Approaches to decision-making among late-stage melanoma patients: a multifactorial investigation.

PurposeThe treatment decisions of melanoma patients are poorly understood. Most research on cancer patient decision-making focuses on limited components of specific treatment decisions. This study aimed to holistically characterize late-stage melanoma patients' approaches to treatment decision-making in order to advance understanding of patient influences and supports.Methods(1) Exploratory analysis of longitudinal qualitative data to identify themes that characterize patient decision-making. (2) Pattern analysis of decision-making themes using an innovative method for visualizing qualitative data: a hierarchically-clustered heatmap. Participants were 13 advanced melanoma patients at a large academic medical center.ResultsExploratory analysis revealed eight themes. Heatmap analysis indicated two broad types of patient decision-makers. "Reliant outsiders" relied on providers for medical information, demonstrated low involvement in decision-making, showed a low or later-in-care interest in clinical trials, and expressed altruistic motives. "Active insiders" accessed substantial medical information and expertise in their networks, consulted with other doctors, showed early and substantial interest in trials, demonstrated high involvement in decision-making, and employed multiple decision-making strategies.ConclusionWe identified and characterized two distinct approaches to decision-making among patients with late-stage melanoma. These differences spanned a wide range of factors (e.g., behaviors, resources, motivations). Enhanced understanding of patients as decision-makers and the factors that shape their decision-making may help providers to better support patient understanding, improve patient-provider communication, and support shared decision-making

Beyond Exploratory: A Tailored Framework for Assessing Rigor in Qualitative Health Services Research

Objective: To propose a framework for assessing the rigor of qualitative research that identifies and distinguishes between the diverse objectives of qualitative studies currently used in patient-centered outcomes and health services research (PCOR and HSR). Study Design: Narrative review of published literature discussing qualitative guidelines and standards in peer-reviewed journals and national funding organizations that support PCOR and HSR. Principal Findings: We identify and distinguish three objectives of current qualitative studies in PCOR and HSR: exploratory, descriptive, and comparative. For each objective, we propose methodological standards that can be used to assess and improve rigor across all study phases—from design to reporting. Similar to quantitative studies, we argue that standards for qualitative rigor differ, appropriately, for studies with different objectives and should be evaluated as such. Conclusions: Distinguishing between different objectives of qualitative HSR improves the ability to appreciate variation in qualitative studies as well as appropriately evaluate the rigor and success of studies in meeting their own objectives. Researchers, funders, and journal editors should consider how adopting the criteria for assessing qualitative rigor outlined here may advance the rigor and potential impact of qualitative research in patient-centered outcomes and health services research

Implementation of a Cancer Education Program in Rural Counties with the Lowest HPV Vaccination Rates and Health Rankings

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection (STI). To address STIs, one rural county public school district developed a series of Family Life Programs to educate pre-teens about pertinent health information. The Schooling Cancer Program (SCP) was developed in partnership with the local Cancer Research and Resource Center to raise awareness about cancer risk factors including HPV-related cancers and HPV prevention methods. Methods: We collected a post-evaluation survey from students who attended a SCP session at one of the targeted middle schools. The SCP educated students about topics focusing on healthy lifestyles. The survey asked students’ knowledge on the SCP topics, HPV knowledge, tobacco usage, and factors that reduced cancer development. Results: 87% agreed that tobacco products are associated with cancer, and 81% did not agree that E-cigarettes are scientifically proven to be safer than cigarettes. Although we do not have pre-evaluation data about these students’ HPV knowledge, our evaluation survey shows that 80% of students correctly identified HPV as the most common STI, and 84% of students correctly identified the factors that decrease their risk of developing cancer. Conclusion: Through this initiative, students learned essential health concepts and HPV-related risk factors

The Influence of Physiological Status on age Prediction of Anopheles Arabiensis Using Near Infra-red spectroscopy

Determining the age of malaria vectors is essential for evaluating the impact of interventions that reduce the survival of wild mosquito populations and for estimating changes in vectorial capacity. Near infra-red spectroscopy (NIRS) is a simple and non-destructive method that has been used to determine the age and species of Anopheles gambiae s.l. by analyzing differences in absorption spectra. The spectra are affected by biochemical changes that occur during the life of a mosquito and could be influenced by senescence and also the life history of the mosquito, i.e., mating, blood feeding and egg-laying events. To better understand these changes, we evaluated the influence of mosquito physiological status on NIR energy absorption spectra. Mosquitoes were kept in individual cups to permit record keeping of each individual insect’s life history. Mosquitoes of the same chronological age, but at different physiological stages, were scanned and compared using cross-validations. We observed a slight trend within some physiological stages that suggest older insects tend to be predicted as being physiologically more mature. It was advantageous to include mosquitoes of different chronological ages and physiological stages in calibrations, as it increases the robustness of the model resulting in better age predictions. Progression through different physiological statuses of An. arabiensis influences the chronological age prediction by the NIRS. Entomologists that wish to use NIR technology to predict the age of field-caught An. gambiae s.l from their study area should use a calibration developed from their field strain using mosquitoes of diverse chronological ages and physiological stages to increase the robustness and accuracy of the predictions.\u

Discovery of Endangered Mexican Blindcat, Prietella phreatophila, in Texas: Implications for International Groundwater Management and Evolution of the Regional Karst Aquifer Biota

Paper presented July 15, 2017 at the annual Joint Meeting of Ichthyologists and Herpetologists in Austin, Texas, USA (http://conferences.k-state.edu/JMIH-Austin-2017/). The oral presentation of this content mentioned questions about the taxonomy and phylogenetic position of Prietella lundbergi and the only specimens attributed to P. lundbergi apart from the holotype. Since the presentation, we obtained high resolution CT scans of both the holotype and a specimen (TNHC 25767) from Cueva del Nacimiento del Río Frio, not far north of the type locality. The anatomy revealed in those CT scans suggests that these specimens represent a single species, and that P. lundbergi is only remotely related to Prietella phreatophila, which would be consistent with results of Wilcox, T.P., F.J. Garcı́a de León, Dean A. Hendrickson, and D.M. Hillis. 2004. “Convergence among Cave Catfishes: Long-Branch Attraction and a Bayesian Relative Rates Test.” Molecular Phylogenetics and Evolution 31 (3): 1101–13. doi:10.1016/j.ympev.2003.11.006). Thus, further research is in progress by Hendrickson, Lundberg, Luckenbill and Arce that may result in taxonomic revision removing P. lundbergi from Prietella.Mexican blindcat, Prietella phreatophila, described in 1954 from a cave system near the town of Múzquiz in central Coahuila state, and considered a Mexican endemic, was listed by the U.S. Fish and Wildlife Service as a foreign endangered species (protected "wherever found") in 1970. Explorations in the 1990s discovered many new localities extending nearly to the international border, and in 2016 the species was discovered in Amistad National Recreation Area (ANRA) in Texas, just north of the international border near Del Rio. Not only does the discovery support the aquifer of this fish being an internationally shared resource, but the stygobitic invertebrate biota found with the fish indicates a potentially large extent of the aquifer, and thus possibly the fish, in Texas. Invertebrate faunal connections (historic or current) extend from the Amistad Lake area of the new occurrence west into the Trans-Pecos region and east into the Edwards Aquifer of central Texas. We explore implications of this for both water management and evolutionary history of this and other blind ictalurids, and suggest that population genetic studies of both stygobitic fishes and invertebrates could help hydrogeologists better define often difficult to map aquifer extents and interconnections. While NPS is continuing to support the cave explorations of ANRA that produced the Texas discovery, we propose a broader bi-national sampling effort for both the fish and invertebrates extending well beyond the current known distribution of P. phreatophila. We also pointed out questions about phylogenetic relatedness of P. phreatophila and P. lundbergi further south, as well as the possibility of a monophyletic clade of blindcats, including those of the Edwards Aquifer, Satan and Trogloglanis. If substantiated, that evolutionary history would imply broader historic inter-aquifer connections ranging from the San Antonio area as far south as southernmost Tamaulipas. Finally, we report establishment of a small captive population of Prietella phreatophila at San Antonio Zoo for research and possibly eventual conservation applications.U.S. National Park Service; San Antonio Zoo; University of Texas at Austin College of Natural Sciences and Department of Integrative BiologyIntegrative Biolog

Discovery of the Mexican Blindcat, Prietella phreatophila, in the U.S., and an update on its rangewide conservation status

presented at the 2017 meeting of the Texas Academy of Science at Mary Hardin Baylor University, Belton, TexasMexican blindcat, Prietella phreatophila, was described in 1954 from a single locality in Northern Coahuila, México. Long listed as endangered by the Mexican federal government, it was listed by the U.S. Fish and Wildlife Service as a foreign endangered species in 1970, and the most recent (1996) update of its assessment for the IUCN Red List considers it endangered as well. Explorations in the late 1990s discovered many new localities extending nearly to the international border, and a captive population established provided insights into the species’ basic biology and behavior. In 2016 the species was discovered in a cave in the Amistad National Recreation Area (ANRA), just north of the Río Grande in Texas. The 1970 listing instantly gave the TX population full protection under the U.S. Endangered Species Act. The species’ subterranean and mostly inaccessible habitat endows it with extremely low detectability and its actual range is likely broader than physical sampling of specimens has revealed. We review all prior and new knowledge of the species and its habitat to provide an updated international reassessment of its overall conservation status and threats, which most notably include aquifer depletion and contamination in both the Mexican and U.S. portions of its known range. A live captive population of two specimens collected in 1997 in Coahuila and one Texas specimen is now at the San Antonio Zoo, we are working with NPS to further explore ANRA caves and hope eventually to return to Coahuila to more fully update the species’ conservation status.Integrative Biolog

Family stories, public silence: Irish identity construction amongst the second-generation Irish in England

Formal narratives of history, especially that of colonial oppression, have been central to the construction of national identities in Ireland. But the Irish diasporic community in Britain has been cut off from the reproduction of these narratives, most notably by their absence from the curriculum of Catholic schools, as result of the unofficial 'denationalisation' pact agreed by the Church in the 19th century (Hickman, 1995). The reproduction of Irish identities is largely a private matter, carried out within the home through family accounts of local connections, often reinforced by extended visits to parent/s 'home' areas. Recapturing a public dimension has often become a personal quest in adulthood, 'filling in the gaps'. This paper explores constructions of narratives of nation by a key diasporic population, those with one or two Irish-born parents. It places particular emphasis on varying regional/national contexts within which such constructions take place, drawing on focus group discussions and interviews for the ESRC-funded Irish 2 Project in five locations — London, Glasgow, Manchester, Coventry and Banbury

Label-free chemically specific imaging in planta with stimulated Raman scattering microscopy.

The growing world population puts ever-increasing demands on the agricultural and agrochemical industries to increase agricultural yields. This can only be achieved by investing in fundamental plant and agrochemical research and in the development of improved analytical tools to support research in these areas. There is currently a lack of analytical tools that provide noninvasive structural and chemical analysis of plant tissues at the cellular scale. Imaging techniques such as coherent anti-Stokes Raman scattering (CARS) and stimulated Raman scattering (SRS) microscopy provide label-free chemically specific image contrast based on vibrational spectroscopy. Over the past decade, these techniques have been shown to offer clear advantages for a vast range of biomedical research applications. The intrinsic vibrational contrast provides label-free quantitative functional analysis, it does not suffer from photobleaching, and it allows near real-time imaging in 3D with submicrometer spatial resolution. However, due to the susceptibility of current detection schemes to optical absorption and fluorescence from pigments (such as chlorophyll), the plant science and agrochemical research communities have not been able to benefit from these techniques and their application in plant research has remained virtually unexplored. In this paper, we explore the effect of chlorophyll fluorescence and absorption in CARS and SRS microscopy. We show that with the latter it is possible to use phase-sensitive detection to separate the vibrational signal from the (electronic) absorption processes. Finally, we demonstrate the potential of SRS for a range of in planta applications by presenting in situ chemical analysis of plant cell wall components, epicuticular waxes, and the deposition of agrochemical formulations onto the leaf surface

Cloxacillin versus vancomycin for presumed late-onset sepsis in the Neonatal Intensive Care Unit and the impact upon outcome of coagulase negative staphylococcal bacteremia: a retrospective cohort study

BACKGROUND: Coagulase negative staphylococcus (CONS) is the main cause of late-onset sepsis in Neonatal Intensive Care Units (NICU). Although CONS rarely causes fulminant sepsis, vancomycin is frequently used as empiric therapy. Indiscriminate use of vancomycin has been linked to the emergence of vancomycin resistant organisms. The objective of this study was to compare duration of CONS sepsis and mortality before and after implementation of a policy of selective vancomycin use and compare use of vancomycin between the 2 time periods. METHODS: A retrospective study was conducted of infants ≥4 days old, experiencing signs of sepsis with a first positive blood culture for CONS, during two 12-month periods. Late-onset sepsis was treated empirically with vancomycin and gentamicin during period 1, and cloxacillin and gentamicin during period 2. The confidence interval method was used to assess non-inferiority of the outcomes between the two study groups. RESULTS: There were 45 episodes of CONS sepsis during period 1 and 37 during period 2. Duration of sepsis was similar between periods (hazard ratio of 1.00, 95%CI: 0.64, 1.57). One death during period 2 was possibly related to CONS sepsis versus none in period 1. Vancomycin was used in 97.8% of episodes in period 1 versus 81.1% of episodes in period 2. CONCLUSION: Although we failed to show non-inferiority of duration of sepsis in the cloxacillin and gentamicin group compared to the vancomycin and gentamicin group, duration of sepsis was clinically similar. Restricting vancomycin for confirmed cases of CONS sepsis resistant to oxacillin appears effective and safe, and significantly reduces vancomycin use in the NICU

International meta-analysis of PTSD genome-wide association studies identifies sex- and ancestry-specific genetic risk loci.

The risk of posttraumatic stress disorder (PTSD) following trauma is heritable, but robust common variants have yet to be identified. In a multi-ethnic cohort including over 30,000 PTSD cases and 170,000 controls we conduct a genome-wide association study of PTSD. We demonstrate SNP-based heritability estimates of 5-20%, varying by sex. Three genome-wide significant loci are identified, 2 in European and 1 in African-ancestry analyses. Analyses stratified by sex implicate 3 additional loci in men. Along with other novel genes and non-coding RNAs, a Parkinson's disease gene involved in dopamine regulation, PARK2, is associated with PTSD. Finally, we demonstrate that polygenic risk for PTSD is significantly predictive of re-experiencing symptoms in the Million Veteran Program dataset, although specific loci did not replicate. These results demonstrate the role of genetic variation in the biology of risk for PTSD and highlight the necessity of conducting sex-stratified analyses and expanding GWAS beyond European ancestry populations