Detection of avascular necrosis on routine diffusion-weighted whole body MRI in patients with multiple myeloma.

OBJECTIVE:Current therapies for multiple myeloma, which include corticosteroids, increase risk of avascular necrosis. The aim of this study was to assess incidental detection of femoral head avascular necrosis on routine whole body MRI including diffusion weighted MRI. METHODS:All whole body MRI studies, performed on patients with known multiple myeloma between 1 January 2010 to 1 May 2017 were assessed for features of avascular necrosis. RESULTS:650 whole body MR scans were analysed. 15 patients (6.6%) had typical MR features of avascular necrosis: 2/15 (13.3%) had femoral head collapse, 4/15 (26.7%) had bilateral avascular necrosis and 9/15 (60%) were asymptomatic. CONCLUSION:This is the first report of avascular necrosis detected on routine whole body MRI in patients with multiple myeloma. Targeted review of femoral heads in multiple myeloma patients undergoing whole body MR is recommended, including in patients without symptoms. ADVANCES IN KNOWLEDGE:Whole body MR which includes diffusion-weighted MRI is extremely sensitive for evaluation of bone marrow. Although whole body MRI is primarily used for evaluation of multiple myeloma disease burden, it also presents an unique opportunity to evaluate the femoral heads for signs of avascular necrosis which can predate symptoms

Innovative Education in Agroecology: Experiential Learning for a Sustainable Agriculture

The transdisciplinary field of agroecology provides a platform for experiential learning based on an expanded vision of research on sustainable farming and food systems and the application of results in creating effective learning landscapes for students. With increased recognition of limitations of fossil fuels, fresh water, and available farmland, educators are changing focus from strategies to reach maximum yields to those that feature resource use efficiency and resilience of production systems in a less benign climate. To help students deal with complexity and uncertainty and a wide range of biological and social dimensions of the food challenge, a whole-systems approach that involves life-cycle analysis and consideration of long-term impacts of systems is essential. Seven educational case studies in the Nordic Region and the U.S. Midwest demonstrate how educators can incorporate theory of the ecology of food systems with the action learning component needed to develop student potentials to create responsible change in society. New roles of agroecology instructors and students are described as they pursue a co-learning strategy to develop and apply technology to assure the productivity and security of future food system

‘They Called Them Communists Then … What D'You Call ‘Em Now? … Insurgents?’. Narratives of British Military Expatriates in the Context of the New Imperialism

This paper addresses the question of the extent to which the colonial past provides material for contemporary actors' understanding of difference. The research from which the paper is drawn involved interview and ethnographic work in three largely white working-class estates in an English provincial city. For this paper we focus on ten life-history interviews with older participants who had spent some time abroad in the British military. Our analysis adopts a postcolonial framework because research participants' current constructions of an amorphous 'Other' (labelled variously as black people, immigrants, foreigners, asylum-seekers or Muslims) reveal strong continuities with discourses deployed by the same individuals to narrate their past experiences of living and working as either military expatriates or spouses during British colonial rule. Theoretically, the paper engages with the work of Frantz Fanon and Edward Said. In keeping with a postcolonial approach, we work against essentialised notions of identity based on 'race' or class. Although we establish continuity between white working-class military emigration in the past and contemporary racialised discourses, we argue that the latter are not class-specific, being as much the creations of the middle-class media and political elite

Alternative Systems of Inquiry for a Sustainable Agriculture

Summary Scientific investigation has long been dominated by positivism, which holds that an independent reality driven by immutable laws exists. Consequently, it should be possible to define sustainability in absolute terms. Advances in alternative paradigms, however, suggest: that any attempt precisely to define sustainability is flawed; that problems are always open to interpretation; that the resolution of one problem inevitably leads to the production of another ‘problem?situation’, as problems are endemic; that the key feature now becomes the capacity of actors continually to learn about these changing conditions, so that they can act rapidly to transform existing activities; and that systems of learning and inquiry are needed to seek the multiple perspectives of the various stakeholders and encourage wider involvement and action. These systems of inquiry are participatory in nature, and the information and action arising from them is judged by a framework of trustworthiness criteria. Resumé Les systèmes de renseignement alternatifs pour l'agriculture durable Depuis longtemps, l'enquête scientifique se trouve dominée par le positivisme, qui maintient l'existence d'une réalité indépendante mue par des lois ellesmêmes immuables. Par conséquent, il devrait être possible de définir la durabilité dans des termes absolus. Toutefois, les progrès au niveau des paradigmes alternatifs auraient tendance à suggérer, d'abord, que toute tentative de définir la durabilité de manière précise est à priori fausse; ensuite, que tout problème est capable d'interprétations différentes; que la solution d'un problème mène inéluctablement à la production de situations problématiques, étant donné que les problèmes sont endémiques; que le facteur primordial est désormais, la capacité des acteurs à apprendre continûment quelles sont ces situations changeantes, de sorte qu'ils puissent agir rapidement pour transformer les activités existantes; et que la mise en place de systèmes d'enquête et d'acquisition des connaissances sont nécessaires afin que l'on puisse interroger les nombreuses perspectives des divers participants et par là, encourager une participation plus grande et plus active. Ces systèmes d'enquète sont intrinsèquement participatoires, aussi l'information et l'action qui en découlent doiventelles être jugées dans le cadre d'un ensemble de critères de fiabilité. Resumen Sistemas alternativos de investigación para una agricultura sostenible La investigación científica ha sido dominada durante mucho tiempo por el positivismo, que mantiene la existencia de una realidad independiente manejada por leyes inmutables. Consecuentemente, debe ser posible definir el mantenimiento en términos absolutos. Sin embargo, el avance de paradigmas alternativos sugiere: a) cualquier intento de definir la sostenibilidad con precisión es defectuoso; b) los problemas siempre están abiertos a la interpretación; c) la solución de un problema inevitablemente lleva a la producción de otra situación problemática, ya que los problemas son endémicos; d) el rasgo clave es la capacidad de los protagonistas para aprender continuamente de estas condiciónes cambiantes, y poder actuar rápidamente en la transformación de las actividades existentes; y e) se necesitan sistemas de averiguación y aprendizaje para registrar las múltiples perspectivas de las varias partes interesadas y estimular un compromiso y una acción mas emplios. Estos sistemas de averiguación son de por sí participatorios, y la información y acción que de ellos surgen son juzgadas por un conjunto de criterios de fiabilidad

Experiences of peer workers and mental health service users with a peer support intervention: applying and critiquing a behaviour change techniques taxonomy

Objective: There is growing evidence for the benefits of peer support in mental health services. Less is known about the specific mechanisms whereby peer support brings about change. The aim of this study was to explore the experiences of adults using mental health services and peer workers to investigate whether the contents of an intentionally provided one-to-one peer support intervention can be adequately described using a standard taxonomy of behaviour change techniques (BCTs). Method: This qualitative comparative case study involved semi-structured interviews with 11 peer workers and 10 people they supported, in 2017–2018. They participated in a randomised controlled trial of a peer support intervention. Data were coded using both an analytical framework, derived from Michie and colleague’s taxonomy of BCTs, and inductive thematic analysis. Results: The findings revealed that the intervention included BCTs from all 16 BCT groupings in the taxonomy, with the emphasis on the groupings of ‘social support’, ‘comparison of behaviour’, ‘comparison of outcomes’, ‘regulation’ ‘shaping knowledge’, ‘identity’ and ‘covert learning’. Thematic analysis revealed a new group, ‘relational aspects’, consisting of five new BCTs: sharing of the peer worker’s experiential knowledge; promoting reciprocity, autonomy, and confidentiality; and validation of a safe and trusting relationship. Discussion: A standard taxonomy of BCTs was shown to be broadly applicable to describing the contents of an intentional one-to-one peer support intervention for adults using mental health services. The taxonomy may need to be extended to consider additional BCTs related to encouraging the therapeutic relationship

Agroecology Education and Research: An Academic Platform for Organic Farming

Agroecology education and research programs are gaining prominence in universities. This emerging field provides an appropriate and convenient platform for bringing organic farming into academia. Agroecology deals with complex systems, uncertainty, and the future. Examples from organic farming and local food systems often provide valuable examples of applications of the principles of ecology in designing a sustainable agriculture. The agroecology MSc program in the NOVA network is a successful example of how organic farming can be brought into university programs, and how interdisciplinary education and research can tap into a regional faculty in agriculture

Learning through exchange about organic agriculture - case of Europe and Australia

LEAFSE is the catch word for an innovative program of exchange study for young Australians and Europeans, with organic agriculture as the focal point of their Masters level studies. Two years ago, the European Commission and the Australian Department of Education, Science and Technology (DEST) came up with the call for applications for a pilot project to support international mobility of tertiary students between the two continents. The grand aims set for the exchange included providing students with an international outlook and a range of perspectives, preparing them for the global marketplace, enable their understanding and empathy for different cultures and traditions and foster exchange of information. A number of us with an interest and an already existing academic network in organic agriculture proposed LEAFSE - Learning through Exchange - Agriculture, Food Systems and Environment, a winning project, which was chosen as the single pilot project from a field of well over a dozen contenders. Within the broader theme of Agriculture, Food Systems and Environment, we named organic farming as the focal point of the exchange, and we were aware of the immense possibilities for learning through exchange inter-continentally in this field. Under this project, Master's level students from EU study for a semester at a partner university in Australia, and students from Australia study for a semester at a partner university in EU. The partners in the programme are, from Europe: • The Royal Veterinary and Agricultural University, Denmark • University of Wales, Aberystwyth, United Kingdom • Wageningen University and Research Centre, The Netherlands • University of Kassel, Witzenhausen, Germany, and from Australia: • University of Western Sydney, New South Wales • University of New England, New South Wales • University of Western Australia, Western Australia • University of Queensland, Queensland The project has an innovative but manageable framework for mobility of the students, a joint programme of study which incorporates many novel elements including holistic thinking, experiential and integrated learning and use of newer tools of communication technologies, and above all, a structure that fosters a high degree of inter-cultural understanding and network building. When completed, the pilot phase of the project would have enabled exchange of 36 students from each continent, nine from each participating institution. The respective government agencies provide the students with an adequate stipend to cover travel and living expenses for six months of study. The project has been running on target and the results of the first year of exchange have been more than impressive. This presentation will be a joint effort by the faculty and a number of participating students to demonstrate the cultural, agricultural, pedagogic, and practical lessons that have been learnt from this exchange in the field of organic farming. It will also highlight some of the challenges which need to be overcome in our efforts towards shaping sustainable agricultural and food systems which are cognizant of our respective environments

The risk of venous thromboembolism associated with peripherally inserted central catheters in ambulant cancer patients

Background Deep vein thrombosis (DVT) is a common complication of peripherally inserted central catheters (PICCs). PICCs are increasingly utilised in the management of cancer patients, a group which carries both additional risks for vascular thromboembolism as well as for complex morbidity. We analysed a cohort of cancer patients subjected to PICC insertion in a single cancer centre for the incidence of all-type vascular thromboembolism (VTE) and investigated relative risk factors. Methods In this clinical audit, the records of patients referred for PICC insertion in our centre in the period between 1/1/2011 and 1/4/2014 were retrospectively reviewed. The primary outcomes investigated were a) PICC-related deep vein thrombosis (PRDVT) and b) distant VTE (lower limb DVT and pulmonary embolism). 4Fr single lumen PICCs were placed in all patients. The Kaplan Meier method was used to study time from PICC insertion to PRDVT/VTE. Survival curves were compared using the log rank method. Logistic and Cox regression analyses were used to assess local, distant and combined endpoints. Results Four hundred ninety patients were included in the analysis of which 27 (5.5%) developed a PRDVT. Statistically significant risk factors for developing PRDVT in multivariate analysis included more than one attempt for insertion (OR 2.61, 95%CI: 1.12–6.05) and the use of fluoropyrimidine containing chemotherapy (OR 4.27, 95%CI 1.3–14.07). Twenty-six patients developed a distant VTE. Male gender was the only significant risk factor for distant VTE. When all-type VTE were considered together fluoropyrimidine containing chemotherapy (OR 4.54, 95% CI 1.63–12.61), male gender (OR 2.03, 95% CI 1.04–3.93) and white cell count (OR 1.12, 95% CI 1.00–1.26) were statistically significant as risk factors in this analysis. Conclusions This is a large study of VTE following PICC insertion in cancer patients which also looks at the rate of distant VTE. The observed PRDVT incidence is comparable with available literature. Fluoropyrimidine containing chemotherapy and more than one attempt for PICC insertion were independent predictors of PICC-associated VTE whilst the former remained an independent predictor of all-type VTE. Anticoagulation did not prevent thrombotic events in this cohort