Records of Parochlus steinenii in the Maritime Antarctic and sub-Antarctic regions.

This study provides the summary of the reports of the geographical distribution in the Maritime Antarctic and sub-Antarctic regions of Parochlus steinenii (Gercke, 1889) (Diptera, Chironomidae), the only flying insect occurring naturally in the Antarctic continent. The distribution encompasses the South Shetland Islands (Maritime Antarctic), South Georgia (sub-Antarctic), and parts of the Cape Horn Biosphere Reserve (CHBR, southern Chile). In total 78 occurrence records were identified, 53 from our own records, 19 from the literature, and six from other data present in GBIF. Of the 78 records, 66 are from the South Shetland Islands, eight are from South Georgia, and four from the CHBR. This database was developed as one of the main objectives of two Chilean-funded research projects addressing understanding the effects of climate change on sub-Antarctic and Antarctic insects. It provides dataset documenting the distribution of Parochlus steinenii in the Maritime Antarctic, the sub-Antarctic, and the CHBR in southern South America (Chile). The complete dataset is available in Darwin Core Archive format via the Global Biodiversity Information Facility (GBIF).

Assessment of the utility of the National Health Service England Low Back and Radicular Pain Pathway: analysis of patient reported outcomes.

INTRODUCTION: Lumbar disc herniation causing radiculopathy is a common reason for referral to spinal out-patient clinics. At our centre following routine referral, patients wait a mean of 109 weeks for a consultation with a spinal surgeon. A pathway in keeping with the National Health Service England Low Back and Radicular Pain Pathway was introduced with two objectives. Patients would be seen sooner by suitably trained health care professionals to avoid long waiting times for assessment with a spinal surgeon, and if a set of criteria were met, they would receive a selective nerve root injection to manage their pain. METHODS: Patients were seen by specially trained orthopaedic physiotherapists following routine general practitioner (GP) referral. A radiologically guided nerve root injection was carried out if patients had radicular pain between 6 and 52 weeks duration and a magnetic resonance imaging (MRI) scan demonstrating an intervertebral disc prolapse correlating with their radicular symptoms. Patient-recorded outcome measures were taken before and after nerve root injection. RESULTS: Seventy five patients entered the pathway. Mean patient age was 49.9 years and 27 patients (36.0%) were male. Mean time from referral to assessment was 15.5 weeks. Mean visual analogue score (VAS) for leg pain was 7.4 out of 10 before nerve root injection and 4.8 out of 10 following nerve root injection (p < 0.001). Mean Oswestry Low Back Pain Disability Questionnaire score before nerve root injection was 58.4% and 49.7% following nerve root injection (p = 0.024). Mean Euroqol EQ-5D-5L Health Index was 0.2 before nerve root injection and 0.4 afterwards (p < 0.001). CONCLUSION: This study suggests that this pathway may help to reduce waiting times for patients with lumbar radiculopathy secondary to intervertebral disc prolapse. The resulting enhanced care may be associated with a reduction in leg and back pain and an improvement in quality of life.

The Leadership Gap: Supporting New Front line Leaders in Cancer Care.

INTRODUCTION: Although an individual may have gained considerable competence and skill in their specific discipline, it is unclear what resources are required for an experienced clinician to develop to a clinical leader. As a first step for many, front line leadership positions are often the only practical way to develop behaviors suited to more advanced leadership roles in health care. A new role requires impactful change in perspective that creates intensive learning opportunities for staff and an organization. Conversely, this transition may also represent risk to those failing to adjust to new behaviors and environment. A paucity of scholarly literature on this subject makes recommendations for best practice challenging, particularly in cancer care. The goals of this project were to understand the current state of leadership orientation in a single cancer center, while encouraging collaborative dialog to connect and engage stakeholders. METHODS: Qualitative data were collected using a focus group with novice leaders and individual interviews with experienced leaders at a single cancer center. Novice leadership was defined as less than 2 years in a management role and experienced leadership as greater than 2 years of experience. The collective narrative was coded to identify repeating indigenous ideas and phrases. Broader review explored the relationships between concepts and categories to reveal important themes. RESULTS: The narrative indicated that contributors understand the importance of support and guidance early in leadership development pathways. Additional findings revealed unmet expectations of novice leadership upon moving from individual clinical expert to front line leader and possible gaps in development support. Further examination of the data shows novice leaders are vulnerable and suggests that alongside didactic programming, peer support, mentorship, coaching with feedback, and project work underpin leadership development. CONCLUSIONS: This project revealed positive behaviors enhancing new leader assimilation and performance while presenting possible solutions for apparent gaps in organizational support. Recommendations include creation of harmonized programming to address competency development and self-directed learning, enhanced peer support networks with job shadowing opportunities, and heightened organizational awareness of leadership transition supports.

Sounding narrative medicine: studying students' professional identity development at Columbia University College of Physicians and Surgeons.

PURPOSE: To learn what medical students derive from training in humanities, social sciences, and the arts in a narrative medicine curriculum and to explore narrative medicine's framework as it relates to students' professional development. METHOD: On completion of required intensive, half-semester narrative medicine seminars in 2010, 130 second-year medical students at Columbia University College of Physicians and Surgeons participated in focus group discussions of their experiences. Focus group transcriptions were submitted to close iterative reading by a team who performed a grounded-theory-guided content analysis, generating a list of codes into which statements were sorted to develop overarching themes. Provisional interpretations emerged from the close and repeated readings, suggesting a fresh conceptual understanding of how and through what avenues such education achieves its goals in clinical training. RESULTS: Students' comments articulated the known features of narrative medicine--attention, representation, and affiliation--and endorsed all three as being valuable to professional identity development. They spoke of the salience of their work in narrative medicine to medicine and medical education and its dividends of critical thinking, reflection, and pleasure. Critiques constituted a small percentage of the statements in each category. CONCLUSIONS: Students report that narrative medicine seminars support complex interior, interpersonal, perceptual, and expressive capacities. Students' lived experiences confirm some expectations of narrative medicine curricular planners while exposing fresh effects of such work to view.

Ion channel transcript expression at the rabbit atrioventricular conduction axis.

BACKGROUND: Little is known about the distribution of gap junctions and ion channels in the atrioventricular node, even though the physiology and pathology of the atrioventricular node is ultimately dependent on them. METHODS AND RESULTS: The abundance of 30 transcripts for markers, gap junctions, ion channels, and Ca(2+)-handling proteins in different regions of the rabbit atrioventricular node (nodal extension and proximal and distal penetrating bundle of His as well as atrial and ventricular muscle) was measured using a novel quantitative polymerase chain reaction technique and in situ hybridization. The expression profile of the nodal extension (slow pathway into penetrating bundle) was similar to that of the sinoatrial node. For example, in the nodal extension, in contrast to the atrial muscle and as expected for a slowly conducting tissue with pacemaker activity, there was no or reduced expression of Cx43, Na(v)1.5, Ca(v)1.2, K(v)1.4, KChIP2, and RYR3 and high expression of Ca(v)1.3 and HCN4. The expression profile of the penetrating bundle was less specialized. In situ hybridization revealed a transitional zone with reduced expression of Cx43, Na(v)1.5, and KChIP2 that may form the fast pathway into the penetrating bundle. CONCLUSIONS: At the atrioventricular node, the expression of gap junctions and ion channels in the nodal extension (slow pathway) and a transitional zone (putative fast pathway) as well as the penetrating bundle (output pathway) is specialized and heterogeneous and roughly matches the electrophysiology of the different regions.

Differential expression of ion channel transcripts in atrial muscle and sinoatrial node in rabbit.

The aim of the study was to identify ion channel transcripts expressed in the sinoatrial node (SAN), the pacemaker of the heart. Functionally, the SAN can be divided into central and peripheral regions (center is adapted for pacemaking only, whereas periphery is adapted to protect center and drive atrial muscle as well as pacemaking) and the aim was to study expression in both regions. In rabbit tissue, the abundance of 30 transcripts (including transcripts for connexin, Na(+), Ca(2+), hyperpolarization-activated cation and K(+) channels, and related Ca(2+) handling proteins) was measured using quantitative PCR and the distribution of selected transcripts was visualized using in situ hybridization. Quantification of individual transcripts (quantitative PCR) showed that there are significant differences in the abundance of 63% of the transcripts studied between the SAN and atrial muscle, and cluster analysis showed that the transcript profile of the SAN is significantly different from that of atrial muscle. There are apparent isoform switches on moving from atrial muscle to the SAN center: RYR2 to RYR3, Na(v)1.5 to Na(v)1.1, Ca(v)1.2 to Ca(v)1.3 and K(v)1.4 to K(v)4.2. The transcript profile of the SAN periphery is intermediate between that of the SAN center and atrial muscle. For example, Na(v)1.5 messenger RNA is expressed in the SAN periphery (as it is in atrial muscle), but not in the SAN center, and this is probably related to the need of the SAN periphery to drive the surrounding atrial muscle.