Detecting epistasis via Markov bases

Rapid research progress in genotyping techniques have allowed large genome-wide association studies. Existing methods often focus on determining associations between single loci and a specific phenotype. However, a particular phenotype is usually the result of complex relationships between multiple loci and the environment. In this paper, we describe a two-stage method for detecting epistasis by combining the traditionally used single-locus search with a search for multiway interactions. Our method is based on an extended version of Fisher's exact test. To perform this test, a Markov chain is constructed on the space of multidimensional contingency tables using the elements of a Markov basis as moves. We test our method on simulated data and compare it to a two-stage logistic regression method and to a fully Bayesian method, showing that we are able to detect the interacting loci when other methods fail to do so. Finally, we apply our method to a genome-wide data set consisting of 685 dogs and identify epistasis associated with canine hair length for four pairs of SNPs

Faithfulness and learning hypergraphs from discrete distributions

The concepts of faithfulness and strong-faithfulness are important for statistical learning of graphical models. Graphs are not sufficient for describing the association structure of a discrete distribution. Hypergraphs representing hierarchical log-linear models are considered instead, and the concept of parametric (strong-) faithfulness with respect to a hypergraph is introduced. Strong-faithfulness ensures the existence of uniformly consistent parameter estimators and enables building uniformly consistent procedures for a hypergraph search. The strength of association in a discrete distribution can be quantified with various measures, leading to different concepts of strong-faithfulness. Lower and upper bounds for the proportions of distributions that do not satisfy strong-faithfulness are computed for different parameterizations and measures of association.Comment: 23 pages, 6 figure

CULTURAL SENSITIVITY IN COOPERATIVE EXTENSION NUTRITION EDUCATION PROGRAMMING IN KENTUCKY

The purpose of this mixed methods study was to learn how cultural sensitivity was integrated and perceived in community nutrition education of an existing program offered by the University of Kentucky Cooperative Extension Service Nutrition Education Program. Data collection consisted of a quantitative cultural competence assessment survey tool used with nutrition education paraprofessionals (n=74), qualitative in-depth interviews of nutrition education paraprofessionals (n=8) and focus groups of Hispanic/Latino nutrition education program participants (n=39). Findings were focused in three areas; the cultural sensitivity needs of the program, the perception of nutrition education by participants and the training and professional development needs of nutrition education paraprofessionals. Among the cultural sensitivity needs of the program identified were curriculum resource needs, community referral needs, the importance of community partnerships and the importance of incorporation of children in nutrition education were identified. Among the training and professional development needs of nutrition education paraprofessionals, a need for Hispanic cultural education, language services education and chronic disease education were reported. The value of cross-cultural exchange and the need for chronic disease education in relation to dietary habits were identified by the participant focus group findings

Spatiotemporal distribution and co-occurrence of Arctic herbivores in spring

Biotic interactions play an important role in the structure and dynamics of food-webs and may drive the spatial distribution of species. In the Arctic, spring snow-cover limits the availability of resources at a critical time for resident and migratory herbivores, which could lead to resource competition. This study takes a first step towards understanding the potential for competition between the major Svalbard herbivores; Svalbard reindeer (Rangifer tarandus platyrhynchus), Svalbard rock ptarmigan (Lagopus muta hyperborea), pink-footed goose (Anser brachyrhynchus) and barnacle goose (Branta leucopsis) during spring when resources are limited. The behaviour of co-occurring herbivores was observed with the aim of describing behaviours that could indicate interference competition. Further, camera-trap data was used to quantify the effects of snow-cover extent, vegetation type and presence of potential competitors on the spatiotemporal distributions of reindeer and geese. Reindeer and geese in Svalbard were found to generally forage in the same areas, especially in moss tundra. Observations suggested that reindeer was the behaviourally dominant competitor, but even though geese were regularly disturbed by close encounters with reindeer, no direct interference interactions were observed. Quantitative analyses confirmed that their spatiotemporal distributions were mainly driven by snow-cover extent and vegetation type. While it was clear that reindeer did not avoid geese, the avoidance of reindeer by geese could not be rejected. Chasing of ptarmigans was observed from both reindeer and geese, however the potential for competition between these species is not further assessed in this study due to a low number of ptarmigan observations. Extensive snow-cover seemed to slightly increase the co-occurrence of reindeer and geese, and the effect is expected to be stronger in years of late snowmelt. The shared space use by these species could potentially lead to exploitative competition, however this should be further studied by assessing dietary overlap, especially in relation to timing of snowmelt which is predicted to change with climate warming. This study adds to the current knowledge of spatial ecology of reindeer and geese in Svalbard and gives insight to the potential for competition between these Arctic herbivores during spring

Amyotrophic lateral sclerosis : exercise and disease progression

Amyotrophic Lateral Sclerosis (ALS) belongs to a group of neurological disorders known as motor neuron diseases, which are caused by gradual degeneration and consequent death of motor neurons. In general, the disease begins in one of two fundamental ways: with involvement of the muscles of the bulbar region; or with loss of muscle strength of the upper or lower limbs - spinal form. Although other rare forms of manifestation are also cited in the literature, such as: respiratory (when respiratory muscles are initially affected); axial (initially affecting the cervical and paraspinal muscles) and the diffuse form (generalized onset of the disease). These forms of presentation determine the initial symptoms. Patients may initially develop muscle weakness in the limbs resulting in various clinical conditions with paresis, speech problems with dysarthria, dysphagia, and respiratory symptoms with dyspnea, and evolve to complete loss of body movements control. The degree of functional disability and dependence resulting from ALS lead the patient to gradually needing a caregiver for all their activities of daily life. The mean survival for ALS is around 3 - 5 years from first symptoms, and the fatal event usually occurs due to respiratory failure or infection. Although there is no effective treatment to halt disease progression, the clinical management has evolved positively in last years. The technological advance of medical interventions has contributed to a longer survival and higher quality of life. The monitoring of non-invasive ventilation has been very helpful for the clinical follow up and to decrease the anxiety experienced by caregivers. Unfortunately, the aerobic exercise is not a usual therapeutic option for ALS patients in the clinical management yet. Physical exercise has been suggested to promote growth factor delivery in experimental animal models of ALS. However, the aerobic exercise is understudied in ALS patients due the suspicious that the exercise could be harmful for this population. Meeting the recommendations from the last Cochrane review about Therapeutic exercise in ALS, we have analyzed the impact of aerobic exercise in the ALS progression. This thesis has 2 main contributions: 1 - To study the efficacy of moderated and accurate defined exercise program on the evolution and survival of ALS, and, 2 - to assess the feasibility to performing exercise monitored remotely from home in ALS patients. In addition, this thesis includes results from additional contributions, which are related to relevant issues always present during disease progression such as management of the respiratory failure (sub-chapters 5.2 and 5.3), the support for ALS caregivers (Chapter 6), and the potential impact of clinical management on disease progression in an environment with lack of resources (Chapter 7). In the sub-chapter 5.2 we present a work which describe the lack of consensus for the ideal timing to start NIV and about the use of alternative respiratory support. We address the impact of NIV and tracheostomy on family and / or informal caregivers, especially how it can affect quality of life. The importance of assessing the emotional, physical, social and psychological capacity of the caregiver is reinforced in order to cope with the increasing care needs of these patients. The sub-chapter 5.3 presents results on the importance of a careful management in the use and configuration of Non-Invasive Ventilation (NIV) parameters, in particular the role of ventilation and adherence adjustments in functional decline and survival of ventilated patients. A wide range of data recorded from the software used in ventilators, nocturnal pulse oximetry measurements and respiratory function tests were analyzed. Our results suggest that the variables that affect the respiratory comfort of the patient are relevant for adherence to NIV and positively affect survival in ALS. The Chapter 6 presents results of a feasibility study about a training program for caregivers. The uncertain progression of the disease and long-term care, as well as the insufficient number of skilled health professionals, determine that the admission of these patients to hospitals or to continuing care units is a complex option. Initiatives that allow better management of the disease at home can be an alternative solution. The functional disability of patients can promote significant financial constraints, and exposes their families to high levels of stress, which can compromise the provision of adequate health care, leading to the hospitalization of these patients. In this project, we identified an excellent level of participation as well as a good result in the evaluation of learning (above 70%). The main limiting factor for participation in the training program was the absence of a secondary caregiver. The Chapter 7 describes results from2 studies conducted with ALS patients in the African continent, which present data on disease progression in an environment with limited resources for clinical management. The Chapter 8 present a general discussion and conclusion of all works included in this Thesis. All the papers presented in this thesis aim to contribute to a broader view of the clinical management of ALS, where the role of exercise associated with more careful respiratory support, and the presence of a well-informed and trained caregiver, can together be an important contribution for the survival and quality of life of the patient with ALS. We hope our work presented in this thesis may contribute to a wider understanding on the clinical management of ALS. In particular demonstrating that controlled exercise associated with careful respiratory support, and the presence of a well-informed and trained caregiver, may be an added value in the survival and quality of life for ALS patient

Nurses\u27 Breastfeeding Knowledge and Confidence After Education Session

Background: Education is an essential part of the nursing profession. Nurses should be teaching their patients every day, ensuring they understand the most reliable evidence-based practices. In breastfeeding education, however, there is a lack of education to expectant mothers on common breastfeeding methods, how to overcome common barriers, and general breastfeeding knowledge. If nurses can be effectively educated in breastfeeding knowledge and build their confidence in teaching their patients, then mothers will receive more thorough and helpful breastfeeding education. The hope in educating both nurses and mothers is to increase breastfeeding exclusivity rates to meet Healthy People2020 goals. Objective: The purpose of this study is to examine the effects of a breastfeeding education session on the knowledge and confidence of pediatric ambulatory care clinic nurses. Methods: Local pediatric clinic nurses (N=11) completed a pre-survey to evaluate baseline knowledge and attitude toward breastfeeding. Breastfeeding education was completed through a presentation by a board certified lactation consultant and advanced practice nurse and a PowerPoint slideshow. Afterward, participants completed a post-survey to evaluate any growth in knowledge or change in attitude. Independent t-test was used to compare pre-education to post-education data. Results: Data showed insignificant results in attitude toward healthcare provider involvement as well as attitude toward breastfeeding for the post-education group, possibly due to the inability to track individual change. However, there was significant improvement in knowledge about breastfeeding in the post-education group. Conclusion: The goal of this study was to increase breastfeeding education among nurses in hopes to consequentially increase patient breastfeeding education and raise breastfeeding adherence and exclusivity rates

One Nation, Many Borders: Language and Identity in Mayan Guatemala and Mexico

This paper explores language ideologies, code choice, and ethnolinguistic identity in Maya-dominated areas of Mexico and Guatemala. As the Maya, or Pan-Maya, Movement has grown in scope and force since the 1980s, particularly in Guatemala, possessing a Maya identity has become defined in new ways. Since Mayan languages are still spoken with a strong degree of vitality in Mexico\u27s Yucatan peninsula and the western highlands of Guatemala, examining Maya identity through beliefs about, and use of, indigenous languages and Spanish is a particularly useful focus. In comparing Maya peoples\u27 beliefs and identities in each of these regions, this paper argues that Maya identity is highly dependent on the historical, political, and cultural context in which it exists

Från teori till praktik : - simuleringens inverkan på vårdstuderandes självförtroende och upplevda kompetens

I detta examensarbete behandlas simuleringsundervisningens inverkan på vårdstuderandes självförtroende och upplevda kompetens. Syftet med arbetet är att utreda hur den praktiska delen i undervisningen påverkar kunnandet och självsäkerheten hos vårdstuderandena. Problemet i dagens vårdutbildning är att studerande inte får tillräckligt med praktisk träning och därför känner sig osäkra både för att gå ut på praktik och ut i arbetslivet. Det borde alltså enligt oss finnas ett klarare samband mellan teori och praktik för att ge en bredare kunskapsbas och öka kompetensnivån hos studerande. Materialet består av femton forskningsartiklar och två fokusgrupp intervjuer. Samplet till intervjuerna består av sex informanter som studerar till vårdare i Arcada. Materialet är indelat i två delar; en induktiv artikelanalys och en deduktiv analys av intervjuerna. Båda delarna är kvalitativa innehållsanalyser. Teman som behandlas i analyserna är: Utbildning, studerande, säkert och utveckling. Som teoretiskt perspektiv i studien används Patricia Benners modell eftersom i den betonar det praktiska lärandet för vårdstuderande och den lyfter fram erfarenhetens betydelse i arbetet. Resultatet av vår studie visar att studerande upplever att simuleringsövningarna bidragit till en ökad kompetens och ett ökat självförtroende men att även andra faktorer så som praktik och arbetserfarenheter påverkat den personliga utvecklingen. Resultatet från både artiklarna och intervjuerna påminner om varandra. Trots detta finns vissa olikheter då resultatet av artiklarna i regel behandlar simuleringen på en mera allmän nivå och intervjuerna mera tar upp resultatet av simuleringen i Arcada.In this degree thesis dealt with the simulation impact on nursing students selfconfidence and perceived competence. The aim of this study is to investigate how the practical part in education affect competence and the confidence of nursing students. The problem in today's health education is that students are not getting enough practical training and therefore feel unsafe both to out for practical training and into the workplace. It should therefore, in our opinion, be a clearer connection between theory and practice to provide a broader knowledge base and upgrade the skills of students. The material consists of fifteen research articles and two focus group interviews. The sample for the interviews consist of six informants who are studying to be nurses in Arcada. The material is divided into two parts: an inductive article analysis and a deductive analysis of the interviews. Both parts are qualitative content analysis. Themes covered in the analysis are: Education, students, security and development. As a theoretical perspective we´ve used Patricia Benners model, because it emphasizes practical learning for nursing students and it highlights the importance of experience. The results of our study shows that students perceive that simulation exercises contributed to increased skills and increased self-confidence, but that other factors such as internships and work experiences influenced their personal development. The results of both the articles and the interviews are close to similar. Despite this, there are certain differences when the results of the articles typically explain the simulation on a more general level and the interviews will take up the results of the simulation in Arcada

The effect of ethical responsibility on performance

In a laboratory real-effort experiment, we study the effect of responsibility on performance. Specifically, we analyze whether being responsible for an ethical or unethical work environment affects workers’ performance. Using a specific randomization technique, we can separate the responsibility effect from a possible selection effect. We find that workers who prefer to work in an ethical work environment perform better if they are also responsible for it, compared to a situation where it was imposed on them. We do not find this positive incentive effect of responsibility for workers that prefer an unethical work environment. Moreover, we observe that if an unethical environment was imposed, workers who prefer an ethical environment perform worse than those whose preference are aligned with the environment

The Tort of Betrayal of Trust

Fiduciary betrayal is a serious harm. When the fiduciary is a doctor or a lawyer, and the entrustor is a patient or client, this harm frequently goes unremedied. Betrayals arise out of disloyalty and conflicts of interest where the lawyer or doctor puts his or her interest above that of his or her client or patient. They cause dignitary harm that is different from the harm flowing from negligent malpractice. Nevertheless, courts, concerned with overdeterrence, have for the most part refused to allow a separate claim for betrayal. In this Article, we suggest that betrayal deserves a remedy and propose a new statutory tort with limits on the available money damages. We begin by explaining the importance of trust and the inadequacy of common law remedies such as malpractice, lack of informed consent, and breach of fiduciary duty. We then set out a statutorily limited monetary proposal and illustrate how this remedy would work. We do this by examining a series of cases in which the courts have struggled to address betrayals and then applying our statutory tort to the facts of those cases. Our proposed statutory tort offers a solution to the current failure to hold professionals accountable for disloyalty that will provide justice to those who are injured by exploitive self-dealing while setting clear parameters that address judicial concerns of runaway juries and overlap with other tort claims