The nineteenth-century California-based photographer Carleton Watkins took thousands of photographs during his career, but only one known self-portrait. It was unusual, not only to his oeuvre but ...because he represented himself as an old-fashioned placer miner, complete with the appropriate tools for extracting value from the land. This dissertation analyzes Watkins’ self-presentation as a purposeful visual statement connecting his work, and western landscape photography in general, with the figure of the mythic gold rush miner, narrowly imagined by the general public as male, white, and independent. Using a close reading methodology for analyzing diverse primary source materials, including Watkins’ rarely-studied portrait photographs, as well as his mining commissions and canonical Yosemite images, I describe the physical and discursive similarities between miner and photographer that enabled Watkins to fashion his camera as an extractive tool and his profession as representative of a particular American ideal emphasizing self-reliance, whiteness, and masculinity. Watkins’ authority with his wide audience came not only through his reputation as an authentic western type, but also through his relationship with California’s flourishing mining industry, which hired him to create the first photograph that was used as evidence in an American courtroom for the 1858 case, U.S. v. Fossat. As a new technology, photography had not yet been established in the minds of Americans as a trusted medium for truth. When the judge in this case, with the full authority of the United States’ justice system, accepted Watkins’ image as worthy of his domain, he offered powerful assurance that Watkins’ photography was a vision of unmediated reality superior to witness testimony, Mexican diseños, and U.S. survey maps.As Watkins’ racialized and gendered images earned evidentiary status, so-called experts on American land began incorporating his photographs to support their own ideas in the debates embroiling their burgeoning fields concerning men’s proper relationship to religion, nature, and each other. Among these experts, geologist Josiah Dwight Whitney, landscape architect Frederick Law Olmsted, and naturalist Louis Agassiz were introduced to Watkins by others within their shared insular community of opinionmakers and through the mining industry, which financially influenced their efforts to assert their vision about topics that would have been out of bounds for them by our contemporary standards. Their veneer of scientific neutrality gave cover to conclusions justifying their own superiority as representatives of idealized white masculinity. They chose particular photographs to assert a sense of control over feminized subjects, both people and land. This work led to the justification of the continued violent erasure and mistreatment of Black, Chinese, indigenous, and Mexican populations throughout the United States and the privileging of a relationship with the environment premised on maintaining the visual qualities of specific sites over other experiences that could be had there. Watkins and his patrons left their mark on the nation, most visibly in their names ascribed to the landmarks they helped delineate on California’s maps while erasing the indigenous naming systems already in place. From Mount Watkins in Yosemite, I follow a map of the Sierra Nevada to interrogate the ideologies represented by the towering heights of Mount Whitney, the breathtaking views from Olmsted Point, and the unyielding Agassiz Column, enabled in part by Watkins’ troubling-limited mining sight.
Abstract
Objective
Paediatric vision screening programs identify children with ocular abnormalities who would benefit from treatment by an eye care professional. A questionnaire was conducted to ...assess existence and uptake of school-based vision screening programs across Canada. A supplementary questionnaire was distributed among Ontario’s public health units to determine implementation of government mandated vision screening for senior kindergarten children.
Methods
Chief Medical Officers of Health for each province and territory, and Ontario’s thirty-four public health units were sent a questionnaire to determine: 1) whether school-based vision screening is being implemented; 2) what age groups are screened; 3) personnel used for vision screening; 4) the type of training provided for vision screening personnel; and 5) vision screening tests performed.
Results
Of the thirteen provinces/territories in Canada, six perform some form of school-based vision screening. Two provinces rely solely on non-school-based programs offering eligible children an eye examination by an optometrist and three rely on ocular assessment conducted by a nurse at well-child visits. In Ontario, where since 2018 vision screening for all senior kindergarten students is government mandated, only seventeen public health jurisdictions are implementing universal vision screening programs using a variety of personnel ranging from food safety workers to optometrists.
Conclusion
Good vision is key to physical and emotional development. There is an urgent need for a universal, evidence-based and cost-effective multidisciplinary approach to standardize paediatric vision screening across Canada and break down barriers preventing children from accessing eye care.
Video Abstract
10.1093/pch/pxab036_video1
Video Abstract
pxab036_media1
6282266463001
Young people are a relatively underrepresented group in literature on poor vision and blindness. This study assessed the quality of life and function of young people who have poor vision or blindness ...by asking directly about their personal experiences.
A modified version of the VFQ-25 was administered to 47 students at a school for blind youth. All students who received the test had visual acuity scores of 20/100 or worse. The VFQ-25 scoring system was used, and results from additional qualitative questions were themed and ranked. Further analysis was performed, using Spearman's rank correlation coefficient to check for correlation between duration of blindness and VFQ score.
Participants recorded a composite VFQ score of 65, showing that poor vision had a self-perceived moderate effect on their daily function. Proportion of participant's life spent with visual impairment correlated with higher composite scores. In general, lower scores were reported by participants with worse visual acuity. However, variations were observed in the mental health category.
Young people have a more optimistic and nuanced view of their function than expected based on VFQ scores of other groups. Larger studies, particularly ones including youth in non-specialized schools would be useful to expand these findings.
Les jeunes sont relativement sous-représentés dans les articles portant sur la basse vision et la cécité. La présente étude visait à évaluer la qualité de vie et l’état fonctionnel de sujets jeunes présentant une basse vision ou une cécité en les interrogeant directement sur leur expérience personnelle.
On a fait passer une version modifiée du questionnaire VFQ-25 à 47 étudiants qui fréquentaient une école pour jeunes aveugles. L'acuité visuelle de tous les répondants était de 20/100 ou pire. Le système de gradation du questionnaire VFQ-25 a été utilisé, et les réponses aux questions qualitatives supplémentaires ont été regroupées par thème et classées. On a procédé à une analyse plus approfondie en recourant au coefficient de corrélation des rangs de Spearman afin de vérifier s'il existe une corrélation entre l'ancienneté de la cécité et le score VFQ.
Les participants ont obtenu un score VFQ composite de 65, ce qui permet de conclure que la basse vision avait un effet modéré sur la façon dont ils percevaient leur fonctionnement quotidien. On note une corrélation entre l'ancienneté du trouble visuel et l'obtention de scores composites plus élevés. En règle générale, les participants qui présentaient la pire acuité visuelle ont obtenu des scores plus faibles. Cela dit, des variations ont été observées au chapitre de la santé mentale.
Les jeunes ont une perception plus optimiste et nuancée de leur état fonctionnel que ce à quoi on se serait attendu compte tenu des scores VFQ obtenus chez d'autres groupes. Des études de plus grande envergure, notamment auprès de jeunes qui fréquentent des écoles non spécialisées, permettraient d'accroître nos connaissances à cet égard.
The development of antibiotic resistance is a growing public health concern. Antibiotic stewardship programs (ASPs) employ strategies to improve antibiotic prescribing practices. The purpose of this ...quality improvement project was to pilot an ASP with a focus on the management of sinusitis and pharyngitis. Antibiotic prescribing practices were evaluated before and after the implementation of the pilot ASP. The primary aim of this project was to improve the concordance of antibiotic prescribing practices with clinical practice guidelines. Although not statistically significant, it was noted that there was an improvement in adherence to clinical practice guidelines after the pilot ASP was implemented.
•Inappropriate prescription of antibiotics is associated with the development of antibiotic resistance, adverse patient outcomes, and increased health care costs.•The Centers for Disease Control and Prevention recommends that all outpatient health care settings focus on improving antibiotic stewardship.•Antibiotic stewardship includes efforts to measure antibiotic prescribing and increase antibiotic prescription concordance with current clinical practice guidelines.•The implementation of antibiotic stewardship initiatives were associated with improved prescribing practices for acute sinusitis and pharyngitis in adult patients.
The aim of this study was to assess the potential of using video screening to interpret the results of paediatric eye examinations.
Prospective multi-centred, blinded study.
Children aged 5 months to ...11 years referred to a paediatric ophthalmology centre were enrolled in the study. Outcome measures included the degree of agreement between examiners for assessment of various aspects of paediatric eye examination. In Phase 1, children were individually assessed in the clinic by three different examiners to determine the level of agreement. In Phase 2 a video recording was made of the first ophthalmologist examining the children. The other two examiners viewed the video recordings to make their diagnoses. Areas of assessment included lid function, pupillary function, ocular motility, strabismus, nystagmus, torticollis and facial asymmetry. Agreement between examiners was measured using Gwet's agreement coefficient (AC1).
A total of 27 patients in Phase 1 (mean age 4.0 years) and 160 children in Phase 2 (mean age 4.8 years) underwent clinical and video-recorded screening. In Phase 1, all but one area of ocular examination (heterotropia) achieved ≥84% agreement between three examiners. In Phase 2, there was greater variation between direct clinical examination and interpretation of video findings, ranging from 55-100% agreement.
Using experienced clinicians and changing only one variable in Phase 2 (the method of assessment - direct examination versus video interpretation), the results show the possible usefulness of video-recorded screening as a means of assessing children. Further research is indicated to assess the accuracy of ophthalmologists interpreting video recordings of eye examinations performed by trained non-eye-care professionals.
Chronic, non-cancer pain affects approximately 20-30% of the population in North America, Europe, and Australia, with surgery and trauma frequently cited as inciting events. Prospective studies of ...fracture patients have demonstrated an association between somatic pre-occupation, poor coping, and low recovery expectations following surgery with persistent pain, functional limitations, and lower rates of return to work. Psychological interventions, such as cognitive behavioural therapy (CBT), that are designed to modify unhelpful beliefs and behaviours have the potential to reduce persistent post-surgical pain and its associated effects among trauma patients.
To determine whether online CBT, versus usual care, reduces the prevalence of moderate to severe persistent post-surgical pain among participants with an open or closed fracture of the appendicular skeleton.
The Cognitive Behavioural Therapy to Optimize Post-Operative Fracture Recovery (COPE) protocol will be followed to conduct a multi-centre randomized controlled trial. Participants undergoing surgical repair of a long bone fracture will be randomized to receive either (1) online CBT modules with asynchronous therapist feedback or (2) usual care. The primary outcome will be the prevalence of moderate to severe persistent post-surgical pain over 12 months post-fracture. Secondary outcomes include the Short Form-36 Physical and Mental Component Summary scores, return to function, pain severity and pain interference over 12 months post-fracture, and the proportion of patients prescribed opioid class medications (and average dose) at 6 and 12 months post-fracture. The COPE trial will enroll 1000 participants with open and closed fractures of the appendicular skeleton from approximately 10 hospitals in North America.
If CBT is effective in improving outcomes among patients with traumatic fractures, our findings will promote a new model of care that incorporates psychological barriers to recovery.
ClinicalTrials.gov Identifier: NCT04274530. Registered on 14 February 2020.
Extremity fractures are common, and most are managed operatively; however, despite successful reduction, up to half of patients report persistent post-surgical pain. Furthermore, psychological ...factors such as stress, distress, anxiety, depression, catastrophizing, and fear-avoidance behaviors have been associated with the development of chronic pain. The purpose of this pilot study was to examine the feasibility of a randomized controlled trial to determine the effect of in-person cognitive behavioral therapy (CBT) vs. usual care on persistent post-surgical pain among patients with a surgically managed extremity fracture.
Eligible patients were randomized to either in-person CBT or usual care. We used four criteria to judge the composite measure of feasibility: 1) successful implementation of CBT at each clinical site, 2) 40 patients recruited within 6 months, 3) treatment compliance in a minimum 36 of 40 participants (90%), and 4) 32 of 40 participants (80%) achieving follow-up at one year. The primary clinical outcome was persistent post-surgical pain at one year after surgery.
Only two of the four participating sites were able to implement the CBT regimen due to difficulties with identifying certified therapists who had the capacity to accommodate additional patients into their schedule within the required timeframe (i.e., 8 weeks of their fracture). Given the challenges associated with CBT implementation, only one site was able to actively recruit patients. This site screened 86 patients and enrolled 3 patients (3.5%) over a period of three months. Participants were unable to comply with the in-person CBT, with no participants attending an in-person CBT session. Follow-up at one year could not be assessed as the pilot study was stopped early, three months into the study, due to failure to achieve the other three feasibility criteria.
Our pilot trial failed to demonstrate the feasibility of a trial of in-person CBT versus usual care to prevent persistent pain after surgical repair of traumatic long-bone fractures and re-enforces the importance of establishing feasibility before embarking on definitive trials. Protocol modifications to address the identified barriers include the delivery of our intervention as a therapist-guided, remote CBT program.
ClinicalTrials.gov (Identifier NCT03196258); Registered June 22, 2017, https://clinicaltrials.gov/ct2/show/NCT03196258.
Poor response to cancer therapy due to resistance remains a clinical challenge. The present study establishes a widely prevalent mechanism of resistance to gemcitabine in pancreatic cancer, whereby ...increased glycolytic flux leads to glucose addiction in cancer cells and a corresponding increase in pyrimidine biosynthesis to enhance the intrinsic levels of deoxycytidine triphosphate (dCTP). Increased levels of dCTP diminish the effective levels of gemcitabine through molecular competition. We also demonstrate that MUC1-regulated stabilization of hypoxia inducible factor-1α (HIF-1α) mediates such metabolic reprogramming. Targeting HIF-1α or de novo pyrimidine biosynthesis, in combination with gemcitabine, strongly diminishes tumor burden. Finally, reduced expression of TKT and CTPS, which regulate flux into pyrimidine biosynthesis, correlates with better prognosis in pancreatic cancer patients on fluoropyrimidine analogs.
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•Gemcitabine resistance is associated with increased glucose uptake in PDAC•HIF-1α upregulates non-oxidative PPP and pyrimidine biosynthesis•HIF-1α is stabilized by MUC1 in gemcitabine-resistant tumors•Targeting HIF-1α or metabolic pathways can sensitize PDAC tumors to gemcitabine
Shukla et al. identify that HIF-1α mediates increased glycolytic flux and de novo pyrimidine biosynthesis, leading to gemcitabine resistance in pancreatic cancer cells. Targeting HIF-1α or de novo pyrimidine biosynthesis increases the efficacy of gemcitabine.
Abstract
We present 2241 exoplanet candidates identified with data from the Transiting Exoplanet Survey Satellite (TESS) during its 2 yr Prime Mission. We list these candidates in the TESS Objects of ...Interest (TOI) Catalog, which includes both new planet candidates found by TESS and previously known planets recovered by TESS observations. We describe the process used to identify TOIs, investigate the characteristics of the new planet candidates, and discuss some notable TESS planet discoveries. The TOI catalog includes an unprecedented number of small planet candidates around nearby bright stars, which are well suited for detailed follow-up observations. The TESS data products for the Prime Mission (sectors 1–26), including the TOI catalog, light curves, full-frame images, and target pixel files, are publicly available at the Mikulski Archive for Space Telescopes.
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