Investigating Disparities in Behavior and Care between Alaska Native and Non-Hispanic White Victims of Sexual Violence: The Importance of Culturally Competent Nursing Care

The purpose of this research was to determine the existence of health care disparities experienced by Alaska Native women victims of sexual violence and to address the need for sexual assault nurse examiners (SANEs) to provide culturally competent care. This was a secondary data analysis of research collected from over 1,600 Alaska SANE surveys between 1996-2006. Variables investigated included: behaviors during examination, condition during assault, time from assault to report, hospital admittance, injuries sustained, and victim-suspect relationships. Alaska Native women were described as having less controlled behavior, being less cooperative, and less likely to be sober; they also often suffered more physically traumatic assaults than non-Hispanic white women victims. This research provides support for the need to include cultural competency training in the preparation curriculum for SANEs working with the Alaska Native population and urges SANEs to collaborate with cultural groups to ensure the delivery of culturally sensitive care

Investigating Disparities in Behavior and Care Between Alaska Native and White Victims of Sexual Violence: The Importance of Culturally Competent Nursing Care

Context: According to Alaska’s former governor the sexual violence issue in the state has become an epidemic. Four out of ten women in Alaska have been victims of sexual assault. The purpose of this research was to determine the existence of health care disparities in the treatment of Alaska Native women victims of sexual violence compared to white women victims and address the need for sexual assault nurse examiners (SANEs) to provide culturally competent nursing care. Objective: The specific research questions addressed in this study compared multiple variables between Alaska Native and white women victims of sexual violence: behaviors during examination, condition during assault, time from assault to report, hospital admittance, injuries experienced, victim-suspect relationship and the decision to engage in intercourse following assault. It was hypothesized that significant differences would be noted between the Alaska Native and white women victims. Design: This was a secondary data analysis of research collected from over 1,600 Alaska Sexual Nurse Examiner surveys conducted by SANEs between 1996-2006. Setting: The SANE examinations were conducted at designated multidisciplinary centers in Anchorage, Homer, Kodiak, Kotzebue, Nome and Soldotna following the occurrence of a sexual assault. Participants: The populations in this research included both the Alaska Native women victims of sexual violence and the white women victims of sexual violence. Interventions: The original data was collected from SANE evaluations to provide supplemental information on sexual assault victimizations. Main Outcome Measures: The original dataset contained 453 variables, but the variables explored in this study included demographic characteristics of victims, assault characteristics, post-assault characteristics, exam characteristics and findings, and suspect characteristics. A univariate analysis was completed to describe the victims’ socio-demographic characteristics (frequencies for categorical variables and descriptive statistics for continuous variables) and a bivariate analysis was performed to test the hypotheses. A level of significance of alpha=0.05 was set to determine statistical significance. Results: Compared to white women, Alaska Natives were less controlled (58% vs. 71%, P=0.000) and less cooperative (72% vs. 81%, P=0.000) during the examination. Alaska Native women were more likely to be alcohol intoxicated at assault (78% vs. 54%, P=0.000) and more likely to experience traumatic injuries (59% vs. 44%, P=0.000). Conclusions: Analysis of the results indicated that the Alaska Native women differ significantly from white women victims in several aspects: different behaviors, reactions to trauma, etc. Cultural competence when caring for Alaska Native victims of sexual violence needs to be a top priority in order to provide these women with high quality, patient-centered care. This research provides support for the need to include cultural competency training in the preparation curriculum for SANEs working with the Alaska Native population and urges SANEs to collaborate with cultural groups to ensure culturally sensitive care

The association of early life socioeconomic conditions with prediabetes and type 2 diabetes: results from the Maastricht study

markdownabstractBackground: Using cross-sectional data from The Maastricht Study, we examined the association of socioeconomic conditions in early life with prediabetes and T2DM in adulthood. We also examined potential mediating pathways via both adulthood socioeconomic conditions and adult BMI and health behaviours. Methods: Of the 3263 participants (aged 40-75 years), 493 had prediabetes and 906 were diagnosed with T2DM. By using logistic regression analyses, the associations and possible mediating pathways were examined. Results: Participants with low early life socioeconomic conditions had a 1.56 times higher odds of prediabetes (95% confidence interval (CI) = 1.21-2.02) and a 1.61 times higher odds of T2DM (95% CI = 1.31-1.99). The relation between low early life socioeconomic conditions and prediabetes was independent of current socioeconomic conditions (OR = 1.38, 95% CI = 1.05-1.80), whereas the relation with T2DM was not independent of current socioeconomic conditions (OR = 1.10, 95% CI = 0.87-1.37). BMI party mediated the association between early life socioeconomic conditions and prediabetes. Conclusions: Socioeconomic inequalities starting in early life were associated with diabetes-related outcomes in adulthood and suggest the usefulness of early life interventions aimed at tackling these inequalities

I-POEMS Listening to the voices of women with a traumatic birth experience

This qualitative study, utilizing a feminist perspective, aimed to explore and articulate women's recall of emotional birth trauma experiences. The reason being that one in every five women has a negative recall of childbirth and one in every nine women has experienced birth as a traumatic event, with sometimes detrimental implications for women and their families. Thirty-six individual narrative interviews with Dutch-speaking women were conducted. Consent was obtained and interviews were audiotaped and fully transcribed. Sentences with the ‘voice of the ‘I’’ were extracted from the transcripts and were constructed into I-poems, showing four key themes: (1) The journey – unmet hopes and expectations of women during pregnancy, birth and thereafter; (2) The ‘I’ in the storm –women’s notions of painful thoughts and memories; (3) The other – women’s responses to the interaction with healthcare professionals; (4) The environment – sensory awareness of the birthingenvironment. The results described and showed the rawness and desolation of women's experiences reflected in their narratives of self, context and in relation to others, maternity care providers in specific. This study showed that acknowledging and listening to women’s voices are of merit to inform (student) midwives and other healthcare professionals who are involved with childbearing women so that the significance of this experience can be understood

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts

Maintenance of Clonogenic KIT+ Human Colon Tumor Cells Requires Secretion of Stem Cell Factor by Differentiated Tumor Cells

Background & Aims Colon tumors contain a fraction of undifferentiated stem cell-like cancer cells with high tumorigenic potential. Little is known about the signals that maintain these stem-like cells. We investigated whether differentiated tumor cells provide support. Methods We established undifferentiated colonosphere cultures from human colon tumors and used them to generate stably differentiated cell lines. Antibody arrays were used to identify secreted factors. Expression of genes involved in stemness, differentiation, and the epithelial to mesenchymal transition was measured using reverse transcription quantitative polymerase chain reaction. Expression of KIT in human tumors was analyzed with gene expression arrays and by immunohistochemistry. Colonospheres were injected into the livers of CBy.Cg-Foxn1nu/J mice. After liver tumors had formed, hypoxia was induced by vascular clamping. Results Differentiated cells from various tumors, or medium conditioned by them, increased the clonogenic capacity of colonospheres. Stem cell factor (SCF) was secreted by differentiated tumor cells and supported the clonogenic capacity of KIT+ colonosphere cells. Differentiated tumor cells induced the epithelial to mesenchymal transition in colonosperes; this was prevented by inhibition of KIT or SCF. SCF prevented loss of clonogenic potential under differentiation-inducing conditions. Suppression of SCF or KIT signaling greatly reduced the expression of genes that regulate stemness and the epithelial to mesenchymal transition and inhibited clonogenicity and tumor initiation. Bioinformatic and immunohistochemical analyses revealed a correlation between expression of KIT- and hypoxia-related genes in colon tumors, which was highest in relapse-prone mesenchymal-type tumors. Hypoxia induced expression of KIT in cultured cells and in human colon tumor xenografts and this contributed to the clonogenic capacity of the tumor cells. Conclusions Paracrine signaling from SCF to KIT, between differentiated tumor cells and undifferentiated stem-like tumor cells, helps maintain the stem-like features of tumor cells, predominantly under conditions of hypoxia

Socialism and the State

Socialism and the Stat

Heterogeneous and Complex Rearrangements of Chromosome Arm 6q in Chondromyxoid Fibroma : Delineation of Breakpoints and Analysis of Candidate Target Genes

Chondromyxoid fibroma (CMF) is an uncommon benign cartilaginous tumor of bone usually occurring during the second decade of life. CMF is associated with recurrent rearrangements of chromosome bands 6p23–25, 6q12–15, and 6q23–27. To delineate further the role and frequency of the involvement of three candidate regions (6q13, 6q23.3 and 6q24) in the pathogenesis of CMF, we studied a group of 43 cases using a molecular cytogenetic approach. Fluorescence in situ hybridization with probe sets bracketing the putative breakpoint regions was performed in 30 cases. The expression level of nearby candidate genes was studied by immunohistochemistry and quantitative RT-PCR in 24 and 23 cases, respectively. Whole-genome copy number screening was performed by array comparative genomic hybridization in 16 cases. Balanced and unbalanced rearrangements of 6q13 and 6q23.3 occurred in six and five cases, respectively, and a hemizygous deletion in 6q24 was found in five cases. Two known tumor suppressor genes map to the latter region: PLAGL1 and UTRN. However, neither of these two genes nor BCLAF1 and COL12A1, respectively located in 6q23.3 and 6q13, showed altered expression. Therefore, although rearrangements of chromosomal regions 6q13, 6q23.3, and 6q24 are common in CMF, the complexity of the changes precludes the use of a single fluorescence in situ hybridization probe set as an adjunct diagnostic tool. These data indicate that the genetic alterations in CMF are heterogeneous and are likely a result of a cryptic rearrangement beyond the resolution level of combined binary ratio fluorescence in situ hybridization or a point mutation

PDGFRB Promotes Liver Metastasis Formation of Mesenchymal-Like Colorectal Tumor Cells

AbstractIn epithelial tumors, the platelet-derived growth factor receptor B (PDGFRB) is mainly expressed by stromal cells of mesenchymal origin. Tumor cells may also acquire PDGFRB expression following epithelial-to-mesenchymal transition (EMT), which occurs during metastasis formation. Little is known about PDGFRB signaling in colorectal tumor cells. We studied the relationship between PDGFRB expression, EMT, and metastasis in human colorectal cancer (CRC) cohorts by analysis of gene expression profiles. PDGFRB expression in primary CRC was correlated with short disease-free and overall survival. PDGFRB was co-expressed with genes involved in platelet activation, transforming growth factor beta (TGFB) signaling, and EMT in three CRC cohorts. PDGFRB was expressed in mesenchymal-like tumor cell lines in vitro and stimulated invasion and liver metastasis formation in mice. Platelets, a major source of PDGF, preferentially bound to tumor cells in a non-activated state. Platelet activation caused robust PDGFRB tyrosine phosphorylation on tumor cells in vitro and in liver sinusoids in vivo. Platelets also release TGFB, which is a potent inducer of EMT. Inhibition of TGFB signaling in tumor cells caused partial reversion of the mesenchymal phenotype and strongly reduced PDGFRB expression and PDGF-stimulated tumor cell invasion. These results suggest that PDGFRB may contribute to the aggressive phenotype of colorectal tumors with mesenchymal properties, most likely downstream of platelet activation and TGFB signaling