Addressing Health Disparities Through Organizational Change - Evaluation Report

In the coming decades, racial and ethnic minorities will constitute more than 50% of many states' populations -- including that of Colorado. Individuals of racial and ethnic minority status are disproportionally affected by disease and disability and have poorer health outcomes than do their white counterparts.1,2 These differences are disparaties in health. Even when minorities have the same insurance status, access, age income and chronic conditions, they still tend to receive lower-quality health care than the white population. Differences in access and quality constitute disparities in health care.3 Shifts in population, coupled with current inequalities in health status and quality of care, clearly establish the need for addressing these disparities.Recognizing the persistence of racial and ethnic health disparities, The Colorado Trust developed the Equality in Health Initiative in 2005. The Initiative provided funding for 14 organizations across the state of Colorado in the first funding cycle, supporting their efforts to reduce health disparities by addressing the needs of racial and ethnic minorities. The initiative intended to strengthen organizations' cultural competency so as to promote and ensure the following for racial and ethnic minority populations: 1) equality in treatment and medical services, 2) attainment of equal access to health care, 3) improvements of environmental conditions and 4) increased healthy behaviors. Grantees received technical assistance in three areas: cultural competency; program planning and implementation related to health disparities; and data collection and evaluation.The Colorado Trust believed if grantee organizations' culturally competent practices improved through technical assistance, interventions and networking then short term health outcomes would improve as well, ultimately leading to reductions in health disparities. This evaluation examined this conceptual model to determine the role organizational cultural competency played in improving short-term health and health care outcomes for racial and ethnic minority groups.Results showed that as grantees' cultural competency in the form of community relationships improved, so did their adaptations to their interventions as well as short-term health and health care outcomes. Cultural competency in the form of organizational policies and procedures predicted improvements in the short-term health and health care outcomes of service recipients. Based on the results of this evaluation, a new conceptual model was developed and is described in this report. Facilitating and challenging conditions to developing cultural competency are also outlined as well as lessons for funders, policy makers and grantees

The influence of urban form on car travel following residential relocation : a current and retrospective study in Scottish urban areas

Spatial planning and spatial policy continues to be used as a tool to bring about changes in travel behaviour. Policy suggests that by creating particular urban forms, demand for travel by car can be reduced. This paper uses data collected in 2006 from 280 households in Glasgow and Edinburgh to analyse the relationships between urban form and vehicle miles driven, with an emphasis on those who had recently relocated. Population densities, housing type, distance to urban centre and measures of mix were collected for the current residential location and previous, for those who had relocated in the previous three years. An ordinal regression model of change in urban form showed significant associations with reported change in miles driven, although the effect was small compared with the effects of socio-economic factors and car ownership. While the results give some weight to intensification as a policy to bring about a reduction in average distance driven, there may be an increase in distance driven in the intensified area. Whether or not such intensification can be enacted against a backdrop of preferences towards suburban, car oriented living is contentious. As such, this study calls into question the use of planning policy as a means to reduce car use in Scottish cities

Computer program TRACK performs transient and/or steady state thermal analysis with coupled fluid flow and heat conduction

Computer program called TRACK was developed by combining a transient fluid flow computer code and the existing modified TOSS heat conduction code to perform the computation

Computerized Response Inhibition Training For Children With Trichotillomania

Evidence suggests that trichotillomania is characterized by impairment in response inhibition, which is the ability to suppress pre-potent/dominant but inappropriate responses. This study sought to test the feasibility of computerized response inhibition training for children with trichotillomania. Twenty-two children were randomized to the 8-session response inhibition training (RIT; n = 12) or a waitlisted control (WLT; n = 10). Primary outcomes were assessed by an independent evaluator, using the Clinical Global Impression-Improvement (CGI-I), and the NIMH Trichotillomania Severity (NIMH-TSS) and Impairment scales (NIMH-TIS) at pre, post-training/waiting, and 1-month follow-up. Relative to the WLT group, the RIT group showed a higher response rate (55% vs. 11%) on the CGI-I and a lower level of impairment on the NIMH-TIS, at post-training. Overall symptom reductions rates on the NIMH-TSS were 34% (RIT) vs. 21% (WLT) at post-training. The RIT\u27s therapeutic gains were maintained at 1-month follow-up, as indicated by the CGI-I responder status (= 66%), and a continuing reduction in symptom on the NIMH-TSS. This pattern of findings was also replicated by the 6 waitlisted children who received the same RIT intervention after post-waiting assessment. Results suggest that computerized RIT may be a potentially useful intervention for trichotillomania

Cochlea-sparing acoustic neuroma treatment with 4π radiation therapy.

PurposeThis study investigates whether 4π noncoplanar radiation therapy can spare the cochleae and consequently potentially improve hearing preservation in patients with acoustic neuroma who are treated with radiation therapy.Methods and materialsClinical radiation therapy plans for 30 patients with acoustic neuroma were included (14 stereotactic radiation surgery [SRS], 6 stereotactic radiation therapy [SRT], and 10 intensity modulated radiation therapy [IMRT]). The 4π plans were created for each patient with 20 optimal beams selected using a greedy column generation method and subsequently recalculated in Eclipse for comparison. Organ-at-risk (OAR) doses, homogeneity index, conformity, and tumor control probability (TCP) were compared. Normal tissue complication probability (NTCP) was calculated for sensorineural hearing loss (SNHL) at 3 and 5 years posttreatment. The dose for each plan was then escalated to achieve 99.5% TCP.Results4π significantly reduced the mean dose to both cochleae by 2.0 Gy (32%) for SRS, 3.2 Gy (29%) for SRT, and 10.0 Gy (32%) for IMRT. The maximum dose to both cochleae was also reduced with 4π by 1.6 Gy (20%), 2.2 Gy (15%), and 7.1 Gy (18%) for SRS, SRT, and IMRT plans, respectively. The reductions in mean/maximum brainstem dose with 4π were also statistically significant. Mean doses to other OARs were reduced by 19% to 56% on average. 4π plans had a similar CN and TCP, with a significantly higher average homogeneity index (0.93 vs 0.92) and significantly lower average NTCP for SNHL at both 3 years (30.8% vs 40.8%) and 5 years (43.3% vs 61.7%). An average dose escalation of approximately 116% of the prescription dose achieved 99.5% TCP, which resulted in 32.6% and 43.4% NTCP for SNHL at 3 years and 46.4% and 64.7% at 5 years for 4π and clinical plans, respectively.ConclusionsCompared with clinical planning methods, optimized 4π radiation therapy enables statistically significant sparing of the cochleae in acoustic neuroma treatment as well as lowering of other OAR doses, potentially reducing the risk of hearing loss

Hydrogen Embrittlement

Hydrogen embrittlement (HE) is a process resulting in a decrease in the fracture toughness or ductility of a metal due to the presence of atomic hydrogen. In addition to pure hydrogen gas as a direct source for the absorption of atomic hydrogen, the damaging effect can manifest itself from other hydrogen-containing gas species such as hydrogen sulfide (H2S), hydrogen chloride (HCl), and hydrogen bromide (HBr) environments. It has been known that H2S environment may result in a much more severe condition of embrittlement than pure hydrogen gas (H2) for certain types of alloys at similar conditions of stress and gas pressure. The reduction of fracture loads can occur at levels well below the yield strength of the material. Hydrogen embrittlement is usually manifest in terms of singular sharp cracks, in contrast to the extensive branching observed for stress corrosion cracking. The initial crack openings and the local deformation associated with crack propagation may be so small that they are difficult to detect except in special nondestructive examinations. Cracks due to HE can grow rapidly with little macroscopic evidence of mechanical deformation in materials that are normally quite ductile. This Technical Memorandum presents a comprehensive review of experimental data for the effects of gaseous Hydrogen Environment Embrittlement (HEE) for several types of metallic materials. Common material screening methods are used to rate the hydrogen degradation of mechanical properties that occur while the material is under an applied stress and exposed to gaseous hydrogen as compared to air or helium, under slow strain rates (SSR) testing. Due to the simplicity and accelerated nature of these tests, the results expressed in terms of HEE index are not intended to necessarily represent true hydrogen service environment for long-term exposure, but rather to provide a practical approach for material screening, which is a useful concept to qualitatively evaluate the severity of hydrogen embrittlement. The effects of hydrogen gas on mechanical properties such as tensile strength, ductility, fracture, low and high cycle fatigue, crack growth rate, and creep rupture are analyzed with respect to the general trends established from the HEE index values. It is observed that the severity of HE effects is also influenced by environmental factors such as pressure, temperature, and hydrogen gas purity. The severity of HE effects is also influenced by material factors such as surface finish, heat treatment, and product forms, compositions, grain direction, and crystal orientations

Light curves from rapidly rotating neutron stars

We calculate light curves produced by a hot spot of a rapidly rotating neutron star, assuming that the spot is perturbed by a core $r$-mode, which is destabilized by emitting gravitational waves. To calculate light curves, we take account of relativistic effects such as the Doppler boost due to the rapid rotation and light bending assuming the Schwarzschild metric around the neutron star. We assume that the core $r$-modes penetrate to the surface fluid ocean to have sufficiently large amplitudes to disturb the spot. For a $l'=m$ core $r$-mode, the oscillation frequency $\omega\approx2m\Omega/[l'(l'+1)]$ defined in the co-rotating frame of the star will be detected by a distant observer, where $l'$ and $m$ are respectively the spherical harmonic degree and the azimuthal wave number of the mode, and $\Omega$ is the spin frequency of the star. In a linear theory of oscillation, using a parameter $A$ we parametrize the mode amplitudes such that ${\rm max}\left(|\xi_\theta|,|\xi_\phi|\right)/R=A$ at the surface, where $\xi_\theta$ and $\xi_\phi$ are the $\theta$ and $\phi$ components of the displacement vector of the mode and $R$ is the radius of the star. For the $l'=m=2$ $r$-mode with $\omega=2\Omega/3$, we find that the fractional Fourier amplitudes at $\omega=2\Omega/3$ in light curves depend on the angular distance $\theta_s$ of the spot centre measured from the rotation axis and become comparable to or even larger than $A\sim0.001$ for small values of $\theta_s$.Comment: 10 pages, 9 figures, submitted to M

WroNG -- Wroclaw Neutrino Generator of events for single pion production

We constructed a new Monte Carlo generator of events for neutrino CC single pion production on free nucleon targets. The code uses dynamical models of the DIS with the PDFs modified according to the recent JLab data and of the Delta excitation. A comparison with experimental data was done in three channels for the total cross sections and for the distributions of events in invariant hadronic mass.Comment: 6 pages, 13 figures, Presented by J.T. Sobczyk at the 3rd International Workshop on Neutrino-Nucleus Interactions in the Few-GeV Region, 17-21 March, Gran Sasso(Italy),to appear in the Proceeding

A table-top, repetitive pulsed magnet for nonlinear and ultrafast spectroscopy in high magnetic fields up to 30 T

We have developed a mini-coil pulsed magnet system with direct optical access, ideally suited for nonlinear and ultrafast spectroscopy studies of materials in high magnetic fields up to 30 T. The apparatus consists of a small coil in a liquid nitrogen cryostat coupled with a helium flow cryostat to provide sample temperatures down to below 10 K. Direct optical access to the sample is achieved with the use of easily interchangeable windows separated by a short distance of ~135 mm on either side of the coupled cryostats with numerical apertures of 0.20 and 0.03 for measurements employing the Faraday geometry. As a demonstration, we performed time-resolved and time-integrated photoluminescence measurements as well as transmission measurements on InGaAs quantum wells.Comment: 7 pages, 6 figure

Phosphorylation by Akt within the ST loop of AMPK-α1 down-regulates its activation in tumour cells

The insulin/IGF-1 (insulin-like growth factor 1)-activated protein kinase Akt (also known as protein kinase B) phosphorylates Ser(487) in the ‘ST loop’ (serine/threonine-rich loop) within the C-terminal domain of AMPK-α1 (AMP-activated protein kinase-α1), leading to inhibition of phosphorylation by upstream kinases at the activating site, Thr(172). Surprisingly, the equivalent site on AMPK-α2, Ser(491), is not an Akt target and is modified instead by autophosphorylation. Stimulation of HEK (human embryonic kidney)-293 cells with IGF-1 caused reduced subsequent Thr(172) phosphorylation and activation of AMPK-α1 in response to the activator A769662 and the Ca(2+) ionophore A23187, effects we show to be dependent on Akt activation and Ser(487) phosphorylation. Consistent with this, in three PTEN (phosphatase and tensin homologue deleted on chromosome 10)-null tumour cell lines (in which the lipid phosphatase PTEN that normally restrains the Akt pathway is absent and Akt is thus hyperactivated), AMPK was resistant to activation by A769662. However, full AMPK activation could be restored by pharmacological inhibition of Akt, or by re-expression of active PTEN. We also show that inhibition of Thr(172) phosphorylation is due to interaction of the phosphorylated ST loop with basic side chains within the αC-helix of the kinase domain. Our findings reveal that a previously unrecognized effect of hyperactivation of Akt in tumour cells is to restrain activation of the LKB1 (liver kinase B1)–AMPK pathway, which would otherwise inhibit cell growth and proliferation