Addressing Disparities for Gambling Treatment Service Use in the Latinx Community: Outreach, Education, Screening, and Referral by Community Health Workers

ABSTRACT Problem gambling/gambling disorder prevalence among Latinx individuals in the U.S. is similar to that seen in the non-Latinx Caucasian community (Alegria et al., 2009). However, there are disparities in the use of State-funded treatment for such problems in California. This is true for mental health service use for ethnic/racial minorities in the US overall (Alegria et al., 2008; Dua et al., 2011; Wells et al., 2001). The California Office of Problem Gambling (OPG), the UCLA Gambling Studies Program (UGSP), and Visión y Compromiso (VyC) are conducting a 2-year pilot project using community health workers (promotores/as) to increase Latinx utilization of CalGETS services in Los Angeles and San Diego Counties. The proximal goal of this project is to implement/evaluate a culturally/linguistically relevant enhancement to program outreach activities. Progress to date includes: (1) a Spanish-language translation of the Breif Biosocial Gambling Screen; (2) focus group data on gambling in the Latinx community; (3) a two-day, gambling-specific Spanish-language training for promotores/as; (4) measures of trainee satisfaction and knowledge; (5) a Spanish-language field guide for promotores/as; and, (6) about 27 trained promotores/as. The distal goal of this work is to create content that is adaptable to other underserved communities in the U.S. IMPLICATIONS State-funded gambling treatment must serve an increasingly diverse population in the U.S. This project may be the first to use promotores/as to address cultural/linguistic gaps in services for Latinx persons. It may help to inform similar work other States and for other underserved communities in the U.S

Medical Students Using Cadavers for Procedural Simulation Education

Background: Cadaver dissection remains integrated into the curriculum of numerous medical schools. Aspiring physicians acquire the opportunity to work directly with the human body, which is intricate and tangible, yet have minimal exposure to certain procedural skills applicable­­ to patient care during the first year of their medical training. Our aim was to incorporate the cadaver as part of a process to introduce procedures to a class of first year medical students in order to improve their confidence and skill in performing these procedures in patients. Methods: During medical gross anatomy at Wayne State University School of Medicine, three workshops involving common procedures performed in the emergency department were integrated into the cadaver dissection laboratory. Each educational workshop began with a short demonstration or a short step-by-step informational video on the focused procedure. The educators consisted of emergency medicine residents, third and fourth year medical student mentors, and emergency medicine attendings. Educators directed the hands-on procedure practice on the cadavers and provided real time feedback. Students completed pre and post questionnaires with scales ranging from one to five to assess the impact of the workshop on their abilities and confidence for the specified procedures. The three sessions included intraosseous (IO) line placement, joint aspiration, and chest tube placement. Results: A total of 108 students participated in the IO line training workshop, 143 students in the arthrocentesis simulation and 79 students in the chest tube session. Prior to the hands on sessions, 0 students (0%) had performed an IO line on a simulated patient, 2 students (1.4%) had performed an arthrocentesis on a simulated patient, and 4 students (5.1%) had performed a chest tube on a simulated patient. The Likert scales were viewed as ordinal variables (categorical variables) and thus the data was analyzed by Wilcoxon signed-rank test (non-parametric paired t-test). The student’s confidence in performing the specified procedure improved with a statistically significant difference in the IO, arthrocentesis and chest tube workshops (p = \u3c0.0001). There was a statistically significant increase in the perception of adequate training in all three sessions (p = \u3c 0.0001). The self-perceived skill in performing the described procedures had a statistically significant improvement for post training session in students participating in the IO, arthrocentesis and chest tube workshops (p = \u3c 0.0001). Lastly, after the hands-on educational sessions, a median of 4.5 out of 5 and mode of 5 out of 5 recommended other medical students participate in the IO simulation activity, and a median and mode of 5 out of 5 recommended the arthrocentesis and chest tube workshops. Conclusion: Workshops introducing procedural simulation in the cadaver to first year medical students improved confidence levels, perception of being adequately trained, and self-evaluated skill. Cadavers are effective models for training medical students in common emergency medical procedures. Integrating workshops into existing medical gross anatomy courses may translate into higher procedural success rates in the clinical setting, as well as stimulate interest in understanding normal anatomy and common variants encountered in practice

Computational and Mathematical Modelling of the EGF Receptor System

This chapter gives an overview of computational and mathematical modelling of the EGF receptor system. It begins with a survey of motivations for producing such models, then describes the main approaches that are taken to carrying out such modelling, viz. differential equations and individual-based modelling. Finally, a number of projects that applying modelling and simulation techniques to various aspects of the EGF receptor system are described

Over-the-Counter Analgesic Use Patterns in Appalachian Older Adults, Focusing on Non-Steroidal Anti-Inflammatory Drugs

Introduction Over-the-counter (OTC) medications are commonly used by elderly patients to self-manage pain symptoms. Medications such as non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen and topical analgesics are readily available and therefore may seem harmless to patients. In the growing population of those 65 years and older, providers need to inquire about OTC medication use due to the increased risk for adverse reactions in this population. Complications related to these medications can be worsened by chronic disease, variable metabolism, polypharmacy, etc. which become more common in the older adults. Methods A survey was created to determine the prevalence and habits of OTC use in the central Appalachian population, as well as the potential harms involved related to provider awareness, chronic disease, and polypharmacy. Results Of surveyed Appalachian seniors (n = 307), 86.3% take OTC medications. Of these, 57.4% report that they do not tell their provider and 51.3% do not take the medication as directed. Within this population, 19.2% of those on blood thinners, 22.4% of those with hypertension, 34.8% of those with chronic kidney disease, and 30.6% of those with gastrointestinal issues are not only using NSAIDs but also do not inform their physician nor follow the packaging instructions. Discussion Potential complications of NSAID use related to these medical comorbidities are well known. Providers need to regularly ask their older adult patients about the use of OTC medication to prevent adverse events in this vulnerable population

Quasi steady state and dynamic hygrothermal performance of fibrous Hemp and Stone Wool insulations: Two innovative laboratory based investigations

Moisture and heat management properties of Hemp and Stone Wool insulations were studied by mounting them between a hot and a cold climate chamber. Both insulations were exposed to identical hygrothermal boundary conditions. Quasi steady state and dynamic tests were carried out at a range of relative humidity exposures. The likelihood of interstitial condensation was assessed and equivalent thermal conductivity values of the insulations were determined. The adsorption-desorption isotherms of the insulations were also determined in a dynamic vapour sorption (DVS) instrument. It was observed that the likelihood of condensation was higher in Stone Wool insulation than in Hemp insulation. Hemp insulation performed better in managing moisture due to its high hygric inertia and water absorption capacity. It was observed that the equivalent thermal conductivity of Stone Wool insulation was dependent on enthalpy flow and phase change of moisture. The equivalent thermal conductivity of Hemp insulation was close to its declared thermal conductivity in dynamic conditions when high relative humidity exposures were transient. In quasi steady state boundary conditions, when the insulation was allowed to reach the equilibrium moisture content at ranges of relative humidity, there was a moisture dependent increase of thermal conductivity in Hemp insulation

IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT) : cluster randomised controlled trial study protocol

Background: Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidencebased clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim: This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design: This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters), which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the control arm will receive access to the guideline using the existing dissemination strategy. Practitioners in the intervention arm will be invited to participate in facilitated face-to-face workshops that have been underpinned by behavioural theory. Investigators (not involved in the delivery of the intervention), patients, outcome assessors and the study statistician will be blinded to group allocation. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN012606000098538 (date registered 14/03/2006).The trial is funded by the NHMRC by way of a Primary Health Care Project Grant (334060). JF has 50% of her time funded by the Chief Scientist Office3/2006). of the Scottish Government Health Directorate and 50% by the University of Aberdeen. PK is supported by a NHMRC Health Professional Fellowship (384366) and RB by a NHMRC Practitioner Fellowship (334010). JG holds a Canada Research Chair in Health Knowledge Transfer and Uptake. All other authors are funded by their own institutions

Estimated HIV Incidence in the United States, 2006–2009

Background The estimated number of new HIV infections in the United States reflects the leading edge of the epidemic. Previously, CDC estimated HIV incidence in the United States in 2006 as 56,300 (95% CI: 48,200–64,500). We updated the 2006 estimate and calculated incidence for 2007–2009 using improved methodology. Methodology We estimated incidence using incidence surveillance data from 16 states and 2 cities and a modification of our previously described stratified extrapolation method based on a sample survey approach with multiple imputation, stratification, and extrapolation to account for missing data and heterogeneity of HIV testing behavior among population groups. Principal Findings Estimated HIV incidence among persons aged 13 years and older was 48,600 (95% CI: 42,400–54,700) in 2006, 56,000 (95% CI: 49,100–62,900) in 2007, 47,800 (95% CI: 41,800–53,800) in 2008 and 48,100 (95% CI: 42,200–54,000) in 2009. From 2006 to 2009 incidence did not change significantly overall or among specific race/ethnicity or risk groups. However, there was a 21% (95% CI:1.9%–39.8%; p = 0.017) increase in incidence for people aged 13–29 years, driven by a 34% (95% CI: 8.4%–60.4%) increase in young men who have sex with men (MSM). There was a 48% increase among young black/African American MSM (12.3%–83.0%; p<0.001). Among people aged 13–29, only MSM experienced significant increases in incidence, and among 13–29 year-old MSM, incidence increased significantly among young, black/African American MSM. In 2009, MSM accounted for 61% of new infections, heterosexual contact 27%, injection drug use (IDU) 9%, and MSM/IDU 3%. Conclusions/Significance Overall, HIV incidence in the United States was relatively stable 2006–2009; however, among young MSM, particularly black/African American MSM, incidence increased. HIV continues to be a major public health burden, disproportionately affecting several populations in the United States, especially MSM and racial and ethnic minorities. Expanded, improved, and targeted prevention is necessary to reduce HIV incidence

Lymphocyte subsets and the role of Th1/Th2 balance in stressed chronic pain patients

Background: The complex regional pain syndrome (CRPS) and fibromyalgia (FM) are chronic pain syndromes occurring in highly stressed individuals. Despite the known connection between the nervous system and immune cells, information on distribution of lymphocyte subsets under stress and pain conditions is limited. Methods: We performed a comparative study in 15 patients with CRPS type I, 22 patients with FM and 37 age- and sex-matched healthy controls and investigated the influence of pain and stress on lymphocyte number, subpopulations and the Th1/Th2 cytokine ratio in T lymphocytes. Results: Lymphocyte numbers did not differ between groups. Quantitative analyses of lymphocyte subpopulations showed a significant reduction of cytotoxic CD8+ lymphocytes in both CRPS (p < 0.01) and FM (p < 0.05) patients as compared with healthy controls. Additionally, CRPS patients were characterized by a lower percentage of IL-2-producing T cell subpopulations reflecting a diminished Th1 response in contrast to no changes in the Th2 cytokine profile. Conclusions: Future studies are warranted to answer whether such immunological changes play a pathogenetic role in CRPS and FM or merely reflect the consequences of a pain-induced neurohumoral stress response, and whether they contribute to immunosuppression in stressed chronic pain patients. Copyright (c) 2008 S. Karger AG, Basel