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Poli F, Ghilardi T, Beijers R, de Weerth C, Hinne M, Mars RB, Hunnius S. Individual differences in processing speed and curiosity explain infant habituation and dishabituation performance. Dev Sci 2024; 27:e13460. [PMID: 38155558 DOI: 10.1111/desc.13460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/05/2023] [Accepted: 11/09/2023] [Indexed: 12/30/2023]
Abstract
Habituation and dishabituation are the most prevalent measures of infant cognitive functioning, and they have reliably been shown to predict later cognitive outcomes. Yet, the exact mechanisms underlying infant habituation and dishabituation are still unclear. To investigate them, we tested 106 8-month-old infants on a classic habituation task and a novel visual learning task. We used a hierarchical Bayesian model to identify individual differences in sustained attention, learning performance, processing speed and curiosity from the visual learning task. These factors were then related to habituation and dishabituation. We found that habituation time was related to individual differences in processing speed, while dishabituation was related to curiosity, but only for infants who did not habituate. These results offer novel insights in the mechanisms underlying habituation and serve as proof of concept for hierarchical models as an effective tool to measure individual differences in infant cognitive functioning. RESEARCH HIGHLIGHTS: We used a hierarchical Bayesian model to measure individual differences in infants' processing speed, learning performance, sustained attention, and curiosity. Faster processing speed was related to shorter habituation time. High curiosity was related to stronger dishabituation responses, but only for infants who did not habituate.
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Affiliation(s)
- Francesco Poli
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Tommaso Ghilardi
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Centre for Brain and Cognitive Development, School of Psychological Sciences, Birkbeck, University of London, London, United Kingdom
| | - Roseriet Beijers
- Behavioral Science Institute, Radboud University, Nijmegen, Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Carolina de Weerth
- Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Max Hinne
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Rogier B Mars
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Sabine Hunnius
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
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James J, Coelho A, Lahore GF, Hernandez CM, Forster F, Malissen B, Holmdahl R. Redox Regulation of LAT Enhances T Cell-Mediated Inflammation. Antioxidants (Basel) 2024; 13:499. [PMID: 38671946 DOI: 10.3390/antiox13040499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/04/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
The positional cloning of single nucleotide polymorphisms (SNPs) of the neutrophil cytosolic factor 1 (Ncf1) gene, advocating that a low oxidative burst drives autoimmune disease, demands an understanding of the underlying molecular causes. A cellular target could be T cells, which have been shown to be regulated by reactive oxygen species (ROS). However, the pathways by which ROS mediate T cell signaling remain unclear. The adaptor molecule linker for activation of T cells (LAT) is essential for coupling T cell receptor-mediated antigen recognition to downstream responses, and it contains several cysteine residues that have previously been suggested to be involved in redox regulation. To address the possibility that ROS regulate T cell-dependent inflammation through LAT, we established a mouse strain with cysteine-to-serine mutations at positions 120 and 172 (LATSS). We found that redox regulation of LAT through C120 and C172 mediate its localization and phosphorylation. LATSS mice had reduced numbers of double-positive thymocytes and naïve peripheral T cells. Importantly, redox insensitivity of LAT enhanced T cell-dependent autoimmune inflammation in collagen-induced arthritis (CIA), a mouse model of rheumatoid arthritis (RA). This effect was reversed on an NCF1-mutated (NCF1m1j), ROS-deficient, background. Overall, our data show that LAT is redox-regulated, acts to repress T cell activation, and is targeted by ROS induced by NCF1 in antigen-presenting cells (APCs).
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Affiliation(s)
- Jaime James
- Medical Inflammation Research, Division of Immunology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Ana Coelho
- Medical Inflammation Research, Division of Immunology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Gonzalo Fernandez Lahore
- Medical Inflammation Research, Division of Immunology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Clara M Hernandez
- Medical Inflammation Research, Division of Immunology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Florian Forster
- Medical Inflammation Research, Division of Immunology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Bernard Malissen
- Centre d'Immunophénomique, Aix Marseille Université, INSERM, 13288 Marseille, France
| | - Rikard Holmdahl
- Medical Inflammation Research, Division of Immunology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, 17177 Stockholm, Sweden
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3
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Trinh MDL, Visintainer D, Günther J, Østerberg JT, da Fonseca RR, Fondevilla S, Moog MW, Luo G, Nørrevang AF, Crocoll C, Nielsen PV, Jacobsen SE, Wendt T, Bak S, López-Marqués RL, Palmgren M. Site-directed genotype screening for elimination of antinutritional saponins in quinoa seeds identifies TSARL1 as a master controller of saponin biosynthesis selectively in seeds. Plant Biotechnol J 2024. [PMID: 38572508 DOI: 10.1111/pbi.14340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 04/05/2024]
Abstract
Climate change may result in a drier climate and increased salinization, threatening agricultural productivity worldwide. Quinoa (Chenopodium quinoa) produces highly nutritious seeds and tolerates abiotic stresses such as drought and high salinity, making it a promising future food source. However, the presence of antinutritional saponins in their seeds is an undesirable trait. We mapped genes controlling seed saponin content to a genomic region that includes TSARL1. We isolated desired genetic variation in this gene by producing a large mutant library of a commercial quinoa cultivar and screening the library for specific nucleotide substitutions using droplet digital PCR. We were able to rapidly isolate two independent tsarl1 mutants, which retained saponins in the leaves and roots for defence, but saponins were undetectable in the seed coat. We further could show that TSARL1 specifically controls seed saponin biosynthesis in the committed step after 2,3-oxidosqualene. Our work provides new important knowledge on the function of TSARL1 and represents a breakthrough for quinoa breeding.
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Affiliation(s)
- Mai Duy Luu Trinh
- Department of Plant and Environmental Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Davide Visintainer
- Department of Plant and Environmental Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Jan Günther
- Department of Plant and Environmental Sciences, University of Copenhagen, Frederiksberg, Denmark
| | | | - Rute R da Fonseca
- Section for Biodiversity, Globe Institute, University of Copenhagen, København Ø, Denmark
| | | | - Max William Moog
- Department of Plant and Environmental Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Guangbin Luo
- Department of Plant and Environmental Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Anton F Nørrevang
- Department of Plant and Environmental Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Christoph Crocoll
- Department of Plant and Environmental Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Philip V Nielsen
- Department of Plant and Environmental Sciences, University of Copenhagen, Frederiksberg, Denmark
| | | | | | - Søren Bak
- Department of Plant and Environmental Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Rosa Laura López-Marqués
- Department of Plant and Environmental Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Michael Palmgren
- Department of Plant and Environmental Sciences, University of Copenhagen, Frederiksberg, Denmark
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Cocola C, Abeni E, Martino V, Piscitelli E, Pelucchi P, Mosca E, Chiodi A, Mohamed T, Palizban M, Porta G, Palizban H, Nano G, Acquati F, Bruno A, Greve B, Gerovska D, Magnaghi V, Mazzaccaro D, Bertalot G, Kehler J, Balbino C, Arauzo-Bravo MJ, Götte M, Zucchi I, Reinbold RA. Transmembrane Protein TMEM230, Regulator of Glial Cell Vascular Mimicry and Endothelial Cell Angiogenesis in High-Grade Heterogeneous Infiltrating Gliomas and Glioblastoma. Int J Mol Sci 2024; 25:3967. [PMID: 38612777 PMCID: PMC11011566 DOI: 10.3390/ijms25073967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/18/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024] Open
Abstract
High-grade gliomas (HGGs) and glioblastoma multiforme (GBM) are characterized by a heterogeneous and aggressive population of tissue-infiltrating cells that promote both destructive tissue remodeling and aberrant vascularization of the brain. The formation of defective and permeable blood vessels and microchannels and destructive tissue remodeling prevent efficient vascular delivery of pharmacological agents to tumor cells and are the significant reason why therapeutic chemotherapy and immunotherapy intervention are primarily ineffective. Vessel-forming endothelial cells and microchannel-forming glial cells that recapitulate vascular mimicry have both infiltration and destructive remodeling tissue capacities. The transmembrane protein TMEM230 (C20orf30) is a master regulator of infiltration, sprouting of endothelial cells, and microchannel formation of glial and phagocytic cells. A high level of TMEM230 expression was identified in patients with HGG, GBM, and U87-MG cells. In this study, we identified candidate genes and molecular pathways that support that aberrantly elevated levels of TMEM230 play an important role in regulating genes associated with the initial stages of cell infiltration and blood vessel and microchannel (also referred to as tumor microtubule) formation in the progression from low-grade to high-grade gliomas. As TMEM230 regulates infiltration, vascularization, and tissue destruction capacities of diverse cell types in the brain, TMEM230 is a promising cancer target for heterogeneous HGG tumors.
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Affiliation(s)
- Cinzia Cocola
- Institute of Biomedical Technologies, National Research Council of Italy, 20054 Milan, Italy; (C.C.); (E.A.); (V.M.); (E.P.); (P.P.); (E.M.); (A.C.); (I.Z.)
| | - Edoardo Abeni
- Institute of Biomedical Technologies, National Research Council of Italy, 20054 Milan, Italy; (C.C.); (E.A.); (V.M.); (E.P.); (P.P.); (E.M.); (A.C.); (I.Z.)
| | - Valentina Martino
- Institute of Biomedical Technologies, National Research Council of Italy, 20054 Milan, Italy; (C.C.); (E.A.); (V.M.); (E.P.); (P.P.); (E.M.); (A.C.); (I.Z.)
| | - Eleonora Piscitelli
- Institute of Biomedical Technologies, National Research Council of Italy, 20054 Milan, Italy; (C.C.); (E.A.); (V.M.); (E.P.); (P.P.); (E.M.); (A.C.); (I.Z.)
| | - Paride Pelucchi
- Institute of Biomedical Technologies, National Research Council of Italy, 20054 Milan, Italy; (C.C.); (E.A.); (V.M.); (E.P.); (P.P.); (E.M.); (A.C.); (I.Z.)
| | - Ettore Mosca
- Institute of Biomedical Technologies, National Research Council of Italy, 20054 Milan, Italy; (C.C.); (E.A.); (V.M.); (E.P.); (P.P.); (E.M.); (A.C.); (I.Z.)
| | - Alice Chiodi
- Institute of Biomedical Technologies, National Research Council of Italy, 20054 Milan, Italy; (C.C.); (E.A.); (V.M.); (E.P.); (P.P.); (E.M.); (A.C.); (I.Z.)
| | - Tasnim Mohamed
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy; (T.M.); (V.M.)
| | - Mira Palizban
- Department of Gynecology and Obstetrics, University Hospital of Münster, 48149 Münster, Germany; (M.P.); (H.P.); (M.G.)
| | - Giovanni Porta
- Center for Genomic Medicine, Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy;
| | - Helga Palizban
- Department of Gynecology and Obstetrics, University Hospital of Münster, 48149 Münster, Germany; (M.P.); (H.P.); (M.G.)
| | - Giovanni Nano
- Operative Unit of Vascular Surgery, I.R.C.C.S. Policlinico San Donato, 20097 San Donato Milanese, Italy; (G.N.); (D.M.)
- Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy
| | - Francesco Acquati
- Human Genetics Laboratory, Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy;
| | - Antonino Bruno
- Laboratory of Immunology and General Pathology, Department of Biotechnologies and Life Sciences, University of Insubria, 21100 Varese, Italy;
- Laboratory of Innate Immunity, Unit of Molecular Pathology, Biochemistry, and Immunology, I.R.C.C.S. MultiMedica, 20138 Milan, Italy
| | - Burkhard Greve
- Department of Radiation Therapy and Radiation Oncology, University Hospital of Münster, 48149 Münster, Germany;
| | - Daniela Gerovska
- Computational Biology and Systems Biomedicine, Biogipuzkoa Health Research Institute, Calle Doctor Begiristain s/n, 20014 San Sebastian, Spain; (D.G.); (M.J.A.-B.)
| | - Valerio Magnaghi
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy; (T.M.); (V.M.)
| | - Daniela Mazzaccaro
- Operative Unit of Vascular Surgery, I.R.C.C.S. Policlinico San Donato, 20097 San Donato Milanese, Italy; (G.N.); (D.M.)
| | - Giovanni Bertalot
- Department of Anatomy and Pathological Histology, Santa Chiara Hospital, APSS, 31822 Trento, Italy;
- Centre for Medical Sciences—CISMed, University of Trento, 38122 Trento, Italy
| | - James Kehler
- Laboratory of Cell and Molecular Biology, NIDDK, National Institutes of Health, Bethesda, MD 20892, USA;
| | | | - Marcos J. Arauzo-Bravo
- Computational Biology and Systems Biomedicine, Biogipuzkoa Health Research Institute, Calle Doctor Begiristain s/n, 20014 San Sebastian, Spain; (D.G.); (M.J.A.-B.)
- Basque Foundation for Science, IKERBASQUE, Calle María Díaz Harokoa 3, 48013 Bilbao, Spain
- Department of Cell Biology and Histology, Faculty of Medicine and Nursing, University of Basque Country (UPV/EHU), 48940 Leioa, Spain
| | - Martin Götte
- Department of Gynecology and Obstetrics, University Hospital of Münster, 48149 Münster, Germany; (M.P.); (H.P.); (M.G.)
| | - Ileana Zucchi
- Institute of Biomedical Technologies, National Research Council of Italy, 20054 Milan, Italy; (C.C.); (E.A.); (V.M.); (E.P.); (P.P.); (E.M.); (A.C.); (I.Z.)
| | - Rolland A. Reinbold
- Institute of Biomedical Technologies, National Research Council of Italy, 20054 Milan, Italy; (C.C.); (E.A.); (V.M.); (E.P.); (P.P.); (E.M.); (A.C.); (I.Z.)
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Ravichandran Y, Hänisch J, Murray K, Roca V, Dingli F, Loew D, Sabatet V, Boëda B, Stradal TE, Etienne-Manneville S. The distinct localization of CDC42 isoforms is responsible for their specific functions during migration. J Cell Biol 2024; 223:e202004092. [PMID: 38386112 PMCID: PMC10883850 DOI: 10.1083/jcb.202004092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/26/2023] [Accepted: 01/04/2024] [Indexed: 02/23/2024] Open
Abstract
The small G-protein CDC42 is an evolutionary conserved polarity protein and a key regulator of polarized cell functions, including directed cell migration. In vertebrates, alternative splicing gives rise to two CDC42 proteins: the ubiquitously expressed isoform (CDC42u) and the brain isoform (CDC42b), which only differ in their carboxy-terminal sequence, including the CAAX motif essential for their association with membranes. We show that these divergent sequences do not directly affect the range of CDC42's potential binding partners but indirectly influence CDC42-driven signaling by controlling the subcellular localization of the two isoforms. In astrocytes and neural precursors, which naturally express both variants, CDC42u associates with the leading-edge plasma membrane of migrating cells, where it recruits the Par6-PKCζ complex to fulfill its polarity function. In contrast, CDC42b mainly localizes to intracellular membrane compartments, where it regulates N-WASP-mediated endocytosis. Both CDC42 isoforms contribute their specific functions to promote the chemotaxis of neural precursors, demonstrating that their expression pattern is decisive for tissue-specific cell behavior.
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Affiliation(s)
- Yamini Ravichandran
- UMR3691 CNRS, Equipe Labellisée Ligue 2023, Université de Paris, Cell Polarity, Migration and Cancer Unit, Institut Pasteur, Paris, France
- Collège Doctoral, Sorbonne Université, Paris, France
| | - Jan Hänisch
- UMR3691 CNRS, Equipe Labellisée Ligue 2023, Université de Paris, Cell Polarity, Migration and Cancer Unit, Institut Pasteur, Paris, France
| | - Kerren Murray
- UMR3691 CNRS, Equipe Labellisée Ligue 2023, Université de Paris, Cell Polarity, Migration and Cancer Unit, Institut Pasteur, Paris, France
| | - Vanessa Roca
- UMR3691 CNRS, Equipe Labellisée Ligue 2023, Université de Paris, Cell Polarity, Migration and Cancer Unit, Institut Pasteur, Paris, France
| | - Florent Dingli
- PSL Research University, Centre de Recherche, Laboratoire de Spectrométrie de Masse Protéomique, Institut Curie, Paris, France
| | - Damarys Loew
- PSL Research University, Centre de Recherche, Laboratoire de Spectrométrie de Masse Protéomique, Institut Curie, Paris, France
| | - Valentin Sabatet
- PSL Research University, Centre de Recherche, Laboratoire de Spectrométrie de Masse Protéomique, Institut Curie, Paris, France
| | - Batiste Boëda
- UMR3691 CNRS, Equipe Labellisée Ligue 2023, Université de Paris, Cell Polarity, Migration and Cancer Unit, Institut Pasteur, Paris, France
| | - Theresia E. Stradal
- Helmholtz Centre for Infection Research, Inhoffenstrasse 7, Braunschweig, Germany
| | - Sandrine Etienne-Manneville
- UMR3691 CNRS, Equipe Labellisée Ligue 2023, Université de Paris, Cell Polarity, Migration and Cancer Unit, Institut Pasteur, Paris, France
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Kinston R, Gay S, McKinley RK, Sam S, Yardley S, Lefroy J. How well do UK assistantships equip medical students for graduate practice? Think EPAs. Adv Health Sci Educ Theory Pract 2024; 29:173-198. [PMID: 37347459 DOI: 10.1007/s10459-023-10249-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/28/2023] [Indexed: 06/23/2023]
Abstract
The goal of better medical student preparation for clinical practice drives curricular initiatives worldwide. Learning theory underpins Entrustable Professional Activities (EPAs) as a means of safe transition to independent practice. Regulators mandate senior assistantships to improve practice readiness. It is important to know whether meaningful EPAs occur in assistantships, and with what impact. Final year students at one UK medical school kept learning logs and audio-diaries for six one-week periods during a year-long assistantship. Further data were also obtained through interviewing participants when students and after three months as junior doctors. This was combined with data from new doctors from 17 other UK schools. Realist methods explored what worked for whom and why. 32 medical students and 70 junior doctors participated. All assistantship students reported engaging with EPAs but gaps in the types of EPAs undertaken exist, with level of entrustment and frequency of access depending on the context. Engagement is enhanced by integration into the team and shared understanding of what constitutes legitimate activities. Improving the shared understanding between student and supervisor of what constitutes important assistantship activity may result in an increase in the amount and/or quality of EPAs achieved.
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Affiliation(s)
- Ruth Kinston
- School of Medicine, Keele University, Clinical Education Centre, University Hospital of North Midlands, Newcastle Road, Staffordshire, ST4 6QG, UK.
| | - Simon Gay
- University of Leicester School of Medicine, Leicester, UK
- Keele University School of Medicine, Keele, UK
| | | | - Sreya Sam
- Keele University School of Medicine, Keele, UK
| | - Sarah Yardley
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Central & North West London NHS Foundation Trust, London, UK
| | - Janet Lefroy
- School of Medicine and Faculty Lead for the Health Professionals Education Research Theme, Keele University, Keele, UK
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Chopra A, Judson MA, Rahman NM, Doelken P. The lung is not a balloon: the self-sealing property of the lung. Lancet Respir Med 2024; 12:190-192. [PMID: 38423702 DOI: 10.1016/s2213-2600(24)00030-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Amit Chopra
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY 12208, USA.
| | - Marc A Judson
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY 12208, USA
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Peter Doelken
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY 12208, USA
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Bristowe K, Timmins L, Pitman A, Braybrook D, Marshall S, Johnson K, King M, Roach A, Yi D, Almack K, Day E, Clift P, Rose R, Harding R. Between loss and restoration: The role of liminality in advancing theories of grief and bereavement. Soc Sci Med 2024; 344:116616. [PMID: 38310729 DOI: 10.1016/j.socscimed.2024.116616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 02/06/2024]
Abstract
A recent national survey of bereaved partners found high levels of complicated grief and psychological distress, with evidence that loneliness and isolation may contribute to these outcomes. However, the mechanisms of action for this have not been explored. To advance grief theory this paper reports analysis of the survey free-text data to examine the relationship between social support and emotional responses to bereavement. Individuals bereaved of a civil partner or spouse 6-10 months previously were identified through death registration data. 569/1945 (29 %) completed surveys were received. Of those, 311 participants (55 %) provided responses to two free-text questions which asked about their 'feelings since the death of their partner or spouse', and 'about the support around' them. Data were analysed using corpus-assisted discourse analysis and the discourse dynamics approach for figurative language. Participants described diverse emotional responses to the bereavement (e.g. sadness, anger, denial, acceptance), and the value of formal and informal bereavement support. Although many of the experiences described are accounted for in existing grief theory, some participants described a liminal experience not recognised within these theories. They felt trapped, unable to engage with loss or restoration, and unable to move forward as their planned future no longer existed. They sought out 'communitas' (solidarity in experiences), but often found support from their social networks had diminished. Metaphors were used to describe this liminality, with partner grief expressed as a dark agentic force, a monster, an abyss, and as water. The findings of this study offer original insights into experiences and trajectories of bereavement, and our understandings of prolonged or complicated grief. A novel model 'Between Loss and Restoration' is presented to include these experiences. Recognition of the place for liminality within the spectrum of grief experiences could enhance grief literacy and improve formal and informal bereavement support provision.
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Affiliation(s)
- Katherine Bristowe
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK.
| | - Liadh Timmins
- Department of Psychology, Swansea University, Singleton Park, Sketty, Swansea, SA2 8PP, Wales, UK.
| | - Alexandra Pitman
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK; Camden and Islington NHS Foundation Trust, St. Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK.
| | - Debbie Braybrook
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK.
| | - Steve Marshall
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK; King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
| | - Katherine Johnson
- Social and Global Studies Centre, Royal Melbourne Institute of Technology, 124 La Trobe Street, Melbourne, Victoria, 3000, Australia.
| | - Michael King
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Anna Roach
- Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Deokhee Yi
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK.
| | - Kathryn Almack
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK.
| | | | - Paul Clift
- Patient and Public Involvement Representative, UK.
| | - Ruth Rose
- Patient and Public Involvement Representative, UK.
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK.
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Price E, Ahmad S, Althobiani MA, Ayoob T, Burgoyne T, De Soyza A, Dobson M, Echevarria C, Martin G, Mendes RG, Preston AM, Rahman NM, Sapey E, Usmani OS, Hurst JR. Development and evaluation of a tool to optimise inhaler selection prior to hospital discharge following an exacerbation of COPD. ERJ Open Res 2024; 10:00010-2024. [PMID: 38444664 PMCID: PMC10910267 DOI: 10.1183/23120541.00010-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Rates of mortality and re-admission after a hospitalised exacerbation of COPD are high and resistant to change. COPD guidelines do not give practical advice about the optimal selection of inhaled drugs and device in this situation. We hypothesised that a failure to optimise inhaled drug and drug delivery prior to discharge from hospital after an exacerbation would be associated with a modifiable increased risk of re-admission and death. We designed a study to 1) develop a practical inhaler selection tool to use at the point of hospital discharge and 2) implement this tool to understand the potential impact on modifying inhaler prescriptions, clinical outcomes, acceptability to clinicians and patients, and the feasibility of delivering a definitive trial to demonstrate potential benefit. Methods We iteratively developed an inhaler selection tool for use prior to discharge following a hospitalised exacerbation of COPD using surveys with multiprofessional clinicians and a focus group of people living with COPD. We surveyed clinicians to understand their views on the minimum clinically important difference (MCID) for death and re-admission following a hospitalised exacerbation of COPD. We conducted a mixed-methods implementation feasibility study using the tool at discharge, and collated 30- and 90-day follow-up data including death and re-admissions. Additionally, we observed the tool being used and interviewed clinicians and patients about use of the tool in this setting. Results We completed the design of an inhaler selection tool through two rounds of consultations with 94 multiprofessional clinicians, and a focus group of four expert patients. Regarding MCIDs, there was majority consensus for the following reductions from baseline being the MCID: 30-day readmissions 5-10%, 90-day readmissions 10-20%, 30-day mortality 5-10% and 90-day mortality 5-10%. 118 patients were assessed for eligibility and 26 had the tool applied. A change in inhaled medication was recommended in nine (35%) out of 26. Re-admission or death at 30 days was seen in 33% of the switch group and 35% of the no-switch group. Re-admission or death at 90 days was seen in 56% of the switch group and 41% of the no-switch group. Satisfaction with inhalers was generally high, and switching was associated with a small increase in the Feeling of Satisfaction with Inhaler questionnaire of 3 out of 50 points. Delivery of a definitive study would be challenging. Conclusion We completed a mixed-methods study to design and implement a tool to aid optimisation of inhaled pharmacotherapy prior to discharge following a hospitalised exacerbation of COPD. This was not associated with fewer re-admissions, but was well received and one-third of people were eligible for a change in inhalers.
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Affiliation(s)
- Evleen Price
- THIS Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Shanaz Ahmad
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | | | - Tareq Ayoob
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | | | - Anthony De Soyza
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Melissa Dobson
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Carlos Echevarria
- Respiratory Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Translational and Clinical Research, Newcastle University, Newcastle upon Tyne, UK
| | - Graham Martin
- THIS Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Renata Gonçalves Mendes
- Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Anne-Marie Preston
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Najib M. Rahman
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Elizabeth Sapey
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham NIHR Biomedical Research Unit, and HDR UK Medicines Driver Programme, Birmingham, UK
| | - Omar S. Usmani
- National Heart and Lung Institute, Imperial College London, London, UK
| | - John R. Hurst
- UCL Respiratory, University College London, London, UK
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Abel K, Agnew E, Amos J, Armstrong N, Armstrong-James D, Ashfield T, Aston S, Baillie JK, Baldwin S, Barlow G, Bartle V, Bielicki J, Brown C, Carrol E, Clements M, Cooke G, Dane A, Dark P, Day J, de-Soyza A, Dowsey A, Evans S, Eyre D, Felton T, Fowler T, Foy R, Gannon K, Gerada A, Goodman A, Harman T, Hayward G, Holmes A, Hopkins S, Howard P, Howard A, Hsia Y, Knight G, Lemoine N, Koh J, Macgowan A, Marwick C, Moore C, O’Brien S, Oppong R, Peacock S, Pett S, Pouwels K, Queree C, Rahman N, Sculpher M, Shallcross L, Sharland M, Singh J, Stoddart K, Thomas-Jones E, Townsend A, Ustianowski A, Van Staa T, Walker S, White P, Wilson P, Buchan I, Woods B, Bower P, Llewelyn M, Hope W. System-wide approaches to antimicrobial therapy and antimicrobial resistance in the UK: the AMR-X framework. Lancet Microbe 2024:S2666-5247(24)00003-X. [PMID: 38461831 DOI: 10.1016/s2666-5247(24)00003-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 03/12/2024]
Abstract
Antimicrobial resistance (AMR) threatens human, animal, and environmental health. Acknowledging the urgency of addressing AMR, an opportunity exists to extend AMR action-focused research beyond the confines of an isolated biomedical paradigm. An AMR learning system, AMR-X, envisions a national network of health systems creating and applying optimal use of antimicrobials on the basis of their data collected from the delivery of routine clinical care. AMR-X integrates traditional AMR discovery, experimental research, and applied research with continuous analysis of pathogens, antimicrobial uses, and clinical outcomes that are routinely disseminated to practitioners, policy makers, patients, and the public to drive changes in practice and outcomes. AMR-X uses connected data-to-action systems to underpin an evaluation framework embedded in routine care, continuously driving implementation of improvements in patient and population health, targeting investment, and incentivising innovation. All stakeholders co-create AMR-X, protecting the public from AMR by adapting to continuously evolving AMR threats and generating the information needed for precision patient and population care.
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11
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Willi N, Pancoast A, Drikaki I, Gu X, Gillanders D, Finucane A. Practitioner perspectives on the use of acceptance and commitment therapy for bereavement support: a qualitative study. BMC Palliat Care 2024; 23:59. [PMID: 38418964 PMCID: PMC10900636 DOI: 10.1186/s12904-024-01390-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND There is currently a high demand for bereavement support coupled with inconclusive findings as to the efficacy of existing approaches. Acceptance and Commitment Therapy (ACT) aims to improve human functioning and has shown efficacy across a wide range of conditions. ACT may be a promising means of supporting bereaved people, yet evidence on the use of ACT for bereavement support is lacking. The aim of this study is to explore how ACT is currently used for bereavement support and practitioner perspectives of how it helps following bereavement. METHODS Semi-structured interviews were conducted online via MS Teams with practitioners experienced in using ACT for bereavement support. Data were analysed thematically guided by a framework approach. RESULTS Nine participants were recruited. Three themes were identified: (i) creating psychological space around grief; (ii) using psychological space for value-directed action in the midst of grieving, and (iii) adapting ACT for bereavement support. Practitioners indicated that ACT improves clients' relationship with distressing internal experiences. Metaphors and mindfulness techniques were used to encourage acceptance of grief responses, taking perspective on distressing thoughts and images, and contact with the present moment. Better relationships with distressing experiences were regarded as less psychologically taxing, improving coping and well-being, while providing the psychological space to engage in value-directed action. Values exploration, sometimes using metaphors and exercises, was seen as supporting the bereaved person to rediscover a sense of purpose and engage in meaningful activities alongside their grief. Practitioners used ACT flexibly, integrating other interventions, and adapted ACT to the perceived sensitivities of bereaved people, and age-related and developmental factors. CONCLUSION ACT is used to support people who have been bereaved to live effectively with the difficult thoughts and feelings associated with grieving and to enable them to gradually identify, reconnect with, and act in line with their values after loss.
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Affiliation(s)
- Nikolaus Willi
- Clinical Psychology, University of Edinburgh, Edinburgh, UK.
| | - Anna Pancoast
- Clinical Psychology, University of Edinburgh, Edinburgh, UK
| | - Ioanna Drikaki
- Clinical Psychology, University of Edinburgh, Edinburgh, UK
| | - Xueying Gu
- Clinical Psychology, University of Edinburgh, Edinburgh, UK
| | | | - Anne Finucane
- Clinical Psychology, University of Edinburgh, Edinburgh, UK
- Marie Curie Hospice Edinburgh, Edinburgh, UK
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12
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Standing JF, Buggiotti L, Guerra-Assuncao JA, Woodall M, Ellis S, Agyeman AA, Miller C, Okechukwu M, Kirkpatrick E, Jacobs AI, Williams CA, Roy S, Martin-Bernal LM, Williams R, Smith CM, Sanderson T, Ashford FB, Emmanuel B, Afzal ZM, Shields A, Richter AG, Dorward J, Gbinigie O, Van Hecke O, Lown M, Francis N, Jani B, Richards DB, Rahman NM, Yu LM, Thomas NPB, Hart ND, Evans P, Andersson M, Hayward G, Hood K, Nguyen-Van-Tam JS, Little P, Hobbs FDR, Khoo S, Butler C, Lowe DM, Breuer J. Randomized controlled trial of molnupiravir SARS-CoV-2 viral and antibody response in at-risk adult outpatients. Nat Commun 2024; 15:1652. [PMID: 38396069 PMCID: PMC10891158 DOI: 10.1038/s41467-024-45641-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
Viral clearance, antibody response and the mutagenic effect of molnupiravir has not been elucidated in at-risk populations. Non-hospitalised participants within 5 days of SARS-CoV-2 symptoms randomised to receive molnupiravir (n = 253) or Usual Care (n = 324) were recruited to study viral and antibody dynamics and the effect of molnupiravir on viral whole genome sequence from 1437 viral genomes. Molnupiravir accelerates viral load decline, but virus is detectable by Day 5 in most cases. At Day 14 (9 days post-treatment), molnupiravir is associated with significantly higher viral persistence and significantly lower anti-SARS-CoV-2 spike antibody titres compared to Usual Care. Serial sequencing reveals increased mutagenesis with molnupiravir treatment. Persistence of detectable viral RNA at Day 14 in the molnupiravir group is associated with higher transition mutations following treatment cessation. Viral viability at Day 14 is similar in both groups with post-molnupiravir treated samples cultured up to 9 days post cessation of treatment. The current 5-day molnupiravir course is too short. Longer courses should be tested to reduce the risk of potentially transmissible molnupiravir-mutated variants being generated. Trial registration: ISRCTN30448031.
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Affiliation(s)
- Joseph F Standing
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK.
- Great Ormond Street Hospital for Children NHS Trust, London, UK.
| | - Laura Buggiotti
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Jose Afonso Guerra-Assuncao
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Maximillian Woodall
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Samuel Ellis
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Akosua A Agyeman
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Charles Miller
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Mercy Okechukwu
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Emily Kirkpatrick
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Amy I Jacobs
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Charlotte A Williams
- Genetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Sunando Roy
- Genetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Luz M Martin-Bernal
- Genetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Rachel Williams
- Genetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Claire M Smith
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Fiona B Ashford
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Beena Emmanuel
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Zaheer M Afzal
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Adrian Shields
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Alex G Richter
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Jienchi Dorward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Oghenekome Gbinigie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Oliver Van Hecke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark Lown
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Nick Francis
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Bhautesh Jani
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Duncan B Richards
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Najib M Rahman
- Respiratory Trials Unit and Oxford NIHR Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Nigel D Hart
- School of Medicine, Dentistry and Biomedical Sciences. Queen's University Belfast, Belfast, UK
| | - Philip Evans
- APEx (Exeter Collaboration for Academic Primary Care), University of Exeter Medical School, Exeter, UK
- National Institute of Health and Care Research, Clinical Research Network, University of Leeds, Leeds, UK
| | | | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Wales, UK
| | | | - Paul Little
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Saye Khoo
- Department of Pharmacology, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Christopher Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - David M Lowe
- Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, UK
- Institute of Immunity and Transplantation, University College London, London, UK
| | - Judith Breuer
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
- Great Ormond Street Hospital for Children NHS Trust, London, UK
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Nodaraki LE, Liu J, Ariciu AM, Ortu F, Oakley MS, Birnoschi L, Gransbury GK, Cobb PJ, Emerson-King J, Chilton NF, Mills DP, McInnes EJL, Tuna F. Metal-carbon bonding in early lanthanide substituted cyclopentadienyl complexes probed by pulsed EPR spectroscopy. Chem Sci 2024; 15:3003-3010. [PMID: 38404384 PMCID: PMC10882510 DOI: 10.1039/d3sc06175b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/12/2024] [Indexed: 02/27/2024] Open
Abstract
We examine lanthanide (Ln)-ligand bonding in a family of early Ln3+ complexes [Ln(Cptt)3] (1-Ln, Ln = La, Ce, Nd, Sm; Cptt = C5H3tBu2-1,3) by pulsed electron paramagnetic resonance (EPR) methods, and provide the first characterization of 1-La and 1-Nd by single crystal XRD, multinuclear NMR, IR and UV/Vis/NIR spectroscopy. We measure electron spin T1 and Tm relaxation times of 12 and 0.2 μs (1-Nd), 89 and 1 μs (1-Ce) and 150 and 1.7 μs (1-Sm), respectively, at 5 K: the T1 relaxation of 1-Nd is more than 102 times faster than its valence isoelectronic uranium analogue. 13C and 1H hyperfine sublevel correlation (HYSCORE) spectroscopy reveals that the extent of covalency is negligible in these Ln compounds, with much smaller hyperfine interactions than observed for equivalent actinide (Th and U) complexes. This is corroborated by ab initio calculations, confirming the predominant electrostatic nature of the metal-ligand bonding in these complexes.
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Affiliation(s)
- Lydia E Nodaraki
- Department of Chemistry, The University of Manchester Oxford Road Manchester M13 9PL UK
- Photon Science Institute, The University of Manchester Oxford Road Manchester M13 9PL UK
| | - Jingjing Liu
- Department of Chemistry, The University of Manchester Oxford Road Manchester M13 9PL UK
| | - Ana-Maria Ariciu
- Department of Chemistry, The University of Manchester Oxford Road Manchester M13 9PL UK
- Photon Science Institute, The University of Manchester Oxford Road Manchester M13 9PL UK
| | - Fabrizio Ortu
- Department of Chemistry, The University of Manchester Oxford Road Manchester M13 9PL UK
| | - Meagan S Oakley
- Department of Chemistry, The University of Manchester Oxford Road Manchester M13 9PL UK
| | - Letitia Birnoschi
- Department of Chemistry, The University of Manchester Oxford Road Manchester M13 9PL UK
| | - Gemma K Gransbury
- Department of Chemistry, The University of Manchester Oxford Road Manchester M13 9PL UK
| | - Philip J Cobb
- Department of Chemistry, The University of Manchester Oxford Road Manchester M13 9PL UK
| | - Jack Emerson-King
- Department of Chemistry, The University of Manchester Oxford Road Manchester M13 9PL UK
| | - Nicholas F Chilton
- Department of Chemistry, The University of Manchester Oxford Road Manchester M13 9PL UK
| | - David P Mills
- Department of Chemistry, The University of Manchester Oxford Road Manchester M13 9PL UK
| | - Eric J L McInnes
- Department of Chemistry, The University of Manchester Oxford Road Manchester M13 9PL UK
- Photon Science Institute, The University of Manchester Oxford Road Manchester M13 9PL UK
| | - Floriana Tuna
- Department of Chemistry, The University of Manchester Oxford Road Manchester M13 9PL UK
- Photon Science Institute, The University of Manchester Oxford Road Manchester M13 9PL UK
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Goodrich J, Watson C, Gaczkowska I, Harding R, Evans C, Firth A, Murtagh FE. Understanding patient and family utilisation of community-based palliative care services out-of-hours: Additional analysis of systematic review evidence using narrative synthesis. PLoS One 2024; 19:e0296405. [PMID: 38381768 PMCID: PMC10880966 DOI: 10.1371/journal.pone.0296405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 12/12/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Community-based out-of-hours services are an integral component of end-of-life care. However, there is little understanding of how patients and families utilise these services. This additional analysis of a systematic review aims to understand and identify patterns of out-of-hours service use and produce recommendations for future service design. METHOD Data on service use was extracted and secondary analysis undertaken, from a systematic review of models of community out-of-hours services. Narrative synthesis was completed, addressing four specific aspects of service use: 1.Times when patients/families/healthcare professionals need to contact out-of-hours services; 2. Who contacts out-of-hours services; 3. Whether a telephone call, centre visit or home visit is provided; 4. Who responds to out-of-hours calls. RESULTS Community-based out-of-hours palliative care services were most often accessed between 5pm and midnight, especially on weekdays (with reports of 69% of all calls being made out-of-hours). Family members and carers were the most frequent callers to of the services (making between 60% and 80% of all calls). The type of contact (telephone, centre visit or home visit) varied based on what was offered and on patient need. Over half of services were led by a single discipline (nurse). CONCLUSIONS Out-of-hours services are highly used up to midnight, and particularly by patients' family and carers. Recommendations to commissioners and service providers are to: • Increase provision of out-of-hours services between 5pm and midnight to reflect the increased use at these times. • Ensure that family and carers are provided with clear contact details for out-of-hours support. • Ensure patient records can be easily accessed by health professionals responding to calls, making the triage process easier. • Listen to patients, family and carers in the design of out-of-hours services, including telephone services. • Collect data systematically on out-of-hours-service use and on outcomes for patients who use the service.
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Affiliation(s)
- Joanna Goodrich
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King’s College London, London, United Kingdom
| | - Caleb Watson
- King’s College London Medical School, London, United Kingdom
| | - Inez Gaczkowska
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King’s College London, London, United Kingdom
| | - Richard Harding
- King’s College London Medical School, London, United Kingdom
| | - Catherine Evans
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King’s College London, London, United Kingdom
- Sussex Community NHS Foundation Trust, Brighton, United Kingdom
| | - Alice Firth
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King’s College London, London, United Kingdom
| | - Fliss E.M. Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
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15
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Stanley S, Finucane A, Thompson A, Nwosu AC. How can technology be used to support communication in palliative care beyond the covid-19 pandemic: a mixed-methods national survey of palliative care healthcare professionals. BMC Palliat Care 2024; 23:40. [PMID: 38351101 PMCID: PMC10865684 DOI: 10.1186/s12904-024-01372-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Developments in digital health have the potential to create new opportunities for healthcare professionals support delivery of palliative care. Globally, many palliative care professionals used digital health innovations to support communication with staff, patients and caregivers, during COVID-19 pandemic. However, there is limited data about the views of palliative care professionals of using digital health to support communication during the pandemic. We aimed to describe how palliative care professionals used technology to support communication (multidisciplinary team working, education and with patients and family caregivers) during the COVID-19 pandemic. METHOD(S) UK based palliative care healthcare professionals completed an electronic questionnaire to describe their use of digital health, during the COVID-19 pandemic, to support (1) communication within the multidisciplinary team (MDT), (2) education and (3) to support communication with patients and carers. RESULTS Two hundred and thirty-four palliative care professionals participated. Most (n = 227, 97%) described an increase in their use of digital health, to support communication, since the start of the COVID-19 pandemic. We identified benefits and challenges for digital health communication, which we summarised into themes, including 'a new way of working', 'developing a new approach to learning' and 'impacting care'. CONCLUSION(S) Since the pandemic, palliative care professionals have increased their use of digital health to support communication in clinical practice. We have identified facilitators and barriers for future practice. Further work should identify the levels of support needed for organisations to ensure that digital health interventions are meaningfully used to help palliative care professionals effectively communicate with patients, caregivers and staff.
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Affiliation(s)
- Sarah Stanley
- Marie Curie Hospice Liverpool, Liverpool, L25 8QA, United Kingdom.
- Liverpool John Moores University, Liverpool, United Kingdom.
| | - Anne Finucane
- Clinical Psychology, University of Edinburgh, Edinburgh, United Kingdom
- Marie Curie Hospice Edinburgh, Edinburgh, United Kingdom
| | - Anthony Thompson
- St Helens and Knowsley NHS Foundation Trust, Prescot, United Kingdom
| | - Amara Callistus Nwosu
- Marie Curie Hospice Liverpool, Liverpool, L25 8QA, United Kingdom
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
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16
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Budgett J. Setting individualised goals for people living with dementia and their family carers: A systematic review of goal-setting outcome measures and their psychometric properties. Dementia (London) 2024; 23:312-340. [PMID: 38105445 PMCID: PMC10807246 DOI: 10.1177/14713012231222309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND Individualised goal-setting outcome measures can be a useful way of reflecting people living with dementia and family carers' differing priorities regarding quality-of-life domains in the highly heterogeneous symptomatology of the disease. Evaluating goal-setting measures is challenging, and there is limited evidence for their psychometric properties. AIM (1) To describe what goal-setting outcomes have been used in this population; (2) To evaluate their validity, reliability, and feasibility in RCTs. METHOD We systematically reviewed studies that utilised goal-setting outcome measures for people living dementia or their family carers. We adapted a risk of bias and quality rating system based on the COSMIN guidelines to evaluate the measurement properties of outcomes when used within RCTs. RESULTS Thirty studies meeting inclusion criteria used four different goal-setting outcome measures: Goal Attainment Scaling (GAS), Bangor Goal Setting Interview (BGSI), Canadian Occupational Performance Measure (COPM) and Individually Prioritized Problems Assessment (IPPA); other papers have reported study-specific goal-setting attainment systems. Only GAS has been used as an outcome over periods greater than 9 months (up to a year). Within RCTs there was moderate quality evidence for sufficient content validity and construct validity for GAS, COPM and the BGSI. Reliability was only assessed in one RCT (using BGSI); in which two raters reviewed interview transcripts to rate goals with excellent inter-rater reliability. Feasibility was reported as good across the measures with a low level of missing data. CONCLUSION We found moderate quality evidence for good content and construct validity and feasibility of GAS, BGSI and COPM. While more evidence of reliability of these measures is needed, we recommend that future trials consider using individualised goal setting measures, to report the effect of interventions on outcomes that are most meaningful to people living with dementia and their families.
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Affiliation(s)
- Jessica Budgett
- Division of Psychiatry, University College London, and Centre for Psychiatry and Mental Health, Wolfsen Institute of Population Health, Queen Mary University of London UK
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17
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Mørkved AL, Søgaard M, Skjøth F, Ording AG, Jensen M, Larsen TB, Jakobsen E, Højen AA, Noble S, Meldgaard P, Petersen RH, Christensen TD. Risk and Timing of Venous Thromboembolism After Surgery for Lung Cancer: A Nationwide Cohort Study. Ann Thorac Surg 2024; 117:289-296. [PMID: 37890818 DOI: 10.1016/j.athoracsur.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a potentially preventable serious complication in patients with lung cancer undergoing thoracic operation. We examined the risk and timing of VTE after surgery for primary non-small cell lung cancer (NSCLC). METHODS All patients undergoing operation for NSCLC in Denmark between 2003 and 2021 were identified in the Danish Lung Cancer Registry. VTE events in the year after operation were assessed by stage, patient characteristics, and surgical procedure. RESULTS We identified 13,197 patients who underwent operation for NSCLC in 2003 to 2021 (mean age, 67.6 years; 50% female); 10,524 (79.7%) had stage I-II NSCLC, and 2673 (20.3%) had stage III-IV. During 1-year follow-up, there were 335 VTE events, yielding a rate of 2.87 events/100 person-years and an absolute risk of 3.3% (95% CI, 2.3-4.0). VTE risk increased with advancing cancer stage (1.8% for stage I vs 3.9% for stage IV) but varied little by pathologic type, sex, and comorbidity level. Bilobectomy was associated with highest VTE risk (4.8%; 95% CI, 3.2-6.9), followed by pneumonectomy (3.5%; 95% CI, 2.3-5.0). The hazard of VTE was highest during the first 3 months after operation, after which it declined. For stage IV cancer, hazards increased again after 6 months. At 1 year, all-cause death was 12.6% (95% CI, 12.0%-13.1%). CONCLUSIONS VTE developed in 3.3% of patients undergoing operation for NSCLC, most commonly within 3 months postoperatively. Prolonged thromboprophylaxis could be considered, particularly in those with advanced cancer stage and undergoing extended resections.
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Affiliation(s)
- Amalie Lambert Mørkved
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Søgaard
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Flemming Skjøth
- Unit of Clinical Biostatistics, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Anne Gulbech Ording
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Martin Jensen
- Unit of Clinical Biostatistics, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Torben Bjerregaard Larsen
- Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Erik Jakobsen
- Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Anette Arbjerg Højen
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, United Kingdom
| | - Peter Meldgaard
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Rene Horsleben Petersen
- Institute for Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Decker Christensen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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18
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Png ME, Harris V, Grabey J, Hart ND, Jani BD, Butler D, Carson-Stevens A, Coates M, Cureton L, Dobson M, Dorward J, Evans P, Francis N, Gbinigie OA, Hayward G, Holmes J, Hood K, Khoo S, Ahmed H, Lown M, Mckenna M, Mort S, Nguyen-Van-Tam J, Rahman N, Richards DB, Thomas N, van Hecke O, Hobbs FR, Little P, Yu LM, Butler CC, Petrou S. Cost-utility analysis of molnupiravir plus usual care versus usual care alone as early treatment for community-based adults with COVID-19 and increased risk of adverse outcomes in the UK PANORAMIC trial. Br J Gen Pract 2024:BJGP.2023.0444. [PMID: 38228357 DOI: 10.3399/bjgp.2023.0444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/20/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The cost-effectiveness of molnupiravir, an oral antiviral for early treatment of SARS-CoV-2, has not been established in vaccinated populations. AIM To evaluate the cost-effectiveness of molnupiravir relative to usual care alone among mainly vaccinated community-based people at higher risk of severe outcomes from COVID-19 over six months. DESIGN AND SETTING Economic evaluation of the PANORAMIC trial in the UK. METHOD A cost-utility analysis that adopted a UK National Health Service and personal social services perspective and a six-month time horizon was performed using PANORAMIC trial data. Cost-effectiveness was expressed in terms of incremental cost per quality-adjusted life year (QALY) gained. Sensitivity and subgroup analyses assessed the impacts of uncertainty and heterogeneity. Threshold analysis explored the price for molnupiravir consistent with likely reimbursement. RESULTS In the base case analysis, molnupiravir had higher mean costs of £449 (95% confidence interval [CI] 445 to 453) and higher mean QALYs of 0.0055 (95% CI 0.004 to 0.007) than usual care (mean incremental cost per QALY of £81190). Sensitivity and subgroup analyses showed similar results, except those aged ≥75 years with a 55% probability of being cost-effective at a £30000 per QALY threshold. Molnupiravir would have to be priced around £147 per course to be cost-effective at a £15000 per QALY threshold. CONCLUSION Molnupiravir at the current cost of £513 per course is unlikely to be cost-effective relative to usual care over a six-month time horizon among mainly vaccinated COVID-19 patients at increased risk of adverse outcomes, except those aged ≥75 years.
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Affiliation(s)
- May Ee Png
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Victoria Harris
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Jenna Grabey
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Nigel David Hart
- Queen's University Belfast, Centre for Medical Education, Belfast, United Kingdom
| | - Bhautesh Dinesh Jani
- University of Glasgow College of Medical Veterinary and Life Sciences, Institute of Health and wellbeing, Glasgow, United Kingdom
| | - Daniel Butler
- Queen's University Belfast, Centre for Medical Education, Belfast, United Kingdom
| | - Andrew Carson-Stevens
- Cardiff University, Division of Population Medicine, School of Medicine, Cardiff, United Kingdom
| | - Maria Coates
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Lucy Cureton
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Melissa Dobson
- University of Oxford, Oxford Respiratory Trials Unit, Oxford, United Kingdom
| | - Jienchi Dorward
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
- University of KwaZulu-Natal, Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Philip Evans
- University of Exeter, Faculty of Health and Life Sciences, Exeter, United Kingdom
- University of Leeds, National Institute of Health and Care Research (NIHR) Clinical Research Network (CRN), Leeds, United Kingdom
| | - Nick Francis
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | | | - Gail Hayward
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Jane Holmes
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Kerenza Hood
- Cardiff University, Centre for Trials Research, Cardiff, United Kingdom
| | - Saye Khoo
- University of Liverpool, Department of Pharmacology, Liverpool, United Kingdom
| | - Haroon Ahmed
- Cardiff University, Division of Population Medicine, School of Medicine, Cardiff, United Kingdom
| | - Mark Lown
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Micheal Mckenna
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Sam Mort
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | | | - Najib Rahman
- University of Oxford, Oxford Respiratory Trials Unit, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
- University of Oxford, Chinese Academy of Medicine Oxford Institute, Oxford, United Kingdom
| | - Duncan B Richards
- University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom
| | - Nicholas Thomas
- Windrush Medical Practice, Witney, United Kingdom
- National Institute for Health and Care Research Applied Research Collaboration Oxford and Thames Valley, Oxford, United Kingdom
- Royal College of General Practitioners, London, United Kingdom
| | - Oliver van Hecke
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Fd Richard Hobbs
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Paul Little
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Ly-Mee Yu
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Christopher C Butler
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Stavros Petrou
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
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D'Eer L, Sallnow L. Compassionate Communities: contemporary tensions and challenges. Ann Palliat Med 2024; 13:5-9. [PMID: 38073297 DOI: 10.21037/apm-23-553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 10/27/2023] [Indexed: 02/07/2024]
Affiliation(s)
- Louise D'Eer
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; Compassionate Communities Centre of Expertise (CoCo), Vrije Universiteit Brussel, Brussels, Belgium
| | - Libby Sallnow
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; St. Christopher's Hospice, London, UK; Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
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Catarata MJ, Creamer AW, Dias M, Toland S, Chaabouni M, Verbeke K, Vieira Naia J, Hassan M, Naidu SB, Lynch GA, Blyth KG, Rahman NM, Hardavella G. ERS International Congress 2023: highlights from the Thoracic Oncology Assembly. ERJ Open Res 2024; 10:00860-2023. [PMID: 38410708 PMCID: PMC10895436 DOI: 10.1183/23120541.00860-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 02/28/2024] Open
Abstract
Lung cancer is the leading cause of cancer mortality in the world. It greatly affects the patients' quality of life, and is thus a challenge for the daily practice in respiratory medicine. Advances in the genetic knowledge of thoracic tumours' mutational landscape, and the development of targeted therapies and immune checkpoint inhibitors, have led to a paradigm shift in the treatment of lung cancer and pleural mesothelioma. During the 2023 European Respiratory Society Congress in Milan, Italy, experts from all over the world presented their high-quality research and reviewed best clinical practices. Lung cancer screening, management of early stages of lung cancer, application of artificial intelligence and biomarkers were discussed and they will be summarised here.
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Affiliation(s)
- Maria Joana Catarata
- Pulmonology Department, Hospital de Braga, Braga, Portugal
- Tumour and Microenvironment Interactions Group, I3S – Institute for Health Research and Innovation, University of Porto, Porto, Portugal
| | | | - Margarida Dias
- Pulmonology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Sile Toland
- Department of Medicine, Letterkenny University Hospital, Letterkenny, Ireland
| | - Malek Chaabouni
- Asklepios Klinik Altona, Department of Internal Medicine II, Pulmonology and Thoracic Oncology Section, Hamburg, Germany
| | - Koen Verbeke
- Department of Respiratory Medicine, University Hospital Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Maged Hassan
- Chest Diseases Department, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | | | - Geraldine A. Lynch
- Academic Respiratory Unit, University of Bristol Medical School, Bristol, UK
| | - Kevin G. Blyth
- Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Najib M. Rahman
- Oxford University Hospitals NHS Foundation Trust, Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, Headington, UK
| | - Georgia Hardavella
- 9th Department of Respiratory Medicine, Sotiria Athens Chest Diseases Hospital, Athens, Greece
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21
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Hardy CJD, Taylor‐Rubin C, Taylor B, Harding E, Gonzalez AS, Jiang J, Thompson L, Kingma R, Chokesuwattanaskul A, Walker F, Barker S, Brotherhood E, Waddington C, Wood O, Zimmermann N, Kupeli N, Yong KXX, Camic PM, Stott J, Marshall CR, Oxtoby NP, Rohrer JD, Volkmer A, Crutch SJ, Warren JD. Symptom-led staging for semantic and non-fluent/agrammatic variants of primary progressive aphasia. Alzheimers Dement 2024; 20:195-210. [PMID: 37548125 PMCID: PMC10917001 DOI: 10.1002/alz.13415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Here we set out to create a symptom-led staging system for the canonical semantic and non-fluent/agrammatic variants of primary progressive aphasia (PPA), which present unique diagnostic and management challenges not well captured by functional scales developed for Alzheimer's disease and other dementias. METHODS An international PPA caregiver cohort was surveyed on symptom development under six provisional clinical stages and feedback was analyzed using a mixed-methods sequential explanatory design. RESULTS Both PPA syndromes were characterized by initial communication dysfunction and non-verbal behavioral changes, with increasing syndromic convergence and functional dependency at later stages. Milestone symptoms were distilled to create a prototypical progression and severity scale of functional impairment: the PPA Progression Planning Aid ("PPA-Squared"). DISCUSSION This work introduces a symptom-led staging scheme and functional scale for semantic and non-fluent/agrammatic variants of PPA. Our findings have implications for diagnostic and care pathway guidelines, trial design, and personalized prognosis and treatment for PPA. HIGHLIGHTS We introduce new symptom-led perspectives on primary progressive aphasia (PPA). The focus is on non-fluent/agrammatic (nfvPPA) and semantic (svPPA) variants. Foregrounding of early and non-verbal features of PPA and clinical trajectories is featured. We introduce a symptom-led staging scheme for PPA. We propose a prototype for a functional impairment scale, the PPA Progression Planning Aid.
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Affiliation(s)
- Chris J. D. Hardy
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Cathleen Taylor‐Rubin
- Uniting War Memorial HospitalSydneyAustralia
- Faculty of MedicineHealth and Human SciencesMacquarie UniversitySydneyAustralia
| | - Beatrice Taylor
- Centre for Medical Image ComputingDepartment of Computer ScienceUCLLondonUK
| | - Emma Harding
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | | | - Jessica Jiang
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | | | | | - Anthipa Chokesuwattanaskul
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
- Division of NeurologyDepartment of Internal MedicineKing Chulalongkorn Memorial HospitalBangkokThailand
- Cognitive Clinical and Computational Neuroscience Research UnitFaculty of MedicineChulalongkorn UniversityBangkokThailand
| | | | - Suzie Barker
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Emilie Brotherhood
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Claire Waddington
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Olivia Wood
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Nikki Zimmermann
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research DepartmentDivision of PsychiatryUCLLondonUK
| | - Keir X. X. Yong
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Paul M. Camic
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Joshua Stott
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
- ADAPT LabResearch Department of ClinicalEducational and Health PsychologyUCLLondonUK
| | | | - Neil P. Oxtoby
- Centre for Medical Image ComputingDepartment of Computer ScienceUCLLondonUK
| | - Jonathan D. Rohrer
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
| | - Anna Volkmer
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
- Psychology and Language Sciences (PALS)UCLLondonUK
| | | | - Jason D. Warren
- Dementia Research CentreUCL Queen Square Institute of NeurologyUCLLondonUK
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22
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Walshe C, Beernart K, Chong PH, Lowe S, Martins Pereira S, Yardley S. Writing for the world: Enhancing engagement and connection with an international audience. Palliat Med 2024; 38:4-6. [PMID: 38050381 DOI: 10.1177/02692163231215980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Affiliation(s)
- Catherine Walshe
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Kim Beernart
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-Life Care Research Group, Brussels, Belgium
| | | | - Sonya Lowe
- University of Alberta, Edmonton, AB, Canada
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23
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Taquet M, Skorniewska Z, Zetterberg H, Geddes JR, Mummery CJ, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Mansoori P, Greening NJ, Harrison EM, Docherty AB, Lone NI, Quint J, Greenhalf W, Wain LV, Brightling CE, Evans RE, Harrison PJ, Koychev I. Post-acute COVID-19 neuropsychiatric symptoms are not associated with ongoing nervous system injury. Brain Commun 2023; 6:fcad357. [PMID: 38229877 PMCID: PMC10789589 DOI: 10.1093/braincomms/fcad357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 10/23/2023] [Accepted: 12/23/2023] [Indexed: 01/18/2024] Open
Abstract
A proportion of patients infected with severe acute respiratory syndrome coronavirus 2 experience a range of neuropsychiatric symptoms months after infection, including cognitive deficits, depression and anxiety. The mechanisms underpinning such symptoms remain elusive. Recent research has demonstrated that nervous system injury can occur during COVID-19. Whether ongoing neural injury in the months after COVID-19 accounts for the ongoing or emergent neuropsychiatric symptoms is unclear. Within a large prospective cohort study of adult survivors who were hospitalized for severe acute respiratory syndrome coronavirus 2 infection, we analysed plasma markers of nervous system injury and astrocytic activation, measured 6 months post-infection: neurofilament light, glial fibrillary acidic protein and total tau protein. We assessed whether these markers were associated with the severity of the acute COVID-19 illness and with post-acute neuropsychiatric symptoms (as measured by the Patient Health Questionnaire for depression, the General Anxiety Disorder assessment for anxiety, the Montreal Cognitive Assessment for objective cognitive deficit and the cognitive items of the Patient Symptom Questionnaire for subjective cognitive deficit) at 6 months and 1 year post-hospital discharge from COVID-19. No robust associations were found between markers of nervous system injury and severity of acute COVID-19 (except for an association of small effect size between duration of admission and neurofilament light) nor with post-acute neuropsychiatric symptoms. These results suggest that ongoing neuropsychiatric symptoms are not due to ongoing neural injury.
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Affiliation(s)
- Maxime Taquet
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Oxford OX3 7JX, UK
| | | | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal 413 90, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal 413 90, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London WC1N 3BG, UK
- UK Dementia Research Institute at UCL, London WC1N 3BG, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Oxford OX3 7JX, UK
| | - Catherine J Mummery
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London WC1N 3BG, UK
| | - James D Chalmers
- University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - Ling-Pei Ho
- MRC Human Immunology Unit, University of Oxford, Oxford OX3 9DS, UK
| | - Alex Horsley
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
- Hospital for Tropical Diseases, University College London Hospital, London WC1E 6JD, UK
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
| | | | - Betty Raman
- Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Olivia C Leavy
- Department of Population Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Matthew Richardson
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester LE3 9QP, UK
| | - Omer Elneima
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester LE3 9QP, UK
| | - Hamish J C McAuley
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester LE3 9QP, UK
| | - Aarti Shikotra
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester LE5 4PW, UK
| | - Amisha Singapuri
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester LE3 9QP, UK
| | - Marco Sereno
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester LE3 9QP, UK
| | - Ruth M Saunders
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester LE3 9QP, UK
| | - Victoria Claire Harris
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester LE3 9QP, UK
- University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Linzy Houchen-Wolloff
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University of Leicester, Leicester LE5 4PW, UK
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 9HN, UK
- Therapy Department, University Hospitals of Leicester, NHS Trust, Leicester LE5 4PW, UK
| | | | - Neil J Greening
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester LE3 9QP, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh EH16 4SS, UK
| | - Annemarie B Docherty
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh EH16 4SS, UK
| | - Nazir I Lone
- Usher Institute, University of Edinburgh, Edinburgh EH16 4SS, UK
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh EH16 4SA, UK
| | - Jennifer Quint
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - William Greenhalf
- University of Liverpool, Liverpool L69 3BX, UK
- The CRUK Liverpool Experimental Cancer Medicine Centre, Liverpool L69 3GL, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8YE, UK
| | - Louise V Wain
- Department of Population Health Sciences, University of Leicester, Leicester LE1 7RH, UK
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester LE3 9QP, UK
| | - Christopher E Brightling
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester LE3 9QP, UK
| | - Rachael E Evans
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester LE3 9QP, UK
- University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Oxford OX3 7JX, UK
| | - Ivan Koychev
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
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24
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Hudson BF, Dzeng E, Burnett A, Yeung M, Shulman C. Palliative care, homelessness, and restricted or uncertain immigration status. Palliat Care Soc Pract 2023; 17:26323524231216993. [PMID: 38144973 PMCID: PMC10748891 DOI: 10.1177/26323524231216993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/07/2023] [Indexed: 12/26/2023] Open
Abstract
Background People experiencing homelessness have limited access to palliative care support despite high levels of ill health and premature mortality. Most research exploring these challenges in the United Kingdom has focused on people living in hostels or temporary accommodation. People with uncertain or restricted immigration status are often unable to access this accommodation due to lack of entitlement to benefits. There is little research about the experiences of those in the United Kingdom who cannot access hostels or temporary accommodation due to restricted or uncertain immigration status with regards to palliative and end-of-life care access. Aim To explore the barriers to palliative and end-of-life care access for people with uncertain or restricted immigration status, who are experiencing homelessness and have advanced ill health, and the experiences of UK hospices of supporting people in this situation. Design A multi-method cross-sectional study. Setting/participants An online survey for hospice staff followed by online focus groups with staff from inclusion health, homelessness and palliative care services, charities and interviews with people experiencing homelessness. Results Fifty hospice staff responded to the online survey and 17 people participated in focus groups and interviews (focus groups: n = 10; interviews: n = 7). The survey demonstrated how hospices are not currently supporting many people with restricted or uncertain immigration status who are homeless and that hospice staff have received limited training around eligibility for entitlements or National Health Service (NHS) care. Interview and focus group data demonstrated high levels of unmet need. Reasons for this included a lack of consistency around eligibility for support from local authorities, issues relating to NHS charging, and mistrust and limited knowledge of the UK health and social care system. These barriers leave many people unable to access care toward the end of their lives. Conclusion To advocate for and provide compassionate palliative and end-of-life care for people with uncertain immigration status, there is need for more legal literacy, with training around people's entitlement to care and support, as well as easier access to specialist legal advice.
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Affiliation(s)
- Briony F. Hudson
- Marie Curie, One Embassy Gardens, 8 Viaduct Gardens, London SW11 7BW, UK
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK Pathway, London, UK
| | - Elizabeth Dzeng
- Department of Global Health and Social Medicine, King’s College London, London, UK
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Michelle Yeung
- Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
| | - Caroline Shulman
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
- Pathway, London, UK
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Boniface G, White N, Tomlinson C, Norris M, O'Connell N, Williamson E, Harries P. Prescribing hand strengthening exercise for patients with rheumatoid arthritis; clinical cues influencing occupational therapists' and physiotherapists' judgements. Musculoskeletal Care 2023; 22. [PMID: 38047721 DOI: 10.1002/msc.1849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To explore the clinical judgements of therapists in prescribing the intensity of hand strengthening exercise in rheumatoid arthritis (RA). METHODS Phase I: Eleven therapists knowledgeable in treating patients with RA subjectively identified seven clinical cues. These were incorporated into 54 hypothetical patient case scenarios. PHASE II Therapists with ≥2 years post-registration experience and current or recent experience in treating patients with RA were asked to assess 69 case scenarios in total (54 + 15 repeats) and judge what intensity of hand strengthening exercise they would prescribe using the OMNI-Resistance Exercise Scale of perceived exertion. Using responses to the repeated cases, the Cochran-Weiss-Shanteau index of expertise was used to identify therapists who prescribed more consistently. Multiple regression was used to determine which clinical cues were most strongly associated with the intensity of exercise prescribed. A sub-group analysis explored differences between consistent and inconsistent prescribers. RESULTS Fifty-three therapists took part. Thirty completed all 69 case scenarios. Across all therapists, the three most important clinical cues associated with lower intensity of exercise prescribed were (1) Patient's reported pain intensity whilst practising the exercise (β = -1.150, p < 0.001), (2) Disease activity (β = -0.425, p < 0.001) and (3) average hand pain over the last week (β = -0.353 p < 0.001). Twelve therapists were categorised as consistent prescribers. This group relied on fewer clinical cues (three vs. seven) when judging what intensity of exercise to prescribe. CONCLUSION This study provides insights into how therapists prescribe hand exercises. Intensity of hand strengthening exercise was influenced by three key clinical cues, including pain intensity and disease activity.
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Affiliation(s)
- Graham Boniface
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, London, UK
| | - Nicola White
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | | | - Meriel Norris
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, London, UK
| | - Neil O'Connell
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, London, UK
| | - Esther Williamson
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Priscilla Harries
- Centre for Applied Health and Social Care Research, Kingston University, Kingston, UK
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Clarke G, Hussain JA, Allsop MJ, Bennett MI. Ethnicity and palliative care: we need better data - five key considerations. BMJ Support Palliat Care 2023; 13:429-431. [PMID: 35589123 PMCID: PMC10803990 DOI: 10.1136/bmjspcare-2022-003565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/13/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Gemma Clarke
- Academic Unit of Palliative Care, Leeds Insitute of Health Sciences, University of Leeds School of Medicine, Leeds, UK
| | | | - Matthew John Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Hansford L, Wyatt K, Creanor S, Davies J, Horne G, Lynn A, McCready S, Pearce S, Peeler A, Rhys A, Sallnow L, Harding R. Engaging with communities in rural, coastal and low-income areas to understand barriers to palliative care and bereavement support: reflections on a community engagement programme in South-west England. Palliat Care Soc Pract 2023; 17:26323524231212514. [PMID: 38044933 PMCID: PMC10693214 DOI: 10.1177/26323524231212514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
Background England's South-west Peninsula is largely rural, has a high proportion of over 65s, and has areas of rural and coastal deprivation. Rural and low-income populations face inequities at end of life and little is known about the support needs of rural, coastal and low-income communities. Objectives To understand how to foster community support for dying and grieving well, a regional, multi-sectoral research partnership developed a community engagement programme to explore experiences of seeking support, issues important to people and the community support they valued. This article shares what people told us about the role that communities can play at end of life, and reflects on learning from our process of engaging communities in conversations about dying. Design and methods A programme of varied community engagement which included: the use of the 'Departure Lounge' installation and four focus groups with interested individuals in a range of community settings; the co-creation of a 'Community Conversation' toolkit to facilitate conversations with individuals with experience of end-of-life care and their carers with Community Builders; a focus group with Community Builders and a storytelling project with three bereaved individuals. Results People valued community support at the end of life or in bereavement that offered connection with others, peer support without judgement, responded to their individual needs and helped them to access services. Creative methods of engagement show potential to help researchers and practitioners better understand the needs and priorities of underserved populations. Collaboration with existing community groups was key to engagement, and contextual factors influenced levels of engagement. Conclusion Local community organizations are well placed to support people at end of life. This work highlighted the potential for partnership with palliative care and bereavement organizations, who could offer opportunities to develop people's knowledge and skills, and together generate sustainable solutions to meet local need.
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Affiliation(s)
- Lorraine Hansford
- Department of Health and Community Sciences, University of Exeter, South Cloisters, St Luke’s Campus, Queen’s Building, Exeter EX1 2LU, UK
| | - Katrina Wyatt
- Department of Health and Community Sciences, University of Exeter, Exeter, UK
| | - Siobhan Creanor
- Department of Health and Community Sciences, University of Exeter, Exeter, UK
| | | | | | - Amanda Lynn
- Torbay Community Development Trust, Torquay, UK
| | | | - Susie Pearce
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Anna Peeler
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
| | | | - Libby Sallnow
- St Christopher’s Hospice, London, UK
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
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Magliacano A, De Bellis F, Panico F, Sagliano L, Trojano L, Sandroni C, Estraneo A. Long-term clinical evolution of patients with prolonged disorders of consciousness due to severe anoxic brain injury: A meta-analytic study. Eur J Neurol 2023; 30:3913-3927. [PMID: 37246500 DOI: 10.1111/ene.15899] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/08/2023] [Accepted: 05/24/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND PURPOSE The prognosis of prolonged (28 days to 3 months post-onset) disorders of consciousness (pDoC) due to anoxic brain injury is uncertain. The present study aimed to evaluate the long-term outcome of post-anoxic pDoC and identify the possible predictive value of demographic and clinical information. METHOD This is a systematic review and meta-analysis. The rates of mortality, any improvement in clinical diagnosis, and recovery of full consciousness at least 6 months after severe anoxic brain injury were evaluated. A cross-sectional approach searched for differences in baseline demographic and clinical characteristics between survivors and non-survivors, patients improved versus not improved, and patients who recovered full consciousness versus not recovered. RESULTS Twenty-seven studies were identified. The pooled rates of mortality, any clinical improvement and recovery of full consciousness were 26%, 26% and 17%, respectively. Younger age, baseline diagnosis of minimally conscious state versus vegetative state/unresponsive wakefulness syndrome, higher Coma Recovery Scale Revised total score, and earlier admission to intensive rehabilitation units were associated with a significantly higher likelihood of survival and clinical improvement. These same variables, except time of admission to rehabilitation, were also associated with recovery of full consciousness. CONCLUSIONS Patients with anoxic pDoC might improve over time up to full recovery of consciousness and some clinical characteristics can help predict clinical improvement. These new insights could support clinicians and caregivers in the decision-making on patient management.
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Affiliation(s)
| | - Francesco De Bellis
- Polo specialistico riabilitativo, Fondazione Don Carlo Gnocchi, Sant'Angelo dei Lombardi, Italy
| | - Francesco Panico
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Laura Sagliano
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Luigi Trojano
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Estraneo
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
- SM Della Pietà General Hospital, Nola, Italy
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Edwards M, Holland‐Hart D, Mann M, Seddon K, Buckle P, Longo M, Byrne A, Nelson A. Understanding how shared decision-making approaches and patient aids influence patients with advanced cancer when deciding on palliative treatments and care: A realist review. Health Expect 2023; 26:2109-2126. [PMID: 37448166 PMCID: PMC10632651 DOI: 10.1111/hex.13822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/09/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Patients with advanced incurable cancer face difficult decisions about palliative treatment options towards their end of life. However, they are often not provided with the appropriate information and support that is needed to make informed decisions. This review aimed to identify contexts and mechanisms associated with communication tools, patient decision-aids and shared decision-making (SDM) approaches that influence patient outcomes. METHODS We used a realist review method to search for published studies of patients (adults > 18) with advanced cancer who were expected to make a decision about palliative treatment and/or supportive care in consultation with healthcare practitioners. We appraised and synthesised literature describing the contexts of (when and how) decision aids and SDM approaches are used, and how these contexts interact with mechanisms (resources and reasoning) which impact patient outcomes. Stakeholders including academics, palliative healthcare professionals (HCPs) and people with lived experience of supporting people with advanced incurable cancer contributed to identifying explanatory accounts. These accounts were documented, analysed and consolidated to contribute to the development of a programme theory. RESULTS From the 33 included papers, we consolidated findings into 20 explanatory accounts to develop a programme theory that explains key contexts and mechanisms that influence patient and SDM. Contexts include underlying patients' and HCPs' attitudes and approaches. These need to be understood in relation to key mechanisms, including presenting information in multiple formats and providing adequate time and opportunities to prepare for and revisit decisions. Contexts influenced mechanisms which then influence the levels of patient decisional satisfaction, conflict and regret. CONCLUSIONS Our programme theory highlights mechanisms that are important in supporting shared treatment decisions for advanced noncurative cancer. The findings are informative for developing and evaluating interventions to improve understanding and involvement in SDM for patients with advanced incurable cancer. PATIENT AND PUBLIC CONTRIBUTION We included patient and public involvement (PPI) representatives in four stakeholder meetings. PPI helped to define the scope of the review, identify their unique experiences and perspectives, synthesise their perspectives with our review findings, make decisions about which theories we included in our programme theory and develop recommendations for policy and practice and future research.
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Affiliation(s)
- Michelle Edwards
- Division of Population Medicine, Marie Curie Palliative Care Research CentreCardiff UniversityCardiffWalesUK
| | - Daniella Holland‐Hart
- Division of Population Medicine, Marie Curie Palliative Care Research CentreCardiff UniversityCardiffWalesUK
| | - Mala Mann
- Division of Population Medicine, Marie Curie Palliative Care Research CentreCardiff UniversityCardiffWalesUK
| | - Kathy Seddon
- Marie Curie Palliative Care Research CentreWales Cancer Research CentreCardiffWalesUK
| | - Peter Buckle
- Marie Curie Palliative Care Research CentreWales Cancer Research CentreCardiffWalesUK
| | - Mirella Longo
- Division of Population Medicine, Marie Curie Palliative Care Research CentreCardiff UniversityCardiffWalesUK
| | - Anthony Byrne
- Division of Population Medicine, Marie Curie Palliative Care Research CentreCardiff UniversityCardiffWalesUK
| | - Annmarie Nelson
- Division of Population Medicine, Marie Curie Palliative Care Research CentreCardiff UniversityCardiffWalesUK
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Papachristopoulos K, Gradito Dubord MA, Jauvin F, Forest J, Coulombe P. Positive Impact, Creativity, and Innovative Behavior at Work: The Mediating Role of Basic Needs Satisfaction. Behav Sci (Basel) 2023; 13:984. [PMID: 38131840 PMCID: PMC10740987 DOI: 10.3390/bs13120984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
In recent research, a growing body of empirical evidence suggests that prosocial impact at work can play a significant role in enhancing creativity and innovativeness. Drawing from self-determination theory, we hypothesized that basic psychological needs and benevolence satisfaction could serve as a mediating factor in the relation between an employee's perceived social impact and innovative work behavior and creativity, thus illuminating the manner in which the contentment of psychological needs fosters inventive proclivities within the organizational milieu. Results from a study in Greece and Canada (N = 528) showed that both perceived social impact and prosocial motivation are positively associated with innovative work behavior and creativity while autonomy and competence satisfaction mediate the relation between perceived social impact and the work outcomes examined within this study. Moreover, prosocial motivation was found to moderate the relation between benevolence satisfaction and innovativeness. Findings extend prior research on the role of prosociality on creative behavior at work and provide supporting evidence for the organizations that encourage and support employees' initiatives to make a positive difference in the lives of others.
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Affiliation(s)
| | - Marc-Antoine Gradito Dubord
- Future of Work Institute, Curtin University, Perth, WA 6000, Australia;
- Department of Human ReSources Management, Université du Québec à Trois-Rivières, Trois-Rivières, QC G8Z 4M3, Canada
| | - Florence Jauvin
- École des Sciences de la Gestion, Université du Québec à Montréal, Montréal, QC H2X 3X2, Canada; (F.J.); (J.F.); (P.C.)
| | - Jacques Forest
- École des Sciences de la Gestion, Université du Québec à Montréal, Montréal, QC H2X 3X2, Canada; (F.J.); (J.F.); (P.C.)
| | - Patrick Coulombe
- École des Sciences de la Gestion, Université du Québec à Montréal, Montréal, QC H2X 3X2, Canada; (F.J.); (J.F.); (P.C.)
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Davies N, West E, Smith EM, Vickerstaff V, Manthorpe J, Shah M, Rait G, Wilcock J, Ward J, Sampson EL. Development of a decision-support framework to support professionals and promote comfort among older hospital inpatients living with dementia. Health Expect 2023; 27:e13922. [PMID: 38010078 PMCID: PMC10757206 DOI: 10.1111/hex.13922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/20/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Acute hospital wards can be difficult places for many people living with dementia. Promoting comfort and wellbeing can be challenging in this environment. There is little evidence-based support for professionals working on acute care wards on how to respond to distress and maximise comfort and wellbeing among patients living with dementia. OBJECTIVES Our overall aim was to codesign an evidence-based easy-to-use heuristic decision-support framework, which was acceptable and practical but acknowledges the complex and acute nature of caring for patients with dementia in the hospital. This paper presents the development process and resulting framework. METHODS A codesign study was informed by data from (1) a literature review of the care and management of people living with dementia in acute hospitals; (2) a cohort study of comfort and discomfort in people with dementia in acute hospitals; and (3) interviews with family carers and health care professionals. We synthesised evidence from these data sources and presented to key stakeholders through codesign meetings and workshops to produce our decision-support framework. RESULTS The framework consists of a series of flowcharts and operates using a three-stage process of: (1) assess comfort/discomfort; (2) consider causes of discomfort; and (3) address patient needs to manage the discomfort. CONCLUSION Working with key stakeholders, synthesising diverse quantitative and qualitative evidence to build a clinical framework is a feasible approach to help address the needs of patients living with dementia in an acute hospital setting. The result is a framework which is now ready for evaluation and implementation. PATIENT AND PUBLIC CONTRIBUTION We worked closely with people living with dementia and family carers throughout this study, including the development of the study protocol with input on study development and design, through to inclusion in stakeholder workshops and codesign of the decision support framework.
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Affiliation(s)
- Nathan Davies
- Department of Primary Care and Population Health, Centre for Ageing Population Studies, Royal Free CampusUniversity College LondonLondonUK
| | - Emily West
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
| | - Ellen M. Smith
- South West London and St George's Mental Health NHS TrustLondonUK
| | - Victoria Vickerstaff
- Department of Primary Care and Population Health, Centre for Ageing Population Studies, Royal Free CampusUniversity College LondonLondonUK
| | - Jill Manthorpe
- NIHR Applied Research Collaborative (ARC) South LondonKing's College London, StrandLondonUK
- NIHR Policy Research Unit in Health and Social Care WorkforceKing's College London, StrandLondonUK
| | - Malvi Shah
- Department of Primary Care and Population Health, Centre for Ageing Population Studies, Royal Free CampusUniversity College LondonLondonUK
| | - Greta Rait
- Department of Primary Care and Population Health, Centre for Ageing Population Studies, Royal Free CampusUniversity College LondonLondonUK
| | - Jane Wilcock
- Department of Primary Care and Population Health, Centre for Ageing Population Studies, Royal Free CampusUniversity College LondonLondonUK
| | - Jane Ward
- Patient and Public Involvement RepresentativeLonodnUK
| | - Elizabeth L. Sampson
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
- Department of Psychological Medicine, Royal London HospitalEast London NHS Foundation TrustLondonUK
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D'Eer L, Chambaere K, Van den Block L, Dury S, Sallnow L, Deliens L, Smets T, Cohen J. How compassionate is your neighborhood? Results of a cross-sectional survey on neighborhood participation regarding serious illness, death, and loss. Death Stud 2023:1-10. [PMID: 38006257 DOI: 10.1080/07481187.2023.2283449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
We conducted a cross-sectional survey measuring the extent and nature of neighborhood participation regarding serious illness, death and loss and the factors that are associated with it. We distributed the survey to 2324 adult citizens in two neighborhoods in Flanders, Belgium, to which 714 citizens responded (response rate 30.7%). Of the respondents, 42.4% participated in at least one action in their neighborhood around serious illness, death, or loss, for 30.8% of them this participation was sporadic. Most of the respondents participated by helping neighbors (32.4%) or by volunteering (10.3%). We found a positive association between perceived neighborhood social cohesion (β = 0.100; CI = 0.003-0.040), previous experiences with serious illness, death, and loss (β = 0.158; CI = 0.204-0.586) and neighborhood participation around serious illness, death and loss. Future research should investigate strategies on how to move from death literacy developed through illness, caregiving and bereavement experiences to neighborhood participation around these topics.
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Affiliation(s)
- Louise D'Eer
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Kenneth Chambaere
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lieve Van den Block
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sarah Dury
- Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Society and Ageing Research Lab, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Libby Sallnow
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- St. Christopher's Hospice, London, UK
- Marie Curie Palliative Care Research Group, University College London, UK
| | - Luc Deliens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Tinne Smets
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Joachim Cohen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Melo S, Guerrero P, Moreira Soares M, Bordin JR, Carneiro F, Carneiro P, Dias MB, Carvalho J, Figueiredo J, Seruca R, Travasso RDM. The ECM and tissue architecture are major determinants of early invasion mediated by E-cadherin dysfunction. Commun Biol 2023; 6:1132. [PMID: 37938268 PMCID: PMC10632478 DOI: 10.1038/s42003-023-05482-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 10/18/2023] [Indexed: 11/09/2023] Open
Abstract
Germline mutations of E-cadherin cause Hereditary Diffuse Gastric Cancer (HDGC), a highly invasive cancer syndrome characterised by the occurrence of diffuse-type gastric carcinoma and lobular breast cancer. In this disease, E-cadherin-defective cells are detected invading the adjacent stroma since very early stages. Although E-cadherin loss is well established as a triggering event, other determinants of the invasive process persist largely unknown. Herein, we develop an experimental strategy that comprises in vitro extrusion assays using E-cadherin mutants associated to HDGC, as well as mathematical models epitomising epithelial dynamics and its interaction with the extracellular matrix (ECM). In vitro, we verify that E-cadherin dysfunctional cells detach from the epithelial monolayer and extrude basally into the ECM. Through phase-field modelling we demonstrate that, aside from loss of cell-cell adhesion, increased ECM attachment further raises basal extrusion efficiency. Importantly, by combining phase-field and vertex model simulations, we show that the cylindrical structure of gastric glands strongly promotes the cell's invasive ability. Moreover, we validate our findings using a dissipative particle dynamics simulation of epithelial extrusion. Overall, we provide the first evidence that cancer cell invasion is the outcome of defective cell-cell linkages, abnormal interplay with the ECM, and a favourable 3D tissue structure.
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Affiliation(s)
- Soraia Melo
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Ipatimup - Institute of Molecular Pathology and Immunology of the University of Porto, University of Porto, Porto, Portugal
| | - Pilar Guerrero
- Departamento de Matemáticas and Grupo Interdisciplinar de Sistemas Complejos (GISC), Universidad Carlos III de Madrid, Leganés, Spain
| | - Maurício Moreira Soares
- Oslo Center for Biostatistics and Epidemiology, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - José Rafael Bordin
- Department of Physics, Institute of Physics and Mathematics, Federal University of Pelotas, Capão do Leão, Rio Grande do Sul, Brazil
| | - Fátima Carneiro
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Ipatimup - Institute of Molecular Pathology and Immunology of the University of Porto, University of Porto, Porto, Portugal
- Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Patrícia Carneiro
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Ipatimup - Institute of Molecular Pathology and Immunology of the University of Porto, University of Porto, Porto, Portugal
| | - Maria Beatriz Dias
- CISUC, Department of Informatics Engineering, University of Coimbra, Coimbra, Portugal
| | - João Carvalho
- CFisUC, Department of Physics, University of Coimbra, Coimbra, Portugal
| | - Joana Figueiredo
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
- Ipatimup - Institute of Molecular Pathology and Immunology of the University of Porto, University of Porto, Porto, Portugal.
- Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Raquel Seruca
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Ipatimup - Institute of Molecular Pathology and Immunology of the University of Porto, University of Porto, Porto, Portugal
- Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rui D M Travasso
- CFisUC, Department of Physics, University of Coimbra, Coimbra, Portugal.
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Quintiens B, Smets T, Chambaere K, Van den Block L, Deliens L, Sallnow L, Cohen J. Discomfort With Suffering and Dying, a Cross-Sectional Survey of the General Public. J Pain Symptom Manage 2023; 66:529-540.e6. [PMID: 37437645 DOI: 10.1016/j.jpainsymman.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/14/2023]
Abstract
CONTEXT Death and the process of dying have become increasingly medicalized and professionalized. The associated cultural estrangement from death may affect how comfortable we feel about death and dying. This study examines the general public's discomfort with another person's suffering and dying, and whether these feelings are associated with specific personal characteristics or experiences. OBJECTIVES Cross-sectional survey in a random sample of people aged 16 or older in four municipalities in Flanders, Belgium (N=4400). We used the self-developed construct Discomfort with someone's suffering and dying. A directed acyclic graph guided the development of a multivariable regression model which explored the effect of different variables on the main outcome measure. RESULTS A total of 2008 completed questionnaires were returned (response rate: 45.6%). Average discomfort with someone's suffering and dying was 3.74 (SD = 0.89). Being female or currently mourning a loss were associated with more discomfort. Not being religious, having better knowledge about palliative care, having worked in healthcare, having been with someone else at the time of their death and having been culturally exposed to death and dying were associated with less discomfort. CONCLUSION A considerable level of discomfort is present within the general public about the suffering and dying of others and this may increase social stigma and a tendency to avoid seriously ill people and their social surroundings. Our findings suggest that interventions may help shift this societal discomfort if they incorporate a focus on cultural and experiential exposure and increasing knowledge about palliative care.
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Affiliation(s)
- Bert Quintiens
- End-of Life Care Research Group (B.Q., T.S., K.C., L.V.B., L.D., L.S., J.C.), Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; Compassionate Community Centre of Expertise (COCO) (B.Q., K.C., L.D., J.C.), Vrije Universiteit Brussel, Brussels, Belgium.
| | - Tinne Smets
- End-of Life Care Research Group (B.Q., T.S., K.C., L.V.B., L.D., L.S., J.C.), Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Kenneth Chambaere
- End-of Life Care Research Group (B.Q., T.S., K.C., L.V.B., L.D., L.S., J.C.), Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; Compassionate Community Centre of Expertise (COCO) (B.Q., K.C., L.D., J.C.), Vrije Universiteit Brussel, Brussels, Belgium
| | - Lieve Van den Block
- End-of Life Care Research Group (B.Q., T.S., K.C., L.V.B., L.D., L.S., J.C.), Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Luc Deliens
- End-of Life Care Research Group (B.Q., T.S., K.C., L.V.B., L.D., L.S., J.C.), Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; Compassionate Community Centre of Expertise (COCO) (B.Q., K.C., L.D., J.C.), Vrije Universiteit Brussel, Brussels, Belgium
| | - Libby Sallnow
- End-of Life Care Research Group (B.Q., T.S., K.C., L.V.B., L.D., L.S., J.C.), Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; St Christopher's Hospice (L.S.), London, UK; Marie Curie Palliative Care Research Department (L.S.), Division of Psychiatry, University College London, London, UK
| | - Joachim Cohen
- End-of Life Care Research Group (B.Q., T.S., K.C., L.V.B., L.D., L.S., J.C.), Vrije Universiteit Brussel and Ghent University, Brussels, Belgium; Compassionate Community Centre of Expertise (COCO) (B.Q., K.C., L.D., J.C.), Vrije Universiteit Brussel, Brussels, Belgium
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Ording AG, Nielsen PB, Skjøth F, Overvad TF, Noble S, Lash TL, Goldhaber SZ, Christensen TD, Larsen TB, Søgaard M. Risk of recurrent cancer-associated venous thromboembolism: A Danish nationwide cohort study. Int J Cardiol 2023; 390:131271. [PMID: 37591413 DOI: 10.1016/j.ijcard.2023.131271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/24/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Predictive factors for recurrent cancer-associated venous thromboembolism have been inconsistent across previous studies. To provide data for improved risk stratification, we described the risk of recurrent venous thromboembolism overall and across age, sex, calendar period, cancer type, Ottawa risk score, cancer stage, and cancer treatment in a nationwide cohort of patients with active cancer. METHODS Using Danish administrative registries, we identified a cohort of all adult patients with active cancer and a first-time diagnosis of venous thromboembolism during 2003-2018. We accounted for the competing risk of death and calculated absolute risks of recurrent venous thromboembolism at six months. RESULTS The population included 34,072 patients with active cancer and venous thromboembolism. Recurrence risks at six months were higher for patients with genitourinary cancer (6.5%), lung cancer (6.1%), gastrointestinal cancer (5.6%), brain cancer (5.2%), and hematological cancer (5.1%) than for patients with gynecological cancer (4.7%), breast cancer (4.1%), and other cancer types (4.8%). Recurrence risks were similar for men (5.2%) and women (4.9%), with and without chemotherapy (5.1%), across Ottawa risk score group (low: 5.0%; high: 5.1%) and across calendar periods but increased with increasing cancer stage. The overall six-month all-cause mortality risk was 26%, and highest for patients with lung cancer (49%) and lowest among breast cancer patients (4.1%). CONCLUSIONS Six-month recurrence risk after first-time cancer-associated venous thromboembolism was high and varied by cancer type and patient characteristics. Refining risk stratification for recurrence may improve decision-making regarding treatment duration after cancer-associated thromboembolism.
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Affiliation(s)
- Anne Gulbech Ording
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Unit for Thrombosis and Drug Research, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
| | - Peter Brønnum Nielsen
- Unit for Thrombosis and Drug Research, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark
| | - Flemming Skjøth
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark; Unit for Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Thure Filskov Overvad
- Unit for Thrombosis and Drug Research, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Pharmacology, Aalborg University Hospital, Aalborg, Denmark
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, USA; Cancer Prevention and Control Research Program, Winship Cancer Institute of Emory University, USA
| | - Samuel Zachery Goldhaber
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas Decker Christensen
- Department of Cardiothoracic and Vascular Surgery & Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Torben Bjerregaard Larsen
- Unit for Thrombosis and Drug Research, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark
| | - Mette Søgaard
- Unit for Thrombosis and Drug Research, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark
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Pisello A, Kueppers U, Düffels K, Nomikou P, Dingwell DB, Perugini D. The porosity of felsic pyroclasts: laboratory validation of field-based approaches. Bull Volcanol 2023; 85:69. [PMID: 37920291 PMCID: PMC10618398 DOI: 10.1007/s00445-023-01679-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 09/18/2023] [Indexed: 11/04/2023]
Abstract
Volcanic eruptions are driven by magma rising through Earth's crust. The style of an eruption depends on intrinsic and extrinsic parameters and is commonly a dynamic process. Thorough and holistic investigation of the related products is key to understanding eruptive phenomena and assessment of volcano-specific hazards. Models of such phenomena are constrained by quantification of the dispersal, the grain size distribution, and pyroclast textures. Pyroclast texture may be described in part by measurements of density and porosity, which depend on pyroclast volume determination. Yet volume determination of irregularly shaped pyroclasts cannot be achieved with geometrical laws, instead necessitating the use of alternative methodologies. Here, we test three methodologies to quantify pyroclast volume on a set of clasts collected from the Minoan eruption deposits from Santorini, Greece. We compare (1) a manual method for obtaining the lengths of three orthogonal axes of the pyroclast with a caliper, (2) an optical method to measure the longest and shortest axes of the pyroclast via multiple photographs, and (3) an Archimedean buoyancy-based method. While the optical and manual methods provide almost identical values of pyroclast volume when tested under laboratory conditions, there is a discrepancy between these two methods and the Archimedean method, which produces an overestimation of ca. 13% in volume. This discrepancy has little impact on the subsequent assessment of porosity and density for which the natural variability of values is observed to be broader. We therefore propose using the manual approach in the field as a simple and fast, yet reliable, method to obtain large volumes of quantitative data on the texture of erupted products, and we also provide a correction factor for in-field volume assessment of rhyodacitic pumices. Supplementary Information The online version contains supplementary material available at 10.1007/s00445-023-01679-4.
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Affiliation(s)
- Alessandro Pisello
- Department of Earth and Environmental Sciences, Ludwig-Maximilians-Universität München, Theresienstrasse 41/III, 80333 München, Germany
- Department of Physics and Geology, Universitá di Perugia, via Alessandro Pascoli, 06123 Perugia, Italy
| | - Ulrich Kueppers
- Department of Earth and Environmental Sciences, Ludwig-Maximilians-Universität München, Theresienstrasse 41/III, 80333 München, Germany
| | - Kai Düffels
- Microtrac Retsch GmbH, Retschallee 1-5, 42781 Haan, Germany
| | - Paraskevi Nomikou
- Department of Geology and Geoenvironment, National and Kapodistrian University of Athens, Athens, Greece
| | - Donald B. Dingwell
- Department of Earth and Environmental Sciences, Ludwig-Maximilians-Universität München, Theresienstrasse 41/III, 80333 München, Germany
| | - Diego Perugini
- Department of Physics and Geology, Universitá di Perugia, via Alessandro Pascoli, 06123 Perugia, Italy
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Machuca-Márquez P, Sánchez-Benito L, Menardy F, Urpi A, Girona M, Puighermanal E, Appiah I, Palmiter RD, Sanz E, Quintana A. Vestibular CCK signaling drives motion sickness-like behavior in mice. Proc Natl Acad Sci U S A 2023; 120:e2304933120. [PMID: 37847729 PMCID: PMC10622874 DOI: 10.1073/pnas.2304933120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/23/2023] [Indexed: 10/19/2023] Open
Abstract
Travel can induce motion sickness (MS) in susceptible individuals. MS is an evolutionary conserved mechanism caused by mismatches between motion-related sensory information and past visual and motion memory, triggering a malaise accompanied by hypolocomotion, hypothermia, hypophagia, and nausea. Vestibular nuclei (VN) are critical for the processing of movement input from the inner ear. Motion-induced activation of VN neurons recapitulates MS-related signs. However, the genetic identity of VN neurons mediating MS-related autonomic and aversive responses remains unknown. Here, we identify a central role of cholecystokinin (CCK)-expressing VN neurons in motion-induced malaise. Moreover, we show that CCK VN inputs onto the parabrachial nucleus activate Calca-expressing neurons and are sufficient to establish avoidance to novel food, which is prevented by CCK-A receptor antagonism. These observations provide greater insight into the neurobiological regulation of MS by identifying the neural substrates of MS and providing potential targets for treatment.
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Affiliation(s)
| | - Laura Sánchez-Benito
- Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona08193, Spain
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona08193, Spain
| | - Fabien Menardy
- Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona08193, Spain
| | - Andrea Urpi
- Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona08193, Spain
| | - Mònica Girona
- Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona08193, Spain
| | - Emma Puighermanal
- Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona08193, Spain
| | - Isabella Appiah
- Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona08193, Spain
| | - Richard D. Palmiter
- HHMI, University of Washington, Seattle, WA98195
- Department of Biochemistry, University of Washington, Seattle, WA98195
| | - Elisenda Sanz
- Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona08193, Spain
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona08193, Spain
| | - Albert Quintana
- Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona08193, Spain
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona08193, Spain
- Focus Area for Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom2520, South Africa
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Bailey C, Guo P, MacArtney J, Finucane A, Meade R, Swan S, Wagstaff E. "Palliative care is so much more than that": a qualitative study exploring experiences of hospice staff and bereaved carers during the COVID-19 pandemic. Front Public Health 2023; 11:1139313. [PMID: 38026434 PMCID: PMC10662348 DOI: 10.3389/fpubh.2023.1139313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background The way in which end-of-life care was provided changed significantly during the first 2 years of the COVID-19 pandemic. The national lockdown restrictions reduced formal care support services and increased the burden on many carers taking on the caring role for the first time. We aimed to explore decision-making about the place of care during the COVID-19 pandemic and the impact on experience from the perspectives of carers and hospice staff caring for people at the end-of-life. Methods A qualitative study using virtual interviews was conducted between October 2020 and April 2021. Data were analyzed thematically using framework analysis, an analytical framework that enables qualitative research to be organized into defined themes derived from the research question. Findings were presented to stakeholders in policy roundtables between March 2022 and March 2023 and discussed collaboratively with staff, stakeholders, and the public to inform policy and practice change. Findings A total of 37 participants (15 bereaved carers and 22 staff) were recruited via hospice services in England and Scotland. Four key themes were identified: (1) changing preferences relating to decision-making about the place of care and the impact at the time of death and into bereavement; (2) missed opportunities related to not being there, not having others around, and being robbed of memory-making; (3) the lone carer during a period of high intensity and reduced home support; (4) process vs. person-centered care resulting from changing rules and restrictions and prioritization of regulations over essential palliative care. Conclusion The study provides valuable global implications for all involved in end-of-life care. Despite great efforts to provide dignified, quality care, palliative care during the pandemic changed, focusing on essential 'physical care'. The psychological suffering experienced by staff and carers may need longer-term support mechanisms put in place, which will benefit from a public health approach. Policymakers should consider improving carer identification and resources for wider end-of-life care education to support the needs of carers, health and social care staff, and citizens.
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Affiliation(s)
- Cara Bailey
- School of Nursing and Midwifery, University of Birmingham, Birmingham, United Kingdom
| | - Ping Guo
- School of Nursing and Midwifery, University of Birmingham, Birmingham, United Kingdom
| | - John MacArtney
- Unit of Primary Care, University of Warwick, Coventry, United Kingdom
| | - Anne Finucane
- Clinical Psychology, University of Edinburgh, Edinburgh, United Kingdom
- Marie Curie Hospice, Edinburgh, United Kingdom
| | - Richard Meade
- Clinical Psychology, Carers UK, Edinburgh, United Kingdom
| | - Susan Swan
- Maggie's Glasgow, Glasgow, United Kingdom
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Bunduc CM, Ding Y, Kuijl C, Marlovits TC, Bitter W, Houben ENG. Reconstitution of a minimal ESX-5 type VII secretion system suggests a role for PPE proteins in the outer membrane transport of proteins. mSphere 2023; 8:e0040223. [PMID: 37747201 PMCID: PMC10597459 DOI: 10.1128/msphere.00402-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 09/26/2023] Open
Abstract
Mycobacteria utilize type VII secretion systems (T7SSs) to secrete proteins across their highly hydrophobic and diderm cell envelope. Pathogenic mycobacteria have up to five different T7SSs, called ESX-1 to ESX-5, which are crucial for growth and virulence. Here, we use a functionally reconstituted ESX-5 system in the avirulent species Mycobacterium smegmatis that lacks ESX-5, to define the role of each esx-5 gene in system functionality. By creating an array of gene deletions and assessing protein levels of components and membrane complex assembly, we observed that only the five components of the inner membrane complex are required for its assembly. However, in addition to these five core components, active secretion also depends on both the Esx and PE/PPE substrates. Tagging the PPE substrates followed by subcellular fractionation, surface labeling and membrane extraction showed that these proteins localize to the mycobacterial outer membrane. This indicates that they could play a role in secretion across this enigmatic outer barrier. These results provide the first full overview of the role of each esx-5 gene in T7SS functionality. IMPORTANCE Pathogenic mycobacteria, such as the notorious Mycobacterium tuberculosis, are highly successful as pathogens, in part due to their specific and diderm cell envelope, with a mycolic acid-containing outer membrane. The architecture of this highly impermeable membrane is little understood and the proteins that populate it even less so. To transport proteins across their cell envelope, mycobacteria employ a specialized transport pathway called type VII secretion. While recent studies have elucidated the type VII secretion membrane channel that mediates transport across the inner membrane, the identity of the outer membrane channel remains a black box. Here, we show evidence that specific substrates of the type VII pathway could form these channels. Elucidating the pathway and mechanism of protein secretion through the mycobacterial outer membrane will allow its exploitation for the development of novel mycobacterial therapeutics.
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Affiliation(s)
- C. M. Bunduc
- Molecular Microbiology Section, Amsterdam Institute for Life and Environment (A-Life), Vrije Universiteit, Amsterdam, The Netherlands
- Centre for Structural Systems Biology, Notkestraße, Hamburg, Germany
- Institute of Structural and Systems Biology, University Medical Center Hamburg-Eppendorf, Notkestraße, Hamburg, Germany
- German Electron Synchrotron Centre, Notkestraße, Hamburg, Germany
| | - Y. Ding
- Molecular Microbiology Section, Amsterdam Institute for Life and Environment (A-Life), Vrije Universiteit, Amsterdam, The Netherlands
| | - C. Kuijl
- Department of Medical Microbiology and Infection Control, Amsterdam UMC, Amsterdam, The Netherlands
| | - T. C. Marlovits
- Centre for Structural Systems Biology, Notkestraße, Hamburg, Germany
- Institute of Structural and Systems Biology, University Medical Center Hamburg-Eppendorf, Notkestraße, Hamburg, Germany
- German Electron Synchrotron Centre, Notkestraße, Hamburg, Germany
| | - W. Bitter
- Molecular Microbiology Section, Amsterdam Institute for Life and Environment (A-Life), Vrije Universiteit, Amsterdam, The Netherlands
- Department of Medical Microbiology and Infection Control, Amsterdam UMC, Amsterdam, The Netherlands
| | - E. N. G. Houben
- Molecular Microbiology Section, Amsterdam Institute for Life and Environment (A-Life), Vrije Universiteit, Amsterdam, The Netherlands
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Mescia F, Bayati S, Brouwer E, Heeringa P, Toonen EJM, Beenes M, Ball MJ, Rees AJ, Kain R, Lyons PA, Nilsson P, Pin E. Autoantibody Profiling and Anti-Kinesin Reactivity in ANCA-Associated Vasculitis. Int J Mol Sci 2023; 24:15341. [PMID: 37895021 PMCID: PMC10607136 DOI: 10.3390/ijms242015341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
ANCA-associated vasculitides (AAV) are rare autoimmune diseases causing inflammation and damage to small blood vessels. New autoantibody biomarkers are needed to improve the diagnosis and treatment of AAV patients. In this study, we aimed to profile the autoantibody repertoire of AAV patients using in-house developed antigen arrays to identify previously unreported antibodies linked to the disease per se, clinical subgroups, or clinical activity. A total of 1743 protein fragments representing 1561 unique proteins were screened in 229 serum samples collected from 137 AAV patients at presentation, remission, and relapse. Additionally, serum samples from healthy individuals and patients with other type of vasculitis and autoimmune-inflammatory conditions were included to evaluate the specificity of the autoantibodies identified in AAV. Autoreactivity against members of the kinesin protein family were identified in AAV patients, healthy volunteers, and disease controls. Anti-KIF4A antibodies were significantly more prevalent in AAV. We also observed possible associations between anti-kinesin antibodies and clinically relevant features within AAV patients. Further verification studies will be needed to confirm these findings.
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Affiliation(s)
- Federica Mescia
- Department of Medicine, University of Cambridge, Cambridge CB2 0SP, UK
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, Cambridge CB2 0AW, UK
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy
| | - Shaghayegh Bayati
- Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, 171 65 Stockholm, Sweden
| | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Peter Heeringa
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Erik J M Toonen
- R&D Department, Hycult Biotech, 5405 PB Uden, The Netherlands
| | - Marijke Beenes
- R&D Department, Hycult Biotech, 5405 PB Uden, The Netherlands
| | - Miriam J Ball
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria
| | - Andrew J Rees
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria
| | - Renate Kain
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria
| | - Paul A Lyons
- Department of Medicine, University of Cambridge, Cambridge CB2 0SP, UK
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, Cambridge CB2 0AW, UK
| | - Peter Nilsson
- Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, 171 65 Stockholm, Sweden
| | - Elisa Pin
- Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, 171 65 Stockholm, Sweden
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Bassanetti T, Cezera S, Delacroix M, Escobedo R, Blanchet A, Sire C, Theraulaz G. Cooperation and deception through stigmergic interactions in human groups. Proc Natl Acad Sci U S A 2023; 120:e2307880120. [PMID: 37816053 PMCID: PMC10589714 DOI: 10.1073/pnas.2307880120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/30/2023] [Indexed: 10/12/2023] Open
Abstract
Stigmergy is a generic coordination mechanism widely used by animal societies, in which traces left by individuals in a medium guide and stimulate their subsequent actions. In humans, new forms of stigmergic processes have emerged through the development of online services that extensively use the digital traces left by their users. Here, we combine interactive experiments with faithful data-based modeling to investigate how groups of individuals exploit a simple rating system and the resulting traces in an information search task in competitive or noncompetitive conditions. We find that stigmergic interactions can help groups to collectively find the cells with the highest values in a table of hidden numbers. We show that individuals can be classified into three behavioral profiles that differ in their degree of cooperation. Moreover, the competitive situation prompts individuals to give deceptive ratings and reinforces the weight of private information versus social information in their decisions.
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Affiliation(s)
- Thomas Bassanetti
- Laboratoire de Physique Théorique, CNRS, Université Toulouse III-Paul Sabatier, 31062Toulouse, France
- Centre de Recherches sur la Cognition Animale, Centre de Biologie Intégrative, CNRS, Université Toulouse III-Paul Sabatier, 31062Toulouse, France
| | | | - Maxime Delacroix
- Laboratoire de Physique Théorique, CNRS, Université Toulouse III-Paul Sabatier, 31062Toulouse, France
| | - Ramón Escobedo
- Centre de Recherches sur la Cognition Animale, Centre de Biologie Intégrative, CNRS, Université Toulouse III-Paul Sabatier, 31062Toulouse, France
| | - Adrien Blanchet
- Toulouse School of Economics, CNRS, 31080Toulouse, France
- Institute for Advanced Study in Toulouse, 31080Toulouse, France
| | - Clément Sire
- Laboratoire de Physique Théorique, CNRS, Université Toulouse III-Paul Sabatier, 31062Toulouse, France
| | - Guy Theraulaz
- Centre de Recherches sur la Cognition Animale, Centre de Biologie Intégrative, CNRS, Université Toulouse III-Paul Sabatier, 31062Toulouse, France
- Institute for Advanced Study in Toulouse, 31080Toulouse, France
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Bruedigam C, van Leeuwen JPTM, van de Peppel J. Gene Expression Analyses in Models of Rosiglitazone-Induced Physiological and Pathological Mineralization Identify Novel Targets to Improve Bone and Vascular Health. Cells 2023; 12:2462. [PMID: 37887306 PMCID: PMC10605243 DOI: 10.3390/cells12202462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/25/2023] [Accepted: 09/30/2023] [Indexed: 10/28/2023] Open
Abstract
Clinical studies revealed detrimental skeletal and vascular effects of the insulin sensitizer rosiglitazone. We have shown earlier that rosiglitazone accelerates osteoblast differentiation from human mesenchymal stem cells (hMSC) at the expense of increased oxidative stress and cell death. In calcifying human vascular cells, rosiglitazone stimulates pathological mineralization, an effect diminished by the antioxidant resveratrol. Here, we aimed to elucidate transcriptional networks underlying the rosiglitazone-enhanced mineralization phenotype. We performed genome-wide transcriptional profiling of osteogenic hMSCs treated with rosiglitazone for short-term periods of 1 up to 48 h during the first two days of differentiation, a phase that we show is sufficient for rosiglitazone stimulation of mineralization. Microarray-based mRNA expression analysis revealed 190 probes that were differently expressed in at least one condition compared to vehicle-treated control. This rosiglitazone gene signature contained well-known primary PPAR targets and was also endogenously regulated during osteogenic hMSC differentiation and osteoblast-like differentiation of vascular smooth muscle cells (VSMCs) into calcifying vascular cells (CVCs). Comparative analysis revealed rosiglitazone targets that were commonly enriched in osteoblasts and CVCs or specifically enriched in either osteoblasts or CVCs. Finally, we compared expression patterns of CVC-specific genes with patient expression data from carotid plaque versus intact adjacent tissue, and identified five rosiglitazone targets to be differentially regulated in CVCs and carotid plaque but not osteoblasts when compared to their non-mineralizing counterparts. These targets, i.e., PDK4, SDC4, SPRY4, TCF4 and DACT1, may specifically control extracellular matrix mineralization in vascular cells, and hence provide target candidates for further investigations to improve vascular health.
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Skovronova R, Scaccia E, Calcat-I-Cervera S, Bussolati B, O'Brien T, Bieback K. Adipose stromal cells bioproducts as cell-free therapies: manufacturing and therapeutic dose determine in vitro functionality. J Transl Med 2023; 21:723. [PMID: 37840135 PMCID: PMC10577984 DOI: 10.1186/s12967-023-04602-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/06/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Extracellular vesicles (EV) are considered a cell-free alternative to mesenchymal stromal cell (MSC) therapy. Numerous reports describe the efficacy of EV in conferring immunomodulation and promoting angiogenesis, yet others report these activities to be conveyed in EV-free bioproducts. We hypothesized that this discrepancy may depend either on the method of isolation or rather the relative impact of the individual bioactive components within the MSC secretome. METHODS To answer this question, we performed an inter-laboratory study evaluating EV generated from adipose stromal cells (ASC) by either sequential ultracentrifugation (UC) or size-exclusion chromatography (SEC). The effect of both EV preparations on immunomodulation and angiogenesis in vitro was compared to that of the whole secretome and of the EV-free protein fraction after SEC isolation. RESULTS In the current study, neither the EV preparations, the secretome or the protein fraction were efficacious in inhibiting mitogen-driven T cell proliferation. However, EV generated by SEC stimulated macrophage phagocytic activity to a similar extent as the secretome. In turn, tube formation and wound healing were strongly promoted by the ASC secretome and protein fraction, but not by EV. Within the secretome/protein fraction, VEGF was identified as a potential driver of angiogenesis, and was absent in both EV preparations. CONCLUSIONS Our data indicate that the effects of ASC on immunomodulation and angiogenesis are EV-independent. Specific ASC-EV effects need to be dissected for their use as cell-free therapeutics.
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Affiliation(s)
- Renata Skovronova
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Eleonora Scaccia
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service, Baden-Württemberg-Hessen, Friedrich-Ebert-Str.107, 68167, Mannheim, Germany
| | - Sandra Calcat-I-Cervera
- College of Medicine, Nursing and Health Science, School of Medicine, Regenerative Medicine Institute (REMEDI), University of Galway, Galway, Ireland
- CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - Benedetta Bussolati
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Timothy O'Brien
- College of Medicine, Nursing and Health Science, School of Medicine, Regenerative Medicine Institute (REMEDI), University of Galway, Galway, Ireland
- CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - Karen Bieback
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service, Baden-Württemberg-Hessen, Friedrich-Ebert-Str.107, 68167, Mannheim, Germany.
- Mannheim Institute of Innate Immunoscience, Medical Faculty of Mannheim, Heidelberg University, Mannheim, Germany.
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44
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van Bijnen S, Muotka J, Parviainen T. Divergent auditory activation in relation to inhibition task performance in children and adults. Hum Brain Mapp 2023; 44:4972-4985. [PMID: 37493309 PMCID: PMC10502686 DOI: 10.1002/hbm.26418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
Adults and children show remarkable differences in cortical auditory activation which, in children, have shown relevance for cognitive performance, specifically inhibitory control. However, it has not been tested whether these differences translate to functional differences in response inhibition between adults and children. We recorded auditory responses of adults and school-aged children (6-14 years) using combined magneto- and electroencephalography (M/EEG) during passive listening conditions and an auditory Go/No-go task. The associations between auditory cortical responses and inhibition performance measures diverge between adults and children; while in children the brain-behavior associations are not significant, or stronger responses are beneficial, adults show negative associations between auditory cortical responses and inhibitory performance. Furthermore, we found differences in brain responses between adults and children; the late (~200 ms post stimulation) adult peak activation shifts from auditory to frontomedial areas. In contrast, children show prolonged obligatory responses in the auditory cortex. Together this likely translates to a functional difference between adults and children in the cortical resources for performance consistency in auditory-based cognitive tasks.
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Affiliation(s)
- Sam van Bijnen
- Centre for Interdisciplinary Brain Research, Department of PsychologyUniversity of JyväskyläJyväskyläFinland
- Faculty of Social and Behavioural ScienceUtrecht UniversityThe Netherlands
| | - Joona Muotka
- Centre for Interdisciplinary Brain Research, Department of PsychologyUniversity of JyväskyläJyväskyläFinland
| | - Tiina Parviainen
- Centre for Interdisciplinary Brain Research, Department of PsychologyUniversity of JyväskyläJyväskyläFinland
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Palmer EI, Betty EL, Murphy S, Perrott MR, Smith ANH, Stockin KA. Reproductive biology of male common dolphins ( Delphinus delphis) in New Zealand waters. Mar Biol 2023; 170:153. [PMID: 37811127 PMCID: PMC10558376 DOI: 10.1007/s00227-023-04266-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/02/2023] [Indexed: 10/10/2023]
Abstract
Reproductive parameters were assessed in 64 male common dolphins (Delphinus delphis) examined post-mortem from strandings and bycatch in New Zealand between 1999 and 2020. The stages of male sexual maturation were assessed using morphological measurements and histological examination of testicular tissue. Age was determined via growth layer groups (GLGs) in teeth. The average age (ASM) and length (LSM) at attainment of sexual maturity were estimated to be 8.8 years and 198.3 cm, respectively. Individual variation in ASM (7.5-10 years) and LSM (190-220 cm) was observed in New Zealand common dolphins. However, on average, sexual maturity was attained at a similar length but at a marginally younger age (< 1 year) in New Zealand compared to populations in the Northern Hemisphere. All testicular variables proved better predictors of sexual maturity compared to demographic variables (age and total body length), with combined testes weight the best outright predictor of sexual maturity. Reproductive seasonality was observed in male common dolphins, with a significant increase in combined testes weight in austral summer. This aligns with most other studied populations, where seasonality in reproduction is typically observed. Given the known anthropogenic impacts on New Zealand common dolphins, we recommend that these findings be used as a baseline from which to monitor population-level changes as part of conservation management efforts. Supplementary Information The online version contains supplementary material available at 10.1007/s00227-023-04266-5.
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Affiliation(s)
- Emily I. Palmer
- Cetacean Ecology Research Group, School of Natural Sciences, Massey University, 0745 Auckland, New Zealand
| | - Emma L. Betty
- Cetacean Ecology Research Group, School of Natural Sciences, Massey University, 0745 Auckland, New Zealand
| | - Sinéad Murphy
- Marine and Freshwater Research Centre, Department of Natural Resources & the Environment, School of Science and Computing, Atlantic Technological University, ATU Galway City, Old Dublin Road, Galway, H91 T8NW Ireland
| | - Matthew R. Perrott
- School of Veterinary Sciences, Massey University, Palmerston North, New Zealand
| | - Adam N. H. Smith
- School of Mathematical and Computational Sciences, Massey University, 0745 Auckland, New Zealand
| | - Karen A. Stockin
- Cetacean Ecology Research Group, School of Natural Sciences, Massey University, 0745 Auckland, New Zealand
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Grunst ML, Grunst AS, Grémillet D, Kato A, Gentès S, Fort J. Keystone seabird may face thermoregulatory challenges in a warming Arctic. Sci Rep 2023; 13:16733. [PMID: 37794049 PMCID: PMC10550970 DOI: 10.1038/s41598-023-43650-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023] Open
Abstract
Climate change affects the Arctic more than any other region, resulting in evolving weather, vanishing sea ice and altered biochemical cycling, which may increase biotic exposure to chemical pollution. We tested thermoregulatory impacts of these changes on the most abundant Arctic seabird, the little auk (Alle alle). This small diving species uses sea ice-habitats for foraging on zooplankton and resting. We equipped eight little auks with 3D accelerometers to monitor behavior, and ingested temperature recorders to measure body temperature (Tb). We also recorded weather conditions, and collected blood to assess mercury (Hg) contamination. There were nonlinear relationships between time engaged in different behaviors and Tb. Tb increased on sea ice, following declines while foraging in polar waters, but changed little when birds were resting on water. Tb also increased when birds were flying, and decreased at the colony after being elevated during flight. Weather conditions, but not Hg contamination, also affected Tb. However, given our small sample size, further research regarding thermoregulatory effects of Hg is warranted. Results suggest that little auk Tb varies with behavior and weather conditions, and that loss of sea ice due to global warming may cause thermoregulatory and energic challenges during foraging trips at sea.
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Affiliation(s)
- Melissa L Grunst
- Littoral, Environnement et Sociétés (LIENSs), UMR 7266 CNRS-La Rochelle Université, 2 Rue Olympe de Gouges, 17000, La Rochelle, France.
| | - Andrea S Grunst
- Littoral, Environnement et Sociétés (LIENSs), UMR 7266 CNRS-La Rochelle Université, 2 Rue Olympe de Gouges, 17000, La Rochelle, France
| | - David Grémillet
- CEFE, Univ Montpellier, CNRS, EPHE, IRD, Montpellier, France
- Percy FitzPatrick Institute of African Ornithology, University of Cape Town, Rondebosch, South Africa
| | - Akiko Kato
- Centre d'Etudes Biologiques de Chizé, CEBC, UMR 7372 CNRS-La Rochelle Université, La Rochelle, France
| | - Sophie Gentès
- Littoral, Environnement et Sociétés (LIENSs), UMR 7266 CNRS-La Rochelle Université, 2 Rue Olympe de Gouges, 17000, La Rochelle, France
| | - Jérôme Fort
- Littoral, Environnement et Sociétés (LIENSs), UMR 7266 CNRS-La Rochelle Université, 2 Rue Olympe de Gouges, 17000, La Rochelle, France
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Warsito IF, Komosar M, Bernhard MA, Fiedler P, Haueisen J. Flower electrodes for comfortable dry electroencephalography. Sci Rep 2023; 13:16589. [PMID: 37789022 PMCID: PMC10547758 DOI: 10.1038/s41598-023-42732-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023] Open
Abstract
Dry electroencephalography (EEG) electrodes provide rapid, gel-free, and easy EEG preparation, but with limited wearing comfort. We propose a novel dry electrode comprising multiple tilted pins in a flower-like arrangement. The novel Flower electrode increases wearing comfort and contact area while maintaining ease of use. In a study with 20 volunteers, we compare the performance of a novel 64-channel dry Flower electrode cap to a commercial dry Multipin electrode cap in sitting and supine positions. The wearing comfort of the Flower cap was rated as significantly improved both in sitting and supine positions. The channel reliability and average impedances of both electrode systems were comparable. Averaged VEP components showed no considerable differences in global field power amplitude and latency, as well as in signal-to-noise ratio and topography. No considerable differences were found in the power spectral density of the resting state EEGs between 1 and 40 Hz. Overall, our findings provide evidence for equivalent channel reliability and signal characteristics of the compared cap systems in the sitting and supine positions. The reliability, signal quality, and significantly improved wearing comfort of the Flower electrode allow new fields of applications for dry EEG in long-term monitoring, sensitive populations, and recording in supine position.
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Affiliation(s)
- Indhika Fauzhan Warsito
- Institute of Biomedical Engineering and Informatics at the Technische Universität Ilmenau, Ilmenau, Germany
| | - Milana Komosar
- Institute of Biomedical Engineering and Informatics at the Technische Universität Ilmenau, Ilmenau, Germany
| | - Maria Anne Bernhard
- Institute of Biomedical Engineering and Informatics at the Technische Universität Ilmenau, Ilmenau, Germany
| | - Patrique Fiedler
- Institute of Biomedical Engineering and Informatics at the Technische Universität Ilmenau, Ilmenau, Germany
| | - Jens Haueisen
- Institute of Biomedical Engineering and Informatics at the Technische Universität Ilmenau, Ilmenau, Germany.
- Department of Neurology, Biomagnetic Center, University Hospital Jena, Jena, Germany.
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Casado-Palacios M, Tonelli A, Campus C, Gori M. Movement-related tactile gating in blindness. Sci Rep 2023; 13:16553. [PMID: 37783746 PMCID: PMC10545755 DOI: 10.1038/s41598-023-43526-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 09/25/2023] [Indexed: 10/04/2023] Open
Abstract
When we perform an action, self-elicited movement induces suppression of somatosensory information to the cortex, requiring a correct motor-sensory and inter-sensory (i.e. cutaneous senses, kinesthesia, and proprioception) integration processes to be successful. However, recent works show that blindness might impact some of these elements. The current study investigates the effect of movement on tactile perception and the role of vision in this process. We measured the velocity discrimination threshold in 18 sighted and 18 blind individuals by having them perceive a sequence of two movements and discriminate the faster one in passive and active touch conditions. Participants' Just Noticeable Difference (JND) was measured to quantify their precision. Results showed a generally worse performance during the active touch condition compared to the passive. In particular, this difference was significant in the blind group, regardless of the blindness duration, but not in the sighted one. These findings suggest that the absence of visual calibration impacts motor-sensory and inter-sensory integration required during movement, diminishing the reliability of tactile signals in blind individuals. Our work spotlights the need for intervention in this population and should be considered in the sensory substitution/reinforcement device design.
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Affiliation(s)
- Maria Casado-Palacios
- DIBRIS, University of Genoa, Genoa, Italy
- UVIP- Unit for Visually Impaired People, Italian Institute of Technology, Genoa, Italy
| | - Alessia Tonelli
- UVIP- Unit for Visually Impaired People, Italian Institute of Technology, Genoa, Italy
| | - Claudio Campus
- UVIP- Unit for Visually Impaired People, Italian Institute of Technology, Genoa, Italy
| | - Monica Gori
- UVIP- Unit for Visually Impaired People, Italian Institute of Technology, Genoa, Italy.
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Cutugno L, O'Byrne C, Pané‐Farré J, Boyd A. Rifampicin-resistant RpoB S522L Vibrio vulnificus exhibits disturbed stress response and hypervirulence traits. Microbiologyopen 2023; 12:e1379. [PMID: 37877661 PMCID: PMC10493491 DOI: 10.1002/mbo3.1379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/15/2023] [Accepted: 08/31/2023] [Indexed: 10/26/2023] Open
Abstract
Rifampicin resistance, which is genetically linked to mutations in the RNA polymerase β-subunit gene rpoB, has a global impact on bacterial transcription and cell physiology. Previously, we identified a substitution of serine 522 in RpoB (i.e., RpoBS522L ) conferring rifampicin resistance to Vibrio vulnificus, a human food-borne and wound-infecting pathogen associated with a high mortality rate. Transcriptional and physiological analysis of V. vulnificus expressing RpoBS522L showed increased basal transcription of stress-related genes and global virulence regulators. Phenotypically these transcriptional changes manifest as disturbed osmo-stress responses and toxin-associated hypervirulence as shown by reduced hypoosmotic-stress resistance and enhanced cytotoxicity of the RpoBS522L strain. These results suggest that RpoB-linked rifampicin resistance has a significant impact on V. vulnificus survival in the environment and during infection.
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Affiliation(s)
- Laura Cutugno
- School of Natural SciencesUniversity of GalwayGalwayIreland
| | - Conor O'Byrne
- School of Biological and Chemical SciencesUniversity of GalwayGalwayIreland
| | - Jan Pané‐Farré
- Centre for Synthetic Microbiology (SYNMIKRO) & Department of ChemistryPhilipps‐University MarburgMarburgGermany
| | - Aoife Boyd
- School of Natural SciencesUniversity of GalwayGalwayIreland
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50
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Sampson E. Implementing Digital Cognitive-Behavioral Therapy for Major Depressive Disorder in Routine Psychiatric Appointments: A Pilot Project in a Rural Population. J Psychosoc Nurs Ment Health Serv 2023; 61:44-51. [PMID: 37134285 DOI: 10.3928/02793695-20230424-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Psychotherapy is well-established as an effective treatment for major depressive disorder (MDD). However, many individuals with MDD in rural areas of the United States do not have access to psychotherapy. Self-management (SM) strategies are now the standard of care for chronic medical conditions and may be a viable alternative for individuals without access to psychotherapy. The current article describes the implementation of a 13-week pilot project to integrate digital cognitive-behavioral therapy (dCBT) SM programs into routine psychiatric advanced practice nurse (APN) telehealth appointments in the rural United States. Eight participants completed the project. The project did not meet the benchmark of 20 participants to improve access to treatment; however, one half (n = 4) of participants reported clinically significant improvement in MDD symptoms over 6 weeks. For clients without access to psychotherapy, dCBT SM programs can be effective in improving individual client outcomes when implemented by APNs in routine telehealth appointments. [Journal of Psychosocial Nursing and Mental Health Services, 61(10), 44-51.].
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