Impact of a Low-Cost, Multicomponent Intervention to Improve Colorectal Cancer Screening Rates at Two Primary Care Clinics in Rural Kansas

Problem Statement: Residents in rural Kansas have lower colorectal cancer screening rates and therefore are more likely to experience poorer outcomes from colorectal cancer. Purpose: Determine the effectiveness of a low-cost multicomponent intervention on improving colorectal cancer screening rates on patients seen in two primary care clinics in rural Kansas. Methods: A quality improvement pre-post intervention study design was used to determine if colorectal cancer screening rates increase within 3 months of the implementation of a multicomponent intervention. The intervention consisted of two components: 1) postcard educational mailers and electronic educational mailers and 2) medical assistant and registered nurse education on colorectal cancer screening and in-clinic order process. Inclusion Criteria: Male and female patients aged 50-75 seen at the Family Care Center in Garnett, Kansas and the Family Care Center South in Colony, Kansas from July 2018 to September 2018 who were overdue for colorectal cancer screening received a postcard mailer or an electronic mailer about colorectal cancer screening. Male and female patients aged 50-75 who visited the Clinics from October 2018 to December 2018 were assessed for colorectal cancer screening adherence and a colorectal cancer screening order was placed, if applicable. Analysis: Post-intervention colorectal cancer screening rates from Quarter 4 (October 1, 2018 to December 31, 2018) were compared to colorectal cancer screening rates pre-intervention during Quarter 3 (July 1, 2018 to September 30, 2018). Results: The Clinics had an increase in post-intervention colorectal cancer screening rate when compared to pre-intervention screening rate. The colorectal cancer screening rate had the largest increase in the two months following the intervention implementation. Significance: Improving colorectal cancer screening rates using low-cost interventions may improve the health of residents in rural Kansas. The multicomponent intervention may offer an inexpensive way to improve colorectal cancer screening adherence in rural areas of the United States where healthcare resources may be scarce. Key Words: colorectal cancer, screening, rural health, preventative healt

Sympathetic Neural Responses to Acute Thermal Sensations

The influence of thermal stimuli on the sympathetic nervous system is variable and largely depends on the change in temperature and timing of the stimuli. Core temperature changes yield increased muscle sympathetic nerve activity (MSNA) while changes in skin temperature yield variable MSNA responses. The MSNA responses to acute heating or cooling sensations remains unclear. Twenty-three participants (11 women, 12 men; age 24±1 years, BMI 26±1 kg/m2) underwent a thermal protocol that included four trials each of cool sensation threshold, warm sensation threshold, and heat pain (12 total trials). Continuous blood pressure (finger plethysmography), heart rate (electrocardiography), and MSNA (via microneurography) were recorded throughout all trials. Data was assessed with a Shapiro-Wilk test and log transformations were utilized for non-normal distributed data. T-tests were used to compare physiological data for cool and warm sensation thresholds, and repeated measures ANOVA to compare multiple heat pain data points. MSNA was significantly attenuated during the immediate recovery of cool threshold and warm threshold. MSNA was inhibited during the sensation of heat pain and systolic arterial pressure was reduced during the recovery from heat pain. There were no significant differences between men and women for any variables and responses. These results indicate that acute thermal sensations result in the inhibition of MSNA

Why legal cannabis may be more widespread in the US after the election.

The process of implementing comprehensive cannabis legislation varies between states and is often met with bureaucratic challenges. With many states putting medical and recreational cannabis on the ballot this election, Lee Hannah, Gideon Cunningham and Daniel Mallinson look at the key differences in these states’ approaches to legalisation. The increasing momentum on legal cannabis, they write, is likely to put further pressure on Congress to pass national cannabis policy reform

Barriers and facilitators to the implementation of the advanced nurse practitioner role in primary care settings: a scoping review

Background: Workload and workforce issues in primary care are key drivers for the growing international trend to expand nursing roles. Advanced nurse practitioners are increasingly being appointed to take on activities and roles traditionally carried out by doctors. Successful implementation of any new role within multidisciplinary teams is complex and time-consuming, therefore it is important to understand the factors that may hinder or support implementation of the advanced nurse practitioner role in primary care settings. Objectives: To identify, appraise and synthesise the barriers and facilitators that impact implementation of advanced practitioner roles in primary care settings. Methods: A scoping review conducted using the Arksey and O’Malley (2005) framework and reported in accordance with PRISMA-ScR. Eight databases (Cochrane Library, Health Business Elite, Kings Fund Library, HMIC, Medline, CINAHL, SCOPUS and Web of Science) were searched to identify studies published in English between 2002 and 2017. Study selection and methodological assessment were conducted by two independent reviewers. A pre-piloted extraction form was used to extract the following data: study characteristics, context, participants and information describing the advanced nurse practitioner role. Deductive coding for barriers and facilitators was undertaken using a modified Yorkshire Contributory Framework. We used inductive coding for barriers or facilitators that could not be classified using pre-defined codes. Disagreements were addressed through discussion. Descriptive data was tabulated within evidence tables, and key findings for barriers and facilitators were brought together within a narrative synthesis based on the volume of evidence. Findings: Systematic searching identified 5976 potential records, 2852 abstracts were screened, and 122 full texts were retrieved. Fifty-four studies (reported across 76 publications) met the selection criteria. Half of the studies (n=27) were conducted in North America (n=27), and 25/54 employed a qualitative design. The advanced nurse practitioner role was diverse, working across the lifespan and with different patient groups. However, there was little agreement about the level of autonomy, or what constituted everyday activities. Team factors were the most frequently reported barrier and facilitator. Individual factors, lines of responsibility and ‘other’ factors (i.e. funding), were also frequently reported barriers. Facilitators included individual factors, supervision and leadership and ‘other’ factors (i.e. funding, planning for role integration). Conclusion: Building collaborative relationships with other healthcare professionals and negotiating the role are critical to the success of the implementation of the advanced nurse practitioner role. Team consensus about the role and how it integrates into the wider team is also essential

The effects of early years' childcare on child emotional and behavioural difficulties in lone and co-parent family situations

With targeted childcare initiatives and welfare-to-work programmes policy-makers have sought to address employment activation of lone mothers and negative outcomes for children in lone parent households. The present study examines non-parental childcare use and maternal employment among children living in lone and co-parent family situations at ages three and four and emotional and behavioural difficulties at ages four and five. The results demonstrate that negative outcomes associated with lone motherhood are explained largely by mother's age, education, material circumstances and area deprivation; and that maternal employment does not relieve lone mothers’ disadvantages in a way that alleviates the risks of difficulties to their children. However, in any family constellation, mainly group-based formal pre-school childcare does have a positive impact on child difficulties compared to drawing on informal childcare arrangements as main provider. In addition, and specifically for the difficulties of children in lone mother family situations, any non-parental childcare – formal or informal − for at least twenty-five hours per week is beneficial. Study findings support policy agendas which tackle families’ material hardship beyond promoting mothers’ employment, and through investment in formal childcare provision, and also through arrangements allowing lone mothers to divide their weekly load of childcare with another main provider

Anchoring Communities Throughout COVID-19: Results from the 2020 Healthy Food in Health Care Survey in New England.

Health Care Without Harm has been surveying their network of facilities since 2009. In 2020 the effort was expanded to include the full population health care facilities throughout New England. This new iteration of the Healthy Food in Health Care Survey focused on hospitals\u27 foodservice operations response to COVID-19 and contributions as anchor institutions in their communities. To supplement the survey results, three in-depth case studies demonstrate various experiences throughout the pandemic and highlight the motivations and ways these facilities successfully navigated the incredible strain put on the health care system while still being an essential community resource. The finding suggests that health care facilities played an important role in supporting their communities beyond procurement by establishing new initiatives that promoted food access and local producers. Based on the survey and case-study findings, recommendations and key takeaways for stakeholders hoping to increase their engagement as an anchor institution were developed. These recommendations highlight the resources used to support food access initiatives throughout COVID-19 and further develop relationships with local producers

Culture Shock: Representation and Presentation

Panel Chair: Whitney Pisani Papers presented: A Grounded Theory analysis of \u27The Karate Kid\u27 by Joshua Newman Grounded Theory by Hannah Chirwa The Effects of Police Killings on African American Adolescents\u27 Internalized behaviors by Ashley Cunningham Abstract: News and social media tycoons including YouTube and Facebook give the world access to social injustices on a day to day basis. A particular injustice that riddles the African American community is the unjust killing of men and women at the hands of police. Often times, these men and women leave behind children that require assistance in which is not offered. There has been minimal research on the effects of how this experience affects youth in a school environment. This review explores the effects on African American adolescents’ ages 13 through 17 internalized behavior after a parent is shot and killed by police. The Socioeconomic Effects on the use of prepositions in titles by Julian P. Quinn Abstract: To delve into the linguistic appeal and popularity of certain titles of texts, specifically newspaper, journal/magazine, and fictional texts that either begin with these prepositions: on, after, concerning, towards, with, or contain one of them. My research will include data analyses of the most common of these five prepositions in titles during three distinct years, 1929, 1969, 2001 – the stock market crash, the landing on the moon, and the Al-Qaeda terrorist attacks. I will make analyses of the potential socioeconomic/linguistic reasons for the leading preposition’s popularity in these distinct cultural moments. I will use GlobalCat, the world\u27s largest network of library content and services to conduct my research. Deaf Culture: An Analysis of Cultural Legitimacy by Sarah Neely Ocana

Results from 2014 Vegetation Monitoring in Prairie and Old Field Habitats Following Shrub Removal at the North Chicago Wetland Mitigation Site, Lake County, Illinois

This report focuses on results from vegetation monitoring in terrestrial plant communities during 2014 and compares trends among reference prairie, transect prairie, and old field habitats. There are four main questions: 1. What are the site-level comparative trends in species composition, total richness, and floristic quality and, for old field and prairie habitats (combining reference prairie and transect prairie habitats), what are the changes in species composition and abundance? 2. Based on 2014 sample data, are there significant between-subjects differences (vegetation types) with regard to ground layer and shrub/sapling parameters (e.g., composition, species richness, diversity, and cover - see Methods for full list and parameter definitions)?3. Are there significant within-subjects differences (year) in these parameters since the 2009 baseline data for each vegetation type and when (what year) do the differences occur?4. What are the between-subjects and within-subjects interactions (i.e., vegetation type x sample year) for selected vegetation parameters since 2009?unpublishednot peer reviewe