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Introduction: Rural and remote nurses are often involved in disaster response. These nurses are faced with unique challenges in their daily practice due to geographical isolation and reduced resources. Nurses' roles and experiences in times of disaster have been discussed in the past; however, in the setting of rural and remote areas it remains largely underreported. The aim of this article is to provide an overview of the literature regarding the experiences of rural and remote nurses during and following disasters. Disasters affect all areas of the world., Methods: This scoping review was guided by Arksey and O'Malley's methodological framework for scoping reviews. Electronic databases CINAHL, MEDLINE, Scopus, Cochrane, Joanna Briggs Institute and Embase were searched. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist was used to guide the reporting of this review. Key concepts and themes were identified using Braun and Clarke's six-step framework for thematic analysis., Results: Eight articles met the inclusion criteria for this review. Themes that were identified included disaster roles, pre-disaster preparations, psychological and emotional states, and community involvement and relationships., Conclusion: Minimal literature exists that explores what rural and remote nurses experience in times of disaster. In this review, the experience of rural and remote nurses included the relationships between their personal and professional obligations and their influence on nurses' ability to respond to disasters. Further research is required in this domain to better understand the phenomena and address knowledge gaps that exist in the existing literature.

Ethanol has been demonstrated to exert profound effects upon cells and tissues via multiple mechanisms. One recently appreciated means by which cells can communicate with other cells is via the production and release of extracellular vesicles. Though smaller exosomes have been demonstrated to be released in response to ethanol exposure, the ability of ethanol to modulate the generation and release of larger microvesicle particles (MVP) is lesser studied. The present studies examined the ability of exogenous ethanol to generate MVP with a focus on skin cells. Acute ethanol exposure resulted in augmented MVP release in keratinocytes and in the skin and blood of mice. Unlike other stimuli such as ultraviolet B radiation or thermal burn injury, ethanol-mediated MVP release was independent of the Platelet-activating Factor receptor (PAFR). However, ethanol pretreatment was found to augment thermal burn injury-induced MVP in a PAFR-dependent manner. These studies provide a novel mechanism for ethanol-mediated effects, that could be relevant in the significant toxicity associated with thermal burn injury in the setting of alcohol intoxication., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Nurses who work in regional and rural hospitals face unique challenges to disaster preparedness and response. Geographical location and isolation, decreased resources and subsequent workforce, along with organizational and financial restraints are some of the hurdles these individuals and communities face [1,2]., Method: The Disaster Preparedness Evaluation Tool was applied a population of Regional and Rural Emergency Nurses in New South Wales., Result: Thirty-two nurses participated in this study. Their level of disaster preparedness was at a moderate level for knowledge, skills and preparation for disaster management. Their experiences broadly mirrored those found in earlier research., Conclusion: Results highlighted the nature of and delivery of continuing professional development in relation to disaster preparedness; mechanisms to encourage emergency department nurses to develop personal and family preparedness plans (to improved disaster preparedness); increased training in relation to psychological assessment of patients, and identification of biological agent signs and symptoms., (Copyright © 2020 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.)

Sickle cell disease (SCD) is a genetic disease associated with both chronic pain and acute painful events referred to as vaso-occlusive crises. Individuals with SCD suffer from a multitude of medical complications in addition to pain. Patients often are stigmatized as "drug-seeking" and receive inadequate pain management. The purpose of this study was to compare clinicians' SCD knowledge and attitudes toward patients with SCD before attending a 2-day conference on SCD (T1) with knowledge and attitudes immediately postconference (T2) and 2 months postconference (T3). A prospective, descriptive survey design was used. The authors administered surveys to assess SCD knowledge and clinicians' attitudes toward patients with SCD at three time points: T1 (N = 59), T2 (N = 38), and T3 (N = 30). SCD knowledge was measured using a 20-item survey, and clinicians' attitudes toward patients with SCD were measured with the General Perceptions About Sickle Cell Patients Scale, which included items on four independent subscales: positive attitudes, negative attitudes, concern-raising behaviors, and red-flag behaviors. The authors compared changes in knowledge and attitude scores between T1-T2 and T1-T3. Overall, knowledge scores were significantly improved (p < .001) and significantly increased between T1-T2 (p < .0001) and T1-T3 (p = .01). Negative attitudes trended lower over the three time points (p = .07), but a significant decrease in the negative attitudes score was only noted for T1-T3 (Z = -2.16.17, p = .03). Attendance at an educational SCD conference was an effective means to improve knowledge and decrease negative attitudes among clinicians. These differences were maintained at 2 months postconference., (Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Sickle cell disease (SCD) is a painful condition wherein breathing often is compromised. This pilot study supports the premise that individuals with SCD are willing to learn breathing exercises. Medical-surgical nurses should encourage breathing exercises for managing pain and preventing complications.

Young adults with sickle cell disease (SCD) are often stigmatized when they seek care for pain. The purpose of this pilot study was to test an intervention to decrease health-related stigma during care-seeking. Young adults with SCD ages 18 to 35 years (n = 90) were randomized to either the care-seeking intervention (CSI) or an attention control group that participated in life review interviews. The two groups were compared by t tests and longitudinal data analyses on the change from baseline to the last time point in total health-related stigma and health-related stigma by doctors. Findings suggest that the CSI was associated with significant increased awareness of perceived total stigma and stigma by doctors compared with the attention control group. These findings are promising in terms of lessons learned from a pilot intervention that focused on the role communication skills play in decreasing health-related stigma in young adults with SCD.

In individuals with sickle cell disease (SCD), recognizing the cues to an acute pain episode and responding appropriately are important. The purpose of this mixed-methods pilot study is to identify preliminary factors that influence care seeking for pain in young adults with SCD. Responses were received from 69 young adults with SCD, age 18-35 years. The majority of respondents (88%) wait until the pain intensity is an average of 8.7 (± 1.2) on a scale of 1 to 10 before seeking care. Prominent themes influencing care seeking for pain include: trying to treat pain at home, avoiding the emergency department because of past treatment experiences, the desire to avoid admission to the hospital, and the importance of time in the lives of the young adults with SCD. Young adults with SCD need additional support from family and healthcare providers in order to make timely, appropriate decisions regarding care seeking., (Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

There have been no published studies that measure health-related stigma in individuals with sickle cell disease (SCD). This study provides preliminary validity and reliability of the Sickle Cell Disease Health-Related Stigma Scale (SCD-HRSS). Using a sample of 77 young adults with SCD, ages 18-35 years, the results support the reliability of the SCD-HRSS with an overall Cronbach's alpha reliability of 0.84 and construct validity with a positive correlation between SCD-HRSS and a measure of depressive symptoms. Participants reported the highest levels of perceived stigma from the general public, then doctors, and lastly family. Limitations and directions for future research are discussed.

Adherence to highly restrictive diets is critical for women of childbearing age who have inborn errors of metabolism such as phenylketonuria. The purpose of this study was to explore attitudes about diet, barriers to and facilitators of dietary adherence, and experiences with the health care system in promoting dietary adherence among adolescent and adult women with inborn errors of metabolism to identify policy-level interventions to improve adherence. We analyzed the results of four focus groups including a total of 19 women between the ages of 12 and 52 years with phenylketonuria, methylmalonic acidemia, or maple syrup urine disease attending an educational summer camp in 2008. Themes were identified after independent analysis of transcripts. Most participants were highly knowledgeable about their dietary requirements and some could describe their own specific negative experiences of nonadherence. Many reported specific challenges, such as feelings of being different, that they experienced in elementary and middle school. Friends and family play an important role in maintaining dietary adherence. Participants identified one registered dietitian in particular who has played an important supportive role. Insurance coverage for medical foods was a common concern. Most participants identified concerns about transitioning from pediatric to adult medical services. We identified four specific strategies for future evaluation that may improve dietary adherence and health outcomes for women and their potential offspring: symptom-based dietary monitoring for some, educating school officials about medical diets, expanding the role of registered dietitians; and assisting with the transition from pediatric to adult health care providers., (Copyright 2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.)

We report the demonstration of a reflection microscope that operates at 13.2 nm wavelength with a spatial resolution of 55+/-3 nm. The microscope uses illumination from a tabletop extreme ultraviolet laser to acquire aerial images of photolithography masks with a 20 s exposure time. The modulation transfer function of the optical system was characterized.

We have demonstrated near-wavelength resolution microscopy in the extreme ultraviolet. Images of 50 nm diameter nanotubes were obtained with a single ~1 ns duration pulse from a desktop-size 46.9 nm laser. We measured the modulation transfer function of the microscope for three different numerical aperture zone plate objectives, demonstrating that 54 nm half-period structures can be resolved. The combination of near-wavelength spatial resolution and high temporal resolution opens myriad opportunities in imaging, such as the ability to directly investigate dynamics of nanoscale structures.

Objectives: To evaluate the safety and efficacy of cisplatin plus gemcitabine in persistent or recurrent platinum-resistant ovarian and primary peritoneal cancer., Study Design: Eligible, consenting subjects with measurable disease and one prior platinum-based regimen, but no prior gemcitabine, were to receive intravenous cisplatin followed by gemcitabine on days 1 and 8 every 28 days., Results: Between December 2000 and March 2003, 59 patients were enrolled from 24 institutions; two were ineligible. During the first stage of accrual, 27 subjects received cisplatin 30 mg/m2 and gemcitabine 750 mg/m2. In the second stage, gemcitabine was reduced to 600 mg/m2 because of hematologic toxicity at the higher dose. There were 4 complete and 5 partial responses for an overall response rate of 16% (9/57). Thirty-one women (54%) had stable disease. Median time to progression was 5.4 months. Overall survival was 14.9+ months. Grade 4 toxicities were hematologic, except one cutaneous reaction., Conclusions: Cisplatin plus gemcitabine, in the doses and schedule employed, has modest activity in this patient population.

Maps and other data graphics may play a role in generating ideas and hypotheses at the beginning of a project. They are useful as part of analyses for evaluating model results and then at the end of a project when researchers present their results and conclusions to varied audiences, such as their local research group, decision makers, or a concerned public. Cancer researchers are gaining skill with geographic information system (GIS) mapping as one of their many tools and are broadening the symbolization approaches they use for investigating and illustrating their data. A single map is one of many possible representations of the data, so making multiple maps is often part of a complete mapping effort. Symbol types, color choices, and data classing each affect the information revealed by a map and are best tailored to the specific characteristics of data. Related data can be examined in series with coordinated classing and can also be compared using multivariate symbols that build on the basic rules of symbol design. Informative legend wording and setting suitable map projections are also basic to skilled mapmaking.

Objectives: This trial was conducted to evaluate the safety and efficacy of cisplatin plus gemcitabine in previously treated squamous cell carcinoma of the cervix., Subjects and Methods: All women had measurable histologically confirmed squamous cell cervical cancer and a GOG performance status less than or equal to 2. The women were to receive cisplatin at 30 mg/m(2) plus gemcitabine at 800 mg/m(2) day 1 and day 8 every 28 days., Results: Between February 2001 and May 2002, 32 eligible patients were entered. All women had received prior chemotherapy and 29 had received radiation. Twenty patients received platinum previously twice. The median time from primary treatment to recurrence was 21 months, but the median time from last prior chemotherapy was less than 2 months. A second phase of accrual was not indicated per the established stopping rules. There were 7 (21.9%) partial responses and median response duration was 2.1 months. Twelve additional women (37.5%) had stable disease. Nine women (28.1%) had increasing disease. Median time to progression was 3.5 months. There were no treatment-related deaths. Six women had grade 4 neutropenia, three had grade 4 anemia, and two had grade 4 thrombocytopenia. Grade 4 gastrointestinal toxicity occurred in two women and grade 4 anorexia occurred in one., Conclusions: This study suggests modest activity for the gemcitabine plus cisplatin doublet in previously treated squamous cell carcinoma of the cervix. The objective response rate of 22% is comparable to that of other active agents and combinations tested in this setting. Toxicities were primarily hematologic and generally manageable with dose reductions.

Objectives: The aim was to determine the safety and efficacy of gemcitabine plus cisplatin for patients with relapsed ovarian carcinoma and to compare ex vivo drug sensitivity profiles with clinical outcomes., Patients and Methods: Previously treated patients with ovarian carcinoma received cisplatin (30 mg/m(2)) plus gemcitabine (600-750 mg/m(2)) on Days 1 and 8 of each 21-day cycle. Seventeen of the 27 patients underwent ex vivo analyses for correlation with clinical response., Results: Of 27 patients, there were 7 (26%) complete and 12 (44%) partial responses, for an overall response rate of 70% (95% CI: 53-87%). Toxicities included neutropenia Grade III in 51.9%, Grade IV in 29.6%; anemia Grade III in 18.5 %; thrombocytopenia Grade III in 66.7 %, Grade IV in 29.6%; nausea and vomiting Grade III in 14.8 %; peripheral neuropathy Grade III in 3.7%; and alopecia Grade IV in 11.1% of patients. The median time to progression for objective responders was 7.9 months with a range of 2.1 to 13.2 months. There were no treatment-related deaths. Ex vivo results correlated with response, time to progression, and survival, remaining significant when adjusted for platin-resistance and number of prior therapies. Adjustment for platin-free interval decreased the significance but did not, in and of itself, predict significantly for progression-free survival., Conclusions: Cisplatin plus gemcitabine is active for patients with relapsed ovarian cancer. Toxicities, primarily hematologic, are manageable with dose modifications. Responses observed in heavily pretreated and platin-resistant patients indicate activity in drug-refractory patients. The results of the ex vivo analyses correlate with clinical outcomes.

•  Relatively little is known about the influences of growing-season background ozone (O 3 ) concentrations on leaf cuticles and foliar water loss. •  Using fumigation chambers, leaf wettability and foliar water loss were studied in two poplar species, Populus nigra and P. euramericana, and a conifer, Pseudotsuga menziesii, under three O 3 regimes; control (approx. 1 ppbv O 3 ), urban O 3 exposure (13-41 ppbv O 3 ), and montane O 3 exposure (30-45 ppbv O 3 ). •  Urban O 3 exposure delayed a decrease in droplet contact angles over time in Populus leaves by 2-4 wk, and decreased droplet contact angles of P. menziesii foliage. Ozone exposure increased foliar water loss and minimal conductance to water vapour for P. euramericana, but not P. nigra and P. menziesii. Both Populus species had lower photosynthetic biomass in O 3 treatments, due to production of fewer new leaves, premature leaf abscission and decreased leaf size (P. euramericana only). Leaf abscission was preceded by foliar injury symptoms characteristic of O 3 exposure. •  Results suggest that exposure to [O 3 ] common during the growing season can increase water loss in Populus saplings, but this effect might be offset by decreased foliar biomass. Importantly, responses were highly species specific in a given O 3 treatment.

The two main resistances in the exchange of gases between plants and the atmosphere are stomatal and boundary layer resistances. We modeled boundary layer dynamics over glabrous and pubescent leaves (assuming non-exchanging trichomes) with leaf lengths varying from 0.01 to 0.2 m, and windspeeds of 0.1-5.0 m x s(-1). Results from theoretical and semi-empirical formulae were compared. As expected, boundary layer thickness decreased with decreasing leaf length and increasing windspeed. The presence of trichomes increased leaf surface roughness, resulting in lowered Reynolds numbers at which the boundary layer became turbulent. This effect is especially important at low windspeeds and over small leaves, where the Reynolds number over glabrous surfaces would be low. We derived a new simple dimensionless number, the trip factor, to distinguish field conditions that would lead to a turbulent boundary layer based on the influence of trichomes. Because modeled rates of CO2 and H2O(v) exchange over turbulent boundary layers are one or more orders of magnitude faster than over laminar boundary layers, a turbulent boundary layer may lead to increased carbon uptake by plants. The biological trade-off is potentially increased transpirational water loss. However, in understory habitats characterized by low windspeeds, even a few trichomes may increase turbulence in the boundary layer, thus facilitating photosynthetic gas exchange. Preliminary field data show that critical trip factors are exceeded for several plant species, both in understory and open habitats., (Copyright 2001 Academic Press.)

Objective: To evaluate endoglin, a membrane protein and member of the transforming growth factor beta-1 receptor complex, as an endothelial marker of angiogenesis in cervical cancer tissues., Methods: Tumor tissue was collected from 31 surgically treated stage IB nonbulky (under 5 cm) cervical cancer subjects, and samples were fixed in formalin and embedded in paraffin. Endoglin was stained on 5-microm slide sections by the DAKO Catalyzed Signal Amplification method (DAKO Corporation, Carpinteria, CA). Factor VIII was stained by standard immunohistochemistry. Positively stained microvessels were counted in "hot spots" at 200x magnification. Clinical data were correlated with vessel counts by Spearman correlation. Mean differences in counts were tested using paired t tests., Results: This staining method for endoglin identified significantly more vessels than the factor VIII method (mean 92 +/- 45 versus 33 +/- 16, P <. 001). Endoglin and factor VIII counts correlated significantly with deep stromal invasion (Spearman rho 0.466 and 0.522, respectively, P <.05); however, only endoglin counts correlated significantly with lymph node metastases (rho =.495, P <.01)., Conclusion: Endoglin is stimulated in tumor angiogenesis and might be relatively more specific than commonly used endothelial markers. The endoglin system was more sensitive for staining capillaries in neoplastic cervical tissue, better predicted lymph node metastases, and should be widely applicable for the study of other tumors.

Objective: Morbidity associated with radical hysterectomy is significant. Utilizing the endoscopic stapler for transection of the cardinal ligaments and uterosacral ligaments is a possible method to decrease operative time and blood loss., Methods: Two groups of patients, one group with the stapler used (n = 21) and the other with the traditional method utilized (n = 18), were compared in regard to operative and postoperative morbidity, operative time, and surgical margins. The groups were similar in regard to medical condition, age, and weight., Results: Median (243 min versus 284 min) and mean (246 min versus 287 min) operative times were significantly less in the stapler group than in the control group (P < 0.002). Median blood loss was reduced by 20% in the stapler group (400 ml versus 500 ml, P < 0.03). There was no significant difference in febrile morbidity, surgical complications, or length of hospital stay., Conclusion: Our data suggest significant reduction in blood loss and operative time with the use of the endoscopic stapler., (Copyright 1998 Academic Press.)

Background: Chemotherapy for steroid tumors of unspecified type has met with limited success and the overall prognosis has been poor., Case: A patient with a virilizing steroid tumor, otherwise unspecified, with demonstrated progressive disease after surgical debulking. Treatment with multiagent chemotherapy failed, but the patient subsequently had a robust response to GnRH agonist therapy., Conclusion: GnRH analogue treatment should be considered prior to cytotoxic chemotherapy in cases of steroid tumor, not otherwise specified.

We present a case report of a patient with a IB1 cervical squamous cell cancer which recurred in a transposed ovary 8 years following radical parametrectomy. The patient was initially treated with a simple vaginal hysterectomy for apparent CIS but was found to have an invasive squamous cell cancer to a depth of 7 mm into the stroma. She was treated with a radical parametrectomy, pelvic lymphadenectomy, and ovarian transposition. There was no evidence of residual disease. The patient then had an apparent isolated recurrence in her left ovary 8 years later. Although there are a few cases of stage IB squamous cell cancer metastatic to a transposed ovary, this is the first case with such minimal primary disease and delayed isolated recurrence.

Objective: To evaluate the serial changes in colposcopic and cervicographic findings of women with cervical intraepithelial neoplasia (CIN) II and III enrolled in a phase III randomized comparison of oral beta carotene and placebo., Methods: All subjects treated with beta carotene or placebo for at least 6 months were included if they met the criteria of persistent or progressive disease (no change or worsening of CIN grade) or disease regression (improvement of two grades or more). These two groups were compared for changes in colposcopic and cervicographic patterns. Colposcopically directed biopsies and cervicography were done at enrollment and after 6 months. Quarterly Papanicolaou smears and colposcopic assessments also were performed. Findings of mosaic pattern, punctation, and white epithelium were graded and diagrammed at colposcopic examinations. Cervicographic measurements of the centripetal movement of metaplastic epithelium were recorded. Data were analyzed by chi 2 analysis and Fisher exact tests., Results: Data were available for 23 subjects with regression and 16 with persistent lesions. Small lesions were significantly more likely to regress than large ones. Lesions without coarse punctation were significantly more likely to regress than lesions with coarse punctation, and lesions with mild acetowhite changes were more likely to regress than those with dense white epithelium. A pattern of centripetal movement of the metaplastic epithelium toward the cervical os was noted in lesions that regressed, but not in those that persisted or progressed., Conclusion: This study describes the centripetal growth of metaplastic squamous epithelium associated with the regression of CIN II and III. This observation contributes to our understanding of the process of disease regression in CIN and may be useful in identifying individuals for conservative management. Failure to identify this pattern correlates with persistent or progressive disease.

The MN protein is a newly described biomarker found to be overexpressed in most cervical carcinomas. This study was an effort to evaluate the prognostic importance of tumor MN expression, HPV status, and the presence of other biomarkers in cervical cancers. Tumor DNA and protein for study were extracted from archived frozen tissue. Tumor tissues and controls were evaluated by Western blot analysis for MN, intestinal alkaline phosphatase (IAP), c-myc, and p53 protein overexpression. Immunohistochemistry was performed for MN quantification and the study of expression patterns in histologic subtypes of cervical cancer. HPV data were obtained by PCR amplification of extracted DNA using consensus and type-specific primers. Clinical data were obtained from the patients' records and from the cancer registry. Clinical and molecular data were correlated by chi2, Fisher's exact test, and logistic regression. The results demonstrate that IAP is not overexpressed in clinical specimens of cervical carcinoma, although in somatic cell hybrid experiments, overexpression of IAP correlates with the malignant state. None of 47 tumors, including those which were HPV negative, overexpressed p53. c-myc protein overexpression occurred in 11 of 52 tumors, most of which contained HPV 16, but this was not significantly different from the tumors as a whole. There was no apparent association between MN protein expression and the overexpression of c-myc protein. MN was overexpressed in all cancers and quantitatively varied with the histologic subtype. Specifically, lower expression of MN correlated with adenosquamous and less-differentiated histology (P < 0.01 for grade 3 tumors). Low expression of MN protein also correlated with HPV negativity (P < 0.05). In stage IB and IIA cancers, low expression of MN was associated with deeper cervical stromal invasion (P < 0.03). Further, low expression of MN correlated with lymph node metastases in small (<3.5 cm) IB and IIA cervical cancers (P < 0.04). These data suggest that MN is emerging as a potentially important new biomarker for cervical carcinoma. The overexpression commonly seen in cervical cancer is possibly associated with loss of a critical tumor suppressor gene located on chromosome 11. Low expression of MN antigen appears to correlate with several adverse prognostic features and further prospective study is warranted.

We present a case of placental-site trophoblastic tumor associated with erythrocytosis. This 42-year-old woman had persistent amenorrhea and low elevations of her hCG titer after term delivery of a healthy female infant. The woman was noted to have polycythemia of uncertain etiology and was treated with serial phlebotomy. Placental-site trophoblastic tumor was diagnosed and hysterectomy was performed, with subsequent resolution of the polycythemia. Although erythrocytosis has been reported with other gynecologic tumors, this is the first reported association with a placental-site trophoblastic tumor. A role has been suggested for placental lactogen in erythropoiesis during pregnancy based on previous animal studies. Diffuse positive staining for hPL is characteristic of placental-site trophoblastic tumors. We postulate that hPL may have played an ancillary role to erythropoietin in the erythrocytosis demonstrated in this case. Spider angiomata and splenomegaly are interesting clinical features previously described in association with placental-site trophoblastic tumors, and were demonstrated in this patient.