Search

Ethnic diversity is not reflected within healthcare professions, including genetic counseling, where lack of growth and membership among minority colleagues extends to upper-level and executive roles. While diversity and inclusion-based topics have been emphasized, studies on potential barriers to career advancement in the field of genetic counseling have not received the same attention. Our study examined the current state of mentorship and sponsorship programs, the presence of diversity and inclusion initiatives, and opportunities for career advancement through the lens of a minority genetic counselor. Practicing genetic counselors in the United States identifying as part of any racial group, other than non-Hispanic White alone, were recruited through the Minority Genetics Professionals Network for survey participation. A 31-item survey was fully completed by 19 practicing genetic counselors from a variety of ethnic backgrounds. Data were analyzed using descriptive statistics and thematic analysis, allowing for individual stories and accounts to be amplified. Results showed 16 of 19 participants had never been promoted in their current employment setting. Additionally, 7 out of 19 respondents disagreed or strongly disagreed that their company had a commitment to an ethnically diverse workforce within upper-level positions. Prominent themes identified from open-ended responses included lack of social connection with supervisors and the cross-race effect, a term referencing a tendency for individuals to better recognize members of their own race or ethnicity than others. Additional themes revealed feelings of isolation, need for support from White colleagues, as well as desired emphasis on sponsorship tailored toward professional growth. These findings demonstrate a need for proactive involvement in reaching ethnic and racial minority genetic counselors through companywide policy efforts, support and advocacy from White colleagues, and modification of cultural perception frameworks. Further focus and emphasis on these distinct but critical topics may be important in promoting increased diversity in upper-level positions in the field of genetic counseling.

Flow cytometry has been traditionally used to diagnose leukaemia and lymphoma in peripheral blood, bone marrow, body fluids, and tissue samples. The diagnosis of a malignant epithelial tumour is usually made by correlation between histopathologic appearance and the use of immunohistochemical staining. A CE approved BerEP4 antibody (anti-EpCAM, CD326) is available for flow cytometric testing, but has been evaluated predominantly in body fluids in the current literature. In this study, we have evaluated the performance of this antibody in detecting the presence of epithelial cells in tissue samples which have traditionally been reported as CD45 negative cells by flow cytometry. Among the 42 cases studied, 21 (50%) were found to be positive for CD326, thereby suggesting epithelial differentiation. The results had good concordance rates (97.6%) with final histopathological diagnosis. The results clearly show that flow cytometric testing for BerEP4 (CD326) can be a useful method for diagnosing nonhaematological malignancies that are poorly differentiated. As this is a rapid method for identifying epithelial differentiation, it can help the histopathologists tailor and rationalise the immunohistochemical panel, with the potential benefits of improving reporting times and work-flow in the laboratory. © 2017 International Clinical Cytometry Society.

Soybean dwarf virus (SbDV), which causes an important disease of soybeans in Japan, is persistently transmitted by aphids and is endemic in forage legumes in the United States. To determine the incidence of SbDV in Illinois, we collected clovers and forage legumes in a total of 49 Illinois counties in 2001 and 2002 and tested them for the presence of SbDV by reversetranscription-polymerase chain reaction. SbDV was detected in 43% of red clover (Trifolium pratense), 10% of white clover (T. repens), and 3% of yellow sweet clover (Melilotus officinalis) plant samples. The dwarfing strain (SbDV-D) was the predominant strain detected in Illinois. In 2000, Aphis glycines, an aphid species that colonizes soybeans, was reported for the first time in North America. To determine whether A. glycines or aphid species found colonizing clover were vectors of SbDV, transmission studies were conducted. Aphids of the species Nearctaphis bakeri reproducibly vectored SbDV among red clovers, and from red clover to soybean. A. glycines did not transmit SbDV; neither did two other clover-infesting aphid species, Acyrthosiphon pisum and Therioaphis trifolii.

The genus Neisseria comprises a diverse group of commensal bacteria, which typically colonize the mucosal surfaces of humans and other animals. Neisseria meningitidis, the meningococcus, is notable for its potential to cause invasive meningococcal disease (IMD) in humans; however, IMD is comparatively rare, and meningococci normally colonize the nasopharynx asymptomatically. Possession of a polysaccharide capsule has been shown to be a prerequisite for disease in almost all IMD cases, and was previously considered unique to N. meningitidis, and potentially acquired by horizontal genetic transfer (HGT). Nevertheless, the capsule must also have some role in asymptomatic colonization and/or transmission, consistent with the existence of six non-disease-associated meningococcal capsule serogroups. In this study, full complements of putative capsule genes were identified in non-pathogenic Neisseria species, including Neisseria subflava and Neisseria elongata. These species contained genes for capsule transport and translocation homologous to those of N. meningitidis, as well as novel putative capsule synthesis genes. Phylogenetic analyses were consistent with the proposal that these genes were acquired by the meningococcus through HGT. In contrast with previous evolutionary models, however, the most parsimonious explanation of these data was that capsule transport genes had been lost in the common ancestor of the meningococcus, gonococcus, and their close relatives, and then reacquired by some meningococci. The most likely donor of the meningococcal transport genes was another Neisseria species.

Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short-term studies, but long-term effects on cardiovascular disease remain unknown. We examined whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among such patients.In 16 study centers in the United States, we randomly assigned 5145 overweight or obese patients with type 2 diabetes to participate in an intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity (intervention group) or to receive diabetes support and education (control group). The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina during a maximum follow-up of 13.5 years.The trial was stopped early on the basis of a futility analysis when the median follow-up was 9.6 years. Weight loss was greater in the intervention group than in the control group throughout the study (8.6% vs. 0.7% at 1 year; 6.0% vs. 3.5% at study end). The intensive lifestyle intervention also produced greater reductions in glycated hemoglobin and greater initial improvements in fitness and all cardiovascular risk factors, except for low-density-lipoprotein cholesterol levels. The primary outcome occurred in 403 patients in the intervention group and in 418 in the control group (1.83 and 1.92 events per 100 person-years, respectively; hazard ratio in the intervention group, 0.95; 95% confidence interval, 0.83 to 1.09; P=0.51).An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes. (Funded by the National Institutes of Health and others; Look AHEAD ClinicalTrials.gov number, NCT00017953.).

In his 2015 framing essay for the Service-Learning & Community Engagement Future Directions Project (SLCE-FDP), Edward Zlotkowski challenges the movement to think carefully about "where we locate the center of our efforts" (p. 84) and reconsiders whether the focus on academic legitimacy and institutional transformation he called for in his 1995 essay "Does Service-Learning Have a Future?" ought still to be the priority 20 years later. He also commends several of the 2015 SLCE-FDP thought pieces for calling attention to "voices often unrepresented or underrepresented" (p. 84). In this essay, we try to further deepen the role of community members and organizations in the movement's efforts to understand and address the opportunities and challenges of the present and future. Specifically, we call on our campus-based colleagues to seek out and learn from examples of community organizations that, in their day-to-day work, enact the principles of democratic engagement; and we call on our community-based colleagues to share and critique their own efforts. We envision the future of SLCE as bringing to life the commitments of democratic engagement and thereby nurturing shared responsibility for and shared power in nudging the world toward peace and justice. And we believe the SLCE movement as a whole can learn much from what may prove to be more democratic and cutting edge approaches in the broader community than are often found in the academy. We have first-hand experience as leaders, staff, partners, and volunteers with community organizations that work diligently to achieve democratic ends through democratic means in social and cultural contexts that make doing so difficult. We find in candid examination of two of our organizations' efforts some illumination of the tensions associated with democratic engagement: asset-oriented norms and co-creation (as they occur within the Interactive Resource Center, described below by Kathleen) and place-based partnerships and a process orientation toward impact (as they occur within ioby, described below by Brandon). We offer these examples not as success stories full of lessons learned and words of wisdom but rather as demonstrations of both challenges and possibilities--attempting in this way to shine light on the complexities of democratic engagement as experienced in communities. Interactive Resource Center The Interactive Resource Center (IRC, hup://gsodaycenter.org/) in Greensboro, North Carolina, is a daytime center for people experiencing homelessness. The IRC's mission is to "assist people who are homeless, recently homeless, or facing homelessness [in reconnecting] with their own lives and with the community at large." We offer practical services: laundry, showers, access to computers and Internet, case management, and referrals. We also partner with other nonprofits and grassroots organizations, sharing our space as an incubator for multiple services and activities (e.g., medical services, art therapy, gardening, transportation via refurbished bicycles, GED courses, and weekly community vegetarian dinners). The following analysis of the IRC's efforts to enact an asset-based orientation and co-creation is based on a snapshot of the organization from 2010-2014, a period that most honestly reflects the aspirations relevant to this thought piece. At its inception, the people designing the IRC--many of whom were experiencing homelessness at the time--intentionally adopted an asset orientation: peer-based, strengths-focused, and collaborative. As we say every day in our morning meeting: "This is the Interactive Resource Center. Your best resource is each other." Our intention is for everyone affiliated with the organization to experience it as their community. The term "guest" displaces the term "client"--the common social service agency name for a person accessing services--because we believe it better establishes a respectful space and affirms non-hierarchical, multi-directional relationships. …

Flow cytometry has been traditionally used to diagnose leukaemia and lymphoma in peripheral blood, bone marrow, body fluids, and tissue samples. The diagnosis of a malignant epithelial tumour is usually made by correlation between histopathologic appearance and the use of immunohistochemical staining. A CE approved BerEP4 antibody (anti-EpCAM, CD326) is available for flow cytometric testing, but has been evaluated predominantly in body fluids in the current literature. In this study, we have evaluated the performance of this antibody in detecting the presence of epithelial cells in tissue samples which have traditionally been reported as CD45 negative cells by flow cytometry. Among the 42 cases studied, 21 (50%) were found to be positive for CD326, thereby suggesting epithelial differentiation. The results had good concordance rates (97.6%) with final histopathological diagnosis. The results clearly show that flow cytometric testing for BerEP4 (CD326) can be a useful method for diagnosing nonhaematological malignancies that are poorly differentiated. As this is a rapid method for identifying epithelial differentiation, it can help the histopathologists tailor and rationalise the immunohistochemical panel, with the potential benefits of improving reporting times and work-flow in the laboratory. © 2017 International Clinical Cytometry Society.

Patients with diabetes who use insulin pumps [continuous subcutaneous insulin infusion (CSII)] undergo surgeries that require postoperative hospital admission. There are no defined guidelines for CSII perioperative use.This retrospective single-institution study identified type 1 and type 2 diabetes subjects by electronically searching 2005-2010 anesthesia preoperative assessments for "pump." Surgical cases (n = 92) were grouped according to intraoperative insulin delivery method: (a) CSII continuation of basal rate with/without correctional insulin bolus(es) (n = 53); (b) conversion to intravenous insulin infusion (n = 20); and (c) CSII suspension with/without correctional insulin bolus(es) (n = 19). These groups were compared on mean intraoperative blood glucose (BG) and category of most extreme intraoperative BG.Differences were found on baseline characteristics of diabetes duration (p = .010), anesthesia time (p = .011), proportions receiving general anesthesia (p = .013), and preoperative BG (p = .033). The conversion group had the longest diabetes duration and anesthesia time; it had a higher proportion of general anesthesia recipients and a higher mean preoperative BG than the continuation group. There was no significant difference in mean BG/surgical case between continuation (163.5 ± 58.5 mg/dl), conversion (152.3 ± 28.9 mg/dl), and suspension groups (188.3 ± 44.9 mg/dl; p = .128). The suspension group experienced a greater percentage of cases (84.2%) with one or more intraoperative BG179 mg/dl than continuation (45.3%) and conversion (40%) groups Figure 1 groupings (p = .034).In this limited sample, preliminary findings are consistent with similar intraoperative glycemic control between CSII continuation and CSII conversion to intravenous insulin infusions. Continuous subcutaneous insulin infusion suspension had a greater rate of hyperglycemia. Preoperative differences between insulin delivery groups complicate interpretations of findings.

Supported employment services for people with mental handicaps are being developed in many parts of the country. These aim to provide them with the levels of job-finding assistance, training, and support required to enter and remain in employment. Finding jobs is crucial to the success of these ventures. This study examines the problem of marketing the labour of people with mental handicaps to employers. The research is based on interviews with 57 employers in Sheffield. It investigates the attitudes, perceptions, and practices of employers in relation to the employment of people with mental handicaps. The findings show that the label “mental handicap” is not always understood accurately by employers. It often communicates negative images. Several concepts were found to underlie employers' perceptions of their employees. People with mental handicaps were expected to perform better than their non-handicapped counterparts on four of these: job satisfaction, genuineness, grafting, and loyalty; but less well on productive capacity, supervision and risk, and learning capacity. The results indicate that small organisations with a low rate of recruitment are the most sympathetic employer groups. The survey also showed that problems envisaged by employers with no experience of employing people with mental handicaps were not reported by those experienced in doing so, especially with respect to safety and co-worker acceptance. The findings will be used to develop a more effective marketing strategy for the supported employment services organisation, Intowork, which is based in Sheffield.

Abstract Many protocols have been used in clinical and research settings for collecting systolic blood pressure (SBP) measurements to calculate the ankle–brachial index (ABI); however, it is not known how useful it is to replicate measurements and which measures best reflect cardiovascular risk. Standardized measurements of ankle and arm SBP from 5140 overweight or obese individuals with type 2 diabetes were used to estimate sources of variation. Measurement characteristics of leg-specific ABI, as calculated using a standard algorithm based on the highest SBP of the dorsalis pedis or posterior tibial arteries, were projected using simulations. Coefficients of variability ranged from 2% to 3% when single SBP measurements were used and ABI was overestimated by 2–3%. Taking two SBP measurements at each site reduced standard errors and bias each by 30–40%. The sensitivity of detecting low ABI ranges exceeded 90% for ABI within 0.05 of the 0.90 clinical cut-point. The average and the minimum of the two (i.e. right and left) leg-specific ABI values had similar U-shaped relationships with Framingham risk scores; however, the average leg ABI had slightly greater precision. Replicating SBP measurements reduces the error and bias of ABI. Averaging leg-specific values may increase power for characterizing cardiovascular disease risk.

The aim of this study was to assess the analytic validity of self-reported family history of hemochromatosis or iron overload.A total of 141 probands, 549 family members, and 641 controls participated in the primary care Hemochromatosis and Iron Overload Screening Study. Participants received a postscreening clinical examination and completed questionnaires about personal and family histories of hemochromatosis or iron overload, arthritis, diabetes, liver disease, and heart disease. We evaluated sensitivities and specificities of proband-reported family history, and concordance of HFE genotype C282Y/C282Y in probands and siblings who reported having hemochromatosis or iron overload.The sensitivities of proband-reported family history ranged from 81.4% for hemochromatosis or iron overload to 18.4% for liver disease; specificities for diabetes, liver disease, and heart disease were greater than 94%. Hemochromatosis or iron overload was associated with a positive family history across all racial/ethnic groups in the study (odds ratio, 14.53; 95% confidence intervals, 7.41-28.49; P.0001) and among Caucasians (odds ratio, 16.98; 95% confidence intervals, 7.53-38.32; P.0001). There was 100% concordance of HFE genotype C282Y/C282Y in 6 probands and 8 of their siblings who reported having hemochromatosis or iron overload.Self-reported family history of hemochromatosis or iron overload can be used to identify individuals whose risk of hemochromatosis or iron overload and associated conditions is increased. These individuals could benefit from further evaluation with iron phenotyping and HFE mutation analysis.

OBJECTIVE—The effectiveness of intentional weight loss in reducing cardiovascular disease (CVD) events in type 2 diabetes is unknown. This report describes 1-year changes in CVD risk factors in a trial designed to examine the long-term effects of an intensive lifestyle intervention on the incidence of major CVD events. RESEARCH DESIGN AND METHODS—This study consisted of a multicentered, randomized, controlled trial of 5,145 individuals with type 2 diabetes, aged 45–74 years, with BMI >25 kg/m2 (>27 kg/m2 if taking insulin). An intensive lifestyle intervention (ILI) involving group and individual meetings to achieve and maintain weight loss through decreased caloric intake and increased physical activity was compared with a diabetes support and education (DSE) condition. RESULTS—Participants assigned to ILI lost an average 8.6% of their initial weight vs. 0.7% in DSE group (P < 0.001). Mean fitness increased in ILI by 20.9 vs. 5.8% in DSE (P < 0.001). A greater proportion of ILI participants had reductions in diabetes, hypertension, and lipid-lowering medicines. Mean A1C dropped from 7.3 to 6.6% in ILI (P < 0.001) vs. from 7.3 to 7.2% in DSE. Systolic and diastolic pressure, triglycerides, HDL cholesterol, and urine albumin-to-creatinine ratio improved significantly more in ILI than DSE participants (all P < 0.01). CONCLUSIONS—At 1 year, ILI resulted in clinically significant weight loss in people with type 2 diabetes. This was associated with improved diabetes control and CVD risk factors and reduced medicine use in ILI versus DSE. Continued intervention and follow-up will determine whether these changes are maintained and will reduce CVD risk.

The objective of this study was to identify predictors of self-reported family health history of breast cancer in an ethnically diverse population of women participating in a breast cancer screening program. Participants completed a self-administered questionnaire about their demography, health, breast health and family health history of breast cancer. The association between family health history of breast cancer and categorical variables were analyzed using the T test, chi square, and multi-nominal logistic regression. Those who were least likely to report a family history of cancer were African Americans (p = 0.02), and immigrant women from South America (p

The annual cost of alcohol‐related harm in the UK is estimated to be between £17.7 and £25.1 billion with healthcare costs alone reaching £2.7 billion and the costs of alcohol‐fuelled crime and disorder accounting for £7.3 billion each year. The aim of the study was to examine the prevalence of alcohol use disorders (AUD) in prison and probation settings in the North East of England, and to compare the ability of the Alcohol Use Disorders Identification Test (AUDIT) and Offender Assessment System (OASys) at identifying alcohol‐related need in probation clients. A quantitative prevalence study was carried out using anonymous questionnaires with participants from four prisons and three probation offices in the North East who voluntarily completed the AUDIT questionnaire during a 1‐month period in 2006. Response outcomes on AUDIT were compared with OASys scores which identify alcohol‐related need in probation. At the time of the study OASys scores were not available for offenders in prison. Seven hundred and fifteen questionnaires were completed. Sixty‐three per cent of men and 57% of women were identified as having an AUD with over a third of all individuals scoring within the possibly dependant range (20+ on AUDIT). Around 40% of probation cases who were classified as either hazardous, harmful or possibly dependant drinkers on AUDIT were not identified by OASys. The results indicate that the prevalence of AUD in offenders is much higher than in the general population. In addition, current methods of identifying offenders with alcohol‐related need in probation are flawed and as many such people go undetected. Alcohol assessment procedures need to be improved in criminal justice setting order to correctly identify people with AUD.

Purpose: Assess the quality of life impact of receiving indeterminate test results for hemochromatosis, a disorder involving HFE genetic mutations and/or elevated serum transferrin saturation and ferritin. Methods: The study sample was from the Hemochromatosis and Iron Overload Screening Study, a large observational study of hemochromatosis among primary care patients in the US and Canada using HFE genotype and serum transferrin saturation and ferritin screening. Study subjects included 2,304 patients found with hemochromatosis risk of uncertain clinical significance. Assessed was SF-36 general health and emotional well-being before screening and six weeks after participants received their test results. Health worries were assessed after screening. Results: Of the study subjects, 1,268 participants (51.5%) completed both assessments. Compared to normal controls, those with HFE mutations or elevated serum transferrin saturation and ferritin levels of uncertain significance were more likely to report diminished general health and mental well-being, and more health worries. These effects were associated with participants' belief of having tested positive for hemochromatosis or iron overload. Conclusion: Notification of indeterminate results from screening may be associated with mild negative effects on well-being, and might be a potential participant risk in screening programs for disorders with uncertain genotype-phenotype.

Purpose: Fear of genetic discrimination might deter participation in research or therapy. This is a major impetus for laws limiting insurers' use of genetic information, yet there is little information about the extent of this fear in the general population and how it varies by social factors. Methods: This study measures concern about insurance problems relating to genetic testing, as part of primary-care screening for hereditary hemochromatosis (iron overload). Data come from a multiethnic, primary care–based survey of 86,859 adults in five field centers in the United States (AL, CA, DC, HI, OR), and one in Canada (Ontario). Logistic regression was used to model the probability of agreeing to the question “Genetic testing is not a good idea because you might have trouble getting or keeping your insurance.” Results: Overall, 40.0% of participants agreed. Adjusting for other characteristics, African Americans and Asians were much less likely (OR = 0.52 and 0.39), and Hispanics were more likely (OR = 1.124), than Caucasians to express concern about insurance discrimination. Participants under 65 years old, US residents, and those without a high school diploma were substantially more likely to be concerned (ORs ranging from 1.4–1.6), as were participants with lower mental health scores. Education showed a nonlinear relationship, with significantly higher concern among both those with less than a high school education and those with a college degree, compared to high school graduates. Conclusions: Concern about genetic discrimination varies substantially by race and other demographic factors and by nationality. One possible explanation for lower concern about Canadians and by people over 64 is that both groups are covered by social insurance for health care (Medicare). However, US residents in states with some legal protections against genetic discrimination had more, not less, concern than either Canadians or US residents in states with no legal protections.

In 1985, Te Wharekura o Rakaumangamanga initiated a Maori-language immersion program for children ages 5 through 18. In recent years, a program based on Waikato-Tainui tribal epistemology has been incorporated into the language immersion program. This article describes the community context and the language immersion and tribal knowledge programs. We consider the relationship of these programs to individual and tribal self-determination and to theories of minority achievement, particularly the work of John Ogbu.

This article explores the establishment of women factory inspectors in the wake of a common sweating furore in Britain and New Zealand. Sweating reformism was not simply transplanted in New Zealand from the motherland. It is argued that Britons and New Zealanders developed related illusions about anti-sweating which had important implications for the confinement of women's work. In New Zealand female factory inspectors were held to be symbols of successful anti-sweating reform, while in Britain they were celebrated for their investigation and exposure of industrial conditions since here reform was limited. The women themselves knew the limits of their success. And they embodied a contradiction. The rationale for their employment was that women's work was different from men's and female employment needed to be regulated. Female factory inspectors accepted this formula for factory workers but were averse to it being applied to their own employment. In this regard, the female factory inspectors expe...

This review starts from the premise that the visual has been, until recently, a neglected dimension in our understanding of social life, despite the role of vision in other disciplines, including medicine itself. The potential for a visual approach will be analysed drawing on a range of studies, broadly within the sociology of health and illness, which have used visual approaches. I highlight the value of visual methodology projects within qualitative approaches to research more generally, and assess the difficulties as well as the advantages. It is suggested that using visual methodologies does not necessarily lead to greater reactivity in the research process as has sometimes been proposed; and that visual worlds are themselves unique topics of sociological study which may be enhanced by using visual techniques rather than written and spoken language. A combination of visual and traditional methods can also be fruitful. Painting and drawing, video, film, and still photography are included as examples which researchers have used and can use.

This paper examines the ways in which photographic images can be used in narrative inquiry. After introducing the renewed interest in visual methodology the first section examines the ways in which researchers have utilised the camera or photographic images in research studies that are broadly similar to forms of narrative inquiry such as auto/biography, photographic journals, video diaries and photo-voice. It then draws on the published literature in relation to the author’s own empirical research into everyday photography. Here the extent to which the practices which are part of everyday photography can be seen as forms of story-telling and provide access to both narratives and counter-narratives, are explored. Ideas about memory and identity construction are considered. A critical area of argument centres on the relationship of images to other texts, and asks whether it is possible for photographs to narrate independent of written or oral word. It concludes with some remarks about how photographs can be used in research and as a resource for narrative inquiry. This necessitates a understanding of what it is people do with photographs in everyday life.

Background Little is known about diet quality with a reduced-energy, low-fat, partial meal replacement plan, especially in individuals with type 2 diabetes. The Action for Health in Diabetes (Look AHEAD) trial implemented a partial meal replacement plan in the Intensive Lifestyle Intervention. Objective To compare dietary intake and percent meeting fat-related and food group dietary recommendations in Intensive Lifestyle Intervention and Diabetes Support and Education groups at 12 months. Design A randomized controlled trial comparing Intensive Lifestyle Intervention with Diabetes Support and Education at 0 and 12 months. Participants/setting From 16 US sites, the first 50% of participants (aged 45 to 76 years, overweight or obese, with type 2 diabetes) were invited to complete dietary assessments. Complete 0- and 12-month dietary assessments (collected between 2001 and 2004) were available for 2,397 participants (46.6% of total participants), with 1,186 randomized to Diabetes Support and Education group and 1,211 randomized to Intensive Lifestyle Intervention group. Main outcome measures A food frequency questionnaire assessed intake: energy; percent energy from protein, fat, carbohydrate, polyunsaturated fatty acids, and saturated fats; trans -fatty acids; cholesterol; fiber; weekly meal replacements; and daily servings from food groups from the Food Guide Pyramid. Statistical analyses performed Mixed-factor analyses of covariance, using Proc MIXED with a repeated statement, with age, sex, race/ethnicity, education, and income controlled. Unadjusted χ 2 tests compared percent meeting fat-related and food group recommendations at 12 months. Results At 12 months, Intensive Lifestyle Intervention participants had a significantly lower fat and cholesterol intake and greater fiber intake than Diabetes Support and Education participants. Intensive Lifestyle Intervention participants consumed more servings per day of fruits; vegetables; and milk, yogurt, and cheese; and fewer servings per day of fats, oils, and sweets than Diabetes Support and Education participants. A greater percentage of Intensive Lifestyle Intervention participants than Diabetes Support and Education participants met fat-related and most food group recommendations. Within Intensive Lifestyle Intervention, a greater percentage of participants consuming two or more meal replacements per day than participants consuming less than one meal replacement per day met most fat-related and food group recommendations. Conclusions The partial meal replacement plan consumed by Intensive Lifestyle Intervention participants was related to superior diet quality.

Look AHEAD (Action for Health in Diabetes) was a randomized clinical trial designed to examine the long-term health effects of weight loss in overweight and obese individuals with type 2 diabetes. The primary result was that the incidence of cardiovascular events over a median follow-up of 9.6 years was not reduced in the Intensive Lifestyle Group relative to the control group. This finding is discussed, with emphasis on its implications for design of trials and clinical treatment of obese persons with type 2 diabetes.

I have only recently come to appreciate the benefits of reflection. In 1996, after nearly 20 years of work in programs with indigenous peoples in Alaska and New Zealand, I began reflecting on my experience in those programs. Some programs had worked but others had not and I wasn't certain of the reasons for success or failure. Reflecting on those experiences resulted in a book about social change programs in indigenous communities (Harrison, 2001). Shortly before I completed that manuscript, I received an e-mail from the Status of Women committee representative of the academic union of my university. She asked women union members for their thoughts as to why so few women had been promoted in the last round, especially in the senior ranges of the salary scale. I didn't know how to respond. I knew that some things had worked for me in academic life but other things had not. Again, I wasn't certain of the reasons for success or failure. I needed to think through my observations of life in the other "field"-higher education. I had announced my intention to retire at the end of the year but, in many respects, I felt as "baffled, buffeted, and buffaloed" (Toth 1997:59) as I had during my first year as an assistant professor. I also wondered if Beverly M. Gordon's description of academia accurately portrayed my experience there

Aims—To review the results of 73 consecutive fine needle aspirations (FNAs) that were collected by a pathologist and analysed by immunoflow cytometry. Material for a cell block was also collected from some of these lesions. Methods—The setting was a large general hospital in rural New Zealand. The FNAs were performed by a pathologist, or a radiologist for image guided localisations. Material for immunoflow cytometry was collected into RPMI and, when required, material for a cell block was collected into formalin. Results—Of the 73 samples collected by FNA nine were inadequate. Light chain restriction could be demonstrated in most FNA samples from B cell lymphomas (28 of 30 adequate samples). The exceptions were two cases of T cell rich B cell lymphoma. Artefactual light chain restriction was seen occasionally in T cell lymphomas, presumably as a result of autoantibodies binding to the cell surfaces. It was possible to subtype most (18 of 30 adequate samples) B cell lymphomas as chronic lymphocytic leukaemia (CLL), follicle centre cell lymphoma (FCCL), or mantle cell lymphoma. The CD4 to CD8 ratio was not usually restricted in T cell lymphomas and coexpression of CD4 and CD8 was not usually found. Loss of pan-T cell antigens was seen in some T cell lymphomas. Four of the six T cell lymphomas and three of the four non-lymphoid malignancies were diagnosed with the aid of cell block immunohistochemistry. Only one of the four cases of Hodgkin's lymphoma showed Reed-Sternberg cells in the FNA smears. Conclusions—It is not always possible to characterise lymphomas as fully with FNA and immunoflow cytometry as is possible with biopsy histology and a full battery of modern investigations. Nevertheless, in the setting of a large rural general hospital immunoflow cytometry on FNA samples is a highly effective method of diagnosing and typing B cell lymphomas. Immunoflow cytometry is of little use for T cell lymphomas or Hodgkin's lymphomas. We advocate the use of cell block immunohistochemistry in preference to immunoflow cytometry for cases in which the cytological appearance of the specimen is overtly malignant but the differential diagnosis includes non-lymphoid malignancy. Key Words: lymphoma • flow cytometry • cell blocks • immunolabelling • fine needle aspiration

Teams hold the potential for outperforming other types of work structures in complex circumstances, but many fail to deliver on this promise. Such failure can threaten the success of an entire project or program. In their work with teams, many of them complex in structure and makeup, the authors have developed a fairly simple and inexpensive process for forming and aligning teams that can significantly reduce the risk of team failure. While the process is fairly simple, the implementation of that process is not.

XK469 (NSC 656889) is a water-soluble member of the novel quinoxaline family of antitumor agents. In vitro, XK469 demonstrated selective cytotoxicity for several murine solid tumors including colorectal and mammary adenocarcinoma cell lines, when compared to both leukemia and normal epithelial cells. In vivo, XK469 was active against 7/7 murine tumors tested, including pancreatic ductal carcinomas #02 and #03, colon adenocarcinomas #38 and #51/A, mammary adenocarcinoma #16/C and the Adriamycin resistant mammary adenocarcinomas #16/C/ADR and #17/ADR. XK469 was efficacious both intravenously and orally. Regardless of dosing schedule, conventional mice tolerated higher total doses than SCID or nu/nu mice did. Despite these reduced doses, XK469 was active against xenografts of 4/6 human tumor lines including mammary adenocarcinoma MX-1, the small cell lung cancer DMS 273, the prostate model LNCaP and the CNS tumor SF295. The lower doses in the xenograft studies were below curative levels. The dose-limiting toxicity appeared to be myelosuppression with rapid host recovery (5-8 days), and in vitro assays of XK469 toxicity to murine bone marrow neutrophil progenitors CFU-GM (colony forming unit-granulocyte/macrophage) demonstrated concentration-dependent toxicity from 0.5-30 microg/mL. The difference in drug tolerance between BDF1 and SCID mice was detected in vitro as a 3-fold difference in the IC90 for CFU-GM, despite similar IC50 values. Comparative in vitro hematotoxicology studies revealed that human bone marrow CFU-GM tolerated XK469 as well as their SCID counterparts (IC90 values 5.7 vs. 7.4 microg/mL). Based on comparison with previously tested anti-cancer agents, these data suggest that humans will be able to tolerate XK469 doses that are efficacious against human tumor xenografts.

In the early 1980s, the Maori people of New Zealand began a dynamic language revitalization movement. The establishment of Maori immersion programs in state funded schools constituted one major aspect of the movement. This article describes the development of the Maori language immersion program in one New Zealand school for children ages 5 to 17. In 1985, the first immersion classroom of 5-year-olds was established. Immersion classrooms were added year by year as the first class of children progressed through primary school, junior high, and high school. The first class completed the final year of high school in 1997, and students entered polytechnics or university programs in 1998. The article briefly summarizes the historical background, cultural context, and program of the school. Indicators of school performance, including student achievement on national examinations, are considered. The findings are examined in terms of a selection of the research and theoretical literature. This case study...

Hereditary breast cancers have unique clinicopathological characteristics. Therefore, the objective of this study was to establish the relationship between self-reported family history of cancer and clinicopathological features in breast cancer patients from Washington, DC. Data on incident breast cancer cases from 2000 to 2010 were obtained from the Washington, DC Cancer Registry. Variables such as estrogen (ER), progesterone (PR), and human epidermal growth factor 2 (HER2) receptor status, as well as stage and grade, were analyzed in those that self-reported with (n = 1,734) and without a family history of cancer (n = 1,712). The breast cancer molecular subtypes were compared when ER, PR, and HER2 statuses were available. Furthermore, tumor characteristics were compared by race/ethnicity. Regression and chi-square analyses were performed. A report of family history was associated with age (OR = 1.27 95 % CI: 1.09–1.48; p

Using the match making industry as a case study, this paper examines the politics of occupational health in late nineteenth century Britain. It argues that this industry had a high profile within the wider political struggle around the question of working conditions and their effect on workers' health. This was due to the identification of match making with a specific and particularly disfiguring industrial disease, phosphorous necrosis, and that one firm, Bryant and May, featured prominently in the struggles around health and safety. This paper examines the role of employers, the state, and those demanding reform. It suggests that medical and dental ‘experts’ were important both in relation to their ‘official’ role with respect to factory regulation, and also because industrial ill health was a site of professional politics. The extent to which gender issues entered into the politics of occupational health at this time is considered. It concludes that mediation, compromise and the different priorities of the various interests involved prevented the dangers to health in matchmaking as in other industries from being controlled and eliminated in this period.

It is self‐evident to anyone capable of seeing beyond the confines of the little spheres within which we spin out our lives, that the day is rapidly approaching when it will no longer be viable for the minority of the world's population who don't live in villages to make every major decision affecting the lives of the majority who do. So any program of village education which intends to be forerunner of a revised world order must, as its first priority, design a delivery system premised on local decision‐making. Bill Vaudrin, 1975

This paper examines two principal issues in the study of accidents: first, the conceptual and measurement problems in arriving at any historical understanding of the incidence and prevalence of accidents; and second, the thesis that accidents are not neutral in terms of gender and gender relations. Using evidence for the period 1880-1914, the paper focusses on the industrial accident and examines these questions in relation to official discourse and regulation around accidents. In mounting the argument that industrial accidents were indeed gendered, machines are given a central locus in explaining the debates about cause, prevention and the nature of sufferers of industrial accidents. The paper concludes that the alienation of women from machines in general, and from industrial accidents and from factory regulation concerned with them in particular, was central to a marginalisation of this form of threat to women's health and livelihood

This research note argues that in discussions about autobiography as a research tool in sociology there has been relative neglect of ethical issues. It suggests that the nature of autobiography as a form of personal document requires a re-examination of ethical principles important to sociology and feminist research practice. This paper aims to begin to approach some of these issues through an analysis of the complexities of autobiography's methodological relationship to the private and public domains, and, in particular, of the nature of the relationship between researcher and subject(s). The problematic relationship of the autobiographer, or self, to other subjects in accounts is examined and it is argued that feminists' ethical concerns with power relations in research remain pertinent in the production and use of autobiography.