Ruin Nation: Destruction and the American Civil War

New Approach to the Civil War’s Legacy No American in the spring of 1861, Northerner or Southerner, white or black, free or slave, could have imagined the scale and devastating longterm effects of the war that would soon engulf them. If the sectional conflict generated a great deal of an...

Clinicians in the classroom: the bereavement midwife

The aim of pre-registration midwifery education is to prepare the student for the demanding and complex role they aspire to, using a range of teaching, learning and assessment strategies both in theory and practice. This article is part of a series exploring the role of clinicians as facilitators of learning in the classroom environment. This article explores the role of the bereavement midwife and discusses a teaching session conducted by bereavement midwife Tracy Rea with second-year students on the 3-year pre-registration midwifery programme. The session included input from a couple who shared their experiences of the loss of their son and their subsequent pregnancy. The article concludes with student feedback on the session, demonstrating the deep and meaningful learning that took place and confirming the value of bringing the realities of practice into the classroom environment

Differential expression of genes involved in iron metabolism in Aspergillus fumigatus

The ability of fungi to survive in many environments is linked to their capacity to acquire essential nutrients. Iron is generally complexed and available in very limited amounts. Like bacteria, fungi have evolved highly specific systems for iron acquisition. Production and uptake of iron-chelating siderophores has been shown to be important for certain human bacterial pathogens, as well as in fungal pathogens such as Cryptococcus neoformans and Fusarium graminearum. This system also enables the opportunistic fungal pathogen Aspergillus fumigatus to infect and subsequently colonize the human lung. In this study, advantage was taken of genome sequence data available for both Aspergillus nidulans and A. fumigatus either to partially clone or to design PCR primers for 10 genes putatively involved in siderophore biosynthesis or uptake in A. fumigatus. The expression of these genes was then monitored by semi-quantitative and quantitative real-time PCR over a range of iron concentrations. As expected, the putative biosynthetic genes sidA, sidC and sidD were all strongly up-regulated under iron starvation conditions, although the variable degree of induction indicates complex regulation by a number of transcriptional factors, including the GATA family protein SreA. In contrast, the gene sidE shows no iron-regulation, suggesting that SidE may not be involved in siderophore biosynthesis. The characterisation of the expression patterns of this subset of genes in the iron regulon facilitates further studies into the importance of iron acquisition for pathogenesis of A. fumigatus. [Int Microbiol 2006; 9(4):281-287

Chemoradiotherapy in octogenarians as primary treatment for muscle-invasive bladder cancer

Introduction: While radical cystectomy is the gold standard for muscle-invasive bladder cancer (MIBC), in octogenarians cystectomy results in a higher perioperative mortality rate (6.8‒11.1%) than in younger patients (2.2%). Trimodality therapy is a bladder-sparing regimen composed of transurethral resection of bladder tumour (TURBT) and chemoradiotherapy, with intent for salvage cystectomy, and has a 62.5‒90% initial complete response rate. In this study, we evaluate TURBT and chemoradiotherapy without salvage cystectomy in medically inoperable octogenarian patients. Methods: We identified a retrospective cohort of patients aged 80‒89 years with invasive urothelial carcinoma who received combination chemoradiotherapy between 2008 and June 2014. Outcomes were evaluated by Kaplan-Meier (KM) and Cox regression. Results: In 40 patients, the mean age was 84.5 years (interquartile range [IQR] 83‒86). Seventeen patients received hypofractionated, low-dose radiotherapy (LD) (37.5‒40 Gy), while 23 received conventionally fractionated radiotherapy (high-dose [HD]) (50‒65 Gy). Mean overall survival (OS) was 20.7 months (IQR 12.75‒23.25), while mean recurrence-free survival (RFS) was 13.75 months (IQR 3.75‒16.5). Patients receiving HD radiotherapy showed improved OS and local RFS (LRFS) without significant differences in Grade 3‒4 toxicities. Univariate Cox regression identified hydronephrosis as a predictor of worse OS and local recurrence and HD radiotherapy as a predictor of improved OS and local recurrence rates. Multivariate Cox regression identified hydronephrosis to be a significant predictor of LRFS. Conclusions: Primary chemoradiotherapy for inoperable patients with MIBC resulted in a three-year OS of 54.9% (comparable to cystectomy) and three-year RFS of 42.3%. Superior outcomes were associated with more aggressive chemoradiotherapy treatment. The results of the local control subanalyses in this study are hypothesis-generating due to the limited patient numbers in the cohort

Supplementary data: Chemoradiotherapy in octogenarians as primary treatment for muscle-invasive bladder cancer

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The relationship between physician burnout and depression, anxiety, suicidality and substance abuse: A mixed methods systematic review

IntroductionThe World Health Organization defines burnout as a problem associated with employment, a category distinct from psychological disorders such as depression, anxiety, suicidality and disorders of substance abuse. Evaluating the association between burnout as an occupational exposure and psychological morbidity may indicate that burnout can act as an occupational risk factor for mental ill-health. The systematic review explores this relationship in physicians due to the increased risk in this population and the implications for healthcare delivery.MethodsA mixed methods systematic review of the literature was conducted across Medline, Cinahl Plus, PsycInfo, Web of Science and The Cochrane Library. Databases were systematically searched using keywords relating to physician burnout and depression, anxiety, suicidality and substance abuse. Identified articles were screened for eligibility by two independent researchers. Data extraction was performed and studies assessed for risk of bias. Quantitative and qualitative results were integrated using a convergent segregated approach and results portrayed as a narrative synthesis.ResultsSixty-one articles were included in the review. There was notable heterogeneity in the measurement and criteria used to define burnout limiting the assimilation of results. Despite this, all studies that measured the association between depression and burnout reported a significant association. Studies that reported association between burnout and anxiety were similarly uniformly consistent. Most studies that reported the association between burnout and suicidality indicated that a significant association exists however difficulty in measurement of suicidality may have influenced variability of results. The reported association between substance abuse and burnout was more variable, suggesting that any association is likely to be weak or influenced by other variables. Qualitative studies described the manifestations of chronic workplace stress as well as perceived links with psychological morbidity. These included lack of time for work-life balance, the contribution of professional relationships and a culture of invulnerability that exists among physicians.ConclusionThe systematic review cannot conclude causality but suggests that physician burnout is associated with depression, anxiety and suicidality. Qualitative data provides insight into the nature of this association. The review indicates the need for longitudinal research and provides considerations for intervention strategies to prevent the development and progression of burnout.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172938, identifier: CRD42020172938

The Grizzly, November 9, 1987

proTheatre Perfects Production • Balloon Bombings Banned • Norman Pearlstine Addresses Problems Associated with the U.S. Free Press • Letters: Beautifying Campus?; In One Ear, Out the Other • Rolling Stone Celebrates 20th Year • Iran Source of Conflict in Dialogue Discussion • Calix Relates Salvadorian Horrors • Notes: Room Policy Changed; Apartheid Subject of Forum; Discussion Includes Pretzels!; Myths to be Explained • Ursinus Not Affected by Stock Market Crash: Others Not as Lucky • Pray TV Damages Churches • UC Robs Team of Championship • Error Prone Bears Drop Another • Early Bowl Picture Thickens • Bears Battle Tough Season • Ursinus \u27Mers Open Season • Bear Pack Finishes Strong • Tri Lambda: Organization for Life Long Learners • Musser: The Year After • Get in The Real World Get the Grizzly Network • Busie Bodys Display Fancy Bodies • Welcome to the Greek Life: Congratulations 1987 Pledges • Phonathons Prove Successful: $30,000 Raised • Student Applauds Washington Semester • Seniors: Where Are You? • November Red and Gold Days • Eshbach Awards Winners • CAB Learns New Ideas • New Equipment Upgrades Dept.https://digitalcommons.ursinus.edu/grizzlynews/1198/thumbnail.jp

The Grizzly, September 25, 1987

Wild Weekend: Tippler Topples, Vandals Varnish, Class Cutters Cavort • Sororities to Begin Formal Rushing Season • Freshmen Find Fun on Campus • Letters: Unholy Parent\u27s Day Irks Jews; Old Men\u27s Life Bad News; Students Have Bills to Pay, Too • Freshman AIDS Orientation • Domestic Violence an Issue • Cameron a Pro Habla-ing • House Bill 749 • Victorious Volleyballers • Soccer\u27s Hoover Earns Athlete of the Week • Football Falls to F&M • Scabs to Score for NFL? • Cross Country Running to the Top • Hockey Lashes LaSalle • Busie Bodys Rehearse • Lantern Announces Deadline • All Greeks Not Geeks • Nautical Natives Sailing with Club Revival • Fat Fear: Freshman Fifteen Thickens Frosh • Ills a Problem Already • E-burg Offers Basic Grub • It\u27s Your Future • CAB Gets Some Public Relations • As Members Drop, the Show Must Go On • Entertainment: Ursinus Stylehttps://digitalcommons.ursinus.edu/grizzlynews/1193/thumbnail.jp

Mapping language networks and their association with verbal abilities in paediatric epilepsy using MEG and graph analysis

Recent theoretical models of language have emphasised the importance of integration within distributed networks during language processing. This is particularly relevant to young patients with epilepsy, as the topology of the functional network and its dynamics may be altered by the disease, resulting in reorganisation of functional language networks. Thus, understanding connectivity within the language network in patients with epilepsy could provide valuable insights into healthy and pathological brain function, particularly when combined with clinical correlates. The objective of this study was to investigate interactions within the language network in a paediatric population of epilepsy patients using measures of MEG phase synchronisation and graph-theoretical analysis, and to examine their association with language abilities. Task dependent increases in connectivity were observed in fronto-temporal networks during verb generation across a group of 22 paediatric patients (9 males and 13 females; mean age 14 years). Differences in network connectivity were observed between patients with typical and atypical language representation and between patients with good and poor language abilities. In addition, node centrality in left frontal and temporal regions was significantly associated with language abilities, where patients with good language abilities had significantly higher node centrality within inferior frontal and superior temporal regions of the left hemisphere, compared to patients with poor language abilities. Our study is one of the first to apply task-based measures of MEG network synchronisation in paediatric epilepsy, and we propose that these measures of functional connectivity and node centrality could be used as tools to identify critical regions of the language network prior to epilepsy surgery