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The Photographic Collection of the Warburg Institute in London, where I had my first summer job in the 1980s, was then a little principality of its own. Situated on the [...]

ObjectiveThe patient-centered medical home (PCMH) includes comprehensive chronic illness and preventive services, including identifying patients who are overdue for colorectal cancer screening (CRCS). The association between PCMH implementation and CRCS during the Systems of Support to Increase Colorectal Cancer Screening Trial (SOS) is described.MethodsThe SOS enrolled 4664 patients from 21 clinics from August 2008 to November 2009. Patients were randomized to usual care, mailed fecal kits, kits plus brief assistance, or kits plus assistance and navigation. A PCMH model that included a workflow for facilitating CRCS was implemented at all study clinics in late 2009. Patients enrolled early had little exposure to the PCMH, whereas patients enrolled later were exposed during most of their first year in the trial. Logistic regression models were used to assess the association between PCMH exposure and CRCS.ResultsUsual care patients with ≥8 months in the PCMH had higher CRCS rates than those with ≤4 months in the PCMH (adjusted difference, 10.1%; 95% confidence interval, 5.7-14.6). SOS interventions led to significant increases in CRCS, but the magnitude of effect was attenuated by exposure to the PCMH (P for interaction = .01).ConclusionExposure to a PCMH was associated with higher CRCS rates. Automated mailed and centrally delivered stepped interventions increased CRCS rates, even in the presence of a PCMH.

Pattern formation originates during embryogenesis by a series of symmetry-breaking steps throughout an expanding cell lineage. In Drosophila, classic work has shown that segmentation in the embryo is established by morphogens within a syncytium, and the subsequent action of the gap, pair-rule, and segment polarity genes. This classic model however does not translate directly to species that lack a syncytium - such as Caenorhabditis elegans - where cell fate is specified by cell-autonomous cell lineage programs and their inter-signaling. Previous single-cell RNA-Seq studies in C. elegans have analyzed cells from a mixed suspension of cells from many embryos to study late differentiation stages, or individual early stage embryos to study early gene expression in the embryo. To study the intermediate stages of early and late gastrulation (28- to 102-cells stages) missed by these approaches, here we determine the transcriptomes of the 1- to 102-cell stage to identify 119 embryonic cell states during cell fate specification, including 'equivalence-group' cell identities. We find that gene expression programs are modular according to the sub-cell lineages, each establishing a set of stripes by combinations of transcription factor gene expression across the anterior-posterior axis. In particular, expression of the homeodomain genes establishes a comprehensive lineage-specific positioning system throughout the embryo beginning at the 28-cell stage. Moreover, we find that genes that segment the entire embryo in Drosophila have orthologs in C. elegans that exhibit sub-lineage-specific expression. These results suggest that the C. elegans embryo is patterned by a juxtaposition of distinct lineage-specific gene regulatory programs each with a unique encoding of cell location and fate. This use of homologous gene regulatory patterning codes suggests a deep homology of cell fate specification programs across diverse modes of development. [ABSTRACT FROM AUTHOR]

Animals are grouped into ~35 'phyla' based upon the notion of distinct body plans (1-4). Morphological and molecular analyses have revealed that a stage in the middle of development--known as [...]

Ascidian larvae develop after an invariant pattern of embryonic cleavage. Fewer than 400 cells constitute the larval central nervous system (CNS), which forms without either extensive migration or cell death. We catalogue the mitotic history of these cells in Ciona intestinalis, using confocal microscopy of whole-mount embryos at stages from neurulation until hatching. The positions of cells contributing to the CNS were reconstructed from confocal image stacks of embryonic nuclei, and maps of successive stages were used to chart the mitotic descent, thereby creating a cell lineage for each cell. The entire CNS is formed from 10th- to 14th-generation cells. Although minor differences exist in cell position, lineage is invariant in cells derived from A-line blastomeres, which form the caudal nerve cord and visceral ganglion. We document the lineage of five pairs of presumed motor neurons within the visceral ganglion: one pair arises from A/A 10.57, and four from progeny of A/A9.30. The remaining cells of the visceral ganglion are in their 13th and 14th generations at hatching, with most mitotic activity ceasing around 85% of embryonic development. Of the approximately 330 larval cells previously reported in the CNS of Ciona, we document the lineage of 226 that derive predominantly from A-line blastomeres. Keywords: Cell lineage; Apoptosis; Neurulation; Cell migration; Motor neurons; Neural plate; Ascidian A-line blastomeres

Background: The costs to healthcare systems of pressure ulcer (PU) prevention and management programmes remain high, and although PU risk assessment tools exist, they generally have poor predictive value. It has been demonstrated that PU are preceded by subtle tissue changes that are invisible to the naked eye before skin breakdown occurs. One such change is an increase in sub-epidermal moisture (SEM) which can be identified by biocapacitance. Aim: To investigate the effect of skin barrier cream on biocapacitance readings made with the SEM Scanner 200 (BBI LLC (CA, USA). Methods: SEM Scanner 200 delta readings were recorded on the heels and sacrums of healthy volunteers with and without barrier cream. This was a two part investigation. In part one participants had barrier cream applied to one heel (right) and not to the other (left). In part two participants were allocated into one of two groups-full application or partial application of barrier cream. Results: No difference in SEM delta values was observed in participants between the right and left heel. With sacral application there was a significant rise in SEM Scanner 200 readings when barrier cream was only applied to a small area compared to those with full coverage though this rapidly resolved with time and skin cleaning. Conclusions: Even distribution of barrier creams over scanned areas did not affect SEM readings though uneven application might adversely affect readings. [ABSTRACT FROM AUTHOR]