A Perspective on the Unserved Mildly Handicapped

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Clinical validity assessment of a breast cancer risk model combining genetic and clinical information

_Background:_ The extent to which common genetic variation can assist in breast cancer (BCa) risk assessment is unclear. We assessed the addition of risk information from a panel of BCa-associated single nucleotide polymorphisms (SNPs) on risk stratification offered by the Gail Model.

_Methods:_ We selected 7 validated SNPs from the literature and genotyped them among white women in a nested case-control study within the Women’s Health Initiative Clinical Trial. To model SNP risk, previously published odds ratios were combined multiplicatively. To produce a combined clinical/genetic risk, Gail Model risk estimates were multiplied by combined SNP odds ratios. We assessed classification performance using reclassification tables and receiver operating characteristic (ROC) curves. 

_Results:_ The SNP risk score was well calibrated and nearly independent of Gail risk, and the combined predictor was more predictive than either Gail risk or SNP risk alone. In ROC curve analysis, the combined score had an area under the curve (AUC) of 0.594 compared to 0.557 for Gail risk alone. For reclassification with 5-year risk thresholds at 1.5% and 2%, the net reclassification index (NRI) was 0.085 (Z = 4.3, P = 1.0×10^-5^). Focusing on women with Gail 5-year risk of 1.5-2% results in an NRI of 0.195 (Z = 3.8, P = 8.6×10^−5^).

_Conclusions:_ Combining clinical risk factors and validated common genetic risk factors results in improvement in classification of BCa risks in white, postmenopausal women. This may have implications for informing primary prevention and/or screening strategies. Future research should assess the clinical utility of such strategies.
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EMSL Quarterly Highlights Report Second Quarter, Fiscal Year 2010 (January 1, 2010 through March 31, 2010)

The Environmental Molecular Sciences Laboratory (EMSL) is a U.S. Department of Energy (DOE) national scientific user facility located at Pacific Northwest National Laboratory (PNNL) in Richland, Washington. EMSL is operated by PNNL for the DOE-Office of Biological and Environmental Research. At one location, EMSL offers a comprehensive array of leading-edge resources and expertise. Access to the instrumentation and expertise is obtained on a peer-reviewed proposal basis. Staff members work with researchers to expedite access to these capabilities. The "EMSL Quarterly Highlights Report" documents current research and activities of EMSL staff and users

Using Intervention Mapping to Develop an Efficacious Multicomponent Systems-Based Intervention to Increase Human Papillomavirus (HPV) Vaccination in a Large Urban Pediatric Clinic Network

Background: The CDC recommends HPV vaccine for all adolescents to prevent cervical, anal, oropharyngeal, vaginal, vulvar, and penile cancers, and genital warts. HPV vaccine rates currently fall short of national vaccination goals. Despite evidence-based strategies with demonstrated efficacy to increase HPV vaccination rates, adoption and implementation of these strategies within clinics is lacking. The Adolescent Vaccination Program (AVP) is a multicomponent systems-based intervention designed to implement five evidence-based strategies within primary care pediatric practices. The AVP has demonstrated efficacy in increasing HPV vaccine initiation and completion among adolescents 10-17 years of age. The purpose of this paper is to describe the application of Intervention Mapping (IM) toward the development, implementation, and formative evaluation of the clinic-based AVP prototype. Methods: Intervention Mapping (IM) guided the development of the Adolescent Vaccination Program (AVP). Deliverables comprised: a logic model of the problem (IM Step 1); matrices of behavior change objectives (IM Step 2); a program planning document comprising scope, sequence, theory-based methods, and practical strategies (IM Step 3); functional AVP component prototypes (IM Step 4); and plans for implementation (IM Step 5) and evaluation (IM Step 6). Results: The AVP consists of six evidence-based strategies implemented in a successful sequenced roll-out that (1) established immunization champions in each clinic, (2) disseminated provider assessment and feedback reports with data-informed vaccination goals, (3) provided continued medical and nursing education (with ethics credit) on HPV, HPV vaccination, message bundling, and responding to parent hesitancy, (4) electronic health record cues to providers on patient eligibility, and (5) patient reminders for HPV vaccine initiation and completion. Conclusions: IM provided a logical and systematic approach to developing and evaluating a multicomponent systems-based intervention to increase HPV vaccination rates among adolescents in pediatric clinics

Urban Horticulture, from Local Initiatives to Global Success Stories

Urban horticulture describes economically viable horticultural production activities conducted in a city or suburb. It is a growing segment of horticulture in the United States as well as in developing countries, where the enormous growth of megalopolis is not backed by a simultaneous increase of farmland or agricultural productivity. Today, urban horticulture includes food sovereignty in underprivileged neighborhoods, increased availability of vegetables and fruits in big cities, healthy and diverse diets, improved food safety, low transportation costs, efficient resource use, and the mitigation of environmental impacts of horticultural production such as the emission of greenhouse gases. The workshop “Urban horticulture: From local initiatives to global success stories,” held at the 2018 American Society for Horticultural Science (ASHS) conference in Washington, DC, featured present and historical success stories of urban horticulture from Asia, Africa, Latin America, and the United States

Examining Change in Confidence: A Unique Approach to Interprofessional Education Evaluation

Introduction. Measuring student confidence is integral to evaluating student perceived ability regarding interprofessional collaborative practice. The purpose of this study was to examine change in confidence after an introductory interprofessional education assignment using Bandura’s self-efficacy framework. Methods. A retrospective pre-post design assessed change in student confidence, targeting the strength dimension of self-efficacy beliefs. Students enrolled in health discipline-specific courses in two sequential years participated in an introductory embedded case-based IPE assignment. Sixteen statements were developed to assess students’ confidence for specific Interprofessional Education Collaborative (IPEC) sub-competencies consistent with student learning outcomes. Descriptive statistics, paired sample t-tests (comparing pre-post), analysis of variance and independent samples t-tests (comparing across disciplines and the two years) were used in the analysis. Results. Data from 203 participants provided a useable response of 80.6%. The percent of students indicating an increase in their confidence for the different IPEC sub-competencies ranged from 38.9% for “Encourage ideas and opinions of other team members” to 82.3% for “Explain the roles and responsibilities of other professionals”. Differences in mean change in confidence was found among nine sub-competencies when comparing across the disciplines. In addition, students in Year 1 reported larger increases in confidence for nine sub-competencies compared to Year 2 students. Discussion. Results give insight to student perceptions for strategic formative assessment and IPE assignment design. A retrospective pre-post design provided a novel means of examining change in confidence that avoids response-shift bias, while providing students the opportunity to explicitly self-report change or lack of change in confidence. Smaller increases in confidence in Year 2 compared to Year 1 were unexpected and may be due to the Year 2 requirement that teams discuss and agree upon team rules. Although counter-intuitive, the potential for reducing the amount of conflict may have contributed to less of an increase in confidence, as confidence can be gained from not only being well prepared, but also overcoming adversity (mastery experience). Each Year 2 student also was required to write a reflection regarding team ground rules and their implementation. This may have helped students realize greater complexities of successful interprofessional collaboration and their own limitations to achieve it