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BACKGROUND: The aim of the study was to demonstrate the efficacy of human muscle stem cells (MuSCs) isolated using innovative technology in restoring internal urinary sphincter function in a preclinical animal model. METHODS: Colonies of pure human MuSCs were obtained from muscle biopsy specimens. Athymic rats were subjected to internal urethral sphincter damage by electrocauterization. Five days after injury, 2 × 10(5) muscle stem cells or medium as control were injected into the area of sphincter damage (n = 5 in each group). Peak bladder pressure and rise in pressure were chosen as outcome measures. To repeatedly obtain the necessary pressure values, telemetry sensors had been implanted into the rat bladders 10 days prior to injury. RESULTS: There was a highly significant improvement in the ability to build up peak pressure as well as a pressure rise in animals that had received muscle stem cells as compared to control (p = 0.007) 3 weeks after the cells had been injected. Only minimal histologic evidence of scarring was observed in treated rats. CONCLUSION: Primary human muscle stem cells obtained using innovative technology functionally restore internal urethral sphincter function after injury. Translation into use in clinical settings is foreseeable.

Background: Nursing students in Canada are typically enrolled in a four-year bachelor degree program that provides students with the necessary skills and knowledge to enter a highly demanding and challenging workforce. Strong critical thinking, clinical reasoning, and clinical judgment skills are essential skills for safe nursing practice. Therefore, educational institutes and their mentors are mandated to teach and assess these skills. In addition, nursing programs operate under an apprenticeship model, which entails the fulfillment of practical experience during which students are expected to develop and refine their skills in critical thinking, clinical reasoning, and clinical judgment. Purpose: The purpose of this scoping review of the literature is to assess the available evidence of how higher-level thinking, including critical thinking, clinical reasoning, and clinical judgment are evaluated in undergraduate nursing students in clinical settings. Methods: The inclusion criteria consisted of quantitative research articles published in the last 10 years. Search databases accessed included CINAHL Plus (EBSCO), Medline, and PubMed. Results: Seven articles that fit the inclusion criteria became the focus of this scoping review. Four tools to evaluate higher-thinking processes in clinical settings were located and scrutinized: Lasater Clinical Judgment Rubric (LCJR), Script Concordance Testing, and Yoon’s Critical Thinking Disposition Instrument. Relevance to Practice: The scoping review will provide direction and contextualize future studies that focus on the appraisal of nursing students’ critical thinking, clinical reasoning, and clinical judgment in clinical settings.

Die Energiewende setzt Regionen immer mehr unter Druck. Auf dem Weg in eine klimaneutrale Gesellschaft und zusätzlich befördert durch die angestrebte Unabhängigkeit von fossilen Energien aus Russland müssen die erneuerbaren Energien und Stromnetze massiv und beschleunigter denn je ausgebaut werden. Bei der Planung und Implementierung der Energie-Infrastrukturen kommt es jedoch immer wieder zu lokalen Konflikten, die heftig ausfallen können und lokale Gemeinschaften erzittern lassen. Wie sehen diese Konflikte aus, welche Dynamiken wohnen ihnen inne und welche Konsequenzen zeitigen sie? Die Konflikttheorie schreibt Disputen auch eine vitalisierende Kraft zu, doch scheinen Energiewende-Konflikte hemmend auf die Erreichung der Ausbauziele zu wirken. Offen bleibt, ob demokratische Potenziale im Sinne der agonistischen Demokratietheorie genutzt werden können. Diese könnten indes durch die Etablierung politischer Populismus-Narrative im Feld der Energiewende blockiert werden. Daher stellt sich die Frage, ob die Energiewende ein Spielfeld des Populismus geworden ist und ob lokale Konflikte populistisch geprägt sind? Der Beitrag liefert erste empirische Ergebnisse auf Grundlage der Analyse verschiedener Energiewende-Konflikte in Deutschland. Hierbei wird deutlich: Die Konflikte sind nicht nur sehr stark durch spezifische lokale Kontexte geprägt, sondern zeichnen sich durch ein hohes Maß an Heterogenität und Komplexität aus. Überdies kristallisieren sich mit Blick auf die Frage, wo und wie sich populistische Erzählungen erfolgreich durchsetzen können, Muster heraus, die hier erstmals beschrieben werden. Abschließend skizziert der Beitrag mögliche Ansatzpunkte für eine Konfliktbearbeitung und bietet einen Ausblick auf zukünftige Forschungsperspektiven.

Critical illness myopathy (CIM) is an acquired, devastating, multifactorial muscle-wasting disease with incomplete recovery. The impact on hospital costs and permanent loss of quality of life is enormous. Incomplete recovery might imply that the function of muscle stem cells (MuSC) is impaired. We tested whether epigenetic alterations could be in part responsible. We characterized human muscle stem cells (MuSC) isolated from early CIM and analyzed epigenetic alterations (CIM n = 15, controls n = 21) by RNA-Seq, immunofluorescence, analysis of DNA repair, and ATAC-Seq. CIM-MuSC were transplanted into immunodeficient NOG mice to assess their regenerative potential. CIM-MuSC exhibited significant growth deficits, reduced ability to differentiate into myotubes, and impaired DNA repair. The chromatin structure was damaged, as characterized by alterations in mRNA of histone 1, depletion or dislocation of core proteins of nucleosome remodeling and deacetylase complex, and loosening of multiple nucleosome-spanning sites. Functionally, CIM-MuSC had a defect in building new muscle fibers. Further, MuSC obtained from the electrically stimulated muscle of CIM patients was very similar to control MuSC, indicating the impact of muscle contraction in the onset of CIM. CIM not only affects working skeletal muscle but has a lasting and severe epigenetic impact on MuSC.

Children negotiate their lives through the narratives to which they are exposed in digital, print and oral form. The Rose’s Story app project drew on a philosophy that positions children as social agents. We used the social and contextual elements underlying children’s experiences with technology to develop a digital app for young children from the Australian military community by leveraging family narratives to portray children’s agency. Data to develop the app was taken from a 2017 study involving 2 to 5 year-old children from 11 Australian Defence Force families. Findings from the Rose’s Story app project can be applied practically to impact the well-being of children from military families, their parents, educators, and the broader community by increasing understanding and empathy. This article outlines effective ways to utilize a productive medium for children’s voices to be heard, as well as identifies potential barriers.

Home dialysis (peritoneal dialysis (PD) and home haemodialysis (HHD)) are ideal options for kidney replacement therapy (KRT). Occasionally, because of technique failure, patients are required to transition out of home dialysis, and the most common option tends to be to in-centre HD. There are few published studies on home-to-home transition (PD to HHD or HHD to PD) and dynamics during the transition period. We present a retrospective review of 28 patients who transitioned from a home-to-home dialysis modality at our centre over a 24-year period. We observed a total of 911 home dialysis patients with technique failure (826 PD patients and 85 HHD patients) with only 28 patients (3% of the total with technique failure) having successful home-to-home transition. During the transition period, 11 patients (39%) were hospitalized and 13 patients (46%) required variable periods of in-centre HD. After a median follow-up of 48 months following dialysis modality transition, four patients switched to in-centre HD permanently (home dialysis technique survival of 86% censored for death and kidney transplantation) and four patients died resulting in a patient survival of 86% (censored for switch to in-centre HD and transplantation). In our centre, home-to-home transition is a feasible strategy with comparable patient and technique survival. A significant proportion of patients switching from a home-to-home dialysis modality required variable intervals of hospitalization and in-centre HD during transitions. Future efforts should be directed towards assessment and home dialysis education during the entire process of dialysis transition.

“If you fail to plan, you are planning to fail” It is often suggested that failure to plan is tantamount to a plan for failure. In our clinical experience, we have not come across a clinician who c...

Introduction Regarding pediatric diabetes, hospital admission for acute complications of type 1 diabetes (T1D) has often been investigated, but little is known about other causes of hospitalization. This study aimed to explore the total burden of hospitalization in individuals with diabetes Methods Using the German Diagnosis-Related Groups data for 2015, we examined the frequencies of hospitalization with diabetes (20 251 inpatient cases), stratified by diabetes type [T1D, type 2 diabetes (T2D), other specified diabetes types (T3D), and unclear diabetes], and without diabetes (1 269 631 inpatient cases). Using estimates of the population at risk with T1D, T2D, and without diabetes, we evaluated hospitalization rates (per patient-year) by Poisson regression. For T1D, T2D, and T3D, we investigated the most frequent diagnoses and the median length of stay. Most analyses were stratified by sex, age-group and east/west residence. Results Children and adolescents with diabetes had a 6 to 9 times higher hospitalization risk than peers without diabetes (hospitalization rate 0.09). The hospitalization rate was higher for T2D compared with T1D (0.84 vs. 0.53, P Conclusion Hospitalization rate in pediatric diabetes in Germany remained high, especially for T2D patients, girls with T1D, and young children.

There are many barriers that prevent people from receiving human immunodeficiency virus (HIV) testing; however, little is known about the impact of age and ethnicity on HIV testing. We explored differences in self-reported HIV risk and willingness to be tested in the 2014 Get Tested Coachella Valley Community Survey by age and ethnicity. Data were collected from 995 participants via survey methods (online, hard copy, and in person). Surveys asked about demographics, sexual history, HIV testing history, thoughts on who should get tested, and future preferences for HIV testing. Most participants were women (62.5%), Hispanic (55.8%), and older than 50 years (51%). Participants who did not receive testing said they did not do so because they did not perceive themselves as at risk of contracting HIV (51.8%). Many participants (24.1%) said they did not receive testing because their health care provider never offered them the HIV test. Participants were more likely to have been tested if they were between 25 and 49 years old, compared to participants aged 50 or older (70.2% vs 48.6%, respectively, P

Background: To investigate the potential of human satellite cells in muscle regeneration small animal models are useful to evaluate muscle regeneration. To suppress the inherent regeneration ability of the tibialis muscle of mice before transplantation of human muscle fibers, a localized irradiation of the mouse leg should be conducted. We analyzed the feasibility of an image-guided robotic irradiation procedure, a routine treatment method in radiation oncology, for the focal irradiation of mouse legs. Methods: After conducting a planning computed tomography (CT) scan of one mouse in its customized mold a three-dimensional dose plan was calculated using a dedicated planning workstation. 18 Gy have been applied to the right anterior tibial muscle of 4 healthy and 12 mice with immune defect in general anesthesia using an imageguided robotic linear accelerator (LINAC). The mice were fixed in a customized acrylic mold with attached fiducial markers for image guided tracking. Results: All 16 mice could be irradiated as prevised without signs of acute radiation toxicity or anesthesiological side effects. The animals survived until scarification after 8, 21 and 49 days as planned. The procedure was straight forward and the irradiation process took 5 minutes to apply the dose of 18 Gy. Conclusions: Localized irradiation of mice legs using a robotic LINAC could be conducted as planned. It is a feasible procedure without recognizable side effects. Image guidance offers precise dose delivery and preserves adjacent body parts and tissues.

Canadian Association of General Surgeons, the American College of Surgeons, the Canadian Society of Colorectal Surgeons, and the American Society of Colorectal Surgeons Evidence Based Reviews in Surgery : Colorectal Surgery

ObjectiveTo investigate HLA-DR genotype in association with chronological age or calendar year of disease onset and the time trend of genotype frequencies from 1969 to 2009. Additionally, to examine genotype frequency in relation to B-cell-, islet cell antibodies (ICA)-, autoantibodies to insulin-, insulinoma antigen 2 (IA2)-, glutamic acid decarboxylase-antibody positivity, thyroid antibody positivity, thyroid diseases or coeliac antibody positivity. Genotype associations with gender and ethnicity are also analyzed.Subjects and methodsHLA-typed children and juveniles (n=1445) aged ≤20 years at disease onset from the German/Austrian DPV-database were examined.χ2statistics and mixed hierarchical logistic regression models were used to compare genotype frequencies and establish associations with age at disease manifestation, autoimmune antibodies/diseases, ethnicity and time trend.ResultsSubjects aged 12 years the most prevalent HLA-DR genotype was X/X (18.1%). IA2 positivity was associated with HLA-DR4/X and HLA-DR3/4 positivity (P=0.011), and hypothyroidism was linked to HLA-DR4/4 (P=0.0103). More females carried the HLA-DR4/4 genotype (18.2 vs 12.7%P=0.0048) or were thyroid antibody positive (24.5 vs 14.7%P=0.0001). Larger numbers of 12 year olds (14.8 vs 9.1%P=0.0037). No associations between migration background and B-cell-, thyroid- or coeliac-antibody positivity, and no time trend were found.ConclusionHLA-DR genotype associated with age at disease onset, ICA positivity and hypothyroidism; female gender with thyroid antibody positivity and low age of diabetes onset with coeliac antibody positivity.

Eye examinations by optometrists and ophthalmologists can be aided by both human and computer assistants for an ultimate lower cost and greater availability. A time study of practising optometrists is used to indicate how the assistants can best be used and the time savings gained. The relative roles of optometry and ophthalmology in visual care may be affected by the general use of human and computer assistants.

Objective This study aimed to describe mental healthcare providers’ attitudes about tobacco use, their personal smoking status, their confidence in offering smoking cessation support to clients living with severe mental illness, and the extent to which they incorporated smoking cessation interventions into their practice. The study also aimed to determine whether the providers’ attitudes, smoking status, and confidence were associated with offering smoking cessation support to clients. Methods Self-administered questionnaires were distributed within community-based mental health agencies to those who provide care and support to adults living with severe mental illness. Outcomes measured included respondents’ smoking status, attitudes related to the provision of smoking cessation support, confidence in providing smoking cessation intervention, and smoking cessation practices. We conducted multivariate analyses using logistic regression analyses to examine the factors associated with the providers’ tobacco-related practices. Results In total 282 of 871 care providers responded to the survey, 22% of whom were current smokers. The providers who held sympathetic attitudes about their role and their clients’ role in smoking cessation, who were never or former smokers, who were healthcare professionals rather than paraprofessionals, who had relatively more confidence, and who had more experience working in the mental health field were more likely to engage their clients in tobacco-related interventions. Conclusions In this study the healthcare providers working in community-based mental health have a smoking prevalence rate that exceeds that of the region's general population and did not provide optimal smoking cessation support to their clients. Practice implications Interventions that bolster the confidence of providers to engage is smoking cessation activities and that support a shift in attitudes about the role of tobacco use in mental health are required.

Since the description of the toxic shock syndrome as a disease entity approximately 700 cases have been reported, mainly in young women during their period using tampons. The cause is thought to be toxins of Staph. aureus. The disease was now observed in a 13-year-old girl, presenting as severe acute septicaemia. The aetiopathogenetic connection with use of tampons could only be established during a second, entirely identical, illness, occurring again precisely 3 days after the onset of the following period.

OBJECTIVE To review the incidence and type of disposition of diabetic emergencies treated in the community by paramedic services. METHOD All paramedic records over a 1 year period for a regionally operated emergency medical service (EMS) in Halton, Ontario, were reviewed for ambulance calls involving diabetic emergencies or capillary blood glucose (CBG) level RESULTS There were 31 171 ambulance calls during the 1 year review period. 3.8% of ambulance calls (1169/31 171) met the inclusion criteria of being coded as a diabetic emergency or involving a CBG CONCLUS ION Paramedics treat a significant number of people with diabetic emergencies in the community and do not transport them to emergency departments. Analysis using only emergency department data may significantly underestimate the incidence of hypoglycemia in the community.We raise the point that there may be more hypoglycemic events in the community that require the assistance of a second party than is demonstrated by emergency room data alone. Further study of the incidence of hypoglycemia in the community is required.

Background Long term care homes (LTC) in Canada have become a major location of death with 20% or more residents dying each year. Given the increasing age and frailty of residents, this is soon expected to increase to 40%. LTC has struggled to incorporate care of the dying into their day to day practice and culture because death is often absent from formalised policy and protocols. Aim This workshop will share resources created during a 5 year participatory action research project in Ontario, Canada that aimed to improve the quality of life of people who were dying in long term care homes. Methods Through staff participation and empowerment, a process of organisational capacity development was undertaken. An extensive needs assessment was followed by creating an interprofessional palliative care resource team within each home. This team assessed the assets and gaps in their home and guided development of education, policy and clinical practices to address needs. Community partners with expertise in palliative care were engaged to support staff. Results A framework for palliative care in LTC integrates the palliative approach into the residents’ journey from admission to death. Resources for organisational change were developed and organised into a toolkit that is unique to the LTC setting and context, and can be accessed at www.palliativealliance.ca Conclusion The Quality Palliative Care in Long term Care Toolkit is the first of its kind in Canada. The toolkit can guide LTC management and staff through a process of culture change to incorporate a palliative approach to care.

In this conversation rhizoanalysis is introduced as a way of processing through an assemblage involving research methodology, generation of data and analytical possibilities entwined within. As a research methodology, rhizomethodology (Author, 2009) is a way of putting the Deleuzo-Guattarian philosophical imaginary of rhizome (Deleuze & Guattari, 1987) to work; it is a way of working (with) data, complexly. With/in/alongside this methodological approach, the rhizoanalysis becomes the inquiry of the research, happening throughout the whole research process. The analysis is not a constant thing relegated to a place of its own, rather, the rhizoanalysis as ‘some of rhizome’ (Deleuze & Guattari, 1987, p. 9) happens throughout. With/in/through processes of thinking rhizome in flux, working rhizome (im)provis(at)ionally is an ongoing experiment with and exploration of my own thinking. Rhizoanalysis (dis)continuously (e)merges with/in/through every dimension of the thinking, ebbing and flowing with/in/through matters of always already becoming so that writing (about) rhizoanalysis is also affected by writing (the) methodology and doing (the) rhizoanalysis; nothing was/is separate or linear in the thinking or writing up~down of the research project drawn on here. Rather, there was/is an ongoing intermingling of data, methodology and analysis with theorising the literature and practicing the theory, each becoming the other(s).

The workloads, study methods, and motivation of students in a five-year BVSc program were studied using questionnaires and focus groups. Students in each year of the program were asked, on three occasions over an academic year, to record details of their out-of-class study time for each course they were taking and to record the study methods they used, how they prioritized their time between subjects, and how they allocated time to study and leisure activities. Mean response rates were 57% (range: 43–85%). Overall mean out-of-class study time ranged from 19 hours per week in Year 2 to 28 hours per week in Year 4. Study time was related to the level of interest the student had in the subject, the demands of assessments, and the number of subjects being studied. Study methods were related to students’ perceptions of the requirements of the subject as well as to their interest in it. Reliance on memorization and the use of set study materials were the predominant methods for courses with low interest scores, whereas higher interest was associated with a broad range of study methods. Leisure time was ring-fenced, especially when workloads were high. Students’ motivation was high when they were studying subjects that were new or were seen as relevant to clinical practice; when working with animals or with enthusiastic faculty members; and when involved in subjects more tightly focused on the ultimate goal of becoming a practitioner. It was poor when students were faced with high workloads, disciplines becoming “stale,” excessive detail, and low perceptions of relevance. Constant assessment activities were also seen as a burden. In terms of good learning practices, workload and the demands of assessment were considered to be antagonistic. A tension between these perceptions of students and the values of faculty in terms of the development of critical thinking skills in the program is evident.

This study evaluated the suitability of invA gene amplification by PCR as an effective means of detecting Salmonella species in pigs experimentally infected with S. Typhimurium DT104. A controlled infection study using 24 pigs was performed in order to compare efficacy, precision and detection rates of the invA-based PCR method originally described by Rahn, K. De Grandis, S.A., Clarke, R.C., McEwan, S.A., Galan, J.E., Ginocchio, C., Curtiss, R. 3rd, C.L. Gyles, (Mol. Cell. Probes 1992; 6: 271-279) as a new in-house invA-based PCR method for the specific detection of Salmonella spp. in pork and different tissue samples of slaughter pigs. Finally, PCR results were compared with culture detection rates obtained by isolation procedures following the ISO 6579:2000, the 'gold standard'. After slaughtering, 14 different tissue samples of each pig were investigated to verify the usefulness of the two invA-based PCR methods in different matrices of slaughter pigs. The results demonstrate that the application of the widely used invA-based primer pair (139 + 141) may result in questionable products if samples gained from selective enrichment in the Rappaport-Vassiliadis medium were investigated. These questionable products can lead to false-positive results, if no additional hybridization procedure is attached or if unspecialized persons use this method in routine laboratory practice. The newly developed in-house PCR method used is based on the 3'-prime region of invA, especially designed and harmonized for the detection of Salmonella in different matrices of slaughtered pigs after bacterial enriched broth culture. In this study, this PCR revealed no questionable products and, furthermore, the specificity of the amplificate could be tested by means of the restriction enzyme NdeI. In comparison with the culture detection procedure, the new PCR method has a sensitivity of 100% and a specificity of 96%. Thus, this method might be used as a meaningful tool in eliminating Salmonella-positive carcasses at slaughterhouse level and thus, keeping them out of the food chain.

Uterine fibroids (UF) represent the most common benign uterine tumor in women of reproductive age. Symptoms including heavy, prolonged menstrual bleeding, pelvic pain/pressure, and/or urinary frequency have a substantial impact on women's quality of life and utility values for UF have not been published.Health state descriptions associated with UF symptoms and treatment side effects were developed based on patient focus groups; validated using expert clinical input; and pilot tested for understandability. Using a web-based questionnaire, 909 community-dwelling, Canadian women were surveyed to assess their perceived value associated with these states.Utility for uncontrolled bleeding was 0.55 (95% CI: 0.54, 0.57) and the decrement associated with hot flashes was 0.06 (95% CI: -0.07, -0.04). Utility improvement associated with bleeding control was 0.18 (95% CI: 0.17, 0.19) and with smaller fibroid size was 0.03 (95% CI: 0.02, 0.04).These values illustrate the high utility associated with control of excessive menstrual bleeding.

The following recommendations are directed to all professional and vocational groups which take care of and support children and adolescents with diabetes, as well as their families. It is also directed to higher level organisations, such as health insurers, which deal with diabetes. This guideline concentrates on the specifics for this age group which are not described in the DDG’s general guidelines for the therapy of type 1 diabetes, or are described there, but somewhat differently [1]. As stated in the specifications of the health ministries of Germany’s states and in keeping with the current practice of many clinics, this paediatric guideline applies to all diabetes patients who are not yet 18 years of age. In individual clinical cases this guideline can also be used for young adults.

Knowledge, as it relates to scholarship, has traditionally been developed through research, which for years was viewed as the sole method of knowledge generation. An expanded view of scholarship was proposed by Boyer, and includes the scholarship of discovery, integration, teaching, and application. This broader framework of scholarship is more suited to today's world. The aim of this paper is to provide clarification regarding the definition and criteria of scholarship and the differences between scholarly activities and scholarship. Nurses are held to the same standards of knowledge generation as other disciplines. There should be clarity on differentiating scholarly activities from scholarship.

In this study, interferon-gamma (IFN-gamma) responses in whole blood cultures stimulated with tuberculins from different sources were compared with regard to their diagnostic reliability in cattle experimentally and naturally infected with Mycobacterium bovis. The IFN-gamma responses to different concentrations of purified protein derivatives (PPDs) from M bovis and Mycobacterium avium were quantified. Significant differences (P0.05) between sources and concentrations of PPDs used for stimulation were detected, indicating a need for standardisation of PPDs used in the IFN-gamma assay. Additionally, a tool named'relative potency 30' that allows rapid comparison of batches and sources of PPDs was defined.

This paper examines the transition from veterinary student to practitioner, in the context of assessing the outcomes of the veterinary degree program in which the students were trained. Questionnaires were sent to all registered veterinarians who graduated from Massey University between 2001 and 2003 and the heads of human resources of all veterinary practices in New Zealand. These groups, together with veterinarians who had graduated from Massey University between 1993 and 2000, were also invited to participate in focus groups or interviews. Replies were received from 64 graduates and 114 employers. In addition, 115 veterinarians were interviewed or joined focus groups. Most participants thought that the veterinary degree program at Massey University provided a strong basis in scientific theory and clinical reasoning, but was lacking in communication skills training. Clinical exposure was regarded as less than optimal, but adequate for starting practice and as much as could be achieved within the duration of the program. Graduates and employers both recognized the pivotal importance of the first year in practice in the careers of veterinarians. Most graduates had positive experiences of their first year, but for those whose experiences were negative, they were often strongly so. Situations in which confidence and clinical competence could be developed in a supportive environment were associated with positive outcomes. The first year after graduation was regarded by graduates and employers as a “make or break” period. Many of the changes that the veterinary profession is currently experiencing, particularly in terms of the demographics of its entrants, impact upon this first post–graduation year.

What follows is my rhizopoiesis, a conjoining of Trueit's (2006) Play which is more than play and my ideas, nomadically -rhizomatically generating a further disruption of ideas about play as presented in the early childhood literature. My reading-writing-thinking can be perceived, both abstractly and with/in the actual, as a "vertical dimension of intensities" (Foucault, 1977, cited in Hand, 1988, p. xliv). To disrupt a conventional interpretation of Trueit's article, I transpose selections of her rather lyrical text into a poietic format, as a way of opening (her) ideas to a rhizomatic understanding of children's play. Centering the text disturbs any regression into a linearly focussed reading. By virtue of what I have included and what I have left out, the re-presentation inevitably reflects my subjective partiality of my understandings of her text, and associated limitations-"Are we not subject to our own limited "understandings" as we impose our interpretations on others?" (Smitherman Pratt, 2006, p. 91). Another (re)reading on another day and I might change what is/not included-"understanding is always changing, in flux, continually being renewed" (p. 93). This (re)reading/writing is processual; I have no idea before doing it what I might find, what might be revealed, what understandings might emerge. Similar to Richardson (1997), I feel the urge to step aside from the dreary writing of ordinary academic prose; to enact "a threshold occasion: a moment of ecstasies when something moves away from its standing as one thing to become another."1 I thus play with the idea of playing with Trueit's text to see what happens, what spaces of possibilities might open.

Background Studies have provided little evidence that critical appraisal skills improve with focused courses. However, outcome measures in these studies have been questionable. The goal of this study was to develop a feasible, reliable, and valid assessment of critical appraisal skills. Methods Forty-four surgery residents read three articles and then responded to short answer questions and provided 7-point ratings regarding various methodological aspects of each article. Reliability and validity of the examination were assessed. Results The mean score was 52.4% (SD 8.6%). Internal consistency of the 55-question examination was 0.77. Interrater reliability of clinician markers was 0.91. Mean score for residents with more intensive critical appraisal training was significantly higher than for those with little or no training (56.6% versus 49.3%, t 35 = 2.31, P = 0.02), suggesting construct validity. Conclusions This examination has promising psychometric properties, and may be useful in evaluating critical appraisal curricula.

Peace education was engendered by the Cold War, and with the thawing of East-West relations the educational interest in peace also dissipated. However, recent events have revoked the calm and initiated a global war against terrorism. In this paper I revisit the role of peace in education to rediscover and re-present how peaceful perspectives are inherent in learning and teaching. I outline a peaceful interpretation of the curriculum and suggest that a mandate for this perspective should be a priority.

The interactions of Mn2+ and Co2+ with glucose isomerases from three microbial sources have been studied using various direct physical methods. Co2+ was found to activate each enzyme, although the degree of activation varied significantly for enzymes from different organisms. EPR spectroscopy measurements revealed that dissimilarities in the coordination sphere of enzyme-bound Mn2+ accompanied the differences in enzyme activity. Variations in the EPR spectra of a nitroxide spin label coupled to two of the three isomerases, possibly near their active sites, were also observed. In no case was the EPR spectrum influenced by Co2+ addition, a result discordant with the hypothesis that Co2+ activates the enzyme by inducing a conformational change. The proximal biochemical environment of enzymebound Co2+ was also examined using EXAFS spectroscopy. This method showed that glucose causes notable changes in the ligand environment of the enzyme-bound metal, suggesting the formation of an enzyme-metal-substrate bridge complex. The significance of these results relative to possible reaction mechanisms is discussed.