bluuebunny/crossref_metadata_2025 huggingface dataset:
Communication, indigenous culture and participatory decision making amongst foster adolescents
Authors: Schiller Ulene , de Wet Gideon
Published: August 2016

This paper analyses the experiences of adolescents in foster care placement with specific reference to participatory decision making in an indigenous African cultural context in South Africa. The emphasis is on the voices of foster adolescents in an indigenous African cultural context and their experiences of inequality when communicating and expressing opinions. The theoretical framework adopted was Interactional Communication Theory in which individuals interact through the use of symbols to co-create and interpret meaning. This theory incorporates some elements of systems theory with the emphasis on the interrelatedness quality as integral to the communication processes. A qualitative exploratory research study was done with 29 adolescents in foster care. Semi-structured interviews were conducted with 13 adolescent participants and as well as enriching the data with two focus groups consisting of eight adolescents in each group. Findings indicate a lack of openness of the foster care system in terms of the communication approach, international covenants and legislation that was used. The approach used was not based on interactional practices and perpetuated inequalities amongst adolescents. Also, the socio-cultural context of the foster family played a major inhibiting and determining role for adolescents regarding the level of free and open communication in their placement pertaining to decision making.
Polly’s story: Using structural narrative analysis to understand a trans migration journey
Authors: Ahmed Anya , Rogers Michaela
Published: August 2016

There is scant theoretical and empirical research on experiences of trans1 and its significance for social work practice. In this paper, we premise that research on trans identity and practice needs to be located in particular temporal, cultural, spatial/geographical contexts and argue that a structural narrative analytical approach centring on plot, offers the opportunity to unravel the ‘how’ and ‘why’ stories are told. We posit that attending to narrative structure facilitates a deeper understanding of trans people’s situated, lived experiences than thematic narrative analysis alone, since people organise their narratives according to a culturally available repertoire including plots. The paper focuses on the life and narrative of Polly, a male-to-female trans woman, and her gender migration journey using the plot typology ‘the Quest’. We are cognisant of the limitations to structural narrative analysis and Western conventions of storytelling, and acknowledge that our approach is subjective; however, we argue that knowledge itself is contextual and perspective ridden, shaped by researchers and participants. Our position holds that narratives are not – and cannot – be separated from the context in which they are told, and importantly the resources used to tell them, and that analysing narrative structure can contextualise individual unique biographies and give voice to less heard communities.
Public Health Models for Preventing Child Maltreatment
Authors: Scott Debbie , Lonne Bob , Higgins Daryl
Published: August 2016

Contemporary approaches to child protection are dominated by individualized forensically focused interventions that provide limited scope for more holistic preventative responses to children at risk and the provision of support to struggling families and communities. However, in many jurisdictions, it is frequently shown, often through public inquiries and program reviews, that investigatory and removal approaches are failing in critically important ways, particularly regarding reducing the inequities that underpin neglect and abuse. Consequently, there have been increasing calls for a public health model for the protection of children, although there is often a lack of clarity as to what exactly this should entail. Yet, there are opportunities to learn from public health approaches successfully used in the field of injury prevention. Specifically, we advocate for the use of Haddon’s Matrix, which provides a detailed theoretical and practical framework for the application of a comprehensive and integrated public health model to guide intervention program design and responses to child protection risk factors. A broad overview of the application of Haddon’s Matrix’s principles and methods is provided with examples of program and intervention design. It is argued that this framework provides the range of interventions necessary to address the complex social and structural factors contributing to inequity and the maltreatment of children. It also provides the foundation for a holistic and integrated system of prevention and intervention to contribute to system-level change and address child maltreatment.
Optimization of alkali treatment condition on jute fabric for the development of rigid biocomposite
Authors: Lakshmanan Ammayappan , Ghosh Rakesh Kumar , Dasgupta Swati , Chakraborty Sujay , Ganguly Prasanta Kumar
Published: August 2016

Jute fiber has poor compatibility with hydrophobic thermosetting polymeric resin for the development of a biocomposite. In this present study, plain weave jute fabric was treated with 1% sodium hydroxide (owf) in three different time (30, 60 and 90 minutes), temperature (30, 40 and 50℃) and material-to-liquor ratio (1:5, 1:10 and 1:15) as per orthogonal array and the treated jute fabrics were used for the preparation of the biocomposite sheet by hand laying-cum-compression moulding method. Developed biocomposite sheets were evaluated for their mechanical properties as per ASTM standards and results were analyzed by Taguchi model to optimize the sodium hydroxide treatment condition. Results inferred that jute fabric reinforcement treated with 1% sodium hydroxide at 50℃ for 60 minutes in 1:10 material-to-liquor ratio could be the optimum condition to develop the biocomposite sheet with higher mechanical properties than other conditions.
Accomplishing More Together
Authors: Biggs Elizabeth E. , Gilson Carly B. , Carter Erik W.
Published: August 2016

Fostering and maintaining strong collaborative relationships are critically important for paraprofessionals and special education teachers working together to provide a high-quality education for students with severe disabilities. Through in-depth interviews with 22 teachers and paraprofessionals comprising nine educational teams, we examined educator perspectives on what influences the quality of their professional relationships, as well as how their perspectives on these influences converged or diverged. Teachers and paraprofessionals identified five themes of influences to the quality of their relationships: teacher influences, paraprofessional influences, shared influences (i.e., related to the collective efforts of teachers and paraprofessionals), administrative influences (i.e., related to school and district leaders), and underlying influences (i.e., related to contextual or other factors). The findings highlight the complex nature of these relationships and emphasize the importance of supporting teachers and paraprofessionals as they work together to meet the needs of students with severe disabilities. We offer recommendations for future research and practice aimed at strengthening the quality and impact of special educator–paraprofessional collaborations.
Unilateral SREDA in a Patient With Stroke
Authors: Campbell Zeke M. , Kaplan Peter W. , Edwards Jonathan C.
Published: August 2016

Subclinical rhythmic electrographic discharges in adults (SREDA) is a well-known benign EEG phenomenon. However, the occurrence of SREDA is rare, and atypical forms are even more elusive, with only few cases reported in the literature. Herein, we describe a case of a 77-year-old woman with a left middle cerebral artery stroke and paroxysms of rhythmic, sharply contoured activity over the right central head region, mimicking focal seizures on EEG, that were determined to represent atypical SREDA. To our knowledge, no case of SREDA with a contralateral structural cerebral abnormality has been described, and its occurrence offers some limited insight as to the mechanisms underlying this mysterious entity.
Shoulder Injuries in Individuals Who Participate in CrossFit Training
Authors: Summitt Ryan J. , Cotton Ryan A. , Kays Adam C. , Slaven Emily J.
Published: August 2016

Background:

CrossFit, a sport and fitness program, has become increasingly popular both nationally and internationally. Researchers have recently identified significant improvements in health and wellness due to CrossFit. However, some individuals assert that CrossFit poses an inherent risk of injury, specifically to the shoulder, due to the intensity of training. Currently, there is limited evidence to support this assertion.

Hypothesis:

Exercises performed during CrossFit do not place the shoulder at greater risk for injury. Injury rates are comparable to other sports of similar intensity.

Study Design:

Descriptive survey study.

Level of Evidence:

Level 5.

Methods:

An electronic survey was developed and dispersed to approximately 980 individuals who trained in CrossFit gyms. The survey identified demographic data, training characteristics, and the prevalence of injury over a 6-month period in individuals who participated in CrossFit training.

Results:

A total of 187 (19.1%) individuals completed the survey. Forty-four (23.5%) indicated that they had experienced a shoulder injury during CrossFit training over the previous 6 months. Of those who reported injury, 17 (38.6%) stated that this injury was an exacerbation of a previous injury sustained prior to starting CrossFit. There was no significant relationship between several demographic and training variables and shoulder injury. All shoulder injuries occurred at a rate of 1.94 per 1000 hours training, while “new” shoulder injuries occurred at a rate of 1.18 per 1000 hours training. The most commonly attributed causes of injury were improper form (33.3%) and exacerbation of a previous injury (33.3%). Twenty-five (64.1%) of those who experienced injury reported 1 month or less of training reduction due to the injury.

Conclusion:

Shoulder injury rates during CrossFit training are comparable to other methods of recreational exercise.

Clinical Relevance:

Clinicians should be aware of training demands of exercises in CrossFit and modifications for these exercises to safely progress their patients back to participation.
The Company You Keep
Authors: Laakasuo Michael , Rotkirch Anna , Berg Venla , Jokela Markus
Published: August 2016

Studies on personality and friendship have focused on similarities between friends, while differences in friendship patterns have received less attention. We used data from the British Household Panel Survey data ( N = 12,098) to investigate how people’s personalities are related to various characteristics of their three closest friends. All personality traits of the five-factor model were associated with several friendship characteristics with effect sizes corresponding to correlations between −.06 and .09. Openness was especially prominent and idiosyncratic; individuals with high (vs. low) openness were about 3% more likely to have friends who live further away, are of the opposite sex and another ethnicity, and whom they meet less often. Agreeableness and extroversion were related to more traditional friendship ties. Individuals with high agreeableness had known their friends for a longer time, lived close to them, and had more “stay-at-homes” among their friends.
The Behavioral Immune System and Attitudes About Vaccines
Authors: Clay Russ
Published: August 2016

The present research utilized evolutionary theory to examine the relation between the behavioral immune system (i.e., disgust sensitivity) and attitudes about vaccines. The findings from the studies suggest that higher levels of dispositional disgust sensitivity is predictive of more negative attitudes toward vaccines. These findings are consistent with several recent publications and thus have broad implications for public health research associated with vaccines. In Study 1, participants reporting higher dispositional disgust sensitivity (specifically, contamination disgust) tended to report more negative attitudes about vaccines. Study 2 replicated this result in a nonstudent sample using additional measures of disgust sensitivity more closely associated with aversion to perceived sources of contamination. Study 2 also revealed that beliefs about the likelihood of contracting illness in the future were unrelated to vaccine attitudes. Implications for the observed relation between intuitive aversion to contamination and vaccine attitudes are discussed.
A huge retropharyngeal bronchogenic cyst displacing the posterior wall of the hypopharynx: Case report and review of the literature
Authors: Cavaliere Michele , Cimmino Mariano , Sicignano Stefania , Rega Felice , Maione Nunzia , Malacario Francesca , Ugga Lorenzo , Russo Camilla
Published: August 2016

Lesions of the retropharyngeal space (RPS) are uncommon, and they generally present as solitary, painless masses, which are often cystic. They usually originate from branchial arches anomalies, and only in a few cases do they turn out to be bronchogenic cysts. Generally, these lesions are diagnosed in childhood, but sometimes they can appear in adulthood. We report here a rare case of a bronchogenic cyst expanding into the RPS and causing dysphagia in an adult patient treated surgically. Since the RPS is clinically inaccessible, clinical examination was not crucial in determining the correct diagnosis, and only the additional information provided by radiological examinations led to the final diagnosis, which is essential for accurate surgical planning.
A systematic review of the association between fish oil supplementation and the development of asthma exacerbations
Authors: Hardy M Scott , Kekic Adrijana , Graybill Nicole L , Lancaster Zachary R
Published: August 2016

A systematic review was conducted to examine the association between fish oil supplementation and the development of asthma exacerbations. Comprehensive literature reviews of recent fish oil studies were performed to evaluate alterations in asthma surrogate markers. Additionally, the relative compositions of the fish oils used in each study were analyzed. The results of the review were inconclusive, but provide a basis for future research methods.
Narrative Theory Applied to the Autobiographies of Three Life-Course Offenders
Authors: Hockey David
Published: August 2016

The written autobiographical accounts of three life-course offenders, which were published following extended life-course offending, were analyzed using a theory-led thematic analysis. The protagonists were each responsible for a broad range of acquisitive and violent crimes, although different offense types are often studied as separate entities. The utility of narrative theory was explored as a life-course theory by contrasting its framework with these disparate areas of inquiry, along the developmental trajectory of the protagonist’s account. Findings showed that onset began with trait-driven and versatile offending, which progressed toward specialization, incorporating modus operandi and rational choice making. Specialization was underpinned by themes of violence and control. The concluding themes dealt with the process of desistance, which was facilitated by a series of cognitive shifts, allowing these offenders to retain a core element of the “self.” Results further showed that narrative-identity played an influential role in the development of specialization and eventual desistance, but less so with onset. Narrative theory has the potential to aid understanding of the criminal life-course trajectory, which in turn can assist in both detection and rehabilitation processes.
Grammar-Related Semantic Losses in the Translation of the Holy Quran, with Special Reference to Surah Al A’araf (The Heights)
Authors: Abdelaal Noureldin Mohamed , Md Rashid Sabariah
Published: August 2016

Translating the Holy Quran is a challenging task. However, it is a necessity due to the large number of Muslims who do not speak Arabic. To date, various translations are available for nonnative speakers of Arabic. These translations, however, have revealed complete and partial translation losses. One type of such losses is grammatical loss, which sometimes occurs due to differences between the source text (ST) and the target text (TT). This study aimed at investigating the grammatical losses in the translation of the Holy Quran, with special reference to Surah Al A’araf, and the extent these losses cause partial or complete semantic loss. Qualitative descriptive approach was adopted to analyze the data extracted from Abdel Haleem’s English translation of Surah Al A’araf. The study revealed losses occurring in translating grammatical aspects such as conjunctions, syntactic order, duality, tense, and verbs. It was also found that grammatical losses contributed to semantic losses, which are mostly partial semantic losses of the connotative or the expressive meanings. However, some of the identified grammatical losses were found to cause complete semantic losses. This study suggests that appropriate translation strategies be adopted to reduce loss in the translation.
Emergency Preparedness Policy and Practice in Massachusetts Hospitals
Authors: Taschner Mary A. , Nannini Angela , Laccetti Margaret , Greene Martin
Published: August 2016

Hospital emergency preparedness has evolved in response to and been challenged by threats of terrorism, meteorological disasters, and public health emergencies. In this case study, the authors examined emergency preparedness policy and practice in Massachusetts hospitals following 9/11/2001, identifying areas of success and opportunities for improvement. Using a qualitative descriptive approach, data analysis included the examination of documents and public health policy. Snowball technique was used to recruit nurses, public health policy makers, and other first responder leaders with historical and present knowledge of emergency preparedness policy and practice. Content analysis identified emerging themes and lessons learned. Key findings included the importance of standardized training, the value of interprofessional collaboration and communication across organizations, and the impact of decreased funding and prior incidents. The lessons learned from this case study contribute to the evolving body of knowledge about emergency preparedness for all hospitals and public health facilities, and their community health partners. Emergency preparedness is a dynamic process, and as it continues to evolve, additional research will be needed to standardize training, encourage collaboration, and facilitate communication so that incident response by hospital professionals, including occupational health nurses, and their public health and community partners is more effective.
The Financial and Professional Impact of Anterior Cruciate Ligament Injuries in National Football League Athletes
Authors: Secrist Eric S. , Bhat Suneel B. , Dodson Christopher C.
Published: August 2016

Background:

Anterior cruciate ligament (ACL) injuries can have negative consequences on the careers of National Football League (NFL) players, however no study has ever analyzed the financial impact of these injuries in this population.

Purpose:

To quantify the impact of ACL injuries on salary and career length in NFL athletes.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Any player in the NFL suffering an ACL injury from 2010 to 2013 was identified using a comprehensive online search. A database of NFL player salaries was used to conduct a matched cohort analysis comparing ACL-injured players with the rest of the NFL. The main outcomes were the percentage of players remaining in the NFL and mean salary at 1, 2, 3, and 4 years after injury. Cohorts were subdivided based on initial salary: group A, <$500,000; group B, ≤$500,000 to $2,000,000; and group C, >$2,000,000. Mean cumulative earnings were calculated by multiplying the percentage of players remaining in the league by their mean salaries and compounding this each season.

Results:

NFL athletes suffered 219 ACL injuries from 2010 to 2013. The 7504 other player seasons in the NFL during this time were used as controls. Significantly fewer ACL-injured players than controls remained in the NFL at each time point ( P < .05). In group A, significantly less ACL-injured players remained in the NFL at 1 to 3 seasons after injury ( P < .05), and in group B, significantly less ACL-injured players remained in the NFL at 1 and 2 seasons after injury ( P < .05). There was no significant decrease in group C. Players in groups A and B remaining in the NFL also had a lower mean salary than controls ( P < .05 in season 1). The mean cumulative earnings over 4 years for ACL-injured players was $2,070,521 less per player than uninjured controls.

Conclusion:

On average, ACL-injured players earned $2,070,521 less than salary-matched controls over the 4 years after injury. Players initially earning less than $2 million per year have lower mean salaries and are less likely to remain in the league than uninjured controls. The careers of players initially earning over $2 million per year, meanwhile, are not negatively affected. This demonstrates the degree of negative impact these injuries have on the careers of NFL players. It also indicates that a player’s standing within the league before injury strongly influences how much an ACL injury will affect his career.
Managing the “Dirty Work” of Illegality
Authors: Olvera Jacqueline
Published: August 2016

Drawing on in-depth interviews with 45 Latinos living in a small city the author calls Sycamore City, the author examines the discourses and practices through which Mexican migrants and Puerto Ricans deal with the “dirty work” of illegality. The focus is on the “physical dirty work” performed by undocumented workers and “social dirty work” performed by workers on the margins of citizenship. This research shows that “physical dirty work” and “social dirty work” overlap when a new class of worker enters the labor market. As such, the author documents the dirty work undocumented workers perform and the ethnoracial distinctions used to gain self-worth while performing physical dirty work. In addition, this article shows that as citizens, Puerto Rican professionals offer discreet assistance when they encounter undocumented migrants. In providing assistance, these professionals diminish citizen-migrant distinctions.
Promoting Teachers’ Ideological Becoming
Authors: Edmiston Brian
Published: August 2016

Freedman and Ball propose a language, literacy, and learning research agenda meant for practitioners as well as researchers, which they locate in Bakhtin’s notion of development, or “ideological becoming.” Language and literacy educators change how they teach when they come to see themselves differently in relation to the students in their classrooms. This article provides a theory and description of practice that suggests potential productive uses of a dramatic inquiry-based dialogic pedagogy in college classrooms intended to promote teachers’ ideological becoming. After first contextualizing Freedman and Ball’s research agenda in terms of current teacher education practices and challenges, including an oppressive status quo in our increasingly culturally and ethnically diverse schools and colleges, and then providing a theoretical framework, a teacher educator–researcher describes his use of dramatic inquiry pedagogy using carefully chosen picture books in an MA class for domestic and international students, which provided participants with opportunities to dialogue with different schooling practices and thus develop their own ideologies. Analysis of narrative responses from three teachers indicates their ideological development in relation to promoting inclusion and antioppressive practices as an integral part of their language and literacy teaching.
How many stroke patients might be eligible for mechanical thrombectomy?
Authors: Tawil Salwa El , Cheripelli Bharath , Huang Xuya , Moreton Fiona , Kalladka Dheeraj , MacDougal Niall JJ , McVerry Ferghal , Muir Keith W
Published: August 2016

Introduction

Recent studies showed improved patient outcomes with endovascular treatment of acute stroke compared to medical care, including IV rtPA, alone. Seven trials have reported results, each using different clinical and imaging criteria for patient selection. We compared eligibility for different trial protocols to estimate the number of patients eligible for treatment.

Patients and methods

Patient data were extracted from a single centre database that combined patients recruited to three clinical studies, each of which obtained both CTA and CTP within 6 h of stroke onset. The published inclusion and exclusion criteria of seven intervention trials (MR CLEAN, EXTEND–IA, ESCAPE, SWIFT-PRIME, REVASCAT, THERAPY and THRACE) were applied to determine the proportion that would be eligible for each of these studies.

Results

A total of 263 patients was included. Eligibility for IAT in individual trials ranged from 53% to 3% of patients; 17% were eligible for four trials and under 10% for two trials. Only three patients (1%) were eligible for all studies. The most common cause of exclusion was absence of large artery occlusion (LAO) on CTA. When applying simplified criteria requiring an ASPECT score > 6, 16% were eligible for IAT, but potentially 40% of these patients were excluded by perfusion criteria and more than half by common NIHSS thresholds.

Conclusion

Around 15% of patients presenting within 6 h of stroke onset were potentially eligible for IAT, but clinical trial eligibility criteria have much more limited overlap than is commonly assumed and only 1% of patients fulfilled criteria for all recent trials.
Lipoleiomyoma Causing Adnexal Torsion
Authors: Kiefer Christopher , Minardi Joseph , Williams Debra , Layman Shelley M.
Published: August 2016

Abdominal pain in women of reproductive age is a frequently encountered chief complaint in the emergency department. Adnexal torsion is a time-sensitive diagnosis that is essential for emergency physicians to consider in the initial differential diagnosis. Bedside sonography can be used to assist the clinician in the detection of adnexal masses placing the patient at risk for torsion. Lipoleiomyomas are uncommon, benign neoplasms consisting of variable portions of mature lipocytes, smooth muscle, or fibrous tissue. Very few cases have been reported, with no cases previously reported by emergency physicians using bedside ultrasound. A case is presented of a middle-aged woman who presented to the emergency department with acute lower abdominal pain. At the time of the initial history and physical examination, bedside screening sonogram was performed, which allowed rapid diagnosis of a large, heterogeneous, relatively avascular adnexal mass that was later identified as a lipoleiomyoma, a rare adnexal neoplasm, that resulted in adnexal torsion.
A Case Study of Baker Cysts With Intramuscular Extension into the Medial Head of the Gastrocnemius
Authors: Li Tony Y.
Published: August 2016

Baker cysts are common pathological findings during sonography of the popliteal fossa. Although they can present as a typical, mild variant or have an atypical sonographic appearance, a common feature of them is that their expansion is usually limited in the intermuscular planes or spaces between muscles and knee capsule. Baker cysts extending into muscles are rare. Two cases of a Baker cyst with extension into the medial head of the gastrocnemius (MHG) are reported with sonographic findings. Both of the cases were discovered in females, who had anterior or bilateral knee pain and radiographic features of osteoarthritis. Knee effusion was identified sonographically in both of the patient cases. In the popliteal fossa, Baker cysts were found in both patients with intramuscular extension into the MHG. In the first case, a cystic penetration was noted into the MHG, near the neck of the cyst, having a cone shape and oriented toward the inferior aspect of the muscle. The second case had a cystic penetration into the MHG near the base of the cyst with a tube shape, along its long axis. The possible pathogenesis is discussed.
inv(16) and NPM1mut AMLs engraft human cytokine knock-in mice
Authors: Ellegast Jana M. , Rauch Philipp J. , Kovtonyuk Larisa V. , Müller Rouven , Wagner Ulrich , Saito Yasuyuki , Wildner-Verhey van Wijk Nicole , Fritz Christine , Rafiei Anahita , Lysenko Veronika , Dudkiewicz Ewa , Theocharides Alexandre P. , Soldini Davide , Goede Jeroen S. , Flavell Richard A. , Manz Markus G.
Published: August 2016

Key Points

Humanized cytokine KI mice support engraftment of human favorable-risk AML. Engraftment and gene-enrichment analysis suggest M-CSF dependency of inv(16) AML.
Access to Care in Vermont: Factors Linked With Time to Chemotherapy for Women With Breast Cancer—A Retrospective Cohort Study
Authors: Johnson Ali , Shulman Leanne , Kachajian Jennifer , Sprague Brian L. , Khan Farrah , James Ted , Cranmer David , Young Peter , Heimann Ruth
Published: August 2016

Purpose:

In the rural United States, there are multiple potential barriers to the timely initiation of chemotherapy. The goal of this study was to identify factors associated with delays in the time from initial diagnosis to first systemic therapy (TTC) among women with breast cancer in Vermont.

Methods:

Using data from the Vermont Cancer Registry, we explored TTC for 702 female Vermont residents diagnosed with stage I to III breast cancer between 2006 and 2010 who received adjuvant chemotherapy. Multivariable linear regression was used to evaluate the associations between TTC and patient, tumor, treatment, and geographic variables.

Results:

Mean TTC was 10.2 weeks. Longer drive time (P < .001), more invasive surgery (P = .01), and breast reconstruction (P < .001) were each associated with longer TTC. Each additional 15 minutes of drive time was associated with a 0.34-week (95% CI, 0.22 to 0.46 weeks) increase in TTC. Participants age younger than 65 years whose primary payer was Medicare (n = 27) had significantly longer average TTC, by 2.37 weeks (P = .001), compared with those with private or military insurance. There was also substantial variation in TTC across hospitals (P < .001).

Conclusion:

Most female patients with stage I to III breast cancer in Vermont are receiving adjuvant chemotherapy within the National Comprehensive Cancer Network–recommended timeframe; however, improvements remain needed for certain subgroups. Novel approaches for women with long drive times need to be developed and evaluated in the community. Variation in TTC by hospital, even after adjusting for patient, tumor, and treatment factors, also suggests opportunities for process improvement.
Achieving Coordinated Care for Patients With Complex Cases of Cancer: A Multiteam System Approach
Authors: Lee Simon J. Craddock , Clark Mark A. , Cox John V. , Needles Burton M. , Seigel Carole , Balasubramanian Bijal A.
Published: August 2016

Patients with cancer with multiple chronic conditions pose a unique challenge to how primary care and specialty care teams provide well-coordinated, patient-centered care. Effectiveness of these care teams in providing optimal health care depends on the extent to which they coordinate their goals and knowledge as components of a multiteam system (MTS). This article outlines challenges of care coordination in the context of an MTS, illustrated through the care experience of “Mr Fuentes,” a patient in the Dallas County integrated safety-net system, Parkland. As a continuing patient with chronic illnesses, the patient being discussed is managed through one of the Parkland community-oriented primary care clinics. However, a cancer diagnosis triggered an additional need for augmented coordination between his different provider teams. Further research and practice should investigate the relationships of MTS coordination for shared care management, transfer to and from specialty care, treatment compliance, barriers to care, and health outcomes of chronic comorbid conditions, as well as cancer control and surveillance.
Use of a Shared Mental Model by a Team Composed of Oncology, Palliative Care, and Supportive Care Clinicians to Facilitate Shared Decision Making in a Patient With Advanced Cancer
Authors: D’Ambruoso Sarah F. , Coscarelli Anne , Hurvitz Sara , Wenger Neil , Coniglio David , Donaldson Dusty , Pietras Christopher , Walling Anne M.
Published: August 2016

Our case describes the efforts of team members drawn from oncology, palliative care, supportive care, and primary care to assist a woman with advanced cancer in accepting care for her psychosocial distress, integrating prognostic information so that she could share in decisions about treatment planning, involving family in her care, and ultimately transitioning to hospice. Team members in our setting included a medical oncologist, oncology nurse practitioner, palliative care nurse practitioner, oncology social worker, and primary care physician. The core members were the patient and her sister. Our team grew organically as a result of patient need and, in doing so, operationalized an explicitly shared understanding of care priorities. We refer to this shared understanding as a shared mental model for care delivery, which enabled our team to jointly set priorities for care through a series of warm handoffs enabled by the team’s close proximity within the same clinic. When care providers outside our integrated team became involved in the case, significant communication gaps exposed the difficulty in extending our shared mental model outside the integrated team framework, leading to inefficiencies in care. Integration of this shared understanding for care and close proximity of team members proved to be key components in facilitating treatment of our patient’s burdensome cancer-related distress so that she could more effectively participate in treatment decision making that reflected her goals of care.
Ezh2 restricts the smooth muscle lineage during mouse lung mesothelial development
Authors: Snitow Melinda , Lu MinMin , Cheng Lan , Zhou Su , Morrisey Edward E.
Published: August 2016

During development, the lung mesoderm generates a variety of cell lineages, including airway and vascular smooth muscle. Epigenetic changes in adult lung mesodermal lineages are thought to contribute towards diseases such as idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease, although the factors that regulate early lung mesoderm development are unknown. We show in mouse that the PRC2 component Ezh2 is required to restrict smooth muscle differentiation in the developing lung mesothelium. Mesodermal loss of Ezh2 leads to the formation of ectopic smooth muscle in the submesothelial region of the developing lung mesoderm. Loss of Ezh2 specifically in the developing mesothelium reveals a mesothelial cell-autonomous role for Ezh2 in repression of the smooth muscle differentiation program. Loss of Ezh2 derepresses expression of myocardin and Tbx18, which are important regulators of smooth muscle differentiation from the mesothelium and related cell lineages. Together, these findings uncover an Ezh2-dependent mechanism to restrict the smooth muscle gene expression program in the developing mesothelium and allow appropriate cell fate decisions to occur in this multipotent mesoderm lineage.
IKKε inhibits PKC to promote Fascin-dependent actin bundling
Authors: Otani Tetsuhisa , Ogura Yosuke , Misaki Kazuyo , Maeda Takuya , Kimpara Akiyo , Yonemura Shigenobu , Hayashi Shigeo
Published: August 2016

Signaling molecules have pleiotropic functions and are activated by various extracellular stimuli. Protein kinase C (PKC) is activated by diverse receptors, and its dysregulation is associated with diseases including cancer. However, how the undesired activation of PKC is prevented during development remains poorly understood. We have previously shown that a protein kinase, IKKε, is active at the growing bristle tip and regulates actin bundle organization during Drosophila bristle morphogenesis. Here, we demonstrate that IKKε regulates the actin bundle localization of a dynamic actin cross-linker, Fascin. IKKε inhibits PKC, thereby protecting Fascin from inhibitory phosphorylation. Excess PKC activation is responsible for the actin bundle defects in IKKε-deficient bristles, whereas PKC is dispensable for bristle morphogenesis in wild-type bristles, indicating that PKC is repressed by IKKε in wild-type bristle cells. These results suggest that IKKε prevents excess activation of PKC during bristle morphogenesis.
Microtubule-severing activity of the AAA+ ATPase Katanin is essential for female meiotic spindle assembly
Authors: Joly Nicolas , Martino Lisa , Gigant Emmanuelle , Dumont Julien , Pintard Lionel
Published: August 2016

In most animals, female meiotic spindles are assembled in the absence of centrosomes. How microtubules (MTs) are organized into acentrosomal meiotic spindles is poorly understood. In Caenorhabditis elegans, assembly of female meiotic spindles requires MEI-1 and MEI-2, which constitute the microtubule-severing AAA+ ATPase Katanin. However, the role of MEI-2 is not known and whether MT severing is required for meiotic spindle assembly is unclear. Here, we show that the essential role of MEI-2 is to confer MT binding to Katanin, which in turn stimulates the ATPase activity of MEI-1, leading to MT severing. To test directly the contribution of MT severing to meiotic spindle assembly, we engineered Katanin variants that retained MT binding and MT bundling activities but that were inactive for MT severing. In vivo analysis of these variants showed disorganized microtubules that lacked focused spindle poles reminiscent of the Katanin loss-of-function phenotype, demonstrating that the MT-severing activity is essential for meiotic spindle assembly in C. elegans. Overall, our results reveal the essential role of MEI-2 and provide the first direct evidence supporting an essential role of MT severing in meiotic spindle assembly in C. elegans.
Increased fat catabolism sustains water balance during fasting in zebra finches
Authors: Rutkowska Joanna , Sadowska Edyta T. , Cichoń Mariusz , Bauchinger Ulf
Published: August 2016

Patterns of physiological flexibility in response to fasting are well established, but much less is known about the contribution of water deprivation to the observed effects. We investigated body composition and energy and water budget in three groups of zebra finches: birds with access to food and water, food-deprived birds having access to drinking water and food-and-water-deprived birds. Animals were not stimulated by elevated energy expenditure and they were in thermoneutral conditions; thus, based on previous studies, water balance of fasting birds was expected to be maintained by increased catabolism of proteins. In contrast to this expectation, we found that access to water did not prevent reduction of proteinaceous tissue, but it saved fat reserves of the fasting birds. Thus, water balance of birds fasting without access to water seemed to be maintained by elevated fat catabolism, which generated 6 times more metabolic water compared with that in birds that had access to water. Therefore, we revise currently established views and propose fat to serve as the primary source for metabolic water production. Previously assumed increased protein breakdown for maintenance of water budget would occur if fat stores were depleted or if fat catabolism reached its upper limits due to high energy demands.
Effects of support diameter and compliance on common marmoset (Callithrix jacchus) gait kinematics
Authors: Young Jesse W. , Stricklen Bethany M. , Chadwell Brad A.
Published: August 2016

Locomotion is precarious in an arboreal habitat, where supports can vary in both diameter and level of compliance. Several previous studies have evaluated the influence of substrate diameter on the locomotor performance of arboreal quadrupeds. The influence of substrate compliance, however, has been mostly unexamined. Here, we used a multifactorial experimental design to investigate how perturbations in both diameter and compliance affect the gait kinematics of marmosets (Callithrix jacchus; N=2) moving over simulated arboreal substrates. We used 3D-calibrated video to quantify marmoset locomotion over a horizontal trackway consisting of variably sized poles (5, 2.5 and 1.25 cm in diameter), analyzing a total of 120 strides. The central portion of the trackway was either immobile or mounted on compliant foam blocks, depending on condition. We found that narrowing diameter and increasing compliance were both associated with relatively longer substrate contact durations, though adjustments to diameter were often inconsistent relative to compliance-related adjustments. Marmosets also responded to narrowing diameter by reducing speed, flattening center of mass (CoM) movements and dampening support displacement on the compliant substrate. For the subset of strides on the compliant support, we found that speed, contact duration and CoM amplitude explained >60% of the variation in substrate displacement over a stride, suggesting a direct performance advantage to these kinematic adjustments. Overall, our results show that compliant substrates can exert a significant influence on gait kinematics. Substrate compliance, and not just support diameter, should be considered a critical environmental variable when evaluating locomotor performance in arboreal quadrupeds.
Animal social learning: associations and adaptations
Authors: Reader Simon M.
Published: August 2016

Social learning, learning from others, is a powerful process known to impact the success and survival of humans and non-human animals alike. Yet we understand little about the neurocognitive and other processes that underpin social learning. Social learning has often been assumed to involve specialized, derived cognitive processes that evolve and develop independently from other processes. However, this assumption is increasingly questioned, and evidence from a variety of organisms demonstrates that current, recent, and early life experience all predict the reliance on social information and thus can potentially explain variation in social learning as a result of experiential effects rather than evolved differences. General associative learning processes, rather than adaptive specializations, may underpin much social learning, as well as social learning strategies. Uncovering these distinctions is important to a variety of fields, for example by widening current views of the possible breadth and adaptive flexibility of social learning. Nonetheless, just like adaptationist evolutionary explanations, associationist explanations for social learning cannot be assumed, and empirical work is required to uncover the mechanisms involved and their impact on the efficacy of social learning. This work is being done, but more is needed. Current evidence suggests that much social learning may be based on ‘ordinary’ processes but with extraordinary consequences.
Cardio-renal syndrome
Authors: Gnanaraj Joseph , Radhakrishnan Jai
Published: August 2016

Cardio-renal syndrome is a commonly encountered problem in clinical practice. Its pathogenesis is not fully understood. The purpose of this article is to highlight the interaction between the cardiovascular system and the renal system and how their interaction results in the complex syndrome of cardio-renal dysfunction. Additionally, we outline the available therapeutic strategies to manage this complex syndrome.
Predictors and brain connectivity changes associated with arm motor function improvement from intensive robotic practice in chronic stroke
Authors: Wittenberg George F. , Richards Lorie G. , Jones-Lush Lauren M. , Roys Steven R. , Gullapalli Rao P. , Yang Suzy , Guarino Peter D. , Lo Albert C.
Published: August 2016

Background and Purpose: The brain changes that underlie therapy-induced improvement in motor function after stroke remain obscure. This study sought to demonstrate the feasibility and utility of measuring motor system physiology in a clinical trial of intensive upper extremity rehabilitation in chronic stroke-related hemiparesis.

Methods: This was a substudy of two multi-center clinical trials of intensive robotic arm therapy in chronic, significantly hemiparetic, stroke patients. Transcranial magnetic stimulation was used to measure motor cortical output to the biceps and extensor digitorum communus muscles. Magnetic resonance imaging (MRI) was used to determine the cortical anatomy, as well as to measure fractional anisotropy, and blood oxygenation (BOLD) during an eyes-closed rest state. Region-of-interest time-series correlation analysis was performed on the BOLD signal to determine interregional connectivity. Functional status was measured with the upper extremity Fugl-Meyer and Wolf Motor Function Test.

Results: Motor evoked potential (MEP) presence was associated with better functional outcomes, but the effect was not significant when considering baseline impairment. Affected side internal capsule fractional anisotropy was associated with better function at baseline. Affected side primary motor cortex (M1) activity became more correlated with other frontal motor regions after treatment. Resting state connectivity between affected hemisphere M1 and dorsal premotor area (PMAd) predicted recovery. 

Conclusions: Presence of motor evoked potentials in the affected motor cortex and its functional connectivity with PMAd may be useful in predicting recovery. Functional connectivity in the motor network shows a trends towards increasing after intensive robotic or non-robotic arm therapy.

Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifiers:  CT00372411 & NCT00333983.
Predicting Outcomes of Hormone and Chemotherapy in the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) Study by Biochemically-inspired Machine Learning
Authors: Rezaeian Iman , Mucaki Eliseos J. , Baranova Katherina , Pham Huy Q. , Angelov Dimo , Ngom Alioune , Rueda Luis , Rogan Peter K.
Published: August 2016

Genomic aberrations and gene expression-defined subtypes in the large METABRIC patient cohort have been used to stratify and predict survival. The present study used normalized gene expression signatures of paclitaxel drug response to predict outcome for different survival times in METABRIC patients receiving hormone (HT) and, in some cases, chemotherapy (CT) agents. This machine learning method, which distinguishes sensitivity vs. resistance in breast cancer cell lines and validates predictions in patients, was also used to derive gene signatures of other HT  (tamoxifen) and CT agents (methotrexate, epirubicin, doxorubicin, and 5-fluorouracil) used in METABRIC. Paclitaxel gene signatures exhibited the best performance, however the other agents also predicted survival with acceptable accuracies. A support vector machine (SVM) model of paclitaxel response containing the ABCB1, ABCB11, ABCC1, ABCC10, BAD, BBC3, BCL2, BCL2L1, BMF, CYP2C8, CYP3A4, MAP2, MAP4, MAPT, NR1I2, SLCO1B3, TUBB1, TUBB4A, TUBB4B genes was 78.6% accurate in 84 patients treated with both HT and CT (median survival ≥ 4.4 yr). Accuracy was lower (73.4%) in 304 untreated patients. The performance of other machine learning approaches were also evaluated at different survival thresholds. Minimum redundancy maximum relevance feature selection of a paclitaxel-based SVM classifier based on expression of ABCB11, ABCC1, BAD, BBC3 and BCL2L1 was 79% accurate in 53 CT patients. A random forest (RF) classifier produced a gene signature (ABCB11, ABCC1, BAD, BCL2, CYP2C8, CYP3A4, MAP4, MAPT, NR1I2, TUBB1, GBP1, OPRK1) that predicted >3 year survival with 82.4% accuracy in 420 HT patients. A similar RF gene signature showed 79.6% accuracy in 504 patients treated with CT and/or HT. These results suggest that tumor gene expression signatures refined by machine learning techniques can be useful for predicting survival after drug therapies.