Task analysis guidance for number of and readability of steps for individuals with intellectual disabilities.

We examined the relationship of number of and readability of content of steps of task analyses with subsequent task performance. The results of the current study indicate that the number of and readability of steps were significantly associated with task performance via a non-linear, quadratic relationship. From our results, we suggest that task analyses may consider up to seven steps with a grade level of content (i.e., readability) of up to approximately 7th grade without diminishing task performance. These results do not provide final guidance as to the suggested number of steps or readability of content for task analyses but some initial guidance, especially in the absence of well-established task analyses. We suggest results should be used for those practitioners seeking guidelines for content development in the absence of well-established task analyses for suggested values for number of and readability of steps.

Predictors of employment for adults with intellectual and developmental disabilities participating in a postsecondary transition program in the United States.

BACKGROUND: Previous research has shown that post-secondary collegiate vocational educational programs often have positive effects on employment outcomes for young adults with intellectual and developmental disabilities. AIMS: Using secondary data of a program in the United States collected over several years, we examined which intervention components of a postsecondary education transition program predicted subsequent employment for young adults with intellectual and developmental disabilities. MATERIALS & METHODS: The sample consisted of 56 individuals that participated in a transition-services collegiate program; Crossing Points, University of Alabama. RESULTS: Results were able to robustly indicate that acquiring job-specific skills was a much better predictor than global measures of intellectual or adaptive behaviour. Additionally, survival curve analyses as an innovative approach to this population showed that there was a positive relation between the number of job-specific training sessions and eventual community employment. DISCUSSION: Results are discussed in relation to a historical parallel movement to expand inclusion of students with intellectual and developmental disabilities in the least restrictive educational setting for primary and secondary public education years. CONCLUSION: In conclusion, the results of the current study suggest positive findings with job-skills training both specific and general.

Ovarian Sex Cord Stromal Tumor, Steroid Cell, NOS in an Adolescent: A Case Report.

BACKGROUND: Ovarian steroid cell tumor, not otherwise specified (NOS), is a rare type of sex cord stromal tumor, which often presents with androgenic symptoms and has a high frequency of malignancy. CASE: This is a case of a 14-year-old Native American girl who presented with acne, amenorrhea, and virilization and was found to have a 2.9-cm solid ovarian mass. Initial pathology revealed steroid-appearing cells with round nuclei, clear/vacuolated cytoplasm, and a low mitotic index. Final diagnosis was ovarian steroid cell tumor, NOS Stage IA. A laparoscopic left salpingo-oophorectomy was subsequently performed. No tumor recurrence was noted 2 years after her initial diagnosis. SUMMARY AND CONCLUSION: Long-term data on these tumors are limited; however, malignancy, recurrence, and death have been reported. This suggests that close follow-up is essential for appropriate management.

Family planning practices of women working in the Cambodian garment industry: a qualitative study.

BACKGROUND: Women working in Cambodian garment factories have unmet needs for family planning (contraception and safe abortion) services, because of their background and living conditions. This study describes their experiences regarding abortion and contraception as part of a larger project to develop an intervention to support comprehensive post-abortion care. METHODS: We conducted semi-structured interviews with women seeking abortion services at private health facilities. In addition, we interviewed the private providers of abortion and contraception services surrounding garment factories. Interviews lasted up to 60 min and were conducted in Khmer and later translated into English. A thematic analysis was undertaken, with medical abortion experiences coded according to the Cambodia comprehensive abortion care protocol. RESULTS: We interviewed 16 women and 13 providers between August and November 2018. Most women reported being married and had at least one child. Among factory workers the major reported reasons for abortion were birth spacing and financial constraints. Family, friends, or co-workers were the major information resources regarding abortion and contraception, and their positive or negative experiences strongly influenced women's attitude towards both. Medical abortion pills were not always provided with adequate instructions. Half of the participants had a manual vacuum aspiration procedure performed after medical abortion. While women knew the side effects of medical abortion, many did not know the adverse warning signs and the signs of abortion completion. Only three women started post abortion family planning, as most of the women expressed fear and hesitation due to concerns about side effects of modern contraception. Fear of infertility was particularly reported among young women without children. CONCLUSION: This research shows that in this setting not all women are receiving comprehensive abortion care and contraceptive counselling. Provision of accurate and adequate information about abortion methods and modern contraception was the dominant shortfall in abortion care. Future work to address this gap could involve the development of appropriate interventions and informative tools for women in the Cambodian garment industry such as through existing client contact-centres or social media, including creation of videos or posts on topics that come from clients questions.

The impact of positive parenting behaviors and maternal depression on the features of young children's home language environments.

This study investigated the associations between maternal depression when infants were 3 to 11 months old (M = 6 months), and positive parenting behaviors when children were between 12 and 22 months (M = 17 months) and the home language environment assessed when children were 18 to 28 months old (M = 23.5 months) in a sample of 29 low-income mother-child dyads. After controlling for maternal education, only teaching behaviors remained a moderate and significant predictor of adult word counts. Observed teaching behaviors significantly predicted conversational turns and marginally predicted child vocalizations; effects sizes were small. Encouraging behaviors were a small and significant predictor of conversational turns and a marginally significant predictor of adult word counts. Maternal depression was a moderate and significant predictor of children's vocal productivity scores and a small, marginal predictor of conversational turns. These findings have important implications for parenting and children's language outcomes.

Biochemical signatures mimicking multiple carboxylase deficiency in children with mutations in MT-ATP6.

Elevations of specific acylcarnitines in blood reflect carboxylase deficiencies, and have utility in newborn screening for life-threatening organic acidemias and other inherited metabolic diseases. In this report, we describe a newly-identified association of biochemical features of multiple carboxylase deficiency in individuals harboring mitochondrial DNA (mtDNA) mutations in MT-ATP6 and in whom organic acidemias and multiple carboxylase deficiencies were excluded. Using retrospective chart review, we identified eleven individuals with abnormally elevated propionylcarnitine (C3) or hydroxyisovalerylcarnitine (C5OH) with mutations in MT-ATP6, most commonly m.8993T>G in high heteroplasmy or homoplasmy. Most patients were ascertained on newborn screening; most had normal enzymatic or molecular genetic testing to exclude biotinidase and holocarboxylase synthetase deficiencies. MT-ATP6 is associated with some cases of Leigh disease; clinical outcomes in our cohort ranged from death from neurodegenerative disease in early childhood to clinically and developmentally normal after several years of follow-up. These cases expand the biochemical phenotype associated with MT-ATP6 mutations, especially m.8993T>G, to include acylcarnitine abnormalities mimicking carboxylase deficiency states. Clinicians should be aware of this association and its implications for newborn screening, and consider mtDNA sequencing in patients exhibiting similar acylcarnitine abnormalities that are biotin-unresponsive and in whom other enzymatic deficiencies have been excluded.

Pediatric and Gynecologic Rates of Documentation of Last Menstrual Period in Female Adolescents.

STUDY OBJECTIVE: The American Academy of Pediatrics and American College of Obstetricians and Gynecologists have identified the menstrual cycle as essential in assessing overall health of adolescent girls. Menses should be considered a "vital sign" and documentation of last menstrual period (LMP) is recommended at every patient encounter. The aim of this study was to estimate and compare LMP documentation among adolescent and pediatric health care providers. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study identified a random sample of 50 female patients seen in the general pediatrics (PEDS), adolescent medicine (AM), and pediatric and adolescent gynecology (PAG) ambulatory clinics at Phoenix Children's Hospital between January 1, 2016 and March 31, 2016. INTERVENTIONS AND MAIN OUTCOME MEASURES: Rates of LMP documentation were compared between clinics using the Pearson χ2 test. Multivariable logistic regression analyses quantified the association of clinic and LMP documentation, with adjustments for visit reason, provider gender, and age at presentation. RESULTS: Rates of LMP documentation were 100% for adolescent gynecologists, but significantly lower for general pediatricians (14%) and AM (60%) providers (P < .0001). These findings were confirmed in multivariable analyses (PAG vs PEDS: odds ratio [OR], 280; 95% confidence interval [CI], 32-2331; PAG vs AM: OR, 34; 95% CI, 4.4-270; AM vs PEDS: OR, 3.8; 95% CI, 1.3-11.0). CONCLUSION: Adolescent gynecologists document LMP routinely. In contrast, LMP documentation rates in AM, and especially in PEDS, were significantly lower. Quality improvement methods such as incorporation of an LMP section into the vitals portion of an electronic medical record could help improve rates of compliance.

Three-Dimensional Technology to Diagnose Unilateral Cervical Atresia in Obstructive Hemivagina with Ipsilateral Renal Anomaly: A Case Report and Review of the Literature.

BACKGROUND: Congenital atresia of the cervix in the setting of an obstructed hemivagina with ipsilateral renal anomaly (OHVIRA) is an unusual occurrence that is frequently missed using preoperative imaging modalities. CASE: A 14-year-old female adolescent presented to a tertiary care facility with abdominal pain associated with a mass. Initial imaging with ultrasound and magnetic resonance suggested OHVIRA but 3-D magnetic resonance imaging (MRI) also correctly identified unilateral cervical atresia on the obstructed left side. SUMMARY AND CONCLUSION: Three-dimensional MRI in the setting of OHVIRA was used successfully in this case to preoperatively identify cervical atresia and to guide preoperative surgical counseling and planning. The use of 3-D MRI for this purpose has, to our knowledge, never been described in the literature. Three-dimensional printed models derived from 3-D MRI can play an evolving role in the management of Müllerian anomalies as preoperative planning and surgical counseling tools.

De novo variants in EBF3 are associated with hypotonia, developmental delay, intellectual disability, and autism.

Using whole-exome sequencing, we identified seven unrelated individuals with global developmental delay, hypotonia, dysmorphic facial features, and an increased frequency of short stature, ataxia, and autism with de novo heterozygous frameshift, nonsense, splice, and missense variants in the Early B-cell Transcription Factor Family Member 3 (EBF3) gene. EBF3 is a member of the collier/olfactory-1/early B-cell factor (COE) family of proteins, which are required for central nervous system (CNS) development. COE proteins are highly evolutionarily conserved and regulate neuronal specification, migration, axon guidance, and dendritogenesis during development and are essential for maintaining neuronal identity in adult neurons. Haploinsufficiency of EBF3 may affect brain development and function, resulting in developmental delay, intellectual disability, and behavioral differences observed in individuals with a deleterious variant in EBF3.

Increasing Colorectal Cancer Screening at an Urban FQHC Using iFOBT and Patient Navigation.

INTRODUCTION: Colorectal cancer is the second leading cause of cancer death in the United States. Black Americans suffer even higher incidence and death rates than the general population. Genetics and patient perceptions explain some of this difference, however, modifiable health care system factors such as lack of access to colon cancer screening also contribute. Partnering an academic health center with local community groups, we piloted a colorectal cancer screening program at a Federally Qualified Health Center (FQHC) serving predominately low socioeconomic status Black Americans. The program was designed to identify and remove barriers to screening and improve screening rates. METHOD: At a single center FQHC, we developed an outreach program centered around (1) patient and provider education, (2) immunochemical fecal occult blood test (iFOBT) distribution, and (3) patient navigation. We identified 402 eligible patients, of which 228 (56.7%) completed screening. RESULTS: Our 56.7% screening rate represented a twofold increase above prepilot levels at the clinic. Nine (4%) iFOBT returned positive. Three of these nine patients completed colonoscopy. Screening rates and follow through were higher under a single navigator model. CONCLUSIONS: Our academic-community partnership provided an effective, evidence based, and sustainable model for increasing colorectal cancer screening in a high risk, low resource community.

Observational study of compliance with Queensland bicycle helmet laws.

Mandatory bicycle helmet laws have been found to increase helmet wearing rates in Australia and internationally. However, much of the research on factors influencing compliance with the Australian helmet laws is dated or focuses on commuters and city areas only. To address this gap, video recordings of bicycle riders were undertaken at 17 sites across Queensland, Australia, representing a mixture of on- and off-road locations, speed limits and regions. Helmet status was able to be determined for 98% of riders observed. The level of compliance with the laws was very high, with 98.3% of the more than 27,000 riders observed wearing helmets. Riders riding on roads were less compliant than those riding on bicycle paths, but no significant differences were observed between the school-holiday and school-term periods. Among the on-road riders, boys were less compliant than girls and overall children were less compliant than adults. Higher compliance levels were found for group riders, road bike riders, lycra-clad riders, during morning hours, and on 50km/h or lower speed limit roads. While the overall level of compliance was very high, certain subgroups were identified as a possible focus for interventions to further improve the compliance level, for example children (particularly boys) riding mountain bikes away from groups during the afternoon hours on 60km/h roads.

The High Burden of Cancer Among American Indians/Alaska Natives in Wisconsin.

OBJECTIVE: American Indians/Alaska Natives (AI/AN) who live in the Northern Plains, includingt Wisconsin, face disproportionate cancer disparities. This report examines cancer incidence and mortality based on residence in Contract Health Service Delivery Areas (CHSDA) to assess disparities between AIs/ANs and other racial populations in Wisconsin. METHODS: To improve identification of the AI/AN race, incidence data were linked with Indian Health Service (IHS) patient records. Analysis further focused on residents of IHS CHSDA counties. Age-adjusted cancer incidence and mortality rates (2007-2011) were calculated by sex and major cancer sites. AI/AN rates were.analyzed for both statewide and CHSDA residency in comparison to statewide white rates and comparable national rates. RESULTS: In comparison with whites, AI/ANs in CHSDA counties had higher incidence rates of cervical (3.5 times), liver (3.2), lung (2.3), and kidney cancers (2.1), and higher mortality rates for liver (2.7), kidney (2.2) and lung (1.9) cancers. Although there were similar rates of prostate cancer incidence between the 2 populations, AI/ANs were 1.9 times more likely to die from the disease. CONCLUSIONS: AI/AN individuals in Wisconsin CHDSA counties experience the highest cancer incidence rate of any racial group for both genders combined and for females. This population also has the highest mortality rate among all racial groups for both males and females. To meet the Wisconsin Comprehensive Cancer Control Plan 2015-2020 and Healthy People 2020 goals of lowering cancer incidence and mortality rates, the disproportionate cancer burden among AIs.

Using community advisory boards to reduce environmental barriers to health in American Indian communities, Wisconsin, 2007-2012.

BACKGROUND: American Indian communities have a high prevalence of chronic diseases including diabetes, obesity, cardiovascular disease, and cancer. Innovative community-based approaches are needed to identify, prioritize, and create sustainable interventions to reduce environmental barriers to healthy lifestyles and ultimately improve health. COMMUNITY CONTEXT: Healthy Children, Strong Families was a family-based and community-based intervention to increase healthy lifestyles on Wisconsin American Indian reservations. This intervention arose from a long-standing partnership between University of Wisconsin researchers and 3 of these American Indian communities. METHODS: In each community, community advisory boards (CABs) were established by the residents and university partners. CAB meetings were open and held at various times and locations to increase member participation. CABs featured continual, snowball recruitment; internal and external expert consultation; and coordination with standing tribal committees. Meetings initially focused on understanding community supports for and barriers to healthy lifestyles but quickly turned toward community action for change. OUTCOME: CAB interventions decreased environmental barriers to health at each site and improved options for healthy lifestyle choices. Over 5 years, 71 CAB meetings occurred with a total of 1,070 participants. Successful CAB interventions included planting community gardens and an apple orchard, conducting gardening and canning workshops, instituting food-related policies and dog control regulations, building an environmentally friendly playground, and providing access to recreational facilities. The CABs are now self-sustaining. INTERPRETATION: CABs can be highly effective action teams capable of improving community environments. Our experience shows that academic researchers can partner with community residents to generate programs and policies that will expand access to local food, increase people's choices for engaging in physical activity, and encourage local policy changes that improve overall community health.

OHVIRA with a twist: obstructed hemivagina ipsilateral renal anomaly with urogenital sinus in 2 patients.

BACKGROUND: OHVIRA syndrome is a rare diagnosis involving the triad of obstructed hemivagina, uterine anomaly, and ipsilateral renal anomaly. OHVIRA syndrome can be associated with other anomalies due to abnormal embryologic development of the urogenital system. CASES: A 14-year-old female with known left renal agenesis, long-standing urinary incontinence, and history of recurrent urinary tract infections presented with abdominal distention. A 4-year-old female with known right renal agenesis and urinary incontinence was found to have a single common channel at the introitus that communicated with the bladder and a hemivagina on the left. SUMMARY AND CONCLUSION: It is important to identify the presence of a urogenital sinus in the OHVIRA setting, as surgical management for these patients may be affected. In both cases, the urogenital sinus was preserved as the vaginal opening.

Place of residence and primary treatment of prostate cancer: examining trends in rural and nonrural areas in Wisconsin.

OBJECTIVE: To determine whether rural residents were at a disadvantage compared with urban residents with regard to the receipt of curative therapy for prostate cancer. MATERIALS AND METHODS: Using the Breast and Prostate Cancer Data Quality and Patterns of Care Study II, patients with prostate cancer who were diagnosed in 2004 were identified. Registrars reviewed the medical records of randomly selected patients with incident prostate cancer (n = 1906). The patients' residential address was geocoded and linked to the census tract from the 2000 U.S. Census. The place of residence was defined as rural or nonrural according to the census tract and rural-urban commuting area categorization. The distance from the residence to the nearest radiation oncology facility was calculated. The odds ratio and 95% confidence intervals associated with receipt of noncurative treatment was calculated from logistic regression models and adjusted for several potential confounders. RESULTS: Of the incident patients, 39.1% lived in urban census tracts, 41.5% lived in mixed tracts, and 19.4% lived in rural tracts. Hormone-only or active surveillance was received by 15.4% of the patients. Relative to the urban patients, the odds ratio for noncurative treatment was 1.01 (95% confidence interval 0.59-1.74) for those living in mixed tracts and 0.96 (95% confidence interval 0.52-1.77) for those living in rural tracts. No association was found for noncurative treatment according to the Rural-Urban Commuting Area categorization. The linear trend was null between noncurative treatment and the distance to nearest radiation oncology facility (P = .92). CONCLUSION: The choice of curative treatment did not significantly depend on the patient's place of residence, suggesting a lack of geographic disparity for the primary treatment of prostate cancer.

The implications of cross-regional differences for the design of In-vehicle Information Systems: a comparison of Australian and Chinese drivers.

The increasing global distribution of automobiles necessitates that the design of In-vehicle Information Systems (IVIS) is appropriate for the regions to which they are being exported. Differences between regions such as culture, environment and traffic context can influence the needs, usability and acceptance of IVIS. This paper describes two studies aimed at identifying regional differences in IVIS design needs and preferences across drivers from Australia and China to determine the impact of any differences on IVIS design. Using a questionnaire and interaction clinics, the influence of cultural values and driving patterns on drivers' preferences for, and comprehension of, surface- and interaction-level aspects of IVIS interfaces was explored. Similarities and differences were found between the two regional groups in terms of preferences for IVIS input control types and labels and in the comprehension of IVIS functions. Specifically, Chinese drivers preferred symbols and Chinese characters over English words and were less successful (compared to Australians) at comprehending English abbreviations, particularly for complex IVIS functions. Implications in terms of the current trend to introduce Western-styled interfaces into other regions with little or no adaptation are discussed.

An observational study of the secondary effects of a local smoke-free ordinance.

INTRODUCTION: The secondary, sometimes unintended effects of smoke-free ordinances have not been thoroughly evaluated. In this observational study, we evaluated the association of a local ordinance implemented in Madison, Wisconsin, with changes in public disturbances; smoking, drinking, and bar-going behaviors in the general population; and smoking and drinking behaviors among university students. METHODS: We obtained data from 4 sources: police records, key informant interviews, a community survey, and an undergraduate survey. Except for interviews, which we conducted postenactment only, we compared measures before and after the ordinance was put into effect. RESULTS: We found no evidence of association of the ordinance with public disturbances. We found that the ordinance was not associated with changes in smoking rates, drinking rates, or bar-going in the general population, although bar-going decreased among the 16% of the general adult population who smokes (from 84% in 2005 to 70% in 2007, P < .001). Student smoking rates also decreased (from 23% in 2005 to 16% in 2007, P < .001), but student binge drinking did not change. CONCLUSION: The study adds unique information to the evidence base on the effect of smoke-free policies, finding little evidence of their secondary, unintended effects. With the addition of these results to existing evidence, we conclude that the potential health benefits of smoke-free ordinances outweigh the potential harms from unintended effects.