Preoperative NUn score serves as a robust predictor of overall and disease-specific survivals following radical surgery for gastric cancer.

PURPOSE: Methods to preoperatively stratify oncological risks associated with gastric cancer (GC) are limited. Host inflammatory parameters, i.e., serum C-reactive protein (CRP) and albumin levels, are known to be associated with outcomes. We examined the relationships between disease-specific mortality and four CRP-albumin-based indices (CRP-albumin ratio [CAR], modified Glasgow prognostic score [mGPS], Osaka prognostic score [OPS], and NUn score) preoperatively measured in cases with resectable GC. METHODS: Survival outcomes of 1290 consecutive GC patients with oncological gastrectomy were reviewed. Predictive significances of preoperative CAR, mGPS, OPS, and NUn scores were assessed with time-dependent receiver operating characteristic curves and Cox regression analyses. RESULTS: Median follow-up was 107 months. Area under the curve for predicting overall and disease-specific survivals (OS/DSS) for the preoperative NUn score was clearly superior to those of the other parameters. On univariate Cox regression analysis, preoperative CAR, mGPS, OPS, and the NUn score all correlated significantly with OS/DSS. On multivariate Cox regression analysis, the preoperative NUn score, as a continuous variable, showed an independent relationship with OS (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.16-1.50, per 1-unit increase, P < 0.001) and even DSS (HR 1.23, 95% CI 1.02-1.49, P = 0.032). The other three markers failed to maintain independence for DSS. CONCLUSIONS: Preoperative NUn scores are stably associated with outcomes, including disease-specific mortality, possibly serving as a simple measure to define the likelihood of progression to systemic disease after meticulous surgery for GC, which may contribute to identifying patients who would benefit from additional modalities.

Evaluation of the natural history of disease by combining incident and prevalent cohorts: application to the Nun Study.

The Nun study is a well-known longitudinal epidemiology study of aging and dementia that recruited elderly nuns who were not yet diagnosed with dementia (i.e., incident cohort) and who had dementia prior to entry (i.e., prevalent cohort). In such a natural history of disease study, multistate modeling of the combined data from both incident and prevalent cohorts is desirable to improve the efficiency of inference. While important, the multistate modeling approaches for the combined data have been scarcely used in practice because prevalent samples do not provide the exact date of disease onset and do not represent the target population due to left-truncation. In this paper, we demonstrate how to adequately combine both incident and prevalent cohorts to examine risk factors for every possible transition in studying the natural history of dementia. We adapt a four-state nonhomogeneous Markov model to characterize all transitions between different clinical stages, including plausible reversible transitions. The estimating procedure using the combined data leads to efficiency gains for every transition compared to those from the incident cohort data only.

[Cross-Sectional Study on Adverse Effects of Metformin Hydrochloride on 130 Patients Type 2 Diabetic Admitted to Medical Center and Diabetes Home of Sidi Bel-Abbès]. / Étude Transversale sur les Effets Indésirables de la Chlorhydrate de Métformine chez 130 Patients Diabétiques Type 2 Admis au Centre Médical et à la Maison du Diabète de Sidi Bel-Abbès.

INTRODUCTION: MetforminHydrochloride is an antidiabetic used for many years, currently; it considered the first choice in treatment of type 2 diabetes (T2D). It decreases insulin resistance, does not induce hypoglycaemia, increases glucose utilization in the liver and skeletal muscle, and decreases hepatic glucose production. Its adverse effects (AE) are gastrointestinal, decrease in vitamin B12 absorption, abnormalities of hemogram and rarely skin reactions. The objective of this study was to report the type and frequency of AEs of Metformin Hydrochloride used in the therapeutic management of T2D patients admitted to the medical center and the diabetes home of Sidi Bel-Abbès in Algeria. MATERIALS AND METHODS: A cross-sectional descriptive study was carried out over a period of four months, from January 1st, 2017 to April 30th, 2017, involving 130 patients treated with Metformin Hydrochloride consulting at Mimoun City Diabetes Home and Gambetta Diabetes Center in the town of Sidi Bel-Abbès. The primary outcome measure was the determination of the type and frequency of AEs related to normal dosages or overdose use of Metformin Hydrochloride in T2D. Data were collected from patient records, using a questionnaire, and analyzed using Statistical Package for the Social Sciences, version 20 software. RESULTS: 130 patients were included, including 82 women, with a mean age of 51.08±8.85 years (30-66). One hundred and ninety-eight (198) AEs were reported, an average of 1.52 AEs per patient. Among them, 95 (47.98%) AEs are digestive disorders (30.77% of patients suffered from diarrhea, 10.77% had nausea and vomiting, 8.46% suffered from abdominal pain and bloating, 3.85% lost their taste, 7.69% complained of epigastric cramps and 11.54% of anorexia), 29 (14.65%) AEs are hypoglycaemia, 73 (36.87%) AEs are other symptoms and 1 (0.50%) EI is vitamin B12 deficiency and no cases of lactic acidosis or allergic reaction were reported. Five (3.85%) patients had a total and lasting intolerance to Metformin Hydrochloride leading to its discontinuation following persistent diarrhoea. CONCLUSION: AEs of Metformin Hydrochloride used in the management of T2D patients consulting at the medical center and the Diabetes home of Sidi Bel-Abbès are frequent. Digestive disorders were the most frequent, diarrhea was very frequent and led to discontinuation of treatment in 3.85% of T2D patients, followed by nausea and vomiting, then abdominal pain, bloating and epigastric cramps, and rarely taste metallic. Hypoglycaemia was frequent following its association with insulin, the onset of headaches and fatigue were frequent, but no case of lactic acidosis or allergic reaction was reported. Due to a lack of means, the dosage of homocysteine and methylmalonic acid had not been carried out to confirm the vitamin B12 deficiency in the patient whose level was less than 200ng/mL. A precise assessment of the imputability of reported AEs is necessary.

Religious Sisters in Healthcare: The Conspicuous Love of Jesus.

ABSTRACT: To better understand the impact Roman Catholic religious sisters have had on healthcare in the United States, the authors initiated the Religious Sisters in Health Care: The Conspicuous Love of Jesus project, recording sisters' stories of service, obedience, and leadership that point to their foundational work of making the healing presence of Jesus central to Catholic healthcare identity. The sisters' counsel for nurses and all staff in Catholic healthcare was to focus on Jesus' love in all work and to keep each person's healing ministry alive through regular rejuvenating opportunities.

Female Vanity in the Early Modern Period: Evidence from the Science Based Reassessment of a Supposed Merovingian Dental Appliance.

Musée de la Cour d'Or, Metz, France, possesses a female skull bearing a gold wire dental appliance claimed in a 1934 Dental Cosmos article on the history of dental prosthetics to be 'probably' Merovingian in origin. Inquiries in 2017 revealed current museum curators were unaware of this claim but were skeptical of such dating suggesting scientific analysis might provide clarity. Carbon dating of a tooth from the skull was carried out placing the artifact in the mid seventeenth-late eighteenth centuries while Metz historical records reveal the find site was occupied by a convent of nuns for most of C14 dated period. Strontium isotopic analysis indicates the woman was a local of the Metz region while fluorine analysis indicates exposure to fluoride early in life. Oral health status and the dentistry indicate the woman was of high social status.

Female Vanity in the Early Modern Period: Evidence from the Science Based Reassessment of a Supposed Merovingian Dental Appliance.

Musée de la Cour d'Or, Metz, France, possesses a female skull bearing a gold wire dental appliance claimed in a 1934 Dental Cosmos article on the history of dental prosthetics to be 'probably' Merovingian in origin. Inquiries in 2017 revealed current museum curators were unaware of this claim but were skeptical of such dating, suggesting scientific analysis might provide clarity. Carbon dating of a tooth from the skull was performed placing the artifact in the mid seventeenth-late eighteenth centuries, while Metz historical records reveal the find site was occupied by a convent of nuns for most of C14 dated period. Strontium isotopic analysis indicated that the woman was a local of the Metz region while fluorine analysis indicated exposure to fluoride early in life. Oral health status and the dentistry indicate the woman was of high social status.

Autonomous orientation predicts longevity: New findings from the Nun Study.

OBJECTIVE: Work on longevity has found protective social, cognitive, and emotional factors, but to date we have little understanding of the impact of motivational dynamics. Autonomy orientation, or stable patterns of self-regulation, is theorized to be a protective factor for long-term mental and physical health (Ryan & Deci, 2017), and it is therefore a prime candidate for examining how stable psychosocial factors are linked to longevity, or life expectancy. METHOD: Essays written in the 1930s by participants in the Nun Study were coded for indicators of an autonomy orientation. These were selected in line with an extensive theoretical literature based in self-determination theory (Deci & Ryan, 1985). Essays were coded for the propensity for choice in action, susceptibility to pressure, self-reflection, integration of experiences, and parental support for autonomy. These coded variables were used to predict age of death. RESULTS: Using 176 codable essays provided by now-deceased participants, linear regression analyses revealed that choiceful behavior, self-reflection, and parent autonomy support predicted age of death. Participants who demonstrated these stable and beneficial motivational characteristics lived longer. CONCLUSIONS: Personality constructs reflecting a healthy form of self-regulation are associated with long-term health. Implications for health interventions are discussed.

Sense of Coherence (SOC) in Christian Orthodox Monks and Nuns in Greece.

This paper aims to investigate the stress management skills of Christian Orthodox monks and nuns, as measured by Antonovsky's scale sense of coherence (SOC). A case-control study was designed to test the hypotheses whether monks and nuns have higher SOC than secular people. The study population consisted of 193 individuals, 96 monks and nuns (study group) and 97 secular men and women (control group). SOC score was higher in monks and nuns as compared to the secular population (p = 0.002), men as compared to women (p = 0.012) and persons of older age (p = 0.004) as compared to younger individuals.

British Icons and Catholic perfidy--Anglo-Saxon historiography and the battle for Crimean War nursing.

Taking as its starting point Carr's view that historical narrative reflects the preoccupations of the time in which it is written and Foucault's concept of consensual historical discourse as the outcome of a social struggle in which the victor suppresses or at least diminishes contrary versions of historical events in favour of their own, this paper traces and discusses the historical narrative of British nursing in the Crimean war and, in particular, three competing narratives that have arisen in the latter half of the 20th century and the first decade of the 21st. These are the established narrative surrounding Florence Nightingale, the new narrative surrounding Mary Seacole and an Irish narrative surrounding the role of the Sisters of Mercy. It is argued that the increased vehemence of the debate surrounding these narratives is representative of the changes that have taken place in British society. However, we also argue that the Irish narrative and its critique are reflective of deep-rooted Anglo-Protestant attitudes articulated by Nightingale and uncritically accepted by subsequent historians even in modern British historiography.

[The complex travel of cinchona barks between Peru and Québec Hôtel-Dieu, in the middle of the eighteenth century]. / Le circuit complexe du quinquina entre le Pérou et l'Hôtel-Dieu de Québec, au milieu du XVIIIe siècle.

Duplessis sisters, who were religious nuns in Hôtel-Dieu (Quebec hospital), were exchanging letters with a French apothecary from Dieppe in Normandy, named Jacques-Tranquilain Féret. They asked him to send them in Quebec the drugs and medicines their apothecary needed. Amongst these drugs were cinchona barks that came from Callao in Peru by boat, passed Cape Horn and then sailed to Cadiz, the great Spanish port. Then they embarked to Rouen, which was the French port for goods coming from overseas. The goods from Peru had then to be transported on little fishing boats to Dieppe, where Féret received the barks. The apothecary sent these drugs to Quebec by boats sailing either from Rouen or from La Rochelle. So these Peruvian drugs had to cross two times the Ocean before accessing to North America.

The Catholic Church and reproductive health and rights in Timor-Leste: contestation, negotiation and cooperation.

In Timor-Leste, high fertility, high maternal mortality and low levels of contraceptive prevalence demonstrate the importance of exploring perceptions, policies and practices around reproductive health and rights. This paper explores the influence of the Catholic Church on reproductive decision-making at different levels of policy and practice. Utilising a feminist qualitative research methodology, in-depth interviews were conducted with a range of participants including nuns and priests, Timorese women and men of different ages and backgrounds and local and national stakeholders working in reproductive health and women's rights. Findings reveal that the Church is reported to play a significant role in reproductive health and rights decision-making at all levels of society, from policy-making to the reproductive decisions made by individual Timorese women and men. Nevertheless, the translation of Church teachings into practice, particularly by nuns, priests and Timorese men and women, reveal a range of attitudes and opinions; some that support and others that contest official Catholic doctrine. In light of the significant influence of the Timorese Catholic Church on policy and practice at many levels of society, there is a need to prioritise the development of rights-based strategies to improve reproductive health services in Timor-Leste.

Primary Cutaneous Coccidioidomycosis in an Italian Nun Working in South America and Review of Published Literature.

Coccidioidomycosis is a systemic disease caused by the dimorphic fungus Coccidioides, endemic in parts of the Southwestern USA and Central and South America. Two species, Coccidioides immitis and Coccidioides posadasii, were differentiated. Primary cutaneous coccidioidomycosis (PCC) has been reported rarely. An unusual case of PCC characterized by a persistent solitary lesion diagnosed in Italy in an immunocompetent Italian nun living in Argentina is described. The isolate was identified by sequence analysis as C. posadasii. Antibody screening was negative. A total of 39 cases of PCC have been reported in the literature. Infections occurred as a consequence of traumatic implantation in a natural setting in endemic areas or of accidental inoculation in laboratory workers. Importance of accurate investigation of travel history and of occupational hazards to laboratory workers is outlined.

A consistent course of events or a series of coincidences: nursing in Poland from the 19(th) to the 21(st) century.

The development of nursing began in Poland much later than it did elsewhere, for instance in the United Kingdom, the United States, or Germany, and it came up against difficult conditions. After a brief twenty-year period of development between 1918 and 1939, it almost stalled during the war (1939-45), only to be followed by nearly twenty years of chaos. Nursing started to come out of this difficult period at the beginning of the 1960s. The turn of the 21st century saw the emergence of extensive professional development and training opportunities for nurses. This change was brought about as much by political, social and economic issues, health care requirements, and the advancement of science, medicine, the birth of humanitarism, the growth of the feminist movement, the European Agreement on the Instruction and Education of Nurses, the WHO European Strategy for Nursing and Midwifery Education, the Bologna declaration, as well as the activities undertaken by the European Union, the International Council of Nurses, the American and Polish Red Cross, the Rockefeller Foundation, the Polish Association of Nurses, and the professional self-governing body. The transformation of nursing into an independent profession was further boosted by physicians deeply involved in the issue and female pioneers of nursing.

Nuns, warts, viruses, and cancer.

It has been known for more than 150 years that the risk of carcinoma of the uterine cervix correlates with the number of sexual partners. Laboratory and epidemiological evidence demonstrated that infection with certain human papillomavirus (HPV) types initiates the vast majority of, if not all, cervical cancer, as well as a substantial fraction of other cancers, including other anogenital cancer and oropharyngeal cancer. Pap smear testing resulted in a dramatic reduction in the incidence of cervical cancer in the developed world, and HPV vaccination has the potential to eradicate HPV-associated cancer worldwide and represents a major public health breakthrough. The major current challenge is to ensure that HPV vaccines are widely administered.

Assessing retinal vein occlusion based on color fundus photographs using neural understanding network (NUN).

OBJECTIVE: To develop and validate a novel deep learning architecture to classify retinal vein occlusion (RVO) on color fundus photographs (CFPs) and reveal the image features contributing to the classification. METHODS: The neural understanding network (NUN) is formed by two components: (1) convolutional neural network (CNN)-based feature extraction and (2) graph neural networks (GNN)-based feature understanding. The CNN-based image features were transformed into a graph representation to encode and visualize long-range feature interactions to identify the image regions that significantly contributed to the classification decision. A total of 7062 CFPs were classified into three categories: (1) no vein occlusion ("normal"), (2) central RVO, and (3) branch RVO. The area under the receiver operative characteristic (ROC) curve (AUC) was used as the metric to assess the performance of the trained classification models. RESULTS: The AUC, accuracy, sensitivity, and specificity for NUN to classify CFPs as normal, central occlusion, or branch occlusion were 0.975 (± 0.003), 0.911 (± 0.007), 0.983 (± 0.010), and 0.803 (± 0.005), respectively, which outperformed available classical CNN models. CONCLUSION: The NUN architecture can provide a better classification performance and a straightforward visualization of the results compared to CNNs.

Prevalence and associated factors of breast cancer screening among nuns in the Catholic Archdiocese of Nairobi.

Introduction: breast cancer is a significant global challenge. The risk of breast cancer among nuns is high mainly due to the basis of nulliparity. Among the effective approaches to addressing breast cancer is early screening. However, there are concerns over the uptake of screening across all populations, including nuns. The objective of the study is to determine the prevalence and the associated factors of breast cancer screening among nuns in the Catholic Archdiocese of Nairobi. Methods: this research used the analytical cross-sectional design. A total of 384 nuns in the Catholic Archdiocese of Nairobi were recruited using a stratified sampling. Structured questionnaires were used to collect data. Chi-square and binary logistic regression were used to determine association between social-demographic factors and breast cancer screening. Statistical package for social sciences (SPSS version 26) was used for analysis. The level of significance was investigated at p<0.05. Results: our findings revealed that the prevalence of breast cancer screening among nuns was 30.7%. The findings established that those who had knowledge on breast cancer screening (AOR=25.52, 95%CI: 8.87 - 73.45, p<0.001) and those who had congregational financial support (AOR=1.97, 95%CI: 1.68 - 5.74, p=0.021) were more likely to undergo breast cancer screening. Those who had hospital check-up for in more than six months prior to the study (AOR=0.001, 95%CI: 0.000 - 0.008, p<0.001) and those who never had a hospital check-up, (AOR=0.001, 95%CI: 0.000 - 0.006, p<0.001) were less likely to undergo breast cancer screening. Conclusion: the findings have shown low uptake of breast cancer screening amongst nuns in the Catholic Archdiocese in Nairobi. Knowledge on breast cancer screening access to congregational support and hospital check-up have been identified as key factors associated with breast cancer screening. Therefore, there is a need to create adequate awareness be created and the Catholic reverend sisters educated through aggressive education campaign programs so as to eliminate misconceptions relating to the topic. Also, to integrate free access to screening services in the government health institutions for nuns.

Outcomes of a Decision-Making Capacity Assessment Model at the Grey Nuns Community Hospital.

BACKGROUND: With an increasing elderly population, the number of persons with dementia is expected to increase and, consequently, the number of persons needing decision-making capacity assessments (DMCA) is too. However, many healthcare professionals do not feel ready to provide DMCAs. Since 2006, we implemented a DMCA Model that includes a care pathway, worksheets, education, and mentoring. The objective of this study was to assess the impact of the utilization of this patient-centered DMCA model on the need for Capacity Interviews. METHODS: This was a retrospective quality assurance chart review of patients referred for DMCA to the Geriatric Service at the Grey Nuns Community Hospital from 2006-2020. The Geriatric Service is run by Family Physicians with extra training in Care of the Elderly. We extracted patient demographics, elements of the DMCA process, and whether Capacity Interviews were performed. We used descriptive statistics to summarize the data. RESULTS: Eighty-eight patients were referred for DMCAs, with a mean age of 76 years (SD = 10.5). Dementia affected 43.2% (38/88) of patients. Valid reasons for conducting a DMCA were evident in 93% (80/86) of referrals, and DMCAs were performed in 72.6% (61/84). 85.3% (58/68) of referrals identified the need for DMCA in two to four domains, most commonly accommodation, healthcare, and finances. Two to three disciplines, frequently social workers and occupational therapists, were involved in conducting the DMCAs for 67.2% (39/58) of patients. The Capacity Assessment Process Worksheet was used 63.2% of the time. Capacity Interviews were conducted in only 20.7% of referrals. Following the DMCAs, 48.2% (41/85) of those assessed were deemed to lack capacity. CONCLUSION: This study suggests that the DMCA Model implemented has decreased the need for Capacity Interviews while simultaneously respecting patient autonomy. This is an important finding as DMCAs carried out following this process reduced the need for both a Capacity Interview and declarations of incapacity while simultaneously respecting patient autonomy and supporting patients in their decisions in accordance with the legislation.