Increasing Quality of Life: Providing Education and Resources for Parents of Children with Autism Spectrum Disorder

This 14-week capstone project aimed to develop and implement meaningful modifications to an early intensive behavioral intervention center from an occupational therapy (OT) perspective. An evidence-based evaluation of the existing program was conducted, and it was identified that parents of children 18 months to 6 years old with autism lacked the awareness of available resources to support their overall quality of life. A new process was developed and implemented for parents to get connected with resources that met their current needs, resulting in a total of 18 different categories of resources. Parents also received education regarding caregiver burnout and developmental milestones in the form of newsletters and blog posts. The program resulted in decreased depression and anxiety, improved satisfaction with life, improved felt control, and improved sense of involvement and support from the community for parents. Board certified behavior analysts (BCBAs) received training on parent resources and education for sustainability. BCBAs also received education on OT’s scope of practice to increase future collaborations. Results showed that the program improved BCBAs confidence levels and satisfaction levels regarding the available resources for parents. Overall, this capstone project helped spread awareness on how OT can benefit parents of children with autism and BCBAs

A Palynological Analysis of Seymour Island and King George Island off the Antarctic Peninsula: A Dating and Climatic Reconstruction

During the Cretaceous and early Paleocene, Antarctica was covered by lush vegetation. However, Antarctica today is covered with ice and snow leaving less than 1% of the continent inhabited by vegetation. By studying this decline in vegetation and reconstructing past environments, we can gain a better understanding of environmental changes and use this knowledge to predict future changes. In this thesis, I present my results and interpretations of palynological changes across the Antarctic Peninsula during the Late Eocene, Middle Oligocene, and Miocene. The first study discusses a paleoenvironmental reconstruction of the upper La Meseta formation (Late Eocene), Seymour Island, and Polonez Cove formation (Middle Oligocene), King George Island. My results indicate a relatively decent abundance of in situ podocarp conifers and southern beech Nothofagidites (brassii, fusca, and menziesii gp.) palynomorphs present within the lower section of the studied La Meseta Formation. This implies the area was relatively free of ice and sparsely inhabited with a temperate-like forest in the Late Eocene. Progressing up section, the presence of sea-ice indicative acritarchs called Leiosphaeridia spp. and the dominance of cool-loving Nothofagidites sp. (fusca gp.) indicate a climate cooling as the region became more glaciated. Evidence of this cooling is more apparent based on the majority of palynomorphs which appear broken and the samples being dominated with Leiosphaeridia spp. in the upper most studied section of La Meseta formation and through the entire section of the Polonez Cove formation. Lastly, my second study discusses a palynological interpretation of Miocene samples collected from the Cape Melville formation on King George Island. The samples revealed a near-shore depositional environment dominated by sea-ice as indicated from the abundance of leiospheres. These samples are also dominated by various reworked palynomorphs of Permian to Paleogene age, mixed with rare in situ Miocene specimens. This study provides new insight into the provenance of the reworked assemblage and give new information on probable glacial advances

Modeling the cost–benefit of nerve conduction studies in pre-employment screening for carpal tunnel syndrome

OBJECTIVES: To evaluate the costs associated with pre-employment nerve conduction testing as a screening tool for carpal tunnel syndrome (CTS) in the workplace. METHODS: We used a Markov decision analysis model to compare the costs associated with a strategy of screening all prospective employees for CTS and not hiring those with abnormal nerve conduction, versus a strategy of no screening for CTS. The variables included in our model included employee turnover rate, the incidence of CTS, the prevalence of median nerve conduction abnormalities, the relative risk of developing CTS conferred by abnormal NCS, the costs of pre-employment screening, and the workers' compensation costs to the employer for a case of CTS. RESULTS: In our base case, total employer costs for CTS from the perspective of the employer (cost of screening plus costs for workers' compensation associated with CTS) were higher when screening was used. Median costs per employee position over five years were $503 for the screening strategy vs.$200 for a strategy of no screening. Sensitivity analysis showed that a strategy of screening was cost-beneficial from the perspective of the employer only under a few circumstances. In Monte Carlo simulation varying all parameters, we found a 30% probability that screening would be cost-beneficial. CONCLUSIONS: A strategy of pre-employment screening for CTS should be carefully evaluated for yield and social consequences before being implemented. Our model suggests such screening is not appropriate for most employers

Investigation and Analysis of Online Reading Strategies

This study represents a two-part, sequential order mixed-methods project which identified and comparatively analyzed the reading strategies of high school seniors. In order to determine the use of online reading strategies, students were surveyed regarding their use of online reading strategies, print reading strategies, and internet use habits. Standardized reading comprehension scores were also used in the analysis. It was hypothesized that readers who were highly strategic when reading print texts would also be highly strategic when reading online texts and that students who spent more time per week online and who scored higher on measures of reading comprehension would be more strategic and utilize more strategies while reading online texts. A subset of students was selected to participate in think-aloud protocols, giving voice to both strategy and thought as they navigated and read online texts. These verbal reports were qualitatively analyzed and compared to the framework of 'during reading' strategiesSchool of Teaching and Curriculum Leadershi

Demonstration of an online tool to assist managed care formulary evidence-based decision making: meta-analysis of topical prostaglandin analog efficacy

BACKGROUND: The purpose of this paper was to demonstrate the use of an online service for conducting a systematic review and meta-analysis of the efficacy of topical prostaglandin analogs in reducing intraocular pressure (IOP) in glaucoma and ocular hypertension. METHODS: An online service provider (Doctor Evidence) reviewed and extracted data from the peer-reviewed literature through September 2009. Randomized controlled studies of at least three months’ duration assessing at least two prostaglandin analogs in patients with primary open-angle glaucoma, ocular hypertension, or normal-tension glaucoma were included. The primary endpoint was mean IOP. Summary estimates were created using random-effects models. The Q Chi-square test was used to assess statistical heterogeneity. RESULTS: Sixteen studies satisfied the inclusion criteria and were analyzed. On average, greater IOP-lowering was seen with bimatoprost relative to latanoprost (1 mmHg, P = 0.025) and travoprost (0.8 mmHg, P = 0.033) based on mean IOP after 12–26 weeks of treatment. No statistical difference was observed in IOP-lowering between latanoprost and travoprost (P = 0.841). Findings were similar to previously published meta-analyses of topical prostaglandin analogs. CONCLUSION: Systematic reviews relying on meta-analytic techniques to create summary statistics are considered to be the “gold standard” for synthesizing evidence to support clinical decision-making. However, the process is time-consuming, labor-intensive, and outside the capability of most formulary managers. We have demonstrated the effectiveness of a commercial service that facilitates the process of conducting such reviews

Apples and oranges? Assessing the relationship between health and vision related quality of life.

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78091/1/perron_abstract.pd

Effect of Corneal Cross-Linking vs standard care on Keratoconus Progression in Young Patients: the Keralink Randomized controlled trial

Supported by the National Institute for Health Research (NIHR ) Efficacy and Mechanism Evaluation Programme (grant no.: 14/23/18), a Medical Research Council and NIHR partnership. It was coordinated by University College London’s Comprehensive Clinical Trials Unit and sponsored by University College London. The trial otherwise was supported in part by the NIHR Moorfields Biomedical Research Centre and NIHR Moorfields Clinical Research Facility (grant no.: CRF-2016-10030).Purpose To examine the efficacy and safety of corneal cross-linking (CXL) for stabilization of progressive keratoconus.DesignObserver-masked, randomized, controlled, parallel-group superiority trial. Participants Sixty participants 10 to 16 years of age with progressive keratoconus, one eye of each deemed the study eye. Methods The study eye was randomized to either CXL plus standard care or standard care alone, with spectacle or contact lens correction as necessary for vision. Main Outcome Measures The primary outcome was steep keratometry (K2) in the study eye as a measure of the steepness of the cornea at 18 months. Secondary outcomes included keratoconus progression defined as a 1.5-diopter (D) increase in K2, visual acuity, keratoconus apex corneal thickness, and quality of life. Results Of 60 participants, 30 were randomized to CXL and standard care groups. Of these, 30 patients in the CXL group and 28 patients in the standard care group were analyzed. Mean K2 in the study eye 18 months after randomization was 49.7 D (standard deviation [SD], 3.8 D) in the CXL group and 53.4 D (SD, 5.8 D) in the standard care group. The adjusted mean difference in K2 in the study eye was –3.0 D (95% confidence interval [CI], –4.9 to –1.1 D; P = 0.002), favoring CXL. Adjusted differences between groups in uncorrected and corrected vision favored eyes receiving CXL: –0.31 logarithm of the minimum angle of resolution (logMAR; 95% CI, –0.50 to –0.11 logMAR; P = 0.002) and –0.51 logMAR (95% CI, –1.37 to 0.35 logMAR; P = 0.002). Keratoconus progression in the study eye occurred in 2 patients (7%) randomized to CXL compared with 12 patients (43%) randomized to standard care. The unadjusted odds ratio suggests that on average, patients in the CXL arm had 90% (odds ratio, 0.1; 95% CI, 0.02–0.48; P = 0.004) lower odds of experiencing progression compared with those receiving standard care. Conclusions CXL arrests progression of keratoconus in the majority of young patients. CXL should be considered as a first-line treatment in progressive disease. If the arrest of keratoconus progression induced by CXL is sustained in longer follow-up, particular benefit may be derived from avoiding a later requirement for contact lens wear or corneal transplantation.Publisher PDFPeer reviewe

Quantitative OCT-based corneal topography in keratoconus with intracorneal ring segments

Custom high-resolution high-speed anterior segment spectral domain Optical Coherence Tomography (OCT) was used to characterize three-dimensionally (3-D) corneal topography in keratoconus before and after implantation of intracorneal ring segments (ICRS). Previously described acquisition protocols were followed to minimize the impact of the motions of the eye. The collected set of images was corrected from distortions: fan (scanning) and optical (refraction). Custom algorithms were developed for automatic detection and classification of volumes in the anterior segment of the eye, in particular for the detection and classification of the implanted ICRS. Surfaces were automatically detected for quantitative analysis of the corneal elevation maps (fitted by biconicoids and Zernike polynomials) and pachymetry. Automatic tools were developed for the estimation of the 3-D positioning of the ICRS. The pupil center reference was estimated from the segmented iris volume. The developed algorithms are illustrated in a keratoconic eye (grade III) pre- and 30 days post-operatively after implantation of two triangular-section, 0.3-mm thick Ferrara ring segments. Quantitative corneal topographies reveal that the ICRS produced a flattening of the anterior surface, a steepening of the posterior surface, meridional differences in the changes in curvature and asphericity, and increased symmetry of the anterior topography. Optical distortion correction through the ICRS (of a different refractive index from the cornea) allowed accurate pachymetric estimates, which showed increased thickness in the ectatic area as well as in peripheral corneal areas. Automatic tools allowed estimation of the depth of the implanted ICRS ring, as well as its rotation with respect to the pupil plane. Anterior segment sOCT provided with fan and optical distortion correction and analysis tools is an excellent instrument for evaluating and monitoring keratoconic eyes and for the quantification of the changes produced by ICRS treatment