Organizational Cultural Competence of Post-Secondary Health-Related Academic Units

Each year, the United States is becoming more racially and ethnically diverse and creating many challenges for healthcare professionals. Extensive literature has documented a gap between minority and majority populations’ health outcomes. According to the Institute of Medicine, one way to eliminate health disparities is by providing cross-cultural training to future and current healthcare professionals. A few models in healthcare delivery systems have assessed their own organizational cultural competence. However, due to the unique differences between health care delivery systems and post-secondary health-related academic units, there exists a need to develop and validate a model for organizational cultural competence of post-secondary health-related academic units. This literature review builds the foundation for this research project, which is to provide initial construct validity of a model for organizational cultural competence of postsecondary health related academic units

Social stressors and air pollution across New York City communities: a spatial approach for assessing correlations among multiple exposures

Background: Recent toxicological and epidemiological evidence suggests that chronic psychosocial stress may modify pollution effects on health. Thus, there is increasing interest in refined methods for assessing and incorporating non-chemical exposures, including social stressors, into environmental health research, towards identifying whether and how psychosocial stress interacts with chemical exposures to influence health and health disparities. We present a flexible, GIS-based approach for examining spatial patterns within and among a range of social stressors, and their spatial relationships with air pollution, across New York City, towards understanding their combined effects on health. Methods: We identified a wide suite of administrative indicators of community-level social stressors (2008–2010), and applied simultaneous autoregressive models and factor analysis to characterize spatial correlations among social stressors, and between social stressors and air pollutants, using New York City Community Air Survey (NYCCAS) data (2008-2009). Finally, we provide an exploratory ecologic analysis evaluating possible modification of the relationship between nitrogen dioxide (NO2) and childhood asthma Emergency Department (ED) visit rates by social stressors, to demonstrate how the methods used to assess stressor exposure (and/or consequent psychosocial stress) may alter model results. Results: Administrative indicators of a range of social stressors (e.g., high crime rate, residential crowding rate) were not consistently correlated (rho = - 0.44 to 0.89), nor were they consistently correlated with indicators of socioeconomic position (rho = - 0.54 to 0.89). Factor analysis using 26 stressor indicators suggested geographically distinct patterns of social stressors, characterized by three factors: violent crime and physical disorder, crowding and poor access to resources, and noise disruption and property crimes. In an exploratory ecologic analysis, these factors were differentially associated with area-average NO2 and childhood asthma ED visits. For example, only the ‘violent crime and disorder’ factor was significantly associated with asthma ED visits, and only the ‘crowding and resource access’ factor modified the association between area-level NO2 and asthma ED visits. Conclusions: This spatial approach enabled quantification of complex spatial patterning and confounding between chemical and non-chemical exposures, and can inform study design for epidemiological studies of separate and combined effects of multiple urban exposures. Electronic supplementary material The online version of this article (doi:10.1186/1476-069X-13-91) contains supplementary material, which is available to authorized users

Moyo Vol. VIII N 2

Durica, Paul. Editor\u27s Letter . 4. Fisher, Dan. Heaven for Thunder (Thoughts on the Last Execution) . 5. Anshuman, Karan. Return to Sender (Mail-Order Brides Log-On Love) . 6. Grindstaff, Michelle. Madonna or Whore (Language Traps Female Sexuality) . 7. Thackeray, Alex. Strike Against the Right (Canada Collegians Take Action) . 8. Dotson, Dorothy. Tori Listening to Mullet Boy . 10. Stine, Alison. Tori Story (Secrets of a Toriphile: Good Girl Gets Plugged) . 11. Barret, Laura. Late Night Crush (Girl Crazy for Conan) . 15. Hankinson, Tom. Environmentally friendly, or Else (DURP tough on DU Junk) . 16. Bussan, David. Fantasy\u27s Island (Alums Find Paradise in Northern Cyprus) . 18. Burt, Kara. Innocents on Break (Students Exercise Alternatives in New York) . 21. Werne, Kirsten. Two Turntables and a Ten-Gallon Hat . 23. Million, Chris. Friendship a Modem Away, Sigh (AOL Alters Denison Social Scene) . 34

Patterns of dietary supplement use among college students

BACKGROUND & AIMS: Dietary supplements (DS) are popular in many countries but little data are available on their use by sub-populations such as college students. Since students share a variety of characteristics and similar lifestyles, their DS use may differ from the general population. This study assessed DS use, factors associated with DS use, and reasons for use among U.S. college students. METHODS: College students (N = 1248) at 5 U.S. universities were surveyed. Survey questions included descriptive demographics, types and frequency of DS used, reasons for use and money spent on supplements. Supplements were classified using standard criteria. Logistic regression analyses examined relationships between demographic and lifestyle factors and DS use. RESULTS: Sixty-six percent of college students surveyed used DS at least once a week, while 12% consumed 5 or more supplements a week. Forty-two percent used multivitamins/multiminerals, 18% vitamin C, 17% protein/amino acids and 13% calcium at least once a week. Factors associated with supplement use included dietary patterns, exercise, and tobacco use. Students used supplements to promote general health (73%), provide more energy (29%), increase muscle strength (20%), and enhance performance (19%). CONCLUSIONS: College students appear more likely to use DS than the general population and many use multiple types of supplements weekly. Habits established at a young age persist throughout life. Therefore, longitudinal research should be conducted to determine whether patterns of DS use established early in adulthood are maintained throughout life. Adequate scientific justification for widespread use of DS in healthy, young populations is lacking

Effectiveness of insecticide-treated bednets in malaria prevention in Haiti: a case-control study

Background Insecticide-treated bednets (ITNs) are eff ective in preventing malaria where vectors primarily bite indoors and late at night, but their eff ectiveness is uncertain where vectors bite outdoors and earlier in the evening. We studied the eff ectiveness of ITNs following a mass distribution in Haiti from May to September, 2012, where the Anopheles albimanus vector bites primarily outdoors and often when people are awake. Methods In this case-control study, we enrolled febrile patients presenting to outpatient departments at 17 health facilities throughout Haiti from Sept 4, 2012, to Feb 27, 2014, who were tested with malaria rapid diagnostic tests (RDTs), and administered questionnaires on ITN use and other risk factors. Cases were defi ned by positive RDT and controls were febrile patients from the same clinic with a negative RDT. Our primary analysis retrospectively matched cases and controls by age, sex, location, and date, and used conditional logistic regression on the matched sample. A sensitivity analysis used propensity scores to match patients on ITN use propensity and analyse malaria among ITN users and non-users. Additional ITN bioeffi cacy and entomological data were collected. Findings We enrolled 9317 patients, including 378 (4%) RDT-positive cases. 1202 (13%) patients reported ITN use. Post-hoc matching of cases and controls yielded 362 cases and 1201 matched controls, 19% (333) of whom reported consistent campaign net use. After using propensity scores to match on consistent campaign ITN use, 2298 patients, including 138 (7%) RDT-positive cases, were included: 1149 consistent campaign ITN users and 1149 non-consistent campaign ITN users. Both analyses revealed that ITNs did not signifi cantly protect against clinical malaria (odds ratio [OR]=0·95, 95% CI 0·68–1·32, p=0·745 for case-control analysis; OR=0·95, 95% CI 0·45–1·97, p=0·884 for propensity score analysis). ITN and entomological data indicated good ITN physical integrity and bioeffi cacy, and no permethrin resistance among local mosquitoes. Interpretation We found no evidence that mass ITN campaigns reduce clinical malaria in this observational study in Haiti; alternative malaria control strategies should be prioritised

Attrition, physical integrity and insecticidal activity of long-lasting insecticidal nets in sub-Saharan Africa and modelling of their impact on vectorial capacity

Long-lasting insecticidal nets (LLINs) are the primary malaria prevention and control intervention in many parts of sub-Saharan Africa. While LLINs are expected to last at least 3 years under normal use conditions, they can lose effectiveness because they fall out of use, are discarded, repurposed, physically damaged, or lose insecticidal activity. The contributions of these different interrelated factors to durability of nets and their protection against malaria have been unclear.; Starting in 2009, LLIN durability studies were conducted in seven countries in Africa over 5 years. WHO-recommended measures of attrition, LLIN use, insecticidal activity, and physical integrity were recorded for eight different net brands. These data were combined with analyses of experimental hut data on feeding inhibition and killing effects of LLINs on both susceptible and pyrethroid resistant malaria vectors to estimate the protection against malaria transmission-in terms of vectorial capacity (VC)-provided by each net cohort over time. Impact on VC was then compared in hypothetical scenarios where one durability outcome measure was set at the best possible level while keeping the others at the observed levels.; There was more variability in decay of protection over time by country than by net brand for three measures of durability (ratios of variance components 4.6, 4.4, and 1.8 times for LLIN survival, use, and integrity, respectively). In some countries, LLIN attrition was slow, but use declined rapidly. Non-use of LLINs generally had more effect on LLIN impact on VC than did attrition, hole formation, or insecticide loss.; There is much more variation in LLIN durability among countries than among net brands. Low levels of use may have a larger impact on effectiveness than does variation in attrition or LLIN degradation. The estimated entomological effects of chemical decay are relatively small, with physical decay probably more important as a driver of attrition and non-use than as a direct cause of loss of effect. Efforts to maximize LLIN impact in operational settings should focus on increasing LLIN usage, including through improvements in LLIN physical integrity. Further research is needed to understand household decisions related to LLIN use, including the influence of net durability and the presence of other nets in the household

Apophis planetary defense campaign

We describe results of a planetary defense exercise conducted during the close approach to Earth by the near-Earth asteroid (99942) Apophis during 2020 December–2021 March. The planetary defense community has been conducting observational campaigns since 2017 to test the operational readiness of the global planetary defense capabilities. These community-led global exercises were carried out with the support of NASA's Planetary Defense Coordination Office and the International Asteroid Warning Network. The Apophis campaign is the third in our series of planetary defense exercises. The goal of this campaign was to recover, track, and characterize Apophis as a potential impactor to exercise the planetary defense system including observations, hypothetical risk assessment and risk prediction, and hazard communication. Based on the campaign results, we present lessons learned about our ability to observe and model a potential impactor. Data products derived from astrometric observations were available for inclusion in our risk assessment model almost immediately, allowing real-time updates to the impact probability calculation and possible impact locations. An early NEOWISE diameter measurement provided a significant improvement in the uncertainty on the range of hypothetical impact outcomes. The availability of different characterization methods such as photometry, spectroscopy, and radar provided robustness to our ability to assess the potential impact risk

Water Resource Distribution: Neoliberal Versus a Social Provisioning Approach

The purpose of this research is to examine how privatization of water resources has created social inequalities and environmental degradation on an international scale by understanding the ways in which water has become a market commodity, and how water resources are managed within a private framework versus a public framework. Two frameworks will be compared: neoliberal policy and the social provisioning approach to managing water resources. It is argued that social provisioning ought to be the focus of policy formulation so as to diminish the degree in which social inequalities and environmental degradation are generated by privatization. As a result, the thesis insists upon policy changes that would enact stricter regulation of natural resources in order to obtain greater levels of ecological sustainability and a more equitable distribution of water resources. These changes are based on changes of economic analysis and policy formulation, and provide the basis of ecological democracy

A Workflow Algorithm That Increases the Initiation of Continuous Glucose Monitors in a Rural Clinic

POSTE

Continuous Glucose Monitoring: Facilitating the Initiation and Use for Patients with Type2 Diabetes Mellitus in a Rural Primary Clinic

Background: Type 2 diabetes mellitus continues to be one of the most significant health problems worldwide. It can lead to several health complications, such as amputations, vision loss, neuropathy, kidney disease, and cardiovascular disease. These complications can be delayed or even avoided by maintaining glycemic stability through effective self- and medical management. Continuous glucose monitors (CGM) help both patients and providers manage glycemic trends and maintain stability, which can decrease the risk for complications and improve patient outcomes. By increasing rural health care providers' awareness of the processes required for successful CGM initiation, more patients will experience long-term benefits and a reduction in devastating complications. Methods: A quality improvement project was implemented to increase rural providers' awareness of the processes required for successful CGM initiation for patients with type 2 diabetes mellitus and insulin dependence. A workflow algorithm was developed and used to accomplish this task in one small, rural Utah clinic. An educational presentation of the workflow algorithm was first introduced to clinic staff, which consisted of office personnel, a physician, and a diabetes educator, before implementation. Pre-project data of CGM initiation were collected and compared to post-project CGM initiation data. Usability, feasibility, and satisfaction were analyzed in a post-survey provided to both clinic staff and qualified patients who participated. Results: Post-intervention, the project analysis found there was an 89.6% increase (17.4% vs 33%) in CGM initiation with the use of the workflow algorithm. Clinic staff reported 100% (n=5) in the ease of use and satisfaction with the algorithm, and 80% (n=4) reported plans for continued use. An unexpected benefit from the use of the algorithm was found when the clinic staff learned that the initiation of CGM and the interpretation of CGM data could be billed, which is something they had not done previously. Patients reported overall satisfaction (n=22, 88%) with the personal care provided, continuity of care, and their improved self-management of diabetes. Three patients reported "dissatisfied" or "very dissatisfied" (n=3, 12%) in improved self-management and overall satisfaction. Conclusions: The CGM workflow algorithm appears to be a valuable resource to help facilitate CGM initiation in a small, rural Utah clinic. Replication of this quality improvement project is needed to determine if the use of this workflow algorithm in other rural clinics would be beneficial and reflect similar results