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Abstract: This paper reports on a research project investigating the role of universities in South Africa in contributing to poverty reduction through the quality of their professional education programmes. The focus here is on theorising and the early operationalisation of multi-layered, multi-dimensional transformation based on ideas from Amartya Sen''s capability approach. Key features of a professionalism oriented to public service, which in South Africa must mean the needs and lives of the poor, are outlined. These features include: the demand from justice; the expansion of the comprehensive capabilities both of the poor and professional capability formation to be able to act in ‘pro-poor’ ways; and, praxis pedagogies which shape this connected process. This theorisation is then tentatively operationalised in a process of selecting transformation dimensions. [Copyright &y& Elsevier]

This paper proposes that widening participation in higher education might distinctively be conceptualised beyond economically driven human capital outcomes, as a matter of widening capability. Specifically, the paper proposes forming the capability of students to become and to be 'strong evaluators', able to make reflexive and informed choices about what makes a good life for each of them. Evaluating equality and justice in higher education, and specifically the case of 'widening participation', is then greatly advanced by considering the conceptual tools provided by Amartya Sen's capability approach. The paper therefore elaborates on Sen's ideas and demonstrates their applicability in relation to widening participation student voices gathered in research interviews. Important though Sen's ideas are, there are barriers that stand in the way of taking up these ideas educationally. While three such barriers are acknowledged in the paper, four resources of possibility for recovering widening participation as capability formation from neoliberal and other forms of instrumentalism are also sketched. [ABSTRACT FROM AUTHOR]

This paper proposes a human capabilities approach for evaluating student learning and the social and pedagogical arrangements that support equality in capabilities for all students. It outlines the focus on valuable beings and doings in the capability approach developed by Amartya Sen, and Martha Nussbaum's capabilities focus on human flourishing. For both, education is understood to include both intrinsic and instrumental aims and to be foundational to other important capabilities. A method for applying the capability approach to evaluating what students said about their own learning is suggested, and from this a list of valued functional capabilities is then outlined. The multi-dimensionality of the approach is emphasised and its relationship to economic opportunities and human security. Finally, generic graduate outcomes are considered but rejected as not being the same as capabilities. [ABSTRACT FROM AUTHOR]

This paper argues for a mild perfectionism in applying Amartya Sen's capability approach for an education transformative of student agency and well-being. Key to the paper is the significance of education as a process of being and becoming in the future, and education's fundamental objective of a positively changed human being. The capability approach therefore provides for additional reasons for investment in education beyond its human capital value. While the capability approach offers a radical freedom-focused approach to education, it is argued here that because it is an approach to human development and not a theory of educational development, it provides a thin account of education and how power and unfreedoms work in education. What is then appropriate in the specific case of education is neither Sen's reluctance to specify valuable capabilities, nor Nussbaum's canonical list of 10 universal capabilities, but a mild perfectionism which steers a path between these two approaches and yet is consistent with the core quality of life and well-being arguments of the capability approach. The argument proceeds through stages of outlining the capability approach and then exploring arguments around power, values and education as a public good, before arguing that capability pedagogical praxis as a practical expression of the theoretical ideas would inflect towards social justice in education. [ABSTRACT FROM AUTHOR]

Introduction: Delayed posthypoxic demyelination may rarely complicate an episode of severe hypoxia, with or without exposure to carbon monoxide. Following recovery from initial coma, progressive neurologic deterioration ensues with outcomes ranging from death to full recovery. Delayed posthypoxic demyelination is hypothesized to be immunemediated, with support coming from recent animal experiments.Methods: We report a 46-year-old man who developed progressive cognitive deficits with abulia approximately 3 weeks after recovering from coma related to alcohol and morphine intoxication.Results: Despite treatment with high-dose steroids and plasmapheresis, he continued to deteriorate and remained in a vegetative state until his death under hospice care more than 2 months after his initial hypoxic insult. Serial brain imaging and postmortem examination showed bilateral necrosis of the globi pallidi and extensive demyelination in the centrum semiovale and corona radiata.Conclusions: Based on an immune-mediated model of disease and given a lack of effective treatments, future use of immunomodulatory therapy may still be worth considering early in the course of this rare and potentially devastating condition. [ABSTRACT FROM AUTHOR]

This paper explores the central place of stories and narratives in action research practices and accounts to argue that it is hard to imagine how we might do or write about action research in a non-storied way. The paper argues that good stories help us to think well and more wisely about ourselves and our practice. An historical example is chosen to illustrate the compelling potential of stories about real people and real lives, followed by a teasing out of six methodological issues that arise. [ABSTRACT FROM AUTHOR]

Anatomic variability in the posterior circulation and small, fragile, or otherwise treacherous origins of vertebral arteries can create a challenge to acute endovascular intervention. We report a case of unsuccessful reperfusion due to inability to access the posterior circulation in a patient with acute basilar artery occlusion. [ABSTRACT FROM AUTHOR]

Increasingly there is interest in development studies and specifically in the field of education in taking up Amartya Sen’s capability approach as a framework for theorizing, implementing and evaluating education policy as a matter of social justice. This paper sets out to contribute to the emerging debate and to show how the capability approach offers an assertive alternative discourse to dominant human capital ideas in education. It considers core ideas of capability and functioning, and the emphasis in Sen’s approach on each person’s freedom and opportunities to develop valued beings and doings. The article then shows more concretely how the ideas might be operationalized by producing a provisional, situated list of education capabilities, with specific attention to gender equity in contemporary South African schools. It closes by presenting and emphasizing the importance of public debate and discussion around the policy potential of the theoretical and empirical ideas raised. [ABSTRACT FROM AUTHOR]

The article describes the disease, Spinocerebellar ataxia type 7 (SCA7). Formerly known as olivopontocerebellar ataxia, SCA7 is among the rarest form of autosomal dominant cerebellar ataxia. It is genetically verifiable which can lead to progressive central visual loss, dementia, sensory deficits, and pyramidal/extrapyramidal signs seen primarily in cases of infantile onset.

Residents of the area now occupied by the southwestern United States and northwestern Mexico have had to deal with coccidioidomycosis and complicating meningitis for 11500 years. The hundredth anniversary of the reporting of disseminated coccidioidomycosis has just passed. This year has the dubious distinction of being the hundredth anniversary of the first description of coccidioidal meningitis. Although intrathecal amphotericin B began to be used for therapy 50 years ago, and although we have benefited from azole therapy for 110 years, the morbidity and mortality associated with this all-too-common disease remain unacceptably high. This review will endeavor to discuss the pathogenic, pathophysiologic, clinical, laboratory, radiologic, and therapeutic features of meningitis secondary to Coccidioides infection. [ABSTRACT FROM AUTHOR]

Not all complications from transradial access can be prevented, even with diligent patient selection and preprocedure planning. This brief visual report offers technical suggestions to reverse knots and kinks encountered during catheter manipulation for endovascular transradial cerebral procedures. [ABSTRACT FROM AUTHOR]

This paper explores both the personal narratives of a group of black and white undergraduate students and the institutional discourse at one historically white and Afrikaans medium university now undergoing its own transformation in post-apartheid South Africa. It considers how students talk about their actual experiences and the micro-realties of their personal biographies, what this reveals about how they construct and reconstruct race and identity, and how discourses of race and racialized identities are being reproduced or transformed under new historical and institutional conditions of possibility. The focus is twofold: on the one hand on the contradictions of institutional discourse which both formally admits black students but may subtly work to exclude them as well; and on the other on the friendships that students develop as just one exemplar of how race works itself out biographically and personally. The particular issue is to understand institutional and individual ‘default identities’ which work to erase or obscure the power relations of race and hence to enable race to persist, but also to explore moments of transformation when new identities are made possible. The paper further seeks to contribute to narrative inquiry, following Wright Mills's notion of the need to consider the intersections of history, biography and society. [ABSTRACT FROM AUTHOR]

The article reports that immunosuppressive therapy reduces cell-mediated immunity to prevent transplant rejection and graft-versus-host disease, but it concomitantly increases the risk of infection due to fungi, viruses, bacteria, and parasites. Central nervous system (CNS) infection occurs in 5%10% of transplant recipients and most often manifests as brain abscess, encephalitis, or meningitis. The risk of CNS infection varies with the type of organ transplanted, and, among bone marrow transplant recipients, infection is more common after allogeneic than autologous transplantation. Aspergillus fumigatus, Listeria monocytogenes, and Cryptococcus neoformans are the most common causes of post-transplantation CNS infections, but immunosuppression also increases the risk of acquiring parasitic CNS infections and can increase the severity of these infections.

This paper examines the life history narratives of a group of 12 black and white male and female undergraduate students at a historically white Afrikaans medium university, now undergoing its own transformation in post-apartheid South Africa. Conceptualizations of identity and discourse across four elements of context, setting, situated activity and self are employed to examine their accounts. Three framing discourses, comprising the official storyline of a rainbow nation and new higher education policies, the formal storyline of institutional change, and the informal space of relationships and interactions are used to analyse student narratives in terms of how they produce, reproduce and transform race and identity. What emerges is a complicated picture in which identities cannot be simply read off either from the official discourse or from colour and culture as the levels of discourse articulate and collide with a history of racial separateness and context and setting, with particular identity effects. What varieties of men and women now prevail in this society and in this period? And what varieties are coming to prevail? In what ways are they selected and formed, liberated and repressed, made sensitive and blunted? ( Mills, 1959 , p. 7) [ABSTRACT FROM AUTHOR]

This paper considers the educational work that narrative does. Against the context of the South African Truth and Reconciliation Commission that examined the crimes of apart-heid, it discusses the narrative implications of South African poet Antjie Krog's multi-layered text of Truth Commission testimony, and autobiographical and philosophical musings. The paper argues that narrative points to education in four ways. The first involves research practices in which subjectivity and experience are acknowledged, celebrated and recognised to be powerful and compelling, allowing us to learn moral truths. Secondly, narrative can be utilised as part of a pedagogy of care, compassion and concern in which we ask questions regarding what it means to be taught by the lives of others, and how stories that are not our own speak to those we already have, enabling us to learn how to act morally through others' experiences. The third aspect of narrative is then the identity work it enables, offering the possibility for the reconstruction of the learning ‘I’, inflecting away from past perspectives to new ways of seeing. Through listening to others we might produce more accountable and more responsible knowledge. Fourthly, we explore how narratives might produce trustworthy accounts in which evidence is not endlessly plastic, but where the narrative form enlarges the scope for understanding. Throughout we show that individual and collective narratives are played out on a structural field, embedded in the political, social and historical conditions of a racial and gendered power, with real material effects. [ABSTRACT FROM AUTHOR]

This paper develops a framework for conceptualising social justice in education, drawing particularly on Martha Nussbaum's (2000) capabilities approach. The practical case for consideration is that of widening participation and pedagogical implications in higher (university) education in England. While the paper supports the value and usefulness of Nussbaum's list of ten capabilities for developing a more radical and challenging language and practice for higher education pedagogies, it also argues that her approach is limited. Other ways of conceptualising social justice are also required in order to develop adjudicating theories which enable us to judge which practices take us closer to social justice. An argument is made for ‘bivalent’ theorising which integrates individual and institutional development and agents and social structures. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to assess the democratic potential of New Community Schools (NCS) as developed by the Scottish Executive in one of its first major educational initiatives. It traces the background to the initiative, locates it within the particular circumstances of the historical, political and cultural contexts of Scotland, and defines its particular ambivalence with regard to deliberative democracy. This ambivalence, it is argued, results from the mediation of state policy. Policy, we argue, does not so much 'migrate' as become culturally 'mediated' in generative local contexts. It has to accommodate itself to, and be assimilated by, different national cultures - even, perhaps especially, across the national boundaries of an increasingly devolved UK, framed simultaneously by a global context. The paper evaluates NCS in terms of the ends and purposes of deliberative democracy under such conditions of possibility. Finally, it infers from the early NCS experience a number of conditions for democratic renewal. [ABSTRACT FROM AUTHOR]

This paper considers the construction by students of feminine and masculine identities in an engineering department in an old Scottish university. It utilises theories of identity that emphasise fragility, contradictions and ambiguity in multiple processes of identity formation, which might involve identification with the dominant gender order, counter identification and resistance, or disidentification and transformation. The paper shows how, while things have changed significantly for young professional women, they and their male peers still reinscribe dominant notions of femininity and masculinity. Gender remains an issue even as the visibility and confidence of women works to destabilise traditional patterns. A narrative approach seeks to represent the voices of these students, and the social lines of power that criss-cross the webs of identity construction. [ABSTRACT FROM AUTHOR]

This paper details a collaborative action research enquiry undertaken while both authors worked at the University of Glasgow. It explores the use of class debates as a teaching method in an International Management Honours course as the framing context for developing students' capacity to assess their own and each other's learning through the debates. In addition, issues of assessment for grading purposes are signalled and explored with the students. The collaborating partners in the study were a Management Studies lecturer and a Higher Education Studies lecturer, who worked together on the framework for the debates, reflected on the unfolding process together, and collected and analysed evidence. This case suggests that the debates enabled students to develop a critical view of the topics under discussion and to acquire a number of 'transferable skills', for example, team work. On peer grading, students were ambivalent. While self-and peer assessment appears to work well for formative purposes, summative peer assessment may not be welcomed by students. [ABSTRACT FROM AUTHOR]

Mitochondrial transplantation and transfer are being explored as therapeutic options in acute and chronic diseases to restore cellular function in injured tissues. To limit potential immune responses and rejection of donor mitochondria, current clinical applications have focused on delivery of autologous mitochondria. We recently convened a Mitochondrial Transplant Convergent Working Group (CWG), to explore three key issues that limit clinical translation: (1) storage of mitochondria, (2) biomaterials to enhance mitochondrial uptake, and (3) dynamic models to mimic the complex recipient tissue environment. In this review, we present a summary of CWG conclusions related to these three issues and provide an overview of pre-clinical studies aimed at building a more robust toolkit for translational trials. [ABSTRACT FROM AUTHOR]

Drawing from theories of identity formation and feminist theories, this paper develops an account which is both structural and personal of the social construction of academic women's lives in a South African setting. Such discussion is necessary given the paucity of material on gender in South Africa, and timely in its comparative account of the shaping effects not only of gender, but also of race in the academy. Using life-history interviews, the paper explores and begins to explain the marginalisation of women in South African universities where male and masculine carries greater cultural prestige, and where the gendered economy and gender divisions in private lives shape and constrain academic selves, but where race has been and is a central carrier of power. Using the words of the women, it seeks to unpick the seamless narration of the White, male, masculinist colonial university as a move towards a more inclusive and so more fully human account of aspects of life in South African universities. [ABSTRACT FROM AUTHOR]

Argues that the precedent from the Chevron USA, Inc. versus Natural Resources Defense Council case should control court's deference to agency interpretations of regulations in the United States. Justification for deference; Legitimacy of applying Chevron deference to regulations; Indications of congressional intent.

ABSTRACT This article explores the experiences of a group of women on two senior academic committees at the University of the Western Cape, in order to understand how practices in such committees contribute to the exclusion and marginalisation of women, and particular constructions of subjectivity. The broader university context, its history and current ranking of academic women and men, black and white, provides a contextual frame for the narrower focus. Experience is not seen to 'speak' for itself, even where narrative 'episodes' attempt to portray what it must be like to 'be there'. Thus, post-structuralist insights reveal women's contestation as well as accommodation of relations of domination so that the account is studded through with moments in which this group of academic women are powerful as well as powerless, speaking as well as silent, struggling against/with inner voices and outdated cultural scripts. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the association between bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, and survival after out-of-hospital cardiac arrest (OHCA) across the urban-rural spectrum.Methods: This was a retrospective cohort study of 325,477 adult OHCAs within the Cardiac Arrest Registry to Enhance Survival from 2013 to 2019. Bystander interventions were categorized into no bystander intervention, bystander CPR alone, and bystander AED use (with or without CPR). The primary outcome was survival to hospital discharge with good neurological outcome. Multivariable logistic regression was used to evaluate the association between bystander interventions and survival by geographical status (urban, suburban, large rural, small town, or rural).Results: Bystander CPR alone occurred most often in rural areas (50.8%), and least often in urban areas (35.4%). Bystander AED use in public settings was similar across the urban-rural spectrum (10.5-13.1%). Survival with good neurological outcome varied for urban (8.1%), suburban (7.7%), large rural (9.1%), small town (7.1%), and rural areas (6.1%). In comparison to no bystander intervention, the adjusted odds ratios (95% confidence intervals) for bystander AED use and survival were 2.57 (2.37-2.79) in urban areas, 2.58 (1.81-3.67) in suburban areas, 1.99 (1.44-2.76) in large rural areas, 1.90 (1.27-2.86) in small towns, and 3.05 (1.99-4.68) in rural areas. Bystander CPR alone was also associated with survival in all areas (adjusted odds ratio range: 1.29-1.45). There was no strong evidence of interaction between bystander interventions and geographical status on the primary outcome (p = 0.63).Conclusion: Bystander CPR and AED use are associated with positive clinical outcomes after OHCA in all areas along the urban-rural spectrum. [ABSTRACT FROM AUTHOR]

Holmes tremor is an arrhythmic, 2- to 5-Hz resting, postural, and kinetic upper extremity movement disorder that occurs weeks to months after acute mesencephalic pathology. We present a patient who developed tremor in three body parts postbrainstem hemorrhage with subsequent hypertrophic olivary degeneration and discuss the relevant clinical evolution. Our case is unique because in addition to expected upper extremity and cervical dystonic head tremors, the patient also developed a severe lower extremity movement disorder, which we believe to be a form of Holmes tremor. Tremor involving the lower extremity in this setting has not been previously reported. © 2006 Movement Disorder Society [ABSTRACT FROM AUTHOR]

Hepatitis C virus (HCV) can be cleared naturally in a subset of individuals. However, the asymptomatic nature of acute HCV infection makes the study of the early immune response and defining the correlates of protection challenging. Despite this, there is now strong evidence implicating the humoral immune response, specifically neutralising antibodies, in determining the clearance or chronicity outcomes of primary HCV infection. In general, immunoglobulin G (IgG) plays the major role in viral neutralisation. However, there are limited investigations of anti-HCV envelope protein 2 (E2) isotypes (IgM, IgG, IgA) and IgG subclasses (IgG1–4) in early HCV infection. In this study, using a rare cohort of 14 very recently HCV-infected individuals (4–45 days) with varying disease outcome (n = 7 clearers), the timing and potency of anti-HCV E2 isotypes and IgG subclasses were examined longitudinally, in relation to neutralising antibody activity. Clearance was associated with anti-E2 IgG, specifically IgG1 and IgG3, and appeared essential to prevent the emergence of new HCV variants and the chronic infection outcome. Interestingly, these IgG responses were accompanied by IgM antibodies and were associated with neutralising antibody activity in the subjects who cleared infection. These findings provide novel insights into the early humoral immune response characteristics associated with HCV disease outcome. [ABSTRACT FROM AUTHOR]

The cover image is based on the Case Report I Knot My Problem: Overcoming Transradial Catheter Complications i by Melanie Walker, Michael Levitt, and Basavaraj Ghodke https://doi.org/10.1002/ccr3.2537 GLO:H4ZE/01dec19:ccr32660-toc-0001.jpg PHOTO (COLOR): . gl. [Extracted from the article]

Hepatitis C virus (HCV) is one of very few viruses that are either naturally cleared, or alternatively persist to cause chronic disease. Viral diversity and escape, as well as host adaptive immune factors, are believed to control the outcome. To date, there is limited understanding of the critical, early host-pathogen interactions. The asymptomatic nature of early HCV infection generally prevents identification of the transmitted/founder (T/F) virus, and thus the study of host responses directed against the autologous T/F strain. In this study, 14 rare subjects identified from very early in infection (4–45 days) with varied disease outcomes (n = 7 clearers) were examined in regard to the timing, breadth, and magnitude of the neutralizing antibody (nAb) response, as well as evolution of the T/F strain. Clearance was associated with earlier onset and more potent nAb responses appearing at a mean of 71 days post-infection (DPI), but these responses were narrowly directed against the autologous T/F virus or closely related variants. In contrast, a delayed onset of nAbs (mean 425 DPI) was observed in chronic progressors that appear to have targeted longitudinal variants rather than the T/F strain. The nAb responses in the chronic progressors mapped to known CD81 binding epitopes, and were associated with rapid emergence of new viral variants with reduced CD81 binding. We propose that the prolonged period of viremia in the absence of nAbs in these subjects was associated with an increase in viral diversity, affording the virus greater options to escape nAb pressure once it emerged. These findings indicate that timing of the nAb response is essential for clearance. Further investigation of the specificities of the early nAbs and the factors regulating early induction of protective nAbs is needed. [ABSTRACT FROM AUTHOR]

Tuberous sclerosis (TS) is caused by point mutations in the TSC1 or TSC2 genes on chromosomes 9q33–34 or 16p13, respectively. Clinical manifestations can be quite variable but are primarily limited to cutaneous, neurologic, and cardiovascular abnormalities. Phenotypes range from neurologically devastated to those with silent lesions. A 34-year-old patient with genetically documented TSC1 developed progressive ataxia over a decade, without TS lesions to correlate with this finding. After evaluation of common causes including long-term antiepileptic regimens, DNA testing for hereditary ataxias was performed and revealed the presence of an additional mutation on chromosome 9. The patient was homozygous for the Friedreich ataxia (FA) mutation, with 500 and 700 GAA repeats in the FRDA gene on chromosome 9q13. There is no established relationship between these two disorders and the occurrence of two mutations on the same chromosome is probably coincidental but emphasizes the importance of searching for additional genetic causes when the phenotype does not fit with an established genetic diagnosis. [Copyright &y& Elsevier]

Chronic gastrointestinal disease can result in nutritional deficiencies that can have a direct effect on the neurologic system. Although acute abnormalities can be corrected, symptoms are rarely reversible. Recognizing the appropriate abnormality is a crucial part of long-term treatment strategies in this population. Because motor and cerebellar symptoms can contribute to poor feeding, aggressive supplementation should begin as soon as symptoms are recognized. We present a patient with delayed onset and progressive hypovitaminosis E and briefly review diagnostic and therapeutic options. [ABSTRACT FROM AUTHOR]

We report an immunocompetent patient with the Ramsay Hunt syndrome (RHS) followed days later by brainstem disease. Extensive virological studies proved that varicella zoster virus (VZV) was the causative agent. Treatment with intravenous acyclovir resulted in prompt resolution of all neurological deficits except peripheral facial palsy. This case demonstrates that after geniculate zoster, brainstem disease may develop even in an immunocompetent individual and effective antiviral therapy can be curative. [Copyright &y& Elsevier]

Clinical immunity to malaria develops slowly after repeated episodes of infection and antibodies are essential in naturally acquired immunity against malaria. However, chronic exposure to malaria has been linked to perturbation in B-cell homeostasis with the accumulation of atypical memory B cells. It is unclear how perturbations in B cell subsets influence antibody breadth, avidity, and function in individuals naturally exposed to malaria. We show that individuals living in high malaria transmission regions in Ghana have higher Plasmodium falciparum merozoite antigen-specific antibodies and an increased antibody breadth score but lower antibody avidities relative to low transmission regions. The frequency of circulating atypical memory B cells is positively associated with an individual's antibody breadth. In vitro growth inhibition is independent of the ability to bind to free merozoites but associated with the breadth of antibody reactivity in an individual. Taken together, our data shows that repeated malaria episodes hamper the development of high avid antibodies which is compensated for by an increase in antibody breadth. Our results provide evidence to reinforce the idea that in regions with high malaria prevalence, repeated malaria infections lead to the broadening of antibody diversity and the continued presence of atypical memory B cell populations. [ABSTRACT FROM AUTHOR]

This article, published in the Journal of Neurological Surgery, discusses the incidence, risk factors, management, and outcomes of internal carotid artery (ICA) injuries during endoscopic transsphenoidal surgery (ETSS) for pituitary adenomas. The study, conducted at the University of Washington Medical Center, included 910 ETSS cases, of which 5 (0.5%) resulted in intraoperative carotid injury. The article highlights the importance of prevention and immediate management, such as hemodynamic support, visualization of the injury, and transport to the angiography suite. The study also discusses different treatment options, including endovascular flow diversion and coil sacrifice, depending on the patient's collaterals and injury. [Extracted from the article]

Background: Of the 40% of breast cancer patients who have a mastectomy as part of their surgical treatment, only approximately 29% have a breast reconstruction. In 2016, Alfred Health established a multidisciplinary surgical clinic with breast and plastic surgeons, aiming to improve interdisciplinary collaboration. This study aimed to assess the provision of breast reconstruction at an Australian tertiary public hospital and examine whether the multidisciplinary surgical clinic have improved our reconstructive service provision. Methods: A retrospective cohort study of patients who underwent mastectomy at Alfred Health between October 2011 and September 2021 was conducted. Patients were divided into before and after groups, treated during the 5‐year period before and after establishing the multidisciplinary clinic respectively. Demographic data, operative details, histopathology, and treatments were compared. Results: Over the 10‐year period, 423 mastectomies were performed for 351 patients. Of those, 153 patients underwent breast reconstruction, providing an overall reconstruction rate of 43.6%. There was a statistically significant increase in the breast reconstruction rate from 36.5% before to 53.4% after the creation of the multidisciplinary surgical clinic. Patient factors such as age and tumour receptor status did not differ significantly between the groups. Conclusion: The establishment of a surgical multidisciplinary clinic has led to a statistically significant increase in the rate of breast reconstruction from 36.5% to 53.4%, leading to improved healthcare provision for our patients. Factors identified to be associated with increased uptake in the reconstruction service include younger age and node negative disease. [ABSTRACT FROM AUTHOR]

Despite recent advances in curative therapy, hepatitis C virus (HCV) still remains a global threat. In order to achieve global elimination, a prophylactic vaccine should be considered high priority. Previous immunogens used to induce broad neutralising antibodies (BnAbs) have been met with limited success. To improve immunogen design, factors associated with the early development of BnAbs in natural infection must first be understood. In this study, 43 subjects identified with acute HCV were analysed longitudinally using a panel of heterogeneous HCV pseudoparticles (HCVpp), to understand the emergence of BnAbs. Compared to those infected with a single genotype, early BnAb development was associated with subjects co-infected with at least 2 HCV subtypes during acute infection. In those that were mono-infected, BnAbs were seen to emerge with increasing viral persistence. If subjects acquired a secondary infection, nAb breadth was seen to boost upon viral re-exposure. Importantly, this data highlights the potential for multivalent and prime-boost vaccine strategies to induce BnAbs against HCV in humans. However, the data also indicate that the infecting genotype may influence the development of BnAbs. Therefore, the choice of antigen will need to be carefully considered in future vaccine trials. [ABSTRACT FROM AUTHOR]

Stenting with flow diverter devices (FDDs) has increasingly emerged as a treatment for intracranial aneurysms. The use of FDDs in the developing world has not been described. A retrospective review was performed of a cohort of patients who underwent flow diversion at 4 tertiary-care centers in Lima, Peru between January 2017 and June 2021. Demographics, clinical features, and aneurysm morphology were evaluated. Clinical outcomes were observed 3 months after discharge and occlusion rates were assessed 12 months after treatment. Sixty-nine patients (mean age, 46 ±14.5 years; 17% female) were treated with FDDs; 4% (n = 3) of the treated aneurysms were ruptured. Most aneurysms were saccular (n = 65; 94%), <10 mm in maximum size (n = 60; 87%), and located in the anterior circulation (n = 67; 97%). Minor complications, such as groin hematoma, occurred in 7 cases. No serious complications or deaths occurred. Patients' functional status was excellent (modified Rankin Scale score 0–1) in 99% (n = 66) at discharge and 100% (n = 67) at 3 months. Although some patients were lost to follow-up, complete occlusion was seen in 76% (n = 31) of 41 treated patients at 12 months. We report the largest multicenter experience of FDDs for cerebral aneurysm treatment in Peru, with reasonable outcomes that are comparable to other settings despite various challenges, suboptimal circumstances, and lack of resources. [ABSTRACT FROM AUTHOR]

This literature review synthesises existing evidence and offers a thematic analysis of primary care and emergency department experiences of lesbian, gay, bisexual, transgender, queer and/or any other sexual or gender minority (LGBTQþ) individuals in Canada. Articles detailing first-person primary or emergency care experiences of LGBTQþpatients were included from EMBASE, MEDLINE, PsycINFO and CINHAL. Studies published before 2011, focused on the COVID-19 pandemic, unavailable in English, non- Canadian, specific to other healthcare settings, and/or only discussing healthcare provider experiences were excluded. Critical appraisal was performed following title/abstract screening and full-text review by three reviewers. Of sixteen articles, half were classified as general LGBTQþexperiences and half as trans-specific experiences. Three overarching themes were identified: discomfort/ disclosure concerns, lack of positive space signalling, and lack of healthcare provider knowledge. Heteronormative assumptions were a key theme among general LGBTQþexperiences. Trans-specific themes included barriers to accessing care, the need for self-advocacy, care avoidance, and disrespectful communication. Only one study reported positive interactions. LGBTQþpatients continue to have negative experiences within Canadian primary and emergency care – at the provider level and due to system constraints. Increasing culturally competent care, healthcare provider knowledge, positive space signals, and decreasing barriers to care can improve LGBTQþexperiences. [ABSTRACT FROM AUTHOR]

Objectives: We quantified the gaze fixation duration of resident and fellowship sonographers interpreting a prerecorded focused assessment with sonography in trauma (FAST). We hypothesized that all sonographers would fixate on each relevant anatomic relationship but that the duration of fixation would differ. Methods: We conducted a cross‐sectional study collecting and analyzing the gaze fixations of a convenience sample of current resident and fellowship sonographers. All sonographers viewed a standardized FAST video, and their gaze fixations were recorded using a Tobii X3‐120 eye‐tracking bar. Gaze fixations over nine anatomic regions of interest (ROIs) were identified. These were assessed for normality and analyzed using the Wilcoxon rank sum test at an alpha of 0.05 and Bonferroni correction p value of <0.0034. The chi‐square test and Pearson's correlation were performed to assess statistical association. Results: The gaze fixation recordings of 24 resident and eight fellowship sonographers were suitable for analysis. Fourteen of the 24 resident sonographers viewed all ROIs in the FAST, whereas all eight fellowship sonographers viewed each of the nine relevant ROIs. Five ROIs were identified over which at least one resident sonographer did not have a gaze fixation. No statistically significant difference was identified between groups. Resident sonographers gaze fixated over the left upper quadrant (LUQ) splenorenal interface for a median (interquartile range) of 10.64 (9.73–11.60) seconds. The fellowship group viewed the same ROI for 8.43 (6.64–8.95) seconds (p < 0.003). All participants viewed this ROI. No other ROIs had a statistical difference. Conclusion: Five ROIs were identified that were not visually interrogated by all resident sonographers. Only 14 of 24 resident sonographers visually interrogated every area in the FAST, whereas all fellowship sonographers interrogated every ROI. A statistically significant difference was found in gaze fixation duration between resident and fellowship sonographers in one ROI. Further study is required for gaze fixation assessment to become a tool for the interpretation component of point‐of‐care ultrasound. [ABSTRACT FROM AUTHOR]

We present a case of brachial neuritis in an adult male who underwent high-dose immunosuppressive therapy and autologous stem cell transplantation (SCT) for primary progressive multiple sclerosis (MS). Brachial neuropathy following SCT has not previously been reported in patients with MS. The etiology of peripheral nerve dysfunction following SCT remains obscure. [ABSTRACT FROM AUTHOR]

Background: Evidence exists showing that various aspects of diet are implicated in the etiology of prostate cancer, although results across studies remain inconsistent. Methods: We examined the ability of the dietary inflammatory index (DII) to predict prostate cancer in a case-control study conducted in Kingston, Ontario, Canada, between 1997 and 1999. The study included 72 cases of incident primary prostate cancer patients and 302 controls of urology clinic patients who had prostate conditions other than prostate cancer. The DII was computed based on intake of 18 nutrients assessed using a 67-item food frequency questionnaire. Univariate and multivariate logistic regression models were used to estimate odds ratios (ORs). Results: Men with higher DII scores were at increased risk of prostate cancer using DII score fit both as a continuous [OR = 1.58, 95% confidence interval (CI) 1.05–2.38] and categorical variable [compared to men in the lowest DII quartile, men in the highest quartile were at elevated risk (OR = 3.50, 95% CI 1.25–9.80; ptrend = 0.02)]. There was no significant heterogeneity by weight status, but stronger association was observed in men with body mass index >25 kg/m2 versus <25 kg/m2. Conclusion: These findings suggest that a proinflammatory diet, as indicated by increasing DII score, is a risk factor for prostate cancer. [ABSTRACT FROM AUTHOR]

Background: Emergency departments (EDs) serve an integral role in healthcare, particularly for vulnerable populations. However, marginalized groups often report negative ED experiences, including stigmatizing attitudes and behaviours. We engaged with historically marginalized patients to better understand their ED care experiences. Method: Participants were invited to complete an anonymous mixed-methods survey about a previous ED experience. We analysed quantitative data including controls and equity-deserving groups (EDGs) - those who self-identified as: (a) Indigenous; (b) having a disability; (c) experiencing mental health issues; (d) a person who uses substances; (e) a sexual and gender minority; (f) a visible minority; (g) experiencing violence; and/or (h) facing homelessness - to identify differences in their perspectives. Differences between EDGs and controls were calculated with chi squared tests, geometric means with confidence ellipses, and the Kruskal-Wallis H test. Results: We collected a total of 2114 surveys from 1973 unique participants, 949 controls and 994 who identified as equity-deserving. Members of EDGs were more likely to attribute negative feelings to their ED experience (p < 0.001), to indicate that their identity impacted the care received (p < 0.001), and that they felt disrespected and/or judged while in the ED (p < 0.001). Members of EDGs were also more likely to indicate that they had little control over healthcare decisions (p < 0.001) and that it was more important to be treated with kindness/respect than to receive the best possible care (p < 0.001). Conclusion: Members of EDGs were more likely to report negative ED care experiences. Equity-deserving individuals felt judged and disrespected by ED staff and felt disempowered to make decisions about their care. Next steps will include contextualizing findings using participants' qualitative data and identifying how to improve ED care experiences among EDGs to make it more inclusive and better able to meet their healthcare needs. [ABSTRACT FROM AUTHOR]

A relatively new condition of sweet cherry (Prunus avium L.), cherry slip-skin-maceration disorder (cherry-SSMD), presumably associated with yeast species, required a detailed study looking at the microbial communities inhabiting the fruit and blossoms of commercial cherry trees. Cherry-SSMD affects the fruit quality of mainly late harvest sweet cherries and may lead to symptom development that is associated with one or more different, but typically non-pathogenic yeast species. These symptoms may be the result of significant shifts within the fruit's normal microbiota, and may in turn be influenced by tree fruit phenology and/or environmental factors relating to variable harvest dates. Therefore, the main objective of this study was to conduct field surveys to investigate the microbial species composition on cherry blossoms and fruit. Results obtained from surveys conducted during the 2013 and 2014 growing seasons indicated that while fungal populations remained low, numbers of yeasts and bacteria continued to increase on the surface of developing fruit throughout the growing season. Species composition was also observed to be variable between years and throughout the growing seasons. However, despite general increases in microbial populations of bacteria and yeasts leading up to harvest, no specific pattern was observed to suggest a pathogenic profile that would link either microbial communities, or individual species to cherry-SSMD. [ABSTRACT FROM AUTHOR]

Recovery of plants from virus-induced symptoms is often described as a consequence of RNA silencing, an antiviral defense mechanism. For example, recovery of Nicotiana clevelandii from a nepovirus (tomato black ring virus) is associated with a decreased viral RNA concentration and sequence-specific resistance to further virus infection. In this study, we have characterized the interaction of another nepovirus, tomato ringspot virus (ToRSV), with host defense responses during symptom induction and subsequent recovery. Early in infection, ToRSV induced a necrotic phenotype in Nicotiana benthamiana that showed characteristics typical of a hypersensitive response. RNA silencing was also activated during ToRSV infection, as evidenced by the presence of ToRSV-derived small interfering RNAs (siRNAs) that could direct degradation of ToRSV sequences introduced into sensor constructs. Surprisingly, disappearance of symptoms was not accompanied by a commensurate reduction in viral RNA levels. The stability of ToRSV RNA after recovery was also observed in N. clevelandii and Cucumis sativus and in N. benthamiana plants carrying a functional RNA-dependent RNA polymerase 1 ortholog from Medicago truncatula. In experiments with a reporter transgene (green fluorescent protein), ToRSV did not suppress the initiation or maintenance of transgene silencing, although the movement of the silencing signal was partially hindered. Our results demonstrate that although RNA silencing is active during recovery, reduction of virus titer is not required for the initiation of this phenotype. This scenario adds an unforeseen layer of complexity to the interaction of nepoviruses with the host RNA silencing machinery. The possibility that viral proteins, viral RNAs, and/or virus-derived siRNAs inactivate host defense responses is discussed. [ABSTRACT FROM AUTHOR]

In times of economic uncertainty, questions of the purpose and value of higher education come to the fore. Such questions have particular relevance when directed towards the preparation of professionally qualified graduates who might be expected to contribute to the public good. However, definitions of the public good are contested and the role of higher education is unclear. This interview-based study contributes to the debate by taking a professional capabilities index (PCI) generated in South Africa and interrogating it in the UK context. The PCI is oriented towards poverty reduction and is grounded in the human development and capabilities approach, an agenda to which UK respondents were broadly sympathetic although with differences in emphasis. This article argues that, if we are to move beyond a narrow economic understanding of the public good and a purely instrumental understanding of graduate ‘attributes’, the human development and capabilities approach has much to offer. [ABSTRACT FROM PUBLISHER]