Quality of Care Assessment at a Resident-based Primary Care HIV Clinic

A quality improvement study based in a primary care resident-based HIV clinic, the Kendig Clinic, was conducted within Jefferson Family Medicine Associates. The study objectives were to • Determine the percentage of the clinic patients meeting each quality measure • Compare these calculated clinic measures to known national averages • Use the data to determine areas to target for future quality improvement initiatives.https://jdc.jefferson.edu/cwicposters/1019/thumbnail.jp

Risk Analysis to Predict Extubation Failure in the Cardiac Intensive Care Unit

The data collected in this project will be used as a part of a multi-center study conducted by Boston Children’s Hospital to assess if the software Etiometry® can be used to predict extubation success in patients in the CICU. After compiling the data from EPIC, the goals of our analysis were to find any associations with extubation failure rates. Trends in this data could help identify potential areas of focus to mitigate extubation failures. Some specific hypotheses that were explored included the associations between extubation failure and delayed sternal closure, increased length of stay, length of post-op stay, ECMO, and death. The similarity between CHMC’s rate of extubation and what is being reported nationally was also considered. Data was collected by reviewing patient charts in EPIC and analyzed using Chi squared and the Student’s T-test where appropriate. This study found that neonatal status and escalated respiratory support in within 48 hours trended towards an association with extubation failure. It was also found that extubation failure trended towards an association with death. Within the collected data, there was not one overarching diagnosis that was more common in failed extubation encounters than successful encounters. While the conclusions from the data collected in this study are limited by the sample size, this data will benefit the multi-center study conducted by Boston Children’s Hospital in assessing the accuracy of Etiometry® in predicting extubation success.https://digitalcommons.unmc.edu/surp2022/1017/thumbnail.jp

Around the table: Are multiple-touch surfaces better than single-touch for children's collaborative interactions?

This paper presents a classroom study that investigated the potential of using touch tabletop technology to support children's collaborative learning interactions. Children aged 7-10 worked in groups of three on a collaborative planning task in which they designed a seating plan for their classroom. In the single-touch condition, the tabletop surface allowed only one child to interact with the digital content at a time. In the multiple-touch condition, the children could interact with the digital content simultaneously. Results showed that touch condition did not affect the frequency or equity of interactions, but did influence the nature of children's discussion. In the multiple-touch condition, children talked more about the task; in the single-touch condition, they talked more about turn taking. We also report age and gender differences

Multisensory Integration of Anticipated Cardiac Signals with Visual Targets Affects Their Detection among Multiple Visual Stimuli

Many studies have elucidated the multisensory processing of different exteroceptive signals (e.g., auditory-visual stimuli), but less is known about the multisensory integration of interoceptive signals with exteroceptive information. Here, we investigated the perceptual outcomes and electrophysiological brain mechanisms of cardio-visual integration by using participants’ electrocardiogram signals to control the color change of a visual target in dynamically changing displays. Reaction times increased when the target change coincided with strong cardiac signals concerning the state of cardiovascular arousal (i.e., presented at the end of ventricular systole), compared to when the target change occurred at a time when cardiac arousal was relatively low (i.e., presented at the end of ventricular diastole). Moreover, the concurrence of the target change and cardiac arousal signals modulated the event-related potentials and the beta power in an early period (~100 ms after stimulus onset), and decreased the N2pc and the beta lateralization in a later period (~200 ms after stimulus onset). Our results suggest that the multisensory integration of anticipated cardiac signals with a visual target negatively affects its detection among multiple visual stimuli, potentially by suppressing sensory processing and reducing attention toward the visual target. This finding highlights the role of cardiac information in visual processing and furthers our understanding of the brain dynamics underlying multisensory perception involving both interoception and exteroception

Restore: Bringing Awareness to Food Insecurity and Food Justice at Grand Valley State University

As food insecurity is becoming a factor among many college students, campus food pantries are opening across the country. ReStore is a food pantry at Grand Valley State University, created in April 2009 to help students who are not able to afford food or are unable to get to the local supermarket. The number of these students is alarming. Statistics show 25 percent of students, at the University of California at San Diego, skip meals due to not having money to buy food. ReStore is an asset to GVSU where it helps reduce food insecurity on campus. Campus food pantries run mostly on donations and ReStore is no exception to this. Research has shown food drives are a successful way to bring in food and personal items along with bringing awareness to the community (Access of West Michigan, 2006). Our semester long effort aims to bring ReStore more than one food drive a year to help keep their shelves stocked for the growing demand of students who will utilize this resource. Our group organized a schedule of different departments/divisions associated with GVSU to participate in one of three food drives to be held throughout the year. We unfortunately cannot convince or force faculty/staff to donate, which makes it difficult to ensure the food drives will continue past our involvement this semester. Our hope is that future students will continue the work we have started and that the system we put into place ensures ReStore will continue to stay fully stocked throughout the year to assist those students who need it

Youth Crisis and Transition Services (CATS): Incorporating Family Peer Support Specialists to Assist Families During Crisis

Abstract Introduction: Crisis and Transition Services (CATS) provides transitional mental health services to high-acuity youth discharging from emergency departments (EDs). A novel component of CATS is the inclusion of a family peer support specialist (FSS) on the care team, who provides direct support to the parent or guardian in developing self-advocacy, crisis management skills, and self-efficacy in navigating systems. The FSS is not a typical role in a clinically oriented crisis program; empiric evaluation of this role can help guide quality improvements in the program and in workforce recruitment, training and support. Methods: Demographic and service data were collected from CATS providers, and families were surveyed two months after completing CATS to collect feedback and clinical outcomes (n=147). Participants were sorted into two groups: did engage with FSS (n=89) and did not engage with FSS (n=58). Predictive factors for successful engagement with a FSS were analyzed using Pearson’s chi-square tests. Descriptive statistics of services provided to families and family satisfaction ratings were also evaluated. A qualitative analysis of family feedback comments identified common themes regarding family experiences of the FSS. Results: When the FSS attended the first team meeting after intake, parents were more likely to engage with peer support χ2 (1, n = 147) = 20.60, p \u3c .001. As part of the follow-up survey, parents rated their experience with the FSS on a scale of 1 (completely unsatisfied) to 10 (completely satisfied). Over 70% (n = 65) of families rated their experience with the FSS as a 7 or above. The most prominent theme in the qualitative comment analysis was that parents had positive experiences with the FSS. The most common negative comment was that the parent didn’t understand how the FSS would be helpful or did not feel the FSS role would be useful for their family. Conclusions: The program elements that predict the likelihood of a family engaging with peer support, together with parent satisfaction ratings and feedback comments, provide insight into the successful implementation of parent peer support in a crisis program for youth. These have important implications for FSS professional and workforce development

Keep calm and age well: Behavioural and electrophysiological investigations into the effects of cumulative stress exposure on ageing cognition

The research presented in this thesis comprises a body of work dedicated to continuing and enriching past exploration into the impact cumulative life stress exerts on ageing cognition. In order to extend previous work into this topic, behavioural measures were paired with electroencephalographic recordings of the cortical oscillatory activity thought to underlie cognitive operations. In a theoretical sense, work presented in this thesis strengthens past investigations highlighting the adverse effects of life stress on elderly peoples’ working memory abilities by replicating the effect under conditions of increased experimental rigour. It further provides evidence that the detrimental effects of cumulative stress extend to the domains of executive control and spatial memory. Electrophysiological findings obtained during task execution and at rest indicate pronounced changes in the oscillatory activity of aged high stress individuals’ delta, theta, alpha and gamma bands and are thus the first to demonstrate that cumulative stress affects the underlying neural processes related to successful task execution. As such, from a methodological standpoint, the current research strongly advocates the use of neuroscientific tools such as the electroencephalogram to gain an increased understanding of the mechanisms by which increased stress exposure evokes progressive cognitive decline in old age. Combined, the work presented in this thesis demonstrates the negative consequences of leading a highly stressful life for the integrity of multiple cognitive functions in old age and is the first to provide an indication of how cumulative stress affects both cortical and (indirectly) subcortical regions of the brain necessary for successful cognitive functioning

From the inside out: Interoceptive feedback facilitates the integration of visceral signals for efficient sensory processing

Neuroscientific studies have mainly focused on the way humans perceive and interact with the external world. Recent work in the interoceptive domain indicates that the brain predictively models information from inside the body such as the heartbeat and that the efficiency with which this is executed can have implications for exteroceptive processing. However, to date direct evidence underpinning these hypotheses is lacking. Here, we show how the brain predictively refines neural resources to process afferent cardiac feedback and uses these interoceptive cues to enable more efficient processing of external sensory information. Participants completed a repetition-suppression paradigm consisting of a neutral repeating face. During the first face presentation, they heard auditory feedback of their heartbeat which either coincided with the systole of the cardiac cycle, the time at which cardiac events are registered by the brain or the diastole during which the brain receives no internal cardiac feedback. We used electroencephalography to measure the heartbeat evoked potential (HEP) as well as auditory (AEP) and visual evoked potentials (VEP). Exteroceptive cardiac feedback which coincided with the systole produced significantly higher HEP amplitudes relative to feedback timed to the diastole. Elevation of the HEP in this condition was followed by significant suppression of the VEP in response to the repeated neutral face and a stepwise decrease of AEP amplitude to repeated heartbeat feedback. Our results hereby show that exteroceptive heartbeat feedback coinciding with interoceptive signals at systole enhanced interoceptive cardiac processing. Furthermore, the same cue facilitating interoceptive integration enabled efficient suppression of a visual stimulus, as well as repetition suppression of the AEP across successive auditory heartbeat feedback. Our findings provide evidence that the alignment of external to internal signals can enhance the efficiency of interoceptive processing and that cues facilitating this process in either domain have beneficial effects for internal as well as external sensory processing