Revolutionizing Health Care Access: Developing a Mobile App for Women and LGBTQIA+ Community Members

Introduction: People who identify themselves, as members of the LGBTQIA+ community are diverse, coming from all walks of life, and include people of all races and ethnicities, ages, socioeconomic statuses and from all parts of the country. A Meta analysis study conducted by the CDC in 2017 estimates that nearly one million adults in the US is transgender (CDC). Despite the fact that these individuals are members of every community, they continue to experience barriers in accessing health care services such as discrimination, unwelcoming attitudes, and lack of understanding and fear from providers and staff in many health care settings (CDC and GLMA). Consequently, LGBTQIA+ individuals are often reluctant to seek medical care except in situations that feel urgent and even then, many still will not access health care services. Other barriers and challenges that lead to disparity in healthcare for the LGBTQIA+ community mirror those faced by women as well, including lack of reliable and affordable healthcare insurance, high co-pay and hidden fees at the time of payment especially as it relates to sexual healthcare and longer and unexpected wait times. Community resources to inform and guide women and LGBTQIA+ persons of free clinics and healthcare settings that provide culturally competent medical care and prevention services to this population are lacking. This presentation will discuss one authors’ journey to reliable and affordable healthcare as limited and discriminatory and how that led to the development of a survey she designed to understand the user and their thoughts on how to streamline the process of finding a free clinic. The process of developing a mobile geographical application that provides detailed information about community clinics specializing in healthcare services for women and LGBTQIA+ individuals will also be addressed. Objective: A clear need to provide the community with an application that was easy to use, supply basic logistical information regarding free clinics, and the ability to specify what services were available regarding women’s and LGBTQ+ sexual health. Methods: Analyzing existing applications that provide similar services presented the shortcomings and successes of what currently exists. Using data from surveys and interviews, user personas helped develop an empathetic understanding of the targeted demographics’ goals, wants, and needs when using the application. Data from a virtual card sort was collected to dictate how the information within the application was arranged. Usability testing with a prototype determined the viability of the design and its effciency in meeting the user\u27s goals. Results: From participant responses, it was determined that this technology would have tremendous benefits to the under-represented community of women and LGBTQIA+ members seeking qualified, cost prohibitive health care services. Themes gathered from the focus group participants include: • Autonomy • Privacy • Advocacy Conclusion: Although there is an identified need for this particular mobile application, the prototype remains in a hiatus status as other design assignments have prioritized and occupied the time that could be devoted to this product launch. The intent is to continue to develop this product and make it available in the near future.https://jdc.jefferson.edu/sexandgenderhealth/1010/thumbnail.jp

Inflation with Non-minimal Gravitational Couplings and Supergravity

We explore in the supergravity context the possibility that a Higgs scalar may drive inflation via a non-minimal coupling to gravity characterised by a large dimensionless coupling constant. We find that this scenario is not compatible with the MSSM, but that adding a singlet field (NMSSM, or a variant thereof) can very naturally give rise to slow-roll inflation. The inflaton is necessarily contained in the doublet Higgs sector and occurs in the D-flat direction of the two Higgs doublets.Comment: 13 pages, 1 figur

LHC and lepton flavour violation phenomenology of a left-right extension of the MSSM

We study the phenomenology of a supersymmetric left-right model, assuming minimal supergravity boundary conditions. Both left-right and (B-L) symmetries are broken at an energy scale close to, but significantly below the GUT scale. Neutrino data is explained via a seesaw mechanism. We calculate the RGEs for superpotential and soft parameters complete at 2-loop order. At low energies lepton flavour violation (LFV) and small, but potentially measurable mass splittings in the charged scalar lepton sector appear, due to the RGE running. Different from the supersymmetric 'pure seesaw' models, both, LFV and slepton mass splittings, occur not only in the left- but also in the right slepton sector. Especially, ratios of LFV slepton decays, such as Br(${\tilde\tau}_R \to \mu \chi^0_1$)/Br(${\tilde\tau}_L \to \mu \chi^0_1$) are sensitive to the ratio of (B-L) and left-right symmetry breaking scales. Also the model predicts a polarization asymmetry of the outgoing positrons in the decay $\mu^+ \to e^+ \gamma$, A ~ [0,1], which differs from the pure seesaw 'prediction' A=1$. Observation of any of these signals allows to distinguish this model from any of the three standard, pure (mSugra) seesaw setups.Comment: 43 pages, 17 figure

When Anomaly Mediation is UV Sensitive

Despite its successes---such as solving the supersymmetric flavor problem---anomaly mediated supersymmetry breaking is untenable because of its prediction of tachyonic sleptons. An appealing solution to this problem was proposed by Pomarol and Rattazzi where a threshold controlled by a light field deflects the anomaly mediated supersymmetry breaking trajectory, thus evading tachyonic sleptons. In this paper we examine an alternate class of deflection models where the non-supersymmetric threshold is accompanied by a heavy, instead of light, singlet. The low energy form of this model is the so-called extended anomaly mediation proposed by Nelson and Weiner, but with potential for a much higher deflection threshold. The existence of this high deflection threshold implies that the space of anomaly mediated supersymmetry breaking deflecting models is larger than previously thought.Comment: 14 pages, 1 figure (version to appear in JHEP

Designing an automated clinical decision support system to match clinical practice guidelines for opioid therapy for chronic pain

Abstract Background Opioid prescribing for chronic pain is common and controversial, but recommended clinical practices are followed inconsistently in many clinical settings. Strategies for increasing adherence to clinical practice guideline recommendations are needed to increase effectiveness and reduce negative consequences of opioid prescribing in chronic pain patients. Methods Here we describe the process and outcomes of a project to operationalize the 2003 VA/DOD Clinical Practice Guideline for Opioid Therapy for Chronic Non-Cancer Pain into a computerized decision support system (DSS) to encourage good opioid prescribing practices during primary care visits. We based the DSS on the existing ATHENA-DSS. We used an iterative process of design, testing, and revision of the DSS by a diverse team including guideline authors, medical informatics experts, clinical content experts, and end-users to convert the written clinical practice guideline into a computable algorithm to generate patient-specific recommendations for care based upon existing information in the electronic medical record (EMR), and a set of clinical tools. Results The iterative revision process identified numerous and varied problems with the initially designed system despite diverse expert participation in the design process. The process of operationalizing the guideline identified areas in which the guideline was vague, left decisions to clinical judgment, or required clarification of detail to insure safe clinical implementation. The revisions led to workable solutions to problems, defined the limits of the DSS and its utility in clinical practice, improved integration into clinical workflow, and improved the clarity and accuracy of system recommendations and tools. Conclusions Use of this iterative process led to development of a multifunctional DSS that met the approval of the clinical practice guideline authors, content experts, and clinicians involved in testing. The process and experiences described provide a model for development of other DSSs that translate written guidelines into actionable, real-time clinical recommendations.http://deepblue.lib.umich.edu/bitstream/2027.42/78267/1/1748-5908-5-26.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/2/1748-5908-5-26.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/3/1748-5908-5-26-S3.TIFFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/4/1748-5908-5-26-S2.TIFFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/5/1748-5908-5-26-S1.TIFFPeer Reviewe

Organism-sediment interactions govern post-hypoxia recovery of ecosystem functioning

Hypoxia represents one of the major causes of biodiversity and ecosystem functioning loss for coastal waters. Since eutrophication-induced hypoxic events are becoming increasingly frequent and intense, understanding the response of ecosystems to hypoxia is of primary importance to understand and predict the stability of ecosystem functioning. Such ecological stability may greatly depend on the recovery patterns of communities and the return time of the system properties associated to these patterns. Here, we have examined how the reassembly of a benthic community contributed to the recovery of ecosystem functioning following experimentally-induced hypoxia in a tidal flat. We demonstrate that organism-sediment interactions that depend on organism size and relate to mobility traits and sediment reworking capacities are generally more important than recovering species richness to set the return time of the measured sediment processes and properties. Specifically, increasing macrofauna bioturbation potential during community reassembly significantly contributed to the recovery of sediment processes and properties such as denitrification, bedload sediment transport, primary production and deep pore water ammonium concentration. Such bioturbation potential was due to the replacement of the small-sized organisms that recolonised at early stages by large-sized bioturbating organisms, which had a disproportionately stronger influence on sediment. This study suggests that the complete recovery of organism-sediment interactions is a necessary condition for ecosystem functioning recovery, and that such process requires long periods after disturbance due to the slow growth of juveniles into adult stages involved in these interactions. Consequently, repeated episodes of disturbance at intervals smaller than the time needed for the system to fully recover organism-sediment interactions may greatly impair the resilience of ecosystem functioning.

Global variation in the cost of increasing ecosystem carbon

Slowing the reduction, or increasing the accumulation, of organic carbon stored in biomass and soils has been suggested as a potentially rapid and cost-effective method to reduce the rate of atmospheric carbon increase(1). The costs of mitigating climate change by increasing ecosystem carbon relative to the baseline or business-as-usual scenario has been quantified in numerous studies, but results have been contradictory, as both methodological issues and substance differences cause variability(2). Here we show, based on 77 standardized face-to-face interviews of local experts with the best possible knowledge of local land-use economics and sociopolitical context in ten landscapes around the globe, that the estimated cost of increasing ecosystem carbon varied vastly and was perceived to be 16-27 times cheaper in two Indonesian landscapes dominated by peatlands compared with the average of the eight other landscapes. Hence, if reducing emissions from deforestation and forest degradation (REDD+) and other land-use mitigation efforts are to be distributed evenly across forested countries, for example, for the sake of international equity, their overall effectiveness would be dramatically lower than for a cost-minimizing distribution.Peer reviewe

Human Immunity and the Design of Multi-Component, Single Target Vaccines

BACKGROUND: Inclusion of multiple immunogens to target a single organism is a strategy being pursued for many experimental vaccines, especially where it is difficult to generate a strongly protective response from a single immunogen. Although there are many human vaccines that contain multiple defined immunogens, in almost every case each component targets a different pathogen. As a consequence, there is little practical experience for deciding where the increased complexity of vaccines with multiple defined immunogens vaccines targeting single pathogens will be justifiable. METHODOLOGY/PRINCIPAL FINDINGS: A mathematical model, with immunogenicity parameters derived from a database of human responses to established vaccines, was used to predict the increase in the efficacy and the proportion of the population protected resulting from addition of further immunogens. The gains depended on the relative protection and the range of responses in the population to each immunogen and also to the correlation of the responses between immunogens. In most scenarios modeled, the gain in overall efficacy obtained by adding more immunogens was comparable to gains obtained from a single immunogen through the use of better formulations or adjuvants. Multi-component single target vaccines were more effective at decreasing the proportion of poor responders than increasing the overall efficacy of the vaccine in a population. CONCLUSIONS/SIGNIFICANCE: Inclusion of limited number of antigens in a vaccine aimed at targeting a single organism will increase efficacy, but the gains are relatively modest and for a practical vaccine there are constraints that are likely to limit multi-component single target vaccines to a small number of key antigens. The model predicts that this type of vaccine will be most useful where the critical issue is the reduction in proportion of poor responders

A generic anti-QCD jet tagger

New particles beyond the Standard Model might be produced with a very high boost, for instance if they result from the decay of a heavier particle. If the former decay hadronically, then their signature is a single massive fat jet which is di cult to separate from QCD backgrounds. Jet substructure and machine learning techniques allow for the discrimination of many speci c boosted objects from QCD, but the scope of possibilities is very large, and a suite of dedicated taggers may not be able to cover every possibility | in addition to making experimental searches cumbersome. In this paper we describe a generic model-independent tagger that is able to discriminate a wide variety of hadronic boosted objects from QCD jets using N-subjettiness variables, with a signi cance improvement varying between 2 and 8. This is in addition to any improvement that might come from a cut on jet mass. Such a tagger can be used in model-independent searches for new physics yielding fat jets. We also show how such a tagger can be applied to signatures over a wide range of jet masses without sculpting the background distributions, allowing to search for new physics as bumps on jet mass distributions.The work of JAAS is supported by MINECO Projects FPA 2016-78220-C3-1-P and FPA 2013-47836-C3-2-P (including ERDF), and by Junta de Andalucía Project FQM-101. The work of JHC and RKM is supported by NSF under Grant No. PHY-1620074 and by the Maryland Center for Fundamental Physics (MCFP)