Marrow fibrosis (MF) has rarely been considered in therapy studies on chronic myeloid leukemia (CML), and there is a lack of long-term observations on the basis of sequential bone marrow biopsies ...(BMBs) taken prospectively during the course of disease. A total of 848 BMBs from 400 patients with Ph(+) CML recruited in the German randomized CML study I were examined for MF before and during therapy. In total, 110 patients had been randomized to receive interferon (IFN)-alpha, and 290 to receive chemotherapy (hydroxyurea (HU): 154, busulfan: 136). During IFN-alpha and HU medication, MF was reduced or did not increase for about 2 years. Evolving or progressive MF was an independent and early predictor of therapy failure about 2 years earlier than indicated by changes in the peripheral blood, spleen size, marrow blast count and cytogenetics (P<0.00005), resulting in a significant shortening of the survival times of patients independent of the type of therapy applied including allografting (multivariate analyses; P<0.00005). The analyzed long-term observations strongly indicate that MF is an independent poor prognostic complication of CML, allowing an early prediction of therapy failure. Consideration of the fiber content in marrow may therefore significantly improve the prediction of therapy efficacy and outcome of disease.
Since the advent of the teaching nursing home, made formal in the 1980s, long-term care has been used to teach geriatric medicine. Despite this, national surveys have indicated a need for more ...training during residency to facilitate the appropriate care for the frail long-term care patient population. In addition to medical knowledge, the long-term care site is appropriate for teaching the Accreditation Council of Graduate Medical Education's core competencies of "practice-based learning and improvement," "interpersonal and communication skills," and "systems-based practice." Program planners should emphasize opportunities for students to demonstrate their skill in one of these competencies.
Difficult behaviors are relatively common challenges that can occur throughout the natural progression of dementia, but are particularly common in the mid to late stages of disease. These behaviors ...can be challenging to manage in nursing and assisted care facilities, and can cause distress to the caregivers and to the patients themselves. Our ability to manage these symptoms can have a profound effect on the patient's quality of life. This article reviews the appropriate assessment of behavioral and psychological symptoms of dementia (BPSD) and the literature supporting various nonpharmacologic and pharmacologic treatments. Nonpharmacologic approaches should be the initial focus for treatment of most BPSD, but should these prove inadequate, a variety of medications are available with varying degrees of clinical research to support their use in ameliorating BPSD.
Geriatrician and nongeriatrician faculty need instruction as teachers to provide quality training for a broader community of physicians who can care for the expanding population of older adults. ...Educators at Duke University designed a program to equip geriatrician and nongeriatrician faculty to develop quality educational programs and teach medical learners about geriatrics. Eighty‐three faculty representing 52 institutions from across the United States participated in mini‐fellowship programs (2005–09) consisting of workshops and 1‐year follow‐up mentoring by Duke faculty. Participants attended 1‐week on‐campus sessions on curriculum development and teaching skills and designed and implemented a curriculum in their home institution. Participant specialties included general medicine (nearly 50%), family medicine, surgery, psychiatry, rehabilitation medicine, and emergency medicine. Pre‐ and postprogram self‐efficacy surveys, program evaluation surveys, and 6‐ and 12‐month progress reports on scholars' educational projects were used to assess the effect of the Duke mini‐fellowship programs on participants' educational practices. Forty‐four scholars (56%) completed the end‐of‐year self‐efficacy survey and end‐of‐program evaluation. Self‐efficacy results indicated significant gains (P < .001) in 12 items assessed at 1 week and 1 year. Scholars reported the largest average gains at 1 year in applying adult learning principles in the design of educational programs (1.72), writing measurable learning objectives (1.51), and identifying optimal instructional methods to deliver learning objectives (1.50). Participants described improved knowledge and skills in designing curricula, implemented new and revised geriatrics curricula, and demonstrated commitment to faculty development and improving learning experiences for medical learners. This faculty development program improved participants' self‐efficacy in curriculum design and teaching and enhanced geriatrics education in their home institutions.
The photon-ion spectrometer PIPE is currently being installed as a permanent end station at beamline P04 of the PETRA III synchrotron radiation source. Various state-of-the-art experimental ...techniques will be available for studies of gaseous matter with circularly and linearly polarized synchrotron radiation with photon energies in range the 100–3000 eV.
A photon-ion merged beam endstation has been set up at the variable polarization XUV-beamline P04 of PETRA III in Hamburg. In a commissioning experiment first results could be obtained for multiple ...photoionization of Xeq+ ions (q = 1,2,..,5) at photon energies around the 3d ionization threshold.
The authors developed a Transitions of Care (TOC) curriculum to teach and measure learner competence in performing TOC tasks for older adults. Internal medicine interns at an academic residency ...program received the curriculum, which consisted of experiential learning, self-study, and small group discussion. Interns completed retrospective pre/post surveys rating their confidence in performing five TOC tasks, qualitative open-ended survey questions, and a self-reflection essay. A subset of interns also completed follow-up assessments. For all five TOC tasks, the interns' confidence improved following completion of the TOC curriculum. Self-confidence persisted for up to 3 months later for some but not all tasks. According to the qualitative responses, the TOC curriculum provided interns with learning experiences and skills integral to performing safe care transitions. The TOC curriculum and a mixed-method assessment approach effectively teaches and measures learner competency in TOC across all six Accreditation Council for Graduate Medical Education competency domains.
The left-right asymmetry parameters of Kr 4p photoelectrons were investigated experimentally in the photon energy range of the 3d−1 → np resonant excitations. An interference effect was observed ...between an unknown photoionization channel and the resonant excitation participator Auger decay processes.
The angular distribution of Kr 4p photoelectrons was investigated experimentally in the photon energy range of the 3d−1 → np resonant excitations. The experimental dipole and non-dipole anisotropy ...parameters were determined for the spin-orbit components of the Kr 4p shell. An interference effect was observed between the direct photoionization and the resonant excitation participator Auger decay processes in the photon energy dependence of the experimental anisotropy parameters.
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