Fuera de lugar: Undocumented Students, Dislocation, and the Search for Belonging

This article presents findings from a Youth Participatory Action Research (YPAR) study on the experiences of six undocumented college students at a community college in the Midwest United States. We focused on two main research questions: What are some of the key developmental experiences of undocumented youth? What is the impact of these experiences on the students’ identity and sense of belonging in educational spaces, especially as they transition to college? The findings illustrate the experiences of the six participant coresearchers (PCRs) as they navigated the messy, fragile, and shifting nature of belonging. A common thread in their narratives was the recurrence across their young lives of moments of dislocation (or “being-out-of-place”) associated with their undocumented status. These moments of dislocation barred these undocumented students from fully inhabiting both educational and noneducational spaces; in addition, they affected their ability to develop a sense of belonging as they transitioned to the college environment. Dislocation entails a degree of vulnerability and liminality that is not necessarily encompassed in current models of student development theory, nor considered in institutional support structures created with majority-population students in mind. We argue that institutional agents require sensitivity to the multiple types of dislocation that undocumented youth may experience within and beyond educational settings

MP70-07 TRANSPERINEAL FOCAL CRYOABLATION AS A TREATMENT FOR CLINICALLY SIGNIFICANT PROSTATE CANCER

INTRODUCTION AND OBJECTIVE: Prostate multiparametric MRI (mpMRI) with Index Lesion identification has led to questioning the need for whole gland therapies for carefully selected men harboring well-defined clinically significant malignant lesions. This investigation sought to determine the safety and efficacy of targeted focal ablative therapy in a community based urological practice. Our goal was to test the image-guided paradigm and to determine whether targeted biopsies were sufficient in assessing prostate cancer risk and whether truly focal target ablative therapy offered our patients a safe and effective alternative to whole gland therapy. We present our experience with our first 35 patients, diagnosed with clinically significant prostate cancer (csPC) managed with transperineal Focal Cryoablation (FC). METHODS: Subject patients were referred for PC detection due to elevated serum PSA. All patients underwent a mpMRI prior to transperineal biopsy. Men with PIRAD 3, 4 and 5 targets underwent both target and template transperineal fusion biopsy. Men diagnosed with Grade Groups (GG) 2, 3, and 4 index lesions were offered focal ablative transperineal cryoablation. Our follow up protocol called for post-ablation clinical evaluation, serial PSA determinations, post-ablation mpMRI and confirmatory biopsy (cBx). All patients were queried with pre and post-ablation SHIM and IPSS scoring. RESULTS: Patients were assessed on an Intent to Treat basis. Of the original 35 patients, 33/35 (94%) underwent post-ablation mpMRI. 19/35 (54%) have undergone post-ablative confirmatory biopsy.With mean follow up of 24 months, 29/33 men (88%) had post-ablation PIRAD ≤ 2 Scores. 14/19 (74%) had no cancer on cBx. 3/5 (60%) of positive post-ablation cBxs were GG 1. 2/5 (40%) of cBxs were GG 2. 4/33 (12%) of men undergoing follow up mpMRI developed new PIRAD 3 lesions (2 patients) or 4 lesions (2 patients). Zero new PIRAD 5 lesions were detected. No men had observable PSA elevations beyond baseline PSA at diagnosis. No men developed locoregional or systemic progression. 32/35 men (91%) adhered to follow up serial PSA testing.With a mean followup of 24 months, 28/32 (88%) of men had a sustained low serum PSA, with an average value of 1.8 ng/mL. No new or worsening erectile dysfunction or urinary incontinence occurred. CONCLUSIONS: Focal Cryoablation is a promising alternative to Whole Gland Therapy for proven focal significant lesions.Strict attention to disease staging and careful follow-up is essential to an effective Focal Ablative program. Source of Funding: Chan Soon-Shiong Nanthealth Foundation

Proyecto de intervención paisajística en la carretera Panamericana ubicada en el casco urbano del municipio El Crucero, Managua para el año 2014

Presenta una propuesta de intervención paisajística en la carretera Panamericana ubicada en el casco urbano del municipio El Crucero, con el fin de integrar y potencializar aquellas áreas que posean algún tipo de atractivo turístico, además de brindar a la sociedad espacios seguros y confortables de estancia, recreación y comercio

1992-1993: Duke's Place

From left: Deborah Torrez, John Fredo, Kimberly Harris, and Diana BDuke's Place;Grayscal

1992-1993: Duke's Place

From left: Deborah Torrez, John Fredo, Kimberly Harris, and Diana BDuke's Place;Grayscal

Performance of a malaria microscopy image analysis slide reading device.

BACKGROUND: Viewing Plasmodium in Romanovsky-stained blood has long been considered the gold standard for diagnosis and a cornerstone in management of the disease. This method however, requires a subjective evaluation by trained, experienced diagnosticians and establishing proficiency of diagnosis is fraught with many challenges. Reported here is an evaluation of a diagnostic system (a "device" consisting of a microscope, a scanner, and a computer algorithm) that evaluates scanned images of standard Giemsa-stained slides and reports species and parasitaemia. METHODS: The device was challenged with two independent tests: a 55 slide, expert slide reading test the composition of which has been published by the World Health Organization ("WHO55" test), and a second test in which slides were made from a sample of consenting subjects participating in a malaria incidence survey conducted in Equatorial Guinea (EGMIS test). These subjects' blood was tested by malaria RDT as well as having the blood smear diagnosis unequivocally determined by a worldwide panel of a minimum of six reference microscopists. Only slides with unequivocal microscopic diagnoses were used for the device challenge, n = 119. RESULTS: On the WHO55 test, the device scored a "Level 4" using the WHO published grading scheme. Broken down by more traditional analysis parameters this result was translated to 89% and 70% sensitivity and specificity, respectively. Species were correctly identified in 61% of the slides and the quantification of parasites fell within acceptable range of the validated parasitaemia in 10% of the cases. On the EGMIS test it scored 100% and 94% sensitivity/specificity, with 64% of the species correct and 45% of the parasitaemia within an acceptable range. A pooled analysis of the 174 slides used for both tests resulted in an overall 92% sensitivity and 90% specificity with 61% species and 19% quantifications correct. CONCLUSIONS: In its current manifestation, the device performs at a level comparable to that of many human slide readers. Because its use requires minimal additional equipment and it uses standard stained slides as starting material, its widespread adoption may eliminate the current uncertainty about the quality of microscopic diagnoses worldwide

Relationships of p16 Immunohistochemistry and Other Biomarkers With Diagnoses of Cervical Abnormalities: Implications for LAST Terminology.

CONTEXT.—: Lower Anogenital Squamous Terminology (LAST) standardization recommended p16INK4a immunohistochemistry (p16 IHC) for biopsies diagnosed morphologically as cervical intraepithelial neoplasia (CIN) grade 2 (CIN2) to classify them as low-grade or high-grade squamous intraepithelial lesions (HSILs). OBJECTIVE.—: To describe the relationships of p16 IHC and other biomarkers associated with cervical cancer risk with biopsy diagnoses. DESIGN.—: A statewide, stratified sample of cervical biopsies diagnosed by community pathologists (CPs), including 1512 CIN2, underwent a consensus, expert pathologist panel (EP) review (without p16 IHC results), p16 IHC interpretation by a third pathology group, and human papillomavirus (HPV) genotyping, results of which were grouped hierarchically according to cancer risk. Antecedent cytologic interpretations were also available. RESULTS.—: Biopsies were more likely to test p16 IHC positive with increasing severity of CP diagnoses, overall (Ptrend ≤ .001) and within each HPV risk group (Ptrend ≤ .001 except for low-risk HPV [Ptrend < .010]). All abnormal grades of CP-diagnosed biopsies were more likely to test p16 IHC positive with a higher HPV risk group (Ptrend < .001), and testing p16 IHC positive was associated with higher HPV risk group than testing p16 IHC negative for each grade of CP-diagnosed biopsies (P < .001). p16 IHC-positive, CP-diagnosed CIN2 biopsies were less likely than CP-diagnosed CIN3 biopsies to test HPV16 positive, have an antecedent HSIL+ cytology, or to be diagnosed as CIN3+ by the EP (P < .001 for all). p16 IHC-positive, CP-diagnosed CIN1 biopsies had lower HPV risk groups than p16 IHC-negative, CP-diagnosed CIN2 biopsies (P < .001). CONCLUSIONS.—: p16 IHC-positive, CP-diagnosed CIN2 appears to be lower cancer risk than CP-diagnosed CIN3. LAST classification of HSIL diagnosis, which includes p16 IHC-positive CIN2, should annotate the morphologic diagnosis (CIN2 or CIN3) to inform all management decisions, which is especially important for young (<30 years) women diagnosed with CIN2 for whom surveillance rather than treatment is recommended

Relationships of p16 Immunohistochemistry and Other Biomarkers With Diagnoses of Cervical Abnormalities: Implications for LAST Terminology.

CONTEXT.—:Lower Anogenital Squamous Terminology (LAST) standardization recommended p16INK4a immunohistochemistry (p16 IHC) for biopsies diagnosed morphologically as cervical intraepithelial neoplasia (CIN) grade 2 (CIN2) to classify them as low-grade or high-grade squamous intraepithelial lesions (HSILs). OBJECTIVE.—:To describe the relationships of p16 IHC and other biomarkers associated with cervical cancer risk with biopsy diagnoses. DESIGN.—:A statewide, stratified sample of cervical biopsies diagnosed by community pathologists (CPs), including 1512 CIN2, underwent a consensus, expert pathologist panel (EP) review (without p16 IHC results), p16 IHC interpretation by a third pathology group, and human papillomavirus (HPV) genotyping, results of which were grouped hierarchically according to cancer risk. Antecedent cytologic interpretations were also available. RESULTS.—:Biopsies were more likely to test p16 IHC positive with increasing severity of CP diagnoses, overall (Ptrend ≤ .001) and within each HPV risk group (Ptrend ≤ .001 except for low-risk HPV [Ptrend < .010]). All abnormal grades of CP-diagnosed biopsies were more likely to test p16 IHC positive with a higher HPV risk group (Ptrend < .001), and testing p16 IHC positive was associated with higher HPV risk group than testing p16 IHC negative for each grade of CP-diagnosed biopsies (P < .001). p16 IHC-positive, CP-diagnosed CIN2 biopsies were less likely than CP-diagnosed CIN3 biopsies to test HPV16 positive, have an antecedent HSIL+ cytology, or to be diagnosed as CIN3+ by the EP (P < .001 for all). p16 IHC-positive, CP-diagnosed CIN1 biopsies had lower HPV risk groups than p16 IHC-negative, CP-diagnosed CIN2 biopsies (P < .001). CONCLUSIONS.—:p16 IHC-positive, CP-diagnosed CIN2 appears to be lower cancer risk than CP-diagnosed CIN3. LAST classification of "HSIL" diagnosis, which includes p16 IHC-positive CIN2, should annotate the morphologic diagnosis (CIN2 or CIN3) to inform all management decisions, which is especially important for young (<30 years) women diagnosed with CIN2 for whom surveillance rather than treatment is recommended