A lived experience co-designed study protocol for a randomised control trial: the Attempted Suicide Short Intervention Program (ASSIP) or Brief Cognitive Behavioural Therapy as additional interventions after a suicide attempt compared to a standard Suicide Prevention Pathway (SPP)

BACKGROUND: Despite being preventable, suicide is a leading cause of death and a major global public health problem. For every death by suicide, many more suicide attempts are undertaken, and this presents as a critical risk factor for suicide. Currently, there are limited treatment options with limited underpinning research for those who present to emergency departments with suicidal behaviour. The aim of this study is to assess if adding one of two structured suicide-specific psychological interventions (Attempted Suicide Short Intervention Program [ASSIP] or Brief Cognitive Behavioural Therapy [CBT] for Suicide Prevention) to a standardised clinical care approach (Suicide Prevention Pathway [SPP]) improves the outcomes for consumers presenting to a Mental Health Service with a suicide attempt. METHODS: This is a randomised controlled trial with blinding of those assessing the outcomes. People who attempt suicide or experience suicidality after a suicide attempt, present to the Gold Coast Mental Health and Specialist Services, are placed on the Suicide Prevention Pathway (SPP), and meet the eligibility criteria, are offered the opportunity to participate. A total of 411 participants will be recruited for the study, with 137 allocated to each cohort (participants are randomised to SPP, ASSIP + SPP, or CBT + SPP). The primary outcomes of this study are re-presentation to hospitals with suicide attempts. Presentations with suicidal ideation will also be examined (in a descriptive analysis) to ascertain whether a rise in suicidal ideation is commensurate with a fall in suicide attempts (which might indicate an increase in help-seeking behaviours). Death by suicide rates will also be examined to ensure that representations with a suicide attempt are not due to participants dying, but due to a potential improvement in mental health. For participants without a subsequent suicide attempt, the total number of days from enrolment to the last assessment (24 months) will be calculated. Self-reported levels of suicidality, depression, anxiety, stress, resilience, problem-solving skills, and self- and therapist-reported level of therapeutic engagement are also being examined. Psychometric data are collected at baseline, end of interventions, and 6,12, and 24 months. DISCUSSION: This project will move both ASSIP and Brief CBT from efficacy to effectiveness research, with clear aims of assessing the addition of two structured psychological interventions to treatment as usual, providing a cost-benefit analysis of the interventions, thus delivering outcomes providing a clear pathway for rapid translation of successful interventions. TRIALS REGISTRATION: ClinicalTrials.govNCT04072666. Registered on 28 August 201

Half a Century of Wilson & Jungner: Reflections on the Governance of Population Screening.

Background: In their landmark report on the "Principles and Practice of Screening for Disease" (1968), Wilson and Jungner noted that the practice of screening is just as important for securing beneficial outcomes and avoiding harms as the formulation of principles. Many jurisdictions have since established various kinds of "screening governance organizations" to provide oversight of screening practice. Yet to date there has been relatively little reflection on the nature and organization of screening governance itself, or on how different governance arrangements affect the way screening is implemented and perceived and the balance of benefits and harms it delivers. Methods: An international expert policy workshop convened by Sturdy, Miller and Hogarth. Results: While effective governance is essential to promote beneficial screening practices and avoid attendant harms, screening governance organizations face enduring challenges. These challenges are social and ethical as much as technical. Evidence-based adjudication of the benefits and harms of population screening must take account of factors that inform the production and interpretation of evidence, including the divergent professional, financial and personal commitments of stakeholders. Similarly, when planning and overseeing organized screening programs, screening governance organizations must persuade or compel multiple stakeholders to work together to a common end. Screening governance organizations in different jurisdictions vary widely in how they are constituted, how they relate to other interested organizations and actors, and what powers and authority they wield. Yet we know little about how these differences affect the way screening is implemented, and with what consequences. Conclusions: Systematic research into how screening governance is organized in different jurisdictions would facilitate policy learning to address enduring challenges. Even without such research, informal exchange and sharing of experiences between screening governance organizations can deliver invaluable insights into the social as well as the technical aspects of governance

ATBF1 and NQO1 as candidate targets for allelic loss at chromosome arm 16q in breast cancer: Absence of somatic ATBF1 mutations and no role for the C609T NQO1 polymorphism

<p>Abstract</p> <p>Background</p> <p>Loss of heterozygosity (LOH) at chromosome arm 16q is frequently observed in human breast cancer, suggesting that one or more target tumor suppressor genes (TSGs) are located there. However, detailed mapping of the smallest region of LOH has not yet resulted in the identification of a TSG at 16q. Therefore, the present study attempted to identify TSGs using an approach based on mRNA expression.</p> <p>Methods</p> <p>A cDNA microarray for the 16q region was constructed and analyzed using RNA samples from 39 breast tumors with known LOH status at 16q.</p> <p>Results</p> <p>Five genes were identified to show lower expression in tumors with LOH at 16q compared to tumors without LOH. The genes for NAD(P)H dehydrogenase quinone (<it>NQO1</it>) and AT-binding transcription factor 1 (<it>ATBF1</it>) were further investigated given their functions as potential TSGs. <it>NQO1 </it>has been implicated in carcinogenesis due to its role in quinone detoxification and in stabilization of p53. One inactive polymorphic variant of <it>NQO1 </it>encodes a product showing reduced enzymatic activity. However, we did not find preferential targeting of the active <it>NQO1 </it>allele in tumors with LOH at 16q. Immunohistochemical analysis of 354 invasive breast tumors revealed that NQO1 protein expression in a subset of breast tumors is higher than in normal epithelium, which contradicts its proposed role as a tumor suppressor gene.</p> <p><it>ATBF1 </it>has been suggested as a target for LOH at 16q in prostate cancer. We analyzed the entire coding sequence in 48 breast tumors, but did not identify somatic sequence changes. We did find several in-frame insertions and deletions, two variants of which were reported to be somatic pathogenic mutations in prostate cancer. Here, we show that these variants are also present in the germline in 2.5% of 550 breast cancer patients and 2.9% of 175 healthy controls. This indicates that the frequency of these variants is not increased in breast cancer patients. Moreover, there is no preferential LOH of the wildtype allele in breast tumors.</p> <p>Conclusion</p> <p>Two likely candidate TSGs at 16q in breast cancer, <it>NQO1 </it>and <it>ATBF1</it>, were identified here as showing reduced expression in tumors with 16q LOH, but further analysis indicated that they are not target genes of LOH. Furthermore, our results call into question the validity of the previously reported pathogenic variants of the <it>ATBF1 </it>gene.</p

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Effects of cooling and internal wave motions on gas transfer coefficients in a boreal lake

Peer reviewe

Future Trends in the Interdependence Between Flood Peaks and Volumes: Hydro‐Climatological Drivers and Uncertainty

International audienc

Least-cost options for integrating intermittent renewables in low-carbon power systems

Large power sector CO2 emission reductions are needed to meet long-term climate change targets. Intermittent renewable energy sources (intermittent-RES) such as wind and solar PV can be a key component of the resulting low-carbon power systems. Their intermittency will require more flexibility from the rest of the power system to maintain system stability. In this study, the efficacy of five complementary options to integrate intermittent-RES at the lowest cost is evaluated with the PLEXUS hourly power system simulation tool for Western Europe in the year 2050. Three scenarios.to reduce CO2 emissions by 96% and maintain system reliability are investigated: 40%, 60% and 80% of annual power generation by RES. This corresponds to 22%, 41% and 59% of annual power generation by intermittent-RES. This study shows that higher penetration of RES will increase the total system costs: they increase by 12% between the 40% and 80% RES scenarios. Key drivers are the relatively high investment costs and integration costs of intermittent-RES. It is found that total system costs can be reduced by: (1) Demand response (DR) (2-3% reduction compared to no DR deployment); (2) natural gas-fired power plants with and without Carbon Capture and Storage (CCS) (12% reduction from mainly replacing RES power generation between the 80% and 40% RES scenarios); (3) increased interconnection capacity (0-1% reduction compared to the current capacity); (4) curtailment (2% reduction in 80% RES scenario compared to no curtailment); (5) electricity storage increases total system costs in all scenarios (0.1-3% increase compared to only current storage capacity). The charging costs and investment costs make storage relatively expensive, even projecting cost reductions of 40% for Compressed Air Energy Storage (CAES) and 70% for batteries compared to 2012. All scenarios are simulated as energy only markets, and experience a "revenue gap" for both complementary options and other power generators: only curtailment and DR are profitable due to their low cost. The revenue gap becomes progressively more pronounced in the 60% and 80% RES scenarios, as the low marginal costs of RES reduce electricity prices. (C) 2015 Elsevier Ltd. All rights reserved

Least-cost options for integrating intermittent renewables in low-carbon power systems

Large power sector CO2 emission reductions are needed to meet long-term climate change targets. Intermittent renewable energy sources (intermittent-RES) such as wind and solar PV can be a key component of the resulting low-carbon power systems. Their intermittency will require more flexibility from the rest of the power system to maintain system stability. In this study, the efficacy of five complementary options to integrate intermittent-RES at the lowest cost is evaluated with the PLEXOS hourly power system simulation tool for Western Europe in the year 2050. Three scenarios to reduce CO2 emissions by 96% and maintain system reliability are investigated: 40%, 60% and 80% of annual power generation by RES. This corresponds to 22%, 41% and 59% of annual power generation by intermittent-RES. This study shows that higher penetration of RES will increase the total system costs: they increase by 12% between the 40% and 80% RES scenarios. Key drivers are the relatively high investment costs and integration costs of intermittent-RES. It is found that total system costs can be reduced by: (1) Demand response (DR) (2-3% reduction compared to no DR deployment); (2) natural gas-fired power plants with and without Carbon Capture and Storage (CCS) (12% reduction from mainly replacing RES power generation between the 80% and 40% RES scenarios); (3) increased interconnection capacity (0-1% reduction compared to the current capacity); (4) curtailment (2% reduction in 80% RES scenario compared to no curtailment); (5) electricity storage increases total system costs in all scenarios (0.1-3% increase compared to only current storage capacity). The charging costs and investment costs make storage relatively expensive, even projecting cost reductions of 40% for Compressed Air Energy Storage (CAES) and 70% for batteries compared to 2012. All scenarios are simulated as energy only markets, and experience a "revenue gap" for both complementary options and other power generators: only curtailment and DR are profitable due to their low cost. The revenue gap becomes progressively more pronounced in the 60% and 80% RES scenarios, as the low marginal costs of RES reduce electricity prices

Motor resonance during linguistic processing as shown by EEG in a naturalistic VR environment

International audienc

Fatal Bile Duct Necrosis: A Rare Complication of Transcatheter Arterial Chemoembolization in a Patient with Endocrine Hepatic Metastasis

We report the first case of fatal bile duct necrosis following transcatheter arterial chemoembolization (TACE) in a 58-year-old woman. The patient underwent two TACEs to treat hepatic metastases from an ileal endocrine tumor. Persistent cholestasis occurred after the second procedure, leading to the diagnosis of bile duct necrosis confirmed by liver biopsy. The patient died of liver failure with encephalopathy six months after the second TACE. Even though this complication is very rare, physicians should consider this diagnosis in patients who develop chronic, marked cholestasis following a TACE procedure