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Abstract Background A recent study demonstrated the effectiveness of the New Hampshire Colorectal Cancer Screening Program’s (NHCRCSP) patient navigation (PN) program. The PN intervention was delivered by telephone with navigators following a rigorous, six-topic protocol to support low-income patients to complete colonoscopy screening. We applied the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework to examine implementation processes and consider potential scalability of this intervention. Methods A mixed-methods evaluation study was conducted including 1) a quasi-experimental, retrospective, comparison group study examining program effectiveness, 2) secondary analysis of NHCRCSP program data, and 3) a case study. Data for all navigated patients scheduled and notified of their colonoscopy test date between July 1, 2012 and September 30, 2013 (N = 443) were analyzed. Researchers were provided in-depth call details for 50 patients randomly selected from the group of 443. The case study included review of program documents, observations of navigators, and interviews with 27 individuals including staff, patients, and other stakeholders. Results Program reach was state-wide, with navigators serving patients from across the state. The program successfully recruited patients from the intended priority population who met the established age, income, and insurance eligibility guidelines. Analysis of the 443 NHCRCSP patients navigated during the study period demonstrated effectiveness with 97.3% completing colonoscopy, zero missed appointments (no-shows), and 0.7% late cancellations. Trained and supervised nurse navigators spent an average of 124.3 min delivering the six-topic PN protocol to patients. Navigators benefited from a real-time data system that allowed for patient tracking, communication across team members, and documentation of service delivery. Evaluators identified several factors supporting program maintenance including consistent funding support from CDC, a strong program infrastructure, and partnerships. Conclusions Factors supporting implementation included funding for colonoscopies, use of registered nurses, a clinical champion, strong partnerships with primary care and endoscopy sites, fidelity to the PN protocol, significant intervention dose, and a real-time data system. Further study is needed to assess scalability to other locations.

Positive patient outcomes depend on clear communication. Understanding healthcare literacy, cultural competency, and health disparities/ inequalities is essential for providing empathetic care to patients and their family members. Guidelines to provide culturally competent care may enhance the patient experience and improve healthcare provider communication. [ABSTRACT FROM AUTHOR]

Balsam poplar (Populus balsamifera L.) is a transcontinental tree species in North America, making it an ideal species to study intra-specific hybrid vigour as a tool for increasing genetic gain in growth. We tested the hypothesis that intra-specific breeding of disparate populations of balsam poplar would lead to the expression of hybrid vigour and we determined the role of endogenous hormones linked to ecophysiological and growth performance. In September 2009, three field trials were established in Canada (two in Alberta (AB), i.e., Fields AB1 and AB2, and one in Quebec (QC), i.e., Field QC1) in conjunction with Alberta-Pacific Forest Industries Inc. and the Ministry of Forests, Wildlife and Parks, Quebec. Five male parents from each province as well as five female parents from QC and four female parents from AB were used for breeding intra-regional and inter-regional crosses. Based on a significant difference at year six for height and diameter, from the AB1 and AB2 field trials, the AB × QC cross-type was selected for further study. Cuttings from the AB × QC cross-type were grown in a randomized complete block design under near-optimal greenhouse conditions. Families were identified as slow- or fast-growing, and the relationship between hormone levels and growth performance of the genotypes within the families were examined. In late June, after 34 days of growth, internode tissue samples collected from each progeny were analyzed for gibberellic acids, indole-3-acetic acid, and abscisic acid content. Stem volume of two-month-old rooted cuttings, grown under optimal greenhouse conditions, was positively and significantly correlated with the photosynthetic rate, greenhouse growth, and stem volume of 8-year-old field-grown trees (Fields AB1 values: r = 0.629 and p = 0.012; AB2 values: r = 0.619 and p = 0.014, and QC1 values: r = 0.588 and p = 0.021, respectively). We determined that disparate and native populations of balsam poplar can be bred to produce superior progeny with enhanced stem growth traits.

Background: To investigate uniformly successful results from a statewide program of patient navigation (PN) for colonoscopy, this comparison study evaluated the effectiveness of the PN intervention by comparing outcomes for navigated versus non-navigated patients in one of the community health clinics included in the statewide program. Outcomes measured included screening completion, adequacy of bowel preparation, missed appointments and cancellations, communication of test results, and consistency of follow-up recommendations with clinical guidelines.Methods: The authors compared a subset of 131 patients who were navigated to a screening or surveillance colonoscopy with a similar subset of 75 non-navigated patients at one endoscopy clinic. The prevalence and prevalence odds ratios were computed to measure the association between PN and each study outcome measure.Results: Patients in the PN intervention group were 11.2 times more likely to complete colonoscopy than control patients (96.2% vs 69.3%; P<.001), and were 5.9 times more likely to have adequate bowel preparation (P =.010). In addition, intervention patients had no missed appointments compared with 15.6% of control patients, and were 24.8 times more likely to not have a cancellation <24 hours before their appointment (P<.001). All navigated patients and their primary care providers received test results, and all follow-up recommendations were consistent with clinical guidelines compared with 82.4% of patients in the control group (P<.001).Conclusions: PN appears to be effective for improving colonoscopy screening completion and quality in the disparate populations most in need of intervention. To the best of our knowledge, the results of the current study demonstrate some of the strongest evidence for the effectiveness of PN to date, and highlight its value for public health. Cancer 2017;123:3356-66. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]

Balsam poplar (Populus balsamifera L.) is a transcontinental tree species in North America, making it an ideal species to study intra-specific hybrid vigour as a tool for increasing genetic gain in growth. We tested the hypothesis that intra-specific breeding of disparate populations of balsam poplar would lead to the expression of hybrid vigour and we determined the role of endogenous hormones linked to ecophysiological and growth performance. In September 2009, three field trials were established in Canada (two in Alberta (AB), i.e., Fields AB1 and AB2, and one in Quebec (QC), i.e., Field QC1) in conjunction with Alberta-Pacific Forest Industries Inc. and the Ministry of Forests, Wildlife and Parks, Quebec. Five male parents from each province as well as five female parents from QC and four female parents from AB were used for breeding intra-regional and inter-regional crosses. Based on a significant difference at year six for height and diameter, from the AB1 and AB2 field trials, the AB × QC cross-type was selected for further study. Cuttings from the AB × QC cross-type were grown in a randomized complete block design under near-optimal greenhouse conditions. Families were identified as slow- or fast-growing, and the relationship between hormone levels and growth performance of the genotypes within the families were examined. In late June, after 34 days of growth, internode tissue samples collected from each progeny were analyzed for gibberellic acids, indole-3-acetic acid, and abscisic acid content. Stem volume of two-month-old rooted cuttings, grown under optimal greenhouse conditions, was positively and significantly correlated with the photosynthetic rate, greenhouse growth, and stem volume of 8-year-old field-grown trees (Fields AB1 values: r = 0.629 and p = 0.012; AB2 values: r = 0.619 and p = 0.014, and QC1 values: r = 0.588 and p = 0.021, respectively). We determined that disparate and native populations of balsam poplar can be bred to produce superior progeny with enhanced stem growth traits. [ABSTRACT FROM AUTHOR]