Reappraisal of gap analysis for effusive crises at Piton de la Fournaise

Effective and rapid effusive crisis response is necessary to mitigate the risks associated with lava flows that could threaten or inundate inhabited or visited areas. At Piton de la Fournaise (La Réunion, France), well-established protocols between Observatoire Volcanologique du Piton de la Fournaise – Institut de Physique du Globe de Paris (OVPF-IPGP) and civil protection, and between scientists of a multinational array of institutes, allow effective tracking of eruptive crises and hazard management embracing all stakeholders. To assess the outstanding needs for such responses Tsang and Lindsay (J Appl Volcanol 9:9, 2020) applied a gap analysis to assess research gaps in terms of preparedness, response and recovery at 11 effusive centers, including Piton de la Fournaise. For Piton de la Fournaise, their gap analysis implied widespread gaps in the state of knowledge. However, their work relied on incomplete and erroneous data and methods, resulting in a gap analysis that significantly underrepresented this state of knowledge. We thus here re-build a correct database for Piton de la Fournaise, properly define the scope of an appropriate gap analysis, and provide a robust gap analysis, finding that there are, actually, very few gaps for Piton de la Fournaise. This is a result of the existence of a great quantity of published work in the peer-reviewed literature, as well as frequent reports documenting event impact in the local press and observatory reports. At Piton de la Fournaise, this latter (observatory-based) resource is largely due to the efforts of OVPF-IPGP who have a wealth of experience having responded to 81 eruptions since its creation in 1979 through the end of September 2021.Although welcome and necessary, especially if it is made by a group of scientists outside the local management of the volcanic risk (i.e., a neutral group), such gap analysis need to be sure to fully consider all available peer-reviewed literature, as well as newspaper reports, observatory releases and non-peer-reviewed eruption reports, so as to be complete and correct. Fundamentally, such an analysis needs to consider the information collected and produced by the volcano observatory charged with handling surveillance operations and reporting duties to civil protection for the volcano under analysis. As a very minimum, to ensure that a necessarily comprehensive and complete treatment of the scientific literature has been completed, we recommend that a third party expert, who is a recognized specialist in terms of research at the site considered, reviews and checks the material used for the gap analysis before final release of recommendations.

Exploring Health Professionals’ Perceptions of Chemotherapy and Radiation Therapy-Related Oral Mucositis

Purpose Determine health professionals’ (HPs’) perceptions of oral mucositis (OM), including clinical presentation of chemotherapy (CT)-induced vs radiation therapy (RT)-induced OM, its assessment and management. Methods HPs involved in the care of head and neck cancer (HNC) patients receiving RT to the oral cavity/oropharynx and haematopoietic stem cell transplantation (HSCT) patients receiving mucositis-inducing CT regimens were invited to participate in a customised 20-question survey. Themes included OM presentation, assessment and management. Results Survey response rate was 81.4%. Most were nurses (33%) and specialist doctors/dentists (25%). Majority (45%) identified as part of the haematology service, followed by radiation oncology (32%). Most haematology and radiation oncology HPs (89% and 70%, respectively) agreed/strongly agreed that OM impacted patients’ ability to complete treatment. There was a significant association (p<0.01) between HPs’ specialty and their perceptions of OM manifestations. Most radiation oncology (85%) and all oral medicine HPs agreed/strongly agreed that clinical manifestations of CT-induced OM and RT-induced OM were different, whereas haematology HPs varied in their perceptions (11% disagreed, 41% were neutral and 48% agreed/strongly agreed). There was uncertainty regarding differences in management of CT vs RT-induced OM: 30% of haematology HPs and 45% of radiation oncology HPs agreed/strongly agreed but most (52% and 45%, respectively in each group) responded “neutral.” Conclusion OM was recognised to adversely impact HSCT and HNC RT patients’ ability to complete treatment. There were differences in HPs’ perceived understanding of OM manifestations and management. Interventions to address these may reduce unwanted variations in patient care and outcomes.

Clinical and Socioeconomic Factors that Predict Non-completion of Adjuvant Chemotherapy for Colorectal Cancer in a Rural Cancer Center

Background Previous literature demonstrates correlations between comorbidities and failure to complete adjuvant chemotherapy. Frailty and socioeconomic disparities have also been implicated in affecting cancer treatment outcomes. This study examines the effect of demographics, comorbidities, frailty, and socioeconomic status on chemotherapy completion rates in colorectal cancer patients. Methods This was an observational case-control study using retrospective data from Stage II and III colorectal cancer patients offered chemotherapy between January 01, 2013 and January 01, 2018. Data was obtained using the cancer registry, supplemented with chart review. Patients were divided based on treatment completion and compared with respect to comorbidities, age, Eastern Cooperative Oncology Group (ECOG) score, and insurance status using univariate and multivariate analyses. Results 228 patients were identified: 53 Stage II and 175 Stage III. Of these, 24.5% of Stage II and 30.3% of Stage III patients did not complete chemotherapy. Neither ECOG status nor any comorbidity predicted failure to complete treatment. Those failing to complete chemotherapy were older (64.4 vs 60.8 years, P = .043). Additionally, those with public assistance or self-pay were less likely to complete chemotherapy than those with private insurance ( P = .049). Both factors (older age/insurance status) remained significant on multivariate analysis (increasing age at diagnosis: OR 1.03, P =.034; public insurance: OR 1.84, P = .07; and self-pay status: OR 4.49, P = .03). Conclusions No comorbidity was associated with failure to complete therapy, nor was frailty, as assessed by ECOG score. Though frailty was not significant, increasing age was, possibly reflecting negative attitudes toward chemotherapy in older populations. Insurance status also predicted failure to complete treatment, suggesting disparities in access to treatment, affected by socioeconomic factors.

Description of on-farm treatment compliance and risk factors for culling in sows

Background In commercial pig farming, sick or injured sows are often treated by producers or hired staff. To date, limited quantitative data exists on treatment compliance and the possible effect on sow longevity post-treatment. The objective of the study was to quantify on-farm compliance of treatment selection, frequency, and dosage, as well as to investigate the association between body condition scores (BCS) and other sow-level factors on post-treatment cull risk. Results On-farm treatment records, including culling reason or reason of death up to 6 months post-treatment, production records and sow characteristics were obtained for 134 sows over an 8-week period. Treatment compliance was based on the accuracy of recorded treatments compared to the herd veterinarian’s established treatment guidelines. Univariable and multivariable logistic regression models including treatment reason, treatment compliance, BCS, parity, production stage and production metrics, were constructed to investigate associations between those variables and sow culling or death. This study found low compliance for on-farm sow treatment protocols, with only 22.4% (30/134) of the sows receiving correct and complete treatment during the duration of the study. No effect of individual treatment components (drug, dosage, or frequency) on sow culling was observed. A trend for an interaction between treatment compliance and BCS was found, and parity and number of piglets born alive were identified as predictors for sow maintenance in the herd. Conclusions On-farm sow treatment compliance was low, resulting in that approximately 80% of the enrolled sows were not treated according to existing guidelines. Non-compliance of treatment guidelines did not seem to affect the risk of culling in treated sows but may have prolonged any associated pain, recovery time and negatively impacted the sow welfare during that time period.

Healthcare Utilization Patterns for Patients with a History of Substance Use Requiring OPAT

Background Uninsured people who use drugs (PWUD) require extended parenteral antibiotic therapy when diagnosed with complex infections such as osteomyelitis. They are ineligible to enroll in our self-administered outpatient antimicrobial therapy (S-OPAT) program and instead sent to a skilled nursing facility (SNF). We aim to retrospectively assess clinical outcomes of PWUD discharged from our safety net hospital to complete OPAT in a SNF. Methods Using our hospital electronic medical record, PWUD and discharged to SNF for extended antibiotic therapy were identified for the study period 1/1/17 -4/30/18. Demographics, drug use, discharge diagnosis, antibiotic therapy, discharge disposition from SNF (AMA, early non-AMA, completed), 30-day emergency department (ED) utilization, and 30-day readmission were collected for the study cohort. ED-utilization and 30-day readmission rates were analyzed by disposition group. Results While the majority of patients completed treatment (83), a sizeable number left AMA (26) or early non-AMA (20) Patients who left early, AMA or non-AMA, had increased rates of 30-day readmission or ED-utilization (p=0.01), increased rates of 30-day readmission alone (p=0.01), but not ED-utilization alone (p=0.43) compared to patients who completed treatment. Conclusions In our cohort, many PWUD discharged to SNF to receive parenteral antibiotics do not complete treatment. These patients are observed to have increased healthcare utilization compared to patients completing therapy.

Adipose tissue-derived mesenchymal stem cells ameliorate experimental acute colitis in rats

Complete treatment of ulcerative colitis (UC) is still difficult, while conventional therapies have various adverse effects. Mesenchymal stem cells (MSCs) have anti-inflammatory and immunomodulatory properties to be a therapeutic candidate for UC. We evaluated therapeutic potential of adipose tissue-derived mesenchymal stem cells (AdSCs) in treatment of an acute colitis rat model using histological and molecular assessments. Thirty male Sprague Dawley acetic acid-induced (2 mL of 3%) acute colitis rat models were randomly divided into three equal groups of control receiving 0.5 mL/kg of normal saline, sulfasalazine group receiving 500 mg/kg sulfasalazine and AdSCs group transplanted transrectally with 2×106 MSCs. They were evaluated histologically and by real time PCR for expression of apoptotic genes until 21 days. MSCs were spindle shape and positive for osteogenic and adipogenic differentiation. They displayed mesenchymal and lacked hematopoietic markers. In control group, severe inflammation, edema, ulcer, necrosis and infiltration of leukocytes were noticed. In sulfasalazine group, a moderate inflammation, edema, ulcer, necrosis and infiltration of leukocytes were visible; and in AdSCs group, mild inflammation, congestion, and infiltration of leukocytes were observed with a mild edema, but necrosis was absent in colonic tissue. A stronger decrease in expression of Bax, together with a higher increase in Bcl-2 was noted in AdSCs group. Based on histological and molecular findings, AdSCs were effective to ameliorate colitis lesions through their anti-inflammatory and anti-apoptotic activities showing that transplantation of AdSCS can be a potentially useful strategy in treatment of colitis.

Constructing Student’s Physical Preparedness through Game-Based Activities in Disaster-Safe School

Indonesia is a country that has great potential for disaster. A major earthquake hit the Special Region of Yogyakarta, especially Bantul Regency, in 2006. This has demanded the establishment of a disaster-safe school that is ready to anticipate disasters. Disaster-safe school students need to be fully prepared in various aspects, including physical aspect. Therefore, this study aims to determine the increase in physical fitness before and after carrying out game-based physical activities for upper grade students in a Disaster-Safe School. This study adopted an experimental method that involved one group pre-test-post-test design. Participants were upper grade students (grade 4 to 5) in Madrasah Ibtidaiyah Negeri 2 Bantul, totaling 74 people under such criteria as aged 10 to 12 years and following the complete treatment. The instrument used was the Indonesian Physical Fitness Test (IPFT) for children aged 10-12 years. Data analysis using paired sample t-test. The results showed that there was an increase in the physical fitness of students after being given treatment in the form of game-based physical activity for 12 meetings. Good physical fitness is a form of physical preparedness in facing various emergencies including disasters. The better physical fitness level of students, the more physically prepared they will be when facing disasters.

AYURVEDIC MANAGEMENT OF KOTA: A CASE STUDY

Skin is the largest and protective organ of the body that comes in contact with the external world. The skin has many roles in the maintenance of life and health. Pathological Manifestations in the skin are caused by both external and internal factors. Nowadays skin diseases are more common due to improper lifestyles and habits. Urticaria is one among them. The present case study is about, a 30-year-old female patient, visited our hospital (KC OPD) with a chief complaint of itching, redness, and mild burning sensation all over the body for nine years. We diagnosed her with Kota. Kota is mentioned in Ayurveda as one among the Twak Vikara. Most of the Acharyas are explained Sheethapitha, Udarda and Kota under a single chapter because of almost similar symptomatology. The main symptoms of Kota are Mandala (elevated round), Kandu (itching), Raga(redness), Bahuni (number) and Sanubandatha (frequency of attack). In comparison to symptomatology, Urticaria is quite similar like Kota. In India, approximately 15-20% of the general population will have Urticaria once in their life. Chronic Urticaria is defined as urticaria persisting daily or almost daily for more than 6 weeks. Chronic autoimmune urticaria or chronic idiopathic urticaria has no discernable external cause. It can cause severe impairment on the quality of life. There is no complete treatment for this, but medicines and lifestyle changes can help the patient to feel better according to modern science. In Ayurveda it is a Sadhyavyadhi, Treatment adopted here are Vamana, Virechana, Siravyada followed by Patolakaturohinyadi kashayam, Nimbadi guggulu, Vilwadigulika, Manibadram Guda. This case study proves the Ayurvedic management in Urticaria is very effective with promising results. Keywords: Kota, Urticaria, Shodhana, Shamana Aushadhis

NoFumo+: A Clinical Trial of an mHealth for Smoking Cessation with Hospitalized Patients

Smartphone applications (apps) improve accessibility to smoking cessation treatments. The NoFumo+ app administers a cognitive behavioral therapy program for smoking cessation. This study evaluates the efficacy of NoFumo+ for quitting smoking or reducing cigarette consumption versus the usual information-based treatment. A clinical trial was conducted with 99 hospitalized smokers, 54 pseudo-randomly assigned to the app treatment and 45 to the usual treatment. The two groups had homogeneous baseline characteristics to ensure comparability. Abstinence was evaluated at post-treatment (two months) and at a six-month follow-up. The results obtained indicate that participants who receive the usual treatment are 5.40 times more likely to continue smoking than those who undergo the app treatment (95% CI = [1.35; 20.15]). Participants who do not succeed in quitting smoking with the app manage to decrease their habitual consumption. Users who successfully complete treatment with NoFumo+ access all its contents and use the chat, but without requesting professional support. There is not enough empirical evidence to attribute this success to any specific element of the app. NoFumo+ achieves better abstinence rates than the usual information-based treatments, and the goal of generalizing its use to the non-hospitalized smoking population may be achievable in the future.

Interventional real-time optical imaging guidance for complete tumor ablation

The aim of this study was to develop an interventional optical imaging (OI) technique for intraprocedural guidance of complete tumor ablation. Our study employed four strategies: 1) optimizing experimental protocol of various indocyanine green (ICG) concentrations/detection time windows for ICG-based OI of tumor cells (ICG cells); 2) using the optimized OI to evaluate ablation-heat effect on ICG cells; 3) building the interventional OI system and investigating its sensitivity for differentiating residual viable tumors from nonviable tumors; and 4) preclinically validating its technical feasibility for intraprocedural monitoring of radiofrequency ablations (RFAs) using animal models with orthotopic hepatic tumors. OI signal-to-background ratios (SBRs) among preablation tumors, residual, and ablated tumors were statistically compared and confirmed by subsequent pathology. The optimal dose and detection time window for ICG-based OI were 100 μg/mL at 24 h. Interventional OI displayed significantly higher fluorescence signals of viable ICG cells compared with nonviable ICG cells (189.3 ± 7.6 versus 63.7 ± 5.7 au, P < 0.001). The interventional OI could differentiate three definitive zones of tumor, tumor margin, and normal surrounding liver, demonstrating significantly higher average SBR of residual viable tumors compared to ablated nonviable tumors (2.54 ± 0.31 versus 0.57 ± 0.05, P < 0.001). The innovative interventional OI technique permitted operators to instantly detect residual tumors and thereby guide repeated RFAs, ensuring complete tumor eradication, which was confirmed by ex vivo OI and pathology. In conclusion, we present an interventional oncologic technique, which should revolutionize the current ablation technology, leading to a significant advancement in complete treatment of larger or irregular malignancies.