An Evaluation of Using Behavioral Skills Training to Increase Instructional Pacing in the Implementation of Discrete Trial Training

Research has indicated that there may be considerable variability in the participants’ outcomes after receiving IBI treatment. It is possible that factors related to the quality of treatment, such as instructional pacing, may contribute to this variability. This study examined the effect of Behavior Skills Training (BST) on the instructional pacing of three instructor therapists during DTT. In addition, the study evaluated the instructor therapist’s accuracy implementing the components of DTT by reviewing a sample of teaching trials implemented during each session. It also examined whether changes in the rate of learning opportunities presented by the instructor participants had a differential effect on the rate correct responding and the occurrences of maladaptive behaviors demonstrated by three client participants in each dyad. Results showed that the introduction of the BST package was associated with an increase in the rate of learning opportunities for two of the instructor participants, and an increase in the accuracy of implementing DTT for two of the instructor participants. The results also demonstrated that the rate of correct responding by the client participants corresponded to the rate of learning opportunities presented to them, while the effect on the occurrence of maladaptive behaviors were minimal across the conditions

Dual Eligibles: Medicaid Enrollment and Spending for Medicare Beneficiaries in 2007

Provides an update on the share of total Medicaid enrollment and spending on those eligible for both Medicare and Medicaid through 2007, state-by-state estimates of Medicaid enrollment and expenditures for dual eligibles, and a breakdown of expenditures

Designing an Educational Program to Promote Diversity and Student Engagement in Professional Advocacy (SEPA)

Little is understood about best educational strategies to engage diverse occupational therapy students in professional advocacy. The purpose of this research was to use design-based research (DBR) methods to design a novel educational intervention to promote professional engagement of diverse students over three subsequent years. This study used a pre/post design to design, implement, evaluate, and revise an educational program entitled “Student Engagement in Professional Advocacy” (SEPA). This manuscript reports on the first year of that study. The participants (N=27) were entry-level Master of Science occupational therapy students. The outcome measure was a survey measuring student knowledge, attitude, and participation specific to professional advocacy. All participants completed the pre and post surveys and participated in four SEPA educational modules. Significant differences were observed in pre and post scores in knowledge (p \u3c 0.0001), action (p= 0.004), and attitude (p=0.012). This suggests that SEPA was effective at increasing student knowledge of, attitudes toward, and participation in professional advocacy. Pearson correlation of domains revealed a strong positive association between knowledge and attitude (p= 0.0003), actions and attitude (p = 0.0018), and action and knowledge (p=0.0262). This indicates that educational programs promoting professional engagement should address knowledge and attitudes and provide opportunities for participation. Qualitative data provided additional information on how students integrated professional engagement into their identity as students, and practical feedback on how to improve the program. Study findings supported the use of SEPA to promote student professional engagement. Further research is indicated, including conducting additional iterations of the project to continue to refine SEPA

Insulin Resistance and Metabolic Hepatocarcinogenesis with Parent-of-Origin Effects in A×B Mice

Insulin resistance is a defining feature of metabolic syndrome and type 2 diabetes mellitus but also may occur independently of these conditions. Nonalcoholic fatty liver disease (NAFLD), the hepatic manifestation of these disorders, increases the risk of hepatocellular carcinoma (HCC). However, mechanisms linking hyperinsulinemia to NAFLD and HCC require clarification. We describe a novel model of primary insulin resistance and HCC with strong parent-of-origin effects. Male AB6F1 (A/JCr dam × C57BL/6 sire) but not B6AF1 (B6 dam × A/J sire) mice developed spontaneous insulin resistance, NAFLD, and HCC without obesity or diabetes. A survey of mitochondrial, imprinted, and sex-linked traits revealed modest associations with X-linked genes. However, a diet-induced obesity study, including B6.A chromosome substitution–strain (consomic) mice, showed no segregation by sex chromosome. Thus, parent-of-origin effects were specified within the autosomal genome. Next, we interrogated mechanisms of insulin-associated hepatocarcinogenesis. Steatotic hepatocytes exhibited adipogenic transition characterized by vacuolar metaplasia and up-regulation of vimentin, adipsin, fatty acid translocase (CD36), peroxisome proliferator–activated receptor-γ, and related products. This profile was largely recapitulated in insulin-supplemented primary mouse hepatocyte cultures. Importantly, pyruvate kinase M2, a fetal anabolic enzyme implicated in the Warburg effect, was activated by insulin in vivo and in vitro. Thus, our study reveals parent-of-origin effects in heritable insulin resistance, implicating adipogenic transition with acquired anabolic metabolism in the progression from NAFLD to HCC.National Institutes of Health (U.S.) (NIH grant AA016563)National Institutes of Health (U.S.) (NIH grant CA067529)National Institutes of Health (U.S.) (NIH grant P01CA0267)National Institutes of Health (U.S.) (NIH grant P30ES02109)National Institutes of Health (U.S.) (NIH grant RR007036)National Institutes of Health (U.S.) (NIH grant CA158661)National Institutes of Health (U.S.) (NIH grant CA016086

How Do Patients with Mental Health Diagnoses Use Online Patient Portals? An Observational Analysis from the Veterans Health Administration

Online patient portals may be effective for engaging patients with mental health conditions in their own health care. This retrospective database analysis reports patient portal use among Veterans with mental health diagnoses. Unadjusted and adjusted odds of portal feature use was calculated using logistic regressions. Having experienced military sexual trauma or having an anxiety disorder, post-traumatic stress disorder, or depression were associated with increased odds of portal use; bipolar, substance use, psychotic and adjustment disorders were associated with decreased odds. Future research should examine factors that influence portal use to understand diagnosis-level differences and improve engagement with such tools

Primary skin fibroblasts as a model of Parkinson's disease

Parkinson's disease is the second most frequent neurodegenerative disorder. While most cases occur sporadic mutations in a growing number of genes including Parkin (PARK2) and PINK1 (PARK6) have been associated with the disease. Different animal models and cell models like patient skin fibroblasts and recombinant cell lines can be used as model systems for Parkinson's disease. Skin fibroblasts present a system with defined mutations and the cumulative cellular damage of the patients. PINK1 and Parkin genes show relevant expression levels in human fibroblasts and since both genes participate in stress response pathways, we believe fibroblasts advantageous in order to assess, e.g. the effect of stressors. Furthermore, since a bioenergetic deficit underlies early stage Parkinson's disease, while atrophy underlies later stages, the use of primary cells seems preferable over the use of tumor cell lines. The new option to use fibroblast-derived induced pluripotent stem cells redifferentiated into dopaminergic neurons is an additional benefit. However, the use of fibroblast has also some drawbacks. We have investigated PARK6 fibroblasts and they mirror closely the respiratory alterations, the expression profiles, the mitochondrial dynamics pathology and the vulnerability to proteasomal stress that has been documented in other model systems. Fibroblasts from patients with PARK2, PARK6, idiopathic Parkinson's disease, Alzheimer's disease, and spinocerebellar ataxia type 2 demonstrated a distinct and unique mRNA expression pattern of key genes in neurodegeneration. Thus, primary skin fibroblasts are a useful Parkinson's disease model, able to serve as a complement to animal mutants, transformed cell lines and patient tissues