Doctor without borders : he's a physician who covers huge stretches of rural Texas -- and whose work provides key lessons about the fate and future of rural health care in America

textDr. Jim Luecke, a rural family physician in Alpine, Texas, is one of six doctors responsible for thousands of patients across a sprawling 25,000 square foot remote region of the state. He is a community doctor that travels between three towns to treat patients with various illnesses, injuries and income levels. But his type of general medicine is a dying practice in Texas, especially in rural areas. Texas, with a primary care and family physician shortage likely to get worse over the next several years, faces continued obstacles in providing access to quality healthcare in some of its most isolated areas. Luecke, while he embodies some of the challenges that come with practicing rural medicine, is in some ways an exception to those challenges.Journalis

The timing and duration of estradiol on social behavior and gene expression in mature adult and aging female rats

Menopause causes declines in ovarian hormones such as estrogens and progesterone. During the menopausal transition, women may experience adverse symptoms such as anxiety, depression and lack of desire to interact. However, since the publication of the Women’s Health Initiative (WHI) many women have been left asking questions about whether, when, and how long to take hormone treatments for menopausal symptoms. This dissertation focuses on the effects of timing and duration of estradiol (E2) relative to loss of ovarian hormones (OVX) on the social brain and behavior in mature adult (MAT) and aging (AG) female rats. The results from these studies illustrated that in MAT rats, 3-months of E2 given immediately following OVX decreased communications and social interactions between cagemates, as assessed in a test quantifying the number of ultrasonic vocalizations emitted, as well as time spent interacting with one another. I interpret this result to mean that the E2 animals had improved social memory. In MAT rats gene expression of the neuropeptides (Oxt, Avp, Oxtr, Avpr1a) involved in regulating social behavior were also greater in the BNST, MeA, and SON of rats treated with estradiol compared to vehicle. Because menopause typically happens at middle age, I conducted a similar experiment in middle-aged rats to assess the influence of estradiol deprivation or replacement in aging rats. Aging animals were behaviorally characterized twice (at 3 and 6-months), groups were given different timing and duration of estradiol or vehicle treatments as a model for the WHI. Similar to the MAT animals, the estradiol-treated AG rats called less than their vehicle counterparts during an ultrasonic vocalization test conducted at the 3-month testing period. However, at the 6-month testing period no differences were observed, which could be the result of aging. Oxt, Oxtr, Avp and Avpr1a showed unique gene expression patterns that were dependent upon the timing and duration of estradiol in a region-specific manner in the AG rats. Most genes were up-regulated by estradiol treatment, irrespective of timing or duration. Overall this work may benefit the field of women’s health through new knowledge on consequences of age, and the timing and duration of estrogen treatment, on the social brain and behavior.Psycholog

Hunting in times of change: Uncovering indigenous strategies in the Colombian amazon using a role-playing game

Despite growing industrialization, the shift to a cash economy and natural resource overexploitation, indigenous people of the Amazon region hunt and trade wildlife in order to meet their livelihood requirements. Individual strategies, shaped by the hunters' values and expectations, are changing in response to the region's economic development, but they still face the contrasting challenges of poverty and overhunting. For conservation initiatives to be implemented effectively, it is crucial to take into account people's strategies with their underlying drivers and their adaptive capabilities within a transforming socio-economic environment. To uncover hunting strategies in the Colombian Amazon and their evolution under the current transition, we co-designed a role-playing game together with the local stakeholders. The game revolves around the tension between ecological sustainability and food security—hunters' current main concern. It simulates the mosaic of activities that indigenous people perform in the wet and dry season, while also allowing for specific hunting strategies. Socio-economic conditions change while the game unfolds, opening up to emerging alternative potential scenarios suggested by the stakeholders themselves. Do hunters give up hunting when given the opportunity of an alternative income and protein source? Do institutional changes affect their livelihoods? We played the game between October and December 2016 with 39 players—all of them hunters—from 9 different communities within the Ticoya reserve. Our results show that providing alternatives would decrease overall hunting effort, but impacts are not spatially homogenous. Legalizing trade could lead to overhunting except when market rules and competition come into place. When it comes to coupled human-nature systems, the best way forward to produce socially just and resilient conservation strategies might be to trigger an adaptive process of experiential learning and scenario exploration. The use of games as “boundary objects” can guide stakeholders through the process, eliciting the plurality of their strategies, their drivers and how outside change affects them

The Effects of Patellofemoral Taping on Patellofemoral Joint Alignment and Contact Area

Purpose/Hypothesis: It is widely accepted that patellofemoral pain (PFP) is the result of excessive stress between the retro-patellar surface and the femoral trochlea. Elevated patellofemoral joint (PFJ) stress may be associated with a reduction in PFJ contact area resulting from patellar malalignment (e.g., lateral displacement, lateral tilt, or patellar alta and/or quadriceps imbalance). McConnell and Kinesio taping techniques are commonly used to address PFP and improve PFJ alignment. It has been theorized that PFJ taping can alter the PFJ alignment which may increase the patella’s contact area within the femoral trochlea, thereby resulting in a reduction in PFP. To date, the effects of these 2 taping approaches on PFJ contact area and PFJ alignment have not yet been studied thoroughly. The primary purpose of this study was to use magnetic resonance imaging (MRI) to examine the effects of patellofemoral taping techniques on PFJ alignment and contact area in persons with PFP at 3 knee joint angles (0°, 20°, and 40°). Number of Subjects: Fourteen female subjects with retropatellar pain and PFJ malalignment participated (age: 27.86 ± 5.95 years; weight: 72.15 ± 19.27 kg; height: 1.67 ± .08 m). Methods: Each subject underwent a pre-taping magnetic resonance imaging (MRI) scan session and 2 MRI scan sessions after the application of the 2 taping techniques aiming to correct lateral patellar displacement. Subjects were asked to report their pain using an 11- point numeric rating scale (NRS) while stepping down from a 23-cm step, before and after tape was administered. During each scan session, subjects were loaded with 25% of body weight on their involved/more symptomatic leg at 0°, 20°, and 40° of knee flexion. The outcome measures included patellar lateral displacement (bisect-offset (BSO) index), patellar mediolateral tilt (patellar tilt angle (PTA)), patellar position (Insall-Salvati ratio (ISR)), PFJ contact area, and NRS. PFJ alignment/contact area was compared among the 3 conditions (No tape, Kinesio, and McConnell) at 3 knee angles using a two-way ANOVA with repeated measures. Pain NRS was compared among the 3 conditions using Friedman test and post-hoc Wilcoxon signed-rank tests. Results: The results of the two-way ANOVAs revealed that neither McConnell nor Kinesio taping had significant effects on BSO index (p = 0.488), PTA (p = 0.558), ISR (p = 0.778), and contact area (p = 0.358) across the 3 knee flexion angles. Knee flexion angle had a significant effect on BSO index (p = 0.001) and contact area (p \u3c 0.001). The Friedman test revealed a significant difference in pain level among the 3 conditions. The post-hoc Wilcoxon signed-rank tests further demonstrated that there was a reduction in NRS during step-down test after the application of the Kinesio Taping technique (p=.007). Conclusions: In a weight-bearing condition, our results did not support the premise that applications of PFJ taping using a medial correction technique can alter the PFJ contact area or alignment of the patella. The reduction in pain, following the application of the Kinesio Taping technique performed in this study supports the previous literature on the use of Kinesio Taping techniques for pain management, although the underlying mechanism for the reduction of pain is unclear

Indicadores para evaluación del acceso vascular de pacientes en hemodiálisis

Os objetivos deste estudo foram construir indicadores para avaliar a qualidade das práticas assistenciais relacionadas ao acesso vascular de usuários em hemodiálise (HD) e proceder à validação dos indicadores. As etapas para elaborar os indicadores constituíram-se de seleção das práticas assistenciais relacionadas ao acesso vascular, fundamentação teórica dessas práticas e construção de quatro indicadores, segundo o modelo Donabediano: desempenho de cateter temporário duplo lúmen para HD, manutenção de cateter temporário de duplo lúmen, monitoramento de fístula arteriovenosa e complicações de fístula arteriovenosa. A coleta de dados ocorreu entre outubro e novembro de 2008, por meio de um questionário composto pelo julgamento do manual operacional, dos atributos dos indicadores e de seus componentes. A validação foi realizada por nove juízes, e todos os indicadores foram validados sob o consenso mínimo de 75%. Acredita-se que o emprego dessa ferramenta contribua para a avaliação e gestão da qualidade nos serviços de hemodiálise.The purpose of this study was to develop reliable assessment instruments to measure hemodialysis vascular access. The design of healthcare indicators involved an indepth-analysis of vascular access practices in hemodialysis and their underlying theoretical rationale, and was grounded on Donabedian's framework. Four indicators were selected: performance of temporary double-lumen catheter, maintenance of temporary double-lumen catheter, monitoring of arteriovenous fistula and complications of arteriovenous fistulas. The first three are process-oriented while the last one relate to outcomes. Data was collected in October and November 2008 using a tree-part questionnaire, thus divided: assessment of the indicators' operations manual, assessment of health attributes of the indicators and assessment of each of the components. The validation of the indicators was carried out by a panel of nine internationally renowned experts in nephrology. All indicators were validated by the panel, with at least a 75% favorable consensus. It is believed that the use of this instrument contributes for evaluation and improvement of quality in hemodialysis services.Los objetivos de este estudio fueron construir indicadores para evaluar la calidad de las prácticas asistenciales relacionadas al acceso vascular de pacientes en hemodiálisis (HD) y proceder a la validación de tales indicadores. Las etapas para elaborar los indicadores se constituyeron de selección de las prácticas asistenciales relacionadas al acceso vascular, fundamentación teórica de esas prácticas y construcción de cuatro indicadores, según el modelo Donabediano: desempeño de catéter temporario doble lumen para HD, mantenimiento de catéter temporario de doble lumen, monitoreo de fístula arteriovenosa y complicaciones de fístula arteriovenosa. La recolección de datos se efectuó entre octubre y noviembre de 2008, a través de un cuestionario compuesto por el juicio del manual operacional, de los atributos de los indicadores y de sus componentes. La validación fue realizada por nueve jueces, y todos los indicadores fueron validados bajo un consenso mínimo de 75%. Se cree que el empleo de esa herramienta haya de contribuir en la evaluación y gestión de calidad en los servicios de hemodiálisis

What Does it Take to Develop Assessments of Mathematical Knowledge for Teaching?: Unpacking the Mathematical Work of Teaching

In the context of the increased mathematical demands of the Common Core State Standards and data showing that many elementary school teachers lack strong mathematical knowledge for teaching, there is an urgent need to grow teachers’ MKT. With this goal in mind, it is crucial to have research and assessment tools that are able to measure and track aspects of teachers’ MKT at scale. Building on the concept of “mathematical tasks of teaching” (Ball et al., 2008), we report on a new framework that unpacks the mathematical work of teaching that could serve as a scaffold for item writers who are developing assessments of MKT. We argue that this framework supports a focus on the mathematical work of teaching that moves beyond common content knowledge but without moving into a space of pedagogical choice. We also illustrate how the framework was constructed to highlight connections within and across the mathematical content of elementary school. The mathematical work of teaching framework has implications for assessment development at scale, and could be useful as an organizing tool in mathematics teacher education efforts to grow teachers’ MKT

Small Molecule and Polymer Effects on Bio-mimetic Sensors

Formation of biomimetic membranes for the purpose of producing a protein based infrared biosensor has proven to be a difficult obstacle. Several methods have been employed and reproducibility is becoming more frequent. The use of polystyrene as an adhesion layer between the biomimetic and diamond surfaces is the most reliable form of reproducibility yet encountered. Unique properties of acetylcholine esterase based biosensors include infrared absorption bands that are not present in either the organo-phosphorous compounds or polystyrene used in this study. This information lends further weight for the practical use of infrared-ATR biosensor for the use of detecting organo-phosphorous nerve agents

Employment Exchange Opportunities for Teens and Adults with Autism

The purpose of this project was to create a resource guide which includes information about the steps an individual with autism (AS) or Asperger syndrome (ASD) must take with the Department of Rehabilitation (DOR) to gain vocational support services within Marin County. The resource guide also includes information about the variety of services available to support individuals with autism and Asperger syndrome, both from the DOR and from private agencies. The effectiveness of the resource guide is of significance as there are many young adults with autism or AS in Marin County who are transitioning from school to employment. Additionally, the guide is a valuable resource to potential employers as it introduces vocation related attributes of a young adult with AS or ASD and highlights the benefits of employing a young adult with AS or ASD

User Guide for the 4-H Livestock Weight Calculators

This fact sheet is a user\u27s guide for the 4-H livestock weight calculators