Clinical reconciliation of patient social context and implementation of preventive care guidelines

Background Preventive care practice guidelines are disseminated regularly through federal and scientific groups as a way of promoting best practices and evidence-based health promotion. Yet rates of their implementation are historically low and complex, with cited barriers including limits on physicians’ time, knowledge or attitudes; and external factors related to the guideline itself, the clinical environment, or patient factors. The objective of this qualitative research is to understand how primary care clinicians and staff reconcile perceived patient-level factors and implementation of preventive care guidelines. Methods Key informant interviews (n=23) with 14 clinicians and 9 office managers from 14 primary care clinics were analyzed using a grounded theory approach. Codes were categorized, then reviewed using conventional content analysis to determine thematic content. Results The importance of using communication tools; convenience for access to preventive services; and weighing the evidence when deciding how to proceed with preventive care emerged as themes related to understanding how providers reconcile between patient factors and implementation of preventive care guidelines. Conclusions The interviews used in this study provide some rich context to address the research objective: how providers reconcile between what they perceive to be patient factors and how they go about providing preventive care according to guidelines. The hope for this study is to identify key themes to instigate future exploratory research and provide evidence to target improvements in patient care.https://scholarscompass.vcu.edu/gradposters/1051/thumbnail.jp

Science Instruction in a Culture of High-Stakes Assessment: A Transcendental Phenomenological Study into the Experiences of Missouri Elementary School Teachers in a Non-Assessed Grade Level

LUO Remote Online Presenter Graduate Theoretical Proposa

Response acquisition with delayed reinforcement in the presence of an irrelevant operandum.

Rats and pigeons responded under schedules of delayed reinforcement in three experiments. Two operanda were available but only one was correlated with reinforcement. In Experiment 1, either operandum could be correlated with reinforcement depending on which was pressed first. Due to this procedure the source of reinforcement varied irregularly between sessions. In Experiment 2, the operandum correlated with reinforcement was pre-determined and remained consistent within conditions. In Experiment 3, the source of reinforcement was pre-determined and varied semi-randomly. Responses were acquired without prior response shaping in the first two experiments and maintained in all three using unsignalled, resetting delays to reinforcement. Response rates were higher on the relevant operandum when it was the same as in previous sessions, and higher response rates were exhibited on the irrelevant operandum when it was relevant in the previous sessions. These results indicate that induction does not account for responding under delayed reinforcement, and the control of responding by the delayed reinforcement contingencies is affected by the subjects\u27 history of responding on each operandum

Comparison of the Compositional Proclivities of the Complete Genomes of Plasmodium Falciparum and Human

Pathogens and hosts have a dynamic relationship, one that is ever changing at the molecular level - the pathogen influencing the evolutionary path of the host and the host influencing the evolutionary path of the pathogen. The pathogen’s adaptation to a particular host could serve several purposes, e.g. to mimic the host to avoid detection, to take advantage of the host’s cellular machinery, to increase virulence, etc. Recognizing these adaptations is far from trivial, particularly when the size of the pathogen’s and host’s genomes differ by orders of magnitudes. Novel algorithms and data structures have been developed in our laboratory that make it possible to quantify the “distance” (or number of mutations) separating pathogen and host sequences. Through the examination of these distances, we hypothesize that it is possible to monitor pathogen adaptations at the sequence level and further our understanding of the function of the pathogen machinery. Even though the genome of Plasmodium falciparum, the agent causing malaria in humans, is complete, the functions of many of the coding regions remain unknown. Herein we present the results of our exhaustive calculations for each of the annotated coding regions in P. falciparum and the human genom

Reinventing the Wheel

The Reinventing the Wheel project is the process of developing a Bicycle Refinement Plan for the City of Redmond. A group of volunteer urban & regional planning graduate students from Portland State University, known as b:spoke Planning & Design, has been charged with developing strategies to increase bicycle ridership and remove barriers to transit options in Redmond. The project is a refinement plan , as it involves the refinement of and building upon existing City plans such as the Transportation Systems Plan (TSP), Bicycle Master Plan, and Parks & Recreation Trails Master Plan. This project was conducted under the supervision of Sumner Sharpe and Ellen Bassett

csPCR: A computational tool for the simulation of the Polymerase Chain Reaction

Dasu S, Williams A, Fofanov Y, Putonti C., csPCR: A computational tool for the simulation of the Polymerase Chain Reaction, Online J Bioinformatics, 11 (1): 30-33, 2010. Herein we present a computational simulation package PCR (csPCR) which models the PCR reaction, taking into consideration the issues of specificity, sensitivity, potential mishybridizations throughout the primer sequence as well as at the 3’ end, and primer interactions, including selfcomplementarity and primer-primer interactions. A single target sequence or multiple target sequences can be considered simultaneously in addition to multiple primer sequences; thus a complex community and/or a multiplex assay can be simulated in a manner analogous with the actual experiment. This tool leaves primer design to the user, as there is a wealth of existing programs already available, and rather focuses on simulation of the anticipated amplification and expected agarose gel in addition to providing information about the location(s) of amplification in both text and graphical format. The software is freely available at www.bioinfo.uh.edu/csPCR

PediApp Finder: Creating a Pediatric Application Database

It is estimated that of the 85% of Americans that own cell phones, over half of these cell phone owners use apps on their phone (Fox & Duggan, 2012; Purcell, 2011). According to the U.S. Food and Drug Administration (2013), by 2015, 500 million mobile device users will be using mobile health, or “m-Health” apps. Healthcare professionals are increasingly adopting mobile technology as an innovative, cost-efficient, and timesaving tool that may promote patient wellness and disease prevention (Kumar, 2013; mHealth Bible, 2013). Although mobile technology is a natural fit to the field of occupational therapy, research demonstrates that few resources exist for finding apps for use in occupational therapy intervention with children (Hoesterey & Chappelle, 2012; Waite, 2012). The purpose of this project was to develop a free and open-source app that serves as a centralized database of apps beneficial to pediatric occupational therapy intervention. Dominican University of California Occupational Therapy graduate students partnered with Mr. Ruben Rivera of Northern New Mexico College (NNMC) in developing and implementing this project. As a result, an app titled PediApp Finder was created for mobile Android platforms and published on Google Play for free public download. The main goals of this project were to provide a resource tool for pediatric occupational therapists that would facilitate and streamline the process of searching for apps for use in pediatric intervention, as well as to provide a platform in which therapists can share the most up-to-date app technology in order to stay current and relevant in pediatric therapy. A pilot version of PediApp Finder was shared with four pediatric occupational therapists along with a Likert scale survey for evaluation of the app’s content, function, and design. Results of this survey guided the final refinement phase of the PediApp Finder development process. PediApp Finder is now currently available for free public download on Google Play

Gait coordination in Parkinson disease: Effects of step length and cadence manipulations

BACKGROUND: Gait impairments are well documented in those with PD. Prior studies suggest that gait impairments may be worse and ongoing in those with PD who demonstrate FOG compared to those with PD who do not. PURPOSE: Our aim was to determine the effects of manipulating step length and cadence individually, and together, on gait coordination in those with PD who experience FOG, those with PD who do not experience FOG, healthy older adults, and healthy young adults. METHODS: Eleven participants with PD and FOG, 16 with PD and no FOG, 18 healthy older, and 19 healthy young adults walked across a GAITRite walkway under four conditions: Natural, Fast (+50% of preferred cadence), Small (−50% of preferred step length), and SmallFast (+50% cadence and −50% step length). Coordination (i.e. phase coordination index) was measured for each participant during each condition and analyzed using mixed model repeated measure ANOVAs. RESULTS: FOG was not elicited. Decreasing step length or decreasing step length and increasing cadence together affected coordination. Small steps combined with fast cadence resulted in poorer coordination in both groups with PD compared to healthy young adults and in those with PD and FOG compared to healthy older adults. CONCLUSIONS: Coordination deficits can be identified in those with PD by having them walk with small steps combined with fast cadence. Short steps produced at high rate elicit worse coordination than short steps or fast steps alone

Upper extremity freezing and dyscoordination in Parkinson\u27s disease: Effects of amplitude and cadence manipulations

Purpose. Motor freezing, the inability to produce effective movement, is associated with decreasing amplitude, hastening of movement, and poor coordination. We investigated how manipulations of movement amplitude and cadence affect upper extremity (UE) coordination as measured by the phase coordination index (PCI)—only previously measured in gait—and freezing of the upper extremity (FO-UE) in people with Parkinson's disease (PD) who experience freezing of gait (PD + FOG), do not experience FOG (PD-FOG), and healthy controls. Methods. Twenty-seven participants with PD and 18 healthy older adults made alternating bimanual movements between targets under four conditions: Baseline; Fast; Small; SmallFast. Kinematic data were recorded and analyzed for PCI and FO-UE events. PCI and FO-UE were compared across groups and conditions. Correlations between UE PCI, gait PCI, FO-UE, and Freezing of Gait Questionnaire (FOG-Q) were determined. Results. PD + FOG had poorer coordination than healthy old during SmallFast. UE coordination correlated with number of FO-UE episodes in two conditions and FOG-Q score in one. No differences existed between PD−/+FOG in coordination or number of FO-UE episodes. Conclusions. Dyscoordination and FO-UE can be elicited by manipulating cadence and amplitude of an alternating bimanual task. It remains unclear whether FO-UE and FOG share common mechanisms