Student Satisfaction and Quality Improvement for an Alzheimer’s Virtual Interprofessional Training (AVIT) Program

Learning Objectives Identify key areas of focus for addressing student satisfaction in 3-DVW IPE simulations Discuss specific quality improvement strategies targeting student satisfaction and engagement based on the Flexible Learning Model Apply findings of the continuous quality improvement (CQI) strategies used in the AVIT 3-D virtual world simulation to their own approaches to CQI for virtual simulation

Evaluation of lymphatic vessel dilatations by anterior segment swept-source optical coherence tomography: Case report

Background: Conjunctival lymphangiectasia is a rare condition presumably caused by the obstruction of lymphatic channels or by an abnormal connection between conjunctival lymphatic and blood vessels. Diagnosis is based on clinical appearance and histology. We report a case of conjunctival lymphangiectasia in which anterior segment optical coherence tomography (OCT) was used to assist the diagnosis and the planning of the biopsy location. Case presentation: A 31-year-old woman was referred with repeated episodes of conjunctival "hemorrhages" and chemosis with extended recovery periods over the last months. Other symptoms were dryness, redness, burning sensation and itching. Photo documentation, anterior segment OCT, ultrasound, computer tomography (CT) and magnetic resonance imaging (MRI) of the brain were performed. MRI revealed dilated atypical Virchow-Robin space (VRS). Conjunctival biopsy was taken and the location of the biopsy was selected based on OCT findings. Based on the clinical appearance we suspected the case to be conjunctival lymphangiectasia or lymphangioma. Histology and immunhistochemistry confirmed the diagnosis of conjunctival lymphangiectasia. Conclusions: Anterior segment OCT is a non-invasive tool, useful in the evaluation of conjunctival lesions and planning surgery. © 2017 The Author(s)

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Hållbar utveckling i förskolan : en intervjustudie om förskollärares syn på sitt arbete med hållbar utveckling

Syftet med denna studie är att undersöka förskollärares uppfattningar om begreppet hållbar utveckling och hur denna uppfattning ligger till grund för hur de arbetar med begreppet i förskolan. Som metod för studien används kvalitativa intervjuer där förskollärare av olika kön, i olika åldrar och på två olika förskolor intervjuas. Tidigare forskning visar att det finns många olika sätt att arbeta med hållbar utveckling i förskolan. Denna studie utgår från att hållbar utveckling består av tre olika delar; en ekologisk, en social och en ekonomisk del. Resultatet visar att förskollärarna har god kännedom om begreppet hållbar utveckling men att det inte är ett begrepp de använder. Frågan vi ställer oss är om förskollärarnas tolkning av begreppet hållbar utveckling har någon betydelse för hur de arbetar med ett lärande för hållbar utveckling i förskolan. Det visar sig att majoriteten av förskollärarna förknippar hållbar utveckling med alla tre delarna; den ekologiska, den sociala och den ekonomiska delen. De anser sig dock inte arbeta med alla delarna. Samtliga förskollärare säger sig arbeta med den ekologiska delen. Studien visar att trots att samtliga förskollärare arbetar med den sociala delen av hållbar utveckling, anser inte alla att det är lärande för hållbar utveckling som ligger till grund för detta arbete

Hållbar utveckling i förskolan : en intervjustudie om förskollärares syn på sitt arbete med hållbar utveckling

Syftet med denna studie är att undersöka förskollärares uppfattningar om begreppet hållbar utveckling och hur denna uppfattning ligger till grund för hur de arbetar med begreppet i förskolan. Som metod för studien används kvalitativa intervjuer där förskollärare av olika kön, i olika åldrar och på två olika förskolor intervjuas. Tidigare forskning visar att det finns många olika sätt att arbeta med hållbar utveckling i förskolan. Denna studie utgår från att hållbar utveckling består av tre olika delar; en ekologisk, en social och en ekonomisk del. Resultatet visar att förskollärarna har god kännedom om begreppet hållbar utveckling men att det inte är ett begrepp de använder. Frågan vi ställer oss är om förskollärarnas tolkning av begreppet hållbar utveckling har någon betydelse för hur de arbetar med ett lärande för hållbar utveckling i förskolan. Det visar sig att majoriteten av förskollärarna förknippar hållbar utveckling med alla tre delarna; den ekologiska, den sociala och den ekonomiska delen. De anser sig dock inte arbeta med alla delarna. Samtliga förskollärare säger sig arbeta med den ekologiska delen. Studien visar att trots att samtliga förskollärare arbetar med den sociala delen av hållbar utveckling, anser inte alla att det är lärande för hållbar utveckling som ligger till grund för detta arbete

Cbfa1/Runx2 expression in an ossifying basal cell carcinoma of the eyelid

A case of basal cell carcinoma (BCC) with intratumoural bone formation affecting the eyelid of a 77-year-old lady is described. Bone formation in BCCs is an uncommon event. We revised the 23 cases described in the literature: most of them occurred on the face. The pathophysiological mechanism responsible for ossification in cutaneous lesions remains unclear. The bone often develops adjacent to, or within hair follicles. We evaluated the immunohistochemical expression in the present case of Cbfa1/Runx2, an early marker for osteoblastic progenitor cells. A well-developed lamellar bone with adipose bone marrow was observed both in the superficial stroma and intratumourally. Cbfa1/Runx2 was localised in the osteocytes of the heterotopic bone and in the keratin cysts of the BCC. The expression of Cbfa1/Runx2 in the present BCC suggests a possible role of this protein in the induction of the heterotopic bone

Impact of an Interprofessional Alzheimer\u27s 3-D Virtual Training on Student Knowlege Confidence

Three dimensional virtual worlds (3-DVW) provide meaningful opportunities for students to practice communication with patients and other providers in a safe, low stakes environment

Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data

Background: General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care. Methods: For this meta-analysis, patient-level data were pooled from all patients included in randomised trials in PuMed published between Jan 1, 2010, and May 31, 2017, that compared endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischaemic stroke patients (HERMES Collaboration). The primary outcome was functional outcome assessed by ordinal analysis of the modified Rankin scale (mRS) at 90 days in the GA and non-GA subgroups of patients treated with endovascular therapy versus those patients treated with standard care, adjusted for baseline prognostic variables. To account for between-trial variance we used mixed-effects modelling with a random effect for trials incorporated in all models. Bias was assessed using the Cochrane method. The meta-analysis was prospectively designed, but not registered. Findings: Seven trials were identified by our search; of 1764 patients included in these trials, 871 were allocated to endovascular thrombectomy and 893 were assigned standard care. After exclusion of 74 patients (72 did not undergo the procedure and two had missing data on anaesthetic strategy), 236 (30%) of 797 patients who had endovascular procedures were treated under GA. At baseline, patients receiving GA were younger and had a shorter delay between stroke onset and randomisation but they had similar pre-treatment clinical severity compared with patients who did not have GA. Endovascular thrombectomy improved functional outcome at 3 months both in patients who had GA (adjusted common odds ratio (cOR) 1·52, 95% CI 1·09–2·11, p=0·014) and in those who did not have GA (adjusted cOR 2·33, 95% CI 1·75–3·10, p&lt;0·0001) versus standard care. However, outcomes were significantly better for patients who did not receive GA versus those who received GA (covariate-adjusted cOR 1·53, 95% CI 1·14–2·04, p=0·0044). The risk of bias and variability between studies was assessed to be low. Interpretation: Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons