RACIAL AND ETHNIC DIFFERENCES IN ACCESSING TIMELY CANCER SCREENING AND TREATMENT SERVICES: A QUANTITATIVE ANALYSIS

This research is organized into three integrated studies that explored differences in screening and treatment services across the cancer care continuum by race and ethnicity. The Andersen Behavioral Model of Health Services Use and the Five Dimensions of Access were used as conceptual frameworks. In the first study (Chapter 2), data from the Medical Expenditure Panel Survey were used to examine breast and cervical cancer screening rates before and during the Great Recession (2007-2009). The interaction terms of recession and race and ethnicity were controlled to examine whether minorities exhibited different utilization patterns under economic shock compared to Whites. In Chapter 3, data from the National Health Interview Survey (NHIS) from 2006-2010 were used to identify adult cancer survivors and adults without a history of cancer. Multivariate logistic regressions were applied to examine the prevalence of cost, organizational and transportation barriers between survivors and the general population. The likelihood of experiencing barriers was explored by race and ethnicity. In Chapter 4, differences in the likelihood of experiencing access barriers among survivors by race and ethnicity was explored. Data were merged from the 2000-2011 (NHIS) to identify adult cancer survivors who reported cost, organizational and transportation barriers. Logistic regressions were applied to determine the likelihood of reporting each type of barrier, while controlling for demographic and socioeconomic variables. The Fairlie decomposition technique was applied to identify contributing factors that explained differences in accessing care based by race and ethnicity. Overall, results of the investigations demonstrate that: (1) breast and cervical screening rates declined most among White women during the recession period, while rates increased among Hispanic women during the same period; (2) minority cancer survivors were significantly more likely to experience access-to-care barriers than Whites; and (3) insurance, comorbidity, perceived health and nativity were leading factors that contributed to racial and ethnic differences in timely receipt of cancer screening and treatment services. As provisions of the Affordable Care Act take effect, findings provide insight into practices, policies, and future research that will help achieve Healthy People 2020 screening objectives and reduce racial and ethnic disparities in accessing timely cancer care

A Gardening Metaphor: A Framework for Closing Racial Achievement Gaps in American Public Education System

The overarching purpose of this article is to introduce A Gardening Metaphor (AGM) as an evolving framework for accelerating the closure of racial achievement gaps in America. Toward this end, we provide: (a) an examination of the racial disparities in education that are disproportionately experienced by Black children; (b) a rationale for why racial achievement gaps must be closed; (c) an introduction to components of AGM; and (d) discussion of AGM gap closing potential through case study with implication for research and practice

Project THANKS: A Socio-Ecological Framework For An Intervention Involving HIV Positive African American Women With Comorbidities

HIV-positive individuals are living longer today as a result of continuing advances in treatment but are also facing an increased risk for chronic diseases such as diabetes, and hypertension. These conditions result in a larger burden of hospitalization, outpatient, and emergency room visits. Impoverished African American women may represent an especially high-risk group due to disparities in health care, racial discrimination, and limited resources. This article describes an intervention that is based on the conceptual framework of the socio-ecological model. Project THANKS uses a community-based participatory, and empowerment building approach to target the unique personal, social, and environmental needs of African American women faced with the dual diagnosis of HIV and one or more chronic diseases. The long-term goal of this project is to identify features in the social and cultural milieu of these women that if integrated into existing harm reduction services can reduce poor health outcomes among them

Setting the Standard for Green Infrastructure: The Need for, and Features of, a Benchmark in England

© 2018, © 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Green infrastructure is an essential component of health and sustainable places. The quality of green infrastructure often represents a missed opportunity to achieve this. This paper presents a review examining how built environment assessment systems evaluate the quality of green infrastructure. This was used to develop proposals for a new benchmark, which were examined by experts in terms of the demand, scope and operation. The findings suggest that current systems are not providing a robust assessment of green infrastructure and that a benchmark for green infrastructure would overcome some of the challenges associated with its planning, design and delivery

Facioscapulohumeral muscular dystrophy: Are telomeres the end of the story

Facioscapulohumeral muscular dystrophy (FSHD) is a progressive myopathy with a relatively late age of onset (usually in the late teens) compared with Duchenne and many other muscular dystrophies. The current FSHD disease model postulates that contraction of the D4Z4 array at chromosome 4q35 leads to a more open chromatin conformation in that region and allows transcription of the DUX4 gene. DUX4 mRNA is stable only when transcribed from certain haplotypes that contain a polyadenylation signal. DUX4 protein is hypothesized to cause FSHD by mediating cytotoxicity and impairing skeletal muscle differentiation. We recently showed in a cell culture model that DUX4 expression is regulated by telomere length, suggesting that telomere shortening during aging may be partially responsible for the delayed onset and progressive nature of FSHD. We here put our data in the context of other recent findings arguing that progressive telomere shortening may play a critical role in FSHD but is not the whole story and that the current disease model needs additional refinement

Molecule Microscopy

Contains reports on summary of research and one research project.Joint Services Electronics Program (Contract DAAB07-75-C-1346)National Institutes of Health (Grant 5 S05 RR07047-10)National Institutes of Health (Grant 5 PO1 HL14322-05)National Institutes of Health (Grant 1 ROI GM22633-01

The mtDNA diversity of captive ruffed lemurs (Varecia spp.): Implications for conservation

Ruffed lemurs (Varecia variegata and V. rubra) are considered Critically Endangered, and genetic studies are therefore needed for assessing the conservation value of captive populations. Using 280 mitochondrial DNA (mtDNA) D-loop sequences, we studied the genetic diversity and structure of captive ruffed lemurs in Madagascar, Europe and North America. We found 10 new haplotypes, one from the European captive V. rubra population, three from captive V. variegata subcincta (one from Europe and two from Madagascar), and six from other captive V. variegata in Madagascar. There was low mtDNA genetic diversity in the European and North American captive populations of V. variegata. Several founder individuals shared the same mtDNA haplotype, and therefore should perhaps not be considered as unrelated founders for making breeding recommendations. The captive population in Madagascar has high genetic diversity, including haplotypes not yet identified in wild populations. The likely geographical provenance of founders of captive populations was determined by comparison with previous studies; all reported haplotypes from captive ruffed lemurs were identical to, or clustered with, haplotypes from wild populations located north of the Mangoro River in Madagascar. Effective conservation strategies for wild populations, with potentially unidentified genetic diversity, should still be considered the priority for conserving ruffed lemurs. However, our results illustrate that the captive population in Madagascar has conservation value as a source of potential release stock for reintroduction or reinforcement projects, and that cross-regional transfers within the global captive population could increase the genetic diversity and therefore the conservation value of each regional population

Early life stress influences acute and sensitised responses of adult mice to cocaine by interacting with GABAA α2 receptor expression

Early life stress (ELS) is known to exert long term effects on brain function, with resulting deleterious consequences for several aspects of mental health, including the development of addiction to drugs of abuse. One potential mechanism in humans is suggested by findings that ELS interacts with polymorphisms of the GABRA2 gene, encoding alpha2 subunits of GABAA receptors, to increase risk for both posttraumatic stress disorder, and vulnerability to cocaine addiction. We used a mouse model, in which the amount of material for nest building was reduced during early postnatal life, to study interactions between ELS and expression of alpha2-containing GABAA receptors in influencing cocaine-related behaviour. Breeding of parents heterozygous for deletion of alpha2 resulted in litters containing homozygous knockout (alpha2-/-), heterozygous knockout (alpha2+/-), and wildtype (alpha2+/+) offspring. Following the ELS procedure, the mice were allowed to develop to adulthood before being tested for the acute effect of cocaine on locomotor stimulation, behavioural sensitisation to repeated cocaine, and to cocaine-conditioned activity. Exposure to ELS resulted in increased acute locomotor stimulant effects of cocaine across all genotypes, with the most marked effects in alpha2-/- mice (which also showed increased activity following vehicle). Repeated cocaine administration to non-stressed mice resulted in sensitisation in alpha2+/+ and alpha2+/- mice, but, in keeping with previous findings, not in alpha2-/- mice. Prior exposure to ELS reduced sensitisation in alpha2+/+ mice, albeit not significantly, and abolished sensitisation in alpha2+/- mice. Conditioned activity was elevated following ELS in all animals, independently of genotype. Thus, while the enhanced acute effects of cocaine following ELS being most marked in alpha2-/- mice suggests a function of alpha2-containing GABAA receptors in protecting against stress, the interaction between ELS and genotype in influencing sensitisation may be more in keeping with ELS reducing expression of alpha2-containing GABAA receptors. The ability of ELS to increase cocaine-conditioned locomotor activity appears to be independent of alpha2-containing GABAA receptors

A NuSTAR observation of the reflection spectrum of the low mass X-ray binary 4U 1728-34

We report on a simultaneous NuSTAR and Swift observation of the neutron star low-mass X-ray binary 4U 1728-34. We identified and removed four Type I X-ray bursts during the observation in order to study the persistent emission. The continuum spectrum is hard and well described by a black body with $kT=$ 1.5 keV and a cutoff power law with $\Gamma=$ 1.5 and a cutoff temperature of 25 keV. Residuals between 6 and 8 keV provide strong evidence of a broad Fe K$\alpha$ line. By modeling the spectrum with a relativistically blurred reflection model, we find an upper limit for the inner disk radius of $R_{\rm in}\leq2 R_{\rm ISCO}$. Consequently we find that $R_{\rm NS}\leq23$ km, assuming M=1.4{\mbox{\rm\,M_{\mathord\odot}}} and $a=0.15$. We also find an upper limit on the magnetic field of $B\leq2\times10^8$ G.Comment: 9 pages, 8 figure