Proton beam therapy causing pericarditis - a rare case of radiation induced cardiotoxicity.

Acute pericarditis is caused by the inflammation of the pericardium which can result in an effusion around the heart. Proton beam therapy causing radiation-induced pericarditis is not a well-known cause of pericarditis. We present a case of a patient with Li-Fraumeni Syndrome who developed acute onset pericarditis, presumed to be secondary to proton beam therapy

House Calls by Mobile Integrated Health Paramedics for Patients with Heart Failure: A Feasibility Study.

Background: Early readmissions following hospital discharge for heart failure (HF) remain a major concern. Among the various strategies designed to reduce readmissions, home evaluations have been observed to have a favorable impact. We assessed the feasibility of integrating community paramedics into the outpatient management of HF patients. Methods: Selected paramedics completed an educational HF curriculum. These Mobile Integrated Health Paramedics (MIHP) performed scheduled home visits 2- and 15-days post-discharge for patients with Stage C HF (Phase I) and patients with Stage D HF (Phase II). Facilitated by a Call Center, a process was created for performing urgent MIHP house calls within 60 minutes of a medical provider’s request. A HF specialist, with an on-call emergency department command physician, could order an intravenous diuretic during home visits. During each phase of the study the incidence of 30-day HF readmissions, 30-day all-cause readmissions, emergency room evaluations, unplanned office encounters, as well as any adverse events were prospectively documented. Results: Collaborative relationships between our hospital network and local EMS organizations were created. There were 82 MIHP home visits. Eight patients received urgent home evaluations within 60 minutes post-request, 1 requiring transport to an ED. The incidence of all-cause 30-day readmissions in 20 Stage C and 20 Stage D patients was 15% and 40%, respectively. There were no adverse events attributable to the MIHP house calls. Conclusions: It is feasible to integrate MIHPs into the outpatient management of HF. Signals of effectiveness for reducing early readmissions were observed. Obstacles to creating an effective paramedic “House Calls” program were identified. A randomized trial is required to assess the value of this care process and its impact on early readmissions in patients with Stage C and Stage D HF

The application of an ecosystem services framework to estimate the economic value of dung beetles to the U.K. cattle industry

Agrobiodiversity is declining across global farm production systems. These declines transcend both farm animal genetic resources (FAnGR) and plant genetic resources (PGR). Both can sustain greater adaptability and resilience in commercial production through so called ‘option value’. In addition, PGR and FAnGR embody cultural and heritage attributes that are often absent in global agriculture, but remain valued by society. Conservation is therefore important and economic incentives represent a potential supply-side mechanism to improve the status of rare breeds, cultivars and crop wild relatives. Yet, the exploration of incentive instruments for their conservation remains underexplored but may improve conservation outcomes. Using different survey instruments and modelling approaches (including choice modelling, linear programming and multi criteria decision analysis) I investigate how rationalising incentive support, through more targeted interventions, could result in better conservation outcomes. The findings suggest optimising subsidy support relies on three key factors. First, conservation contracts offered to farmers for conservation should reflect local farm business preferences and circumstances. This includes addressing barriers-to-entry in conservation programmes and the design of contractual schemes, that when improved will likely increase participation in conservation contracts. Second, identifying least cost suppliers of conservation services may enable more diversity to be conserved at comparable cost. Third, optimising what species, varieties and breeds are supported may improve conservation outcomes through more rational investments in diversity. Policy responses to address declining agrobiodiversity should consider the use of tender instruments (i.e. reverse auctions) to identify least cost suppliers for conservation services. Optimisation modelling and decision analysis techniques can be used to measure trade-offs inherent in different conservation goals, including social equity and diversity. Ultimately there is a need to balance the supply of use and non-use values of diversity that span the total economic value framework. While the drive for sustainable intensification of production may improve productivity, we need to be clear how breed and cultivar diversity can be encompassed into future policy priorities that reflect the need for greater food security plus cultural and heritage value attributes. The implications of deploying new and potentially disruptive technologies (i.e. gene editing) in the context of farm diversity are discussed

The role of science in regulation and decision making

This paper discusses the problem of making decisions based on science, without taking into consideration societal values. Science is value-neutral which is problematic if it is used as a sole guide to decision-making, as is the case in the United States' regulation of genetically modified foods (GMFs). In order to resolve political conflicts that may arise from technologies that involve conflicting values, it is argued that interested stakeholders must come together, discuss the issues, and find common ground