Case 9 : Shifting Culture Between Patients and Health Care Teams To Impact Symptom Screen and Management

Health Promotion Specialist Lisa Grey is faced with the task of strengthening patient and health care team culture using the Edmonton Symptoms Assessment Screening (ESAS) tool. ESAS is a standardized symptom screening tool used in health care settings across Ontario and is completed by patients at each clinic visit. The tool measures and tracks a patient’s symptom severity relating to nine common cancer symptoms. Symptoms are an indication of the progression of cancer and patient health status. ESAS gives an opportunity to identify symptoms earlier on, prevent emergency admission, and manage symptoms such as pain (Barbera et al., 2012; Barbera et al., 2015). The percentage of total cancer patients who were screened at least once with ESAS had declined at the London Regional Cancer Program; screening rates were below the provincial target of 70% and the provincial average of 58.4% (Cancer Care Ontario, 2014). Grey oversees five work streams in an effort to change attitudes and beliefs among patients and health care employees, and highlight the value of using ESAS on a consistent basis

Increased Drinking in a Trial of Treatments for Marijuana Dependence: Substance Substitution?

This report examines whether participants in a study of treatments for marijuana dependence may have increased their use of alcohol when they reduced or ceased marijuana use. Participants were randomly assigned to one of four psychosocial treatments and followed at 3-month intervals for one-year. Findings are from 207 cases with data at posttreatment and at least one other follow-up. 73% of cases reported an increase of at least 10% in drinking days over their level at intake, and 65% reported an increase of at least 10% in drinks per drinking day. Drinking increases were not related to treatment condition nor to change in marijuana use, but were related to baseline drinking: those with less baseline drinking tended to increase their drinking during treatment and those with more baseline drinking reported less drinking during treatment. Thereafter, drinking levels remained fairly stable throughout the follow-up year. The results are most likely reflective of a regression to the mean effect, and indicate that use of alcohol and marijuana are independent of one another

Intracranial EEG fluctuates over months after implanting electrodes in human brain.

OBJECTIVE: Implanting subdural and penetrating electrodes in the brain causes acute trauma and inflammation that affect intracranial electroencephalographic (iEEG) recordings. This behavior and its potential impact on clinical decision-making and algorithms for implanted devices have not been assessed in detail. In this study we aim to characterize the temporal and spatial variability of continuous, prolonged human iEEG recordings. APPROACH: Intracranial electroencephalography from 15 patients with drug-refractory epilepsy, each implanted with 16 subdural electrodes and continuously monitored for an average of 18 months, was included in this study. Time and spectral domain features were computed each day for each channel for the duration of each patient\u27s recording. Metrics to capture post-implantation feature changes and inflexion points were computed on group and individual levels. A linear mixed model was used to characterize transient group-level changes in feature values post-implantation and independent linear models were used to describe individual variability. MAIN RESULTS: A significant decline in features important to seizure detection and prediction algorithms (mean line length, energy, and half-wave), as well as mean power in the Berger and high gamma bands, was observed in many patients over 100 d following implantation. In addition, spatial variability across electrodes declines post-implantation following a similar timeframe. All selected features decreased by 14-50% in the initial 75 d of recording on the group level, and at least one feature demonstrated this pattern in 13 of the 15 patients. Our findings indicate that iEEG signal features demonstrate increased variability following implantation, most notably in the weeks immediately post-implant. SIGNIFICANCE: These findings suggest that conclusions drawn from iEEG, both clinically and for research, should account for spatiotemporal signal variability and that properly assessing the iEEG in patients, depending upon the application, may require extended monitoring

Outcome-related metabolomic patterns from 1H/31P NMR after mild hypothermia treatments of oxygen–glucose deprivation in a neonatal brain slice model of asphyxia

Human clinical trials using 72 hours of mild hypothermia (32°C–34°C) after neonatal asphyxia have found substantially improved neurologic outcomes. As temperature changes differently modulate numerous metabolite fluxes and concentrations, we hypothesized that 1H/31P nuclear magnetic resonance (NMR) spectroscopy of intracellular metabolites can distinguish different insults, treatments, and recovery stages. Three groups of superfused neonatal rat brain slices underwent 45 minutes oxygen–glucose deprivation (OGD) and then were: treated for 3 hours with mild hypothermia (32°C) that began with OGD, or similarly treated with hypothermia after a 15-minute delay, or not treated (normothermic control group, 37°C). Hypothermia was followed by 3 hours of normothermic recovery. Slices collected at different predetermined times were processed, respectively, for 14.1 Tesla NMR analysis, enzyme-linked immunosorbent assay (ELISA) cell-death quantification, and superoxide production. Forty-nine NMR-observable metabolites underwent a multivariate analysis. Separated clustering in scores plots was found for treatment and outcome groups. Final ATP (adenosine triphosphate) levels, severely decreased at normothermia, were restored equally by immediate and delayed hypothermia. Cell death was decreased by immediate hypothermia, but was equally substantially greater with normothermia and delayed hypothermia. Potentially important biomarkers in the 1H spectra included PCr-1H (phosphocreatine in the 1H spectrum), ATP-1H (adenosine triphosphate in the 1H spectrum), and ADP-1H (adenosine diphosphate in the 1H spectrum). The findings suggest a potential role for metabolomic monitoring during therapeutic hypothermia

Visualizing the Influence of Social Networks on Recovery:A Mixed-Methods Social Identity Mapping Study with Recovering Adolescents

BackgroundSocial recovery capital (SRC) refers to resources and supports gained through relationships and is vital to adolescent addiction recovery. Much is known about how substance use relates to social networks, but little is known about how other dimensions of social networks influence recovery (e.g., network size/exposure, degree of conflict). MethodsThis mixed-methods study sampled 28 adolescents who received treatment for alcohol and other drug (AOD) use disorder (14-19 yrs.: 71% male; M=17.32 yrs., SD=1.33; White 82%): 20 were recovery high school (RHS) students. Adolescents completed a social identity map for addiction recovery (SIM-AR), survey, and interview. Qualitative data were content analyzed and the data from the SIM-AR were quantified. ResultsOn average, participants reported belonging to five having 5 distinct groups (Range, 2-9; SD=1.63; M=27.89 people, SD = 20.09) in their network. Of their social network connections, on average, 51% drank alcohol and 46% used other substances. Larger networks involved more conflict (r=0.57). Participants were more likely to spend more time with groups that had greater proportions of non-substance usinge members; these relationships were stronger for RHS than for non-RHS students. Qualitative analyses revealed that youth reported their recovery-oriented groups as supportive, yet some felt their substance-using friends also supported their recovery.DiscussionSIM-AR was a useful measurement tool, and, through qualitative interviews, we identified unique aspects of youth’s social networks important for further examination. Research with recovering youth should examine SRC-related elements within their networks including relationship quality, belonging, and conflict, in addition to the substance use behaviors of network members. <br/

Climate Change during and after the Roman Empire: Reconstructing the Past from Scientific and Historical Evidence

Growing scientific evidence from modern climate science is loaded with implications for the environmental history of the Roman Empire and its successor societies. The written and archaeological evidence, although richer than commonly realized, is unevenly distributed over time and space. A first synthesis of what the written records and multiple natural archives (multi-proxy data) indicate about climate change and variability across western Eurasia from c. 100 b.c. to 800 a.d. confirms that the Roman Empire rose during a period of stable and favorable climatic conditions, which deteriorated during the Empire's third-century crisis. A second, briefer period of favorable conditions coincided with the Empire's recovery in the fourth century; regional differences in climate conditions parallel the diverging fates of the eastern and western Empires in subsequent centuries. Climate conditions beyond the Empire's boundaries also played an important role by affecting food production in the Nile valley, and by encouraging two major migrations and invasions of pastoral peoples from Central Asia.Earth and Planetary SciencesHistor

Further localization of a gene for paroxysmal dystonic choreoathetosis to a 5-cM region on chromosome 2q34

Paroxysmal dystonic choreoathetosis (PDC) is a rare neurological disorder characterized by episodes of involuntary movement, involving the extremities and face, which may occur spontaneously or be precipitated by caffeine, alcohol, anxiety, and fatigue. PDC is transmitted as an autosomal dominant trait with incomplete penetrance. A gene implicated in this paroxysmal disorder has been mapped to a 10–15 cM region on chromosome 2q31–36 in two families. We describe a third family with PDC. Two-point linkage analyses with markers linked to the candidate PDC locus were performed. A maximum two-point LOD score of 4.20 at a recombination fraction of zero was obtained for marker D2S120, confirming linkage to the distal portion of chromosome 2q. The anion exchanger gene, SLC2C, maps to this region, but the family was poorly informative for polymorphic markers within and flanking this candidate gene. Haplotype analysis revealed a critical recombination event that confines the PDC gene to a 5-cM region bounded by the markers D2S164 and D2S377. We compared the haplotype in our family with that in another chromosome 2-linked PDC family, but did not detect a region of shared genotypes. However, identifying a third family whose disease maps to the same region and narrowing the critical region will facilitate identification of the 2q-linked PDC gene.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42259/1/439-102-1-93_81020093.pd

An Australian general practice based strategy to improve chronic disease prevention, and its impact on patient reported outcomes: Evaluation of the preventive evidence into practice cluster randomised controlled trial

© 2017 The Author(s). Background: Implementing evidence-based chronic disease prevention with a practice-wide population is challenging in primary care. Methods: PEP Intervention practices received education, clinical audit and feedback and practice facilitation. Patients (40 69 years) without chronic disease from trial and control practices were invited to participate in baseline and 12 month follow up questionnaires. Patient-recalled receipt of GP services and referral, and the proportion of patients at risk were compared over time and between intervention and control groups. Mean difference in BMI, diet and physical activity between baseline and follow up were calculated and compared using a paired t-test. Change in the proportion of patients meeting the definition for physical activity diet and weight risk was calculated using McNemar's test and multilevel analysis was used to determine the effect of the intervention on follow-up scores. Results: Five hundred eighty nine patients completed both questionnaires. No significant changes were found in the proportion of patients reporting a BP, cholesterol, glucose or weight check in either group. Less than one in six at-risk patients reported receiving lifestyle advice or referral at baseline with little change at follow up. More intervention patients reported attempts to improve their diet and reduce weight. Mean score improved for diet in the intervention group (p = 0.04) but self-reported BMI and PA risk did not significantly change in either group. There was no significant change in the proportion of patients who reported being at-risk for diet, PA or weight, and no changes in PA, diet and BMI in multilevel linear regression adjusted for patient age, sex, practice size and state. There was good fidelity to the intervention but practices varied in their capacity to address changes. Conclusions: The lack of measurable effect within this trial may be attributable to the complexities around behaviour change and/or system change. This trial highlights some of the challenges in providing suitable chronic disease preventive interventions which are both scalable to whole practice populations and meet the needs of diverse practice structures. Trial registration: Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000578808 (29/5/2012). This trial registration is retrospective as our first patient returned their consent on the 21/5/2012. Patient recruitment was ongoing until 31/10/2012

Girls Are Good At STEM: Opening Minds And Providing Evidence Reduce Boys\u27 Stereotyping Of Girls\u27 STEM Ability

Girls and women face persistent negative stereotyping within STEM (science, technology, engineering, mathematics). This field intervention was designed to improve boys\u27 perceptions of girls\u27 STEM ability. Boys (N = 667; mostly White and East Asian) aged 9-15 years in Canadian STEM summer camps (2017-2019) had an intervention or control conversation with trained camp staff. The intervention was a multi-stage persuasive appeal: a values affirmation, an illustration of girls\u27 ability in STEM, a personalized anecdote, and reflection. Control participants discussed general camp experiences. Boys who received the intervention (vs. control) had more positive perceptions of girls\u27 STEM ability, d = 0.23, an effect stronger among younger boys. These findings highlight the importance of engaging elementary-school-aged boys to make STEM climates more inclusive