bluuebunny/crossref_metadata_2025 huggingface dataset:
B Chromosome Diversity and Repetitive Sequence Distribution in an Isolated Population of Akodon montensis (Rodentia, Sigmodontinae)
Authors: Soares Amanda A. , Castro Jonathan P. , Balieiro Pedro , Dornelles Sidnei , Degrandi Tiago M. , Sbalqueiro Ives J. , Ferreira Artoni Roberto , Hass Iris
Published: March 2018

B chromosomes are supernumerary chromosomes found in the karyotypes of approximately 15% of all eukaryotic species. They present parasitic behavior and do not follow the standard Mendelian pattern of inheritance, resulting in an imbalance in gametogenesis. The evolutionary dynamics of B chromosomes is still unknown for many species, but studies indicate that the accumulation of repetitive sequences plays an important role in the differentiation of these elements. We analyzed morphology, frequency, and possible homologies amongst different B chromosomes found in an isolated Akodon montensis population in southern Brazil. Repetitive sequences (18S, 5S rDNA and telomeric sequences) were used to test for their accumulation on the supernumerary chromosomes and describe their localization in the species. The results indicate 4 different B chromosome morphotypes, and DNA libraries were generated for 3 of them. 18S rDNA was labelled polymorphically, except in the B chromosomes, whereas the 5S rDNA was located exclusively in an interstitial position on the long arm of chromosome 5. Chromosome painting with the B probes based on FISH revealed a homologous composition for all B chromosome morphotypes and no homology with the chromosomes in the A complement. B chromosomes found in this population may have a common origin and subsequently diversified in size and morphology.
A Novel PTCH1 Frameshift Mutation Leading to Nevoid Basal Cell Carcinoma Syndrome
Authors: Durmaz Ceren D. , Evans Gareth , Smith Miriam J. , Ertop Pelin , Akay Bengü N. , Tuncalı Timur
Published: March 2018

Nevoid basal cell carcinoma syndrome (NBCCS), also known as Gorlin syndrome, is a rare multisystemic autosomal dominant disorder typically presenting with cutaneous basal cell carcinomas, multiple keratocysts, and skeletal anomalies. NBCCS is caused by heterozygous mutations in the PTCH1 gene in chromosome 9q22, in the PTCH2 gene in 1p34, or the SUFU gene in 10q24.32. Here, we report on an 18-month-old boy presenting with medulloblastoma, frontal bossing, and multiple skeletal anomalies and his father who has basal cell carcinomas, palmar pits, macrocephaly, bifid ribs, calcification of falx cerebri, and a history of surgery for odontogenic keratocyst. These clinical findings were compatible with the diagnosis of NBCCS, and a novel mutation, c.1249delC; p.Gln417Lysfs*15, was found in PTCH1 causing a premature stop codon.
Pim-1 Kinase Phosphorylates Cardiac Troponin I and Regulates Cardiac Myofilament Function
Authors: Zhu Ni , Yi Bing , Guo Zhifu , Zhang Guanxin , Huang Shengdong , Qin Yongwen , Zhao Xianxian , Sun Jianxin
Published: March 2018

Background/Aims: Pim-1 is a serine/threonine kinase that is highly expressed in the heart, and exerts potent cardiac protective effects through enhancing survival, proliferation, and regeneration of cardiomyocytes. Its myocardial specific substrates, however, remain unknown. In the present study, we aim to investigate whether Pim-1 modulates myofilament activity through phosphorylation of cardiac troponin I (cTnI), a key component in regulating myofilament function in the heart. Methods: Coimmunoprecipitation and immunofluorescent assays were employed to investigate the interaction of Pim-1 with cTnI in cardiomyocytes. Biochemical, site directed mutagenesis, and mass spectrometric analyses were utilized to identify the phosphorylation sites of Pim1 in cTnI. Myofilament functional assay using skinned cardiac fiber was used to assess the effect of Pim1-mediated phosphorylation on cardiac myofilament activity. Lastly, the functional significance of Pim1-mediated cTnI in heart disease was determined in diabetic mice. Results: We found that Pim-1 specifically interacts with cTnI in cardiomyocytes and this interaction leads to Pim1-mediated cTnI phosphorylation, predominantly at Ser23/24 and Ser150. Furthermore, our functional assay demonstrated that Pim-1 induces a robust phosphorylation of cTnI within the troponin complex, thus leading to a decreased Ca2+ sensitivity. Insulin-like growth factor 1 (IGF-1), a peptide growth factor that has been shown to stimulate myocardial contractility, markedly induces cTnI phosphorylation at Ser23/24 and Ser150 through increasing Pim-1 expression in cardiomyocytes. In a high-fat diabetic mice model, the expression of Pim1 in the heart is significantly decreased, which is accompanied by a decreased phosphorylation of cTnI at Ser23/24 and Ser150, further implicating the pathological significance of the Pim1/cTnI axis in the development of diabetic cardiomyopathy. Conclusion: Our results demonstrate that Pim-1 is a novel kinase that phosphorylates cTnI primarily at Ser23/24 and Ser150 in cardiomyocytes, which in turn may modulate myofilament function under a variety of physiological and pathophysiological conditions.
ОСОБЛИВОСТІ ПРОФЕСІЙНОЇ ПІДГОТОВКИ МЕДИЧНИХ СЕСТЕР НА СУЧАСНОМУ ЕТАПІ
Authors: Krynytska I. Ya. , Marushchak M. I. , Klishch I. M.
Published: March 2018

Мета: висвітлити роль медичних сестер у сучасній системі охорони здоров’я та обґрунтувати шляхи поліпшення їх професійної підготовки.Матеріали і методи. У дослідженні використа­но бібліосемантичний та аналітичний методи.Результати. У статті викладено сучасні дані щодо професійних та етичних якостей медичної сестри, реформи медсестринства на сучасному етапі та нових компетенцій в роботі середнього медичного персоналу.Висновки. Без докорінного перегляду всієї програми підготовки та перепідготовки фахівців сестринської справи, без впровадження нових технологій організації сестринської допомоги, матеріальної та правової підтримки медичних сестер подальше вдосконалення системи охорони здоров’я просто не можливі.
Rediscovery of Sanderia malayensis and remarks on Rhopilema nomadica record in Pakistan (Cnidaria: Scyphozoa)
Authors: Morandini André Carrara , Gul Shahnawaz
Published: March 2018

In this report, we record the rediscovery of Sanderia malayensis in Pakistani waters since the John Murray Expedition (1933‑34) who collected two small specimens off-Karachi, Pakistan. The specimens were described and we discuss the shape of gastric pouches contour. We also comment upon the newly recorded Rhopilema nomadica jellyfish from the region, and assume it to be previously recorded as Rhopilema hispidum.
Particulate Matter Air Pollution and Racial Differences in Cardiovascular Disease Risk
Authors: Erqou Sebhat , Clougherty Jane E. , Olafiranye Oladipupo , Magnani Jared W. , Aiyer Aryan , Tripathy Sheila , Kinnee Ellen , Kip Kevin E. , Reis Steven E.
Published: March 2018

Objective—

We aimed to assess racial differences in air pollution exposures to ambient fine particulate matter (particles with median aerodynamic diameter <2.5 µm [PM
2.5
]) and black carbon (BC) and their association with cardiovascular disease (CVD) risk factors, arterial endothelial function, incident CVD events, and all-cause mortality.

Approach and Results—

Data from the HeartSCORE study (Heart Strategies Concentrating on Risk Evaluation) were used to estimate 1-year average air pollution exposure to PM
2.5
and BC using land use regression models. Correlates of PM
2.5
and BC were assessed using linear regression models. Associations with clinical outcomes were determined using Cox proportional hazards models, adjusting for traditional CVD risk factors. Data were available on 1717 participants (66% women; 45% blacks; 59±8 years). Blacks had significantly higher exposure to PM
2.5
(mean 16.1±0.75 versus 15.7±0.73µg/m
3
;
P
=0.001) and BC (1.19±0.11 versus 1.16±0.13abs;
P
=0.001) compared with whites. Exposure to PM
2.5
, but not BC, was independently associated with higher blood glucose and worse arterial endothelial function. PM
2.5
was associated with a higher risk of incident CVD events and all-cause mortality combined for median follow-up of 8.3 years. Blacks had 1.45 (95% CI, 1.00–2.09) higher risk of combined CVD events and all-cause mortality than whites in models adjusted for relevant covariates. This association was modestly attenuated with adjustment for PM
2.5
.

Conclusions—

PM
2.5
exposure was associated with elevated blood glucose, worse endothelial function, and incident CVD events and all-cause mortality. Blacks had a higher rate of incident CVD events and all-cause mortality than whites that was only partly explained by higher exposure to PM
2.5
.
Inhibition of Endothelial SCUBE2 (Signal Peptide-CUB-EGF Domain-Containing Protein 2), a Novel VEGFR2 (Vascular Endothelial Growth Factor Receptor 2) Coreceptor, Suppresses Tumor Angiogenesis
Authors: Lin Yuh-Charn , Liu Chun-Yu , Kannagi Reiji , Yang Ruey-Bing
Published: March 2018

Objective—

SCUBE2 (signal peptide-CUB-EGF domain-containing protein 2), expressed on the endothelial cell surface, functions as a novel coreceptor for VEGFR2 (vascular endothelial growth factor receptor 2) and enhances VEGF-induced signaling in adult angiogenesis. However, whether SCUBE2 plays a role in pathological angiogenesis and whether anti-SCUBE2 antibody is an effective strategy for blocking tumor angiogenesis remain unknown. The aim of this study was to investigate the pathological role and targeting therapy of SCUBE2 in tumor vasculature.

Approach and Results—

Immunohistochemistry revealed that SCUBE2 is highly expressed in endothelial cells of numerous carcinomas. Genetic endothelial cell knockout of SCUBE2 and pharmacological inhibition with the anti-SCUBE2 monoclonal antibody SP.B1 significantly reduced xenograft tumor growth, decreased tumor vascular density, increased apoptosis, and decreased the proliferation of tumor cells. Mechanistic studies revealed that SP.B1 binds to SCUBE2 and induces its internalization for lysosomal degradation, thereby reducing its cell surface level and inhibiting the binding of and downstream signaling of VEGF, including VEGFR2 phosphorylation and AKT/MAPK (mitogen-activated protein kinase) activation. Importantly, dual combination therapy with anti-SCUBE2 monoclonal antibody and anti-VEGF antibody or chemotherapy was more effective than single-agent therapy.

Conclusions—

Endothelial cell surface SCUBE2 is a VEGFR2 coreceptor essential for pathological tumor angiogenesis, and anti-SCUBE2 monoclonal antibody acting as an internalization inducer may provide a potent combination therapy for tumor angiogenesis.
The COMMD Family Regulates Plasma LDL Levels and Attenuates Atherosclerosis Through Stabilizing the CCC Complex in Endosomal LDLR Trafficking
Authors: Fedoseienko Alina , Wijers Melinde , Wolters Justina C. , Dekker Daphne , Smit Marieke , Huijkman Nicolette , Kloosterhuis Niels , Klug Helene , Schepers Aloys , Willems van Dijk Ko , Levels Johannes H.M. , Billadeau Daniel D. , Hofker Marten H. , van Deursen Jan , Westerterp Marit , Burstein Ezra , Kuivenhoven Jan Albert , van de Sluis Bart
Published: March 2018

Rationale:

COMMD (copper metabolism MURR1 domain)-containing proteins are a part of the CCC (COMMD–CCDC22 [coiled-coil domain containing 22]–CCDC93 [coiled-coil domain containing 93]) complex facilitating endosomal trafficking of cell surface receptors. Hepatic COMMD1 inactivation decreases CCDC22 and CCDC93 protein levels, impairs the recycling of the LDLR (low-density lipoprotein receptor), and increases plasma low-density lipoprotein cholesterol levels in mice. However, whether any of the other COMMD members function similarly as COMMD1 and whether perturbation in the CCC complex promotes atherogenesis remain unclear.

Objective:

The main aim of this study is to unravel the contribution of evolutionarily conserved COMMD proteins to plasma lipoprotein levels and atherogenesis.

Methods and Results:

Using liver-specific
Commd1
,
Commd6
, or
Commd9
knockout mice, we investigated the relation between the COMMD proteins in the regulation of plasma cholesterol levels. Combining biochemical and quantitative targeted proteomic approaches, we found that hepatic COMMD1, COMMD6, or COMMD9 deficiency resulted in massive reduction in the protein levels of all 10 COMMDs. This decrease in COMMD protein levels coincided with destabilizing of the core (CCDC22, CCDC93, and chromosome 16 open reading frame 62 [C16orf62]) of the CCC complex, reduced cell surface levels of LDLR and LRP1 (LDLR-related protein 1), followed by increased plasma low-density lipoprotein cholesterol levels. To assess the direct contribution of the CCC core in the regulation of plasma cholesterol levels,
Ccdc22
was deleted in mouse livers via CRISPR/Cas9-mediated somatic gene editing. CCDC22 deficiency also destabilized the complete CCC complex and resulted in elevated plasma low-density lipoprotein cholesterol levels. Finally, we found that hepatic disruption of the CCC complex exacerbates dyslipidemia and atherosclerosis in ApoE3*Leiden mice.

Conclusions:

Collectively, these findings demonstrate a strong interrelationship between COMMD proteins and the core of the CCC complex in endosomal LDLR trafficking. Hepatic disruption of either of these CCC components causes hypercholesterolemia and exacerbates atherosclerosis. Our results indicate that not only COMMD1 but all other COMMDs and CCC components may be potential targets for modulating plasma lipid levels in humans.
The Impact of Foreign Ownership on Research and Development Intensity and Technology Acquisition in Indian Industries: Pre and Post Global Financial Crisis
Authors: Aggarwal Aradhna
Published: March 2018

This study examines how interfirm heterogeneities in modes of technology acquisition and technology intensities are linked to firm ownership in India using a panel data set of about 2,000 firms listed on the Bombay Stock Exchange for the period 2003–2014 drawn from the Prowess database of the Center for Monitoring Indian Economy. Foreign ownership is categorized according to the level of control exercised by foreign firms as defined under the Companies Act of India. A comparative analysis of domestic and different categories of foreign firms was conducted for two time periods: (i) the global boom period of 2004–2008, and (ii) the post global financial crisis period of 2008–2014. A horizontal cluster analysis of 3-digit, industry-level data shows that foreign firms cluster in high-technology industries. The propensity score matching analysis, however, reveals that in a matched sample of foreign and domestic firms, majority-owned foreign firms spend less on research and development and more on technology transfers than their local counterparts, demonstrating that the level of equity holdings by a foreign firm matters. There is little evidence of the global financial crisis affecting the relocation of research and development activities to India. An alternative assessment based on panel data regression analysis confirms these findings and validates the propensity score matching results.
Foreign Direct Investment, Firm Heterogeneity, and Exports: An Analysis of Indian Manufacturing
Authors: Ghosh Maitri , Roy Saikat Sinha
Published: March 2018

Using firm-level data, this paper investigates whether foreign direct investment and the presence of multinational enterprises explains India's improved export performance during the postreform period. The recent literature stresses that firm heterogeneity gives some firms an edge over others to self-select into export markets. Apart from ownership, this paper considers firm heterogeneity and other firm-specific factors of export performance. Estimation results show that the impact of foreign ownership on export performance does not significantly differ from that of domestic firms across sectors in Indian manufacturing. Rather, firms build their international competitiveness by importing raw materials and foreign technical know-how, and by investing in research and development. Further, firm heterogeneity, measured in terms of sunk costs, significantly impacts firm-level export intensity. The study also reveals that there are ownership-specific factors that determine firm-level exports.
Does Plant Size Matter? Differential Effects of Foreign Direct Investment on Wages and Employment in Indian Manufacturing
Authors: Sharma Shruti
Published: March 2018

This paper examines the differential effects, based on the size of the plant, of industry-level foreign direct investment (FDI) on plant-level employment and the wages of skilled and unskilled workers in India's manufacturing sector. On average, there are strong positive differential effects of increased inward-level FDI for large plants relative to small and average-sized plants in terms of employment and the average wages of both skilled and unskilled workers. Small plants experience negative effects from inward FDI, which can be explained by intra-industry reallocation of output from smaller to larger plants. After conducting a regional analysis, I find positive spillovers to small plants in Indian states that receive large and persistent flows of FDI. This suggests that a critical mass of FDI is necessary for small plants to experience positive spillover effects.
Can Barents Sea Ice Decline in Spring Enhance Summer Hot Drought Events over Northeastern China?
Authors: Li Huixin , Chen Huopo , Wang Huijun , Sun Jianqi , Ma Jiehua
Published: March 2018

In July–August (JA) of 2016, northeastern China (NEC) suffered from the most severe hot drought event of the past 50 years, leading to profound impacts on agriculture, the ecosystem, and society. Results indicate that the loss of sea ice over the Barents Sea (SICBS) in March might have influenced the hot drought events over NEC in JA for the period of 1997–2016. Further analyses reveal that lower SICBS is closely related to thinner snow depth over western Eurasia (SDWEA) in April. The decline of SDWEA leads to drier soil from the Yangtze River valley to northern China during May–June, which is favorable for precipitation deficiency over NEC in JA. Besides, the loss of SICBS in March and decline of SDWEA in April are closely related to the polar–Eurasia teleconnection pattern and dry soil over NEC in JA, which provides favorable atmospheric circulation patterns for occurrences of hot droughts. The large ensemble simulations from the Community Earth System Model and the numerical experiments based on version 4 of the Community Atmosphere Model further confirmed their connections and the associated possible physical processes. Therefore, snow depth and soil moisture might serve as linkages between Barents Sea ice in March and hot droughts over NEC during JA, and the Barents Sea ice in March might be an important potential predictor for the summer hot droughts over NEC.
A Psychospiritual Model of Spiritual Formation: A Review of David Benner's Contributions
Authors: Howard Phil
Published: March 2018

Our culture is in tune with the “spiritual.” Yet, understanding what constitutes the spiritual, let alone how to cultivate it, remains unclear. This article will explore the foundations of Benner's psychospiritual model of human nature and its implications for Christian educators. Of particular interest is the influence that Benner's model can have on our efforts toward holistic Christian formation.
Prognostic and diagnostic value of REG4 serum and tissue expression in pancreatic ductal adenocarcinoma
Authors: Saukkonen Kapo , Hagström Jaana , Mustonen Harri , Lehtinen Laura , Carpen Olli , Andersson Leif C , Seppänen Hanna , Haglund Caj
Published: March 2018

Expression of regenerating islet-derived protein 4 (REG4), a secretory protein involved in cell differentiation and proliferation, is upregulated in inflammatory bowel diseases and in many gastrointestinal malignancies. The prognostic significance of its expression in pancreatic ductal adenocarcinoma is unknown. Our aim was to investigate tumor tissue and serum REG4 expression in pancreatic ductal adenocarcinoma patients. We also evaluated as a control the diagnostic value of serum REG4 level in patients with chronic pancreatitis. Immunohistochemical expression of REG4 was evaluated in 154 surgical specimens and serum REG4 level in 130 samples from pancreatic ductal adenocarcinoma patients treated at Helsinki University Hospital, Finland, in 2000–2011. REG4 tissue and serum expression was assessed in relation to clinicopathological parameters and patient survival. A chronic pancreatitis control group comprised 34 patients who underwent pancreatic resection because of suspicion of malignancy. Significant survival differences were detectable in subgroups: in tumor stages IA–IIA, high serum REG4 level predicted worse survival (p=0.046). In patients with grade I tumor, positive tissue REG4 expression predicted better survival (p=0.006). In multivariate analysis, neither tissue nor serum REG4 expression was independent prognostic factors. Serum REG4 levels were higher in pancreatic ductal adenocarcinoma than in chronic pancreatitis (p=0.002), with diagnostic sensitivity of 45% and specificity of 91%. In logistic regression analysis, a multivariate model with REG4, CA19-9, and age provided sensitivity of 82% and specificity of 79%. REG4 tissue expression is a prognostic marker in subgroups of pancreatic ductal adenocarcinoma patients. Serum REG4 level might be useful in differential diagnosis between pancreatic ductal adenocarcinoma and chronic pancreatitis.
A Systematic Review of Biological Mechanisms of Fatigue in Chronic Illness
Authors: Matura Lea Ann , Malone Susan , Jaime-Lara Rosario , Riegel Barbara
Published: March 2018

Fatigue, a commonly reported symptom, is defined as an overwhelming, debilitating, and sustained sense of exhaustion that decreases the ability to function and carry out daily activities. To date, cancer researchers have been in the forefront in investigating the possible biological mechanisms of fatigue, identifying inflammation, dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, and activation of the autonomic nervous system. The purpose of this systematic review is to describe fatigue and what is known about the biological mechanisms described in cancer in five chronic, noninfectious illnesses: heart failure, multiple sclerosis, chronic kidney disease, rheumatoid arthritis, and chronic obstructive pulmonary disease. We searched PubMed and EMBASE using fatigue as a major Medical subject headings (MeSH) heading with each individual disease added as a search term followed by each biological mechanism. We included only primary research articles published in English between 1996 and 2016 describing studies conducted in adult humans. We identified 26 relevant articles. While there is some evidence that the biological mechanisms causing fatigue in cancer are also associated with fatigue in other chronic illnesses, more research is needed to explore inflammation, the HPA axis, and the autonomic nervous system, and other mechanisms in relation to fatigue in a variety of chronic illnesses.
Pain Management in Cancer Center Inpatients: A Cluster Randomized Trial to Evaluate a Systematic Integrated Approach—The Edinburgh Pain Assessment and Management Tool
Authors: Fallon Marie , Walker Jane , Colvin Lesley , Rodriguez Aryelly , Murray Gordon , Sharpe Michael ,   for the Edinburgh Pain Assessment and Management Tool Study Group
Published: March 2018

Purpose

Pain is suboptimally managed in patients with cancer. We aimed to compare the effect of a policy of adding a clinician-delivered bedside pain assessment and management tool (Edinburgh Pain Assessment and management Tool [EPAT]) to usual care (UC) versus UC alone on pain outcomes.

Patients and Methods

In a two-arm, parallel group, cluster randomized (1:1) trial, we observed pain outcomes in 19 cancer centers in the United Kingdom and then randomly assigned the centers to either implement EPAT or to continue UC. The primary outcome was change in the percentage of study participants in each center with a clinically significant (≥ 2 point) improvement in worst pain (using the Brief Pain Inventory Short Form) from admission to 3 to 5 days after admission. Secondary outcomes included quality of analgesic prescribing and opioid-related adverse effects.

Results

Ten centers were randomly assigned to EPAT, and nine were assigned to UC. We enrolled 1,921 patients and obtained outcome data from 93% (n = 1,795). Participants (mean age, 60 years; 49% women) had a variety of cancer types. For centers randomly assigned to EPAT, the percentage of participants with a clinically significant improvement in worst pain increased from 47.7% to 54.1%, and for those randomly assigned to continue UC, this percentage decreased from 50.6% to 46.4%. The absolute difference was 10.7% (95% CI, 0.2% to 21.1%; P = .046) and it increased to 15.4% (95% CI, 5.8% to 25.0%; P = .004) when two centers that failed to implement EPAT were excluded. EPAT centers had greater improvements in prescribing practice and in the Brief Pain Inventory Short Form pain subscale score. Other pain and distress outcomes and opioid adverse effects did not differ between EPAT and UC.

Conclusion

A systematic integrated approach improves pain outcomes for inpatients in cancer centers without increasing opioid adverse effects.
Developing Media to Promote Community Awareness of Early Detection of Kaposi’s Sarcoma in Africa
Authors: Laker-Oketta Miriam , Butler Lisa , Makanga Philippa , Maurer Toby , Mbidde Edward , Martin Jeffrey
Published: March 2018

Abstract 44

Purpose

Despite overt presentation on the skin, most Kaposi’s sarcoma (KS) in Africa is diagnosed too late for treatment to be effective. Training health care workers to recognize KS early can increase knowledge, but is only clinically impactful if providers actually encounter early KS—that is, if patients with early KS present to care. Indeed, recent work from Zimbabwe has shown that facility-based KS training failed to increase early diagnosis, which is unsurprising given the public’s lack of awareness of KS. We hypothesized that educating affected populations about KS is critical to making progress in early detection and that enhanced community awareness about KS can be achieved through exposure to common media.

Methods

Working in Uganda, we used community-engaged research to learn about health-related behaviors in the context of skin disease, craft a culturally appropriate educational theme regarding the detection of KS, and develop three forms of media. We interacted with survivors of KS, HIV-infected patients, facility-based and community health workers, traditional healers, and media professionals. We tested our media among adults at community-based venues in rural Uganda. Participants were randomly assigned to be exposed to one of the three media and were evaluated for changes in knowledge and attitudes concerning KS before and after exposure to media.

Results

In comics, 90-second radio plays, and a 10-minute film, we developed a three-part theme that was aimed at the public: “look,” meaning to regularly examine one’s skin and mouth; “show” to bring to the attention of a health care worker any skin changes; and “test” to remind providers about skin biopsy for diagnosis. Among the 240 participants who were exposed to media, median age was 30 years, 50% were women, 6% were HIV infected, and 60% were literate. Exposure to media resulted in increases in the ability to recognize and/or name KS (+47%), awareness that anyone is at risk for KS (+15%), and knowledge of how to prevent KS from becoming a substantial problem (+34%).

Conclusion

Featuring the theme, “Look, show, and test,” we developed media—comics, radio plays, and film—for the public in Africa about the early detection of KS. Exposure to these media resulted in increases in knowledge and changes in attitudes concerning KS. Although the increases in knowledge were not large, they may be as much as can be expected from a single exposure. Optimal outcomes will likely require multiple exposures and facilitated discussions. Media elements are freely available online.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.
Impact of Pharmacist Participation on Chemotherapy Administration Outcomes in a Low-Resource Setting
Authors: Downey-Wall Kathryn , Hilary Keneth , Katabalo Deo , Masalu Nestory , Schroeder Kristin
Published: March 2018

Abstract 50

Purpose

Implementation of specialty oncology pharmacy services is associated with improved patient care and reduced medical errors. Pharmacy capacity is limited in many low-resource countries, with chemotherapy preparation and administration often being performed by other allied health care providers. At Bugando Medical Center in Tanzania, both nurses and pharmacists are responsible for mixing and administering chemotherapy; however, most nurses do not have specialized oncology training, which increases the risk for medication errors. The purpose of the current study was to assess the effects of pharmacist participation on therapeutic outcomes, including verified dosage calculations, chemotherapy administration adherence, and dose documentation.

Methods

Chemotherapy encounters were observed over a 1-month period. Recorded observations included adherence to prescribed chemotherapy administration times; errors, including spills and extravasation; and administrative adherence, including dose verification and documentation.

Results

There were 53 observed encounters—32 with a pharmacist and 21 without; 15 were for pediatric patients. Pharmacist participation increased adherence to prescribed administration time (54% v 19%; P = .009) and decreased errors (zero v two extravasations; zero v one spill). Pharmacist participation improved chemotherapy administration documentation (96.8% v 76.2%; P = .049); however, patient safety measures, including intravenous catheter placement verification, secondary dose check, and toxicity monitoring during administration, were not done with or without pharmacist participation.

Conclusion

Pharmacist participation increased adherence to prescribed chemotherapy administration and documentation, and reduced extravasation; however, additional patient safety training is needed. A larger study can further evaluate the impact of the participation of a specialty pharmacist on patient-related outcomes.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.
Access to Cancer Medicine Issues: Implication for Policy and Practice in Ethiopia
Authors: Tegegn Henok Getachew , Reda Hailemariam Lemma , Tilahun Yared
Published: March 2018

Abstract 55

Purpose

Cancer currently is a major public health problem in developing countries. In Ethiopia, cancer is responsible for 5.8% of total national deaths. Patients often present with advanced stage cancer and have limited access to screening, diagnosis, and treatment. Access to affordable cytotoxic medicines is a major challenge in the care of patients with cancer, especially in resource-poor settings, such as Ethiopia. This aim of this study was to explore perceived challenges in the accessibility of cancer chemotherapy drugs among different stakeholders in Ethiopia.

Methods

A qualitative study was performed using face-to-face in-depth interviews with such key informants as health care providers, supply chain management experts, and decision makers working in the Ministry of Health.

Results

A total of six key informants participated in this case report, with two oncology pharmacists, two supply chain management experts, one expert from the Ministry of Health, and one private supplier. Challenges were explored and viewed from the perspectives of policy, supply chain management, and health service. The most frequently identified challenges were the presence of inconsistent services and few currently active cancer centers, such as Tikur Anbesa Specialized Hospital, Gondar University Hospital, and Jimma University Hospital; difficulties in cancer commodity management; implementation challenges with cancer medicine cost subsidy programs; lack of an efficient stock status reporting system; supplementary medicine requirements; an inefficient market (costly, few suppliers, and noneconomic quantities); the need for combinations of cancer medicines; and a lack of national treatment guidelines.

Conclusion

Respondents suggested ways forward that included the participation of relevant and specific stakeholders, such as government and private pharmaceutical suppliers, the Ministry of Health, nongovernmental organizations, and hospitals. Strengthening supply chain management at all levels and sustainable subsidy programs for cancer medicines should be sought to avoid frequent interruptions in the availability of chemotherapy drugs.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.
Age-Standardized Mortality Rates in the Caribbean: One Source, Three Different Interpretations
Authors: Wolf Nicholas G. , Morgan Camille , Flanigan John S.
Published: March 2018

Abstract 74

Purpose

A recent publication in the Morbidity and Mortality Weekly Report (MMWR) provided the opportunity to calculate differences in published cancer mortality estimates for Caribbean jurisdictions from three organizations, MMWR, the International Agency for Research on Cancer, and the Institute for Health Metrics and Evaluation. This comparison study serves to educate end users of these data.

Methods

We downloaded the publicly available cancer mortality estimates for 15 jurisdictions and the United States from the three organizations. We compared reported age-standardized mortality rates for each jurisdiction, and calculated the range among the estimates for each jurisdiction. We repeated this analysis after applying the same world population standard to all estimates.

Results

For males, ranges of Caribbean estimates were between 49% (Grenada and Trinidad) and 201% (US Virgin Islands) of the MMWR value, with an average of 88%. For females, ranges were between 15% (Trinidad) and 171% (US Virgin Islands) of the MMWR value, with an average of 64%. After all estimates were compared using the same population standard, ranges of Caribbean estimates for males were between 6% (Grenada) and 111% (US Virgin Islands) of the MMWR value, with an average of 34%. For females, ranges were between 7% (Grenada) and 97% (US Virgin Islands), with an average of 28%.

Conclusion

The use of different standard populations complicates comparisons across organizations. Data modeling does not completely compensate for the quality of source data, as our analysis has demonstrated by the differences in mortality rates despite the good quality of the vital registration in the Caribbean.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.
Saving the Security State
Authors: Grewal Inderpal
Published: March 2018

In Saving the Security State Inderpal Grewal traces the changing relations between the US state and its citizens in an era she calls advanced neoliberalism. Marked by the decline of US geopolitical power, endless war, and increasing surveillance, advanced neoliberalism militarizes everyday life while producing the “exceptional citizens”—primarily white Christian men who reinforce the security state as they claim responsibility for protecting the country from racialized others. Under advanced neoliberalism, Grewal shows, others in the United States strive to become exceptional by participating in humanitarian projects that compensate for the security state’s inability to provide for the welfare of its citizens. In her analyses of microfinance programs in the global South, security moms, the murders at a Sikh temple in Wisconsin, and the post-9/11 crackdown on Muslim charities, Grewal exposes the fissures and contradictions at the heart of the US neoliberal empire and the centrality of race, gender, and religion to the securitized state.
Kompression nach Sklerotherapie mit flüssigen und aufgeschäumten Agenzien
Authors: Cucuruz B. , Noppeney T. , Noppeney J.
Published: March 2018

Die Kompressionstherapie gehört zu den basistherapeutischen Maßnahmen der Phlebologie. Aus einer Befragung unter deutschen Phlebologen wissen wir, dass diese in etwa 30 Prozent der Fälle, Patienten nach Sklerotherapie mit Kompressionsstrümpfen versorgen.

Um die Frage zu beantworten ob Kompressionstherapie nach Sklerotherapie zu besseren Ergebnissen führt, haben wir eine systemische Literaturrecherche in Medline, Pubmed Central und Embase durchgeführt. Dabei konnten wir fünf prospektive randomisierte Studien, eine prospektive Kohortenstudie und Leitlinienempfehlungen zu diesem Thema identifizieren.

Die vorliegende Literatur zeigt, dass Kompressionstherapie bis zu 3 Wochen nach Sklerotherapie von Besenreiser und retikulären Varizen zu einer Verbesserung der Ergebnisse, sowie zu einer Verminderung von Pigmentierungen führt. Die Datenlage zur Schaumsklerotherapie größerer Venen ist uneinheitlich, eine prospektiv randomisierte Studie zeigt keinen positiven Effekt der Kompressionstherapie, eine prospektive Kohortenstudie ergibt einen besseren Sklerosierungserfolg in Abhängigkeit von der Compliance der Patienten.

In den Leitlinien wird im Allgemeinen eine Empfehlung zur Kompressionstherapie nach Sklerotherapie abgegeben, wobei keine Empfehlungen zur Dauer der Kompression erfolgen. Aufgrund der eingeschränkten Datenlage sind weitere Studien nötig um den Benefit der Kompression nach Sklerotherapie deutlich zu belegen.
Using Homemade, Short, Fictional Cases for Teaching the Theory of Constraints
Authors: Orchard Ryan K.
Published: March 2018

For our undergraduate Operations Management course, a lack of case studies meeting our specific needs, coupled with our reluctance to reuse cases too frequently, inspired development of a collection of “homemade” cases. These cases, which focus on application of the Theory of Constraints, are fictional (of necessity) and short (by design); however, we have found that these two characteristics have not limited the effectiveness of the case assignments: They are consistently meeting our pedagogical objectives, including eliciting deliberation and varied responses from students. This paper discusses the motivation for developing homemade cases, the nature of the cases (short, fictional) and associated implications, advice for development and implementation, and feedback from students.

The online appendix is available at http://pubsonline.informs.org/doi/suppl/10.1287/ited.2017.0190 .
Pain, inflammation and wound healing
Authors: Muldoon Jeanette
Published: March 2018

The link between pain and wound healing is a well-documented phenomenon ( Rice, 1994 ; Clay and Chen, 2005 ; Soon and Acton, 2006 ). This article describes how prolonged pain and chronic inflammation contribute to form a vicious cycle that, if left unbroken, further delays healing. Within this cycle, factors such as the effect on assessment, the ability to move normally, stress, anxiety and insomnia exist, with resulting concordance issues that could disrupt treatment. As the cycle persists, conditions associated with open wounds such as infection, excess exudate and skin complications can increase the risks of non-healing and pain (Muldoon, 2005). Additional challenges are comorbidities, individual pain thresholds, patient reporting, trigger factors for pain and responses to management.
Self-care: Empowering patients
Authors: Todd Marie
Published: March 2018

Marie Todd, lymphoedema clinical nurse specialist, discusses the advancements in chronic oedema and lymphoedema that have enabled patients to self-care and empowered them to manage their condition, while reducing the impact on NHS resources
The management and treatment of hyperkeratosis
Authors: Elwell Rebecca
Published: March 2018

Rebecca Elwell, Macmillan lymphoedema advanced nurse practitioner, Royal Stoke University Hospital, discusses recommendations on management of this skin problem, which may co-occur with chronic oedema
Ofsted chief: ‘Don't be afraid to challenge inspection teams’
Authors: Parr Chris
Published: March 2018

Amanda Spielman also warns against workload-heavy practices, such as creating ‘Ofsted-ready’ files or organising ‘mocksteds’
Staff working groups
Authors: Rutter John
Published: March 2018

Staff working groups can be an effective approach to tackling a range of issues in school, not least planning/delivering CPD or developing practice in specific areas. John Rutter advises
The Unplanned Lesson: Part 2
Authors: Mallaghan Gerry
Published: March 2018

Have you ever had to cover a lesson last minute with no preparation time? In the second part of his article on unplanned lessons, Gerry Mallaghan offers further advice and activity ideas
Ensuring patient safety when implementing a new diagnostic pathway for thyroid nodules
Authors: Brimioulle M , Al-Lami A , Marzouk S , Emerson H , Balfour A , Dhar V , Nixon IJ
Published: March 2018

Introduction

The aim of this study was to determine whether ultrasound alone is sufficient to safely exclude malignancy in thyroid nodules in a district general hospital setting, to comply with the latest British Thyroid Association guidelines.

Methods

This retrospective study investigated the quality of ultrasound reporting and the correlation between ultrasound report and histology for individual thyroid nodules. Cases were selected from the thyroid multidisciplinary meeting and included all patients having undergone surgery for a thyroid malignancy in a one-year period.

Results

Forty-seven patients were included in the study. Ultrasound reports were reviewed and assessed, in which 21 clinicians were involved; 36% of scans included a summary of whether the nodule(s) overall appeared benign, equivocal, suspicious or malignant; 4% of reports included a U classification; 81% of reports commented on cervical lymph nodes. Ultrasound was compared with histology. The sensitivity of ultrasound in correctly identifying nodules requiring further investigation was of 56% and specificity was 81%. Positive predictive value was 81% and negative predictive value was 56%.

Discussion

These findings suggest that, in a district general hospital setting without a dedicated head and neck radiologist, using only ultrasound and limiting fine-needle aspiration cytology to identify suspicious nodules may not be safe, as a high number of nodules appearing benign on ultrasound may ultimately prove to be malignant.
Translinguajamento: pensando entre línguas a partir de práticas e metadiscursos de docentes indígenas em formação superior
Authors: Pimenta de Oliveira Denise , Nascimento André Marques do
Published: March 2018

O objetivo deste trabalho é estabelecer a genealogia epistemológica do conceito de translinguajamento a partir de pressupostos teóricos do campo dos estudos decoloniais e compreendê-lo com base em práticas comunicativas e metadiscursos de docentes indígenas em formação superior específica na Universidade Federal de Goiás (UFG). O translinguajamento é apresentado como uma alternativa para problematizar os essencialismos decorrentes da invenção das línguas (MAKONI; PENNYCOOK, 2007) – e, consequentemente, das nações e de outros construtos – e para compreender as práticas comunicativas contemporâneas. Pretendemos mobilizar reflexões relacionadas a práticas híbridas de linguagem, que rompam com a ideologia do monolinguajamento colonial e nacional e considerem a possibilidade de pensar entre línguas, na fronteira, conforme sugere Mignolo (2003), considerando o processo de globalização e os contextos locais e pensando a interculturalidade de forma crítica, marcada por processos de interação amplamente diversificados e profundamente afetados pela diferença colonial. Além disso, procuramos evidenciar e compreender como práticas e metadiscursos relacionados a essa ideia de translinguajamento se manifestam em um contexto de formação de docentes indígenas no curso de Licenciatura em Educação Intercultural da Universidade Federal de Goiás, a partir de dados orais e escritos gerados em sala de aula, em uma análise com direcionamento metodológico qualitativo e de cunho etnográfico. Considera-se o translinguajamento como uma alternativa para desinventar e reconstituir as línguas, questionando concepções fixas e totalizantes sobre linguagem, sobretudo em situações em que a complexidade social reconfigura os mapas linguísticos e exige novas perspectivas, como é o caso dos povos indígenas no Brasil. Para tanto, partimos da ideia de que o translinguajamento pode, inclusive, ser utilizado como uma estratégia de negociação nas relações interculturais, intrinsicamente constituídas na fluidez e no hibridismo, fundamentadas na mobilização de recursos pertencentes a repertórios linguísticos diversos, móveis e heterogêneos.
Variação linguística e leitura: fenômenos variáveis da fala na leitura em voz alta
Authors: Machado Alessandra Pereira Gomes
Published: March 2018

Estabelecendo um contraponto à análise da precisão na decodificação da palavra escrita na avaliação da fluência em leitura oral baseada no certo e errado (RASINSKI, 2004), este estudo funda-se na Sociolinguística Educacional (BORTONI-RICARDO, 2004) que propõe o tratamento do “erro” considerando as variantes e estilos da língua a partir de três contínuos: urbanização, oralidade-letramento e monitoração estilística. Esses contínuos compreendem a heterogeneidade da língua e a avaliação social desta, possibilitando identificar traços descontínuos, fenômenos que recebem maior estigma social, e traços graduais, presentes na oralidade de quase todos os brasileiros. Este estudo objetiva analisar os fenômenos variáveis transpostos para a leitura em voz alta de estudantes do 6º ano do ensino fundamental de duas escolas públicas de Sergipe e verificar qual a rota de leitura esses estudantes estão acessando que podem nos dar pistas da proficiência em leitura. A sessão de gravação foi realizada, no ano letivo de 2016, com 74 estudantes, com idade entre 10 e 14 anos. A análise foi realizada em 1 minuto da leitura em voz alta de 2 textos adequados ao currículo do leitor (DENO, 2003), totalizando um corpus de 148 minutos de áudio. Os resultados mostram que foi possível verificar os fenômenos variáveis na leitura em voz alta e que eles podem nos dar pistas das rotas de leitura, possibilitando identificar os possíveis leitores proficientes e não taxar como “erro” o apagamento de R na desinência verbal de infinitivo ou de S no núcleo de SN na posição mais à direita ou ainda na monotongação de /ow/ numa avaliação de leitura.
‘They could have defended my mum and me’: children’s perspectives on grandparent responses to intimate partner violence
Authors: Åkerlund Nina
Published: March 2018

While children’s exposure to intimate partner violence (IPV) is a growing field of inquiry, their experiences of informal network responses have generally been overlooked. Particularly lacking are studies of grandchildren’s experiences of their relationship with their grandparents in the face of IPV. Drawing on interviews with 10 children aged 12–17, this article explores how violence-exposed children describe their relationships with their grandparents and how the older generation has responded to the abuse. The children’s stories can be interpreted as they expected their grandparents to ‘be there’ for them, to be important parts of their everyday lives, and wanted their grandparents to intervene and support them when learning of the IPV. Some grandparents intervened in helpful ways, for instance, they contributed to normality in the child’s everyday life, siding with the child and the adult victim and providing support and care. Others intervened in unhelpful ways, such as ignoring the violence, or taking the perpetrator’s side, and few intervened by attempting to end the violence. This article suggests that grandparents may, but not always, be a resource, both for violence-exposed children and professionals working with IPV.