Reimagining the River: An Outdoor Vision of the Anthropocene and the White River through the Lens of Place

poster abstractIn 2016, the International Union of Geological Sciences will decide whether or not human impact on the Earth constitutes a new geologic epoch – the Anthropocene. If agreed upon, this epoch will acknowledge the effects human agency has upon the stratigraphic record, and the implications of a human-driven world. Reimagining the River takes the global Anthropocene to the City of Indianapolis by creating an outdoor museum of the White River. This museum exhibit will display the past, present, and future of the White River, showcasing the historical narrative of the human-river relationship. Exploring the Anthropocene through the story of the White River will engage the citizens of Indianapolis to develop a sense of ownership for the intertwined state of the River and Indianapolis. The intention of this engagement is to build a community that reimagines what the river was, is, and can become. Reimagining the River will be located on the White River State Park Bridge, and will feature audiovisual elements that relate current scenes surrounding the River to the past. Historical photographs complemented with a brief historical narrative will be juxtaposed with the areas surrounding the installation, framing Indianapolis’ urban environment as the exhibit. The installation will be accessible to all demographics, including children and individuals with disability. The exhibit will also include resources to encourage further audience participation, including podcasts, geocaching, and a website. Ongoing research pathways will be created to encourage the tracking and measurement of audience engagement and understanding of how human agency has affected the White River, its tributaries, and the City of Indianapolis

Holistic health and social care outreach for people experiencing homelessness with recent non-fatal overdose in Glasgow, Scotland: the Pharmacist and third sector Homeless charity worker Outreach Engagement Non-medical Independent prescriber Rx (PHOENIx) pilot randomised controlled trial

Objectives: To examine randomised controlled trial (RCT) progression criteria including emergency department (ED) attendance and non-fatal overdose, from a holistic, integrated health and social care outreach intervention (PHOENIx), for people experiencing homelessness with recent non-fatal street drug overdose. Design: Pilot RCT. 1:1 randomisation to PHOENIx plus usual care (UC) or UC. Setting: Glasgow, Scotland. Participants: 128 adults experiencing homelessness with at least one non-fatal street drug overdose in the preceding 6 months. Interventions: Pharmacists from the National Health Service and third sector homelessness workers offered weekly outreach. PHOENIx teams develop therapeutic relationships to address health (physical health, mental health and problem drug use) and social care (housing, welfare benefits and social prescribing) in addition to UC. UC comprised building-based primary and secondary health, social and third sector services. Outcomes: Primary: progression criteria: recruitment (≥100 participants in 4 months); ≥80% of participants with data collected at baseline, 6 and 9 months; ≥60% of participants retained in the trial at each follow-up period (6 and 9 months); ≥60% of participants receiving the intervention weekly; any reduction in the rate of presentation to ED and overdoses, at 6- or 9-month follow-up. Secondary: participants with, and time to: hospitalisations; health-related quality of life (QoL); treatment uptake for physical and mental health conditions, and problematic drug use. Results: Progression criteria were exceeded. In PHOENIx compared with UC, there appeared to be a delay in the median time to ED visit, overdose and hospitalisation but no improvement in number of participants with ED visits, overdoses or hospitalisations. QoL and treatment uptake appeared to be higher in PHOENIx versus UC at 6 and 9 months. Conclusions: A definitive RCT is merited, to assess the impact of PHOENIx on people with multiple, severe disadvantages

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Genetic and epigenetic variation in vulvar cancer: Current research and future clinical practice

Vulvar cancer is a relatively rare gynaecological malignancy, the treatment of which is associated with significant patient morbidity. With reports that the incidence of vulvar cancer is increasing, there is a rising need for improved preventive, diagnostic and therapeutic tools. Recent advances within genetics and epigenetics present possible approaches for addressing this need, by contributing to the clari fication of the aetiology of this disease, identifying screening and drug targets and introducing the potential for personalised treatments. This paper reviews the genetic and epigenetic research undertaken to date within vulvar cancer, evaluates its potential for clinical application and identifies directions for future research

Improving transition from pediatric to adult cystic fibrosis care: lessons from a national survey of current practices

OBJECTIVES: More than 500,000 adolescents with special health care needs age into adulthood each year in the United States, and there is growing recognition of the need for support of their transition to adult-oriented health care. Because of improved survival, cystic fibrosis has experienced this increasing transition need, and cystic fibrosis policy leaders responded by mandating the transition of adults with cystic fibrosis to adult-focused cystic fibrosis care programs by 2000. The primary objective of this study was to characterize in detail recent transition practices at US cystic fibrosis programs, to identify areas for improvement and to serve as a model for other diseases. A secondary objective of this study was to develop and validate a survey for formal assessment of transition practices. METHODS: A 105-question survey on key aspects of transition was administered to cystic fibrosis care team members from all 195 US Cystic Fibrosis Care programs. Rates of adherence to recommended components of transition care were measured. RESULTS: A total of 448 surveys were obtained from 170 (87%) of 195 cystic fibrosis programs. Although transfer of care occurs at a median age of 19 years, initial discussion of transition does not occur until a median age of 17 years, limiting time to foster self-care skills. Only half of programs consistently perform a transition readiness assessment, 28% of centers offer visits focused on transition, and CONCLUSIONS: There is significant variability in transition support provided to young adults with cystic fibrosis, but there are simple steps that may lead to more consistent delivery of transition services. Methods of assessment and lessons learned from transitioning young adults at US cystic fibrosis programs may serve to improve transition for individuals with other childhood diseases

Validating laboratory results in a national observational cohort study without field centers: The Reasons for Geographic and Racial Differences in Stroke cohort

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Recurrence patterns identify aggressive form of human papillomavirus-dependent vulvar cancer

Background: Vulvar cancer is rare and, as a result, is understudied. Treatment ispredominantly surgery, irrespective of the type of vulvar cancer, and is associatedwith physical, emotional and sexual complications. A cluster of humanpapillomavirus (HPV)-dependent vulvar cancer patients was identified in ArnhemLand Northern Territory (NT), Australia, in which young Indigenous women werediagnosed at 70 times the national incidence rate.Aims: To assess whether women from the Arnhem Land cluster differ from womenwith vulvar squamous cell carcinoma (VSCC) and vulvar intraepithelial neoplasia(VIN) resident elsewhere in the NT in recurrence after treatment, diseaseprogression and mortality.Materials and methods: A retrospective cohort study of NT-resident womendiagnosed with VIN or invasive vulvar cancer (VSCC) between 1 January 1993 and30 June 2015 was undertaken. Time to recurrence was assessed using cumulativeincidence plots and Fine and Gray competing risk regression models. Meancumulative count was used to estimate the burden of recurrent events.Results: Indigenous women from Arnhem Land experienced more recurrencesafter treatment than non-Indigenous women, the cancers recurred faster, andIndigenous women have worse survival at five years.Conclusions: In characterising the epidemiological features of this cluster, wehave identified a particularly aggressive form of vulvar cancer. This provides aunique opportunity for elucidating the aetiopathological pathways driving vulvarcancer development that may ultimately lead to preventive and therapeutic targetsfor this neglected malignancy. Further, these findings have important implicationsfor clinical practice and HPV vaccination policy in the affected population