"Negotiating selves" : the (re)construction of teachers? professional identities in the era of educational reform : a narrative inquiry

The study is set within the context where government-led education reforms have moved the teaching community to a new management culture in Hong Kong. Using narrative inquiry, I seek to gain an understanding on how education reforms are shaping the lives and identities of a group of four experienced secondary teachers in Hong Kong. Through a new construct-attending to teachers' own voices, the data were gathered from teachers through open-ended narrative interviews, focusing on their own experiences and personal values, over a period of two years. Assuming the dual roles of a researcher and a participant in this study, I worked collaboratively with the participant teachers across different school settings, yet closely linked with our experiences, to explore the nature and meaning of our life experiences in the reform context. While keeping past experiences central to the inquiry, multi-layered life stories among us were connected and new meanings emerged during the research process. The study is composed of interacting levels of narrative accounts which appear in various literacy forms, such as scholarly verbatim, songs, poems, dialogues and personal reflections. Through representation and interpretation of stories in the form of metaphors, as in the use of flower labels for participant teachers' attributes and the parallels of 'The Sound of Silence' teachers experienced, stories lived and told by teachers appeared to become new and 'fluid' experiences to both the researcher and the participants. The study contributes to an attempt to relate teachers' past experiences, in the form of stories, to their professional growth. The study also enters into the professionalEThOS - Electronic Theses Online ServiceGBUnited Kingdo

Radiation-associated angiosarcoma after autologous breast reconstruction: report of two cases in a plastic surgery unit

Radiation-associated breast angiosarcoma is a rare diagnosis but is commonly reported. Angiosarcoma occurring in non-breast tissue in breasts that have been reconstructed with autologous tissue following mastectomy is extremely rare. In our unit, we have managed two patients with angiosarcoma arising in non-breast tissue autologous reconstructions. Our report emphasises that any tissue treated with radiotherapy—that is, the residual mastectomy skin flaps or non-breast tissue autologous reconstructions—are at a risk of secondary angiosarcoma. We also discuss recommended surgical management, surveillance and genetic testing. Level of Evidence is V, risk study

Opportunities for improving recognition of coastal wetlands in global ecosystem assessment frameworks

Vegetated coastal wetlands, including seagrass, saltmarsh and mangroves, are threatened globally, yet the need to avert these losses is poorly recognized in international policy, such as in the Convention on Biological Diversity and the United Nations (UN) Sustainable Development Goals. Identifying the impact of overlooking coastal wetlands in ecosystem assessment frameworks could help prioritize research efforts to fill these gaps. Here, we examine gaps in the recognition of coastal wetlands in globally applicable ecosystem assessments. We address both shortfalls in assessment frameworks when it comes to assessing wetlands, and gaps in data that limit widespread application of assessments. We examine five assessment frameworks that track fisheries, greenhouse gas emissions, ecosystem threats, and ecosystem services. We found that these assessments inform management decisions, but that the functions provided by coastal wetlands are incompletely represented. Most frameworks had sufficient complexity to measure wetland status, but limitations in data meant they were incompletely informed about wetland functions and services. Incomplete representation of coastal wetlands may lead to them being overlooked by research and management. Improving the coverage of coastal wetlands in ecosystem assessments requires improving global scale mapping of wetland trends, developing global-scale indicators of wetland function and synthesis to quantitatively link animal population dynamics to wetland trends. Filling these gaps will help ensure coastal wetland conservation is properly informed to manage them for the outstanding benefits they bring humanity

Global typologies of coastal wetland status to inform conservation and management

Global-scale conservation initiatives and policy instruments rely on ecosystem indicators to track progress towards targets and objectives. A deeper understanding of indicator interrelationships would benefit these efforts and help characterize ecosystem status. We study interrelationships among 34 indicators for mangroves, saltmarsh, and seagrass ecosystems, and develop data-driven, spatially explicit typologies of coastal wetland status at a global scale. After accounting for environmental covariates and gap-filling missing data, we obtained two levels of clustering at 5 and 18 typologies, providing outputs at different scales for different end users. We generated 2,845 cells (1° (lat) × 1° (long)) globally, of which 29.7% were characterized by high land- and marine-based impacts and a high proportion of threatened species, 13.5% by high climate-based impacts, and 9.6% were refuges with lower impacts, high fish density and a low proportion of threatened species. We identify instances where specific actions could have positive outcomes for coastal wetlands across regions facing similar issues. For example, land- and marine-based threats to coastal wetlands were associated with ecological structure and function indicators, suggesting that reducing these threats may reduce habitat degradation and threats to species persistence. However, several interdimensional relationships might be affected by temporal or spatial mismatches in data. Weak relationships mean that global biodiversity maps that categorize areas by single indicators (such as threats or trends in habitat size) may not be representative of changes in other indicators (e.g., ecosystem function). By simplifying the complex global mosaic of coastal wetland status and identifying regions with similar issues that could benefit from knowledge exchange across national boundaries, we help set the scene for globally and regionally coordinated conservation

Perceived Roles and Barriers in Delivering Community-Based Care: A Qualitative Study of Health and Social Care Professionals

Introduction: As healthcare systems increasingly embrace population health management, the integration of health and social care to improve the health and well-being of individuals is crucial. Thus, we conducted a qualitative study in Singapore to understand health and social care professionals’ (HCPs and SCPs) perception of the roles they played in delivering community-based care. Methods: A descriptive phenomenological research design was adopted. HCPs and SCPs (n = 53) providing services in community settings were recruited purposefully and interviewed through eleven focus group discussions. Each session was recorded and transcribed. Thematic analysis was applied. Results: Our results revealed eight themes in three main categories describing the roles played by HCPs and SCPs, including: (1) delivering needs-based care in community settings; (2) activating and empowering clients in health care, and (3) fostering community-based sustainable support networks. Six barriers encountered while performing these roles were also identified. Discussion and Conclusion: Our results highlight that the roles of HCPs and SCPs go beyond the provision of direct medical and social care. They were involved in activating and empowering clients to take care of their health, and importantly, fostering community-based sustainable support networks to better empower individuals in coping with health challenges. The identified barriers shed light on areas for potential improvements for integrated community care

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Simple and effective bacterial-based intratumoral cancer immunotherapy

Background We describe intratumoral injection of a slow-release emulsion of killed mycobacteria (complete Freund’s adjuvant (CFA)) in three preclinical species and in human cancer patients. Methods Efficacy and safety were tested in mammary tumors in mice, in mastocytomas in mice and dogs, and in equine melanomas. In mice, survival, tumor growth, and tumor infiltration by six immune cell subsets (by flow cytometry) were investigated and analyzed using Cox proportional hazards, a random slopes model, and a full factorial model, respectively. Tumor growth and histology were investigated in dogs and horses, as well as survival and tumor immunohistochemistry in dogs. Tumor biopsies were taken from human cancer patients on day 5 (all patients) and day 28 (some patients) of treatment and analyzed by histology. CT scans are provided from one patient. Results Significantly extended survival was observed in mouse P815 and 4T1 tumor models. Complete tumor regressions were observed in all three non-human species (6/186 (3%) of mouse mastocytomas; 3/14 (21%) of canine mastocytomas and 2/11 (18%) of equine melanomas). Evidence of systemic immune responses (regression of non-injected metastases) was also observed. Analysis of immune cells infiltrating mastocytoma tumors in mice showed that early neutrophil infiltration was predictive of treatment benefit. Analysis of the site of mastocytoma regression in dogs weeks or months after treatment demonstrated increased B and T cell infiltrates. Thus, activation of the innate immune system alone may be sufficient for regression of some injected tumors, followed by activation of the acquired immune system which can mediate regression of non-injected metastases. Finally, we report on the use of CFA in 12 human cancer patients. Treatment was well tolerated. CT scans showing tumor regression in a patient with late-stage renal cancer are provided. Conclusion Our data demonstrate that intratumoral injection of CFA has major antitumor effects in a proportion of treated animals and is safe for use in human cancer patients. Further trials in human cancer patients are therefore warranted. Our novel treatment provides a simple and inexpensive cancer immunotherapy, immediately applicable to a wide range of solid tumors, and is suitable to patients in developing countries and advanced care settings.g Canberra trial: Canberra Hospital Private Practice Fund, Janice and Ron Parker Fund. Mouse preclinical studies: Lea Chapuis Memorial Fund. Canine preclinical studies: The John and Mary Kibble Trust (grants CT22492, CT21335) and the William Peter Richards Bequest for research into veterinary pathology. CSEC, ERA, and AAA was supported by Australian Government Research Training Program Stipend Scholarships. CSEC and K-MS were supported by Max Lindemann Memorial Foundation, Miam

UN Decade on Ecosystem Restoration 2021–2030: what chance for success in restoring coastal ecosystems?

On 1 March 2019, the United Nations (UN) General Assembly (New York) declared 2021–2030 the “UN Decade on Ecosystem Restoration.” This call to action has the purpose of recognizing the need to massively accelerate global restoration of degraded ecosystems, to fight the climate heating crisis, enhance food security, provide clean water and protect biodiversity on the planet. The scale of restoration will be key; for example, the Bonn Challenge has the goal to restore 350 million km2 (almost the size of India) of degraded terrestrial ecosystems by 2030. However, international support for restoration of “blue” coastal ecosystems, which provide an impressive array of benefits to people, has lagged. Only the Global Mangrove Alliance (https://mangrovealliance.org/) comes close to the Bonn Challenge, with the aim of increasing the global area of mangroves by 20% by 2030. However, mangrove scientists have reservations about this target, voicing concerns that it is unrealistic and may prompt inappropriate practices in attempting to reach this target (Lee et al., 2019). The decade of ecosystem restoration declaration also coincides with the UN Decade of Ocean Science for Sustainable Development, which aims to reverse deterioration in ocean health. If executed in a holistic and coordinated manner, signatory nations could stand to deliver on both these UN calls to action

Recurrence Risk of Autism in Siblings and Cousins: A Multinational, Population-Based Study

Objective:Familial recurrence risk is an important population-level measure of the combined genetic and shared familial liability of autism spectrumdisorder (ASD). Objectives were to estimate ASD recurrence risk among siblings and cousins by varying degree of relatedness and by sex.Method:This is a population-based cohort study of livebirths from 1998 to 2007 in California, Denmark, Finland, Israel, Sweden and WesternAustralia followed through 2011 to 2015. Subjects were monitored for an ASD diagnosis in their older siblings or cousins (exposure) and for their ASDdiagnosis (outcome). The relative recurrence risk was estimated for different sibling and cousin pairs, for each site separately and combined, and by sex.Results:During follow-up, 29,998 cases of ASD were observed among the 2,551,918 births used to estimate recurrence in ASD and 33,769 cases ofchildhood autism (CA) were observed among the 6,110,942 births used to estimate CA recurrence. Compared with the risk in unaffected families, therewas an 8.4-fold increase in the risk of ASD following an older sibling with ASD and a 17.4-fold increase in the risk of CA following an older sibling withCA. A 2-fold increase in the risk for cousin recurrence was observed for the 2 disorders. There also was a significant difference in sibling ASD recurrencerisk by sex.Conclusion:The present estimates of relative recurrence risks for ASD and CA will assist clinicians and families in understanding autism risk in thecontext of other families in their population. The observed variation by sex underlines the need to deepen the understanding of factors influencing ASD familial risk.</p