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Health specialists’ views on the needs for developing a digital gaming solution for paediatric day surgery: A qualitative study

Abstract

Aims and objectives

To describe the views on the needs of health specialists to consider when developing a digital gaming solution for children and families in a paediatric day surgery.

Background

Children’s day surgery treatment is often cancelled at the last minute for various reasons, e.g. due to the lack of information. Digital gaming solutions could help families to be better oriented to the coming treatment. Despite the increasing demands for mHealth systems, there is not enough evidence‐based information from the health specialist perspective for developing a digital gaming solution.

Design

A qualitative descriptive study was conducted.

Methods

Health specialists (N=15) including 11 nurses, one physiotherapist and four doctors from different areas from one university hospital in Finland were recruited using a snowball sampling method. Semi‐structured, face to face interviews were conducted in March and April 2019. The data was analysed using inductive conduct analyses. The COREQ checklist was used to report the data collection, analysis, and the results.

Results

The data yielded 469 open codes, 21 sub‐categories, three upper‐categories and one main category. The main category The Digital Gaming Solution to support knowledge, care and guidance in children’s day surgery included three upper categories: 1) support for pre‐operative information and guidance, 2) support for intra‐operative information and care, and 3) support for post‐operative information, care and guidance.

Conclusion

Digital gaming solutions could be used to help children and families to be better prepared for upcoming treatments, to support for communication in different languages and to improve children’s pain management after operations.

Relevance to clinical practice

Evidence‐based information is important to ensure that future digital solutions answer the real needs of the staff and patients. There is a need for families and children’s views to be taken into consideration when developing digital gaming solutions in the hospital context.

Flare-IBD: development and validation of a questionnaire based on patients messages on an internet forum for early detection of flare in inflammatory bowel disease: study protocol

Por: Ricci · L. · Epstein · J. · Buisson · A. · Devos · C. · Toussaint · Y. · Peyrin-Biroulet · L. · Guillemin · F.
Introduction

Crohn’s disease and ulcerative colitis, the two major forms of inflammatory bowel disease (IBD), are chronic disabling conditions characterised by flares followed by periods of remission. However, patients with IBD are seen every 3–6 months in the outpatient clinic, and the occurrence of a flare between two outpatient visits is not captured. To our knowledge, there is no validated patient-reported outcome (PRO) tool to measure the phenomenon of flare in IBD. This study aimed to use an innovative methodology to collect messages posted by patients in an internet forum for developing and validating a PRO measuring flare in IBD.

Methods and analysis

The design involves (1) computer engineering sciences for scraping extraction of messages posted in an internet forum and for identification of messages related to flare; (2) qualitative methods for thematic content analyse of the messages posted, for candidate items generation, for items selection (Delphi process) and for items adjustment (‘think-aloud’ interviews) and (3) quantitative methods for psychometric validation of the PRO.

Ethics and dissemination

Ethical approval was obtained from the Comité de Protection des Personnes (CPP) CPP Nord-Ouest I (19.07.15.44139) in November 2019. The project aims to provide a tool to evaluate IBD flare in current medical practice that is constructed with patients’ perspectives. Items generation from a source corresponding to exchanges in an internet forum is an innovative method in this field and provides a wider coverage of qualitative data. If such a forum can result in interesting material, then this could be a new methodological perspective for generating items for questionnaires. Findings will be reported and disseminated widely through international peer-reviewed journal publications, oral and poster presentations at scientific conferences.

Trial registration number

NCT04180345.

Cohort profile: Resettlement in Uprooted Groups Explored (REFUGE)--a longitudinal study of mental health and integration in adult refugees from Syria resettled in Norway between 2015 and 2017

Por: Nissen · A. · Cauley · P. · Saboonchi · F. · Andersen · A. · Solberg · O.
Purpose

In the field of forced migration and mental health research, longitudinal studies with large sample sizes and rigorous methodology are lacking. Therefore, the Resettlement in Uprooted Groups Explored (REFUGE)-study was initiated in order to enhance current knowledge on mental health, quality of life and integration among adult refugees from Syria resettled in Norway. The main aims of the study are to investigate risk and protective factors for mental ill health in a longitudinal perspective; to trace mental health trajectories and investigate important modifiers of these trajectories and to explore the association between mental health and integration in the years following resettlement. The aims will be pursued by combining data from a longitudinal, three-wave questionnaire survey with data from population-based registries on education; work participation and sick-leave; healthcare utilisation and drug prescription. The goal is to incorporate the data in an internationally shared database, the REFUGE-database, where collaborating researchers may access and use data from the study as well as deposit data from similar studies.

Participants

Adult (≥18 years), Syrian citizens who arrived in Norway as quota refugees, asylum seekers or through Norway’s family reunion programme between 1 January 2015 and 31 December 2017. Of the initial 9990 sampled individuals for the first wave of the study (REFUGE-I), 8752 were reached by post or telephone and 902 responded (response rate=10.3%).

Findings to date

None published.

Future plans

The REFUGE-cohort study will conduct two additional data collections (2020 and 2021). Furthermore, questionnaire data will be linked to population-based registries after all three waves of data collection have been completed. Registry data will be obtained for time-periods both prior to and after the survey data collection points. Finally, pending ethics approval, we will begin the process of merging the Norwegian REFUGE-cohort with existing datasets in Sweden, establishing the extended REFUGE-database.

Trial registration number

ClincalTrials.gov Registry (NCT03742128).

Prioritising outcomes for evaluating eosinophil-guided corticosteroid therapy among patients with acute COPD exacerbations requiring hospitalisation: a Delphi consensus study

Por: Suehs · C. M. · Zysman · M. · Chenivesse · C. · Burgel · P.-R. · Couturaud · F. · Deslee · G. · Berger · P. · Raherison · C. · Devouassoux · G. · Brousse · C. · Roche · N. · Molimard · M. · Chinet · T. · Devillier · P. · Chanez · P. · Kessler · R. · Didier · A. · Martinat · Y. · Le Rouzic
Objectives

Presently, those outcomes that should be prioritised for chronic obstructive pulmonary disease (COPD) exacerbation studies remain unclear. In order to coordinate multicentre studies on eosinophilia-driven corticosteroid therapy for patients hospitalised for acute exacerbation of COPD (AECOPD), we aimed to find consensus among experts in the domain regarding the prioritisation of outcomes.

Design

A modified Delphi study was proposed to recognised COPD experts. Two brainstorming questionnaires were used to collect potential outcomes. Four subsequent rounds of questionnaires were used to rank items according to a six-point Likert scale for their importance in the protocol, as well as for being the primary outcome. Priority outcome criteria were predefined as those for which ≥70% of experts indicated that the outcome was essential for interpreting study results.

Setting

COPD exacerbation management in France.

Participants

34 experts recommended by the French Language Pulmonology Society were invited to participate. Of the latter, 21 experts participated in brainstorming, and 19 participated in all four ranking rounds.

Results

105 outcomes were ranked. Two achieved consensus as candidate primary outcomes: (1) treatment failure defined as death from any cause or the need for intubation and mechanical ventilation, readmission because of COPD or intensification of pharmacologic therapy, and (2) the time required to meet predefined discharge criteria. The 10 secondary priority outcomes included survival, time with no sign of improvement, episodes of hospitalisation, exacerbation, pneumonia, mechanical or non-invasive ventilation and oxygen use, as well as comorbidities during the initial hospitalisation.

Conclusions

This Delphi consensus project generated and prioritised a great many outcomes, documenting current expert views concerning a diversity of COPD endpoints. Among the latter, 12 reached consensus as priority outcomes for evaluating the efficacy of eosinophil-driven corticosteroid therapy in AECOPD inpatients.

Study registration

The eo-Delphi project/protocol was registered on 23 January 2018 at https://osf.io/4ahqw/.

Effect of RaceRunning on cardiometabolic disease risk factors and functional mobility in young people with moderate-to-severe cerebral palsy: protocol for a feasibility study

Por: Ryan · J. · Theis · N. · Koufaki · P. · Phillips · S. · Anokye · N. · Andreopoulou · G. · Kennedy · F. · Jagadamma · K. C. · vanSchie · P. · Dines · H. · van der Linden · M. L.
Introduction

There is consistent evidence that people with cerebral palsy (CP) do not engage in the recommended physical activity guidelines for the general population from a young age. Participation in moderate-to-vigorous physical activity is particularly reduced in people with CP who have a moderate-to-severe disability. RaceRunning is a growing disability sport that provides an opportunity for people with moderate-to-severe disability to participate in physical activity in the community. It allows those who are unable to walk independently to propel themselves using a RaceRunning bike, which has a breastplate for support but no pedals. The aim of this study is to examine the feasibility and acceptability of RaceRunning for young people with moderate-to-severe CP and the feasibility of conducting a definitive study of the effect of RaceRunning on cardiometabolic disease risk factors and functional mobility.

Methods and analysis

Twenty-five young people (age 5–21 years) with CP or acquired brain injury affecting coordination will be included in this single-arm intervention study. Participants will take part in one RaceRunning session each week for 24 weeks. Outcomes assessed at baseline, 12 and 24 weeks include body mass index, waist circumference, blood pressure, muscle strength, cardiorespiratory fitness, physical activity and sedentary behaviour, functional mobility, activity competence and psychosocial impact. Adverse events will be systematically recorded throughout the 24 weeks. Focus groups will be conducted with participants and/or parents to explore their views and experiences of taking part in RaceRunning.

Ethics and dissemination

Approval has been granted by Queen Margaret University Research Ethics Committee (REC) and the South East of Scotland REC. Results will be disseminated through peer-reviewed journals and distributed to people with CP and their families through RaceRunning and Athletic Clubs, National Health Service trusts and organisations for people with disabilities.

Trial registration number

NCT04034342; pre-results.

Protocol for a multinational risk-stratified randomised controlled trial in paediatric Crohns disease: methotrexate versus azathioprine or adalimumab for maintaining remission in patients at low or high risk for aggressive disease course

Por: Harris · R. E. · Aloi · M. · de Ridder · L. · Croft · N. M. · Koletzko · S. · Levine · A. · Turner · D. · Veereman · G. · Neyt · M. · Bigot · L. · Ruemmele · F. M. · Russell · R. K. · On behalf of PIBD SETQuality consortium and PIBDnet
Introduction

Immunomodulators such as thiopurines (azathioprine (AZA)/6-mercaptopurine (6MP)), methotrexate (MTX) and biologics such as adalimumab (ADA) are well established for maintenance of remission within paediatric Crohn’s disease (CD). It remains unclear, however, which maintenance medication should be used first line in specific patient groups.

Aims

To compare the efficacy of maintenance therapies in newly diagnosed CD based on stratification into high and low-risk groups for severe CD evolution; MTX versus AZA/6MP in low-risk and MTX versus ADA in high-risk patients. Primary end point: sustained remission at 12 months (weighted paediatric CD activity index ≤12.5 and C reactive protein ≤1.5 fold upper limit) without relapse or ongoing requirement for exclusive enteral nutrition (EEN)/steroids 12 weeks after treatment initiation.

Methods and analysis

REDUCE-RISK in CD is an international multicentre open-label prospective randomised controlled trial funded by EU within the Horizon2020 framework (grant number 668023). Eligible patients (aged 6–17 years, new-onset disease receiving steroids or EEN for induction of remission for luminal ± perianal CD are stratified into low and high-risk groups based on phenotype and response to induction therapy. Participants are randomised to one of two treatment arms within their risk group: low-risk patients to weekly subcutaneous MTX or daily oral AZA/6MP, and high-risk patients to weekly subcutaneous MTX or fortnightly ADA. Patients are followed up for 12 months at prespecified intervals. Electronic case report forms are completed prospectively. The study aims to recruit 312 participants (176 low risk; 136 high risk).

Ethics and dissemination

ClinicalTrials.gov Identifier: (NCT02852694), authorisation and approval from local ethics committees have been obtained prior to recruitment. Individual informed consent will be obtained prior to participation in the study. Results will be published in a peer-reviewed journal with open access.

Trial registration number

NCT02852694; Pre-results.

Competencies for collaboration between general practitioners and medical specialists: a qualitative study of the patient perspective

Por: Janssen · M. · Fluit · C. R. M. G. · Sagasser · M. H. · Kusters · L. H. J. · Scherpbier-de Haan · N. D. · de Graaf · J.
Objectives

To explore the patient view of competencies essential for doctors to provide good collaboration at the primary–secondary care interface.

Design

We used a qualitative research approach. Focus groups with patients were conducted to explore their opinions of doctors’ competencies to provide good collaboration between primary and secondary care doctors. Transcripts were analysed using thematic analysis.

Setting

Dutch primary–secondary care interface.

Participants

Sixteen participants took part in five focus groups. Patients treated in both primary and secondary care, defined as having a minimum of two contacts with their general practitioner and two contacts with a medical specialty in the last 6 months, were included. Psychiatric patients and children were excluded from this study.

Results

Three groups of competencies were identified: (1) relationship building, both with patients and with other doctors; (2) transparent collaborating: be able to provide clarity on the process of collaboration and on roles and responsibilities of those involved and (3) reflective practising: to be willing to acknowledge mistakes, give and receive feedback and act as a lifelong learner.

Conclusions

This focus group study enhances our understanding of the patient perspective on doctors’ collaborative competencies at the primary–secondary care interface. With this information, doctors can improve their collaborative skills to a level that would meet their patients’ needs. Patients expect doctors to be able to build relationships and act as reflective practitioners. Including patients in the collaborative process by giving them a role that is appropriate to their abilities and by making collaboration more explicit could help to improve collaboration between general practitioners and medical specialists.

Challenges and facilitators of hospice decision-making: a retrospective review of family caregivers of home hospice patients in a rural US-Mexico border region--a qualitative study

Por: Ko · E. · Fuentes · D. · Singh-Carlson · S. · Nedjat-Haiem · F.
Objectives

Hospice care (HC) is seen as a comprehensive approach, that enhances quality of end-of-life (EOL) care, for terminally ill patients. Despite its positive aspects, HC enrolment is disproportionate for rural patients, who are less likely to use HC in comparison to their urban counterparts. The purpose of this study was to explore decision-making experiences, related to utilisation of HC programmes from a retrospective perspective, with family caregivers (FCGs) in a rural US–Mexico border region.

Design

This qualitative study was conducted from May 2017 to January 2018 using semistructured face to face interviews with FCGs. Data were analysed using thematic analysis.

Setting

The HC programme was situated at a local home health agency, located in rural Southern California, USA.

Participants

Twenty-eight informal FCGs of patients who were actively enrolled in the HC programme agreed to participate in the study.

Results

Conversation about HC as an option was initiated by home healthcare staff (39.3%), followed by physicians (32.1%). Emerging themes related to challenges in utilisation of HC and decision-making included: (1) communication barriers; (2) lack of knowledge/misperception about HC; (3) emotional difficulties, including fear of losing their patient, doubt and uncertainty about the decision, denial and (4) patients are not ready for HC. Facilitators included: (1) patient’s known EOL wishes; (2) FCG-physician EOL communication; (3) the patient’s deteriorating health and (4) home as the place for death.

Conclusions

HC patients’ FCGs in this rural region reported a lack of knowledge or misunderstanding of HC. It is recommended that healthcare providers need to actively engage family members in patient’s EOL care planning. Optimal transition to an HC programme can be facilitated when FCGs are informed and have a clear understanding about patients’ medical status along with information about HC.

Mapping adolescent sexual and reproductive health research in sub-Saharan Africa: protocol for a scoping review

Por: Ajayi · A. I. · Ushie · B. A. · Mwoka · M. · Igonya · E. K. · Ouedraogo · R. · Juma · K. · Aboderin · I.
Introduction

Previous studies have attempted to review the vast body of evidence on adolescent sexual and reproductive health (ASRH), but none has focused on a complete mapping and synthesis of the body of inquiry and evidence on ASRH in sub-Saharan Africa (SSA). Such a comprehensive scoping is needed, however, to offer direction to policy, programming and future research. We aim to undertake a scoping review of studies on ASRH in SSA to capture the landscape of extant research and findings and identify gaps for future research.

Methods and analysis

This protocol is designed using the framework for scoping reviews developed by the Joanna Briggs Institute. We will include English and French language peer-reviewed publications and grey literature on ASRH (aged 10–19) in SSA published between January 2010 and June 2019. A three-step search strategy involving an initial search of three databases to refine the keywords, a full search of all databases and screening of references of previous review studies for relevant articles missing from our full search will be employed. We will search AJOL, JSTOR, HINARI, Scopus, Science Direct, Google Scholar and the websites for the WHO, UNICEF, UNFPA, UNESCO and Guttmacher Institute. Two reviewers will screen the titles, abstracts and full texts of publications for eligibility and inclusion—using Covidence (an online software). We will then extract relevant information from studies that meet the inclusion criteria using a tailored extraction frame and template. Extracted data will be analysed using descriptive statistics and thematic analysis. Results will be presented using tables and charts and summaries of key themes arising from available research findings.

Ethics and dissemination

Ethical approval is not required for a scoping review as it synthesises publicly available publications. Dissemination will be through publication in a peer-review journal and presentation at relevant conferences and convening of policymakers and civil society organisations working on ASRH in SSA.

Impact of COVID-19 pandemic on mental health of young people and adults: a systematic review protocol of observational studies

Introduction

Since the WHO declared COVID-19 as a pandemic, the spread of the new coronavirus has been the focus of attention of scientists, governments and populations. One of the main concerns is the impact of this pandemic on health outcomes, mainly on mental health. Even though there are a few empirical studies on COVID-19 and mental health, so far, there is no systematic review about the impact of COVID-19 on mental health of young people and adults yet. We aim to critically synthesise the scientific evidence about the impact of the COVID-19 pandemic on the mental health of young people and adults.

Methods and analysis

A systematic review will be performed through eight databases: MEDLINE (Medical Literature Analysis and Retrieval System Online), ISI-of-Knowledge, CENTRAL (Cochrane Central Register of Controlled Trials), EMBASE (Excerpta Medica Database), SCOPUS, LILACS (Latin American and Caribbean Health Sciences Literature), PsycINFO (Psychology Information) and CNKI (Chinese National Knowledge Infrastructure), from inception until 30 June 2020. No restriction regarding the publication date, setting or languages will be considered. Preliminary search strategies were carried out on 29 March 2020 and will be updated in June 2020. The primary outcomes will be the prevalence and the severity of psychological symptoms in young people and adults (>18 years old) resulting from the impact of COVID-19 pandemic. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Pooled standardised mean differences and 95% CIs will be calculated. The risk of bias of the observational studies will be assessed through the Methodological Index for Non-Randomised Studies (MINORS). Additionally, if sufficient data are available, a meta-analysis will be conducted. Heterogeneity between the studies will be determined by the I2 statistics. Subgroup analyses will also be performed. Publication bias will be checked with funnel plots and Egger’s test. Heterogeneity will be explored by random-effects analysis.

Ethics and dissemination

Ethical assessment was not required. Findings will be disseminated through peer-reviewed publication and will be presented at conferences related to this field.

PROSPERO registration number

CRD42020177366.

International prospective observational study investigating the disease course and heterogeneity of paediatric-onset inflammatory bowel disease: the protocol of the PIBD-SETQuality inception cohort study

Por: Aardoom · M. A. · Kemos · P. · Tindemans · I. · Aloi · M. · Koletzko · S. · Levine · A. · Turner · D. · Veereman · G. · Neyt · M. · Russell · R. K. · Walters · T. D. · Ruemmele · F. M. · Samsom · J. N. · Croft · N. M. · de Ridder · L. · PIBD-SETQuality consortium and PIBD-NET
Introduction

Patients with paediatric-onset inflammatory bowel disease (PIBD) may develop a complicated disease course, including growth failure, bowel resection at young age and treatment-related adverse events, all of which can have significant and lasting effects on the patient’s development and quality of life. Unfortunately, we are still not able to fully explain the heterogeneity between patients and their disease course and predict which patients will respond to certain therapies or are most at risk of developing a more complicated disease course. To investigate this, large prospective studies with long-term follow-up are needed. Currently, no such European or Asian international cohorts exist. In this international cohort, we aim to evaluate disease course and which patients are most at risk of therapy non-response or development of complicated disease based on patient and disease characteristics, immune pathology and environmental and socioeconomic factors.

Methods and analysis

In this international prospective observational study, which is part of the PIBD Network for Safety, Efficacy, Treatment and Quality improvement of care (PIBD-SETQuality), children diagnosed with inflammatory bowel disease

Ethics and dissemination

Medical ethical approval has been obtained prior to patient recruitment for all sites. The results will be disseminated through peer-reviewed scientific publications.

Trial registration number

NCT03571373.

Eleven-year multimorbidity burden among 637 255 people with and without type 2 diabetes: a population-based study using primary care and linked hospitalisation data

Por: Zghebi · S. S. · Steinke · D. T. · Rutter · M. K. · Ashcroft · D. M.
Objectives

To compare the patterns of 18 physical and mental health comorbidities between people with recently diagnosed type 2 diabetes (T2D) and people without diabetes and how these change by age, gender and deprivation over time between 2004 and 2014. Also, to develop a metric to identify most prevalent comorbidities in people with T2D.

Design

Population-based cohort study.

Setting

Primary and secondary care, England, UK.

Participants

108 588 people with T2D and 528 667 comparators registered in 391 English general practices. Each patient with T2D aged ≥16 years between January 2004 and December 2014 registered in Clinical Practice Research Datalink GOLD practices was matched to up to five comparators without diabetes on age, gender and general practice.

Primary and secondary outcome measures

Prevalence of 18 physical and mental health comorbidities in people with T2D and comparators categorised by age, gender and deprivation. Odds for association between T2D diagnosis and comorbidities versus comparators. A metric for comorbidities with prevalence of ≥5% and/or odds ≥2 in patients with T2D.

Results

Overall, 77% of patients with T2D had ≥1 comorbidity and all comorbidities were more prevalent in patients with T2D than in comparators. Across both groups, prevalence rates were higher in older people, women and those most socially deprived. Conditional logistic regression models fitted to estimate (OR, 95% CI) for association between T2D diagnosis and comorbidities showed that T2D diagnosis was significantly associated with higher odds for all conditions including myocardial infarction (OR 2.13, 95% CI 1.85 to 2.46); heart failure (OR 2.12, 1.84 to 2.43); depression (OR 1.75, 1.62 to 1.89), but non-significant for cancer (OR 1.12, 0.98 to 1.28). In addition to cardiovascular disease, the metric identified osteoarthritis, hypothyroidism, anxiety, schizophrenia and respiratory conditions as highly prevalent comorbidities in people with T2D.

Conclusions

T2D diagnosis is associated with higher likelihood of experiencing other physical and mental illnesses. People with T2D are twice as likely to have cardiovascular disease as the general population. The findings highlight highly prevalent and under-reported comorbidities in people with T2D. These findings can inform future research and clinical guidelines and can have important implications on healthcare resource allocation and highlight the need for more holistic clinical care for people with recently diagnosed T2D.

Systemic evaluation and localization of resistin expression in normal human tissues by a newly developed monoclonal antibody

by Qing Lin, Shari A. Price, John T. Skinner, Bin Hu, Chunling Fan, Kazuyo Yamaji-Kegan, Roger A. Johns

Resistin and resistin-like molecules are pleiotropic cytokines that are involved in inflammatory diseases. Our previous work suggested that resistin has the potential to be used as a biomarker and therapeutic target for human pulmonary arterial hypertension. However, data are limited on the distribution of resistin in healthy human organs. In this study, we used our newly developed anti-human resistin (hResistin) antibody to immunohistochemically detect the expression, localization, and intracellular/extracellular compartmentalization of hResistin in a full human tissue panel from healthy individuals. The potential cross reactivity of this monoclonal anti-hResistin IgG1 with normal human tissues also was verified. Results showed that hResistin is broadly distributed and principally localized in the cytoplasmic granules of macrophages scattered in the interstitium of most human tissues. Bone marrow hematopoietic precursor cells also exhibited hResistin signals in their cytoplasmic granules. Additionally, hResistin labeling was observed in the cytoplasm of nervous system cells. Notably, the cytokine activity of hResistin was illustrated by positively stained extracellular material in most human tissues. These data indicate that our generated antibody binds to the secreted hResistin and support its potential use for immunotherapy to reduce circulating hResistin levels in human disease. Our findings comprehensively document the basal expression patterns of hResistin protein in normal human tissues, suggest a critical role of this cytokine in normal and pathophysiologic inflammatory processes, and offer key insights for using our antibody in future pharmacokinetic studies and immunotherapeutic strategies.

Using liquid chromatography mass spectrometry (LC-MS) to assess the effect of age, high-fat diet, and rat strain on the liver metabolome

by Greg Boyce, Mohammad Shoeb, Vamsi Kodali, Terence Meighan, Jenny R. Roberts, Aaron Erdely, Michael Kashon, James M. Antonini

The goal of this study was to use liquid chromatography mass spectrometry to assess metabolic changes of two different diets in three distinct rat strains. Sprague-Dawley, Fischer 344, and Brown-Norway male rats were maintained on a high-fat, or regular diet for 24 weeks. Liver tissue was collected at 4, 12, and 24 weeks to assess global small molecule metabolite changes using high resolution accurate mass spectrometry coupled to ultra-high-performance liquid chromatography. The results of the global metabolomics analysis revealed significant changes based on both age and diet within all three strains. Principal component analysis revealed that the influence of diet caused a greater variation in significantly changing metabolites than that of age for the Brown Norway and Fisher 344 strains, whereas diet had the greatest influence in the Sprague Dawley strain only at the 4-week time point. As expected, metabolites involved in lipid metabolism were changed in the animals maintained on a high fat diet compared to the regular diet. There were also significant changes observed in the concentration of Tri carboxylic acid cycle intermediates that were extracted from the liver of all three strains based on diet. The results of this study showed that a high fat diet caused significant liver and metabolic changes compared to a regular diet in multiple rat strains. The inbred Fisher 344 and Brown Norway rats were more metabolically sensitive to the diet changes than outbred Sprague Dawley strain. The study also showed that age, as was the case for Sprague Dawley, is an important variable to consider when assessing metabolic changes.

Prevalence of clinically manifested drug interactions in hospitalized patients: A systematic review and meta-analysis

by Tâmara Natasha Gonzaga de Andrade Santos, Givalda Mendonça da Cruz Macieira, Bárbara Manuella Cardoso Sodré Alves, Thelma Onozato, Geovanna Cunha Cardoso, Mônica Thaís Ferreira Nascimento, Paulo Ricardo Saquete Martins-Filho, Divaldo Pereira de Lyra Jr., Alfredo Dias de Oliveira Filho

Aims

This review aims to determine the prevalence of clinically manifested drug-drug interactions (DDIs) in hospitalized patients.

Methods

PubMed, Scopus, Embase, Web of Science, and Lilacs databases were used to identify articles published before June 2019 that met specific inclusion criteria. The search strategy was developed using both controlled and uncontrolled vocabulary related to the following domains: “drug interactions,” “clinically relevant,” and “hospital.” In this review, we discuss original observational studies that detected DDIs in the hospital setting, studies that provided enough data to allow us to calculate the prevalence of clinically manifested DDIs, and studies that described the drugs prescribed or provided DDI adverse reaction reports, published in either English, Portuguese, or Spanish.

Results

From the initial 5,999 articles identified, 10 met the inclusion criteria. The pooled prevalence of clinically manifested DDIs was 9.2% (CI 95% 4.0–19.7). The mean number of medications per patient reported in six studies ranged from 4.0 to 9.0, with an overall average of 5.47 ± 1.77 drugs per patient. The quality of the included studies was moderate. The main methods used to identify clinically manifested DDIs were evaluating medical records and ward visits (n = 7). Micromedex® (27.7%) and Lexi-Comp® (27.7%) online reference databases were commonly used to detect DDIs and none of the studies evaluated used more than one database for this purpose.

Conclusions

This systematic review showed that, despite the significant prevalence of potential DDIs reported in the literature, less than one in ten patients were exposed to a clinically manifested drug interaction. The use of causality tools to identify clinically manifested DDIs as well as clinical adoption of DDI lists based on actual adverse outcomes that can be identified through the implementation of real DDI notification systems is recommended to reduce the incidence of alert fatigue, enhance decision-making for DDI prevention or resolution, and, consequently, contribute to patient safety.

Beak and feather disease virus (BFDV) prevalence, load and excretion in seven species of wild caught common Australian parrots

by Johanne M. Martens, Helena S. Stokes, Mathew L. Berg, Ken Walder, Shane R. Raidal, Michael J. L. Magrath, Andy T. D. Bennett

Pathogens pose a major risk to wild host populations, especially in the face of ongoing biodiversity declines. Beak and feather disease virus (BFDV) can affect most if not all members of one of the largest and most threatened bird orders world-wide, the Psittaciformes. Signs of disease can be severe and mortality rates high. Its broad host range makes it a risk to threatened species in particular, because infection can occur via spill-over from abundant hosts. Despite these risks, surveillance of BFDV in locally abundant wild host species has been lacking. We used qPCR and haemagglutination assays to investigate BFDV prevalence, load and shedding in seven abundant host species in the wild in south-east Australia: Crimson Rosellas (Platycercus elegans), Eastern Rosellas (Platycercus eximius), Galahs (Eolophus roseicapillus), Sulphur-crested Cockatoos (Cacatua galerita), Blue-winged Parrots (Neophema chrysostoma), Rainbow Lorikeets (Trichoglossus moluccanus) and Red-rumped Parrots (Psephotus haematonotus). We found BFDV infection in clinically normal birds in six of the seven species sampled. We focused our analysis on the four most commonly caught species, namely Crimson Rosellas (BFDV prevalence in blood samples: 41.8%), Sulphur-crested Cockatoos (20.0%), Blue-winged Parrots (11.8%) and Galahs (8.8%). Species, but not sex, was a significant predictor for BFDV prevalence and load. 56.1% of BFDV positive individuals were excreting BFDV antigen into their feathers, indicative of active viral replication with shedding. Being BFDV positive in blood samples predicted shedding in Crimson Rosellas. Our study confirms that BFDV is endemic in our study region, and can inform targeted disease management by providing comparative data on interspecies variation in virus prevalence, load and shedding.

Attitude and beliefs about the social environment associated with chemsex among MSM visiting STI clinics in the Netherlands: An observational study

by Ymke J. Evers, Jill J. H. Geraets, Geneviève A. F. S. Van Liere, Christian J. P. A. Hoebe, Nicole H. T. M. Dukers-Muijrers

Background

Drug use during sex, ‘chemsex’, is common among men who have sex with men (MSM) and related to sexual and mental health harms. This study assessed associations between chemsex and a wide range of determinants among MSM visiting STI clinics to increase understanding of characteristics and beliefs of MSM practicing chemsex.

Methods

In 2018, 785 MSM were recruited at nine Dutch STI clinics; 368 (47%) fully completed the online questionnaire. All participants reported to have had sex in the past six months. Chemsex was defined as using cocaine, crystal meth, designer drugs, GHB/GBL, ketamine, speed or XTC/MDMA during sex in the past six months. Associations between chemsex and psychosocial determinants, socio-demographics, sexual behaviour and using tobacco or alcohol were assessed by multivariable logistic regression analyses.

Results

Chemsex was reported by 44% of MSM (161/368) and was not associated with socio-demographics. Independent determinants were ‘believing that the majority of friends/sex partners use drugs during sex’ (descriptive norm) (aOR: 1.95, 95%CI: 1.43–2.65), ‘believing that sex is more fun when using drugs’ (attitude) (aOR: 2.06, 95%CI: 1.50–2.84), using tobacco (aOR: 2.65, 95%CI: 1.32–5.32), multiple sex partners (aOR: 2.69, 95%CI: 1.21–6.00), group sex (aOR: 4.65, 95%CI: 1.54–14.05) and using online dating platforms (aOR: 2.73, 95%CI: 1.13–6.62).

Conclusion

MSM are likely to find themselves in distinct social networks where it is the norm to use drugs when having sex and pleasure is linked to chemsex. Health services should acknowledge the social influence and pleasurable experiences to increase acceptability of strategies aimed at minimizing the possible harms of chemsex.

Sero-prevalence of arthropod-borne viral infections among Lukanga swamp residents in Zambia

by Caroline C. Chisenga, Samuel Bosomprah, Kalo Musukuma, Cynthia Mubanga, Obvious N. Chilyabanyama, Rachel M. Velu, Young Chan Kim, Arturo Reyes-Sandoval, Roma Chilengi

Introduction

The re-emergence of vector borne diseases affecting millions of people in recent years has drawn attention to arboviruses globally. Here, we report on the sero-prevalence of chikungunya virus (CHIKV), dengue virus (DENV), mayaro virus (MAYV) and zika virus (ZIKV) in a swamp community in Zambia.

Methods

We collected blood and saliva samples from residents of Lukanga swamps in 2016 during a mass-cholera vaccination campaign. Over 10,000 residents were vaccinated with two doses of Shanchol during this period. The biological samples were collected prior to vaccination (baseline) and at specified time points after vaccination. We tested a total of 214 baseline stored serum samples for IgG antibodies against NS1 of DENV and ZIKV and E2 of CHIKV and MAYV on ELISA. We defined sero-prevalence as the proportion of participants with optical density (OD) values above a defined cut-off value, determined using a finite mixture model.

Results

Of the 214 participants, 79 (36.9%; 95% CI 30.5–43.8) were sero-positive for Chikungunya; 23 (10.8%; 95% CI 6.9–15.7) for Zika, 36 (16.8%; 95% CI 12.1–22.5) for Dengue and 42 (19.6%; 95% CI 14.5–25.6) for Mayaro. Older participants were more likely to have Zika virus whilst those involved with fishing activities were at greater risk of contracting Chikungunya virus. Among all the antigens tested, we also found that Chikungunya saliva antibody titres correlated with baseline serum titres (Spearman’s correlation coefficient = 0.222; p = 0.03).

Conclusion

Arbovirus transmission is occurring in Zambia. This requires proper screening tools as well as surveillance data to accurately report on disease burden in Zambia.

Hyperglycemia enhances pancreatic cancer progression accompanied by elevations in phosphorylated STAT3 and MYC levels

by Katsuhiko Sato, Hayato Hikita, Yuta Myojin, Kenji Fukumoto, Kazuhiro Murai, Sadatsugu Sakane, Takeshi Tamura, Takuo Yamai, Yasutoshi Nozaki, Teppei Yoshioka, Takahiro Kodama, Minoru Shigekawa, Ryotaro Sakamori, Tomohide Tatsumi, Tetsuo Takehara

Diabetes mellitus is a well-known risk factor for pancreatic cancer. We focused on hyperglycemia, a main feature of diabetes mellitus, and uncovered its effect on precancerous pancreatic intraepithelial neoplasia (PanIN) progression. In vivo induction of hyperglycemia with 100 mg/kg streptozotocin in KrasLSL G12DPdx1Cre (KP) mice promoted the PanIN formation and progression. Preconditioning with a high- or low-glucose medium for 28 days showed that a high-glucose environment increased cell viability and sphere formation in PANC-1, a Kras-mutant human pancreatic ductal adenocarcinoma cell line, and mPKC1, a Kras-mutant murine pancreatic cancer cell line. In contrast, no changes were observed in BxPC3, a Kras-wild-type human pancreatic cancer cell line. Orthotopic injection of mPKC1 into the pancreatic tails of BL6/J mice showed that cells maintained in high-glucose medium grew into larger tumors than did those maintained in low-glucose medium. Hyperglycemia strengthened the STAT3 phosphorylation, which was accompanied by elevated MYC expression in Kras-mutant cells. Immunohistochemistry showed stronger phosphorylated STAT3 (pSTAT3) and MYC staining in PanINs from diabetic KP mice than in those from euglycemic counterparts. STAT3 inhibition with 1 μM STAT3 inhibitor STATTIC in Kras-mutant pancreatic cell lines blocked the cell viability- and sphere formation-enhancing effects of the hyperglycemic environment and reversed the elevated pSTAT3 and MYC expression. MYC knockdown did not affect cell viability but did reduce sphere formation. No decrease in pSTAT3 expression was observed upon siMYC treatment. In conclusion, hyperglycemia, on a Kras-mutant background, aggravates the PanIN progression, which is accompanied by elevated pSTAT3 and MYC expression.

PyDSLRep: A domain-specific language for robotic simulation in V-Rep

by Andrés C. Jiménez, John P. Anzola, Vicente García-Díaz, Rubén González Crespo, Liping Zhao

Calculating forward and inverse kinematics for robotic agents is one of the most time-intensive tasks when controlling the robot movement in any environment. This calculation is then encoded to control the motors and validated in a simulator. The feedback produced by the simulation can be used to correct the code or to implement the code can be implemented directly in the robotic agent. However, the simulation process executes instructions that are not native to the robotic agents, extending development time or making it preferable to validate the code directly on the robot, which in some cases might result in severe damage to it. The use of Domain-Specific Languages help reduce development time in simulation tasks. These languages simplify code generation by describing tasks through an easy-to-understand language and free the user to use a framework or programming API directly for testing purposes. This article presents the language PyDSLRep, which is characterized by the connection and manipulation of movement in mobile robotic agents in the V-Rep simulation environment. This language is tested in three different environments by twenty people, against the framework given by V-Rep, demonstrating that PyDSLRep reduces the average development time by 45.22%, and the lines of code by 76.40% against the Python framework of V-Rep.
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