Ensuring and Enhancing Respect for Patients with Disabilities: The Making of an Educational Video

Abstract Although there are more than thirty-seven million people in the United States living with some form of disability, many health care professionals lack significant awareness of and training in caring for patients with disabilities. Furthermore, many patients with disabilities describe experiencing a lack of proper care and respect in health care settings. Lehigh Valley Health Network hopes to expand education throughout the network on this very important topic, through the creation of a twenty-minute educational video, which is currently being produced. Background Invisible is what patients with disabilities have described feeling when dealing with health care providers at the Lehigh Valley Health Network and beyond. Patients have described negative experiences such as practice staff members assuming they were unable to advocate for their own care, addressing aides or family members while looking right past them. Individuals with disabilities clearly deserve the same amount of dignity and respect due to every individual, yet many clinicians are unaware of how to treat them, or simply too nervous around them to employ the proper etiquette. In recent years, there has been a significant amount of study conerning the health care of people with disabilities. In a 2008 report by the ARC of Massachusetts, focus group data revealed that health care professionals lack sufficient training and exposure in caring for patients with disabilities[1]. Morrison et al. noted from the consumer side that clinicians needed more training and awareness about how to work with patients with disabilities.[2] These are very significant findings in light of the Centers for Disease Control and Prevention (CDC) estimates that more than 37 million people living in the United States have some form of a disability[3]. In 2006, LVHN Department of Family Medicine in collaboration with the Pennsylvania Academy of Family Physician Foundation (PAFP/F) and in partnership with patients with disabilities, their families and community agencies, commenced the Medical Home Project. The vision of this multidisciplinary project team is to integrate patient centered care into all medical practices in the Lehigh Valley Region. All persons involved in health care for individuals with disabilities will be educated on ways to provide care that is accessible, continuous, comprehensive, patient centered, coordinated, compassionate, and culturally competent. Methodology One strategy the Medical Home Project team has employed to meet its vision is a three-hour educational session called Patients with Disabilities as Teachers (P-DAT). This session places a patient from an LVHN primary care practice in the role of educator to give medical students a first-hand lesson on how to interact with patients with disabilities. Students view a video called “The Ten Commandments of Communicating with People with Disabilities,”[10] a film created in nineteen ninety-four, that provides examples of interactions in a business setting. While looking for more current productions, the team determined that most existing films teaching disability etiquette do not cover specific instances that are seen in healthcare. The previous work has shown that additional training in disability etiquette can increase knowledge and sensitivity in communicating with patients with disabilities [4, 5]. There has been other work to increase awareness among medical students about patients with disabilities [6-8], but curricula are not consistent across medical schools and residency programs. The work of Tervo et al. showed that work experience influenced attitudes of healthcare professionals who worked with patients with disabilities [9]. Working with advisors from the Medical Home Project and the Media Producer of the LVHN Division of Education (DOE), Mark Flamisch and the Medical Home Project team have created a screenplay for a new video to be used throughout the Network. The video is currently being produced onsite, utilizing the DOE’s Simulation Labs. Editing and Post-production will also be done by Mark Flamisch in the DOE. When completed, the video will be used in place of the film currently in use for the P-DAT training, which is outdated and does not focus on a medical setting. Employees across the LVH network will view the video as a part of their training. Video production crew: Mark Flamisch Senior eLearning Designer Instructional Media Producer Producer Director Editor Director of Photography Camera & Sound Screenplay Elizabeth Fasanello Research Scholar Research Camera & Sound Grip Purpose and Objectives The purpose of this project is to enhance the educational experiences that LVHN is already providing and to expand learning opportunities to all colleagues. The expected outcomes are: Create a 20-minute video featuring health-related interactions and utilizing the disability etiquette standards set forth by United Cerebral Palsy[11]. By showcasing examples of real-life healthcare scenarios involving these etiquettes, healthcare employees will demonstrate proper protocols when caring for people with disabilities. Integrate the new production into ten in-person P-DAT (Patients with Disabilities as Teachers) training lessons for medical students, residents, and practice teams through the Network. Produce a version of P-DAT training that can be utilized by employees through LVHN’s “The Learning Curve” (TLC). Results Hypothesis and Measurement The team involved in the making of this video hypothesize that through educating employees across the network, they will gain the awareness and practical knowledge needed to interact respectfully with patients with disabilities, improving the relationships between these patients and the network, as well as their overall experience with health care anywhere in the network. Because the video will show the proper interactions in several different situations, it will include clinicians in outpatient or inpatient settings, and other health care employees who interact with patients, such as receptionists. The team will be working with the DOE on how to proceed with creating the education module featuring scenes from the video within TLC. As a part of the course, there will be a short questionnaire on disability etiquette within TLC. An evaluation form is to be completed by each participant at the end of every P-DAT educational session. This form will ask participants to rate the different activities on a Likert scale of one through five (i.e., one equalling really disliked; and five equaling really liked) and will include open-ended questions for feedback on the program. Based on the surveys collected over the past two years, the outdated and business-setting focused video has on average scored lower than the other aspects of the program. It is the hope that after implementation of the new video within the P-DAT training, those scores will increase, as the awareness and knowledge on this important topic increases. Conclusion This video project is currently in the production stage. The video will be some twenty minutes long when completed and edited, and will cover a variety of types of disabilities. The individuals with disabilities involved will be: an individual with a vision impairment, an individual with a hearing impairment, an individual with a prosthetic, an individual with autism, an individual of short stature, and an individual with a wheelchair. After editing, the video structure will include short vignettes of the interactions between the individuals with disabilities and the health care staff and clinicians, each demonstrating a different reason for seeking medical care, such as a new patient visit or a pre-operation discussion. Through watching these interactions, viewers will gain not only important knowledge on the subject, but also practical ways to implement the proper protocols. The scenes will be supported by text on-screen as well as vocal narration, which together will serve to clearly outline and review the proper etiquette and protocols demonstrated in the scenes. Every person involved in the production and post-production of this video is working to create an end product that will enhance the awareness and education of health care employees in the Lehigh Valley Health Network on this important topic. Measurement of the impact of this video will be determined using the evaluation forms to be completed by each participant. Hopefully, this video will enhance the knowledge of health care professionals on proper and respectful etiquette in caring for patients with disabilities. In the future, the video will have the potential of inspiring other networks and institutions to further their education of disability etiquette. In upholding the dignity of each person, the experiences of both patients with disabilities and clinicians will improve. Works Cited (1) Nichols, A.D., et al. (2008) Left Out in the Cold: Health Care Experiences of Adults with Intellectual and Developmental Disabilities in Massachusetts. (2) Morrison, E.H., V. George, and L. Mosqueda, Primary care for adults with physical disabilities: perceptions from consumer and provider focus groups. Fam Med, 2008. 40(9): p. 645-51. (3) Centers for Disease Control and Prevention. Disabilities and Health, Data and Statistics. December 16, 2011 [cited 2013 September 12]; Available from: http://www.cdc.gov/ncbddd/disabilityandhealth/data.html. (4) Jain, S., et al., Patients with disabilities as teachers. Fam Med, 2013. 45(1): p. 37-9. (5) Royce-Hickey, R., et al., Patients With Disabilities as Teachers (P-DAT) Training in Medical Education, in Society of Teachers of Family Medicine 2013 Annual Spring Conference. 2013: Baltimre, MD. (6) Graham, C.L., et al., Teaching medical students about disability in family medicine. Fam Med, 2009. 41(8): p. 542-4. (7) Moroz, A., et al., Immediate and follow-up effects of a brief disability curriculum on disability knowledge and attitudes of PM&R residents: a comparison group trial. A curriculum to teach medical students to care for people with disabilities: development and initial implementation. Med Teach, 2010. 32(8): p. e360-4. (8) Woodard, L.J., et al., An innovative clerkship module focused on patients with disabilities. Acad Med, 2012. 87(4): p. 537-42. (9)Tervo, R.C.P.G.P., Health professional student attitudes towards people with disability. Clinical Rehabilitation, 2004. 18(8): p. 908-915. (10) Program Development Associates, The Ten Commandments of Communicating with People with Disabilities. 1994, Irene M. Ward &Associates: Columbus, OH. (11) United Cerebral Palsy. Disability Etiquette. [electronic] 2013 [cited 2013 September 12]; Available from: http://www.ucp.org/resources/disability-etiquette

Sorghum bicolor, Xanthomonas vasicola, and the Environment: An Interdependent and Dynamic Relationship

From the Washington University Senior Honors Thesis Abstracts (WUSHTA), 2017. Published by the Office of Undergraduate Research. Joy Zalis Kiefer, Director of Undergraduate Research and Associate Dean in the College of Arts & Sciences; Lindsey Paunovich, Editor; Helen Human, Programs Manager and Assistant Dean in the College of Arts and Sciences Mentors: Rebecca Bart and Kira Vele

High-throughput analysis of adaptation using barcoded strains of Saccharomyces cerevisiae

Background: Experimental evolution of microbes can be used to empirically address a wide range of questions about evolution and is increasingly employed to study complex phenomena ranging from genetic evolution to evolutionary rescue. Regardless of experimental aims, fitness assays are a central component of this type of research, and low-throughput often limits the scope and complexity of experimental evolution studies. We created an experimental evolution system in Results: We first confirm that barcode insertions do not alter fitness and that barcode sequencing can be used to efficiently detect fitness differences via pooled competition-based fitness assays. Next, we examine the effects of ploidy, chemical stress, and population bottleneck size on the evolutionary dynamics and fitness gains (adaptation) in a total of 76 experimentally evolving, asexual populations by conducting 1,216 fitness assays and analyzing 532 longitudinal-evolutionary samples collected from the evolving populations. In our analysis of these data we describe the strengths of this experimental evolution system and explore sources of error in our measurements of fitness and evolutionary dynamics. Conclusions: Our experimental treatments generated distinct fitness effects and evolutionary dynamics, respectively quantified via multiplexed fitness assays and barcode lineage tracking. These findings demonstrate the utility of this new resource for designing and improving high-throughput studies of experimental evolution. The approach described here provides a framework for future studies employing experimental designs that require high-throughput multiplexed fitness measurements

Audiovisual production in the struggles of rural social movements in Brazil: Communication and epistemological dimensions

O artigo aborda a potencialidade da produção audiovisual, em especial o documentário, como estratégia de lutas sociais envolvendo dimensões comunicacionais e epistemológicas. Referencia-se na produção recente de documentários que resultou de alianças realizadas no Brasil entre movimentos sociaisdo campo, cineastas e grupos militantes de investigação em torno das lutas contra as consequências do agronegócio e dos agrotóxicos, assim como a favor da agricultura camponesa e agroecológica. Tais lutas evidenciam a relação intrínseca entre as dimensões comunicacional e epistemológica: a negociação e luta dos sentidos se dá por processos eminentemente comunicacionais, ao mesmo tempo que potencializam a construção de epistemologias do Sul. Temas como alimentação, terra, reforma agrária e o reencontro entre produção, trabalho e natureza possibilitam diluir fronteiras entre ciência, política, cultura e arte. Argumentamos que o cinema, por suas potencialidades criativas de expressão, dialogicidade e polifonia, propicia novas formas de compreender e expressar temas complexos e sensíveis.The article discusses the potential of audiovisual production, especially the documentary, as a strategy of social struggles involving communicational and epistemological dimensions. It refers to the recent production of documentaries that resulted from alliances made in Brazil amongst rural social movements, filmmakers and activist research groups around the struggles against the consequences of agribusiness and pesticides, as well as in favor of peasant and agroecological agriculture. Such struggles highlight the intrinsic relationship between the communicational and epistemological dimensions: the negotiation and struggle of meanings takes place through eminently communicational processes, at the same time that they potentiate the construction of epistemologies of the South. Topics such as food, land, agrarian reform and the reencounter between production, labour and nature make possible to merge the boundaries between science, politics, culture and art. We argue that cinema, through its creative potentialities of expression, dialogicity and polyphony, provides new ways of understanding and expressing complex and sensitive themes

Student Voices from a Student- and Faculty-Led Diversity, Equity, and Inclusion Committee

Speech-language pathologists and audiologists have recognized an increased need for discussions surrounding diversity, equity, and inclusion (DEI) in the profession. The purpose of this work is to describe one evidence-informed approach to forming a departmental student- and faculty-led committee at a university and to highlight participant student voices from the committee. The committee’s formation, organization, and activities are discussed from the perspectives of its members

Weathering the storm: parental effort and experimental manipulation of stress hormones predict brood survival

BACKGROUND:Unpredictable and inclement weather is increasing in strength and frequency, challenging organisms to respond adaptively. One way in which animals respond to environmental challenges is through the secretion of glucocorticoid stress hormones. These hormones mobilize energy stores and suppress non-essential physiological and behavioral processes until the challenge passes. To investigate the effects of glucocorticoids on reproductive decisions, we experimentally increased corticosterone levels (the primary glucocorticoid in birds) in free-living female tree swallows, Tachycineta bicolor, during the chick-rearing stage. Due to an unprecedented cold and wet breeding season, 90% of the nests in our study population failed, which created a unique opportunity to test how challenging environmental conditions interact with the physiological mechanisms underlying life-history trade-offs.RESULTS:We found that exogenous corticosterone influenced the regulation of parental decisions in a context-dependent manner. Control and corticosterone-treated females had similar brood failure rates under unfavorable conditions (cold and rainy weather), but corticosterone treatment hastened brood mortality under more favorable conditions. Higher female nest provisioning rates prior to implantation were associated with increased probability of brood survival for treatment and control groups. However, higher pre-treatment male provisioning rates were associated with increased survival probability in the control group, but not the corticosterone-treated group.CONCLUSIONS:These findings reveal complex interactions between weather, female physiological state, and partner parental investment. Our results also demonstrate a causal relationship between corticosterone concentrations and individual reproductive behaviors, and point to a mechanism for why naturally disturbed populations, which experience multiple stressors, could be more susceptible and unable to respond adaptively to changing environmental conditions

A method for measuring dark current electron beams in an rf linac

X-ray fluorescence from thin foils inserted into the NPS linac has been used to measure the integrated electron beam intensity when the accelerator is operating with dark current. The measured x-ray flux, the known inner shell ionization cross sections and radiative transition probabilities are used to obtain measurements of dark currents of the order of 10{sup -14} amperes. The same arrangement allows continuous, in-situ energy calibration of our SiLi detector in the electromagnetic noise environment of the linac. This technique was orginally developed to perform absolute production efficiency measurements of parametric x-ray generation in the 5-50 keV range

Is there an oxidative cost of acute stress? Characterization, implication of glucocorticoids and modulation by prior stress experience

Acute rises in glucocorticoid hormones allow individuals to adaptively respond to environmental challenges but may also have negative consequences, including oxidative stress. While the effects of chronic glucocorticoid exposure on oxidative stress have been well characterized, those of acute stress or glucocorticoid exposure have mostly been overlooked. We examined the relationship between acute stress exposure, glucocorticoids and oxidative stress in Japanese quail (Coturnix japonica). We (i) characterized the pattern of oxidative stress during an acute stressor in two phenotypically distinct breeds; (ii) determined whether corticosterone ingestion, in the absence of acute stress, increased oxidative stress, which we call glucocorticoid-induced oxidative stress (GiOS); and (iii) explored how prior experience to stressful events affected GiOS. Both breeds exhibited an increase in oxidative stress in response to an acute stressor. Importantly, in the absence of acute stress, ingesting corticosterone caused an acute rise in plasma corticosterone and oxidative stress. Lastly, birds exposed to no previous acute stress or numerous stressful events had high levels of GiOS in response to acute stress, while birds with moderate prior exposure did not. Together, these findings suggest that an acute stress response results in GiOS, but prior experience to stressors may modulate that oxidative cost

Hyaluronic acid synthesis, degradation, and crosslinking in equine osteoarthritis: TNF-α-TSG-6-mediated HC-HA formation

Background TNF-α-stimulated gene 6 (TSG-6) protein, a TNF-α-responsive hyaladherin, possesses enzymatic activity that can catalyze covalent crosslinks of the polysaccharide hyaluronic acid (HA) to another protein to form heavy chain-hyaluronic acid (HC-HA) complexes in pathological conditions such as osteoarthritis (OA). Here, we examined HA synthase and inflammatory gene expression; synovial fluid HA, TNF-α, and viscosity; and TSG-6-mediated HC-HA complex formation in an equine OA model. The objectives of this study were to (1) evaluate the TNF-α-TSG-6-HC-HA signaling pathway across multiple joint tissues, including synovial membrane, cartilage, and synovial fluid, and (2) determine the impact of OA on synovial fluid composition and biophysical properties. Methods HA and inflammatory cytokine concentrations (TNF-α, IL-1β, CCL2, 3, 5, and 11) were analyzed in synovial fluid from 63 OA and 25 control joints, and HA synthase (HAS1-3), TSG-6, and hyaluronan-degrading enzyme (HYAL2, HEXA) gene expression was measured in synovial membrane and cartilage. HA molecular weight (MW) distributions were determined using agarose gel electrophoresis and solid-state nanopore measurements, and HC-HA complex formation was detected via immunoblotting and immunofluorescence. SEC-MALS was used to evaluate TSG-6-mediated HA crosslinking, and synovial fluid and HA solution viscosities were analyzed using multiple particle-tracking microrheology and microfluidic measurements, respectively. Results TNF-α concentrations were greater in OA synovial fluid, and TSG6 expression was upregulated in OA synovial membrane and cartilage. TSG-6-mediated HC-HA complex formation was greater in OA synovial fluid and tissues than controls, and HC-HA was localized to both synovial membrane and superficial zone chondrocytes in OA joints. SEC-MALS demonstrated macromolecular aggregation of low MW HA in the presence of TSG-6 and inter-α-inhibitor with concurrent increases in viscosity. Conclusions Synovial fluid TNF-α concentrations, synovial membrane and cartilage TSG6 gene expression, and HC-HA complex formation were increased in equine OA. Despite the ability of TSG-6 to induce macromolecular aggregation of low MW HA with resultant increases in the viscosity of low MW HA solutions in vitro, HA concentration was the primary determinant of synovial fluid viscosity rather than HA MW or HC-HA crosslinking. The TNF-α-TSG-6-HC-HA pathway may represent a potential therapeutic target in OA