The Mobile Health Program's first semester in the spring of 2015, provided three clinic sites, while 12 clinic sites were provided in the fall of the same year. In 2016, the spring program witnessed 15 clinic sites, while 24 clinic sites were available in the fall of that year. In the most recent spring 2017 semester, 26 clinical sites were held due to increased funding. Students were given the opportunity to provide care for vulnerablepopulations including those from diverse age groups, ethnicities, as well as differing social economical statuses. Services offered to individuals included physical examinations, screening for diabetes and heart disease, blood pressure monitoring, cholesterol checks, random glucose checks and Hemoglobin A1C tests.
The Los Angeles County-USC Medical Center is a public hospital considered to be the safety net for health care access for Los Angeles County residents. It is the largest single provider of healthcare for the area ’ s medi- cally underserved community and the emergency department (ED) treats more than 300,000 visits a year. It is the population that seeks diabetes related care through this particular outlet that provides the focus of this paper. An analysis of people using the ED for pri- mary diabetes care is important as it is suggestive of a vulnerable population to whom this is the only point of access to health care and whose actions pose the great- est cost burden to the system. This cohort is also likely to suffer the greatest chronic disease burden in general. In order to develop a neighbourhood scale analysis of where these diabetic sufferers live, and where spatial variation exists in terms of the health problems asso- ciated with diabetes, a fine spatial scale dataset is required. Using LAC+USC Medical Center data, this paper describes an analytical frame that can be trans- ferred to other urban environments as datasets utilized here should be available in most urban settings. Although the specific situation described in this paper for Los Angeles should only be considered as an initial “exploratory” analysis, the following general research question can still be advanced:
Conservative estimates place direct health care costs of sedentary behavior at 24.3 billion dollars per year and of obesity at 70–147 (2008 est.) billion dollars per year [65,66]. Recent data suggest that behavioral risk factors such as inadequate physical activity account for a greater portion of health disparities than was previously thought . Disadvantaged groups are less likely to have sufficient physical activity [52,68] and more likely to suffer related adverse health outcomes [69-71]. Disadvantaged groups have not been well represented in clinical trials to promote physical activity, though this is beginning to change [72-75]. Primary care has potential for successful interven- tions focused on disadvantaged groups because it offers a trusted source of continuity across an individual’ s lifespan, often serving entire families or generations. Safety net clinics, particularly federally qualified health centers, hold promise for reducing disparities because they provide the largest proportion of primary health care services to medic- ally underserved and vulnerablepopulations . Federally qualified health centers serve 20 million patients—this is expected to double to 40 million patients under the Affordable Care Act . Primary care clinicians are on the front lines of managing medical complications related to inadequate physical activity . Therefore there is an urgent need to accelerate the translation of physical activity interventions into community-based and primary care settings, which this project will evaluate.
The tension is clear. To provide a comprehensive review of the proposed research, the informed consent document and process are often lengthy, complex, and burdensome. 2 Consequently, research participants who sign or verbalize consent often do so without truly understanding the form that they are being asked to sign. In a recent systematic review, participants in one-third of trials assessed did not have adequate understanding in the areas of risks, beneﬁts, randomization, study aims, withdrawal, and voluntarism. 3 There are no clear standards for “how much ” understanding is adequate. Furthermore, we know that lower education levels, lower literacy, and a participant ’ s primary language are all associated with poor comprehension of the informed consent process. 4 These issues are particularly important when studies are being done in children, adding an additional dimension to vulnerablepopulations. Our approach was developed as a part of an ongoing randomized controlled trial (RCT) designed to prevent childhood obesity. As a part of the Growing Right Onto Wellness Trial (GROW; clinicaltrials.gov, NCT01316653), 5 839 mother-child pairs consented to participate in this 3-year family-centered, community-based behavioral RCT. All 839 participants were from low-income, underservedpopulations at highest risk for obesity, and all children were between 3 and 5 years old. The institutional review board at Vanderbilt University Medical Center approved the trial.
effective than phone call reminders (Yeager & Menachemi, 2011). The authors noted that only two of these 10 studies were conducted in primary care and none were conducted in the United States. In addition, few studies have explored the benefits of using this type of technology in vulnerablepopulations which are cared for by FQHCs. Thus, the present project will help to address this knowledge gap. In our project, we intend to extend beyond text messaging, into the use of social media such as Facebook and Twitter, to provide patient easy access to clinic information and ease scheduling.
We cannot provide definitive advice on how a suitable threshold for the proportion of a population exposed to disturbance might be set, because this will be specific to the taxa, regions and legislation under consideration. However, for illustrative purposes, we show how iPCoD can be used to identify a suitable threshold for three marine mammal species with different breeding strate- gies. We ran a scenario that was likely to cause substan- tial disturbance: wind farm construction occurring on 180 days each year, continuing for 20 years, and with a 0.05 probability that an individual within the affected area would be disturbed on a particular day. We simu- lated the effect of this disturbance on populations of 5,000 harbor seals (Phoca vitulina), harbor porpoise (Pho- coena phocoena) and bottlenose dolphin (Tursiops truncatus), varying the proportion of those populations likely to be exposed. Mean vital rates were set so that an undisturbed population would neither increase nor decline over the 20 year period. We used two sets of mean vital rates for harbor porpoise. In the high-fertility scenario females were expected to breed annually, while in the low-fertility scenario females were expected to breed biennially. For each scenario we ran 500 simula- tions and determined the median decline over 20 years relative to the predicted change in an identical, undisturbed population. We chose the median decline because Jitlal, Burthe, Freeman, and Daunt (2017) con- cluded this was the population simulation metric likely to be least sensitive to inaccuracies in input parameters. Figure 2 indicates that, there is no threshold value for the proportion of the population exposed to disturbance that results in zero decline. However, when 0.025 or less of the population was exposed to disturbance the median relative decline over 20 years was less than 1% for all four species/fertility scenarios, and no simulated population went extinct. Therefore, for this example, 0.025 of the population might be an appropriate “ set threshold. ”
promotion program to address the diverse needs of underservedpopulations in community-based settings. The combination of racial and ethnic disparities coupled with aspects of environmental, physical, social, and spiritual contexts have contributed to negative health behaviors (Yeary et al., 2011). Multiple organizations have taken up the charge of addressing the health and well-being of the population in an effort to control health care costs as well as to contribute to a healthier and more productive society. A primary goal of the CDC’s National Center for Chronic Disease Control and Health Promotion (NCCDCHP) is to address issues of health disparities and thereby promote optimal health for all Americans (2009).
Several PCR-based techniques, such as RFLP (Restric- tion fragment length polymorphism), RAPD (Random amplified polymorphic DNA), AFLP (Amplified fragment length polymorphism) or SSR (Simple sequence repeat, also known as microsatellites), are routinely used to study the genetic diversity of plant populations. Microsatellites are tandemly repeated, short DNA sequence motifs that are ubiquitous components of all eukaryotic genomes and show size-polymorphism within populations. Therefore, several strategies have been developed to use the potential of SSR as population markers. Microsatellite-primed PCR (also called Inter-simple sequence repeat, ISSR) is prob- ably the most widely used of these techniques, and is a powerful tool to investigate the genetic diversity of natural plant populations. ISSR markers generate more reproduc- ible fingerprintings than RAPD amplification due to the longer SSR-based primers, which enables a higher-strin- gency of the DNA amplifications. However, as a dominant marker, ISSR does not allow to distinguish heterozygotes from homozygous dominant individuals, which prevent a
antidepressant prescription fills after Part D. This suggests that once they surmounted initial barriers to access (such as clinician prescribing and coverage restrictions), they received prescription drug treatment for a longer period after Part D. Among nonelderly disabled beneficiaries, our findings were similar. We did not observe any change in terms of the prevalence of treatment initiation among the disabled, but there was a significant increase in treatment intensity for those who were treated. These main findings raise several questions about the effectiveness of Part D in increasing access to medications for vulnerablepopulations. It is possible special protections around antidepressants under Part D were insufficient to ensure access to this drug class, and Part D plans erected excessively high barriers to treatment.
[1,3,4,17-19]. Unconditional incentives, which are pre- paid and not conditional upon participation, have been shown to be more effective than conditional incentives, [9,14,16,20-22] particularly in minority and low income populations [1,3,17-19]. However, no studies have exam- ined the effect of unconditional incentives in Canadian lower socioeconomic status, lower education and immi- grant populations in a telephone survey. A telephone survey differs from a mailed questionnaire in that a higher response rate is usually attained  and hence, an incentive may not further increase this rate. We con- ducted a pilot study to evaluate the effect of uncondi- tional incentives on the response rate of vulnerablepopulations invited to participate in a telephone survey.
Carotid artery total plaque volume (TPV) is a three-dimensional (3D) ultrasound (US) imaging measurement of carotid atherosclerosis, providing a direct non-invasive and regional estimation of atherosclerotic plaque volume – the direct determinant of carotid stenosis and ischemic stroke. While 3DUS measurements of TPV provide the potential to monitor plaque in individual patients and in populations enrolled in clinical trials, until now, such measurements have been performed manually which is laborious, time-consuming and prone to intra-observer and inter-observer variability. To address this critical translational limitation, here we describe the development and application of a semi-automated 3DUS plaque volume measurement. This semi-automated TPV measurement incorporates three user-selected boundaries in two views of the 3DUS volume to generate a geometric approximation of TPV for each plaque measured. We compared semi-automated repeated measurements to manual segmentation of 22 individual plaques ranging in volume from 2mm 3 to 151mm 3 . Mean plaque volume was 43±40 mm 3 for semi-automated and 48±46 mm 3 for manual measurements and these were not significantly different (p=0.60). Mean coefficient of variation (CV) was 12.0±5.1% for the semi-automated measurements.
own livelihoods, and their surrounding social and material environments. Yet, they are also articulated through the lens of the nation, in which the UK – and specifically its ability to support hard working majority citizens and ‘deserving’ vulnerable communities within it – is represented as under threat. In this sense, the hurt expressed by our majority respondents represents what Darling (2010:134) has described as a “(re)assertion of a national logic of territorialised prioritisation and concern”. Whereas some of the asylum seekers and refugees in the first section expressed a sense of agency in terms of their resilience and a sense of security in their own self‐ identities and moral values, the evidence of this section is that many of the majority interviews were suggestive of a lack of agency. Here, the research participants implicit discomfort at voicing their prejudices is suggestive of a lack of confidence in their own moral values and uncertainty about their social environments.
In contrast to those who articulated their sense of hurt through the lens of the self or kith and kin other respondents’ narratives of injustice were framed in the context of the nation. Here, they represented asylum seekers as a threat to more ‘deserving’ ‘vulnerable’ or marginal populations in the UK (including homeless people, unemployed, children etc) with whom they are perceived to be in competition with for access to limited resources. Although there was also a notable uncomfortableness or defensiveness about the way some interviewees rationalised their views (I'm sorry'; 'They’re maybe, maybe not undeserving'; 'try and sort the homeless out first, and then welcome the asylum seekers in') which suggests an insecurity about voicing prejudices and consequently about their own sense of moral values and identities i .
Ultimately, the success of health insurance marketplaces is predicated on consumers, including tobacco users, un- derstanding the products being offered and actively partici- pating in enrollment and re-enrollment. When there is a mismatch between health care needs and plan choices resulting from poor health insurance literacy, costs are often shifted to the safety net and other providers of un- compensated care. The difficulty many vulnerable popula- tions face in choosing and using health insurance cast doubt on whether private insurance markets are managed and regulated sufficiently to achieve the aims of coverage expansion efforts. Importantly, our results lend preliminary evidence supporting tobacco use as a unique marker for low HIL among low-SES, minority populations and of po- tential importance to tailoring communication strategies
KPMG can help your financial services organization respond to this underserved market opportunity. Our Financial Services practice can work with you to analyze customer segmentation, design a portfolio of business opportunities, manage risks, leverage technology, and if appropriate, develop a target operating model and deploy a multigenerational plan.
This study was completed as part of the collaborative research being conducted by the National Institutes of Health (NIH) and Food and Drug Administration (FDA) Tobacco Centers of Regulatory Science (TCORS) VulnerablePopulations Workgroup. The review reported in this publication was supported by grant numbers P50CA180905 and U54CA180905 from the National Cancer Institute (NCI) and the FDA Center for Tobacco Products (CTP) for Cruz, Unger, Lienemann, Baezconde-Garbanati and Soto; grant number T32CA009492-29 from NCI for Lienemann; grant number U54CA189222 under a subcontract to Westat from NCI, FDA and the Center for Evaluation and Coordination of Training and Research (CECTR) in Tobacco Regulatory Science for Rose; grant number P50 CA180907 from the NCI and FDA CTP for Byron and Huang and the National Research Service Award T32 DA007097 from the National Institute on Drug Abuse for Carroll. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the FDA.
izers, and diuretics), people with lower socioeconomic status (e.g., those engaging in outdoor occupations), and socially isolated populations (e.g., living alone, especially on higher floors of apartment buildings) (2). Few epidemi- ologic studies have focused on identifying subgroups vul- nerable for mortality associated with ambient temperature using modern statistical methods. Models of the relation between ambient temperature exposure and mortality are needed to prevent heat-related deaths that may occur from exposure to elevated ambient temperature. No epidemiol- ogic study has identified high-risk groups specifically for California, where the temperature and humidity levels are generally lower than those of the rest of the country and pollutant levels tend to be higher with distinct sources and
A comprehensive literature search was conducted to identify articles meeting the following criteria: empirical articles, measuring the association between alcohol use and an outcome of risky sexual behaviour among migrant populations. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. To best assess the influence between alcohol use and risky sexual behaviour, we incorporated quanti- tative studies. This method was chosen because it is bet- ter suited to assess more precise estimates of the group studied. Conversely, qualitative studies are better suited to answering “why” and “how” questions.