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The purpose of this exploratory study was to develop a preliminary understanding of the influence of state-level contextual factors predictive of employment outcomes for the U.S. State/Federal Vocational Rehabilitation System (State VR) participants with traumatic brain injury (TBI). Participants were 5,213 individuals with TBI with Individualized Plans for Employment closed during federal Fiscal Year 2016. A four-step hierarchical logistic regression model (5.6% explained variance) containing five demographic, three state-level economic, six state TBI service climate, and nine State VR service variable expenditures correctly classified 57.0% of cases as attaining or not attaining an employment outcome at closure. Significant predictors associated with an employment closure were (a) education, veteran status, and presence of a secondary area of disability impairment; (b) state-level per-capita income; (c) State VR specialized acquired brain injury (ABI)/TBI service and state TBI Implementation Partnership grant funding; and (d) State VR service expenditures on diagnosis and treatment, occupational or vocational training, on-the-job training, job readiness training, transportation, maintenance support, and benefits counseling. The practice, policy, and research implications of these findings are presented.

RAC1 is a highly conserved Rho GTPase critical for many cellular and developmental processes. De novo missense RAC1 variants cause a highly variable neurodevelopmental disorder. Some of these variants have previously been shown to have a dominant negative effect. Most previously reported patients with this disorder have either severe microcephaly or severe macrocephaly. Here, we describe eight patients with pathogenic missense RAC1 variants affecting residues between Q61 and R68 within the switch II region of RAC1. These patients display variable combinations of developmental delay, intellectual disability, brain anomalies such as polymicrogyria and cardiovascular defects with normocephaly or relatively milder micro- or macrocephaly. Pulldown assays, NIH3T3 fibroblast spreading assays and staining for activated PAK1/2/3 and WAVE2 suggest that these variants increase RAC1 activity and over-activate downstream signalling targets. Axons of neurons isolated from Drosophila embryos expressing the most common of the activating variants are significantly shorter, with an increased density of filopodial protrusions. In vivo, these embryos exhibit frequent defects in axonal organization. Class IV dendritic arborization neurons expressing this variant exhibit a significant reduction in the total area of the dendritic arbour, increased branching and failure of self-avoidance. RNAi knock down of the WAVE regulatory complex component Cyfip significantly rescues these morphological defects. These results establish that activating substitutions affecting residues Q61–R68 within the switch II region of RAC1 cause a developmental syndrome. Our findings reveal that these variants cause altered downstream signalling, resulting in abnormal neuronal morphology and reveal the WAVE regulatory complex/Arp2/3 pathway as a possible therapeutic target for activating RAC1 variants. These insights also have the potential to inform the mechanism and therapy for other disorders caused by variants in genes encoding other Rho GTPases, their regulators and downstream effectors.

Objective Growing use of clinical exome sequencing (CES) has led to an increased burden of genomic education. Self-guided educational tools can minimize the educational burden for genetic counselors (GCs). The effectiveness of these tools must be evaluated. Methods Parents of patients offered CES were randomized to watch educational videos before their visit or to receive routine care. Parents and GCs were surveyed about their experiences following the sessions. The responses of the video (n = 102) and no-video (n = 105) groups were compared. Results GCs reported no significant differences between parents in the video and no-video groups on genetics knowledge or CES knowledge. In contrast, parents’ scores on genetics knowledge questions were lower in the video than no-video group (p = 0.007). Most parents reported the videos were informative, and the groups did not differ in satisfaction with GCs or decisions to have CES. Conclusion GCs and parents perceived the videos to be beneficial. However, lower scores on genetics knowledge questions highlight the need for careful development of educational tools. Practice implications Educational tools should be developed and assessed for effectiveness with the input of all stakeholders before widespread implementation. Better measures of the effectiveness of these educational tools are needed.

Speculative fiction, through its explicit engagement with possible futures of the present world, represents a unique opportunity for writers and readers to connect present-day cultural concerns to possible futures. Speculative fiction allows authors to set characters in worlds created by misguided values present in the world of the reader, providing a platform to “break” and remake that world through critique. By examining not just the world that an author has created but also the trajectory of its creation, we can gain insight into the author's understanding of how religion and politics interact and impact history. Using works from Orson Scott Card's Ender's Game canon as a case study, this article argues that speculative fiction can serve as a vehicle for cultural values and is thus useful to historians of American religion.

Objectives We report a case of discordant total and free testosterone values in a patient with hypogonadism and juvenile hypophosphatasia after he initiated treatment with asfotase alfa, recombinant tissue non-specific alkaline phosphatase. Methods Total testosterone was evaluated using immunoassay pre and post initiation of therapy with asfotase alfa, and free testosterone was evaluated using radioimmunoassay and LC-MS/MS while on asfotase alfa therapy. Results Total testosterone measured by immunoassay was normal prior to therapy with asfotase alfa, and was low post initiation of therapy. During the same time frame, free testosterone measured using RAI and total testosterone measured using LC-MS/MS were normal on asfotase alfa therapy. This suggests assay interference with the total testosterone immunoassay. Conclusion When laboratory results are discordant or do not match the clinical impression, the possibility of assay interference should be considered. Alternative laboratory methods free of the interference should be selected to evaluate these patients. Human genes discussed in the paper ALPL gene, Approved name: Alkaline phosphatase, liver/bone/kidney, Synonym: Tissue non-specific alkaline phosphatase (TNSAP).

The dramatic rise in the prevalence of obesity and diabetes is associated with increased morbidity, mortality, and public health care costs worldwide. The need for new, effective, and long-lasting drugs is urgent. Recent research has focused on the role of the inhibitors of sodium- glucose co-transporter 2 (SGLT-2). Clinical trials have shown that SGLT-2 inhibitors have glycemic efficacy and weight-lowering potential. Dual drug therapy is a recommended therapy for patients with new-onset type 2 diabetes who need significant glycemic control. Fixed-dose combination therapy represents a particularly attractive option as it may reduce pill burden and improve adherence. The combination of metformin and empagliflozin was approved by the US Food and Drug Administration in 2014 and represents a safe and effective means to combat glycemic control and weight gain. The purpose of this systematic review is to summarize the background of the SGLT-2 inhibitors, particularly empagliflozin, and focus on the safety and efficacy of the fixed-dose combination of empagliflozin and metformin.

Physicians play a vital and important role in newborn hearing screening programs (NHSPs) and early hearing detection and intervention programs (EHDIPs). The information that physicians convey to parents of infants suspected of having hearing loss and the enthusiasm with which they make referrals for audiological services can greatly affect whether children are seen in a timely manner or are lost to follow-up and the perceptions of parents and others of these programs, which ultimately contributes to their overall success. It is essential that physicians have the most current and accurate knowledge of the Joint Committee on Infant Hearing Year 2007 Position Statement guidelines for screening, diagnosing, and intervening with hearing losses in children. Therefore, it is important to monitor these programs and their individual team members, especially physicians, at national, state, and local levels. This study used a systematic review as part of an evidence-based practice process to determine what types of information physicians might need to enhance their participation in NHSPs and EHDIPs. The results revealed that physicians could benefit from having additional information about this subject. Audiologists and their professional organizations should conduct physician outreach efforts to remind physicians of the important role they play in these programs and provide them with basic knowledge and updates in desired formats that meet their busy schedules. Such outreach efforts could strengthen relationships among team members, enhance the success of NHSPs and EHDIPs, and benefit all stakeholders (infants, families, physicians, and audiologists). Effective physician outreach efforts should help ensure that infants with hearing loss and their families receive necessary and appropriate diagnostic and intervention services in the most efficacious manner.

PurposeThe purpose of this paper is to propose and support a model to predict the effectiveness of teams.Design/methodology/approachThe literature provides a wide variety of variables or constructs to measure the effectiveness of a team. The article proposes a mathematical model to predict the effectiveness of a team. A priori comparisons are used to develop a mathematical model of the optimum team.FindingsThe study expands on the theory of team effectiveness and demonstrates that a theoretically developed empirical model can predict team effectiveness quantitatively. A mathematical model was developed as an empirical function of performance, behavior, attitude, team member style and corporate culture.Research limitations/implicationsThere has been little effort to standardize the measurable variables of team effectiveness. Additionally, the means to evaluate the individual's influence on team effectiveness has not been documented in relation to the effectiveness of the team. This paper uses a specific set of constructs, which might be the optimum set of variables to measure performance, behavior, and attitude.Practical implicationsBy considering the model suggested here, managers will be able to select individual team members to enhance team performance.Originality/valueFew models have been proposed to predict the effectiveness of a team based on team member selection. This model provides anyone selecting team members with a model to use when choosing among technically qualified candidates.

International students have realistic expectations about their adjustment to college, however, they seem to experience a more difficult transition than U.S. students. Scores on the Student Adaptation to College Questionnaire for international and U.S. students are compared. The results indicated that international students scored significantly lower on the social and the institutional attachment and goal commitment subscales. The Student Adaptation to College Questionnaire may have applications in targeting international student needs.

Intramural duodenal hematoma is a rare cause of a proximal gastrointestinal tract obstruction. Presentation of intramural duodenal hematoma most often occurs following blunt abdominal trauma in children, but spontaneous non-traumatic cases have been linked to anticoagulant therapy, pancreatitis, malignancy, vasculitis and endoscopy. We report an unusual case of spontaneous intramural duodenal hematoma presenting as an intestinal obstruction associated with acute pancreatitis in a patient with established von Willebrand disease, type 2B. The patient presented with abrupt onset of abdominal pain, nausea, and vomiting. Computed tomography imaging identified an intramural duodenal mass consistent with blood measuring 4.7 cm × 8.7 cm in the second portion of the duodenum abutting on the head of the pancreas. Serum lipase was 3828 units/L. Patient was managed conservatively with bowel rest, continuous nasogastric decompression, total parenteral nutrition, recombinant factor VIII (humateP) and transfusion. Symptoms resolved over the course of the hospitalization. This case highlights an important complication of an inherited coagulopathy.

Lipophilic phosphonium cations were first used to investigate mitochondrial biology by Vladimir Skulachev and colleagues in the late 1960s. Since then, these molecules have become important tools for exploring mitochondrial bioener getics and free radical biology. Here we review why these molecules are useful in mitochondrial research and outline some of the ways in which they are now being utilized.