Chemokines in the balance: Maintenance of homeostasis and protection at CNS barriers

In the adult central nervous system (CNS), chemokines and their receptors are involved in developmental, physiological and pathological processes. Although most lines of investigation focus on their ability to induce the migration of cells, recent studies indicate that chemokines also promote cellular interactions and activate signaling pathways that maintain CNS homeostatic functions. Many homeostatic chemokines are expressed on the vasculature of the blood brain barrier including CXCL12, CCL19, CCL20, and CCL21. While endothelial cell expression of these chemokines is known to regulate the entry of leukocytes into the CNS during immunosurveillance, new data indicate that CXCL12 is also involved in diverse cellular activities including adult neurogenesis and neuronal survival, having an opposing role to the homeostatic chemokine, CXCL14, which appears to regulate synaptic inputs to neural precursors. Neuronal expression of CX3CL1, yet another homeostatic chemokine that promotes neuronal survival and communication with microglia, is partly regulated by CXCL12. Regulation of CXCL12 is unique in that it may regulate its own expression levels via binding to its scavenger receptor CXCR7/ACKR3. In this review, we explore the diverse roles of these and other homeostatic chemokines expressed within the CNS, including the possible implications of their dysfunction as a cause of neurologic disease

Patient and clinician engagement with health information in the primary care waiting room: A mixed methods case study

Background. Primary care waiting rooms can be sites of health promotion and health literacy development through the provision of readily accessible health information. To date, few studies have considered patient engagement with televised health messages in the waiting room, nor have studies investigated whether patients ask their clinicians about this information. The aim of this study was therefore to examine patient (or accompanying person) and clinician engagement with waiting room health information, including televised health messages. Design and methods. The mixed methods case study was undertaken in a regional general practice in Victoria, Australia, utilising patient questionnaires, waiting room observations, and clinician logbooks and interviews. The qualitative data were analysed by content analysis; the questionnaire data were analysed using descriptive statistics. Results. Patients engaged with a range of health information in the waiting room and reportedly received health messages from this information. 44% of the questionnaire respondents (33 of 74) reported watching the television health program, and half of these reported receiving a take home health message from this source. Only one of the clinicians (N=9) recalled a patient asking about the televised health program. Conclusions. The general practice waiting room remains a site where people engage with the available health information, with a televised health ‘infotainment’ program receiving most attention from patients. Our study showed that consumption of health information was primarily passive and tended not to activate patient discussions with clinicians. Future studies could investigate any link between the health infotainment program and behaviour change.N/

Deepening our Understanding of Quality in Australia (DUQuA): a study protocol for a nationwide, multilevel analysis of relationships between hospital quality management systems and patient factors.

INTRODUCTION: Despite the growing body of research on quality and safety in healthcare, there is little evidence of the association between the way hospitals are organised for quality and patient factors, limiting our understanding of how to effect large-scale change. The 'Deepening our Understanding of Quality in Australia' (DUQuA) study aims to measure and examine relationships between (1) organisation and department-level quality management systems (QMS), clinician leadership and culture, and (2) clinical treatment processes, clinical outcomes and patient-reported perceptions of care within Australian hospitals. METHODS AND ANALYSIS: The DUQuA project is a national, multilevel, cross-sectional study with data collection at organisation (hospital), department, professional and patient levels. Sample size calculations indicate a minimum of 43 hospitals are required to adequately power the study. To allow for rejection and attrition, 70 hospitals across all Australian jurisdictions that meet the inclusion criteria will be invited to participate. Participants will consist of hospital quality management professionals; clinicians; and patients with stroke, acute myocardial infarction and hip fracture. Organisation and department-level QMS, clinician leadership and culture, patient perceptions of safety, clinical treatment processes, and patient outcomes will be assessed using validated, evidence-based or consensus-based measurement tools. Data analysis will consist of simple correlations, linear and logistic regression and multilevel modelling. Multilevel modelling methods will enable identification of the amount of variation in outcomes attributed to the hospital and department levels, and the factors contributing to this variation. ETHICS AND DISSEMINATION: Ethical approval has been obtained. Results will be disseminated to individual hospitals in de-identified national and international benchmarking reports with data-driven recommendations. This ground-breaking national study has the potential to influence decision-making on the implementation of quality and safety systems and processes in Australian and international hospitals

Do large-scale hospital- and system-wide interventions improve patient outcomes: a systematic review

BackgroundWhile health care services are beginning to implement system-wide patient safety interventions, evidence on the efficacy of these interventions is sparse. We know that uptake can be variable, but we do not know the factors that affect uptake or how the interventions establish change and, in particular, whether they influence patient outcomes. We conducted a systematic review to identify how organisational and cultural factors mediate or are mediated by hospital-wide interventions, and to assess the effects of those factors on patient outcomes.MethodsA systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Database searches were conducted using MEDLINE from 1946, CINAHL from 1991, EMBASE from 1947, Web of Science from 1934, PsycINFO from 1967, and Global Health from 1910 to September 2012. The Lancet, JAMA, BMJ, BMJ Quality and Safety, The New England Journal of Medicine and Implementation Science were also hand searched for relevant studies published over the last 5 years. Eligible studies were required to focus on organisational determinants of hospital- and system-wide interventions, and to provide patient outcome data before and after implementation of the intervention. Empirical, peer-reviewed studies reporting randomised and non-randomised controlled trials, observational, and controlled before and after studies were included in the review.ResultsSix studies met the inclusion criteria. Improved outcomes were observed for studies where outcomes were measured at least two years after the intervention. Associations between organisational factors, intervention success and patient outcomes were undetermined: organisational culture and patient outcomes were rarely measured together, and measures for culture and outcome were not standardised.ConclusionsCommon findings show the difficulty of introducing large-scale interventions, and that effective leadership and clinical champions, adequate financial and educational resources, and dedicated promotional activities appear to be common factors in successful system-wide change

Regional astrocyte IFN signaling restricts pathogenesis during neurotropic viral infection

Type I IFNs promote cellular responses to viruses, and IFN receptor (IFNAR) signaling regulates the responses of endothelial cells of the blood-brain barrier (BBB) during neurotropic viral infection. However, the role of astrocytes in innate immune responses of the BBB during viral infection of the CNS remains to be fully elucidated. Here, we have demonstrated that type I IFNAR signaling in astrocytes regulates BBB permeability and protects the cerebellum from infection and immunopathology. Mice with astrocyte-specific loss of IFNAR signaling showed decreased survival after West Nile virus infection. Accelerated mortality was not due to expanded viral tropism or increased replication. Rather, viral entry increased specifically in the hindbrain of IFNAR-deficient mice, suggesting that IFNAR signaling critically regulates BBB permeability in this brain region. Pattern recognition receptors and IFN-stimulated genes had higher basal and IFN-induced expression in human and mouse cerebellar astrocytes than did cerebral cortical astrocytes, suggesting that IFNAR signaling has brain region–specific roles in CNS immune responses. Taken together, our data identify cerebellar astrocytes as key responders to viral infection and highlight the existence of distinct innate immune programs in astrocytes from evolutionarily disparate regions of the CNS

Assessing the Effectiveness of an In-home Training Program for Parents of Children with Autism or Related Developmental Delays: A Multiple Baseline across Parent Skills

Autism spectrum disorders (ASD) are characterized by difficulty in communication and social interaction, and repetition of behaviors, requiring focused intervention efforts over time. Research has supported the role of parents as intervention agents in improving their children’s behavior, but relatively little of this research has been conducted in the home. This study examined the effectiveness of an in-home intervention of five two-hour sessions combining positive behavior supports (PBS) with the provision of visual supports (VS). The Positive Behavior Visual Support (PBVS) curriculum was developed by the Center for Leadership in Disability at Georgia State University and was previously implemented with both individual in-home and group delivery. In the present study, we wanted to examine more closely the session-by-session acquisition of parental skills using the PBVS curriculum. A single-subject multiple baseline design was used with one family, and partially replicated with a second, to document whether parent training on PBS increased the use of specific skills and whether that, in turn, had an effect on child problem behaviors. We hypothesized that the parents who participated in the PBVS study would increase their use of the positive behavior approaches, which would be accompanied by a decrease in one or more of their children’s targeted challenging behaviors. We looked at five positive behavior parenting skills, as well as child behaviors, during parent-child interaction sessions. We also predicted that parents would report a decrease in stress and an increase in knowledge and self-efficacy. One family withdrew from the study after three sessions so no follow-up was available. Results from the multiple baseline failed to support the predicted outcomes as both parent and child behaviors were quite variable from session to session. This family did demonstrate enhanced self-efficacy and parenting knowledge following the training. The brief time frame (only five sessions), paired with the relative long in-session time spent on parenting strategies (approximately 90 minutes per session), and that the data collection occurred in the first 15 minutes of the session (no time for warm-up or reminders) may have mitigated finding more specific session-by-session changes in behavior

‘New-new’ diplomacy: A new technological dawn

DIPLOMACY is often characterised in terms of two phases: ‘old’ and ‘new’. Old diplomacy dates from the era of Greek city-states until 1814, when the Congress of Vienna prompted a new phase in diplomacy. Both phases were influenced by trends in international relations, the needs of the state, and the tools that were available at the time. Old diplomacy was secretive, with a small pool of actors. New diplomacy was more open, with the introduction of multilateralism as well as non-state actors. Today, however, a wider array of actors and instruments is at play in international relations. This article argues that a third phase in diplomacy is unfolding, referred to as the ‘new-new’ diplomacy. This has been prompted by the fourth industrial revolution, as artificial intelligence, big data, and the Internet of Things have come to play a significant role This article explores the nature of and trends in the ‘new-new’ diplomacy. It is qualitative, comprising desktop research. It explores primary and secondary literature and refers to several real-world examples that have become apparent over the past five years. The main finding is that contemporary global trends and the influence of advanced technology will not change the relevance of diplomacy and diplomatic agents, but will rather complement it. Diplomacy will remain resilient and agile. Diplomacy is often referred to in two phases, old and new. Old diplomacy dates from the era of Greek city-states until 1814, when the Congress of Vienna was formed, prompting a new phase in diplomacy- new diplomacy. Both phases were influenced by trends in international relations, the needs of the state and the tools that were available at the time. Old diplomacy was secretive with a small pool of actors. New diplomacy became more open with the introduction of multilateralism and state and non-state actors. However, today, there is a wider array of actors and tools at play in international relations. This article argues that there is a third phase in diplomacy that is unfolding, as referred to in the paper as new \u27new\u27 diplomacy. This third phase of diplomacy is prompted by the fourth industrial revolution, as artificial intelligence, big data, and the Internet of Things come to play a significant role in international relations. This article explores the trends and characteristics of a new \u27new\u27 diplomacy. The study is qualitative, comprising desktop research. It explores primary and secondary literature and refers to several real-world examples that have been visible over the past five years. The global trends and influence of advanced technology may not change the relevance of diplomacy and diplomatic agents but rather complement the practice. It is predicted that, as with old and new diplomacy, diplomacy will remain resilient and agile, resulting in a new \u27new\u27 diplomacy

A comparative study of geometry curricula

In the United States, geometry has long been offered to high school students in the tenth grade. Attempts have been made in recent years to expand the role of geometry across grades Pre-K through twelve. However, based on the latest TIMSS results, although students in the United States made gains in most content areas, they still struggle with geometric concepts compared to their counterparts in other nations of the world, primarily those in certain Asian countries like Singapore and China. We argue that the structure of the curriculum and the instructional strategies used in these countries may lead to more progressive reform strategies for the United States curriculum. These strategies may provide the catalyst to push our students back to the head of the class when assessed locally, nationally, and internationally