CD34‐positive superficial myxofibrosarcoma: a potential diagnostic pitfall

Background Myxofibrosarcoma (MFS) arises most commonly in the proximal extremities of the elderly, where it may involve subcutaneous and dermal tissues and masquerade as benign entities in limited biopsy samples. We encountered such a case, in which positivity for CD34 and morphologic features were initially wrongly interpreted as a ‘low‐fat/fat‐free’ spindle cell/pleomorphic lipoma. Case series have not assessed prevalence of CD34 reactivity among cutaneous examples of MFS. Methods We performed a systematic review of our institution's experience, selecting from among unequivocal MFS resection specimens those superficial cases in which a limited biopsy sample might prove difficult to interpret. These cases were immunostained for CD34 and tabulated for clinicopathologic characteristics. Results After review of all MFS diagnoses over 5 years (n = 56), we identified a study group of superficial MFS for comparison to the index case (total n = 8). Of these, the index and three additional cases (4 of 8, 50%; 2 low, 2 high grade) demonstrated positive staining for CD34 , with diffuse staining of spindled cells including cellular processes. Four additional cases showed no or equivocal/rare staining. Conclusions CD34 positivity should be recognized as prevalent among such cases and should not be inappropriately construed as inveighing against a diagnosis of MFS in favor of benign entities.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98187/1/cup12158.pd

Identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the Theoretical Domains Framework

Background: The Theoretical Domains Framework (TDF) was developed to investigate determinants of specific clinical behaviors and inform the design of interventions to change professional behavior. This framework was used to explore the beliefs of chiropractors in an American Provider Network and two Canadian provinces about their adherence to evidence-based recommendations for spine radiography for uncomplicated back pain. The primary objective of the study was to identify chiropractors’ beliefs about managing uncomplicated back pain without xrays and to explore barriers and facilitators to implementing evidence-based recommendations on lumbar spine xrays. A secondary objective was to compare chiropractors in the United States and Canada on their beliefs regarding the use of spine x-rays. Methods: Six focus groups exploring beliefs about managing back pain without x-rays were conducted with a purposive sample. The interview guide was based upon the TDF. Focus groups were digitally recorded, transcribed verbatim, and analyzed by two independent assessors using thematic content analysis based on the TDF. Results: Five domains were identified as likely relevant. Key beliefs within these domains included the following: conflicting comments about the potential consequences of not ordering x-rays (risk of missing a pathology, avoiding adverse treatment effects, risks of litigation, determining the treatment plan, and using x-ray-driven techniques contrasted with perceived benefits of minimizing patient radiation exposure and reducing costs; beliefs about consequences); beliefs regarding professional autonomy, professional credibility, lack of standardization, and agreement with guidelines widely varied (social/professional role & identity); the influence of formal training, colleagues, and patients also appeared to be important factors (social influences); conflicting comments regarding levels of confidence and comfort in managing patients without x-rays (belief about capabilities); and guideline awareness and agreements (knowledge). Conclusions: Chiropractors’ use of diagnostic imaging appears to be influenced by a number of factors. Five key domains may be important considering the presence of conflicting beliefs, evidence of strong beliefs likely to impact the behavior of interest, and high frequency of beliefs. The results will inform the development of a theorybased survey to help identify potential targets for behavioral-change strategies

S100A6 preferentially labels type C nevus cells and nevic corpuscles: additional support for Schwannian differentiation of intradermal nevi

Melanocytic nevi typically show a morphologic sequence of maturation from epithelioid “type A” cells to fusiform, Schwann cell-like “type C” cells with dermal descent. Nevi may also produce Wagner-Meissner-like structures (nevic corpuscles). Previous studies have shown that this maturation of intradermal nevi recapitulates intermediate stages in Schwann cell development. In intradermal nevi, we have evaluated the pattern of S100A6 protein, a form of S100 found in Schwann cells. Methods: Formalin-fixed, paraffin-embedded archival tissues were evaluated by immunohistochemistry using antibodies specific for S100A6 and S100B in 38 intradermal nevi (IDN). Ten neurofibromas (NF), 3 Schwannomas (SCH), 2 palisaded and encapsulated neuromas (PEN), and 2 granular cell tumors (GCT) were included as positive controls since these lesions have large numbers of Schwann cells. Results: Melanocytic nevi demonstrated preferential anti-S100A6 staining of “type C” cells (36/38; 28 strong, 8 weak) and nevic corpuscles (25/38; 19 strong, 6 weak) compared to “type A” cells (17/38; 17 weak) and “type B” cells (17/38; 4 strong, 13 weak). All NF, SCH, and PEN stained strongly with anti-S100A6. Both GCT were negative with anti-S100A6 but positive with anti-S100B. Conclusions: The pattern of S100A6 expression in intradermal nevi further supports the hypothesis that maturation in these lesions recapitulates features of Schwann cell differentiation. The lack of S100A6 expression by both GCT suggests that these lesions have lost this feature of Schwann cells, which may play a role in their peculiar phenotypic appearance.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75660/1/j.1600-0560.2001.028008393.x.pd

Linking floral biodiversity with nitrogen and carbon translocations in semi-natural grasslands in Lithuania

© 2015 The Authors. Published by Walter de Gruyter/Sciendo. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1515/eko-2015-0014The aim of the present study is to evaluate the long-term effects of long-term piggery effluent application on semi-natural grassland ecotop-phytotop changes (above- and below-ground phytomass production, and carbon and nitrogen allocation in grassland communities) in relation to changes (or variability) in topsoil properties. Analysis of phytomass distribution in piggery effluent irrigated grassland communities showed that dry biomass yield varied from 1.7-5.3 t ha-1. Variability in soil and plant cover created a unique and highly unpredictable site specific system, where long-term anthropogenic influences established successor communities with specific characteristics of above- and below-ground biomass distribution. These characteristics depend more on grassland communities than on soil chemical properties. Families of grasses (Poaceae) dominated the surveyed communities and accumulated most carbon and least nitrogen, while legumes accumulated most nitrogen and lignin and least carbon. Carbon concentrations in above-ground biomass had minor variations, while accumulation of nitrogen was strongly influenced by species diversity (r = 0.94, n = 10, p <0.001) and production of above-ground biomass.Published versio

A 300-year record of sedimentation in a small tilled catena in Hungary based on δ13C, δ15N, and C/N distribution

Purpose Soil erosion is one of the most serious hazards that endanger sustainable food production. Moreover, it has marked effects on soil organic carbon (SOC) with direct links to global warming. At the same time, soil organic matter (SOM) changes in composition and space could influence these processes. The aim of this study was to predict soil erosion and sedimentation volume and dynamics on a typical hilly cropland area of Hungary due to forest clearance in the early eighteenth century. Materials and methods Horizontal soil samples were taken along two parallel intensively cultivated complex convex-concave slopes from the eroded upper parts at mid-slope positions and from sedimentation in toe-slopes. Samples were measured for SOC, total nitrogen (TN) content, and SOMcompounds (δ13C, δ15N, and photometric indexes). They were compared to the horizons of an in situ non-eroded profile under continuous forest. On the depositional profile cores, soil depth prior to sedimentation was calculated by the determination of sediment thickness. Results and discussion Peaks of SOC in the sedimentation profiles indicated thicker initial profiles, while peaks in C/N ratio and δ13C distribution showed the original surface to be ~ 20 cm lower. Peaks of SOC were presumed to be the results of deposition of SOC-enriched soil from the upper slope transported by selective erosion of finer particles (silts and clays). Therefore, changes in δ13C values due to tillage and delivery would fingerprint the original surface much better under the sedimentation scenario than SOC content. Distribution of δ13C also suggests that the main sedimentation phase occurred immediately after forest clearance and before the start of intense cultivation with maize. Conclusions This highlights the role of relief in sheet erosion intensity compared to intensive cultivation. Patterns of δ13C indicate the original soil surface, even in profiles deposited as sediment centuries ago. The δ13C and C/N decrease in buried in situ profiles had the same tendency as recent forest soil, indicating constant SOM quality distribution after burial. Accordingly, microbiological activity, root uptake, and metabolism have not been effective enough to modify initial soil properties

Using theory to improve low back pain care in Australian Aboriginal primary care: a mixed method single cohort pilot study

Background: Low back pain (LBP) care is frequently discordant with research evidence. This pilot study evaluated changes in LBP care following a systematic, theory informed intervention in a rural Australian Aboriginal Health Service. We aimed to improve three aspects of care; reduce inappropriate LBP radiological imaging referrals, increase psychosocial oriented patient assessment and, increase the provision of LBP self-management information to patients. Methods: Three interventions to improve care were developed using a four-step systematic implementation approach. A mixed methods pre/post cohort design evaluated changes in the three behaviours using a clinical audit of LBP care in a six month period prior to the intervention and then following implementation. In-depth interviews elicited the perspectives of involved General Practitioners (GPs). Qualitative analysis was guided by the theoretical domains framework. Results: The proportion of patients who received guideline inconsistent imaging referrals (GICI) improved from 4.1 GICI per 10 patients to 0.4 (95 % CI for decrease in rate: 1.6 to 5.6) amongst GPs involved in the intervention. Amongst non-participating GPs (locum/part-time GPs who commenced post-interventions) the rate of GICI increased from 1.5 to 4.4 GICI per 10 patients (95 % CI for increase in rate: .5 to 5.3). There was a modest increase in the number of patients who received LBP self-management information from participating GPs and no substantial changes to psychosocial oriented patient assessments by any participants; however GPs qualitatively reported that their behaviours had changed. Knowledge and beliefs about consequences were important behavioural domains related to changes. Environmental and resource factors including protocols for locum staff and clinical tools embedded in patient management software were future strategies identified. Conclusions: A systematic intervention model resulted in partial improvements in LBP care. Determinants of practice change amongst GPs were increased knowledge of clinical guidelines, education delivered by someone considered a trusted source of information, and awareness of the negative consequences of inappropriate practices, especially radiological imaging on patient outcomes. Inconsistent and non-evidence based practices amongst locum GPs was an issue that emerged and will be a significant future challenge. The systematic approach utilised is applicable to other services interested in improving LBP care

Utilising biological geotextiles: Introduction to the BORASSUS project and global perspectives

Field and laboratory studies indicate that utilisation of biological geotextiles constructed from palm-leaves and other selected organic materials are an effective, sustainable and economically viable soil conservation technique. The three-year plus (1 July 2005–28 February 2009) EU-funded BORASSUS Project (contract no. INCO-CT-2005-510745) evaluated the long-term effectiveness of biological geotextiles in controlling soil erosion and assessing their sustainability and economic viability. These studies progressed in ten countries, both in the ‘industrial north’ (in Europe) and in the ‘developing south’ (Africa, South America and South East Asia). The studied countries in the ‘developing south’ included Brazil, China, The Gambia, South Africa, Thailand and Vietnam. The ‘industrial north’ countries included Belgium, Hungary, Lithuania and the UK. The main findings of these studies are summarised in this paper and thematic information is presented in the other four papers in this Special Issue. Biological geotextiles offer potentially novel bioengineering solutions to environmental problems, including technologies for soil conservation, sustainable plant production and use of indigenous plants, improved ecosystem management by decreasing deforestation, improving agroforestry and cost-effective biogeotextile applications in diverse environments. Biogeotextiles may provide socio-economic platforms for sustainable development and the benefits for developing countries may include poverty alleviation, engagement of local people as stakeholders, employment for disadvantaged groups, small and medium enterprise (SME) development, earning hard currency, environmental education and local community involvement in land reclamation and environmental education programmes. These benefits are achieved through: (i) promotion of sustainable and environmentally friendly palm-agriculture to discourage deforestation, promoting both reforestation and agroforestry; (ii) construction of biogeotextiles enabling development of a rural labour-intensive industry, particularly encouraging employment of socially disadvantaged groups and (iii) export of biogeotextiles to industrialised countries could earn hard currency for developing economies, based on the principles of fair trade. Research and development activities of the BORASSUS Project have improved our knowledge on the effect of biogeotextile mats on the micro- and macro-soil environments and at larger scales through controlled laboratory and field experiments in diverse environments

Connecting With Clients in Later Life: The Use of Telebehavioral Health to Address Older Adults’ Mental Health Needs

Telebehavioral health offers a unique opportunity to expand access to mental health services for older clients by addressing systemic barriers that often render mental health care inaccessible in later life. Although health interventions facilitated by technology, including telebehavioral health approaches, proliferated at the start of the COVID-19 pandemic, little guidance exists for counselors seeking to provide such services to clients in later life. In this manuscript, we describe challenges accessing mental health services, how telebehavioral health services can address these barriers, and practical consideration for delivering telebehavioral health approaches for counselors who work with older clients

Comprehensive histopathological comparison of epidermotropic/dermal metastatic melanoma and primary nodular melanoma

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141829/1/his13384.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141829/2/his13384_am.pd