Registered nurses' experiences of caring for patients in hospitals transitioning from curative to palliative care: A qualitative study.

The aim of this study was twofold: to illuminate registered nurses' experiences of palliative care and of caring for patients transitioning from curative to palliative care in hospitals. A qualitative descriptive design was used. Group interviews were conducted with 11 registered nurses in three different hospital settings. Content analysis was performed. The results are presented in four themes: "Understanding palliative care in a hospital setting"; "Involving, supporting, and caring for patients and families"; "Striving for consensus and common goals of care"; and "Struggling with the hospital environment." The registered nurses described struggling with the interpretation of palliative care and with how to transfer it into clinical practice in their specific care settings. Teamwork and collaboration were challenging and goals of care incongruent within the team. Further implementation of a palliative care approach, with core components symptom relief, teamwork, communication and relationship, and family support, is crucial to improve both patient care and the conditions enabling registered nurses to provide good care for the patients and their families in hospital settings.

Un recorrido por el aprendizaje de la escritura desde una perspectiva evolutivo - educativa y semiótica / An overview on learning to write from a developmental- educational and semiotic perspective

Se presenta una revisión en torno al aprendizaje de la escritura integrando aportes relevantes en los últimos 30 años de la Psicología, la Lingüística y la Semiótica. Inicialmente se analizan los usos y funciones que la escritura cumple en la cultura: la preservación, transmisión y modificación del conocimiento compartido socialmente; la regulación de la conducta social, a partir del establecimiento de leyes y la definición de roles sociales; la estandarización de una variedad lingüística y el uso estético en diversos géneros discursivos. Luego se describen los atributos que la caracterizan como objeto semiótico y las particularidades que adoptan los textos escritos según sus funciones en ciertos contextos situacionales y socioculturales. A continuación se abordan características relevantes del aprendizaje de la escritura a lo largo de la vida de las personas. Este proceso, que comienza prácticamente desde el nacimiento y se extiende durante la vida adulta, requiere múltiples dimensiones cognitivas y niveles lingüísticos correlacionados entre sí y vinculados a los contextos de uso. Tomando en cuenta cuatro dimensiones principales (metaconocimiento, conocimientos generales, conocimiento de los atributos de la lengua escrita y conocimiento procedimental) se revisan estudios que, desde una perspectiva evolutivo-educativa, han abordado la alfabetización en escritura. Esa revisión está organizada en tres momentos: antes, durante y más allá de la escolaridad. Al considerar el aprendizaje de la escritura durante la escolaridad, se focaliza en las concepciones de los aprendices acerca del aprendizaje de la escritura. Se concluye destacando la importancia de considerar el aprendizaje de la escritura desde una perspectiva multimodal que articule recursos y concepciones.

This paper presents a review about the learning of writing. It integrates relevant contributions from fields of Psychology, Linguistics and Semiotics during the last 30 years. We begin by addressing different aspects of writing as a semiotic object and synthesize its uses and functions within a culture. Writing functions as a mnemonic tool through graphic representation, allowing preservation, transmission and modification of collective shared knowledge, enabling its functioning as an epistemic tool. Writing also has regulatory functions on social behavior. It contributes to the organization of social roles and the establishment of hierarchical order through the enactment of written laws. It also contributes to the standardization of a linguistic variety -the one used for writing- in order to fulfill several official functions related to public administration and education. Consequently, the linguistic variety represented in writing usually becomes a linguistic model, outlining diverse social and personal paths in learning to write. Finally, we focus on its aesthetic and imaginative function, which is present in a variety of genres. We then describe the attributes of writing as a semiotic system, including written texts' distinctive features according to their functions in certain situational and socio-cultural settings. All writing systems have a dual nature: they constitute physical objects with an external existence that is relatively independent from its context of production, also are semiotic objects that enable to represent something else. In writing systems, a set of graphic elements are integrated on a surface. Rules conventionally established and formal properties are the base of these graphic elements. These graphic marks endure through time and space, allowing for iterative formal and conceptual revision and change. A dialectic relationship between mind and semiotic system is established, in which representational systems, as external scaffolding, expanding the possibilities of thought. Thereby, this technology of thought entails important cognitive and social transformations by helping to construct a multiple and broadening personal perspective. This will allow the conversion of own representations into meta- representations through their externalization, and the acquirement of new and more complex ways of knowing. In the second part of this article, we tackle relevant characteristics of learning to write along a person's life. This process begins almost from birth and continues through adult life, under the guide of someone with more expertise. Becoming an expert writer requires more than two decades of continuous instruction and practice. The appropriation of writing requires processes correlated at multiple cognitive dimensions and linguistic levels, deeply related to specific contexts of use. The dimensions considered are the following: metaknowledge; general knowledge about writing; specific knowledge regarding graph phonic, syntactic, and textual aspects; and procedural knowledge. We review studies regarding the different dimensions involved in this process from a developmental and educational perspective. We organize such review by considering three moments. The stage named roots of literacy comprises all the activities and conceptualizations of reading and writing that children carry out in the course of early childhood, which precedes conventional literacy. During schooling writing becomes a learning object, and children's main efforts move from mastering the alphabetic code to understanding coherence and cohesion, as well as producing texts of several types. When referring to learning to write during schooling we also focus on learners' conceptions of this process. The conceptions' viewpoint enables us to understand the learners' own perspective displayed in first person. Beyond schooling learning to write continues developing towards the ability of constructing and reconstructing knowledge through reading and writing. Finally, we analyze contributions on learning to write from a multimodal perspective. We acknowledge a research vacancy which would articulate learners' resources for text production and their conceptions about this process. Based on the idea that learning entails unfolding a variety of resources -particularly semiotic and epistemic- in a situated and contextualized manner, we propose that an articulation among the different approaches reviewed in this paper will help to overcome the deficit perspectives.

Un recorrido por el aprendizaje de la escritura desde una perspectiva evolutivo - educativa y semiótica / An overview on learning to write from a developmental- educational and semiotic perspective

Se presenta una revisión en torno al aprendizaje de la escritura integrando aportes relevantes en los últimos 30 años de la Psicología, la Ling³ística y la Semiótica. Inicialmente se analizan los usos y funciones que la escritura cumple en la cultura: la preservación, transmisión y modificación del conocimiento compartido socialmente; la regulación de la conducta social, a partir del establecimiento de leyes y la definición de roles sociales; la estandarización de una variedad ling³ística y el uso estético en diversos géneros discursivos. Luego se describen los atributos que la caracterizan como objeto semiótico y las particularidades que adoptan los textos escritos según sus funciones en ciertos contextos situacionales y socioculturales. A continuación se abordan características relevantes del aprendizaje de la escritura a lo largo de la vida de las personas. Este proceso, que comienza prácticamente desde el nacimiento y se extiende durante la vida adulta, requiere múltiples dimensiones cognitivas y niveles ling³ísticos correlacionados entre sí y vinculados a los contextos de uso. Tomando en cuenta cuatro dimensiones principales (metaconocimiento, conocimientos generales, conocimiento de los atributos de la lengua escrita y conocimiento procedimental) se revisan estudios que, desde una perspectiva evolutivo-educativa, han abordado la alfabetización en escritura. Esa revisión está organizada en tres momentos: antes, durante y más allá de la escolaridad. Al considerar el aprendizaje de la escritura durante la escolaridad, se focaliza en las concepciones de los aprendices acerca del aprendizaje de la escritura. Se concluye destacando la importancia de considerar el aprendizaje de la escritura desde una perspectiva multimodal que articule recursos y concepciones.(AU)

This paper presents a review about the learning of writing. It integrates relevant contributions from fields of Psychology, Linguistics and Semiotics during the last 30 years. We begin by addressing different aspects of writing as a semiotic object and synthesize its uses and functions within a culture. Writing functions as a mnemonic tool through graphic representation, allowing preservation, transmission and modification of collective shared knowledge, enabling its functioning as an epistemic tool. Writing also has regulatory functions on social behavior. It contributes to the organization of social roles and the establishment of hierarchical order through the enactment of written laws. It also contributes to the standardization of a linguistic variety -the one used for writing- in order to fulfill several official functions related to public administration and education. Consequently, the linguistic variety represented in writing usually becomes a linguistic model, outlining diverse social and personal paths in learning to write. Finally, we focus on its aesthetic and imaginative function, which is present in a variety of genres. We then describe the attributes of writing as a semiotic system, including written texts distinctive features according to their functions in certain situational and socio-cultural settings. All writing systems have a dual nature: they constitute physical objects with an external existence that is relatively independent from its context of production, also are semiotic objects that enable to represent something else. In writing systems, a set of graphic elements are integrated on a surface. Rules conventionally established and formal properties are the base of these graphic elements. These graphic marks endure through time and space, allowing for iterative formal and conceptual revision and change. A dialectic relationship between mind and semiotic system is established, in which representational systems, as external scaffolding, expanding the possibilities of thought. Thereby, this technology of thought entails important cognitive and social transformations by helping to construct a multiple and broadening personal perspective. This will allow the conversion of own representations into meta- representations through their externalization, and the acquirement of new and more complex ways of knowing. In the second part of this article, we tackle relevant characteristics of learning to write along a persons life. This process begins almost from birth and continues through adult life, under the guide of someone with more expertise. Becoming an expert writer requires more than two decades of continuous instruction and practice. The appropriation of writing requires processes correlated at multiple cognitive dimensions and linguistic levels, deeply related to specific contexts of use. The dimensions considered are the following: metaknowledge; general knowledge about writing; specific knowledge regarding graph phonic, syntactic, and textual aspects; and procedural knowledge. We review studies regarding the different dimensions involved in this process from a developmental and educational perspective. We organize such review by considering three moments. The stage named roots of literacy comprises all the activities and conceptualizations of reading and writing that children carry out in the course of early childhood, which precedes conventional literacy. During schooling writing becomes a learning object, and childrens main efforts move from mastering the alphabetic code to understanding coherence and cohesion, as well as producing texts of several types. When referring to learning to write during schooling we also focus on learners conceptions of this process. The conceptions viewpoint enables us to understand the learners own perspective displayed in first person. Beyond schooling learning to write continues developing towards the ability of constructing and reconstructing knowledge through reading and writing. Finally, we analyze contributions on learning to write from a multimodal perspective. We acknowledge a research vacancy which would articulate learners resources for text production and their conceptions about this process. Based on the idea that learning entails unfolding a variety of resources -particularly semiotic and epistemic- in a situated and contextualized manner, we propose that an articulation among the different approaches reviewed in this paper will help to overcome the deficit perspectives.(AU)

The cysteinyl leukotriene 2 receptor contributes to all-trans retinoic acid-induced differentiation of colon cancer cells.

BACKGROUND: Cysteinyl leukotrienes (CysLTs) are potent pro-inflammatory mediators that are increased in samples from patients with inflammatory bowel diseases (IBDs). Individuals with IBDs have enhanced susceptibility to colon carcinogenesis. In colorectal cancer, the balance between the pro-mitogenic cysteinyl leukotriene 1 receptor (CysLT(1)R) and the differentiation-promoting cysteinyl leukotriene 2 receptor (CysLT(2)R) is lost. Further, our previous data indicate that patients with high CysLT(1)R and low CysLT(2)R expression have a poor prognosis. In this study, we examined whether the balance between CysLT(1)R and CysLT(2)R could be restored by treatment with the cancer chemopreventive agent all-trans retinoic acid (ATRA). METHODS: To determine the effect of ATRA on CysLT(2)R promoter activation, mRNA level, and protein level, we performed luciferase gene reporter assays, real-time polymerase chain reactions, and Western blots in colon cancer cell lines under various conditions. RESULTS: ATRA treatment induces CysLT(2)R mRNA and protein expression without affecting CysLT(1)R levels. Experiments using siRNA and mutant cell lines indicate that the up-regulation is retinoic acid receptor (RAR) dependent. Interestingly, ATRA also up-regulates mRNA expression of leukotriene C4 synthase, the enzyme responsible for the production of the ligand for CysLT(2)R. Importantly, ATRA-induced differentiation of colorectal cancer cells as shown by increased expression of MUC-2 and production of alkaline phosphatase, both of which could be reduced by a CysLT(2)R-specific inhibitor. CONCLUSIONS: This study identifies a novel mechanism of action for ATRA in colorectal cancer cell differentiation and demonstrates that retinoids can have anti-tumorigenic effects through their action on the cysteinyl leukotriene pathway.

Regulation of cysteinyl leukotriene receptor 2 expression--a potential anti-tumor mechanism.

BACKGROUND: The cysteinyl leukotrienes receptors (CysLTRs) are implicated in many different pathological conditions, such as inflammation and cancer. We have previously shown that colon cancer patients with high CysLT(1)R and low CysLT(2)R expression demonstrate poor prognosis. Therefore, we wanted to investigate ways for the transcriptional regulation of CysLT(2)R, which still remains to be poorly understood. METHODOLOGY/PRINCIPAL FINDINGS: We investigated the potential role of the anti-tumorigenic interferon α (IFN-α) and the mitogenic epidermal growth factor (EGF) on CysLT(2)R regulation using non-transformed intestinal epithelial cell lines and colon cancer cells to elucidate the effects on the CysLT(2)R expression and regulation. This was done using Western blot, qPCR, luciferase reporter assay and a colon cancer patient array. We found a binding site for the transcription factor IRF-7 in the putative promoter region of CysLT(2)R. This site was involved in the IFN-α induced activity of the CysLT(2)R luciferase reporter assay. In addition, IFN-α induced the activity of the differentiation marker alkaline phosphatase along with the expression of mucin-2, which protects the epithelial layer from damage. Interestingly, EGF suppressed both the expression and promoter activity of the CysLT(2)R. E-boxes present in the CysLT(2)R putative promoter region were involved in the suppressing effect. CysLT(2)R signaling was able to suppress cell migration that was induced by EGF signaling. CONCLUSIONS/SIGNIFICANCE: The patient array showed that aggressive tumors generally expressed less IFN-α receptor and more EGFR. Interestingly, there was a negative correlation between CysLT(2)R and EGFR expression. Our data strengthens the idea that there is a protective role against tumor progression for CysLT(2)R and that it highlights new possibilities to regulate the CysLT(2)R.

Regulation of the eicosanoid pathway by tumour necrosis factor alpha and leukotriene D4 in intestinal epithelial cells.

In this study the mRNA and protein levels of the key enzymes involved in eicosanoid biosynthesis and the cysteinyl leukotriene receptors (CysLT1R and CysLT2R) have been analysed in non-transformed intestinal epithelial and colon cancer cell lines. Our results revealed that tumour necrosis factor alpha (TNF-alpha), and leukotriene D4 (LTD4), which are inflammatory mediators implicated in carcinogenesis, stimulated an increase of cyclooxygenase-2 (COX-2), in non-transformed epithelial cells, and 5-lipoxygenase (5-LO) in both non-transformed and cancer cell lines. Furthermore, these mediators also stimulated an up-regulation of LTC4 synthase in cancer cells as well as non-transformed cells. We also observed an endogenous production of CysLTs in these cells. TNF-alpha and LTD4, to a lesser extent, up-regulate the CysLT1R levels. Interestingly, TNF-alpha also reduced CysLT2R expression in cancer cells. Our results demonstrate that inflammatory mediators can cause intestinal epithelial cells to up-regulate the expression of enzymes needed for the biosynthesis of eicosanoids, including the cysteinyl leukotrienes, as well as the signal transducing proteins, the CysLT receptors, thus providing important mechanisms for both maintaining inflammation and for tumour progression.

Leukotriene D(4) induces AP-1 but not NFkappaB signaling in intestinal epithelial cells.

We have previously shown that leukotriene D(4) (LTD(4)), a known pro-inflammatory mediator, induces increased survival and proliferation of intestinal epithelial cells. In this study we examined whether LTD(4) functions via activation of the transcription factors NFkappaB and AP-1, which are potent inducers of mitogenesis. We found that the NFkappaB inhibitory protein IkappaBalpha was not degraded upon LTD(4) stimulation. Furthermore, nuclear translocation of the classical p65 or alternative p52 subunits of NFkappaB was not observed. Accordingly, LTD(4) stimulation failed to induce NFkappaB transcriptional activity. Instead we found that LTD(4) induced phosphorylation of c-Jun-N-terminal kinase (JNK) and transcriptional activity of AP-1, which could be reduced by a JNK inhibitor. Moreover, LTD(4) induced cell proliferation, and this effect was also blocked upon addition of a JNK inhibitor. Our findings show for the first time that JNK/AP-1 but not NFkappaB is a downstream target of LTD(4) in intestinal epithelial cells, suggesting that AP-1 is an important mediator of LTD(4)-induced mitogenic effects.

Genomic and functional delineation of dendritic cells and memory T cells derived from grass pollen-allergic patients and healthy individuals.

Dendritic cells (DCIs) possess a potent ability to modulate and activate specific T-cell responses to allergens, which play a pivotal role in allergic inflammation by secreting cytokines and other mediators. However, the molecular mechanisms by which allergen-challenged DCs regulate specific T-cell responses are still not well characterized. This study aims at elucidating the molecular mechanisms underlying the DC-T-cell interaction during an allergic immune response to grass pollen, using a genomic and functional approach. Transcriptional analysis was performed on grass allergen Phleum pratense-stimulated DCs and on autologous memory CD4(+) T cells co-cultured with allergen-challenged DCs from healthy and allergic donors. DCs from the allergic donors were potent inducers of T-cell proliferation and T(h)2 polarization, as demonstrated by high IL-4, IL-5 and IL-13, and low IFN-gamma production. A gradual up-regulation of activation markers on both DCs and T cells was evident during the co-culture period, demonstrating an educational element of the DC-T-cell interaction. The global transcriptional analysis revealed a differential gene regulation in DCs and T cells derived from allergic donors after stimulation with allergen, as compared with the healthy donors. Peripheral memory CD4(+) T cells from healthy and allergic donors also responded differently after stimulation with allergen-loaded DCs with respect to cytokine production, proliferation, surface marker expression and gene transcription. We found up-regulated genes involved in T(h)2 cell biology, such as genes important for homing, adhesion, signaling and transcription, in addition to genes previously not described in the context of allergy. The panel of differentially expressed genes in the allergic group will form the basis for an increased understanding of the molecular mechanisms in allergy.