Publications by authors named "Kathleen Shea"

14 Publications

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Preparing for the COVID-19 Pandemic and Its Impact on a Nursing Simulation Curriculum.

J Nurs Educ 2021 Jan;60(1):52-55

Background: This article describes one school's process to maintain their undergraduate nursing simulation program during campus closure and clinical placement suspension due to the COVID-19 pandemic.

Method: After the campus closure, faculty replaced clinical hours with simulation using virtual clinical education such as telehealth with standardized patients (SPs), virtual simulations using commercial products, and virtual faculty skills instruction.

Results: Using virtual clinical education and SP-based telehealth simulations provided an alternative for 50% of the required direct patient care hours. Virtual simulation accounted for 18,403 clinical hours completed by 244 students.

Conclusion: Preparation for emergencies that force campus and clinical site closures should include processes to provide virtual simulation and remote simulations with SPs to replace clinical hours. Planning for the impacts of COVID-19 on the operation of this school of nursing highlights the importance of having a detailed plan to address campus closure due to emergencies. [J Nurs Educ. 2021;60(1):52-55.].
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http://dx.doi.org/10.3928/01484834-20201217-12DOI Listing
January 2021

Bridging the Gap: A Pilot Program to Understand and Meet the Needs of Pediatric Patients and Families as They Transition Off Cancer-Directed Therapy.

J Pediatr Oncol Nurs 2019 Mar/Apr;36(2):86-92. Epub 2018 Dec 25.

Columbia University Medical Center, New York, NY, USA.

With improved curative therapies, over 80% of children and adolescent/young adults diagnosed with cancer are expected to live into adulthood. This population is at risk for increased morbidity and early mortality and requires ongoing health care and surveillance for late effects of treatment. This pilot study assessed the acceptability of a structured medical visit at the completion of cancer-directed therapy as well as patient/family's knowledge of diagnosis and other aspects of care. Patients/families who were 0 to 6 months from completion of cancer-directed therapy attended a one-time transition visit during which they completed a series of questionnaires assessing knowledge about diagnosis, treatment, potential late effects, and duration of ongoing care. They were then given treatment summaries, a plan for follow-up care, information about care after treatment as well as late effects. They completed a questionnaire to assess their satisfaction with this visit. The majority of patients/families knew their diagnosis and treatment modalities. Less knew that their treatment put them at risk for cardiac toxicity or problems with future fertility. A significant number thought follow-up care would continue for only 5 years. Overall participants were satisfied with the visit. The transition period from on to off therapy may be a critical time point to provide patients with cancer and their families with information regarding treatment, follow-up care and testing, and potential late effects. Future studies should assess if this intervention improves compliance with recommended care and surveillance, and improved outcomes.
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http://dx.doi.org/10.1177/1043454218819452DOI Listing
July 2020

Influence of Community-Level Cultural Beliefs about Autism on Families' and Professionals' Care for Children.

Transcult Psychiatry 2018 10 4;55(5):623-647. Epub 2018 Jul 4.

University of Pennsylvania.

This qualitative study aimed to understand how community-level cultural beliefs affect families' and professionals' care for children with autism and developmental delays in immigrant communities, as a first step towards promoting early identification and access to early intervention services. The study was part of the larger New York City (NYC) Korean Community Autism Project, which was designed to identify strategies to increase awareness of autism and reduce delays in treatment seeking within the NYC Korean-American community. Our study elicited early childcare workers' and church leaders' beliefs about autism and developmental disorders and, in particular, early intervention. We also elicited responses to newly developed outreach materials targeting this community. An inductive approach was used to identify concepts and categories associated with autism. Our study confirmed that discomfort, stigma and discrimination are the prevailing community attitudes toward autism and developmental disorders in the Korean-American community. Families' and professionals' understanding of autism and their care for children are affected by these community beliefs. Approaching immigrant communities with general information about child development and education rather than directly talking about autism and developmental disorders is likely to engage more families and professionals in need for diagnostic evaluation and early intervention for autism.
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http://dx.doi.org/10.1177/1363461518779831DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008392PMC
October 2018

The Accuracy of the ADOS-2 in Identifying Autism among Adults with Complex Psychiatric Conditions.

J Autism Dev Disord 2017 Sep;47(9):2703-2709

Center for Autism Research, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.

The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), Module 4 is considered a "gold-standard" instrument for diagnosing autism spectrum disorder (ASD) in adults. Although the ADOS-2 shows good sensitivity and specificity in lab-based settings, it is unknown whether these results hold in community clinics that serve a more psychiatrically impaired population. This study is the first to evaluate the diagnostic accuracy of the ADOS-2 among adults in community mental health centers (n = 75). The ADOS-2 accurately identified all adults with ASD; however, it also had a high rate of false positives among adults with psychosis (30%). Findings serve as a reminder that social communication difficulties measured by the ADOS-2 are not specific to ASD, particularly in clinically complex settings.
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http://dx.doi.org/10.1007/s10803-017-3188-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5813679PMC
September 2017

Effects of Autism Spectrum Disorder Insurance Mandates on the Treated Prevalence of Autism Spectrum Disorder.

JAMA Pediatr 2016 09;170(9):887-93

Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia5Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia.

Importance: Most states have passed insurance mandates requiring commercial health plans to cover services for children with autism spectrum disorder (ASD). Insurers have expressed concerns that these mandates will increase the number of children diagnosed with ASD (treated prevalence) and therefore increase costs associated with their care. To our knowledge, no published studies have addressed this question.

Objective: To examine whether implementing ASD insurance mandates increases the number of commercially insured children diagnosed with ASD.

Design, Setting, And Participants: A difference-in-differences study was performed using inpatient and outpatient health insurance claims for children 21 years or younger covered by 3 of the largest insurers in the United States-United HealthCare, Aetna, and Humana-from January 1, 2008, through December 31, 2012, made available through the Health Care Cost Institute. Data analysis was conducted from March 15 to August 11, 2015.

Exposures: Implementation of an ASD insurance mandate in a child's state of residence.

Main Outcomes And Measures: The treated prevalence of ASD, measured as a binary indicator of whether a given child in a given calendar month had at least 1 health care service claim associated with a diagnosis of ASD.

Results: The adjusted treated prevalence among 1 046 850 eligible children (575 299 male [55.0%]) in states with ASD insurance mandates was 1.8 per 1000 and 1.6 per 1000 among children in states without such a mandate (P = .006). The mean increase in treated prevalence attributable to the mandates was 0.21 per 1000 children during the study period (95% CI, 0.11-0.30; P < .001). Mandates in place longer had a larger effect on treated prevalence. The mean increase in treated prevalence of ASD attributable to the mandate was 0.17 per 1000 children (95% CI, 0.09-0.24; P < .001) in the first year following implementation, 0.27 per 1000 children (95% CI, 0.13-0.42; P < .001) in the second year, and 0.29 per 1000 children (95% CI, 0.15-0.42; P < .001) 3 years or more following implementation.

Conclusions And Relevance: Implementing state ASD insurance mandates resulted in increases in the number of children diagnosed with ASD; these numbers increased each year after implementation. Even 3 years or more after implementation, however, treated prevalence of ASD was much lower than community prevalence estimates. This finding may allay concerns that mandates will substantially increase insurance costs, but it suggests that many commercially insured children with ASD remain undiagnosed or are being treated only through publicly funded systems.
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http://dx.doi.org/10.1001/jamapediatrics.2016.1049DOI Listing
September 2016

Assessing early implementation of state autism insurance mandates.

Autism 2016 10 27;20(7):796-807. Epub 2015 Nov 27.

University of Pennsylvania, USA.

In the United States, health insurance coverage for autism spectrum disorder treatments has been historically limited. In response, as of 2015, 40 states and Washington, DC, have passed state autism insurance mandates requiring many health plans in the private insurance market to cover autism diagnostic and treatment services. This study examined five states' experiences implementing autism insurance mandates. Semi-structured, key-informant interviews were conducted with 17 participants representing consumer advocacy organizations, provider organizations, and health insurance companies. Overall, participants thought that the mandates substantially affected the delivery of autism services. While access to autism treatment services has increased as a result of implementation of state mandates, states have struggled to keep up with the demand for services. Participants provided specific information about barriers and facilitators to meeting this demand. Understanding of key informants' perceptions about states' experiences implementing autism insurance mandates is useful for other states considering adopting or expanding mandates or other policies to expand access to autism treatment services.
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http://dx.doi.org/10.1177/1362361315605972DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884164PMC
October 2016

Vaginal Examination Simulation Using Citrus Fruit to Simulate Cervical Dilation and Effacement.

Cureus 2015 Sep 1;7(9):e314. Epub 2015 Sep 1.

School of Nursing, San Francisco State University.

This technical report describes the creation and use of a cervical dilation and effacement model in a pre-licensure nursing course in reproductive health. Vaginal examination is typically taught in reproductive health courses; however, nursing students do not always have sufficient opportunity to practice on actual patients. This low-cost task-training model provides undergraduate nursing students the opportunity to experience performing a vaginal examination to assess for cervical dilation and effacement during the labor process.
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http://dx.doi.org/10.7759/cureus.314DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592286PMC
September 2015

Development of an alternative to mechanical shaft encoders for a “smart” wheelchair.

Biomed Sci Instrum 2012 ;48:401-6

University of Wyoming.

One device that is receiving a considerable amount of attention in the biomedical community is the “smart” wheelchair. “Smart” wheelchairs provide those who are unable to control the traditional joystick of a powered wheelchair with an alternative option. With minimal user input, these wheelchairs are able to autonomously navigate around a person’s environment, providing them with a higher level of mobility. The limited competition and extreme complexity of these wheelchairs propels their price outside of the affordable range for the average household. An alternative, cheaper system that could be attached to a typical powered wheelchair would be beneficial to the community.
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February 2016

Mapping and navigational control for a “smart” wheelchair.

Biomed Sci Instrum 2012 ;48:380-5

University of Wyoming.

A “smart” wheelchair is in development to provide mobility to those unable to control a traditional wheelchair. A “smart” wheelchair is an autonomous machine with the ability to navigate a mapped environment while avoiding obstacles. The flexibility and complex design of “smart” wheelchairs have made those currently available expensive. Ongoing research at the University of Wyoming has been aimed at designing a cheaper, alternative control system that could be interfaced with a typical powered wheelchair. The goal of this project is to determine methods for mapping and navigational control for the wheelchair. The control system acquires data from eighteen sensors and uses the data to navigate around a pre-programmed map which is stored on a micro SD card. The control system also provides a user interface in the form of a touchscreen LCD. The designed system will be an easy-to-use and cost effective alternative to current “smart” wheelchair technology.
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February 2016

Incidence of thrombotic thrombocytopenic purpura/hemolytic uremic syndrome.

Epidemiology 2004 Mar;15(2):208-15

Ingenix, Newton, Massachusetts 02466, USA.

Background: Thrombotic thrombocytopenic purpura and hemolytic uremic syndrome are rare disorders characterized by platelet aggregation, microthrombi, and resulting tissue damage. We studied the incidence and possible risk factors for these diseases in 3 large populations in the United States, United Kingdom, and Canada.

Methods: Data were derived from a large health insurer in the United States, general practices in the United Kingdom, and the Province of Saskatchewan. We identified potential cases of thrombotic thrombocytopenia purpura and hemolytic uremic syndrome in computerized data and verified them by medical record review. We estimated incidence rates for thrombotic thrombocytopenia purpura and hemolytic uremic syndrome together and separately, and we conducted a case-control study to evaluate potential risk factors.

Results: The age-sex standardized incidence of thrombotic thrombocytopenia purpura and hemolytic uremic syndrome was higher than previously reported (6.5, 2.2, and 3.2 per million per year in the United States, United Kingdom, and Saskatchewan, respectively), but there was no secular trend. The incidence of thrombotic thrombocytopenia purpura and hemolytic uremic syndrome was higher in women than men. Most cases of hemolytic uremic syndrome occurred before 20 years of age. We confirmed several known risk factors for thrombotic thrombocytopenia purpura and hemolytic uremic syndrome (cancer, bone marrow transplantation, pregnancy).

Conclusion: The incidence of thrombotic thrombocytopenia purpura and hemolytic uremic syndrome is higher than previously reported but does not appear to be rising. Apparent international differences in incidence could be the result of imprecision in identifying thrombotic thrombocytopenia purpura and hemolytic uremic syndrome in large research databases.
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http://dx.doi.org/10.1097/01.ede.0000113273.14807.53DOI Listing
March 2004

Monomeric yeast PCNA mutants are defective in interacting with and stimulating the ATPase activity of RFC.

Biochemistry 2002 Oct;41(43):12975-85

Molecular Biology and Biochemistry Department, Wesleyan University, Middletown, Connecticut 06459-0175, USA.

Yeast PCNA is a homo-trimeric, ring-shaped DNA polymerase accessory protein that can encircle duplex DNA. The integrity of this multimeric sliding DNA clamp is maintained through the protein-protein interactions at the interfaces of adjacent subunits. To investigate the importance of trimer stability for PCNA function, we introduced single amino acid substitutions at residues (A112T, S135F) that map to opposite ends of the monomeric protein. Recombinant wild-type and mutant PCNAs were purified from E. coli, and they were tested for their properties in vitro. Unlike the stable wild-type PCNA trimers, the mutant PCNA proteins behaved as monomers when diluted to low nanomolar concentrations. In contrast to what has been reported for a monomeric form of the beta clamp in E. coli, the monomeric PCNAs were compromised in their ability to interact with their associated clamp loader, replication factor C (RFC). Similarly, monomeric PCNAs were not effective in stimulating the ATPase activity of RFC. The mutant PCNAs were able to form mixed trimers with wild-type subunits, although these mixed trimers were unstable when loaded onto DNA. They were able to function as weak DNA polymerase delta processivity factors in vitro, and when the monomeric PCNA-41 (A112T, S135F double mutant) allele was introduced as the sole source of PCNA in vivo, the cells were viable and healthy. These pol30-41 mutants were, however, sensitive to UV irradiation and to the DNA damaging agent methylmethane sulfonate, implying that DNA repair pathways have a distinct requirement for stable DNA clamps.
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http://dx.doi.org/10.1021/bi026029sDOI Listing
October 2002

Genetic variation and population structure in central and isolated populations of balsam fir, Abies balsamea (Pinaceae).

Am J Bot 2002 May;89(5):783-91

Department of Biology, St. Olaf College, Northfield, Minnesota 55057 USA;

Genetic variation and spatial genetic structure in balsam fir (Abies balsamea) were examined in two isolated populations in Iowa and Minnesota thought to be paleorefugia and in two ecologically central populations in old-growth forests of Upper Michigan. Overall levels of genetic variability at 22 allozyme loci were lower than that found in most conifer species (H(o) values ranged from 0.005 in the isolated populations to 0.025 in the central populations). The mean F(IS) value (0.154) was larger than usually found in conifers and suggests moderate levels of inbreeding. The mean F(ST), an estimate of genetic diversity among populations, was 3.7% of the total diversity, a value lower than the mean for conifers. Nm, the number of migrants per generation, was 6.5, suggesting either some gene flow among populations or a lack of genetic differentiation. Spatial autocorrelation analysis revealed a moderately patchy structure, with gene flow distances of 30-70 m in the central populations and at least 10 m in the isolated populations. The future of the ecologically central populations depends on maintenance of an intact forest mosaic. The low genetic variability in the small, isolated populations suggests that habitat fragmentation has led to a reduction in evolutionary potential and that the future viability of these populations will likely require active management in the face of global climate change.
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http://dx.doi.org/10.3732/ajb.89.5.783DOI Listing
May 2002

EFFECTS OF POPULATION STRUCTURE AND CONE PRODUCTION ON OUTCROSSING RATES IN ENGELMANN SPRUCE AND SUBALPINE FIR.

Authors:
Kathleen L Shea

Evolution 1987 Jan;41(1):124-136

Department of Environmental, Population, and Organismic Biology, University of Colorado, Boulder, CO, 80309.

Variation in the mating systems of Engelmann spruce and subalpine fir was examined in two adjacent subpopulations in the Colorado Front Range. Multilocus outcrossing rates were estimated from analysis of allozyme variation in embryo and megagametophyte tissue. The overall multilocus outcrossing rate of 0.93 for spruce was significantly higher than the outcrossing rate of 0.89 for fir. Outcrossing rates varied from 0.73 to 0.97 for spruce and from 0.65 to 0.94 for fir when trees of each species were grouped according to age, size, spatial distribution, maternal heterozygosity, cone production, and year of sampling. In both spruce and fir, trees with higher levels of male-cone production and/or more clumped spatial distribution had lower outcrossing rates. Temporal variation in outcrossing rates within subpopulations, examined only in spruce, was less than variation between subpopulations. Male-cone production was significantly correlated with tree size, and regression analyses revealed that the highest outcrossing rates are expected on trees that are medium to large in size, rather than the largest trees in the forest. The results show that, while there is some temporal variation, patterns of male cone production and spatial distribution of individuals are the most important factors influencing outcrossing levels in these wind-pollinated forest trees.
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http://dx.doi.org/10.1111/j.1558-5646.1987.tb05775.xDOI Listing
January 1987