A Longitudinal Medical Spanish Program at One US Medical School and Accuracy of Self-assessed Spanish Fluency among Medical Students

Introduction: Policymakers have recommended recruiting and/or training more US physicians who can provide care in Spanish. Few longitudinal medical Spanish programs have been described and evaluated. Aim: To describe development and evaluation of the preclinical phase of a fouryear program designed to graduate physicians who can provide languageconcordant care in Spanish. Setting: One public medical school in southeastern US. Program description: The program targeted intermediate/advanced Spanish speakers. Standardized fluency assessments were used to determine eligibility and evaluate participants' progress. Curriculum included didactic coursework, simulated patients, socio-cultural seminars, clinical skills rotations at sites serving Latinos, service-learning, and international immersion. Program evaluation: For the first two cohorts (n=45) qualitative evaluation identified program improvement opportunities and found participants believed the program helped them maintain their Spanish skills. Mean interim (two-year) speaking proficiency scores were unchanged from baseline: 9.0 versus 8.7 at baseline on 12-point scale (p=.15). Mean interim listening comprehension scores (second cohort only, n=25) increased from a baseline of 77% to 86% (p=.003). Proportions passing the listening comprehension test increased from 72% to 92% (p=0.06). Discussion: We describe development of a longitudinal Spanish program within a medical school. Participation was associated with improved Spanish listening comprehension and no change in speaking proficiency.Master of Public Healt

A New Population of High Redshift, Dusty Lyman-Alpha Emitters and Blobs Discovered by WISE

We report a new technique to select 1.6<z<4.6 dusty Lyman-alpha emitters (LAEs), over a third of which are `blobs' (LABs) with emission extended on scales of 30-100kpc. Combining data from the NASA Wide-field Infrared Survey Explorer (WISE) mission with optical spectroscopy from the W.M. Keck telescope, we present a color criteria that yields a 78% success rate in identifying rare, dusty LAEs of which at least 37% are LABs. The objects have a surface density of only ~0.1 per square degree, making them rare enough that they have been largely missed in narrow surveys. We measured spectroscopic redshifts for 92 of these WISE-selected, typically radio-quiet galaxies and find that the LAEs (LABs) have a median redshift of 2.3 (2.5). The WISE photometry coupled with data from Herschel reveals that these galaxies have extreme far-infrared luminosities (L_IR>10^{13-14}L_sun) and warm colors, typically larger than submillimeter-selected galaxies (SMGs) and dust-obscured galaxies (DOGs). These traits are commonly associated with the dust being energized by intense AGN activity. We hypothesize that the combination of spatially extended Lyman-alpha, large amounts of warm IR-luminous dust, and rarity (implying a short-lived phase) can be explained if the galaxies are undergoing strong `feedback' transforming them from an extreme dusty starburst to a QSO.Comment: Submitted to ApJ Letters, 6 pages, 4 figures. Comments welcom

Correction to: Sociodemographic correlates of colorectal cancer screening completion among women adherent to mammography screening guidelines by place of birth

Correction to "Sociodemographic correlates of colorectal cancer screening completion among women adherent to mammography screening guidelines by place of birth

Sociodemographic correlates of colorectal cancer screening completion among women adherent to mammography screening guidelines by place of birth

Introduction Colorectal cancer screening rates in the U.S. still fall short of national goals, while screening rates for other cancer sites, such as breast, remain high. Understanding characteristics associated with colorectal cancer screening among different groups of women adherent to breast cancer screening guidelines can shed light on the facilitators of colorectal cancer screening among those already engaged in cancer prevention behaviors. The purpose of this study was to explore which demographic characteristics, healthcare access factors, and cancer-related beliefs were associated with colorectal cancer screening completion among U.S. and foreign-born women adherent to mammography screening recommendations. Methods Analyses of the 2015 National Health Interview Survey were conducted in 2019. A sample of 1206 women aged 50–74 who had a mammogram in the past 2 years and were of average risk for colorectal cancer was examined. Logistic regression was used to determine demographic, health service, and health belief characteristics associated with colorectal cancer screening completion. Results Fifty-five percent of the sample were adherent to colorectal cancer screening recommendations. Women over the age of 65 (AOR = 1.76, 95% CI 1.06–2.91), with any type of health insurance, and who were bilingual (AOR = 3.84, 95% CI 1.83–8.09) were more likely to complete screening, while foreign-born women (AOR = 0.53, 95% CI 0.34–0.83) were less likely. Cancer-related beliefs did not influence adherence. Stratified analyses by nativity revealed additional associations. Conclusions  Demographic and health service factors interact to influence colorectal cancer screening among women completing breast cancer screening. Colorectal cancer screening interventions targeting specific underserved groups and financing reforms may enhance women’s colorectal cancer screening rates

Prevalence of Lung Cancer Screening in the US, 2022

This cross-sectional study compares lung cancer screening prevalence in 2022 among individuals eligible by 2021 vs 2013 criteria by sociodemographics and state

An Obscured Radio Galaxy at High Redshift

Perhaps as many as 10% of high redshift radio galaxy (HzRG; z > 2) candidates that are selected using an Ultra Steep radio Spectrum (USS) criterion fail to show optical emission (continuum, lines) in deep Keck exposures. Their parent objects are only detected in the near-IR and are probably heavily obscured and/or at very high redshift. To search for signatures of dust and help constrain the nature and redshifts of these ``no-z'' radio galaxies, we have conducted a program of submillimeter and millimeter observations. Here we report the first results of a detailed study of one of these objects, WN J0305+3525. WN J0305+3525 appears associated with a small group of K ~ 21 - 22 objects and is strongly detected at both 850 micron and 1.25 mm. On the basis of its faint K-band magnitude, spectral energy distribution (SED) and other evidence we estimate that the radio galaxy is probably at a redshift z = 3 +/- 1. This would make WN J0305+3525 a radio-loud Hyper Luminous Infrared Galaxy (LFIR ~ 10^13 Lsun) similar to, but more obscured than, other dusty radio galaxies in this redshift range. This, together with the absence of Lya emission and compact (theta < 1.9") radio structure, suggests that WN J0305+3525 is embedded in a very dense, dusty medium and is probably at an early stage of its formation.Comment: 13 Pages LaTeX, including 3 Postscript figure

A Galactic Wind at z = 5.190

We report the serendipitous detection in high-resolution optical spectroscopy of a strong, asymmetric Ly-alpha emission line at z = 5.190. The detection was made in a 2.25 hour exposure with the Echelle Spectrograph and Imager on the Keck II telescope through a spectroscopic slit of dimensions 1" x 20". The progenitor of the emission line, J123649.2+621539 (hereafter ES1), lies in the Hubble Deep Field North West Flanking Field where it appears faint and compact, subtending just 0.3" (FWHM) with I(AB) = 25.4. The ES1 Ly-alpha line flux of 3.0 x 10^(-17) ergs/cm^2/s corresponds to a luminosity of 9.0 x 10^(42) ergs/s, and the line profile shows the sharp blue cut-off and broad red wing commonly observed in star-forming systems and expected for radiative transfer in an expanding envelope. We find that the Ly-alpha profile is consistent with a galaxy-scale outflow with a velocity of v > 300 km/s. This value is consistent with wind speeds observed in powerful local starbursts (typically 10^2 to 10^3 km/s), and compares favorably to simulations of the late-stage evolution of Ly-alpha emission in star-forming systems. We discuss the implications of this high-redshift galactic wind for the early history of the evolution of galaxies and the intergalactic medium, and for the origin of the UV background at z > 3.Comment: 12 pages, 7 figures, accepted for publication in the Astrophysical Journa

Testing a Spanish-language colorectal cancer screening decision aid in Latinos with limited English proficiency: Results from a pre-post trial and four month follow-up survey

Abstract Background Compared with non-Latinos, Latinos in the US have low rates of colorectal cancer (CRC) screening and low rates of knowledge regarding CRC screening tests and guidelines. Spanish speaking Latinos have particularly low CRC screening rates and screening knowledge. Our purpose was twofold: (1) to evaluate the effect of a computer-based, Spanish-language CRC screening decision aid on screening knowledge, intent to obtain screening, and screening self-efficacy in a community sample of Latinos with limited English proficiency (LEP); and (2) to survey these decision aid viewers at four months to determine their rates of CRC discussions with a health care provider as well as their rates of screening test completion. Methods We recruited 50-75 year old Latinos with LEP who were not current with CRC. Participants screening viewed a 14 minute multimedia decision aid that addresses CRC screening rationale, recommendations, and options. We conducted an uncontrolled (pre-post) study in which we assessed screening knowledge, self-efficacy, and intent at baseline and immediately after decision aid viewing. We also conducted a follow-up telephone survey of participants at four months to examine rates of patient-provider screening discussions and test completion. Results Among n = 80 participants, knowledge scores increased from 20% (before) to 72% (after) decision aid viewing (absolute difference [95%CI]: 52% [46, 59]). The proportion with high screening self-efficacy increased from 67% to 92% (25% [13, 37]); the proportion with high screening intent increased from 63% to 95% (32% [21, 44]). We reached 68 (85%) of 80 participants eligible for the follow-up survey. Of these 36 (53%) reported discussing screening with a provider and 13 (19%) completed a test. Conclusion Viewing a Spanish-language decision aid increased CRC screening knowledge, self-efficacy, and intent among Latinos with LEP. Decision aid viewing appeared to promote both CRC screening discussions with health care providers and test completion. The decision aid may be an effective tool for promoting CRC screening and reducing screening disparities in this population

Cultural and Linguistic Adaptation of a Multimedia Colorectal Cancer Screening Decision Aid for Spanish-Speaking Latinos

As the United States becomes more linguistically and culturally diverse, there is a need for effective health communication interventions that target diverse and most vulnerable populations. Latinos also have the lowest colorectal (CRC) screening rates of any ethnic group in the U.S. To address such disparities, health communication interventionists are often faced with the challenge to adapt existing interventions from English into Spanish in a way that retains essential elements of the original intervention while also addressing the linguistic needs and cultural perspectives of the target population. We describe the conceptual framework, context, rationale, methods, and findings of a formative research process used in creating a Spanish language version of an evidenced-based (English language) multimedia CRC screening decision aid. Our multi-step process included identification of essential elements of the existing intervention, literature review, assessment of the regional context and engagement of key stakeholders, and solicitation of direct input from target population. We integrated these findings in the creation of the new adapted intervention. We describe how we used this process to identify and integrate socio-cultural themes such as personalism (personalismo), familism (familismo), fear (miedo), embarrassment (verguenza), power distance (respeto), machismo, and trust (confianza) into the Spanish language decision aid

Why Wait Until Our Community Gets Cancer?: Exploring CRC Screening Barriers and Facilitators in the Spanish-Speaking Community in North Carolina

Colorectal cancer (CRC) is a leading cause of death among Hispanics in the United States. Despite the benefits of CRC screening, many Hispanics are not being screened. Using a combined methodology of focus groups and discrete choice experiment (DCE) surveys, the objectives for this research were as follows: (1) to improve understanding of preferences regarding potential CRC screening program characteristics, and (2) to improve understanding of the barriers and facilitators around CRC screening with the Hispanic, immigrant community in North Carolina. Four gender-stratified focus groups were conducted and DCE surveys were administered to 38 Spanish-speaking individuals across four counties in North Carolina. In-depth content analysis was used to examine the focus group data; descriptive analyses and mean attribute importance scores for cost of screening and follow-up care, travel time, and test options were calculated from DCE data. Data analyses showed that this population has a strong interest in CRC screening but experience barrier such as lack of access to resources, cost uncertainty, and stigma. Some of these barriers are unique to their cultural experiences in the United States, such as an expressed lack of tailored CRC information. Based on the DCE, cost variables were more important than testing options or travel time. This study suggests that Hispanics may have a general awareness of and interest in CRC screening, but multiple barriers prevent them from getting screened. Special attention should be given to designing culturally and linguistically appropriate programs to improve access to healthcare resources, insurance, and associated costs among Hispanics