Case 10 : Changing the Service Delivery Model: How to Make it Happen?

The case follows Ruksana Kadam, the 2SLGBTQ+ Programs and Community Engagement Manager at the HIV/AIDS Caring Communities (HACC). She has been tasked with developing and implementing a new service delivery model to be adopted at the HACC. The board and executive director are seeking change in order to improve services and care for its diverse clients. The new service delivery model would involve dissolving the current teams, which focused on priority populations such as people who have HIV/AIDS, 2SLGBTQ+ individuals, those who need harm reduction services, and African, Caribbean, and Black communities. The plan would involve creating two new teams – a health promotion team and a community engagement team. Where can Ruksana turn to learn more about organizational change? Have any similar agencies faced such a large change and how did they accomplish it? Are there known pitfalls that she should avoid? The goal of the case note is to allow students to understand the perspectives of stakeholders such as community members, funding organizations, and partnering organizations in a region with a very diverse population. The students will also be given an opportunity during class to formulate the exploratory stage of implementation

HCMV Antivirals and Strategies to Target the Latent Reservoir.

Human cytomegalovirus (HCMV) is a ubiquitous human herpesvirus. In healthy people, primary infection is generally asymptomatic, and the virus can go on to establish lifelong latency in cells of the myeloid lineage. However, HCMV often causes severe disease in the immunosuppressed: transplant recipients and people living with AIDS, and also in the immunonaive foetus. At present, there are several antiviral drugs licensed to control HCMV disease. However, these are all faced with problems of poor bioavailability, toxicity and rapidly emerging viral resistance. Furthermore, none of them are capable of fully clearing the virus from the host, as they do not target latent infection. Consequently, reactivation from latency is a significant source of disease, and there remains an unmet need for treatments that also target latent infection. This review briefly summarises the most common HCMV antivirals used in clinic at present and discusses current research into targeting the latent HCMV reservoir

Exploring the loblolly pine (Pinus taeda L.) genome by BAC sequencing and Cot analysis.

Loblolly pine (LP; Pinus taeda L.) is an economically and ecologically important tree in the southeastern U.S. To advance understanding of the loblolly pine (LP; Pinus taeda L.) genome, we sequenced and analyzed 100 BAC clones and performed a Cot analysis. The Cot analysis indicates that the genome is composed of 57, 24, and 10% highly-repetitive, moderately-repetitive, and single/low-copy sequences, respectively (the remaining 9% of the genome is a combination of fold back and damaged DNA). Although single/low-copy DNA only accounts for 10% of the LP genome, the amount of single/low-copy DNA in LP is still 14 times the size of the Arabidopsis genome. Since gene numbers in LP are similar to those in Arabidopsis, much of the single/low-copy DNA of LP would appear to be composed of DNA that is both gene- and repeat-poor. Macroarrays prepared from a LP bacterial artificial chromosome (BAC) library were hybridized with probes designed from cell wall synthesis/wood development cDNAs, and 50 of the "targeted" clones were selected for further analysis. An additional 25 clones were selected because they contained few repeats, while 25 more clones were selected at random. The 100 BAC clones were Sanger sequenced and assembled. Of the targeted BACs, 80% contained all or part of the cDNA used to target them. One targeted BAC was found to contain fungal DNA and was eliminated from further analysis. Combinations of similarity-based and ab initio gene prediction approaches were utilized to identify and characterize potential coding regions in the 99 BACs containing LP DNA. From this analysis, we identified 154 gene models (GMs) representing both putative protein-coding genes and likely pseudogenes. Ten of the GMs (all of which were specifically targeted) had enough support to be classified as intact genes. Interestingly, the 154 GMs had statistically indistinguishable (α = 0.05) distributions in the targeted and random BAC clones (15.18 and 12.61 GM/Mb, respectively), whereas the low-repeat BACs contained significantly fewer GMs (7.08 GM/Mb). However, when GM length was considered, the targeted BACs had a significantly greater percentage of their length in GMs (3.26%) when compared to random (1.63%) and low-repeat (0.62%) BACs. The results of our study provide insight into LP evolution and inform ongoing efforts to produce a reference genome sequence for LP, while characterization of genes involved in cell wall production highlights carbon metabolism pathways that can be leveraged for increasing wood production

Consultation Checklists : Standardising the Human Evaluation of Medical Note Generation

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Pain Coping Skills Training for Patients Who Catastrophize About Pain Prior to Knee Arthroplasty: A Multisite Randomized Clinical Trial

BACKGROUND: Pain catastrophizing has been identified as a prognostic indicator of poor outcome following knee arthroplasty. Interventions to address pain catastrophizing, to our knowledge, have not been tested in patients undergoing knee arthroplasty. The purpose of this study was to determine whether pain coping skills training in persons with moderate to high pain catastrophizing undergoing knee arthroplasty improves outcomes 12 months postoperatively compared with usual care or arthritis education. METHODS: A multicenter, 3-arm, single-blinded, randomized comparative effectiveness trial was performed involving 5 university-based medical centers in the United States. There were 402 randomized participants. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Scale, measured at baseline, 2 months, 6 months, and 12 months following the surgical procedure. RESULTS: Participants were recruited from January 2013 to June 2016. In 402 participants, 66% were women and the mean age of the participants (and standard deviation) was 63.2 ± 8.0 years. Three hundred and forty-six participants (90% of those who underwent a surgical procedure) completed a 12-month follow-up. All 3 treatment groups had large improvements in 12-month WOMAC pain scores with no significant differences (p > 0.05) among the 3 treatment arms. No differences were found between WOMAC pain scores at 12 months for the pain coping skills and arthritis education groups (adjusted mean difference, 0.3 [95% confidence interval (CI), -0.9 to 1.5]) or between the pain coping and usual-care groups (adjusted mean difference, 0.4 [95% CI, -0.7 to 1.5]). Secondary outcomes also showed no significant differences (p > 0.05) among the 3 groups. CONCLUSIONS: Among adults with pain catastrophizing undergoing knee arthroplasty, cognitive behaviorally based pain coping skills training did not confer pain or functional benefit beyond the large improvements achieved with usual surgical and postoperative care. Future research should develop interventions for the approximately 20% of patients undergoing knee arthroplasty who experience persistent function-limiting pain. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence

Extraction of Stride Events From Gait Accelerometry During Treadmill Walking

Objective: evaluating stride events can be valuable for understanding the changes in walking due to aging and neurological diseases. However, creating the time series necessary for this analysis can be cumbersome. In particular, finding heel contact and toe-off events which define the gait cycles accurately are difficult. Method: we proposed a method to extract stride cycle events from tri-axial accelerometry signals. We validated our method via data collected from 14 healthy controls, 10 participants with Parkinson's disease, and 11 participants with peripheral neuropathy. All participants walked at self-selected comfortable and reduced speeds on a computer-controlled treadmill. Gait accelerometry signals were captured via a tri-axial accelerometer positioned over the L3 segment of the lumbar spine. Motion capture data were also collected and served as the comparison method. Results: our analysis of the accelerometry data showed that the proposed methodology was able to accurately extract heel and toe-contact events from both feet. We used t-tests, analysis of variance (ANOVA) and mixed models to summarize results and make comparisons. Mean gait cycle intervals were the same as those derived from motion capture, and cycle-to-cycle variability measures were within 1.5%. Subject group differences could be similarly identified using measures with the two methods. Conclusions: a simple tri-axial accelerometer accompanied by a signal processing algorithm can be used to capture stride events. Clinical impact: the proposed algorithm enables the assessment of stride events during treadmill walking, and is the first step toward the assessment of stride events using tri-axial accelerometers in real-life settings

Imperative functional programs that explain their work

Program slicing provides explanations that illustrate how program outputs were produced from inputs. We build on an approach introduced in prior work by Perera et al., where dynamic slicing was defined for pure higher-order functional programs as a Galois connection between lattices of partial inputs and partial outputs. We extend this approach to imperative functional programs that combine higher-order programming with references and exceptions. We present proofs of correctness and optimality of our approach and a proof-of-concept implementation and experimental evaluation.Comment: Full version of ICFP 2017 paper, with appendice