Word Adjacency Graph Modeling: Separating Signal From Noise in Big Data

There is a need to develop methods to analyze Big Data to inform patient-centered interventions for better health outcomes. The purpose of this study was to develop and test a method to explore Big Data to describe salient health concerns of people with epilepsy. Specifically, we used Word Adjacency Graph modeling to explore a data set containing 1.9 billion anonymous text queries submitted to the ChaCha question and answer service to (a) detect clusters of epilepsy-related topics, and (b) visualize the range of epilepsy-related topics and their mutual proximity to uncover the breadth and depth of particular topics and groups of users. Applied to a large, complex data set, this method successfully identified clusters of epilepsy-related topics while allowing for separation of potentially non-relevant topics. The method can be used to identify patient-driven research questions from large social media data sets and results can inform the development of patient-centered interventions

Epilepsy self-management during a pandemic: Experiences of people with epilepsy

This article is made available for unrestricted research re-use and secondary analysis in any form or be any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.The purpose of this descriptive study was to, from the perspective of adult people with epilepsy (PWE) and caregivers of PWE, explore the effects of the current pandemic and resulting societal changes on epilepsy self-management. Ninety-four respondents completed a mixed-methods quantitative and qualitative survey focused on their epilepsy self-management experiences during the coronavirus disease-19 (COVID-19) pandemic. Respondents noted significant disruption in epilepsy self-management. Lack of ability to obtain medications or see epilepsy providers, as well as increased stress, social isolation, and changes in routine were all reported as troublesome, and more than one-third of the sample reported an increase in seizure frequency since the onset of the pandemic. Suggestions are given regarding how to support PWE during future COVID-19 outbreaks and to better prepare PWE and their caregivers for any life-altering events, such as a pandemic, with robust self-management skills that will allow them to maintain the highest level of function possible

Chronic Disease Self-Management: A Hybrid Concept Analysis

BACKGROUND: Chronic diseases require chronic disease self-management (CDSM). Existing CDSM interventions, while improving outcomes, often do not lead to long-lasting effects. To render existing and new CDSM interventions more effective, an exploration of the concept of CDSM from both the literature and patient perspectives is needed. The purpose of this study was to describe the current conceptualization of CDSM in the literature, identify potential inadequacies in this conceptualization based on a comparison of literature- and patient-based CDSM descriptions, and to offer a more comprehensive definition of CDSM. METHODS: A hybrid concept analysis was completed. DISCUSSION: In the literature, CDSM is defined as behaviors influenced by individual characteristics. Patients in the fieldwork phase discussed aspects of CDSM not well represented in the literature. CONCLUSIONS: CDSM is a complex process involving behaviors at multiple levels of a person's environment. Pilot work to develop and test CDSM interventions based on both individual and external characteristics is needed

Advances in the Understanding of the Genetic Determinants of Congenital Heart Disease and Their Impact on Clinical Outcomes

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/143784/1/jah33022.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143784/2/jah33022_am.pd

Oncology Nurses’ Experiences with Prognosis Related Communication

poster abstractBackground: Oncology nurses have opportunities to engage in prognosis related communication with advanced cancer patients but often encounter barriers that impede patient prognosis understanding. Deficits in prognosis understanding have been associated with delays in transitions to end of life care, overly aggressive and potentially non-beneficial cancer treatments, and poor quality of life. Purpose: The purpose of this study was to describe nurses' experiences with prognosis related communication with advanced cancer patients. Methods: A framework of realism was used in this qualitative, descriptive design. A thematic analysis of audio-recorded interviews with oncology nurses (n=27) recruited from a Midwestern urban academic health center and 3 affiliated institutions was performed. Interviews were transcribed verbatim and accuracy checked. Data were coded by 3 experienced researchers. After coding, themes were identified, and a thematic map was developed. Methods to ensure trustworthiness of the findings were used. Results: Six themes were identified: Being in the middle, assessing the situation, barriers to prognosis communication, nurse actions, benefits of prognosis understanding, and negative outcomes. Nurses managed barriers through facilitation, collaboration, or independent actions to assist patients and/or families with prognosis understanding. Conclusions: Shortcomings in prognosis related communication with advanced cancer patients may contribute to negative outcomes for patients and nurses. Interventions to advance nurses’ abilities to facilitate and engage in prognosis communications are needed. Inter-professional communication skills education may also be beneficial

HIV pre‐exposure prophylaxis uptake by advanced practice nurses: Interplay of agency, community and attitudinal factors

Aims To identify associations among agency, community, personal and attitudinal factors that affect advanced practice nurses’ uptake of HIV pre‐exposure prophylaxis, an intervention consists of emtricitabine/tenofovir once‐daily pill, along with sexual risk reduction education. Design Cross‐sectional. Methods During March‐May 2017, randomly selected Indiana advanced practice nurses were invited to complete an online survey, consisted of several validated self‐rating measures (N = 1,358; response = 32.3%). Final sample (N = 369) was predominantly White, non‐Hispanic, female advanced practice nurses in urban practices (mean age = 46). Conceptual model for structural equation model included 29 original/composite variables and five latent factors. Results Final model consisted of 11 variables and four factors: agency, community, HIV prevention practices (including screening) and motivation to adopt evidence‐based practices overall. Community had direct effects on HIV prevention practices (estimate = 0.28) and agency (estimate = 0.29). Agency had direct effects on HIV prevention practices (estimate = 0.74) and motivation to adopt evidence‐based practices (estimate = 0.24). Community had indirect effects, through agency, on the two remaining factors. Conclusion Barriers exist against pre‐exposure prophylaxis implementation, although practice guidelines are available. HIV prevention practices must be integrated across organizational structures, especially in high‐risk communities, whereas practice change is more effective when focused on changing providers’ attitudes towards intervention. When planning a pre‐exposure prophylaxis intervention, advancing inputs from healthcare professionals, organizational leadership and community members, is crucial to success. Impact In settings where advanced practice nurses are primary contact points for health care, they may be best positioned to have an impact on implementation of HIV risk reduction strategies. Further research is needed to optimize their contributions to pre‐exposure prophylaxis implementation

RAMPART: RowHammer Mitigation and Repair for Server Memory Systems

RowHammer attacks are a growing security and reliability concern for DRAMs and computer systems as they can induce many bit errors that overwhelm error detection and correction capabilities. System-level solutions are needed as process technology and circuit improvements alone are unlikely to provide complete protection against RowHammer attacks in the future. This paper introduces RAMPART, a novel approach to mitigating RowHammer attacks and improving server memory system reliability by remapping addresses in each DRAM in a way that confines RowHammer bit flips to a single device for any victim row address. When RAMPART is paired with Single Device Data Correction (SDDC) and patrol scrub, error detection and correction methods in use today, the system can detect and correct bit flips from a successful attack, allowing the memory system to heal itself. RAMPART is compatible with DDR5 RowHammer mitigation features, as well as a wide variety of algorithmic and probabilistic tracking methods. We also introduce BRC-VL, a variation of DDR5 Bounded Refresh Configuration (BRC) that improves system performance by reducing mitigation overhead and show that it works well with probabilistic sampling methods to combat traditional and victim-focused mitigation attacks like Half-Double. The combination of RAMPART, SDDC, and scrubbing enables stronger RowHammer resistance by correcting bit flips from one successful attack. Uncorrectable errors are much less likely, requiring two successful attacks before the memory system is scrubbed.Comment: 16 pages, 13 figures. A version of this paper will appear in the Proceedings of MEMSYS2

Characterizing Mathematics Graduate Student Teaching Assistants’ Opportunities to Learn from Teaching

Exemplary models to inform novice instruction and the development of graduate teaching assistants (TAs) exist. What is missing from the literature is the process of how graduate students in model professional development programs make sense of and enact the experiences offered. A first step to understanding TAs’ learning to teach is to characterize how and whether they link observations of student work to hypotheses about student thinking and then connect those hypotheses to future teaching actions. A reason to be interested in these connections is that their strength and coherence determine how well TAs can learn from experiences. We found TAs can connect observations and future teaching, but that the connections vary in quality. Our analysis suggests future revisions to TA development programs, which we discuss in the conclusion