Project Home Evaluation: Final Report

Evaluates a New York State Department of Health-funded project to help nursing home patients move home or into community-based settings through discharge planning services, training, and education. Examines differentiating factors such as Medicaid status

Disentangling the Relationship Between Deformed wing virus, the Honey Bee Host (Apis mellifera) and the Viral Vector, the Ectoparasitic Mite Varroa destructor

The ectoparasitic mite Varroa destructor is indisputably the most significant driver of global colony losses of the Western honeybee, Apis mellifera. Colony deaths are frequently attributed to Deformed wing virus (DWV), which is vectored by the mite. In this thesis I attempt to disentangle the tripartite relationship between DWV, A. mellifera and V. destructor, by investigating whether the two major DWV genotypes, A and B, differ from the point of view of the virus, the honey bee and the mite. First, I assessed the viral accumulation dynamics of multiple DWV genotypes during single or co-infection in Australian pupae (naïve to both DWV and Varroa). I found that DWV-B accumulated to higher levels than DWV-A when singly and co-injected, suggesting that DWV-B is able to outcompete DWV-A. Yet despite higher viral loads, DWV-B was associated with the lowest level of mortality. Therefore, I next investigated if the bees’ immune system reacted differently to the two DWV genotypes. I examined the expression of 19 immune genes and analysed the small RNA response of pupae exposed to DWV-A and DWV-B. Overall, I found little evidence to indicate that A. mellifera responds differently to either genotype. Finally, to uncover what role vector transmission by V. destructor plays in DWV genotype prevalence at the colony level, I experimentally increased and decreased the number of mites within A. mellifera colonies and analysed viral loads over a period of ten months. I found that DWV-A was strongly affected by mite numbers, whereas DWV-B persisted in the presence and absence of V. destructor. Overall, my thesis furthers our understanding of the intricate relationship between DWV, A. mellifera and V. destructor, and provides insight into some of the factors that may be contributing to the increasing prevalence of DWV-B

So much more than a “pair of brown shoes”: Triumphs of patient and other stakeholder engagement in patient-centered outcomes research

This piece illustrates the “real world” experiences of patients and other stakeholder partners in research to help inform and inspire future patient-centered outcomes research (PCOR) efforts. The Patient-Centered Outcomes Research Institute (PCORI) was created in 2010 to fund research that helps patients, clinicians, and other healthcare stakeholders make informed health decisions. The first 50 funded PCORI Pilot Projects engaged patients, caregivers, parents, patient advocates, clinicians, and other non-traditional research stakeholders to serve in advisory and leadership positions on their research teams, many for the first time. In interviews with seven patients and other stakeholders, several lessons learned emerged, including how to build confidence over the course of a research project; how to offer translation and interpretation insights reflective of practical experience; how to understand the benefits and limitations to stakeholder participation; and how to positively influence the research process and study outcomes. By the completion of their Pilot Projects, the stakeholder partners profiled here considered themselves “empowered” research contributors. The authors are hopeful these stories will encourage more patients and other stakeholders to contribute their time and experiential learnings to improve the process, and results of, PCOR

Development and Identification of Soybean Plants with an Increased Tolerance to Osmotic Stress

Choline oxidase A is an enzyme in the two-step oxidation reaction of choline to glycine betaine, an osmoregulator. As a cell is subjected to osmotic stress such as an increase in salinity, glycine betaine accumulates in the cell’s cytoplasm to modulate the salt concentration. This maintains the cell’s water homeostasis, preventing the cell from bursting. Soybeans, in particular, are sensitive to soil salinity and low producers of glycine betaine. Since soybeans are of great economic importance to the U.S. economy, efforts to increase glycine betaine synthesis in soybeans with the aim of increasing their salt tolerance would be beneficial. In our experiment we are attempting to insert the gene for choline oxidase A (cox) into soybeans via the agrobacterium-mediated transformation method in an effort to increase glycine betaine synthesis

Conservative interventions for urinary or faecal incontinence, or both, in adults with multiple sclerosis

© 2018 The Cochrane Collaboration. This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of conservative interventions for urinary or faecal incontinence (or both) in adults with multiple sclerosis, compared to no treatment, sham and usual care, any other active treatment, or another conservative treatment. To critically appraise and summarise the current evidence on resource use, costs and cost effectiveness of conservative interventions for adults with urinary or faecal incontinence (or both) and MS. We will make the following comparisons. Conservative treatment versus no treatment Conservative treatment versus sham treatment Conservative treatment versus usual care Conservative treatment versus pharmacological treatment Conservative treatment versus surgical treatment Conservative treatment versus any other conservative treatmen

Disagreeable Privacy Policies: Mismatches between Meaning and Users’ Understanding

Privacy policies are verbose, difficult to understand, take too long to read, and may be the least-read items on most websites even as users express growing concerns about information collection practices. For all their faults, though, privacy policies remain the single most important source of information for users to attempt to learn how companies collect, use, and share data. Likewise, these policies form the basis for the self-regulatory notice and choice framework that is designed and promoted as a replacement for regulation. The underlying value and legitimacy of notice and choice depends, however, on the ability of users to understand privacy policies. This paper investigates the differences in interpretation among expert, knowledgeable, and typical users and explores whether those groups can understand the practices described in privacy policies at a level sufficient to support rational decision-making. The paper seeks to fill an important gap in the understanding of privacy policies through primary research on user interpretation and to inform the development of technologies combining natural language processing, machine learning and crowdsourcing for policy interpretation and summarization. For this research, we recruited a group of law and public policy graduate students at Fordham University, Carnegie Mellon University, and the University of Pittsburgh (“knowledgeable users”) and presented these law and policy researchers with a set of privacy policies from companies in the e-commerce and news & entertainment industries. We asked them nine basic questions about the policies’ statements regarding data collection, data use, and retention. We then presented the same set of policies to a group of privacy experts and to a group of non-expert users. The findings show areas of common understanding across all groups for certain data collection and deletion practices, but also demonstrate very important discrepancies in the interpretation of privacy policy language, particularly with respect to data sharing. The discordant interpretations arose both within groups and between the experts and the two other groups. The presence of these significant discrepancies has critical implications. First, the common understandings of some attributes of described data practices mean that semi-automated extraction of meaning from website privacy policies may be able to assist typical users and improve the effectiveness of notice by conveying the true meaning to users. However, the disagreements among experts and disagreement between experts and the other groups reflect that ambiguous wording in typical privacy policies undermines the ability of privacy policies to effectively convey notice of data practices to the general public. The results of this research will, consequently, have significant policy implications for the construction of the notice and choice framework and for the US reliance on this approach. The gap in interpretation indicates that privacy policies may be misleading the general public and that those policies could be considered legally unfair and deceptive. And, where websites are not effectively conveying privacy policies to consumers in a way that a “reasonable person” could, in fact, understand the policies, “notice and choice” fails as a framework. Such a failure has broad international implications since websites extend their reach beyond the United States

Self-help cognitive behaviour therapy for working women with problematic hot flushes and night sweats (MENOS@Work): a multicentre randomised controlled trial

Objective: The aim of the study was to examine the efficacy of an unguided, self-help cognitive behavior therapy (SH-CBT) booklet on hot flush and night sweat (HFNS) problem rating, delivered in a work setting. Methods: Women aged 45 to 60 years, having 10 or more problematic HFNS a week, were recruited to a multicenter randomized controlled trial, via the occupational health/human resources departments of eight organizations. Participants were 1:1 randomized to SH-CBT or no treatment waitlist control (NTWC). The primary outcome was HFNS problem rating; secondary outcomes included HFNS frequency, work and social adjustment, sleep, mood, beliefs and behaviors, and work-related variables (absence, performance, turnover intention, and work impairment due to presenteeism). Intention-to-treat analysis was used, and between-group differences estimated using linear mixed models. Results: A total of 124 women were randomly allocated to SH-CBT ( n  = 60) and NTWC ( n  = 64). 104 (84%) were assessed for primary outcome at 6 weeks and 102 (82%) at 20 weeks. SH-CBT significantly reduced HFNS problem rating at 6 weeks (SH-CBT vs NTWC adjusted mean difference, −1.49; 95% CI, −2.11 to −0.86; P  < 0.001) and at 20 weeks (−1.09; 95% CI, −1.87 to −0.31; P  < 0.01). SH-CBT also significantly reduced HFNS frequency, improved work and social adjustment; sleep, menopause beliefs, HFNS beliefs/behaviors at 6 and 20 weeks; improved wellbeing and somatic symptoms and reduced work impairment due to menopause-related presenteeism at 20 weeks, compared with the NTWC. There was no difference between groups in other work-related outcomes. Conclusions: A brief, unguided SH-CBT booklet is a potentially effective management option for working women experiencing problematic HFNS

Study protocol of a multicentre randomised controlled trial of self-help cognitive behaviour therapy for working women with menopausal symptoms (MENOS@Work)

Background Hot flushes and night sweats (HFNS) – the main symptoms of the menopause transition – can reduce quality of life and are particularly difficult to manage at work. A cognitive behaviour therapy (CBT) intervention has been developed specifically for HFNS that is theoretically based and shown to reduce significantly the impact of HFNS in several randomised controlled trials (RCTs). Self-help CBT has been found to be as effective as group CBT for these symptoms, but these interventions are not widely available in the workplace. This paper describes the protocol of an RCT aiming to assess the efficacy of CBT for menopausal symptoms implemented in the workplace, with a nested qualitative study to examine acceptability and feasibility. Methods/Design One hundred menopausal working women, aged 45–60 years, experiencing bothersome HFNS for two months will be recruited from several (2–10) large organisations into a multicentre randomised controlled trial. Women will be randomly assigned to either treatment (a self-help CBT intervention lasting 4 weeks) or to a no treatment-wait control condition (NTWC), following a screening interview, consent, and completion of a baseline questionnaire. All participants will complete follow-up questionnaires at 6 weeks and 20 weeks post-randomisation. The primary outcome is the rating of HFNS; secondary measures include HFNS frequency, mood, quality of life, attitudes to menopause, HFNS beliefs and behaviours, work absence and presenteeism, job satisfaction, job stress, job performance, disclosure to managers and turnover intention. Adherence, acceptability and feasibility will be assessed at 20 weeks post-randomisation in questionnaires and qualitative interviews. Upon trial completion, the control group will also be offered the intervention. Discussion This is the first randomised controlled trial of a self-management intervention tailored for working women who have troublesome menopausal symptoms