Radiation Reveal: Moving from research engagement to involvement.

Here, we report on the process of a highly impactful and successful creative, collaborative, and multi-partner public engagement project, Radiation Reveal. It brought together ten young adults aged 17-25-year-olds with experience of radiotherapy with researchers at Cancer Research UK RadNet City of London across three 2-hour online workshops. Our aims were to 1) initiate discussions between young adults and radiation researchers, and 2) identify what people wish they had known about radiotherapy before or during treatment. These aims were surpassed; other benefits included peer support, participants' continued involvement in subsequent engagement projects, lasting friendships, creation of support groups for others, and creation and national dissemination of top ten tips for medical professionals and social media resources. A key learning was that this project required a dedicated and (com)passionate person with connections to national cancer charities. When designing the project, constant feedback is also needed from charities and young adults with and without radiotherapy experience. Finally, visually capturing discussions and keeping the door open beyond workshops further enhanced impact. Here, we hope to inform and inspire people to help project the patient voice in all we do.

Building an Integrated Data Infrastructure to Examine the Spectrum of Suicide Risk Factors in Philadelphia Medicaid.

While there are many data-driven approaches to identifying individuals at risk of suicide, they tend to focus on clinical risk factors, such as previous psychiatric hospitalizations, and rarely include risk factors that occur in nonclinical settings, such as jails or emergency shelters. A better understanding of system-level encounters by individuals at risk of suicide could help inform suicide prevention efforts. In Philadelphia, we built a community-level data infrastructure that encompassed suicide death records, behavioral health claims, incarceration episodes, emergency housing episodes, and involuntary commitment petitions to examine a broader spectrum of suicide risk factors. Here, we describe the development of the data infrastructure, present key trends in suicide deaths in Philadelphia, and, for the Medicaid-eligible population, determine whether suicide decedents were more likely to interact with the behavioral health, carceral, and housing service systems compared to Medicaid-eligible Philadelphians who did not die by suicide. Between 2003 and 2018, there was an increase in the number of annual suicide deaths among Medicaid-eligible individuals, in part due to changes in Medicaid eligibility. There were disproportionately more suicide deaths among Black and Hispanic individuals who were Medicaid-eligible, who were younger on average, compared to suicide decedents who were never Medicaid-eligible. However, when we accounted for the racial and ethnic composition of the Medicaid population at large, we found that White individuals were four times as likely to die by suicide, while Asian, Black, Hispanic, and individuals of other races were less likely to die by suicide. Overall, 58% of individuals who were Medicaid-eligible and died by suicide had at least one Medicaid-funded behavioral health claim, 10% had at least one emergency housing episode, 25% had at least one incarceration episode, and 22% had at least one involuntary commitment. By developing a data infrastructure that can incorporate a broader spectrum of risk factors for suicide, we demonstrate how communities can harness administrative data to inform suicide prevention efforts. Our findings point to the need for suicide prevention in nonclinical settings such as jails and emergency shelters, and demonstrate important trends in suicide deaths in the Medicaid population.

Extending the TIME concept: what have we learned in the past 10 years?(*).

The TIME acronym (tissue, infection/inflammation, moisture balance and edge of wound) was first developed more than 10 years ago, by an international group of wound healing experts, to provide a framework for a structured approach to wound bed preparation; a basis for optimising the management of open chronic wounds healing by secondary intention. However, it should be recognised that the TIME principles are only a part of the systematic and holistic evaluation of each patient at every wound assessment. This review, prepared by the International Wound Infection Institute, examines how new data and evidence generated in the intervening decade affects the original concepts of TIME, and how it is translated into current best practice. Four developments stand out: recognition of the importance of biofilms (and the need for a simple diagnostic), use of negative pressure wound therapy (NPWT), evolution of topical antiseptic therapy as dressings and for wound lavage (notably, silver and polyhexamethylene biguanide) and expanded insight of the role of molecular biological processes in chronic wounds (with emerging diagnostics and theranostics). Tissue: a major advance has been the recognition of the value of repetitive and maintenance debridement and wound cleansing, both in time-honoured and novel methods (notably using NPWT and hydrosurgery). Infection/inflammation: clinical recognition of infection (and non infective causes of persisting inflammation) is critical. The concept of a bacterial continuum through contamination, colonisation and infection is now widely accepted, together with the understanding of biofilm presence. There has been a return to topical antiseptics to control bioburden in wounds, emphasised by the awareness of increasing antibiotic resistance. Moisture: the relevance of excessive or insufficient wound exudate and its molecular components has led to the development and use of a wide range of dressings to regulate moisture balance, and to protect peri-wound skin, and optimise healing. Edge of wound: several treatment modalities are being investigated and introduced to improve epithelial advancement, which can be regarded as the clearest sign of wound healing. The TIME principle remains relevant 10 years on, with continuing important developments that incorporate new evidence for wound care.

Lise Meitner, the scientist who changed medicine through the discovery of splitting atoms.

The splitting of atoms, also known as nuclear fission, is the physics behind radiation and radioactivity. Dr Lise Meitner discovered how radioactivity could be produced in 1939. She realised firing a small particle present in the nucleus of all atoms, a neutron, at another atom could release energy in the form of radiation. Radioactive atoms can also be created in this way and are useful in detecting cancer or checking if the brain and heart are working properly. This is because when radioactive atoms are injected into the blood vein of a patient, they travel through the body and release radiation that is detected using special cameras. This creates images or videos of tumours or normal tissues inside the body. Radiation therefore helps doctors diagnose and treat patients better. Unfortunately, Dr Meitner was never credited officially for her key discovery of nuclear fission.

Coronary artery augmentation with the right subclavian artery for single coronary artery variants of dextro transposition of the great arteries treated by an arterial switch operation.

Objective: Single coronary artery variants in dextro transposition of the great arteries increase the technical demands of performing coronary translocations during the arterial switch operation (ASO). Coronary augmentation using the right subclavian artery as an interposition graft is a viable option in certain cases. The aim of this study is to describe this operative technique and review outcomes. Methods: Of 59 patients who underwent an ASO, from July 2015 to May 2021, 6 had single coronary variants in which the right subclavian artery was used as an interposition graft. Mean follow-up was 21.5 months. Results: Patients mean age and weight at the time of surgery were 7.1 ± 3.8 days and 2.84 ± 0.76 kg, respectively. Four patients had the left anterior descending coronary artery and right coronary artery coming from the left sinus and the circumflex coronary artery coming from the right sinus. One patient had a single ostium arising from the left sinus and another patient had a single ostium coming from the right sinus. All patients are alive and free of cardiac symptoms at follow-up. Conclusions: Single coronary artery variants in dextro transposition of the great arteries can pose technical challenges for coronary translocation during ASO. The augmentation of coronary buttons using a segment of the right subclavian artery is an option which should be considered in selective cases.

Preoperative Evaluation of Refugee Children With Heart Disease.

The objective of this report is to identify nutritional deficiencies and health concerns in Canadian paediatric refugee patients with heart disease before cardiac surgery. A retrospective case study was conducted with 4 refugee children, aged 0-18 years, with heart disease referred to Cardiac Surgery. A total of 75% of patients had low vitamin D levels, 50% had selenium deficiency, 50% had iron deficiency anaemia, 75% were below the third percentile for height and weight for age, and 75% had dental caries. Early laboratory, nutritional, and dental screening of paediatric refugee patients at the time of heart disease diagnosis can optimize general and cardiovascular health before surgical intervention.

Notre étude visait à dépister des carences nutritionnelles et des problèmes de santé présents chez les enfants réfugiés au Canada atteints de cardiopathie, avant une intervention chirurgicale cardiaque. Une étude de cas rétrospective a été menée auprès de quatre enfants réfugiés, âgés de 0 à 18 ans, souffrant de cardiopathie et orientés vers la chirurgie cardiaque. Au total, 75 % des patients présentaient un faible taux de vitamine D, 50 % avaient une carence en sélénium, 50 % souffraient d'anémie ferriprive, 75 % avaient une taille et un poids inférieurs au troisième percentile pour leur âge et 75 % présentaient des caries dentaires. Un dépistage précoce comprenant des analyses de laboratoire, une évaluation nutritionnelle et un examen dentaire, au moment d'un diagnostic de cardiopathie chez les enfants réfugiés, pourrait permettre d'améliorer leur état de santé général et cardiovasculaire avant une intervention chirurgicale.

Suppression of Endothelial Cell FAK Expression Reduces Pancreatic Ductal Adenocarcinoma Metastasis after Gemcitabine Treatment.

Despite substantial advances in the treatment of solid cancers, resistance to therapy remains a major obstacle to prolonged progression-free survival. Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive cancers, with a high level of liver metastasis. Primary PDAC is highly hypoxic, and metastases are resistant to first-line treatment, including gemcitabine. Recent studies have indicated that endothelial cell (EC) focal adhesion kinase (FAK) regulates DNA-damaging therapy-induced angiocrine factors and chemosensitivity in primary tumor models. Here, we show that inducible loss of EC-FAK in both orthotopic and spontaneous mouse models of PDAC is not sufficient to affect primary tumor growth but reduces liver and lung metastasis load and improves survival rates in gemcitabine-treated, but not untreated, mice. EC-FAK loss did not affect primary tumor angiogenesis, tumor blood vessel leakage, or early events in metastasis, including the numbers of circulating tumor cells, tumor cell homing, or metastatic seeding. Phosphoproteomics analysis showed a downregulation of the MAPK, RAF, and PAK signaling pathways in gemcitabine-treated FAK-depleted ECs compared with gemcitabine-treated wild-type ECs. Moreover, low levels of EC-FAK correlated with increased survival and reduced relapse in gemcitabine-treated patients with PDAC, supporting the clinical relevance of these findings. Altogether, we have identified a new role of EC-FAK in regulating PDAC metastasis upon gemcitabine treatment that impacts outcome. SIGNIFICANCE: These findings establish the potential utility of combinatorial endothelial cell FAK targeting together with gemcitabine in future clinical applications to control metastasis in patients with pancreatic ductal adenocarcinoma.

A checklist for ecological management of landscapes for conservation.

The management of landscapes for biological conservation and ecologically sustainable natural resource use are crucial global issues. Research for over two decades has resulted in a large literature, yet there is little consensus on the applicability or even the existence of general principles or broad considerations that could guide landscape conservation. We assess six major themes in the ecology and conservation of landscapes. We identify 13 important issues that need to be considered in developing approaches to landscape conservation. They include recognizing the importance of landscape mosaics (including the integration of terrestrial and aquatic areas), recognizing interactions between vegetation cover and vegetation configuration, using an appropriate landscape conceptual model, maintaining the capacity to recover from disturbance and managing landscapes in an adaptive framework. These considerations are influenced by landscape context, species assemblages and management goals and do not translate directly into on-the-ground management guidelines but they should be recognized by researchers and resource managers when developing guidelines for specific cases. Two crucial overarching issues are: (i) a clearly articulated vision for landscape conservation and (ii) quantifiable objectives that offer unambiguous signposts for measuring progress.

Testing hypotheses associated with bird responses to wildfire.

Disturbance is a key ecological process influencing the distribution and abundance of many elements of the earth's biota. Predicting the response of biota to disturbance is therefore important, but it nevertheless remains difficult to make accurate forecasts of response. We tested predictions from disturbance-related theories and concepts in 10 vegetation types at Booderee National Park (southeastern Australia) using a retrospective study of bird responses to fire history (over 35 years) on 110 sites and a prospective study following a single wildfire event in 2003 at 59 of these sites. Our data did not support predictions from the intermediate-disturbance hypothesis; observed bird species richness at a site was significantly (F(1,99) = 6.30, P = 0.014) negatively related to the number of fires since 1972 and was 8.7% lower (95% CI, 1.8-15.1%) for each additional fire. In contrast to fire history effects, we found that after the 2003 fire, the vast majority of individual species and the bird assemblage per se in most vegetation types recovered within two years. Thus, recovery after a single fire did not reflect long-term effects of multiple fires on overall bird species richness at a site. We postulated that the recovery of bird species richness and bird assemblage composition after the 2003 fire would be fastest in structurally simple vegetation types and slowest in structurally complex vegetation, but observed the opposite. Although observed bird species richness in vertically heterogeneous forest and woodland had returned to prefire levels by 2006, bird species richness in structurally simple vegetation types (e.g., sedgeland) had not. Postfire vegetation regeneration, together with a paucity of early-successional specialists, would explain the speed of recovery of the bird assemblage and why it changed relatively little during our investigation.

The combined effects of remnant vegetation and tree planting on farmland birds.

Biodiversity conservation on agricultural land is a major issue worldwide. We estimated separate and joint effects of remnant native woodland vegetation and recent tree plantings on birds on farms (approximately 500-1000 ha) in the heavily cleared wheat and sheep belt of southern Australia. Much of the variation (>70%) in bird responses was explained by 3 factors: remnant native-vegetation attributes (native grassland, scattered paddock trees, patches of remnant native woodland); presence or absence of planted native trees; and the size and shape of tree plantings. In terms of the number of species, remnant native vegetation was more important than tree planting, in a 3:1 ratio, approximately. Farms with high values for remnant native vegetation were those most likely to support declining or vulnerable species, although some individual species of conservation concern occurred on farms with large plantings. Farm management for improved bird conservation should account for the cumulative and complementary contributions of many components of remnant native-vegetation cover (e.g., scattered paddock trees and fallen timber) as well as areas of restored native vegetation.

Beyond the walls: Risk factors for overdose mortality following release from the Philadelphia Department of Prisons.

BACKGROUND: High overdose mortality after release from state prison systems is well documented; however, little is known about overdose mortality following release from local criminal justice systems (CJS). The purpose of this study was to assess overdose mortality following release from a local CJS in Philadelphia, PA. METHODS: We conducted a retrospective cohort study of individuals released to the community from a local CJS between 2010 and 2016. Incarceration records were linked to overdose fatality data from the Medical Examiner's Office and death certificate records. All-cause, overdose, and non-overdose mortality were examined. RESULTS: Of the 82,780 individuals released between 2010 and 2016, 2,522 (3%) died from any cause, of which 837 (33%) succumbed to overdose. Individuals released from incarceration had higher risk of overdose death compared to the non-incarcerated population (Standardized Mortality Ratio [SMR]: 5.29, 95% CI 4.93-5.65), and risk was greatest during the first two weeks following release (SMR: 36.91, 95% CI: 29.92-43.90). Among released individuals, black, non-Hispanic individuals (Hazard Rate [HR]: 0.17, 95% CI: 0.14-0.19) and Hispanic individuals (HR: 0.41, 95% CI: 0.34-0.50) were at lower risk for overdose than white, non-Hispanic individuals. Individuals released with a serious mental illness (SMI) were at higher risk of overdose (HR: 1.54, 95% CI: 1.27-1.87) than those without a SMI. DISCUSSION: Previously incarcerated individuals are at high risk of overdose death following release from a local CJS, especially in the earliest weeks following release. Prevention measures including behavioral health treatment and referral and take-home naloxone may reduce overdose mortality after release.

Association of Drug and Alcohol Use With Adolescent Firearm Homicide at Individual, Family, and Neighborhood Levels.

Importance: Homicide is the third leading cause of death for adolescents in the United States and the leading cause of death for adolescents who are African American. Large cities have disproportionate homicide rates. Objective: To determine the relationships between exposures to drugs and alcohol at the individual, family, and neighborhood levels and adolescent firearm homicide and to inform new approaches to preventing firearm violence. Design, Setting, and Participants: Population-based case-control study from January 2010 to December 2012 of all 13- to 20-year-olds who were homicide victims in Philadelphia during the study period matched to randomly selected 13- to 20-year-old controls from the general population. Exposures: Individual drug and alcohol use at the time of injury, history of drug and alcohol use, caregiver drug and alcohol use, and neighborhood availability of alcohol and illegal drugs. We also controlled for age, race, school suspensions, arrests, and neighborhood ethnicity. Main Outcomes and Measures: Adolescent firearm homicide identified from police and medical examiner's reports. Results: We enrolled 161 adolescent homicide cases, including 157 (97.5%) firearm homicide cases and 172 matched controls, including 166 (96.5%) firearm homicide controls. Adolescents with a history of alcohol use (adjusted odds ratio [AOR], 4.1; 95% CI, 1.2-14.0) or drug use (AOR, 4.4; 95% CI, 1.7-11.6) had increased odds of firearm homicide. Adolescents whose caregiver had a history of drug use had increased odds of firearm homicide (AOR, 11.7; 95% CI, 2.8-48.0). Adolescents in neighborhoods with high densities of alcohol outlets (AOR, 3.2; 95% CI, 1.1-9.1) and moderate or high drug availability had increased odds of firearm homicide (AOR, 3.4; 95% CI, 1.1-10.3 vs AOR, 7.5; 95% CI, 2.2-25.8). Conclusions and Relevance: Almost all adolescent homicides in Philadelphia between 2010 and 2012 were committed with a firearm. Substance use at the individual, family, and neighborhood levels was associated with increased odds of adolescent firearm homicide; drug use was associated at all 3 levels and alcohol at the individual and neighborhood levels. Expanding violence prevention efforts to target drug and alcohol use at multiple levels may help to reduce the firearm violence that disproportionately affects adolescents in minority populations in large US cities.

Not all kinds of revegetation are created equal: revegetation type influences bird assemblages in threatened Australian woodland ecosystems.

The value for biodiversity of large intact areas of native vegetation is well established. The biodiversity value of regrowth vegetation is also increasingly recognised worldwide. However, there can be different kinds of revegetation that have different origins. Are there differences in the richness and composition of biotic communities in different kinds of revegetation? The answer remains unknown or poorly known in many ecosystems. We examined the conservation value of different kinds of revegetation through a comparative study of birds in 193 sites surveyed over ten years in four growth types located in semi-cleared agricultural areas of south-eastern Australia. These growth types were resprout regrowth, seedling regrowth, plantings, and old growth. Our investigation produced several key findings: (1) Marked differences in the bird assemblages of plantings, resprout regrowth, seedling regrowth, and old growth. (2) Differences in the number of species detected significantly more often in the different growth types; 29 species for plantings, 25 for seedling regrowth, 20 for resprout regrowth, and 15 for old growth. (3) Many bird species of conservation concern were significantly more often recorded in resprout regrowth, seedling regrowth or plantings but no species of conservation concern were recorded most often in old growth. We suggest that differences in bird occurrence among different growth types are likely to be strongly associated with growth-type differences in stand structural complexity.Our findings suggest a range of vegetation growth types are likely to be required in a given farmland area to support the diverse array of bird species that have the potential to occur in Australian temperate woodland ecosystems. Our results also highlight the inherent conservation value of regrowth woodland and suggest that current policies which allow it to be cleared or thinned need to be carefully re-examined.

The prevalence of fentanyl in drug-related deaths in Philadelphia 2004-2006.

Fentanyl is an increasingly common drug of abuse. The Philadelphia Medical Examiner's Office reported 252 drug-related deaths in Philadelphia that tested positive for fentanyl during the year 2006 in comparison to 22 and 19 in 2005 and 2004, respectively. We reviewed the data from 2004 to 2006 from the Philadelphia Medical Examiner's office. Key words such as fentanyl, drug, cocaine, ethanol, medic (medication), tox (intoxication), or poison were used as search words. In comparison to 2004 and 2005 data, there was a statistically significant increase in number of drug-related deaths (DRDs) and the percentage of DRDs that tested positive for fentanyl in 2006. We postulate that the increase in DRDs in 2006 may be related to increase use or abuse of fentanyl, lack of general public awareness that fentanyl is a potent opioid, inadequate dose of naloxone and/or the surge of clandestinely manufactured fentanyl.