Standardizing Initial Inpatient Palliative Care Consultations for Patients Receiving Left Ventricular Assist Devices at a Large Urban Hospital

For patients with advanced heart failure (HF) ineligible for or awaiting heart transplantation, left ventricular assist device (LVAD) implantation can be considered. LVADs have helped to improve recipients’ survival rates and quality of life. However, LVAD patients are at risk for complications such as stroke, bleeding, infection, and right ventricular failure. Moreover, events such as end-stage malignancy or progression of a neurodegenerative disorder may occur. Such complications and repeated hospitalizations can pose questions about the acceptability of LVAD therapy. As such, both the Centers for Medicare and Medicaid Services and The Joint Commission require that palliative care (PC) be part of the multidisciplinary team prior to and following VAD placement. However, execution of this mandate is unclear, leaving specifics up to the discretion of individual healthcare facilities. At our facility, all patients being evaluated for LVAD implantation must receive a PC consultation. However, confusion around the objectives and structure of this consultation persists. Therefore, the purpose of this project was to implement an evidence-based, semi-structured script to guide pre-LVAD PC consultations. Training on the script was provided to PC clinicians, and pre- and post-surveys helped to identify whether this script improved confidence in PC clinicians conducting pre-LVAD consultations. Confidence levels remained generally unchanged. However, valuable insight was gained through written feedback. Namely, clinicians felt the script provided structure and guidance but that script verbiage and flow could be improved. Moreover, clinicians expressed that communication from the HF team and a standardized workflow between PC and HF teams would be beneficial

Engineering synthetic vaccines using cues from natural immunity

Vaccines aim to protect against or treat diseases through manipulation of the immune response, promoting either immunity or tolerance. In the former case, vaccines generate antibodies and T cells poised to protect against future pathogen encounter or attack diseased cells such as tumours; in the latter case, which is far less developed, vaccines block pathogenic autoreactive T cells and autoantibodies that target self tissue. Enormous challenges remain, however, as a consequence of our incomplete understanding of human immunity. A rapidly growing field of research is the design of vaccines based on synthetic materials to target organs, tissues, cells or intracellular compartments; to co-deliver immunomodulatory signals that control the quality of the immune response; or to act directly as immune regulators. There exists great potential for well-defined materials to further our understanding of immunity. Here we describe recent advances in the design of synthetic materials to direct immune responses, highlighting successes and challenges in prophylactic, therapeutic and tolerance-inducing vaccines.United States. Dept. of Defense (contract W911NF-13-D-0001)United States. Dept. of Defense (contract W911NF-07-D-0004)National Institutes of Health (U.S.) (AI095109)Bill & Melinda Gates FoundationRagon Institute of MGH, MIT, and HarvardNational Institutes of Health (U.S.) (AI091693)Howard Hughes Medical Institute (Investigator)Carigest S

Shoulder posture and median nerve sliding

Background: Patients with upper limb pain often have a slumped sitting position and poorshoulder posture. Pain could be due to poor posture causing mechanical changes (stretch; localpressure) that in turn affect the function of major limb nerves (e.g. median nerve). This studyexamines (1) whether the individual components of slumped sitting (forward head position, trunkflexion and shoulder protraction) cause median nerve stretch and (2) whether shoulderprotraction restricts normal nerve movements.Methods: Longitudinal nerve movement was measured using frame-by-frame cross-correlationanalysis from high frequency ultrasound images during individual components of slumped sitting.The effects of protraction on nerve movement through the shoulder region were investigated byexamining nerve movement in the arm in response to contralateral neck side flexion.Results: Neither moving the head forward or trunk flexion caused significant movement of themedian nerve. In contrast, 4.3 mm of movement, adding 0.7% strain, occurred in the forearm duringshoulder protraction. A delay in movement at the start of protraction and straightening of thenerve trunk provided evidence of unloading with the shoulder flexed and elbow extended and thescapulothoracic joint in neutral. There was a 60% reduction in nerve movement in the arm duringcontralateral neck side flexion when the shoulder was protracted compared to scapulothoracicneutral.Conclusion: Slumped sitting is unlikely to increase nerve strain sufficient to cause changes tonerve function. However, shoulder protraction may place the median nerve at risk of injury, sincenerve movement is reduced through the shoulder region when the shoulder is protracted andother joints are moved. Both altered nerve dynamics in response to moving other joints and localchanges to blood supply may adversely affect nerve function and increase the risk of developingupper quadrant pain

Tissue distribution and subcellular localization of the family of Kidney Ankyrin Repeat Domain (KANK) proteins

Kidney Ankyrin Repeat-containing Proteins (KANKs) comprise a family of four evolutionary conserved proteins (KANK1 to 4) that localize to the belt of mature focal adhesions (FAs) where they regulate integrin-mediated adhesion, actomyosin contractility, and link FAs to the cortical microtubule stabilization complex (CMSC). The human KANK proteins were first identified in kidney and have been associated with kidney cancer and nephrotic syndrome. Here, we report the distributions and subcellular localizations of the four Kank mRNAs and proteins in mouse tissues. We found that the KANK family members display distinct and rarely overlapping expression patterns. Whereas KANK1 is expressed at the basal side of epithelial cells of all tissues tested, KANK2 expression is mainly observed at the plasma membrane and/or cytoplasm of mesenchymal cells and KANK3 exclusively in vascular and lymphatic endothelial cells. KANK4 shows the least widespread expression pattern and when present, overlaps with KANK2 in contractile cells, such as smooth muscle cells and pericytes. Our findings show that KANKs are widely expressed in a cell type-specific manner, which suggests that they have cell- and tissue-specific functions

Students\u27 use of personal technology in the classroom: analyzing the perceptions of the digital generation

Faculty frequently express concerns about students’ personal use of information and communication technologies in today’s university classrooms. As a requirement of a graduate research methodology course in a university in Ontario, Canada, the authors conducted qualitative research to gain an in-depth understanding of students’ perceptions of this issue. Their findings reveal students’ complex considerations about the acceptability of technology use. Their analysis of the broader contexts of students’ use reveals that despite a technological revolution, university teaching practices have remained largely the same, resulting in ‘cultural lag’ within the classroom. While faculty are technically ‘in charge’, students wield power through course evaluations, surveillance technologies and Internet postings. Neoliberalism and the corporatisation of the university have engendered an ‘entrepreneurial student’ customer who sees education as a means to a career. Understanding students’ perceptions and their technological, social and political contexts offers insights into the tensions within today’s classrooms

Topological correlations in soap froths

Correlation in two-dimensional soap froth is analysed with an effective potential for the first time. Cells with equal number of sides repel (with linear correlation) while cells with different number of sides attract (with NON-bilinear) for nearest neighbours, which cannot be explained by the maximum entropy argument. Also, the analysis indicates that froth is correlated up to the third shell neighbours at least, contradicting the conventional ideas that froth is not strongly correlated.Comment: 10 Pages LaTeX, 6 Postscript figure

Cluster Persistence: a Discriminating Probe of Soap Froth Dynamics

The persistent decay of bubble clusters in coarsening two-dimensional soap froths is measured experimentally as a function of cluster volume fraction. Dramatically stronger decay is observed in comparison to soap froth models and to measurements and calculations of persistence in other systems. The fraction of individual bubbles that contain any persistent area also decays, implying significant bubble motion and suggesting that T1 processes play an important role in froth persistence.Comment: 5 pages, revtex, 4 eps figures. To appear in Europhys. Let