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A primary barrier to translation of clinical research discoveries into care delivery and population health is the lack of sustainable infrastructure bringing researchers, policymakers, practitioners, and communities together to reduce silos in knowledge and action. As National Institutes of Healthʼs (NIH) mechanism to advance translational research, Clinical and Translational Science Award (CTSA) awardees are uniquely positioned to bridge this gap. Delivering on this promise requires sustained collaboration and alignment between research institutions and public health and healthcare programs and services. We describe the collaboration of seven CTSA hubs with city, county, and state healthcare and public health organizations striving to realize this vision together. Partnership representatives convened monthly to identify key components, common and unique themes, and barriers in academic–public collaborations. All partnerships aligned the activities of the CTSA programs with the needs of the city/county/state partners, by sharing resources, responding to real-time policy questions and training needs, promoting best practices, and advancing community-engaged research, and dissemination and implementation science to narrow the knowledge-to-practice gap. Barriers included competing priorities, differing timelines, bureaucratic hurdles, and unstable funding. Academic–public health/health system partnerships represent a unique and underutilized model with potential to enhance community and population health.
Every nuclear weapons program for decades has relied extensively on illicit imports of nuclear-related technologies. This book offers the most detailed public account of how states procure what they need to build nuclear weapons, what is currently being done to stop them, and how global efforts to prevent such trade could be strengthened. While illicit nuclear trade can never be stopped completely, effective steps to block illicit purchases of nuclear technology have sometimes succeeded in slowing nuclear weapons programs and increasing their costs, giving diplomacy more chance to work. Hence, this book argues, preventing illicit transfers wherever possible is a key element of an effective global non-proliferation strategy.
The discovery of the first electromagnetic counterpart to a gravitational wave signal has generated follow-up observations by over 50 facilities world-wide, ushering in the new era of multi-messenger astronomy. In this paper, we present follow-up observations of the gravitational wave event GW170817 and its electromagnetic counterpart SSS17a/DLT17ck (IAU label AT2017gfo) by 14 Australian telescopes and partner observatories as part of Australian-based and Australian-led research programs. We report early- to late-time multi-wavelength observations, including optical imaging and spectroscopy, mid-infrared imaging, radio imaging, and searches for fast radio bursts. Our optical spectra reveal that the transient source emission cooled from approximately 6 400 K to 2 100 K over a 7-d period and produced no significant optical emission lines. The spectral profiles, cooling rate, and photometric light curves are consistent with the expected outburst and subsequent processes of a binary neutron star merger. Star formation in the host galaxy probably ceased at least a Gyr ago, although there is evidence for a galaxy merger. Binary pulsars with short (100 Myr) decay times are therefore unlikely progenitors, but pulsars like PSR B1534+12 with its 2.7 Gyr coalescence time could produce such a merger. The displacement (~2.2 kpc) of the binary star system from the centre of the main galaxy is not unusual for stars in the host galaxy or stars originating in the merging galaxy, and therefore any constraints on the kick velocity imparted to the progenitor are poor.
Olfactory neuroblastoma is a rare sinonasal malignancy, with poorly defined treatment protocols. Management at a tertiary centre was retrospectively evaluated to inform future treatment and follow up.
Cases treated with curative intent (2000–2014) were included. Data were collected, and overall and disease-free survival rates were calculated.
Eleven cases were identified, with a median follow up of 87 months. One patient was Kadish stage A, one was stage B, eight were stage C and one was stage D. The latter patient underwent chemoradiotherapy alone. The remaining patients proceeded to: endoscopic-assisted wide local excision (n = 2), anterior craniofacial resection (n = 4) or endoscopic craniofacial resection (n = 4). No patients had primary nodal disease or elective neck treatment. One patient had neoadjuvant chemoradiation. Six patients had post-operative radiotherapy; three received adjuvant chemotherapy. Two patients had late cervical node failure, and proceeded to neck dissection and post-operative radiotherapy. Two patients had late local recurrence. Ten-year overall and disease-free survival rates were 68.2 and 46.7 per cent, respectively.
Longer-term follow up is supported given the incidence of late regional and local recurrence. Prophylactic treatment of cervical nodes in locally advanced disease is an area for further investigation.
Maternal diet-induced obesity can cause detrimental developmental origins of health and disease in offspring. Perinatal exposure to a high-fat diet (HFD) can lead to later behavioral and metabolic disturbances, but it is not clear which behaviors and metabolic parameters are most vulnerable. To address this critical gap, biparental and monogamous oldfield mice (Peromyscus polionotus), which may better replicate most human societies, were used in the current study. About 2 weeks before breeding, adult females were placed on a control or HFD and maintained on the diets throughout gestation and lactation. F1 offspring were placed at weaning (30 days of age) on the control diet and spatial learning and memory, anxiety, exploratory, voluntary physical activity, and metabolic parameters were tested when they reached adulthood (90 days of age). Surprisingly, maternal HFD caused decreased latency in initial and reverse Barnes maze trials in male, but not female, offspring. Both male and female HFD-fed offspring showed increased anxiogenic behaviors, but decreased exploratory and voluntary physical activity. Moreover, HFD offspring demonstrated lower resting energy expenditure (EE) compared with controls. Accordingly, HFD offspring weighed more at adulthood than those from control fed dams, likely the result of reduced physical activity and EE. Current findings indicate a maternal HFD may increase obesity susceptibility in offspring due to prenatal programming resulting in reduced physical activity and EE later in life. Further work is needed to determine the underpinning neural and metabolic mechanisms by which a maternal HFD adversely affects neurobehavioral and metabolic pathways in offspring.
This study aimed to compare management, readmission rates and length of in-patient stay amongst warfarinised and non-warfarinised patients to ascertain future treatment protocols.
A 12-month retrospective review was conducted of ENT epistaxis admissions. Admission details such as length of in-patient stay, clotting profile and management plan were recorded. Comparisons of management and outcome for warfarinised and non-warfarinised patients were made using the Fisher's exact paired t-test.
Of 176 epistaxis patients admitted, 31 per cent were warfarinised, 18 per cent were on another form of anticoagulation or antiplatelet therapy, and 51 per cent were not on any medication that might impose a bleeding risk. The international normalised ratio at admission was high in 13 per cent of warfarinised patients; the remaining patients had therapeutic or sub-therapeutic international normalised ratios and so warfarin was continued. The mean in-patient stay was similar for all cohorts; however, warfarinised patients had a higher readmission rate.
Warfarinised epistaxis patients may be safely managed without stopping their anticoagulation therapy, provided their international normalised ratio is at therapeutic or sub-therapeutic levels. By continuing regular anticoagulation therapy, warfarinised patients may be discharged without delay.
An estimated 800 million people live within 100 km of an active volcano in 86 countries and additional overseas territories worldwide [see Chapter 4 and Appendix B]1. Volcanoes are compelling evidence that the Earth is a dynamic planet characterised by endless change and renewal. Humans have always found volcanic activity fascinating and have often chosen to live close to volcanoes, which commonly provide favourable environments for life. Volcanoes bring many benefits to society: eruptions fertilise soils; elevated topography provides good sites for infrastructure (e.g. telecommunications on elevated ground); water resources are commonly plentiful; volcano tourism can be lucrative; and volcanoes can acquire spiritual, aesthetic or religious significance. Some volcanoes are also associated with geothermal resources, making them a target for exploration and a potential energy resource.
Much of the time volcanoes are not a threat because they erupt very infrequently or because communities have become resilient to frequently erupting volcanoes. However, there is an everpresent danger of a long-dormant volcano re-awakening or of volcanoes producing anomalously large or unexpected eruptions. Volcanic eruptions can cause loss of life and livelihoods in exposed communities, damage or disrupt critical infrastructure and add stress to already fragile environments. Their impacts can be both short-term, e.g. physical damage, and long-term, e.g. sustained or permanent displacement of populations. The risk from volcanic eruptions and their attendant hazards is often underestimated beyond areas within the immediate proximity of a volcano. For example, volcanic ash hazards can have effects hundreds of kilometres away from the vent and have an adverse impact on human and animal health, infrastructure, transport, agriculture and horticulture, the environment and economies. The products of volcanism and their impacts can extend beyond country borders, to be regional and even global in scale.
Although known historical loss of life from volcanic eruptions (since 1600 AD about 280,000 fatalities are recorded, Auker et al. (2013)) is modest compared to other major natural hazards, volcanic eruptions can be catastrophic for exposed communities. In 1985 the town of Armero in Colombia was buried by lahars (volcanic mudflows) with more than 21,000 fatalities due to relatively small explosive eruptions at the summit of Nevado del Ruiz volcano that partially melted a glacier (Voight, 1990).
The 2013 Infection Prevention and Control (IP&C) Guideline for Cystic Fibrosis (CF) was commissioned by the CF Foundation as an update of the 2003 Infection Control Guideline for CF. During the past decade, new knowledge and new challenges provided the following rationale to develop updated IP&C strategies for this unique population:
1. The need to integrate relevant recommendations from evidence-based guidelines published since 2003 into IP&C practices for CF. These included guidelines from the Centers for Disease Control and Prevention (CDC)/Healthcare Infection Control Practices Advisory Committee (HICPAC), the World Health Organization (WHO), and key professional societies, including the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). During the past decade, new evidence has led to a renewed emphasis on source containment of potential pathogens and the role played by the contaminated healthcare environment in the transmission of infectious agents. Furthermore, an increased understanding of the importance of the application of implementation science, monitoring adherence, and feedback principles has been shown to increase the effectiveness of IP&C guideline recommendations.
2. Experience with emerging pathogens in the non-CF population has expanded our understanding of droplet transmission of respiratory pathogens and can inform IP&C strategies for CF. These pathogens include severe acute respiratory syndrome coronavirus and the 2009 influenza A H1N1. Lessons learned about preventing transmission of methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant gram-negative pathogens in non-CF patient populations also can inform IP&C strategies for CF.
Chronic obliterative otitis externa is a rare cause of conductive hearing loss, characterised by stenosis of the deep ear canal secondary to chronic inflammation. A multitude of canalplasty techniques have been described, with variable success.
Fourteen patients undergoing canalplasty performed by the senior author for refractory obliterative otitis externa, over an 8-year period, were included in the study. All underwent split-skin grafting of the denuded canal and meticulous post-operative aural care. Outcome measures included the Glasgow Benefit Inventory and pure tone audiology.
At 3 months post-operatively, the four-tone average threshold had improved by a mean of 13.9 dB (95 per cent confidence interval –9.9 to 37.8 dB; t < 0.001) in the operated ear. The mean Glasgow Benefit Inventory score was 20 (95 per cent confidence interval −2.3 to 42.1).
Significant improvements in both hearing and quality of life are achievable in patients with end-stage obliterative otitis externa treated surgically. Highly trained and competent aural care practitioners are a prerequisite for the success of the procedure, and a substantial number of patients must be prepared to submit to long-term follow-up care.
Countries of the Wider Caribbean have committed to principled ocean governance through several multilateral environmental and fisheries agreements at both the regional (e.g., the Cartagena Convention SPAW Protocol) and international level (e.g., the Convention on Biological Diversity, the United Nations Fish Stocks Agreement, the FAO Code of Conduct for Responsible Fishing). They have also committed to the 2002 World Summit on Sustainable Development (WSSD) targets for fisheries and biodiversity conservation. However, the ongoing challenge is to put in place the measures required to give effect to these principles at the local, national and regional levels (Fanning et al. 2009). While not minimising the important role of science in an ecosystem approach to managing the living marine resources of the Wider Caribbean Region, the chapters in this book serve to highlight the importance that regional experts have placed on the role of governance to address the problems in the region.
This synthesis chapter presents the outputs of a discussion specifically relating to the role of governance in achieving and implementing a shared vision for ecosystem-based management (EBM) in the Wider Caribbean, using the process described in Chapter 1. In terms of structure, the chapter first describes a vision for governance and reports on the priorities assigned to the identified vision elements. It then discusses how the vision might be achieved by taking into account assisting factors (those that facilitate achievement) and resisting factors (those that inhibit achievement). The chapter concludes with guidance on the strategic direction needed to implement the vision, identifying specific actions to be undertaken for each of the vision elements.
The occupational breakdown of members of the Governance Working Group reflected the diversity of affiliations present at the EBM Symposium and included governmental, intergovernmental, academic, non-governmental and private sector (fishers and fishing industry and consulting) representatives. With guidance provided by the facilitator, this diverse grouping of participants was asked to first address the question: “What do you see in place in 10 years’ time when EBM/EAF has become a reality in the Caribbean?”. This diversity provided for a fruitful and comprehensive visioning process, the results of which are summarised in Table 25.1, in terms of the key vision elements and their subcomponents, and in Figure 25.1, which illustrates the level of priority assigned to each of the vision elements.