Functional status measures for the COPD patient : a practical categorization

The objective of this study is to review available functional status measures (FSMs) validated for use in the chronic obstructive pulmonary disease (COPD) population and categorizing the measures by their commonalities to formulate a framework that supports clinicians in the selection and application of FSMs. A literature review identifying valid and reliable measures of functional status for people with COPD was undertaken. Measures were thematically analyzed and categorized to develop a framework for clinical application. A variety of measures of activity levels exist, with 35 included in this review. Thematic categorization identified five categories of measures: daily activity, impact, surrogate, performance-based, and disability-based measures. The vast variety of FSMs available for clinicians to apply with people who have COPD may be overwhelming, and selection must be thoughtfully based on the nature of the population being studied/evaluated, and aims of evaluation being conducted, not simply as a standard measure used at the institution. Psychometric testing is a critical feature to a strong instrument and issues of reliability, validity, and responsiveness need to be understood prior to measurement use. Contextual nature of measures such as language used and activities measured is also important. A categorical framework to support clinicians in the selection and application of FSMs has been presented in this article

Extreme Pyroconvective Updrafts During a Megafire

Airborne cloud radar reveals extreme wildfire updrafts (~60 m s−1) and downdrafts (~30 m s−1) rivaling those in supercell thunderstorms. These extreme vertical velocities occur through a 3-km-deep layer and below the base of a developing pyrocumulonimbus (pyroCb) cloud, which extends to the tropopause at 12 km. In situ aircraft sampling shows updrafts are linked to large temperature and moisture excesses but remain subsaturated at flight level (i.e., below cloud base). Parcel estimates using the in situ data help explain how these “hot-moist” updrafts trigger the overlying pyroCb. The extreme vertical motions observed also pose a previously undocumented aviation hazard

Preschool Verbal and Nonverbal Ability Mediate the Association Between Socioeconomic Status and School Performance

We compared the extent to which the long-term influence of family socioeconomic status (SES) on children's school performance from age 7 through 16 years was mediated by their preschool verbal and nonverbal ability. In 661 British children, who completed 17 researcher-administered ability tests at age 4.5 years, SES correlated more strongly with verbal than nonverbal ability (.39 vs.26). Verbal ability mediated about half of the association between SES and school performance at age 7, while nonverbal ability accounted for a third of the link. Only SES, but not verbal or nonverbal ability, was associated with changes in school performance from age 7 to 16. We found that SES-related differences in school performance are only partly transmitted through children's preschool verbal abilities

Unequal childhoods: A case study application of Lareau’s ‘accomplishment of natural growth’ in British working-class and poor families

International authors have argued that social class inequalities can influence parental engagement in education (Bourdieu, 1974). Lareau argued that middle-class families possess the resources to actively cultivate their children to succeed academically, whereas working-class and poor families feel they lack such resources and allow their children to develop limited and passive relations with school. This paper applies a core element of Lareau’s typology of child rearing to examine disadvantaged British mothers’ experience of engaging with schools. A study involving 77 parents and caregivers of secondary school children, considered disadvantaged, sought to understand the experiences of parental engagement in primary and secondary education. Selective case studies have been chosen from this larger study, using a thematic analysis, to understand how these mothers interpreted their experiences of engaging with secondary education, their feelings of frustration, powerlessness and distance from secondary school. The stories presented illustrate that the ‘accomplishment of natural growth’ provides a contemporary class analysis framework to interpret the experiences of some disadvantaged British parents. Recommendations are made advising how Lareau’s typology of child rearing can inform policy and practice in the British education system and recommendations for future research are made with the purpose of promoting equal access to educational engagement and opportunitie

Clonal expansion and epigenetic inheritance of long-lasting NK cell memory

Clonal expansion of cells with somatically diversified receptors and their long-term maintenance as memory cells is a hallmark of adaptive immunity. Here, we studied pathogen-specific adaptation within the innate immune system, tracking natural killer (NK) cell memory to human cytomegalovirus (HCMV) infection. Leveraging single-cell multiomic maps of ex vivo NK cells and somatic mitochondrial DNA mutations as endogenous barcodes, we reveal substantial clonal expansion of adaptive NK cells in HCMV(+) individuals. NK cell clonotypes were characterized by a convergent inflammatory memory signature enriched for AP1 motifs superimposed on a private set of clone-specific accessible chromatin regions. NK cell clones were stably maintained in specific epigenetic states over time, revealing that clonal inheritance of chromatin accessibility shapes the epigenetic memory repertoire. Together, we identify clonal expansion and persistence within the human innate immune system, suggesting that these mechanisms have evolved independent of antigen-receptor diversification

Raising children with high self-esteem (but not narcissism)

With the rise of individualism since the 1960s, Western parents have become increasingly concerned with raising children’s self-esteem. This is understandable, given the benefits of self-esteem for children’s psychological health. However, parents’ well-intentioned attempts to raise self-esteem, such as inflated praise, may inadvertently breed narcissism. How, then, can parents raise self-esteem without breeding narcissism? Here, we propose a tripartite model of self-regard, which holds that the development of self-esteem without narcissism can be cultivated through realistic feedback (rather than inflated praise), focus on growth (rather than on outperforming others), and unconditional regard (rather than regard that is conditional). We review evidence in support of these practices and outline promising research directions. The tripartite model integrates existing research, stimulates theory development, and identifies leverage points for intervention concurrently to raise self-esteem and curtail narcissism from a young age

Childcare, choice and social class: Caring for young children in the UK

This paper draws on the results of two qualitative research projects examining parental engagements with the childcare market in the UK. Both projects are located in the same two London localities. One project focuses on professional middle class parents, and the other on working class families, and we discuss the key importance of social class in shaping parents' differential engagement with the childcare market, and their understandings of the role childcare plays in their children's lives. We identify and discuss the different "circuits" of care (Ball et al 1995) available to and used by families living physically close to each other, but in social class terms living in different worlds. We also consider parents' relationships with carers, and their social networks. We conclude that in order to fully understand childcare policies and practices and families' experiences of care, an analysis which encompasses social class and the workings of the childcare market is needed

Single Cell Transcriptomics Implicate Novel Monocyte and T Cell Immune Dysregulation in Sarcoidosis

Sarcoidosis is a systemic inflammatory disease characterized by infiltration of immune cells into granulomas. Previous gene expression studies using heterogeneous cell mixtures lack insight into cell-type-specific immune dysregulation. We performed the first single-cell RNA-sequencing study of sarcoidosis in peripheral immune cells in 48 patients and controls. Following unbiased clustering, differentially expressed genes were identified for 18 cell types and bioinformatically assessed for function and pathway enrichment. Our results reveal persistent activation of circulating classical monocytes with subsequent upregulation of trafficking molecules. Specifically, classical monocytes upregulated distinct markers of activation including adhesion molecules, pattern recognition receptors, and chemokine receptors, as well as enrichment of immunoregulatory pathways HMGB1, mTOR, and ephrin receptor signaling. Predictive modeling implicated TGFβ and mTOR signaling as drivers of persistent monocyte activation. Additionally, sarcoidosis T cell subsets displayed patterns of dysregulation. CD4 naïve T cells were enriched for markers of apoptosis and Th17/T(reg) differentiation, while effector T cells showed enrichment of anergy-related pathways. Differentially expressed genes in regulatory T cells suggested dysfunctional p53, cell death, and TNFR2 signaling. Using more sensitive technology and more precise units of measure, we identify cell-type specific, novel inflammatory and regulatory pathways. Based on our findings, we suggest a novel model involving four convergent arms of dysregulation: persistent hyperactivation of innate and adaptive immunity via classical monocytes and CD4 naïve T cells, regulatory T cell dysfunction, and effector T cell anergy. We further our understanding of the immunopathology of sarcoidosis and point to novel therapeutic targets