Development of a Protocol for Implementing a Registered Nurse-Led Annual Wellness Visit in a Primary Care Setting

This project was a quality improvement initiative utilizing a new format to deliver the Medicare Annual Wellness Visit (AWV) to Medicare recipients. The purpose of the project was the development of a protocol for implementing a registered nurse (RN)-led AWV in a primary care setting. The pilot project focused on changing the clinic’s current AWV structure from a provider-led format to a RN-led format. The pilot was geared towards improving care coordination, while enhancing preventive services and early intervention for chronic disease management. The 6-week pilot was used to help identify areas of weaknesses in the registered nurse-led AWV. During the pilot, the RNs performed 16 AWVs. The objectives of the project were to determine the acceptability of the new format and assess the organization’s capability for efficient performance of an RN-led AWV. Outcome measures determined staff satisfaction for the visit was high and efficiency was apparent through enhanced care coordination and reimbursement opportunities. A final protocol and sustainability tools were developed as a guide for RNs to use. The guide was developed based on the weaknesses identified during the pilot period. This document discusses the background information, problem statement, intervention, evaluation methods, outcomes, sustainability resources, and dissemination methods related to the pilot project

Kepler: A Search for Terrestrial Planets - SOC 9.3 DR25 Pipeline Parameter Configuration Reports

This document describes the manner in which the pipeline and algorithm parameters for the Kepler Science Operations Center (SOC) science data processing pipeline were managed. This document is intended for scientists and software developers who wish to better understand the software design for the final Kepler codebase (SOC 9.3) and the effect of the software parameters on the Data Release (DR) 25 archival products

Conceptualization of Digital Twins in an Education Services Environment: A Straw Man Proposal

Digital twins have been used in manufacturing to describe, predict, and prescribe responses to complex problems. The digital twin is a constellation of technologies that mirror physical objects in the virtual world, including what has happened, is happening and could or should happen in the future for the mirrored object. What is common in previous conceptualizations of digital twins is that there is a physical boundary to the extent that digital twins can mirror real objects (sometimes including the objects’ environments). We propose a blended approach, using McKinsey’s straw man and Parmar et al.’s. (2020) framework, to offer a more rigorously structured process for arriving at a refined conceptualization of digital twins in the educational service environment

Are Consumers Willing to Pay More for Biodegradable Containers Than for Plastic Ones? Evidence from Hypothetical Conjoint Analysis and Nonhypothetical Experimental Auctions

This study used and compared hypothetical conjoint analysis and nonhypothetical experimental auctions to elicit floral customers’ willingness to pay for biodegradable plant containers. The results of the study show that participants were willing to pay a price premium for biodegradable containers, but the premium is not the same for different types of containers. This article also shows the mixed ordered probit model generates more accurate results when analyzing the conjoint analysis Internet survey data than the ordered probit model.biodegradable, willingness to pay, marketing, carbon footprint, waste composition, green industry, nursery crops, floriculture crops, Agribusiness, Agricultural and Food Policy, Environmental Economics and Policy, Financial Economics, Food Consumption/Nutrition/Food Safety, Marketing, Public Economics, Research and Development/Tech Change/Emerging Technologies, D12, Q13,

Dystrophin deficiency exacerbates skeletal muscle pathology in dysferlin-null mice

<p>Abstract</p> <p>Background</p> <p>Mutations in the genes coding for either dystrophin or dysferlin cause distinct forms of muscular dystrophy. Dystrophin links the cytoskeleton to the sarcolemma through direct interaction with β-dystroglycan. This link extends to the extracellular matrix by β-dystroglycan's interaction with α-dystroglycan, which binds extracellular matrix proteins, including laminin α2, agrin and perlecan, that possess laminin globular domains. The absence of dystrophin disrupts this link, leading to compromised muscle sarcolemmal integrity. Dysferlin, on the other hand, plays an important role in the Ca²⁺-dependent membrane repair of damaged sarcolemma in skeletal muscle. Because dysferlin and dystrophin play different roles in maintaining muscle cell integrity, we hypothesized that disrupting sarcolemmal integrity with dystrophin deficiency would exacerbate the pathology in dysferlin-null mice and allow further characterization of the role of dysferlin in skeletal muscle.</p> <p>Methods</p> <p>To test our hypothesis, we generated dystrophin/dysferlin double-knockout (DKO) mice by breeding <it>mdx </it>mice with dysferlin-null mice and analyzed the effects of a combined deficiency of dysferlin and dystrophin on muscle pathology and sarcolemmal integrity.</p> <p>Results</p> <p>The DKO mice exhibited more severe muscle pathology than either <it>mdx </it>mice or dysferlin-null mice, and, importantly, the onset of the muscle pathology occurred much earlier than it did in dysferlin-deficient mice. The DKO mice showed muscle pathology of various skeletal muscles, including the mandible muscles, as well as a greater number of regenerating muscle fibers, higher serum creatine kinase levels and elevated Evans blue dye uptake into skeletal muscles. Lengthening contractions caused similar force deficits, regardless of dysferlin expression. However, the rate of force recovery within 45 minutes following lengthening contractions was hampered in DKO muscles compared to <it>mdx </it>muscles or dysferlin-null muscles, suggesting that dysferlin is required for the initial recovery from lengthening contraction-induced muscle injury of the dystrophin-glycoprotein complex-compromised muscles.</p> <p>Conclusions</p> <p>The results of our study suggest that dysferlin-mediated membrane repair helps to limit the dystrophic changes in dystrophin-deficient skeletal muscle. Dystrophin deficiency unmasks the function of dysferlin in membrane repair during lengthening contractions. Dystrophin/dysferlin-deficient mice provide a very useful model with which to evaluate the effectiveness of therapies designed to treat dysferlin deficiency.</p

Beyond Crossing Fibers: Bootstrap Probabilistic Tractography Using Complex Subvoxel Fiber Geometries

Diffusion magnetic resonance imaging fiber tractography is a powerful tool for investigating human white matter connectivity in vivo. However, it is prone to false positive and false negative results, making interpretation of the tractography result difficult. Optimal tractography must begin with an accurate description of the subvoxel white matter fiber structure, includes quantification of the uncertainty in the fiber directions obtained, and quantifies the confidence in each reconstructed fiber tract. This paper presents a novel and comprehensive pipeline for fiber tractography that meets the above requirements. The subvoxel fiber geometry is described in detail using a technique that allows not only for straight crossing fibers but for fibers that curve and splay. This technique is repeatedly performed within a residual bootstrap statistical process in order to efficiently quantify the uncertainty in the subvoxel geometries obtained. A robust connectivity index is defined to quantify the confidence in the reconstructed connections. The tractography pipeline is demonstrated in the human brain

The Eyes Have It: Measuring Spatial Orientation in Virtual Worlds to Explain Gender Differences in Real Ones

Here, we explore how 3D, networked virtual worlds - in particular Second Life, which enables users to create and modify their own environments - can act as a kind of \u27virtual\u27 laboratory for studying gender difference. By tracking users\u27 eye movements as they navigate a virtual rendition of the Morris Water Maze (the \u27gold standard\u27 for measuring gender difference in spatial orientation, navigation and mobility), this work constitutes an empirical basis for claims that we have attempted to make in the context of ethnographic work with female and male video game players, both novice and expert: that mastery of, and the ability to competently navigate through space, both real and virtual, is as much (if not more) learned and acquired, as it inheres in the bodies and brains of differently-sexed subjects

Measuring Transit Signal Recovery in the Kepler Pipeline II: Detection Efficiency as Calculated in One Year of Data

The Kepler planet sample can only be used to reconstruct the underlying planet occurrence rate if the detection efficiency of the Kepler pipeline is known, here we present the results of a second experiment aimed at characterising this detection efficiency. We inject simulated transiting planet signals into the pixel data of ~10,000 targets, spanning one year of observations, and process the pixels as normal. We compare the set of detections made by the pipeline with the expectation from the set of simulated planets, and construct a sensitivity curve of signal recovery as a function of the signal-to-noise of the simulated transit signal train. The sensitivity curve does not meet the hypothetical maximum detection efficiency, however it is not as pessimistic as some of the published estimates of the detection efficiency. For the FGK stars in our sample, the sensitivity curve is well fit by a gamma function with the coefficients a = 4.35 and b = 1.05. We also find that the pipeline algorithms recover the depths and periods of the injected signals with very high fidelity, especially for periods longer than 10 days. We perform a simplified occurrence rate calculation using the measured detection efficiency compared to previous assumptions of the detection efficiency found in the literature to demonstrate the systematic error introduced into the resulting occurrence rates. The discrepancies in the calculated occurrence rates may go some way towards reconciling some of the inconsistencies found in the literature.Comment: 13 pages, 7 figures, 1 electronic table, accepted by Ap

Prevalence and Correlates of Diagnosed and Undiagnosed Hypertension in the Indigenous Kuna Population of Panamá

Background: To determine the prevalence of hypertension and investigate sociodemographic correlates in an indigenous Kuna community living on the San Blas islands of Panama. Methods: Data was collected from adults using a paper-based survey using a cross sectional study design. Blood pressure was measured, and hypertension defined at two cut-points: 130/80 mmHg and 140/90 mmHg. Individuals with undiagnosed hypertension had a blood pressure measurement that indicated hypertension, however, the individual had not been told by a doctor they had hypertension. Whereas individuals with diagnosed hypertension had been told by a healthcare provider that they had hypertension. Univariate tests compared diagnosed and undiagnosed hypertension by sociodemographic categories and logistic regression models tested individual correlates adjusting for all sociodemographic factors. Results: Two hundred and eleven adult indigenous Kuna participated in the study. Overall prevalence of hypertension was 6.2% (95%CI:3.32–10.30) as defined by 140/90 mmHg, and 16.6% (95%CI:11.83–22.31) as defined by 130/80 mmHg. Hypertension was significantly higher in men (31.6, 95% CI:19.90–45.24, compared to 11.0, 95% CI:6.56–17.09). Individuals with low income were 3 times more likely to be hypertensive (OR = 3.13, 95% CI:1.02–9.60) and 3.5 times more likely to have undiagnosed hypertension (OR = 3.42, 95% CI:1.01–11.52); while those with moderate income were 6 times more likely to be hypertensive (OR = 7.37, 95% CI:1.76–30.90) compared to those who were poor. Conclusion: The prevalence of diagnosed and undiagnosed hypertension is higher in men and those with higher income. Investigating these factors remains vitally important in helping improve the health of the Kuna through targeted interventions to address chronic disease