An assessment of American Indian women's mammography experiences

<p>Abstract</p> <p>Background</p> <p>Mortality from breast cancer has increased among American Indian/Alaskan Native (AI/AN) women. Despite this alarming reality, AI/AN women have some of the lowest breast cancer screening rates. Only 37% of eligible AI/AN women report a mammogram within the last year and 52% report a mammogram within the last two years compared to 57% and 72% for White women. The experiences and satisfaction surrounding mammography for AI/AN women likely are different from that of women of other racial/ethnic groups, due to cultural differences and limited access to Indian Health Service sponsored mammography units. The overall goals of this study are to identify and understand the mammography experiences and experiential elements that relate to satisfaction or dissatisfaction with mammography services in an AI/AN population and to develop a culturally-tailored AI/AN mammography satisfaction survey.</p> <p>Methods and Design</p> <p>The three project aims that will be used to guide this work are: 1) To compare the mammography experiences and satisfaction with mammography services of Native American/Alaska Native women with that of Non-Hispanic White, Hispanic, and Black women, 2) To develop and validate the psychometric properties of an American Indian Mammography Survey, and 3) To assess variation among AI/AN women's assessments of their mammography experiences and mammography service satisfaction. Evaluations of racial/ethnic differences in mammography patient satisfaction have received little study, particularly among AI/AN women. As such, qualitative study is uniquely suited for an initial examination of their experiences because it will allow for a rich and in-depth identification and exploration of satisfaction elements.</p> <p>Discussion</p> <p>This formative research is an essential step in the development of a validated and culturally tailored AI/AN mammography satisfaction assessment. Results from this project will provide a springboard from which a maximally effective breast cancer screening program to benefit AI/AN population will be developed and tested in an effort to alter the current breast cancer-related morbidity and mortality trajectory among AI/AN women.</p

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

AN INDIVIDUAL-BASED MODEL FOR FERAL HOGS IN GREAT SMOKY MOUNTAINS NATIONAL PARK

The expansion of feral hog (Sus scrofa) populations in the United States has resulted in increased efforts to develop and implement control strategies designed to minimize the impacts done by this invasive species. We describe an individual-based model for feral hogs in Great Smoky Mountains National Park (GSMNP). The objectives of the model are to provide an understanding of the population dynamics of this feral hog population and to determine the efficacy of the annual harvest as a population control method. Results suggest that the dynamics of the population are driven by fall hard mast production and the GSMNP harvests currently limit growth of the population, but these control efforts have not reduced the population

Surface Orientation of Polystyrene Based Polymers: Steric Effects from Pendant Groups on the Phenyl Ring

Near edge X-ray absorption fine structure (NEXAFS) coupled with molecular dynamics simulations were utilized to probe the orientation at the exposed surface of the polymer film for polystyrene type polymers with various pendant functional groups off the phenyl ring. For all the polymers, the surface was oriented so that the rings are nominally normal to the film surface and pointing outward from the surface. The magnitude of this orientation was small and dependent on the size of the pendant functional group. Bulky functional groups hindered the surface orientation, leading to nearly unoriented surfaces. Depth dependent NEXAFS measurements demonstrated that the surface orientation was localized near the interface. Molecular dynamics simulations showed that the phenyl rings were not oriented strongly around a particular “average tilt angle”. In contrast, simulations demonstrate that the phenyl rings exhibit a broad distribution of tilt angles, and that changes in the tilt angle distribution with pendant functionality give rise to the observed NEXAFS response. The more oriented samples exhibit a higher probability of phenyl ring orientation at angles greater than 60 degrees relative to the plane of the films surface

Molecular Dynamics Simulation of the Effects of Layer Thickness and Chain Tilt on Tensile Deformation Mechanisms of Semicrystalline Polyethylene

We performed molecular dynamics simulations to investigate the effects of layer thicknesses of both crystalline and noncrystalline domains and chain tilt within the crystalline lamellae on tensile deformation mechanisms of the lamellar stack model of semicrystalline polyethylene. For equal thicknesses of crystalline and noncrystalline regions, similar stress–strain profiles were obtained with two different initial orientations of the crystal stem relative to the tensile direction. Repeated melting/recrystallization transitions were observed, at the slower strain rate of 5 × 10⁶ s^–1, characterized by oscillating stress–strain profiles. With increasing thickness of the crystalline regions, these oscillations occurred less frequently. For systems with initially tilted chain stems in the crystalline domain, decreasing the thickness of the noncrystalline region increased the number of short bridge segments in the noncrystalline region connecting the two crystalline regions and induced significant shear stresses, rearrangements in the crystalline region, and the strain hardening during the tensile deformation