How can video-reflexive ethnographers anticipate positive impact on healthcare practice?

Evidence suggests that studies aiming to improve healthcare practice should be flexible and prioritise patient, family and clinician engagement. Video-reflexive ethnography (VRE), a form of qualitative research often employed in healthcare settings, is well-suited to these aims. VRE supplements ethnographic techniques with video-recordings of in situ practices, allowing practitioners to reflect on taken-for-granted practices. Its prioritisation of collaboration, affective entanglement, theory-driven analysis and flexibility – aligned with participatory and post-qualitative inquiry (PQI) – can facilitate re-flexivity among researchers and participants for local practice improvement. Yet paradoxically, flexibility can hinder the predictability of impact, and demonstrating likely impact is crucial to securing research funding. This article offers practical advice to qualitative researchers facing this methodological challenge. Using three exemplars, we examine how differing onto-epistemological groundings, conceptualisations of participant engagement and researcher positionings affect the timing, predictability, scalability and transferability of each study’s impact. We show how prioritising affective engagement, flexible goals and collaboration can enable local healthcare practice improvement; prioritising theory generation via consultation can lead to traditional, more transferable, forms of impact. We share insights for researchers seeking to improve healthcare using methods inspired by PQI such as VRE. While predicting impact is fraught, optimising conditions for impactful VRE research can be accomplished by: foregrounding epistemology; prioritising affective engagement; aligning research and stakeholder goals; assessing timing and organisational readiness; and considering researcher and participant positioning

Differential Microglial Responses Induced by N-a-Synuclein-Specific Effector T Cell Clones

Parkinson\u27s disease (PD) is a neurodegenerative movement disorder in which symptoms derive from deficits in dopamine neurotransmitter levels secondary to loss of dopaminergic neurons in the substantia nigra pars compacta (SNpc) associated with misfolding and accumulation of α−synuclein. Neuroinflammation via microglia and T effector cells (Teffs) contribute to dopaminergic neuronal cell death. Recognition of cytokine profiles of pro-inflammatory microglia is not well understood and serve as potential therapeutic targets to reduce neuroinflammation. Recent studies demonstrated a novel Th17.1 Teff clonotype increases neurotoxicity. The aim of this study was to demonstrate in vitro cytokine responses by BV-2 microglia induced by Th1, Th17, and Th17.1 clonotypes to assess neuroinflammation mechanisms in PD. Cytokine responses by BV-2 microglia co-cultured with activated Teff clonotypes were analyzed using a cytokine membrane array. Co-culture with Teffs led to significant increases in the majority of cytokine responses from BV-2 microglia compared to control. Cross group analysis relative expression demonstrated variation in cytokine profiles produced between microglia treated with different Teff clonotypes, especially with regard to IFNγ, MIG, MIP-1α, TIMP-1, RANTES, SDF-1, and IL-12 p40/p70. Ingenuity Pathway Analysis (IPA) of cytokines displaying significant relative expression levels for each Teff clonotype showed Th1- and Th17- treated BV-2 microglia demonstrated pathways related to cellular movement, hematological development and function, and immune trafficking while Th17.1-treated microglia upregulated pathways related to disorders of connective tissues, inflammation, and organismal injury. In conclusion, Th1, Th17, and Th17.1 Teffs treatment of BV-2 microglia led to upregulation of most pro-inflammatory cytokines and pathways. However, specific Teff clonotype culture with BV-2 microglia displayed different cytokine profile responses through varying relative expression profiles with significant differences related to IFNγ, MIG, MIP-1α, TIMP-1, RANTES, SDF-1, and IL12 p40/p70 delineating alternative inflammatory pathways. These results provide relevant targets for strategies to attenuate neuroinflammation and protect dopaminergic neurons in PD.https://digitalcommons.unmc.edu/emet_posters/1005/thumbnail.jp

“Everyone My Age Doesn’t Know What It’s Like”: A Mixed-Method Study of Young Mothers and Social Support in Australia

Young mothers often experience long-term social disadvantage. This research examines how young Australian mothers (i) compare to older mothers in levels of social support and personal resources, and (ii) perceive and experience the quality and type of social support available to them. Statistical analyses of survey data from The Longitudinal Study of Australian Children (n=5,087) is undertaken to compare the circumstances of young mothers (15-24 years old at birth of their child) and all older mothers (25+ years at birth of their child). Young mothers generally reported higher levels of social support, but poorer family relationships, and fewer personal resources (such as education and home ownership). In-depth interviews with nine young mothers (16-25 years at birth) in Southeast Queensland provided additional insights into how young mothers construct their sense of identity and experiences of motherhood. Young mothers often had difficult childhoods and strained relationships with their parents, but many reconnected with their mothers after pregnancy and found them to be important sources of support. This research suggests that being a mother outside the typical age range (25-34 years old) is challenging for both young and older mothers, but in different ways. These results provide important insights for policies and services aimed at supporting mothers of all ages

Effect of Polymer Chemistry on the Linear Viscoelasticity of Complex Coacervates

Complex coacervates can form through the electrostatic complexation of oppositely charged polymers. The material properties of the resulting coacervates can change based on the polymer chemistry and the complex interplay between electrostatic interactions and water structure, controlled by salt. We examined the effect of varying the polymer backbone chemistry using methacryloyl- and acryloyl-based complex coacervates over a range of polymer chain lengths and salt conditions. We simultaneously quantified the coacervate phase behavior and the linear viscoelasticity of the resulting coacervates to understand the interplay between polymer chain length, backbone chemistry, polymer concentration, and salt concentration. Time-salt superposition analysis was used to facilitate a broader characterization and comparison of the stress relaxation behavior between different coacervate samples. Samples with mismatched polymer chain lengths highlighted the ways in which the shortest polymer chain can dominate the resulting coacervate properties. A comparison between coacervates formed from methacryloyl vs acryloyl polymers demonstrated that the presence of a backbone methyl group affects the phase behavior, and thus the rheology in such a way that coacervates formed from methacryloyl polymers have a similar phase behavior to those of acryloyl polymers with ∼10× longer polymer chains

Comparison of Patient- and Practitioner-Reported Toxic Effects Associated With Chemoradiotherapy for Head and Neck Cancer

Agreement between patient- and practitioner-reported toxic effects during chemoradiotherapy for head and neck cancer is unknown. To compare patient-reported symptom severity and practitioner-reported toxic effects among patients receiving chemoradiotherapy for head and neck cancer. Forty-four patients participating in a phase 2 trial of deintensified chemoradiotherapy for oropharyngeal carcinoma were included in the present study (conducted from February 8, 2012, to March 2, 2015). Most treatment (radiotherapy, 60 Gy, with concurrent weekly administration of cisplatin, 30 mg/m2) was administered at academic medical centers. Included patients had no prior head and neck cancers, were 18 years or older, and had a smoking history of 10 pack-years or less or more than 10 pack-years but 30 pack-years or less and abstinent for the past 5 years. Cancer status was untreated human papillomavirus or p16-positive squamous cell carcinoma of the oropharynx or unknown head and neck primary site; and cancer staging was category T0 to T3, category N0 to N2c, M0, and Eastern Cooperative Oncology Group performance status 0 to 1. Baseline, weekly, and posttreatment toxic effects were assessed by physicians or nurse practitioners using National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE), version 4.0. Patient-reported symptom severity was measured using the Patient-Reported Outcomes version of the CTCAE (PRO-CTCAE). Descriptive statistics were used to characterize raw agreement between CTCAE grades and PRO-CTCAE severity ratings. Baseline, weekly, and posttreatment toxic effects assessed using CTCAE, version 4.0, and PRO-CTCAE. Raw agreement indices between patient-reported toxic effects, including symptom frequency, severity, and interference with daily activities (score range, 0 [none] to 4 [very severe]), and practitioner-measured toxic effects, including swallowing, oral pain, and hoarseness (score range, 1 [mild] to 5 [death]). Of the 44 patients included in the analysis (39 men, 5 women; mean [SD] age, 61 [8.4] years), there were 327 analyzable pairs of CTCAE and PRO-CTCAE symptom surveys and no treatment delays due to toxic effects. Patient-reported and practitioner-reported symptom severity agreement was high at baseline when most symptoms were absent but declined throughout treatment as toxic effects increased. Most disagreement was due to lower severity of toxic effects reported by practitioners (eg, from 45% agreement at baseline to 27% at the final week of treatment for pain). This was particularly noted for domains that are not easily evaluated by physical examination, such as anxiety and fatigue (eg, severity of fatigue decreased from 43% at baseline to 12% in the final week of treatment). Practitioner-reported toxic effects are lower than patient self-reports during head and neck chemoradiotherapy. The inclusion of patient-reported symptomatic toxic effects provides information that can potentially enhance clinical management and improve data quality in clinical trials

Impact of the Cancer Prevention and Control Research Network: Accelerating the Translation of Research Into Practice

The Cancer Prevention and Control Research Network (CPCRN) is a thematic network dedicated to accelerating the adoption of evidence-based cancer prevention and control practices in communities by advancing dissemination and implementation science. Funded by the Centers for Disease Control and Prevention and National Cancer Institute, CPCRN has operated at two levels: Each participating Network Center conducts research projects with primarily local partners as well as multicenter collaborative research projects with state and national partners. Through multicenter collaboration, thematic networks leverage the expertise, resources, and partnerships of participating centers to conduct research projects collectively that might not be feasible individually. Although multicenter collaboration often is advocated, it is challenging to promote and assess. Using bibliometric network analysis and other graphical methods, this paper describes CPCRN’s multicenter publication progression from 2004 to 2014. Searching PubMed, Scopus, and Web of Science in 2014 identified 249 peer-reviewed CPCRN publications involving two or more centers out of 6,534 total. The research and public health impact of these multicenter collaborative projects initiated by CPCRN during that 10-year period were then examined. CPCRN established numerous workgroups around topics such as: 2-1-1, training and technical assistance, colorectal cancer control, federally qualified health centers, cancer survivorship, and human papillomavirus. The paper discusses the challenges that arise in promoting multicenter collaboration and the strategies that CPCRN uses to address those challenges. The lessons learned should broadly interest those seeking to promote multisite collaboration to address public health problems, such as cancer prevention and control

Methods for Assessing Child and Family Outcomes in Early Childhood Special Education Programs

Although many concerns have been raised about methods of assessing outcomes in early childhood special education programs, professionals in the field are nevertheless faced with the need to select appropriate instruments for evaluating child and family outcomes as the result of intervention. A conference to address the current assessment needs of professionals was convened. This paper summarizes this conference, in which five prominent individuals in the field of early childhood special education gave specific recommendations for one child and one family outcome measure which would be applicable to a range of handicapped children between birth and age 5 being served in typical early intervention programs.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68510/2/10.1177_027112148600600202.pd

Navigating whiteness: affective relational intensities of non-clinical psychosocial support by and for culturally and linguistically diverse people

Mental health is political, with intersecting economic, cultural, racialized, and affective dimensions making up the care assemblage, signalling how care is conceptualised and who is deserving of care. In this article, we examine emotions circulating in a non-clinical psychosocial support program for culturally and linguistically diverse people experiencing mental ill-health, foregrounding the relations between culture, race, economy, and assumptions underpinning understandings of care. The mental health program under study offers psychosocial support for culturally and linguistically diverse people to manage life challenges and mental ill-health exacerbated by navigating the complexities of Australia’s health and social care systems. We draw on interviews with clients, staff, and providers of intersecting services, employing Ahmed’s concept of affective economies and Savreemootoo’s concept of navigating whiteness to examine the care assemblage within interview transcripts. We provide insight into affective intensities such as hate, anger, and indifference embedded in white Anglo-centric services, positioning culturally and linguistically diverse people on the margins of care. Non-clinical psychosocial support programs can counter such affective intensities by training and employing multicultural peer support workers—people with lived experience—prioritising relational and place-based approaches to care and supporting and providing clients with relevant skills to navigate an Anglo-centric care system. However, this support is filled with affective tensions: (com)passion, frustration and fatigue circulate and clash due to the scarcity of resources, further signalling what type of care (and with/for whom) is prioritised within Australian relations of care

High Rate of Mobilization for blaCTX-Ms

The blaCTX-Ms have been mobilized to plasmids more frequently than other class A β-lactamases

PATRIC, the bacterial bioinformatics database and analysis resource

The Pathosystems Resource Integration Center (PATRIC) is the all-bacterial Bioinformatics Resource Center (BRC) (http://www.patricbrc.org). A joint effort by two of the original National Institute of Allergy and Infectious Diseases-funded BRCs, PATRIC provides researchers with an online resource that stores and integrates a variety of data types [e.g. genomics, transcriptomics, protein-protein interactions (PPIs), three-dimensional protein structures and sequence typing data] and associated metadata. Datatypes are summarized for individual genomes and across taxonomic levels. All genomes in PATRIC, currently more than 10 000, are consistently annotated using RAST, the Rapid Annotations using Subsystems Technology. Summaries of different data types are also provided for individual genes, where comparisons of different annotations are available, and also include available transcriptomic data. PATRIC provides a variety of ways for researchers to find data of interest and a private workspace where they can store both genomic and gene associations, and their own private data. Both private and public data can be analyzed together using a suite of tools to perform comparative genomic or transcriptomic analysis. PATRIC also includes integrated information related to disease and PPIs. All the data and integrated analysis and visualization tools are freely available. This manuscript describes updates to the PATRIC since its initial report in the 2007 NAR Database Issu