Police and hospital data linkage for traffic injury surveillance: A systematic review.

This systematic review examines studies of traffic injury that involved linkage of police crash data and hospital data and were published from 1994 to 2023 worldwide in English. Inclusion and exclusion criteria were the basis for selecting papers from PubMed, Web of Science, and Scopus, and for identifying additional relevant papers using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and supplementary snowballing (n = 60). The selected papers were reviewed in terms of research objectives, data items and sample size included, temporal and spatial coverage, linkage methods and software tools, as well as linkage rates and most significant findings. Many studies found that the number of clinically significant road injury cases was much higher according to hospital data than crash data. Under-estimation of cases in crash data differs by road user type, pedestrian cases commonly being highly under-counted. A limited number of the papers were from low- and middle-income countries. The papers reviewed lack consistency in what was reported and how, which limited comparability.

Identifying foci for safety messages targeting child injury from driving quad bikes: A critical beliefs analysis of parental beliefs in Australia.

INTRODUCTION: In Australia, between 2017-2021, 16% of quad bike fatalities involved children. Trauma statistics highlight that public awareness of the risks associated with children driving quads is required. Consistent with the Step approach to Message Design and Testing (SatMDT) and, in particular, Steps 1 and 2, this study sought to identify critical beliefs influencing parental intentions to allow their children to drive a quad bike and develop message content. The critical beliefs analysis was based on eliciting the Theory of Planned Behavior's (TPB) behavioral, normative, and control beliefs. METHODS: An online survey was distributed via parenting blogs, social media posts, and snowballing of the researchers' network list. Parents who participated (N = 71; 53F, 18 M), were aged between 25-57 years (M = 40.96, SD = 6.98), had at least one child aged between 3 to 16 years, and currently resided in Australia. RESULTS: The critical beliefs analysis identified four critical beliefs that significantly predicted parental intentions to allow their child to drive a quad bike. These beliefs included a behavioral belief (the perceived advantage that allowing their child to drive a quad bike would enable tasks to be completed), two normative beliefs (the perception that one's parents and partner would likely approve of allowing their child to drive a quad bike), and one control belief (a perceived barrier to allowing one's child to drive a quad that was associated with being aware of an increasing cultural concern around the safety of quad bikes). CONCLUSIONS: Findings contribute to insights regarding parental beliefs underpinning their intention to allow their child to drive a quad bike, an area previously lacking in research evidence. PRACTICAL APPLICATIONS: With child-use posing a high-risk activity for children, this study provides an important contribution that may help to inform future safety messaging targeting children's use of quad bikes.

Understanding compensable and non-compensable patient profiles, pathways and physical outcomes for transport and work-related injuries in Queensland, Australia through data linkage.

INTRODUCTION: In many jurisdictions, people experiencing an injury often pursue compensation to support their treatment and recovery expenses. Healthcare costs form a significant portion of payments made by compensation schemes. Compensation scheme regulators need accurate and comprehensive data on injury severity, treatment pathways and outcomes to enable scheme modelling, monitoring and forecasting. Regulators routinely rely on data provided by insurers which have limited healthcare information. Health data provide richer information and linking health data with compensation data enables the comparison of profiles, patterns, trends and outcomes of injured patients who claim and injured parties who are eligible but do not claim. METHODS AND ANALYSIS: This is a retrospective population-level epidemiological data linkage study of people who have sought ambulatory, emergency or hospital treatment and/or made a compensation claim in Queensland after suffering a transport or work-related injury, over the period 1 January 2011 to 31 December 2021. It will use person-linked data from nine statewide data sources: (1) Queensland Ambulance Service, (2) Emergency Department, (3) Queensland Hospital Admitted Patients, (4) Retrieval Services, (5) Hospital Costs, (6) Workers' Compensation, (7) Compulsory Third Party Compensation, (8) National Injury Insurance Scheme and (9) Queensland Deaths Registry. Descriptive, parametric and non-parametric statistical methods and geospatial analysis techniques will be used to answer the core research questions regarding the patient's health service use profile, costs, treatment pathways and outcomes within 2 years postincident as well as to examine the concordance and accuracy of information across health and compensation databases. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Royal Brisbane and Women's Hospital Human Research Ethics Committee, and governance approval was obtained via the Public Health Act 2005, Queensland. The findings of this study will be used to inform key stakeholders across the clinical, research and compensation regulation area, and results will be disseminated through peer-reviewed journals, conference presentations and reports/seminars with key stakeholders.

A data fusion approach of police-hospital linked data to examine injury severity of motor vehicle crashes.

Injury severity studies typically rely on police-reported crash data to examine risk factors associated with traffic injuries. The police crash database includes essential information on roadways, crashes and driver-vehicle characteristics but may not contain accurate and sufficient information on traffic injuries. Despite sizable efforts on injury severity modelling, very few studies have employed hospital records to classify injury severities accurately. As such, the inferences drawn from the police-recorded injury severity classifications may be questionable. This study investigates factors affecting road traffic injuries of motor vehicle crashes in two approaches (1) police-reported injury severity data and (2) a data fusion approach linking police and hospital records. Data from 2015 to 2019 were collected from the Abu Dhabi Traffic Police Department and linked with hospital records by the Department of Health, Abu Dhabi. A total of 6,333 casualty crashes were categorised into non-severe, severe, and fatal crashes following police-reported data and non-hospitalised, hospitalised and fatal crashes based on the police-hospital linked data. The state-of-the-art random thresholds random parameters hierarchical ordered Probit models were then employed to examine the differences in factors affecting crash-injury severities between police-reported and police-hospital linked data. While there are similarities between these two approaches, there are numerous notable differences in injury severity factors. For instance, head-on collisions are associated with high crash-injury severities in the model with police-hospital linked data, but they tend to show low injury severities in the model with police-reported data. In addition, the police-reported approach identifies that crashes occurred in remote areas and angle collisions are associated with low injury severities, which is not intuitive. These findings highlight that modelling the misclassified injury severity in police crash data may lead to wrong estimations and misleading inferences. Instead, the data fusion approach of police-hospital linked data provides critical and accurate insights into road traffic injuries and is a valuable approach for understanding traffic injuries.

Comparing the accuracy of ICD-based severity estimates to trauma registry-based injury severity estimates for predicting mortality outcomes.

INTRODUCTION: Trauma registries have been used internationally for several decades to measure the quality of trauma care between hospitals. Given the significant costs involved in establishing and maintaining trauma registries, and increasing availability of routinely collected, linked health data describing a patient's journey (and inherent cost savings in data re-use), there is significant interest in development of integrated, comprehensive trauma data repositories. However, approaches to estimating injury severity using routinely collected data would need to be developed if routinely collected hospital data were to be used as an alternative/supplement to registries. OBJECTIVES: This study aimed to compare the accuracy of registry-based injury severity estimates with ICD-based injury severity estimates in predicting mortality outcomes in a cohort of minor and major trauma patients in Queensland, using retrospectively linked trauma registry and hospital admissions data. METHODS: Queensland Trauma Registry (QTR) data with an admission date between 1 January 2005 and 31 December 2011 was linked with all acute care patients included in the Queensland Hospital Admitted Patient Data Collection (QHAPDC) with a Principal Diagnosis coded with an ICD-10-AM code within Chapter 19 (S00-T98). Abbreviated Injury Scale coding was undertaken manually by QTR trauma data nurses for the registry data. ICD-based injury severity scores (ICISS) were calculated automatically using all injury-related diagnoses captured in the QHAPDC data using the ICISS multiplicative and worst injury method. RESULTS: There were 92,140 QTR patients admitted between January 2005 and December 2011 with a valid ISS with a matching QHAPDC record (98.4% survived, 1.6% died). ICISS (multiplicative and worst injury approach) showed marginally better predictive accuracy than ISS when predicting mortality across minor and major injury and ICISS showed marginally better predictive accuracy to ISS when restricted to major trauma/high threat to life cases. Both ICISS and ISS restricted to major trauma/high threat to life showed poorer accuracy compared to the predictive performance when both minor and major cases were included. CONCLUSION: ICD-based predictions were as accurate as ISS-based predictions for this cohort and this study provides evidence to support the potential for using routinely coded hospital data for risk adjustment within State-based trauma data repositories.

Three Es of linked injury data: Episodes, Encounters and Events.

BACKGROUND: Treatment and recovery times following injury can be lengthy, comprising multiple interactions with the hospital system for initial acute care, subsequent rehabilitation and possible re-presentation due to complications. AIMS: This article aims to promote the use of consistent terminology in injury data linkage studies, suggest important factors to consider when managing linked injury data, and encourage thorough documentation and a robust discourse around different approaches to data management to ensure reproducibility, consistency and comparability of analyses arising from linked injury data. APPROACH: This paper is presented in sections describing: (1) considerations for identifying injury cohorts, (2) considerations for grouping Episodes into Encounters and (3) considerations for grouping Encounters into Events. Summary tools are provided to aid researchers in the management of linked injury data. DISCUSSION: Careful consideration of decisions made when identifying injury cohorts and grouping data into units of analysis (Episodes/Encounters/Events) is essential when using linked injury data. Choices made have the potential to significantly impact the epidemiological and clinical findings derived from linked injury data studies, which ultimately affect the quality of injury prevention initiatives and injury management policy and practice. It is intended that this paper will act as a call to action for injury linkage methodologists, and those using linked data, to critique approaches, share tools and engage in a robust discourse to further advance the use of linked injury data, and ultimately enhance the value of linked injury data for clinicians and health and social policymakers.

Effectiveness of vehicle impoundment for high-range speeding offences in Victoria, Australia.

Speeding behaviour has been shown to account for a large number of deaths and serious injuries on Australian roads. Vehicle impoundment is one countermeasure which has been implemented to discourage drivers from engaging in high-range speeding. Despite this countermeasure being used as a sanction in all Australian jurisdictions to combat high-range speeding offences, limited research has examined the effectiveness of vehicle impoundments in Australia. The purpose of this research was to examine the effectiveness of vehicle impoundment for high-range speeding offences on subsequent offence and crash rates. Data were collected from drivers with an eligible excessive speeding offence in Victoria, Australia between 1 July 2006 and 31 December 2014. During this time, there were 17,440 impoundment eligible offences, 6,883 (41.8 %) of which resulted in vehicle impoundment. The analysis revealed that drivers who had a vehicle impounded were more likely to be male, younger, hold a probationary licence, and to have a court offence. In terms of the effectiveness of vehicle impoundment, among high-range offenders, re-offence rates for those who had their vehicle impounded were statistically significantly lower for all licence periods compared with offenders who did not have their vehicle impounded. There was evidence of an effect of impoundment on reducing speeding re-offence rates during the impoundment period as well as some evidence that the impact of licence suspension was greater for those who experienced impoundment. Given that vehicle impoundment is a sanction which aims to discourage and/or incapacitate drivers from engaging in on-road risk taking behaviour, in this case high-range speeding behaviour, the longer-term positive effects of this sanction may assist with the on-going effort to reduce on-road risk taking behaviours.

Understanding the psychological precursors of young drivers' willingness to speed and text while driving.

This study applied the Prototype Willingness Model (PWM) to investigate the factors that may predict young drivers' (non-intentional) willingness to text while driving, text while stopped, and engage in high and low levels of speeding. In addition, the study sought to assess whether general optimism bias would predict young drivers' willingness to text and speed over and above the PWM. Licenced drivers (N = 183) aged 17-25 years (M = 19.84, SD = 2.30) in Queensland, Australia completed an online survey. Hierarchical multiple regressions revealed that the PWM was effective in explaining the variance in willingness to perform all four illegal driving behaviours. Particularly, young drivers who possessed favourable attitudes and a positive prototype perception towards these behaviours were more willing to engage in texting and speeding. In contrast to the study's predictions, optimistically biased beliefs decreased young drivers' willingness to text while stopped and engage in high and low levels of speeding. The findings of the study may help inform policy and educational campaigns to better target risky driving behaviours by considering the influence of attitudes, prototypes and the non-intentional pathway that may lead to engagement in texting while driving and stopped and engagement in high and low levels of speeding.

Musical Tasks and Energetic Arousal.

BACKGROUND: Music is widely recognized as a motivating stimulus. Investigators have examined the use of music to improve a variety of motivation-related outcomes; however, these studies have focused primarily on passive music listening rather than active participation in musical activities. OBJECTIVE: To examine the influence of participation in musical tasks and unique participant characteristics on energetic arousal. METHODS: We used a one-way Welch's ANOVA to examine the influence of musical participation (i.e., a non-musical control and four different musical task conditions) upon energetic arousal. In addition, ancillary analyses of participant characteristics including personality, age, gender, sleep, musical training, caffeine, nicotine, and alcohol revealed their possible influence upon pretest and posttest energetic arousal scores. RESULTS: Musical participation yielded a significant relationship with energetic arousal, F(4, 55.62) = 44.38, p = .000, estimated ω2 = 0.60. Games-Howell post hoc pairwise comparisons revealed statistically significant differences between five conditions. Descriptive statistics revealed expected differences between introverts' and extraverts' energetic arousal scores at the pretest, F(1, 115) = 6.80, p = .010, partial η2= .06; however, mean differences failed to reach significance at the posttest following musical task participation. No other measured participant characteristics yielded meaningful results. CONCLUSIONS: Passive tasks (i.e., listening to a story or song) were related to decreased energetic arousal, while active musical tasks (i.e., singing, rhythm tapping, and keyboard playing) were related to increased energetic arousal. Musical task participation appeared to have a differential effect for individuals with certain personality traits (i.e., extroverts and introverts).

Falls from ladders in Australia: comparing occupational and non-occupational injuries across age groups.

OBJECTIVE: To examine national ladder-related fall injury patterns and trends, and compare the changes over time in occupational and non-occupational falls across age groups. METHODS: Analysis of national hospital morbidity data to examine trends over time and differences between groups. RESULTS: There were 41,092 hospitalised falls from ladders in Australia over the ten year period from July 2002 to June 2012, rising from 3,374 hospitalisations in 2002/03 to 4,945 hospitalisations in 2011/12. The age standardised rate of ladder-related fall hospitalisations rose significantly for males, and a higher increase was evident in people aged over 60 years. Occupational falls accounted for 20% of hospitalisations, and the hospitalisation rate for both occupational and non-occupational falls increased significantly over the ten year period. CONCLUSIONS: With almost 5,000 hospital admissions per year in recent years and a significant rise in the rate of hospitalisations over the past decade, this paper highlights the importance of focusing injury prevention efforts to reduce the growing number of ladder-related falls. IMPLICATIONS: This study demonstrates the significant burden that ladder-related falls are continuing to have on the community, both in the occupational and domestic setting.

Mental and behavioral health environments: critical considerations for facility design.

OBJECTIVES: The purpose of the study was to identify features in the physical environment that are believed to positively impact staff and patients in psychiatric environments and use these features as the foundation for future research regarding the design of mental and behavioral health facilities. METHODS: Pursuant to a broad literature review that produced an interview script, researchers conducted 19 interviews of psychiatric staff, facility administrators and architects. Interview data were analyzed using the highly structured qualitative data analysis process authored by Lincoln and Guba (1985). Seventeen topics were addressed ranging from the importance of a deinstitutionalized environment to social interaction and autonomy. RESULTS: The interviewees reinforced the controversy that exists around the implications of a deinstitutionalized environment, when the resulting setting diminishes patient and staff safety. Respondents tended to support open nurse stations vs. enclosed stations. Support for access to nature and the provision of an aesthetic environment was strong. Most interviewees asserted that private rooms were highly desirable because lower room density reduces the institutional character of a unit. However, a few interviewees adamantly opposed private rooms because they considered the increased supervision of one patient by another to be a deterrent to self-harm. The need to address smoking rooms in future research received the least support of all topics. CONCLUSION: Responses of interviews illustrate current opinion regarding best practice in the design of psychiatric facilities. The findings emphasize the need for more substantive research on appropriate physical environments in mental and behavioral health settings.

Self-Efficacy, Planning, and Drink Driving: Applying the Health Action Process Approach.

OBJECTIVE: This study examines the constructs from the health action process approach (HAPA) theoretical model (Schwarzer, 1992) on future drink driving avoidance by first time drink driving offenders. This research presents an advance in health related theory by the novel application of the health model to predict risk avoidance. METHOD: Baseline interviews were conducted with 198 first time drink driving offenders at the time of court appearance, and offenders were followed up 6-8 months following the offense date. The key outcome variables used in 3 stages were behavioral expectation, planning, and self-reported avoidance of drink driving at follow-up. RESULTS: Bivariate and multivariate analyses were conducted for each stage. High task self-efficacy and female gender were significantly related to having no behavioral expectation of future drink driving. High maintenance self-efficacy was significantly related to high levels of planning to avoid future drink driving. Those with higher planning scores at baseline had significantly higher odds of reporting that they had avoided drink driving at follow up. CONCLUSION: Planning plays an important role in drink driving rehabilitation and should be a focus of early intervention programs aimed at reducing drink driving recidivism following a first offense. Self-efficacy is an important construct to consider for the behavior and could strengthen a planning focused intervention. (PsycINFO Database Record

Predicting Crashes Using Traffic Offences. A Meta-Analysis that Examines Potential Bias between Self-Report and Archival Data.

BACKGROUND: Traffic offences have been considered an important predictor of crash involvement, and have often been used as a proxy safety variable for crashes. However the association between crashes and offences has never been meta-analysed and the population effect size never established. Research is yet to determine the extent to which this relationship may be spuriously inflated through systematic measurement error, with obvious implications for researchers endeavouring to accurately identify salient factors predictive of crashes. METHODOLOGY AND PRINCIPAL FINDINGS: Studies yielding a correlation between crashes and traffic offences were collated and a meta-analysis of 144 effects drawn from 99 road safety studies conducted. Potential impact of factors such as age, time period, crash and offence rates, crash severity and data type, sourced from either self-report surveys or archival records, were considered and discussed. After weighting for sample size, an average correlation of r = .18 was observed over the mean time period of 3.2 years. Evidence emerged suggesting the strength of this correlation is decreasing over time. Stronger correlations between crashes and offences were generally found in studies involving younger drivers. Consistent with common method variance effects, a within country analysis found stronger effect sizes in self-reported data even controlling for crash mean. SIGNIFICANCE: The effectiveness of traffic offences as a proxy for crashes may be limited. Inclusion of elements such as independently validated crash and offence histories or accurate measures of exposure to the road would facilitate a better understanding of the factors that influence crash involvement.

Estimating under-reporting of road crash injuries to police using multiple linked data collections.

The reliance on police data for the counting of road crash injuries can be problematic, as it is well known that not all road crash injuries are reported to police which under-estimates the overall burden of road crash injuries. The aim of this study was to use multiple linked data sources to estimate the extent of under-reporting of road crash injuries to police in the Australian state of Queensland. Data from the Queensland Road Crash Database (QRCD), the Queensland Hospital Admitted Patients Data Collection (QHAPDC), Emergency Department Information System (EDIS), and the Queensland Injury Surveillance Unit (QISU) for the year 2009 were linked. The completeness of road crash cases reported to police was examined via discordance rates between the police data (QRCD) and the hospital data collections. In addition, the potential bias of this discordance (under-reporting) was assessed based on gender, age, road user group, and regional location. Results showed that the level of under-reporting varied depending on the data set with which the police data was compared. When all hospital data collections are examined together the estimated population of road crash injuries was approximately 28,000, with around two-thirds not linking to any record in the police data. The results also showed that the under-reporting was more likely for motorcyclists, cyclists, males, young people, and injuries occurring in Remote and Inner Regional areas. These results have important implications for road safety research and policy in terms of: prioritising funding and resources; targeting road safety interventions into areas of higher risk; and estimating the burden of road crash injuries.

Profile of women detected drink driving via Roadside Breath Testing (RBT) in Queensland, Australia, between 2000 and 2011.

BACKGROUND: Drink driving among women is a growing problem in many motorised countries. While research has shown that male and female drink drivers differ on a number of characteristics, few studies have addressed the circumstances surrounding women's drink driving offences specifically. AIM: To add to previous research by comparing apprehension characteristics among men and women and to extend the understanding of the female drink driving problem by investigating the drink driving characteristics that are unique to women. RESULTS: The sample consisted of the 248,173 (21.5% women) drink drivers apprehended between 2000 and 2011 in Queensland, Australia. Gender comparisons showed that women were older, had lower levels of reoffending, and were more likely to be apprehended in Major Cities compared to men. Comparisons of age group and reoffending and non-reoffending among female drink drivers only revealed that higher BAC readings were more common among younger women. Moreover, a substantial minority (13.7%) of women aged 24 years or younger were apprehended with a BAC below 0.05%, reflecting a breach of the zero tolerance BAC for provisional licence holders in Australia. Older women were more likely to be charged with a 'failure to provide a test' offence as a result of refusing to provide a breath or blood sample, indicating that drink driving is associated high levels of stigma for this group. Reoffending occurred among 16.2% of the female drink drivers and these drivers were more likely than non-reoffending drivers to record a mid to high range BAC, to be aged 30-39 or below 21 years, and to be apprehended in Inner Regional or Remote locations. CONCLUSION: Findings highlight the unique circumstances and divergent needs of female drink drivers compared to male drivers and for different groups of female drivers.

The impact of daylight and views on ICU patients and staff.

OBJECTIVE: Using a pre-test/post-test quasi-experimental study in two New Hampshire ICUs, the impact of daylight and window views on patient pain levels, length of stay, staff errors, absenteeism, and vacancy rates were examined. One ICU was operational until 2007, the second opened in 2007. ICU patients were randomly selected from cardiac surgery, pneumonia, and chronic obstructive pulmonary disease admissions of one or more days, 58 from the old ICU, and 52 from the new. Regular medical staff members assigned to the unit between October 2006 and September 2007 (old unit) and March 2008 and February 2009 (new unit) were included. RESULTS: Variables other than unit design had a more significant impact on relative pain levels in each unit. Comparing light levels independent of ICU assignment supported the hypothesis that increased light levels reduce pain perception and length of stay, but the relationship was not statistically significant. One trend, not statistically significant, suggested that view was associated with reduced pain perception. A decrease in incident filings supported the hypothesis that improved natural light and views reduced errors, but results were not statistically significant. Some subcategories demonstrated significance. Mean absenteeism per person decreased from 38 to 23 hours from the old unit to the new (p = 0.05). Average vacancy rates decreased by 25% (from 10.12% to 7.49% staff openings per year) in the old and new units (p = 0.04). CONCLUSION: High levels of natural light and window views may positively affect staff absenteeism and staff vacancy. Factors such as medical errors, patient pain, and length of stay require additional research.

A computerized intervention to promote colorectal cancer screening for underserved populations: theoretical background and algorithm development.

OBJECTIVE: The aim of this exploratory study was to assess factors deemed by patients as "important" as they planned and considered undergoing colorectal cancer (CRC) screening, and to use this data to design a computer-delivered intervention to promote screening. METHODS: Fifty participants 50 years or older, not up-to-date with current recommended CRC screening guidelines, were recruited from a primary care clinic. A semi-structured interview focused on aspects of preparing for colorectal cancer screening was administered; after transcription, researchers used triangulation and consensus to identify relevant themes and concepts. RESULTS: Four main themes were identified that dealt with issues important for both FOBT and colonoscopy planning: personal concerns, reminders, communication with healthcare providers and obtaining test results. FOBT specific themes included: sample collection and return. For colonoscopy screening, themes included: scheduling, intervention questions, colonoscopy preparation, and transportation. These can be classified as barrier, process and accessory themes. The developed computer-administered implementation intentions algorithm addressed all the identified concerns in a planned and sequential manner, in order to facilitate planning for CRC screening. CONCLUSIONS: The results of this study suggest that appropriate reminders, explanations of procedures, and patient understanding of temporary life disruptions, help patients develop and accept a detailed screening plan.

Ruta graveolens extract induces DNA damage pathways and blocks Akt activation to inhibit cancer cell proliferation and survival.

BACKGROUND: Ruta graveolens is a medicinal herb that has been used for centuries against various ailments. This study examined the anticancer properties of the herb using cancer cell lines. MATERIALS AND METHODS: Methanolic extract of R. graveolens was tested on colon, breast and prostate cancer cells. Viability, cell cycle profiles, clonogenicity and capase activation were measured. Induction and subcellular localizations of p53, 53BP1 and γ-H2AX proteins were examined. RESULTS: The extract dose-dependently decreased the viability and the clonogenicity of treated cells and induced G2/M arrest, aberrant mitoses, and caspase-3 activation. It also induced the p53 pathway and focal concentration of the DNA damage response proteins 53BP1 and γ-H2AX. Moreover, the levels of phospho-Akt and cyclin B1 were reduced by treatment, whereas only cyclin B1 was reduced in normal dermal fibroblasts. CONCLUSION: R. graveolens extract contains bioactive compounds which, independently of known photoactivatable mechanisms, potently inhibit cancer cell proliferation and survival through multiple targets.