FACTORS THAT INFLUENCE BREAST CANCER DIAGNOSES IN VIRGINIA WOMEN 40-64 YEARS OLD WHO UTLIZED THE EVERY WOMAN’S LIFE PROGRAM 1998-2012

This dissertation examines sociodemographic determinants and preventive health behaviors among women 40-64 years of age who participated in the Virginia Department of Health’s Every Woman’s Life breast cancer screening program. Utilizing secondary data, this research sought to explore patterns of breast cancer incidence, mammography screening utilization and sources of health information among low-income women. The Virginia Department of Health provided a large sample size (N=34,942) on which to perform binary logistic regression analyses. Sociodemographic determinants and preventive health behaviors were analyzed as potential influencing factors in the diagnosis of breast cancer, the stage at the time of diagnosis and source of health information. Additionally, frequencies across all variables were explored and compared to state and national statistics, where appropriate. In this study, cancer and preventive health disparities reported in the literature persist within this sample of low income women. The binary regression analyses demonstrated that there are marginally worse outcomes for each level of decreasing income. Those with the most “wealth” were less likely to be diagnosed with invasive breast cancer and were more likely to obtain health information from a health provider. Additionally, it was determined that those without a prior mammogram were more likely to be diagnosed with breast cancer and the cancer was more likely to be invasive. The aims of the Every Woman’s Life program align with Affordable Care Act (2010) to strengthen health care and eliminate cancer disparities. Highlighting program characteristics and presenting these analyses allows policymakers, program officials and practitioners an opportunity to tailor health promotion activities while considering all tiers of influence

Creation of a CIP Method for the Heat Exchangers at Rolls-Royce

Rolls-Royce produces various engines which must be tested prior to their distribution to ensure a high-quality product. The manufacturing plant contains four test cells where the engines can be subjected to high levels of torque and extreme temperatures. A heat exchanger is necessary in this testing system and over time, unwanted waste accumulates on the system’s plates. The team is tasked with developing and implementing a system mounted on a mobile cart which can provide data to determine whether the plates need to be cleaned. For this cleaning system to work, it must fully saturate the heat exchanger in cleaning solution, making the choice of pump important to the planning process. Additionally, the pump must be able to handle liquid containing silt and other debris and possess a maximum flow rate allowing the plates to be saturated. The pump must have four connection points to the heat exchanger system, and the fitting nozzle to control the flow rate of the cleaning solution into the heat exchanger. The cleaning solution for the system must be strong enough to clean the waste from the heat exchanger, yet weak enough to not corrode the plates. Additionally, some cleaning solutions have standards regarding storage and disposal, which have considerable influence on the selection of an acceptable solution. The final design incorporates a workable pump, a suitable solution, and the supporting materials needed to sustain the system. Implementation of the design will include pressure testing and a cleaning system that will improve the life span and efficiency of the heat exchanger in each test cell

Perceptions of Clinical Education Preparedness at a Large Urban US University: Is There a Difference Between US-Born and Non-US Born Students?

This research compared three clinical preparedness domains, communication ability, social comfort, and clinical confidence, between US-born and non-US born radiation sciences students. The aim of the study was to determine if there were perceived differences in clinical preparedness between them. Student’s place of birth was found to be an influencing factor in each of the clinical preparedness domains. Informing faculty, clinical instructors, and hospital staff of the perceived differences in clinical education preparedness among non-US born students may serve as a catalyst for instructional change. Educators can then formulate instructional strategies to better prepared non-US born students

‘I am free in my wheelchair but pain does have a say in it though’: The meaning and experience of quality of life when living with paraplegia and chronic pain

This study investigated how wheelchair-using individuals with paraplegia and chronic pain make sense of the factors associated with quality of life based on interviews using photo-elicitation and interpretative phenomenological analysis. Three superordinate themes emerged in the analysis: experiencing quality of life through the perception of self and identity, interpersonal relationships as facilitators and barriers to quality of life and life in a wheelchair: pain experience and management. Quality of life for those living with paraplegia and chronic pain is experienced as a complex interaction across several life domains. The use of photographs may improve the communication of pain-related experiences and understanding by healthcare staff

Safety considerations for IMRT: Executive summary

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98742/1/MPH005067.pd

Self-reported walking pace and 10-year cause-specific mortality:A UK biobank investigation

Objective: To investigate associations of self-reported walking pace (SRWP) with relative and absolute risks of cause-specific mortality. Patients and methods: In 391,652 UK Biobank participants recruited in 2006–2010, we estimated sex- and cause-specific (cardiovascular disease [CVD], cancer, other causes) mortality hazard ratios (HRs) and 10-year mortality risks across categories of SRWP (slow, average, brisk), accounting for confounders and competing risk. Censoring occurred in September 30, 2021 (England, Wales) and October 31, 2021 (Scotland). Results: Over a median follow-up of 12.6 years, 22,413 deaths occurred. In women, the HRs comparing brisk to slow SRWP were 0.74 (95% CI: 0.67, 0.82), 0.40 (0.33, 0.49), and 0.29 (0.26, 0.32) for cancer, CVD, and other causes of death, respectively, and 0.71 (0.64, 0.78), 0.38 (0.33, 0.44), and 0.29 (0.26, 0.32) in men. Compared to CVD, HRs were greater for other causes (women: 39.6% [6.2, 72.9]; men: 31.6% [9.8, 53.5]) and smaller for cancer (−45.8% [−58.3, −33.2] and − 45.9% [−54.8, −36.9], respectively). For all causes in both sexes, the 10-year mortality risk was higher in slow walkers, but varied across sex, age, and cause, resulting in different risk reductions comparing brisk to slow: the largest were for other causes of death at age 75 years [women: −6.8% (−7.7, −5.8); men: −9.5% (−10.6, −8.4)]. Conclusion: Compared to slow walkers, brisk SRWP was associated with reduced cancer (smallest reduction), CVD, and other (largest) causes of death and may therefore be a useful clinical predictive marker. As absolute risk reductions varied across age, cause, and SRWP, certain groups may particularly benefit from interventions to increase SRWP.</p

Association Between Accelerometer-Assessed Physical Activity and Severity of COVID-19 in UK Biobank.

Funder: UKRI Science and Technology Facilities CouncilOBJECTIVE: To quantify the association between accelerometer-assessed physical activity and coronavirus disease 2019 (COVID-19) outcomes. METHODS: Data from 82,253 UK Biobank participants with accelerometer data (measured 2013-2015), complete covariate data, and linked COVID-19 data from March 16, 2020, to March 16, 2021, were included. Two outcomes were investigated: severe COVID-19 (positive test result from in-hospital setting or COVID-19 as primary cause of death) and nonsevere COVID-19 (positive test result from community setting). Logistic regressions were used to assess associations with moderate to vigorous physical activity (MVPA), total activity, and intensity gradient. A higher intensity gradient indicates a higher proportion of vigorous activity. RESULTS: Average MVPA was 48.1 (32.7) min/d. Physical activity was associated with lower odds of severe COVID-19 (adjusted odds ratio per standard deviation increase: MVPA, 0.75 [95% CI, 0.67 to 0.85]; total, 0.83 [0.74 to 0.92]; intensity, 0.77 [0.70 to 0.86]), with stronger associations in women (MVPA, 0.63 [0.52 to 0.77]; total, 0.76 [0.64 to 0.90]; intensity, 0.63 [0.53 to 0.74]) than in men (MVPA, 0.84 [0.73 to 0.97]; total, 0.88 [0.77 to 1.01]; intensity, 0.88 [0.77 to 1.00]). In contrast, when mutually adjusted, total activity was associated with higher odds of a nonsevere infection (1.10 [1.04 to 1.16]), whereas the intensity gradient was associated with lower odds (0.91 [0.86 to 0.97]). CONCLUSION: Odds of severe COVID-19 were approximately 25% lower per standard deviation (∼30 min/d) MVPA. A greater proportion of vigorous activity was associated with lower odds of severe and nonsevere infections. The association between total activity and higher odds of a nonsevere infection may be through greater community engagement and thus more exposure to the virus. Results support calls for public health messaging highlighting the potential of MVPA for reducing the odds of severe COVID-19

Quality of life research: a case for combining photo-elicitation with interpretative phenomenological analysis

In this paper we provide practical and theoretical discussion of the use of two complementary research methods to explore quality of life. We present a case example of the use of photo-elicitation alongside Interpretative Phenomenological Analysis and use examples from our research with people living with paraplegia and chronic pain to demonstrate how these methods can be combined to provide a participant-led understanding of QoL. This discussion includes consideration of practical and ethical issues relevant to others wishing to combine these research methods. Furthermore, we highlight some of the potential practical and therapeutic opportunities provided by the approach through an illustration of how photographs work to enhance self-reflection and promote hermeneutic sense making

Can, Want and Try: Parents' Viewpoints Regarding the Participation of Their Child with an Acquired Brain Injury

BACKGROUND: Acquired brain injury (ABI) is a leading cause of permanent disability, currently affecting 20,000 Australian children. Community participation is essential for childhood development and enjoyment, yet children with ABI can often experience barriers to participation. The factors which act as barriers and facilitators to community participation for children with an ABI are not well understood. AIM: To identify the viewpoints of parents of children with an ABI, regarding the barriers and facilitators most pertinent to community participation for their child. METHODS: Using Q-method, 41 parents of children with moderate/severe ABI sorted 37 statements regarding barriers and facilitators to community participation. Factor analysis identified three viewpoints. RESULTS: This study identified three distinct viewpoints, with the perceived ability to participate decreasing with a stepwise trend from parents who felt their child and family "can" participate in viewpoint one, to "want" in viewpoint two and "try" in viewpoint three. CONCLUSIONS: Findings indicated good participation outcomes for most children and families, however some families who were motivated to participate experienced significant barriers. The most significant facilitators included child motivation, supportive relationships from immediate family and friends, and supportive community attitudes. The lack of supportive relationships and attitudes was perceived as a fundamental barrier to community participation. SIGNIFICANCE: This research begins to address the paucity of information regarding those factors that impact upon the participation of children with an ABI in Australia. Findings have implications for therapists, service providers and community organisations

The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis

Background A growing body of research identifies the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life. Studies have quantified such effects for individual ACEs. However, ACEs frequently co-occur and no synthesis of findings from studies measuring the effect of multiple ACE types has been done. Methods In this systematic review and meta-analysis, we searched five electronic databases for cross-sectional, case-control, or cohort studies published up to May 6, 2016, reporting risks of health outcomes, consisting of substance use, sexual health, mental health, weight and physical exercise, violence, and physical health status and conditions, associated with multiple ACEs. We selected articles that presented risk estimates for individuals with at least four ACEs compared with those with none for outcomes with sufficient data for meta-analysis (at least four populations). Included studies also focused on adults aged at least 18 years with a sample size of at least 100. We excluded studies based on high-risk or clinical populations. We extracted data from published reports. We calculated pooled odds ratios (ORs) using a random-effects model. Findings Of 11 621 references identified by the search, 37 included studies provided risk estimates for 23 outcomes, with a total of 253 719 participants. Individuals with at least four ACEs were at increased risk of all health outcomes compared with individuals with no ACEs. Associations were weak or modest for physical inactivity, overweight or obesity, and diabetes (ORs of less than two); moderate for smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease (ORs of two to three), strong for sexual risk taking, mental ill health, and problematic alcohol use (ORs of more than three to six), and strongest for problematic drug use and interpersonal and self-directed violence (ORs of more than seven). We identified considerable heterogeneity (I 2 of > 75%) between estimates for almost half of the outcomes. Interpretation To have multiple ACEs is a major risk factor for many health conditions. The outcomes most strongly associated with multiple ACEs represent ACE risks for the next generation (eg, violence, mental illness, and substance use). To sustain improvements in public health requires a shift in focus to include prevention of ACEs, resilience building, and ACE-informed service provision. The Sustainable Development Goals provide a global platform to reduce ACEs and their life-course effect on health. Funding Public Health Wales. © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licens