Baseline Assessment of Providers\u27 Perspectives on Integrating Community Health Workers into Primary Care Teams to Improve Diabetes Prevention

• Type 2 Diabetes Mellitus (T2DM) affects 11% of U.S. adults • Additional 35% considered pre-diabetic, at-risk for developing T2DM1 • Bellevue Hospital and the VA NY Harbor Hospital disproportionately affected: 2x the prevalence in the general population, and increasing2 • Only 55% of adults receive recommended preventive services3 • Panel management: each care team is responsible for preventive care, disease management, and acute care of a patient panel • Community health worker (CHW): non-clinical frontline public health professional trained in behavioral counseling, care follow-up, program referrals, and health education4-8 • Come from the community that they serve, so they can offer ongoing social support, key to successful behavior change9-12 • CHW interventions have been shown to improve diabetes outcomes and progression to diabetes13 • Lack of literature on integrating CHWs on a larger scale into a clinical care team • CHORD study: Community Health Outreach to Reduce Diabetes • Randomized controlled intervention trial to assess the efficacy of integrating CHWs into primary care teams at Bellevue and the VA to prevent T2DM in pre-diabetic patients • Present study is a baseline assessment in preparation for the CHORD studyhttps://jdc.jefferson.edu/cwicposters/1036/thumbnail.jp

Perceptions of English Language Learning and Teaching among Primary and Secondary Teachers and Students Participating in English in Action: Second Cohort (2013)

Executive summary a) Background The purpose of the Perceptions Study 2013 was to explore the perceptions of English language (EL) practices within schools participating in English in Action (EIA) from the point of view of both the teachers and the students. The first part of the study focused on primary and secondary teachers’: - Perceptions of their practices in teaching English; - Attitudes to the communicative language teaching (CLT) approaches being promoted through EIA; -Perceptions of their students’ responses to these approaches; - Opinions of the general usefulness of the EIA programme. The second part of the study explored primary and secondary students : - Current experience in English lessons in EIA intervention schools; - Perceptions and attitudes to EL and learning English. The Perceptions Study 2013 is a repeat of the study of the pilot EIA programme (Cohort 1), carried out in 2010. In addition to understanding the views of the current cohort (Cohort 2), one aim was to see the extent to which there are any changes from Cohort 1 to 2. This 2013 study is part of a set of three studies – including one on teachers’ classroom practice (EIA 2014a), and another on the EL competence of students and teachers (EIA 2014b). b) Research methodology The design of this study was a repeat of that of the previous study (2010) and looked to reveal the perceptions of students and teachers in EIA Cohort 2, enabling a comparison with the study carried out on Cohort 1 in 2010. The research question for the study was thus: - To what extent has the programme been successful in repeating the mid-intervention changes in perceptions of students and teachers seen in Cohort 1, at the much larger scale of Cohort 2? Fieldwork was carried out by researchers from the Institute of Education and Research (IER) at the University of Dhaka in September and October 2013, some 12 months after Cohort 2 teachers began participating in the EIA programme. It took place in a sample of EIA schools across six divisions in Bangladesh and used a multi-layer stratified sampling strategy. Teacher data were collected by a self-completion questionnaire: 269 primary teachers, 123 primary head teachers (HTs) and 143 secondary teachers participated in the study. Primary student data were collected by interview survey, while secondary student data were collected by self-completion questionnaire; a total of 376 primary students and 457 secondary students participated. As this study was carried out using questionnaires only, either self-completed and through interview, the comparison is with the quantitative element of the 2010 study only. c) Key findings: Teachers i) Primary teachers 99% of the primary teachers reported that taking part in EIA helped improve their own English (53% strongly agreed). 89% also felt that EIA has had an impact on their confidence to use more English, and 92% agreed it has had an impact on the way they teach. Primary teachers seemed to be fairly confident about their competence in English, with 87% agreeing that they felt comfortable modelling English for students to repeat. This is reflected in their classroom practice, where they used English three-quarters of the time they talked (EIA 2014a: 17). This links also with the fact that 70% of primary teachers agreed that they use mostly English in the classroom, i.e. their perceptions matched their practice; 80% agreed that it is essential that English teachers speak in English in the classroom for their students to learn English. Primary teachers had mixed opinions about the use of Bangla to support student learning: when asked whether Bangla should be used frequently in English classes for students’ better understanding, 43% felt that students preferred it when their teachers spoke Bangla most of the time; a slightly smaller proportion (38%) felt their students did not prefer it. Most primary teachers (87%) agreed that the focus in their English classes is communication, but that they explain grammar when necessary. 47% of primary teachers thought that grammar rules should be explicitly explained in class, and over half of the teachers (73%) agreed that students’ English improves most quickly if they study and practise grammar. 89% of primary teachers reported they often use activities where the students interact with each other in English. 81% agreed that students like these activities. 98% reported using more pair and group work as a result of EIA and 91% agreed that students play games or sing songs more often now. 99% of primary teachers reported that changes in teaching have improved student motivation, with 57 strongly agreeing. 82% reported that changes in teaching have had a positive impact on student learning. Primary teachers still retained some more traditional notions as being important to their practice, with 95% agreeing that drilling and repetition is common practice, while EIA approaches promote fluency and creativity in language use. 81% felt that error correction was important, while EIA approaches suggest that teachers pay less attention to errors, as this can inhibit students experimenting with language. 81% of primary teachers agreed that students like to interact in English with classmates. (This positive attitude was confirmed by data from the primary students.) In terms of a comparison with the Cohort 1 study in 2010 and the baseline (2009), this study of Cohort 2 confirmed that primary teachers supported the view that English is seen as an important language and that it is necessary to learn it for both jobs and study. For primary teachers, there was a slight increase in the perceived difficulty of English compared with the baseline study (2009). In terms of their reported practice and views in relation to a communicative approach, primary teachers supported it but were somewhat less supportive in 2013 than those in 2010 were. In addition, there was some increase in reported practice and views of traditional elements of English language teaching (ELT), including the role of grammar, error correction and drill and repetition. ii) Secondary teachers 96% of secondary teachers agreed that taking part in EIA helped them to improve their own English. 88% also felt that it has had an impact on their confidence to use more English, and 94% agreed that it has had an impact on the way they teach. Secondary teachers seemed to be fairly confident about their competence in English, with 87% agreeing that they feel comfortable modelling English for students to repeat. 80% of secondary teachers agreed that they use mostly English in the classroom (this finding is corroborated by direct observation [EIA 2014a]); 88% agreed that it is essential that English teachers speak in English in the classroom for their students to learn English. Secondary teachers had mixed opinions about the use of Bangla to support student learning: when asked whether Bangla should be used frequently in English classes for students’ better understanding, 57% disagreed while 27% agreed. About two fifths of secondary teachers felt that their students liked it when the teacher spoke Bangla most of the time (40%), but a similar proportion (38%) felt that their students do not prefer it. A large proportion of secondary teachers (89%) agreed that the focus in their English classes is on communication, but that they explain grammar when necessary. However, over half (58%) thought that grammar rules should be explicitly explained in class and 70% agreed that students’ English improves most quickly if they study and practise grammar. 88% of secondary teachers reported that they often use activities to have the students interact with each other in English. 74% agreed that students like these activities. 92% reported using more pair and group work, whilst 71% agreed that students now play games or sing songs more often than before EIA. 97% of secondary teachers reported that changes in teaching have improved student motivation, with 60% ‘strongly agreeing’. 79% reported that changes in teaching have had a positive impact on student learning. Secondary teachers still perceived some more traditional notions as being important to their practice, with 85% agreeing that drilling and repetition is common practice, in contrast to EIA approaches, which promote fluency and creativity in language use. 88% felt that error correction was important, while EIA approaches suggest teachers pay less attention to errors, as this can inhibit students experimenting with language use. 74% of secondary teachers agreed that students like to interact in English with classmates. In terms of a comparison with the Cohort 1 study in 2010 and the baseline (2009), this study of Cohort 2 confirmed that secondary teachers supported the view that English is seen as an important language and that it is necessary to learn it for both jobs and study. For secondary teachers, there was a slight decrease in the perceived difficulty of English compared with the baseline study (2009). In terms of their reported practice and views in relation to a communicative approach, secondary teachers supported it in 2013 much as they did in 2010. Although their reported practice and views of traditional elements of ELT (including the role of grammar, error correction and drill and repetition) still exist, they are much as they were in 2010. iii) Comparison of teacher perceptions: Primary and secondary - Almost all teachers (99% primary; 96% secondary) reported that taking part in EIA is helping improve their own English. - Most teachers (87% primary; 87% secondary) were comfortable in their competence to model English in the classroom. - Most teachers (70% primary; 80% secondary) reported mostly using English in the classroom. - Most teachers (87% primary; 89% secondary) said the focus of their lessons is on communication, with grammar being explained as required. - Most teachers (89% primary; 88% secondary) reported often using activities to have students interact in English, though singing and playing games are more popular classroom activities for primary teachers than for secondary. - Most teachers (99% primary; 97% secondary) reported improved student motivation as a result of changes to classroom practice. - Over half of secondary teachers (58%) thought grammar rules should be explained explicitly and over two-thirds (70%) thought that students’ English improves most quickly through grammar practice. Less than half of primary teachers (47%) thought that grammar rules should be explained explicitly, and similarly over two-thirds (70%) thought that students’ English improves most quickly through grammar practice. - Most teachers (95% primary; 85% secondary) reported they still commonly practise traditional techniques, such as drilling and repetition. d) Key findings: Students i) Primary students Over half of primary students (64%) reported that their English teachers used English most of the time in their lessons. 69% reported they liked it when their teacher spoke Bangla most of the time. The majority of the primary students reported regularly participating in classroom activities that are promoted in the EIA materials, such as talking in English with classmates, playing games and singing songs. Most primary students reported that these kinds of activities, promoted by EIA, are enjoyable (interacting in English: 79%; games: 95%; songs: 93%). Most also reported that more traditional activities were enjoyable, such as learning grammar rules (95%) and being corrected by the teacher (98%). Most primary students liked learning English (99%). Almost all said that they liked learning English because it is important for them (96%), even if just under a third felt it was difficult to learn (32%). There are no direct comparisons with Cohort 1 in terms of primary students’ views of their teachers’ practice and of their own learning of English, or with the 2009 baseline in terms of difficulty of learning English or its importance to them and to their future. ii) Secondary students About a third of secondary students reported that their English teachers used English most of the time in their lessons (36%). Also, 37% reported that they prefer their teacher speaking Bangla to speaking English, which is a lot lower than in the previous study (61%). Most (69%) said that they liked to speak English in their English lessons. Secondary students also reported participating in classroom activities that are promoted in the EIA materials, including speaking English with classmates (80%), but also playing and singing (though a lot less: 33%). Secondary students reported speaking English with classmates to be an enjoyable aspect of their English lessons (82%); a minority reported playing and singing as enjoyable (35%). Secondary students reported that some EIA teachers still carry out more traditional language learning activities in their English lessons, such as drilling, memorising grammar rules and correcting errors. Secondary students also reported they enjoyed these traditional practices: the large majority (89%) believed that repeating teachers’ sentences helps them learn English. 86% agreed that they liked learning grammar rules in English classes and two-thirds (69%) believed that learning English means learning grammar rules. The majority (95%) said that their English teachers should correct all errors and most liked it (93%). Most secondary students reported having a strong motivation to learn English. 94% agreed that learning English is important in their life; 92% felt that English will help them find a good job and improve their income (74%). Students had mixed feelings about whether English was difficult to learn – a third (33%) felt it was, while 44% felt it wasn’t. In terms of a comparison with the Cohort 1 study in 2010 and the baseline (2009), this study of Cohort 2 confirmed that secondary students supported the view that English is seen as an important language and that it is necessary to learn it for both jobs and study. For secondary students, there is no difference in the perceived difficulty of English compared with the baseline study (2009). In terms of their reporting of their teachers’ practice and their own views in relation to a communicative approach, secondary students show more support for some elements in 2013 - much as they did in 2010 - and less support for other elements. Although their reports of their teachers’ practice and their own views of traditional elements of ELT (including the role of grammar, error correction and drill and repetition) still exist, they are generally less strong than in 2010

Gendered Risk Perceptions Associated with Human-Wildlife Conflict: Implications for Participatory Conservation

This research aims to foster discourse about the extent to which gender is important to consider within the context of participatory approaches for biological conservation. Our objectives are to: (1) gender-disaggregate data about stakeholders' risk perceptions associated with human-wildlife conflict (HWC) in a participatory conservation context, and (2) highlight insights from characterizing gendered similarities and differences in the way people think about HWC-related risks. Two communal conservancies in Caprivi, Namibia served as case study sites. We analyzed data from focus groups (n = 2) to create gendered concept maps about risks to wildlife and livelihoods and any associations of those risks with HWC, and semi-structured interviews (n = 76; men = 38, women = 38) to measure explicit risk attitudes associated with HWC. Concept maps indicated some divergent perceptions in how groups characterized risks to wildlife and livelihoods; however, not only were identified risks to wildlife (e.g., pollution, hunting) dissimilar in some instances, descriptions of risks varied as well. Study groups reported similar risk perceptions associated with HWC with the exception of worry associated with HWC effects on local livelihoods. Gendered differences in risk perceptions may signal different priorities or incentives to participate in efforts to resolve HWC-related risks. Thus, although shared goals and interests may seem to be an obvious reason for cooperative wildlife management, it is not always obvious that management goals are shared. Opportunity exists to move beyond thinking about gender as an explanatory variable for understanding how different groups think about participating in conservation activities

New asymmetrical modular multilevel inverter topology with reduced number of switches

In this article, a new single-phase multilevel inverter is introduced with a reduced number of power switches and reduced voltage stress on power switches. The proposed topology consists of four input dc sources and nine semiconductor switches (eight unidirectional and one bidirectional switch). The topology can be used for asymmetrical voltage source configuration to generate seventeen voltage levels. The extended topology is constructed by a series connection of the topology circuit to produce higher voltage levels with less voltage stress on the switches without modifying the existing structure. Comparison is made with traditional and recently introduced topologies based on the number of power switches, dc sources, total blocking voltage of switches, and gate driver circuits, to prove the proposed topology's superiority. A simple nearest level modulation has been deployed as the switching scheme. Validation on the viability of the proposed topology has been carried out through simulation and hardware experimental setup

Early life inter-kingdom interactions shape the immunological environment of the airways

Background: There is increasing evidence that the airway microbiome plays a key role in the establishment of respiratory health by interacting with the developing immune system early in life. While it has become clear that bacteria are involved in this process, there is a knowledge gap concerning the role of fungi. Moreover, the inter-kingdom interactions that influence immune development remain unknown. In this prospective exploratory human study, we aimed to determine early post-natal microbial and immunological features of the upper airways in 121 healthy newborns. Results: We found that the oropharynx and nasal cavity represent distinct ecological niches for bacteria and fungi. Breastfeeding correlated with changes in microbiota composition of oropharyngeal samples with the greatest impact upon the relative abundance of Streptococcus species and Candida. Host transcriptome profiling revealed that genes with the highest expression variation were immunological in nature. Multi-omics factor analysis of host and microbial data revealed unique co-variation patterns. Conclusion: These data provide evidence of a diverse multi-kingdom microbiota linked with local immunological characteristics in the first week of life that could represent distinct trajectories for future respiratory health

Transcriptomics reveal an integrative role for maternal thyroid hormones during zebrafish embryogenesis

Thyroid hormones (THs) are essential for embryonic brain development but the genetic mechanisms involved in the action of maternal THs (MTHs) are still largely unknown. As the basis for understanding the underlying genetic mechanisms of MTHs regulation we used an established zebrafish monocarboxylic acid transporter 8 (MCT8) knock-down model and characterised the transcriptome in 25hpf zebrafish embryos. Subsequent mapping of differentially expressed genes using Reactome pathway analysis together with in situ expression analysis and immunohistochemistry revealed the genetic networks and cells under MTHs regulation during zebrafish embryogenesis. We found 4,343 differentially expressed genes and the Reactome pathway analysis revealed that TH is involved in 1681 of these pathways. MTHs regulated the expression of core developmental pathways, such as NOTCH and WNT in a cell specific context. The cellular distribution of neural MTH-target genes demonstrated their cell specific action on neural stem cells and differentiated neuron classes. Taken together our data show that MTHs have a role in zebrafish neurogenesis and suggest they may be involved in cross talk between key pathways in neural development. Given that the observed MCT8 zebrafish knockdown phenotype resembles the symptoms in human patients with Allan-Herndon-Dudley syndrome our data open a window into understanding the genetics of this human congenital condition.Portuguese Fundacao para Ciencia e Tecnologia (FCT) [PTDC/EXPL/MARBIO/0430/2013]; CCMAR FCT Plurianual financing [UID/Multi/04326/2013]; FCT [SFRH/BD/111226/2015, SFRH/BD/108842/2015, SFRH/BPD/89889/2012]; FCT-IF Starting Grant [IF/01274/2014]info:eu-repo/semantics/publishedVersio

The long-term fate of the hip arthrodesis: does it remain a valid procedure for selected cases in the 21st century?

Even in current orthopaedic practice, some cases are still not suitable candidates for hip replacement and hip fusion remains the only option in these highly selected patients. In this retrospective study we describe the long-term clinical outcome, quality of life and radiological evaluation of all adjacent joints in a cohort of 47 hip fusions. The main objective of our study was to show the long-term effects of a fusion. Thirty patients were analysed after an average of 18.2 years (range 6.2–30.5 years) with a mean SMFA of 31.2 (range 9–70). The VAS for pain for the fused hip was an average 1.9 (range 0–8), for the contralateral hip 2.0 (0–8), for the ipsilateral knee 2.0 (0–8), for the contralateral knee 1.8 (0–8) and for the lower back 3.6 (0–8). Average walking distance was 115 minutes (range 10–unlimited). Although the hip arthrodesis has lost popularity, it still is an option for the young patient with severe hip disorders, while leaving the possibility to perform a THA at a later stage. If the arthrodesis is performed with an optimal alignment of the leg, complaints from the adjacent joints are minimal, even in the long-term, and an acceptable quality of life can be obtained. We believe that in highly selected cases a hip fusion, even in current practice, is still a valid option

A Robust, Simple Genotyping-by-Sequencing (GBS) Approach for High Diversity Species

Advances in next generation technologies have driven the costs of DNA sequencing down to the point that genotyping-by-sequencing (GBS) is now feasible for high diversity, large genome species. Here, we report a procedure for constructing GBS libraries based on reducing genome complexity with restriction enzymes (REs). This approach is simple, quick, extremely specific, highly reproducible, and may reach important regions of the genome that are inaccessible to sequence capture approaches. By using methylation-sensitive REs, repetitive regions of genomes can be avoided and lower copy regions targeted with two to three fold higher efficiency. This tremendously simplifies computationally challenging alignment problems in species with high levels of genetic diversity. The GBS procedure is demonstrated with maize (IBM) and barley (Oregon Wolfe Barley) recombinant inbred populations where roughly 200,000 and 25,000 sequence tags were mapped, respectively. An advantage in species like barley that lack a complete genome sequence is that a reference map need only be developed around the restriction sites, and this can be done in the process of sample genotyping. In such cases, the consensus of the read clusters across the sequence tagged sites becomes the reference. Alternatively, for kinship analyses in the absence of a reference genome, the sequence tags can simply be treated as dominant markers. Future application of GBS to breeding, conservation, and global species and population surveys may allow plant breeders to conduct genomic selection on a novel germplasm or species without first having to develop any prior molecular tools, or conservation biologists to determine population structure without prior knowledge of the genome or diversity in the species

Prevalence and factors associated with traditional herbal medicine use among patients on highly active antiretroviral therapy in Uganda

<p>Abstract</p> <p>Background</p> <p>In Africa, herbal medicines are often used as primary treatment for Human immunodeficiency virus (HIV) related problems. Concurrent use of traditional herbal medicines (THM) with antiretroviral drugs (ARVs) is widespread among HIV infected patients. However, the extent of THM use is not known in most settings in Sub-Saharan Africa. This study aimed at determining the prevalence and factors associated with THM use among HIV infected patients on highly active antiretroviral therapy (HAART) attending The AIDS Support Organization (TASO) in Uganda. TASO is a non-governmental organization devoted to offering HIV/AIDS care and treatment services in the population.</p> <p>Methods</p> <p>This was a cross-sectional study carried out in two TASO treatment centres in Uganda among 401 randomly selected eligible participants. We included participants who were 18 years and above, were enrolled on HAART, and consented to participate in the study. Data was collected using an interviewer-administered semi-structured questionnaire. THM use referred to someone who had ever used or was currently using herbal medicine while on highly active antiretroviral therapy (HAART) by the time of the study. Data was captured in Epi-data version 3.1 and exported to STATA version 9.0 for analysis.</p> <p>Results</p> <p>The prevalence of THM use was 33.7%. Patients on HAART for < 4 years were more likely to use THM (OR = 5.98, 95% CI 1.13 - 31.73) as well as those who experienced HAART side effects (OR = 3.66, 95% CI: 1.15 - 11.68). Older patients (≥39 years) were less likely to use THM (OR = 0.26 95% CI: 0.08 - 0.83). Participants with HAART adherence levels > 95% were less likely to use THM (OR = 0.09, 95% CI 0.01 - 0.65).</p> <p>Conclusion</p> <p>The prevalence of THM use among participants on HAART was high. This raises clinical and pharmacological concerns that need attention by the health care service providers.</p