Results of a multi-site pragmatic hybrid type 3 cluster randomized trial comparing level of facilitation while implementing an intervention in community-dwelling disabled and older adults in a Medicaid waiver

Background: Evidence-based interventions that optimize physical function for disabled and older adults living in the community who have difficulty with daily living tasks are available. However, uptake has been limited, particularly in resource-constrained (Medicaid) settings. Facilitation may be an effective implementation strategy. This study’s aim was to compare internal facilitation (IF) versus IF and external facilitation (EF) on adoption and sustainability of an intervention in a Medicaid home and community-based waiver. Methods: In a hybrid type 3 trial, waiver sites (N = 18) were randomly assigned to implement the intervention using a bundle of strategies with either IF or IF and EF. Adoption and sustainability were assessed via Stages of Implementation Completion (SIC) for each site. Clinician attitudes toward evidence-based practice and self-efficacy were evaluated among 539 registered nurses, social workers, and occupational therapists. Medicaid beneficiary outcomes of activities of daily living, depression, pain, falls, emergency department visits, and hospitalizations were evaluated in a sample of N = 7030 as reflected by electronic health records data of the Medicaid waiver program. Linear mixed-effects models were used to compare outcomes between trial arms while accounting for cluster-randomized design. Results: The mean SIC scores were 72.22 (standard deviation [SD] = 16.98) in the IF arm (9 sites) and 61.33 (SD = 19.29) in the IF + EF arm (9 sites). The difference was not statistically significant but corresponded to the medium clinically important effect size Cohen’s d = 0.60. Clinician implementation outcomes of attitudes and self-efficacy did not differ by trial arm. Beneficiary depression was reduced significantly in the IF + EF arm compared to the IF arm (p = .04, 95% confidence interval for the difference [0.01, 0.24]). No differences between trial arms were found for other beneficiary outcomes. Conclusions: Level of facilitation did not enhance capacity for adoption and sustainability of an evidence-based intervention in a Medicaid setting that cares for disabled and older adults. Improved beneficiary depression favored use of IF and EF compared to IF alone, and no differences were found for other outcomes. These findings also suggest level of facilitation may not have impacted beneficiary outcomes

Engaging caregivers to use an evidence‑based intervention for medicaid benefciaries with Alzheimer’s disease: a pilot study

Background This pilot study aimed to adapt an intervention, engaging informal caregivers to help clinicians with providing care to improve (or maintain) physical function of individuals with Alzheimer’s Disease or other dementias. To the best of our knowledge, for the frst time, we report on use of the intervention in those with Alzheimer’s Disease or other dementias. Methods This was a 5-month mixed methods cohort study in a convenience sample of clinicians, caregivers, and benefciaries at 3-Medicaid Home and Community-based Service sites in Michigan. Two content experts and 5 caregivers modifed the intervention. We trained 116 clinicians to engage caregivers and 50 caregivers to help clinicians provide the modifed intervention to 52 benefciaries with Alzheimer’s Disease or other dementias. Thematic analyses, descriptive statistics, counts, proportion comparisons, t-tests, and McNemar’s tests were used to examine socio-demographics, clinician knowledge uptake and satisfaction with training and use of the intervention; caregiver self-efcacy, feasibility, acceptability, usability, and satisfaction with intervention and benefciary outcomes (pre-/post). Results Feasibility (enrolled/recruited=78.5–86.7%), acceptability (7.55–8.35 [SD 1.50–2.06]), and usability (7.85–8.81 [SD 1.50–2.6]) of the modifed intervention (1=low;10=high) were high. Pre-/post-intervention clinician knowledge (12.33–12.28, SD 1.80–2.84; -0.52, SD 1.95) was high. Caregiver self-efcacy increased (0.81 [SD 0.62] p\u3c0.01). Benefciary outcomes did not improve nor decline (\u3e0.05). Conclusions Engaging informal caregivers to assist clinicians with providing an intervention adapted to the needs of those with Alzheimer’s Disease or other dementias was feasible, acceptable, and usable. Further testing in a broader sample of those with dementia in various settings is needed

Distance perception in immersive environments: the role of photorealism

Immersive environments (IE) are being increasingly used in order to perform psychophysical experiments. The versatility in terms of stimuli presentation and control and the less time-consuming procedures are their greatest strengths. However, to ensure that IE results can be generalized to real world scenarios we must first provide evidence that performance in IE is quantitatively indistinguishable from performance in real-world. Our goal was to perceptually validate distance perception for CAVE-like IEs. Participants performed a Frontal Matching Distance Task (Durgin & Li, 2011) in three different conditions: real-world scenario (RWS); photorealistic IE (IEPH) and non-photorealistic IE (IENPH). Underestimation of distance was found across all the conditions, with a significant difference between the three conditions (Wilks’ Lambda = .38, F(2,134)= 110.8, p<.01, significant pairwise differences with p<.01). We found a mean error of 2.3 meters for the RWS, 5 meters for the IEPH, and of 6 meters for the IENPH in a pooled data set of 5 participants. Results indicate that while having a photorealistic IE with perspective and stereoscopic depth cues might not be enough to elicit a real-world performance in distance judgment tasks, nevertheless this type of environment minimizes the discrepancy between simulation and real-world when compared with non-photorealistic IEs

RELAÇÕES EXISTENTES ENTRE O DESENVOLVIMENTO PSICOMOTOR E A INTELIGÊNCIA (QI) DAS CRIANÇAS PARTICIPANTES DO PROGRAMA DE ERRADICAÇÃO DO TRABALHO INFANTIL (PETI)

Diante das inúmeras problemáticas relacionadas ao desenvolvimento e à aprendizagem de crianças em fase escolar esta pesquisa é de grande importância na identificação e no diagnóstico, podendo auxiliar no melhor conhecimento e entendimento desses acontecimentos. Frente a isso, para a realização desta pesquisa, foram analisadas crianças com faixa etária entre 6 e 11 anos, participantes do Programa de Erradicação do Trabalho Infantil (PETI) da Unoesc Chapecó. Para avaliar a Inteligência (QI) foi utilizado como instrumento de avaliação o Teste das Matrizes Progressivas Coloridas de Raven, sendo este um teste de inteligência não verbal, indicado principalmente na avaliação de crianças entre 5 e 11 anos e meio, mas que também pode ser aplicado em pessoas com deficiência. No que se refere à avaliação psicomotora foi usada a Escala de Desenvolvimento Motor (EDM), de Francisco Rosa Neto. Esse instrumento consiste em avaliar o desenvolvimento motor de crianças com dificuldades de aprendizagem em nível escolar, dificuldades ou atrasos no desenvolvimento neuropsicomotor, problemas na fala, escrita e cálculo. Diante disso, como objetivo desta pesquisa, buscou-se conhecer as relações existentes entre o desenvolvimento psicomotor e a inteligência (QI) das crianças participantes do PETI, utilizando os instrumentos/testes citados, para então identificar a relação entre idade cronológica, desenvolvimento de inteligência e desenvolvimento motor a partir do comparativo realizado. Para que isso fosse possível, foi utilizada uma metodologia quanti-qualitativa do tipo descritivo, em que a análise dos dados se baseou no manual dos testes e na análise de conteúdo. Ao realizar esta pesquisa foi possível constatar que os indivíduos com dificuldades motoras, na maioria das vezes, apresentam baixo nível de inteligência (QI), e os indivíduos com alto nível de inteligência (QI) apresentaram desenvolvimento motor em nível médio e acima da média, o que permite concluir a forte relação entre essas variáveis. Enfim, foi possível unir a saúde mental/intelectual e física dos sujeitos, galgando à construção consciente do corpo humano em um movimento positivo que reflita de maneira interior, exterior, emocional, psicológica e social.Palavras-chave: Crianças. Inteligência (QI). Psicomotricidade. 

Audiovisual integration increases the intentional step synchronization of side-by-side walkers

When people walk side-by-side, they often synchronize their steps. To achieve this, individuals might cross-modally match audiovisual signals from the movements of the partner and kinesthetic, cutaneous, visual and auditory signals from their own movements. Because signals from different sensory systems are processed with noise and asynchronously, the challenge of the CNS is to derive the best estimate based on this conflicting information. This is currently thought to be done by a mechanism operating as a Maximum Likelihood Estimator (MLE). The present work investigated whether audiovisual signals from the partner are integrated according to MLE in order to synchronize steps during walking. Three experiments were conducted in which the sensory cues from a walking partner were virtually simulated. In Experiment 1 seven participants were instructed to synchronize with human-sized Point Light Walkers and/or footstep sounds. Results revealed highest synchronization performance with auditory and audiovisual cues. This was quantified by the time to achieve synchronization and by synchronization variability. However, this auditory dominance effect might have been due to artifacts of the setup. Therefore, in Experiment 2 human-sized virtual mannequins were implemented. Also, audiovisual stimuli were rendered in real-time and thus were synchronous and co-localized. All four participants synchronized best with audiovisual cues. For three of the four participants results point toward their optimal integration consistent with the MLE model. Experiment 3 yielded performance decrements for all three participants when the cues were incongruent. Overall, these findings suggest that individuals might optimally integrate audiovisual cues to synchronize steps during side-by-side walking.info:eu-repo/semantics/publishedVersio

Sensorimotor synchronization when walking side by side with a point light walker

[Excerpt] Synchronization of periodic movements like side-by-side walking [7] is frequently modeled by coupled oscillators [5] and the coupling strength is defined quantitatively [3]. In contrast, in most studies on sensorimotor synchronization (SMS), simple movements like finger taps are synchronized with simple stimuli like metronomes [4]. While the latter paradigm simplifies matters and allows for the assessment of the relative weights of sensory modalities through systematic variation of the stimuli [1], it might lack ecological validity. Conversely, using more complex movements and stimuli might complicate the specification of mechanisms underlying coupling. We merged the positive aspects of both approaches to study the contribution of auditory and visual information on synchronization during side-by-side walking. As stimuli, we used Point Light Walkers (PLWs) and auralized steps sound; both were constructed from previously captured walking individuals [2][6]. PLWs were retro-projected on a screen and matched according to gender, hip height, and velocity. The participant walked for 7.20m side by side with 1) a PLW, 2) steps sound, or 3) both displayed in temporal congruence. Instruction to participants was to synchronize with the available stimuli. [...]Acknowledgments: [Supported by Fundação Bial (Grant 77/12) and Fundação para a Ciência e Tecnologia - FCT: SFRH/BD/88396/2012; EXPL/MHC-PCN/0162/2013; FCOMP-01-0124 - FEDER-022674 and PEst-C/CTM/U10264/2011; FCOMP-01-0124-FEDER-037281 and PEstC/EEI/LA0014/2013. This work was financed by FEDER grants through the Operational Competitiveness Program – COMPETE]

A non-invasive approach to monitor chronic lymphocytic leukemia engraftment in a xenograft mouse model using ultra-small superparamagnetic iron oxide-magnetic resonance imaging (USPIO-MRI).

This work was supported by: Associazione Italiana Ricerca sul Cancro (AIRC) [Grant 5 x mille n.9980, (to M.F., F.M. and A. N.)]; AIRC I.G. [n. 14,326 (to M.F.)], [n.10136 and 16,722 (A.N.)], [n.15426 (to F.F.)]. AIRC and Fondazione CaRiCal co-financed Multi Unit Regional Grant 2014 [n.16695 (to F.M.)]. Italian Ministry of Health 5 × 1000 funds (to F.F). A.G R. was supported by Associazione Italiana contro le Leucemie-Linfomi-Mielomi (AIL) Cosenza - Fondazione Amelia Scorza (FAS). S.M. C.M., F.V., L. E., S. B., were supported by AIRC.Peer reviewedPostprin

Ensinando polinômios através da ludicidade

O presente artigo trata-se de um relato de uma atividade desenvolvida em sala de aula, chamada jogo do alvo, com as turmas de 7º e 8º anos da Escola Municipal de Ensino Fundamental Professora Maria Margarida Zambon Benini. A oficina foi conduzida pelas bolsistas do Projeto PIBID (Subprojeto Matemática) IFRS – Campus Bento Gonçalves e realizada no turno da manhã, durante as aulas de Matemática. O jogo trabalhado proporcionou um contato inicial com a álgebra, fazendo com que os alunos relacionassem números com a parte literal (letras) e soubessem como identificá-las. Os alunos deveriam jogar feijões no alvo e após representar a cor acertada por cada um deles com uma letra. Ao final do jogo, os alunos somaram os resultados de todas as jogadas, resultando em um único monômio/polinômio. A atividade e a utilização de materiais diversificados proporcionam uma aprendizagem mais interativa e espontânea, facilitando assim o melhor desempenho dos alunos

Induction of Expandable Tissue-Specific Stem/Progenitor Cells through Transient Expression of YAP/TAZ

The ability to induce autologous tissue-specific stem cells in culture could have a variety of applications in regenerative medicine and disease modeling. Here we show that transient expression of exogenous YAP or its closely related paralogue TAZ in primary differentiated mouse cells can induce conversion to a tissue-specific stem/progenitor cell state. Differentiated mammary gland, neuronal, and pancreatic exocrine cells, identified using a combination of cell sorting and lineage tracing approaches, efficiently convert to proliferating cells with properties of stem/progenitor cells of their respective tissues after YAP induction. YAP-induced mammary stem/progenitor cells show molecular and functional properties similar to endogenous MaSCs, including organoid formation and mammary gland reconstitution after transplantation. Because YAP/TAZ function is also important for self-renewal of endogenous stem cells in culture, our findings have implications for understanding the molecular determinants of the somatic stem cell state

Experimental Multi-state Quantum Discrimination in the Frequency Domain with Quantum Dot Light

The quest for the realization of effective quantum state discrimination strategies is of great interest for quantum information technology, as well as for fundamental studies. Therefore, it is crucial to develop new and more efficient methods to implement discrimination protocols for quantum states. Among the others, single photon implementations are more advisable, because of their inherent security advantage in quantum communication scenarios. In this work, we present the experimental realization of a protocol employing a time-multiplexing strategy to optimally discriminate among eight non-orthogonal states, encoded in the four-dimensional Hilbert space spanning both the polarization degree of freedom and photon energy. The experiment, built on a custom-designed bulk optics analyser setup and single photons generated by a nearly deterministic solid-state source, represents a benchmarking example of minimum error discrimination with actual quantum states, requiring only linear optics and two photodetectors to be realized. Our work paves the way for more complex applications and delivers a novel approach towards high-dimensional quantum encoding and decoding operations