Roles and recommendations from primary care physicians towards managing low-risk breast cancer survivors in a shared-care model with specialists in Singapore-a qualitative study.

BackgroundBreast cancer is prevalent and has high cure rates. The resultant increase in numbers of breast cancer survivors (BCS) may overwhelm the current oncology workforce in years to come. We postulate that primary care physicians (PCPs) could play an expanded role in comanaging survivors, provided they are given the appropriate tools and training to do so.ObjectiveTo explore the perspectives of PCPs towards managing BCS in a community-based shared-care programme with oncologists.MethodsEleven focus groups and six in-depth interviews were conducted with seventy PCPs recruited by purposive sampling. All sessions were audio-recorded, transcribed verbatim and coded by three independent investigators. Thematic data analysis was performed and the coding process facilitated by NVivo 12.ResultsMajority of PCPs reported currently limited roles in managing acute and non-cancer issues, optimizing comorbidities and preventive care. PCPs aspired to expand their role to include cancer surveillance, risk assessment and addressing unmet psychosocial needs. PCPs preferred to harmonize cancer survivorship management of their primary care patients who are also BCS, with defined role distinct from oncologists. Training to understand the care protocol, enhancement of communication skills, confidence and trust were deemed necessary. PCPs proposed selection criteria of BCS and adequacy of their medical information; increased consultation time; contact details and timely access to oncologists (if needed) in the shared-care programme.ConclusionsPCPs were willing to share the care of BCS with oncologists but recommended role definition, training, clinical protocol, resources and access to oncologist's consultation to optimize the programme implementation

Mannose binding lectin (MBL) codon 54 gene polymorphism and susceptibility to infection in patients with systemic lupus erythematosus (SLE)

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Structure, bonding and morphology of hydrothermally synthesised xonotlite

The authors have systematically investigated the role of synthesis conditions upon the structure and morphology of xonotlite. Starting with a mechanochemically prepared, semicrystalline phase with Ca/Si=1, the authors have prepared a series of xonotlite samples hydrothermally, at temperatures between 200 and 250 degrees C. Analysis in each case was by X-ray photoelectron spectroscopy, environmental scanning electron microscopy and X-ray diffraction. The authors’ use of a much lower water/solid ratio has indirectly confirmed the ‘through solution’ mechanism of xonotlite formation, where silicate dissolution is a key precursor of xonotlite formation. Concerning the role of temperature, too low a temperature (~200 degrees C) fails to yield xonotlite or leads to increased number of structural defects in the silicate chains of xonotlite and too high a temperature (>250 degrees C) leads to degradation of the xonotlite structure, through leaching of interchain calcium. Synthesis duration meanwhile leads to increased silicate polymerisation due to diminishing of the defects in the silicate chains and more perfect crystal morphologies

The clinical significance of aldosterone synthase deficiency: report of a novel mutation in the CYP11B2 gene

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Word juncture characteristics in world Englishes: a research report

The subtle juncture cues in older varieties of English such as Received Pronunciation can be difficult for speakers of new English varieties to perceive. This study looks at the perception of word juncture characteristics in three varieties of English (British, Hong Kong and Singapore) among British, Hong Kong and Singaporean listeners in order to widen our understanding of English juncture characteristics in general. We find that, even though reaction time data indicates that listeners perform quickest in the variety they are most familiar with, not only are juncture differences in British English difficult for Hong Kong and Singaporean listeners to perceive, they are also the most difficult for British listeners. Juncture characteristics in Hong Kong English are the easiest to distinguish among the three varieties

Strain- and Adsorption-Dependent Electronic States and Transport or Localization in Graphene

The chapter generalizes results on influence of uniaxial strain and adsorption on the electron states and charge transport or localization in graphene with different configurations of imperfections (point defects): resonant (neutral) adsorbed atoms either oxygen- or hydrogen-containing molecules or functional groups, vacancies or substitutional atoms, charged impurity atoms or molecules, and distortions. To observe electronic properties of graphene-admolecules system, we applied electron paramagnetic resonance technique in a broad temperature range for graphene oxides as a good basis for understanding the electrotransport properties of other active carbons. Applied technique allowed observation of possible metal-insulator transition and sorption pumping effect as well as discussion of results in relation to the granular metal model. The electronic and transport properties are calculated within the framework of the tight-binding model along with the Kubo-Greenwood quantum-mechanical formalism. Depending on electron density and type of the sites, the conductivity for correlated and ordered adsorbates is found to be enhanced in dozens of times as compared to the cases of their random distribution. In case of the uniaxially strained graphene, the presence of point defects counteracts against or contributes to the band-gap opening according to their configurations. The band-gap behaviour is found to be nonmonotonic with strain in case of a simultaneous action of defect ordering and zigzag deformation. The amount of localized charge carriers (spins) is found to be correlated with the content of adsorbed centres responsible for the formation of potential barriers and, in turn, for the localization effects. Physical and chemical states of graphene edges, especially at a uniaxial strain along one of them, play a crucial role in electrical transport phenomena in graphene-based materials.Comment: 16 pages, 10 figure

Mechanism of bacterial interference with TLR4 signaling by Brucella TIR-domain-containing protein TcpB

Upon activation of Toll-like receptors (TLRs), cytoplasmic Toll/interleukin-1 receptor (TIR) domains of the receptors undergo homo- or hetero-dimerization. This in turn leads to the recruitment of adaptor proteins, activation of transcription factors, and the secretion of pro-inflammatory cytokines. Recent studies have described the TIR-domain-containing protein from Brucella melitensis, TcpB (BtpA/Btp1), to be involved in virulence and suppression of host innate immune responses. TcpB interferes with TLR4 and TLR2 signaling pathways by a mechanism that remains controversial. In this study, we show using co-immunoprecipitation analyses that TcpB interacts with MAL, MyD88, and TLR4, but interferes only with the MAL:TLR4 interaction. We present the crystal structure of the TcpB TIR domain, which reveals significant structural differences in the loop regions compared to other TIR domain structures. We demonstrate that TcpB forms a dimer in solution, and the crystal structure reveals the dimerization interface, which we validate by mutagenesis and biophysical studies. Our study advances the understanding of the molecular mechanisms of host immunosuppression by bacterial pathogens

Recent Advances in Graph Partitioning

We survey recent trends in practical algorithms for balanced graph partitioning together with applications and future research directions

Drivers for implementing green building technologies : an international survey of experts

2016-2017 > Academic research: refereed > Publication in refereed journal201804_a bcm