Low socioeconomic status is associated with worse survival in children with cancer: A systematic review

Background: While low socioeconomic status (SES) has been associated with inferior cancer outcome among adults, its impact in pediatric oncology is unclear. Our objective was therefore to conduct a systematic review to determine the impact of SES upon outcome in children with cancer. Methods: We searched Ovid Medline, EMBASE and CINAHL from inception to December 2012. Studies for which survival-related outcomes were reported by socioeconomic subgroups were eligible for inclusion. Two reviewers independently assessed articles and extracted data. Given anticipated heterogeneity, no quantitative meta-analyses were planned a priori. Results: Of 7,737 publications, 527 in ten languages met criteria for full review; 36 studies met final inclusion criteria. In low- and middle-income countries (LMIC), lower SES was uniformly associated with inferior survival, regardless of the measure chosen. The majority of associations were statistically significant. Of 52 associations between socioeconomic variables and outcome among high-income country (HIC) children, 38 (73.1%) found low SES to be associated with worse survival, 15 of which were statistically significant. Of the remaining 14 (no association or high SES associated with worse survival), only one was statistically significant. Both HIC studies examining the effect of insurance found uninsured status to be statistically associated with inferior survival. Conclusions: Socioeconomic gradients in which low SES is associated with inferior childhood cancer survival are ubiquitous in LMIC and common in HIC. Future studies should elucidate mechanisms underlying these gradients, allowing the design of interventions mediating socioeconomic effects. Targeting the effect of low SES will allow for further improvements in childhood cancer survival. © 2014 Gupta et al

Antenatal Steroid Therapy for Fetal Lung Maturation and the Subsequent Risk of Childhood Asthma: A Longitudinal Analysis

This study was designed to test the hypothesis that fetal exposure to corticosteroids in the antenatal period is an independent risk factor for the development of asthma in early childhood with little or no effect in later childhood. A population-based cohort study of all pregnant women who resided in Nova Scotia, Canada, and gave birth to a singleton fetus between 1989 and 1998 was undertaken. After a priori specified exclusions, 80,448 infants were available for analysis. Using linked health care utilization records, incident asthma cases developed after 36 months of age were identified. Extended Cox proportional hazards models were used to estimate hazard ratios while controlling for confounders. Exposure to corticosteroids during pregnancy was associated with a risk of asthma in childhood between 3–5 years of age: adjusted hazard ratio of 1.19 (95% confidence interval: 1.03, 1.39), with no association noted after 5 years of age: adjusted hazard ratio for 5–7 years was 1.06 (95% confidence interval: 0.86, 1.30) and for 8 or greater years was 0.74 (95% confidence interval: 0.54, 1.03). Antenatal steroid therapy appears to be an independent risk factor for the development of asthma between 3 and 5 years of age

Farmers’ management of functional biodiversity goes beyond pest management in organic European apple orchards

Supporting functional biodiversity (FB), which provides natural pest regulation, is an environmentally sound and promising approach to reduce pesticide use in perennial cultures such as apple, especially in organic farming. However, little is known about farmers’ practices and motivations to implement techniques that favor FB, especially whether or not they really expect anything from FB in terms of pest regulation. In fact, FB-supporting techniques (FB-techniques) are massively questioned by practitioners due to inadequate information about their effectiveness. An interview survey was performed in eight European countries(i) to describe farmers’ practices and identify promising FB-techniques: (ii) to better understand their perceptions of and values associated with FB; and (iii) to identify potential drivers of (non-)adoption. Fifty-five advisors and 125 orchard managers with various degrees of experience and convictions about FB were interviewed and a total of 24 different FB-techniques which can be assigned to three different categories (ecological infrastructures, farming practices and redesign techniques) were described. Some were well-established measures (e.g., hedges and bird houses), while others were more marginal and more recent (e.g., animal introduction and compost). On average, farmers combined more than four techniques that had been implemented over a period of 13 years, especially during their establishment or conversion period. In general, it was difficult for farmers to evaluate the effectiveness of individual FB-techniques on pest regulation. They considered FB-techniques as a whole, targeting multiple species, and valued multiple ecosystem services in addition to pest regulation. The techniques implemented and their associated values differed among farmers who adopted various approaches towards FB. Three different approaches were defined: passive, active and integrated. Their appraisal of FB is even more complex because it may change with time and experience. These findings provide empirical evidence that the practical implementation of promising techniques remains a challenge, considering the diversity of situations and evaluation criteria. Increased cooperation between researchers, farmers and advisors should more effectively target research, advisory support and communication to meet farmers’ needs and perceptions

Formality and informality in the summative assessment of motor vehicle apprentices: a case study

This article explores the interaction of formal and informal attributes of competence‐based assessment. Specifically, it presents evidence from a small qualitative case study of summative assessment practices for competence‐based qualifications within apprenticeships in the motor industry in England. The data are analysed through applying an adaptation of a framework for exploring the interplay of formality and informality in learning. This analysis reveals informal mentoring as a significant element which influences not only the process of assessment, but also its outcomes. We offer different possible interpretations of the data and their analysis, and conclude that, whichever interpretation is adopted, there appears to be a need for greater capacity‐building for assessors at a local level. This could acknowledge a more holistic role for assessors; recognise the importance of assessors’ informal practices in the formal retention and achievement of apprentices; and enhance awareness of inequalities that may be reinforced by both informal and formal attributes of assessment practices

Protocol: Evaluating the impact of a nation-wide train-the-trainer educational initiative to enhance the quality of palliative care for children with cancer

Background: There are identified gaps in the care provided to children with cancer based on the self-identified lack of education for health care professionals in pediatric palliative care and in the perceptions of bereaved parents who describe suboptimal care. In order to address these gaps, we will implement and evaluate a national roll-out of Education in Palliative and End-of-Life Care for Pediatrics (EPEC (R)-Pediatrics), using a 'Train-the-Trainer' model.Methods/design: In this study we are using a pre-post-test design and an integrated knowledge translation approach to assess the impact of the educational roll-out in four areas: 1) self-assessed knowledge of health professionals; 2) knowledge dissemination outcomes; 3) practice change outcomes; and 4) quality of palliative care. The quality of palliative care will be assessed using data from three sources: a) parent and child surveys about symptoms, quality of life and care provided; b) health record reviews of deceased patients; and c) bereaved parent surveys about end-of-life and bereavement care. After being trained in EPEC (R)-Pediatrics, 'Master Facilitators' will train 'Regional Teams' affiliated with 16 pediatric oncology programs in Canada. Each team will consist of three to five health professionals representing oncology, palliative care, and the community. Each team member will complete online modules and attend one of two face-to-face conferences, where they will receive training and materials to teach the EPEC (R)-Pediatrics curriculum to 'End-Users' in their region. Regional Teams will also choose a Tailored Implementation of Practice Standards (TIPS) Kit to guide implementation of a quality improvement project in their region; support will be provided via quarterly meetings with Co-Leads and via a listserv and webinars with other teams.Discussion: Through this study we aim to raise the level of pediatric palliative care education amongst health care professionals in Canada. Our study will be a significant step forward in evaluation of the impact of EPEC (R)-Pediatrics both on dissemination outcomes and on care quality at a national level. Based on the anticipated success of our project we hope to expand the EPEC (R)-Pediatrics roll-out to health professionals who care for children with non-oncological life-threatening conditions

Occupy: in theory and practice

This paper situates the discourse of the Occupy movement within the context of radical political philosophy. Our analysis takes place on two levels. First, we conduct an empirical analysis of the ‘official’ publications of Occupy Wall Street (OWS) and Occupy London (OL). Operationalising core concepts from the framing perspective within social movement theory, we provide a descriptive-comparative analysis of the ‘collective action frames’ of OWS and OL. Second, we consider the extent to which radical political philosophy speaks to the discourse of Occupy. Our empirical analysis reveals that both movements share diagnostic frames, but there were notable differences in terms of prognostic framing. The philosophical discussion suggests that there are alignments between anarchist, post-anarchist and post-Marxist ideologies at the level of both identity and strategy. Indeed, the absence of totalising anti-capitalist or anti-statist positions in Occupy suggests that – particularly with Occupy London – alignments are perhaps not so distant from typically social democratic demands

Single-molecule analysis of genome rearrangements in cancer.

Rearrangements of the genome can be detected by microarray methods and massively parallel sequencing, which identify copy-number alterations and breakpoint junctions, but these techniques are poorly suited to reconstructing the long-range organization of rearranged chromosomes, for example, to distinguish between translocations and insertions. The single-DNA-molecule technique HAPPY mapping is a method for mapping normal genomes that should be able to analyse genome rearrangements, i.e. deviations from a known genome map, to assemble rearrangements into a long-range map. We applied HAPPY mapping to cancer cell lines to show that it could identify rearrangement of genomic segments, even in the presence of normal copies of the genome. We could distinguish a simple interstitial deletion from a copy-number loss at an inversion junction, and detect a known translocation. We could determine whether junctions detected by sequencing were on the same chromosome, by measuring their linkage to each other, and hence map the rearrangement. Finally, we mapped an uncharacterized reciprocal translocation in the T-47D breast cancer cell line to about 2 kb and hence cloned the translocation junctions. We conclude that HAPPY mapping is a versatile tool for determining the structure of rearrangements in the human genome

Organic farmers’ reality to manage functional agrobiodiversity in European organic apple orchards

According to its principles and standards, organic farming particularly rely on natural processes and functional agro-biodiversity (FAB) to benefit from essential ecosystem services. However, these processes are mostly complex, hardly visible and site-specific, thereby making it difficult to assess and manage on-farm. A European survey has been carried out among organic farmers and emphasizes the variability among countries with a diversity of techniques targeting different functional groups according to farming contexts and farmers’ expectations. The different criteria used by farmers to evaluate FABtechniques efficiency and implementation potential clearly illustrate the difficulty to assess the agroecosystem as a whole

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population.Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay.Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity.Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes

Online Political Communication Strategies: MEPs, E-Representation, and Self-Representation

Research into the communication strategies of legislators has a long history. The European Parliament offers an opportunity to add to understanding of how legislators prioritize styles of communication, with a comparative perspective across 27 nations. Through content analysis of online communication, we investigate how the Internet is used by members of the European Parliament. Our analysis assesses three communication strategies: homestyle, impression management, and participatory. We find that a homestyle strategy predominates, followed by impression management. Participatory communication is emergent, but may earn legislators political capital, as it appears that proactive communicators who offer participatory opportunities are more likely to build an online following