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.

Development and implementation of a dynamic heterogeneous proton equivalent anthropomorphic thorax phantom for the assessment of scanned proton beam therapy

DEVELOPMENT AND IMPLEMENTATION OF A DYNAMIC HETEROGENEOUS PROTON EQUIVALENT ANTHROPOMORPHIC THORAX PHANTOM FOR THE ASSESSMENT OF SCANNED PROTON BEAM THERAPY by James Leroy Neihart, B.S. APPROVED: ______________________________David Followill, Ph.D. ______________________________Peter Balter, Ph.D. ______________________________Narayan Sahoo, Ph.D. ______________________________Kenneth Hess, Ph.D. ______________________________Paige Summers, M.S. APPROVED: ____________________________ Dean, The University of Texas Graduate School of Biomedical Sciences at Houston DEVELOPMENT AND IMPLEMENTATION OF A DYNAMIC HETEROGENEOUS PROTON EQUIVALENT ANTHROPOMORPHIC THORAX PHANTOM FOR THE ASSESSMENT OF SCANNED PROTON BEAM THERAPY A THESIS Presented to the Faculty of The University of Texas Health Science Center at Houston andThe University of TexasMD Anderson Cancer CenterGraduate School of Biomedical Sciences in Partial Fulfillment of the Requirements for the Degree of MASTER OF SCIENCE by James Leroy Neihart, B.S. Houston, Texas Date of Graduation August, 2013 Acknowledgments I would like to acknowledge my advisory committee members, chair David Followill, Ph.D., Peter Balter, Ph.D, Narayan Sahoo, Ph.D., Kenneth Hess, Ph.D., Paige Summers M.S. and, for their time and effort contributed to this project. I would additionally like to thank the faculty and staff at the PTC-H and the RPC who assisted in many aspects of this project. Falk Pӧnisch, Ph.D. for his breath hold proton therapy treatment expertise, Matt Palmer and Jaques Bluett for proton dosimetry assistance, Matt Kerr for verification plan assistance, Carrie Amador, Nadia Hernandez, Trang Nguyen, Andrea Molineu, Lynda McDonald for TLD and film dosimetry assistance. Finally, I would like to thank my wife and family for their support and encouragement during my research and studies. Development and implementation of a dynamic heterogeneous proton equivalent anthropomorphic thorax phantom for the assessment of scanned proton beam therapy By: James Leroy Neihart, B.S. Chair of Advisory Committee: David Followill, Ph.D Proton therapy has been gaining ground recently in radiation oncology. To date, the most successful utilization of proton therapy is in head and neck cases as well as prostate cases. These tumor locations do not suffer from the resulting difficulties of treatment delivery as a result of respiratory motion. Lung tumors require either breath hold or motion tracking, neither of which have been assessed with an end-to-end phantom for proton treatments. Currently, the RPC does not have a dynamic thoracic phantom for proton therapy procedure assessment. Additionally, such a phantom could be an excellent means of assessing quality assurance of the procedures of proton therapy centers wishing to participate in clinical trials. An eventual goal of this phantom is to have a means of evaluating and auditing institutions for the ability to start clinical trials utilizing proton therapy procedures for lung cancers. Therefore, the hypothesis of this study is that a dynamic anthropomorphic thoracic phantom can be created to evaluate end-to-end proton therapy treatment procedures for lung cancer to assure agreement between the measured and calculated dose within 5% / 5 mm with a reproducibility of 2%. Multiple materials were assessed for thoracic heterogeneity equivalency. The phantom was designed from the materials found to be in greatest agreement. The phantom was treated in an end-to-end treatment four times, which included simulation, treatment planning and treatment delivery. Each treatment plan was delivered three times to assess reproducibility. The dose measured within the phantom was compared to that of the treatment plan. The hypothesis was fully supported for three of the treatment plans, but failed the reproducibility requirement for the most aggressive treatment plan.

Development and evaluation of a video-based modeling strategy for the dissemination phase of a school health tobacco -use prevention program

Even the best school health education programs will be unsuccessful if they are not disseminated effectively in a manner that encourages classroom adoption and implementation. This study involved two components: (1) the development of a videotape intervention to be used in the dissemination phase of a 4-year, NCI-funded diffusion study and (2) the evaluation of that videotape intervention strategy in comparison with a print (information transfer) strategy. Conceptualization has been guided by Social Learning Theory, Diffusion Theory, and communication theory. Additionally, the PRECEDE Framework has been used. Seventh and 8th grade classroom teachers from Spring Branch Independent School District in west Houston participated in the evaluation of the videotape and print interventions using a 57-item preadoption survey instrument developed by the UT Center for Health Promotion Research and Development. Two-way ANOVA was used to study individual score differences for five outcome variables: Total Scale Score (comprised of 57 predisposing, enabling, and reinforcing items), Adoption Characteristics Subscale, Attitude Toward Innovation Subscale, Receptivity Toward Innovation, and Reinforcement Subscale. The aim of the study is to compare the effect upon score differences of video and print interventions alone and in combination. Seventy-three 7th and 8th grade classroom teachers completed the study providing baseline and post-intervention measures on factors related to the adoption and implementation of tobacco-use prevention programs. Two-way ANOVA, in relation to the study questions, found significant scoring differences for those exposed to the videotape intervention alone for both the Attitude Toward Innovation Subscale and the Receptivity to Adopt Subscale. No significant results were found to suggest that print alone influences favorable scoring differences between baseline and post-intervention testing. One interaction effect was found suggesting video and print combined are more effective for influencing favorable scoring differences for the Reinforcement for the Adoption Subscale.^ This research is unique in that it represents a newly emerging field in health promotion communications research with implications for Social Learning Theory, Diffusion Theory, and communication science that are applicable to the development of improved school health interventions. ^

Organizational perspectives on the management and evaluation of large -scale multicenter controlled clinical trials: An exploratory study of participation in the beta -blocker heart attack trial

A review of literature related to appointment-keeping served as the basis for the development of an organizational paradigm for the study of appointment-keeping in the Beta-blocker Heart Attack Trial (BHAT). Features of the organizational environment, demographic characteristics of BHAT enrollees, organizational structure and processes and previous organizational performance variables were measured so as to provide exploratory information relating to the appointment-keeping behavior of 3,837 participants enrolled at thirty-two Clinical Centers. Results suggest that the social context of individual behavior is an important consideration for the understanding of patient compliance. In particular, the degree to which previous organizational performance--as measured by obtaining recruitment goals--and the ability to utilize resources had particularly strong bivariate associations with appointment-keeping. Implications for future theory development, research and practical implications were provided as was a suggestion for the development of multidisciplinary research efforts conducted within the context of Centers for the study and application of adherence behaviors. ^

The effects of adequacy and content of prenatal care on birth outcomes in a high -risk Missouri population

The purpose of this observational study was investigation of the relationship between quantitative adequacy of prenatal care, specific prenatal care content and pregnancy outcome in a high risk Missouri population. A sample of 1484 women from three Missouri regions known to have high rates of low birth weight, infant mortality, and inadequate prenatal care rates participated in structured post-partum interviews. Approximately one-half of the sample had received adequate prenatal care and the other half inadequate prenatal care as determined by an index utilized by the Missouri Department of Health.^ Prenatal care content was assessed by reports of prenatal education in six different areas: Diet, smoking, alcohol, drug, preterm labor counseling, and advice on when to call the health provider if preterm labor was suspected by the woman. Low birth weight, in both term and preterm infants, were the two birth outcomes examined. A variety of maternal socio-demographic variables were also considered.^ The results of this study suggest that specific educational content, delivered during prenatal care, may have lessen the risk of giving birth to a preterm-low birth weight infant. Prenatal education for recognition of preterm labor, and advice on when to call the health provider if preterm labor was suspected were found to be associated with a decreased risk of preterm delivery. Specific educational content was not, however, associated with risk of term-low weight birth nor was quantitative adequacy of care associated with the risk of either term- or preterm-low birth weight.^ These findings reinforce a body of literature which stresses the importance of appropriate prenatal care in preventing preterm low birth weight. Additionally, the findings suggest interventions that may be specifically effective for prematurity prevention. ^

Where does Philippine education go? : the "K to 12" program and reform of Philippine basic education

In 2012 the Philippines launched its "K to 12" Program, a comprehensive reform of its basic education. Through this reform, the Philippines is catching up with global standards in secondary education and is attaching a high value to kindergarten. The structure, curricula, and philosophy of the education system are undergoing reform and improvement. The key points of the new policy are "preparation" for higher education, "eligibility" for entering domestic and overseas higher educational institutions, and immediate "employability" on graduating, all leading toward a "holistically developed Filipino". This policy appears admirable and timely, but it faces some pedagogical and socioeconomic problems. The author wants to point out in particular that the policy needs to address gender problems and should be combined with demand-side approaches in order to promote poverty alleviation and human development in the Philippines.

Competence Training in Higher Education: The case of the Technological Master "Prestación de Servicios Profesionales" from the Colegio de Postgraduados (México).

The Competency-Based Education in the context of training is intended as a comprehensive approach that seeks to link education with the productive sector and increase the potential of individuals, in the face of social, economic, political and cultural transformations that suffers the world and the contemporary society; this is how educational services associated to the rural area takes part of the global revalorization of the role of learning and knowledge. Under the competence approach and taking into account the CONOCER model, we design a Technological Master from the “Colegio de Postgraduados” identifying the competences needed so that the students, professional from different areas of knowledge, managed to develop them, but mainly to achieve the goal of developing the capacities of producers in Mexican rural area.

Results of students surveys in similar courses given in different centers of the Technical University of Madrid

We present and analyze the results of surveys conducted in recent years with students from two related subjects, but taught in different centers of the University of Madrid. These surveys are part of the objectives of various projects of educational innovation, and applied through the platform Moodle.

Survey on student motivation and approval of educational environment at Universidad Politécnica de Madrid within the European Higher Education area implementation

A recent study elaborated by Vicerrectorado de Ordenación Académica y Planificación Estratégica of Technical University of Madrid (UPM) defines the satisfaction of the university student body as "the response that the University offers to the expectations and demands of service of the students, considered in a general way ". Besides an indicator of academic and institutional insertion of the student, the assessment of student engagement allows us to adapt the academic offer and the extension services of the University to the real needs of the students. The process of convergence towards the European Higher Education Area (EHEA) raises the need to form in competitions, that is to say, of developing in our students capacities and knowledge beyond the purely theoretical-practical thing. Therefore, the perception and experience of the educational process and environment by the students is an important issue to be addressed to accomplish their expectations and achieve a curriculum accordingly to EHEA expectations. The present study aims to explore the student motivation and approval of the educational environment at the UPM. To this end a total of 97 students enrolled in the undergraduate program of Civil Engineering, Computer Engineering and Agronomic Engineering at UPM were surveyed. The survey consisted of 40 questions divided in three blocks. The first one of 20 questions of personal character in that they were gathering, besides the sex and the age, the degree of fulfilment, implication and dedication with the institution and the academic tasks. In the second block we identify 10 questions related to the perception of the student on the teaching quality, and finally a block of 10 questions regarding the Bologna Process. The students personal motivation was moderately high, with a score of 3.6 (all scores are provided on a 5-point scale), being the most valuable items obtaining a university degree (4,3) and the friendship between students (4,2). Any significant difference was shown between sexes (P=0.23) since the averages for this block of questions were of 3.7±0.3 and 3.5±0.4 for women and men respectively. The students are moderately satisfied with their graduate studies with an average score of 3,2, being the questions that reflect a minor satisfaction the research profile of the teachers (2,8) and the organization of the Schools (2,9). The best valued questions are related to the usefulness and quality of the degrees, with 3,5 and 3,4 respectively, and to the interest of the courses within the degree (3,4). For sexes, the results of this block of questions are similar (3.1±0.3 and 3.2±0.3 for men and women respectively=0.79). Also, there were no differences (P=0.39) between the students who arrange work and studies or do not work (3.1±0.2 and 3.2±0.3 respectively). In conclusion, students at UPM present an acceptable degree of motivation and satisfaction with regard to the studies and services that offer their respective Schools. Both characteristics receive the same value both for men and for women and so much for students who arrange work and studies as for those who devote themselves only to studying. In a significant way, students who are more engaged and are in-class attendants present the major degree of satisfaction.Overall, there is a great lack of information regarding the Bologna Process. In fact to the majority, they would like to know more on what it is, what it means and what changes will involve its implementation.

Design and implementation of an adaptive dashboard and visualization interface for the dynamic optimization and control of Data Centers

Over the last few years, the Data Center market has increased exponentially and this tendency continues today. As a direct consequence of this trend, the industry is pushing the development and implementation of different new technologies that would improve the energy consumption efficiency of data centers. An adaptive dashboard would allow the user to monitor the most important parameters of a data center in real time. For that reason, monitoring companies work with IoT big data filtering tools and cloud computing systems to handle the amounts of data obtained from the sensors placed in a data center.Analyzing the market trends in this field we can affirm that the study of predictive algorithms has become an essential area for competitive IT companies. Complex algorithms are used to forecast risk situations based on historical data and warn the user in case of danger. Considering that several different users will interact with this dashboard from IT experts or maintenance staff to accounting managers, it is vital to personalize it automatically. Following that line of though, the dashboard should only show relevant metrics to the user in different formats like overlapped maps or representative graphs among others. These maps will show all the information needed in a visual and easy-to-evaluate way. To sum up, this dashboard will allow the user to visualize and control a wide range of variables. Monitoring essential factors such as average temperature, gradients or hotspots as well as energy and power consumption and savings by rack or building would allow the client to understand how his equipment is behaving, helping him to optimize the energy consumption and efficiency of the racks. It also would help him to prevent possible damages in the equipment with predictive high-tech algorithms.

Adults'Education and Agricultural Innovation: A Social Learning Approach

Social learning processes can be the basis of a method of agricultural innovation that involves expert and empirical knowledge. In this sense, the objective of this study was to determine the effectiveness and sustainability of an innovation process, understood as social learning, in a group of small farmers in the southern highlands of Peru. Innovative proposals and its permanence three years after the process finished were evaluated. It was observed that innovation processes generated are maintained over time; however, new innovations are not subsequently generated. We conclude that adult learning processes and innovation based on social learning are more effective and sustainable; however, the farmers internalization in innovation processes is given longer term.

How future trends may affect international cooperation in planning education : the case of Spain and Latin America

Despite the benefits for exc hanging experiences among planners at the global scale, the strong context dependency of urban planning creates in many instances significant difficulties to extrapolate experiences from one geographical context to the other. If progress is to be achieved in international cooperation programmes, differences and commonalities should be assessed before la unching any academic initiative. In that respect, this p aper makes a brief foresight exercise on how future trends and challenges, which may affect the urban pl anning field, should be taken into consideration according to two different contexts: Spain and Latin America. A segmentation matrix is used to expose a nd discuss the different effects of future trends on both contexts. Some tentative conclusions are drawn for the development of international educational programmes

Efficient exchange of the primary quinone acceptor QA in isolated reaction centers of Rhodopseudomonas viridis

A key step in the conversion of solar energy into chemical energy by photosynthetic reaction centers (RCs) occurs at the level of the two quinones, QA and QB, where electron transfer couples to proton transfer. A great deal of our understanding of the mechanisms of these coupled reactions relies on the seminal work of Okamura et al. [Okamura, M. Y., Isaacson, R. A., & Feher, G. (1975) Proc. Natl. Acad. Sci. USA 88, 3491–3495], who were able to extract with detergents the firmly bound ubiquinone QA from the RC of Rhodobacter sphaeroides and reconstitute the site with extraneous quinones. Up to now a comparable protocol was lacking for the RC of Rhodopseudomonas viridis despite the fact that its QA site, which contains 2-methyl-3-nonaprenyl-1,4-naphthoquinone (menaquinone-9), has provided the best x-ray structure available. Fourier transform infrared difference spectroscopy, together with the use of isotopically labeled quinones, can probe the interaction of QA with the RC protein. We establish that a simple incubation procedure of isolated RCs of Rp. viridis with an excess of extraneous quinone allows the menaquinone-9 in the QA site to be almost quantitatively replaced either by vitamin K1, a close analogue of menaquinone-9, or by ubiquinone. To our knowledge, this is the first report of quinone exchange in bacterial photosynthesis. The Fourier transform infrared data on the quinone and semiquinone vibrations show a close similarity in the bonding interactions of vitamin K1 with the protein at the QA site of Rp. viridis and Rb. sphaeroides, whereas for ubiquinone these interactions are significantly different. The results are interpreted in terms of slightly inequivalent quinone–protein interactions by comparison with the crystallographic data available for the QA site of the two RCs.

DNA immunization: Induction of higher avidity antibody and effect of route on T cell cytotoxicity

Immunizations of mice with plasmid DNAs encoding ovalbumin (OVA), human Ig, and hen egg lysozyme were compared with doses of soluble protein (without adjuvant) that induced similar IgG responses. The route of immunization influenced the magnitude of the antibody (Ab) response in that intradermal (i.d.) injection elicited higher IgG Ab levels than i.m. injection in both DNA- and protein-immunized mice. Although total IgG levels were similar to soluble protein controls, the avidity of the anti-OVA Abs generated by DNA immunization were 100- and 1,000-fold higher via the i.m. or i.d. route, respectively. However, despite the generation of high-avidity Ab in DNA-immunized mice, germinal centers could not be detected in either DNA- or protein-immunized mice. Examination of the IgG subclass response showed that IgG2a was induced by i.m. DNA immunization, coinciding with elevated interferon γ production, whereas a dominant and elevated IgG1 response, coinciding with detectable interleukin 4 production, was generated after i.d. immunization with DNA or soluble OVA and hen egg lysozyme but not human Ig protein. As expected, cytotoxic T cell (CTL) responses could be detected only after DNA immunization. I.d. immunization produced the strongest CTL responses early (2 weeks) but was similar to i.m. later. Therefore, DNA immunization can differ from protein immunization by its ability to induce rapid CTL responses and higher avidity Ab, both of which are advantageous for vaccination.