A study of the professional values and perceptions of social workers, by Coetta Lou Berry, Emma McDonald Dawson, Moragh Lesslie Shepherd and Sally Hall Wood

Thesis (M.S.)--Boston Universit

Investigating the Infection and Persistence of Sindbis Virus in Host Neurons

Sindbis virus, an Alphavirus in the Togaviridae family, is an enveloped, single-stranded positive-sense RNA virus. Found mostly in parts of Africa, Australia, Egypt, Philippines, and Northern Europe – it is known to cause Ockelbo or Pogosta disease [1]. This disease is characterized by the sudden onset of fever, headache, and arthralgia; followed by arthritis, rash, fatigue, and muscle pain. The symptoms are gone within 14 days, though cases have shown joint pain to last from 12 months to 2 and a half years [4]. Common to several other viruses, Sindbis is transmitted from birds (its reservoir) to humans via an arthropod vector, the mosquito [5]. The transmission and symptoms of Sindbis virus are well documented. Once inside a human host, however, much less is known. When Sindbis enters the body, its target is the nervous system. The mechanism of not only neuroinvasion, but neurovirulence and persistence is unknown. Both the virus and the host play important roles in the progression of a neurological, viral infection [2,6]. The aim of this study is to investigate the infection and persistence of Sindbis virus in an environment that replicates the neurological system of a rodent host using iCHIP (in-vitro Chip-Based Human Investigational Platform). The multi-electrode array (MEA) on the iCHIP is used to detect signaling between the seeded neurons and to map the effect of the virus on them [3]. After detection, samples are taken at intervals and tested to observe persistence of both live virus and viral RNA. We hypothesize that the samples will show evidence of viable virus for the first couple weeks of sampling via a TCID50 assay, but then observe drop in viral population while the levels of viral RNA remain constant

Building social capital with interprofessional student teams in rural settings: A service-learning model

Objective: To describe outcomes of a model of service learning in interprofessional learning (IPL) aimed at developing a sustainable model of training that also contributed to service strengthening. Design: A total of 57 semi-structured interviews with key informants and document review exploring the impacts of interprofessional student teams engaged in locally relevant IPL activities. Setting: Six rural towns in South East New South Wales. Participants: Local facilitators, staff of local health and other services, health professionals who supervised the 89 students in 37 IPL teams, and academic and administrative staff. Main outcome measures: Perceived benefits as a consequence of interprofessional, service-learning interventions in these rural towns. Results: Reported outcomes included increased local awareness of a particular issue addressed by the team; improved communication between different health professions; continued use of the team\u27s product or a changed procedure in response to the teams\u27 work; and evidence of improved use of a particular local health service. Conclusions: Given the limited workforce available in rural areas to supervise clinical IPL placements, a service-learning IPL model that aims to build social capital may be a useful educational model

Legacy and social media respectively influence risk perceptions and protective behaviors during emerging health threats: A multi-wave analysis of communications on Zika virus cases.

ObjectiveBoth legacy media, such as television and newspapers, and online social media are potentially important but incompletely understood sources of information in the face of emerging public health risks. This research aimed to understand media effects on risk perceptions and behaviors concerning the Zika virus in the United States.MethodsWe analyzed a multi-wave nationally representative survey (N = 29,062) and the volume of communications in social and legacy media (i.e., legacy media data from news sources and databases, N = 2,660 and social media data from Twitter, N = 1,605,752) in the United States between April and October 2016, dates coinciding with the early cases of local transmission of Zika in the United States (i.e., 25 weeks). The present study conducted econometric analyses (i.e., Granger causality tests) to assess the associations of legacy and social media coverage with risk perceptions and protective behaviors in the total sample and specific groups separated by pregnancy status/intent, geographic region, income, education level, age, and ethnicity.ResultsThe results from the overall sample suggested that changes in the volume of information in legacy and social media (i.e., Twitter) were followed by different changes in community risk perceptions and protective behaviors. Specifically, social media coverage correlated with the level of risk perceptions, whereas the legacy media coverage correlated with the level of protective behaviors. Analyses across different subpopulations, including those of different pregnancy status/intent, geographic Zika risk, income, education level, age, and ethnicity, replicated the social media associations with risk perceptions in most cases. However, legacy media and protective behaviors were linked only in some vulnerable subpopulations (e.g., the less-educated populations).ConclusionUnderstanding how media coverage relates to Zika risk perceptions and protective behaviors will help to facilitate effective risk communications by healthcare professionals and providers, particularly when a health risk emerges

Impact of interprofessional education about psychological and medical comorbidities on practitioners’ knowledge and collaborative practice: mixed method evaluation of a national program

BACKGROUND Many patients with chronic physical illnesses have co-morbid psychological illnesses, which may respond to interprofessional collaborative care. Continuing education programs frequently focus on skills and knowledge relevant for individual illnesses, and unidisciplinary care. This study evaluates the impact of “Mind the Gap”, an Australian interprofessional continuing education program about management of dual illnesses, on practitioners’ knowledge, use of psychological strategies and collaborative practice. METHODS A 6-h module addressing knowledge and skills needed for patients with physical and psychological co-morbid illnesses was delivered to 837 practitioners from mixed health professional backgrounds, through locally-facilitated workshops at 45 Australian sites. We conducted a mixed-methods evaluation, incorporating observation, surveys and network analysis using data collected, before, immediately after, and three months after training. RESULTS Six hundred forty-five participants enrolled in the evaluation (58 % GPs, 17 % nurses, 15 % mental health professionals, response rate 76 %). Participants’ knowledge and confidence to manage patients with psychological and physical illnesses improved immediately. Among the subset surveyed at three months (response rate 24 %), referral networks had increased across seven disciplines, improvements in confidence and knowledge were sustained, and doctors, but no other disciplines, reported an increase in use of motivational interviewing (85.9 % to 96.8 %) and mindfulness (58.6 % to 74 %). CONCLUSIONS Interprofessional workshops had an immediate impact on the stated knowledge and confidence of participants to manage patients with physical and psychological comorbidities, which appears to have been sustained. For some attendees, there was a sustained improvement in the size of their referral networks and their use of some psychological strategies.This project was funded by the Australian Medicare Local Alliance, through a grant from the Department of Veterans Affairs

Ecology and emergence: Understanding factors that drive variation in process quality and clinical outcomes in general practice

Clinical practice variation (CPV), where differences in healthcare delivery do not reflect differences in patient preferences or clinical need, is considered a hallmark of poor quality care. 'Unwarranted' variation is the focus of mounting policy attention and a growing body of literature, but remains poorly explained and theorised, with ways of determining when variation is warranted only weakly developed. Many assertions around CPV remain under-explored and untested. Much of the literature operates on the assumption that the legitimacy of variation depends on its source or cause, and that variation in processes of care will lead to related variation in outcomes. This doctoral research focuses on two overarching questions relating to CPV in Australian general practice: (1) what is CPV, and how can it be best conceptualised and understood; and (2) what can routinely-collected clinical data tell us about the phenomenon of CPV in general practice? Accordingly, this thesis explores the operationalisation of CPV as a theoretical construct and also examines variation in a series of clinical performance measures for coronary heart disease (CHD) and diabetes. Together, these lines of inquiry constitute a mixed-methods 'sense-making' exercise that seeks an incremental interplay between literature and data, to shed light on the phenomenon of CPV. Data are drawn from a unique dataset of aggregate reporting metrics, using extracted electronic medical record data, among an affiliated group of 36 general practice clinics serving approximately 189,848 patients over a 5-year period. These data are examined descriptively and ultimately analysed using Qualitative Comparative Analysis (QCA) against an empirically derived explanatory framework. Theory development draws on complexity science, especially complex adaptive systems theory, and the disciplines of social epidemiology and health ecology. Results show that a series of discourses have strongly shaped thinking about CPV, converging around a normative 'bad apples' approach to understanding variation. However, CPV may also contribute to healthcare quality in ways that are not well considered, especially in primary care settings. I demonstrate that there may be unconventional but more illuminating ways to conceptualise variation that enable our collective understanding to progress. These include using an ecological framework to conceive CPV as an emergent property of coupled, complex adaptive systems, and employing an equity lens to distinguish between CPV in processes and outcomes of care. In descriptive analyses, I find that variation frequently behaves differently across different measures, with crucial system information contained in the interstices of the data. Contrary to common assumptions, relationships between processes and outcomes of care are not straightforward. Using a framework of factors associated with CPV in general practice management of diabetes and CHD, I confirm that causality is complex and multifactorial, operating at a number of levels. Employing the case-based configurational method of QCA, I show that there may be no single or primary cause for CPV. Instead, clinics can arrive at a particular outcome via multiple independent causal pathways which are themselves multifactorial. These multi-component causes may be defined as much by the interactions between component elements as by individual elements themselves. The same factor may have differential effects within different combinations, or at different scales. These findings suggest that relying on causal explanations to demarcate unwarranted variation may be insufficient. However, both theory and methods require continued development to ensure an adequate understanding of the role and representation of warranted and unwarranted variation in performance measurement systems. Case-based configurational methods such as QCA may have substantial utility in helping to explain and delineate these phenomena

The Effect of Environmental Selection Pressure on the Rate of Recombination to an Advantageous Receptor Mutation in Bovine Coronavirus

Bovine Coronavirus (BCoV) is an important analogue in understanding the effectiveness of zoonotic, single-stranded, positive sense RNA viruses. Many of the most recent viral outbreaks have been attributed to RNA viruses that have one, or more, animal reservoirs [1]. BCoV is such a great candidate for studying these types of viruses because they are from the family Coronaviridae, which also contains the viruses that cause severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The goal of this study was to observe changes in genetic makeup of the virus’ outer membrane Spike protein via recombination between two BCoV strains. The Nebraska strain and the Mebus strain were co-infected into a human cell line (HRT-18) in a 1 to 100 ratio and their rate of infection recorded. The Nebraska strain contains a 12 nt insert in its Spike protein which has been hypothesized to allow for trypsin-independent cell entry [2]. Like SARS, BCoV has been found to require proteolytic cleavage by host trypsin in order for it to infect its host. To test the ability of the coronavirus strains to recombine and transfer this insert through template swapping, some cell lines were infected with the virus strains and incubated in media containing trypsin and trypsin-free media. RNA extraction of the virus present in the supernatant from the infected cells and subsequent RT-PCR and TaqMan PCR was used to determine the level of successfully infecting virus of each strain. The study concluded that, even at small levels, the presence of the Nebraska strain allowed recombination to occur and therefore boost the speed of infection and replication of the Mebus strain. Specific primers also indicated that the Mebus strain acquired the insert through template swapping. This results points out the importance of understanding the quasispecies of emerging viruses

The effect of processing load on loss of information from short-term memory.

We report an experiment in which we varied the nature of the articulatory suppression task being performed during a filled retention interval in serial recall. During the retention interval participants performed one of three computer-paced colour naming tasks designed to prevent subvocal rehearsal: A Stroop color-interference task with items presented at a rate of one every 750 ms, and two color-consistent control tasks at a rate of either 750 ms or 500 ms per item. Memory performance over a 12 s interval declined much more dramatically with the Stroop task and the 500 ms control task than with the 750 ms control. There was no difference between the Stroop condition and the 500 ms control. These results pose problems for models that assume that loss of information from memory is determined entirely by interference, as there are more interfering events in the control 500 ms condition than the 750 ms Stroop. They also pose problems for models relying solely on time-based decay and articulatory rehearsal because all three conditions should block rehearsal and produce equivalent performance. The results illustrate that articulatory suppression tasks are not all equivalent, and suggest that the rate of decay from short-term memory is strongly influenced by the resource demands of concurrent processing

Using qualitative mixed methods to study small health care organizations while maximising trustworthiness and authenticity

Background The primary health care sector delivers the majority of health care in western countries through small, community-based organizations. However, research into these healthcare organizations is limited by the time constraints and pressure facing them, and the concern by staff that research is peripheral to their work. We developed Q-RARA—Qualitative Rapid Appraisal, Rigorous Analysis—to study small, primary health care organizations in a way that is efficient, acceptable to participants and methodologically rigorous. Methods Q-RARA comprises a site visit, semi-structured interviews, structured and unstructured observations, photographs, floor plans, and social scanning data. Data were collected over the course of one day per site and the qualitative analysis was integrated and iterative. Results We found Q-RARA to be acceptable to participants and effective in collecting data on organizational function in multiple sites without disrupting the practice, while maintaining a balance between speed and trustworthiness. Conclusions The Q-RARA approach is capable of providing a richly textured, rigorous understanding of the processes of the primary care practice while also allowing researchers to develop an organizational perspective. For these reasons the approach is recommended for use in small-scale organizations both within and outside the primary health care sector