A Systematic Literature Review of the Current State of Knowledge Related to Interventions for Bereaved Parents

Aims: The purpose of this systematic literature review is to describe the interventions for bereaved parents, evaluate intervention effectiveness through study methodology rigor, replicability, and theoretical foundations. Methods: We searched MEDLINE via PubMed (1966-2018), CINAHL (1937-present), PsycINFO (1887-present), and Embase (1947-present) using various search words and MeSH terms related to the study purpose. A blinded screening of title/abstract was performed, with conflicting inclusion decisions resolved through group discussions. Matrices for remaining articles were created and discussed among the team. The levels of evidence of the 9 records were rated from very low to high based on the Grading of Recommendations Assessment, Development, and Evaluation guidelines. Results: Our initial pool included 1025 articles. After the screening of titles/abstracts, 63 articles were retained for full-text reviews. Evaluated based on the inclusion/exclusion criteria, 9 records met the review criteria. Of the 9 records, 1 was graded as very low, 3 low, and 5 low to moderate. The interventions for bereaved parents varied from using single-model interventions such as expressive arts therapy and telephone support to multimodal interventions that combined resources (ie, peer support, resource packets, and health-care support). Only 1 study explicitly illustrated how its bereavement intervention was designed based on the proposed theoretical model. Conclusions: This review highlights the need for individualized, well-tested, and effective bereavement care interventions to support bereaved parents. In summary, the state of the science on interventions for bereaved parents is poor and much work needs to be done to effectively address the needs of bereaved parents, including both their physical and emotional health needs

Impact of Singing Intervention on Vocal Fatigue Effects : A Single Subject Study

This single subject descriptive study investigated the efficacy of singing intervention on the effects of vocal fatigue on the speaking voice of a non-singing individual. Baseline measures were taken on a single subject prior to voice treatment. Data were collected before and after the subject performed a vocally fatiguing task of 1 hour of prolonged reading at 80% of his maximum vocal intensity level. Data collection consisted of the following acoustic and aerodynamic characteristics of the subject\u27s speaking voice: fundamental frequency, jitter, shimmer, maximum intensity level, and maximum phonation duration, as well as obtainment of the subject\u27s self-perceptions of vocal quality, tension, and pain in his own speaking voice. The subject underwent 4 weeks of singing intervention. The goal of singing intervention was to reduce the fatiguing effects of prolonged, loud, speaking. After 4 weeks of singing intervention, the collection of acoustic, physiologic, and perceptual data was repeated before and after the subject performed 1 hour of reading at 80% of his maximum vocal intensity level. Pre-treatment data were compared to posttreatment data using descriptive techniques. Based on the comparison of pre-treatment data to post-treatment data, the results indicated that singing intervention allowed for a reduction in the fatiguing effects of prolonged aloud reading as measured by fundamental frequency, jitter, maximum intensity level, and maximum phonation duration. Specifically, prior to singing intervention, fundamental frequency (Fo) exceeded normal limits when the patient was vocally fatigued. Following singing intervention, Fo remained within normal limits during both the pre and post-fatigue conditions. The subject\u27s jitter values were not within normal limits prior to intervention; jitter values improved, but continued to fall outside the normative data for an individual of the subject\u27s age and gender. The subject\u27s shimmer values remained constant throughout the study. In the pretreatment condition, the subject\u27s maximum intensity and maximum phonation duration levels were negatively affected by fatigue. Fatigue effects were no longer observed on these levels following intervention. Singing intervention had no effect on the subject\u27s perceptions of vocal quality, laryngeal muscular tension, and sensations of pain

Development of a Capillary Blood Mail-in Kit for the Measurement of Hemoglobin A1c

Biomedical Tissue Engineering, Biomaterials and Medical Devices Poster SessionIt is estimated that in the United States diabetes affects 25 million children and adults, and is a major cause of morbidity and mortality. Cost of diabetes in the United States is over $175 billion a year. To optimize insulin dose diabetic patients regularly measure their blood glucose. Random glucose measurement does not provide indication of long-term glucose control. The long-term indicator of glucose control is the hemoglobin A1c (HbA1c). It provides average blood glucose level of the previous 2 to 3 months. In most cases, for HbA1c testing, patients come to clinical laboratories for blood draw. It is time consuming and inconvenient. In recent years efforts have been made to develop sample mail-in kit where the blood sample can be collected at home and mailed to a testing laboratory. We present the development of a stabilizing solution (SS) and mail-in kit for Hb A1c testing. With this kit, after a simple finger prick, a patient collects blood using a capillary tube. The blood-containing capillary tube is dropped in a tube containing SS, and is mailed to the laboratory in a pre-stamped box in a regular mail. Validation of the kit included 1) Comparing HbA1c levels in the whole blood to hemolysate and SS immediately after preparation of the samples, 2) Stability of HbA1c in SS for 4 and 7 days at 4oC, room temperature and 37oC, 3) mailing the samples in the regular mail and comparing the values of HbA1c in mailed-in samples to the whole blood samples. The data for some of these comparisons are shown in the Table below. No significant difference was found in the values of HbA1c in various test groups. In conclusion, we have developed a convenient mail-in kit for the measurement of HbA1c. The advantages of mail-in kit for HbA1c measurement include patients' satisfaction as it negates the need for venipuncture and laboratory visit for sample collection, and the availability of results to a physician before the patient's visit for optimal care

Performance of some tests for bivariate independence, interchangeability, and equality of distributions of ratios

The purpose of this thesis is to derive and compare asymptotic performances of certain tests of independence, interchangeability and equality of the distributions of_ratios Y/X for positive variates and Y with joint c.d.f. H(x,y) of particular forms. Three bivariate families, Morgenstern, Plackett, and Moran, are considered which permit marginal c.d.f.'s F(x) and G(y) of specified forms. For testing independence of X and Y, asymptotic locally optimal parametric tests are derived for bivariate gamma and Weibull distributions for each of three families. Locally most powerful nonparametric tests are also derived for each of the three bivariate families, and asymptotic relative efficiency comparisons are made among the various tests of independence. Nonparametric tests for interchangeability of X and Y, based on the Wilcoxon, symmetric squared ranks, and Savage statistics are considered. Asymptotic relative efficiency comparisons of the nonparametric tests are made for scale alternatives in the Morgenstern and Moran bivariate gamma distributions and bivariate log normal distributions. Wilcoxon, symmetric squared ranks, and normal score tests are considered for testing equality of two distributions of ratios Y/X. Asymptotic relative efficiency comparisons of the nonparametric tests are made for scale alternatives in some Morgenstern bivariate gamma distributions. The techniques and results of this study may have application in the analysis of data from rain-making experiments, reliability studies and medical research

Finland: An Exemplary STEM Educational System

There is a need for an increase in the number of students entering fields of science, technology, engineering, and mathematics (STEM) and the only way for that to happen is for educational reforms to be put into place (PCAST, 2012). Improvement and focus on STEM education are a concern of all nations whether they have an emerging economy or one that is long established. The world of the 21st century is such that in order to compete globally countries must invest in STEM education (Kennedy & Odell, 2014). The United States scores on the Program for International Student Assessment (PISA) were not in the top ten for reading, mathematics, nor science. To rectify this, it is imperative that changes be made to the educational system (Schleicher, ed., 2012). Looking at countries that are consistently at the top is one way to find potential solutions and models of reform. One country that has successfully reformed their educational system is Finland. Within their educational system, the strategies of collaboration and communication are widely utilized by the instructors as well as the students (Sislian, Gabardo, Macedo, & Ribeiro, 2015). While analyzing a single country’s instructional program can give insights into what makes it successful, it is beneficial to compare that country to others that are also achieving success in order to determine any trends and commonalities. The countries used for this comparison were chosen because they were different culturally, geographically, and politically, but in spite of their differences, they were among the top-scoring nations on the PISA

Aphid Thermal Tolerance Is Governed by a Point Mutation in Bacterial Symbionts

Symbiosis is a ubiquitous phenomenon generating biological complexity, affecting adaptation, and expanding ecological capabilities. However, symbionts, which can be subject to genetic limitations such as clonality and genomic degradation, also impose constraints on hosts. A model of obligate symbiosis is that between aphids and the bacterium Buchnera aphidicola, which supplies essential nutrients. We report a mutation in Buchnera of the aphid Acyrthosiphon pisum that recurs in laboratory lines and occurs in field populations. This single nucleotide deletion affects a homopolymeric run within the heat-shock transcriptional promoter for ibpA, encoding a small heat-shock protein. This Buchnera mutation virtually eliminates the transcriptional response of ibpA to heat stress and lowers its expression even at cool or moderate temperatures. Furthermore, this symbiont mutation dramatically affects host fitness in a manner dependent on thermal environment. Following a short heat exposure as juveniles, aphids bearing short-allele symbionts produced few or no progeny and contained almost no Buchnera, in contrast to aphids bearing symbionts without the deletion. Conversely, under constant cool conditions, aphids containing symbionts with the short allele reproduced earlier and maintained higher reproductive rates. The short allele has appreciable frequencies in field populations (up to 20%), further supporting the view that lowering of ibpA expression improves host fitness under some conditions. This recurring Buchnera mutation governs thermal tolerance of aphid hosts. Other cases in which symbiont microevolution has a major effect on host ecological tolerance are likely to be widespread because of the high mutation rates of symbiotic bacteria and their crucial roles in host metabolism and development

Oxygen Vacancies in LiAlO\u3csub\u3e2\u3c/sub\u3e Crystals

Singly ionized oxygen vacancies are produced in LiAlO2 crystals by direct displacement events during a neutron irradiation. These vacancies, with one trapped electron, are referred to as V+O centers. They are identified and characterized using electron paramagnetic resonance (EPR) and optical absorption. The EPR spectrum from the V+O centers is best monitored near 100 K with low microwave power. When the magnetic field is along the [001] direction, this spectrum has a g value of 2.0030 and well-resolved hyperfine interactions of 310 and 240 MHz with the two 27Al nuclei that are adjacent to the oxygen vacancy. A second EPR spectrum, also showing hyperfine interactions with two 27Al nuclei, is attributed to a metastable state of the V+O center. An optical absorption band peaking near 238 nm is assigned to V+O centers. Bleaching light from a Hg lamp converts a portion of the V+O centers to V0O centers (these latter centers are oxygen vacancies with two trapped electrons). The V0O centers have an absorption band peaking near 272 nm, a photoluminescence band peaking near 416 nm, and a photoluminescence excitation band peaking near 277 nm. Besides the oxygen-vacancy EPR spectra, a holelike spectrum with a resolved, but smaller, hyperfine interaction with one 27Al nucleus is present in LiAlO2 after the neutron irradiation. This spectrum is tentatively assigned to doubly ionized aluminum vacancies

The Effect of Systematic Clinical Interventions with Cigarette Smokers on Quit Status and the Rates of Smoking-Related Primary Care Office Visits

Background: The United States Public Health Service (USPHS) Guideline for Treating Tobacco Use and Dependence includes ten key recommendations regarding the identification and the treatment of tobacco users seen in all health care settings. To our knowledge, the impact of system-wide brief interventions with cigarette smokers on smoking prevalence and health care utilization has not been examined using patient population-based data. Methods and Findings Data on clinical interventions with cigarette smokers were examined for primary care office visits of 104,639 patients at 17 Harvard Vanguard Medical Associates (HVMA) sites. An operational definition of “systems change” was developed. It included thresholds for intervention frequency and sustainability. Twelve sites met the criteria. Five did not. Decreases in self-reported smoking prevalence were 40% greater at sites that achieved systems change (13.6% vs. 9.7%, p<.01). On average, the likelihood of quitting increased by 2.6% (p<0.05, 95% CI: 0.1%–4.6%) per occurrence of brief intervention. For patients with a recent history of current smoking whose home site experienced systems change, the likelihood of an office visit for smoking-related diagnoses decreased by 4.3% on an annualized basis after systems change occurred (p<0.05, 95% CI: 0.5%–8.1%). There was no change in the likelihood of an office visit for smoking-related diagnoses following systems change among non-smokers. Conclusions: The clinical practice data from HVMA suggest that a systems approach can lead to significant reductions in smoking prevalence and the rate of office visits for smoking-related diseases. Most comprehensive tobacco intervention strategies focus on the provider or the tobacco user, but these results argue that health systems should be included as an integral component of a comprehensive tobacco intervention strategy. The HVMA results also give us an indication of the potential health impacts when meaningful use core tobacco measures are widely adopted