Inform Future Decisions Research Articles

Learning from our patients: An exploratory study to inform the development of a case tracking dashboard for internal medicine subspecialty fellows

Background Case tracking (following-up prior patient encounters) can help inform future clinical decisions and supplement experiential learning. Internal medicine subspecialty fellows see a high volume of patients and need to become subject matter experts within a short time frame, yet little is known about their specific needs and motivations around case tracking. Objective The objective of this study was to explore internal medicine subspecialty fellows’ motivations, preferences, and practices around case tracking. Methods We conducted interviews with internal medicine subspecialty fellows at a single academic medical center during the 2022–2023 academic year. Interviews were analyzed using qualitative content analysis. Results 22 fellows were interviewed for our study. We found that most fellows engaged in case tracking with lists in the electronic health record (EHR). Fellows primarily tracked cases of clinical uncertainty and patients with specific diseases or conditions of interest. Fellows sought information on patients’ health outcomes, results, and clinical notes. Motivations for tracking were predominantly related to curiosity, professional growth, and development of practice patterns. Barriers to case tracking included time, challenges maintaining patient lists, losing track of patients, and lack of motivation to develop and maintain an organized system. Conclusions Internal medicine subspecialty fellows engaged in and valued case tracking as a way to supplement their experiential learning. Our study highlighted their current practices, motivations, preferences, and challenges related to case tracking. We plan to use these findings to help develop an EHR-embedded dashboard to facilitate case tracking among subspecialty fellows.

Modelling Adverse Events in Patients Receiving Chronic Oral Corticosteroids in the UK.

Oral corticosteroids (OCS) are effective anti-inflammatory agents used across a range of conditions. However, substantial evidence associates their use with increased risks for adverse events (AEs), causing high burden on healthcare resources. Emerging biologics present as alternative agents, enabling the reduction of OCS use. However, current modelling approaches may underestimate their effects by not capturing OCS-sparing effects. In this study, we present a modelling approach designed to capture the health economic benefits of OCS-sparing regimens and agents. We developed a disease-agnostic model using a UK health technology assessment (HTA) perspective, with discounting of 3.5% for costs and outcomes, a lifetime horizon, and 4-week cycle length. The model structure included type 2 diabetes mellitus, established cardiovascular disease, and osteoporosis as key AEs and drivers of morbidity and mortality, as well as capturing transient events. Quality-adjusted life-years (QALYs), life-years, and costs were determined for OCS-only and OCS-sparing treatment arms. Outcomes were determined using baseline 50% OCS-sparing, considering several OCS average daily doses (5, 10, 15mg). A treatment regimen with 50% OCS dose-sparing led to lifetime incremental cost savings per patient of £1107 (95% confidence interval £1014-£1229) at 5mg, £2403 (£2203-£2668) at 10mg, and £19,501 (£748-£51,836) at 15mg. Patients also gained 0.033 (0.030-0.036) to 0.356 (0.022-2.404) QALYs dependent on dose. The benefits of OCS sparing were long-term, plateauing after 35-40years of treatment. We present a modelling approach that captures additional long-term health economic benefits from OCSsparing that would otherwise be missed from current modelling approaches. These results may help inform future decision making for emerging OCS-sparing therapeutics by comparing them against the cost of such treatments.

Effectiveness of the Application of the Integrated Population Information System (Sintren) in the Issuance of Death Certificates at the Population and Civil Registration Office of Cirebon Regency

The Integrated Population Information System (SINTREN) is a collection of actions to organize and distribute death certificate documents and population data electronically or via the internet using existing technology, communication, and information facilities. The SINTREN system is used with the aim of providing convenience in population administration services related to death certificates in Cirebon Regency. This research aims to review whether the management of the application or website is able to cut the distance and time of users to be more efficient. The research employs a qualitative approach through observation, documentation, and observations, with a particular focus on informants who were directly involved in the application of the SINTEREN application for issuing death certificates. Data analysis was conducted using Budiani's theory of effectiveness, which includes evaluating the accuracy of program goals, the effectiveness of program socialization, the achievement of program objectives, and the monitoring mechanisms in place. The study contributes by analyzing and interpreting data collected from various sources, providing insights into its implementation, functionality, and impact on improving population and civil registration services. This study could help identify areas for improvement, enhance system efficiency, and inform future policy decisions regarding population information management in the region.

Metaheuristic algorithms applied in ANN salinity modelling

Salinity is a classic problem in planning the quality of freshwater resources management. Recent studies related to hybrid machine learning models have shown it's capability to simulate salinity dynamics. However, previous studies of metaheuristic algorithms have not dealt with comparing single- and hybrid-based algorithms in much detail. The present study aimed to develop univariate salinity by applying an artificial neural network model (ANN) integrated with (hybrid-based) coefficient-based particle swarm optimisation and chaotic gravitational search algorithm (CPSOCGSA). The methodology was developed and tested using electrical conductivity (EC) and total dissolved solids (TDS) data collected from the Euphrates River in Babylon Province, Iraq, from 2010 to 2019. The CPSOCGSA performance was evaluated by various single-based ones, including multi-verse optimiser (MVO), marine predator's optimisation algorithm (MPA), particle swarm optimiser (PSO), and the slim mould algorithm (SMA). The principal finding here confirms that hybrid-based outperformed four single-based algorithms based on different criteria. The outcomes for TDS were 0.004, 0.0248, and 0.98 for CPSOCGSA-ANN technique concern scatter index (SI), root-mean-squared error (RMSE), and correlation coefficient (R2), respectively. For EC, the results were 0.96 for R2, 0.0386 for RMSE, and 0.006 for SI. Due to its predictive accuracy, the proposed CPSOCGSA-ANN approach is suggested as a potential strategy for predicting monthly salinity data. Considering agriculture's vital role in Babylon Province's economy, this study may help inform future freshwater quality management decisions.

Anthropogenic Eutrophication Drives Major Food Web Changes in Mwanza Gulf, Lake Victoria

Discerning ecosystem change and food web dynamics underlying anthropogenic eutrophication and the introduction of non-native species is necessary for ensuring the long-term sustainability of fisheries and lake biodiversity. Previous studies of eutrophication in Lake Victoria, eastern Africa, have focused on the loss of endemic fish biodiversity over the past several decades, but changes in the plankton communities over this same time remain unclear. To fill this gap, we examined sediment cores from a eutrophic embayment, Mwanza Gulf, to determine the timing and magnitude of changes in the phytoplankton and zooplankton assemblages over the past century. Biogeochemical proxies indicate nutrient enrichment began around ~ 1920 CE and led to rapid increases in primary production, and our analysis of photosynthetic pigments revealed three zones: pre-eutrophication (prior to 1920 CE), onset of eutrophication with increases in all pigments (1920–1990 CE), and sustained eutrophication with cyanobacterial dominance (1990 CE–present). Cladoceran remains indicate an abrupt decline in biomass in ~ 1960 CE, in response to the cumulative effects of eutrophication and lake-level rise, preceding the collapse of haplochromine cichlids in the 1980s. Alona and Chydorus, typically benthic littoral taxa, have remained at relatively low abundances since the 1960s, whereas the abundance of Bosmina, typically a planktonic taxon, increased in the 1990s concurrently with the biomass recovery of haplochromine cichlid fishes. Overall, our results demonstrate substantial changes over the past century in the biomass structure and taxonomic composition of Mwanza Gulf phytoplankton and zooplankton communities, providing a historical food web perspective that can help understand the recent changes and inform future resource management decisions in the Lake Victoria ecosystem.

Teaching as a Prospective Career: Motivators and Disincentives

There is a growing sentiment that teaching, as a prospective career, is losing its attractiveness. Encouraging young people to pursue a career in teaching is becoming a challenge. A teacher shortage crisis is being experienced globally, and locally a similar situation has evolved. Young people are shying away from teaching as a career. In this scenario, a quantitative study to investigate 16- to 18-year-olds’ perspectives on teaching as a prospective career will be conducted through a questionnaire survey. The participants, all in post-secondary institutions, will be invited to share their opinions and ideas on the topic. The aim of this research is to comprehend the factors that encourage or discourage 16- to 18-year-olds when considering teaching as their prospective career. The research findings could help inform future decisions at a policy level to help render teaching a desirable profession. The motivators and disincentives perceived by young people could provide a valuable perspective to different stakeholders who are interested in overcoming the teacher shortage crisis and in attracting the best talent from young people for the teaching profession.

A Study on Entrepreneurial Inclination and Characteristics of Students of Civil Engineering in Nepal- A Case Study of Himalayan Institute of Science and Technology (HIST), Nepal

A study conducted at the Himalayan Institute of Science and Technology (HIST) in Nepal explored entrepreneurial inclinations and characteristics among Civil Engineering students, aiming to achieve three objectives. Firstly, the study assessed entrepreneurial inclination among these students. Secondly, it examined demographic factors associated with entrepreneurial tendencies. Lastly, it identified and analyzed perceived entrepreneurial traits among engineering students. The study included students from all years of the Civil Engineering program, with over 80% responding to a questionnaire survey. Demographic analysis revealed a male majority across all age groups, with a significant portion falling within the 18-24 age range. Most fathers were engaged in occupations categorized as "Other," while mothers predominantly fell into the same category. Limited representation was observed in government sectors for both parents. Student engagement in extracurricular activities varied, with a notable increase in entrepreneurial activities among older age groups. T-test results highlighted gender disparities in certain areas, although both male and female students demonstrated entrepreneurial tendencies. These findings underscore the importance of entrepreneurial education and inform future research and policy decisions. T-test analyses further revealed nuanced insights into age groups and entrepreneurial aptitude, suggesting the need for tailored educational approaches. Successful entrepreneurship was associated with higher scores in networking, leadership, time management, and sales/marketing skills. The study emphasized the significance of adaptability, resilience, customer orientation, and efficient time management in entrepreneurship. These insights can inform entrepreneurship education programs, emphasizing key characteristics and addressing diverse perceptions among aspiring entrepreneurs. Further research is recommended to explore the underlying factors contributing to age-related entrepreneurial differences

Quantifying the Cost of Shigella Diarrhea in the Enterics for Global Health (EFGH) Shigella Surveillance Study.

Comparative costs of public health interventions provide valuable data for decision making. However, the availability of comprehensive and context-specific costs is often limited. The Enterics for Global Health (EFGH) Shigella surveillance study-a facility-based diarrhea surveillance study across 7 countries-aims to generate evidence on health system and household costs associated with medically attended Shigella diarrhea in children. EFGH working groups comprising representatives from each country (Bangladesh, Kenya, Malawi, Mali, Pakistan, Peru, and The Gambia) developed the study methods. Over a 24-month surveillance period, facility-based surveys will collect data on resource use for the medical treatment of an estimated 9800 children aged 6-35 months with diarrhea. Through these surveys, we will describe and quantify medical resources used in the treatment of diarrhea (eg, medication, supplies, and provider salaries), nonmedical resources (eg, travel costs to the facility), and the amount of caregiver time lost from work to care for their sick child. To assign costs to each identified resource, we will use a combination of caregiver interviews, national medical price lists, and databases from the World Health Organization and the International Labor Organization. Our primary outcome will be the estimated cost per inpatient and outpatient episode of medically attended Shigella diarrhea treatment across countries, levels of care, and illness severity. We will conduct sensitivity and scenario analysis to determine how unit costs vary across scenarios. Results from this study will contribute to the existing body of literature on diarrhea costing and inform future policy decisions related to investments in preventive strategies for Shigella.

Top Year for High-Impact Global Exploration in the Cards

This year is being viewed as a bounce-back period for high-impact oil and gas drilling after a lackluster 2023, with Africa and Latin America pegged to lead the way. Researchers at Rystad Energy have identified 36 potential high-impact wells to be drilled or spud in 2024, the highest annual total since it started tracking the market in 2015. This year’s slate would mark a sizable jump from the 27 high-impact wells drilled in 2023. Of the 36 potentially significant wells, 13 are in Africa and 10 in Latin America, accounting for almost 64% of the global total. Explorers will drill six of these in Asia, two each in the Middle East, Europe, and North America, and one in Oceania with TotalEnergies’ planned exploration in Papua New Guinea. Rystad found only eight of the 27 high-impact wells drilled in 2023 resulted in commercially movable volumes, a success rate of less than 30%, well below the annual average of 42%. These wells discovered volumes of 1 billion BOE, a sharp decline from the 3.5 billion BOE found in 2022, and they accounted for 20% of the 5 billion BOE discovered by all exploration activities globally last year. In addition, 2023 was an expensive year, with drilling costs rising due to a significantly tighter rig market than in prior years, worsening the blow of a low success rate. Rystad Energy classifies high-impact wells through a combination of factors including the size of the prospect, whether they would unlock new hydrocarbon resources in frontier areas or emerging basins, and their significance to an operator’s strategy. Of the high-impact wells planned this year, 14 will be drilled in frontier and emerging basins, with three opening new plays entirely. Eight planned high-impact wells target prospective offshore resources of more than 430 million BOE and considerable prospective onshore resources of more than 230 million BOE, according to the research firm. The remaining 11 wells are strategically relevant for their respective operators, meaning exploration success would help them gain traction in the region or inform future operational decisions. If all planned wells proceed as scheduled, 2024 would see the highest number of high-impact wells drilled in at least 10 years. Oil majors like BP, Chevron, Eni, ExxonMobil, Shell, and TotalEnergies will dominate high-impact well drilling. About 16 (44%) of the total wells planned will be drilled by these companies, with TotalEnergies planning five, Shell three, and Chevron, Eni, and ExxonMobil targeting two each. Most drilling will be undertaken in the Atlantic margin and Asian waters. National oil companies and internationally focused NOCs will account for eight (22%) of this year’s planned wells, with upstream operators responsible for 17% and smaller operators for the remainder, according to Rystad. Around 70% of African wells will be drilled in frontier and emerging basins or will open new plays. Important frontier wells include in the Red Sea offshore Egypt, in the Angoche Basin offshore Mozambique, and in the Namibe Basin offshore Angola.

Imperfect detection and misidentification affect inferences from data informing water operation decisions

AbstractObjectiveManagers can modify river flow regimes using fish monitoring data to minimize impacts from water management infrastructure. For example, operation of the gate‐controlled Delta Cross Channel (DCC) in California can negatively affect the endangered Sacramento River winter‐run Chinook Salmon Oncorhynchus tshawytscha. Although guidelines have been developed for DCC operations by using real‐time juvenile fish sampling count data, there is uncertainty about how environmental conditions influence fish occupancy and the extent to which those relationships are affected by sampling and identification error.MethodsWe evaluated the effect of environmental conditions, imperfect detection, and misidentification error on salmon occupancy by analyzing data using hierarchical multistate occupancy models. A total of 14,147 trawl tows and beach seine hauls were conducted on 1058 sampling days between October and December from 1996 to 2019. During these surveys, 2803 juvenile winter‐run Chinook Salmon were identified, and approximately 29% of the sampling days had at least one winter‐run juvenile detected.ResultThe probability of misidentifying an individual juvenile winter‐run Chinook Salmon in the field was estimated to be 0.056 based on fish identification examinations and genetic sampling. Occupancy varied considerably and was related to flow characteristics, water clarity, weather, time of year, and whether occupancy was detected during the previous sampling day. However, these relationships and their significance changed considerably when accounting for imperfect detection and the probability of misidentifying individual juvenile salmon. Detection was <0.3 under average sampling conditions during a single sample and was influenced by flow, water clarity, site, and volume sampled.ConclusionOur modeling results indicate that DCC gate closure decisions could occur on fewer days when imperfect detection and misidentification error are not accounted for. These findings demonstrate the need to account for identification and detection error while using monitoring data to assess factors influencing fish occupancy and inform future management decisions.

A refined measurement method of highway truck carbon emissions in the context of carbon peaking and carbon neutrality --Take G30 Yandun Toll Station as an Example

This study uses two different carbon emission factor methods to analyze the differences in carbon emissions from trucks under different types and times. The analysis is based on the Xinjiang Expressway Database and other data, with the G30 Yandun Toll Station as an example. The study aims to provide insight into the environmental impact of trucking and inform future policy decisions. The study indicates that heavy-duty trucks are responsible for 90% and 97% of the total carbon emissions from all trucks, respectively. The number of vehicles and the type of trucks are the main factors contributing to these emissions. Additionally, the second quarter shows the highest carbon emissions, while the first quarter exhibits the most considerable difference between the results of the two methods. In March, carbon emissions were at their highest. Additionally, the fuel consumption of trucks with GVW ⩾ 31000kg was the highest, with a significant difference between the results of the two methods. It is worth noting that the fuel consumption of trucks with GVW ⩾ 31000kg was also measured. This study provides data to support the implementation of policies related to transportation carbon emissions in Xinjiang. The paper is significant for promoting green travel.

What's in the Box? Preschoolers Consider Ambiguity, Expected Value, and Information for Future Decisions in Explore-Exploit Tasks.

Self-directed exploration in childhood appears driven by a desire to resolve uncertainties in order to learn more about the world. However, in adult decision-making, the choice to explore new information rather than exploit what is already known takes many factors beyond uncertainty (such as expected utilities and costs) into account. The evidence for whether young children are sensitive to complex, contextual factors in making exploration decisions is limited and mixed. Here, we investigate whether modifying uncertain options influences explore-exploit behavior in preschool-aged children (48-68 months). Over the course of three experiments, we manipulate uncertain options' ambiguity, expected value, and potential to improve epistemic state for future exploration in a novel forced-choice design. We find evidence that young children are influenced by each of these factors, suggesting that early, self-directed exploration involves sophisticated, context-sensitive decision-making under uncertainty.

A Descriptive Study ofCasualties Evacuated Out ofAfghanistan by Critical Care Air Transport Teams During the Withdrawal ofU.S. Troops.

The War in Afghanistan ended in August 2021. Evacuation from the country was a large effort during the last days of the conflict. During evacuation efforts at Kabul Hamid Karzai International Airport, a suicide bombing occurred necessitating emergent medical care for many injured troops and civilians. The U.S. Air Force Critical Care Air Transport Teams (CCATTs) played a role in the medical care provided during the operations in Afghanistan. We report on in-flight events and interventions that took place during the final days of the Afghanistan withdrawal. We performed a retrospective chart review of patients requiring aeromedical evacuation from the Afghanistan theater of operations by CCATT from July 1 to August 30, 2021. From the CCATT patient care record, data abstractors collected patient characteristics, flight information, vital signs, laboratory values, in-flight interventions, and in-flight events in a study-specific electronic database. We performed descriptive analyses of patient characteristics and in-flight interventions. This study was approved by the San Antonio Institutional Review Board. Nine patients were included in this analysis. Seven out of nine patients were foreign nationals; the remaining two were U.S. Marines. Five patients suffered penetrating injuries from gunshot wounds and four suffered blast injuries. Six received intravenous narcotic analgesia. Four received intravenous sedatives, and four received antibiotics in flight. Two patients required chest tube management. One patient received blood. Three patients were in acute respiratory distress. Severe injuries were sustained during the withdrawal efforts at the end of the War in Afghanistan. Critical Care Air Transport Teams played a role in the care and evacuation of patients out of theater during this unique and unprecedented time. Even given the limitations associated with retrospective studies and a small sample size, information reported in this study can help inform future decisions, and aid in preparatory efforts for future operations, that may require medical care by CCATT.

Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation

Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation

Differentiation of Hair Sheep Breeds Based on the Physiological and Blood Biochemical Changes in Response to Different Stressors Using Multivariate Analysis Techniques.

Physiological and blood measurement changes due to high heat load, restricted feed intake, and limited drinking water availability in 135 animals of three hair sheep breeds (Dorper, Katahdin, and St. Croix) were subjected to multivariate analysis techniques. The objective of this analysis was to evaluate the ability of these variables to separate individual hair sheep into groups based on adaptation characteristics in response to three physiological stressors and identify variables with greater discriminatory power. There were 16, 8, and 13 physiological and blood variables obtained from high heat load, restricted feed consumption, and water intake studies, respectively, for multivariate analysis. Physiological variables such as respiration rate, rectal and skin temperature, and panting score were measured only in the heat stress study. The results of the cluster and canonical discriminant analyses showed the presence of wide divergence (p < 0.05) between St. Croix and other breeds in their responses to high heat loads and restricted-feed- and -water-intake conditions. Dorper and Katahdin were grouped (p > 0.05) together based on the changes in physiological variables, which were separated (p < 0.05) from those of St. Croix as a resilient group. The stepwise discriminant analysis indicated that skin temperature, panting score, rectal temperature, respiration rate, and blood urea nitrogen and oxygen concentrations were the significant (p < 0.05) discriminating variables in clustering individual sheep into groups based on their responses to the high-heat-stress condition. Under the limited feed intake condition, the significant (p < 0.05) traits responsible for the separation of St. Croix from Dorper and Katahdin were blood triglyceride and cholesterol concentrations, whereas blood hemoglobin, osmolality, protein, and albumin were most important discriminating variables under the limited water intake condition. In conclusion, the results of the present study suggest that the stress responses of Dorper and Katahdin are similar and different from that of St. Croix. This finding can be useful information for future decisions in developing climate-resilient sheep through selective breeding.

Perception and acceptance of robots in dairy farming—a cluster analysis of German citizens

AbstractSocietal attitude acceptance can influence the digital transformation in agriculture. Digital technologies, such as robots in dairy farming, can lead to more sustainable, animal welfare-friendly and consumer-oriented milk production. This study used the example of the milking and feeding robots to investigate whether society accepts the use of robots in dairy farming and whether there are differences in society based on perceived risks and opportunities of digitalization in dairy farming and acceptance. To this end, an online-based study was conducted with a total of 1007 citizens in Germany. Overall, the respondents in this study suspect that the use of robots in dairy farming is associated with various risks but also with opportunities for society and for farmers in particular. However, these attitudes are quite heterogeneous. Four clusters could be identified: “proponents of robots”, “indifferent citizens”, “skeptical citizens”, and “critical supporters of robots”. Proponents of robots see only opportunities and little risks, whereas the critical citizens perceive not only opportunities but also many risks of using robots in dairy farming. The indifferent citizens show a rather indifferent attitude, in contrast to the skeptical citizens, who reject the opportunities at the societal level, while they agree with the opportunities of robots for farmers. This research contributes to understanding societal attitudinal acceptance and highlights differences in society that can help inform future decisions about the development and adoption of robots in dairy farming.

Urbanization driving Ocypode quadrata burrow density, depth, and width across Caribbean beaches

Globally, sandy beaches support local economies and are the most commonly-used type of coastline. This importance is perhaps most striking in the Caribbean; however, no study has assessed the morphological features of the U.S. Virgin Islands (USVI) sandy beaches or evaluated how their biodiversity is influenced by human activities. We addressed these gaps by sampling eight St. Thomas, USVI, beaches with different urbanization levels (Stumpy Bay, Santa Maria Bay, Caret Bay, Neltjeberg Bay, Lindberg Bay, Magens Bay, Coki Point Beach, and Sapphire Beach) multiple times during high- and low-tourist season. At each sampling site and occasion, we measured environmental features (i.e., grain size, waves, and slope), urbanization variables (e.g., solid waste, traffic of vehicles, and beach cleaning) and ghost crab (Ocypode quadrata) population parameters (i.e., burrow density, depth, and width). We found that all studied beaches have similar morphodynamic features, being generally characterized as wave dominated reflective. Urbanization variables were the main drivers of ghost crab populations, with visitor frequency, distance to urban center, and evidence of vehicles on sand exerting stronger roles than variations in physical beach characteristics. Overall, our results provide important information on the morphology of USVI beaches and the impact of beach use. We expect these results will increase understanding of the drivers and threats to local sandy beach biodiversity, inform future management decisions for the territory, while creating a baseline for ghost crab studies in the U.S. Virgin Islands.

Metastatic Prostate Cancers with BRCA2 versus ATM Mutations Exhibit Divergent Molecular Features and Clinical Outcomes.

In patients with metastatic prostate cancer (mPC), ATM and BRCA2 mutations dictate differences in PARPi inhibitor response and other therapies. We interrogated the molecular features of ATM- and BRCA2-mutated mPC to explain the divergent clinical outcomes and inform future treatment decisions. We examined a novel set of 1,187 mPCs after excluding microsatellite-instable (MSI) tumors. We stratified these based on ATM (n = 88) or BRCA2 (n = 98) mutations. As control groups, mPCs with mutations in 12 other homologous recombination repair (HRR) genes were considered non-BRCA2/ATM HRR-deficient (HRDother, n = 193), whereas lack of any HRR mutations were considered HRR-proficient (HRP; n = 808). Gene expression analyses were performed using Limma. Real-world overall survival was determined from insurance claims data. In noncastrate mPCs, only BRCA2-mutated mPCs exhibited worse clinical outcomes to AR-targeted therapies. In castrate mPCs, both ATM and BRCA2 mutations exhibited worse clinical outcomes to AR-targeted therapies. ATM-mutated mPCs had reduced TP53 mutations and harbored coamplification of 11q13 genes, including CCND1 and genes in the FGF family. BRCA2-mutated tumors showed elevated genomic loss-of-heterozygosity scores and were often tumor mutational burden high. BRCA2-mutated mPCs had upregulation of cell-cycle genes and were enriched in cell-cycle signaling programs. This was distinct from ATM-mutated tumors. Tumoral ATM and BRCA2 mutations are associated with differential clinical outcomes when patients are stratified by treatments, including hormonal or taxane therapies. ATM- and BRCA2-mutated tumors exhibited differences in co-occurring molecular features. These unique molecular features may inform therapeutic decisions and development of novel therapies.

Tunnelled central venous catheters for incident haemodialysis patients: a Victorian survey exploring reasons for use.

Tunnelled central venous catheters (T-CVCs) are used globally as vascular access for patients on haemodialysis (HD) but are associated with increased sepsis, mortality, cost and length of hospitalisation compared with more permanent HD vascular access. The reasons for using T-CVC are varied and poorly understood. A significant and increasing proportion of incident HD patients in Victoria, Australia, have required T-CVC over the last decade. To explore reasons for a significant and increasing proportion of incident HD patients in Victoria, Australia, having required T-CVC over the last decade. With rates of starting HD with definitive vascular access consistently below a Victorian quality indicator target of 70%, an online survey was developed to explore reasons why the rate remained lower than desired and to help inform future decisions about this quality indicator. The survey was completed by dialysis access coordinators over an 8-month period and involved all public nephrology services in Victoria. Of the 125 surveys completed, 101 incident HD patients had no attempt at permanent vascular access prior to T-CVC insertion. For almost half of these (48 patients), there was no active medical decision not to create permanent vascular access prior to commencing dialysis. Reasons for insertion of the T-CVC included deterioration of kidney function faster than anticipated, surgical referral being overlooked, complications related to peritoneal dialysis requiring a change in dialysis modality and changes to initial decisions regarding dialysis modality for kidney failure. These survey results provide an opportunity for quality improvement initiatives with respect to dialysis access planning and care.

Examining the Hydro-Climatic Drivers of Lagoon Breaching and Healing in a Deltaic Barrier

As sea-level rise (SLR) and human-made interventions affect coastal currents and sediment transport, coastal barriers have become more vulnerable to the effect of storms, hurricanes, and climate variability. The response of each barrier is unique and depends on wave regime, coastline orientation, weather conditions, bathymetry, and type of human-made interventions, among other factors. In the Magdalena River deltaic barrier, located on the Colombian Caribbean coast, coastal erosion has caused the loss of hundreds of square kilometers of critical ecosystems, such as wetlands and lagoons, since the 1960s. This work aims to analyze the short-term drivers behind the observed loss of lagoons, particularly the drivers of lagoon breaching events and subsequent healing along the deltaic barrier. Lagoon breaching events and healings were detected using satellite imagery, and the timing of these events was related to prior local atmospheric, oceanographic, and fluvial conditions. The findings reveal that the dynamics of the lagoons are driven by extreme river discharges and energetic wave conditions associated with storms or hurricanes. Healing is driven by the sediment supplied by littoral currents and average waves punctuated by energetic events. The cumulative effect of breaching and healing has resulted in a deltaic barrier that has rolled over the lagoons, reducing their size over time. These findings provide a better understanding of the forces of coastal retreat and will help inform future management decisions of the coastal zone.