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BACKGROUND: With the sharp increase in the involvement of patients (including family and informal caregivers) as active participants, collaborators, advisors and decision-makers in health systems, a new role has emerged: the patient partner. The role of patient partner differs from other forms of patient engagement in its longitudinal and bidirectional nature. This systematic review describes extant work on how patient partners are conceptualized and engaged in health systems. In doing so, it furthers the understanding of the role and activities of patient partners, and best practices for future patient partnership activities. METHODS: A systematic review was conducted of peer-reviewed literature published in English or French that describes patient partner roles between 2000 and 2021 in any country or sector of the health system. We used a broad search strategy to capture descriptions of longitudinal patient engagement that may not have used words such as "partner" or "advisor". RESULTS: A total of 506 eligible papers were identified, representing patient partnership activities in mostly high-income countries. These studies overwhelmingly described patient partnership in health research. We identified clusters of literature about patient partnership in cancer and mental health. The literature is saturated with single-site descriptive studies of patient partnership on individual projects or initiatives. There is a lack of work synthesizing impacts, facilitating factors and outcomes of patient partnership in healthcare. CONCLUSIONS: There is not yet a consolidated understanding of the role, activities or impacts of patient partners. Advancement of the literature has been stymied by a lack of consistently used terminology. The literature is ready to move beyond single-site descriptions, and synthesis of existing pockets of high-quality theoretical work will be essential to this evolution.
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Atención a la Salud , Salud Mental , HumanosRESUMEN
Cultural evolutionary theory posits that human cultural complexity rests on a set of adaptive learning biases that help to guide functionality and optimality in social learning, but this sits in contrast with the commonly held view that children are unselective "over-imitators." Here, we tested whether 4- and 6-year-old children use social learning biases flexibly to fine-tune their copying of irrelevant actions. Children watched a video of a majority demonstrating causally irrelevant actions and a minority demonstrating only causally relevant actions. In one condition observers approved of the majority and disapproved of the minority, and in the other condition observers watched the majority and minority neutrally. Results showed that both 4- and 6-year-olds copied the inefficient majority more often than the efficient minority when the observers had approved of the majority's actions, but they copied the efficient minority significantly more when the observers had watched neutrally. We discuss the implications of children's optimal selectivity in copying and the importance of integrating social approval into majority-biased learning when acquiring norms and conventions and in broader processes of cultural evolution.
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Conducta Imitativa , Aprendizaje Social , Niño , Conducta Infantil , Humanos , Aprendizaje , Conducta SocialRESUMEN
Human children, in contrast to other species, are frequently cast as prolific "over-imitators". However, previous studies of "over-imitation" have overlooked many important real-world social dynamics, and may thus provide an inaccurate account of this seemingly puzzling and potentially maladaptive phenomenon. Here we investigate this topic using a cultural evolutionary approach, focusing particularly on the key adaptive learning strategy of majority-biased copying. Most "over-imitation" research has been conducted using consistent demonstrations to the observer, but we systematically varied the frequency of demonstrators that 4- to 6-year-old children observed performing a causally irrelevant action. Children who "over-imitate" inflexibly should copy the majority regardless of whether the majority solution omits or includes a causally irrelevant action. However, we found that children calibrated their tendency to acquire the majority behavior, such that copying did not extend to majorities that performed irrelevant actions. These results are consistent with a highly functional, adaptive integration of social and causal information, rather than explanations implying unselective copying or causal misunderstanding. This suggests that our species might be better characterized as broadly "optimal-" rather than "over-" imitators.
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Conducta Infantil/fisiología , Conducta Infantil/psicología , Conducta Imitativa/fisiología , Influencia de los Compañeros , Conducta Social , Niño , Preescolar , Evolución Cultural , Femenino , Humanos , Aprendizaje/fisiología , MasculinoRESUMEN
BACKGROUND: The literature emphasizes that friendships are essential to youths' successful transition to and adjustment in adulthood. Few studies have explored the friendships of transition-aged youths with intellectual and developmental disabilities (IDD), and even fewer include youths' own perspectives. This qualitative study explored the perspectives of transition-aged youths with IDD regarding their own experiences of friendship. METHOD: A subset of video-recorded data of 21 interviews with seven participants (20-24 years) was extracted from a larger study for secondary analysis. Data were analysed using thematic analysis, informed by constructivist grounded theory methods. RESULTS: Three themes were revealed: meanings of friends and friendship, deepening self-knowledge and negotiating in(ter)dependence. CONCLUSIONS: The findings expand existing knowledge about friendships of transition-aged youths with IDD. Findings can potentially inform development of new services or enhancement of existing services aimed at facilitating transition to adulthood for youths with IDD and point to key areas for future research.
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Discapacidades del Desarrollo/psicología , Amigos/psicología , Discapacidad Intelectual/psicología , Personas con Discapacidades Mentales/psicología , Adolescente , Adulto , Femenino , Humanos , Masculino , Investigación Cualitativa , Adulto JovenRESUMEN
Group size predicts brain size in primates and some other mammal groups, but no such relationship has been found in birds. Instead, stable pair-bonding and bi-parental care have been identified as correlates of larger brains in birds. We investigated the relationship between brain size and social system within the family Picidae, using phylogenetically controlled regression analysis. We found no specific effect of duration or strength of pair-bonds, but brain sizes were systematically smaller in species living in long-lasting social groups of larger sizes. Group-living may only present a cognitive challenge in groups in which members have individually competitive relationships; we therefore propose that groups functioning for cooperative benefit may allow disinvestment in expensive brain tissue.
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Aves/anatomía & histología , Aves/fisiología , Encéfalo/anatomía & histología , Conducta Social , Animales , Tamaño de los Órganos , Apareamiento , FilogeniaRESUMEN
We have previously shown that during pregnancy the E-twenty-six (ETS) transcription factor ELF5 directs the differentiation of mammary progenitor cells toward the estrogen receptor (ER)-negative and milk producing cell lineage, raising the possibility that ELF5 may suppress the estrogen sensitivity of breast cancers. To test this we constructed inducible models of ELF5 expression in ER positive luminal breast cancer cells and interrogated them using transcript profiling and chromatin immunoprecipitation of DNA followed by DNA sequencing (ChIP-Seq). ELF5 suppressed ER and FOXA1 expression and broadly suppressed ER-driven patterns of gene expression including sets of genes distinguishing the luminal molecular subtype. Direct transcriptional targets of ELF5, which included FOXA1, EGFR, and MYC, accurately classified a large cohort of breast cancers into their intrinsic molecular subtypes, predicted ER status with high precision, and defined groups with differential prognosis. Knockdown of ELF5 in basal breast cancer cell lines suppressed basal patterns of gene expression and produced a shift in molecular subtype toward the claudin-low and normal-like groups. Luminal breast cancer cells that acquired resistance to the antiestrogen Tamoxifen showed greatly elevated levels of ELF5 and its transcriptional signature, and became dependent on ELF5 for proliferation, compared to the parental cells. Thus ELF5 provides a key transcriptional determinant of breast cancer molecular subtype by suppression of estrogen sensitivity in luminal breast cancer cells and promotion of basal characteristics in basal breast cancer cells, an action that may be utilised to acquire antiestrogen resistance.
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Neoplasias de la Mama/metabolismo , Resistencia a Antineoplásicos/efectos de los fármacos , Estrógenos/farmacología , Proteínas Proto-Oncogénicas c-ets/metabolismo , Animales , Sitios de Unión , Neoplasias de la Mama/clasificación , Neoplasias de la Mama/genética , Neoplasias de la Mama/patología , Adhesión Celular/efectos de los fármacos , Puntos de Control del Ciclo Celular/efectos de los fármacos , Línea Celular Tumoral , Proliferación Celular/efectos de los fármacos , Inmunoprecipitación de Cromatina , ADN de Neoplasias/metabolismo , Proteínas de Unión al ADN , Femenino , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Genoma Humano/genética , Humanos , Ratones , Modelos Biológicos , Fenotipo , Unión Proteica/efectos de los fármacos , Unión Proteica/genética , Proteínas Proto-Oncogénicas c-ets/genética , Análisis de Secuencia de ADN , Factores de Transcripción , Transcripción Genética/efectos de los fármacosRESUMEN
Although it is well known that mating increases the risk of infection, we do not know how females mitigate the fitness costs of sexually transmitted infections (STIs). It has recently been shown that female fruitflies, Drosophila melanogaster, specifically upregulate two members of the Turandot family of immune and stress response genes, Turandot M and Turandot C (TotM and TotC), when they hear male courtship song. Here, we use the Gal4/UAS RNAi gene knockdown system to test whether the expression of these genes provides fitness benefits for females infected with the entomopathogenic fungus, Metarhizium robertsii under sexual transmission. As a control, we also examined the immunity conferred by Dorsal-related immunity factor (Dif), a central component of the Toll signalling pathway thought to provide immunity against fungal infections. We show that TotM, but not TotC or Dif, provides survival benefits to females following STIs, but not after direct topical infections. We also show that though the expression of TotM provides fecundity benefits for healthy females, it comes at a cost to their survival, which helps to explain why TotM is not constitutively expressed. Together, these results show that the anticipatory expression of TotM promotes specific immunity against fungal STIs and suggest that immune anticipation is more common than currently appreciated.
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Proteínas de Drosophila/inmunología , Drosophila melanogaster/inmunología , Proteínas de Choque Térmico/inmunología , Conducta Sexual Animal , Animales , Resistencia a la Enfermedad , Proteínas de Drosophila/antagonistas & inhibidores , Proteínas de Drosophila/fisiología , Drosophila melanogaster/microbiología , Drosophila melanogaster/fisiología , Femenino , Fertilidad , Regulación de la Expresión Génica , Proteínas de Choque Térmico/antagonistas & inhibidores , Proteínas de Choque Térmico/fisiología , Masculino , Metarhizium/inmunología , Interferencia de ARN , Transducción de SeñalRESUMEN
Despite playing a pivotal role in the inception of animal culture studies, macaque social learning is surprisingly understudied. Social learning is important to survival and influenced by dominance and affiliation in social animals. Individuals generally rely on social learning when individual learning is costly, and selectively use social learning strategies influencing what is learned and from whom. Here, we combined social learning experiments, using extractive foraging tasks, with network-based diffusion analysis (using various social relationships) to investigate the transmission of social information in free-ranging Barbary macaques. We also investigated the influence of task difficulty on reliance on social information and evidence for social learning strategies. Social learning was detected for the most difficult tasks only, with huddling relations outside task introductions, and observation networks during task introductions, predicting social transmission. For the most difficult task only, individuals appeared to employ a social learning strategy of copying the most successful demonstrator observed. Results indicate that high social tolerance represents social learning opportunities and influences social learning processes. The reliance of Barbary macaques on social learning, and cues of model-success supports the costly information hypothesis. Our study provides more statistical evidence to the previous claims indicative of culture in macaques.
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Aprendizaje Social , Animales , Conducta Animal , Macaca , Aprendizaje , Conducta SocialRESUMEN
The factors that contribute to postoperative trismus after mandibulectomy and fibula free flap reconstruction (FFFR) are undefined. We retrospectively assessed postoperative trismus (defined as a maximum interincisal opening ≤35 mm) in 106 patients undergoing mandibulectomy with FFFR, employing logistic regression to identify risk factors associated with this sequela. The surgical indication was primary ablation in 64%, salvage for recurrence in 24%, and osteonecrosis in 12%. Forty-five percent of patients had existing preoperative trismus, and 58% of patients received adjuvant radiation/chemoradiation following surgery. The overall rates of postoperative trismus were 76% in the early postoperative period (≤3 months after surgery) and 67% in the late postoperative period (>6 months after surgery). Late postoperative trismus occurred more frequently in patients with ramus-involving vs. ramus-preserving posterior mandibulotomies (82% vs. 46%, p = 0.004). A ramus-involving mandibulotomy was the only variable significantly associated with trismus >6 months postoperatively on multivariable logistic regression (OR, 7.94; 95% CI, 1.85−33.97; p = 0.005). This work demonstrates that trismus is common after mandibulectomy and FFFR, and suggests that posterior mandibulotomies that involve or remove the ramus may predispose to a higher risk of persistent postoperative trismus.
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Modern phylogenetic methods are increasingly being used to address questions about macro-level patterns in cultural evolution. These methods can illuminate the unobservable histories of cultural traits and identify the evolutionary drivers of trait change over time, but their application is not without pitfalls. Here, we outline the current scope of research in cultural tree thinking, highlighting a toolkit of best practices to navigate and avoid the pitfalls and 'abuses' associated with their application. We emphasize two principles that support the appropriate application of phylogenetic methodologies in cross-cultural research: researchers should (1) draw on multiple lines of evidence when deciding if and which types of phylogenetic methods and models are suitable for their cross-cultural data, and (2) carefully consider how different cultural traits might have different evolutionary histories across space and time. When used appropriately phylogenetic methods can provide powerful insights into the processes of evolutionary change that have shaped the broad patterns of human history. This article is part of the theme issue 'Foundations of cultural evolution'.
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Antropología Cultural/métodos , Evolución Cultural , Evolución Biológica , Humanos , FilogeniaRESUMEN
XprG, a putative p53-like transcriptional activator, regulates production of extracellular proteases in response to nutrient limitation and may also have a role in programmed cell death. To identify genes that may be involved in the XprG regulatory pathway, xprG2 revertants were isolated and shown to carry mutations in genes which we have named sogA-C (suppressors of xprG). The translocation breakpoint in the sogA1 mutant was localized to a homolog of Saccharomyces cerevisiae VPS5 and mapping data indicated that sogB was tightly linked to a VPS17 homolog. Complementation of the sogA1 and sogB1 mutations and identification of nonsense mutations in the sogA2 and sogB1 alleles confirmed the identification. Vps17p and Vps5p are part of a complex involved in sorting of vacuolar proteins in yeast and regulation of cell-surface receptors in mammals. Protease zymograms indicate that mutations in sogA-C permit secretion of intracellular proteases, as in S. cerevisiae vps5 and vps17 mutants. In contrast to S. cerevisiae, the production of intracellular protease was much higher in the mutants. Analysis of serine protease gene expression suggests that an XprG-independent mechanism for regulation of extracellular protease gene expression in response to carbon starvation exists and is activated in the pseudorevertants.
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Aspergillus nidulans/genética , Aspergillus nidulans/metabolismo , Proteínas Portadoras/genética , Péptido Hidrolasas/metabolismo , Proteínas de Transporte Vesicular/genética , Aspergillus nidulans/enzimología , Espacio Extracelular/metabolismo , Proteínas Fúngicas/genética , Proteínas Fúngicas/fisiología , Regulación Enzimológica de la Expresión Génica , Regulación Fúngica de la Expresión Génica , Genes Fúngicos/fisiología , Espacio Intracelular/metabolismo , Metaloendopeptidasas/genética , Modelos Biológicos , Mutación/fisiología , Organismos Modificados Genéticamente , Péptido Hidrolasas/genética , Nexinas de ClasificaciónAsunto(s)
Organizaciones Responsables por la Atención , Costos de la Atención en Salud , Reforma de la Atención de Salud/economía , Calidad de la Atención de Salud , Organizaciones Responsables por la Atención/economía , Humanos , Evaluación de Resultado en la Atención de Salud , Satisfacción del Paciente , Calidad de la Atención de Salud/economía , Estados UnidosRESUMEN
It has been proposed that the uniqueness of human cumulative culture may be attributable to humans' greater orientation toward copying the process of behavior (imitation), as compared with the products (emulation), resulting in particularly high fidelity transmission. Following from previous work indicating that adult human participants can exhibit cumulative learning on the basis of product copying alone, we now investigate whether such learning involves high fidelity transmission. Eighty adult human (Homo sapiens) participants were presented with a task previously shown to elicit cumulative learning under experimental conditions, which involved building a tower from spaghetti and modeling clay. Each participant was shown two completed towers, ostensibly built by previous participants, but actually built to prespecified designs by the experimenter. This end state information was provided either in the form of photographs, or the presence of actual towers. High fidelity matching to these end states was apparent in both demonstration conditions, even for a design that was demonstrably suboptimal with regard to the goal of the task (maximizing tower height). We conclude that, although high fidelity transmission is likely to be implicated in cumulative culture, action copying is not always necessary for this to occur. Furthermore, since chimpanzees apparently copy behavioral processes and well as products, and also transmit behavior with high fidelity, the stark absence of unequivocal examples of cumulative culture in nonhumans may be attributable to factors other than imitative ability.
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Conducta Imitativa/fisiología , Aprendizaje/fisiología , Solución de Problemas/fisiología , Adolescente , Adulto , Evolución Cultural , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Conducta Social , Adulto JovenRESUMEN
OHTs are being introduced to provide a new way of organizing and delivering care that is more integrated from the perspective of the patients in their local communities, and that achieves measurable improvements in key quadruple-aim metrics of improving care experiences and health outcomes at manageable per capita costs and with positive provider experiences. This change requires significant adjustments to the way in which care is organized and provided, as well as the ways in which organizations and providers across the system interact with one another.
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Administración de Personal/tendencias , Sistemas de Salud/tendencias , Tutoría/métodosRESUMEN
In February 2019, the Government of Ontario revealed its plans to reform the Ontario health system. The plans include the amalgamation of the province's six provincial agencies (i.e., Cancer Care Ontario, Health Quality Ontario, eHealth Ontario, Trillium Gift of Life Network, Health Shared Services Ontario and HealthForceOntario Marketing and Recruitment Agency) and its 14 Local Health Integration Networks into one central agency responsible for planning, delivering and improving the quality of care in Ontario.(1) In addition, the province announced its intention to support the development of a number of Ontario Health Teams (OHTs), which would have providers and organizations work together in networks to deliver the