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Cities are making infrastructure investments to make travel by bicycle safer and more attractive. A challenge for promoting bicycling is effectively using data to support decision making and ensuring that data represent all communities. However, ecologists have been addressing a similar type of question for decades and have developed an approach to stratifying landscapes based on ecozones or areas with homogenous ecology. Our goal is to classify street and path segments and map streetscape categories by applying ecological classification methods to diverse spatial data on the built environment, communities, and bicycling. Piloted in Ottawa, Canada, we use GIS data on the built environment, socioeconomics and demographics of neighborhoods, and bicycling infrastructure, behavior, and safety, and apply a k-means clustering algorithm. Each street or path, an intuitive spatial unit that reflects lived experience in cities, is assigned a streetscape category: bicycling destination; wealthy neighborhoods; urbanized; lower income neighborhoods; and central residential streets. We demonstrate how streetscape categories can be used to prioritize monitoring (counts), safety, and infrastructure interventions. With growing availability of continuous spatial data on urban settings, it is an opportune time to consider how street and path classification approaches can help guide our data collection, analysis, and monitoring. While there is no one right answer to clustering, care must be taken when selecting appropriate input variables, the number of categories, and the correct spatial unit for output. The approach used here is designed for bicycling application, yet the methods are applicable to other forms of active transportation and micromobility.

Abstract Here, we report the results of the prospective cohort study EORTC‐CLG 58081 and compare them to the control arm of the randomized phase 3 trial EORTC‐CLG 58951, on which treatment recommendations were built. In both studies, patients aged 1–18 years with BCR::ABL1 negative acute lymphoblastic leukemia of the B‐lineage (B‐ALL) or T‐lineage (T‐ALL) were treated using a BFM backbone without cranial irradiation. Similarly to the control arm of 58951, prednisolone (PRED) 60 mg/m2/day was used for induction therapy, but a few modifications were made. Dexamethasone (DXM) was used in average‐risk 2 (AR2) T‐ALL and B‐ALL during induction, 10 and 6 mg/m2/day, respectively. Leucovorin rescue was delayed to 42 h instead of 36 h after initiation of high‐dose methotrexate, and a postconsolidation MRD time point was added to stratify patients. Between 2011 and 2017, 835 patients were prospectively enrolled in the 58081 study. Overall, the 5‐year event‐free survival (EFS) was 84.8% versus 83.6% (hazard ratio [HR], 0.96 [95% confidence interval [CI]: 0.76–1.21]) for 58081 versus 58951 considered as a control group, respectively, 84.3% versus 84.9% (HR, 1.06 [99% CI: 0.75–1.49]) in B‐ALL but 87.3% versus 76.6% (HR, 0.59 [99% CI: 0.28–1.24]) in T‐ALL. The comparison between the two studies regarding EFS differed by risk group (p = 0.012). The HR was 2.15 (99% CI: 0.67–6.85) for very low‐risk but 0.34 (99% CI: 0.13–0.89) for AR2. The particularly favorable results observed in the T‐ALLs and AR2 subgroups suggest the benefit of using DXM in specific patient groups and highlight the importance of risk stratification.

Background: Positive and negative alcohol expectancies (PAEs and NAEs, respectively) and impulsivity are key risk factors for the onset of alcohol use. While both factors independently contribute to alcohol initiation, the developmental aspects of AEs and their nuanced relationship with impulsivity are not adequately understood. Understanding these relationships is imperative for developing targeted interventions to prevent or delay alcohol use onset in youth. Methods: This study utilized the Adolescent Brain Cognitive Development cohort to examine how PAEs and NAEs develop over time and relate to each other. We also explored how self-reported and behavioral impulsivity at baseline (~10 years old) are associated with the longitudinal development of PAEs and NAEs in youth Ages 11, 12, and 13 (n = 7493; 7500; and 6981, respectively), as well as their time-specific relationships. Results: Findings revealed while PAEs increased steadily over all three years, NAEs increased from ages 11–12 and then remained unchanged between 12 and 13. Overall, PAEs and NAEs were inversely related. Moreover, PAEs positively correlated with sensation seeking and lack of premeditation, while NAEs negatively correlated with positive urgency. Interestingly, a time-specific association was observed with PAEs and lack of perseverance, with a stronger correlation to PAEs at Age 11 compared to Age 12. Conclusions: Overall, this study provides valuable insights into the divergent developmental trajectory of PAEs and NAEs, and their overall and time-specific associations with impulsivity. These findings may guide focused and time-sensitive prevention and intervention initiatives, aiming to modify AEs and reduce underage drinking.

Abstract Survival after childhood acute lymphoblastic leukemia (ALL) has increased over the last 40 years with an overall survival above 90%. Survivors may experience neurological late effects secondary to chemotherapy and radiotherapy. This observational retrospective study evaluated the cumulative incidence of neurological late effects among 890 childhood ALL survivors treated in EORTC CLG trials (58741, 58831/2 and 58881) between 1971 and 1998. Median follow-up was 19 years and interquartile range of the follow-up was 15–22 years. At 20 years from the end of treatment, approximately 66% of patients from the 58741 trial (accrual time: 1971–1978) and approximately 15% from the more recent trials had cognitive disturbance grade 1 or higher. Cumulative incidences at 20 years from treatment end of seizures, stroke and leukoencephalopathy were respectively 45%, 16% and 62% in study 58741, 13%, 2% and 5% in study 58831/2, and 8%, 2% and 3% in study 58881. Patients who were 10–17 years of age at diagnosis had a higher incidence of stroke and leukoencephalopathy as compared to those less than 6 years of age. Noteworthy, all neurological late effects continued to occur beyond 5 years after end of treatment. This retrospective study highlights the frequency of neurological late effects in survivors of childhood ALL. With the increase of the overall survival of ALL patients, the role and potential benefit of longitudinal neurological screening should be evaluated in further studies as these neurological late effects become an important public health challenge. This study is part of the larger EORTC CLG 58 Late Adverse Effects (LAE) study (ClinicalTrials.gov Identifier NCT01298388, date of registration February 16, 2011).

Abstract Interconnections between ocean basins are recognized as an important driver of climate variability. Recent modeling evidence suggests that the North Atlantic climate can respond to persistent warming of the tropical Indian Ocean sea surface temperature (SST) relative to the rest of the tropics (rTIO). Here, we use observational data to demonstrate that multi-decadal changes in pantropical ocean temperature gradients lead to variations of an SST-based proxy of the Atlantic Meridional Overturning Circulation (AMOC). The largest contribution to this temperature gradient-AMOC connection comes from gradients between the Indian and Atlantic Oceans. The rTIO index yields the strongest connection of this tropical temperature gradient to the AMOC. Focusing on the internally generated signal in three observational products reveals that an SST-based AMOC proxy index has closely followed low-frequency changes of rTIO temperature with about 26-year lag since 1870. Analyzing the pre-industrial control simulations of 44 CMIP6 climate models shows that the AMOC proxy index lags simulated mid-latitude AMOC variations by 4 ± 4 years. These model simulations reveal the mechanism connecting AMOC variations to pantropical ocean temperature gradients at a 27 ± 2 years lag, matching the observed time lag in 28 out of the 44 analyzed models. rTIO temperature changes affect the North Atlantic climate through atmospheric planetary waves, impacting temperature and salinity in the subpolar North Atlantic, which modifies deep convection and ultimately the AMOC. Through this mechanism, observed internal rTIO variations can serve as a multi-decadal precursor of AMOC changes with important implications for AMOC dynamics and predictability.

Background and objectivesManagement of severe allergic transfusion reactions (ATR) is challenging. In this study, we investigate the usefulness of skin tests and basophil activation tests (BAT) in chronically transfused patients for the prevention of future ATR.Materials and methodsBAT and skin tests were carried with the supernatant of red blood cell (RBC) units for a sickle-cell disease patient under chronic exchange transfusion who has presented a severe ATR, in order to prevent potential future ATR. If the results for both BAT and skin tests were negative, the RBC units could be transfused to the patient. If either one of the results was positive, the tested RBC unit was discarded for the patient.Results192 RBC units were tested with both tests. The level of results concordance between the two tests was 95%. Out of the 169 negative units with both tests, 118 units were transfused to the patient for which he presented no ATR.ConclusionIn our study, combining both BAT and skin tests was associated with a good negative predictive value since we were able to safely transfuse our patient. Further studies are still necessary to confirm this result but this pilot study indicates that skin tests and BAT might help prevent ATR. When BAT is not available, skin tests may also be useful in preventing ATR.