What factors are driving increasing demand for community nursing?

Demand for district nursing services is increasing significantly. With increasing economic pressures, services are struggling to meet increases in demand, and are looking to become more proactive in planning for future demand. Traditional quantitative forecasting methods have limited use, because of the complexity of inter-linking factors that potentially drive demand for community services. Qualitative system dynamics approaches can be useful to model the complex interplay of causal factors leading to an effect, such as increased demand for services, and identify particular areas of concern for future focus. We ran a facilitated qualitative system dynamics workshop with representatives working across community nursing services in Cornwall. The generated models identified 7 key areas of concern that could be significantly contributing to demand for district nursing services. We outline the identified problem areas in this paper, and discuss potential recommendations to reduce their effects based on causal links identified in the models.

Broadening equity through recruitment: Pre-college STEM program recruitment in literature and practice.

One way that institutions of higher education try to address racial inequities in STEM is through pre-college programs aimed at racially minoritized high school students. Out of school time and informal STEM programming have the potential to complement K-12 opportunities, and pre-college programs may support the development of infrastructure to increase admissions of minoritized youth in STEM fields. In this article, we focus on the recruitment of racially minoritized youth into pre-college STEM programs to better understand what works for youth and their families to both inform program practices and support clear pathways between STEM in K-12 schools and these programs. Drawing from three sources of data: (1) existing research and evaluation on recruitment; (2) program recruitment data from four pre-college programs currently serving racially minoritized youth, and (3) survey feedback from youth who have participated in these four programs, we examined the recruitment practices of programs designed to serve and support minoritized students. Through this work, we hope to reorient programming to better serving minoritized youth and supporting and enhancing K-12 STEM experiences to broaden STEM career pathways for racially minoritized students.

Identification of a Titin-derived HLA-A1-presented peptide as a cross-reactive target for engineered MAGE A3-directed T cells.

MAGE A3, which belongs to the family of cancer-testis antigens, is an attractive target for adoptive therapy given its reactivation in various tumors and limited expression in normal tissues. We developed an affinity-enhanced T cell receptor (TCR) directed to a human leukocyte antigen (HLA)-A*01-restricted MAGE A3 antigen (EVDPIGHLY) for use in adoptive therapy. Extensive preclinical investigations revealed no off-target antigen recognition concerns; nonetheless, administration to patients of T cells expressing the affinity-enhanced MAGE A3 TCR resulted in a serious adverse event (SAE) and fatal toxicity against cardiac tissue. We present a description of the preclinical in vitro functional analysis of the MAGE A3 TCR, which failed to reveal any evidence of off-target activity, and a full analysis of the post-SAE in vitro investigations, which reveal cross-recognition of an off-target peptide. Using an amino acid scanning approach, a peptide from the muscle protein Titin (ESDPIVAQY) was identified as an alternative target for the MAGE A3 TCR and the most likely cause of in vivo toxicity. These results demonstrate that affinity-enhanced TCRs have considerable effector functions in vivo and highlight the potential safety concerns for TCR-engineered T cells. Strategies such as peptide scanning and the use of more complex cell cultures are recommended in preclinical studies to mitigate the risk of off-target toxicity in future clinical investigations.