Geographical Variation in Underlying Social Deprivation, Cardiovascular and Other Comorbidities in Patients with Potentially Curable Cancers in England: Results from a National Registry Dataset Analysis

Aims: To describe the prevalence of cardiovascular disease (CVD), multiple comorbidities and social deprivation in patients with a potentially curable cancer in 20 English Cancer Alliances. Materials and methods: This National Registry Dataset Analysis used national cancer registry data and CVD databases to describe rates of CVD, comorbidities and social deprivation in patients diagnosed with a potentially curable malignancy (stage I–III breast cancer, stage I–III colon cancer, stage I–III rectal cancer, stage I–III prostate cancer, stage I–IIIA non-small cell lung cancer, stage I–IV diffuse large B-cell lymphoma, stage I–IV Hodgkin lymphoma) between 2013 and 2018. Outcome measures included observation of CVD prevalence, other comorbidities (evaluated by the Charlson Comorbidity Index) and deprivation (using the Index of Multiple Deprivation) according to tumour site and allocation to Cancer Alliance. Patients were allocated to CVD prevalence tertiles (minimum: 66.6th percentile). Results: In total, 634 240 patients with a potentially curable malignancy were eligible. The total CVD prevalence for all cancer sites varied between 13.4% (CVD n = 2058; 95% confidence interval 12.8, 13.9) and 19.6% (CVD n = 7818; 95% confidence interval 19.2, 20.0) between Cancer Alliances. CVD prevalence showed regional variation both for male (16–26%) and female patients (8–16%) towards higher CVD prevalence in northern Cancer Alliances. Similar variation was observed for social deprivation, with the proportion of cancer patients being identified as most deprived varying between 3.3% and 32.2%, depending on Cancer Alliance. The variation between Cancer Alliance for total comorbidities was much smaller. Conclusion: Social deprivation, CVD and other comorbidities in patients with a potentially curable malignancy in England show significant regional variations, which may partly contribute to differences observed in treatments and outcomes

The importance of sex as a risk factor for hospital readmissions due to pulmonary diseases

BACKGROUND: Pulmonary diseases are a common and costly cause of 30-day readmissions. Few studies have focused on the difference in risk for rehospitalization between men and women in older patients. In this study we analyzed the association between sex and the risk of readmission in a cohort of patients admitted to the hospital for chronic obstructive pulmonary disease (COPD) exacerbation and other major pulmonary diseases. METHODS: This was a retrospective cohort study based on administrative data collected in the Veneto Region in 2016. We included 14,869 hospital admissions among residents aged 6565\u2009years for diagnosis related groups (DRGs) of the most common disorders of the respiratory system: bronchitis and asthma, pneumonia, pulmonary edema, respiratory failure, and COPD. Multilevel logistic regressions were performed to test the association between 30-day hospital readmission and sex, adjusting for confounding factors. RESULTS: For bronchitis and asthma, male patients had significantly higher odds of 30-day readmission than female patients (adjusted odds ratio (aOR), 2.07; 95% confidence interval (CI), 1.11-3.87). The odds of readmission for men were also significantly higher for pneumonia (aOR, 1.40; 95% CI, 1.13-1.72), for pulmonary edema and respiratory failure (aOR, 1.28; 95% CI, 1.05-1.55), and for COPD (aOR, 1.34; 95% CI, 1.00-1.81). CONCLUSIONS: This study found that male sex is a major risk factors for readmission in patients aged more than 65\u2009years with a primary pulmonary diagnosis. More studies are needed to understand the underlying determinants of this phenomena and to provide targets for future interventions

Assessing habitat-related disturbance in bird communities: Applying hemeroby and generalism as indicators

We tested the application of the concept of hemeroby and generalism at community level, on a set of birds occurring in various habitats of central Italy characterized by different level of disturbance. In each habitat-related bird community, we applied the recently published species-specific score in hemeroby (a proxy of habitat-related disturbance; HSi) and hemerobiotic diversity (a proxy of generalism; H’Hi) to local species frequency, obtaining weighted values at community level (HStot and H’Htot). The relationship between HStot vs. H’Htot showed an increasing trend moving from reed beds through forests and mosaics to urban communities. Quadratic model (best fit) evidenced a significant correlation between these variables and a tendency toward a hump-shaped curve, corroborating results already observed at species level (intermediate generalism hypothesis). The co-inertia analysis discriminated four groups of habitat-related communities, characterized by species with different levels of disturbance-sensitivity (expressed by HSi) and generalism (expressed by hemerobiotic diversity; H’Hi): (i) forest type-related, where mature wood communities were separated from a coppiced wood one; (ii) communities of moderately disturbed agricultural habitats; (iii) communities embedded in highly disturbed mosaics, and (iv) a group including either a highly disturbed urban habitat or a low disturbed wetland reed bed, with highly specialized species (respectively, synanthropic species and water-related species). Total scores in hemeroby and hemerobiotic diversity, expressing the composition in species with different disturbance preference and generalism, might act as good community-based indicators of degree of naturalness, especially for forest habitat types

Oncology-led early identification of nutritional risk: a pragmatic, evidence-based protocol (PRONTO)

Simple Summary Early identification of patients on antineoplastic therapy who are at risk for or already malnourished is critical for optimizing treatment success. Malnourished patients are at increased risk for being unable to tolerate the most effective 'level' and 'duration' of treatment, with grave implications for both the short- (during treatment) and long-term outcomes. Herein, we provide a practical PROtocol for NuTritional risk in Oncology (PRONTO) to enable oncologists to identify patients with or at risk of malnutrition for further evaluation and follow-up with members of the multidisciplinary care team (MDT). Additional guidance is included on the oncologist-led provision of nutritional support if referral to a dietary service is not available. Nutritional issues, including malnutrition, low muscle mass, sarcopenia (i.e., low muscle mass and strength), and cachexia (i.e., weight loss characterized by a continuous decline in skeletal muscle mass, with or without fat loss), are commonly experienced by patients with cancer at all stages of disease. Cancer cachexia may be associated with poor nutritional status and can compromise a patient's ability to tolerate antineoplastic therapy, increase the likelihood of post-surgical complications, and impact long-term outcomes including survival, quality of life, and function. One of the primary nutritional problems these patients experience is malnutrition, of which muscle depletion represents a clinically relevant feature. There have been recent calls for nutritional screening, assessment, treatment, and monitoring as a consistent component of care for all patients diagnosed with cancer. To achieve this, there is a need for a standardized approach to enable oncologists to identify patients commencing and undergoing antineoplastic therapy who are or who may be at risk of malnutrition and/or muscle depletion. This approach should not replace existing tools used in the dietitian's role, but rather give the oncologist a simple nutritional protocol for optimization of the patient care pathway where this is needed. Given the considerable time constraints in day-to-day oncology practice, any such approach must be simple and quick to implement so that oncologists can flag individual patients for further evaluation and follow-up with appropriate members of the multidisciplinary care team. To enable the rapid and routine identification of patients with or at risk of malnutrition and/or muscle depletion, an expert panel of nutrition specialists and practicing oncologists developed the PROtocol for NuTritional risk in Oncology (PRONTO). The protocol enables the rapid identification of patients with or at risk of malnutrition and/or muscle depletion and provides guidance on next steps. The protocol is adaptable to multiple settings and countries, which makes implementation feasible by oncologists and may optimize patient outcomes. We advise the use of this protocol in countries/clinical scenarios where a specialized approach to nutrition assessment and care is not available

De um projeto de estágio curricular supervisionado à co-docência e co-formação no Colégio de Aplicação da UFSC

From a supervised internship project to co-teaching and co-training at an elementary school (Colégio de Aplicação, UFSC)ResumoNeste artigo, apresentamos um estudo sobre o estágio curricular com foco na co-docência e co-formação, que fundamentam a concepção do projeto de estágio realizado com os 4ºs e 5ºs anos no Colégio de Aplicação da UFSC. Há dupla finalidade: debater princípios basilares para a formação docente e sistematizar conhecimentos produzidos no período de 2016 a 2018, com vistas a fortalecer ainda mais os vínculos interinstitucionais entre UFSC e Udesc. Abordagem qualitativa orientada pelos critérios da pesquisa exploratória e documental, as ações do estágio se traduzem como o campo empírico de ação e investigação. Os resultados apontam que quanto maior conjugação colaborativa, articulada a um plano mais amplo de mudança social, entre o campo de estágio e a instituição formadora maior será a efetividade na formação docente por estar comprometida com uma Didática crítica, sensível e emancipadora.Palavras-chave: Estágio Curricular Supervisionado; Co-docência; Formação de Professores.AbstractIn this paper, we describe a study on a supervised curricular internship focusing on co-teaching and co-training, which guides the conception of the internship project carried out with the fourth- and fifth-year pupils at Colégio de Aplicação, UFSC. The goals are: to reflect on the basic principles of teacher training and to systematize the knowledge gained from 2016 to 2018. A qualitative approach guided by the criteria of exploratory and documentary research, the internship activities translate into the empirical field of action and investigation. The results indicate that the greater the collaborative association, combined with a broader plan of social exchange between the internship field of action and the larger educational institution, the more effective the teacher training will be, since it is committed to a critical, sensitive and emancipating didactic strategy and theory.Keywords: Supervised Internship; Co-teaching; Teacher training.

The MOSDEF Survey: the Variation of the Dust Attenuation Curve with Metallicity

We derive the UV-optical stellar dust attenuation curve of galaxies at z=1.4-2.6 as a function of gas-phase metallicity. We use a sample of 218 star-forming galaxies, excluding those with very young or heavily obscured star formation, from the MOSFIRE Deep Evolution Field (MOSDEF) survey with H$\alpha$, H$\beta$, and [NII]$\lambda 6585$ spectroscopic measurements. We constrain the shape of the attenuation curve by comparing the average flux densities of galaxies sorted into bins of dust obscuration using Balmer decrements, i.e., H$\alpha$-to-H$\beta$ luminosities. The average attenuation curve for the high-metallicity sample (12+log(O/H)>8.5, corresponding to $M_*\gtrsim10^{10.4}\,M_{\odot}$) has a shallow slope, identical to that of the Calzetti local starburst curve, and a significant UV 2175A extinction bump that is $\sim 0.5\times$ the strength of the Milky Way bump. On the other hand, the average attenuation curve of the low-metallicity sample (12+log(O/H) $\sim 8.2-8.5$) has a steeper slope similar to that of the SMC curve, only consistent with the Calzetti slope at the $3\sigma$ level. The UV bump is not detected in the low-metallicity curve, indicating the relative lack of the small dust grains causing the bump at low metallicities. Furthermore, we find that on average the nebular reddening (E(B-V)) is a factor of 2 times larger than that of the stellar continuum for galaxies with low metallicities, while the nebular and stellar reddening are similar for galaxies with higher metallicities. The latter is likely due to a high surface density of dusty clouds embedding the star forming regions but also reddening the continuum in the high-metallicity galaxies.Comment: 20 pages and 9 figures and 1 appendix, accepted for publication in Ap

A Deep View into the Nucleus of the Sagittarius Dwarf Spheroidal Galaxy with MUSE. III. Discrete Multicomponent Population-dynamical Models Based on the Jeans Equations

We present comprehensive multicomponent dynamical models of M54 (NGC 6715), the nuclear star cluster of the Sagittarius (Sgr) dwarf galaxy, which is undergoing a tidal disruption in the Milky Way halo. Previous papers in this series used a large MUSE mosaic data set to identify multiple stellar populations in the system and study their kinematic differences. Here, we use Jeans-based dynamical models that fit the population properties (mean age and metallicity), spatial distributions, and kinematics simultaneously. They provide a solid physical explanation for our previous findings. Population-dynamical models deliver a comprehensive view of the whole system, and allow us to disentangle the different stellar populations. We explore their dynamical interplay and confirm our previous findings about the build-up of Sgr’s nuclear cluster via contributions from globular cluster stars, Sgr inner field stars, and in situ star formation. We explore various parameterizations of the gravitational potential and show the importance of a radially varying mass-to-light ratio for the proper treatment of the mass profile. We find a total dynamical mass within M54's tidal radius (∼75 pc) of 1.60 ± 0.07 × 106 M ⊙ in excellent agreement with N-body simulations. Metal-poor globular cluster stars contribute about 65% of the total mass or 1.04 ± 0.05 × 106 M ⊙. Metal-rich stars can be further divided into young and intermediate-age populations, which contribute 0.32 ± 0.02 × 106 M ⊙ (20%) and 0.24 ± 0.02 × 106 M ⊙ (15%), respectively. Our population-dynamical models successfully distinguish the different stellar populations in Sgr’s nucleus because of their different spatial distributions, ages, metallicities, and kinematic features