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Objective: The purpose of this project was to develop evidence‐based clinical practice guidelines (CPGs) for the management of oral health (OH) for patients with Parkinson’s disease (PD). Background: Individuals with PD have significantly poorer OH than the general population. Poor OH is a risk factor for systemic diseases, including cardiovascular disease, diabetes, and respiratory infections. Materials and Methods: After an extensive literature review was completed, available evidence was evaluated for inclusion in the initial draft of the guidelines. The draft was then reviewed for content validity by experts in the areas of dentistry, dental hygiene and neurology using the Delphi method. After consensus among the content experts, final guidelines were completed. The final CPG was presented to individuals with PD and their caregivers at a support group. Participants were asked to review the information in the guidelines for 2 weeks and then submit a survey regarding the usefulness of the CPG. The CPG was also evaluated by practicing nurse practitioners (NPs) and dental hygienists using the AGREE II tool. Results: Twenty people from the PD support group participated in the educational intervention, and surveys were received from 14 participants. Overall, participants agreed or strongly agreed with each statement related to the applicability and usefulness of the guidelines. The CPG was evaluated using the AGREE II tool, and scores were >80% in all domains with an overall score of 97.1%. Conclusion: Development of these guidelines represent an initial step in improving the oral health and overall health of individuals with PD.

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In 2015, participating US Emergency Departments (EDs) reported approximately 2.8 million visits related to skin and soft tissue infections (SSTIs). Studies indicate that there may be disparities by patient sex in physician treatment guideline adherence rates as a result of a gender bias during physician-patient interactions; however, only two epidemiologic studies have investigated the role of patient sex in guideline adherence rates for SSTIs. These prior studies were limited in size and covariate assessment. Thus, the magnitude and direction of the effect of patient sex is uncertain, warranting further research. Therefore, we conducted a large prospective study to elucidate the role that patient sex plays in guideline adherence rates among physicians for non-purulent cellulitis at two UMass Memorial Health Care Group EDs in 2017. Data on treatment and sex was abstracted from electronic medical records. Compliance with treatment guidelines was based on 2014 Infectious Disease Society of America (IDSA) guidelines. Adjusted multinomial regressions indicated that female patient sex was associated with lower prevalence of overtreatment (POR=0.72, 95%CI: 0.57-0.92). In contrast, female physician sex was significantly associated with higher prevalence of overtreatment (POR=1.48, 95%CI: 1.16-1.87), but did not affect the relationship of patient sex with overtreatment (P-interaction=0.80). Awareness of differential treatment by patient sex may improve physician adherence to guidelines. This study contributes to a growing body of literature elucidating the role of sex in medical decision making and is the first to account for both patient and physician sex as well as relevant covariates in studies regarding cellulitis treatment.

The Web Content Accessibility Guidelines (WCAG) are an important resource for making the web more accessible for people with disabil- ities. They are used as a source of information for web content cre- ators, but also in standards as a basis for legislation when measuring whether a website is accessible or not. The guidelines have been criti- cized for poor coverage when studying real-life accessibility, especially for people with cognitive impairments. A newly released version of the guidelines, WCAG 2.1 aims to improve accessibility but has not been studied yet. This study evaluates the coverage of WCAG guidelines by con- ducting a user study and comparing the results with WCAG evalu- ation to find out if the problems found by users would be fixed by conforming to the guidelines. 3 websites were evaluated with a total of 6 users from 3 different disability groups. Same sites were evaluated with WCAG 2.0 and 2.1. The results show none of the site passed the WCAG evaluation. The users found 40 issues, of which 32,5% would be fixed if conform- ing to WCAG criteria. Most of the issues not covered by WCAG were related to understandability and readability of the content and the user interface. The blind group found the biggest number of issues, but al- most half of the issues would be fixed by WCAG, compared to only 13% for people with cognitive impairments. Despite the fact that all critical issues were covered by WCAG, the amount of serious issues not covered reveals that WCAG as a sole measure for accessibility is not enough to guarantee equal access to the web. / Riktlinjerna för tillgängligt webbinnehåll (WCAG) är en viktig resurs för att göra webbsidor mer tillgängliga för personer med funktionsnedsättningar. Riktlinjerna används som informationskälla av webbinnehållsskapare, men också i standarder som grund för lagstiftning när man mäter om en webbplats är tillgänglig. Riktlinjerna har kritiserats för att dom inte är tillräckligt omfattande när man studerar tillgänglighet med användare, särskilt med personer med kognitiva funktionsnedsättningar. En nyligen släppt version av riktlinjerna, WCAG 2.1, syftar till att förbättra tillgängligheten men har ännu inte studerats. Syftet med detta forskningsprojekt är att utvärdera om riktlinjerna ger en tillräcklig nivå av tillgänglighet for en webbplats genom att utföra en användarstudie och jämföra resultaten med WCAG riktlinjerna för att ta reda på om problemen som användarna upptäckte skulle lösas genom att följa riktlinjerna. 3 webbplatser testades med totalt 6canvändare från 3 olika funktionshindergrupper. Webbplatser granskades också med WCAG 2.0 och 2.1. Resultaten visar att ingen av webbplatserna uppfyllde alla kriterier i WCAG. Användarna hittade 40 problem, varav 32,5% skulle undvikas om webbplatserna uppfyllde WCAG-kriterierna. De flesta av de problem som inte omfattas av WCAG gällde förståelse och läsbarhet av innehållet och olika element på sidan. Blinda gruppen fann det största antalet problem, men nästan hälften av problemen skulle undvikas genom att följa WCAG, jämfört med endast 13% för personer med kognitiva funktionsnedsättningar. Alla kritiska problem omfattades av WCAG, men största delen av allvarliga problem stod kvar, som visar att WCAG räcker inte som den enda sätt at mäta tillgänglighet.

Reticulitermids were significantly more likely to discover subterranean baits connected by physical guidelines than freestanding baits under both laboratory and field conditions. In the laboratory, subterranean termites built significantly longer tunnels adjacent to cellulosic guidelines than plastic guidelines. In the field, all guideline materials were equally effective at directing tunneling activity. Reticulitermes spp. workers were tested to determine their preferred substrate temperature. The preferred range for Reticulitermes spp. workers was found to be 18 to 27 degrees C. A laboratory bioassay was performed to determine if Reticulitermes spp. aggregates within thermal shadows. Significantly more Reticulitermes spp. workers aggregated within cool thermal shadows than control areas. In a multiple choice bioassay, mean consumption was higher for paper baits treated with fructose, galactose, glucose, raffinose, sucrose, trehalose and uric acid than for control baits. In a multiple choice bioassay, mean consumption was significantly lower for baits treated with arbutin, and most amino acids than for control baits. In the no-choice bioassay, the amount of paper bait consumed did not differ significantly for any of the treated baits tested and control baits. / Ph. D.

To date, minimal research has been conducted on proper use of personal protective equipment and hand hygiene within endoscopy. The American Society for Gastrointestinal Endoscopy has developed guidelines for infection control within the endoscopy suite. A practice change based upon these guidelines was implemented. Education was provided to endoscopy procedural staff within a Midwestern hospital based upon the World Health Organization 5 Moments for Hand Hygiene initiative and included personal protective equipment. Knowledge, skills, and attitudes of the participant group were compared from paired pre- to posteducation surveys pertaining to hand hygiene and personal protective equipment. Observation of personal protective equipment use and hand hygiene implementation during procedures was also documented pre- to posteducation. The project results revealed both willingness to implement proper donning and doffing of personal protective equipment and improved technique as evidenced by improved observed technique with the endoscopy suite and moderately improved hand hygiene questionnaire results. Although conducted as a quality improvement project, clinical significance was found via observation following education. These practices can aid in reduction of organism transmission from patients to staff [...]

Background: HIV drug resistance limits the effectiveness of antiretroviral therapy. Adequate surveillance of HIV drug resistance prevalence is challenged by heterogenous and inadequate data reporting. In this study, we sought to identify a list of reporting items for studies of HIV drug resistance prevalence and an understanding of why these items are important to report. Methods: We used a mixed-methods sequential explanatory design involving authors and users of studies of HIV drug resistance prevalence. In the quantitative phase we conducted a cross-sectional electronic survey (n=51). Survey participants rated various reporting items on whether they are essential to report, producing validity ratios which were used to produce a draft reporting item checklist. In the qualitative phase, two focus group discussions (n=9 in total) discussed this draft item checklist and which of the items should be reported and why. We also conducted a thematic analysis of the group discussions to identify emergent themes regarding items to be considered for the reporting guideline. Results: We identified 38 potential reporting items including participant characteristics, sampling methods, and resistance testing methods. The strongest themes that emerged from the discussions were agreement over the importance of reporting certain items, concerns over the availability and ethics of reporting certain participant data, the importance of interpretability and comparability, and the necessity for reporting guidelines to appreciate context-specific prevalence research. Conclusions: We have identified a list of reporting items for studies of the prevalence of HIV drug resistance along with an explanation of why researchers believe these items are important. The next steps involve further elaborating upon these findings in the reporting guidelines. / Thesis / Master of Science (MSc) / Drug resistant HIV is very challenging to treat and is an important global health problem. It is difficult to know how common HIV drug resistance is around the world because the studies on HIV drug resistance are not reported similarly. This is because there are no standard guidelines for these studies. In this study, we asked HIV drug resistance researchers to complete a survey on what they thought should be reported is studies measuring HIV drug resistance. Then, we had group conversations where we asked them to explain why they believed the items were important. We identified 38 potential reporting items, most of which would require authors of HIV drug resistance studies to clarify the settings, participants and methods used in their research. These items will make up a reporting checklist for authors of HIV drug resistance studies and make research in this area more comparable

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