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The goal of the present set of experiments was to examine whether a cue-based mechanism could account for how, and under what conditions, spatial information is tracked. In five experiments, reading times were measured for a target sentence that contradicted the earlier-described location of a protagonist. When the target sentence contained either one or two cues to earlier spatial information (Experiments 1a-1c), reading times were disrupted. When all cues were eliminated (Experiments 2a and 2b), reading time were disrupted only when readers were instructed to take the perspective of the protagonist. The combined results of all five experiments are consistent with a cue-based mechanism: Readers encode spatial information but do not update earlier-encoded spatial information except in response to specific text characteristics (i.e., cues to earlier spatial information) or task demands (e.g., an instruction to read from the perspective of the protagonist) that increase the accessibility of earlier-encoded spatial information.

Community-based participatory research (CBPR) initiatives such as the National Cancer Institute's Community Networks Program (CNP) (2005-2010) often emphasize training of junior investigators from underrepresented backgrounds to address health disparities. From July to October 2010, a convenience sample of 80 participants from the 25 CNP national sites completed our 45-item, web-based survey on the training and mentoring of junior investigators. This study assessed the academic productivity and CBPR-related experiences of the CNP junior investigators (n=37). Those from underrepresented backgrounds reported giving more presentations in non-academic settings (nine vs. four in the last 5 years, p=0.01), having more co-authored publications (eight vs. three in the last 5 years, p=0.01), and spending more time on CBPR-related activities than their non-underrepresented counterparts. Regardless of background, junior investigators shared similar levels of satisfaction with their mentors and CBPR experiences. This study provides support for the success of the CNP's training program, especially effort directed at underrepresented investigators.

The complexity of dementia care combined with the lack of care experience and external support systems creates unique burdens for the caregiver. This article describes the initial findings from the Scott & White Family Caregiver Program (FCP), the Resources for Enhancing Alzheimer's Caregiver Health (REACH II) intervention adapted for a healthcare setting. The FCP targeted one large hospital and one large ambulatory internal medicine primary care clinic within the Scott & White system. The 6-month program provided support and skills training tailored to the specific needs of caregivers based on their level of risk. At follow-up, the overall risk score, caregiver burden, and patient problem behaviors were significantly decreased and care recipient safety significantly increased. All caregivers reported that the information provided was helpful. This model successfully translated REACH II into an integrated healthcare setting and significantly reduced risks associated with dementia caregiving.

Background: In Bolivia, in 2008, the under-five mortality rate is 54 per 1000 live births. Diarrhea causes 15% of these deaths, and 40% of pediatric diarrhea-related hospitalizations are caused by rotavirus illness (RI). Rotavirus vaccination (RV), subsidized by international donors, is expected to reduce morbidity, mortality, and economic burden to the Bolivian state. Estimates of illness and economic burden of RI and their reduction by RV are essential to the Bolivian state's policies on RV program financing. The goal of this report is to estimate the economic burden of RI and the cost-effectiveness of the RV program., Methods: To assess treatment costs incurred by the healthcare system, we abstracted medical records from 287 inpatients and 6751 outpatients with acute diarrhea between 2005 and 2006 at 5 sentinel hospitals in 4 geographic regions. RI prevalence rates were estimated from 4 years of national hospital surveillance. We used a decision-analytic model to assess the potential cost-effectiveness of universal RV in Bolivia., Results: Our model estimates that, in a 5-year birth cohort, Bolivia will incur over US$3 million in direct medical costs due to RI. RV reduces, by at least 60%, outpatient visits, hospitalizations, deaths, and total direct medical costs associated with rotavirus diarrhea. Further, RV was cost-savings below a price of US$3.81 per dose and cost-effective below a price of US$194.10 per dose. Diarrheal mortality and hospitalization inputs were the most important drivers of rotavirus vaccine cost-effectiveness., Discussion: Our data will guide Bolivia's funding allocation for RV as international subsidies change., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: In the United States, and particularly in South Carolina, African-American women suffer disproportionately higher mortality rates from breast cancer than European-American women. The timeliness of patient adherence to the follow-up of mammographic abnormalities may influence prognosis and survival. The objective of the current investigation was to examine racial differences in the completion and completion time of a diagnostic workup after the finding of a suspicious breast abnormality., Methods: Study participants of the Best Chance Network, a statewide service program that provides free mammography screening to economically disadvantaged and medically underserved women, were included in the study. Racial differences in tumor characteristics and adherence to recommended workup were tested using chi-square tests and t tests. Logistic and Cox regression modeling was used to assess the relation between workup completion and other factors among African-American women and European-American women., Results: Completion of the workup was associated with the number of previous procedures and income, and no significant differences were noted by race. The amount of time to completion of the workup was influenced by previous procedures, income, and race. After accounting for completion time, African-American women were 12% less likely than European-American women to complete the recommended workup (hazard ratio, 0.88; P=.01)., Conclusions: The results from this study established a racial disparity in the time to completion of a diagnostic workup among Best Chance Network participants. These findings highlight the importance of understanding the factors associated with delays in and adherence to completing the recommended workup when breast abnormalities are detected in mammograms., (Copyright (c) 2009 American Cancer Society.)

Background: Nursing home (NH) placement among older adults is influenced by numerous factors and is associated with multiple problematic outcomes. Interventions to prevent or delay NH placement have mainly been researched in the community. However, prediction of these factors during hospitalization could provide an ideal opportunity to shape targeted interventions among high-risk patients. The purposes of this investigation were to compare characteristics of patients discharged to the community and those discharged to the NH, and to identify predictors of NH placement., Methods: A retrospective hospital-based cohort design was used to identify predictors of NH placement. Information about the study population was obtained from Scott and White (S&W) Healthcare's Electronic Medical Records and billing records. Study participants included S&W persons discharged to the community (n=5025) or to a nursing home (n=981). Descriptive characteristics were compared between community discharges and NH discharges using chi(2) statistic for categorical data and t test for continuous variables. Multiple logistic regression models were performed to identify the most salient predictors of NH placement., Results: Traditional risk factors, such as having less caregiving support, using more hospital services, being more severely ill, and not understanding their illness, characterized persons discharged to the NH compared with community-discharged persons. Significant predictors of being discharged to the NH included longer hospitalizations, not understanding one's illness, being female, living alone, not having a caregiver, needing assistance with dressing, and having a fall risk., Conclusion: In conclusion, these results could help develop hospital-based interventions to postpone or prevent NH placement among high-risk patients.

Caring for a family member with dementia is associated with unique stressors and burdens related to caregiving. Delivering interventions with proven efficacy to dementia caregivers remains a challenge because of the complexity of providing psychosocial support and skills training for caregivers within current models of formal healthcare services. This article focuses on implementation research and presents a dementia caregiver model program that merges an evidence-based intervention with a proven volunteer program, resulting in the implementation research program called Support Teams for Caregivers. In this article, we delineate our implementation model, describe the program, and present a case study.