Racial and Ethnic Disparities in Post-neonatal Mortality in Florida

This policy-related study examines primary care delivery methods in reducing population health disparities. We use post- neonatal mortality as an indicator ofpopulation health within counties to study the effects ofusing contracted service providers compared to direct provision of primary care by county health departments in improving health equity. We analyzed post- neonatal mortality data collected annually between 1997 and 2006 from ten ofFlorida’s most populous counties (\u3e500,000). Using Poisson regression analyses with generalized estimating equations (GEE), we examined differences in post-neonatal mortality among racial and ethnic groups; and among counties and groups over time. The results show significant differences in post-neonatal mortality between Black and White groups in both counties that outsource county health department primary care services and also counties that do not outsource these services. After adjusting for low birth weight and age ofthe mother (\u3c 20 years), the post-neonatal mortality rate for black infants remains higher in outsourced counties but not in non- outsourced counties. The increase in disparity in post-neonatal mortality rates between black and white infants in outsourced counties compared to non-outsourced counties is also significant. Contracted service providers are being used with greater frequency to expand access to health services with the idea that they can improve health outcomes; however, these data show that all groups may not benefit equally under this mechanism ofservice delivery

Measures of Highly Functioning Health Coalitions: Corollaries for an Effective Public Health System

In Tennessee, health coalitions provide guidance in conducting community assessments, health improvement plans and policies and delivering of health and human services, which are considered core functions of public health. In fact, it has been postulated that these coalitions may serve as the organizational embodiment of the local public health system (LPHS). This study identifies functional characteristics of 63 Tennessee County Health Councils (CHCs), advisory councils to local and regional governmental public health agencies on broad issues of health, that contribute to its ability to operate as the primary advising entity of the LPHS. Exploratory factor analysis was conducted on 20 questions serving as proxy measures of functional characteristics. Eight functional characteristics related to structure, operations and leadership were identified. These characteristics are essential in further developing and tracking capacity and performance of health coalitions serving as an advisory and possibly decision making entity of the LPHS. This study also lays the groundwork to explore how to link coalition function with performance in order to determine characteristics that are most strongly associated with optimal performance and population health

A State-Level Analysis of Maternal and Child Health Partnerships among Indiana Local Health Departments

Background: As one of many organizations within a system of networks, numerous U.S. local health departments (LHDs) use partnerships as a structural intervention to address physical, mental, social concerns of women and infants. Purpose: This state level study examines current levels of maternal and child partnerships among Indiana LHDs and sectors in the public health system. Geography and organizational readiness (infant mortality listed as a goal in the strategic plan) were used as proxy measures to examine how likely LHDs work with these sectors. Methods: An eighteen-item online survey was administered to 93 LHDs collected between March and June 2014. Descriptive and Pearson Chi-Square analyses were conducted using SPSS 23.0. Results: LHDs reported having more formal (coordinating, cooperating, collaborating) partnerships with hospitals, the state health department, and physician practices/medical groups. LHDs less frequently reported partnerships with transportation, midwives, and parks and recreation. Furthermore, LHDs in non-metropolitan LHDs were more likely to have both informal and formal partnerships with non-public health sectors than LHDs in metropolitan jurisdictions. LHDs that did not have infant mortality as a goal in their strategic plan were more likely to have informal partnerships with health care, health insurance, and quasi-governmental organizations. Implications: This study presents opportunities to further explore the influence of contextual and functional characteristics in existing LHD partnerships that focus on women and infants

The impact of FADS genetic variants on ω6 polyunsaturated fatty acid metabolism in African Americans

<p>Abstract</p> <p>Background</p> <p>Arachidonic acid (AA) is a long-chain omega-6 polyunsaturated fatty acid (PUFA) synthesized from the precursor dihomo-gamma-linolenic acid (DGLA) that plays a vital role in immunity and inflammation. Variants in the Fatty Acid Desaturase (<it>FADS</it>) family of genes on chromosome 11q have been shown to play a role in PUFA metabolism in populations of European and Asian ancestry; no work has been done in populations of African ancestry to date.</p> <p>Results</p> <p>In this study, we report that African Americans have significantly higher circulating levels of plasma AA (p = 1.35 × 10^-48) and lower DGLA levels (p = 9.80 × 10^-11) than European Americans. Tests for association in N = 329 individuals across 80 nucleotide polymorphisms (SNPs) in the Fatty Acid Desaturase (<it>FADS</it>) locus revealed significant association with AA, DGLA and the AA/DGLA ratio, a measure of enzymatic efficiency, in both racial groups (peak signal p = 2.85 × 10^-16in African Americans, 2.68 × 10^-23in European Americans). Ancestry-related differences were observed at an upstream marker previously associated with AA levels (rs174537), wherein, 79-82% of African Americans carry two copies of the G allele compared to only 42-45% of European Americans. Importantly, the allelic effect of the G allele, which is associated with <it>enhanced </it>conversion of DGLA to AA, on enzymatic efficiency was similar in both groups.</p> <p>Conclusions</p> <p>We conclude that the impact of <it>FADS </it>genetic variants on PUFA metabolism, specifically AA levels, is likely more pronounced in African Americans due to the larger proportion of individuals carrying the genotype associated with increased FADS1 enzymatic conversion of DGLA to AA.</p

The Limits and Intensity of Plasmodium falciparum Transmission: Implications for Malaria Control and Elimination Worldwide

Combining extensive surveillance and climate data, as well as biological characteristics of Anopheles mosquitoes, Robert Snow and colleagues create a global map of risk for P. falciparum malaria

Changing behaviour 'more or less'-do theories of behaviour inform strategies for implementation and de-implementation? A critical interpretive synthesis

BACKGROUND: Implementing evidence-based care requires healthcare practitioners to do less of some things (de-implementation) and more of others (implementation). Variations in effectiveness of behaviour change interventions may result from failure to consider a distinction between approaches by which behaviour increases and decreases in frequency. The distinction is not well represented in methods for designing interventions. This review aimed to identify whether there is a theoretical rationale to support this distinction. METHODS: Using Critical Interpretative Synthesis, this conceptual review included papers from a broad range of fields (biology, psychology, education, business) likely to report approaches for increasing or decreasing behaviour. Articles were identified from databases using search terms related to theory and behaviour change. Articles reporting changes in frequency of behaviour and explicit use of theory were included. Data extracted were direction of behaviour change, how theory was operationalised, and theory-based recommendations for behaviour change. Analyses of extracted data were conducted iteratively and involved inductive coding and critical exploration of ideas and purposive sampling of additional papers to explore theoretical concepts in greater detail. RESULTS: Critical analysis of 66 papers and their theoretical sources identified three key findings: (1) 9 of the 15 behavioural theories identified do not distinguish between implementation and de-implementation (5 theories were applied to only implementation or de-implementation, not both); (2) a common strategy for decreasing frequency was substituting one behaviour with another. No theoretical basis for this strategy was articulated, nor were methods proposed for selecting appropriate substitute behaviours; (3) Operant Learning Theory makes an explicit distinction between techniques for increasing and decreasing frequency. DISCUSSION: Behavioural theories provide little insight into the distinction between implementation and de-implementation. Operant Learning Theory identified different strategies for implementation and de-implementation, but these strategies may not be acceptable in health systems. Additionally, if behaviour substitution is an approach for de-implementation, further investigation may inform methods or rationale for selecting the substitute behaviour

Design, Performance and Calibration of the CMS Forward Calorimeter Wedges

We report on the test beam results and calibration methods using charged particles of the CMS Forward Calorimeter (HF). The HF calorimeter covers a large pseudorapidity region (3\l |\eta| \le 5), and is essential for large number of physics channels with missing transverse energy. It is also expected to play a prominent role in the measurement of forward tagging jets in weak boson fusion channels. The HF calorimeter is based on steel absorber with embedded fused-silica-core optical fibers where Cherenkov radiation forms the basis of signal generation. Thus, the detector is essentially sensitive only to the electromagnetic shower core and is highly non-compensating (e/h \approx 5). This feature is also manifest in narrow and relatively short showers compared to similar calorimeters based on ionization. The choice of fused-silica optical fibers as active material is dictated by its exceptional radiation hardness. The electromagnetic energy resolution is dominated by photoelectron statistics and can be expressed in the customary form as a/\sqrt{E} + b. The stochastic term a is 198% and the constant term b is 9%. The hadronic energy resolution is largely determined by the fluctuations in the neutral pion production in showers, and when it is expressed as in the electromagnetic case, a = 280% and b = 11%

Design, Performance, and Calibration of CMS Hadron-Barrel Calorimeter Wedges

Extensive measurements have been made with pions, electrons and muons on four production wedges of the Compact Muon Solenoid (CMS) hadron barrel (HB) calorimeter in the H2 beam line at CERN with particle momenta varying from 20 to 300 GeV/c. Data were taken both with and without a prototype electromagnetic lead tungstate crystal calorimeter (EB) in front of the hadron calorimeter. The time structure of the events was measured with the full chain of preproduction front-end electronics running at 34 MHz. Moving-wire radioactive source data were also collected for all scintillator layers in the HB. These measurements set the absolute calibration of the HB prior to first pp collisions to approximately 4%

Synchronization and Timing in CMS HCAL

The synchronization and timing of the hadron calorimeter (HCAL) for the Compact Muon Solenoid has been extensively studied with test beams at CERN during the period 2003-4, including runs with 40 MHz structured beam. The relative phases of the signals from different calorimeter segments are timed to 1 ns accuracy using a laser and equalized using programmable delay settings in the front-end electronics. The beam was used to verify the timing and to map out the entire range of pulse shapes over the 25 ns interval between beam crossings. These data were used to make detailed measurements of energy-dependent time slewing effects and to tune the electronics for optimal performance