Using concept mapping in the knowledge-to-action process to compare stakeholder opinions on barriers to use of cancer screening among South Asians

BACKGROUND: Using the knowledge-to-action (KTA) process, this study examined barriers to use of evidence-based interventions to improve early detection of cancer among South Asians from the perspective of multiple stakeholders. METHODS: In 2011, we used concept mapping with South Asian residents, and representatives from health service and community service organizations in the region of Peel Ontario. As part of concept mapping procedures, brainstorming sessions were conducted with stakeholders (n = 53) to identify barriers to cancer screening among South Asians. Participants (n = 46) sorted barriers into groups, and rated barriers from lowest (1) to highest (6) in terms of importance for use of mammograms, Pap tests and fecal occult blood tests, and how feasible it would be to address them. Multi-dimensional scaling, cluster analysis, and descriptive statistics were used to analyze the data. RESULTS: A total of 45 unique barriers to use of mammograms, Pap tests, and fecal occult blood tests among South Asians were classified into seven clusters using concept mapping procedures: patient’s beliefs, fears, lack of social support; health system; limited knowledge among residents; limited knowledge among physicians; health education programs; ethno-cultural discordance with the health system; and cost. Overall, the top three ranked clusters of barriers were ‘limited knowledge among residents,’ ‘ethno-cultural discordance,’ and ‘health education programs’ across surveys. Only residents ranked ‘cost’ second in importance for fecal occult blood testing, and stakeholders from health service organizations ranked ‘limited knowledge among physicians’ third for the feasibility survey. Stakeholders from health services organizations ranked ‘limited knowledge among physicians’ fourth for all other surveys, but this cluster consistently ranked lowest among residents. CONCLUSION: The limited reach of cancer control programs to racial and ethnic minority groups is a critical implementation issue that requires attention. Opinions of community service and health service organizations on why this deficit in implementation occurs are fundamental to understanding the solutions because these are the settings in which evidence-based interventions are implemented. Using concept mapping within a KTA process can facilitate the engagement of multiple stakeholders in the utilization of study results and in identifying next steps for action

Ground Heave Due to Jet Grouting Near an Existing Structure

Renovations of the MBTA Copley Station in Boston included construction of a new elevator shaft to improve disabled access to the existing Green Line station. The site is immediately adjacent to the Eastern façade of the historic Old South Church. The construction work required excavation support including a perimeter secant pile wall and a jet-grouted base plug. Significant ground and structural movements were observed during jet grouting, mainly associated with soil displacements during grout injection. A three dimensional numerical model was developed, using the Plaxis 3D Foundation™ program, in order to test the hypothesis that the observed movements of the structure could be associated with the installation of the jet grout piles. The amount of volume expansion associated with installation of jet grout piles is estimated based by calibrating the model to measured ground movements. The finite element model results give a consistent explanation for the observed pattern of movements, including the heave of the church wall and lateral displacements at inclinometers located within the vicinity of the structure, measured at the time when damage occurred. The model assumes there is a vertical line of weakness in the masonry, representative of a pre-existing structural crack, as observed by structural investigations; and hence, confirms the underlying mechanical hypothesis for the source of ground movements

What knowledge is needed? Teaching undergraduate medical students to “go upstream” and advocate on social determinants of health

Background: We rarely teach medical students the skills required to engage in policy change to address the structural factors that underpin the social determinants of health, which are driven by the unequal distribution of power and resources in society. Acquiring the knowledge and skills to influence policy can empower students to act on healthcare inequities rather than simply be aware of them. Methods: Using Metzl and Hansen’s structural competency framework, we designed and piloted an intervention for medical students. Participants attended a workshop, presented to a hypothetical political stakeholder, and wrote an opinion editorial piece. Students participated in a focus group that was audio-recorded and transcribed. We coded and analyzed presentations, editorials, and transcripts to develop a thematic analysis. Results: Nine students participated in the workshop. They chose structural interventions and presented potential solutions to structural barriers in written and oral outputs. Students identified a lack of knowledge about health and political systems as a potential barrier to future advocacy work. Conclusion: Medical trainees require training in specific advocacy skills such as oral and written communication, however this alone may be insufficient. As future advocates, trainees must also acquire a specific skill set and associated knowledge about health systems and policy to navigate the systems in which they will practice.   &nbsp

ARTICLES GLOBAL HEALTH ETHICS FOR STUDENTS

ABSTRACT As a result of increased interest in global healt

Mu-Metal Enhancement of Effects in Electromagnetic Fields Over Single Emitters Near Topological Insulators

We focus on the transmission and reflection coefficients of light in systems involving of topological insulators (TI). Due to the electro-magnetic coupling in TIs, new mixing coefficients emerge leading to new components of the electromagnetic fields of propagating waves. We have discovered a simple heterostructure that provides a 100-fold enhancement of the mixing coefficients for TI materials. Such effect increases with the TI's wave impedance. We also predict a transverse deviation of the Poynting vector due to these mixed coefficients contributing to the radiative electromagnetic field of an electric dipole. Given an optimal configuration of the dipole-TI system, this deviation could amount to $0.18\%$ of the Poynting vector due to emission near not topological materials, making this effect detectable

HST Snaphot Study of Variable Stars in Globular Clusters: Inner Region of NGC 6441

[Abridged] We present the results of a Hubble Space Telescope snapshot program to survey the inner region of the globular cluster NGC 6441 for its variable stars. A total of 57 variable stars was found including 38 RR Lyrae stars, 6 Population II Cepheids, and 12 long period variables. Of the RR Lyrae stars observed in this survey, 26 are pulsating in the fundamental mode with a mean period of 0.753d and 12 are first-overtone mode pulsators with a mean period of 0.365d. These values match up very well with those found in ground-based surveys. Combining all the available data for NGC 6441, we find mean periods of 0.759d and 0.375d for the RRab and RRc stars, respectively. We also find that the RR Lyrae in this survey are located in the same regions of a period-amplitude diagram as those found in ground-based surveys. Although NGC 6441 is a metal-rich globular cluster, its RR Lyrae more closely resemble those in Oosterhoff type II globular clusters. However, even compared to typical Oosterhoff type II systems, the mean period of its RRab stars is unusually long. We also derived I-band period-luminosity relations for the RR Lyrae stars. Of the six Population II Cepheids, five are of W Virginis type and one is a BL Herculis variable stars. This makes NGC 6441, along with NGC 6388, the most metal-rich globular cluster known to contain these types of variable stars. Another variable, V118, may also be a Population II Cepheid given its long period and its separation in magnitude from the RR Lyrae stars. We argue that there does not appear to be a change in the period-luminosity relation slope between the BL Herculis and W Virginis stars, but that a change of slope does occur when the RV Tauri stars are added to the period-luminosity relation.Comment: 28 pages, including 9 figures and 8 tables, emulateapj5/apjfonts style. Accepted by the Astronomical Journal. Approximate publication date September 2003. We recommend the interested reader to download the preprint with full-resolution figures, which can be found at http://www.astro.puc.cl/~mcatelan/Pritzl.zi

The Carnegie Supernova Project: First Near-Infrared Hubble Diagram to z~0.7

The Carnegie Supernova Project (CSP) is designed to measure the luminosity distance for Type Ia supernovae (SNe Ia) as a function of redshift, and to set observational constraints on the dark energy contribution to the total energy content of the Universe. The CSP differs from other projects to date in its goal of providing an I-band {rest-frame} Hubble diagram. Here we present the first results from near-infrared (NIR) observations obtained using the Magellan Baade telescope for SNe Ia with 0.1 < z < 0.7. We combine these results with those from the low-redshift CSP at z <0.1 (Folatelli et al. 2009). We present light curves and an I-band Hubble diagram for this first sample of 35 SNe Ia and we compare these data to 21 new SNe Ia at low redshift. These data support the conclusion that the expansion of the Universe is accelerating. When combined with independent results from baryon acoustic oscillations (Eisenstein et al. 2005), these data yield Omega_m = 0.27 +/- 0.0 (statistical), and Omega_DE = 0.76 +/- 0.13 (statistical) +/- 0.09 (systematic), for the matter and dark energy densities, respectively. If we parameterize the data in terms of an equation of state, w, assume a flat geometry, and combine with baryon acoustic oscillations, we find that w = -1.05 +/- 0.13 (statistical) +/- 0.09 (systematic). The largest source of systematic uncertainty on w arises from uncertainties in the photometric calibration, signaling the importance of securing more accurate photometric calibrations for future supernova cosmology programs. Finally, we conclude that either the dust affecting the luminosities of SNe Ia has a different extinction law (R_V = 1.8) than that in the Milky Way (where R_V = 3.1), or that there is an additional intrinsic color term with luminosity for SNe Ia independent of the decline rate.Comment: 44 pages, 23 figures, 9 tables; Accepted for publication in the Astrophysical Journa

Adaptation and qualitative evaluation of the BETTER intervention for chronic disease prevention and screening by public health nurses in low income neighbourhoods : views of community residents

The adaptation phase is one component of a study funded as a grant proposal entitled 'Advancing Cancer Prevention Among Deprived Neighbourhoods' by the Canadian Cancer Society Research Institute grant #704042 and by the Canadian Institutes of Health Research Institute of Cancer grant OCP #145450. Aisha Lofters is supported by a CIHR New Investigator Award, as a Clinician Scientist by the Department of Family and Community Medicine, University of Toronto, and as Chair in Implementation Science at the Peter Gilgan Centre for Women’s Cancers at Women’s College Hospital in partnership with the Canadian Cancer Society. Dr. Andrew Pinto holds a Canadian Institutes of Health Research Applied Public Health Chair and is supported as a Clinician-Scientist in the Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, and supported by the Department of Family and Community Medicine, St. Michael’s Hospital, and the Li Ka Shing Knowledge Institute, St. Michael’s Hospital. He is also the Associate Director for Clinical Research at the University of Toronto Practice-Based Research Network. Lawrence Paszat is supported by a Clinician Scientist award funded by the Ontario Ministry of Health and Long Term Care.Background The BETTER intervention is an effective comprehensive evidence-based program for chronic disease prevention and screening (CDPS) delivered by trained prevention practitioners (PPs), a new role in primary care. An adapted program, BETTER HEALTH, delivered by public health nurses as PPs for community residents in low income neighbourhoods, was recently shown to be effective in improving CDPS actions. To obtain a nuanced understanding about the CDPS needs of community residents and how the BETTER HEALTH intervention was perceived by residents, we studied how the intervention was adapted to a public health setting then conducted a post-visit qualitative evaluation by community residents through focus groups and interviews. Methods We first used the ADAPT-ITT model to adapt BETTER for a public health setting in Ontario, Canada. For the post-PP visit qualitative evaluation, we asked community residents who had received a PP visit, about steps they had taken to improve their physical and mental health and the BETTER HEALTH intervention. For both phases, we conducted focus groups and interviews; transcripts were analyzed using the constant comparative method. Results Thirty-eight community residents participated in either adaptation (n = 14, 64% female; average age 54 y) or evaluation (n = 24, 83% female; average age 60 y) phases. In both adaptation and evaluation, residents described significant challenges including poverty, social isolation, and daily stress, making chronic disease prevention a lower priority. Adaptation results indicated that residents valued learning about CDPS and would attend a confidential visit with a public health nurse who was viewed as trustworthy. Despite challenges, many recipients of BETTER HEALTH perceived they had achieved at least one personal CDPS goal post PP visit. Residents described key relational aspects of the visit including feeling valued, listened to and being understood by the PP. The PPs also provided practical suggestions to overcome barriers to meeting prevention goals. Conclusions Residents living in low income neighbourhoods faced daily stress that reduced their capacity to make preventive lifestyle changes. Key adapted features of BETTER HEALTH such as public health nurses as PPs were highly supported by residents. The intervention was perceived valuable for the community by providing access to disease prevention. Trial registration #NCT03052959, 10/02/2017.Peer reviewe