A Case Study of Journey Mapping to Create a Palliative Care Pathway for Naotkamegwanning First Nation: An Analysis and Lessons Learning using Participatory Action Research

There is little known about how to conduct an effective journey mapping process to design a care pathway for First Nations community members who would benefit by having access to local, community-based palliative care programs. This research analyzed a unique journey mapping process that was developed and implemented collaboratively by a Leadership Team of community members in Naotkamegwanning First Nation in Northwestern Ontario, and the members of an EOLFN Research Team based at Lakehead University. The purpose of the journey mapping process was to create the care pathway to guide providing integrated palliative home care for community members who choose to die at home. This thesis analyzes that journey mapping process and offers lessons learned and promising practices that may be applicable for use in other First Nations communities

Underperforming Students: Factors and Decision-Making in Occupational Therapy Programs

The purpose of this study was to better understand factors related to occupational therapy (OT) educators’ decisions to fail underperforming students and to clarify why educators sometimes fail to fail or pass students despite sub-standard performance. Assessing student competence is an essential part of ensuring the safety of those receiving occupational therapy services and ensuring the integrity of the OT profession. Educators in academic and fieldwork settings are responsible for confirming that students who graduate from their programs are able to demonstrate skills required for entry into the profession. A total of 323 OT academic and fieldwork educators responded to a researcher developed survey. Results were analyzed using descriptive statistics and linear regressions. 82% of OT academic educators and 34% of OT fieldwork educators reported failing a student at one time and results revealed common reasons for both groups. In addition, 60% of OT academic educators and 26% of OT fieldwork educators thought there had been a time when they should have failed an underperforming student but did not. Common reasons for failure to fail included lack of proof, vague procedures, giving students the benefit of the doubt, and decreased confidence in handling a failing situation. Recommendations to minimize failure to fail are discussed

A germline exome analysis reveals harmful POT1 variants in multiple myeloma patients and families

Peer reviewe

Enrichment of cancer-predisposing germline variants in adult and pediatric patients with acute lymphoblastic leukemia

Despite recent progress in acute lymphoblastic leukemia (ALL) therapies, a significant subset of adult and pediatric ALL patients has a dismal prognosis. Better understanding of leukemogenesis and recognition of germline genetic changes may provide new tools for treating patients. Given that hematopoietic stem cell transplantation, often from a family member, is a major form of treatment in ALL, acknowledging the possibility of hereditary predisposition is of special importance. Reports of comprehensive germline analyses performed in adult ALL patients are scarce. Aiming at fulfilling this gap of knowledge, we investigated variants in 93 genes predisposing to hematologic malignancies and 70 other cancer-predisposing genes from exome data obtained from 61 adult and 87 pediatric ALL patients. Our results show that pathogenic (P) or likely pathogenic (LP) germline variants in genes associated with predisposition to ALL or other cancers are prevalent in ALL patients: 8% of adults and 11% of children. Comparison of P/LP germline variants in patients to population-matched controls (gnomAD Finns) revealed a 2.6-fold enrichment in ALL cases (CI 95% 1.5-4.2, p = 0.00071). Acknowledging inherited factors is crucial, especially when considering hematopoietic stem cell transplantation and planning post-therapy follow-up. Harmful germline variants may also predispose patients to excessive toxicity potentially compromising the outcome. We propose integrating germline genetics into precise ALL patient care and providing families genetic counseling.Peer reviewe

Clinically relevant germline variants in allogeneic hematopoietic stem cell transplant recipients

Allogeneic hematopoietic stem cell transplantation (HSCT) provides patients with severe hematologic disease a well-established potential for curation. Incorporation of germline analyses in the workup of HSCT patients is not a common practice. Recognizing rare harmful germline variants may however affect patients' pre-transplantation care, choice of the stem cell donor, and complication risks. We analyzed a population-based series of germline exome data of 432 patients who had undergone HSCT. Our aim was to identify clinically relevant variants that may challenge the outcome of the HSCT. We focused on genes predisposing to hematological diseases, or solid tumors, and genes included in the American College of Medical Genetics secondary findings list v3.0. As population-specific controls, we used GnomAD non-cancer Finns (n = 10,816). We identified in our population-based analysis rare harmful germline variants in disease-predisposing or actionable toxicity-increasing genes in 17.8% of adult and pediatric patients that have undergone HSCT (15.1% and 22.9%, respectively). More than half of the patients with a family member as a donor had not received genetic diagnosis prior to the HSCT. Our results encourage clinicians to incorporate germline genetic testing in the HSCT protocol in the future in order to reach optimal long-term outcome for the patients.Peer reviewe

Aquilegia, Vol. 38 No. 4 - Fall, 2014, Newsletter of the Colorado Native Plant Society

https://epublications.regis.edu/aquilegia/1150/thumbnail.jp

ICES Viewpoint background document: Impact from exhaust gas cleaning systems (scrubbers) on the marine environment (Ad hoc).

Shipping is a diverse industry that connects the world. The distribution and intensity of commercial shipping is increasing and there is a growing need to assess and mitigate the impacts of vessel activities on the marine environment. New global standards on sulphur content in marine fuels have led to an increasing number of ships installing exhaust gas cleaning systems (EGCS), also known as scrubbers, to reduce their emissions of sulphur oxides to the atmosphere. Ships equipped with a scrubber can continue to use heavy fuel oil, and the process results in discharges of large volumes of acidified water that contain a mix of contaminants, such as heavy metals, polycyclic aromatic hydrocarbons (PAHs), oil residues, and nitrates. For the most common type of scrubber, open loop, this polluted water is directly discharged back to the sea, trading reductions in air pollution for increased water pollution. The scrubber discharge mixture has demonstrated toxic effects in laboratory studies, causing immediate mortality in plankton and exhibiting negative synergistic effects. The substances found in scrubber discharge water are likely to have further impacts in the marine environment through bioaccumulation, acidification and eutrophication. The impacts of scrubber discharge water can be completely avoided through the use of alternative fuels, such as distilled low sulphur fuels. Distilled fuels have the added benefit that they remove the threat of heavy fuel oil spills from shipping activities. If the use of alternative fuels is not adopted, and scrubbers continue to be considered an equivalent method to meet the sulphur emissions limits, then there is urgent need for:1) significant investment in technological advances and port reception facilities to allow zero discharge closed loop scrubber systems;2) improved protocols and standards for measuring, monitoring and reporting on scrubber discharge water acidity and pollutants;3) evidence-based regulations on scrubber water discharge limits that consider the full suite of contaminants

Progression of type 1 diabetes from latency to symptomatic disease is predicted by distinct autoimmune trajectories

Development of islet autoimmunity precedes the onset of type 1 diabetes in children, however, the presence of autoantibodies does not necessarily lead to manifest disease and the onset of clinical symptoms is hard to predict. Here we show, by longitudinal sampling of islet autoantibodies (IAb) to insulin, glutamic acid decarboxylase and islet antigen-2 that disease progression follows distinct trajectories. Of the combined Type 1 Data Intelligence cohort of 24662 participants, 2172 individuals fulfill the criteria of two or more follow-up visits and IAb positivity at least once, with 652 progressing to type 1 diabetes during the 15 years course of the study. Our Continuous-Time Hidden Markov Models, that are developed to discover and visualize latent states based on the collected data and clinical characteristics of the patients, show that the health state of participants progresses from 11 distinct latent states as per three trajectories (TR1, TR2 and TR3), with associated 5-year cumulative diabetes-free survival of 40% (95% confidence interval [CI], 35% to 47%), 62% (95% CI, 57% to 67%), and 88% (95% CI, 85% to 91%), respectively (p < 0.0001). Age, sex, and HLA-DR status further refine the progression rates within trajectories, enabling clinically useful prediction of disease onset

Clinically relevant germline variants in allogeneic hematopoietic stem cell transplant recipients

Allogeneic hematopoietic stem cell transplantation (HSCT) provides patients with severe hematologic disease a well-established potential for curation. Incorporation of germline analyses in the workup of HSCT patients is not a common practice. Recognizing rare harmful germline variants may however affect patients' pre-transplantation care, choice of the stem cell donor, and complication risks. We analyzed a population-based series of germline exome data of 432 patients who had undergone HSCT. Our aim was to identify clinically relevant variants that may challenge the outcome of the HSCT. We focused on genes predisposing to hematological diseases, or solid tumors, and genes included in the American College of Medical Genetics secondary findings list v3.0. As population-specific controls, we used GnomAD non-cancer Finns (n = 10,816). We identified in our population-based analysis rare harmful germline variants in disease-predisposing or actionable toxicity-increasing genes in 17.8% of adult and pediatric patients that have undergone HSCT (15.1% and 22.9%, respectively). More than half of the patients with a family member as a donor had not received genetic diagnosis prior to the HSCT. Our results encourage clinicians to incorporate germline genetic testing in the HSCT protocol in the future in order to reach optimal long-term outcome for the patients.</p

Social network and dominance hierarchy analyses at Chimpanzee Sanctuary Northwest

Different aspects of sociality bear considerable weight on the individual- and group-level welfare of captive nonhuman primates. Social Network Analysis (SNA) is a useful tool for gaining a holistic understanding of the dynamic social relationships of captive primate groups. Gaining a greater understanding of captive chimpanzees through investigations of centrality, preferred and avoided relationships, dominance hierarchy, and social network diagrams can be useful in advising current management practices in sanctuaries and other captive settings. In this study, we investigated the dyadic social relationships, group-level social networks, and dominance hierarchy of seven chimpanzees (Pan troglodytes) at Chimpanzee Sanctuary Northwest. We used focal-animal and instantaneous scan sampling to collect 106.75 total hours of associative, affiliative, and agonistic data from June to September 2016. We analyzed our data using SOCPROG to derive dominance hierarchies and network statistics, and we diagrammed the group\u27s social networks in NetDraw. Three individuals were most central in the grooming network, while two others had little connection. Through agonistic networks, we found that group members reciprocally exhibited agonism, and the group\u27s dominance hierarchy was statistically non-linear. One chimpanzee emerged as the most dominant through agonism but was least connected to other group members across affiliative networks. Our results indicate that the conventional methods used to calculate individuals\u27 dominance rank may be inadequate to wholly depict a group\u27s social relationships in captive sanctuary populations. Our results have an applied component that can aid sanctuary staff in a variety of ways to best ensure the improvement of group welfare