Almost 50 million Americans have cumulatively borrowed more than
$1.5 trillion to attend college. Roughly one-third of all adults
aged 25 to 34 have a student loan. In Education without
Debt ...businessman and philanthropist Scott MacDonald examines
the real-life impact of crushing levels of student debt on
borrowers and what can be done to fix this crisis.
Weaving together stories of debt-impaired lives with stories of
personal success achieved with the essential help of financial aid,
MacDonald reveals the devastating personal and societal impact of
the debt problem and offers possible solutions. He explores the
efforts of colleges and private philanthropists to make education
affordable and relates his own experience of funding financial aid
for need-eligible students at five universities.
Education without Debt is a must-read book for anyone
concerned about the rising cost of education and what to do about
this critical policy and societal issue.
Neuroimaging has revealed a left-lateralized network of brain areas implicated in understanding the conceptual and sensorimotor aspects of tool perception and tool use. Often this network of areas is ...identified by contrasting brain activity when participants view pictures of tools vs. pictures of non-tools (e.g., animals or buildings). It is unclear, however, what aspect of tools drive activity in the tool network as both tools and non-tools tend to differ in their low-level features. For instance, areas in the tool network may simply activate to elongated objects or to handheld objects over round or ungraspable objects irrespective of object category. To test whether tools indeed drive activity in tool-selective areas over non-tools, participants passively viewed real tools and non-tools matched on low-level features during functional magnetic resonance imaging (fMRI). To maximize the potential for action, participants saw real-tools as opposed to pictures of tools. The non-tools were created by chopping the business ends of tools into pieces and attaching the pieces to both ends of the original tool handles. In doing so, the tools and non-tools were matched for elongation and real-world size. Importantly, tools and non-tools were viewed directly without the use of mirrors and placed within the participants' reach. Stimuli were presented at two opposite horizontal orientations to investigate whether areas that are selective for tools also show greater activation when the tool's handle is directed towards the hand as opposed to away from it. Our results showed that, even after the low-level differences between tools and non-tools were controlled, tools evoked more activation in the tool network as well as in sensorimotor areas. The orientation of the tool handles did not mediate effects within these sensorimotor areas. In sum, when we passively view tools, even without an intent to act, functional associations are automatically evoked and these associations are not specific to a particular hand.
•We examined human brain activation to real tools vs. scrambled versions.•Tool-selective activity was due to function not elongation nor real-world size.•Tool areas did not preferentially activate to different handle orientations.
Despite ongoing efforts aimed to improve treatment engagement for people with substance-related disorders, evidence shows modest rates of utilization as well as client-perceived barriers to care. ...Patient-centered care (PCC) is one widely recognized approach that has been recommended as an evidence-based practice to improve the quality of substance use disorder treatment. PCC includes four core principles: a holistic and individualized focus to care, shared decision-making and enhanced therapeutic alliance.
This scoping review aimed to explore which PCC principles have been described and how they have defined and measured among people with substance-related disorders.
Following the iterative stages of the Arksey and O'Malley scoping review methodology, empirical (from Medline, Embase, PsycINFO, CINAHL and ISI Web of Science) and grey literature references were eligible if they focused on people accessing treatment for substance-related disorders and described PCC. Two reviewers independently screened the title/abstract and full-texts of references. Descriptive analyses and a directed content analysis were performed on extracted data.
One-hundred and forty-nine references met inclusion from the 2951 de-duplicated references screened. Therapeutic alliance was the most frequent principle of PCC described by references (72%); this was consistently defined by characteristics of empathy and non-judgment. Shared decision-making was identified in 36% of references and was primarily defined by client and provider strategies of negotiation in the treatment planning process. Individualized care was described by 30% of references and included individualized assessment and treatment delivery efforts. Holistic care was identified in 23% of references; it included an integrated delivery of substance use, health and psychosocial services via comprehensive care settings or coordination. Substance use and treatment engagement outcomes were most frequently described, regardless of PCC principle.
This review represents a necessary first step to explore how PCC has been defined and measured for people accessing substance use disorder treatment. The directed content analysis revealed population and context-specific evidence regarding the defining characteristics of PCC-principles that can be used to further support the implementation of PCC.
In the current era of touchscreen technology, humans commonly execute visually guided actions directed to two-dimensional (2D) images of objects. Although real, three-dimensional (3D), objects and ...images of the same objects share high degree of visual similarity, they differ fundamentally in the actions that can be performed on them. Indeed, previous behavioral studies have suggested that simulated grasping of images relies on different representations than actual grasping of real 3D objects. Yet the neural underpinnings of this phenomena have not been investigated. Here we used functional magnetic resonance imaging (fMRI) to investigate how brain activation patterns differed for grasping and reaching actions directed toward real 3D objects compared to images. Multivoxel Pattern Analysis (MVPA) revealed that the left anterior intraparietal sulcus (aIPS), a key region for visually guided grasping, discriminates between both the format in which objects were presented (real/image) and the motor task performed on them (grasping/reaching). Interestingly, during action planning, the representations of real 3D objects versus images differed more for grasping movements than reaching movements, likely because grasping real 3D objects involves fine-grained planning and anticipation of the consequences of a real interaction. Importantly, this dissociation was evident in the planning phase, before movement initiation, and was not found in any other regions, including motor and somatosensory cortices. This suggests that the dissociable representations in the left aIPS were not based on haptic, motor or proprioceptive feedback. Together, these findings provide novel evidence that actions, particularly grasping, are affected by the realness of the target objects during planning, perhaps because real targets require a more elaborate forward model based on visual cues to predict the consequences of real manipulation.
Injectable opioid agonist treatment (iOAT) was designed as a pragmatic and compassionate approach for people who have not benefitted from medication assisted treatment with oral opioids (e.g., ...methadone). While, a substantial body of clinical trial evidence has demonstrated the safety and effectiveness of iOAT, considerably less is known about the patient-centered aspects of this treatment and their role in self-reported treatment goals and outcomes. The aim of this study was to explore participants' experiences in iOAT as they broadly relate to the domains of patient-centered care. A secondary goal was to explore how these experiences affected participants' self-reported treatment outcomes.
A qualitative methodology, and constructivist grounded theory approach, was used to guide sampling, data collection and analysis. A total of 30 in-depth interviews were conducted with people receiving iOAT in North America's first clinic. Audio-recordings for each semi-structured interview were transcribed and read repeatedly. The strategy of constant comparison was used through iterative stages of line-by-line, focused and theoretical coding until theoretical saturation was achieved.
"Building healthcare provider relationships for patient-centered care in iOAT" was the emergent core concept. Healthcare provider relationships were established through two interrelated processes: 'Opening up' was attributed to the positive environment, and to feeling understood and supported by healthcare providers. 'Being a part of care' emerged as participants felt safe to ask for what was needed and had opportunities to collaborate in treatment decisions. These processes established a foundation in which participants experienced care that was responsive to their individual dose, health and psychosocial needs.
The core concept suggested that therapeutic relationships were fundamental to experiences of patient-centered care in iOAT. When relationships were respectful and understanding, participants received individualized and holistic care in iOAT. These findings offer a valuable example of how therapeutic relationships can be strengthened in other substance use treatment settings, particularly when responding to the diverse treatment needs of clients.
American Ethnographic Film and Personal Documentary is a critical history of American filmmakers crucial to the development of ethnographic film and personal documentary. The Boston and Cambridge ...area is notable for nurturing these approaches to documentary film via institutions such as the MIT Film Section and the Film Study Center, the Carpenter Center and the Visual and Environmental Studies Department at Harvard. Scott MacDonald uses pragmatism’s focus on empirical experience as a basis for measuring the groundbreaking achievements of such influential filmmakers as John Marshall, Robert Gardner, Timothy Asch, Ed Pincus, Miriam Weinstein, Alfred Guzzetti, Ross McElwee, Robb Moss, Nina Davenport, Steve Ascher and Jeanne Jordan, Michel Negroponte, John Gianvito, Alexander Olch, Amie Siegel, Ilisa Barbash, and Lucien Castaing-Taylor. By exploring the cinematic, personal, and professional relationships between these accomplished filmmakers, MacDonald shows how a pioneering, engaged, and uniquely cosmopolitan approach to documentary developed over the past half century.
Neonatal herpes simplex virus (nHSV) infections often result in significant mortality and neurological morbidity despite antiviral drug therapy. Maternally transferred herpes simplex virus ...(HSV)-specific antibodies reduce the risk of clinically overt nHSV, but this observation has not been translationally applied. Using a neonatal mouse model, we tested the hypothesis that passive transfer of HSV-specific human mAbs can prevent mortality and morbidity associated with nHSV. The mAbs were expressed in vivo via vectored immunoprophylaxis or recombinantly. Through these maternally derived routes or through direct administration to pups, diverse mAbs to HSV glycoprotein D protected against neonatal HSV-1 and HSV-2 infection. Using in vivo bioluminescent imaging, both pre- and post-exposure mAb treatment significantly reduced viral load in mouse pups. Together these studies support the notion that HSV-specific mAb-based therapies could prevent or improve HSV infection outcomes in neonates.
Across different types of oral Opioid Agonist Treatment for people with Opioid Use Disorder, receiving a dose that meets their needs is associated with better outcomes. Evidence also shows patients ...are more likely to receive an "adequate dose" when their prescribers are involving them in decision making. Neither of these findings have been studied in the context of injectable Opioid Agonist Treatment, which is the purpose of this study.
This study was a retrospective analysis of an 18-month prospective longitudinal cohort study of 131 people receiving injectable Opioid Agonist Treatment. In the 18-month study, observations were collected every two months for one year, and then once more at 18 months. At 6 months, participants were asked whether their dose was satisfactory to them (outcome variable). Generalized Estimating Equations were used, to account for multiple observations from each participant. The final multivariate model was built using a stepwise approach.
Five hundred forty-five participant-observations were included in the analysis. Participant-observations were grouped by "dose is satisfactory" and "wants higher dose". From unadjusted analyses, participants were less likely to report being satisfied with their dose if they: were Indigenous, had worse psychological or physical health problems, had ever attempted suicide, were younger when they first injected any drug, were a current smoker, felt troubled by drug problems, gave their medication a lower "drug liking" score, and felt that their doctor was not including them in decisions the way they wanted to be. In the final multivariate model, all previously significant associations except for "current smoker" and "troubled by drug problems" were no longer significant after the addition of the "drug liking" score.
Patients in injectable Opioid Agonist Treatment who are not satisfied with their dose are more likely to: be troubled by drug problems, be a current smoker, and report liking their medication less than dose-satisfied patients. Prescribers' practicing shared decision-making can help patients achieve dose-satisfaction and possibly alleviate troubles from drug problems. Additionally, receiving a satisfactory dose may be dependent on patients being able to access an opioid agonist medication (and formulation) that they like.
In North America the opioid poisoning crisis currently faces the unprecedented challenges brought by the COVID-19 pandemic, further straining people and communities already facing structural and ...individual vulnerabilities. People with opioid use disorder (OUD) are facing unique challenges in response to COVID-19, such as not being able to adopt best practices (e.g., physical distancing) if they're financially insecure or living in shelters (or homeless). They also have other medical conditions that make them more likely to be immunocompromised and at risk of developing COVID-19. In response to the COVID-19 public health emergency, national and provincial regulatory bodies introduced guidance and exemptions to mitigate the spread of the virus. Among them, clinical guidance for prescribers were issued to allow take home opioid medications for opioid agonist treatment (OAT). Take Home for injectable opioid agonist treatment (iOAT) is only considered within a restrictive regulatory structure, specific to the pandemic. Nevertheless, this risk mitigation guidance allowed carries, mostly daily dispensed, to a population that would not have access to it prior to the pandemic. In this case it is presented and discussed that if a carry was possible during the pandemic, then the carry could continue post COVID-19 to address a gap in our approach to individualize care for people with OUD receiving iOAT.
Here we present the first case of a patient in Canada with long-term OUD that received take home injectable diacetylmorphine to self-isolate in an approved site after being diagnosed with COVID-19 during a visit to the emergency room where he was diagnosed with cellulitis and admitted to receive antibiotics.
In the present case we demonstrated that it is feasible to provide iOAT outside the community clinic with no apparent negative consequences. Improving upon and making permanent these recently introduced risk mitigating guidance during COVID-19, have the potential not just to protect during the pandemic, but also to address long-overdue barriers to access evidence-based care in addiction treatment.
Poly(ethylene glycol) (PEG) is a polymer used widely in drug delivery to create “stealth” nanoparticles (NPs); PEG coatings suppress NP detection and clearance by the immune system and beneficially ...increase NP circulation time in vivo. However, NP PEGylation typically obstructs cell attachment and uptake in vitro compared to the uncoated equivalent. Here, we report on a cationic liposome (CL) NP system loaded with the hydrophobic cancer drug paclitaxel (PTX) in which PEGylation (i.e., PEG-CLPTX NPs) unexpectedly enhances, rather than diminishes, delivery efficacy and cytotoxicity to human cancer cells. This highly unexpected enhancement occurs even when the PEG-chains coating the NP are in the transition regime between the mushroom and brush conformations. Cryogenic transmission electron microscopy (TEM) of PEG-CLPTX NPs shows that PEG causes the proliferation of a mixture of sterically stabilized nanometer-scale vesicles and anisotropic micelles (e.g., bicelles). Remarkably, the onset of bicelles at sub-monolayer concentrations of the PEG coat has to our knowledge not been previously reported; it was previously thought that PEG-lipid in this composition regime was incorporated into vesicles but did not alter their shape. Confocal microscopy and flow cytometry reveal significantly greater PTX cell uptake from stabilized PEG-CLPTX NPs (vesicles and bicelles) in contrast to bare CLPTX NPs, which can aggregate in cell medium. This underscores the ability of steric stabilization to facilitate NP entry into cells via distinct size-dependent endocytic pathways, some of which cannot transport large NP aggregates into cells. This study highlights the value of understanding how PEGylation alters NP shape and structure, and thus NP efficacy, to design next-generation stealth drug carriers that integrate active cell-targeting strategies into NPs for in vivo delivery.
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