Addressing Skill Gaps by Onboarding IT Graduates into the Workplace

46 pagesThis annotated bibliography focuses on the premise that providing comprehensive onboarding programs upon hiring new IT graduates will significantly improve job performance, retention, and satisfaction for employers and graduates. The author identifies the issue, noting categories of skills that IT graduates need to improve. A description of best practices of onboarding programs and how they can help fill skill gaps is provided. Finally, a literature review identifies the best practices for IT graduate onboarding programs

Comparative effectiveness of triple therapy compared to combination or mono long-acting pharmacotherapy for COPD

The current literature on COPD treatment, in particular the impact of treatment on exacerbations, demonstrates that confounding by indication has not been adequately addressed in observational studies. The goal of this research was to develop better methods for describing the effectiveness of COPD treatment in the general population. The central hypothesis of this research is that marginal structural model (MSM) methods are an effective way of addressing the bias introduced by confounding by indication in this clinical situation. To test this hypothesis, we compared the effectiveness of monotherapy with the long-acting muscarinic antagonist (LAMA) tiotropium or dual therapy with an inhaled corticosteroid/long-acting beta-agonist (ICS/LABA) combination inhaler, as compared with use of both concurrently (triple therapy). The primary outcome measure was severe exacerbation risk over a two-year period. Three different analysis design methods were evaluated: an intent-to-treat (ITT) approach, an as protocol (As Protocol) approach that considered discontinuation of initial treatment during the follow-up period, and an MSM analysis that incorporated time-varying covariates related to prior period moderate exacerbations, use of short-acting beta-agonist (SABA) rescue medication, and discontinuation of the treatment during the follow-up period. Claims data from two managed care health plans in New Mexico for the time period July 1, 2004 through September 31, 2013 was used to identify 5,475 study subject age 40 or older with a diagnosis of COPD who were new users (no use in the prior six months) of ICS/LABA, LAMA or triple therapy. In the two-year period after initial receipt of therapy, 855 study subjects had a severe exacerbation (15.6% of 5,475). Among the 855 subjects, 411 had a severe exacerbation while still using their index therapy (events for the As Protocol analysis), and 476 while using ICS/LABA and/or LAMA medication that may or may not have been their index therapy. Discontinuation of therapy was very prevalent. By six months after index, 53.5% of the study sample had no evidence of use of ICS/LABA or LAMA medication. Factors related to discontinuation were considered in the MSM analysis. Important differences among these three approaches were revealed by these analyses. In the MSM analysis, triple therapy was not more effective than use of either ICS/LABA or LAMA in reducing the risk of severe exacerbation (HR 1.11, 95% CI 0.68 to 1.81). The ITT analysis using Cox proportional hazard models suggested that triple therapy was associated with increased risk of severe exacerbation over a 24 month period after initiation of therapy (HR 1.24, 95% confidence interval (CI) 1.00 to 1.53), however over 50% of the study sample discontinued use of ICS/LABA or LAMA by six months post-index, suggesting bias in the ITT risk estimate. No increased risk was seen in the As Protocol analysis (HR 1.00, 95% CI 0.73 to 1.36), suggesting that the increased risk observed in the ITT analysis is largely attributable to events occurring after study subjects have discontinued use of ICS/LABA or LAMA. Important relationships that were discerned in the MSM analyses were that use of SABA medication in a prior period were strongly associated with both use of triple therapy at the start of the next period, and with continuation of therapy and that moderate exacerbations in a prior period were strongly associated with use of triple therapy at the start of the next period. The MSM approach offered some insights into the relationships between treatment and outcomes in this observational database that would have been difficult to identify using either the traditional ITT approach or the As Protocol approach. MSM is a useful and informative complementary analysis to include in studies of treatment effectiveness

Metabolic Regulation and Cryotolerance of In Vitro-Produced Holstein Embryos

In vitro production and transfer of embryos has become a common practice within the dairy industry to efficiently breed superior animals and meet the consumption demand of the growing population. Cyropreservation is necessary for the application of commercialized embryo transfer, however, in vitro-produced embryos show morphological and physiological defects which negatively impact their ability to withstand cryopreservation in comparison to their in vivo counterparts. These artifacts result from culture conditions that cause stress to the embryo during development, leading to an accumulation of intracellular lipids, mitochondrial dysfunction, and ultimately poor ability to withstand freezing and thawing. The objective of these studies was to examine the effects of various metabolic regulators on the viability and cryotolerance of in vitro-produced embryos. Pilot studies revealed that evaluating early (stage 6) versus late (stage 7) blastocysts did not affect the trend seen in results, nor did culturing embryos in continuous versus sequential media. From the main experiment performed, it was concluded that a combination of metabolic regulators decreased lipid content, improved cryopreservation survival, and lowered the percentage of apoptotic cells present after thawing. Conditioned media increased the blastocyst percentage, but did not produce superior quality embryos as measured by cryotolerance. Research concerning the metabolic needs of the preimplantation embryo must continue to determine more relevant markers of embryo quality in vitro

Annual Survey of Virginia Law: Domestic Relations

Several significant developments in the area of domestic relations law took place in the past year. This article summarizes the key judicial decisions and legislative enactments pertaining to child support, child custody and visitation, marriage and divorce, spousal support, equitable distribution (including property classification and valuation) property settlement agreements, adoption, domestic violence, jurisdiction, and procedure that occurred from June 1, 1998 through May 15, 1999

Understanding the Association Between Social Networks, College Student Alcohol Use, and Protective Behavioral Strategy Use and Beliefs

Heavy drinking and alcohol-related problems are a growing concern for American college students (Jun, Agley, Huang, & Gassman, 2015). Social networks, or peer groups, have demonstrated predictive associations with college students’ alcohol outcomes (Neighbors, Lee, Lewis, Fossos, & Larimer, 2007). Protective behavioral strategies (PBS), defined as behaviors used to reduce negative alcohol-related consequences, are often assessed as a mechanism of change and predictor of alcohol outcomes (Martens, Taylor, Damann, Page, Mowry, & Cimini, 2004). Still, the association between social networks’ and college students’ own PBS use has yet to be explored. The current study was designed to address this gap in the literature to better understand the association between social network members’ drinking-related behaviors and college students’ alcohol use. Participants (n = 566) were undergraduates who completed the web-based survey for research credit in participating psychology classes. Students were asked about their alcohol use, PBS use, and beliefs about PBS, as well as the perceived alcohol use and PBS use of five members of their social networks. Results show that a larger proportion of social network members reported as heavy drinkers was a significant predictor of higher alcohol quantity, higher peak alcohol use, and more alcohol-related problems by participants. A larger proportion of social network members reported as light drinkers or abstainers was a significant predictor of more PBS use by participants. Additionally, a larger proportion of high PBS using social network members was a significant predictor of more PBS use and perceived importance of PBS by participants. Closeness (i.e., amount of time spent with the individual social network members) did not moderate any of these association

Clinical and economic outcomes in an observational study of COPD maintenance therapies: multivariable regression versus propensity score matching

Melissa H Roberts1, Anand A Dalal21Lovelace Clinic Foundation, (Lovelace Respiratory Research Institute at the time of the study), Albuquerque, NM, 2US Health Outcomes, GlaxoSmithKline, Durham, NC, USAPurpose: To investigate equivalency of results from multivariable regression (MR) and propensity score matching (PSM) models, observational research methods used to mitigate bias stemming from non-randomization (and consequently unbalanced groups at baseline), using, as an example, a large study of chronic obstructive pulmonary disease (COPD) initial maintenance therapy.Methods: Patients were 32,338 health plan members, age ≥40 years, with COPD initially treated with fluticasone propionate/salmeterol combination (FSC), tiotropium (TIO), or ipratropium (IPR) alone or in combination with albuterol. Using MR and PSM methods, the proportion of patients with COPD-related health care utilization, mean costs, odds ratios (ORs), and incidence rate ratios (IRRs) for utilization events were calculated for the 12 months following therapy initiation.Results: Of 12,595 FSC, 9126 TIO, and 10,617 IPR patients meeting MR inclusion criteria, 89.1% (8135) of TIO and 80.2% (8514) of IPR patients were matched to FSC patients for the PSM analysis. Methods produced substantially similar findings for mean cost comparisons, ORs, and IRRs for most utilization events. In contrast to MR, for TIO compared to FSC, PSM did not produce statistically significant ORs for hospitalization or outpatient visit with antibiotic or significant IRRs for hospitalization or outpatient visit with oral corticosteroid. As in the MR analysis, compared to FSC, ORs and IRRs for all other utilization events, as well as mean costs, were less favorable for IPR and TIO.Conclusion: In this example of an observational study of maintenance therapy for COPD, more than 80% of the original treatment groups used in the MR analysis were matched to comparison treatment groups for the PSM analysis. While some sample size was lost in the PSM analysis, results from both methods were similar in direction and statistical significance, suggesting that MR and PSM were equivalent methods for mitigating bias.Keywords: multivariate analysis, outcomes research, propensity score, pulmonary disease, chronic obstructive, statistical bias, statistical model

Assessment of arsenate bioavailability in iron-rich environments: development of a high-pressure liquid chromatography method of quanitification for arsenate sorbed by Fe3+-substituted chelating resins in arsenic-bearing ferrihydrite suspensions

Given that the mobility, bioavailability, and toxicity of arsenate in natural systems is often controlled by the strong binding capacity of iron oxyhydroxides, the objective of this study was to document the interactions of Dowex M4195 Fe3+-substituted chelating resins (a potential fieldbased tool for the quantification of potential arsenate bioavailability) and arsenic-bearing ferrihydrite (AFH) as a function of suspension pH, suspension concentration, and background electrolyte concentration. In 0.5 g AFH/L (0.001 M NaNO3) suspensions, arsenate sorption to the resins was proportional to the degree of acidification of the AFH suspensions by the resins. H+-enhanced dissolution of ferrihydrite artificially increased the arsenate in solution, causing a consistent overestimation of potential arsenate bioavailability. Resin-induced acidification was decreased with increasing suspension concentration. Arsenate sorption to the resins in 0.5 g/L suspensions at pH 8 decreased with increasing NaNO3 concentrations, reflecting the decreasing activity of arsenate under these conditions. The results of this study indicate that the high buffer capacity of natural soils would prevent acidification as a result of resin introduction. Thus, Dowex M4195 Fe3+-substituted chelating resins should provide a reasonable assessment of potential arsenate bioavailability from poorly-crystalline iron oxide minerals. Possibly more importantly, Dowex M4195 Fe3+-substituted chelating resins appear to be a new choice of passive equilibrium sampling device that should work well for the determination of bioavailable arsenate concentrations in the field

Loss of Rb Cooperates with Ras to Drive Oncogenic Growth in Mammalian Cells

Background The p53, Rb, and Ras/PI3K pathways are implicated in the development of the majority of human cancers. A number of studies have established that these pathways cooperate at the level of the cell cycle leading to loss of normal proliferative controls. Here we have investigated how these signals influence a second critical component of tumor formation—cell growth. Results We find that oncogenic Ras is sufficient to drive growth via the canonical growth pathway, PI3K-AKT-TOR; however, it does so relatively weakly and p53 loss does not drive cell growth at all. Importantly, we identify a novel role for the Rb family of tumor suppressors in directing cell growth via a signaling pathway distinct from PI3K-AKT-TOR and via an E2F-independent mechanism. However, we find that strong, sustained growth requires Rb loss together with Ras signaling, identifying an additional mechanism by which these oncogenic pathways cooperate and a critical role for Ras in preserving the uptake of extracellular nutrients required for biogenesis. Conclusions We have identified a new role for the Rb family in cell biogenesis and show that, as for other processes associated with tumor development, oncogenic cell growth is dependent on cooperating oncogenes

Kaizen: Improving Patient flow

Background: Since Cobb & Douglas Public Health (CDPH) achieved accreditation in May 2015, efforts to mature a culture of quality have been emphasized. In addition, the Adult Health Clinic moved to a new facility in Spring 2016. This move has improved many patient flow issues, but also has had unexpected consequences that spurred interest in doing several quality improvement (QI) projects. Methods: Rather than doing one QI project at a time, a kaizen event was held. Kaizen is a Japanese term for continuous improvement. This workshop allowed the Adult Health Team to plan seven QI projects and implement them simultaneously over the next several weeks. After the first six weeks of implementation, nearly 14 different projects were in various stages of the PlanDo-Study-Act (PDSA) cycle. Baseline average patient flow for 1880 patient encounters was 75.11 minutes. Results: Results are still pending. Preliminary results reflect increased collaboration among clinic staff and an increase in staff members taking the initiative to make improvements. Employee morale has improved, and employee and customer satisfaction seems to be improved. Conclusions: The Adult Health Clinic used the LEAN methodology to reduce waste in the patient flow process and used the PDSA framework to structure their 14 QI projects. A kaizen event allows rapid improvements to be planned and implemented in a short period of time