Challenges Facing Young Adults with Complex Communication Needs Entering the Adult Health Care System

Barbara Abbott, PhD, OTR/L is a school-based occupational therapist currently working with students grades K-12 in four schools in Kent, WA. The purpose of our project was to identify the most effective service delivery models and/or components of interventions for young adults with complex communication needs to understand their health information. We conducted a systematic review to critically appraise literature published between the years of 1990-2018 to address our research question. Our research yielded a total of seven qualitative and 12 quantitative studies to address our research question. Qualitative data found that individuals with complex communication needs (CCN) experience significant challenges in adulthood with managing and communicating their health needs. Quantitative research identified seven evidence-based interventions that improved health knowledge, health literacy, and health advocacy skills for improving participation in the adult healthcare system. The overarching recommendation from the studies highlighted the importance of promoting self-advocacy and self-determination to navigate the system and manage individual health needs. There is a need for professionals to help prepare these young adults throughout the transition phase from pediatric to the adult healthcare system. Our subsequent knowledge translation product entailed developing a tri-fold pamphlet intended for school administrators and school-based occupational therapists. It includes qualitative data and evidence based interventions to improve health literacy and self-advocacy skills for young adults with communication challenges in the school setting. Outcomes data collected from school based occupational therapists indicated that the research findings in the pamphlet were widely new information for them. Additionally, they reported positive reactions to the pamphlet. Occupational therapists surveyed agreed that teaching health education is within their scope of practice in the school setting, and reported an interest in incorporating a health education intervention for students with disabilities into their services. Future research is recommended for developing additional evidence-based interventions for preparing these young adults to advocate for their health needs. Recommendations for future translation of knowledge include catering the information in the pamphlets to specific audiences, such as one pamphlet for occupational therapists and a separate pamphlet for school administrators, with suggestions regarding support for families and educators

Freeing Energy Data: A Guide for Regulators to Reduce One Barrier to Residential Energy Efficiency

This report advocates for improving entrepreneurs' access to residential energy-use data, thereby increasing the deployment of cost-effective energy-efficiency measures, generating saving and improving the environment. While this report does discuss policy, its focus is on informing policy makers on how to address liability, consumer privacy, and administrative concerns that could arise when third parties receive energy-use data from utilities. What makes this report novel compared to other efforts is that it provides model language for laws or rules that lawmakers or regulators can use as building blocks to open up access to energy data

Highly productive polar forests from the Permian of Antarctica

Two stratigraphically closely spaced bedding planes exposed at Lamping Peak in the Upper Buckley Formation, Beardmore Glacier area, Antarctica contain abundant in situ stumps (n=53, n=21) and other plant fossils that allow reconstruction of forest structure and biomass of Glossopteris forests that thrived at ~ 75o S paleolatitude in the Permian. Mean trunk diameter is 14 and 25 cm, corresponding to estimated mean maximum heights of 12 and 19 m. Basal areas are 65 and 80 m2ha- 1. The above ground biomass was calculated using allometric equations for Ginkgo biloba, yielding biomasses of 147 and 178 Mg ha- 1. Biomass estimates based on comparison with biomass of modern forests with equivalent basal areas are higher (225 – 400 Mg ha- 1). The amount of above ground biomass added each year (Annual Net Primary Productivity), based on biomass estimates and growth rings in silicified plant material from the Buckley Formation nearby, is poorly constrained, ranging from ~ 100 – 2000 g m- 2 yr- 1. Compared to modern forests at all latitudes, the Permian forests have high basal areas and high biomass, exceeded in both only by forests of the U.S. Pacific northwest and Sequoia forests. The estimated range of productivity (ANPP) is within that of many very productive modern forests. The Lamping Peak forests’ basal areas and calculated biomass are also larger than younger high paleolatitude fossil forests except for Arctic Cenozoic forests. Presence of these highly productive fossil forests at high paleolatitude is consistent with hothouse conditions during the Late Permian, prior to the eruption of the Siberian flood basalts

Critical research needs for successful food systems adaptation to climate change

There is a growing sense of the fragility of agricultural production in the Global North and South and of increasing risks to food security, as scientific observations confirm significant changes in the Gulf Stream, polar ice, atmospheric CO2, methane release, and other measures of climate change. This sense is heightened as each of us experiences extreme weather, such as the increasing frequency of droughts, floods, unseasonal temperatures, and erratic seasonality. The central research challenge before us is how global, national, regional, and local food systems may adapt to accelerating climate change stresses and uncertainties to ensure the availability, access, consumption, and stability of healthy food for and by all people. Missing aspects of research fall into two broad categories: the impacts of rapid climate change on the environmental systems supporting food production, and climate change’s impact on the predominantly human systems that influence food security. Of particular concern is how different policy and governance mechanisms can support or hinder the collective decision-making needed to promote a swift adaptive response to increase and sustain food security. Human systems research is needed to investigate food system activities beyond production (processing, distribution, consumption, and waste management). It also must consider political, cultural, and regulatory factors that influence behavior and facilitate positive behavioral changes. To accurately envision future scenarios, research is needed to characterize risk comprehensively throughout the food system, assess barriers to and opportunities for changing food systems, and evaluate novel and traditional approaches that may lead to greater food security

Food webs and food sovereignty: Research agenda for sustainability

Future food production will be constrained by the scarcity of fossil fuel and fresh water as well as increasing intensity and unpredictability of weather events and climate changes. The assurance of food security and equity for many consumers is complicated by concentration of ownership of land and other production resources, as well as a global corporate food systems model that is driven by profit at the expense of people and the environment. To assess potential alternatives to the contemporary global food chain, well focused research is needed on local food production and food webs where small- and midscale family farms provide economic viability for rural communities and their regions. We suggest multiple and integrative research priorities in production, enterprise, and farm economics, environmental impacts of farming at different scales, and social and community consequences of value adding and economic multipliers in local food webs and systems as well as the structure of agriculture. Research into key questions on food security and how it relates to increased food sovereignty is clearly needed to assess creative food system alternatives for the future

Assessing Injury and Violence Prevention Programs in North Carolina Local Health Departments: Capstone Summary Report

Background: Injury and violence comprise the leading causes of death amongst North Carolinians ages one to 65. Ensuring that effective programming occurs at the local level is critical to reducing this burden. There is significant unmet need for successful injury and violence prevention (IVP) programming, particularly in motor vehicle crash, suicide, homicide, falls, and unintentional poisoning. The Injury and Violence Prevention Branch (IVPB) of the North Carolina Division of Public Health conducts surveillance, provides statistical reports, technical support and training in IVP, and is a networking hub for IVP stakeholders. Although most IVP programming is carried out at the local level, IVPB lacked a comprehensive statewide assessment of local health departments' (LHD) work in IVP. The primary aims of this Capstone project, therefore, were to fill this knowledge gap for IVPB, identify targets for improving programming, and promote effective initiatives. To this end, the team mapped the IVP work conducted by NC's 85 LHDs, assessed LHDs' priorities, partnerships and readiness to implement evidence-based IVP projects, and compiled case studies to share lessons from successful initiatives. Methods: To assess the state of IVP, the Capstone team conducted key informant interviews (KIIs) and a survey of NC LHDs, and compiled results into a final report and model program case studies. First, the team utilized formative research strategies by conducting a literature review of LHDs' work in IVP, and drafting an evidence table that categorized and summarized best practices for each of the five prioritized areas. Next, the team conducted KIIs with leaders in IVP about their perspectives on successful and evidence-based programs, program selection, and implementation. The team drew on interview findings to develop the online survey assessing NC LHDs' IVP work. The team then identified model programs, conducted interviews with program staff, and developed case studies, which will be shared with NC IVP practitioners to inform their programming. The team compiled findings in a report for IVPB. Results: About half of LHDs reported conducting programs that are evidence-based. In the literature and in the KIIs, the team found varying definitions of evidence-based IVP programs; however, there was consensus across the evidence table, KIIs and case studies on criteria for successful IVP programs: those which meet an identified need, have some evidence of effectiveness, involve community members, demonstrate positive change, and are sustainable. Findings across deliverables highlighted three key themes in NC IVP efforts: capacity, partnerships, and program priorities. Capacity: Most LHDs in NC were active in IVP; however, interviewees and survey respondents recognized a need for technical assistance and staff training in evidence-based interventions (EBIs), specifically in program selection and implementation. Additionally, funding constraints limited their capacity. Partnerships: LHDs played a key role in building community support for IVP, and partnerships they formed were important to program success. Collaboration with hospitals, governmental and non-governmental organizations, and academic institutions expanded LHDs' capacity and potential sustainability of initiatives. Programming: Survey findings confirmed key informants' insight that capacity limitations and conflicting community priorities can outweigh community health assessment (CHA) data, resulting in a misalignment between local burden and local programming. Nearly half of issues identified by survey respondents as the most burdensome injury and violence problems in their respective service areas were not targeted in their programming. LHDs conducted programming most frequently in sudden infant death syndrome (SIDS), unintentional poisoning, and child maltreatment. None addressed homicide specifically; however, several had programs targeting interpersonal violence. The six case studies provide models for LHDs going forward. Exemplifying successful partnerships, sustainability and community engagement, these replicable programs leverage local interest to address high-burden outcomes. Discussion: Through this Capstone project-the first statewide assessment of local IVP-IVPB has gained a rich understanding of the work local practitioners are doing. Project deliverables promote networking and capacity across the state, and provide baseline data and tools for future assessments.Master of Public Healt

Ultra-high-field arterial spin labeling MRI for non-contrast assessment of cortical lesion perfusion in multiple sclerosis

ObjectivesAssess the feasibility of using an optimised ultra-high-field high-spatial-resolution low-distortion ASL MRI acquisition to measure focal haemodynamic pathology in cortical lesions (CLs) in Multiple Sclerosis (MS).MethodsTwelve MS patients (8 female, mean age=50; range=35-64 years) gave informed consent and were scanned on a 7 Tesla Philips Achieva scanner. Perfusion data were collected at multiple post-labeling delay times using a single-slice flow-sensitive alternating inversion recovery ASL protocol with a balanced steady-state free precession readout scheme. CLs were identified using a high-resolution Phase-Sensitive Inversion Recovery (PSIR) scan. Significant differences in perfusion within CLs compared to immediately surrounding normal appearing grey matter (NAGMlocal) and total cortical normal appearing grey matter (NAGMcortical) were assessed using paired t-tests.Results40 CLs were identified in PSIR scans that overlapped with the ASL acquisition coverage. After excluding lesions due to size or intravascular contamination, 27 lesions were eligible for analysis. Mean perfusion was 40 ± 25 ml/100g/min in CLs, 53 ± 12 ml/100g/min in NAGMlocal, and 53±8 ml/100g/min in NAGMcortical. CL perfusion was significantly reduced by 23 ± 9% (mean±SE, p=0.013) and 26 ± 9% (mean±SE, p=0.006) relative to NAGMlocal and NAGMcortical perfusion, respectively.ConclusionThis is the first ASL MRI study quantifying CL perfusion in MS at 7T, demonstrating that an optimised ASL acquisition is sensitive to focal haemodynamic pathology previously observed using Dynamic Susceptibility Contrast MRI. ASL requires no exogenous contrast agent, making it a more appropriate tool to monitor longitudinal perfusion changes in MS, providing a new window to study lesion development

Ultra-high-field arterial spin labeling MRI for non-contrast assessment of cortical lesion perfusion in multiple sclerosis

Objectives Assess the feasibility of using an optimised ultra-high-field high-spatial-resolution low-distortion ASL MRI acquisition to measure focal haemodynamic pathology in cortical lesions (CLs) in Multiple Sclerosis (MS). Methods Twelve MS patients (8 female, mean age=50; range=35-64 years) gave informed consent and were scanned on a 7 Tesla Philips Achieva scanner. Perfusion data were collected at multiple post-labeling delay times using a single-slice flow-sensitive alternating inversion recovery ASL protocol with a balanced steady-state free precession readout scheme. CLs were identified using a high-resolution Phase-Sensitive Inversion Recovery (PSIR) scan. Significant differences in perfusion within CLs compared to immediately surrounding normal appearing grey matter (NAGMlocal) and total cortical normal appearing grey matter (NAGMcortical) were assessed using paired t-tests. Results 40 CLs were identified in PSIR scans that overlapped with the ASL acquisition coverage. After excluding lesions due to size or intravascular contamination, 27 lesions were eligible for analysis. Mean perfusion was 40 ± 25 ml/100g/min in CLs, 53 ± 12 ml/100g/min in NAGMlocal, and 53±8 ml/100g/min in NAGMcortical. CL perfusion was significantly reduced by 23 ± 9% (mean±SE, p=0.013) and 26 ± 9% (mean±SE, p=0.006) relative to NAGMlocal and NAGMcortical perfusion, respectively. Conclusion This is the first ASL MRI study quantifying CL perfusion in MS at 7T, demonstrating that an optimised ASL acquisition is sensitive to focal haemodynamic pathology previously observed using Dynamic Susceptibility Contrast MRI. ASL requires no exogenous contrast agent, making it a more appropriate tool to monitor longitudinal perfusion changes in MS, providing a new window to study lesion development