Evaluating the implementation of a community health worker-delivered intervention integrating asthma care in West Philadelphia public schools.

OBJECTIVE: Schools are an important setting because students spend much of their time in school and engage in physical activity during the school day that could exacerbate asthma symptoms. Our objective is to understand the barriers and facilitators to implementing an experimental community health worker-delivered care coordination program for students with asthma within the context of the West Philadelphia Controls Asthma study. METHODS: Surveys (n = 256) and semi-structured interviews (n = 41) were completed with principals, teachers, nurses, and community health workers from 21 public and charter schools in West Philadelphia between January 2019 and September 2021. Survey participants completed the Evidence Based Practice Attitudes Scale, the Implementation Leadership Scale, and Organizational Climate Index. Semi-structured qualitative interview guides were developed, informed by the Consolidated Framework for Implementation Research. RESULTS: Participant responses indicate that they perceived benefits for schools and students related to the community health worker-based care coordination program. Several barriers and facilitators to implementing the program were noted, including challenges associated with incorporating the program into school nurse workflow, environmental triggers in the school environment, and challenges communicating with family members. An important facilitator that was identified was having supportive school administrators and staff who were engaged and saw the benefits of the program. CONCLUSIONS: This work can inform implementation planning for other locales interested in implementing community-based pediatric asthma control programs delivered by community health workers in schools.

Phone Versus In-Person Navigation of Social Needs and Caregivers' Desire for Resources in the Pediatric Emergency Department.

OBJECTIVE: To determine the association between in-person versus telephone-based contact by a resource navigator and caregivers' expressed desire for community-based resources to meet social needs in a pediatric emergency department (PED). METHODS: This retrospective observational study used data from the PED in a large, metropolitan, academic children's hospital. Families were approached by resource navigators and offered community-based resources either in-person or by phone during waiting periods in the PED exam room. We used descriptive statistics and chi-square analysis to summarize demographics and mode of contact, and simple and multivariable logistic regression to estimate the association between desire for resources and mode of contact. RESULTS: Contact was attempted among 4902 caregivers, with 2918 (59.5%) caregivers approached in-person, 1913 (39.0%) approached by phone, and 71 (1.5%) with no mode of contact recorded. Resource navigators successfully reached 2738 (93.8%) caregivers approached in-person and 1432 (74.9%) caregivers approached by phone. Of caregivers successfully reached, 782 (18.8%) desired resources; 526 (19.2%) in-person, and 256 (17.9%) by phone. Caregivers contacted by phone were no more or less likely to desire resources than caregivers contacted in-person in unadjusted (odds ratio (OR) = 0.92, 95% confidence interval (CI) = 0.78-1.08) and adjusted analyses (OR = 0.92, 95% CI = 0.77-1.09). CONCLUSIONS: Within a large, urban PED, caregivers' expressed desire for community-based resources was no different whether a caregiver was engaged in-person or by phone. This suggests caregivers may be equally receptive to discussing social needs and community-based resources remotely versus in-person. More work is needed to examine if rates of resource connection differ by mode of contact.

Optimization and evaluation of an in vitro model of PEG-mediated fusion of nerve cell bodies.

Polyethylene glycol (PEG) is a cell membrane fusogen (de StGroth et al., 1980; Hoehn et al., 1978 [2]; Pontecorvo et al., 1975 [3]). In clinical application PEG allows some axonal fusion in peripheral nerve repairs, resulting in retention of some mobility and sensation during the regeneration process and reducing muscular atrophy. Several manuscripts exist concerning in vivo models of PEG fusion, while there is a distinct lack of in vitro studies. This study optimizes an experimental in vitro PEG fusion procedure in B35 rat neuroblastoma cells, through alteration of PEG and dimethyl sulfoxide (DMSO) concentrations and utilizes flow cytometry for assessment. The optimized procedure was then tested on B104-1-1 cells, a mouse neuroblastoma line expressing P2X7R, to validate our in vitro procedure/model against previous in vivo testing of P2X7R modulators, Brilliant Blue FCF (FCF) and bzATP. In brief, two cell populations were differentially stained, mixed, pre-treated (if applicable) and PEG-fused. Initial optimization generated the highest fusion rates with 70% PEG + 0% DMSO. Subsequent testing of the model with FCF and bzATP proved that assessment over time is required when evaluating potential modulators of PEG fusion. Our conclusion, at 72 h post PEG fusion, is that the optimized procedure is suitable for initial candidate testing of modulators of PEG fusion. In vitro experiments with FCF and bzATP corroborated previous in vivo findings and confirmed that DMSO is not required to aid PEG fusion in the in vitro model. The development of this cellular based in vitro model will be invaluable as a substitute for initial assessment of chemical modulators of PEG fusion.