Proposing clinician competency guidelines for the inclusion of disability in the undergraduate medical curriculum of South Africa - an exploratory study

Introduction Persons with disability make up the largest minority group in the world yet there is a dearth of research both internationally and nationally on how disability is included in professional training curricula for medical doctors. Aim of the study The purpose of this study is to add to the body of knowledge that would facilitate the inclusion of disability in the undergraduate medical curriculum in South Africa. Methods This is a mixed method, sequential study – Phase one followed by Phase two. Phase one, data was collected - via focus groups and in-depth interviews - from Medical Doctors, Medical Students, Physiotherapists, Occupational Therapists, Speech and Language Therapists and Persons with disability. Phase two used a modified Delphi Method with an expert panel of disabled and abled Disability Studies Academics, Medical Educators, Disability Rights Activists and Medical Doctors. The experts were asked to rate – using a 5-point Likert Scale - each competency according to its importance and language clarity. They were also asked in open-ended questions, to make any suggestions relating to the language of each competency and whether any competencies could be combined. 2 Findings Four main themes emerged from Phase one data: Experience of disability, Attitudes towards disability, Knowledge about Disability and Life beyond the disability. Data from these four themes contributed to the generation of an initial competency set – 17 competencies and 13 sub-competencies. In Phase two the initial competency set was presented to an expert panel as part of a modified Delphi Method. In the first iteration consensus was regarding the importance of each competency. In the second iteration consensus was reached regarding the language of each competency and a final competency set – containing 13 competencies and 9 sub-competencies - was generated. Competencies and sub-competencies 1-6 are clustered as knowledge competencies, 7-10 as attitudes and 11-13 as skills. Conclusion This study sets an important precedent for the inclusion of the subject of disability in undergraduate medical curricula. It proposes an approach to teaching and learning about disability inclusion for medical students. The list of disability specific competencies set forth by this study are a steppingstone in the process of curriculum transformation. The use of this guideline to improve the understanding of disability, and as a catalyst for undergraduate medical curriculum review is recommended

Sexual dimorphism in myocardial acylcarnitine and triglyceride metabolism

Figure S1. Concentrations of non-esterified fatty acid moieties in NOD and Wistar rats by sex. (PPTX 163 kb

HIV-Related Sexual Risk among African American Men Preceding Incarceration: Associations with Support from Significant Others, Family, and Friends

We evaluated the association between social support received from significant others, family, and friends and HIV-related sexual risk behaviors among African American men involved in the criminal justice system. Project DISRUPT is a cohort study among African American men released from prison in North Carolina (N = 189). During the baseline (in-prison) survey, we assessed the amount of support men perceived they had received from significant others, family, and friends. We measured associations between low support from each source (<median value) and participants' sex risk in the 6 months before incarceration. Low levels of social support from significant others, family, or friends were associated with poverty and homelessness, mental disorders, and substance use. Adjusting for age, poverty, and other sources of support, perceiving low support from significant others was strongly associated with multiple partnerships (fully adjusted odds ratio (OR) 2.64, 95% confidence interval (CI) 1.29-5.42). Low significant other support also was strongly associated with sex trade involvement when adjusting for age and poverty status (adjusted OR 3.51, 95% CI 1.25-9.85) but further adjustment for low family and friend support weakened the association (fully adjusted OR 2.81, 95% CI 0.92-8.55). Significant other support was not associated with other sex risk outcomes including concurrent partnerships, anal sex, or sex with an STI/HIV-infected partner. Low family support was associated with multiple partnerships in analyses adjusting for age and poverty (adjusted OR 1.98, 95% CI 1.05-3.76) but the association weakened and was no longer significant after adjusting for other sources of support (fully adjusted OR 1.40, 95% CI 0.65-3.00); family support was not correlated with other risk behaviors. Friend support was not significantly associated with sex risk outcomes. Indicators of overall support from any source were not associated with sex risk outcomes. Helping inmates maintain ties may improve economic security and well-being during community re-entry, while supporting and strengthening relationships with a significant other in particular may help reduce sex risk. Studies should evaluate the protective effects of distinct support sources to avoid masking effects of support and to best understand the influence of social support on health

Forested Wetlands of the Southern United States: A Bibliography

The term forested wetland covers a variety of forest types including mangroves, cypress/tupelo swamps, bottomland hardwoods, pocosins and Carolina bays, flatwoods, and mountain fens. These forests are dominated by woody species that have morphological features, physiological adaptations, and/or reproductive strategies enabling them to achieve maturity and reproduce in an environment where the soils within the rooting zone may be inundated or saturated for various periods during the growing season. Although alluvial floodplains occur along most streams of the United States, they are most extensive in the Atlantic Coastal Plain, Gulf Coastal Plain, and Mississippi Alluvial Plain. Only about half of the original floodplain forests remained by the 1930s, and conversion to agriculture continued at an accelerated pace during the 1960s and 1970s.The purpose of this bibliography is to provide a detailed listing of references for students and researchers of the varied studies conducted in these forest types

Benefit-Cost Analysis of FEMA Hazard Mitigation Grants

Mitigation ameliorates the impact of natural hazards on communities by reducing loss of life and injury, property and environmental damage, and social and economic disruption. The potential to reduce these losses brings many benefits, but every mitigation activity has a cost that must be considered in our world of limited resources. In principle benefit-cost analysis (BCA) can be used to assess a mitigation activity’s expected net benefits (discounted future benefits less discounted costs), but in practice this often proves difficult. This paper reports on a study that refined BCA methodologies and applied them to a national statistical sample of FEMA mitigation activities over a ten-year period for earthquake, flood, and wind hazards. The results indicate that the overall benefit-cost ratio for FEMA mitigation grants is about 4 to 1, though the ratio varies according to hazard and mitigation type.

Educational Interventions to Improve Advance Care Planning Discussions, Documentation and Billing

Background/Objectives: To determine the impact of educational interventions, clinic workflow redesign, and quality improvement coaching on the frequency of advance care planning (ACP) activities for patients over the age of 65. Design: Nonrandomized before-and-after study. Setting: 13 ambulatory care clinics with 81 primary care providers in eastern and central North Carolina. Participants: Patients across 13 primary care clinics staffed by 66 physicians, 8 physician assistants and 7 family nurse practitioners. Interventions: Interprofessional, interactive ACP training for the entire interprofessional team and quality improvement project management with an emphasis on workflow redesign. Measurements: From July 2017 through June 2018—number of ACP discussions, number of written ACP documents incorporated into the electronic medical record (EMR), number of ACP encounters billed. Results: Following the interventions, healthcare providers were more than twice as likely to conduct ACP discussions with their patients. Patients were 1.4 times more likely to have an ACP document included in their electronic medical record. Providers were significantly (p < 0.05) more likely to bill for an ACP encounter in only one clinic. Conclusions: Implementing ACP education for all clinic staff, planning for workflow changes to involve the entire interprofessional team and supporting ACP activities with quality improvement coaching leads to statistically significant improvements in the frequency of ACP discussions, the number of ACP documents included in the electronic medical record and number of ACP encounters billed

The Lantern Vol. 76, No. 2, Spring 2009

• Coffee and Morning • Charlie Brown Testifies at the Trial of Westley Allan Dodd, Convicted Child Killer • In a Women\u27s Bathroom • The Naming • An Urban Nightmare • In the Yellow Kitchen • City Streets • Engineering • Walter Bixby Walks Through Hunsberger Woods • Sing a Happy Tune • Apology • Will You Wear a Helmet?! • Molly Can\u27t Answer the Phone • Marked Man • He\u27s Under a Lot of Pressure • Ne Me Quitte Pas • Last Night • All of Our Second Hand Books are Lightly Wornhttps://digitalcommons.ursinus.edu/lantern/1174/thumbnail.jp

Risk Factors for First Cerebrospinal Fluid Shunt Infection: Findings from a Multi-Center Prospective Cohort Study

ObjectiveTo quantify the extent to which cerebrospinal fluid (CSF) shunt revisions are associated with increased risk of CSF shunt infection, after adjusting for patient factors that may contribute to infection risk.Study designWe used the Hydrocephalus Clinical Research Network registry to assemble a large prospective 6-center cohort of 1036 children undergoing initial CSF shunt placement between April 2008 and January 2012. The primary outcome of interest was first CSF shunt infection. Data for initial CSF shunt placement and all subsequent CSF shunt revisions prior to first CSF shunt infection, where applicable, were obtained. The risk of first infection was estimated using a multivariable Cox proportional hazard model accounting for patient characteristics and CSF shunt revisions, and is reported using hazard ratios (HRs) with 95% CI.ResultsOf the 102 children who developed first infection within 12 months of placement, 33 (32%) followed one or more CSF shunt revisions. Baseline factors independently associated with risk of first infection included: gastrostomy tube (HR 2.0, 95% CI, 1.1, 3.3), age 6-12 months (HR 0.3, 95% CI, 0.1, 0.8), and prior neurosurgery (HR 0.4, 95% CI, 0.2, 0.9). After controlling for baseline factors, infection risk was most significantly associated with the need for revision (1 revision vs none, HR 3.9, 95% CI, 2.2, 6.5; ≥2 revisions, HR 13.0, 95% CI, 6.5, 24.9).ConclusionsThis study quantifies the elevated risk of infection associated with shunt revisions observed in clinical practice. To reduce risk of infection risk, further work should optimize revision procedures