'Talking lines': the stories of diagnosis and support as told by those with lived experience of rare forms of dementia.

BACKGROUND: People living with, or caring for someone with, rare forms of dementia can encounter issues while obtaining a diagnosis and trying to access appropriate support. This can affect their wellbeing, quality of life, social relationships and employment status. This study makes use of an arts-based narrative approach to explore individual accounts of these experiences whilst also exploring how, in telling their stories, those affected by rare forms of dementia might invoke, and situate their stories in relation to, broader cultural narratives around dementia and illness. METHODS: Semi-structured interviews were conducted via video-conferencing software with participants (N = 27), living with, or caring for someone with, a rare forms of dementia. Participants used line drawings to depict their journey from initial symptoms to the present day, followed by prompts to verbally narrate their experiences. All interview transcripts and line drawings were subjected to narrative analysis. Four sets of transcripts and drawings were then subjected to more in-depth analysis. RESULTS: Analysis shed light on the struggles encountered by both care-partners and people with a diagnosis, while navigating a health and social care system that does not always understand their needs. This often led to individuals feeling isolated and unsupported. Accounts also depicted challenges to identity brought on by the process. The moment of diagnosis was also drawn in a complicated light. Individuals found comfort in gaining understanding, but felt fear at recognising upcoming challenges. Participants situated their own accounts against mainstream cultural narratives around what good support for cognitive impairment and dementia might look like, whilst also demonstrating the influential role they took on in pursuing the right care. CONCLUSIONS: The use of line drawing, alongside narrative interviews, allowed participants to tell complicated, sometimes anachronistic, stories about difficult experiences, whilst also reflecting on, and attaching meaning to, them. These stories highlighted pressing gaps in healthcare services and shone a light on the various pieces of collective action individuals were engaged in in order to improve them. Finally, in modelling some elements of the participants' service provision which were working, the narratives pointed to future directions services might move in.

Microbiota Transplantation as an Adjunct to Standard Periodontal Treatment in Periodontal Disease: A Systematic Review.

Periodontitis is a disease linked to severe dysbiosis of the subgingival microbiome. The treatment of periodontitis aims to change the dysbiosis environment to a symbiosis environment. We hypothesized that oral microbiota transplantation can lead to a significant improvement in periodontitis. Therefore, the aim of this study was to determine the effectiveness of microbiota transplantation after standard periodontal treatment in periodontitis patients. The search strategy was carried out by using the Boolean term "AND" to combine the keywords, which were "periodontitis AND microbiota transplantation". Due to the limited resources of the study, we included both in vitro and in vivo investigations in this systematic review. The QUIN risk of bias tool was employed to assess the risk of bias in in vitro studies, while SYRCLE's risk of bias assessment was used for in vivo studies. Oral microbiota transplants (OMTs) have shown potential in treating periodontitis. OMTs significantly reduced periodontitis-associated pathogenic microbial species (P. endodontalis, Prevotella intermedia, T. vincentii, Porphyromonas sp.) and increased beneficial bacteria (P. melaninogenica, Fusobacterium nucleatum, P. catoniae, Capnocytophaga ochracea, C. sputigena, C. gingivalis, Haemophilus parainfluenzae, and Neisseria elongata) upon in vitro testing. Furthermore, in the in vivo tests, single adjunctive OMT also had an effect on the oral microbiota composition compared to the full-mouth mechanical and antimicrobial debridement. OMTs may be cheaper and more effective at addressing high-risk individuals. At present, it is not possible to provide OMT clinical advice due to the lack of available information. This treatment needs to be subjected to more safety and efficacy testing before being included human clinical trials.

Video Conferencing Peer Support and Rarer Forms of Dementia: An Exploration of Family Carers' Positive Experiences.

Little is known regarding the nuanced experiences of family carers for people living with rare dementias (PLWRD), with no known literature exploring their positive experiences of caring discussed within peer support group settings. This article explores family carers of PLWRD's positive experiences reported in video conferencing peer support groups. Six peer support group sessions involving a total of nine participants were qualitatively analysed using thematic analysis, guided by the conceptual framework of positive aspects of caring (CFPAC) (Carbonneau et al., 2010). Six themes were identified: (1) Protecting, maintaining, enjoying and finding strength in their relationship with the PLWRD; (2) Using tools and resources in response to challenges; (3) Positive impact of interactions and others' responses to the dementia; (4) Overcoming barriers to taking a break while maintaining their wellbeing, (5) Maintaining positive outlooks and showing psychological resilience in adversity; and (6) Attributing meaning to the caring role. This article highlights family carers of PLWRD's positive psychological, physical and social resources, balanced against the challenges of caring and maintaining their wellbeing, and identifies ways of promoting family carers' positive caring experiences and resources within healthcare and supportive settings.

Single-item principal stress and coping measures: Concurrent and predictive validity and comparisons to teacher measures.

The present study analyzed concurrent and predictive validity of single-item scales for assessing principal stress and coping. We examined concurrent and prospective relations among stress and coping single-items with principal job satisfaction, overall health, perceptions of school safety, and principal leadership self-efficacy. We also compared principals and teachers on their stress and coping levels using the same single-item scales. Consistent with the literature on teacher stress and coping, the correlations of principal coping with different outcomes-job satisfaction, overall health, leadership efficacy, and safety perceptions-were stronger in comparison to the correlations between principal stress and those same outcomes. In regression models with both stress and coping, only principal coping predicted concurrent and future principal job satisfaction and overall health, as well as change in those outcomes. Coping also predicted concurrent but not future perceptions of school safety. Stress and coping did not consistently predict concurrent or future measures of leadership self-efficacy. Last, we found that principals reported even higher levels of stress than the well-documented high levels reported by teachers. We discuss areas for further research and potential use of these measures. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Individual and school predictors of teacher stress, coping, and wellness during the COVID-19 pandemic.

The Coronavirus disease 2019 (COVID-19) pandemic created unprecedented challenges for the U.S. education system and for teachers. The present study examined correlates and predictors of teacher well-being in the immediate aftermath of school closures related to the pandemic. Data were collected as part of a larger group randomized trial. Six hundred and thirty-nine teachers completed surveys about their stress, coping, health, job satisfaction, and internalizing symptoms in Fall 2019, before the pandemic, and May 2020, during the pandemic. Teachers also provided ratings during COVID-19 of their teaching, student attendance and engagement, and concern about students and families. Teachers reported lower levels of work-related stress after the pandemic's onset compared to their prepandemic levels. Multilevel regression analyses revealed teacher confidence in their ability to manage student behaviors as a consistent and robust predictor of teacher well-being outcomes. Additionally, pre-COVID-19 school-level factors measured in Fall 2019, including collegial school leadership and fair and equitable school discipline structures, also predicted aspects of teacher well-being at the onset of COVID-19. Findings suggest the importance of teacher competence and perceived efficacy in managing student behavior and engaging them in learning to help them adapt to the stressors of a pandemic. Additionally, aspects of organizational health and climate may also help facilitate or hinder teacher adjustment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Flexible Krylov Methods for Edge Enhancement in Imaging.

Many successful variational regularization methods employed to solve linear inverse problems in imaging applications (such as image deblurring, image inpainting, and computed tomography) aim at enhancing edges in the solution, and often involve non-smooth regularization terms (e.g., total variation). Such regularization methods can be treated as iteratively reweighted least squares problems (IRLS), which are usually solved by the repeated application of a Krylov projection method. This approach gives rise to an inner-outer iterative scheme where the outer iterations update the weights and the inner iterations solve a least squares problem with fixed weights. Recently, flexible or generalized Krylov solvers, which avoid inner-outer iterations by incorporating iteration-dependent weights within a single approximation subspace for the solution, have been devised to efficiently handle IRLS problems. Indeed, substantial computational savings are generally possible by avoiding the repeated application of a traditional Krylov solver. This paper aims to extend the available flexible Krylov algorithms in order to handle a variety of edge-enhancing regularization terms, with computationally convenient adaptive regularization parameter choice. In order to tackle both square and rectangular linear systems, flexible Krylov methods based on the so-called flexible Golub-Kahan decomposition are considered. Some theoretical results are presented (including a convergence proof) and numerical comparisons with other edge-enhancing solvers show that the new methods compute solutions of similar or better quality, with increased speedup.

Exploring the link between principal leadership and family engagement across elementary and middle school.

As leaders in the school, principals play an important role in fostering family engagement. Unfortunately, little is known about specific aspects of leadership that promote family engagement. Collegial leadership, an aspect of principal leadership that promotes organizational health via trusting relationships and a sense of community, may be particularly useful to understanding how principals influence family engagement. Drawing on data from two randomized controlled trials evaluating the effects of teacher training in universal classroom management practices, the current study explores the relationship between teacher reports of family engagement and principal collegial leadership. Participants included 3208 students and 207 teachers across 18 elementary and middle schools in the Midwest United States. Utilizing hierarchical linear modeling, results revealed a significant positive relationship between family engagement and overall collegial leadership in addition to specific collegial leadership practices/characteristics. Further, baseline collegial leadership predicted increased end-of-year family engagement when controlling for baseline family engagement, developmental context, intervention status, and student-level characteristics. Overall, results provide empirical evidence for an important link between principal leadership practices and family engagement. Albeit promising, more research is needed to identify and explain the particular mechanisms by which principal collegial leadership may promote family engagement.

High-Throughput Nanocapillary Filling Enabled by Microwave Radiation for Scanning Ion Conductance Microscopy Imaging.

Solid-state nanopores provide a highly sensitive tool for single-molecule sensing and probing nanofluidic effects in solutions. Glass nanopipettes are a cheap and robust type of solid-state nanopore produced from pulling glass capillaries with opening orifice diameters down to below tens of nanometers. Sub-50 nm nanocapillaries allow an unprecedented resolution for translocating single molecules or for scanning ion conductance microscopy imaging. Due to the small opening orifice diameters, such nanocapillaries are difficult to fill with solutions, compromising their advantages of low cost, availability, and experimental simplicity. We present a simple and cheap method to reliably fill nanocapillaries down to sub-10 nm diameters by microwave radiation heating. Using a large statistic of filled nanocapillaries, we determine the filling efficiency and physical principle of the filling process using sub-50 nm quartz nanocapillaries. Finally, we have used multiple nanocapillaries filled by our method for high-resolution scanning ion conductance microscopy imaging.

Sensitivity Analysis and Extensions of Testing the Causal Direction of Dependence: A Rejoinder to Thoemmes (2019).

A commentary by Thoemmes on Wiedermann and Sebastian's introductory article on Direction Dependence Analysis (DDA) is responded to in the interest of elaborating and extending direction dependence principles to evaluate causal effect directionality. Considering Thoemmes' observation that some DDA principles are already well-established in machine learning, we argue that several other connections between DDA and research lines in theoretical statistics, econometrics, and quantitative psychology exist, suggesting that DDA is best conceptualized as a framework that summarizes and extends existing knowledge on properties of linear models under non-normality. Further, Thoemmes articulates concerns about assumptions of error distributions used in our main article and presents an artificial data example in which some DDA tests have suboptimal statistical power. We present extensions of DDA to entirely relax distributional assumptions about errors and describe two sensitivity analysis approaches to critically evaluate DDA results. Both sensitivity approaches are illustrated using Thoemmes' artificial data example. Incorporating DDA sensitivity results yields correct causal conclusions. Thus, overall, we stay with our initial conclusion that the use of higher moments in causal inference constitutes an exciting open research area.

Direction Dependence Analysis in the Presence of Confounders: Applications to Linear Mediation Models Using Observational Data.

Statistical methods to identify mis-specifications of linear regression models with respect to the direction of dependence (i.e. whether x→y or y→x better approximates the data-generating mechanism) have received considerable attention. Direction dependence analysis (DDA) constitutes such a statistical tool and makes use of higher-moment information of variables to derive statements concerning directional model mis-specifications in observational data. Previous studies on direction of dependence mainly focused on statistical inference and guidelines for the selection from the two directionally competing candidate models (x→y versus y→x) while assuming the absence of unobserved common causes. The present study describes properties of DDA when confounders are present and extends existing DDA methodology by incorporating the confounder model as a possible explanation. We show that all three explanatory models can be uniquely identified under standard DDA assumptions. Further, we discuss the proposed approach in the context of testing competing mediation models and evaluate an organizational model proposing a mediational relation between school leadership and student achievement via school safety using observational data from an urban school district. Overall, DDA provides strong empirical support that school safety has indeed a causal effect on student achievement but suggests that important confounders are present in the school leadership-safety relation.

Do organizational conditions influence teacher implementation of effective classroom management practices: Findings from a randomized trial.

Although there is a growing evidence base about effective classroom management practices, teacher implementation of these practices varies due to a number of factors. A school's organizational health is one aspect of the broader social environment that has been hypothesized to influence implementation of interventions. Yet, empirical evidence is limited on whether organizational contexts can influence teacher implementation of effective interventions and subsequently, classroom environments and student outcomes. In the present study, teachers in an urban school district were randomly assigned to receive training in the Incredible Years Teacher Classroom Management program (IY TCM), a classroom management intervention. We examined how teacher perceptions of their school environment moderated intervention effects for previously established treatment outcomes - implementation of effective classroom methods, students' social behaviors, emotional regulation, and social competence. Results showed that treatment effects on teacher implementation and student outcomes were moderated by teachers' sense of affiliation to their school. Specifically, main effects on implementation of effective classroom management strategies were only observed among teachers whose perceptions of initial teacher affiliation was low or average; whereas main effects on student outcomes were only found for teachers with initial high levels of affiliation.

Indaziflam: a new cellulose-biosynthesis-inhibiting herbicide provides long-term control of invasive winter annual grasses.

BACKGROUND: Indaziflam is a cellulose-biosynthesis-inhibiting (CBI) herbicide that is a unique mode of action for resistance management and has broad spectrum activity at low application rates. This research further explores indaziflam's activity on monocotyledons and dicotyledons and evaluates indaziflam's potential for restoring non-crop sites infested with invasive winter annual grasses. RESULTS: Treated Arabidopsis, downy brome, feral rye and kochia were all susceptible to indaziflam in a dose-dependent manner. We confirmed that indaziflam has increased activity on monocots (average GR50  = 231 pm and 0.38 g AI ha-1 ) at reduced concentrations compared with dicots (average GR50  = 512 pm and 0.87 g AI ha-1 ). Fluorescence microscopy confirmed common CBI symptomologies following indaziflam treatments, as well as aberrant root and cell morphology. Across five application timings, indaziflam treatments resulted in superior invasive winter annual grass control 2 years after treatment (from 84 ± 5.1% to 99 ± 0.5%) compared with imazapic (36% ± 1.2%). Indaziflam treatments significantly increased biomass and species richness of co-occurring species 2 years after treatment. CONCLUSION: Indaziflam's increased activity on monocots could provide a new alternative management strategy for long-term control of multiple invasive winter annual grasses that invade >23 million ha of US rangeland. Indaziflam could potentially be used to eliminate the soil seed bank of these invasive grasses, reduce fine fuel accumulation and ultimately increase the competitiveness of perennial co-occuring species. © 2017 Society of Chemical Industry.

Procedural and interpretive skills of medical students: experiences and attitudes of fourth-year students.

BACKGROUND: Recent data do not exist regarding fourth-year medical students' performance of and attitudes toward procedural and interpretive skills, and how these differ from third-year students'. METHOD: Cross-sectional survey conducted in February 2006 of 122 fourth-year students from seven U.S. medical schools, compared with their responses in summer 2005. Students estimated their cumulative performance of 22 skills and reported self-confidence and perceived importance using a five-point Likert-type scale. RESULTS: The response rate was 79% (96/122). A majority reported never having performed cardioversion, thoracentesis, cardiopulmonary resuscitation, blood culture, purified protein derivative placement, or paracentesis. One fifth of students had never performed peripheral intravenous catheter insertion, phlebotomy, or arterial blood sampling. Students reported increased cumulative performance of 17 skills, increased self-confidence in five skills, and decreased perceived importance in three skills (two-sided P < .05). CONCLUSIONS: A majority of fourth-year medical students still have never performed important procedures, and a substantial minority have not performed basic procedures.

Feasibility, reliability and user satisfaction with a PDA-based mini-CEX to evaluate the clinical skills of third-year medical students.

BACKGROUND: The mini-clinical evaluation exercise (mini-CEX) has been used to assess clinical skills of 3rd-year medical schools. However a PDA-based mini-CEX has not been developed or evaluated before. Our objective was to determine the feasibility, implementation, and user satisfaction with a PDA-based mini-CEX. DESCRIPTION: Third-year medical students at the Medical College of Wisconsin who rotated on their core clinical clerkship in internal medicine during the period of July 2004 to April 2005 (n = 177) were required to complete two PDA-based mini-CEXs that were supervised by a faculty member or senior resident. Descriptive statistics and sample t test with equal variances were performed to analyze PDA-based mini-CEX completion rates, satisfaction scores by overall user and by evaluator type. EVALUATION: During the 10-month study period, 354 PDA-based mini-CEX forms were collected (100% completion rate). Seventy-five percent (n = 267) of mini-CEXs occurred in the inpatient setting and 24% (n = 87) in the outpatient clinics. Students reported receiving feedback from their evaluator in 96% of these exercises. The most frequently evaluated competencies were humanism (90%), physical examination (90%), and overall clinical competence (90%). Third-year students were evaluated by residents in 58% (n = 205) of encounters and by faculty in 42% (n = 149). Residents rated students significantly higher than faculty (overall M = 7.6 vs. 7.1, respectively) in all clinical domains of the PDA-based form (p < .05). Satisfaction with the PDA based mini-CEX was high (scale = 1-9) for residents (8.1; SD = 1.5), faculty (7.4; SD = 1.5), and students (8.0; SD = 1.7). CONCLUSIONS: A PDA-based mini-CEX is a feasible tool to facilitate the direct observation of students' clinical skills. The PDA-based mini-CEX was highly rated by students and evaluators as a valuable technology-based tool to document direct supervision of clinical skills.

Procedural and interpretive skills of medical students: experiences and attitudes of third-year students.

BACKGROUND: Recent data do not exist on medical students' performance of and attitudes toward procedural and interpretive skills deemed important by medical educators. METHOD: A total of 171 medical students at seven medical schools were surveyed regarding frequency of performance, self-confidence, and perceived importance of 21 procedural and interpretive skills. RESULTS: Of the 122 responding students (71% response rate), a majority had never performed lumbar puncture, thoracentesis, paracentesis, or blood culture, and students reported lowest self-confidence in these skills. At least one-quarter of students had never performed phlebotomy, peripheral intravenous catheter insertion, or arterial blood sampling. Students perceived all 21 skills as important to learn and perform during medical school. CONCLUSION: Through the third year of medical school, a majority of students had never performed important procedures, and a substantial minority had not performed basic procedures. Students had low self-confidence in skills they rarely performed, but perceived all skills surveyed as important.

The prophylaxis of medical patients for thromboembolism pilot study.

PURPOSE: We assessed the feasibility of a large randomized trial intended to determine whether low-dose heparin prophylaxis given throughout hospitalization reduces mortality and morbidity in general medical patients. SUBJECTS AND METHODS: Hospitalized general medical patients aged more than 60 years at 5 Department of Veterans Affairs (VA) medical centers were randomized to receive enoxaparin 40 mg or identical placebo, given daily by subcutaneous injection until hospital discharge. Outcomes included total mortality at 90 days (the primary outcome) and 1 year, and occurrence in the VA hospital within 90 days of symptomatic deep venous thrombosis, pulmonary embolism, and major bleeding. RESULTS: Only 7.6% of hospitalized patients aged more than 60 years were eligible for the study, although a chart review had predicted 25%. The principal exclusions were prior indication for anticoagulation, anticipated need for anticoagulation, contraindication to heparin, expected hospitalization less than 3 days, and "supportive/palliative care only" status. We randomized 140 patients into each group, 28% of target recruitment. The groups were well matched by age and comorbidities. Death occurred in 13 patients receiving enoxaparin and 14 patients receiving placebo at 90 days (relative risk 0.93, 95% confidence interval 0.26-1.59), and in 36 and 32 patients, respectively, at 1 year (relative risk 1.13, 95% confidence interval 0.66-1.60). Clinical thromboembolic events occurred in 5 patients receiving enoxaparin and 8 patients receiving placebo, and major bleeding occurred in 2 and 5 patients, respectively. CONCLUSIONS: The pilot study indicated that the full study was not feasible. The decision to use prophylaxis pertains to only a small proportion of general medical patients hospitalized at VA medical centers, and this proportion is overestimated by chart review. The effect of low-dose heparin prophylaxis on clinical outcomes in hospitalized general medical patients remains uncertain.

Learning Activities and Third-Year Medical Student Ratings of High Quality Teaching Across Different Clerkships.

OBJECTIVE: To identify and compare learning activities that students associate with high quality teaching across clerkships. METHODS: For six months, 110 third year medical students recorded data on learning activities and teaching quality using personal digital assistants (PDAs) during five different required clinical clerkships. Univariate and multivariate analyses were performed to assess the association between learning activities and student ratings of high teaching quality. RESULTS: 11,450 teaching interactions were recorded. Univariate analysis revealed that feedback was associated with perceptions of high quality teaching in all clerkships. Proposing a plan, formulating an assessment and giving an oral case presentation were associated with high quality teaching in 80% of the clerkships (p < 0.01). Multivariate analysis demonstrated that receiving high quality feedback was an independent predictor of student ratings of high quality teaching for all clerkships. CONCLUSION: Receiving high quality feedback is the learning activity most strongly associated with students' ratings of high quality teaching across four different clerkships.

Learning/feedback activities and high-quality teaching: perceptions of third-year medical students during an inpatient rotation.

PURPOSE: To identify specific learning activities (and teaching methods) that students associate with high-quality teaching in the inpatient setting. METHOD: For ten months in 2003-04, 170 third-year medical students recorded data on learning/feedback activities and teaching quality via personal digital assistants during the inpatient portion of a required two-month medicine clerkship at four sites affiliated with the Medical College of Wisconsin. Univariate and multivariate analyses were performed to assess the association between learning/feedback activities and students' perceptions of high-quality teaching. RESULTS: A total of 2,671 teaching encounters were rated by 170 students during their required inpatient medicine rotations. Bedside teaching was reported in almost two-thirds of teaching/learning encounters. Feedback on case presentation and differential diagnosis were the inpatient feedback activities most often provided by faculty. The univariate analysis revealed that students' perceptions of high-quality teaching was associated with receiving mini-lectures, developing short presentations on relevant inpatient topics, bedside teaching, case-based conferences, learning electrocardiogram and chest X-ray interpretation, teaching with other team members present (p <. 001), and receiving feedback on history and physical examination, on case presentation, at the bedside, on differential diagnosis, and on daily progress notes. Results from the regression analysis revealed that giving mini-lectures on inpatient topics, teaching electrocardiogram and chest X-ray interpretation, providing feedback on case presentation, and at the bedside were predictors of overall high-quality teaching. CONCLUSIONS: Aspects of feedback, giving mini-lectures, and learning test-interpretation skills were the learning and feedback activities associated with students' perceptions of high-quality teaching. In an increasingly time-pressured inpatient environment, clinical educators should understand which activities students value.