Fibrosis induced by resident macrophages has divergent roles in pancreas inflammatory injury and PDAC.

Tissue-resident macrophages (TRMs) are long-lived cells that maintain locally and can be phenotypically distinct from monocyte-derived macrophages. Whether TRMs and monocyte-derived macrophages have district roles under differing pathologies is not understood. Here, we showed that a substantial portion of the macrophages that accumulated during pancreatitis and pancreatic cancer in mice had expanded from TRMs. Pancreas TRMs had an extracellular matrix remodeling phenotype that was important for maintaining tissue homeostasis during inflammation. Loss of TRMs led to exacerbation of severe pancreatitis and death, due to impaired acinar cell survival and recovery. During pancreatitis, TRMs elicited protective effects by triggering the accumulation and activation of fibroblasts, which was necessary for initiating fibrosis as a wound healing response. The same TRM-driven fibrosis, however, drove pancreas cancer pathogenesis and progression. Together, these findings indicate that TRMs play divergent roles in the pathogenesis of pancreatitis and cancer through regulation of stromagenesis.

BIPOC experiences of (anti-)racist patient engagement in adolescent and young adult oncology research: an electronic Delphi study.

Aims: To characterize Black, Indigenous and People of Color (BIPOC) adolescent and young adult (AYA) cancer patients' experiences of patient engagement in AYA oncology and derive best practices that are co-developed by BIPOC AYAs and oncology professionals. Materials & methods: Following a previous call to action from AYA oncology professionals, a panel of experts composed exclusively of BIPOC AYA cancer patients (n = 32) participated in an electronic Delphi study. Results: Emergent themes described BIPOC AYA cancer patients' direct experiences and consensus opinion on recommendations to advance antiracist patient engagement from BIPOC AYA cancer patients and oncology professionals. Conclusion: The findings reveal high-priority practices across all phases of research and are instructional for advancing health equity.

Revealing Decision-Making Strategies of Americans in Taking COVID-19 Vaccination.

Efficient coverage for newly developed vaccines requires knowing which groups of individuals will accept the vaccine immediately and which will take longer to accept or never accept. Of those who may eventually accept the vaccine, there are two main types: success-based learners, basing their decisions on others' satisfaction, and myopic rationalists, attending to their own immediate perceived benefit. We used COVID-19 vaccination data to fit a mechanistic model capturing the distinct effects of the two types on the vaccination progress. We proved the identifiability of the population proportions of each type and estimated that 47 % of Americans behaved as myopic rationalists with a high variation across the jurisdictions, from 31 % in Mississippi to 76 % in Vermont. The proportion was correlated with the vaccination coverage, proportion of votes in favor of Democrats in 2020 presidential election, and education score.

Biomarker Testing Trends in Patients With Metastatic Colorectal Cancer Who Live in Rural Areas and Urban Clusters in the US.

BACKGROUND: There is a paucity of data on biomarker testing rates in rural populations with metastatic colorectal cancer (mCRC). To assess biomarker testing practices, oncologists in rural areas and urban clusters in the US were surveyed. MATERIALS AND METHODS: A web-based survey was administered to oncologists spending ≥40% of their time practicing in rural areas or urban clusters and who had treated ≥2 patients with stage IV mCRC in the prior month. RESULTS: Ninety-nine oncologists completed the quantitative survey and 17 the qualitative interview. Among respondents, 97% reported ordering biomarker tests. Oncologists reported testing for KRAS, NRAS, BRAF, HER2, and mismatch repair deficiency/microsatellite instability in 72%, 65%, 63%, 56%, and 66% of patients with metastatic disease, respectively. Forty-one percent reported performing reflex testing. The most cited testing barriers were lack of insurance coverage, insufficient tissue samples, and long turnaround times. CONCLUSION: Further assessment of rural testing practices is needed.

Two distinct rotations of bithiazole DNA intercalation revealed by direct comparison of crystal structures of Co(III)•bleomycin A2 and B2 bound to duplex 5'-TAGTT sites.

Bleomycins constitute a family of anticancer natural products that bind DNA through intercalation of a C-terminal tail/bithiazole moiety and hydrogen-bonding interactions between the remainder of the drug and the minor groove. The clinical utility of the bleomycins is believed to result from single- and double-strand DNA cleavage mediated by the HOO-Fe(III) form of the drug. The bleomycins also serve as a model system to understand the nature of complex drug-DNA interactions that may guide future DNA-targeted drug discovery. In this study, the impact of the C-terminal tail on bleomycin-DNA interactions was investigated. Toward this goal, we determined two crystal structures of HOO-Co(III)•BLMA2 "green" (a stable structural analogue of the active HOO-Fe(III) drug) bound to duplex DNA containing 5'-TAGTT, one in which the entire drug is bound (fully bound) and a second with only the C-terminal tail/bithiazole bound (partially bound). The structures reported here were captured by soaking HOO-Co(III)•BLMA2 into preformed host-guest crystals including a preferred DNA-binding site. While the overall structure of DNA-bound BLMA2 was found to be similar to those reported earlier at the same DNA site for BLMB2, the intercalated bithiazole of BLMB2 is "flipped" 180˚ relative to DNA-bound BLMA2. This finding highlights an unidentified role for the C-terminal tail in directing the intercalation of the bithiazole. In addition, these analyses identified specific bond rotations within the C-terminal domain of the drug that may be relevant for its reorganization and ability to carry out a double-strand DNA cleavage event.

Sources of informal financial support among adolescent and young adult cancer survivors: a mixed methods analysis from the HIAYA CHAT study.

PURPOSE: The purpose of this exploratory sequential mixed methods study was to describe the sources of informal financial support used by adolescent and young adult (AYA) cancer survivors and how financial toxicity and demographic factors were associated with different types and magnitudes of informal financial support. METHODS: This analysis is part of a larger health insurance literacy study that included pre-trial interviews and a randomized controlled trial (RCT) for AYA cancer survivors. Eligible study participants were 18 years of age, diagnosed with cancer as an AYA (15-39 years), insured, and for the RCT sample less than 1 year from diagnosis. Interview audio was transcribed, quality checked, and thematically analyzed. RCT baseline and follow-up surveys captured informal financial support use. Chi-squared and Fisher's exact tests were used to assess differences in informal financial support type use and frequency by financial toxicity and AYA demographics. RESULTS: A total of N = 24 and N = 86 AYAs participated in pre-trial interviews and the RCT respectively. Interview participants reported a variety of informal financial support sources including savings, community, family/friends, and fundraisers. However, only half of participants reported their informal financial support to be sufficient. High financial toxicity was associated with the most types of informal financial support and a higher magnitude of use. The lowest income group accessed informal financial supports less frequently than higher income groups. CONCLUSION: Our study demonstrates that AYA survivors experiencing financial toxicity frequently turn to informal sources of financial support and the magnitude is associated with financial toxicity. However, low-income survivors, and other at-risk survivors, may not have access to informal sources of financial support potentially widening inequities.

Coupling Mountain Pine Beetle and Forest Population Dynamics Predicts Transient Outbreaks that are Likely to Increase in Number with Climate Change.

Mountain pine beetle (MPB) in Canada have spread well beyond their historical range. Accurate modelling of the long-term dynamics of MPB is critical for assessing the risk of further expansion and informing management strategies, particularly in the context of climate change and variable forest resilience. Most previous models have focused on capturing a single outbreak without tree replacement. While these models are useful for understanding MPB biology and outbreak dynamics, they cannot accurately model long-term forest dynamics. Past models that incorporate forest growth tend to simplify beetle dynamics. We present a new model that couples forest growth to MPB population dynamics and accurately captures key aspects of MPB biology, including a threshold for the number of beetles needed to overcome tree defenses and beetle aggregation that facilitates mass attacks. These mechanisms lead to a demographic Allee effect, which is known to be important in beetle population dynamics. We show that as forest resilience decreases, a fold bifurcation emerges and there is a stable fixed point with a non-zero MPB population. We derive conditions for the existence of this equilibrium. We then simulate biologically relevant scenarios and show that the beetle population approaches this equilibrium with transient boom and bust cycles with period related to the time of forest recovery. As forest resilience decreases, the Allee threshold also decreases. Thus, if host resilience decreases under climate change, for example under increased stress from drought, then the lower Allee threshold makes transient outbreaks more likely to occur in the future.

A unifying framework for the transient parasite dynamics of migratory hosts.

Migrations allow animals to track seasonal changes in resources, find mates, and avoid harsh climates, but these regular, long-distance movements also have implications for parasite dynamics and animal health. Migratory animals have been dubbed "superspreaders" of infection, but migration can also reduce parasite burdens within host populations via migratory escape from contaminated habitats and transmission hotspots, migratory recovery due to parasite mortality, and migratory culling of infected individuals. Here, we show that a single migratory host-macroparasite model can give rise to these different phenomena under different parametrizations, providing a unifying framework for a mechanistic understanding of the parasite dynamics of migratory animals. Importantly, our model includes the impact of parasite burden on host movement capability during migration, which can lead to "parasite-induced migratory stalling" due to a positive feedback between increasing parasite burdens and reduced movement. Our results provide general insight into the conditions leading to different health outcomes in migratory wildlife. Our approach lays the foundation for tactical models that can help understand, predict, and mitigate future changes of disease risk in migratory wildlife that may arise from shifting migratory patterns, loss of migratory behavior, or climate effects on parasite development, mortality, and transmission.

Regenerative proliferation of differentiated cells by mTORC1-dependent paligenosis.

In 1900, Adami speculated that a sequence of context-independent energetic and structural changes governed the reversion of differentiated cells to a proliferative, regenerative state. Accordingly, we show here that differentiated cells in diverse organs become proliferative via a shared program. Metaplasia-inducing injury caused both gastric chief and pancreatic acinar cells to decrease mTORC1 activity and massively upregulate lysosomes/autophagosomes; then increase damage associated metaplastic genes such as Sox9; and finally reactivate mTORC1 and re-enter the cell cycle. Blocking mTORC1 permitted autophagy and metaplastic gene induction but blocked cell cycle re-entry at S-phase. In kidney and liver regeneration and in human gastric metaplasia, mTORC1 also correlated with proliferation. In lysosome-defective Gnptab-/- mice, both metaplasia-associated gene expression changes and mTORC1-mediated proliferation were deficient in pancreas and stomach. Our findings indicate differentiated cells become proliferative using a sequential program with intervening checkpoints: (i) differentiated cell structure degradation; (ii) metaplasia- or progenitor-associated gene induction; (iii) cell cycle re-entry. We propose this program, which we term "paligenosis", is a fundamental process, like apoptosis, available to differentiated cells to fuel regeneration following injury.

Spreading speed of chronic wasting disease across deer groups with overlapping home ranges.

Chronic wasting disease (CWD) is a fatal disease of cervid species that continues to spread across North America and now in Europe. It poses a threat to cervid populations and the local ecological and economic communities that depend on them. Although empirical studies have shown that host home range overlap and male dispersal are important in the spread of disease, there are few mechanistic models explicitly considering those factors. We built a spatio-temporal, differential equation model for CWD spreading with restricted movement of hosts within home ranges. The model incorporates both direct and environmental transmission within and between groups as well as male dispersal. We compared the relative influence of host density, sex ratio, home range size, and male dispersal distance on the spreading speed using sensitivity analysis. We also assessed the effect of landscape heterogeneity, quantified as edge density, on the spreading speed of CWD because it jointly alters the host density and home range size. Our model binds the theoretical study of CWD spreading speed together with empirical studies on deer home ranges and sets a base for models in 2D space to evaluate management and control strategies.

Energy-based step selection analysis: Modelling the energetic drivers of animal movement and habitat use.

The energetic gains from foraging and costs of movement are expected to be key drivers of animal decision-making, as their balance is a large determinant of body condition and survival. This fundamental perspective is often missing from habitat selection studies, which mainly describe correlations between space use and environmental features, rather than the mechanisms behind these correlations. To address this gap, we present a novel parameterisation of step selection functions (SSFs), that we term the energy selection function (ESF). In this model, the likelihood of an animal selecting a movement step depends directly on the corresponding energetic gains and costs, and we can therefore assess how moving animals choose habitat based on energetic considerations. The ESF retains the mathematical convenience and practicality of other SSFs and can be quickly fitted using standard software. In this article, we outline a workflow, from data gathering to statistical analysis, and use a case study of polar bears Ursus maritimus to demonstrate application of the model. We explain how defining gains and costs at the scale of the movement step allows us to include information about resource distribution, landscape resistance and movement patterns. We further demonstrate this process with a case study of polar bears and show how the parameters can be interpreted in terms of selection for energetic gains and against energetic costs. The ESF is a flexible framework that combines the energetic consequences of both movement and resource selection, thus incorporating a key mechanism into habitat selection analysis. Further, because it is based on familiar habitat selection models, the ESF is widely applicable to any study system where energetic gains and costs can be derived, and has immense potential for methodological extensions.

"I thought there would be more I understood": health insurance literacy among adolescent and young adult cancer survivors.

BACKGROUND: Health insurance literacy is crucial for navigating the US healthcare system. Low health insurance literacy may be especially concerning for adolescent and young adult (AYA) cancer survivors. To describe AYAs' health insurance literacy, we conducted semi-structured interviews with AYA survivors, on and off of treatment. METHODS: We interviewed 24 AYA cancer survivors (aged 18-39 years) between November 2019 and March 2020. Interviews were recorded, transcribed, and quality-checked. Using two cycles of structured coding, we explored AYAs' health insurance literacy and examined thematic differences by policy holder status and age. RESULTS: AYAs were 58.3% female, 79.2% non-Hispanic White, 91.7% heterosexual, and 62.5% receiving cancer treatment. Most participants had employer-sponsored health insurance (87.5%), and 41.7% were their own policy holder. Four themes emerged; in the first theme, most AYAs described beginning their cancer treatment with little to no understanding of their health insurance. This led to the three subsequent themes in which AYAs reported: unclear expectations of what their insurance would cover and their out-of-pocket costs; learning about insurance and costs by trial and error; and how their health insurance literacy negatively impacted their ability to navigate the healthcare system. CONCLUSIONS: Our findings, while requiring confirmation in larger samples and in other health systems, suggest that the health insurance literacy needed to navigate insurance and cancer care is low among US AYA survivors and may have health and financial implications. As the burden of navigating insurance is often put on patients, health insurance education is an important supportive service for AYA survivors on and off of treatment.

A Fisher-KPP Model with a Nonlocal Weighted Free Boundary: Analysis of How Habitat Boundaries Expand, Balance or Shrink.

In this paper, we propose a novel free boundary problem to model the movement of single species with a range boundary. The spatial movement and birth/death processes of the species found within the range boundary are assumed to be governed by the classic Fisher-KPP reaction-diffusion equation, while the movement of a free boundary describing the range limit is assumed to be influenced by the weighted total population inside the range boundary and is described by an integro-differential equation. Our free boundary equation is a generalization of the classical Stefan problem that allows for nonlocal influences on the boundary movement so that range expansion and shrinkage are both possible. In this paper, we prove that the new model is well-posed and possesses steady state. We show that the spreading speed of the range boundary is smaller than that for the equivalent problem with a Stefan condition. This implies that the nonlocal effect of the weighted total population on the boundary movement slows down the spreading speed of the population. While the classical Stefan condition categorizes asymptotic behavior via a spreading-vanishing dichotomy, the new model extends this dichotomy to a spreading-balancing-vanishing trichotomy. We specifically analyze how habitat boundaries expand, balance or shrink. When the model is extended to have two free boundaries, we observe the steady state scenario, asymmetric shifts, or even boundaries moving synchronously in the same direction. These are newly discovered phenomena in the free boundary problems for animal movement.

Detecting minimum energy states and multi-stability in nonlocal advection-diffusion models for interacting species.

Deriving emergent patterns from models of biological processes is a core concern of mathematical biology. In the context of partial differential equations, these emergent patterns sometimes appear as local minimisers of a corresponding energy functional. Here we give methods for determining the qualitative structure of local minimum energy states of a broad class of multi-species nonlocal advection-diffusion models, recently proposed for modelling the spatial structure of ecosystems. We show that when each pair of species respond to one another in a symmetric fashion (i.e. via mutual avoidance or mutual attraction, with equal strength), the system admits an energy functional that decreases in time and is bounded below. This suggests that the system will eventually reach a local minimum energy steady state, rather than fluctuating in perpetuity. We leverage this energy functional to develop tools, including a novel application of computational algebraic geometry, for making conjectures about the number and qualitative structure of local minimum energy solutions. These conjectures give a guide as to where to look for numerical steady state solutions, which we verify through numerical analysis. Our technique shows that even with two species, multi-stability with up to four classes of local minimum energy states can emerge. The associated dynamics include spatial sorting via aggregation and repulsion both within and between species. The emerging spatial patterns include a mixture of territory-like segregation as well as narrow spike-type solutions. Overall, our study reveals a general picture of rich multi-stability in systems of moving and interacting species.

A call to action: Antiracist patient engagement in adolescent and young adult oncology research and advocacy.

Amidst the concurrent global crises of coronavirus disease 2019 (COVID-19), uprisings against Anti-Black racism and police brutality, as well as anti-Asian racism and violence, the field of medicine found itself simultaneously called upon to respond as essential workers in the public health devastation of COVID-19, and as representatives of healthcare institutions wrought with the impacts of systemic racism. Clinicians, researchers, and advocates in adolescent and young adult (AYA) oncology, must come together in authentic activism to begin the work of creating structural change to advance antiracist approaches to patient engagement in AYA oncology research and advocacy. Critical review of existing practices is needed to ensure that ethical and effective research methods are employed when engaging with racial and ethnic minority AYA patients with cancer, who may be particularly vulnerable and exploited in the current context.

The Signature of Endemic Populations in the Spread of Mountain Pine Beetle Outbreaks.

The mountain pine beetle (MPB) is among the most destructive eruptive forest pests in North America. A recent increase in the frequency and severity of outbreaks, combined with an eastward range expansion towards untouched boreal pine forests, has spurred a great interest by government, industry and academia into the population ecology of this tree-killing bark beetle. Modern approaches to studying the spread of the MPB often involve the analysis of large-scale, high-resolution datasets on landscape-level damage to pine forests. This creates a need for new modelling tools to handle the unique challenges associated with large sample sizes and spatial effects. In two companion papers (Koch et al. in Environ Ecol Stat. https://doi.org/10.1007/s10651-020-00456-2 , 2020a; J R Soc Interface 17(170):20200434, 2020b), we explain how the computational challenges of dispersal and spatial autocorrelation can be addressed using separable kernels. In this paper, we use these ideas to capture nonstationary patterns in the dispersal flights of MPB. This facilitates a landscape-level inference of subtle properties of MPB attack behaviour based on aerial surveys of killed pine. Using this model, we estimate the size of the cryptic endemic MPB population, which formerly has been measurable only by means of costly and time-intensive ground surveys.

Managing aquatic invasions: Optimal locations and operating times for watercraft inspection stations.

Aquatic invasive species (AIS) cause significant ecological and economic damages around the world. A major spread mechanism for AIS is traffic of boaters transporting their watercraft from invaded to uninvaded waterbodies. To inhibit the spread of AIS, Canadian provinces and American states often set up watercraft inspection stations at roadsides, where potentially infested boats are screened for AIS and, if necessary, decontaminated. However, since budgets for AIS control are limited, watercraft inspection stations can only be operated at specific locations and daytimes. Though theoretical studies provide managers with general guidelines for AIS management, more specific results are needed to determine when and where watercraft inspections would be most effective. This is the subject of this paper. We show how linear integer programming techniques can be used to optimize watercraft inspection policies under budget constraints. We introduce our approach as a general framework and apply it to the prevention of the spread of zebra and quagga mussels (Dreissena spp.) to the Canadian province of British Columbia. We consider multiple scenarios and show how variations in budget constraints, propagule sources, and model uncertainty affect the optimal policy. Based on these results, we identify simple, generally applicable principles for optimal AIS management.

Modeling the dispersal-reproduction trade-off in an expanding population.

Trade-offs between dispersal and reproduction are known to be important drivers of population dynamics, but their direct influence on the spreading speed of a population is not well understood. Using integrodifference equations, we develop a model that incorporates a dispersal-reproduction trade-off which allows for a variety of different shaped trade-off curves. We show there is a unique reproductive-dispersal allocation that gives the largest value for the spreading speed and calculate the sensitivities of the reproduction, dispersal, and trade-off shape parameters. Uncertainty in the model parameters affects the expected spread of the population and we calculate the optimal allocation of resources to dispersal that maximizes the expected spreading speed. Higher allocation to dispersal arises from uncertainty in the reproduction parameter or the shape of the reproduction trade-off curve. Lower allocation to dispersal arises from uncertainty in the shape of the dispersal trade-off curve, but does not come from uncertainty in the dispersal parameter. Our findings give insight into how parameter sensitivity and uncertainty influence the spreading speed of a population with a dispersal-reproduction trade-off.

Hereditary Syndromes in Neuroendocrine Tumors.

OPINION STATEMENT: Oncologists should be able to discern the salient clinical features of the most common germline mutations that give rise to neuroendocrine tumors. Astute recognition of an index patient affected by a hereditary syndrome can lead to a "tip-of-the-iceberg" phenomenon whereby their entire kindred can then be proactively monitored and managed potentially with substantial reduction of morbidity and mortality. Through careful history-taking, as well as thoughtful assimilation of findings from the physical exam, biochemical laboratories, scans, and pathology reports, the clinician can spot phenotypic clues that distinguish these familial patterns from sporadic cases of tumorigenesis.