An Urgent Human Health Dilemma Facing Refugees and Their Host Caregivers

The continuous waves of refugees from Africa and the Middle East to Europe present major inter¬cultural challenges to European health professionals and to society at large. A recent workshop in Sicily brought together local physicians, nurses, psychologists and managers of governmental agencies, along with representatives from Lebanon, Israel, Iraq, Iran, Sudan, Tunisia, Jordan and the European Society of Medical Oncology (ESMO) to develop training programs aimed at formulating dialogue between regional professionals and refugees. A major barrier refugees face is a lack of verbal and cultural communication, which hinders their smooth absorption into the new society. Cultural mediators who speak Arabic and Italian and understand the refugees' faith, tradition and beliefs are vital to successfully build bridges of trust between caregivers and refugees. Most asylum seekers experience anxiety, fear, and depression upon arrival in Europe. To achieve trust, all workshop participants agreed to develop a palliative care model that would best suit the unique circumstances now facing some Mediterranean countries and assist in overcoming the suffering of refugees during their initial stay in Europe. Such a model would include bio-psychosocial elements, essential for a culturally sensitive approach and based on core ethical principles

Interprofessional spiritual care in oncology: a literature review

Spiritual care is recognised as an essential element of the care of patients with serious illness such as cancer. Spiritual distress can result in poorer health outcomes including quality of life. The American Society of Clinical Oncology and other organisations recommend addressing spiritual needs in the clinical setting. This paper reviews the literature findings and proposes recommendations for interprofessional spiritual care

Global survey of the roles, satisfaction, and barriers of home healthcare nurses on the provision of palliative care

Background: the World Health Assembly urges members to build palliative care (PC) capacity as an ethical imperative. Nurses provide PC services in a variety of settings, including the home and may be the only health care professional able to access some disparate populations. Identifying current nursing services, resources, and satisfaction and barriers to nursing practice are essential to build global PC capacity. Objective: to globally examine home health care nurses' practice, satisfaction, and barriers, regarding existing palliative home care provision. Design: needs assessment survey. Setting/Subjects: five hundred thirty-two home health care nurses in 29 countries. Measurements: a needs assessment, developed through literature review and cognitive interviewing. Results: nurses from developing countries performed more duties compared with those from high-income countries, suggesting a lack of resources in developing countries. Significant barriers to providing home care exist: personnel shortages, lack of funding and policies, poor access to end-of-life or hospice services, and decreased community awareness of services provided. Respondents identified lack of time, funding, and coverages as primary educational barriers. In-person local meetings and online courses were suggested as strategies to promote learning. Conclusions: it is imperative that home health care nurses have adequate resources to build PC capacity globally, which is so desperately needed. Nurses must be up to date on current evidence and practice within an evidence-based PC framework. Health care policy to increase necessary resources and the development of a multifaceted intervention to facilitate education about PC is indicated to build global capacity

The Interstellar Medium of Star-forming Irregular Galaxies: The View with ISO

We present mid-infrared imaging and far-infrared (FIR) spectroscopy of 5 IBm galaxies observed by ISO as part of our larger study of the inter- stellar medium of galaxies. Most of the irregulars in our sample are very actively forming stars. The mid-infrared imaging was in a band centered at 6.75 microns that is dominated by polycyclic aromatic hydrocarbons (PAHs) and in a band centered at 15 microns that is dominated by small dust grains. The spectroscopy of 3 of the galaxies includes [CII]158 microns and [OI]63 microns, important coolants of photodissociation regions (PDRs), and [OIII]88 microns and [NII]122 microns, which come from ionized gas. [OI]145 microns and [OIII]52 microns were measured in one galaxy as well. These data are combined with PDR and HII region models to deduce properties of the interstellar medium of these galaxies.Comment: To be published in ApJ, Apr 10, 2001; higher resolution figures available from ftp.lowell.edu, cd pub/dah/isopaper

Tibial Loading Increases Osteogenic Gene Expression and Cortical Bone Volume in Mature and Middle-Aged Mice

There are conflicting data on whether age reduces the response of the skeleton to mechanical stimuli. We examined this question in female BALB/c mice of different ages, ranging from young to middle-aged (2, 4, 7, 12 months). We first assessed markers of bone turnover in control (non-loaded) mice. Serum osteocalcin and CTX declined significantly from 2 to 4 months (p<0.001). There were similar age-related declines in tibial mRNA expression of osteoblast- and osteoclast-related genes, most notably in late osteoblast/matrix genes. For example, Col1a1 expression declined 90% from 2 to 7 months (p<0.001). We then assessed tibial responses to mechanical loading using age-specific forces to produce similar peak strains (−1300 µε endocortical; −2350 µε periosteal). Axial tibial compression was applied to the right leg for 60 cycles/day on alternate days for 1 or 6 weeks. qPCR after 1 week revealed no effect of loading in young (2-month) mice, but significant increases in osteoblast/matrix genes in older mice. For example, in 12-month old mice Col1a1 was increased 6-fold in loaded tibias vs. controls (p = 0.001). In vivo microCT after 6 weeks revealed that loaded tibias in each age group had greater cortical bone volume (BV) than contralateral control tibias (p<0.05), due to relative periosteal expansion. The loading-induced increase in cortical BV was greatest in 4-month old mice (+13%; p<0.05 vs. other ages). In summary, non-loaded female BALB/c mice exhibit an age-related decline in measures related to bone formation. Yet when subjected to tibial compression, mice from 2–12 months have an increase in cortical bone volume. Older mice respond with an upregulation of osteoblast/matrix genes, which increase to levels comparable to young mice. We conclude that mechanical loading of the tibia is anabolic for cortical bone in young and middle-aged female BALB/c mice

Infrared Emission of Normal Galaxies from 2.5 to 12 Microns: ISO Spectra, Near-Infrared Continuum and Mid-Infrared Emission Features

We present ISO-PHOT spectra of the regions 2.5-4.9um and 5.8-11.6um for a sample of 45 disk galaxies from the U.S. ISO Key Project on Normal Galaxies. The spectra can be decomposed into three spectral components: (1) continuum emission from stellar photospheres, which dominates the near-infrared (2.5- 4.9um; NIR) spectral region; (2) a weak NIR excess continuum, which has a color temperature of ~ 1000K, carries a luminosity of a few percent of the total far-infrared luminosity L(FIR), and most likely arises from the ISM; and (3) the well-known broad emission features at 6.2, 7.7, 8.6 and 11.3 um, which are generally attributed to aromatic carbon particles. These aromatic features in emission (AFEs) dominate the mid-infrared (5.8-11.6 um; MIR) part of the spectrum, and resemble the so-called Type-A spectra observed in many non-stellar sources and the diffuse ISM in our own Galaxy. The relative strengths of the AFEs vary by 15-25% among the galaxies. However, little correlation is seen between these variations and either IRAS 60um-to-100um flux density ratio R(60/100) or the FIR-to-blue luminosity ratio L(FIR)/L(B), suggesting that the observed variations are not a direct consequence of the radiation field differences among the galaxies. We demonstrate that the NIR excess continuum and AFE emission are correlated, suggesting that they are produced by similar mechanisms and similar (or the same) material. On the other hand, as the current star-formation activity increases, the overall strengths of the AFEs and the NIR excess continuum drop significantly with respect to that of the far-infrared emission from large dust grains. This is likely a consequence of the preferential destruction in intense radiation fields of the small carriers responsible for the NIR/AFE emission.Comment: With 8 tables and 12 figures; to appear in the Astrophysical Journa

Cytomegalovirus induces abnormal chondrogenesis and osteogenesis during embryonic mandibular development

<p>Abstract</p> <p>Background</p> <p>Human clinical studies and mouse models clearly demonstrate that cytomegalovirus (CMV) disrupts normal organ and tissue development. Although CMV is one of the most common causes of major birth defects in humans, little is presently known about the mechanism(s) underlying CMV-induced congenital malformations. Our prior studies have demonstrated that CMV infection of first branchial arch derivatives (salivary glands and teeth) induced severely abnormal phenotypes and that CMV has a particular tropism for neural crest-derived mesenchyme (NCM). Since early embryos are barely susceptible to CMV infection, and the extant evidence suggests that the differentiation program needs to be well underway for embryonic tissues to be susceptible to viral infection and viral-induced pathology, the aim of this study was to determine if first branchial arch NCM cells are susceptible to mCMV infection prior to differentiation of NCM derivatives.</p> <p>Results</p> <p>E11 mouse mandibular processes (MANs) were infected with mouse CMV (mCMV) for up to 16 days <it>in vitr</it>o. mCMV infection of undifferentiated embryonic mouse MANs induced micrognathia consequent to decreased Meckel's cartilage chondrogenesis and mandibular osteogenesis. Specifically, mCMV infection resulted in aberrant stromal cellularity, a smaller, misshapen Meckel's cartilage, and mandibular bone and condylar dysmorphogenesis. Analysis of viral distribution indicates that mCMV primarily infects NCM cells and derivatives. Initial localization studies indicate that mCMV infection changed the cell-specific expression of FN, NF-κB2, RelA, RelB, and Shh and Smad7 proteins.</p> <p>Conclusion</p> <p>Our results indicate that mCMV dysregulation of key signaling pathways in primarily NCM cells and their derivatives severely disrupts mandibular morphogenesis and skeletogenesis. The pathogenesis appears to be centered around the canonical and noncanonical NF-κB pathways, and there is unusual juxtaposition of abnormal stromal cells and surrounding matrix. Moreover, since it is critically important that signaling molecules are expressed in appropriate cell populations during development, the aberrant localization of components of relevant signaling pathways may reveal the pathogenic mechanism underlying mandibular malformations.</p