Shared Medical Appointments: An Innovative Model to Reduce Health Disparities Among Latinxs With Type-2 Diabetes.

In the United States, diabetes is epidemic. A study of Latinxs with diabetes evaluated a behavioral shared medical appointment (SMA) intervention. This quasi-experimental study included nonrandomized matched control group participants receiving usual care. The nonprobability convenience sample consisted of 90 participants (SMA = 30; control = 60) receiving primary care at an FQHC (Federally Qualified Health Center) clinic. At 6 months, the percentage of participants achieving target A1C goals was greater in the intervention group (59%) than in the control group (31%; χ2 = 4.462, p ≤ .05). In a multiple regression model, the SMA intervention group, compared to the control group had an A1C decline at 3 months of 0.55% (b = - 0.55, t = - 1.48, p=.14) and an A1C decline at 6 months of 0.83% (b= - 0.83, t= - 2.25, p = .03). Therefore, the results showed 3- and 6-month declines that were greater in the SMA group than in the control group. Underserved, underinsured Latinxs in the ALDEA program achieved significant A1C reductions; the program succeeded in empowering Latino patients and improving glycemic control

Cultural and Family Challenges to Managing Type 2 Diabetes in Immigrant Chinese Americans

OBJECTIVE— Although Asians demonstrate elevated levels of type 2 diabetes, little attention has been directed to their unique cultural beliefs and practices regarding diabetes. We describe cultural and family challenges to illness management in foreign-born Chinese American patients with type 2 diabetes and their spouses. RESEARCH DESIGN AND METHODS— This was an interpretive comparative interview study with 20 foreign-born Chinese American couples (n = 40) living with type 2 diabetes. Multiple (six to seven) semistructured interviews with each couple in individual, group, and couple settings elicited beliefs about diabetes and narratives of care within the family and community. Interpretive narrative and thematic analysis were completed. A separate respondent group of 19 patients and spouses who met the RESULTS— Cultural and family challenges to diabetes management within foreign-born Chinese American families included how 1) diabetes symptoms challenged family harmony, 2) dietary prescriptions challenged food beliefs and practices, and 3) disease management requirements challenged established family role responsibilities. CONCLUSIONS— Culturally nuanced care with immigrant Chinese Americans requires attentiveness to the social context of disease management. Patients’ and families’ disease management decisions are seldom made independent of their concerns for family well-being, family face, and the reciprocal responsibilities required by varied family roles. Framing disease recommendations to include cultural concerns for balance and significant food rituals are warranted

Learning formative skills of nursing practice in an accelerated program

The purpose of this qualitative research study was to describe how students in an accelerated master’s degree entry program experientially learned the practice of nursing. One research question examined in this study was: What formative experiences did students identify as helping them develop and differentiate their clinical practice? Data from clinical observations and a combination of small group and individual interviews were collected and analyzed using interpretive phenomenological methods. Students identified formative skills learned through the independent care of a patient as pivotal in their identity and agency development. By experiencing the responsibility and action from within the body and from within concrete situations, students developed a new understanding that changed their embodied ways of perceiving and orienting to the situation, as well as their skills and sense of agency

Expanding teacher candidate linguistic knowledge: Analyzing recorded virtual exchange sessions

[EN] Teaching English to Speakers of Other Languages (TESOL) teacher candidates must have a working knowledge of English linguistics in order to support their students’ language development. This article reports on TESOL teacher candidates’ reflective practice to highlight how interaction with non-native speakers can develop awareness of linguistic features of the English language through virtual exchange. Sixteen teacher candidates from a university in the United States were paired with 22 undergraduate English as a Foreign Language (EFL) learners from a university in Mexico. The teacher candidates completed journal entries in which they analyzed authentic language produced by their EFL partners during their virtual meetings. Teacher candidates were taking a course that covered topics related to pragmatics, semantics, morphology, phonology and syntax. Each teacher candidate submitted a final error analysis of recorded conversations to determine how many linguistic errors were made by their partners. This study describes the errors the teacher candidates were able to identify in order to explore the benefits of this reflective activity on their understanding of linguistics. This study confirms the need to utilize virtual exchange in teacher preparation programs and subsequent self-reflection in order to give teacher candidates a way to put linguistic content area into practice.Hilliker, SM.; Lenkaitis, CA.; Ramirez, A. (2021). Expanding teacher candidate linguistic knowledge: Analyzing recorded virtual exchange sessions. The EuroCALL Review. 29(1):19-26. https://doi.org/10.4995/eurocall.2021.13241OJS1926291Bohinski, C. A., & Leventhal, Y. (2015). Rethinking the ICC framework: Transformation and telecollaboration. Foreign Language Annals, 48(3), 521-534. https://doi.org/10.1111/flan.12149.Ellis, E. (2003). Bilingualism among teachers of ESL. A study of second language learning experience as a contributor to the professional knowledge and beliefs of teachers of ESL to adults (Unpublished doctoral dissertation). Brisbane, Griffith University.Ellis, E.M. (2004). The invisible multilingual teacher: The contribution of language background to Australian ESL teachers' professional knowledge and beliefs. International Journal of Multilingualism, 1(2), 90-108. https://doi.org/10.1080/14790710408668181Erasmus (2019). What is Virtual Exchange? Retrieved from https://evolve-erasmus.eu/about-evolve/what-is-virtual-exchange/Hawkins, E. (1999). Foreign language study and language awareness. Language Awareness, 8(3&4), 124-142. https://doi.org/10.1080/09658419908667124Hilliker, S. M., Lenkaitis, C. A., & Bouhafa, Y. (2020). The role of intercultural virtual exchanges in developing pragmatic awareness. In C-C. Lin & C. Zaccarini (Eds.). Internationalization in Action: Leveraging Diversity and Inclusion in Globalized Classrooms. Bern, Switzerland: Peter Lang.Hsu, L. (2016). Examining EFL teachers' technological pedagogical content knowledge and the adoption of mobile-assisted language learning: A partial least square approach. Computer Assisted Language Learning, 29(8), 1287-1297. https://doi.org/10.1080/09588221.2016.1278024Ito, K. & Hilliker, S. (2018). Supporting University International Students Through Supportive ESL Instruction and Corrective Feedback. In B. Blummer, J. Kenton, and M. Wiatrowski (Eds). Promoting Ethnic Diversity and Multiculturalism in Higher Education (pp. 40-58). Hershey, PA: IGI Global. https://doi.org/10.4018/978-1-5225-4097-7.ch003Lenkaitis, C. A. (2019). Rethinking virtual exchange: Partnering EFL learners with TESOL teacher candidates. NYS TESOL Journal, Special Issue on the Role of SLA in Teaching and Learning, 6(2), 3-15. http://journal.nystesol.orgLenkaitis, C. A. (2020). Teacher candidate reflection: Benefits of using a synchronous computer-mediated communication-based virtual exchange. Teaching and Teacher Education, 92. https://doi.org/10.1016/j.tate.2020.103041Lenkaitis, C. A., & Hilliker, S. (2019). Building a community of practice: Authentic practice through games. In C. A. Lenkaitis & S. M. Hilliker (Eds.), Engaging teacher candidates and language learners with authentic practice (p. 1-14). IGI Global. https://doi.org/10.4018/978-1-5225-8543-5.ch001Lenkaitis, C. A., Calo, S., & Venegas Escobar, S. (2019). Exploring the intersection of language and culture via telecollaboration: Utilizing Zoom for intercultural competence development. International Multilingual Research Journal, 13(2), 102-115. https://doi.org/10.1080/19313152.2019.1570772Lenkaitis, C. A., Loranc-Paszylk, B., & Hilliker, S. (2019). Global awareness and global identity development among foreign language learners: The impact of virtual exchanges. MEXTESOL Journal, 43(4), 1-11. http://mextesol.net/journal/Loranc‐Paszylk, B, Hilliker, S.M, Lenkaitis, C.A. (2021). Virtual exchanges in language teacher education: Facilitating reflection on teaching practice through the use of video. TESOL J. https://doi.org/10.1002/tesj.580Lucas, T., & Villegas, A. M. (2010). The missing piece in teacher education: The preparation of linguistically responsive teachers. National Society for the Study of Education, 109(2), 297-318. Retrieved from https://www.researchgate.net/profile/T_Lucas2/publication/292697945_The_missing_piece_in_teacher_education_The_preparation_of_linguistically_responsive_teachers/links/57444c7008aea45ee84f157b/The-missing-piece-in-teacher-education-The-preparation-of-linguistically-responsive-teachers.pdfO'Dowd, R. (2017). Exploring the impact of telecollaboration in initial teacher education: The EVALUATE project. The EuroCALL Review, 25(2), 38-41. 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Assessing the Cultural in Culturally Sensitive Printed Patient-Education Materials for Chinese Americans With Type 2 Diabetes

Type 2 diabetes affects Chinese Americans at an alarming rate. To address this health disparity, research in the area of cultural sensitivity and health literacy provide useful guidelines for creating culturally appropriate health education. In this article, we use discourse analysis to examine a group of locally-available, Chinese and English language diabetes print documents from a surface and deep structure level of culture. First, we compared these documents to research findings about printed health information to determine if and how these documents apply current best practices for health literacy and culturally appropriate health communication. Second, we examined how diabetes as a disease and diabetes management is being constructed. The printed materials addressed surface level culture through the use of Chinese language, pictures, foods and exercises. From a deeper cultural level, the materials constructed diabetes management as a matter of measurement and control that contrasted with previous research suggesting an alternative construction of balance. A nuanced assessment of both surface and deeper levels of culture is essential for creating health education materials that are more culturally appropriate and can lead to increase health literacy and improved health outcomes

Cultural Norms Shaping Research Group Interviews with Chinese American Immigrants

Practical knowledge on how to tailor research methods for Asian Americans is relatively scarce despite the rapid population growth of this ethnic group and the ongoing calls for greater cultural competence among researchers. Based on a 4-year qualitative study of family and cultural issues in diabetes management among Chinese American immigrants, this article presents data-based analyses of culturally nuanced group interview processes, and recommendations for conducting culturally appropriate group interviews. Group interview processes were prominently shaped by 4 cultural norms: sensitivity to social hierarchy, monitoring public display of strong emotions, face concerns, and emphasis on group harmony. Strategies for facilitating open and dynamic group interviews in the presence of these norms were identified. Skillful facilitation of group processes, either by accommodating or diffusing norms, was required to promote participant rapport and encourage disclosure of everyday experience

Two dimensional (solid phase) kinetic analysis of FCnGamma receptor III (CD16) Interactions with IgG

Cellular adhesion research has recently focused on the small scale at the level of individual receptor-ligand bonds. This trend in research is primarily due to experimental advances which allow such individual bond force measurements. Here, one of these techniques, micromanipulation, has been extended to not only determine the bond force of individual receptor-ligand pairs, but also the intrinsic kinetic rates of the interaction. Using transmembrane (TM ) Fc gamma receptor III (CD16a-TM) and human IgG (hIgG), the dependence of adhesion probability on receptor-ligand expression densities, contract duration and contact area was quantitated. A probabilistic based theoretical formulation was developed and validated that relates the intrinsic molecular kinetic rates of the receptorVligand interaction to the experimentally determined adhesion probability. This theoretical formulation describing individual receptor-ligand kinetics has also allowed direct evaluation of existing biophysical bond strength/kinetics paradigms at the extreme condition of single bonds. A force-displacement model was also developed to quantitate the force exerted on the RBC membrane transducer during the micropipette retraction process and found to be in agreement with previous work. In addition to CD16a-TM, the kinetic rates of CD16a anchored via a glycosyl phosphatidylinositol (GPI) moiety (CD16a-GPI) and the two alleles of CD16b (NA1 and NA2) were determined for human, rabbit, and mouse IgG species. The binding affinity of these CD16 interactions to soluble IgG was also measured by traditional bulk chemistry approaches and compared to those measured via the micromanipulation protocol in which the IgG ligand is membrane bound in the solid phase. These data suggest that the membrane anchor itself can alter CD16 binding properties. This represents the first reported effect of the anchor on an intrinsic receptor property, its kinetic rates and binding affinity. This thesis presents two specific aims or goals. These goals were achieved and reported in this thesis. During the course of this research, I also explored other directions and gathered initial data. These directions were further explored by other researchers but the initial data is also presented here.Ph.D.Committee Chair: Dr. Cheng Zhu; Committee Co-Chair: Dr. Periasamy Selvaraj; Committee Member: Dr. Lyle Sinor; Committee Member: Dr. Raymond Vito; Committee Member: Dr. Robert Nerem; Committee Member: Dr. Timothy Wic

Transmen: The HIV Risk of Gay Identity

Many female-to-male transgender individuals, or transmen, are situated within the gay community, one of the highest risk communities for HIV, yet there has been little research regarding the experience of risk for these transmen. Seventeen transmen were interviewed regarding their sexuality and HIV risk behavior. Fourteen of the 17 reported having non-trans gay men as sexual partners. Risk behaviors included not using condoms with multiple partners who were HIV-positive, or of unknown HIV status. Aspects of risk included the unfamiliarity of the gay community and the lack of safe sex negotiating skills. The dynamics of acceptance and rejection between transmen and non-trans gay men impacted risk by compromising safety. Incorrect assumptions regarding transmen, non-trans gay men, and risk included beliefs that neither person could be at risk. Other aspects included the impact of testosterone on sexual behavior, the changed bodies of transmen, and sex work

Acculturation and Bicultural Efficacy Effects on Chinese American Immigrants’ Diabetes and Health Management

The primary goal of this study was to examine effects of bicultural efficacy, or perceived confidence in dealing with bicultural acculturation stressors, on type 2 diabetes management and health for first-generation, Cantonese-speaking, Chinese American immigrants (N=162) recruited for a larger community-based diabetes intervention study (Chesla et al., 2013). The current study also tested whether a new Bicultural Efficacy in Health Management (BEFF-HM) scale is a more robust predictor of diabetes and health outcomes than proxy (years in the U.S.) and general acculturation measures. Hierarchical regression analyses of cross-sectional data revealed that high BEFF-HM was significantly related to positive outcomes on five of six diabetes and health measures as hypothesized after accounting for participant characteristics, proxy and general acculturation measures, and social support. Proxy and general acculturation measures failed to predict any study outcome supporting our secondary hypothesis that BEFF-HM is a better predictor of Chinese American immigrants’ diabetes and health management. An immigrant-focused research approach advances understanding of acculturation and bicultural efficacy effects on health by identifying key acculturation domains for study