Perceived Self-Efficacy, Confidence, and Skill Among Factors of Adult Patient Participation in Transitional Care: A Systematic Review of Quantitative Studies.

Introduction: An advancing healthcare system in which patients are often required to self-manage care needs across countless settings and clinicians is increasing focus on participation in care. Mismanagement of care during already risky care-transitions further increases adverse care outcomes. Understanding factors of patient participation in transitional care in an adult population can help guide ways to reduce this burden. Methods: A systematic review of the literature guided by the PRISMA method was conducted to identify factors of patient participation in transitional care. Quantitative studies in which patient participation was measured as an outcome variable and related statistics reported, and data were collected from an adult sample, were included. Two authors independently reviewed, critiqued, and synthesized the articles, and later categorized study variables according to identified trends. Results: Twelve studies across international and multidisciplinary backgrounds were identified. Across studies, efforts were largely based on understanding or improving patient self-management of care during transitions. The majority of studies were experimental and care interventions grounded in patient and healthcare team partnerships, delivered beyond the hospital setting. An array of measures was used to quantify patient participation. Factors of patient participation in transitional care included higher perceived levels of self-efficacy, confidence, and skills to participate in care. Conclusion: The results of this study suggest patient participation in transitional care is largely based on perceptions of self-efficacy, confidence, and skill. Patient-centric transitional care interventions targeting these factors and delivered beyond the hospital setting may improve care outcomes. Implications and direction for further studies includes conceptual clarity, the study of a broader-reaching patient population demographic, and use of multidisciplinary interventions. Outcome variables should remain focused on patient perception of care involvement and participation and expanded to include variables such as functional abilities and social determinants of health

Degree of Hazard Evaluation Program User's Guide

The Degree of Hazard program is a computer model which incorporates the Degree of Hazard Methodology as developed by the Institute for Environmental Studies at the University of Illinois through funding by the Hazardous Waste Research and Information Center. The Degree of Hazard Methodology is an evaluation process which identifies the toxicity, fire, disease, leaching, and environmental hazards within a specific waste stream. The details of the various calculations are described within the Illinois Administrative Code, Section 808, Appendix B. The Degree of Hazard (DOH) program allows entry of the components of a specific waste stream, computes the degree of hazard for the waste stream, and displays or prints the results. Several related reports may be generated and printed. (Note: This software program is no longer available).Ope

Field and data analysis studies related to the atmospheric environment

This report summarizes work on a broad array of projects including: (1) applications of meteorological and/or oceanographic satellites; (2) improvement of the current set of NASA/USAF lightning related launch commit criteria rules; (3) the design, building, testing and deployment of a set of cylindrical field mills for aircraft use; (4) the study of marginal electrification storm conditions in relationship to the current launch commit rules for the space shuttle and various other launch vehicles using an instrumented aircraft; (5) support of the DC-8 and ER-2 lightning instrument package as part of both the Tropical Ocean - Global Atmospheric/Coupled Ocean-Atmospheric Response Experiment and the Convection and Moisture Experiment; (6) design of electronic circuitry and microprocessor firmware for the NASA Advanced Ground Based Field Mill; (7) design and testing of electronic and computer instrumentation for atmospheric electricity measurements; (8) simulating observations from a lightning imaging sensor on the Tropical Rainfall Measuring satellite; and (9) supporting scientific visualization and the development of computer software tools

Spectral Dynamics and Therapeutic Implications of the Theta/Alpha Crossover in Alpha-Theta Neurofeedback

Article describes study examining 182 alpha-theta session graphs from 10 subject case files for interactions between frequency band activity and subject reports of imagery or biographical memories during crossovers, as well as treatment outcomes

The influence of membrane physical properties on microvesicle release in human erythrocytes

Exposure of human erythrocytes to elevated intracellular calcium causes fragments of the cell membrane to be shed as microvesicles. This study tested the hypothesis that microvesicle release depends on microscopic membrane physical properties such as lipid order, fluidity, and composition. Membrane properties were manipulated by varying the experimental temperature, membrane cholesterol content, and the activity of the trans-membrane phospholipid transporter, scramblase. Microvesicle release was enhanced by increasing the experimental temperature. Reduction in membrane cholesterol content by treatment with methyl-β-cyclodextrin also facilitated vesicle shedding. Inhibition of scramblase with R5421 impaired vesicle release. These data were interpreted in the context of membrane characteristics assessed previously by fluorescence spectroscopy with environment-sensitive probes such as laurdan, diphenylhexatriene, and merocyanine 540. The observations supported the following conclusions: 1) calcium-induced microvesicle shedding in erythrocytes relates more to membrane properties detected by diphenylhexatriene than by the other probes; 2) loss of trans-membrane phospholipid asymmetry is required for microvesicle release

Different Measures, Different Outcomes? A Systematic Review of Performance-Based versus Self-Reported Measures of Health Literacy and Numeracy

BACKGROUND Health literacy (HL) and numeracy are measured by one of two methods: performance on objective tests or self-report of one’s skills. Whether results from these methods differ in their relationship to health outcomes or use of health services is unknown. METHODS We performed a systematic review to identify and evaluate articles that measured both performance-based and self-reported HL or numeracy and examined their relationship to health outcomes or health service use. To identify studies, we started with an AHRQ-funded systematic review of HL and health outcomes. We then looked for newer studies by searching MEDLINE from 1 February 2010 to 9 December 2014. We included English language studies meeting pre-specified criteria. Two reviewers independently assessed abstracts and studies for inclusion and graded study quality. One reviewer abstracted information from included studies while a second checked content for accuracy. RESULTS We identified four “fair” quality studies that met inclusion criteria for our review. Two studies measuring HL found no differences between performance-based and self-reported HL for association with self-reported outcomes (including diabetes, stroke, hypertension) or a physician-completed rheumatoid arthritis disease activity score. However, HL measures were differentially related to a patient-completed health assessment questionnaire and to a patient’s ability to interpret their prescription medication name and dose from a medication bottle. Only one study measured numeracy and found no difference between performance-based and self-reported measures of numeracy and colorectal cancer (CRC) screening utilization. However, in a moderator analysis from the same study, performance-based and self-reported numeracy were differentially related to CRC screening utilization when stratified by certain patient–provider communication behaviors (e.g., the chance to always ask questions and get the support that is needed). DISCUSSION Most studies found no difference in the relationship between results of performance-based and self-reported measures and outcomes. However, we identified few studies using multiple instruments and/or objective outcomes

Genome-wide association study of male sexual orientation

Family and twin studies suggest that genes play a role in male sexual orientation. We conducted a genome-wide association study (GWAS) of male sexual orientation on a primarily European ancestry sample of 1,077 homosexual men and 1,231 heterosexual men using Affymetrix single nucleotide polymorphism (SNP) arrays. We identified several SNPs with p < 10 -5 , including regions of multiple supporting SNPs on chromosomes 13 (minimum p = 7.5 × 10 -7 ) and 14 (p = 4.7 × 10 -7 ). The genes nearest to these peaks have functions plausibly relevant to the development of sexual orientation. On chromosome 13, SLITRK6 is a neurodevelopmental gene mostly expressed in the diencephalon, which contains a region previously reported as differing in size in men by sexual orientation. On chromosome 14, TSHR genetic variants in intron 1 could conceivably help explain past findings relating familial atypical thyroid function and male homosexuality. Furthermore, skewed X chromosome inactivation has been found in the thyroid condition, Graves' disease, as well as in mothers of homosexual men. On pericentromeric chromosome 8 within our previously reported linkage peak, we found support (p = 4.1 × 10 -3 ) for a SNP association previously reported (rs77013977, p = 7.1 × 10 -8 ), with the combined analysis yielding p = 6.7 × 10 -9 , i.e., a genome-wide significant association

Liquid Medication Errors and Dosing Tools: A Randomized Controlled Experiment

Poorly designed labels and packaging are key contributors to medication errors. To identify attributes of labels and dosing tools that could be improved, we examined the extent to which dosing error rates are affected by tool characteristics (ie, type, marking complexity) and discordance between units of measurement on labels and dosing tools; along with differences by health literacy and language

Mutant Neurogenin-3 in congenital malabsorptive diarrhea

Background: Neurogenin-3 (NEUROG3) is expressed in endocrine progenitor cells and is required for endocrine-cell development in the pancreas and intestine. The NEUROG3 gene (NEUROG3) is therefore a candidate for the cause of a newly discovered autosomal recessive disorder characterized by generalized malabsorption and a paucity of enteroendocrine cells. Methods: We screened genomic DNA from three unrelated patients with sparse enteroendocrine cells for mutations of NEUROG3. We then tested the ability of the observed mutations to alter NEUROG3 function, using in vitro and in vivo assays. Results: The patients had few intestinal enteroendocrine cells positive for chromogranin A, but they had normal numbers of Paneth\u27s, goblet, and absorptive cells. We identified two homozygous mutations in NEUROG3, both of which rendered the NEUROG3 protein unable to activate NEUROD1, a downstream target of NEUROG3, and compromised the ability of NEUROG3 to bind to an E-box element in the NEUROD1 promoter. The injection of wild-type but not mutant NEUROG3 messenger RNA into xenopus embryos induced NEUROD1 expression. Conclusions: A newly discovered disorder characterized by malabsorptive diarrhea and a lack of intestinal enteroendocrine cells is caused by loss-of-function mutations in NEUROG3. Copyright © 2006 Massachusetts Medical Society