Multidisciplinary teams, and parents, negotiating common ground in shared-care of children with long-term conditions: A mixed methods study

Background: Limited negotiation around care decisions is believed to undermine collaborative working between parents of children with long-term conditions and professionals, but there is little evidence of how they actually negotiate their respective roles. Using chronic kidney disease as an exemplar this paper reports on a multi-method study of social interaction between multidisciplinary teams and parents as they shared clinical care. Methods. Phases 1 and 2: a telephone survey mapping multidisciplinary teams' parent-educative activities, and qualitative interviews with 112 professionals (Clinical-psychologists, Dietitians, Doctors, Nurses, Play-specialists, Pharmacists, Therapists and Social-workers) exploring their accounts of parent-teaching in the 12 British children's kidney units. Phase 3: six ethnographic case studies in two units involving observations of professional/parent interactions during shared-care, and individual interviews. We used an analytical framework based on concepts drawn from Communities of Practice and Activity Theory. Results: Professionals spoke of the challenge of explaining to each other how they are aware of parents' understanding of clinical knowledge, and described three patterns of parent-educative activity that were common across MDTs: Engaging parents in shared practice; Knowledge exchange and role negotiation, and Promoting common ground. Over time, professionals had developed a shared repertoire of tools to support their negotiations with parents that helped them accomplish common ground during the practice of shared-care. We observed mutual engagement between professionals and parents where a common understanding of the joint enterprise of clinical caring was negotiated. Conclusions: For professionals, making implicit knowledge explicit is important as it can provide them with a language through which to articulate more clearly to each other what is the basis of their intuition-based hunches about parents' support needs, and may help them to negotiate with parents and accelerate parents' learning about shared caring. Our methodology and results are potentially transferrable to shared management of other conditions. © 2013 Swallow et al.; licensee BioMed Central Ltd

LHC Discovery Potential for Non-Standard Higgs Bosons in the 3b Channel

In a variety of well motivated models, such as two Higgs Doublet Models (2HDMs) and the Minimal Supersymmetric Standard Model (MSSM), there are neutral Higgs bosons that have significantly enhanced couplings to b-quarks and tau leptons in comparison to those of the SM Higgs. These so called non-standard Higgs bosons could be copiously produced at the LHC in association with b quarks, and subsequently decay into b-quark pairs. However, this production channel suffers from large irreducible QCD backgrounds. We propose a new search strategy for non-standard neutral Higgs bosons at the 7 TeV LHC in the 3b's final state topology. We perform a simulation of the signal and backgrounds, using state of the art tools and methods for different sets of selection cuts, and conclude that neutral Higgs bosons with couplings to b-quarks of about 0.3 or larger, and masses up to 400 GeV, could be seen with a luminosity of 30 fb^{-1}. In the case of the MSSM we also discuss the complementarity between the 3b channel and the inclusive tau pair channel in exploring the supersymmetric parameter space.Comment: 14 pages, 3 figures, 4 tables, references added, published versio

Excluding Electroweak Baryogenesis in the MSSM

In the context of the MSSM the Light Stop Scenario (LSS) is the only region of parameter space that allows for successful Electroweak Baryogenesis (EWBG). This possibility is very phenomenologically attractive, since it allows for the direct production of light stops and could be tested at the LHC. The ATLAS and CMS experiments have recently supplied tantalizing hints for a Higgs boson with a mass of ~ 125 GeV. This Higgs mass severely restricts the parameter space of the LSS, and we discuss the specific predictions made for EWBG in the MSSM. Combining data from all the available ATLAS and CMS Higgs searches reveals a tension with the predictions of EWBG even at this early stage. This allows us to exclude EWBG in the MSSM at greater than (90) 95% confidence level in the (non-)decoupling limit, by examining correlations between different Higgs decay channels. We also examine the exclusion without the assumption of a ~ 125 GeV Higgs. The Higgs searches are still highly constraining, excluding the entire EWBG parameter space at greater than 90% CL except for a small window of m_h ~ 117 - 119 GeV.Comment: 24 Pages, 4 Figures (v3: fixed typos, minor corrections, added references

The Evolution of Compact Binary Star Systems

We review the formation and evolution of compact binary stars consisting of white dwarfs (WDs), neutron stars (NSs), and black holes (BHs). Binary NSs and BHs are thought to be the primary astrophysical sources of gravitational waves (GWs) within the frequency band of ground-based detectors, while compact binaries of WDs are important sources of GWs at lower frequencies to be covered by space interferometers (LISA). Major uncertainties in the current understanding of properties of NSs and BHs most relevant to the GW studies are discussed, including the treatment of the natal kicks which compact stellar remnants acquire during the core collapse of massive stars and the common envelope phase of binary evolution. We discuss the coalescence rates of binary NSs and BHs and prospects for their detections, the formation and evolution of binary WDs and their observational manifestations. Special attention is given to AM CVn-stars -- compact binaries in which the Roche lobe is filled by another WD or a low-mass partially degenerate helium-star, as these stars are thought to be the best LISA verification binary GW sources.Comment: 105 pages, 18 figure

Family involvement and firms’ establishment mode choice in foreign markets

Extant literature on foreign entry increasingly recognizes firms’ heterogeneity as a potential reason for inconsistency in results on the establishment mode choice, i.e. whether and under which conditions firms should choose to enter a new country through a greenfield investment or an acquisition. Our study contributes to this debate by identifying family ownership and family involvement in management as potential powerful sources of such heterogeneity. Integrating international business studies with both corporate finance literature on family firms and recent contributions from the Socio Emotional Wealth perspective on family ownership, we claim that, due to greater risk aversion and lower access to information, the family involvement either in the firm ownership and management leads to a higher propensity towards greenfield initiatives (vs. acquisitions). However, we also find that such a propensity decreases with international experience especially in family-owned firms given the greater ability of professionalized management to overcome family-related concerns on making acquisitions. Our analysis on 1,045 foreign initiatives undertaken by 311 Italian family and non-family firms between 2003 and 2013 confirms our expectations – indicating family ownership as a significant driver of international business choices

Panel 6 : Vaccines

Objective. To review the literature on progress regarding (1) effectiveness of vaccines for prevention of otitis media (OM) and (2) development of vaccine antigens for OM bacterial and viral pathogens. Data Sources. PubMed database of the National Library of Science. Review Methods. We performed literature searches in PubMed for OM pathogens and candidate vaccine antigens, and we restricted the searches to articles in English that were published between July 2011 and June 2015. Panel members reviewed literature in their area of expertise. Conclusions. Pneumococcal conjugate vaccines (PCVs) are somewhat effective for the prevention of pneumococcal OM, recurrent OM, OM visits, and tympanostomy tube insertions. Widespread use of PCVs has been associated with shifts in pneumococcal serotypes and bacterial pathogens associated with OM, diminishing PCV effectiveness against AOM. The 10-valent pneumococcal vaccine containing Haemophilus influenzae protein D (PHiD-CV) is effective for pneumococcal OM, but results from studies describing the potential impact on OM due to H influenzae have been inconsistent. Progress in vaccine development for H influenzae, Moraxella catarrhalis, and OM-associated respiratory viruses has been limited. Additional research is needed to extend vaccine protection to additional pneumococcal serotypes and other otopathogens. There are likely to be licensure challenges for protein-based vaccines, and data on correlates of protection for OM vaccine antigens are urgently needed. Implications for Practice. OM continues to be a significant health care burden globally. Prevention is preferable to treatment, and vaccine development remains an important goal. As a polymicrobial disease, OM poses significant but not insurmountable challenges for vaccine development.Peer reviewe

High-resolution analysis of HLA class I alterations in colorectal cancer

BACKGROUND: Previous studies indicate that alterations in Human Leukocyte Antigen (HLA) class I expression are frequent in colorectal tumors. This would suggest serious limitations for immunotherapy-based strategies involving T-cell recognition. Distinct patterns of HLA surface expression might conceal different immune escape mechanisms employed by the tumors and are worth further study. METHOD: We applied four-color multiparameter flow cytometry (FCM), using a large panel of alloantigen-specific anti-HLA-A and -B monoclonal antibodies, to study membranous expression of individual HLA alleles in freshly isolated colorectal cancer cell suspensions from 21 patients. RESULTS: Alterations in HLA class I phenotype were observed in 8 (38%) of the 21 tumors and comprised loss of a single A or B alleles in 4 cases, and loss of all four A and B alleles in the other 4 cases. Seven of these 8 tumors were located on the right side of the colon, and those showing loss of both HLA-A and -B membranous expression were all of the MSI-H phenotype. CONCLUSION: FCM allows the discrimination of complex phenotypes related to the expression of HLA class I. The different patterns of HLA class I expression might underlie different tumor behavior and influence the success rate of immunotherapy

Binarity at LOw Metallicity (BLOeM) The multiplicity properties and evolution of BAF-type supergiants

\ua9 The Authors 2025. Given the uncertain evolutionary status of blue supergiant stars, their multiplicity properties hold vital clues to better understand their origin and evolution. As part of The Binarity at LOw Metallicity (BLOeM) campaign in the Small Magellanic Cloud, we present a multi-epoch spectroscopic survey of 128 supergiant stars of spectral type B5–F5, which roughly correspond to initial masses in the 6–30 M range. The observed binary fraction for the B5–9 supergiants is 25 \ub1 6% (10 \ub1 4%) and 5 \ub1 2% (0%) for the A–F stars, which were found using a radial-velocity (RV) variability threshold of 5 km s−1 (10 km s−1) as a criterion for binarity. Accounting for observational biases, we find an intrinsic multiplicity fraction of less than 18% for the B5–9 stars and 8+−97% for the AF stars, for the orbital periods up to 103.5 days and mass ratios (q) in the 0.1 < q < 1 range. The large stellar radii of these supergiant stars prevent short orbital periods, but we demonstrate that this effect alone cannot explain our results. We assessed the spectra and RV time series of the detected binary systems and find that only a small fraction display convincing solutions. We conclude that the multiplicity fractions are compromised by intrinsic stellar variability, such that the true multiplicity fraction may be significantly smaller. Our main conclusions from comparing the multiplicity properties of the B5–9- and AF-type supergiants to that of their less evolved counterparts is that such stars cannot be explained by a direct evolution from the main sequence. Furthermore, by comparing their multiplicity properties to red supergiant stars, we conclude that the AF supergiant stars are neither progenitors nor descendants of red supergiants