Patient-, Provider- and System-Level Factors Impacting Contraceptive Access and Use

Contraception plays vital roles in promoting women’s health, quality of life and reproductive autonomy. The research described in this dissertation aimed to identify and evaluate factors at the patient, provider, and system levels that contribute to individuals’ abilities to access and use contraceptive methods in concordance with their goals and preferences. We assessed contraceptive preference matching and evaluated system-level policies and provider practices that directly impact access to specific methods, with a particular focus on the medically vulnerable population of women Veterans who use the Veterans Affairs (VA) healthcare system. First, we used a novel measure to investigate the extent to which women Veterans are currently using the contraceptive methods they consider to be “ideal,” and identified characteristics associated with ideal-current method match. Only 58% were currently using their stated ideal method, and match was reduced among non-white women and women with mental health disorders, suggestive of established health care disparities. However, qualitative analysis revealed that the bulk of reasons for ideal method non-use were personal and contextual, rather than resulting from access barriers. Our results underscore the complexity of contraceptive method selection and highlight enduring methodologic challenges of measuring contraceptive preferences. Next, we used decision analysis to estimate financial and reproductive health impacts to the VA healthcare system of a policy change to allow for twelve-month dispensing of oral contraceptive pills. We found that extended dispensing would better enable women Veterans to prevent unintended pregnancies, while also being economically feasible and sustainable for VA. These findings may help to inform evidence-based policy in VA. Finally, we conducted a cross-sectional survey study to evaluate provider-level adherence to best practice guidelines for provision of long-acting reversible contraception (LARC, i.e. intrauterine devices and contraceptive implants) in a single large healthcare system in Western Pennsylvania. We found substantial room for improvement in adherence to best practices, particularly same-day provision of these methods, and identified provider-reported barriers to best practice implementation, which were primarily logistical rather than stemming from knowledge deficits. These results may be used to inform efforts to expand access to LARC methods across this healthcare system

Instructional Methods that Foster the Reading Development of Students with Significant Intellectual Disabilities

Educational legislation has made reading a priority for students with significant intellectual disabilities (ID) and associated speech, language, sensory, or physical impairments. Historically, reading instruction for students with significant ID has focused on sight word instruction, with limited exposure to other essential reading skills. This article focuses on the evidence-based instructional methods that effectively and efficiently foster the reading development of students with significant ID. The authors reviewed the literature from the past 20 years on reading interventions for students with significant ID. In spite of access and opportunity barriers that have inhibited the reading development of students with significant ID, a synthesis of the empirical research on reading instruction suggests that students with significant ID and associated disabilities can learn phonemic awareness, phonics, vocabulary, fluency, and comprehension skills with direct instruction. Implications for providing reading instruction that effectively promotes reading development are discussed and areas for future research are identified

Pharmacologically blocking p53-dependent apoptosis protects intestinal stem cells and mice from radiation.

Exposure to high levels of ionizing radiation (IR) leads to debilitating and dose-limiting gastrointestinal (GI) toxicity. Using three-dimensional mouse crypt culture, we demonstrated that p53 target PUMA mediates radiation-induced apoptosis via a cell-intrinsic mechanism, and identified the GSK-3 inhibitor CHIR99021 as a potent radioprotector. CHIR99021 treatment improved Lgr5+ cell survival and crypt regeneration after radiation in culture and mice. CHIR99021 treatment specifically blocked apoptosis and PUMA induction and K120 acetylation of p53 mediated by acetyl-transferase Tip60, while it had no effect on p53 stabilization, phosphorylation or p21 induction. CHIR99021 also protected human intestinal cultures from radiation by PUMA but not p21 suppression. These results demonstrate that p53 posttranslational modifications play a key role in the pathological and apoptotic response of the intestinal stem cells to radiation and can be targeted pharmacologically

Designing a course model for distance-based online bioinformatics training in Africa: the H3ABioNet experience

Africa is not unique in its need for basic bioinformatics training for individuals from a diverse range of academic backgrounds. However, particular logistical challenges in Africa, most notably access to bioinformatics expertise and internet stability, must be addressed in order to meet this need on the continent. H3ABioNet (www.h3abionet.org), the Pan African Bioinformatics Network for H3Africa, has therefore developed an innovative, free-of-charge "Introduction to Bioinformatics" course, taking these challenges into account as part of its educational efforts to provide on-site training and develop local expertise inside its network. A multiple-delivery±mode learning model was selected for this 3-month course in order to increase access to (mostly) African, expert bioinformatics trainers. The content of the course was developed to include a range of fundamental bioinformatics topics at the introductory level. For the first iteration of the course (2016), classrooms with a total of 364 enrolled participants were hosted at 20 institutions across 10 African countries. To ensure that classroom success did not depend on stable internet, trainers pre-recorded their lectures, and classrooms downloaded and watched these locally during biweekly contact sessions. The trainers were available via video conferencing to take questions during contact sessions, as well as via online "question and discussion" forums outside of contact session time. This learning model, developed for a resource-limited setting, could easily be adapted to other settings.IS