The state of care transitions education: A survey of AGS teachers section members

posterCare transitions pose significant risks for older and more complex medical patients, including medication errors and rehospitalizations. Unfortunately, few medical schools and residency programs provide targeted care transitions training. Changes in the healthcare system, including coordination of care provisions in the Affordable Care Act and proposed CMS billing codes for care coordination underscore the need for future health professionals to perform care transitions effectively. Given the impact of care transitions on older adults, we sought to determine the extent to which geriatric educators currently address care transitions education

Depression, physical activity and mental health: an interpretative phenomenological analysis of healthcare professionals’ attitudes to exercise referral schemes

Depression is, today more than ever, a profoundly serious public health concern in the UK, impacting upon the lives of individuals from all social backgrounds and strata (Yohannes & Caton, 2010). Moreover, and contrary to the often-held stereotype of a relatively simple disorder of mood, the condition manifests in an additional array of psychological and somatic symptoms such as “…loss of interest and pleasure, loss of appetite, weight loss/gain, sleep disturbance, psychomotor agitation or retardation, energy decrease, sense of worthlessness, guilt, difficulty in concentrating, or thoughts of suicide.” (Legrand & Heuze, 2007, p.348). In recent years a body of research has emerged dedicated to exploring the value and impacts of exercise in assisting individuals suffering from depression (see Callaghan, Khalil, Morres, & Carter, 2011; Carter, Callaghan, Khalil, & Morres, 2012), and Exercise Referral Schemes (ERS) have been developed to provide access to structured programmes of physical activity. Robust evidence indicates that such physical activity can have strong positive impacts upon the rehabilitation process, not least in terms of enhancing happiness with physical appearance and providing venues for social interaction (Daley, MacArthur, & Winter, 2007; Johnson & Taliaferro, 2011). Despite the well-documented success of various ERSs, and the relative affordability thereof when compared to CBT or pharmaceutical options, however, rates of such referral in cases of mild to moderate depression are low (Callaghan, Khalil, Morres, & Carter, 2011). The research reported in this paper stems from a high-definition investigation of the attitudes of a small number of General Practioners in the North West (N=4), utilising Interpretative Phenomenological Analysis (Pringle, Drummond, McLafferty, & Hendry, 2011; Smith, Flowers, & Larkin, 2009) to reveal how such attitudes are embedded in first- and second-hand experience of ERSs, with a view to illuminating why progress toward their wider use remains slow in the locale. References: Callaghan, P., Khalil, E., Morres, I., & Carter, T. (2011). Pragmatic randomised controlled trial of preferred intensity exercise in women living with depression. BMC Public Health, 11, 465-465. Carter, T., Callaghan, P., Khalil, E., & Morres, I. (2012). The effectiveness of a preferred intensity exercise programme on the mental health outcomes of young people with depression: A sequential mixed methods evaluation. BMC Public Health, 12, 187-187. Daley, A. J., MacArthur, C., & Winter, H. (2007). Brief report: The role of exercise in treating postpartum depression: A review of the literature. Journal of Midwifery and Women's Health, 52, 56-62. Johnson, K. E., & Taliaferro, L. A. (2011). Relationships between physical activity and depressive symptoms among middle and older adolescents: A review of the research literature. Journal for Specialists in Pediatric Nursing, 16(4), 235-251. Legrand, F., & Heuze, J. P. (2007). Antidepressant effects associated with different exercise conditions in participants with depression: A pilot study. Journal of Sport & Exercise Psychology, 29(3), 348-364. Pringle, J., Drummond, J., McLafferty, E., & Hendry, C. (2011). Interpretative phenomenological analysis: A discussion and critique. Nurse Researcher, 18(3), 20-24. Smith, J. A., Flowers, P., & Larkin, M. (2009). Interpretative phenomenological analysis: Theory, method and research. London: Sage. Yohannes, A. M., & Caton, S. (2010). Management of depression in older people with osteoarthritis: A systematic review. Aging & Mental Health, 14(6), 637-651

Nonlinear Scattering of a Bose-Einstein Condensate on a Rectangular Barrier

We consider the nonlinear scattering and transmission of an atom laser, or Bose-Einstein condensate (BEC) on a finite rectangular potential barrier. The nonlinearity inherent in this problem leads to several new physical features beyond the well-known picture from single-particle quantum mechanics. We find numerical evidence for a denumerably infinite string of bifurcations in the transmission resonances as a function of nonlinearity and chemical potential, when the potential barrier is wide compared to the wavelength of oscillations in the condensate. Near the bifurcations, we observe extended regions of near-perfect resonance, in which the barrier is effectively invisible to the BEC. Unlike in the linear case, it is mainly the barrier width, not the height, that controls the transmission behavior. We show that the potential barrier can be used to create and localize a dark soliton or dark soliton train from a phonon-like standing wave.Comment: 15 pages, 15 figures, new version includes clarification of definition of transmission coefficient in general nonlinear vs. linear cas

Empowering Faculty to Support Academic Persistence through a Blended, Scholarship-Based Faculty Professional Development Program: The Persistence Scholars Program

While it is well-known that faculty-student interaction is key to student success, few institutions have directly leveraged faculty in supporting academic persistence. Many myths about persistence proliferate, and faculty can unwittingly hinder persistence by implementing the wrong kinds of practices. Faculty are most empowered to support student persistence when they understand and care about this issue. They are also better equipped to help when they have a good, current command of the body of knowledge relating to persistence. To address this, we created a blended faculty development program to engage faculty in the scholarship of academic persistence, addressing myths and misconceptions about persistence, and expanding understanding of what it is like to be a first-year student at our university. The Persistence Scholars Program engaged a total of 32 faculty over two semesters, beginning with pre-readings and an in-person daylong workshop followed by an eight or ten-week course. The curriculum was built around a central text, Completing College by Vincent Tinto, and selected empirical and germane articles. Participants engaged in online discussions and two experiential projects, including one that asked them to complete an activity that would enhance their understanding of first-year students’ experiences. Assessments of this program focused on participant ratings of target competencies (e.g., the ability to identify and dispel myths about why students persist), perception of usefulness of different specific assignments and materials, and suggestions for how the program can be refined for future cohorts

Intra-articular Injection of HB-IGF-1 Sustains Delivery of IGF-1 to Cartilage through Binding to Chondroitin Sulfate

Objective: Insulin-like growth factor 1 (IGF-1) stimulates cartilage repair but is not a practical therapy due to its short half-life. We have previously modified IGF-1 by adding a heparin-binding domain and have shown that this fusion protein (HB-IGF-1) stimulates sustained proteoglycan synthesis in cartilage. This study was undertaken to examine the mechanism by which HB-IGF-1 is retained in cartilage and to test whether HB-IGF-1 provides sustained growth factor delivery to cartilage in vivo and to human cartilage explants. Methods: Retention of HB-IGF-1 and IGF-1 was analyzed by Western blotting. The necessity of heparan sulfate (HS) or chondroitin sulfate (CS) glycosaminoglycans (GAGs) for binding was tested using enzymatic removal and cells with genetic deficiency of HS. Binding affinities of HB-IGF-1 and IGF-1 proteins for isolated GAGs were examined by surface plasmon resonance and enzyme-linked immunosorbent assay. Results: In cartilage explants, chondroitinase treatment decreased binding of HB-IGF-1, whereas heparitinase had no effect. Furthermore, HS was not necessary for HB-IGF-1 retention on cell monolayers. Binding assays showed that HB-IGF-1 bound both CS and HS, whereas IGF-1 did not bind either. After intraarticular injection in rat knees, HB-IGF-1 was retained in articular and meniscal cartilage, but not in tendon, consistent with enhanced delivery to CS-rich cartilage. Finally, HB-IGF-1 was retained in human cartilage explants but IGF-1 was not. Conclusion: Our findings indicate that after intraarticular injection in rats, HB-IGF-1 is specifically retained in cartilage through its high abundance of CS. Modification of growth factors with heparin-binding domains may be a new strategy for sustained and specific local delivery to cartilage.National Institute of Biomedical Imaging and Bioengineering (U.S.) (Grant EB-003805)National Institute of Arthritis and Musculoskeletal and Skin Diseases (U.S.) (Grant AR-045779

UNC-98 links an integrin-associated complex to thick filaments in Caenorhabditis elegans muscle

Focal adhesions are multiprotein assemblages that link cells to the extracellular matrix. The transmembrane protein, integrin, is a key component of these structures. In vertebrate muscle, focal adhesion–like structures called costameres attach myofibrils at the periphery of muscle cells to the cell membrane. In Caenorhabditis elegans muscle, all the myofibrils are attached to the cell membrane at both dense bodies (Z-disks) and M-lines. Clustered at the base of dense bodies and M-lines, and associated with the cytoplasmic tail of β-integrin, is a complex of many proteins, including UNC-97 (vertebrate PINCH). Previously, we showed that UNC-97 interacts with UNC-98, a 37-kD protein, containing four C2H2 Zn fingers, that localizes to M-lines. We report that UNC-98 also interacts with the C-terminal portion of a myosin heavy chain. Multiple lines of evidence support a model in which UNC-98 links integrin-associated proteins to myosin in thick filaments at M-lines

Filariasis of the Axilla in a Patient Returning from Travel Abroad: A Case Report

Background: The term filariasis comprises a group of parasitic infections caused by helminths belonging to different genera in the superfamily Filaroidea. The human parasites occur mainly in tropical and subtropical regions, but filariae are also found in temperate climates, where they can infect wild and domestic animals. Humans are rarely infected by these zoonotic parasites. Patients and Methods: A 55-year-old patient presented with a new-onset, subcutaneous, non-tender palpable mass in the right axilla. Ultrasonography showed a 1.3-cm, solid, singular encapsulated node. Sonography of the breast on both sides, axilla and lymphatic drainage on the left side, lymphatic drainage on the right side, and mammography on both sides were without pathological findings. The node was excised under local anesthesia as the patient refused minimal invasive biopsy. Results: On histopathological examination, the tail of a parasite of the group of filariae was found. The patient revealed that she had stayed in Africa and Malaysia for professional reasons. 6 months before the time of diagnosis, she had also suffered from a fever and poor general condition after a trip abroad. The patient was referred for further treatment to the Institute for Tropical Medicine at the University of Dusseldorf, where a treatment with ivermectin was conducted on the basis of positive staining with antibodies against filariae. Conclusion: Our case demonstrates the importance of interdisciplinary collaboration between breast center, pathology, and other specialties such as microbiology and tropical medicine

Detecting and reporting domestic abuse of the elderly: mapping the practical concerns of experienced radiographers

Background: While over 65,000 suspected cases of elder abuse are reported to English councils each year, it is estimated that upwards of 95% of incidences are either missed or not reported by healthcare professionals in emergency department settings.[1] Despite the call from Murray and Devos[2], two decades ago, for greater investigation of the extant and prospective role of radiographers in identifying abuse of the elderly, the broad phenomenon has continued to receive limited attention in medical imaging research. Methods: Using a standard model of Interpretative Phenomenological Analysis,[3,4] extended semi-structured interviews with N=8 experienced plain radiographers were analysed. Results: In A&E contexts, where safeguarding issues have primarily been the responsibility of a physician, it was reported that the degree to which physicians take account of radiographers’ concerns about elder abuse is inconsistent at best. This had sometimes resulted in a borderline defeatist attitude among radiographers, who would now only raise such a concern if they were uncategorically certain it would be taken seriously. In the outpatient domain, where radiographers felt more in control of the medical process itself, progressively higher levels of confidence to take a lead around these matters were reported. Even here, however, participants routinely argued that the available information and clinical communication necessary for them to recognise potential elder abuse was often lacking in a way it was not around other forms of domestic abuse. Conclusions: The analysis signposts some important issues around elder abuse and radiography that foregrounds, above all, the importance of clinical context and communication. References 1. NHS Digital. Safeguarding adults: Annual report, England 2015-16 experimental statistics. London: Health and Social Care Information Centre; 2016. 2. Murray L, Devos D. The escalating problem of elder abuse. Radiol Technol 1997;68:351-353. 3. Miller PK, Woods AL, Sloane C, Booth L. Obesity, heuristic reasoning and the organisation of communicative embarrassment in diagnostic radiography. Radiography 2017;23:130-134. 4. Woods AL, Miller PK, Sloane C. Patient obesity and the practical experience of the plain radiography professional: On everyday ethics, patient positioning and infelicitous equipment. Radiography 2016;22:118-123