2013 Review and Update of the Genetic Counseling Practice Based Competencies by a Task Force of the Accreditation Council for Genetic Counseling

The first practice based competencies (PBCs) for the field of genetic counseling were adopted by the American Board of Genetic Counseling (ABGC), 1996. Since that time, there has been significant growth in established and new work settings (clinical and non‐clinical) and changes in service delivery models and the roles of genetic counselors. These changes prompted the ABGC to appoint a PBC Task Force in 2011 to review the PBCs with respect to their current relevance and to revise and update them as necessary. There are four domains in the revised PBCs: (I) Genetics Expertise and Analysis (II) Interpersonal, Psychosocial and Counseling Skills (III) Education and (IV) Professional Development and Practice. There are 22 competencies, each clarified with learning objectives or samples of activities and skills; a glossary is included. New competencies were added that address genomics, genetic testing and genetic counselors’ roles in risk assessment, education, supervision, conducting research and presenting research options to patients. With PBCs serving as the pre‐defined abilities or outcomes of training, graduating genetic counselors will be well prepared to enter the field with a minimum level of skills and abilities. A description of the Task Force’s work, key changes and the 2013 PBCs are presented herein.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147172/1/jgc40868.pd

Observational models of requirements evolution

Requirements Evolution is one of the main issues that affect development activities as well as system features (e.g., system dependability). Although researchers and practitioners recognise the importance of requirements evolution, research results and experience are still patchy. This points out a lack of methodologies that address requirements evolution. This thesis investigates the current understanding of requirements evolution and explores new directions in requirements evolution research. The empirical analysis of industrial case studies highlights software requirements evolution as an important issue. Unfortunately, traditional requirements engineering methodologies provide limited support to capture requirements evolution. Heterogeneous engineering provides a comprehensive account of system requirements. Heterogeneous engineering stresses a holistic viewpoint that allows us to understand the underlying mechanisms of evolution of socio-technical systems. Requirements, as mappings between socio-technical solutions and problems, represent an account of the history of socio-technical issues arising and being solved within industrial settings. The formal extension of a heterogeneous account of requirements provides a framework to model and capture requirements evolution. The application of the proposed framework provides further evidence that it is possible to capture and model evolutionary information about requirements. The discussion of scenarios of use stresses practical necessities for methodologies addressing requirements evolution. Finally, the identification of a broad spectrum of evolutions in socio-technical systems points out strong contingencies between system evolution and dependability. This thesis argues that the better our understanding of socio-techn..

Exercise for falls prevention in community-dwelling older adults: Trial and participant characteristics, interventions and bias in clinical trials from a systematic review

IntroductionThere is strong evidence that exercise prevents falls in community-dwelling older people. This review summarises trial and participant characteristics, intervention contents and study quality of 108 randomised trials evaluating exercise interventions for falls prevention in community-dwelling older adults.MethodsMEDLINE, EMBASE, CENTRAL and three other databases sourced randomised controlled trials of exercise as a single intervention to prevent falls in community-dwelling adults aged 60+ years to May 2018.Results108 trials with 146 intervention arms and 23 407 participants were included. Trials were undertaken in 25 countries, 90% of trials had predominantly female participants and 56% had elevated falls risk as an inclusion criterion. In 72% of trial interventions attendance rates exceeded 50% and/or 75% of participants attended 50% or more sessions. Characteristics of the trials within the three types of intervention programme that reduced falls were: (1) balance and functional training interventions lasting on average 25 weeks (IQR 16–52), 39% group based, 63% individually tailored; (2) Tai Chi interventions lasting on average 20 weeks (IQR 15–43), 71% group based, 7% tailored; (3) programmes with multiple types of exercise lasting on average 26 weeks (IQR 12–52), 54% group based, 75% tailored. Only 35% of trials had low risk of bias for allocation concealment, and 53% for attrition bias.ConclusionsThe characteristics of effective exercise interventions can guide clinicians and programme providers in developing optimal interventions based on current best evidence. Future trials should minimise likely sources of bias and comply with reporting guidelines

Creating High Quality Assessments for a Bilingual Population

Lack of teacher training in test writing in both colleges and professional development programs has resulted in poorly designed assessments, particularly for culturally diverse and bilingual populations, that do not align with the high standards expected of standardized tests. Weak teacher-made assessments can result in improper student placement, ill-fitting lessons and interventions, and unnecessary frustration and confusion among test takers. These low quality tests can also serve as false predictors for student performance on standardized tests. The danger caused by skewed scores is such that if teachers do not have a reliable means by which to predict students’ future success, many students will be left unprepared. In an attempt to remedy the negative effects of poorly constructed and administered assessments, this research has created a professional development program through which teachers will be trained in writing culturally sensitive multiple-choice items and essay prompts that are aligned to the Common Core State Standards. This research and professional development program place a heavy emphasis on the importance of culturally sensitive language combined with well-crafted test items in order to insure that culturally and linguistically diverse students are provided an equal opportunity to demonstrate their knowledge on teacher-made tests. In addition, this researcher hopes that by improving the quality of teacher-made tests, educators can better prepare students for standardized tests, particularly those that are based on the new Common Core State Standards

Towards Identifying and closing Gaps in Assurance of autonomous Road vehicleS - a collection of Technical Notes Part 2

This report provides an introduction and overview of the Technical Topic Notes (TTNs) produced in the Towards Identifying and closing Gaps in Assurance of autonomous Road vehicleS (Tigars) project. These notes aim to support the development and evaluation of autonomous vehicles. Part 1 addresses: Assurance-overview and issues, Resilience and Safety Requirements, Open Systems Perspective and Formal Verification and Static Analysis of ML Systems. This report is Part 2 and discusses: Simulation and Dynamic Testing, Defence in Depth and Diversity, Security-Informed Safety Analysis, Standards and Guidelines

Identifying Effective Behavior Change Techniques for Alcohol and Illicit Substance Use During Pregnancy: A Systematic Review.

Background: During pregnancy, consuming alcohol and using illicit drugs can have serious health implications for both mother and child. Behavioral change interventions, especially those underpinned by theoretical constructs, can be effective in reducing harmful substance use among pregnant women. Purpose: To understand what type of behavior change mechanisms could be useful in reducing alcohol consumption or achieving abstinence from illicit drug use during pregnancy, this review aimed to identify behavior change techniques (BCTs), the smallest, active components of interventions that may be effective. It also aimed to establish the extent that psychosocial-based theories were used to inform intervention design. Methods: To identify eligible randomized controlled trials (RCTs), five databases were searched electronically from the end search dates of the most recent Cochrane systematic reviews on behavioral interventions for each behavior, until March 2018. Within the RCTs, intervention descriptions were analyzed for BCT content and extent of theory use in the intervention design process and outcome measurements, in each trial, was established. "Effectiveness percentages," the number of times a BCT had been a component of an effective intervention divided by the total number of interventions it had been used in, were calculated for BCTs used in two or more trials. Results: Including all RCTs from the Cochrane reviews, and those published subsequently, nine alcohol and six illicit drug trials were identified. Interventions tested in four alcohol RCTs and no illicit drugs RCTs showed positive results. Subsequent data were extracted for alcohol consumption trials only. Thirteen BCTs showed "potential effectiveness" for alcohol consumption. Six of nine included alcohol trials reported using theory but not extensively. Conclusions: Action planning, behavioral contract, prompts/cues, self-talk, offer/direct toward written material, problem solving, feedback on behavior, social support (unspecified), information about health consequences, behavior substitution, assess current readiness and ability to reduce excess alcohol consumption, goal setting (behavior), and tailor interactions appropriately are BCTs that could be useful in helping reduce alcohol consumption among pregnant women

Clinical questions raised by providers in the care of older adults: a prospective observational study

pre-printObjective: To characterise clinical questions raised by providers in the care of complex older adults in order to guide the design of interventions that can help providers answer these questions. Materials and methods: To elicit clinical questions, we observed and audio recorded outpatient visits at three healthcare organisations. At the end of each appointment, providers were asked to identify clinical questions raised in the visit. Providers rated their questions based on their urgency, importance to the patient's care and difficulty in finding a useful answer to. Transcripts of the audio recordings were analysed to identify ageing-specific factors that may have contributed to the nature of the questions. Results: We observed 36 patient visits with 10 providers at the three study sites. Providers raised 70 clinical questions (median of 2 clinical questions per patient seen; range 0-12), pursued 50 (71%) and successfully answered 34 (68%) of the questions they pursued. Overall, 36 (51%) of providers' questions were not answered. Over one-third of the questions were about treatment alternatives and adverse effects. All but two clinical questions were motivated either directly or indirectly by issues related to ageing, such as the normal physiological changes of ageing and diseases with higher prevalence in the elderly. Conclusions: The frequency of clinical questions was higher than in previous studies conducted in general primary care patient populations. Clinical questions were predominantly influenced by ageing-related issues. We propose a series of recommendations that may be used to guide the design of solutions to help providers answer their clinical questions in the care of older adults

Behavior Change Techniques to Promote Smoking Cessation During Pregnancy: A Theory-Based Meta-Analysis

Despite significant progress, smoking during pregnancy remains one of the leading preventable causes of adverse fetal and maternal health outcomes. Using the current best practice standard of psychosocial counseling, only about one out of every 20 pregnant women quits smoking, and relapse rates are very high. Developing more effective interventions to promote smoking cessation during pregnancy is a critical public health priority that requires a thorough understanding of behavior change and its complex pathways and determinants. As such, the purpose of this three-part study was to conduct the first systematic theory-based evidence synthesis of smoking cessation interventions during pregnancy, and to quantify the effectiveness of specific behavior change techniques and behavioral theories used in these interventions, with the long-term goal of informing the development of more effective interventions to reduce smoking during pregnancy. The first aim was to conduct a meta-analysis to produce quantitative estimates of intervention effect sizes and to identify factors that may explain the observed heterogeneity in intervention effectiveness. A search of six major bibliographic databases for prenatal smoking cessation interventions published between 1995 and 2015 yielded 1,223 unique articles, of which 38 met criteria for inclusion and 34 were randomized controlled trials where the primary outcome was late-pregnancy biochemically-validated smoking cessation and the unit of randomization was the individual. The results of a random effects meta-analysis of the 34 randomized controlled trials of prenatal smoking cessation interventions yielded a significant risk ratio for the primary outcome of late-pregnancy smoking cessation, such that women in the treatment groups were 1.53 times as likely to achieve smoking cessation before giving birth than women in the respective control groups (RR = 1.53; 95% CI: 1.30-1.79). Several study-level variables emerged as potential moderators of intervention effectiveness. Treatment-group participants in contingent rewards interventions were 2.82 times as likely to achieve late-pregnancy smoking abstinence than control group participants. In comparison, treatment-group participants in counseling interventions were 1.3 times as likely to achieve late pregnancy smoking abstinence than their control group counterparts. Intensity level was not associated with effectiveness in this sample. Interventions in this review also yielded promising (significant) results for many secondary outcomes of interest, including additional measures of smoking behavior as well as perinatal outcomes. Specifically, treatment group participants were 1.44 times as likely as control group participants to significantly reduce (by at least 50%) their cigarette consumption, 1.54 times as likely to be smoke free in the early postpartum period, and 1.99 times as likely to be smoke free in the late postpartum period. The results also revealed that smoking cessation interventions reduced the risk of two very common adverse perinatal health outcomes: low birthweight and preterm birth. Specifically, treatment group participants had 73% less risk of delivering a low birthweight or very low birthweight infant and 67% less risk of preterm birth compared to control group participants. The second aim was to evaluate the use of the health behavior theory in intervention design, implementation, and evaluation, and to assess whether the use of theory was associated with intervention effectiveness. Of the 26 published trials that explicitly mentioned theory in the introduction or methods, only nine were based on a single theoretical framework. Five of these studies utilized the learning-based theory of operant conditioning, two studies utilized the transtheoretical/stages of change model, one study used social cognitive theory, and one study used social learning theory. Even among these nine trials, theory was used primarily in a descriptive manner, as opposed to an explanatory or predictive manner. The results of the subgroup analyses and meta-regression models were counter to the hypothesis that use of theory would be positively associated with intervention effectiveness. Scores on two categories of the theory coding scheme (“Was theory tested?” and “Was theory used to tailor or select participants?”) were significantly associated with the primary outcome of late-pregnancy smoking abstinence, but both of the associations were negative, indicating that greater use of theory was associated with a lower likelihood of smoking abstinence during the late-pregnancy period. However, this may reflect the limited use of theory in intervention planning and design among trials included in this meta-analysis, rather than the contribution of theory when it is used optimally. The third aim was to isolate the “active” ingredients in prenatal smoking cessation programs by applying a standardized taxonomy of behavior change techniques to identify the techniques, and then quantifying the effectiveness of each individual technique. We first used Abraham and Michie’s (2008) 26-item taxonomy to identify theory-derived behavior change techniques in published descriptions of intervention content, then performed a meta-regression analysis to determine whether interventions utilizing more techniques were more likely to be effective, and then used subgroup and moderator analyses in order to quantify the effectiveness of each technique. The results revealed that the total number of behavior change techniques used was not associated with late pregnancy smoking abstinence, indicating that more is not necessarily better. Effect sizes were significantly larger for the treatment group than the control group for subsets of interventions that 1) provided information about the link between smoking and health (RR = 1.68; 95% CI: 1.26-2.12); 2) provided information about the negative consequences of smoking (RR = 1.38; 95% CI: 1.08-1.77); 3) prompted the formation of intentions to quit smoking (RR = 1.24; 95% CI: 1.00-1.53); 4) provided instructions (RR = 1.51; 95% CI: 1.21-1.89); 5) prompted specific goal setting (RR = 1.48; 95% CI: 1.17-1.88); 6) provided contingent rewards (RR = 2.82; 95% CI: 2.05-3.88); 7) taught participants to use prompts and/or cues (RR = 1.63; 95% CI: 1.03-2.59); and/or 8) had participants agree to a behavioral contract (RR = 2.14; 95% CI: 1.29-3.56). Several key findings emerged from this study. First, behavior change theory is not being utilized to its full capacity in the development and evaluation of prenatal smoking cessation interventions, with only half of the studies in this review (n = 19) reporting an explicit link between at least one behavior change technique and at least one targeted predictor of behavior change. Secondly, many of the most common behavior change techniques used in prenatal smoking cessation interventions were not associated with better intervention outcomes, nor was the quantity of techniques used associated with effectiveness. Third, the current review identified contingent rewards as the most effective behavior change technique for promoting smoking cessation during pregnancy and into the postpartum period when tangible rewards were no longer offered. While previous meta-analyses have assessed whether or not prenatal smoking cessation interventions were effective, this review expanded on existing findings by using a recently developed taxonomy to identify, isolate, and quantify the effectiveness of individual behavior change techniques used in interventions, as well as applying a coding scheme to evaluate how theory is being used in the literature and whether the use of theory is associated with the effectiveness of interventions. The results provide a framework for evaluating not only if an intervention worked, but also why, how, and under what conditions, marking an important step towards a new set of standards in evidence synthesis and theory-testing in smoking cessation research and beyond