Modeling Longitudinal Ordinal Response Variables for Educational Data

This article presents applications for the analysis of multilevel ordinal response data through the proportional odds model. Data are drawn from the public-use Early Childhood Longitudinal Study. Results showed that gender, number of family risk characteristics, and age at kindergarten entry were associated with initial reading proficiency (0 to 5 scale). The number of family risks and age were associated with time-slopes. Three issues are highlighted: building multilevel ordinal models, interpretation of multilevel effects; and determination of predicted probabilities based on results of the multilevel proportional odds models

Pharmacist Contributions to the U.S. Health Care System

Objective: The overall goal for this study was to conduct a segment analysis of the pharmacist workforce during 2009 based upon time spent in medication providing and in patient care services. Methods: Data for this study were obtained from the 2009 National Pharmacist Workforce Survey in which a random sample of 3,000 pharmacists was selected. Cluster analysis was used for identifying pharmacist segments and descriptive statistics were used for describing and comparing segments.Results: Of the 2,667 surveys that were presumed to be delivered to a pharmacist, 1,395 were returned yielding a 52.3% overall response rate. Of these, 1,200 responses were usable for cluster analysis. Findings from this study revealed five segments ofpharmacists: (1) Medication Providers, (2) Medication Providers who also Provide Patient Care, (3) Other Activity Pharmacists, (4) Patient Care Providers Who also Provide Medication, and (5) Patient Care Providers. The results showed that, in 2009, 41% of U.S. pharmacists were devoted wholly to medication providing (Medication Providers). Forty-three percent of pharmacists contributed significantly to patient care service provision (Medication Providers who also Provide Patient Care, Patient Care Providers who also Provide Medication, and Patient Care Providers) and the remaining 16% (Other Activity Pharmacists) contributed most of their time to business / organization management, research, education, and other health-system improvement activities. Conclusions: Based on the findings, we propose that the pharmacy profession currently has, and will continue to build, capacity for contributing to the U.S. health care system in new roles for which they have been identified. However, as shifts in professional roles occur, a great deal of capacity is required related to new service provision. Resources are scarce, so an understanding of the most appropriate timing for making such changes can lead to cost-effective use of limited resources for improving patient care

Characterization of Actions Taken During the Delivery of Medication Therapy Management: A Time-and-Motion Approach

OBJECTIVES: To characterize actions performed by pharmacists and support staff during provision of medication therapy management (MTM) and to compare actions performed according to practice characteristics. METHODS: A purposeful sample of 7 MTM practices (2 call centers and 5 community practices) was identified and visited by investigators. Pharmacists and support staff were observed during their routine provision of MTM. Investigators characterized "major" (e.g., preparation for a comprehensive medication review) and "minor" (i.e., specific steps in overarching major action) actions with the use of a time-and-motion approach. RESULTS: A total of 32 major and 469 minor actions were observed. Practices were characterized as Later Maturity Level or Early Maturity Level on the basis of their self-reported MTM appointment volume, self-assessment of the extent of integration of chronic care model principles, and payer mix. Later Maturity Level practices were more likely to deliver follow-up medication therapy reviews and comprehensive medication reviews (CMRs) as opposed to targeted medication reviews (TMRs) and to receive physician referrals for MTM. Later Maturity Level practices were also more likely to use paid interns than pharmacy rotation students. CMR activities observed at Later Maturity Level practices lasted a median of 30.8 minutes versus 20.3 minutes for CMR activities at Early Maturity Level practices. Similarly, TMR activities observed at Later Maturity Level practices were longer: a median of 31.0 minutes versus 12.3 minutes. At Later Maturity Level practices, pharmacists spent a greater proportion of time providing patient education, while support staff spent a greater proportion of time on tasks such as capturing demographics and introducing or explaining MTM. CONCLUSION: MTM activities were longer at Later Maturity Level practices, and these practices were more likely to use paid pharmacy interns and to receive physician referrals for MTM. This work provides a foundation for future research

Alien Registration- Doucette, Daniel A. (Portland, Cumberland County)

https://digitalmaine.com/alien_docs/24039/thumbnail.jp

Cloning of Bovine Placental Lactogen and Production in Vitro

Bovine placental lactogen (bPL) is a hormone produced by the fetal portion of the placenta during gestation. Although there is little known about the structure and function of the protein, it is thought to play a role in the growth of the fetus and in mammary growth and differentiation. Attempts have been made to heighten the understanding of bPL through the use of recombinant DNA technology. Thus far, researchers have been able to produce the recombinant molecule in bacteria cells. Bacteria, however, are incapable of carrying out some of the post-translational modifications characteristic of mammalian proteins. For example, unlike native bPL, recombinant bPL is non-glycosylated. Other examples of post-translational modifications include disulfide bond formation and correct folding of the proetin. The aim of this study, therefore, was to clone the bPL cDNA into a mammalian expression vector, amplify the recombinant molecule in E. coli cells, and transfect the rbPL into mouse fibroblast cells. The idea behind this research was that the mouse cells would be able to produce the bPL complete with the post-tanslational modifications seen in the native protein. Attempts were made to transfect the pcDNA3.1-bPL into mouse L929 cells. Media was collected post-transfection and awwayed (Wallace, 1993) for the presence of pBL. An average concentration of 1 ng/mL bPL was measured. It was also noted that the transfected cells, as compared to control non-transfected cells, grew at a slower rate. Initially, it was suspected that the L929 cells were infected with mycoplasma. Transfection of a new batch of mouse cells showed improved growth rate, but did not produce a higher transfection efficiency. Studies with ovine placental lactogen have shown that the 5\u27 flanking sequence of the PL gene is important in the production of the protein. In this study, the 5\u27 flanking region of the bPL gene was removed during the making of the recombinant bPL molecule. It is therefore hypothesized that the 5\u27 flanking sequence of the bPL gene is important to the production of the protein due to the low transfection efficiency observed

Alien Registration- Doucette, Fred A. (Van Buren, Aroostook County)

https://digitalmaine.com/alien_docs/33440/thumbnail.jp

Attributions of school children and their relationship to depression

Hypothesized relationships between students\u27 attributions for academic and social success and failure on two newly developed attribution scales were examined and compared to students\u27 general attributions for success and failure on an established attribution scale, the Children\u27s Attribution Style Questionnaire (CASQ). The newly developed scales were used to assess students\u27 academic attributions (Student Academic Attribution Scale, SAAS) and social attributions (Student Social Attribution Scale, SSAS)The SAAS and SSAS were developed to allow students to rate success and failure due to internal causes, ability and effort, or external causes, chance and task difficulty, for typical school situations; also, optimism and pessimism global scales were calculatedBoth the SAAS and the SSAS and the CASQ were used to predict depression in 70 4th through 6th grade students using the Depression subscale of the Behavior Assessment System for Children (BASC). Results support anticipated relationships between the SAAS and SSAS subscales and global scales of the CASQ subscales and global scales. For example, math success ability is positively correlated with all but one of the positive subscales of the CASQ (P \u3c.05) as well as the overall attributional style of the CASQ (P\u3c.01). When global scales from the SAAS, SSAS and the CASQ were evaluated for predictive capability, only the global scale from the SAAS and SSAS combined (Failure Internal, consisting of Failure Ability and Effort from both the SAAS and the SSAS) demonstrated the ability to predict the BASC Depression Scale to a significant degree (P \u3c.05). Similarly, when global optimism and pessimism scales from the three instruments were compared for predictive utility, both Pessimism Failure Social (SSAS) and Pessimism Failure Academic (SAAS) predicted depression scores to a significant degree (P \u3c.05), the Optimism-Pessimism global scales from the CASQ did not predict depression to a significant degree in this study. The fact that the SAAS and SSAS subscales correlated significantly with the well- established, but more clinically oriented CASQ demonstrates the utility of the SAAS and the SSAS to assess attribution style with a general population from a school setting. The ability of the SAAS and SSAS global scores to predict significantly depressive symptoms in school children indicate a link between attributions and depression