Effect of two behavioural 'nudging' interventions on management decisions for low back pain: A randomised vignette-based study in general practitioners

Objective €Nudges' are subtle cognitive cues thought to influence behaviour. We investigated whether embedding nudges in a general practitioner (GP) clinical decision support display can reduce low-value management decisions. Methods Australian GPs completed four clinical vignettes of patients with low back pain. Participants chose from three guideline-concordant and three guideline-discordant (low-value) management options for each vignette, on a computer screen. A 2×2 factorial design randomised participants to two possible nudge interventions: €partition display' nudge (low-value options presented horizontally, high-value options listed vertically) or €default option' nudge (high-value options presented as the default, low-value options presented only after clicking for more). The primary outcome was the proportion of scenarios where practitioners chose at least one of the low-value care options. Results 120 GPs (72% male, 28% female) completed the trial (n=480 vignettes). Participants using a conventional menu display without nudges chose at least one low-value care option in 42% of scenarios. Participants exposed to the default option nudge were 44% less likely to choose at least one low-value care option (OR 0.56, 95%CI 0.37 to 0.85; p=0.006) compared with those not exposed. The partition display nudge had no effect on choice of low-value care (OR 1.08, 95%CI 0.72 to 1.64; p=0.7). There was no interaction between the nudges (OR 0.94, 95% CI 0.41 to 2.15; p=0.89). Interpretation A default option nudge reduced the odds of choosing low-value options for low back pain in clinical vignettes. Embedding high value options as defaults in clinical decision support tools could improve quality of care. More research is needed into how nudges impact clinical decision-making in different contexts

Counting on Collaboration: A Triangular Approach in the Educator Preparation Program for Teachers of Mathematics

This paper outlines the process of establishing a stronger and more reciprocal partnership for collaboration between an education preparation program and a local education agency. The essential partners identified included the College of Natural Sciences and Mathematics and the College of Education at Lee University and stakeholders in the local school district. First, this paper will discuss a theoretical framework that speaks to the importance of dialogue and a dialogic approach to teaching mathematics. Secondly, the processes and methods of the project involving collaboration through partnerships are described. These partnerships gave rise to the realization that coursework would be more effective if it mirrored the instructional practices of local education agencies. A detailed description of the process of changes to the coursework and initial outcomes of the project are outlined. Included are questions and recommendations for further collaboration

Dialogues that Dig Deeper: Surfacing the Multiple Faces of Homelessness in Grand Rapids, MI (Report One)

This Community dialogue was designed to discover what homeless individuals need, in terms of services and assistance, to prevent the perpetuating cycle of homelessness itself. After the discussion, our team hopes service organizations in Grand Rapids will take our findings into consideration in their efforts towards designing and implementing programs around homelessness

A Tale of Four Departments: Interdisciplinary Faculty Learning Communities Informing Mathematics Education

As a result of the Curriculum Foundations Project and the SUMMIT-P consortium, faculty from four different departments at Lee University created a Faculty Learning Community (FLC) with the goal of improving students’ attitudes toward undergraduate mathematics courses, including students’ perception of the utility of mathematics in their lives and the feelings of anxiety that they experience in these courses. The interdisciplinary collaborations resulted in introducing novel activities and manipulatives in various mathematics courses (Introduction to Statistics, Concepts of Mathematics I and II, and Algebra for Calculus). This paper first describes the efforts of creating the inter-departmental FLC. Second, it discusses the interventions that were introduced in the mathematics courses. Finally, it reflects on the lessons learned while participating in the learning community. The goal is to guide and challenge readers to consider how similar collaborative opportunities can be initiated at their own institutions

Conductance-Based Profiling of Nanopores: Accommodating Fabrication Irregularities

Solid-state nanopores are nanoscale channels through otherwise impermeable membranes. Single molecules or particles can be passed through electrolyte-filled nanopores by, e.g. electrophoresis, and then detected through the resulting physical displacement of ions within the nanopore. Nanopore size, shape, and surface chemistry must be carefully controlled, and on extremely challengingwork, confirmed the suitability of the basic conductance equation using the results of a time-dependent experimental conductance measurement during nanopore fabrication by Yanagi et al., and then deliberately relaxed the model constraints to allow for (1) the presence of defects; and (2) the formation of two small pores instead of one larger one. Our simulations demonstrated that the time-dependent conductance formalism supports the detection and characterization of defects, as well as the determination of pore number, but with implementation performance depending on the measurement context and results. In some cases, the ability to discriminate numerically between the correct and incorrect nanopore profiles was slight, but with accompanying differences in candidate nanopore dimensions that could yield to post-fabrication conductance profiling, or be used as convenient uncertainty bounds. Time-dependent nanopore conductance thus offers insight into nanopore structure and function, even in the presence of fabrication defects

Accelerating restrictive cardiomyopathy after liver transplantation in a patient with familial amyloidotic polyneuropathy: a case report

<p>Abstract</p> <p>Introduction</p> <p>Hereditary amyloidodis is a rare disease process with a propensity to cause polyneuropathies, autonomic dysfunction, and restrictive cardiomyopathy. It is transmitted in an autosomal dominant manner, with disease onset usually in the 20s-40s. The most common hereditary amyloidogenic protein, transthyretin, is synthesized in the liver and lies on Chromosome 18. Over 80 amyloidogenic transthyretin mutations have been described, the majority of which are neuropathic and hence the common name, Familial Amyloidotic Polyneuropathy. Until 1990, the disease was intractable with a 5–15 year survival after diagnosis. The prognosis changed after the implementation of orthotropic liver transplantation as a treatment strategy which halts the synthesis of amyloidogenic transthyretin. This has now has been performed over 1300 times in 67 centers.</p> <p>Case presentation</p> <p>We describe the case of a man of Irish ancestry with Familial Amyloidotic Polyneuropathy and no clinical history of cardiac involvement. Shortly after orthotropic liver transplantation, he developed congestive heart failure. He was subsequently diagnosed with an accelerating post-transplant restrictive cardiomyopathy due to amyloid infiltration.</p> <p>Conclusion</p> <p>A liver transplant induced cardiomyopathy in Familial Amyloidotic Polyneuropathy can be observed in patients without any history of cardiac symptoms. All patients with Familial Amyloidotic Polyneuropathy should be followed after transplantation to assess for a deterioration in cardiac function.</p