Sensitive sexualities: dichotomized discourse in the erasure of bisexuality

A combination of Q methodology and a Think Aloud task explored how cultural knowledge about bisexuality is constructed and maintained. Q methodology revealed positive interpretations of bisexuality. Critical Discourse Analysis of the Think Aloud task however, exposed the maintenance of dualistic categories of sex, gender and sexuality acting as ‘operating systems’ and strategically guiding the social representation of bisexuality as ‘non-existent’, ‘deviant’, ‘abnormal’ and/or ‘promiscuous’. The findings of this study suggest that overt heterosexism is not becoming extinct; instead it has found rather subtle ways of incorporating itself into ‘liberal’ discourses

Enhanced Synthesis of Collagenase by Human Keratinocytes Cultured on Type I or Type IV Collagen

Human keratinocytes in culture are known to produce collagenase. As part of studies to ascertain the physiologic stimuli for collagenase production by keratinocytes, we wanted to determine whether extracellular matrix could modulate the production of collagenase in vitro. Immunoprecipitable collagenase from the conditioned medium of cells grown on different types of matrix was measured. Metabolically labeled human keratinocytes were cultured in 0.1 mM calcium in serum-free medium on colloidal gold-coated coverslips plus type IV collagen, type I collagen, or laminin or in the absence of matrix. Immunoprecipitation of the conditioned medium with anti-collagenase antiserum was performed and the immunoprecipitates were analyzed by sodium dodecyl sulfate polyacrylamide gel electrophoresis, fluorography, and densitometry. The keratinocytes cultured on type IV or type I collagen produced more collagenase than did those cultured on laminin or in the absence of matrix. This effect did not reflect a general increase in secreted proteins, because the production of tissue inhibitor of metalloproteinase, or TIMP, did not increase under the same conditions. Phagocytosis of the gold salts by the keratinocytes migrating on types I or IV collagen did not account for the increased collagenase produced by these cells since the effect persisted in the absence of the colloidal gold and phagocytosis of latex beads did not augment collagenase production

A Model to Restructure Nursing Education- Vision on 22nd Street

Since 1993, the Cleveland State University Department of Nursing and the Visiting Nurse Association of Cleveland have been involved in an innovative partnership known as Vision on 22nd Street. This partnership has produced a model to restructure the nursing curriculum and the practice setting in such a way that a seamless process, fully integrated within university and agency operations, prepares undergraduate nursing students for community-based practice. The groundwork supporting the model, the development of the curriculum, the preparation of participants, and the implementation of the model for program evaluation are the subject of this article

Actinic keratoses progress more quickly to squamous cell carcinoma than basal cell carcinoma

Actinic keratoses (AK) are common, costly, and may evolve to keratinocyte carcinoma (KC): basal cell (BCC) and squamous cell carcinoma (SCC) of the skin. Time to malignant transformation is controversial. We used data from the placebo arm (n=166) of a randomized trial of veterans with multiple prior KCs. Study dermatologists examined participants’ faces/ears at enrollment and semiannual visits. Clinically diagnosed AKs were marked, photographed, and treated with cryotherapy (starting at 6 months). Lesions suspicious for KC were marked, photographed, and biopsied. AKs were tracked using these photographs. For each AK that progressed to KC (n=23), the time between the first appearance of the AK and the biopsy resulting in a KC diagnosis was measured. Among all 4,231 tracked AKs, the difference in time to progression of AKs that progressed to BCC (12/4,231) vs. SCC (11/4,231) was not statistically detectable (Cox proportional hazards analysis). However, among the 23 AKs that progressed to KC, AKs progressed more quickly to SCC compared to BCC (two-sided Wilcoxon test; p=0.01) with respective mean progression times of 13 and 25 months. This may be due to clinical misdiagnosis of early BCCs as AKs, as BCCs are known to grow slowly; or perhaps SCCs become more rapidly clinically distinguishable. Differences in progression could also indicate differences in sensitivity to cryotherapy, as lesions progressed despite this treatment. Alternatively, if these were true AKs, then certain events—with different likelihoods and timing—may be needed for AKs to progress to BCC vs. SCC

Classic and Overlap Chronic Graft-versus-Host Disease (cGVHD) Is Associated with Superior Outcome after Extracorporeal Photopheresis (ECP)

The National Institutes of Health (NIH) classification of graft-versus-host disease (GVHD) is a significant improvement over prior classifications, and has prognostic implications. We hypothesized that the NIH classification of GVHD would predict the survival of patients with GVHD treated with extracorporeal photopheresis (ECP). Sixty-four patients with steroid refractory/dependent GVHD treated with ECP were studied. The 3-year overall survival (OS) was 36% (95% confidence interval [CI] 13-59). Progressive GVHD was seen in 39% of patients with any acute GVHD (aGVHD) (classic acute, recurrent acute, overlap) compared to 3% of patients with classic chronic GVHD (cGVHD) (P=.002). OS was superior for patients with classic cGVHD (median survival, not reached) compared to overlap GVHD (median survival, 395 days, 95% CI 101 to not reached) and aGVHD (delayed, recurrent or persistent) (median survival, 72 days, 95% CI 39-152). In univariate analyses, significant predictors of survival after ECP included GVHD subtype, bilirubin, platelet count, and steroid dose. In multivariate analyses overlap plus classic cGVHD was an independent prognostic feature predictive of superior survival (hazard ratio [HR] 0.34, 95% CI 0.14-0.8, p=.014). This study suggests that NIH classification can predict outcome after ECP for steroid refractory/dependent GVHD

Actinic keratoses progress more quickly to squamous cell carcinoma than basal cell carcinoma

Actinic keratoses (AK) are common, costly, and may evolve to keratinocyte carcinoma (KC): basal cell (BCC) and squamous cell carcinoma (SCC) of the skin. Time to malignant transformation is controversial. We used data from the placebo arm (n=166) of a randomized trial of veterans with multiple prior KCs. Study dermatologists examined participants’ faces/ears at enrollment and semiannual visits. Clinically diagnosed AKs were marked, photographed, and treated with cryotherapy (starting at 6 months). Lesions suspicious for KC were marked, photographed, and biopsied. AKs were tracked using these photographs. For each AK that progressed to KC (n=23), the time between the first appearance of the AK and the biopsy resulting in a KC diagnosis was measured. Among all 4,231 tracked AKs, the difference in time to progression of AKs that progressed to BCC (12/4,231) vs. SCC (11/4,231) was not statistically detectable (Cox proportional hazards analysis). However, among the 23 AKs that progressed to KC, AKs progressed more quickly to SCC compared to BCC (two-sided Wilcoxon test; p=0.01) with respective mean progression times of 13 and 25 months. This may be due to clinical misdiagnosis of early BCCs as AKs, as BCCs are known to grow slowly; or perhaps SCCs become more rapidly clinically distinguishable. Differences in progression could also indicate differences in sensitivity to cryotherapy, as lesions progressed despite this treatment. Alternatively, if these were true AKs, then certain events—with different likelihoods and timing—may be needed for AKs to progress to BCC vs. SCC

Long-term Efficacy of Topical Fluorouracil Cream, 5%, for Treating Actinic Keratosis: A Randomized Clinical Trial

Topical fluorouracil was demonstrated to be effective in reducing the number of actinic keratoses (AKs) for up to 6 months, but no randomized trials studied its long-term efficacy. To evaluate the long-term efficacy of a single course of fluorouracil cream, 5%, for AK treatment. The Veterans Affairs Keratinocyte Carcinoma Chemoprevention (VAKCC) trial was a randomized, double-blinded, placebo-controlled trial with patients from dermatology clinics at 12 VA medical centers recruited from 2009 to 2011 and followed up until 2013. Our study population comprised 932 veterans with 2 or more keratinocyte carcinomas in the 5 years prior to enrollment. The mean follow-up duration was 2.6 years in both treatment and control groups. Participants applied either topical fluorouracil cream, 5% (n = 468), or vehicle control cream (n = 464) to the face and ears twice daily for up to 4 weeks. This study reports on AK counts and treatments, which were secondary outcomes of the VAKCC trial. Actinic keratoses on the face and ears were counted by study dermatologists at enrollment and at study visits every 6 months. The number of spot treatments for AKs on the face and ears at semiannual study visits and in between study visits was recorded. The number of AKs on the face and ears per participant was not different between the fluorouracil and control groups at randomization (11.1 vs 10.6, P > .10). After randomization, the fluorouracil group had fewer AKs compared with the control group at 6 months (3.0 vs 8.1, P < .001) and for the overall study duration (P < .001). The fluorouracil group also had higher complete AK clearance rates (38% vs 17% at 6 months) and fewer spot treatments at 6-month intervals, at study visits, and in between study visits during the trial (P < .01 for all). The fluorouracil group took longer to require the first spot AK treatment (6.2 months) compared with the control group (6.0 months) (hazard ratio, 0.69; 95% CI, 0.60-0.79). The number of hypertrophic AKs was not different between the 2 groups overall (P = .60), although there were fewer hypertrophic AKs in the fluorouracil group at 6 months (0.23 vs 0.41) (P = .05). Our results indicate that a single course of fluorouracil cream, 5%, effectively reduces AK counts and the need for spot treatments for longer than 2 years. clinicaltrials.gov Identifier:NCT00847912