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From James Baldwin's (1962) "A Letter to My Nephew," which laid bare the brutalities of being black in 1960s America, to Chanelle Miller's published victim impact statement addressed to her assailant, which provided vocabulary and was kindle for #MeToo, examples abound demonstrating the ways in which the open letter continuously surfaces during pivotal historical junctures. Although the contextual significance of this format of authorship is widely used in scholarly disciplines ranging from education to history, the structural significance of the open letter as a methodologic approach to academic writing has yet to be theorized, leaving questions that merit attention: Why is the open letter so often used by marginalized groups? What are the literary and rhetorical effects of the enclosed addressed between sender and receiver? Finally, how does this format of writing create and affect the positionality and subjectivity of authors? By writing a letter addressed to Academia/School, this essay makes the case for the open letter as something to be studied but also a methodology and study in and of itself. By drawing on literary theory, cultural studies, and research on writing in academia, this essay suggests that the open letter is an important form of authorship and argues for revisiting the open letter as a legitimate form of scholarship as well as an authentic form of academic writing in education.

With ascent to high altitude (HA), compensatory increases in cerebral blood flow and oxygen delivery must occur to preserve cerebral metabolism and consciousness. We hypothesized that this compensation in cerebral blood flow and oxygen delivery preserves tolerance to simulated hemorrhage (via lower body negative pressure, LBNP), such that tolerance is similar during sustained exposure to HA vs. low altitude (LA). Healthy humans (4F/4 M) participated in LBNP protocols to presyncope at LA (1130 m) and 5-7 days following ascent to HA (3800 m). Internal carotid artery (ICA) blood flow, cerebral delivery of oxygen (CDO2) through the ICA, and cerebral tissue oxygen saturation (ScO2) were determined. LBNP tolerance was similar between conditions (LA: 1276 ± 304 s vs. HA: 1208 ± 306 s; P = 0.58). Overall, ICA blood flow and CDO2 were elevated at HA vs. LA (P ≤ 0.01) and decreased with LBNP under both conditions (P

Abstract Open-lung ventilation during cardiopulmonary bypass (CPB) in patients undergoing heart transplantation (HTx) is a potential strategy to mitigate postoperative acute respiratory distress syndrome (ARDS). We utilized an ovine HTx model to investigate whether open-lung ventilation during CPB reduces postoperative lung damage and complications. Eighteen sheep from an ovine HTx model were included, with ventilatory interventions randomly assigned during CPB: the OPENVENT group received low tidal volume (VT) of 3 mL/kg and positive end-expiratory pressure (PEEP) of 8 cm H20, while no ventilation was provided in the NOVENT group as per standard of care. The recipient sheep were monitored for 6 h post-surgery. The primary outcome was histological lung damage, scored at the end of the study. Secondary outcomes included pulmonary shunt, driving pressure, hemodynamics and inflammatory lung infiltration. All animals completed the study. The OPENVENT group showed significantly lower histological lung damage versus the NOVENT group (0.22 vs 0.27, p = 0.042) and lower pulmonary shunt (19.2 vs 32.1%, p = 0.001). In addition, the OPENVENT group exhibited a reduced driving pressure (9.6 cm H2O vs. 12.8 cm H2O, p = 0.039), lower neutrophil (5.25% vs 7.97%, p ≤ 0.001) and macrophage infiltrations (11.1% vs 19.6%, p

Abstract Autologous stem‐cell transplantation (ASCT) is standard therapy for relapsed/refractory large B‐cell lymphoma (R/R LBCL), but many patients are either ineligible or unable to receive it. This retrospective study characterized outcomes in R/R LBCL, delineated by eligibility for, and receipt of, ASCT. Median progression‐free survival (PFS) and event‐free survival (EFS) for patients undergoing ASCT were 35.2 and 31.6 months (overall survival [OS] not reached). Median PFS, EFS, and OS were 4.3, 4.3, and 6.9 months for ineligible patients, and 2.7, 2.6, and 9.4 months for those eligible for but unable to receive ASCT. This highlights an unmet need for alternative therapies in patients unable to receive ASCT.

Numerous cancer therapies have detrimental cardiovascular effects on cancer survivors. Cardiovascular toxicity can span the course of cancer treatment and is influenced by several factors. To mitigate these risks, cardio-oncology has evolved, with an emphasis on prevention and treatment of cardiovascular complications resulting from the presence of cancer and cancer therapy. Artificial intelligence (AI) holds multifaceted potential to enhance cardio-oncologic outcomes. AI algorithms are currently utilizing clinical data input to identify patients at risk for cardiac complications. Additional application opportunities for AI in cardio-oncology involve multimodal cardiovascular imaging, where algorithms can also utilize imaging input to generate predictive risk profiles for cancer patients. The impact of AI extends to digital health tools, playing a pivotal role in the development of digital platforms and wearable technologies. Multidisciplinary teams have been formed to implement and evaluate the efficacy of these technologies, assessing AI-driven clinical decision support tools. Other avenues similarly support practical application of AI in clinical practice, such as incorporation into electronic health records (EHRs) to detect patients at risk for cardiovascular diseases. While these AI applications may help improve preventive measures and facilitate tailored treatment to patients, they are also capable of perpetuating and exacerbating healthcare disparities, if trained on limited, homogenous datasets. However, if trained and operated appropriately, AI holds substantial promise in positively influencing clinical practice in cardio-oncology. In this review, we explore the impact of AI on cardio-oncology care, particularly regarding predicting cardiotoxicity from cancer treatments, while addressing racial and ethnic biases in algorithmic implementation.

Even though agriculture already spread into Eurasia during the Neolithic, the transition between the Copper Age and the Bronze Age was the time where Italian communities tuned horticultural techniques to foster the soil productivity. Carbon and nitrogen stable isotope analyses could be leveraged to identify some of those practices, such as manuring and irrigation. The former could spike the nitrogen values of plants, while water availability affects the carbon values.This work provides one of the first datasets of isotopic data for seeds from four Bronze Age Italian sites spanning overall from the end of the 3rd millennium to the first half of the 2nd millennium BCE: pile-dwelling of Ledro (TN, Trentino Alto Adige), settlement of S. Maria in Belverde (SI, Tuscany), Grotta Nuova (VT, Latium), and Grotta di Pastena (FR, Latium).One-hundred eighty seeds were first classified, then carbon and nitrogen stable isotope analysis were carried out for broad beans, wheat, emmer and barley. The obtained values were compared to predictive models to enhance the understanding of the agricultural efforts for each community. The provided dataset would be beneficial for future research on agricultural practices, subsistence strategies identification, and even local ecological reconstruction, as it represents one of the most extensive surveys for carbon and nitrogen stable isotopes values for plants in the focused time span.

We develop a Huntington’s disease (HD) progression model and integrate this with a novel economic model, accounting for the major factors of the HD’s societal cost. Data from the Enroll-HD observational study were used to fit a continuous-time hidden Markov disease progression model, which identified five distinct states. The number of disease states was determined using a cross-validated maximum likelihood approach. A novel data augmentation method was used to correct the biased life expectancy of the progression model. Multiple sources of cost data were then mapped to Enroll-HD variables using expert experience. A simulation of a synthetic patient population was used to show the feasibility of the approach in estimating population costs and the impact of hypothetical intervention scenarios. Our results confirm that early cognitive decline, which is not captured by the total functional capacity score currently used by clinicians but flagged up in HD integrated staging system, can be quantified from participants’ visits. Finally, the results of the UK cost modelling show that indirect costs of HD such as state benefits and lost gross domestic product contribution could be the driving factors for the societal cost, over and above health and social care costs.

Background Staff sickness absenteeism and presenteeism (attending work while unwell) incur high costs to the NHS, are associated with adverse patient outcomes and have been exacerbated by the COVID-19 pandemic. The main causes are mental and musculoskeletal ill health with cardiovascular risk factors common. Objectives To undertake a feasibility study to inform the design of a definitive randomised controlled trial of the effectiveness and cost effectiveness of a health screening clinic in reducing absenteeism and presenteeism amongst the National Health Service staff. Design Individually randomised controlled pilot trial of the staff health screening clinic compared with usual care, including qualitative process evaluation. Setting Four United Kingdom National Health Service hospitals from two urban and one rural Trust. Participants Hospital employees who had not previously attended a pilot health screening clinic at Queen Elizabeth Hospital Birmingham. Interventions Nurse-led staff health screening clinic with assessment for musculoskeletal health (STarT musculoskeletal; STarT Back), mental health (patient health questionnaire-9; generalised anxiety disorder questionnaire-7) and cardiovascular health (NHS health check if aged ≥ 40, lifestyle check if < 40 years). Screen positives were given advice and/or referral to services according to UK guidelines. Main outcome measures The three coprimary outcomes were recruitment, referrals and attendance at referred services. These formed stop/go criteria when considered together. If any of these values fell into the ‘amber’ zone, then the trial would require modifications to proceed to full trial. If all were ‘red’, then the trial would be considered unfeasible. Secondary outcomes collected to inform the design of the definitive randomised controlled trial included: generalisability, screening results, individual referrals required/attended, health behaviours, acceptability/feasibility of processes, indication of contamination and costs. Outcomes related to the definitive trial included self-reported and employee records of absenteeism with reasons. Process evaluation included interviews with participants, intervention delivery staff and service providers. Descriptive statistics were presented and framework analysis conducted for qualitative data. Due to the COVID-19 pandemic, outcomes were captured up to 6 months only. Results Three hundred and fourteen participants were consented (236 randomised), the majority within 4 months. The recruitment rate of 314/3788 (8.3%) invited was lower than anticipated (meeting red for this criteria), but screening identified that 57/118 (48.3%) randomised were eligible for referral to either general practitioner (81%), mental health (18%) and/or physiotherapy services (30%) (green). Early trial closure precluded determination of attendance at referrals, but 31.6% of those eligible reported intending to attend (amber). Fifty-one of the 80 (63.75%) planned qualitative interviews were conducted. Quantitative and qualitative data from the process evaluation indicated that the electronic database-driven screening intervention and data collection were efficient, promoting good fidelity, although needing more personalisation at times. Recruitment and delivery of the full trial would benefit from a longer development period to better understand local context, develop effective strategies for engaging with underserved groups, provide longer training and better integration with referral services. Delivery of the pilot was limited by the impact of COVID-19 with staff redeployment, COVID-research prioritisation and reduced availability of community and in-house referral services. While recruitment was rapid, it did not fully represent ethnic minority groups and truncated follow-up due to funding limitations prevented full assessment of attendance at recommended services and secondary outcomes. Conclusions There is both a clinical need (evidenced by 48% screened eligible for a referral) and perceived benefit (data from the qualitative interviews) for this National Health Service staff health screening clinic. The three stop/go criteria were red, green and amber; therefore, the Trial Oversight Committee recommended that a full-scale trial should proceed, but with modifications to adapt to local context and adopt processes to engage better with underserved communities. Trial registration This trial is registered as ISRCTN10237475. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/42/42) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 23. See the NIHR Funding and Awards website for further award information. Plain language summary Sickness absenteeism and presenteeism (attendance at work while ill, with poor work performance) are major problems in the NHS and associated with worse patient health care. The most common causes of NHS staff sickness absenteeism and presenteeism are muscular complaints and mental ill health. Poor lifestyle and illnesses associated with heart disease are also important factors. Staff health checks might improve the health of NHS staff, but no studies have included screening tests to address the most common causes of poor staff health. This pilot study tested whether it would be possible to deliver a randomised controlled trial of an NHS staff health screening clinic, where some people get the screening check and others do not (chosen at random, like flipping a coin). We used an electronic database to capture all data. Participants completed initial questionnaires either at home or at work, then attended a face-to-face screening clinic using recognised screening questionnaires and tests to detect problems with muscular, mental or heart health. We considered how NHS staff and healthcare organisations would want the screening clinic and trial to run, how a diverse range of NHS staff could best be approached, how many staff might need to be invited and what their healthcare needs would be. The study ran in four UK NHS hospitals during the COVID-19 pandemic. Two hundred and thirty-six NHS staff participated, but early trial closure due to the pandemic meant that some results were unavailable. For the primary feasibility outcomes, although recruitment rates of around 8% were lower than anticipated, half of staff screened needed referral for further health care and one-third reported intending to attend. Staff felt that the clinic addressed an important health need. The Trial Oversight Committee recommended proceeding to a full-scale trial but with modifications to address findings from the process evaluation, including ways to encourage a wider group of NHS staff to take part. Scientific summary Background Staff sickness absenteeism and presenteeism (attending work while unwell) incur high costs to the NHS, are associated with adverse patient outcomes and have been exacerbated by the COVID-19 pandemic. The main causes are mental and musculoskeletal ill health with cardiovascular risk factors also common. Objectives The aim of this pilot trial was to assess the feasibility of a definitive randomised controlled trial (RCT) evaluating the clinical and cost effectiveness of a health screening clinic compared to usual care, in reducing sickness absenteeism and presenteeism amongst NHS staff. The key objectives were to: describe recruitment rates describe participant characteristics and assess generalisability compared to the hospital workforce describe intervention screening assessment results describe recommended referrals and their uptake assess the feasibility of measuring the outcomes relating to the definitive trial, and obtain an estimate of the standard deviation of the proposed primary outcomes for a full RCT assess levels of contamination between intervention and usual care arms to inform RCT design (individual vs. cluster RCT) describe and explain the fidelity to the intervention and evaluate the barriers and enablers to participation describe the views, experiences and satisfaction of participants and those delivering the health checks quantify the costs of undertaking the screening service and its consequences. Design A multicentre, two-arm, parallel group, open-label, 1 : 1 individually randomised pilot RCT of a complex intervention comparing a staff health screening clinic with usual care. Setting Three large urban hospitals and one rural district general hospital in the West Midlands. Participants All employees in the participating hospitals were eligible to participate except those who had previously attended a pilot health screening clinic at Queen Elizabeth Hospital Birmingham (QEHB) or who were currently taking part in another non-COVID drug trial or similar health and well-being trial. Participants were informed of the trial through staff meetings, noticeboards, posters and ward champions, and invited (with up to three reminders) through multiple approaches including e-mail and personal invitation. Wards were chosen to reflect the characteristics of the hospital. Data collection Potential participants joined the trial via weblink to a custom-designed electronic trial data collection platform hosted by the Birmingham Clinical Trials Unit. Eligibility questions, consent and a baseline questionnaire were completed prior to randomisation. Randomisation and blinding Participants were randomised to intervention or usual care (1 : 1 ratio) using an integrated randomisation module on the trial database, using a minimisation algorithm (with random element) to ensure balance on key characteristics. Interventions Intervention Staff health screening clinic with two stages: screening assessment for three components: mental health, musculoskeletal health and cardiovascular health, followed by appropriate advice and/or referral, according to level of risk, to appropriate services for management according to NHS/National Institute for Health and Care Excellence (NICE) recommendations. The screening assessment was delivered by trained research nurses using a standardised protocol. All data were captured by a customised database with prompts to guide the research nurses. Local pathways were used for referrals to lifestyle, physiotherapy, psychological and primary care services. Participants reporting relevant conditions already being treated did not receive the referral element of that component. A results letter detailing findings and recommendations was sent to participants and their general practitioners (GPs) for appropriate action. Usual care Standard access to medical services for management of any presenting condition. Main outcome measures This pilot trial was originally planned to have a 52-week follow-up period to fully test the processes for a definitive trial, but this was reduced to 26 weeks due to the pandemic delays and funding restrictions. Primary outcomes and stop/go criteria Three coprimary outcomes were originally planned to inform progression to the definitive trial: Recruitment (consented) as a proportion of those invited. Referral to any recommended services as a result of the three screening components (usually GP, local physiotherapy/community psychological services) – intervention arm only. Attendance at any recommended services at 26 weeks (self-report) – intervention arm only. We defined ‘referral’ as anyone who was eligible for a referral, that is they recorded a suitable risk value and were not already being treated for that condition. Due to the pandemic, only a small number of participants completed the 26-week follow-up assessment. Therefore, acceptance of the referral (signifying intention), which was collected during the screening assessment, was used as a proxy for attendance. The three coprimary outcomes formed stop/go criteria when considered together. If any of these values fell into the ‘amber’ zone, then the trial would require modifications to proceed to full trial. If all were ‘red’, then the trial would be considered unfeasible. Secondary outcomes were collected to inform the design of the definitive RCT and any modifications required. Secondary outcomes Comparison of baseline characteristics of included participants and hospital population. Description of intervention screening assessments results. Number/type of referrals to recommended services (intervention arm only). Attendance at each individual recommended service (intervention arm only). Lifestyle relevant to screening intervention advice and referrals (self-report at 26 weeks compared with baseline). Acceptability of intervention to participants and health screening clinic staff (interviews). Feasibility of trial processes (completeness of relevant data items, interviews). Indication of contamination (comparing pre/post data for health behaviours and health care/other service utilisation in control arm). Outcomes related to the definitive trial Absenteeism at 26 weeks with reasons, measured by days and spells. Self-reported absolute absenteeism, relative absenteeism and relative hours of work – for last 7 days and last 28 days [World Health Organization Health and Work Performance Questionnaire (WHO-HPQ)]. Self-reported absenteeism (6-month recall period). Employee records of absenteeism, the proposed primary outcome of the definitive trial. Routinely collected linked data from the NHS Electronic Staff Record Programme. Presenteeism at 26 weeks [self-reported absolute presenteeism and relative presenteeism for last 28 days (WHO-HPQ)]. Attendance at occupational health service at 26 weeks (self-report). Healthcare utilisation at 26 weeks (self-report) including GP consultations and hospital admissions. EuroQol-5 Dimensions, five-level version (EQ-5D-5L) index value measuring health-related quality of life (HRQoL) (EuroQol EQ-5D 5-level) at 26 weeks. Resource use and costs collected by self-report questionnaire to participants on health service utilisation and information from the screening assessment regarding duration and resources used. Sample size We aimed to recruit 480 participants (20 per week) in 24 weeks. With this sample size, the 95% confidence interval (CI) for the proportion of staff recruited could be estimated to be 4% either side of the estimate. Statistical methods Analyses were mainly descriptive. No statistical modelling was undertaken, and no p-values are reported. No subgroup analyses were planned. Process evaluation A mixed-methods process evaluation explored programme reach, fidelity of screening delivery, attendance at referrals and participants’ views of the intervention to support any modifications required for the design of the definitive trial. Quantitative data to support the process evaluation were obtained as above. Semistructured qualitative interviews/focus groups were conducted (choice of Zoom, telephone, face-to-face) to obtain views of relevant stakeholders [trial participants, enhancing the Health of NHS Staff (eTHOS) nurses, referral providers, outside agencies] on the feasibility and acceptability of the staff health screening intervention and trial and inform any protocol adaptations needed for a full trial. Due to the COVID-19 delays, a pragmatic approach was taken to sampling; all eligible participants in the intervention arm were invited to participate, and invitations were sent to all controls until the target number of participants had been reached. Data were recorded either on Zoom or an encrypted recorder and transferred via secure file transfer to an external company for transcription. Interviews were transcribed intelligent/clean verbatim and anonymised. A thematic analysis of content was informed by the framework analytical approach. Data collection and analysis ran concurrently so that the emergent analytical themes could inform further data collection. Health economic analysis A descriptive analysis was presented with average costs of screening per participant and quality of life obtained in the baseline questionnaire. Information was obtained from participating centres on estimated time taken for each screening clinic task, grade of the member of staff responsible and cost of individual blood tests. Staff time required for each task was then multiplied by the relevant unit costs obtained from standard source. The total cost of blood tests per participant was weighted according to the proportion who received each type of blood test. Quality of life of all participants was estimated using the EQ-5D-5L. Patient and public involvement Four to six clinical, administrative and retired NHS staff met on a regular basis throughout the project to provide advice. One hospital healthcare worker was included on the Trial Oversight Committee (TOC). Similarly, we consulted a stakeholder advisory group representing a wider body of professionals relevant to the trial, for example, GPs. Impact of COVID-19 pandemic on trial delivery It was not possible to commence the trial in March 2020 due to the COVID-19 pandemic. Two hospital sites commenced the trial in December 2020, but after 3–4 weeks, recruitment was paused. The trial recommenced in May 2021 in all four sites. The original trial was planned to include a 52-week follow-up; however, due to the delays, a 26-week follow-up was agreed with the funder, but only a few people reached this time point before trial closure. Results Three thousand seven hundred and eighty-eight of the 24,344 NHS staff across the four sites were invited to take part. Of the 353 eligible respondents, 314 consented (8.3% of those invited and 65.4% of our planned target of n = 480). Two hundred and thirty-six were randomised into the study; n = 118 to the intervention screening arm and 118 to usual care. One hundred and one (85.6%) attended and completed the screening clinic. Only 26/236 (11.0%) participants reached the 26-week follow-up. Primary outcomes and stop/go criteria Three hundred and fourteen of the 3788 [8.3% (95% CI 7.4% to 9.2%)] invited staff gave their consent to participate, which meets the red stop/go criterion for recruitment. Fifty-seven of the 118 [48.3% (95% CI 39.0% to 57.7%)] participants randomised to the intervention arm were eligible for referral to at least one service, which meets the green stop/go criterion for referral. Eighteen of the 57 [31.6% (95% CI 19.9% to 45.2%)] participants eligible for a referral accepted a referral to at least one service, which meets the amber stop–go progression criterion for attendance, although the CIs were wide. Secondary outcomes Assessing generalisability (programme reach) The invited population was similar to the hospital population, although those who participated in the trial were more likely to be white British (78.0% compared to 59.7%), allied health professionals (14.0% compared to 6.9%) and healthcare scientists (11.9% compared to 5.0%), and less likely to be from estates/ancillary, medical/dental and nursing/midwifery registered staff groups. Results of intervention screening assessments Most reported minimal/mild anxiety, but 11 (10.9%) were classified as having moderate and 5 (5.0%) severe anxiety. Most people reported minimal/mild depression, but 13 (12.9%) reported moderate/moderately severe depression and 4 (4.0%) severe depression. Most participants had no significant back pain, although eight (7.9%) were at medium risk and two (2.0%) at high risk on the StarT Back tool. Twenty-seven (27.0%) scored with medium risk for other types of pain and five (5.0%) high risk. Thirty-eight (38.0%) participants were classified as overweight and 32 (32.0%) obese. Forty-six (46.0%) were self-reported as physically active. Twelve (11.9%) reported increasing/higher risk of alcohol dependence and 10 (9.9%) were current smokers. Of those eligible for the cardiovascular risk score (QRISK2), nine (14.5%) had medium risk (10–19.9%) and two (3.2%) had a high risk of developing cardiovascular disease (CVD) in the next 10 years. Completeness of data items and attendance at screening clinic (fidelity) Sixty-six of the 314 (21.0%) consented participants did not complete the baseline questionnaire. One hundred and one of the 118 (86%) participants randomised to the intervention arm attended and completed the screening clinic. Individual data items were generally well completed and deoxyribonucleic acid (DNA) rates low. Costs and quality of life The maximum screening cost per participant (including blood tests) was £107.48 if the highest band staff were used and £99.98 if the lowest band staff ran the clinic. Complete EQ-5D-5L data were available for 233/236 randomised participants [mean score 0.793 (SD 0.168)]. Process evaluation We conducted 51 (63.8%) out of the 80 originally planned interviews. Four different hospital sites utilised a nurse-led screening intervention with prompts and electronic data collection, which was efficient and promoted good fidelity, although this was viewed as impersonal at times. Participants appreciated the convenience of the onsite service and valued time to focus on their own needs. However, some felt that it did not reflect or address their stress levels appropriately or meet their expectations in providing faster access to additional services. There were also concerns that it would not address the wider determinants of ill health and problems in the workplace, that it was just a ‘sticking plaster’. The eTHOS staff delivering the intervention generally found the delivery of the study feasible, although there were a number of suggestions from staff both delivering and receiving the intervention to adapt the approach for a full trial. Conclusions Despite significant delays, truncation and amendments required due to the COVID-19 pandemic, we were able to assess the most important aspects of the feasibility of a RCT to evaluate the clinical and cost effectiveness of a novel hospital-based staff health screening clinic in reducing absenteeism and presenteeism. Recruitment was feasible in a short space of time, and delivery of the intervention feasible, efficient and acceptable. Although a lower proportion of staff were recruited than anticipated, this was offset by the findings of the screening assessments which revealed significant health needs of those attending with 48% requiring referral to additional services. The three stop/go criteria were red, green and amber; therefore, the TOC recommended that a full-scale trial should proceed, but with modifications (see below) to adapt to local context and adopt processes to engage better with underserved communities, to improve both reach and effectiveness. Implications/modifications for full trial design There was no evidence of contamination; therefore, an individual RCT would remain the design of choice. Wait-list controls might also be a potential option to encourage people to participate. While our approach to recruitment was successful for many (most people responded to an e-mail), additional strategies would be needed to recruit the underserved groups, and specific minority staff network groups and leaders should be engaged in order to do so. Messaging to potential participants needs to be clearer in order to reduce concerns about confidentiality, optimise recruitment and manage expectations. More flexible clinic times/alternative options could be explored to improve inclusion. Electronic data capture was considered convenient, but extra training and practice should be provided to ensure sufficient familiarity and personalisation. Consideration (on a site-by-site basis) of clearer referral pathways is important for the full trial, in order to optimise attendance at referrals and realise health outcomes. Further consideration should also be given to the mental health screening tools used, as qualitative interviews with staff revealed their concerns that occupational stress and burnout may not be adequately identified and treated. There was no evidence from this study that self-reported absenteeism data should replace human resources (HR) data as the potential primary outcome as correlation between the two was poor. Acknowledging the 25% dropout between consent and randomisation, the amount of data collected and length of questionnaires should be reviewed prior to a full trial. Resource use and cost data were relatively straightforward to collect, although it was evident that more detailed site-by-site data collection would be required in a full trial, to reflect the full range of clinic organisation scenarios. Trial registration This trial is registered as ISRCTN10237475. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/42/42) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 23. See the NIHR Funding and Awards website for further award information.

As climate change impacts human systems, associated adaptation efforts are beginning to shape the quality of life in cities and other places. How the work of climate change adaptation is being undertaken, by whom, where and for whose benefit, has important justice and equity outcomes. Increasingly, adaptation work is being formalised into paid jobs. This emerging field of work has been rarely studied, but it is important to understand because the disciplinary backgrounds, organisational positions, roles, responsibilities and spatial locations involved are likely to have a disproportionate influence on wider approaches to climate change risk and adaptation, including societal understandings of what actually is climate change adaptation. This paper commences the investigation into paid adaptation work by analysing Australian job advertisements for adaptation roles, and interviewing associated hiring managers. It identifies three biases in the jobs of adaptation on offer towards: well-resourced and urban-based positions; professional services; and a climate risk management interpretation of adaptation. These biases indicate that urban adaptation has the potential to ossify, if not exacerbate, unjust urban geographies. To help moderate this risk of maladaptation, investment is required into other forms of adaptation work, particularly within the public sector. Policy relevance The biases within the emerging work of adaptation towards consulting firms and local government in larger cities, as well as few jobs addressing vulnerability, indicates the need for government to undertake the work of inclusive and just climate change adaptation. This work would minimise the potential for existing socio-economic disparities to be exacerbated though climate change adaptation.

Cerebral hypoxia is a serious consequence of several cardiorespiratory illnesses. Measuring the retinal microvasculature at high altitude provides a surrogate for cerebral microvasculature, offering potential insight into cerebral hypoxia in critical illness. In addition, although sex-specific differences in cardiovascular diseases are strongly supported, few have focused on differences in ocular blood flow. We evaluated the retinal microvasculature in males (n = 11) and females (n = 7) using functional optical coherence tomography at baseline (1,130 m) (day 0), following rapid ascent (day 2), and prolonged exposure (day 9) to high altitude (3,800 m). Retinal vascular perfusion density (rVPD; an index of total blood supply), retinal thickness (RT; reflecting vascular and neural tissue volume), and arterial blood were acquired. As a group, rVPD increased on day 2 versus day 0 (P < 0.001) and was inversely related to [Formula: see text] (R2 = 0.45; P = 0.006). By day 9, rVPD recovered to baseline but was significantly lower in males than in females (P = 0.007). RT was not different on day 2 versus day 0 (P > 0.99) but was reduced by day 9 relative to day 0 and day 2 (P < 0.001). RT changes relative to day 0 were inversely related to changes in [Formula: see text] on day 2 (R2 = 0.6; P = 0.001) and day 9 (R2 = 0.4; P = 0.02). RT did not differ between sexes. These data suggest differential time course and regulation of the retina during rapid ascent and prolonged exposure to high altitude and are the first to demonstrate sex-specific differences in rVPD at high altitude. The ability to assess intact microvasculature contiguous with the brain has widespread research and clinical applications.NEW & NOTEWORTHY Measuring the retinal microvasculature at high altitude provides a surrogate for cerebral microvasculature, offering potential insight into consequence of cerebral hypoxia in critical illness. This study demonstrates dynamic regulation of the retina during rapid ascent and prolonged exposure to high altitude and is the first to demonstrate sex-specific differences in retinal microvasculature at high altitude. The ability to dynamically assess intact microvasculature contiguous with the brain has widespread research and clinical applications.

The rise of performative culture in education and intensifying forms of test-based accountability have subjected teachers to a ubiquitous 'field of judgment' through which they are held to account. Within this context, professional development is consistently deployed as a key solution to stagnant or declining student outcomes. In this paper, we examine how accountability might be reimagined through one approach to professional development known as Quality Teaching Rounds (QTR). We draw on Foucault's notion of panopticism and Ball's influential writings on performativity to analyse interviews with 21 educators from 14 schools in New South Wales, Australia, conducted during a 2014-2015 randomised controlled trial. Participants highlighted the pervasiveness of testing and test results in shaping their experience of teaching in a system of perpetual surveillance where numbers bite deep into practice. By contrast, participation in QTR afforded teachers rare spaces of freedom within the structure of performativity to collaboratively focus on pedagogy. We argue meaningful professional development can alter the field of judgment and enable teachers to reclaim accountability on their own terms, while maintaining a clear focus on student outcomes.

In this report, we analyze students' learning of compound probability by describing connections they generated while engaged with tasks involving two independent events. Several of their connections were compatible with the development of expertise, such as recognizing the need to determine sample spaces across a variety of situations and noting structural similarities among tasks, even when their task solutions were incomplete from a normative standpoint. Students reasoned about dimensions of context, variation, mathematical structure, sample space, and probability quantification. We describe the extent to which they coordinated these dimensions. We also describe teaching moves, such as posing idealized situations and shifting to structurally similar tasks, that prompted students to attend to multiple relevant task dimensions.

Through the use of horror movie motifs like zombies and mad doctors, "The Maze Runner: The Scorch Trials" (2015) stands in drastic contrast to other young adult dystopian properties like "The Hunger Games" (2012), for example, in that "Scorch Trials" uses allegory as a means to comment on neoliberalism, alienated labor, and commodity fetishism essentially functioning as a Marxist critique of capital. However, this reading only occurs subtextually. By using a contextual cultural studies approach, which reads film as embedded in cultural politics, and a "monsterology," which captures capital as a specter within the film, this essay will serve as an intervention surrounding discourse on "The Maze Runner: The Scorch Trials." In doing so, this analysis will make the case that films targeted at students and young adults are important sites of pedagogy that contribute to an understanding of how capital alienates us from ourselves, each other, and social democratic structures.

The archaeological site of Pompeii is one of the 54 UNESCO World Heritage sites in Italy, thanks to its uniqueness: the town was completely destroyed and buried by a Vesuvius' eruption in 79 AD. In this work, we present a multidisciplinary approach with bioarchaeological and palaeogenomic analyses of two Pompeian human remains from the Casa del Fabbro. We have been able to characterize the genetic profile of the first Pompeian' genome, which has strong affinities with the surrounding central Italian population from the Roman Imperial Age. Our findings suggest that, despite the extensive connection between Rome and other Mediterranean populations, a noticeable degree of genetic homogeneity exists in the Italian peninsula at that time. Moreover, palaeopathological analyses identified the presence of spinal tuberculosis and we further investigated the presence of ancient DNA from Mycobacterium tuberculosis. In conclusion, our study demonstrates the power of a combined approach to investigate ancient humans and confirms the possibility to retrieve ancient DNA from Pompeii human remains. Our initial findings provide a foundation to promote an intensive and extensive paleogenetic analysis in order to reconstruct the genetic history of population from Pompeii, a unique archaeological site.

Humans live in complex socio-ecological systems where we interact with parasites and pathogens that spend time in abiotic and biotic environmental reservoirs (e.g., water, air, soil, other vertebrate hosts, vectors, intermediate hosts). Through a synthesis of published literature, we reviewed the life cycles and environmental persistence of 150 parasites and pathogens tracked by the World Health Organization's Global Burden of Disease study. We used those data to derive the time spent in each component of a pathogen's life cycle, including total time spent in humans versus all environmental stages. We found that nearly all infectious organisms were "environmentally mediated" to some degree, meaning that they spend time in reservoirs and can be transmitted from those reservoirs to human hosts. Correspondingly, many infectious diseases were primarily controlled through environmental interventions (e.g., vector control, water sanitation), whereas few (14%) were primarily controlled by integrated methods (i.e., combining medical and environmental interventions). Data on critical life history attributes for most of the 150 parasites and pathogens were difficult to find and often uncertain, potentially hampering efforts to predict disease dynamics and model interactions between life cycle time scales and infection control strategies. We hope that this synthetic review and associated database serve as a resource for understanding both common patterns among parasites and pathogens and important variability and uncertainty regarding particular infectious diseases. These insights can be used to improve systems-based approaches for controlling environmentally mediated diseases of humans in an era where the environment is rapidly changing.