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Autistic college students are often forced to navigate stigma on campus, but little is known about how autistic college students manage communicated stigma. Semi-structured interviews with ten autistic college students were conducted to explore how they manage peer stigma. Interpretative Phenomenological Analysis (IPA) was used to identify three themes from the data: First, participants seek to avoid peer stigma by concealing attributes associated with autism. Next, participants buffer against peer stigma by engaging in favorable social comparison. Finally, participants perceive the autism label as highly stigmatizing, necessitating limited disclosure on campus. These results can help researchers and practitioners focus efforts to promote neurodiversity to both autistic students and their peers on campus.

TP53 mutations are implicated in the progression of mucinous borderline tumors (MBOT) to mucinous ovarian carcinomas (MOC). Optimized immunohistochemistry (IHC) for TP53 has been established as a proxy for the TP53 mutation status in other ovarian tumor types. We aimed to confirm the ability of TP53 IHC to predict TP53 mutation status in ovarian mucinous tumors and to evaluate the association of TP53 mutation status with survival among patients with MBOT and MOC. Tumor tissue from an initial cohort of 113 women with MBOT/MOC was stained with optimized IHC for TP53 using tissue microarrays (75.2%) or full sections (24.8%) and interpreted using established criteria as normal or abnormal (overexpression, complete absence, or cytoplasmic). Cases were considered concordant if abnormal IHC staining predicted deleterious TP53 mutations. Discordant tissue microarray cases were re-evaluated on full sections and interpretational criteria were refined. The initial cohort was expanded to a total of 165 MBOT and 424 MOC for the examination of the association of survival with TP53 mutation status, assessed either by TP53 IHC and/or sequencing. Initially, 82/113 (72.6%) cases were concordant using the established criteria. Refined criteria for overexpression to account for intratumoral heterogeneity and terminal differentiation improved concordance to 93.8% (106/113). In the expanded cohort, 19.4% (32/165) of MBOT showed evidence for TP53 mutation and this was associated with a higher risk of recurrence, disease-specific death, and all-cause mortality (overall survival: HR = 4.6, 95% CI 1.5-14.3, p = 0.0087). Within MOC, 61.1% (259/424) harbored a TP53 mutation, but this was not associated with survival (overall survival, p = 0.77). TP53 IHC is an accurate proxy for TP53 mutation status with refined interpretation criteria accounting for intratumoral heterogeneity and terminal differentiation in ovarian mucinous tumors. TP53 mutation status is an important biomarker to identify MBOT with a higher risk of mortality.

Objective: To evaluate myeloid differentiation primary response gene 88 (MyD88) and Toll-like receptor 4 (TLR4) expression in relation to clinical features of epithelial ovarian cancer, histologic subtypes, and overall survival. Patients and Methods: We conducted centralized immunohistochemical staining, semi-quantitative scoring, and survival analysis in 5263 patients participating in the Ovarian Tumor Tissue Analysis consortium. Patients were diagnosed between January 1, 1978, and December 31, 2014, including 2865 high-grade serous ovarian carcinomas (HGSOCs), with more than 12,000 person-years of follow-up time. Tissue microarrays were stained for MyD88 and TLR4, and staining intensity was classified using a 2-tiered system for each marker (weak vs strong). Results: Expression of MyD88 and TLR4 was similar in all histotypes except clear cell ovarian cancer, which showed reduced expression compared with other histotypes (P

Mental health services in the Eastern Mediterranean Region are predominantly centralized and institutionalized, relying on scarce specialist manpower. This creates a major treatment gap for patients with common and disabling mental disorders and places an unnecessary burden on the individual, their family and society. Six steps for reorganization of mental health services in the Region can be outlined: (1) integrate delivery of interventions for priority mental disorders into primary health care and existing priority programmes; (2) systematically strengthen the capacity of non-specialized health personnel for providing mental health care; (3) scale up community-based services (community outreach teams for defined catchment, supported residential facilities, supported employment and family support); (4) establish mental health services in general hospitals for outpatient and acute inpatient care; (5) progressively reduce the number of long-stay beds in mental hospitals through restricting new admissions; and (6) provide transitional/bridge funding over a period of time to scale up community-based services and downsize mental institutions in parallel.إعادة تنظيم خدمات الصحة النفسية: من نماذج رعاية مؤسسية إلى نماذج رعاية مجتمعية.بيندتو ساراسنيو، ريتشارد جير، عاطف رحمان، خالد سعيد، جوليان إيتون، جبريل افبيجارو، مايكل كيد، كريستوفر دوريك، شيارا سرفيي، مايكل كارن فنك، كريس أندرهيل.إن خدمات الصحة النفسية في إقليم شرق المتوسط غالباً ما تكون مركزية ومؤسسية، وتعتمد عى القليل من القوى العاملة المتخصصة. ويخلق هذا فجوة كبرة في معالجة المرضى المصابن باضطرابات نفسية شائعة ومسبِّبة للعجز، ويحمِّل الفرد وأسرته ومجتمعه عبئاً لا داعي له. ويمكن إيجاز إعادة تنظيم خدمات الصحة النفسية في الإقليم في ست خطوات: (1) إدماج تقديم التدخات الخاصة بالاضطرابات النفسية ذات الأولوية في برامج الرعاية الصحية الأولية والبرامج ذات الأولوية القائمة، (2) تعزيز منهجي لقدرات العاملن في مجال الصحة غر المتخصصن عى تقديم الرعاية الصحية النفسية، (3) توسيع نطاق الخدمات المجتمعية (فرق توعية مجتمعية معنية بالتعريف بمناطق الخدمات الصحية)، وبدعم المرافق السكنية، ودعم التوظيف، ودعم الأسرة)، (4) إنشاء خدمات للصحة النفسية في المستشفيات العامة، وذلك بالعيادات الخارجية وكذلك بالأقسام الداخلية للرعاية الحرجة، (5) الحد تدريجياً من عدد أسَِّة الإقامة الطويلة في المستشفيات النفسية من خال الحدّ من حالات دخول جديدة، (6) توفر تمويل انتقالي لفرة من الزمن عى مدى فرة من الزمن، لتوسيع نطاق الخدمات المجتمعية وتقليص عدد المؤسسات النفسية بالتوازي مع ذلك.Réorganisation des services de santé mentale : des modèles de soins institutionnels aux modèles communautaires.Les services de santé mentale dans la Région de la Méditerranée orientale sont essentiellement centralisés et institutionnalisés. Ils reposent sur un personnel spécialisé qui est rare. Cette situation crée un large fossé thérapeutique pour les patients atteints de troubles mentaux courants et handicapants, et fait porter une charge inutile pour l'individu, sa famille et la société. Six étapes pour la réorganisation des services de santé mentale dans la Région peuvent être présentées de la manière suivante : 1) intégrer l’offre des interventions pour les troubles de santé mentale prioritaires dans les programmes de soins de santé primaires et les programmes prioritaires existants ; 2) renforcer systématiquement les capacités du personnel de santé non spécialisé à fournir des soins de santé mentale ; 3) intensifier les services communautaires (équipes communautaires de proximité pour une zone de desserte définie, établissements résidentiels bénéficiant d'assistance aide à l'emploi et soutien apporté à la famille) ; 4) établir des services de soins de santé mentale dans des hôpitaux généraux pour les soins externes et les soins aigus chez le patient hospitalisé ; 5) réduire progressivement le nombre de lits de long séjour dans les hôpitaux de soins de santé mentale en diminuant le nombre des nouvelles admissions ; 6) fournir un financement de transition/provisoire pendant une certaine durée pour intensifier les services communautaires et parallèlement réduire la taille des institutions de santé mentale.

This is the first prospective study in a contemporary Australian/New Zealand population to determine the prevalence of testosterone deficiency in testicular cancer survivors at 12 months from treatment, and any association with poorer quality of life. Hormone assays from 54 evaluable patients in a prospective cohort study revealed biochemical hypogonadism in 18 patients (33%) and low-normal testosterone in 13 patients (24%). We found no association between testosterone levels and quality of life (all P > 0.05). Hypogonadal patients should be considered for testosterone replacement to prevent long-term morbidity.

Giant cell arteritis (GCA) is a systemic vasculitis with symptoms that could cause a patient to present to a general dental practitioner. A case of GCA that presented as headache, jaw claudication, unilateral visual loss and tongue ulceration leading to necrosis is reported and the literature reviewed, with an emphasis on dentally relevant aspects. It is vital that GCA is not overlooked in patients over the age of 50 with unexplained dental pain, tissue necrosis or jaw pain which may be misdiagnosed as a temporomandibular joint disorder. Early diagnosis and prompt treatment is the key to preventing visual loss. Early referral in such cases would be warranted. Clinical Relevance: Dental clinicians may play a part in the early diagnosis of GCA by having a high index of suspicion for its symptoms in patients, so that devastating ischaemic consequences, such as irreversible visual loss, can be prevented.

In Israeli director Yael Bartana’s 2007 film Mary Koszmary—meaning “Bad Dreams” or “Nightmares”—a young Polish politician delivers a resounding speech to an empty, crumbling, communist-era Stadion Dziesięciolecia in Warsaw. The speech, he says, is an appeal: “This is a call. . . . It is an appeal for life. We want three million Jews to return to Poland, to live with us again. We need you! Please come back!” This article considers the powerful and perhaps disturbing premise of these lines and explores their possible meanings in a contemporary Polish context. What can it mean for Poles and Polish culture to need Jews—and in particular, to need those Jews who can never return? The complex phenomenon of Jewish memory in Poland and Eastern Europe cannot be contained within specific, present-day borders—whether of geography or of academic discipline: similar dynamics to those Bartana has identified in Poland exist throughout the region. Thus, against the background of Bartana’s film, the article considers the growing phenomenon and importance of local Jewish festivals in Poland and present-day Ukraine, focusing in detail on two specific festivals: the annual festival “Encounters with Jewish Culture,” held in Chmielnik, Poland, and the biannual Bruno Schulz Festival in Drohobych, Ukraine. The analysis explores ways that the memory of Polish Jews—and more specifically the figure of the absent Polish Jew—can function as a central element in the construction of new, communal Polish and Ukrainian narratives since the fall of Communism.

We report the case of a 3-year-old child, who presented with lid swelling which progressed to proptosis of the left eye. He also had systemic symptoms of fatigue and weight loss. An examination revealed hepatosplenomegaly and lymph node enlargement. Investigations showed a peripheral smear with blast cells, which were also revealed through a bone marrow biopsy. A CT scan showed a mass lesion in the left orbit that had infiltrated into the surrounding tissues. He was diagnosed with acute lymphoblastic leukaemia (ALL) with left-sided orbital mass secondary to it. Haematogenous masses in the orbit are commonly due to granulocytic sarcomas, which are usually associated with acute myelogenous leukaemia (AML), not ALL, and are rare especially when they precede systemic disease.

Burning mouth syndrome (BMS) is an idiopathic disease characterized by the feeling of burning in the oral cavity. Ten per cent of patients presenting to oral medicine clinics have BMS. Anxiety and depression are common co-morbidities in BMS, but it is not known if they are associated with specific BMS symptoms.In an exploratory analysis, this study examined the association of generalized anxiety and depression with individual BMS symptoms.Forty-one patients were recruited from a dental outpatient clinic (30 with BMS and 11 with other oral conditions), evaluating specific BMS symptoms and their intensity. Anxiety and depression symptoms were assessed using a standardized measure (Clinical Interview Schedule-Revised).Taste change (p = 0.007), fear of serious illness (p = 0.011), metallic taste (p = 0.018) and sensation of a film on the gums (p = 0.047) were associated with an excess of psychiatric symptoms. More specifically, metallic taste (coefficient = 0.497, 95% CI = 0.149-0.845; p = 0.006) and sensation of film on gums (coefficient = 0.625, 95% CI = 0.148-1.103; p = 0.012) were associated significantly with higher scores for depressive symptoms; taste change (coefficient = 0.269, 95% CI = 0.077-0.461; p = 0.007), bad breath (coefficient = 0.273, 95% CI = 0.065-0.482; p = 0.012) and fear of serious illness (coefficient = 0.242, 95% CI = 0.036-0.448; p = 0.023) were associated with higher anxiety scores.Specific BMS symptoms are associated differentially with generalized anxiety and depression. Dental practitioners should ascertain which BMS symptoms are predominant and be mindful of the association of certain symptoms with anxiety or depression and, where necessary, consider medical consultation.

These guidelines, informed by the best available evidence and consensus expert opinion, provide a framework to guide the timely initiation of chemotherapy for treating cancer. They sit at the intersection of patient experience, state-of-the-art disease management and rational efficient service provision for these patients at a system level. Internationally, cancer waiting times are routinely measured and publicly reported. In Australia, there are existing policies and guidelines relating to the timeliness of cancer care for surgery and radiation therapy; however, until now, equivalent guidance for chemotherapy was lacking. Timeliness of care should be informed, where available, by evidence for improved patient outcomes. Independent of this, it should be recognised that shorter waiting periods are likely to reduce patient anxiety. While these guidelines were developed as part of a proposed framework for consideration by the Victorian Department of Health, they are clinically relevant to national and international cancer services. They are intended to be used by clinical and administrative staff within cancer services. Adoption of these guidelines, which are for the timely triage, review and treatment of cancer patients receiving systemic chemotherapy, aims to ensure that patients receive care within a timeframe that will maximise health outcomes, and that access to care is consistent and equitable across cancer services. Local monitoring of performance against this guideline will enable cancer service providers to manage proactively future service demand.

The aim was to measure mesiodistal crown size of both sexes in different age groups of a well characterised Romano-British population to determine the progressive effects of approximal attrition. From the collection in the British Museum of Romano-British skeletons excavated from Poundbury, aged and sexed by Museum staff on established criteria, two samples were selected randomly from those with intact permanent dentitions. The first examiner measured the teeth of 30 males and 30 females aged 14-24 years and the second examiner those of 59 males and 51 females distributed across the four age groups, namely 14-24, 25-34, 35-45, over 45 years. The mesiodistal diameter of each permanent tooth was measured on two separate occasions and the mean for each tooth type in each age group calculated. Differences were explored with two sample t-tests and multiple regression analysis. The intra-operator reproducibility for difference tooth types ranged from r = 0.92 to r = 0.99 and for inter-operator reproducibility from r = 0.74 to r = 0.99. In the youngest age group males had larger teeth than females with this difference being statistically significant for most tooth types. There was a pattern of decreasing tooth size over the four age groups, with males more affected than females. Different tooth types showed different reductions, the greatest being in upper and lower incisors and upper first molars and the least in lower second molars, upper second molars and third molars. The average total arch length reduction estimated by two different methods between aged groups 1 and 4 was 10.0mm in the upper jaw and 6.4 mm in the lower jaw. Thus, in this Romano-British sample all tooth types showed reduction in mesiodistal diameter with increasing age, the extent varying between the sexes, the jaws and tooth types. From comparable studies, this approximal attrition was slightly greater than for mediaeval Swedes and considerably greater than modern Swedes and other Caucasians.

Objective: Determine if aspirin inhibits the IL-1β–stimulated expression of inducible nitric oxide synthase (iNOS), nitric oxide (NO), and prostaglandin E 2 (PGE 2 ) in rat ovarian dispersates cultured in vitro . Design: Prospective, controlled in vitro study. Setting: Academic research laboratory. Animals: Ovaries collected from immature rats. Intervention(s): Ovaries were collected from immature rats and enzymatically dispersed. Ovarian dispersates were placed into plates containing media alone or media supplemented with IL-1β (100 U/mL) and varying concentrations of aspirin (0, 1, 3, 5 and 10 mM). Ovarian dispersates were cultured in a humidified environment of 5% CO 2 in air at 37°C for 24 or 48 hours. Main Outcome Measure(s): Twenty-four– and 48-hour iNOS, nitrite (a stable metabolite of NO), and PGE 2 levels were determined from ovarian dispersates cultured in vitro. Result(s): Administration of IL-1β increased nitrite and PGE 2 levels over that observed in the control group after culture of ovarian dispersates for 24 and 48 hours. Aspirin dose dependently reduced the IL-1β–stimulated increase in nitrite production from ovarian dispersates after culture for 24 and 48 hours. Aspirin completely (24 hours) or dose dependently (48 hours) prevented the IL-β–stimulated increase in PGE 2. Coadministration of IL-1β and aspirin (10 mM) attenuates IL-1β–stimulated iNOS expression after culture for 24 and 48 hours. Conclusion(s): Aspirin significantly inhibits the IL-1β–stimulated expression of iNOS, NO, and PGE 2 in ovarian dispersates cultured in vitro.

The cleanability of stainless steel using a starch soil was investigated using X-ray photoelectron spectroscopy and atomic force microscopy. Two cleaning regimes were examined: high pressure spray system removed absorbed material much more effectively than mechanical action. Surface defects on the stainless steel acted as sites for soil retention. When starch was combined with the Staphylococcus aureus bacterium the two components were removed at different rates from the surface caused by difference in size between the starch molecules and bacterium cells.

The study was performed to evaluate prospectively the efficacy and safety of insertion of tunnelled central venous catheters as an out-patient procedure in the radiology department. Tunnelled central venous catheters were inserted via the jugular or subclavian veins in 94 patients. The insertion was guided by ultrasound or venography. A post-procedure chest radiograph was obtained and, if the patients were well, they were discharged from hospital after 2h. Insertion was successfully achieved in all patients. Early complications occurred in 19 patients (20.2%) but these were generally minor. A chest drain was inserted into one patient who had a pneumothorax on the post-procedure chest radiograph. All other patients were fit to go home. Late complications occurred in 32 patients (34%), resulting in death in one patient. This study suggests that, with appropriate precautions, out-patient percutaneous image-guided insertion of tunnelled central venous catheters is a safe procedure.

This is the first prospective study in a contemporary Australian/New Zealand population to determine the prevalence of testosterone deficiency in testicular cancer survivors at 12 months from treatment, and any association with poorer quality of life. Hormone assays from 54 evaluable patients in a prospective cohort study revealed biochemical hypogonadism in 18 patients (33%) and low-normal testosterone in 13 patients (24%). We found no association between testosterone levels and quality of life (all P0.05). Hypogonadal patients should be considered for testosterone replacement to prevent long-term morbidity.

An abundance of new evidence regarding treatment strategies for neutropenic fever is likely to contribute to variability in practice across institutions and clinicians alike.To describe current clinical practices in Australia, by surveying haematologists, oncologists and infectious diseases physicians involved in cancer care.Clinician members from Australian professional associations, accounting for the vast majority of Australian cancer specialists, were invited to participate in an electronic survey, comprising of a clinical case-based questionnaire. Clinical practice areas explored were: use of risk-assessment and empiric antibiotic strategies across various treatment settings; use of anti-bacterial prophylaxis; and use of granulocyte-colony stimulating factors for established neutropenic fever and for secondary prophylaxis.A total of 252 clinicians returned responses (approximately 30% response rate). The majority (70%) were representative of practices in public, major city, tertiary referral hospitals. Less than half of clinicians were aware of risk-assessment tools and less than quarter currently used ambulatory care strategies. If adequate resources were made available, more than 80% were willing to use risk-assessment tools and 60% more clinicians were likely to use ambulatory care strategies. Most clinicians prescribed dual therapy parenteral antibiotics, even for clinically stable patients (53% haematologists, 56% oncologists). Granulocyte-colony stimulating factor was used frequently as secondary prophylaxis in the breast cancer case (91%), follicular lymphoma case (59%) and non-small cell lung cancer case (31%). Fluoroquinolone prophylaxis was infrequently prescribed (19% oncologists, 30% haematologists).Evidence-practice gaps were identified around the use of risk-assessment-based empiric therapy, and help to inform better clinical guidance.

The current consensus guidelines were developed to standardize the clinical approach to the management of neutropenic fever in adult cancer patients throughout Australian treating centres. The three areas of clinical practice covered by the guidelines, the process for developing consensus opinion, and the system used to grade the evidence and relative strength of recommendations are described. The health economics implications of establishing clinical guidance are also discussed.

A population of dwarf cisco in Minnesota was studied in native and transplant environments. Life history characters were recorded and the stability of meristics and morphometrics of the population over a two year period in three different environments was assessed with univariate and multivariate statistics. Transplanted cisco lived longer and grew larger than they did in their native lake, yet retained distinctive pigmentation patterns and an unusually early spawning season. Meristic characters of dwarf fish remained within ranges reported forCoregonus artedii during the lifetimes of individuals in their new environments, but morphometric measures underwent significant size- and shape-related changes. Incubation and rearing studies show egg incubation time and behavior of larvae were identical of those of non-dwarf cisco. Comparisons with non-dwarf cisco populations illustrate the ecophenotypic plasticity of adult fish of this population of North American cisco.

Foods brought to the nest by Montagu's Harriers breeding within an area of intensive arable farmland in England are described. About 50% of prey identified from pellets and prey remains was small birds (< 50 g), which, together with gamechicks and small mammals, made up 70–90% of the diet. At one nest, twothirds of small bird prey were juveniles or nestlings. Live prey weight varied between 6-300 g, with an estimated mean of 36–51 g, about 14–18 and 10–13% of male and female harrier weights, respectively. A male harrier ate (or discarded) about 10% of the prey before delivery, about 9% of his own body weight. The frequency of prey deliveries varied after hatching within and between males, and was linked to brood size. There was no uniform pattern to daily delivery times.

This study compared the chromosome complement and mitochondrial DNA profile of a population of dwarf cisco in Ten Mile Lake, Cass County, Minnesota, to two populations of normal-sized Coregonus artedii in order to determine if the dwarf fish were conspecific with C. artedii. Chromosomal analysis revealed a diploid chromosome number (2n = 80) the same as reported for C. artedii. Mitochondrial DNA (mtDNA) analysis revealed unexpected levels of intrapopulational diversity in each study population, with the dwarf fish displaying the highest level of mtDNA diversity. Heteroplasmy, restriction site polymorphisms, and three size variants were documented. Each population was characterized by a unique profile of mtDNA clonal types, yet interpopulational comparisons revealed more similarities between the dwarf fish in Ten Mile Lake and the two normal populations than between the populations of normal-sized fish. Based on these data, the dwarf fish of Ten Mile Lake should be considered conspecific with Coregonus artedii.

Apart from one report of phimosis, involvement of the penis has not been reported as a complication of chronic GVHD. We report a patient with recurrent chronic GVHD who developed skin discoloration of the penile shaft, together with erectile dysfunction consistent with Peyronie's disease. Histological features were consistent with sclerodermatous change. These features suggest that the penis may be a target organ in chronic GVHD.

Purpose of the Study: The management of malignant wounds is a challenge for the supportive care team. Patients have an impaired quality of life due to the presence of the skin lesion. The discomfort related to odour, pain, risk of infection and bleeding is frequently observed in this type of wound. The goal of the wound care (curative or palliative) depends on the patient's response to anticancer treatments and the surgical possibilities, sometimes limited in geriatric oncology. The odours due to necrosis and microbial flora especially impact the distress for patients, families and caregivers. Objectives: The objectives of this study are to investigate the bacterial profile of malignant breast cancer wounds and suggest the most appropriate approach to manage two important symptoms: the odours and the risk of infection. Methods: Followed case studies of malignant wounds of older patients and compared the clinical aspect and impact with the results of the bacterial flora. Results and Discussion: Many antimicrobial products and antibiotics are proposed to reduce the growth of bacteria and the odours, but there is no evidence of their efficiencies (except metronidazole), and potential adverse effects. Only very few studies exist. In our experience, the malignant wounds were colonised by multiple bacterial species and the most common resident were Staphylococcus aureus andPseudomonas aeruginosa. The anaerobic bacteriawere present inmany cases (e.g.: Peptostreptococcus, Fusobacteriumnecrophorum). The odours seem dependent of: the number of bacteria, the presence of anaerobic germs and special bacteria like Proteus mirabilis or Peptostreptococcus. Antimicrobial dressings seemed to be inefficient and charcoal dressing completely controls odours in only 50% of cases. Conclusions: Contrary to other chronic wounds, malignant wounds are under the influence of the progression of the cancer and the effects of the treatments (e.g.: chemotherapy/aplasia). Our findings suggest that planktonic bacteria, biofilm, and bacterial volatiles interact in dynamic context. No one dressing could control odours and colonisation, so it is necessary to know, use and adapt all the products and wound care to each situation, in order to limit the prescription of antibiotics. Moreover, peculiarities of this elderly population must be considered: frequency of dressings, inpatient or outpatient, comorbidities, and personal hygiene. A multidisciplinary cooperation between the geriatrician, the oncologist and the nurses is essential.