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CONTEXT: Pain can be a debilitating side effect of radiation therapy (RT). Data from the general population has shown that sleep disturbance can influence pain incidence and severity; however, less is known about this relationship in breast cancer patients receiving RT. OBJECTIVES: This secondary analysis examined the association of pre-treatment moderate/severe levels of sleep disturbance with subsequent RT-induced pain after adjusting for pre-RT pain. METHODS: We report on 573 female breast cancer patients undergoing RT from a previously completed phase II clinical trial for radiation dermatitis. Sleep disturbance, total pain, and pain subdomains – sensory pain, affective pain, and perceived pain intensity were assessed at pre- and post-RT. At pre-RT, patients were dichotomized into 2 groups: those with moderate/severe sleep disturbance (N=85) vs. those with no/mild sleep disturbance (control; N=488). RESULTS: At pre-RT, women with moderate/severe sleep disturbance were younger, less likely to be married, more likely to have had mastectomy and chemotherapy, and more likely to have depression/anxiety disorder and fatigue than the control group (all p’s

Context is usually conceptualized as external to a theory or model and treated as something to be controlled or eliminated in empirical research. We depart from this tradition and conceptualize context as permeating processual phenomena. This move is possible because digital trace data are now increasingly available, providing rich and fine-grained data about processes mediated or enabled by digital technologies. This paper introduces a novel method for including fine-grained contextual information from digital trace data within the description of process (e.g., who, what, when, where, why). Adding contextual information can result in a very large number of fine-grained categories of events, which are usually considered undesirable. However, we argue that a large number of categories can make process data more informative for theorizing and that including contextual detail enriches the understanding of processes as they unfold. We demonstrate this by analyzing audit trail data of electronic medical records using ThreadNet, an open source software application developed for the qualitative visualization and analysis of process data. The distinctive contribution of our approach is the novel way in which we contextualize events and action in process data. Providing new, usable ways to incorporate context can help researchers ask new questions about the dynamics of processual phenomena.

Resistance to the pandemic strain of Austropuccinia psidii was identified in New Zealand provenance Leptospermum scoparium, Kunzea robusta, and K. linearis plants. Only 1 Metrosideros excelsa-resistant plant was found (of the 570 tested) and no resistant plants of either Lophomyrtus bullata or L. obcordata were found. Three types of resistance were identified in Leptospermum scoparium. The first two, a putative immune response and a hypersensitive response, are leaf resistance mechanisms found in other myrtaceous species while on the lateral and main stems a putative immune stem resistance was also observed. Both leaf and stem infection were found on K. robusta and K. linearis plants as well as branch tip dieback that developed on almost 50% of the plants. L. scoparium, K. robusta, and K. linearis are the first myrtaceous species where consistent infection of stems has been observed in artificial inoculation trials. This new finding and the first observation of significant branch tip dieback of plants of the two Kunzea spp. resulted in the development of two new myrtle rust disease severity assessment scales. Significant seed family and provenance effects were found in L. scoparium, K. robusta, and K. linearis: some families produced significantly more plants with leaf, stem, and (in Kunzea spp.) branch tip dieback resistance, and provenances provided different percentages of resistant families and plants. The distribution of the disease symptoms on plants from the same seed family, and between plants from different seed families, suggested that the leaf, stem, and branch tip dieback resistances were the result of independent disease resistance mechanisms.

Patient-reported outcome (PRO) measures play an important role in clinical care. Currently, a broad-spectrum, validated PRO measure suitable for all dermatology patients, as part of clinical care, does not exist. Patient-reported Outcome Measures Information System (PROMIS) measures track specific domain outcomes across all diseases. To assess the relevance and utility of a computer-adaptive health assessment consisting of three PROMIS domains in routine dermatologic care. This retrospective study evaluated a PROMIS health assessment, consisting of three computer-adaptive test domains (pain interference, anxiety, and depression), administered as part of routine clinical care in three dermatology clinics at an academic medical center. The primary objective was to identify clinically significant associations between high PROMIS domain scores (i.e., t score > 55) and dermatologic disease, as well as change in PROMIS domain scores in response to treatment. The majority of patients who initiated the assessment completed all domains (88.7%). In patients with atopic dermatitis, acne, hidradenitis suppurativa, and psoriasis, high PROMIS scores correlated with clinically relevant outcomes, such as severe disease, unsuccessful treatment, uncontrolled disease, and the presence of a mental health condition. PROMIS Pain Interference, anxiety and depression identified patients with severe disease, unsuccessful treatment regimens, poorly-controlled disease, and/or mental health comorbidities for multiple skin conditions. Further utilization of PROMIS domains in routine clinical care will promote patient-centered care and improve quality of care.

Radiation dermatitis (RD) is a common side effect of radiation therapy (RT). While many different treatment strategies are currently used to address RD, there is a lack of consensus and RD prophylaxis and management guidelines have remained largely unchanged over the last 10 years. This review aims to formulate unambiguous supportive care interventions by comparing RD clinical practice guidelines published between 2010 and 2021 by several organizations: Multinational Association for Supportive Care in Cancer (MASCC), British Columbia Cancer Agency (BCCA), Cancer Care Manitoba (CCMB), Oncology Nursing Society (ONS), Society and College of Radiographers (SCoR), and International Society of Nurses in Cancer Care (ISNCC).Areas of agreement and discordance were assessed among the MASCC, BCCA, CCMB, ONS, SCoR, and ISNCC guidelines.Treatment recommendations across guidelines for acute RD and chronic RT-induced skin toxicities have been summarized. The strongest agreement among the guidelines exists for the use of topical corticosteroids, silver sulfadiazine, washing, and deodorant. All guidelines recommend the use of topical corticosteroids, and washing with water and soap is consistently supported. There is minimal consensus on an optimal dressing or barrier film for RD prophylaxis or management. MASCC weakly recommends prophylactic use of silver sulfadiazine to reduce RD, while BCCA, CCMB, and SCoR recommend its use upon signs of infection. MASCC and CCMB recommend the use of a long-pulsed dye laser to manage telangiectasia, a late effect of RT.Given the extent of discordance among guideline recommendations, further research is recommended to establish optimal treatments for RD prophylaxis and management.

We argue that the distinction between dialogue (after Bakhtin) and dialectics(after Hegel, Marx, Vygotsky), is of key importance to learning-teaching and tomathematics education. Some followers of Bakhtin have argued that theseconcepts are irreconcilable, or incompatible, since dialectics implies anddialogism implicitly denies the requirement of telos (i.e., a targeted endpoint). Onthe contrary, we argue for compatibility; dialogism can allow for the progressimplied by dialectics, but its teleology is inherent in its efficacy in practice ratherthan in any pre-defined endpoint. We show how a mathematical or professionaldialogue can involve dialectical negations and supersession, thus providing forprogress or development, without loss of dialogism. Our case is taken from alesson study in which progress emerging from classroom and staffroom dialoguesis interpreted in dialectical terms as developmental. The connection withVygotsky’s theory of concepts in learning-teaching and the possiblegeneralization of the argument are discussed. We conclude that the key momentson which concept development turns are: (1) the negation by multiple, livedpractices, and (2) the creative, speculative, supersession of inadequate concepts,in appropriate dialogues.

Our Developing Perioperative Practice service improvement project, sponsored by the Royal Bournemouth Hospital, addressed whether the remarkably simple idea of putting names and roles on hats in theatre would improve communication and patient care. We were inspired by our own experiences as a group of student Operating Department Practitioners: unfamiliarity with members of the team, wanting to feel included in the work but not out of our depth, and by social media campaigns such as the ‘#TheatreCapChallenge’ and ‘#hellomynameis’, aiming to humanise care and increase patient safety. Researching, clinically trialling and presenting this project gave us a systematic approach to improving the quality of care within the theatre environment.

Resistance to the pandemic strain of

Patient-reported outcome (PRO) measures play an important role in clinical care. Currently, a broad-spectrum, validated PRO measure suitable for all dermatology patients, as part of clinical care, does not exist. Patient-reported Outcome Measures Information System (PROMIS) measures track specific domain outcomes across all diseases. To assess the relevance and utility of a computer-adaptive health assessment consisting of three PROMIS domains in routine dermatologic care. This retrospective study evaluated a PROMIS health assessment, consisting of three computer-adaptive test domains (pain interference, anxiety, and depression), administered as part of routine clinical care in three dermatology clinics at an academic medical center. The primary objective was to identify clinically significant associations between high PROMIS domain scores (i.e., t score 55) and dermatologic disease, as well as change in PROMIS domain scores in response to treatment. The majority of patients who initiated the assessment completed all domains (88.7%). In patients with atopic dermatitis, acne, hidradenitis suppurativa, and psoriasis, high PROMIS scores correlated with clinically relevant outcomes, such as severe disease, unsuccessful treatment, uncontrolled disease, and the presence of a mental health condition. PROMIS Pain Interference, anxiety and depression identified patients with severe disease, unsuccessful treatment regimens, poorly-controlled disease, and/or mental health comorbidities for multiple skin conditions. Further utilization of PROMIS domains in routine clinical care will promote patient-centered care and improve quality of care.

A high-density linkage map was constructed for mānuka (Leptospermum scoparium) genotyping by sequencing (GBS) and a segregating population developed using accessions from the East Cape region of Ne...

PURPOSE: Despite advances in medical technology, radiation dermatitis occurs in 95% of patients receiving radiation therapy (RT) for cancer. Currently, there is no standard and effective treatment for the prevention or control of radiation dermatitis. The goal of the study was to determine the efficacy of oral curcumin, one of the biologically active components in turmeric, at reducing radiation dermatitis severity (RDS) at the end of RT, using the RDS scale, compared to placebo. METHODS: This was a multisite, randomized, double-blinded, placebo-controlled trial of 686 breast cancer patients. Patients took four 500 mg capsules of placebo or curcumin three times daily throughout their prescribed course of RT until one week post-RT. RESULTS: A total of 686 patients were included in the final analyses (87.5% white females, mean age = 58). Linear mixed model analyses demonstrated that curcumin did not reduce radiation dermatitis severity at the end of RT compared to placebo (B (95% CI) =0.044 (−0.101, 0.188), p=0.552). Fewer curcumin patients with RDS > 3.0 suggested a trend toward reduced severity (7.4% vs. 12.9%, p=0.082). Patient-reported changes in pain, symptoms, and quality of life were not statistically significant between arms. CONCLUSIONS: Oral curcumin did not significantly reduce radiation dermatitis severity compared to placebo. The skin rating variation and broad eligibility criteria could not account for the undetectable therapeutic effect. An objective measure for radiation dermatitis severity and further exploration for an effective treatment for radiation dermatitis is warranted.

PURPOSE: Although topical agents are often provided during radiation therapy, there is limited consensus and evidence for their use prophylactically to prevent or reduce radiation dermatitis. METHODS: This was a multi-site, randomized, placebo-controlled, blinded study of 191 breast cancer patients to compare the prophylactic effectiveness of three topical agents (Curcumin, HPR Plus™, and Placebo) for reducing radiation dermatitis and associated pain. Patients applied the topical agent to their skin in the radiation area site three times daily starting the first day of radiation therapy (RT) until 1 week after RT completion. RESULTS: Of the 191 randomized patients, 171 patients were included in the final analyses (87.5% white females, mean age = 58 (range = 36–88)). Mean radiation dermatitis severity (RDS) scores did not significantly differ between study arms (Curcumin = 2.68 [2.49, 2.86]; HPR Plus™ = 2.64 [2.45, 2.82]; Placebo = 2.63 [2.44, 2.83];p = 0.929). Logistic regression analyses showed that increased breast field separation positively correlated with increased radiation dermatitis severity (p = 0.018). In patients with high breast field separation (≥ 25 cm), RDS scores (Curcumin = 2.70 [2.21, 3.19]; HPR Plus™ = 3.57 [3.16, 4.00]; Placebo = 2.95 [2.60, 3.30];p = 0.024) and pain scores (Curcumin = 0.52 [− 0.28, 1.33]; HPR Plus™ = 0.55 [− 0.19, 1.30]; Placebo = 1.73 [0.97, 2.50]; p = 0.046) significantly differed at the end of RT. CONCLUSIONS: Although there were no significant effects of the treatment groups on the overall population, our exploratory subgroup analysis suggests that prophylactic treatment with topical curcumin may be effective for minimizing skin reactions and pain for patients with high breast separation (≥ 25 cm) who may have the worst skin reactions.

Business process mining algorithms discover processes from event logs that record sequences of events or actions. Typical event logs may or may not contain information about the attributes of the actions, such as the particular workstations used to carry out an action or the identity of the person performing the action. In this paper, we test the effect of action attributes on action sequence using data from electronic medical records at five dermatology clinics. We demonstrate that action sequence is influenced by attributes such as actors (who does what) and workstations (what is done where) that are not typically considered relevant to process flow control. We introduce a new metric – attribute alignment – that summarizes the extent to which actions are carried out with the same attributes throughout a process instance. If each action is always performed with the same attributes, attribute alignment is 100%. We discuss the implications and limitations of this finding for research and practice.

Previous research has demonstrated a relationship between family stability and adjustment, which is partially mediated by self-regulatory behavior (e.g., self-control). However, the relationships between family stability and time management, one aspect of self-regulation, and attention problems have not yet been explored. The present study investigates the associations between perceived family stability while growing up, current time management and attention problems, and it evaluates time management as a mediator of the relationship between family stability and attention problems in a sample of 292 emerging adults. Perceived family stability was assessed retrospectively using the Stability of Activities in the Family Environment, and current aspects of time management and attention problems were measured using the Time Management Questionnaire and Adult Self-Report, respectively. Using bootstrapping methods, results indicated that time management mediates the relationship between perceived family stability and attention problems. These findings suggest possible targets of prevention and intervention for attention problems.

In research on process organization studies, the concept of multiplicity is widely used, but a fundamental confusion about what process multiplicity means persists. As a result, we miss some of the potential of this concept for understanding process dynamics and process change. In this paper, we define process multiplicity as a duality of ‘one’ and ‘many’, and we conceptualize ‘the many’ as a space of possible paths encompassed by a process. We use the notion of paths to operationalize process multiplicity and make it accessible for empirical research. When we see process as a multiplicity, process change can be understood as expanding, shifting or contracting the space of possible paths. We suggest that this concept of process multiplicity also has implications for a range of other theoretical and practical topics, including standards, standardization and flexibility as well as process replication, management and resilience.

OBJECTIVES/SPECIFIC AIMS: The purpose of the present secondary data analysis was to examine the effect of moderate-severe disturbed sleep before the start of radiation therapy (RT) on subsequent RT-induced pain. METHODS/STUDY POPULATION: Analyses were performed on 676 RT-naïve breast cancer patients (mean age 58, 100% female) scheduled to receive RT from a previously completed nationwide, multicenter, phase II randomized controlled trial examining the efficacy of oral curcumin on radiation dermatitis severity. The trial was conducted at 21 community oncology practices throughout the US affiliated with the University of Rochester Cancer Center NCI’s Community Oncology Research Program (URCC NCORP) Research Base. Sleep disturbance was assessed using a single item question from the modified MD Anderson Symptom Inventory (SI) on a 0–10 scale, with higher scores indicating greater sleep disturbance. Total subjective pain as well as the subdomains of pain (sensory, affective, and perceived) were assessed by the short-form McGill Pain Questionnaire. Pain at treatment site (pain-Tx) was also assessed using a single item question from the SI. These assessments were included for pre-RT (baseline) and post-RT. For the present analyses, patients were dichotomized into 2 groups: those who had moderate-severe disturbed sleep at baseline (score≥4 on the SI; n=101) Versus those who had mild or no disturbed sleep (control group; score=0–3 on the SI; n=575). RESULTS/ANTICIPATED RESULTS: Prior to the start of RT, breast cancer patients with moderate-severe disturbed sleep at baseline were younger, less likely to have had lumpectomy or partial mastectomy while more likely to have had total mastectomy and chemotherapy, more likely to be on sleep, anti-anxiety/depression, and prescription pain medications, and more likely to suffer from depression or anxiety disorder than the control group (all p’s≤0.02). Spearman rank correlations showed that changes in sleep disturbance from baseline to post-RT were significantly correlated with concurrent changes in total pain (r=0.38; pr=0.35; pr=0.21; pr=0.37; pr=0.35; pp=0.006). Generalized linear estimating equations, after controlling for baseline pain and other covariates (baseline fatigue and distress, age, sleep medications, anti-anxiety/depression medications, prescription pain medications, and depression or anxiety disorder), showed that patients with moderate-severe disturbed sleep at baseline had significantly higher mean values of post-RT total pain (by 39%; p=0.033), post-RT sensory pain (by 41%; p=0.046), and post-RT affective pain (by 55%; p=0.035) than the control group. Perceived pain intensity (p=0.066) and pain-Tx (p=0.086) at post-RT were not significantly different between the 2 groups. DISCUSSION/SIGNIFICANCE OF IMPACT: These findings suggest that moderate-severe disturbed sleep prior to RT is an important predictor for worsening of pain at post-RT in breast cancer patients. There could be several plausible reasons for this. Sleep disturbance, such as sleep loss and sleep continuity disturbance, could result in impaired sleep related recovery and repair of tissue damage associated with cancer and its treatment; thus, resulting in the amplification of pain. Sleep disturbance may also reduce pain tolerance threshold through increased sensitization of the central nervous system. In addition, pain and sleep disturbance may share common neuroimmunological pathways. Sleep disturbance may modulate inflammation, which in turn may contribute to increased pain. Further research is needed to confirm these findings and whether interventions targeting sleep disturbance in early phase could be potential alternate approaches to reduce pain after RT.

3581 Background: Pain is a prevalent, debilitating symptom in more than half of cancer patients. Accumulating evidence suggests a bi-directional relationship between gut microbiota and pain, potentially via inflammation and oxidative stress. Fusobacterium nucleatum (Fn), a pro-inflammatory anaerobic bacterium, is frequently detected in colorectal cancer (CRC) patients. To date, no study has identified a relationship between Fn and cancer pain in CRC patients. We investigated the associations between pre-treatment Fn and cancer pain at 6 months post-surgery in CRC patients. Methods: We utilized pre-surgery stool samples collected from 80 prospectively followed, newly diagnosed CRC patients recruited from the German site of the international ColoCare Study. Eligible patients were neo-adjuvant treatment naïve and did not use antibiotics for at least 1 month before stool collection. Fn DNA was assessed via quantitative real-time polymerase chain reaction. Patients were median split into Fn-high (>17.27; n=40) or Fn-low (≤17.27; n=40). Cancer pain was assessed using the 2 pain symptom items from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core-30 (lower score=lower pain) at pre- and 6 months post-surgery. Results: Before surgery, 48% of all patients reported any pain. At 6 months post-surgery, we observed a decrease in cancer pain by 33% for Fn-low, while there was an increase in cancer pain by 41% for Fn-high. After controlling for pre-surgery cancer pain in ANCOVA model, we observed significantly higher mean cancer pain at 6 months post-surgery in the Fn-high group vs. the Fn-low group (24.07 vs. 13.44; effect size, ES=0.45; p=0.04). These results were maintained even after controlling for age, sex, tumor stage and site, adjuvant chemotherapy, BMI, physical activity, and any pain medications (29.11 vs. 16.55; ES=0.53; p=0.03). Conclusions: These findings suggest that high Fn is an independent predictor of cancer pain at 6 months post-surgery in colorectal cancer patients. Further research is needed to confirm and understand the mechanisms of these results. Funding: NCI U01 CA206110.

Importance: Atopic dermatitis (AD) is a common chronic skin disease with significant comorbidities and a dramatic impact on quality of life. Despite this, there is little published information about healthcare utilization patterns for adults and children with AD. Objective: To examine healthcare utilization for patients with AD who are cared for in a regional academic medical center. Design: Retrospective cohort analysis. Setting: A mixed urban, suburban and rural catchment in the Western NY region. Participants: All patients seeking medical care for their AD from March of 2011 to September 2015. Exposure(s) for observational studies: Active AD. Main Measure(s): Age, sex, race, ethnicity, (demographics) and medical specialty (healthcare utilization). Patients were stratified and analyzed by age group. Results: Adult AD patients (n=767) accounted for 38.2% of the AD population seeking healthcare in our system with a mean age of 42.7 ± 18.7 years. Among adults, females were seen more commonly than males (65.3% vs. 34.7%). In contrast, both genders were equally represented in the pediatric population ( 18 years; 35.2%). Dermatologists cared for the majority of patients (35.2%), followed by pediatricians (25.7%) and family medicine physicians (10.1%). African-Americans were nearly 3 times more likely than Caucasians to visit primary care physicians for their initial AD management (p

10100Background: Pain is a debilitating side effect that remains poorly controlled in ~50% of cancer patients. Data from the general population has shown a strong bi-directional relationship betwee...

This paper reports an innovative assessment feedback tool - the mathsmap - and describes how two pre-service teachers made sense of this personalised diagnostic map to reflect on their own subject knowledge in mathematics. The mathsmap provided both a summative and a diagnostic profile of their attainment and errors across the mathematics curriculum required for teacher training. The use of the mathsmap to reflect learning on a personal level is seen to also provoke 'accounts' or 'stories' that might inform pedagogical content knowledge: in making their mathsmap comprehensible to themselves, the teachers needed to account for their own knowledge-troubles, that is, to narrate their metacognition.

Harmonisation of reference intervals for routine general chemistry analytes has been a goal for many years. Analytical bias may prevent this harmonisation. To determine if analytical bias is present when comparing methods, the use of commutable samples, or samples that have the same properties as the clinical samples routinely analysed, should be used as reference samples to eliminate the possibility of matrix effect. The use of commutable samples has improved the identification of unacceptable analytical performance in the Netherlands and Spain. The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) has undertaken a pilot study using commutable samples in an attempt to determine not only country specific reference intervals but to make them comparable between countries. Australia and New Zealand, through the Australasian Association of Clinical Biochemists (AACB), have also undertaken an assessment of analytical bias using commutable samples and determined that of the 27 general chemistry analytes studied, 19 showed sufficiently small between method biases as to not prevent harmonisation of reference intervals. Application of evidence based approaches including the determination of analytical bias using commutable material is necessary when seeking to harmonise reference intervals.

We describe a procedure for developing pedagogical knowledge about the argumentation of groups of children in relation to conceptual locales. The method involved the collection of small groups of children who had made different but significant responses to diagnostic test items, the recording and analysis of their subsequent researcher-managed discourses, and the mapping of the main productive elements of argument and charting a flow through it. Two examples of the method are presented which show how children can develop argument, and how these can be charted. These charts and other tools encapsulate research knowledge on children's learning in a form designed to help teachers to plan argumentation in their classroom practice: i.e. as pedagogical content knowledge. In addition to content-focused results, we also find general teaching strategies which appear to be effective generally, i.e. across conceptual locales. We discuss the relationship of this work to the development of teacher's pedagogical conten...

INCOSE has become one of the professional societies overseeing ABET accreditation for systems engineering. This session present an overview of INCOSE's accreditation strategy, perspectives from recent evaluators of an undergraduate and a graduate program, an international perspective, a summary of why one major school has decided not to accredit its program, and a summary of why another did attempt accreditation. A floor discussion will follow.

Can children's responses to tests be used to provide useful diagnostic information for classroom teachers? This article describes an analysis of children's performance in the 1997 UK mathematics tests by 7 and 14 year-olds. The children's responses and errors were scaled against their ability using Rasch methodology. These were then interpreted in terms of the literature on the psychology of mathematics education, especially that related to misconceptions, and an attempt was made to describe children's progression in thinking as it relates to their test performance. This work has been reported to all primary and secondary schools in England and Wales, and is intended to provide a description of what the children believe and know. As such it provides a resource to help raise teachers' awareness of their children's thinking and present openings for diagnostic assessment and teaching. Opportunities for and obstacles to developing this approach in future are discussed.

We report an innovative assessment feedback tool – we call it a mathsmap – and describe how two pre-service teachers in the UK made sense of this personalised diagnostic map to reflect on their own subject knowledge in mathematics. The mathsmap provides both a summative and a diagnostic profile of their attainment and errors across the mathematics curriculum. The use of the mathsmap to reflect on learning on a personal level is also seen to provoke ‘accounts’ or ‘stories’ that might inform pedagogical content knowledge: in making their mathsmap comprehensible to themselves, the teachers needed to account for their own ‘knowledge-troubles’, that is to narrate their metacognition.

The United States continues to be a prime target for attack by terrorist organizations in which nuclear detonation or dispersal of radiological material are legitimate threats. These types of attacks could result in devastating consequences to a multitude of individuals in the form of radiation injury to particular organ systems. One of these organs, the cutaneous system, which provides the first line of defense against invading pathogens, is particularly sensitive to ionizing radiation (IR) leaving the host vulnerable to cutaneous pathogen invasion. Our laboratory demonstrated that exposure to IR depleted murine cutaneous dendritic cells (cDCs); a network of cells responsible for forming a cutaneous immunological barrier that is critical in protecting the host against microorganism infection. This IR-induced depletion was caused by a migration of cDCs out of the skin responding to abnormal upregulation of cDC migratory factors, CCR7 and CCL21. As a result, this breakdown in the immunological barrier left the host susceptible to a cutaneous Candida albicans challenge where the pathogen was not contained locally but rather disseminated systemically to the kidneys. Interestingly, a subcutaneous treatment with IL-12 prevented the IR-induced depletion of cDCs offering a potential radiation countermeasure to preserve the cutaneous immunological barrier and perhaps prevent the lethal dissemination of opportunistic pathogens following radiation exposure.

Lesson study originated in Japan and is now becoming attractive worldwide as a research-based approach to developing teaching in the workplace. Like research, it is understood to be collectively constructed, but it is grounded in the practice, analysis and reflection of groups of teachers focused on real lessons collectively observed and analysed. We report two case studies of our lesson study work with primary and secondary teachers in England. The practice of lesson study is evolving as it disseminates globally, and the aim of this paper is to describe and analyse how lesson study can develop in a culture of performativity, where teacher professional learning in England is dominated by graded lesson observations and scrutinised in the light of national league tables. We theorise this performativity in social terms using the concept of commodification of knowledge and the use and exchange value of education. Our experience suggests that lesson study can pose an additional threat to teachers, but that they can find value in the professional learning derived from an appropriately evolved lesson study process in the workplace when that practice is able to focus on collaboration and make space free of competition and teacher-performance focused judgments. We discuss the potential for the profession to make such spaces for teaching to develop, and argue that resources from the wider community are essential for helping schools to build such spaces.