Simulations of a monolithic lanthanum bromide gamma-ray detector

We have been working on the development of a detector design for a large area coded aperture imaging system operating in the 10-600 keV energy range. The detector design is based on an array of Lanthanum Bromide (LaBr3) scintillators, each directly coupled to a Hamamatsu 64-channel multi-anode photomultiplier tube (MAPMT). This paper focuses on the development of the GEANT4-based simulations as an aid in the optimization of the detector design. The simulations have been validated by comparisons with various laboratory data sets. We will summarize the current status and latest findings from this study

In search of knowledge and understanding: working with individuals suffering from serious mental illness and their families

This research study describes a journey taken by ten health care professionals on an educational course, the English National Board for Nursing, Midwifery and Health Visiting (ENB) A28, which aimed to enable them to develop the therapeutic skills and confidence to work effectively with the families/carers of individuals suffering from a major mental illness. Their previous education and training had not equipped them to meet the clinical demands now made of them since the focus of mental health care relocated from hospital to the • community' . The course was based in a Family Intervention Service provided in an Inner London Mental Health Trust whose clinicians had developed a treatment model which they termed 'psychosocial' and combined systemic theory. expressed emotion research findings and limited behavioural methods. Grounded Theory was the chosen research method for this study as it was important to be able to access the experience and views of each student as they emerged. The students were interviewed twice, using a semi-structured interview schedule: at the beginning of the course and within three months after its completion. The questions posed at interview were informed following a pilot study of eight of the previous year's students. The students concluded that three elements in the course teaching had most contributed to achieving their aims; theory, practice and live supervision. The role of management and its influence in the clinical life of the students emerged as important. Consequently eight managers were interviewed and revealed the degree to which they supported both the students and the aims of the course. On this depended whether the Trust's clinical services would be able to maximise the benefits from its investment in this educational resource. A retrospective study by questionnaire. and subsidiary to the main investigation. is reported on in Appendices A through F. It focussed on the experience of students who had successfully completed the course during the previous years since its validation. As in the main study. the questionnaire was formulated from information given following a pilot study of eight of the previous year's student group. The aim was to ascertain the long term effects on their clinical practice. The results were analysed using a descriptive analysis technique. Although there had been changes to the original course. the findings were similar to those in the main study and showed the importance of theoretical understanding and supervised practice. Overall. the findings indicate that the respondents valued the systemic approach which was the cornerstone of the educational experience and continued to exert an influence on their practice. They gained an awareness of the extent to which social and family systems impacted on the lives of individuals during the lengthy course of major mental illness

Plans for the next GRAPE balloon flight

The Gamma RAy Polarimeter Experiment (GRAPE) was first flown on a 26-hour balloon flight in the fall of 2011. GRAPE consists of an array of Compton polarimeter modules (based on traditional scintillation technologies) designed to operate in the energy range from 50 keV up to 500 keV. The ultimate goal is to operate GRAPE in a wide FoV configuration for the study of gamma-ray bursts. For the first (demonstration) balloon flight, GRAPE was configured in a collimated mode to facilitate observations of known point sources. The Crab nebula/pulsar, the active Sun, and Cygnus X-1 were the primary targets for the first flight. Although the Crab was detected, the polarization sensitivity was worse than expected. This paper will review the plans for the next GRAPE balloon flight, which is scheduled to take place in the fall of 2014 from Ft. Sumner, NM. These plans involve several modifications designed to improve the polarization sensitivity, including an expansion of the array of polarimeter modules from 16 to 24 and improvements to the instrument shielding. Sensitivity estimates of the resulting instrument, based on GEANT4 simulations, will be presented

Development and implementation of a new service delivery model for children with disabilities : implications for DCD

There is a general consensus that new service delivery models are needed for children with developmental coordination disorder (DCD). Emerging principles to guide service delivery include the use of graduated levels of intensity and evidence-based services that focus on function and participation. Interdisciplinary, community-based service delivery models based on best practice principles are needed. In this case report, we propose the Apollo model as an example of an innovative service delivery model for children with DCD. We describe the context that led to the creation of a program for children with DCD, describe the service delivery model and services, and share lessons learned through implementation. The Apollo model has 5 components: first contact, service delivery coordination, community-, group- and individual-interventions. This model guided the development of a streamlined set of services offered to children with DCD, including early-intake to share educational information with families, community interventions, inter-disciplinary and occupational therapy groups and individual interventions. Following implementation of the Apollo model, waiting times decreased and numbers of children receiving services increased, without compromising service quality. Lessons learned are shared to facilitate development of other practice models to support children with DCD

Cholecystectomy Is Risker in Male Patients

Introduction: While cholecystitis has a female preponderance, some observe a trend towards more challenging disease in male patients. The confluence of sex and patient acuity has not been thoroughly investigated. We hypothesize that men present with worse disease compared with women, as evidenced by higher rates of open surgery and higher resource consumption. Methods: An inpatient registry from a 5-hospital system was queried for cholecystectomy procedures not associated with neoplasm or malignancy. Cases from 2015 to 2021 were included. Demographics, clinical and outcome variables were analyzed. Univariate analysis and multivariate logistic regression were performed. The data were de-identified before analysis and deemed exempt from IRB review, and were analyzed using R within R-Studio. Results: There were 2789 cholecystectomy patients, 1616 (58%) were women and 1173 (42%) were men. Demographics and baseline health characteristics differed across sex. Univariate analysis highlighted that males experienced more harms (1.35 vs 1.14; p = 0.002), more open approaches (18% vs 11%; p \u3c 0.001), longer inpatient lengths of stays (median: 4 vs 3 days; p \u3c 0.001), higher hospital cost ($15,694 vs$13,173; p \u3c 0.001), increased laboratory orders (37.65 vs 30.01; p \u3c 0.001), higher MS-DRG weight (2.104 vs 1.842; p \u3c 0.001) and greater mortality risk (56% vs 36%; p \u3c 0.001). Further, multivariate analysis found male cholecystectomy patients were correlated with higher instances of open surgical approach (OR: 1.80; p \u3c 0.001), hospital readmission (OR: 1.50; p = 0.008), and higher cost (β: $981; R2: 0.27; p = 0.006). Conclusion: Inpatient male cholecystectomy patients present with worse disease and require more hospital resources

P2Y2 nucleotide receptors mediate inflammatory responses in mouse salivary gland cells

Abstract only availableSjögren's syndrome (SS) is a chronic inflammatory autoimmune disease characterized by destruction of salivary and lacrimal glands leading to xerostomia (dry mouth) and xerophthalmia (dry eyes). Although the mechanisms involved have not been adequately elucidated, the diminished function of exocrine glands in SS is often associated with lymphocytic infiltration of the tissue. Aberrant expression of specific adhesion molecules such as vascular cell adhesion molecule-1 (VCAM-1) and intracellular cell adhesion molecule-1 (ICAM-1) is also observed in salivary gland with SS, which enable salivary epithelium to interact directly with infiltrating lymphocytes. P2Y2 nucleotide receptor (P2Y2R) is G protein-couple receptor that is activated by extracellular ATP and UTP. P2Y2R expression and activity is up-regulated in response to damage or stress in a variety of tissues, including submandibular glands (SMGs), where it mediates a complex set of cellular responses to injury of disease. Additionally, P2Y2R activation up-regulates VCAM-1 expression in dispersed rat SMG cell culture and human submandibular gland (HSG) cells. Our objective is to investigate weather P2Y2R up-regulation correlates with increased expression of adhesion molecules in SMGs from a mouse model for SS (C57BL/6.NOD-Aec1Aec2) as compared with normal mouse strain (C57BL/6). P2Y2R expression was measured by RT-PCR and adhesion molecules expression was determined by Western blot analysis. Salivary flow was preformed by cannulation of individual glands. We could see that P2Y2R expression and ICAM-1 expression were both up-regulated in the SMGs from a mouse model for SS as compared with normal mouse strain. And salivary flow was decreased in salivary glands from a mouse model for SS. These results suggest that P2Y2R mediate inflammatory responses related to secretory dysfunction in the mouse model for SS. Our ultimate goal would be to translate all this information to the human salivary gland in order to understand SS and to develop new therapies for salivary dysfunction in SS.Gyeongsang National Universit

Working with physical therapists to develop and evaluate an evidence-based online module for Developmental Coordination Disorder (DCD): bridging the knowledge-to-practice gap

Aims: Developmental Coordination Disorder (DCD) is a chronic condition with potential negative health consequences. Clinicians working with children with DCD need access to tailored, synthesized, evidence-based DCD information; however a knowledge-to-practice gap exists. The aim of this study was to develop and evaluate an evidence-based online DCD module tailored to physical therapists’ (PTs) identified needs. Methods: Guided by the Knowledge to Action framework, we interviewed PTs working with children with DCD (n=9) to identify their information needs. Their recommendations, along with synthesized DCD research evidence, informed module development. PTs (n=50) responded to scaled items and open-ended questions to evaluate module usefulness. Results: The module incorporated important PT DCD content areas including: 1) Identification; 2) Planning Interventions and Goals; 3) Evidence-Based Practice; 4) Management; and, 5) Resources. Case scenarios, clinical applications, interactive media, links to resources, and interactive learning opportunities were also embedded. PTs perceived the module to be comprehensive and useful and provided feedback to improve module navigation. Conclusions: Involving end-users throughout the development and evaluation of an online PT DCD module contributed to its relevance, applicability, and utility. The ongoing clinical use of this module may have the potential to improve the quality of PT DCD services

Bcl11b and combinatorial resolution of cell fate in the T-cell gene regulatory network

T-cell development from hematopoietic progenitors depends on multiple transcription factors, mobilized and modulated by intrathymic Notch signaling. Key aspects of T-cell specification network architecture have been illuminated through recent reports defining roles of transcription factors PU.1, GATA-3, and E2A, their interactions with Notch signaling, and roles of Runx1, TCF-1, and Hes1, providing bases for a comprehensively updated model of the T-cell specification gene regulatory network presented herein. However, the role of lineage commitment factor Bcl11b has been unclear. We use self-organizing maps on 63 RNA-seq datasets from normal and perturbed T-cell development to identify functional targets of Bcl11b during commitment and relate them to other regulomes. We show that both activation and repression target genes can be bound by Bcl11b in vivo, and that Bcl11b effects overlap with E2A-dependent effects. The newly clarified role of Bcl11b distinguishes discrete components of commitment, resolving how innate lymphoid, myeloid, and dendritic, and B-cell fate alternatives are excluded by different mechanisms

Development, implementation, and evaluation of the Apollo model of pediatric rehabilitation service delivery

This article presents the experience of a rehabilitation program that un- dertook the challenge to reorganize its services to address accessibility issues and im- prove service quality. The context in which the reorganization process occurred, along with the relevant literature justifying the need for a new service delivery model, and an historical perspective on the planning; implementation; and evaluation phases of the process are described. In the planning phase, the constitution of the working committee, the data collected, and the information found in the literature are presented. Apollo, the new service delivery model, is then described along with each of its components (e.g., community, group, and individual interventions). Actions and lessons learnt during the implementation of each component are presented. We hope by sharing our experiences that we can help others make informed decisions about service reorganization to im- prove the quality of services provided to children with disabilities, their families, and their communities

Factor structure and construct validity of the Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer)

Background: The ASCOT-Carer is a self-report instrument designed to measure social care-related quality of life (SCRQoL). This article presents the psychometric testing and validation of the ASCOT-Carer four response-level interview (INT4) in a sample of unpaid carers of adults who receive publicly-funded social care services in England. Methods: Unpaid carers were identified through a survey of users of publicly-funded social care services in England. 387 carers completed a face-to-face or telephone interview. Data on variables hypothesised to be related to SCRQoL (for example, characteristics of the carer, cared-for person and care situation) and measures of carer experience, strain, health-related quality of life and overall QoL were collected. Relationships between these variables and overall SCRQoL score were evaluated through correlation, ANOVA and regression analysis to test the construct validity of the scale. Internal reliability was assessed using Cronbach’s alpha and feasibility by the number of missing responses. Results: The construct validity was supported by statistically significant relationships between SCRQoL and scores on instruments of related constructs, as well as with characteristics of the carer and care recipient in univariate and multivariate analyses. A Cronbach’s alpha of 0.87 (7 items) indicates that the internal reliability of the instrument is satisfactory and a low number of missing responses (<1%) indicates a high level of acceptance. Conclusions: The results provide evidence to support the construct validity, factor structure, internal reliability and feasibility of the ASCOT-Carer INT4 as an instrument for measuring social care-related quality of life of unpaid carers who care for adults with a variety of long-term conditions, disability or problems related to old age