Understanding Patients Experiences with a Brief Alcohol Reduction Intervention among People Living with HIV in Uganda: A Qualitative Study.

Background: Brief alcohol reduction interventions for people living with HIV (PLWH) have resulted in mixed findings with some studies showing null or limited treatment effects. To better understand factors that may contribute to their success or failure, this qualitative study sought to explore participants experiences in a randomized trial (RCT) of a brief counseling-based alcohol reduction intervention, including challenges that may have impeded alcohol reduction. Methods: We conducted in-depth semi-structured interviews with 24 PLWH engaging in unhealthy alcohol use, who were enrolled in an RCT to reduce alcohol consumption conducted in southwestern Uganda in 2019-2020 (NCT03928418). We used a collaborative thematic approach to analyze data from transcribed and translated audio recordings. Results: Perceived benefits of the intervention included increased awareness of alcohol use and its impact on personal finances, the relationship between alcohol use and violence, and a commitment to drinking reduction. Participants experienced several barriers to decreasing their alcohol use, including: prevailing social norms about alcohol use, lack of social support, and economic and social consequences of the COVID-19 pandemic. Conclusion: Factors in the immediate contexts of PLWH in low-income settings, including social norms influencing alcohol consumption and lack of social support, may impede the impact of alcohol reduction interventions, especially during times of stress such as the COVID-19 pandemic

Imaging for Assessment of Radiation-Induced Normal Tissue Effects

Imaging can provide quantitative assessment of radiation-induced normal tissue effects. Identifying an early sign of normal tissue damage with imaging would have the potential to predict organ dysfunction, thereby allowing re-optimization of treatment strategies based upon individual patients’ risks and benefits. Early detection with non-invasive imaging may enable interventions to mitigate therapy-associated injury prior to its clinical manifestation. Further, successive imaging may provide an objective assessment of the impact of such mitigation therapies. However, many problems make application of imaging to normal tissue assessment challenging, and further work is required to establish imaging biomarkers as surrogate endpoints of clinical outcome. The performance of clinical trials where normal tissue injury is a clearly defined endpoint would greatly aid in realization of these goals

Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline

AbstractPurposeTo provide guidance to physicians and patients with regard to the use of external beam radiotherapy, endobronchial brachytherapy, and concurrent chemotherapy in the setting of palliative thoracic treatment for lung cancer, based on available evidence complemented by expert opinion.Methods and MaterialsA Task Force authorized by the American Society for Radiation Oncology (ASTRO) Board of Directors synthesized and assessed evidence from 3 systematic reviews on the following topics: (1) dose fractionation in thoracic external beam radiotherapy (EBRT); (2) clinical utility of initial and salvage endobronchial brachytherapy (EBB); and (3) use of concurrent chemotherapy (CC) with palliative thoracic radiotherapy. Practice guideline recommendations were produced and are contained herein.ResultsStudies suggest that higher dose/fractionation palliative EBRT regimens (eg, 30 Gy/10 fraction equivalent or greater) are associated with modest improvements in survival and total symptom score, particularly in patients with good performance status. As these improvements are associated with an increase in esophageal toxicity, various shorter EBRT dose/fractionation schedules (eg, 20 Gy in 5 fractions, 17 Gy in 2 weekly fractions, 10 Gy in 1 fraction), which provide good symptomatic relief with fewer side effects, can be used for patients requesting a shorter treatment course and/or in those with a poor performance status. No defined role for EBB in the routine initial palliative treatment of chest disease has been demonstrated; however, EBB can be a reasonable option for the palliation of endobronchial lesions causing obstructive symptomatology including lung collapse, or for hemoptysis after EBRT failure. The integration of concurrent chemotherapy with palliative intent/fractionated radiotherapy is not currently supported by the medical literature.ConclusionThis Guideline is intended to serve as a guide for the use of EBRT, EBB, and CC in thoracic palliation of lung cancer outside the clinical trial setting. Further prospective clinical investigations with relevant palliative endpoints into the respective roles of EBB and CC/targeted therapy in the thoracic palliation of lung cancer are warranted, given the current state of the medical literature in these areas

Radiation Dose–Volume Effects in the Brain

We have reviewed the published data regarding radiotherapy (RT)-induced brain injury. Radiation necrosis appears a median of 1–2 years after RT; however, cognitive decline develops over many years. The incidence and severity is dose and volume dependent and can also be increased by chemotherapy, age, diabetes, and spatial factors. For fractionated RT with a fraction size of 80 Gy. For large fraction sizes (≥2.5 Gy), the incidence and severity of toxicity is unpredictable. For single fraction radiosurgery, a clear correlation has been demonstrated between the target size and the risk of adverse events. Substantial variation among different centers’ reported outcomes have prevented us from making toxicity–risk predictions. Cognitive dysfunction in children is largely seen for whole brain doses of ≥18 Gy. No substantial evidence has shown that RT induces irreversible cognitive decline in adults within 4 years of RT

The challenge of measuring intra-individual change in fatigue during cancer treatment

Evaluate how well three different patient-reported outcomes (PROs) measure individual change

Gene content evolution in the arthropods

Arthropods comprise the largest and most diverse phylum on Earth and play vital roles in nearly every ecosystem. Their diversity stems in part from variations on a conserved body plan, resulting from and recorded in adaptive changes in the genome. Dissection of the genomic record of sequence change enables broad questions regarding genome evolution to be addressed, even across hyper-diverse taxa within arthropods. Using 76 whole genome sequences representing 21 orders spanning more than 500 million years of arthropod evolution, we document changes in gene and protein domain content and provide temporal and phylogenetic context for interpreting these innovations. We identify many novel gene families that arose early in the evolution of arthropods and during the diversification of insects into modern orders. We reveal unexpected variation in patterns of DNA methylation across arthropods and examples of gene family and protein domain evolution coincident with the appearance of notable phenotypic and physiological adaptations such as flight, metamorphosis, sociality, and chemoperception. These analyses demonstrate how large-scale comparative genomics can provide broad new insights into the genotype to phenotype map and generate testable hypotheses about the evolution of animal diversity

Rangelands at equilibrium and non-equilibrium recent developments in the debate around rangeland ecology and management

The debate on equilibrium vs non-equilibrium dynamics in pastoral systems emerged in the early 1980s, when economists, ecologists and social scientists began to challenge the widespread claims of overgrazing and degradation in African rangelands and subsequent interventions based on rangeland succession theory and correct stocking rates (for example, Sandford 1982; 1983; Homewood & Rodgers 1987; Ellis & Swift 1988; Abel & Blaikie 1989; Westoby et al. 1989). The debate gained momentum in the early 1990s after two international workshops around emergent new paradigms in rangeland ecology and socio-economics (Woburn I and II), which resulted in the publication of two books, Range Ecology at Disequilibrium edited by Behnke et al. (1993) and Living with Uncertainty edited by Scoones (1994). The ‘new rangeland ecology’ argued that the traditional, equilibrium-based rangeland models did not take into account the considerable spatial heterogeneity and climatic variability of semi-arid rangelands, and that mobility, variable stocking rates and adaptive management were essential for the effective and sustainable utilisation of semi-arid and arid rangelands

Public History and the study of Law: reviewing The Limehouse Golem (2017). Directed by Juan Carlos Medina [film]. 109 min. UK. Production: Lipsync Post, Number 9 Films.

This is an interdisciplinary discussion, looking at the use of popular history for the critical understanding of the reconstruction of crime and patriarchal hierarchy. By way of reviewing the recent movie The Limehouse Golem, it illustrates the significance of theoretically engaging with a period crime fiction movie. It is argued that this assessment is less relevant in terms of producing historical understanding; rather, what may be a fiction, reveals instead our own contemporary cultural fixations