Supporting Survivors of Public Mass Shootings

Mass casualty incidents, particularly mass shootings, are a serious issue in the United States. These incidents have increased over the past two decades and more than 32 public mass shootings have occurred since 2016, with approximately 12.8 incidents occurring each year. Since 1966, there have been over 1,202 fatalities and countless injuries due to public mass shooting incidents. Therefore, it is essential that professional counselors are equipped to treat primary, secondary, and tertiary victims of these incidents. The purpose of this article is to examine the current literature on public mass shootings, including psychological consequences, treatment considerations, ethical and legal issues, and cultural factors. Vicarious traumatization and self-care are also explored. Recommendations for training and resources are offered, and implications for professional counselors and counselor trainees are discussed

Perceptions of Grief Education in Accredited Counseling Programs: Recommendations for Counselor Education

As grief can be considered a critical life event, unresolved grief can interfere with quality of life, affecting lifestyle, behavior, emotional strength, and cognitive function. Unresolved grief can even result in suicidal ideation. Counselors can and often do work with grief issues in clients and can promote positive outcomes for grieving clients by addressing personal loss and helping clients process grief related issues. This study was based on an analysis of students within counseling programs accredited by the Council for Accreditation of Counseling and Related Educational Programs based on earlier research conducted by one of the authors. Self-perception of competency in counseling clients who are having grief-related issues from loss was assessed using the Grief Counseling Competency Scale. By analyzing results of the Grief Counseling Competency Scale, participants showed a need for further training in grief counseling skills and theory. Results and implications of the quantitative analysis as well as suggestions for further study are discussed

Leadership Skill Development in Master’s-Level Counselor Education

Student leadership identity is fast becoming one of the most critical challenges educational institutions face today. However, mental health counselors may be limited in the amount of education and training received as they become leaders in the field. There is currently no known mandate at the master’s level for leadership embedded within the counseling curriculum in the educational environment, although research suggests otherwise. The purpose of this correlational predictive empirical study was to investigate leadership identity characteristics as measured by the Socially Responsible Leadership Scale, Revision 2 (SLRS-R2), moderated by demographic factors. Multiple regression analysis was used to determine outcome measures of the SLRS-R2 relating to leadership. Conclusions and suggestions for future practice regarding leadership skill development are provided

The impact of protocol assignment for older adolescents with Hodgkin lymphoma

Background and Purpose: Hodgkin lymphoma (HL) treatment has evolved to reduce or avoid radiotherapy (RT) dose and volume and minimize the potential for late effects. Some older adolescents are treated on adult protocols. The purpose of this study is to examine the protocol assignment of older adolescents and its impact on radiation dose to relevant thoracic structures. Materials and Methods: Cooperative group data were reviewed and 12 adolescents were randomly selected from a pediatric HL protocol. Treatment plans were generated per one pediatric and two adult protocols. Dose volume histograms for heart, lung, and breast allowed comparison of radiation dose to these sites across these three protocols. Results: A total of 15.2% of adolescents were treated on adult HL protocols and received significantly higher radiation dosage to heart and lung compared to pediatric HL protocols. Adolescents treated on either pediatric or adult protocols received similar RT dose to breast. Conclusion: Older adolescents treated on adult HL protocols received higher RT dose to thoracic structures except breast. Level of nodal involvement may impact overall RT dose to breast. The impact of varying field design and RT dose on survival, local, and late effects needs further study for this vulnerable age group

Imaging and Neuro-Oncology Clinical Trials of the National Clinical Trials Network (NCTN)

Imaging in neuro-oncology clinical trials can be used to validate patient eligibility, stage at presentation, response to therapy, and radiation therapy. A number of National Clinical Trials Network trials illustrating this are presented. Through the Imaging and Radiation Oncology Core’s quality assurance processes for data acquisition and review, there are uniform data and imaging sets for review. Once the trial endpoints have been analyzed and published, the clinical trial information including pathology, imaging, and radiation therapy objects can be moved to a public archive for use by investigators interested in translational science and the application of new informatics tools for trial analysis

Cerebrovascular and blood-brain barrier impairments in Huntington's disease: Potential implications for its pathophysiology: Vascular impairments in HD

ObjectiveAlthough the underlying cause of Huntington's disease (HD) is well established, the actual pathophysiological processes involved remain to be fully elucidated. In other proteinopathies such as Alzheimer's and Parkinson's diseases, there is evidence for impairments of the cerebral vasculature as well as the blood–brain barrier (BBB), which have been suggested to contribute to their pathophysiology. We investigated whether similar changes are also present in HD.MethodsWe used 3‐ and 7‐Tesla magnetic resonance imaging as well as postmortem tissue analyses to assess blood vessel impairments in HD patients. Our findings were further investigated in the R6/2 mouse model using in situ cerebral perfusion, histological analysis, Western blotting, as well as transmission and scanning electron microscopy.ResultsWe found mutant huntingtin protein (mHtt) aggregates to be present in all major components of the neurovascular unit of both R6/2 mice and HD patients. This was accompanied by an increase in blood vessel density, a reduction in blood vessel diameter, as well as BBB leakage in the striatum of R6/2 mice, which correlated with a reduced expression of tight junction‐associated proteins and increased numbers of transcytotic vesicles, which occasionally contained mHtt aggregates. We confirmed the existence of similar vascular and BBB changes in HD patients.InterpretationTaken together, our results provide evidence for alterations in the cerebral vasculature in HD leading to BBB leakage, both in the R6/2 mouse model and in HD patients, a phenomenon that may, in turn, have important pathophysiological implications. Ann Neurol 2015;78:160–17

Acquisition and Management of Data for Translational Science in Oncology

Oncology clinical trials provide opportunity to advance care for patients with cancer. Bridging basic science with bedside care, cancer clinical trials have brought new and updated scientific knowledge at a rapid pace. Managing subject data in translation science requires a sophisticated informatics infrastructure that will enable harmonized datasets across all areas that could influence outcomes. Successful translational science requires that all relevant information be made readily available in a digital format that can be queried in a facile manner. Through a translational science prism, we look at past issues in cancer clinical trials and the new National Institutes of Health/National Cancer Institute initiative to address the need of database availability at an enterprise level

Observations of MeV electrons in Jupiter's innermost radiation belts and polar regions by the Juno radiation monitoring investigation: Perijoves 1 and 3

Juno's "Perijove 1" (27 August 2016) and "Perijove 3" (11 December 2016) flybys through the innermost region of Jupiter's magnetosphere (radial distances J at closest approach) provided the first in situ look at this region's radiation environment. Juno's Radiation Monitoring Investigation collected particle counts and noise signatures from penetrating high-energy particle impacts in images acquired by the Stellar Reference Unit and Advanced Stellar Compass star trackers, and the Jupiter Infrared Auroral Mapper infrared imager. This coordinated observation campaign sampled radiation at the inner edges of the high-latitude lobes of the synchrotron emission region and more distant environments. Inferred omnidirectional >5 MeV and >10 MeV electron fluxes derived from these measurements provide valuable constraints for models of relativistic electron environments in the inner radiation belts. Several intense bursts of high-energy particle counts were also observed by the Advanced Stellar Compass in polar regions outside the radiation belts

A Deep Learning Approach Validates Genetic Risk Factors for Late Toxicity After Prostate Cancer Radiotherapy in a REQUITE Multi-National Cohort.

Background: REQUITE (validating pREdictive models and biomarkers of radiotherapy toxicity to reduce side effects and improve QUalITy of lifE in cancer survivors) is an international prospective cohort study. The purpose of this project was to analyse a cohort of patients recruited into REQUITE using a deep learning algorithm to identify patient-specific features associated with the development of toxicity, and test the approach by attempting to validate previously published genetic risk factors. Methods: The study involved REQUITE prostate cancer patients treated with external beam radiotherapy who had complete 2-year follow-up. We used five separate late toxicity endpoints: ≥grade 1 late rectal bleeding, ≥grade 2 urinary frequency, ≥grade 1 haematuria, ≥ grade 2 nocturia, ≥ grade 1 decreased urinary stream. Forty-three single nucleotide polymorphisms (SNPs) already reported in the literature to be associated with the toxicity endpoints were included in the analysis. No SNP had been studied before in the REQUITE cohort. Deep Sparse AutoEncoders (DSAE) were trained to recognize features (SNPs) identifying patients with no toxicity and tested on a different independent mixed population including patients without and with toxicity. Results: One thousand, four hundred and one patients were included, and toxicity rates were: rectal bleeding 11.7%, urinary frequency 4%, haematuria 5.5%, nocturia 7.8%, decreased urinary stream 17.1%. Twenty-four of the 43 SNPs that were associated with the toxicity endpoints were validated as identifying patients with toxicity. Twenty of the 24 SNPs were associated with the same toxicity endpoint as reported in the literature: 9 SNPs for urinary symptoms and 11 SNPs for overall toxicity. The other 4 SNPs were associated with a different endpoint. Conclusion: Deep learning algorithms can validate SNPs associated with toxicity after radiotherapy for prostate cancer. The method should be studied further to identify polygenic SNP risk signatures for radiotherapy toxicity. The signatures could then be included in integrated normal tissue complication probability models and tested for their ability to personalize radiotherapy treatment planning