Explore the vast range of titles available.

We provide bijections between the cluster variables (and clusters) in two families of cluster algebras which have received considerable attention. These cluster algebras are the ones associated with certain Grassmannians of k-planes, and those associated with certain spaces of decorated SLk-local systems in the disk in the work of Fock and Goncharov. When k is 3, this bijection can be described explicitly using the combinatorics of Kuperberg's basis of non-elliptic webs. Using our bijection and symmetries of these cluster algebras, we provide evidence for conjectures of Fomin and Pylyavskyy concerning cluster variables in Grassmannians of 3-planes. We also prove their conjecture that there are infinitely many indecomposable nonarborizable webs in the Grassmannian of 3-planes in 9-dimensional space.

Adoptive T-cell immunotherapy holds great promise for the treatment of viral complications in immunocompromised patients resistant to standard anti-viral strategies. We present a retrospective analysis of 78 patients from 19 hospitals across Australia and New Zealand, treated over the last 15 years with “off-the-shelf” allogeneic T cells directed to a combination of Epstein–Barr virus (EBV), cytomegalovirus (CMV), BK polyomavirus (BKV), John Cunningham virus (JCV) and/or adenovirus (AdV) under the Australian Therapeutic Goods Administration’s Special Access Scheme. Most patients had severe post-transplant viral complications, including drug-resistant end-organ CMV disease, BKV-associated haemorrhagic cystitis and EBV-driven post-transplant lymphoproliferative disorder. Adoptive immunotherapy is well tolerated with few adverse effects. Importantly, 46/71 (65%) patients show definitive clinical improvement including reduction in viral load, clinical symptoms and complete resolution of end-organ disease. In addition, seven high-risk patients remain disease free. Based on this long-term encouraging clinical experience, we propose that a dedicated nationally funded centre for anti-viral cellular therapies should be considered to provide T cell therapies for critically ill patients for compassionate use. Adoptive T-cell immunotherapy offers promise to patients who are resistant to standard anti-viral strategies. Here the authors describe clinical observations in patients with viral complications treated with adoptive immunotherapy over the last 15 years.

Background and AimsDouble balloon enteroscopy (DBE) has revolutionised the diagnosis and treatment of small bowel (SB) conditions. However, deep SB insertion can be challenging in patients with a history of abdominal surgery and a two-step procedure is required when findings are not amenable to endoscopic therapy. This case series reports the development of laparoscopically assisted DBE (LA-DBE) using single incision laparoscopic surgery (SILS).MethodsRetrospective review of LA-DBE procedures performed in a single tertiary centre over 6 years.ResultsSeventeen patients (median age: 40 years, male 41%) underwent 17 LA-DBE procedures. The approach was oral in 13 and rectal in 4. Laparoscopic approach was standard (multi-port) in the first four cases, SILS was then used in all subsequent patients (13/17). Indications for LA-DBE were previously failed standard DBE (n = 16) and need for a combined procedure (n = 1). Indications for DBE were Peutz–Jeghers syndrome (PJS) (n = 10), suspected submucosal/polypoid lesion at small bowel imaging (n = 5) and obscure gastrointestinal bleeding (OGIB) with vascular abnormalities seen at capsule endoscopy (n = 2). In 1/17 the suggested pathology on imaging was not identified. Therapy was applied in 15/17 (88%) cases. Diagnoses were PJS polyps (n = 8), neuroendocrine tumour (NET) (n = 2), PJS and NET (n = 1), transmural arteriovenous malformation (n = 1), angioectesia (n = 1), inflammatory polyp (n = 1), leiomyoma (n = 1) and Meckel’s diverticulum (n = 1). The median (range) procedure time was 147 (84–210) mins. Median (range) length of stay post-procedure was 2 (1–19) days. Three patients developed complications. The 30-day mortality rate was 0%.ConclusionsLA-DBE is a safe, effective and minimally invasive procedure that can be applied for the management of selected patients with small bowel pathology. A SILS approach allows all therapeutic modalities to be available, including conversion to intraoperative enteroscopy (IOE), laparoscopic small bowel resection and laparotomy.

People who are incarcerated experience a high rate of hepatitis C (HCV) worldwide, and HCV micro-elimination in prisons is an effective strategy to support treatment. In Victoria, British Columbia, administrative barriers limited HCV testing and treatment at Vancouver Island Correctional Centre (VIRCC), and people who were HCV RNA+ were lost to follow up. Cool Aid Community Health Centre (CACHC) is an inner-city, primary care clinic that serves a marginalized population. The CACHC HCV nurse coordinator with the VIRCC nurse held HCV testing 'blitzes' at VIRCC and offered phlebotomy for screening and pre-treatment bloodwork. Clients who tested HCV RNA+ were started on HCV treatment and if discharged before completion, CACHC followed them in the community. A retrospective chart review was conducted to identify all clients who accessed HCV testing and treatment through the VIRCC partnership. To date, 230 clients were tested: 49 tested HCV antibody+, 11 tested HCV RNA+, and 10 started on treatment (6 SVR). Case management and consultation with the nurse coordinator and VIRCC nurse supported treatment starts for an additional 18 clients (14 SVR). This pragmatic and innovative approach to HCV care with people who are incarcerated demonstrated effective HCV testing and treatment. CACHC and VIRCC have established closer relationships and reduced barriers to reach and maintain continuity with this target population.

Background People who experience criminalization, such as those who use drugs, are incarcerated, and are affected by homelessness, have a high prevalence of HIV and/or hepatitis C virus (HCV) infection and low treatment uptake in British Columbia. Barriers to care include unreliable means of maintaining contact with healthcare providers. To reduce these barriers, the Test, Link, Call (TLC) Project provides cell phones and peer health mentors to support access to HIV and/or HCV care. This study aims to determine the outcomes and acceptability of TLC and its impact on care engagement. Methods A mixed-methods evaluation was conducted over the first 29 months (October 2021–March 2024) of the TLC Project. Data were collected concurrently in two rounds: the first after one year and the second two years after launch. Qualitative data were collected using semi-structured interviews conducted with healthcare providers ( n  = 8), peer health mentors ( n  = 6), and program participants ( n  = 20). Quantitative data, including demographic and clinical information, were gathered through program records and cross-sectional clinical chart reviews. Factors associated with HCV treatment uptake were assessed among HCV RNA positive participants ( n  = 245) using multivariate logistic regression. Data from both rounds were integrated for comprehensive analysis. Results 273 participants were enrolled in HCV care, and 26 in HIV care. Interviewees found TLC highly acceptable and effective. Positive outcomes included increased access to health and social services, connection to loved ones, independence, and safety. Challenges included phone theft and digital literacy issues. Overall, 57% of TLC participants enrolled for HCV care initiated curative treatment, compared to 40% among people who currently inject drugs in the provincial administrative database in 2020. The multivariate logistic regression analysis suggested that gender, housing stability, safer supply prescriptions, and length of involvement in the TLC program are predictive factors influencing treatment initiation. Conclusions The provision of cell phones and peer health mentors effectively increased engagement in HIV and HCV care, demonstrating substantial benefits despite some challenges. This cost-effective intervention could be expanded to support people who experience criminalization in other geographic locations and addressing other health conditions, such as syphilis and substance use disorder.

The contrasting approaches to death and bereavement in classical Confucianism and Daoism epitomize the different orientations of the two ethical traditions. Confucianism, here represented by Xunzi, interprets and manages death and bereavement through distinctive cultural practices, specifically rituals and associated norms of propriety, which are intended to bring order, harmony, and beauty to human events and conduct. Daoism, here represented by the Zhuangzi, contextualizes and copes with death and loss through an understanding of and identification with natural processes. Both approaches address death and bereavement through a systematic, naturalistic philosophy of life that makes no appeal to a conception of divinity or a personal afterlife. For Xunzi, the heart of this system is ritual propriety, through which all human affairs—including inevitable, natural events such as death—must be mediated. For the Zhuangzi, by contrast, rigid, ritualized cultural forms are an obstacle to coping efficiently with natural processes such as death. Rather than constructing a sphere of “the human” as distinct from “the natural,” the Zhuangzi urges us to situate the human within nature in a way that removes the opposition between the two. This essay contrasts and critiques the two approaches, contending that although Xunzi’s theory of ritual presents a plausible account of the relation between humanity, culture, and nature, it fails to address death appropriately as an inexorable, natural event. By contrast, the Zhuangzi presents an attractive way of relating human life and death to nature and thus perhaps offers a means of finding solace concerning death. The essay suggests, however, that the Zhuangist stance may be grounded primarily in a certain ethical or aesthetic attitude, rather than in an objectively compelling argument. Ultimately, both approaches may rest as much on contrasting ethical and aesthetic sensibilities as on rational argumentation.

Population-based cancer registries (PBCRs) generate measures of cancer incidence and survival that are essential for cancer surveillance, research, and cancer control strategies. In 2014, the Toronto Paediatric Cancer Stage Guidelines were developed to standardise how PBCRs collect data on the stage at diagnosis for childhood cancer cases. These guidelines have been implemented in multiple jurisdictions worldwide to facilitate international comparative studies of incidence and outcome. Robust stratification by risk also requires data on key non-stage prognosticators (NSPs). Key experts and stakeholders used a modified Delphi approach to establish principles guiding paediatric cancer NSP data collection. With the use of these principles, recommendations were made on which NSPs should be collected for the major malignancies in children. The 2014 Toronto Stage Guidelines were also reviewed and updated where necessary. Wide adoption of the resultant Paediatric NSP Guidelines and updated Toronto Stage Guidelines will enhance the harmonisation and use of childhood cancer data provided by PBCRs.

Background Blood and oral fluid-based HIV self-tests are important for reaching the undiagnosed living with HIV. The study objectives were to evaluate the oral fluid-based OraQuick® HIV Self-Test (HIV-ST) performance in comparison to laboratory reference testing; determine if laypersons can correctly perform the HIV-ST; document if intended users can successfully interpret pre-made contrived positive, negative, and invalid results; and document if intended users can understand the key messages in the product labeling. Methods This prospective study enrolled consenting adult intended users of HIV self-testing from six community health centres in four Canadian provinces between June 2022 and January 2024. Positive and negative agreement was determined by comparing the results of the HIV self-tests with the results of the laboratory-based “gold standard” Abbott Alinity HIV Antigen/Antibody Combo test. Descriptive statistics were used to summarize usability self-test procedure steps. Results Overall, 951 participants were recruited and consented with 911 available for all analyses. With respect to sociodemographics: 84% of participants were between 18–45 years of age, 73% had at least a college education, 48% were Cis-male, 45% were employed; and 26% identified as White, 23% as African, Caribbean or Black, 5% as Indigenous [First Nations, Métis or Inuit], 33% as Asian, and 6% as LatinX. Primary efficacy analysis on the 911 who completed HIV-ST revealed a single confirmed positive participant and a negative percent agreement of 100% (880/880, 95% CI: 99.9–100%) with the comparator method. For usability determination, the average success rate for “critical” steps for completing the test was 94.1%. Approximately 97% of participants found the instructions easy to follow and 98% of participants reported they would use the test again. Of the 465 participants who interpreted the strong positive, weak positive, negative, and invalid pre-made contrived results, the average of correct interpretations ranged from 59–97% Conclusions A licensed oral fluid-based HIV self-test in Canada can present an accurate, easy-to-use, and less invasive alternative to blood-based HIV testing. The addition of an oral-fluid self-test along with the current licensed blood-based HIV self-test could help reach the undiagnosed with HIV in Canada and positively impact HIV testing rates overall by offering individuals a choice of self-testing devices.