Delays in follow-up after cancer screening contribute to racial/ethnic disparities in cancer outcomes. We evaluated a patient navigator intervention among innercity women with breast abnormalities. A full-time patient navigator supported patients using the care management model. Female patients 18 years and above, referred to an urban, hospital-based, diagnostic breast health practice from January to June 2000 (preintervention) and November 2001 to February 2003, were studied. Timely follow-up was defined as arrival to diagnostic evaluation within 120 days from the date the original appointment was scheduled. Data were collected via computerized registration, medical records, and patient interview. Bivariate and multivariate logistic regression analyses were conducted, comparing preintervention and intervention groups, with propensity score analysis and time trend analysis to address the limitations of the pre-post design. 314 patients were scheduled preintervention; 1018, during the intervention. Overall, mean age was 44 years; 40% black, 36% non-Hispanic white, 14% Hispanic, 4% Asian, 5% other; 15% required an interpreter; 68% had no or only public insurance. Forty-four percent of referrals originated from a community health center, 34% from a hospital-based practice. During the intervention, 78% had timely follow-up versus 64% preintervention (P < .0001). In adjusted analyses, women in the intervention group had 39% greater odds of having timely follow-up (95% CI, 1.01-1.9). Timely follow-up in the adjusted model was associated with older age (P ¼ .0003), having private insurance (P ¼ .006), having an abnormal mammogram (P ¼ .0001), and being referred from a hospital-based practice, as compared to a community health center (P ¼ .003). Our data suggest a benefit of patient navigators in reducing delay in breast cancer care for poor and minority populations.

Prediction models based on claims-derived demographics and morbidity profiles can be extremely accurate. While one-year post-AMI mortality in Medicare may not be worsening, outcomes appear not to have continued to improve as they had in the prior decade. Rich morbidity information is available in claims data, especially when longitudinally tracked across multiple settings of care, and is important in setting performance targets and evaluating trends.

Medical respite programs offer medical, nursing, and other care as well as accommodation for homeless persons discharged from acute hospital stays. They represent a community-based adaptation of urban health systems to the specific needs of homeless persons. This paper examines whether post-hospital discharge to a homeless medical respite program was associated with a reduced chance of 90-day readmission compared to other disposition options. Adjusting for imbalances in patient characteristics using propensity scores, Respite patients were the only group that was significantly less likely to be readmitted within 90 days compared to those released to Own Care. Respite programs merit attention as a potentially efficacious service for homeless persons leaving the hospital.

Summary Vegetation and biogeomorphology are highly coupled in beach dune systems, but plant species effects on abating storm erosion are largely unexplored. We quantified coastal dune erosion from Hurricane Sandy (October 2012) as a function of pre‐storm system characteristics – dune height, beach width and dominant vegetation stabilizing dunes (native Ammophila breviligulata or invasive Carex kobomugi) at Island Beach State Park, New Jersey, USA. We assessed dune erosion using a combination of pre‐ and post‐Sandy aerial image spatial analyses in ArcGIS and GPS field mapping. Our two erosion metrics are novel, macroscale 2D surface area changes and Dune Crest Transgression, the later of which is measured at the microscale (1 m−1) and analysed using a mixed model incorporating spatial autocorrelation. We document a species‐specific effect on collision erosion. Although C. kobomugi reduces native diversity and abundance, it may be beneficial for coastal protection, as dunes fronted and stabilized by C. kobomugi suffered less erosion than those dominated by A. breviligulata under the same abiotic conditions. Dune height and beach width were equal for species prior to the storm and therefore do not account for or confound differences in erosion. Similarly, traditional calculations of erosion with volumetric loss confer these results. Synthesis and applications. This is the first study to show a species effect on coastal dune erosion. Native Ammophila breviligulata stabilized dune stretches suffered more erosion from Hurricane Sandy than complimentary invasive Carex kobomugi stretches, contradicting anecdotal reports that foredunes stabilized by a shorter statured species are more prone to erosion. This study highlights the importance of vegetation for dune stability and management using two novel metrics for erosion. Our erosion metrics are related to volumetric loss, can be monitored and calculated by managers with or without remote sensing, and can be applied to other systems. Discussions on coastal management of dunes as habitats and protective buffers must include vegetation and the results of this study suggest that not all species are equal with regard to their ability to combat storm erosion. Multidisciplinary studies with applied implications will grow increasingly important as storms continue to grow more frequent, severe and unpredictable with climate change.

After accounting for the caretaker's report of the level of the child's exposure to violence, the child's own report significantly increased the amount of variance in predicting child behavior problems with the CBCL. These findings indicate that clinicians and researchers should elicit children's own accounts of exposure to violence in addition to the caretakers' when attempting to understand children's behavior.