What Do Caregivers Tell Us about Infant Babbling?

<em>Phonetic repertoires in babbling are an important marker of prelinguistic development. Typical phonetic development, however, is difficult to identify given variability within and across infants. Prior to 18 months of infant age, caregiver report of prelinguistic vocal development is often an important part of clinical practice for early intervention. As a first step toward understanding the utility of caregiver report of babbling, the purpose of this exploratory study was to determine how the phonetic makeup of sounds reported by caregivers in infant babbling would develop, in particular comparison to markedness theory and established norms. In a longitudinal design, caregiver report was tracked through weekly interviews from 7 to 18 months of infant age (N = 15). Reports were phonetically transcribed and examined in terms of the number of utterances; place, manner, and voicing for consonants; and tongue position for vowels. In general, the number of utterances and phonetic segments reported by caregivers increased significantly with infant age (p &lt; .05) and phonetic feature patterns were similar to what one would expect in the vocal development of English-learning infants. Results support the notion that caregiver report of infant vocalizations may provide a valuable means for describing early infant babbling development.</em>

Dental Hygiene Faculty Calibration Using Two Accepted Standards for Calculus Detection: A Pilot Study

Faculty calibration studies for calculus detection use two different standards for examiner evaluation, yet the only therapeutic modality that can be used for nonsurgical periodontal treatment is scaling/root debridement or planing. In this study, a pretest-posttest design was used to assess the feasibility of faculty calibration for calculus detection using two accepted standards: that established by the Central Regional Dental Testing Service, Inc. (CRDTS; readily detectible calculus) and the gold standard for scaling/root debridement (root roughness). Four clinical dental hygiene faculty members out of five possible participants at Halifax Community College agreed to participate. The participants explored calculus on the 16 assigned teeth (64 surfaces) of four patients. Calculus detection scores were calculated before and after training. Kappa averages using CRDTS criteria were 0.561 at pretest and 0.631 at posttest. Kappa scores using the scaling/root debridement or planing standard were 0.152 at pretest and 0.271 at posttest. The scores indicated improvement from moderate (Kappa=0.41-0.60) to substantial agreement (Kappa=0.61-0.80) following training using the CRDTS standard. Although this result differed qualitatively and Kappas were significantly different from 0, the differences for pre- to post-Kappas for patient-rater dyads using CRDTS were not statistically significant (p=0.778). There was no difference (p=0.913) in Kappa scores pre- to post-training using the scaling/root debridement standard. Despite the small number of participants in this study, the results indicated that training to improve interrater reliability to substantial agreement was feasible using the CRDTS standard but not using the gold standard. The difference may have been due to greater difficulty in attaining agreement regarding root roughness. Future studies should include multiple training sessions with patients using the same standard for scaling/root debridement used for evaluation of students.

Burnout in Rural Physician Assistants: An Initial Study

PURPOSE

To assess the prevalence and causes of burnout in rural physician assistants. (PA in this article refers to personal accomplishment. To avoid confusion, we will spell out physician assistant throughout the article, instead of using PA to refer to both physician assistant and personal accomplishment.)

METHODS

Physician assistants who practice in rural communities were asked to complete the Maslach Burnout Inventory. A preliminary assessment of burnout was determined using the 3 Maslach Burnout Inventory subscale scores: emotional exhaustion, depersonalization, and personal accomplishment, as well as causes of burnout assessed for a correlation to personal and professional factors.

RESULTS

Burnout within the rural physician assistant population responding to this survey (response rate = 11.3%) was measured to have high to moderate emotional exhaustion and depersonalization subscores (64% each) and a low to moderate personal accomplishment subscore (46%).

CONCLUSIONS

The rural physician assistant population who responded to this survey exhibited burnout correlating to feelings of professional isolation and various workplace conditions such as the adequacy of administrative support and control over workload. To begin addressing burnout within this community, we suggest adjusting rural physician assistant workload and support, enhancing professional communications, and addressing burnout prevention techniques within physician assistant training programs.

Spatial and Census Data to Evaluate Obese Persons and their Environment (SCOPE)

OBJECTIVE

To evaluate the built environment and its relationship to BMI for individuals in eastern Idaho.

METHODS

Geospatial analyses were coupled to demographic data of adult individuals. ArcGIS Community Analyst was used to compare demographics relative to median BMI.

RESULTS

For every kilometer increase in distance to prepared food sites, BMI went down by 1.3% and every kilometer increase in distance to green space, BMI went down by 0.8% (p < .001). For every kilometer increase in distance to trails, BMI went up by 1.5%. No other built environment variables had a statistically significant association with BMI.

CONCLUSION

The distance to prepared foods and trails was associated with expected changes in BMI. Conversely, increased distance to green space was associated with a lower BMI.

A pilot study of an HbA1c chairside screening protocol for diabetes in patients with chronic periodontitis: the dental hygienist's role

OBJECTIVE

To assess effectiveness, convenience and cost of point-of-care diabetes screenings performed by a dental hygienist for patients with periodontitis, using a diabetes risk questionnaire, periodontal findings and a glycosylated haemoglobin (HbA1c) analyser.

METHODS

A purposive sample of 50 participants with periodontitis, never diagnosed with diabetes, reporting ≥one diabetes risk factor, were administered an HbA1c test. Spearman's correlation measured relationships between HbA1c and diabetes risk test scores, numbers of missing teeth, percentage of deep pockets ≥5 mm and percentage of bleeding sites (BOP). Cost and time were assessed. Analyses used 0.05 alpha levels.

RESULTS

Thirty-two per cent (n = 16) of participants presented HbA1c values indicating prediabetes; one HbA1c value indicated type 2 diabetes, totalling 34% (N = 17). No relationships existed between HbA1c values and diabetes risk scores (rs = 0.153; P = 0.144), numbers of missing teeth (r = 0.190; P = 0.093), percentage of deep pockets (rs = -0.048; P = 0.370) or percentage of BOP sites (rs = 0.066, P = 0.324). Direct cost for each HbA1c was $9US, excluding follow-up medical diagnosis. Mean screening time including patient education was 14 min (SD = 6.2). Fifty-three per cent (n = 9 of 17) of participants with elevated HbA1c values contacted their primary healthcare provider within 2 weeks as recommended.

CONCLUSION

Point-of-care HbA1c screenings by dental hygienists were effective and convenient for identifying undiagnosed prediabetes and provide opportunity for interprofessional patient care; cost or lack of dental insurance may inhibit implementation. Identification of patients at risk for diabetes requires further evaluation.

Understanding the Structural, Human Resource, Political, and Symbolic Dimensions of Implementing and Sustaining Interprofessional Education

This study investigated the perceptions of deans and faculty members of the Association of Schools of Allied Health Professions (ASAHP) concerning the degree to which their institutions implement and integrate the structural, human resource, political, and symbolic frames or dimensions of interprofessional education (IPE). The study identified correlations among these frames/dimensions, including their relationship with overall IPE program progress and success.

METHODS

This study utilized a nonexperimental comparative descriptive and correlational survey design. The instrument was developed by the researchers and administered online using a readily accessible data collection process. Data were analyzed using descriptive and inferential statistics. Content validity and reliability were established prior to full implementation of the survey.

RESULTS

Results revealed high levels of interest but lower levels of progress and success in implementing the various frames/dimensions of IPE. Strong correlations existed between the structural, human resource, political, and symbolic dimensions of IPE, and these dimensions individually and collectively predicted overall IPE program progress and success.

CONCLUSION

The differences between interest and performance raised important questions and led to conclusions about leadership effectiveness, organizational clarity, and the process of implementing the organizational change needed for effective IPE at ASAHP institutions.

Developing dental hygiene students as future leaders in legislative advocacy

The purpose of this investigation was to determine the effect of a legislative advocacy project on the knowledge, values, and actions of dental hygiene students enrolled in a leadership course. A quasi-experimental design was employed with a convenience sample of twenty-one undergraduate and seventeen graduate students. The data collection instrument was designed by the authors with three scales (knowledge, values, and actions), a section on barriers to future advocacy actions, and two open-ended questions. Content validity of the instrument was established before it was administered with an online survey tool. Students scored their pre-project and post-project status on the three scales. Cronbach's alphas revealed internal consistency of the three scales at 0.95 or higher. Pre-project scores and post-project scores were analyzed by parametric tests and confirmed using nonparametric tests. Knowledge, values, and actions statements were statistically significant; however, actions were rated the lowest. Multiple barriers for future advocacy actions were identified. Implementation of a legislative advocacy project in an undergraduate and graduate leadership course can positively influence the development of knowledge, values, and actions; however, mentorship in the professional association is needed after graduation to continue the development of future leaders.

Perceived risk, severity of abuse, expectations, and needs of women experiencing intimate partner violence

This prospective, descriptive, correlational study examined perceived risk, severity of abuse, expectations, and needs of women experiencing intimate partner violence (IPV) with arrest of the offender occurring at the time of incident. This study builds on previous research completed on fear and expectations of female victims/survivors of IPV that come to the attention of police, to expand knowledge of women's experiences once they enter the criminal justice system and to create a comprehensive response to this recognized public health problem (). Forty-three women were interviewed regarding the incident, relationship, and experience. Most of the women in this study reported experiencing mild violence and varied forms of threats. There was a significant relationship between the experience of mild violence, serious violence, sexual violence, threats to victims, threats to objects, and others and nonverbal threats with fear of the offender. However, there were no significant correlations between levels of violence or threats with perceived risk of future physical abuse. As the criminal justice response to this crime has changed with the development of legislation and laws aimed at keeping women safe and holding offenders accountable, further research is needed to understand the experience of IPV victims and support an informed response. Forensic nurses are critical interdisciplinary team members in these efforts and play a significant role in providing expertise, sharing of knowledge, and application of evidence fostering victim-centered approaches to addressing IPV.

Effects of periodontal instrumentation on quality of life and illness in patients with chronic obstructive pulmonary disease: a pilot study

PURPOSE

To assess if patients with chronic obstructive pulmonary disease (COPD) receiving periodontal debridement for treatment of chronic periodontitis with ultrasonic or hand instrumentation experienced changes in quality of life or incidents of illness following treatment or no treatment.

METHODS

The study design was a 3 group, randomized, controlled pre- and post-test experimental pilot study. Volunteers with COPD and chronic periodontitis (n=30) were recruited from physician offices or fliers and randomly assigned to 1 of 3 groups. Of those, 2 groups had periodontal debridement using either magnetostrictive ultrasonic instrumentation (n=10) or hand instrumentation (n=10). A control group (n=10) received no treatment. Primary outcomes, quality of life and illness were measured by the St. George's Respiratory Questionnaire (SGRQ-A) and Illness Questionnaire, respectively. Subjects completed the questionnaires as pre-tests at baseline and as post-tests 4 weeks post-treatment/no treatment. Repeated measures ANOVA was used to compare groups on continuous variables (p ≤ 0.05) measured by SGRQ-A total scores and symptoms, activities and impacts subscales. Percentages, frequencies and cross tabulations were calculated for categorical data.

RESULTS

SGRQ-A and Illness Questionnaire scores showed no significant differences between groups in quality of life or illness following periodontal debridement. Total SGRQ-A scores decreased slightly for all groups with no significant difference among groups (p=0.138) and no interaction (p=0.794). Cross tabulations showed no relationship between indicators of self-reported illness before and after treatment/no treatment. No adverse events were reported.

CONCLUSION

Based on this small-scale study, it seems periodontal debridement for chronic periodontitis has no effect on quality of life and illness in patients with COPD, and it may be performed with ultrasonic or hand instruments without adverse events.

Aging and quality control of color LCDs for radiologic imaging

Our practice has long been concerned with the effects of display quality, including color accuracy and matching among paired color displays. Three years of data have been collected on the historical behavior of color stability on our clinical displays. This has permitted an analysis of the color-aging behavior of those displays over that time. The results of that analysis show that all displays tend to yellow over time, but that they do so together. That is, neither the intra- nor inter-display color variances observed at initial deployment diverge over time as measured by a mean radial distance metric in color space (Commission Internationale d'Eclairage L', u', v' 1976). The consequence of this result is that color displays that are matched at deployment tend to remain matched over their lifetime even as they collectively yellow.

Constructing defined chromosome segmental duplications in maize

We describe the production of chromosome segmental duplications and deletions of defined length in maize. The method utilizes a collection of previously isolated transposon-induced reciprocal translocations with sequence-defined breakpoints. These balanced translocations involve a first common breakpoint at the site of transposon Ac/fAc insertions on chromosome 1S, and a second variable endpoint elsewhere in the genome. Stocks containing translocations with different endpoints on the same chromosome arms were crossed together to generate heterozygous combinations. Subsequent meiotic segregation generates gametes that contain the original balanced translocations, or pairs of translocation chromosomes that are genetically unbalanced; i.e., they contain a duplication or deletion of the affected segment. Self-pollination produces progeny plants that are genetically balanced, or that contain 0 to 4 copies of the affected segment. The chromosome constitution of progeny plants can be determined using PCR primers flanking the translocation breakpoints. In addition, plants segregating genetically unbalanced gametes exhibit significant pollen grain abnormalities and thus can be easily detected in the field. In this way, we constructed 4 different segmental tetrasomic stocks involving genomic regions of approximately 7.8, 18.7, 21, and 42.6 Mb on chromosomes 5S, 5L, 5L, and 4L, respectively. FISH analysis using specific probes located within the affected segments confirms their aneuploid composition. These and similar lines containing precisely defined segmental duplications and deletions may be useful to study the genetic impact of gene dosage.

Students' perceptions of the interprofessional team in practice through the application of servant leadership principles

This study examined students' perceptions of interprofessional practice within a framework of servant leadership principles, applied in the care of rural older adults utilizing a service learning model. Mobile wellness services were provided through the Idaho State University Senior Health Mobile project in a collaborative team approach in the community-based setting. Students from varied health professional programs were placed in teams for the provision of wellness care, with communication among team members facilitated by a health professions faculty member serving as field coordinator. The Interdisciplinary Education Perception Scale (IEPS) was used to measure students' perceptions of interprofessional practice using a pretest post-test research design. Multivariate analysis was performed revealing a significant pretest to post-test effect on students' perceptions as measured by factors inherent in the IEPS and deemed essential to effective interprofessional practice. Univariate analysis revealed a significant change in students' perception of professional competence and autonomy, actual cooperation and resource sharing within and across professions, and an understanding of the value and contributions of other professionals from pretest to post-test.

Hospital missions and the education of our future health care workforce

Today's U.S. health care industry is facing unprecedented shortages of health personnel in a great variety of disciplines and locations. An adequate supply of well-educated and trained health professionals is imperative to ensure sufficient access to health care for our citizenry. Hospital mission statements reflect the character, strategic direction, and priorities of the organization; thus, we might expect these statements to address the position and strategy of the organizations in regard to education of future health professionals. To investigate hospitals' publicly stated attention and commitment to the education of health professionals, we analyzed publicly available mission statements from a random stratified sample of 402 hospitals. The hospitals were stratified on the basis of teaching status, rural or urban, and profit status. The percentage of hospitals mentioning an education-related keyword was estimated using a 95% confidence interval with a finite population correction factor on the proportion within each stratum. As expected, teaching hospitals were significantly more likely to include language about education in their mission statements than nonteaching hospitals, with 74% of teaching hospitals mentioning education at least once. We found no significant difference in the use of education language among the mission statements of nonteaching hospitals, where 20% mentioned education at least once. From these findings, we conclude that despite the key importance of health professionals, strategies and policy regarding the education of future health personnel have not yet become "mission level" in importance to hospitals.

An alternate hypothesis to explain the high frequency of "revertants" in hothead mutants in Arabidopsis

Lolle et al. reported a high frequency of genomic changes in ARABIDOPSIS plants carrying the hothead mutation and proposed that the changes observed were the result of a gene correction system mediated by a hypothetical RNA cache. Here, we propose a very different hypothesis to explain the data reported by Lolle et al. Our hypothesis is based on a relatively straightforward developmental aberration in which maternal cells ("Legacy cells") fuse with the developing embryo, resulting in a chimera, which could then give rise to the aberrant genetic segregations reported by Lolle et al.

Measurement of the absolute n p scattering differential cross section at 194 MeV

We describe a double-scattering experiment with a novel tagged neutron beam to measure differential cross sections for np backscattering to better than +/-2% absolute precision. The measurement focuses on angles and energies where the cross section magnitude and angle dependence constrain the charged pion-nucleon coupling constant, but existing data show serious discrepancies among themselves and with energy-dependent partial-wave analyses. The present results are in good accord with the partial-wave analyses, but deviate systematically from other recent measurements.

Changes in students' perceptions of interdisciplinary practice reaching the older adult through mobile service delivery

This study examined students' perceptions of interdisciplinary health care practice in a facilitated, community-based practicum experience. Students' perceptions of interdisciplinary practice relative to their own profession and other health disciplines were examined before and after involvement in mobile service delivery to the older adult in a collaborative team approach. The Interdisciplinary Education Perception Scale was used to collect data before and after planned and facilitated interdisciplinary experiences of students enrolled in health professional programs (nursing, dietetics, physical therapy, occupational therapy, pharmacy, health education, social work, and physician assistant). Univariate repeated-measures analysis of variance revealed significant pretest to posttest and discipline effects following the interdisciplinary interaction of students in the practicum experience. Univariate analysis revealed a significant change in students' perceptions of professional competence and autonomy, actual cooperation and resource sharing within and across professions, and understanding of the value and contributions of other professionals from pretest to posttest. The findings support the need for educators to facilitate communication through innovative interdisciplinary clinical opportunities for health professions students to influence perceptions that promote active participation in a team approach to care delivery in an increasingly complex health care system.

Gender interactions and success

Does gender by itself, or does gender's interaction with career variables, better explain the difference between women and men's careers in healthcare management? US healthcare managers were surveyed regarding career and personal experiences. Gender was statistically interacted with explanatory variables. Multiple regression with backwards selection systematically removed non-significant variables. All gender interaction variables were non-significant. Much of the literature proposes that work and career factors impact working women differently than working men. We find that while gender alone is a significant predictor of income, it does not significantly interact with other career variables.

Blood Pressure Control and Factors Predicting Control in a Treatment-Compliant Male Veteran Population

STUDY OBJECTIVE

To estimate blood pressure control and identify treatment variables predicting control in treatment-compliant, hypertensive, male veterans.

SETTING

Outpatient clinic of a Veterans Affairs medical center.

DESIGN

Retrospective review of computerized patient records over a 12-month period for demographics, comorbidities, patient-specific blood pressure goals, blood pressure history, antihypertensive therapy, and refill history.

PATIENTS

Two hundred fifty hypertensive men aged 39-90 years whose antihypertensive regimen remained unchanged over 12 months.

MEASUREMENTS AND MAIN RESULTS

The proportion of patients with blood pressures below 160/90 mm Hg was 86%; only 34.8% had pressures below 140/90 mm Hg. Blood pressure control was less common with advancing age (42.1%, 33.7%, and 29.4% for patients aged < 60, 60-75, and > 75 yrs, respectively, p = 0.057 for trend). Treatment intensity was highest in obese men, those aged 60-75 years, and those with a history of chronic heart failure or angina, and lowest in men older than 75 years or with a history of stroke. Blood pressure control was independently associated with therapy with beta-blockers (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.5-10.2, p = 0.005), loop diuretics (OR 4.3, 95% CI 1.6-12.1, p = 0.005), angiotensin-converting enzyme inhibitors (OR 3.1, 95% CI 1.2-8.2, p = 0.025), and long-term simvastatin therapy (OR 3.7, 95% CI 1.9-7.4, p = 0.0001), and with a diagnosis of coronary artery disease (OR 3.2, 95% CI 1.35-7.69, p = 0.009). The relationship between simvastatin therapy and blood pressure control persisted after controlling for the higher treatment intensity in patients taking the drug. Factors predicting poor control included a history of stroke (OR for control 0.36, 95% CI 0.19-0.69, p = 0.002), age over 75 years (OR 0.43, 95% CI 0.18-0.98, p = 0.046), highest low-density lipoprotein tertile (OR 0.37, 95% CI 0.17-0.80, p = 0.013), highest body mass index tertile (OR 0.46, 95% CI 0.21-1.00, p = 0.05), and therapy with two or fewer antihypertensives (OR 0.14, 95% CI 0.04-0.61, p = 0.009).

CONCLUSION

In a compliant veteran population, control of blood pressure appeared inadequate but was significantly more likely in those receiving at least three antihypertensive agents. Long-term therapy with simvastatin was independently associated with increased odds of control.

Ac transposition is impaired by a small terminal deletion

In maize, the P1-vv allele specifies variegated pericarp and cob pigmentation, and contains an Ac transposable element inserted in the second intron of the P1-rr gene. Starting from P1-vv, we recovered a new allele, called P1-vv5145, which gives an extremely light variegated pericarp and cob phenotype. The P1-vv5145 allele contains an Ac element ( Ac5145) at the same position and in the same orientation as in the progenitor P1-vv allele; however, the P1-vv5145 allele has a 2-bp deletion which removes the last nucleotide (A) from the 3' end of the Ac element, and an adjacent flanking nucleotide (C) from the p1 intron. In crosses with a Ds tester stock, P1-vv5145 shows a normal ability to induce Ds transposition; however, Ac excision from P1-vv5145 is 3800-fold less frequent than from the progenitor P1-vv allele. Our results demonstrate that the alteration of the 3' terminal base strongly impairs Ac transposition. The P1-vv5145 allele thus provides a relatively stable source of Ac transposase for controlling Ds transposition in genetic experiments. In addition, we describe two further alleles ( P1-ww7B8, P1-ww9A146-3) that contain deletions of Ac and flanking p1 gene sequences. These latter deletions are larger and involve the 5' end of the the Ac element. A model is proposed to explain the formation of one-sided deletions as a consequence of Ac transposition during replication of the element.