Browsing by Subject "District of Columbia"

Now showing 1 - 2 of 2
  • Thumbnail Image
    ItemOpen Access
    Addressing barriers to optimal oral anticoagulation use and persistence among patients with atrial fibrillation: Proceedings, Washington, DC, December 3-4, 2012.
    (American heart journal, 2014-09) Hess, Paul L; Mirro, Michael J; Diener, Hans-Christoph; Eikelboom, John W; Al-Khatib, Sana M; Hylek, Elaine M; Bosworth, Hayden B; Gersh, Bernard J; Singer, Daniel E; Flaker, Greg; Mega, Jessica L; Peterson, Eric D; Rumsfeld, John S; Steinberg, Benjamin A; Kakkar, Ajay K; Califf, Robert M; Granger, Christopher B; Atrial Fibrillation Think-Tank Participants
    Approximately half of patients with atrial fibrillation and with risk factors for stroke are not treated with oral anticoagulation (OAC), whether it be with vitamin K antagonists (VKAs) or novel OACs (NOACs); and of those treated, many discontinue treatment. Leaders from academia, government, industry, and professional societies convened in Washington, DC, on December 3-4, 2012, to identify barriers to optimal OAC use and adherence and to generate potential solutions. Participants identified a broad range of barriers, including knowledge gaps about stroke risk and the relative risks and benefits of anticoagulant therapies; lack of awareness regarding the potential use of NOAC agents for VKA-unsuitable patients; lack of recognition of expanded eligibility for OAC; lack of availability of reversal agents and the difficulty of anticoagulant effect monitoring for the NOACs; concerns with the bleeding risk of anticoagulant therapy, especially with the NOACs and particularly in the setting of dual antiplatelet therapy; suboptimal time in therapeutic range for VKA; and costs and insurance coverage. Proposed solutions were to define reasons for oral anticoagulant underuse classified in ways that can guide intervention and improve use, to increase awareness of stroke risk as well as the benefits and risks of OAC use via educational initiatives and feedback mechanisms, to better define the role of VKA in the current therapeutic era including eligibility and ineligibility for different anticoagulant therapies, to identify NOAC reversal agents and monitoring strategies and make knowledge regarding their use publicly available, to minimize the duration of dual antiplatelet therapy and concomitant OAC where possible, to improve time in therapeutic range for VKA, to leverage observational data sets to refine understanding of OAC use and outcomes in general practice, and to better align health system incentives.
  • Thumbnail Image
    ItemOpen Access
    AN OVERLAY DISTRICT TO ADDRESS STORMWATER RUNOFF QUANTITY AND QUALITY IN THE DISTRICT OF COLUMBIA: EMPHASIS ON THE ANACOSTIA RIVER
    (2011-04-28) Backhus, Theresa
    This Masters Project (MP) addresses the serious water quality issue of the Anacostia River in the District of Columbia. Focusing on non-point source pollution, the research explores the need for a more unified approach to stormwater runoff policy in DC and how specific examples from across the country can be applied to create a solution. It provides recommendations that will help reduce the burden on the combined sewer overflow (CSO) system that empties into the Anacostia River. Reducing the burden on the CSO system will reduce the number of overflow events during storms. Reducing overflow events and increasing runoff infiltration will have a direct effect on the water quality of the Anacostia River by reducing the quantity of raw sewage, trash, toxicants, and debris that enter the river. The research questions explored are: •What are the roadblocks to effective stormwater management in the District of Columbia? •What are the most effective strategies to eliminate CSO events? •How can a DC stormwater overlay district improve the water quality of the Anacostia River? Extensive literature review and interviews were conducted to define the current stormwater management approach in the District of Columbia. The interviews clarified common goals and conflicting objectives for stormwater management, as well as the degree of stormwater management fragmentation in the District. Analysis of the research and interviews led to the identification of gaps in stormwater policy. Further research was conducted to seek successful, model, local government stormwater district policies from across the country. Additional interviews were conducted with representatives of these municipalities (South Burlington, VT, Philadelphia, PA, Pittsburgh, PA, Anne Arundel County, MD, and Portland, OR) to learn about the development and implementation of the specific program, as well as its successes and opportunities for improvement. A cross-case comparison was conducted to compare each program’s features and explore its applicability to the District of Columbia. Limited content recommendations were then developed for an Anacostia-specific Stormwater Management Overlay District, and implementation strategies were suggested. The results of the research, interviews, and analysis indicate that a Stormwater Management Overlay District would be an effective tool to reduce the burden on the Anacostia River CSO system. The overlay district will help to increase stormwater infiltration as runoff passes through the watershed. This tool could be used as a model for urban cities across the country that are facing similar CSO and stormwater management issues.