Search Results (38)

A global poly-crisis of climate change, biodiversity loss, dwindling natural resources, geopolitical instability, among other complex challenges, is on the rise. Societal transformations are therefore imminent, whether intended or unintended. The key question is how to steward and facilitate such changes where fragmentation and siloed ways of working persist. The concept of synergies and the notion of synergic action could help overcome fragmented efforts to steer transformative changes. However, there exists a critical research gap in understanding the conditions needed to enable synergic action. This paper thus explores how synergic action is currently undertaken and the key essentials needed to deliver synergic action. The study uses a case study of the Yorkshire food system transformation to learn from its exemplar practitioners. The study used semi-structured interviews and a thematic analysis process to reach our two key findings. First, we highlight the three types of synergic action: (1) Non-systemic synergic action, (2) Non-systemic synergic action with multiple outcomes, and (3) Systemic synergic action. Differentiating types of synergic action can help identify where synergic action is already underway and guide more explicit efforts towards transformative change. The second key finding is the five essentials for synergic action, which are (1) leadership for synergic action; (2) networking, partnerships, and collaborations; (3) care and understanding; (4) a systems approach; and (5) intentionality for synergic action. This study brings to the fore the importance of intentionality, without which the first four essentials are less likely to coalesce. This is important to inform the reflection and learning of practitioners of systemic change about how they are currently and could be working more synergistically in the future, driven by clear intentionality. Full article

Background: Approximately 71% of antibiotics in England are prescribed in general practice settings. Whilst there are various impactful training resources available to support clinicians in antimicrobial stewardship (AMS) activities, implementation, reach, and uptake affect how successful they are nationally. This case study explores the feasibility, acceptability, and usefulness of embedding the TARGET (Treat Antibiotics Responsibly, Guidance, Education and Tools) AMS training into a local incentive scheme. Method: Black Country Integrated Care Board (ICB) invited a representative from all associated general practises to a TARGET AMS training event; attendance was linked to a local incentive scheme. Data were collected via a pre- and post-workshop survey capturing TARGET toolkit knowledge, AMS attitudes and behaviours, training feedback, and intention to implement AMS behaviours. Descriptive analyses were conducted. Results: 157 and 101 attendees completed the pre- and post-session surveys, respectively. In total, 89% agreed that attending the session was a good use of their time. The proportions of attendees stating an intention to use the TARGET toolkit and implement a range of AMS strategies following the session were high (TARGET Toolkit: >82%, AMS strategies: >90%). Most attendees planned to implement these actions within 3 months (47%) or within 3–6 months (30%). Conclusion: Results suggest that embedding the training into a local incentive scheme is a viable implementation approach in extending training reach. Although the impact on prescribing rates is not yet available, the high engagement and intention to implement AMS strategies observed should inspire confidence in this approach to training implementation. Full article

Background: Spectroscopic MRI (sMRI) is a quantitative imaging technique that maps infiltrated tumors in the brain without contrast injections. In a previous study (NCT03137888), sMRI-guided radiation treatment extended patient survival, showing promise for clinical translation. The spectral fitting of individual voxels in an sMRI dataset generate metabolite concentration maps that guide treatment. The established spectral analysis methods use iterative least-squares fitting (FITT) that are computationally demanding. This study compares the performance of NNFit, a neural network-based, accelerated spectral fitting model, to the established FITT for metabolite quantification and radiation treatment planning. Methods: NNFit is a self-supervised deep learning model trained on 50 ms echo-time (TE) sMRI data to estimate metabolite levels of choline (Cho), creatine (Cr), and NAA. We trained the model on 30 GBM patients (56 scans) and tested it on 17 GBM patients (29 scans). NNFit’s performance was compared to the FITT using structural similarity indices (SSIM) and the Dice coefficient. Results: NNFit significantly improved processing speed while maintaining strong agreement with FITT. The radiation target volumes defined by Cho/NAA ≥ 2x were visually comparable, with fewer artifacts in NNFit. Structural similarity indices (SSIM) indicated minimal bias and high consistency across methods. Conclusions: This study highlights NNFit’s potential for rapid, accurate, and artifact-reduced metabolic imaging, enabling faster radiotherapy planning. Full article

Background/Objectives: Advancements in radiotherapy technology now enable the delivery of ablative doses to targets in the upper urinary tract, including primary renal cell carcinoma (RCC) or upper tract urothelial carcinomas (UTUC), and secondary involvement by other histologies. Magnetic resonance imaging-guided linear accelerators (MR-Linacs) have shown promise to further improve the precision and adaptability of stereotactic body radiotherapy (SBRT). Methods: This single-institution retrospective study analyzed 34 patients (31 with upper urinary tract non-metastatic primaries [RCC or UTUC] and 3 with metastases of non-genitourinary histology) who received SBRT from August 2020 through September 2024 using a 1.5 Tesla MR-Linac system. Treatment plans were adjusted by using [online settings] for “adapt-to-position” (ATP) and “adapt-to-shape” (ATS) strategies for anatomic changes that developed during treatment; compression belts were used for motion management. Results: The median duration of treatment was 56 min overall and was significantly shorter using the adapt-to-position (ATP) (median 54 min, range 38–97 min) in comparison with adapt-to-shape (ATS) option (median 80, range 53–235 min). Most patients (77%) experienced self-resolving grade 1–2 acute radiation-induced toxicity; none had grade ≥ 3. Three participants (9%) experienced late grade 1–2 toxicity, potentially attributable to SBRT, with one (3%) experiencing grade 3. Conclusions: We conclude that MR-Linac-based SBRT, supported by online plan adaptation, is a feasible, safe, and highly precise treatment modality for the definitive management of select upper urinary tract lesions. Full article

Pancreatic cancer is a complex malignancy associated with poor prognosis and high symptom burden. Optimal patient care relies on the integration of various sectors in the healthcare field as well as innovation through research. The Canadian National Pancreas Conference (NPC) was co-organized and hosted by Craig’s Cause Pancreatic Cancer Society and The Royal College of Physicians and Surgeons in November 2023 in Montreal, Canada. The conference sought to bridge the gap between Canadian healthcare providers and researchers who share the common goal of improving the prognosis, quality of life, and survival for patients with pancreatic cancer. The accredited event featured discussion topics including diagnosis and screening, value-based and palliative care, pancreatic enzyme replacement therapy, cancer-reducing treatment, and an overview of the current management landscape. The present article reviews the NPC sessions and discusses the presented content with respect to the current literature. Full article

Despite the increasing use of assistive mobility devices, practical education to navigate real-world ground transportation barriers is lacking. The educational board game, called HERL-Town, was developed to teach safe and effective navigation for mobility device users (MDUs) in the community. The study examined the initial validity, reliability, and overall quality of HERL-Town as an educational tool for overcoming transportation barriers in real-world environments. HERL-Town featured fifty scenarios focused on transportation barriers and strategies, which were assessed for content validity, while the game quality was evaluated using the Model for the Evaluation of Educational Games (MEEGA+) tool. Twenty-three experienced MDUs and four caregivers participated in the study. The results indicated a good quality score of 60.15 and forty-five scenarios met the content validity standards. The overall reliability of the scenarios was moderate (ICC = 0.729). Early psychometric findings suggest HERL-Town as a promising effective educational game for helping new MDUs and their travel companions navigate safe and effective ground transportation barriers, hence enhancing their confidence, independence, and participation in the community. Full article

Polychlorinated biphenyls (PCBs) are a group of 209 highly stable molecules that were used extensively in industry. Although their commercial use ceased in 1979, they are still present in many aquatic ecosystems due to improper disposal, oceanic currents, atmospheric deposition, and hydrophobic nature. PCBs pose a significant and ongoing threat to the development and sustainability of aquatic organisms. In areas with PCB exposure high mortality rates of organisms inhabiting them are still seen today, posing a significant threat to local species. Zebrafish were exposed to a standard PCB mixture (Aroclor 1254) for the first 5 days post fertilization, as there is a gap in knowledge during this important developmental period for fish (i.e., organization of the body). This PCB mixture was formally available commercially and has a high prevalence in PCB-contaminated sites. We tested for the effects of PCB dosage (control (embryo water only; 0 mg/L), methanol (solvent control; 0 mg/L); PCB 1 (0.125 mg/L), PCB 2 (0.25 mg/L), PCB 3 (0.35 mg/L), and PCB 4 (0.40 mg/L)) on zebrafish survival, rate of metamorphosis, feeding efficiency, and growth. We found significant, dose-dependent effects of PCB exposure on mortality, feeding efficiency, and growth, but no clear effect of PCBs on the rate of zebrafish metamorphosis. We identified a concentration in which there were no observable effects (NOEC), PCB concentration above the NOEC had a significant impact on life-critical processes. This can further inform local management decisions in environments experiencing PCB contamination. Full article

Humans can be infected with anthroponotic (Ancylostoma duodenale and Necator americanus) and with zoonotic (Ancylostoma ceylanicum, A. caninum, A. braziliense, and Uncinaria stenocephala) hookworms from dogs. Anthroponotic species are usually thought not to infect dogs. We used the internal transcribed spacer–1 (ITS1) gene in a quantitative PCR to detect anthroponotic and zoonotic hookworm species in fecal samples from 54 children and 79 dogs living in an indigenous community in tropical Northwestern Ecuador. Hookworm DNA was detected in 59.3% of children and 92.4% of dogs. Among samples from children, zoonotic hookworms were detected in 24.1% (A. ceylanicum 14.8%, A. caninum 11.1%, and A. braziliense 1.9%), whilst in dog samples, anthroponotic species were detected in 19.0% (N. americanus 12.4% and A. duodenale 6.3%). Sanger sequencing was performed successfully on 60 qPCR-positive samples (16 from children and 44 from dogs), and consensus sequences were obtained with >98% homology to GenBank references for hookworm spp. Phylogenetic analysis showed a close relationship between anthroponotic and zoonotic Ancylostoma species and no heterogeneity between A. duodenale and A. caninum; in human samples, we found A. ceylanicum but not A. braziliense sequences and we were unable to identify N. americanus in the dog samples. No infections with U. stenocephala were detected. Our data provide evidence for high rates of hookworm infections in indigenous children and dogs in a marginalized rural setting in coastal Ecuador. We also found evidence for potential cross-transmission of hookworm spp. between humans and dogs that represent a potential domestic reservoir for zoonotic and anthroponotic hookworms. Full article

Despite advances in wearable robots across various fields, there is no consensus definition or design framework for the application of this technology in rehabilitation or musculoskeletal (MSK) injury prevention. This paper aims to define wearable robots and explore their applications and challenges for military rehabilitation and force protection for MSK injury prevention. We conducted a modified Delphi method, including a steering group and 14 panelists with 10+ years of expertise in wearable robots. Panelists presented current wearable robots currently in use or in development for rehabilitation or assistance use in the military workforce and healthcare. The steering group and panelists met to obtain a consensus on the wearable robot definition applicable for rehabilitation or primary injury prevention. Panelists unanimously agreed that wearable robots can be grouped into three main applications, as follows: (1) primary and secondary MSK injury prevention, (2) enhancement of military activities and tasks, and (3) rehabilitation and reintegration. Each application was presented within the context of its target population and state-of-the-art technology currently in use or under development. Capturing expert opinions, this study defines wearable robots for military rehabilitation and MSK injury prevention, identifies health outcomes and assessment tools, and outlines design requirements for future advancements. Full article

COVID-19 breakthrough infection (BTI) can occur despite vaccination. Using a multi-centre, prospective, observational Canadian cohort of people with HIV (PWH) receiving ≥2 COVID-19 vaccines, we compared the SARS-CoV-2 spike (S) and receptor-binding domain (RBD)-specific IgG levels 3 and 6 months post second dose, as well as 1 month post third dose, in PWH with and without BTI. BTI was defined as positivity based on self-report measures (data up to last study visit) or IgG data (up to 1 month post dose 3). The self-report measures were based on their symptoms and either a positive PCR or rapid antigen test. The analysis was restricted to persons without previous COVID-19 infection. Persons without BTI remained COVID-19-naïve until ≥3 months following the third dose. Of 289 participants, 92 developed BTI (31.5 infections per 100 person-years). The median days between last vaccination and BTI was 128 (IQR 67, 176), with the most cases occurring between the third and fourth dose (n = 59), corresponding to the Omicron wave. In analyses adjusted for age, sex, race, multimorbidity, hypertension, chronic kidney disease, diabetes and obesity, a lower IgG S/RBD (log10 BAU/mL) at 1 month post dose 3 was significantly associated with BTI, suggesting that a lower IgG level at this time point may predict BTI in this cohort of PWH. Full article

Single-use plastic foams are used extensively as interior packaging to insulate and protect items during shipment but have come under increasing scrutiny due to the volume sent to landfills and their negative impact on the environment. Insulative compression molded cellulose fiber foams could be a viable alternative, but they do not have the mechanical strength of plastic foams. To address this issue, a novel approach was used that combined the insulative properties of cellulose fiber foams, a binder (starch), and three different reinforcing paperboard elements (angular, cylindrical, and grid) to make low-density foam composites with excellent mechanical strength. Compression molded foams and composites had a consistent thickness and a smooth, flat finish. Respirometry tests showed the fiber foams mineralized in the range of 37 to 49% over a 46 d testing period. All of the samples had relatively low density (D_d) and thermal conductivity (TC). The D_d of samples ranged from 33.1 to 64.9 kg/m³, and TC ranged from 0.039 to 0.049 W/mk. The addition of starch to the fiber foam (FF+S) and composites not only increased D_d, drying time (T_d), and TC by an average of 18%, 55%, and 5.5%, respectively, but also dramatically increased the mechanical strength. The FF+S foam and paperboard composites had 240% and 350% higher average flexural strength (σ_fM) and modulus (E_f), respectively, than the FF-S composites. The FF-S grid composite and all the FF+S foam and composite samples had equal or higher σ_fM than EPS foam. Additionally, FF+S foam and paperboard composites had 187% and 354% higher average compression strength (CS) and modulus (E_c), respectively, than the FF-S foam and composites. All the paperboard composites for both FF+S and FF-S samples had comparable or higher CS, but only the FF+S cylinder and grid samples had greater toughness (Ω_c) than EPS foam. Fiber foams and foam composites are compatible with existing paper recycling streams and show promise as a biodegradable, insulative alternative to EPS foam internal packaging. Full article

Protected cultivation systems, such as high tunnels, have gained popularity for their ability to enhance growth conditions and extend the growing season of horticultural crops. The choice of the covering film in these systems can significantly impact crop productivity and quality while influencing pest and pathogen incidence. This study aimed to evaluate the yield, physiological responses, and nutritional quality of green and purple basil grown in high tunnels using different plastic film covers. The study was conducted in Central Pennsylvania using twelve research high tunnels covered with four alternative polyethylene films with varying light diffusion and ultraviolet (UV) radiation transparency levels: TuffLite IV (TIV), KoolLite Plus (KLP), UV-transparent (UVT), and UV-opaque (UVO). Green ‘Genovese Compact Improved’ and purple ‘Amethyst Improved’ basil (Ocimum basilicum L.) cultivars were grown as test crops. The plastic covering film had a significant effect on the growth of both basil cultivars, with a significant interaction between the film and basil genotype. Green basil generally exhibited higher fresh and dry biomass compared to purple basil, and the film effect varied with the basil genotype. Leaf area, stem, leaf, and total plant biomass were influenced by the plastic cover, with UVO and UVT films resulting in higher biomass production. The plastic covering films showed varying effects on the mineral content, total chlorophyll, carotenoids, total phenolic compounds, and antioxidant activity, with UVO and UVT films often resulting in improved nutritional quality compared to traditional films. Furthermore, covering films influenced the downy mildew severity on both cultivars and the UVT film consistently limited the severity of the foliar disease in both genotypes. Overall, this study highlights the importance of selecting appropriate plastic covering films with varying levels of UV transparency in high tunnel production systems. Full article

KRAS and BRAF mutation rates in colorectal cancer (CRC) reported from various mono-ethnic studies vary amongst different ethnic groups. However, these differences in mutation rates may not be statistically significant or may be due to differences in environmental and/or laboratory factors across countries rather than racial genetic differences. Here, we compare the KRAS/BRAF mutation rates and survival outcomes in CRC between ethnic groups at a single institution. We also investigate the contributions of genetic, environmental, and laboratory factors to the variations in KRAS/BRAF mutation rates reported from different countries. Clinicopathological data from 453 ethnically diverse patients with CRC were retrospectively analyzed at Liverpool Hospital, NSW Australia (2014–2016). KRAS/BRAF mutations were detected using real-time PCR (Therascreen kits from Qiagen). Mismatch repair (MMR) status was determined using immunohistochemical staining. Four ethnic groups were analyzed: Caucasian, Middle Eastern, Asian, and South American. Overall survival data were available for 406 patients. There was no significant difference in KRAS mutation rates between Caucasians (41.1%), Middle Easterners (47.9%), Asians (44.8%), and South Americans (25%) (p = 0.34). BRAF mutation rates differed significantly between races (p = 0.025), with Caucasians having the highest rates (13.5%) and Middle Easterners the lowest (0%). A secondary analysis in which Caucasians were divided into three subgroups showed that ethnic grouping correlated significantly with KRAS mutation rate (p = 0.009), with central and eastern Europeans having the highest rates (58.3%). There were no significant differences in overall survival (OS) or disease-free survival (DFS) between the four races. The similarity in KRAS mutation rates across races raises the possibility that the differences in KRAS mutation rates reported from various countries may either not be statistically significant or may be due to environmental and/or laboratory factors rather than underlying racial genetic differences. In contrast, we verified that BRAF mutation rates differ significantly between races, suggesting racial genetic differences may be responsible for the discrepant BRAF mutation rates reported from different countries. Full article

Genetic histone variants have been implicated in cancer development and progression. Mutations affecting the histone 3 (H3) family, H3.1 (encoded by HIST1H3B and HIST1H3C) and H3.3 (encoded by H3F3A), are mainly associated with pediatric brain cancers. While considered poor prognostic brain cancer biomarkers in children, more recent studies have reported H3 alterations in adult brain cancer as well. Here, we established reliable droplet digital PCR based assays to detect three histone mutations (H3.3-K27M, H3.3-G34R, and H3.1-K27M) primarily linked to childhood brain cancer. We demonstrate the utility of our assays for sensitively detecting these mutations in cell-free DNA released from cultured diffuse intrinsic pontine glioma (DIPG) cells and in the cerebral spinal fluid of a pediatric patient with DIPG. We further screened tumor tissue DNA from 89 adult patients with glioma and 1 with diffuse hemispheric glioma from Southwestern Sydney, Australia, an ethnically diverse region, for these three mutations. No histone mutations were detected in adult glioma tissue, while H3.3-G34R presence was confirmed in the diffuse hemispheric glioma patient. Full article

Cigar smoking remains a public health issue in the United States (U.S.), with a heterogeneous prevalence based on sociodemographic characteristics. Nationally representative data suggest changes in cigar smoking over time, with some evidence for sociodemographic differences. Using data from the 2002–2019 National Survey on Drug Use and Health (NSDUH), the prevalence of past-30-day cigar smoking was examined overall and stratified by sociodemographic characteristics; joinpoint regression examined the trends. Logistic regression analyses identified the correlates of cigar smoking using 2020 NSDUH data. From 2002 to 2004, the prevalence of cigar smoking remained stable (5.33–5.73%), but declined from 2004 to 2019 (5.73–4.29%). Cigar smoking declined in some periods between 2002–2019 among the non-Hispanic White, Hispanic, ages 12–17, ages 18–20, ages 21–25, age ≥ 35, and male subgroups, but remained unchanged among the non-Hispanic Other, ages 26–34, and female subgroups. Cigar smoking increased among non-Hispanic Black persons overall from 2002 to 2019 (6.67–8.02%). Past-30-day cigarette smoking and drug or alcohol use disorder was associated with an increased likelihood of cigar use, while female sex was associated with a decreased likelihood of cigar use, across all age groups. Though a decline in the prevalence of past-30-day cigar smoking is seen in the general population, the same is not evident among all sociodemographic subgroups. Our findings have the potential to inform tobacco cessation efforts within clinical practice, as well as regulatory efforts to reduce cigar use. Full article