Perceptions of Adult Patients Accessing Telehealth in an Urban Medical Group

Problem: Although implementation of in-patient electronic healthcare records is nearly complete in the United States, this achievement has not translated into consumer-to-business telehealth in the primary care setting. Because there are few studies that describe how and why patients select telehealth, the aim of this study was to learn about perceptions of adult patients in an urban setting when telehealth options are available. Research questions included a) How do patients select any type of appointment? b) How do patients perceive and use telehealth options? c) How and when might telehealth be useful in the future? Methods: A qualitative study design was used to collect data through semi-structured open-ended interviews from 21 patients in a primary care practice. Interviews were transcribed and analyzed using grounded theory methodology. Results: The theory of weighing options emerged from the data. The process of weighing options explains how patients balance factors of urgency, timing/scheduling, relationships, distance, convenience, and various technical aspects before selecting a telehealth encounter or not. If all the factors show a benefit, then the decision is made to use telehealth. Information obtained from the patient perspective may identify strategies to support increased use of telehealth. Conclusion: The benefit of this study will be to facilitate awareness among patients about telehealth options. This information can be used by providers and nurses to maintain caring while supporting patients who choose virtual care

Implementing Multi-Tiered Systems of Support in Mathematics: Findings from Two Schools

This study examined the benefits and challenges associated with implementing RtI in the area of mathematics in an elementary and a middle school in a rural district in the northeastern United States. We sought to document the ways in which two schools approached implementation of RtI and to explore the issues they encountered with respect to instruction, intervention, and assessment. Five themes were identified that described implementation of the RtI framework: Shifting roles and changing structures, increasing opportunities for collaboration and communication, increasing instructional and assessment support for students who struggle in math, increasing knowledge of support strategies for learners who struggle with math, and “spreading the word” and enhancing the use of the model. The results of this study suggest that the RtI model has potential to improve how math instruction is approached in elementary and middle schools

Examining the Perspectives of Elementary Education Teachers Prepared Through Traditional and Dual License Programs

Preparing classroom teachers to work with students with diverse learning needs is a challenge that has been well documented by the literature. Earning a dual license in general and special education has been posited as one possible solution to this challenge. This paper reports on a qualitative study that examined the differences between dually licensed and traditionally prepared educators with regards to their self-efficacy and ideas about inclusion. Findings suggest that teachers who earn a dual license in general education and special education may have a stronger sense of self-efficacy as well as a stronger skill set for working with students with disabilities and other types of difference

Cell-specific activity-dependent fractionation of layer 2/3→5B excitatory signaling in mouse auditory cortex

© The Author(s), 2015. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Journal of Neuroscience 35 (2015): 3112-3123, doi:10.1523/JNEUROSCI.0836-14.2015.Auditory cortex (AC) layer 5B (L5B) contains both corticocollicular neurons, a type of pyramidal-tract neuron projecting to the inferior colliculus, and corticocallosal neurons, a type of intratelencephalic neuron projecting to contralateral AC. Although it is known that these neuronal types have distinct roles in auditory processing and different response properties to sound, the synaptic and intrinsic mechanisms shaping their input–output functions remain less understood. Here, we recorded in brain slices of mouse AC from retrogradely labeled corticocollicular and neighboring corticocallosal neurons in L5B. Corticocollicular neurons had, on average, lower input resistance, greater hyperpolarization-activated current (Ih), depolarized resting membrane potential, faster action potentials, initial spike doublets, and less spike-frequency adaptation. In paired recordings between single L2/3 and labeled L5B neurons, the probabilities of connection, amplitude, latency, rise time, and decay time constant of the unitary EPSC were not different for L2/3→corticocollicular and L2/3→corticocallosal connections. However, short trains of unitary EPSCs showed no synaptic depression in L2/3→corticocollicular connections, but substantial depression in L2/3→corticocallosal connections. Synaptic potentials in L2/3→corticocollicular connections decayed faster and showed less temporal summation, consistent with increased Ih in corticocollicular neurons, whereas synaptic potentials in L2/3→corticocallosal connections showed more temporal summation. Extracellular L2/3 stimulation at two different rates resulted in spiking in L5B neurons; for corticocallosal neurons the spike rate was frequency dependent, but for corticocollicular neurons it was not. Together, these findings identify cell-specific intrinsic and synaptic mechanisms that divide intracortical synaptic excitation from L2/3 to L5B into two functionally distinct pathways with different input–output functions.This work was supported by National Institutes of Health grants DC013272 (T.T. and G.M.G.S.), DC007905 (T.T.), NS061963 (G.M.G.S), R03DC012585 (J.W.M.), T32DC011499 (C.T.A.), and F32DC013734 (C.T.A), and by the Albert and Ellen Grass Faculty Award (T.T. and G.M.G.S.) and Charles Evans Foundation Award (T.T. and G.M.G.S.).2015-08-1

Ionized Gas Towards Molecular Clumps: Physical Properties of Massive Star Forming Regions

We have conducted a search for ionized gas at 3.6 cm, using the Very Large Array, toward 31 Galactic intermediate- and high-mass clumps detected in previous millimeter continuum observations. In the 10 observed fields, 35 H II regions are identified, of which 20 are newly discovered. Many of the H II regions are multiply peaked indicating the presence of a cluster of massive stars. We find that the ionized gas tends to be associated toward the millimeter clumps; of the 31 millimeter clumps observed, nine of these appear to be physically related to ionized gas, and a further six have ionized gas emission within 1'. For clumps with associated ionized gas, the combined mass of the ionizing massive stars is compared to the clump masses to provide an estimate of the instantaneous star formation efficiency. These values range from a few percent to 25%, and have an average of 7% ± 8%. We also find a correlation between the clump mass and the mass of the ionizing massive stars within it, which is consistent with a power law. This result is comparable to the prediction of star formation by competitive accretion that a power-law relationship exists between the mass of the most massive star in a cluster and the total mass of the remaining stars

Intrinsically Red Sources Observed by Spitzer in the Galactic Midplane

We present a highly reliable flux-limited census of 18,949 point sources in the Galactic midplane that have intrinsically red mid-infrared colors. These sources were selected from the Spitzer Space Telescope Galactic Legacy Infrared Midplane Survey Extraordinaire (GLIMPSE) I and II surveys of 274 deg2 of the Galactic midplane, and consist mostly of high- and intermediate-mass young stellar objects (YSOs) and asymptotic giant branch (AGB) stars. The selection criteria were carefully chosen to minimize the effects of position-dependent sensitivity, saturation, and confusion. The distribution of sources on the sky and their location in the Infrared Array Camera and the Multiband Image Photometer for Spitzer 24 μm color-magnitude and color-color space are presented. Using this large sample, we find that YSOs and AGB stars can be mostly separated by simple color-magnitude selection criteria into approximately 50%-70% of YSOs and 30%-50% of AGB stars. Planetary nebulae and background galaxies together represent at most 2%-3% of all the red sources. 1004 red sources in the GLIMPSE II region, mostly AGB stars with high mass-loss rates, show significant (≥0.3 mag) variability at 4.5 and/or 8.0 μm. With over 11,000 likely YSOs and over 7000 likely AGB stars, this is to date the largest uniform census of AGB stars and high- and intermediate-mass YSOs in the Milky Way Galaxy

Developing a matrix to identify and prioritise research recommendations in HIV Prevention

BACKGROUND: HIV prevention continues to be problematic in the UK, as it does globally. The UK Department of Health has a strategic direction with greater focus on prevention as part of its World Class Commissioning Programme. There is a need for targeted evidence-based prevention initiatives. This is an exploratory study to develop an evidence mapping tool in the form of a matrix: this will be used to identify important gaps in contemporary HIV prevention evidence relevant to the UK. It has the potential to aid prioritisation in future research.METHODS: Categories for prevention and risk groups were developed for HIV prevention in consultation with external experts. These were used as axes on a matrix tool to map evidence. Systematic searches for publications on HIV prevention were undertaken using electronic databases for primary and secondary research undertaken mainly in UK, USA, Canada, Australia and New Zealand, 2006-9. Each publication was screened for inclusion then coded. The risk groups and prevention areas in each paper were counted: several publications addressed multiple risk groups. The counts were exported to the matrix and clearly illustrate the concentrations and gaps of literature in HIV prevention.RESULTS: 716 systematic reviews, randomised control trials and other primary research met the inclusion criteria for HIV prevention. The matrix identified several under researched areas in HIV prevention.CONCLUSIONS: This is the first categorisation system for HIV prevention and the matrix is a novel tool for evidence mapping. Some important yet under-researched areas have been identified in HIV prevention evidence: identifying the undiagnosed population; international adaptation; education; intervention combinations; transgender; sex-workers; heterosexuals and older age groups.<br/

The standard model of low-mass star formation applied to massive stars: multiwavelength modelling of IRAS 20126+4104

In order to investigate whether massive stars form similarly to their low-mass counterparts, we have used the standard envelope plus disc geometry successfully applied to low-mass protostars to model the near-IR to submillimetre spectral energy distribution (SED) and several mid-IR images of the embedded massive star IRAS 20126+4104. We have used a Monte Carlo radiative transfer dust code to model the continuum absorption, emission and scattering through two azimuthally symmetric dust geometries, the first consisting of a rotationally flattened envelope with outflow cavities, and the second which also includes a flared accretion disc. Our results show that the envelope plus disc model reproduces the observed SED and images more accurately than the model without a disc, although the latter model more closely reproduces the morphology of the mid-IR emission within a radius of 1.1 arcsec or ∼1800 au. We have put forward several possible causes of this discontinuity, including inner truncation of the disc due to stellar irradiation or precession of the outflow cavity. Our best-fitting envelope plus disc model has a disc radius of 9200 au. We find that it is unlikely that the outer regions of such a disc would be in hydrostatic or centrifugal equilibrium, however we calculate that the temperatures within the disc would keep it stable to fragmentation

Cliques of Neurons Bound into Cavities Provide a Missing Link between Structure and Function

A recent publication provides the network graph for a neocortical microcircuit comprising 8 million connections between 31,000 neurons (H. Markram, et al., Reconstruction and simulation of neocortical microcircuitry, Cell, 163 (2015) no. 2, 456-492). Since traditional graph-theoretical methods may not be sufficient to understand the immense complexity of such a biological network, we explored whether methods from algebraic topology could provide a new perspective on its structural and functional organization. Structural topological analysis revealed that directed graphs representing connectivity among neurons in the microcircuit deviated significantly from different varieties of randomized graph. In particular, the directed graphs contained in the order of $10^7$ simplices {\DH} groups of neurons with all-to-all directed connectivity. Some of these simplices contained up to 8 neurons, making them the most extreme neuronal clustering motif ever reported. Functional topological analysis of simulated neuronal activity in the microcircuit revealed novel spatio-temporal metrics that provide an effective classification of functional responses to qualitatively different stimuli. This study represents the first algebraic topological analysis of structural connectomics and connectomics-based spatio-temporal activity in a biologically realistic neural microcircuit. The methods used in the study show promise for more general applications in network science