Critical Thinking and Transformational Learning: Using Case Studies as Narrative Frameworks for Threshold Concepts

Critical thinking is an essential component to the occupational therapy process that is a timely skill with the rapid pace of change in our healthcare system. Critical thinking exposes assumptions, biases, beliefs and points of view and challenges a shift in epistemology by asking, ‘how do we know what we believe to know?’ Case studies are a tool to engage the learner in critical thinking and are commonly employed in occupational therapy curricula. Social determinants of health (SDH) describe environmental circumstances that affect health. The authors propose that SDH, embedded in case studies, serve as a threshold concept. A threshold concept serves as a means of transformative learning and promotion of critical thinking in occupational therapy education. Social determinants of health taught through case study presentation represent the authentic complex lives of those therapists serve, bolster student critical thinking, and help to consider the multiple perspectives that may challenge long held beliefs. Qualitative content analysis of 59 case studies for SDH content across one curriculum and five semesters, revealed cases built on client factors and foundational knowledge with missed opportunity to add SDH context. Eleven guidelines for case development are proposed to foster transformational learning. Intentional instructional approaches can assist educational programs to develop the professional change agents needed to serve communities and populations with a larger goal of health equity

In vivo anomalous diffusion and weak ergodicity breaking of lipid granules

Combining extensive single particle tracking microscopy data of endogenous lipid granules in living fission yeast cells with analytical results we show evidence for anomalous diffusion and weak ergodicity breaking. Namely we demonstrate that at short times the granules perform subdiffusion according to the laws of continuous time random walk theory. The associated violation of ergodicity leads to a characteristic turnover between two scaling regimes of the time averaged mean squared displacement. At longer times the granule motion is consistent with fractional Brownian motion.Comment: 4 pages, 4 figures, REVTeX. Supplementary Material. Physical Review Letters, at pres

Supporting Parental Decisions About Genomic Sequencing for Newborn Screening: The NC NEXUS Decision Aid

Advances in genomic sequencing technology have raised fundamental challenges to the traditional ways genomic information is communicated. These challenges will become increasingly complex and will affect a much larger population in the future if genomics is incorporated into standard newborn screening practice. Clinicians, public health officials, and other stakeholders will need to agree on the types of information that they should seek and communicate to parents. Currently, few evidence-based and validated tools are available to support parental informed decision-making. These tools will be necessary as genomics is integrated into clinical practice and public health systems. In this article we describe how the North Carolina Newborn Exome Sequencing for Universal Screening study is addressing the need to support parents in making informed decisions about the use of genomic testing in newborn screening. We outline the context for newborn screening and justify the need for parental decision support. We also describe the process of decision aid development and the data sources, processes, and best practices being used in development. By the end of the study, we will have an evidenced-based process and validated tools to support parental informed decision-making about the use of genomic sequencing in newborn screening. Data from the study will help answer important questions about which genomic information ought to be sought and communicated when testing newborns

Erratum to: How Can Psychological Science Inform Research About Genetic Counseling for Clinical Genomic Sequencing?

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147141/1/jgc40372.pd

How Can Psychological Science Inform Research About Genetic Counseling for Clinical Genomic Sequencing?

Next generation genomic sequencing technologies (including whole genome or whole exome sequencing) are being increasingly applied to clinical care. Yet, the breadth and complexity of sequencing information raise questions about how best to communicate and return sequencing information to patients and families in ways that facilitate comprehension and optimal health decisions. Obtaining answers to such questions will require multidisciplinary research. In this paper, we focus on how psychological science research can address questions related to clinical genomic sequencing by explaining emotional, cognitive, and behavioral processes in response to different types of genomic sequencing information (e.g., diagnostic results and incidental findings). We highlight examples of psychological science that can be applied to genetic counseling research to inform the following questions: (1) What factors influence patients’ and providers’ informational needs for developing an accurate understanding of what genomic sequencing results do and do not mean?; (2) How and by whom should genomic sequencing results be communicated to patients and their family members?; and (3) How do patients and their families respond to uncertainties related to genomic information?Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147034/1/jgc40193.pd

International Guillain-Barré Syndrome Outcome Study (IGOS): protocol of a prospective observational cohort study on clinical and biological predictors of disease course and outcome in Guillain-Barré syndrome

Guillain-Barré syndrome (GBS) is an acute polyradiculoneuropathy with a highly variable clinical presentation, course, and outcome. The factors that determine the clinical variation of GBS are poorly understood which complicates the care and treatment of individual patients. The protocol of the ongoing International GBS Outcome Study (IGOS), a prospective, observational, multi-centre cohort study that aims to identify the clinical and biological determinants and predictors of disease onset, subtype, course and outcome of GBS is presented here. Patients fulfilling the diagnostic criteria for GBS, regardless of age, disease severity, variant forms, or treatment, can participate if included within two weeks after onset of weakness. Information about demography, preceding infections, clinical features, diagnostic findings, treatment, course and outcome is collected. In addition, cerebrospinal fluid and serial blood samples for serum and DNA is collected at standard time points. The original aim was to include at least 1000 patients with a follow-up of 1-3 years. Data are collected via a web-based data entry system and stored anonymously. IGOS started in May 2012 and by January 2017 included more than 1400 participants from 143 active centres in 19 countries across 5 continents. The IGOS data/biobank is available for research projects conducted by expertise groups focusing on specific topics including epidemiology, diagnostic criteria, clinimetrics, electrophysiology, antecedent events, antibodies, genetics, prognostic modelling, treatment effects and long-term outcome of GBS. The IGOS will help to standardize the international collection of data and biosamples for future research of GBS. ClinicalTrials.gov Identifier: NCT01582763

Human induced pluripotent stem cell-derived endothelial cells in thrombosis-on-a-chip devices

A microfluidic thrombosis-on-a-chip platform was developed to compare the pro-thrombotic response of healthy and inflamed monolayers of human umbilical vein endothelial cells (HUVECs) and human induced pluripotent stem cell-derived endothelial cells (hiPSC-ECs). Inflammation was induced by exposing the endothelial cells (ECs) to an inflammatory cytokine Tumor Necrosis Factor-α (TNF-α). After human whole blood perfusion at an arterial shear rate, the platelet coverage and average clot size were determined. Healthy endothelium showed a lower platelet coverage than inflamed endothelium. A minor difference was measured for both platelet coverage and average clot sizes on inflamed HUVECs versus hiPSC-ECs