Tracking Onslow: a community in transition. edition 3, late 2013

When change is happening, communities talk and some tales get taller in the telling. Opinions are often based on shared stories and collectively these opinions are the community sentiment that affects the way people live and act. This magazine was produced by a collaboration between the ECU Journalism Program and the Shire of Ashburton that set out to track the shifts in the community sentiment in Onslow over the construction phase of the Wheatstone and Macedon gas hubs. The project aims to capture the stories being told in Onslow as the town changes, regardless of their factual accuracy. Where possible we have sought to verify facts and provide balance, but we have not excluded comments by community members on the grounds that they didn\u27t check out, because if we did that, then this would not be an accurate record of what people are saying. In all cases we have been careful to correctly report what people said in our interviews. The result is a sometimes optimistic and sometimes disgruntled reaction to the town\u27s rapid, but in some ways not rapid enough, growth spurt. We hope that you enjoy this snapshot of what was being said in Onslow in the middle of 2013 and find it interesting food for thought about the impact of major resource projects on their host communities. There is a digital version of the magazine available on the website so you can email a link to it to your family and friends in other places. The website also has soon-to-be updated galleries showing how parts of the town have changed almost beyond recognition and video interviews with Onslow locals. We look forward to seeing you when we come back in early 2014

ESCROTO AGUDO URGENCIA EN NIÑOS Y ADOLESCENTES

El escroto agudo comprende una serie de afecciones urológicas que tienen como denominador común el aumento brusco de la bolsa escrotal, acompañado de dolor o molestias y signos inflamatorios locales en mayor o menor grado.  Es la urgencia más común en el campo de la urología pediátrica. Las afecciones que forman parte del escroto agudo pueden aparecer en cualquier edad, con mayor incidencia en la primera década de la vida. Es frecuente en 1 de cada 4.000 pacientes masculinos.  Se han descrito numerosas causas de escroto agudo en pacientes en la edad pediátrica, entre ellas la torsión testicular, torsión de hidátides, orquiepididimitis, orquitis, epididimitis, edema escrotal idiopático, necrosis grasa del escroto, deferentitis, funiculitis, abscesos (escrotal y testicular), traumatismos y, aunque con menor frecuencia en las edades pediátricas, los tumores testiculares. En algunos casos es difícil precisar la causa, después de la anamnesis y el examen físico, es necesario la ecografía Doppler para confirmarlo.  El tratamiento es controversial entre cirujanos y urólogos. Los cirujanos abogan por la exploración quirúrgica de inmediato o en las primeras 6 horas de iniciado el cuadro clínico. Por su parte, los urólogos prefieren una conducta más conservadora, con seguimiento estricto del paciente. Es necesario una actuación médica oportuna para evitar complicaciones. El manejo actual de las entidades que forman parte del escroto agudo sigue siendo un desafío y varía en dependencia del criterio médico, así como del protocolo vigente en cada institución sanitaria

Molecular Investigations of a Locally Acquired Case of Melioidosis in Southern AZ, USA

Melioidosis is caused by Burkholderia pseudomallei, a Gram-negative bacillus, primarily found in soils in Southeast Asia and northern Australia. A recent case of melioidosis in non-endemic Arizona was determined to be the result of locally acquired infection, as the patient had no travel history to endemic regions and no previous history of disease. Diagnosis of the case was confirmed through multiple microbiologic and molecular techniques. To enhance the epidemiological analysis, we conducted several molecular genotyping procedures, including multi-locus sequence typing, SNP-profiling, and whole genome sequence typing. Each technique has different molecular epidemiologic advantages, all of which provided evidence that the infecting strain was most similar to those found in Southeast Asia, possibly originating in, or around, Malaysia. Advancements in new typing technologies provide genotyping resolution not previously available to public health investigators, allowing for more accurate source identification

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown