Using written narratives in public health practice: A creative writing perspective

Narratives have become an increasingly common health communication tool in recent years. Vivid, engaging writing can help audiences identify with storytellers and understand health messages, but few public health practitioners are trained to create such stories. A transdisciplinary perspective, informed by both creative writing advice and evidence-based public health practices, can help public health professionals use stories more effectively in their work. This article provides techniques for creating written narratives that communicate health information for chronic disease prevention. We guide public health professionals through the process of soliciting, writing, and revising such stories, and we discuss challenges and potential solutions

An Assessment of the Republican and Democratic Party Platforms with Respect to Justice

Thesis advisor: Michael KellyThis thesis is an assessment of the notion of justice through the eyes of various philosophers including Aristotle, Montesquieu, the Federalists/Anti-Federalists, Rawls, and Sandel. These philosophies of justice are then applied to the Republican and Democratic platforms to assess which platform is the most just.Thesis (BA) — Boston College, 2013.Submitted to: Boston College. College of Arts and Sciences.Discipline: Carroll School of Management Honors Program.Discipline: Philosophy Honors Program.Discipline: Philosophy

Social Support and Intimate Partnerships in African American Women with Breast Cancer

This mixed methods study investigated social support in African American breast cancer patients in one Midwestern metropolitan area. The study includes a quantitative analysis of social support in 227 African American breast cancer patients participating in a quality of life study, as well as a qualitative component involving a subsample of 15 married participants. In the larger sample, growth curve models were used to assess factors contributing to initial levels of perceived social support and change in social support over time. Interviews with women in the qualitative study allowed an in-depth exploration of how breast cancer affected womens relationships with their partners. Results from both parts of the study show that there is variability in womens and couples adaptation to breast cancer. Clinicians should consider breast cancer patients psychosocial context and provide interventions for women with low levels of social support or women who experience declines in support

Seasonal predictability of the winter North Atlantic Oscillation from a jet stream perspective

The winter North Atlantic Oscillation (NAO) has varied on interannual and decadal timescales over the last century, associated with variations in the speed and latitude of the eddy-driven jet stream. This paper uses hindcasts from two operational seasonal forecast systems (the European Centre for Medium-range Weather Forecasts's seasonal forecast system, and the U.K. Met Office global seasonal forecast system) and a century-long atmosphere-only experiment (using the European Centre for Medium-range Weather Forecasts's Integrated Forecasting System model) to relate seasonal prediction skill in the NAO to these aspects of jet variability. This shows that the NAO skill realized so far arises from interannual variations in the jet, largely associated with its latitude rather than speed. There likely remains further potential for predictability on longer, decadal timescales. In the small sample of models analyzed here, improved representation of the structure of jet variability does not translate to enhanced seasonal forecast skill

Vaccination Options for Medicaid Parents Uncomfortable with Office Visits during COVID Pandemic

Objective: Rates of child vaccinations declined during the COVID pandemic, which increases the risk of outbreaks of preventable diseases among children. Methods: We conducted an online survey of parents of Medicaid beneficiaries age 0-5 years old in Florida USA during January 2021 to assess barriers and strategies to increase adherence to childhood vaccinations. Results: We surveyed 1,951 parents. Most (91%) respondents reported their child was up-to-date with childhood vaccinations, but fewer (36%) children had received a flu shot. Some (31%) parents had wanted to take their child to see a doctor but decided not to, and 22% were not comfortable with in-office visits. Not taking their child to a doctor despite wanting to was associated with lower odds of that child being up-to-date and greater odds of being uncomfortable with in-office visits. Predictors of vaccine adherence included beliefs in their safety, efficacy and being easy to get. Promising strategies for getting parents to vaccinate their children during the pandemic include advertising COVID-compliant cleaning and masking policies, reinforcing parents’ perceived importance and ease of vaccination, and reserving vaccination appointment times for healthy children. Conclusions: Results inform future messaging and structural interventions to encourage parents to vaccinate their children, which also may be useful for encouraging vaccinations recommended for older adolescents including COVID-19 vaccinations. This study demonstrates the importance of vaccination surveillance and identifying which interventions may appeal to parents in order to maintain high adherence rates and avoid outbreaks of preventable diseases in children

Successful Use of a Cadaver Model to Teach Ultrasound-Guided Breast Procedures to Surgical Trainees

IntroductionIn academic breast surgery, ultrasound use tends to be limited to radiology departments, thus formal surgical resident training in breast ultrasound is sparse. Building on residents' ultrasound skills in our general surgery training program, we developed a novel curriculum to teach ultrasound-guided breast procedures (UGBPs), including core needle biopsy (CNB) and wire localization (WL). We hypothesized that learning UGBPs on cadavers would be preferred to learning with a breast phantom model using chicken breasts.MethodsResidents received a 1-h lecture on breast CNB and WL followed by a 1-h hands-on laboratory session. Olives stuffed with red pimentos were used to replicate breast masses and implanted in chicken breasts and the breasts of lightly embalmed and unembalmed female cadavers. All residents practiced UGBPs with a course instructor on both models. Residents completed anonymous prelaboratory and postlaboratory surveys utilizing five-point Likert scales.ResultsA total of 35 trainees participated in the didactics; all completed the prelaboratory survey and 28 completed the postlaboratory survey. Participant clinical year ranged from 1 to 6. Residents' confidence in describing and performing CNBs and WLs increased significantly on postlaboratory surveys, controlling for clinical year (P < 0.001). Eighty-point seven percent preferred learning UGBPs on cadavers over phantoms most commonly citing that the cadaver was more realistic.ConclusionsFollowing a novel 2-h UGBP training curriculum using phantom and cadaveric models, resident confidence in describing and performing UGBPs significantly improved. Most favored the cadaveric model and reported that the course prepared them for real-life procedures

Viral Hepatitis and Rapid Diagnostic Test Based Screening for HBsAg in HIV-infected Patients in Rural Tanzania.

\ud \ud Co-infection with hepatitis B virus (HBV) is highly prevalent in people living with HIV in Sub-Saharan Africa. Screening for HBV surface antigen (HBsAg) before initiation of combination antiretroviral therapy (cART) is recommended. However, it is not part of diagnostic routines in HIV programs in many resource-limited countries although patients could benefit from optimized antiretroviral therapy covering both infections. Screening could be facilitated by rapid diagnostic tests for HBsAg. Operating experience with these point of care devices in HIV-positive patients in Sub-Saharan Africa is largely lacking. We determined the prevalence of HBV and Hepatitis C virus (HCV) infection as well as the diagnostic accuracy of the rapid test device Determine HBsAg in an HIV cohort in rural Tanzania. Prospectively collected blood samples from adult, HIV-1 positive and antiretroviral treatment-naïve patients in the Kilombero and Ulanga antiretroviral cohort (KIULARCO) in rural Tanzania were analyzed at the point of care with Determine HBsAg, a reference HBsAg EIA and an anti-HCV EIA. Samples of 272 patients were included. Median age was 38 years (interquartile range [IQR] 32-47), 169/272 (63%) subjects were females and median CD4+ count was 250 cells/µL (IQR 97-439). HBsAg was detected in 25/272 (9.2%, 95% confidence interval [CI] 6.2-13.0%) subjects. Of these, 7/25 (28%) were positive for HBeAg. Sensitivity of Determine HBsAg was rated at 96% (95% CI 82.8-99.6%) and specificity at 100% (95% CI, 98.9-100%). Antibodies to HCV (anti-HCV) were found in 10/272 (3.7%, 95% CI 2.0-6.4%) of patients. This study reports a high prevalence of HBV in HIV-positive patients in a rural Tanzanian setting. The rapid diagnostic test Determine HBsAg is an accurate assay for screening for HBsAg in HIV-1 infected patients at the point of care and may further help to guide cART in Sub-Saharan Africa

Ethical, legal and social issues in diversifying genomic data: literature review and synthesis

Advances in technology have resulted in the ability to sequence entire human genomes as a routine, relatively inexpensive, investigation in healthcare. This offers many promises of personalising, stratifying, and targeting healthcare with an understanding of genetic susceptibility to particular diseases or conditions. However, research collections (databases, biobanks etc) that underpin these developments are significantly skewed towards populations of European ancestry meaning that our understanding of genetic susceptibility (or indeed of genetic protection to disease) is less good for many other populations in the world. Just as a dermatology text book skewed towards skin problems on white skin may be less useful to black populations, so genomic knowledge derived from one particular ancestry means it may be less useful to people with different ancestries. The need to diversify genomic data, to improve the evidence base for genomic medicine for all ancestries, is well recognised, but is more complex than simply increasing the collection of data from people from a range of ancestries. We reviewed the literature to understand the challenges of diversifying genomic data to identify key ethical, legal and social issues. Our findings were: 1. Many research practices are exclusionary and need to change. Examples include approaches to recruitment or data collection that do not consider the cultural setting in which potential participants are situated. Research also often lacks reflexivity about diversity on the part of researchers and research institutions. 2. Co-design is key to identifying and avoiding potential problems around data diversification. This requires an understanding of the concerns of underserved individuals and communities regarding exploitation and stigmatisation, as well as issues of data ownership and sovereignty. Without attention to group as well as individual concerns, participant engagement may become tokenistic which in turn risks exacerbating existing, as well as creating new, inequalities. 3. There are wider structural issues that influence researchers’ and participants’ attempts to generate diverse data. For example, (a) some researchers view data as neutral, but this ignores the social construction of data and technologies, and their tendencies to reflect societal inequalities. (b). Efforts to diversify data should be contextualised within the historical trajectory of structural racism and legacies of colonialism. (c) Classification and categorisation of populations have political consequences and need to be closely interrogated. These findings show that deliberation between researchers and participants, during all stages of research from planning and recruitment through to analysis, interpretation and dissemination is key to successful diversification

Made by hand

Although the mainstream animation industry has adopted digital production methods, the attraction of laborious hand-made methods for making animation persists in the independent sector. The chapter considers how ‘craftivist’ opposition to mechanical, technological and digital techniques is validated in this community of practice through ideas that haptic knowledge by skilled physical labour and an exploration of materiality, autographic mark-making and imperfection (Wabi-sabi) are guarantors of authenticity and individuality that can only be carried out by hand. Why is this? What ideas and assumptions can be seen to underpin the notions of craft and crafting? Tracing connections between craft and activism since the Industrial Revolution, this chapter critically reflects on discourses of craft and the handmade through reference to Ruskin (1851), Morris (1892), Hobsbawm (2000), Thompson (1980), Benjamin (1935), Krauss (2000) and Takahashi (2005). Whereas the experimental animation community privileges analogue, handmade processes that appear to oppose and critique commercial animation production, building upon Warburton (2016) and Frayling (2017) it is argued here that this approach is underpinned by nostalgia and often faked. What looks like a hand-painted animation could actually be a simulation that was ‘painted’ in a software package: a pastiche of manual labour. Aesthetics alone do not guarantee that a work of art opposes the mainstream. Instead of recycling the past to create ‘artistic’ animation, it is argued in the conclusion that contemporary practitioners can equally investigate issues of labour and materiality through digital tools and virtual materials such as in the ‘ugly’ CGI animation of Nikita Daikur (2017)

Implementing core outcomes in kidney disease: report of the Standardized Outcomes in Nephrology (SONG) implementation workshop.

There are an estimated 14,000 randomized trials published in chronic kidney disease. The most frequently reported outcomes are biochemical endpoints, rather than clinical and patient-reported outcomes including cardiovascular disease, mortality, and quality of life. While many trials have focused on optimizing kidney health, the heterogeneity and uncertain relevance of outcomes reported across trials may limit their policy and practice impact. The international Standardized Outcomes in Nephrology (SONG) Initiative was formed to identify core outcomes that are critically important to patients and health professionals, to be reported consistently across trials. We convened a SONG Implementation Workshop to discuss the implementation of core outcomes. Eighty-two patients/caregivers and health professionals participated in plenary and breakout discussions. In this report, we summarize the findings of the workshop in two main themes: socializing the concept of core outcomes, and demonstrating feasibility and usability. We outline implementation strategies and pathways to be established through partnership with stakeholders, which may bolster acceptance and reporting of core outcomes in trials, and encourage their use by end-users such as guideline producers and policymakers to help improve patient-important outcomes