Mr. F. is a fifty‐year‐old father of two school‐aged daughters. Six years ago, he received a double lung transplant because he was suffering from interstitial lung disease, a fatal illness that causes suffocation by progressive scarring of the lungs. He is now experiencing chronic rejection of the transplant and is being considered to receive another. Without it, he is expected to survive only a year and a half. With it, his prognosis will improve, but the numbers are still not good. (...) Three years after his lung transplant, Mr. F. stopped attending his office visits. For a period of sixteen months he went without the studies and attention essential to posttransplant care. He stopped performing the required daily self‐monitoring of his lung function about eight months after his transplant, but he has maintained a regular exercise regimen. While lost to follow‐up, he continued to take his immunosuppressant medications, but he stopped taking medicine to control his high blood pressure because of its expense. (shrink)

While outcomes for children with T-cell acute lymphoblastic leukemia have improved dramatically, survival rates for patients with relapsed/refractory disease remain dismal. Prior studies indicate that glucocorticoid resistance is more common than resistance to other chemotherapies at relapse. In addition, failure to clear peripheral blasts during a prednisone prophase correlates with an elevated risk of relapse in newly diagnosed patients. Here we show that intrinsic GC resistance is present at diagnosis in early thymic precursor T-ALLs as well as in a subset (...) of non-ETP T-ALLs. GC-resistant non-ETP T-ALLs are characterized by strong induction of JAK/STAT signaling in response to interleukin-7 stimulation. Removing IL7 or inhibiting JAK/STAT signaling sensitizes these T-ALLs, and a subset of ETP T-ALLs, to GCs. The combination of the GC dexamethasone and the JAK1/2 inhibitor ruxolitinib altered the balance between pro- and anti-apoptotic factors in samples with IL7-dependent GC resistance, but not in samples with IL7-independent GC resistance. Together, these data suggest that the addition of ruxolitinib or other inhibitors of IL7 receptor/JAK/STAT signaling may enhance the efficacy of GCs in a biologically defined subset of T-ALL.Leukemia advance online publication, 30 May 2017; doi:10.1038/leu.2017.136. (shrink)

The National Center for Biomedical Ontology is a consortium that comprises leading informaticians, biologists, clinicians, and ontologists, funded by the National Institutes of Health (NIH) Roadmap, to develop innovative technology and methods that allow scientists to record, manage, and disseminate biomedical information and knowledge in machine-processable form. The goals of the Center are (1) to help unify the divergent and isolated efforts in ontology development by promoting high quality open-source, standards-based tools to create, manage, and use ontologies, (2) to create (...) new software tools so that scientists can use ontologies to annotate and analyze biomedical data, (3) to provide a national resource for the ongoing evaluation, integration, and evolution of biomedical ontologies and associated tools and theories in the context of driving biomedical projects (DBPs), and (4) to disseminate the tools and resources of the Center and to identify, evaluate, and communicate best practices of ontology development to the biomedical community. Through the research activities within the Center, collaborations with the DBPs, and interactions with the biomedical community, our goal is to help scientists to work more effectively in the e-science paradigm, enhancing experiment design, experiment execution, data analysis, information synthesis, hypothesis generation and testing, and understand human disease. (shrink)

The present study examined gender and attitude toward science in fourth- and eighth-grade students in the United States and also assessed to what extent the relationship between science attitude and science achievement differed by gender. Results showed that both fourth- and eighth-grade boys demonstrated more confidence in science than girls, while eighth-grade boys also showed greater liking for science than girls. Additionally, gender moderated the relationship between science achievement and (a) liking science (for fourth-grade students) and (b) confidence in science (...) (eighth-grade students). Results are discussed in terms of addressing gender inequities in science education and career opportunities. (shrink)

puri in 1026 can hardly be right. Bed-wetting is normally confined to children, and tum quibus…in 1030 presupposes the mention of an earlier stage of life in the previous sentence. And what does puri mean? Munro and Bailey translated it as ‘cleanly people’ , though Munro himself pointed out that the Latin for this was mundi rather than puri, and in any case there is no reason to suppose that in ancient Rome cleanly people were addicted to bed-wetting. Giussani, followed (...) by Merrill and by Leonard and Smith, tried to give the required sense by supposing that puri meant ‘innocents’ and hence ‘children’, an expedient which is very far from convincing. Emendation seems called for. M. F. Smith in the 1982 edition of the Loeb Lucretius adopts Avancius' multi,2 but this does not provide the reference we need to the age of those concerned. (shrink)

puri in 1026 can hardly be right. Bed-wetting is normally confined to children, and tum quibus…in 1030 presupposes the mention of an earlier stage of life in the previous sentence. And what does puri mean? Munro and Bailey translated it as ‘cleanly people’, though Munro himself pointed out that the Latin for this was mundi rather than puri, and in any case there is no reason to suppose that in ancient Rome cleanly people were addicted to bed-wetting. Giussani, followed by (...) Merrill and by Leonard and Smith, tried to give the required sense by supposing that puri meant ‘innocents’ and hence ‘children’, an expedient which is very far from convincing. Emendation seems called for. M. F. Smith in the 1982 edition of the Loeb Lucretius adopts Avancius' multi,2 but this does not provide the reference we need to the age of those concerned. (shrink)

Checklists have been used to improve quality in many industries, including healthcare. The use of checklists, however, has not been extensively evaluated in clinical ethics consultation. This article seeks to fill this gap by exploring the efficacy of using a checklist in ethics consultation, as tested by an empirical investigation of the use of the checklist at a large academic medical system (Cleveland Clinic). The specific aims of this project are as follows: (1) to improve the quality of ethics consultations (...) by providing reminders to ethics consultants about process steps that are important for most patient-centered ethics consultations, (2) to create consistency in the ethics consultation process across the medical system, and (3) to establish an effective educational tool for trainers and trainees in clinical ethics consultation. The checklist was developed after a thorough literature review and an iterative process of revising and testing by a group of experienced ethics consultants. To pilot test the checklist, it was distributed to 46 ethics consultants. After a six-month pilot period in which ethics professionals used the checklist during their clinical activities, a survey was distributed to all of those who used the checklist. The 10-item survey examined consultants’ perceptions regarding the three aims listed above. Of the 25 survey respondents, 11 self-reported as experts in ethics consultation, nine perceived themselves to have mid-level expertise, and five self-reported as novices. The majority (68 percent) of all respondents, regardless of expertise, believed that the checklist could be a “helpful” or “very helpful” tool in the consultation process generally. Novices were more likely than experts to believe that the checklist would be useful in conducting consultations. The limitations of this study include: reduced generalizability given that this project was conducted at one medical system, utilized a small sample size, and used self-reported quality outcome measures. Despite these limitations, to the authors’ knowledge this is the first investigatation of the use of a checklist systematically to improve quality in ethics consultation. Importantly, our findings shed light on ways this checklist can be used to improve ethics consultation, including its use as an educational tool. The authors hope to test the checklist with consultants in other healthcare systems to explore its usefulness in different healthcare environments. (shrink)

This article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper "Biomedical Informatics: We Are What We Publish", written by Peter L. Elkin, Steven H. Brown, and Graham Wright. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the Elkin et al. paper. In subsequent issues the discussion can continue through letters to the editor.

Plagiarism is a serious, yet widespread type of research misconduct, and is often neglected in developing countries. Despite its far-reaching implications, plagiarism is poorly acknowledged and discussed in the academic setting, and insufficient evidence exists in Latin America and developing countries to inform the development of preventive strategies. In this context, we present a longitudinal case study of seven instances of plagiarism and cheating arising in four consecutive classes of an Epidemiology Masters program in Lima, Peru, and describes the implementation (...) and outcomes of a multifaceted, “zero-tolerance” policy aimed at introducing research integrity. Two cases involved cheating in graded assignments, and five cases correspond to plagiarism in the thesis protocol. Cases revealed poor awareness of high tolerance to plagiarism, poor academic performance, and widespread writing deficiencies, compensated with patchwriting and copy-pasting. Depending on the events’ severity, penalties included course failure and separation from the program. Students at fault did not engage in further plagiarism. Between 2011 and 2013, the Masters program sequentially introduced a preventive policy consisting of: intensified research integrity and scientific writing education, a stepwise, cumulative writing process; honor codes; active search for plagiarism in all academic products; and a “zero-tolerance” policy in response to documented cases. No cases were detected in 2014. In conclusion, plagiarism seems to be widespread in resource-limited settings and a greater response with educational and zero-tolerance components is needed to prevent it. (shrink)

ABSTRACT Real-time graphical interval logic is a modal logic for reasoning about time in which the basic modality is the interval. The logic differs from other logics in that it has a natural intuitive graphical representation that resembles the timing diagrams drawn by system designers. We have developed an automted deduction system for the logic, which includes a theorem prover and a user interface. The theorem prover checks the validity of proofs in the logic and produces counterexamples to invalid proofs. (...) The user interface includes a graphical editor that enables the user to create graphical formulas on a workstation display, and a database and proof manager that tracks proof dependencies and allows graphical formulas to be stored and retrieved. In this paper we describe the logic, the automated deduction system, and an application to robotics. (shrink)

The authors illuminate the process of preservice teacher learning about race through a narrativized case study of Michelle, a White elementary teacher. Michelle displayed elements of White resistance to race but also a desire to engage in teaching about race. When race is viewed as a threshold concept ( Meyer & Land, 2006 ), Michelle's struggles with race highlight important considerations for teacher education.

Folk stories featuring prosocial content are ubiquitous across cultures. One explanation for the ubiquity of such stories is that stories teach people about the local socioecology, including norms of prosociality, and stories featuring prosocial content may increase generosity in listeners. We tested this hypothesis in a sample of 185 Hadza hunter-gatherers. We read participants a story in which the main character either swims with another person (control story) or rescues him from drowning (prosocial story). After hearing the story, participants played (...) a dictator game with dried meat sticks and then were given a recall test of facts presented in the story. There was moderate evidence for a small effect of the prosocial story: participants who heard the prosocial story gave an estimated 0.22 [90% HDI: −0.12–0.57] more meat sticks than those who heard the control story. However, the association between generosity and sex, marital status, and region of residence was stronger; men gave more than women, unmarried participants gave more than married participants, and participants living in a region with more exposure to markets gave more than participants living further from markets. There was no evidence that the prosocial story was more easily recalled than the control story. These results provide some support for the hypothesis that prosocial stories can increase prosociality in listeners, though the effect of hearing a single story is small. (shrink)

In China, the transformation from a centrally planned economy to one dominated by market forces has been characterized by the devolution of authority from the center to localities. This is as true of the enormous state bureaucracy associated with the control of fertility as it is with the economic bureaucracies more often studied in transitional societies. Using observations from several field sites, the authors document how county-, township-and village-level family planning cadres have gone from being agents of the state to (...) autonomous actors who must negotiate between the ongoing demands of the central bureaucracy and the new opportunities available in the locales in which they work and dwell. They suggest that any serious change in the draconian restrictions on fertility that have obtained in China for almost thirty years is likely to derive from initiatives at the local level. Local actors have already begun to adjust to the tensions between responsibilities and available resources that have tended to induce paralysis in the upper levels of this long-standing state bureaucracy. (shrink)

Although very young children have unprecedented access to touchscreen devices, there is limited research on how successfully they operate these devices for play and learning. For infants and toddlers, whose cognitive, fine motor, and executive functions are immature, several basic questions are significant: Can they operate a tablet purposefully to achieve a goal? Can they acquire operating skills and learn new information from commercially available apps? Do individual differences in executive functioning predict success in using and learning from the apps? (...) Accordingly, 31 2-year-olds were compared with 29 3-year-olds using two commercially available apps with different task and skill requirements: a shape matching app performed across 3 days, and a storybook app with performance compared to that on a matched paper storybook. Children also completed the Minnesota Executive Functioning Scale. An adult provided minimal scaffolding throughout. The results showed: toddlers could provide simple goal-directed touch gestures and the manual interactions needed to operate the tablet after controlling for prior experience with shape matching, toddlers’ increased success and efficiency, made fewer errors, decreased completion times, and required less scaffolding across trials, they recognized more story content from the e-book and were less distracted than from the paper book, executive functioning contributed unique variance to the outcome measures on both apps, and 3-year-olds outperformed 2-year-olds on all measures. The results are discussed in terms of the potential of interactive devices to support toddlers’ learning. (shrink)