Infrared reflectance measurements of Missouri waters for water quality applications

Students supported: 2 studentsThe relative specular reflectance of laboratory solutions of 3.0 M Sulfuric Acid and 0.5 M Sodium Nitrate was measured in the 2.0 - 20-[mu]m wavelength region of the infrared. The relative specular reflectance of natural samples of (1) acid mine drainage taken from a ditch leading from the Peabody Mark Twain Mine to Hinkson Creek; (2) surface water runoff from an agricultural test plot which had received a 314 lb/acre application of nitrate fertilizer; and (3) an oil sample from the Mexico, Missouri oil release into the Salt River was measured in the same spectral region. The data was collected using a Perkin Elmer E-14 spectrophotometer and a reflectometer consisting of a Cassegrain unit which collimated the radiant flux to about 18 mrad divergence, a sample holder and a Cassegrain condenser for focusing the radiant flux, reflected by the sample, onto the entrance slit of the monochromator. The angle of incidence was 70 degrees. The index of refraction, extinction coefficient and phase difference spectrum throughout the 2-20-[mu]m wavelength region was determined for the mine drainage, fuel oil, sulfuric acid, sodium nitrate and nitrate runoff samples using the relative reflectance measurements, the optical constants of distilled water and an algorithm for Kramers-Kronig analysis. The absolute reflectance spectrum of the alluvium and loess was determined using the relative reflectance measurements, the optical constants of distilled water and the Cauchy equation for reflectance. It is very desirable to make water quality measurements remotely. However before such measurements can be taken the characteristic manner in which aqueous solutions reflect electromagnetic radiation (in the optical properties) must be known. Thus the results obtained from this research are a part of a much larger goal to determine water quality remotely.Project # A-063-MO Agreement # 14-31-0001-382

Economic impact of introducing TYRX amongst patients with heart failure and reduced ejection fraction undergoing implanted cardiac device procedures: a retrospective model based cost analysis

BACKGROUND AND AIMS: Infection is a serious and expensive complication of Cardiac Implantable Electronic Device (CIED) procedures. A retrospective based cost analysis was performed to estimate Trust level savings of using the TYRX antibacterial envelope as a primary prevention measure against infection in a tertiary referral centre in South London, UK. METHODS: A retrospective cohort of heart failure patients with reduced ejection fraction undergoing Implantable Cardioverter Defibrillator (ICD) or Cardiac Resynchronization Therapy (CRT) procedures were evaluated. Decision-analytic modelling was performed to determine economic savings of using the envelope during CIED procedure vs CIED procedure alone. RESULTS: Over a 12 month follow-up period following CIED procedure, the observed infection rate was 3.14% (n = 5/159). The average cost of a CIED infection inpatient admission was £41,820 and, further to economic analysis, the additional costs attributable to infection was calculated at £62,213.94. A cost saving of £624 per patient by using TYRX during CIED procedure as a primary preventative measure against infection was estimated. CONCLUSIONS: TYRX would be a cost-saving treatment option amongst heart failure patients undergoing ICD and CRT device procedures based on analysis in the local geographical area of South London. If upscaled to the UK population, we estimate potential cost savings for the National Health Service (NHS)

Prepregnancy weight, gestational weight gain, and risk of growth affected neonates

BACKGROUND: In 2009, the Institute of Medicine published revised gestational weight gain (GWG) guidelines with changes notable for altered body mass index (BMI) categorization as per World Health Organization criteria and a stated range of recommended gain (11-20 pounds) for obese women. The goal of this study was to evaluate associations between maternal BMI-specific GWG adherence in the context of these new guidelines and risk of small for gestational age (SGA) and large for gestational age (LGA) neonates. METHODS: Subjects were a retrospective cohort of 11,203 live birth singletons delivered at 22-44 weeks at a Massachusetts tertiary care center between April 2006 and March 2010. Primary exposure was GWG adherence (inadequate, appropriate, or excessive) based on BMI-specific recommendations. SGA and LGA were defined as /=90th percentiles of U.S. population growth curves, respectively. The association between GWG adherence and SGA and LGA was examined in polytomous logistic regression models that estimated adjusted odds ratios (AOR) stratified by prepregnancy weight status, controlling for potential confounders. RESULTS: Before pregnancy, 3.8% of women were underweight, 50.9% were normal weight, 24.6% were overweight, and 20.6% were obese. Seventeen percent had inadequate GWG, and 57.2% had excessive GWG. Neonates were 9.6% SGA and 8.7% LGA. Inadequate GWG was associated with increased odds of SGA (AOR 2.51, 95% confidence interval [CI] 1.31-4.78 for underweight and AOR 1.78, 95% CI 1.42-2.24 for normal weight women) and decreased odds of LGA (AOR 0.5, 95% CI 0.47-0.73 for normal weight and AOR 0.56, 95% CI 0.34-0.90 for obese women). Excessive GWG was associated with decreased odds of SGA (AOR 0.59, 95% CI 0.47-0.73 for normal weight and AOR 0.64, 95% CI 0.47-0.89 for overweight women) and increased odds of LGA (AOR 1.76, 95% CI 1.38-2.24 for normal weight, AOR 2.99, 95% CI 1.92-4.65 for overweight, and AOR 1.55, 95% CI 1.10-2.19 for obese women). CONCLUSIONS: Efforts to optimize GWG are essential to reducing the proportion of SGA and LGA neonates, regardless of prepregnancy BMI

Demographic Characteristics Associated with the Presence of Recalled and Measured Prepregnancy Weights

Background: Gestational weight gain within prepregnancy BMI-specific Institute of Medicine (IOM) recommended ranges are associated with good outcomes for both mother and baby. Availability of measured prepregnancy weight, recalled prepregnancy weight or measured weight at first prenatal visit if the former two weights are not available, influences the accuracy of provider recommendations for gestational weight gain. Objective: The purpose of this study is to examine demographic characteristics associated with the presence of recalled prepregnancy weight and measured prepregnancy weight in the prenatal care medical record. Methods: Medical record review of 1,998 randomly selected pregnancies, of which 1,911 met inclusion criteria of delivery between January 2007 and December 2012 and receipt of prenatal care in faculty and resident clinic sites at UMass Memorial Health Care (UMMHC). Subjects\u27 paper prenatal chart and electronic record (AllScripts and QS prenatal EMR) were fully abstracted if available and contained both: (1) a recorded measured weight within one year of conception, and (2) a self-reported prepregnancy weight obtained at first prenatal visit. Additionally, exclusion criteria included those pregnancies with only prenatal weights recorded one year prior to conception for index pregnancy. For women with multiple pregnancies during the study time period, one pregnancy was randomly selected for inclusion in study analyses. Demographic data was abstracted for all available charts regardless of presence or absence of weights of interest. Demographic characteristics considered were age (15-29, 20-24, 25-29, 30-34, 35+ years), prepregnancy BMI calculated based on recalled height and weight (underweight: BMI2, normal weight: 18.5≤ BMI/m2, overweight: 25≤BMI/m2, and obese: 30 kg/m2≤BMI), race/ethnicity (non-Hispanic white vs. other race/ethnicity), marital status (not married vs. married), primary language (non-English vs. English), gravidity (1, 2, 3+), education (high school diploma or less, some college, 4 year college or more) and prenatal care site (faculty vs. resident obstetric clinic). Logistic regressions were performed to calculate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) and adjusted analyses controlled for demographics. Results: Of the 1911 pregnancies meeting initial inclusion criteria, 1711 (89.5%) had charts available for abstraction; fifty-three subjects had multiple pregnancies of which only one was included in analyses resulting in an analytic sample of 1656 pregnancies. Of these, 511 (30.9%) were missing a recalled prepregnancy weight at first prenatal visit, 711 (42.9%) had the recalled prepregnancy weight but did not have a measured weight; and only 434 (26.2%) had both weights of interest. Overweight women had decreased odds of having a recalled weight compared to women of normal weight (aOR 0.75; 95% CI 0.56-1.00). Additionally, women with ≥4 years of college compared to those with ≤ high school diploma (aOR 0.54; 95% CI 0.40-0.73), and those receiving care in the faculty compared to the resident clinics (aOR 0.48; 95% CI 0.35-0.65) had decreased odds of having a recalled weight available in the chart. Among women with available recalled prepregnancy weight (n=1101), 390 (35.4%) also had a documented measured weight within one year of conception and 711 (64.6%) did not. Women who were not married (aOR 0.54; 95% 0.39-0.76) had decreased odds of having a measured weight, whereas those receiving care in the faculty compared to resident clinics had greater odds (aOR 1.79; 95% CI 1.26-2.53) of having a measured weight within one year of conception available in their charts. Conclusions: Our results suggest that approximately 25% of women have both recalled weight at first prenatal visit and at least one weight measured within one year of conception in their medical records. Prepregnancy BMI, education, and prenatal care site were associated with presence or absence of recalled weight. Similarly, amongst those with recalled weight, martial status and prenatal care in faculty practice where associated with decreased and increased odds respectively of having a measured weight within one year of conception. We can use this information to help practitioners target women for which greater efforts are needed to provide accurate IOM-recommended BMI-specific gestational weight gain guidelines. This may be utilized to discern patterns of health care access in this patient population

The Accuracy of Recalled versus Measured Pre-Pregnancy Weight for the Calculation of Pre-Pregnancy Body Mass Index

Background: In 2009, the Institute of Medicine (IOM) published gestational weight gain (GWG) guidelines with the goal of optimizing maternal and fetal outcomes. GWG recommendations are specific to pre-pregnancy body mass index (BMI): 28-40 lbs for underweight (UW; BMI2), 25-35 lbs for normal weight (NW; 18.5≤BMI/m2), 15-25 lbs for overweight (OW; 25 ≤BMI/m2), and 11-20 lbs for obese (OB; BMI≥30 kg/m2) women. With upwards of 50% of pregnancies in the U.S. unplanned, measured pre-pregnancy weight is often unavailable in clinical and research settings. Evaluating the accuracy of recalled pre-pregnancy weight early in prenatal care is important in order to establish accuracy of pre-pregnancy BMI calculations in order to counsel about GWG accurately. Objective: To examine differences in recalled versus measured pre-pregnancy weight and to examine factors associated with accuracy of recalled weights. Methods: Medical record review of 1,998 randomly selected pregnancies. Eligible women received prenatal care in faculty and resident clinics at UMass Memorial Health Care (UMMHC), delivered between January 2007 and December 2012, and had available both: (1) a measured weight within one year of conception and (2) a pre-pregnancy weight self-reported at first prenatal visit. Data were obtained from the UMMHC paper or electronic prenatal record and the Allscripts EMR. We calculated the difference in weights as recalled pre-pregnancy weight minus most recent measured weight within one year of conception. Subjects were excluded if they received care at a non-faculty or non-resident practice, charts not available after three separate retrieval attempts, both weights of interest not available, or if measured weight occurred at a prenatal visit for a prior pregnancy. For women with more than one pregnancy during the study time frame, one was randomly selected for inclusion in the analytic data set. Results: Of the 1,998 pregnancy charts reviewed, 400 records met eligibility criteria and were included in this analysis. Women were mean age 29.7 (SD: 6.2) years, 69.3% multigravida, 64.4% non-Hispanic white, 65.2% married, and 62.4% had a college or greater education. Based on recalled weight, 3.3% of women were underweight, 46.6% were normal weight, 25.9% overweight, and 24.2% obese. 63% received care in the faculty obstetric clinic. Recorded recalled weights were mean 2.4 (SD: 11.1) pounds lower than measured pre-pregnancy weight. This difference did not differ by age, location of care, pre-pregnancy BMI, marital status, race/ethnicity, primary language, gravity, education, or time between measured weight and conception, in unadjusted and adjusted models. For 88.7% of women, calculating pre-pregnancy BMI based on weight measured up to a year prior to conception or based on recalled pre-pregnancy weight reported at the first prenatal visit resulted in the same classification of pre-pregnancy BMI. Conclusion: Prenatal care providers may calculate pre-pregnancy BMIs using recalled pre-pregnancy weights early in prenatal care and use such calculated BMIs to accurately provide GWG recommendations regardless of demographic variables, gravity, or location of care

Cognitive Status, Initiation of Lifestyle Changes and Medication Adherence after Acute Coronary Syndrome: TRACE-CORE (Transitions, Risks, and Actions in Coronary Events- Center for Outcomes Research and Education)

Background: Lifestyle changes and medication adherence are often recommended to patients after acute coronary syndrome (ACS) as secondary prevention strategies. However, the impact of cognitive impairment (CI) on these secondary prevention strategies following ACS has not been examined. Methods: Cognitive status of 1374 patients with ACS from six hospitals in Massachusetts and Georgia enrolled in the ongoing TRACE-CORE (Transitions, Risks, and Actions in Coronary Events- Center for Outcomes Research and Education) study was assessed during hospitalization using the 41-point Telephone Interview for Cognitive Status (TICS). Information on recommendation and initiation of changes to diet, exercise, tobacco and alcohol use, stress, and cardiac rehabilitation attendance was collected through self-report one month after discharge. Medication adherence was assessed using the 8-item Morisky Scale. Among patients who reported receiving a recommendation for a lifestyle change, we modeled associations between CI and initiation of lifestyle changes and medication adherence, adjusting for demographics via logistic regression. Results: Mean age of participants was 63.0±11.1 years, 67% were male and 79% white; 526 (38.3%) screened positive for CI (TICS score ≤30) during hospitalization. Screening positive for CI was associated with being older, male, non-white, and less educated. Patients with CI more frequently received a recommendation to reduce alcohol use (25% vs. 16% of drinkers, p=.003) but were referred less often to a cardiac rehabilitation program (45% vs. 61%, p=.01). Among patients referred to cardiac rehabilitation (n=743), those with CI at baseline were less likely to report rehabilitation attendance at 1-month (OR= 0.70, 95%CI 0.50-0.97) compared to patients with normal cognitive function. Initiation of other lifestyle changes and medication adherence did not differ by cognitive status. Conclusions: CI is common among patients hospitalized for ACS and is associated with recommendation and initiation of certain lifestyle changes, making it an important factor to consider during the peri-discharge period

Gait Speed and Mood, Cognition, and Quality of Life in Older Adults With Atrial Fibrillation

Background: Low gait speed has been linked with impaired mood, cognition, and quality of life (QOL) in older adults. We examined whether low gait speed was associated with impaired mood, cognition, and QOL among older adults with atrial fibrillation (AF). Methods and Results: Participants (n=1185) had a diagnosis of AF, aged \u3e /=65 years, CHA2DS2VASc \u3e /=2 and had no contraindications to anticoagulation. Participants completed a 15-foot walk test, and low gait speed was categorized using cutoffs from the Fried Frailty Index. Participants self-reported measures of depressive symptoms (Patient Health Questionnaire 9 \u3e /=10), anxiety symptoms (Generalized Anxiety Disorder 7 \u3e /=10), cognitive impairment (Montreal Cognitive Assessment \u3c /=23), and potentially impaired Atrial Fibrillation Effect Quality-of-Life Questionnaire \u3c 80. Participants were on average aged 75.3 (SD: 7.0) years, 48.0% were women, and 85.5% were non-Hispanic white; 85.6% were taking an oral anticoagulant, 26.1% had low gait speed, 8.4% had elevated depressive symptoms, 5.7% had elevated anxiety symptoms, 41.1% were cognitively impaired, and 41.6% had potentially impaired AF-related QOL. Participants with low gait speed were significantly more likely to have elevated depressive symptoms (adjusted odds ratio: 2.1, 95% CI: 1.3-3.4), elevated anxiety symptoms (adjusted odds ratio: 2.2, 95% CI: 1.2-3.9), and cognitive impairment (adjusted odds ratio: 1.5, 95% CI: 1.1-2.1). Impaired AF-related QOL did not differ by gait speed after adjustment for clinical characteristics (adjusted odds ratio: 1.1, 95% CI: 0.8-1.5). Conclusions: Twenty-six percent of older adults with AF had low gait speed, and low gait speed was associated with impaired mood and cognition. Further research is needed to determine whether declines in gait speed lead to impaired mood and cognition or whether these conditions develop concurrently

Contribution of Collaborative Work to Teacher Reflection and the Transformation of Pedagogical Practices of School and University Science Teachers // Contribución del trabajo colaborativo en la reflexión docente y en la transformación de las prácticas pedagógicas de profesores de ciencia escolares y universitarios

Poor results of science learning, both at school and university, have led us to acknowledge the need to transform our teaching. Currently, reflection and collaborative work with colleagues are conceived as being key factors in the process of the transformation of practices. Based on the experiences of a group of school and university science teachers working on action-research, we describe the contribution that collaborative work has on reflection for the transformation of practices. The main aspects are the recognition of strengths and weaknesses, listening to and learning from the experience of others, and the discussion of specific classroom practices. On the other hand, these reflections contribute to the transformation at different levels: the teacher, classroom teaching practices, and the school community. The fact that it is a diverse group that includes both school and university teachers generate enriching reflections that help to transform practices in both areas. These reflections not only benefit the school system, but also science teachers education, and provide insights on a new University-School relationship // Los deficientes resultados de aprendizaje en el área de las ciencias, tanto en el ámbito escolar como universitario, nos han llevado a la necesidad de transformar nuestra enseñanza. En la actualidad, la reflexión y el trabajo colaborativo con colegas se conciben como claves en el proceso de transformación de las prácticas. A partir de la experiencia de un grupo de docentes escolares y universitarios de ciencia que realiza una investigación-acción, describimos la contribución que tiene el trabajo colaborativo sobre la reflexión para la transformación de las prácticas. Destacan aspectos como el reconocimiento de debilidades y fortalezas, el escuchar y aprender de la experiencia de otros y la discusión de prácticas concretas de aula. Por otra parte, estas reflexiones contribuyen a la transformación en diferentes niveles: del profesor, de las prácticas del docente en el aula y de la comunidad escolar. El hecho de que sea un grupo diverso, que incluye a profesores tanto del sistema escolar como universitario, genera reflexiones enriquecedoras, que ayudan a transformar las prácticas en estos dos ámbitos, beneficiando no solo al sistema escolar, sino también a la formación de profesores de ciencia, y dando luces acerca de una nueva relación universidad-escuela

Clinic Versus Online Social Network-Delivered Lifestyle Interventions: Protocol for the Get Social Noninferiority Randomized Controlled Trial

BACKGROUND: Online social networks may be a promising modality to deliver lifestyle interventions by reducing cost and burden. Although online social networks have been integrated as one component of multimodality lifestyle interventions, no randomized trials to date have compared a lifestyle intervention delivered entirely via online social network with a traditional clinic-delivered intervention. OBJECTIVE: This paper describes the design and methods of a noninferiority randomized controlled trial, testing (1) whether a lifestyle intervention delivered entirely through an online social network would produce weight loss that would not be appreciably worse than that induced by a traditional clinic-based lifestyle intervention among overweight and obese adults and (2) whether the former would do so at a lower cost. METHODS: Adults with body mass index (BMI) between 27 and 45 kg/m(2) (N=328) will be recruited from the communities in central Massachusetts. These overweight or obese adults will be randomized to two conditions: a lifestyle intervention delivered entirely via the online social network Twitter (Get Social condition) and an in-person group-based lifestyle intervention (Traditional condition) among overweight and obese adults. Measures will be obtained at baseline, 6 months, and 12 months after randomization. The primary noninferiority outcome is percentage weight loss at 12 months. Secondary noninferiority outcomes include dietary intake and moderate intensity physical activity at 12 months. Our secondary aim is to compare the conditions on cost. Exploratory outcomes include treatment retention, acceptability, and burden. Finally, we will explore predictors of weight loss in the online social network condition. RESULTS: The final wave of data collection is expected to conclude in June 2019. Data analysis will take place in the months following and is expected to be complete in September 2019. CONCLUSIONS: Findings will extend the literature by revealing whether delivering a lifestyle intervention via an online social network is an effective alternative to the traditional modality of clinic visits, given the former might be more scalable and feasible to implement in settings that cannot support clinic-based models. TRIAL REGISTRATION: ClinicalTrials.gov NCT02646618; https://clinicaltrials.gov/ct2/show/NCT02646618

Psychosocial and cognitive multimorbidity and health-related quality of life and symptom burden in older adults with atrial fibrillation: The systematic assessment of geriatric elements in atrial fibrillation (SAGE-AF) cohort study

BACKGROUND: Depression, anxiety, and cognitive impairments occur in up to 40 % of adults with AF and are associated with poorer health-related quality of life (HRQoL) and higher symptom burden. However, it is unknown how often these impairments co-occur, or multimorbidity, and how multimorbidity effects HRQoL and symptom burden. METHODS: Patients with AF age \u3e /=65 years with a CHA2DS2VASC risk score \u3e /= 2 and eligible for oral anticoagulation therapy were recruited from five clinics in a prospective cohort study. Participants completed validated measures of depression (PHQ9) and anxiety (GAD7), cognitive impairment (MoCA), and HRQOL and AF symptom burden (AFEQT). Multinomial logistic regression was used. RESULTS: Participants (N = 1244, 49 % female) were on average 76 +/- 7 years; 86 % were non-Hispanic white. Approximately 35 % of participants had 1 impairment, 17 % had 2 impairments and 8% had 3 impairments; 39 % had none of the 3 impairments examined. Compared to participants with no impairments, patients with 1, 2 and 3 impairments had higher odds of poor HRQoL (adjusted OR [AOR] = 1.77, 95 % CI 1.21, 2.60; AOR = 6.64, 95 % CI 4.43, 9.96; and AOR = 7.50, 95 % CI 4.40, 12.77, respectively) and those with 2 and 3 impairments had higher odds of high symptom burden (AOR = 3.69 95 % CI 2.22, 6.13; and AOR = 5.41 95 % CI 2.85, 10.26). CONCLUSIONS: Psychosocial/cognitive multimorbidity is common among older adults with AF and is associated with poor HRQoL and high symptom burden. Clinicians might consider incorporating psychosocial and cognitive screens into routine care as this may identify a high-risk population