Radiofrequente ablatiebehandeling van de oudere patiënte met een mammacarcinoom

Het mammacarcinoom is een belangrijk gezondheidsprobleem in de in omvang toenemende geriatrische populatie. De behandeling van deze fragiele groep patiënten is een uitdaging voor de behandelend arts. Enerzijds geeft onderbehandeling aanleiding tot een hogere incidentie van recidief tumoren alsook tumorgerelateerde mortaliteit. Anderzijds leidt overbehandeling tot iatrogene morbiditeit en mortaliteit. Minimaal invasieve behandelingstechnieken worden in toenemende mate in de literatuur beschreven en bieden nieuwe therapeutische mogelijkheden voor patiënten die niet voor conventionele chirurgie in aanmerking komen. Bij diverse minimaal invasieve tumor ablatie technieken wordt een maligne laesie onder controle van de beeldvormende technieken selectief behandeld met een minimale schade aan het omliggende weefsel en een goede lokale tumorcontrole. De procedure kan plaatsvinden onder lokale anesthesie. Radiofrequente ablatie lijkt een effectieve en veilige methode in de behandeling van oudere, inoperabele patiënten met kleinere (< 3 cm) mamma tumoren

Transformative Autoethnography: An Examination of Cultural Identity and its Implications for Learners

The cultural experiences of minority learners are often omitted from the formal curriculum leading to exclusion and a sense of cultural loss. In this study, the researcher’s lived experience serves as the basis to develop a novel research strategy: transformative autoethnography. The researcher uses the method of autoethnography to more deeply understand his roles as Chickasaw and adult educator, amplified by his unique role as the developer of a tribal learning community situated at a research university. This immersive experience serves as the context for self-reflection, which includes an educational history marred by my perceptions of Whiteness and lack of cultural connectedness. Transformative learning theory serves as the theoretical framework by which the author comes to appreciate the intersection of culture, identity, and meaning. The research context is triangulated with the experiences of other Chickasaws, including learning community participants, providing an autoethnography steeped in phenomenological thought. This credible qualitative account serves as a roadmap for the educational journeys of Native Americans and other minority adult learners and the educators, advisors, and program developers who strive to support them.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Challenges and priorities for river cetacean conservation

River cetaceans are particularly vulnerable to anthropogenic impacts due to their constrained ranges in freshwater systems of China, South Asia, and South America. We undertook an exhaustive review of 280 peer-reviewed papers and grey literature reports (1998-2020) to examine the current status of knowledge regarding these cetaceans and their conservation. We aimed to better understand the scale of threats they face, and to identify and propose priority future efforts to better conserve these species. We found that the species have been studied with varying frequency and that most of the research on threats has focused on habitat degradation and fragmentation (43%, mainly driven by dams and extractive activities such as sand mining and deforestation), and fishery interactions (39%, in the form of bycatch and direct take). These threats occur across all species, but more information is needed, primarily on quantifying the population impacts as a basis for designing mitigation measures. Other threats identified include pollution, vessel collisions, traditional use, and poorly managed tourism. Emerging methods such as environmental DNA and unmanned aerial vehicles are described for studying these species. Promising conservation interventions include cetacean-specific protected areas, natural ex situ protection, community-led conservation, and education programmes. However, transnational political will is required for a step change towards broad-scale protection in freshwater environments. In addition, we propose increasing capacity building, developing management plans, working closely with fishing communities, enhancing public awareness, expanding regional collaborations, and diversifying funding

To see or not to see: investigating detectability of Ganges River dolphins using a combined visual-acoustic survey

Detection of animals during visual surveys is rarely perfect or constant, and failure to account for imperfect detectability affects the accuracy of abundance estimates. Freshwater cetaceans are among the most threatened group of mammals, and visual surveys are a commonly employed method for estimating population size despite concerns over imperfect and unquantified detectability. We used a combined visual-acoustic survey to estimate detectability of Ganges River dolphins (Platanista gangetica gangetica) in four waterways of southern Bangladesh. The combined visual-acoustic survey resulted in consistently higher detectability than a single observer-team visual survey, thereby improving power to detect trends. Visual detectability was particularly low for dolphins close to meanders where these habitat features temporarily block the view of the preceding river surface. This systematic bias in detectability during visual-only surveys may lead researchers to underestimate the importance of heavily meandering river reaches. Although the benefits of acoustic surveys are increasingly recognised for marine cetaceans, they have not been widely used for monitoring abundance of freshwater cetaceans due to perceived costs and technical skill requirements. We show that acoustic surveys are in fact a relatively cost-effective approach for surveying freshwater cetaceans, once it is acknowledged that methods that do not account for imperfect detectability are of limited value for monitoring

Mitogenomic phylogenetic analyses of the Delphinidae with an emphasis on the Globicephalinae

BACKGROUND: Previous DNA-based phylogenetic studies of the Delphinidae family suggest it has undergone rapid diversification, as characterised by unresolved and poorly supported taxonomic relationships (polytomies) for some of the species within this group. Using an increased amount of sequence data we test between alternative hypotheses of soft polytomies caused by rapid speciation, slow evolutionary rate and/or insufficient sequence data, and hard polytomies caused by simultaneous speciation within this family. Combining the mitogenome sequences of five new and 12 previously published species within the Delphinidae, we used Bayesian and maximum-likelihood methods to estimate the phylogeny from partitioned and unpartitioned mitogenome sequences. Further ad hoc tests were then conducted to estimate the support for alternative topologies. RESULTS: We found high support for all the relationships within our reconstructed phylogenies, and topologies were consistent between the Bayesian and maximum-likelihood trees inferred from partitioned and unpartitioned data. Resolved relationships included the placement of the killer whale (Orcinus orca) as sister taxon to the rest of the Globicephalinae subfamily, placement of the Risso's dolphin (Grampus griseus) within the Globicephalinae subfamily, removal of the white-beaked dolphin (Lagenorhynchus albirostris) from the Delphininae subfamily and the placement of the rough-toothed dolphin (Steno bredanensis) as sister taxon to the rest of the Delphininae subfamily rather than within the Globicephalinae subfamily. The additional testing of alternative topologies allowed us to reject all other putative relationships, with the exception that we were unable to reject the hypothesis that the relationship between L. albirostris and the Globicephalinae and Delphininae subfamilies was polytomic. CONCLUSION: Despite their rapid diversification, the increased sequence data yielded by mitogenomes enables the resolution of a strongly supported, bifurcating phylogeny, and a chronology of the divergences within the Delphinidae family. This highlights the benefits and potential application of large mitogenome datasets to resolve long-standing phylogenetic uncertainties

Regulation of phosphorylase kinase by low concentrations of Ca ions upon muscle contraction: the connection between metabolism and muscle contraction and the connection between muscle physiology and Ca-dependent signal transduction

It had long been one of the crucial questions in muscle physiology how glycogenolysis is regulated in connection with muscle contraction, when we found the answer to this question in the last half of the 1960s. By that time, the two principal currents of muscle physiology, namely, the metabolic flow starting from glycogen and the mechanisms of muscle contraction, had already been clarified at the molecular level thanks to our senior researchers. Thus, the final question we had to answer was how to connect these two currents. We found that low concentrations of Ca ions (10−7–10−4 M) released from the sarcoplasmic reticulum for the regulation of muscle contraction simultaneously reversibly activate phosphorylase kinase, the enzyme regulating glycogenolysis. Moreover, we found that adenosine 3′,5′-monophosphate (cyclic AMP), which is already known to activate muscle phosphorylase kinase, is not effective in the absence of such concentrations of Ca ions. Thus, cyclic AMP is not effective by itself alone and only modifies the activation process in the presence of Ca ions (at that time, cyclic AMP-dependent protein kinase had not yet been identified). After a while, it turned out that our works have not only provided the solution to the above problem on muscle physiology, but have also been considered as the first report of Ca-dependent protein phosphorylation, which is one of the central problems in current cell biology. Phosphorylase kinase is the first protein kinase to phosphorylate a protein resulting in the change in the function of the phosphorylated protein, as shown by Krebs and Fischer. Our works further showed that this protein kinase is regulated in a Ca-dependent manner. Accordingly, our works introduced the concept of low concentrations of Ca ions, which were first identified as the regulatory substance of muscle contraction, to the vast field of Ca biology including signal transduction

Interactions between marine megafauna and plastic pollution in Southeast Asia

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record Southeast (SE) Asia is a highly biodiverse region, yet it is also estimated to cumulatively contribute a third of the total global marine plastic pollution. This threat is known to have adverse impacts on marine megafauna, however, understanding of its impacts has recently been highlighted as a priority for research in the region. To address this knowledge gap, a structured literature review was conducted for species of cartilaginous fishes, marine mammals, marine reptiles, and seabirds present in SE Asia, collating cases on a global scale to allow for comparison, coupled with a regional expert elicitation to gather additional published and grey literature cases which would have been omitted during the structured literature review. Of the 380 marine megafauna species present in SE Asia, but also studied elsewhere, we found that 9.1 % and 4.5 % of all publications documenting plastic entanglement (n = 55) and ingestion (n = 291) were conducted in SE Asian countries. At the species level, published cases of entanglement from SE Asian countries were available for 10 % or less of species within each taxonomic group. Additionally, published ingestion cases were available primarily for marine mammals and were lacking entirely for seabirds in the region. The regional expert elicitation led to entanglement and ingestion cases from SE Asian countries being documented in 10 and 15 additional species respectively, highlighting the utility of a broader approach to data synthesis. While the scale of the plastic pollution in SE Asia is of particular concern for marine ecosystems, knowledge of its interactions and impacts on marine megafauna lags behind other areas of the world, even after the inclusion of a regional expert elicitation. Additional funding to help collate baseline data are critically needed to inform policy and solutions towards limiting the interactions of marine megafauna and plastic pollution in SE Asia.National Research Foundation, Prime Minister’s Office (Singapore) and the Natural Environment Research Council (United Kingdom)National Research Foundation, Prime Minister’s Office (Singapore) and the Natural Environment Research Council (United Kingdom

Non-technical Skills in Healthcare

AbstractNon-technical Skills (NTS) are a set of generic cognitive and social skills, exhibited by individuals and teams, that support technical skills when performing complex tasks. Typical NTS training topics include performance shaping factors, planning and preparation for complex tasks, situation awareness, perception of risk, decision-making, communication, teamwork and leadership. This chapter provides a framework for understanding these skills in theory and practice, how they interact, and how they have been applied in healthcare, as well as avenues for future research