Evaluating the Effectiveness of a Heart Improvement Toolkit Program: A Pilot Project

Heart failure (HF) is a chronic, debilitating disease resulting in over one million hospitalizations with an estimated 30.7 million dollars in total health care cost per year (Go et al., 2014). Evidence shows that HF education programs that promote adherence to pharmacological and non-pharmacological provider recommendations are effective in reducing 30-day HF recidivism rates, increasing self-care behavior, and decreasing adverse clinical events. The purpose of this evidence-based project was to implement the Heart Improvement Toolkit (HIT) Program which is a one-on-one, comprehensive HF-specific education program, for patients with a HF diagnosis who have been admitted to non-cardiac specialty units. Program evaluation included 30-day recidivism rates, adverse clinical events, and self-care behavior (SCB)

What Really Matters: Assessing Individual Problem-Solving Performance in the Context of Biological Sciences

The evaluation of higher-level cognitive skills can augment traditional discipline-based knowledge testing by providing timely assessment of individual student problem-solving abilities that are critical for success in any professional development program. However, the wide-spread acceptance and implementation of higher level cognitive skills analysis has been delayed by the lack of rapid, valid, and reliable quantified-scoring techniques. At the University of New Mexico School of Medicine, Department of Biochemistry & Molecular Biology, we have developed an examination format that can be routinely and sequentially implemented for both formative and summative assessments of individual students in large classes. Rather than providing results in terms of an individual student’s knowledge base in a single academic discipline or group of disciplines, this type of examination provides information on performance in the application of specific problem-solving skills, which we term “domains,” to a contextual clinical or scientific problem. These domains, derived from the scientific method, are tested across various academic disciplines, and are reported in terms of the following: Initial and sequential hypothesis generation, investigation of these hypotheses, evaluation of newly acquired data, integration of basic science mechanisms with new information to explain the basis of the problem, and reflection on one’s own professional development in the context of the examination. The process for criterion referenced quantified grading of the examination is outlined in this paper. This process involves relatively rapid scoring, and permits the timely use of the resulting information for individual student feedback as well as curricular improvement. Data regarding grading consistency and comparison with other measures of student performance is also presented in this paper. An analysis of the performance characteristics of this examination, which has been utilized for over 10 years in a variety of course settings, indicates that it is valid, reliable, and utilizable. As such, the methodology is now routinely used in several undergraduate and graduate level biochemistry classes to monitor the development of individual student problem-solving abilities

Diagnosed prevalence of Alzheimer’s disease and related dementias in Medicare Advantage plans

IntroductionOne- third of Medicare beneficiaries are enrolled in Medicare Advantage (MA). Yet, little is known about MA beneficiaries diagnosed with Alzheimer’s disease (AD) and AD- related dementias (AD/ADRD).MethodsWe calculated the prevalence of AD/ADRD diagnoses in 2014 and 2016 in three MA plans. We determined the demographic characteristics of beneficiaries diagnosed with AD/ADRD, and whether they disenrolled from the MA plan for any reason within 364 days from the index date.ResultsIn 2014 and 2016, the overall prevalence of AD/ADRD diagnoses was 5.6% and 6.5%, respectively. In 2016, AD/ADRD beneficiaries were on average 82.4 (SD = 7.4) years of age, 61.8% female, and had multiple comorbidities. By 364 days post- index date, 32% of beneficiaries with AD/ADRD had disenrolled from their plan. The demographic characteristics of 2014 beneficiaries with diagnosed AD/ADRD were similar to their 2016 counterparts.DiscussionThe prevalence of AD/ADRD diagnosis in MA is lower than rates reported in Medicare fee- for- service.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156169/2/dad212048.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156169/1/dad212048_am.pd

Using the Game of Mastermind to Teach, Practice, and Discuss Scientific Reasoning Skills

The code-breaking game Mastermind, which can be played in minutes at no cost, creates opportunities for students to discuss scientific reasoning, hypothesis-testing, effective experimental design, and sound interpretation of results

Informing investment to reduce inequalities: a modelling approach

Background: Reducing health inequalities is an important policy objective but there is limited quantitative information about the impact of specific interventions. Objectives: To provide estimates of the impact of a range of interventions on health and health inequalities. Materials and methods: Literature reviews were conducted to identify the best evidence linking interventions to mortality and hospital admissions. We examined interventions across the determinants of health: a ‘living wage’; changes to benefits, taxation and employment; active travel; tobacco taxation; smoking cessation, alcohol brief interventions, and weight management services. A model was developed to estimate mortality and years of life lost (YLL) in intervention and comparison populations over a 20-year time period following interventions delivered only in the first year. We estimated changes in inequalities using the relative index of inequality (RII). Results: Introduction of a ‘living wage’ generated the largest beneficial health impact, with modest reductions in health inequalities. Benefits increases had modest positive impacts on health and health inequalities. Income tax increases had negative impacts on population health but reduced inequalities, while council tax increases worsened both health and health inequalities. Active travel increases had minimally positive effects on population health but widened health inequalities. Increases in employment reduced inequalities only when targeted to the most deprived groups. Tobacco taxation had modestly positive impacts on health but little impact on health inequalities. Alcohol brief interventions had modestly positive impacts on health and health inequalities only when strongly socially targeted, while smoking cessation and weight-reduction programmes had minimal impacts on health and health inequalities even when socially targeted. Conclusions: Interventions have markedly different effects on mortality, hospitalisations and inequalities. The most effective (and likely cost-effective) interventions for reducing inequalities were regulatory and tax options. Interventions focused on individual agency were much less likely to impact on inequalities, even when targeted at the most deprived communities

Effects of chronic and intermittent cocaine treatment on dominance, aggression, and oxytocin levels in post-lactational rats

Little is known about mechanisms underlying female rodent aggression during the late postpartum period with no pups present. Studies of aggression, dominance, and oxytocin (OT) response in cocaine-treated females are sparse

Diversity and pedagogic practice: reflections on the role of an adult educator in higher education

This is a postprint of an article whose final and definitive form has been published in Teaching in Higher Education (c) 2007 Copyright Taylor & Francis; Teaching in Higher Education is available online at http://www.informaworld.comBased on a model developed by Brookfield (1995), a deliberately reflective approach is taken in this paper to the relationship between the author's earlier work in a department of adult education and her current teaching on a course for new university lecturers. As increasing numbers of mature students are being encouraged into universities, she wonders whether the principles and practices of adult education have a place in the pedagogic practices of higher education. She summarises the development of adult education departments in British universities, and draws attention to different pedagogic approaches in adult and higher education. Looking through various 'lenses', the author concludes that there is a need for a new professional agenda in higher education - where commonality and difference provide the starting points for mutual exploration and self-understanding - and that the traditions of adult education have a significant contribution to make to this agenda

A molecular assay for sensitive detection of pathogen-specific T-cells.

Here we describe the development and validation of a highly sensitive assay of antigen-specific IFN-γ production using real time quantitative PCR (qPCR) for two reporters--monokine-induced by IFN-γ (MIG) and the IFN-γ inducible protein-10 (IP10). We developed and validated the assay and applied it to the detection of CMV, HIV and Mycobacterium tuberculosis (MTB) specific responses, in a cohort of HIV co-infected patients. We compared the sensitivity of this assay to that of the ex vivo RD1 (ESAT-6 and CFP-10)-specific IFN-γ Elispot assay. We observed a clear quantitative correlation between the two assays (P<0.001). Our assay proved to be a sensitive assay for the detection of MTB-specific T cells, could be performed on whole blood samples of fingerprick (50 uL) volumes, and was not affected by HIV-mediated immunosuppression. This assay platform is potentially of utility in diagnosis of infection in this and other clinical settings

Getting “Just Deserts” or Seeing the “Silver Lining”: The Relation between Judgments of Immanent and Ultimate Justice

People can perceive misfortunes as caused by previous bad deeds (immanent justice reasoning) or resulting in ultimate compensation (ultimate justice reasoning). Across two studies, we investigated the relation between these types of justice reasoning and identified the processes (perceptions of deservingness) that underlie them for both others (Study 1) and the self (Study 2). Study 1 demonstrated that observers engaged in more ultimate (vs. immanent) justice reasoning for a "good" victim and greater immanent (vs. ultimate) justice reasoning for a "bad" victim. In Study 2, participants' construals of their bad breaks varied as a function of their self-worth, with greater ultimate (immanent) justice reasoning for participants with higher (lower) self-esteem. Across both studies, perceived deservingness of bad breaks or perceived deservingness of ultimate compensation mediated immanent and ultimate justice reasoning respectively. © 2014 Harvey and Callan

Meta-Analysis of Genomewide Association Studies Reveals Genetic Variants for Hip Bone Geometry

Hip geometry is an important predictor of fracture. We performed a meta-analysis of GWAS studies in adults to identify genetic variants that are associated with proximal femur geometry phenotypes. We analyzed four phenotypes: (i) femoral neck length; (ii) neck-shaft angle; (iii) femoral neck width, and (iv) femoral neck section modulus, estimated from DXA scans using algorithms of hip structure analysis. In the Discovery stage, 10 cohort studies were included in the fixed-effect meta-analysis, with up to 18,719 men and women ages 16 to 93 years. Association analyses were performed with ∼2.5 million polymorphisms under an additive model adjusted for age, body mass index, and height. Replication analyses of meta-GWAS significant loci (at adjusted genomewide significance [GWS], threshold p ≤ 2.6 × 10 –8 ) were performed in seven additional cohorts in silico. We looked up SNPs associated in our analysis, for association with height, bone mineral density (BMD), and fracture. In meta-analysis (combined Discovery and Replication stages), GWS associations were found at 5p15 (IRX1 and ADAMTS16); 5q35 near FGFR4; at 12p11 (in CCDC91); 11q13 (near LRP5 and PPP6R3 (rs7102273)). Several hip geometry signals overlapped with BMD, including LRP5 (chr. 11). Chr. 11 SNP rs7102273 was associated with any-type fracture (p = 7.5 × 10 –5 ). We used bone transcriptome data and discovered several significant eQTLs, including rs7102273 and PPP6R3 expression (p = 0.0007), and rs6556301 (intergenic, chr.5 near FGFR4) and PDLIM7 expression (p = 0.005). In conclusion, we found associations between several genes and hip geometry measures that explained 12% to 22% of heritability at different sites. The results provide a defined set of genes related to biological pathways relevant to BMD and etiology of bone fragility