Shaping Attitudes in Public Child Welfare: An Innovative MSW Training Program

Children investigated by child welfare are at significant risk for poor cognitive, emotional, social, behavioral and economic outcomes. In 2000, California formed the Child Welfare Services Group to propose changes in how child welfare services are delivered, the CWS Redesign. California State University, Long Beach’s child welfare training program developed its complement. Fundamentally, Redesign calls for partnering with families and communities to strengthen families, prevent unnecessary placements or re-unite families successfully. These changes are a paradigm shift in attitudes toward birth families and communities. In a qualitative study, interns logged their observations and subsequent impressions of CWS-Client encounters to explore how attitudes are learned. Majority of interns observed positive, collaborative encounters and perceived birth parents as motivated. Their impressions support introducing interns to birth families on the front-end of CWS training

Active Learning on Center Stage: Theater as a Tool for Medical Education

Introduction: Knowledge and skill development related to communication must incorporate both affective and behavioral components, which are often difficult to deliver in a learning activity. Using theater techniques and principles can provide medical educators with tools to teach communication concepts. Methods: This 75-minute faculty development workshop presents a variety of techniques from theater and adapts them for use in medical education. Using examples related to diversity and inclusion, this session addresses general educational and theater principles, role-play, sociodrama, applied improvisation, and practical aspects of involving theater partners. The session materials include a PowerPoint presentation with facilitator notes, interactive activities to demonstrate each modality, and an evaluation. The sessions can be extended to longer formats as needed. Results: Forty-five participants at Learn Serve Lead 2016: The AAMC Annual Meeting attended the 75-minute session. We emailed 32 participants 5 months after the conference, and eight responded. Participants reported that their confidence level in using theater techniques as a tool for medical education increased from low-to-medium confidence presession to high confidence postsession. All survey respondents who were actively teaching said they had made changes to their teaching based on the workshop. All commented that they appreciated the active learning in the session. Many indicated they would appreciate video or other follow-up resources. Discussion: Principles and techniques from theater are effective tools to convey difficult-to-teach concepts related to communication. This workshop presents tools to implement activities in teaching these difficult concepts

Global Breast Cancer: The Lessons to Bring Home

Breast cancer is the most common cancer affecting women globally. This paper discusses the current progress in breast cancer in Western countries and focuses on important differences of this disease in low- and middle-income countries (LMCs). It introduces several arguments for applying caution before globalizing some of the US-adopted practices in the screening and management of the disease. Finally, it suggests that studies of breast cancer in LMCs might offer important insights for a more effective management of the problem both in developing as well as developed countries

The Changing Landscape of Race, Culture, and Family Life: Interracial Couples' Contribution to the Conversation

The published social science research on interracial marriages has burgeoned considerably over the past few decades as experts address not only traditional, but also emerging questions about the quality of life in mixed-race families. The "emic" experience of being in a mixed race family remains, though, a relatively under-explored topic. To help fill the gap, we conducted a nationally distributed, snowball sample, anonymous, online survey of 241 married or cohabiting individuals; 83.6% self-identified as a member of a bi-racial couple. The 131 items surveyed couples' experiences of their partnership, family life, support, and discrimination—both in time and in place. The study presented multiple findings including a persistence of race discrimination in neighborhoods and at work; surprisingly, the couples also reported that their children were allowed to play with the children of White neighbors, regardless of the racial makeup of the family. There was a significant relationship between "importance of falling in love" and the racial makeup of the couple (x2 (15, N=205) =30.42, p=.01); Black/White and Hispanic/White couples choose their partner for love. Moreover, same race couples expressed the most unhappiness and the most regret of all of the couple-groups surveyed. Most concerning, though, was that interracial couples perceive raising multiracial children as more difficult; these results were significant (x2 (30, N=206) =62.68, p=.00) with Black/White couples, at 45.7%. The study presents multiple correlation tables. Additionally, limitations of the study are discussed and suggestions for further studies are presented

In vivo model for microbial invasion of tooth root dentinal tubules

ABSTRACT Objective Bacterial penetration of dentinal tubules via exposed dentine can lead to root caries and promote infections of the pulp and root canal system. The aim of this work was to develop a new experimental model for studying bacterial invasion of dentinal tubules within the human oral cavity. Material and Methods Sections of human root dentine were mounted into lower oral appliances that were worn by four human subjects for 15 d. Roots were then fixed, sectioned, stained and examined microscopically for evidence of bacterial invasion. Levels of invasion were expressed as Tubule Invasion Factor (TIF). DNA was extracted from root samples, subjected to polymerase chain reaction amplification of 16S rRNA genes, and invading bacteria were identified by comparison of sequences with GenBank database. Results All root dentine samples with patent tubules showed evidence of bacterial cell invasion (TIF value range from 5.7 to 9.0) to depths of 200 mm or more. A spectrum of Gram-positive and Gram-negative cell morphotypes were visualized, and molecular typing identified species of Granulicatella, Streptococcus, Klebsiella, Enterobacter, Acinetobacter, and Pseudomonas as dentinal tubule residents. Conclusion A novel in vivo model is described, which provides for human root dentine to be efficiently infected by oral microorganisms. A range of bacteria were able to initially invade dentinal tubules within exposed dentine. The model will be useful for testing the effectiveness of antiseptics, irrigants, and potential tubule occluding agents in preventing bacterial invasion of dentine

In vivo model for microbial invasion of tooth root dentinal tubules

Objective Bacterial penetration of dentinal tubules via exposed dentine can lead to root caries and promote infections of the pulp and root canal system. The aim of this work was to develop a new experimental model for studying bacterial invasion of dentinal tubules within the human oral cavity. Material and Methods Sections of human root dentine were mounted into lower oral appliances that were worn by four human subjects for 15 d. Roots were then fixed, sectioned, stained and examined microscopically for evidence of bacterial invasion. Levels of invasion were expressed as Tubule Invasion Factor (TIF). DNA was extracted from root samples, subjected to polymerase chain reaction amplification of 16S rRNA genes, and invading bacteria were identified by comparison of sequences with GenBank database. Results All root dentine samples with patent tubules showed evidence of bacterial cell invasion (TIF value range from 5.7 to 9.0) to depths of 200 mm or more. A spectrum of Gram-positive and Gram-negative cell morphotypes were visualized, and molecular typing identified species of Granulicatella, Streptococcus, Klebsiella, Enterobacter, Acinetobacter, and Pseudomonas as dentinal tubule residents. Conclusion A novel in vivo model is described, which provides for human root dentine to be efficiently infected by oral microorganisms. A range of bacteria were able to initially invade dentinal tubules within exposed dentine. The model will be useful for testing the effectiveness of antiseptics, irrigants, and potential tubule occluding agents in preventing bacterial invasion of dentine

IL-15 and PIM kinases direct the metabolic programming of intestinal intraepithelial lymphocytes

Intraepithelial lymphocytes (IEL) respond to IL-15 complexed with IL-15Ra but how this intrinsically affects IEL is unclear. Here the authors use proteomics analyses of the main mouse IEL subsets and identify PIM kinases as essential for IEL proliferation, metabolism and effector function downstream of IL-15

EnROL: A multicentre randomised trial of conventional versus laparoscopic surgery for colorectal cancer within an enhanced recovery programme

BACKGROUND: During the last two decades the use of laparoscopic resection and a multimodal approach known as an enhanced recovery programme, have been major changes in colorectal perioperative care. Clinical outcome improves using laparoscopic surgery to resect colorectal cancer but until recently no multicentre trial evidence had been reported regarding whether the benefits of laparoscopy still exist when open surgery is optimized within an enhanced recovery programme. The EnROL trial (Enhanced Recovery Open versus Laparoscopic) examines the hypothesis that laparoscopic surgery within an enhanced recovery programme will provide superior postoperative outcomes when compared to conventional open resection of colorectal cancer within the same programme. METHODS/DESIGN: EnROL is a phase III, multicentre, randomised trial of laparoscopic versus open resection of colon and rectal cancer with blinding of patients and outcome observers to the treatment allocation for the first 7 days post-operatively, or until discharge if earlier. 202 patients will be recruited at approximately 12 UK hospitals and randomised using minimization at a central computer system in a 1:1 ratio. Recruiting surgeons will previously have performed >100 laparoscopic colorectal resections and >50 open total mesorectal excisions to minimize conversion. Eligible patients are those suitable for elective resection using either technique. Excluded patients include: those with acute intestinal obstruction and patients in whom conversion from laparoscopic to open procedure is likely. The primary outcome is physical fatigue as measured by the physical fatigue domain of the multidimensional fatigue inventory 20 (MFI-20) with secondary outcomes including postoperative hospital stay; complications; reoperation and readmission; quality of life indicators; cosmetic assessments; standardized performance indicators; health economic analysis; the other four domains of the MFI-20. Pathological assessment of surgical quality will also be undertaken and compliance with the enhanced recovery programme will be recorded for all patients. DISCUSSION: Should this trial demonstrate that laparoscopic surgery confers a significant clinical and/or health economic benefit this will further support the transition to this type of surgery, with implications for the training of surgeons and resource allocation. TRIAL REGISTRATION: ISRCTN48516968

Characterization of the microbiome of nipple aspirate fluid of breast cancer survivors.

The microbiome impacts human health and disease. Until recently, human breast tissue and milk were presumed to be sterile. Here, we investigated the presence of microbes in the nipple aspirate fluid (NAF) and their potential association with breast cancer. We compared the NAF microbiome between women with a history of breast cancer (BC) and healthy control women (HC) using 16S rRNA gene amplicon sequencing. The NAF microbiome from BC and HC showed significant differences in community composition. Two Operational Taxonomic Units (OTUs) showed differences in relative abundances between NAF collected from BC and HC. In NAF collected from BC, there was relatively higher incidence of the genus Alistipes. By contrast, an unclassified genus from the Sphingomonadaceae family was relatively more abundant in NAF from HC. These findings reflect the ductal source DNA since there were no differences between areolar skin samples collected from BC and HC. Furthermore, the microbes associated with BC share an enzymatic activity, Beta-Glucuronidase, which may promote breast cancer. This is the first report of bacterial DNA in human breast ductal fluid and the differences between NAF from HC and BC. Further investigation of the ductal microbiome and its potential role in breast cancer are warranted

Who lives in Scotland’s care homes? Descriptive analysis using routinely collected social care data 2012–16

Background: Adults living in long-term care are a significant and complex population who are under-represented in research using traditional methodologies. Methods: The aim of this study was to provide the first description of the adult care home population and their homes, using routinely collected data. A retrospective descriptive analysis was performed using the Scottish Care Home Census (SCHC) between 1 April 2012 and 31 March 2016. Results: Data are from 1,299 care home services (79.3–89.7% completeness), including 34,399–39,311 residents per year across all regions of Scotland. A total of 68% of residents are female, with median age 84 years. 27% fund their own care. Over 85% of self-funded residents receive free personal care allowance. Around 60% require care from a registered nurse and 49% have a formal diagnosis of dementia. The majority of admissions come from hospital (46%). Between 13 and 17% of residents die annually, with a median time to death of 596–653 days. Conclusions: This study provides the most comprehensive descriptive data of UK care home residents available. There is scope to enhance the information available through linkage to other routine sources