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BACKGROUND Aberrant expression of mucin-4 (MUC4) is present in a variety of human solid cancers, but the expression pattern of MUC4 and its clinical relevance in acute myeloid leukemia (AML) is unknown. We aimed to evaluate the expression level of MUC4 and explore its prognostic value in newly diagnosed adult patients with AML. METHODS Bone marrow from 70 AML patients and 26 healthy donors were obtained. MUC4 levels were quantified by Quantitative real time- PCR. Routine blood indices were measured by standard techniques. RESULTS Bone marrow MUC4 expression levels were significantly elevated in AML patients compared to controls at median (range) 2.77 (0.7-16.6) and 1.14 (0.5-1.99) respectively (p=0.005). Moreover, lower MUC4 expression was strongly associated with persistent remission (p=0.001) while higher MUC4 levels were associated with worse overall as well as disease-free survival (p=0.011 and p=0.006, respectively). Thus, its level may act as an indicator of disease progression. High MUC4 expression was identified as an independent prognostic predictor for both overall survival and disease-free survival. CONCLUSION MUC4 over-expression is an independent predictor of a poor prognosis in AML patients.This study used the minority stress model to explore experiences of gender transitioning among hijra (trans woman) individuals in Mumbai, India. It used a qualitative life history calendar approach to examine transitioning as a critical life experience in a chronological manner. Twenty hijra-identified persons were recruited using purposive snowball sampling and interviewed at a community-based organisation. Data were analysed using thematic analysis. Participants reported diverse experiences living as hijra and shared perspectives on transitioning. Most participants identified to undergo transitioning at their own will. Many cited biological families as a factor that restricted or delayed transitioning, while gharana (congregation of hijras) and gurus were listed as sources of support. Participants also differed in the reasons given for transitioning, expectations, types of practices, and issues of access and support. Transitioning was described as an integral part of their experiences as hijra and developing a congruent self. Implications of the study include the need to engage communities in determining their needs and social support, provide holistic transitioning services at public hospitals, and develop technical and cultural sensitivity training for health professionals.Background Evidence-based practice (EBP) mentors serve as catalysts in the facilitation of innovation, improvement of patient outcomes, and enhancement of the quality of nursing care. The importance of the role of clinical nursing leaders as EBP mentors has increased; however, information regarding their experiences is limited. PEG300 solubility dmso Aims This study aimed to explore and describe EBP mentors' lived experiences of EBP mentorship projects. Design A qualitative study design and the phenomenological framework suggested by Colaizzi were used. Methods Participants were recruited via purposive sampling. The participants were seven EBP mentors working as unit managers in a university and a research-oriented tertiary hospital in Korea. Data were collected via in-depth, semi-structured interviews concerning their experiences of EBP mentorship projects. We analysed the data using analytical phenomenological methodology, which consisted of seven steps. Findings The experiences of EBP mentors were identified based on three categories 'challenges in taking on the new role of EBP mentor', 'forming intimate EBP mentor-staff nurse relations' and 'becoming independent as a facilitator'. The EBP mentors experienced role ambiguity, stress, and burden during the initial phase of EBP mentorship; however, they adjusted and reported positive experiences during the adjustment process. Conclusion The EBP mentors play an important role as a guide and reduces barriers to the successful implementation of EBP. Before implementation an EBP initiative, systematic and educational programs that target the EBP mentors should be offered. A systematic approach to creating an institutional culture of EBP and focus on strategic planning for EBP are needed.Impact statementsThis study provides an understanding of EBP mentors' experiences that can contribute to the development of strategies and policies to facilitate EBP in nursing.BACKGROUND The class III NAD-dependent histone deacetylase (HDAC) sirtuin 1 (SIRT1) is an important regulator of senescence, aging, and inflammation. SIRT1de-acetylates chromatin histones, thereby silencing inflammatory gene transcription. We have reported increased steroid-resistant senescent pro-inflammatory CD28nullCD8+ T cells in patients with chronic obstructive pulmonary disease (COPD). We hypothesized that SIRT1 is reduced in these cells in COPD, and that treatment with SIRT1 activators (resveratrol, curcumin) and agents preventing NAD depletion (theophylline) would upregulate SIRT1 and reduce pro-inflammatory cytokine expression in these steroid-resistant cells. METHODS Blood was collected from n = 10 COPD and n = 10 aged-matched controls. Expression of CD28, SIRT1, and pro-inflammatory cytokines was determined in CD8+ and CD8- T and natural killer T (NKT)-like cells cultured in the presence of ±1 µM prednisolone, ±5 mg/L theophylline, ±1 µM curcumin, ±25 µM resveratrol, using flow cytometry and immunatrol increases SIRT1 expression, restores steroid sensitivity, and inhibits pro-inflammatory cytokine production from these cells and may reduce systemic inflammation in COPD. The reviews of this paper are available via the supplemental material section.BACKGROUND Donor organ recovery is a complex process involving organ procurement organizations and multiple surgical teams from various transplant centers. Nearly 30% of discarded organs are wasted due to reasons related to improper coordination and communication. PROBLEM STATEMENT Lack of real-time communication results in many hours of preventable delay between procurement and transplant teams resulting in the high volume of organ waste, clinical frustration, and critical delays. METHODS A Plan-Do-Study-Act performance improvement methodology was utilized to design and implement a dedicated mobile communication application (app). Critical time points in the organ offer, procurement, and transplant processes were analyzed from the Report of Organ Offers, and relation coordination metrics were measured. PROCESSES ADDRESSED Members of procurement and transplant teams in Iowa were interviewed and a dedicated smartphone application was implemented to replace phone calls, e-mails, faxes, and text messages during upcoming kidney offers from July 31, 2017 to July 31, 2018.
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