Cultural Sensitivity and African American Women\u27s Compliance With Breast Cancer Screening

Although the incidence of breast cancer is almost the same for middle-aged African American and Caucasian women, the rate of patients\u27 following breast cancer screening and following up recommendations differs. African American women are less likely to follow recommendations and have higher mortality rates when compared to Caucasian women. One factor thought to affect compliance with breast cancer screening and follow up is culturally sensitive communication. This purpose of this quantitative correlational study was to determine if the culturally sensitive communication of a medical center influenced compliance with breast cancer screening and follow up and if compliance has an effect on the stage of breast cancer when diagnosed for African American women between the ages of 50 and 74. The research questions were aligned with the theoretical pathways of the Patient-Centered Culturally Sensitive Healthcare Model. This quantitative cross-sectional study was based on secondary data of African American women aged 50-74 from electronic systems for each Southern California location of a national health maintenance organization between the years 2012-2016. The results of the regression analysis from averages of the scores from the Member Appraisal of Physician/Provider Services questionnaire, determined associations between the cultural sensitivity scores of the African American woman\u27s medical center and their compliance with recommendations for breast cancer screening and follow up after screening. However, no association between the stage of cancer and medical center\u27s cultural sensitivity was found. Results can be used to develop cultural sensitivity interventions at medical centers aimed to enhance African American women\u27s compliance with breast cancer screening and follow-up recommendations

Adaptation and Feasibility Study of a Digital Health Program to Prevent Diabetes among Low-Income Patients: Results from a Partnership between a Digital Health Company and an Academic Research Team.

Background. The feasibility of digital health programs to prevent and manage diabetes in low-income patients has not been adequately explored. Methods. Researchers collaborated with a digital health company to adapt a diabetes prevention program for low-income prediabetes patients at a large safety net clinic. We conducted focus groups to assess patient perspectives, revised lessons for improved readability and cultural relevance to low-income and Hispanic patients, conducted a feasibility study of the adapted program in English and Spanish speaking cohorts, and implemented real-time adaptations to the program for commercial use and for a larger trial of in multiple safety net clinics. Results. The majority of focus group participants were receptive to the program. We modified the curriculum to a 5th-grade reading level and adapted content based on patient feedback. In the feasibility study, 54% of eligible contacted patients expressed interest in enrolling (n = 23). Although some participants' computer access and literacy made registration challenging, they were highly satisfied and engaged (80% logged in at least once/week). Conclusions. Underserved prediabetic patients displayed high engagement and satisfaction with a digital diabetes prevention program despite lower digital literacy skills. The collaboration between researchers and a digital health company enabled iterative improvements in technology implementation to address challenges in low-income populations

Evaluation of the palatability and toxicity of candidate baits and toxicants for mongooses (\u3ci\u3eHerpestes auropunctatus\u3c/i\u3e)

The small Indian mongoose (Herpestes auropunctatus) is an invasive pest species responsible for damage to native avian, reptile, and amphibian species on Hawaii, Croatia, Mauritius, and several Caribbean Islands, among other regions.Mongoose control has been pursued through a variety of means, with varying success. One toxicant, diphacinone, has been shown to be effective in mongooses and is co-labeled in a rodenticide bait for mongoose control in Hawaii; however, preliminary observations indicate low performance as a mongoose toxicant due likely to poor consumption. We evaluated the efficacy and palatability of 10 commercial rodenticide baits, technical diphacinone powder, and two alternative acute toxicants against mongooses in laboratory feeding trials. We observed poor acceptance and subsequent low overall mortality, of the hard grain-based pellets or block formulations typical of most of the commercial rodenticide baits. The exception was Tomcat® bait blocks containing 0.1% bromethalin, an acute neurotoxin, which achieved up to 100% mortality. Mortality among all other commercial rodenticide formulations ranged from 10 to 50%. Three-day feedings of 0.005% technical diphacinone formulated in fresh minced chicken achieved 100% mortality. One-day feedings of para-aminopropiophenone (PAPP), a chemical that reduces the oxygen-carrying capacity of the blood, achieved 100% mortality at concentrations of 0.10 to 0.15%. Bait acceptance of two sodium nitrite formulations (similar toxic mode of action as PAPP) was relatively poor, and mortality averaged 20%. In general, commercially produced rodenticide baits were not preferred by mongooses and had lower mortality rates compared to freshly prepared meat bait formulations. More palatable baits had higher consumption and achieved higher mortality rates. The diphacinone bait registered for rat and mongoose control in Hawaii achieved 20% mortality and was less effective than some of the other commercial or candidate fresh bait products evaluated in this study

Predicting Gull/Human Conflicts with Mathematical Models: A Tool for Management

Gulls are highly adaptable animals that thrive in proximity to humans. Although gulls enjoy legal protection in North America, England, and Europe, they often conflict with human interests by spreading disease, transporting contaminants, fouling public areas with droppings, and colliding with aircraft. Of particular concern are aggregates of loafing gulls that gather on parking lots, rooftops, and airport runways. Loafing in birds is a general state of immobility that involves behaviors such as sleeping, sitting, standing, resting, preening, and defecating. The ability to predict the incidence of aggregated loafing provides a first step toward the amelioration of bird/human conflicts. We used mathematical models to predict the aggregate loafing behavior of gulls as a function of environmental conditions and tested model portability across years, phase of breeding cycle, loafing location, and species. Because groups of loafing birds quickly reassemble after disturbance, algebraic models for the steady-state dynamics can be obtained from the differential equations using time-scale analysis. The accessible management tool requires data collection on an appropriate time scale and information-theoretic model selection from a suite of alternative algebraic models. ©2009 Wiley Periodicals, Inc

Analysis of Iophenoxic Acid Analogues in Small Indian Mongoose (\u3ci\u3eHerpestes Auropunctatus\u3c/i\u3e) Sera for Use as an Oral Rabies Vaccination Biological Marker

The small Indian mongoose (Herpestes auropunctatus) is a reservoir of rabies virus (RABV) in Puerto Rico and comprises over 70% of animal rabies cases reported annually. The control of RABV circulation in wildlife reservoirs is typically accomplished by a strategy of oral rabies vaccination (ORV). Currently no wildlife ORV program exists in Puerto Rico. Research into oral rabies vaccines and various bait types for mongooses has been conducted with promising results. Monitoring the success of ORV relies on estimating bait uptake by target species, which typically involves evaluating a change in RABV neutralizing antibodies (RVNA) post vaccination. This strategy may be difficult to interpret in areas with an active wildlife ORV program or in areas where RABV is enzootic and background levels of RVNA are present in reservoir species. In such situations, a biomarker incorporated with the vaccine or the bait matrix may be useful. We offered 16 captive mongooses placebo ORV baits containing ethyl-iophenoxic acid (et-IPA) in concentrations of 0.4% and 1% inside the bait and 0.14% in the external bait matrix. We also offered 12 captive mongooses ORV baits containing methyl-iophenoxic acid (me-IPA) in concentrations of 0.035%, 0.07% and 0.14% in the external bait matrix. We collected a serum sample prior to bait offering and then weekly for up to eight weeks post offering. We extracted Iophenoxic acids from sera into acetonitrile and quantified using liquid chromatography/mass spectrometry. We analyzed sera for et-IPA or me-IPA by liquid chromatography-mass spectrometry. We found adequate marking ability for at least eight and four weeks for et- and me-IPA, respectively. Both IPA derivatives could be suitable for field evaluation of ORV bait uptake in mongooses. Due to the longevity of the marker in mongoose sera, care must be taken to not confound results by using the same IPA derivative during consecutive evaluations

Analysis of Iophenoxic Acid Analogues in Small Indian Mongoose (\u3ci\u3eHerpestes Auropunctatus\u3c/i\u3e) Sera for Use as an Oral Rabies Vaccination Biological Marker

The small Indian mongoose (Herpestes auropunctatus) is a reservoir of rabies virus (RABV) in Puerto Rico and comprises over 70% of animal rabies cases reported annually. The control of RABV circulation in wildlife reservoirs is typically accomplished by a strategy of oral rabies vaccination (ORV). Currently no wildlife ORV program exists in Puerto Rico. Research into oral rabies vaccines and various bait types for mongooses has been conducted with promising results. Monitoring the success of ORV relies on estimating bait uptake by target species, which typically involves evaluating a change in RABV neutralizing antibodies (RVNA) post vaccination. This strategy may be difficult to interpret in areas with an active wildlife ORV program or in areas where RABV is enzootic and background levels of RVNA are present in reservoir species. In such situations, a biomarker incorporated with the vaccine or the bait matrix may be useful. We offered 16 captive mongooses placebo ORV baits containing ethyl-iophenoxic acid (et-IPA) in concentrations of 0.4% and 1% inside the bait and 0.14% in the external bait matrix. We also offered 12 captive mongooses ORV baits containing methyl-iophenoxic acid (me-IPA) in concentrations of 0.035%, 0.07% and 0.14% in the external bait matrix. We collected a serum sample prior to bait offering and then weekly for up to eight weeks post offering. We extracted Iophenoxic acids from sera into acetonitrile and quantified using liquid chromatography/mass spectrometry. We analyzed sera for et-IPA or me-IPA by liquid chromatography-mass spectrometry. We found adequate marking ability for at least eight and four weeks for et- and me-IPA, respectively. Both IPA derivatives could be suitable for field evaluation of ORV bait uptake in mongooses. Due to the longevity of the marker in mongoose sera, care must be taken to not confound results by using the same IPA derivative during consecutive evaluations

The Otterbein Miscellany - Spring 1991

https://digitalcommons.otterbein.edu/miscellany/1003/thumbnail.jp

Development and internal validation of the multivariable CIPHER (Collaborative Integrated Pregnancy High-dependency Estimate of Risk) clinical risk prediction model

Background: Intensive care unit (ICU) outcome prediction models, such as Acute Physiology And Chronic Health Evaluation (APACHE), were designed in general critical care populations and their use in obstetric populations is contentious. The aim of the CIPHER (Collaborative Integrated Pregnancy High-dependency Estimate of Risk) study was to develop and internally validate a multivariable prognostic model calibrated specifically for pregnant or recently delivered women admitted for critical care.Methods: A retrospective observational cohort was created for this study from 13 tertiary facilities across five high-income and six low- or middle-income countries. Women admitted to an ICU for more than 24 h during pregnancy or less than 6 weeks post-partum from 2000 to 2012 were included in the cohort. A composite primary outcome was defined as maternal death or need for organ support for more than 7 days or acute life-saving intervention. Model development involved selection of candidate predictor variables based on prior evidence of effect, availability across study sites, and use of LASSO (Least Absolute Shrinkage and Selection Operator) model building after multiple imputation using chained equations to address missing data for variable selection. The final model was estimated using multivariable logistic regression. Internal validation was completed using bootstrapping to correct for optimism in model performance measures of discrimination and calibration.Results: Overall, 127 out of 769 (16.5%) women experienced an adverse outcome. Predictors included in the final CIPHER model were maternal age, surgery in the preceding 24 h, systolic blood pressure, Glasgow Coma Scale score, serum sodium, serum potassium, activated partial thromboplastin time, arterial blood gas (ABG) pH, serum creatinine, and serum bilirubin. After internal validation, the model maintained excellent discrimination (area under the curve of the receiver operating characteristic (AUROC) 0.82, 95% confidence interval (CI) 0.81 to 0.84) and good calibration (slope of 0.92, 95% CI 0.91 to 0.92 and intercept of −0.11, 95% CI −0.13 to −0.08).Conclusions: The CIPHER model has the potential to be a pragmatic risk prediction tool. CIPHER can identify critically ill pregnant women at highest risk for adverse outcomes, inform counseling of patients about risk, and facilitate bench-marking of outcomes between centers by adjusting for baseline risk

Experiences during the first four years of a postpartum perineal clinic in the USA

ObjectiveTo assess the characteristics of patients seen at a postpartum perineal clinic in the USA during the first 4 years of its existence, and to identify factors contributing to the clinic’s success.MethodsIn a retrospective study, the charts of patients presenting to the clinic between July 1, 2007, and June 30, 2011, were reviewed for presenting complaint, findings, treatment, number of visits, and referral source. Strategies that led to successful clinic implementation were reviewed.ResultsA total of 247 patients were seen during the 4‐year period. Indications for referral included lacerations, pain, urinary and fecal incontinence, and fistulas. The most common referral indication was a third‐ or fourth‐degree laceration, which affected 154 (62.3%) patients. Overall, 53 (21.5%) patients required a procedure, of whom 20 (8.1%) underwent surgery. Most women were counseled about pelvic floor exercises, and 39 (15.8%) were referred for pelvic floor physical therapy. Nurse‐led triage, patient education, and follow‐up were key to the success of the program.ConclusionThe postpartum perineal clinic is sustainable and offers an opportunity for early assessment and treatment of pelvic floor dysfunction after a complicated vaginal delivery.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135192/1/ijgo68.pd