Exploring the impact of an Aboriginal Health Worker on hospitalised Aboriginal experiences: lessons from cardiology.

To enhance Aboriginal inpatient care and improve outpatient cardiac rehabilitation utilisation, a tertiary hospital in Western Australia recruited an Aboriginal Health Worker (AHW). Interviews were undertaken with the cardiology AHW, other hospital staff including another AHW, and recent Aboriginal cardiac patients to assess the impact of this position. The impact of the AHW included facilitating culturally appropriate care, bridging communication divides, reducing discharges against medical advice, providing cultural education, increasing inpatient contact time, improving follow-up practices and enhancing patient referral linkages. Challenges included poor job role definition, clinical restrictions and limitations in AHW training for hospital settings. This study demonstrates that AHWs can have significant impacts on Aboriginal cardiac inpatient experiences and outpatient care. Although this study was undertaken in cardiology, the lessons are transferable across the hospital setting

Neonatal exposure to xenobiotic estrogen alters the adult immune response and exacerbates endometriosis in mice [abstract]

Faculty Mentor: Dr. Susan C. Nagel, Obstetrics/Gynecology, and Women's HealthAbstract only availableEndometriosis is a common medical condition affecting 5-10% of women worldwide, and results in severe cramps, pelvic pain, and infertility. The cause of the disease is still unknown. Endometriosis occurs when endometrial tissue, which escapes into the peritoneal cavity via retrograde menstruation, adheres to other tissues in the cavity and causes irritated, inflamed lesions. Studies have suggested that the risk of developing endometriosis increases in women who have been exposed to xenobiotic (foreign to the body) estrogens during developmental stages of life. Thus, it is our hypothesis that programming of the immune system by xenoestrogens during development could potentially exacerbate endometriosis. This could occur by altering the peritoneal environment and/or the invading endometrial tissue. Therefore, it is our goal to study the effects of neonatal xenoestrogen exposure on the immune system; and ultimately, on the establishment of endometriosis in adulthood. In order to study this response, we dosed two strains of mice (CD1 and C57) with xenobiotic estrogens on postnatal days 2-14. In experiment A, CD1 mice were dosed with vehicle control (corn oil), 20 µg/kg/day, or 200 µg/kg/day bisphenol A. In experiment B, C57 mice were dosed with a vehicle control (corn oil) or 0.1 µg/kg/day diethylstilbestrol. At 8 weeks of age, endometriosis was induced in each strain via both a surgical induction and an injection technique. At 12 weeks, the endometriotic implants were counted and weighed to determine which mice had a greater susceptibility to the condition. Our next objective will be to analyze peritoneal fluid from the treated mice to identify key immune functions (for example, the release of certain cytokines) that may have been programmed by developmental xenoestrogen exposure.Endometriosis is a common medical condition affecting 5-10% of women worldwide, and results in severe cramps, pelvic pain, and infertility.  The cause of the disease is still unknown.  Endometriosis occurs when endometrial tissue, which escapes into the peritoneal cavity via retrograde menstruation, adheres to other tissues in the cavity and causes irritated, inflamed lesions.  Studies have suggested that the risk of developing endometriosis increases in women who have been exposed to xenobiotic (foreign to the body) estrogens during developmental stages of life.  Thus, it is our hypothesis that programming of the immune system by xenoestrogens during development could potentially exacerbate endometriosis.  This could occur by altering the peritoneal environment and/or the invading endometrial tissue.  Therefore, it is our goal to study the effects of neonatal xenoestrogen exposure on the immune system; and ultimately, on the establishment of endometriosis in adulthood.  In order to study this response, we dosed two strains of mice (CD1 and C57) with xenobiotic estrogens on postnatal days 2-14.  In experiment A, CD1 mice were dosed with vehicle control (corn oil), 20 µg/kg/day, or 200 µg/kg/day bisphenol A.  In experiment B, C57 mice were dosed with a vehicle control (corn oil) or 0.1 µg/kg/day diethylstilbestrol.  At 8 weeks of age, endometriosis was induced in each strain via both a surgical induction and an injection technique.  At 12 weeks, the endometriotic implants were counted and weighed to determine which mice had a greater susceptibility to the condition.  Our next objective will be to analyze peritoneal fluid from the treated mice to identify key immune functions (for example, the release of certain cytokines) that may have been programmed by developmental xenoestrogen exposure

What Are the Factors that Influence Caregiver/Parent Co-sleeping Education?

poster abstractBackground: In the United States, 13% of infants routinely co-sleep with a caregiver, and 50% of infants share a bed with a caregiver for part of the night. Co-sleeping has been identified as a risk factor for infant death by Sudden Unexplained Infant Death Syndrome (SUIDS). The purpose of this research was to carry out a systematic review for determining best practices related to education to caregivers on the risks of co-sleeping. Method: After a rigorous multi-database search, we accessed 100 research articles related to SUIDS from years 2002-2015 for inclusion for this review. A total of 20 papers related to co-sleeping and SUIDS met the inclusion criteria and were assessed for validity by a primary and secondary reviewer via standardized critical appraisal instruments from the Joanna Briggs Institute. Due to the articles’ descriptive methods, NOTARI (Narrative, Opinion, and Text Assessment and Review Instrument) was used to appraise, extract data, and thematically organize the findings resulting in meta-aggregation. Results: The data extracted included specific details for co-sleeping. We identified that a) educational, b) family dynamics, c) racial/cultural, and d) socioeconomic factors were the significant concepts that influenced the caregivers’ attitude toward co-sleeping and their likelihood to co-sleep. Heterogeneity for the study’s methods was represented in the results. Conclusions: Many caregivers and families that practice co-sleeping display resistance to education about the discontinuation of co-sleeping based on the belief that healthcare providers do not take into account the family’s personal situation. The caregivers are more likely to be receptive to advice regarding safer co-sleeping practices as opposed to omitting the practice of co-sleeping. Family-centered interventions and tailored education delivered by nurses should be identified. Caregiver safe practices for sleep, taking into account situational factors such as socioeconomic level, race, culture, and core beliefs, should be encouraged

Drip Paintings and Fractal Analysis

It has been claimed [1-6] that fractal analysis can be applied to unambiguously characterize works of art such as the drip paintings of Jackson Pollock. This academic issue has become of more general interest following the recent discovery of a cache of disputed Pollock paintings. We definitively demonstrate here, by analyzing paintings by Pollock and others, that fractal criteria provide no information about artistic authenticity. This work has also led to two new results in fractal analysis of more general scientific significance. First, the composite of two fractals is not generally scale invariant and exhibits complex multifractal scaling in the small distance asymptotic limit. Second the statistics of box-counting and related staircases provide a new way to characterize geometry and distinguish fractals from Euclidean objects

A community partnership to evaluate the feasibility of addressing food insecurity among adult patients in an urban healthcare system

BACKGROUND: Food insecurity (FI) is a significant public health problem. Possible sequelae of prolonged food insecurity include kidney disease, obesity, and diabetes. Our objective was to assess the feasibility of a partnership between Henry Ford Health System (HFHS) and Gleaners Community Foodbank of Southeastern Michigan to implement and evaluate a food supplementation intervention initiated in a hospital outpatient clinic setting. METHODS: We established a protocol for using the Hunger Vital Signs to screen HFHS internal medicine patients for food insecurity and established the data sharing infrastructure and agreements necessary for an HFHS-Gleaners partnership that would allow home delivery of food to consenting patients. We evaluated the food supplementation program using a quasi-experimental design and constructing a historical comparison group using the electronic medical record. Patients identified as food insecure through screening were enrolled in the program and received food supplementation twice per month for a total of 12 months, mostly by home delivery. The feasibility outcomes included successful clinic-based screening and enrollment and successful food delivery to consenting patients. Our evaluation compared healthcare utilization between the intervention and historical comparison group during a 12-month observation period using a difference-in-differences (DID) analysis. RESULTS: Of 1691 patients screened, 353 patients (20.9%) met the criteria for FI, of which 340/353 (96.3%) consented, and 256/340 (75.3%) were matched and had data sufficient for analysis. Food deliveries were successfully made to 89.9% of participant households. At follow-up, the intervention group showed greater reductions in emergency department visits than the comparison group, -41.5% and -25.3% reduction, respectively. Similar results were observed for hospitalizations, -55.9% and -17.6% reduction for intervention and control groups, respectively. DID regression analysis also showed lower trends in ED visits and hospitalizations for the intervention group compared to the comparison group. CONCLUSIONS: Results suggest that community-health system partnerships to address patient-reported food insecurity are feasible and potentially could reduce healthcare utilization in these patients. A larger, randomized trial may be the next step in fully evaluating this intervention, perhaps with more outcomes (e.g., medication adherence), and additional covariates (e.g., housing insecurity and financial strain)

Pedestrian Behavior Study to Advance Pedestrian Safety in Smart Transportation Systems Using Innovative LiDAR Sensors

Pedestrian safety is critical to improving walkability in cities. Although walking trips have increased in the last decade, pedestrian safety remains a top concern. In 2020, 6,516 pedestrians were killed in traffic crashes, representing the most deaths since 1990 (NHTSA, 2020). Approximately 15% of these occurred at signalized intersections where a variety of modes converge, leading to the increased propensity of conflicts. Current signal timing and detection technologies are heavily biased towards vehicular traffic, often leading to higher delays and insufficient walk times for pedestrians, which could result in risky behaviors such as noncompliance. Current detection systems for pedestrians at signalized intersections consist primarily of push buttons. Limitations include the inability to provide feedback to the pedestrian that they have been detected, especially with older devices, and not being able to dynamically extend the walk times if the pedestrians fail to clear the crosswalk. Smart transportation systems play a vital role in enhancing mobility and safety and provide innovative techniques to connect pedestrians, vehicles, and infrastructure. Most research on smart and connected technologies is focused on vehicles; however, there is a critical need to harness the power of these technologies to study pedestrian behavior, as pedestrians are the most vulnerable users of the transportation system. While a few studies have used location technologies to detect pedestrians, this coverage is usually small and favors people with smartphones. However, the transportation system must consider a full spectrum of pedestrians and accommodate everyone. In this research, the investigators first review the previous studies on pedestrian behavior data and sensing technologies. Then the research team developed a pedestrian behavioral data collecting system based on the emerging LiDAR sensors. The system was deployed at two signalized intersections. Two studies were conducted: (a) pedestrian behaviors study at signalized intersections, analyzing the pedestrian waiting time before crossing, generalized perception-reaction time to WALK sign and crossing speed; and (b) a novel dynamic flashing yellow arrow (D-FYA) solution to separate permissive left-turn vehicles from concurrent crossing pedestrians. The results reveal that the pedestrian behaviors may have evolved compared with the recommended behaviors in the pedestrian facility design guideline (e.g., AASHTO’s “Green Book”). The D-FYA solution was also evaluated on the cabinet-in-theloop simulation platform and the improvements were promising. The findings in this study will advance the body of knowledge on equitable traffic safety, especially for pedestrian safety in the future