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Closing Gaps to Address Lifespan Health: Considerations for Developing a Preconception Healthcare Training for Community Health Workers
Get PDFCommunity health workers (CHWs) are frontline public health workers who are embedded in their own communities and as linkages to care, decreasing health disparities for underserved individuals. The goal of this capstone project was to identify Michigan CHWs\u27 knowledge gaps in the area of preconception healthcare. Through administering a training needs assessment to a sample of community health workers, the goal was to characterize knowledge gaps and make recommendations about what type of training would be most useful to them. The results of this needs assessment showed that the general state of self-reported knowledge about preconcept health among Michigan community healthcare workers is low. However, the barriers to incorporating preconception health into their work were also low. This needs assessment provides a foundation of information for developing the appropriate training for community health work workers to address preconception health concerns and raise awareness about the importance of preconception health in their communities
A Comprehensive Usability and Economic Analysis of Heat-Related Wearable Technologies: Applications to Occupational Health
No full textThe purpose of this research was to analyze the usability and economic considerations of real-time wearable technologies that are implemented in occupational settings to assess risk of heat stress and heat strain. The study population included current agriculture workers and Department of Energy (DOE), Environmental Management (EM) contractors. We employed a mixed-methods approach to comprehensively analyze the usability and economic considerations of heat-related technologies. Specifically, our approach assessed three distinct aspects the applications of these technologies in occupational settings to comprehensively address our research objective: (1) worker perceptions of heat-related wearable technologies, (2) field-based assessment of these heat-related wearable technologies, and (3) the economic impacts of using and implementing wearable technologies for heat strain risk. The results of this research demonstrate that the devices are generally perceived favorably by workers, can be used for real-time occupational heat assessment, and the devices can increase productivity. Our findings offer practical strategies and key considerations that employers should address during the deployment of these technologies. We conclude by outlining a comprehensive strategy for the utilization and implementation of heat related technologies. This research contributes to the existing occupational heat literature by offering a holistic business perspective that integrates risk assessments, worker engagement, and industrial economics
Therapeutic Muscle Power Training for Transition Aged Individuals with Cerebral Palsy
No full textMuscle power or the ability to produce muscle force rapidly plays a significant role in functional mobility. It has also been repeated shown as a deficit in individuals with cerebral palsy. Muscle power training as a therapeutic intervention as not been well operationalized in the literature. The intent of this dissertation is to explore 1) the state of the science as it relates to therapeutic muscle power training for individuals with cerebral palsy, 2) bridge the gap in understanding of therapeutic muscle power training through intervention design and trial to determine the role of visual feedback supported training, and 3) propose a new frontier using wearable technology to optimize therapeutic muscle power training intervention implementation and functional mobility outcomes for adolescents and young adults with cerebral palsy, specifically the ages of transition 14- 25 years. Therapeutic muscle power training in its current state is highly subjective and dependent on the tenacity of the participant and interventionist to promote optimal engagement and high velocity movements. The novelty of high velocity movement for individuals with cerebral palsy and limited therapeutic interventions with an acute focus on speed create a barrier to ensuring adequate thresholds are being met to promote the development of muscle power. Resistance training without adequate velocity employed results in muscular strength training which has consistently fell short of promoting v functional mobility improvements for individuals with cerebral palsy. Providing visual feedback of repetition velocity and power during training provides the participants and physical therapists with critical information to ensure muscle power training is achieved. However, this preliminary study was limited to performing only a single movement on a leg press machine. The proposed study comprehensively addresses current gaps in the literature by providing critical feedback to the participant and physical therapist while performing contextually relevant skill training with functional movements. Results from this work are foundational to operationalizing therapeutic muscle power training for physical therapists and individuals with cerebral palsy
Driving Key Partner Engagement by Integrating Community-Engaged Principles into a Stakeholder Analysis: a Qualitative Study
Get PDFIntroduction: The stakeholder analysis approach has historically been top-down rather than collaborative with key partners. However, this approach poses challenges for key partner engagement and community-engaged research, which aims to incorporate key partners throughout the project. This study, conducted by the Community Engagement Network (CEN) at a Midwest academic medical center, seeks to examine the value of community-engaged research for diverse key partners to increase collaboration, strengthen partnerships, and enhance impact, which will ultimately drive key partner engagement.
Methods: The study involved semi-structured interviews with 38 key partners from diverse groups, including community members, community organizations, Practice-Based Research Network (PBRN) members, researchers, research administration, university administration, and potential funders. The interview guide, informed by an extensive literature review, assessed perceived value, barriers, and improvement strategies for community-engaged research, supplemented by value proposition statements.
Results: Analysis revealed three main themes: 1) Fostering Community Buy-In: Authentic representation and inclusive partnerships were essential for trust and commitment; 2) Enhancing Communication and Dissemination: Effective communication strategies were vital for maintaining engagement and sharing research outcomes; and 3) Building Capacity and Ensuring Sustainability: Continuous learning and long-term investments were crucial for sustaining community-engaged research efforts.
Discussion: This study underscores the value of incorporating key partners into stakeholder analyses to enhance collaboration, strengthen partnerships, and improve the impact of community-engaged research. The findings offer valuable insight for institutional transformation and implementation of effective stakeholder analyses and engagement tools, ultimately enhancing the effectiveness of research strategies and initiatives
CCR5-Ligand Decorated Rilpivirine Lipid-Based Nanoparticles for Sustained Antiretroviral Responses
Get PDFAntiretroviral therapy (ART) is the standard remedy to improve the health-related quality of life of people living with human immunodeficiency virus (HIV). However, limited access to the viral reservoir has significantly hindered its effectiveness in fully eradicating HIV. Therefore, to improve HIV therapy, here we propose a C-C chemokine receptor type 5 (CCR5)-targeted theranostic lipid Based Nanoparticles (LBNPs) to noninvasively track and specifically deliver the antiretroviral drugs (ARVs) to the viral reservoir. A multi-modular radioactive nanoprobe was synthesized and co-encapsulated with rilpivirine (RPV, an ARV) into the LBNP to achieve a theranostic LBNP that can be tracked by positron emission tomographic and 3D-computed tomographic (PET-CT) imaging systems. The CCR5-targeted LBNPs were formulated by microfluidic mixing, and their physicochemical properties were thoroughly analyzed. The cell viability, CCR5-mediated RPV uptake, retention, and a 25-day-long viral suppression efficacy of a single dose of LBNPs were demonstrated in HIV-ADA infected human monocyte-derived macrophages (MDMs), potential HIV reservoir cells. The non-invasive PET-CT imaging system demonstrated the biodistribution of LBNPs in the humanized mice model. We also demeonstrated the tissue distribution of targeted RPV using LBNPs and their higher viral suppression efficiency in the infected Hu-mice. The LBNP safety profile was also evaluated by examining the hematotoxicity and histological abnormality in the major organs of the treated animals. Comprehensively, the study showed a proof-of-concept of CCR5-targeted LBNP to effectively deliver rilpivirine to the HIV reservoirs and substantially suppress the viral growth. This targeting strategy can be further propelled by using a combination of ARVs
Implementing a Standardized Protocol for Early Detection of Undiagnosed Hypertension Patients
Get PDFIntroduction: Hypertension is a preventable disease that frequently goes unrecognized and undertreated. Early diagnosis can prevent further comorbidities such as heart disease, stroke, and chronic kidney disease. Implementation of this protocol aims to decrease the number of patients with undiagnosed hypertension and increase the identification of patients with elevated blood pressure who did not have a pre-existing diagnosis of hypertension. The goal of implementing a standardized protocol would help eliminate the number of patients who go undiagnosed.
Methods: This quality improvement design had clinical staff flag patients with elevated blood pressure. Identified patients without a diagnosis of hypertension were educated by providers, given an education packet, encouraged to monitor their blood pressure at home, and asked to return for a follow-up appointment in two to four weeks.
Results: Prior to the protocol being initiated from June to August 2021, 0 (0%) patients were identified with elevated blood pressure, and 93 (100%) were found to have elevated blood pressure with no pre-existing diagnosis of hypertension. After the protocol was initiated from June to August 2022, however, 49 (13.6%) patients were identified with elevated blood pressure, and 312 (86.4%) were not identified for a total of 361 patients with elevated blood pressure and no current diagnosis of hypertension.
Discussion: Overall, the protocol implementation improved identification of patients with high blood pressure without a previous diagnosis of hypertension. The protocol raised awareness within the clinic regarding hypertension and associated comorbidities. There was a large increase in the number of patients found to have elevated blood pressure from 2021 to 2022. This increase is likely influenced by the change from manual to standardized automatic blood pressure cuffs. Despite protocol implementation, there was still a large volume of patients that had elevated blood pressures that remained unidentified. While staff training was done prior to protocol implementation, there was no process in place to monitor the fidelity of proper blood pressure technique and protocol adherence. Continued focus on protocol adherence may improve the number of individuals identified with elevated blood pressure
Syphilis-Related Glomerulopathy: A Rare Presentation of a Common Disease
Get PDFBackground: Syphilis is a preventable and curable sexually transmitted infection (STI) caused by the bacterium Treponema Pallidum. Syphilis has often been described as the “great mimicker” as it can affect multiple organ systems and leads to a wide variety of clinical manifestations. Kidney manifestations are rare, and the most commonly reported glomerular lesion is membranous nephropathy. Herein, we present an unusual case of a rash, membranous nephropathy and cholestatic hepatitis due to secondary syphilis. Case: A 68-year-old male with well-controlled HIV, hypertension, anemia, and depression was admitted to the hospital for evaluation of acute kidney injury and nephrotic-range proteinuria. Three weeks prior, he had experienced flu-like symptoms followed by a generalized pruritic rash. He also noted that his urine had been darker in color. He denied dysuria, hematuria, or foamy urine. He denied any sexual activity in the last year. One week before admission, he sought treatment for his rash at an outpatient dermatology clinic. A punch biopsy was performed, and triamcinolone ointment was prescribed but never utilized. On admission, physical exam revealed bilateral lower extremity edema and a diffuse maculopapular rash that spared the palms and soles. Labs were notable for creatinine of 2.34 mg/dL (up from 1.36 mg/dL six months prior), urine protein/creatinine ratio of 9.2, and alkaline phosphatase of 417 U/L. Renal biopsy exhibited membranous glomerulopathy and skin biopsy demonstrated psoriasiform acanthotic epidermis with moderately dense superficial perivascular lymphoplasmacytic infiltrate and a positive Treponema antibody immunostain. Syphilis treponemal antibody was newly positive and RPR was reactive at 1:128. The patient received 2.4 million units of benzathine penicillin intramuscularly for the treatment of secondary syphilis and was discharged two days later. Two weeks after discharge, the patient was noted to have resolution of his rash and significant improvement in his edema, proteinuria, and serum creatinine. Discussion: Identification and appropriate treatment of secondary syphilis resulted in resolution of this patient’s rash and acute kidney injury. Conclusion: This case highlights the importance of maintaining syphilis on the differential, regardless of reported risk factors, in patients with generalized rashes, cholestatic hepatitis, and/or membranous glomerulopathy as secondary syphilis can have a wide range of clinical manifestations. Checking serology before more invasive diagnostic testing should be considered with uncommon combinations of presenting symptoms.https://digitalcommons.unmc.edu/com_students_pres/1004/thumbnail.jp
Pharmacokinetic-Pharmacodynamic Evidence From a Phase 3 Trial to Support Flat-Dosing of Rifampicin for Tuberculosis
Get PDFBACKGROUND: The optimal dosing strategy for rifampicin in treating drug-susceptible tuberculosis (TB) is still highly debated. In the phase 3 clinical trial Study 31/ACTG 5349 (NCT02410772), all participants in the control regimen arm received 600 mg rifampicin daily as a flat dose. Here, we evaluated relationships between rifampicin exposure and efficacy and safety outcomes.
METHODS: We analyzed rifampicin concentration time profiles using population nonlinear mixed-effects models. We compared simulated rifampicin exposure from flat- and weight-banded dosing. We evaluated the effect of rifampicin exposure on stable culture conversion at 6 months; TB-related unfavorable outcomes at 9, 12, and 18 months using Cox proportional hazard models; and all trial-defined safety outcomes using logistic regression.
RESULTS: Our model-derived rifampicin exposure ranged from 4.57 mg · h/L to 140.0 mg · h/L with a median of 41.8 mg · h/L. Pharmacokinetic simulations demonstrated that flat-dosed rifampicin provided exposure coverage similar to the weight-banded dose. Exposure-efficacy analysis (n = 680) showed that participants with rifampicin exposure below the median experienced similar hazards of stable culture conversion and TB-related unfavorable outcomes compared with those with exposure above the median. Exposure-safety analysis (n = 722) showed that increased rifampicin exposure was not associated with increased grade 3 or higher adverse events or serious adverse events.
CONCLUSIONS: Flat-dosing of rifampicin at 600 mg daily may be a reasonable alternative to the incumbent weight-banded dosing strategy for the standard-of-care 6-month regimen. Future research should assess the optimal dosing strategy for rifampicin, at doses higher than the current recommendation
Search strategies for Community Engagement Definition and Evaluation for Cancer Center: Scoping Review
Get PDFAI for A Eye: Implementing Point-of-Care Artificial Intelligence Retinal Screening in a Resident Clinic
Get PDFhttps://digitalcommons.unmc.edu/com_fam_pres/1003/thumbnail.jp