Evaluation of Patient-Centered Tool for Measuring Opioid Addiction Recovery

Vermont has expanded access to medication assisted treatment (MAT) since the onset of the opiate epidemic. This has included the use of family medicine clinicians as waivered prescribers of buprenorphine. In the absence of clear expectations or knowledge of discontinuation and detox, patients and providers must now reframe the traditional understanding of addiction recovery success as simply abstinence, maintenance medication detox, and survivorship. A 20-question, interactive “POWERS Form” has been developed by Stowe’s MAT team as part of routine counseling and clinical visits. Tracking score changes with patients allows reflection on the broader life changes during recovery process. This activity can perhaps challenge harmful perceptions of pharmacotherapy and destigmatize patients\u27 potential need for long term or indefinite bupenorphine treatment. This project began the process of evaluation and validation of this questionnaire and analyzed its preliminary results.https://scholarworks.uvm.edu/fmclerk/1418/thumbnail.jp

Role of the Dental Community in HPV Vaccination Promotion

Introduction. With increasing awareness that human papillomavirus (HPV) can cause oropharyngeal cancer (OPC), dental providers may play an important role in promoting HPV vaccination and preventing cancer. Our goal was to assess knowledge and current HPV vaccine counseling practices among Vermont dentists and dental hygienists to identify potential targets for state-level interventions to increase vaccine coverage. Methods. We developed a survey to assess knowledge, beliefs, practices and barriers regarding HPV vaccination, and distributed it via email to practicing Vermont dentists and dental hygienists. Free responses were analyzed using a coding framework generated from three key informant interviews. Results. 90% of providers believe it is important for them to play an “active role” in their patients’ general medical care, yet only 50% believe it is their responsibility to recommend HPV vaccine. Only 50% feel knowledgeable enough to recommend the vaccine. 78.6% of providers rarely discuss HPV vaccination with their age-appropriate patients, and 82% rarely recommend the vaccine. When asked to name the biggest barrier against recommending vaccination, providers named the following factors most frequently: “not responsibility of dental provider” (27%); lack of confidence in knowledge (19%); time constraints (14%); and parent philosophical/religious opposition (11%). Discussion. Because dentists and dental hygienists care for a broad pediatric population across the state, dental communities may be poised to play an expanded role in Vermont’s efforts to improve its HPV vaccination coverage. Our study identifies several potential areas for provider-focused interventions, which include educating providers about the HPV vaccine and reducing significant barriers against recommending.https://scholarworks.uvm.edu/comphp_gallery/1266/thumbnail.jp

Longitudinal kinematic imbalances in (anti-)neutrino interactions for improved measurements of nuclear removal energies and the axial vector form factor

Current and future accelerator neutrino oscillation experiments require an improved understanding of nuclear effects in neutrino-nucleus interactions. One important systematic uncertainty is given by potential mismodeling of the removal energy, which biases the reconstruction of the neutrino energy. In this manuscript, we introduce a novel observable for accelerator neutrino oscillation experiments, the visible longitudinal momentum imbalance, reconstructed in charged current quasi-elastic interactions from the outgoing charged lepton and nucleon. Minimally dependent on the neutrino energy and directly sensitive to the removal energy distribution, we demonstrate a method to constrain the latter. Further, we show how the use of the longitudinal imbalance in anti-neutrino interactions in a target containing hydrogen allows for an improved, high-purity selection of the interactions on hydrogen. This approach offers the potential for precise measurements of the nuclear axial vector form factor as well as of the anti-neutrino flux.Comment: 9 pages, 9 figure

Multiclass insect counting through deep learning-based density maps estimation

The use of digital technologies and artificial intelligence techniques for the automation of some visual assessment processes in agriculture is currently a reality. Image-based, and recently deep learning-based systems are being used in several applications. Main challenge of these applications is to achieve a correct performance in real field conditions over images that are usually acquired with mobile devices and thus offer limited quality. Plagues control is a problem to be tackled in the field. Pest management strategies relies on the identification of the level of infestation. This degree of infestation is established through a counting task manually done by the field researcher so far. Current models were not able to appropriately count due to the small size of the insects and on the last year we presented a density map based algorithm that superseded state of the art methods for a single insect type. In this paper, we extend previous work into a multiclass and multi-stadia approach. Concretely, the proposed algorithm has been tested in two use cases: on the one hand, it counts five different types of adult individuals over multiple crop leaves; and on the other hand, it identifies four different stages for immatures over 2-cm leaf disks. In these leaf disks, some of the species are in different stadia being some of them micron size and difficult to be identified even for the non-expert user. The proposed method achieves good results in both cases. The model for counting adult insects in a leaf achieves a RMSE ranging from 0.89 to 4.47, MAE ranging from 0.40 to 2.15, and R2 ranging from 0.86 to 0.91 for 4 different species in its adult phase (BEMITA, FRANOC, MYZUPE and APHIGO) that may appear together in the same leaf. Besides, for FRANOC, two stadia nymphs and adults are considered. The model developed for counting BEMITA immatures in 2-cm disks obtains R2 values up to 0.98 for big nymphs. This solution was embedded in a docker and can be accessed through an app via REST service in mobile devices. It has been tested in the wild under real conditions in different locations worldwide and over 14 different crops.The authors would like to thank all field researchers that generated the dataset, carried out the annotation process, performed the validation in the wild, and in general, supported the work in Tecnalia and BASF specially to Javier Romero, Carlos Javier Jim ́enez, Amaia Ortiz, Aitor Alvarez and Jone Echazarra

Trainer in a pocket - proof-of-concept of mobile, real-time, foot kinematics feedback for gait pattern normalization in individuals after stroke, incomplete spinal cord injury and elderly patients

Background: Walking disabilities negatively affect inclusion in society and quality of life and increase the risk for secondary complications. It has been shown that external feedback applied by therapists and/or robotic training devices enables individuals with gait abnormalities to consciously normalize their gait pattern. However, little is known about the effects of a technically-assisted over ground feedback therapy. The aim of this study was to assess whether automatic real-time feedback provided by a shoe-mounted inertial-sensor-based gait therapy system is feasible in individuals with gait impairments after incomplete spinal cord injury (iSCI), stroke and in the elderly. Methods: In a non-controlled proof-of-concept study, feedback by tablet computer-generated verbalized instructions was given to individuals with iSCI, stroke and old age for normalization of an individually selected gait parameter (stride length, stance or swing duration, or foot-to-ground angle). The training phase consisted of 3 consecutive visits. Four weeks post training a follow-up visit was performed. Visits started with an initial gait analysis (iGA) without feedback, followed by 5 feedback training sessions of 2–3 min and a gait analysis at the end. A universal evaluation and FB scheme based on equidistant levels of deviations from the mean normal value (1 level = 1 standard deviation (SD) of the physiological reference for the feedback parameter) was used for assessment of gait quality as well as for automated adaptation of training difficulty. Overall changes in level over iGAs were detected using a Friedman’s Test. Post-hoc testing was achieved with paired Wilcoxon Tests. The users’ satisfaction was assessed by a customized questionnaire. Results: Fifteen individuals with iSCI, 11 after stroke and 15 elderly completed the training. The average level at iGA significantly decreased over the visits in all groups (Friedman’s test, p < 0.0001), with the biggest decrease between the first and second training visit (4.78 ± 2.84 to 3.02 ± 2.43, p < 0.0001, paired Wilcoxon test). Overall, users rated the system’s usability and its therapeutic effect as positive. Conclusions: Mobile, real-time, verbalized feedback is feasible and results in a normalization of the feedback gait parameter. The results form a first basis for using real-time feedback in task-specific motor rehabilitation programs. Trial registration: DRKS00011853 , retrospectively registered on 2017/03/23

Large spatial variations in the flux balance along the front of a Greenland tidewater glacier

The frontal flux balance of a medium-sized tidewater glacier in western Greenland in the summer is assessed by quantifying the individual components (ice flux, retreat, calving, and submarine melting) through a combination of data and models. Ice flux and retreat are obtained from satellite data. Submarine melting is derived using a high-resolution ocean model informed by near-ice observations, and calving is estimated using a record of calving events along the ice front. All terms exhibit large spatial variability along the  ∼ 5&thinsp;km wide ice front. It is found that submarine melting accounts for much of the frontal ablation in small regions where two subglacial discharge plumes emerge at the ice front. Away from the subglacial plumes, the estimated melting accounts for a small fraction of frontal ablation. Glacier-wide, these estimates suggest that mass loss is largely controlled by calving. This result, however, is at odds with the limited presence of icebergs at this calving front – suggesting that melt rates in regions outside of the subglacial plumes may be underestimated. Finally, we argue that localized melt incisions into the glacier front can be significant drivers of calving. Our results suggest a complex interplay of melting and calving marked by high spatial variability along the glacier front.</p

Arbeitsmarktintegration von Müttern mit Migrationshintergrund - Analyse der Maßnahmenerfolge des Bundesprogramms "Stark im Beruf": Bericht

Das durch das Bundesministerium für Familie, Senioren, Frauen und Jugend (BMFSFJ) geförderte Bundesprogramm des Europäischen Sozialfonds (ESF) "Stark im Beruf - Mütter mit Migrationshintergrund steigen ein" soll Müttern mit Migrationshintergrund den Erwerbseinstieg erleichtern und ihren Zugang zu vorhandenen Angeboten zur Arbeitsmarktintegration verbessern. Der vorliegende Bericht präsentiert eine Auswertung der im Rahmen des Programms "Stark im Beruf" erhobenen Daten zu den durch die Teilnehmerinnen erzielten Programmerfolge vor dem Hintergrund individueller Merkmale, regionaler Kontextfaktoren sowie der Belegung unterschiedlicher Programmmodule. Hierzu werden auf Grundlage theoretischer Überlegungen zunächst Hypothesen zur Wahrscheinlichkeit für einen Programmerfolg in Abhängigkeit von potentiellen Erklärfaktoren abgeleitet, die danach mithilfe eines multivariaten Regressionsmodells getestet werden. Die Ergebnisse zeigen, dass Teilnehmerinnen kurze Zeit nach Programmabschluss mit einer höheren Wahrscheinlichkeit eine Beschäftigung aufnehmen, wenn sie bei Programmeintritt bessere Voraussetzungen hinsichtlich ihres übertragbaren Humankapitals und ihrer Nähe zum Arbeitsmarkt in Deutschland mitbringen. Teilnehmerinnen, die über einen längeren Zeitraum arbeitslos gemeldet sind oder sich im SGB II-Bezug befinden, haben nach Programmabschluss hingegen eine niedrigere Wahrscheinlichkeit eine Beschäftigung aufzunehmen. Außerdem zeigt sich, dass Teilnehmerinnen mit kleinen Kindern, die mit größeren Herausforderungen bezüglich der Vereinbarkeit von Beruf und Familie konfrontiert sind, das "Stark im Beruf" Programm mit einer geringeren Erfolgswahrscheinlichkeit abschließen. Entgegen der Erwartungen bestätigt sich kein systematischer Zusammenhang zwischen dem Aufenthaltsstatus oder der Aufenthaltsdauer der Teilnehmerinnen in Deutschland und einem erfolgreichen Programmabschluss. Neben individuellen Merkmalen der Teilnehmerinnen beziehen wir auch Informationen zur regionalen Arbeitsmarkt- und Bevölkerungsstruktur sowie Angaben zur Belegung unterschiedlicher Modulkategorien im "Stark im Beruf" Programm in unsere Analysen ein. Es zeigt sich, dass Teilnehmerinnen, die eher berufsorientierte Module belegen, auch unter Berücksichtigung aller weiteren beobachtbaren Merkmale eine höhere Wahrscheinlichkeit für einen Programmerfolg haben als Teilnehmerinnen, die andere Programmmodule belegen

Integrating ecosystem services and life cycle assessment: a framework accounting for local and global (socio-)environmental impacts

Purpose: Human activities put pressure on our natural ecosystems in various ways, such as globally through the spread of emissions or locally through the degradation of species-rich landscapes. However, life cycle assessment (LCA) studies that integrate ecosystem services (ES) are still in the minority because of intrinsic differences in data, modelling, and interpretation. This study aims to overcome these challenges by developing and testing a framework that comprehensively evaluates the (socio-)environmental impacts of human activities. Methods: LCA and ecosystem services assessment (ESA) were integrated in two different ways: (1) both methodologies run in parallel and results are combined, and (2) LCA as a driving method where ES are integrated. Because local ESA studies contain the most accurate information but will not be available for all processes in the value chain, it was necessary to advance the life cycle impact assessment method ReCiPe 2016 including three new midpoint impact categories (terrestrial provision, regulation, and cultural ES) and site-generic CFs based on the Ecosystem Services Valuation Database to account for changes in regulating, cultural and provisioning ES due to land use, for the remaining processes in the value chain. Monetary valuation is used to aggregate at the areas of protection (AoP). Results and discussion: A comprehensive LCA$_{+ES}$-ESA sustainability assessment framework is developed to account for local and global impacts due to human activities on three AoPs (natural resources, ecosystem quality, and human health and well-being), of which the results are expressed in monetary terms. The framework is able to visualize all benefits and burdens accounted for through the handprint/footprint approach. A simplified terrestrial case study on Scots pinewood shows the applicability of the proposed framework, resulting in a handprint (€$_{2022}$ 9.81E+02) which is four times larger than the footprint (€$_{2022}$ 2.31E+02) for 1 kg of wood produced. Challenges related to the framework such as data availability and database shortcomings (i.e., beyond land use) and ES interrelations are discussed. Conclusion: While classical LCA studies focus more on burdens, this framework can also take into account benefits, such as the provision of ecosystem services (or the value of the functional unit of the study). Although the integration of both LCA and ESA has been increasingly explored recently, until now no framework has been available that can incorporate results from local ESA, site-specific ESA, and classical LCA studies, which is considered highly relevant to decision-making