The death of a family member affects not only individual family members but also their relationships and interactions. Grief has been studied mostly as an intrapersonal experience. Adopting the family perspective, this systematic scoping review focused on parent-child relationships in widowed families so as to identify what is already known on this topic and the research gaps for future study. The review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Four databases (Web of Science, Psycinfo, PubMed, and CINAHL Plus) were searched. Search terms were combinations of two concepts (1) loss of a parent (20 terms) and (2) parent-child (eight terms). 5,419 studies were identified during the search, of which 36 studies were included in the review following two rounds of screening. Four research themes emerged, and the aggregated findings were identified (a) The surviving parent and children are likely to become closer following the loss of a parent, while other relevant factors need to be taken into account; (b) Better parent-child relationships play a protective role in children's adjustment to loss; (c) The surviving parent and children's adjustment to loss are interdependent; (d) Through parenting, communication style, coping strategy, and other attributes, the surviving parent can influence their children's adjustment. Gender and age differences were identified in parent-child relationships. The findings further justify the importance of a family perspective when conducting research and practice on bereavement. Several research gaps were identified. https://www.selleckchem.com/products/ginkgolic-acid-s9432.html Existing studies paid insufficient attention to children's agency and bidirectional relationships, and the interaction process and its role underlying parent-child bidirectional causality. A conceptual framework of parent-child relationships in widowed families is proposed based on these findings.The impacts of woody encroachment and removal on ecosystems are highly variable and are thought to be related to the traits of the individual woody species. Decisions on whether to remove or to retain woody plants are hampered by a lack of empirical evidence of the relationship between woody traits and the ecosystem consequences of their removal or retention. We used a global meta-analysis of 149 ecosystem attributes from 172 woody species to evaluate the relative effects of woody plant traits and abiotic environmental variables on the ecosystem consequences of woody encroachment and removal. The ecosystem consequences were closely related to woody plant traits. For example, encroachment of plants characterized by high structural traits (e.g. tall, mixed tap and fibrous roots) reduced ecosystem composition, while removal of plants characterized by high functional traits (e.g. nitrogen fixing, deciduous) reduced ecosystem function. Structural and functional traits of woody plants mainly regulated soil stability during woody encroachment and herbaceous cover after woody removal. Conversely, environmental conditions mainly affected herbaceous cover under encroachment and soil stability under removal scenarios. We demonstrate that the ecosystem consequences of encroachment and removal are closely linked to the structural and functional traits of the target woody species. Furthermore, biotic (woody plant traits) and abiotic (climate, soils) factors have different impacts on regulating trade-offs between ecosystem responses under these two management scenarios. Our study provides empirical support for management decisions on whether to retain or remove different woody taxa under various environments across the globe.
To characterize physician health system membership in four states between 2012 and 2016 and to compare primary care quality and cost between in-system providers and non-system providers for the commercially insured population.

Physician membership in health systems was obtained from a unique longitudinal database on health systems and matched at the provider level to 2014 all-payer claims data from Colorado, Massachusetts, Oregon, and Utah.

Using an observational study design, we compared physicians in health systems to non-system physicians located in the same state and geography on average cost of care (risk-adjusted using the Johns Hopkins' Adjusted Clinical Grouper), five HEDIS quality measures, one measure of developmental screening, and two Prevention Quality Indicator Measures.

Patients in commercial health plans were attributed to a primary care physician accounting for the plurality of office visits. A cohort for each quality measure was constructed based on appropriate measure specificationsare of physicians is part of a health system from 2012 to 2016. Providers in health systems are not delivering primary care more efficiently than non-system providers for the commercially insured.
Uterine sarcomas can be grouped into tumours with pathognomonic genetic fusions such as low-grade endometrial stromal sarcoma (LGESS), high-grade endometrial stromal sarcoma (HGESS), and inflammatory myofibroblastic tumour (IMT), and tumours lacking genetic fusions such as leiomyosarcoma (LMS) and undifferentiated uterine sarcoma (UUS). Members of the latter group frequently harbour TP53 mutations. The aim of this study was to evaluate TP53 mutations by the use of immunohistochemistry in fusion-positive uterine sarcomas.

We performed p53 immunohistochemical staining on 124 uterine sarcomas harbouring genetic fusions and 38 fusion-negative LMSs and UUSs. These included 41 HGESSs with YWHAE, BCOR and BCORL1 fusions/rearrangements, 13 IMTs with ALK fusion, 12 sarcomas with NTRK1/3 fusion, three sarcomas with PDGFB fusion, and 55 LGESSs with JAZF1, SUZ12 and PHF1 fusions/rearrangements. All HGESSs, LGESSs, IMTs and sarcomas with PDGFB fusion showed wild-type p53 expression. Among NTRK1/3-positive sarcomas, a morphic round/ovoid cell histology, which may represent a mechanism of progression in these tumours.Anthracyclines are used to treat solid and haematological cancers, particularly breast cancers, lymphomas and childhood cancers. Myelosuppression and cardiotoxicity are the primary toxicities that limit treatment duration and/or intensity. Cardiotoxicity, particularly heart failure, is a leading cause of morbidity and mortality in cancer survivors. Cumulative anthracycline dose is a significant predictor of cardiotoxicity risk, suggesting a role for anthracycline pharmacokinetic variability. Population pharmacokinetic modelling in children has shown that doxorubicin clearance in the very young is significantly lower than in older children, potentially contributing to their higher risk of cardiotoxicity. A model of doxorubicin clearance based on body surface area and age offers a patient-centred dose-adjustment strategy that may replace the current disparate initial-dose selection tools, providing a rational way to compensate for pharmacokinetic variability in children aged less then 7 years. Population pharmacokinetic models in adults have not adequately addressed older ages, obesity, hepatic and renal dysfunction, and potential drug-drug interactions to enable clinical application.