Mental health-related hospitalisations of adolescents and their contact with child protection services to age 11 years, South Australia: a whole-of-population descriptive study

OBJECTIVES

To investigate the number of mental health-related hospitalisations of adolescents (12-17 years) in South Australia by level of contact with the child protection system (0-11 years).

STUDY DESIGN

Whole-of-population descriptive study; analysis of de-identified linked administrative data from the Better Evidence Better Outcomes Linked Data (BEBOLD) platform.

SETTING, PARTICIPANTS

Adolescents born in South Australia, 1991-1999; linked SA Department for Child Protection, Admitted Patient Care (SA Health), and South Australian Perinatal Statistics collection (SA Department for Health and Wellbeing) data.

MAIN OUTCOME MEASURES

Proportion of adolescents (12-17 years) hospitalised with mental health-related diagnoses; proportion of mental health-related hospitalisations of adolescents, by level of child protection contact (0-11 years) (no contact, notification but not screened in, screened-in notification but not investigated, investigation but not substantiated, substantiation, and out-of-home care).

RESULTS

Of 175 115 adolescents born during 1991-1999, 5646 (3.2%) had been hospitalised with mental health conditions, and 27 203 (15.5%) had histories of contact with child protection services. The proportion of adolescents admitted to hospital with mental health-related diagnoses increased with the level of prior child protection contact, from 3366 of 147 912 adolescents with no contact (2.3%), to 398 of 6645 with notifications (6.0%), to 209 of 1191 who had been placed in out-of-home care (17.5%). Contact with child protection services was recorded for 2280 of 5646 adolescents admitted to hospital with mental health-related diagnoses (40.4%); 4477 of 10 633 mental health-related hospitalisations (44.9%) were of adolescents with histories of child protection services contact, including 1285 hospitalisations (12.1%) of adolescents for whom substantiated maltreatment (but not out-of-home care) was recorded, and 568 hospitalisations (5.3%) of adolescents who had been placed in out-of-home care.

CONCLUSION

About 45% of mental health-related hospitalisations of 12-17-year-old adolescents were of people who had had contact with child protection services by the age of 11 years, although only 15.5% of all adolescents had histories of child protection contact. The trauma associated with a history of child protection can have longer term sequelae, and this should be considered when adolescents are hospitalised with mental health conditions.

Systematic Review and Meta-Analysis: Multisystemic Therapy and Functional Family Therapy Targeting Antisocial Behaviour in Adolescence

OBJECTIVE

Youth criminal justice systems are under growing pressure to reduce re-offending behaviour and support young people's health and developmental needs. This systematic review and meta-analysis sought to synthesise evidence for two prominent community-based interventions for delinquent and antisocial behaviour, multisystemic therapy (MST) and functional family therapy (FFT).

METHOD

We searched Medline, PsycInfo, Scopus, Web of Science, and Social Services Abstracts for randomised controlled trials (RCTs) and quasi-experimental studies evaluating MST/FFT. Included studies involved participants aged under 18; included interventions targeted delinquent/antisocial behaviour, but not maltreatment. We estimated effect sizes for 6 primary outcomes, synthesising RCTs comparing MST/FFT to usual care using correlated hierarchical effects meta-analysis. We assessed risk of bias and evidence strength using best-practice tools. Given the additional resources needed to implement MST/FFT, we rated evidence strength against a minimum clinically important difference rather than a null effect. This study is registered with PROSPERO, CRD42021279736.

RESULTS

We included 35 studies for MST (16 RCTs meta-analysed comprising 4095 participants, 26% female) and 19 studies for FFT (7 RCTs meta-analysed comprising 1471 participants, 22% female). MST had a likely clinically important effect on time in out-of-home care, but no clinically important effects on other primary outcomes (delinquency, new offences/convictions, placement in out-of-home care, substance use), with low-to-moderate evidence strength. FFT demonstrated possible clinically important effects for the number of new offences/convictions, time in out-of-home care, and substance use, but evidence strength was low.

CONCLUSION

Contrary to reports in some evidence clearinghouses indicating that MST/FFT are supported by the highest level of evidence strength, there is limited evidence that these interventions are superior to usual care in reducing delinquent and antisocial behaviour in adolescence. These findings should be viewed in the context of important methodological differences with prior reviews, including the rating of evidence strength against a minimum clinically important difference.

Effects of environmental impact labels on the sustainability of food purchases: A randomised controlled trial in an experimental online supermarket

Providing consumers with product-specific environmental impact information for food products (ecolabels) may promote more sustainable purchasing, needed to meet global environmental targets. This UK study (N = 1051 participants) investigated the effectiveness of different ecolabels using an experimental online supermarket platform, comparing three labels against control (no label). Significant reductions were found in the environmental impact score (EIS) for all labels compared to control (labels presented: values for four environmental indicators [-3.9 percentiles, 95%CIs: -5.3, -2.6]; a composite score [taking values from A to E; -3.9, 95%CIs: -5.2,-2.5]; or both together [-3.2, 95%CIs: -4.5, -1.9]). Providing ecolabels is a promising intervention to promote the selection of more sustainable products.

To Know Me Is to Exonerate Me: Appeals to Character in Defense of the Willowbrook Hepatitis Study

The Willowbrook Hepatitis Study is one of the best-known examples of unethical medical research, but the research has always had defenders. One of the more intriguing defenses continually used was that critics did not know the researchers on the study and, therefore, could not assess their ethics. This essay traces the appeal to the researchers' characters across published research and archival sources from the 1960s through today. These appeals reflect the observation as old as Aristotle that one of the most potent modes of persuasion is ethos or character. The specific types of character in these appeals develop out of the paternalistic nature of clinical and research practice in the mid-twentieth century. If the individual physician is the locus of medical judgment, then the physician's character becomes a key concern for bioethics. These appeals still appear and have implications for bioethics in the present day.

Reliability and agreement of manual and automated morphological radiographic hip measurements

Objective

To determine the reliability and agreement of manual and automated morphological measurements, and agreement in morphological diagnoses.

Methods

Thirty pelvic radiographs were randomly selected from the World COACH consortium. Manual and automated measurements of acetabular depth-width ratio (ADR), modified acetabular index (mAI), alpha angle (AA), Wiberg center edge angle (WCEA), lateral center edge angle (LCEA), extrusion index (EI), neck-shaft angle (NSA), and triangular index ratio (TIR) were performed. Bland-Altman plots and intraclass correlation coefficients (ICCs) were used to test reliability. Agreement in diagnosing acetabular dysplasia, pincer and cam morphology by manual and automated measurements was assessed using percentage agreement. Visualizations of all measurements were scored by a radiologist.

Results

The Bland-Altman plots showed no to small mean differences between automated and manual measurements for all measurements except for ADR. Intraobserver ICCs of manual measurements ranged from 0.26 (95%-CI 0-0.57) for TIR to 0.95 (95%-CI 0.87-0.98) for LCEA. Interobserver ICCs of manual measurements ranged from 0.43 (95%-CI 0.10-0.68) for AA to 0.95 (95%-CI 0.86-0.98) for LCEA. Intermethod ICCs ranged from 0.46 (95%-CI 0.12-0.70) for AA to 0.89 (95%-CI 0.78-0.94) for LCEA. Radiographic diagnostic agreement ranged from 47% to 100% for the manual observers and 63%-96% for the automated method as assessed by the radiologist.

Conclusion

The automated algorithm performed equally well compared to manual measurement by trained observers, attesting to its reliability and efficiency in rapidly computing morphological measurements. This validated method can aid clinical practice and accelerate hip osteoarthritis research.

Skeletal Muscle Composition, Power, and Mitochondrial Energetics in Older Men and Women With Knee Osteoarthritis

OBJECTIVE

Our objective was to investigate the overall and sex-specific relationships between the presence and severity of knee osteoarthritis (KOA) and muscle composition, power, and energetics in older adults.

METHODS

Male and female patients (n = 655, mean ± SD age 76.1 ± 4.9 years; 57% female) enrolled in the Study of Muscle, Mobility, and Aging completed standing knee radiographs and knee pain assessments. Participants were divided into three groups using Kellgren-Lawrence grade (KLG) of KOA severity (0-1, 2, or 3-4). Outcome measures included whole-body muscle mass, thigh fat-free muscle (FFM) volume and muscle fat infiltration (MFI), leg power, specific power (power normalized to muscle volume), and muscle mitochondrial energetics.

RESULTS

Overall, the presence and severity of KOA is associated with greater MFI, lower leg power and specific power, and reduced oxidative phosphorylation (P trend < 0.036). Sex-specific analysis revealed reduced energetics only in female patients with KOA (P trend < 0.007) compared to female patients without KOA. In models adjusted for age, sex, race, nonsteroidal anti-inflammatory drug administration, site or technician, physical activity, height, and participants with abdominal adiposity with KLG 3 to 4 had greater MFI (mean 0.008%, 95% confidence interval [CI] 0.004%-0.011%) and lower leg power (mean -51.56 W, 95% CI -74.03 to -29.10 W) and specific power (mean -5.38 W/L, 95% CI -7.31 to -3.45 W/L) than those with KLG 0 to 1. No interactions were found between pain and KLG status. Among those with KOA, MFI and oxidative phosphorylation were associated with thigh FFM volume, leg power, and specific power.

CONCLUSION

Muscle health is associated with the presence and severity of KOA and differs by sex. Although muscle composition and power are lower in both male and female patients with KOA, regardless of pain status, mitochondrial energetics is reduced only in female patients.

Intra-Articular Mineralization on Computerized Tomography of the Knee and Risk of Cartilage Damage: The Multicenter Osteoarthritis Study

OBJECTIVE

Intra-articular (IA) mineralization may contribute to osteoarthritis (OA) structural progression. We studied the association of IA mineralization on knee computed tomography (CT) with cartilage damage worsening on knee magnetic resonance imaging (MRI), with a focus on location- and tissue-specific effects.

METHODS

Participants from the Multicenter Osteoarthritis Study with knee CT and MRI scans were included. Presence of IA mineralization on CT was defined as a Boston University Calcium Knee Score >0 anywhere in the knee. Cartilage worsening on MRI was defined as any increase in the MRI OA Knee Score, including incident damage. We evaluated the association of whole-knee, compartment-specific (ie, medial or lateral), and subregion-specific (ie, location-matched) IA mineralization at baseline with cartilage worsening at two years' follow-up in the corresponding locations using binomial regression with generalized estimating equations, adjusting for age, sex, and body mass index (BMI).

RESULTS

We included 1,673 participants (mean age 60 years, 56% female, mean BMI 29). Nine percent had any IA mineralization in the knee, and 47.4% had any cartilage worsening on follow-up. Mineralization of any tissue in the knee, regardless of location, was not associated with MRI cartilage worsening. However, cartilage mineralization was associated with 1.39 (95% confidence interval 1.04-1.88) times higher risk of cartilage worsening in the same compartment, with similar results in subregion-specific analysis.

CONCLUSION

CT-detected IA mineralization in the cartilage was associated with higher risk of MRI cartilage worsening in the same compartment and subregion over two years. These findings suggest potential localized, tissue-specific effects of IA mineralization on cartilage pathology in knee OA.

Does 'net zero' mean zero cows?

A significant share of anthropogenic global warming comes from livestock production. There is debate about whether there can be any role for livestock in a climatically sustainable future; the debate is particularly heated for cows and sheep, largely due to the methane they burp out. However, short-lived gases like methane affect climate in a fundamentally different way than long-lived gases like carbon dioxide. Consequently, climate stabilization does not require zeroing-out cattle herds. But this doesn't mean we can eat our beef and have it (a tolerable climate) too-livestock still contribute to global warming. Preventing or limiting future growth in livestock-related emissions can represent a sensible part of the portfolio of responses to the climate crisis, particularly when carbon dioxide emissions are not on track to reach net zero sufficiently quickly.

First reported case in an Irish flock of MCF- like systemic necrotizing vasculitis in sheep associated with ovine herpesvirus 2

BACKGROUND

Ovine gammaherpesvirus 2 (OvHV-2) is the causative agent of sheep associated malignant catarrhal fever (MCF). As sheep are the adapted host for OvHV-2, it is generally presumed that infection is not associated with disease in this species. However, a recent case review combined in-situ hybridisation, PCR and histopathology and correlated the viral distribution with systemic necrotizing vasculitis and concluded OvHV-2 was the likely agent responsible for sporadic, MCF-like vascular disease in sheep.

CASE PRESENTATION

Using similar methods this case study reports on the findings of the first reported cases in an Irish Flock of MCF- like systemic necrotizing vasculitis in sheep associated with OvHV-2. Sheep A, a 16-month-old Texel-cross hogget displayed signs of ill- thrift, Sheep B, a nine-month-old Belclare-cross lamb, was found dead having displayed no obvious symptoms. Both cases occurred on the same farm, however the animals were not related. Lymphohistiocytic vasculitis of various tissues was the predominant histopathological finding in both animals.

CONCLUSION

By combining histopathology, PCR and in-situ hybridisation results, MCF- like systemic necrotizing vasculitis associated with OvHV-2 has been diagnosed for the first time in an Irish flock.

The burden of prenatal and early life maternal substance use among children at risk of maltreatment: A systematic review

ISSUES

Although maternal substance use is a known risk factor for child maltreatment, evidence on the scale of substance use is needed to inform prevention responses. This systematic review synthesised prevalence estimates of maternal substance use during pregnancy and early life among children at risk of maltreatment. Ovid, Pubmed, CINAHL, PsychInfo and ProQuest databases were searched. We included observational studies that sampled children at risk of maltreatment in high-income countries and reported information on maternal substance use during pregnancy and/or the child's first year of life. We extracted study characteristics and data to calculate prevalence, assessed risk of bias and conducted a narrative synthesis; there were insufficient comparable populations or outcomes to quantitatively synthesise results.

KEY FINDINGS

Thirty five of 14,084 titles were included. Fifteen studies had adequately sized and representative samples to estimate prevalence. Maternal substance use prevalence ranged from 2.4% to 40.6%. Maternal substance use was highest among infants referred to child protection at birth (40.6%) and children in out-of-home care (10.4% to 37.2%). Prevalence was higher when studies defined substance use more broadly and when maternal substance use was ascertained from both child and mother records.

IMPLICATIONS

Supportive, coordinated responses to maternal substance use are needed from health and child protection services, spanning alcohol and other drug treatment, antenatal and postnatal care.

CONCLUSIONS

Prenatal and early life maternal substance use is common among child maltreatment populations, particularly among younger children and those with more serious maltreatment.

Counting culturally and linguistically diverse (CALD) children in Australian health research: Does it matter how we count?

OBJECTIVE

To describe how culturally and linguistically diverse (CALD) children are identified and enumerated in routine data collections and in child health research in Australia.

METHODS

Descriptive analysis, where different definitions of CALD were applied to the 2021 Australian Census to measure the size of the CALD population of Australian children aged 0 to 17 years. Narrative review of the Australian child health literature to examine how CALD children were defined.

RESULTS

Applying various definitions to the 2021 Census, the estimated proportion of CALD children aged 0 to 17 ranged from 6.3% to 43%. The most commonly applied CALD indicators were language background other than English and being born overseas.

CONCLUSIONS

There is no consensus on how CALD is defined in Australian child health research. Application of different CALD indicators can generate up to seven-fold differences in estimates of who counts as being a CALD child.

IMPLICATIONS FOR PUBLIC HEALTH

If we are to advance health and well-being equity for CALD children, we need a more consistent approach to understanding which children are counted as CALD.

The Imipridone ONC213 Targets α-Ketoglutarate Dehydrogenase to Induce Mitochondrial Stress and Suppress Oxidative Phosphorylation in Acute Myeloid Leukemia

Eradication of acute myeloid leukemia (AML) is therapeutically challenging; many patients succumb to AML despite initially responding to conventional treatments. Here, we showed that the imipridone ONC213 elicits potent antileukemia activity in a subset of AML cell lines and primary patient samples, particularly in leukemia stem cells, while producing negligible toxicity in normal hematopoietic cells. ONC213 suppressed mitochondrial respiration and elevated α-ketoglutarate by suppressing α-ketoglutarate dehydrogenase (αKGDH) activity. Deletion of OGDH, which encodes αKGDH, suppressed AML fitness and impaired oxidative phosphorylation, highlighting the key role for αKGDH inhibition in ONC213-induced death. ONC213 treatment induced a unique mitochondrial stress response and suppressed de novo protein synthesis in AML cells. Additionally, ONC213 reduced the translation of MCL1, which contributed to ONC213-induced apoptosis. Importantly, a patient-derived xenograft from a relapsed AML patient was sensitive to ONC213 in vivo. Collectively, these findings support further development of ONC213 for treating AML.

SIGNIFICANCE

In AML cells, ONC213 suppresses αKGDH, which induces a unique mitochondrial stress response, and reduces MCL1 to decrease oxidative phosphorylation and elicit potent antileukemia activity. See related commentary by Boët and Sarry, p. 950.

Tumor-acquired somatic mutation affects conformation to abolish ABCG2-mediated drug resistance

ABCG2 is an important ATP-binding cassette transporter impacting the absorption and distribution of over 200 chemical toxins and drugs. ABCG2 also reduces the cellular accumulation of diverse chemotherapeutic agents. Acquired somatic mutations in the phylogenetically conserved amino acids of ABCG2 might provide unique insights into its molecular mechanisms of transport. Here, we identify a tumor-derived somatic mutation (Q393K) that occurs in a highly conserved amino acid across mammalian species. This ABCG2 mutant seems incapable of providing ABCG2-mediated drug resistance. This was perplexing because it is localized properly and retained interaction with substrates and nucleotides. Using a conformationally sensitive antibody, we show that this mutant appears "locked" in a non-functional conformation. Structural modeling and molecular dynamics simulations based on ABCG2 cryo-EM structures suggested that the Q393K interacts with the E446 to create a strong salt bridge. The salt bridge is proposed to stabilize the inward-facing conformation, resulting in an impaired transporter that lacks the flexibility to readily change conformation, thereby disrupting the necessary communication between substrate binding and transport.

A restatement of the natural science evidence base concerning grassland management, grazing livestock and soil carbon storage

Approximately a third of all annual greenhouse gas emissions globally are directly or indirectly associated with the food system, and over a half of these are linked to livestock production. In temperate oceanic regions, such as the UK, most meat and dairy is produced in extensive systems based on pasture. There is much interest in the extent to which such grassland may be able to sequester and store more carbon to partially or completely mitigate other greenhouse gas emissions in the system. However, answering this question is difficult due to context-specificity and a complex and sometimes inconsistent evidence base. This paper describes a project that set out to summarize the natural science evidence base relevant to grassland management, grazing livestock and soil carbon storage potential in as policy-neutral terms as possible. It is based on expert appraisal of a systematically assembled evidence base, followed by a wide stakeholders engagement. A series of evidence statements (in the appendix of this paper) are listed and categorized according to the nature of the underlying information, and an annotated bibliography is provided in the electronic supplementary material.

Perinatal mental healthcare in Northern Ireland: challenges and opportunities

Perinatal mental health is a vital component of public mental health. The perinatal period represents the time in a woman's life when she is at the highest risk of developing new-onset psychiatric disorders or relapse of an existing mental illness. Optimisation of maternal mental health in the perinatal period is associated with both short- and long-term benefits not only for the mother, but also for her infant and family. However, perinatal mental health service provision remains variable across the world. At present in Northern Ireland, 80% of women do not have access to specialist community perinatal mental health services, and without access to a mother and baby unit, mothers who require a psychiatric admission in the postnatal period are separated from their baby. However, following successful campaigns, funding for development of specialist perinatal mental health community teams has recently been approved. In this article, we discuss the importance of perinatal mental health from a public health perspective and explore challenges and opportunities in the ongoing journey of specialist service development in Northern Ireland.

Relation of Intra-Articular Mineralization to Knee Pain in Knee Osteoarthritis: A Longitudinal Analysis in the MOST Study

OBJECTIVE

Intra-articular (IA) calcium crystal deposition is common in knee osteoarthritis (OA), but of unclear significance. It is possible that low-grade, crystal-related inflammation may contribute to knee pain. We examined the longitudinal relation of computed tomography (CT)-detected IA mineralization to the development of knee pain.

METHODS

We used data from the National Institutes of Health-funded longitudinal Multicenter Osteoarthritis Study. Participants had knee radiographs and bilateral knee CTs at baseline, and pain assessments every 8 months for 2 years. CT images were scored using the Boston University Calcium Knee Score. We longitudinally examined the relation of CT-detected IA mineralization to the risk of frequent knee pain (FKP), intermittent or constant knee pain worsening, and pain severity worsening using generalized linear mixed-effects models.

RESULTS

We included 2,093 participants (mean age 61 years, 57% women, mean body mass index 28.8 kg/m2 ). Overall, 10.2% of knees had IA mineralization. The presence of any IA mineralization in the cartilage was associated with 2.0 times higher odds of having FKP (95% confidence interval [CI] 1.38-2.78) and 1.86 times more frequent intermittent or constant pain (95% CI 1.20-2.78), with similar results seen for the presence of any IA mineralization in the meniscus or joint capsule. A higher burden of IA mineralization anywhere within the knee was associated with a higher odds of all pain outcomes (odds ratio ranged from 2.14 to 2.21).

CONCLUSION

CT-detected IA mineralization was associated with risk of having more frequent, persistent, and worsening knee pain over 2 years. Targeting IA mineralization may have therapeutic potential for pain improvement in knee OA.

The fraction of life years lost after diagnosis (FLYLAD): a person-centred measure of cancer burden

BACKGROUND

Cancer control initiatives are informed by quantifying the capacity to reduce cancer burden through effective interventions. Burden measures using health administrative data are a sustainable way to support monitoring and evaluating of outcomes among patients and populations. The Fraction of Life Years Lost After Diagnosis (FLYLAD) is one such burden measure. We use data on Aboriginal and non-Aboriginal South Australians from 1990 to 2010 to show how FLYLAD quantifies disparities in cancer burden: between populations; between sub-population cohorts where stage at diagnosis is available; and when follow-up is constrained to 24-months after diagnosis.

METHOD

FLYLADcancer is the fraction of years of life expectancy lost due to cancer (YLLcancer) to life expectancy years at risk at time of cancer diagnosis (LYAR) for each person. The Global Burden of Disease standard life table provides referent life expectancies. FLYLADcancer was estimated for the population of cancer cases diagnosed in South Australia from 1990 to 2010. Cancer stage at diagnosis was also available for cancers diagnosed in Aboriginal people and a cohort of non-Aboriginal people matched by sex, year of birth, primary cancer site and year of diagnosis.

RESULTS

Cancers diagnoses (N = 144,891) included 777 among Aboriginal people. Cancer burden described by FLYLADcancer was higher among Aboriginal than non-Aboriginal (0.55, 95% CIs 0.52-0.59 versus 0.39, 95% CIs 0.39-0.40). Diagnoses at younger ages among Aboriginal people, 7 year higher LYAR (31.0, 95% CIs 30.0-32.0 versus 24.1, 95% CIs 24.1-24.2) and higher premature cancer mortality (YLLcancer = 16.3, 95% CIs 15.1-17.5 versus YLLcancer = 8.2, 95% CIs 8.2-8.3) influenced this. Disparities in cancer burden between the matched Aboriginal and non-Aboriginal cohorts manifested 24-months after diagnosis with FLYLADcancer 0.44, 95% CIs 0.40-0.47 and 0.28, 95% CIs 0.25-0.31 respectively.

CONCLUSION

FLYLAD described disproportionately higher cancer burden among Aboriginal people in comparisons involving: all people diagnosed with cancer; the matched cohorts; and, within groups diagnosed with same staged disease. The extent of disparities were evident 24-months after diagnosis. This is evidence of Aboriginal peoples' substantial capacity to benefit from cancer control initiatives, particularly those leading to earlier detection and treatment of cancers. FLYLAD's use of readily available, person-level administrative records can help evaluate health care initiatives addressing this need.

Excess Hospital Burden Among Young People in Contact With Homelessness Services in South Australia: A Prospective Linked Data Study

PURPOSE

Youth homelessness remains an ongoing public health issue worldwide. We aimed to describe the burden of emergency department (ED) presentations and hospitalizations among a South Australian population of young people in contact with specialist homelessness services (SHS).

METHODS

This whole-of-population study used de-identified, linked administrative data from the Better Evidence Better Outcomes Linked Data (BEBOLD) platform on all individuals born between 1996 and 1998 (N = 57,509). The Homelessness2Home data collection was used to identify 2,269 young people in contact with SHS at ages 16-17 years. We followed these 57,509 individuals to age 18-19 years and compared ED presentations and hospital separations related to mental health, self-harm, drug and alcohol, injury, oral health, respiratory conditions, diabetes, pregnancy, and potentially preventable hospitalizations between those in contact and not in contact with SHS.

RESULTS

Four percent of young people had contact with SHS at ages 16-17 years. Young people who had contact with SHS were 2 and 3 times more likely to have presented to an ED and hospital respectively, compared to those who did not contact SHS. This accounted for 13% of all ED presentations and 16% of all hospitalizations in this age group. Excess burden causes included mental health, self-harm, drug and alcohol, diabetes, and pregnancy. On average, young people in contact with SHS experienced an increased length of stay in ED (+0.6 hours) and hospital (+0.7 days) per presentation, and were more likely to not wait for treatment in ED and to self-discharge from hospital.

DISCUSSION

The 4% of young people who contacted SHS at ages 16-17 years accounted for 13% and 16% of all ED presentations and hospitalizations respectively at age 18-19 years. Prioritizing access to stable housing and primary health-care services for adolescents in contact with SHS in Australia could improve health outcomes and reduce health-care costs.

The net electrostatic potential and hydration of ABCG2 affect substrate transport

ABCG2 is a medically important ATP-binding cassette transporter with crucial roles in the absorption and distribution of chemically-diverse toxins and drugs, reducing the cellular accumulation of chemotherapeutic drugs to facilitate multidrug resistance in cancer. ABCG2's capacity to transport both hydrophilic and hydrophobic compounds is not well understood. Here we assess the molecular basis for substrate discrimination by the binding pocket. Substitution of a phylogenetically-conserved polar residue, N436, to alanine in the binding pocket of human ABCG2 permits only hydrophobic substrate transport, revealing the unique role of N436 as a discriminator. Molecular dynamics simulations show that this alanine substitution alters the electrostatic potential of the binding pocket favoring hydration of the transport pore. This change affects the contact with substrates and inhibitors, abrogating hydrophilic compound transport while retaining the transport of hydrophobic compounds. The N436 residue is also required for optimal transport inhibition of ABCG2, as many inhibitors are functionally impaired by this ABCG2 mutation. Overall, these findings have biomedical implications, broadly extending our understanding of substrate and inhibitor interactions.

Are single global warming potential impact assessments adequate for carbon footprints of agri-food systems?

The vast majority of agri-food climate-based sustainability analyses use global warming potential (GWP100) as an impact assessment, usually in isolation; however, in recent years, discussions have criticised the 'across-the-board' application of GWP100 in Life Cycle Assessments (LCAs), particularly of food systems which generate large amounts of methane (CH4) and considered whether reporting additional and/or alternative metrics may be more applicable to certain circumstances or research questions (e.g. Global Temperature Change Potential (GTP)). This paper reports a largescale sensitivity analysis using a pasture-based beef production system (a high producer of CH4 emissions) as an exemplar to compare various climatatic impact assessments: CO2-equivalents using GWP100 and GTP100, and 'CO2-warming-equivalents' using 'GWP Star', or GWP*. The inventory for this system was compiled using data from the UK Research and Innovation National Capability, the North Wyke Farm Platform, in Devon, SW England. LCAs can have an important bearing on: (i) policymakers' decisions; (ii) farmer management decisions; (iii) consumers' purchasing habits; and (iv) wider perceptions of whether certain activities can be considered 'sustainable' or not; it is, therefore, the responsibility of LCA practitioners and scientists to ensure that subjective decisions are tested as robustly as possible through appropriate sensitivity and uncertainty analyses. We demonstrate herein that the choice of climate impact assessment has dramatic effects on interpretation, with GWP100 and GTP100 producing substantially different results due to their different treatments of CH4 in the context of carbon dioxide (CO2) equivalents. Given its dynamic nature and previously proven strong correspondence with climate models, out of the three assessments covered, GWP* provides the most complete coverage of the temporal evolution of temperature change for different greenhouse gas emissions. We extend previous discussions on the limitations of static emission metrics and encourage LCA practitioners to consider due care and attention where additional information or dynamic approaches may prove superior, scientifically speaking, particularly in cases of decision support.

Vegans, vegetarians, fish-eaters and meat-eaters in the UK show discrepant environmental impacts

Modelled dietary scenarios often fail to reflect true dietary practice and do not account for variation in the environmental burden of food due to sourcing and production methods. Here we link dietary data from a sample of 55,504 vegans, vegetarians, fish-eaters and meat-eaters with food-level data on greenhouse gas emissions, land use, water use, eutrophication risk and potential biodiversity loss from a review of 570 life-cycle assessments covering more than 38,000 farms in 119 countries. Our results include the variation in food production and sourcing that is observed in the review of life-cycle assessments. All environmental indicators showed a positive association with amounts of animal-based food consumed. Dietary impacts of vegans were 25.1% (95% uncertainty interval, 15.1-37.0%) of high meat-eaters (≥100 g total meat consumed per day) for greenhouse gas emissions, 25.1% (7.1-44.5%) for land use, 46.4% (21.0-81.0%) for water use, 27.0% (19.4-40.4%) for eutrophication and 34.3% (12.0-65.3%) for biodiversity. At least 30% differences were found between low and high meat-eaters for most indicators. Despite substantial variation due to where and how food is produced, the relationship between environmental impact and animal-based food consumption is clear and should prompt the reduction of the latter.

A PPIX-binding probe facilitates discovery of PPIX-induced cell death modulation by peroxiredoxin

While heme synthesis requires the formation of a potentially lethal intermediate, protoporphyrin IX (PPIX), surprisingly little is known about the mechanism of its toxicity, aside from its phototoxicity. The cellular protein interactions of PPIX might provide insight into modulators of PPIX-induced cell death. Here we report the development of PPB, a biotin-conjugated, PPIX-probe that captures proteins capable of interacting with PPIX. Quantitative proteomics in a diverse panel of mammalian cell lines reveal a high degree of concordance for PPB-interacting proteins identified for each cell line. Most differences are quantitative, despite marked differences in PPIX formation and sensitivity. Pathway and quantitative difference analysis indicate that iron and heme metabolism proteins are prominent among PPB-bound proteins in fibroblasts, which undergo PPIX-mediated death determined to occur through ferroptosis. PPB proteomic data (available at PRIDE ProteomeXchange # PXD042631) reveal that redox proteins from PRDX family of glutathione peroxidases interact with PPIX. Targeted gene knockdown of the mitochondrial PRDX3, but not PRDX1 or 2, enhance PPIX-induced death in fibroblasts, an effect blocked by the radical-trapping antioxidant, ferrostatin-1. Increased PPIX formation and death was also observed in a T-lymphoblastoid ferrochelatase-deficient leukemia cell line, suggesting that PPIX elevation might serve as a potential strategy for killing certain leukemias.