Potential distributions of pre-Columbian people in Tropical Andean landscapes.

Much has yet to be learned of the spatial patterning of pre-Columbian people across the Tropical Andes. Using compiled archaeological data and a suite of environmental variables, we generate an ensemble species distribution model (SDM) that incorporates general additive models, random forest models and Maxent models to reconstruct spatial patterns of pre-Columbian people that inhabited the Tropical Andes east of the continental divide, within the modern countries of Bolivia, Peru and Ecuador. Within this region, here referred to as the eastern Andean flank, elevation, mean annual cloud frequency, distance to rivers and precipitation of the driest quarter are the environmental variables most closely related to human occupancy. Our model indicates that 11.04% of our study area (65 368 km2) was likely occupied by pre-Columbian people. Our model shows that 30 of 351 forest inventory plots, which are used to generate ecological understanding of Andean ecosystems, were likely occupied in the pre-Columbian period. In previously occupied sites, successional trajectories may still be shaping forest dynamics, and those forests may still be recovering from the ecological legacy of pre-Columbian impacts. Our ensemble SDM links palaeo- and neo-ecology and can also be used to guide both future archaeological and ecological studies. This article is part of the theme issue 'Tropical forests in the deep human past'.

Metastatic melanoma in the breast and axilla: A case report.

Metastatic melanoma of the breast is rare, and demonstrates nonspecific imaging findings which may overlap with both benign and malignant pathology.1-3 Immunohistochemical stains are important to confirm the diagnosis, particularly combining S100, a sensitive marker for melanoma, with more specific tumor markers such as Melan-A and HMB-45, and lack of cytokeratin staining.4-7 We present a case of a 64-year-old female who presented for diagnostic imaging of a palpable abnormality in her right breast, with medical history notable for previously excised cutaneous melanoma, recent COVID-19 vaccination, and significant family history of breast cancer. Diagnostic mammogram of the right breast demonstrated a circumscribed mass in the lower inner quadrant corresponding to the area of palpable concern, as well as an additional non-palpable circumscribed mass in the lower inner quadrant. Targeted right breast ultrasound demonstrated corresponding circumscribed cystic versus solid masses as well as a morphologically abnormal right axillary lymph node. Pathologic results after tissue sampling of the two right breast masses and right axillary lymph node all yielded metastatic melanoma.

Unilateral axillary adenopathy in the setting of COVID-19 vaccine: Follow-up.

With the Pfizer-BioNTech, Moderna, and now Johnson and Johnson COVID-19 vaccines readily available to the general population, the appearance of vaccine-induced axillary adenopathy on imaging has become more prevalent. We are presenting follow up to the first reported four cases of vaccine induced unilateral axillary adenopathy on imaging to our knowledge, which demonstrate expected self-resolving adenopathy. Our hope is that by providing this follow-up and reviewing current management guidelines, clinicians as well as patients will appreciate that this is an expected, benign, and self-resolving finding. In addition, we hope to quell any vaccine hesitancy brought about by recent mainstream media attention to this topic and ultimately empower patients to receive both the COVID-19 vaccine and undergo routine screening mammography, as both are vital to their health.

Unilateral axillary Adenopathy in the setting of COVID-19 vaccine.

With the recent U.S. Food and Drug Administration (FDA)-approval and rollout of the Pfizer-BioNTech and Moderna COVID-19 vaccines, it is important for radiologists to consider recent COVID-19 vaccination history as a possible differential diagnosis for patients with unilateral axillary adenopathy. Hyperplastic axillary nodes can be seen on sonography after any vaccination but are more common after a vaccine that evokes a strong immune response, such as the COVID-19 vaccine. As the differential of unilateral axillary adenopathy includes breast malignancy, it is crucial to both thoroughly evaluate the breast for primary malignancy and to elicit history of recent vaccination. As COVID-19 vaccines will soon be available to a larger patient population, radiologists should be familiar with the imaging features of COVID-19 vaccine induced hyperplastic adenopathy and its inclusion in a differential for unilateral axillary adenopathy. Short-term follow-up for unilateral axillary adenopathy in the setting of recent COVID-19 vaccination is an appropriate recommendation, in lieu of immediately performing potentially unnecessary and costly axillary lymph node biopsies.

A statistical framework for radiation dose estimation with uncertainty quantification from the γ-H2AX assay.

Over the last decade, the γ-H2AX focus assay, which exploits the phosphorylation of the H2AX histone following DNA double-strand-breaks, has made considerable progress towards acceptance as a reliable biomarker for exposure to ionizing radiation. While the existing literature has convincingly demonstrated a dose-response effect, and also presented approaches to dose estimation based on appropriately defined calibration curves, a more widespread practical use is still hampered by a certain lack of discussion and agreement on the specific dose-response modelling and uncertainty quantification strategies, as well as by the unavailability of implementations. This manuscript intends to fill these gaps, by stating explicitly the statistical models and techniques required for calibration curve estimation and subsequent dose estimation. Accompanying this article, a web applet has been produced which implements the discussed methods.

Intradermal invasive lobular carcinoma presenting: Not everything in the skin is benign.

In this case report, the history and imaging of two patients with invasive lobular carcinoma (ILC) in the skin are presented, followed by a discussion of both benign and malignant intradermal findings on breast ultrasound. Although the majority of dermal findings are benign, these cases are a reminder that malignancy can manifest within the skin. The purpose of presenting these cases together is to remind breast imagers of the importance of considering malignancy in the differential diagnosis of intradermal lesions on breast ultrasound, especially in special circumstances such as a personal history of breast cancer or associated clinical findings.

Improving and validating children's nurses communication skills with standardized patients in end of life care.

Children's nurse education is experiencing increases in recruitment targets at the same time that clinical placements are decreasing. With regard to end-of-life care, it is has become a challenge to ensure that all students come into contact with a satisfactory range of experience as part of the requirement for competency at the point of registration. The aim of our study was to find out if students at the end of their course were able to use communication skills acquired in their three years of training and adapt and transfer them to a specific palliative care context even if they had never worked in that area of care. Focus groups were conducted after the simulations which explored the students' experiences of being involved in the scenarios. Four themes emerged that students identified either inhibited or enabled their communication skills, which included anxiety and fear, the need for professional props, the experience of it being real and feeling empowered.

The challenges of providing palliative care for people with intellectual disabilities: a literature review.

People with intellectual disabilities are often marginalised from mainstream health-care services because of the complexities of their disability. They are under-referred to specialist palliative care owing to a limited understanding of its role and little collaborative working. Furthermore, professionals caring for people with intellectual disabilities and palliative care services often lack knowledge about and confidence in their ability to meet the needs of people with an intellectual disability who require palliative care. This literature review explores the challenges of providing palliative care for people with intellectual disability. It highlights that training requirements need to be effectively identified, referrals between professional groups made, and the perspectives of patients understood to overcome the marginalisation of people with intellectual disability. There is a need for ongoing staff development focusing on staff confidence, collaborative working between professionals, and the empowerment of people with intellectual disability to be involved in decisions about their end-of-life care. Further research is needed to examine the most effective way of capturing the perspectives of those with intellectual disability and of enabling people with intellectual disability to access and engage with health surveillance, cancer screening, and palliative care services.

Online multimedia delivery of the European Union directive within adult nursing education.

The use of online multimedia content in nurse education is still in its infancy with limited research about its role and acceptance by students and staff within nursing courses. This paper describes the development of interactive web-based delivery for the European Union directive (77/453/EEC) for maternity, child care and mental health within adult nursing education. An evaluative study carried out by an online questionnaire with students, using both structured questions and free text, and a focus group with staff whilst identifying areas for further development found general acceptance of this approach. The study has provided important insights into both the content and delivery of the packs, and the format of the material. The use of IT, with multimedia elements, was seen as being beneficial by both students and staff. The findings will be useful in improving and developing the packs for future cohorts.

Student experiences and mentor views of the use of simulation for learning.

This paper presents the findings of a two phase mixed methods study. Phase 1 investigated whether simulation could support the development of a range of clinical skills amongst pre-registration adult and children's nursing students. The second phase of the study gathered mentors' views and experiences of the use of simulation in the preparation of students for practice. Commissioned by the Nursing and Midwifery Council, the United Kingdom (UK) professional body, the study is reported as one of 13 pilot sites using designated practice hours for simulation. The commission resulted from a call to review the current pre-registration nursing curriculum that includes 4600 equally divided theory and practice hours delivered across the programme. Phase 1 included a sample of 69 adult and children's pre-registration students from years one and three of their programme, studying at one UK University. The group attended five simulation sessions including basic life support, manual handling, infection control, clinical decision making and managing violence and aggression. Students completed pre- and post-tests in basic life support and manual handling, and vignettes and objective structured clinical examinations (OSCEs) covering the five areas of simulation. Phase 2 included interviews with six mentors who were supervising students involved in the study. Simulation was positively received by both students and mentors as it was apparent that it offered scope for interdisciplinary learning that could be broadened to inter-professional applications. The study also identified that the use of simulation could provide scope for collaborative working between education providers and clinical staff.

Manual handling and nursing children.

The aim of this article is to highlight some of the unique challenges relating to handling children, such as: their stage of physical and cognitive development, their position in relation to the carer's centre of gravity, their level of comprehension and their ability to communicate.