The regulation and role of oxidative signal-inducible 1 protein kinase in Arabidopsis thaliana

Word processed copy.Includes bibliographical references (leaves 209-232).This study attempted to further characterise OXI1 protein kinase. Confocal microscopy and subcellular fractionation studies revealed a cytosolic localisation pattern for OXI1. Employment of a bioinformatics approach confirmed the induction of OXI1 gene expression in response to a range of AOS generating stimuli. However, the transcriptional increase of OXI1 in response to salinity and heat appears to be of no biological significance since the oxi1 mutant did not display altered tolerance to these two stresses in comparison to wild type

Varieties of Insurgency and Counterinsurgency in Iraq, 2003–2009

Varieties of Insurgency and Counterinsurgency in Iraq, 2003-2009 offers a useful analytical framework for understanding how and why rebellions either grow or diminish. This case study was created to focus on two specific challenges that operators and practitioners faced in Iraq: how to understand the actors and the complex irregular warfare environment; and how to manage interaction, adaptation, and reassessment in irregular warfare.https://digital-commons.usnwc.edu/ciwag-case-studies/1004/thumbnail.jp

Early Onset Angiosarcoma of the Breast Following Breast Conserving Therapy

Introduction: Breast angiosarcoma following treatment for breast cancer is a rare event and generally presents no earlier than 6 years after treatment. We identified 2 cases of early-onset angiosarcoma and evaluated patient and treatment factors. Methods: At our large multi-hospital health system, the tumor registry was searched for breast sarcoma from 2000-2020. Patient, tumor, and treatment details were collected. Results: 39 patients were identified, 4 with radiation induced angiosarcoma following breast cancer treatment (range 3-11 years). Two of the cases were early-onset, diagnosed at 3 and 4 years respectively. Patient 1 underwent BCT at age 44 for T1bN0 estrogen positive Her2 negative breast cancer. She presented 3 years later with progressive skin discoloration. After a delay of 3 months as multiple providers thought this was bruising secondary to trauma sustained during a fall, she was referred to breast surgery and punch biopsy was diagnostic for angiosarcoma (Figure 1). She underwent right mastectomy revealing 9.7-cm of high grade angiosarcoma. Patient 2 underwent BCT at 72 for T1cN1a estrogen positive Her2 negative breast cancer. She presented 4 years later with a suspicious skin finding. Punch biopsy was diagnostic for angiosarcoma. She underwent right mastectomy revealing 8-cm of high grade angiosarcoma. Conclusions: Radiation induced breast angiosarcoma is a known but rare entity typically occurring at least 6 years after treatment for breast cancer; however, it should remain high on the differential for patients with suspicious breast lesions before 6 years to avoid a delay in diagnosis as early-onset angiosarcoma does occur.https://scholarlycommons.henryford.com/merf2020caserpt/1126/thumbnail.jp

Analyzing point of care tools through faculty, resident, and stakeholder buy-in: a cautionary tale

Purpose: Costs for Preston Medical Library’s primary point-of-care (POC) clinical tool have increased to half of the acquisitions budget, while user affiliation data have not been provided to facilitate cost sharing. In response, user preferences for POC tools were analyzed to determine a viable, less expensive alternative to the current subscription. Setting/Participants/Resources: Faculty and residents at the University of Tennessee Graduate School of Medicine (GSM), and other clinical staff at the University of Tennessee Medical Center (UTMC), a 685-bed teaching hospital. Methodology: At the direction of school leadership, a working group of library staff, resident physicians, and medical faculty members was appointed, and data were gathered through individual user surveys of clinical support tools. Three POC tool options were considered. Select clinicians evaluated the tools using a series of questions individually chosen as typical to their disciplines. Additionally, feedback was sought from other AAHSL institutions regarding subscriptions to the tool in question and funding schemes. At the same time, the Dean communicated to the medical campus community that cost increases for the product had become prohibitive, requiring consideration of alternatives. Results/Outcomes: Survey responses revealed a strong preference for the incumbent tool, rating PubMed as the second preferred source, but not substitutable. Working group members preferred the current product at POC, judging one of the candidate tools as “adequate” but less user friendly and more time consuming to access. Hospital leadership also received responses from clinical staff. As a result, a cost sharing agreement with the school was forged. Discussion/Conclusion: A deliberative approach to assessing POC clinical tools was used, resulting in continued access to the preferred product. Enhanced data gathering on a go-forward basis will help to ascertain use patterns by academic and hospital users. The library and the other stakeholders will monitor development of alternative POC tools and costs for future decision making

Elevating Library Practice through Process Improvement Teams: The Electronic Resources Task Force

Objective Organizations in fields from manufacturing to health care use process improvement teams, an important aspect of LEAN practice, to improve their work. The library faced challenges with interfaces for electronic resources, including a dated electronic journals interface, out-of-control LibGuides, and lack of control over our web presence. The library formed the Electronic Resources Task Force to foster a collaborative approach to solving these problems. This poster will show techniques used and what we accomplished. Methods The library experienced many changes in the last year including changes in leadership and staff. With our new director’s emphasis on improving electronic access, new staff members, and a staff member’s recent training in Lean, we had a great opportunity to incorporate new techniques in team development. Our goal was to provide attractive, modern, and seamless access to evidence-based, high quality information resources. To share information and improve accountability, the team developed a shared flowchart document that allows any team member to update progress on any task at any time. The team meets regularly, further improving accountability and providing opportunities to address electronic resources and collections issues as a group. Results To date, the Electronic Resources Task Force has reduced the number of active LibGuides from 71 to 33 updated guides. Our transition to EBSCO’s Full Text Finder is complete. Additionally, we developed a new search box for LibGuides, introduced a LibGuides-based Databases A-Z page, updated LibAnswers, and rolled out a new literature search form and database. The team continues to follow up on a list of future improvements. Conclusions Incorporating Lean into our work is ongoing, as is our staff member’s training in these techniques. However, we can conclude that the techniques originally developed in manufacturing and being used in healthcare can also be used to improve library work

Launching Virtual Care in a Benign Breast Surgery Clinic

The aim of this study is to assess the success of implementation of a telemedicine clinic in a benign breast surgery practice, and the hypothesis was that some women may feel uncomfortable virtually discussing breast complaints and problems. Twelve women seen as new patients in the benign breast surgery clinic and scheduled for surgery were asked if they were interested in having their post-operative visit performed virtually. Demographic information was also collected. Ages ranged from 24 to 77 years, and distance from the hospital ranged from 4.3 miles to 14.3 miles. Of the 12 women surveyed, 8 women were interested in the telemedicine visits. The 4 women that declined were either not active on the patient portal, not active on the computer, or without access to a computer, and their ages ranged from 52-77. The 8 women that were interested in telemedicine ranged in age from 24-67, which was a younger group overall. There was no significant difference in distance from the hospital within the two groups. Of the 8 women who were interested in telemedicine, 2 have completed the post-operative virtual visit without requiring an in-person visit and were satisfied with their virtual visits. There is an opportunity for use of telemedicine in the benign breast clinic for routine post-operative visits. The hypothesis that women would be reluctant to participate due to discomfort with discussing breast problems virtually was not demonstrated. Telemedicine visits can be an important way to personalize care for patients and increase satisfaction

A Double-Mode RR Lyrae Star with a Strong Fundamental Mode Component

NSVS 5222076, a thirteenth magnitude star in the Northern Sky Variability Survey, was identified by Oaster as a possible new double-mode RR Lyrae star. We confirm the double-mode nature of NSVS 5222076, supplementing the survey data with new V band photometry. NSVS 5222076 has a fundamental mode period of 0.4940 day and a first overtone period of 0.3668 day. Its fundamental mode light curve has an amplitude twice as large as that of the first overtone mode, a ratio very rarely seen. Data from the literature are used to discuss the location in the Petersen diagram of double-mode RR Lyrae stars having strong fundamental mode pulsation. Such stars tend to occur toward the short period end of the Petersen diagram, and NSVS 5222976 is no exception to this rule.Comment: 14 pages, 4 figures, To be published in the March, 2006, issue of PAS

The effect of lymphatic microsurgical preventive healing approach (LYMPHA) on the development of upper-extremity lymphedema following axillary lymph node dissection in breast cancer patients

Background/Objective: Lymphedema following axillary lymph node dissection (ALND) is a common complication that can negatively impact quality of life as it reduces the functional capacity of the affected arm. It can also predispose patients to serious infectious complications such as limb cellulitis and development of malignancy. The lymphatic microsurgical preventive healing approach (LYMPHA procedure) involves the creation of a lymphatic‐to‐venous bypass at the time of axillary lymph node dissection (ALND) as a means of preventing lymphedema. The goal of our study is to assess the effect of LYMPHA on the development of clinical and subjective post‐operative lymphedema. Methods: This is a prospective longitudinal study in patients with breast cancer who underwent ALND with or without LYMPHA. The incidence of lymphedema was compared between ALND alone and ALND with LYMPHA using descriptive statistics. Limb circumference of both affected and unaffected limbs were measured and used to calculate limb volume by using an equation that converts limb circumference (cm) to volume (cc). Lymphedema was defined as a volume difference of ≥10% between the affected and unaffected limb. Patient symptoms were also assessed and compared between the 2 groups. Patient demographics including age, preoperative body mass index (BMI), smoking history, comorbidities, receipt of neoadjuvant or adjuvant chemotherapy, and receipt of adjuvant radiation were compared between the groups. Results: In our cohort of 139 patients, 104 underwent ALND with LYMPHA, while 35 underwent ALND alone. Of these, 52.5% of patients had documented interlimb circumference measurements. The mean age was 52.6 years old, mean BMI was 30.16 kg/m2, 4 patients (2.9%) had pre‐operative radiation, 102 patients (73.4 %) had post‐operative radiation, 86 patients (61.9 %) had neoadjuvant chemotherapy, 41 and 58 patients (41.7 %) had adjuvant chemotherapy. There were no significant differences between the 2 groups in the above demographics and treatment variables, except those who underwent ALND alone had a significantly higher incidence of diabetes mellitus (25.7% patients with ALND alone vs 11.5% LYMPHA patients (p=0.043)). Based on patient reported symptoms and the need to initiate complete decongestive therapy, 57.1% (n=20) of patients who underwent ALND alone developed lymphedema compared to 26.9% (n=28 patients) of those who had ALND with LYMPHA (p=0.0011). When comparing the relative volume difference, 57.1% (n=8) of ALND alone patients developed lymphedema versus 20.3% (n=12) of LYMPHA patients (p=0.0055). Conclusions: Our data support the universal use of LYMPHA at the time of ALND as a means of preventing upper extremity lymphedema. Further studies are needed to evaluate quality of life and functional differences between those who had LYMPHA and those who did not