The Engagement Practices of Performing Arts-Makers: A Phenomenological Case Study of Prometheus Bound, the Rock Musical: A Dissertation

This phenomenological case study explored the lived experiences of performing arts-makers, who participated in the engagement practices utilized in Prometheus Bound, the rock musical produced by the American Repertory Theater in 2011. Engagement practices are actions employed to deepen the impact of the artistic experience, which may involve the creative use of physical space, choreography, physical contact, social justice, community collaboration, and other aspects of a live performance. Engagement practices occur in the liminal zone; the neutral space between performing arts-makers and audience members that is conducive to deep empathetic reflection since the boundary between arts-maker and audience is transformed and sometimes removed. Conceptual models developed by artist, Suzanne Lacy and artist and educator, Charles Garoian informed this study, which found that performing arts-makers demonstrated behavior that one might consider to be other-oriented and self-reported reflective learning experiences, following their participation in the engagement practices of Prometheus Bound

Assessment of a Novel Pediatric Resident Simulation Curriculum

Aim: To assess the efficacy of a newly implemented resident simulation curriculum at a medium sized pediatric residency program. Background: Many pediatric residency programs incorporate high-fidelity simulation into their curriculum, but there is limited data discussing the utility/educational impacts of a longitudinal/standardized/multimodal simulation curriculum. Several studies of simulation-based training have employed “self-efficacy” as a barometer for trainee education and performance 1,2,. The level of a person’s self-efficacy can influence their behavior and may be a pivotal factor in performance. We have implemented a newly devised standardized, multimodal resident simulation curriculum and used resident self-efficacy to assess its effectiveness. Methods: Participants were UMass Pediatric and Med/Peds residents. Implementation of our curriculum occurred at the start of the 2016-2017 academic year. Surveys were administered to all residents prior to curriculum implementation and at 6 months post-implementation. They assessed resident self-efficacy with regards to specific technical/procedural skills (i.e. running a code, performing intubation, etc.) and resident confidence in their ability to identify/manage specific pediatric disease presentations (i.e. respiratory failure, tachyarrhythmia, etc.). Data was pooled and averaged for each resident class separately. We predetermined a 10% change in self-efficacy to be a clinically significant difference. Results: 36 of 40 residents completed the initial survey and 31 completed the 6-month follow-up. PGY1 residents reported improved self-efficacy for 4 PALS-related skills and 8 pediatric case presentations. Similarly, PGY2 residents reported improved self-efficacy for 3 PALS-related skills and 6 pediatric case presentations. Conversely, PGY3/4 residents reported no significant change in self-efficacy for any survey question. Conclusions: These results suggest that our newly implemented longitudinal, standardized, multidisciplinary, multi-modal simulation curriculum has significantly improved resident self-efficacy related to core Pediatric Advanced Life-Support (PALS) skills/topics, with the greatest impact affecting our PGY1 class. Further study and curriculum development will attempt to address this issue

Specifically neuropathic Gaucher's mutations accelerate cognitive decline in Parkinson's.

OBJECTIVE: We hypothesized that specific mutations in the β-glucocerebrosidase gene (GBA) causing neuropathic Gaucher's disease (GD) in homozygotes lead to aggressive cognitive decline in heterozygous Parkinson's disease (PD) patients, whereas non-neuropathic GD mutations confer intermediate progression rates. METHODS: A total of 2,304 patients with PD and 20,868 longitudinal visits for up to 12.8 years (median, 4.1) from seven cohorts were analyzed. Differential effects of four types of genetic variation in GBA on longitudinal cognitive decline were evaluated using mixed random and fixed effects and Cox proportional hazards models. RESULTS: Overall, 10.3% of patients with PD and GBA sequencing carried a mutation. Carriers of neuropathic GD mutations (1.4% of patients) had hazard ratios (HRs) for global cognitive impairment of 3.17 (95% confidence interval [CI], 1.60-6.25) and a hastened decline in Mini-Mental State Exam scores compared to noncarriers (p = 0.0009). Carriers of complex GBA alleles (0.7%) had an HR of 3.22 (95% CI, 1.18-8.73; p = 0.022). By contrast, the common, non-neuropathic N370S mutation (1.5% of patients; HR, 1.96; 95% CI, 0.92-4.18) or nonpathogenic risk variants (6.6% of patients; HR, 1.36; 95% CI, 0.89-2.05) did not reach significance. INTERPRETATION: Mutations in the GBA gene pathogenic for neuropathic GD and complex alleles shift longitudinal cognitive decline in PD into "high gear." These findings suggest a relationship between specific types of GBA mutations and aggressive cognitive decline and have direct implications for improving the design of clinical trials. Ann Neurol 2016;80:674-685

Slc20a2, Encoding the Phosphate Transporter PiT2, Is an Important Genetic Determinant of Bone Quality and Strength.

Osteoporosis is characterized by low bone mineral density (BMD) and fragility fracture and affects over 200 million people worldwide. Bone quality describes the material properties that contribute to strength independently of BMD, and its quantitative analysis is a major priority in osteoporosis research. Tissue mineralization is a fundamental process requiring calcium and phosphate transporters. Here we identify impaired bone quality and strength in Slc20a2-/- mice lacking the phosphate transporter SLC20A2. Juveniles had abnormal endochondral and intramembranous ossification, decreased mineral accrual, and short stature. Adults exhibited only small reductions in bone mass and mineralization but a profound impairment of bone strength. Bone quality was severely impaired in Slc20a2-/- mice: yield load (-2.3 SD), maximum load (-1.7 SD), and stiffness (-2.7 SD) were all below values predicted from their bone mineral content as determined in a cohort of 320 wild-type controls. These studies identify Slc20a2 as a physiological regulator of tissue mineralization and highlight its critical role in the determination of bone quality and strength. © 2019 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc

High-resolution, 3D radiative transfer modeling: I. The grand-design spiral galaxy M 51

International audienceContext. Dust reprocesses about half of the stellar radiation in galaxies. The thermal re-emission by dust of absorbed energy is considered to be driven merely by young stars so is often applied to tracing the star formation rate in galaxies. Recent studies have argued that the old stellar population might be responsible for a non-negligible fraction of the radiative dust heating.Aims. In this work, we aim to analyze the contribution of young (≲100 Myr) and old (~10 Gyr) stellar populations to radiative dust heating processes in the nearby grand-design spiral galaxy M 51 using radiative transfer modeling. High-resolution 3D radiative transfer (RT) models are required to describe the complex morphologies of asymmetric spiral arms and clumpy star-forming regions and to model the propagation of light through a dusty medium. Methods. In this paper, we present a new technique developed to model the radiative transfer effects in nearby face-on galaxies. We construct a high-resolution 3D radiative transfer model with the Monte-Carlo code SKIRT to account for the absorption, scattering, and non-local thermal equilibrium (NLTE) emission of dust in M 51. The 3D distribution of stars is derived from the 2D morphology observed in the IRAC 3.6 μm, GALEX FUV, Hα, and MIPS 24 μm wavebands, assuming an exponential vertical distribution with an appropriate scale height. The dust geometry is constrained through the far-ultraviolet (FUV) attenuation, which is derived from the observed total-infrared-to-far-ultraviolet luminosity ratio. The stellar luminosity, star formation rate, and dust mass have been scaled to reproduce the observed stellar spectral energy distribution (SED), FUV attenuation, and infrared SED.Results. The dust emission derived from RT calculations is consistent with far-infrared and submillimeter observations of M 51, implying that the absorbed stellar energy is balanced by the thermal re-emission of dust. The young stars provide 63% of the energy for heating the dust responsible for the total infrared emission (8−1000 μm), while 37% of the dust emission is governed through heating by the evolved stellar population. In individual wavebands, the contribution from young stars to the dust heating dominates at all infrared wavebands but gradually decreases towards longer infrared and submillimeter wavebands for which the old stellar population becomes a non-negligible source of heating. Upon extrapolation of the results for M 51, we present prescriptions for estimating the contribution of young stars to the global dust heating based on a tight correlation between the dust heating fraction and specific star formation rate

Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

Aims: To critically review the available transcatheter aortic valve implantation techniques and their results, as well as propose recommendations for their use and development. Methods and results: A committee of experts including European Association of Cardio-Thoracic Surgery and European Society of Cardiology representatives met to reach a consensus based on the analysis of the available data obtained with transcatheter aortic valve implantation and their own experience. The evidence suggests that this technique is feasible and provides haemodynamic and clinical improvement for up to 2 years in patients with severe symptomatic aortic stenosis at high risk or with contraindications for surgery. Questions remain mainly concerning safety and long-term durability, which have to be assessed. Surgeons and cardiologists working as a team should select candidates, perform the procedure, and assess the results. Today, the use of this technique should be restricted to high-risk patients or those with contraindications for surgery. However, this may be extended to lower risk patients if the initial promise holds to be true after careful evaluation. Conclusion: Transcatheter aortic valve implantation is a promising technique, which may offer an alternative to conventional surgery for high-risk patients with aortic stenosis. Today, careful evaluation is needed to avoid the risk of uncontrolled diffusio

Subtelomeric study of 132 patients with mental retardation reveals 9 chromosomal anomalies and contributes to the delineation of submicroscopic deletions of 1pter, 2qter, 4pter, 5qter and 9qter

BACKGROUND: Cryptic chromosome imbalances are increasingly acknowledged as a cause for mental retardation and learning disability. New phenotypes associated with specific rearrangements are also being recognized. Techniques for screening for subtelomeric rearrangements are commercially available, allowing the implementation in a diagnostic service laboratory. We report the diagnostic yield in a series of 132 subjects with mental retardation, and the associated clinical phenotypes. METHODS: We applied commercially available subtelomeric fluorescence in situ hybridization (FISH). All patients referred for subtelomeric screening in a 5-year period were reviewed and abnormal cases were further characterized clinically and if possible molecularly. RESULTS: We identified nine chromosomal rearrangements (two of which were in sisters) corresponding to a diagnostic yield of approx. 7%. All had dysmorphic features. Five had imbalances leading to recognizable phenotypes. CONCLUSION: Subtelomeric screening is a useful adjunct to conventional cytogenetic analyses, and should be considered in mentally retarded subjects with dysmorphic features and unknown cause

Long-Term Exposure to Primary Traffic Pollutants and Lung Function in Children: Cross-Sectional Study and Meta-Analysis.

BACKGROUND: There is widespread concern about the possible health effects of traffic-related air pollution. Nitrogen dioxide (NO2) is a convenient marker of primary pollution. We investigated the associations between lung function and current residential exposure to a range of air pollutants (particularly NO2, NO, NOx and particulate matter) in London children. Moreover, we placed the results for NO2 in context with a meta-analysis of published estimates of the association. METHODS AND FINDINGS: Associations between primary traffic pollutants and lung function were investigated in 4884 children aged 9-10 years who participated in the Child Heart and Health Study in England (CHASE). A systematic literature search identified 13 studies eligible for inclusion in a meta-analysis. We combined results from the meta-analysis with the distribution of the values of FEV1 in CHASE to estimate the prevalence of children with abnormal lung function (FEV1<80% of predicted value) expected under different scenarios of NO2 exposure. In CHASE, there were non-significant inverse associations between all pollutants except ozone and both FEV1 and FVC. In the meta-analysis, a 10 μg/m3 increase in NO2 was associated with an 8 ml lower FEV1 (95% CI: -14 to -1 ml; p: 0.016). The observed effect was not modified by a reported asthma diagnosis. On the basis of these results, a 10 μg/m3 increase in NO2 level would translate into a 7% (95% CI: 4% to 12%) increase of the prevalence of children with abnormal lung function. CONCLUSIONS: Exposure to traffic pollution may cause a small overall reduction in lung function and increase the prevalence of children with clinically relevant declines in lung function

Mobile health apps to facilitate self-care: a qualitative study of user experiences

Objective: Consumers are living longer, creating more pressure on the health system and increasing their requirement for self-care of chronic conditions. Despite rapidly-increasing numbers of mobile health applications (‘apps’) for consumers’ self-care, there is a paucity of research into consumer engagement with electronic self-monitoring. This paper presents a qualitative exploration of how health consumers use apps for health monitoring, their perceived benefits from use of health apps, and suggestions for improvement of health apps. Materials and Methods: ‘Health app’ was defined as any commercially-available health or fitness app with capacity for self-monitoring. English-speaking consumers aged 18 years and older using any health app for self-monitoring were recruited for interview from the metropolitan area of Perth, Australia. The semi-structured interview guide comprised questions based on the Technology Acceptance Model, Health Information Technology Acceptance Model, and the Mobile Application Rating Scale, and is the only study to do so. These models also facilitated deductive thematic analysis of interview transcripts. Implicit and explicit responses not aligned to these models were analyzed inductively.Results: Twenty-two consumers (15 female, seven male) participated, 13 of whom were aged 26–35 years. Eighteen participants reported on apps used on iPhones. Apps were used to monitor diabetes, asthma, depression, celiac disease, blood pressure, chronic migraine, pain management, menstrual cycle irregularity, and fitness. Most were used approximately weekly for several minutes per session, and prior to meeting initial milestones, with significantly decreased usage thereafter. Deductive and inductive thematic analysis reduced the data to four dominant themes: engagement in use of the app; technical functionality of the app; ease of use and design features; and management of consumers’ data. Conclusions: The semi-structured interviews provided insight into usage, benefits and challenges of health monitoring using apps. Understanding the range of consumer experiences and expectations can inform design of health apps to encourage persistence in self-monitoring

Deletions at 22q11.2 in idiopathic Parkinson's disease: a combined analysis of genome-wide association data.

BACKGROUND: Parkinson's disease has been reported in a small number of patients with chromosome 22q11.2 deletion syndrome. In this study, we screened a series of large, independent Parkinson's disease case-control studies for deletions at 22q11.2. METHODS: We used data on deletions spanning the 22q11.2 locus from four independent case-control Parkinson's disease studies (UK Wellcome Trust Case Control Consortium 2, Dutch Parkinson's Disease Genetics Consortium, US National Institute on Aging, and International Parkinson's Disease Genomics Consortium studies), which were independent of the original reports of chromosome 22q11.2 deletion syndrome. We did case-control association analysis to compare the proportion of 22q11.2 deletions found, using the Fisher's exact test for the independent case-control studies and the Mantel-Haenszel test for the meta-analyses. We retrieved clinical details of patients with Parkinson's disease who had 22q11.2 deletions from the medical records of these patients. FINDINGS: We included array-based copy number variation data from 9387 patients with Parkinson's disease and 13 863 controls. Eight patients with Parkinson's disease and none of the controls had 22q11.2 deletions (p=0·00082). In the 8451 patients for whom age at onset data were available, deletions at 22q11.2 were associated with Parkinson's disease age at onset (Mann-Whitney U test p=0·001). Age at onset of Parkinson's disease was lower in patients carrying a 22q11.2 deletion (median 37 years, 95% CI 32·0-55·5; mean 42·1 years [SD 11·9]) than in those who did not carry a deletion (median 61 years, 95% CI 60·5-61·0; mean 60·3 years [SD 12·8]). A 22q11.2 deletion was present in more patients with early-onset (p<0·0001) and late-onset Parkinson's disease (p=0·016) than in controls, and in more patients with early-onset than late-onset Parkinson's disease (p=0·005). INTERPRETATION: Clinicians should be alert to the possibility of 22q11.2 deletions in patients with Parkinson's disease who have early presentation or features associated with the chromosome 22q11.2 deletion syndrome, or both. FUNDING: UK Medical Research Council, UK Wellcome Trust, Parkinson's UK, Patrick Berthoud Trust, National Institutes of Health, "Investissements d'Avenir" ANR-10-IAIHU-06, Dutch Parkinson Foundation (Parkinson Vereniging), Neuroscience Campus Amsterdam, National Institute for Health Research, National Institute on Aging, National Institutes of Health.UK Medical Research Council, UK Wellcome Trust, Parkinson's UK, Patrick Berthoud Trust, National Institutes of Health, “Investissements d'Avenir” ANR-10-IAIHU-06, Dutch Parkinson Foundation (Parkinson Vereniging), Neuroscience Campus Amsterdam, National Institute for Health Research, National Institute on Aging, National Institutes of Health.This is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/S1474-4422(16)00071-