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Many patients do not have access to community oncology nursing care in a primary setting and are completely reliant on tertiary hospital care. The aim of this study is to gain an understanding of oncology patients' and nurses' perceptions of community oncology nursing, delivered by an urban Community Intervention Team (CIT) in Ireland. A descriptive, concurrent mixed methods approach was used which included semi-structured interviews with 14 oncology patients and an online survey of 27 hospital and community nurses. Thematic analysis and descriptive statistics were used to analyse the data. Six broad themes captured patients' views. Right care related to patients' satisfaction with the range of care available. Right place reflected positive views of the physical setting and the option for homecare for those that needed it. Right time represented patients' comments about the increased appointment efficiency, flexibility, and availability of the service out-of-hours, compared to hospital-based care. Right people was based on patients' portrayals of community cancer nurses as professional, confident, friendly, reassuring and relatable. Integration and communication reflected the communication between the services and patients' impressions of how the services were integrated together. The last theme was improvements to the CIT service. Hospital nurses reported satisfaction with the CIT service while CIT nurses responses suggest the need for better communication with hospital partners. Patients had positive perceptions of the service provided by the CIT. Both hospital and community cancer nurses were satisfied with the service and reported that they would like to see an expansion of community oncology nursing services delivered by the CIT. • Main focus on the patient's perspective about community oncology nursing. • The community oncology nursing service enhanced patients' quality of life. • Insight into patients' views of integrated care during oncology treatment. [ABSTRACT FROM AUTHOR]

Equality and disability legislation, coupled with increasing numbers of students with a disability, and inadequate supports in clinical practice, acted as catalysts to explore how best to support undergraduate nursing and midwifery students on clinical placements. Historically, higher education institutions provide reasonable accommodations for theoretical rather than clinical modules for practice placements. This paper describes the development and implementation of a Clinical Needs Assessment designed to identify the necessary supports or reasonable accommodations for nursing and midwifery students with a disability undertaking work placements in clinical practice. The existing literature, and consultation with an expert panel, revealed that needs assessments should be competency based and clearly identify the core skills or elements of practice that the student must attain to achieve proficiency and competence. The five Domains of Competence, advocated by An Bord Altranais, the Nursing and Midwifery Board of Ireland, formed the framework for the Clinical Needs Assessment. A panel of experts generated performance indicators to enable the identification of individualised reasonable accommodations for year 1 nursing and midwifery students in one Irish University. Development and implementation of the Clinical Needs Assessment promoted equality, inclusion and a level playing field for nursing and midwifery students with a disability in clinical practice. [ABSTRACT FROM AUTHOR]

Engagement and successful completion of nursing and midwifery programmes may be predicated on the identification and implementation of reasonable accommodations to facilitate clinical learning for students with a disability. This qualitative study aims to evaluate a clinical needs assessment for students with a disability and explore their experiences of support in clinical practice. A purposive sample of year one undergraduate students was used. Four students consented to participate and undertook an individual interview. Their disabilities were categorised as specific learning disability (dyslexia) (n = 3) and mental health (n = 1). Data analysis revealed two main themes 'students' experiences of disclosure' and 'receiving support'. Findings revealed that all students disclosed on placement, however, the extent of disclosure was influenced by personal and environmental factors. Students used the clinical needs assessment to highlight accommodations to clinical staff on placement. Issues of concern that arose, included communication between all key stakeholders, negative staff attitudes and the need to improve the provision of accommodations. This preliminary evaluation indicates that the Clinical Needs Assessment bridges the gap in provision of student support between higher education and healthcare institutions. Findings suggest that competence based needs assessments can identify individualised reasonable accommodations for students undertaking clinical placements. [ABSTRACT FROM AUTHOR]

Highlights: [•] High rates of emotional and behavioural problems were found in children and young people with ASD and ID attending specialist autism schools. [•] Higher levels of emotional and behavioural problems were associated with greater use of mental health services. [•] However, only a minority of participants had accessed mental health services in the previous 6 months. [•] Services need to ensure that children and young people are offered appropriate support for their emotional and behavioural problems. [Copyright &y& Elsevier]

The developmental trajectories of Theory of Mind (ToM) in later childhood and into adolescence have not been thoroughly investigated, partly due to a lack of sensitive paradigms that can chart development in typical populations or in individuals with a core deficit in ToM, such as those with autism spectrum disorder (ASD). The present study assessed understanding of emotions, beliefs, and intentions using both an established ToM task (Baron-Cohen et al., 2001) and the more recently developed Comic Strip Task (CST; Cornish et al., 2010). Participants comprised 12 typically-developing (TD) children (mean age: 12·0 years, range: 9·9-14·8 years) and 12 high-functioning children with ASD (mean age: 11·0 years, range: 9·1-13·6 years). Results indicated that the ASD group were not impaired on any of the ToM tasks relative to TD children. It was concluded that although children with high-functioning ASD appear to develop basic ToM skills, they do not generalize these to naturalistic situations. The comic-strip paradigm is suggested as a promising way to approach the measurement of ToM across childhood in typical children and those with ASD. [ABSTRACT FROM AUTHOR]

Abstract: Polycomb repressive complex 2 (PRC2) and its core member enhancer of zeste homolog 2 (EZH2) mediate the epigenetic gene silencing mark: trimethylation of lysine 27 on histone 3 (H3K27me3). H3K27me3 is characteristic of the chromatin at genes involved in developmental regulation in undifferentiated cells. Overexpression of EZH2 has been found in several cancer types such as breast, prostate, melanoma and bladder cancer. Moreover, overexpression is associated with highly proliferative and aggressive types of breast and prostate tumors. We have analyzed the abundance of EZH2 and H3K27me3 using immunohistochemistry in two large and well-characterized breast tumor data sets encompassing more than 400 tumors. The results have been analyzed in relation to the molecular subtypes of breast tumors (basal-like, luminal A, luminal B, HER2-enriched and normal-like), as well as in subtypes defined by clinical markers (triple negative, ER+/HER2−/Ki67low, ER+/HER2−/Ki67high and HER2+), and were validated in representative breast cancer cell lines by western blot. We found significantly different expression of both EZH2 and H3K27me3 across all subtypes with high abundance of EZH2 in basal-like, triple negative and HER2-enriched tumors, and high H3K27me3 in luminal A, HER2-enriched and normal-like tumors. Intriguingly, the two markers show an inverse correlation, particularly for the basal-like and triple negative tumors. Consequently, high expression of EZH2 was associated with poor distant disease-free survival whereas high expression of H3K27me3 was associated with better survival. Additionally, none of 182 breast tumors was found to carry a previously described EZH2 mutation affecting Tyr641. Our observation that increased expression of EZH2 does not necessarily correlate with increased abundance of H3K27me3 supports the idea that EZH2 can have effects beyond epigenetic silencing of target genes in breast cancer. [Copyright &y& Elsevier]

Objective: This article examines the form and function of spontaneous communication and outcome predictors in nonverbal children with autism following classroom-based intervention (Picture Exchange Communication System [PECS] training). Method: 84 children from 15 schools participated in a randomized controlled trial (RCT) of PECS (P. Howlin, R. K. Gordon. G. Pasco, A. Wade, & T. Charman, 2007). They were aged 4-10 years (73 boys). Primary outcome measure was naturalistic observation of communication in the classroom. Multilevel Poisson regression was used to test for intervention effects and outcome predictors. Results: Spontaneous communication using picture cards, speech, or both increased significantly following training (rate ratio [RR] = 1.90, 95% CI [ 1.46. 2.48], p < .001; RR = 1.77, 95% CI [1.35. 2.32], p < .001; RR = 3.74, 95% CI [2.19, 6,371, p < .001, respectively). Spontaneous communication to request objects significantly increased (RR = 2.17. 95% CI [1.75, 2.68], p < .001), but spontaneous requesting for social purposes did not (RR = 1.34, 95% CI [0.83, 2.18], p = .237). Only the effect on spontaneous speech persisted by follow-up (9 months later). Less severe baseline autism symptomatology (lower Autism Diagnosis Observation Schedule [ADOS[ score; C. Lord et al., 2000) was associated with greater increase in spontaneous speech (RR = 0.90. 95% CI [0.83, 0.98], p = .011) and less severe baseline expressive language impairment (lower ADOS item AI score), with larger increases in spontaneous use of speech and pictures together (RR = 0.62.95% CI [0.44, 0.88], p = .008). Conclusion: Overall, PECS appeared to enhance children's spontaneous communication for instrumental requesting using pictures, speech, or a combination of both. Some effects of training were moderated by baseline factors. For example, PECS appears to have increased spontaneous speech in children who could talk a little at baseline. [ABSTRACT FROM AUTHOR]

Abstract: There are few long-term follow-up studies of children with Autism Spectrum Disorders (ASD) who attended intensive intervention programmes in their pre-school years. Thirty-six children with ASD enrolled in relatively intensive, specialist pre-school programmes (minimum of 15h intervention per week for 2 years at a mean age of 3.4 years) were assessed after 2 years (mean age 5.5 years) and again after a further 5 years (mean age 10.3 years). Cognitive, language and adaptive behaviour skills and severity of autism symptoms were assessed at intake (Time 1) and subsequent follow-ups (Times 2 and 3). Children made significant increases in raw and age equivalent scores in most areas of development assessed, although mean standard scores remained stable or decreased over time. Time 1 IQ, language and adaptive behaviour skills were predictive of outcome at Time 3. Although there were marked individual differences in the rate and patterns of change over time, many children continued to show increases in test scores over the course of the study. This study highlights that whilst overall group improvements may be evident, the rate and nature of these improvements is highly variable across individual children. Further investigation of the specific child characteristics that affect treatment effectiveness is required. [Copyright &y& Elsevier]

Summary: Current World Health Organization guidelines pertaining to the reprocessing of surgical instruments in the face of potential iatrogenic transmission of Creutzfeldt–Jakob disease (iCJD) are incompatible for the vast majority of devices. This has led to the advent of a range of new decontamination measures. Even without the implementation of these new procedures, the incidence of proven iCJD through surgery remains low. In this study, existing decontamination processes in sterile service departments have been evaluated using simulated washer-disinfector cycles on surgical grade stainless steel wires inoculated with ME7 scrapie homogenate. The consequence of varying the soil drying times and choice of cycle pre-treatment on prion removal were evaluated. Assessment of residual contamination at each cycle phase was carried out with the application of a sensitive fluorescent staining procedure to identify both total protein and prion-associated amyloid. The study confirmed that immediate reprocessing following contamination was beneficial during the pre-treatment phase with either an enzymatic or pre-soak wetting agent. Final total protein levels at the end of the cycles, were not significantly different from those where the soil was allowed to dry. In addition, cycles involving a pre-treatment with either an enzymatic cleaner or pre-soak, whether the soil was allowed to dry or not, showed complete removal of detectable prion amyloid. The results suggest that current decontamination procedures, combined with immediate processing of surgical instruments, have the potential to be highly effective alone at reducing the risk of surgical transmission of CJD. [Copyright &y& Elsevier]

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Abstract: This contribution presents an update on recent research into autism spectrum disorders (ASD). The areas covered include the genetic and neurological bases of ASD and the procedures required for accurate diagnostic assessment. Findings that challenge traditional views of ASD, particularly related to prevalence rates (now known to be much higher than originally believed), and levels of cognitive and linguistic ability are also discussed. The results of treatment trials are variable and the need for a much higher level of experimental sophistication in intervention research is highlighted. The necessity of providing more effective treatments and support networks for adults with ASD, rather than the focus being almost entirely on children, is stressed. [Copyright &y& Elsevier]

Abstract: Changes in structure and function of spruce forests occurred following a recent spruce beetle (Dendroctonus rufipennis) epidemic in the temperate forests of south-central Alaska. To assess the effects of this infestation and the subsequent land management practices used to reduce the risk of catastrophic fire, we measured northern red-backed vole (Clethrionomys rutilus) abundance over a 10-year period. We established eight live trapping grids across white spruce (Picea glauca) forests. Dead trees were harvested from four treatment grids; four grids remained as reference (not harvested). Northern red-backed vole populations synchronously declined across all sampling areas following the spruce beetle infestation, and began recovery by the end of the study. Population decline and subsequent recovery did not appear to be influenced by timber harvest. [Copyright &y& Elsevier]

We developed, tested, and applied an index of biological integrity (IBI) for fish and amphibian assemblages in coldwater streams of the Oregon and Washington Coast Range. A probability sample of 104 wadeable sites was quantitatively sampled for fish and amphibian assemblages as well as physical and chemical habitat from 1994 to 1996. Natural gradients and anthropogenic disturbances were assessed by examining digital data for catchment-scale road density and vegetation cover, along with site-scale physical and chemical habitat data. A set of 109 candidate metrics was evaluated for variance properties, redundancy, and responsiveness to multiple measures of disturbance, resulting in the selection of eight metrics for the index. The IBI itself was subsequently evaluated for variance and responsiveness to disturbance, then compared against an independently selected set of 101 reference sites that had minimal anthropogenic disturbance. Our IBI was fairly precise, with an among-stream variance-residual variance (sampling time, measurement error, and crew error) ratio of 4.0 (indicating a theoretical maximum correlation of 0.80 between the IBI and a predictor variable with a similar ratio). The IBI was significantly correlated with multiple estimates of anthropogenic disturbance, and reference sites had significantly higher IBI scores than the nonreference sites. Low IBI scores were associated with low bed stability, instream cover, and riparian cover and structural complexity but high percent fine substrate, road density, and human disturbances of riparian areas. Applying this IBI, we assessed fish assemblage condition in the Coast Range, inferring our results to all mapped (1:100,000-scale) wadeable streams in this region. Using 2 SDs from the reference sites mean as a biological criterion, 45% of stream kilometers (10,646 km) were classified as impaired. High IBI scores clustered near national parks and wilderness areas. Our results indicate that minimally disturbed regional reference sites and probability survey designs, which produce statistically representative sites and inferences with known confidence bounds, offer considerable advantages over least disturbed reference sites and hand-picked survey sites for making regional ecological assessments. [ABSTRACT FROM AUTHOR]

Commercial thinning has the potential to increase structural diversity in managed conifer stands and redirect development of young stands towards structure characteristic of late-seral habitats. Thinning to increase diversity, however, is likely to require different strategies than thinning to maximize timber production. To prescribe thinning regimes that will promote diversity, managers need more information on response of wildlife to a range of thinning intensities and patterns. We studied the response of forest songbirds to three different intensities and patterns of thinning in 40-year-old stands dominated by Douglas-fir (Pseudotsuga menziesii) in the Oregon Cascades. We estimated densities of songbirds for 2 years before and 4 years after experimental thinning with standard point count methodology. We compared changes in density before and after thinning between each thinning treatment and the control with repeated measures analysis of variance. Thinning increased species richness and the density of 10 species. Furthermore, the frequency of detection of four additional species increased in thinned stands. Thinning decreased the density of five species, but no species was excluded by thinning. Our results were largely consistent with those from other studies of bird response to thinning from different regions of the Pacific Northwest. We conclude that commercial thinning rapidly promotes diversity of breeding songbirds in young, conifer-dominated stands. However, we suggest using a variety of thinning intensities and patterns, ranging from no thinning to very widely spaced residual trees, in order to maximize avian diversity at the landscape scale and structural diversity both within and among stands. [Copyright &y& Elsevier]

Karpf J, Turk J, Howlin P. Cognitive, language, and adaptive behavior profiles in individuals with a diagnosis of Cohen syndrome. Although the physical characteristics of Cohen syndrome have been studied in considerable detail, data on other aspects of development are relatively limited. We report findings on cognitive, linguistic, and adaptive profiles in a group of 45 individuals clinically diagnosed with Cohen syndrome when aged between 4 and 49 years. The profile of skills observed was consistent with other recent findings. Thus, independence levels generally were poor, but socialization skills as assessed by the Vineland were relatively less impaired. This particular area of strength probably underlies the ‘sociable’ temperament typically associated with Cohen syndrome. However, the range of cognitive ability was wider than reported in most previous research, raising the issue of whether mental retardation should be considered as a necessary component of the phenotype. The implications for genetic testing are discussed. [ABSTRACT FROM AUTHOR]

A pilot study was conducted to evaluate the effects of training teachers of children with autistic spectrum disorders (ASDs) in the use of the Picture Exchange Communication System (PECS). Thirty-four children with ASDs (29 boys and 5 girls) were selected from eight specialist schools. Teaching staff attended a 2 day PECS workshop and received six half-day visits from PECS consultants. Data on the children's use of PECS, spontaneous communication, and adaptive behaviour were collected before the study and at set times following the workshop. Significant, rapid increases were recorded in the level of PECS attained by the children, in their PECS vocabulary, and in their frequency of PECS use over time. Improvements in children's general level of communication were slower to occur. The majority of participants showed improvements in their ability to use PECS. The results are discussed in relation to the methodological and practical difficulties that arose during the project. [ABSTRACT FROM AUTHOR]

Background: Parents commonly report a significant improvement in quality of life following the provision of hospice and supportive care and have identified a need for such a service in the home. The purpose of this study was to understand the experiences of families receiving a nurse led pilot hospice at home programme and the experiences of healthcare professionals delivering and engaging with the programme. Methods: An exploratory, qualitative study was conducted, including telephone interviews with parents and focus groups and individual interviews with healthcare professionals. All parents of families who received the programme of care between June 2014 and September 2015 and healthcare professionals delivering and engaging with the programme were invited to participate. Results: Seven parents participated in telephone interviews. Four focus groups took place, two with external stakeholders (18 participants in total), one with in-patient hospice staff (13 participants) and one with the hospice at home team (8 participants). Two additional interviews took place with individual stakeholders who were unable to attend a scheduled focus group. Themes from interviews with parents focused on the value of having consistent and expert care. The findings from healthcare professionals centred on communication within and across services, education and training and lone working. Conclusions: The pilot hospice at home programme was welcomed by all those who took part in the study. The programme may be improved by enhanced clarification of roles, enhanced access to multi-disciplinary services, greater communication across services and improved information provision to families., Version of Record

Melanoma is currently divided on a genetic level according to mutational status. However, this classification does not optimally predict prognosis. In prior studies, we have defined gene expression phenotypes (high-immune, pigmentation, proliferative and normal-like), which are predictive of survival outcome as well as informative of biology. Herein, we employed a population-based metastatic melanoma cohort and external cohorts to determine the prognostic and predictive significance of the gene expression phenotypes. We performed expression profiling on 214 cutaneous melanoma tumors and found an increased risk of developing distant metastases in the pigmentation (HR, 1.9; 95% CI, 1.05-3.28; P=0.03) and proliferative (HR, 2.8; 95% CI, 1.43-5.57; P=0.003) groups as compared to the high-immune response group. Further genetic characterization of melanomas using targeted deep-sequencing revealed similar mutational patterns across these phenotypes. We also used publicly available expression profiling data from melanoma patients treated with targeted or vaccine therapy in order to determine if our signatures predicted therapeutic response. In patients receiving targeted therapy, melanomas resistant to targeted therapy were enriched in the MITF-low proliferative subtype as compared to pre-treatment biopsies (P=0.02). In summary, the melanoma gene expression phenotypes are highly predictive of survival outcome and can further help to discriminate patients responding to targeted therapy., Version of Record

Registration as a children's nurse in Ireland occurs via two routes, an undergraduate degree in children's and general nursing and a twelve-month post-registration children's nurse programme. Candidates undertaking the latter are experienced nurses on the register for either general, intellectual disability or mental health nursing yet they are required to become a nursing student for the duration of the programme. Although anecdotal evidence indicates that this presents unique challenges for these students the experiences of transitioning from registered nurse to nursing student has not been explored since inception of the programme in 2006. The study aimed to explore the experiences of the registered nurse that transitioned to nursing student during the Post-registration Children's Nurse Programme, to identify the previous experience of the registered nurse and to identify what challenged and supported successful transition. A qualitative descriptive research design was used. The study was carried out in a large teaching children's hospital in Dublin, Ireland. A purposeful sample of six registered nurses that completed the programme within the last 12 months was interviewed about their experiences of being a post-registration nursing student. Face-to-face, semi-structured, conversation-style interviews were conducted. Four main themes were identified from the data: ' Feelings related to returning to student status ', ' Supports throughout the transition ', ' Differences between disciplines ' and ' Knowing your place '. Registered General Nurses (RGN) had different learning needs in comparison to registered nurses in intellectual disability (RNID) and expressed difficulty adapting to the role of nursing student as they felt that their previous knowledge and experience was being overlooked. In contrast, RNIDs were more challenged on clinical placement by unfamiliarity with clinical equipment and terminology. Both RNIDs and RGNs found that the nursing staff on their placements were a source of support despite reporting that they rarely worked with their designated preceptor. The challenges experienced by nursing students from different nursing disciplines sharing the same post-registration programme needs to be considered in the planning and implementation of all aspects of the programme. Healthcare staff should become more aware of the challenges experienced by the postgraduate nursing student when educating and supporting their learning within the preceptor-student relationship. [ABSTRACT FROM AUTHOR]