Cognitive requirements for primary care providers during the referral process: Information needed from and interactions with an electronic health record system

Objectives This study sought to identify and describe the cognitive requirements and associated information needs of referring primary care providers (PCPs) during the referral process as well as characterize referring PCPs’ experiences with current health information technology. Materials and methods We interviewed 62 referring PCPs. Our four-member analysis team used hierarchical task analysis to construct a goal-directed hierarchy. We utilized extensions of the task analysis to describe PCPs’ common experiences with health information technologies throughout the referral process. Results The resultant goal hierarchy includes one main goal (Referral for Additional Care), two sub-goals (Assess Patient’s Condition and Manage Referrals), and four major tasks with respective decisions (What consultation is warranted; What information should I provide; What additional action is needed; and How to integrate specialists’ findings). Approximately 22 information needs were commonly identified and PCPs described their use of various sources - other PCPs, electronic health records, chat software, and paper- to satisfy those information needs. Conclusion Cognitive demand for referring PCPs is high throughout the referral process. They have to search, identify, compose, track, and integrate information across multiple screens, systems, and people. Existing interfaces do not adequately support the communication, information exchange, or care coordination related to the referral process. Results from this study provide an important foundation for developing patient-centered displays that support PCPs’ decision-making process and reduce cognitive challenges

Apples and Oranges: Comparing the Backgrounds and Academic Trajectories of International Baccalaureate (IB) Students to a Matched Comparison Group

This report presents findings from a retrospective study of the academic histories of International Baccalaureate (IB) students and other students in the state of Florida. The IB Diploma Program is an internationally recognized college-preparatory curriculum designed to provide students with a rigorous and comprehensive academic experience. IB has grown dramatically in recent years and is thought by many to be among the best college-preparatory programs in existence. As such, there is tremendous interest in the potential impacts of IB, but any attempts to examine those impacts must deal with selection bias that results from the voluntary participation of schools and students. Failure to do so makes it impossible to determine whether the performance of participating students was actually influenced by IB, or whether the outcomes for these students would have been just as good without IB. As a critical step in understanding the impacts of IB, the analyses presented in this report examined the selection mechanisms behind IB participation across Florida, the state with the second highest representation of IB programs in the nation. We use longitudinal student and school-level data from 1995 through 2009 from the Florida K-20 Education Data Warehouse (EDW) to characterize individual students’ educational histories from elementary school through high school and into college. To address issues of selection bias, we use propensity score methods (Rosenbaum & Rubin, 1983) to adjust for preexisting differences between IB and non-IB students

Nursing with Eating, Activity, and Supportive Environment (EASE) : Effects of an Eight-week Mentoring Program

Each year, approximately 2.8 million adults die from complications related to obesity (World Health Organization, 2011). One in three adults aged 20 years or older is obese, and 6% are morbidly obese. This problem is increasing at an alarming rate in young adults, and 20.5% of college students are classified as being overweight based upon their body mass index (BMI) (Adderley-Kelly, 2007). The purpose of this study was to increase knowledge about evidence-based, effective interventions that will enable college-aged, pre-nursing students to attain physical and mental well-being. The participants (N=24) were freshman and sophomore pre-nursing majors who were randomized into two groups (control and intervention). The intervention group met once a week for an eight-week nutrition and physical activity mentoring program at Texas Woman’s University. The participants were educated about proper diet and exercise recommendations and kept physical activity, nutrition, and stress management logs. Measured outcomes, mean changes and standard deviations over the eight week period included body weight (-0.3 kg + 1.7), BMI (-0.12 kg/m2 + 0.68), waist circumference (-2.5 cm + 1.9), and perceived stress scale (0.0 + 3.6). One-way ANOVAs with a p value of 0.05 were used for statistical analysis. There were no significant differences in weight, BMI, waist circumference or stress between the groups. Body composition and mental stress are difficult to change in an eight-week mentoring program, although improved knowledge may set the stage for future behavior change. A longer term program may need to be used to observe changes in weight, BMI, waist circumference, and stress

Miniaturized data loggers and computer programming improve seabird risk and damage assessments for marine oil spills in Atlantic Canada

Obtaining useful information on marine birds that can aid in oil spill (and other hydrocarbon release) risk and damage assessments in offshore environments is challenging. Technological innovations in miniaturization have allowed archival data loggers to be deployed successfully on marine birds vulnerable to hydrocarbons on water. A number of species, including murres (both Common, Uria aalge, and Thick-billed, U. lomvia) have been tracked using geolocation devices in eastern Canada, increasing our knowledge of the seasonality and colony-specific nature of their susceptibility to oil on water in offshore hydrocarbon production areas and major shipping lanes. Archival data tags are starting to resolve questions around behaviour of vulnerable seabirds at small spatial scales relevant to oil spill impact modelling, specifically to determine the duration and frequency at which birds fly at sea. Advances in data capture methods using voice activated software have eased the burden on seabird observers who are collecting increasingly more detailed information on seabirds during ship-board and aerial transects. Computer programs that integrate seabird density and bird behaviour have been constructed, all with a goal of creating more credible seabird oil spill risk and damage assessments. In this paper, we discuss how each of these technological and computing innovations can help define critical inputs into seabird risk and damage assessments, and when combined, can provide a more realistic understanding of the impacts to seabirds from any hydrocarbon release

THE DESIGN AND IMPLEMENTATION OF AN INTERVENTION TO SUPPORT AND RETAIN EARLY CAREER MATHEMATICS TEACHERS

This study reports on efforts over several years to design and implement a yearlong intervention intended to support secondary mathematics teachers in their early years of teaching. The intervention is designed to support these teachers’ development of meaningful professional relationships with a school-based mentor and to create an online community of practice for support with other professionals. The intervention itself consists of early career teachers and their mentors participating in monthly professional development sessions such as online meetings, Zoom panels with experts, and collaboratively reading and discussing timely, purposeful, and relevant content. The intervention is designed to not over burden the participants and to be feasible for national implementation with little funding. The goal of the intervention is to try to retain secondary mathematics teachers in the profession by providing them with meaningful and targeted support Half of all teachers leave the profession within the first five years, and this rate is highest for mathematics positions in high poverty schools (Fantilli & McDougall, 2009; Goldring et al., 2014). Furthermore, half of all current teachers in the U.S. retiring in the next five years (Foster, 2010), enrollment in teacher preparation programs declining, and teacher turnover is costing America $7.3 billion annually (National Math + Science Initiative, 2013), which represents a crisis for public education in the U.S. These conditions lead to classrooms staffed with underprepared/unqualified teachers, which profoundly affects the mathematical preparation of students in high school, college, and beyond. Experts agree that addressing the mathematics-teaching crisis meaningfully will require building a more cohesive system of teacher preparation, support, and development (Mehta, TheisenHomer, Braslow, & Lopatin 2015). The purpose of this study is to report on the design and implementation of a cost effective, easily replicable intervention for early career secondary mathematics teachers with the goal of positively impacting teacher retention. We also present lessons learned over two years of implementing the intervention and provide suggestions for future research

Fiction Fix 03

https://digitalcommons.unf.edu/fiction_fix/1012/thumbnail.jp

A computational exploration of resilience and evolvability of protein–protein interaction networks

Protein–protein interaction (PPI) networks represent complex intra-cellular protein interactions, and the presence or absence of such interactions can lead to biological changes in an organism. Recent network-based approaches have shown that a phenotype’s PPI network’s resilience to environmental perturbations is related to its placement in the tree of life; though we still do not know how or why certain intra-cellular factors can bring about this resilience. Here, we explore the influence of gene expression and network properties on PPI networks’ resilience. We use publicly available data of PPIs for E. coli, S. cerevisiae, and H. sapiens, where we compute changes in network resilience as new nodes (proteins) are added to the networks under three node addition mechanisms—random, degree-based, and gene-expression-based attachments. By calculating the resilience of the resulting networks, we estimate the effectiveness of these node addition mechanisms. We demonstrate that adding nodes with gene-expression-based preferential attachment (as opposed to random or degree-based) preserves and can increase the original resilience of PPI network in all three species, regardless of gene expression distribution or network structure. These findings introduce a general notion of prospective resilience, which highlights the key role of network structures in understanding the evolvability of phenotypic traits

Evolution of structural diversity of trichothecenes, a family of toxins produced by plant pathogenic and entomopathogenic fungi

[EN] Trichothecenes are a family of terpenoid toxins produced by multiple genera of fungi, including plant and insect pathogens. Some trichothecenes produced by the fungus Fusarium are among the mycotoxins of greatest concern to food and feed safety because of their toxicity and frequent occurrence in cereal crops, and trichothecene production contributes to pathogenesis of some Fusarium species on plants. Collectively, fungi produce over 150 trichothecene analogs: i.e., molecules that share the same core structure but differ in patterns of substituents attached to the core structure. Here, we carried out genomic, phylogenetic, gene-function, and analytical chemistry studies of strains from nine fungal genera to identify genetic variation responsible for trichothecene structural diversity and to gain insight into evolutionary processes that have contributed to the variation. The results indicate that structural diversity has resulted from gain, loss, and functional changes of trichothecene biosynthetic (TRI) genes. The results also indicate that the presence of some substituents has arisen independently in different fungi by gain of different genes with the same function. Variation in TRI gene duplication and number of TRI loci was also observed among the fungi examined, but there was no evidence that such genetic differences have contributed to trichothecene structural variation. We also inferred ancestral states of the TRI cluster and trichothecene biosynthetic pathway, and proposed scenarios for changes in trichothecene structures during divergence of TRI cluster homologs. Together, our findings provide insight into evolutionary processes responsible for structural diversification of toxins produced by pathogenic fungiSISG received funding from the Spanish Ministry of Economy and Competitiveness (grant number MINECO-AGL2015-70671-C2-2-R). TL received funding from the National Institute of Agricultural Sciences, Rural Development Administration (grant number PJ00843203). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscrip

Database Evaluation for Muscle and Nerve Diseases - DEMAND: An academic neuromuscular coding system

Background: A database which documents the diagnosis of neuromuscular patients is useful for determining the types of patients referred to academic centers and for identifying participants for clinical trials and other studies. The ICD-9 or ICD-10 numeric systems are insufficiently detailed for this purpose. Objective: To develop a database for neuromuscular diagnoses Methods: We developed a detailed diagnostic coding system for neuromuscular diseases called DEMAND: Database Evaluation for Muscle and Nerve Diseases that has been adopted by neuromuscular clinics at University of Texas Health Science Center San Antonio (UTHSCSA), Ohio State University (OSU), University of Kansas Medical Center (KUMC), and University of Texas Southwestern (UTSW). At the initial visit, patients are assigned a diagnostic code which can be revised later if appropriate. Fields include patient’s name, date of birth, and diagnostic code. The neuromuscular database consisted of 457 codes. Each code has a prefix (MUS or PNS) followed by a three-digit number. Depending on whether muscle or nerve is primarily involved, there are eight broad groups: motor neuron disease (MUS codes 100-139); neuromuscular junction disorders (MUS 200-217); acquired and hereditary myopathies (MUS 300-600s); acquired and hereditary polyneuropathies (PNS 100-400); mononeuropathies (PNS 500s); plexopathies (PNS 600s); radiculopathies (PNS 700s); and mononeuritis multiplex (PNS 800s). Results: During a period of 10 years, 17,163 of patients were entered (1,752 at UTHSCSA, 1,840 at OSU, 3,699 at KUMC, 9,872 at UTSW). The number of patients in several broad categories are: 3,080 motor neuron disease; 1,575 neuromuscular junction disease; 1,851 muscular dystrophies; 633 inflammatory myopathies; 1,090 hereditary neuropathies; 1,001 immune-mediated polyneuropathies; 620 metabolic/toxic polyneuropathies; 535 mononeuropathies; 296 plexopathies; and 769 radiculopathies. Conclusion: A detailed diagnostic neuromuscular database can be utilized at multiple academic centers. The database should be simple without too many fields to complete, to ensure compliance during busy clinic operations. This database has been very useful in identifying groups of patients for retrospective, observational studies and for prospective treatment studies including trials for Amyotrophic Lateral Sclerosis (ALS), Muscular Dystrophies (MD), Myasthenia Gravis (MG), and retrospective studies of Primary Lateral Sclerosis (PLS), chronic inflammatory demyelinating neuropathy (CIDP), etc