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Northern New England (northern + new_england)
Selected AbstractsDahlgren/Rappahannock, Tidewater, Northern New England, and Metropolitan SectionsNAVAL ENGINEERS JOURNAL, Issue 4 2004Article first published online: 29 OCT 200 First page of article [source] Improving genetic health care: A Northern New England pilot project addressing the genetic evaluation of the child with developmental delays or intellectual disability,AMERICAN JOURNAL OF MEDICAL GENETICS, Issue 3 2009John B. Moeschler Abstract In 2006, all clinical genetics practices in Northern New England (Vermont, New Hampshire, and Maine) formed a learning collaborative with the purpose of improving genetic health care and outcomes. This article describes the current status of this effort. The methodology is based on our own modifications of the Institute of Healthcare Improvement "Breakthrough Series" and the Northern New England Cystic Fibrosis Consortium. Because of similarities across practices and the availability of existing published practice parameters, the clinical genetics evaluation of the child with developmental delay or intellectual disability was chosen as the topic to be studied. The aim was to improve the rate of etiological diagnosis of those with developmental delays referred to each genetics center by improving the processes of care. Process and outcomes were evaluated. Four of five sites also evaluated the impact of array comparative genomic hybridization (a-CGH) laboratory testing of such patients. There was significant site-to-site variation in the rate of new diagnoses by a-CGH with the average new diagnosis rate of 11.8% (range 5.4,28.8%). Barriers to implementation of the process and outcome data collection and analysis were significant and related to time pressures, lack of personnel or staff to support this activity, and competing quality improvement initiatives at the institutional home of some genetics centers. © 2009 Wiley-Liss, Inc. [source] CT15 RISK STRATIFICATION MODELS FOR HEART VALVE SURGERYANZ JOURNAL OF SURGERY, Issue 2007C. H. Yap Purpose Risk stratification models may be useful in aiding surgical decision-making, preoperative informed consent, quality assurance and healthcare management. While several overseas models exist, no model has been well-validated for use in Australia. We aimed to assess the performance of two valve surgery risk stratification models in an Australian patient cohort. Method The Society of Cardiothoracic Surgeons of Great Britain and Ireland (SCTS) and Northern New England (NNE) models were applied to all patients undergoing valvular heart surgery at St Vincent's Hospital Melbourne and The Geelong Hospital between June 2001 and November 2006. Observed and predicted early mortalities were compared using the chi-square test. Model discrimination was assessed by the area under the receiver operating characteristic (ROC) curve. Model calibration was tested by applying the chi-square test to risk tertiles. Results SCTS model (n = 1095) performed well. Observed mortality was 4.84%, expected mortality 6.64% (chi-square p = 0.20). Model discrimination (area under ROC curve 0.835) and calibration was good (chi-square p = 0.9). the NNE model (n = 1015) over-predicted mortality. Observed mortality 4.83% and expected 7.54% (chi-square p < 0.02). Model discrimination (area under ROC curve 0.835) and calibration was good (chi-square p = 0.9). Conclusion Both models showed good model discrimination and calibration. The NNE model over-predicted early mortality whilst the SCTS model performed well in our cohort of patients. The SCTS model may be useful for use in Australia for risk stratification. [source] Persistence of coastal spruce refugia during the Holocene in northern New England, USA, detected by stand-scale pollen stratigraphiesJOURNAL OF ECOLOGY, Issue 2 2002Molly Schauffler Summary 1 Pollen data from wet, forested hollows in five spruce (Picea) stands on the eastern coast of Maine, USA, reveal that spruce has been well-established (spruce pollen > 6%) for at least 5000 years at four of the sites (Isle au Haut, Schoodic Peninsula, and Roque Island). Spruce became dominant in the fifth stand (Blackwoods, Mount Desert Island) only in the last 2000 years. This is in contrast to pollen stratigraphies from two inland forest hollows and from inland lakes that indicate a significant region-wide increase in the abundance of spruce only 1000 years ago. 2 All five coastal pollen stratigraphies suggest that conditions along the east coast of Maine became cooler and moister sometime between 6000 and 5000 years ago. Mid-Holocene changes in vegetation and sediment accumulation correspond with the timing of rapid increases in tidal amplitude and diurnal mixing of cold water in the Gulf of Maine, suggestive that these resulted in increased marine effects on the local climate at a time that was generally warmer than present. 3 Two inland forest-hollow stratigraphies do not show evidence of mid-Holocene cooling. Coastal effects therefore persisted for several thousand years despite regional climate changes. 4 The pollen data suggest that refugia along the coast (and probably in isolated sites inland), may have played a critical role in allowing the rapid regional expansion of spruce around 1000 years ago. The steep increases in the abundance of spruce pollen in all forest-hollow and lake pollen stratigraphies in northern New England at that time corroborate other evidence of a region-wide shift to cooler and moister conditions. 5 Pollen stratigraphies from small forested hollows provide a means to examine local vegetation dynamics and interpret those dynamics in the context of regional signals. [source] | ||||||||||