Kellie Wong Honors Portfolio

Kellie Wong\u27s honors portfolio captured in May 2018

Breaking bad news: enhancing PA student competencies around difficult patient discussions

BACKGROUND: The ability to disclose bad news to patients is a complex and essential skill for health care providers. Although certain specialties have a higher incidence of engaging in these conversations, this task is done regardless of a provider’s discipline. There are many components to breaking bad news, some of which include finding a private setting, eliciting how much the patient wants to know, providing clear information, and responding to the patients’ emotional needs and reactions. As this task is associated with a large amount of emotional stress, the outcome of this exchange can have lasting impact on both the provider and patient. Unfortunately, patients are dissatisfied with how they receive bad news, and providers admit to lack of comfort and knowledge with this task. LITERATURE REVIEW FINDINGS: Studies show that inadequate education is main area for improvement. Fortunately, the ability to break bad news is a teachable and retainable skill. Didactic sessions, role-play, and small groups are some of the available models used to educate learners. There is promising evidence for the incorporation of SPs into various curricula, because they provide an opportunity for students to learn without compromising patient safety and allow for feedback useful to enhancing skills. PAs are valued health care providers who practice across a variety of specialties. As their education is similar to that of a medical student, and they practice autonomously under the supervision of a physician, it is equally important that they are able to successfully break bad news. However, there are few studies that examine the PA student curriculum for breaking bad news education. Furthermore, there are no studies that examine PA student competency with this skill. PROPOSED PROJECT: The goal of this study is to use a literature review to create a novel curriculum that employs SPs to increase PA students’ competencies for breaking bad news. CONCLUSIONS: An optimal curriculum intervention will include opportunities for feedback, discussion, and practice. SPs can help aid with many of these components, as well as assess interpersonal and technical components of breaking bad news. SIGNIFICANCE: It is expected that the results of this study will parallel those identified for medical students, and PA students’ skills will improve to meet the standards set forth by the ARC-PA. It is the hope that the results of this study will serve as an initial platform for future studies aimed at PAs’ ability to disclose bad news to patients

Liquid Chromatography-Mass Spectrometry Strategies for in vivo Neurochemical Monitoring with Microdialysis.

Liquid chromatography mass spectrometry (LC-MS) is a powerful analytical tool for multi-analyte quantification. This method can be combined with microdialysis sampling to study small molecules and neuropeptides within discrete brain regions. This thesis focuses on the development of targeted LC-MS assays to analyze dialysate samples collected from awake animals to correlate neurochemical dynamics with behavior. Previous LC-MS assays used benzoyl chloride derivatization to enable quantification of 17 neurotransmitters and metabolites in dialysate samples. In this work, derivatization conditions were modified to improve sensitivity up to 25-fold and reduce complexity of the procedure. The assay was also expanded to 70 compounds including amino acids, polyamines (e.g., putrescine, spermidine, spermine), compounds from catecholamine biosynthesis pathways (e.g., tyrosine and tryptophan metabolic pathways), and trace amines (e.g., tyramine, octopamine, synephrine). Besides measurements in dialysate, the method was able to analyze plasma and cerebrospinal fluid samples. This work improves the utility of benzoyl chloride, which labels multiple important functional groups, for widely targeted metabolomics methods. Neuropeptides constitute the largest group of neurotransmitters in the central nervous system. Neuropeptide signaling is involved in many physiological functions but detection in vivo is challenging due to low picomolar concentrations. Targeted capillary LC-MS methods were developed for neurotensin, oxytocin, dynorphin, and enkephalins. The assays utilize desalting and preconcentration on a single analytical column to achieve low picomolar limits of detection. Detection was improved by optimizing all facets of neuropeptide handling from sampling to detection with capillary LC-MS. These techniques were applied to examine several aspects of neuronal function. Specific neuronal circuits were defined, confirmed, and targeted by combining these analytical tools with pharmacogenetic and optogenetic methods. Novel pathophysiological changes to opioid neuropeptide (dynorphin and enkephalins) dynamics were elucidated in a rat model of Parkinson’s disease, and a potential neuropeptide-based treatment was established to reduce the abnormal dyskinetic movements associated with chronic dopamine replacement therapies in Parkinson’s Disease. These new multiplexed approaches will advance our understanding of the complex processes underlying neuronal function at the molecular and circuit levels, as well as provides an improved set of experimental tools to better understand lingering questions in the field of neuroscience.PHDChemistryUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/135792/1/jmtwong_1.pd

Inference for the Sharpe Ratio Using a Likelihood-Based Approach

The Sharpe ratio is the prominent risk-adjusted performance measure used by practitioners. Statistical testing of this ratio using its asymptotic distribution has lagged behind its use. In this paper, highly accurate likelihood analysis is applied for inference on the Sharpe ratio. Both the one- and two-sample problems are considered. The methodology has O(n-3/2) distributional accuracy and can be implemented using any parametric return distribution structure. Simulations are provided to demonstrate the method\u27s superior accuracy over existing methods used for testing in the literature

Robotic Book Scanner

Digitizing books has been an issue tackled by companies to allow people to read off Kindles and iPads rather than the traditional paperback. Companies like Google have spent more than $1000 on machines to convert books into electronic copies readable on devices. Yet, not much effort has been made into the invention of an automatic book scanner for consumers. This project seeks to determine a cost-effective approach to robotic book scanning to create PDFs from physical books. This project serves as a proof of concept for a reasonably priced automatic book scanner accessible to consumers. Potentially, the device may be used in libraries similarly to copy machines where the user pays to have their book converted to electronic form, however, security measures would need to be made over access to the PDFs. If developed cost-efficiently enough, consumers may benefit as far as to have the device in their homes to convert their entire book collections to personal PDFs

Relation of Infants' Memory and Expectation Formation: Evidence from Anticipatory Eye Movements and Pupil Diameter Changes

Theories have suggested that infants’ ability to form expectations and exhibiting anticipatory eye movements, highlight our memory’s function of providing a foundation upon which expectations for future events are formed. This study aimed to assess this hypothesis by investigating the relation between long-term memory and expectation formation in 3-month-old infants. Infants underwent the Visual Expectation Paradigm and after a delay of 24 hours, infants were tested with either a change in the stimuli or the same stimuli. Infants’ level of anticipatory eye movements were measured on both test days. This study also aimed to study the relation between working memory and long-term memory by investigating if temporal decay (a limitation of working memory), would affect infants’ long-term memory. To this end, this study assessed the effect of two different interstimulus intervals (ISIs) on infants’ long-term memory performance. Finally, changes in pupil diameter during encoding and retrieval were also measured

Spatial Attention-Modulated Surround Suppression Across Development: A Psychophysical Study

Several studies have demonstrated that surrounding a given spatial location of attentional focus is a suppressive field (e.g., Hopf et al., 2006). Though several studies have provided psychophysical (e.g., Cutzu & Tsotsos, 2003) and neural evidence of this effect in young adults (e.g., Boehler et al., 2009), whether this phenomenon is also observed in development was not fully known. Experiment 1 of the current study was therefore conducted to examine whether attention-modulated surround suppression was observed in younger age groups. Participants between the ages of 8 and 22 years were tested on a two-alternative forced choice task, in which their accuracy in discriminating between two red target letters among black distractor letters was measured. A spatial cue guided the participants attention to the upcoming location of one of the target letters. As would be predicted for the young adults, their accuracy increased as the inter-target separation increased, suggesting that visual processing is suppressed in the immediate vicinity of an attended location. Pre-adolescents (12 to 13 years) and adolescents (14 to 17 years) also exhibited attentional surround suppression, but intriguingly their inhibitory surround appeared to be larger than that of young adults. The 8- to 11-year-olds did not exhibit attentional suppression. In Experiment 2, when a central cue instead of a spatial cue was presented, surround suppression was no longer observed in an independent set of 8- to 27-year-olds, suggesting that the findings of Experiment 1 were indeed related to spatial attention. In Experiment 3, yet another independent group of 8- to 9-year-olds were tested on a modified version of the Experiment 1 task, where the cue presentation time was doubled to provide them with more support and more time to complete their top-down feedback processes. With this manipulation, attention-modulated surround suppression was still not observed in the 8- to 11-year-olds. Overall the current study findings suggest that top-down attentional feedback processes are still immature until approximately 12 years of age, and that they continue to be refined throughout adolescence. Protracted white matter maturation and diffuse functional connectivity in younger age groups are some of the potential underlying mechanisms driving the current findings

Learnings from Poulet du Faso

The Poulet du Faso initiative aimed to improve the genetics and control of infectious diseases of local chickens, by crossing local cockerels with exotic Sasso hens, and kick-starting large-scale production of vaccinated day-old-chicks. This brief describes key lessons learned during the project and factors for success to consider in the design and implementation of future projects

Learnings from Vache du Faso

The Vache du Faso project aimed to improve milk production in Burkina Faso by crossbreeding local low-yielding zebu cattle with more productive dairy breeds through fixed-time artificial insemination (AI). This brief describes key lessons learned and factors for success to consider in the design and implementation of future projects