Creating and Activating an Implementation Community to Drive HPV Vaccine Uptake in Texas: The Role of an NCI-Designated Cancer Center.

The University of Texas MD Anderson Cancer Center, a comprehensive cancer center designated by the National Cancer Institute (NCI), defines its service population area as the State of Texas (29.1 M), the second most populous state in the country and the state with the greatest number of uninsured residents in the United States. Consistent with a novel and formal commitment to prevention as part of its core mission, alongside clear opportunities in Texas to drive vaccine uptake, MD Anderson assembled a transdisciplinary team to develop an institutional Framework to increase adolescent HPV vaccination and reduce HPV-related cancer burden. The Framework was developed and activated through a four-phase approach aligned with the NCI Cancer Center Support Grant Community Outreach and Engagement component. MD Anderson identified collaborators through data-driven outreach and constructed a portfolio of collaborative multi-sector initiatives through review processes designed to assess readiness, impact and sustainability. The result is an implementation community of 78 institutions collaboratively implementing 12 initiatives within a shared measurement framework impacting 18 counties. This paper describes a structured and rigorous process to set up the implementation of a multi-year investment in evidence-based strategies to increase HPV vaccination that solves challenges preventing implementation of recommended strategies and to encourage similar initiative replication.

Magnetically active lithium-ion batteries towards battery performance improvement.

Lithium-ion batteries (LIBs) are currently the fastest growing segment of the global battery market, and the preferred electrochemical energy storage system for portable applications. Magnetism is one of the forces that can be applied improve performance, since the application of magnetic fields influences electrochemical reactions through variation of electrolyte properties, mass transportation, electrode kinetics, and deposits morphology. This review provides a description of the magnetic forces present in electrochemical reactions and focuses on how those forces may be taken advantage of to influence the LIBs components (electrolyte, electrodes, and active materials), improving battery performance. The different ways that magnetic forces can interact with LIBs components are discussed, as well as their influence on the electrochemical behavior. The suitable control of these forces and interactions can lead to higher performance LIBs structures and to the development of innovative concepts.

Cancer Patients' Perception of Usefulness of Wearable Exercise Trackers.

OBJECTIVE: To determine the feasibility and perception of usefulness of wearable trackers in inpatient and outpatient cancer rehabilitation patients. DESIGN: Prospective study. SETTING: Acute inpatient rehabilitation and outpatient clinic at a tertiary cancer center. PARTICIPANTS: Adult cancer patients (N = 100). INTERVENTIONS: Participants were provided with wearable trackers for the duration of the study. MAIN OUTCOME MEASURES: Survey regarding feasibility (as defined as equal or more than two-thirds of participants reporting use of the wearable tracker) and usefulness of the wearable tracker and Edmonton Symptom Assessment Scale (ESAS-FS) in both inpatient and outpatient populations. Activity minutes, number of steps, heart rate, and sleep data were collected from the wearable tracker. RESULTS: Patients reported the use of a wearable tracker is feasible, with 48/50 (96%) outpatients and 47/50 (94%) inpatients reported wearing the wearable tracker daily and 37/49 (76%) outpatients and 29/50 (58%) inpatients reported that they would continue to wear the wearable tracker after this study. The majority of cancer patients (41/49 [84%] of outpatient and 33/50 [66%] of inpatient patients) reported that the wearable tracker was useful and 41/49 (84%) outpatients and 27/50 (54%) inpatients perceived the wearable tracker as helping to increase physical activity. CONCLUSIONS: The use of wearable trackers in cancer patients is feasible and patients perceive wearable trackers as useful in both the inpatient and outpatient rehabilitation setting. Physical activity in these patients was better in the outpatient population, as expected because of less medical acuity.

Extension for Community Healthcare Outcomes-Palliative Care in Africa Program: Improving Access to Quality Palliative Care.

PURPOSE: There is limited access to quality palliative care (PC) for patients with advanced cancer in sub-Saharan Africa. Our aim was to describe the development of the Project Extension for Community Healthcare Outcomes-Palliative Care in Africa (ECHO-PACA) program and describe a preliminary evaluation of attitudes and knowledge of participants regarding the ability of the program to deliver quality PC. METHODS: An interdisciplinary team at the MD Anderson Cancer Center, guided by experts in PC in sub-Saharan Africa, adapted a standardized curriculum based on PC needs in the region. Participants were then recruited, and monthly telementoring sessions were held for 16 months. The monthly telementoring sessions consisted of case presentations, discussions, and didactic lectures. Program participants came from 14 clinics and teaching hospitals in Ghana, Kenya, Nigeria, South Africa, and Zambia. Participants were surveyed at the beginning, midpoint, and end of the 16-month program to evaluate changes in attitudes and knowledge of PC. RESULTS: The median number of participants per session was 30. Thirty-three (83%) of 40 initial participants completed the feedback survey. Health care providers' self-reported confidence in providing PC increased with participation in the Project ECHO-PACA clinic. There was significant improvement in the participants' attitudes and knowledge, especially in titrating opioids for pain control (P = .042), appropriate use of non-opioid analgesics (P = .012), and identifying and addressing communication issues related to end-of-life care (P = .014). CONCLUSION: Project ECHO-PACA was a successful approach for disseminating knowledge about PC. The participants were adherent to ECHO PACA clinics and the completion of feedback surveys. Future studies should evaluate the impact of Project ECHO-PACA on changes in provider practice as well as patient outcomes.

Revealing the Reconstructed Surface of Li[Mn2]O4.

The spinel Li[Mn2]O4 is a candidate cathode for a Li-ion battery, but its capacity fades over a charge/discharge cycle of Li1-x[Mn2]O4 (0 < x < 1) that is associated with a loss of Mn to the organic-liquid electrolyte. It is known that the disproportionation reaction 2Mn(3+) = Mn(2+) + Mn(4+) occurs at the surface of a Mn spinel, and it is important to understand the atomic structure and composition of the surface of Li[Mn2]O4 in order to understand how Mn loss occurs. We report a study of the surface reconstruction of Li[Mn2]O4 by aberration-corrected scanning transmission electron microscopy. The atomic structure coupled with Mn-valence and the distribution of the atomic ratio of oxygen obtained by electron energy loss spectroscopy reveals a thin, stable surface layer of Mn3O4, a subsurface region of Li1+x[Mn2]O4 with retention of bulk Li[Mn2]O4. This observation is compatible with the disproportionation reaction coupled with oxygen deficiency and a displacement of surface Li(+) from the Mn3O4 surface phase. These results provide a critical step toward understanding how Mn is lost from Li[Mn2]O4, once inside a battery.

Raman measurements of thermal transport in suspended monolayer graphene of variable sizes in vacuum and gaseous environments.

Using micro-Raman spectroscopy, the thermal conductivity of a graphene monolayer grown by chemical vapor deposition and suspended over holes with different diameters ranging from 2.9 to 9.7 µm was measured in vacuum, thereby eliminating errors caused by heat loss to the surrounding gas. The obtained thermal conductivity values of the suspended graphene range from (2.6 ± 0.9) to (3.1 ± 1.0) × 10(3) Wm(-1)K(-1) near 350 K without showing the sample size dependence predicted for suspended, clean, and flat graphene crystal. The lack of sample size dependence is attributed to the relatively large measurement uncertainty as well as grain boundaries, wrinkles, defects, or polymeric residue that are possibly present in the measured samples. Moreover, from Raman measurements performed in air and CO(2) gas environments near atmospheric pressure, the heat transfer coefficient for air and CO(2) was determined and found to be (2.9 +5.1/-2.9) and (1.5 +4.2/-1.5) × 10(4) Wm(-2)K(-1), respectively, when the graphene temperature was heated by the Raman laser to about 510 K.

The association of drug use and post-traumatic stress reactions due to Hurricane Ike among Fifth Ward Houstonian youth.

This study shows the important link between higher drug use and self-medication among youth with higher reported posttraumatic stress reactions after natural disasters. The study offers secondary analysis of cross-sectional data collected on 170 predominately African American males through the Fifth Ward Enrichment program (FWEP) in Houston, Texas, between November and December 2009. Men who stated that in the last week they tried to keep from thinking or talking about the hurricane or things that remind them of what happen were significantly more likely to use alcohol (p < .05), marijuana (p < .01), codeine cough syrup (p < .00), anti-energy drinks (p < .00), crystal methamphetamines (p < .00), and Viagra (p < .00). Unadjusted logistic regression showed that they also experienced over twice the odds of reporting past 30 day use of alcohol (OR = 2.57, 95% CI = .98, 6.8), marijuana (OR = 4.31, 95% CI = 1.2, 15.3), codeine cough syrup (OR = 5.22, 95% CI = 1.4, 19.5), and anti-energy drinks (OR = 3.27, 95% CI = 1.0, 1.4). Adjusted logistic regression revealed that male youth post-traumatic stress reaction is a significant predictor of marijuana use (OR = 4.1, 95% CI = 1.0, 16.5). This study shows the important link of higher drug use and self-medication among youth with higher reported posttraumatic stress reactions after natural disasters.

Smoking cessation recruitment among African American youth: what youth think will help them attend.

Data on the perceived sources of cessation information and the reasons why alternative school students would attend a smoking cessation program were collected from 302 students at an alternative high school who were surveyed through the Safer Decisions Program in Houston, Texas. Data collection took place between September 2006 and January 2007. Logistic regression identified that non-smokers were more likely to believe it was important to receive cessation information from doctors (4.93 adjusted odds ratio 95% confidence interval CI=1.96; 12.40), health educators (4.70 AOR; 95% CI=1.46; 15.10), people who have been affected by smoking (3.20 AOR; 95% CI=1.04; 9.80), teachers (2.73 AOR; 95% CI=1.3; 5.60), and celebrities (2.44 AOR; 95% CI=1.21; 4.92) compared to smokers. In addition, persons who had smoked in the past 30 days were twice as likely to report embarrassment (1.86 AOR; 95% CI=1.00; 3.44) and feel that it was not right to smoke (2.24 AOR; 95% CI=1.00; 5.00) compared to respondents who had not smoked during the past 30 days. While the relationships tested in this study are exploratory, they provide initial evidence for understanding the importance of smoking cessation recruitment strategies that may impact minority alternative school youth.

The link between recent sexual abuse and drug use among African American male college students: it's not just a female problem in and around campus.

This study examined the relationship between sexual abuse in or around campus and drug use among young African-American males in college. It offers cross-sectional analysis of data collected from the Alcohol and Substance Abuse Awareness and Use Study (ASAAUS). Data collection took place in October 2004 via a self-administered survey among 181 African-American male students. Males who reported past sexual abuse in or around campus were significantly more likely than nonsexually-abused males to have used tobacco (41% v. 19%, p < .05), alcohol (82% v. 49%, p < .05), marijuana (59% v. 30%, p < .05), and cocaine (18% v. 2%, p < .05) in the 30 day preceding the interview. Logistic regression analyses indicated that sexual abuse history in or around campus was significantly associated with past year (OR = 9.8, p < or = 0.001) and past 30 day (OR = 5.0, p < or = 0.001) drug use.

Electronic templates versus dictation for the completion of Mohs micrographic surgery operative notes.

BACKGROUND: Operative notes can be generated electronically by manual input of the entire note, free-form oral dictation, or using either an electronic template or a template for dictation. There are few studies that have directly compared these modalities in terms of speed, accuracy, and completeness. OBJECTIVE: The objective was to determine whether electronic templates are more efficient and reduce errors compared to free-form oral dictation for the completion of Mohs micrographic surgery operative notes. METHODS: Operative notes for 110 consecutive Mohs micrographic surgery cases were completed either by oral dictation or by electronic template. The time to dictate or complete the template was recorded for each note. Notes were subsequently edited, recording the number and type of errors as well as the time required to edit each note. RESULTS: Compared with dictation, operative notes completed with the electronic template had fewer errors (5.8% vs. 81%), took less time to complete (175.5 seconds vs. 240.0 seconds), took less time to review and edit (41.6 seconds vs. 201.1 seconds), and were completed and signed in a more timely fashion (0.115 days vs. 20.7 days). CONCLUSION: Electronic templates are a more accurate and rapid method compared to free-form oral dictation for the completion of Mohs micrographic surgery operative notes and have the advantage of being immediately available to review and sign.

The impact of a situationally focused individual human immunodeficiency virus/sexually transmitted disease risk-reduction intervention on risk behavior in a 1-year cohort of Nigerian military personnel.

Human immunodeficiency virus (HIV) and sexually transmitted disease (STD)-related risks in peacekeeping troops is a concern when they are stationed in areas of high HIV prevalence. We carried out an assessment of a situationally focused individual HIV/STD reduction intervention (where avoidance of risk situations, as well as risk behaviors, are emphasized) in one Nigerian military unit (N = 1,222), with a comparable unit from the same service as a waiting list control (N = 987). The intervention consisted of a possible five modules that were presented to groups of up to 50 personnel. Data were collected on reported sexual behaviors, condom beliefs, sexual risk behaviors with casual partners, and number of interventions attended. Data indicated significant increases in reported condom use with casual partners and positive condom beliefs at 6- and 12-month follow-up. Risk behavior was reduced 30% from baseline at 6 months and 23% from baseline at 12 months. There was also a significant dose-response effect for number of interventions attended. These data suggest that relatively brief situationally focused individual interventions are effective in military and West African contexts in reducing HIV/STD risk behaviors.

The relationship between perceived exposure to promotional smoking messages and smoking status among high school students.

Data on self-reported perceived exposure to pro-smoking messages were collected from 1,608 high school students surveyed through the ASPIRE (A Smoking Prevention Interactive Experience) Program in Houston, Texas, in 2003. Results indicated that high school smoking quitters had approximately twice the odds of perceived exposure to pro-smoking messages as nonsmokers through billboard advertisements (Adjusted Odds Ratio [AOR] = 2.04, 95% CI: 1.09, 3.81), newspapers & magazines (AOR: 1.97, 95% CI: 1.09, 3.56), and movies (AOR: 1.94, 95% CI: 1.03, 3.65). Smoking experimenters marginally perceived more exposure to pro-smoking radio messages (AOR = 1.31, 95% CI: 1.04, 1.67) and billboard advertisements (AOR = 1.28, 95% CI: 1.02, 1.61) compared to nonsmokers. Lastly, current smokers were 1.82 times as likely to report exposure to pro-smoking poster advertisements as nonsmokers (95% CI: 1.19, 2.79, p < or = .05). These findings suggest that experimenters and quitters may pay more attention to smoking advertisements than nonsmokers and current smokers.

The relationship between perceived youth exposure to anti-smoking advertisements: how perceptions differ by race.

Data on self-reported perceived exposure to anti-smoking messages were collected from 1,608 high school students surveyed through the ASPIRE (A Smoking Prevention Interactive Experience) Program in Houston, Texas. Data collection took place between October 2002 and March 2003. Logistic regression identified that African Americans perceived significantly less exposure to anti-smoking advertisements via television (OR = .50, p < 0.05) and posters (OR = .61, p < 0.05) than whites. However, they had nearly twice as much perceived exposure to anti-smoking advertisements at movies (OR = 1.79, p < or = 0.05) and sporting events (OR = 2.1, p < or = 0.05) than their white counterparts. Hispanic youth perceived significantly less exposure to anti-smoking posters (OR = .51, p < or = 0.05) and significantly higher exposure to anti-smoking messages at sporting events (OR = 1.92, p < or = 0.05) and school programs (OR = 3.44, p < or = 0.05) compared to white youth. While the relationships tested in this study are exploratory, they provide initial evidence for an important nexus between race and communication channels that may impact perceived exposure to tobacco advertising.

The relationship between sexual abuse and drug use: a view of African-American college students in Texas.

This study offers cross-sectional analysis of data collected from the Alcohol and Substance Abuse Awareness and Use Study (ASAAUS). Data collection took place in October 2003 via a self-administered survey. Students who reported sexual abuse history in or around campus were 4 times more likely to report current amphetamine, cocaine, hallucinogen, opiate, or designer drug use compared to students with no sexual abuse history. Logistic regression analyses indicated that lifetime drug use was significantly associated with sexual abuse history (OR = 2.2, p < .05). While the relationships tested in this study are exploratory, they provide evidence for an important connection between sexual abuse and substance use among African-American college students.