And the World Will Keep Spinning

This creative nonfiction article is a study in grief and what it means to lose a friend

Predictive Testing for Huntington’s Disease: A New Paradigm of Patient Care

Radical changes have occurred in America’s health care system in the last twenty years. Technological and research advances have given medicine the knowledge to treat and to cure diseases once only dreamt about. But in the race to cure, the focus of health care has shifted from treating the W patient to treating the disease. Attending to the psychological and psychosocial aspects of disease has been lost, leaving patients feeling increasingly afraid, ignored, neglected, and bureaucratically managed. This honor’s thesis presents a new program of care to bridge the existing gap between the treatment of the disease and the treatment of the patient by examining the problems currently facing Huntington’s disease patients in respect to prediagnostic testing, and suggest ways to improve the protocol for testing and for patient care. The study will be presented in five parts: Part One examines the nature and scope of Huntington’s disease; specifically, the nature of the disease, advances in research in technology, the impact of the disease on patients and patients’ families, and issues surrounding pre-diagnostic testing for the disease. Part Two traces the development of protocols that are currently prescribed for the pre-diagnostic testing of Huntington’s disease by the International Huntington Disease Society (IHDS) and the Huntington’s Disease Society of America (HDSA), and examines how Shodair Children’s Hospital in Helena, Montana, has revised and adopted them for use. Part Three examines the strengths and weaknesses of Shodair’s protocol through a random survey of Helena physicians. Based on these analyses, Part Four proposes revisions to all the existing protocols that will enhance the treatment of patients. Part Five concludes the study with a discussion of the implications of the revised protocol for health care.

Clinical Use of the Nintendo WII for Balance Rehabilitation: a Case Report

Background and Purpose: Falls in the elderly population may be due to a number of factors and may pose long-term detrimental effects or contribute to mortality. The purpose of this case report is to describe the non-traditional clinical use of the Nintendo Wii for balance rehabilitation in conjunction with traditional balance interventions for an elderly male patient in order to decrease his risk for falls. Case Description: The patient was an 83-year-old male with a medical diagnosis of cerebral vascular insult, Alzheimer‟s disease and a closed head injury due to a fall secondary to a seizure. His balance was assessed post-hospitalization at a transitional care unit (TCU) and was categorized as high risk for falls. Intervention: The Nintendo Wii was used in conjunction with traditional physical therapy interventions including: therapeutic activity, functional mobility and therapeutic exercise. Three Wii games were chosen to improve the patient‟s static and dynamic standing balance. These games included the Balance Bubble and Tilt Table games on the Wii Balance Board and golf. Golf was performed in a variety of standing postures (i.e. tandem). Outcomes: Following a total of 42 physical therapy treatment sessions over four weeks, 11 of which included using the Nintendo Wii, the patient‟s Berg Balance Score (BBS) improved from 32 to 49 out of 56. The patient‟s Tinetti Balance Assessment (POMA) score improved from 16 to 24 out of 28, which demonstrates a decrease risk of falls. Upon discharge, the patient was able to return home and complete all activities of daily living (ADL) with supervision from his wife. Discussion: Despite the patient scoring in the unbalanced and amateur categories for the Nintendo Wii Tilt Table and Balance Bubble games, his balance scores as measured by BBS and POMA showed significant improvement over the four weeks. Further research is needed for the clinical use of the Nintendo Wii as a valid and reliable balance intervention in populations with high risk of falls

Discussing Topics of Diversity in the Elementary Classroom

This is a breif overview of a self-study with the guiding research question of How does discussing topics of diversity in my classroom affect my teaching practice?

El uso del español en la NFL: La evolución del español en las páginas web desde 2009 y las implicaciones de las palabras clave a través de un miniestudio de corpus.

Espa&ntilde;ol: Un estudio anterior realizado en 2009 explor&oacute; las formas en que las ligas deportivas profesionales de EE.UU. llegan a los aficionados hispanos a trav&eacute;s del idioma espa&ntilde;ol en Internet. Sus resultados concluyeron que los 2 equipos de la NFL ten&iacute;an p&aacute;ginas en espa&ntilde;ol. Estamos en 2021 y el crecimiento de la poblaci&oacute;n hispana y el consiguiente poder adquisitivo asociado ha sido r&aacute;pido y significativo. El n&uacute;mero de consumidores y fans hispanos y latinos de la NFL est&aacute; ciertamente en expansi&oacute;n, por lo que ahora, m&aacute;s que nunca, resonar con los consumidores y fans hispanos y latinos es imperativo para el &eacute;xito. Los resultados de la primera parte del estudio, relativa a la p&aacute;gina web, validaron la hip&oacute;tesis de un aumento de m&aacute;s del 28% respecto al estudio de 2009. Este fue un resultado positivo y apoy&oacute; la creencia de que un enfoque coordinado para incluir m&aacute;s contenido en espa&ntilde;ol en los sitios web de las ligas y equipos deportivos profesionales ser&aacute; un paso importante para llegar a los aficionados hispanos. Sin embargo, hay 21 equipos que no producen ning&uacute;n sitio web en espa&ntilde;ol. El an&aacute;lisis ling&uuml;&iacute;stico ilustr&oacute; que, a partir de las palabras clave encontradas, los principales temas encontrados entre las palabras fueron: t&eacute;rminos sobre noticias, partes del cuerpo y salud, posiciones en el campo de f&uacute;tbol y relaci&oacute;n con los medios sociales u otras variedades comunicativas. Desde el punto de vista ling&uuml;&iacute;stico, 14 lemas de los 35 eran pr&eacute;stamos y 2 eran palabras calcadas, lo que indica la fuerte dependencia de la lengua inglesa. En lo que respecta espec&iacute;ficamente al dialecto deportivo, las palabras &ldquo;cornerbacks&rdquo;, &ldquo;linebackers&rdquo;, &ldquo;quarterbacks&rdquo;, &ldquo;corredores&rdquo; &ldquo;posici&oacute;n&rdquo; &ldquo;ofensivo&rdquo; y &ldquo;defensivo&rdquo; eran una mezcla de traducci&oacute;n inversa y de pr&eacute;stamo, con la excepci&oacute;n de &ldquo;corredores&rdquo; que significa &ldquo;runningback&rdquo;. Aunque hubo hallazgos que condujeron a una conclusi&oacute;n s&oacute;lida, todo el conocimiento recogido en este estudio dio lugar a m&aacute;s curiosidad y preguntas para el desarrollo futuro. English: A previous study conducted in 2009 explored the ways in which professional sports leagues in the U.S reach Hispanic fans through the Spanish language on the Internet. Its results concluded that the 2 of the NFL&rsquo;s teams had pages in Spanish. It is now 2021 and the booming growth of the Hispanic population and subsequent associated spending power has been fast and significant. The number of Hispanic and Latino consumers and fans of the NFL are certainly expanding, so now, more than ever, resonating with Hispanic and Latino consumers and fans is imperative for success. The results of the first part of the study, relating to the website, validated the hypothesis of more than a 28% increase over the 2009 study. This was a positive result and supported the belief that a coordinated approach to include more Spanish-language content on the websites of professional sports leagues and teams will be an important step in reaching Hispanic fans. However, there are 21 teams that do not produce any Spanish language websites. The linguistic analysis illustrated that, from the keywords found, the main themes found among the words were: terms about news, body parts and health, positions on the football field, and relationship to social media or other communicative varieties. When viewed through a linguistic lens, 14 lemmas out of the 35 were borrowings and 2 were calque words, indicating the strong reliance on the English language. Specifically looking at the sports dialect, the words &ldquo;cornerbacks&rdquo;, &ldquo;linebackers&rdquo;, &ldquo;quarterbacks&rdquo;, &ldquo;corredores&rdquo; &ldquo;posici&oacute;n&rdquo; &ldquo;ofensivo&rdquo; y &ldquo;defensive&rdquo; were a mix of inverse translation and loan words with the exception of &ldquo;corredores&rdquo; meaning &ldquo;runningback&rdquo;. Although there were findings that led to a solid conclusion, all the knowledge gathered from this study led to more curiosity and questions for future development. &nbsp;</p

Implementation of health IT for cancer screening in US primary care: Scoping review

BACKGROUND: A substantial percentage of the US population is not up to date on guideline-recommended cancer screenings. Identifying interventions that effectively improve screening rates would enhance the delivery of such screening. Interventions involving health IT (HIT) show promise, but much remains unknown about how HIT is optimized to support cancer screening in primary care. OBJECTIVE: This scoping review aims to identify (1) HIT-based interventions that effectively support guideline concordance in breast, cervical, and colorectal cancer screening provision and follow-up in the primary care setting and (2) barriers or facilitators to the implementation of effective HIT in this setting. METHODS: Following scoping review guidelines, we searched MEDLINE, CINAHL Plus, Web of Science, and IEEE Xplore databases for US-based studies from 2015 to 2021 that featured HIT targeting breast, colorectal, and cervical cancer screening in primary care. Studies were dual screened using a review criteria checklist. Data extraction was guided by the following implementation science frameworks: the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework; the Expert Recommendations for Implementing Change taxonomy; and implementation strategy reporting domains. It was also guided by the Integrated Technology Implementation Model that incorporates theories of both implementation science and technology adoption. Reporting was guided by PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). RESULTS: A total of 101 studies met the inclusion criteria. Most studies (85/101, 84.2%) involved electronic health record-based HIT interventions. The most common HIT function was clinical decision support, primarily used for panel management or at the point of care. Most studies related to HIT targeting colorectal cancer screening (83/101, 82.2%), followed by studies related to breast cancer screening (28/101, 27.7%), and cervical cancer screening (19/101, 18.8%). Improvements in cancer screening were associated with HIT-based interventions in most studies (36/54, 67% of colorectal cancer-relevant studies; 9/14, 64% of breast cancer-relevant studies; and 7/10, 70% of cervical cancer-relevant studies). Most studies (79/101, 78.2%) reported on the reach of certain interventions, while 17.8% (18/101) of the included studies reported on the adoption or maintenance. Reported barriers and facilitators to HIT adoption primarily related to inner context factors of primary care settings (eg, staffing and organizational policies that support or hinder HIT adoption). Implementation strategies for HIT adoption were reported in 23.8% (24/101) of the included studies. CONCLUSIONS: There are substantial evidence gaps regarding the effectiveness of HIT-based interventions, especially those targeting guideline-concordant breast and colorectal cancer screening in primary care. Even less is known about how to enhance the adoption of technologies that have been proven effective in supporting breast, colorectal, or cervical cancer screening. Research is needed to ensure that the potential benefits of effective HIT-based interventions equitably reach diverse primary care populations

Report of the 2019-2020 strategic engagement standing committee

© 2020, American Association of Colleges of Pharmacy. All rights reserved. For the American Association of Colleges of Pharmacy (AACP) strategic engagement is critical to the success of colleges and schools of pharmacy in expanding pharmacy and public health practice, meeting programmatic needs, and fulfilling institutional missions. The 2019-2020 Strategic Engagement Committee was charged with exploring the collaborative relationships colleges and schools have within their state to advance pharmacy practice. More specifically, this committee was tasked to examine those relationships with current state pharmacy and medical associations. This report seeks to provide insights from this work and share recommendations to assist AACP in facilitating practice transformation. To uncover current schools’ relationships with state and medical associations, the committee utilized AACP’s ability in convening members to conduct focus groups at INsight 2020 and one-on-one interviews with key faculty members. Overall, partnerships with state pharmacy associations are successful or growing, whereas there is still work to be done in developing relationships and collaborating with medical and health care societies. We found that there are several schools with “best practices” related to state association collaborations and look to highlight exemplar practices in this report as they are critical towards practice transformations

Report of the 2020-2021 Strategic Engagement Standing Committee

EXECUTIVE SUMMARY For the American Association of Colleges of Pharmacy (AACP), strategic engagement is critical to the success of colleges and schools of pharmacy in expanding pharmacy and public health practice, meeting programmatic needs, and fulfilling institutional missions. The 2020-2021 Strategic Engagement Standing Committee was charged with identifying effective strategies to leverage the temporary expansion of pharmacist practice capabilities granted during the COVID-19 pandemic for sustained practice. The group was also tasked with looking at ways to partner with the Association of American Medical Colleges (AAMC), our medicine counterparts to develop a plan for collaborating with them to advance interprofessional practice. In this unique year, all standing committees were charged with reading all the reports last year to put President Lin’s charges into perspective with the hopes of carrying over the overall theme and work of the previous years committee. Overall, throughout the COVID-19 pandemic, there have been several expansions on the scope of practice for pharmacists and vary by state. We hope to draw out some of those expansions to see how we can build upon efforts to make those permanent

Ammonia exposure promotes algal biomass in an ombrotrophic peatland

Nitrogen pollution affects many peatlands with consequences for their biodiversity and ecosystem function. Microorganisms control nutrient cycling and constitute most of the biodiversity of peatlands but their response to nitrogen is poorly characterised and likely to depend on the form of deposition. Using a unique field experiment we show that ammonia exposure at realistic point source levels is associated with a general shift from heterotrophic (bacteria and fungi) to autotrophic (algal) dominance and an increase in total biomass. The biomass of larger testate amoebae increased, suggesting increased food supply for microbial predators. Results show the widespread impacts of N pollution and suggest the potential for microbial community-based bioindicators in these ecosystems