The impact of genetic counseling on patient engagement

Recent healthcare efforts have targeted patient engagement as a means to improve medical outcomes and reduce the healthcare costs of chronic conditions. This pilot study analyzed engagement levels among patients who underwent genetic counseling for Gastrointestinal (GI) cancer risk assessment, and examined the feasibility of implementing engagement measures in an outpatient specialty clinic. We hypothesized that undergoing genetic counseling would empower patients and result in increased engagement scores. Patients seen at the UPMC Hereditary GI Tumor Program were asked to complete a patient engagement measure, the Altarum Consumer Engagement (ACE), prior to undergoing genetic counseling. Post-appointment ACE measures were completed for each participant three months after enrollment via telephone. Paired t-test analysis was conducted to assess changes in the ACE scores before and after genetic counseling. In the sample of 38 participants, the ACE Measure scores were found to increase significantly after having genetic counseling (p = 0.0342). No statistically significant differences were found in ACE scores between participants recently diagnosed with cancer and those with a past personal history or a family history of cancer (p = 0.2042). The implementation of engagement measures in the clinical setting is feasible, and may assess the impact of genetic counseling on healthcare efficacy in patients suspected to have a genetic cancer susceptibility. Identifying novel approaches for patient activation is of public health significance, both in improving patient outcomes and lowering healthcare cost. Future research is ongoing to investigate whether improved patient engagement correlates to lifestyle modifications that reduce cancer risk

Climate Mitigation Planning: Are Plans with Policy Tools Measurably More Effective?

A climate action plan is the ultimate tool used by cities in their efforts to combat climate change. Climate action plans are used by cities as a guide to reduce their contribution of greenhouse gas (GHG) emissions. Within a climate action plan it is common to find record of the city’s current emissions; information on the risks the city faces in a changing climate; goals and targets for reducing greenhouse gas emissions often broken down into sectors such as electricity, industry, and transportation; suggestions on how to reduce GHG emissions; and policy recommendations needed to achieve reductions. I analyzed ten climate action plans using a unique scoring mechanism to answer the question: Are climate mitigation plans with policy tools measurably more effective than plans without? The plans were chosen based off three criteria: 1) The climate action plan must be focused on mitigation strategies or include a mitigation component, as op posed to adaptation 2) The city represents one of the four regions of the U.S. as defined by the Census Bureau 3) The climate action plan must have been published at least three years prior to this report. Results from the analysis found that policy tools may not always equate to action. However, policy recommendations contributed to higher scores overall, therefore this study suggests climate action plans with policy tools are measurably more effective than plans without. The end of this study offers recommendations on how climate action plans can be most effective

Teaching social studies content to students with autism using a graphic organizer intervention

The National Council for the Social Studies (NCSS) emphasizes the teaching of social studies to provide students with information, critical thinking skills, and experiences to allow them to grow into responsible and effective citizens. In the past more attention was given to creating central standards in the area of social studies (National Curriculum Standards for Social Studies, 2010). There has been very little research in academic skill acquisition for students with developmental disabilities (Browder et al., 2006). There were no studies found that addressed social studies instruction for student with developmental disabilities. One of the barriers to teaching social studies to students without and with disabilities is students’ ability to read and understand written expository text. This current study investigated the use of specific vocabulary of social studies instruction to teach middle school students with autism to use a modified graphic organizer procedure to promote improved expository text comprehension in social studies topic area of United States History. Three students were instructed to use a modified graphic organizer intervention to answer nine items from self-read history passages. Results indicated that each of the three students increased their ability to independently respond to the nine items on the graphic organizer

Effects of a Treatment Package to Facilitate English/Language Arts Learning for Middle School Students with Moderate to Severe Disabilities

This pilot study sought to develop and evaluate the use of a treatment package that included systematic and direct instruction on acquisition of literacy skills aligned with middle school English/Language Arts standards for students with moderate to severe disabilities, including autism. Participants included five teachers and 15 middle school students with moderate to severe disabilities who were primarily served in a self-contained setting. A one-group, nonrandomized, pre-posttest design was implemented to measure vocabulary, comprehen- sion of familiar text and unfamiliar text, poetry, research, and writing skills. Results indicated significant gains in vocabulary and comprehension of familiar text. Limitations, implications, and the need for future research are discussed

Unilateral vs. bilateral hamstring strength assessments: comparing reliability and inter-limb asymmetries in female soccer players

The aims in the present study were to assess reliability for two unilateral and two bilateral field-based hamstring assessments and compare magnitude, direction and agreement of inter-limb asymmetry between tests and sessions. Twenty-nine female soccer players (age: 21.1±4.5 years; height: 169.7±5.8 cm; body mass: 66.2±6.4 kg) performed three repetitions per leg of unilateral isometric 30° (ISO 30°) and 90° (ISO 90°) knee flexion (KF) tasks, and three repetitions total for a bilateral 90° isometric (kneeling ISO) KF and Nordic hamstring exercise (NHE). Absolute reliability of most methods within- and between-session were acceptable (<10%). Relative reliability within-session demonstrated fair to excellent reliability (ICC≥0.784; lower bound 95%CI ≥0.623). Greater variability in between-session relative reliability was observed during the unilateral tests, demonstrating poor to good (ICC=0.698–0.798; lower bound 95%CI = 0.274–0.638). Bilateral assessments demonstrated similar ranges of poor to excellent (ICC=0.679–0.963; lower bound 95%CI = 0.231–0.790). Agreement between-session for inter-limb asymmetry identification was slight and fair in the unilateral tests, with moderate to substantial agreement demonstrated in the bilateral. Being the most reliable within- and between-sessions, demonstrating substantial agreement in asymmetry between-sessions, the NHE would be most appropriate to identify inter-limb asymmetry and assess chronic changes in hamstring strength

Do Neuro-Muscular Adaptations Occur in Endurance-Trained Boys and Men?

Most research on the effects of endurance training has focused on endurance training's health-related benefits and metabolic effects in both children and adults. The purpose of this study was to examine the neuromuscular effects of endurance training and to investigate whether they differ in children (9.0-12.9 years) and adults (18.4-35.6 years). Maximal isometric torque, rate of torque development (RTD), rate of muscle activation (Q30), electromechanical delay (EMD), and time to peak torque and peak RTD were determined by isokinetic dynamometry and surface electromyography (EMG) in elbow and knee flexion and extension. The subjects were 12 endurance-trained and 16 untrained boys, and 15 endurance-trained and 20 untrained men. The adults displayed consistently higher peak torque, RTD, and Q30, in both absolute and normalized values, whereas the boys had longer EMD (64.7+/-17.1 vs. 56.6+/-15.4 ms) and time to peak RTD (98.5+/-32.1 vs. 80.4+/-15.0 ms for boys and men, respectively). Q30, normalized for peak EMG amplitude, was the only observed training effect (1.95+/-1.16 vs. 1.10+/-0.67 ms for trained and untrained men, respectively). This effect could not be shown in the boys. The findings show normalized muscle strength and rate of activation to be lower in children compared with adults, regardless of training status. Because the observed higher Q30 values were not matched by corresponding higher performance measures in the trained men, the functional and discriminatory significance of Q30 remains unclear. Endurance training does not appear to affect muscle strength or rate of force development in either men or boys

Effect of mammographic screening from age 40 years on breast cancer mortality (UK Age trial):final results of a randomised, controlled trial

Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.BACKGROUND: The appropriate age range for breast cancer screening remains a matter of debate. We aimed to estimate the effect of mammographic screening at ages 40-48 years on breast cancer mortality. METHODS: We did a randomised, controlled trial involving 23 breast screening units across Great Britain. We randomly assigned women aged 39-41 years, using individual randomisation, stratified by general practice, in a 1:2 ratio, to yearly mammographic screening from the year of inclusion in the trial up to and including the calendar year that they reached age 48 years (intervention group), or to standard care of no screening until the invitation to their first National Health Service Breast Screening Programme (NHSBSP) screen at approximately age 50 years (control group). Women in the intervention group were recruited by postal invitation. Women in the control group were unaware of the study. The primary endpoint was mortality from breast cancers (with breast cancer coded as the underlying cause of death) diagnosed during the intervention period, before the participant's first NHSBSP screen. To study the timing of the mortality effect, we analysed the results in different follow-up periods. Women were included in the primary comparison regardless of compliance with randomisation status (intention-to-treat analysis). This Article reports on long-term follow-up analysis. The trial is registered with the ISRCTN registry, ISRCTN24647151. FINDINGS: 160 921 women were recruited between Oct 14, 1990, and Sept 24, 1997. 53 883 women (33·5%) were randomly assigned to the intervention group and 106 953 (66·5%) to the control group. Between randomisation and Feb 28, 2017, women were followed up for a median of 22·8 years (IQR 21·8-24·0). We observed a significant reduction in breast cancer mortality at 10 years of follow-up, with 83 breast cancer deaths in the intervention group versus 219 in the control group (relative rate [RR] 0·75 [95% CI 0·58-0·97]; p=0·029). No significant reduction was observed thereafter, with 126 deaths versus 255 deaths occurring after more than 10 years of follow-up (RR 0·98 [0·79-1·22]; p=0·86). INTERPRETATION: Yearly mammography before age 50 years, commencing at age 40 or 41 years, was associated with a relative reduction in breast cancer mortality, which was attenuated after 10 years, although the absolute reduction remained constant. Reducing the lower age limit for screening from 50 to 40 years could potentially reduce breast cancer mortality. FUNDING: National Institute for Health Research Health Technology Assessment programme.Peer reviewe