Developing an Online Collaborative Approach to Global Education in Vocational Contexts

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Atypical Ductal Hyperplasia at the Margin of Lumpectomy Performed for Early Stage Breast Cancer: Is there Enough Evidence to Formulate Guidelines?

Background. Negative margins are associated with a reduced risk of ipsilateral breast tumor recurrence (IBTR) in women with early stage breast cancer treated with breast conserving surgery (BCS). Not infrequently, atypical ductal hyperplasia (ADH) is reported as involving the margin of a BCS specimen, and there is no consensus among surgeons or pathologists on how to approach this diagnosis resulting in varied reexcision practices among breast surgeons. The purpose of this paper is to establish a reasonable approach to guide the treatment of ADH involving the margin after BCS for early stage breast cancer. Methods. the published literature was reviewed using the PubMed site from the US National Library of Medicine. Conclusions. ADH at the margin of a BCS specimen performed for early stage breast cancer is a controversial pathological diagnosis subject to large interobserver variability. There is not enough data evaluating this diagnosis to change current practice patterns; however, it is reasonable to consider reexcision for ADH involving a surgical margin, especially if it coexists with low grade DCIS. Further studies with longer followup and closer attention to ADH at the margin are needed to formulate treatment guidelines

The ornament of grammar

Part of an ongoing research project to interpret linguistic grammar visually, this essay presents initial experiments to visualise rhetorical patterns in English sentences. Creative contextualisation is offered with reference to earlier visual forms that were treated as a kind of language. A certain strand in Modernism - in particular that running through the Bauhaus which used abstract devices as a foundational design syntax - opened the way for post-war picture books to activate the narrative potential of simple coloured shapes; and, again, avant-garde musical scores from the 1950s onwards used exploratory graphic notations to instigate expressive new treatments of sound. My own visualisations are playful in spirit but posit a serious idea that grammar works by means of deep aesthetic tendencies. My case studies - featuring a model user and a model abuser of English - flag up common patterns in typical sentence construction under seven descriptive labels. Ultimately the essay suggests that Illustration might flourish at the level of the sentence, the basic unit of meaning within word-based language and, in very simple terms, the expression of a thought. Ornamenting the rhythm and flow of how a sentence operates is one means of ‘seeing’ a voice give shape to thought

The language of narrative drawing: A close reading of contemporary graphic novels

The study offers an alternative analytical framework for thinking about the contemporary graphic novel as a dynamic area of visual art practice. Graphic narratives are placed within the broad, open-ended territory of investigative drawing, rather than restricted to a special category of literature, as is more usually the case. The analysis considers how narrative ideas and energies are carried across specific examples of work graphically. Using analogies taken from recent academic debate around translation, aspects of Performance Studies, and, finally, common categories borrowed from linguistic grammar, the discussion identifies subtle varieties of creative processing within a range of drawn stories.The study is practice-based in that the questions that it investigates were first provoked by the activity of drawing, and it sustains a dominant interest in practice throughout, pursuing aspects of graphic processing as its primary focus.Chapter 1 applies recent ideas from Translation Studies to graphic narrative, arguing for a more expansive understanding of how process brings about creative evolutions and refines directing ideas.Chapter 2 considers the body as an area of core content for narrative drawing. A consideration of elements of Performance Studies stimulates a reconfiguration of the role of the figure in graphic stories, and selected artists are revisited for the physical qualities of their narrative strategies.Chapter 3 develops the grammatical concept of tense to provide a central analogy for analysing graphic language. The chapter adapts the idea of the graphic ‘confection’ to the territory of drawing to offer a fresh system of analysis and a potential new tool for teaching.The conclusion identifies the study’s contribution to knowledge as twofold: first, in presenting a range of new interpretations of its field; and, second, in its employment of specifically adapted research methods which connect with a wider call for a return to ‘close reading’ as a productively sensitive research tool in its own right

Issue 13: Syrian Refugee Resettlement and the Role of Local Immigration Partnerships (LIPs) in Ontario, Canada

During the peak of the Syrian refugee “crisis” in 2015 and early 2016, the Canadian Federal Government responded with a push to drastically increase the number of Syrian refugees it planned to resettle. The resulting Syrian Refugee Resettlement Initiative (SRRI) put to the test Local Immigration Partnerships (LIPs), a form of place-based policy that had been in place since 2008 where communities collaborate in the support, development and execution of local immigration and refugee resettlement plans. This issue of Policy Points discusses a study of three LIPs (Hamilton, Ottawa, and Waterloo Region) and their response to the SRRI. The research provides three policy insights relevant to refugee and immigrant community resettlement. Bringing the community into the fold through multi stakeholder tables such as LIPs can coordinate local responses to the resettlement of refugees (policy insight 1). LIPs must be embedded in the local community and include leaders and personnel able to build and enhance local stakeholder networks (policy insight 2). Finally, it is key to involve LIPs in communication channels during mass resettlement events (policy insight 3). Policy action under points 2 and 3 will in turn enable LIPs to effectively support refugee resettlement at the local level. The experience of the three Ontario LIPs in this study is relevant to existing and potential new LIPs, but it also offers a unique place-based policy approach to engaging local communities in resettlement at other locations and scales

An investigation of the Ciliary Protein PKHD1 in Cyst development in liver disease: clues to the pathogenesis of Biliary Atresia

Biliary atresia is a common form of paediatric liver disease, with progressive, inflammatory obliteration of the biliary tree, leading to liver failure early in life. Mutations in PKHD1, encoding the ciliary protein fibrocystin, are associated with autosomal recessive polycystic kidney disease (ARPKD), a ciliopathy with clinical features that resemble biliary atresia. The hepatic developmental defects detectable in a significant number of infants with ARPKD are thought to be caused by dysfunction in the structure and function of primary cilia. The pathogenetic mechanism of both disorders is thought to be dysregulation of epithelial cell growth and tubulomorphogenesis. Preliminary investigations uncovered an association of PKHD1 sequence variants in a subset of biliary atresia patients with renal cysts, promoting further investigation to determine the functional role of fibrocystin in epithelial cells from renal and biliary tubules. Immunohistochemical studies, using a monoclonal antibody raised against wildtype fibrocystin, showed that it localises specifically to intrahepatic bile ducts. Absence of fibrocystin staining in end-stage liver tissue reflects ongoing damage to the intrahepatic biliary tree, rather than a phenomenon specific to biliary atresia. Studies utilising the Pkhd1 $^{del2/del2}$ mouse model of ARPKD revealed 17β-estradiol sensitive centrosomal overduplication underlies the dysregulation of epithelial cell growth in renal tubules, however this does not appear to be in synergy with $Pkhd1$ knockdown. Therefore, it remains uncertain whether sequence variants of PKHD1 are associated with biliary atresia

International online collaboration as a boundary crossing activity for vocational educators

The authors acknowledge the support of many colleagues in their respective universities and within partner colleges during this research. Course tutors in Scotland, Dr Margaret Harris and Dr Aileen Ackland, are thanked for their support in implementing COLIGE with their students. Students who completed surveys or provided feedback in other ways are also thanked for their helpful comments. Professor Paul Kirschner kindly engaged in discussions associated with this work and colleagues and anonymous reviewers have provided helpful feedback on draft versions of this paper.Peer reviewedPostprin

The Influence of Patient Exposure to Breast Reconstruction Approaches and Education on Patient Choices in Breast Cancer Treatment.

BackgroundThe landscape of surgical and medical management and patient choices for breast cancer treatment changes as breast reconstruction and oncoplastic approaches improve and diversify. Increased access to breast reconstruction, in addition to patient education, influences the breast cancer patient. Therefore, the examination of the possible impact of reconstructive surgery on all stages of the breast cancer management per se seemed timely.MethodsPlastic surgery consults were arranged for 520 new patients diagnosed with breast cancer (2012-2016) including patients with noninvasive breast cancer but at high risk of further cancer development. To test the plastic surgery impact on patient choices regarding the management of the cancer, a subset of 90 patients was identified to test the plastic surgery impact on patient choices. These patients were referred to plastic surgery, following the first round of consultations by surgical and medical oncologists with only the preliminary oncological management plan defined. After a plastic surgery consultation, but prior to finalization of the overall oncological management plan, they were surveyed on the subject of modification of their personal choices and requests pertaining to their cancer management.ResultsIn this subset of 90 patients 40 (44%) returned to their surgical or medical oncologist considering changes of the primary management plan after their plastic surgery consultation. Twenty-six (28%) ultimately altered their plan, and the following patient-driven changes were made: mastectomy as opposed to lumpectomy (18 patients [20%]), contralateral prophylactic mastectomy (11 patients [12%]), nipple/areola removal as opposed to nipple/areola sparing suggested by the oncologists (5 patients [6%]), oncoplastic breast reduction as part of lumpectomy (5 patients [6%]), and other modifications (3 patients [3%]).ConclusionsDecisions for altering the preliminary oncologic plan or choosing a specific alternative (eg, lumpectomy plus radiation vs mastectomy) resulted from patient education on (1) reconstructive options, (2) aesthetic pitfalls and results. and (3) their interfacing with the oncological outcomes. Ultimately, plastic surgeons influence the multispecialty breast cancer management and patient decision-making process. Therefore, oncological literacy for plastic surgeons is essential to provide state-of-the-art breast cancer care and avoidance of suboptimal patient decisions

Age and cancer type:associations with increased odds of receiving a late diagnosis in people with advanced cancer

PURPOSE: In order to deliver appropriate and timely care planning and minimise avoidable late diagnoses, clinicians need to be aware of which patients are at higher risk of receiving a late cancer diagnosis. We aimed to determine which demographic and clinical factors are associated with receiving a 'late' cancer diagnosis (within the last 12 weeks of life).METHOD: Retrospective cohort study of 2,443 people who died from cancer ('cancer decedents') in 2013-2015. Demographic and cancer registry datasets linked using patient-identifying Community Health Index numbers. Analysis used binary logistic regression, with univariate and adjusted odds ratios (SPSS v25).RESULTS: One third (n = 831,34.0%) received a late diagnosis. Age and cancer type were significantly associated with late cancer diagnosis (p &lt; 0.001). Other demographic factors were not associated with receiving a late diagnosis. Cancer decedents with lung cancer (Odds Ratios presented in abstract are the inverse of those presented in the main text, where lung cancer is the reference category. Presented as 1/(OR multivariate)) were more likely to have late diagnosis than those with bowel (95% Confidence Interval [95%CI] Odds Ratio (OR)1.52 (OR1.12 to 2.04)), breast or ovarian (95%CI OR3.33 (OR2.27 to 5.0) or prostate (95%CI OR9.09 (OR4.0 to 20.0)) cancers. Cancer decedents aged &gt; 85 years had higher odds of late diagnosis (95%CI OR3.45 (OR2.63 to 4.55)), compared to those aged &lt; 65 years.CONCLUSIONS: Cancer decedents who were older and those with lung cancer were significantly more likely to receive late cancer diagnoses than those who were younger or who had other cancer types.</p