Factors Influencing Vaccination Rates in Children Under Two in Southeast Kansas

Introduction A large Federally Qualified Health Center (FQHC) in Southeast Kansas has a 37% compliance of children completing the recommended combo 10 primary vaccination series before their second birthday. An additional 20% of children would be compliant if the flu vaccine was excluded, raising the compliance rate to 57%. This is still below the national average of 68-75%, leaving many children in Southeast Kansas and northeast Oklahoma unprotected from preventable childhood diseases. Purpose The purpose of this scholarly project was to identify barriers to vaccination, including vaccine hesitancy and socioeconomic barriers affecting completion of the primary vaccine series, or combo 10, in children under age two in Southeast Kansas. Materials/Methods This descriptive study used a validated questionnaire, the Searching for Hardships and Obstacles to Shots (SHOTS) survey to gather information about parental attitudes toward vaccination and socioeconomic barriers that may be affecting vaccination rates in children under the age of two in Southeast Kansas. Results/Conclusion Concerns about shots was the most problematic for this population, followed by importance of shots, then access to shots. Although concerns about vaccines may contribute to low vaccination rates, demographic data indicate that 77% children are fully vaccinated to the knowledge of the parent/guardian, implying that there are likely other factors that are contributing low vaccination rates

Birthing change: an ethnographic study of the Alaska Family Health & Birth Center in Fairbanks, Alaska

Thesis (M.A.) University of Alaska Fairbanks, 2013This study examines the practices of the Alaska Family Health & Birth Center in order to understand how midwives help clients navigate the process of pregnancy, birth, and the postpartum period with a high rate of success, as defined by a low cesarean rate, low mortality and morbidity, and high maternal satisfaction. How do the midwives prepare mothers to navigate the transformation and how do they address failure to progress during birth? This study analyzes birth as a rite of passage, which incorporates a culture's worldview and its practices. These outcomes are achieved by employing a positive, holistic view of the natural, physiological process, by using practices that support the physiological process and minimize intervention, and by keeping the space in which out-of hospital birth takes place. The fact that parents are choosing an alternative ritual for birth at an increasing rate nationwide reflects a change happening in American culture.Chapter 1. Introduction -- 1.1. The Alaska Family Health & Birth Center (AFH & BC) -- 1.2. Controversy in American maternity care -- 1.3. Pregnancy and birth at AFH & BC as a rite of passage: research questions, hypothesis, and analysis -- 1.4. Rites of passage -- 1.5. Methods and methodology -- 1.6. Execution of research -- 1.7. Chapter summaries -- Chapter 2: The Alaska context -- 2.1. Geography, environment, and culture -- 2.2. Costs and insurance -- 2.3. Alaska native birthing traditions -- Chapter 3. The Alaska Family Health & Birth Center setting -- 3.1. The midwifery model of care -- 3.2. Different types of birth attendants -- 3.3. The legal context -- 3.4. Participant demographics -- 3.5. Study participants and what brought them to AFH & BC -- 3.6. AFH & BC statistics, legal status, and funding -- 3.7. Out-of-hospital and AFH & BC demographics -- Chapter 4. Prenatal care -- 4.1. A prenatal care appointment with Sienna -- 4.2. The childbirth preparation class with Deb -- 4.3. Additional notes on prenatal care -- 4.4. Conclusions about preparation for birth -- Chapter 5. Birth stories -- 5.1. Participant birth stories -- 5.2. Postpartum care -- 5.3. Conclusions about intrapartum care -- Chapter 6. The physiological process -- 6.1. Emotions and hormones -- 6.2. "Going deep within" -- 6.3. Authoritative knowledge: the knowledge -- 6.4. Conclusion -- Chapter 7. Failure to progress -- 7.1. Preventing failure to progress -- 7.2. Defining progress -- 7.3. Authoritative knowledge: the authority -- 7.4. Conclusion -- Chapter 8. AFH & BC and Fairbanks Memorial Hospital -- 8.1. Jane's birth story -- 8.2. The relationship between AFH & BC and Fairbanks Memorial Hospital -- 8.3. Crisis as normal -- Chapter 9. The role of the midwife -- 9.1. Guardians of birth -- 9.1.1. Holding the physical space by maintaining infrastructure -- 9.1.2. Holding the external space during birth -- 9.1.3. Holding the political space -- 9.2. Empowerment -- Chapter 10. Conclusion -- 10.1. Summary of findings -- 10.2. Epilogue -- References -- Participant interviews

Improving the outcomes of foot and ankle surgery through the audit cycle: a case study

The direct costs of managing adverse outcomes from Australian health care are estimated to be $2 billion. The audit cycle is considered an important tool to assist in the preventive management of adverse outcomes.Australian guidelines for audit cycle design allow for comparison of data sets derived from similar surgical specialities. However a lack of data set standardisation inhibits meaningful comparisons of foot and ankle surgical audits. This research will assist development of a best practice model for auditing foot and ankle surgery. Data derived from this model will improve the safety and quality of foot and ankle surgery. The preliminary phase of this process is to identify and understand the attitudes and behaviours of how and why surgeons participate in the audit cycle. A descriptive embedded multiple case study research design is planned to provide an intense focus on a single phenomenon (the audit cycle) within its real life context (clinical governance). The measures to be included in the case study have been identified by the Balanced Patient Safety Measurement Framework. These include: audit and peer review activity, provider attitudes to patient safety, safety learning, action and performance. A purposive sample of 6 to 8 surgeons (units of analysis) from 3 to 4 specialities (cases) will undergo semi-structured interview. This will investigate: current audit tools and processes; attitudes; and behaviours of surgeons to the audit cycle. Similarities in and differences between the units of analysis will indicate which identified measures function as barriers or enablers of the audit cycle. Reliability and validity (external and construct) will be assessed using established methods for case studies. The descriptive embedded multiple case study will reveal how and why foot and ankle surgeons participate in the audit cycle. This will inform further research to improve the outcomes of foot and ankle surgery through development of an audit tool

Mobile Apps Catalog

The Mobile Apps Catalog is a collection of emergency management and assistive mobile applications intended to assist first responders, emergency managers, and the public, specifically people with disabilities or others with access and function needs. Highlighted in this catalog are readily available preparedness and response apps that can be accessed by wireless devices, as well as assistive resources to advance the usability of wireless devices for consumers with disabilities. The apps are also helpful for the whole community. “Federal Emergency Management Agency (FEMA)’s “Whole Community” approach to emergency management recognizes that individuals, families and communities are assets and keys to success (Fugate 2011).

Dissemination of WEA: Survey of Alert Authorities

In 2013, researchers from the Center for Advanced Communication Policy (CACP) at Georgia Institute of Technology were tasked by the Federal Emergency Management Agency (FEMA) Integrated Public Alert and Warning System (IPAWS) program office to research the inclusiveness of people with disabilities and those with language differences with regards to emergency alerts, namely Wireless Emergency Alerts (WEAs). Several research methods were employed to examine the accessibility of emergency alerts and impacts to all stakeholders. This brief summarizes the survey results on how FEMA approved alert authorities used IPAWS to send WEAs to the public. The survey was sent to all 425 alert authorities in 2014. The questions asked were intended to assist the CACP in identifying current best practices that can be used as benchmarks for emergency managers and other potential alerting authorities regarding ways to assist the identified population. 139 alerting authorities (33%) responded to this survey

Digital analysis of nanoparticle sensors for single molecule point-of-care virus detection.

The recent pandemic has shown the vital importance of point-of-care detection of RNA in mediating harm reduction. As RNA levels in clinical samples are as low as 103 viral particles / mL, to obtain immediate sensing results without amplification sensors are required have a working range within the single molecule regime. Challenges arise within this regime due to large volumes and low target amounts – low-signal to noise results in non-specific signal from other biological analytes dwarfing specific signal and large volumes result in slower Poisson statistics dictating target movement and interaction with the sensor. The main objective of this thesis was to create a single molecule sensor which addresses these challenges to attain a sensing response within the region of clinical relevancy. The first sensor presented in this work utilised plasmonic colour changes upon an RNA-DNA hairpin interaction and is highly specific to the target analyte to address these challenges. The application of a consumer grade Canon camera and dark-field microscope makes this technique highly scalable and relevant for point-of-care. Use of digital image analysis allowed fast colour analysis of all particles within a field-of-view. The next generation of image analysis analysed individual particles before and after target addition instead of the entire field-of-view to improve the working range of the sensor towards lower concentrations. Due to uncontrollable surface variation (such as orientation of the constructs), significant care had to be taken in developing an accurate colour analysis algorithm. An unsupervised learning algorithm using LAB colour space generated image features was demonstrated and validated. Preliminary work from a secondary sandwich assay aims to further reduce uncertainties from single molecule effects these uncertainties by using more direct reporter particle binding to the target. Using particle tracking analysis single particle binding was observed. This thesis demonstrated the power of using massive repeatable arrays for single particle sensing, in both instances having huge amounts of sensor data made the results more statistically significant and thus more robust

Trafficking regulation of the chemokine receptor CCR2B compared to CCR5

The closely-related CC chemokine receptors 2B and 5 are seven-transmembrane domain receptors coupled to heterotrimeric G proteins. The two receptors bind inflammatory chemokines and play important complementary roles in the recruitment of specific leukocyte sub-populations to sites of infection. To enable fine-tuning of cellular responses to chemokines, CCR2B and CCR5, like other GPCRs, can be desensitised in response to agonist stimulation or cross-talk with other receptors. This involves down-modulation of cell surface active receptor through two essential transportation events, endocytosis and recycling. The CCR5 endocytic and recycling pathways are well established and several mechanisms involved have been clearly defined. Conversely, less is known about the route followed by CCR2B upon stimulation. This study investigated the regulation, trafficking and fate of CCR2B in the context of THP-1 cells endogenously expressing the receptor and HEK293 transfectants. Comparison with CCR5 highlighted marked differences in the behavious of the two receptors. However, my initial findings indicate that certain aspects of the regulation of CCR5 as well as CCR2B may be cell type-dependent. Flow cytometry, immunofluorescence and biochemical analyses showed that unlike CCR5, internalised CCR2B can be both degraded and recycled following agonist stimulation. In HEK293, CCR2B follows an EGF receptor-like pathway, transiting through early endosomes containing EEA1, transferrin and Rab4, reaching CD63 and Lamp1 positive late endosomes/lysosomes before being degraded. Importantly, I showed that CCR2B cell surface molecules are N- and O-glycosylated, and only this glycosylated form of the receptor is targeted for agonist-induced degradation. This thesis also presents findings from proteomics approaches developed in an attempt to identify interacting proteins implicated in the trafficking of each receptor. This study brings new insights to the endocytic regulation of agonist-treated CC chemokine receptors, revealing receptor- and cell type-specific behaviours, which add complexity to a relatively conserved process

Annotated Names in the Sales Minutes from the Auctions of the Collection of Daniel Marie Fouquet

This dataset includes the legible names that appear in the sales minutes of the auctions of the collection of Dr. Daniel Marie Fouquet, which took place in Paris, Hôtel Drouot, 12-14, 19-20 June 1922. Buyers were only indicated by last names. When possible, the most likely person has been identified with relevant information. Some names that I could not decipher are not included. Whenever additional details, such as an address, were included in the minutes, those are noted. The frequency of an individual name appearing in the minutes is not recorded in this resource. This dataset is meant to accompany the article by Danielle Smotherman Bennett, "Identifying Old Collection Marks on Hellenistic and Roman Terracottas Associated with the Collection of Daniel Marie Fouquet.

Mapping Circadian Output Pathways in Neurospora crassa

Circadian clocks are ubiquitous in eukaryotic organisms, providing the ability to anticipate regularly occurring stressful environmental changes. The molecular clock leads to a change in physiology of the organism such that it is prepared for predictable changes. While the external signals detected by the clock, as well as the molecular mechanism of clock components have been extensively characterized, less is known about how the clock manifests time of day information to the organism as a whole. Our lab has focused on identifying output pathways from the clock, using the model organism Neurospora crassa. We have previously demonstrated the circadian regulation of the conserved Mitogen Activated Protein Kinase (MAPK) OS-2 pathway, a homolog of the mammalian p38 pathway, and necessary for maintaining osmotic homeostasis in Neurospora. I present data indicating the circadian regulation of the 2 other MAPK pathways in Neurospora, the mammalian ERK1 and ERK2 like MAPKs, MAK-1 and MAK-2, and show that they are outputs of the clock. Furthermore, I identified around 500 genes that are mis-regulated when MAK-1 is deleted; greater than 25% of those genes are predicted to be clock-controlled. I demonstrated that the clock is signaling through the MAK-1 pathway to regulate 3 clock-controlled genes (ccgs) that encode proteins involved in several different biological processes including, stress response, cell wall formation, and mitochondrial phosphate transport. I established the circadian regulation of the transcript levels of 2 of the MAK-1 cascade components, mek-1 and mak-1. Additionally, I found that the accumulation of MEK-1 protein is clock-controlled, suggesting this is one mechanism by which the clock regulates the activity of MAK-1. Additional studies were carried out to elucidate the proteins that directly regulate the expression of mek-1 and mak-1; however, the mechanisms of direct clock control remain unclear and require further investigation. The finding that the circadian clock regulates all MAPK pathways in Neurospora, combined with the conservation of both the circadian clock and MAPK pathways in mammals provide compelling evidence that mammalian MAPK pathways are also regulated as clock output pathways to control circadian physiology. There is a strong link between aberrations in mammalian clocks, MAPKs, and disease, and therefore, an urgent need to further characterize the circadian regulation of the MAPK families, which will reveal new avenues for therapeutic treatments

Flea‘in Around: A Look at the Identification, Preservation, Clearing, and Mounting of Siphonaptera

Fleas are remarkable and highly specialized insects, with no part of their external anatomy being easily mistaken for that of any other insect. Due to their small size, the subtle differences among the distinguishing morphological characteristics of each species, and complexities of preparing specimens, identifying, and working with fleas is challenging. Various documents and taxonomic keys are available that discuss mounting procedures and the identification of medically important fleas for large regions of the world including the United States; however, many of these have become antiquated over time. Some of the distinguishing specialized characteristics exhibited among flea species, as presented in older keys, come in the form of line drawings, which are accurate but can be difficult to use when comparing it to structures on a whole specimen when viewed through a microscope. This paper presents a guide which describes in detail previously developed, but obscure techniques covering the preservation, preparation, clearing, and mounting of Siphonaptera specimens. In addition, we are also presenting an easy-to-use photographic key of twelve flea species collected from back yard wildlife, as well as pet cats and dogs in Orange County, CA. This key, which is freely available online at the Orange County Mosquito and Vector Control District’s website, is an effective tool for the identification of common flea species found in southern California. Using the key in conjunction with the mounting guide will provide users with a full-circle guide to preserving, identifying, and mounting flea specimens. Keyed flea genera include Cediopsylla, Ctenocephalides, Diamanus, Echidinophaga, Hoplopsyllus, Leptopsylla, Nosopsyllus, Orchopoeas, Pulex, and Xenopsylla. Examined hosts include cats, coyotes, dogs, mice, opossums, rabbits, raccoons, rats, skunks, squirrels, and woodrats