Strategies for Effective Collaboration among Multidisciplinary Teams: Integration of an ABA Professional

Our collaborating practitioner (CP), Kari Tanta, PhD, OTR/L, FAOTA, manages Valley Medical Center which is a multidisciplinary pediatric outpatient therapy clinic. Dr. Tanta was seeking research to support incorporating an applied behavior analysis (ABA) professional into VMC’s practice. The focused question became, “What are strategies to promote successful collaboration when integrating a Board Certified Behavior Analyst (BCBA) into an established multidisciplinary pediatric clinic to promote best practice for clients?” From September 2016 - January 2017, 26 articles were analyzed using a critically appraised topic (CAT) table. The literature indicated effective health care team collaboration yields positive patient outcomes, provided strategies for successful collaboration, and provided information pertaining directly to BCBA professionals. To support knowledge translation for clinicians practicing at the facility, our CP recommended an electronic resource in the form of a word document. The resource provides a quick reference guide for occupational therapists (OT) and speech language pathologists (SLP) to understand what ABA is, barriers and supports to collaboration with an ABA professional, and tips for overall effective collaboration to support best practice for clients. Resource outcome effectiveness was monitored with a peer-review survey. It is recommended that the clinicians engage in self-reflection on the usefulness of the strategies and activities provided in the resource for their future collaborative teaming efforts with BCBA professionals. Documenting these reflections will help fill a gap in the existing literature on this topic

Adverse Childhood Experiences (ACEs) in Early Childhood and Their Associations with Middle Childhood Behavior Problems

Experiences in early childhood lay the foundation for physical and psychological health and wellbeing throughout the life course. A large body of literature demonstrates a graded relationship between adverse childhood experiences (ACEs) and health and social outcomes. Children living in poverty are disproportionately likely to experience multiple adversities, placing them at risk for negative health and developmental outcomes and contributing to widening health disparities. Among the outcomes associated with ACEs are internalizing and externalizing behavior problems, which increase children’s risk of later depression and anxiety, substance use, criminality, low socioeconomic status, and chronic physical health problems. In spite of the substantial knowledge base that has developed around childhood adversity and its association with behavior problems, there are gaps in the literature that warrant further research. Firstly, few studies utilizing prospective longitudinal data have examined the role of timing and duration of exposure to adversities in early childhood, and their relationship with later behaviors. Secondly, researchers have only just begun exploring whether certain patterns or constellations of risk factors are common among different groups of children, and whether these patterns place certain groups at greater risk for behavior problems. A third gap relates to the role of father involvement by unmarried fathers and the potential for these fathers to promote more positive outcomes among children exposed to various levels of early adversity. The three studies in this dissertation analyze data from four waves of the Fragile Families and Child Wellbeing Study to document associations between ACEs experienced at ages 1, 3, and 5, and behavior problems at age 9. Life course theory provides an overarching framework for the dissertation. The first study examines the associations between the accumulation, timing, and duration of ACEs in the first five years of life and odds of behavior problems at age 9. The second study employs latent class analysis to identify patterns of risk exposure and their potential association with age 9 behaviors. The third study investigates whether early father involvement by fathers who were unmarried at the child’s birth moderates the association between early childhood adversity and age 9 behavior problems

Online Financial Education Programs: Theory, Research, and Recommendations

Technological advances have created unprecedented opportunities for online financial education that can be used to improve financial literacy and money management practices. While online financial education programs have become popular, relevant research and theoretical frameworks have rarely been considered in the development of such programs. This article synthesizes lessons from literature and theories for the development of an effective online financial education program. Drawing from literature on financial literacy education and online education, implications and recommendations for integrating technology into online financial education programs for adults are discussed

Low-Income Mothers' Mental Health in the Context of Family Comorbidity

The present study utilized longitudinal ethnographic data from the Welfare, Children, and Families: A Three-City Study to analyze how low-income mothers construct meaning of and cope with mental health problems. The study focused on a subsample of 20 mothers with one or more mental health problems. Findings demonstrated the importance of family relationships and family comorbidity. Mothers often attributed mental health problems to problematic family relationships. Mothers also emphasized their children's health and well-being in assessing their own health. Their ability to care for their children shaped how they viewed themselves. A related feature of mothers' experience of mental health was cumulative disadvantage. Almost all of the mothers linked their mental health to one or more aspects of poverty. Finally, mothers employed a multiple strategies to cope with mental health problems, with mental health treatment being one strategy. Implications for research, policy, and clinical work were discussed

Metabolomic “Dark Matter” Dependent on Peroxisomal β-Oxidation in Caenorhabditis elegans

Peroxisomal β-oxidation (pβo) is a highly conserved fat metabolism pathway involved in the biosynthesis of diverse signaling molecules in animals and plants. In Caenorhabditis elegans, pβo is required for the biosynthesis of the ascarosides, signaling molecules that control development, lifespan, and behavior in this model organism. Via comparative mass spectrometric analysis of pβo mutants and wildtype, we show that pβo in C. elegans and the satellite model P. pacificus contributes to life stage-specific biosynthesis of several hundred previously unknown metabolites. The pβo-dependent portion of the metabolome is unexpectedly diverse, e.g., intersecting with nucleoside and neurotransmitter metabolism. Cell type-specific restoration of pβo in pβo-defective mutants further revealed that pβo-dependent submetabolomes differ between tissues. These results suggest that interactions of fat, nucleoside, and other primary metabolism pathways can generate structural diversity reminiscent of that arising from combinatorial strategies in microbial natural product biosynthesis

Synergistic drug combinations from electronic health records and gene expression.

ObjectiveUsing electronic health records (EHRs) and biomolecular data, we sought to discover drug pairs with synergistic repurposing potential. EHRs provide real-world treatment and outcome patterns, while complementary biomolecular data, including disease-specific gene expression and drug-protein interactions, provide mechanistic understanding.MethodWe applied Group Lasso INTERaction NETwork (glinternet), an overlap group lasso penalty on a logistic regression model, with pairwise interactions to identify variables and interacting drug pairs associated with reduced 5-year mortality using EHRs of 9945 breast cancer patients. We identified differentially expressed genes from 14 case-control human breast cancer gene expression datasets and integrated them with drug-protein networks. Drugs in the network were scored according to their association with breast cancer individually or in pairs. Lastly, we determined whether synergistic drug pairs found in the EHRs were enriched among synergistic drug pairs from gene-expression data using a method similar to gene set enrichment analysis.ResultsFrom EHRs, we discovered 3 drug-class pairs associated with lower mortality: anti-inflammatories and hormone antagonists, anti-inflammatories and lipid modifiers, and lipid modifiers and obstructive airway drugs. The first 2 pairs were also enriched among pairs discovered using gene expression data and are supported by molecular interactions in drug-protein networks and preclinical and epidemiologic evidence.ConclusionsThis is a proof-of-concept study demonstrating that a combination of complementary data sources, such as EHRs and gene expression, can corroborate discoveries and provide mechanistic insight into drug synergism for repurposing

Biosynthesis of Modular Ascarosides in C. elegans

The nematode Caenorhabditis elegans uses simple building blocks from primary metabolism and a strategy of modular assembly to build a great diversity of signaling molecules, the ascarosides, which function as a chemical language in this model organism. In the ascarosides, the dideoxysugar ascarylose serves as a scaffold to which diverse moieties from lipid, amino acid, neurotransmitter, and nucleoside metabolism are attached. However, the mechanisms that underlie the highly specific assembly of ascarosides are not understood. We show that the acyl-CoA synthetase ACS-7, which localizes to lysosome-related organelles, is specifically required for the attachment of different building blocks to the 4′-position of ascr#9. We further show that mutants lacking lysosome-related organelles are defective in the production of all 4′-modified ascarosides, thus identifying the waste disposal system of the cell as a hotspot for ascaroside biosynthesis

The variability of song variability in zebra finch (Taeniopygia guttata) populations

Birdsong is a classic example of a learned social behaviour. Song behaviour is also influenced by genetic factors, and understanding the relative contributions of genetic and environmental influences remains a major goal. In this study, we take advantage of captive zebra finch populations to examine variation in a population-level song trait: song variability. Song variability is of particular interest in the context of individual recognition and in terms of the neuro-developmental mechanisms that generate song novelty. We find that the Australian zebra finch Taeniopygia guttata castanotis (TGC) maintains higher song diversity than the Timor zebra finch T. g. guttata (TGG) even after experimentally controlling for early life song exposure, suggesting a genetic basis to this trait. Although wild-derived TGC were intermediate in song variability between domesticated TGC populations and TGG, the difference between domesticated and wild TGC was not statistically significant. The observed variation in song behaviour among zebra finch populations represents a largely untapped opportunity for exploring the mechanisms of social behaviour

Testing implementation facilitation of a primary care-based collaborative care clinical program using a hybrid type III interrupted time series design: a study protocol

Abstract Background Dissemination of evidence-based practices that can reduce morbidity and mortality is important to combat the growing opioid overdose crisis in the USA. Research and expert consensus support reducing high-dose opioid therapy, avoiding risky opioid-benzodiazepine combination therapy, and promoting multi-modal, collaborative models of pain care. Collaborative care interventions that support primary care providers have been effective in medication tapering. We developed a patient-centered Primary Care-Integrated Pain Support (PIPS) collaborative care clinical program based on effective components of previous collaborative care interventions. Implementation facilitation, a multi-faceted and dynamic strategy involving the provision of interactive problem-solving and support during implementation of a new program, is used to support key organizational staff throughout PIPS implementation. The primary aim of this study is to evaluate the effectiveness of the implementation facilitation strategy for implementing and sustaining PIPS in the Veterans Health Administration (VHA). The secondary aim is to examine the effect of the program on key patient-level clinical outcomes—transitioning to safer regimens and enhancing access to complementary and integrative health treatments. The tertiary aim is to determine the categorical costs and ultimate budget impact of PIPS implementation. Methods This multi-site study employs an interrupted time series, hybrid type III design to evaluate the effectiveness of implementation facilitation for a collaborative care clinical program—PIPS—in primary care clinics in three geographically diverse VHA health care systems (sites). Participants include pharmacists and allied staff involved in the delivery of clinical pain management services as well as patients. Eligible patients are prescribed either an outpatient opioid prescription greater than or equal to 90 mg morphine equivalent daily dose or a combination opioid-benzodiazepine regimen. They must also have an upcoming appointment in primary care. The Consolidated Framework for Implementation Research will guide the mixed methods work across the formative evaluation phases and informs the selection of activities included in implementation facilitation. The RE-AIM framework will be used to assess Reach, Effectiveness, Adoption, Implementation, and Maintenance of PIPS. Discussion This implementation study will provide important insight into the effectiveness of implementation facilitation to enhance uptake of a collaborative care program in primary care, which targets unsafe opioid prescribing practices.https://deepblue.lib.umich.edu/bitstream/2027.42/146542/1/13012_2018_Article_838.pd

The Grizzly, April 18, 2013

Curriculum Review • Relay Raises Money, Awareness • Tuition Explained • Mental Health Resources Reviewed • Collegeville Community Day April 20 • Student Art Exhibit April 24 • Ursinus College Dance Company\u27s Spring Show • Spanish Classes Popular Among UC Students • Opinion: ESPN Debate Isn\u27t Really About Sports; Autism Awareness Month is a Learning Opportunity • Hockey Not Netting Enough Attention • Senior Spotlight: Wytch Rigger, Men\u27s Lacrosse • Baseball Loses in 18 Inningshttps://digitalcommons.ursinus.edu/grizzlynews/1882/thumbnail.jp