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Lessons learned from the development and implementation of a shared decision making process for severe stroke using a digital communication platform
Get PDFClinical decisions made immediately post-stroke can determine survival outcomes and disability. This study aimed to develop, implement, and evaluate a shared decision-making (SDM) process for severe stroke that incorporates a digital communication platform (Tailored Talks) within a 36-bed stroke unit. Using a coproduction approach, we introduced Tailored Talks to facilitate information sharing and assessed its impact on 6-month mortality, discharge to institutional care, and tube-feeding. Additionally, we explored perspectives of patients, families, and staff regarding SDM. Of 1020 patient with stroke, eight received Tailored Talks (4 before and 4 after implementation), with no observed changes in clinical outcomes. Staff interviews identified insufficient time, lack of a personal touch, and inadequate leadership as barriers to implementation. Workforce shortages and technological limitations hindered the integration of SDM into routine stroke care. Addressing these challenges is crucial to enhancing SDM for patients with severe stroke.<br/
"The Prophet said so!":On exploring Hadith presence on Arabic social media
Get PDFHadith, the recorded words and actions of the prophet Muhammad, is a key source of the instructions and foundations of Islam, alongside the Quran. Interpreting individual hadiths and verifying their authenticity can be difficult, even controversial, and the subject has attracted the attention of many scholars who have established an entire science of Hadith criticism. Recent quantitative studies of hadiths focus on developing systems for automatic classification, authentication, and information retrieval that operate over existing hadith compilations. Qualitative studies on the other hand try to discuss different social and political issues from the perspective of hadiths, or they inspect how hadiths are used in specific contexts in official communications and press releases for argumentation and propaganda. However, there are no studies that attempt to understand the actual presence of hadiths among Muslims in their daily lives and interactions. In this study, we try to fill this gap by exploring the presence of hadiths on Twitter from January 2019 to January 2023. We highlight the challenges that quantitative methods should consider while processing texts that include hadiths and we provide a methodology for Islamic scholars to validate their hypotheses about hadiths on big data that better represent the position of the society and Hadith influence on it
Time to start taking time seriously: How to investigate unexpected biological rhythms within infectious disease research
Get PDFThe discovery of rhythmicity in host and pathogen activities dates back to the Hippocratic era, but the causes and consequences of these biological rhythms have remained poorly understood. Rhythms in infection phenotypes or traits are observed across taxonomically diverse hosts and pathogens, suggesting general evolutionary principles. Understanding these principles may enable rhythms to be leveraged in manners that improve drug and vaccine efficacy or disrupt pathogen timekeeping to reduce virulence and transmission. Explaining and exploiting rhythms in infections requires an integrative and multidisciplinary approach, which is a hallmark of research within chronobiology. Many researchers are welcomed into chronobiology from other fields after observing an unexpected rhythm or time-of-day effect in their data. Such findings can launch a rich new research topic, but engaging with the concepts, approaches, and dogma, in a new discipline can be daunting. Fortunately, chronobiology has well-developed frameworks for interrogating rhythms that can be readily applied in novel contexts. Here, we provide a “how to” guide for exploring unexpected daily rhythms in infectious disease research. We outline how to establish: if the rhythm is circadian, to what extent the host and pathogen are responsible, the relevance for host-pathogen interactions, and how to explore therapeutic potential
Antimicrobial resistance profiles and molecular epidemiology of Klebsiella pneumoniae isolates from Scottish bovine mastitis cases
Get PDFKlebsiella pneumoniae are opportunistic pathogens which can cause mastitis in dairy cattle. K. pneumoniae mastitis often has a poor cure rate and can lead to the development of chronic infection, which has an impact on both health and production. However, there are few studies which aim to fully characterize K. pneumoniae by whole-genome sequencing from bovine mastitis cases. Here, K. pneumoniae isolates associated with mastitis in dairy cattle were identified using matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS) and whole-genome sequencing. Furthermore, whole-genome sequence data were used for phylogenetic analyses and both virulence and antimicrobial resistance (AMR) prediction, in parallel with phenotypic AMR testing. Forty-two isolates identified as K. pneumoniae were subject to whole-genome sequencing, with 31 multi-locus sequence types being observed, suggesting the source of these isolates was likely environmental. Isolates were examined for key virulence determinants encoding acquired siderophores, colibactin, and hypermucoidy. The majority of these were absent, except for ybST (encoding yersiniabactin) which was present in six isolates. Across the dataset, there were notable levels of phenotypic AMR against streptomycin (26.2%) and tetracycline (19%), and intermediate susceptibility to cephalexin (26.2%) and neomycin (21.4%). Of importance was the detection of two ESBL-producing isolates, which demonstrated multi-drug resistance to amoxicillin-clavulanic acid, streptomycin, tetracycline, cefotaxime, cephalexin, and cefquinome.</p
What does it mean to conduct ethical research after disasters? A case study of the 3.11 disaster
Get PDFThe 3.11 disaster in Fukushima Prefecture, Japan, is a useful case study through which to interrogate research ethics. This region has been the site of a high degree of research interest, which sometimes presented a source of stress to local communities. This study examines researcher perspectives on the ethics of post-disaster health research. Qualitative interviews were conducted with these informants, who noted that recovering communities experienced significant over-research, particularly in the form of survey fatigue, which was seen to influence viewpoints concerning both recovery and agency. Efforts to integrate better into community needs reoriented reflexive research towards ‘post-normal’ forms of working. Simultaneously, researchers had to navigate funding and reward structures that prioritised the swift production of results. Focusing on community engagement and feedback, and managing this ethical complexity, were seen as essential forms of ethical practice to mitigate the negative impacts that the influx of research activity can have on a recovering community
Competitiveness versus competition? The Draghi Report and a new vision for competition policy in Europe
Get PDFTracking Persistent Symptoms in Scotland (TraPSS):A longitudinal prospective cohort study of COVID-19 recovery after mild acute infection
Get PDFBackground COVID-19 disease results in disparate responses between individuals and has led to the emergence of long coronavirus disease (Long-COVID), characterised by persistent and cyclical symptomology. To understand the complexity of Long-COVID, the importance of symptom surveillance and prospective longitudinal studies is evident.Methods A 9-month longitudinal prospective cohort study was conducted within Scotland (n=287), using a mobile app to determine the proportion of recovered individuals and those with persistent symptoms and common symptoms, and associations with gender and age.Results 3.1% of participants experienced symptoms at month 9, meeting the criteria for Long-COVID, as defined by the National Institute for Health and Care Excellence terminology. The random effects model revealed a significant time (month) effect for infection recovery (p<0.001, estimate=0.07). Fatigue, cough and muscle pain were the most common symptoms at baseline, with fatigue persisting the longest, while symptoms like cough improved rapidly. Older age increased the likelihood of reporting pain (p=0.028, estimate=0.07) and cognitive impairment (p<0.001, estimate=0.93). Female gender increased the likelihood of headaches (p=0.024, estimate=0.53) and post-exertional malaise (PEM) frequency (p=0.05, estimate=137.68), and increased time x gender effect for PEM frequency (p=0.033, estimate=18.96).Conclusions The majority of people fully recover from acute COVID-19, although often slowly. Age and gender play a role in symptom burden and recovery rates, emphasising the need for tailored approaches to Long-COVID management. Further analysis is required to determine the characteristics of the individuals still reporting ongoing symptoms months after initial infection to identify risk factors and potential predictors for the development of Long-COVID
Bacteria encode post-mortem protein catabolism that enables altruistic nutrient recycling
Get PDFBacterial death is critical in nutrient recycling. However, the underlying mechanisms that permit macromolecule recycling after bacterial death are largely unknown. We demonstrate that bacteria encode post-mortem protein catabolism via Lon protease released from the dead bacteria. Growth assays reveal that the lysate of Lon protease-null bacteria does not provide a growth benefit to wild type cells. This deficiency is reversed with exogenous recombinant Lon protease, confirming its post-mortem role and is independent of Lon ATPase activity. Biochemistry, growth assays and metabolomics demonstrate that Lon protease facilitates peptide nutrient release, benefitting living cells and acting as a cooperative public good. We also show that the production of Lon protease cannot be explained by a personal benefit to living cells. Although Lon protease can also provide a benefit to living cells under stressful conditions by helping control protein quality, this private benefit does not outweigh the cost under the conditions examined. These results suggest that Lon protease represents a post-mortem adaptation that can potentially be explained by considering the post-mortem indirect benefit to other cells (kin selection). This discovery highlights an unexpected post-mortem biochemistry, reshaping our understanding of nutrient recycling.</p
Systematic review and meta-analysis of the pelvic organ prolapse and vaginal prolapse among the global population
Get PDFBackground: Pelvic organ prolapse (POP) occurs when one or more pelvic organs (uterus, bowel, bladder or top of the vagina) descend from their normal position and bulge into the vagina. Symptoms include pelvic discomfort, fullness, and changes in bladder or bowel function. Treatment ranges from conservative approaches to surgery, depending on symptom severity. Surgical methods include vaginal wall repair, with or without hysterectomy, or via laparoscopic, robotic or open techniques. Common complications include bleeding, infection, and urinary or bowel dysfunction. Methods: A systematic review was conducted, and a protocol was registered with PROSPERO (CRD42022346051). Publications from 30 April 1980 to 30 April 2023 were retrieved from multiple databases. Data were analysed using random-effects and common-effects models with subgroup and sensitivity analyses. Findings: Forty-four studies met the inclusion criteria, with 29 studies used for meta-analysis of vaginal prolapse surgery outcomes. Sixteen studies focused on patients who had undergone hysterectomy alongside prolapse repair. Interpretation: Patients who underwent vaginal prolapse surgery with hysterectomy experienced higher operative and postoperative complication rates than those without hysterectomy. Increased risks included hospital readmission, POP recurrence and re-operation. The review highlighted a lack of diversity in terms of ethnicity, age and comorbidity status, which are essential to fully understanding the impact of POP. Future research should focus on these underrepresented factors.</p
Extended pharmacological thromboprophylaxis and post-discharge clinically relevant venous thromboembolism after major abdominal and pelvic surgery: an international, prospective, propensity score-weighted cohort study
Get PDFBACKGROUND: There is low-certainty evidence on the impact of extended pharmacological prophylaxis on venous thromboembolism-associated morbidity and mortality. The aim of this study was to determine the efficacy and safety of extended prophylaxis after major abdominopelvic surgery for the prevention of clinically relevant venous thromboembolism after hospital discharge.METHODS: CArdiovaSCulAr outcomes after major abDominal surgEry (CASCADE) was a prospective, international, cohort study into which consecutive adult patients undergoing major abdominopelvic surgery were enrolled (January-May 2022). Extended prophylaxis was considered at least 28 days of anticoagulant prescription after surgery. The primary efficacy outcome was clinically relevant venous thromboembolism and the primary safety outcome was clinically relevant bleeding within 30 days after surgery (European Medicines Agency definitions). The independent association of these outcomes with extended prophylaxis was explored using mixed-effects logistic regression and propensity score weighting.RESULTS: A total of 11 571 patients (median age of 58.0 years; 6399 (55.3%) women) from 29 countries were included. The extended prophylaxis prescription rate was 31.7% (3670 patients). The post-discharge venous thromboembolism and bleeding rates were 0.1% (12 patients) and 0.7% (85 patients) respectively. After weighting, extended prophylaxis was not significantly associated with increased bleeding risk (OR 1.07 (95% c.i. 0.64 to 1.81); P = 0.792) or decreased venous thromboembolism incidence, both in the overall cohort (OR 1.13 (95% c.i. 0.33 to 3.90); P = 0.848) and in a subgroup analysis of patients undergoing complex major surgery and with active cancer (OR: 1.36 (95% c.i. 0.33 to 5.57); P = 0.669).CONCLUSION: In modern practice, the incidence of postoperative venous thromboembolism is low. Extended prophylaxis appears safe, yet the clinical efficacy remains uncertain. Further work is required to define patients who stand to benefit.</p
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