Health Technology in School-based Health Centers: Supporting Continuous Care During COVID-19

Background: Children and adolescents in the United States face disparities by race, ethnicity, and socioeconomic status, including unequal access to consistent and high-quality healthcare. School-based health centers (SBHCs) promote health equity by delivering primary, mental, and other health services directly to students in their schools. The COVID-19 outbreak in the United States resulted in schools and SBHCs closing their physical sites and pivoting to virtual service delivery. Methods: In the months immediately following school closures, school-based health center practitioners and sponsors participated in an online listening series to share how they used technology to creatively advertise services, engage with students, and continue delivering care. These discussions highlight challenges, opportunities, and future implications for telehealth and the use of technology in SBHCs. Results: With no or limited opportunity to interact with patients in-person, school-based health center staff used technology to conduct marketing and outreach and offer virtual care. Many launched telehealth operations for the first time due to the pandemic, whereas others altered or expanded previously established virtual service offerings. Listening session participants recognize the unique benefits of telehealth during and after the pandemic, but they also discussed unique challenges, such as privacy concerns and the digital divide. Conclusions: The findings outlined in this manuscript should serve as a baseline for future research and programs related to school-based health, health technology, and pediatric care, especially during global crises. Health technology, particularly telehealth, is a crucial tool to mitigate strain on emergency departments, administer screening and preventative care, and provide mental health care as COVID cases continue to rise. Enabling policy solutions, shared best practices, and supportive partnerships are crucial as SBHCs continue to find ways to help students remain healthy and achieve their fullest potential

Health and social care commissioning: an exploration of processes, services and outcomes. Final report.

It is suggested that public sector organisations should work together more effectively to deliver the best services. In recent years this notion of partnership-working has been stressed in terms of the joint commissioning of services. Commissioning is the activity that decides of the services to be provided to local populations and who shall provide and pay for them. The concept of joint commissioning is used here to describe the ways in which health and social care agencies work together to determine this. There is little evidence which describes either the processes or provides clear messages about outcomes it produces. This project proposes an approach which builds on previous experience of evaluating public sector collaborative activities to investigate ways in which joint commissioning operates and the types of outcomes these processes produce for service users. The approach proposed incorporates a range of stakeholders, but in particular front-line staff members and service users within the case-study areas, a factor which has been lacking in previous evaluations. The project aims to produce practical knowledge about the types of joint commissioning activities taking place in England and the outcomes this produces - with the aim that these practical lessons may provide useful learning for other health and social care communities

Using participatory research to expand the customer base of farmers markets

Direct-to-consumer sales (DTC) through farmers markets, CSAs, and urban farm stands is an important venue for bringing fresh, nutritious, and regional food to urban consumers and creating economic and social linkages between urban and peri-urban farms. However, many urban consumers who use government food programs have limited access to DTC markets. Farmers Market LIFE (Local Incentives for Food and Economy) seeks to expand the customer base of farmers market shoppers in Sonoma County, California, through the acceptance of SNAP (the Supplemental Nutrition Assistance Program) and Market Match, a dollar-for-dollar nutrition incentive program that makes farmers markets more economically accessible to low-income shoppers while also increasing overall sales for farmers’ market vendors. We explore the use of “environmental scans” an innovative research instrument used at farmers’ markets to identify social, cultural, linguistic, behavioral and economic obstacles and opportunities for low-income consumers and people of color to shop at farmers’ markets. Community partners co-designed and gathered data about selected farmers markets using environmental scans in fall 2019. This methodology has proved effective in providing insight into farmers’ market dynamics including potential barriers and solutions to make farmers’ markets more accessible and inviting to SNAP customers and people of color. We share results of this tool as a method that others interested in community-engaged research may want to use to investigate their own unique farmers’ market settings and to illustrate the nature of findings from our application of the tool in Sonoma County, California, in 2019

National priorities for dementia care : perspectives of individuals living with dementia and their care partners

The current article reports the consensus recommendations from individuals living with dementia and their care partners on priorities for public policy and research funding, which were found using a nationwide, Delphi study. A modified snowball sample was used. Listservs, personal contacts, and advocacy groups were asked to distribute the survey. Paper versions were provided upon request. In Rounds 1 and 2 of the study, 388 and 301 responses, respectively, were received. Borda counts produced a ranked order consensus of priorities. Research ranked third, after the need for caregiver support and resources for the provision of long-term care. Education and training in person-centered practices for all care partners was also a high priority. Responses indicated that research funding should be expanded beyond its current emphasis on cure. Policymakers should reconsider the current priorities of the National Alzheimer's Project Act to better address the long-term needs of individuals living with dementia and their care partners

Multiple mentoring in academe: Developing the professional network.

Abstract Previous studies in business organizations have shown that mentoring provides numerous benefits for both individuals and organizations. Most of this mentoring research has been based on traditional, hierarchical mentor-prot eg e relationships in non-academic settings. We discuss why there is little empirical research on faculty mentoring and review changes in professorsÕ careers that necessitate a fresh look at this issue. We suggest that because of environmental changes, the traditional model of professors being guided throughout their careers by one primary mentor, usually the dissertation advisor, may no longer be realistic or desirable. Instead, professors may be better served by a portfolio of mentor

IL-1R and MyD88 Contribute to the Absence of a Bacterial Microbiome on the Healthy Murine Cornea

Microbial communities are important for the health of mucosal tissues. Traditional culture and gene sequencing have demonstrated bacterial populations on the conjunctiva. However, it remains unclear if the cornea, a transparent tissue critical for vision, also hosts a microbiome. Corneas of wild-type, IL-1R (-/-) and MyD88 (-/-) C57BL/6 mice were imaged after labeling with alkyne-functionalized D-alanine (alkDala), a probe that only incorporates into the peptidoglycan of metabolically active bacteria. Fluorescence in situ hybridization (FISH) was also used to detect viable bacteria. AlkDala labeling was rarely observed on healthy corneas. In contrast, adjacent conjunctivae harbored filamentous alkDala-positive forms, that also labeled with DMN-Tre, a Corynebacterineae-specific probe. FISH confirmed the absence of viable bacteria on healthy corneas, which also cleared deliberately inoculated bacteria within 24 h. Differing from wild-type, both IL-1R (-/-) and MyD88 (-/-) corneas harbored numerous alkDala-labeled bacteria, a result abrogated by topical antibiotics. IL-1R (-/-) corneas were impermeable to fluorescein suggesting that bacterial colonization did not reflect decreased epithelial integrity. Thus, in contrast to the conjunctiva and other mucosal surfaces, healthy murine corneas host very few viable bacteria, and this constitutive state requires the IL-1R and MyD88. While this study cannot exclude the presence of fungi, viruses, or non-viable or dormant bacteria, the data suggest that healthy murine corneas do not host a resident viable bacterial community, or microbiome, the absence of which could have important implications for understanding the homeostasis of this tissue

Host-linked soil viral ecology along a permafrost thaw gradient

Climate change threatens to release abundant carbon that is sequestered at high latitudes, but the constraints on microbial metabolisms that mediate the release of methane and carbon dioxide are poorly understood1,2,3,4,5,6,7. The role of viruses, which are known to affect microbial dynamics, metabolism and biogeochemistry in the oceans8,9,10, remains largely unexplored in soil. Here, we aimed to investigate how viruses influence microbial ecology and carbon metabolism in peatland soils along a permafrost thaw gradient in Sweden. We recovered 1,907 viral populations (genomes and large genome fragments) from 197 bulk soil and size-fractionated metagenomes, 58% of which were detected in metatranscriptomes and presumed to be active. In silico predictions linked 35% of the viruses to microbial host populations, highlighting likely viral predators of key carbon-cycling microorganisms, including methanogens and methanotrophs. Lineage-specific virus/host ratios varied, suggesting that viral infection dynamics may differentially impact microbial responses to a changing climate. Virus-encoded glycoside hydrolases, including an endomannanase with confirmed functional activity, indicated that viruses influence complex carbon degradation and that viral abundances were significant predictors of methane dynamics. These findings suggest that viruses may impact ecosystem function in climate-critical, terrestrial habitats and identify multiple potential viral contributions to soil carbon cycling

Rheumatic heart disease in pregnancy: strategies and lessons learnt implementing a population-based study in Australia

Background The global burden of rheumatic heart disease (RHD) is two-to-four times higher in women, with a heightened risk in pregnancy. In Australia, RHD is found predominantly among Aboriginal and Torres Strait Islander peoples. Methods This paper reviews processes developed to identify pregnant Australian women with RHD during a 2-year population-based study using the Australasian Maternity Outcomes Surveillance System (AMOSS). It evaluates strategies developed to enhance reporting and discusses implications for patient care and public health. Results AMOSS maternity coordinators across 262 Australian sites reported cases. An extended network across cardiac, Aboriginal and primary healthcare strengthened surveillance and awareness. The network notified 495 potential cases, of which 192 were confirmed. Seventy-eight per cent were Aboriginal and/or Torres Strait Islander women, with a prevalence of 22 per 1000 in the Northern Territory. Discussion Effective surveillance was challenged by a lack of diagnostic certainty, incompatible health information systems and varying clinical awareness among health professionals. Optimal outcomes for pregnant women with RHD demand timely diagnosis and access to collaborative care. Conclusion The strategies employed by this study highlight gaps in reporting processes and the opportunity pregnancy provides for diagnosis and re/engagement with health services to support better continuity of care and promote improved outcomes.The authors gratefully acknowledge aid from the Australian National Health and Medical Research Council (NHMRC) project grant #1024206 and NHMRC Postgraduate Scholarship #11332944; University of Technology Sydney Chancellor’s Research Scholarship; and END RHD Centre of Research Excellence, Telethon Kids Institute, University of Western Australia

Quantitative measures of estrogen receptor expression in relation to breast cancer-specific mortality risk among white women and black women

Abstract Introduction The association of breast cancer patients’ mortality with estrogen receptor (ER) status (ER + versus ER-) has been well studied. However, little attention has been paid to the relationship between the quantitative measures of ER expression and mortality. Methods We evaluated the association between semi-quantitative, immunohistochemical staining of ER in formalin-fixed paraffin-embedded breast carcinomas and breast cancer-specific mortality risk in an observational cohort of invasive breast cancer in 681 white women and 523 black women ages 35-64 years at first diagnosis of invasive breast cancer, who were followed for a median of 10 years. The quantitative measures of ER examined here included the percentage of tumor cell nuclei positively stained for ER, ER Histo (H)-score, and a score based on an adaptation of an equation presented by Cuzick and colleagues, which combines weighted values of ER H-score, percentage of tumor cell nuclei positively stained for the progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) results. This is referred to as the ER/PR/HER2 score. Results After controlling for age at diagnosis, race, study site, tumor stage, and histologic grade in multivariable Cox proportional hazards regression models, both percentage of tumor cell nuclei positively stained for ER (P trend = 0.0003) and the ER H-score (P trend = 0.0004) were inversely associated with breast cancer-specific mortality risk. The ER/PR/HER2 score was positively associated with breast cancer-specific mortality risk in women with ER + tumor (P trend = 0.001). Analyses by race revealed that ER positivity was associated with reduced risk of breast cancer-specific mortality in white women and black women. The two quantitative measures for ER alone provided additional discrimination in breast cancer-specific mortality risk only among white women with ER + tumors (both P trend ≤ 0.01) while the ER/PR/HER2 score provided additional discrimination for both white women (P trend = 0.01) and black women (P trend = 0.03) with ER + tumors. Conclusions Our data support quantitative immunohistochemical measures of ER, especially the ER/PR/HER2 score, as a more precise predictor for breast cancer-specific mortality risk than a simple determination of ER positivity