Statin use after diagnosis of breast cancer and survival: a population-based cohort study

BACKGROUND: Preclinical studies have shown that statins, particularly simvastatin, can prevent growth in breast cancer cell lines and animal models. We investigated whether statins used after breast cancer diagnosis reduced the risk of breast cancer-specific, or all-cause, mortality in a large cohort of breast cancer patients.</p>

METHODS: A cohort of 17,880 breast cancer patients, newly diagnosed between 1998 and 2009, was identified from English cancer registries (from the National Cancer Data Repository). This cohort was linked to the UK Clinical Practice Research Datalink, providing prescription records, and to the Office of National Statistics mortality data (up to 2013), identifying 3694 deaths, including 1469 deaths attributable to breast cancer. Unadjusted and adjusted hazard ratios (HRs) for breast cancer-specific, and all-cause, mortality in statin users after breast cancer diagnosis were calculated using time-dependent Cox regression models. Sensitivity analyses were conducted using multiple imputation methods, propensity score methods and a case-control approach.</p>

RESULTS: There was some evidence that statin use after a diagnosis of breast cancer had reduced mortality due to breast cancer and all causes (fully adjusted HR = 0.84 [95% confidence interval = 0.68-1.04] and 0.84 [0.72-0.97], respectively). These associations were more marked for simvastatin 0.79 (0.63-1.00) and 0.81 (0.70-0.95), respectively.p><p>CONCLUSIONS: In this large population-based breast cancer cohort, there was some evidence of reduced mortality in statin users after breast cancer diagnosis. However, these associations were weak in magnitude and were attenuated in some sensitivity analyses.</p>

Urban Leptospirosis in Africa: A Cross-Sectional Survey of Leptospira Infection in Rodents in the Kibera Urban Settlement, Nairobi, Kenya

Leptospirosis is a widespread but under-reported cause of morbidity and mortality. Global re-emergence of leptospirosis has been associated with the growth of informal urban settlements in which rodents are thought to be important reservoir hosts. Understanding the multi-host epidemiology of leptospirosis is essential to control and prevent disease. A cross-sectional survey of rodents in the Kibera settlement in Nairobi, Kenya was conducted in September–October 2008 to demonstrate the presence of pathogenic leptospires. A real-time quantitative polymerase chain reaction showed that 41 (18.3%) of 224 rodents carried pathogenic leptospires in their kidneys, and sequence data identified Leptospira interrogans and L. kirschneri in this population. Rodents of the genus Mus (37 of 185) were significantly more likely to be positive than those of the genus Rattus (4 of 39; odds ratio = 15.03). Questionnaire data showed frequent contact between humans and rodents in Kibera. This study emphasizes the need to quantify the public health impacts of this neglected disease at this and other urban sites in Africa.

Produ��ão e purificaç��o da prote��na rica em gla (grp) humana recombinante

Disserta��ão de mest., Biologia Molecular e Microbiana, Faculdade de Ciências e Tecnologia, Univ. do Algarve, 2011

SWOT analysis of a pediatric rehabilitation programme : a participatory evaluation fostering quality improvement

Purpose. To present the results of a strengths, weaknesses, opportunities and threats (SWOT) analysis used as part of a process aimed at reorganising services provided within a pediatric rehabilitation programme (PRP) in Quebec, Canada and to report the perceptions of the planning committee members regarding the usefulness of the SWOT in this process. Method. Thirty-six service providers working in the PRP completed a SWOT questionnaire and reported what they felt worked and what did not work in the existing model of care. Their responses were used by a planning committee over a 12- month period to assist in the development of a new service delivery model. Committee members shared their thoughts about the usefulness of the SWOT. Results. Current programme strengths included favourable organisational climate and interdisciplinary work whereas weaknesses included lack of psychosocial support to families and long waiting times for children. Opportunities included working with community partners, whereas fear of losing professional autonomy with the new service model was a threat. The SWOT results helped the planning committee redefine the programme goals and make decisions to improve service coordination. SWOT analysis was deemed as a very useful tool to help guide service reorganisation. Conclusions. SWOT analysis appears to be an interesting evaluation tool to promote awareness among service providers regarding the current functioning of a rehabilitation programme. It fosters their active participation in the reorganisation of a new service delivery model for pediatric rehabilitation.

Going beyond the identification of change facilitators to effectively implement a new model of services: lessons learned from a case example in paediatric rehabilitation

Purpose: To identify facilitators and barriers to service reorganization, how they evolved and interacted to influence change during the implementation of a new service delivery model of paediatric rehabilitation. Methods: Over 3 years, different stakeholders responded to SWOT questionnaires (n =��139) and participated in focus groups (n =��19) and telephone interviews (n���= 13). A framework based on socio constructivist theories made sense of the data. Results: Facilitators related to the programme's structure (e.g. funding), the actors (e.g. willingness to test the new service model) and the change management process (e.g. participative approach). Some initial facilitators became barriers (e.g. leadership lacked at the end), while other barriers emerged (e.g. lack of tools). Understanding factor interactions requires examining the multiple actors�� intentions, actions and consequences and their relations with structural elements. Conclusions: Analysing facilitators and barriers helped better understand the change processes, but this must be followed by concrete actions to successfully implement new paediatric rehabilitation models.

Development, implementation, and evaluation of the Apollo model of pediatric rehabilitation service delivery

This article presents the experience of a rehabilitation program that un- dertook the challenge to reorganize its services to address accessibility issues and im- prove service quality. The context in which the reorganization process occurred, along with the relevant literature justifying the need for a new service delivery model, and an historical perspective on the planning; implementation; and evaluation phases of the process are described. In the planning phase, the constitution of the working committee, the data collected, and the information found in the literature are presented. Apollo, the new service delivery model, is then described along with each of its components (e.g., community, group, and individual interventions). Actions and lessons learnt during the implementation of each component are presented. We hope by sharing our experiences that we can help others make informed decisions about service reorganization to im- prove the quality of services provided to children with disabilities, their families, and their communities.

New method for the simultaneous identification of pathogenic human viruses using multiplex PCR

Tese de mestrado. Biologia (Biologia Molecular e Genética). Universidade de Lisboa, Faculdade de Ciências, 2014

Reform, Standards and Teacher Identity: Challenges of Sustaining Commitment

Teacher commitment has been found to be a critical predictor of teachers�� work performance, absenteeism, retention, burnout and turnover, as well as having an important influence on students�� motivation, achievement, attitudes towards learning and being at school (Firestone (1996). Educational Administration Quarterly, 32(2), 209���235; Graham (1996). Journal of Physical Education, Recreation and Dance, 67(1), 45–47; Louis (1998). School Effectiveness and School Improvement, 9(1), 1��27; Tsui & Cheng (1999). Educational Research and Evaluation, 5(3), 249���268). It is also a necessary ingredient to the successful implementation, adaptation or resistance reform agendas. Surprisingly, however, the relationship between teachers�� motivation, efficacy, job satisfaction and commitment, and between commitment and the quality of their work has not been the subject of extensive research. Some literature presents commitment as a feature of being and behaving as a professional (Helsby, Knight, McCulloch, Saunders, & Warburton (1997). A report to participants on the professional cultures of Teachers Research Project, Lancaster University, January). Others suggest that it fluctuates according to personal, institutional and policy contexts (Louis (1998). School Effectiveness and School Improvement, 9(1), 1��27) and identify different dimensions of commitment which interact and fluctuate (Tyree (1996). Journal of Educational Research, 89(5), 295��304). Others claim that teachers’ commitment tends to decrease progressively over the course of the teaching career (Fraser, Draper, & Taylor (1998). Evaluation and Research in Education, 12 (2), 61���71; Huberman (1993). The lives of teachers. London: Cassell). In this research, experienced teachers in England and Australia were interviewed about their understandings of commitment. The data suggest that commitment may be better understood as a nested phenomena at the centre of which is a set of core, relatively permanent values based upon personal beliefs, images of self, role and identity which are subject to challenge by change which is socio-politically constructed.

Pollen Sources

This chapter reviews what is known about abundance and distribution of the 12 most important aeroallergenic pollens in Europe: Ambrosia, Alnus, Artemisia, Betula, Chenopodiaceae, Corylus, Cupressaceae/Taxaceae, Olea, Platanus, Poaceae, Quercus and Urtica/Parietaria. Abundance is based on 10 years of pollen records from 521 stations of the European Aeroallergen Network that were interpolated into 12 distribution maps covering most of Europe. The chapter compares the distribution maps with other types of distribution maps that are available for selected tree species and discuss two methods for making harmonized pollen source inventories: ���bottom-up��� and ��top-down”. Both methods have advantages and disadvantages, and both need to be explored and further developed. Remote sensing has shown to be a valuable method to improve the inventories, especially the use of satellites. The full potential as well as limitations of remote sensing in relation to pollen sources remains to be explored. The review suggests that the most probable way of obtaining inventories of all 12 pollen species is to use top-down methods that use an ecosystem-based approach that for each particular species connects ecological preference, pollen counts and remote sensing.

Lessons Learnt From Ragweed and Birch Studies

Here we review some of the most important aspects of recent work on Ragweed (Ambrosia) and birch (Betula) concerning: 1) sources, 2) trends & phenology and 3) dispersion and transformation. Sources: At Northern latitudes the birch fraction in forests usually exceeds 50% of all broadleaved trees and the abundance of birch decreases with latitude from 5%-20% in many mid-latitude regions and down to 0%-2% in more southern areas. Birches are also commonly found in small woodlands or planted as ornamental trees in urban areas. Ragweeds are herbaceous weed species that are associated with areas of disturbance. Ragweed is native to North America, but considered an invasive species in Europe, Australia and China. In Europe, the four main centres are: The Pannonian Plain, Ukraine, The Po Valley (Italy) and the Rhone Valley (France). Trends & Phenology: Birch pollen seasons have started earlier during the last decades. This trend appears have decreased during recent years despite increasing spring temperatures. Ragweed tends to experience less change in flowering date as ragweed flowering depends on photoperiod. Ragweed is increasing its distribution in Europe, but airborne concentrations of ragweed pollen are not universally increasing, e.g. due to control measures or pest attacks. Dispersion & transformation: The beginning of the birch pollen season is often heralded by episodes of Long Distance Transport (LDT) from the south. Similar LDT episodes are intermittently seen for ragweed, which can reach as far north as Scandinavia. Humidity and air pollution can modify pollen grains during atmospheric transport. This can cause a change in allergenic potential of the pollen grain and is a direction for future research including the effect of co-exposure of air pollution and the transformation of aeroallergens.

Ragweed (Ambrosia) Pollen Source Inventory for Austria

This study improves the spatial coverage of top-down Ambrosia pollen source inventories for Europe by expanding the methodology to Austria, a country that is challenging in terms of topography and the distribution of ragweed plants. The inventory combines annual ragweed pollen counts from 19 pollen-monitoring stations in Austria (2004–2013), 657 geographical observations of Ambrosia plants, a Digital Elevation Model (DEM), local knowledge of ragweed ecology and CORINE land cover information from the source area. The highest mean annual ragweed pollen concentrations were generally recorded in the East of Austria where the highest densities of possible growth habitats for Ambrosia were situated. Approximately 99% of all observations of Ambrosia populations were below 745 m. The European infection level varies from 0.1% at Freistadt in Northern Austria to 12.8% at Rosalia in Eastern Austria. More top-down Ambrosia pollen source inventories are required for other parts of Europe.

From engagement to outcomes: measuring the impact of researcher training using the rugby team impact framework

This study addresses our approach to the difficult task of measuring the impact of an eLearning service, the Graduate Virtual Research Environment (GVRE), provided to doctoral students at a UK University since October 2009. The GVRE provides research students with access to a training needs analysis tool which is linked to a repository of video learning resources created by academics and experienced research students. This paper explores the use of the Rugby Team Impact Framework as a guide to measuring impact and our use of a number of techniques to gather evidence about the changes resulting from use of the GVRE. The framework gives four levels of evidence, starting with simple measures of provision, through attendance, interest and to outcomes. As with other research, we found the former easy to assess but the outcomes harder to define. We conclude with a critical evaluation of our research process and outcomes.

Supporting the learning and networking experiences of doctoral students

This study explores the impact of a Graduate Virtual Research Environment (GVRE) on the learning and networking experiences of research students. The GVRE was established to support and enhance research skills and employability training across a university. It provides an extensive range of resources including video reflections based on the experiences of students and staff; GVRE members are encouraged to comment and engage in discussions on these resources. Our work is framed using social theories of learning and the role of communities in the support and development of research students. In particular, we are interested in exploring the challenges involved in developing communities and networks for students whose main focus is their individual research. The GVRE was made available to over 600 students and in this research we explore its impact on the experiences of research students. In particular, we investigate four questions: (a) what impact does the students use of the GVRE have on the development of their research skills; (b) what impact does membership of the GVRE have on the networks and communities of research students; (c) how do research students view the relationships between their research skills training programme, their individual research and the GVRE; and (d) how do research students currently use social media. We use an interpretivist approach and our data sources include site statistics, responses to a questionnaire and also feedback from a focus group. Our findings indicate that networking remains an issue and students suggested approaches to facilitating this using the GVRE: (1) A clearer pathway from skills need identification to skills acquisition; (2) Rewards for activities around networking - possibly through credit on the training scheme; (3) Activities that would involve research directly. Feedback on the GVRE indicated that it is valued by research students as it facilitates the development of their research skills. In terms of marketing the GVRE to research students important factors identified were: the ease of access to the site, the overview it gives of the PhD process; and the value of the site to students around the defining moments of their studies when the students felt they needed additional advice and guidance.

Networked learning ten years on: the rise of the virtual graduate school

The aim of this paper is to reflect on how conceptions of networked learning have changed, particularly in relation to educational practices and uses of technology, that can nurture new ideas of networked learning to sustain multiple and diverse communities of practice in institutional settings. Our work is framed using two theoretical frameworks: Giddens's (1984) structuration theory and Callon & Latour's (1981) Actor Network Theory as critiqued by Fox (2005) in relation to networked learning. We use these frameworks to analyse and critique ideas of networked learning embodied in both cases. We investigate three questions: (a) the role of individual agency in the development of networked learning; (b) the impact of technological developments on approaches to supporting students within institutional infrastructures; and (c) designing networked learning to incorporate Web 2.0 practices that sustain multiple communities and foster engagement with knowledge in new ways. We use an interpretivist approach by drawing on experiential knowledge of the Masters programme in Networked Collaborative Learning and the decision making process of designing the virtual graduate schools. At this early stage, we have limited empirical data related to the student experience of networked learning in current and earlier projects. Our findings indicate that the use of two different theoretical frameworks provided an essential tool in illuminating, situating and informing the process of designing networked learning that involves supporting multiple and diverse communities of practice in institutional settings. These theoretical frameworks have also helped us to analyze our existing projects as case studies and to problematize and begin to understand the challenges we face in facilitating the participation of research students in networked learning communities of practice and the barriers to that participation. We have also found that this process of theorizing has given us a way of reconceptualizing communities of practice within research settings that have the potential to lead to new ideas of networked learning.