Using Intervention Mapping to Develop an Efficacious Multicomponent Systems-Based Intervention to Increase Human Papillomavirus (HPV) Vaccination in a Large Urban Pediatric Clinic Network

Background: The CDC recommends HPV vaccine for all adolescents to prevent cervical, anal, oropharyngeal, vaginal, vulvar, and penile cancers, and genital warts. HPV vaccine rates currently fall short of national vaccination goals. Despite evidence-based strategies with demonstrated efficacy to increase HPV vaccination rates, adoption and implementation of these strategies within clinics is lacking. The Adolescent Vaccination Program (AVP) is a multicomponent systems-based intervention designed to implement five evidence-based strategies within primary care pediatric practices. The AVP has demonstrated efficacy in increasing HPV vaccine initiation and completion among adolescents 10-17 years of age. The purpose of this paper is to describe the application of Intervention Mapping (IM) toward the development, implementation, and formative evaluation of the clinic-based AVP prototype. Methods: Intervention Mapping (IM) guided the development of the Adolescent Vaccination Program (AVP). Deliverables comprised: a logic model of the problem (IM Step 1); matrices of behavior change objectives (IM Step 2); a program planning document comprising scope, sequence, theory-based methods, and practical strategies (IM Step 3); functional AVP component prototypes (IM Step 4); and plans for implementation (IM Step 5) and evaluation (IM Step 6). Results: The AVP consists of six evidence-based strategies implemented in a successful sequenced roll-out that (1) established immunization champions in each clinic, (2) disseminated provider assessment and feedback reports with data-informed vaccination goals, (3) provided continued medical and nursing education (with ethics credit) on HPV, HPV vaccination, message bundling, and responding to parent hesitancy, (4) electronic health record cues to providers on patient eligibility, and (5) patient reminders for HPV vaccine initiation and completion. Conclusions: IM provided a logical and systematic approach to developing and evaluating a multicomponent systems-based intervention to increase HPV vaccination rates among adolescents in pediatric clinics

Teaching with Feminist Judgments: A Global Conversation

This conversational-style essay is an exchange among fourteen professors—representing thirteen universities across five countries—with experience teaching with feminist judgments. Feminist judgments are ‘shadow’ court decisions rewritten from a feminist perspective, using only the precedent in effect and the facts known at the time of the original decision. Scholars in Canada, England, the U.S., Australia, New Zealand, Scotland, Ireland, India, and Mexico have published (or are currently producing) written collections of feminist judgments that demonstrate how feminist perspectives could have changed the legal reasoning or outcome (or both) in important legal cases. This essay begins to explore the vast pedagogical potential of feminist judgments. The contributors to this conversation describe how they use feminist judgments in the classroom; how students have responded to the judgments; how the professors achieve specific learning objectives through teaching with feminist judgments; and how working with feminist judgments—whether studying them, writing them, or both—can help students excavate the multiple social, political, economic, and even personal factors that influence the development of legal rules, structures, and institutions. The primary takeaway of the essay is that feminist judgments are a uniquely enriching pedagogical tool that can broaden the learning experience. Feminist judgments invite future lawyers, and indeed any reader, to re-imagine what the law is, what the law can be, and how to make the law more responsive to the needs of all people

Mid-gestation Angiogenic Biomarker Levels are Increased in Women at High Risk for Preeclampsia

Background: Pre-pregnancy hypertension and diabetes mellitus, multiple gestations, prior preeclampsia, are significant risk factors for preeclampsia. Whether altered maternal levels of angiogenic factors contribute to increased preeclampsia risk in these conditions is unknown. Our objective was to compare maternal serum angiogenic biomarker levels in women with major risk factors for preeclampsia and healthy controls. Methods: Women presenting for prenatal care were enrolled if they had one of the following preeclampsia risk factors: pre-pregnancy hypertension and/or diabetes mellitus, nulliparity with pre-pregnancy BMI\u3e30, multiple gestations, or prior preeclampsia. Healthy control pregnancies without these risk factors were enrolled for comparison. Maternal serum samples were collected at 3 pre-specified gestational windows between 23 and 36 weeks gestation. sFlt1, sEng, and PlGF were measured by ELISA. The (sFlt1+sEng):PlGF ratio was calculated and compared for each risk group at each gestational window. Results: Gestational patterns of angiogenic biomarkers differed in high-risk groups vs. healthy control subjects. The angiogenic ratio (sFlt1+sEng):PlGF was higher for all high risk groups except obesity/nulliparity as compared with healthy control subjects after 28 weeks gestation. Biomarker ratio levels were highest in subjects with MG and prior PE, and differences from the health control group became more pronounced as gestation progressed. Women with hypertension/diabetes had more subtle differences as compared with healthy control subjects. Conclusion: Women with preeclampsia risk factors had higher angiogenic ratios compared with healthy control women. This study illuminates the interplay between risk factors and placental angiogenic biomarkers in the pathogenesis of preeclampsia

Neutron Resonance Spectroscopy of 106Pd, and 108Pd from 20–2000 eV

Parity nonconserving asymmetries have been measured in p-wave resonances of 106Pd and 108Pd. The data analysis requires knowledge of the neutron resonance parameters. Transmission and capture γ-ray yields were measured for En=20–2000 eV with the time-of-flight method at the Los Alamos Neutron Science Center (LANSCE). A total of 28 resonances in 106Pd and 32 resonances in 108Pd were studied. The resonance parameters for 106Pd are new for all except one resonance. In 108Pd six new resonances were observed and the precision improved for many of the resonance parameters. A Bayesian analysis was used to assign orbital angular momentum for the resonances studied

Parity Nonconservation in 106Pd and 108Pd Neutron Resonances

Parity nonconservation (PNC) has been studied in the neutron p-wave resonances of 106Pd and 108Pd in the energy range of 20 to 2000 eV. Longitudinal asymmetries in p-wave capture cross sections are measured using longitudinally polarized neutrons incident on ∼20-g metal-powder targets at LANSCE. A CsI γ-ray detector array measures capture cross section asymmetries as a function of neutron energy which is determined by the neutron time-of-flight method. A total of 21 p-wave resonances in 106Pd and 21 p-wave resonances in 108Pd were studied. One statistically significant PNC effect was observed in106Pd, and no effects were observed in 108Pd. For 106Pd a weak spreading width of Γw=34-28+47×10-7 eV was obtained. For 108Pd an upper limit on the weak spreading width of Γw\u3c12×10-7 eV was determined at the 68% confidence level

Parity Violation in Neutron Resonances of Palladium

Parity violation in p-wave neutron resonances of the palladium isotopes 104, 105, 106, and 108 has been measured by transmission of a longitudinally polarized neutron beam through a natural palladium target. The measurements were performed at the pulsed spallation neutron source of Los Alamos Neutron Science Center. The rms weak interaction matrix elements and the corresponding spreading widths were determined for 104 Pd, 105 Pd, and 106 P

Neutron Resonance Spectroscopy of 103Rh from 30 eV to 2 keV

Neutron resonances in 103Rh have been measured for neutron energies from 30 to 2000 eV using the time-of-flight method and the (n,γ) reaction. The rhodium resonance spectroscopy is essential for the analysis of parity violation measurements recently performed on neutron resonances in 103Rh. Neutron scattering and radiative widths were determined, and orbital angular momentum assignments made with a Bayesian analysis. The s-wave and p-wave strength functions and average level spacings were determined

Parity Violation in Neutron Resonances of 103Rh

Parity nonconservation (PNC) was studied in p-wave neutron resonances of 103Rh in the neutron energy range 30 to 490 eV. The helicity dependence of the neutron total cross section of rhodium was determined by capture measurements with the time-of-flight method at the Manuel Lujan Neutron Scattering Center at the Los Alamos National Laboratory. A total of 32 p-wave resonances were studied and statistically significant longitudinal asymmetries were observed for resonances at En=44.5, 110.8, 321.6, and 432.9 eV. A statistical analysis treating the PNC matrix elements as random variables yields a weak spreading widthΓw=(1.42-0.59+1.21)×10-7eV

Neutron Resonance Spectroscopy of 104Pd, 105Pd, and 110Pd

We have measured neutron resonances in the palladium isotopes 104, 105, and 110 for neutron energies from 1 to 2100 eV. Many new p-wave resonances have been observed. Their neutron widths and, in several cases, the radiative widths were measured. The average level spacings and the s-wave and p-wave neutron strength functions were determined. The time-of-flight method was used for both neutron total cross section measurements and total (n,γ) reaction yield measurements at the pulsed spallation neutron source of Los Alamos Neutron Science Center. Well established resonance spectroscopy for these isotopes is essential for the analysis of parity violation data that were recently measured in palladium

Neutron Resonance Spectroscopy of 117Sn from1 eV to 1.5 keV

Parity violation has been studied recently for neutron resonances in 117Sn. The neutron resonance spectroscopy is essential for the analysis of the parity violation data. We have measured neutron resonances in 117Sn for neutron energies from 1 to 1500 eV using the time-of-flight method and the (n,γ) reaction. The sample was enriched to 87.6% 117Sn. Neutron scattering and radiative widths were determined, and orbital angular momentum assignments were made with a Bayesian analysis. The s-wave and p-wave strength functions and average level spacings were determined