Local Outreach Research Articles

Memory and Relevance: Local History and Outreach at Eckley Miners’ Village

Memory and Relevance: Local History and Outreach at Eckley Miners’ Village

Abstract B082: Design Studios for Health to identify distinct outreach events and interventions to reduce the burden of cancer among Hispanic/Latino and Black adults in a major southwestern metropolitan region

Abstract Introduction: Cancer is the second leading cause of death in Arizona. While there was a 7% decrease in cancer mortality among Arizonans from 2016-2020, more work is needed to decrease cancer incidence and mortality among racial and ethnic minorities, including Black and Hispanic/Latino populations. Further, it is critical to engage community members to identify cancer-related priorities, brainstorm feasible and acceptable community-based interventions, and co-create community-academia-healthcare solutions to reduce cancer disparities. Methods: The team conducted a series of Design Studios for Health (DSH) – guided listening sessions to foster community involvement, facilitate knowledge exchange, and identify the priorities and concerns for cancer prevention and control in the Black and Hispanic/Latino communities. Each DSH session included introductions, information dissemination, and breakout sessions with a moderator and a notetaker. The first DSH sessions were held in February 2024 via Zoom, one for Black community members (n=14) and one for Hispanic/Latino community members (n=14). In March 2024, an in-person DSH aimed to bring together all previous participants from both communities (n=27). This session deepened collaborations and knowledge exchange, building on insights from the initial sessions. The iterative nature of DSH ensured continuous refinement and co-creation of precision health solutions based on feedback and the data collected. Results: DSH participants identified the following cancer priorities: breast, skin, cervical, prostate, colorectal, and stomach cancers. They emphasized the need for community-shared information on survivorship resources, prevention (shared via social media), symptoms, costs, payment options, resource guides for community health workers, and guidance on navigating medical and insurance payments. Recommendations for academic partners included offering workshops and educational seminars on cancer prevention, using university space to host community cancer prevention events, alternating event locations in the metropolitan region to reach multiple underserved communities, hosting community fairs with multiple cancer education and screening opportunities, forming community advisory boards focused on cancer prevention and control, and organizing local forums to share cancer prevention and control resources. To support local organizations and health education outreach, they recommended creating additional training on cancer, e.g. for community health workers, to enhance public dissemination. Future directions: Based on these findings, our team is developing interactive, virtual, games-based cancer education to help dispel myths about cancer prevention and control. We are collaborating with community health workers to increase the accessibility of cancer prevention, screening, and resource education at pop-up cancer screening events (October and November 2024) held in areas of Phoenix serving low-income, racially, and ethnically diverse communities. Citation Format: Alexis M. Koskan, Maricarmen Vizcaino, Maissa Khatib, Tina M. Brown, Dorothy D. Sears. Design Studios for Health to identify distinct outreach events and interventions to reduce the burden of cancer among Hispanic/Latino and Black adults in a major southwestern metropolitan region [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B082.

Evaluation of the New York City COVID-19 case investigation and contact tracing program: a cascade of care analysis

BackgroundNew York City (NYC) was the first COVID-19 epicenter in the United States and home to one of the country’s largest contact tracing programs, NYC Test & Trace (T2). Understanding points of attrition along the stages of program implementation and follow-up can inform contact tracing efforts for future epidemics or pandemics. The objective of this study was to evaluate the completeness and timeliness of T2 case and contact notification and monitoring using a “cascade of care” approach.MethodsThis cross-sectional study included all SARS-CoV-2 cases and contacts reported to T2 from May 31, 2020 to January 1, 2022. Attrition along the “cascade of care” was defined as: (1) attempted, (2) reached, (3) completed intake (main outcome), (4) eligible for monitoring, and (5) successfully monitored. Timeliness was assessed: (1) by median days from a case’s date of testing until their positive result was reported to T2, (2) from result until the case was notified by T2, and (3) from a case report of a contact until notification of the contact.ResultsA total of 1.45 million cases and 1.38 million contacts were reported to T2 during this period. For cases, attrition occurred evenly across the first three cascade steps (~-12%) and did not change substantially until the Omicron wave in December 2021. During the Omicron wave, the proportion of cases attempted dropped precipitously. For contacts, the largest attrition occurred between attempting and reaching (-27%), and attrition rose with each COVID-19 wave as contact volumes increased. Attempts to reach contacts discontinued entirely during the Omicron wave. Overall, 67% of cases and 49% of contacts completed intake interviews (79% and 57% prior to Omicron). T2 was timely, with a median of 1 day to receive lab results, 2 days to notify cases, and < 1 day to notify contacts.ConclusionsT2 provided a large volume of NYC residents with timely notification and monitoring. Engagement in the program was lower for contacts than cases, with the largest gap coming from inability to reach individuals during call attempts. To strengthen future test-and-trace efforts, strategies are needed to encourage acceptance of local contact tracer outreach attempts.

Access to community-based eye services in Meru, Kenya: a cross-sectional equity analysis

BackgroundOver 80% of blindness in Kenya is due to curable or preventable causes and 7.5 m Kenyans currently need eye services. Embedding sociodemographic data collection into screening programmes could help identify the groups facing systematic barriers to care. We aimed to determine the sociodemographic characteristics that were associated with access among patients diagnosed with an eye problem and referred for treatment in the Vision Impact Programme, currently operating in Meru County.MethodWe used an embedded, pragmatic, cross-sectional design. A list of sociodemographic questions was developed with input from key stakeholders. The final question set included the following domains: age, gender, religion, marital status, disability, education, occupation, income, housing, assets, and health insurance. These were integrated into an app that is used to screen, refer, and check-in (register) participants within a major eye screening programme. We gathered data from 4,240 people who screened positive and were referred to their local outreach treatment clinic. We used logistic regression to identify which groups were facing the greatest barriers to accessing care.ResultsA quarter of those screened between April – July 2023 were found to have an eye problem and were referred, however only 46% of these people were able to access care. In our fully adjusted model, at the 0.05 level there were no statistically significant differences in the odds of attendance within the domains of disability, health insurance, housing, income, or religion. Strong evidence (p < 0.001) was found of an association between access and age, gender, and occupation; with males, younger adults, and those working in sales, services and manual jobs the least likely to receive care.ConclusionsAccess to essential eye services is low and unequal in Meru, with less than a third of those aged 18–44 receiving the care they need. Future work should explore the specific barriers faced by this group.

The impact of targeted local outreach clinics to improve COVID-19 vaccine uptake: controlled interrupted time series in South West England

BackgroundOutreach clinics were part of efforts to maximise uptake in COVID-19 vaccination.MethodsWe used controlled interrupted time series, matching on age, sex, deprivation and vaccination eligibility date, to determine the effect of outreach clinics on time to first COVID-19 vaccine, using a population-based electronic health record database of 914,478 people, from December 2020 to December 2021; people living within 1 mile of each outreach clinics were exposed.Results50% of 288,473 exposed citizens were white British, and 71% were aged 0–49 years. There was no evidence for an overall statistically significant increase in cumulative percentage vaccinated due to the outreach clinic at 6 weeks, with an overall pooled effect estimate of -0.07% (95% CI: -1.15%, 1.02%). The pooled estimate for increased cumulative vaccine uptake varied slightly depending on how the analysis was stratified; by ethnic group it was − 0.12% (95% CI: -0.90%, 0.66%); by age group it was − 0.06% (95% CI: -0.41%, 0.28%); and by deprivation it was 0.03% (95% CI: -0.74%, 0.79%).ConclusionsLiving within a mile of an outreach clinic was not associated with higher vaccine uptake. Evaluation of future outreach clinics should consider the relative importance of travel amongst other barriers to accessing vaccines.

A Protocol for the Inclusion of Minoritized Persons in Alzheimer Disease Research From the ADNI3 Diversity Taskforce

Black or African American (hereinafter, Black) and Hispanic or Latino/a/x (hereinafter, Latinx) adults are disproportionally affected by Alzheimer disease, but most research studies do not enroll adequate numbers of both of these populations. The Alzheimer's Disease Neuroimaging Initiative-3 (ADNI3) launched a diversity taskforce to pilot a multipronged effort to increase the study inclusion of Black and Latinx older adults. To describe and evaluate the culturally informed and community-engaged inclusion efforts to increase the screening and enrollment of Black and Latinx older adults in ADNI3. This cross-sectional study used baseline data from a longitudinal, multisite, observational study conducted from January 15, 2021, to July 12, 2022, with no follow-up. The study was conducted at 13 ADNI3 sites in the US. Participants included individuals aged 55 to 90 years without cognitive impairment and those with mild cognitive impairment or Alzheimer disease. Efforts included (1) launch of an external advisory board, (2) changes to the study protocol, (3) updates to the digital prescreener, (4) selection and deployment of 13 community-engaged research study sites, (5) development and deployment of local and centralized outreach efforts, and (6) development of a community-science partnership board. Screening and enrollment numbers from centralized and local outreach efforts, digital advertisement metrics, and digital prescreener completion. A total of 91 participants enrolled in the trial via centralized and local outreach efforts, of which 22 (24.2%) identified as Latinx and 55 (60.4%) identified as Black (median [IQR] age, 65.6 [IQR, 61.5-72.5] years; 62 women [68.1%]). This represented a 267.6% increase in the monthly rate of enrollment (before: 1.11 per month; during: 4.08 per month) of underrepresented populations. For the centralized effort, social media advertisements were run between June 1, 2021, and July 31, 2022, which resulted in 2079 completed digital prescreeners, of which 1289 met criteria for subsequent site-level screening. Local efforts were run between June 1, 2021, to July 31, 2022. A total of 151 participants underwent site-level screening (100 from local efforts, 41 from centralized efforts, 10 from other sources). In this cross-sectional study of pilot inclusion efforts, a culturally informed, community-engaged approach increased the inclusion of Black and Latinx participants in an Alzheimer disease cohort study.

A Journey Through the History and Statistics of ArASNews

A review of ArAS Electronic Newsletter ArASNews (e-newsletter of the Armenian Astronomical Society – ArAS) is given. ArASNews has been published since 2002 and during these years it has largely contributed to the circulation of information among the Armenian astronomical community, as well as other astronomical societies and organizations. It is being distributed monthly to all ArAS members. ArASNews publishes informative materials on ArAS, Byurakan Astrophysical Observatory (BAO), and Armenian astronomy in general, reports on ArAS Annual Meetings and other astronomy-related events in Armenia, participation of the Armenian astronomers in important international meetings. Additionally, it features articles commemorating notable Armenian astronomers, announcements of new ArAS members, and discussions on various astronomical topics including archaeoastronomy and public outreach initiatives, acceptance of new ArAS members, achievements of the Armenian astronomers, ArAS Annual Prizes for Young Astronomers and other international and local prizes, Astronomical Education and Public Outreach in Armenia, Armenian Archaeoastronomy, as well as scientific articles (reviews) on important studies. We will give some statistics on the number of published articles and pages, the distribution of articles by topics, and more. ArASNews’ numerous useful articles may be accessed through its Reference List.

Mental Health, Sleep Quality, and Psychological Well-Being during the Holy Month of Ramadan.

Ramadan, a significant month for Muslims, presents unique challenges, particularly in the context of the USA. This study aimed to explore the relationship between mental health factors (depression, anxiety, and stress), sleep quality, and psychological well-being (subjective happiness and life satisfaction) during the month of Ramadan among participants and by gender. This study enlisted 163 participants (74% female, 25.7% male), with an average age of 36.8 years (SD = 13.1), mostly of Middle Eastern descent. Recruitment was conducted via flyers at local community mosques, social media, and outreach through local religious leaders. Data collection took place in the last three weeks of Ramadan, utilizing a Qualtrics survey that included the Depression Anxiety and Stress Scale (DASS-21), the Subjective Happiness Scale (SHS), Satisfaction with Life Scale (SWLS), and the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed by means of descriptive statistics and multiple linear regression models using SPSS version 28. The study indicates that while mental health and psychological well-being remained within normal levels during Ramadan, sleep scores indicated significant sleep disturbance among participants. Multiple linear regression models revealed that subjective happiness, sleep duration, and the global PSQI score were significant predictors of stress for the total sample (F = 9.816, p = 0.001). Life satisfaction was the only significant predictor of anxiety (F = 7.258, p = 0.001), and it, alongside subjective happiness, significantly predicted depression (F = 12.317, p = 0.001). For men, subjective happiness alone predicted stress, while life satisfaction was a predictor for both anxiety and depression (F = 4.637, p = 0.001). In women, sleep duration and medication usage were linked to stress but not anxiety. Life satisfaction and subjective happiness were, however, predictors of depression (F = 6.380, p = 0.001). Fostering positive affective states can serve as a protective mechanism against the potential psychological distress associated with altered sleep patterns and lifestyle changes that accompany Ramadan. This study highlights that Ramadan is a tool for bolstering happiness and life satisfaction, thereby lowering levels of stress, anxiety, and depression. In non-Muslim majority contexts like the USA, there is a need for accommodations to safeguard against potential psychological distress.

ECG Characteristics of Young High School Athletes in Northwest Florida

ABSTRACT Background: Sudden cardiac death in young athletes is a rare and tragic occurrence. A preparticipation physical examination (PPE) is widely used to identify athletes who might be at risk of sudden cardiac death. High school athletes in Escambia, Okaloosa, Santa Rosa, and Walton counties in Florida undergo annual sports physicals through a local sports medicine outreach program. A resting electrocardiogram (ECG) was implemented during the 2022 PPE. The aim of this study was to document the efficacy of implementing ECGs and to highlight the cardiac abnormalities identified in young athletes as part of a 1-d PPE. Methods: In total, 1,357 high school athletes (males = 879 and females = 478; age, 15.1 ± 1.3 years) completed a resting 12-lead ECG. These were interpreted by cardiologists using the International Criteria, with abnormal results being further investigated before final sports clearance. Descriptive statistics regarding ECG findings were analyzed. Results: Twenty-three ECGs (1.7%) were classified as “abnormal” and were referred for further testing. Of these, 14 athletes were cleared to participate in sports, and 6 declined further evaluation. Three athletes, all males, were not cleared for sports participation. Of these, 2 athletes presented with Wolf-Parkinson-White syndrome (0.15%), and 1 athlete (0.10%) presented with dilated cardiomyopathy. Conclusion: Adding ECG screening as part of a single-day PPE can be used as a tool in identifying cardiac abnormalities among young athletes. To our knowledge, this is the highest number of athletes screened during a PPE in 1 d nationwide.

Multimodal Surveillance Model for Enterovirus D68 Respiratory Disease and Acute Flaccid Myelitis among Children in Colorado, USA, 2022.

Surveillance for emerging pathogens is critical for developing early warning systems to guide preparedness efforts for future outbreaks of associated disease. To better define the epidemiology and burden of associated respiratory disease and acute flaccid myelitis (AFM), as well as to provide actionable data for public health interventions, we developed a multimodal surveillance program in Colorado, USA, for enterovirus D68 (EV-D68). Timely local, state, and national public health outreach was possible because prospective syndromic surveillance for AFM and asthma-like respiratory illness, prospective clinical laboratory surveillance for EV-D68 among children hospitalized with respiratory illness, and retrospective wastewater surveillance led to early detection of the 2022 outbreak of EV-D68 among Colorado children. The lessons learned from developing the individual layers of this multimodal surveillance program and how they complemented and informed the other layers of surveillance for EV-D68 and AFM could be applied to other emerging pathogens and their associated diseases.

Commenting on local politics: An analysis of YouTube video comments for local government videos

This study compares the content of transcripts of videos uploaded by local governments with the comments on those videos, utilizing three transformer-model-based techniques: summarization of the discourse content of video transcripts, topic modeling of summarized transcripts, and sentiment analysis of transcripts and of comments. The analysis shows that some types of video content, for example those dealing with music or education, are more likely to attract positive comments than content related to policing or government meetings. In addition to their potential relevance for local government outreach, the study may represent a viable exploratory method for comparison of online video content and written comments in the context of computational social science analyses of user interaction and commenting behavior.

A Protocol for the Comparison of Telephone and In-Person Interview Modalities: Duration, Richness, and Costs in the Context of Exploring Determinants of Equitable Access to Community Health Services in Meru, Kenya

Our research team is conducting phenomenological interviews with people who have not been able to access health services in Meru County, Kenya, aiming to explore the barriers they face and their perceptions of how we could modify our community outreach services to improve accessibility. We plan to conduct an embedded study that compares in-person and telephone interview modalities in terms of the richness of the data and the resources required for each modality. This is a qualitative mode comparison study, embedded within a broader project to understand and address the issues that lead to inequitable access to local outreach clinics in Kenya. We will recruit at least 40 people who have been referred to local services but who have not been able to attend. We will conduct in-person interviews with half of these people, and telephone interviews with the other half. We will use random numbers to determine the modality that is used for each participant. All interviews will be conducted in the same month by a team of six research assistants who will use the same topic guide and analytic matrix for each interview. For all interviews conducted in each mode we will record and compare the mean duration; mean number of themes reported by each participant; total number of themes reported; interviewer rating of perceived richness; interviewer rating of perceived ease of building rapport; number of days taken by the team to complete all interviews; and all costs associated with conducting the interviews. The findings will help us to weigh up the relative strengths and weaknesses of each modality for our research context. Given that we are exploring a focused research question in a fairly homogenous population, we anticipate that there may not be a meaningful difference in the number of themes reported.

Recruitment and Engagement of LGBTQIA+ Older Adults for The Stonewall Generations Study

AbstractBackgroundAccording to the Alzheimer’s Association, approximately 350,000 LGBTQIA+ older adults in the U.S. currently have Alzheimer’s disease and related disorders (ADRD), increasing to over a million by 2030. Our recent research suggests that 1 in 7 LGBTQIA+ older adults report problems with their memory and thinking (subjective cognitive decline), which was much higher than their cisgender (not transgender), heterosexual counterparts. However, very few studies have assessed the cognitive function of LGBTQIA+ older adults.MethodsWe are utilizing tailored recruitment and engagement strategies to recruit a racial/ethnically diverse sample of at least 250 LGBTQIA+ and 250 non‐LGBTQIA+ older adults aged 50+ from the U.S. with a range of cognitive function from healthy to mildly impaired. Our recruitment and engagement approaches are guided by community‐based participatory research approaches that focus on building trust, collaboration, cultural humility, and giving back to the community.ResultsWe have been utilizing novel methods to recruit and engage LGBTQIA+ older adults and community organizations across the U.S. into The Stonewall Generations Study. Our current efforts involve a diverse recruitment plan that relies on recruitment via social media (e.g., Facebook, Twitter), referrals from community organizations, local outreach (tabling at community resource fairs, attending Pride and other LGBTQIA+ focused events), presenting to LGBTQIA+ aging service organizations, and developing unique social and educational engagement events.ConclusionsOur current efforts to recruit and engage LGBTQIA+ older adults are important because they can help to identify ways to improve representation of diverse communities in Alzheimer’s disease and aging research. There is a need for tailoring research and recruiting and engaging diverse older adults, especially LGBTQIA+, into research and finding ways to address the health and Alzheimer’s disease risk of underserved populations. The Stonewall Generations Study aims to increase knowledge of culturally‐relevant recruitment and engagement strategies and identify targets for preventative interventions to decrease ADRD risk among LGBTQIA+ older adults.

Cognitive Testing in Diverse Populations to Further the Objective and Clinical Understanding Study ‐ FOCUS

AbstractBackgroundOne of the great challenges facing clinical trial recruitment is to have a representative sample reflective of the diversity of the US population. While racial and ethnic minorities compromise 39% of the United States population, they only account for 2%‐16% of clinical trial participants.1 The aim of the FOCUS study was to collect cognitive testing data from a diverse population and develop normative ranges for Cognivue, the first FDA‐cleared computerized cognitive assessment device based on modern cognitive neuroscience. Cognivue Thrive provides a 5‐minute cognitive screen while Cognivue Clarity provides a 10‐minute comprehensive assessment, allowing both physicians and non‐physician clinicians to objectively and quantitatively access brain health beyond traditional paper and pencil cognitive tests.MethodCognivue partnered with Velocity Clinical Research to lead the recruitment efforts for the FOCUS study. The enrollment goal included an objective to enroll a group resembling the racial, ethnic, gender, and educational makeup recorded in the 2020 U.S. census data. Study subjects were recruited through local community outreach, participant referrals, and advertising. Recruitment was stopped once goals for specific sub‐groups were reached, to model real‐world outcomes. Cognivue Thrive and Clarity were administered to assess scoring and normative ranges and compared against performance on other neuropsychological test batteries within the diverse study cohort.ResultThe Cognivue/Velocity partnership resulted in recruitment of more than 1,500 subjects from 14 sites in 11 states with a mean age of 50.2±16.3y (range 18‐89), 59.2% female, and 51.8% with 12 years or less of education. Over 28% of subjects identified their race as Black or African American, American Indian or Alaska Native, Asian, Native Hawaiian or Pacific Islander, or other non‐white, and over 12% of participants identified as Hispanic or Latino.ConclusionWorking in collaboration with Velocity, a clinical research partner with study sites throughout the United States, Cognivue was able to reach a 37% research participation rate of historically underserved and underrepresented populations in the national FOCUS study. 1Clin Pharmacol Ther. 2015 Mar;97(3):263‐73. https://doi.org/10.1002/cpt.61.

Raising Rarity: Creating meaningful and sustainable conservation outcomes through community-based outreach.

A priority in plant conservation science is the identification of species at risk of extinction, allowing for conservation efforts to be focused on those that are most critically endangered to prevent their loss. A 2023 revision of threatened plants in Victoria found that 1,557 species remain under direct threat of extinction, despite conservation work being undertaken across the state to safeguard both individual species and plant communities. Although conservation efforts are fundamental to the protection of our flora, the persistently high number of threatened species illustrates a need to reimagine the way in which we approach conservation. Central to this is a need to engage more people across a broader cross-section of the community so that they can contribute to initiatives that effectively reduce the number of species at risk.Raising Rarity is a community-based outreach programme run by Royal Botanic Gardens Victoria (RBGV). It is designed to actively engage distinct sectors of the Victorian community in local plant conservation. The programme acknowledges that although the expertise provided by RBGV in areas that include conservation horticulture, seed ecology, population genetics, outreach and education is critical to plant conservation efforts, the engagement and involvement of the broader community is fundamental to creating sustainable plant conservation solutions. Raising Rarity achieves this by working with volunteers, school groups, regional botanic gardens, local councils and members of the nursery industry to grow and display rare and threatened Victorian plants in accessible horticultural settings. The initiative aims to increase public knowledge, awareness and hands-on involvement in plant conservation.There are four key components to the Raising Rarity programme: (1) school outreach; (2)local government outreach; (3) botanic gardens outreach in an initiative called Care for the Rare; and (4) commercialisation of an RBGV rare plant collection. This article provides an overview of each of these components and outlines future objectives for the Raising Rarity programme.

Professional medical education approaches: mobilizing evidence for clinicians.

Rapidly proliferating high-quality evidence supports daily decision-making in clinical practice. Continuing professional medical education links this evidence to practicing clinicians who are strongly motivated to improve the quality of their care by using the latest information. Approaches to professional education vary, and their effects depend on specific scenarios. This narrative review summarizes the main approaches for professional medical education that facilitate the mobilization of evidence for clinicians. It includes traditional learning (passive and active dissemination of educational materials, lectures, and mass media dissemination), constructivist learning (engaging in local consensus processes and education outreach visits, interfacing with local opinion leaders, conducting patient-mediated interventions, employing audit and feedback processes, and utilizing clinical decision-supporting systems), and blended learning approaches (the integration of in-person or online passive learning with active and creative learning by the learners). An optimized selection from these approaches is challenging but critical to clinicians and healthcare systems.

Travel-associated cost savings to patients and the health system through provision of specialist head and neck surgery outreach clinics in rural New South Wales, Australia.

Centralisation of head and neck surgical services means that patients in regional and remote Australia need to travel long distances for treatment and follow-up, imparting a significant financial burden on patients and the health system. To estimate costs of travel to local outreach clinics and determine potential cost savings to patients and the health system by avoiding patient travel to major cities for head and neck surgical care. Retrospective audit of three head and neck surgery outreach clinics in New South Wales, Australia over 4 years (2017-2020). Direct costs of travel from a patient's residence to their local outreach clinic were estimated. Costs of travel and accommodation to Sydney for an appointment were calculated for different travel modes. Estimated reimbursements for travel through government support schemes were calculated based on published rates. Some 657 patients attended the three clinics, accounting for 1981 appointments. Depending on mode of travel, the estimated median cost of return travel (including accommodation) to Sydney was $379 to $739 per patient per trip and the median government reimbursement ranged from $182 to $279 per trip. In comparison, the cost of return travel by car to local outreach clinics ranged from $28 to $163 per appointment. Outreach clinics were estimated to save patients a median of $285 per trip and avoided government reimbursements of $215 per trip. Despite uptake in telehealth, outreach medical services remain an important asset for people living in regional areas to address inequities in access. However, the cost benefits are likely to be underestimated as our approach did not account for indirect costs associated with travel. Outreach head and neck surgical services located in regional areas can reduce the financial burden on both patients and the healthcare system. Greater investment in outreach clinics could ensure sustainability of services to promote equitable access to specialised surgical services.

Factors Associated With Awareness, Adoption, and Implementation of Anterior Cruciate Ligament Injury Prevention in Youth Sports.

Anterior cruciate ligament (ACL) injuries are among the most common injuries in adolescent athletes and result in significant financial and physical morbidity. Evidence-based programs designed to prevent ACL injury are effective. However, their adoption remains low. We sought to evaluate the awareness, evidence-based implementation, and barriers to implementation of ACL injury prevention programs (ACL-IPP) among youth athletic coaches. Higher education level of the coach, higher level of training, number of teams coached, and coaching female teams would be associated with ACL-IPP implementation. Cross-sectional survey. Level 4. We conducted an email survey sent to all 63 school districts within Section VI of the New York State Public High School Athletic Association. We employed descriptive statistics and tests of correlation to identify factors associated with ACL-IPP implementation. A total of 73% of coaches said they were aware of ACL-IPP, and only 12% of coaches implemented ACL-IPP according to best evidence. Coaches of higher competitive levels were more likely to adopt ACL-IPP (P = 0.01), more likely to use them multiple times per week (P = 0.03), and for ≥1 seasons (P = 0.02). Coaches of multiple teams were more likely to adopt ACL-IPP (P = 0.01). There were no differences in evidence-based implementation of ACL-IPP with gender coached or level of education of the coach. Overall awareness, adoption, and evidence-based implementation of ACL-IPP remain low. These results suggest that coaches at higher levels of play and multiple teams tend to use ACL-IPP more often. Gender coached and level of education do not appear to be associated with awareness or implementation. Evidence-based ACL-IPP implementation remains low. Targeting coaches of younger athletes and fewer teams with local outreach programs and ACL-IPP may increase the implementation of ACL-IPP.

114 Evaluation of Assertions from Educational, Outreach and Engagement Programs in Pasture-Based Livestock Systems

Abstract Assertions about grazing management and grazing systems should be evaluated based on the scientific literature. Prior assumptions can limit our ability to achieve constructive dialogue regarding the merits of various stocking methods. These include the assumption that rotational stocking is inherently superior to continuous stocking, regardless of the nature of the overall grazing system, and the presumption that continuous stocking implies overgrazing. We revisited assertions about grazing management in general, but more specifically the choice of the stocking method, and considered their merit in the context of evidence from the literature, including a chapter titled Prescribed Grazing on Pasturelands from a National Resource Conservation Service (NRCS) literature synthesis published in 2012. We framed those assertions in the form of questions. The questions were: a) Does choice of rotational stocking ensure well-managed pastures?, b) Does rotational stocking result in greater accumulation of soil carbon than continuous stocking?, c) Does rotational stocking increase pasture productivity and optimal stocking rate compared with continuous stocking?, d) Does forage nutritive value and individual animal performance increase in rotational versus continuous stocking?, and e) Do pastures “look better” in rotational versus continuous stocking?. The objectives were to consider whether these often-stated assertions about grazing management were supported, refuted, or simply not adequately assessed by the body of scientific evidence. It is important to recognize that choice of stocking method is only one element of grazing management and grazing management is only one element of a grazing system. Thus, stocking method is “one piece of a very large pie”. Additionally, stocking rate (grazing intensity) is a separate and independent grazing management choice from stocking method, such that both rotationally and continuously stocked pastures can be understocked, overstocked, or optimally stocked. It is unfortunate that choice of stocking method dominates discussions of improving grazing management to the expense of other issues, when in fact intensity of grazing has been shown conclusively to be the most important determinant of a wide array of soil, plant, animal, and ecosystem responses. We have observed that terminology such us regenerative grazing, holistic planned grazing, adaptative multipaddock grazing, management intensive grazing, high intensity low frequency grazing, and others, arise frequently and can dominate discussions in the realm of education, outreach and engagement programs in pasture-based livestock systems. These words/themes lack clear definition, and this lack of specificity may promote misconceptions, thus hindering the opportunity for critical thinking and ultimately the advancement and improvement of grazing systems. Educational efforts in pasture management should strive to remain relevant by focusing on experimental evidence. Local (i.e., state or county level) outreach and engagement programs are challenged with providing timely and specific information with implementable guidelines based on frequent observations at the landscape and farm levels.

Measuring the short-term economic impacts of ecological restoration

Increasing demand for ecological restoration has resulted in the development of a “restoration economy” in the United States. Often, the implementation phase of restoration efforts involves substantial capital and labor investments, the short-term economic impacts of which should not be ignored when evaluating the outcomes of restoration efforts. This publication describes the relevant economic impact analysis methods and summarizes a case study application of these methods for the restoration of the Lone Cabbage Reef (LCR) Complex, a recently restored oyster reef in Florida. It should be useful to local governments, outreach and Extension agents, and management agency personnel who want to better understand the economic impacts of restoration actions.