Giant Cell Tumor of Bone: Documented Progression over 4 Years from Its Origin at the Metaphysis to the Articular Surface.

The exact location of origin for giant cell tumors of bone (GCTB) remains controversial, as lesions are not routinely imaged early but rather late when the tumor is large and clinically symptomatic. At the time of diagnosis, GCTB are classically described as lucent, eccentric lesions with nonsclerotic margins, located within the epiphysis to a greater extent than the metaphysis. Here we present a case of a biopsy proven GCTB initially incidentally seen on MRI as a small strictly metaphyseal lesion, which over the course of several years expanded across a closed physis to involve the epiphysis and abut the articular surface/subchondral bone plate

Drivers of future urban flood risk

Managing urban flood risk is a key global challenge of the 21st Century. Drivers of future UK flood risk were identified and assessed by the Flood Foresight project in 2002-04 and 2008; envisaging flood risk during the 2050s and 2080s under a range of scenarios for climate change and socio-economic development. This paper qualitatively reassesses and updates these drivers, using empirical evidence and advances in flood risk science, technology and practice gained since 2008. Of the original drivers, five have strengthened, three have weakened and 14 remain within their 2008 uncertainty bands. Rainfall, as impacted by climate change, is the leading source driver of future urban flood risk. Intra-urban Asset Deterioration, leading to increases in a range of consequential flood risks, is the primary pathway driver. Social impacts (risk to life and health, and the intangible impacts of flooding on communities) and continued capital investment in Buildings and Contents (leading to greater losses when newer buildings of higher economic worth are inundated), have strengthened as receptor drivers of urban flood risk. Further, we propose two new drivers: Loss of Floodable Urban Spaces, and Indirect Economic Impacts, which we suggest may have significant impacts on future urban flood risk

Evaluating the multiple benefits of a sustainable drainage scheme in Newcastle, UK

Sustainable Drainage Systems (SuDS) and Blue-Green infrastructure (BGI) provide a range of environmental, economic and social benefits in addition to managing water quantity and quality. Recognition of the multifunctionality of SuDS and BGI, and the specific benefits that may accrue to different beneficiaries, may facilitate partnership working towards multifunctional infrastructure that meets the strategic objectives of public and private organisations. We evaluate the multiple benefits of the Killingworth and Longbenton surface water management scheme, a Partnership Project in NE England jointly funded by Northumbrian Water, the Environment Agency and North Tyneside Council. Using CIRIA’s Benefits of SuDS Tool (BeST) and the Blue-Green Cities Multiple Benefits GIS Toolbox, we a) quantify and monetise six key benefits, b) assess two qualitative benefits, c) illustrate the spatial distribution of five non-flood benefits, and d) highlight locations with the greatest opportunity for multi-beneficial intervention. The Killingworth and Longbenton scheme generates; significant flood damage reduction benefits; improves water quality, habitat size, carbon sequestration, attractiveness of the area and property prices (amenity), and; reduces noise pollution. Utilisation of these complementary tools for multiple benefit evaluation shows promise as an aid to facilitate partnership working towards implementation of multifunctional SuDS and BGI

Impact of financial incentives on alcohol intervention delivery in primary care: a mixed-methods study

Background Local and national financial incentives were introduced in England between 2008 and 2015 to encourage screening and brief alcohol intervention delivery in primary care. We used routine Read Code data and interviews with General Practitioners (GPs) to assess their impact. Methods A sequential explanatory mixed-methods study was conducted in 16 general practices representing 106,700 patients and 99 GPs across two areas in Northern England. Data were extracted on screening and brief alcohol intervention delivery for 2010-11 and rates were calculated by practice incentive status. Semi-structured interviews with 14 GPs explored which factors influence intervention delivery and recording in routine consultations. Results Screening and brief alcohol intervention rates were higher in financially incentivised compared to non-incentivised practices. However absolute rates were low across all practices. Rates of short screening test administration ranged from 0.05% (95% CI: 0.03-0.08) in non-incentivised practices to 3.92% (95% CI: 3.70-4.14) in nationally incentivised practices. For the full AUDIT, rates were also highest in nationally incentivised practices (3.68%, 95% CI: 3.47-3.90) and lowest in non-incentivised practices (0.17%, 95% CI: 0.13-0.22). Delivery of alcohol interventions was highest in practices signed up to the national incentive scheme (9.23%, 95% CI: 8.91-9.57) and lowest in non-incentivised practices (4.73%, 95% CI: 4.50-4.96). GP Interviews highlighted a range of influences on alcohol intervention delivery and subsequent recording including: the hierarchy of different financial incentive schemes; mixed belief in the efficacy of alcohol interventions; the difficulty of codifying complex conditions; and GPs’ beliefs about patient-centred practice. Conclusions Financial incentives have had some success in encouraging screening and brief alcohol interventions in England, but levels of recorded activity remain low. To improve performance, future policies must prioritise alcohol prevention work within the quality and outcomes framework, and address the values, attitudes and beliefs that shape how GPs’ provide care

Diagnostic accuracy of 3.0-T magnetic resonance T1 and T2 mapping and T2-weighted dark-blood imaging for the infarct-related coronary artery in Non-ST-segment elevation myocardial infarction

Background: Patients with recent non–ST‐segment elevation myocardial infarction commonly have heterogeneous characteristics that may be challenging to assess clinically. Methods and Results: We prospectively studied the diagnostic accuracy of 2 novel (T1, T2 mapping) and 1 established (T2‐weighted short tau inversion recovery [T2W‐STIR]) magnetic resonance imaging methods for imaging the ischemic area at risk and myocardial salvage in 73 patients with non–ST‐segment elevation myocardial infarction (mean age 57±10 years, 78% male) at 3.0‐T magnetic resonance imaging within 6.5±3.5 days of invasive management. The infarct‐related territory was identified independently using a combination of angiographic, ECG, and clinical findings. The presence and extent of infarction was assessed with late gadolinium enhancement imaging (gadobutrol, 0.1 mmol/kg). The extent of acutely injured myocardium was independently assessed with native T1, T2, and T2W‐STIR methods. The mean infarct size was 5.9±8.0% of left ventricular mass. The infarct zone T1 and T2 times were 1323±68 and 57±5 ms, respectively. The diagnostic accuracies of T1 and T2 mapping for identification of the infarct‐related artery were similar (P=0.125), and both were superior to T2W‐STIR (P<0.001). The extent of myocardial injury (percentage of left ventricular volume) estimated with T1 (15.8±10.6%) and T2 maps (16.0±11.8%) was similar (P=0.838) and moderately well correlated (r=0.82, P<0.001). Mean extent of acute injury estimated with T2W‐STIR (7.8±11.6%) was lower than that estimated with T1 (P<0.001) or T2 maps (P<0.001). Conclusions: In patients with non–ST‐segment elevation myocardial infarction, T1 and T2 magnetic resonance imaging mapping have higher diagnostic performance than T2W‐STIR for identifying the infarct‐related artery. Compared with conventional STIR, T1 and T2 maps have superior value to inform diagnosis and revascularization planning in non–ST‐segment elevation myocardial infarction. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02073422

Evaluating the multiple benefits of a sustainable drainage scheme in Newcastle, UK

Sustainable Drainage Systems (SuDS) and Blue-Green infrastructure (BGI) provide a range of environmental, economic and social benefits in addition to managing water quantity and quality. Recognition of the multifunctionality of SuDS and BGI, and the specific benefits that may accrue to different beneficiaries, may facilitate partnership working towards multifunctional infrastructure that meets the strategic objectives of public and private organisations. We evaluate the multiple benefits of the Killingworth and Longbenton surface water management scheme, a Partnership Project in NE England jointly funded by Northumbrian Water, the Environment Agency and North Tyneside Council. Using CIRIA’s Benefits of SuDS Tool (BeST) and the Blue-Green Cities Multiple Benefits GIS Toolbox, we a) quantify and monetise six key benefits, b) assess two qualitative benefits, c) illustrate the spatial distribution of five non-flood benefits, and d) highlight locations with the greatest opportunity for multi-beneficial intervention. The Killingworth and Longbenton scheme generates; significant flood damage reduction benefits; improves water quality, habitat size, carbon sequestration, attractiveness of the area and property prices (amenity), and; reduces noise pollution. Utilisation of these complementary tools for multiple benefit evaluation shows promise as an aid to facilitate partnership working towards implementation of multifunctional SuDS and BGI

Predictive Modeling Techniques in Prostate Cancer

A number of new predictive modeling techniques have emerged in the past several years. These methods can be used independently or in combination with traditional modeling techniques to produce useful tools for the management of prostate cancer. Investigators should be aware of these techniques and avail themselves of their potentially useful properties. This review outlines selected predictive methods that can be used to develop models that may be useful to patients and clinicians for prostate cancer management.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63147/1/10915360152745812.pd

Public health engagement in alcohol licensing in England and Scotland:The ExILEnS mixed-method, natural experiment evaluation

BACKGROUND: International systematic reviews suggest an association between alcohol availability and increased alcohol-related harms. Alcohol availability is regulated through separate locally administered licensing systems in England and Scotland, in which local public health teams have a statutory role. The system in Scotland includes a public health objective for licensing. Public health teams engage to varying degrees in licensing matters but no previous study has sought to objectively characterise and measure their activity, examine their effectiveness, or compare practices between Scotland and England.AIM: To critically assess the impact and mechanisms of impact of public health team engagement in alcohol premises licensing on alcohol-related harms in England and Scotland.METHODS: We recruited 39 diverse public health teams in England (n = 27) and Scotland (n = 12). Public health teams more active in licensing were recruited first and then matched to lower-activity public health teams. Using structured interviews (n = 66), documentation analysis, and expert consultation, we developed and applied the Public Health Engagement In Alcohol Licensing (PHIAL) measure to quantify six-monthly activity levels from 2012 to 2019. Time series of PHIAL scores, and health and crime outcomes for each area, were analysed using multivariable negative binomial mixed-effects models to assess correlations between outcome and exposure, with 18-month average PHIAL score as the primary exposure metric. In-depth interviews (n = 53) and a workshop (n = 10) explored public health team approaches and potential mechanisms of impact of alcohol availability interventions with public health team members and licensing stakeholders (local authority licensing officers, managers and lawyers/clerks, police staff with a licensing remit, local elected representatives).FINDINGS: Nineteen public health team activity types were assessed in six categories: (1) staffing; (2) reviewing and (3) responding to licence applications; (4) data usage; (5) influencing licensing stakeholders/policy; and (6) public involvement. Usage and intensity of activities and overall approaches varied within and between areas over time, including between Scotland and England. The latter variation could be explained by legal, structural and philosophical differences, including Scotland's public health objective. This objective was felt to legitimise public health considerations and the use of public health data within licensing. Quantitative analysis showed no clear evidence of association between level of public health team activity and the health or crime outcomes examined, using the primary exposure or other metrics (neither change in, nor cumulative, PHIAL scores). Qualitative data suggested that public health team input was valued by many licensing stakeholders, and that alcohol availability may lead to harms by affecting the accessibility, visibility and norms of alcohol consumption, but that the licensing systems have limited power to act in the interests of public health.CONCLUSIONS: This study provides no evidence that public health team engagement in local licensing matters was associated with measurable downstream reductions in crime or health harms, in the short term, or over a 7-year follow-up period. The extensive qualitative data suggest that public health team engagement is valued and appears to be slowly reorienting the licensing system to better address health (and other) harms, especially in Scotland, but this will take time. A rise in home drinking, alcohol deliveries, and the inherent inability of the licensing system to reduce - or in the case of online sales, to contain - availability, may explain the null findings and will continue to limit the potential of these licensing systems to address alcohol-related harms.FUTURE WORK: Further analysis could consider the relative success of different public health team approaches in terms of changing alcohol availability and retailing. A key gap relates to the nature and impact of online availability on alcohol consumption, harms and inequalities, alongside development and study of relevant policy options. A national approach to licensing data and oversight would greatly facilitate future studies and public health input to licensing.LIMITATIONS: Our interview data and therefore PHIAL scores may be limited by recall bias where documentary evidence of public health activity was not available, and by possible variability in grading of such activity, though steps were taken to minimise both. The analyses would have benefited from additional data on licensing policies and environmental changes that might have affected availability or harms in the study areas.STUDY REGISTRATION: The study was registered with the Research Registry (researchregistry6162) on 26 October 2020. The study protocol was published in BMC Medical Research Methodology on 6 November 2018.FUNDING: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 15/129/11.</p