The Emerging Role of HIV Peer Navigators as Associate Medical Case Managers in Northeast Florida

What is the role of policy in improving the system of care for people living with HIV/AIDS, (PLWHAs)? This policy brief describes an innovation in medical case management within the Jacksonville Transitional Grant Area. Emphases center on how the innovation originated, why the innovation matters, the participants’ involved, outcomes, and the potential impact of the innovation on jurisdictional HIV health services

Building the HIV Public Health Service Structure by Quality Improvement

Quality improvement (QI) is a tool in the public health inventory. It has value in that it provides a modality for accelerating science-based intervention into routine public health practice. In doing so, it holds promise to make transparent how care and service systems demonstrate efficiencies in the structure, operations, and outputs that should translate into improvements in population health outcomes. One HIV health services grant in Northeast Florida touches the lives of over 4,200 persons. How to render services so that it maximally benefits all clients is ongoing work. Service recipients engage nine HIV care funded providers, who differentiate on client census, service mix, staffing, expertise, and resources. Past 12-months QI activities indicated that seven of nine providers had implementation scores in the range of 62.32 to 88.90, (one standard deviation of the geometric mean of 74.51). Submitting implemented improvement activities for external evaluation allows for assessment of implementation fidelity and critique of methodology covering review of documents, including an improvement plan, an annual report, and a normative reference document, (NRD); completion of a scoring rubric, which modeled themes in the NRD, and rendering a qualitative, professional judgment of the extent to which agency annual reports operationalized the NRD underpinnings. Such transparency holds the promise to build public trust by demonstrating accountability to diverse stakeholders. Viewed this way, QI in public health is a necessity, not an option

Efforts Targeting Factors of Health Disparities that Impair HIV Treatment Engagement

Health disparities exist in Northeast Florida. Some locations experience morbidities at higher rates than others. Health zone 1 is a prime example. Differences in disease rates are interlaced with the social determinants of health, (SDOH). Long-standing social and structural influences of disparities are beyond the scope of Ryan White programs. However, empowerment for health promotion is a strategy for targeting health disparities. The Theory of Health Empowerment targets sense of agency and offers some leverage for helping people living with HIV/AIDS, (PLWHA) despite environments blemished by SDOH. Eclectic leadership occurring in a climate of respectful point-counter point discussions established the context for implemented projects in Northeast Florida. Nine activities directed efforts to reduce disparities. These activities are in the infancy stage of development. Some successes have been achieved, but much more remains to be accomplished to increase overall viral suppression above the 80% threshold. Directions for the future suggest that perhaps external influences of federal Ryan White Parts may be a catalyst for incentivizing the JTGA to participate in national efforts to reduce health disparities. Opportunities to strengthen understanding of approaches to nullify SDOH using science-based approaches hold promise to pursue health equity in treatment cascade outcomes for PLWHAs

Mitigating Disparities in Community HIV Testing among Youth and Young Adults

Prevention strategies are a key lever for reducing HIV incidence, which differentially affects jurisdictions. HIV incidence coexists with social determinants of health, health-related disparities, poverty, and other risk factors. One zip code in Jacksonville, Florida’s urban core fit the description of a disadvantaged jurisdiction; hence, the local HIV prevention consortia implemented a theory-based, social outreach HIV prevention event, which attracted 189 residents and 64 tested for HIV. Survey data from 120 respondents indicated that event attendees viewed the event’s prevention activities and the supporting entertainment music favorably. Respondents liked the emphases on healthy behaviors, health education, and community capacity to address HIV; but they disliked the outdoor heat and the small turnout; therefore, they recommended hosting future events indoors and doing more advertising. Some respondents even volunteered to assist in planning future events. Logistic regression examined odds ratios for five dichotomous outcome variables cross-tabbed by race, comparing null and saturated models. None of the odds ratios were significant, indicating respondent’s consensus on event feedback. Going forward, event planners aim to implement feedback received from participants; attract a large fan base, and increase the sample size from 120 to 263, so the margin of error is 6.0% rather than 8.92%

Lessons from the Field: A Systems Thinking Approach for Case Management Documentation

Case management is a core HIV health service that focuses on service coordination—the seamless access to an array of integrated services. Integration aims to reduce barriers to medical care. In the busy HIV health services environment, inadequate documentation of case management activities limits the capacity of stakeholders to know what happens during care encounters. This study used theory and qualitative inquiry to uncover best practices that support optimal case management documentation. Two research questions guided the inquiry: What principles should arise in higher order cognitive functioning among case managers during client encounters? What characteristics of a system level approach to care encounter documentation reinforces case management critical thinking skills? The study settings included two, Northeast Florida, Ryan White funded organizations. Findings indicated that the confluence of intrapersonal, interpersonal, organizational, community, and policy factors support more rather than less robust case management documentation. A multi-tired approach to documentation of services rendered is no panacea. However, it offers a useful framework for defining stakeholders’ roles and expectations and monitoring the performance of activities. Disseminating these findings in the local Ryan White network and the public domain may trigger dialog and more research about the preservation and effective use of documentation skills

Can, Want and Try: Parents' Viewpoints Regarding the Participation of Their Child with an Acquired Brain Injury

BACKGROUND: Acquired brain injury (ABI) is a leading cause of permanent disability, currently affecting 20,000 Australian children. Community participation is essential for childhood development and enjoyment, yet children with ABI can often experience barriers to participation. The factors which act as barriers and facilitators to community participation for children with an ABI are not well understood. AIM: To identify the viewpoints of parents of children with an ABI, regarding the barriers and facilitators most pertinent to community participation for their child. METHODS: Using Q-method, 41 parents of children with moderate/severe ABI sorted 37 statements regarding barriers and facilitators to community participation. Factor analysis identified three viewpoints. RESULTS: This study identified three distinct viewpoints, with the perceived ability to participate decreasing with a stepwise trend from parents who felt their child and family "can" participate in viewpoint one, to "want" in viewpoint two and "try" in viewpoint three. CONCLUSIONS: Findings indicated good participation outcomes for most children and families, however some families who were motivated to participate experienced significant barriers. The most significant facilitators included child motivation, supportive relationships from immediate family and friends, and supportive community attitudes. The lack of supportive relationships and attitudes was perceived as a fundamental barrier to community participation. SIGNIFICANCE: This research begins to address the paucity of information regarding those factors that impact upon the participation of children with an ABI in Australia. Findings have implications for therapists, service providers and community organisations

Ratio of the Isolated Photon Cross Sections at \sqrt{s} = 630 and 1800 GeV

The inclusive cross section for production of isolated photons has been measured in \pbarp collisions at $\sqrt{s} = 630$ GeV with the \D0 detector at the Fermilab Tevatron Collider. The photons span a transverse energy ($E_T$) range from 7-49 GeV and have pseudorapidity $|\eta| < 2.5$. This measurement is combined with to previous \D0 result at $\sqrt{s} = 1800$ GeV to form a ratio of the cross sections. Comparison of next-to-leading order QCD with the measured cross section at 630 GeV and ratio of cross sections show satisfactory agreement in most of the $E_T$ range.Comment: 7 pages. Published in Phys. Rev. Lett. 87, 251805, (2001

Search for new phenomena in final states with an energetic jet and large missing transverse momentum in pp collisions at √ s = 8 TeV with the ATLAS detector

Results of a search for new phenomena in final states with an energetic jet and large missing transverse momentum are reported. The search uses 20.3 fb−1 of √ s = 8 TeV data collected in 2012 with the ATLAS detector at the LHC. Events are required to have at least one jet with pT > 120 GeV and no leptons. Nine signal regions are considered with increasing missing transverse momentum requirements between Emiss T > 150 GeV and Emiss T > 700 GeV. Good agreement is observed between the number of events in data and Standard Model expectations. The results are translated into exclusion limits on models with either large extra spatial dimensions, pair production of weakly interacting dark matter candidates, or production of very light gravitinos in a gauge-mediated supersymmetric model. In addition, limits on the production of an invisibly decaying Higgs-like boson leading to similar topologies in the final state are presente

Historicising Material Agency: from Relations to Relational Constellations

Relational approaches have gradually been changing the face of archaeology over the last decade: analytically, through formal network analysis; and interpretively, with various frameworks of human-thing relations. Their popularity has been such, however, that it threatens to undermine their relevance. If everyone agrees that we should understand past worlds by tracing relations, then ‘finding relations’ in the past becomes a self-fulfilling prophecy. Focusing primarily on the interpretive approaches of material culture studies, this article proposes to counter the threat of irrelevance by not just tracing human-thing relations, but characterising how sets of relations were ordered. Such ordered sets are termed ‘relational constellations’. The article describes three relational constellations and their consequences based on practices of fine ware production in the Western Roman provinces (first century BC – third century AD): the fluid, the categorical, and the rooted constellation. Specifying relational constellations allows reconnecting material culture to specific historical trajectories, and offers scope for meaningful cross-cultural comparisons. As such a small theoretical addition based on the existing toolbox of practice-based approaches and relational thought can impact on historical narratives, and can save relational frameworks from the danger of triviality.This is the author accepted manuscript. The final version is available from Springer via http://dx.doi.org/10.1007/s10816-015-9244-

Search for single top quark production at D0 using neural networks

We present a search for electroweak production of single top quarks in ~90 pb^-1 of data collected with the DZero detector at the Fermilab Tevatron collider. Using arrays of neural networks to separate signals from backgrounds, we set upper limits on the cross sections of 17 pb for the s-channel process ppbar->tb+X, and 22 pb for the t-channel process ppbar->tqb+X, both at the 95% confidence level