Feasibility Pilot Outcomes of a Mammography Decision Support and Navigation Intervention for Women With Serious Mental Illness Living in Supportive Housing Settings.

Objective: People with serious mental illness (SMI) experience significant disparities in morbidity and mortality from preventable and treatable medical conditions. Women with SMI have low mammography screening rates. SMI, poverty, and poor access to care can have a significant effect on a woman’s opportunity to learn about and discuss breast cancer screening with health care providers. This study examines the feasibility pilot outcomes of mammography decision support and patient navigation intervention (DSNI) for women with SMI living in supportive housing settings. The primary research question was: Does the DSNI increase knowledge, promote favorable attitudes, and decrease decisional conflict relating to screening mammography? Methods: We developed the intervention with the community using participatory methods. Women (n = 21) with SMI who had not undergone screening mammography in the past year participated in an educational module and decision counseling session and received patient navigation over a 6-month period. We conducted surveys and interviews at baseline and follow-ups to assess mammography decisional conflict. Results: Among study participants, 67% received a mammogram. The mammogram DSNI was feasible and acceptable to women with SMI living in supportive housing settings. From baseline to 1-month follow-up, decisional conflict decreased significantly (P= .01). The patient navigation process resulted in 270 attempted contacts (M= 12.86, SD = 10.61) by study staff (phone calls and emails with patient and/or case manager) and 165 navigation conversations (M= 7.86, SD = 4.84). A barrier to navigation was phone communication, with in-person navigation being more successful. Participants reported they found the intervention helpful and made suggestions for further improvement. Conclusions: The process and outcomes evaluation support the feasibility and acceptability of the mammography DSNI. This project provides initial evidence that an intervention developed with participatory methods can improve cancer screening outcomes in supportive housing programs for people with SMI

Determinants of Successful Weight Loss in Low-Income African American Women: A Positive Deviance Analysis.

OBJECTIVE: We set out to investigate the behaviors of low-income African American women who successfully lost weight. METHODS: From an urban, academic, family medicine practice, we used a mixed methods positive deviance approach to evaluate 35 low-income African American women who were obese and lost at least 10% of their maximum weight, and maintained this loss for 6 months, comparing them with 36 demographically similar control participants who had not lost weight. Survey outcomes included demographics and behaviors that were hypothesized to be related to successful weight loss. Interviews focused on motivations, barriers, and what made weight loss successful. Survey data were analyzed using t tests and linear regression for continuous outcomes and chi-square tests and logistic regression for categorical outcomes. Interviews were analyzed using a modified approach to grounded theory. RESULTS: In adjusted analyses, women in the positive deviant group were more likely to be making diet changes compared with those women who did not lose at least 10% of their initial body weight. Major themes from qualitative analyses included ( a) motivations (of health, appearance, quality of life, family, and epiphanies), ( b) opportunity (including time and support), ( c) adaptability. CONCLUSIONS: The findings of this study may be useful in developing motivational interviewing strategies for primary care providers working with similar high-risk populations

Overcoming Obesity: A Mixed Methods Study of the Impact of Primary Care Physician Counseling on Low-Income African American Women Who Successfully Lost Weight.

Purpose: Low-income, African American women are disproportionately impacted by obesity. Little is known about the interactions between low-income, African American women who successfully lost weight and their primary care physicians (PCPs). Design: Mixed methods, positive deviance study. Setting: Urban university-based family medicine practice. Participants: The positive deviance group comprised low-income, African American women who were obese, lost 10% body weight, and maintained this loss for 6 months. Measures: The PCP- and patient-reported weight-related variables collected through the electronic medical record (EMR), surveys, and interviews. Analysis: Logistic regression of quantitative variables. Qualitative analysis using modified grounded theory. Results: The EMR documentation by PCPs of dietary counseling and a weight-related medical problem were significant predictors of positive deviant group membership. Qualitative analyses of interviews revealed 5 major themes: framing obesity in the context of other health problems provided motivation; having a full discussion around weight management was important; an ongoing relationship with the physician was valuable; celebrating small successes was beneficial; and advice was helpful but self-motivation was necessary. Conclusion: The PCP counseling may be an important factor in promoting weight loss in low-income, African American women. Patients may benefit from their PCPs drawing connections between obesity and weight-related medical conditions and enhancing intrinsic motivation for weight loss

The balance of trade in alien species between South Africa and the rest of Africa

BACKGROUND : Alien organisms are not only introduced from one biogeographical region to another but also spread within regions. As South Africa shares land borders with six countries, multiple opportunities exist for the transfer of alien species between South Africa and other African countries; however, the direction and importance of intra-regional spread is unclear. OBJECTIVES : The aim of this study was to gain a greater understanding of the introduction of alien species into Africa and the spread of species between South Africa and other African countries. METHOD : We developed scenarios that describe the routes by which alien species are introduced to and spread within Africa and present case studies for each. Using data from literature sources and databases, the relative importance of each scenario for alien birds and insect pests of eucalypts was determined, and the direction and importance of intra-regional spread was assessed. RESULTS : Alien species from many taxonomic groups have, through various routes, been introduced to and spread within Africa. For birds and eucalypt insect pests, the number of species spreading in the region has recently increased, with South Africa being a major recipient of birds (14 species received and 5 donated) and a major donor of eucalypt insect pests (1 species received and 10 donated). For both groups, many introduced species have not yet spread in the region. CONCLUSION : The intra-regional spread of alien species in Africa represents an important and possibly increasing threat to biosecurity. To address this threat, we propose a framework that details how African countries could cooperate and develop a coordinated response to alien species introductions.This paper was initially delivered at the 43rd Annual Research Symposium on the Management of Biological Invasions in South Africa, Goudini Spa, Western Cape, South Africa on 18-20 May 2016.The South African National Department of Environment Affairs through its funding of the South African National Biodiversity Institute’s Invasive Species Programme, the DST-NRF Centre for Invasion Biology, the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation of South Africa.http://abcjournal.org/index.php/ABCam2018Forestry and Agricultural Biotechnology Institute (FABI)Zoology and Entomolog

Identifying ADP-Ribosylation as the Biochemical Signal that Marks DNA-Protein Crosslinks for SPRTN-Dependent Proteolysis

DNA-protein crosslinks (DPCs) form when proteins covalently attach to DNA. It is estimated that hundreds of DPCs form in our cells each day. Because these lesions are cytotoxic, mammalian cells have evolved multiple intricate repair systems to remove DPCs and restore genome integrity. One mechanism mammalian cells rely on for DPC repair is direct proteolysis by the metalloprotease, SPRTN. While it is known that SPRTN degrades a heterogenous array of DPCs, including both naturally occurring and chemically induced, how SPRTN selects DPCs amongst chromatin-associated proteins remains unknown. Our main objective is to determine how DPC repair is regulated. In Chapter 2, we describe our findings that poly (ADP-ribose) polymerase 1 (PARP1) plays a critical role in DPC repair by regulating SPRTN activity towards DPCs. We identified a previously unrecognized Nudix homology domain (NHD) in SPRTN that functions as a direct poly- ADP-ribose interacting region. Interaction with poly-ADP-ribose is required for SPRTNdependent DPC repair. To further demonstrate PARP1 as a key regulator of DPC repair, we found that Topoisomerase 1 covalent complexes (Top1cc) accumulate in cells with compromised PARP1 activity and in cells harboring a SPRTN NHD mutant allele. Likewise, Caenorhabditis elegans expressing the SPRTN NHD mutant as their sole SPRTN source phenocopy SPRTN null nematodes in that they are sensitive to DNA-protein crosslinking agents. Our data implicates PARP1 as an immediate sensor for DPCs and shows that ADP-ribosylation is the biochemical signal that marks DPCs for SPRTNdependent proteolysis. In Chapter 3, we describe methodology we established to quantify DPC repair in C. elegans. Previously, there were no assays adapted for direct analysis of DPC repair in C. elegans. We modified the RADAR assay (rapid approach to DNA adduct recovery) and potassium chloride (KCl)/sodium dodecyl sulfate (SDS) protein precipitation methodology to detect DPCs from C. elegans extracts. These methods are beneficial tools that extend our ability to analyze DPC repair in a new system, C. elegans. Lastly, we conclude with future directions in Chapter 4. DPCs are not only marked with poly-ADP-ribose (PAR); they can also be SUMOylated and/or ubiquitinated to signal for proteasome-mediated degradation. We next aim to understand how the cell coordinates multiple DPC repair pathways and how it decides which DPC repair pathway to employ. We will investigate if PARP1-mediated ADP-ribosylation regulates DPC SUMOylation and ubiquitination. These findings will make strides toward grasping the molecular mechanisms of DPC repair

Program Evaluation of a Youth-Led Workforce Development Community Garden Program: Teens4Good

Teens4Good (T4G) is a youth-led entrepreneurial program that converts vacant city lots into community gardens in Philadelphia. T4G aims to build work-readiness and life skills among high school-age teens through hands-on farming and business training. A program evaluation was conducted to (1) determine the impact of T4G on teen participants specific to nutrition knowledge and healthy eating behaviors, and the development of work-readiness and life skills; (2) explore how participation in T4G impacts participants’ families and the community; and (3) determine participant and staff perceptions of program strengths and weaknesses and explore suggestions for program improvement. Six semi-structured interviews with T4G staff and 2 focus groups with youth participants of the 6-week T4G summer internship (n=10) were conducted in the summer of 2013. Interviews and focus groups were audio recorded and transcribed, and coded to reveal themes. Results demonstrate that teens learn professional development skills, workforce development skills, and life skills through participation in T4G. Results also show that T4G helps youth build confidence, and teaches teens about new and different kinds of fruits and vegetables. Findings suggest that the program may influence nutrition habits in participants’ families, and that the program positively impacts the community; however challenges with community engagement were reported. Suggestions for program improvement included making the program year long, hiring more staff and teens, and making the program more youth run. Interview and focus group results suggest that program impact is greatest on teens that have participated in the program for a number of years. Overall results indicate that T4G is contributing to positive youth development in program participants, and that future research describing program impact on teens’ families and the community is needed. Staff and youth descriptions of program strengths and weaknesses and suggestions for program improvement could help inform future program planning. Presentation: 25 minute

Teens 4 Good: Positive Youth Development Through Urban Community Gardening

Background and Rationale Teens that grow up in poor, blighted neighborhoods are at risk for a variety of negative outcomes, including poor health.1 In Philadelphia and many other urban communities, disparities in race, income, and education impact access to and consumption of fresh, healthy foods.2 Youth development programs (YDP) have grown as a viable solution to ameliorate negative outcomes among at-risk youth.3 Community gardens have been introduced in many urban environments to address issues of food insecurity.4 Teens 4 Good (T4G) is a youth-led entrepreneurial program that converts vacant city lots into community gardens. T4G was founded in 2005 by the Federation of Neighborhood Centers. The program targets urban at-risk youth attending Philadelphia public high schools. T4G Summer Internship: Teens are paid to plant, harvest, and sell produce to local communities. Teens are also involved in designing marketing materials, managing finances, and other business operations. Program Goals: Improve leadership skills, self-efficacy, and work readiness skills in youth, empowering them to become healthy young adults, and leaders who give back to their community. Ameliorate income and place barriers to accessing healthy affordable food by converting vacant city lots into community gardens. In 2013, 40 teens participated in the 6-week T4G summer internship program (June – August). During this time the study authors conducted a supplemental program evaluation to describe how and to what extent T4G is contributing to Positive Youth Development (PYD), and how and to what extent T4G is impacting teens’ families and the community

Determinants of Successful Weight Loss in Low-Income African American Women: A Positive Deviance Analysis.

OBJECTIVE: We set out to investigate the behaviors of low-income African American women who successfully lost weight. METHODS: From an urban, academic, family medicine practice, we used a mixed methods positive deviance approach to evaluate 35 low-income African American women who were obese and lost at least 10% of their maximum weight, and maintained this loss for 6 months, comparing them with 36 demographically similar control participants who had not lost weight. Survey outcomes included demographics and behaviors that were hypothesized to be related to successful weight loss. Interviews focused on motivations, barriers, and what made weight loss successful. Survey data were analyzed using t tests and linear regression for continuous outcomes and chi-square tests and logistic regression for categorical outcomes. Interviews were analyzed using a modified approach to grounded theory. RESULTS: In adjusted analyses, women in the positive deviant group were more likely to be making diet changes compared with those women who did not lose at least 10% of their initial body weight. Major themes from qualitative analyses included ( a) motivations (of health, appearance, quality of life, family, and epiphanies), ( b) opportunity (including time and support), ( c) adaptability. CONCLUSIONS: The findings of this study may be useful in developing motivational interviewing strategies for primary care providers working with similar high-risk populations