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Assistant Professor, Michigan State University College of Human Medicine

Nowadays about half of people who inject drugs live outside of cities, often in relative isolation, in areas not well equipped to access medical care or addiction treatment services (Havens et al. In rural counties deaths from drug overdose have increased three times faster than in urban ones (Keyes et al. Opioid Agonist Therapy the most effective way to prevent hepatitis C among people who inject drugs is to combine strategies that improve the safety of injection with those that treat the underlying addiction (Cox and Thomas, 2013; Hagan et al. Such therapy is part of the tertiary prevention of substance use disorders, meaning that it prevents the worst complications of the disorder, including overdose and transmission of blood-borne infections (Kolodny et al. A 2012 analysis found that 30 million Americans live in places where not a single provider can prescribe opioid agonists (Rosenblatt et al. There is a need for wider access to treatment for opioid dependence, especially in rural areas (Rosenblatt et al. Regarding medications, long-acting buprenorphine and naltrexone formulations may be more suitable in such areas (Kjome and Moeller, 2011; Laffont et al. When naltrexone is administered via a sustained-release implant, for example, it can be active in blood, controlling drug cravings, for up to 6 months (Hulse et al. Syringe Exchange Syringe exchange programs in the United States do not have sufficient coverage even in cities; availability is worse in rural areas (Des Jarlais et al. Of every dollar spent on syringe services in the United States, about 17 cents goes to rural or suburban areas (Des Jarlais et al. With fewer staff and smaller budgets, rural programs have to reach people injecting drugs in remote parts of the country, such as Appalachia, and vast ones, such as the Central Valley. When syringe services are far away, people are less likely to use them (Allen et al. Part of the value of both opioid agonist therapy and syringe exchange programs is that they provide clients with an entry point to the health system (MacNeil and Pauly, 2011). Staff at exchanges, especially case managers, can also help interested clients enroll in drug counseling or cessation programs. A randomized, controlled trial in Baltimore syringe exchange programs found that clients working with case managers were 87 percent more likely to enter drug treatment within a week of their referral than clients without such support (Strathdee et al. Ensuring linkage to care is more challenging; fewer than half of survey respondents (a third in rural areas) reported tracking the referral process for clients who tested positive (Des Jarlais et al. Although legally prohibited in the United States, supervised injection facilities, clinics where people can inject under clinical supervision, may be another means of harm reduction (Drug Policy Alliance, 2016). Supervised injection has been shown to reduce death from overdose; in Vancouver, the introduction of such a facility was associated with a 35 percent reduction in the rate of fatal overdose, compared to only a 9 percent reduction in other parts of the city (Marshall et al. A systematic review of research (mainly from Canada and Australia) found supervised sites to be effective at reaching people with unstable housing and a recent history of incarceration (Potier et al. But these services are least available in the places that most need them, rural areas with an injection opioid problem (see Box 4-1). Expanding harm reduction services (both exchanges and opioid agonist therapy) to rural and suburban areas is complicated, as these parts of the country are characterized by fewer resources for health and principled opposition to anything seen to facilitate illicit drug use (Havens et al. Such obstacles can be overcome, but only with commitment from states and federal agencies. The epidemic of nonmedical opioid use has captured the attention of policy makers and providers, with new emphasis on diagnosing substance use disorder and using opioid agonist therapy to treat it when possible (Tetrault and Butner, 2015). Action against the opioid epidemic complements work on viral hepatitis elimination, with attention to the two goals benefiting both. In some states, drug paraphernalia laws and rules regulating the prescription and sale of syringes can present an obstacle to full coverage (Burris et al. Evidence regarding unmet need for syringe services may help persuade legislators to remove restrictions on them, including the restrictions on the number of syringes exchanged per visit or per client. Such surveys will be valuable in charting progress on this recommendation and determining if the reach of the exchanges is expanding. Other valuable indicators will be the number of providers authorized to provide buprenorphine, and the number of people in opioid treatment programs. Expansion of syringe exchange to rural and suburban areas may require modifications to models developed in cities. Pharmacies are an accessible venue for people who inject drugs across a range of settings (Hammett et al.

Most existing residential forced air heating systems and air-conditioning systems in the United States do not intentionally bring outdoor air into the house. Current consensus standards and some residential buildings codes have recently changed to encourage or require deliberate and continuous outdoor air ventilation. To date, however, no national regulatory requirement or standard exists that requires removal of fine particles or gases from outdoor air used for continuous ventilation. Local exhausting of air from the kitchen when cooking and from bathrooms when showering provides occupants an effective way to achieve reductions in the otherwise unavoidable high concentrations of water vapor, particles, and gases that result from daily household activity. Note, however, that the act of exhausting air from the bathrooms or kitchen pulls outdoor air into that home. So to gain the greatest benefit from exhaust, it is important any replacement ventilation air be clean and dry. Air cleaning has proven useful when used along with source control and ventilation, although it is not a substitute for either method. Air cleaning alone cannot ensure adequate indoor air quality where significant sources are present, when exhaust and outdoor air ventilation are insufficient, or when the operating hours of an air-cleaning device are not sufficient to reduce indoor pollutant concentrations. Stand-alone portable air cleaners are generally designed to filter or clean the air in a single room or area. They are installed either at the base of the air-handling unit or upstream in return grilles. The typical low-efficiency furnace air filter is a simple air cleaner that captures particles in the airstream to protect fan motors, heat exchangers, and ducts from soiling. These aircleaning technologies are described in more detail in subsequent sections. Portable air cleaners are available as small tabletop units and larger console units. They are used to clean the air in a single room, as shown in Figure 3, but not in an entire house. The units can be moved to wherever continuous and localized air cleaning is needed. Larger console units may be useful in houses that are not equipped with forced air heating and/or airconditioning systems. The basic components of a portable air cleaner include a filter or other air cleaning technology and a fan that propels air through that filter/air cleaner. Portable air cleaners may also have a panel filter with bonded fine granules of activated carbon, an activated carbon filter encased in a frame, or other sorbent mixtures to remove gases and odorous compounds. Beyond simple filtration and sorption of odorous compounds using carbon, some portable air cleaners add further technologies to increase pollutant removal, inactivation, or conversion. Some units marketed as having the quietest operation may have no fan; however, units that do not have a fan typically are much less effective than units that have a fan. Efficiency: the efficiency of an air-cleaning device is a fractional measure of its ability to reduce the concentration of pollutants in the air that passes once through the device. The efficiency of a device is measured in a laboratory, where all relevant variables are controlled. Efficiency ratings allow comparison between different devices when they are tested under the same conditions. Effectiveness: the effectiveness of an air-cleaning device or system is a measure of its ability to remove pollutants from the spaces in which it is operated. The effectiveness of the device or system is a function of its use in real-world situations. While this can be simulated under controlled conditions in a laboratory test space, the in-use effectiveness of any device depends on many factors including its location, installation, airflow rate, and operating hours. In fact, these factors may have stronger influences on its effectiveness than does its laboratory-tested efficiency. As an example, while a given device can have a high laboratory-measured and certified efficiency, its effectiveness. In addition, the air cleaner removal rate must also be competitive with other removal processes that occur within the space to be effective (Batterman et al. Other removal mechanisms within the space include surface deposition (for particles) or adsorption (for gases), indoor air reactions (typically for gases), and ventilation (outdoor air exchange).

An Example: Games in Analytic Geometry I developed the business game "Curves Help a Person" for a course in analytic geometry. The floor is taken by the chief, who emphasizes the fact that geometry is around us everywhere: radio masts consist of separate sections of one-sheet hyperboloid, high-voltage lines form catenaries, easement curves on railway tracks, etc. Geometrical lines and surfaces are used by people because of their properties that allow us to solve various technical projects most effectively. Game participants are working at these enterprises as architects, designers, builders, biologists. Finally, students are working as biologists are asked to solve a problem such as this: Calculate the length of the first coil of a snail shell if it is twirled in the spiral of Archimedes and the distance between coils equals 12 mm. In all these tasks, the work of departments is estimated at 100 points; a penalty of 25 points is imposed for each mistake, and the first team done receives a 50-point award. It is necessary to design such games with the possibility for each player to make a decisions; the greater the freedom of choice, the more willingly players join a game. At the end of a game, participants should discuss mistakes they made, find out why this or that decision was made, and what results it has brought. It is also possible to lead a discussion and to offer the following questions: Was the game interesting to play? Conclusion Beyond any shadow of doubt, the need to modernize higher education has manifested itself. The valuable goals discussed in this article may be a response to the growing demand for new approaches in education. Engaging the students in joint activity, communication, and games provides more opportunity for them to be actively involved in the learning process. The educational function of business games is very significant because they provide a positive environment in which students are active participants rather than passive recipients of teaching, creating conditions for the development of the expert. Business games model real industrial or scientific activity and are an effective form of collective knowledge. Self-efficacy for reading and writing: Influence of modeling, goal setting, and self-evaluation. About the Author Natalie Losyeva Doctor of Pedagogic Sciences, PhD, Professor Department of Mathematics National University Donetsk, Ukraine natalie. Purpose of the Study the overarching purpose of the study was to discover from the perceptions of teacher candidates whether learning outcomes in a course were met through a specific assignment, and thus whether adaptations to teaching or to the assignment were needed. The assignment required candidates to interact with a group based on two considerations: the group should be one with whom the candidate had little or no previous contact, and thus "new" to the candidate; and the group should represent differences candidates might expect to find amongst future students. Such questions are relevant and in broad agreement about the need for instructors to identify the extent to which students have met learning outcomes, and then to use evidence to inform teaching practice (Booth, 2007; Dietz, 2006; Leonard & Swap, 2004; Popham, 2008; Schmoker, 2007). The action research nature of the study provided creative opportunity to enhance teaching and learning in the following ways: 1. By doing so, the study itself models an action research study for teacher candidates. As DarlingHammond and McLaughlin (1995) stated, one of the characteristics of effective teaching is to model best practices for students. Additionally, Rock and Levin (2002) noted the need to enhance preservice teacher development by modeling and developing "the skills of inquiry, reflection, problem solving, and collaboration" (pp. The findings informed the instructor about whether students met course and program learning outcomes, and thus whether adaptations to teaching or to assignments were needed (Dietz, 2006; Popham, 2008). The findings provided evidence for external reviewers about whether students met standards of regional and national accrediting agencies. Context of the Study the study investigated student learning in an assignment within a program in which candidates earn a teaching credential at National University. The University is the second-largest private nonprofit institution of higher learning in California. For the past eight years, the University has prepared more credentialed teachers than any other single institution of higher education in the state (as cited in National University, 2008). The course in which the assignment took place is an educational foundations course, the Diverse Classroom. The term diversity tends to bring to mind cultural diversity, which in itself is an important justification for the course.

That the evidence in the case is such that further review is required; in such an instance the Steering Committee shall notify both the grievant and the graduate program in writing of the additional evidence the committee wishes to see and whether that evidence should be provided in writing or in personal testimony before the committee. If the Steering Committee seeks evidence by means of personal testimony, the meeting at which such testimony is presented shall be conducted in the manner of any other academic committee meeting and not as a formal hearing; both the grievant and the graduate program shall be given appropriate opportunities to present their views, but the meeting shall be conducted as an inquiry by the committee members, and not as an adversarial proceeding; there shall be no cross-examination. All meetings at which the Steering Committee considers a grievance shall be closed to the public; the committee shall keep minutes of the meeting, but it need not tape-record its proceedings, nor shall a transcript be prepared. The Steering Committee shall report to the Graduate Council on the issues involved in the grievance and on its determination of the case, without identifying the graduate student who filed the grievance. The option of Credit/No Credit grading for graduate students on 100/200/300/400-level courses is subject to specific regulations of the individual departments regarding their graduate students and regarding the authorization for this option intrinsic to the approved course. Otherwise, no limitation exists as to the number of courses taken under this policy. Requests for such examinations must be made to the department concerned and approved by the department chair. Please see Credit by Examination in the General Regulations section of this Catalog. Registration is also required in winter or summer session if that is when a student plans to graduate. Application forms are available from and must be signed by department graduate advisors. Students must be familiar with the rules governing residency (see previous section on Advancement to Candidacy). If a candidate wishes to exceed this limit, it should be Graduate Transfer Units by Extension discussed with the departmental graduate advisor. Students who are employed vanced degree requiring a total of thirty units, up to six units of full-time should not exceed six units per semester. Petition forms and inforbe increased further for graduate degrees requiring more than 30 mation may be obtained in the college offices. Candidates for this Extension courses completed at campuses including California honor will normally have completed the coursework applicable State University, Long Beach shall be acceptable within the to their graduate student programs at the University. Those honored will be named in the Commencelent graduate degree on the campus where taught. Extension/ ment Program and will receive a certificate from the Dean of continuing education and transfer course material shall be evaluGraduate Studies. Excess grade points ate student honors are usually restricted to students not earned in extension classes may not be used to offset a otherwise recognized by University or college awards. How- artistic exhibitions, special achievements in field work and in ever, grades of "C" earned at another institution in courses trans- University committees and functions, as well as participation in scholarly and professional organizations resulting from student ferred to satisfy subject matter requirements for an advanced research. The program is designed for the professional administrator or those who wish to become administrators within organizations which deliver personal health care services. Bachelor of Science in Health Care Administration the schedule of graduate and undergraduate courses offerings is in the regular Schedule of Classes. Computer proficiency in word processing, spreadsheet, database and presentation software is expected. Complete the electives as needed, to total 124 semester units, a minimum of 40 units in the upper division. Students should contact the Program director for a determination of deficiencies and required remediation. Completion of any one of the courses in site specialization: 536, 537, 538, or 552. The program is designed for persons with a variety of undergraduate experiences who give evidence of interest and potential success in health care management or research. Advancement to Candidacy Students will be instructed to apply for advancement to candidacy after: 1. Completion of 6 units of course work that applies to the degree with an average grade of "B" or better, 2. Passing the Writing Proficiency Examination and submit evidence of same to Department Office, and 3. Certificate in Health Care Administration (code 1-1205) the Certificate Program in Health Care Administration is comparable to a minor of 18 semester units and, with prerequisite course work, may require up to 21 semester units for completion.