Effects of a dog walking program with older adults in long-term care

The purpose of this study was to determine if walking a dog would increase motivation to adhere to a walking program and result in an increase in walking endurance and mobility among institutionalized elderly. An experimental pre and post test two group randomly assigned study design was utilized. Thirty subjects, 20 females and 10 males with an average age of 72, were enrolled from three long-term care facilities. The walking program was 3 times a week for 6 weeks. The experimental group walked with a certified therapy dog and the handler. The control group walked with only the handler. The Outcome Expectations for Exercise Scale (OEES) was used to measure the perceived benefits of exercise. The 2-minute walk test and the 30 second chair stand test were administered before and after the walking program. The OEES scores did not significantly predict adherence to the program. The pre- and post-chair stand test and the 2-minute walk test did not show statistical significant differences between groups. All of the participants did show an increase (7 minutes) in walking time during the 6 week period (p=0.048). The mean pre and post walk test scores for participants with stroke/arthritis were significantly less than those without stroke/arthritis (p=0.013). The experimental group had 12 subjects with stroke/arthritis compared with 6 in the control group. The walk test means in feet walked were 362.44 ± 130.36 (control) vs. 201.27 ± 106.25 (experimental), p=0.001. The results indicate walking practice has the potential to increase walking time and endurance. Because residents of long-term care facilities were not allowed outside the facilities without accompaniment, the presence of the dog handler was key to their walking. Analysis of conversations during the walks indicated that for participants who walked with dogs, the dogs did serve as motivation for continuing in the program. ^

Assessment of executive function before and after vitamin D replacement in vulnerable adults who self-neglect

Purpose: Self-neglect (SN) is the inability to maintain self-care needs. It is thought that older adults who have impaired executive function (EF) develop the inability to do self-care and to protect themselves. The specific aims were to (1) determine the feasibility of using multiple EF measures with community-dwelling elders with SN, (2) identify changes in EF between baseline and 5-months in community-dwelling elders with SN who receive 50,000 IU or 400 IU of oral vitamin D monthly and (2) explore changes in specific dimensions of EF between the groups. ^ Methods: Fifty adults, 65 years of age and older, were recruited from Adult Protective Services with confirmed SN. A research nurse administered the following tests at baseline and five-months: Delis-Kaplan Card Sort Test (D-KEFS), Executive Interview (EXIT 25), CLOX Drawing Test (CLOX I, II), Trails Making Test A and B (TMT A & B) and the Mini-Mental State Examination (MMSE). Demographic data was collected at baseline and serum 25-OHD levels were collected at baseline and five-months. ^ Results: Older adults with SN were more likely to fail the CLOX1 and D-KEFS, while passing the MMSE, CLOX II, TMT A & B and the EXIT 25. At five-months, the only statistically significant difference between groups was in the TMT A & B test scores; the control group did better than the treatment group. There was a non-significant increase in serum vitamin D levels for both groups and no difference between groups. ^ Conclusions: Results from this study provide support that individuals who SN will complete a battery of EF tests and that they exhibit the following impairments consistent with executive dysfunction: 'concept generation', 'planning', 'inhibition', and 'spatial working memory'. Utilizing only one EF measure in individuals with intact cognition may result in unidentification of individuals with executive dysfunction, thus delaying necessary treatment. Future studies should attempt to determine different etiologies of executive dysfunction and determine if early treatment can prevent or reverse SN. ^ Key Words: Self-neglect, Executive Dysfunction, Executive Function, Adult Protective Services, Community-dwelling, Vitamin D ^

AN ASSESSMENT OF KNOWLEDGE AND ATTITUDES OF GENETIC COUNSELING SERVICES IN U.S. HTCs

Hemophilia is a hereditary bleeding disorder which requires lifelong specialized care. A network of Hemophilia Treatment Centers (HTCs) exists to meet the medical needs of patients affected by hemophilia. Genetic counseling services are an integral part of the HTC model of care; however, many HTCs do not have genetic counselors on staff. As a result, the duty to provide these services must fall to other healthcare providers within the HTC. To assess the knowledge and attitudes of these providers we developed a 49 question survey that was distributed electronically to hematologists and nurses at U.S. HTCs. The survey consisted of a three sections: demographic information, knowledge of hemophilia genetics, and attitudes towards genetic services. A total of 111 complete responses were received and analyzed. The average knowledge score among all participants was 74.8% with a total of 81 participants receiving a passing score of 70% or above. Thirty participants scored below 70% in the knowledge section. In general, attitude scores were high indicating that the majority of hematologists and nurses in HTCs feel confident in their ability to provide genetic counseling services. Over 90% of participants reported that they have some form of access to genetic counseling services at their center. Hematologists and nurses practicing in U.S. HTCs demonstrate sufficient knowledge of the genetics of hemophilia, and they generally feel confident in their ability to provide genetic counseling services to their patients. While their knowledge is sufficient, the average knowledge score was lower than 75%. Certain questions covering new genetic technologies and testing practices were more commonly missed than questions asking about more basic aspects of hemophilia genetics, such as inheritance and carrier testing. Finally, many clinics report having access to a counselor, but it is oftentimes a hematologist or nurse who is providing genetic counseling services to patients. Given the inconsistency in knowledge among providers coupled with the high confidence in one’s ability to counsel patients, it leaves room to question whether information about the genetics of hemophilia is being communicated to patients in the most appropriate and accurate manner.

Macroinvertebrate abundance and proportion of trait categories in river biotopes across England and Wales

There is a long tradition of river monitoring using macroinvertebrate communities to assess environmental quality in Europe. A promising alternative is the use of species life-history traits. Both methods, however, have relied on the time-consuming identification of taxa. River biotopes, 1-100 m**2 'habitats' with associated species assemblages, have long been seen as a useful and meaningful way of linking the ecology of macroinvertebrates and river hydro-morphology and can be used to assess hydro-morphological degradation in rivers. Taxonomic differences, however, between different rivers had prevented a general test of this concept until now. The species trait approach may overcome this obstacle across broad geographical areas, using biotopes as the hydro-morphological units which have characteristic species trait assemblages. We collected macroinvertebrate data from 512 discrete patches, comprising 13 river biotopes, from seven rivers in England and Wales. The aim was to test whether river biotopes were better predictors of macroinvertebrate trait profiles than taxonomic composition (genera, families, orders) in rivers, independently of the phylogenetic effects and catchment scale characteristics (i.e. hydrology, geography and land cover). We also tested whether species richness and diversity were better related to biotopes than to rivers. River biotopes explained 40% of the variance in macroinvertebrate trait profiles across the rivers, largely independently of catchment characteristics. There was a strong phylogenetic signature, however. River biotopes were about 50% better at predicting macroinvertebrate trait profiles than taxonomic composition across rivers, no matter which taxonomic resolution was used. River biotopes were better than river identity at explaining the variability in taxonomic richness and diversity (40% and <=10%, respectively). Detailed trait-biotope associations agreed with independent a priori predictions relating trait categories to near river bed flows. Hence, species traits provided a much needed mechanistic understanding and predictive ability across a broad geographical area. We show that integration of the multiple biological trait approach with river biotopes at the interface between ecology and hydro-morphology provides a wealth of new information and potential applications for river science and management.

Cognitive and neurobiologic markers of early Alzheimer disease

Recent studies indicate that impairments in two cognitive domains characterize the cognitive abnormalities that appear earliest in the course of Alzheimer disease (AD). These cognitive domains pertain to memory and executive function ability; in particular, memory test scores reflecting the difference between immediate and delayed recall and tasks that assess cognitive flexibility (e.g., set-shifting). Preliminary data indicate that tasks of this nature, along with specific genetic information (i.e., APOE-4 status), are important in identifying which individuals with recent cognitive changes (considered to have “questionable” disease) will progress to the point where they meet criteria for AD over time. When this cognitive and genetic information is combined with neuroimaging measures targeted at the brain regions demonstrating pathology early in AD, it may serve as specific and accurate prognostic markers of AD.

A two-year experience teaching computer literacy to first-year medical students using skill-based cohorts

Because it is widely accepted that providing information online will play a major role in both the teaching and practice of medicine in the near future, a short formal course of instruction in computer skills was proposed for the incoming class of students entering medical school at the State University of New York at Stony Brook. The syllabus was developed on the basis of a set of expected outcomes, which was accepted by the dean of medicine and the curriculum committee for classes beginning in the fall of 1997. Prior to their arrival, students were asked to complete a self-assessment survey designed to elucidate their initial skill base; the returned surveys showed students to have computer skills ranging from complete novice to that of a systems engineer. The classes were taught during the first three weeks of the semester to groups of students separated on the basis of their knowledge of and comfort with computers. Areas covered included computer basics, e-mail management, MEDLINE, and Internet search tools. Each student received seven hours of hands-on training followed by a test. The syllabus and emphasis of the classes were tailored to the initial skill base but the final test was given at the same level to all students. Student participation, test scores, and course evaluations indicated that this noncredit program was successful in achieving an acceptable level of comfort in using a computer for almost all of the student body.

Mental Health Effects of Equine Therapy with Children

This study examined the effects of eight weekly lessons of therapeutic horseback riding (THR) on five children between the ages of 6 and 12 years who displayed behavioral issues, mood disturbance, relationship issues, or other mental health disorders. All of the children's parents/caregivers completed the Child Behavior Checklist for Ages 6-18 at the onset of the lessons and at the conclusion of the lessons. The children did not show any significant improvement on the Internalizing, Externalizing, Total Problems scales or the syndrome scales. However, comparisons between the pre-test and post-test scores on the Behavior scale and the Externalizing scale showed positive trends which warrant further study. The lack of significance in the data suggests that a greater participant population or a mixed method study using a combination of quantitative and qualitative strategies may yield more conclusive results.

Educational Systems for Maximizing Learning Online and in the Classroom

Thesis (Ph.D.)--University of Washington, 2016-06

Prevalence of mixed neuropathologies in autopsied older adults and associations with clinical disease progression

Thesis (Ph.D.)--University of Washington, 2016-06

Testing the energetic equivalence rule with helminth endoparasites of vertebrates

As a general test of the energetic equivalence rule, we examined macroecological relationships among abundance, density and host body mass in a comparative analysis of the assemblages of trophically transmitted endoparasitic helminths of 131 species of vertebrate hosts. Both the numbers and total volume of parasites per gram of host decreased allometrically with host body mass, with slopes roughly consistent with those expected from the allometric relationship between host basal metabolic rate and body mass. From an evolutionary perspective, large body size may therefore allow hosts to escape from the deleterious effects of parasitism.

The Stanford Binet fourth edition and its use with individuals with Down syndrome: Cautions for clinicians

Stanford Binet: Fourth Edition (SB:IV) assessments have been collected longitudinally for 195 individuals with Down syndrome. This article discusses individual assessments which were selected for their ability to highlight major concerns that practitioners need to consider when interpreting intelligence test scores with this population. In this study, Intelligence Quotient (IQ) changed substantially for many individuals, demonstrating changes in classification from a mild level of intellectual impairment on initial assessment to a severe level on later assessment. Subtests used in calculating composite scores were found to have a dramatic effect on IQ. There was up to 9 IQ points difference depending on whether only the “core” subtests or all subtests used by the assessor were included in the calculations. Thirty-seven percent of the assessments were at “floor level” (i.e., IQ of 36), despite obvious divergent abilities illustrated by age equivalent scores. Mean Age Equivalent (MAE) scores were also problematic as they failed to adequately represent either the range, or divergence, of abilities of the individuals whose data are presented. Directions for future research are discussed.

Addressing internet training issues for people with Parkinson's disease

The Internet enables access to information, services, support and participation in leisure opportunities. Some populations, including people with disabilities, lack access to these opportunities through the Internet. Barriers may include finances, physical access, lack of resources and inaccessible websites. Limited access to Internet training is an additional barrier for people with communication impairments. People with Parkinson's disease (PD) may have difficulty accessing usual Internet training due to high-level language, cognitive and physical limitations. Aphasia-friendly Internet training materials were trialed with this population to investigate if participants could learn to use the Internet and would benefit from Internet training. The tutors' experience was also investigated using qualitative measures. Seven people with PD were matched with volunteer tutors. These pairs met for six Internet training lessons using training materials available as a free download from: http://dexter.shrs.uq.edu.au/cdaru/aphasiagroups/. Pre and post-test Internet skills assessments and attitudinal questionnaires were conducted. Significant differences between pre and post-test scores were found. Participants reached varying levels of independence on Internet tasks. Favorable outcomes were reported by participants, and tutors reported a positive experience. Further investigation is recommended to determine the efficacy of this approach compared with other training avenues and with other communication-impaired populations. Practical and theoretical implications for speech pathology practice are discussed.

Telling the story of theory of mind: Deaf and hearing children's narratives and mental state understanding

Theory of mind (ToM) was examined in late-signing deaf children in two studies by using standard tests and measures of spontaneous talk about inner states of perception, affect and cognition during storytelling. In Study 1, there were 21 deaf children aged 6 to 11 years and 13 typical-hearing children matched with the deaf by chronological age. In Study 2, there were 17 deaf children aged 6 to 12 years and 17 typical-hearing preschoolers aged 4 to 5 years who were matched with the deaf by ToM test performance. In addition to replicating the consistently reported finding of poor performance on standard false belief tests by late-signing deaf children, significant correlations emerged in both studies between deaf children's ToM test scores and their spontaneous narrative talk about imaginative cognition (e.g. 'pretend'). In Study 2, with a new set of purpose-built pictures that evoked richer and more complex mentalistic narration than the published picture book of Study 1, results of multiple regression analyses showed that children's narrative talk about imaginative cognition was uniquely important, over and above hearing status and talking of other kinds of mental states, in predicting ToM scores. The same was true of children's elaborated narrative talk using utterances that either spelt out thoughts, explained inner states or introduced contrastives. In addition, results of a Guttman scalograrn analysis in Study 2 suggested a consistent sequence in narrative and standard test performance by deaf and hearing children that went from (1) narrative mention of visible (affective or perceptual) mental states only, along with FB failure, to (2) narrative mention of cognitive states along with (1), to (3) elaborated narrative talk about inner states along with (2), and finally to (4) simple and elaborated narrative talk about affective/perceptual and cognitive states along with FIB test success. Possible explanations for this performance ordering, as well as for the observed correlations in both studies between ToM test scores and narrative variables, were considered.

A Cochrane review (update 2004): Hylan G-F 20 vs placebo for knee OA

Aim of study: As part of a Cochrane review of viscosupplementation in knee OA, randomised controlled trials (RCT) were reviewed to evaluate evidence for the efficacy of viscosupplementation with Hylan G-F 20 compared to placebo. Methods: Electronic searches were conducted of MEDLINE, EMBASE, Premedline, Current Contents, and CENTRAL. Human, RCT involving Hylan G-F 20 compared to placebo, published prior to 1Q2004, were included. Trials were selected and data extracted by two independent reviewers. Methodological quality was assessed with the Jadad criteria by two reviewers. Data on the OARSI and OMERACT core set clinical outcome measures were extracted where possible. Weighted mean difference (WMD), based on post-test scores, and 95% confidence intervals (CI) were calculated for continuous outcome measures and relative risk (RR) for dichotomous outcome measures. Results: Seven RCT met the inclusion criteria. Median methodological quality was 4 (range 1–5). A further two studies were only reported in abstract form (Jadad score Z 1) and contained insufficient extractable data for inclusion in the analysis. Nine RCT, which compared Hylan G-F 20 to other interventions such as intra-articular corticosteroid, physiotherapy, NSAID, appropriate care, intra-articular gaseous oxygen and other hyaluronan, are not reported here. Twenty-three studies failed to meet inclusion criteria and were excluded. Hylan G-F 20 was more efficacious than placebo at 1–4 weeks post-injection for pain on weight-bearing WMD (random effects [RE]) 13 mm on a 0–100 mm VAS (P Z 0.002) based on 6 RCT. This difference was even greater at 5–13 weeks post-injection, 22 m (RE) (P Z 0.001) based on 5 RCT, and at 14–6 weeks postinjection, 21 m (RE) (P Z 0.006) based on 4 RCT. Hylan G-F 20 was more efficacious than placebo at 1–4 weeks post-injection for pain at night, WMD 7 mm on a 0–100 mm VAS (P Z 0.003) based on 5 RCT. This difference was even greater at 5–13 weeks post-injection, 11 mm (P Z 0.008) based on 4 RCT, and at 14–26 weeks post-injection, 17 mm (P ! 0.00001) based on 3 RCT. There was no significant difference (WMD 8 mm) between Hylan G-F 20 C oral placebo and arthrocentesis C oral placebo at 5–13 weeks post-injection for WOMAC Pain, but Hylan G-F 20 C oral placebo was more efficacious than arthrocentesis C oral placebo for WOMAC Function, WMD 9 mm on a 0–100 mm VAS (P Z 0.01) (Dickson, 2001). Hylan G-F 20 was more effective than placebo at 1–4 weeks postinjection for the variable designed treatment efficacy, WMD 22 mm on a 0–100 mm VAS (P ! 0.00001) based on improvement in 4 RCT. This difference was even greater at 5–13 weeks post injection, 35 mm (P ! 0.00001). Conclusions: Evidence from this updated Cochrane review supports the superior efficacy of Hylan G-F 20 compared to placebo on weight-bearing pain, night pain, function and treatment efficacy in the treatment of knee OA.

The development and evaluation of distance learning materials for administrative personnel in a multi-national company

There has been substantial research into the role of distance learning in education. Despite the rise in the popularity and practice of this form of learning in business, there has not been a parallel increase in the amount of research carried out in this field. An extensive investigation was conducted into the entire distance learning system of a multi-national company with particular emphasis on the design, implementation and evaluation of the materials. In addition, the performance and attitudes of trainees were examined. The results of a comparative study indicated that trainees using distance learning had significantly higher test scores than trainees using conventional face-to-face training. The influence of the previous distance learning experience, educational background and selected study environment of trainees was investigated. Trainees with previous experience of distance learning were more likely to complete the course and with significantly higher test scores than trainees with no previous experience. The more advanced the educational background of trainees, the greater the likelihood of their completing the course, although there was no significant difference in the test scores achieved. Trainees preferred to use the materials at home and those opting to study in this environment scored significantly higher than those studying in the office, the study room at work or in a combination of environments. The influence of learning styles (Kolb, 1976) was tested. The results indicated that the convergers had the greatest completion rates and scored significantly higher than trainees with the assimilator, accommodator and diverger learning styles. The attitudes of the trainees, supervisors and trainers were examined using questionnaire, interview and discussion techniques. The findings highlighted the potential problems of lack of awareness and low motivation which could prove to be major obstacles to the success of distance learning in business.