Action learning has evolved with multiple variants and a multiplicity of interpretations which have moved it away from Revans Classical Principles. This account of practice describes the use of an ...adapted action learning set within the legal profession with a specific focus on a 'provided' problem and collective reflective practice in the form of critical reflective questioning. Reformulating the classic action learning equation L (Learning) = P (Practice Knowledge) + Q (Questioning Insight) to L = P (Shared Experience of Practice) + (C)RQ (Critical Reflective Questioning), I reflect upon the way in which the participants engaged with this new approach and consider the adaptivity of action learning within professional legal practice.
A hallmark of participatory research is its ability to overcome power imbalances and empower its participants through a sharing of power and decision making from design to dissemination. However, ...that is not to say that such sharing of power and decision making is unproblematic. This brief reports on one such experience of problematic power dynamics set within the legal profession and reflexively considers the positionality of participants on the power balance continuum.
Managing complex psychiatric disorders like PTSD and bipolar disorder is challenging in Federally Qualified Health Centers (FQHCs) delivering care to U.S residents living in underserved rural areas. ...This protocol paper describes SPIRIT, a pragmatic comparative effectiveness trial designed to compare two approaches to managing PTSD and bipolar disorder in FQHCs.
Treatment comparators are: 1) Telepsychiatry Collaborative Care, which integrates consulting telepsychiatrists into primary care teams, and 2) Telepsychiatry Enhanced Referral, where telepsychiatrists and telepsychologists treat patients directly.
Because Telepsychiatry Enhanced Referral is an adaptive intervention, a Sequential, Multiple Assignment, Randomized Trial design is used. Twenty-four FQHC clinics without on-site psychiatrists or psychologists are participating in the trial. The sample is patients screening positive for PTSD and/or bipolar disorder who are not already engaged in pharmacotherapy with a mental health specialist. Intervention fidelity is measured but not controlled. Patient treatment engagement is measured but not required, and intent-to-treat analysis will be used. Survey questions measure treatment engagement and effectiveness. The Short-Form 12 Mental Health Component Summary (SF-12 MCS) is the primary outcome.
A third (34%) of those enrolled (n = 1004) are racial/ethnic minorities, 81% are not fully employed, 68% are Medicaid enrollees, 7% are uninsured, and 62% live in poverty. Mental health related quality of life (SF-12 MCS) is 2.5 standard deviations below the national mean.
We hypothesize that patients randomized to Telepsychiatry Collaborative Care will have better outcomes than those randomized to Telepsychiatry Enhanced Referral because a higher proportion will engage in evidence-based treatment.
The
MLL gene is frequently rearranged in acute human leukemia of both the myeloid and lymphoid lineages. Using a sensitive reverse transcriptase-polymerase chain reaction (RT-PCR) assay, we ...identified several abnormally spliced transcripts in which
MLL exons were joined in an order different from the genomic orientation (scrambled exons). Mis-splicing of
MLL was present in both normal and malignant tissues. Although the majority of these scrambled transcripts were joined accurately at consensus splice sites, there were several examples in which the junctions of exons spliced in aberrant order were at non-consensus sites. A number of features differentiate mis-splicing of
MLL from the previously described cases of scrambled exons and circular RNAs. Some scrambled transcripts appear to be present in the polyadenylated fraction of RNA. No correlation of exon scrambling with exon skipping was found, and there was no particular tendency for the exons involved to be near large introns. Our data show that splicing of
MLL is extremely complex. The presence of scrambled transcripts in both normal and leukemic cells, indistinguishable from transcripts resulting from genomic
MLL rearrangements, precludes the use of nested RT-PCR as a screening method for detection of tandem duplication of
MLL.
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