Malnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions, and greater in-hospital mortality: Results from the Nutrition Care Day Survey 2010

Background & aims The Australasian Nutrition Care Day Survey (ANCDS) ascertained if malnutrition and poor food intake are independent risk factors for health-related outcomes in Australian and New Zealand hospital patients. Methods Phase 1 recorded nutritional status (Subjective Global Assessment) and 24-h food intake (0, 25, 50, 75, 100% intake). Outcomes data (Phase 2) were collected 90-days post-Phase 1 and included length of hospital stay (LOS), readmissions and in-hospital mortality. Results Of 3122 participants (47% females, 65 ± 18 years) from 56 hospitals, 32% were malnourished and 23% consumed ≤ 25% of the offered food. Malnourished patients had greater median LOS (15 days vs. 10 days, p < 0.0001) and readmissions rates (36% vs. 30%, p = 0.001). Median LOS for patients consuming ≤ 25% of the food was higher than those consuming ≤ 50% (13 vs. 11 days, p < 0.0001). The odds of 90-day in-hospital mortality were twice greater for malnourished patients (CI: 1.09–3.34, p = 0.023) and those consuming ≤ 25% of the offered food (CI: 1.13–3.51, p = 0.017), respectively. Conclusion The ANCDS establishes that malnutrition and poor food intake are independently associated with in-hospital mortality in the Australian and New Zealand acute care setting.

The lost boys : creating appealing and engaging fiction for adolescent male reluctant readers & Duende a young adult novella

Reading plays an important role in establishing lifelong learning and providing the reader with an avenue to new experiences and a language with which to express their ideas and feelings (Owen 2003; Hamston & Love 2005). In particular adolescents need a language that allows them to 'play with their identities in a safe and controlled manner to explore who they want to be in this ever changing world' (Koss & Teale 2009, 569). Block (1995) advances that there is a distinct correlation between what we read and how we live in the world, and argues 'if what we read influences our identity in the world, the ways we are able to imagine and live in the world, then there is some responsibility to address these various texts, their readers and possible reading experiences' (Koss & Teale 2009, 569). Within my research I attempt to take on this responsibility by establishing a connection between reluctant adolescent male readers, and their reading experiences and by using their opinions to create a novella that seeks to more fully engage them. Centred within the larger debate about boys and books are two central discussions: why don't boys read and what should boys read? While a number of reasons why adolescent boys don't read are mentioned in this paper and it might not be possible to fully account for why many are reluctant readers, it is possible to argue that specific forms of literature addressing certain themes and topics relevant to the age group might appeal to reluctant readers. The conceptual framework for this research was structured using a mixed-method approach consisting of four phases. In positioning my research for determining literature that reluctant readers may want to read I draw on a variety of material which tends to support the longevity of S.E Hinton's (1967) argument that 'teenagers today, want to read about teenagers today' (cited in Smith & Wilhelm 2002, 6). My practice-based research was conducted within a high school in Brisbane, Australia. Six participants were selected and required to read three recently published Australian Young Adult novels, and opinion was collected via semi-structured interviews on these case studies. Grounded Theory (Charmaz 2003; Charmaz 2006; Glaser & Strauss 2011) informed the design of the questions, and the process of concurrent interviews and analysis of opinion. This analysis led to construction of my theory: adolescent male reluctant readers want to read about female relationships and family conflict within a story that consists of an adventure that, although unlikely to happen, could happen. From this study there are two main contributions, which have theoretical and practical implications for stakeholders with a vested interest in the discussion regarding boys and books. First, this study, through the research methodology, presents key findings that indicate that reluctant readers are interested in realistic texts addressing themes that will help with the construction of, and understanding of, their own lives. Secondly, the grounded theory derived from these findings is applied to my own praxis and my creative artefact (Duende) is included with this exegesis as a text intended to create a connection between engaging texts and adolescent male reluctant readers.

Tumor necrosis correlates with angiogenesis and is a predictor of poor prognosis in malignant mesothelioma

Objectives: Malignant mesothelioma (MM) is a fatal tumor of increasing incidence related to asbestos exposure. Microscopic tumor necrosis (TN) is a poor prognostic factor in solid tumors, but it has not been characterized in MM. We wished to evaluate the incidence of TN in MM and its correlations with clinicopathologic factors, angiogenesis, and survival. Methods: TN was graded in 171 routine formalin-fixed, paraffin-embedded hematoxylin-eosinstained tumor sections by two independent observers. Angiogenesis was assessed by the microvessel count (MVC) of CD34 immunostained sections. TN was correlated with survival by Kaplan-Meier and log-rank analysis, and stepwise, multivariate Cox models were used to compare TN with angiogenesis and established prognostic factors and prognostic scoring systems. Results: TN was identified in 39 cases (22.8%) and correlated with low hemoglobin (p = 0.01), thrombocytosis (p = 0.04), and high MVC (p = 0.02). TN was a poor prognostic factor in univariate analysis (p = 0.008). Patients with TN had a median survival of 5.3 months vs 8.3 months in negative cases. Independent indicators of poor prognosis in multivariate analysis were nonepithelioid cell type (p = 0.0001), performance status > 0 (p = 0.007), and increasing MVC (p = 0.004) but not TN. TN contributed independently to the European Organisation for Research and Treatment of Cancer (EORTC) [p = 0.03] and to the Cancer and Leukemia Group B (CALGB) [p = 0.03] prognostic groups in respective multivariate Cox analyses. Conclusions: TN correlates with angiogenesis and is a poor prognostic factor in MM. TN contributes to the EORTC and CALGB prognostic scoring systems.

Overexpression of the mammalian target of rapamycin (mTOR) and angioinvasion are poor prognostic factors in early stage NSCLC: A verification study

Background: A recent study by Dhillon et al. [12], identified both angioinvasion and mTOR as prognostic biomarkers for poor survival in early stage NSCLC. The aim of this study was to verify the above study by examining the angioinvasion and mTOR expression profile in a cohort of early stage NSCLC patients and correlate the results to patient clinico-pathological data and survival. Methods: Angioinvasion was routinely recorded by the pathologist at the initial assessment of the tumor following resection. mTOR was evaluated in 141 early stage (IA-IIB) NSCLC patients (67 - squamous; 60 - adenocarcinoma; 14 - others) using immunohistochemistry (IHC) analysis with an immunohistochemical score (IHS) calculated (% positive cells × staining intensity). Intensity was scored as follows: 0 (negative); 1+ (weak); 2+ (moderate); 3+ (strong). The range of scores was 0-300. Based on the previous study a cut-off score of 30 was used to define positive versus negative patients. The impact of angioinvasion and mTOR expression on prognosis was then evaluated. Results: 101 of the 141 tumors studied expressed mTOR. There was no difference in mTOR expression between squamous cell carcinoma and adenocarcinoma. Angioinvasion (p= 0.024) and mTOR staining (p= 0.048) were significant univariate predictors of poor survival. Both remained significant after multivariate analysis (p= 0.037 and p= 0.020, respectively). Conclusions: Our findings verify angioinvasion and mTOR expression as new biomarkers for poor outcome in patients with early stage NSCLC. mTOR expressing patients may benefit from novel therapies targeting the mTOR survival pathway. © 2011 Elsevier Ireland Ltd.

Expression of thrombospondin-1 in resected colorectal liver metastases predicts poor prognosis

Purpose The aim of this study was to examine the expression and prognostic relevance of thrombospondin-1 (TSP-1) in tumor biopsies taken from a consecutive series of liver resections done at the University Hospitals of Leicester and the Royal Liverpool Hospital. Experimental Design Patients having undergone a liver resection for colorectal liver metastases at our institutions between 1993 and 1999 inclusive were eligible. Inclusion criteria were curative intent, sufficient tumor biopsy, and patient follow-up data. One hundred eighty-two patients were considered in this study. Standard immunohistochemical techniques were used to study the expression of TSP-1 in 5-μm tumor sections from paraffin-embedded tissue blocks. TSP-1 was correlated with survival using the Kaplan-Meier method and log-rank test for univariate analysis and the Cox proportional hazard model for multivariate analysis. Results One hundred eighty-two patients (male, n = 122 and female, n = 60) ages between 25 and 81 years (mean, 61 years) were included. TSP-1 was expressed around blood vessels (n = 45, 25%) or in the stroma (n = 59, 33%). No expression was detected in the remaining tumors. TSP-1 significantly correlated with poor survival on univariate (P = 0.01 for perivascular expression and P = 0.03 for stromal expression) and multivariate analysis (P = 0.01 for perivascular expression). Conclusion TSP-1 is a negatively prognostic factor for survival in resected colorectal liver metastases. © 2005 American Association for Cancer Research.

Coexpression of epidermal growth factor receptor with related factors is associated with a poor prognosis in non-small-cell lung cancer

The epidermal growth factor receptor (EGFR) is commonly expressed in non-small-cell lung cancer (NSCLC) and promotes a host of mechanisms involved in tumorigenesis. However, EGFR expression does not reliably predict prognosis or response to EGFR-targeted therapies. The data from two previous studies of a series of 181 consecutive surgically resected stage I-IIIA NSCLC patients who had survived in excess of 60 days were explored. Of these patients, tissue was available for evaluation of EGFR in 179 patients, carbonic anhydrase (CA) IX in 177 patients and matrix metalloproteinase-9 (MMP-9) in 169 patients. We have previously reported an association between EGFR expression and MMP-9 expression. We have also reported that MMP-9 (P=0.001) and perinuclear (p)CA IX (P=0.03) but not EGFR expression were associated with a poor prognosis. Perinuclear CA IX expression was also associated with EGFR expression (P<0.001). Multivariate analysis demonstrated that coexpression of MMP-9 with EGFR conferred a worse prognosis than the expression of MMP-9 alone (P<0.001) and coexpression of EGFR and pCA IX conferred a worse prognosis than pCA IX alone (P=0.05). A model was then developed where the study population was divided into three groups: group 1 had expression of EGFR without coexpression of MMP-9 or pCA IX (number=21); group 2 had no expression of EGFR (number=75); and group 3 had coexpression of EGFR with pCA IX or MMP-9 or both (number=70). Group 3 had a worse prognosis than either groups 1 or 2 (P=0.0003 and 0.027, respectively) and group 1 had a better prognosis than group 2 (P=0.036). These data identify two cohorts of EGFR-positive patients with diametrically opposite prognoses. The group expressing either EGFR and or both MMP-9 and pCA IX may identify a group of patients with activated EGFR, which is of clinical relevance with the advent of EGFR-targeted therapies. © 2004 Cancer Research UK.

Carbonic anhydrase IX expression, a novel surrogate marker of tumor hypoxia, is associated with a poor prognosis in non-small-cell lung cancer

Purpose To evaluate carbonic anhydrase (CA) IX as a surrogate marker of hypoxia and investigate the prognostic significance of different patterns of expression in non-small-cell lung cancer (NSCLC). Methods Standard immunohistochemical techniques were used to study CA IX expression in 175 resected NSCLC tumors. CA IX expression was determined by Western blotting in A549 cell lines grown under normoxic and hypoxic conditions. Measurements from microvessels to CA IX positivity were obtained. Results CA IX immunostaining was detected in 81.8% of patients. Membranous (m) (P = .005), cytoplasmic (c) (P = .018), and stromal (P < .001) CA IX expression correlated with the extent of tumor necrosis (TN). The mean distance from vascular endothelium to the start of tumor cell positivity was 90 μm, which equates to an oxygen pressure of 5.77 mmHg. The distance to blood vessels from individual tumor cells or tumor cell clusters was greater if they expressed mCA IX than if they did not (P < .001). Hypoxic exposure of A549 cells for 16 hours enhanced CAIX expression in the nuclear and cytosolic extracts. Perinuclear (p) CA IX (P = .035) was associated with a poor prognosis. In multivariate analysis, pCA IX (P = .004), stage (P = .001), platelet count (P = .011), sex (P = .027), and TN (P = .035) were independent poor prognostic factors. Conclusion These results add weight to the contention that mCA IX is a marker of tumor cell hypoxia. The absence of CA IX staining close to microvessels suggests that these vessels are functionally active. pCA IX expression is representative of an aggressive phenotype. © 2003 by American Society of Clinical Oncology.

English in the urban environment : resources for 21st century readers

Where teachers of English as a foreign language (EFL) once observed a paucity of authentic language input, public displays of written English are now proliferating. Ideas for capitalising on this abundance can be drawn from two strands of pedagogic thought: a psycholinguistic approach to conventional literacy long established in foreign, second and first language education (e.g., Teng, 2009), and a more recent and critical approach informed by diverse theoretical understandings of the ‘linguistic landscape’ (e.g., Rowland, 2013). In this paper I draw from these two approaches to suggest ways of helping EFL learners use environmental print to develop knowledge and skills required of English readers in the twenty-first century: (1) fluency in breaking the codes of English and other languages of publicly displayed text; (2) facility with making meaning as the English of these texts becomes ever more diverse in cultural, historical and contextual implication; (3) use of environmental English in contexts that range from the local to the transnational; and (4) critique of the presence of English and attendant worldviews in the urban environment (Chern & Dooley, forthcoming). The psychological concept of motivation and the complementary sociological concept of investment are at the heart of my deliberations here: realisation of the pedagogic potential of environmental print to develop literate resources requires consideration of sources of motivation in the classroom learning situation (Dörnyei & Ushioda, 2011), as well as learner investment in literate practices in English (Norton, 2010).

The poor penetration of topical burn agent through burn eschar on a porcine burn model [Letter to the Editor]

We read with great interest the article entitled “Enhancing drugs absorption through third-degree burn wound eschar” by Manafi et al. [1]. The authors addressed the concern of poor penetration of topically applied anti-microbials through burn eschar and detailed the improvement of this penetration by penetration enhancers. Here, we would like to report the poor penetration of a topical agent into the viable deep dermal layer under burn eschar on a porcine burn model [2]. In burn treatment, a common practice is the topical application of either anti-microbial products or wound enhancing agents. While the activity of anti-microbial products is designed to fight against microbes on the wound surface but with the least toxicity to viable tissue, wound enhancing agents need to reach the viable tissue layer under the burn eschar. Many studies have reported the accelerated healing of superficial burn wounds and skin graft donor sites by the topical application of exogeneous growth factors [3]. It is well known that the efficacy of the penetration of a topical agent on intact skin mostly depends on the molecular size of the product [4] and [5]. While burn injury destroys this epidermal physiological barrier, the coagulated burn tissue layer on the burn wound surface makes it difficult for topical agents to reach viable tissue....

Responding to literature : accessible texts for reluctant readers

The Australian Curriculum: English 5.2 states, across all year level descriptions, that “students engage with a variety of texts for enjoyment”, with the level types of texts and levels of understanding developing over time (ACARA, 2014a). Problems arise when students are unable or unwilling to enjoy texts, and are reluctant to read, view, interpret, and evaluate written texts. This in turn impedes their ability to perform these texts for assessment purposes. The literacy abilities of students can vary widely within a single classroom, and it is a challenge for teachers to source and present texts which are accessible across the spectrum of reading abilities, as well as reflecting themes that are relevant and engaging for students, in addition to being consistent with the General Capabilities and Cross-Curriculum Priorities of the AC:E. In senior English also, the mainstream Qld Senior Syllabus (QSA, 2010, p. 6) requires that students have learning experiences developed through 15-20 literary texts, including the in-depth study of a complete novel. In the leisure context of English Communications, students may also “write stories, poems, or song lyrics” (QSA, 2004, p. 14). Since students’ responses to literature often take the form of other imaginative text creation we address this in this paper. We start by offering synopses of some accessible texts and strategies for teachers with these students who are unwilling or low literacy readers in junior secondary and senior level English. This paper canvases some easily read novels and some films with companion text suggestions which may serve as models for students responses. For the junior secondary texts, we identify how these align with the architecture of the Australian Curriculum’s General Capabilities and Cross Curriculum Priorities. Then, we will outline some suitable imaginative responses as possible assessment outcomes, such as short stories and digital stories.

High coexpression of both EGFR and IGF1R correlates with poor patient prognosis in resected non-small-cell lung cancer

Background Recent experimental and biomarker evidence indicates that the epidermal growth factor receptor (EGFR) and insulin-like growth factor receptor 1 (IGF1R) interact in the pathogenesis of malignant epithelial tumors, including lung cancer. This study examines the expression of both receptors and their prognostic significance in surgically resected non-small-cell lung cancer (NSCLC). Methods EGFR and IGF1R expression were evaluated in 184 patients with NSCLC (83 squamous cell carcinomas [SCCs], 83 adenocarcinomas [ADCs], and 18 other types) using immunohistochemical (IHC) analysis. Expression of both receptors was examined in matched fresh frozen normal and tumor tissues from 40 patients with NSCLC (20 SCCs and 20 ADCs) by Western blot analysis. Results High EGFR expression was detected in 51% of patients, and SCCs had higher EGFR expression than did non-SCCs (57.4% vs. 42.5%; P =.028). High IGF1R expression was observed in 53.8% of patients, with SCC having higher expression than non-SCC (62.6% vs. 37.3%; P =.0004). A significant association was shown between EGFR and IGF1R protein overexpression (P <.005). Patients with high expression of both receptors had a poorer overall survival (OS) (P =.04). Higher EGFR and IGF1R expression was detected in resected tumors relative to matched normal tissues (P =.0004 and P =.0009), with SCC having higher expression levels than ADC. Conclusion Our findings indicate a close interrelationship between EGFR and IGF1R. Coexpression of both receptors correlates with poor survival. This subset of patients may benefit from treatments cotargeting EGFR and IGF1R. © 2014 Elsevier Inc. All rights reserved.

The environmental enigma : why do producers professing stewardship continue to practice poor natural resource management?

Despite a wide acceptance that primary producers in Australia subscribe to a stewardship ethic, land and water degradation remains an ongoing problem. Recent calculations suggest that the economic cost of Australia's environmental degradation is amounting to more than $A3.5 billion a year with an estimated cost of managing (not overcoming) problems of salinity, acidification, soil erosion totalling $A60 billion over the next decade. This paper argues that stewardship itself is an unsatisfactory concept when looking to landholders to respond to environmental problems, for rarely does the attitude of stewardship translate into behaviours of improving natural resource management practices on private land. Whilst there is some acceptance of the environmental problem among primary producers, a number of external constraints may also impede the uptake of conservation-orientated practices. In light of the prevailing accounts of poor adoption of sustainable practices a number of policy options are reviewed in this paper, including formal regional partnerships, regulatory frameworks and market-based measures. It is concluded that the contentious nature of some of these new opportunities for change will mean that any moves aimed at reversing environmental degradation in Australia will be slow.

Irregular readers : Arthur Conan Doyle’s “six dirty scoundrels”, boyhood and literacy in contemporary Sherlockian children’s literature

Young adult (YA) literature is a socialising genre that encourages young readers to take up particular ways of relating to historical or cultural materials. The first decade of the twenty-first century witnessed a boom in Sherlockian YA fiction using the Conan Doyle canon as a context and vocabulary for stories focused on the Baker Street Irregulars as figures of identification. This paper reads YA fiction’s deployment of Conan Doyle’s fictional universe as a strategy for negotiating anxieties of adolescent masculinity, particularly in relation to literacy and social agency.

An examination of microfinance self-help groups and the poorest of the poor women in Tamil Nadu, India

This study examined the formation and operation of women's microfinance self-help groups in southern India and investigated whether or not the poorest of the poor women were accepted as members of those groups. The study found that caste was used as a selection criterion. Many eligible women excluded themselves from joining the self-help group due to their own lack of education, age, poor health, poverty and lack of trust in the system. The research revealed that self-help groups enhanced women's income and education, improved village infrastructure, and reduced household conflict. Factors that might prevent inclusion of the poorest of the poor in future microfinance programs were identified.

Crowdsourcing in developing countries : a possible model to co-create with the poor

The interest in poverty and the moral sense of'helping the poor' are a constant topic in Western culture (Mayo 2009).ln recent years, multinational corporations (MNCs) have evolved in their understanding of how social issues, such as poverty alleviation, relate to their fundamental purposes. From a business strategy point of view, 'socially responsible' initiatives are generally born with lhe dual purpose of attaining social visibility (i.e. marketing) and increasing economic returns. Besides addressing social challenges as part of their corporate social responsibility strategies, MNCs have also begun 'selling to the poor' in emerging markets (Prahalad 2004). A few forward -looking companies consider tltis base of the pyramid (BOP) market also as a source of innovation and have started to co-create with consumers (Simanis and Hart 2008).