Less-frequent surveillance is noninferior to annual mammography
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Long term follow-up of women treated for screen detected atypical ductal hyperplasia or lobular neoplasia in a large UK screening centre
Atypical ductal hyperplasia (ADH) and lobular neoplasia (LN) increase subsequent breast cancer (BC) risk. However, optimal surveillance and risk reduction regimes remain uncertain. We report management and outcomes of women with ADH and LN to provide data on potential screening/prevention strategies.
Task-sharing and telemedicine delivery of psychotherapy to treat perinatal depression: a pragmatic, noninferiority randomized trial
Task-sharing and telemedicine can increase access to effective psychotherapies. Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) is pragmatic, multisite, noninferiority, four-arm trial that tested the non-inferiority of provider (non-specialist vs. specialist providers) and modality (telemedicine vs. in-person) in delivering psychotherapy for perinatal depressive symptoms. Across three university-affiliated networks in the United States and Canada, pregnant and postpartum adult participants were randomized 1:1:1:1 to each arm (472 nonspecialist telemedicine, 145 nonspecialist in-person, 469 specialist telemedicine and 144 specialist in-person) and offered weekly behavioral activation treatment sessions. The primary outcome was depressive symptoms (Edinburgh Postnatal Depression Scale (EPDS)) and the secondary outcome was anxiety (Generalized Anxiety Disorder (GAD-7)) symptoms at 3 months post-randomization. Between 8 January 2020 and 4 October 2023, 1,230 participants were recruited. Noninferiority was met for the primary outcome comparing provider (EPDS: nonspecialist 9.27 (95% CI 8.85–9.70) versus specialist 8.91 (95% CI 8.49–9.33)) and modality (EPDS: telemedicine 9.15 (95% CI 8.79–9.50) versus in-person 8.92 (95% CI 8.39–9.45)) for both intention-to-treat and per protocol analyses. Noninferiority was also met for anxiety symptoms in both comparisons. There were no serious or adverse events related to the trial. This trial suggests compelling evidence for task-sharing and telemedicine to improve access to psychotherapies for perinatal depressive and anxiety symptoms. ClinicalTrials.gov NCT04153864
Power price stability and the insurance value of renewable technologies
To understand if renewables stabilize or destabilize electricity prices, we simulate European power markets as projected by the National Energy and Climate Plans for 2030 but replicating the historical variability in electricity demand, the prices of fossil fuels and weather. We propose a β-sensitivity metric, defined as the projected increase in the average annual price of electricity when the price of natural gas increases by 1 euro. We show that annual power prices spikes would be more moderate because the β-sensitivity would fall from 1.4 euros to 1 euro. Deployment of solar photovoltaic and wind technologies exceeding 30% of the 2030 target would lower it further, below 0.5 euros. Our framework shows that this stabilization of prices would produce social welfare gains, that is, we find an insurance value of renewables. Because market mechanisms do not internalize this value, we argue that it should be explicitly considered in energy policy decisions.
Health inequalities in hepatocellular carcinoma surveillance, diagnosis, treatment, and survival in the United Kingdom: a scoping review
Hepatocellular carcinoma (HCC) remains a deadly cancer in the UK despite advancements in curative therapies. Societal conditions and health inequalities influence the development of chronic liver disease and outcomes from complications including HCC. Scoping this emergent evidence-base is required to inform research and solutions for the NHS.
Socio-economic factors constrain climate change adaptation in a tropical export crop
Climate change will alter the geographical locations most suited for crop production, but adaptation to these new conditions may be constrained by edaphic and socio-economic factors. Here we investigate climate change adaptation constraints in banana, a major export crop of Latin America and the Caribbean. We derived optimal climatic, edaphic and socio-economic conditions from the distribution of intensive banana production across Latin America and the Caribbean, identified using remote sensing imagery. We found that intensive banana production is constrained to low-lying, warm aseasonal regions with slightly acidic soils, but is less constrained by precipitation, as irrigation facilitates production in drier regions. Production is limited to areas close to shipping ports and with high human population density. Rising temperatures, coupled with requirements for labour and export infrastructure, will result in a 60% reduction in the area suitable for export banana production, along with yield declines in most current banana producing areas.
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