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Like other insular religious movements such as Hutterites and Amish, Hasidic communities are faced with the challenge of preserving their distinctive ideals in a technologically advanced, capitalist world. Studies done in the 1960s and 1970s documented the success of Hasidim in safeguarding their convictions and creating well-functioning communities in contemporary North America. Recent evidence has demonstrated, however, that unprecedented growth rates are presenting significant challenges to Hasidim trying to sustain their way of life. Focusing on a case-study of the Hasidic community of Outremont, a residential neighbourhood in central Montreal, this paper outlines the social and economic challenges facing the community and argues that, while some important changes have been implemented, there is a need to modify survival strategies further in order to maintain community viability.

A study involving 1 urban site and 5 rural sites investigated the effectiveness of the Mustard Seed Project in training teachers to differentiate curricula for gifted students. The majority of the teachers (n=74) at each site made changes. Participants cited staff-development activities, leadership, mentoring, resources, and project support as extremely beneficial. (Contains references.) (Author/CR)

ABSTRACT/RESUME While documentation and discussion of out-marriage rates among heterosexual Jews is widespread, very little similar analysis exists for inter-group partnering patterns of gay Jews. Using both quantitative and qualitative [...]

The aim of this study was to determine whether X-ray fluorescence spectrometry (XRF) could be used to detect changes in hair zinc concentration in response to a modest daily increase in zinc from the consumption of zinc biofortified wheat flour. This study was conducted as part of an effectiveness trial (BiZiFED2) exploring the potential for zinc biofortified wheat to alleviate zinc deficiency in adolescent girls aged 10–16 years in Pakistan (trial registration ID ISRCTN17107812). A randomized controlled design was used. Participants received either control flour or zinc biofortified flour for 6 months. Consumption of biofortified flour resulted in an average daily increase in dietary zinc intake of 1.5 mg per day above that of the control flour. At baseline and at the end of the intervention, individual hair samples (control: n = 59, intervention: n = 64) were analyzed for zinc and sulfur content by XRF. Data were analyzed using linear mixed effects models to contrast between trial groups the changes from baseline to end point and also to compare baseline and end point values within each trial group. Increases from baseline to endpoint in both sulfur and zinc were significantly greater in the intervention group compared to control (sulfur counts. Control: baseline = 119.87 ± 20.33 and endpoint = 121.58 ± 23.58/intervention: baseline = 122.67 ± 24.19 and endpoint = 131.60 ± 21.34); (Zinc counts. Control: baseline = 50.88 ± 14.33 and endpoint = 54.82 ± 14.61/intervention: baseline = 49.61 ± 10.77 and endpoint = 58.79 ± 12.20). For these parameters, there were also significant increases from baseline to endpoint in the intervention group but not in control. Furthermore, for Zn:S count ratio there were no differences in terms of the magnitude of the change from baseline to endpoint in the control group, although significant increases from baseline to endpoint were evident in the intervention group (Zn:S count ratio. Control: baseline = 0.42 ± 0.10 and endpoint = 0.45 ± 0.08/intervention: baseline = 0.41 ± 0.08 and endpoint = 0.45 ± 0.08). A modest increase in dietary zinc over 6 months resulted in a detectable increase in both sulfur and zinc counts in individual hairs measured using XRF. This offers a sensitive, non-invasive method to monitor changes within subjects in response to dietary zinc interventions.

A reprint of the article "Professional Ethics and Polygraph Examiners," by Randal F. Mueller, which appeared in the 2002 issue of "Polygraph" is presented. It focuses on the professional ethics of polygraph examiners. It notes that polygraph is considered a discipline that is measured by integrity. It stresses the need for polygraph examiners to demonstrate the highest standards of integrity, truthfulness, honesty and fortitude.

The article discusses pain management as a leading emergency medical complaint and a priority for the emergency medical services (EMS) teams. The author states that the first step in the treatment of pain is understanding its pathophysiology. The EMS providers need to sympathize with the victims in their desire to be relieved from pain. The author mentions ways in assessing pain including checking on the physiological and behavioral signs and considering patients with communication difficulty. INSET: Pain Classification.

An outbreak of norovirus (NoV) genotype I and Enterotoxigenic Escherichia coli (ETEC) occurred among US Navy Ship personnel following a visit to Lima, Peru, in June 2008. Visiting a specific area in Lima was significantly associated with illness. While ETEC and NoV are commonly recognized as causative agents of outbreaks, co-circulation of both pathogens has been rarely observed in shipboard outbreaks.

Asian Americans have experienced compounding stressors during the pandemic as a result of racial discrimination. We aim of to investigate the prevalence of depression symptoms among Asian Americans before and during the COVID-19 pandemic and examine differences based on socio-demographic factors. Data are from a cross-sectional study (N = 636) among Chinese and South Asian adults in Chicago collected between February and May 2020. One cohort of participants were surveyed from each ethnic group before the pandemic and a second cohort of participants were surveyed during the pandemic. Depression symptoms increased more than two-fold, from 9% pre-pandemic to 21% during the COVID-19 pandemic. We found an increase in depression symptoms during the pandemic for South Asians, men and adults older than 30 years. These findings call for public health education that effectively addresses anti-Asian harassment and violence and ensure that culturally competent mental health services are provided to Asian Americans from diverse ethnic backgrounds., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Many evidence-based interventions (EBIs) found to be effective in research studies often fail to translate into meaningful patient outcomes in practice. The purpose of this study was to identify facilitators and barriers that affect the implementation of three EBIs to improve colorectal cancer (CRC) screening in an urban federally qualified health center (FQHC) and offer actionable recommendations to improve future implementation efforts., Methods: We conducted 16 semi-structured interviews guided by the Consolidation Framework for Implementation Research (CFIR) to describe diverse stakeholders' implementation experience. The interviews were conducted in the participant's clinic, audio-taped, and professionally transcribed for analysis., Results: We used the five CFIR domains and 39 constructs and subconstructs as a coding template to conduct a template analysis. Based on experiences with the implementation of three EBIs, stakeholders described barriers and facilitators related to the intervention characteristics, outer setting, and inner setting. Implementation barriers included (1) perceived burden and provider fatigue with EHR (Electronic Health Record) provider reminders, (2) unreliable and ineffectual EHR provider reminders, (3) challenges to providing health care services to diverse patient populations, (4) lack of awareness about CRC screening among patients, (5) absence of CRC screening goals, (6) poor communication on goals and performance, and (7) absence of printed materials for frontline implementers to educate patients. Implementation facilitators included (1) quarterly provider assessment and feedback reports provided real-time data to motivate change, (2) integration with workflow processes, (3) pressure from funding requirement to report quality measures, (4) peer pressure to achieve high performance, and (5) a culture of teamwork and patient-centered mentality., Conclusions: The CFIR can be used to conduct a post-implementation formative evaluation to identify barriers and facilitators that influenced the implementation. Furthermore, the CFIR can provide a template to organize research data and synthesize findings. With its clear terminology and meta-theoretical framework, the CFIR has the potential to promote knowledge-building for implementation. By identifying the contextual determinants, we can then determine implementation strategies to facilitate adoption and move EBIs to daily practice.

Background: Screening for colorectal cancer (CRC) not only detects disease early when treatment is more effective but also prevents cancer by finding and removing precancerous polyps. Because many of our nation's most disadvantaged and vulnerable individuals obtain health care at federally qualified health centers, these centers play a significant role in increasing CRC screening among the most vulnerable populations. Furthermore, the full benefits of cancer screenings must include timely and appropriate follow-up of abnormal results. Thus, the purpose of this study is to implement a multilevel intervention to increase rates of CRC screening, follow-up, and referral-to-care in federally qualified health centers, as well as simultaneously to observe and to gather information on the implementation process to improve the adoption, implementation, and sustainment of the intervention. The multilevel intervention will target three different levels of influences: organization, provider, and individual. It will have multiple components, including provider and staff education, provider reminder, provider assessment and feedback, patient reminder, and patient navigation., Methods: This study is a multilevel, three-phase, stepped wedge cluster randomized trial with four clusters of clinics from four different FQHC systems. In the first phase, there will be a 3-month waiting period during which no intervention components will be implemented. After the 3-month waiting period, we will randomize two clusters to cross from the control to the intervention and the remaining two clusters to follow 3 months later. All clusters will stay at the same phase for 9 months, followed by a 3-month transition period, and then cross over to the next phase., Discussion: There is a pressing need to reduce disparities in CRC outcomes, especially among racial/ethnic minority populations and among populations who live in poverty. Single-level interventions are often insufficient to lead to sustainable changes. Multilevel interventions, which target two or more levels of changes, are needed to address multilevel contextual influences simultaneously. Multilevel interventions with multiple components will affect not only the desired outcomes but also each other. How to take advantage of multilevel interventions and how to implement such interventions and evaluate their effectiveness are the ultimate goals of this study., Trial Registration: This protocol is registered at clinicaltrials.gov ( NCT04514341 ) on 14 August 2020.

Background: This report details the cost effectiveness of a non-nurse patient navigation (PN) program that was implemented at the University of Chicago Medical Center to increase colonoscopy-based colorectal cancer (CRC) screening., Methods: The authors investigated the impact of the PN intervention by collecting process measures. Individuals who received navigation were compared with a historic cohort of non-navigated patients. In addition, a previously validated data-collection instrument was tailored and used to collect all costs related to developing, implementing, and administering the program; and the incremental cost per patient successfully navigated (the cost of the intervention divided by the change in the number who complete screening) was calculated., Results: The screening colonoscopy completion rate was 85.1% among those who were selected to receive PN compared with 74.3% when no navigation was implemented. With navigation, the proportion of no-shows was 8.2% compared with 15.4% of a historic cohort of non-navigated patients. Because the perceived risk of noncompletion was greater among those who received PN (previous no-show or cancellation, poor bowel preparation) than that in the historic cohort, a scenario analysis was performed. Assuming no-show rates between 0% and 50% and using a navigated rate of 85%, the total incremental program cost per patient successfully navigated ranged from $148 to $359, whereas the incremental intervention-only implementation cost ranged from $88 to $215., Conclusions: The current findings indicate that non-nurse PN can increase colonoscopy completion, and this can be achieved at a minimal incremental cost for an insured population at an urban academic medical center., (© 2018 American Cancer Society.)

Objective: The Chicago south side, even more so than national populations, continues to be burdened with widening gaps of disparities in cancer outcomes. Therefore, Chicago community members were engaged in addressing the following content areas for a cancer disparities curriculum: (1) the south side Chicago community interest in participating in curriculum design, (2) how community members should be involved in designing cancer disparities curriculum, and (3) what community members believe the curriculum should address to positively impact their community., Methods: Eighty-six community members from 19 different zip code areas of Chicago attended the deliberative session. A survey composed of three quantitative and three short-answer content questions was analyzed., Results: The majority of participants were from the south side of Chicago (62 %) and females (86 %). Most, 94 %, believed community members should be involved in cancer disparities curriculum development. Moreover, 56 % wanted to be involved in designing the curriculum, and 61 % reported an interest in taking a course in cancer disparities. Three categorical themes were derived from the qualitative questions: (1) community empowerment through disparities education-"a prescription for change," (2) student skill development in community engagement and advocacy training, and (3) community expression of shared experiences in cancer health disparities., Conclusion: The community provided valuable input for curricular content and has an interest in collaborating on cancer disparities curriculum design. Community participation must be galvanized to improve disparities curricular development and delivery to successfully address the challenges of eliminating disparities in health.

Background and Objectives: Uninsured patients without a primary care home tend to use the emergency department (ED) for primary care. We examined whether an enhanced scheduling system for follow-up care from the University of New Mexico Hospital Emergency Department (UNMH-ED) that assigns patients to a family medicine home can decrease ED utilization., Methods: The Community Access Program for Central New Mexico (CAP-NM) is a consortium of primary care safety net provider organizations. CAP-NM developed a HIPAA-compliant (Health Insurance Portability and Accountability Act), Web-based information system used by the UNMH-ED to refer uninsured, unassigned patients to family medicine practices ("homes") within the consortium. The Web site referral system operated 24 hours a day, 7 days a week; printed maps to clinic sites; and listed services offered. Analysis of quality assurance data compared (1) ED utilization outcomes of eligible patients referred by the CAP-NM Web site to a family medicine home to (2) outcomes of controls discharged from the ED in the usual manner., Results: The 756 patients referred to family medicine homes through the CAP-NM Web site demonstrated a significant 31% reduction in subsequent ED visits compared to controls. This reduction was most evident among those who had infrequent ED use before institution of the program., Conclusions: Implementing an enhanced referral system to family medicine homes from the ED is associated with decreased subsequent ED utilization by uninsured patients.

Nosebleeds from a break and/or obstructon can result in life-threatening problems. The nose is the airway opening that warms, humidifies and filters air. Control epistaxis with well-aimed direct pressure for 10-15 minutes. Nasal fractures, which are the most common facial fracture, can be the outward sign of skull fracture, brain injury or c-spine impairment, and may pose a threat to the airway and breathing. The greatest concern of a nose obstruction is aspiration.

To summarize: The best fetal protection is proper maternal use of seat belt restraints. All pregnant occupants in a motor vehicle crash require physician evaluation. Focus on maternal assessment. Maternal stability is the best indicator of fetal stability. Key treatments are high-flow oxygen, i.v. fluid loading and immobilizing in left lateral position. Evaluate the fetus after maternal stabilization.