The Appropriateness of Spy Fiction for the Pre-Adolescent and Adolescent Aged Nine to Fifteen

This study examines the portrayal of spies and espionage in literature written for children and young adults aged nine to fifteen. Specifically, it looks at the traits and qualities of the spies as they appear in the spy fiction genre that makes the genre appropriate for the pre-adolescent and adolescent reader. This study looks at twelve books chosen from the spy genre. Content analysis methodology was used to study the works and find common themes within spy fiction that are appropriate for readers aged nine to fifteen. The method chosen to study these books is content analysis and information was grouped into main themes that emerged. The themes within spy fiction that emerged were ethics and values, the portrayal of espionage, the relationship with authority, peer relationships, problem solving skills, their knowledge, skills and training, and the use of technology

Economic Stress and the Safety Net: A Health Center Update

Federally funded health centers provided care to 11.3 million patients in 2002, the vast majority of whom were either uninsured (39%) or covered by Medicaid (34%). This paper provides new information on the demographic profile of health center patients and the revenue sources available for financing their care, including recent increases in federal discretionary funding. It examines the impact of the recent economic downturn on health centers in selected communities, exploring the effect of elevated unemployment levels among lower wage workers, declining private health insurance coverage, and widespread state cutbacks in Medicaid – the single most important source of health center financing

CASE 6: A Rapid Risk Assessment Tool: Determining the Risk of New/Emerging/Re-Emerging Infectious Diseases in Canada

The protagonist, Dr. Anna Moreno, is an epidemiologist at the Public Health Agency of Canada (PHAC), where she manages the Public Health Risk Sciences Department. Her role includes managing monthly meetings and advising when it is necessary to use the Rapid Risk Assessment (RRA) tool to conduct an analysis of any emerging infectious disease relevant to Canada. The case presents a fictitious situation in which a series of outbreaks of an influenzalike infectious disease have occurred in certain regions of the Americas. In response to outbreaks of severe respiratory and influenza-like symptoms within the Americas and the more than 100 associated deaths over the past month, the World Health Organization has declared the unknown infectious disease a Public Health Emergency of International Concern (PHEIC). Anna has a meeting that morning, and she will need to prepare an approach to create a working group responsible for conducting an RRA for this unknown disease. Challenges arise because the existing scientific evidence and literature about the disease is limited and Anna will need to defer to the expert knowledge of her team while minimizing expert opinion bias. Given the general standards of RRAs, the assessment should be conducted within the next 24 to 48 hours. Knowing that the outcomes of the risk assessment will set the landscape for the PHAC’s response to the PHEIC, Anna and her team will need to ensure the assessment is conducted in a timely and efficient manner. The results of the RRA will be presented to upper management before being disseminated to the general public. Finally, the case includes a case study, based on true events, of the initial application of the tool to the 2015 Zika virus disease outbreak. Although the initial assessment led to the conclusion that Canadians were at minimal risk, unexpected subsequent Zika outbreaks in 2016 revealed the need to refine and adapt the RRA tool. This case study emphasizes the importance of completing a risk assessment at multiple time points throughout the course of a disease to capture the complexities of evolving information and circumstances. The pedagogical value of presenting this case is rooted in presenting a real-world situation and exposing students to the complexities of translating foundational public health practices to social contexts that do not allow for typical solutions. Although it is necessary to learn concrete knowledge in a classroom environment, this information serves as a foundation to build on through experience within the public health field. Being immersed in real-world situations is imperative for enabling students to visualize how this knowledge may not translate perfectly during a public health event. This case will complement the focus on emergency preparedness and monitoring and managerial control mechanisms emphasized in the course MPH 9010- Managing Health Services. This level of public health response provides direction and recommendations for all sectors in the face of urgent events, such as infectious disease outbreaks

Diversion as a Work-Oriented Welfare Reform Strategy and its Effect on Access to Medicaid: An Examination of the Experiences of Five Local Communities

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) ended the individual entitlement to welfare benefits and gave states new flexibility to emphasize work instead welfare. PRWORA also severed the traditional eligibility link between Medicaid and welfare. This research examined the emergence of diversion programs as a particular aspect of state welfare reform efforts and the potential for diversion programs to reduce access to Medicaid. In this second of two reports, we present the results of case studies in five states

Health Centers\u27 Role as Safety Net Providers for Medicaid Patients and the Uninsured

In order to understand the role of health centers as safety net providers, as well as the potential impact of these trends, this issue paper provides an in-depth examination of federally-funded health centers. Using data from the Uniform Data System (UDS), a government-maintained system that collects extensive patient, revenue, and service data on a calendar-year basis from health centers that receive federal grants, this issue paper profiles federally-funded health centers. It presents information on health center patients and revenue sources and analyzes similarities and differences both between health centers and private practices and among health centers. Health centers perform a unique role in the American health care system as nearly 85 percent of their patients are low-income and more than a third of their revenue comes from the Medicaid program, compared with less than 10 percent for most physician practices. The paper also reviews trends in health center patients and funding and concludes with an assessment of current challenges facing health centers

Building a Model of Collaboration Between Historically Black and Historically White Universities

Despite increases over the last two decades in the number of degrees awarded to students from underrepresented groups in science, technology, engineering, and mathematics (STEM) disciplines, enhancing diversity in these disciplines remains a challenge. This article describes a strategic approach to this challenge—the development of a collaborative partnership between two universities: the historically Black Elizabeth City State University and the historically White University of New Hampshire. The partnership, a type of learning organization built on three mutually agreed upon principles, strives to enhance opportunities for underrepresented students to pursue careers in the STEM disciplines. This article further describes six promising practices that framed the partnership, which resulted in the submission of nine proposals to federal agencies and the funding of four grants that led to the implementation, research, learning, and evaluation that followed

Quality Incentives for Federally Qualified Health Centers, Rural Health Clinics and Free Clinics: A Report to Congress

This report to Congress is submitted pursuant to Section 13113(b) of the American Recovery and Reinvestment Act of 2009 (hereafter, the Recovery Act), under Title XIII, also known as the Health Information Technology for Economic and Clinical Health Act or the HITECH Act. The Section requires the Secretary of Health and Human Services to provide a study that examines methods to create efficient reimbursement incentives for improving health care quality in federally qualified health centers, rural health clinics, and free clinics. The report discusses current initiatives and incentives that apply to these categories of primary care clinics and the current knowledge regarding quality of care and the use of health information technology in this sector. Insofar as the report was authorized under the HITECH Act, it particularly addresses issues related to the use of health information technology by these clinics

The Impact of Patient Navigation on the Delivery of Diagnostic Breast Cancer Care in the National Patient Navigation Research Program: A Prospective Meta-Analysis.

Patient navigation is emerging as a standard in breast cancer care delivery, yet multi-site data on the impact of navigation at reducing delays along the continuum of care are lacking. The purpose of this study was to determine the effect of navigation on reaching diagnostic resolution at specific time points after an abnormal breast cancer screening test among a national sample. A prospective meta-analysis estimated the adjusted odds of achieving timely diagnostic resolution at 60, 180, and 365 days. Exploratory analyses were conducted on the pooled sample to identify which groups had the most benefit from navigation. Clinics from six medical centers serving vulnerable populations participated in the Patient Navigation Research Program. Women with an abnormal breast cancer screening test between 2007 and 2009 were included and received the patient navigation intervention or usual care. Patient navigators worked with patients and their care providers to address patient-specific barriers to care to prevent delays in diagnosis. A total of 4675 participants included predominantly racial/ethnic minorities (74 %) with public insurance (40 %) or no insurance (31 %). At 60 days and 180 days, there was no statistically significant effect of navigation on achieving timely diagnostic care, but a benefit of navigation was seen at 365 days (aOR 2.12, CI 1.36-3.29). We found an equal benefit of navigation across all groups, regardless of race/ethnicity, language, insurance status, and type of screening abnormality. Patient navigation resulted in more timely diagnostic resolution at 365 days among a diverse group of minority, low-income women with breast cancer screening abnormalities. Trial registrations clinicaltrials.gov Identifiers: NCT00613275, NCT00496678, NCT00375024, NCT01569672

A Mouse Model of the Human Fragile X Syndrome I304N Mutation

The mental retardation, autistic features, and behavioral abnormalities characteristic of the Fragile X mental retardation syndrome result from the loss of function of the RNA–binding protein FMRP. The disease is usually caused by a triplet repeat expansion in the 5′UTR of the FMR1 gene. This leads to loss of function through transcriptional gene silencing, pointing to a key function for FMRP, but precluding genetic identification of critical activities within the protein. Moreover, antisense transcripts (FMR4, ASFMR1) in the same locus have been reported to be silenced by the repeat expansion. Missense mutations offer one means of confirming a central role for FMRP in the disease, but to date, only a single such patient has been described. This patient harbors an isoleucine to asparagine mutation (I304N) in the second FMRP KH-type RNA–binding domain, however, this single case report was complicated because the patient harbored a superimposed familial liver disease. To address these issues, we have generated a new Fragile X Syndrome mouse model in which the endogenous Fmr1 gene harbors the I304N mutation. These mice phenocopy the symptoms of Fragile X Syndrome in the existing Fmr1–null mouse, as assessed by testicular size, behavioral phenotyping, and electrophysiological assays of synaptic plasticity. I304N FMRP retains some functions, but has specifically lost RNA binding and polyribosome association; moreover, levels of the mutant protein are markedly reduced in the brain specifically at a time when synapses are forming postnatally. These data suggest that loss of FMRP function, particularly in KH2-mediated RNA binding and in synaptic plasticity, play critical roles in pathogenesis of the Fragile X Syndrome and establish a new model for studying the disorder