Improving Communication Between Community Care Settings and Primary Care

Background In older patients with more complex and chronic health concerns, consistency and continuity of care is essential. Patients often live in assisted living residences or independently with support from programs such as Support and Services at Home (SASH), so nurses are available to address concerns and assist with certain aspects of care. Effective inter-professional communication is essential, but communication of assessments and coordinating care with participants’ primary care providers is complex. Purpose Improve efficiency and clarity of care-related communication for patient and care team by developing a system that standardizes and streamlines workflow and addresses current concerns. Methods At a small primary care office in New England, a standardized communication tool was developed based on concerns voiced by community nurses and primary care staff, to be used to relay pertinent information, and request appropriate follow-up. Primary care providers and support staff were surveyed about communication efficacy with residential care sites prior to implementation of the communication tool, and utilization and outcomes of the tool were measured quantitatively. Results Primary concerns at the outset were redundancy, communication by multiple methods, unclear expectation of office action, and lack of follow-up communication. During the 6 week implementation, the communication tool was utilized nine times for non-urgent issues, and resulted in reduction in back-and-forth communication and increased clarity. Conclusion Tool was used appropriately for non-urgent concerns. Initial response indicates the tool improves communication, and that this office will continue to use this tool for future communication with community based care staff

Self-Efficacy and Social Support: An Application of Social Cognitive Career Theory

Self-efficacy is a driving force for motivation, conceived from agency. However, selfefficacy is not a one-dimensional concept that expresses itself uniformly across individuals. Rather, an individual’s sense of self-efficacy is impacted by contextual variables such as social support and economic means. This paper evaluates the multidimensionality of self-efficacy, along with its contributing factors and barriers. These concepts are then applied to research measuring pre- and post-test levels of selfefficacy and social support for women participating in a job-training program. Measurements are taken using the Self-Efficacy Scale (SES) and the Social Support Appraisals Scale (SSA). Descriptive statistics are used to analyze the data, however, results prove to be inconclusive due to the small sample size and high dropout rate of initial participants. The results are discussed in light of potential contributors to outcomes and recommendations are made for future research. This study concludes in support of the effectiveness of such a training program due to the history of participant successes and numerous supports in place for participants, despite the inability of this study’s numerical evidence to prove such a result

Dynamic Simulations and Data Mining of Single-Leg Jump Landing: Implications for Anterior Cruciate Ligament Injury Prevention

It is estimated that 400,000 anterior cruciate ligament (ACL) injuries occur in the United States each year with the cost of ACL reconstruction surgery and rehabilitation exceeding $1 billion annually. The majority of ACL injuries are non-contact injuries occurring during cutting and jump landing movements. Because the majority of the injuries are non-contact injuries there is the potential to develop programs to reduce the risk of injury. Given our understanding of the joint kinematics and kinetics that place an individual at high risk for ACL, researchers have developed neuromuscular training programs that focus on improving muscle function in order to help the muscles support and stabilize the knee during the dynamic movements that increase the strain on the ACL. Yet, despite the implementation of these neuromuscular-based ACL injury training intervention programs ACL rates continue to rise. Thus the objective of this dissertation is to determine the cause and effect relationship between joint biomechanics and muscle function with respect ACL injury. There are four studies in this dissertation. The first two studies rely heavily on the development of subject-specific musculoskeletal models to analyze muscle contribution during single-leg jump landing. These studies will generate forward dynamic simulations to estimate muscle force production and contribution to movement. The results of these studies will aid in the development of muscle-targeted ACL injury training intervention programs. The last two studies will employ data mining techniques; such as, principal component analysis (PCA) and wavelet analysis along with stability methods from control theory, to evaluate an individual’s risk of ACL injury and determine how muscle function differs for individuals at varying levels of injury risk. The goal will be to use this information to develop a more robust ACL injury prescreening tool. The use of both dynamic simulations and data mining techniques provides a unique approach to investigating the relationship between joint biomechanics and muscle function with respect to ACL injury. And this approach has the potential to gain much needed insight about the underlying mechanism of ACL injury and help progress ACL research forward

Intensive Archaeological Survey for the NTMWD North McKinney Pipeline Phase III—Project No. 431, Collin County, Texas

The North Texas Municipal Water District (NTMWD) contracted HDR Engineering, Inc. (HDR) to conduct an intensive archaeological survey prior to the installation of the proposed North McKinney Pipeline in McKinney, Collin County, Texas. The pipeline will consist of 23,918 linear feet (ft) of pipeline, with a diameter measuring between 72 inches (in) and 84 in, along an approximately 4.53-mile (mi) long easement corridor. Of this total, approximately 3.28 mi have been previously surveyed by Geo-Marine, Inc. in 2009 (Tiné 2009). Thus, the current cultural resources investigation conducted by HDR will cover the remaining 1.25 mi of pipeline easement. The survey corridor comprises the 40-ft permanent easement with an additional 60 ft temporary construction easement, totaling 100ft. The total Area of Potential Effects (APE) is 660,000 square ft (15.2 acres), and construction impacts are projected at depths of 12 to 20 ft. HDR completed an intensive archaeological survey of the 1.25 mi APE on April 4, 2017. During the course of the survey notifications, one landowner instructed the HDR crew to avoid entry to a portion of an agricultural field containing young crops. In total, 15 shovel tests were excavated within the remainder of the APE. The survey crew included principal investigator Megan Koszarek and project archaeologist Ben Fullerton, and a total of 16 person hours were invested in the field survey. This work was conducted under Texas Antiquities Permit Number 7792. In accordance with 13 Texas Administrative Code [TAC] 26, no further archaeological investigations are recommended. As a result of the present survey, it is recommended that the proposed installation of approximately 1.25 mi of pipeline will not have any effect on archaeological resources in the project APE, and construction may proceed. In the event that any archaeological deposits are encountered during construction, work should cease, and the Texas Historical Commission (THC) should be notified. All records and materials generated by this project will be permanently curated at the Center for Archaeological Studies (CAS) at Texas State University in San Marcos, Texas

Intensive Archaeological Survey for the Hayhurst Lateral Pipeline Project

XRI Blue (XRI) has contracted HDR to conduct an intensive archaeological survey in advance of the installment of the Hayhurst Lateral Pipeline in Reeves and Culberson Counties, Texas (Figure 1-1). The proposed pipeline will begin approximately 0.5 mile (mi; 0.8 kilometer [km]) west of Orla, Texas, along Ranch-to-Market (RM) 652. The proposed project area is approximately 8.5 mi (13.7 km) long located within the existing Texas Department of Transportation (TxDOT) Right-of-Way (ROW) with six pump station easements located on private land. Since the majority of the project area is on stateowned land, the proposed developments are required to be in compliance with Chapter 191 of the Texas Natural Resources Code, also known as the Antiquities Code of Texas (13 Texas Administrative Code [TAC] 26.12). The pipeline is a 16-inch water pipeline. It will begin on the south side of RM 652 and cross to the north side at Pump #5.5 approximately 0.8 mi (1.3 km) west from the eastern edge of the Area of Potential Effects (APE). The permanent pipeline easement is 8.5 mi (13.7 km) long and 10 feet (ft; 3 meters [m]) wide. Each pump station easement is 100 ft x 100 ft (30.5 m x 30.5 m). The depth of impacts will be up to 4 ft (1.2 m) along the entire project area. Pipeline construction will include boring at waterway crossings. The APE for the main pipeline will be contained within the existing TxDOT ROW. The total APE includes the 8.5 mi x 10 ft pipeline corridor and the six 100 ft x 100 ft pump station easements for a total of approximately 12 acres (ac; 4.9 hectares [ha]). The purpose of the archaeological investigation is to determine the presence/absence of archaeological resources within the APE as per the Antiquities Code of Texas (13 TAC 26.12) and to evaluate identified resources for their eligibility for inclusion in the National Register of Historic Places (NRHP) or as a designated State Antiquities Landmark (SAL). The cultural resources survey was conducted under Texas Antiquities Permit Number 8163. The field effort was led by Melanie Johnson on September 20, 2017. HDR conducted an intensive archaeological survey within the 12-ac (4.9 ha) APE. A total of 11 shovel tests were excavated during the survey: 5 within the RM 652 ROW and 6 within the pump station easements. The soils encountered were typically shallow overlying caliche. All shovel tests were negative. No cultural materials were discovered within the APE during the investigation. In accordance with 13 TAC 26.12, no further archaeological investigations are recommended and construction may proceed. In the event that any archaeological deposits are encountered during construction, work should cease and the Texas Historical Commission (THC) should be notified. All records and materials generated by this project will be permanently curated at the Center for Archaeological Studies (CAS) at Texas State University in San Marcos, Texas

Intensive Cultural Resources Survey for the Proposed Buena Vista Road Improvements

The Federal Highway Administration (FHWA) Central Federal Lands Highway Division (CFLHD) is proposing to improve Buena Vista Road, a two-lane, paved roadway accessing the Laguna Atascosa National Wildlife Refuge (NWR) in Cameron County, Texas. While the project is located within the Laguna Atascosa NWR, the roadway falls under the jurisdiction of Cameron County. The proposed project includes pavement reconstruction and widening by pulverizing and overlaying Buena Vista Road along a 2.7-mile (4.35 kilometer [km]) segment from the intersection of General Brant Road to the north entrance of the Laguna Atascosa NWR (Figure 1-1). The improvements will also include the installation of roadside ditches, signage, and speed humps. The survey corridor will comprise the approximately 65-feet (ft) wide (32.5 ft on either side of the centerline) existing road Right-of-Way (ROW), and areas adjacent to the Laguna Atascosa NWR will extend an additional two ft beyond the existing ROW fence line. The survey will extend 100 ft past road/driveway intersections, where the survey corridor will also be limited to the existing ROW (65 ft in width). The maximum depth of impacts for the proposed project is 3.5 ft (1.1 meters [m]) below surface in order to replace the existing culverts. As a county road, the proposed project is required to be in compliance with Chapter 191 of the Texas Natural Resources Code, also known as the Antiquities Code of Texas (13 Texas Administrative Code [TAC] 26.12). The purpose of the cultural resources investigation is to conduct an inventory to determine the presence/absence of cultural resources (36 Code of Federal Regulations [CFR] 800.4) and to evaluate identified resources for their eligibility for inclusion in the National Register of Historic Places (NRHP), as per Section 106 (36 CFR 800) of the National Historic Preservation Act of 1966, as amended, or as a designated State Antiquities Landmark (SAL) under the Antiquities Code of Texas (13 TAC 26.12). Archaeology fieldwork was completed by Principal Investigator Ben Fullerton and Archaeology Field Technicians Katie Alexander and Corinne Harvey on July 2–7, 2017. This survey was conducted under Texas Antiquities Permit Number 8089. The fieldwork for historic resources was conducted by HDR architectural historian Kristin Morgan on July 5–6, 2017. During the course of the archaeological field survey, the APE was subjected to pedestrian survey, shovel testing, and photo-documentation. The survey resulted in a 100 percent pedestrian walkover and a staggered 100-m shovel test transect for the entire length of the APE. A total of 44 shovel tests were excavated, none of which yielded cultural materials. All shovel tests were terminated prior to reaching 80 cmbs (32 inbs) due to encounter with subsoil or disturbance. A scatter of seven oyster shell fragments was identified on the ground surface within the eastern ROW at the intersection of Buena Vista Road and Ocelot Road. The location of the scatter is approximately 150 m (492 feet) east of Site 41CF115, which consists of a campsite yielding bone, as well as shell. Pedestrian survey and shovel testing near the scatter encountered disturbed soils and no cultural material. Due to the lack of associated cultural material and distance of the scatter from 41CF115, it is unclear if the shell fragments are archaeological or modern deposits. Overall, no definitive cultural materials were identified during the intensive survey. During the course of the field survey for historic resources, six resources built prior to 1972 were identified within the APE: Buena Vista Road, two vehicular access gates onto unpaved refuge roads, and three culverts. Two of the culverts span Buena Vista Road, and the other spans an unpaved access road for the refuge. None of the culverts have any visible marks to designate construction date or under whose authority it was installed. None of the six historic resources are recommended eligible for NRHP listing due to lack of significance. In accordance with and 13 TAC 26.12, no further cultural resources investigations are recommended for the presently-defined APE, and the proposed Buena Vista Road improvements project may proceed. However, in the event that any archaeological deposits are encountered during construction, work should cease and the Texas Historical Commission (THC) should be notified. All records and materials generated by this project will be permanently curated at the Center for Archaeological Studies at Texas State University in San Marcos, Texas

Intensive Archaeological Survey for the Lake Leon Dam Improvements Project

Eastland County Water Supply District has contracted with HDR Engineering, Inc. (HDR) to conduct an intensive archaeological survey in advance of the proposed improvements to the Lake Leon Dam in Eastland County, Texas (Figure 1). The Area of Potential Effects (APE) includes an approximately 6-acre emergency spillway area located east of Farm-to-Market Road (FM) 2461, approximately 400 feet (ft; 122 meters [m]) south of its intersection with County Road (CR) 569, in Eastland County, Texas. Correspondence with the Texas Historical Commission (THC) recommended that a survey be conducted within the emergency spillway area on the east side of FM 2461, but no survey was recommended for the proposed dam slope improvements (Osburn 2016). This project is being funded by a grant from the Federal Emergency Management Agency’s (FEMA’s) Hazard Mitigation Grant Program (HMGP). The use of federal funding for the project requires that the project comply with the regulations set forth in Section 106 of the National Historic Preservation Act of 1966 (NHPA) as amended. Additionally, as an entity of the State of Texas, the Eastland County Water Supply District is required to be in compliance with Chapter 191 of the Texas Natural Resources Code, also known as the Antiquities Code of Texas (13 Texas Administrative Code [TAC] 26.12). The purpose of the archaeological investigation is to determine the presence/absence of archaeological resources (36 Code of Federal Regulations [CFR] 800.4) within the APE and to evaluate identified resources for their eligibility for inclusion in the National Register of Historic Places (NRHP) as per Section 106 (36 CFR 800) of the NHPA, as amended or as a designated State Antiquities Landmark (SAL) under the Antiquities Code of Texas (13 TAC 26.12). HDR completed an intensive archaeological survey of the entire six-acre APE on August 14, 2017. The survey crew included principal investigator Megan Koszarek and crew chief Melanie Johnson, and a total of 16 person hours were invested in the field survey. This work was conducted under Texas Antiquities Permit Number 8129. During the course of the survey, the entire APE was pedestrian surveyed with transect intervals no greater than 15 m (49 ft), and a total of 12 shovel tests were excavated. No archaeological sites were recorded during the course of the survey. One historic isolated find (HDR-ISO-001) was recorded within an ephemeral creek bed. Isolated finds do not meet the basic definition of a site and are therefore not eligible for inclusion in the NRHP. In accordance with 36 CFR 800 and 13 TAC 26.12, no further cultural resources investigations are recommended for the presently-defined APE, and the proposed improvements project to the Lake Leon Dam may proceed. However, in the event that any archaeological deposits are encountered during construction, work should cease, and the THC should be notified. Upon the completion of fieldwork, all project-related materials (i.e., field forms, photographs, correspondence, etc.) will be curated at the Center for Archaeological Studies (CAS) at Texas State University in San Marcos

Intensive Archaeological Survey of the Nacogdoches to Nacogdoches SE 138 kV Transmission Line Improvements Project on Stephen F. Austin State University Land

Oncor Electric Delivery Company LLC (Oncor) has contracted with HDR, Inc. (HDR) to conduct an intensive archaeological survey in advance of proposed improvements to the existing Nacogdoches to Nacogdoches SE 138 kV transmission line that runs through property owned by Stephen F. Austin State University (SFASU) (Figure 1). The proposed improvements would involve replacing 13 existing electric transmission structures with new structures. The replacement structures will be located within the existing Oncor right-of-way (ROW) that is approximately 100 feet (ft; 30.5 meters [m]) wide. Because SFASU is a state university, the proposed developments are required to be in compliance with Chapter 191 of the Texas Natural Resources Code, also known as the Antiquities Code of Texas (13 TAC 26.12). The portion of the transmission line on SFASU property is approximately 1 mile (1.6 km) long and 100 ft (30.5 m) wide. The dimensions of the replacement tower foundations are anticipated to range from approximately 4 to 9 ft (1–2.7 m) in diameter and 20 to 30 ft (6– 9 m) in depth, but foundations could ultimately be deeper or shallower depending on the soil conditions in the area. The total Area of Potential Effects (APE) is 12.12 acres (4.9 hectares). The purpose of the cultural resources investigation is to determine the presence/absence of cultural resources within the APE and to evaluate identified resources for their eligibility for inclusion in the National Register of Historic Places (NRHP) or as a designated State Antiquities Landmark (SAL) under the Antiquities Code of Texas (13 TAC 26.12). The survey was conducted under permit number 8267. The survey was conducted by principal investigator Melanie Johnson and crew chief Amy Leuchtmann on February 12–13, 2018, resulting in a total of 16 person-hours. During the cultural resources survey of the APE, a total of 21 shovel tests were excavated, and the previously recorded site 41NA78 was revisited. No archaeological materials were found during the course of the survey. In accordance with 13 TAC 26.12, no further cultural resources investigations are recommended for the presently-defined APE, and the proposed improvements project on SFASU property may proceed. However, in the event that any archaeological deposits are encountered during construction, work should cease, and the THC should be notified

Identification of Knee Gait Waveform Pattern Alterations in Individuals with Patellofemoral Pain Using Fast Fourier Transform

Patellofemoral pain (PFP) is one of the most common overuse injuries of the knee. Previous research has found that individuals with PFP exhibit differences in peak hip kinematics; however, differences in peak knee kinematics, where the pain originates, are difficult to elucidate. To better understand the mechanism behind PFP, we sought to characterize differences in knee gait kinematic waveform patterns in individuals with PFP compared to healthy individuals using fast Fourier transform (FFT). Sixteen control and sixteen individuals with PFP participated in a fast walk protocol. FFT was used to decompose the sagittal, frontal and transverse plane knee gait waveforms into sinusoidal signals. A two-way ANOVA and Bonferroni post hoc analysis compared group, limb and interaction effects on sagittal, frontal and transverse amplitude, frequency and phase components between control and PFP individuals gait waveforms. Differences in frequency and phase values were found in the sagittal and frontal plane knee waveforms between the control and PFP groups. The signal-to-noise ratio also reported significant differences between the PFP and control limbs in the sagittal (p \u3c 0.01) and frontal planes (p = 0.04). The findings indicate that differences in gait patterns in the individuals with PFP were not the result of amplitude differences, but differences attributed to temporal changes in gait patterns detected by the frequency and phase metrics. These changes suggest that individuals with PFP adopted a more deliberate, stiffer gait and exhibit altered joint coordination. And the FFT technique could serve as a fast, quantifiable tool for clinicians to detect PFP