This article offers methodological insights and tools to those engaged in design-based research (DBR) seeking to advance equity-oriented learning and outcomes through co-design. We respond to recent ...scholarship that points to the inseparability between the assumptions we hold about society and those we hold about learning, and consider how such insights can inform the methods we employ to facilitate learning in DBR. To do so, we examine the affordances of equity conjectures, statements about how learning remedies socially and historically constructed injustices, within conjecture mapping, a process frequently used in DBR efforts to make assumptions about learning visible to ground design, implementation, and iterative refinement. We share how we made participants' equity conjectures visible in a research-practice partnership (RPP) between university researchers, elementary computer science (CS) curriculum designers, and elementary school teachers. We examine how making these equity conjectures visible during co-design of equity-focused CS lessons facilitated shifts in both the design process and the CS education practices of participating teachers. Our findings point to the utility of explicitly surfacing equity conjectures in collaborative design efforts aimed at equity and justice.
Purpose
To determine whether the benefits of sentinel-node-based management (SNBM) over routine axillary clearance (RAC) persisted to 5 years.
Methods
A total of 1088 women with breast cancer less ...than 3 cm in diameter and clinically negative axillary nodes were randomized to SNBM with axillary clearance if the sentinel node was positive or RAC preceded by sentinel-node biopsy. The outcomes were: (1) objectively measured change in the volume of the operated and contralateral nonoperated arms; (2) the proportion with an increase in arm volume <15%; and (3) subjectively assessed arm morbidity for the domains swelling, symptoms, dysfunction, and disability. Assessments were performed at 1 and 6 months after surgery and then annually.
Results
Limb volume increased progressively in the operated and nonoperated arms for 2 years and persisted unchanged to year 5, accompanied by weight gain. Correction by change in the nonoperated arm showed a mean volume increase of 70 mL in the RAC group and 26 mL in the SNBM group (
P
< 0.001) at 5 years. Only 28 patients (3.3%) had a corrected increase >15% from baseline (RAC 5.0% vs. SNBM 1.7%). Significant predictors were surgery type (RAC vs. SNBM), obesity, diabetes, palpable tumor, and weight gain exceeding 10% of baseline value.
Conclusions
Subjective assessments revealed persisting patient concerns about swelling and symptoms but not overall disability at 5 years. Subjective scores were only moderately correlated with volume increase. SNAC1 has demonstrated that objective morbidity and subjective morbidity persist for 5 years after surgery and that SNBM significantly lowers the risk of both.
High cardiorespiratory fitness (CRF) is associated with decreased mortality in people with pre-diabetes (pre-DM) and diabetes mellitus (DM); however, the degree to which CRF attenuates the risk of ...cardiovascular disease (CVD)-related and all-cause mortality is unclear.
We examined the impact of CRF status on CVD-related morbidity and all-cause mortality in non-DM, Pre-DM, and DM populations.
13,968 adults from the Third US National Health and Nutrition Examination Survey (NHANES III) were stratified into non-DM, pre-DM, or DM groups based on HbA1c levels. VO2Max was calculated using the Fitness Registry and Importance of Exercise: A National Database (FRIEND) equation.
Participants were categorized into tertiles of VO2Max; first VO2Max tertile was the lowest VO2Max and third VO2Max tertile was the highest.
Cox regression was used to analyze the relationship between glycemic levels, VO2Max, and CVD-related and all-cause mortality.
Those with DM in the highest fitness tertile had CVD (HR 0.13; 95 % CI 0.06, 0.27; p < 0.0001) and all cause (HR 0.28; 95 % CI 0.21, 0.38; p < 0.0001) mortality rates as low or lower than those with pre-DM (CVD HR 1.02; 95 % CI 0.78, 1.33 p < 0.892; all cause HR 0.96; 95 % CI 0.83, 1.12; p < 0.5496) or non-DM (CVD HR 0.65; 95 % CI 0.52, 0.80; p < 0.0001; all cause HR 0.61; 95 % CI 0.55, 0.68; p < 0.0001) at lower fitness levels. Regardless of DM status, there was lower all-cause mortality with higher CRF levels.
Higher fitness levels in DM individuals are associated with total and CVD mortality rates as low or lower than those without DM with lower fitness.
•French Polynesia is a biodiversity hotspot for Gambierdiscus species.•Gambierdiscus polynesiensis is the main source of ciguatoxins in French Polynesia.•Herbivores and omnivores can be as toxic as ...carnivores in French Polynesia.•French Polynesia has a long-term epidemiological surveillance program on CP.•Cultural ramifications of CP have strong implications for risk management strategies.
Ciguatera Poisoning (CP) is a seafood poisoning highly prevalent in French Polynesia. This illness results from the consumption of seafood contaminated with ciguatoxins (CTXs) produced by Gambierdiscus, a benthic dinoflagellate. Ciguatera significantly degrades the health and economic well-being of local communities largely dependent on reef fisheries for their subsistence. French Polynesia has been the site of rich and active CP research since the 1960′s. The environmental, toxicological, and epidemiological data obtained in the frame of large-scale field surveys and a country-wide CP case reporting program conducted over the past three decades in the five island groups of French Polynesia are reviewed. Results show toxin production in Gambierdiscus in the natural environment may vary considerably at a temporal and spatial scale, and that several locales clearly represent Gambierdiscus spp. “biodiversity hotspots”. Current data also suggest the “hot” species G. polynesiensis could be the primary source of CTXs in local ciguateric biotopes, pending formal confirmation. The prevalence of ciguatoxic fish and the CTX levels observed in several locales were remarkably high, with herbivores and omnivores often as toxic as carnivores. Results also confirm the strong local influence of Gambierdiscus spp. on the CTX toxin profiles characterized across multiple food web components including in CP-prone marine invertebrates. The statistics, obtained in the frame of a long-term epidemiological surveillance program established in 2007, point towards an apparent decline in the number of CP cases in French Polynesia as a whole; however, incidence rates remain dangerously high in some islands. Several of the challenges and opportunities, most notably those linked to the strong cultural ramifications of CP among local communities, that need to be considered to define effective risk management strategies are addressed.
Summary
Background
Anti‐tumour necrosis factor (TNF) therapy is used for treatment of ulcerative colitis (UC). As approximately 30% of patients with UC do not benefit from the treatment, it is of ...clinical interest to identify biomarkers of response before therapy is initiated.
Aim
To identify prognostic biomarkers of anti‐TNF therapy response in anti‐TNF therapy‐naïve patients with UC.
Methods
Peripheral blood cells were obtained from 56 patients with UC before therapy started. Thirty‐four patients were included in an exploratory cohort and 22 patients in a validation cohort. Blood cells were stimulated in vitro with influenza vaccine with and without anti‐TNF. T‐cell surface receptor expression and cytokine release were determined (in total 17 variables). Treatment response was evaluated using the Mayo score 12–14 weeks after the first infusion.
Results
In the exploratory cohort, blood cells from the patients showed stronger anti‐TNF‐dependent suppression of T‐cell surface receptor expression and cytokine secretion among therapy responders than nonresponders. In particular, anti‐TNF suppressed the expression of CD25 on T cells and secretion of interleukin 5, to a higher degree in responders than in nonresponders. These variables were used to a create model to predict therapy outcome, which was confirmed in the validation cohort. Correct classification of future therapy response was achieved in 91% of the cases in the validation cohort.
Conclusion
The effects of anti‐TNF on cultured blood T cells, obtained before therapy started, predict treatment outcome in patients with UC.
BACKGROUND In a retrospective study bile acid malabsorption was observed in patients with collagenous colitis. AIMS To study the occurrence of bile acid malabsorption and the effect of bile acid ...binders prospectively in patients with chronic diarrhoea and collagenous colitis. METHODS Over 36 months all patients referred because of chronic diarrhoea completed a diagnostic programme, including gastroscopy with duodenal biopsy, colonoscopy with biopsies, and the 75Se-homocholic acid taurine (75SeHCAT) test for bile acid malabsorption. Treatment with a bile acid binder (cholestyramine in 24, colestipol in three) was given, irrespective of the results of the 75SeHCAT test. RESULTS Collagenous colitis was found in 28 patients (six men, 22 women), 27 of whom had persistent symptoms and completed the programme. Four patients had had a previous cholecystectomy or a distal gastric resection. The 75SeHCAT test was abnormal in 12/27 (44%) of the collagenous colitis patients with 75SeHCAT values 0.5–9.7%, and normal in 15 patients (56%). Bile acid binding treatment was followed by a rapid, marked, or complete improvement in 21/27 (78%) of the collagenous colitis patients. Rapid improvement occurred in 11/12 (92%) of the patients with bile acid malabsorption compared with 10/15 (67%) of the patients with normal 75SeHCAT tests. CONCLUSION Bile acid malabsorption is common in patients with collagenous colitis and is probably an important pathophysiological factor. Because of a high response rate without serious side effects, bile acid binding treatment should be considered for collagenous colitis, particularly patients with bile acid malabsorption.
Summary
Background Bile acid malabsorption is frequent in collagenous colitis and harmful bile acids may play a pathophysiological role. Glucocorticoids increase ileal bile acid transport. ...Budesonide have its main effect in the terminal ileum.
Aims To evaluate whether the symptomatic effect of budesonide is linked to increased uptake of bile acids.
Methods Patients with collagenous colitis were treated with budesonide 9 mg daily for 12 weeks. Prior to and after 8 weeks of treatment, the 75SeHCAT test, an indirect test for the active uptake of bile acid‐s, measurements of serum 7α‐hydroxy‐4‐cholesten‐3‐one, an indicator of hepatic bile acid synthesis, and registration of symptoms were performed.
Results The median 75SeHCAT retention increased from 18% to 35% (P < 0.001, n = 25) approaching the values of healthy controls (38%). The 7α‐hydroxy‐4‐cholesten‐3‐one values decreased significantly among those with initially high synthesis (from 36 to 23 ng/mL, P = 0.04, n = 9); however, for the whole group the values were not altered (19 ng/mL vs. 13 ng/mL, P = 0.23, N.S., n = 19).
Conclusion The normalization of the 75SeHCAT test and the reduction of bile acid synthesis in patients with initially high synthetic rate, suggests that the effect of budesonide in collagenous colitis may be in part due to decreased bile acid load on the colon.
In the framework of the UNECE Task Force on Measurement and Modelling (TFMM) under the Convention on Long-range Transboundary Air Pollution (LRTAP), the EURODELTAIII project is evaluating how well ...air quality models are able to reproduce observed pollutant air concentrations and deposition fluxes in Europe. In this paper the sulphur and nitrogen deposition estimates of six state-of-the-art regional models (CAMx, CHIMERE, EMEP MSC-W, LOTOS-EUROS, MINNI and CMAQ) are evaluated and compared for four intensive EMEP measurement periods (25 Feb–26 Mar 2009; 17 Sep–15 Oct 2008; 8 Jan–4 Feb 2007 and 1–30 Jun 2006).
For sulphur, this study shows the importance of including sea salt sulphate emissions for obtaining better model results; CMAQ, the only model considering these emissions in its formulation, was the only model able to reproduce the high measured values of wet deposition of sulphur at coastal sites. MINNI and LOTOS-EUROS underestimate sulphate wet deposition for all periods and have low wet deposition efficiency for sulphur.
For reduced nitrogen, all the models underestimate both wet deposition and total air concentrations (ammonia plus ammonium) in the summer campaign, highlighting a potential lack of emissions (or incoming fluxes) in this period. In the rest of campaigns there is a general underestimation of wet deposition by all models (MINNI and CMAQ with the highest negative bias), with the exception of EMEP, which underestimates the least and even overestimates deposition in two campaigns. This model has higher scavenging deposition efficiency for the aerosol component, which seems to partly explain the different behaviour of the models.
For oxidized nitrogen, CMAQ, CAMx and MINNI predict the lowest wet deposition and the highest total air concentrations (nitric acid plus nitrates). Comparison with observations indicates a general underestimation of wet oxidized nitrogen deposition by these models, as well as an overestimation of total air concentration for all the campaigns, except for the 2006 campaign. This points to a low efficiency in the wet deposition of oxidized nitrogen for these models, especially with regards to the scavenging of nitric acid, which is the main driver of oxidized N deposition for all the models. CHIMERE, LOTOS-EUROS and EMEP agree better with the observations for both wet deposition and air concentration of oxidized nitrogen, although CHIMERE seems to overestimate wet deposition in the summer period. This requires further investigation, as the gas-particle equilibrium seems to be biased towards the gas phase (nitric acid) for this model.
In the case of MINNI, the frequent underestimation of wet deposition combined with an overestimation of atmospheric concentrations for the three pollutants indicates a low efficiency of the wet deposition processes. This can be due to several reasons, such as an underestimation of scavenging ratios, large vertical concentration gradients (resulting in small concentrations at cloud height) or a poor parameterization of clouds.
Large differences between models were also found for the estimates of dry deposition. However, the lack of suitable measurements makes it impossible to assess model performance for this process. These uncertainties should be addressed in future research, since dry deposition contributes significantly to the total deposition for the three deposited species, with values in the same range as wet deposition for most of the models, and with even higher values for some of them, especially for reduced nitrogen.
•The estimates of N and S deposition by six regional models are evaluated.•The inclusion of sea salt sulfate emissions was found to be important.•Formation of NH3+NH4+ is generally underestimated in summer.•There is a general underestimation of wet deposition of reduced N by most models.•Different performance was found for the different models and pollutants.
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