Mobile Van Research Articles

Major and minor discordance in dual-energy X-ray absorptiometry diagnosis of osteoporosis – A cross-sectional, population-based, observational study in Indian women

Objective:The study objective was to evaluate the presence of major and minor discordance in the diagnosis of osteoporosis in a population-based screening program of Indian women using hip and spine dual-energy X-ray absorptiometry (DEXA).Methods:In this institutional review board-approved study, a population-based screening program was offered to women aged > 40 using a mobile van model. A total of 5708 women underwent DEXA between May 2012 and May 2016 as a population-based, opt-in screening program offered to women as an outreach program. Bone mineral density (BMD) was measured at the hip and spine, which was used to derive T-scores and to determine the prevalence of discordance.Results:The densitometry scores were concordant in 42.50% of the cases, with abnormal bone mineral density, whereas in 54.15% of cases, there was minor discordance and major discordance in 3.35% of cases. Body mass index, weight, age, and postmenopausal status of the patient were important predictors of the presence of discordance.Conclusions:Clinicians and epidemiologists should be prepared for at least five out of every ten women screened to have discordance of the T scores at the two anatomical sites scanned. If there is discordance of BMD in underweight persons or in those with low body mass index, then causes other than physiological discordance should be considered, which may be further evaluated.

Challenges Faced by Police Officers in Forensic Criminal Investigation A Case Study of District Peshawar, Khyber-Pakhtunkhwa

Forensic science plays a crucial role as a component in the criminal justice system. During criminal investigation, forensic labs are one of the key stakeholders which maintain the chain of custody of the physical evidence collected from the crime scene which need to be examined scientifically by forensic expert to provide testimony before the court. Forensic science is essential because no one can deny from their DNA, fingerprints impression, audio, video examination etc. This study aims to know about the problems police officials are facing in Forensic Criminal Investigation in district Peshawar. Investigation officers around the world are facing problems in forensic investigation in which the most crucial is the damaging the physical evidences on crime scene by the people before the arrival of investigation officers which eventually disturb the forensic examination process. Pakistan is not an exception in this regard. Police experiences problems in proper preservation of physical evidences from crime scene and its transportation to forensic lab; DNA records; lack of DNA labs; etc. which create hurdles in maintaining the criminal case with respect to forensics. A quantitative research was carried out by using 50 sample size of male Police Investigation officers through convenience sampling technique and data was collected through interview schedule. Research findings shows that investigation officers were facing numerous problems in conducting forensic criminal investigation in district Peshawar like problems in forensic training on crime scene; untrained investigator were damaging the physical evidence; lack of Crime Scene Mobile Van. Furthermore it was founded that DNA lab at Khyber Medical College (KMC) was not properly operational and Police were facing problems in coordination from other agencies like NADRA and KMC. This study recommends for the provision of crime scene mobile van to the investigators, creation of forensic training schools, and establishment of Forensic and DNA lab which is important to maintain the proper flow of forensic criminal investigation.

“Diabetes care at doorsteps”: A customised mobile van for the prevention, screening, detection and management of diabetes in the urban underprivileged populations of Delhi

Diabetes is on the rise in India and recently shown to be increasing in the urban underprivileged. Lack of awareness of the disease, its complications, combined with lack of financial resources among the underprivileged, often results in late detection and more complications in them. To combat this, healthcare delivered at the doorstep through the use of a customised mobile medical van is a potentially attractive option.We used a customized mobile van (included trained personnel, glucose meters, fundus evaluation camera, apparatus for detection of neuropathy and foot circulation and net enabled Skype calling for remote consultation) for educating general population regarding healthy lifestyle and screening, management and intervention in patients with diabetes.The project covered 10 underprivileged areas (n, 2,31,000 people) in Delhi. Total of 24,072 individuals (10.9% of total population) attended 352 awareness sessions. A total 3,12,347 visits (included repeat visits) were carried out for screening, education and management for obesity and diabetes. During screening (n, 16,834), 2933 subjects (18.7%) had high random blood glucose levels (>200 mg/dL) and had a blood pressure averaging 127.1 ± 23.6/81.3 ± 16.6 mm of mercury (n, 16,339). A pre-post intensive lifestyle counselling for 6 months in a subset of 352 diabetic patients (of which 77.8% i.e. n, 274 were overweight/obese) showed a significant lowering in weight (p < 0.001). In addition, 292 frontline workers and 256 paramedical workers were given training regarding lifestyle and diabetes, over 20 sessions.Based on achievements of this project of spreading awareness, screening, and management of diabetes and obesity in the large number of individuals in urban underprivileged colony, we believe this project could be extended to other cities and rural areas of India, and to other developing countries as well.

Static, Portable and Smart Detection of Water Quality in Panchayath Distribution Tank

The significant crunch in the Current world is Water pollution. It has created an abundant influence on the Environment. With the intention of the non-toxic distribution of the water and its eminence should be monitored at real time. This paper suggested the smart detection with low cost real time system which is used to monitor the quality of water through IOT(internet of things). The system entail of different sensors which are used to measure the physical and chemical parameters of the water. The quality parameters are temperature, pH, turbidity, conductivity and Total dissolved solids of the water are measured. Commercially available products capable of monitoring such parameters are usually somewhat expensive and the data’s are collected by mobile van. Using Sensor technology provides a cost-effective and pre-eminent reliable as they can provide real time output. The measured values from the sensors can be observed by the core controller. The controller was programmed to monitor the distribution tank on a daily basis to hour basis monitoring. The TIVA C series is used as a core controller. The Controller is mounted on the side of the distribution tank. Finally, the sensor data from the controller is sent to Wi-Fi module through UART protocol. Wi-fi Module is connected to a public Wi-Fi system through which data is seen by the locals who are all connected to that Wi-Fi network.

The impact of caregiver health literacy on healthcare outcomes for low income minority children with asthma

Objectives: The aim of this exploratory study was to assess the impact of caregiver health literacy (HL) on health care outcomes for their child with asthma.Methods: Caregiver dyads across two different healthcare delivery systems completed a battery of validated asthma outcome instruments, including the Newest Vital Sign™ as a measure of HL for the caregivers of children ages 7–18 y. Utilization history was obtained through the electronic medical record. Descriptive analysis with bivariate associations was conducted.Results: There was no direct relationship between HL and asthma outcomes in the 34 Hispanic and African American caregiver-child dyads. However, caregiver health literacy was significantly related to language (p = 0.02). African American English-speaking caregivers, seen in an urban emergency department, demonstrated adequate health literacy. Hispanic Spanish-speaking caregivers, seeking care in a mobile asthma van, showed limited health literacy. There was no significant association between caregivers’ HL and routine asthma care visits when language and child age were controlled.Conclusions: Assessing patient factors can identify persons at risk who need additional support to negotiate the healthcare system when providing care for a child with asthma.

Increasing Childhood Asthma Care Appointments on a Mobile Asthma Van

Children in two communities of a large city in the Midwestern United States have higher rates of asthma than other areas of the city. The communities have barriers to accessing care, including high rates of unemployment and being uninsured and undocumented. A mobile van provides no-cost asthma care to children at schools in these communities, but use of these services has decreased more than 50% over the past 5 years. School nurses have the potential to improve asthma outcomes by collaborating with health-care providers. The purpose of the program was to increase the number of appointments scheduled and attended on the asthma van at both schools. For this program, we (a) implemented an unaccompanied minor consent, (b) enhanced care coordination, and (c) improved a respiratory health survey tool. Results showed an increased number of appointments scheduled and attended on the asthma van. The program was successful even though community-specific barriers existed.

Expanding low-threshold buprenorphine to justice-involved individuals through mobile treatment: Addressing a critical care gap

BackgroundOpioid use disorder (OUD) is highly prevalent among justice-involved individuals. While risk for overdose and other adverse consequences of opioid use are heightened among this population, most justice-involved individuals and other high-risk groups experience multiple barriers to engagement in opioid agonist treatment. MethodsThis paper describes the development of Project Connections at Re-Entry (PCARE), a low-threshold buprenorphine treatment program that engages vulnerable patients in care through a mobile van parked directly outside the Baltimore City Jail. Patients are referred by jail staff or can walk in from the street. The clinical team includes an experienced primary care physician who prescribes buprenorphine, a nurse, and a peer recovery coach. The team initiates treatment for those with OUD and refers those with other needs to appropriate providers. Once stabilized, patients are transitioned to longer-term treatment programs or primary care for buprenorphine maintenance. This paper describes the process of developing this program, patient characteristics and initial outcomes for the first year of the program, and implications for public health practice. ResultsFrom November 15, 2017 through November 30, 2018, 220 people inquired about treatment services and completed an intake interview, and 190 began treatment with a buprenorphine/naloxone prescription. Those who initiated buprenorphine were primarily male (80.1%), African American (85.1%), had a mean age of 44.1 (SD = 12.2), and a mean of 24.0 (SD = 13.6) years of opioid use. The majority of patients (94.4%) had previous criminal justice involvement, were unemployed (72.9%) and were unstably housed (70.8%). Over a third (32.1%) of patients had previously overdosed. Of those who began treatment, 67.9% returned for a second visit or more, and 31.6% percent were still involved in treatment after 30 days. Of those who initiated care, 20.5% have been transferred to continue buprenorphine treatment at a partnering site. ConclusionsThe PCARE program illustrates the potential for low-threshold buprenorphine treatment to engage populations who are justice-involved and largely disconnected from care. While more work is needed to improve treatment retention among vulnerable patients and engaging persons in care directly after release from detention, offering on-demand, flexible and de-stigmatizing treatment may serve as a first point to connect high-risk populations with the healthcare system and interventions that reduce risk for overdose and related harms.

EMS Can Safely Transport Intoxicated Patients to a Sobering Center as an Alternate Destination

We evaluate a sobering center as an alternate destination for acute intoxication. Our aims are to count patient visits that originated from emergency medical services (EMS) or the emergency department (ED) that then result in a secondary transfer from the sobering center to the ED, and to describe and categorize the clinical reasons for transfer to the ED. The San Francisco Sobering Center, a continuously nurse-staffed facility operating since 2003, provides short-term (6-to 8-hour) care for adults with acute alcohol intoxication. Paramedics use a county EMS protocol to triage low-risk intoxicated patients to the sobering center. A case review was performed on all visitors during 3 years who were secondarily transferred from the sobering center. Reason for transfer was categorized by clinical indication. From July 2013 to June 2016, 11,596 visits (from 3,268 unduplicated adults) were documented. Of these, 4,045 (35%) were referred by EMS and 1,348 (12%) were referred from the ED. Other referring parties included the mobile van service, police, homeless service provider, self-referral, and others. Of the total visitors, 506 (4.4%; 95% confidence interval 4.0% to 4.8%) were secondarily transferred to an ED; 151 were referred by EMS and 62 by the ED. Clinical indications for ED transfer included pulse greater than 100 beats/min (26%), alcohol withdrawal (19%), pain (excluding chest pain) (19%), altered mental status (13%), and emesis (13%). Most clients had more than one clinical indication for transfer (median 2; range 1 to 5). The San Francisco Sobering Center is an appropriate, safe EMS destination for patients with acute alcohol intoxication.

Planning area-specific prevention and intervention programs for HIV using spatial regression analysis

ObjectiveThe study was conducted to inform area-based prevention intervention programs and plan resource allocation to reduce new infections in the District of Columbia (DC), United States of America. Study designThe analysis used spatial regression to evaluate the spatial heterogeneity of the new HIV rate and its association with sexually transmitted infection repeaters (STIREPs) and socio-economic as well as demographic characteristics. The HIV and STIREP data were obtained from the DC Department of Health surveillance data (2010–2016). Other covariates were obtained from the American Community Survey, 2016. MethodsOrdinary least squares (OLS) and geographically weighted regression (GWR) were used to compare global and local relationships. GWR-computed robust results were compared with other spatial regression methods such as spatial lag or spatial error methods. ResultsFor the OLS model, age, high school dropouts (NHSD), and the black population had an association with new HIV diagnoses (HIVDVi). The results from the GWR model demonstrate spatial variations of association of STIREPs; mean age of each block group; and percentage of female population, NHSD, unemployment, and poverty with HIVDVi. Akaike information criterion (AICc) value for the global model was 2770.99, and R2 was 0.54 (54%). The R2 and AICc of the GWR model was 0.81 (81%) and 2580.84, respectively, where the latter showed a 0.27 (27%) increase in R2 and a decreased AICc. ConclusionThese results will assist in planning HIV prevention and intervention strategies. These results will also be used for targeted testing, planning pre-exposure prophylaxis, and access to health care. The results will help plan resource allocation to community-based providers for prevention intervention programs and fund public health programs such as condom distribution, mobile vans, and youth-based sex education.

Point-of-care testing (POCT) for HIV/STI targeting MSM in regional Australia at community \u2018beat\u2019 locations

BackgroundInnovative health promotion strategies are needed to improve access to HIV testing among regional people in Australia, particularly for men who have sex with men (MSM). This project aimed to establish proof of concept for point-of-care-testing (POCT) via a mobile van clinic at community ‘beat’ locations. Surveys evaluated client satisfaction, characteristics and testing preferences among ‘early adopters’. Sequential mixed-methods approach was used which included secondary qualitative analysis of field notes written by peer-testers (i.e., trained lay providers from the key population being targeted; to extend the contextualise the pilot evaluation), documenting barriers/facilitators and innovations, per action research and to guide recommendations for future health promotion initiatives.MethodsA POCT ‘proof of concept’ project (2, 3-hourly sessions/week; 20 weeks) was delivered in a regional town by peer-testers using a mobile clinic van, recruited by geosocial ‘apps’ targeting MSM. Clients completed surveys regarding demographics, and testing satisfaction, frequency and preferences. Peer-testers completed detailed field notes for each session including client characteristics and impressions, salient events, concerns and recommendations.ResultsThe program resulted in 34 online health promotion conversations with MSM and 34 POCT tests (19 HIV, 15 Syphilis; 18 unique client visits; 17 identified as MSM, with 1 heterosexual female. Rates of satisfaction among early adopters of POCT was high. Analysis of field notes revealed three major themes: 1) Practical challenges; 2) Barriers to engagement; and 3) Recruitment method/project promotion.ConclusionsAmongst early adopters satisfaction was high, with 47% of clients reported infrequent testing (over 12 months ago) or having ‘never tested’. No tests were reactive. Challenges associated with this health promotion initiative and recommendations for future HIV testing promotion and programs were outlined.

Baseline differences in characteristics and risk behaviors among people who inject drugs by syringe exchange program modality: an analysis of the Miami IDEA syringe exchange

BackgroundIn March of 2016, Florida passed the Infection Disease Elimination Act (IDEA), legalizing the formation of the first syringe exchange program in Florida, which opened in December of 2016 at a fixed site in Overtown, Miami. Since that time, the exchange expanded in April of 2017 to include a mobile van unit that provides the same services at different locations throughout Miami-Dade County.MethodsTrained interviewers conducted face-to-face interviews from all first-time participants at the IDEA Exchange, both at the fixed site and the mobile van unit.ResultsAmong 718 first-time enrollees, 74.8% were male, 52.1% were non-Hispanic White, 85.9% completed high school, 59.8% were unemployed, 42.1% were homeless, 54.2% reported an annual income of less than $15,000, and the mean age was 38 years. Participants at the fixed site and mobile van unit reported differences in socioeconomic status, injection drug-related behaviors, and pre-existing hepatitis C virus (HCV) infection status.ConclusionsTaken together, these results suggest that the mobile unit is capturing a subset of PWID in Miami that the fixed site is not, and vice-versa. As the opioid crisis extends into all demographics, such multimodal efforts to target various populations of PWID should be kept in mind, especially when unveiling future syringe exchanges in Florida and other late-adopting states.

Comparison of clinical and cost-effectiveness of two strategies using mobile digital x-ray to detect pulmonary tuberculosis in rural India

BackgroundMedanta - The Medicity, a multi-super specialty corporate hospital in Gurugram, Haryana launched a “TB-Free Haryana” Campaign; mobile van equipped with a digital CXR machine to screen patients with presumptive Tuberculosis (TB). Objectives: In this study, we aimed to assess the (1) yield and cost analysis of two strategies using mobile digital x-ray to detect Pulmonary TB in rural Haryana.MethodsAn observational study was conducted on all individuals screened by either of the two case finding strategies using a mobile x-ray unit (MXU) mounted on a mobile van in District Mewat, Haryana during Jan-March 2016.ResultsStrategy 1: Out of 121 smear negative cases, x-rays were suggestive of TB in 39(32%), of which 24 were started on TB treatment. Cost of identifying a smear negative TB was US$ 32. Strategy 2: Out of 596 presumptive TB, chest x-rays were suggestive of TB in 108 (18%), of which 67 were started on TB treatment (56 were smear negative TB). Cost of detecting any case of TB was US$ 08 (1 USD = 64 INR).ConclusionThe study reports a new initiative within a PPM model to improve the diagnosis of PTB by filling the gap in the current diagnostic infrastructure. We believe there is potential for replication of strategy 2 model in other states, although further evidence is required.

Evaluation of a local government \u201cshelter and van\u201d intervention to improve safety and reduce alcohol-related harm

BackgroundThe entertainment precincts of cities, while contributing to local economies, need to be carefully managed to mitigate harms. Individual behaviours and government regulation have typically been the foci of interventions aimed at reducing alcohol-related harm. Little is known about how changes to the built environment might influence alcohol-related harms in these settings. The aim of this study was to explore how a public shelter and a volunteer-funded and staffed mobile van in a regional city influenced perceptions of safety and reduction in alcohol-related harm.MethodsAn intrinsic case-study approach was used. Document reviews, qualitative interviews with 16 key informants (volunteers, licensees, police, local business owners, patrons, community members and security guards), observation, and secondary data analysis were conducted in 2016. A conceptual framework of the causative pathways linking the drivers of alcohol consumption with social and health outcomes was used to inform the analysis.ResultsThe shelter and van were frequently utilised but there was no significant association with a reduction in the proportion of alcohol-related hospital emergency department presentations or police incident reports. Occupational health and safety risks were identified for the volunteers which had no management plan.ConclusionsThe findings highlight the challenge faced by local governments/authorities wanting to provide community-based interventions to complement other evidence-based approaches to reduce alcohol-related harm. Local governments/authorities with restricted regulatory oversight need to collaborate with key agencies for targeted upstream and evidence-based alcohol prevention and management interventions before investing resources. Such approaches are critical for improving community safety as well as health and social outcomes in communities at greatest risk of alcohol-related harm.

Cancer-Free Drive in Rural India: Constituency Wise Initiatives by Member of Legislative Assembly

Background and context: Reducing the rate of cancer through awareness and prevention programs as well improvements in screening and treatment techniques is paramount. Citizen especially in rural India tend to neglect health due to routine chores of family life. The nonavailability of facilities worsen the issue. Tobacco habits leads to potentially malignant disorders and oral cancers. There is increasing trend of breast cancer, uterine and cervical cancers and also oral cancers. In India oral cancers are main cancers in males. Member of legislative assembly is public representative to represent state of Maharashtra. Cancer Free Constituency Drive was for creating awareness and screening for villagers. Katol is a rural constituency. There are 288 constituencies in Maharashtra state. Aim: 1) To create public awareness of all types of cancers. 2) To provide diagnosis and investigations and treatment to affected population. 3) Capacity building of young medical and dental professionals in cancer diagnosis and paramedical workers in screening all types of cancers. Strategy/Tactics: 72,056 house visits by 220 Asha workers and 129 nursing students and 30 dental interns to sensitize about 3,00,000 people through well designed brochure for all cancers. Self-Mouth mirror examination was designed for oral cancers and awareness against tobacco. The persons with complaints were told to visit camps on scheduled dates at 10 primary health centers. Program/Policy process: The mammography facilities and Papanicolaou test examination, dental examination in mobile vans and self-mouth mirror examination for oral cancers with trained professional carried out diagnosis in 10 primary health centers with the help of experts in medical and dental professionals. Suspeced cases were referred to tertiary referral medical hospitals. Outcomes: 5100 (males 2216 and females 2954) with complaints visited. Total 813 patients suspected to have cancers were examined by specialists from gynecology(84) general surgery (374) otorhinolaryngology (77) pediatrics (37) dermatology (19) and dentistry (131). 38 abnormal on mammography in 132 females, 55 abnormal reports from Pap smears in 472 females were evaluated, however no cancer detected in three months span. Twelve cases of oral cancers were detected and treated. Six breast cancers were detected and treated. Seven other cancers were reported by medicine and pediatric specialists. 150 cases of potentially malignant disorders were also identified. 90 had the oral submucous fibrosis (inability to open the mouth) caused due to areca quid chewing. The self-mouth mirror examination helped to create awareness against tobacco. What was learned: Awareness of cancer leading to early detection and treatment is possible in rural areas through “Cancer-Free Constituency”. The concept will help to pave the way for improved strategies and policies to better control occurrence and treatment of cancer and to address tobacco related health disparities across cancer care continuum.

A Study of Customer Satisfaction on After Sales Service of Two Wheelers in Kathmandu Valley

&lt;p&gt;The purpose of this study is to explore the relationship between various identified after-sales service attributes of Two Wheeler brands and customer satisfaction. It further intends at segregating the major after sales service as per Kano Model. This research is a quantitative research with a sample size of 280, 40 each on the basis of brands of bike and scooter. Sample is selected in a quota and convenience basis. The brands which are taken as samples includes Honda, Hero, Bajaj, Mahindra, Yamaha, Royal Enfield and others (TVS, Suzuki and VR). Kano Model analysis, frequency analysis, correlation, ANOVA test, independent sample t-test, etc. are used for data analysis. Kano model is taken as a basic model for the study.&lt;/p&gt;&lt;p&gt;Surprisingly, it is found that supporting after sales service has more impact on customer satisfaction than major after sales services have. Apparently, the most valued after sales service is behaviour of technicians which has the strongest and positive relation with customer satisfaction. Behaviour attributes play major role in customer satisfaction. Likewise, functional and dysfunctional questions are analyzed to carry out Kano Model Analysis. From the research, it is found that Spare part supply, Warranty, Bike wash and Service camp are the must be requirements. Likewise, Repair and Maintenance, Customer Care, Inspection and Mobile Van (office hours) are regarded as one dimensional services. And, Driving Orientation and 24 hours Mobile Van service are regarded as Attractive services. At present, 63% of customers are satisfied with the after sales service and 10% are very satisfied with the current after sales service. This study is significant to distributors of two wheelers and parent companies, as they can formulate after sales service strategies by understanding the present satisfaction level of customers and degree of each after sales service attributed to satisfy the customers.&lt;/p&gt;&lt;p&gt;Journal of Business and Social Sciences Research, Vol. 1, Issue 1, pp. 1-21&lt;/p&gt;

Abstract C73: A mobile mammography outreach program to increase screening in medically underserved areas in Missouri

Abstract Background: Breast cancer screening rates still lag behind US Preventive Services Task Force recommendations. Mobile health units are one common strategy to address barriers to mammography screening. Mobile mammography programs improve screening rates in medically underserved and rural communities by reducing barriers such as cost and travel distance. The aim of this study was to evaluate the characteristics of women who participated in a mobile mammography screening program affiliated with a comprehensive cancer center in Missouri. Methods: The Alvin J. Siteman Cancer Center (SCC) at Washington University School of Medicine initiated a Mammography Outreach Registry to assess the effectiveness of mammography services among the medically underserved. The Breast Health Center is housed within the SCC and provides on-site service as well as off-site care through use of a single mobile mammography van (MMV). The Registry database included women who received a mammogram on the MMV between April 2006 and July 2015. The total sample included 10,523 women. The sample was stratified to examine women served by the MMV who lived in designated Medically Underserved Areas (MUAs) versus non-MUAs. Results: The MMV traveled throughout much of the eastern portion of Missouri, serving both the urban St. Louis region as well as rural areas in the southeastern “Bootheel” region. The total sample included 57% non-Hispanic Black, 33% non-Hispanic White, and 10% of other races, with a mean age of 52 years old. The majority (72%) of women had no insurance and were unemployed (67%). Over three-quarters (77%) reported annual household income less than $20,000 and 74% had completed 12 years or less of education. About one-quarter of women reported a family history of breast cancer and presented for their first mammogram (21%). Approximately 25% of women who received MMV services were from MUAs, mainly in St. Louis City, northern St. Louis County, and the rural Bootheel region. MUAs had a statistically significantly higher prevalence of women who are Black, unmarried, have lower education and lower income, and who are current cigarette smokers compared to non–MUAs. Conclusions: The MMV improved access to breast cancer screening among a largely vulnerable uninsured population, reaching women in both urban and rural areas in Missouri. In particular, the MMV successfully engaged economically disadvantaged women in MUAs including women without health insurance, who had never had a mammogram, and those with a family history of breast cancer. While much of the research on MMVs illustrates the impact on improving access to mammography in rural areas, this study highlights there is an unmet need for low/no-cost preventive services in both urban and rural areas. In states such as Missouri, with a large number of health professional shortage areas and that did not expand Medicaid under the Affordable Care Act, MMVs are even more imperative to provide mammography screening to populations that do not routinely access preventive health services. MMVs should work closely with community-based partners and safety net health clinics in both urban and rural MUAs to maximize MMVs outreach efforts. Further, given the higher number of women in MUAs reported as current smokers, outreach conducted by MMV staff may also coordinate efforts to create interventions tailored to women who smoke in MUAs to address smoking cessation. Citation Format: Goldie Komaie, Sarah Lyons, Catherine Appleton, Katherine Glover-Collins, Christine Marx, Graham Colditz. A mobile mammography outreach program to increase screening in medically underserved areas in Missouri [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C73.

Diagnosing Cervical Neoplasia in Rural Brazil Using a Mobile Van Equipped with In Vivo Microscopy: A Cluster-Randomized Community Trial.

Cervical cancer is a leading cause of death in underserved areas of Brazil. This prospective randomized trial involved 200 women in southern/central Brazil with abnormal Papanicolaou tests. Participants were randomized by geographic cluster and referred for diagnostic evaluation either at a mobile van upon its scheduled visit to their local community, or at a central hospital. Participants in both arms underwent colposcopy, in vivo microscopy, and cervical biopsies. We compared rates of diagnostic follow-up completion between study arms, and also evaluated the diagnostic performance of in vivo microscopy compared with colposcopy. There was a 23% absolute and 37% relative increase in diagnostic follow-up completion rates for patients referred to the mobile van (102/117, 87%) compared with the central hospital (53/83, 64%; P = 0.0001; risk ratio = 1.37, 95% CI, 1.14-1.63). In 229 cervical sites in 144 patients, colposcopic examination identified sites diagnosed as cervical intraepithelial neoplasia grade 2 or more severe (CIN2+; 85 sites) with a sensitivity of 94% (95% CI, 87%-98%) and specificity of 50% (95% CI, 42%-58%). In vivo microscopy with real-time automated image analysis identified CIN2+ with a sensitivity of 92% (95% CI, 84%-97%) and specificity of 48% (95% CI, 40%-56%). Women referred to the mobile van were more likely to complete their diagnostic follow-up compared with those referred to a central hospital, without compromise in clinical care. In vivo microscopy in a mobile van provides automated diagnostic imaging with sensitivity and specificity similar to colposcopy. Cancer Prev Res; 11(6); 359-70. ©2018 AACR.

The WITS Atlas: A Black Southern African dental atlas for permanent tooth formation and emergence.

To develop a population-specific atlas of permanent tooth emergence and formation for age estimation of Black Southern Africans. Using data from a cross-sectional study of 642 school children aged 5-20 years, panoramic radiographs taken during routine dental examination in a mobile treatment van were analyzed using the Demirjian method of eight (A-H) tooth formation stages. Tables of the stages of tooth development for each tooth, including the third molars, were generated separately for age cohorts and by sex. The most frequently occurring (modal) stage of tooth formation was considered the signature developmental stage for the age. The relationship of the third molar occlusal surfaces with occlusal tables on the radiographs were checked and compared with the findings recorded during intra oral examination. Comparison with the London atlas shows that at age 9.5 years, the canine and premolar emergence are at least one year ahead and the third molar formation completes four years earlier in the WITS Atlas. Similarities in advancement in tooth formation and emergence across sub-Saharan Africa suggest that the WITS Atlas can be used for those populations as well.

Improving fertilizer recommendations for Nepalese farmers with the help of soil-testing mobile van

ABSTRACTSmallholder farmers dominate agriculture in Nepal. These farmers have poor knowledge about agriculture and lack of support for soil management and integrated plant-nutrient systems. Focusing on the importance and need for soil-fertility management, a soil-testing mobile van program has recently been introduced in Nepal by Soil Management Directorate, Hariharbhawan. With the introduction of the mobile lab, famers can get their soil tested for nutrient deficiencies and fertilizer requirements at their doorsteps. Using mobile lab, spatial distributions of chemical properties, including pH, organic matter (OM), total nitrogen (N), available phosphorus (as P2O5), and available potassium (as K2O) were examined in soil samples taken from the 0 to 15 cm depth from selected agricultural fields in eight different districts in the mid-hills and Terai regions of Nepal. Tests conducted on 1,479 soil samples in the soil-testing mobile van revealed the following: the mean soil OM ranged from 0.01 to 1.77%; total N content ranged from 0.01 to 0.08%; mean available P2O5 ranged from 16.47 to 197.82 kg ha−1; and mean available K2O ranged from 84.3 to 422.57 kg ha−1. For each crop to be grown, farmers were provided with individual soil health reports and fertilizer recommendations (rate, amount, and type). This program not only allows scientists and farmers to work closely and share information but also serves as a model for the nation to successfully transfer technology for improving soil health and sustainability.

HIV seroconversion among Baltimore City residents tested at a mobile van programme

BackgroundMany individuals with HIV in the USA are unaware of their diagnosis, and therefore cannot be engaged in treatment services, have worse clinical outcomes and are more likely to transmit...