DNA mismatch repair and the transition to hormone independence in breast and prostate cancer

The molecular basis for the progression of breast and prostate cancer from hormone dependent to hormone independent disease remains a critical issue in the management of these two cancers. The DNA mismatch repair system is integral to the maintenance of genomic stability and suppression of tumorigenesis. No firm consensus exists regarding the implications of mismatch repair (MMR) deficiencies in the development of breast or prostate cancer. However, recent studies have reported an association between mismatch repair deficiency and loss of specific hormone receptors, inferring a potential role for mismatch repair deficiency in this transition. An updated review of the experimental data supporting or contradicting the involvement of MMR defects in the development and progression of breast and prostate cancer will be provided with particular emphasis on their implications in the transition to hormone independence.

Contribution of biobanks to care services

Approaches to the management of patients with cancer have been revolutionised by the ability to examine tumours at a genetic and molecular level and tailor treatments accordingly. Underpinning this work is the need for large numbers of high-quality human biospecimens for use in translational research studies to identify new biomarkers for the prediction, diagnosis and treatment of cancer. Biobanking has subsequently emerged as a dedicated activity to provide the infrastructure required for the standardised collection, storage and distribution of high quality human biospecimens for research purposes. This article provides an overview of the role of biobanks and the vital contribution they make to the delivery of cancer care for patients now and in the future

Factors affecting transition to second year of an engineering degree

Much research has focused on students’ transition from secondary school to university. Less is known about the transition from first to second year of a university degree programme. Given the difficulties that many students face at this stage of their education, research into the relevant factors is required. Through questionnaires and focus groups, views of second- and third-year aerospace and mechanical engineering students in our university have been gathered. A large majority believed that both the volume and difficulty of work increased in second year. Many stated that first year was slightly too trivial and could have been made more challenging to prepare them better for second year. Different teaching and assessment styles in second year were considered to affect attendance and performance. The survey revealed that students were generally very well settled into university life by the end of first year and were happy with their choice of course and only 23% reported that financial responsibilities have had a negative effect on their academic performance. Differences were observed between male and female students. Male students believed that transition was helped by having regular assessments and by worked examples in lectures. Females found the teaching staff were the most helpful factor for a successful transition. The results indicate that males require more structure and guidance whereas females are more independent and settle in better.

Families with multiple problems: Some challenges in identifying and providing services to those experiencing adversities across the life course

Summary A concern amongst policy makers to identify high cost and low productivity populations has created a new interest in identifying those who experience adversities across the life-course. This paper outlines the development of conceptual understandings of families whose children experience multiple adversities and links this with later poor outcomes in adult life and examines some of the research challenges in establishing such linkages. Findings It is argued that current thinking with regard to these issues reflects historical domains within which services to children and to adults are located. The challenge to domain thinking is both horizontal and vertical. Policy being required to address the horizontal axis by co-ordinating planned approaches to multiple needs across services. And policy being necessary to address the vertical cleavage between children’s and adult services in ways which join up services across the life path; conceptually and practically acknowledging the links between child and adult experiences. Application Such policy developments will inevitably require social work to develop alternative paradigms for understanding the needs of children and adults and designing services to effectively meet these.

SMAD inhibition attenuates epithelial to mesenchymal transition by primary keratinocytes in vitro

Epithelial to mesenchymal transition (EMT) is a process whereby epithelial cells undergo transition to a mesenchymal phenotype and contribute directly to fibrotic disease. Recent studies support a role for EMT in cutaneous fibrotic diseases including scleroderma and hypertrophic scarring, though there is limited data on the cytokines and signalling mechanisms regulating cutaneous EMT. We investigated the ability of TGF-β and TNF-α, both over-expressed in cutaneous scleroderma and central mediators of EMT in other epithelial cell types, to induce EMT in primary keratinocytes and studied the signalling mechanisms regulating this process. TGF-β induced EMT in normal human epidermal keratinocytes (NHEK cells) and this process was enhanced by TNF-α. EMT was characterised by changes in morphology, proteome (down-regulation of E-cadherin and Zo-1, and up-regulation of vimentin and fibronectin), MMP secretion and COL1α1 mRNA expression. TGF-β and TNF-α in combination activated SMAD and p38 signalling in NHEK cells. P38 inhibition with SB203580 partially attenuated EMT, whereas SMAD inhibition using SB431542 significantly inhibited EMT and also reversed established EMT. These data highlight the retained plasticity of adult keratinocytes and support further studies of EMT in clinically relevant in vivo models of cutaneous fibrosis, and investigation of SMAD inhibition as a potential therapeutic intervention. This article is protected by copyright. All rights reserved.

A connectionist perspective of the transition from Face-to-Face to online teaching in Higher Education

Existing research shows a slow transition to online education by many university teaching staff. A mixed methods approach is used to survey teacher educators in three jurisdictions in the UK who have made the transition to online teaching, followed by focus group and individual interviews to triangulate the data. The eight tenets of connectivism are used as a lens for analysis. Findings reveal sound pedagogical reasons for the limited choice of online tools and tutors highlight two elements, namely, self-fulfilment and their desire to continually develop as an educator, as the rationale for adopting informal professional development in the 21st century.

Trades Unions and the Transition away from 'actually existing unsustainability':From economic crisis to a new political economy beyond growth

Traditionally trades unions have accepted and promoted orthodox economic growth as a policy imperative. In recent years there has been a noticeable ‘greening’ of trade unions in relation to initiatives such as the ‘Green new deal’ and the creation of ‘green collar’ employment and the focus on a ‘just transition’ to a low carbon economy. Yet given the growing evidence of the negative impacts of economic growth in terms of environmental, resource and pollution impacts as well as the inability of economic growth to tackle (as opposed to managed) socio-economic inequality, it is timely to review the case for trades unions to fundamentally rethink the commitment to orthodox economic growth. That is, for trades unions to consider going beyond their current ‘green/sustainability’ strategies to consider more radical ‘post-growth’ policy positions. This chapter will explore some of the dimensions of a ‘post-growth’ trade union agenda by considering the evidence for going beyond growth from within the trade union movement (specifically looking at the International Labor Organization’s 2004 report on Economic Security, to internal union discussions around trades unionism and climate change) and external evidence ranging from Wilkinson and Pickett’s The Spirit Level (which suggests amongst other things that in the developed world what is needed is not economic growth but greater redistribution and lowering inequality – issues also of traditional interest to the Trades Union movement) to Tim Jackson’s Prosperity without Growth (which suggests that economic growth is ecologically unsustainable as well having passed a threshold beyond which it is contributing to human well-being in the developed world). As well as discussing the relationship between trades unionism and what may be called ‘green political economy’ (such as the ‘degrowth’ and ‘limits to growth’ perspectives) this chapter will also discuss the practical/policy implications of this ‘post-growth’ perspective in relation to trades unionism’s analysis of capitalism and its transformation in the context of a climate changed, carbon constrained world, including implications for ideas such as basic income, a shorter working week and what a trades unionism focused on how to achieve high quality of life within a low carbon context might look like.

Collaborative practice:a strategy to improve the relevance of health services research.

Health services research has emerged as a tool for decision makers to make services more effective and efficient. While its value as a basis for decision making is well established, the incorporation of such evidence into decision making remains inconsistent. To this end, strengthening collaborative relationships between researchers and healthcare decision makers has been identified as a significant strategy for putting research evidence into practice.

Socio-emotional effects of the transition from sight to blindness,

The research examined the socio-emotional impact of sight loss on a sample of 18 blind and partially sighted adults from the East coast of Scotland (average age 64). The impact of sight loss in four core areas mood, self concept, social connectedness and loss was explored. Data was collected using the mental health and social functioning sub-scales of the National Eye Institute Visual Functioning Questionnaire-25 and semi-structured interviews. Data indicated that participants experienced reduced mental health and decreased social functioning as a result of sight loss. Data also showed that participants shared common socio-emotional issues during transition from sight to blindness, starting with diagnosis, coping with deterioration of sight, experiencing loss, experiencing changed perceptions of self in relation to society, experiencing others in a changed way and experiencing rehabilitation. A theoretical model describing the socio-emotional transition from sight to blindness is proposed. Implications for practice are explored.

Care Leavers’ Experiences of Transition and Turning Points: Findings from a Biographical Narrative Study

This paper reports on the findings of a PhD research project that set out to explore how young people leaving out of home care experienced and made sense of their transition to adulthood. Using the Biographical Narrative Interpretative Method, in-depth accounts were collected and analysed for eight care leavers. The data suggest that in addition to care leavers living their lives as a series of biographical events, their ‘care career’, they also experience changes in the way they make sense of their lives which form a ‘subjective pathway’. Influenced by the literature on resilience, the research had anticipated that ‘turning point’ events would play a significant role in the young people’s subjective pathways. But the findings show a more gradual, phased shifting of subjectivity. It is suggested that legislation, policy, services and care practices need to facilitate this more drawn out ‘subjective pathway’. Attachment, resilience and humanistic social psychology are proposed as useful theoretical underpinnings for that work

Investigating Fractured Flow from Orthopaedics to Rehabilitation

Patients often spend time as inpatients in hospitals outside their home area because of the need to access specialist services. If there is a need for ongoing care after the need for specialist care has passed, patients are transferred (or ‘repatriated’) back to the inpatient care of a hospital in their local Health and Social Care Trust. The need for bed space in specialist units means that there is pressure for this transition to occur in a timely way. We investigated the flow of patients through a trauma and orthopaedics unit using the 6M Design® framework and Vitals Charts® in order to investigate concerns about delayed repatriation. We found that repatriation was part of a complex system that had interdependent components. There was considerable variation in the number of discharges (to any destination) by day of week, with a reduction on Saturdays and Sundays. Understanding that the pressure for quicker repatriation was really due to high work-in-progress led us to model the effects of strategies to address the high work-in-progress. We found that, because only a small proportion of patients require repatriation, expediting the repatriation process by one day for each patient would only reduce WIP by an average of 1.6 patients. Reducing the average length of stay for all trauma and orthopaedics inpatients by one day would reduce the WIP by 10 patients, which would make a much greater impact on the problem of high bed occupancy. Though the smooth and timely repatriation of patients to rehabilitation units is desirable, it is unlikely that efforts to achieve this will have a substantial impact on the problem of high WIP, so other strategies will be required. We will model the effects of strategies to reduce variation in daily discharges by the day of week in a future essay.

Bridging the Gap: Developing a Palliative Approach to Care for Young Adults with Life Limiting Conditions

Bridging the Gap: Developing a Palliative Approach to Care for Young Adults with Life Limiting Conditions

More young adults (YAs) with life limiting conditions (LLC) are surviving into adulthood as earlier diagnosis and improved medical management in pediatric care lead to higher rates of survival for cancer, congenital heart and neuromuscular conditions. When these YAs leave pediatric care, they leave behind comprehensive and coordinated health, social and education services for uncoordinated adult systems, with limited access to palliative services they received in pediatric care.

YAs with LLCs will benefit from a public health palliative approach to care. This approach better matches their chronic disease trajectories of a series of declining plateaus over a period of months to years, punctuated by unpredictable periodic crises. Public health palliative care is a blended provision of health care and community services based on evidence that health care is most effective and least expensive when offered in conjunction with a complement of services that reflects social determinants of health and well-being. For YAs with LLCs, these resources will support their health, social, vocational, independent living, and educational goals to maximize their opportunities in an abbreviated time frame.


The objectives of this workshop are to:

1. Provide an overview of the young adult population with palliative care needs.
2. Discuss current care of this population.
3. Highlight results from three recent projects to examine and address needs of this population.
4. Dialogue with audience about other programs, initiatives, or ideas to address the needs of this population.

We look forward to robust conversations and ideas from your practice and research.

Perceived and reported access to the general practitioner: an international comparison of universal access and mixed private/public systems.

Timely and convenient access to primary healthcare is essential for the health of the population as delays can incur additional health and financial costs. Access to health care is under increasing scrutiny as part of the drive to contain escalating costs, while attempting to maintain equity in service provision. The objective was to compare primary care services in Republic of Ireland and Northern Ireland, and to report on perceived and reported access to GP services in universal access and mixed private/public systems. A questionnaire study was performed in Northern Ireland (NI) and the Republic of Ireland (ROI). Patients of 20 practices in the ROI and NI were contacted (n = 22,796). Main outcome measures were overall satisfaction and the access to GP services. Individual responses and scale scores were derived using the General Practice Assessment Questionnaire (G-PAQ). The response rate was 52% (n = 11,870). Overall satisfaction with GP practices was higher in ROI than in NI (84.2% and 80.9% respectively). Access scores were higher in ROI than in NI (69.2% and 57.0% respectively) Less than 1 in 10 patients in ROI waited two or more working days to see a doctor of choice (8.1%) compared to almost half (45.0%) in NI. In NI overall satisfaction decreased as practice size increased; 82.8%, 80.4%, and 75.8%. In both systems, in large practices, accessibility is reduced when compared to smaller practices. The faster access to GP services in ROI may be due to the deterrent effect of the consultation charge freeing up services although, as it is the poorest and sickest who are deterred by the charge this improved accessibility may come at a significant cost in terms of equity. The underlying concern for policy makers centres around provision of equitable services.