A Review of Generalist and Specialist Community Health Workers for Delivering Adolescent Health Services in sub-Saharan Africa.

The health of adolescents is increasingly seen as an important international priority because the world's one point eight billion young people (aged 10 to 24 years) accounts for 15.5% of the global burden of disease and are disproportionately located in low- and middle-income countries (LMICs). Furthermore, an estimated 70% of premature adult deaths are attributable to unhealthy behaviors often initiated in adolescence (such as smoking, obesity, and physical inactivity). In order for health services to reach adolescents in LMICs, innovative service delivery models need to be explored and tested. This paper reviews the literature on generalist and specialist community health workers (CHWs) to assess their potential for strengthening the delivery of adolescent health services. We reviewed the literature on CHWs using Medline (PubMed), EBSCO Global Health, and Global Health Archive. Search terms (n = 19) were sourced from various review articles and combined with subject heading 'sub-Saharan Africa' to identify English language abstracts of original research articles on generalist and specialist CHWs. A total of 106 articles, from 1985 to 2012, and representing 24 African countries, matched our search criteria. A single study in sub-Saharan Africa used CHWs to deliver adolescent health services with promising results. Though few comprehensive evaluations of large-scale CHW programs exist, we found mixed evidence to support the use of either generalist or specialist CHW models for delivering adolescent health services. This review found that innovative service delivery approaches, such as those potentially offered by CHWs, for adolescents in sub-Saharan Africa are lacking, CHW programs have proliferated despite the absence of high quality evaluations, rigorous studies to establish the comparative effectiveness of generalist versus specialist CHW programs are needed, and further investigation of the role of CHWs in providing adolescent health services in sub-Saharan Africa is warranted

Gap Closure to Complete the Genome Assembly for Staphylococcus agnetis

Poultry lameness is a significant problem resulting in millions of dollars in lost revenue annually. In commercial broilers, the most common cause of lameness is bacterial chondronecrosis with osteomyelitis (BCO). The majority of BCO infections involve Staphylococcus agnetis, a bacterium previously not isolated from poultry. Administrating S. agnetis in drinking water to broilers reared on wire flooring increased the incidence of BCO three-fold when compared with broilers drinking tap water (P= 0.001). We are completing an assembly of the sequence of the S. agnetis genome. Currently, the assembly is in 2 large contigs of 2491 kbp and 38 kbp, and 7 small contigs of 2-3 kbp. We have been using bioinformatics and PCR sequencing to determine how these contigs are organized relative to the main bacterial chromosome and plasmids to constitute the entire S. agnetis genome. Annotation of that genome and identification of toxin genes will allow future researchers to better understand the etiology of BCO in broilers, and possibly develop vaccines for reducing BCO in commercial settings. Isolating pathogenic bacterial species, defining their likely route of transmission to boilers, and genomic analyses will contribute substantially to the development of measures for mitigating BCO losses in poultry

Magnetic superlens-enhanced inductive coupling for wireless power transfer

We investigate numerically the use of a negative-permeability "perfect lens" for enhancing wireless power transfer between two current carrying coils. The negative permeability slab serves to focus the flux generated in the source coil to the receiver coil, thereby increasing the mutual inductive coupling between the coils. The numerical model is compared with an analytical theory that treats the coils as point dipoles separated by an infinite planar layer of magnetic material [Urzhumov et al., Phys. Rev. B, 19, 8312 (2011)]. In the limit of vanishingly small radius of the coils, and large width of the metamaterial slab, the numerical simulations are in excellent agreement with the analytical model. Both the idealized analytical and realistic numerical models predict similar trends with respect to metamaterial loss and anisotropy. Applying the numerical models, we further analyze the impact of finite coil size and finite width of the slab. We find that, even for these less idealized geometries, the presence of the magnetic slab greatly enhances the coupling between the two coils, including cases where significant loss is present in the slab. We therefore conclude that the integration of a metamaterial slab into a wireless power transfer system holds promise for increasing the overall system performance

Position Measurements for Heavy Ion Beams Using a Sodium Iodide Scintillator

A 50 cm diameter, 1.7 cm thick disc of NaI(Tl) scintillator has been mounted to permit edge viewing by four photomultipliers. Energetic heavy ions passing through the scintillator at different positions cause a variation in the division of light among the photomultipliers. We have achieved a performance close to the expected limit for 670 MeV/n· ·neon. Calculations of expected response using an optical model agree well with the measurements

Training Evaluation for Introductory Ocean Lifeguard Instruction: A Practical Example from California

Ocean lifeguards have several responsibilities that require precise training. California State Parks is one of the largest providers of open water lifeguard services in the United States, and trains approximately 200 new lifeguards per year. As part of our lifeguard training section’s quality improvement efforts, we conducted a training needs assessment to help determine how well our introductory ocean lifeguard training curriculum prepared lifeguards to perform job related tasks upon successful completion of the training program. We surveyed both first year and seasoned lead lifeguards on operational needs, training gaps, and specific subject areas. We identified several areas where our training program required improvement. This assessment provided us with evidence from which to update our curriculum, helped identify gaps in the field, and provided a feedback mechanism from field staff not previously involved in prioritizing training needs

A usable home: A qualitative investigation of the relationship between home usability and community participation for people with disabilities

Background People with mobility disabilities frequently have unmet needs in their home environment, which can lead to difficulties completing daily living activities. Therefore, it is important that homes are not just accessible, but rather useable, meaning that the home complements an individual's functional, social, and psychological needs. Although previous research has shown the importance of home usability for people with mobility disabilities on health outcomes, this research explores the relationship between home usability and community participation both inside and outside the home. Objective The objective of this study was to understand the perception of people with mobility disabilities on the relationship between community participation and home usability. Method Twelve participants completed in-person semi-structured interviews to answer questions related to home usability and community participation. A content analysis was used to identify emergent themes. Results Results indicate that personal, social, and environment factors influence home usability and one's ability to participate in the community. Conclusion Home usability is a complex concept that is intertwined with a person's ability to participate in their community. Useable homes can facilitate community participation, both inside and outside the home. In fact, home usability is a critical component of community participation, as homes are not only located in the community but are sites from which people access community. Further research is needed to understand the significance of this interaction and the impact of changing home usability on one's ability to participate in the community

Water Safety Education Programs in Culturally and Linguistically Diverse Seattle Communities: Program Design and Pilot Evaluation

Drowning is a public health concern that disproportionally affects children and minorities in Washington State. Community health educators from Seattle Children’s Hospital designed a Water Safety Education and Lifejacket Giveaway Program for low-income parents of preschool-aged children from culturally and linguistically diverse backgrounds. The program was interpreted into multiple languages and parents and children in attendance received free lifejackets. The mixed-methods pilot evaluation of this program found statistically significant relationships between language and self-reported parent swim skill level (English-speaker OR 4.6; 95%CI: 1.84 – 11.54); and confidence of keeping one’s child safe (English-speaker OR 3.34; 95%CI: 1.10 – 10.4). Additionally, parents who self-reported that they could swim had four times the odds of feeling confident in keeping their children safe around the water (95% CI: 1.21 - 13.28). Qualitative data from follow-up interviews identified that the program boosted parent knowledge and confidence in safe water practices. Multi-lingual delivery and the role of partner preschools was critical to this program’s success. Specific programmatic focus on adult parent/caregiver skills and knowledge that reduce risk around the water should be a priority for future efforts to reduce drowning

The Ocean Lifeguard Intervention Continuum: A Cognitive Aid for Surf Lifeguard Education

Ocean lifeguards are constantly engaged in beach risk analysis, required to efficiently evaluate a variety of environmental and other factors quickly in order to triage and prioritize who needs help. Teaching these skills is a challenge for introductory training programs. We sought to improve new lifeguards’ understanding of the interaction of various risk components in the beach environment and aid decision-making related to when a lifeguard should intervene in a situation. We developed a two-part cognitive aid for introductory ocean lifeguard education depicting individual and interacting elements of a beach goer’s risk of drowning or injury and the process by which that risk increases with associated lifeguard interventions on a continuum from low risk and no distress to drowning. This new cognitive aid represented an advancement in the presentation of complex material in introductory training programs for those involved in aquatic rescue

Eyes Save Lives Water Safety Program for Parents and Caregivers: Program Design and Pilot Evaluation from Southern California

Despite expert consensus and evidence-based preventative strategies against drowning, limited formal study exists on translating recommendations into practical and effective interventions. This paper describes the design of an education-based drowning prevention intervention and reports results from a pilot evaluation of the program’s effect on self-reported water-safe behaviors, attitudes, self-efficacy, and knowledge. Parents and caregivers attending children’s swim lessons in July and August 2018 participated in a brief water-safety education program. A pre-post-test design evaluated Theory of Planned Behavior indicators to assess for changes. We found significant increases in scores related to water safety knowledge, attitudes on maintaining arms reach distance to children in the pool, recognizing a child in distress, and self-efficacy of responding to water emergencies involving a child between pre- and post-program. Swim lessons provided a captive audience receptive to drowning prevention information. Due to minimal costs, the program could easily be replicated and delivered to a variety of parent groups

Transportation challenges for persons aging with mobility disability: Qualitative insights and policy implications

Background Persons aging with mobility disability (PAwMD) experience transportation barriers, which can hinder their ability to fully participate in society. Despite a vast infrastructure of federal laws and programs designed to ensure access to transportation, PAwMD remain a transportation-disadvantaged population. Objectives This paper presents detailed insights on transportation challenges experienced by PAwMD along with recent Federal programmatic initiatives designed to enhance access and mobility for transportation for older adults and people with disabilities. To identify policy gaps and opportunities to improve transportation services, we compared individual-level challenges from PAwMD to national survey data about barriers associated with delivering transportation services at state and local levels. Methods To assess individual-level transportation challenges, we conducted in-depth, structured interviews with sixty older adult participants with self-identified mobility disabilities for at least 10 years. We also conducted a content analysis of end-user transportation challenges and agency-level transportation coordination barriers to identify correspondences. Results Participants reported challenges utilizing public and private modes of transportation, related to availability; accessibility; safety; advanced planning; as well as societal attitudes. Barriers to the availability, delivery, and coordination of access and mobility services are linked directly or indirectly to the PAwMD reports of experiencing a shortage of accessible transportation options. Conclusions Findings highlight the complexity of federal transportation policies and programmatic initiatives designed to support older adults and people with disabilities, which contribute to implementation barriers and transportation challenges. Results highlight the importance of integrating end-user and state and local provider input into transportation policy development and program implementation