To change or not to change: A case study of one urban high school\u27s technological transformational process.

This study utilized a case study format for examining one urban high school\u27s inclusion of technology and subsequent changes to the curriculum, school design, school organization, and teachers\u27 pedagogy brought about as a consequence. Specifically, the study addressed five broad questions: (1) How do teachers view technology\u27s role in their curriculum? (2) What is the role of computers in curriculum change? (3) Does extended work with computers change the types of communications processes used? (4) How does work with computers change (a) instructional practices, (b) overall school design, and (c) school organization? and (5) What is the role of change management theory in educational change? Data was collected through the use of a 61-item, Likert-type questionnaire; in-depth conversations with randomly selected teachers; classroom observations; and analysis of documents relating to technology integration. Teachers reported strong beliefs in both traditional and non-traditional uses of computers, but these beliefs did not necessarily reflect actual classroom practices. In terms of curriculum changes, teachers reported that student learning had increased overall and that student expectations were changing. That belief was supported by student editorials calling for widespread teacher integration of technology. Fully 79% of the teachers responding stated that they had made changes to their curriculum within the past five years. Teachers felt positive about support that they received for using and integrating technology. They had access to an on-site school technologist, a supportive principal, and specific technology courses offered by the school district. It appeared that when teachers and students had access to, extended work with, and support in learning to use technology, the communications processes within the content classrooms did begin to change. This was apparent as students reassessed the audience for writing tasks they completed, or as they considered issues of plagiarism and copyright laws. Within school design, there did not appear to be major design changes in classrooms. Student desks were typically in straight rows, and in classrooms with one computer, the computer was usually placed on the teacher\u27s desk or very near to it. Only 25% of the teachers felt that the computer area in their classroom had become a major focus area

Rapid culture and identification: a practical method for early preliminary laboratory diagnosis of sepsis

ABSTRACTThis study describes the development of a method for rapid preliminary species identification of bacteria from positive blood culture vials. The method yielded preliminary identification results for 496 (92%) of 541 positive blood cultures within 5 h. The method was capable of identifying the most frequently isolated bacteria (i.e., Staphylococcus aureus, coagulase-negative staphylococci, Escherichia coli, Streptococcus pneumoniae and Enterococcus spp.) to the species level. The method can be established easily, with a materials cost of 2–5 Euros per sample

Multi-visceral resection of pancreatic VIPoma in a patient with sinistral portal hypertension

BACKGROUND: VIPomas are rare neuroendocrine tumors poorly described in the literature. Aggressive resection of patients with advanced VIPoma neuroendocrine tumors has rarely been reported. CASE PRESENTATION: A 46 year old women presented with abdominal pain and diarrhea. A three-dimensional (3-D) pancreas protocol computed tomography scan revealed an 18 × 12 cm pancreatic VIPoma abutting the liver, stomach, spleen, left adrenal, colon that also invaded the distal duodenum – proximal jejunum at the ligament of Treitz in association with sinistral portal hypertension. Following preoperative proximal splenic artery embolization, the patient with underwent successful en bloc resection of the locally advanced VIPoma in conjunction with a diaphragmatic resection, total gastrectomy, splenectomy, left adrenalectomy, as well as small and large bowel resection. The estimated blood loss was 500 ml. All margins were negative (R0 resection). The patient is alive and disease-free. CONCLUSION: This case illustrates the role of aggressive resection of pancreatic neuroendocrine tumors and highlights several key technical points that allowed for successful resection

Incorporating daily physical activity in kindergarten children with disabilities: effect on classroom behavior and activity engagement

Children with disabilities often experience challenges staying on-task during instructional time in a classroom which is why this an important area of study for teachers and researchers. Physical activity has been shown to have a positive impact on classroom behavior. The purpose of this study was to determine the effectiveness of implementing 4 5-min breaks of daily physical activity (DPA) in a kindergarten classroom of children with disabilities at improving on-task behavior and reducing self-stimulatory behavior (n=14). A secondary purpose was to determine the level of engagement and feasibility of incorporating a DPA program in a classroom of children with disabilities. Classroom Behavior: Results indicated significant increases in on-task behavior from baseline measures to follow-up measures, immediately following 5-minutes of DPA, and from baseline to intervention phase. In addition, self-stimulatory behaviors also significantly reduced in participants who exhibited self-stimulatory behavior. Engagement and Feasibility: Results indicated significant improvements in engagement during DPA from week 1 to week 4. Conclusion: The results of this study indicate that incorporating 4 5-minute bouts of DPA in a classroom of children with disabilities is effective at increasing time on-task and reducing self-stimulatory behaviors. In addition, the DPA program was feasible and engagement level was achieved in students. These findings warrant future research with greater ranges of age groups and a longitudinal study design for children with disabilities

Antimicrobial resistance of Escherichia coli isolates from outpatient urinary tract infections in women in six European countries including Russia

Objectives In the Northern Dimension Antibiotic Resistance Study (NoDARS), Finland, Germany, Latvia, Poland, Russia and Sweden collected urine samples from outpatient women (aged 18–65 years) with symptoms of uncomplicated urinary tract infection (UTI) to investigate the levels of antimicrobial resistance (AMR) among Escherichia coli isolates. Methods A total of 775 E. coli isolates from 1280 clinical urine samples were collected from October 2015 to January 2017. Antimicrobial susceptibility testing was performed and the results were interpreted according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. Results Overall AMR rates to the commonly used antibiotics nitrofurantoin, fosfomycin and mecillinam (except for Germany that was missing a result for mecillinam) were 1.2%, 1.3% and 4.1%, respectively. The highest overall resistance rates were determined for ampicillin (39.6%), trimethoprim (23.8%), trimethoprim/sulfamethoxazole (22.4%), amoxicillin/clavulanic acid (16.7%) and ciprofloxacin (15.1%), varying significantly between countries. The rate of extended-spectrum β-lactamase (ESBL) production was 8.7%. None of the isolates showed resistance to meropenem. Conclusions In most cases, low AMR rates were detected against the first-line antibiotics recommended in national UTI treatment guidelines, giving support to their future use. These results also support the European Association of Urology guidelines stating that nitrofurantoin, fosfomycin and mecillinam are viable treatment options for uncomplicated UTI.Peer Reviewe

A Call for Action: The Application of the International Health Regulations to the Global Threat of Antimicrobial Resistance

Stephen Harbarth and colleagues argue that the International Health Regulations (IHR) should be applied to the global health threat of antimicrobial resistance

Patient-derived luminal breast cancer xenografts retain hormone receptor heterogeneity and help define unique estrogen-dependent gene signatures

Bypassing estrogen receptor (ER) signaling during development of endocrine resistance remains the most common cause of disease progression and mortality in breast cancer patients. To date, the majority of molecular research on ER action in breast cancer has occurred in cell line models derived from late stage disease. Here we describe patient-derived ER + luminal breast tumor models for the study of intratumoral hormone and receptor action. Human breast tumor samples obtained from patients post surgery were immediately transplanted into NOD/SCID or NOD/SCID/ILIIrg−/− mice under estrogen supplementation. Five transplantable patient-derived ER + breast cancer xenografts were established, derived from both primary and metastatic cases. These were assessed for estrogen dependency, steroid receptor expression, cancer stem cell content, and endocrine therapy response. Gene expression patterns were determined in select tumors ±estrogen and ±endocrine therapy. Xenografts morphologically resembled the patient tumors of origin, and expressed similar levels of ER (5–99 %), and progesterone and androgen receptors, over multiple passages. Four of the tumor xenografts were estrogen dependent, and tamoxifen or estrogen withdrawal (EWD) treatment abrogated estrogen-dependent growth and/or tumor morphology. Analysis of the ER transcriptome in select tumors revealed notable differences in ER mechanism of action, and downstream activated signaling networks, in addition to identifying a small set of common estrogen-regulated genes. Treatment of a na¨ıve tumor with tamoxifen or EWD showed similar phenotypic responses, but relatively few similarities in estrogen-dependent transcription, and affected signaling pathways. Several core estrogen centric genes were shared with traditional cell line models. However, novel tumor-specific estrogen-regulated potential target genes, such as cancer/testis antigen 45, were uncovered. These results evoke the importance of mapping both conserved and tumor-unique ER programs in breast cancers. Furthermore, they underscore the importance of primary xenografts for improved understanding of ER+ breast cancer heterogeneity and development of personalized therapies

Worldwide Diversity of Klebsiella pneumoniae That Produce β-Lactamase blaKPC-2 Gene1

TOC summary: Clones harboring different plasmids with identical genetic structure could be the origin of worldwide spread

Large variation in ESBL-producing Escherichia coli carriers in six European countries including Russia

We investigated the faecal carriage prevalence of extended-spectrum β-lactamase production in Escherichia coli (EP-EC) and/or Klebsiella pneumoniae (EP-KP) and risk factors associated with carriage among adult study subjects in Finland, Germany, Latvia, Poland, Russia and Sweden (partner countries). The aim was to get indicative data on the prevalence of ESBL-carriage in specific populations in the region. Faecal samples were collected from four study populations and screened on ChromID-ESBL and ChromID-OXA-48 plates. Positive isolates were further characterised phenotypically. Our results show a large variation in carrier prevalence ranging from 1.6% in Latvia to 23.2% in Russia for EP-EC. For the other partner countries, the prevalence of EP-EC were in increasing numbers, 2.3% for Germany, 4.7% for Finland, 6.6% for Sweden, 8.0% for Poland and 8.1% for all partner countries in total. Carriers of EP-KP were identified only in Finland, Russia and Sweden, and the prevalence was < 2% in each of these countries. No carriers of carbapenemase-producing isolates were identified. This is the first study reporting prevalence of carriers (excluding traveller studies) for Finland, Latvia, Poland and Russia. It contributes with important information regarding the prevalence of EP-EC and EP-KP carriage in regions where studies on carriers are limited