Building an interactive online textbook: a tool at our fingertips

BACKGROUND: Last year, we reported on the Health SciencesToolkit,which is an intensive bridging program that covers basic concepts in the disciplines of chemistry and biology, and then applies them to anatomy and physiology(Kapoor, Megaw, Harrison, Simcock & Miller 2018). We needed a resource that would lay the foundations for this diverse range of disciplines. As today's university students are often considered digital natives, we triedto source anE-book. Unable to finda commercially available text book pitched at an appropriate level, we decided to build our own, embracing Macknight's advice on creating online content to create ahealthylearning environment(2019).Here,we report on the development of a custom-made online textbook for ToolKit. PROCESS: The educational software company TopHat provided us access to online resources from which we could source and modify content. We produced a 10-chapter text book; each chapter matched a content module and explicitly linked with the learning outcomes of the subject. The modification included the insertion of links to interactive learning resources for student exploration. Each chapter concluded with a list of key words and concepts, a summary discussion, and selected multiple choice questions for knowledge consolidation and review; we were able to regulate the timing of the release of chapters.The textbook was hosted within the TopHatlearning platform and students were given access on payment of a minimal fee($11). REFLECTION: We found the development of the custom textbook a very efficient and effective process. We did not have to worry about copyright issues; or the time-consuming editing process for consistency, as the$6000 contract outlay to TopHat covered that. The resource can be edited, scaffolded and customised to future cohort needs(we can report on this process as we have also utilized this resource for an AQF-5 level diploma subject based on the ToolKit). Most importantly, the majority of students found the interactive text book useful for their understanding of the subject content, a finding supported by others (for example,Chen 2018) who have used custom-built online textbooks to create engaging digital learning environments

Galactomannan Does Not Precede Major Signs on a Pulmonary Computerized Tomographic Scan Suggestive of Invasive Aspergillosis in Patients with Hematological Malignancies

Background. Detection of serum galactomannan (GM) antigen and presence of the halo sign on a pulmonary computerized tomographic (CT) scan have a high specificity but a low sensitivity to diagnose invasive aspergillosis (IA) in patients at risk for this disease. To our knowledge, the relationship between the time at which pulmonary infiltrates are detected by CT and the time at which GM antigens are detected by enzyme immunoassay (EIA) has not been studied. Methods. In a prospective study, tests for detection of GM were performed twice weekly for patients with hematological malignancies who had undergone hematopoetic stem cell transplantation (HSCT) or had received induction and/or consolidation chemotherapy. A pulmonary CT scan was performed once weekly. Infiltrates were defined as either major or minor signs. IA was classified as proven, probable, or possible, in accordance with the definition stated by the European Organization for Research and Treatment of Cancer-Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group. Results. We analyzed 161 episodes of infection in 107 patients (65 allogeneic HSCT recipients, 30 autologous HSCT recipients, and 66 induction and/or consolidation chemotherapy recipients). A total of 109 episodes with no IA, 32 episodes with possible IA, and 20 episodes with probable or proven IA were identified. Minor pulmonary signs were detected by CT in 70 episodes (43%), and major pulmonary signs were detected by CT in 11 episodes (7%). Univariate and multivariate analyses revealed no significant association between detection of GM by EIA and detection of abnormal pulmonary signs by CT. A significant association was found between GM levels and receipt of piperacillin-tazobactam. GM test results were not positive before major signs were seen on CT images. Only 7 (10%) of 70 patients with minor pulmonary signs had positive GM test results before detection of the greatest pathologic change by CT. Conclusions. We show that detection of GM by EIA does not precede detection of major lesions by pulmonary CT. In the clinical setting, the decision to administer mold-active treatment should based on detection of new pulmonary infiltrates on CT performed early during infection, rather than on results of EIA for detection of G

COVID-19: Global radiation oncology's targeted response for pandemic preparedness

As the global COVID-19 pandemic escalates there is a need within radiation oncology to work to support our patients in the best way possible. Measures are required to reduce infection spread between patients and within the workforce. Departments need contingency planning to create capacity and continue essential treatments despite a reduced workforce. The #radonc community held an urgent online journal club on Twitter in March 2020 to discuss these issues and create some consensus on crucial next steps. There were 121 global contributors. This document summarises these discussions around themes of infection prevention, rationalisation of workload and working practice in the presence of infection

Axillary management in older women with early operable invasive breast carcinoma: a narrative review

Background and Objective: Breast cancer management in older women presents challenges due to competing comorbidities and life expectancy concerns. Traditional axillary surgeries as part of treatment of breast cancer are being reconsidered, particularly in two settings (I) early operable disease with positive sentinel lymph node biopsy (SLN+) and (II) cases of early operable clinically node-negative disease (cN0). Current guidelines and emerging evidence suggest that axillary lymph node dissection (ALND) may not always be necessary, especially in patients with low-risk disease. The objective of this study is to offer an updated synthesis of current guidelines and discuss the latest evidence from significant clinical studies. Methods: A literature search was conducted using the PubMed database and articles up to Nov 2023 were included for analysis. Key Content and Findings: Recent trials, including AMAROS and OTOASOR, demonstrate the non- inferiority of radiotherapy compared to ALND in early breast cancer with positive sentinel lymph node biopsy (SLNB), offering a shift towards de-escalation of axillary surgery. Similarly, studies like IBCSG 10- 93 highlight the potential benefits of omitting axillary surgery in clinically node-negative tumours, showing improved quality of life without compromising oncological outcomes. Despite promising findings from these studies, challenges remain, including disparities between real-world evidence and controlled trials. Variation in clinical management persists, influenced by factors such as trials designs, restricted inclusion criteria, and clinician interpretation. Ongoing trials are still needed to further elucidate the role of axillary surgery, particularly in older women, by assessing quality of life outcomes, the need for comprehensive geriatric assessment tools, and individualised treatment decisions. Conclusions: While evidence supporting the use of radiotherapy or adjuvant systemic therapy for managing axillary lymph nodes continues to grow, the reduction in both ALND and SLNB in older women may be on the horizon, emphasising the importance of tailored treatment approaches based on patient characteristic

An International Expert Delphi Consensus to Develop Dedicated Geriatric Radiation Oncology Curriculum Learning Outcomes.

PURPOSE: The management of older adults with cancer is rapidly becoming a significant challenge in radiation oncology (RO) practice. The education of future radiation oncologists in geriatric oncology is fundamental to ensuring that older adults receive high-quality care. Currently RO trainees receive little training and education in geriatric oncology. The objective of this study was to define core geriatric RO curriculum learning outcomes relevant to RO trainees worldwide. METHODS AND MATERIALS: A 2-stage modified Delphi consensus was conducted. Stage 1 involved the formation of an expert reference panel (ERP) of multiprofessional experts in geriatric oncology and/or RO and the compilation of a potential geriatric RO learning outcomes set. Stage 2 involved 3 iterative rounds: round 1 and round 2 (both online surveys), and an intervening ERP round. These aimed at identifying and refining ideal geriatric RO learning outcomes. Invited participants for round 1 and 2 included oncology health care professionals with expertise across RO, geriatric oncology, and/or education and consumers. Predefined Delphi consensus definitions were applied to the results of rounds 1 and 2. RESULTS: An ERP of 11 experts in geriatric oncology and/or RO was formed. Seventy potential knowledge- and skill-based learning outcomes were identified. In round 1, 103 of 179 invited eligible Delphi participants completed the survey (58% response rate). The ERP round was conducted, resulting in the exclusion of 28 learning outcomes. In round 2, 54 of 103 completed the survey (52% response rate). This identified a final total of 33 geriatric RO learning outcomes. CONCLUSIONS: The geriatric RO learning outcomes described in this study form an international consensus that can inform RO training bodies worldwide. This represents the first fundamental step in developing a global educational framework aimed at improving RO trainee knowledge and skills in geriatric oncology

Bone mineral density in breast cancer patients treated with adjuvant letrozole, tamoxifen, or sequences of letrozole and tamoxifen in the BIG 1-98 study (SAKK 21/07)

Background: The risk of osteoporosis and fracture influences the selection of adjuvant endocrine therapy. We analyzed bone mineral density (BMD) in Swiss patients of the Breast International Group (BIG) 1-98 trial [treatment arms: A, tamoxifen (T) for 5 years; B, letrozole (L) for 5 years; C, 2 years of T followed by 3 years of L; D, 2 years of L followed by 3 years of T]. Patients and methods: Dual-energy X-ray absorptiometry (DXA) results were retrospectively collected. Patients without DXA served as control group. Repeated measures models using covariance structures allowing for different times between DXA were used to estimate changes in BMD. Prospectively defined covariates were considered as fixed effects in the multivariable models. Results: Two hundred and sixty-one of 546 patients had one or more DXA with 577 lumbar and 550 hip measurements. Weight, height, prior hormone replacement therapy, and hysterectomy were positively correlated with BMD; the correlation was negative for letrozole arms (B/C/D versus A), known osteoporosis, time on trial, age, chemotherapy, and smoking. Treatment did not influence the occurrence of osteoporosis (T score < −2.5 standard deviation). Conclusions: All aromatase inhibitor regimens reduced BMD. The sequential schedules were as detrimental for bone density as L monotherap

Fuel poverty in the cost of living crisis

Access to energy is being severely restricted by the cost of living crisis, with almost a quarter of households experiencing fuel poverty, despite existing interventions. Here we draw on a large body of evidence on fuel poverty to summarise likely effects on households this winter. We find there is urgent need for further bill support, energy efficiency and targeted advice for vulnerable households

First-line temozolomide combined with bevacizumab in metastatic melanoma: a multicentre phase II trial (SAKK 50/07)

Background: Oral temozolomide has shown similar efficacy to dacarbazine in phase III trials with median progression-free survival (PFS) of 2.1 months. Bevacizumab has an inhibitory effect on the proliferation of melanoma and sprouting endothelial cells. We evaluated the addition of bevacizumab to temozolomide to improve efficacy in stage IV melanoma. Patients and methods: Previously untreated metastatic melanoma patients with Eastern Cooperative Oncology Group performance status of two or more were treated with temozolomide 150 mg/m2 days 1-7 orally and bevacizumab 10 mg/kg body weight i.v. day 1 every 2 weeks until disease progression or unacceptable toxicity. The primary end point was disease stabilisation rate [complete response (CR), partial response (PR) or stable disease (SD)] at week 12 (DSR12); secondary end points were best overall response, PFS, overall survival (OS) and adverse events. Results: Sixty-two patients (median age 59 years) enrolled at nine Swiss centres. DSR12 was 52% (PR: 10 patients and SD: 22 patients). Confirmed overall response rate was 16.1% (CR: 1 patient and PR: 9 patients). Median PFS and OS were 4.2 and 9.6 months. OS (12.0 versus 9.2 months; P = 0.014) was higher in BRAF V600E wild-type patients. Conclusions: The primary end point was surpassed showing promising activity of this bevacizumab/temozolomide combination with a favourable toxicity profile. Response and OS were significantly higher in BRAF wild-type patient

Chronic bee paralysis as a serious emerging threat to honey bees

This work was funded jointly by BBSRC grants BB/R00482X/1 (Newcastle University) and BB/R00305X/1 (University of St Andrews) in partnership with The Bee Farmers’ Association and the National Bee Unit of the Animal and Plant Health Agency.Chronic bee paralysis is a well-defined viral disease of honey bees with a global distribution that until recently caused rare but severe symptomatology including colony loss. Anecdotal evidence indicates a recent increase in virus incidence in several countries, but no mention of concomitant disease. We use government honey bee health inspection records from England and Wales to test whether chronic bee paralysis is an emerging infectious disease and investigate the spatiotemporal patterns of disease. The number of chronic bee paralysis cases increased exponentially between 2007 and 2017, demonstrating chronic bee paralysis as an emergent disease. Disease is highly clustered spatially within most years, suggesting local spread, but not between years, suggesting disease burnt out with periodic reintroduction. Apiary and county level risk factors are confirmed to include scale of beekeeping operation and the history of honey bee imports. Our findings offer epidemiological insight into this damaging emerging disease.Publisher PDFPeer reviewe