PURPOSE Primary care physicians have an important role in encouraging adequate cancer screening. Disparities in cancer screening by socioeconomic status (SES) may affect presentation stage and cancer survival. This study aimed to examine whether breast, colorectal, and cervical cancer screening rates in women differed by SES and age, and whether screening rates and SES disparities changed after introduction of a primary care-based national quality indicator program. METHODS This repeated cross-sectional study spanning 2002-2017 included all female Israeli residents in age ranges appropriate for each cancer screening assessed. SES was measured both as an individual-level variable based on exemption from copayments and as an area-level variable using census data.
RESULTSIn 2017, the most recent year in the study period, screening rates among 1,529,233 women were highest for breast cancer (70.5%), followed by colorectal cancer (64.3%) and cervical cancer (49.6%). Women in the highest area-level SES were more likely to undergo cervical cancer screening compared with those in the lowest (odds ratio = 3.56; 99.9% CI, 3.47-3.65). Temporal trends showed that after introduction of quality indicators for breast and colorectal cancer screening in 2004 and 2005, respectively, rates of screening for these cancers increased, with greater reductions in disparities for the former. The quality indicator for cervical cancer screening was introduced in 2015, and no substantial changes have occurred yet for this screening.
CONCLUSIONSWe found increased uptake and reduced socioeconomic disparities after introduction of cancer screening indicators. Recent introduction of a cervical cancer screening indicator may increase participation and reduce disparities, as has occurred for breast and colorectal cancer screening. These findings related to Israel's quality indicators program highlight the importance of primary care clinicians in increasing cancer screening rates to improve outcomes and reduce disparities.
Highlights• There is a national shortage of high-quality early childhood educators.• The workforce pipeline must be expanded to increase cultural and linguistic preparedness.• This paper highlights three Chicago-based partnerships to increase workforce skill and diversity.• Each "grow-your-own" program is designed to meet the specific needs of the communities they serve.• These community-responsive examples can inform national conversation about workforce development.
Background:The ability for hydrogen production of 13 native strains of Clostridium spp. strains isolated from Colombian soil was evaluated using glycerol substrate. Glycerol to hydrogen conversion was investigated using a batch fermentation reactor and industrial glycerol source (50 g.l -1 , pH 7.00).
Results:The results were quantified regarding acids, hydrogen, biomass and solvent production. The selected strain gave good hydrogen over production output at 14.4 mmol H2.l -1 , productivity 0.3167 mg H2.h -1 l -1 culture mediumand yield 0.1962 mol H2.mol -1 glycerol. A further fermentation assay a 4.0 liter batch reactor let to being 0.26 mg.l -1 .h -1 after 18 hrs of fermentation. Logistic model, Luedeking-Piret model and Luedeking-Piret modified models were used for modeling changes in cell growth, hydrogen production and substrate consumption (Correlation coefficients R 2 = 0.95 for biomass substrate, R 2 = 0.77 hydrogen production).
Conclusions:Our results indicate that hydrogen production through glycerol bioconversion by native strains is possible.
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