A Descriptive Correlational Study of Rate and Determinants of Parental mHealth Adherence to Symptom Home Monitoring for Infants with Congenital Heart Disease during the Single Ventricle Interstage Period: The DOMAIN Study

Title from PDF of title page viewed June 9, 2020Dissertation advisor: Cynthia L. RussellVitaIncludes bibliographical references (pages 166-188)Thesis (Ph.D.)--School of Nursing and Health Studies. University of Missouri--Kansas City, 2020Single ventricle heart disease care in the ambulatory setting affects approximately 4,000 infants in the United States annually. Treatment typically involves a three-staged surgical strategy over the first three years of life with parental home monitoring of the infant during the interstage period, which is the time between the first two surgeries. Symptom home monitoring during the interstage period increasingly requires technology to maximize patient outcomes. Mobile health, or mHealth, transfers infant hemodynamic monitoring data captured by parents from the home to designated registered nurse coordinators who monitor the data remotely. Parental mHealth symptom home monitoring adherence is critical to improve morbidity and reduce mortality in infants during this high-risk period. However, rates and determinants of mHealth adherence have yet to be studied. The purpose of this research was to quantify the rate of parental mHealth adherence and to describe the relationship between patient-related, family-related, community-related, and healthcare system-related determinants of parental mHealth adherence for infants with congenital heart disease during the single ventricle interstage period. The pediatric self-management conceptual framework was used with a retrospective, descriptive, correlational research design. De-identified data from 312 infants treated at nine pediatric hospitals between March 2014-September 2019 were included from the Cardiac High Acuity Monitoring Program multi-site registry. This registry was developed in 2014 by Children’s Mercy Kansas City and includes patient, family, and medical record data. SPSS AMOS software was used to refine a model to develop a theoretically identified, recursive structural equation model. The rate of parental mHealth adherence-data days was 75.54%. The overall model variance was 24.0%, with good local and global fit. A higher parental age (p<.001) and Medicaid insurance (p=.009) were positively associated with parental mHealth adherence. Higher rates of implementation of oxygen saturation symptom home monitoring were associated with lower clinic visits (p< .001) and increased education levels (p=.001). Adherence to mHealth video use was associated with increased healthcare team driven communications (p=.047). Future research areas proposed from these findings include determining mHealth adherence rates associated with optimized clinical outcomes and ways to reduce parental mHealth non-adherence.Introduction -- Review of literature -- Methodology -- Results -- Discussion -- Appendi

Skunk River Review Fall 2001, vol 13

https://openspace.dmacc.edu/skunkriver/1022/thumbnail.jp

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase&nbsp;1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation&nbsp;disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age&nbsp; 6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score&nbsp; 652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc&nbsp;= 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N&nbsp;= 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in&nbsp;Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in&nbsp;Asia&nbsp;and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

A Monte Carlo approach to modeling lost person behavior in wilderness areas using a geographic information system

Due to the character of the original source materials and the nature of batch digitization, quality control issues may be present in this document. Please report any quality issues you encounter to [email protected], referencing the URI of the item.Includes bibliographical references.Issued also on microfiche from Lange Micrographics.Monte Carlo modeling techniques using mean information fields (MIF), developed by Torsten Hagerstrand in the 1950s, were integrated with a geographic information system (GIS) to simulate lost person behavior in wilderness areas. Big Bend Ranch State Natural Area, a 265,000 acre park acquired by Texas Parks and Wildlife, was used as the study area. A comprehensive GIS data base for the park was developed, including relevant layers of contours, hydrography, vegetation, roads/trails, and other man-made features. Travel behaviors were collected from 1 18 lost person mission reports provided by the National Association of Search and Rescue (NASAR). Two models for travel rate and time mobile were developed from these data using linear regression; the first model providing probabilities for input into the MIF based on four significant variables: age, age,-4, sex, and equipment. Only age was significant in determining the total time mobile for the second model. In a simulation program written in ARC/INFO, these initial probabilities in the MIF were modified according to attributes of the terrain underlying the MIF and according to the lost person's characteristics. Visibility was calculated for each cell in the MIF, and the probabilities of the visible cells were converted to ranges. A random number was generated, and the cell encompassing that random number became the new center of the MIF. Several Monte Carlo simulation runs were conducted, and model behavior was observed by outputting the simulation waypoints and the topographic data on 1:24,000 color maps. The adult lost person profile model migrated an average of 4 kilometers in a predominantly northwest direction from the test point and chose locations which contained drainage features, roads, or gentle slopes. The northwest direction of travel appeared to be partly a result of the southeastern trend of the underlying topography. These choices reflect the lost person behavior data model well, although distance traveled was overestimated and underestimated for minimum and maximum values, respectively. Five simulations for a child profile were performed as a comparison to the adult profile. These simulation runs yielded shorter distances and a preference for gentler slopes

Defining developmentally appropriate practice in the age of academic rigor and high stakes accountability

The purpose of this study was to answer the research question: How do early childhood experts and kindergarten teachers describe Developmentally Appropriate Practice (DAP)? Secondary questions included: How do early childhood experts and kindergarten teachers evaluate sample hybrid lesson plans? How do early childhood experts and kindergarten teachers address the challenges of academic rigor and accountability in DAP? DAP is a philosophy closely associated with early learning. Therefore, the participants in this study included two early childhood experts and two practicing kindergarten teachers. For the purpose of this inquiry, a case study design was employed. This study had three primary data collection methods. The methods were individual interviews, analysis of sample hybrid lesson plans, and a group discussion. After a thorough review of the data it was found that the participants in this study rely heavily on their philosophical knowledge of DAP in order to navigate the current trend of high stakes accountability and academically rigorous curricula. Thus, it is imperative for teacher preparation programs and school district curricula to provide in-depth coursework and professional development surrounding DAP. The data also revealed that the participants of this study reviewed the sample hybrid lesson plans in a favorable manner. The sample hybrid lesson plans were able to support an academically rigorous program while maintaining a level of developmental appropriateness. Hence, the definition of DAP has evolved to meet the changing needs of early learners