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Our objective was to integrate lessons learned from perinatal collaborative care programs across the United States, recognizing the diversity of practice settings and patient populations, to provide guidance on successful implementation.
Collaborative care is a health services delivery system that integrates behavioral health care into primary care. While efficacious, effectiveness requires rigorous attention to implementation to ensure adherence to the core evidence base.
Implementation strategies are divided into three pragmatic stages: preparation, program launch, and program growth and sustainment; however, these steps are non-linear and dynamic.
The discussion that follows is not meant to be prescriptive; rather, all implementation tasks should be thoughtfully tailored to the unique needs and setting of the obstetric community and patient population. In particular, we are aware that implementation on the level described here assumes commitment of both effort and money on the part of clinicians, administrators, and the health system, and that such financial resources are not always available. We conclude with synthesis of a survey of existing collaborative care programs to identify implementation practices of existing programs.
OBJECTIVES/GOALS: Natural killer (NK) cells are a potential cancer therapeutic but expanding NK cells efficiently in vitro is difficult. Natural killer cell deficiency (NKD), a primary immune deficiency affecting only NK cells, is caused by defects in several DNA replication proteins. By studying NKD we will achieve better NK cell in vitro differentiation. METHODS/STUDY POPULATION: One patient with NKD has a compound heterozygous mutation in the essential DNA replication protein MCM10. We hypothesize that in individuals with NKD, dramatic telomere erosion from abnormal DNA replication leads to premature senescence and the loss of NK cells. To test our hypothesis, we will knockout one allele of MCM10 or over express MCM10 in NK cells isolated from blood. We will then monitor telomere length, expansion and cytotoxic activity of these NK cells. To understand the role of MCM10 in early stages of NK cell development we will deplete MCM10 in induced pluripotent stem cells and differentiate these cells into NK cells. During this differentiation we will monitor progression through NK cell developmental stages as well as telomere length and senescence markers. RESULTS/ANTICIPATED RESULTS: Telomeres insulate chromosomes and induce permanent growth arrest (senescence) when they are critically short. We have demonstrated that depletion of a DNA replication protein causes telomere erosion and increases senescence markers. NK cells have shorter telomeres and lower telomerase expression than other immune cells. We predict, this relatively poor telomere maintenance sensitizes NK cells to telomere loss upon depletion of replication proteins. During in vitro differentiation, we expect NK cell precursors to undergo premature senescence secondary to telomere shortening. Furthermore, we expect supplementation of DNA replication proteins will enhance NK cell expansion and maturation. DISCUSSION/SIGNIFICANCE OF IMPACT: NKD patients have provided the scientific community with clues as to what proteins NK cells rely on for their development. This project aims not only to understand why these proteins are critical, but to harness that information for cellular anti-cancer therapeutics.
Aboriginal and Torres Strait Islander people in Australia are especially vulnerable to traumatic and discriminatory experiences. However, limited literature and research has implemented and evaluated school-based interventions designed to assist Aboriginal and Torres Strait Islander children and young people to overcome their adversity and achieve their potential at school. This article reviews the literature and frameworks on school programs designed for Aboriginal and Torres Strait Islander students who have experienced trauma. The key aspects of trauma-informed programs in schools for Aboriginal and Torres Strait Islander students is explored and recommendations made for further research and greater acknowledgement of cultural and historical issues for Aboriginal and Torres Strait Islander students when implementing culturally informed and trauma-informed practices in schools.
Navigating the research domain at an academic medical center can be challenging, even for seasoned investigators. To address this, Duke University launched two initiatives: (1) a research navigation “hotline” to provide brief assistance with a variety of research questions; and (2) researcher onboarding and consultation, a one-to-one tailored offering to ensure that researchers are equipped to navigate research resources and processes effectively. The services are provided by the myRESEARCHnavigators (MRN) team, funded by Duke’s CTSA. The diverse scientific backgrounds of the six team members align well with those of the research community, allowing for a good match between the researcher and MRN team member. The MRN team answers approximately 30 questions per month, and has provided consultations to almost 400 researchers. Both services receive high satisfaction ratings (4 or 5 stars [out of 5 stars] given to 90% of hotline answers, and 99% of researcher onboarding/consultation sessions). As of July 2019, the School of Medicine has determined that the consultations are critical to their mission and have made them a requirement for new research faculty. The team will continue marketing both services to encourage adoption.
Clonal Mycobacterium mucogenicum isolates (determined by molecular typing) were recovered from 19 bronchoscopic specimens from 15 patients. None of these patients had evidence of mycobacterial infection. Laboratory culture materials and bronchoscopes were negative for Mycobacteria. This pseudo-outbreak was caused by contaminated ice used to provide bronchoscopic lavage. Control was achieved by transitioning to sterile ice.
Previous research in mild cognitive impairment (MCI) suggests that visual episodic memory impairment may emerge before analogous verbal episodic memory impairment. The current study examined working memory (WM) test performance in MCI to assess whether patients present with greater visual versus verbal WM impairment. WM performance was also assessed in relation to hippocampal occupancy (HO), a ratio of hippocampal volume to ventricular dilation adjusted for demographic variables and intracranial volume.
Jak et al. (2009) (The American Journal of Geriatric Psychiatry, 17, 368–375) and Edmonds, Delano-Wood, Galasko, Salmon, & Bondi (2015) (Journal of Alzheimer’s Disease, 47(1), 231–242) criteria classify patients into four groups: little to no cognitive impairment (non-MCI); subtle cognitive impairment (SCI); amnestic MCI (aMCI); and a combined mixed/dysexecutive MCI (mixed/dys MCI). WM was assessed using co-normed Wechsler Adult Intelligence Scale-IV (WAIS-IV) Digit Span Backwards and Wechsler Memory Scale-IV (WMS-IV) Symbol Span Z-scores.
Between-group analyses found worse WMS-IV Symbol Span and WAIS-IV Digit Span Backwards performance for mixed/dys MCI compared to non-MCI patients. Within-group analyses found no differences for non-MCI patients; however, all other groups scored lower on WMS-IV Symbol Span than WAIS-IV Digit Span Backwards. Regression analysis with HO as the dependent variable was statistically significant for WMS-IV Symbol Span performance. WAIS-IV Digit Span Backwards performance failed to reach statistical significance.
Worse WMS-IV Symbol Span performance was observed in patient groups with measurable neuropsychological impairment and better WMS-IV Symbol Span performance was associated with higher HO ratios. These results suggest that visual WM may be particularly sensitive to emergent illness compared to analogous verbal WM tests.
This study examined differences in learning outcomes among newborn intensive care unit (NICU) workers who underwent virtual reality simulation (VRS) emergency evacuation training versus those who received web-based clinical updates (CU). Learning outcomes included a) knowledge gained, b) confidence with evacuation, and c) performance in a live evacuation exercise.
A longitudinal, mixed-method, quasi-experimental design was implemented utilizing a sample of NICU workers randomly assigned to VRS training or CUs. Four VRS scenarios were created that augmented neonate evacuation training materials. Learning was measured using cognitive assessments, self-efficacy questionnaire (baseline, 0, 4, 8, 12 months), and performance in a live drill (baseline, 12 months). Data were collected following training and analyzed using mixed model analysis. Focus groups captured VRS participant experiences.
The VRS and CU groups did not statistically differ based upon the scores on the Cognitive Assessment or perceived self-efficacy. The virtual reality group performance in the live exercise was statistically (P<.0001) and clinically (effect size of 1.71) better than that of the CU group.
Training using VRS is effective in promoting positive performance outcomes and should be included as a method for disaster training. VRS can allow an organization to train, test, and identify gaps in current emergency operation plans. In the unique case of disasters, which are low-volume and high-risk events, the participant can have access to an environment without endangering themselves or clients. (Disaster Med Public Health Preparedness. 2019;13:301–308)
Good education requires student experiences that deliver lessons about practice as well as theory and that encourage students to work for the public good—especially in the operation of democratic institutions (Dewey 1923; Dewy 1938). We report on an evaluation of the pedagogical value of a research project involving 23 colleges and universities across the country. Faculty trained and supervised students who observed polling places in the 2016 General Election. Our findings indicate that this was a valuable learning experience in both the short and long terms. Students found their experiences to be valuable and reported learning generally and specifically related to course material. Postelection, they also felt more knowledgeable about election science topics, voting behavior, and research methods. Students reported interest in participating in similar research in the future, would recommend other students to do so, and expressed interest in more learning and research about the topics central to their experience. Our results suggest that participants appreciated the importance of elections and their study. Collectively, the participating students are engaged and efficacious—essential qualities of citizens in a democracy.
Philip Roth was a notorious author of the extraordinary stories in Goodbye, Columbus, and novels Letting Go, When She Was Good, and Portnoy's Complaint. Jay Cantor wrote two remarkable novels in the period between 1970 and 2000: The Death of Che Guevara and Krazy Kat and a little later published Great Neck. This chapter groups together the writers: Sontag, Auster, Cantor, Price and Lethem because they are Jewish American writers who do not advertise their Jewishness in any particular way. In Chabon's novel it is something like a smothered dream and permitting oneself the fantasy of freedom is a route to whatever freedom is to be had. In this perspective, to live a Jewish life in the American language is to remember difference and loss with especial intensity and to be alert to the chances of slipping free from at least some of the restrictive chains of the New World.
Escherichia coli is an indicator of fecal pollution used to mandate recreational and drinking water quality. Concentrations of culturable E. coli following contamination of surface water are determined by three factors: dilution; cell attachment to particulate material and settling or resuspension in the water column; and the net rate of change in viability. This study evaluated the variability in the latter parameter, and how predictive variation in death rate was of culturable population densities at the time of sampling. Water samples (N=232) with varying levels of E. coli contamination were collected from 46 discrete locations in four watersheds across Canada over a three-month period and enumerated for culturable E. coli by membrane filtration plate counting (T0EC). Water samples were again enumerated following a laboratory 24 h holding period at 30°C in the dark, and the difference considered the death rate (ΔEC). Relationships of T0EC and ΔEC with environmental and water chemistry factors were explored using step-wise multiple regression. The model predicting T0EC indicated that stream order, total rainfall seven days in advance of sampling day, total phosphorus, and ΔEC were the most significant contributors. The model predicting ΔEC indicated that turbidity and NH3+NH4 were the most important contributors. A model suggests that the persistence factor is less important than dilution (i.e. stream order) in describing E. coli densities, followed by factors that influence the loading of E. coli into watersheds.
Image of an intraepithelial lymphocyte (IEL) from a CLIC5 mutant mouse small intestine. The CLIC (Chloride Intracellular Channel) family of proteins is expressed in a wide variety of cell types, and several isoforms are known to cycle between soluble and membranebound forms. As well as being widely expressed, the CLICs are involved in diverse functions, including tubulogenesis, immune cell activation, apoptosis and calcium handling. CLIC5 has been shown to associate with cytoskeletal proteins in placental microvilli and inner ear cells, and is required for proper maintenence of hair cell steriocilia. It has also been localized to the cytosol of human intestinal epithelial cells, though its function there remains unclear. The study in which this particular “IEL” was found, involved a search to see what function CLIC5 played in the modulation of tubulovesicles and microvillar apical membranes in the process of acid secretion. In particular, the relative amounts and structural characteristics of these two membrane types was quantified in parietal cells.
This paper reports on the initial findings of an ongoing research project to capture differences in pest management strategies and decision-making among growers using the California Pesticide Use Reports (PUR) database. Analysis was performed for prunes in Sutter and Yuba counties to identify on-farm innovation by analyzing the PUR for best management practices to reduce pesticide use. Results showed that large variations in pesticide use were present in 2000, with a range of less than 5 kg to more than 41 kg of pesticide applied per hectare (ha) crop planted in Sutter County and a range of less than 2 kg to close to 30 kg per ha crop planted in Yuba County. Among the 42 growers selected cultivating more than 80 ha, five growers in Sutter County and three growers in Yuba County in 2000 were identified as low pesticide use growers. The results indicated a surprising number of low to no fungicide users and an even higher number of growers using no herbicides in both counties. Twenty-nine viable low pesticide use growers were identified overall among the total 294 growers in the Sutter and Yuba counties. However, there were no spatial patterns of where these low pesticide use growers' fields were located. The transition from higher-risk active ingredients (AIs) to reduced-risk AIs used by many of the low pesticide users suggests intentional substitution. Initial yield data indicate that quantity and quality were not adversely affected by low use growers employing reduced-risk pesticides, fewer (AIs) per field, and lower rates per chemical than their moderate to high use counterparts. Diverse collaborators consisting of university researchers, environmental and community organizations, state government scientists, and growers worked together throughout the entire project, beginning with defining the research parameters, then interpreting the results, and finally suggesting practical applications for the outcomes. The paper also highlights the effectiveness of using such collaborative research relationships to explore low pesticide use alternatives, to directly exchange research findings with growers, and to encourage a farmer-to-farmer extension model.
Objectives: The National Institutes of Health (NIH) Consensus Development Conference (CDC) was instituted to provide evidence-based guidance on controversial medical issues to researchers, health practitioners, and the public; however, the degree of impact this activity has on stimulating relevant research is unclear. This study examines the impact of CDC statements on the initiation of related NIH-funded research projects.
Methods: Six CDCs from 1998 to 2001 were examined. Research initiatives related to the Conferences' topics were collected through two discrete methods: (i) the overall number of relevant pre- and postconference research activities was compiled using NIH's Information for Management, Planning, Analysis, and Coordination II (IMPAC II) and the Department of Health and Human Services' (DHHS) Computer Retrieval of Information on Scientific Projects (CRISP) grant application and award databases; (ii) for each CDC, the sponsoring institute's conference coordinator and other identified Program Directors were queried for their knowledge of new conference-specific research initiatives sponsored by their institute. The main outcome measure was the total number of requests for applications, requests for proposals, program announcements, broad agency announcements, notices, and funded investigator-initiated research program grants (RO1s) for a given Consensus topic in the 3 years before (baseline measure) and following (measure of impact) a CDC.
Results: As identified through NIH's IMPAC II and DHHS' CRISP grants and announcements databases, the total number of relevant postconference research initiatives increased for five of six CDCs when compared with baseline activity levels; research activities remained constant for the sixth. When inclusion criteria were restricted to institute-identified research initiatives, two of six CDC topics had overall increases in relevant research activity in the postconference period.
Conclusions: CDCs appear to have a positive impact on the stimulation of related NIH-funded research initiatives. Future outcomes evaluations using prospective data collection methods and more robust participation by sponsoring and cosponsoring institutes should strengthen the reliability of the association between new research initiatives on a given topic and their causal relationship to a given CDC.
In The Anatomy Lesson (1983), Roth has his authorial alter ego, Nathan Zuckerman, explicitly blame the loss of his writerly subject on the creation of the Jewish state. In the wake of Israel, Zuckerman has exhausted the subject of being an American Jew. While “the great Jewish struggle was with the Arab states,” Zuckerman's own great struggle was with “the Jersey side of the Hudson, his West Bank.” His difficulty was to portray how this conflict had ended with his territory “occupied now by an alien tribe.” Zuckerman's despair is that with his parents dead and his neighborhood lost, he must confront the recognition that “no new Newark was going to spring up again for” him (Zuckerman Bound, 445).
One might well imagine that when Zuckerman does, in The Counterlife, recover his “posture for writing” -or perhaps his imposture for writing - it is because Israel has finally been launched into the position of “homeland” and, thereby, Oedipal father. “There's a world outside the Oedipal swamp,” Nathan's brother Henry angrily responds in The Counterlife, when Nathan questions Henry's new-found home in a right-wing Israeli settlement. “Tell me something, is it at all possible, at least outside of those books, for you to have a frame of reference slightly larger than the kitchen table in Newark?” (Counterlife, 138). Nathan's response amounts to an honest and resounding no.