When Students Grieve: Teachers of Students With Intellectual Disabilities

The identification and provision of support for the emotional needs of children with intellectual disabilities is essential as these students are often “disenfranchised grievers”-- meaning their grief is not recognized by others. The purpose of this study was to explore the experiences of teachers who have had elementary students with intellectual disabilities who have lost a parent or guardian. Additionally, this study documented behavioral changes and grief symptoms noted by teachers in their students, as well as how teachers responded to these perceived expressions of grief. Five teachers participated in two interviews designed to elicit information on their experience with grieving students. Constructivist grounded theory methods were used to analyze the data. Findings indicated that students were deeply impacted by the death of their parent or guardian. They displayed a range of grieving symptoms such as crying and aggression. Teachers overwhelmingly supported their grieving students despite being emotionally impacted themselves. They responded in ways suggested by grief and educational professionals such as when they provided concrete and simple explanations to assist with student understanding of death. Teachers expressed concern about the surviving caregivers’ own grief and the subsequent impact on their students. Teachers also highlighted the need for more grieving resources

Using social media to disseminate injury prevention content: Is a picture worth a thousand words?

Social media (SM) offers an opportunity for injury professionals to disseminate reliable safety recommendations to parents, yet little is known about the reach and impact of SM messages on parental safety knowledge and safety behavior adoption. It is also unclear whether electronic health (eHealth) literacy level is associated with understanding of messages. Parents of children (\u3c 7 years) were recruited from a nationally representative consumer panel to complete an online survey assessing their Internet and SM usage and eHealth literacy level using the eHealth Literacy Scale (eHEALS). Participants were shown three safety SM posts where images and text matched or did not match. A post-exposure survey captured participant understanding of SM post message. Five-hundred eighty parents completed the survey. A majority of participants were female (58.6%) with high eHealth literacy (84.5%). Compared to low eHealth literate parents, a larger proportion of high eHealth literate parents correctly identified the message in mismatched posts (safe sleep: p = .0081; poison prevention: p = .0052), while similar proportions of parents with high and low eHealth literacy correctly identified a matched post for bike safety (p = .7022). Within each eHealth literacy level, high eHealth literate parents were more often able to correctly identify SM post messaging when the photo and text matched. Parents are using SM to acquire safety, health, and parenting information; therefore, it is incumbent upon disseminators to create content with clear messages. SM posts should utilize matching text with imagery that illustrates the recommended safety behavior to facilitate parental understanding of safety recommendations, regardless of audience eHealth literacy level

Allies Already Poised to Comply: How Social Proximity Affects Lactation-at-Work Law Compliance

This study demonstrates how legal compliance may be better achieved when organizations include individuals who will advocate for newly codified rights and related accommodations. To understand compliance with a new law and the rights it confers, this article examines as its case study the Lactation at Work law, which amends the Fair Labor Standards Act to mandate basic provisions for employees to express breast milk at work. In particular, this study interviewed those organizational actors who translate the law into the policies affecting workers\u27 daily lives: supervising mangers and human resources personnel. Those studied in this article were “Allies Already:” friends or relatives of breastfeeding workers, or ones themselves, who held pro‐breastfeeding values and understood the complexities of combining lactation and employment. They mobilized within their organization to comply with the law swiftly and fully—often even overcomplying. This article demonstrates how heightened compliance, particularly with new laws, may be achieved even without directly affected actors mobilizing their own rights if allies champion needed accommodations

Exploring gender and fear retrospectively:stories of women’s fear during the ‘Yorkshire Ripper’ murders

The murder of 13 women in the North of England between 1975 and 1979 by Peter Sutcliffe who became known as the Yorkshire Ripper can be viewed as a significant criminal event due to the level of fear generated and the impact on local communities more generally. Drawing upon oral history interviews carried out with individuals living in Leeds at the time of the murders, this article explores women’s accounts of their fears from the time. This offers the opportunity to explore the gender/fear nexus from the unique perspective of a clearly defined object of fear situated within a specific spatial and historical setting. Findings revealed a range of anticipated fear-related emotions and practices which confirm popular ‘high-fear’ motifs; however, narrative analysis of interviews also highlighted more nuanced articulations of resistance and fearlessness based upon class, place and biographies of violence, as well as the way in which women drew upon fear/fearlessness in their overall construction of self. It is argued that using narrative approaches is a valuable means of uncovering the complexity of fear of crime and more specifically provides renewed insight onto women’s fear

Addressing the needs of children with disabilities experiencing disaster or terrorism

Purpose of review: This paper reviews the empirical literature on psychosocial factors relating to children with disabilities in the context of disaster or terrorism. Recent findings: Research indicates individuals with disabilities experience increased exposure to hazards due to existing social disparities and barriers associated with disability status. However, studies on the psychological effects of disaster/terrorism on children with preexisting disabilities are exceedingly few and empirical evidence of the effectiveness of trauma-focused therapies for this population is limited. Secondary adversities, including social stigma and health concerns, also compromise the recovery of these children post-disaster/terrorism. Schools and teachers appear to be particularly important in the recovery of children with disabilities to disaster. Disasters, terrorism, and war all contribute to the incidence of disability, as well as disproportionately affect children with preexisting disabilities. Summary: Disaster preparedness interventions and societal changes are needed to decrease the disproportionate environmental and social vulnerability of children with disabilities to disaster and terrorism

Common Genetic Polymorphisms Influence Blood Biomarker Measurements in COPD

Implementing precision medicine for complex diseases such as chronic obstructive lung disease (COPD) will require extensive use of biomarkers and an in-depth understanding of how genetic, epigenetic, and environmental variations contribute to phenotypic diversity and disease progression. A meta-analysis from two large cohorts of current and former smokers with and without COPD [SPIROMICS (N = 750); COPDGene (N = 590)] was used to identify single nucleotide polymorphisms (SNPs) associated with measurement of 88 blood proteins (protein quantitative trait loci; pQTLs). PQTLs consistently replicated between the two cohorts. Features of pQTLs were compared to previously reported expression QTLs (eQTLs). Inference of causal relations of pQTL genotypes, biomarker measurements, and four clinical COPD phenotypes (airflow obstruction, emphysema, exacerbation history, and chronic bronchitis) were explored using conditional independence tests. We identified 527 highly significant (p 10% of measured variation in 13 protein biomarkers, with a single SNP (rs7041; p = 10−392) explaining 71%-75% of the measured variation in vitamin D binding protein (gene = GC). Some of these pQTLs [e.g., pQTLs for VDBP, sRAGE (gene = AGER), surfactant protein D (gene = SFTPD), and TNFRSF10C] have been previously associated with COPD phenotypes. Most pQTLs were local (cis), but distant (trans) pQTL SNPs in the ABO blood group locus were the top pQTL SNPs for five proteins. The inclusion of pQTL SNPs improved the clinical predictive value for the established association of sRAGE and emphysema, and the explanation of variance (R2) for emphysema improved from 0.3 to 0.4 when the pQTL SNP was included in the model along with clinical covariates. Causal modeling provided insight into specific pQTL-disease relationships for airflow obstruction and emphysema. In conclusion, given the frequency of highly significant local pQTLs, the large amount of variance potentially explained by pQTL, and the differences observed between pQTLs and eQTLs SNPs, we recommend that protein biomarker-disease association studies take into account the potential effect of common local SNPs and that pQTLs be integrated along with eQTLs to uncover disease mechanisms. Large-scale blood biomarker studies would also benefit from close attention to the ABO blood group

Mapping the Environmental Fitness Landscape of a Synthetic Gene Circuit

Gene expression actualizes the organismal phenotypes encoded within the genome in an environment-dependent manner. Among all encoded phenotypes, cell population growth rate (fitness) is perhaps the most important, since it determines how well-adapted a genotype is in various environments. Traditional biological measurement techniques have revealed the connection between the environment and fitness based on the gene expression mean. Yet, recently it became clear that cells with identical genomes exposed to the same environment can differ dramatically from the population average in their gene expression and division rate (individual fitness). For cell populations with bimodal gene expression, this difference is particularly pronounced, and may involve stochastic transitions between two cellular states that form distinct sub-populations. Currently it remains unclear how a cell population's growth rate and its subpopulation fractions emerge from the molecular-level kinetics of gene networks and the division rates of single cells. To address this question we developed and quantitatively characterized an inducible, bistable synthetic gene circuit controlling the expression of a bifunctional antibiotic resistance gene in Saccharomyces cerevisiae. Following fitness and fluorescence measurements in two distinct environments (inducer alone and antibiotic alone), we applied a computational approach to predict cell population fitness and subpopulation fractions in the combination of these environments based on stochastic cellular movement in gene expression space and fitness space. We found that knowing the fitness and nongenetic (cellular) memory associated with specific gene expression states were necessary for predicting the overall fitness of cell populations in combined environments. We validated these predictions experimentally and identified environmental conditions that defined a “sweet spot” of drug resistance. These findings may provide a roadmap for connecting the molecular-level kinetics of gene networks to cell population fitness in well-defined environments, and may have important implications for phenotypic variability of drug resistance in natural settings

Facilitators and barriers to implementing electronic referral and/or consultation systems: a qualitative study of 16 health organizations

BACKGROUND: Access to specialty care remains a challenge for primary care providers and patients. Implementation of electronic referral and/or consultation (eCR) systems provides an opportunity for innovations in the delivery of specialty care. We conducted key informant interviews to identify drivers, facilitators, barriers and evaluation metrics of diverse eCR systems to inform widespread implementation of this model of specialty care delivery. METHODS: Interviews were conducted with leaders of 16 diverse health care delivery organizations between January 2013 and April 2014. A limited snowball sampling approach was used for recruitment. Content analysis was used to examine key informant interview transcripts. RESULTS: Electronic referral systems, which provide referral management and triage by specialists, were developed to enhance tracking and operational efficiency. Electronic consultation systems, which encourage bi-directional communication between primary care and specialist providers facilitating longitudinal virtual co-management, were developed to improve access to specialty expertise. Integrated eCR systems leverage both functionalities to enhance the delivery of coordinated, specialty care at the population level. Elements of successful eCR system implementation included executive and clinician leadership, established funding models for specialist clinician reimbursement, and a commitment to optimizing clinician workflows. CONCLUSIONS: eCR systems have great potential to streamline access to and enhance the coordination of specialty care delivery. While different eCR models help solve different organizational challenges, all require institutional investments for successful implementation, such as funding for program management, leadership and clinician incentives. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-015-1233-1) contains supplementary material, which is available to authorized users

Review of genitourinary tuberculosis with focus on end-stage renal disease

Tuberculosis (TB) is a current public health problem, remaining the most common worldwide cause of mortality from infectious disease. Recent studies indicate that genitourinary TB is the third most common form of extra-pulmonary disease. The diagnosis of renal TB can be hypothesized in a non-specific bacterial cystitis associated with a therapeutic failure or a urinalysis with a persistent leukocyturia in the absence of bacteriuria. We report on the case of a 33-year-old man who presented on admission end stage renal disease (ESRD) secondary to renal TB and a past history of pulmonary TB with important radiologic findings. The diagnosis was based on clinical findings despite all cultures being negative. Empiric treatment with tuberculostatic drugs was started and the patient became stable. He was discharged with no symptom, but without renal function recovery. He is on maintenance hemodialysis three times a week. TB is an important cause of kidney disease and can lead to irreversible renal function loss