How can students-as-partners work address challenges to student, faculty, and staff mental health and well-being?

Mental health has emerged as a critical area of attention in higher education, and educational research over the last 15 years has focused increasingly on emotions and wellbeing at all stages of education (Hill et al., 2021). While definitions of well-being vary, most are premised on “good quality of life” (Nair et al., 2018, p. 69). Within the last few years, we have experienced an intersection of several forces that undermine or threaten good quality of life. These include the uncertainties prompted by the COVID-19 pandemic (Hews et al., 2022, U.S. Surgeon General, n.d.), climate change (Charlson et al., 2021), racism and social injustices (Williams & Etkins, 2021), the cost-of-living crisis (Montacute, 2023), and the lack of motivation and higher incidence of mental health issues associated with growing concerns about job prospects and income (Chowdhury et al., 2022). This fifth iteration of Voices from the Field explores some of the ways in which students-as-partners work can address challenges to the mental health and well-being of students, faculty, and staff. This focus, proposed by members of the IJSaP Editorial Board, both responds to the intersecting realities named above and remains true to the goal of this section of the journal, which is to offer a venue for a wide range of contributors to address important questions around and aspects of students-as-partners work without going through the intensive submission, peer-review, and revision processes. The prompt we included in the call for this iteration of Voices was: “In what ways can students-as-partners work address challenges to the mental health and well-being of students, staff, and faculty posed by the current realities in the wider world (socio-political, environmental, economic, etc.) that affect higher education?

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

Descriptive analysis of horse movement networks during the 2015 equestrian season in Ontario, Canada.

Horses are a highly mobile population, with many travelling locally, nationally, and internationally to participate in shows and sporting events. However, the nature and extent of these movements, as well as the potential impact they may have on disease introduction and spread, is not well documented. The objective of this study was to characterise the movement network of a sample of horses in Ontario, Canada, over a 7-month equestrian season. Horse owners (n = 141) documented their travel patterns with their horse(s) (n = 330) by completing monthly online questionnaires between May and November 2015. Directed networks were constructed to represent horse movements in 1-month time periods. A total of 1754 horse movements met the inclusion criteria for analysis. A variety of location types were included in each monthly network, with many including non-facilities such as parks, trails, and private farms. Only 34.3% of competitions attended by participants during the study period were regulated by an official equestrian organisation. Comparisons of the similarity between monthly networks indicated that participants did not travel to the same locations each month, and the most connected locations varied between consecutive months. While the findings should not be generalized to the wider horse population, they have provided greater insight into the nature and extent of observed horse movement patterns. The results support the need to better understand the variety of locations to which horses can travel in Ontario, as different types of locations may have different associated risks of disease introduction and spread

Descriptive and network analyses of the equine contact network at an equestrian show in Ontario, Canada and implications for disease spread

Abstract Background Identifying the contact structure within a population of horses attending a competition is an important element towards understanding the potential for the spread of equine pathogens as the horses subsequently travel from location to location. However, there is limited information in Ontario, Canada to quantify contact patterns of horses. The objective of this study was to describe the network of potential contacts associated with an equestrian show to determine how this network structure may influence potential disease transmission. Results This was a descriptive study of horses attending an equestrian show in southern Ontario, Canada on July 6 and 7, 2014. Horse show participants completed a questionnaire about their horse, travel patterns, and infection control practices. Questionnaire responses were received from horse owners of 79.7% (55/69) of the horses attending the show. Owners reported that horses attending the show were vaccinated for diseases such as rabies, equine influenza, and equine herpesvirus. Owners demonstrated high compliance with most infection control practices by reporting reduced opportunities for direct and indirect contact while away from home. The two-mode undirected network consisted of 820 nodes (41 locations and 779 horses). Eight percent of nodes in the network represented horses attending the show, 87% of nodes represented horses not attending the show, but boarded at individual home facilities, and 5% represented locations. The median degree of a horse in the network was 33 (range: 1–105). Conclusions Developing disease management strategies without the explicit consideration of horses boarded at individual home facilities would underestimate the connectivity of horses in the population. The results of this study provides information that can be used by equestrian show organizers to configure event management in such a way that can limit the extent of potential disease spread