Long-Term Outcomes Following Hepatic Resection and Radiofrequency Ablation of Colorectal Liver Metastases

Recently some have called for randomized controlled trials comparing RFA to hepatic resection, particularly for patients with only a few small metastases. The objectives were to compare local recurrence and survival following RFA and hepatic resection for colorectal liver metastases. This was a retrospective review of open RFA and hepatic resection for colorectal liver metastases between January 1998 and May 2007. All patients who had RFA were considered to have unresectable disease. 58 patients had hepatic resection and 43 had RFA. A 5-year survival after resection was 43% compared to 23% after RFA. For patients with solitary lesions, a 5-year survival was 48% after resection and 15% after RFA. Sixty percent of patients suffered local recurrences after RFA compared to 7% after hepatic resection. RFA is inferior to resection. The results observed in this study support the consensus that RFA cannot be considered an equivalent procedure to hepatic resection

Video-Based Electronic Surveillance for Hand Hygiene Auditing: An Exploratory and Evaluative Study

Hand hygiene (HH) is recognised as the most important thing a healthcare worker (HCW) can do to prevent healthcare associated infection. Practice is audited according to the WHO 5 Moments for HH and while direct human observation is considered the gold standard method, questions regarding utility have arisen. Various electronic systems have been suggested, however most use proxy measures. Video-based systems (VMS) offer possibilities in that compliance can be ascertained according to the WHO 5 Moments framework. However, this has yet to be explored via systematic, sustained research. This thesis explored the utility of VMS as a method of HH auditing via pragmatic, mixed-methods research across 3 interconnected studies. Study 1 explored the technical and methodological specifications that might be required of a VMS. Study 2 examined the feasibility and time efficiency of VMS approaches via a trial. Study 3 unearthed the acceptability of VMS methods for HH auditing to HCWs and patients. This study reveals the utility of VMS for auditing according to the WHO 5 Moments. It offers technical and methodological specifications for effective and efficient data collection and demonstrates VMS auditing is more time efficient. The literature suggested acceptability for HCWs and patients could be a potential barrier to the use within the patient zone, however, this thesis has demonstrated that this was not the case provided certain technical and methodological features and protections are in place. HCWs could see the advantages of the approach in relation to time efficiency, but expressed fears in terms of negative feedback or punitive consequences. A variety of legislative issues relating to privacy, consent, legal status of footage, retention and deletion and open disclosure would need to be taken into consideration. Future research should undertake in vivo experimentation of the technology and methodology

Disparities in Debt: Why Debt is a Driver in the Racial Wealth Gap

Racial wealth inequality has been pervasive in the United States from the earliest days of colonization 400 years ago. Despite Constitutional guarantees of equality and numerous anti-discrimination laws, racial wealth gaps not only remain but some are growing. Scholars, policymakers, and others have deeply investigated the historical roots and current drivers of racial wealth inequality in the United States. Most analyses focus on total asset holdings, intergenerational transfers, or disparities in specific assets (such as home equity). Media coverage and social narratives about racial wealth gaps similarly tend to concentrate on assets.Less attention has been paid to the other side of the household balance sheet: debt. Although there has been analysis of racial disparities in mortgages, and recent research has illuminated the role of student loans in widening the wealth gap between Black and white households, debt remains under-appreciated as a driver of racial wealth gaps.This brief explores the links between racial disparities in debt and those in wealth. It is informed by traditional research and by Aspen FSP's years of engagement with consumers and families about their financial challenges. It reflects findings from a literature review, interviews with experts from the academic and private sectors, analysis of federal survey data, and focus groups and consumer surveys. We believe that fully understanding the impact of debt on people's lives requires a multidisciplinary approach that includes systematically seeking input from and listening to people who struggle financially.  The growth in racial wealth inequality makes it imperative that policymakers, business leaders, and nonprofit and philanthropic institutions invest in strategies that increase wealth accumulation among those with the least and reduce racial disparities across every dimension of personal net worth. This brief provides a resource for leaders across sectors to understand more deeply the interactions between racial disparities in debt and racial gaps in wealth and the ways in which redressing the racial wealth gap requires addressing racial debt disparities

With Federal Moratorium Expiring, 15 Million People at Risk of Eviction

Nationwide, renters are recovering from an unprecedented economic crisis. With vaccines widely accessible, employment rising, and federal and state benefits available to millions of people, many of the over 100 million people living in rental housing are making a gradual recovery. Despite this progress, a meaningful percentage of renters are on the precipice of eviction, displacement, and homelessness. More than 15 million people live in households that are currently behind on their rental payments (7.4 million adults, 6.5 million households), which places them at legal risk of eviction. According to one estimate, these households collectively owe more than $20 billion to their landlords. On a per tenant basis, average debt owed to landlords exceeds$3,000, with significant variation based on time away from work, family needs, and other factors.When the Centers for Disease Control and Prevention (CDC) eviction moratorium ends on July 31st, these renters may face eviction, civil lawsuits for unpaid rent, and aggressive debt collection—crises that will continue to cause harm years into the future. Nearly 50% of those who are behind on rent anticipate that they will be evicted in the next two months. The threat of eviction is particularly acute for renters of color. Currently, 22% of Black renters and 17% of Latinx renters are in debt to their landlords, compared to 15% overall and 11% of White renters. Rental debt is also challenging for renters with children, with 19% unable to make payments.This report highlights the current number of people at risk of eviction as the federal moratorium expires, how we got here, and policies states can implement to help prevent a wave of evictions from cascading into long-term health and financial crises for millions of households

Resolving ecological feedbacks on the ocean carbon sink in Earth system models

The Earth's oceans are one of the largest sinks in the Earth system for anthropogenic CO2 emissions, acting as a negative feedback on climate change. Earth system models project that climate change will lead to a weakening ocean carbon uptake rate as warm water holds less dissolved CO2 and as biological productivity declines. However, most Earth system models do not incorporate the impact of warming on bacterial remineralisation and rely on simplified representations of plankton ecology that do not resolve the potential impact of climate change on ecosystem structure or elemental stoichiometry. Here, we use a recently developed extension of the cGEnIE (carbon-centric Grid Enabled Integrated Earth system model), ecoGEnIE, featuring a trait-based scheme for plankton ecology (ECOGEM), and also incorporate cGEnIE's temperature-dependent remineralisation (TDR) scheme. This enables evaluation of the impact of both ecological dynamics and temperature-dependent remineralisation on particulate organic carbon (POC) export in response to climate change. We find that including TDR increases cumulative POC export relative to default runs due to increased nutrient recycling (+∼1.3 %), whereas ECOGEM decreases cumulative POC export by enabling a shift to smaller plankton classes (−∼0.9 %). However, interactions with carbonate chemistry cause opposite sign responses for the carbon sink in both cases: TDR leads to a smaller sink relative to default runs (−∼1.0 %), whereas ECOGEM leads to a larger sink (+∼0.2 %). Combining TDR and ECOGEM results in a net strengthening of POC export (+∼0.1 %) and a net reduction in carbon sink (−∼0.7 %) relative to default. These results illustrate the degree to which ecological dynamics and biodiversity modulate the strength of the biological pump, and demonstrate that Earth system models need to incorporate ecological complexity in order to resolve non-linear climate–biosphere feedbacks

Seroprevalence of Toxoplasma gondii in burrowing bettongs (Bettongia lesueur): a comparison of cat-free and cat-exposed populations

Toxoplasma gondii is a ubiquitous protozoan transmitted by felids and infection, morbidity, and mortality occur in numerous marsupial species. This study explores the relationship between cat exposure and Toxoplasma in burrowing bettongs (Bettongia lesueur) in the Arid Recovery Reserve (ARR), South Australia. We estimated seroprevalence, using a modified agglutination test for T. gondii-specific immunoglobulins, in cat-free and cat-exposed bettong populations. Tissue samples collected opportunistically from bettong carcasses and from cats within and around the reserve were screened for T. gondii DNA using multiplex real-time polymerase chain reaction (M-qPCR). Two cats trapped inside the ARR tested positive (50.0%; 95% CI: 15.0–85.0%). All bettongs tested from the cat-free (n = 48) and cat-exposed (n = 19) exclosures were seronegative (95% CI: 0–7.41% and 0–16.82% respectively). We found no evidence of fatal toxoplasmosis, with all bettong carcasses negative on M-qPCR (n = 11). We propose that T. gondii was not detected in bettongs coexisting with cats primarily due to low exposure of bettongs at the time of sampling, possibly due to poor oocyst viability in arid conditions or low shedding by cats. Ongoing screening throughout high and low rainfall years should be conducted to better establish the risk of Toxoplasma to bettongs in the ARR

The Sense of Incompleteness as a Motivator of Obsessive-Compulsive Symptoms: An Empirical Analysis of Concepts and Correlates

Contemporary models of obsessive-compulsive disorder emphasize the importance of harm avoidance (HA) and related dysfunctional beliefs as motivators of obsessive-compulsive (OC) symptoms. Recently, there has been a resurgence of interest in Janet’s (1908) concept of incompleteness (INC) as another potentially important motivator. Contemporary investigators define INC as the sense that one’s actions, intentions, or experiences have not been properly achieved. Janet defined INC more broadly to include alexithymia, depersonalization, derealization, and impaired psychological mindedness. We conducted two studies to address four issues: (a) the clinical correlates of INC; (b) whether INC and HA are distinguishable constructs; (c) whether INC predicts OC symptoms after controlling for HA; and (d) the relative merits of broad versus narrow conceptualizations of INC. Study 1 was a meta-analysis of the clinical correlates of narrowly defined INC (16 studies, N=5,940). INC was correlated with all types of OC symptoms, and was more strongly correlated with OC symptoms than with general distress. Study 2 (N=534 nonclinical participants) showed that: (a) INC and HA were strongly correlated but factor analytically distinguishable; (b) INC statistically predicted all types of OC symptoms even after controlling for HA; and (c) narrow INC was most strongly correlated with OC symptoms whereas broad INC was most strongly correlated with general distress. Although the findings are limited by being correlational in nature, they support the hypothesis that INC, especially in its narrow form, is a motivator of OC symptoms

“Time to Reflect”: Enhancing the self-efficacy of secondary school wellbeing personnel in recognising and responding to mental health needs of students

“Time to Reflect” (TTR) is an innovative five-session professional development program for secondary school wellbeing personnel working with students between the ages of 12 and 18. TTR is jointly designed and delivered by an educational and a youth mental health specialist service. The program provides education on a range of mental health related topics and offers participants an opportunity to reflect on their current practices. The primary aim of this study was to evaluate whether the TTR program increases perceived competence and confidence of participants in recognising and responding to the mental health needs of students. The secondary aim was to assess changes in the use of reflection and its perceived benefits for professional practice. Participants completed a self-assessment questionnaire at three time points: prior to the first session, after the final session, and three months after completion of the program. One hundred and thirty-five school wellbeing personnel from a variety of state, independent, and Catholic secondary schools participated. Following completion of the program, participants reported significantly greater confidence and competence in helping students with mental health problems, with this level of change being maintained at the three-month post-training assessment. The majority of participants reported positive changes in their use of reflection, and consequent benefits to their professional practice. The findings from this study suggest that the TTR program promoted the self-efficacy of participants in responding to the mental health needs of students, and that regular reflective practice may be an effective and beneficial model for continued professional learning and development in schools

A randomized controlled pilot trial of different mobile messaging interventions for problem drinking compared to weekly drink tracking

This study was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) R34AA021502. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Elevating Voices, Addressing Depression, Toxic Stress, and Equity through Group Prenatal Care: A pilot study

INTRODUCTION: Elevating Voices, Addressing Depression, Toxic Stress and Equity (EleVATE) is a group prenatal care (GC) model designed to improve pregnancy outcomes and promote health equity for Black birthing people. This article outlines the foundational community-engaged process to develop EleVATE GC and pilot study results. METHODS: We used community-based participatory research principles and the Ferguson Commission Report to guide creation of EleVATE GC. The intervention, designed by and for Black birthing people, centers trauma-informed care, antiracism, and integrates behavioral health strategies into group prenatal care to address unmet mental health needs. Using a convenience sample of patients seeking care at one of three safety-net health care sites, we compared preterm birth, small for gestational age, depression scores, and other pregnancy outcomes between patients in individual care (IC), CenteringPregnancy™ (CP), and EleVATE GC. RESULTS: Forty-eight patients enrolled in the study ( DISCUSSION: Our findings model a systematic approach to design a feasible, patient-centered, community-based, trauma-informed, antiracist intervention. Further study is needed to determine whether EleVATE GC improves perinatal outcomes and promotes health equity