Despite the evidence that colorectal cancer screening is effective in reducing the incidence of and mortality from colorectal cancer, racial and ethnic disparities in colorectal cancer screening persist in the United States. African-born immigrants in the United States have lower colorectal cancer screening rates than native-born Americans. The purpose of this quantitative, retrospective, cross-sectional study was to examine how family income, health insurance status, language of interview, length of stay in the United States, perceived health status, level of education, and having a usual place for medical care affect colorectal cancer screening among African-born immigrants in the United States. The immigrant health services utilization model provided the framework for the study. Secondary data collected in 2010, 2013, and 2015 through the National Health Interview Survey from 349 African-born immigrants age 40 years and above were analyzed using logistic regression and a chi-square test of independence. A stratified multistage sampling procedure was used to select the sample for the study. Results showed a significant association between colorectal cancer screening and health insurance status, length of stay in the United States, perceived health status, and having a usual place for medical care. However, no association was found between colorectal cancer screening and family income, education level, and interview language. Findings may be used to impact positive social change and guide policy decisions on colorectal cancer preventive interventions targeting African-born immigrants living in the United States.

Peripheral artery disease (PAD) affects 8 to 10 million Americans, and the incidence of PAD is expected to increase as the population ages. A high percentage of the PAD is undiagnosed prior to the onset of a serious cardiovascular event; therefore, the inability to screen and diagnose for PAD in the early stages could hinder efforts to decrease adverse consequences of cardiovascular disease. Individuals with PAD have a 3 to 5 times increased risk of cardiovascular disease (CVD) mortality when compared to people without PAD. Guided by the Stetler model, the purpose of this project was to evaluate the relationship between level of PAD, as measured by skin perfusion pressure, and HbA1c using secondary data obtained from charts of patients within the clinic setting. Data included patient gender, age, degree of PAD, and HbA1c. A Pearson's correlation investigated the relationship between the patients' HbA1c and level of PAD. There was a significant relationship between HbA1c and LT PAD (r = .21, p =.009). There was no relation in RT PAD (r =.01, n = 149, p = .90). There was a significant relationship between HbA1c and age (r = .34, p = .00). Ultimately, the goal of this study was to improve PAD recognition, encourage early intervention, and facilitate effective preventive methods. Critical limb ischemia might be delayed or prevented if it is identified earlier by screening methodologies. Early identification and treatment of PAD can improve the quality of life and care for individuals suffering with PAD.

Depression is a pervasive mental health disorder worldwide. Although being diagnosed with chronic illness exacerbates susceptibility to depression, detection and subsequent treatment of comorbid depression in primary care settings remain suboptimal because patients with chronic medical disorders are not commonly screened for depression. There is a need to initiate proactive measures by implementing routine screening in primary care settings. The plan-do-study-act (PDSA) model guided an intervention to establish a depression screening practice. This study aimed to determine if the implementation of evidence-based screening for depression using the Patient Health Questionnaire-9 (PHQ-9) tool could increase diagnosis of comorbid depression among patients suffering from chronic diseases. Convenience sampling served as the method for selecting healthcare records that met the predetermined criteria. Two hundred established patients over 18 years of age were screened for depression at a primary care clinic in Maryland within a 10-week period following Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Study participants included 84 (42%) males and 116 (58%) females. Of these, 84 (42%) had minimal depression, 57 (29%) had mild depression, 23 (12%) had moderate depression, 24 (12%) had moderate-severe depression, and 12 (6%) had severe depression. The baseline report from the clinic revealed 0% depression screening practices yet the post-project chart review revealed a surprisingly high rate of depression diagnosis in 34 (17%) of 200 patients suffering from chronic illnesses. Identification of a reliable tool that would be used to screen depression among patients with chronic diseases at primary care clinics to mitigate the deleterious effects of depression and promote the well-being and health of patients and their families is important.

Second-generation antipsychotics (SGAs) are prescribed for treatment of psychosis. A major side effect of SGAs is an increased risk of metabolic syndrome (MetS) with symptoms of hypertension, hyperlipidemia, hyperglycemia, and truncal obesity. A clinic in the northeastern United States was not screening patients for MetS when being treated with SGAs. The purpose of this project was to educate staff on MetS risk factors, signs, symptoms, and patient management with a goal to improve their knowledge of MetS. Lewin's change theory provided a conceptual framework for the project. The project question explored the development and evaluation of an educational module on MetS increased staff knowledge. Educational content was guided by current literature and the American Psychiatric Association and American Diabetic Association practice guidelines. Five expert panel members, consisting of 3 psychiatrists, an advance practice nurse, and a registered nurse reviewed the education program and evaluated content using a Likert-type questionnaire. Expert panel evaluations indicated that the module content contained useful clinical information on MetS screening for patients on SGAs. After panel review, the program was presented to 7 clinic staff. Pretest and posttest questionnaires asked 10 multiple choice questions and results were compared. Questions on SGA side effects, MetS complications, prevalence, baseline assessment measures, lab work, and needed collaboration were answered correctly by 6 of the participants pretest and all questions after receiving the education program. The project has the potential to promote positive social change through staff education on MetS screening for patients, thus improving patient outcomes.

acase@tulane.edu

acase@tulane.edu

This study investigated potential ways in which student-reported stress and support levels, represented by the Ecomap stress-support index (SSI), could inform school-based universal screening efforts. Participants included 260 students in grades K to 3 attending an urban elementary charter school in New Orleans, Louisiana, during the academic year of 2011-2012, for whom specific data relevant to the study's variables were available in school records. Child self-report of stress and support (SSI), measured by the Ecomap, was hypothesized to enhance the prediction of school academic and behavioral outcomes, measured by achievement and behavior reports, beyond teacher report of social emotional functioning and school functioning, as reported on the Behavioral Assessment System for Children: Behavioral and Emotional Screening System (BESS) 1. Step-wise regression analyses were conducted. Results indicated that the BESS and Ecomap SSI together predicted variance in behavior reports and academic scores; however, the SSI did not account for significant additional variance. The Ecomap SSI also was hypothesized to explain variances in student self-reports of internalizing difficulties, whereas teacher reports of student functioning on the (BESS) were hypothesized to explain variances in reports of externalizing difficulties. Multiple regression analyses were used to explore this relationship. The Ecomap SSI was found to predict Attention Difficulties reported by students on the Behavioral Assessment System for Children: Self-Report Protocol C (BASC-2, SRP), with higher reports of stress corresponding to higher reports of attention problems. Findings indicate that data on student stress can be useful in the mental health screening process and provide important information that could inform intervention. / acase@tulane.edu

Gestational diabetes mellitus (GDM) is the most common metabolic complication in pregnancy and is associated with substantial maternal and neonatal morbidity. The standard of care for GDM in most developed countries is universal mid- to late- pregnancy (24-28 weeks gestation) glucose testing. While earlier diagnosis and treatment could improve pregnancy outcomes, tools for early identification of risk for GDM are not commonly used in practice. Existing models for predicting GDM risk within the first trimester of pregnancy based on maternal risk factors perform only modestly in the clinical setting. Heavy reliance on history of GDM to predict GDM development in the current pregnancy prevents these tools from being applicable to nulliparous women (i.e., women who have never given birth). In order to offer timely preventive intervention and enhanced antenatal care to nulliparous women, we need to be able to accurately identify those at high risk for GDM early in pregnancy. Data from the California Office of Statewide Health Planning and Development Linked Birth File was used to address three aims: 1) improve early pregnancy prediction of GDM risk in nulliparous women through development of a risk factor-based model, 2) conduct a systematic review and meta-analysis assessing the relationship between first trimester prenatal screening biomarker levels and development of GDM, and 3) determine if the addition of first and second trimester prenatal screening biomarkers to risk factor-based models will improve early prediction of GDM in nulliparous women. We developed a clinical prediction model including five well-established risk factors for GDM (race/ethnicity, age at delivery, pre-pregnancy body mass index, family history of diabetes, and pre-existing hypertension). Our model had moderate predictive performance among all nulliparous women, and performed particularly well among Hispanic and Black women when assessed within specific racial/ethnic groups. Our risk prediction model also showed superior performance over the commonly used American College of Obstetricians and Gynecologists (ACOG) screening guidelines, encouraging the prompt incorporation of this tool into preconception and prenatal care. Biomarkers commonly assessed in prenatal screening have been associated with a number of adverse perinatal and birth outcomes. However, reports on the relationship between first trimester measurements of prenatal screening biomarkers and GDM development are inconsistent. Our meta-analysis demonstrated that women who are diagnosed with GDM have lower first trimester multiple of the median (MoM) levels of both pregnancy associated plasma protein-A (PAPP-A) and free β-human chorionic gonadotropin (free β-hCG) than women who remain normoglycemic throughout pregnancy. Findings from our meta-analysis suggested that incorporation of prenatal screening biomarkers in clinical risk prediction models could aid in earlier identification of women at risk of developing GDM. Upon linkage of California Office of Statewide Health Planning and Development Linked Birth File and California Prenatal Screening Program records, we found that decreased levels of first trimester PAPP-A, increased second trimester unconjugated estriol, and increased second trimester dimeric inhibin A were associated with GDM development in nulliparous women. However, the addition of these biomarkers in clinical models did not offer improvements to the clinical utility (i.e., risk stratification) of models including maternal risk factors alone. Our findings demonstrate that incorporation of maternal risk factors in a clinical risk prediction model can more accurately identify nulliparous women at high risk for GDM early in pregnancy compared to current standard practice. The maternal characteristics model we developed is based on clinical history and demographic variables that are already routinely collected by clinicians in the United States so that it may be easily adapted into existing prenatal care practice and screening programs. Future work should focus on evaluating the clinical impact of model implementation on maternal and infant outcomes as well as financial costs to the health care system.

Cervical cancer is the single most common cancer in India, affecting an estimated 134,420 women in 2008. With access to early detection and basic treatments, most cases of cervical cancer are preventable. Moreover, if treatment is administered during the earliest stages of cervical cancer, 5-year survival rates can be increased to higher than 90 percent. Unfortunately, despite the availability of methods for prevention, more than 95 percent of women in India have never been screened for cervical cancer. Consequently, women in India are most often diagnosed during later stages of cervical cancer, significantly reducing survival prognosis. The objective of this study was to explore the role of awareness and knowledge of cervical cancer as a barrier to screening participation among urban women in Tamil Nadu; and further to identify the potential impact of increased cervical cancer awareness and knowledge on screening attitude. Quantitative and qualitative methods were used to characterize existing levels of awareness and knowledge of cervical cancer and screening among 207 women from the metropolitan area of Chennai. The results suggest that the majority of women (69.6%) were not aware of cervical cancer and very few (16.4%) were aware of screening. Demographically, women with secondary levels of education or higher were significantly more likely to have heard of cervical cancer and screening. Of the women that were aware of cervical cancer screening, most reported receiving information through television (33%) or a healthcare provider (28.6%). To describe the potential benefit of providing women with basic information about the secondary prevention of cervical cancer, levels of knowledge, measured before and after an educational session, were compared. This study further explored changes in associations between awareness, knowledge, perceived susceptibility, and screening attitude. It was observed that an overwhelming majority of women were receptive to participating in free cervical cancer screening, independent of previous knowledge of cervical cancer. Results also suggest that although lack of awareness appears to be a major barrier to participation in cervical cancer screening, providing women with information about cervical cancer has the potential to change the attitude of a significant proportion (58.3%) of women who were previously unreceptive to screening. Further, perceived susceptibility to cervical cancer appeared to be strongly associated with a positive screening attitude before and after receiving information. Finally, we examined and compared the socio-demographic characteristics of three subgroups of women: those who were receptive to screening without information, those who were receptive to screening after receiving information, and those who were not receptive to screening at either point. We found that younger, more educated women were receptive to screening without information. In addition, previously unscreened women who were less educated and illiterate in Tamil were most likely to acquire a positive attitude toward screening after receiving information. It also appeared that women who were most likely to be unreceptive to cost-free cervical cancer screening were more likely to be older and previously screened. These findings from our exploratory research with insights from additional comments made by several participants who were unreceptive to cost-free screening suggest that perceptions of free versus private healthcare may have influenced responses in this study.

Transkriptionsfaktoren (TF) sind wichtige Regulatoren der Genexpression. In Arabidopsis kodieren ca. 1500-2000 Gene für TF, von denen die Mehrheit bis heute nicht funktionell charakterisiert ist. Um die Aufklärung der TF-Funktionen weiter voranzutreiben, werden daher Analyse-Plattformen für Hochdurchsatzverfahren immer wichtiger. In den letzten Jahren sind umfangreiche Gateway® -kompatible ORF (open-reading-frame)-Kollektionen für Arabidopsis aufgebaut worden, die nun als nützliche Ressourcen für genetische Analysen zur Verfügung stehen. Auf Grundlage dieser Kollektionen wurde in dieser Arbeit eine neue Screening-Plattform etabliert, mit der trans-regulatorische Eigenschaften von TF in einem Hochdurchsatzverfahren untersucht werden können. Ein Mikrotiterplatten-System für Protoplastentransformationen erlaubt die transiente Koexpression von 96 verschiedenen TF-Expressionsvektoren mit einem Promotor:Luciferase-Reporter der Wahl. Das Transaktivierungspotential jedes einzelnen TF kann über die Luciferaseaktivität bestimmt werden, indem emittierte Lumineszenz in einem Luminometer detektiert wird. Die Funktionalität des PTA (Protoplast Trans Activation)-Systems wurde anhand einer Transaktivierungsstudie der bereits gut charakterisierten Promotoren von RD29A und PDF1.2 und der ERF (Ethylene Response Factor)-TF-Familie überprüft, wobei bekannte Bindungsspezifitäten der TF bestätigt werden konnten. Für das System wurde eine umfassende Arabidopsis TF-Kollektion aufgebaut. Ca. 950 verschiedene Gateway® -kompatible TF-Expressionsvektoren stehen für Screening-Ansätze zur Verfügung. Für das PTA-System wurden verschiedene Anwendungen etabliert. Neben transaktivierenden, konnten beispielsweise auch repressive Eigenschaften von TF bestimmt werden. Darüber hinaus wurde gezeigt, dass es möglich ist, (I) die Expression von Promotoren gezielt durch verschiedene Stimuli, wie Salz oder Pflanzenhormone zu modulieren, (II) Protein-Protein-Interaktionen zu bestimmen, sowie (III) den Einfluss von Signalmolekülen (wie z. B. Kinasen) auf ihre Aktivierungseigenschaften zu untersuchen. Das PTA-System wurde in verschiedenen Screening-Ansätzen zur Identifizierung transkriptioneller Regulatoren pflanzlicher Stressantworten eingesetzt. In einer Analyse des Auxin-induzierbaren GH3.3-Promotors wurde dabei gezeigt, dass weit mehr bZIP-TF Einfluss auf die Auxin-vermittelte GH3.3-Expression haben, als bisher angenommen. Beispielsweise zeigten bZIP16 und bZIP68 ein höheres Transaktivierungspotential, als die bisher beschriebenen bZIP-Regulatoren der GH3.3-Expression. In einem zweiten Ansatz wurde die koordinierte Regulation der Biosynthese von Tryptophan-abgeleiteten antimikrobiellen Sekundärmetaboliten (Indol-Glukosinolate, Camalexin) untersucht. Dabei konnten ERF-TF der phylogenetischen Gruppen VIII und IX als potentielle Regulatoren mehrerer wichtiger Gene der Biosynthesewege identifiziert werden. Mit einem zusätzlichen Screening-Ansatz der gesamten TF-Expressionsvektor-Kollektion und einem Markerpromotor des Camalexin-Biosynthesewegs wurden weitere potentielle Regulatoren identifiziert, von denen einige bereits in der Pathogenantwort beschrieben sind. In einem weiteren Schwerpunkt dieser Arbeit wurde die von Weiste et al. (2007) etablierte Arabidopsis thaliana TF-ORF-Überexpressions-Kollektion (AtTORF-EX) erweitert. Mit Hilfe des dafür entwickelten Hochdurchsatzverfahrens zur Generierung stabil transformierter Pflanzenlinien wurden neue Überexpressionssamen-Kollektionen hergestellt und anschließend in einem Screening-Ansatz auf erhöhte Toleranz gegenüber oxidativem Stress getestet, wobei die Chemikalie Paraquat als oxidativer Stress-Geber eingesetzt wurde. Die TF bZIP1 und OBP1 konnten dabei als Resistenz-vermittelnd identifiziert werden. Zusammenfassend wurden in dieser Arbeit mit Hilfe beider Systeme neue potentielle Regulatoren pflanzlicher Stressantworten identifiziert. / Transcription factors (TFs) are important cellular regulators of gene expression. In Arabidopsis approximately 1500-2000 genes encode for TFs. Until now, the majority of these genes has not been functionally characterized. To further promote the evaluation of TF function, high-throughput tools are required. In recent years, comprehensive Arabidopsis open reading frame (ORF) collections have been established, which are valuable resources for functional genomics. Based on these collections a high-throughput microtiter plate based Protoplast Trans Activation (PTA) system has been established to screen for TFs which regulate a given promoter:Luciferase construct in planta. 96 protoplast transfection experiments can be performed simultaneously in a standard microtiter plate. Transactivation of a promoter:Luciferase reporter is measured via luciferase imaging. A screening collection of roughly 950 TFs expression vectors has been assembled using Gateway® technology and can be tested in various screening approaches. In this respect, it is possible to analyze transactivating as well as repressive properties. Moreover (I) stimulus induced transcription, (II) studies of protein-protein interaction and (III) the impact of signaling molecules (e.g. kinases) on the promoters activation potential can be measured. To demonstrate the feasibility of the high-throughput system, the transactivating properties of the Ethylene Response Factor (ERF) TF family were studied in combination with the well-characterized RD29A and PDF1.2 promoters. By this means, known binding specificities of the TF family were confirmed. Furthermore, the PTA-System was applied to identify transcriptional regulators involved in plant stress responses. In one approach the influence of bZIP TFs on the auxin-inducibility of the GH3.3-promoter was studied. In particular, bZIP16 and bZIP68 showed a stronger transactivation potential than those bZIPs which were previously described to regulate this auxin-responsive promoter. In an independent approach the transcriptional regulation of tryptophan-derived antifungal compounds (indol-glycosinolates, camalexin) biosynthesis has been studied. ERF TFs of the groups VIII and IX were identified as potential regulators of several biosynthetic genes. A subsequent screening approach of a key promoter of the camalexin biosynthetic pathway disclosed further potential regulators. Among these TFs, many have been described previously in plant pathogen responses. As a second approach to examine TF function the Arabidopsis thaliana TF ORF-EXpression-library (AtTORF-EX) established by Weiste et al. (2007) was extended. The developed high-throughput transformation procedure was used to generate new TF overexpression seed collections. Afterwards the library was applied in a screening approach to identify regulators which mediate enhanced tolerance towards the oxidative stress inducing chemical Paraquat. Thus, the TFs bZIP1 and OBP1 were found to promote resistance against Paraquat when overexpressed in Arabidopsis. In summary, using both approaches novel putative regulators of plant stress response signaling were identfied.