Protein S deficiency is associated with increased risk of venous thromboembolism, complicating the perioperative management of such patients. We present a patient with sickle cell disease (Hb SC ...genotype) and inherited protein S deficiency who underwent a living-donor renal transplant. To minimize thrombotic risk and sickle cell complications, both plasma exchange and red blood cell (RBC) exchange transfusion were performed pre-operatively.
Plasma exchange was utilized to increase protein S levels and to reduce the risk of post-operative venous thromboembolism, including allograft thrombosis, while RBC exchange was performed to reduce the risk of acute post-operative sickle cell disease complications.
With the use of combined pre-operative plasma exchange and RBC exchange transfusion, this patient with protein S deficiency and Hb SC underwent a successful renal transplant without acute sickle cell complications or thrombotic complications.
This case demonstrates the potential use of pre-operative plasma exchange in patients with protein S deficiency undergoing high thrombotic risk procedures.
Children enter kindergarten with a variety of experiences and skills. In this transition to formal school, they are expected to adapt quickly to new demands such as remembering specific pieces of ...information, knowing when to retrieve this information, and understanding how to use this information to complete specific tasks. These skills have been referred to as children’s deliberate memory skills and are thought to serve children’s long term academic success. However, limited research has focused on specific aspects of children’s everyday contexts that play a role in the development of these skills – such as adult-to-child language exchanges in home and school settings. Therefore, the goals of the current study were to (a) understand the role of children’s every day, lived experiences such as parent–child reminiscing and teacher– child linguistic exchanges (i.e., cognitive processing language in classrooms) on the initial acquisition and sustained use of mnemonic strategies across the kindergarten and first-grade years, and (b) describe the interplay between individual-level factors – such as other components of children’s cognition – and these adult-to-child scaffolding practices on children’s memory development.Drawing on a sample of 79 children nested in 10 kindergarten classrooms, children’s deliberate memory skills were assessed at 6 timepoints from kindergarten entry to the end of first grade. Kindergarten teachers’ instruction was recorded using GoPro cameras during regular mathematics and language arts lessons; these recordings were subsequently coded for the prevalence use of cognitive processing language (Coffman et al., 2008; 2019). Parent–child dyads took part in a parent-child reminiscing task in which they were asked to reminisce about two recent events. Conversations were coded for parents’ elaborative reminiscing style (Reese et al., 1993; Langley et al., 2017). Finally, children’s executive function and self-regulation skills were assessed during the kindergarten year using the Dimensional Change Card Sort Task (Zelazo, 2006) and the Head Toes Knees Shoulders Task, (Ponitz et al., 2009; McClelland et al., 2014) respectively. Results from a series of growth curve models using a multilevel modeling framework revealed significant predictors of children’s deliberate memory skills at the start of kindergarten and at the end of first grade, as well as of the rate at which changes in these skills occurred as a function of home-, school-, and individual-level factors. First, although children of parents with high levels of elaborative reminiscing entered kindergarten with higher levels of deliberate memory skills, it was children who had parents who used lower levels of elaborative reminiscing who developed more rapidly over the course of the kindergarten and first grade years. Second, children who were exposed to teachers who used higher levels of cognitive processing language (CPL) in kindergarten developed strategic sorting skills more rapidly over the course of first grade and ended the year with higher levels of deliberate strategy use than their peers who were exposed to lower levels of cognitive processing language. Finally, for children with lower self-regulation skills, those exposed to higher levels of CPL in kindergarten evidenced higher levels of deliberate strategy use at the end of first grade than their peers who were exposed to lower levels of CPL. Taken together, these findings provide insight to the role of parent-child and teacher-child processes on the development of children’s deliberate memory skills during the first two years of elementary school. Strengths, limitations, and future directions for researchers and educators are discussed.
•Specialist nurses identified the need for greater definition and delineation of specialist and advanced practice nurse roles.•Non-standardised nomenclature and pay, and poorly defined career ...pathways, were perceived as barriers to succession planning.•Specialist gynae-oncology nurses suggested guidelines for practice could assist standardisation and regulation of practice.
Over recent years there has been a proliferation in specialist nurse roles that require expertise and advanced practice in a particular field of nursing. In Australia and New Zealand, specialist nursing care of women with gynaecological cancers is recommended, however the role remains largely undefined and unregulated.
To determine Australian and New Zealand gynaecological oncology specialist nurses’ perspectives on the future of their role, and make recommendations for future practice and education.
An interpretive descriptive methodology was adopted for this study. Gynaecological oncology specialist nurses participated in individual and focus group interviews and a thematic analysis of transcribed data was conducted.
Nineteen specialist nurses participated in the study and three major themes were derived from the interview data: The first theme, ‘Delineation of roles’ highlighted the challenges for specialist nurses inherent in new, poorly defined roles. ‘Identifiable career path’ explored the lack of clear education and career pathways and disparate nomenclature for their roles, which they believed impeded succession planning. The theme, ‘What should I be doing’, related to the bespoke development of participants’ current roles due to the paucity of formal guidelines for practice.
Gynaecological oncology specialist nurse roles have emerged and developed with limited direction from the nursing profession. Poor role legitimacy and a weak professional identity were evident among participants.
Gynaecological oncology specialist nurses identified standardised nomenclature, defined career and education pathways, guidelines for practice, and succession planning as important elements in the progression of their roles.
In animals, the early-life environment influences growth and development, which can have lasting effects on life history and fitness into adulthood. We investigated the patterns of growth, pupal ...development time, and their covariation in Protopiophila litigata Bonduriansky (Diptera: Piophilidae) larvae of both sexes collected from three discarded moose (Alces alces (Linnaeus) (Artiodactyla: Cervidae)) antlers of varying size, chewing damage (used to infer relative age), and
P. litigata density. Males tended to be smaller and their pupation lasted longer than females. One of the antlers was highly attractive to adult P. litigata, whereas the other two attracted few or none. Individuals from one antler of low attractiveness were smaller and took longer to eclose than individuals from either other antler, perhaps due to its high larval density. The relationship between body size and pupal development time also differed among antlers, being positively correlated in the most attractive antler and negatively correlated in the two other antlers.
In the present study, stainless steel 316 L (SS316L) and stainless steel 316 infiltrated with bronze (SS316 +bronze) samples fabricated with binder jet additive manufacturing were characterized ...through ultrasonic testing, optical microscopy, and mechanical testing. Attenuation and wave speed values obtained from ultrasonic testing were connected to grain size and porosity, where attenuation was positively correlated, and wave speed was inversely correlated, with porosity. Wave speed also increased as grain size increased. The SS316L sample contained interconnected pores and larger grains near the center of the sample compared to isolated pores and smaller grains near the surfaces, leading to competing influences in the measured wave speed. Uniaxial tension testing of specimens machined from the SS316L and SS316 +bronze blocks showed lower tensile strength and ductility with increased porosity and grain size, which were indicated by the ultrasonic signals. Tensile strength and ductility were inversely correlated to attenuation and standard deviation of wave speed. This study provides a demonstration of the use of ultrasonic testing to detect relative microstructural and mechanical property variances in binder jetted metal alloys.
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Prilocaine plain has a high pH and concentration (4%), which could decrease the pain of injection and increase success. The purpose of this study was to compare pain associated with anesthetic ...solution deposition and the degree of pulpal anesthesia obtained with the combination of prilocaine and lidocaine versus a lidocaine and lidocaine combination when used for inferior alveolar nerve blocks (IANBs).
One hundred eighteen asymptomatic subjects were randomly given a combination of 1 cartridge of 4% prilocaine plain plus 1 cartridge of 2% lidocaine with 1:100,000 epinephrine or a combination of 2 cartridges of 2% lidocaine with 1:100,000 epinephrine for the IANB at 2 separate appointments. Subjects rated the pain associated with anesthetic solution deposition of injection. Mandibular teeth were tested with an electric pulp tester every 4 minutes for 57 minutes. Anesthesia was considered successful when 2 consecutive 80 readings were obtained within 17 minutes and the 80 reading was continuously sustained for 57 minutes. Comparisons for anesthetic success were analyzed using the exact McNemar test, and pain ratings associated with anesthetic solution deposition were analyzed using multiple Wilcoxon matched pairs signed rank tests; both were adjusted using the step-down Bonferroni method of Holm.
Four percent prilocaine plain was significantly less painful upon anesthetic solution deposition. Pulpal anesthetic success was not significantly different between the 2 combinations.
The combination of 4% prilocaine plain plus 2% lidocaine with 1:100,000 epinephrine did not increase pulpal anesthetic success for IANBs compared with a combination of 2 cartridges of 2% lidocaine with 1:100,000 epinephrine. Pain associated with anesthetic solution deposition from the first cartridge of 4% prilocaine plain was significantly less when compared with the first cartridge of 2% lidocaine with 1:100,000 epinephrine.
Stereotactic ablative body radiotherapy (SABR) is a novel non-invasive alternative for patients with primary renal cell cancer who do not undergo surgical resection. The FASTRACK II clinical trial ...investigated the efficacy of SABR for primary renal cell cancer in a phase 2 trial.
This international, non-randomised, phase 2 study was conducted in seven centres in Australia and one centre in the Netherlands. Eligible patients aged 18 years or older had biopsy-confirmed diagnosis of primary renal cell cancer, with only a single lesion; were medically inoperable, were at high risk of complications from surgery, or declined surgery; and had an Eastern Cooperative Oncology Group performance status of 0–2. A multidisciplinary decision that active treatment was warranted was required. Key exclusion criteria were a pre-treatment estimated glomerular filtration rate of less than 30 mL/min per 1·73 m2, previous systemic therapies for renal cell cancer, previous high-dose radiotherapy to an overlapping region, tumours larger than 10 cm, and direct contact of the renal cell cancer with the bowel. Patients received either a single fraction SABR of 26 Gy for tumours 4 cm or less in maximum diameter, or 42 Gy in three fractions for tumours more than 4 cm to 10 cm in maximum diameter. The primary endpoint was local control, defined as no progression of the primary renal cell cancer, as evaluated by the investigator per Response Evaluation Criteria in Solid Tumours (version 1.1). Assuming a 1-year local control of 90%, the null hypothesis of 80% or less was considered not to be worthy of proceeding to a future randomised controlled trial. All patients who commenced trial treatment were included in the primary outcome analysis. This trial is registered with ClinicalTrials.gov, NCT02613819, and has completed accrual.
Between July 28, 2016, and Feb 27, 2020, 70 patients were enrolled and initiated treatment. Median age was 77 years (IQR 70–82). Before enrolment, 49 (70%) of 70 patients had documented serial growth on initial surveillance imaging. 49 (70%) of 70 patients were male and 21 (30%) were female. Median tumour size was 4·6 cm (IQR 3·7–5·5). All patients enrolled had T1–T2a and N0–N1 disease. 23 patients received single-fraction SABR of 26 Gy and 47 received 42 Gy in three fractions. Median follow-up was 43 months (IQR 38–60). Local control at 12 months from treatment commencement was 100% (p<0·0001). Seven (10%) patients had grade 3 treatment-related adverse events, with no grade 4 adverse events observed. Grade 3 treatment-related adverse events were nausea and vomiting (three 4% patients), abdominal, flank, or tumour pain (four 6%), colonic obstruction (two 3%), and diarrhoea (one 1%). No treatment-related or cancer-related deaths occurred.
To our knowledge, this is the first multicentre prospective clinical trial of non-surgical definitive therapy in patients with primary renal cell cancer. In a cohort with predominantly T1b or larger disease, SABR was an effective treatment strategy with no observed local failures or cancer-related deaths. We observed an acceptable side-effect profile and renal function after SABR. These outcomes support the design of a future randomised trial of SABR versus surgery for primary renal cell cancer.
Cancer Australia Priority-driven Collaborative Cancer Research Scheme.
Introduction: Research suggests that clinical supervision (CS) has multiple benefits for supervisees' professional and personal lives. However, it remains a novel approach in nursing practice.
Aim: ...This study aims to explore specialist and advanced cancer nurses' engagement with CS.
Method: A mixed methods design was employed including a cross-sectional survey and qualitative interviews.
Results: Of the 80 survey and 25 interview participants, 25% and 20% respectively were engaged in CS. Participants engaged in CS reported more personal accomplishment, less depersonalisation, and higher job satisfaction. Most were satisfied with their CS arrangement.
Practice implications: CS may be an effective way for employers to support nurses employed in specialist and advanced practice cancer roles.
Conclusion: A low proportion of advanced practice cancer nurses were engaged in CS. Further interventional research engaging larger numbers of nurses in CS is recommended to identify the most effective forms of CS and constraints to workplace implementation.
Patients and health systems rely on a skilled and available cancer nursing workforce to deliver quality nursing care to optimise cancer outcomes. Understanding the education, qualifications, and ...roles of cancer nurses across Australia is an essential aspect of effective service planning.
To explore the associations between the geographical location of cancer nurses and their education, qualifications, roles, activities, and scope of practice.
A cross-sectional electronic survey was distributed through the Cancer Nurses Society Australia membership and social media platforms from October 2021 to February 2022. The self-report survey captured demographics, education, qualifications, roles, scope of practice, and salary. Descriptive statistics and bivariate analysis were used to summarise and report the findings.
Responses were received from 930 nurses. Most identified as female (94%), lived in metropolitan areas (69%), worked in dedicated cancer centres (79%), and in the public sector (69%). While 80% had more than 10 years of nursing experience and 70% possessed postgraduate qualifications, 58% indicated their intention to remain in the profession for 10 years or less. Roles, pay, education, and activities varied across regions, states, and territories, with regional nurses more likely to be involved in multiple activities and roles compared with their metropolitan counterparts.
This study highlights the importance of understanding geographic variations within the cancer nursing workforce to formulate strategies aimed at enhancing workforce sustainability and, consequently, patient outcomes. Addressing disparities in education and opportunities for career advancement is crucial to ensuring equitable access to quality cancer care nationwide.
Abstract The fingernail hyponychium is an isolated area where biological material may accumulate and can provide a valuable source of evidential material in police investigations. DNA transfer ...between the victim and suspect frequently occurs during violent crimes and in court there is often reasonable doubt that a mixed DNA profile in a fingernail sample has originated from the assault as the profile may be attributed to previous contact between the two individuals. The purpose of this study was to assess background levels of foreign DNA under the fingernails of individuals from the general population in order to provide data that may help to determine whether DNA transfer occurred during or prior to the assault. Fingernail swabs sampled from 100 volunteers were processed by Qiagen™ extraction and amplified using AMP Fl STR® SGM Plus™ to obtain DNA profiles. Foreign DNA was detected in 13% of samples, with only 6% of these giving reportable mixed DNA profiles, suggesting the incidence of foreign DNA under the fingernails was low. A significant proportion of the mixed DNA profiles came from male donors; the majority had experienced physical contact within the 24 h time period prior to sampling.
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