African American women are disproportionately impacted by sexually transmitted infections (STIs), such as chlamydia and gonorrhea, which are known risk factors for human immunodeficiency virus (HIV) ...infection. STIs, particularly chlamydia and gonorrhea, are even more prevalent among young African American women with a juvenile detention history. The population with experiences with the criminal justice system has greater rates of STIs and is diagnosed more often with mental health issues, often related to sexual abuse or intimate partner violence, compared to peers who have not been detained by law enforcement. Psychosocial factors, especially those related to intimate relationships (ie, the imperativeness of being in a relationship and the power one has in their relationship), have emerged as important explanatory factors for acquiring STIs, including HIV, and a component of risk reduction interventions.
To investigate more comprehensively the relationship between psychosocial risk factors and STIs, including HIV, as it relates to reduction and prevention of these diseases. The long-term goal is to improve the effectiveness of evidence-based interventions with a major focus on intimate relationship dynamics.
This descriptive study surveys young women (ages 13-17) who have been detained (incarcerated) by a department of juvenile justice. In addition to being female and detained, eligibility criteria include being detained longer than 30 days and being free of cognitive impairments. This study will include young women from one juvenile detention center. The primary outcomes to be measured are STI knowledge, intimate relationship dynamics (ie, imperativeness and power), and high-risk sexual behaviors. High-risk sexual behaviors will be assessed using data extracted from health records.
Preliminarily, we have received assent from 26 primarily young African American women. The majority of participants (81%) had inadequate knowledge about STIs, 52% perceived a lack of power in their relationship, 56% were fearful of negotiating condom use, and 60% were not comfortable refusing sex. Interestingly, a majority of participants (68%) did not perceive a relationship as imperative.
When enrollment and data collection are completed, it is expected that the primary outcome of intimate relationship dynamics (ie, imperativeness and power) will be associated with high-risk sexual behaviors and having an STI. Further, the findings are expected to provide guidance in developing a risk reduction intervention, for the population in which psychosocial factors related to intimate relationships will be central.
Little is known about the rates of obesity among African American (AA) breast cancer survivors (BCSs), the availability and use of lifestyle modification methods suitable for this population, and the ...impact of changes in dietary intake and physical activity on health-related quality of life (HR-QoL).
The objectives of the study were to describe obesity rates, dietary intake, and physical activity as lifestyle modification strategies; examine predictors of engagement in these strategies post diagnosis; and learn more about salient features of lifestyle interventions from AA BCSs participating in a breast cancer support group.
The needs assessment included four components: (1) a literature review to determine existing lifestyle modification strategies of AA BCSs; (2) secondary data analysis of the 2010 National Health Interview Survey, Cancer Control Supplement to examine HR-QoL; (3) administration, to 200 AA BCSs, of an assessment tool relating to weight and breast cancer history, dietary intake, and physical activity through a variety of approaches (eg, Internet, mail, in-person, and telephone); and (4) focus group discussions to frame lifestyle interventions.
Preliminary findings indicate that AA BCSs are underrepresented in lifestyle intervention research, have disparities in HR-QoL outcomes, do not meet current cancer prevention guidelines, and have recommendations for effective strategies for lifestyle modification.
As analyses of the needs assessment are completed, the research team is partnering with community coalitions and breast cancer support groups in Miami, Chicago, Houston, Los Angeles, and Philadelphia to develop community-engaged intervention approaches for promoting adherence to cancer prevention guidelines.
Little is known about the rates of obesity among African American (AA) breast cancer survivors (BCSs), the availability and use of lifestyle modification methods suitable for this population, and the ...impact of changes in dietary intake and physical activity on health-related quality of life (HR-QoL).
The objectives of the study were to describe obesity rates, dietary intake, and physical activity as lifestyle modification strategies; examine predictors of engagement in these strategies post diagnosis; and learn more about salient features of lifestyle interventions from AA BCSs participating in a breast cancer support group.
The needs assessment included four components: (1) a literature review to determine existing lifestyle modification strategies of AA BCSs; (2) secondary data analysis of the 2010 National Health Interview Survey, Cancer Control Supplement to examine HR-QoL; (3) administration, to 200 AA BCSs, of an assessment tool relating to weight and breast cancer history, dietary intake, and physical activity through a variety of approaches (eg, Internet, mail, in-person, and telephone); and (4) focus group discussions to frame lifestyle interventions.
Preliminary findings indicate that AA BCSs are underrepresented in lifestyle intervention research, have disparities in HR-QoL outcomes, do not meet current cancer prevention guidelines, and have recommendations for effective strategies for lifestyle modification.
As analyses of the needs assessment are completed, the research team is partnering with community coalitions and breast cancer support groups in Miami, Chicago, Houston, Los Angeles, and Philadelphia to develop community-engaged intervention approaches for promoting adherence to cancer prevention guidelines.
The incidence of anal carcinoma has increased over the last few decades especially in African Americans (AA) despite the use of highly active anti-retroviral therapy (HAART). Here, we retrospectively ...review oncologic outcomes of AA patients with anal squamous cell carcinoma (SCC) with and without HIV to further examine the cause of this trend.
All adult AA patients diagnosed with anal SCC from 2000 to 2007 who met inclusion were examined. All patients were staged according to the American Joint Committee on Carcinoma (AJCC) sixth edition staging classification. Patients were divided into two cohorts: HIV (-) and HIV (+). Demographics, comorbidities, and oncologic outcomes were analyzed.
Twenty-two AA patients with anal SCC were analyzed. Fifteen (68.%) were HIV (+) and seven (32%) were negative. Seventy-four percent of HIV (+) patients were on HAART therapy at the time of diagnosis. The HIV (+) cohort was significantly younger, mostly male, and had more comorbidities compared to the negative cohort. There was no difference in tumor, nodal or metastasis (TNM) stage for both cohorts. HIV (+) patients were more likely to receive non-operative therapy. The 5-year survival rate for HIV negative and positive patients was 57% and 58%, respectively. AJCC stage was the only factor predictive of survival after performing Cox hazard proportional regression analysis, HR: 1.96 (95% CI, 0.987 to 3.881).
In the HAART era, HIV (+) AA patients are at high risk of developing anal SCC. However, the prognosis of HIV (+) AA with anal SSC is similar to that of their HIV (-) counterparts. Carcinoma stage is the only factor predictive of survival.
In 5G networks, mitigating blockage effects in millimeter-wave (mmWave) signals is a major challenge to overcome. Coordinated multipoint (CoMP) transmission is one of the inference mitigation schemes ...that can be used in a densified cellular network. CoMP transmission is usually implemented within a cloud radio access network (C-RAN) via fronthaul links which is connected to a control unit (CU). In this paper, a radio unit clustering scheme (RCS) was proposed based on CoMP transmission to mitigate blockage effect of mmWave links. Applying a clustering scheme in C-RAN can increase the network capacity by avoiding data transmission via non-line-of-sight (NLOS) links. Based on stochastic geometry, the coverage probability of the proposed RCS is derived into a closed-form expression by modeling the position of base stations as a Poisson point process. In addition, an enhanced cooperative handover scheme is proposed to increase mobility robustness of the proposed RCS. Simulation results show that the coverage probability is enhanced as the cluster size increases in mmWave C-RANs and a radio link failure (RLF) probability during handover procedure is reduced.
This research compares two models for longitudinal prostate specific antigen (PSA) readings according to their ability to detect prostate cancer (PCa) onset. We consider a fully Bayesian hierarchical ...change point model, similar to that of Slate and Clark (1999); in which cancer onset is represented as a change point in the men's PSA trajectories and all men are presumed to experience onset eventually. We provide two models, Model I and Model II. Model I generalizes the model, considering risk factors of prostate cancer as covariates. Our model permits the covariates to affect an individual's PSA three ways: the overall level, the age at which cancer initiates (changepoint), and the growth rate following the changepoint. This is a Bayesian variable selection procedure. Model II postulates a mixture for the PSA series, for which one component contains a change point and the other does not. Both models are fit using Markov chain Monte Carlo methods, with a reversible jump (Green, 1995) implementation for Model II. Since we allows different parameter dimensions depending on incorporation of a changepoint in Model II, this is a Bayesian model determination procedure. We apply these models to data from the Nutritional Prevention of Cancer Trials (Clark et al., 1996); and investigate the effects of covariates (smoking, alcohol usage and body mass index) on PSA growth by examining credible regions for covariate parameters and by computing conditional predictive ordinate (CPO) values (Gelfand et al., 1992) and pseudo Bayes factors. We then use ROC curves to compare the performance of diagnostic rules for PCa onset derived from the posterior distributions of the change points for each model. This research shows that a decision based on longitudinal biomarkers can be more effective in diagnostic cancer detection than one based on a single measurement. For Mode I, we consider three risk factors for early detection of prostate cancer, smoking habit, alcohol consumption and BMI. Based on this work, we have two important risk factors of prostate cancer, smoking history and body mass index. For smoking related variables, the variable related with smoking history is the most important with a slope effect, and a continuous variable BMI with a changepoint effect more important than the other dichotomous variable for obese subject. With the Bayesian variable selection procedure, we select the best model including above two covariates. Finally we compare Model I and Model II using cross-validation and retrospective ROC methods. Based on the goodness of fit, we conclude that Model II is better than Model I.
The patient-centered medical home (PCMH) model has been proposed as the ideal model for delivering primary care and is focused on improving patient safety and quality, reducing costs, and enhancing ...patient satisfaction. The mandated Accreditation Council for Graduate Medical Education educational milestones for evaluation of resident competency represent the skills graduates will utilize after graduation. Many of these skills are reflected in the PCMH model. We sought to determine if residency programs whose main family medicine (FM) practice sites have achieved PCMH recognition are therefore more prepared to evaluate milestones.
A national Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine program directors (PDs) was conducted during June and July 2015 to determine if PCMH recognition influences PDs' ability to evaluate training methods and their level of preparedness to evaluate milestones.
The response rate for the survey was 53.3% (252/473). Nearly two-thirds of the PDs (62.7%) reported that their main FM practice site had earned PCMH recognition. There was no statistical difference between non-PCMH-recognized vs PCMH-recognized programs in how PDs perceived that their program was prepared to assess residents' milestone levels overall (
=0.414). Residents of PCMH-recognized programs were more likely to receive training for team-based care (
=0.009), system improvement plans (
<0.001), root-cause analysis (
=0.002), and health behavior change (
=0.003).
PCMH recognition itself did not improve preparedness of FM residency programs to assess milestones. Residents from programs whose main FM practice site is PCMH-recognized are more likely to be trained in the key concepts and tasks associated with the PCMH model, tools that they are expected to utilize extensively after graduation.
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