Digital Holland

Founded in 2014, Digital Holland is a publicly accessible website that hosts research about the communities that include and surround Hope College. The website, digitalholland.org, was developed by students in the college’s Mellon Scholars Program, a three-year curriculum of digitally-enabled collaborative research and experiential education funded by the Andrew W. Mellon Foundation. The website features engaging galleries and pages covering a wide variety of topics, highlighting the diversity and historical importance of the Holland community. The site also hosts relevant artifacts including images, audio, and video files shared with permission by the Joint Archives of Holland and the Holland Museum. The project continues to grow as Hope College students, Mellon Scholars, and community members contribute to the site. In the 2016-2017 academic year, Digital Holland underwent both an aesthetic and conceptual shift, redefining our audience and user experience. The new Digital Holland actively promotes community engagement through local partnerships, a joint venture in digital public history. In addition, the site features research projects completed by Hope College students from a variety of disciplines, providing a platform to disseminate exemplary scholarship. Our poster highlights both the process and product of the Digital Holland redesign: our work product as a team and the engaging, community-oriented repository of research. We will feature examples of student research exhibits as well as crowd-sourced articles. Digital Holland can serve as an example for other communities and institutions committed to partnering on digital public scholarship

The Founding Fathers and the New York Society Library

The Founding Fathers have long been considered in the public imagination as the creators of the modern democratic system. Like their educated, political-minded European contemporaries, these men supplemented their formal education with outside reading borrowed from libraries such as the New York Society Library, the oldest library in New York City (founded in 1754). Thousands of entries in its ledgers dating to the eighteenth-century track the lending histories of books read before, during, and after the American Revolution. Through examination of these recently digitized ledger pages available at the New York Society Library from 1789 to 1805, the books that these Founding Fathers chose to read shed light on who these men were, both politically and personally, in relation to the world around them. By visualizing data and analyzing the relationships present between these men and literature that they read, this project explores how the Founding Fathers were influenced by their continual education and presents the results on a Wordpress website. As the ledgers show, the Founding Fathers were more than the American political icons that they have come to embody

Exploring factors that influence the spread and sustainability of a dysphagia innovation: an instrumental case study

Background: Swallowing difficulties challenge patient safety due to the increased risk of malnutrition, dehydration and aspiration pneumonia. A theoretically driven study was undertaken to examine the spread and sustainability of a locally developed innovation that involved using the Inter-Professional Dysphagia Framework to structure education for the workforce. A conceptual framework with 3 spread strategies (hierarchical control, participatory adaptation and facilitated evolution) was blended with a processual approach to sustaining organisational change. The aim was to understand the processes, mechanism and outcomes associated with the spread and sustainability of this safety initiative. Methods: An instrumental case study, prospectively tracked a dysphagia innovation for 34 months (April 2011 to January 2014) in a large health care organisation in England. A train-the-trainer intervention (as participatory adaptation) was deployed on care pathways for stroke and fractured neck of femur. Data were collected at the organisational and clinical level through interviews (n = 30) and document review. The coding frame combined the processual approach with the spread mechanisms. Pre-determined outcomes included the number of staff trained about dysphagia and impact related to changes in practice. Results: The features and processes associated with hierarchical control and participatory adaptation were identified. Leadership, critical junctures, temporality and making the innovation routine were aspects of hierarchical control. Participatory adaptation was evident on the care pathways through stakeholder responses, workload and resource pressures. Six of the 25 ward based trainers cascaded the dysphagia training. The expected outcomes were achieved when the top-down mandate (hierarchical control) was supplemented by local engagement and support (participatory adaptation). Conclusions: Frameworks for spread and sustainability were combined to create a ‘small theory’ that described the interventions, the processes and desired outcomes a priori. This novel methodological approach confirmed what is known about spread and sustainability, highlighted the particularity of change and offered new insights into the factors associated with hierarchical control and participatory adaptation. The findings illustrate the dualities of organisational change as universal and context specific; as particular and amendable to theoretical generalisation. Appreciating these dualities may contribute to understanding why many innovations fail to become routine

Exploring scale-up, spread, and sustainability: an instrumental case study tracing an innovation to enhance dysphagia care

Background Adoption, adaptation, scale-up, spread, and sustainability are ill-defined, undertheorised, and little-researched implementation science concepts. An instrumental case study will track the adoption and adaptation, or not, of a locally developed innovation about dysphagia as a patient safety issue. The case study will examine a conceptual framework with a continuum of spread comprising hierarchical control or ‘making it happen’, participatory adaptation or ‘help it happen’, and facilitated evolution or ‘let it happen’. Methods This case study is a prospective, longitudinal design using mixed methods. The fifteen-month (October 2012 to December 2013) instrumental case study is set in large, healthcare organisation in England. The innovation refers to introducing a nationally recognised, inter-disciplinary dysphagia competency framework to guide workforce development about fundamental aspects of care. Adoption and adaptation will be examined at an organisational level and along two, contrasting care pathways: stroke and fractured neck of femur. A number of educational interventions will be deployed, including training a cadre of trainers to cascade the essentials of dysphagia management and developing a Dysphagia Toolkit as a learning resource. Mixed methods will be used to investigate scale-up, spread, and sustainability in acute and community settings. A purposive sample of senior managers and clinical leaders will be interviewed to identify path dependency or the context specific particularities of implementation. A pre- and post-evaluation, using mealtime observations and a survey, will investigate the learning effect on staff adherence to patient specific dysphagia recommendations and attitudes towards dysphagia, respectively. Official documents and an ethnographic field journal allow critical junctures, temporal aspects and confounding factors to be explored. Discussion Researching spread and sustainability presents methodological and practical challenges. These include fidelity, adaptation latitude, time, and organisational changes. An instrumental case study will allow these confounding factors to be tracked over time and in place. The case study is underpinned by, and will test a conceptual framework about spread, to explore theoretical generalizability

Multiancestry analysis of the HLA locus in Alzheimer’s and Parkinson’s diseases uncovers a shared adaptive immune response mediated by HLA-DRB1*04 subtypes

Across multiancestry groups, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s disease (PD) and Alzheimer’s disease (AD) versus controls. We demonstrate that the two diseases share the same protective association at the HLA locus. HLA-specific fine-mapping showed that hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, and intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03. The same signal was associated with decreased neurofibrillary tangles in postmortem brains and was associated with reduced tau levels in cerebrospinal fluid and to a lower extent with increased Aβ42. Protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, however only when acetylated at a lysine (K311), a common posttranslational modification central to tau aggregation. An HLA-DRB1*04-mediated adaptive immune response decreases PD and AD risks, potentially by acting against tau, offering the possibility of therapeutic avenues

Enhancing dysphagia management: Facilitated e-learning works and offers value for money.

Introduction: Dysphagia is a common, potentially life-threatening problem that compromises quality of life. A collaborative project was set up between the CLAHRC for South Yorkshire and the Stroke Service at Sheffield Teaching Hospitals to tackle identified inconsistencies in the management of dysphagia. The aim was to enhance staff knowledge and skills by piloting an innovative approach to workplace-based e-learning. Each session comprised a needs analysis, e-learning programmes, practical skills about modifying fluids, and action planning to transfer learning into practice. Method: Twelve-month’s (March 2010-February 2011) action research on a stroke rehabilitation ward, evaluating the training effect and resource use cost of the facilitated e-learning. The methods were a scoping review, baseline and follow-up observations of dysphagia management (16 and 18 hours respectively), four bespoke questionnaires with attitude (Colodny 2001) and knowledge scales; and the cost per working hour for the stroke service. Results: Only five of 32 participants (22 registered nurses, 10 health care assistants) reported attending any previous dysphagia training. The training effect was evident in statistically significant differences in attitudes and knowledge held by the same people, at two time points, using the Wilcoxon signed rank test. The most common changes in practice related to medicines management, thickening fluids and oral hygiene. The resource use cost was estimated at £2,688 for 108 hours training. Conclusion: All participants achieved Assistant Dysphagia Practitioner competence level. Key success factors were designating dysphagia as mandatory, job specific training and combining expert facilitation with relevant e-learning programmes. These factors are easily replicable

Deciphering the mechanism underlying late-onset Alzheimer disease

Despite tremendous investments in understanding the complex molecular mechanisms underlying Alzheimer disease (AD), recent clinical trials have failed to show efficacy. A potential problem underlying these failures is the assumption that the molecular mechanism mediating the genetically determined form of the disease is identical to the one resulting in late-onset AD. Here, we integrate experimental evidence outside the 'spotlight' of the genetic drivers of amyloid-β (Aβ) generation published during the past two decades, and present a mechanistic explanation for the pathophysiological changes that characterize late-onset AD. We propose that chronic inflammatory conditions cause dysregulation of mechanisms to clear misfolded or damaged neuronal proteins that accumulate with age, and concomitantly lead to tau-associated impairments of axonal integrity and transport. Such changes have several neuropathological consequences: focal accumulation of mitochondria, resulting in metabolic impairments; induction of axonal swelling and leakage, followed by destabilization of synaptic contacts; deposition of amyloid precursor protein in swollen neurites, and generation of aggregation-prone peptides; further tau hyperphosphorylation, ultimately resulting in neurofibrillary tangle formation and neuronal death. The proposed sequence of events provides a link between Aβ and tau-related neuropathology, and underscores the concept that degenerating neurites represent a cause rather than a consequence of Aβ accumulation in late-onset AD