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A data-collection tool developed to document health promotion services and describe program participants was used by 7 community-based nursing centers for 12 months. Data analysis results found that a wide range of services were offered to target populations across the life span, with adults aged 60 and older being the largest group of program users. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance was estimated to be associated with 4.95 million deaths worldwide in 2019. It is possible to frame the antimicrobial resistance problem as a feedback-control problem. If we could optimize this feedback-control problem and translate our findings to the clinic, we could slow, prevent, or reverse the development of high-level drug resistance. Prior work on this topic has relied on systems where the exact dynamics and parameters were known a priori. In this study, we extend this work using a reinforcement learning (RL) approach capable of learning effective drug cycling policies in a system defined by empirically measured fitness landscapes. Crucially, we show that it is possible to learn effective drug cycling policies despite the problems of noisy, limited, or delayed measurement. Given access to a panel of 15 [Formula: see text]-lactam antibiotics with which to treat the simulated Escherichia coli population, we demonstrate that RL agents outperform two naive treatment paradigms at minimizing the population fitness over time. We also show that RL agents approach the performance of the optimal drug cycling policy. Even when stochastic noise is introduced to the measurements of population fitness, we show that RL agents are capable of maintaining evolving populations at lower growth rates compared to controls. We further tested our approach in arbitrary fitness landscapes of up to 1,024 genotypes. We show that minimization of population fitness using drug cycles is not limited by increasing genome size. Our work represents a proof-of-concept for using AI to control complex evolutionary processes., Competing Interests: Competing interests statement:The authors declare no competing interest.

Repetitive transcranial magnetic stimulation (rTMS) has become an increasingly popular tool to modulate neural excitability and induce neural plasticity in clinical and preclinical models; however, the physiological mechanisms in which it exerts these effects remain largely unknown. To date, studies have primarily focused on characterizing rTMS-induced changes occurring at the synapse, with little attention given to changes in intrinsic membrane properties. However, accumulating evidence suggests that rTMS may induce its effects, in part, via intrinsic plasticity mechanisms, suggesting a new and potentially complementary understanding of how rTMS alters neural excitability and neural plasticity. In this review, we provide an overview of several intrinsic plasticity mechanisms before reviewing the evidence for rTMS-induced intrinsic plasticity. In addition, we discuss a select number of neurological conditions where rTMS-induced intrinsic plasticity has therapeutic potential before speculating on the temporal relationship between rTMS-induced intrinsic and synaptic plasticity., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Mutant selection windows (MSWs), the range of drug concentrations that select for drug-resistant mutants, have long been used as a model for predicting drug resistance and designing optimal dosing strategies in infectious disease. The canonical MSW model offers comparisons between two subtypes at a time: drug-sensitive and drug-resistant. In contrast, the fitness landscape model with N alleles, which maps genotype to fitness, allows comparisons between N genotypes simultaneously, but does not encode continuous drug response data. In clinical settings, there may be a wide range of drug concentrations selecting for a variety of genotypes in both cancer and infectious diseases. Therefore, there is a need for a more robust model of the pathogen response to therapy to predict resistance and design new therapeutic approaches. Fitness seascapes, which model genotype-by-environment interactions, permit multiple MSW comparisons simultaneously by encoding genotype-specific dose-response data. By comparing dose-response curves, one can visualize the range of drug concentrations where one genotype is selected over another. In this work, we show how N-allele fitness seascapes allow for N * 2N-1 unique MSW comparisons. In spatial drug diffusion models, we demonstrate how fitness seascapes reveal spatially heterogeneous MSWs, extending the MSW model to more fully reflect the selection of drug resistant genotypes. Furthermore, using synthetic data and empirical dose-response data in cancer, we find that the spatial structure of MSWs shapes the evolution of drug resistance in an agent-based model. By simulating a tumor treated with cyclic drug therapy, we find that mutant selection windows introduced by drug diffusion promote the proliferation of drug resistant cells. Our work highlights the importance and utility of considering dose-dependent fitness seascapes in evolutionary medicine., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 King et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Static magnetic stimulation (SMS) is a form of non-invasive brain stimulation that alters neural activity and induces neural plasticity that outlasts the period of stimulation. This can modify corticospinal excitability or motor behaviours, suggesting that SMS may alter the intrinsic excitability of neurons. In mammalian neurons, the axon initial segment (AIS) is the site of action potential initiation and undergoes structural plasticity (changes in length and position from the soma) as a homeostatic mechanism to counteract chronic changes in neuronal activity. We investigated whether the chronic application of SMS (6 and 48 h, 0.5 T) induces structural AIS plasticity in postnatally derived primary cortical neurons. Following 6 h of SMS, we observed a shortening in mean AIS length compared to control, that persisted 24 h post stimulation. In contrast, 48 h of SMS induced an immediate distal shift that persisted 24 h post-stimulation. Pharmacological blockade of voltage gated L/T-type calcium channels during stimulation did not prevent SMS-induced AIS structural plasticity. Our findings provide the foundation to expand the use of chronic SMS as a non-invasive method to promote AIS plasticity., (© 2024. The Author(s).)

Personal protective equipment (PPE) is crucially important to the safety of both patients and medical personnel, particularly in the event of an infectious pandemic. As the incidence of Coronavirus Disease 2019 (COVID-19) increases exponentially in the United States and many parts of the world, healthcare provider demand for these necessities is currently outpacing supply. In the midst of the current pandemic, there has been a concerted effort to identify viable ways to conserve PPE, including decontamination after use. In this study, we outline a procedure by which PPE may be decontaminated using ultraviolet (UV) radiation in biosafety cabinets (BSCs), a common element of many academic, public health, and hospital laboratories. According to the literature, effective decontamination of N95 respirator masks or surgical masks requires UV-C doses of greater than 1 Jcm-2, which was achieved after 4.3 hours per side when placing the N95 at the bottom of the BSCs tested in this study. We then demonstrated complete inactivation of the human coronavirus NL63 on N95 mask material after 15 minutes of UV-C exposure at 61 cm (232 μWcm-2). Our results provide support to healthcare organizations looking for methods to extend their reserves of PPE., Competing Interests: JGS, the senior author, has, subsequent to this research, led a related patent for a UV decontamination device (PCT/US2021/022771, led march 17, 2021: \Decontam-ination System"). This does not alter our adherence to all PLOS ONE policies on sharing data and materials, and in fact, the patent was a reaction to this work, and so therefore was entirely performed subsequently to this research. Further, beyond the fact that the patent is for a UV-C decontamination chamber, it has little to do with this research.

Background: Filtering facepiece respirators (FFR) are critical for protecting essential personnel and limiting the spread of disease. Due to the current COVID-19 pandemic, FFR supplies are dwindling in many health systems, necessitating re-use of potentially contaminated FFR. Multiple decontamination solutions have been developed to meet this pressing need, including systems designed for bulk decontamination of FFR using vaporous hydrogen peroxide or ultraviolet-C (UV-C) radiation. However, the large scale on which these devices operate may not be logistically practical for small or rural health care settings or for ad hoc use at points-of-care., Methods: Here, we present the Synchronous UV Decontamination System, a novel device for rapidly deployable, point-of-care decontamination using UV-C germicidal irradiation. We designed a compact, easy-to-use device capable of delivering over 2 J cm2 of UV-C radiation in one minute., Results: We experimentally tested Synchronous UV Decontamination System' microbicidal capacity and found that it eliminates near all virus from the surface of tested FFRs, with less efficacy against pathogens embedded in the inner layers of the masks., Conclusions: This short decontamination time should enable care-providers to incorporate decontamination of FFR into a normal donning and doffing routine following patient encounters., (Copyright © 2020 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Community-based educational programs can complement clinical strategies to increase cancer screenings and encourage healthier lifestyles to reduce cancer burden. However, implementation quality can influence program outcomes and is rarely formally evaluated in community settings. This mixed-methods study aimed to characterize implementation of a community-based cancer prevention program using the Consolidated Framework for Implementation Research (CFIR), determine if implementation was related to participant outcomes, and identify barriers and facilitators to implementation that could be addressed., Methods: This study utilized quantitative participant evaluation data (n = 115) and quantitative and qualitative data from semi-structured interviews with program instructors (N = 13). At the participant level, demographic data (age, sex, insurance status) and behavior change intention were captured. Instructor data included implementation of program components and program attendance to create a 7-point implementation score of fidelity and reach variables. Degree of program implementation (high and low) was operationalized based on these variables (low: 0-4, high: 5-7). Relationships among degree of implementation, participant demographics, and participant outcomes (e.g., intent to be physically active or limit alcohol) were assessed using linear or ordinal logistic mixed effects models as appropriate. Interview data were transcribed and coded deductively for CFIR constructs, and constructs were then rated for magnitude and valence. Patterns between ratings of high and low implementation programs were used to determine constructs that manifested as barriers or facilitators., Results: Program implementation varied with scores ranging from 4 to 7. High implementation was related to greater improvements in intention to be physically active (p <  0.05), achieve a healthy weight (p <  0.05), and limit alcohol (p <  0.01). Eight constructs distinguished between high and low implementation programs. Design quality and packaging, compatibility, external change agents, access to knowledge and information, and experience were facilitators of implementation and formally appointed internal implementation leaders was a barrier to implementation., Conclusions: As higher implementation was related to improved participant outcomes, program administrators should emphasize the importance of fidelity in training for program instructors. The CFIR can be used to identify barriers and/or facilitators to implementation in community interventions, but results may be unique from clinical contexts.

This study describes the sensory composition of commercial sweet almond varieties across two California growing seasons. It also discusses the relationship between sensory attributes and chemical and physical measures. Raw, whole almonds (43 samples each of 13 varieties in 2015 and 40 samples each of 10 varieties in 2016) were evaluated for their sensory profiles using descriptive sensory analysis. The 2016 samples were also analyzed for macro- and micronutrients, amygdalin, volatile composition (using gas chromatography-mass spectrometry), and physical properties, and the results were modeled with the sensory data. Independence, Sonora, and Wood Colony were harder, more fracturable, and crunchy, whereas Fritz and Monterey were more moist and chewy, reflecting their moisture contents. Aldrich and Fritz were higher in marzipan/benzaldehyde flavor, which is related to amygdalin, benzaldehyde, phenylethyl alcohol, and benzyl alcohol. New insights are provided into sweet-almond composition and the sensorial contribution of headspace volatiles. This assists almond growers and processors in describing and marketing almond varieties.

Monitoring oxidative flavor changes in almonds is possible only if the chemical and sensory profile during roasting and storage is first established. Herein, almonds roasted at two different temperatures (115 and 152 °C) were stored at 39 °C for 0 to 12 months and were analyzed by headspace solid-phase microextraction gas chromatography-mass spectrometry, descriptive analysis, and consumer hedonic analysis. Volatile profiles, descriptive sensory profiles, and consumer hedonic scores were analyzed for predictive relationships. Descriptive attributes involving Roasted and Nutty as well as consumer liking were highest in fresh almonds, while flavors typically associated with oxidative rancidity such as Cardboard, Painty/Solvent, Soapy, and Total Oxidized increased during storage. Compounds most important for predicting rancidity-related attributes were lipid oxidation products, including pentanal, hexanal, heptanal, and octanal. Consumer liking was best predicted by similar compounds to those predicting Clean Nutty flavor, including Maillard reaction products such as 2- and 3-methylbutanal, 2-methylpyrazine, and 2,5-dimethylpyrazine.

In almonds, there is no standard method for detecting oxidative changes and little data correlating consumer perception with chemical markers of rancidity. To address this, we measured peroxide values (PV), free fatty acid values (FFAs), conjugated dienes, tocopherols, headspace volatiles, and consumer hedonic response in light roasted (LR) and dark roasted (DR) almonds stored under conditions that promote rancidity development over 12 months. Results demonstrate that, although rancidity develops at different rates in LR and DR almonds, consumer liking was not significantly different between LR and DR almonds. Average hedonic ratings of almonds were found to fall below a designated acceptable score of 5 ("neither like nor dislike") by 6 months of storage. This did not correspond with recommended industry rejection standard of PV < 5 mequiv peroxide/kg oil and FFA < 1.5% oleic. FFAs remain well below <1.5% oleic during storage, indicating that FFAs are not a good marker of rancidity in roasted almonds stored in low humidity environments. Regression of consumer liking to concentration of rancidity indicators revealed that selected headspace volatiles, including heptanal, octanal, nonanal, 2-octenal, 2-heptanone, 2-pentylfuran, hexanal, and pentanal, had a better correlation with liking than did nonvolatile indicators.

The impact of micro-oxygenation (MOX) in conjunction with a variety of oak alternatives on phenolic composition and red wine aging was investigated and compared with traditional barrel aging. Although several studies concluded that MOX give similar results to barrel aging, few have compared them directly and none directly compared MOX with and without wood alternatives and barrel aging. Results confirmed that MOX had a positive effect on colour density, even after 5 months of bottle aging. This is supported by an increase in polymeric phenol and pigment content not only with aging but in the MOX compared to barrel matured wine treatments. Descriptive analysis showed that MOX in combination with wood alternatives such as oak chips and staves could mimic short term (six months) barrel aging in new American and French oak barrels in regards to sensory characteristics., (Published by Elsevier Ltd.)

Rationale, Aims and Objectives: Declining capacity to function safely and independently in the community is a manifestation of ageing. Multiple measures are used to define and predict functional decline. This paper explores the use of partial least squares (PLS) analysis to understand the interaction between overtime measures of functional decline., Methods: Comprehensive information was captured on individuals aged 65+ who presented at a large metropolitan Australian hospital Emergency Department (ED) for a complaint, which did not result in a hospital admission. They were followed-up by telephone 1 and 3 months, post-ED discharge. Information was collected each time on home situations (living alone, using community services, using a gait aid and having a formal carer), recent falls, hospitalizations and instrumental activities of daily living (IADLs). PLS analysis was applied to identify overtime relationships between measures., Results: Valid information was provided by 147 individuals at all three time points. The eight individual IADL items clustered clearly around physical, mental or combined mental and physical IADLs. These clusters were strongly related to increased use of community supports, gait aid and carer, and living alone. The relationship was less convincingly for hospitalizations, and falls were not explained well., Conclusion: PLS analysis offers a novel and comprehensive way of analysing complex health data, which allows sense to be made of relationships over a 3-month period. This analysis provides a better understanding of declining function over time, than could be provided by current health modelling methods., (© 2014 John Wiley & Sons, Ltd.)

Malbec grapes are widely grown and studied in Argentina, whereas the smaller production in California is less well known. This study sought to define and compare Malbec wine compositions from various regions in Mendoza, Argentina and California, USA. The Malbec wines were clearly separated, based on their chemical and sensory profiles, by wine region and country. Descriptors of Malbec wines were aromas of cooked vegetal, earthy, soy and volatile acidity, as well as acidic taste and astringent mouthfeel, regardless of the region of origin. Malbec wines from Mendoza generally had more ripe fruit, sweetness, and higher alcohol levels, while the Californian Malbec wines had more artificial fruit and citrus aromas, and bitter taste. Compositional differences between the two countries were related more to altitude than precipitation and growing degree days. To our knowledge, this is the first time that an extensive regionality study has been attempted for Malbec wines., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

A trained sensory panel evaluated the 6 fig cultivars currently sold in the California dried fig market. The main flavor and aroma attributes determined by the sensory panel were "caramel," "honey," "raisin," and "fig," with additional aroma attributes: "common date," "dried plum," and "molasses." Sensory differences were observed between dried fig cultivars. All figs were processed by 2 commercial handlers. Processing included potassium sorbate as a preservative and SO2 application as an antibrowning agent for white cultivars. As a consequence of SO2 use during processing, high sulfite residues affected the sensory profiles of the white dried fig cultivars. Significant differences between dried fig cultivars and sources demonstrate perceived differences between processing and storage methods. The panel-determined sensory lexicon can help with California fig marketing., (© 2013 The Regents of California, Davis Campus Department of Plant Sciences.)

Twelve fig cultivars, including cultivars destined for the fresh and dried markets, were harvested from 6 locations and evaluated by a trained panel using descriptive sensory analysis. Instrumental measurements were taken at harvest and also during sensory analysis. Each fresh fig cultivar had a characteristic appearance and flavor sensory profile regardless of the source. The primary flavor attributes used to describe the fig cultivars were "fruity,""melon,""stone fruit,""berry,""citrus,""honey,""green," and "cucumber." Maturity levels significantly affected the chemical composition and sensory profiles of the fig cultivars. Less mature figs had a higher compression force, a thicker outer skin, and higher ratings for "green" and "latex" flavors, firmness, graininess, bitterness, tingling, and seed adhesiveness. Meanwhile, more mature figs had higher soluble solids concentration, and were perceptibly higher in "fruit" flavors, juiciness, stickiness, sliminess, and sweetness. The specific sensory terminology used for fig appearance and flavor profiles will assist with communication between marketers and consumers, which can increase fresh fig consumption., (© 2012 The Regents of the University of California, Davis Campus Department of Plant Sciences.)

The main objective of this study was to investigate the effect of different Saccharomyces cerevisiae wine yeast strains on the concentration of aroma-enhancing volatile thiols and fermentation metabolites in Sauvignon Blanc wine. Seven commercial wine yeast strains were selected based on their putative ability to modulate the concentrations of the fruity volatile thiols, 4-mercapto-4-methylpentan-2-one (4MMP), 3-mercapto-hexanol (3MH) and 3-mercapto-hexylacetate (3MHA). Each of these yeasts was used to produce Sauvignon Blanc wines under controlled conditions, in triplicate, in 20-L quantities. The levels of 4MMP, 3MH and 3MHA in these wines were quantified using the p-hydroxymercuribenzoate method. In addition, a total of 24 volatile yeast-derived fermentation aroma compounds were also quantified using headspace solid-phase microextraction coupled with gas chromatography mass spectrometry (HS-SPME-GC-MS). Formal sensory analysis was conducted by 12 trained assessors and, additionally, a panel of 24 experienced wine industry professionals assessed the wines and ranked them in order of preference. The results indicated that the yeast strains varied significantly in terms of their capabilities to (i) produce volatile thiols and fermentation metabolites; and (ii) to modulate the varietal characters of Sauvignon Blanc wine. Yeast strains that produced the highest levels of volatile thiols were responsible for wines with the highest perceived intensity of fruitiness, and these wines were preferred by the tasting panels. While the 'green' characters in Sauvignon Blanc wines can be manipulated through vineyard management, the 'tropical fruity' characters appear to be largely dependent on the wine yeast strain used during fermentation. Therefore, the choice of yeast strain offers great potential to modulate wine aroma profiles to definable styles and predetermined consumer market specifications.

Alcoholic fermentation using Saccharomyces wine yeast is an effective means of modulating wine aroma. This study investigated the impact of coinoculating commercial yeast strains (Vin7, QA23, Vin13) on the volatile composition and sensory profile of Sauvignon Blanc wines. Small-scale replicated fermentations were conducted using single-strain and coinoculations of Vin7 with QA23 and with Vin13. The results showed that the chemical and sensory profiles of the coinoculated wines were different from both the single-strain wines and equal blends of the single-strain wines. Volatile thiol analysis indicated that the Vin7/QA23 coinoculated wines were highest in 3-mercaptohexan-1-ol (3MH) and 3-mercaptohexyl acetate (3MHA), although this pattern was not observed for the Vin7/Vin13 yeast combination. The negative white vinegar aroma and high volatile acidity measured in the Vin7 single-strain wines were not present in the coinoculated wines. This study demonstrates that coinoculations can modify the aroma profile of wines, when complementary yeasts are used.

Since 1985, there has been rapid growth in nurse-managed health centers (NMHCs). Many were established by academic schools of nursing, and several have closed. The Independence Foundation undertook this study to identify the challenges and survival strategies employed by four academic nurse-managed center grantees during a 10-year period. Data from Foundation records, interviews with directors and staff from the centers and the National Nursing Centers Consortium, a focus group with center founders, and field notes were analyzed for themes related to the centers' challenges and survival strategies. Although the centers faced many challenges from the sociopolitical environment, the community, and their parent organizations, the most difficult challenge was achieving financial sustainability, which was attainable only by obtaining cost-based reimbursement. Because of existing health policies, that was possible only through organizational restructuring and affiliation with an existing federally qualified health center. The future of nursing centers depends upon favorable health policies, data documenting centers' effectiveness, and adequate preparation of the next generation of nursing center directors and practitioners.

Background: Despite the number of patient safety incidents that occur in hospitals, physicians currently may not have the ideal incident reporting tools for easy disclosure. A study was undertaken to assess the effectiveness of a simplified paper incident reporting process for internal medicine physicians on uncovering patient safety incidents., Design: Thirty-nine internal medicine attending physicians were instructed to incorporate the use of a simplified paper incident reporting tool (DISCLOSE) into daily patient rounds during a three-month period. All physicians were surveyed at the conclusion of the three months., Results: Compared with physician reporting via the hospital's traditional incident reports from the same time period, a higher number (98 incidents versus 37; a 2.6-fold increase) of incidents were uncovered using the DISCLOSE reporting tool in a larger number of error categories (58 versus 14, a 4.1-fold increase). When reviewed and classified with a five-point harm scale, 41% of events were judged to have reached patients but not caused harm, 33% to have resulted in temporary harm, and 9% of reports, though not considered events, were to indicate a "risky situation." Surveyed physicians were more satisfied with the process of submitting incident reports using the new DISCLOSE tool., Discussion: A simplified incident reporting process at the point of care generated a larger number and breadth of physician disclosed error categories, and increased physician satisfaction with the process.

A peer volunteer intervention to encourage attendance at mammography education programs was developed and evaluated as part of a multi-intervention study to improve mammography by women 65 years and older. Approximately five to seven women from each of 20 racially and socioeconomically diverse senior citizens' housing facilities were recruited. After completing a training session, they distributed invitations and spoke personally with fellow residents about attending the upcoming program. Attendance rates for facilities with the peer volunteer program were compared with those in facilities without the volunteers. Results of a logistic regression analysis found the volunteer program, in addition to facility size, to have had a statistically significant effect on attendance at the mammography education presentations.

Background: This study hypothesized that an office-based training program in clinical breast examination (CBE) would improve the lump-detection skills of primary care physicians., Methods: A one-group pretest-posttest design was utilized, without outcome measurements taken prior to instruction, immediately afterwards, and six months later. Fifty physicians from 117 practices that had been randomly selected and met program eligibility criteria elected to participate. The intervention was a one-hour office-based CBE training program based on the MammaCare method, a standardized approach to teaching the detection of breast lumps using silicone breast models., Results: There were five lumps in the silicone model. The mean number of correct lump detections increased significantly, from 0.66 before to 3.2 after instruction, and this gain was maintained at six-month follow-up. The mean number of false positives decreased from 2.9 before to 1.16 after instruction, increasing slightly to 1.6 at six-month follow-up. Ninety-six percent of the physicians reported that they had modified their methods of CBE as a result of the training., Conclusions: This office-based instruction using an academic detailing model improved the participating physicians' abilities to correctly detect lumps in a silicone breast model and was received favorably.

We have characterized a family of repetitive DNA elements with homology to the MgPa cellular adhesion operon of Mycoplasma genitalium, a bacterium that has the smallest known genome of any free-living organism. One element, 2272 bp in length and flanked by DNA with no homology to MgPa, was completely sequenced. At least four others were partially sequenced. The complete element is a composite of six regions. Five of these regions show sequence similarity with nonadjacent segments of genes of the MgPa operon. The sixth region, located near the center of the element, is an A+T-rich sequence that has only been found in this repeat family. Open reading frames are present within the five individual regions showing sequence homology to MgPa and the adjacent open reading frame 3 (ORF3) gene. However, termination codons are found between adjacent regions of homology to the MgPa operon and in the A+T-rich sequence. Thus, these repetitive elements do not appear to be directly expressible protein coding sequences. The sequence of one region from five different repetitive elements was compared with the homologous region of the MgPa gene from the type strain G37 and four newly isolated M. genitalium strains. Recombination between repetitive elements of strain G37 and the MgPa operon can explain the majority of polymorphisms within our partial sequences of the MgPa genes of the new isolates. Therefore, we propose that the repetitive elements of M. genitalium provide a reservoir of sequence that contributes to antigenic variation in proteins of the MgPa cellular adhesion operon.

This study evaluated interventions implemented with women in a health maintenance organization who had not utilized their annual free mammogram referral 45 days (step 2) and 95 days (step 3) after its mailing. The step 2 evaluation compared mammography utilization for women randomly assigned to receive a brief reminder letter or no reminder: 42% of the reminder group vs 28% of the control group obtained mammograms. The step 3 evaluation compared utilization for women randomly assigned to receive a second reminder, a letter suggesting a preventive office visit, or telephone counseling: 29% of those who received telephone counseling, 14% of those who received a letter, and 12% of those who received a second reminder obtained mammograms.

Background: The purposes of this study were (a) to learn more about the existing breast cancer screening practices of women age 65 and older and (b) to identify factors related to breast cancer screening., Method: A random sample of 752 women age 65 and older residing in independent living apartments in eight retirement communities was selected to participate in a survey of breast cancer screening practices and related factors. A total of 616 surveys were complete, yielding a response rate of 82%; of those, 571 of the surveys were administered by telephone, with the remaining 45 administered in person., Results: Thirty-eight percent of the women reported having had a mammogram within the past year, 53% had a clinical breast exam, and 39% reported performing monthly breast self-examination. The percentage of women reporting either annual clinical breast examinations or mammography decreased with increasing age. Results of a logistic regression analysis found that having discussed mammography with a physician, believing in the need for mammography, having no mammography-related concerns, and the combination of personal experience with breast cancer and having had a clinical breast examination in the past year were all independently related to having had a mammogram within the past year (P < 0.05)., Conclusion: In order to increase older women's participation in screening, particularly in mammography, educational interventions need to be developed and directed both to older women and to their physicians.

We compared mammography reports in medical records to self-reports obtained during a 1989 telephone interview survey for a sample of 100 women members of a health maintenance organization (HMO) who indicated they had mammograms within the past year and 100 who said they had not had mammograms within the past year. Of the women reporting they had not had mammograms within the past year, none had mammogram reports in the HMO data center. Of the 100 women reporting they had mammograms within the past year, 94 had confirmatory radiology records.

Staffing alternatives and recruitment and retention strategies used by the pharmacy department of a pediatric teaching hospital are described. In addition to overtime compensation, the following alternative strategies have been implemented: (1) use of contingent or "on-call" personnel, (2) coverage by management staff, (3) use of temporary agencies, (4) review of ongoing activities, and (5) use of supportive personnel. All these strategies have been effective in compensating for shortages by supplying qualified individuals on an as-needed basis, eliminating nonessential departmental activities, or delegating nonprofessional duties to technicians and other supportive personnel. Effective recruitment and retention strategies include scholarship and training programs, communication with pharmacy staff about management efforts to improve salary and practice opportunities, and insight into the nature of the local competition from chain and mail-order pharmacies. Use of alternate approaches to staffing has helped the pharmacy department at this institution maintain adequate staffing during periods of pharmacist shortages.