Knowledge and Expectations of Support People in Prenatal Genetic Counseling Sessions

Prenatal genetic counseling patients have the ability to choose from a myriad of screening and diagnostic testing options, each with intricacies and caveats regarding accuracy and timing. Decisions regarding such testing can be difficult and are often made on the same day that testing is performed. Therefore, it is reasonable to consider that the support people brought to an appointment may have a role in the decision-making process. We aimed to better define this potential role by examining the incoming knowledge and expectations of support people who attended prenatal genetic counseling appointments. Support people were asked to complete a survey at one of seven Houston area prenatal clinics. The survey included questions regarding demographics, relationship to patient, incoming knowledge of the appointment, expectations of decision-making and perceived levels of influence over the decisions that would be made during the counseling session. The majority (79.4%) of the 252 participants were spouses/partners. Overall, there was poor knowledge of the referral indications with only 33.5% of participants correctly identifying the patient’s indication. Participants had even poorer knowledge of testing options that would be offered during the session, as only 17.7% were able to correctly identify testing options that would be discussed during the genetic counseling session. Of participants, just 3.6% said that they did not want to be included in discussions about screening/testing options. Only a few participants thought that they had less influence over decisions related to the pregnancy than over non-pregnancy decisions. Participants who reported feeling like they had a higher level of influence were likely to attend more of the pregnancy-related appointments with the patient. Findings from this study have provided insight into the perspective of support persons and have identified gaps in knowledge that may exist between the patients and the people they choose to bring with them into the genetic counseling session. In addition, this study is a starting point to assess how much the support people think that they impact the decision-making process of prenatal genetic counseling patients versus how much the prenatal patients value the input of the support people.

Use of a modified delphi process for establishing occupational exposure limits in support of health surveillance for space travelers

On-orbit exposures can come from numerous factors related to the space environment as evidenced by almost 50 years of environmental samples collected for water analysis, air analysis, radiation analysis, and physiologic parameters. For astronauts and spaceflight participants the occupational exposures can be very different from those experienced by workers performing similar tasks in workplaces on Earth, because the duration of the exposure could be continuous for very long orbital, and eventually interplanetary, missions. The establishment of long-term exposure standards is vital to controlling the quality of the spacecraft environment over long periods. NASA often needs to update and revise its prior exposure standards (Spacecrafts Maximum Allowable Concentrations (SMACs)). Traditional standards-setting processes are often lengthy, so a more rapid method to review and establish standards would be a substantial advancement in this area. This project investigates use of the Delphi method for this purpose. ^ In order to achieve the objectives of this study a modified Delphi methodology was tested in three trials executed by doctoral students and a panel of experts in disciplines related to occupational safety and health. During each test/trial modifications were made to the methodology. Prior to submission of the Delphi Questionnaire to the panel of experts a pilot study/trial was conducted using five doctoral students with the goals of testing and adjusting the Delphi questionnaire to improve comprehension, work out any procedural issues and evaluate the effectiveness of the questionnaire in drawing the desired responses. The remainder of the study consisted of two trials of the Modified Delphi process using 6 chemicals that currently have the potential of causing occupational exposures to NASA astronauts or spaceflight participants. To assist in setting Occupational Exposure Limits (OEL), the expert panel was established consisting of experts from academia, government and industry. Evidence was collected and used to create close-ended questionnaires which were submitted to the Delphi panel of experts for the establishment of OEL values for three chemicals from the list of six originally selected (trial 1). Once the first Delphi trial was completed, adjustments were made to the Delphi questionnaires and the process above was repeated with the remaining 3 chemicals (trial 2). ^ Results indicate that experience in occupational safety and health and with OEL methodologies can have a positive effect in minimizing the time experts take in completing this process. Based on the results of the questionnaires and comparison of the results with the SMAC already established by NASA, we conclude that use of the Delphi methodology is appropriate for use in the decision-making process for the selection of OELs.^

Intersystem Collaboration: A Statewide Initiative to Support Families

The study described in this paper utilized a qualitative case study method to assess the processes involved in inter-system collaboration in the context of one state's system change initiative. The collaborative experience is described from the perspective of participating service system professionals and family members. The major themes of collaboration that emerged from the study included changes in communication across systems, changes in inter-system relationships, changes in attitudes, changes in interactions with families, and changes in the ways services are delivered. Lessons learned and practice implications of each theme are discussed.

Promising Practices to Engage Families and Support Family Preservation

The Adoption and Safe Families Act of 1997 (ASFA) is the latest legislation in two decades of important child welfare policy in the United States. The Adoption and Safe Families Act has served to shorten the period of time that caseworkers and families have to show that families are making progress toward family preservation, with permanency decisions being made after 12 months, rather than 18. The importance of engaging and motivating families in services has therefore increased. The practice directive of ASFA can be summarized as 'Act Smart, Fast, and Accountable. " Using findings from largely correlational research, concrete recommendations are made to ensure that practices to preserve families are smart, fast, and accountable, particularly critical given these new timeframes.

Perceptions of institutional support of community -based participatory research within prevention research centers

The Institute of Medicine (IOM) report on the future of health care states that the focus on health needs to shift to the management and prevention of chronic illnesses and that academic health centers (AHCs) should play an active role in this process through community partnerships (IOM, 2002). Grant funding from the National Institutes of Health and the creation of the Centers for Disease Control and Prevention (CDC) Prevention Research Centers (PRC) across the county represent a transition toward more proactively seeking out community partnerships to better design and disseminate health promotion programs (Green, 2001). ^ The focus of the PRCs is to conduct rigorous, community-based, prevention research, to seek outcomes applicable to public health programs and policies. The PRCs work is to create and foster partnerships among public health and community organizations, to address health promotion and disease prevention issues (CDC, 2003). ^ The W.K. Kellogg Foundation defines CBPR as "a collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community health." ^ In 1995, CDC asked the IOM to review the PRC program to examine the extent to which the program is providing the public health community with strategies to address public health problems in disease prevention and health promotion (IOM, 1997). No comprehensive evaluation n of the individual PRCs had ever been done (IOM, 1997). ^ The CDC was interested in understanding how it could better support the PRC program through improved management and oversight to influence the program's success. The CDC only represents one of the entities that influence the success of a PRC. Another key entity to consider is the support of and influence of the Schools of Public Health in which the PRCs reside. Using evaluation criteria similar to those that were developed by the IOM, this study examined how aspects of structural capacity of the Schools of Public Health in which the PRCs reside are perceived to influence PRC community-based research activities. ^

Assessment of "mobile mapping system": A GIS-based support methodology

In this article, the authors examine the current status of different elements that integrate the landscape of the municipality of Olias del Rey in Toledo (Spain). A methodology for the study of rural roads, activity farming and local hunting management. We used Geographic Information Technologies (GIT) in order to optimize spatial information including the design of a Geographic Information System (GIS). In the acquisition of field data we have used vehicle "mobile mapping" instrumentation equipped with GNSS, LiDAR, digital cameras and odometer. The main objective is the integration of geoinformation and geovisualization of the information to provide a fundamental tool for rural planning and management.

A knowledge based framework to support active aging at home based environments

Information and Communication Technologies can support Active Aging strategies in a scenario like the Smart Home. This paper details a person centered distributed framework, called TALISMAN+, whose aim is to promote personal autonomy by taking advantage of knowledge based technologies, sensors networks, mobile devices and internet. The proposed solution can support an elderly person to keep living alone at his house without being obliged to move to a residential center. The framework is composed by five subsystems: a reasoning module that is able to take local decisions at home in order to support active aging, a biomedical variables telemonitorisation platform running on a mobile device, a hybrid reasoning middleware aimed to assess cardiovascular risk in a remote way, a private vision based sensor subsystem, and a secure telematics solution that guarantees confidentiality for personal information. TALISMAN+ framework deployment is being evaluated at a real environment like the Accessible Digital Home.

A model of economic management of cultural heritage: the rehabilitation of fort christmas as an interpretation center of defensive architecture of the Mediterranean in Cartagena (Spain)

The Cultural Heritage constitutes a way to generate social identities and play an important role in the development of the Spanish Mediterranean cities that opt to sustainable quality tourism. The reflection on the necessity of intervention on this heritage, in addition to establishing what should be done, brings up the need to define the reasons for taking action, why and what-for. These decisions are essential to establish if its maintenance and recovery are economically sustainable. The Project "Cartagena Port of Cultures", with support from the European Union, is an example of effective instrument for ensuring the sustainability of our built heritage conservation. Its main objective was to enable sustainable development of tourism in Cartagena based on sustainability and seasonality. This was achieved through a process of recovery of heritage resources and their optimum promotion and marketing.

Luz industrial e imagen tecnificada: de Moholy Nagy al C.A.V.S. (Center for Advanced Visual Studies)

El desarrollo de la tecnología de la luz implicará la transformación de la vida social, cultural y económica. Tanto las consideraciones espaciales del Movimiento Moderno, como los efectos producidos por la segunda Guerra Mundial, tendrán efectos visibles en las nuevas configuraciones espaciales y en la relación simbiótica y recíproca que se dará entre ideología y tecnología. La transformación en la comprensión de la articulación espacial, asociada al desarrollo tecnológico, afectará al modo en que este espacio es experimentado y percibido. El espacio expositivo y el espacio escénico se convertirán en laboratorio práctico donde desarrollar y hacer comprensible todo el potencial ilusorio de la luz, la proyección y la imagen, como parámetros modificadores y dinamizadores del espacio arquitectónico. Esta experimentación espacial estará precedida por la investigación y creación conceptual en el mundo plástico, donde los nuevos medios mecánicos serán responsables de la construcción de una nueva mirada moderna mediatizada por los elementos técnicos. La experimentación óptica, a través de la fotografía, el cine, o el movimiento de la luz y su percepción, vinculada a nuevos modos de representación y comunicación, se convertirá en elemento fundamental en la configuración espacial. Este ámbito de experimentación se hará patente en la Escuela de la Bauhaus, de la mano de Gropius, Schlemmer o Moholy Nagy entre otros; tanto en reflexiones teóricas como en el desarrollo de proyectos expositivos, arquitectónicos o teatrales, que evolucionarán en base a la tecnología y la modificación de la relación con el espectador. El espacio expositivo y el espacio escénico se tomarán como oportunidad de investigación espacial y de análisis de los modos de percepción, convirtiéndose en lugares de experimentación básicos para el aprendizaje. El teatro se postula como punto de encuentro entre el arte y la técnica, cobrando especial importancia la intersección con otras disciplinas en la definición espacial. Las múltiples innovaciones técnicas ligadas a los nuevos fundamentos teatrales en la modificación de la relación con la escena, que se producen a principios del siglo XX, tendrán como consecuencia la transformación del espacio en un espacio dinámico, tanto física como perceptivamente, que dará lugar a nuevas concepciones espaciales, muchas de ellas utópicas. La luz, la proyección y la creación de ilusión en base a estímulos visuales y sonoros, aparecen como elementos proyectuales efímeros e inmateriales, que tendrán una gran incidencia en el espacio y su modo de ser experimentado. La implicación de la tecnología en el arte conllevará modificaciones en la visualización, así como en la configuración espacial de los espacios destinados a esta. Destacaremos como propuesta el Teatro Total de Walter Gropius, en cuyo desarrollo se recogen de algún modo las experiencias espaciales y las investigaciones desarrolladas sobre la estructura formal de la percepción realizadas por Moholy Nagy, además de los conceptos acerca del espacio escénico desarrollados en el taller de Teatro de la Bauhaus por Oskar Schlemmer. En el Teatro Total, Gropius incorporará su propia visión de cuestiones que pertenecen a la tradición de la arquitectura teatral y las innovaciones conceptuales que estaban teniendo lugar desde finales del s.XIX, tales como la participación activa del público o la superación entre escena y auditorio, estableciendo en el proyecto una nueva relación perceptual entre sala, espectáculo y espectador; aumentando la sensación de inmersión, a través del uso de la física, la óptica, y la acústica, creando una energía concéntrica capaz de extenderse en todas direcciones. El Teatro Total será uno de los primeros ejemplos en los que desde el punto de partida del proyecto, se conjuga la imagen como elemento comunicativo con la configuración espacial. Las nuevas configuraciones escénicas tendrán como premisa de desarrollo la capacidad de transformación tanto perceptiva, como física. En la segunda mitad del s.XX, la creación de centros de investigación como el CAVS (The Center for Advanced Visual Studies,1967), o el EAT (Experiments in Art and Technology, 1966), favorecerán la colaboración interdisciplinar entre arte y ciencia, implicando a empresas de carácter tecnológico, como Siemens, HP, IBM o Philips, facilitando soporte técnico y económico para el desarrollo de nuevos sistemas. Esta colaboración interdisciplinar dará lugar a una serie de intervenciones espaciales que tendrán su mayor visibilidad en algunas Exposiciones Universales. El resultado será, en la mayoría de los casos, la creación de espacios de carácter inmersivo, donde se establecerá una relación simbiótica entre espacio, imagen, sonido, y espectador. La colocación del espectador en el centro de la escena y la disposición dinámica de imagen y sonido, crearán una particular narrativa espacial no lineal, concebida para la experiencia. Desde las primeras proyecciones de cine a la pantalla múltiple de los Eames, las técnicas espaciales de difusión del sonido en Stockhausen, o los experimentos con el movimiento físico interactivo, la imagen, la luz en movimiento y el sonido, quedan inevitablemente convertidos en material arquitectónico. ABSTRACT. Light technology development would lead to a social, cultural and economic transformation. Both spatial consideration of “Modern Movement” and Second World War effects on technology, would have a visible aftereffect on spatial configuration and on the symbiotic and mutual relationship between ideology & technology. Comprehension adjustment on the articulation of space together with technology development, would impact on how space is perceived and felt. Exhibition space and scenic space would turn into a laboratory where developing and making comprehensive all illusory potential of light, projection and image. These new parameters would modify and revitalize the architectonic space. as modifying and revitalizing parameters of architectonic space. Spatial experimentation would be preceded by conceptual creation and investigation on the sculptural field, where new mechanic media would be responsible for a fresh and modern look influenced by technical elements. Optical experimentation, through photography, cinema or light movement and its perception, would turn into essential components for spatial arrangement linked to new ways of performance and communication. This experimentation sphere would be clear at The Bauhaus School, by the hand of Gropius, Schlemmer or Moholy Nag among others; in theoretical, theatrical or architectural performance’s projects, that would evolve based on technology and also based on the transformation of the relationship with the observer. Exhibition and perfor-mance areas would be taken as opportunities of spatial investigation and for the analysis of the different ways of perception, thus becoming key places for learning. Theater is postulated as a meeting point between art and technique, taking on a new significance at its intersection with other disciplines working with spatial definition too. The multiple innovation techniques linked to the new foundations for the theater regarding stage relation, would have as a consequence the regeneration of the space. Space would turn dynamic, both physically and perceptibly, bringing innovative spatial conceptions, many of them unrealistic. Light, projection and illusory creation based on sound and visual stimulus would appear as intangible and momentary design components, which would have a great impact on the space and on the way it is experienced. Implication of technology in art would bring changes on the observer as well as on the spatial configuration of the art spaces2. It would stand out as a proposal Walter Groupis Total Theater, whose development would include somehow the spatial experiments and studies about formal structure of perception accomplished by Moholy Nagy besides the concepts regarding stage space enhanced at the Bauhaus Theater Studio by Oskar Schlemmer. Within Total Theater, Groupis would incorporate his own view about traditional theatric architecture and conceptual innovations that were taking place since the end of the nineteenth century, such as active audience participation or the diffusing limits between scene and audience, establishing a new perception relationship between auditorium, performance and audience, improving the feeling of immersion through the use of physics, optics and acoustics, creating a concentric energy capable of spreading in all directions. Total Theater would be one of the first example in which, from the beginning of the Project, image is combined as a communicating element with the spatial configuration. As a premise of development, new stage arrangement would have the capacity of transformation, both perceptive and physically. During the second half or the twentieth century, the creation of investigation centers such as CAVS (Center for Advanced Visual Studies, 1967) or EAT (Experiments in Art and Technology, 1966), would help to the interdisciplinary collaboration between art and science, involving technology companies like Siemens, HP, IBM or Philips, providing technical and economic support to the development of new systems. This interdisciplinary collaboration would give room to a series of spatial interventions which would have visibility in some Universal Exhibitions. The result would be, in most cases, the creation of immersive character spaces, where a symbiotic relationship would be stablished between space, image, sound and audience. The new location of the audience in the middle of the display, together with the dynamic arrangement of sound and image would create a particular, no lineal narrative conceived to be experienced. Since the first cinema projections, the multiple screen of Eames, the spatial techniques for sound dissemination at Stockhausen or the interactive physical movement experimentation, image, motion light and sound would turn inevitably into architectural material.

In Vivo Observations of Myosin II Dynamics Support a Role in Rear RetractionV⃞

To investigate myosin II function in cell movement within a cell mass, we imaged green fluorescent protein-myosin heavy chain (GFP-MHC) cells moving within the tight mound of Dictyostelium discoideum. In the posterior cortex of cells undergoing rotational motion around the center of the mound, GFP-MHC cyclically formed a “C,” which converted to a spot as the cell retracted its rear. Consistent with an important role for myosin in rotation, cells failed to rotate when they lacked the myosin II heavy chain (MHC−) or when they contained predominantly monomeric myosin II (3xAsp). In cells lacking the myosin II regulatory light chain (RLC−), rotation was impaired and eventually ceased. These rotational defects reflect a mechanical problem in the 3xAsp and RLC− cells, because these mutants exhibited proper rotational guidance cues. MHC− cells exhibited disorganized and erratic rotational guidance cues, suggesting a requirement for the MHC in organizing these signals. However, the MHC− cells also exhibited mechanical defects in rotation, because they still moved aberrantly when seeded into wild-type mounds with proper rotational guidance cues. The mechanical defects in rotation may be mediated by the C-to-spot, because RLC− cells exhibited a defective C-to-spot, including a slower C-to-spot transition, consistent with this mutant’s slower rotational velocity.

Mutagenesis of the peptidyltransferase center of 23S rRNA: the invariant U2449 is dispensable

U2449 is one of many invariant residues in the central loop of domain V of 23S rRNA, a region that constitutes part of the peptidyltransferase center of the ribosome. In Escherichia coli, this U is post-transcriptionally modified to dihydrouridine (D) and is the only D modification found in E.coli rRNAs. To analyze the role of this base and its modification in ribosomal function, all three base substitutions were constructed on a plasmid copy of the rrnB operon and assayed for their ability to support cell growth in a strain of E.coli lacking chromosomal rrn operons. Both purine substitution mutations were not viable. However, growth and antibiotic sensitivity of cells expressing only the mutant D2449C rRNA was indistinguishable from wild type. We conclude that while a pyrimidine is required at position 2449 for proper ribosomal function, the D modification is dispensable.

Minimal definition of the imprinting center and fixation of chromosome 15q11-q13 epigenotype by imprinting mutations.

Patients with disorders involving imprinted genes such as Angelman syndrome (AS) and Prader-Willi syndrome (PWS) can have a mutation in the imprinting mechanism. Previously, we identified an imprinting center (IC) within chromosome 15q11-ql3 and proposed that IC mutations block resetting of the imprint, fixing on that chromosome the parental imprint (epigenotype) on which the mutation arose. We now describe four new microdeletions of the IC, the smallest (6 kb) of which currently defines the minimal region sufficient to confer an AS imprinting mutation. The AS deletions all overlap this minimal region, centromeric to the PWS microdeletions, which include the first exon of the SNRPN gene. None of five genes or transcripts in the 1.0 Mb vicinity of the IC (ZNF127, SNRPN, PAR-5, IPW, and PAR-1), each normally expressed only from the paternal allele, was expressed in cells from PWS imprinting mutation patients. In contrast, AS imprinting mutation patients show biparental expression of SNRPN and IPW but must lack expression of the putative AS gene 250-1000 kb distal of the IC. These data strongly support a model in which the paternal chromosome of these PWS patients carries an ancestral maternal epigenotype, and the maternal chromosome of these AS patients carries an ancestral paternal epigenotype. The IC therefore functions to reset the maternal and paternal imprints throughout a 2-Mb imprinted domain within human chromosome 15q11-q13 during gametogenesis.

FMVSS 208 RM crash simulation support: a crash test of a 1986 Volkswagen Golf into a fixed 30 degree oblique barrier with a closing velocity of 48.4 kph. Test report.

Mode of access: Internet.

Final report of a 1990 Chevrolet Caprice into a 50% left offset barrier in support of CRASH3 damage algorithm reformulation. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

A 1993 Honda Civic CX into a 50% left offset barrier in support of CRASH3 damage algorithm reformulation. Final report.

National Highway Traffic Safety Administration, Washington, D.C.