Centering High Risk Pregnancies Interprofessionaly (CHRPI) to Reduce Racial Disparities in Pregnancy Outcomes

Background: Despite the steady rise in use of prenatal care, significant racial disparities exist in pregnancy-related outcomes. This calls for innovative prenatal care to improve pregnancy outcomes in racial minorities. CHRPI is an innovative prenatal care model designed to address risk factors and manageable conditions particularly prevalent in African Americans that threaten their course of pregnancy. Methods: CHRPI is an outpatient model (Fig. 1) that will accept pregnant moms with risk-factors outlined by the ACOG. They are initially evaluated by a Maternal Fetal Medicine physician where management is outlined. Then, patients are placed in groups of 4 according to their expected course of pregnancy, social, and medical needs. Between medical appointments, patients will attend sessions facilitated by a multidisciplinary team to receive education on nutrition, insulin management, alarming symptoms and more. Additionally, patients will have opportunity to address individual social and medical needs with licensed clinical social workers and mid-level providers outside of groups. Lastly, CHRPI’s care extends as far as 6 months postpartum to reassess newly diagnosed conditions or risk-factors to protect future pregnancies and establish primary care upon exiting the program. Results: Compared to traditional care of high-risk patients (Fig. 2), proposed CHRPI model is expected to decrease rate of maternal and infant mortality, pre-term birth, NICU admissions, and patient satisfaction. Conclusion: CHRPI aims to reduce racial disparities in maternal and infant mortalities associated with high-risk pregnancies by utilizing an innovative multidisciplinary group approach with significant emphasis on nutrition, education, and primary care to protect future pregnancies.https://scholarscompass.vcu.edu/gradposters/1100/thumbnail.jp

A model of how targeted and universal welfare entitlements impact on material, psycho-social and structural determinants of health in older adults.

A growing body of research attests to the impact of welfare regimes on health and health equity. However, the mechanisms that link different kinds of welfare entitlement to health outcomes are less well understood. This study analysed the accounts of 29 older adults in England to delineate how the form of entitlement to welfare and other resources (specifically, whether this was understood as a universal entitlement or as targeted to those in need) impacts on the determinants of health. Mechanisms directly affecting access to material resources (through deterring uptake of benefits) have been well documented, but those that operate through psychosocial and more structural pathways less so, in part because they are more challenging to identify. Entitlement that was understood collectively, or as arising from financial or other contributions to a social body, had positive impacts on wellbeing beyond material gains, including facilitating access to important health determinants: social contact, recognition and integration. Entitlement understood as targeted in terms of individualised concepts of need or vulnerability deterred access to material resources, but also fostered debate about legitimacy, thus contributing to negative impacts on individual wellbeing and the public health through the erosion of social integration. This has important implications for both policy and evaluation. Calls to target welfare benefits at those in most need emphasise direct material pathways to health impact. We suggest a model for considering policy change and evaluation which also takes into account how psychosocial and structural pathways are affected by the nature of entitlement

Understanding welfare conditionality in the context of a generational habitus: A qualitative study of older citizens in England.

In many welfare states, 'austerity' policies have ignited debates about the fairness and cost-effectiveness of universal welfare benefits, with benefits received by older citizens a particular topic of concern. Empirical studies suggest that conditionality generates problems of access and uptake but, to date, there has been little research on how different conditions of entitlement are understood by older citizens. This study drew on interviews with 29 older citizens from three areas of England to explore how eligibility for and uptake of different kinds of welfare benefits were understood. In interviews, current entitlement was understood in relation to a generational habitus, in which 'our generation' was framed as sharing cohort experiences, and moral orientations to self-reliance, hard work and struggle. Entitlement to some welfare benefits was taken for granted as a reward owed by the state to its citizens for hard-earned lives. State transfers such as pensions, free travel and fuel subsidies were congruent with a nationalised generational habitus, and fostered recognition, self-worth and the sense of a generation as a collective. In contrast, transfers contingent on economic or need-based conditionality were more explicitly framed as 'benefits', and negatively associated with vulnerability and moral contestation. Uptake was therefore often incompatible with their generational habitus. Calls for introducing further conditionality to benefits for older adults are often based on claims that this will increase fairness and equality. Our analysis suggests, however, that introducing conditionality has the potential to promote inequality and foster differentiation and division, within the older population and between generations.This work was supported by the National Institute for Health Research (NIHR)’s School for Public Health Research (SPHR).This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.jaging.2015.06.00

A model of how targeted and universal welfare entitlements impact on material, psycho-social and structural determinants of health in older adults.

A growing body of research attests to the impact of welfare regimes on health and health equity. However, the mechanisms that link different kinds of welfare entitlement to health outcomes are less well understood. This study analysed the accounts of 29 older adults in England to delineate how the form of entitlement to welfare and other resources (specifically, whether this was understood as a universal entitlement or as targeted to those in need) impacts on the determinants of health. Mechanisms directly affecting access to material resources (through deterring uptake of benefits) have been well documented, but those that operate through psychosocial and more structural pathways less so, in part because they are more challenging to identify. Entitlement that was understood collectively, or as arising from financial or other contributions to a social body, had positive impacts on wellbeing beyond material gains, including facilitating access to important health determinants: social contact, recognition and integration. Entitlement understood as targeted in terms of individualised concepts of need or vulnerability deterred access to material resources, but also fostered debate about legitimacy, thus contributing to negative impacts on individual wellbeing and the public health through the erosion of social integration. This has important implications for both policy and evaluation. Calls to target welfare benefits at those in most need emphasise direct material pathways to health impact. We suggest a model for considering policy change and evaluation which also takes into account how psychosocial and structural pathways are affected by the nature of entitlement

Critical Importance of Using FibroScan to Identify Patients with Cirrhosis in a Predominantly African American Patient Population

Introduction: Identifying patients with cirrhosis is complicated, but the availability of Transient Elastography by FibroScan for non-invasive assessment of fibrosis appears to have resolved this issue. The objective of our study was to use a Fibroscan database to identify patients with cirrhosis in our primarily African American Hepatitis C patients and to track outcome especially of patients with Hepatitis C (HCV). Methods: The electronic medical records of 79 out of the 332 individuals (24%) with a Fibroscan between 2014 and 2016 and a score of \u3e12.5 kPa laboratory values recorded, and etiology and outcomes evaluated. AST to Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) scores were calculated. An APRI score \u3e0.7 and FIB-4 score \u3e3.25 was used for predicting advanced fibrosis. Results: Cirrhotic patients were 92% AA, 52% male, and the majority had Hepatitis C (92%). In patients who had FibroScan-defined cirrhosis, neither their APRI nor FIB-4 scores were as reliable as FibroScan for identifying cirrhosis. The lack of accuracy for APRI and FIB-4 was due to low serum-based scores in patients with early onset cirrhosis. Outcomes for patients with HCV who were treated or not treated were tracked using improvement in FibroScan scores, and development of decompensated cirrhosis. For patients who had a subsequent FibroScan performed after HCV eradication (SVR), there was a statistically significant improvement in fibrosis, as compared to the non-treated patients (p Conclusions: FibroScan is useful for evaluating for cirrhosis in a predominantly African American population, including regression of fibrosis after HCV eradication

Trace element geochemistry in Balchit obsidian (Upper Awash, Ethiopia)

autorisation des éditeurs de l'ouvrage par email du 01/07/05The only identified source on the left bank of the Awash River is obsidian of type A (Balchit main lava outcrop). Thus, differences observed among the analysed samples concerning obsidians of types B and C may reflect minor variations among a single source during the emplacement of the lava or refer to unidentified sources upstream or on the left bank basin of the Awash River. Obsidian of type D collected south of the Awash River in Simbiro Creek formations is a grey vitrous fluidal lava with a porphyric microstructure; quartz and feldspar crystals are oriented according to the fluidal structure. This material appears to be an ignimbrite facies which vitreous bedsole rapidly cooled in the contact with the substratum. We have identified several similar ignimbrites in this area. The Balchit obsidian lava and its reworked debris are widely distributed in the paleoenvironment and form a major raw material source for prehistoric artefacts. In the future we may expect to identify more obsidian types in primary and secondary positions and including some flaked by hominids, especially in the southern part of the Melka Kunture are

Control at stability’s edge minimizes energetic costs: expert stick balancing

Stick balancing on the fingertip is a complex voluntary motor task that requires the stabilization of an unstable system. For seated expert stick balancers, the time delay is 0.23 s, the shortest stick that can be balanced for 240 s is 0.32 m and there is a Embedded Image° dead zone for the estimation of the vertical displacement angle in the saggital plane. These observations motivate a switching-type, pendulum–cart model for balance control which uses an internal model to compensate for the time delay by predicting the sensory consequences of the stick's movements. Numerical simulations using the semi-discretization method suggest that the feedback gains are tuned near the edge of stability. For these choices of the feedback gains, the cost function which takes into account the position of the fingertip and the corrective forces is minimized. Thus, expert stick balancers optimize control with a combination of quick manoeuvrability and minimum energy expenditures