Using Telemedicine to Improve Breastfeeding Outcomes in the Primary Care Setting

Approved May 2017 by the faculty of UMKC in partial fulfillment of the requirements for the degree of Doctor of Nursing PracticeBreastmilk is the most complete form of nutrition for most infants, and it is recommended that infants are exclusively breastfed for the first six months of life. Nationally, breastfeeding rates fall short of the goals set by the Healthy People 2020 initiative and community-based breastfeeding support programs can lead to an increase in the initiation, duration, and exclusivity of breastfeeding (CDC, 2016). The purpose of this quantitative, pre-test/post-test design Doctorate of Nursing Practice project was to determine if the use of telemedicine technology to provide breastfeeding support would increase breastfeeding duration and exclusivity in mother infant dyads within a primary care setting. Data collected from the electronic medical record was used to compare breastfeeding duration and exclusivity rates between the pre and post intervention groups. Convenience sampling was used, and participants were established patients within the primary care clinics of a local pediatric primary care clinic. Three mothers attempted to participate in the intervention. Breastfeeding duration and exclusivity rates were found to be similar between the pre- and post-intervention groups. The goal of this project was to provide access to lactation support to a wider range of patients and prevent the barriers associated with attendance of on-site breastfeeding support groups. Providing mothers with resources for successful breastfeeding can lead to increased breastfeeding duration and exclusivity rates, which can further lead to improved health outcomes for both mothers and infants

Associations of Mail Survey Length and Layout With Response Rates.

We assess the association between survey layout and response rates (RRs) in the 2017 Medicare Advantage Consumer Assessment of Healthcare Providers and Systems mail survey. Among 438 Medicare Advantage plans surveyed by six vendors, there was latitude in survey layout, and plans could add up to 12 supplemental items. Regression models predicted survey response from survey characteristics (page count, number of supplemental items, and survey attractiveness), and beneficiary sociodemographics. Beneficiary-age-by-survey-characteristic interactions assessed whether survey characteristics were more strongly related to RRs among older beneficiaries. We found that surveys with more supplemental items and less attractive layouts had lower adjusted odds of response. RRs were more sensitive to format among older beneficiaries. The difference in adjusted RRs for the most favorable versus the least favorable survey design was 14.5%. For a 65-year-old, this difference was 13.6%; for an 80-year-old, it was 21.0%. These findings suggest that even within a relatively standardized survey, formatting can substantially influence RRs

Identifying optimal level-of-care placement decisions for adolescent substance use treatment

Background: Adolescents respond differentially to substance use treatment based on their individual needs and goals. Providers may benefit from guidance (via decision rules) for personalizing aspects of treatment, such as level-of-care (LOC) placements, like choosing between outpatient or inpatient care. The field lacks an empirically-supported foundation to inform the development of an adaptive LOC-placement protocol. This work begins to build the evidence base for adaptive protocols by estimating them from a large observational dataset. Methods: We estimated two-stage LOC-placement protocols adapted to individual adolescent characteristics collected from the Global Appraisal of Individual Needs assessment tool (n = 10,131 adolescents). We used a modified version of Q-learning, a regression-based method for estimating personalized treatment rules over time, to estimate four protocols, each targeting a potentially distinct treatment goal: one primary outcome (a composite of ten positive treatment outcomes) and three secondary (substance frequency, substance problems, and emotional problems). We compared the adaptive protocols to non-adaptive protocols using an independent dataset. Results: Intensive outpatient was recommended for all adolescents at intake for the primary outcome, while low-risk adolescents were recommended for no further treatment at followup while higher-risk patients were recommended to inpatient. Our adaptive protocols outperformed static protocols by an average of 0.4 standard deviations (95 % confidence interval 0.2-0.6) of the primary outcome. Conclusions: Adaptive protocols provide a simple one-to-one guide between adolescents' needs and recommended treatment which can be used as decision support for clinicians making LOC-placement decisions

The Grizzly, November 17, 1992

Ann Landers at Founder\u27s Day • Dr. Clayton Speaks on Education • An Active MSU • Elliot Speaks on Racism • Dinosaurs and Meteors • What Wismer Can Do For You • Greeks Grow With Chi Rho Psi • Top Ten Reasons Ursinus Needs a Coffeehouse • Catch of the Week • Shoulder Dancing to Depeche Mode • Voyages to Freedom Exhibit and the Jewish Experience in America • Messiah • In Their Own Words • Let\u27s See How They Like It • Concert and Jazz Bands to Perform • A Push for Physically Challenged Accessibility • Who\u27s on First? • Letters to the Editor • The Editorial Mission: Our Relationship to The Grizzly • UC Men\u27s Basketball For \u2792-\u2793 • Senior Billitto Glad He Transferred to UC • Field Hockey \u2792: A Look Back • Football Ends Tough Yearhttps://digitalcommons.ursinus.edu/grizzlynews/1305/thumbnail.jp

Size-resolved mixing state of black carbon in the Canadian high Arctic and implications for simulated direct radiative effect

Transport of anthropogenic aerosol into the Arc- tic in the spring months has the potential to affect regional climate; however, modeling estimates of the aerosol direct radiative effect (DRE) are sensitive to uncertainties in the mixing state of black carbon (BC). A common approach in previous modeling studies is to assume an entirely exter- nal mixture (all primarily scattering species are in separate particles from BC) or internal mixture (all primarily scat- tering species are mixed in the same particles as BC). To provide constraints on the size-resolved mixing state of BC, we use airborne single-particle soot photometer (SP2) and ultrahigh-sensitivity aerosol spectrometer (UHSAS) mea- surements from the Alfred Wegener Institute (AWI) Polar 6 flights from the NETCARE/PAMARCMIP2015 campaign to estimate coating thickness as a function of refractory BC (rBC) core diameter and the fraction of particles contain- ing rBC in the springtime Canadian high Arctic. For rBC core diameters in the range of 140 to 220 nm, we find av- erage coating thicknesses of approximately 45 to 40 nm, re- spectively, resulting in ratios of total particle diameter to rBC core diameters ranging from 1.6 to 1.4. For total par- ticle diameters ranging from 175 to 730 nm, rBC-containing particle number fractions range from 16% to 3%, respec- tively. We combine the observed mixing-state constraints with simulated size-resolved aerosol mass and number dis- tributions from GEOS-Chem–TOMAS to estimate the DRE with observed bounds on mixing state as opposed to assuming an entirely external or internal mixture. We find that the pan-Arctic average springtime DRE ranges fro

Growing our future: Introducing the Pacific School Food Network to support healthy school food and nutrition environments for better nourished children in the Pacific Islands

Food systems in the Pacific Islands (P.I.) are transitioning from local, traditional diets to those with low fruit and vegetable intake and largely based on ultra-processed foods that are often, but not always, imported. Alongside changes in diet and health outcomes, there is a loss of traditional and sociocultural dimensions of food, resulting in poor quality diets in many P.I. populations, including children. Besides high rates of overweight and obesity, in some areas stunting rates are up to 48.4%,1 and prevalence of anaemia (5-14 years) as high as 45%.2 After many years of limited multisectoral action and effort to enact sustainable change across policy and practice, there is growing interest in improving school food and nutrition environments (SFE) in the region. Against this backdrop of limited capacity, coordination, effort, research and evidence, the Pacific School Food Network (PSFN) was formed

Pacific food systems The role of fish and other aquatic foods for nutrition and health

This report is intended for actors, policymakers and funders concerned with improving food and nutrition security with fisheries as an entry point. It is equally valuable for food system, agricultural, health and nutrition actors who are seeking to protect and enhance the benefits that fish and other aquatic foods provide to a diversity of nutrition goals. This report has been developed from an extensive review of published scientific articles and technical reports, as well as interviews and consultations with 17 experts. It also draws upon insights from the Pacific Food System regional dialogues, which were held in the lead-up to the United Nations Food Systems Summit 2021

Fundulus as the premier teleost model in environmental biology : opportunities for new insights using genomics

Author Posting. © Elsevier B.V., 2007. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Comparative Biochemistry and Physiology Part D: Genomics and Proteomics 2 (2007): 257-286, doi:10.1016/j.cbd.2007.09.001.A strong foundation of basic and applied research documents that the estuarine fish Fundulus heteroclitus and related species are unique laboratory and field models for understanding how individuals and populations interact with their environment. In this paper we summarize an extensive body of work examining the adaptive responses of Fundulus species to environmental conditions, and describe how this research has contributed importantly to our understanding of physiology, gene regulation, toxicology, and ecological and evolutionary genetics of teleosts and other vertebrates. These explorations have reached a critical juncture at which advancement is hindered by the lack of genomic resources for these species. We suggest that a more complete genomics toolbox for F. heteroclitus and related species will permit researchers to exploit the power of this model organism to rapidly advance our understanding of fundamental biological and pathological mechanisms among vertebrates, as well as ecological strategies and evolutionary processes common to all living organisms.This material is based on work supported by grants from the National Science Foundation DBI-0420504 (LJB), OCE 0308777 (DLC, RNW, BBR), BES-0553523 (AW), IBN 0236494 (BBR), IOB-0519579 (DHE), IOB-0543860 (DWT), FSML-0533189 (SC); National Institute of Health NIEHS P42-ES007381(GVC, MEH), P42-ES10356 (RTD), ES011588 (MFO); and NCRR P20 RR-016463 (DWT); Natural Sciences and Engineering Research Council of Canada Discovery (DLM, TDS, WSM) and Collaborative Research and Development Programs (DLM); NOAA/National Sea Grant NA86RG0052 (LJB), NA16RG2273 (SIK, MEH,GVC, JJS); Environmental Protection Agency U91620701 (WSB), R82902201(SC) and EPA’s Office of Research and Development (DEN)

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead