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Older patients with acute myeloid leukemia (AML) have high relapse risk and poor survival after allogeneic hematopoietic cell transplantation (HCT). Younger patients may receive myeloablative conditioning to mitigate relapse risk associated with high-risk genetics or measurable residual disease (MRD), but older adults typically receive reduced-intensity conditioning (RIC) to limit toxicity. To identify factors that drive HCT outcomes in older patients, we performed targeted mutational analysis (variant allele fraction ≥2%) on diagnostic samples from 295 patients with AML aged ≥60 years who underwent HCT in first complete remission, 91% of whom received RIC, and targeted duplex sequencing at remission in a subset comprising 192 patients. In a multivariable model for leukemia-free survival (LFS) including baseline genetic and clinical variables, we defined patients with low (3-year LFS, 85%), intermediate (55%), high (35%), and very high (7%) risk. Before HCT, 79.7% of patients had persistent baseline mutations, including 18.3% with only DNMT3A or TET2 (DT) mutations and 61.4% with other mutations (MRD positive). In univariable analysis, MRD positivity was associated with increased relapse and inferior LFS, compared with DT and MRD-negative mutations. However, in a multivariable model accounting for baseline risk, MRD positivity had no independent impact on LFS, most likely because of its significant association with diagnostic genetic characteristics, including MDS-associated gene mutations, TP53 mutations, and high-risk karyotype. In summary, molecular associations with MRD positivity and transplant outcomes in older patients with AML are driven primarily by baseline genetics, not by mutations present in remission. In this group of patients, where high-intensity conditioning carries substantial risk of toxicity, alternative approaches to mitigating MRD-associated relapse risk are needed.

Little research has focused on the accuracy of gonad shield placement, especially by students. While studies have investigated the presence of gonad shields they do not aim to measure accuracy but only look at repeatability. This study aimed to establish students' knowledge of gonad shields and their accuracy in placing it.Following an invitation email and informed consent, students completed a 7-question questionnaire and placed a gonad shield on a Pixi full body adult phantom (male configuration). The phantom was x-rayed and images were assessed for gonad shield positioning in terms of obscuring bony anatomy, correct orientation and distance from a "gold standard" position.36% of images displayed shields covering bony anatomy while 16% of shields were incorrectly orientated. All shields incorrectly orientated also covered bony anatomy. Statistical significance was seen between incorrect shield orientation and the obscuring of bony anatomy (p = 0.01). Dispersion of positioning error measurements ranged from -6.80 mm (better placed than the "gold standard") to 62.35 mm inferiorly, with an average 28.22 mm inferiorly.The average misplacement of 28.22 mm suggests participants placed the gonad shielding lower than necessary to avoid obscuring bony anatomy. The 36% of misplaced shields, while lower than in previous studies, is still a significant number of radiographs that would require repeats.Given the associated difficulties surrounding gonad shields and their placement, this study supports previous research suggesting that the benefit of using gonad shielding is questionable.

Neurons throughout the brain modulate their firing rate lawfully in response to changes in sensory input. Theories of neural computation posit that these modulations reflect the outcome of a constrained optimization: neurons aim to efficiently and robustly represent sensory information under resource limitations. Our understanding of how this optimization varies across the brain, however, is still in its infancy. Here, we show that neural responses transform along the dorsal stream of the visual system in a manner consistent with a transition from optimizing for information preservation to optimizing for perceptual discrimination. Focusing on binocular disparity – the slight differences in how objects project to the two eyes – we re-analyze measurements from neurons characterizing tuning curves in macaque monkey brain regions V1, V2, and MT, and compare these to measurements of the natural visual statistics of binocular disparity. The changes in tuning curve characteristics are computationally consistent with a shift in optimization goals from maximizing the information encoded about naturally occurring binocular disparities to maximizing the ability to support fine disparity discrimination. We find that a change towards tuning curves preferring larger disparities is a key driver of this shift. These results provide new insight into previously-identified differences between disparity-selective regions of cortex and suggest these differences play an important role in supporting visually-guided behavior. Our findings support a key re-framing of optimal coding in regions of the brain that contain sensory information, emphasizing the need to consider not just information preservation and neural resources, but also relevance to behavior.SignificanceA major role of the brain is to transform information from the sensory organs into signals that can be used to guide behavior. Neural activity is noisy and can consume large amount of energy, so sensory neurons must optimize their information processing so as to limit energy consumption while maintaining key behaviorally-relevant information. In this report, we re-examine classically-defined brain areas in the visual processing hierarchy, and ask whether neurons in these areas vary lawfully in how they represent sensory information. Our results suggest that neurons in these brain areas shift from being an optimal conduit of sensory information to optimally supporting perceptual discrimination during natural tasks.

Osmosis is an important force in all living organisms, yet the molecular basis of osmosis is widely misunderstood as arising from differences in water concentration in solutions of differing osmolarities. In 1923 Debye proposed a physical model for a semipermeable membrane that was hardly noticed at the time and slipped out of view. We show that Debye’s analysis of van’t Hoff’s law for osmotic equilibrium provides a consistent and plausible explanation for osmotic flow. A difference in osmolyte concentrations in solutions separated by a semipermeable membrane generates different pressures at the two water-membrane interfaces. Water is therefore driven through the membrane for exactly the same reason that pure water flows in response to an imposed hydrostatic pressure difference. In this paper we present the Debye model in both equilibrium and flow conditions. We point out its applicability regardless of the nature of the membrane with examples ranging from predominantly convective flow of water through synthetic membranes to purely diffusive flow of independent water molecules through a lipid bilayer and the flow of strongly interacting water molecules in single file across narrow protein channels.

The aim was to explore the feasibility and safety of performing common surgical steps in epiretinal membrane (ERM) peeling using the Preceyes Surgical System (PSS).In a tertiary centre, 15 pseudophakic patients with an idiopathic ERM were randomised to robot-assistance or manual surgery in a 2:1 ratio. In the robot-assisted group, the following steps were performed using PSS: (1) staining the internal limiting membrane (ILM), (2) removal of the dye, (3) creating an ILM flap, (4) completing the peeling, (5) holding a light pipe and (6) fluid-air exchange. Primary outcome measures were feasibility and safety. Secondary outcome measures were duration, best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Moreover, the distance travelled by the instrument during peeling was assessed using motion tracking software.All steps performed with PSS were feasible with no clinical adverse events or complications. The surgical time was longer in the robot-assisted group (mean 56 min, SD = 12 vs. 24 min, SD = 5). During the study, the duration of robot-assisted surgeries decreased from 72 to 46 min. The distance travelled by the forceps was shorter in the robot-assisted group (mean 403 mm, SD = 186 vs. 550 mm, SD = 134). BCVA and CRT improved equally in both groups.This is the world's first randomised controlled trial on robotic surgery for ERM. Although more time-consuming, we found that several surgical steps were feasible with assistance of the PSS.

Persons living with mental health challenges are at increased risk of stigma, social isolation, and social exclusion. Due to its emphasis on member participation and community, the clubhouse model of mental health may help address these issues. In this study, we examined experiences of social belonging and of various social determinants of mental health among members attending a psychosocial clubhouse. Twelve members of a large psychosocial clubhouse were interviewed regarding their experiences of community life and belonging. Phenomenological qualitative methods were utilized to examine the meaning and structure of these experiences. Members overwhelmingly experienced the clubhouse as a central site of belonging ("an oasis"), but members also recounted devastating portraits of life in the outside world ("a desert"). This world presented fundamental restrictions on their movement and speech and held deeply sedimented norms pertaining to who is considered valuable, productive, and even human, which they were reminded of through an endless tyranny of questions ("what do you do," "where do you live," etc.). Life in the clubhouse presented an alternative world for members to experience nourishment, dignity, reaffirmed personhood, and a sense of beauty. And yet, the desert outside remained. Implications of these findings for clubhouses, mental health practice, and sociopolitical and community engagement are discussed, including the need to address profound deprivations and power imbalances within the wider world, beyond the walls of humane spaces such as these. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

This study was conducted to assess the utility of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting radiographic sacroiliitis and active disease in axial spondyloarthritis (SpA) and to explore the association between use of a tumor necrosis factor inhibitor (TNFi) and these laboratory values compared with traditional inflammatory markers.Observational data from the Program to Understand the Longterm Outcomes in Spondyloarthritis (PULSAR) registry were analyzed. We generated receiver operating characteristic curves to calculate laboratory cutoff values; we used these values in multivariable logistic regression models to identify associations with radiographically confirmed sacroiliitis and active disease. We also used logistic regression to determine the likelihood of elevated laboratory values after initiation of TNFi.Most study participants (n = 354) were White, male, and HLA-B27 positive. NLR (odds ratio [OR] 1.459, P = 0.034), PLR (OR 4.842, P 0.001), erythrocyte sedimentation rate (OR 4.397, P 0.001), and C-reactive protein (CRP) level (OR 2.911, P = 0.001) were independent predictors of radiographic sacroiliitis. Models that included PLR with traditional biomarkers performed better than those with traditional biomarkers alone. NLR (OR 6.931, P = 0.002) and CRP (OR 2.678, P = 0.004) were predictors of active disease, but the model that included both NLR and CRP performed better than CRP alone. TNFi use reduced the odds of elevated NLR (OR 0.172, P 0.001), PLR (OR 0.073, P 0.001), erythrocyte sedimentation rate (OR 0.319, P 0.001), and CRP (OR 0.407, P 0.001), but models that included NLR or PLR and traditional biomarkers performed best.These findings demonstrate an association between NLR and PLR and sacroiliitis and disease activity, with NLR and PLR showing response after TNFi treatment and adding useful clinical information to established biomarkers, thus perhaps assisting in management of axial SpA.

PurposeTo examine perceptual adaptation when people wear spectacles that produce unequal retinal image magnification.MethodsTwo groups of 15 participants (10 male; mean age 25.6 ± 4.9 years) wore spectacles with a 3.8% horizontal magnifier over one eye. The continuous-wear group wore the spectacles for 5 hours straight. The intermittent-wear group wore them for five 1-hour intervals. To measure slant and shape distortions produced by the spectacles, participants adjusted visual stimuli until they appeared frontoparallel or equiangular, respectively. Adaptation was quantified as the difference in responses at the beginning and end of wearing the spectacles. Aftereffects were quantified as the difference before and after removing the spectacles. We hypothesized that intermittent wear may lead to visual cue reweighting, so we fit a cue combination model to the data and examined changes in weights given to perspective and binocular disparity slant cues.ResultsBoth groups experienced significant shape adaptation and aftereffects. The continuous-wear group underwent significant slant adaptation and the intermittent group did not, but there was no significant difference between groups, suggesting that the difference in adaptation was negligible. There was no evidence for cue reweighting in the intermittent wear group, but unexpectedly, the weight given to binocular disparity cues for slant increased significantly in the continuous-wear group.ConclusionsWe did not find strong evidence that adaptation to spatial distortions differed between the two groups. However, there may be differences in the cue weighting strategies employed when spectacles are worn intermittently or continuously.

Present political climate and an increase in visibility and voice for Indigenous people are being leveraged to attract attention to dire social, environmental, and political issues. However, we need a more unified, organized, and coordinated policy platform, strategy, and public response. NDN Collective, an all Indigenous-led and staffed organization devoted to building Indigenous self-determination and power across Turtle Island, provides cohesion through a strong meta narrative of its Land Back campaign and an ecosystem of resources for Native Nations and peoples built around its three pillars: Defend, Develop, and Decolonize. This article shares a brief history of colonization and the lasting impacts of the American Indian Movement of the 1960s and what is needed from Indigenous leadership today. In recognizing that the collective liberation of Indigenous people is bound together with those of other Black and brown relatives, this article also explores our shared history with Black Americans and the success of the Black Lives Matter movement.

A central question in neuroscience is how sensory inputs are transformed into percepts. At this point, it is clear that this process is strongly influenced by prior knowledge of the sensory environment. Bayesian ideal observer models provide a useful link between data and theory that can help researchers evaluate how prior knowledge is represented and integrated with incoming sensory information. However, the statistical prior employed by a Bayesian observer cannot be measured directly, and must instead be inferred from behavioral measurements. Here, we review the general problem of inferring priors from psychophysical data, and the simple solution that follows from assuming a prior that is a Gaussian probability distribution. As our understanding of sensory processing advances, however, there is an increasing need for methods to flexibly recover the shape of Bayesian priors that are not well approximated by elementary functions. To address this issue, we describe a novel approach that applies to arbitrary prior shapes, which we parameterize using mixtures of Gaussian distributions. After incorporating a simple approximation, this method produces an analytical solution for psychophysical quantities that can be numerically optimized to recover the shapes of Bayesian priors. This approach offers advantages in flexibility, while still providing an analytical framework for many scenarios. We provide a MATLAB toolbox implementing key computations described herein.

STRUCTURED Summary Background Registered nurses perform numerous functions critical to the success of antimicrobial stewardship but only 63% of pre-registration nursing programmes include any teaching about stewardship. Updated nursing standards highlight nurses require antimicrobial stewardship knowledge and skills. Aim To explore the delivery of key antimicrobial stewardship competencies within updated pre-registration nursing programmes. Method A cross-sectional survey design. Data were collected between March and June 2021. Findings Lecturers from 35 UK universities responsible for teaching antimicrobial stewardship participated. The provision of antimicrobial stewardship teaching and learning was inconsistent across programmes with competencies in infection prevention and control, patient centred care, and interprofessional collaborative practice taking precedent over those pertaining to the use, management, and monitoring of antimicrobials. On-line learning and teaching surrounding hand hygiene, personal protective equipment, and immunisation theory was reported to have increased during the pandemic. Only a small number of respondents reported that students shared taught learning with other healthcare professional groups. Conclusion There is a need to ensure consistency in antimicrobial stewardship across programmes, and greater knowledge pertaining to the use, management and monitoring of antimicrobials should be included. Programmes need to adopt teaching strategies and methods that allow nurses to develop interprofessional skill in order to practice collaboratively.

Proprioception of all animals is important in being able to have coordinated locomotion. Stretch activated ion channels (SACs) transduce the mechanical force into electrical signals in the proprioceptive sensory endings. The types of SACs vary among sensory neurons in animals as defined by pharmacological, physiological and molecular identification. The chordotonal organs within insects and crustaceans offer a unique ability to investigate proprioceptive function. The effects of the extracellular environment on neuronal activity, as well as the function of associated SACs are easily accessible and viable in minimal saline for ease in experimentation. The effect of extracellular [Ca2+] on membrane properties which affect voltage-sensitivity of ion channels, threshold of action potentials and SACs can be readily addressed in the chordotonal organ in crab limbs. It is of interest to understand how low extracellular [Ca2+] enhances neural activity considering the SACs in the sensory endings could possibly be Ca2+ channels and that all neural activity is blocked with Mn2+. It is suggested that axonal excitability might be affected independent from the SAC activity due to potential presence of calcium activated potassium channels (K(Ca)) and the ability of Ca2+ to block voltage gated Na+ channels in the axons. Separating the role of Ca2+ on the function of the SACs and the excitability of the axons in the nerves associated with chordotonal organs is addressed. These experiments may aid in understanding the mechanisms of neuronal hyperexcitability during hypocalcemia within mammals.

Introduction The NHS Long Term Plan aims to ‘prevent up to 150,000 heart attacks, strokes and dementia cases over the next 10 years’.1 People with Familial Hypercholesterolaemia (FH) are considered to be at high-risk of heart attack, stroke and dementia but an estimated 90% remain undiagnosed.1 The Chesterfield and Dronfield Primary Care Network were commissioned to set-up a 12-month pharmacist-led clinic across 9 practices to identify, treat and refer FH patients. Patients with suspected FH benefit from referral to specialist services.2 Aim This study aimed to evaluate the number of FH patients identified and any unintended benefits of the Lipid Clinic. Methods Ethical approval was not required for this service evaluation. Informed consent was sought prior to data collection and the dataset was anonymised. Searches of practice patient records identified patients with a previously raised lipid level (total Cholesterol >7.5mmol/L and/or non-HDL-C > 5.9mmol/L)2 for review in the Lipid Clinic. Patients reviewed in the Lipid Clinic were initiated/optimised on lipid lowering medication as appropriate.2 Data were collected for patients invited for review in the Lipid Clinic between May-July 2022. Patients’ attendance as well as decline/non-response to the Clinic was recorded. The data collected included family history, QRISK score (where applicable), lipid lowering treatment the patient was taking (if any) and blood tests results (serum lipids, HBA1c and thyroid function tests). If bloods were deranged it was documented whether or not it was a new finding. The data was analysed by categorising patients into potential FH, primary/secondary prevention of cardiovascular disease and whether they needed referral to secondary care. Results Out of the 260 patients invited for review, 219 attended the clinic. Of these, 30 (13.7%) were provided with lifestyle advice as they did not meet the criteria for treatment. Twenty-three patients (10.5%) met the Simon-Broom criteria for possible FH. A further 3 patients identified were known to have FH but had not undergone genetic cascade testing. These 26 patients (11.8%) were referred to secondary care for genetic testing and specialist input. Newly raised HbA1c indicative of either diabetes or non-diabetic hyperglycaemia was incidentally found in 39 patients (17.8%). Lipid-lowering medication was initiated/titrated in 189 patients (86.3%). Discussion/Conclusion The significant proportion of patients requiring follow up in secondary care (11.8%) suggesting targeted searches are effective in identifying patients with possible FH. Identifying FH patients, testing and treating their family members appropriately reduces their risk of cardiovascular events.2 The Lipid Clinic has identifying that nearly a fifth of patients were previously undiagnosed with either diabetes or non-diabetic hyperglycaemia (17.8%) suggests that this is also an opportunity to identify and treat these patients earlier than they would otherwise have been identified. The results highlight the need for primary care staff education on the new AAC NHS Guidelines2 relating to managing lipid results. One limitation of the study is although the Lipid Clinic has received good informal feedback, formal feedback is yet to be collected from patients and stake holders. In addition, the clinic is still ongoing, and more data is being collected. References 1. NHS Long Term Plan. Chapter 3: Further progress on care quality and outcomes. Better care for major health conditions. Cardiovascular Disease. 2019. Available from: https://www.longtermplan.nhs.uk/online-version/chapter-3-further-progress-on-care-quality-and-outcomes/better-care-for-major-health-conditions/cardiovascular-disease/ 2. Khatib R, Neely D, on behalf of the AAC Clinical Subgroup. Summary of National Guidance for Lipid Management for Primary and Secondary Prevention of CVD, AAC NHS Guidelines, Nov 2021. Review date: Nov 2022. NICE endorsed Dec 2021. 3. National Institution for Health and Care Excellence (NICE). Cardiovascular disease: risk assessment and reduction, including lipid modification, Clinical guideline [CG181] Published: 18 July 2014 Last updated: 27 September 2016.

This work was supported by a Wellcome Trust Four-Year PhD Studentship in Basic Science to J.B. (219992/Z/19/Z) and a Wellcome Trust Senior Research Fellowship to N.P. (090868/Z/09/Z). C.M. was supported by a Sir Henry Wellcome Fellowship (103986/Z/14/Z) and University of Manchester Presidential Fellowship. M.R.’s work was supported by a Wellcome Trust Investigator Award (204832/B/16/Z). Gene expression dynamics, such as stochastic oscillations and aperiodic fluctuations, have been associated with cell fate changes in multiple contexts, including development and cancer. Single cell live imaging of protein expression with endogenous reporters is widely used to observe such gene expression dynamics. However, the experimental investigation of regulatory mechanisms underlying the observed dynamics is challenging, since these mechanisms include complex interactions of multiple processes, including transcription, translation and protein degradation. Here, we present a Bayesian method to infer kinetic parameters of oscillatory gene expression regulation using an auto-negative feedback motif with delay. Specifically, we use a delay-adapted nonlinear Kalman filter within a Metropolis-adjusted Langevin algorithm to identify posterior probability distributions. Our method can be applied to time-series data on gene expression from single cells and is able to infer multiple parameters simultaneously. We apply it to published data on murine neural progenitor cells and show that it outperforms alternative methods. We further analyse how parameter uncertainty depends on the duration and time resolution of an imaging experiment, to make experimental design recommendations. This work demonstrates the utility of parameter inference on time course data from single cells and enables new studies on cell fate changes and population heterogeneity. Publisher PDF

Acute coronary syndrome is a rare complication of vasculitis. We present a case of fulminant medium-vessel vasculitis, most likely PAN, complicated by STEMI and stroke, that was successfully treated with percutaneous revascularization, high-quality stroke care, and immunosuppression. This case highlights the importance of prompt diagnosis and treatment of vasculitis and the recognition of coronary and cerebral ischemia as potentially serious complications.

Purpose North Carolina macular dystrophy (NCMD) is an autosomal dominant, congenital disorder affecting the central retina. Here, we report clinical and genetic findings in three families segregating NCMD and use epigenomic datasets from human tissues to gain insights into the effect of NCMD-implicated variants. Methods Clinical assessment and genetic testing were performed. Publicly available transcriptomic and epigenomic datasets were analyzed and the activity-by-contact method for scoring enhancer elements and linking them to target genes was used. Results A previously described, heterozygous, noncoding variant upstream of the PRDM13 gene was detected in all six affected study participants (chr6:100,040,987G>C [GRCh37/hg19]). Interfamilial and intrafamilial variability were observed; the visual acuity ranged from 0.0 to 1.6 LogMAR and fundoscopic findings ranged from visually insignificant, confluent, drusen-like macular deposits to coloboma-like macular lesions. Variable degrees of peripheral retinal spots (which were easily detected on widefield retinal imaging) were observed in all study subjects. Notably, a 6-year-old patient developed choroidal neovascularization and required treatment with intravitreal bevacizumab injections. Computational analysis of the five single nucleotide variants that have been implicated in NCMD revealed that these noncoding changes lie within two putative enhancer elements; these elements are predicted to interact with PRDM13 in the developing human retina. PRDM13 was found to be expressed in the fetal retina, with greatest expression in the amacrine precursor cell population. Conclusions We provide further evidence supporting the role of PRDM13 dysregulation in the pathogenesis of NCMD and highlight the usefulness of widefield retinal imaging in individuals suspected to have this condition.

Gene expression dynamics, such as stochastic oscillations and aperiodic fluctuations, have been associated with cell fate changes in multiple contexts, including development and cancer. Single cell live imaging of protein expression with endogenous reporters is widely used to observe such gene expression dynamics. However, the experimental investigation of regulatory mechanisms underlying the observed dynamics is challenging, since these mechanisms include complex interactions of multiple processes, including transcription, translation, and protein degradation. Here, we present a Bayesian method to infer kinetic parameters of oscillatory gene expression regulation using an auto-negative feedback motif with delay. Specifically, we use a delay-adapted nonlinear Kalman filter within a Metropolis-adjusted Langevin algorithm to identify posterior probability distributions. Our method can be applied to time series data on gene expression from single cells and is able to infer multiple parameters simultaneously. We apply it to published data on murine neural progenitor cells and show that it outperforms alternative methods. We further analyse how parameter uncertainty depends on the duration and time resolution of an imaging experiment, to make experimental design recommendations. This work demonstrates the utility of parameter inference on time course data from single cells and enables new studies on cell fate changes and population heterogeneity.

PurposeNorth Carolina macular dystrophy (NCMD) is an autosomal dominant, congenital disorder affecting the central retina. Here, we report clinical and genetic findings in three families segregating NCMD and use epigenomic datasets from human tissues to gain insights into the effect of NCMD-implicated variants.MethodsClinical assessment and genetic testing were performed. Publicly-available transcriptomic and epigenomic datasets were analyzed and the ‘Activity-by-Contact’ (ABC) method for scoring enhancer elements and linking them to target genes was used.ResultsA previously-described, heterozygous, non-coding variant upstream of the PRDM13 gene was detected in all six affected study participants (chr6:100,040,987G>C [GRCh37/hg19]). Inter- and intra-familial variability were observed; the visual acuity ranged from 0.0 to 1.6 LogMAR and fundoscopic findings ranged from visually insignificant, confluent, drusen-like macular deposits to coloboma-like macular lesions. Variable degrees of peripheral retinal spots (which were easily detected on widefield retinal imaging) were observed in all study subjects. Notably, a 6-year-old patient developed choroidal neovascularization and required treatment with intravitreal bevacizumab injections. Computational analysis of the five single nucleotide variants that have been implicated in NCMD revealed that these non-coding changes lie within two putative enhancer elements; these elements are predicted to interact with PRDM13 in the developing human retina. PRDM13 was found to be expressed in the fetal retina, with highest expression in the amacrine precursor cell population.ConclusionsWe provide further evidence supporting the role of PRDM13 dysregulation in the pathogenesis of NCMD and highlight the utility of widefield retinal imaging in individuals suspected to have this condition.

Curriculum that informs students about social work practice with Native Peoples must be culturally relevant and responsive. However, the voices of Native Peoples are often excluded from identification of needs and relevant practice models for services. A unique partnership between the Native People from several tribes and a rural southwestern social work program led to an innovative project of curriculum development for social work practice with Native Peoples. The curriculum content evolved directly from the experiences of Native tribal members in the region. A retreat format initiated the process with subsequent quarterly meetings that provided a venue for course development with specific attention to the development of Native faculty as authors and teachers. The impact of this process is discussed through the voices of Council members, students, and Native instructors. This paper offers guidance to social work programs who are interested in expanding their understanding of Native curriculum development.

Positive Youth Development (PYD) is a theoretically founded, developmental framework that is strengths-based, incorporates ecological assets, and has been effective in supporting at-risk youth. A growing number of adolescents and young adults (AYA) with chronic conditions will survive into adulthood, and thus greater focus on understanding their long-term development is paramount. This chapter presents the development of the PYD model from a historical and theoretical lens. It introduces Lerner and Lerner’s 5Cs framework as an empirically supported perspective shown to positively impact long-term outcomes in at-risk youth. Next, the utility of the application of PYD to AYA with childhood onset chronic conditions (COCC) is examined. Finally, empirical evidence on PYD-based interventions and programs for AYA with COCC are described, and recommendations for practice are outlined. PYD remains a promising approach to support the development of positive assets and life skills in AYA with COCC.

Introduction: A study of 42,000 cardiology consults within the Veterans Health Administration (VHA) in 2016 found that patients who received electronic consultation (e-consults) had similar healthcare costs at 6 months compared to those who received face-to-face (F2F) consults. However, results may have been confounded if patients with less costly conditions received e-consults. Our aim was to compare costs between those receiving F2F vs. e-consults for a similar indication. Hypothesis: Electronic rather than F2F consultation for atrial fibrillation (AF) management will be associated with lower total healthcare costs. Methods: We conducted a retrospective cohort study of a national sample of VHA patients who received cardiology consultation in 2016. We used a natural language processing script to identify consults for AF management. Primary outcomes were total healthcare costs at 3 and 6 months. Secondary outcomes included inpatient and outpatient costs. We compared costs between groups using a generalized linear model with a gamma distribution and log link. We adjusted for community wage and Charlson comorbidity indices, distance to nearest facility, age, and gender. Standard errors were clustered at the facility level. Results: We sampled 176 F2F and 136 e-consults from 43 facilities. Mean total 6-month costs were $12,928 (95% confidence interval [CI]: 1,377; 40,644) and $8,286 (95% CI: 959; 31,320) among e-consult and F2F groups, respectively. The e-consult group had 12.3% higher 3-month (p Conclusions: Use of e-consults for AF management is associated with reduced inpatient costs at 3 months, but higher total costs, which were largely driven by outpatient costs. Improving our understanding of healthcare utilization after initial consultation, or in differences in reasons for consultation within AF management may help explain these differences.