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"Anderson, Sheila"
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Between a Rock and a Hard Place: COVID-19 Lessons Learned From Providers Rounding at Skilled Nursing Facilities in the Rural Midwest
On March 11, 2020, coronavirus disease 2019 (COVID-19) was classified as a pandemic, setting in motion unprecedented practice changes across the healthcare industry. Never was this more evident than in Skilled Nursing Facilities (SNFs). SNFs were tested on multiple fronts, requiring innovation and perseverance at levels never before seen. Lessons learned from this setting to better prepare for the next pandemic include: updating and standardizing infection control and prevention policies, ensuring the supply chain keeps up with demand, updating infrastructure, creating a work environment that promotes well-being, and having clear communication plans.
Journal Article
What can live in a lake?
Introduces readers to animals that live in a lake and the concept of habitat. Simple text describes the common features and behaviors of lake dwellers as well as offering many examples of creatures in this group.
Book
The development, implementation and evaluation of clinical pathways for chronic obstructive pulmonary disease (COPD) in Saskatchewan: protocol for an interrupted times series evaluation
Background
Chronic obstructive pulmonary disease (COPD) has substantial economic and human costs; it is expected to be the third leading cause of death worldwide by 2030. To minimize these costs high quality guidelines have been developed. However, guidelines alone rarely result in meaningful change. One method of integrating guidelines into practice is the use of clinical pathways (CPWs). CPWs bring available evidence to a range of healthcare professionals by detailing the essential steps in care and adapting guidelines to the local context.
Methods/design
We are working with local stakeholders to develop CPWs for COPD with the aims of improving care while reducing utilization. The CPWs will employ several steps including: standardizing diagnostic training, unifying components of chronic disease care, coordinating education and reconditioning programs, and ensuring care uses best practices. Further, we have worked to identify evidence-informed implementation strategies which will be tailored to the local context.
We will conduct a three-year research project using an interrupted time series (ITS) design in the form of a multiple baseline approach with control groups. The CPW will be implemented in two health regions (experimental groups) and two health regions will act as controls (control groups). The experimental and control groups will each contain an urban and rural health region. Primary outcomes for the study will be quality of care operationalized using hospital readmission rates and emergency department (ED) presentation rates. Secondary outcomes will be healthcare utilization and guideline adherence, operationalized using hospital admission rates, hospital length of stay and general practitioner (GP) visits. Results will be analyzed using segmented regression analysis.
Discussion
Funding has been procured from multiple stakeholders. The project has been deemed exempt from ethics review as it is a quality improvement project. Intervention implementation is expected to begin in summer of 2017.
This project is expected to improve quality of care and reduce healthcare utilization. In addition it will provide evidence on the effects of CPWs in both urban and rural settings. If the CPWs are found effective we will work with all stakeholders to implement similar CPWs in surrounding health regions.
Trial registration
Clinicaltrials.gov (
NCT03075709
). Registered 8 March 2017.
Journal Article
Iron-responsive degradation of iron-regulatory protein 1 does not require the Fe-S cluster
The generally accepted role of iron‐regulatory protein 1 (IRP1) in orchestrating the fate of iron‐regulated mRNAs depends on the interconversion of its cytosolic aconitase and RNA‐binding forms through assembly/disassembly of its Fe–S cluster, without altering protein abundance. Here, we show that IRP1 protein abundance can be iron‐regulated. Modulation of IRP1 abundance by iron did not require assembly of the Fe–S cluster, since a mutant with all cluster‐ligating cysteines mutated to serine underwent iron‐induced protein degradation. Phosphorylation of IRP1 at S138 favored the RNA‐binding form and promoted iron‐dependent degradation. However, phosphorylation at S138 was not required for degradation. Further, degradation of an S138 phosphomimetic mutant was not blocked by mutation of cluster‐ligating cysteines. These findings were confirmed in mouse models with genetic defects in cytosolic Fe–S cluster assembly/disassembly. IRP1 RNA‐binding activity was primarily regulated by IRP1 degradation in these animals. Our results reveal a mechanism for regulating IRP1 action relevant to the control of iron homeostasis during cell proliferation, inflammation, and in response to diseases altering cytosolic Fe–S cluster assembly or disassembly.
Journal Article
Infrastructure as intermeditation – from archives to research infrastructures
Purpose
– The purpose of this paper is to analyse the steps taken to produce new kinds of integrated documentation on the Holocaust in the European Holocaust Research Infrastructure project. The authors present the user investigation methodology as well as the novel data design to support this complex field.
Design/methodology/approach
– The paper is based on the scholarly primitives framework. From here, it proceeds with two empirical studies of Holocaust archival research and the implementation steps taken. The paper employs key insights from large technology studies in how to organise such work. In particular, it uses the concepts of social-technical assemblages and intermediation.
Findings
– The paper offers a number of findings. First from the empirical studies, it presents how Holocaust researchers and archivist perceive the way they currently do research in archives. It then presents how the intermediation and digital transformation of such research can be enabled without violating its foundations. The second major insight is the technical research into how to use graph databases to integrate heterogeneous research collections and the analysis opportunities behind.
Originality/value
– The paper is based on existing work by the authors but takes this work forward into the world of real-life existing historical research on archives. It demonstrates how the theoretical foundations of primitives are fit for purpose. The paper presents a completely new approach on how to (re)organise archives as research infrastructures and offers a flexible way of implementing this. Next to these major insights, a range of new solutions are presented how to arrange the socio-technical assemblages of research infrastructures.
Journal Article
Measuring the Quality of Early Father–Child Rough and Tumble Play: Tools for Practice and Research
BackgroundFathers are increasingly acknowledged as active participants in rearing young children, yet few observational measures recognize gender-differentiated parenting and can be used by practitioners and researchers to assess and improve fathers’ parenting capacity in playful settings, in order to inform program effectiveness. Two potential measures are the Rough-and-Tumble Play Quality Scale (RTPQ), which is based on evolutionary and attachment theory and assesses rough-and-tumble play behaviors related to social-emotional competencies. The second is Dads’ Parenting Interaction with Children: Checklist of Observations Linked to Outcomes (PICCOLO-D), which is grounded in a systemic approach linking parenting behaviors to child outcomes.ObjectiveThe aim of this study was to compare the two observational measures for suitability of assessment of fathers’ parenting capacity with diverse low-income families.MethodA correlational longitudinal design was used to examine naturalistic rough-and-tumble play extant video observations of 25 fathers and their 2- to 4-year-old children independently coded with each measure, with child prekindergarten and fifth grade outcomes.ResultsConvergent validity showed strong association between the two measures. No associations were found with family characteristics. Both measures predicted child prekindergarten attention regulation and aggression (inversely). PICCOLO-D predicted prekindergarten language and cognition, and language/literacy in fifth grade.ConclusionsThe similarities and subtle differences between the measures confirm the distinctive theoretical approaches underpinning each measure, and suggest both are suitable tools for practitioners and researchers. PICCOLO-D may be useful for multiple type of play, while the RTPQ may be more relevant to specific qualities of paternal physical play interaction.
Journal Article
Selective Inhibition of the Citrate-to-Isocitrate Reaction of Cytosolic Aconitase by Phosphomimetic Mutation of Serine-711
Iron-regulatory protein 1 (IRP1) is a dual-function protein with mutually exclusive roles as a posttranscriptional regulator of animal-cell iron metabolism or as the cytosolic isoform of the iron-sulfur enzyme aconitase (c-acon). Much effort has focused on the role of IRP1 in posttranscriptional gene regulation and in factors that influence its interconversion with c-acon, but little is known about the metabolic function and regulation of c-acon. The role of PKC-dependent phosphorylation of S711 on IRP1/c-acon function was examined. Phosphorylation state-specific antibodies revealed that S711 is phosphorylated by PKC in vitro and in human embryonic kidney cells treated with a PKC activator. In aco1 yeast, the phosphomimetic mutants S711D and S711E exhibited severely impaired aconitase function, whereas S711A and S711T were unaffected relative to the WT protein. Aconitase activity in yeast extracts displayed a similar pattern when assayed for capacity to convert citrate to isocitrate: WT, S711A, and S711T were active, but S711D and S711E activity was undetectable. In contrast, when measured by the conversion of isocitrate to cis-aconitate, S711D and S711E displayed substantial activity, indicating that phosphorylation impairs the citrate but not isocitrate mode of aconitase function. This possibility was confirmed in vivo by demonstrating that S711D and S711E specifically antagonized the requirement for isocitrate in two metabolic scenarios. Iron-responsive element RNA-binding affinity was unaffected by S711 mutations. Our results show that S711 is a target of phosphorylation capable of conferring distinct effects on c-acon function potentially dictating changes in cytosolic citrate/isocitrate metabolism.
Journal Article
Novel Role of Phosphorylation in Fe--S Cluster Stability Revealed by Phosphomimetic Mutations at Ser-138 of Iron Regulatory Protein 1
Animals regulate iron metabolism largely through the action of the iron regulatory proteins (IRPs). IRPs modulate mRNA utilization by binding to iron-responsive elements (IRE) in the 5′or 3′untranslated region of mRNAs encoding proteins involved in iron homeostasis or energy production. IRP1 is also the cytosolic isoform of aconitase. The activities of IRP1 are mutually exclusive and are modulated through the assembly/disassembly of its [4Fe-4S] cluster, reversibly converting it between an IRE-binding protein and cytosolic aconitase. IRP1 is also phosphoregulated by protein kinase C, but the mechanism by which phosphorylation posttranslationally increases IRE binding activity has not been fully defined. To investigate this, Ser-138 (S138), a PKC phosphorylation site, was mutated to phosphomimetic glutamate (S138E), aspartate (S138D), or non-phosphorylatable alanine (S138A). The S138E IRP1 mutant and, to a lesser extent, the S138D IRP1 mutant were impaired in aconitase function in yeast when grown aerobically but not when grown anaerobically. Purified wild-type and mutant IRP1s could be reconstituted to active aconitases anaerobically. However, when exposed to oxygen, the [4Fe-4S] cluster of the S138D and S138E mutants decayed 5-fold and 20-fold faster, respectively, than was observed for wild-type IRP1. Our findings suggest that stability of the Fe--S cluster of IRP1 can be regulated by phosphorylation and reveal a mechanism whereby the balance between the IRE binding and [4Fe-4S] forms of IRP1 can be modulated independently of cellular iron status. Furthermore, our results show that IRP1 can function as an oxygen-modulated posttranscriptional regulator of gene expression.
Journal Article