Improving Advance Directive Use Through Provider Education at Newtown Primary Care

Nationally, there seems to be a discrepancy between a patient\u27s desire to talk about end-of-life care and their act of doing so. An advance directive is a legal document that enables an individual facilitate an end-of-life care discussion with someone. For many patients, primary care is their first contact with healthcare on many occasions. Educating primary care providers about common misconceptions of advance directives and advance care planning may increase the amount patients that have talked to someone about their goals and desires at end of life. This project uses a handout and an oral presentation to educate providers with the goal to encourage more advance care planning discussions and advance directive completion.https://scholarworks.uvm.edu/fmclerk/1410/thumbnail.jp

System Design and Analysis for Creating a 3D Virtual Street Scene for Autonomous Vehicles using Geometric Proxies from a Single Video Camera

Self-driving vehicles use a variety of sensors to understand the environment they are in. In order to do so, they must accurately measure the distances and positions of the objects around them. A common representation of the environment around the vehicle is a 3D point cloud, or a set of 3D data points which represent the positions of objects in the real world relative to the car. However, while accurate and useful, these point clouds require large amounts of memory compared to other representations such as lightweight polygonal meshes. In addition, 3D point clouds can be difficult for a human to visually understand as the data points do not always form a naturally coherent object. This paper introduces a system to lower the memory consumption needed for the graphical representation of a virtual street environment. At this time, the proposed system takes in as input a single front-facing video. The system uses the video to retrieve still images of a scene which are then segmented to distinguish the different relevant objects, such as cars and stop signs. The system generates a corresponding virtual street scene and these key objects are visualized in the virtual world as low poly, or low resolution, models of the respective objects. This virtual 3D street environment is created to allow a remote operator to visualize the world that the car is traveling through. At this time, the virtual street includes geometric proxies for parallel parked cars in the form of lightweight polygonal meshes. These meshes are predefined, taking up less memory than a point cloud, which can be costly to transmit from the remote vehicle and potentially difficult for a remote human operator to understand. This paper contributes a design and analysis of an initial system for generating and placing these geometric proxies of parked cars in a virtual street environment from one input video. We discuss the limitations and measure the error for this system as well as reflect on future improvements

Modeling key drivers of e-learning satisfaction among student teachers

This study explored the key drivers of student teachers' e-learning satisfaction. Three hundred and eighty-seven participants completed a survey questionnaire measuring their self-reported responses to six constructs (tutor quality, perceived usefulness, perceived ease of use, course delivery, facilitating conditions, and course satisfaction). Data analysis was performed using structural equation modeling. The results of this study showed that, apart from facilitating conditions, all constructs were significant predictors of e-learning satisfaction. However, facilitating conditions was found to be a significant mediator of perceived ease of use and satisfaction. Some implications for e-learning and teacher education were discussed

Investigating the technology acceptance among student teachers in Malaysia : an application of the Technology Acceptance Model (TAM).

This study investigated 245 Malaysian student teachers' self-reported intentions to use (ITU) computers. Using the Technology Acceptance Model (TAM) as a research framework, this study found perceived usefulness (PU) of computer technology, perceived ease of use (PEU), and attitude towards computer use (ATCU) to be significant determinants of ITU. Results obtained using structural equation modelling revealed that (I) PEU significantly influenced PU, (2) both PU and PEU significantly influenced ATCU, and (3) both PU and ATCU significantly influenced ITU. In essence, the results of this study present some evidence that TAM serves as a valid model to predict technology acceptance among student teachers in Malaysia

Vaginal Microbicides: Detecting Toxicities in Vivo that Paradoxically Increase Pathogen Transmission

BACKGROUND: Microbicides must protect against STD pathogens without causing unacceptable toxic effects. Microbicides based on nonoxynol-9 (N9) and other detergents disrupt sperm, HSV and HIV membranes, and these agents are effective contraceptives. But paradoxically N9 fails to protect women against HIV and other STD pathogens, most likely because it causes toxic effects that increase susceptibility. The mouse HSV-2 vaginal transmission model reported here: (a) Directly tests for toxic effects that increase susceptibility to HSV-2, (b) Determines in vivo whether a microbicide can protect against HSV-2 transmission without causing toxicities that increase susceptibility, and (c) Identifies those toxic effects that best correlate with the increased HSV susceptibility. METHODS: Susceptibility was evaluated in progestin-treated mice by delivering a low-dose viral inoculum (0.1 ID50) at various times after delivering the candidate microbicide to detect whether the candidate increased the fraction of mice infected. Ten agents were tested – five detergents: nonionic (N9), cationic (benzalkonium chloride, BZK), anionic (sodium dodecylsulfate, SDS), the pair of detergents in C31G (C14AO and C16B); one surface active agent (chlorhexidine); two non-detergents (BufferGel®, and sulfonated polystyrene, SPS); and HEC placebo gel (hydroxyethylcellulose). Toxic effects were evaluated by histology, uptake of a 'dead cell' dye, colposcopy, enumeration of vaginal macrophages, and measurement of inflammatory cytokines. RESULTS: A single dose of N9 protected against HSV-2 for a few minutes but then rapidly increased susceptibility, which reached maximum at 12 hours. When applied at the minimal concentration needed for brief partial protection, all five detergents caused a subsequent increase in susceptibility at 12 hours of ~20–30-fold. Surprisingly, colposcopy failed to detect visible sign of the N9 toxic effect that increased susceptibility at 12 hours. Toxic effects that occurred contemporaneously with increased susceptibility were rapid exfoliation and re-growth of epithelial cell layers, entry of macrophages into the vaginal lumen, and release of one or more inflammatory cytokines (Il-1β, KC, MIP 1α, RANTES). The non-detergent microbicides and HEC placebo caused no significant increase in susceptibility or toxic effects. CONCLUSION: This mouse HSV-2 model provides a sensitive method to detect microbicide-induced toxicities that increase susceptibility to infection. In this model, there was no concentration at which detergents provided protection without significantly increasing susceptibility.JHU Woodrow Wilson Fellowship; National Institutes of Health (Program Project A1 45967

Development of Schizophrenia in a Genetically Predisposed Individual Following COVID-19

We present a patient who is a 56-year-old female with a psychiatric history of anxiety disorder and a medical history of hypercholesterolemia and hyperthyroidism, who was admitted to the hospital after a witnessed seizure at an inpatient psychiatric facility. This patient’s family history is significant for her mother experiencing unspecified psychotic disorder that required psychiatric hospitalization. Our patient was first admitted to the psychiatric hospital after exhibiting worsening paranoid delusions and hallucinations that began several months prior. The patient had reportedly begun locking herself in the restroom and screaming “get out, they’re spying on me”, referring to her next-door neighbors whom she began exhibiting paranoia towards upon discharge from her hospital stay for COVID-19. At first, the patient believed her neighbors were “too noisy” during their home renovations, and more recently believed they were infiltrating her mind with “radio waves”. While in the hospital, we increased the dosage of Quetiapine that she was receiving at the inpatient psychiatric facility. To enhance a supportive environment at home, psychoeducation regarding her presentation and management was provided to her nephew. After stabilizing her medical conditions, the patient was discharged back to the inpatient psychiatric facility where she was originally admitted involuntarily. The dual hit hypothesis denotes the significance of genetic vulnerability compounded by environmental factors in the pathogenesis of schizophrenia. Our patient has a genetic predisposition to psychotic disorders based on her mother’s psychiatric history. She later developed a severe case of COVID-19 infection that required ICU-level of care, which has likely served as the environmental insult that instigated the development of a psychotic syndrome. COVID-19 has been shown in recent studies to trigger an inflammatory response and alter the biochemical profile in the nervous system. The long-term and downstream effects of COVID infection, which may include long COVID and psychosis, remain a topic of intense research interest. In the case of our patient, her genetic predisposition to psychosis, coupled with COVID-19 infection, has led to the development of schizophrenia in accordance with the dual hit hypothesis. We are hopeful that further investigation into the relationship between COVID-19 infection and the development of primary psychotic disorders will yield further insights into the pathogenesis of psychosis and post-COVID psychiatric symptoms

Case of New Onset Alice in Wonderland Syndrome in Adolescent After Prolonged Hospitalization

Alice in wonderland syndrome (AIWS) has been described as body image illusions involving distortions of the size, mass, or shape of the patient’s own body or its position in space, often occurring with depersonalization and derealization. Most cases typically affect young children. Common distortions are micropsia, macropsia, metamorphopsia, and pelopsia. The term was adopted from the book by Lewis Carroll, wherein the main character perceived her size and shape to change in different scenarios. These distortions are often expressed as sensory perceptions rather than illusions or hallucinations, and are often distressing to the patient. AIWS onset has been found to be associated with infection, among most frequent pathogens are epilepsy, migraine, depression, and Epstein Barr Virus. The most common which have been reported to show association are infection and migraine/head trauma. This case describes a relatively quick onset of symptoms of AIWS in a patient after a prolonged hospital stay

Human-Powered Swing Generator

Many developing countries lack sufficient resources to provide enough electricity for every family to live with a satisfying level of comfort and convenience. Our project proposes a solution that provides families with an alternative access to electricity using a playground swing. This project addresses the design and construction of the Human-Powered Swing Generator, which converts mechanical energy to electrical energy for charging a battery. The charged battery serves as a source of DC energy for potential DC purposes, such as charging a cell phone

Persistent Neurocognitive Impairment and Neurological Complications Following COVID-19: Challenges of the Long COVID Syndrome

Coronavirus disease 2019 (COVID-19) is a highly contagious respiratory disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2).(1) As of April 23, 2021, there are close to 150 million cumulative cases, with over 3 million deaths worldwide.(2) In terms of clinical presentation, individuals afflicted with COVID-19 vary greatly in terms of their disease progression and symptomatology.(3,4) During the acute phase of COVID-19, patients may experience flu-like symptoms including fever, cough, dyspnea, headache,(5,7) though gastrointestinal, renal, hepatological, rheumatological, and neurological symptoms and complications have been reported.(8,9) Recently, there has been increasing interest in the chronic sequelae of COVID-19.(10). One study has estimated that over 87% of COVID patients continue to experience at least one symptom, two months after COVID symptom onset.(11) The etiology and clinical profile of the so called long COVID(12) is still under investigation, but some studies have suggested that long COVID may involve respiratory, neuropsychiatric, cardiovascular, immunological symptoms.(13,16) With the likely devastating disease burden of long COVID, clinicians need to understand the presentation and management of patients suffering from long COVID symptoms