Light Element Synthesis in High Entropy Relativistic Flows Associated with Gamma Ray Bursts

We calculate and discuss the light element freeze-out nucleosynthesis in high entropy winds and fireballs for broad ranges of entropy-per-baryon, dynamic timescales characterizing relativistic expansion, and neutron-to-proton ratios. With conditions characteristic of Gamma Ray Bursts (GRBs) we find that deuterium production can be prodigious, with final abundance values 2H/H approximately 2%, depending on the fireball isospin, late time dynamics, and the effects of neutron decoupling- induced high energy non-thermal nuclear reactions. This implies that there potentially could be detectable local enhancements in the deuterium abundance associated with GRB events.Comment: 14 pages 3 figure

Medical-Legal Partnerships to Support Continuity of Care for Immigrants Impacted by HIV: Lessons Learned from California.

The United States (US) has experienced a surge of anti-immigrant policies and rhetoric, raising concerns about the influence on health outcomes for immigrants living in the US. We conducted qualitative interviews (n = 20) with health care and social service providers, attorneys, and legal/policy experts in California to understand how agencies were maintaining access to HIV care and prevention for immigrant clients. We conducted a thematic analysis to describe the role of medical-legal partnerships (MLPs) and document best practices. Informants reported high demand for legal services. Referrals were facilitated by case managers, medical providers, and pre-existing relationships between clinics and legal agencies. Informants identified a need for additional funding and further guidance on screening for and supporting patients with legal needs. MLPs have the capacity to create sustainable, efficient, comprehensive structural changes that minimize barriers to HIV prevention and treatment and improve health outcomes among immigrant populations

Reducing Blood Pressure through Education on Lifestyle Interventions

The purpose of this study was to develop an educational plan for patients with elevated blood pressure to increase their knowledge and self-efficacy of lifestyle interventions proven to help lower blood pressure rates.https://jagworks.southalabama.edu/scholarsday2023_spring-posters/1001/thumbnail.jp

Reducing Blood Pressure through Education on Lifestyle Interventions

This is the virtual presentation on a quality improvement study conducted in fulfillment of the Doctor of Nursing Practice degree requirements. The purpose of this study was to develop an educational plan for patients with elevated blood pressure to increase their knowledge and self-efficacy of lifestyle interventions proven to help lower blood pressure rates

Patients' Perceptions and Experiences of Shared Decision-Making in Primary HIV Care Clinics

Shared decision-making (SDM) is considered best practice in health care. Prior studies have explored attitudes and barriers/facilitators to SDM, with few specific to HIV care. We interviewed 53 patients in HIV primary care clinics in California to understand the factors and situations that may promote or hinder engagement in SDM. Studies in other populations have found that patients' knowledge about their diseases and their trust in providers facilitated SDM. We found these features to be more nuanced for HIV. Perceptions of personal agency, knowledge about one's disease, and trust in provider were factors that could work for or against SDM. Overall, we found that participants described few experiences of SDM, especially among those with no comorbidities. Opportunities for SDM in routine HIV care (e.g., determining antiretroviral therapy) may arise infrequently because of treatment advances. These findings yield considerations for adapting SDM to fit the context of HIV care

Modulus Computational Entropy

The so-called {\em leakage-chain rule} is a very important tool used in many security proofs. It gives an upper bound on the entropy loss of a random variable $X$ in case the adversary who having already learned some random variables $Z_{1},\ldots,Z_{\ell}$ correlated with $X$, obtains some further information $Z_{\ell+1}$ about $X$. Analogously to the information-theoretic case, one might expect that also for the \emph{computational} variants of entropy the loss depends only on the actual leakage, i.e. on $Z_{\ell+1}$. Surprisingly, Krenn et al.\ have shown recently that for the most commonly used definitions of computational entropy this holds only if the computational quality of the entropy deteriorates exponentially in $|(Z_{1},\ldots,Z_{\ell})|$. This means that the current standard definitions of computational entropy do not allow to fully capture leakage that occurred "in the past", which severely limits the applicability of this notion. As a remedy for this problem we propose a slightly stronger definition of the computational entropy, which we call the \emph{modulus computational entropy}, and use it as a technical tool that allows us to prove a desired chain rule that depends only on the actual leakage and not on its history. Moreover, we show that the modulus computational entropy unifies other,sometimes seemingly unrelated, notions already studied in the literature in the context of information leakage and chain rules. Our results indicate that the modulus entropy is, up to now, the weakest restriction that guarantees that the chain rule for the computational entropy works. As an example of application we demonstrate a few interesting cases where our restricted definition is fulfilled and the chain rule holds.Comment: Accepted at ICTS 201

Practice transformations to optimize the delivery of HIV primary care in community healthcare settings in the United States: A program implementation study.

BackgroundThe United States HIV care workforce is shrinking, which could complicate service delivery to people living with HIV (PLWH). In this study, we examined the impact of practice transformations, defined as efficiencies in structures and delivery of care, on demonstration project sites within the Workforce Capacity Building Initiative, a Health Resources and Services Administration (HRSA) Ryan White HIV/AIDS Program Special Projects of National Significance (SPNS).Methods and findingsData were collected at 14 demonstration project sites in 7 states and the District of Columbia. Organizational assessments were completed at sites once before and 4 times after implementation. They captured 3 transformation approaches: maximizing the HIV care workforce (efforts to increase the number of existing healthcare workforce members involved in the care of PLWH), share-the-care (team-based care giving more responsibility to midlevel providers and staff), and enhancing client engagement in primary HIV care to reduce emergency and inpatient care (e.g., care coordination). We also obtained Ryan White HIV/AIDS Program Services Reports (RSRs) from sites for calendar years (CYs) 2014-2016, corresponding to before, during, and after transformation. The RSR include data on client retention in HIV care, prescription of antiretroviral therapy (ART), and viral suppression. We used generalized estimating equation (GEE) models to analyze changes among sites implementing each practice transformation approach. The demonstration projects had a mean of 18.5 prescribing providers (SD = 23.5). They reported data on more than 13,500 clients per year (mean = 969/site, SD = 1,351). Demographic characteristics remained similar over time. In 2014, a majority of clients were male (71% versus 28% female and 0.2% transgender), with a mean age of 47 (interquartile range [IQR] 37-54). Racial/ethnic characteristics (48% African American, 31% Hispanic/Latino, 14% white) and HIV risk varied (31% men who have sex with men; 31% heterosexual men and women; 7% injection drug use). A substantial minority was on Medicaid (41%). Across sites, there was significant uptake in practices consistent with maximizing the HIV care workforce (18% increase, p < 0.001), share-the-care (25% increase, p < 0.001), and facilitating patient engagement in HIV primary care (13% increase, p < 0.001). There were also significant improvements over time in retention in HIV care (adjusted odds ratio [aOR] = 1.03; 95% confidence interval [CI] 1.02-1.04; p < 0.001), ART prescription levels (aOR = 1.01; 95% CI 1.00-1.01; p < 0.001), and viral suppression (aOR = 1.03; 95% CI 1.02-1.04; p < 0.001). All outcomes improved at sites that implemented transformations to maximize the HIV care workforce or improve client engagement. At sites that implemented share-the-care practices, only retention in care and viral suppression outcomes improved. Study limitations included use of demonstration project sites funded by the Ryan White HIV/AIDS Program (RWHAP), which tend to have better HIV outcomes than other US clinics; varying practice transformation designs; lack of a true control condition; and a potential Hawthorne effect because site teams were aware of the evaluation.ConclusionsIn this study, we found that practice transformations are a potential strategy for addressing anticipated workforce challenges among those providing care to PLWH. They hold the promise of optimizing the use of personnel and ensuring the delivery of care to all in need while potentially enhancing HIV care continuum outcomes

The Association Between Multiple Domains of Discriminations and Self-Assessed Health: A Multilevel Analysis of Latinos and Blacks in Four Low-Income New York City Neighborhoods

Objective. This study examines the association between discrimination due to race and other attributes (e.g., sex, age) and self-assessed mental and physical health among Latinos and blacks. Data Source. Latino and black adult participants (n5873) identified by randomdigit dialing were interviewed by telephone in four low-income neighborhoods in New York City: the South Bronx, East Harlem, Central Harlem, and Bedford-Stuyvesant. Study Design. In this cross-sectional study, generalized estimating equations were used to fit multilevelmultivariablemodels to test the association between discrimination and poor mental and physical health while controlling for socioeconomic status, access to health care, social support, smoking, and the racial and ethnic composition of each neighborhood. Principal Findings. Discrimination due to race and discrimination due to other attributes were associated with poor self-assessed mental but not physical health in separate multivariable models. Persons who experienced multiple domains of discrimination had a greater probability of reporting poor mental health than persons who experienced no discrimination. Conclusions. Discrimination due to race and other attributes was a significant correlate of mental health among Latinos and blacks independent of other accepted determinants of health.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40298/2/Stuber_The Association Between Multiple Domains_2003.pd

Preliminary Evidence of Health Care Provider Support for Naloxone Prescription as Overdose Fatality Prevention Strategy in New York City

Preliminary research suggests that naloxone (Narcan), a short-acting opiate antagonist, could be provided by prescription or distribution to heroin users to reduce the likelihood of fatality from overdose. We conducted a random postal survey of 1,100 prescription-authorized health care providers in New York City to determine willingness to prescribe naloxone to patients at risk of an opiate overdose. Among 363 nurse practitioners, physicians, and physician assistants responding, 33.4% would consider prescribing naloxone, and 29.4% were unsure. This preliminary study suggests that a substantial number of New York City health care providers would prescribe naloxone for opiate overdose prevention.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40255/2/Coffin_Preliminary Evidence of Health Care Provider_2003.pd

Gender differences in sexual behaviors, sexual partnerships, and HIV among drug users in New York City

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/48789/1/absalon_gender differences in sexual behaviors_2006.pd