An evaluation of the Elementary Evaluative Criteria

Thesis (Ed.M.)--Boston University, 1955. This item was digitized by the Internet Archive

DNA-based Diagnosis of Uncharacterized Inherited Macrothrombocytopenias Using Next-generation Sequencing Technology with a Candidate Gene Array

Inherited macrothrombocytopenias comprise a heterogeneous group of inherited platelet disorders that are characterized by large platelets, thrombocytopenia and bleeding tendencies in affected individuals. Diagnostic platforms have traditionally involved a battery of complex phenotypic tests that often fail to reach a diagnosis. Next-generation sequencing lacks the pre-analytical and analytical shortcoming of these tests and provides an attractive alternate diagnostic approach. Our group has developed a candidate gene array targeting genes known to affect platelet function and tested it in a large cohort of Australasian patients with presumed platelet function disorders, particularly macrothrombocytopenia. This array identified causative variants in a significant portion of patients with uncharacterized platelet disorders, including transcription factor mutations that cannot easily be diagnosed with standard platelet phenotyping procedures. We propose that targeted genotypic screening can identify the genetic basis of platelet function defects and has the potential to be developed into a powerful clinical platform to help clinicians diagnose these rare disorders

Breaking bad news and the importance of compassionate palliative care of the infant

Bad news to parents regarding their infant is information that negatively impacts the parent’s feelings and view of the present and/or future. It is implemented in situations with feelings of no hope or those that induce a threat to a parent’s mental and physical well-being. The term is difficult to define as it is based on parent’s subjective feelings. However, it is important to be aware of the impact of bad news as it can cause severe anguish and stress on the parent’s emotional stability. The style of delivering bad news has a significant impact on the physician/parent relationship and the satisfaction of the family upon the healthcare team and palliative care system. In the case of an inevitable death of an infant, the implementation of palliative care follows the delivery of bad news. The strategy of palliative care and the philosophy of communication between the healthcare provider and family unit leave a lasting impression on the parents regarding the care of their infant. Clinicians should strive to educate themselves regarding the art of breaking bad news as well as the approach to palliative care to minimize the suffering and grief of the family in their time of sorrow

Replicating or franchising a STEM afterschool program model: core elements of programmatic integrity

Background: Designed in 2012 with a first implementation in 2013, NE STEM 4U is a professional development program for post-secondary students/undergraduates, and serves as a source of outreach, content knowledge generation, and STEM literacy for youth in grades kindergarten through 8th grade (ages 5–14). The model empowers post-secondary students as facilitators of inquiry-based learning within the context of an out-of-school time program. This study investigated the potential for replicating or ‘franchising’ this model by evaluating on the following: (1) Is the model replicable? And, if so, (2) what core elements are necessary for program fidelity? And (3) is there a dependency on a particular setting/participant type (e.g., a more rural or urban setting)? Results: Strategic expansion of the program to different institutional types (i.e., Research 1, Research II, and a predominantly undergraduate institution), different geographical locations (i.e., rural and urban), and with various school district partners (i.e., large and small) determined that program fidelity and replicability required 4 core elements or criteria: (i) intentional programming, (ii) staff quality, (iii) effective partnerships, and (iv) program evaluation and continuous improvement. Importantly, we examined emergent themes by each site, as well as in combination (n = 16 focus group participants, n = 12 reflection surveys). These data indicated that Flexibility (21.22%), Student Engagement (i.e., Youth) (19.53%), Classroom Management (i.e., also pertaining to youth) (19.31%), and Communication (15.71%) were the themes most referenced by the post-secondary student mentors in the NE STEM 4U program, regardless of site. Finally, the YPQA results demonstrate general replication of program quality in a “franchise” location. Conclusions: These results highlight the core elements of the NE STEM 4U program for consideration of expansion (through strategic replication or ‘franchising’) as a possible international model. The findings and voices highlight the program’s trajectory toward success into environments that expand professional development for post-secondary students, and for delivering STEM opportunities for youth

Evidence that pneumococcal serotype replacement in Massachusetts following conjugate vaccination is now complete

Invasive pneumococcal disease (IPD) has been reduced in the US following conjugate vaccination (PCV7) targeting seven pneumococcal serotypes in 2000. However, increases in IPD due to other serotypes have been observed, in particular 19A. How much this serotype replacement will erode the benefits of vaccination and over what timescale is unknown. We used a population genetic approach to test first whether the selective impact of vaccination could be detected in a longitudinal carriage sample, and secondly how long it persisted for following introduction of vaccine in 2000. To detect the selective impact of the vaccine we compared the serotype diversity of samples from pneumococcal carriage in Massachusetts children collected in 2001, 2004 and 2007 with others collected in the pre-vaccine era in Massachusetts, the UK and Finland. The 2004 sample was significantly (p \u3e0.0001) more diverse than pre-vaccine samples, indicating the selective pressure of vaccination. The 2007 sample showed no significant difference in diversity from the pre-vaccine period, and exhibited similar population structure, but with different serotypes. In 2007 the carriage frequency of 19A was similar to that of the most common serotype in pre-vaccine samples. We suggest that serotype replacement involving 19A may be complete in Massachusetts due to similarities in population structure to pre-vaccine samples. These results suggest that the replacement phenomenon occurs rapidly with high vaccine coverage, and may allay concerns about future increases in disease due to 19A. For other serotypes, the future course of replacement disease remains to be determined

Disrupted seasonal biology impacts health, food security and ecosystems

The rhythm of life on earth is shaped by seasonal changes in the environment. Plants and animals show profound annual cycles in physiology, health, morphology, behaviour and demography in response to environmental cues. Seasonal biology impacts ecosystems and agriculture, with consequences for humans and biodiversity. Human populations show robust annual rhythms in health and well-being, and the birth month can have lasting effects that persist throughout life. This review emphasizes the need for a better understanding of seasonal biology against the backdrop of its rapidly progressing disruption through climate change, human lifestyles and other anthropogenic impact. Climate change is modifying annual rhythms to which numerous organisms have adapted, with potential consequences for industries relating to health, ecosystems and food security. Disconcertingly, human lifestyles under artificial conditions of eternal summer provide the most extreme example for disconnect from natural seasons, making humans vulnerable to increased morbidity and mortality. In this review, we introduce scenarios of seasonal disruption, highlight key aspects of seasonal biology and summarize from biomedical, anthropological, veterinary, agricultural and environmental perspectives the recent evidence for seasonal desynchronization between environmental factors and internal rhythms. Because annual rhythms are pervasive across biological systems, they provide a common framework for trans-disciplinary research

Semiquantal dynamics of fluctuations: Ostensible quantum chaos

The time-dependent variational principle using generalized Gaussian trial functions yields a finite dimensional approximation to the full quantum dynamics and is used in many disciplines. It is shown how these 'semi-quantum' dynamics may be derived via the Ehrenfest theorem and recast as an extended classical gradient system with the fluctuation variables coupled to the average variables. An extended potential is constructed for a one-dimensional system. The semiquantal behavior is shown to be chaotic even though the system has regular classical behavior and the quantum behavior had been assumed regular.Comment: 9 pages, TeX, 2 figures (not attached; hard copies available immediately on request). To appear in Physical Review Letter

Ischaemic stroke, haemorrhage and mortality in elderly patients with chronic kidney disease newly started on anticoagulation for atrial fibrillation: a population-based study from UK primary care

Objective To assess the association between anticoagulation, ischaemic stroke, gastrointestinal and cerebral haemorrhage, and all cause mortality in older people with atrial fibrillation and chronic kidney disease. Design Propensity matched, population based, retrospective cohort analysis from January 2006 through December 2016. Setting The Royal College of General Practitioners Research and Surveillance Centre database population of almost 2.73 million patients from 110 general practices across England and Wales. Participants Patients aged 65 years and over with a new diagnosis of atrial fibrillation and estimated glomerular filtration rate (eGFR) of <50 mL/min/1.73m2, calculated using the chronic kidney disease epidemiology collaboration creatinine equation. Patients with a previous diagnosis of atrial fibrillation or receiving anticoagulation in the preceding 120 days were excluded, as were patients requiring dialysis and recipients of renal transplants. Intervention Receipt of an anticoagulant prescription within 60 days of atrial fibrillation diagnosis. Main outcome measures Ischaemic stroke, cerebral or gastrointestinal haemorrhage, and all cause mortality. Results 6977 patients with chronic kidney disease and newly diagnosed atrial fibrillation were identified, of whom 2434 were on anticoagulants within 60 days of diagnosis and 4543 were not. 2434 pairs were matched using propensity scores by exposure to anticoagulant or none and followed for a median of 506 days. The crude rates for ischaemic stroke and haemorrhage were 4.6 and 1.2 after taking anticoagulants and 1.5 and 0.4 in patients who were not taking anticoagulant per 100 person years, respectively. The hazard ratios for ischaemic stroke, haemorrhage, and all cause mortality for those on anticoagulants were 2.60 (95% confidence interval 2.00 to 3.38), 2.42 (1.44 to 4.05), and 0.82 (0.74 to 0.91) compared with those who received no anticoagulation. Conclusion Giving anticoagulants to older people with concomitant atrial fibrillation and chronic kidney disease was associated with an increased rate of ischaemic stroke and haemorrhage but a paradoxical lowered rate of all cause mortality. Careful consideration should be given before starting anticoagulants in older people with chronic kidney disease who develop atrial fibrillation. There remains an urgent need for adequately powered randomised trials in this population to explore these findings and to provide clarity on correct clinical management