Short Courses: Flexible Learning Opportunities in Informatics

In today’s fast-paced, data-driven world, researchers need to have a good foundation in informatics to store, organize, process, and analyze growing amounts of data. However, not all degree programs offer such training. Obtaining training in informatics on your own can be a daunting task for both new and established researchers who have little informatics experience. Providing educational opportunities appropriate for various skill levels and that mesh with a full-time schedule can remove barriers and foster a collaborative, informatics-savvy community that is better equipped to push science forward. To enhance informatics education in bioinformatics, VCUs Wright Center for Clinical and Translational Research of- fers a complementary series of seminars and workshops. These short course offerings introduce attendees to bioinformatics concepts and applications, and provide hands-on experience using online Bioinformatics databases. Bioinformatics 101 (B101) is an 8-week long series of 1-hour seminars focused on introducing topics in bioinformatics related to Next Generation Sequencing (NGS). Lectures are application focused and include overviews of NGS technology, practical bioinformatics pipelines, and examples of how the technology can influence downstream bioinformatics analyses. Bioinformatics 102 (B102) is a 5-day, 2 hours per day workshop developed in collaboration with VCU Libraries that provides attendees with hands-on experience accessing and using public data repositories. Sessions include a brief lecture followed by hands-on exercises. A Certificate of Completion is awarded upon meeting certain criteria for either the 101 or 102 courses. Bioinformatics 101 has been offered 3 times with a combined total of 246 registrants, and Bioinformatics 102 has been offered twice with a total of 78 registrants (limited to 30 per session per day). From course surveys, 82% (n=108) and 95% (n=47) of respondents gave B101 and B102 a positive rating, respectively. In addition, 89% of B101 respondents indicated their knowledge was improved, with 100% of B102 respondents indicating the same. A total of 84 and 33 certificates have been awarded for B101 and B102, respectively. The Bioinformatics 101 and 102 courses have become highly anticipated across the university, and have gained the external attention of surrounding businesses and colleges. Registrants have diverse backgrounds including biological, clinical, computational, administrative, librarian, business, and others with a total of 77 departments across VCU and VCU Health represented. Due to this interest, Bioinformatics 101 began offering live online attendance to accommodate those who were unable to travel across campus, or who are attending from outside VCU. This past year, 50% of attendance was online indicating a growing need for flexible education opportunities in informatics. Increasing researcher knowledge of Bioinformatics along with awareness of university resources for informatics support fosters an informatics-savvy research community that is empowered to take advantage of existing and new data sources in the pursuit of new insights and scientific discoveries for the betterment of human health. Future work will include the development of a more comprehensive educational framework by creating new and flexible learning opportunities that will make informatics education easy and convenient for our dedicated researchers

Medicare Payment Reform: Aligning Incentives for Better Care

The Affordable Care Act (ACA) has provided the Medicare program with an array of tools to improve the quality of care that beneficiaries receive and to increase the efficiency with which that care is provided. Notably, the ACA has created the Center for Medicare and Medicaid Innovation, which is developing and testing promising new models to improve the quality of care provided to Medicare beneficiaries while reducing spending. These new models are part of an effort by the U.S. Department of Health and Human Services to increase the proportion of traditional Medicare payments tied to quality or value to 85 percent by 2016 and 90 percent by 2018. This issue brief, one in a series on Medicare's past, present, and future, explores the evolution of Medicare payment policy, the potential of value-based payment to improve care for beneficiaries and achieve savings, and strategies for accelerating its adoption

Oral Health Disparities and Unmet Dental Needs among Preschool Children in Chelsea, MA: Exploring Mechanisms, Defining Solutions

Background: Significant disparities exist in children’s receipt of preventive dental care (PDC) in the United States. Many of the children at greatest risk of dental disease do not receive timely PDC; when they do receive dental care, it is often more for relief of dental pain. Chelsea is a low-income, diverse Massachusetts community with high rates of untreated childhood caries. There are various dental resources available in Chelsea, yet many children do not access dental care at levels equivalent to their needs. Objective: Using Chelsea as a case-study, to explore factors contributing to forgone PDC (including the age 1 dental visit) in an in-depth way. Methods: We used a qualitative study design that included semi-structured interviews with parents of preschool children residing in Chelsea, and Chelsea-based providers including pediatricians, dentists, a dental hygienist and early childhood care providers. We examined: a) parents’ dental attitudes and oral health cultural beliefs; b) parents’ and providers’ perspectives on facilitators and barriers to PDC, reasons for unmet needs, and proposed solutions to address the problem. We recorded, transcribed and independently coded all interviews. Using rigorous, iterative qualitative data analyses procedures, we identified emergent themes. Results: Factors perceived to facilitate receipt of PDC included Head-Start oral health policies, strong pediatric primary care/dental linkages, community outreach and advertising, and parents’ own oral health experiences. Most parents and providers perceived there to be an adequate number of accessible dental services and resources in Chelsea, including for Medicaid enrollees. However, several barriers impeded children from receiving timely PDC, the most frequently cited being insurance related problems for children and adults. Other barriers included limited dental services for children <2 years, perceived poor quality of some dental practices, lack of emphasis on prevention-based dental care, poor care-coordination, and insufficient culturally-appropriate care. Important family-level barriers included parental oral health literacy, cultural factors, limited English proficiency and competing priorities. Several solutions were proposed to address identified barriers. Conclusion: Even in a community with a considerable number of dental resources, various factors may preclude access to these services by preschool-aged children. Opportunities exist to address modifiable factors through strategic oral health policies, community outreach and improved care coordination between physicians, dentists and early childhood care providers

Relationship between continuity of care and adverse outcomes varies by number of chronic conditions among older adults with diabetes

Background: Continuity of care is a basic tenant of primary care practice. However, the evidence on the importance of continuity of care for older adults with complex conditions is mixed. Objective: To assess the relationship between measurement of continuity of care, number of chronic conditions, and health outcomes. Design: We analyzed data from a cohort of 1,600 US older adults with diabetes and ≥1 other chronic condition in a private Medicare health plan from July 2010 to December 2011. Multivariate regression models were used to examine the association of baseline continuity (the first 6 months) and the composite outcome of any emergency room use or inpatient hospitalization occurring in the following 12-month period. Results: After adjusting for baseline covariates, high known provider continuity (KPC) was associated with an 84% (adjusted odds ratio 0.16; 95% confidence interval 0.09–0.26) reduction in the risk of the composite outcome. High KPC was significantly associated with a lower risk of the composite outcome among individuals with ≥6 conditions. However, the usual provider of care and continuity of care indices were not significantly related with the composite outcome in the overall sample or in those with ≥6 conditions. Conclusion: The relationship between continuity of care and adverse outcomes depends on the measure of continuity of care employed. High morbidity patients are more likely to benefit from continuity of care interventions as measured by the KPC, which measures the proportion of a patient’s visits that are with the same providers over time. Journal of Comorbidity 2016;6(2):65–7

Spying and Surveillance in Shakespeare’s Dramatic Courts

This thesis examines representations of spying and surveillance in Shakespearean drama in conjunction with historical practices of espionage in later sixteenth-century England. The introductory chapter outlines how spying operations were conducted in Elizabethan England, with specific attention to the complex attitudes and behaviour of individual agents working in the broader context of the religious wars, both hot and cold, taking place between Protestant England and the Catholic powers of continental Europe. It also provides some analysis of the organisational structures within which those agents worked and examines a wide range of particular cases to illustrate how surveillance operations might play out in practice. The memory of Sir Francis Walsingham, often described as the ‘spymaster’ of Elizabeth’s government and noted for his skill in intelligence work, would have loomed large for any dramatist thinking about espionage at the turn of the seventeenth century. Subsequent chapters each examine a specific play in light of the material presented in the introduction, comprising Much Ado About Nothing, The Tempest, Measure for Measure, Henry V and Hamlet. Each chapter seeks to elucidate how Shakespeare draws upon the world of Elizabethan espionage to provide vital structural components in his dramatic plotting, especially as regards inter-personal relationships between courtiers, secretaries and agents on the ground. Real individuals and the spies depicted in Shakespeare’s plays all behave in a manner that is personally inflected to a profound degree, and it is this particular aspect of early-modern espionage that provides the single most important connection between history and drama. Periodically, this thesis also reflects upon the metatheatrical relationship between characters’ schemes and Shakespeare’s own plotting as a dramatist

6-OHDA generated ROS induces DNA damage and p53- and PUMA-dependent cell death

<p>Abstract</p> <p>Background</p> <p>Parkinson's disease (PD) is characterized by the selective loss of dopaminergic neurons in the substantia nigra (SN), resulting in tremor, rigidity, and bradykinesia. Although the etiology is unknown, insight into the disease process comes from the dopamine (DA) derivative, 6-hydroxydopamine (6-OHDA), which produces PD-like symptoms. Studies show that 6-OHDA activates stress pathways, such as the unfolded protein response (UPR), triggers mitochondrial release of cytochrome-c, and activates caspases, such as caspase-3. Because the BH3-only protein, Puma (p53-upregulated mediator of apoptosis), is activated in response to UPR, it is thought to be a link between cell stress and apoptosis.</p> <p>Results</p> <p>To test the hypothesis that Puma serves such a role in 6-OHDA-mediated cell death, we compared the response of dopaminergic neurons from wild-type and <it>Puma</it>-null mice to 6-OHDA. Results indicate that Puma is required for 6-OHDA-induced cell death, in primary dissociated midbrain cultures as well as <it>in vivo</it>. In these cultures, 6-OHDA-induced DNA damage and p53 were required for 6-OHDA-induced cell death. In contrast, while 6-OHDA led to upregulation of UPR markers, loss of ATF3 did not protect against 6-OHDA.</p> <p>Conclusions</p> <p>Together, our results indicate that 6-OHDA-induced upregulation of <it>Puma </it>and cell death are independent of UPR. Instead, p53 and DNA damage repair pathways mediate 6-OHDA-induced toxicity.</p

Nursing manpower: recent trends and policy operations

The total number of nursing and midwifery staff rose by 17 per cent from 1976 to 1982. The aim of this paper is to provide a detailed analysis of what this substantial investment actually meant in terms of grades, types of hospital and region. Total numbers in the general hospitals rose by 24 per cent compared to 97 per cent in the geriatric hospitals, 12 per cent in mental illness hospitals and 28 per cent in mental handicap hospitals. There were very significant changes in the balance of grades. Within the general hospitals total hours available from registered nurses rose by 11.4 per cent. This averaged out from a fall of 2.8 per cent in Sisters hours and a rise of 34.6 per cent in Staff Nurse hours. Hours from Enrolled nurses rose significantly and those from student and pupil nurses fell whilst hours from nursing auxiliaries rose by 70.6 per cent. The balance of decision implies that registered nurses were becoming, on average, less experienced. The paper a1so examines changes in RAWP-1osing and RAWP-gaining regions. RAWP-losing regions in general economized on untrained staff in order to recruit more qualified staff. In general the extra nurses went as much into long-stay care and into the community as into general hospitals and the more technological areas. Local managers' decisions seemed to reflect a different approach from that adopted by some of the leaders of the profession. Local managers have continued to recruit enrolled nurses and nursing auxiliaries, even in the general hospitals. This paper concludes with a discussion of policy options at a time when nursing faces an unprecedented reality of nil growth in manpower. In broad terms there are only 2 million hours a week of registered nurse time available for the whole of general nursing. The manpower context is one in which there will be little increase in nursing time: the probability of particular shortages in general nursing; a need for more flexibility than in the past as most of the investment in priority care is now in the wrong place, and one in which there are strong disincentives to training. The authors suggest that there should be more attention to methods of increasing the skill level of the existing work-force through in-service training: there could be more personal career and retraining plans in areas such as psychiatric care which are subject to rapid change. There should also be a new approach to rationing out available resources at the local level. Districts need to examine how the existing resource is being used and weigh up competing claims in terms of their effect on services. The authors estimate that shortagee of particular types of nursing manpower are likely to be an increasingly serious constraint on changes in patterns of care.