Lung cancer is the most common cause of cancer-related deaths in the United States. Prevention and early detection of lung cancer are imperative in decreasing lung cancer mortality. Screening for lung cancer with low-dose computed tomography (LDCT) decreases lung cancer by 20%. Several organizations introduced lung cancer screening (LCS) guidelines in 2013, including Centers for Medicare and Medicaid (CMS) and the United States Preventive Services Task Force. However, LCS participation for eligible patients remains low, due in part to the complexity of the LCS process. The goal of this practice improvement project was to increase the knowledge of rural primary care providers regarding LCS guidelines and the related CMS requirements and to increase their confidence in initiating shared decision-making (SDM) discussions. An educational intervention consisting of a LCS educational session and a toolkit was implemented in two rural clinics. Providers at both clinics reported a benefit to the educational intervention. Pre-, immediate post-, and two-month post-education surveys were collected to evaluate the impact of the educational intervention, including provider knowledge of LCS guidelines and CMS requirements, and confidence in SDM. Project results demonstrated an increased knowledge of LCS guidelines and CMS requirements with the greatest knowledge at immediate post-education and a high level of knowledge remaining at two months post-education. A small, nonsignificant, increase in provider confidence in initiating SDM discussions occurred. At both clinics, data collected through chart audit demonstrated an improvement in documentation needed to determine LCS eligibility and increased the percentage of patients identified at high risk for lung cancer and thus, eligible for LCS. At one clinic these changes were significant. The data were further examined for SDM discussions and referrals for LDCT or to specialist for LCS with one clinic increasing SDM documentation and LDCT referrals post-education. In conclusion, although further research is needed in implementation processes of LCS, specifically in consistent documentation to improve determination of LCS eligibility of patients, this practice improvement project found education increased provider knowledge and ability to complete requirements needed to improve LDCT screenings for lung cancer.

Introduction: Although colorectal cancer (CRC) is the second leading cause of cancer-related deaths among men and women combined in the United States, only 61% of eligible adults are up-to-date with current screening recommendations. Effective screening is hindered by numerous barriers and underutilization of evidence-based interventions. The purpose of this clinical dissertation project was to increase CRC screening in the rural community of Elgin, North Dakota, determine the efficacy of providing targeted educational handouts and endorsement letters, and to identify screening barriers and facilitators. Methods: Educational handouts and screening endorsement letters were developed and distributed to 75 average risk patients (without personal or family history of CRC or certain types of polyps, personal history of inflammatory bowel disease, personal history of receiving radiation to the abdomen or pelvic region, and confirmed or suspected hereditary CRC syndrome). Additional handouts were placed around the community of Elgin. Patients who presented for CRC screening were sent a questionnaire to determine the impact of the interventions. These 75 patients were also contacted via telephone and completed a questionnaire to identify barriers and facilitators and to highlight the effectiveness of the educational handout and the endorsement letter. Results: Five patients contacted the clinic to receive CRC screening. Ninety-seven percent of patients who recalled receiving the endorsement letter and educational handout (n=32) found the material to be informative, 91% of patients appreciated being contacted on behalf of the clinic, and 59% found the handwritten signature on the endorsement letter to be influential. Fifty-one patients identified screening barriers including (in descending order) lack of awareness/knowledge, cost, unpleasant previous experience, embarrassment, lack of motivation, and fear of abnormal findings. Forty-one patients identified screening facilitators including (in descending order) recommending during office visits, providing education on different screening options, sending letter reminders, calling patients, utilizing social media, and sending email reminders. Conclusion: The clinical dissertation project increased CRC screening compliance in Elgin, ND, identified barriers, and highlighted screening facilitators that can be utilized. Future projects should focus efforts on alleviating these barriers via targeted patient education and provider recommendation in order to decrease CRC morbidity and mortality.

Cellulolytic microorganisms are considered to be key players in biorefinery, especially for the utilization of plant biomass. These organisms have been isolated from various environments. The Red Sea is one of the seas with high biodiversity and a unique environment, characterized by high water temperature and high salinity . However, there is little information regarding cellulases in Red Sea environments. The aim of the present study is to evaluate the Red Sea as a gene resource for microbial cellulase. I first surveyed microbial cellulases in the Red Sea using a method called metagenomes, and then investigated their abundance and diversity. My survey revealed that the Red Sea biome has a substantial abundance and a wide range of cellulase enzymes with substantial abundance, when compared with those in other environments. Next, I tried to isolate cellulase-active microorganisms from the Red Sea and I successfully obtained seven strains of four different taxonomic groups. These strains showed a similarity of 99% identity to Aspergillus ustus, 99% to Staphylococcus pasteuri, 99% to Bacillus aerius and 99% to Bacillus subtilis. The enzyme assay I conducted, revealed that these strains actually secreted active cellulases. These results suggest that the Red Sea environment can be, indeed, an excellent gene resource of microbial cellulases.

The purpose of this study was to examine how recruitment and selection processes are conducted at the Robben Island Museum and the challenges associated with it. Correct implementation of the recruitment and selection practices is crucial in order for the organisation to fill the right positions with the right people who are experienced and competent. In other words, organisations should strive for excellence in ensuring that there is conformity to legal prescripts whenever the recruitment and selection of employees commence. A qualitative research design was applied in order to achieve the primary aim of this study. Data collection techniques that were utilised to collect information comprised interviews and document analysis. A group of fourteen (14) purposively selected participants, namely seven operational staff members and seven managers were chosen for interviews. Data that was obtained was analysed through qualitative content analysis. The major findings of the study indicate that the Robben Island Museum recruits potential candidates through various means such as newspaper advertisements, employment agencies, headhunting, job posting and online recruitment. The study found that although qualifications are seen to be necessary during the recruitment and selection processes but do not seem to be seriously considered as part of the selection criteria. Essentially, the study identified some inconsistencies and failure to adhere to the recruitment and selection policy during recruitment and selection processes. Therefore, the processes of recruiting and selecting potential employment candidates should be undertaken in accordance with organisational policies and in a professional manner. / Public Administration and Management

Well-Child Examinations are an integral part of monitoring growth and development for children. These visits allow for establishment of a therapeutic relationship between patient and caregiver, and provide opportunities to screen for underlying conditions while simultaneously following growth and development milestones. Well-child examinations provide opportunities for parents to voice concerns and help to identify those children at risk for delays or underlying medical conditions. When these conditions are identified early, they tend to have an improvement of outcomes. Since the core items to be included in wellness examinations vary by age, insurance provider, and risk factors, our aim is to measure and improve the knowledge and comprehension of examination components among a group of Family Medicine resident physicians that provide primary care to a pediatric population. Provider knowledge and understanding was measured by means of a set of multiple-choice questions prior to an educational session. A post-educational examination was then administered to assess recruitment and retention of information. There appeared to be an overall positive trend toward increased knowledge base following the education session, indicating and improvement of understanding and medical knowledge.

Millions of men, as a result of the natural aging process, injury, illness, and medical therapies, experience a decline in testosterone levels that necessitate a need for testosterone supplementation therapy (TST). The signs and symptoms of testosterone decline may occur gradually, and low testosterone levels may be misdiagnosed as other medical conditions. Over the past two decades, there has been an increase in testing of testosterone levels and the use of TST. With so many men now on TST, it is essential for health care professionals to know the signs and symptoms, the causes of testosterone decline, how testosterone deficiency is diagnosed, what pathological changes are associated with testosterone decline, and the benefits and risks of TST. In addition, health care providers need to be aware of the various forms of testosterone available as well as the advantages and disadvantages of each. This article provides a brief overview of testosterone deficiency, TST treatment options and guidelines, and the risks and benefits associated with of TST.

TITLE: Racial disparities associated with colon cancer screening in a nationally representative sample; A cross-sectional study AUTHOR INFO Yorandos Tafesse MD1 Manik Ahuja PhD, MA1 Author Affiliations: 1College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States Colon cancer impacts nearly 2 million individuals in the U.S. each year. Early detection of colon cancer using colonoscopy can reduce the risk of mortality. The United States Preventive Services Task Force (USPSTF) recommends routine screening for colon cancer for all adults 50 to 75 years of age. Colon cancer screening behavior is different across a variety of predictor variables. Previous studies have identified older age, male gender, higher education, higher income, marriage, and the presence of chronic diseases to be associated with increased odds of colon cancer screening. However, less is known about the role of racial differences in screening. This study aims to determine if colon cancer screening rates are different between Whites and racial minorities in the United States controlling for potential confounders. This research can help bridge the existing gap on this topic and aid in identifying high-risk racial groups that could be targeted by future intervention strategies. We used cross-sectional data from the 2019 Behavioral Risk Factor Surveillance System, a nationally representative U.S. telephone-based survey of adults aged 18 years or older. We extracted data for adults age 50 or older (n=10,972). Logistic regression analyses were conducted to test the association between race and colon cancer screening. We also included chronic disease status, alcohol use, smoking, gender, and age in our model. Chronic disease status was coded as self-report 2 or more, 1 and 0 chronic diseases (referent), which included the summation of heart disease, hypertension, COPD, and diabetes. Overall, colon cancer screening is as follows among Whites (77.2%), Blacks (72.4%), Asian (60.1%), American Indian/Alaska Native (69.7%), and Hispanic (68.6%). Logistic regression results revealed that having 2 or more chronic diseases (OR=1.73; 95% CI 1.53,1.96), 1 chronic disease (OR=1.45; 95% CI 1.31,1.65), and female gender (OR=1.14; 95% CI 1.04,1.23) were associated with higher odds of screening. Race/ethnic minority status (OR=0.72; 95% CI 0.65, 0.81), low income (OR=0.64; 95% CI 0.57,0.70), and less than high school education (OR=0.71; 95% CI 0.59,0.84) were associated with lower odds of screening. Our research showed that racial minorities have lower odds of colon cancer screening after adjusting for gender, age, chronic diseases, income, and education status. Preventive practices should focus on increasing awareness on and availability of colon cancer screening means to racial minorities in the United States. Further research on the association between race and other screening modalities will help maximize the impacts of targeted interventions.

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Osteoporosis, the most common human bone disease, affects 8 million American women and has significant morbidity and mortality. Screening is important in older women and younger postmenopausal women with additional risk factors for osteoporosis/fracture. Preventive measures include avoiding smoking, excessive alcohol/caffeine intake, and falls in addition to maintaining adequate calcium/vitamin D intake and exercise. Estrogen/hormone therapy may be considered in some patients. Various medications have proven efficacy in treating postmenopausal osteoporosis; however, potential adverse effects such as hypocalcemia, worsening of renal impairment, and osteonecrosis of the jaw must be considered. The optimal duration of therapy requires further investigation.

Osteoporosis, the most common human bone disease, affects 8 million American women and has significant morbidity and mortality. Screening is important in older women and younger postmenopausal women with additional risk factors for osteoporosis/fracture. Preventive measures include avoiding smoking, excessive alcohol/caffeine intake, and falls in addition to maintaining adequate calcium/vitamin D intake and exercise. Estrogen/hormone therapy may be considered in some patients. Various medications have proven efficacy in treating postmenopausal osteoporosis; however, potential adverse effects such as hypocalcemia, worsening of renal impairment, and osteonecrosis of the jaw must be considered. The optimal duration of therapy requires further investigation.