Role of patient factors, preferences, and distrust in health care and access to liver transplantation and organ donation.

Despite major improvements in access to liver transplantation (LT), disparities remain. Little is known about how distrust in medical care, patient preferences, and the origins shaping those preferences contribute to differences surrounding access. We performed a single-center, cross-sectional survey of adults with end-stage liver disease and compared responses between LT listed and nonlisted patients as well as by race. Questionnaires were administered to 109 patients (72 nonlisted; 37 listed) to assess demographics, health care system distrust (HCSD), religiosity, and factors influencing LT and organ donation (OD). We found that neither HCSD nor religiosity explained differences in access to LT in our population. Listed patients attained higher education levels and were more likely to be insured privately. This was also the case for white versus black patients. All patients reported wanting LT if recommended. However, nonlisted patients were significantly less likely to have discussed LT with their physician or to be referred to a transplant center. They were also much less likely to understand the process of LT. Fewer blacks were referred (44.4% versus 69.7%; P = 0.03) or went to the transplant center if referred (44.4% versus 71.1%; P = 0.02). Fewer black patients felt that minorities had as equal access to LT as whites (29.6% versus 57.3%; P < 0.001). For OD, there were more significant differences in preferences by race than listing status. More whites indicated OD status on their driver's license, and more blacks were likely to become an organ donor if approached by someone of the same cultural or ethnic background (P < 0.01). In conclusion, our analysis demonstrates persistent barriers to LT and OD. With improved patient and provider education and communication, many of these disparities could be successfully overcome. Liver Transplantation 22 895-905 2016 AASLD.

Access to Better Education: The School Choice Experience of Families Served by Low-Performing Elementary Public Schools in Miami-Dade County

Public school choice education policy attempts to create an education marketplace. Although school choice research has focused on the parent role in the school choice process, little is known about parents served by low-performing schools. Following market theory, students attending low-performing schools should be the primary students attempting to use school choice policy to access high performing schools rather than moving to a better school. However, students remain in these low-performing schools. This study took place in Miami-Dade County, which offers a wide variety of school choice options through charter schools, magnet schools, and open-choice schools. This dissertation utilized a mixed-methods design to examine the decision-making process and school choice options utilized by the parents of students served by low-performing elementary schools in Miami-Dade County. Twenty-two semi-structured interviews were conducted with the parents of students served by low-performing schools. Binary logistic regression models were fitted to the data to compare the demographic characteristics, academic achievement and distance from alternative schooling options between transfers and non-transfers. Multinomial logistic regression models were fitted to the data to evaluate how demographic characteristics, distance to transfer school, and transfer school grade influenced the type of school a transfer student chose. A geographic analysis was conducted to determine how many miles students lived from alternative schooling options and the miles transfer students lived away from their transfer school. The findings of the interview data illustrated that parents’ perceived needs are not being adequately addressed by state policy and county programs. The statistical analysis found that students from higher socioeconomic social groups were not more likely to transfer than students from lower socioeconomic social groups. Additionally, students who did transfer were not likely to end up at a high achieving school. The findings of the binary logistic regression demonstrated that transfer students were significantly more likely to live near alternative school options.

Family Background and Access to Post-Secondary Education: What Happened in the 1990's (Woking Paper 34)

This paper presents new evidence on the relationships between access to post-secondary education and family background. More specifically, we use the School Leavers Survey (SLS) and the Youth in Transition Survey (YITS)to analyze participation rates first in 1991, and then almost a decade later in 2000. Overall, post-secondary education participation rates rose over this period. However, participation is strongly related to parent’s education, and whereas participation increased for individuals with more highly educated parents (especially those who went to university), they increased rather less, or in some cases (especially for males) declined for those from lower parental education families. The already strong “effect” of parents’ education on post-secondary access became even greater in the 1990’s. Participation rates are also strongly related to family type, but whereas those from two parent families continue to have an advantage over single mother families, the gap generally shrunk in the 1990’s, especially where the mother had university level schooling. We also find a number of interesting trends by province.

Children’s access to beneficial information in Arab states: Implementation of Article 17 of the Convention on the Rights of the Child in Egypt, Morocco and the United Arab Emirates

In theory, the multiple platforms and transnational nature of digital media, along with a related proliferation of diverse forms of content, make it easier for children’s right to access socially and culturally beneficial information and material to be realised, as required by Article 17 of the UN Convention on the Rights of the Child (CRC). Drawing on data collected during research on children’s screen content in the Arab world, combined with scrutiny of documents collated by the Committee on the Rights of the Child, which monitors compliance with the CRC, this paper explores how three Arab countries, Egypt, Morocco and the United Arab Emirates, presented their efforts to implement Article 17 as part of their periodic reporting on their overall performance in putting the CRC into effect. It uncovers tensions over the relationship between provision, participation and protection in relation to media, reveals that Article 17 is liable to get less attention than it deserves in contexts where governments keep a tight grip on media, and that, by appearing to give it a lower priority, all parties neglect the intersection between human rights in relation to media and children’s rights.

DNA in Amphibian and Reptile Venom Permits Access to Genomes Without Specimen Sacrifice

Amphibian defensive skin secretions and reptile venoms are rich sources of bioactive peptides with potential pharmacological/pharmaceutical applications. As amphibian and reptile populations are in rapid global decline, our research
group has been developing analytical methods that permit generation of robust molecular data from non-invasive skin secretion samples and venom samples. While previously we have demonstrated that parallel proteome and venom gland
transcriptome analyses can be performed on such samples, here we report the presence of DNA that facilitates the more widely-used applications of gene sequencing, such as molecular phylogenetics, in a non-invasive manner that circumvents specimen sacrifice. From this “surrogate” tissue, we acquired partial 12S and 16S rRNA gene sequences that are presented for illustration purposes. Thus from a single sample of amphibian skin secretion and reptile venom, robust and complementary proteome, transcriptome and genome data can be generated for applications in diverse scientific disciplines.

An Assessment of How Nurse Practitioners Create Access to Primary Care in Canadian Residential Long-Term Care Settings

The aim of this paper is to explore the role and activities of nurse practitioners (NPs) working in long-term care (LTC) to understand concepts of access to primary care for residents. Utilizing the "FIT" framework developed by Penchanksy and Thomas, we used a directed content analysis method to analyze data from a pan-Canadian study of NPs in LTC. Individual and focus group interviews were conducted at four sites in western, central and eastern regions of Canada with 143 participants, including NPs, RNs, regulated and unregulated nursing staff, allied health professionals, physicians, administrators and directors and residents and family members. Participants emphasized how the availability and accessibility of the NP had an impact on access to primary and urgent care for residents. Understanding more about how NPs affect access in Canadian LTC will be valuable for nursing practice and healthcare planning and policy and may assist other countries in planning for the introduction of NPs in LTC settings to increase access to primary care.

Widening Access to Higher Education through Partnership Working

This chapter considers the policy and practice of partnership working amongst educational organisations and related service providers as a means of promoting social inclusion in higher education (HE). It draws on an empirical study of partnership working in an area of England which has low levels of participation in HE, consistently performs poorly in national measures of educational achievement, and contains pockets of severe economic and social deprivation. The empirical research focuses on the work of senior managers from seventeen organisations who formed a sub-regional partnership as a strategy to raise aspirations, widen participation in HE and promote social inclusion.

Computational statistics, electronic publishing, and access to research data

Abstract not available

L'accessibilité aux services de physiothérapie en clinique externe dans les centres hospitaliers du Québec

Des contraintes d’accessibilité aux services de physiothérapie en clinique externe ont été rapportées dans les établissements publics au Canada. Celles-ci se traduisent souvent par un temps d’attente élevé avant d’obtenir des services. Différentes stratégies ont été proposées afin de gérer les listes d’attente, mais leur impact sur le temps d’attente est méconnu, notamment dans le contexte des services de physiothérapie au Québec. Le but de cette étude était de documenter l’accessibilité aux services de physiothérapie en clinique externe dans les centres hospitaliers au Québec. Les objectifs spécifiques étaient de 1) décrire les caractéristiques organisationnelles en lien avec l’accessibilité aux services de physiothérapie, 2) quantifier le temps d’attente pour accéder aux services et 3) explorer l’association entre les caractéristiques organisationnelles et le temps d’attente. Une enquête a été réalisée dans les cliniques externes de physiothérapie des centres hospitaliers publics du Québec offrant des services à des adultes souffrant de troubles musculosquelettiques. Des données ont été obtenues auprès de 97 (99%) centres hospitaliers. Au moment de l’enquête, 18 245 personnes étaient sur les listes d’attente. Le temps d’attente médian était de plus de six mois dans 41% des centres hospitaliers. Parmi les pratiques organisationnelles et les stratégies de gestion de listes d’attente évaluées, les politiques en cas d’annulation ou d’absence (99%) et la priorisation des demandes (96%) étaient les plus utilisées. Selon les résultats d’analyses multivariées, seule l’utilisation d’une méthode de priorisation comprenant une rencontre d’évaluation et une intervention initiale était associée au temps d’attente (p=0,008). Les résultats de cette étude démontrent qu’une grande quantité de personnes sont inscrites sur les listes d’attente des services de physiothérapie et que le temps d’attente peut être très élevé. D’après nos résultats, l’implantation d’une méthode de priorisation comprenant une évaluation et une intervention pourrait permettre d’améliorer l’accès en temps opportun aux services de physiothérapie.

Analysis of Federal Policy on Public Access to Scientific Research Data

Presentation from the MARAC conference in Pittsburgh, PA on April 14–16, 2016. S13 - Student Poster Session; Analysis of Federal Policy on Public Access to Scientific Research Data