Education and training in the use of physical agent modalities by occupational therapists practicing in the physical disabilities area

This study was conducted to examine how occupational therapists (OTs) practicing in the physical disabilities area received their training in the use of physical agent modalities (PAMs); to determine the frequency of PAMs usage by those therapists; and to obtain their opinions regarding the training of OTs and OT students in the administration of PAMs. Three hundred OTs practicing in physical diabilities (n = 194 returned) were surveyed. The most frequently used modalities were hot and cold packs, paraffin, and ultrasound. The least frequently used modalities were transcutaneous electrical stimulation (TENS) and whirlpool. On-the-job training was the most common educational method received by the respondents for PAMs usage. The respondents considered a combination of undergraduate education, fieldwork, continuing education and on-the-job training as the most appropriate educational setting for training in modalities. While few of the respondents received preparation in PAMs during entry-level academic programs, the majority felt that OT students should be trained in PAMs usage as part of their education curriculum. ^

Anxiety disorders and depression and risk for drug use disorders across the life course: Sex and ethnic contrasts

The present study examined the linkage between mental (i.e., anxiety disorders and depression) and drug use disorders in a multi-ethnic (i.e., 25% Euro-American, 38% Hispanic/Latino, 33% African American, 4% other) sample of adults (N = 1638, age 18–93 years old). Risk for drug use disorders was examined, while attending to methodological issues of prior research including (1) psychiatric comorbidity, (2) variations in risk associated with sex, ethnicity, and age, and (3) temporal order between mental and drug use disorders. ^ Participants were assessed using the Composite International Diagnostic Interview (CIDI; World Health Organization, 1990). A life history calendar (Freedman et al., 1988) was used to aid the ordering of onsets of all disorders assessed. ^ Preliminary analysis indicated anxiety disorders and depression were significant predictors of drug use disorders, but after controlling for comorbidity and temporal order, anxiety disorders and depression were no longer predictive of drug use disorders. Findings are discussed in terms of their usefulness for prevention and treatment of drug use disorders. ^

Demographic effects of thatch harvest and implications for sustainable use of irapai palm (Lepidocaryum tenue, Mart.), by riverine communities in the Peruvian Amazon

Lepidocaryum tenue Mart. (Arecaceae) is a small, understory palm of terra firme forests of the western and central Amazon basin. Known as irapai, it is used for roof thatch by Amazonian peoples who collect its leaves from the wild and generate income from its fronds and articles fabricated from them. Increasing demand has caused local concern that populations are declining. Cultivation attempts have been unsuccessful. The purpose of this study was to investigate market conditions and quantify population dynamics and demographic responses of harvested and unharvested irapai growing near Iquitos, Peru. ^ Ethnobotanical research included participant surveys to determine movement of thatch tiles, called crisnejas, through Moronacocha Port. I also conducted a seed germination trial, and for four years studied five populations growing in communities with similar topography and soils but different land tenure and management strategies. Stage, survival, leaf production, and reproductive transitions were used to calculate ramet demographic rates and develop population projection matrices. ^ Weavers made an average of 20–30 crisnejas per day (90–130 leaves each), and earned US$0.09 to 0.70 each (US$1.80 to 21.00 per day). Average crisnejas per month sold per vendor was 2,955 with a profit range of US$0.05 to 0.32 per crisneja. Wholesalers worked with capital outlay from US$100 to 400, and an estimated ten to twenty vendors could be found at a given time. Consumers paid between US$0.23 to 1.20 per crisneja. Although differences in demographic rates by location existed, most were not significant enough to attribute to management. ^ After 60 months, mean seed germination rate was 19.5% in all media (37.9% in peat). Seedling survival was less than two percent after twelve months. Annual palm mortality was three percent, and occurred disproportionately in small (<50 cm) palms. Small palms grew more in height. Unharvested palms grew less than harvested palms. Large palms (≥50 cm) produced more leaves, were more likely to reproduce, and collectors harvested them more frequently. Reproductive potentials (sexual and asexual) were low. Population growth rates were greater than or not significantly different from 1.0, indicating populations maintained or increased in size. Current levels of irapai harvest appear sustainable. DNA analysis of stems and recruits is recommended to understand population composition and stage-specific asexual fecundity. ^

Children with special health care needs: Comparison of the effects of home care setting, prescribed pediatric extended care setting, and long-term care setting on child and family health outcomes and health care service use

Technological advances during the past 30 years have dramatically improved survival rates for children with life-threatening conditions (preterm births, congenital anomalies, disease, or injury) resulting in children with special health care needs (CSHCN), children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who require health and related services beyond that required by children generally. There are approximately 10.2 million of these children in the United States or one in five households with a child with special health care needs. Care for these children is limited to home care, medical day care (Prescribed Pediatric Extended Care; P-PEC) or a long term care (LTC) facility. There is very limited research examining health outcomes of CSHCN and their families. The purpose of this research was to compare the effects of home care settings, P-PEC settings, and LTC settings on child health and functioning, family health and function, and health care service use of families with CSHCN. Eighty four CSHCN ages 2 to 21 years having a medically fragile or complex medical condition that required continual monitoring were enrolled with their parents/guardians. Interviews were conducted monthly for five months using the PedsQL™ Generic Core Module for child health and functioning, PedsQL™ Family Impact Module for family health and functioning, and Access to Care from the NS-CSHCN survey for health care services. Descriptive statistics, chi square, and ANCOVA were conducted to determine differences across care settings. Children in the P-PEC settings had a highest health care quality of life (HRQL) overall including physical and psychosocial functioning. Parents/guardians with CSHCN in LTC had the highest HRQL including having time and energy for a social life and employment. Parents/guardians with CSHCN in home care settings had the poorest HRQL including physical and psychosocial functioning with cognitive difficulties, difficulties with worry, communication, and daily activities. They had the fewest hours of employment and the most hours providing direct care for their children. Overall health care service use was the same across the care settings.

Elementary music and classroom teachers' time -use: A comparison by grade level, time of day, and day of the week

This study investigated time-use of elementary music teachers and elementary classroom teachers to determine: (1) whether there was a relationship between grade level, time of day, and day of the week and teachers' time-use in teaching, monitoring, and non-curricular, and (2) whether ethnicity, training, and years of experience affect teacher time-use. Sixty-nine music teachers and 55 classroom teachers participated. ^ A MANOVA was used to examine the hypothesized relationship. ANOVA results were significant for time spent teaching, monitoring, and non-curricular. An independent t test revealed a significance difference (t (302) = 5.20, p < .001) between the two groups of teachers. A significant difference was found for teaching, t (302) = 5.20, p < .001: music teachers spent more time actively teaching than did classroom teachers. There was a significant difference for monitoring (t (302) = 13.62, p < .001): classroom teachers allocated more time to monitoring than did music teachers. A significant difference was also found for non-curricular (t (302) = 7.03, p < .001): music teachers spent more time in this category of activities than did classroom teachers. ^ Analyses of the activities subsumed under the major categories indicated significant differences between elementary music teachers and elementary classroom teachers, overall, in subject matter (p < .001), discussion (p < .05), school-wide activities (p < .001), seatwork (p < .001), giving directions (p < .001), changing activities (p < .001), lunch (p < .05), planning (p < .001) and interruption (p < .001). Analyses of the relationship and ethnicity, training, degree, experience indicated significant difference for main effect, ethnicity (F(2, 116) = 4.22, p < .017). Time-use for black non-Hispanic teachers was higher than time-use for those who were Hispanic and white non-Hispanic. ^ Analyses of time-use by grade showed no increase for either group as grade level increased. A statistically significant Wilks Lambda ( F (1,294) = .917 p < .013) was found for the independent variable day of the week. ANOVA indicated that elementary classroom teachers monitored more on Thursdays and Fridays: music teachers allocated more time to non-curricular activities on Fridays. ^

The influence of neurocognitive impairment, alcohol and other drug (AOD) use, and psychosocial factors on antiretroviral treatment adherence, service utilization and viral load among HIV-seropositive adults

Among people living with HIV (PLWH), adherence to antiretroviral therapy (ART) can be affected by problems of neurocognitive (NC) impairment, stress, alcohol and other drug (AOD) abuse, and other barriers. The aims of this research were to: (1) examine factors associated with NC impairment, (2) explore relationships between psychosocial variables with ART adherence and viral load (VL), and (3) evaluate the efficacy of an evidence-based intervention in improving ART adherence, increasing service utilization, and decreasing VL. The first study (n=370) was cross sectional and used structural equation modeling to test whether AOD use, years living with HIV, and time from HIV diagnosis to seeking care were associated with poorer NC functioning. The second study (n=246) used similar methods to test the hypothesis that stress, barriers to adherence, NC impairment, poor social support, and AOD use were related to lower VL mediated by ART adherence. The third study (n=243) evaluated an evidence-based, eight-session program to improve ART adherence, reduce VL, and increase service utilization in a randomized controlled trial. Study participants were PLWH living in South Florida, 18 to 60 years old, with a history of alcohol abuse enrolled from January 2009 through November 2012. Secondary analysis of available data showed: (1) scores on interference with executive functioning increased by 0.32 for each day of marijuana use and 1.18 for each year living with HIV, but no association was found between alcohol use and NC functioning; (2) each barrier to adherence was associated with a 10% decrease in adherence to ART and a 0.42 unit increase in VL (log10) and the relationship between barriers and VL was partially mediated by ART adherence; (3) participants in the evidence-based program were more likely than the comparison group to report an undetectable VL (OR=2.25, p<0.01) at 6 months, but not 3 months, post-intervention. Psychosocial factors affect VL, but ART adherence is essential in achieving an undetectable VL in PLWH.

Elementary music and classroom teachers' time-use: a comparison by grade level, time of day, and day of the week

This study investigated time-use of elementary music teachers and elementary classroom teachers to determine: (1) whether there was a relationship between grade level, time of day, and day of the week and teachers' time-use in teaching, monitoring, and non-curricular, and (2) whether ethnicity, training, and years of experience affect teacher time-use. Sixty-nine music teachers and 55 classroom teachers participated. A MANOVA was used to examine the hypothesized relationship. ANOVA results were significant for time spent teaching, monitoring, and non-curricular. An independent t test revealed a significance difference (t (302) = 5.20, p Analyses of the activities subsumed under the major categories indicated significant differences between elementary music teachers and elementary classroom teachers, overall, in subject matter ( p teachers was higher than time-use for those who were Hispanic and white non-Hispanic. Analyses of time-use by grade showed no increase for either group as grade level increased. A statistically significant Wilks Lambda ( F (1,294) = .917 p < .013 ) was found for the independent variable day of the week. ANOVA indicated that elementary classroom teachers monitored more on Thursdays and Fridays: music teachers allocated more time to non-curricular activities on Fridays.

An evaluation of home range models for marine fish tracking and fine scale habitat use and movement patterns of age 1 Greenland cod (Gadus macrocephalus ogac)

My thesis examines fine-scale habitat use and movement patterns of age 1 Greenland cod (Gadus macrocephalus ogac) tracked using acoustic telemetry. Recent advances in tracking technologies such as GPS and acoustic telemetry have led to increasingly large and detailed datasets that present new opportunities for researchers to address fine-scale ecological questions regarding animal movement and spatial distribution. There is a growing demand for home range models that will not only work with massive quantities of autocorrelated data, but that can also exploit the added detail inherent in these high-resolution datasets. Most published home range studies use radio-telemetry or satellite data from terrestrial mammals or avian species, and most studies that evaluate the relative performance of home range models use simulated data. In Chapter 2, I used actual field-collected data from age-1 Greenland cod tracked with acoustic telemetry to evaluate the accuracy and precision of six home range models: minimum convex polygons, kernel densities with plug-in bandwidth selection and the reference bandwidth, adaptive local convex hulls, Brownian bridges, and dynamic Brownian bridges. I then applied the most appropriate model to two years (2010-2012) of tracking data collected from 82 tagged Greenland cod tracked in Newman Sound, Newfoundland, Canada, to determine diel and seasonal differences in habitat use and movement patterns (Chapter 3). Little is known of juvenile cod ecology, so resolving these relationships will provide valuable insight into activity patterns, habitat use, and predator-prey dynamics, while filling a knowledge gap regarding the use of space by age 1 Greenland cod in a coastal nursery habitat. By doing so, my thesis demonstrates an appropriate technique for modelling the spatial use of fish from acoustic telemetry data that can be applied to high-resolution, high-frequency tracking datasets collected from mobile organisms in any environment.

Ribosomal frameshifting and transcriptional slippage: from genetic steganography and cryptography to adventitious use

Genetic decoding is not ‘frozen’ as was earlier thought, but dynamic. One facet of this is frameshifting that often results in synthesis of a C-terminal region encoded by a new frame. Ribosomal frameshifting is utilized for the synthesis of additional products, for regulatory purposes and for translational ‘correction’ of problem or ‘savior’ indels. Utilization for synthesis of additional products occurs prominently in the decoding of mobile chromosomal element and viral genomes. One class of regulatory frameshifting of stable chromosomal genes governs cellular polyamine levels from yeasts to humans. In many cases of productively utilized frameshifting, the proportion of ribosomes that frameshift at a shift-prone site is enhanced by specific nascent peptide or mRNA context features. Such mRNA signals, which can be 5′ or 3′ of the shift site or both, can act by pairing with ribosomal RNA or as stem loops or pseudoknots even with one component being 4 kb 3′ from the shift site. Transcriptional realignment at slippage-prone sequences also generates productively utilized products encoded trans-frame with respect to the genomic sequence. This too can be enhanced by nucleic acid structure. Together with dynamic codon redefinition, frameshifting is one of the forms of recoding that enriches gene expression.

An Investigation of the Relationship Between Maltreatment and Alcohol and Other Drug (AOD) Use Among African-American and Hispanic Adolescent Girls

Maltreatment experienced in childhood or adolescence is a known risk factor for later problem alcohol and/or other drug (AOD) use (Bailey & McCloskey, 2005; Shin, Edwards, Heeren, 2009). A growing body of empirical work has found significant associations between adolescent girls’ AOD use and maltreatment experiences. However, questions remain as to how this relation unfolds with African-American and Hispanic adolescent girls. Guided by four relational models that have been proposed in the literature, this study examined the links between maltreatment, trauma symptoms, and alcohol and/or other drug (AOD) problems in a sample of 170 African-American and Hispanic adolescent girls who were participants in a school-based AOD use intervention. Results of this study revealed that maltreatment experiences (physical and emotional abuse) were positively related to trauma symptoms, which were positively related to AOD problem severity, alcohol abuse, alcohol dependency, drug abuse, and drug dependency. Perceived discrimination moderated this relation between sexual abuse and trauma symptoms, such that more perceived discrimination resulted in a stronger effect of sexual abuse on trauma symptoms. Ethnic identity moderated the relation between sexual abuse and AOD problem severity, such that ethnic identity demonstrated protective properties in the relation between sexual abuse and AOD problem severity. My research adds to extant knowledge on the relation between maltreatment and AOD use in adolescent girls and suggests the importance of developing interventions targeting maltreatment and AOD use concurrently.

Survery and simulation of energy use in the European building stock

the work towards increased energy efficiency. In order to plan and perform effective energy renovation of the buildings, it is necessary to have adequate information on the current status of the buildings in terms of architectural features and energy needs. Unfortunately, the official statistics do not include all of the needed information for the whole building stock.   This paper aims to fill the gaps in the statistics by gathering data from studies, projects and national energy agencies, and by calibrating TRNSYS models against the existing data to complete missing energy demand data, for countries with similar climate, through simulation. The survey was limited to residential and office buildings in the EU member states (before July 2013). This work was carried out as part of the EU FP7 project iNSPiRe.   The building stock survey revealed over 70% of the residential and office floor area is concentrated in the six most populated countries. The total energy consumption in the residential sector is 14 times that of the office sector. In the residential sector, single family houses represent 60% of the heated floor area, albeit with different share in the different countries, indicating that retrofit solutions cannot be focused only on multi-family houses.   The simulation results indicate that residential buildings in central and southern European countries are not always heated to 20 °C, but are kept at a lower temperature during at least part of the day. Improving the energy performance of these houses through renovation could allow the occupants to increase the room temperature and improve their thermal comfort, even though the potential for energy savings would then be reduced.

“It’s the People That Drive It”: Motivating and Supporting Collaborative Data Use Practices in Three Teacher Education Programs

Thesis (Ph.D.)--University of Washington, 2016-08

Information Presentation Features and Comprehensibility of Hospital Report Cards: Design Analysis and Online Survey Among Users

Background: Improving the transparency of information about the quality of health care providers is one way to improve health care quality. It is assumed that Internet information steers patients toward better-performing health care providers and will motivate providers to improve quality. However, the effect of public reporting on hospital quality is still small. One of the reasons is that users find it difficult to understand the formats in which information is presented. Objective: We analyzed the presentation of risk-adjusted mortality rate (RAMR) for coronary angiography in the 10 most commonly used German public report cards to analyze the impact of information presentation features on their comprehensibility. We wanted to determine which information presentation features were utilized, were preferred by users, led to better comprehension, and had similar effects to those reported in evidence-based recommendations described in the literature. Methods: The study consisted of 5 steps: (1) identification of best-practice evidence about the presentation of information on hospital report cards; (2) selection of a single risk-adjusted quality indicator; (3) selection of a sample of designs adopted by German public report cards; (4) identification of the information presentation elements used in public reporting initiatives in Germany; and (5) an online panel completed an online questionnaire that was conducted to determine if respondents were able to identify the hospital with the lowest RAMR and if respondents’ hospital choices were associated with particular information design elements. Results: Evidence-based recommendations were made relating to the following information presentation features relevant to report cards: evaluative table with symbols, tables without symbols, bar charts, bar charts without symbols, bar charts with symbols, symbols, evaluative word labels, highlighting, order of providers, high values to indicate good performance, explicit statements of whether high or low values indicate good performance, and incomplete data (“N/A” as a value). When investigating the RAMR in a sample of 10 hospitals’ report cards, 7 of these information presentation features were identified. Of these, 5 information presentation features improved comprehensibility in a manner reported previously in literature. Conclusions: To our knowledge, this is the first study to systematically analyze the most commonly used public reporting card designs used in Germany. Best-practice evidence identified in international literature was in agreement with 5 findings about German report card designs: (1) avoid tables without symbols, (2) include bar charts with symbols, (3) state explicitly whether high or low values indicate good performance or provide a “good quality” range, (4) avoid incomplete data (N/A given as a value), and (5) rank hospitals by performance. However, these findings are preliminary and should be subject of further evaluation. The implementation of 4 of these recommendations should not present insurmountable obstacles. However, ranking hospitals by performance may present substantial difficulties.

Investigation into various fungicides and alternative solutions for controlling postharvest diseases in papaya fruit

In Australia, Sportak® (a.i., prochloraz) has been registered since the early 1980's for the postharvest control of both anthracnose and stem-end rots in papaya fruit, despite the persistence of fruit breakdown due to disease during transit and at market destinations. Consequently, the Australian papaya industry has been concerned over the efficacy of prochloraz and whether substitute or alternative solutions were available for better disease control, particularly during times of peak disease pressure. This study therefore investigated the effects of various postharvest treatments for disease control in papaya. Fruit were harvested at colour break from coastal farms in Far North Queensland and treated with commercial rates of various fungicides, including prochloraz, imazalil, thiabendazole and fludioxonil. Additional solutions known to inhibit disease were examined, including chitosan and carnauba wax both with and without ammonium carbonate (AC). Following treatment, fruit were ripened and assessed for quality over their shelf life. Fludioxonil when applied as a hot dip was found to be a more efficacious treatment for control of disease in papaya than prochloraz. The other fungicides were moderately effective, as both thiabendazol and prochloraz exhibited an intermediate response and imazalil was the least effective. Disease severity was lowest in fruit treated with AC followed by chitosan, whilst chitosan delayed degreening. Overall, the study found that hot fludioxonil provided an effective replacement of the currently registered chemical prochloraz, and that alternate solutions such chitosan and AC may also be beneficial, particularly for low chemical input farming systems.