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Evidence-based interventions (EBIs) exist to increase colorectal cancer (CRC) screening, but implementation remains slow in federally qualified health centers (FQHCs). Assessing organizational readiness can improve EBI implementation outcomes, but no studies have quantitatively examined the relation between organizational readiness subcomponents and implementation outcomes. This study examines associations between readiness subcomponents and CRC screening EBI implementation outcomes in FQHCs.
Methods:
We used data from an ongoing parent study to develop an organizational readiness measure using the R = MC2 heuristic. We conducted descriptive and cross-sectional analyses using FQHC clinic (n = 57) data across three states. A clinic contact completed a survey about clinic characteristics and then distributed an EBI-specific survey to clinic staff containing readiness and implementation questions about Community Guide EBIs (e.g., patient reminders). Pearson correlations assessed bivariate associations between readiness variables and implementation outcomes. We then computed multivariable linear associations between readiness variables and implementation outcomes while controlling for clinic-level variables. One-way analysis of variance tested group differences in readiness subcomponent mean scores using EBI implementation responses.
Results:
Respondents’ most common job type was medical assistant, and the most frequently implemented EBIs were provider or patient reminders. Organizational structure was associated with implementing patient reminders. Clinics reporting inconsistent implementation had lower organizational structure scores than clinics planning or fully implementing patient reminders.
Conclusion:
This study guides researchers in prioritizing organizational structure and selecting specific implementation strategies to improve this construct to implement CRC screening-related EBIs. Future research should examine these associations using a larger sample size to explore additional relations between organizational readiness and implementation outcomes.
The internet constantly evolves and facilitates the development of new avenues for users to interact and communicate internationally. Social media and search engines represent the forefront of internet technologies that enable users to produce content, develop digital participatory networks, and share information across various topics. These internet tools are reshaping the continuum of care by enabling patients to acquire medical information, consult peers and healthcare practitioners, and even make treatment decisions without leaving their connected device. The consequences of circumventing traditional pathways to care are amplified in men’s health due to the fact that men frequently do not engage with the healthcare system and that erectile dysfunction and male infertility are stigmatized. The focus of this chapter is to evaluate the emerging online landscape for common men’s health conditions including male infertility, erectile dysfunction, hypogonadism, and Peyronie’s disease.
The transition from residency to paediatric cardiology fellowship is challenging due to the new knowledge and technical skills required. Online learning can be an effective didactic modality that can be widely accessed by trainees. We sought to evaluate the effectiveness of a paediatric cardiology Fellowship Online Preparatory Course prior to the start of fellowship.
Methods:
The Online Preparatory Course contained 18 online learning modules covering basic concepts in anatomy, auscultation, echocardiography, catheterisation, cardiovascular intensive care, electrophysiology, pulmonary hypertension, heart failure, and cardiac surgery. Each online learning module included an instructional video with pre-and post-video tests. Participants completed pre- and post-Online Preparatory Course knowledge-based exams and surveys. Pre- and post-Online Preparatory Course survey and knowledge-based examination results were compared via Wilcoxon sign and paired t-tests.
Results:
151 incoming paediatric cardiology fellows from programmes across the USA participated in the 3 months prior to starting fellowship training between 2017 and 2019. There was significant improvement between pre- and post-video test scores for all 18 online learning modules. There was also significant improvement between pre- and post-Online Preparatory Course exam scores (PRE 43.6 ± 11% versus POST 60.3 ± 10%, p < 0.001). Comparing pre- and post-Online Preparatory Course surveys, there was a statistically significant improvement in the participants’ comfort level in 35 of 36 (97%) assessment areas. Nearly all participants (98%) agreed or strongly agreed that the Online Preparatory Course was a valuable learning experience and helped alleviate some anxieties (77% agreed or strongly agreed) related to starting fellowship.
Conclusion:
An Online Preparatory Course prior to starting fellowship can provide a foundation of knowledge, decrease anxiety, and serve as an effective educational springboard for paediatric cardiology fellows.
Previous genetic association studies have failed to identify loci robustly associated with sepsis, and there have been no published genetic association studies or polygenic risk score analyses of patients with septic shock, despite evidence suggesting genetic factors may be involved. We systematically collected genotype and clinical outcome data in the context of a randomized controlled trial from patients with septic shock to enrich the presence of disease-associated genetic variants. We performed genomewide association studies of susceptibility and mortality in septic shock using 493 patients with septic shock and 2442 population controls, and polygenic risk score analysis to assess genetic overlap between septic shock risk/mortality with clinically relevant traits. One variant, rs9489328, located in AL589740.1 noncoding RNA, was significantly associated with septic shock (p = 1.05 × 10–10); however, it is likely a false-positive. We were unable to replicate variants previously reported to be associated (p < 1.00 × 10–6 in previous scans) with susceptibility to and mortality from sepsis. Polygenic risk scores for hematocrit and granulocyte count were negatively associated with 28-day mortality (p = 3.04 × 10–3; p = 2.29 × 10–3), and scores for C-reactive protein levels were positively associated with susceptibility to septic shock (p = 1.44 × 10–3). Results suggest that common variants of large effect do not influence septic shock susceptibility, mortality and resolution; however, genetic predispositions to clinically relevant traits are significantly associated with increased susceptibility and mortality in septic individuals.
Pharyngocutaneous fistulae are dreaded complications following total laryngectomy. This paper presents our experience using 3–5 ml gastrografin to detect pharyngeal leaks following total laryngectomy, and compares post-operative videofluoroscopy with clinical follow-up findings in the detection of pharyngocutaneous fistulae.
Methods
A retrospective case–control study was conducted of total laryngectomy patients. The control group (n = 85) was assessed clinically for development of pharyngocutaneous fistulae, while the study group (n = 52) underwent small-volume (3–5 ml) post-operative gastrografin videofluoroscopy.
Results
In the control group, 24 of 85 patients (28 per cent) developed pharyngocutaneous fistulae, with 6 requiring surgical correction. In the study group, 24 of 52 patients (46 per cent) had videofluoroscopy-detected pharyngeal leaks; 4 patients (8 per cent) developed pharyngocutaneous fistulae, but all cases resolved following non-surgical management. Patients who underwent videofluoroscopy had a significantly lower risk of developing pharyngocutaneous fistulae; sensitivity and specificity in the detection of pharyngocutaneous fistulae were 58 per cent and 100 per cent respectively.
Conclusion
Small-volume gastrografin videofluoroscopy reliably identified small pharyngeal leaks. Routine use in total laryngectomy combined with withholding feeds in cases of early leaks may prevent the development of pharyngocutaneous fistulae.
Mungbean yellow mosaic virus (MYMV) is a disastrous pathogen of mungbean. It is widespread in most of southern India and no complete resistance has been identified among its commercial cultivars. Two isolates of MYMV, representing its diversity, were used to assess and characterize the susceptibility reaction of all the three species of Vigna. The seeds were agroinoculated with the virus and the presence of the viral DNA was confirmed after 12 d by reverse transcriptase-polymerase chain reaction (RT-PCR) analysis after which the plants were monitored for the expression of symptoms. All of the 20 accessions of Vigna radiata and ten accessions of Vigna mungo were systemically infected with MYMV, and they all produced typical symptoms. On the other hand, the 24 accessions of Vigna umbellata were found to be resistant to both the isolates. For additional affirmation, three representative accessions of V. radiata and V. mungo and all the accessions of V. umbellata were agroinoculated, and quantitative RT-PCR was performed for the quantitative detection of the MYMV. The mRNA transcripts of MYMV were detected in V. radiata and V. mungo plants but not in the V. umbellata plants. Researching the molecular basis of the resistance in V. umbellate against MYMV might definitely be very constructive for developing resistant varieties of mungbean on a commercial scale. This genetic quality offering resistance to MYMV could also be incorporated into V. radiata/V. mungo by means of interspecific crosses.
Perturbations in a non-normal system can grow transiently even if the system is linearly stable. If this transient growth is sufficiently large, it can trigger self-sustained oscillations from small initial disturbances. This has important practical consequences for combustion–acoustic oscillations, which are a persistent problem in rocket and aircraft engines. Balasubramanian & Sujith (J. Fluid Mech., vol. 594, 2008, pp. 29–57) modelled an infinite-rate chemistry diffusion flame in an acoustic duct and found that the transient growth in this system can amplify the initial energy by a factor, ${G}_{max} $, of the order of $1{0}^{5} $ to $1{0}^{7} $. However, recent investigations by L. Magri and M. P. Juniper have brought to light certain errors in that paper. When the errors are corrected, ${G}_{max} $ is found to be of the order of 1 to 10, revealing that non-normality is not as influential as it was thought to be.
During a routine survey, the scalloped hammerhead shark, Sphyrna lewini was caught from Nagapattinam coastal waters, south-east coast of India. It is the second time this species has occurred after a long period along the Indian coast, and this substantiates the possibility of its entry from another place.
In this study, the developmental ability and cellular composition of porcine IVF, parthenote and somatic cell nuclear transfer (SCNT) embryos were evaluated following different in vitro culture systems. Group 1, embryos were cultured in NCSU-23 with 5.55 mM D-glucose (NCSU+) until day 6 on 20% O2 or 5% O2 (Group 2). Group 3, embryos were cultured in D-glucose-free NCSU-23 (NCSU−) with 0.17 mM Na pyruvate/2.73 mM Na lactate for 58 h and subsequently cultured in NCSU+ until day 6 (NCSU −/+) on 20% O2 or 5% O2 (Group 4). IVF blastocysts did not differ significantly with O2 concentrations, but differed significantly with major energy source (glucose and pyruvate/lactate). In Group 3 and 4 IVF blastocysts, the total cell number and apoptosis rates were not significantly different with different O2 concentrations. Blastocyst rate, total cell number and apoptosis rate in Groups 3 and 4 parthenote embryos also were not significantly different. Parthenote and SCNT, under the same culture treatment, exhibited significant differences in blastocyst and apoptosis rates (47.5 ± 16.1 vs. 24.0 ± 4.0 and 4.9 ± 9.0 vs. 22.8 ± 23.3). Apoptosis-generating rate increased in the order parthenote, IVF and then SCNT. In conclusion, in vitro development of porcine embryos was not affected by O2 concentrations but was affected by major energy source. Even so, the concentration of each major energy source and the timing of its inclusion in culture could accomplish relatively high embryonic development, the apoptosis rate stressed that more work still needs to be done in developing a better defined culture system that could support SCNT embryos equivalent to in vivo preimplantation porcine embryos.
Occulting focal plane masks for the Terrestrial Planet Finder Coronagraph (TPF-C) could be designed with continuous gray scale profile of the occulting pattern such as $1-{\rm sinc}^2$ on a suitable material or with micron-scale binary transparent and opaque structures of metallic pattern on glass. We have designed, fabricated and tested both kinds of masks. The fundamental characteristics of such masks and initial test results from the High Contrast Imaging Test bed (HCIT) at JPL are presented.
The tensile strengths of Nextel™ 720 fibers as well as tows and minicomposites made of these fibers were measured to study the effects of monazite coating at room temperature (RT) and 1200°C (HT). Tests were conducted on as-received materials (called unsoaked) as well as materials that had been thermally soaked at HT for 100 hours. Weibull analysis of fiber strength data shows close agreement between the Weibull modulus obtained from the statistical fracture distribution and the modulus obtained from a study of the gage length dependence of strength. The monazite coating does not change the RT strength of unsoaked single fibers, but has a beneficial effect in terms of strength retention under HT testing. This beneficial effect of the coating disappears for soaked samples. The results for tows and minicomposites also indicate that for the unsoaked condition, tensile failure appears to be driven by fiber surface flaws and the presence of the monazite coatings clearly improves both RT and HT strength of fibers, tows and minicomposites. However, the beneficial effects of the coating disappear after long term exposure to HT.
An international Low Frequency VLBI Network (LFVN) has been organized for observations at 327 MHz and 1665 MHz frequencies with MARK-II and S2 recording terminals. Data on the interplanetary medium and spike-like solar bursts were obtained in first preliminary experiments.
Germanium nitride (Ge3N4) was examined as a potential negative electrode material for Li-ion batteries. The electrochemistry of Ge3N4 versus Li showed high reversible capacity (500mAh/g) and good capacity retention during cycling. A combination of ex-situ and in-situ x-ray diffraction (XRD), ex-situ transmission electron microscopy (TEM) and ex-situ selective area electron diffraction (SAED) analyses revealed evidence supporting the conversion of a layer of Ge3N4 crystal into an amorphous Li3N+LixGe nanocomposite during the first lithiation. The nanocomposite was electrochemically active via a reversible Li-Ge alloying reaction while a core of unreacted Ge3N4 crystal remained inactive. The lithium/metal nitride conversion reaction process was kinetically hindered resulting in limited capacity. Mechanical milling was found to improve the material capacity.
We have utilized “in situ” X-ray Absorption Fine Structure Spectroscopy to investigate the structure and composition of thin oxide films of nickel and iron that have been prepared by electrodeposition on a graphite substrate from aqueous solutions. The films are generally disordered. Structural information has been obtained from the analysis of the data. We also present initial findings on the local structure of heavy metal ions, e.g. Sr and Ce, incorporated into the electrodeposited nickel oxide films. Our results are of importance in a number of technological applications, among them, batteries, fuel cells, electrochromic and ferroelectric materials, corrosion protection, as well as environmental speciation and remediation.
One-pot post-polymerization modification reactions such as azo-coupling and tricyanovinylation reactions were employed to synthesize a series of polymers containing different nonlinear optical (NLO) chromophoric as well as ionic functionalities. We have extended and established the versatility of our earlier reported post-modification strategy to incorporate various heteroaromatic chromophores as well as ionic functionalities in the polymers, at the final stage of synthesis. The correlation between different heteroaromatic chromophore structures and the NLO properties of the polymers was extensively studied. Polymers containing heteroaromatic chromophores exhibit improved temporal stability and enhanced NLO activity. Polymers with ionic chromophores were employed to fabricate NLO active ultra-thin films using electrostatic selfassembling (ESA) technique. Attempts were also made to synthesize second order NLO active polydiacetylene derivatives using post azo-coupling reaction.
Laboratory studies have been made on molecules of astrophysical interest such as AlO, CO, CrO, SiS, NH+ and OH. Vibrational and rotational constants have been determined more accurately in the various electronic states.
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