Case 1 : Policy Change and Public Health: Obstacles to Advocating for Public Health Interventions

Robin Scherbatsky, a public health nurse at Lambton Public Health in Sarnia, Ontario, plans to advocate for public funding of the more accurate interferon-gamma release assay (IGRA) test for latent tuberculosis infection (LTBI). She wants the IGRA to be covered by the Ontario Health Insurance Plan the same way the tuberculin skin test, which also tests for LTBI, is covered. Although IGRA tests are more expensive than tuberculin skin tests, IGRAs are very accurate and effective at reducing unnecessary treatments given to people falsely diagnosed with LTBI, and this results in cost savings for the public payer. Given that the Ontario government is regarding preventative health interventions as soft targets for reduced funding, Robin is worried about whether her future advocacy activity will be successful. Robin has formed working relationships with local stakeholders such as health facilities, physicians, general practitioners, and nurses through advocating to them about how to test and treat LTBI and tuberculosis. She has to decide how to best advocate for this issue, making sure she has used all available and potential resources. The case aims to provide foundational knowledge of relevant political models and theories by applying them to Robin’s example

Quality of Local Drainage Systems in Underserved Communities: Assessment Method and Tool using Lidar Data

A properly functioning local stormwater drainage system is essential for mitigating flood economic, health, and safety risks. Failure of a local drainage system occurs when runoff overloads the system and flows into the streets and surrounding low-lying areas. The impacts of these failures include flooding and standing water, which lead to property damage, health risks (e.g., mold, mosquitoes), and pollution (e.g., pesticides, heavy metals carried by the runoff). Local drainage systems are designed to collect and convey stormwater runoff through multiple infrastructure components (such as roadside ditches, drain inlets, pipes, ponds). This study provides a method for evaluating roadside drainage channels using field measurements obtained from mobile lidar (Light Detection and Ranging) scanning systems. We applied this method to evaluate the quality of roadside drainage channels in three underserved communities in Texas. The three communities are the Sunnyside neighborhood in Houston (Harris County), neighborhoods in the City of Rockport (Aransas County), and the Hoehn colonia (Hidalgo County). These communities were selected because they have a history of localized flooding and rely on roadside ditches as their principal infrastructure for runoff control. Ditch conditions were evaluated based on five channel geometric properties (bottom width, channel depth, front slope, back slope, longitudinal slope), the channel’s hydraulic capacity, and the channel’s level of service (LOS). The ditch properties and the LOS are visualized in a geographic information system (GIS). Finally, the ditch properties and LOS were compared across the three communities to determine prevailing failure types

Experimental Assessment of Cardiovascular Physiology in the Chick Embryo.

High resolution assessment of cardiac functional parameters is crucial in translational animal research. The chick embryo is a historically well-used in vivo model for cardiovascular research due to its many practical advantages, and the conserved form and function of the chick and human cardiogenesis programs. This review aims to provide an overview of several different technical approaches for chick embryo cardiac assessment. Doppler echocardiography, optical coherence tomography, micro-magnetic resonance imaging, micro-particle image velocimetry, real-time pressure monitoring, and associated issues with the techniques will be discussed. Alongside this discussion, we also highlight recent advances in cardiac function measurements in chick embryos. This article is protected by copyright. All rights reserved

Impact of chronic renal insufficiency on the early and late clinical outcomes of carotid artery stenting using serum creatinine vs glomerular filtration rate

Background—This study analyzed the impact of chronic renal insufficiency (CRI) on early and late clinical outcomes of carotid artery stenting (CAS) using serum creatinine and glomerular filtration rate (GFR). Study Design—There were 313 CAS patients classified into 3 groups: normal (serum creatinine \u3c1.5 mg/dL or GFR ≥ 60 mL/min/1.73 m2 ); moderate CRI, and severe CRI (serum creatinine ≥3 or GFR \u3c 30 mL/min/1.73 m2 ). Major adverse events ([MAE] stroke, death, and myocardial infarction) were compared for all groups. Results—Using serum creatinine, perioperative stroke rates for normal, moderate, and severe CRI were: 5%, 0%, and 25%, respectively, (p = 0.05) vs 4.6%, 3.7%, and 11.1%, respectively, (p = 0.44) using GFR. The perioperative MAE rates for symptomatic patients were 9.3% and 0% (p = 0.355) and 2% and 5.9% (p = 0.223) for asymptomatic patients for normal and moderate/severe CRI, respectively, using serum creatinine vs 8.1% and 7.8%, respectively, for symptomatic patients and 2.5% and 3%, respectively, for asymptomatic patients using GFR. At a mean followup of 21 months, late MAE rates in normal vs moderate/severe CRI patients were 8.2% and 14%, respectively, (p = 0.247) using serum creatinine vs 6.6% and 13.3%, respectively, (p = 0.05) using GFR. Late MAE rates for symptomatic patients in normal vs moderate/severe CRI were: 8.7% vs 27%, respectively, (p = 0.061) using serum creatinine and 5.7% vs 18.8%, respectively, (p = 0.026) using GFR. Late death rate was 0.55% in normal vs 7.6% (p = 0.002) for moderate/severe CRI. Freedom from MAE at 3 years in symptomatic patients was 81% in normal and 46% in moderate/severe CRI (p = 0.0198). A multivariate Cox regression analysis showed that a GFR of \u3c 60 mL/min/1.73 m2 had an odds ratio of 1.6 (p = 0.222) of having a MAE after CAS. Conclusions—The GFR was more sensitive in detecting late MAE after CAS. Carotid artery stenting in moderate CRI patients can be done with a satisfactory perioperative outcome; however, late death was significan