A Multiple Sclerosis Education Module to Promote Patient Activation and Efficacy

Executive Summary A Multiple Sclerosis (MS) Education Module to Promote Patient Activation and Efficacy Problem It is estimated that over 572,000 people in the United States have MS, with approximately 200 new cases being diagnosed each week (National Multiple Sclerosis Society, n.d.). In order to increase self-care, reduce the level of impairment, and ultimately, cost to the healthcare system, the consistent use of a targeted educational intervention should be implemented. The problem statement describing the capstone project was: Will the implementation of a structured educational program enhance the knowledge of MS patients and their caregivers regarding the disease process of MS, resulting in increased patient activation and self-efficacy? Purpose The purpose of the project was to examine whether an educational module related to the disease process of MS would improve patient activation and self-efficacy of MS patients and their caregivers with the goal being the creation of a uniform curriculum that can provide patients with enhanced knowledge of MS as well as an increased confidence related to self-care activities. Goal The goal of this project was to determine the impact of patient education on self-efficacy and patient activation on MS patients. Objectives Project objectives included the provision of a learning opportunity for MS patients to enhance their knowledge of the disease process and self-efficacy. Additionally, the project created a sustainable, reproducible patient education program, which would hopefully lead to an improvement in self-efficacy and patient activation, and potentially show improvement in their quality of life and delay disability. Plan In order to assess the effectiveness of the educational intervention that was introduced in this project, a pre- and post-intervention design was utilized, comparing the scores that were achieved on both the Multiple Sclerosis Knowledge Questionnaire (MSKQ) and the Patient Activation Measure (PAM). The MSKQ has been found to be a reliable and valid method for the assessment of knowledge in regards to MS symptomatology, treatment options, and prognosis (Giordano et al., 2010). The PAM has been shown to be a valid and highly reliable method for measuring patient activation (Hibbard, Stockard, Mahoney, & Tusler, 2004). Outcomes and Results The results from the study indicate that the educational intervention was effective in increasing the level of knowledge participants possessed with respect to the symptoms of MS. Based on the data obtained, the effect size between the pre- and post-test conditions in regards to the PAM, the Cohen’s d was 0.49, which is considered to be a medium effect size (Polit, 2010). The difference between the pre- and post-test conditions in regards to the MSKQ scores provided a Cohen’s d of 1.37, which is considered to be a relatively large effect size. Such a result would suggest that the educational intervention program used in the current study was effective in expanding the knowledge base of the participants in regards to MS

The relation between hemispheric lateralisation and measures of immune competence and adherence in Human Immunodeficiency Virus Type 1 (HIV-1)

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited - Copyright © 2012 Sumner et al

Axonal and dendritic endocytic pathways in cultured neurons

The endocytic pathways from the axonal and dendritic surfaces of cultured polarized hippocampal neurons were examined. The dendrites and cell body contained extensive networks of tubular early endosomes which received endocytosed markers from the somatodendritic domain. In axons early endosomes were confined to presynaptic terminals and to varicosities. The somatodendritic but not the presynaptic early endosomes were labeled by internalized transferrin. In contrast to early endosomes, late endosomes and lysosomes were shown to be predominantly located in the cell body. Video microscopy was used to follow the transport-t of internalized markers from the periphery of axons and dendrites back to the cell body. Labeled structures in both domains moved unidirectionally by retrograde fast transport. Axonally transported organelles were sectioned for EM after video microscopic observation and shown to be large multivesicular body-like structures. Similar structures accumulated at the distal side of an axonal lesion. Multivesicular bodies therefore appear to be the major structures mediating transport of endocytosed markers between the nerve terminals and the cell body. Late endocytic structures were also shown to be highly mobile and were observed moving within the cell body and proximal dendritic segments. The results show that the organization of the endosomes differs in the axons and dendrites of cultured rat hippocampal neurons and that the different compartments or stages of the endocytic pathways can be resolved spatially

Child-centric Information and Communication Technology (ICT) and the fragmentation of child welfare practice in England

The ways in which government supports families and protects children are always a fine balance. In recent years, we suggest that this balance can be characterised increasingly as ‘child-centric’, less concerned with families and more focused on individual children and their needs. This article charts the changes in families and government responses over the last 40 years, and the way this is reflected in organisational and administrative arrangements. It notes in particular the impact on everyday practice of the introduction of information and communication technologies. Findings are reported from recent research which shows the struggles faced by practitioners who try to manage systems which separate children from their familial, social and relational contexts. As a consequence, we suggest, the work has become increasingly fragmented and less mindful of children's life within families. While the data and analysis draw on research carried out in England, we suggest that similar changes may be going on in other Western liberal democracies

Nocodazole-Dependent Transport, and Brefeldin A-Sensitive Processing and Sorting, of Newly Synthesized Membrane-Proteins in Cultured Neurons

The envelope glycoproteins of Semliki Forest virus (SFV), Vesicular Stomatitis virus (VSV), and Influenza Fowl Plague virus (FPV) are vectorially targeted in neurons to the plasma membrane of dendrites (SFV and VSV) and axons (FPV), To gain insight into the mechanisms responsible for such polarized delivery we have examined the effects on neurons of nocodazole and brefeldin A (BFA), which are known to cause microtubule depolymerization and disassembly of the Golgi apparatus, respectively, Nocodazole treatment blocked transport of all viral glycoproteins to both axons and dendrites, BFA treatment induced disruption of the Golgi complex, including the trans-Golgi network (TGN), and tubulation of endosomes, However, the delivery of the SFV and FPV glycoproteins to the cell surface was not affected significantly by BFA, although processing and sorting were altered as revealed by surface biotinylation and immunofluorescence microscopy of fixed nonpermeabilized cells, These results demonstrate the involvement of microtubules in axonal and dendritic transport of integral membrane glycoproteins, and the existence of a BFA-sensitive component in the sorting but not in the transport machinery

Applied Remote Sensing Program (ARSP)

There are no author-identified significant results in this report

Children, family and the state : revisiting public and private realms

The state is often viewed as part of the impersonal public sphere in opposition to the private family as a locus of warmth and intimacy. In recent years this modernist dichotomy has been challenged by theoretical and institutional trends which have altered the relationship between state and family. This paper explores changes to both elements of the dichotomy that challenge this relationship: a more fragmented family structure and more individualised and networked support for children. It will also examine two new elements that further disrupt any clear mapping between state/family and public/private dichotomies: the third party role of the child in family/state affairs and children's application of virtual technology that locates the private within new cultural and social spaces. The paper concludes by examining the rise of the 'individual child' hitherto hidden within the family/state dichotomy and the implications this has for intergenerational relations at personal and institutional levels

SAI: A sensible artificial intelligence that plays with handicap and targets high scores in 9x9 Go

We develop a new framework for the game of Go to target a high score, and thus a perfect play. We integrate this framework into the Monte Carlo tree search - policy iteration learning pipeline introduced by Google DeepMind with AlphaGo. Training on 9×9 Go produces a superhuman Go player, thus proving that this framework is stable and robust. We show that this player can be used to effectively play with both positional and score handicap. We develop a family of agents that can target high scores against any opponent, recover from very severe disadvantage against weak opponents, and avoid suboptimal moves

pH-induced microtubule-dependent redistribution of late endosomes in neuronal and epithelial cells

The interaction between late endocytic structures and microtubules in polarized cells was studied using a procedure previously shown to cause microtubule-dependent redistribution of lysosomes in fibroblasts and macrophages (Heuser, J. 1989. J. Cell Biol. 108:855-864). In cultured rat hippocampal neurons, low cytoplasmic pH caused cation-independent mannose-6-phosphate receptor-enriched structures to move out of the cell body and into the processes. In filter grown MDCK cells lowering the cytosolic pH to approximately 6.5 caused late endosomes to move to the base of the cell and this process was shown to be microtubule dependent. Alkalinization caused a shift in distribution towards the apical pole of the cell. The results are consistent with low pH causing the redistribution of late endosomes towards the plus ends of the microtubules. In MDCK cells the microtubules orientated vertically in the cell may play a role in this process. The shape changes that accompanied the redistribution of the late endosomes in MDCK cells were examined by electron microscopy. On low pH treatment fragmentation of the late endosomes was observed whereas after microtubule depolymerization individual late endosomal structures appeared to fuse together. The late endosomes of the MDCK cell appear to be highly pleomorphic and dependent on microtubules for their form and distribution in the cell

Cross-biome transplants of plant litter show decomposition models extend to a broader climatic range but lose predictability at the decadal time scale

We analyzed results from 10-year long field incubations of foliar and fine root litter from the Long-term Intersite Decomposition Experiment Team (LIDET) study. We tested whether a variety of climate and litter quality variables could be used to develop regression models of decomposition parameters across wide ranges in litter quality and climate and whether these models changed over short to long time periods. Six genera of foliar and three genera of root litters were studied with a 10-fold range in the ratio of acid unhydrolyzable fraction (AUF, or ‘lignin’) to N. Litter was incubated at 27 field sites across numerous terrestrial biomes including arctic and alpine tundra, temperate and tropical forests, grasslands and warm deserts. We used three separate mathematical models of first-order (exponential) decomposition, emphasizing either the first year or the entire decade. One model included the proportion of relatively stable material as an asymptote. For short-term (first-year) decomposition, nonlinear regressions of exponential or power function form were obtained with r 2 values of 0.82 and 0.64 for foliar and fine-root litter, respectively, across all biomes included. AUF and AUF : N ratio were the most explanative litter quality variables, while the combined temperature-moisture terms AET (actual evapotranspiration) and CDI (climatic decomposition index) were best for climatic effects. Regressions contained some systematic bias for grasslands and arctic and boreal sites, but not for humid tropical forests or temperate deciduous and coniferous forests. The ability of the regression approach to fit climate-driven decomposition models of the 10-year field results was dramatically reduced from the ability to capture drivers of short-term decomposition. Future work will require conceptual and methodological improvements to investigate processes controlling decadal-scale litter decomposition, including the formation of a relatively stable fraction and its subsequent decomposition.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78615/1/j.1365-2486.2009.02086.x.pd