Final DNP Capstone Report: Improving Adolescent HPV Vaccination Rates

Background: Human papillomavirus (HPV) vaccines have been shown to be effective against HPV types that are linked to cervical, vaginal, vulvar, penile, anal, and oropharyngeal cancers. Despite Advisory Committee on Immunization Practices (ACIP) recommendations that all 11-12 year old males and females in the U.S. should be vaccinated with the three-dose HPV vaccine series, vaccination rates remain low. In 2012, only 34.9% of adolescent females and 6.8% of adolescent males completed the series. Efforts to increase vaccination rates are needed, and healthcare providers have been shown to be an important part of the solution. Purpose: This investigation was conducted to determine providers’ current practices regarding HPV vaccine recommendation, consistency with following ACIP guidelines, and perceived facilitators and barriers to recommending the HPV vaccine. Methods: This descriptive study utilized a retrospective chart review of all 11-12 year old adolescents presenting to a primary care clinic for a well-child exam between April 23, 2013 and September 30, 2013. Charts were audited for patient demographics, whether HPV vaccination counseling was offered and by whom, patient response (accepted/declined/deferred), if the vaccine was initiated, and if it was completed. Additionally, an anonymous provider survey was administered via REDCap and a provider focus group was conducted to elicit perceived facilitators and barriers to recommending the vaccine. Results: Chart audits (N= 60) revealed that 42% of the adolescents initiated the vaccine, and only 14% completed the series within the CDC recommended interval. Review of provider documentation revealed that counseling and/or provider recommendation was documented in only 11 of 60 charts. Barriers to vaccine initiation included recommending the vaccine more often to female than male patients, language barriers, low medical literacy, time constraints, inconsistent patient follow-up, and patient/parent concerns about long-term safety. Recommendations: Based on focus group discussion, suggestions to improve HPV vaccination rates included offering a strong provider recommendation for HPV vaccination to all adolescent patients, standardizing documentation of HPV vaccine recommendation, and using the EMR to improve return rates for second and third vaccine dose

Scholarly Writing: Ideas, Examples, and Execution

Most law schools now require upper-level students to write a sophisticated legal research paper on a topic of their choice. Scholarly Writing: Ideas, Examples, and Execution guides students through the process of constructing their legal research papers, from topic selection and thesis development to finishing a publishable product. The book walks students through a five-step process for researching and writing scholarly papers and follows multiple published student papers from idea to final execution as a method of illustrating the principles advocated in the text. The book includes up-to-date information about legal research and organizational tools. It also includes “bright ideas” that supplement the text with ideas and examples for student writers. The text may be used as either a required text for a course in Scholarly Legal Writing or a companion guide for students working on scholarly legal writing projects independently

Scholarly Writing: Ideas, Examples, and Execution

Most law schools now require upper-level students to write a sophisticated legal research paper on a topic of their choice. Scholarly Writing: Ideas, Examples, and Execution guides students through the process of constructing their legal research papers, from topic selection and thesis development to finishing a publishable product. The book walks students through a five-step process for researching and writing scholarly papers and follows multiple published student papers from idea to final execution as a method of illustrating the principles advocated in the text. The book includes up-to-date information about legal research and organizational tools. It also includes “bright ideas” that supplement the text with ideas and examples for student writers. The text may be used as either a required text for a course in Scholarly Legal Writing or a companion guide for students working on scholarly legal writing projects independently

Nicotine and what else?: HPLC elution optimization for the analysis of alkaloids found in electronic cigarettes

Electronic cigarettes, or e-cigarettes, have been scrutinized by the Food and Drug Administration and other public health organizations for issues related to quality control and efficacy. Erratic nicotine delivery and numerous toxic compounds in refill solutions have been reported. The ultimate goal of this research is to add to the growing amount of knowledge regarding e-cigarette ingredient content, safety, and quality. Standards of the tobacco alkaloids nicotine, anabasine, cotinine, and myosmine were prepared and quantified using high performance liquid chromatography (HPLC). Various elution schemes were tested and adjusted for optimal analyte resolution, and a final elution scheme was developed to characterize e-cigarette alkaloids

Slip rates and spatially variable creep on faults of the northern San Andreas system inferred through Bayesian inversion of Global Positioning System data

Fault creep, depending on its rate and spatial extent, is thought to reduce earthquake hazard by releasing tectonic strain aseismically. We use Bayesian inversion and a newly expanded GPS data set to infer the deep slip rates below assigned locking depths on the San Andreas, Maacama, and Bartlett Springs Faults of Northern California and, for the latter two, the spatially variable interseismic creep rate above the locking depth. We estimate deep slip rates of 21.5 ± 0.5, 13.1 ± 0.8, and 7.5 ± 0.7 mm/yr below 16 km, 9 km, and 13 km on the San Andreas, Maacama, and Bartlett Springs Faults, respectively. We infer that on average the Bartlett Springs fault creeps from the Earth's surface to 13 km depth, and below 5 km the creep rate approaches the deep slip rate. This implies that microseismicity may extend below the locking depth; however, we cannot rule out the presence of locked patches in the seismogenic zone that could generate moderate earthquakes. Our estimated Maacama creep rate, while comparable to the inferred deep slip rate at the Earth's surface, decreases with depth, implying a slip deficit exists. The Maacama deep slip rate estimate, 13.1 mm/yr, exceeds long-term geologic slip rate estimates, perhaps due to distributed off-fault strain or the presence of multiple active fault strands. While our creep rate estimates are relatively insensitive to choice of model locking depth, insufficient independent information regarding locking depths is a source of epistemic uncertainty that impacts deep slip rate estimates

Oregon Psychologists on Prescriptive Authority: Divided Views and Little Knowledge

With over half of all states having considered legislating prescriptive authority, an immense amount of time and money has been invested. The literature is limited in terms of understanding if opinions toward prescriptive authority are grounded in knowledge and what implications that has for altering these opinions. Following a veto of a prescriptive authority bill in Oregon, 399 licensed Oregon clinical psychologists were surveyed regarding their attitudes and knowledge. In terms of knowledge, only 6.5% knew which three states/territories currently have prescriptive authority and 70.4% were unfamiliar with any of the prerequisites for postdoctoral training in psychopharmacology. Reflecting division, 43.4% were in favor, 25.4% were undecided, and 31.2% were in opposition to broadening privileges for psychologists. Further, only 15.2% expressed interest in pursuing training or 6.7% in becoming prescribers. Data on access, training, and legislative costs were presented to participants in the education condition. These participants showed significant gains in their knowledge across all domains and their opinions shifted only in these specific areas leaving their general stance on the issue unchanged. In contrast to ardent supporters who argue that their “data should provide reassurance to psychologists spearheading legislative initiatives” because of high approval ratings (Sammons et al., 2000, p. 608), our data suggest disagreement amongst a group of professionals who are not particularly well-informed, nor interested in becoming prescribers. Future work should investigate whether expanding the data relevant to other facets of the argument contributes to further targeted change or an overall change in opinion toward prescriptive authority

The Tumor Suppressor HHEX Inhibits Axon Growth when Prematurely Expressed in Developing Central Nervous System Neurons

Neurons in the embryonic and peripheral nervoussystem respond to injury by activating transcriptional programs supportive of axon growth, ultimately resulting in functional recovery. In contrast, neurons in the adult central nervous system (CNS) possess a limited capacity to regenerate axons after injury, fundamentally constraining repair. Activating pro-regenerative gene expression in CNS neurons is a promising therapeutic approach, but progress is hampered by incomplete knowledge of the relevant transcription factors. An emerging hypothesis is that factors implicated in cellular growth and motility outside the nervous system may also control axon growth in neurons. We therefore tested sixty-nine transcription factors, previously identified as possessing tumor suppressive or oncogenic properties in non-neuronal cells, in assays of neurite outgrowth. This screen identified YAP1 and E2F1 as enhancers of neurite outgrowth, and PITX1, RBM14, ZBTB16, and HHEX as inhibitors. Follow-up experiments are focused on the tumor suppressor HHEX, one of the strongest growth inhibitors. HHEX is widely expressed in adult CNS neurons, including corticospinal tract neurons after spinal injury, but is present only in trace amounts in immature cortical neurons and adult peripheral neurons. HHEX overexpression in early postnatal cortical neurons reduced both initial axonogenesis and the rate of axon elongation, and domain deletion analysis strongly implicated transcriptional repression as the underlying mechanism. These findings suggest a role for HHEX in restricting axon growth in the developing CNS, and substantiate the hypothesis that previously identified oncogenes and tumor suppressors can play conserved roles in axon extension

Written evidence for the Justice Committee follow-up inquiry on the Coroner Service from Birkbeck and the University of Bath

The evidence in this submission derives from an ESRC-funded study, Voicing Loss (ESRC project reference ES/V002732/1), on the role of bereaved people in the coronial process. The study, conducted by the authors with colleagues Professor Penny Cooper (Birkbeck), Dr Camillia Kong (Queen Mary University of London) and Dr Hannah Rumble (University of Bath), started in May 2021 and runs until April 2024. The submission draws on the Voicing Loss empirical research findings in addressing the first question posed by the Justice Committee: ‘What progress has been made towards the goal of placing bereaved people at the heart of the Coroner Service?’ The findings reported here have not yet been published

A Theater-Based Approach to Primary Prevention of Sexual Behavior for Early Adolescents

This article compares four mixed-model analyses valid for group-randomized trials (GRTs) involving a nested cohort design with a single pretest and posttest. This study makes estimates of intraclass correlations (ICCs) available to investigators planning GRTs addressing dietary outcomes. It also provides formulae demonstrating the potential benefits to the standard error of the intervention effect (σΔ) from adjustments for both fixed and time-varying covariates and correlations over time. These estimates will allow other researchers using these variables to plan their studies by estimating a priori detectable differences and sample size requirements for any of the four analytic options. These methods are demonstrated using data from the Teens Eating for Energy and Nutrition at School study. Mixed-model analyses of covariance proved to be the most powerful analysis in that data set. The formulae may be applied to any dependent variable in any GRT given corresponding information for those variables on the parameters that define the formulae