Richmond City Health District (RCHD), Bon Secours Richmond City Hospital (RCH), and Virginia Commonwealth Universities (VCU) Department of Health Behavior Policy (HBP): Partnering with Community Health Workers (CHW) to Improve Community Health Outcomes and Reduce Emergency Department (ED) Use

Background: Frequent ED users (5%) are sicker, poorer, not satisfied with the health system and cost 20% of total ED charges. Objective: A pilot study of feasibility of partnering with CHW to improve health knowledge and outcomes and reduce ED use in low income community. Methods: RCH ED utilizers were randomized to intervention and control groups. CHW contacted intervention group within 10 days of ED visit, surveyed about access to care, healthy living, and knowledge about chronic disease, and offered education, referrals to insurance and social and economic support. ED utilization and cost were recorded for all patients for 6 months. Preventable ED visits were classified according to Johnston et al1 and high utilizers have 2+ ED visits. Intervention and control characteristics and ED utilizations and cost were described and compared using t-tests, ANOVA, and Chi-square at alpha=0.1. Adjusted analyses were performed using linear and logistic regressions. Results: 91 and 61 randomized to intervention and control with 29 and 23 high utilizers respectively. Drop-in percent of patients with all and preventable ED visits was higher among intervention (12 and 17 percentage points, respectively). 65% of the total ED cost is preventable in the pre-intervention period. That dropped by 17 and 7% in intervention period among the intervention and control groups. The intervention estimated cost savings were $120K. Intervention group had significant improvement in self-reported general health, regular exercise, understanding of health benefits and chronic disease. Conclusions: hospital, academic, and CHW partnership reduces ED utilization and cost and improves health.https://scholarscompass.vcu.edu/gradposters/1116/thumbnail.jp

Understanding the public health role, motivations, and perceptions of Community Health Workers deployed to Low-Income Housing in Richmond, Virginia

Background For the US health indicators to improve to the level of other developed countries, the use of Community Health Workers (CHWs) in vulnerable populations has been indicated as a possible long-term intervention. There are few models of long-term deployment of CHWs as part of the district level public health system in the US. Method In this study we interviewed CHWs who served as neighborhood-integrated health district staff assigned to low-income housing in Richmond, Virginia for 10 years. Qualitative analyses of their taped and transcribed interviews resulted in 5 themes from the interviews. The themes were Activities, Satisfaction, Strengths, Facilitation/Resources and Challenges. We highlighted quotes from the CHWs interviews for themes and summarized the findings from each theme. Results CHWs carried out a variety of activities daily and these were described. The CHWs were generally satisfied with their job because it enabled them to assist others. The strength of their communities was resilience, and the resources they needed more included physical resources, human resources, political support, and more comprehensive programming. Their client’s challenges include transportation, mental health, and physical safety and the CHWs challenge to effectively carrying out their work with clients was trust by community members. Conclusion The information garnered from the CHWs would be useful in designing CHW programs at other health districts

Tuning the bandgap of Cs2AgBiBr6 through dilute tin alloying.

The promise of lead halide hybrid perovskites for optoelectronic applications makes finding less-toxic alternatives a priority. The double perovskite Cs2AgBiBr6 (1) represents one such alternative, offering long carrier lifetimes and greater stability under ambient conditions. However, the large and indirect 1.95 eV bandgap hinders its potential as a solar absorber. Here we report that alloying crystals of 1 with up to 1 atom% Sn results in a bandgap reduction of up to ca. 0.5 eV while maintaining low toxicity. Crystals can be alloyed with up to 1 atom% Sn and the predominant substitution pathway appears to be a ∼2 : 1 substitution of Sn2+ and Sn4+ for Ag+ and Bi3+, respectively, with Ag+ vacancies providing charge compensation. Spincoated films of 1 accommodate a higher Sn loading, up to 4 atom% Sn, where we see mostly Sn2+ substitution for both Ag+ and Bi3+. Density functional theory (DFT) calculations ascribe the bandgap redshift to the introduction of Sn impurity bands below the conduction band minimum of the host lattice. Using optical absorption spectroscopy, photothermal deflection spectroscopy, X-ray absorption spectroscopy, 119Sn NMR, redox titration, single-crystal and powder X-ray diffraction, multiple elemental analysis and imaging techniques, and DFT calculations, we provide a detailed analysis of the Sn content and oxidation state, dominant substitution sites, and charge-compensating defects in Sn-alloyed Cs2AgBiBr6 (1:Sn) crystals and films. An understanding of heterovalent alloying in halide double perovskites opens the door to a wider breadth of potential alloying agents for manipulating their band structures in a predictable manner

MFA09 (MFA 2009)

Catalogue of a culminating student exhibition held at the Mildred Lane Kemper Art Museum in 2009. Content includes A new paradigm / Carmon Colangelo -- Evolving practices / Patricia Olynyk -- Stephanie Barenz -- Carolyn Dawn Bendel -- Jacob Cruzen -- Rachel Ann Dennis -- Bryan Eaton -- Maya Escobar -- Meredith Foster -- Morgan Gehris -- Gina Grafos -- Stephen Hoskins -- Amelia Jones -- Hye Young Kim -- Anne Lindberg -- Goran Maric -- Kelda Martensen -- Erica L. Millspaugh -- Carianne Noga -- Joel Parker -- Rebecca C. Potts -- Shannon Randol -- Elaine Rickles -- Michael Kenneth Smith -- Dan Solberg -- Natalie Toney -- Glenn Tramantano -- Kathryn Trout -- J. Taylor Wallace.https://openscholarship.wustl.edu/books/1006/thumbnail.jp

Persistence of Nontuberculous Mycobacteria in a Drinking Water System after Addition of Filtration Treatment

There is evidence that drinking water may be a source of infections with pathogenic nontuberculous mycobacteria (NTM) in humans. One method by which NTM are believed to enter drinking water distribution systems is by their intracellular colonization of protozoa. Our goal was to determine whether we could detect a reduction in the prevalence of NTM recovered from an unfiltered surface drinking water system after the addition of ozonation and filtration treatment and to characterize NTM isolates by using molecular methods. We sampled water from two initially unfiltered surface drinking water treatment plants over a 29-month period. One plant received the addition of filtration and ozonation after 6 months of sampling. Sample sites included those at treatment plant effluents, distributed water, and cold water taps (point-of-use [POU] sites) in public or commercial buildings located within each distribution system. NTM were recovered from 27% of the sites. POU sites yielded the majority of NTM, with >50% recovery despite the addition of ozonation and filtration. Closely related electrophoretic groups of Mycobacterium avium were found to persist at POU sites for up to 26 months. Water collected from POU cold water outlets was persistently colonized with NTM despite the addition of ozonation and filtration to a drinking water system. This suggests that cold water POU outlets need to be considered as a potential source of chronic human exposure to NTM

Early central cardiovagal dysfunction after high fat diet in a murine model

Abstract High fat diet (HFD) promotes cardiovascular disease and blunted cardiac vagal regulation. Temporal onset of loss of cardiac vagal control and its underlying mechanism are presently unclear. We tested our hypothesis that reduced central vagal regulation occurs early after HFD and contributes to poor cardiac regulation using cardiovascular testing paired with pharmacology in mice, molecular biology, and a novel bi-transgenic mouse line. Results show HFD, compared to normal fat diet (NFD), significantly blunted cardio/pulmonary chemoreflex bradycardic responses after 15 days, extending as far as tested (> 30 days). HFD produced resting tachycardia by day 3, reflected significant loss of parasympathetic tone. No differences in bradycardic responses to graded electrical stimulation of the distal cut end of the cervical vagus indicated diet-induced differences in vagal activity were centrally mediated. In nucleus ambiguus (NA), surface expression of δ-subunit containing type A gamma-aminobutyric acid receptors (GABAA(δ)R) increased at day 15 of HFD. Novel mice lacking δ-subunit expression in vagal motor neurons (ChAT-δnull) failed to exhibit blunted reflex bradycardia or resting tachycardia after two weeks of HFD. Thus, reduced parasympathetic output contributes to early HFD-induced HR dysregulation, likely through increased GABAA(δ)Rs. Results underscore need for research on mechanisms of early onset increases in GABAA(δ)R expression and parasympathetic dysfunction after HFD

Impact of the crystallite orientation distribution on exciton transport in donor-acceptor conjugated polymers

Conjugated polymers are widely used materials in organic photovoltaic devices. Owing to their extended electronic wave functions, they often form semicrystalline thin films. In this work, we aim to understand whether distribution of crystallographic orientations affects exciton diffusion using a low-band-gap polymer backbone motif that is representative of the donor/acceptor copolymer class. Using the fact that the polymer side chain can tune the dominant crystallographic orientation in the thin film, we have measured the quenching of polymer photoluminescence, and thus the extent of exciton dissociation, as a function of crystal orientation with respect to a quenching substrate. We find that the crystallite orientation distribution has little effect on the average exciton diffusion length. We suggest several possibilities for the lack of correlation between crystallographic texture and exciton transport in semicrystalline conjugated polymer films.7 page(s

Molecular Comparison of Mycobacterium avium Isolates from Clinical and Environmental Sources▿

We collected Mycobacterium avium isolates from clinical and drinking-water sources and compared isolates among themselves and to each other using molecular methods. Four clinical isolates were related to water isolates. Groups of indistinguishable clinical isolates were identified. The groups of identical clinical isolates suggest a common source of exposure