A prospective multiple case study of the impact of emerging scientific evidence on established colorectal cancer screening programs: a study protocol.

BackgroundHealth-policy decision making is a complex and dynamic process, for which strong evidentiary support is required. This includes scientifically produced research, as well as information that relates to the context in which the decision takes place. Unlike scientific evidence, this "contextual evidence" is highly variable and often includes information that is not scientifically produced, drawn from sources such as political judgement, program management experience and knowledge, or public values. As the policy decision-making process is variable and difficult to evaluate, it is often unclear how this heterogeneous evidence is identified and incorporated into "evidence-based policy" decisions. Population-based colorectal cancer screening poses an ideal context in which to examine these issues. In Canada, colorectal cancer screening programs have been established in several provinces over the past five years, based on the fecal occult blood test (FOBT) or the fecal immunochemical test. However, as these programs develop, new scientific evidence for screening continues to emerge. Recently published randomized controlled trials suggest that the use of flexible sigmoidoscopy for population-based screening may pose a greater reduction in mortality than the FOBT. This raises the important question of how policy makers will address this evidence, given that screening programs are being established or are already in place. This study will examine these issues prospectively and will focus on how policy makers monitor emerging scientific evidence and how both scientific and contextual evidence are identified and applied for decisions about health system improvement.MethodsThis study will employ a prospective multiple case study design, involving participants from Ontario, Alberta, Manitoba, Nova Scotia, and Quebec. In each province, data will be collected via document analysis and key informant interviews. Documents will include policy briefs, reports, meeting minutes, media releases, and correspondence. Interviews will be conducted in person with senior administrative leaders, government officials, screening experts, and high-level cancer system stakeholders.DiscussionThe proposed study comprises the third and final phase of an Emerging Team grant to address the challenges of health-policy decision making and colorectal cancer screening decisions in Canada. This study will contribute a unique prospective look at how policy makers address new, emerging scientific evidence in several different policy environments and at different stages of program planning and implementation. Findings will provide important insight into the various approaches that are or should be used to monitor emerging evidence, the relative importance of scientific versus contextual evidence for decision making, and the tools and processes that may be important to support challenging health-policy decisions

School Social Workers and Extracurricular Activities: The Unanswered Questions About Potential Role Conflict

Abstract School social workers respond to students’ mental health needs from an education training perspective that defines set professional role boundaries in service provision that may differ from the multiple roles teachers have with students. One of those perspectives is a recognition of what may happen if a boundary crossing was to occur in a dual relationship with a client. Teachers are encouraged to take on a secondary role with students by coaching athletics or advising a club. Taking on dual roles with students has led to both increased job satisfaction and concerns regarding burnout for teachers. There is an absence of information that exists on what the experience has been of school social workers taking on secondary roles with students. Not having guidance for school social workers who elect to oversee extracurricular activities led the authors to explore what is the intended mission for the practice of school social work, how the existing literature on dual relationships may apply to school settings, and the findings from research conducted with teachers who take on dual roles with students. The recommendations provided are a need for data to establish what experience school social workers have with managing secondary roles and to not preclude school social workers from extracurricular activities when their presence can be of benefit to students and the school if dual relationships are properly managed

Extracellular vesicles produced in B cells deliver tumor suppressor miR-335 to breast cancer cells disrupting oncogenic programming in vitro and in vivo.

The successful implementation of miRNA (miR) therapies in humans will ultimately rely on the use of vehicles with improved cellular delivery capability. Here we tested a new system that leverages extracellular vesicles (EVs) laden with a tumor suppressor miRNA (miR-335) produced in B cells by plasmid DNA induction (iEVs). We demonstrate that iEVs-335 efficiently and durably restored the endogenous miR-335 pool in human triple negative breast cancer cells, downregulated the expression of the miR-335 target gene SOX4 transcription factor, and markedly inhibited tumor growth in vivo. Remarkably, iEVs-335 mediated transcriptional effects that persisted in tumors after 60 days post orthotopic implantation. Genome-wide RNASeq analysis of cancer cells treated in vitro with iEVs-335 showed the regulation of a discrete number of genes only, without broad transcriptome perturbations. This new technology may be ideally suited for therapies aimed to restore tumor suppressor miRNAs in cancer cells, disrupting the oncogenic program established after escape from miRNA control

Observations of Reconnection Flows in a Flare on the Solar Disk

Magnetic reconnection is a well-accepted part of the theory of solar eruptive events, though the evidence is still circumstantial. Intrinsic to the reconnection picture of a solar eruptive event, particularly in the standard model for two-ribbon flares ("CSHKP" model), are an advective flow of magnetized plasma into the reconnection region, expansion of field above the reconnection region as a flux rope erupts, retraction of heated post-reconnection loops, and downflows of cooling plasma along those loops. We report on a unique set of SDO/AIA imaging and Hinode/EIS spectroscopic observations of the disk flare SOL2016-03-23T03:54 in which all four flows are present simultaneously. This includes spectroscopic evidence for a plasma upflow in association with large-scale expanding closed inflow field. The reconnection inflows are symmetric, and consistent with fast reconnection, and the post-reconnection loops show a clear cooling and deceleration as they retract. Observations of coronal reconnection flows are still rare, and most events are observed at the solar limb, obscured by complex foregrounds, making their relationship to the flare ribbons, cusp field and arcades formed in the lower atmosphere difficult to interpret. The disk location and favorable perspective of this event have removed these ambiguities giving a clear picture of the reconnection dynamics.Comment: 9 pages, 5 figures, and 1 table. Accepted for publication in ApJ

The sub-arcsecond hard X-ray structure of loop footpoints in a solar flare

The newly developed X-ray visibility forward fitting technique is applied to Reuven Ramaty High Energy Solar Spectroscopic Imager (RHESSI) data of a limb flare to investigate the energy and height dependence on sizes, shapes, and position of hard X-ray chromospheric footpoint sources. This provides information about the electron transport and chromospheric density structure. The spatial distribution of two footpoint X-ray sources is analyzed using PIXON, Maximum Entropy Method, CLEAN and visibility forward fit algorithms at nonthermal energies from $\sim 20$ to $\sim 200$ keV. We report, for the first time, the vertical extents and widths of hard X-ray chromospheric sources measured as a function of energy for a limb event. Our observations suggest that both the vertical and horizontal sizes of footpoints are decreasing with energy. Higher energy emission originates progressively deeper in the chromosphere consistent with downward flare accelerated streaming electrons. The ellipticity of the footpoints grows with energy from $\sim 0.5$ at $\sim 20$ keV to $\sim 0.9$ at $\sim 150$ keV. The positions of X-ray emission are in agreement with an exponential density profile of scale height $\sim 150$~km. The characteristic size of the hard X-ray footpoint source along the limb is decreasing with energy suggesting a converging magnetic field in the footpoint. The vertical sizes of X-ray sources are inconsistent with simple collisional transport in a single density scale height but can be explained using a multi-threaded density structure in the chromosphere.Comment: 7 pages, 7 figures, submitted to Ap

Evaluation of the Senior Community Service Employment Program (SCSEP)

Older workers -- defined as those over the age of 55 -- account for an ever-increasing segment of the American labor force. As they grow in numbers, however, older workers are also particularly vulnerable to job dislocation, in part because rapid economic globalization has eliminated millions of jobs in manufacturing and other traditional fields of employment.Older workers are also becoming a growing share of the long-term and very long-term unemployed, a trend that started before the recent recession and has steadily advanced. Between 2007 and 2011, the proportion of unemployed workers over 50 who were jobless for six months or more jumped from 24 percent to 54 percent. Against this backdrop, the assistance offered by the Senior Community Service Employment Program (SCSEP) is of particularly timely importance. SCSEP was established in 1965 and incorporated under the Older Americans Act (OAA) in 1973. Operated by the U.S. Department of Labor's Employment and Training Administration (ETA), SCSEP provides subsidized minimum-wage, part-time community service assignments for low-income persons age 55 or older who would otherwise have poor employment prospects. Over its 46-year history, SCSEP has responded to the fact that older workers tend to have more difficulty than younger workers in finding new jobs when they become unemployed because of their greater likelihood as a group to have lower levels of formal education and obsolete skills, and because many employers hold negative stereotypes of older workers

Student Pharmacists’ Emotional Responses and Coping During the COVID-19 Pandemic

Introduction: Health professions students, including student pharmacists, have been impacted by the coronavirus disease 19 (COVID-19 pandemic) as schools have transitioned to remote learning and cancelled milestone events. During times of crises, media consumption and hobby participation also impact well-being. The adverse emotional responses and coping strategies of student pharmacists amidst the COVID-19 pandemic have not been evaluated, nor have factors that may contribute to emotional responses. The purpose of this study is to determine Doctor of Pharmacy students’ emotional responses and coping precipitated by the COVID-19 pandemic, and the influence of media use, working status, and participation in hobbies. Methods: An anonymous online survey was administered to student pharmacists from May 21 to June 7, 2020 at one school of pharmacy in Kentucky. Measures included gender, working status, media source and use, hobby participation, emotional responses, and the Brief COPE to measure coping reactions. Results: A total of 550 student pharmacists from the University of Kentucky College of Pharmacy were invited to participate the study. Seventy-seven participants completed the survey, identifying feelings of anxiety, fear, sadness, and anger related to the COVID-19 pandemic. Participants who consumed less than one hour of media per day were significantly less likely to feel fear than those who consumed one to three hours (p = 0.043). The primary news source for participants, as determined by the survey, was social media, including Twitter®, Instagram®, and Facebook®. Students who continued to work during the pandemic reported less fear (p = 0.02) and sadness (p = 0.025) compared to those who did not. Those who participated in hobbies were also significantly less likely to report feelings of sadness (p = 0.001). Student pharmacists reported using approach coping more frequently than avoidant. Conclusion: Life-disorienting events, like the COVID-19 pandemic, can negatively affect student pharmacists’ well-being. Pharmacy schools should prepare student pharmacists for times of both major and minor crises

Eye in the Sky

This project is separated into two parts: an unmanned aerial vehicle (UAV) and a corresponding capsule. The UAV will be stored in the capsule as the pair is released from underwater and floats to the surface where the capsule will autonomously open and discharge the drone. Following release, the UAV will fly up and record video surveillance of the surrounding area. Finally, the UAV will record the data onto a micro SD card inserted in the monitor that shows the camera’s live feed. The objective is to design, build, test, and finalize a UAV and capsule that meet NUWC’s, the customer, specifications as much as possible. The overarching design for this system consists of a cylindrical capsule with chambers for the drone, electronic controls, controlled air flow, and the tank of compressed air. An Arduino UNO is programmed to trigger the flow of air that pushes the drone out after a certain number of seconds. The UAV is a quadcopter whose arms spread open by a simple spring mechanism once ejected from the capsule but sits linearly while inside the capsule. The capsule has been manufactured from aluminum and the drone uses the Vortex 250 Pro as a base but has been modified to feature the required fold-able arms. Testing has shown that the capsule functions as expected. It floats to the surface, maintains a vertical position, and ejects the UAV after the programmed number of seconds. Testing has also shown that the UAV’s physical body also functions as expected in terms of its arms springing open when no longer constrained within the capsule. Photos and videos have been successfully recorded onto the monitor. The drone’s flight was not tested due to unforeseen and currently unresolved software issues. Overall, if the drone was capable of flight, the team would expect the system to work well as a whole

Does adaptation to high altitude affect hypoxia-dependent structural plasticity of the placenta?

High altitude residence causes fetal growth restriction (FGR) during pregnancy in lowland mammals. Highland-adapted mammals do not experience this altitude-dependent FGR, suggesting that adaptation to altitude has produced some protective mechanisms. However, the specific mechanisms by which highland-adapted mammals preserve fetal growth at altitude remain unknown. We hypothesized that highland-adapted populations protect fetal growth through structural changes to the placenta that increase surface area for nutrient and gas exchange. We tested this hypothesis using deer mice (Peromyscus maniculatus), from populations native to low [400 m, Lincoln, NE] and high [4300 m, Mt. Evans, CO] altitudes. We predicted structural adaptation would occur via increases to the relative size of the labyrinth zone (LZ), the layer within the rodent placenta where nutrient and gas exchange occur. Placentas were collected from lowland and highland deer mice undergoing pregnancy under normoxia or hypoxia (60 kPa) to understand how hypoxia-dependent structural plasticity might interact with adaptive remodeling of the placenta (N = 5-7 per strain and treatment). Using immunohistochemistry, we quantified the size of each placenta zone. Our preliminary results show that highlanders have relatively larger placental arteries and LZs under both normoxia and hypoxia (P \u3c 0.05 in generalized linear mixed model), suggesting that blood delivery and area for exchange (as determined by the LZ size) may protect fetal growth in highlanders. Future work will pair histological characterization of placental structure with transcriptomics to guide a mechanistic understanding of how placentation constrains to fetal growth under hypoxia