Supervisors behaving badly: Witnessing Ethical Dilemmas and What to Do About It

The NASW Code of Ethics (1996) guides social workers’ professional conduct, but provides little instruction when one’s own supervisor behaves unethically. Using student-collected interviews, we found six typologies of supervisors behaving badly, and used descriptive qualitative analysis to outline steps taken to navigate the situation. Results hold pedagogical relevance to social work practice

Krill availability in adjacent Adélie and gentoo penguin foraging regions near Palmer Station, Antarctica

The Palmer Deep canyon along the West Antarctic Peninsula is a biological hotspot with abundant phytoplankton and krill supporting Adélie and gentoo penguin rookeries at the canyon head. Nearshore studies have focused on physical mechanisms driving primary production and penguin foraging, but less is known about finer-scale krill distribution and density. We designed two acoustic survey grids paired with conductivity–temperature–depth profiles within adjacent Adélie and gentoo penguin foraging regions near Palmer Station, Ant-arctica. The grids were sampled from January to March 2019 to assess variability in krill availability and associations with oceanographic properties. Krill density was similar in the two regions, but krill swarms were longer and larger in the gentoo foraging region, which was also less stratified and had lower chlorophyll concentrations. In the inshore zone near penguin colonies, depth-integrated krill density increased from summer to autumn (January–March) independent of chlorophyll concentration, suggesting a life history-driven adult krill migration rather than a resource-driven biomass increase. The daytime depth of krill biomass deepened through the summer and became decoupled from the chlorophyll maximum in March as diel vertical migration magnitude likely increased. Penguins near Palmer Station did not appear to be limited by krill availability during our study, and regional differences in krill depth match the foraging behaviors of the two penguin species. Understanding fine-scale physical forcing and ecological interactions in coastal Antarctic hotspots is critical for predicting how environmental change will impact these ecosystems

2015 Progress Report: Design And Health Research Consortium

The Architects Foundation, along with the American Institute of Architects (AIA) and the Association of Collegiate Schools of Architecture (ACSA), issued this first progress report of the AIA's Design and Health Research Consortium. The consortium helps translate research on design's influence on public health into architectural practice for policymakers, design and public health professionals and the general public.The 2015 report covers consortium activities across a spectrum of research issues where design contributes to public health, from the effects of indoor temperatures on sleep deprivation and depression to a "best design" competition for a mobile isolation treatment unit to combat the Ebola epidemic

A Subsurface Eddy Associated With a Submarine Canyon Increases Availability and Delivery of Simulated Antarctic Krill to Penguin Foraging Regions

The distribution of marine zooplankton depends on both ocean currents and swimming behavior. Many zooplankton perform diel vertical migration (DVM) between the surface and subsurface, which can have different current regimes. If concentration mechanisms, such as fronts or eddies, are present in the subsurface, they may impact zooplankton near-surface distributions when they migrate to near-surface waters. A subsurface, retentive eddy within Palmer Deep Canyon (PDC), a submarine canyon along the West Antarctic Peninsula (WAP), retains diurnal vertically migrating zooplankton in previous model simulations. Here, we tested the hypothesis that the presence of the PDC and its associated subsurface eddy increases the availability and delivery of simulated Antarctic krill to nearby penguin foraging regions with model simulations over a single austral summer. We found that the availability and delivery rates of simulated krill to penguin foraging areas adjacent to PDC were greater when the PDC was present compared to when PDC was absent, and when DVM was deepest. These results suggest that the eddy has potential to enhance krill availability to upper trophic level predators and suggests that retention may play a significant role in resource availability for predators in other similar systems along the WAP and in other systems with sustained subsurface eddies

Supervisors Behaving Badly: Witnessing Ethical Dilemmas and What To Do About It

Abstract The NASW Code of Ethics (1996) guides social workers' professional conduct, but provides little instruction when one's own supervisor behaves unethically. Using student-collected interviews, we found six typologies of supervisors behaving badly, and used descriptive qualitative analysis to outline steps taken to navigate the situation. Results hold pedagogical relevance to social work practice

A survey of practices for the use of electronic health records to support research recruitment

Electronic health records (EHRs) provide great promise for identifying cohorts and enhancing research recruitment. Such approaches are sorely needed, but there are few descriptions in the literature of prevailing practices to guide their use. A multidisciplinary workgroup was formed to examine current practices in the use of EHRs in recruitment and to propose future directions. The group surveyed consortium members regarding current practices. Over 98% of the Clinical and Translational Science Award Consortium responded to the survey. Brokered and self-service data warehouse access are in early or full operation at 94% and 92% of institutions, respectively, whereas, EHR alerts to providers and to research teams are at 45% and 48%, respectively, and use of patient portals for research is at 20%. However, these percentages increase significantly to 88% and above if planning and exploratory work were considered cumulatively. For most approaches, implementation reflected perceived demand. Regulatory and workflow processes were similarly varied, and many respondents described substantive restrictions arising from logistical constraints and limitations on collaboration and data sharing. Survey results reflect wide variation in implementation and approach, and point to strong need for comparative research and development of best practices to protect patients and facilitate interinstitutional collaboration and multisite research

Adalimumab for prevention of uveitic flare in patients with inactive non-infectious uveitis controlled by corticosteroids (VISUAL II):a multicentre, double-masked, randomised, placebo-controlled phase 3 trial

Background Non-infectious uveitis is a potentially sight-threatening ocular disorder caused by chronic inflammation and its complications. Therapeutic success is limited by systemic adverse effects associated with long-term corticosteroid and immunomodulator use if topical medication is not sufficient to control the inflammation. We aimed to assess the efficacy and safety of adalimumab in patients with inactive, non-infectious uveitis controlled by systemic corticosteroids. Methods We did this multicentre, double-masked, randomised, placebo-controlled phase 3 trial at 62 study sites in 21 countries in the USA, Canada, Europe, Israel, Australia, and Latin America. Patients (aged >= 18 years) with inactive, non-infectious intermediate, posterior, or panuveitic uveitis controlled by 10-35 mg/day of prednisone were randomly assigned (1: 1), via an interactive voice and web response system with a block size of four, to receive either subcutaneous adalimumab (loading dose 80 mg; biweekly dose 40 mg) or placebo, with a mandatory prednisone taper from week 2. Randomisation was stratified by baseline immunosuppressant treatment. Sponsor personnel with direct oversight of the conduct and management of the study, investigators, study site personnel, and patients were masked to treatment allocation. The primary efficacy endpoint was time to treatment failure, a multicomponent endpoint encompassing new active inflammatory chorioretinal or inflammatory retinal vascular lesions, anterior chamber cell grade, vitreous haze grade, and visual acuity. Analysis was done in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01124838. Findings Between Aug 10, 2010, and May 14, 2015, we randomly assigned 229 patients to receive placebo (n=114) or adalimumab (n=115); 226 patients comprised the intention-to-treat population. Median follow-up time was 155 days (IQR 77-357) in the placebo group and 245 days (119-564) in the adalimumab group. Treatment failure occurred in 61 (55%) of 111 patients in the placebo group compared with 45 (39%) of 115 patients in the adalimumab group. Time to treatment failure was significantly improved in the adalimumab group compared with the placebo group (median not estimated [>18 months] vs 8.3 months; hazard ratio 0.57, 95% CI 0.39-0.84; p=0.004). The 40th percentile for time to treatment failure was 4.8 months in the placebo group and 10.2 months in the adalimumab group. No patients in either group had opportunistic infections (excluding oral candidiasis and tuberculosis). No malignancies were reported in the placebo group whereas one (1%) patient in the adalimumab group reported non-serious squamous cell carcinoma. The most common adverse events were arthralgia (12 [11%] patients in the placebo group and 27 [23%] patients in the adalimumab group), nasopharyngitis (16 [17%] and eight [16%] patients, respectively), and headache (17 [15%] patients in each group). Interpretation Adalimumab significantly lowered the risk of uveitic flare or loss of visual acuity upon corticosteroid withdrawal in patients with inactive, non-infectious intermediate, posterior, or panuveitic uveitis controlled by systemic corticosteroids. No new safety signals were observed and the rate of adverse events was similar between groups. These findings suggest that adalimumab is well tolerated and could be an effective treatment option in this patient population. An open-label extension study (NCT01148225) is ongoing to provide long-term safety data for adalimumab in patients with non-infectious uveitis

Activation of the hypothalamic-pituitary-adrenal axis by exogenous and endogenous GDF15.

An acute increase in the circulating concentration of glucocorticoid hormones is essential for the survival of severe somatic stresses. Circulating concentrations of GDF15, a hormone that acts in the brain to reduce food intake, are frequently elevated in stressful states. We now report that GDF15 potently activates the hypothalamic-pituitary-adrenal (HPA) axis in mice and rats. A blocking antibody to the GDNF-family receptor α-like receptor completely prevented the corticosterone response to GDF15 administration. In wild-type mice exposed to a range of stressful stimuli, circulating levels of both corticosterone and GDF15 rose acutely. In the case of Escherichia coli or lipopolysaccharide injections, the vigorous proinflammatory cytokine response elicited was sufficient to produce a near-maximal HPA response, regardless of the presence or absence of GDF15. In contrast, the activation of the HPA axis seen in wild-type mice in response to the administration of genotoxic or endoplasmic reticulum toxins, which do not provoke a marked rise in cytokines, was absent in Gdf15 -/- mice. In conclusion, consistent with its proposed role as a sentinel hormone, endogenous GDF15 is required for the activation of the protective HPA response to toxins that do not induce a substantial cytokine response. In the context of efforts to develop GDF15 as an antiobesity therapeutic, these findings identify a biomarker of target engagement and a previously unrecognized pharmacodynamic effect, which will require monitoring in human studies

Guidance on noncorticosteroid systemic immunomodulatory therapy in noninfectious uveitis: fundamentals of care for uveitis (focus) initiative

Topic: An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics. Clinical Relevance: The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents. Methods: An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic reviewof the literature (English language studies from January 1996 through June 2016; Medline [OVID], the Central Cochrane library, EMBASE,CINAHL,SCOPUS,BIOSIS, andWeb of Science). Publications included randomized controlled trials, prospective and retrospective studies with sufficient follow-up, case series with 15 cases or more, peer-reviewed articles, and hand-searched conference abstracts from key conferences. The proposed statements were circulated among 130 international uveitis experts for review.Atotal of 44 globally representativegroupmembersmet in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence. Results: In total, 10 questions were addressed resulting in 21 evidence-based guidance statements covering the following topics: when to start noncorticosteroid immunomodulatory therapy, including both biologic and nonbiologic agents; what data to collect before treatment; when to modify or withdraw treatment; how to select agents based on individual efficacy and safety profiles; and evidence in specific uveitic conditions. Shared decision-making, communication among providers and safety monitoring also were addressed as part of the recommendations. Pharmacoeconomic considerations were not addressed. Conclusions: Consensus guidelines were developed based on published literature, expert opinion, and practical experience to bridge the gap between clinical needs and medical evidence to support the treatment of patients with noninfectious uveitis with noncorticosteroid immunomodulatory agents