Developing a Worksite Health Promotion Program Plan for UNC Facilities Services Staff

Background: Low-wage workers experience poorer health outcomes compared to high-wage workers, including increased risk of high blood pressure, cardiovascular disease, cancer, obesity, and a shorter life expectancy. Additionally, shift workers also face higher rates of disrupted sleep patterns, mental health problems, and gastrointestinal disorders. As most full-time employees spend over half of their waking hours at work, worksite health promotion programs (WHPPs) offer an important means of addressing many salient health issues, including those specifically faced by low-wage and shift workers. Effective WHPPs improve worker health, morale and job satisfaction, reduce absenteeism and injuries, increase productivity, lower healthcare premiums, and ultimately produce cost-saving benefits for employers. Despite the higher risk for disease and demonstrated positive health benefits of participation in WHPPs, low-wage and shift workers engage in WHPP activities at lower rates than their high-wage counterparts. Methods: The purpose of this Capstone project was 1) to conduct formative research to identify the needs, assets, and barriers to WHPP participation among low-wage shift workers at the University of North Carolina at Chapel Hill (UNC) and 2) to develop a Wellness Action Plan of potential interventions for this population based on importance and feasibility. To address these aims, the Capstone team conducted a literature review and key informant interviews and focus groups discussions (FGDs) with upper management, direct supervisors, and frontline staff in the Facilities Services Division at UNC. Following data collection, a data analysis matrix was used to identify themes from the field notes gathered from interviews and FGDs. For the Wellness Action Plan, elements of the public health program-planning model PRECEDE-PROCEED were used to identify and prioritize determinants and precursors of the intervention strategies to address the health issues relevant to the population. Results: In sum, six upper managers, seven direct supervisors, and forty-two frontline staff participated in either a key informant interview or FGD. A number of individual, managerial, and organizational-level barriers were identified in both key informant interviews and FGDs, including the importance of management support, the need to incorporate wellness activities into the work shift, and insufficient communication about available programs and benefits. These findings were consistent with our findings in the literature review. These findings formed the basis for the Wellness Action Plan, which included low and high resource program options. The Wellness Action Plan recommendations were presented to two major stakeholders-the Work Well, Live Well (WWLW) Committee and the UNC Employee Forum Executive Committee. Discussion: These formative research results suggest that there is both a need and desire for WHPPs among low-wage shift workers at UNC and that some level of intervention is possible. The ultimate goal of our Capstone project is to present feasible WHPP recommendations for Facilities Services employees. Our Capstone project accomplished this goal through formative research and evidence-based recommendations for the selection and implementation of WHPPs within the Facilities Services Division. Our literature review, Formative Research Summary Report, and Wellness Action Plan can be used to guide WHPP decision making by the Carolina Collaborative for Research on Work and Health (CCRWH), the WWLW Committee, Facilities Services, and the 2014-2015 Capstone team.Master of Public Healt

Production of He-4 and (4) in Pb-Pb collisions at root(NN)-N-S=2.76 TeV at the LHC

Results on the production of He-4 and (4) nuclei in Pb-Pb collisions at root(NN)-N-S = 2.76 TeV in the rapidity range vertical bar y vertical bar <1, using the ALICE detector, are presented in this paper. The rapidity densities corresponding to 0-10% central events are found to be dN/dy4(He) = (0.8 +/- 0.4 (stat) +/- 0.3 (syst)) x 10(-6) and dN/dy4 = (1.1 +/- 0.4 (stat) +/- 0.2 (syst)) x 10(-6), respectively. This is in agreement with the statistical thermal model expectation assuming the same chemical freeze-out temperature (T-chem = 156 MeV) as for light hadrons. The measured ratio of (4)/He-4 is 1.4 +/- 0.8 (stat) +/- 0.5 (syst). (C) 2018 Published by Elsevier B.V.Peer reviewe

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Increased Likelihood of Missed Appointments (“No Shows”) for Racial/Ethnic Minorities in a Safety Net Health System

Missed appointments have been linked to adverse outcomes known to affect racial/ethnic minorities. However, the association of missed appointments with race/ethnicity has not been determined. We sought to determine the relationships between race/ethnicity and missed appointments by performing a cross-sectional study of 161 350 patients in a safety net health system. Several race/ethnicity categories were significantly associated with missed appointment rates, including Hispanic/Latino patients, American Indian/Alaskan Native patients, and Black/African American patients, as compared with White non-Hispanic patients. Other significant predictors included Mexico as country of origin, medical complexity, and major mental illness. We recommend additional research to determine which interventions best reduce missed appointments for minority populations in order to improve the care of vulnerable patients

Identifying Homeless Medicaid Enrollees Using Enrollment Addresses.

OBJECTIVE: To design and test the validity of a method to identify homelessness among Medicaid enrollees using mailing address data. DATA SOURCES/STUDY SETTING: Enrollment and claims data on Medicaid expansion enrollees in Hennepin and Ramsey counties who also provided self-reported information on their current housing situation in a psychosocial needs assessment. STUDY DESIGN: Construction of address-based indicators and comparison with self-report data. PRINCIPAL FINDINGS: Among 1,677 enrollees, 427 (25 percent) self-reported homelessness, of whom 328 (77 percent) had at least one positive address indicator. Depending on the type of addresses included in the indicator, sensitivity to detect self-reported homelessness ranged from 30 to 76 percent and specificity from 79 to 97 percent. CONCLUSIONS: An address-based indicator can identify a large proportion of Medicaid enrollees who are experiencing homelessness. This approach may be of interest to researchers, states, and health systems attempting to identify homeless populations

Emotional support for diabetes management : an international cross-cultural study

Purpose. The purpose of this study was to explore how emotional support emerged in interactions between peer supporters (PSs) and adults living with type 2 diabetes. Methods. Qualitative data were analyzed from 22 semistructured interviews with PSs in 3 settings: low-income Latinos in Chicago, middle-class Caucasians in the United Kingdom, and low-income African American women in North Carolina. Emotional support was defined as expressions of empathy, trust, and caring. Results. Across all sites, emotional support gradually emerged over time, was often combined with informational support, and was conveyed both implicitly (through nonverbal actions connoting emotional acceptance; eg, a walk together without discussion of problems) and explicitly (eg, by reassurance or discussion of stressors). Cross-site differences did appear regarding the strategies to address barriers to diabetes management (eg, PSs in North Carolina and Chicago reported providing support for social stressors) and the role of PSs (eg, PSs in Chicago reported providing directive support). Conclusions. Across different settings and populations, emotional support for diabetes management evolved over time, was often integrated with informational support, and emerged through both implicit and explicit strategies that addressed varied context-specific stressors

supplementary_material – Supplemental material for Changes in Quality of Life Among Enrollees in Hennepin Health: A Medicaid Expansion ACO

<p>Supplemental material, supplementary_material for Changes in Quality of Life Among Enrollees in Hennepin Health: A Medicaid Expansion ACO by Katherine D. Vickery , Nathan D. Shippee, Laura M. Guzman-Corrales, Cindy Cain, Sarah Turcotte Manser, Tom Walton, Jessica Richards and Mark Linzer in Medical Care Research and Review</p

Multiplicity dependence of light (anti-)nuclei production in p–Pb collisions at sNN=5.02 TeV

The measurement of the deuteron and anti-deuteron production in the rapidity range −1 < y < 0 as a function of transverse momentum and event multiplicity in p–Pb collisions at √sNN = 5.02 TeV is presented. (Anti-)deuterons are identified via their specific energy loss dE/dx and via their time-of- flight. Their production in p–Pb collisions is compared to pp and Pb–Pb collisions and is discussed within the context of thermal and coalescence models. The ratio of integrated yields of deuterons to protons (d/p) shows a significant increase as a function of the charged-particle multiplicity of the event starting from values similar to those observed in pp collisions at low multiplicities and approaching those observed in Pb–Pb collisions at high multiplicities. The mean transverse particle momenta are extracted from the deuteron spectra and the values are similar to those obtained for p and particles. Thus, deuteron spectra do not follow mass ordering. This behaviour is in contrast to the trend observed for non-composite particles in p–Pb collisions. In addition, the production of the rare 3He and 3He nuclei has been studied. The spectrum corresponding to all non-single diffractive p-Pb collisions is obtained in the rapidity window −1 < y < 0 and the pT-integrated yield dN/dy is extracted. It is found that the yields of protons, deuterons, and 3He, normalised by the spin degeneracy factor, follow an exponential decrease with mass number