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This article examines geography teachers', parents' and learners' understanding and experiences of the integration of Information and Communication Technologies (ICTs) in the teaching of that subject. The study was guided by the TPACK-SAMR model, which proved to be a reliable tool for measuring the extent of ICT integration. The purposive sampling technique that was employed enabled the researchers to identify participants for the research study related to the importance of integrating ICTs into the teaching and learning of geography. The article draws its purpose from the integration of technologies into the teaching of geography as a means of preparing and equipping learners who take this subject with the type of skills required in the 21st-century job market. Surprisingly, the research findings revealed that some teachers still do not feel comfortable to integrate diverse technologies into their teaching of geography, perceiving it as time consuming. Their unwillingness to become digital citizens and conform to the demands of the Fourth Industrial Revolution (4IR) is a drawback, as are learners' inappropriate use of ICTs (visiting irrelevant, unwanted sites instead of downloading subject-related content). To empower learners to adopt and use ICTs as valuable tools and solutions on their learning journey drastic changes are required, particularly on the part of curriculum planners in geography. [ABSTRACT FROM AUTHOR]

Purpose: To develop a framework that jointly estimates rigid motion and polarizing magnetic field (B0) perturbations (δB0$$ \delta {\mathbf{B}}_{\mathbf{0}} $$) for brain MRI using a single navigator of a few milliseconds in duration, and to additionally allow for navigator acquisition at arbitrary timings within any type of sequence to obtain high‐temporal resolution estimates. Theory and Methods: Methods exist that match navigator data to a low‐resolution single‐contrast image (scout) to estimate either motion orδB0$$ \delta {\mathbf{B}}_{\mathbf{0}} $$. In this work, called QUEEN (QUantitatively Enhanced parameter Estimation from Navigators), we propose combined motion and δB0$$ \delta {\mathbf{B}}_{\mathbf{0}} $$ estimation from a fast, tailored trajectory with arbitrary‐contrast navigator data. To this end, the concept of a quantitative scout (Q‐Scout) acquisition is proposed from which contrast‐matched scout data is predicted for each navigator. Finally, navigator trajectories, contrast‐matched scout, and δB0$$ \delta {\mathbf{B}}_{\mathbf{0}} $$ are integrated into a motion‐informed parallel‐imaging framework. Results: Simulations and in vivo experiments show the need to model δB0$$ \delta {\mathbf{B}}_{\mathbf{0}} $$ to obtain accurate motion parameters estimated in the presence of strong δB0$$ \delta {\mathbf{B}}_{\mathbf{0}} $$. Simulations confirm that tailored navigator trajectories are needed to robustly estimate both motion and δB0$$ \delta {\mathbf{B}}_{\mathbf{0}} $$. Furthermore, experiments show that a contrast‐matched scout is needed for parameter estimation from multicontrast navigator data. A retrospective, in vivo reconstruction experiment shows improved image quality when using the proposed Q‐Scout and QUEEN estimation. Conclusions: We developed a framework to jointly estimate rigid motion parameters and δB0$$ \delta {\mathbf{B}}_{\mathbf{0}} $$ from navigators. Combing a contrast‐matched scout with the proposed trajectory allows for navigator deployment in almost any sequence and/or timing, which allows for higher temporal‐resolution motion and δB0$$ \delta {\mathbf{B}}_{\mathbf{0}} $$ estimates. [ABSTRACT FROM AUTHOR]

Purpose: To demonstrate for the first time the feasibility of performing prospective motion correction using spherical navigators (SNAVs). Methods: SNAVs were interleaved in a 3D FLASH sequence with an additional short baseline scan (6.8 s) for fast rotation estimation. Assessment of SNAV‐based prospective motion correction was performed in six volunteers. Participant motion was guided using randomly generated stepwise prompts as well as prompts derived from real motion cases. Experiments were performed on a 3 T MRI scanner using a 32‐channel head coil. Results: When optimized for real‐time application, SNAV‐based motion estimates were computed in 25.8 ± 1.3 ms. Phantom‐based quantification of rotation and translation accuracy indicated mean absolute errors of 0.10 ± 0.09° and 0.25 ± 0.14 mm, respectively. Implementing SNAV‐based motion estimates for prospective motion correction led to a clear improvement in image quality with minimal increase in scan time (<5%). Conclusion: Optimization of SNAV processing for real‐time application enables prospective motion correction with low latency and minimal scan time requirements. [ABSTRACT FROM AUTHOR]

BackgroundHealth and wellbeing inequities between the Indigenous Māori and non-Māori populations in Aotearoa, New Zealand continue to be unresolved. Within this context, and of particular concern, hospitalisations for diseases of poverty are increasing for tamariki Māori (Māori children). To provide hospitalised tamariki Māori, and their whānau (families) comprehensive support, a wellbeing needs assessment; the Harti Hauora Tamariki Tool (The Harti tool) was developed. The purpose of this study is to determine how effective the Harti tool is at identifying wellbeing needs, ensuring the documentation of needs, enabling access to services and improving wellbeing outcomes for tamariki and their whānau.MethodsThe study uses a Kaupapa Māori methodology with qualitative and quantitative methods. Qualitative methods include in-depth interviews with whānau. This paper presents an overview of a randomised, two parallel, controlled, single blinded, superiority trial for quantitative evaluation of the Harti programme, and hospital satisfaction with care survey. Participants will be Māori and non-Māori tamariki/children aged 0–4 years admitted acutely to the paediatric medical wards at Waikato Hospital, Hamilton, Aotearoa New Zealand. They will be randomised electronically into the intervention or usual care group. The intervention group will receive usual care in addition to the Harti programme, which includes a 24-section health needs assessment delivered by trained Māori navigators to whānau during the time they are in hospital. The primary endpoint is the relative risk of an acute hospital readmission in the 30 days following discharge for the intervention group patients compared with control group patients. Secondary outcomes include access and utilisation of preventative health services including: oral health care, general practice enrolment, immunisation, healthy home initiatives, smoking cessation and the Well Child Tamariki Ora universal health checks available free of charge for children in Aotearoa New Zealand.DiscussionRandomised controlled trials are a gold standard for measuring efficacy of complex multifaceted interventions and the results will provide high quality evidence for implementing the intervention nationwide. We expect that this study will provide valuable evidence for health services and policy makers who are considering how to improve the configuration of paediatric hospital services.Trial registrationThe study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), registration number: ACTRN12618001079235.

Unhealthy alcohol use (UAU) affects nearly 1 in 4 Latinx/o/a individuals in the United States (US). Compared with White individuals, Latinx/o/a individuals with UAU face increased morbidity, decreased access to addiction treatment, and higher rates of incarceration. Community health workers (CHWs), also known as promotores, provide culturally and linguistically informed services while augmenting social and health care interventions. Although there is extensive literature evaluating the role of CHWinterventions for chronic conditions including hypertension and diabetes, less is known about CHWinterventions for UAU in the US. To better understand how CHWs can address UAU in the Latinx/o/a community in the US, we performed a scoping reviewof the literature for CHWinterventions for UAU in the Latinx/o/a population. We reviewed publications up toMarch 8, 2022, which described CHWinterventions for UAU in Latinx/o/a individuals in the US and identified 6 publications thatmet inclusion criteria after full-text review. These publications included 3 randomized controlled trials, 2 follow-up feasibility and acceptability assessments within the randomized controlled trial intervention group, and a pre-post noncontrolled feasibility study. All interventions were brief, with low-intensity touchpoints between CHWs and patients. None included medications for alcohol use disorder. We found few publications related to CHW-delivered interventions for UAU within the Latinx/o/a population. Given the acceptance and success of CHW-delivered interventions other conditions, as well as the increasing use of CHWs in the US, we need to invest in research that examines the efficacy of the CHWs in UAU. [ABSTRACT FROM AUTHOR]

The article analyzes the destructive manifestations in the emotional and behavioral spheres of seafarers in a sample of 40 seafarers. In the research we studied the behavioral patterns of sailors according to their professional status: senior officers, officers, deck crew, engine crew, and support staff. We also examined the correlation between the characteristics of destructive manifestations and the professional status of seafarers. Statistical analysis revealed unfavorable assertiveness scores in all five study groups. This suggests that the sailors in the studied sample, as representatives of an extreme profession, have a constant willingness to enter into conflictual interaction. For people in the seafaring profession, who operate in extreme conditions, it is necessary to develop and implement developmental and psychotherapeutic psychological intervention programs.

Three North Carolina Medicaid surveys conducted from 2000 to 2012 reported increasing numbers of Hispanic children enrolled in Medicaid and much lower trust in providers expressed by their adult caregiver respondents compared with responses for non-Hispanic Black and White children. To verify and explain this apparent trust chasm, we used bivariate and regression analyses. The variables employed included trust (dependent variable); child's race/ethnicity, age, and sex; satisfaction and health status scales; two utilization measures; respondent's age, sex, and education; geographical region; and population density of county of residence. Race/ethnicity was strongly associated with trust (p <.001), controlling for other independent variables. Access, satisfaction, and respondent's age and education were also significant. Our results fit the Behavioral Model for Vulnerable Populations, which maps the role of significant variables in health-seeking behavior. After analyzing the concept of trust, we argue that lower acculturation explains lower Hispanic trust compared with non-Hispanic Blacks. We suggest policies to improve acculturation. [ABSTRACT FROM AUTHOR]

The US Preventive Services Task Force has recommended lung cancer screening (LCS) with low-dose CT (LDCT) in high-risk individuals since 2013. Because LDCT encompasses the lower neck, chest, and upper abdomen, many incidental findings (IFs) are detected. The authors created a quick reference guide to describe common IFs in LCS to assist LCS program navigators and ordering providers in managing the care continuum in LCS. The ACR IF white papers were reviewed for findings on LDCT that were age appropriate for LCS. A draft guide was created on the basis of recommendations in the IF white papers, the medical literature, and input from subspecialty content experts. The draft was piloted with LCS program navigators recruited through contacts by the ACR LCS Steering Committee. The navigators completed a survey on overall usefulness, clarity, adequacy of content, and user experience with the guide. Seven anatomic regions including 15 discrete organs with 45 management recommendations were identified as relevant to the age of individuals eligible for LCS. The draft was piloted by 49 LCS program navigators from 32 facilities. The guide was rated as useful and clear by 95% of users. No unexpected or adverse experiences were reported in using the guide. On the basis of feedback, relevant sections were reviewed and edited. The ACR Lung Cancer Screening CT Incidental Findings Quick Reference Guide outlines the common IFs in LCS and can serve as an easy-to-use resource for ordering providers and LCS program navigators to help guide management. [Display omitted] [ABSTRACT FROM AUTHOR]

This paper examines health care utilization among indigenous immigrants from Oaxaca, Mexico, who have settled in a farmworker community in southern California. In 2016, two trained Spanish-Mixteco and Spanish-Zapoteco bi-lingual interviewers conducted in-depth interviews with 44 indigenous women residing in Oxnard, California on issues that affect health care utilization. Interviews were conducted in Mixteco, Zapoteco and Spanish and were coded to identify structural, cultural, and provider-related barriers to health care utilization. Five bi-lingual Spanish-Mixteco indigenous interpreters employed at local clinics were also interviewed. Many women reported lack of health insurance, inability to pay, language barriers, long waiting times, rushed encounters with providers, and seeking western medical care only after home remedies did not work. However, several women were able to access routine health care services, often with support from indigenous interpreters employed at clinics. Interviews with five interpreters found that they provided assistance with interpretation during medical encounters and appointment making. They also educated patients about upcoming exams, identified low-cost services and insurance programs available to patients, assisted with paperwork and occasionally educated physicians on behalf of their patients. In addition to addressing barriers to health care access our findings suggest the importance of identifying and leveraging community assets, such as indigenous navigators, when developing programs for such underserved communities. Our findings can inform best practice in settings that provide health care to indigenous populations and may also apply to settings that provide health care to other immigrant communities that have very limited familiarity and contact with western health care.

Ancient cosmography had to adapt to new historical circumstances during the early modern period in Europe, leading to a proliferation of roles and even a sort of identity crisis. This entailed the revival of cosmography as a new and modern science, which, however, was neither unitary nor homogeneous. Cosmography was not associated with a single epistemic community, a certain scholarly profile or a specific corpus of literature, but with different groups and practitioners who produced diverse kinds of documents. Numerous practices emerged, and knowledge circulated in several forms. The article explores so-called practical cosmography in the Iberian world from the early sixteenth century. This will be illustrated not by the classical works of the period (Faleiro, Medina, Cortés, Oliveira) but by the lesser-known figure of the Pilot Major Alonso de Chaves and his nautical encyclopaedia Quatri partitu en cosmographia pratica (c. 1530). Chaves' responsibilities as cosmographer of the Casa de la Contratación in Seville, the subjects and structure of his treatise, the intended audience and the style and language used show that there were substantial differences between the cosmography practised in Seville and Central European cosmography. The characteristics of this cosmography will be interpreted from the perspective of artisanal epistemology. [ABSTRACT FROM AUTHOR]

Purpose: Abdominal MRI scans may require breath‐holding to prevent image quality degradation, which can be challenging for patients, especially children. In this study, we evaluate whether FID navigators can be used to measure and correct for motion prospectively, in real‐time. Methods: FID navigators were inserted into a 3D radial sequence with stack‐of‐stars sampling. MRI experiments were conducted on 6 healthy volunteers. A calibration scan was first acquired to create a linear motion model that estimates the kidney displacement due to respiration from the FID navigator signal. This model was then applied to predict and prospectively correct for motion in real time during deep and continuous deep breathing scans. Resultant images acquired with the proposed technique were compared with those acquired without motion correction. Dice scores were calculated between inhale/exhale motion states. Furthermore, images acquired using the proposed technique were compared with images from extra‐dimensional golden‐angle radial sparse parallel, a retrospective motion state binning technique. Results: Images reconstructed for each motion state show that the kidneys' position could be accurately tracked and corrected with the proposed method. The mean of Dice scores computed between the motion states were improved from 0.93 to 0.96 using the proposed technique. Depiction of the kidneys was improved in the combined images of all motion states. Comparing results of the proposed technique and extra‐dimensional golden‐angle radial sparse parallel, high‐quality images can be reconstructed from a fraction of spokes using the proposed method. Conclusion: The proposed technique reduces blurriness and motion artifacts in kidney imaging by prospectively correcting their position both in‐plane and through‐slice. [ABSTRACT FROM AUTHOR]

The purpose of this study was to utilize mixed methods to evaluate the initial implementation of a system of care (SOC) developed and implemented from a community organizing framework. Surveys were conducted with partners (navigators, community partners, parents) to examine changes pre- and post-implementation of the SOC. Surveys assessed care coordination, effectiveness of communication across organizations, quality of services and relationships, barriers, health-related stressors, and distrust. Surveys were conducted at baseline and follow-up approximately 1 year later. At baseline, 160 parents and 40 community partners completed surveys. At follow-up, 125 parents and 33 community partners participated. Qualitative interviews and focus groups were conducted with participating community-based organization staff (n = 10), community navigators (n = 13), school staff (n = 10), and recipients of services (n = 13). Parent surveys suggested promising improvements in care coordination, communication, and quality of services. These results were supported by qualitative themes describing increased communication, care coordination, relationships, and access to services driven by community navigators. Despite these encouraging findings, surveys completed by community partners did not reveal significant changes. Findings must also be understood within the context of COVID-19., (© 2024 Society for Community Research and Action.)

Purpose: Accuracy investigation of volumetric navigators for motion correction, with emphasis on geometric EPI distortions at ultrahigh field. Methods: High‐resolution Dixon images were collected in different head positions and reconstructed to water, fat, T2*, and B0 maps. Resolution reduction was performed, and the T2* and B0 maps were used to apply effects of TE and EPI distortions to simulate various volumetric water and fat navigators. Registrations of the simulated navigators were compared with registrations of the original high‐resolution images. Results: Increased accuracy was observed with increased spatial resolution for non‐EPI navigators. When using EPI, the distortions had a negative effect on registration accuracy, which was most noticeable for high‐resolution navigators. Parallel imaging helped to alleviate those caveats to a certain extent, and 5‐fold acceleration gave close to similar accuracy to non‐EPI in most cases. Shortening the TE by partial Fourier sampling was shown to be mostly beneficial, except for water navigators with long readout durations. The EPI blip direction had an influence on navigator accuracy, and positive blip gradient polarities (yielding mostly image stretching frontally) typically gave the best accuracy for water navigators, whereas no clear recommendation could be made for fat navigators. Generally, fat EPI navigators had lower accuracy than water EPI navigators with otherwise similar parameters. Conclusions: Echo planar imaging has been widely used for MRI navigators, but the induced distortions reduce navigator accuracy at ultrahigh field. This study can help protocol optimization and guide the complex tradeoff between resolution and EPI acceleration in navigator parameter setup. [ABSTRACT FROM AUTHOR]

PurposeDevelop self-gated MRI for distinct heartbeat morphologies in subjects with arrhythmias.MethodsGolden angle radial data was obtained in seven sinus and eight arrhythmias subjects. An image-based cardiac navigator was derived from single-shot images, distinct beat types were identified, and images were reconstructed for repeated morphologies. Image sharpness, contrast, and volume variation were quantified and compared with self-gated MRI. Images were scored for image quality and artifacts. Hemodynamic parameters were computed for each distinct beat morphology in bigeminy and trigeminy subjects and for sinus beats in patients with infrequent premature ventricular contractions.ResultsImages of distinct beat types were reconstructed except for two patients with infrequent premature ventricular contractions. Image contrast and sharpness were similar to sinus self-gated images (contrast = 0.45 ± 0.13 and 0.43 ± 0.15; sharpness = 0.21 ± 0.11 and 0.20 ± 0.05). Visual scoring was highest in self-gated images (4.1 ± 0.3) compared with real-time (3.9 ± 0.4) and ECG-gated cine (3.4 ± 1.5). ECG-gated cine had less artifacts than self-gating (2.3 ± 0.7 and 2.1 ± 0.2), but was affected by misgating in two subjects. Among arrhythmia subjects, post-extrasystole/sinus (58.1 ± 8.6 mL) and interrupted sinus (61.4 ± 5.9 mL) stroke volume was higher than extrasystole (32.0 ± 16.5 mL; P

Purpose: Magnetic resonance current‐density imaging (MRCDI) combines MRI with low‐intensity transcranial electrical stimulation (TES; 1‐2 mA) to map current flow in the brain. However, usage of MRCDI is still hampered by low measurement sensitivity and image quality. Methods: Recently, a multigradient‐echo–based MRCDI approach has been introduced that presently has the best‐documented efficiency. This MRCDI approach has now been advanced in three directions and has been validated by phantom and in vivo experiments. First, the importance of optimum spoiling for brain imaging was verified. Second, the sensitivity and spatial resolution were improved by using acquisition weighting. Third, navigators were added as a quality control measure for tracking physiological noise. Combining these advancements, the optimized MRCDI method was tested by using 1 mA TES for two different injection profiles. Results: For a session duration of 4:20 min, the new MRCDI method was able to detect TES‐induced magnetic fields at a sensitivity level of 84 picotesla, representing a twofold efficiency increase against our original method. A comparison between measurements and simulations based on personalized head models showed a consistent increase in the coefficient of determination of ΔR2 = 0.12 for the current‐induced magnetic fields and ΔR2 = 0.22 for the current flow reconstructions. Interestingly, some of the simulations still clearly deviated from the measurements despite the strongly improved measurement quality. This highlights the utility of MRCDI to improve head models for TES simulations. Conclusion: The achieved sensitivity improvement is an important step from proof‐of‐concept studies toward a broader application of MRCDI in clinical and basic neuroscience research. [ABSTRACT FROM AUTHOR]

Abstract Background Health services in high-income countries increasingly recognise the challenge of effectively serving and engaging with marginalised people. Effective engagement with marginalised people is essential to reduce health disparities these populations face. One solution is by tapping into the phenomenon of boundary-spanning people in the community—those who facilitate the flow of ideas, information, activities and relationships across organisation and socio-cultural boundaries. Methods A scoping review methodology was applied to peer-reviewed articles to answer the question: “How do health services identify, recruit and use boundary spanners and what are the outcomes?” The review was conducted in seven databases with search terms based on community-based boundary spanning, marginalised people and health services. Findings We identified 422 articles with the screening process resulting in a final set of 30 articles. We identified five types of community-based boundary spanning: navigators, community health workers, lay workers, peer supporters and community entities. These range from strong alignment to the organisation through to those embedded in the community. We found success in four domains for the organisation, the boundary spanner, the marginalised individuals and the broader community. Quantifiable outcomes related to cost-savings, improved disease management and high levels of clinical care. Outcomes for marginalised individuals related to improved health knowledge and behaviours, improved health, social benefits, reduced barriers to accessing services and increased participation in services. We identified potential organisational barriers to using boundary spanners based on organisational culture and staff beliefs. Conclusions Community boundary spanners are a valuable adjunct to the health workforce. They enable access to hard to reach populations with beneficial health outcomes. Maintaining the balance of organisational and community alignment is key to ongoing success and diffusion of this approach.

Concentrating primarily on the so-called 'Navvies,' this paper interprets the songs of metal workers among casual labourers in nineteenth and twentieth century Britain as an expression of shared values and aspirations. The term 'Navigators' or 'Navvies' was first used of Irish refugees of Celtic origin, though some were of 'English settlement' origin, who came to Scotland and England in the 19th century to take part in manual work. This study focuses first on songs which concentrated on working conditions, and later discusses songs (which have usually been neglected) in which the workplace features more than one singer. The last part of the study examines a Scottish demonstration and march to London in the 1980s when metal workers resisted the planned closure of their rolling mill with a 'sung' march to London that echoes the resistance of the early Navvies and others. In an article in Imagined States (2001), written in collaboration with the present writer, Reimund Kvideland made a study of 'rallar(e)' (navvies) in Norway and Sweden between 1880 and 1930. He wrote, 'the railway navvies constructed a new genre of narrative song and employed it to give voice to a unique and positive occupational worldview [...] This occupational group created a compensatory and imagined state in which inverted and opposing values prevailed.' This process is what I aim to investigate in relation to the material described above. [ABSTRACT FROM AUTHOR]

Competing Interests: Declaration of Competing Interest We have no conflicts of interest or corporate sponsors.

Background: Health and wellbeing inequities between the Indigenous Māori and non-Māori populations in Aotearoa, New Zealand continue to be unresolved. Within this context, and of particular concern, hospitalisations for diseases of poverty are increasing for tamariki Māori (Māori children). To provide hospitalised tamariki Māori, and their whānau (families) comprehensive support, a wellbeing needs assessment; the Harti Hauora Tamariki Tool (The Harti tool) was developed. The purpose of this study is to determine how effective the Harti tool is at identifying wellbeing needs, ensuring the documentation of needs, enabling access to services and improving wellbeing outcomes for tamariki and their whānau., Methods: The study uses a Kaupapa Māori methodology with qualitative and quantitative methods. Qualitative methods include in-depth interviews with whānau. This paper presents an overview of a randomised, two parallel, controlled, single blinded, superiority trial for quantitative evaluation of the Harti programme, and hospital satisfaction with care survey. Participants will be Māori and non-Māori tamariki/children aged 0-4 years admitted acutely to the paediatric medical wards at Waikato Hospital, Hamilton, Aotearoa New Zealand. They will be randomised electronically into the intervention or usual care group. The intervention group will receive usual care in addition to the Harti programme, which includes a 24-section health needs assessment delivered by trained Māori navigators to whānau during the time they are in hospital. The primary endpoint is the relative risk of an acute hospital readmission in the 30 days following discharge for the intervention group patients compared with control group patients. Secondary outcomes include access and utilisation of preventative health services including: oral health care, general practice enrolment, immunisation, healthy home initiatives, smoking cessation and the Well Child Tamariki Ora universal health checks available free of charge for children in Aotearoa New Zealand., Discussion: Randomised controlled trials are a gold standard for measuring efficacy of complex multifaceted interventions and the results will provide high quality evidence for implementing the intervention nationwide. We expect that this study will provide valuable evidence for health services and policy makers who are considering how to improve the configuration of paediatric hospital services., Trial Registration: The study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), registration number: ACTRN12618001079235., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Scott, Atatoa Carr, Jones, Sandiford, Masters-Awatere and Clark.)

Purpose: To demonstrate feasibility and performance of prospective motion and B0 shim correction for MRS in human brain at 7T. Methods: Prospective motion correction using an optical camera and linear B0 shim correction using FASTMAP‐like navigators were implemented into a semi‐LASER sequence. The effect of motion on spectral quality was assessed without and with prospective correction in prefrontal cortex in 11 subjects. Results: Without prospective motion and shim correction, motion resulted in considerable degradation of MR spectra (broader linewidth, lower signal‐to‐noise ratio, degraded water suppression). With prospective motion and shim correction, spectral quality remained excellent despite motion. Prospective motion correction alone was not sufficient to prevent degradation of spectral quality. Conclusion: Prospective motion and B0 shim correction is feasible at 7T and should help improve the robustness of MRS, particularly in motion‐prone populations. [ABSTRACT FROM AUTHOR]

Engagement in HIV care is critical to achieve viral suppression and ultimately improve health outcomes for people living with HIV (PLWH). However, maintaining their engagement in care is often a challenging goal. Utilizing patient navigators, trained in an adapted ARTAS intervention, to help re-engage out-of-care PLWH has proven to be a valuable resource. This qualitative study describes the encounters between PLWH (n = 11) and their care re-engagement navigators (n = 9). Participants were interviewed in-person; interviews were transcribed and analyzed using the strengths model of case management. PLWH shared how working with navigators increased their motivation to return to HIV care and assisted them to overcome barriers that were a hindrance to care engagement. Navigators described a strengths-based approach to working with their clients, thus helping facilitate PLWH care re-engagement goals and successes. Results from this study may inform the development of effective HIV navigation programs to re-engage out-of-care PLWH, often the hardest-to-engage. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the precision of estimates of temporal variations of magnetic field achievable by double‐echo fat image navigators (FatNavs), and their potential application to retrospective correction of 3‐dimensional gradient echo–based sequences. Methods: Both head motion and temporal changes of B0 were tracked using double‐echo highly accelerated 3‐dimensional FatNavs as navigators, allowing estimation of the temporal changes in low spatial‐order field coefficients. The accuracy of the method was determined by direct comparison to controlled offsets in the linear imaging gradients. Double‐echo FatNavs were also incorporated into a high‐resolution, 3‐dimensional gradient echo–based sequence to retrospectively correct for both motion and temporal changes in B0 during natural and deep breathing. The additional scan time was 5 min (a 40% increase). Correction was also investigated using only the first echo of the FatNav to explore the trade‐off in accuracy versus scan time. Results: Excellent accuracy (0.27 Hz, 1.57–2.75 Hz/m) was achieved for tracking field changes, and no significant bias could be observed. Artifacts in the 3‐dimensional gradient echo–based images induced by temporal field changes, if present, were effectively reduced using either the field estimates from the double echo or the first echo only from the FatNavs. Conclusion: The FatNavs were shown to be an excellent candidate for accurate, fast, and precise estimation of global field variations for the tested patterns of respiration. Future work will investigate ways to increase the temporal sampling to increase robustness to variations in breathing patterns. Magn Reson Med 80:585–597, 2018. © 2018 International Society for Magnetic Resonance in Medicine. [ABSTRACT FROM AUTHOR]

Background Cancer-patient navigators who are oncology nurses support and connect patients to resources throughout the cancer care trajectory, including end of life. Although qualitative and cohort studies of navigated patients have been reported, no population-based studies were found. The present population-based study compared demographic, disease, and outcome characteristics for decedents who had been diagnosed with cancer by whether they did or did not see a navigator. Methods This retrospective study used patient-based administrative data in Nova Scotia (cancer registry, death certificates, navigation visits) to generate descriptive statistics. The study population included all adults diagnosed with cancer who died during 2011-2014 of a cancer or non-cancer cause of death. Results Of the 7694 study decedents, 74.9% had died of cancer. Of those individuals, 40% had seen a navigator at some point in their disease trajectory. The comparable percentage for those who did not die of cancer was 11.9%. Decedents at the oldest ages had the lowest navigation rates. Navigation rates, time from diagnosis to death, and time from last navigation visit to death varied by disease site. Conclusions This population-based study of cancer-patient navigation enrolees compared with non-enrolees is the first of its kind. Most findings were consistent with expectations. However, we do not know whether the rates of navigation are consistent with the navigation needs of the population diagnosed with cancer. Because more people are living longer with cancer and because the population is aging, ongoing surveillance of who requires and who is using navigation services is warranted. [ABSTRACT FROM AUTHOR]

Patient navigation is a patient-centered intervention that uses trained personnel to identify patient-level barriers, including financial, cultural, logistical, and educational obstacles to health care and then mitigate these barriers to facilitate complete and timely access to health services. For example, to assist a woman with Medicaid who is seeking postpartum care, a patient navigator could help her schedule an appointment before her insurance benefits change, coordinate transportation and child care, give her informational pamphlets on contraception options, and accompany her to the appointment to ensure her questions are answered. Existing studies examining the efficacy of patient navigation interventions show particularly striking benefits in the realm of cancer care, including gynecological oncology; patient navigation has been demonstrated to increase access to screening, shorten time to diagnostic resolution, and improve cancer outcomes, particularly in health disparity populations, such as women of color, rural populations, and poor women. Because of the successes in cancer care at reducing disparities in health care access and health outcomes, patient navigation has the potential to improve care and reduce disparities in obstetric and benign gynecological care. We review the concept of patient navigation, offer potential roles for patient navigation in obstetrics and gynecology, and discuss areas for further investigation. [ABSTRACT FROM AUTHOR]

Purpose To develop a novel approach for head motion and B0 field monitoring based on tracking discrete off-resonance markers with three spokes (trackDOTS). Methods Small markers filled with acetic acid were built and attached to a head cap. Marker positions and phase were tracked with fast MR navigators (DotNavs) consisting of three off-resonance, double-echo, orthogonal one-dimensional projections. Individual marker signals were extracted using optimized coil combinations, and used to estimate head motion and field perturbations. To evaluate the approach, DotNavs were integrated in submillimeter MP2RAGE and long-echo time gradient-echo sequences at 7 Tesla, and tested on six healthy volunteers. Results The DotNav-based motion estimates differed by less than 0.11 ± 0.09 mm and 0.19 ± 0.17 ° from reference estimates obtained with an existing navigator approach (FatNavs). Retrospective motion correction brought clear improvements to MP2RAGE image quality, even in cases with submillimeter involuntary motion. The DotNav-based field estimates could track deep breathing-induced oscillations, and in cases with small head motion, field correction visibly improved the gradient-echo data quality. Conversely, field estimates were less robust when strong motion was present. Conclusions The trackDOTS approach is suitable for head-motion tracking and correction, with significant benefits for high-spatial-resolution MRI. With small head motion, DotNav-based field estimates also allow correcting for deep-breathing artifacts in T2*-weighted acquisitions. Magn Reson Med 79:160-171, 2018. © 2017 International Society for Magnetic Resonance in Medicine. [ABSTRACT FROM AUTHOR]

Purpose To develop a retrospective nonrigid motion-correction method based on 3D image-based navigators (iNAVs) for free-breathing whole-heart coronary magnetic resonance angiography (MRA). Methods The proposed method detects global rigid-body motion and localized nonrigid motion from 3D iNAVs and compensates them with an autofocusing algorithm. To model the global motion, 3D rotation and translation are estimated from the 3D iNAVs. Two sets of localized nonrigid motions are obtained from deformation fields between 3D iNAVs and reconstructed binned images, respectively. A bank of motion-corrected images is generated and the final image is assembled pixel-by-pixel by selecting the best focused pixel from this bank. In vivo studies with six healthy volunteers were conducted to compare the performance of the proposed method with 3D translational motion correction and no correction. Results In vivo studies showed that compared to no correction, 3D translational motion correction and the proposed method increased the vessel sharpness by 13% ± 13% and 19% ± 16%, respectively. Out of 90 vessel segments, 75 segments showed improvement with the proposed method compared to 3D translational correction. Conclusion We have developed a nonrigid motion-correction method based on 3D iNAVs and an autofocusing algorithm that improves the vessel sharpness of free-breathing whole-heart coronary MRA. Magn Reson Med 77:1884-1893, 2017. © 2016 International Society for Magnetic Resonance in Medicine [ABSTRACT FROM AUTHOR]

A number of researchers have shown that brokers (e.g., navigators and street-level bureaucrats) bridge access to healthcare services and information for immigrant patients through rich personal relationships and a mission of ethical care. An open question remains concerning how the increasing rationalization of healthcare over the past few decades influences brokerage for undocumented immigrant patients. Drawing from fieldwork and interviews conducted in California, as the Affordable Care Act (ACA) was implemented, I develop the concept of the “double-embedded-liaison.” While other studies treat brokers as acting either as gatekeepers or patient representatives, this study explains how brokers simultaneously operate on multiple planes when new roles are added. I argue that with more formalization and scrutiny at health centers, the impact of brokerage is destabilized and, subsequently, diminished. Two consequences of the double-embedded-liaison brokerage form are: (1) some brokers become disillusioned and exit –resulting in the loss of valuable resources at the health centers, and (2) immigrants move away from the health centers that historically served them. In looking at brokers’ simultaneous performance as gatekeepers and representatives, this research extends brokerage typologies and street-level bureaucracy arguments that largely treat brokerage in a mono-planar rather than in a bi-planar mode. Furthermore, in examining the risks and opportunities brokerage brings to addressing health disparities, the study provides insights into the effects of replacing the ACA or repealing it all together in the Post-Obama era. [ABSTRACT FROM AUTHOR]

Purpose To investigate the effect of spatial resolution and parallel imaging acceleration factor on the quality of the motion estimates derived from image navigators with a three-dimensional (3D) gradient-recalled echo (GRE) acquisition with fat excitation (3D FatNavs) for neuroimaging at 7T. Methods Six healthy subjects were scanned for 10 min, during which time repeated GRE volumes were acquired during small movements-alternating between fat and water excitations (WaterNavs)-allowing retrospective decimation of the data to simulate a variety of combinations of image resolution and acceleration factor. Bias and error in the motion estimates were then compared across navigator parameters. Results The 2-mm, 4 × 4 accelerated data (TRvolume = 1.2 s) provided motion estimates that were almost indistinguishable from those from the full original acquisition (2 mm, 2 × 2, TRvolume = 5.2 s). For faster navigators, it was found that good accuracy and precision were achievable with TRvolume = 144 ms, using a lower spatial resolution (4 mm, 6 × 6 acceleration) to avoid the bias observed at exceptionally high acceleration factors (8 × 8 or higher). Parameter estimates from WaterNavs and FatNavs showed close agreement with FatNavs, with better performance at exceptionally high acceleration factors. Conclusion Our data help to guide the parameter choice for 3D FatNavs when a compromise must be reached between the quality of the motion estimates and the available scan time. Magn Reson Med 77:547-558, 2017. © 2016 International Society for Magnetic Resonance in Medicine [ABSTRACT FROM AUTHOR]

In the article the questions of algorithmic preparation of navigators are examined in the conditions of informative of communication pedagogical environment. For teaching of algorithmization and programming it is suggested to use the integrated environment of study of course of «Basis of algorithmization and programming» (http://weboap.ksu.ks.ua), which is developed in RIIT of the Kherson state university.

Objective: Multiple detoxification admissions among clients with substance use disorders (SUD) are costly to the health care system. This study explored the impact on behavior and cost outcomes of recovery support navigator (RSN) services delivered with and without a contingent incentive intervention.Methods: New intakes at four detoxification programs were offered RSN-only (N=1116) or RSN plus incentive (RSN+I; N=1551) services. The study used a group-level cross-over design with the intervention in place at each clinic reversed halfway through the enrollment period. RSN+I clients could earn up to $240 in gift cards for accomplishing 12 different recovery-oriented target behaviors. All eligible clients entering the detoxification programs were included in the analyses, regardless of actual service use.Results: Among RSN+I clients, 35.5% accessed any RSN services compared to 22.3% in the RSN-only group (p<.01). Of RSN+I clients, 19% earned one, 12% earned two and 18% earned three or more incentives; 51% did not earn any incentives. The majority of incentives earned were for meeting with the RSN either during or after detoxification. Adjusted average monthly health care costs among clients in the RSN-only and RSN+I groups increased at a similar rate over 12 months post-detoxification.Discussion: Possible explanations for limited uptake of the incentive program discussed include features of the incentive program itself, navigator-client communication, organizational barriers and navigator bias. The findings provide lessons to consider for future design and implementation of multi-target contingency management interventions in real-world settings. [ABSTRACT FROM AUTHOR]

Purpose The goal of the present study was to use a three-dimensional (3D) gradient echo volume in combination with a fat-selective excitation as a 3D motion navigator (3D FatNav) for retrospective correction of microscopic head motion during high-resolution 3D structural scans of extended duration. The fat excitation leads to a 3D image that is itself sparse, allowing high parallel imaging acceleration factors - with the additional advantage of a minimal disturbance of the water signal used for the host sequence. Methods A 3D FatNav was inserted into two structural protocols: an inversion-prepared gradient echo at 0.33 × 0.33 × 1.00 mm resolution and a turbo spin echo at 600 μm isotropic resolution. Results Motion estimation was possible with high precision, allowing retrospective motion correction to yield clear improvements in image quality, especially in the conspicuity of very small blood vessels. Conclusion The highly accelerated 3D FatNav allowed motion correction with noticeable improvements in image quality, even for head motion which was small compared with the voxel dimensions of the host sequence. Magn Reson Med 75:1030-1039, 2016. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Introduction The passage of the Affordable Care Act improved access to gender-affirming care but positioned insurers as the primary gatekeepers of treatment. Insurers have developed criteria for coverage approval that result in barriers to care for some individuals. In this study, the author sought to understand the experiences of individuals seeking insurance coverage for gender-affirming top surgery. This report summarizes the role of navigators in facilitating access to coverage. Methods This study is based on semistructured, in-depth interviews with 30 transgender and gender diverse people assigned female at birth. The participants were diverse in age, race and ethnicity, geographic location, type of insurance coverage, and care setting. Thematic analysis was used to examine key influences on the coverage-seeking process. Results Participants identified navigation as a key domain. Analysis centered on 3 themes: navigators improving access to care; the contribution of lesbian, gay, bisexual, transgender, queer plus (LGBTQ+) health centers in facilitating access; and the role of informal navigators in furthering the inequitable distribution of care. Participants reported that navigators improved the likelihood of insurance coverage for gender-affirming surgeries and reduced health care inequities based on sociodemographic characteristics. Conclusion Nonstandardized criteria among insurers promote inequitable access to health care because approval relies on consumer ability to navigate complex systems and adequate economic resources to fulfill criteria. Improved access to navigators would reduce barriers to gender-affirming care.

For nearly 30 years, Programa Compañeros Inc (Compañeros) has worked in Ciudad Juarez, Chihuahua, Mexico, to ensure that vulnerable populations can exercise their rights to receive HIV and substance abuse prevention and treatment services. Compañeros staff has worked to ameliorate the negative results that limit access to care to the most vulnerable individuals: those who are poor, homeless, sex workers, addicted, and others whose life context put them at greater risk for being infected with HIV. With support from the MAC AIDS Foundation, Compañeros has expanded its capacity to deliver services to persons living with HIV/AIDS (PLWHA) and to HIV-vulnerable populations. This short communication describes findings from an internal evaluation conducted to investigate the effectiveness of the MAC AIDS-funded navigator-based program implemented at Compañeros. [ABSTRACT FROM AUTHOR]

Purpose: To compare low b value (10s/mm(2)) spin-echo echo-planar (SE-EP) diffusion-weighted imaging (DWI) acquired with respiratory-triggering (RT), triggering and tracking navigator (TT), tracking only navigator (TRON) techniques for image quality and focal liver lesions (FLL) detection in non-cirrhotic patients.Material and Methods: This bi-centric study was approved by the institutional review boards; informed consent was obtained. Eighty-three patients were prospectively included and SE-EP-DWI with RT, TT and TRON techniques were performed. DWI sequences were randomized and independently analyzed by two readers. The qualitative evaluation was based on a 3-point score for axial artifacts (motion, ghost, susceptibility artifacts and distortion) and stair-step artifacts. Sensitivity of FLL detection was calculated for all lesions together and after lesion size stratification (≤ 10 mm, >10-20mm and >20mm). The standard of reference consisted of a retrospective reading of the conventional MRI, the three DWI sequences and by follow-up (12 months): a total of 409 FLL were detected. Data between sequences was compared with non-parametric tests. Cohen's kappa coefficient was used for inter-observer agreement.Results: Image quality was comparable for RT and TT. TRON showed statistically significantly more axial artifacts for the two readers (p<0.05). Stair-step artifacts were not statistically significantly different between DWI sequences. Overall sensitivities for RT, TT, TRON were 85%, 86%, 82% and 86%, 89% 83%, respectively, for readers 1 and 2. The inter-observer agreement was very good.Conclusion: Image quality was better for RT and TT compared to TRON. Overall sensitivities for FLL detection were comparable between techniques and readers. [ABSTRACT FROM AUTHOR]

Object: The investigation of three-dimensional radial, zero-echo time (TE) imaging for high-resolution, free-breathing magnetic resonance (MR) lung imaging using prospective and retrospective motion correction. Materials and methods: Zero-TE was implemented similarly to the rotating-ultra-fast-imaging-sequence, providing 3D, isotropic, radial imaging with proton density contrast. Respiratory motion was addressed using prospective triggering (PT), prospective gating (PG) and retrospective gating (RG) with physiological signals obtained from a respiratory belt and interleaved pencil beam and DC navigators. The methods were demonstrated on four healthy volunteers at 3T. Results: 3D, radial zero-TE imaging with high imaging bandwidth and nominally zero echo-time enables efficient capture of short-lived signals from the lung parenchyma and the vessels. Compared to Cartesian encoding, unaccounted for free-breathing respiration resulted in only benign blurring artifacts confined to the origin of motion. Breath holding froze respiration but achieved only limited image resolution (~1.8 mm, 30 s). PT and PG obtained similar quality expiratory-phase images at 1.2 mm resolution in ~6 min scan time. RG allowed multi-phase imaging in ~15 min, derived from eight individually stored averages. Conclusion: Zero-TE appears to be an attractive pulse sequence for 3D isotropic lung imaging. Prospective and retrospective approaches provide high-quality, free-breathing MR lung imaging within reasonable scan time. [ABSTRACT FROM AUTHOR]

Significant racial disparities in cancer mortality are seen between Medicare beneficiaries. A randomized controlled trial tested the use of lay navigators (care managers) to increase cancer screening of Asian and Pacific Islander Medicare beneficiaries. The study setting was Moloka'i General Hospital on the island of Moloka'i, Hawai'i, which was one of six sites participating in the Cancer Prevention and Treatment Demonstration sponsored by the Centers for Medicare and Medicaid Services. Between 2006 and 2009, 488 Medicare beneficiaries (45% Hawaiian, 35% Filipino, 11% Japanese, 8% other) were randomized to have a navigator help them access cancer screening services (experimental condition, n = 242) or cancer education (control condition, n = 246). Self-reported data on screening participation were collected at baseline and exit from the study, and differences were tested using chi-square. Groups were similar in demographic characteristics and baseline screening prevalence of breast, cervical, prostate, and colorectal cancers. At study exit, 57.0% of women in the experimental arm and 36.4% of controls had had a Papanicolaou test in the past 24 months ( P = .001), 61.7% of women in the experimental arm and 42.4% of controls had had a mammogram in the past 12 months ( P = .003), 54.4% of men in the experimental arm and 36.0% of controls had had a prostate-specific antigen test in the past 12 months ( P = .008), and 43.0% of both sexes in the experimental arm and 27.2% of controls had had a flexible sigmoidoscopy or colonoscopy in the past 5 years ( P < .001). Findings suggest that navigation services can increase cancer screening in Medicare beneficiaries in groups with significant disparities. [ABSTRACT FROM AUTHOR]

According to the World Health Organization (WHO), more than 80% of worldwide diabetes (DM)-related deaths presently occur in low- and middle-income countries (LMIC), and left unchecked these DM-related deaths will likely double over the next 20 years. Cardiovascular disease (CVD) is the most prevalent and detrimental complication of DM: doubling the risk of CVD events (including stroke) and accounting for up to 80% of DM-related deaths. Given the aforementioned, interventions targeted at reducing CVD risk among people with DM are integral to limiting DM-related morbidity and mortality in LMIC, a majority of which are located in Sub-Saharan Africa (SSA). However, SSA is contextually unique: socioeconomic obstacles, cultural barriers, under-diagnosis, uncoordinated care, and shortage of physicians currently limit the capacity of SSA countries to implement CVD prevention among people with DM in a timely and sustainable manner. This article proposes a theory-based framework for conceptualizing integrated protocol-driven risk factor patient self-management interventions that could be adopted or adapted in future studies among hospitalized stroke patients with DM encountered in SSA. These interventions include systematic health education at hospital discharge, use of post-discharge trained community lay navigators, implementation of nurse-led group clinics and administration of health technology (personalized phone text messaging and home tele-monitoring), all aimed at increasing patient self-efficacy and intrinsic motivation for sustained adherence to therapies proven to reduce CVD event risk. [ABSTRACT FROM AUTHOR]

In dialogue with Bishop and Phillips’ (2013) concern to establish what the category of the urban might mean in the context of megacities, this piece offers four provocations in the spirit of developing their analysis. The first is the need to attend to the specifics of megacities; the second insists on the importance of including those who navigate them in the analysis; the third is a concern to unwind different forms of urban traction, and the fourth is a need to be mindful of the intersecting logics of translocality. Drawing on my own empirical research into the urban translocalities drawn by the flip-flop trail, it concludes that globalization is less solid and more fragile and shifting than many of its theorists suggest. [ABSTRACT FROM PUBLISHER]