Adopting a systems-thinking approach to optimise dietary and exercise referral practices for cancer survivors

Purpose: Service referrals are required for cancer survivors to access specialist dietary and exercise support. Many system-level factors influence referral practices within the healthcare system. Hence, the aim of this study was to identify system-level factors and their interconnectedness, as well as strategies for optimising dietary and exercise referral practices in Australia. Methods: A full-day workshop involving national multidisciplinary key stakeholders explored system-level factors impacting dietary and exercise referral practices. Facilitated group discussions using the nominal group technique identified barriers and facilitators to referral practices based on the six World Health Organisation (WHO) building blocks. The systems-thinking approach generated six cognitive maps, each representing a building block. A causal loop diagram was developed to visualise factors that influence referral practices. Additionally, each group identified their top five strategies by leveraging facilitators and addressing barriers relevant to their WHO building block. Results: Twenty-seven stakeholders participated in the workshop, including consumers (n = 2), cancer specialists (n = 4), nursing (n = 6) and allied health professionals (n = 10), and researchers, representatives of peak bodies, not-for-profit organisations, and government agencies (n = 5). Common system-level factors impacting on referral practices included funding, accessibility, knowledge and education, workforce capacity, and infrastructure. Fifteen system-level strategies were identified to improve referral practices. Conclusion: This study identified system-level factors and strategies that can be applied to policy planning and practice in Australia

Absorption Coefficient (ABSCO) Tables for the Orbiting Carbon Observatories: Version 5.1

The accuracy of atmospheric trace gas retrievals depends directly on the accuracy of the molecular absorption model used within the retrieval algorithm. For remote sensing of well-mixed gases, such as carbon dioxide (CO₂), where the atmospheric variability is small compared to the background, the quality of the molecular absorption model is key. Recent updates to oxygen (O₂) absorption coefficients (ABSCO) for the 0.76 μm A-band and the water vapor (H₂O) continuum model within the 1.6 μm and 2.06 μm CO₂ bands used within the Orbiting Carbon Observatory (OCO-2 and OCO-3) algorithm are described here. Updates in the O₂ A-band involve the inclusion of new laboratory measurements within multispectrum fits to improve relative consistency between O₂ line shapes and collision-induced absorption (CIA). The H₂O continuum model has been updated to MTCKD v3.2, which has benefited from information from a range of laboratory studies relative to the model utilized in the previous ABSCO version. Impacts of these spectroscopy updates have been evaluated against ground-based atmospheric spectra from the Total Carbon Column Observing Network (TCCON) and within the framework of the OCO-2 algorithm, using OCO-2 soundings covering a range of atmospheric and surface conditions. The updated absorption coefficients (ABSCO version 5.1) are found to offer improved fitting residuals and reduced biases in retrieved surface pressure relative to the previous version (ABSCO v5.0) used within B8 and B9 of the OCO-2 retrieval algorithm and have been adopted for the OCO B10 Level 2 algorithm

Absorption Coefficient (ABSCO) Tables for the Orbiting Carbon Observatories: Version 5.1

The accuracy of atmospheric trace gas retrievals depends directly on the accuracy of the molecular absorption model used within the retrieval algorithm. For remote sensing of well-mixed gases, such as carbon dioxide (CO₂), where the atmospheric variability is small compared to the background, the quality of the molecular absorption model is key. Recent updates to oxygen (O₂) absorption coefficients (ABSCO) for the 0.76 μm A-band and the water vapor (H₂O) continuum model within the 1.6 μm and 2.06 μm CO₂ bands used within the Orbiting Carbon Observatory (OCO-2 and OCO-3) algorithm are described here. Updates in the O₂ A-band involve the inclusion of new laboratory measurements within multispectrum fits to improve relative consistency between O₂ line shapes and collision-induced absorption (CIA). The H₂O continuum model has been updated to MTCKD v3.2, which has benefited from information from a range of laboratory studies relative to the model utilized in the previous ABSCO version. Impacts of these spectroscopy updates have been evaluated against ground-based atmospheric spectra from the Total Carbon Column Observing Network (TCCON) and within the framework of the OCO-2 algorithm, using OCO-2 soundings covering a range of atmospheric and surface conditions. The updated absorption coefficients (ABSCO version 5.1) are found to offer improved fitting residuals and reduced biases in retrieved surface pressure relative to the previous version (ABSCO v5.0) used within B8 and B9 of the OCO-2 retrieval algorithm and have been adopted for the OCO B10 Level 2 algorithm

The Golden Age of European Cabaret

Program for the second annual RISD Cabaret held in the Cellar in the Pit. Design and layout by Anne Johnson, Susan Sellers and Georgie Stout.https://digitalcommons.risd.edu/liberalarts_cabaret_programs/1001/thumbnail.jp

From St. Petersburg to Krushchev\u27s Boot

Program for the first annual RISD Cabaret held in Memorial Hall. Design and layout by Justin Kerr.https://digitalcommons.risd.edu/liberalarts_cabaret_programs/1000/thumbnail.jp

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society