‘Making it Meaningful’: Co-designing an intervention to improve medication safety for people from culturally and linguistically diverse backgrounds accessing cancer services.

This study reports on the process of using an adapted Experienced-Based Co-Design (EBCD) conducted with culturally and linguistically diverse (CALD) consumers and cancer service staff to co-design the novel ‘Making it Meaningful’(MiM) instrument at a cancer service in Australia. Multi-source experiential and contextual information was gathered in phase 1 of the co-design and this evidence, coupled with knowledge gathered via a feedback event was used to inform three co-design workshops in phase 2. A series of meetings were conducted prior to and in between the workshops. Theory was progressively integrated into the workshop content. Two Mandarin speaking CALD consumers and three cancer service staff participated as co-design members. Workshops were supported by a multilingual fieldworker, co-facilitated by researchers and a consumer co-facilitator, and conducted using a hybrid model (face-to-face or online participation). In the first workshop members democratically selected to focus on a strategy to enable CALD consumers to make non-emergency urgent contact with the cancer service for medication related communication. The second workshop resulted in consensus to develop an accessible instrument that would identify appropriate contacts and information sources for medication management between appointments. In the third workshop, the prototype MiM instrument was developed and refined. The MiM is a novel instrument designed with CALD consumers to enhance their knowledge of medication management and empower them to contact cancer service staff about medication safety concerns. Feasibility testing is the next step with successful implementation requiring senior health leadership support and involvement of co-design members as change agents. Experience Framework This article is associated with the Quality & Clinical Excellence lens of The Beryl Institute Experience Framework (https://theberylinstitute.org/experience-framework/). Access other PXJ articles related to this lens. Access other resources related to this lens

Health, education, and social care provision after diagnosis of childhood visual disability

Aim: To investigate the health, education, and social care provision for children newly diagnosed with visual disability.Method: This was a national prospective study, the British Childhood Visual Impairment and Blindness Study 2 (BCVIS2), ascertaining new diagnoses of visual impairment or severe visual impairment and blindness (SVIBL), or equivalent vi-sion. Data collection was performed by managing clinicians up to 1-year follow-up, and included health and developmental needs, and health, education, and social care provision.Results: BCVIS2 identified 784 children newly diagnosed with visual impairment/SVIBL (313 with visual impairment, 471 with SVIBL). Most children had associated systemic disorders (559 [71%], 167 [54%] with visual impairment, and 392 [84%] with SVIBL). Care from multidisciplinary teams was provided for 549 children (70%). Two-thirds (515) had not received an Education, Health, and Care Plan (EHCP). Fewer children with visual impairment had seen a specialist teacher (SVIBL 35%, visual impairment 28%, χ2p < 0.001), or had an EHCP (11% vs 7%, χ2p < 0 . 01).Interpretation: Families need additional support from managing clinicians to access recommended complex interventions such as the use of multidisciplinary teams and educational support. This need is pressing, as the population of children with visual impairment/SVIBL is expected to grow in size and complexity.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited

Rethinking Social Justice in Education: An Epistemological Approach

There are many different notions of social justice in education. For example, some argue that social justice in education means giving individuals the opportunity to succeed; for others, it means seeking equality of outcome so that everyone does succeed. So great is the diversity of views that it has been suggested the term has become meaningless, or that it can mean anything people want it to mean. This has led some to argue that trying to define social justice in education is a hopeless task. This chapter argues that an approach informed by the later philosophy of Wittgenstein can be helpful in dealing with such issues. In particular, attention is focussed on Wittgenstein’s epistemology and theory of meaning in the Philosophical Investigations. It is argued that these are helpful in understanding the multiplicity of meanings of the term social justice in education. This multiplicity however, it is argued, does not lead to a situation where the term can mean anything its users want it to mean. Nor does it lead to a situation where all attempts to define the term are ruled out, or where only one definition is acceptable, presumably to be imposed on all users of the term. Instead, the significance of contextual understanding and meaning in different language-games is highlighted. Wittgenstein’s theory of meaning is then allied to Gallie’s notion of an essentially contested concept to advance the idea of engagement between those with different views, and of the need to recontextualize rather than decontextualize the notion of social justice in education

The FANCM:p.Arg658* truncating variant is associated with risk of triple-negative breast cancer

Abstract: Breast cancer is a common disease partially caused by genetic risk factors. Germline pathogenic variants in DNA repair genes BRCA1, BRCA2, PALB2, ATM, and CHEK2 are associated with breast cancer risk. FANCM, which encodes for a DNA translocase, has been proposed as a breast cancer predisposition gene, with greater effects for the ER-negative and triple-negative breast cancer (TNBC) subtypes. We tested the three recurrent protein-truncating variants FANCM:p.Arg658*, p.Gln1701*, and p.Arg1931* for association with breast cancer risk in 67,112 cases, 53,766 controls, and 26,662 carriers of pathogenic variants of BRCA1 or BRCA2. These three variants were also studied functionally by measuring survival and chromosome fragility in FANCM−/− patient-derived immortalized fibroblasts treated with diepoxybutane or olaparib. We observed that FANCM:p.Arg658* was associated with increased risk of ER-negative disease and TNBC (OR = 2.44, P = 0.034 and OR = 3.79; P = 0.009, respectively). In a country-restricted analysis, we confirmed the associations detected for FANCM:p.Arg658* and found that also FANCM:p.Arg1931* was associated with ER-negative breast cancer risk (OR = 1.96; P = 0.006). The functional results indicated that all three variants were deleterious affecting cell survival and chromosome stability with FANCM:p.Arg658* causing more severe phenotypes. In conclusion, we confirmed that the two rare FANCM deleterious variants p.Arg658* and p.Arg1931* are risk factors for ER-negative and TNBC subtypes. Overall our data suggest that the effect of truncating variants on breast cancer risk may depend on their position in the gene. Cell sensitivity to olaparib exposure, identifies a possible therapeutic option to treat FANCM-associated tumors

Special Report on Global warming of 1.5°C (SR15) - Chapter 5:Sustainable Development, Poverty Eradication and Reducing Inequalities

The Special Report on 1.5°C assesses three main themes: • What would be required to limit warming to 1.5°C (mitigation pathways) • The impacts of 1.5°C of warming, compared to 2ºC and higher • Strengthening the global response to climate change; mitigation and adaptation options The connections between climate change and sustainable development and efforts to eradicate poverty are discussed throughout the report. This chapter takes sustainable development as the starting point and focus for analysis. It considers the broad and multifaceted bi-directional interplay between sustainable development, including its focus on eradicating poverty and reducing inequality in their multidimensional aspects, and climate actions in a 1.5°C warmer world. These fundamental connections are embedded in the Sustainable Development Goals (SDGs). The chapter also examines synergies and trade-offs of adaptation and mitigation options with sustainable development and the SDGs and offers insights into possible pathways, especially climate-resilient development pathways towards a 1.5°C warmer world

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