1720 Highway 59 S Sanford Thief River Falls
Thief River Falls MN 56701
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Derivation and Evaluation of a Risk-Scoring Tool to Predict Participant Attrition in a Lifestyle Intervention Project. - Prevention science : the official journal of the Society for Prevention Research
Participant attrition in clinical trials and community-based interventions is a serious, common, and costly problem. In order to develop a simple predictive scoring system that can quantify the risk of participant attrition in a lifestyle intervention project, we analyzed data from the Special Diabetes Program for Indians Diabetes Prevention Program (SDPI-DP), an evidence-based lifestyle intervention to prevent diabetes in 36 American Indian and Alaska Native communities. SDPI-DP participants were randomly divided into a derivation cohort (nâ€‰=â€‰1600) and a validation cohort (nâ€‰=â€‰801). Logistic regressions were used to develop a scoring system from the derivation cohort. The discriminatory power and calibration properties of the system were assessed using the validation cohort. Seven independent factors predicted program attrition: gender, age, household income, comorbidity, chronic pain, site's user population size, and average age of site staff. Six factors predicted long-term attrition: gender, age, marital status, chronic pain, site's user population size, and average age of site staff. Each model exhibited moderate to fair discriminatory power (C statistic in the validation set: 0.70 for program attrition, and 0.66 for long-term attrition) and excellent calibration. The resulting scoring system offers a low-technology approach to identify participants at elevated risk for attrition in future similar behavioral modification intervention projects, which may inform appropriate allocation of retention resources. This approach also serves as a model for other efforts to prevent participant attrition.
Comparison Between 1.5-T and 3-T MRI for Fetal Imaging: Is There an Advantage to Imaging With a Higher Field Strength? - AJR. American journal of roentgenology
Fetal MRI at 3 T is emerging as a promising modality for evaluating fetal anatomy. The objective of this study was to compare the quality of images obtained with commonly used fetal imaging sequences at 1.5 T and 3 T. We hypothesized that the visualization and anatomic detail of fetal structures would be better at 3 T than at 1.5 T.A retrospective search of the radiology department database at our institution identified 58 fetal MRI examinations performed at 3 T to evaluate body abnormalities during the period from July 2012 to February 2014. A blind comparison was conducted between these examinations and 58 1.5-T MRI examinations of age-matched fetuses undergoing evaluation for similar abnormalities during the same period. The anatomic structures analyzed included the bowel, liver, kidney, airway, cartilage, and spine. Scores for the depiction of anatomic structures ranged from 0 to 4, with 4 denoting the best depiction.Fetal imaging at 3 T was associated with higher imaging scores in the evaluation of the cartilage and spine when single-shot turbo spin-echo (SSTSE) and steady-state free precession (SSFP) sequences were used and in the assessment of most structures (e.g., bowel, liver, kidney, cartilage, and spine) when SSFP sequences were used. The mean scores for all structures evaluated with the use of SSTSE sequences were higher when MRI was performed at 3 T than at 1.5 T; similar findings were noted when SSFP sequences were used. Evaluation of imaging scores with regard to gestational age showed that scores improved with increasing gestational age on 1.5-T MRI but not on 3-T MRI. Overall, more imaging artifacts were found when imaging was performed at 3 T than at 1.5 T.An overall advantage to performing fetal imaging at 3 T was made evident by the higher imaging scores obtained with 3-T MRI versus 1.5-T MRI when different fetal anatomic structures were evaluated. These higher scores were predominantly associated with use of SSFP sequences. The findings of this study and future advancements in MRI software and 3-T protocols may allow optimal visualization and examination of fetal pathologic abnormalities, thus better identifying fetal and maternal needs both prenatally and postnatally.
Hypoplastic left heart syndrome and the nutmeg lung pattern in utero: a cause and effect relationship or prognostic indicator? - Pediatric radiology
Hypoplastic left heart syndrome (HLHS) is the third most common cause of critical congenital heart disease in newborns, and one of the most challenging forms to treat. Secondary pulmonary lymphangiectasia has been recognized in association with HLHS, an appearance described on fetal MRI as the "nutmeg lung."To investigate the association of fetal nutmeg lung with HLHS survival.A retrospective search of the fetal MRI database was performed. The nutmeg lung pattern was defined as T2 heterogeneous signal with tubular structures radiating peripherally from the hila. Postnatal echocardiograms and charts were reviewed.Forty-four fetal MR studies met inclusion criteria, of which 4 patients (9%) had the nutmeg lung pattern and 3 of whom also had restrictive lesions. Mortality in this nutmeg lung group was 100% by 5Â months of age. Of the 40 patients without nutmeg lung, mortality/orthotopic heart transplant (OHT) was 35%. Of these 40 patients without nutmeg lung, 5 had restriction on echo, 3 of whom died/had OHT before 5Â months of age (60% of patients with restriction and non-nutmeg lung). There was a significantly higher incidence of restrictive lesions (Pâ€‰=â€‰0.02) and mortality/OHT (Pâ€‰=â€‰0.02) in patients with nutmeg lung compared to those without.The nutmeg lung MR appearance in HLHS fetuses is associated with increased mortality/OHT (100% in the first 5Â months of life compared to 35% with HLHS alone). Not all patients with restrictive lesions develop nutmeg lung, and outcome is not as poor when restriction is present in isolation. Dedicated evaluation for nutmeg lung pattern on fetal MR studies may be useful to guide prognostication and aid clinicians in counseling parents of fetuses with HLHS.
Socioeconomic Disparities in Weight and Behavioral Outcomes Among American Indian and Alaska Native Participants of a Translational Lifestyle Intervention Project. - Diabetes care
To investigate possible socioeconomic disparities in weight and behavioral outcomes among American Indian and Alaska Native (AI/AN) participants in a translational diabetes prevention project.We analyzed data from the Special Diabetes Program for Indians Diabetes Prevention (SDPI-DP) Program, an evidence-based lifestyle intervention to prevent diabetes in 36 AI/AN grantee sites. A total of 2,553 participants started the 16-session Lifestyle Balance Curriculum between 1 January 2006 and 31 July 2008. Linear mixed models were used to evaluate the relationships of participant and staff socioeconomic characteristics with weight and behavioral outcomes at the end of the curriculum.A strong, graded association existed between lower household income and less BMI reduction, which remained significant after adjusting for other socioeconomic characteristics. Compared with others, participants with annual income <$15,000 also had less improvement in physical activity and unhealthy food consumption in bivariate models, but the relationships were only marginally significant in multivariate regressions. Furthermore, grantee sites with fewer professionally prepared staff were less successful at improving participant BMI and healthy food consumption than the other sites. The strong association between income and BMI reduction was reduced by 20-30% in the models with changes in diet variables but was unrelated to changes in physical activity.Significant socioeconomic disparities exist in weight outcomes of lifestyle intervention at both participant and site staff levels. Helping low-income participants choose more affordable healthy foods and increasing the proportion of professionally trained staff might be practical ways to maximize the effectiveness of lifestyle interventions implemented in "real-world" settings.Â© 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
Evaluation of a support worker role, within a nurse delegation and supervision model, for provision of medicines support for older people living at home: the Workforce Innovation for Safe and Effective (WISE) Medicines Care study. - BMC health services research
Support with managing medicines at home is a common reason for older people to receive community nursing services. With population ageing and projected nurse shortages, reliance on nurses may not be sustainable. We developed and tested a new workforce model: 'Workforce Innovation for Safe and Effective (WISE) Medicines Care', which enabled nurses to delegate medicines support home visits for low-risk clients to support workers (known as community care aides [CCAs]). Primary study aims were to assess whether the model increased the number of medicines support home visits conducted by CCAs, explore nurses', CCAs' and consumers' experiences with the CCAs' expanded role, and identify enablers and barriers to delegation of medicines support.A prospective before-after mixed-methods study was conducted within a community nursing service that employed a small number of CCAs. The CCAs' main role prior to the WISE Medicines Care model was personal care, with a very limited role in medicines support. CCAs received training in medicines support, and nurses received training in assessment, delegation and supervision. Home visit data over two three-month periods were compared. Focus groups and interviews were conducted with purposive samples of nurses (nâ€‰=â€‰27), CCAs (nâ€‰=â€‰7) and consumers (nâ€‰=â€‰28).Medicines support visits by CCAs increased from 43/16,863 (0.25 %) to 714/21,552 (3.3 %) (pâ€‰<â€‰0.001). Nurses reported mostly positive experiences, and high levels of trust and confidence in CCAs. They reported that delegating to CCAs sometimes eliminated the need for duplicate nurse and CCA visits (for people requiring personal care plus medicines support) and enabled them to visit people with more complex needs. CCAs enjoyed their expanded role and were accepted by clients and/or carers. Nurses and CCAs reported effective communication when medicine-related problems occurred. No medication incidents involving CCAs were reported. Barriers to implementation included the limited number of CCAs employed in the organisation and reluctance from some nurses to delegate medicines support to CCAs. Enablers included training and support, existing relationships between CCAs and nurses, and positive staff attitudes.Appropriately trained and supervised support workers can be used to support community nurses with providing medicines management for older people in the home care setting, particularly for those who are at low risk of adverse medication events or errors. The model was acceptable to nurses, clients and carers, and may offer a sustainable and safe and effective future workforce solution to provision of medicines support for older people in the home care setting.
Up the years with the Bettersons: Gender and parent education in interwar America. - History of psychology
In the 1920s and 1930s, the parent education movement opened doors for many female psychologists and other child development professionals by providing training and jobs. Female experts in the parent education movement spread the emerging "gospel of child development" to other women-mothers-in a variety of formats. Although psychologists like John B. Watson advocated traditional definitions of motherhood focusing on role adjustment, there is evidence that women psychologists and parent educators introduced ways of thinking about family life that challenged tradition, encouraging role expansion and self-fulfillment. We explore examples provided by women at the Minnesota Institute of Child Welfare who produced radio programs on child rearing. Starting in 1932, advice about child rearing was embedded within stories featuring a fictional family, the Bettersons. The family narrative format provides an opportunity to identify implicit (and sometimes explicit) values and norms informing prescribed roles for mothers, fathers, and children. Analysis suggests that gender roles were shifting in more egalitarian directions, with an awareness of new identity options for both women and men. We explore implications for evaluating the impact of female experts involved in the parent education movement.(c) 2015 APA, all rights reserved).
Driving Errors in Persons with Dementia. - Journal of the American Geriatrics Society
To differentiate driving errors in persons with dementia who fail a performance- based road test from errors in persons who pass.Cross-sectional.Community.Active drivers diagnosed with dementia (nÂ =Â 60) and older adult controls (nÂ =Â 32).All participants completed a standardized clinical and on-road driving assessment. The outcome variable was the number and types of driving errors according to the Record of Driving Errors (RODE), a standardized tool to record driving errors.Sixty-two percent (nÂ =Â 37) of individuals with dementia and 3% (nÂ =Â 1) of controls failed the road test. Based on the RODE, individuals with dementia made twice as many driving errors as healthy controls. Within the dementia sample, individuals who failed the road test had more difficulties driving straight and making left and right turns than during lane changes. Dangerous actions occurred most often while driving straight and making left turns. Specific driving behaviors associated with road test failure in the sample with dementia included difficulties in lane positioning and usage, stopping the vehicle appropriately, attention, decision-making, and following rules of the road. Informants of participants with dementia who failed the road test reported more impairment with cognitive functioning on the Assessing Dementia 8 Screening Interview (AD8).This report highlights the driving errors most common in people with dementia who fail a road test. The finding that most of the dangerous actions in the sample with dementia occurred while driving straight condition is novel. Driving on straight roads has not been considered a condition of "high challenge" in prior driving studies in individuals with dementia. This finding has potential implications for future interventions related to vehicle instrumentation and driving recommendations for people with dementia.Â© 2015, Copyright the Authors Journal compilation Â© 2015, The American Geriatrics Society.
Florence Goodenough and child study: The question of mothers as researchers. - History of psychology
This article examines the views of early developmental psychologist Florence Goodenough, summarizing her contributions to the field, her complex viewpoints on science and gender issues, and her arguments for maternal record-keeping as a valuable scientific strategy, as drawn from her writings in textbooks, popular magazine articles, and private correspondence. During the 1920s, 1930s, and 1940s, when Goodenough enjoyed a high professional profile as a research scientist, the field of child psychology shifted from focus on producing applied knowledge to benefit parents and educators to a preference for laboratory-controlled basic science approaches to understanding development. Goodenough championed observation and other descriptive methods, including use of mothers as data collectors in the home, even while these approaches were increasingly discredited by prominent peers in the United States. I argue that Goodenough's allegiance to maternal record-keeping highlights a forgotten strand of context-sensitive, descriptive work that survived despite its general disparagement among proponents of a narrower version of strictly experimental developmental science emerging in the 1920s.(c) 2015 APA, all rights reserved).
Detection of inflammatory sacroiliitis in children with magnetic resonance imaging: is gadolinium contrast enhancement necessary? - Arthritis & rheumatology (Hoboken, N.J.)
In adults, gadolinium contrast enhancement does not add incremental value to fluid-sensitive sequences for evaluation of bone marrow edema. This study was undertaken to determine if magnetic resonance imaging (MRI) contrast is necessary to assess lesions consistent with inflammatory sacroiliitis in children.Patients with clinically suspected or diagnosed juvenile spondyloarthritis (SpA) underwent pelvic MRI consisting of multiplanar fluid-sensitive and postgadolinium T1-weighted fat-saturated sequences including dedicated sacral imaging. Three radiologists independently evaluated the fluid-sensitive sequences, and later, the complete study (including postcontrast images). With postcontrast imaging as the reference standard, we calculated the test properties of fluid-sensitive sequences for depiction of acute and chronic findings consistent with sacroiliitis.The 51 patients had a median age of 15 years, and 57% were male. Nineteen patients (22 joints) were diagnosed as having sacroiliitis based on postcontrast imaging, and none had synovitis in the absence of bone marrow edema. All 22 joints demonstrated bone marrow edema on both fluid-sensitive and postgadolinium T1-weighted fat-saturated sequences. Eighteen percent of joints with sacroiliitis had capsulitis, which was observed on both noncontrast and postcontrast imaging. Fifty-nine percent of joints with sacroiliitis had synovitis on postcontrast imaging. Sensitivity, specificity, positive predictive value, and negative predictive value of fluid-sensitive sequences for the detection of acute inflammatory lesions consistent with sacroiliitis using postgadolinium imaging as the reference standard were excellent. Interrater reliability was substantial for all parameters.Our findings indicate that fluid-sensitive sequences are sufficient to detect acute and chronic lesions consistent with inflammatory sacroiliitis in children.Â© 2015, American College of Rheumatology.
Optimizing functional MR urography: prime time for a 30-minutes-or-less fMRU. - Pediatric radiology
Current protocols for functional MR urography (fMRU) require long scan times, limiting its widespread use.Our goal was to use pre-defined criteria to reduce the number of sequences and thus the examination time without compromising the morphological and functional results.The standard fMRU protocol in our department consists of eight sequences, including a 17-min dynamic post-contrast scan. Ninety-nine children and young adults (43 male, 56 female, mean age 7 years) were evaluated with this protocol. Each sequence was retrospectively analyzed for its utility and factors that affect its duration.Mean scan time to perform the eight sequences, without including the variable time between sequences, was 40.5 min. Five sequences were categorized as essential: (1) sagittal T2 for planning the oblique coronal plane, (2) axial T2 with fat saturation for the assessment of corticomedullary differentiation and parenchymal thickness, (3) coronal 3-D T2 with fat saturation for multiplanar and 3-D reconstructions, (4) pre-contrast coronal T1 with fat saturation to ensure an appropriate scan prior to injecting the contrast material and (5) the coronal post-contrast dynamic series. Functional information was obtained after 8 min of dynamic imaging in the majority of children. The coronal fat-saturated T2, coronal T1, and post-contrast sagittal fat-saturated T1 sequences did not provide additional information. Because of the effects of pelvicalyceal dilation and ureteropelvic angle on the renal transit time, prone position is recommended, at least in children with high-grade pelvicalyceal dilation.Comprehensive fMRU requires approximately 19 min for sequence acquisition. Allowing for time between sequences and motion correction, the total study time can be reduced to about 30 min. Four pre-contrast sequences and a shortened post-contrast dynamic scan, optimally with the child in prone position, are sufficient.
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1720 Highway 59 S Sanford Thief River Falls Thief River Falls, MN 56701
1720 Hwy 59 Se Suite 1 Box 505
120 Labree Ave S
211 N Labree Avenue Midwest Vision Centers
1720 Hwy 59 Se Suite 1 Box 505