Background
Speech–language therapists and audiologists (SLT&As) may encounter difficulties when confronted with patient death and dying, which may conflict with their moral beliefs and result in ...moral injury. Furthermore, South African SLT&As practice in a country with a high mortality rate, which may add to the complexity of their experience. Moreover, they may be influenced by African philosophies promoting care, which might conflict with their experiences of patient death and dying.
Aims
To explore the moral injury experienced by South African SLT&As in patient death and dying, and how they overcame the injury.
Methods & Procedures
This article forms part of a larger qualitative study that explored SLT&As’ experiences of patient death and dying in South Africa. Thematic analysis was conducted on the transcripts of 25 episodic narrative interviews conducted with South African SLT&As on their experiences of patient death and dying.
Outcomes & Results
Findings suggest that South African SLT&As experienced helplessness, guilt and anger in patient death and dying. However, with support from the allied team, engaging in self‐reflection and religious practices, they reported alleviation of moral injury.
Conclusions & Implications
In order to mitigate moral injury in South African SLT&As, they require professional education, self‐care strategies, guidelines and support from the teams in which they work and their supervisors. Research is needed that explores how SLT&As’ biographical characteristics and interactions with significant others of dying and deceased patients, may result in moral injury.
What this paper adds?
What is already known on this subject?
Moral injury and measures used to overcome the injury have been explored in military personnel, doctors and nurses, but not in SLT&As. However, studies that explored the perceptions of SLTs and/or audiologists regarding providing palliative care and of death and dying, particularly that by Rivers et al. in 2009, suggested that these professionals may be at risk of experiencing emotional trauma due to patient death, particularly when not receiving undergraduate education on this subject. However, the extent of this trauma and the support needed to overcome it is unknown because the participants in these studies may have not experienced patient death, and were only students or just SLTs.
What this article adds?
This article highlights the complexity of speech–language therapy and audiology practice when confronted with patient death and dying. South African SLT&As may have to make decisions that conflict with their morals and professional practice standards, especially as the helping nature of their profession is characterized by African philosophies that promote care, which may result in moral injury.
Clinical implications of this article
This article indicates that in addition to undergraduate education on patient death and dying, SLTs and audiologists require continuous professional education on this topic, self‐care strategies, support from the teams in which they work, and their supervisors and guidelines for when they encounter patient death and dying.
The Brazil nut tree (Bertholletia excelsa) is an iconic and economically valuable species that dominates vast swathes of the Amazon Basin. This species seems to have been an important part of human ...subsistence strategies in the region from at least the Early Holocene, and its current distribution may be a legacy of past human settlement. Because B. excelsa is a long-lived pioneer tree it requires natural or human disturbances to increase light availability in the understory for a successful establishment. However, it remains unclear how the long-term population dynamics of this species have been shaped by pre-colonial and post-colonial human practices. Here, we use tree-ring analyses to look at changes in growing conditions over the past 400 years in a Brazil nut tree population in Central Amazonia. We identify changes in tree recruitment and growth rates associated not only with regional climatic variability, but also major political and socio-economic activities recorded by historical documents in the vicinity of Manaus. We demonstrate that the expansion of a post-colonial political center (Manaus) from the middle of the 18th century onwards coincided with a reduction in recruitment of B. excelsa. We argue that this hiatus suggests the interruption of indigenous management practices, probably due to the collapse of pre-Columbian societies. A second recruitment pulse, and unprecedented cycles of growth release and suppression, aligns with a shift to modern exploitation of the forest into the 20th century. Our findings shed light on how past histories of human-forest interactions can be revealed by the growth rings of trees in Amazonia. Future interdisciplinary analysis of these trees should enable more detailed investigation of how human forest management has changed in this part of the world, through pre-colonial, colonial, and industrial periods of human activity, with potential implications for conservation.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The increased breast cancer risk conferred by a diagnosis of lobular carcinoma in situ (LCIS) is poorly understood. Here, we review our 29-year longitudinal experience with LCIS to evaluate factors ...associated with breast cancer risk.
Patients participating in surveillance after an LCIS diagnosis are observed in a prospectively maintained database. Comparisons were made among women choosing surveillance, with or without chemoprevention, and those undergoing bilateral prophylactic mastectomies between 1980 and 2009.
One thousand sixty patients with LCIS without concurrent breast cancer were identified. Median age at LCIS diagnosis was 50 years (range, 27 to 83 years). Fifty-six patients (5%) underwent bilateral prophylactic mastectomy; 1,004 chose surveillance with (n = 173) or without (n = 831) chemoprevention. At a median follow-up of 81 months (range, 6 to 368 months), 150 patients developed 168 breast cancers (63% ipsilateral, 25% contralateral, 12% bilateral), with no dominant histology (ductal carcinoma in situ, 35%; infiltrating ductal carcinoma, 29%; infiltrating lobular carcinoma, 27%; other, 9%). Breast cancer incidence was significantly reduced in women taking chemoprevention (10-year cumulative risk: 7% with chemoprevention; 21% with no chemoprevention; P < .001). In multivariable analysis, chemoprevention was the only clinical factor associated with breast cancer risk (hazard ratio, 0.27; 95% CI, 0.15 to 0.50). In a subgroup nested case-control analysis, volume of disease, which was defined as the ratio of slides with LCIS to total number of slides reviewed, was also associated with breast cancer development (P = .008).
We observed a 2% annual incidence of breast cancer among women with LCIS. Common clinical factors used for risk prediction, including age and family history, were not associated with breast cancer risk. The lower breast cancer incidence in women opting for chemoprevention highlights the potential for risk reduction in this population.
Alzheimer's disease (AD) is the most frequent type of dementia in the elderly, severely affecting functional and executive skills of subjects suffering from this disease. Moreover, the distress of ...caregivers as well as the social implications constitute a critical issue for families. Furthermore, cognitive impairment, along with behavioral disorders and neuropsychiatric symptoms are characteristics of AD. Although these are present with variations in prevalence, intensity, and progression, an important core of them is visible before cognitive impairment, especially depression and apathy, which affect at least 50% of patients. The most updated literature shows that depression and/or behavioral and neuropsychiatric symptoms (BNS) are part of the initial phase of the disease rather than just a risk factor. Thus, mood disorders are associated with anomalies in specific brain regions that disturb the normal balance of neurotransmission. This in turn is linked with an inflammatory pathway that leads to microglial activation and aggregated neurofibrillary tangle formation, finally triggering neuronal loss, according to our neuroimmunomodulation theory. Altogether, inflammation and tau aggregation are observed in preclinical stages, preceding the BNS of patients, which in turn are exhibited earlier than cognitive and functional impairment detected in AD. This review is focused on the latest insights of cellular and molecular processes associated with BNS in asymptomatic early-onset stages of AD. An important medical research focus is to improve quality of life of patients, through prevention and treatments of AD, and the study of behavioral disorders and early event in AD pathogenesis has a major impact.
Cancer research currently is heavily skewed toward high-income countries (HICs), with little research conducted in, and relevant to, the problems of low- and middle-income countries (LMICs). This ...regional discordance in cancer knowledge generation and application needs to be rebalanced. Several gaps in the research enterprise of LMICs need to be addressed to promote regionally relevant research, and radical rethinking is needed to address the burning issues in cancer care in these regions. We identified five top priorities in cancer research in LMICs based on current and projected needs: reducing the burden of patients with advanced disease; improving access and affordability, and outcomes of cancer treatment; value-based care and health economics; quality improvement and implementation research; and leveraging technology to improve cancer control. LMICs have an excellent opportunity to address important questions in cancer research that could impact cancer control globally. Success will require collaboration and commitment from governments, policy makers, funding agencies, health care organizations and leaders, researchers and the public.
Encontros nas quadras de grama de Melo, Victor Andrade
Estudos feministas,
2021, Letnik:
29, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Considerando que, no cenário internacional, as iniciativas organizadas ao redor do tênis sempre foram marcadas por contar com o intenso envolvimento de mulheres, este artigo objetiva discutir a ...participação feminina nas primeiras experiências da modalidade estruturadas no Brasil, especificamente as promovidas nas duas décadas finais do século XIX, em cidades nas quais havia ativa presença de britânicos. Como fontes, fez-se uso de periódicos, notadamente do The Rio News. Mais do que refletir sobre a formação de uma cultura esportiva, o intuito é lançar um olhar sobre o aumento da visibilidade feminina na sociedade brasileira. Argumenta-se que a prática do tênis foi uma estratégia de subjetivação que se articulou com o processo de distensão das considerações acerca do papel social das mulheres.
Considering that, in the international scenario, the initiatives organized around tennis have always been marked by the strong involvement of women, this article aims to discuss the female participation in the first experiences of this sport structured in Brazil, specifically those promoted in the last two decades of the nineteenth century, in cities in which there was an active presence of Briton. As sources, newspapers were used, notably The Rio News. More than thinking about the formation of a sporting culture, the intention is to take a look at the increase of female visibility in the Brazilian society. It is argued that the practice of tennis was a strategy of subjectivation that was articulated with the process of considerations about the social role of women.
Teniendo en cuenta que, en el escenario internacional, las iniciativas organizadas alrededor del tenis siempre han estado marcadas por contar con la intensa participación de las mujeres, este artículo tiene el objetivo de discutir la participación femenina en las primeras experiencias de esto deporte estructuradas en Brasil, específicamente las promovidas en las dos últimas décadas del siglo XIX, en ciudades en la cuales hubo una activa presencia británica. Como fuentes, se utilizaron publicaciones periódicas, en particular The Rio News. Más que reflexionar sobre la formación de una cultura deportiva, el objetivo es lanzar una mirada para el aumento de la visibilidad de las mujeres en la sociedad brasileña. Se argumenta que la práctica del tenis fue una estrategia de subjetivación que se articuló con el proceso de distensión de las consideraciones sobre el rol social de la mujer.
• The long-lived tree species Eschweilera tenuifolia (O. Berg) Miers is characteristic of oligotrophic Amazonian black-water floodplain forests (igapó), seasonally inundated up to 10 months per year, ...often forming monodominant stands. We investigated E. tenuifolia′ growth andmortality patterns in undisturbed (Jaú National Park - JNP) and disturbed igapós (Uatumã Sustainable Development Reserve - USDR, downstream of the Balbina hydroelectric dam).
• We analysed age–diameter relationships, basal area increment (BAI) through 5-cm diameter classes, growth changes and growth ratios preceding death, BAI clustering, BAI ratio, and dated the individual year of death (14C). Growth and mortality patterns were then related to climatic or anthropogenic disturbances.
• Results were similar for both populations for estimated maximum ages (JNP, 466 yr; USDR, 498 yr, except for one USDR tree with an estimated age of 820 yr) and slightly different for mean diameter increment (JNP: 2.04 mm; USDR: 2.28 mm). Living trees from JNP showed altered growth post-1975 and sparse tree mortality occurred at various times, possibly induced by extreme hydroclimatic events. In contrast with the JNP, abrupt growth changes and massive mortality occurred in the USDR after the dam construction began (1983).
• Even more than 30 yr after dam construction, flood-pulse alteration continues to affect both growth and mortality of E. tenuifolia. Besides its vulnerability to anthropogenic disturbances, this species is also susceptible to long-lasting dry and wet periods induced by climatic events, the combination of both processes may cause its local and regional extinction.
Background Triple-negative mammary carcinoma (TNBC) is an aggressive breast cancer subtype associated with dismal prognosis. The interaction between the immune system and the cancer cells plays a ...crucial role in tumor development and progression. However, it is still unclear how each diverse cell of the immune system contributes to the prognosis of patients with breast cancer. In this study, we investigated how the cell composition of the immune cell infiltrated modifies the survival of patients with resected TNBC. Methods Retrospectively, we collected data from 76 patients diagnosed with non-metastatic TNBC with available tissue blocks for tissue micro-array (TMA) construction. The TMA was constructed using two cores from each tumor block. The expression of CD4, CD8, FOXP3, CD20, CD68, CD163, PD-1, PD-L1, PTEN and phospho-STAT1 was determined by immunohistochemistry. Results We observed that the inflammatory infiltrate in TNBC is enriched for M2 macrophages and T lymphocytes (CD4+, CD8+). PD-L1 expression in the stroma was associated with the percentage of TILs (p = 0.018) as, PD-L1 expression in the tumor was associated with the percentage of TILs (p = 0.049). We found a correlation between TILs and PD-L1 expression in stroma cells (p = 0.020) and in tumor cells (p = 0.027). In our cohort, we observed a trend for improved survival associated with higher CD8+ (p = 0.054) and CD4 + (p = 0.082) cell counts, but the results were not statistically significant. Conversely, the expression of PTEN in tumor cells and a low number of FOXP3+ cells in tumor stroma were both associated with improved OS. The CD8 to FOXP3 ratio and the CD4 to FOXP3 ratio were associated with better OS as well, however, only the CD8 to FOXP3 ratio had its prognostic impact confirmed in the METABRIC TNBC cohort. There was no association between PD-L1 expression and OS. Conclusion TNBC tumor microenvironment is enriched for lymphocytes and macrophages. FOXP3 expression and the CD8 to FOXP3 ratio in the tumor stroma as well as the loss of PTEN expression in tumor cells are prognostic factors in non-metastatic TNBC. Keywords: Triple-negative breast cancer, Immune infiltrate, PTEN, CD8, FOXP3, Survival
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In South Africa, education is considered a basic right and our constitution calls for accessible educational contexts which ought to be conducive for learning. Even though schools are meant to be ...places in which learning can occur, poor classroom acoustics may threaten that basic right to education. The aim of this study was, therefore, to explore and understand how teachers in special needs schools managed classroom acoustics in their efforts to enhance learning. We report on a qualitative study using semi-structured face-to-face interviews with teachers from 2 special needs schools in Johannesburg in the Gauteng province of South Africa. A non-probability purposive sampling strategy was used to recruit participants. The results of this study confirm that classrooms in special needs schools may not be acoustically sound spaces which teachers feel may compromise effective learning. As a result, teachers reported using a variety of active and passive strategies to manage classroom acoustics in order to enhance learning. The results of this study contribute to existing knowledge on the importance of the strategies used by teachers in managing classroom acoustics. Further research is required to determine the efficacy of these and other strategies used by teachers in special needs schools.
Alzheimer's disease (AD) is a neurodegenerative disease characterized by a progressive cognitive impairment of patients, affecting around 12% of people older than 65 years old. WHO estimated that ...over 48.6 million all over the world suffer this disease. On the basis of cumulative results on our research, we have postulated the neuroimmunomodulation hypothesis that appears to provide a reasonable explanation of both the preclinical and clinical observations. In this context, the long-term activation of the innate immune system triggers an anomalous cascade of molecular signals, finally leading to tau oligomerization in the pathway to neuronal degeneration. In the present scenario of the failure of many anti-AD drugs, nutraceutical compounds provide an avenue for AD prevention and possibly as coadjuvants in the treatment of this disease. Recent discoveries point to the relevance of curcumin, a natural anti-inflammatory agent, in controlling oxidative stress and improving cholinergic function in the brain, even though the mechanisms underlying these actions are unknown. We investigated the effects of curcumin in cultures of neuronal cells. For this study, we exposed cells to prooxidant conditions, both in the presence and absence of curcumin. Our data reveal that curcumin exert a strong neuroprotective effect in N2a cells, thus preventing toxicity by oxidative agents H2O2 and Fe+3. This is supported by results that indicate that curcumin control the neurodegenerative effects of both oxidative agents, relieving cells from the loss of neuritogenic processes induced by prooxidants. In addition, curcumin was able to slow down the tau aggregation curve and disassemble tau pathological oligomeric structures. Data suggest that curcumin could be a potential compound for prevention of cognitive disorders associated with AD.
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