Teaching Courage: Service Learning at Pathway School

Troubled children are rarely afforded the opportunity to view themselves as valuable and worthy. Because they are often in the role of care-recipients, they are not challenged to be, nor do they see themselves as capable of being, caregivers. Although many child and youth programs seek to provide these opportunities, a systematic and effective program for doing so has been lacking

The early diagnosis of sepsis in the acutely ill cancer patient.

The sepsis syndrome is the systemic response of the body to infection. It develops from the earliest stage, Systemic Inflammatory Response Syndrome sepsis, to severe sepsis, septic shock and multi-organ dysfunction syndrome. The incidence of sepsis is growing and globally accounts for one in ten admissions to Intensive Care Units. The mortality rate for severe sepsis ranges from 25% to 67%. People with cancer are ten times more likely to develop sepsis and having developed it have a higher mortality rate. Early recognition and treatment of sepsis has been demonstrated to improve outcomes. This study sought to improve early recognition of sepsis in cancer patients receiving acute treatment. Nurses and patient assessment were the focus of this study. The design was a prospective multi-method observational study with two interventions: a teaching session for 177 nurses; the introduction of a bedside test - Procalcitonin (PCT-Q), an immunological marker of sepsis. PCT has been shown to be a reliable marker of sepsis. The PCT-Q, has been used since the late 1990s but never by ward nurses. Methods used were: qualitative interviews of ten nurses and a questionnaire survey of 177 nurses pre and post intervention; and a patient database with the PCT-Q test being used 416 times in 320 patients to diagnose sepsis. The study showed that nurses and patients recognise the early changes of deterioration before their observations change. Nurses recognise these changes because they know their patients well. Nurses' knowledge improved in several areas during the study and they used PCT-Q appropriately, diagnosing sepsis at an early stage in 66% of cases. Ordinal multi-regression analysis demonstrated that PCT was more reliable than CRP and, used together with a low WBC and high lactate, accurately predicts sepsis

Evolutionary tracks for Betelgeuse

We have constructed a series of non-rotating quasi-hydrostatic evolutionary models for the M2 Iab supergiant Betelgeuse ($\alpha~Orionis$). Our models are constrained by multiple observed values for the temperature, luminosity, surface composition and mass loss for this star, along with the parallax distance and high resolution imagery that determines its radius. We have then applied our best-fit models to analyze the observed variations in surface luminosity and the size of detected surface bright spots as the result of up-flowing convective material from regions of high temperature in the surface convective zone. We also attempt to explain the intermittently observed periodic variability in a simple radial linear adiabatic pulsation model. Based upon the best fit to all observed data, we suggest a best progenitor mass estimate of $20 ^{+5}_{-3} M_\odot$ and a current age from the start of the zero-age main sequence of $8.0 - 8.5$ Myr based upon the observed ejected mass while on the giant branch.Comment: 27 pages, 11 figures, Revised per referee suggestions, Accepted for publication in the Astrophysical Journa

Home management of lower limb lymphoedema with an intermittent pneumatic compression device: a feasibility study

Background Lymphoedema is a chronic condition that causes swelling in the body tissues. Presently, there is no cure for lymphoedema; instead, current treatment is aimed at lifelong management to help control symptoms. Intermittent pneumatic compression (IPC) therapy can be considered as an adjunct to standard lymphoedema care; however, research regarding the efficacy of this treatment modality is limited. Methods Twenty participants were recruited from an outpatient lymphoedema clinic (South Wales, UK) to a feasibility randomised control trial designed to evaluate the efficacy of an IPC device (LymphAssist, Huntleigh Healthcare) in reducing lower limb volume. The primary objective was to assess feasibility in terms of (1) study feasibility, including recruitment, retention and assessment of outcome measures, and (2) intervention feasibility, including intervention fidelity and acceptability to participants. Participants were randomly assigned to a control group (n = 10) or intervention group (n = 10). The control group received their standard lymphoedema care only for a 6-month period, whereas the intervention group received their standard lymphoedema care plus an IPC device to use for 6 months. A bilateral lower limb assessment and quality of life survey were undertaken at baseline and 3- and 6-month time points. Results The study recruited to target within the planned time frame with a retention rate of 80%. Issues relating to potential recruitment bias and study attrition were identified and possible solutions explored. In addition, supplementary primary outcome measures that are important to the study population were identified and will be incorporated into the design of future studies. Conclusion This feasibility study identified that a larger randomised controlled trial investigating the efficacy of home use IPC devices is feasible with modifications to the study protocol. Trial registration This trial is registered with clinicaltrials.gov (NCT03825263)

Challenges in Enforcing Home Smoking Rules in a Low-Income Population: Implications for Measurement and Intervention Design

Smoke-free homes reduce exposure to secondhand smoke, contribute to lower levels of consumption, and help smokers to quit. Even when home smoking rules are established however, they may not be consistently enforced

A Minimal Intervention to Promote Smoke-Free Homes among 2-1-1 Callers: North Carolina Randomized Effectiveness Trial

This study examined the extent to which delivery of the minimal Smoke-Free Homes intervention by trained 2-1-1 information and referral specialists had an effect on the adoption of home smoking bans in low-income households. A randomized controlled trial was conducted among 2-1-1 callers (n = 500) assigned to control or intervention conditions. 2-1-1 information and referral specialists collected baseline data and delivered the intervention consisting of 3 mailings and 1 coaching call; university-based data collectors conducted follow-up interviews at 3 and 6 months post-baseline. Data were collected from June 2013 through July 2014. Participants were mostly female (87.2%), African American (61.4%), and smokers (76.6%). Participants assigned to the intervention condition were more likely than controls to report a full ban on smoking in the home at both 3- (38.1% vs 19.3%, p = < .001) and 6-month follow-up (43.2% vs 33.2%, p = .02). The longitudinal intent-to-treat analysis showed a significant intervention effect over time (OR = 1.31, p = .001), i.e. OR = 1.72 at 6 months. This study replicates prior findings showing the effectiveness of the minimal intervention to promote smoke-free homes in low-income households, and extends those findings by demonstrating they can be achieved when 2-1-1 information and referral specialists deliver the intervention. Findings offer support for this intervention as a generalizable and scalable model for reducing secondhand smoke exposure in homes

Monosomal Karyotype at the Time of Diagnosis or Transplantation Predicts Outcomes of Allogeneic Hematopoietic Cell Transplantation in Myelodysplastic Syndrome

AbstractVarious cytogenetic risk scoring systems may determine prognosis for patients with myelodysplastic syndromes (MDS). We evaluated 4 different risk scoring systems in predicting outcome after allogeneic hematopoietic cell transplantation (alloHCT). We classified 124 patients with MDS using the International Prognostic Scoring System (IPSS), the revised International Prognostic Scoring System (R-IPSS), Armand's transplantation-specific cytogenetic grouping, and monosomal karyotype (MK) both at the time of diagnosis and at alloHCT. After adjusting for other important factors, MK at diagnosis (compared with no MK) was associated with poor 3-year disease-free survival (DFS) (27% [95% confidence interval, 12% to 42%] versus 39% [95% confidence interval, 28% to 50%], P = .02) and overall survival (OS) (29% [95% confidence interval, 14% to 44%] versus 47% [95% confidence interval, 36% to 59%], P = .02). OS but not DFS was affected by MK at alloHCT. MK frequency was uncommon in low-score R-IPPS and IPSS. Although IPSS and R-IPSS discriminated good/very good groups from poor/very poor groups, patients with intermediate-risk scores had the worst outcomes and, therefore, these scores did not show a progressive linear discriminating trend. Cytogenetic risk score change between diagnosis and alloHCT was uncommon and did not influence OS. MK cytogenetics in MDS are associated with poor survival, suggesting the need for alternative or intensified approaches to their treatment

The truth behind food and cancer: Simple explanations based on scientific evidence

Background: Specialist oncology dietetic care is lacking in Ireland. This results in knowledge gaps that are filled by unreliable information from unqualified outlets such as the media and alternative-health providers, who promote complementary/alternative medicine (CAM). The aim of this resource is to provide cancer survivors with up-to-date, evidence-based information on cancer and nutrition. Methods: Common myths about nutrition and cancer and the most popular CAM used by Irish cancer survivors were included. National cancer organisations were also reviewed. To ensure readability, content was written according to the National Adult Literacy Agency recommendations, and peer-reviewed by other dietitians. Patient feedback was sought from patient advocates. Funding was secured from Breakthrough Cancer Research to print 20,000 copies for free distribution. Results: ‘The Truth Behind Food and Cancer: Simple Explanations based on Scientific Evidence’ is a coloured printed resource written by dietitians. It discussed popular diet-based CAM and food avoidance patterns practiced by patients with cancer and provides an evidence-based response to myths and unproven dietary strategies. Conclusion: Following a restrictive dietary strategy can place vulnerable cancer patients at an even greater risk of malnutrition and its debilitating effects. Research shows that a significant number of cancer survivors turn to unproven dietary strategies in the absence of dietetic care or reliable resources