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Community health workers (CHWs) have been bridging the gap between under-served populations and health care systems for centuries; however, their experiences are rarely recounted. The Miami Healthy Heart Initiative is a randomized control trial designed to examine the effectiveness of CHWs on reducing the risk for cardiovascular disease among Hispanics with poorly controlled diabetes in South Florida. This manuscript, told from the perspective of CHWs, is a summary of cases that were successful and some that did not achieve optimal outcomes. These case summaries include anecdotal data and clinical variables that demonstrate each patient's progress during the intervention.

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Background: This study evaluates the accuracy, biomechanical profile, and learning curve of the transverse process trajectory technique (TPT) compared to the straightforward (SF) and in-out-in (IOI) techniques. SF and IOI have been used for fixation in the thoracic spine. Although widely used, there are associated learning curves and symptomatic pedicular breaches. We have found the transverse process to be a reproducible pathway into the pedicle.Methods: Three surgeons with varying experience (experienced [E] with 20 years in practice, surgeon [S] with less than 10 years in practice, and senior resident trainee [T] with no experience with TPT) operated on 8 cadavers. In phase 1, each surgeon instrumented 2 cadavers, alternating between TPT and SF from T1 to T12 (n ¼ 48 total levels). In phase 2, the E and T surgeons instrumented 1 cadaver each, alternating between TPT and IOI. Computed tomography scans were analyzed for accuracy of screw placement, defined as the percentage of placements without critical breaches. Axial pullout and derotational force testing were performed. Statistical analyses include paired t test and analysis of variance with Tukey correction.Results: Overall accuracy of screw placement was comparable between techniques

Introduction: Self-image and body shape are important to adolescent idiopathic scoliosis (AIS) patients. The impact of scoliosis on anterior trunk shape has been incompletely studied. The Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ) was developed to assess anterior truncal appearance concerns and mental preoccupation and behavioral modification related to those concerns. The purpose of this study is to validate TAASQ in AIS. Methods: A total of 105 female surgical AIS patients (average age, 14.9 years; mean Cobb, 53°) completed the TAASQ, Spinal Appearance Questionnaire (SAQ), and Scoliosis Research Society Questionnaire (SRS-22) questionnaires. TAASQ was developed with breast cancer researchers and piloted in 13 perioperative adolescent and adult idiopathic scoliosis patients. TAASQ contains 14 questions, both response scale and free response. Questions are categorized into three domains: breast, appearance, and clothing. Internal consistency/reliability (Cronbach's α) and concurrent validity were determined. Results: Internal consistency was 0.86, 0.77, and 0.84 for clothing, appearance, and breast domains, respectively (good to excellent). Domains and subdomains of the TAASQ correlate well with the image domain of the SRS-22 but not with the SAQ. However, given that the TAASQ was designed to assess concerns with anterior appearance, the correlation with the image domain establishes concurrent validity of the questionnaire. Conclusions: TAASQ is a reliable and valid measure of the concerns and behavioral modifications related to anterior truncal appearance in female AIS patients. Further study of TAASQ will help clinicians counsel patients on the impact of surgery on anterior truncal deformity. Clinical Relevance: There is a clinical lack of knowledge about the significant self-image and anterior body shape concerns of adolescent females with AIS. The TAASQ has been developed to assess concerns related to anterior truncal appearance and mental preoccupation and behavioral modification. (

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