Experimental Investigation of Stagnation Point Electrodes

Space resolved measurements for electrode in stagnation flow of arc heated plasm

Center for HPV Research at IUPUI

poster abstractHuman Papillomavirus (HPV) infection is highly prevalent among women and men and is associated with a number of diseases including genital warts, cervical cancers, other anogenital cancers in both men and women, and cancers of the head and neck. HPV infections are also associated with millions of dollars in annual health care costs. Two vaccines have been developed to prevent HPV infection. Both are approved for use in females ages 9 through 26, and one vaccine is approved for use in 9 to 26 year old males as well. Both vaccines are efficacious, safe, and cost-effective. Despite the great promise of HPV vaccines, vaccination rates in the U.S. are much lower than desired, with 2011 data indicating that 53% of 13-17 year old females received one or more doses and only 37% completed the 3-dose series. The ongoing medical, psychosocial, and financial costs of HPV infection indicate the need for comprehensive, cross-disciplinary research efforts coordinated with community outreach. We have established the Center for Human Papillomavirus (HPV) Research at IUPUI; which fosters cohesion and collaboration among investigators from multiple disciplines and departments at IUPUI, IU Bloomington, and University of Notre Dame pursuing HPV-related research. This group of accomplished senior faculty and promising junior scholars represents a growing synergy between basic, clinical, and social/behavioral sciences. The Center for HPV Research will provide formal infrastructure and resources for pilot research projects, and a collaborative environment for development of proposals for external funding. By capitalizing on the unique strengths of an internationally recognized faculty and IUPUI’s remarkable culture of collaborative and interdisciplinary research, we will establish a world-class center for HPV research, research training, and research translation. The overall mission of the Center for HPV Research will be to improve understanding of HPV transmission, infection, and prevention of HPV infection and its consequences

State statutes and regulations related to human papillomavirus vaccination

A cross-sectional analysis of human papillomavirus (HPV) vaccine statutes and regulations from states and the District of Columbia in the United States (U.S.) was conducted from September-November 2018 to advance analyses of policy impact on HPV vaccination uptake. A search was conducted using WestlawNext, a legal research database. Statutes and regulations relevant to the study were analyzed and coded based on their legal attributes into ten broad coding questions and several sub-questions. Of the 212 laws identified by the initial search string, 93 (43.9%) reference HPV vaccination in statute or regulation. An additional three laws were added following subsequent review. There was a total of 52 statutes and 44 regulations from 34 states and the District of Columbia. Most laws were related to developing and distributing HPV vaccination materials for parents, and mechanisms to fund and reimburse for the vaccination. This study can be used by policymakers in jurisdictions that are considering establishing HPV vaccination promotion interventions in state law and highlighting the limited statutory and regulatory efforts that have been implemented to promote HPV vaccination. Importantly, this study can also be used to conduct evaluations of the efficacy of statutory and regulatory strategies in increasing HPV vaccination rates

Acceptability of HPV vaccine implementation among parents in India.

Due to high cervical cancer rates and limited research on human papillomavirus (HPV) vaccine acceptability in India, the research team examined parental attitudes toward HPV vaccines. Thirty-six interviews with parents were conducted to assess sexually transmitted infection (STI)-related knowledge and HPV-specific vaccine awareness and acceptability. Despite limited knowledge, parents had positive views toward HPV vaccines. Common barriers included concerns about side effects, vaccine cost, and missing work to receive the vaccine. Parents were strongly influenced by health care providers' recommendations. Our findings suggest that addressing parental concerns, health worker training and polices, and efforts to minimize cost will be central to successful HPV vaccine implementation

Risk perceptions, sexual attitudes, and sexual behavior after HPV vaccination in 11-12 year-old girls

OBJECTIVES: Among 11-12 year-old girls who received the human papillomavirus (HPV) vaccine, we explored, over the subsequent 30 months: (1) trajectories of knowledge about HPV/HPV vaccines and vaccine-related risk perceptions; (2) whether knowledge and risk perceptions impacted sexual attitudes and sexual experience; (3) whether mothers, clinicians, and media influenced girls' risk perceptions, attitudes, and behavior. METHODS: Girls and mothers (n=25dyads) completed separate, semi-structured interviews within 2 days of, and 6, 18, and 30 months after, their first HPV vaccine dose. Knowledge, risk perceptions related to HPV and other sexually transmitted infections (STIs), and attitudes about sexual behaviors were assessed. Sexual experience was assessed at girls' 30 month interviews. Clinicians completed interviews at baseline. Transcribed interviews were analyzed using framework analysis. RESULTS: Girls' baseline knowledge was poor but often improved with time. Most girls (n=18) developed accurate risk perceptions about HPV but only half (n=12) developed accurate risk perceptions about other STIs by 30 months. The vast majority of girls thought that safer sex was still important, regardless of knowledge, risk perceptions, or sexual experience. Girls whose HPV knowledge was high at baseline or increased over time tended to articulate accurate risk perceptions; those who were able to articulate accurate risk perceptions tended to report not having initiated sexual activity. Girls whose mothers demonstrated higher knowledge and/or communication about HPV vaccination tended to articulate accurate risk perceptions, whereas clinicians and media exposure did not appear to influence risk perceptions. CONCLUSIONS: Higher knowledge about HPV vaccines among mothers and girls was linked with more accurate risk perceptions among girls. Clinicians may play an important role in providing education about HPV vaccines to mothers and girls

A qualitative study of healthcare provider awareness and informational needs regarding the nine-valent HPV vaccine

The 9-valent Human Papillomavirus (HPV) vaccine, 9vHPV, was licensed in the U.S. in December, 2014. We assessed healthcare provider (HCP) awareness of the newly approved vaccine and identified questions HCPs have about the vaccine. As part of a larger study, we used semi-structured interviews to ask 22 pediatric HCPs about their awareness of 9vHPV, questions they have about the vaccine, and questions they anticipate from patients and parents. Interviews were audio-recorded and transcribed then analyzed using inductive content analysis. Over half were aware of the vaccine but few HCPs claimed to be familiar with it. HCPs indicated several questions with common themes pertaining to efficacy, side effects, and cost. Only half of HCPs believed patients or parents would have questions. The results suggest strategies and areas for health systems and public health organizations to target in order to resolve unmet educational needs among HCPs regarding 9vHPV

Healthcare providers’ beliefs and attitudes regarding risk compensation following HPV vaccination

Background Provider recommendation is a significant predictor of HPV vaccine uptake. Prior research suggests that concerns regarding risk compensation could cause some providers to hesitate recommending the HPV vaccine. Methods During 15–30 min semi-structured interviews in early 2015, 22 U.S. pediatric providers were asked about their beliefs regarding sexual risk compensation and cervical cancer screening following HPV vaccination. Providers were asked if these beliefs result in reservations recommending the vaccine. Interviews were audio-recorded, transcribed, and analyzed using inductive content analysis. Results None of the providers believed the HPV vaccine would result in risky sexual behavior. Half indicated it was better to start vaccination early, before sexual activity was a worry. Others noted that patients’ risky behavior decisions happen independently of vaccination. When providers were asked if they were concerned about decreased cervical cancer screening, half said they did not know and some stated they had never thought about it before. The main themes addressed were the significant time lapse between vaccination and screening and that women tend to get over-screened as opposed to under-screened. Conclusion Providers were generally in favor of HPV vaccination and do not perceive risk compensation as a barrier to HPV recommendation

Health care providers’ perceptions of use and influence of clinical decision support reminders: qualitative study following a randomized trial to improve HPV vaccination rates

Background Human Papillomavirus (HPV) leads to serious health issues and remains the most common sexually transmitted infection. Despite availability of effective vaccines, HPV vaccination rates are suboptimal. Furthermore, providers recommend the HPV vaccine less than half the time for eligible patients. Prior informatics research has demonstrated the effectiveness of computer-based clinical decision support (CDS) in changing provider behavior, especially in the area of preventative services. Methods Following a randomized clinical trial to test the effect of a CDS intervention on HPV vaccination rates, we conducted semi-structured interviews with health care providers to understand whether they noticed the CDS reminders and why providers did or did not respond to the prompts. Eighteen providers, a mix of medical doctors and nurse practitioners, were interviewed from five publicly-funded, urban health clinics. Interview data were qualitatively analyzed by two independent researchers using inductive content analysis. Results While most providers recalled seeing the CDS reminders, few of them perceived the intervention as effective in changing their behavior. Providers stated many reasons for why they did not perceive a change in their behavior, yet the results of the trial showed HPV vaccination rates increased as a result of the intervention. Conclusions CDS reminders may be effective at changing provider behavior even if providers perceive them to be of little use. Trial registration ClinicalTrials.gov Identifier: NCT02551887 , Registered on September 15, 2015 Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0521-6) contains supplementary material, which is available to authorized users

Differences in cervical cancer screening knowledge, practices, and beliefs: An examination of survey responses

Among the identified barriers to HPV vaccination is the concern that women may compensate for their reduced susceptibility to cervical cancers by reducing cervical cancer screening. This exploratory study examined the relationship between cervical cancer screening rates and HPV vaccination. We conducted a cross-sectional survey using a convenience sample of women aged 21-35 attending a local minority health fair in July 2015. Data were analyzed in 2015-2016. Outcomes assessed were: receiving a Pap test within the last three years, awareness and comfort with current Pap test recommendations, and knowledge regarding the purpose of a Pap test. A total of 291 women were included in the analyses. Mean age was 28.5 years and 62% were non-Hispanic black. 84% had received a Pap test in the last three years and 33% had received at least one HPV vaccine. Logistic regression results showed that women who had been vaccinated did not have lower odds of having a Pap test in the past three years (OR = 1.32; 95% CI = 0.66-2.65). In an adjusted regression model controlling for age and race, vaccinated women were significantly more likely to have had a Pap test (AOR = 3.06; 95% CI = 1.37-6.83). Yet only 26% of women knew the purpose of a Pap test and the proportion who answered correctly was higher among non-Hispanic white women. Women who have been vaccinated for HPV are more likely to have been screened for cervical cancer. These results suggest areas for more robust studies examining pro-health attitudes, behaviors, and communication regarding vaccination and preventive screening

An Educational Intervention to Improve HPV Vaccination: A Cluster Randomized Trial

Background: Human Papillomavirus (HPV) infection can lead to serious health issues and remains the most common sexually transmitted infection. Despite availability of effective vaccines, HPV vaccination rates are suboptimal. Methods: In a cluster randomized trial, an intervention targeting parents of adolescents (11-17 years) eligible for a dose of HPV vaccine was tested in pediatric clinics part of an urban health system. Parents watched a digital video outlining the risks and benefits of vaccine using a tablet in the exam room. The primary outcome was change in HPV vaccine status two weeks after the clinic visit. An intention to treat analysis for the primary outcome utilized generalized estimating equations to accommodate the potential cluster effect of clinics. Results: A total of 1596 eligible adolescents were observed during the 7-month trial. One-third of adolescents visited an intervention clinic. Adolescents who attended an intervention clinic were more likely to be younger (11-12 years) than those who attended a control clinic (72.4% versus 49.8%; p<0.001). No differences in race or gender were observed. The proportion of adolescents with an observed change in vaccine status was higher for those attending an intervention clinic (64.8%) versus control clinic (50.1%; OR=1.82; 95% CI=1.47-2.25; p<0.001). Adolescents whose parents watched the video had a three times greater odds of receiving a dose of the HPV vaccine (78.0%; OR=3.07; 95% CI=1.47-6.42; p=0.003). Conclusions: Educational interventions delivered within a clinical setting hold promise to improve vaccination behaviors