Influences of social context on parent guidance and low-income preschoolers' independent and guided math performance

Mathematical knowledge at school entry predicts school achievement, and children from low-income families are at risk for low math achievement. The study purpose was to observe low-income parents' numeracy guidance in two contexts, a board game and a number concept assessment, and to compare preschoolers' independent and guided math performances. Eighteen four-year-olds enrolled in Head Start participated with one parent. Although parents employed guidance for a wider range of math activities during the number assessment activity as compared with the board game, the total guidance provided in each context did not differ. In both contexts, children performed at a higher level when guided by a parent as compared with independent math performance. Parental reports of home numeracy practices were positively correlated with children's math abilities but not with observed parent guidance. The findings provide further support for the importance of adult guidance in order to enhance children's opportunities to reinforce known skills and develop new mathematical understandings.     

ProTaper和K3预备对上颌前磨牙根管形态影响的研究

目的比较ProTaper和K3预备对根管形态的影响。方法选取正畸减数拔除含颊舌双根管的上颌前磨牙40颗,随机分为2组,分别采用机用镍钛器械ProTaper和K3预备根管,预备前、后进行三维成像,记录预先设立的根管横断面、颊舌向切面、近远中向切面三个位点的三维数据,评价根管预备的效果。结果 K3组相对于ProTaper组对牙本质的切削量少,对根管形态的影响较小,ProTaper组和K3组有显著性差异(P<0.01);结论 K3组预备后的根管形态优于ProTaper组。K3预备后能较好的保持根管形态,对根管壁牙本质的切削量少,较少地削弱了余留牙体组织的抗折力。     

Pharmacy based surveillance for identifying missing tuberculosis cases: A mixed methods study from South India

BackgroundNo Indian studies have assessed the implementation of recent policy on pharmacy based surveillance and its contribution in TB notification. So, this study was conducted with objectives to describe: a) pharmacy based TB surveillance and TB notification, and b) experiences of pharmacy based surveillance implementation from the programme managers and pharmacists perspective.MethodsA mixed methods study—quantitative (cross-sectional) and qualitative (in-depth interviews) in two selected districts Dharmapuri and Salem districts of Tamil Nadu State, India.ResultsIn 2018, 45 (11%) of 397 pharmacies in Dharmapuri and 90 (6%) of 1457 pharmacies in Salem districts reported sale of anti-TB drugs to 1307 and 1673 persons respectively. Upon validation through direct patient contact 942 (72%) persons in Dharmapuri and 863 (52%) persons were identified as previously ‘un-notified’ TB patients. These patients constituted 20% and 29% of the total TB cases notified in Dharmapuri and Salem respectively. The enablers for implementing this activity were: understanding the importance of notification, availability of resources (manpower, computers) to record, report and validate the patient data, repeated trainings and partnerships. The barriers were: patients' hesitancy to share their details to pharmacists (confidentiality), cumbersome recording and reporting process, difficulties in recording patient details during high workload busy business hours.ConclusionThis process contributed about one-fourth of the TB patients notified in these districts. Its implementation needs to be strengthened and should be scaled up in other parts of the country.     

Benefits of the Restorative Exercise and Strength Training for Operational Resilience and Excellence Yoga Program for Chronic Low Back Pain in Service Members: A Pilot Randomized Controlled Trial

Objective

To examine the feasibility and preliminary effectiveness of an individualized yoga program.

Caspase-6 activity predicts lower episodic memory ability in aged individuals

Caspase-6 (Casp6), a cysteinyl protease that induces axonal degeneration, is activated early in Alzheimer Disease (AD) brains. To determine whether Casp6 activation is responsible for early cognitive impairment, we investigated the abundance of Casp6 activity, paired helical filament–1 (PHF-1) phosphorylated Tau and amyloid beta peptide (Aβ) pathology by immunohistochemistry in the hippocampal formation of aged non–cognitively impaired (NCI) individuals. Casp6 activity was restricted to the entorhinal cortex (ERC) and CA1 regions of the hippocampus. Pathology scores were then correlated with cognitive scores obtained within 1 year of death. Regression analyses revealed that ERC and CA1 Casp6 activity were the main contributor to lower episodic memory performance, whereas ERC PHF-1 pathology predicted lower semantic and working memory performance. Aβ did not correlate with any of the cognitive tests. Because Casp6 activity and PHF-1 pathology are intimately associated with AD pathology and memory decline is an early event in AD, we conclude that Casp6 activity and PHF-1 immunoreactivity in ERC identifies aged individuals at risk for developing AD.     

Identifying Areas for Operational Improvement and Growth in IR Workflow Using Workflow Modeling,Simulation, and Optimization Techniques

Identifying areas for workflow improvement and growth is essential for an interventional radiology (IR) department to stay competitive. Deployment of traditional methods such as Lean and Six Sigma helped in reducing the waste in workflows at a strategic level. However, achieving efficient workflow needs both strategic and tactical approaches. Uncertainties about patient arrivals, staff availability, and variability in procedure durations pose hindrances to efficient workflow and lead to delayed patient care and staff overtime. We present an alternative approach to address both tactical and strategic needs using discrete event simulation (DES) and simulation based optimization methods. A comprehensive digital model of the patient workflow in a hospital-based IR department was modeled based on expert interviews with the incumbent personnel and analysis of 192 days’ worth of electronic medical record (EMR) data. Patient arrival patterns and process times were derived from 4393 individual patient appointments. Exactly 196 unique procedures were modeled, each with its own process time distribution and rule-based procedure-room mapping. Dynamic staff schedules for interventional radiologists, technologists, and nurses were incorporated in the model. Stochastic model simulation runs revealed the resource “computed tomography (CT) suite” as the major workflow bottleneck during the morning hours. This insight compelled the radiology department leadership to re-assign time blocks on a diagnostic CT scanner to the IR group. Moreover, this approach helped identify opportunities for additional appointments at times of lower diagnostic scanner utilization. Demand for interventional service from Outpatients during late hours of the day required the facility to extend hours of operations. Simulation-based optimization methods were used to model a new staff schedule, stretching the existing pool of resources to support the additional 2.5 h of daily operation. In conclusion, this study illustrates that the combination of workflow modeling, stochastic simulations, and optimization techniques is a viable and effective approach for identifying workflow inefficiencies and discovering and validating improvement options through what-if scenario testing.     

医学高职课堂小演讲与学生综合能力培养的研究与思考

培养探索与创新等综合能力是医学高职教育的核心任务,课堂小演讲是训练综合素质的重要方式,以讲授为主的教学法为对照,将“小演讲”引入助产专业《医学遗传与优生》课程教学,经笔试、总结和教学反馈等方式评价显示教学效果显著,小演讲是学生综合能力培养的重要方法。     

Abilities,skills and knowledge in measures of health literacy

Objective

Health literacy has been recognized as an important factor in patients’ health status and outcomes, but the relative contribution of demographic variables, cognitive abilities, academic skills, and health knowledge to performance on tests of health literacy has not been as extensively explored. The purpose of this paper is to propose a model of health literacy as a composite of cognitive abilities, academic skills, and health knowledge (ASK model) and test its relation to measures of health literacy in a model that first takes demographic variables into account.

Methods

A battery of cognitive, academic achievement, health knowledge and health literacy measures was administered to 359 Spanish- and English-speaking community-dwelling volunteers. The relations of health literacy tests to the model were evaluated using regression models.

Results

Each health literacy test was related to elements of the model but variability existed across measures.

Conclusion

Analyses partially support the ASK model defining health literacy as a composite of abilities, skills, and knowledge, although the relations of commonly used health literacy measures to each element of the model varied widely.

Practice implications

Results suggest that clinicians and researchers should be aware of the abilities and skills assessed by health literacy measures when choosing a measure.