TOWARDS BETTER OUTCOMES FOR FAMILIES WITH TRANSITION-AGE YOUTH OR YOUNG ADULTS WITH ASD: A MIXED METHODS STUDY FROM A PARENT’S PERSPECTIVE

The after-high-school outcomes for individuals with autism spectrum disorder (ASD) and their families are less than desirable. The current study employed an exploratory sequential mixed methods design in order to enhance understanding of the family adaptation process during transition. First, a qualitative study was conducted in order to understand the stressors, external and internal support, coping strategies, and family adaptation outcomes during transition, from a parent’s perspective, using the ABCX model. Thirteen parents of adolescents and young adults with ASD were interviewed. These parents reported a continually high level of stress due to normative strains and ASD-related demands. They clearly described the tangible, emotional, informational, and internal resources both received and needed. Parents, as active agents in their children’s lives, have their own views towards transition, philosophy, and ways of coping. Even though many of them reported negative experiences, these parents also found new meanings and happiness in their lives. Based on the literature review and the qualitative results, a quantitative study was then developed, which applied the ABCX model to understand the predictors of good parent transition outcomes and investigate the mediating mechanism between stressors and parent transition outcomes. At the indicator level, autism severity, mental health crisis/challenging behaviors, filial obligation, general social support, transition planning quality, parent-teacher alliance, parenting efficacy, problem-focused coping, avoidance-focused coping, and optimism were important predictors of the four benchmarks of parents’ outcomes (i.e., parents’ burden, parents’ transition experience, parents’ subjective health, and family quality of life). At the structural level, optimism, emotion-coping strategies, and resources mediated the relationships between stressors and parents’ outcomes. Research and practical applications are discussed. Findings across the two studies led to identification of key factors that influence the outcomes of parents of adolescents and young adults with ASD, as well as an understanding of the complex relationships among the predictors. The results build upon existing empirical and theoretical work related to the transition of families of adolescents and young adults with ASD. Recommendations for future research and clinical practices are discussed

Exploiting Structure Information for Network Dissimilarity Characterization - Application to Disease Network Analysis and Treatment Prediction

Most cancers lack effective early disease markers, prognostic and predictive signatures, primarily due to tumor heterogeneity. As a result, we fail treating cancer heterogeneity due to multiple ways cancer initiates and develops treatment resistance. Models that represent these differences and the underlying molecular mechanism in cancer enhance the possibility in characterizing and in turn treating cancer successfully. We introduce novel graph-based methods for exploiting network structure information in the comparison between any graphs, and validate them on non-small cell lung cancer datasets. We generate normal and tumor graphs using normal and tumor samples from gene expression datasets, where vertices are genes, and edges connect co-expressed genes. In the first part of this dissertation, we propose a systems approach with an aim to revert disease conditions to healthy ones through treatments. In order to achieve the objective, we propose three novel methods to 1) systematically identify network structure differences between normal and tumor graphs, 2) identify and prioritize drug combinations based on extracted network structure differences, and 3) computationally estimate the potential of the proposed drug combination to "repair" deregulated subgraphs. Biological validation of the predictions highlights that our systems approach is a promising method to provide treatment options to non-small cell lung cancer through the rewiring of disease networks. In the second part of this dissertation, we introduce the notion of differential graphlet community to detect deregulated subgraphs between any graphs such that the network structure information is exploited. We observed a trend that the shortest path lengths are shorter for tumor graphs than for normal graphs between genes that are in differential graphlet communities, suggesting that cancer creates shortcuts between biological processes that may not be present in normal conditions. In the third part of this dissertation, we propose a heuristic, the differential correlation graph approach, that identifies areas that are different between the normal and tumor graph, and perform graphlet enumeration on the identified areas. Results showed that our approach achieves accurate estimation in the difference between normal and tumor states by performing network comparisons in important areas only

Genome sequence and genetic linkage analysis of Shiitake mushroom _Lentinula edodes_

_Lentinula edodes_ (Shiitake/Xianggu) is an important cultivated mushroom. Understanding the genomics and functional genomics of _L. edodes_ allows us to improve its cultivation and quality. Genome sequence is a key to develop molecular genetic markers for breeding and genetic manipulation. We sequenced the genome of _L. edodes_ monokaryon L54A using Roche 454 and ABI SOLiD genome sequencing. Sequencing reads of about 1400Mb were de novo assembled into a 40.2 Mb genome sequence. We compiled the genome sequence into a searchable database with which we have been annotating the genes and analyzing the metabolic pathways. In addition, we have been using many molecular techniques to analyze genes differentially expressed during development. Gene ortholog groups of _L. edodes_ genome sequence compared across genomes of several fungi including mushrooms identified gene families unique to mushroom-forming fungi. We used a mapping population of haploid basidiospores of dikaryon L54 for genetic linkage analysis. High-quality variations such as single nucleotide polymorphisms, insertions, and deletions of the mapping population formed a high-density genetic linkage map. We compared the linkage map to the _L. edodes_ L54A genome sequence and located selected quantitative trait loci. The Shiitake community will benefit from these resources for genetic studies and breeding.
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Renal and Splenic Micro-Infarctions Following Bronchial Artery Embolization with Tris-Acryl Microspheres

A bronchial artery embolization (BAE) is an important therapeutic method used to control acute and chronic hemoptysis. We report a case of multiple micro-infarcts involving both the kidneys and spleen, following a BAE with 500-700 µm crossed-linked tris-acryl microspheres (Embospheres) in a patient with bronchial artery pulmonary vein shunts. The superior penetration characteristics of the microspheres may have resulted in the greater tendency to cross the bronchial artery pulmonary vein shunts, which subsequently caused the systemic infarcts in our patient. We propose the use of larger sized microspheres (700-900 µm), which may aid in avoiding this complication

Hand numbness and carpal tunnel syndrome after volar plating of distal radius fracture

We report the incidence of late onset post-operative carpal tunnel syndrome (late carpal tunnel syndrome) and late median nerve neuropathy after volar plating of distal radius fracture by conducting a retrospective study on volar plating for distal radius fracture performed during 2002 to 2006. Two hundred eighty-two volar plating were performed for acute distal radius fracture after exclusion. Post-operative hand numbness occurred in 24 patients of which nine had carpal tunnel syndrome. Thus, the incidence of late carpal tunnel syndrome was 3.2% (9/282). Of the eight (8/24, 33%) patients with post-operative hand numbness that failed to respond to conservative treatment, five had carpal tunnel release and three had neurolysis of median nerve at distal forearm. All had clinical improvement except in one patient. The incidence of late carpal tunnel syndrome after volar plating of distal radius in the present series is similar to the prevalence of carpal tunnel syndrome in general population. The incidence is low compared with other series, regardless of treatment method (conservative treatment, volar or dorsal plating). The outcome of post-operative hand numbness is generally favourable

Protective effects and potential mechanisms of Pien Tze Huang on cerebral chronic ischemia and hypertensive stroke

<p>Abstract</p> <p>Background</p> <p>Stroke caused by brain ischemia is the third leading cause of adult disability. Active prevention and early treatment of stroke targeting the causes and risk factors may decrease its incidence, mortality and subsequent disability. Pien Tze Huang (PZH), a Chinese medicine formula, was found to have anti-edema, anti-inflammatory and anti-thrombotic effects that can prevent brain damage. This study aims to investigate the potential mechanisms of the preventive effects of Pien Tze Huang on brain damage caused by chronic ischemia and hypertensive stroke in rats.</p> <p>Methods</p> <p>The effects of Pien Tze Huang on brain protein expression in spontaneously hypertensive rat (SHR) and stroke prone SHR (SHRsp) were studied with 2-D gel electrophoresis and mass spectrometric analysis with a matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF)/TOF tandem mass spectrometer and on brain cell death with enzyme link immunosorbent assay (ELISA) and immunostaining.</p> <p>Results</p> <p>Pien Tze Huang decreased cell death in hippocampus and cerebellum caused by chronic ischemia and hypertensive stroke. Immunostaining of caspase-3 results indicated that Pien Tze Huang prevents brain cells from apoptosis caused by ischemia. Brain protein expression results suggested that Pien Tze Huang downregulated QCR₂in the electron transfer chain of mitochondria preventing reactive oxygen species (ROS) damage and possibly subsequent cell death (caspase 3 assay) as caused by chronic ischemia or hypertensive stroke to hippocampus and cerebellum.</p> <p>Conclusion</p> <p>Pien Tze Huang showed preventive effects on limiting the damage or injury caused by chronic ischemia and hypertensive stroke in rats. The effect of Pien Tze Huang was possibly related to prevention of cell death from apoptosis or ROS/oxidative damage in mitochondria.</p

Responsiveness of the EuroQoL 5-Dimension (EQ-5D) questionnaire in patients with spondyloarthritis.

BACKGROUND: Spondyloarthritis (SpA) has a significant impact on patients' quality of life due to functional impairments. Generic health instruments like the EuroQoL 5-dimension (EQ-5D) is important for cost-utility analysis of health care interventions and calculation of quality-adjusted life-years. It has been validated in patients with SpA. However, its responsiveness property is unclear. Hence, the aim of study is to test the responsiveness properties of the EQ-5D health measure for Chinese patients with SpA. METHODS: Prospective and consecutive recruitment of 151 Chinese patients with SpA was conducted with follow-up assessments 6 months later. Demographic data including smoking and drinking habits, education level, income and occupation was collected. Disease-associated data including disease duration, presence of back pain, peripheral arthritis, dactylitis, enthesitis, uveitis, psoriasis, and inflammatory bowel disease was also recorded. Questionnaires regarding disease activity and functional disability (BASDAI, BASFI, BASGI, BASMI, ASDAS), mental health (HADS) and the EQ-5D scores were recorded. Responsiveness was tested against the global rating of change scale (GRC) and changes in disease activity using BASDAI and ASDAS-CRP. RESULTS: A total of 113 (74.8%) patients completed the follow-up assessments. Most patients (61.6%) had low disease activity level with BASDAI <4 and 39.7% of patients had inactive disease by ASDAS-CRP. EQ-5D scores was well discriminated along with BASDAI and BASFI scores. EQ-5D scores also correlated well with HADS. The GRC was not able to discriminate adequately. No significant ceiling or floor effect was observed. CONCLUSIONS: EQ-5D demonstrates satisfactory responsiveness property for assessment of changes in SpA disease activity. LEVEL OF EVIDENCE: II