Group Workshops for Advance Care Planning

The issue of Advanced Care Planning (ACP) is a pressing public health concern. The most opportune environment for effective ACP is in the primary care setting, though barriers such as time limitations and provider discomfort with the subject can be difficult to overcome. We worked with a county health clinic to create a referral process for group sessions. Over an eight-week period, data on 285 encounters was collected, which revealed breakdown in the chart review and referral process. Despite this, our innovation did increase ACP and can provide insight for others seeking to implement ACP related workflow changes

Evaluation of the Selective Anti-Cancer Activity of Natural and Synthetic Alkaloids

Cancer is a disease of uncontrolled cell growth and proliferation that is predicted to directly affect one-third of Canadians. Standard chemotherapy, which targets DNA or its replicative machinery, effectively eradicates cancer cells but also causes non-specific toxicity to non-cancerous cells. Pancratistatin is a natural alkaloid isolated from Hymenocallis littoralis found to selectively induce apoptosis (programmed cell death) in numerous human cancer cell lines with an insignificant effect on non-cancerous cells. The major objectives of this study were to: 1) assess the selectivity and efficacy of pancratistatin and synthetic derivatives on patient-obtained and commercially available leukemia models; 2) test the effect of pancratistatin on human colon and prostate cancer cells in vitro and in vivo; and 3) to determine the mechanism of action of pancratistatin. Results suggested that 1 ┬╡M pancratistatin induces apoptosis in leukemia ex vivo with an insignificant effect on non-cancerous peripheral blood mononuclear cells. Apoptosis was monitored by nuclear staining and phosphatidylserine exposure by microscopy and flow cytometry. Structure-activity relationship screening of synthetic derivatives of pancratistatin on leukemia (Jurkat) cells revealed that certain analogs retain activity of the native compound, albeit at higher concentrations. The effects of pancratistatin on colon (HCT116, HT-29) and prostate (LNCaP, DU145) cancer cell lines, expressing either the wild-type or functionally inactive p53 tumor suppressor protein, were studied using cell-based assays and animal models. Pancratistatin treatment caused increased production of reactive oxygen species, collapse of mitochondrial membrane potential, and release of the pro-apoptotic proteins cytochrome c, apoptosis-inducing factor and endonuclease G to the cytosol. Furthermore, pancratistatin induced cell death independent of p53, caspase activation or Bax expression. Importantly, components of the mitochondrial respiratory chain were deemed crucial for pancratistatin activity, as mtDNA-deficient \u27Rho-0\u27 cells were resistant to pancratistatin. A significant finding of this study was that pancratistatin reduced growth of human colon and prostate tumor xenografts in immune-compromised mice, was well-tolerated and determined to be non-toxic to vital organs compared to control. In conclusion, pancratistatin is a natural anti-cancer compound that selectively targets cancer cell mitochondria to induce apoptosis and significantly reduces growth of human tumor xenografts

Pancratistatin induces apoptosis in clinical leukemia samples with minimal effect on non-cancerous peripheral blood mononuclear cells

<p>Abstract</p> <p>Background</p> <p>Pancratistatin, a natural compound extracted from <it>Hymenocallis littoralis</it>, can selectively induce apoptosis in several cancer cell lines. In this <it>ex vivo </it>study, we evaluated the effect of pancratistatin on peripheral blood mononuclear cells obtained from 15 leukemia patients prior to clinical intervention of newly diagnosed patients, as well as others of different ages in relapse and at various disease progression states.</p> <p>Results</p> <p>Mononuclear cells from healthy volunteers and leukemia patients were exposed to 1 μM pancratistatin for up to 48 h. Irrespective of leukemia type, pancratistatin induced apoptosis in the leukemic samples, with minimal effects on non-cancerous peripheral blood mononuclear control cells.</p> <p>Conclusion</p> <p>Our results show that pancratistatin is an effective and selective anti-cancer agent with potential for advancement to clinical trials.</p

Modification of the Rosenberg Scale to Assess Self-Esteem in Children

Rosenberg's scale (RSES) is widely used to assess global self-esteem (SE) in adults and adolescents but is not validated for children 0.05); but were significantly reduced in children aged 9–10 and 11–12 years compared to children aged 7–8 years. The global SE score was significantly correlated (r = 0.51; P < 0.001) with LS. The current version of the CRSES can reliably examine global SE in children aged 7–12 years; extending the use of the RSES to allow tracking across the life course

Cognitive and behavioural strategies employed to overcome "lapses" and prevent "relapse" among weight-loss maintainers and regainers: A qualitative study.

While many behavioural weight management programmes are effective in the short-term, post-programme weight regain is common. Overcoming "lapses" and preventing "relapse" has been highlighted as important in weight-loss maintenance, but little is known on how this is achieved. This study aimed to compare the cognitive and behavioural strategies employed to overcome "lapses" and prevent "relapse" by people who had regained weight or maintained weight-loss after participating in a weight management programme. By investigating differences between groups, we intended to identify strategies associated with better weight-loss maintenance. Semi-structured interviews were conducted with 26 participants (58% female) recruited from the 5-year follow-up of the Weight Loss Referrals for Adults in Primary Care (WRAP) trial (evaluation of a commercial weight-loss programme). Participants who had lost ≥5% baseline weight during the active intervention were purposively sampled according to 5-year weight trajectories (n = 16 'Regainers', n = 10 'Maintainers'). Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Key differences in strategies were that Maintainers continued to pay attention to their dietary intake, anticipated and planned for potential lapses in high-risk situations, and managed impulses using distraction techniques. Regainers did not report making plans, used relaxed dietary monitoring, found distraction techniques to be ineffective and appeared to have difficulty navigating food within interpersonal relationships. This study is one of the longest qualitative follow-ups of a weight loss trial to date, offering unique insights into long-term maintenance. Future programmes should emphasize strategies focusing on self-monitoring, planning and managing interpersonal relationships to help participants successfully maintain weight-loss in the longer-term.This study is funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research RP-PG-0216-20010. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. ALA and SJG are supported by the Medical Research Council (MC_UU_12015/4). SJG is an NIHR senior investigator. The University of Cambridge has received salary support in respect of SJG from the National Health Service in the East of England through the Clinical Academic Reserve

Third-wave cognitive behaviour therapies for weight management: A systematic review and network meta-analysis.

This systematic review and network meta-analysis synthesized evidence on the effects of third-wave cognitive behaviour therapies (3wCBT) on body weight, and psychological and physical health outcomes in adults with overweight or obesity. Studies that included a 3wCBT for the purposes of weight management and measured weight or body mass index (BMI) pre-intervention and ≥ 3 months post-baseline were identified through database searches (MEDLINE, CINAHL, Embase, Cochrane database [CENTRAL], PsycINFO, AMED, ASSIA, and Web of Science). Thirty-seven studies were eligible; 21 were randomized controlled trials (RCT) and included in the network meta-analyses. Risk of bias was assessed using RoB2, and evidence quality was assessed using GRADE. Random-effects pairwise meta-analysis found moderate- to high-quality evidence suggesting that 3wCBT had greater weight loss than standard behavioural treatment (SBT) at post-intervention (standardized mean difference [SMD]: -0.09, 95% confidence interval [CI]: -0.22, 0.04; N = 19; I2 = 32%), 12 months (SMD: -0.17, 95% CI: -0.36, 0.02; N = 5; I2 = 33%), and 24 months (SMD: -0.21, 95% CI: -0.42, 0.00; N = 2; I2 = 0%). Network meta-analysis compared the relative effectiveness of different types of 3wCBT that were not tested in head-to-head trials up to 18 months. Acceptance and commitment therapy (ACT)-based interventions had the most consistent evidence of effectiveness. Only ACT had RCT evidence of effectiveness beyond 18 months. Meta-regression did not identify any specific intervention characteristics (dose, duration, delivery) that were associated with greater weight loss. Evidence supports the use of 3wCBT for weight management, specifically ACT. Larger trials with long-term follow-up are needed to identify who these interventions work for, their most effective components, and the most cost-effective method of delivery.This study is funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research RP-PG-0216-20010. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. ALA and SJG are supported by the Medical Research Council (MC_UU_12015/4). SJG is an NIHR senior investigator. The University of Cambridge has received salary support in respect of SJG from the National Health Service in the East of England through the Clinical Academic Reserve.We want to thank the patient user group panel for assisting with the refinement of the research question, and interpretation of results. We would like to thank individuals within the unit that assisted with article language translation, Eleanor Barker for help in developing the search strategy and Rebecca Jones for assisting with database searches. We would also like to thank all corresponding authors of articles that provided additional information or clarity on their studies

Injuries in England and Wales Elite Men’s Domestic Cricket:A nine season review from 2010 to 2018

Objectives: This study primarily aimed to explore injury incidence rates in the three main domestic competition formats in England and Wales (First-Class, One-Day and Twenty20 [T20]). For the first time, the study also describes the epidemiology of elite men's domestic cricket injuries across nine seasons (2010–2018 inclusive). Design: Prospective cohort analysis. Methods: Injury incidence and prevalence from all injuries calculated according to the updated international consensus statement on injury surveillance in cricket, with statistical process control charts (SPC) used to detect trends in the data. Results: The average match injury incidence was 102 injuries/1000 days of play, with highest incidence in One-Day (254 injuries/1000 days of play), followed by T20 (136 injuries/1000 days of play) and First-Class Cricket (68 injuries/1000 days of play). Most match injuries were sustained during bowling (41.6 injuries/1000 days of play), followed by fielding (26.8 injuries/1000 days of play) and batting (22.3 injuries/1000 days of play). The thigh was the body area most commonly injured (7.4 injuries/100 players per season), with lumbar spine injuries the most prevalent (1.3% of players unavailable on any given day during the season). On average, 7.5% of players were unavailable on any given day during the domestic season when all injuries were considered (match and training). The SPC charts showed relatively consistent match injury incidence for all competitions, reproduced across all nine seasons. Conclusion: These findings provide a robust empirical base for the extent of the injury problem in domestic cricket played in England and Wales, with similar injury profiles across the three formats.</p

“Let Our Freak Flags Fly”: Shrek the Musical and the Branding of Diversity

This is the publisher's version, also available electronically from http://muse.jhu.edu/journals/theatre_journal/v062/62.2.brater.html“’Let Our Freak Flags Fly’: Shrek the Musical and the Branding of Diversity” argues that DreamWorks used Shrek the Musical to exploit a generic theme of multiculturalism to extend the reach of the Shrek franchise and challenge Disney’s domination of the Broadway market. By bringing a political-economic analysis to bear on the study of commercial theatre, the essay shows that DreamWorks’s marketing strategy—diversification—provided the theme—diversity—for the product it was employing to implement that strategy. Yet because Shrek’s multicultural message is contradicted by the blatant racial stereotyping of Donkey, Shrek’s “jive-spouting sidekick,” the musical in fact epitomizes the contradictions that inform multiculturalism in the early twenty-first-century marketplace and functions as an unlikely emblem of the Age of Obam