Past 5-years Research Articles

Translation and validation of the Czech Partner version of the Birth Satisfaction Scale-Revised (BSS-R)

ABSTRACT Background The Birth Satisfaction Scale-Revised (BSS-R) is a widely used, psychometrically robust and brief self-report measure of birth experience from the mothers perspective. The current study sought to adapt and validate the BSS-R for partners, evaluating key psychometric properties, including the underlying tri-dimensional factor structure of stress experienced, personal attributes and quality of care. Aim To translate and validate a Czech speaking partner version of the Birth Satisfaction Scale-Revised (BSS-R) and examine key measurement characteristics and association with fundamental clinical outcome variables. Method Following translation of the UK partner BSS-R into Czech, the Czech Partner BSS-R (CZP-BSS-R) was administered to 225 partners of women who had given birth within the past 5-years. Key psychometric characteristics were examined, including factor structure, divergent and known-groups discriminant validity and internal reliability, Results Established measurement models of the BSS-R observed in mothers were found to offer an excellent fit to partner data. The CZP-BSS-R also demonstrated excellent validity and reliability characteristics. Conclusions The CZP-BSS-R was found to be valid and reliable, with results from Czech partners ‘mirroring’ factor structure and key validity characteristics previously established in Czech mothers. The BSS-R validated for completion by Czech speaking mothers now has a matched version available for use with Czech speaking partners.

Riparian vegetation response amid variable climate conditions across the Upper Gila River watershed: informing Tribal restoration priorities

Riparian systems across the Southwest United States are extremely valuable for the human and ecological communities that engage with them. However, they have experienced substantial changes and stresses over the past century, including non-native vegetation expansion, vegetation die-offs, and increased fire activity. Vegetation management approaches, such as ecological restoration, may address some of these stressors as well as reduce the risk of future impacts. We apply remote sensing to inform restoration priorities along the upper Gila River within the San Carlos Apache Reservation and Upper Gila River watershed. First, we develop a spatially and temporally explicit trend analysis across three observed climate periods (1985–1993, 1993–2014, 2014–2021) using the Landsat-derived indices to quantify changes in riparian vegetation conditions. These maps can be used to identify areas potentially more at risk for degradation. Second, we analyze changes in riparian vegetation within a climate framework to better understand trends and the potential effect of climate change. Vegetation greenness has largely increased throughout the watershed despite intensifying drought conditions across our study period, though areas within the lower watershed have shown increased stress and higher rates of wildfire and other disturbances over the past 5-years. Nevertheless, small-scale restoration activities appear to show improving vegetation conditions, suggesting efficacy of these restoration activities. Results from this study may be integrated with restoration objectives to develop a restoration plan that will help riparian vegetation communities adapt to change.

Predictive accuracy of post-fire conifer death declines over time in models based on crown and bole injury.

A key uncertainty of empirical models of post-fire tree mortality is understanding the drivers of elevated post-fire mortality several years following fire, known as delayed mortality. Delayed mortality can represent a substantial fraction of mortality, particularly for large trees that are a conservation focus in western US coniferous forests. Current post-fire tree mortality models have undergone limited evaluation of how injury level and time since fire interact to influence model accuracy and predictor variable importance. Less severe injuries potentially serve as an indicator for vulnerability to additional stressors such as bark beetle attack or moisture stress. We used a collection of 164,293 individual tree records to examine post-fire tree mortality in eight western USA conifers: Abies concolor, Abies grandis, Calocedrus decurrens, Larix occidentalis, Pinus contorta, Pinus lambertiana, Pinus ponderosa, and Pseudotsuga menziesii. We evaluated the importance of fire injury predictors on discriminating between surviving trees versus immediate and delayed post-fire mortality. We fit balanced random forest models for each species using cumulative tree mortality from 1 to 5-years post-fire. We compared these results to multi-class random forest models using first-year mortality, 2-5-year mortality, and survival 5-years post-fire as a response variable. Crown volume scorched, diameter at breast height, and relative bark char height, were used as predictor variables. The cumulative mortality models all predicted trees that died within 1-year of fire with high accuracy but failed to predict 2-5-year mortality. The multi-class models were an improvement but had lower accuracy for predicting 2-5-year mortality. Multi-class model accuracies ranged from 85% to 95% across all species for predicting 1-year post-fire mortality, 42%-71% for predicting 2-5-year mortality, and 64%-85% for predicting trees that lived past 5-years. Our study highlights the differences in tree species tolerance to fire injury and suggests that including second-order predictors such as beetle attack or climatic water stress before and after fire will be critical to improve accuracy and better understand the mechanisms and patterns of fire-caused tree death. Random forest models have potential for management applications such as post-fire harvesting and simulating future stand dynamics.

Seniors from United States allopathic medical schools matching into pathology residency, 2018–2022

BackgroundFrom 2008 to 2017, 28.8 % fewer United States allopathic medical students (MD seniors) applied to pathology residency in the Main Residency Match (MRM) and 27.5 % fewer matched. This study is a 5-year follow-up. MethodsMRM data from 2018 to 2022 were reviewed to determine the numbers of MD seniors that applied and matched to pathology residency and other major medical specialties. ResultsFrom 2018 to 2022, the number of MD seniors applying to pathology increased 4.6 % from 237 to 248, while MD seniors matching to pathology increased 5.0 % from 220 to 231. For the 4 years from 2018 to 2021, there was a slight decline in MD seniors filling pathology positions, followed by a substantial 16.7 % spike in 2022. For the entire 5-year interval, because the number of filled pathology residency positions increased by 9.0 %, the percentage of filled positions taken by MD seniors declined from 38.7 % to 37.3 %. Of the 15 major medical specialties evaluated, pathology now has the 14th lowest percentage of filled positions taken by MD seniors. ConclusionsThe number of MD seniors applying and matching to pathology residency increased over the past 5-years, in contrast to the timespan of 2008 to 2017. However, the percentage of pathology residency positions taken by MD seniors continued to decline and remains low compared to other major medical specialties. MRM data should be continually monitored to study trends in MD seniors filling pathology residency positions in the context of new recruitment efforts and the pandemic.

1,8-Naphthyridine Derivatives: An Updated Review on Recent Advancements of Their Myriad Biological Activities

Among all nitrogen-containingheterocycles, the1,8-naphthyridine scaffold has recently gained an immense amount of curiosity from numerous researchers across fields of medicinal chemistry and drug discovery. This new attention can be ascribed to its versatilityof synthesis, its reactivenessand the variety ofbiologicalactivities it has exhibited. Over the past half-decade, numerous diverse biological evaluationshave beenconducted on 1,8-naphthyridine and its derivatives in a quest to unravel novel pharmacological facets to this scaffold. Its potency to treat neurodegenerative and immunomodulatory disorders, along with its anti-HIV, antidepressant and antioxidant properties, has enticed researchers to look beyond its broad-spectrum activities, providing further scope for exploration. This review is a consolidated update of previous works on 1,8-naphthyridines and their analogs, focusing on the past5 years.

Gastric Cancer: Advances in Carcinogenesis Research and New Therapeutic Strategies.

Gastric cancer’s bad incidence, prognosis, cellular and molecular heterogeneity amongst others make this disease a major health issue worldwide. Understanding this affliction is a priority for proper patients’ management and for the development of efficient therapeutical strategies. This review gives an overview of major scientific advances, made during the past 5-years, to improve the comprehension of gastric adenocarcinoma. A focus was made on the different actors of gastric carcinogenesis, including, Helicobacter pylori cancer stem cells, tumour microenvironment and microbiota. New and recent potential biomarkers were assessed as well as emerging therapeutical strategies involving cancer stem cells targeting as well as immunotherapy. Finally, recent experimental models to study this highly complex disease were discussed, highlighting the importance of gastric cancer understanding in the hard-fought struggle against cancer relapse, metastasis and bad prognosis.

Tobacco farmers Perspective towards increasing climate change risk on agriculture sector: a case study of Temanggung- Indonesia

Predicted increasing climate variability and change in the future by the Intergovernmental Panel of Climate Change have significant impact towards agricultural sector in Indonesia.Local farm commodities in Indonesia, such as tobacco, are very sensitive to changing climate. This study aims to measure tobacco farmers perspective towards increasing climate riskin Indonesia. Tobacco plantationarea in Temanggung District is selected as a case study since it is well known for its tobacco production, particularly for cigarette.Focus Group Discussion (FGD) towards local tobacco farmers has been conducted to identify how the weather and climate affect the farmer activity, as well as the climate risk due to increasing unpredictability of weather and climate. The result shows that in farmers perspective, it becomes more difficult to manage the farmlands. For the case of tobacco, excessive rainfalls orinsufficient rainfall could cause crop failure. As a result, the tobacco productivity is not as large compared to the past. The farmers also have lower income compared to the past5 years due to lower tobacco quality and quantity.

Impact of Endoscopic Vacuum Therapy with Low Negative Pressure for Esophageal Perforations and Postoperative Anastomotic Esophageal Leaks

Introduction: Management of esophageal anastomotic leaks (AL) and esophageal perforations (EP) remains difficult and often requires an interdisciplinary treatment modality. For primary endoscopic management, self-expanding metallic stent (SEMS) placement is often considered first-line therapy. Recently, endoscopic vacuum therapy (EVT) has emerged as an alternative or adjunct for management of these conditions. So far, data for EVT in the upper gastrointestinal-tract is restricted to single centre, non-randomized trials. No studies on optimal negative pressure application during EVT exist. The aim of our study is to describe our centre’s experience with low negative pressure (LNP) EVT for these indications over the past 5-years. Patients and Methods: Between January 2014 and December 2018, 30 patients were endoscopically treated for AL (n = 23) or EP (n = 7). All patients were primarily treated with EVT and LNP between –20 and –50 mm Hg. Additional endoscopic treatment was added when EVT failed. Procedural and peri-procedural data, as well as clinical outcomes including morbidity and mortality, were analysed. Results: Clinical successful endoscopic treatment of EP and AL was achieved in 83.3% (n = 25/30), with 73.3% success using EVT alone (n = 22/30). Mean treatment duration until leak closure was 16.1 days (range 2–58 days). Additional treatment modalities for complete leak resolution was necessary in 10% (n = 3/30), including SEMS placement and fibrin glue injection. Mean hospital stay for patients with EP was shorter with 33.7 days compared to AL with 54.4 days (p = 0.08). Estimated preoperative 10-year overall survival (Charlson comorbidity score) was 39.4% in patients with AL and 59.9% in patients with EP (p = 0.26). A mean of 5.1 EVT changes (range 1–12) was needed in EP and 3.6 changes (range 1–13) in AL to achieve complete closure, switch to other treatment modality, or reach endoscopic failure (p = 0.38). Conclusion: LNP EVT enables effective minimally – invasive endoluminal leak closure from anastomotic esophageal leaks and EP in high-morbid patients. In this study, EVT was combined with other endoscopic treatment options such as SEMS placement or fibrin glue injection in order to achieve leak or perforation closure in the vast majority of patients (83.3%). Low aspiration pressures led to slower but still sufficient clinical results.

Histone methylation in DNA repair and clinical practice: new findings during the past 5-years.

DNA double-strand breaks (DSBs) are highly toxic lesions that can impair cellular homeostasis and genome stability to result in tumorigenesis for inappropriate repair. Although DSBs are repaired by homologous recombination (HR) or non-homologous end-joining (NHEJ), the related mechanisms are still incompletely unclear. Indeed, more and more evidences indicate that the methylation of histone lysine has an important role in choosing the pathways of DNA repair. For example, tri-methylated H3K36 is required for HR repair, while di-methylated H4K20 can recruit 53BP1 for NHEJ repair. Here, we reviewed the recent progress in the molecular mechanisms by which histone methylation functions in DNA double-strand breaks repair (DSBR). The insight into the mechanisms of histone methylation repairing DNA damage will supply important cues for clinical cancer treatment.

P2.04-031 Predictors of Pathological Complete Response (TRG=1) among Esophageal Cancer Cases; NCI Pooled Data: Topic: Esophageal Cancer and Other Malignancies

Commonly used chemotherapy regimens for esophageal cancer (EC) are EOX(Epirubicin/Oxaloplatin/Capecitabine) for adenocarcinoma and CF(Cisplatin and 5-Fluorouracil) for squamous carcinoma. In this study we aim to assess prevalence of pathological complete response (pCR) after current chemotherapeutic regimens among our EC cases and compare pCR cases to the remaining cohort. We retrospectively reviewed Pathology Department database to retrieve EC patients treated in our National Cancer Institute (NCI), Cairo University during the past 5-years. Available variables were age, gender, operation, diagnosis, tumor size and grade, LN-size, presence of Barrett’s esophagus or in-situ/micro-invasive carcinoma, gross and microscopic pictures. MANDARD’s pathological response using tumor regression grade (TRG) was quantitated into five grades (1-5) with TRG=1 showing absence of residual cancer (Mandard et al.,1994. Esophageal carcinoma regression after chemoradiotherapy, Cancer,73(11),2680-86). Logistic regression was used to identify pCR(TRG-1)predictors. Kaplan-Meier survival curves were used. 334 patients were encountered with males predominance; 202 (60.5%), Median age was 64(Inter-quartile range;IQR;58-68), Pathology was SqCC in 227 (68%), adenocarcinoma in 94 (28.1%), undifferentiated ca in 9 (2.7%)and others in 4 (1.2%). pCR (TRG-1) was evident in 15 cases (4.5%). Among mentioned variables, only advanced age, non SqCC and high grade tumors adversely affect pathological response to induction treatment. On MVA, Advanced age (Odd Ratio (OR)=0.923, 95%Confidence interval (CI)=0.86-0.99) p=0.025), moderate/high grade tumors(OR=0.03, p<0.001)adversely affect response while SqCC pathology has better response trend(OR4.39, p=0.086). 3-years overall survival (OS) was 100% in pCR (TRG-1) vs 82.3% in the remaining cohort (Figure). Among esophagectomy cases, surgery was done in 71.7% males vs28.3% females (p=0.093). Gastric pull up was performed in all surgical cases. R1 was present in 2.2%. Median tumor size was 4.3cm (IQR;3-5.6cm), least surgical margin was 3 (2-4) and max (LN) size was 1(1-2cm).Median +veLN, total LNnumber&LN-ratio was 0 (0-1), 10 (7-17) and 0 (0-5%) respectively. 30-days-perioperative mortality was 6.5%. 3 years OS among esophagectomy patients was 79.6%. Young EC patients and low grade tumor show better response to chemotherapy so aggressive treatment is warranted among this cohort. SqCC carries a good prediction to pathological response and hence better survival mandating aggressive chemo-radiation in this cohort aiming to cure.

University Hospital Waterford: 5-year experience of cutaneous melanoma.

The incidence of cutaneous melanoma (CM) continues to rise in Ireland. Despite significant advances in melanoma molecular therapy, surgery remains the mainstay of treatment for CM. The University Hospital Waterford (UHW) prospectively maintained CM registry was established in 2010. To summarize 5-year experience (2010-2015) of primary CM presenting to UHW. Data were retrospectively obtained from a central electronic pathology and radiology repository augmented by HIPE data and theatre logs. Data collected included patient demographics and clinico-pathological characteristics, specimen number, size, anatomical location, melanoma subtype, Breslow thickness, Clark's level, ulceration, and mitosis. 592 CMs were managed in UHW during the study period. Overall, females comprised the majority of cases with mean age at presentation 60.78±18.29years. The most commonly affected anatomical location was the lower limb (26.7%) followed by the back (15.1%), upper limb (15.07%), and face (14.40%). Superficial spreading and lentigo maligna were the most common histological subtype accounting for 19.8 and 20%, respectively. Overall, the mean Breslow depth was 2.4±3.7mm with corresponding Clark's Level III. Sentinel lymph node positivity was 39/103 (37.89%) most commonly located in the axilla (53.8%) and groin (30.7%). There has been a steady increase in the number of cutaneous melanoma presentations over the past 5-years to the South East Cancer Centre. Patients are managed best by prompt surgical excision and multidisciplinary management. Our results are in keeping with international standards and work continues in determining overall 5-year survival and recurrence rates.

Perspectives on making big data analytics work for oncology

Oncology, with its unique combination of clinical, physical, technological, and biological data provides an ideal case study for applying big data analytics to improve cancer treatment safety and outcomes. An oncology treatment course such as chemoradiotherapy can generate a large pool of information carrying the 5Vs hallmarks of big data. This data is comprised of a heterogeneous mixture of patient demographics, radiation/chemo dosimetry, multimodality imaging features, and biological markers generated over a treatment period that can span few days to several weeks. Efforts using commercial and in-house tools are underway to facilitate data aggregation, ontology creation, sharing, visualization and varying analytics in a secure environment. However, open questions related to proper data structure representation and effective analytics tools to support oncology decision-making need to be addressed. It is recognized that oncology data constitutes a mix of structured (tabulated) and unstructured (electronic documents) that need to be processed to facilitate searching and subsequent knowledge discovery from relational or NoSQL databases. In this context, methods based on advanced analytics and image feature extraction for oncology applications will be discussed. On the other hand, the classical p (variables)≫n (samples) inference problem of statistical learning is challenged in the Big data realm and this is particularly true for oncology applications where p-omics is witnessing exponential growth while the number of cancer incidences has generally plateaued over the past 5-years leading to a quasi-linear growth in samples per patient. Within the Big data paradigm, this kind of phenomenon may yield undesirable effects such as echo chamber anomalies, Yule–Simpson reversal paradox, or misleading ghost analytics. In this work, we will present these effects as they pertain to oncology and engage small thinking methodologies to counter these effects ranging from incorporating prior knowledge, using information-theoretic techniques to modern ensemble machine learning approaches or combination of these. We will particularly discuss the pros and cons of different approaches to improve mining of big data in oncology.

An Update on Familial Hyperaldosteronism.

Familial forms of primary aldosteronism have been suggested to account for up to 6% of cases in referral centers. For many years, the genetics of familial hyperaldosteronism remained unknown, with the notable exception of glucocorticoid-remediable aldosteronism, due to unequal crossing over and formation of a chimeric 11β-hydroxylase/aldosterone synthase gene. Over the past 5 years, mutations in 3 additional genes have been shown to cause familial forms of primary aldosteronism. Gain-of-function heterozygous germline mutations in KCNJ5, which encodes an inward rectifier potassium channel, cause autosomal dominant syndromes of PA and hypertension with or without adrenal hyperplasia. Germline mutations in CACNA1D, which codes for an L-type calcium channel, have so far only been found in 2 cases with a syndrome of primary aldosteronism, seizures, and neurologic abnormalities. Both KCNJ5 and CACNA1D mutations in familial hyperaldosteronism were only discovered following identification of similar or identical somatic mutations in aldosterone-producing adenomas. In contrast, a recent exome sequencing study identified germline mutations in CACNA1H (a T-type calcium channel), previously undescribed in adenomas, in 5 unrelated families with early-onset primary aldosteronism and hypertension, without any additional shared symptoms. Future exome or genome sequencing studies are expected to shed light on the genetic basis of many cases of familial hyperaldosteronism that remain unexplained.

Mathematical Measures of Network Complexity for Cancer Signaling Networks

The 5-year survival for patients afterdiagnosis/treatment is strongly dependent on tumor type. Prostate cancer patients have a >99% chance of survival past 5-years since diagnosis, while pancreatic patients have <6% chance of survival past 5-years. Since each cancer type has its own molecular signaling network, we asked if there are “signatures” embedded in these networks that inform us as to the 5-year survival. In other words, are there statistical metrics of the network that correlate with survival? And further, if there are, can such signatures provide clues to selecting new therapeutic targets? From the KEGG Cancer Pathway database we computed several conventional and some less conventional network statistics. In particular we found a high correlation (R2 = 0.7) between degree-entropy and 5-year survival based on the SEER database. This correlation suggests that cancers that have a more complex molecular pathway are more refractory than those with less complex molecular pathway. We also found potential new targets by computing the betweenness – a statistical metric of the centrality of a node – for the molecular networks. We have also investigated algebraic and topological indices for network complexity for protein-protein interaction networks of 11 human cancers. We have found evidence that greater network complexity is associated with lower five year survival probabilities. Moreover, we identify several protein families (PIK, ITG, AKT) that are repeated motives in many of the cancer pathways. Our results can aide in identification of promising targets for anti-cancer drugs.

Predictors and Consequences of Negative Patient-Provider Interactions Among a Sample of African American Sexual Minority Women

Using Andersen's Behavioral Model of Health Services Utilization, we examined the associations between negative experience in a health care setting and subsequent reductions in health care utilization among African American sexual minority women (SMW). The data were collected as part of a larger study exploring health and health care experiences of a volunteer sample of African American SMW (n=226). We examined predisposing, enabling, and need factors as predictors of a negative experience and changes in health care utilization. More than one-third of the sample reported a negative health care experience in the past 5-years. One fourth of those reporting a negative experience attributed it to discrimination including race/ethnicity (70.4%), gender (58.2%), and sexual orientation (46.2%). (The categories were not mutually exclusive). Reduction in health care utilization (i.e., didn't see a doctor next time when they were ill) following the negative experience was common (34%). Predisposing (younger age), enabling (lack of insurance, part-time employment, and no regular provider), and need factors (living with a chronic illness) predicted experiencing a negative event. In multivariate analysis, health care factors (quality of health care, negative experience due to discrimination) and patient factors (passive coping response) were factors associated with reduced health care utilization. Problems in the patient-provider relationship were a significant factor in decreasing healthcare use among SMW. Anderson's model helped to inform our understanding of who might be at risk of experiencing a negative experience but not subsequent changes in health care utilization. Modifiable variables related to the health care environment and patient coping responses predicted changes in health care use.

What Is the Outcome of Allograft and Intramedullary Free Fibula (Capanna Technique) in Pediatric and Adolescent Patients With Bone Tumors?

After bone tumor resection, reconstruction for limb salvage surgery can be challenging because of the resultant large segmental bony defects. Structural allografts have been used to fill these voids; however, this technique is associated with high complication rates. To circumvent the complications associated with this procedure, massive bony allografts have been supplemented with an intramedullary vascularized free fibula. However, few studies have examined the outcomes using this technique in the pediatric and adolescent populations. The purpose of this study was to examine the revision-free survival using he Capanna technique for limb salvage for pediatric lower limb salvage. We attempted to answer the following questions: (1) What was the overall limb salvage rate along with incidence of reoperation and complications? (2) How did pediatric and adolescent patients functionally perform after this technique? (3) What was the incidence of late complications including infection and fracture? (4) What was the incidence of limb length discrepancy? Eighteen pediatric patients who underwent lower extremity limb salvage with the use of cadaveric allograft and intramedullary free fibular transfer (Capanna technique) were identified. There were nine boys males and nine girls with a mean age of 11years (range, 5-18years) and mean followup of 8years (range, 2-15years), respectively. All patients had at least 2years followup. Three patients have not been seen in followup during the past 5-years; however, all had made it to their 5-year clinical followup. The patients' medical records were reviewed for clinical and functional outcomes as well as postoperative complications. Time to union was recorded through an evaluation of radiographs. Mankin functional outcome and Musculoskeletal Tumor Society (MSTS) rating scale were recorded for each patient. The overall limb salvage rate was 94%. Fourteen patients underwent an additional surgical procedure. Six patients underwent additional procedure(s) to treat a symptomatic nonunion. Seventeen of the patients had a good or excellent Mankin score with a mean MSTS rating of 93% at last followup. Six of the patients underwent a limb length modification procedure. Use of large allografts in conjunction with intramedullary vascularized free fibulas appears to be a reliable method for the reconstruction of large bony tumors of the lower extremity in this population, although we did not directly compare this with allografts alone in our study. The use of locked plates may improve union times. The proportion of patients achieving limb preservation was high and complication rates are acceptable. Level IV, therapeutic study.

Acute Poisoning among Children Admitted to a Regional University Hospital in Northern Greece

The aim of our study was to elucidate the current pattern of acute poisoning among children admitted to a regional University Hospital in the prefecture of Evros in Northern Greece. We also compared the obtained findings with those of two previous studies performed in the same region. Demographic and clinical data, management, and outcome of children with acute poisoning were recorded in our region, during the past 5-years (2005-2009, period C) and compared to similar studies carried out in the periods 1985-1989 (period A) and 1995-1999 (period B). Comparison between the three periods showed that in period Athe lower incidence of children's acute poisoning (CAP) was observed. Also this revealed a 20%-reduction in the frequency of poisoning over the past 5-years (period C) compared to period B (p = 0.219), a significant increase in tobacco intoxication over the years (in the order A-C; p < 0.001 for comparisons of periods A and B, and periods B and C), while poisoning from insecticides-pesticides decreased (p < 0.001). The incidence of poisoning via salicylates significantly reduced from 9.7% in period A to 6.2% in period B, and further to 4.7% in period C (p = 0.016), whereas during the same periods poisoning via paracetamol increased from 2.3% to 5.1% and then to 10.4%, respectively (p < 0.001). Atrend toward a higher incidence of suicide attempt via poisoning was found during the three periods (from 3.0% in period A to 4.7% and 6.6%, in periods B and C, respectively; p = 0.049). The frequency of acute poisoning among children has decreased over the past 5 years. The incidences of poisoning via paracetamol and tobacco, and attempted suicide have increased in recent years. Targeted and continuous educational preventive programs are mandatory.

Peace and Social Cohesion Through Education: Global Perspectives and Experiences From the GPPAC Education Working Group

This article describes activities and methodologies of the Global Partnership for thePrevention of Armed Conflict Peace Education Working Group. Drawing its members fromcivil society organizations, higher-education institutions, and government over the past5 years, the working group has collaborated to share resources, policies, curriculum, research,and expertise, particularly in terms of what is working in peace education and conflict resolutioneducation. After describing the values and principles of the group and how these aretranslated into practice, methodologies and future directions are presented around the followingthemes: (a) reporting and encouraging evaluation research on peace education andconflict resolution education; (b) encouraging conflict resolution and peace education asan integral part of teacher education; (c) curricular focus on social emotional student-centeredlearning; (d) strengthening collaboration between government, civil society organizations,and education authorities; (e) creating grassroots education programs; and (f) buildingsocial cohesion through a multicultural/multifaith lens.

Oregon hospice nurses and social workers' assessment of physician progress in palliative care over the past 5 years

The 1997 enactment of the Oregon Death with Dignity Act intensified interest in improving physician education and skills in caring for patients at the end of life. To obtain hospice nurse and social workers' collateral ratings of efforts made by Oregon physicians to improve their palliative care skills over the previous 5 years. A descriptive survey of nurses and social workers from all 50 Oregon outpatient hospice agencies. Oregon hospice nurse (N=185) and social worker (N=52) respondents, who had worked in hospice for at least 5 years, rated changes they observed over the past 5 years in physicians' approach to caring for their hospice clients. Six characteristics, including willingness to refer patients to hospice, willingness to prescribe sufficient pain medications, knowledge about using pain medications in hospice patients, interest in caring for hospice patients, competence in caring for hospice patients, and fearfulness of prescribing sufficient opioid medications were evaluated. Positive changes were endorsed by the majority of respondents on all but the scale measuring fearfulness of prescribing opioid medications; on the latter, 47% of nurses rated doctors as less fearful, whereas 53% rated them as about the same or more fearful than they were 5 years earlier. Most respondents rated Oregon physicians as showing improvements in knowledge and willingness to refer and care for hospice patients.

Regulation of Bile Acid Biosynthesis

Abstract: An elevated concentration of low density lipoprotein (LDL) cholesterol is an independent risk factor for cardiovascular disease. The only quantitatively significant way by which cholesterol is removed from the body is via the bile, either directly or after conversion to bile acids. Therapeutic modalities which increase bile acid biosynthesis, e.g. bile acid-binding resins, have been shown to reduce plasma LDL levels and the risk of coronary heart disease. Their effects, however, are limited and patients' acceptibility is poor. This warrants the search for more potent drugs and new ways to enhance bile acid synthesis. In this review the various pathways along which bile acids are formed will be discussed with emphasis on the regulation of cholesterol 7o:-hydroxylase, the major rate­ limiting step in bile acid formation, as a target to increase bile acid synthesis. In the past 5 years our understanding of the transcriptional mechanism that regulates the expression of this gene has rapidly expanded. In view of the increasing evidence for the substantial contribution of the alternative or 27- hydroxylase route to bile acid synthesis, the current knowledge on sterol 27-hydroxylase, the first enzyme in this pathway and a potentially new target, is reviewed. Several companies are involved in developing new bile acid sequestrants and other inhibitors of intestinal bile acid absorption to remove cholesterol from the body. This review article presents recent developments in this field as appeared in the patent literature during past the years.