Understanding social determinants of healthcare access from the perspective of Hispanic Latino immigrants in Louisville, Ky.

In the last decade, the total foreign-born population in the U.S. has grown exponentially, with the Hispanic Latino immigrants (HLI) experiencing the greatest growth. The literature clearly identifies that HLI experience significant health disparities as a result of the negative impact of influential social determinants of health, such as access to healthcare services. Barriers to healthcare access among HLI are related to the access dimensions of accessibility, availability, affordability, and acceptability. Despite research on the barriers to healthcare for this population, issues of access from the perspective of immigrant community members are poorly understood. There is an increased need to understand barriers and facilitators to healthcare access as perceived by HLI themselves to develop culturally appropriate strategies aimed at eliminating healthcare access inequities and health disparities. The purpose of this dissertation was to critically explore the perceived barriers and facilitators to primary healthcare access among HLI residing in highly concentrated communities of the southern metropolitan city of Louisville, KY. Critical ethnographic methods and postcolonial theory were used to investigate access to healthcare in this community within historical, sociocultural, economic and political contexts. Twenty participants were interviewed for this study using a semi-structured interview guide and descriptive survey form. Participant observations, document reviews and geospatial analysis assisted in providing in-depth understanding of findings within various contexts. Research findings revealed that significant barriers and facilitators to healthcare access were closely related to historical, sociocultural, political and economic contexts that shaped HLI health experiences in Louisville. These social determinants of healthcare access were influenced by the underlying social structures of race, ethnicity, power and oppression embedded in the colonial histories of the Americas. Additionally, findings indicated that although providers and HLI recipients shared similar perspectives on healthcare access, discrepancies between the provision and utilization of healthcare services were perpetuated by the social determinants of healthcare access. Findings from this study provide several implications and recommendations for healthcare systems, community programs, nursing, policy reform and future programs of research focused on enhanced culturally appropriate interventions and programs addressing the perceived needs of HLI in the Louisville community

The Effects of a Closed-Chain, Eccentric Training Program on Hamstring Injuries of a Professional Football Cheerleading Team

Objective Hamstring injuries are a common occurrence among professional football cheerleaders. The purpose of this study is to identify the effects of an eccentric, closed-chain hamstring exercise intervention on hamstring injury–associated pain during the course of the football season among professional football cheerleaders. Methods Forty-three female cheerleaders participated in an eccentric, closed-chain hamstring exercise intervention protocol provided by doctors of chiropractic that incorporated loops of elastic-band or Thera-Band Loops (Hygenic Corporation, Akron, OH) during practice and at home during the regular football season. Hamstring injury–related pain was assessed in June, during team selection; in September, at the start of the season; and in December, at the end of season. No intervention was applied between June and September, although the sample participated in 4 hours of practice 2 to 3 times per week. The intervention was applied to the entire sample regardless of hamstring injury–related pain during the regular football season between September and December. The interventions included 2 exercises and were completed bilaterally 2 times per week at each biweekly practice and were encouraged to be done at least 3 additional times per week at home on nonpractice days. Results Among the subsample who reported hamstring-related injury pain between June and September, the exercise intervention significantly decreased (P \u3c .007) pain between September (6.07 ± 0.58) and December (3.67 ± 0.65). Conclusions The eccentric, closed-chain hamstring exercise intervention reduced hamstring injury–related pain among this group of professional football cheerleaders

The Corrected Log N-Log Fluence Distribution of Cosmological Gamma-Ray Bursts

Recent analysis of relativistically expanding shells of cosmological gamma-ray bursts has shown that if the bursts are cosmological, then most likely total energy (E_0) is standard and not peak luminosity (L_0). Assuming a flat Friedmann cosmology (q_o = 1/2, Lambda = 0) and constant rate density (rho_0) of bursting sources, we fit a standard candle energy to a uniformly selected log N-log S in the BATSE 3B catalog correcting for fluence efficiency and averaging over 48 observed spectral shapes. We find the data consistent with E_0 = 7.3^{+0.7}_{-1.0} X 10^{51} ergs and discuss implications of this energy for cosmological models of gamma-ray bursts.Comment: A five page LateX file that uses the Revtex conference proceedings macro aipbook.sty, and includes three postscript figures using psfig. To Be published in the Proceedings of the Third Hunstville Symposium on Gamma-Ray Bursts, eds. C. Kouveliotou, M.S. Briggs and G.J. Fishman (New York:AIP). Postscript version availible at http://nis-www.lanl.gov/~jsbloom/LOG_S.p

Higher-order Continuum Approximation for Rarefied Gases

The Hilbert-Chapman-Enskog expansion of the kinetic equations in mean flight times is believed to be asymptotic rather than convergent. It is therefore inadvisable to use lower order results to simplify the current approximation as is done in the traditional Chapman-Enskog procedure, since that is an iterative method. By avoiding such recycling of lower order results, one obtains macroscopic equations that are asymptotically equivalent to the ones found in the Chapman-Enskog approach. The new equations contain higher order terms that are discarded in the Chapman-Enskog method. These make a significant impact on the results for such problems as ultrasound propagation. In this paper, it is shown that these results turn out well with relatively little complication when the expansions are carried to second order in the mean free time, for the example of the relaxation or BGK model of kinetic theory.Comment: 20 pages, 2 figures, RevTeX 4 macro

Sleep Characteristics in Patients with Whiplash-Associated Disorders: A Descriptive Study

Study Objectives: The purpose of this study was to explore sleep habits and characteristics of patients with whiplash-associated disorders (WAD) presenting at an outpatient, chiropractic clinic using the Medical Outcomes Study (MOS) Sleep Scale. Methods: Fifty-one patients from an outpatient chiropractic and physical therapy clinic specializing in spinal rehabilitation participated in this cross-sectional, descriptive study. Data were collected using a descriptive survey, the Visual Analog Scale (VAS), the Neck Disability Index (NDI), and the self-administered 12-item MOS Sleep Scale. Data analysis included descriptive statistics to describe pain, disability, and sleep characteristics of the study sample, and computation of confidence intervals to determine differences in means of sleep characteristics between the non-WAD population (as determined by previous studies) and the study sample of WAD patients. Results: Results indicate that when compared to normative values of the non-WAD population, the sample of WAD patients in this study presents with significantly greater measures of neck disability (NDI), neck pain (VAS), sleep disturbance, snoring, shortness of breath and headache, sleep somnolence and sleep problems index I and II. This sample also presents with significantly lower measures of optimal sleep when compared to the general population. Conclusion: Consistent with previous research, findings from this study indicate that WAD patients have increased neck disability and pain, and poorer sleep outcomes, indicating the need for clinicians to assess sleep characteristics and incorporate interventions aimed at alleviating these symptoms when planning rehabilitation. Findings provide evidence for the need to further explore sleep disturbances among WAD patients to establish a stronger understanding of the course and prognosis of this condition

The Yearly Cycle of the Mistassini Indians

Describes the seasonal activities and movements of Indians around Lake Mistassini, Quebec (51 N, 73 30 W), on the basis of 13 months' field work in 1953-54. Their fur-trapping, hunting and fishing economy and the climatic conditions necessitate periodic changes in occupation and habitation. Eight such periods are distinguished: summer, fall travel, fall hunt, winter camp construction, early winter trapping, late winter hunt, spring trapping, and spring travel. These periods, implicit (though not explicit) in Mistassini discussion of their activities, conform only in part to the six climatic seasons recognized by the Indians

Fit Into College: A Program to Improve Physical Activity and Dietary Intake Lifestyles Among College Students

The purpose of this study was to determine whether a 10-week program could improve physical activity, physical fitness, body weight, dietary intake, and perceptions of exercise and diet among college 30 healthy college freshmen. Outcomes were measured at baseline, and following the 10-week program. The weekly sessions incorporated constructs of the Transtheoretical Model of Health Behavior Change and were administered by fitness interns who were junior or senior college students enrolled in health-related majors. The participants presented with low physical activity, physical fitness, and poor dietary intake, and 50% were overweight/obese (BMI \u3e 25). Participants demonstrated gains in their physical fitness and their perceived benefits to engaging in exercise and decreased their perceived barriers to engaging in exercise and a healthy diet. College freshmen presented with low levels of physical activity, poor dietary intake, and excess body weight. A peer-administered program can improve these measures and favorably change perceptions of exercise and diet

Palliative care and Parkinson's disease : meeting summary and recommendations for clinical research

Introduction: Palliative care is an approach to caring for patients and families affected by serious illnesses that focuses on the relief of suffering through the management of medical symptoms, psychosocial issues, advance care planning and spiritual wellbeing. Over the past decade there has been an emerging clinical and research interest in the application of palliative care approaches to Parkinson’s disease (PD) and outpatient palliative care services are now offered by several movement disorders centers. Methods: An International Working Group Meeting on PD and Palliative Care supported by the Parkinson’s Disease Foundation was held in October 2015 to review the current state of the evidence and to make recommendations for clinical research and practice. Results: Topics included: 1) Defining palliative care for PD; 2) Lessons from palliative care for heart failure and other chronic illnesses; 3) Patient and caregiver Needs; 4) Needs assessment tools; 5) Intervention strategies; 6) Predicting prognosis and hospice referrals; 7) Choice of appropriate outcome measures; 8) Implementation, dissemination and education research; and 9) Need for research collaborations. We provide an overview of these discussions, summarize current evidence and practices, highlight gaps in our knowledge and make recommendations for future research. Conclusions: Palliative Care for PD is a rapidly growing area which holds great promise for improving outcomes for PD patients and their caregivers. While clinical research in this area can build from lessons learned in other diseases, there is a need for observational, methodological and interventional research to address the unique needs of PD patients and caregivers

Life expectancy of persons receiving combination antiretroviral therapy in low-income countries: a cohort analysis from Uganda

Little is known about the effect of combination antiretroviral therapy (cART) on life expectancy in sub-Saharan Africa

Reflections on Interdisciplinary Teamwork in Service-Learning

This article examines partnership experiences in a community-based research project that involved an interdisciplinary team composed of nursing and social work clinical faculty and graduate students. Using Bronfenbrenner’s social ecology theory, the project assessed individual and community levels of health and quality of life in a low-income housing community. Students were involved in research activities that required community collaboration and needs assessment. They also actively engaged community members in problem solving related to their health concerns. The effects of these experiences on student learning were examined using a student reflection technique. Service-learning activities led to mutual positive regard, increased cultural sensitivity, improved organizational and research skills, growth in ethical decision making, and valuing interdisciplinary teamwork. These findings are discussed in light of the literature on the social determinants of health. Reflection on work in an interdisciplinary team and the importance of mutuality in relationships with community members were determined to be important considerations in service-learning. Student learning in this setting has implications for graduate teaching and learning, and the conduct of research. Keywords: service-learning, research, health disparities, community, reflection, graduate studen