Papillary carcinoma arising in struma ovarii versus ovarian metastasis from primary thyroid carcinoma: a case report and review of the literature

We present a case of a postmenopausal woman diagnosed with an ovarian mass containing thyroid follicles and foci of papillary thyroid carcinoma during pathological examination. This patient referred having had a metachronous thyroid malignancy 10 years before. The differential diagnosis between a thyroid malignancy arising from a struma ovarii and a metastatic ovarian tumor originating from thyroid-cancer is challenging. Struma ovarii should be considered when thyroid components are the predominant element or when thyroid malignant tissue is identified within an ovarian lesion. Thyroid carcinoma arising from a struma ovarii is reported to occur in a minority of cases. Of these, papillary carcinoma is the most frequent subtype encountered. Regarding primary thyroid carcinomas, papillary carcinomas have a lower metastatic potential when compared to follicular carcinomas, and most of the metastases occur in the cervical lymph nodes. Ovarian metastases are exceedingly rare and generally associated with widespread disease. However, they must be considered in the presence of previous history of malignant thyroid carcinoma. The authors review the main clinical, imaging and therapeutic aspects of both these entities and present the most likely diagnosis.

Étude d’évaluabilité et évaluation des processus et des effets d’un programme de prévention de l’usage de substances psychoactives lors de la transition primaire-secondaire

La mise en œuvre d’activités de prévention de la consommation de substances psychoactives (SPA) (tabac, alcool et cannabis) en milieu scolaire est une stratégie couramment utilisée pour rejoindre un grand nombre de jeunes. Ces activités s’inspirent, soit de programmes existant, soit d’innovations dictées par le contexte d’implantation ou l’existence de données de recherche. Dans un cas comme dans l’autre, l’évaluation de ces programmes représente la meilleure voie pour mesurer leur efficacité et/ou connaître comment ceux-ci sont implantés. C’est cet impératif qui a motivé une commission scolaire du Québec a recommandé l’évaluation de l’Intervention en Réseau (IR), un programme développé en vue de retarder l’âge d’initiation et de réduire la consommation problématique de SPA chez les élèves. Ce programme adopte une approche novatrice avec pour principal animateur un intervenant pivot (IP) qui assure le suivi des élèves de la 5e année du primaire jusqu’en 3e secondaire. Inspiré des modèles en prévention de la santé et de l’Approche École en santé (AES), le rôle de l’IP ici se démarque de ceux-ci. Certes, il est l’interface entre les différents acteurs impliqués et les élèves mais dans le cadre du programme IR, l’IP est intégré dans les écoles primaires et secondaires qu’il dessert. C’est cet intervenant qui assure la mobilisation des autres acteurs pour la mise en œuvre des activités. Cette thèse vise à rendre compte de ce processus d’évaluation ainsi que des résultats obtenus. L’approche d’évaluation en est une de type participatif et collaboratif avec des données quantitatives et qualitatives recueillies par le biais de questionnaires, d’entrevues, de groupes de discussion, d’un journal de bord et de notes de réunions. Les données ont été analysées dans le cadre de trois articles dont le premier concerne l’étude d’évaluabilité (ÉÉ) du programme. Les participants de cette ÉÉ sont des acteurs-clés du programme (N=13) rencontrés en entrevues. Une analyse documentaire (rapports et journal de bord) a également été effectuée. Cette ÉÉ a permis de clarifier les intentions des initiateurs du programme et les objectifs poursuivis par ces derniers. Elle a également permis de rendre la théorie du programme plus explicite et de développer le modèle logique, deux éléments qui ont facilité les opérations d’évaluation qui ont suivi. Le deuxième article porte sur l’évaluation des processus en utilisant la théorie de l’acteur-réseau (TAR) à travers ses quatre moments du processus de traduction des innovations (la problématisation, l’intéressement, l’enrôlement et la mobilisation des alliés), l’analyse des controverses et du rôle des acteurs humains et non-humains. Après l’analyse des données obtenues par entrevues auprès de 19 informateurs-clés, les résultats montrent que les phases d’implantation du programme passent effectivement par les quatre moments de la TAR, que la gestion des controverses par la négociation et le soutien était nécessaire pour la mobilisation de certains acteurs humains. Cette évaluation des processus a également permis de mettre en évidence le rôle des acteurs non-humains dans le processus d’implantation du programme. Le dernier article concerne une évaluation combinée des effets (volet quantitatif) et des processus (volet qualitatif) du programme. Pour le volet quantitatif, un devis quasi-expérimental a été adopté et les données ont été colligées de façon longitudinale par questionnaires auprès de 901 élèves de 5e et 6e année du primaire et leurs enseignants de 2010 à 2014. L’analyse des données ont montré que le programme n’a pas eu d’effets sur l’accessibilité et les risques perçus, l’usage problématique d’alcool et la polyconsommation (alcool et cannabis) chez les participants. Par contre, les résultats suggèrent que le programme pourrait favoriser la réduction du niveau de consommation et retarder l’âge d’initiation à l’alcool et au cannabis. Ils suggèrent également un effet potentiellement positif du programme sur l’intoxication à l’alcool chez les élèves. Quant au volet qualitatif, il a été réalisé à l’aide d’entrevues avec les intervenants (N=17), de groupes de discussion avec des élèves du secondaire (N=10) et d’une analyse documentaire. Les résultats montrent que le programme bénéficie d’un préjugé favorable de la part des différents acteurs ayant participé à l’évaluation et est bien acceptée par ces derniers. Cependant, le roulement fréquent de personnel et le grand nombre d’écoles à suivre peuvent constituer des obstacles à la bonne marche du programme. En revanche, le leadership et le soutien des directions d’écoles, la collaboration des enseignants, les qualités de l’IP et la flexibilité de la mise en œuvre sont identifiés comme des éléments ayant contribué au succès du programme. Les résultats et leur implication pour les programmes et l’évaluation sont discutés. Enfin, un plan de transfert des connaissances issues de la recherche évaluative est proposé.

"Learning together, growing with family": the implementation and evaluation of a family support programme

The "Learning together, growing with family" programme is targeted to at-risk parents and children from 6 to 11 years old, with a preventive focus on promoting positive parent-child relationships. In this study, we examined the quality of the programme implementation and its influence on the programme results in a sample of 425 parents and 138 facilitators drawn from the first trial. Mixed methods were used, consisting of: parental self-reports on parenting dimensions, professionals' records on parental attendance and appraisals on six topics of the implementation process, and focus group discussions in which facilitators reported on the initial steps of the implementation. Results showed a high quality of implementation with respect to the group facilitator and the programme organization factors, followed by the coordination with services and the support facilities offered to participants and, finally, by the factors of fidelity and prior organization steps. Results of the focus groups confirmed that the prior steps were challenging and offered the more effective strategies. Better quality in the implementation factors predicted better parenting styles and parental competencies after the programme, as well as a higher attendance rate. In sum, this study demonstrates the importance of good implementation in at-risk contexts and provides some clues as to the key elements that moderate programme effectiveness.

Teacher perceived difficulty in implementing differentiated instructional strategies in primary school

This study analyses teacher perceived difficulty in implementing differentiated instructional strategies in regular classes. The participants were 273 Portuguese primary school teachers with teaching experience ranging from 1 to 33 years. A 39-item questionnaire was used to evaluate teacher perceived difficulty in relation to different instructional strategies. Teacher responses were factor analysed and five different domains were identified: (1) activities and materials; (2) assessment; (3) management; (4) planning and preparation; and (5) classroom environment. Results showed that with the exception of the classroom environment domain, all the instruction practices in the remaining domains were considered to be difficult. In particular, the most difficult practices were under the domain of activities and materials and were associated with the adaptation of curricular elements (content, process, and product) based on student characteristics (readiness, interest, and learning profiles). The results also revealed a strong association between the activities and materials domain and the assessment domain. Some implications of these findings for initial teacher training and teacher professional development programmes are discussed.

Presentation of Primary Open Angle Glaucoma (POAG) at Lions Sight First Eye Hospital in Blantyre, Malawi

Objective Primary open angle glaucoma (POAG) is the most common type of glaucoma in Africa. We carried out a study to determine the clinical presentation pattern of patients with primary open angle glaucoma (POAG) at a tertiary hospital in Malawi. Design A cross-sectional study Setting Lions Sight First Eye Hospital—a major referral and teaching state eye hospital in Blantyre, Malawi Subjects Study participants were newly diagnosed POAG patients at specialist eye clinic during study period. Results A total of 60 POAG patients were recruited into the study. The mean age was 58.7 years (SD= 16.6, range 18 - 86). There were more male (44, 73.3%) than female (16, 27.7%) patients. The majority of patients (73%) presented one year after onset of visual symptoms. Twenty-six patients (43%) had unilateral blindness (visual acuity < 3/60; WHO classification), while nine patients (15%) presented with bilateral blindness. A vertical cup-to-disc ratio (CDR) of 0.8 or worse was seen in 92 eyes (79%). The mean intraocular pressure (IOP) reading was 35.5 mmHg (SD 13.30). Of the thirty-three eyes that successfully underwent visual field analysis, very advanced defects were recorded in 12 eyes (36%). Conclusion This study demonstrates delayed presentation and male predominance among POAG patients at a tertiary eye hospital in Malawi. Glaucoma intervention programmes should aim at identifying patients with treatable glaucoma with particular attention to women.

Establishing a children’s orthopaedic hospital for Malawi: A review after 10 years

Background BEIT CURE International Hospital (BCIH) opened in 2002 providing orthopaedic surgical services to children in Malawi. This study reviews the hospital’s progress 10 years after establishment of operational services. In addition we assess the impact of the hospital’s Malawi national clubfoot programme (MNCP) and influence on orthopaedic training. Methods All operative paediatric procedures performed by BCIH services in the 10th operative year were included. Data on clubfoot clinic locations and number of patients treated were obtained from the MNCP. BCIH records were reviewed to identify the number of healthcare professionals who have received training at the BCIH. Results 609 new patients were operated on in the 10th year of hospital service. Patients were treated from all regions; however 60% came from Southern regions compared with the 48% in the 5th year. Clubfoot, burn contracture and angular lower limb deformities were the three most common pathologies treated surgically. In total BCIH managed 9,842 patients surgically over a 10-year period. BCIH helped to establish and co-ordinate the MNCP since 2007. At present the program has a total of 29 clinics, which have treated 5748 patients. Furthermore, BCIH has overseen the full or partial training of 5 orthopaedic surgeons and 82 orthopaedic clinical officers in Malawi. Conclusion The BCIH has improved the care of paediatric patients in a country that prior to its establishment had no dedicated paediatric orthopaedic service, treating almost 10,000 patients surgically and 6,000 patients in the MNCP. This service has remained consistent over a 10-year period despite times of global austerity. Whilst the type of training placement offered at BCIH has changed in the last 10 years, the priority placed on training has remained paramount. The strategic impact of long-term training commitments are now being realised, in particular by the addition of Orthopaedic surgeons serving the nation.

QTLs mapping for primary metabolites responsible of the organoleptic and nutritional characteristics of strawberry (Fragaria x ananassa)

The cultivated strawberry (Fragaria x ananassa) is the berry fruit most consumed worldwide and is well-known for its delicate flavour and nutritional properties. However, fruit quality attributes have been lost or reduced after years of traditional breeding focusing mainly on agronomical traits. To face the obstacles encountered in the improvement of cultivated crops, new technological tools, such as genomics and high throughput metabolomics, are becoming essential for the identification of genetic factors responsible of organoleptic and nutritive traits. Integration of “omics” data will allow a better understanding of the molecular and genetic mechanisms underlying the accumulation of metabolites involved in the flavour and nutritional value of the fruit. To identify genetic components affecting/controlling? fruit metabolic composition, here we present a quantitative trait loci (QTL) analysis using a 95 F1 segregating population derived from genotypes ‘1392’, selected for its superior flavour, and ‘232’ selected based in high yield (Zorrilla-Fontanesi et al., 2011; Zorrilla-Fontanesi et al., 2012). Metabolite profiling was performed on red stage strawberry fruits using gas chromatography hyphenated to time-of-flight mass spectrometry, which is a rapid and highly sensitive approach, allowing a good coverage of the central pathways of primary metabolism. Around 50 primary metabolites, including sugars, sugars derivatives, amino and organic acids, were detected and quantified after analysis in each individual of the population. QTL mapping was performed on the ‘232’ x ‘1392’ population separately over two successive years, based on the integrated linkage map (Sánchez-Sevilla et al., 2015). First, significant associations between metabolite content and molecular markers were identified by the non-parametric test of Kruskal-Wallis. Then, interval mapping (IM), as well as the multiple QTL method (MQM) allowed the identification of QTLs in octoploid strawberry. A permutation test established LOD thresholds for each metabolite and year. A total of 132 QTLs were detected in all the linkage groups over the two years for 42 metabolites out of 50. Among them, 4 (9.8%) QTLs for sugars, 9 (25%) for acids and 7 (12.7%) for amino acids were stable and detected in the two successive years. We are now studying the QTLs regions in order to find candidate genes to explain differences in metabolite content in the different individuals of the population, and we expect to identify associations between genes and metabolites which will help us to understand their role in quality traits of strawberry fruit.

Control programme for cystic echinococcosis in Uruguay

Cystic echinococcosis is a highly endemic parasitic zoonosis that is present in the Southern Cone countries of America. For several decades, various prevention and control programmes have been implemented in different countries and regions, with varying results. In Uruguay, a new control programme was implemented in 2006 that employed new strategies for canine diagnosis and treatment, dog population control, diagnosis in humans, epidemiological surveillance, and health education, including community participation. The control programme in Uruguay addresses the control and surveillance of the disease from a holistic perspective based on Primary Health Care, which has strengthened the community’s participation in developing and coordinating activities in an interdisciplinary manner. Similarly, the control programme that is currently implemented is based on a risk-focused approach. The surveillance and control measures were focused on small villages and extremely poor urban areas. In this study, the strategies used and the results obtained from 2008-2013 are analysed and discussed.

The Cat Who Walks Through Years: Chris Claremont's X-Men as Kitty Pryde's bildungsroman

This dissertation examines the fictional character Kitty Pryde from the X-Men comic book series during the tenure of writer Chris Claremont. Claremont's work on the character primarily involves the years 1980-1990, though a return to writing the character in the 2000s is also discussed when relevant. The thesis question revolves around the definition of the bildungsroman genre and whether Claremont's narrative arc for Kitty Pryde's character fulfills that definition. Jerome Hamilton Buckley's 1974 book Season of Youth: The Bildungsroman from Dickens to Golding is used as the primary authority for the bildungsroman genre, and more specifically a list of nine criteria that Buckley deems particularly key to the definition of the genre. Each of the nine criteria is looked at in depth, demonstrating where and how they can be found in the narrative, if at all. However, because Buckley's perspective and criteria come from a time of less diversity, examination from a feminist and minority perspective is also added with ideas from Rita Felski and Stella Bolaki. Combining Buckley's initial list of nine criteria with more modern criticism, these ideas are then used to analyze Kitty Pryde's narrative arc and to determine whether it can be seen as a bildungsroman. The findings support reading Claremont's narrative arc of the Kitty Pryde character as a bildungsroman. Three of Buckley's nine key themes are identified as particularly prevalent in the narrative: the search for a vocation, ordeal by love, and the conflict of generations. Three more key themes are found to be less prevalent but still clearly present: the search for a working philosophy, the larger society, and alienation. Because Buckley's definition for the bildungsroman genre requires the presence of six of his nine key themes, the presence of the aforementioned six thus validate the reading of the narrative as a bildungsroman. The text also provides some suggestions for finding the three least applicable key themes within the narrative, but because their presence is not necessary to fulfill the definition of the bildungsroman, they are not rigorously examined. In addition to fulfilling Buckley's key themes, the paper also discusses the more modern minority-oriented views. It is shown how the narrative can be read in terms of a journey to diverge from norms, as per Felski's ideas of the unique qualities of the specifically female bildungsroman. As Kitty Pryde's narrative can be shown to conform to the bildungsroman ideas of both Buckley and Felski, the thesis question is thus answered positively: Chris Claremont's X-Men can indeed be read as Kitty Pryde's bildungsroman.

Calcium Intake, Major Dietary Sources and Bone Health Indicators in Iranian Primary School Children

Background: Adequate calcium intake may have a crucial role with regards to prevention of many chronic diseases, including hypertension, hypercholesterolemia, different types of cancer, obesity and osteoporosis. In children, sufficient calcium intake is especially important to support the accelerated growth spurt during the preteen and teenage years and to increase bone mineral mass to lay the foundation for older age. Objectives: This study aimed to assess daily calcium intake in school-age children to ensure whether they fulfill the FGP dairy serving recommendations, the recommended levels of daily calcium intake and to assess the relationship between dietary calcium intake and major bone health indicators. Patients and Methods: A total of 501 Iranian school-age children were randomly selected. Calcium intake was assessed using a semi-quantitative food frequency questionnaire. Bone health indicators were also assessed. Results: Dairy products contributed to 69.3% of the total calcium intake of the children. Daily adequate intake of calcium was achieved by 17.8% of children. Only 29.8% met the Food guide pyramid recommendations for dairy intake. Dietary calcium intake was not significantly correlated with serum calcium and other selected biochemical indicators of bone health. Conclusions: The need for planning appropriate nutrition strategies for overcoming inadequate calcium intake in school age children in the city of Tehran is inevitable.

Primary Antibiotic Resistance to Helicobacter pylori Strains Isolated From Children in Northern Iran: A Single Center Study

Background: Initial resistance to antibiotics is the main reason for the failure of Helicobacter pylori (H. pylori) eradication in children. Objectives: As we commonly face high antibiotic resistance rates in children, we aimed to determine the susceptibility of H. pylori to common antibiotics. Patients and Methods: In this cross-sectional in vitro study, 169 children younger than 14 years with clinical diagnosis of peptic ulcer underwent upper gastrointestinal endoscopy. Biopsy specimens from stomach and duodenum were cultured. In isolated colonies, tests of catalase, urease, and oxidase as well as gram staining were performed. After confirming the colonies as H. pylori, the antibiogram was obtained using disk diffusion method. Results: Culture for H. pylori was positive in 12.3% of the specimens, urease test in 21.3%, serological test in 18.9% and stool antigen test was positive in 21.9%. We could show high specificity but moderate sensitivity of both histological and H. pylori stool antigen tests to detect H. pylori. The overall susceptibility to metronidazole was 42.9%, amoxicillin 95.2%, clarithromycin 85.7%, furazolidone 61.9%, azithromycin 81.0%, and tetracycline 76.2% with the highest resistance to metronidazole and the lowest to clarithromycin. Conclusions: In our region, there is high resistance of H. pylori to some antibiotics including metronidazole and furazolidone among affected children. To reduce the prevalence of this antibiotic resistance, more controlled use of antibiotics should be considered in children.

Dyslipidemia and blood lipid levels in patients tratied in primary care centers in east SAN JOSE

Dyslipidemia, i.e. high levels of blood lipids (cholesterol and triglycerides), is strongly related to cardiovascular disease (CVD). In order to reduce the risk of CVD at any moment in a person ́s life, it is crucial to know his/her –and the population’s– lipid profile. The aim of this study was to assess the (statistical) indicators of blood lipids and the prevalence of dyslipidemia in patients treated in the Integral Health Attention Program from Universidad de Costa Rica. A descriptive study was conducted including 10,044 patients aged 20 to 65 years, who were tested for a blood lipid profile in 2006. A total of 2,969 (29.6%) male and 7,075 (70.4%) female patients took part in the study, with an average age of 43.5 years. General averages for blood lipids were: 203.3 mg/dl for total cholesterol, 50.1 mg/dl for HDL, 120.1 mg/dl for LDL, and 165.6 mg/dl for triglycerides. Prevalence of 17.2% was determined for hypercholesterolemia (≥240 mg/dl), as well as 21.3% for low HDL levels (<40 mg/dl), 11.9% for high LDL levels (≥160 mg/dl), and 26.3% for high triglyceride levels (≥200 mg/dl). Women showed higher overall levels of dyslipidemia than men. Based on health areas, no significant differences were found in general lipid levels by age or sex. Results indicate that the general prevalence of dyslipidemia is close to half the rate reported in worldwide literature and lower than results reported in Costa Rican studies. However, general averages exceeded optimal levels for each blood lipid; consequently, it is important to develop health interventions oriented to reduce the impact of dyslipidemia in the studied population.

Small clonal B-cell population in the bone marrow as a possible tool in the diagnosis of occult primary parotid lymphoma

Case Description: An 82-years old Hispanic woman with a past medical history significant for pulmonary thromboembolism on oral anticoagulation, rheumatoid arthritis, and hypertension developed a new onset thrombocytopenia. Clinical Findings: Small clonal B-cells populations (SCBP) also known as monoclonal B-cell lymphocytosis was found as part of the workup for an idiopathic thrombocytopenia and lead ultimately to the diagnosis of parotid primary follicular lymphoma coexisting with Warthin tumor involving the bone marrow in a small extent and oncocytic papilloma located in the maxillary sinus. Treatment and Outcome: Patient was treated with Rituximab monotherapy with improvement on her platelet count. Clinical relevance: Although it is unclear the role of this clonal cells, they may work as a possible diagnostic tool for occult lymphomas. Further prospective studies are needed to confirm this possible association.

We're offering true play-based learning: teacher perspectives on educational dis/continuity in the early years

Educational continuity is a well-documented challenge facing the early childhood field. This research project investigated preschool and primary teachers' perspectives of educational dis/continuity, as they have been under-represented in the literature to date. The inclusion of dual-qualified educators in the sample group provided the counter-perspective of those who have trained and taught in both settings. It was found that teacher perceptions of how preschool and primary school differentiate have historical roots, and are orientated in the belief that the two settings apply incongruent approaches to teaching and learning. It was argued that gaining knowledge and experience in both settings could open up teachers' perceptions and assist them to find opportunities for improving continuity.

Estimating the risk of cardiovascular disease using an obese-years metric

OBJECTIVE: To examine the association between obese-years and the risk of cardiovascular disease (CVD).

STUDY DESIGN: Prospective cohort study.

SETTING: Boston, USA.

PARTICIPANTS: 5036 participants of the Framingham Heart Study were examined.

METHODS: Obese-years was calculated by multiplying for each participant the number of body mass index (BMI) units above 29 kg/m(2) by the number of years lived at that BMI during approximately 50 years of follow-up. The association between obese-years and CVD was analysed using time-dependent Cox regression adjusted for potential confounders and compared with other models using the Akaike information criterion (AIC). The lowest AIC indicated better fit.

PRIMARY OUTCOME CVD RESULTS: The median cumulative obese-years was 24 (range 2-556 obese-years). During 138,918 person-years of follow-up, 2753 (55%) participants were diagnosed with CVD. The incidence rates and adjusted HR (AHR) for CVD increased with an increase in the number of obese-years. AHR for the categories 1-24.9, 25-49.9, 50-74.9 and ≥75 obese-years were, respectively, 1.31 (95% CI 1.15 to 1.48), 1.37 (95% CI 1.14 to 1.65), 1.62 (95% CI 1.32 to 1.99) and 1.80 (95% CI 1.54 to 2.10) compared with those who were never obese (ie, had zero obese-years). The effect of obese-years was stronger in males than females. For every 10 unit increase in obese-years, the AHR of CVD increased by 6% (95% CI 4% to 8%) for males and 3% (95% CI 2% to 4%) for females. The AIC was lowest for the model containing obese-years compared with models containing either the level of BMI or the duration of obesity alone.

CONCLUSIONS: This study demonstrates that obese-years metric conceptually captures the cumulative damage of obesity on body systems, and is found to provide slightly more precise estimation of the risk of CVD than the level or duration of obesity alone.