Personalizing Longitudinal Care Coordination for Patients with Chronic Kidney Disease

Chronic care coordination efforts often focus on the needs of the healthcare team and not on the individual needs of each patient. However, developing a personalized care plan for patients with Chronic Kidney Disease (CKD) requires individual patient engagement with the health care team. We describe the development of a CKD e-care plan that focuses on patient specific needs and life goals, and can be personalized according to provider needs

The Roth Project - Music and Memory: A Community Agency Initiated Individualized Music Intervention for People with Dementia

Introduction “The Roth Project - Music and Memory” is a music based intervention program, implemented by the Alzheimer’s Association of Central and Western Kansas, which provides a nonpharmacologicalmeans for addressing neuropsychiatric symptoms in individuals with dementia. Methods Participants were individuals with dementia who were enrolled in The Roth Project - Music and Memory. Post-intervention surveys were distributed to caregivers of participants which assessed caregiver satisfaction with the program as well as caregiver perception of the impact of individualized music on mood and behavioralsymptoms. Results Of returned surveys (n = 79), 99% of caregivers indicated they were satisfied or very satisfied with the program and 94% of caregivers perceived participants to like or very much like listening to the music. While a substantial number of participants required assistance with iPod use (95%), the majority of participants were observed to listen to the music with stable or increased frequency over time. Personalized music was observed to improve mood in 78% of cases, with the most frequent benefits being improved overall happiness, decreased anxiety, increased positive emotional expression, and decreased depression. Conclusions The Roth Project - Music and Memory was well received by caregivers and was perceived to benefit mood of individuals with dementia. These results provided ongoing support for individualized music-based interventions and demonstrated that such interventions, when implemented by community agencies, can be well received by those who use them

The Association between Y-Balance and the Delos Postural Proprioceptive System in Professional Basketball Players

Background/Purpose: Lower extremity injury is common in professional basketball. The Y-Balance Test (YBT) and the Delos Postural Proprioceptive System (DPPS) have been purported to assess dynamic postural control and balance, which has been associated with injury in elite athletics. It has been reported that performance on balance assessments is influenced by many factors that include mobility, strength, and proprioception. The purpose of this exploratory study was to investigate the relationship between DPPS and YBT performance in professional basketball players. Methods: 13 professional basketball players (age=25.5 yrs +/- 3.9, height = 2.00 m +/- .079 weight = 99.89 kg +/- 12.38, BMI = 24.66 +/- 1.89) participated. YBT and Delos Measurements were completed as part of preseason mobility screening prior to the 2018-19 NBA season. A Friedman’s ANOVA was used to investigate the differences between the DPPS and YBT, using individuals scoring below 1SD on both the static and dynamic Delos cutoff score (90) for both left and right lower extremities. The ICC was used to investigate the relationship between (right or left) dynamic and static Delos scores to scores on the respective y-balance test. Results: The Delos Static and Dynamic tests for the right side were statistically different than the YBT composite scores. The ICC for the Delos static (right) score was -.910 and the Delos dynamic (right) score was -.999 with a 95% confidence interval from -7.127 to .962 (F(2,10)=.671,p Conclusion: This exploratory study suggests that the direct correlation between the YBT and the DPPS should be further investigated. The YBT may be an assessment that is more sensitive to factors related to strength and mobility while the DPPS may be more representative of proprioceptive function. Clinical Relevance: Balance and mobility is influenced by many factors. Understanding the association between the Delos and Y-Balance can give clinicians a better understanding of the utility and value these assessments when working with elite athletes.https://ecommons.udayton.edu/dpt_symposium/1001/thumbnail.jp

Research Needs for Effective Transition in Lifelong Care of Congenital Genitourinary Conditions: A Workshop Sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases

Over the last 5 decades, health-care advances have yielded quantum improvements in the life expectancy of individuals with congenital genitourinary conditions (CGCs), leading to a crisis of care. Many individuals with CGC enter adulthood unprepared to manage their condition. Pediatric CGC specialists lack training to manage adulthood-related health-care issues, whereas adult genitourinary specialists lack training within the context of CGCs. To address these challenges, the National Institutes of Diabetes and Digestive and Kidney Diseases convened individuals with CGCs and experts from a variety of fields to identify research needs to improve transitional urology care. This paper outlines identified research needs

Special Feature CKD as a Model for Improving Chronic Disease Care through Electronic Health Records

Abstract Electronic health records have the potential to improve the care of patients with chronic medical conditions. CKD provides a unique opportunity to show this potential: the disease is common in the United States, there is significant room to improve CKD detection and management, CKD and its related conditions are defined primarily by objective laboratory data, CKD care requires collaboration by a diverse team of health care professionals, and improved access to CKD-related data would enable identification of a group of patients at high risk for multiple adverse outcomes. However, to realize the potential for improvement in CKD-related care, electronic health records will need to provide optimal functionality for providers and patients and interoperability across multiple health care settings. The goal of the National Kidney Disease Education Program Health Information Technology Working Group is to enable and support the widespread interoperability of data related to kidney health among health care software applications to optimize CKD detection and management. Over the course of the last 2 years, group members met to identify general strategies for using electronic health records to improve care for patients with CKD. This paper discusses these strategies and provides general goals for appropriate incorporation of CKD-related data into electronic health records and corresponding design features that may facilitate (1) optimal care of individual patients with CKD through improved access to clinical information and decision support, (2) clinical quality improvement through enhanced population management capabilities, (3) CKD surveillance to improve public health through wider availability of population-level CKD data, and (4) research to improve CKD management practices through efficiencies in study recruitment and data collection. Although these strategies may be most effectively applied in the setting of CKD, because it is primarily defined by laboratory abnormalities and therefore, an ideal computable electronic health record phenotype, they may also apply to other chronic diseases

Nucleoprotein Nanostructures Combined with Adjuvants Adapted to the Neonatal Immune Context: A Candidate Mucosal RSV Vaccine

BACKGROUND: The human respiratory syncytial virus (hRSV) is the leading cause of severe bronchiolitis in infants worldwide. The most severe RSV diseases occur between 2 and 6 months-of-age, so pediatric vaccination will have to be started within the first weeks after birth, when the immune system is prone to Th2 responses that may turn deleterious upon exposure to the virus. So far, the high risk to prime for immunopathological responses in infants has hampered the development of vaccine. In the present study we investigated the safety and efficacy of ring-nanostructures formed by the recombinant nucleoprotein N of hRSV (N(SRS)) as a mucosal vaccine candidate against RSV in BALB/c neonates, which are highly sensitive to immunopathological Th2 imprinting. METHODOLOGY AND PRINCIPAL FINDINGS: A single intranasal administration of N(SRS) with detoxified E. coli enterotoxin LT(R192G) to 5-7 day old neonates provided a significant reduction of the viral load after an RSV challenge at five weeks of age. However, neonatal vaccination also generated an enhanced lung infiltration by neutrophils and eosinophils following the RSV challenge. Analysis of antibody subclasses and cytokines produced after an RSV challenge or a boost administration of the vaccine suggested that neonatal vaccination induced a Th2 biased local immune memory. This Th2 bias and the eosinophilic reaction could be prevented by adding CpG to the vaccine formulation, which, however did not prevent pulmonary inflammation and neutrophil infiltration upon viral challenge. CONCLUSIONS/SIGNIFICANCE: In conclusion, protective vaccination against RSV can be achieved in neonates but requires an appropriate combination of adjuvants to prevent harmful Th2 imprinting

Increasing students self-esteem through the implementation of the Bucket Filler Lesson Plans

The purpose of this study was to examine the ways in which positive psychology can impact the educational system. Twenty-three second grade students enrolled in Berlin Community School, located in Berlin New Jersey participated in this study. All students were enrolled in a regular education classroom and assumed to be learning at the appropriate age group level. The Piers-Harris 2 Self-Concept Scale was used to measure student\u27s self-esteem as a pre-test and a post-test assessment. The experimental group received the implementation of the Bucket Filler Lesson plans in hopes that their self-esteem would improve upon completion of the lessons. The lessons took place over the course of three consecutive Fridays. The control group only received the pre-test and post-test assessment. A Two-Way Mixed ANOVA was used to assess whether students self-esteem improved upon completion of the lesson plans. Results indicated that there was no significant difference between pre-test and post-test assessments for both the experimental and control group

Civil war peace agreement implementation and state capacity

Negotiated civil war terminations differ from their interstate war counterparts in that one side must disarm and cease to exist as a fighting entity. While termination through military victory provides a relatively more enduring peace, many civil wars end with peace agreements signed after negotiations. However, research has shown that the implementation of civil war peace agreements is difficult and prone to collapse. Often these failures are followed by recurrence of the conflict. In some cases, the agreements break down before key provisions are implemented. This article adds to this topic by focusing on the role of state capacity in peace agreement success. We argue that peace agreements and state capacity are necessary but not sufficient conditions for sustainable peace. The article employs a case study approach to explore the importance of state capacity in implementing civil war peace agreements. The role of third-party interventions is also considered. The cases (United Kingdom-Northern Ireland, Indo-nesia-Aceh, Burundi, Mali, and Somalia) include 14 peace agreements that vary by war type (secessionist or control over govemment), type of agreement (comprehensive or partial), levels of state capacity (high or low), and peace success (success, partial or failure), and each experienced third-party involvement in the peace process.civil war, implementation, peacebuilding, peace agreement, state capacity