The purpose of this qualitative descriptive design study was to explore how hospital middle managers (HMMs) described the innovation implementation experiences that influenced their innovation ...implementation in Long Island, New York. The consolidated framework for implementation research (CFIR) guided this study and shaped the overarching research question: how do HMMs describe their innovation implementation experiences that influence their innovation implementation outcomes? The fourth domain of CFIR guided three additional sub-RQs. Purposeful and snowball sampling were used to select 15 HMMs that participated in one-to-one interviews. Nine of the same 15 HMMs partook in two focus groups. Thematic analysis was used to identify and interpret deductive and inductive patterns found in the data. Data analysis generated twelve themes, nine were facilitators of innovation implementation and remaining three were barriers. Study results found participants desired continuous feedback and leadership development; this fostered enhanced affective commitment and mindset which helped guide more successful innovation implementations. Therefore, healthcare organizations need to develop strategies to incorporate HMM in the planning and execution of future innovation implementations.
Background
Cervical cancer screening is one of the most effective cancer prevention strategies, but most women in Africa have never been screened. In 2007, the Cameroon Baptist Convention Health ...Services, a large faith‐based health care system in Cameroon, initiated the Women's Health Program (WHP) to address this disparity. The WHP provides fee‐for‐service cervical cancer screening using visual inspection with acetic acid enhanced by digital cervicography (VIA‐DC), prioritizing care for women living with HIV/AIDS. They also provide clinical breast examination, family planning (FP) services, and treatment for reproductive tract infection (RTI). Here, we document the strengths and challenges of the WHP screening program and the unique aspects of the WHP model, including a fee‐for‐service payment system and the provision of other women's health services.
Methods
We retrospectively reviewed WHP medical records from women who presented for cervical cancer screening from 2007–2014.
Results
In 8 years, WHP nurses screened 44,979 women for cervical cancer. The number of women screened increased nearly every year. The WHP is sustained primarily on fees‐for‐service, with external funding totaling about $20,000 annually. In 2014, of 12,191 women screened for cervical cancer, 99% received clinical breast exams, 19% received FP services, and 4.7% received treatment for RTIs. We document successes, challenges, solutions implemented, and recommendations for optimizing this screening model.
Conclusion
The WHP's experience using a fee‐for‐service model for cervical cancer screening demonstrates that in Cameroon VIA‐DC is acceptable, feasible, and scalable and can be nearly self‐sustaining. Integrating other women's health services enabled women to address additional health care needs.
Implication for Practice
The Cameroon Baptist Convention Health Services Women's Health Program successfully implemented a nurse‐led, fee‐for‐service cervical cancer screening program using visual inspection with acetic acid‐enhanced by digital cervicography in the setting of a large faith‐based health care system in Cameroon. It is potentially replicable in many African countries, where faith‐based organizations provide a large portion of health care. The cost‐recovery model and concept of offering multiple services in a single clinic rather than stand‐alone “silo” cervical cancer screening could provide a model for other low‐and‐middle‐income countries planning to roll out a new, or make an existing, cervical cancer screening services accessible, comprehensive, and sustainable.
This report documents the strategies that led to the successful implementation of a nurse‐led cervical cancer screening program using visual inspection with acetic acid enhanced by digital cervicography, describes programmatic challenges, makes recommendations to optimize screening and treatment outcomes, and discusses the unique aspects of the Women's Health Program model developed in Cameroon.
Abstract
SHARPIN is a component of the linear ubiquitination assembly complex and a key regulator of NFkB and integrin signaling. SHARPIN-deficient mice develop a phenotype known as chronic ...proliferative dermatitis (cpdm), characterized by progressive epidermal hyperplasia, apoptosis of keratinocytes, cutaneous and systemic eosinophilic inflammation, and hypoplasia of secondary lymphoid organs. We recently reported that the cutaneous inflammation in SHARPIN-deficient mice (Sharpincpdm) develops independently of B and T lymphocytes. We therefore sought to determine the role of innate lymphoid cells (ILCs) in the dermatitis of Sharpincpdm mice. ILCs were identified as a discrete population of CD45+ Lin−CD90.2hi cells in the skin and draining lymph nodes (LN) of wild type (WT) and Sharpincpdm mice. The number of ILCs was markedly increased in Sharpincpdm mice. The majority of cells were group 2 ILC (ILC2) as indicated by labeling for GATA3, IL5, and IL13. The skin of Sharpincpdm mice had increased expression of Il33 and Tslp mRNA. To determine the role of IL33, double mutant mice were generated in which the receptor for IL33 (Il1lr1 also known as ST2) was deleted. Loss of IL33-signaling greatly reduced the number of ILCs and reduced the severity of the dermatitis. These experiments suggest that the dermatitis in Sharpincpdm mice is driven by IL33-dependent ILC2. Supported by the NIH (AR049288).
Dissection reports of large cats (family Felidae) have been published since the late 19th century. These reports generally describe the findings in words, show drawings of the dissection, and usually ...include some masses of muscles, but often neglect to provide muscle maps showing the precise location of bony origins and insertions. Although these early reports can be highly useful, the absence of visual depictions of muscle attachment sites makes it difficult to compare muscle origins and insertions in living taxa and especially to reconstruct muscle attachments in fossil taxa. Recently, more muscle maps have been published in the primary literature, but those for large cats are still limited. Here, we describe the muscular anatomy of the forelimb of the tiger (Panthera tigris), and compare muscle origins, insertions, and relative muscle masses to other felids to identify differences that may reflect functional adaptations. Our results reiterate the conservative nature of felid anatomy across body sizes and behavioral categories. We find that pantherines have relatively smaller shoulder muscle masses, and relatively larger muscles of the caudal brachium, pronators, and supinators than felines. The muscular anatomy of the tiger shows several modifications that may reflect an adaptation to terrestrial locomotion and a preference for large prey. These include in general a relatively large m. supraspinatus (shoulder flexion), an expanded origin for m. triceps brachii caput longum, and relatively large m. triceps brachii caput laterale (elbow extension), as well as relatively large mm. brachioradialis, abductor digiti I longus, and abductor digiti V. Muscle groups that are well developed in scansorial taxa are not well developed in the tiger, including muscles of the cranial compartment of the brachium and antebrachium, and m. anconeus. Overall, the musculature of the tiger strongly resembles that of the lion (Panthera leo), another large‐bodied terrestrial large‐prey specialist.
We describe the muscular anatomy of the tiger forelimb, and compare muscle origins, insertions, and relative muscle masses to other felids. Our results reiterate the conservative nature of felid anatomy across body sizes and behavioral categories. We find several differences in regional muscle mass between the two felid subfamilies, Pantherinae and Felinae, and identify modifications of tiger musculature that may reflect an adaptation to terrestrial locomotion and a preference for large prey.
Kemp’s ridley sea turtles placed for <6 h in unfamiliar saltwater pools after ground transport exhibited normalization of plasma glucose and potassium, as well as partial improvements in ...corticosterone and immune measures. A brief period in saltwater pools may help sea turtles recover from transport stress prior to release to sea.
Abstract
Sea turtle rehabilitation clinics and aquaria frequently transport stranded sea turtles long distances out of water, e.g. for release at sites with appropriate water temperatures. Endangered Kemp’s ridley turtles (Lepidochelys kempii) are known to exhibit an adrenal stress response during such transports. In an opportunistic study of turtles transported by road from Massachusetts to Georgia for release, we tested whether placing turtles in saltwater pools for short periods after transport would help turtles recover from transport-related stress. Eighteen juvenile Kemp’s ridley turtles were examined and blood samples collected (1) immediately pre-transport, (2) immediately post-transport and (3) after a 6 h (n = 9) or 24 h (n = 9) post-transport period in unfamiliar pools, after which all turtles were released to the sea. Blood samples were analyzed for corticosterone, glucose, total white blood cell (WBC) count, heterophil/lymphocyte (H/L) ratio, pH, pO2, pCO2, HCO3 (bicarbonate), sodium, potassium, ionized calcium, lactate and hematocrit. Though the majority of turtles remained in good clinical condition, corticosterone, glucose, WBC and H/L elevated significantly during transport, while potassium declined slightly but significantly. After at least 6 h in a saltwater pool, potassium and glucose returned to pre-transport baselines and corticosterone partially recovered toward baseline. Extending the pool time to 24 h did not markedly enhance the physiological recovery of turtles, and two immune measures (WBC, H/L) remained elevated from the effect of transport. Six hours in a saltwater pool appears to facilitate the recovery of Kemp’s ridley sea turtles from transport-related stress and may therefore improve their readiness for release.
Governments around the world are pressed to invest in postsecondary education. However, little research exists to document whether large-scale educational reforms aimed at increasing rates of ...postsecondary attendance benefit youth’s developmental outcomes. This study tested whether an educational reform occurring in Québec, Canada, in the 1960s increased educational levels, and whether it benefitted some youth more than others. In the 1970’s, 4109 low-income youth (50% females) aged 7–13 years old were recruited at Time 1 from first, fourth, and seventh grade classes (
M
age
= 10.6,
SD
= 2.5). Socio-behavioral characteristics and academic skills at Time 1 were examined as predictors of educational attainment at Time 2, three decades later, on 3883 of the same participants. Multinomial logistic regressions were used to examine the likelihood of youth obtaining a diploma from the newly created, accessible, and affordable colleges (“cégeps”). Low-educated groups (high school dropouts and high school graduates) presented a higher early risk profile than did college graduates. Interactions revealed that social withdrawal protected youth from disadvantaged neighborhoods, helping them graduate from college. Likeability helped academically weaker girls go beyond college and access university, and helped academically competent boys graduate from college. Aggressive behavior decreased the odds of university attendance for academically competent boys. Policies promoting higher education for disadvantaged youth should be supplemented with early interventions integrating academic and socio-behavioral objectives.
Abstract In the HIV context, risky sexual behaviours can be reduced through effective parent–adolescent communication. This study used the Parent Adolescent Communication Scale to determine ...parent–adolescent communication by ethnicity and identify predictors of high parent–adolescent communication amongst South African adolescents post-apartheid. A cross-sectional interviewer-administered survey was administered to 822 adolescents from Johannesburg, South Africa. Backward stepwise multivariate regressions were performed. The sample was predominantly Black African (62%, n = 506) and female (57%, n = 469). Of the participants, 57% ( n = 471) reported high parent–adolescent communication. Multivariate regression showed that gender was a significant predictor of high parent–adolescent communication (Black African OR:1.47, CI: 1.0–2.17, Indian OR: 2.67, CI: 1.05–6.77, White OR: 2.96, CI: 1.21–7.18). Female-headed households were predictors of high parent–adolescent communication amongst Black Africans (OR:1.49, CI: 1.01–2.20), but of low parent–adolescent communication amongst Whites (OR:0.36, CI: 0.15–0.89). Overall levels of parent–adolescent communication in South Africa are low. HIV prevention programmes for South African adolescents should include information and skills regarding effective parent–adolescent communication.
Primary care is a key component of medical care delivery and has a role to play in reducing obesity in the United States. The purpose of this study was to explore attitudes and perceptions about ...obesity in low-income primary care patients and to identify preferences for weight management interventions from the patient and healthcare provider perspectives.
A convenience sample of 28 patients and 6 healthcare providers from across the state of Louisiana participated in 1 of 5 structured focus groups. Demographic information was collected from both the patients and healthcare providers using survey instruments.
Patients and healthcare providers were more similar than dissimilar in their perceptions of obesity in that both groups selected referral to a nutritionist, use of medication, and prescribed exercise as the top 3 strategies that would have the greatest impact on losing weight. Referral to a nutritionist was selected as the easiest strategy to implement.
Receiving feedback from both patients and healthcare providers gives researchers the opportunity to acquire useful knowledge that may be beneficial in designing and conducting interventions suitable for patients desiring to lose weight, especially those in primary care settings.
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