An Exploratory Study into the Traumatic Impact of Advanced Cancer among Patients and Partners

People living with cancer may experience both psychological distress and a sense of personal development. These two responses can be conceptualised using theories of post-traumatic stress (PTS) and post-traumatic growth (PTG), respectively. This hospice-based study investigated the range of experiences of people living with advanced cancer and of their partners, with consideration of how theories of PTS and PTG resonated with their accounts. Strategic sampling (n=11) was used to gather data from eight individuals living with advanced cancer and from three individuals caring for someone with the diagnosis. Q methodology was used to investigate the participants’ subjective experiences. A set of 62 statements, informed by theories of trauma, were sorted by the participants according to the extent to which the individual statements were consistent with their personal experiences of living with cancer. The participants were then interviewed about their Q sorts, to consider the personal meanings that had informed their statement rankings. The Q sort data were factor analysed, and theories of PTS and PTG were used to aid the interpretation of four differing viewpoints: “Accepting and Growing,†“Fearful yet Adapting,†“Resigned and Grieving†and “Traumatised.†These different expressions of the positive and negative feelings associated with living with advanced cancer are considered in relation to professional healthcare provision. The study recommends that future research involve a broader sample of individuals, including patients not accessing hospice care, the partners of this population and cancer healthcare professionals

Interprofessional Education in a Child Mental Healthcare Context: Children's Nursing and Clinical Psychology Students Learning Together.

Interprofessional education (IPE) is said to occur when ‘two or more professions learn with, from, and about each other to improve collaboration and the quality of care’ (Freeth et al., 2005, p. 11). Four domains are believed to be core to inter-professional education: the ethics and values for inter-professional practice; knowledge and understanding of roles and responsibilities; communication; and collaborative teamwork (DeLeon et al., 2015). All healthcare professionals share a desire to provide high quality care for patients, and in providing that care, it is essential that they work together. It is therefore imperative that training providers find ways to establish collaborative learning, ideally early on in students’ professional careers, and to demonstrate how they facilitate IPE within their curricula (Williams et al., 2017)

An exploratory study into the traumatic impact of advanced cancer among patients and partners.

People living with cancer may experience both psychological distress and a sense of personal development. These two responses can be conceptualised using theories of post-traumatic stress (PTS) and post-traumatic growth (PTG), respectively. This hospice-based study investigated the range of experiences of people living with advanced cancer and of their partners, with consideration of how theories of PTS and PTG resonated with their accounts. Strategic sampling (n=11) was used to gather data from eight individuals living with advanced cancer and from three individuals caring for someone with the diagnosis. Q methodology was used to investigate the participants’ subjective experiences. A set of 62 statements, informed by theories of trauma, were sorted by the participants according to the extent to which the individual statements were consistent with their personal experiences of living with cancer. The participants were then interviewed about their Q sorts, to consider the personal meanings that had informed their statement rankings. The Q sort data were factor analysed, and theories of PTS and PTG were used to aid the interpretation of four differing viewpoints: “Accepting and Growing,” “Fearful yet Adapting,” “Resigned and Grieving” and “Traumatised.” These different expressions of the positive and negative feelings associated with living with advanced cancer are considered in relation to professional healthcare provision. The study recommends that future research involve a broader sample of individuals, including patients not accessing hospice care, the partners of this population and cancer healthcare professionals

Inter-professional education in a child mental health-care context: children’s nursing and clinical psychology students learning together

Purpose Previous research has explored inter-professional education (IPE) in mental health contexts, for example, between mental health nurses and clinical psychologists (CPs). However, little research has explored IPE with children’s nurses (CNs) and CPs, who often work together in a range of in-patient and community mental health settings. Indeed, a significant proportion of CNs’ work involves identifying and responding to the mental health needs of children, young people and families; equally, CPs work directly into child teams, and their consultancy work requires awareness of other professional roles. However, knowledge and understanding of roles, and true collaborative working, appears to be limited. This study aimed to address these limitations. Design/methodology/approach A project was designed to bring together these two groups in an educational context, to explore ways in which collaborative working may enable effective mental health-care delivery. A total of 17 children’s nursing students and 15 clinical psychology trainees participated in a 3-day workshop, including experiential and clinical vignette work. Workshops were evaluated at three time points, using a questionnaire. Findings The workshops were effective in improving knowledge, skills and understanding of roles. Teamwork and discussions were helpful in modifying attitudes and perceptions. However, “defensiveness” was an important theme, demonstrating somewhat fixed beliefs about roles in relation to child mental health care. Originality/value Few studies have explored IPE in child mental health contexts, especially in the pre-qualification arena. </jats:sec

Identification of a conserved subset of cold tumors responsive to immune checkpoint blockade

BackgroundThe efficacy of immune checkpoint blockade (ICB) depends on restoring immune recognition of cancer cells that have evaded immune surveillance. Transforming growth factor-beta (TGFβ) is associated with immune-poor, so-called cold tumors whereas loss of its signaling promotes DNA misrepair that could stimulate immune response.MethodsWe analyzed transcriptomic data from IMvigor210, The Cancer Genome Atlas, and Tumor Immune Syngeneic MOuse data sets to evaluate the predictive value of high βAlt, a score representing low expression of a signature consisting of TGFβ targets and high expression of genes involved in error-prone DNA repair. The immune context of βAlt was assessed by evaluating tumor-educated immune signatures. An ICB-resistant, high βAlt preclinical tumor model was treated with a TGFβ inhibitor, radiation, and/or ICB and assessed for immune composition and tumor control.ResultsWe found that a high βAlt score predicts ICB response yet is paradoxically associated with an immune-poor tumor microenvironmentcancer in both human and mouse tumors. We postulated that high βAlt cancers consist of cancer cells in which loss of TGFβ signaling generates a TGFβ rich, immunosuppressive tumor microenvironment. Accordingly, preclinical modeling showed that TGFβ inhibition followed by radiotherapy could convert an immune-poor, high βAlt tumor to an immune-rich, ICB-responsive tumor. Mechanistically, TGFβ inhibition increased activated natural killer (NK) cells, which were required to recruit lymphocytes to respond to ICB in irradiated tumors. NK cell activation signatures were also increased in high βAlt, cold mouse and human tumors that responded to ICB.ConclusionsThese studies indicate that loss of TGFβ signaling competency and gain of error-prone DNA repair identifies a subset of cold tumors that are responsive to ICB. Our mechanistic studies show that inhibiting TGFβ activity can convert a high βAlt, cold tumor into ICB-responsive tumors via NK cells. A biomarker consisting of combined TGFβ, DNA repair, and immune context signatures is a means to prospectively identify patients whose cancers may be converted from cold to hot with appropriate therapy

Radio jet–ISM interaction and positive radio-mechanical feedback in Abell 1795

We present XSHOOTER observations with previous ALMA, MUSE, and HST observations to study the nature of radio jet triggered star formation and the interaction of radio jets with the interstellar medium in the brightest cluster galaxy (BCG) in the Abell 1795 cluster. Using HST UV data, we determined an ongoing star formation rate of 9.3 M⊙ yr−1. The star formation follows the global Kennicutt–Schmidt law; however, it has a low efficiency compared to circumnuclear starbursts in nearby galaxies with an average depletion time of ∼1 Gyr. The star formation and molecular gas are offset by ∼1 kpc indicating that stars have decoupled from the gas. We detected an arc of high linewidth in ionized gas where electron densities are elevated by a factor of ∼4 suggesting a shock front driven by radio jets or peculiar motion of the BCG. An analysis of nebular emission line flux ratios suggests that the gas is predominantly ionized by star formation with a small contribution from shocks. We also calculated the velocity structure function (VSF) of the ionized and molecular gases using velocity maps to characterize turbulent motion in the gas. The ionized gas VSF suggests that the radio jets are driving supersonic turbulence in the gas. Thus radio jets cannot only heat the atmosphere on large scales and may quench star formation on longer time-scales while triggering star formation in positive feedback on short time-scales of a few million years

Spatially Resolved Transcriptomes of Mammalian Kidneys Illustrate the Molecular Complexity and Interactions of Functional Nephron Segments

Available transcriptomes of the mammalian kidney provide limited information on the spatial interplay between different functional nephron structures due to the required dissociation of tissue with traditional transcriptome-based methodologies. A deeper understanding of the complexity of functional nephron structures requires a non-dissociative transcriptomics approach, such as spatial transcriptomics sequencing (ST-seq). We hypothesize that the application of ST-seq in normal mammalian kidneys will give transcriptomic insights within and across species of physiology at the functional structure level and cellular communication at the cell level. Here, we applied ST-seq in six mice and four human kidneys that were histologically absent of any overt pathology. We defined the location of specific nephron structures in the captured ST-seq datasets using three lines of evidence: pathologist's annotation, marker gene expression, and integration with public single-cell and/or single-nucleus RNA-sequencing datasets. We compared the mouse and human cortical kidney regions. In the human ST-seq datasets, we further investigated the cellular communication within glomeruli and regions of proximal tubules–peritubular capillaries by screening for co-expression of ligand–receptor gene pairs. Gene expression signatures of distinct nephron structures and microvascular regions were spatially resolved within the mouse and human ST-seq datasets. We identified 7,370 differentially expressed genes (padj < 0.05) distinguishing species, suggesting changes in energy production and metabolism in mouse cortical regions relative to human kidneys. Hundreds of potential ligand–receptor interactions were identified within glomeruli and regions of proximal tubules–peritubular capillaries, including known and novel interactions relevant to kidney physiology. Our application of ST-seq to normal human and murine kidneys confirms current knowledge and localization of transcripts within the kidney. Furthermore, the generated ST-seq datasets provide a valuable resource for the kidney community that can be used to inform future research into this complex organ

Cold, clumpy accretion onto an active supermassive black hole

Supermassive black holes in galaxy centres can grow by the accretion of gas, liberating energy that might regulate star formation on galaxy-wide scales. The nature of the gaseous fuel reservoirs that power black hole growth is nevertheless largely unconstrained by observations, and is instead routinely simplified as a smooth, spherical inflow of very hot gas. Recent theory and simulations instead predict that accretion can be dominated by a stochastic, clumpy distribution of very cold molecular clouds - a departure from the "hot mode" accretion model - although unambiguous observational support for this prediction remains elusive. Here we report observations that reveal a cold, clumpy accretion flow towards a supermassive black hole fuel reservoir in the nucleus of the Abell 2597 Brightest Cluster Galaxy (BCG), a nearby (redshift z=0.0821) giant elliptical galaxy surrounded by a dense halo of hot plasma. Under the right conditions, thermal instabilities can precipitate from this hot gas, producing a rain of cold clouds that fall toward the galaxy's centre, sustaining star formation amid a kiloparsec-scale molecular nebula that inhabits its core. The observations show that these cold clouds also fuel black hole accretion, revealing "shadows" cast by the molecular clouds as they move inward at about 300 kilometres per second towards the active supermassive black hole in the galaxy centre, which serves as a bright backlight. Corroborating evidence from prior observations of warmer atomic gas at extremely high spatial resolution, along with simple arguments based on geometry and probability, indicate that these clouds are within the innermost hundred parsecs of the black hole, and falling closer towards it

An interlaboratory study of TEX86 and BIT analysis using high-performance liquid chromatography–mass spectrometry

Author Posting. © American Geophysical Union, 2009. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Geochemistry Geophysics Geosystems 10 (2009): Q03012, doi:10.1029/2008GC002221.Recently, two new proxies based on the distribution of glycerol dialkyl glycerol tetraethers (GDGTs) were proposed, i.e., the TEX86 proxy for sea surface temperature reconstructions and the BIT index for reconstructing soil organic matter input to the ocean. In this study, fifteen laboratories participated in a round robin study of two sediment extracts with a range of TEX86 and BIT values to test the analytical reproducibility and repeatability in analyzing these proxies. For TEX86 the repeatability, indicating intra-laboratory variation, was 0.028 and 0.017 for the two sediment extracts or ±1–2°C when translated to temperature. The reproducibility, indicating among-laboratory variation, of TEX86 measurements was substantially higher, i.e., 0.050 and 0.067 or ±3–4°C when translated to temperature. The latter values are higher than those obtained in round robin studies of Mg/Ca and U37 k′ paleothermometers, suggesting the need to primarily improve compatibility between labs. The repeatability of BIT measurements for the sediment with substantial amounts of soil organic matter input was relatively small, 0.029, but reproducibility was large, 0.410. This large variance could not be attributed to specific equipment used or a particular data treatment. We suggest that this may be caused by the large difference in the molecular weight in the GDGTs used in the BIT index, i.e., crenarchaeol versus the branched GDGTs. Potentially, this difference gives rise to variable responses in the different mass spectrometers used. Calibration using authentic standards is needed to establish compatibility between labs performing BIT measurements