Barriers and facilitators to HPV vaccination in primary care practices: A mixed methods study using the Consolidated Framework for Implementation Research

Abstract Background In the United States, the effective, safe huma papilloma virus (HPV) vaccine is underused and opportunities to prevent cancer continue to be missed. National guidelines recommend completing the 2–3 dose HPV vaccine series by age 13, well before exposure to the sexually transmitted virus. Accurate characterization of the facilitators and barriers to full implementation of HPV vaccine recommendations in the primary care setting could inform effective implementation strategies. Methods We used the Consolidated Framework for Implementation Research (CFIR) to systematically investigate and characterize factors that influence HPV vaccine use in 10 primary care practices (16 providers) using a concurrent mixed methods design. The CFIR was used to guide collection and analysis of qualitative data collected through in-person semi-structured interviews with the primary care providers. We analyzed HPV vaccine use with data abstracted from medical charts. Constructs that most strongly influenced vaccine use were identified by integrating the qualitative and quantitative data. Results Of the 72 CFIR constructs assessed, seven strongly distinguished and seven weakly distinguished between providers with higher versus lower HPV vaccine coverage. The majority of strongly distinguishing constructs were facilitators and were related to characteristics of the providers (knowledge and beliefs; self-efficacy; readiness for change), their perception of the intervention (relative advantage of vaccinating younger vs. older adolescents), and their process to deliver the vaccine (executing). Additional weakly distinguishing constructs that were facilitators were from outer setting (peer pressure; financial incentives), inner setting (networks and communications and readiness for implementation) and process (planning; engaging, and reflecting and evaluating). Two strongly distinguishing constructs were barriers to use, one from the intervention (adaptability of the age of initiation) and the other from outer setting (patient needs and resources). Conclusions Using CFIR to systematically examine the use of this vaccine in independent primary care practices enabled us to identify facilitators and barriers at the provider, interpersonal and practice level that need to be addressed in future efforts to increase vaccine use in such settings. Our findings suggest that implementation strategies that target the provider and help them to address multi-level barriers to HPV vaccine use merit further investigation

Inbreeding depression in red deer calves

BACKGROUND Understanding the fitness consequences of inbreeding is of major importance for evolutionary and conservation biology. However, there are few studies using pedigree-based estimates of inbreeding or investigating the influence of environment and age variation on inbreeding depression in natural populations. Here we investigated the consequences of variation in inbreeding coefficient for three juvenile traits, birth date, birth weight and first year survival, in a wild population of red deer, considering both calf and mother's inbreeding coefficient. We also tested whether inbreeding depression varied with environmental conditions and maternal age. RESULTS We detected non-zero inbreeding coefficients for 22% of individuals with both parents and at least one grandparent known (increasing to 42% if the dataset was restricted to those with four known grandparents). Inbreeding depression was evident for birth weight and first year survival but not for birth date: the first year survival of offspring with an inbreeding coefficient of 0.25 was reduced by 77% compared to offspring with an inbreeding coefficient of zero. However, it was independent of measures of environmental variation and maternal age. The effect of inbreeding on birth weight appeared to be driven by highly inbred individuals (F = 0.25). On the other hand first year survival showed strong inbreeding depression that was not solely driven by individuals with the highest inbreeding coefficients, corresponding to an estimate of 4.35 lethal equivalents. CONCLUSIONS These results represent a rare demonstration of inbreeding depression using pedigree-based estimates in a wild mammal population and highlight the potential strength of effects on key components of fitness.This research was supported by a NERC grant to LEBK, JMP and THCB, NERC and BBSRC fellowships to DHN and a Royal Society fellowship to LEBK

A Study of Soil Erosion on a Steep Cultivated Slope in the Mt. Gongga Region near Luding, Sichuan, China, using the 137 Cs Technique

This paper reports the results of an investigation of soil erosion on a steep cultivated slope in the Mt Gongga region of the Upper Yangtze River Basin, Southwest China, using the 137Cs technique. The effective 137Cs reference inventory for the study field, estimated from the bottom layer of a 137Cs depth profile at the deposition zones, is 2373.9 Bq/m2, accounting for 65.8% the local 137Cs reference inventory of 3607.7 Bq/m2. It strongly indicates that a considerable amount of 137Cs input was lost prior to incorporation into the ploughing layer from the study field during the nuclear weapons testing period because of 137Cs surface enrichment. The average erosion rate is estimated to be 4914 t/km2 yr for a typical cultivated steep slope with an angle of 34°at the subtropical zone in the Mt Gongga region. It can reach to 22856 t/km2 yr for a failure slope under cultivation

Update on the Fishes of Texas Project

Poster presentation presented at the 2017 Texas Academy of Sciences annual meeting in Belton, Texas on March 4, 2017.The Fishes of Texas project (www.fishesoftexas.org), originating in 2006, remains the most reliable (quality controlled) and data rich site for acquiring occurrence data for Texas fishes, holding over 124,000 records from 42 institutions. Among many discoveries, the project is responsible for detecting at least 3 freshwater species not previously known from the state. We continue making improvements, but substantial updates so far have been onerous for our developers for various reasons. A recent major update reduces coding redundancies, points the website to a new massively restructured and more fully normalized PostgreSQL database (was MySQL), and places the code in a versioning environment. These changes have little immediate effect on user experience, but will greatly accelerate development. PostgreSQL allows for complex spatial queries which will allow users to quickly map occurrence data alongside many more political/environmental layers than currently possible. While our database/web designers have been implementing these changes and fixing bugs etc., we’ve been preparing resources for them to integrate into the website. Some highlights to expect: 1 new updates to the state Species of Greatest Concern list; 2 expert opinion-determined nativity spatial layers for all freshwater fishes displaying in our new mapping system; 3 dynamic statistical summaries; 4 new data types from the literature (>14,900 records), citizen science (>4,300), anglers (>37,000), and agency databases (>1,000,000); 5 new museum records, many derived from our gap sampling (~19,000, 4 museums); 6 more specimen examinations (>400) and photographs (1000); 7 document archive with “smart” text search tools (currently in beta testing using TPWD fisheries reports). So be patient and keep your eyes open for updates.University of Texas at Austin, Texas Parks and Wildlife Department, Texas Commission on Environmental Quality, U.S. Department of the Interior,Integrative Biolog

Transport between edge states in multilayer integer quantum Hall systems: exact treatment of Coulomb interactions and disorder

A set of stacked two-dimensional electron systems in a perpendicular magnetic field exhibits a three-dimensional version of the quantum Hall effect if interlayer tunneling is not too strong. When such a sample is in a quantum Hall plateau, the edge states of each layer combine to form a chiral metal at the sample surface. We study the interplay of interactions and disorder in transport properties of the chiral metal, in the regime of weak interlayer tunneling. Our starting point is a system without interlayer tunneling, in which the only excitations are harmonic collective modes: surface magnetoplasmons. Using bosonization and working perturbatively in the interlayer tunneling amplitude, we express transport properties in terms of the spectrum for these collective modes, treating electron-electron interactions and impurity scattering exactly. We calculte the conductivity as a function of temperature, finding that it increases with increasing temperature as observed in recent experiments. We also calculate the autocorrelation function of mesoscopic conductance fluctuations induced by changes in a magnetic field component perpendicular to the sample surface, and its dependence on temperature. We show that conductance fluctuations are characterised by a dephasing length that varies inversely with temperature.Comment: 13 pages, 10 figures, minor changes made for publicatio