College of Medicine IT Meeting Minutes

Meeting Minutes of the College of Medicine Implementation Team (College of Medicine IT).

College of Medicine IT Meeting Minutes - November 18, 2007

Meeting Minutes of the College of Medicine Implementation Team (COM IT).

Stressors, mediators, and health care outcomes of home enteral nutrition in family caregivers and their older adult care recipients

Family caregivers manage home enteral nutrition (HEN) for over 77% of an estimated 1 of every 400 Medicare recipients. Increasing usage of HEN in older adults combined with reliance on family caregivers raises concerns for the quality, outcomes, and costs of care. These concerns are relevant in light of Medicare limitations on nursing assistance and non-reimbursement for nutrition services, despite annual costs of over $600 million. This study applied stress process theories to assess stressor, mediator, and outcome variables salient to HEN and caregiving. In-home structured interviews occurred with a multi-ethnic sample of 30 caregiving dyads at 1–3 months after discharge on HEN. Care recipients were aged ≥60 (M = 68.4 years) and did not have dementia. Caregivers were aged ≥21, unpaid, and lived within 45 minutes of care recipients. Caregivers performed an average of 19.7 tasks daily for 61.9 hours weekly. Training needs were identified for 33 functional, care management, technical, and nutritional tasks. Preparedness scores were low (M = 1.73/4.0), and positively correlated with competence, self-rated quality of care and positive feelings, and negatively with overload, role captivity, and negative feelings (Ps < .05). Caregivers had multiple changes in lifestyle and dietary behaviors. Lifestyle changes positively correlated with overload, and negatively with preparedness and positive feelings. Dietary changes positively correlated with number of tasks, overload, role captivity and negative feelings, and negatively with preparedness (Ps < .01). Fifty-seven percent of caregivers aged >50 were at nutrition risk. Care recipients fared worse. Average weight change was −4.35 pounds (P < .001). Physical complications interrupted daily enteral infusions. Water intake was half of fluid need and associated with signs of dehydration (P < .001). Physical and social function was poor, with older subjects more impaired ( P < .04). Those with better prepared or less overloaded caregivers had higher functionality and QOL (P < .002). Complications, type of feeding tube, and caregiver preparedness correlated with frequency of health care utilization (Ps < .05). Efficacy of HEN in older adults requires specialized caregiver training, attention to caregivers' needs, and frequent monitoring from a highly skilled multidisciplinary team including dietitians. ^

The use of computer graphic organizers for narrative writing by elementary school students with Specific Learning Disabilities

Writing is an academic skill critical to students in today's schools as it serves as a predominant means for demonstrating knowledge during school years (Graham, 2008). However, for many students with Specific Learning Disabilities (SLD), learning to write is a challenging, complex process (Lane, Graham, Harris, & Weisenbach, 2006). Students SLD have substantial writing challenges related to the nature of their disability (Mayes & Calhoun, 2005). ^ This study investigated the effects of computer graphic organizer software on the narrative writing compositions of four, fourth- and fifth-grade, elementary-level boys with SLD. A multiple baseline design across subjects was used to explore the effects of the computer graphic organizer software on four dependent variables: total number of words, total planning time, number of common story elements, and overall organization. ^ Prior to baseline, participants were taught the fundamentals of narrative writing. Throughout baseline and intervention, participants were read a narrative writing prompt and were allowed up to 10 minutes to plan their writing, followed by 15 minutes for writing, and 5 minutes of editing. During baseline, all planning was done using paper and pencil. During intervention, planning was done on the computer using a graphic organizer developed from the software program Kidspiration 3.0 (2011). All compositions were written and editing was done using paper and pencil during baseline and intervention. ^ The results of this study indicated that to varying degrees computer graphic organizers had a positive effect on the narrative writing abilities of elementary aged students with SLD. Participants wrote more words (from 54.74 to 96.60 more), planned for longer periods of time (from 4.50 to 9.50 more minutes), and included more story elements in their compositions (from 2.00 to 5.10 more out of a possible 6). There were nominal to no improvements in overall organization across the 4 participants. ^ The results suggest that teachers of students with SLD should considering use computer graphic organizers in their narrative writing instruction, perhaps in conjunction with remedial writing strategies. Future investigations can include other types of writing genres, other stages of writing, participants with varied demographics and their use combined with remedial writing instruction. ^

The role of *language in early childhood mathematics

Math literacy is imperative to succeed in society. Experience is key for acquiring math literacy. A preschooler's world is full of mathematical experiences. Children are continually counting, sorting and comparing as they play. As children are engaged in these activities they are using language as a tool to express their mathematical thinking. If teachers are aware of these teachable moments and help children bridge their daily experiences to mathematical concepts, math literacy may be enhanced. This study described the interactions between teachers and preschoolers, determining the extent to which teachers scaffold children's everyday language into expressions of mathematical concepts. Of primary concern were the teachers' responsive interactions to children's expressions of an implicit mathematical utterance made while engaged in block play. The parallel mixed methods research design consisted of two strands. Strand 1 of the study focused on preschoolers' use of everyday language and the teachers' responses after a child made a mathematical utterance. Twelve teachers and 60 students were observed and videotaped while engaged in block play. Each teacher worked with five children for 20 minutes, yielding 240 minutes of observation. Interaction analysis was used to deductively analyze the recorded observations and field notes. Using a priori codes for the five mathematical concepts, it was found children produced 2,831 mathematical utterances. Teachers ignored 60% of these utterances and responded to, but did not mediate 30% of them. Only 10% of the mathematical utterances were mediated to a mathematical concept. Strand 2 focused on the teacher's view of the role of language in early childhood mathematics. The 12 teachers who had been observed as part of the first strand of the study were interviewed. Based on a thematic analysis of these interviews three themes emerged: (a) the importance of a child's environment, (b) the importance of an education in society, and (c) the role of math in early childhood. Finally, based on a meta-inference of both strands, three themes emerged: (a) teacher conception of math, (b) teacher practice, and (c) teacher sensitivity. Implications based on the findings involve policy, curriculum, and professional development.

Evaluation of non-contact sampling and detection of explosives using receiver operating characteristic curves

The growing need for fast sampling of explosives in high throughput areas has increased the demand for improved technology for the trace detection of illicit compounds. Detection of the volatiles associated with the presence of the illicit compounds offer a different approach for sensitive trace detection of these compounds without increasing the false positive alarm rate. This study evaluated the performance of non-contact sampling and detection systems using statistical analysis through the construction of Receiver Operating Characteristic (ROC) curves in real-world scenarios for the detection of volatiles in the headspace of smokeless powder, used as the model system for generalizing explosives detection. A novel sorbent coated disk coined planar solid phase microextraction (PSPME) was previously used for rapid, non-contact sampling of the headspace containers. The limits of detection for the PSPME coupled to IMS detection was determined to be 0.5-24 ng for vapor sampling of volatile chemical compounds associated with illicit compounds and demonstrated an extraction efficiency of three times greater than other commercially available substrates, retaining >50% of the analyte after 30 minutes sampling of an analyte spike in comparison to a non-detect for the unmodified filters. Both static and dynamic PSPME sampling was used coupled with two ion mobility spectrometer (IMS) detection systems in which 10-500 mg quantities of smokeless powders were detected within 5-10 minutes of static sampling and 1 minute of dynamic sampling time in 1-45 L closed systems, resulting in faster sampling and analysis times in comparison to conventional solid phase microextraction-gas chromatography-mass spectrometry (SPME-GC-MS) analysis. Similar real-world scenarios were sampled in low and high clutter environments with zero false positive rates. Excellent PSPME-IMS detection of the volatile analytes were visualized from the ROC curves, resulting with areas under the curves (AUC) of 0.85-1.0 and 0.81-1.0 for portable and bench-top IMS systems, respectively. Construction of ROC curves were also developed for SPME-GC-MS resulting with AUC of 0.95-1.0, comparable with PSPME-IMS detection. The PSPME-IMS technique provides less false positive results for non-contact vapor sampling, cutting the cost and providing an effective sampling and detection needed in high-throughput scenarios, resulting in similar performance in comparison to well-established techniques with the added advantage of fast detection in the field.