Reviews

Danny Saunders and Nina Smalley (eds.), The International Simulation and Gaming Research Yearbook — Volume 8: Simulations and Games for Transition and Change, London: Kogan Page, 2000. ISBN: 0–7494–3397–3. Hardback, viii+271 pages, £40.00

Translational Science and Evidence-Based Healthcare: A Clarification and Reconceptualization of How Knowledge Is Generated and Used in Healthcare

The importance of basing health policy and health care practices on the best available international evidence (“evidence-based health care”) and on translating knowledge or evidence into action (“translation science” or “translational research”) is increasingly being emphasized across all health sectors inmost countries. Evidence-based healthcare is a process that identifies policy or clinical questions and addresses these questions by generating knowledge and evidence to effectively and appropriately deliver healthcare in ways that are effective, feasible, and meaningful to specific populations, cultures, and settings. This evidence is then appraised, synthesized, and transferred to service delivery settings and health professionals who then utilize it and evaluate its impact on health outcomes, health systems, and professional practice. Many of the common theories that address this translational process place it apart from the evidence-based practice cycle and most recognise only two translational gaps. This paper seeks to clarify the nature of evidence-based healthcare and translation science and proposes a reconceptualization that both brings together these two dominant ideas in modern healthcare and asserts the existence of a third fundamental gap that is rarely addressed the gap between knowledge need and discovery

Post-Traumatic Stress and Marijuana outcomes: The Mediating Role of Marijuana Protective Behavioral Strategies

Background: The present study investigated the mediating role of protective behavioral strategies for marijuana (PBSM) on the relationship between posttraumatic stress disorder (PTSD) and marijuana outcomes (i.e. marijuana use frequency, marijuana use quantity, cannabis use disorder (CUD) symptoms, and marijuana-related problems). Methods: Participants were 1,107 traditional age college students (Mage = 20.26, SD = 3.32; 66.5% White, non-Hispanic; 68.8% female), who reported consuming marijuana at least once in the last 30 days and completed measures of PTSD symptoms, PBSM, and marijuana-related outcomes. Results: PBSM significantly mediated the positive relationships between PTSD symptoms and both CUD symptoms and marijuana-related problems. More specifically, PTSD symptoms were negatively associated with PBSM, which in turn was negatively associated with marijuana use frequency and marijuana use quantity, which were in turn positively associated with CUD symptoms and marijuana-related problems. Conclusion: Taken together, the associations between higher PTSD symptoms and greater experience of CUD symptoms and marijuana-related problems may occur because students use fewer PBSM and thus engage in larger quantity and frequency of marijuana use. These findings lend support to the utility of targeting PBSM as a harm reduction effort for students with PTSD symptoms who use marijuana

Outpatient and Home Chemotherapy with Novel Local Control Strategies in Desmoplastic Small Round Cell Tumor

Desmoplastic Small Round Cell Tumor (DSRCT) has a very poor prognosis. This report illustrates novel chemotherapy and local control interventions in a 5-year old patient. The patient was treated in the outpatient setting, achieved remission, with excellent quality of life. The patient presented with massive ascites and >1000 abdominal tumors. Neoadjuvant chemotherapy included vincristine (1.5 mg/m2), ifosfamide (3 g/m2/day × 3), dexrazoxane/doxorubicin (750/75 mg/m2), and etoposide (150 mg/m2). Continuous hyperthermic peritoneal perfusion (CHPP) with cisplatin (100 mg/m2) was given after extensive cytoreductive surgery. This was followed by irinotecan (10 mg/m2/day × 5 × 2 weeks) + temozolomide monthly × 2, then abdominal radiation 30 Gy with simultaneous temozolomide (100 mg/m2/day × 5). A total of 12 cycles of irinotecan and temozolamide were given. Except for initial chemotherapy, subsequent courses were in the outpatient setting. Focal retroperitoneal relapse at 18 months was treated with IMRT with bevacizumab (5 mg/kg) and 2 perihepatic metastases with radio frequency ablation/cryoablation followed by chronic outpatient maintenance chemotherapy (valproic acid, cyclophosphamide, and rapamycin). Almost 2 years from diagnosis, the patient maintained an excellent quality of life. This is a novel approach to the treatment of children with massive abdomino-pelvic DSRCT

Evaluating a web-based computer-tailored physical activity intervention for those living with and beyond lung cancer (ExerciseGuide UK): protocol for a single group feasibility and acceptability study

Background: Lung cancer is the leading cause of cancer-related death globally. Physical activity and exercise provide unequivocal benefits to those living with and beyond lung cancer. However, few of those living with and beyond cancer meet the national physical activity guidelines. Various barriers exist for this population’s engagement in physical activity and exercise, such as the lack of knowledge and lack of tailored information, little access to exercise specialists, fatigue, and mobility challenges. Digitally delivered programmes have the potential to address several of these barriers, with techniques like “computer-tailoring” available to enable the delivery of tailored content at a time and place that is convenient. However, evaluation of such programmes is needed prior to implementation. This protocol describes a single group study that will examine the feasibility and acceptability of an online tool (ExerciseGuide UK) that provides those living with and beyond lung cancer web-based computer-tailored physical activity prescription and modules underpinned by behaviour change theories. Methods: Thirty-five individuals diagnosed with lung cancer, or cancer affecting the lung (e.g. pleural mesothelioma), will be recruited into a single-intervention arm. The platform will provide tailored resources and a personalised physical activity programme using IF-THEN algorithms. Exercise prescription will be tailored on factors such as self-reported specific pain location, exercise history, and current physical fitness. In addition, modules grounded in behaviour change will supplement the physical activity programme and will focus on topics such as exercise benefits, safety, goal setting, and tracking. The primary outcome will be assessed using pre-established criteria on feasibility and mixed-methods approach for acceptability. Secondary outcomes will explore changes in the physical activity, quality of life, anxiety, and depression. Discussion: This manuscript describes the protocol for a study examining the feasibility and acceptability of a web-based computer-tailored physical activity intervention for those living with and beyond lung cancer. The publication of this protocol aims to increase the transparency of the methods, report pre-determined criteria, and aid replication of the study and associated materials. If feasible and acceptable, this intervention will inform future studies of digital-based interventions. Trail registration: ClinicalTrails.gov, NCT05121259. Registered on November 16, 2021

Estimating the Health Effects of Adding Bicycle and Pedestrian Paths at the Census Tract Level: Multiple Model Comparison

Background: Adding additional bicycle and pedestrian paths to an area can lead to improved health outcomes for residents over time. However, quantitatively determining which areas benefit more from bicycle and pedestrian paths, how many miles of bicycle and pedestrian paths are needed, and the health outcomes that may be most improved remain open questions. Objective: Our work provides and evaluates a methodology that offers actionable insight for city-level planners, public health officials, and decision makers tasked with the question “To what extent will adding specified bicycle and pedestrian path mileage to a census tract improve residents’ health outcomes over time?” Methods: We conducted a factor analysis of data from the American Community Survey, Center for Disease Control 500 Cities project, Strava, and bicycle and pedestrian path location and use data from two different cities (Norfolk, Virginia, and San Francisco, California). We constructed 2 city-specific factor models and used an algorithm to predict the expected mean improvement that a specified number of bicycle and pedestrian path miles contributes to the identified health outcomes. Results: We show that given a factor model constructed from data from 2011 to 2015, the number of additional bicycle and pedestrian path miles in 2016, and a specific census tract, our models forecast health outcome improvements in 2020 more accurately than 2 alternative approaches for both Norfolk, Virginia, and San Francisco, California. Furthermore, for each city, we show that the additional accuracy is a statistically significant improvement (P2 weeks of poor physical health days in the census tract within 1.83% (SD 0.57%). For San Francisco (n=49 census tracts), our approach estimates, on average, that the percentage of individuals who had a stroke in the census tract is within 1.81% (SD 0.52%), and the percentage of individuals with diabetes in the census tract is within 1.26% (SD 0.91%). Conclusions: We propose and evaluate a methodology to enable decision makers to weigh the extent to which 2 bicycle and pedestrian paths of equal cost, which were proposed in different census tracts, improve residents’ health outcomes; identify areas where bicycle and pedestrian paths are unlikely to be effective interventions and other strategies should be used; and quantify the minimum amount of additional bicycle path miles needed to maximize health outcome improvements. Our methodology shows statistically significant improvements, compared with alternative approaches, in historical accuracy for 2 large cities (for 2016) within different geographic areas and with different demographics

Social infrastructures for the post-Covid recovery in the UK

The central conflict facing policymakers, the voluntary sector, and communities during the Covid-19 pandemic has been keeping safe from a virus that is transmitted interpersonally while also providing vital support to those in need. The report presents the findings from 12 months of ethnographic, participatory, and quantitative research, which has revealed that people have fallen back on their families, neighbourhoods and communities in order to navigate new challenges and burden. We call these networks of kinship and care within and between families, friends, and communities “social infrastructures” and argue that economic life and pandemic recovery relies on the strength of these foundational relations. In the UK, local and rapid response initiatives saved lives as voluntary sector, religious organisations, and Community Champions built on these relations of care to encourage vaccine uptake. These innovative social projects also helped people to grieve and recover from losses of life and livelihoods. We argue that both short- and long-term investment in these integrated social infrastructures is crucial for the post-Covid recovery in the UK

Discovery of a gatekeeper residue in the C terminal tail of the extracellular signal-regulated protein kinase 5 (ERK5)

The extracellular signal-regulated protein kinase 5 (ERK5) is a non-redundant mitogen-activated protein kinase (MAPK) that exhibits a unique C terminal extension which comprises distinct structural and functional properties. Here, we sought to elucidate the significance of phosphoacceptor sites in the C terminal transactivation domain of ERK5. We have found that Thr732 acted as a functional gatekeeper residue controlling C terminal-mediated nuclear translocation and transcriptional enhancement. Consistently, using a non-bias quantitative mass spectrometry approach, we demonstrated that phosphorylation at Thr732 conferred selectivity for binding interactions of ERK5 with proteins related to chromatin and RNA biology, whereas a number of metabolic regulators were associated with full-length wild type ERK5. Additionally, our proteomic analysis revealed that phosphorylation of the Ser730-Glu-Thr732-Pro motif could occur independently of dual phosphorylation at Thr218-Glu-Tyr220 in the activation loop. Together these results firmly establish the significance of C terminal phosphorylation in regulating ERK5 function, independently of MEK5. This novel mechanism may be of particular relevance in cancer cells where ERK5 has be found to be hyperphosphoryated on its C terminal tail

On the mass transfer in AE Aquarii

The observed properties of the close binary AE Aqr indicate that the mass transfer in this system operates via the Roche lobe overflow mechanism, but the material transferred from the normal companion is neither accreted onto the surface of the white dwarf nor stored in a disk around its magnetosphere. As previously shown, such a situation can be realized if the white dwarf operates as a propeller. At the same time, the efficiency of the propeller action by the white dwarf is insufficient to explain the rapid braking of the white dwarf, which implies that the spin-down power is in excess of the bolometric luminosity of the system. To avoid this problem we have simulated the mass-transfer process in AE Aqr assuming that the observed braking of the white dwarf is governed by a pulsar-like spin-down mechanism. We show that the expected H_alpha Doppler tomogram in this case resembles the tomogram observed from the system. We find that the agreement between the simulated and the observed tomograms is rather good provided the mean value of the mass-transfer rate ~5x10^16 g/s. Three spatially separated sources of H_alpha emission can be distinguished within this approach. The structure of the tomogram depends on the relative contributions of these sources to the H_alpha emission and is expected to vary from night to night.Comment: 12 pages, 3 figures (6 eps files). Published in A&A. The paper with high resolution images can be downloaded from http://urania.it.nuigalway.ie/papers/ae_aqr.ps.g