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Roman G, Yousefi-Nooraie R, Vermilion P, Cupertino A, Barnett S, Epstein R. Mindful practice with medical interpreters. Front Psychol 2023; 14:1171993. [PMID: 37954177 PMCID: PMC10637490 DOI: 10.3389/fpsyg.2023.1171993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 09/28/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction Medical interpreters experience emotional burdens from the complex demands at work. Because communication access is a social determinant of health, protecting and promoting the health of medical interpreters is critical for ensuring equitable access to care for language-minority patients. The purpose of this study was to pilot a condensed 8-h program based on Mindful Practice® in Medicine addressing the contributors to distress and psychosocial stressors faced by medical sign and spoken language interpreters. Methods Using a single-arm embedded QUAN(qual) mixed-methods pilot study design, weekly in-person 1-h sessions for 8 weeks involved formal and informal contemplative practice, didactic delivery of the week's theme (mindfulness, noticing, teamwork, suffering, professionalism, uncertainty, compassion, and resilience), and mindful inquiry exercises (narrative medicine, appreciative interviews, and insight dialog). Quantitative well-being outcomes (mean±SEM) were gathered via survey at pre-, post-, and 1-month post-intervention time points, compared with available norms, and evaluated for differences within subjects. Voluntary feedback about the workshop series was solicited post-intervention via a free text survey item and individual exit interviews. A thematic framework was established by way of qualitative description. Results Seventeen medical interpreters (46.2 ± 3.1 years old; 16 women/1 man; 8 White/9 Hispanic or Latino) participated. Overall scores for teamwork (p ≤ 0.027), coping (p ≤ 0.006), and resilience (p ≤ 0.045) increased from pre- to post-intervention and pre- to 1-month post-intervention. Non-judging as a mindfulness component increased from pre- to post-intervention (p = 0.014). Compassion satisfaction (p = 0.021) and burnout (p = 0.030) as components of professional quality of life demonstrated slightly delayed effects, improving from pre- to 1-month post-intervention. Themes such as workshop schedule, group size, group composition, interactivity, topics to be added or removed, and culture are related to the overarching topic areas of intervention logistics and content. Integration of the findings accentuated the positive impact of the intervention. Discussion The results of this research demonstrate that mindful practice can serve as an effective resource for medical interpreters when coping with work-related stressors. Future iterations of the mindful practice intervention will further aspire to address linguistic and cultural diversity in the study population for broader representation and subsequent generalization.
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Affiliation(s)
- Gretchen Roman
- Department of Public Health Sciences, University of Rochester, Rochester, NY, United States
- Department of Family Medicine, University of Rochester, Rochester, NY, United States
| | - Reza Yousefi-Nooraie
- Department of Public Health Sciences, University of Rochester, Rochester, NY, United States
| | - Paul Vermilion
- Department of Medicine, Palliative Care Program, University of Rochester, Rochester, NY, United States
| | - Anapaula Cupertino
- Department of Public Health Sciences, University of Rochester, Rochester, NY, United States
- Department of Surgery, University of Rochester, Rochester, NY, United States
| | - Steven Barnett
- Department of Family Medicine, University of Rochester, Rochester, NY, United States
| | - Ronald Epstein
- Department of Family Medicine, University of Rochester, Rochester, NY, United States
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Keilty D, Isaacson B, Avkshtol V, Kutz W, Moon DH, Hunter J, Dan T, Vo DT, Barnett S, Sher DJ, Wardak Z. Five-Fraction Stereotactic Radiation for Head and Neck Paragangliomas. Int J Radiat Oncol Biol Phys 2023; 117:e183-e184. [PMID: 37784809 DOI: 10.1016/j.ijrobp.2023.06.1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Paragangliomas of the head and neck (HN) are benign, slow-growing neoplasms that are rarely functional. Treatment is often indicated for patients presenting with mass effect, cranial neuropathies, or pulsatile tinnitus. Radiotherapy, traditionally conventionally fractionated, is often used for primary, post-operative, and salvage therapy, given its excellent control rates and reduced risks to adjacent neurovascular structures. Stereotactic ablative radiation (SAbR) offers shorter treatment time, and modern techniques eliminate margins to improve organ-at-risk avoidance. SAbR may offer additional radiobiological sparing of normal structures over single-fraction SAbR. We aimed to evaluate tumor and symptom response, acute and late toxicity rates, and recurrence patterns in HN paraganglioma patients treated with 25 Gy in 5 fractions. MATERIALS/METHODS Retrospective chart review collected baseline patient and tumor information, treatment and dosimetry details, acute and long-term toxicity grades (per the CTCAE v. 5.0), symptom and tumor response, and survival. Local control was defined as the absence of local enlargement (per RECIST v. 1.1) or marginal failure and was estimated using the Kaplan-Meier method. RESULTS Between December 2009-March 2020, 39 patients received 25 Gy in 5 fractions to 43 HN paragangliomas, of which 17 were treated in 11 patients with hereditary paraganglioma-pheochromocytoma syndrome. Fifteen targets were post-operative recurrent or residual tumors. There were 27 jugulotympanic tumors, 4 jugular, 1 tympanic, 8 vagal, 5 carotid body, and 2 jugulotympanic or vagal. Median follow-up time was 3.3 years (range 0-11.4 years), and 21 targets had at least 4 years of follow-up. Tumor volume decreased by a median of 37%. Three-year local control was 100%. One patient, known to harbor an SDHD mutation, had 2 out-of-field recurrences within the post-operative bed at 7.1 years. Two patients experienced 2 marginal recurrences within the post-operative bed at 6.1 and 8.4 years: one had an SDHB mutation and developed metastatic disease, and the other did not have genetic testing. The most common grade 1-2 acute toxicities were headache and fatigue; the most common grade 1-2 late toxicities were dysphagia and otalgia. There were no grade >2 acute toxicities. A late grade 3 aspiration event was seen in 1 patient who presented with paralyzed vocal cord requiring multiple medialization laryngoplasties. Within 6 months of SAbR, 18% of symptoms or toxicities improved or resolved; 34% improved or resolved more than 6 months after SAbR. CONCLUSION This is the largest series of HN paragangliomas treated with SAbR, detailing a 10-year experience with a 5-fraction regimen that is well-tolerated and achieves excellent local control. Post-SAbR recurrences occurred outside of the radiation field but within the post-operative bed, suggesting that some post-operative patients may benefit from expanded radiation volumes or close surveillance for salvage therapy.
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Affiliation(s)
- D Keilty
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - B Isaacson
- University of Texas Southwestern Department of Otolaryngology - Head and Neck Surgery, Dallas, TX
| | - V Avkshtol
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - W Kutz
- University of Texas Southwestern Department of Otolaryngology - Head and Neck Surgery, Dallas, TX
| | - D H Moon
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - J Hunter
- University of Texas Southwestern Department of Otolaryngology - Head and Neck Surgery, Dallas, TX
| | - T Dan
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - D T Vo
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - S Barnett
- University of Texas Southwestern Department of Otolaryngology - Head and Neck Surgery, Dallas, TX
| | - D J Sher
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Z Wardak
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
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Roman G, Samar V, Ossip D, McKee M, Barnett S, Yousefi-Nooraie R. Experiences of Sign Language Interpreters and Perspectives of Interpreting Administrators During the COVID-19 Pandemic: A Qualitative Description. Public Health Rep 2023; 138:691-704. [PMID: 37243519 PMCID: PMC10225799 DOI: 10.1177/00333549231173941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
OBJECTIVE Interpreting during the COVID-19 pandemic caused stress and adverse mental health among sign language interpreters. The objective of this study was to summarize the pandemic-related work experiences of sign language interpreters and interpreting administrators upon transitioning from on-site to remote work. METHODS From March through August 2021, we conducted focus groups with 22 sign language interpreters in 5 settings, 1 focus group for each setting: staff, educational, community/freelance, video remote interpreting, and video relay services. We also conducted 5 individual interviews with interpreting administrators or individuals in positions of administrative leadership in each represented setting. The 22 interpreters had a mean (SD) age of 43.4 (9.8) years, 18 were female, 17 were White, all identified as hearing, and all worked a mean (SD) of 30.6 (11.6) hours per week in remote interpreting. We asked participants about the positive and negative consequences of transitioning from on-site to remote at-home interpreting. We established a thematic framework by way of qualitative description for data analysis. RESULTS We found considerable overlap across positive and negative consequences identified by interpreters and interpreting administrators. Positive consequences of transitioning from on-site to remote-at-home interpreting were realized across 5 overarching topic areas: organizational support, new opportunities, well-being, connections/relationships, and scheduling. Negative consequences emerged across 4 overarching topic areas: technology, financial aspects, availability of the interpreter workforce, and concerns about the occupational health of interpreters. CONCLUSIONS The positive and negative consequences shared by interpreters and interpreting administrators provide foundational knowledge upon which to create recommendations for the anticipated sustainment of some remote interpreting practice in a manner that protects and promotes occupational health.
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Affiliation(s)
- Gretchen Roman
- Department of Family Medicine, University of Rochester, Rochester, NY, USA
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
| | - Vincent Samar
- Department of Liberal Studies, National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, NY, USA
| | - Deborah Ossip
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
| | - Michael McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Steven Barnett
- Department of Family Medicine, University of Rochester, Rochester, NY, USA
| | - Reza Yousefi-Nooraie
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
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Barnett S, Matthews K, DeWindt L, Sutter E, Samuel-Hodge C, Yang H, Pearson TA. Deaf Weight Wise: A novel randomized clinical trial with Deaf sign language users. Obesity (Silver Spring) 2023; 31:965-976. [PMID: 36890106 PMCID: PMC10033396 DOI: 10.1002/oby.23702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 03/10/2023]
Abstract
OBJECTIVE The goal of this study was to address the absence of evidence-based weight-control programs developed for use with Deaf people. METHODS Community-based participatory research informed the design of the Deaf Weight Wise (DWW) trial and intervention. DWW focuses primarily on healthy lifestyle and weight through change in diet and exercise. The study enrolled 104 Deaf adults aged 40 to 70 years with BMI of 25 to 45 from community settings in Rochester, New York, and randomized participants to immediate intervention (n = 48) or 1-year delayed intervention (n = 56). The delayed intervention serves as a no-intervention comparison until the trial midpoint. The study collected data five times (every 6 months) from baseline to 24 months. All DWW intervention leaders and participants are Deaf people who use American Sign Language (ASL). RESULTS At 6 months, the difference in mean weight change for the immediate-intervention arm versus the delayed-intervention arm (no intervention yet) was -3.4 kg (multiplicity-adjusted p = 0.0424; 95% CI: -6.1 to -0.8 kg). Most (61.6%) in the immediate arm lost ≥5% of baseline weight versus 18.1% in the no-intervention-yet arm (p < 0.001). Participant engagement indicators include mean attendance of 11/16 sessions (69%), and 92% completed 24-month data collection. CONCLUSION DWW, a community-engaged, culturally appropriate, and language-accessible behavioral weight loss intervention, was successful with Deaf ASL users.
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Affiliation(s)
- Steven Barnett
- Rochester Prevention Research Center: National Center for
Deaf Health Research (RPRC/NCDHR), University of Rochester School of Medicine &
Dentistry, Rochester NY
| | - Kelly Matthews
- Rochester Prevention Research Center: National Center for
Deaf Health Research (RPRC/NCDHR), University of Rochester School of Medicine &
Dentistry, Rochester NY
| | - Lori DeWindt
- Rochester Prevention Research Center: National Center for
Deaf Health Research (RPRC/NCDHR), University of Rochester School of Medicine &
Dentistry, Rochester NY
| | - Erika Sutter
- Rochester Prevention Research Center: National Center for
Deaf Health Research (RPRC/NCDHR), University of Rochester School of Medicine &
Dentistry, Rochester NY
| | | | - Hongmei Yang
- Department of Biostatistics and Computational Biology,
University of Rochester School of Medicine & Dentistry, Rochester NY
| | - Thomas A. Pearson
- Department of Epidemiology, College of Public Health and
Health Professions & College of Medicine, University of Florida
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Bukvic A, Barnett S. Drivers of flood-induced relocation among coastal urban residents: Insight from the US east coast. J Environ Manage 2023; 325:116429. [PMID: 36244285 DOI: 10.1016/j.jenvman.2022.116429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/22/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Many coastal urban areas are experiencing impacts of accelerated chronic and episodic flooding on the built environment and people's livelihoods and quality of life. These impacts sometimes exceed the households' adaptive and coping capacities to deal with flooding, prompting residents to consider relocation. It is unclear how urban dwellers living in flood-prone locations perceive this adaptation strategy and under what flood-driven circumstances they would consider permanently moving. This paper provides empirical evidence on relocation preferences among urban residents along the U.S. East Coast. It further explores how this decision is influenced by socioeconomic determinants, experiences with flood exposure, comprehensive concerns with flooding, and preferences for relocation destinations. We administered an online survey to 1450 residents living in flood-prone urban areas across multiple states, from New York to Florida, and analyzed the results using descriptive and inferential statistics. Results show that almost half of respondents would consider relocating due to coastal flooding, with only 13 percent declining this option. The results show that age and race, several determinants of place attachment, problem-solving capacity, and flood-related household- and community-level concerns play a significant role in willingness to relocate.
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Affiliation(s)
- Anamaria Bukvic
- Department of Geography, Center for Coastal Studies, Virginia Tech, 207 Wallace Hall, 295 West Campus Dr., Blacksburg, VA, 24061, USA.
| | - Steven Barnett
- Department of Statistics, Statistical Applications and Innovations Group, Virginia Tech, 403A Hutcheson Hall, Blacksburg, VA, 24061, USA.
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Skirrow H, Barnett S, Bell S, Mounier-Jack S, Kampmann B, Holder B. Women’s experiences of accessing vaccines during pregnancy and for their babies during COVID-19. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
COVID-19 changed access to healthcare, including vaccinations, in the United Kingdom (UK). This study explored UK women’s experiences of accessing pertussis vaccination during pregnancy and infant vaccinations during COVID-19.
Methods
An online cross-sectional survey was completed, between 3rd August-11th October 2020, by 1404 women aged 16+ years who were pregnant at some point after the first UK lockdown from March 23rd 2020. Ten follow-up semi-structured interviews were conducted.
Results
Most women surveyed were pregnant (65.7%) and a third postnatal (34.3%). Almost all women (95.6%) were aware that pertussis vaccination is recommended in pregnancy. Most pregnant (72.1%) and postnatal women (84.0%) had received pertussis vaccination however, access issues were reported. Over a third (39.6%) of women had a pregnancy vaccination appointment changed. COVID-19 made it physically difficult to access pregnancy vaccinations for one fifth (21.5%) of women and physically difficult to access infant vaccinations for almost half of women (45.8%). Nearly half of women (45.2%) reported feeling less safe attending pregnancy vaccinations and over three quarters (76.3%) less safe attending infant vaccinations due to COVID-19. The majority (94.2%) felt it was important to get their baby vaccinated during COVID-19. Pregnant women from ethnic-minorities and lower-income households were less likely to have been vaccinated. Minority-ethnicity women were more likely to report access problems and feeling less safe attending vaccinations for both themselves and their babies. Qualitative analysis found women experienced difficulties accessing antenatal care and relied on knowledge from previous pregnancies to access vaccine appointments.
Conclusions
COVID-19 disrupted access to vaccinations in the UK. Vaccine services must ensure equitable access to vaccine appointments during ongoing and future pandemics including tailoring services for lower income and ethnic minority families.
Key messages
• Pregnancy and infant vaccines was disrupted by COVID-19 with women feeling less safe and having difficulties accessing vaccinations with ethnic minority women more likely to report access issues.
• Equitable access to routine pregnancy and infant vaccine appointments must be prioritised during future pandemics, including considering tailoring services for different population groups.
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Affiliation(s)
- H Skirrow
- Department of Primary Care and Public Health, Imperial College London , London, UK
| | - S Barnett
- Institute of Reproductive and Developmental Biology, Imperial College London , London, UK
| | - S Bell
- Department of Global Health and Development, LSHTM , London, UK
| | - S Mounier-Jack
- Department of Global Health and Development, LSHTM , London, UK
| | - B Kampmann
- The Vaccine Centre, LSHTM , London, UK
- Vaccines and Immunity Theme, MRC Unit The Gambia at LSHTM , Banjul, Gambia
| | - B Holder
- Institute of Reproductive and Developmental Biology, Imperial College London , London, UK
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Roman G, Samar V, Ossip D, McKee M, Barnett S, Yousefi-Nooraie R. Ditching the Driving: A Cross-Sectional Study on the Determinants of Remote Work From Home for Sign Language Interpreters. Front Health Serv 2022; 2:882615. [PMID: 36908716 PMCID: PMC9998024 DOI: 10.3389/frhs.2022.882615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic dramatically impacted the working conditions for sign language interpreters, shifting the provision of interpreting services from onsite to remote. The goal of this cross-sectional study was to examine the perceptions of determinants of remote interpreting implementation from home by sign language interpreters during the pandemic. We hypothesized that interpreters working across the primary settings of staff (agency, government, business, or hospital employees), educational (K-12 or postsecondary), community/freelance (independent contractor), video remote (the two-way connection between onsite participants and remote interpreter), and video relay (three-way telecommunication) would present with differing experiences of the implementation process. Methods The Determinants of Implementation Behavior Questionnaire was adapted for sign language interpreters (DIBQ-SLI) and administered to certified interpreters working remotely at least 10 h per week. The DIBQ-SLI included eight constructs (knowledge, skills, self-efficacy, perceived behavioral control, innovation characteristics, organizational resources and support, innovation strategies, and social support) and 30 items. Parametric statistics assessed differences in interpreters' perceptions across settings. Principal component analysis was conducted for data reduction and affirmation of the most critical constructs and items. Results One hundred and six interpreters (37 video relay, 27 video remote, 18 educational, 11 community/freelance, 11 staff interpreters, and two from "other" settings) completed the DIBQ-SLI. The video relay and staff interpreters consistently demonstrated the most favorable and the educational interpreters demonstrated the least favorable perceptions. Of the total variance, 58.8% of interpreters' perceptions was explained by organizational (41%), individual (10.7%), and social (7.1%) dimensions. There were significant differences across settings for the organizational and individual principal components; however, no differences were detected for the social principal component. Conclusions An administrative infrastructure devoted to ensuring that interpreters receive sufficient managerial support, training, materials and resources, experience with remote interpreting before having to commit, and insights based on the results of their remote work (organizational principal component) may be necessary for improving perceptions. Remote interpreting is expected to continue after the pandemic ends; thus, settings with the least favorable ratings across behavior constructs may borrow strategies from settings with the most favorable ratings to help promote perceptions of the contextual determinants of future remote interpreting implementation.
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Affiliation(s)
- Gretchen Roman
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NY, United States
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Vincent Samar
- Department of Liberal Studies, National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, NY, United States
| | - Deborah Ossip
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NY, United States
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Michael McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Steven Barnett
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Reza Yousefi-Nooraie
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, NY, United States
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
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Roman G, Samar V, Ossip D, McKee M, Barnett S, Yousefi-Nooraie R. The Occupational Health and Safety of Sign Language Interpreters Working Remotely During the COVID-19 Pandemic. Prev Chronic Dis 2022; 19:E30. [PMID: 35679479 PMCID: PMC9258443 DOI: 10.5888/pcd19.210462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction The COVID-19 pandemic has caused a dramatic shift in work conditions, bringing increased attention to the occupational health of remote workers. We aimed to investigate the physical and mental health of sign language interpreters working remotely from home because of the pandemic. Methods We measured the physical and mental health of certified interpreters who worked remotely 10 or more hours per week. We evaluated associations within the overall sample and compared separate generalized linear models across primary interpreting settings and platforms. We hypothesized that physical health would be correlated with mental health and that differences across settings would exist. Results We recruited 120 interpreters to participate. We calculated scores for disability (mean score, 13.93 [standard error of the mean (SEM), 1.43] of 100), work disability (mean score, 10.86 [SEM, 1.59] of 100), and pain (mean score, 3.53 [SEM, 0.29] of 10). Shoulder pain was most prevalent (27.5%). Respondents had scores that were not within normal limits for depression (22.5%), anxiety (16.7%), and stress (24.2%). Although disability was not associated with depression, all other outcomes for physical health were correlated with mental health (r ≥ 0.223, P ≤ .02). Educational and community/freelance interpreters trended toward greater adverse physical health, whereas educational and video remote interpreters trended toward more mental health concerns. Conclusion Maintaining the occupational health of sign language interpreters is critical for addressing the language barriers that have resulted in health inequities for deaf communities. Associations of disability, work disability, and pain with mental health warrant a holistic approach in the clinical treatment and research of these essential workers.
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Affiliation(s)
- Gretchen Roman
- Clinical and Translational Science Institute, University of Rochester, Rochester, New York.,Department of Public Health Sciences, University of Rochester, Rochester, New York.,Clinical and Translational Science Institute and Department of Public Health Sciences, 265 Crittenden Blvd, Rochester, NY 14642.
| | - Vincent Samar
- Department of Liberal Studies, National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, New York
| | - Deborah Ossip
- Clinical and Translational Science Institute, University of Rochester, Rochester, New York.,Department of Public Health Sciences, University of Rochester, Rochester, New York
| | - Michael McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Steven Barnett
- Department of Family Medicine, University of Rochester, Rochester, New York
| | - Reza Yousefi-Nooraie
- Clinical and Translational Science Institute, University of Rochester, Rochester, New York.,Department of Public Health Sciences, University of Rochester, Rochester, New York
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Benzing S, Couceiro F, Barnett S, Williams JB, Pearce P, Stanford C. Impact of hydraulic retention time on phosphorus removal from wastewater using reactive media. Water Sci Technol 2020; 82:2920-2928. [PMID: 33341781 DOI: 10.2166/wst.2020.526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Phosphorus (P) discharge from wastewater treatment plants into the environment contributes to eutrophication issues. Reactive media filters represent an effective, simple and cost-effective solution to decrease the P content. Previous research used various experimental designs and often synthetic wastewater, making assessment of real-world performance difficult. This study assesses the impact of the hydraulic retention time (HRT) on P removal using real wastewater to refine design criteria for full-scale installations. Four media were compared in column experiments for >200 days. Different HRTs were applied and initially the media achieved low P effluent concentrations of >0.1 mg/L PO4-P, increasing over time. Best P removal was observed for the highest HRT with on average >99%. HRT was seen to be the driving factor for P removal rather than media capacity. Three of the four materials showed pH levels above 12 initially, decreasing over time. Water quality parameters, including organics, solids and metals, were monitored. In-depth analysis confirmed formation of calcium phosphate precipitation on the media's surface. The results suggest the importance of an optimal HRT to achieve high P removal and show that the reactive media application is an appropriate technology for P removal on small sites if the elevated pH is addressed.
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Affiliation(s)
- S Benzing
- School of Civil Engineering and Surveying, University of Portsmouth, Portland Building, Portland St, Portsmouth, Hampshire PO3 1AH, UK E-mail:
| | - F Couceiro
- School of Civil Engineering and Surveying, University of Portsmouth, Portland Building, Portland St, Portsmouth, Hampshire PO3 1AH, UK E-mail:
| | - S Barnett
- School of Civil Engineering and Surveying, University of Portsmouth, Portland Building, Portland St, Portsmouth, Hampshire PO3 1AH, UK E-mail:
| | - J B Williams
- School of Civil Engineering and Surveying, University of Portsmouth, Portland Building, Portland St, Portsmouth, Hampshire PO3 1AH, UK E-mail:
| | - P Pearce
- Farmiloe Fisher Environment Ltd, Tregatherall Farm, Minster, Boscastle, Cornwall PL35 0EQ, UK
| | - C Stanford
- Southern Water Services, Southern House, Yeoman Road, Worthing, West Sussex, BN13 3NX, UK
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Jalali O, Scudday T, Fickenscher MC, Barnett S, Gorab R. Third-Generation Medium Cross-Linked Polyethylene Demonstrates Very Low Wear in Total Hip Arthroplasty. Arthroplast Today 2020; 6:316-321. [PMID: 32514421 PMCID: PMC7267711 DOI: 10.1016/j.artd.2020.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/21/2020] [Accepted: 04/07/2020] [Indexed: 02/08/2023] Open
Abstract
Background Cross-linked polyethylene (XLPE) liners have shown lower wear rates than conventional polyethylene liners in total hip arthroplasty. The primary aim of our study was to report our most recent analysis of wear rates and clinical outcomes of a third-generation XLPE liner. Secondary aims were to investigate the rate of adverse events related to mechanical failure or oxidation of this liner. Methods A series of 266 total hip arthroplasties using a specific XLPE liner were retrospectively reviewed. Radiographs were examined to determine linear and volumetric wear rates and presence of osteolysis. Clinical outcomes, revision rates, mechanical failures, and risk factors for accelerated polyethylene wear were additionally investigated. Results The mean age at the time of surgery was 65.8 years and the mean follow-up was 5.5 years. The mean linear wear rate was 0.003 mm/year and the mean volumetric wear rate was 0.42 mm3/year, and there was no evidence of osteolysis. Harris hip scores increased from 50.9 preoperatively to 96.0 at the latest follow-up. The revision rate was 0.4%, with no liner rim fractures and no liner dissociations/loosenings. Femoral head material, head size, age, body mass index, and time since implantation had no effect on wear rates. Conclusion Wear rates for this third-generation XLPE liner were low at mid-term follow-up, and no adverse sequelae of oxidation or deleterious mechanical properties were observed. This remained true regardless of femoral head size and material or patient age and body mass index. Further analysis will be necessary to ensure continued wear resistance, oxidative stability, and mechanical strength at long-term follow-up.
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Affiliation(s)
- Omid Jalali
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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11
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Lynn MA, Butcher E, Cuculick JA, Barnett S, Martina CA, Smith SR, Pollard RQ, Simpson-Haidaris PJ. A review of mentoring deaf and hard-of-hearing scholars. ACTA ACUST UNITED AC 2020; 28:211-228. [PMID: 32489313 DOI: 10.1080/13611267.2020.1749350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Diversification of the scientific workforce usually focuses on recruitment and retention of women and underrepresented racial and ethnic minorities but often overlooks deaf and hard-of hearing (D/HH) persons. Usually classified as a disability group, such persons are often members of their own sociocultural linguistic minority and deserve unique support. For them, access to technical and social information is often hindered by communication- and/or language-centered barriers, but securing and using communication access services is just a start. Critical aspects of training D/HH scientists as part of a diversified workforce necessitates: (a) educating hearing persons in cross-cultural dynamics pertaining to deafness, sign language, and Deaf culture; (b) ensuring access to formal and incidental information to support development of professional soft skills; and (c) understanding that institutional infrastructure change may be necessary to ensure success. Mentorship and training programs that implement these criteria are now creating a new generation of D/HH scientists.
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Affiliation(s)
- Matthew A Lynn
- Department of Science and Mathematics, National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, NY 14623
| | - Elizabeth Butcher
- Access Services, University of Rochester School of Medicine & Dentistry, Rochester, NY 14642
| | - Jessica A Cuculick
- Center on Cognition and Language, National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, NY 14623
| | - Steven Barnett
- Departments of Family Medicine, Public Health Sciences and the National Center for Deaf Health Research, University of Rochester School of Medicine & Dentistry, Rochester, NY 14642
| | - Camille A Martina
- Departments of Public Health Sciences and Environmental Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY 14642
| | - Scott R Smith
- Office of the Associate Dean of Research, National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, NY 14623
| | - Robert Q Pollard
- Office of the Associate Dean of Research, National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, NY 14623.,Deaf Wellness Center, University of Rochester School of Medicine & Dentistry, Rochester NY, 14642
| | - Patricia J Simpson-Haidaris
- Departments of Medicine, Microbiology & Immunology and Pathology, University of Rochester School of Medicine & Dentistry, Rochester, NY 14642
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Barnett S, Bhatt A. A chewable pediatric preparation of ibuprofen is palatable and acceptable to children. Paediatric and Neo Pain 2020; 2:2-6. [PMID: 35547858 PMCID: PMC8975196 DOI: 10.1002/pne2.12013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/15/2019] [Accepted: 01/12/2020] [Indexed: 11/11/2022]
Abstract
The development of palatable and acceptable analgesics for children is a major challenge. Given the majority of medications are administered orally, and children are more sensitive to and less tolerant of bitterness, novel “child‐friendly” preparations need to be developed and tested specifically in this patient population. This study investigated the palatability and acceptability of a therapeutic dose of ibuprofen in the form of soft chewable capsules in 100 healthy children aged 7‐12 years of age and the acceptability of this novel preparation to their caregivers. About 97% of children adhered to a full therapeutic age‐related dose, with 72% of these participants rating the preparation as acceptable on a hedonic facial scale. Despite 22% of children noting a “hot, spicy, or burning” sensation, consistent with known chemesthetic effects of ibuprofen, 83% of children confirmed they would take the medication in future, which rose to 87% in the context of future illness. In addition, after observing their children ingesting the medication, 92% of parents/guardians confirmed that they would be happy to administer this preparation of ibuprofen to their child if they were unwell. In conclusion, ibuprofen administered in the form of soft chewable capsules was palatable and acceptable to the majority of children and their parents/guardians and may provide a convenient and easy to dose preparation to reduce fever and relieve pain in children.
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Affiliation(s)
| | - Aomesh Bhatt
- Reckitt Benckiser Research & Development Berkshire UK
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13
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Tanner JT, Barnett SA, Mountford MK, Barnett S, Beare-Rogers JL, Bueno MP, DeAngelis N, deVries EJ, DeVries JW, Dube D, Ellefson W, Landen WO, Navis J, Pearson D, Reynolds SL, Richards P, Soliman AG, Thomson W. Analysis of Milk-Based Infant Formula. Phase IV. Iodide, Linoleic Acid, and Vitamins D and K: U.S. Food and Drug Administration-Infant Formula Council: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/76.5.1042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
In 1982, the U.S. Food and Drug Administration, the Infant Formula Council and its member companies, contract laboratories, and other government laboratories began a study of analytical methods for the nutrients listed in the Infant Formula Act of 1980. Phases I, II, III, and V have been completed. The present report provides data on Phase IV, in which 13 laboratories collaboratively studied an ion-selective electrode method for analyzing iodide, a gas chromatographic method for linoleic acid, and 2 liquid chromatographic (LC) methods each for vitamins D and K. Data were insufficient to evaluate one each of the LC methods studied for vitamins K and D. The relative standard deviations (RSD) are sufficient for the nutrient levels found in infant formula. RSDs (%) for repeatability (RSDr) and reproducibility (RSDR), respectively, were as follows: iodide, 4.0-11.4 and 13.5-18.2; linoleic acid, 1.0-1.6 and 3.5-5.1; vitamin K1, 3.2-16.0 and 6.2-19.4; and vitamin D3,4.2 and 35.0. The recommendation to adopt the method for vitamin D was supported by the results of a ministudy. All laboratories were capable of using these methods with little training. The methods for determination of iodide, linoleic acid, and vitamins D and K in ready-to-feed milkbased infant formula have been adopted first action by AOAC International.
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Affiliation(s)
- James T Tanner
- U.S. Food and Drug Administration, Division of Nutrition, Washington, DC 20204
| | | | - Mardi K Mountford
- Infant Formula Council, 5775 Peachtree-Dunwoody Rd, Atlanta, GA 30342
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Wallerstein N, Muhammad M, Sanchez-Youngman S, Rodriguez Espinosa P, Avila M, Baker EA, Barnett S, Belone L, Golub M, Lucero J, Mahdi I, Noyes E, Nguyen T, Roubideaux Y, Sigo R, Duran B. Power Dynamics in Community-Based Participatory Research: A Multiple-Case Study Analysis of Partnering Contexts, Histories, and Practices. Health Educ Behav 2019; 46:19S-32S. [PMID: 31549557 DOI: 10.1177/1090198119852998] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Community-based participatory research has a long-term commitment to principles of equity and justice with decades of research showcasing the added value of power-sharing and participatory involvement of community members for achieving health, community capacity, policy, and social justice outcomes. Missing, however, has been a clear articulation of how power operates within partnership practices and the impact of these practices on outcomes. The National Institutes of Health-funded Research for Improved Health study (2009-2013), having surveyed 200 partnerships, then conducted seven in-depth case studies to better understand which partnership practices can best build from community histories of organizing to address inequities. The diverse case studies represented multiple ethnic-racial and other marginalized populations, health issues, and urban and rural areas and regions. Cross-cutting analyses of the qualitative results focus on how oppressive and emancipatory forms of power operate within partnerships in response to oppressive conditions or emancipatory histories of advocacy within communities. The analysis of power was conducted within each of the four domains of the community-based participatory research conceptual model, starting from how contexts shape partnering processes to impact short-term intervention and research outputs, and contribute to outcomes. Similarities and differences in how partnerships leveraged and addressed their unique contexts and histories are presented, with both structural and relational practices that intentionally addressed power relations. These results demonstrate how community members draw from their resilience and strengths to combat histories of injustice and oppression, using partnership principles and practices toward multilevel outcomes that honor community knowledge and leadership, and seek shared power, policy, and community transformation changes, thereby advancing health equity.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Ihsan Mahdi
- New Mexico Department of Health, Santa Fe, NM, USA
| | - Emma Noyes
- Washington State University-Spokane, WA, USA
| | - Tung Nguyen
- University of California San Francisco, CA, USA
| | - Yvette Roubideaux
- National Congress on American Indians Policy Research Center, Washington, DC, USA
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15
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Leiker A, Meyer J, Yan Y, Ahn C, Wardak Z, Dan T, Nedzi L, Timmerman R, Patel T, Barnett S, Mickey B, Stojadinovic S. Modeling Radiosurgery Normal Tissue Dose: Target Surface Area Serves as the Best Single Pre-treatment Predictor. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Morgan H, Abdulrahman R, Choe K, Timmerman R, Barnett S, Mickey B, Whitworth T, Ding C, Stevenson S, Nedzi L. Hypofractionated 25Gy/5 Radiotherapy for Intracranial Meningiomas: Long-Term Follow-Up and Results. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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Hansen BD, Sabey CV, Rich M, Marr D, Robins N, Barnett S. Latency‐based functional analysis in schools: Correspondence and differences across environments. Behavioral Interventions 2019. [DOI: 10.1002/bin.1674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Blake D. Hansen
- Department of Counseling Psychology and Special EducationBrigham Young University Provo Utah
| | - Christian V. Sabey
- Department of Counseling Psychology and Special EducationBrigham Young University Provo Utah
| | - Megan Rich
- Center for the School of the FutureUtah State University Logan Utah
| | - Dallin Marr
- Department of Counseling Psychology and Special EducationBrigham Young University Provo Utah
| | - Noah Robins
- Department of Counseling Psychology and Special EducationBrigham Young University Provo Utah
| | - Steven Barnett
- Department of Counseling Psychology and Special EducationBrigham Young University Provo Utah
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18
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Barnett S, Allan D, Gutmann M, Cockcroft J, Mai V, Aliev A, Saßmannshausen J. Combined high resolution X-ray and DFT Bader analysis to reveal a proposed Ru–H⋯Si interaction in Cp(IPr)Ru(H)2SiH(Ph)Cl. Inorganica Chim Acta 2019. [DOI: 10.1016/j.ica.2019.01.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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19
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Martindale A, Trenhaile-Grannemann M, Barnett S, Miller P, Burkey T. 171 Growth performance of weaned pigs fed a high-protein corn co-product. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Martindale
- University of Nebraska,Lincoln, NE, United States
| | | | - S Barnett
- University of Nebraska,Lincoln, NE, United States
| | - P Miller
- University of Nebraska,Lincoln, NE, United States
| | - T Burkey
- University of Nebraska,Lincoln, NE, United States
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20
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Mathos KK, Landsberger SA, Diaz DR, Barnett S. Experiences in Psychiatric Residency Training: Teaching About the Mental Health of Persons Who Are Deaf or Hard of Hearing. Acad Psychiatry 2018; 42:869-870. [PMID: 30171493 DOI: 10.1007/s40596-018-0975-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/15/2018] [Indexed: 06/08/2023]
Affiliation(s)
| | | | - David R Diaz
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Steven Barnett
- University of Rochester Medical Center, Rochester, NY, USA
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21
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Thapa B, Walkeiwicz M, Rivalland G, Murone C, Asadi K, Barnett S, Knight S, Hendry S, Russell P, John T. OA08.05 Quantifying Tumour Infiltrating Lymphocytes (TILs) in Malignant Pleural Mesothelioma (MPM) -Defining the Hot, the Warm and the Cold Tumours. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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22
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Brown A, Agbor-Enoh S, Shah P, Timofte I, Orens J, Iacono A, Lemma M, Barnett S, Soares F, Nathan S, Ahmad K, Valantine H. Role of dd-cfDNA in Predicting Early Post-operative Course in Lung Transplant Recipients. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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23
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Kim M, Perera N, Knight S, Barnett S, Gooi J, Seevanayagam S. P3.16-052 Use of Decellularised Porcine Intestinal Submucosa Extracellular Matrix in Airway Reconstruction to Enable Lung-Sparing Oncological Surgery. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Kumar T, Mathis C, Sathanandam S, Zurakowski D, Subramanian S, Allen J, Solimine M, Berrios L, Jackson S, Landers M, Sullivan R, Barnett S, Loftis C, Price L, Tansey J, Hoskoppal D, Knott-Craig C. Effect of Thyroid Hormone on Cardiac Function Following Orthotopic Heart Transplantation in Piglets. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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25
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Al-sirri N, Palmer S, Cramp M, Barnett S. The effects of joint hypermobility syndrome on pain and participation in adults. Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Palmer S, Lewis R, Barnett S, Cramp M, Berry A, Thomas A, Clark E. FRI0640-HPR Effects of Postural Taping on Pain and Function Following Osteoporotic Vertebral Fractures – A Pilot Study:. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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27
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Pollard RQ, Betts WR, Carroll JK, Waxmonsky JA, Barnett S, deGruy FV, Pickler LL, Kellar-Guenther Y. Integrating primary care and behavioral health with four special populations: Children with special needs, people with serious mental illness, refugees, and deaf people. ACTA ACUST UNITED AC 2015; 69:377-87. [PMID: 24820687 DOI: 10.1037/a0036220] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Special patient populations can present unique opportunities and challenges to integrating primary care and behavioral health services. This article focuses on four special populations: children with special needs, persons with severe and persistent mental illness, refugees, and deaf people who communicate via sign language. The current state of primary care and behavioral health collaboration regarding each of these four populations is examined via Doherty, McDaniel, and Baird's (1996) five-level collaboration model. The section on children with special needs offers contrasting case studies that highlight the consequences of effective versus ineffective service integration. The challenges and potential benefits of service integration for the severely mentally ill are examined via description of PRICARe (Promoting Resources for Integrated Care and Recovery), a model program in Colorado. The discussion regarding a refugee population focuses on service integration needs and emerging collaborative models as well as ways in which refugee mental health research can be improved. The section on deaf individuals examines how sign language users are typically marginalized in health care settings and offers suggestions for improving the health care experiences and outcomes of deaf persons. A well-integrated model program for deaf persons in Austria is described. All four of these special populations will benefit from further integration of primary care and mental health services.
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Affiliation(s)
- Robert Q Pollard
- Department of Psychiatry, University of Rochester Medical Center
| | - William R Betts
- Department of Pediatrics, University of Colorado Denver School of Medicine
| | | | - Jeanette A Waxmonsky
- Departments of Psychiatry and Family Medicine, University of Colorado Denver School of Medicine
| | - Steven Barnett
- Department of Family Medicine, University of Rochester Medical Center
| | - Frank V deGruy
- Department of Family Medicine, University of Colorado Denver School of Medicine
| | - Laura L Pickler
- Department of Family Medicine, University of Colorado Denver School of Medicine
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Gondusky JS, Pinkos KA, Choi L, Patel JJ, Barnett S, Gorab RS. Simultaneous Bilateral Anterior Approach Total Hip Arthroplasty. Orthopedics 2015; 38:e611-5. [PMID: 26186324 DOI: 10.3928/01477447-20150701-60] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 09/02/2014] [Indexed: 02/03/2023]
Abstract
Simultaneous bilateral total hip arthroplasty (THA) has been performed successfully, with good outcomes and low complication rates reported. Most published studies on the topic used anterolateral or posterior surgical approaches. The anterior approach is performed under live fluoroscopy with the patient supine, obviating the need for patient repositioning during bilateral surgery. The authors report their experience with simultaneous bilateral anterior approach total hip arthroplasty. The authors retrospectively reviewed data for 75 patients (150 hips). Mean follow-up was 26 months (range, 5-60 months). Mean patient age was 59 years and the majority were American Society of Anesthesiology class 2 (range, 1-3). Mean total surgical time was 144 minutes (72 minutes per hip). Mean blood loss was 565 mL. Mean hospital length of stay was 2.75 days (range, 1-4 days). Ninety-six percent of patients were able to ambulate on postoperative day 1. Sixty-eight percent of patients were discharged to home. Mean Harris Hip Score improved from 50 to 97. All patients noted a return to preoperative level of activity or higher. Complications included 1 atraumatic minimally displaced trochanteric fracture occurring 2 weeks postoperatively, 1 pulmonary embolism on postoperative day 3 treated without sequelae, 1 episode of postoperative atrial fibrillation, and 4 minor local wound complications. No readmission, infection, nerve palsy, dislocation, reoperation, or death occurred. Anterior approach THA has the advantage of a single supine position for bilateral simultaneous surgery and the current study supports its use in appropriate patients.
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Ip S, Barnett S, Gooi J, Seevanayagam S, Knight S. Diagnostic utility of electromagnetic navigation bronchoscopy: A pilot study. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2014.12.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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30
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Jiang Z, Mclean C, Perez C, Barnett S, Friedman D, Batra P. Long-Term Surgical Outcomes of Spontaneous CSF Rhinorrhea. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1383995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
The number of elderly patients undergoing anesthesia is increasing. At the same time aging is associated with decreased functional reserve of all major organ systems and an increase in comorbid conditions, requiring a comprehensive perioperative evaluation to minimize morbidity and mortality. The preoperative assessment should focus on the risk/benefit analysis vis-à-vis the proposed intervention, allowing the practitioner to adapt surgical and anesthetic care, as well optimize health and functional status. In addition to the usual evaluation for cardiac and pulmonary risk, the preoperative assessment in the older patient should also address the risk of postoperative cognitive dysfunction and delirium. 'Do-not-resuscitate' orders must be clarified with the patients or substitute decision maker. Studies have not been able to clearly show the superiority of one anesthetic approach for the geriatric patient, although there are probably advantages to using regional anesthetic techniques. Overall the patient's preoperative functional status along with the proposed intervention is the primary determinants of the patient's long term functional outcome and wellbeing. The elderly patient may be at his most vulnerable during the postoperative phase, and a relatively high frequency of adverse events in the elderly, including respiratory insufficiency, myocardial and cerebrovascular ischemia, renal failure, infectious complications as well as delirium and postoperative cognitive dysfunction have been observed. Perioperative interventions should target modifiable risk factors and the avoidance of even minor complications with an ultimate goal of improving long-term outcome.
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Affiliation(s)
- M M Kurrek
- Matt M. Kurrek, 150 College Street, Room 121, Fitzgerald Building, Toronto, ON M5S 3E2, Canada, Tel: (416) 987-4306, Fax: (416) 978-2408,
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33
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Wong SF, Seow J, Profitis K, Johns J, Barnett S, John T. Marantic endocarditis presenting with multifocal neurological symptoms. Intern Med J 2013; 43:211-4. [PMID: 23402487 DOI: 10.1111/imj.12018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 02/09/2012] [Indexed: 12/31/2022]
Abstract
Non-bacterial thrombotic endocarditis (NBTE), also known as marantic endocarditis, has been reported to occur in 0.3-9.3% of the adult population at autopsy. NBTE associated with malignancy is an underrecognised cause of thromboembolic disorders. The clinical spectrum encountered and investigation results can be non-specific, often mimicking other acute conditions such as infective endocarditis. We describe the case of a 34-year-old woman with non-localising and multifocal neurological symptoms, who was subsequently diagnosed with NBTE secondary to a resectable primary lung adenocarcinoma.
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Affiliation(s)
- S F Wong
- Joint Ludwig Austin Oncology Unit, Melbourne, Victoria, Australia
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Mckay T, Bianco T, Rhodes L, Barnett S. Prevalence of Dirofilaria immitis (Nematoda: Filarioidea) in mosquitoes from northeast Arkansas, the United States. J Med Entomol 2013; 50:871-878. [PMID: 23926787 DOI: 10.1603/me12197] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A mosquito survey was conducted to identify which species of mosquitoes carry Dirofilaria immitis (Leidy) (Nematoda: Filarioidea), dog heartworm, in northeast Arkansas. Using polymerase chain reaction, mosquitoes were analyzed for D. immitis, Dirofilaria repens Railliet & Henry, and Acanthocheilonema dracunculoides Cobbold. Mosquitoes were collected from April to October 2009 using black light ultraviolet traps baited with dry ice. Sixteen mosquito species were identified. D. immitis was identified in nine mosquito species, which included Aedes vexans (Meigen), Anopheles quadrimaculatus Say, Anopheles punctipennis (Say), Culex pipiens quinquefasciatus Say, Culex erraticus (Dyer & Knab), Culiseta inornata (Williston), Psorophora columbiae (Dyer & Knab), Psorophora ferox (Humboldt), and Psorophora howardii Coquillett. No D. repens or A. dracunculoides DNA was amplified. Of the 1,212 mosquito pools tested, 7.3% were positive for D. immitis. Frequency of D. immitis infections from six collection sites ranged from 2.1 to 19.4%. Ae. vexans and An. quadrimaculatus were the two most abundant species, composing 58.7 and 23.7% of the total mosquitoes collected, with 9.6 and 6.9% of pools positive for D. immitis, respectively. To investigate localized vector infection rates of D. immitis, mosquitoes were collected from inside the kennel of a heartworm-positive dog. Of the 114 mosquitoes collected, 84 (73.7%) were positive for D. immitis. The frequency of D. immitis-infected mosquitoes collected near a heartworm-positive dog was considerably higher than in the original six collection sites, suggesting a single heartworm-positive dog potentially increases infection pressure on susceptible animals sharing mosquito exposure.
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Affiliation(s)
- Tanja Mckay
- Department of Biological Sciences, Arkansas State University, P.O. Box 599, State University, AR 72467, USA.
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Lewis J, Barnett S, Mickey B, Boudreaux B. Chordoid Meningioma: A Clinical, Radiographic, and Pathologic Review of Seven Cases. Skull Base Surg 2013. [DOI: 10.1055/s-0033-1336337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Deaf and hard-of-hearing (DHoH) individuals are underrepresented among physicians and physicians-in-training, yet this group is frequently overlooked in the diversity efforts of many medical training programs. The inclusion of DHoH individuals, with their diverse backgrounds, experiences, and struggles, contributes to medical education and health care systems in a variety of ways, including (1) a richer medical education experience for students and faculty resulting in greater disability awareness and knowledge about how to interact with and care for DHoH individuals and their families, (2) the provision of empathetic care desired by many patients and their families, including individuals who have a disability or chronic condition, and (3) the promotion of a more supportive and accessible professional environment for physicians, including older physicians in practice and as educators, who are experiencing age-associated decreased hearing acuity or other acquired disabilities.Today, many qualified DHoH individuals face barriers to pursuing medical careers even while physicians who become DHoH can continue to practice medicine. These barriers still exist two decades after the implementation of the Americans with Disabilities Act of 1990 and despite technological advancements and changing attitudes. In light of the findings by Moreland and colleagues, the authors of this commentary discuss reasons to include DHoH individuals in the physician workforce, explain why this group remains underrepresented among physicians, and suggest ways that medical schools and training programs can ensure fair application processes and inclusive educational opportunities for work with DHoH students who are interested in health care careers.
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Wen Y, Stephenson S, Zambonelli C, Hilt S, Wininger M, Dey A, Barnett S, Carfi A. Simple, scalable and robust purification of two HIV-1 subtype C gp120 monomer subunit antigens for phase II clinical trial in Republic of South Africa. Retrovirology 2012; 9. [PMCID: PMC3441894 DOI: 10.1186/1742-4690-9-s2-p356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Y Wen
- Novartis, Cambridge, MA, USA
| | | | | | - S Hilt
- Novartis, Cambridge, MA, USA
| | | | - A Dey
- Novartis, Cambridge, MA, USA
| | | | - A Carfi
- Novartis, Cambridge, MA, USA
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Spearman P, Tomaras G, Montefiori D, Huang Y, Ahmed H, Elizaga M, Hural J, McElrath J, Ouedraogo L, Pensiero M, Butler C, Kalams S, Overton ET, Barnett S, Group N. Rapid development of cross-clade neutralizing antibody responses after clade B gp120/gp140 protein priming and clade c gp140 protein boosting. Retrovirology 2012. [PMCID: PMC3441648 DOI: 10.1186/1742-4690-9-s2-p137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Liew M, Murone C, Walkiewicz M, Mitchell P, Gan H, Barnett S, Russell P, Wright G, Scott A, John T. Correlation of wtEGFR Activation Assessed by mAB806 Binding and EGFR Kinase Mutations in Stage IIIA N2 NSCLC. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)34250-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Hutnick NA, Karuppiah M, Pollara J, Yan J, Myles DJ, Broderick K, Morrow M, Sardasai N, Montefiori D, Barnett S, Ferrari G, Weiner DB. E-DNA IM or ID delivery prime enhances antibody and T cell responses following recombinant gp120 env boost. Retrovirology 2012. [PMCID: PMC3442033 DOI: 10.1186/1742-4690-9-s2-p364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
We investigated whether hard-of-hearing older adults were more likely to report difficulties and delays in accessing care and decreased satisfaction with healthcare access than those without hearing loss. The Wisconsin Longitudinal Study (2003-2006 wave, N = 6,524) surveyed respondents regarding hearing, difficulties/delays in accessing care, satisfaction with healthcare access, socio-demographics, chronic conditions, self-rated health, depression, and length of relationship with provider/site. We used multivariate regression to compare access difficulties/delays and satisfaction by respondents' hearing status (hard-of-hearing or not). Hard-of-hearing individuals comprised 18% of the sample. Compared to those not hard-of-hearing, hard-of-hearing individuals were significantly more likely to be older, male and separated/divorced. They had a higher mean number of chronic conditions, including atherosclerotic vascular disease, diabetes and depression. After adjustment for potential confounders, hard-of-hearing individuals were more likely to report difficulties in accessing healthcare (Odds Ratio 1.85; 95% Confidence Interval 1.19-2.88). Satisfaction with healthcare access was similar in both groups. Our findings suggest healthcare access difficulties will be heightened for more of the population because of the increasing prevalence of hearing loss. The prevalence of hearing loss in this data is low and our findings from a telephone survey likely underestimate the magnitude of access difficulties experienced by hard-of-hearing older adults. Further research which incorporates accessible surveys is needed. In the meantime, clinicians should pay particular attention to assessing barriers in healthcare access for hard-of-hearing individuals. Resources should be made available to proactively address these issues for those who are hard-of-hearing and to educate providers about the specific needs of this population.
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Affiliation(s)
- Nancy Pandhi
- Department of Family Medicine, University of Wisconsin, Madison, WI 53705, USA.
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Johnson S, Hall J, Barnett S, Draper M, Derbyshire G, Haynes L, Rooney C, Cameron H, Moseley GL, de C Williams AC, McCabe C, Goebel A. Using graded motor imagery for complex regional pain syndrome in clinical practice: failure to improve pain. Eur J Pain 2011; 16:550-61. [PMID: 22337591 DOI: 10.1002/j.1532-2149.2011.00064.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND There is good evidence from studies conducted in a single-centre research setting for the efficacy of graded motor imagery (GMI) treatment, a complex physiotherapy intervention, to reduce pain in long-standing complex regional pain syndrome (CRPS). However, whether GMI is effective in clinical practice is not established. AIM To establish whether GMI is effective in clinical practice. METHODS We undertook a prospective audit of GMI treatment at two UK centres with a special interest in the management of patients with CRPS. All patients received GMI, in conjunction with a range of other 'best practice' physical and psychological interventions. RESULTS The patients' average pain intensities did not improve with treatment [centre 1: n = 20, pre-post numeric rating scale (NRS) difference 0.6 [confidence interval (CI) -0.3 to 1.5]; centre 2: n = 12, pre-post NRS difference 0.2 (CI: -0.9 to 1.2)]. Patients at centre 1 reported significant functional improvement. Improved performance on left/right judgement replicated in both centres seen in the clinical trials. CONCLUSIONS The failure of our real-world implementation of GMI suggests that better understanding of both the GMI methodology and its interaction with other treatment methods is required to ensure that GMI research results can be translated into clinical practice. Our results highlight challenges with the translation of complex interventions for chronic pain conditions into clinical practice.
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Affiliation(s)
- S Johnson
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
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Barnett S, Klein JD, Pollard RQ, Samar V, Schlehofer D, Starr M, Sutter E, Yang H, Pearson TA. Community participatory research with deaf sign language users to identify health inequities. Am J Public Health 2011; 101:2235-8. [PMID: 22021296 DOI: 10.2105/ajph.2011.300247] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Deaf people who use American Sign Language (ASL) are medically underserved and often excluded from health research and surveillance. We used a community participatory approach to develop and administer an ASL-accessible health survey. We identified deaf community strengths (e.g., a low prevalence of current smokers) and 3 glaring health inequities: obesity, partner violence, and suicide. This collaborative work represents the first time a deaf community has used its own data to identify health priorities.
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Affiliation(s)
- Steven Barnett
- Department of Family Medicine, Rochester Prevention Research Center/National Center for Deaf Health Research, University of Rochester Medical Center, Rochester, NY 14642, USA
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Mathews JL, Parkhill AL, Schlehofer DA, Starr MJ, Barnett S. Role-reversal exercise with Deaf Strong Hospital to teach communication competency and cultural awareness. Am J Pharm Educ 2011; 75:53. [PMID: 21655407 PMCID: PMC3109807 DOI: 10.5688/ajpe75353] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 01/05/2011] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To implement a role-reversal exercise to increase first-year pharmacy students' awareness of communication barriers in the health care setting, especially for deaf and hard-of-hearing patients. DESIGN Volunteers from the local deaf community conducted Deaf Strong Hospital, a role-reversal exercise in which students were the "patients." Students navigated through a reception area, encounter with a physician, and having a prescription filled at a pharmacy without receiving or using any spoken language. ASSESSMENT A debriefing session was held in which small groups of students had the opportunity to ask questions of a panel of deaf and hard-of-hearing volunteers. On a survey administered to assess students' learning, 97% agreed or strongly agreed that the experience would likely impact their attitudes and behavior in future interactions with patients who did not speak English. CONCLUSIONS The role-reversal exercise was an effective method of teaching students that the delivery of health care is dependent on adequate communication between health care providers and the patient.
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Affiliation(s)
- Jennifer L Mathews
- Wegmans School of Pharmacy, St. John Fisher College, Rochester, NY 14618, USA.
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Barnett S, McKee M, Smith SR, Pearson TA. Deaf sign language users, health inequities, and public health: opportunity for social justice. Prev Chronic Dis 2011; 8:A45. [PMID: 21324259 PMCID: PMC3073438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Steven Barnett
- Rochester Prevention Research Center, National Center for Deaf Health Research, Rochester, New York, USA.
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Millward S, Barnett S, Jones A. Independent health care: using a board-to-ward approach to achieve improvement in infection prevention standards. J Infect Prev 2010. [DOI: 10.1177/1757177410377539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The Health and Social Care Act 2008 places a legal responsibility upon healthcare organisations to provide a clean environment where infection risks are minimised. From April 2010, the regulation of both the NHS and the independent healthcare sector will, for the first time, fall under the same legislative framework. Nuffield Health (NH) is an independent healthcare provider with 30 acute hospitals. Strategic management of infection prevention is led by the NH Director for Infection Prevention. Management at the hospital level is led by the matron/Director for Infection Prevention and Control supported by trained infection prevention link practitioners (IPLPs). High-quality infection prevention across a large geographical area presents many challenges and IPLPs have been used to both monitor and improve the quality of infection prevention using national audit tools and acting as role models to influence practice. Audit results over 4 years demonstrate yearly improvements and low rates of healthcare-associated infections.
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Affiliation(s)
- S. Millward
- Infection Prevention Ltd, Nuffield Health, 40-44 Coombe Road, New Malden, Surrey, KT3 4QF, UK,
| | - S. Barnett
- Infection Prevention Ltd, Nuffield Health, 40-44 Coombe Road, New Malden, Surrey, KT3 4QF, UK
| | - A. Jones
- Infection Prevention Ltd, Nuffield Health, 40-44 Coombe Road, New Malden, Surrey, KT3 4QF, UK
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Barnett S, Plourde G, Zheng J, Pietanza M, Akhurst TJ, Downey RJ, Kris MG, Shen R, Rusch VW, Park BJ. Use of PET-measured response in involved mediastinal lymph nodes to predict overall survival (OS) in non-small cell lung cancer (NSCLC) patients treated with induction therapy (IT) and surgery. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.7077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Malherbe DC, Doria-Rose N, Misher L, Beckett T, Blay-Puryear W, Barnett S, Srivastava I, Richardson B, Stamatatos L, Haigwood NL. P05-10. Sequential immunization with a subtype B HIV-1 envelope quasispecies elicits broader neutralization than vaccination with a single envelope clone. Retrovirology 2009. [PMCID: PMC2767991 DOI: 10.1186/1742-4690-6-s3-p86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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