Achieving Consensus on Measure-Driven Child Health Quality: Maine’s Improving Health Outcomes for Children Initiative

This brief describes Maine’s process for selecting child health quality measures, including identified strengths and limitations of the CHIPRA core measures that led to the inclusion of additional state-specific measures and the factors considered for selection. Subsequent articles will describe how measures have been implemented and used to improve child health quality and how they have been integrated into systems of care (e.g. health information technology systems, policy changes)

Florida Public Health Association 2009 Survey of Academic Public Health Programs in Florida

ABSTRAC

Adaptive Developmental Delay in Chagas Disease Vectors: An Evolutionary Ecology Approach

The developmental time of vector insects is important to their population dynamics, evolutionary biology, epidemiology of the diseases they transmit, and to their responses to global climatic change. In various triatomine species vectors of Chagas disease (Triatominae, Reduviidae), a delay in the molt of a small proportion of individuals has been observed, and from an evolutionary ecology approach, we propose the hypothesis that the developmental delay is an adaptation to environmental stochasticity through a spreading of risk (bet-hedging) diapause strategy. We confirmed, by means of a survey among specialists, the existence of the developmental delay in triatomines. Statistical descriptions of the developmental time of 11 species of triatomines showed some degree of bi-modality in nine of them. We predicted by means of an optimization model which genotype, coding for a given frequency of developmental diapause, is expected to evolve. We identified a series of parameters that can be measured in the field and in the laboratory to test the hypothesis of an optimal diapause frequency. We also discuss the importance of these findings for triatomines in terms of global climatic change and epidemiological consequences such as their resistance to insecticides

How friendly are New York State Hospital employment applications to individuals with an incarceration history?

Although discrimination on the basis of previous incarceration is illegal in New York, many employers still screen job applicants based on prior convictions. We conducted a study of New York State hospitals to examine the use of incarceration histories in online applications. Two-thirds of NYS hospitals asked questions about convictions. This was most common in hospitals located in suburban and rural areas. This practice may deny returning prisoners and their communities the numerous benefits of employment. Keywords: Formerly incarcerated, Employment, Community Health, Policie

Qualitative study of Oncology Clinicians’ Perceptions of Barriers to Offering Clinical Trials to Underserved Populations

Introduction Cancer clinical trials represent the “gold standard” for advancing novel cancer therapies. Optimizing trial participation is critical to ensuring the generalizability of findings across patients, yet trial enrollment rates, particularly among minority and socioeconomically disadvantaged populations, remain suboptimal. Methods We conducted in-depth interviews with oncologists at a large academic medical center to explore their (1) attitudes and perceived barriers to offering clinical trials to minority and socioeconomically disadvantaged patients, and (2) recommendations for improving the enrollment of minority and socioeconomically disadvantaged patients in cancer clinical trials. Results Of 23 medical oncologists approached, 17 enrolled (74% response rate; mean age = 47; female = 42%; White = 67%). Content analysis revealed several barriers to enrollment: (1) ethical dilemmas; (2) ambivalence about trial risks and benefits; and (3) concern about patient well-being. Concerns about the legitimacy of informed consent, perceived lack of equipoise, and fear of personal bias influenced clinicians’ decisions to recommend trials during treatment discussions. Concerns about creating an imbalance between trial risks and benefits among patients with high-level needs, including patients with literacy, psychiatric, and other socioeconomic vulnerabilities, impacted clinicians’ enthusiasm to engage in trial discussions. Clinicians identified patient, provider, and system-level solutions to address challenges, including increasing patient and clinician support as well as involving external personnel to support trial enrollment. Conclusion Findings reveal multi-level barriers to offering cancer clinical trials to underrepresented patients. Targeted solutions, including system level changes to support clinicians, patient financial support, and implementation of clinical trial navigation programs were recommended to help reduce access barriers and increase enrollment of underrepresented patients into cancer clinical trials

Artificial intelligence-enabled healthcare delivery.

In recent years, there has been massive progress in artificial intelligence (AI) with the development of deep neural networks, natural language processing, computer vision and robotics. These techniques are now actively being applied in healthcare with many of the health service activities currently being delivered by clinicians and administrators predicted to be taken over by AI in the coming years. However, there has also been exceptional hype about the abilities of AI with a mistaken notion that AI will replace human clinicians altogether. These perspectives are inaccurate, and if a balanced perspective of the limitations and promise of AI is taken, one can gauge which parts of the health system AI can be integrated to make a meaningful impact. The four main areas where AI would have the most influence would be: patient administration, clinical decision support, patient monitoring and healthcare interventions. This health system where AI plays a central role could be termed an AI-enabled or AI-augmented health system. In this article, we discuss how this system can be developed based on a realistic assessment of current AI technologies and predicted developments

The State of the Great Central Valley of California-Assessing the Region via Indicators: Public Health and Access to Care

Each year the Great Valley Center produces a report in the five part State of the Great Central Valley series. The data is updated in 5-year increments.Based on the data, the Great Valley Center recognizes the potential to improve health outcomes throughout the region. Overall, the indicators suggest five strategies:* Invest in Prevention * Be Strategic With Limited Resources * Model Healthy Lifestyles for Youth * Build Coalitions in Support of a Healthier Environment * Reduce Povert

The State of the Great Central Valley of California-Assessing the Region via Indicators: Public Health and Access to Care

Each year the Great Valley Center produces a report in the five part State of the Great Central Valley series. The data is updated in 5-year increments.Based on the data, the Great Valley Center recognizes the potential to improve health outcomes throughout the region. Overall, the indicators suggest five strategies:* Invest in Prevention * Be Strategic With Limited Resources * Model Healthy Lifestyles for Youth * Build Coalitions in Support of a Healthier Environment * Reduce Povert

Ultrasound-Guided Cannulation: Time to Bring Subclavian Central Lines Back

Despite multiple advantages, subclavian vein (SCV) cannulation via the traditional landmark approach has become less used in comparison to ultrasound (US) guided internal jugular catheterization due to a higher rate of mechanical complications. A growing body of evidence indicates that SCV catheterization with real-time US guidance can be accomplished safely and efficiently. While several cannulation approaches with real-time US guidance have been described, available literature suggests that the infraclavicular, longitudinal “in-plane” technique may be preferred. This approach allows for direct visualization of needle advancement, which reduces risk of complications and improves successful placement. Infraclavicular SCV cannulation requires simultaneous use of US during needle advancement, but for an inexperienced operator, it is more easily learned compared to the traditional landmark approach. In this article, we review the evidence supporting the use of US guidance for SCV catheterization and discuss technical aspects of the procedure itself