The Focal Nature of Darier's Disease Lesions: Calcium Pumps, Stress, and Mutation?

Haploinsufficiency of the ATP2A2 gene product, SERCA2, underlies most cases of Darier's disease. Sarcoplasmic/endoplasmic reticulum Ca2+ ATPase isoform 2 (SERCA2) is an intracellular Ca2+ pump that replenishes ER Ca2+, and it seems likely that the disease manifests in stress-induced lesions because SERCA levels become limiting as extra demands are made on the pump in times of stress. However, Müller and colleagues (2006) present a radical new proposal invoking somatic mutation as the basis for Darier lesions. Using a novel animal model for depleted keratinocyte SERCA-gated Ca2+ stores, the authors show that keratinocytes from Darier-like lesions retain their distinctive phenotype after culture, suggesting heritable defects. Mechanistically linking stress, calcium levels, mutation, and disease pathogenesis is complicated, and the proposal is likely to be controversial. However, recent reports of age- and stress-dependent tumor formation in the mouse model for SERCA2 haploinsufficiency (ATP2A2 heterozygous mouse) support the proposal that deficiency in SERCA-gated ER Ca2+ replenishment may be linked to mutation accumulation

Barrier Formation in the Human Fetus is Patterned

We recently demonstrated patterned stratum corneum maturation and skin barrier formation during fetal development in rodents and rabbit. The presence of skin patterning in these mammals led us to predict patterned barrier formation during human infant development. Here we extend our mammalian study and demonstrate patterned stratum corneum development and skin barrier formation in the pre-term human infant. Surprisingly, we show initiation of human barrier regionally as early as 20–24 wk gestational age (22–26 wk menstrual age), bringing barrier formation close to the time of periderm disaggregation. We use the mouse model to show that patterns of periderm disaggregation mirrors barrier formation. Periderm disaggregation follows and recapitulates barrier pattern, suggesting a relationship between the processes. This work reveals regional patterning in skin maturation and barrier formation in the human infant and demonstrates that initiation of human skin barrier formation in utero coincides with the current lower limit of viability of the pre-term infant

Transforming Problem-Based Learning through Abductive Reasoning

Background: Hypothetico-deductive reasoning is the current approach for reasoning through care situations within problem-based learning (PBL). While this approach is widely used in both PBL and non-PBL curricula, abductive reasoning is recommended (as an alternative approach) due to its broader method for analyzing and explaining care situations within problem-based learning. Method: A step-by-step process rooted in abductive reasoning is proposed and demonstrated as a new way of examining and explaining care situations within problem-based learning. Results: The proposed strategy emphasizes the creation of hypotheses through phenomena detection, development of a causal model, identification of learning needs, recognition of salience, synthesis and reflection. Conclusion: Since the proposed approach has not been implemented previously, its practical implications require research attention which will contribute to the emerging field of abductive reasoning within nursing education. Résumé : Contexte : Dans l’apprentissage par problèmes (APP), le raisonnement hypothético-déductif est l’approche actuellement utilisée pour raisonner à partir de situations de soins. Or, bien que cette approche soit largement utilisée dans les programmes fondés sur l’APP et ceux qui ne le sont pas, le raisonnement abductif est recommandé (comme autre approche) puisque sa méthode d’analyse et d’explication des situations de soins au sein de l’APP est plus vaste. Méthode : Proposer et démontrer un processus étape par étape ancré dans le raisonnement abductif, comme une nouvelle manière d’analyser et d’expliquer des situations de soins dans le cadre de l’APP. Résultats : La stratégie proposée favorise la formulation d’hypothèses par la détection de phénomènes, la mise en place d’un modèle causal, l’identification des besoins d’apprentissage, la reconnaissance de la prépondérance, la synthèse et la réflexion.. Conclusion : Puisque l’approche proposée n’a pas été mise en place auparavant, ses implications pratiques nécessitent des recherches, qui contribueront au domaine émergent du raisonnement abductif dans le cadre de la formation en sciences infirmières

Conceptualizing and validating the human services integration measure

PURPOSES: This paper proposes both a model and a measure of human service integration through strategic alliances with autonomous services as one way to achieve comprehensive health and social services for target populations. THEORY: Diverse theories of integrated service delivery and collaboration were combined reflecting integration along a continuum of care within a service sector, across service sectors and between public, not-for-profit and private sectors of financing services. METHODS: A measure of human service integration is proposed and tested. The measure identifies the scope and depth of integration for each sector and service that make up a total service network. It captures in quantitative terms both intra and inter sectoral service integration. RESULTS: Results are provided using the Human Service Measure in two networks of services involved in promoting Healthy Babies and Healthy Children known to have more and less integration. CONCLUSIONS: The instrument demonstrated discriminate validity with scores correctly distinguishing the two networks. The instrument does not correlate (r=0.13) with Weiss (2001) measure of partnership synergy confirming that it measures a distinct component of integration. DISCUSSION: We recommend the combined use of the proposed measure and the Weiss (2001) measure to more completely capture the scope and depth of integration efforts as well as the nature of the functioning of a service program or network

Core Interprofessional Education (IPE) health competencies: The process of adaptation and implementation for a local environment

IPE: Interprofessional Healthcare Education (IPE) competencies provide the criteria against which to measure the capacity and capability of fully collaborative healthcare teams to learn and work together. Significant work already exists in the determination of IPE competencies across all disciplines. Although there is still a lack of agreement on a single set of shared core competencies, successive competency iterations enhance its development. IPE competencies need to take into account local and cultural contexts as recommended by WHO, (2010). Here we present a collaborative process that builds on existing competency development, assessing additional academic IPE needs. Core competencies: After the development of a set of shared core IPE competencies a two-day workshop was delivered to healthcare students from four professions. The results and feedback from students showed the value of the competencies. We discuss the evolving process through two major stages: (1) development of a model determining four ..

The Development of Competencies in Interprofessional Health Care for Use in Health Science Educational Programs

Background: The Health Education Technology Research Unit (HETRU) at the University of Ontario Institute of Technology (UOIT) has developed an interprofessional framework for use as a learning map to create computer-based simulations that can automatically assess interprofessional competencies of undergraduate health sciences students.Methods: Our interprofessional competency framework was developed through an iterative process of competency mapping. Each iteration involved: 1) a literature review of interprofessional competencies, 2) the mapping of these competencies within a meaningful taxonomy, and 3) the review of the mapping by an expert panel of educators and clinicians.Findings and Conclusions: After three iterations, the research team developed a competency taxonomy that mapped interprofessional competencies from our literature reviews into six competency domains and three cross-cutting themes for each domain. The competency matrix was then used as a learning map to define learning resources related to interprofessional education and learning activities associated with such resources to help students develop competencies in interprofessional healthcare planning and delivery. Interactive, computer-based clinical simulations were then developed to portray opportunities in which the learning resources and activities could be explored and to provide more realistic exposure to complexities in healthcare planning and delivery

Insights into the subsurface structure of the Caloris basin, Mercury, from assessments of mechanical layering and changes in long-wavelength topography

The volcanic plains that fill the Caloris basin, the largest recognized impact basin on Mercury, are deformed by many graben and wrinkle ridges, among which the multitude of radial graben of Pantheon Fossae allow us to resolve variations in the depth extent of associated faulting. Displacement profiles and displacement-to-length scaling both indicate that faults near the basin center are confined to a ~ 4-km-thick mechanical layer, whereas faults far from the center penetrate more deeply. The fault scaling also indicates that the graben formed in mechanically strong material, which we identify with dry basalt-like plains. These plains were also affected by changes in long-wavelength topography, including undulations with wavelengths of up to 1300 km and amplitudes of 2.5 to 3 km. Geographic correlation of the depth extent of faulting with topographic variations allows a first-order interpretation of the subsurface structure and mechanical stratigraphy in the basin. Further, crosscutting and superposition relationships among plains, faults, craters, and topography indicate that development of long-wavelength topographic variations followed plains emplacement, faulting, and much of the cratering within the Caloris basin. As several examples of these topographic undulations are also found outside the basin, our results on the scale, structural style, and relative timing of the topographic changes have regional applicability and may be the surface expression of global-scale interior processes on Mercury

Insights into the subsurface structure of the Caloris basin, Mercury, from assessments of mechanical layering and changes in long-wavelength topography

The volcanic plains that fill the Caloris basin, the largest recognized impact basin on Mercury, are deformed by many graben and wrinkle ridges, among which the multitude of radial graben of Pantheon Fossae allow us to resolve variations in the depth extent of associated faulting. Displacement profiles and displacement-to-length scaling both indicate that faults near the basin center are confined to a ~ 4-km-thick mechanical layer, whereas faults far from the center penetrate more deeply. The fault scaling also indicates that the graben formed in mechanically strong material, which we identify with dry basalt-like plains. These plains were also affected by changes in long-wavelength topography, including undulations with wavelengths of up to 1300 km and amplitudes of 2.5 to 3 km. Geographic correlation of the depth extent of faulting with topographic variations allows a first-order interpretation of the subsurface structure and mechanical stratigraphy in the basin. Further, crosscutting and superposition relationships among plains, faults, craters, and topography indicate that development of long-wavelength topographic variations followed plains emplacement, faulting, and much of the cratering within the Caloris basin. As several examples of these topographic undulations are also found outside the basin, our results on the scale, structural style, and relative timing of the topographic changes have regional applicability and may be the surface expression of global-scale interior processes on Mercury

Deformation Associated with Ghost Craters and Basins in Volcanic Smooth Plains on Mercury: Strain Analysis and Implications for Plains Evolution

Since its insertion into orbit about Mercury in March 2011, the MESSENGER spacecraft has imaged most previously unseen regions of the planet in unprecedented detail, revealing extensive regions of contiguous smooth plains at high northern latitudes and surrounding the Caloris basin. These smooth plains, thought to be emplaced by flood volcanism, are populated with several hundred ghost craters and basins, nearly to completely buried impact features having rims for which the surface expressions are now primarily rings of deformational landforms. Associated with some ghost craters are interior groups of graben displaying mostly polygonal patterns. The origin of these graben is not yet fully understood, but comparison with numerical models suggests that the majority of such features are the result of stresses from local thermal contraction. In this paper, we highlight a previously unreported category of ghost craters, quantify extensional strains across graben-bearing ghost craters, and make use of graben geometries to gain insights into the subsurface geology of smooth plains areas. In particular, the style and mechanisms of graben development imply that flooding of impact craters and basins led to substantial pooling of lavas, to thicknesses of ∼1.5 km. In addition, surface strains derived from groups of graben are generally in agreement with theoretically and numerically derived strains for thermal contraction