnostic tests during two cross-sectional surveys conducted 3 months apart in 3632 individuals from 790 households. For all households demographic data were collected by means of questionnaires. Environmental variables were derived using Quickbird satellite images. Analyses were performed on 81 project clusters constructed by a traveling salesman algorithm, each containing 50-51 households. A standard linear regression model was fitted containing multiple variables to determine how much of the spatial variation in malaria prevalence could be explained by the demographic and environmental data. Subsequently, a geographically-weighted regression (GWR) was performed assuming non-stationarity of risk factors. Special attention was taken to investigate the effect of residual spatial autocorrelation and local multicollinearity. Results: Combining the data from both surveys, overall malaria prevalence was 24 %. Scan statistics revealed two clusters which had significantly elevated numbers of malaria cases compared to the background prevalence across the rest of the study area. A multivariable linear model including environmental and household factors revealed that higher socioeconomic status, outdoor occupation and population density were associated with increased malaria risk. The local GWR model improved the model fit considerably and the relationship of malaria with risk factors was found to vary spatially over the island; in different areas of the island socio-economic status, outdoor occupation and population density were found to be positively or negatively associated with malaria prevalence. Discussion: Identification of risk factors for malaria that vary geographically can provide insight into the local epidemiology of malaria. Examining spatially variable relationships can be a helpful tool in exploring which set of targeted interventions could locally be implemented. Supplementary malaria control may be directed at areas, which are identified as at risk. For instance, areas with many people that work outdoors at night may need more focus in terms of vector control. Trial registration: Trialregister.nl NTR3496 - SolarMal, registered on 20 June 2012.

Group cycling events have become a common practice in the cycling community to encouraging every day cycling. That said, scant literature has evaluated their actual impact on changing participant travel behavior. The purpose of this research is to investigate how group and social dynamics influence cycling behavior. We survey individuals participating in a monthly group cycling event in San Luis Obispo, CA to investigate their motivations for participation and if that participation is reflective of their everyday travel behavior or if is not. We hypothesize that these kinds of events have an impact on encouraging non-regular cyclists to bicycle. We find quite the opposite, those that these events encourage participation of who, on-the-whole, already regular cycling commuters—what we define as ‘hardcore’ cyclists. This offers opportunities to rethink such programs and target them to everyday other users.

Plasmodium vivax has the ability to relapse from dormant parasites in the liver weeks or months after inoculation, causing further blood-stage infection and potential onward transmission. Estimates of the force of blood-stage infections arising from primary infections and relapses are important for designing intervention strategies. However, in endemic settings their relative contributions are unclear. Infections are frequently asymptomatic, many individuals harbor multiple infections, and while high-resolution genotyping of blood samples enables individual infections to be distinguished, primary infections and relapses cannot be identified. We develop a model and fit it to longitudinal genotyping data from children in Papua New Guinea to estimate the incidence and seasonality of P vivax primary infection and relapse. The children, aged one to three years at enrolment, were followed up over 16 months with routine surveys every two months. Blood samples were taken at the routine visits and at other times if the child was ill. Samples positive by microscopy or a molecular method for species detection were genotyped using high-resolution capillary electrophoresis for P vivax MS16 and msp1F3, and P falciparum msp2. The data were summarized as longitudinal patterns of success or failure to detect a genotype at each routine time-point (eg 001000001). We assume that the seasonality of P vivax primary infection is similar to that of P falciparum since they are transmitted by the same vectors and, because P falciparum does not have the ability to relapse, the seasonality can be estimated. Relapses occurring during the study period can be a consequence of infections occurring prior to the study: we assume that the seasonal pattern of primary infections repeats over time. We incorporate information from parasitological and entomology studies to gain leverage for estimating the parameters, and take imperfect detection into account. We estimate the force of P vivax primary infections to be 11.5 (10.5, 12.3) for a three-year old child per year and the mean number of relapses per infection to be 4.3 (4.0, 4.6) over 16 months. The peak incidence of relapses occurred in the two month interval following the peak interval for primary infections: the contribution to the force of blood-stage infection from relapses is between 71% and 90% depending on the season. Our estimates contribute to knowledge of the P vivax epidemiology and have implications for the timing of intervention strategies targeting different stages of the life cycle., Author Summary Plasmodium vivax is the most widespread of the malaria species affecting humans. It has the ability for parasites to lie dormant in liver cells and then to relapse weeks or months later, causing further blood-stage infections and onward transmission. Relapses present a challenge to control and elimination programs. The contribution of relapses to the force of blood-stage infection is not well established. While genotyping can distinguish individual infections, the difficulty lies in the inability to distinguish primary infections (occurring shortly after an infectious mosquito bite) and relapses. This is a gap in the knowledge of the epidemiology of P vivax. We develop a statistical model to tease out and estimate the contributions of primary infections and relapses to the force of blood-stage infection. We use data from a cohort of children in Papua New Guinea with genotyped routine blood samples. The study area has both P vivax and P falciparum malaria: we use the seasonality of P falciparum to estimate the seasonality of P vivax primary infections. We also take into account infections occurring prior to the study period and their subsequent relapses during the study period. We find that approximately 80% of the force of blood-stage infection l is contributed by relapses and that primary infections and relapses have different seasonal patterns. The findings are important to the epidemiology of P vivax and for designing intervention strategies targeting different stages of the parasite life cycle.

This article examines the effect of receiving a housing voucher on the mobility and neighborhood attributes of low-income households. Housing policy has shifted toward vouchers in lieu of public housing projects to allow households to move away from high-poverty areas. We use administrative records collected from an experiment to examine this issue. We find that households moved immediately after receiving the subsidy but did not relocate to lower poverty neighborhoods until several quarters later. Our findings suggest that recipients initially lease in nearby units to secure the subsidy, while continuing to search for housing in lower poverty neighborhoods.

The aim of this review was to explore the range and prevalence of cancer treatment or disease-related symptoms in the emergency department and their associated outcomes. A systematic review examined studies cited in Medline, Embase, PsycINFO, and CINAHL published from 1980 to July 2011. Eligible studies measured emergency department visits for symptom assessment in adult oncology patients. Two reviewers independently screened citations and double data extraction was used. Descriptive analysis was conducted. Of 1,298 citations, six prospective and 12 retrospective descriptive studies were included. Of these, eight focused on multiple symptoms and 10 targeted specific symptoms. The studies were published between 1995 and 2011, conducted in seven countries, and had a median sample size of 143 (range 9–27,644). Of the 28 symptoms reported, the most common were febrile neutropenia, infection, pain, fever, and dyspnea. Definitions provided for individual symptoms were inconsistent. Of 16 studies reporting admission rates, emergency visits resulted in hospital admissions 58 % (median) of the time in multi-symptom studies (range 31 % to 100 %) and 100 % (median) of the time in targeted symptoms studies (range 39 % to 100 %). Of 11 studies reporting mortality rates, 13 % (median) of emergency visits captured in multi-symptom studies (range 1 % to 56 %) and 20 % (median) of visits in targeted symptoms studies (range 4 % to 67 %) resulted in death. Individuals with cancer present to emergency departments with a myriad of symptoms. Over half of emergency department visits resulted in hospital admissions. Few symptoms were defined adequately to compare data across studies, thereby revealing an important gap in cancer symptom reporting.

This study examined the effects of types of representations, constructivist teaching approaches, and student engagement on middle school algebra students' procedural knowledge and conceptual understanding. Data gathered from 16 video lessons and algebra pretest/posttests were used to run three multilevel structural equation models. Symbolic representations (p < .02), shared meanings (p < .05), and meaningful feedback (p < .10) significantly increased procedural and conceptual understanding. Enactive representations significantly increased procedural knowledge (p < .05). There was also a significant relationship between the two types of learning at the within level (p < .01) and between level (p < .05).

Medication delivery is a complex process which provides numerous opportunities for error occurrence. While the community environment presents a unique potential for medication errors, to date, an exploration of these errors had not been conducted.The overall objective of the review was to identify the incidence, prevalence and contributing factors associated with the occurrence of medication errors for children and adults in the community setting.Studies involving children and adults from the community setting.In this review we considered studies that evaluate the incidence, prevalence and contributing factors associated with the occurrence of medication errors in the community setting for both children and adults.In this review we considered any randomised controlled trials, non-randomised controlled trials, controlled before and after studies, other designs such as cohort, case control studies and descriptive studies.Papers in English between the years 1990-2011 were searched in various scholarly databases, including: CINAHL, Medline, Mosby's Nursing Consult, PsycINFO, and Web of Science.Full papers were assessed for methodological quality independently by two reviewers using critical appraisal checklists from the Joanna Briggs Institute.Details of each study included in the review were extracted using an adaptation of the standardised data extraction forms developed by the Joanna Briggs Institute.Meta-analysis was not possible due to methodological and statistical heterogeneity of the included studies. Hence study findings are presented in narrative form.Twenty-one studies were included in the final review. Thirteen studies examined either incidence or prevalence. Ten studies identified contributing factors and five studies reported the frequency of errors.This study provides the first systematic review of medication error occurrence for children and adults in the community. Evidence emerging for this review highlighted the incomparability within the included studies and current research and thus the inability to make recommendations to advance the science.Commonly reported causal factors were dosing errors, misreading prescriptions and calculation errors. Therefore, it is recommended that adequate education is provided to ensure that healthcare providers are well equipped to perform the tasks involved in medication delivery. Further recommendations include: 1) ensure workloads within the community setting support safe and reasonable assignments; 2) reinforce communication protocols between healthcare providers and patients regarding medication delivery; and 3) separate and identify look alike and sound alike medications.For the science in this area to advance, there is a need for standardization on how outcomes are identified and measured within each stage. Therefore, it is recommended that common conceptualizations for these terms be established or agreed upon and a valid tracking system is in place in the community.

This paper considers two related questions: the impact of spatial variation in crime prevention policies on the migration of criminal activity into nearby locations and the tendency for higher-level government anti-crime policies to be offset by a scaling back of local crime deterrent efforts. A key source of identification is to draw upon variation in the timing of adoption of state-wide Truth-in-Sentencing (TIS) legislation during the 1990s. To estimate the effect of the policy, I compare activity in adjacent counties on opposite sides of state boundaries in the 59 urban areas that cross state lines. There are three key results. First, adoption of TIS lowers the level of criminal activity in the adopting state. Second, adoption of the stiffer sentencing policy prompts migration of criminal activity into adjacent counties in the neighboring state, especially in the most populated urban areas. Finally, after the imposition of TIS by the state government, local governments reduce the level of police protection. This suggests that some of the deterrent effect of higher-level government anti-crime policy is offset by a scaling back on anti-crime efforts at the local level.

Objectives The objective of this systematic review is to identify the range of safety issues and experiences of safety issues that arise for seniors living independently in the community with respect to therapeutic self‐care and personal self‐care. Questions 1. What are the potential safety issues for seniors who engage in self‐care in their home community setting? 2. What are the potential safety issues related to activities of daily living? 3. Is there a distinction between adverse events resulting from therapeutic self‐care and selfcare related to activities of daily living in this population? 4. What is the experience of seniors living at home in dealing with adverse events resulting from self‐care behaviours? Inclusion Criteria Types of participants This systematic review will consider studies that address community‐dwelling seniors (65 years of age and older) who live alone or with others, but who have the capacity to and do engage in self‐care. Although studies may include younger participants, the average age of participants should be 65 years and older. Data from studies may be collected from seniors themselves, family members, formal and informal caregivers, including healthcare practitioners or from community organizations. Includes seniors who may have ongoing or occasional assistance with therapeutic or personal care, but who are able to direct such care. Data generated from studies of institutional settings or from those who are unable to direct their care because of impaired cognition will be excluded. Types of intervention This systematic review will focus on safety issues for seniors who engage in self‐care behaviours that are related to therapeutic regimes or daily living activities. The phenomena addressed in qualitative studies will be the experience of seniors living at home in dealing with adverse events resulting from self‐care behaviours. Types of outcomes Outcomes of interest for this study include: the occurrence of illness, accidents or adverse events related to self‐care; the nature of the adverse event; the impact of this adverse event on the health/well‐being of the individual and/or family/caregivers; the capacity of individuals/family to recognize adverse events when they occur; the capacity of individuals to deal with adverse events.