It Opened My Eyes... : The Potential of an Embedded Clinical Experience in Teacher Preparation

Teacher candidates (TCs) often feel underprepared for their first teaching positions. Teacher education programs are, at least partially, responsible for the level of readiness of their graduating TCs. Fortunately, teacher educators have the capacity to positively change teacher education, creating a more effective, better prepared teaching force. Embedded clinical experiences connected to university literacy courses are one innovative approach to create more purposeful and engaging learning opportunities for TCs. TCs in an early childhood and special education program participated in an embedded clinical experience focused on reading and assessment, which allowed them to implement course content directly with elementary students, effectively connecting theory and practice. This qualitative study explored the impacts of an embedded clinical experience on TCs’ beliefs, content knowledge, and instructional practices related to reading and assessment. Content analysis was used to analyze data collected through semistructured interviews, participants’ reflective journal entries, weekly lesson plans, audio-recorded Socratic seminars, and video-recorded reading lessons. This inquiry revealed an increase in TCs’ pedagogical knowledge and confidence. The authors found that implementing an embedded clinical experience working with elementary students in conjunction with university coursework contextualized and meaningfully integrated course content in practical teaching experiences, encouraging TCs to refine their philosophical and pedagogical beliefs

Reaching the Summit: From exposure to immersion in quality improvement in physical therapy education

Following the release of its 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine (IOM) convened a summit of 150 interprofessional healthcare educators to reform health professions education. As a result, in 2002, the IOM established an overarching vision to achieve care that is safe, effective, patient-centered, timely efficient, and equitable: “All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.” Physical Therapy educators have expanded curricula to teach three of these five competencies. We routinely teach that physical therapists practice in interprofessional teams to provide care that is patient-centered and evidence-based. However, we lag behind other health professions in teaching quality improvement concepts and skills in entry-level education. This session will describe the five IOM competencies and use key frameworks to engage small groups of learners to develop and evaluate quality improvement curricula appropriate for academic and clinical settings. These frameworks include: Kern’s six steps of curriculum design University of Toronto framework of curriculum development, and Kirkpatrick’s Four Levels of Training Evaluation

Racial Stratification in Self-Rated Health Among Black Mexicans and White Mexicans

How do Mexicans of distinct racial backgrounds fit into the recognized patterns of racial health disparities? We conduct regression analyses using data from the 2000-2017 National Health Interview Survey to determine if Mexicans who self-identify as White or Black have a relative advantage or disadvantage in self-rated health in relation to Non-Hispanic (NH) Whites and Blacks in the U.S. Our results indicate that both Black Mexicans and White Mexicans have a significant disadvantage in relation to NH-Whites while White Mexicans have a slight advantage in relation to both NH-Blacks and Black Mexicans. Overall, our results suggest that studying health outcomes among Hispanics without considering race may mask inequalities not observed in the aggregate

TGF beta 1 attenuates expression of prolactin and IGFBP-1 in decidualized endometrial stromal cells by both SMAD-dependent and SMAD-independent pathways

Background: Decidualization (differentiation) of the endometrial stromal cells during the secretory phase of the menstrual cycle is essential for successful implantation. Transforming Growth Factor beta 1 (TGF beta 1) canonically propagates its actions via SMAD signalling. A role for TGF beta 1 in decidualization remains to be established and published data concerning effects of TGF beta 1 on markers of endometrial decidualization are inconsistent. Methodology/Principal Findings: Non-pregnant endometrial stromal cells (ESC) and first trimester decidual stromal cells (DSC) were cultured in the presence or absence of a decidualizing stimulus. Incubation of ESCs with TGF beta 1 (10 ng/ml) down-regulated the expression of transcripts encoding the decidual marker proteins prolactin (PRL), insulin-like growth factor binding protein-1 (IGFBP-1) and tissue factor (TF). TGF beta 1 also inhibited secretion of PRL and IGFBP-1 proteins by ESCs and surprisingly this response preceded down-regulation of their mRNAs. In contrast, DSCs were more refractory to the actions of TGF beta 1, characterized by blunted and delayed down-regulation of PRL, IGFBP-1, and TF transcripts, which was not associated with a significant reduction in secretion of PRL or IGFBP-1 proteins. Addition of an antibody directed against TGF beta 1 increased expression of IGFBP-1 mRNA in decidualised cells. Knockdown of SMAD 4 using siRNAs abrogated the effect of TGF beta 1 on expression of PRL in ESCs but did not fully restore expression of IGFBP-1 mRNA and protein. Conclusions/Significance: TGF beta 1 inhibits the expression and secretion of decidual marker proteins. The impact of TGF beta 1 on PRL is SMAD-dependent but the impact on IGFBP1 is via an alternative mechanism. In early pregnancy, resistance of DSC to the impact of TGF beta 1 may be important to ensure tissue homeostasis

Requirements for a Nutrition Education Demonstrator

[Context and Motivation] Development of innovative ICT-based applications is a complex process involving collaboration of all relevant disciplines. This complexity arises due to differences in terminology, knowledge and often also the ways of working between developers in the disciplines involved. [Question/problem] Advances in each discipline bring a rich design environment of theories, models, methods and techniques. Making a selection from these makes the development of distributed applications very challenging, often requiring a holistic approach to address the needs of the disciplines involved. This paper describes early stage requirements acquisition of a mobile nutrition education demonstrator which supports overweight persons in adopting healthier dietary behaviour. [Principal idea/results] We present a novel way to combine and use known requirements acquisition methods involving a two stage user needs analysis based on scenarios which apply a theory-based model of behavioural change and are onstructed in two phases. The first phase scenarios specify an indicative description reflecting the use of the transtheoretical model of behavioural change. In the second phase, a handshake protocol adds elements of optative system-oriented descriptions to the scenarios such that the intended system can support the indicative description. [Contribution] The holistic and phased approach separates design concerns to which each of the disciplines contributes with their own expertise and domain principles. It preserves the applied domain principles in the design and it bridges gaps in terminology, knowledge and ways of working

Real-time Suboptimal Model Predictive Control Using a Combination of Explicit MPC and Online Optimization

Limits on the storage space or the computation time restrict the applicability of model predictive controllers (MPC) in many real problems. Currently available methods either compute the optimal controller online or derive an explicit control law. In this paper we introduce a new approach combining the two paradigms of explicit and online MPC to overcome their individual limitations. The algorithm computes a piecewise affine approximation of the optimal solution that is used to warm-start an active set linear programming procedure. A preprocessing method is introduced that provides hard real-time execution, stability and performance guarantees for the proposed controller. By choosing a combination of the quality of the approximation and the number of online active set iterations the presented procedure offers a tradeoff between the warm-start and online computational effort. We show how the problem of identifying the optimal combination for a given set of requirements on online computation time, storage and performance can be solved. Finally, we demonstrate the potential of the proposed warm-start procedure on numerical examples

Telomere dysfunction accurately predicts clinical outcome in chronic lymphocytic leukaemia, even in patients with early stage disease

© 2014 John Wiley & Sons Ltd. Defining the prognosis of individual cancer sufferers remains a significant clinical challenge. Here we assessed the ability of high-resolution single telomere length analysis (STELA), combined with an experimentally derived definition of telomere dysfunction, to predict the clinical outcome of patients with chronic lymphocytic leukaemia (CLL). We defined the upper telomere length threshold at which telomere fusions occur and then used the mean of the telomere 'fusogenic' range as a prognostic tool. Patients with telomeres within the fusogenic range had a significantly shorter overall survival (P  <  0·0001; Hazard ratio [HR] = 13·2, 95% confidence interval [CI]  = 11·6-106·4) and this was preserved in early-stage disease patients (P  <  0·0001, HR=19·3, 95% CI = 17·8-802·5). Indeed, our assay allowed the accurate stratification of Binet stage A patients into those with indolent disease (91% survival at 10 years) and those with poor prognosis (13% survival at 10 years). Furthermore, patients with telomeres above the fusogenic mean showed superior prognosis regardless of their IGHV mutation status or cytogenetic risk group. In keeping with this finding, telomere dysfunction was the dominant variable in multivariate analysis. Taken together, this study provides compelling evidence for the use of high-resolution telomere length analysis coupled with a definition of telomere dysfunction in the prognostic assessment of CLL

Downregulation of miR-342 is associated with tamoxifen resistant breast tumors

<p>Abstract</p> <p>Background</p> <p>Tumor resistance to the selective estrogen receptor modulator tamoxifen remains a serious clinical problem especially in patients with tumors that also overexpress HER2. We have recently demonstrated that the clinically important isoform of HER2, HERΔ16, promotes therapeutically refractory breast cancer including resistance to endocrine therapy. Likewise additional breast tumor cell models of tamoxifen resistance have been developed that do not involve HER2 overexpression. However, a unifying molecular mechanism of tamoxifen resistance has remained elusive.</p> <p>Results</p> <p>Here we analyzed multiple cell models of tamoxifen resistance derived from MCF-7 cells to examine the influence of microRNAs (miRNAs) on tamoxifen resistance. We compared miRNA expression profiles of tamoxifen sensitive MCF-7 cells and tamoxifen resistant MCF-7/HER2Δ16 cells. We observed significant and dramatic downregulation of miR-342 in the MCF-7/HER2Δ16 cell line as well as the HER2 negative but tamoxifen resistant MCF-7 variants TAMR1 and LCC2. Restoring miR-342 expression in the MCF-7/HER2Δ16 and TAMR1 cell lines sensitized these cells to tamoxifen-induced apoptosis with a dramatic reduction in cell growth. Expression of miR-342 was also reduced in a panel of tamoxifen refractory human breast tumors, underscoring the potential clinical importance of miR-342 downregulation. Towards the goal of identifying direct and indirect targets of miR-342 we restored miR-342 expression in MCF-7/HER2Δ16 cells and analyzed changes in global gene expression by microarray. The impact of miR-342 on gene expression in MCF-7/HER2Δ16 cells was not limited to miR-342 <it>in silica </it>predicted targets. Ingenuity Pathways Analysis of the dataset revealed a significant influence of miR-342 on multiple tumor cell cycle regulators.</p> <p>Conclusions</p> <p>Our findings suggest that miR-342 regulates tamoxifen response in breast tumor cell lines and our clinical data indicates a trend towards reduced miR-342 expression and tamoxifen resistance. In addition, our results suggest that miR-342 regulates expression of genes involved in tamoxifen mediated tumor cell apoptosis and cell cycle progression. Restoring miR-342 expression may represent a novel therapeutic approach to sensitizing and suppressing the growth of tamoxifen refractory breast tumors.</p

Bioengineered Cell Niche for Skeletal Muscle Regeneration

Skeletal muscles can self-repair minor strains, lacerations, and contusions; however, in cases of volumetric muscle lossand muscle degenerative diseases, tissue fails to regenerate. Current cell-based therapies, such as myoblast transplantation, have significant drawbacks of low survival rates and engraftment efficacy, mainly due to the absence of supportive cell microenvironment. Scaffolds that mimic the natural cell microenvironment provide a robust platform to support cell adhesion, migration, proliferation, and differentiation. Electrospinning is a versatile technology platform used for fabricating the fiber scaffold that mimics the extracellular matrix. Thus, we aim to reconstitute the cell microenvironment through development of aligned fiber scaffolds by electrospinning as oriented muscle fibers create natural microenvironment of myogenic cells. In particular, aligned fiber scaffolds will be optimized in term of mechanical properties and fiber diameters as fiber curvature and mechanical stiffness provide significant physical cues for myogenic cell behaviors. Here, we fabricated and characterized electrospun polyester fiber scaffolds with different diameters from micro-scale to nano-scale. The mechanical properties of the fabricated nanofibers were found to be in the range of contractile muscles as evidenced from atomic force microscopy measurements. With these scaffolds, C2C12 myoblasts were seeded and analyzed for the initial attachment. It was shown that aligned fibers with varying diameters resulted in different responses in cell attachment, indicating the role of cell topography sensing in cell-biomaterial interactions. Current ongoing studies focus on long-term in vitro culture of scaffolds in a custom-made muscle bioreactor emulating the contraction/relaxation of skeletal muscle tissue

Practical suggestions for harms reporting in exercise oncology : the Exercise Harms Reporting Method (ExHaRM)

The volume of high-quality evidence supporting exercise as beneficial to cancer survivors has grown exponentially; however, the potential harms of exercise remain understudied. Consequently, the trade-off between desirable and undesirable outcomes of engaging in exercise remains unclear to clinicians and people with cancer. Practical guidance on collecting and reporting harms in exercise oncology is lacking. We present a harms reporting protocol developed and refined through exercise oncology trials since 2015. Development of the Exercise Harms Reporting Method (ExHaRM) was informed by national and international guidelines for harms reporting in clinical trials involving therapeutic goods or medical devices, with adaptations to enhance applicability to exercise. The protocol has been adjusted via an iterative process of implementation and adjustment through use in multiple exercise oncology trials involving varied cancer diagnoses (types: breast, brain, gynaecological; stages at diagnosis I–IV; primary/ recurrent), and heterogeneous exercise intervention characteristics (face to face/telehealth delivery; supervised/unsupervised exercise). It has also involved the development of terms (such as, adverse outcomes, which capture all undesirable physical, psychological, social and economic outcomes) that facilitate the harms assessment process in exercise. ExHaRM involves: step 1: Monitor occurrence of adverse outcomes through systematic and non-systematic surveillance; step 2: Assess and record adverse outcomes, including severity, causality, impact on intervention and type; step 3: Review of causality by harms panel (and revise as necessary); and step 4: Analyse and report frequencies, rates and clinically meaningful details of all-cause and exercise-related adverse outcomes. ExHaRM provides guidance to improve the quality of harms assessment and reporting immediately, while concurrently providing a framework for future refinement. Future directions include, but are not limited to, standardising exercise-specific nomenclature and methods of assessing causality