A non-endoscopic device to sample the oesophageal microbiota: a case-control study.

BACKGROUND: The strongest risk factor for oesophageal adenocarcinoma is reflux disease, and the rising incidence of this coincides with the eradication of Helicobacter pylori, both of which might alter the oesophageal microbiota. We aimed to profile the microbiota at different stages of Barrett's carcinogenesis and investigate the Cytosponge as a minimally invasive tool for sampling the oesophageal microbiota. METHODS: In this case-control study, 16S rRNA gene amplicon sequencing was done on 210 oesophageal samples from 86 patients representing the Barrett's oesophagus progression sequence (normal squamous controls [n=20], non-dysplastic [n=24] and dysplastic Barrett's oesophagus [n=23], and oesophageal adenocarcinoma [n=19]), relevant negative controls, and replicates on the Illumina MiSeq platform. Samples were taken from patients enrolled in the BEST2 study at five UK hospitals and the OCCAMS study at six UK hospitals. We compared fresh frozen tissue, fresh frozen endoscopic brushings, and the Cytosponge device for microbial DNA yield (qPCR), diversity, and community composition. FINDINGS: There was decreased microbial diversity in oesophageal adenocarcinoma tissue compared with tissue from healthy control patients as measured by the observed operational taxonomic unit (OTU) richness (p=0·0012), Chao estimated total richness (p=0·0004), and Shannon diversity index (p=0·0075). Lactobacillus fermentum was enriched in oesophageal adenocarcinoma (p=0·028), and lactic acid bacteria dominated the microenvironment in seven (47%) of 15 cases of oesophageal adenocarcinoma. Comparison of oesophageal sampling methods showed that the Cytosponge yielded more than ten-times higher quantities of microbial DNA than did endoscopic brushes or biopsies using quantitative PCR (p<0·0001). The Cytosponge samples contained the majority of taxa detected in biopsy and brush samples, but were enriched for genera from the oral cavity and stomach, including Fusobacterium, Megasphaera, Campylobacter, Capnocytophaga, and Dialister. The Cytosponge detected decreased microbial diversity in patients with high-grade dysplasia in comparison to control patients, as measured by the observed OTU richness (p=0·0147), Chao estimated total richness (p=0·023), and Shannon diversity index (p=0·0085). INTERPRETATION: Alterations in microbial communities occur in the lower oesophagus in Barrett's carcinogenesis, which can be detected at the pre-invasive stage of high-grade dysplasia with the novel Cytosponge device. Our findings are potentially applicable to early disease detection, and future test development should focus on longitudinal sampling of the microbiota to monitor for changes in microbial diversity in a larger cohort of patients. FUNDING: Cancer Research UK, National Institute for Health Research, Medical Research Council, Wellcome Trust, The Scottish Government (RESAS).Cancer Research UK, National Institute for Health Research, Medical Research Council, and Wellcome Trust.This is the author accepted manuscript. The final version is available from Elsevier via https://doi.org/10.1016/S2468-1253(16)30086-

Texas STATEMAP Program Summary, FY19 (2019–2020)

Five geologic maps have been completed at a 1:24,000 scale in four project areas with support from STATEMAP and the Bureau of Economic Geology's State of Texas Advanced Resource Recovery program (STARR). Three of these maps were on the Texas Coastal Plain, including one (the Lake Stephenson quadrangle) on the upper Texas Coastal Plain in the Galveston Bay area and two (the Bloomington and Olivia quadrangles) on the middle Texas Coastal Plain in the Matagorda Bay area. These maps continue efforts to: 1. Better understand the evolution of the coastal plain in response to sea-level changes associated with numerous Quaternary glacial and interglacial cycles. 2. Develop more effective methods to map low-relief coastal deposits using high-resolution topographic maps produced from airborne lidar data and near-surface geophysical methods. High-resolution topography and geophysical methods both aid in the identification of stratal units and their distribution in areas where exposures are poor or nonexistent. Mineral-resource mapping produced one map (the Katemcy quadrangle) to extend recent mapping of an industrial sand resource area in central Texas. This map facilitates the development of mineral resources of the state, emphasizing those that will help meet the demand for industrial sand for hydraulic fracturing and construction. The detailed map can be used to evaluate and explore the mineral-resource potential of the area. Mapping in the central Texas urban growth corridor northeast of Austin produced one map (the Taylor quadrangle) that extends previous mapping in this critical urban growth and transportation corridor. This map addresses the ongoing need for planning and managing groundwater, surface water, land use, and construction projects where rapid population growth and suburban development have caused an increased demand for water and earth resources.Bureau of Economic Geolog

Lateral line morphology, sensory perception and collective behaviour in African cichlid fish

The lateral line system of fishes provides cues for collective behaviour, such as shoaling, but it remains unclear how anatomical lateral line variation leads to behavioural differences among species. Here we studied associations between lateral line morphology and collective behaviour using two morphologically divergent species and their second-generation hybrids. We identify collective behaviours associated with variation in canal and superficial lateral line morphology, with closer proximities to neighbouring fish associated with larger canal pore sizes and fewer superficial neuromasts. A mechanistic understanding of the observed associations was provided by hydrodynamic modelling of an artificial lateral line sensor, which showed that simulated canal-based neuromasts were less susceptible to saturation during unidirectional movement than simulated superficial neuromasts, while increasing the canal pore size of the simulated lateral line sensor elevated sensitivity to vortices shed by neighbouring fish. Our results propose a mechanism behind lateral line flow sensing during collective behaviour in fishes

Alternative Markers of Performance in Simulation: Where We Are and Where We Need To Go

This article on alternative markers of performance in simulation is the product of a session held during the 2017 Academic Emergency Medicine Consensus Conference â Catalyzing System Change Through Health Care Simulation: Systems, Competency, and Outcomes.â There is a dearth of research on the use of performance markers other than checklists, holistic ratings, and behaviorally anchored rating scales in the simulation environment. Through literature review, group discussion, and consultation with experts prior to the conference, the working group defined five topics for discussion: 1) establishing a working definition for alternative markers of performance, 2) defining goals for using alternative performance markers, 3) implications for measurement when using alternative markers, identifying practical concerns related to the use of alternative performance markers, and 5) identifying potential for alternative markers of performance to validate simulation scenarios. Five research propositions also emerged and are summarized.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142535/1/acem13321_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142535/2/acem13321.pd

Health related quality of life trajectories and predictors following coronary artery bypass surgery

BACKGROUND: Many studies have demonstrated that health related quality of life (HRQoL) improves, on average, after coronary artery bypass graft surgery (CABGS). However, this average improvement may not be realized for all patients, and it is possible that there are two or more distinctive groups with different, possibly non-linear, trajectories of change over time. Furthermore, little is known about the predictors that are associated with these possible HRQoL trajectories after CABGS. METHODS: 182 patients listed for elective CABGS at The Royal Melbourne Hospital completed a postal battery of questionnaires which included the Short-Form-36 (SF-36), Profile of Mood States (POMS) and the Everyday Functioning Questionnaire (EFQ). These data were collected on average a month before surgery, and at two months and six months after surgery. Socio-demographic and medical characteristics prior to surgery, as well as surgical and post-surgical complications and symptoms were also assessed. Growth curve and growth mixture modelling were used to identify trajectories of HRQoL. RESULTS: For both the physical component summary scale (PCS) and the mental component summary scale (MCS) of the SF-36, two groups of patients with distinct trajectories of HRQoL following surgery could be identified (improvers and non-improvers). A series of logistic regression analyses identified different predictors of group membership for PCS and MCS trajectories. For the PCS the most significant predictors of non-improver membership were lower scores on POMS vigor-activity and higher New York Heart Association dyspnoea class; for the MCS the most significant predictors of non-improver membership were higher scores on POMS depression-dejection and manual occupation. CONCLUSION: It is incorrect to assume that HRQoL will improve in a linear fashion for all patients following CABGS. Nor was there support for a single response trajectory. It is important to identify characteristics of each patient, and those post-operative symptoms that could be possible targets for intervention to improve HRQoL outcomes

Impact of Habitual Water Intake on Muscle Quality and Total Body Water-A Pilot Study

Proper hydration is essential for critical health and performance functions, such as muscle function and body fluid balance. The effect of acute hydration status has been studied on health and muscle performance; however, the effect of habitual water intake on muscle quality and total body water between high and low consumption has not been examined. PURPOSE: To determine the impact of habitual water intake on muscle quality and total body water. METHODS: Eleven women (age: 27.6±7.9 years; mass: 60.3±10.8 kg) provided a five-day dietary food log to categorize them into HIGH or LOW daily total water intake (TWI). TWI values \u3e2.5-3.3 L/day (HIGH) or \u3c 0.7-1.6 L/day (LOW) were used to determine groups. Bioelectrical impedance analysis (BIA) and ultrasound images were obtained to assess overall muscle quality and total body fluid balance between the two groups. Analysis of ultrasound images using ImageJ determined length (cm), cross-sectional area (CSA), and muscle quality through echo intensity (EI) of the participant’s right and left rectus femoris (RF). An independent sample T-Test and effect sizes (ES) were used to assess differences between HIGH and LOW. RESULTS: Due to this study being a pilot study, there was no significant differences in right RF length between LOW (1.44±0.22 cm) and HIGH (1.22±0.24 cm, p=0.153) with a large effect size of (ES=0.98). There were no significant differences in left RF length (p=0.861) between HIGH (1.46±0.28 cm) and LOW (1.42±0.32) groups with a trivial effect size (ES=0.11). Right RF CSA had non-significant differences between LOW (3.72±1.18 cm2) and HIGH (2.95±1.05 cm2, p=0.309) with medium effect (ES=0.68). There were no differences in CSA-left between HIGH (3.63 ± 1.06 cm) and LOW (3.83±1.44, p=0.816, ES=0.15). Right RF muscle quality also had a medium effect size (ES=0.78) between HIGH (135.30±21.82 A.U) and LOW (117.71±23.10 A.U). Muscle quality of the left RF had a small effect size (ES=0.26) between LOW (118.29±22.18 A.U) and HIGH (125.97±39.47 A.U, p=0.684). While there was no statistical difference due to the power (p=0.163), total body water (TBW) percentage (%) was greater in HIGH (53.9±1.5%) compared to LOW (50.6±5.4%, ES= 0.75) with medium effects. HIGH and LOW demonstrated no statistical difference (p=0.579) with a small effect size (ES=0.36) between ECF% and ICF%, respectively (41.00±0.72%, 41.39±1.20%; 59.00±0.72%, 58.61±1.20%). CONCLUSION: Despite no significant differences, based on ES, HIGH habitual water intake increases TBW% than LOW. Further data must be collected to draw definitive conclusions; however, these results suggest skeletal muscle quality is high with LOW habitual water intake

Predicting erythropoietin resistance in hemodialysis patients with type 2 diabetes

&lt;p&gt;Background: Resistance to ESAs (erythropoietin stimulating agents) is highly prevalent in hemodialysis patients with diabetes and associated with an increased mortality. The aim of this study was to identify predictors for ESA resistance and to develop a prediction model for the risk stratification in these patients.&lt;/p&gt; &lt;p&gt;Methods: A post-hoc analysis was conducted of the 4D study, including 1015 patients with type 2 diabetes undergoing hemodialysis. Determinants of ESA resistance were identified by univariate logistic regression analyses. Subsequently, multivariate models were performed with stepwise inclusion of significant predictors from clinical parameters, routine laboratory and specific biomarkers.&lt;/p&gt; &lt;p&gt;Results: In the model restricted to clinical parameters, male sex, shorter dialysis vintage, lower BMI, history of CHF, use of ACE-inhibitors and a higher heart rate were identified as independent predictors of ESA resistance. In regard to routine laboratory markers, lower albumin, lower iron saturation, higher creatinine and higher potassium levels were independently associated with ESA resistance. With respect to specific biomarkers, higher ADMA and CRP levels as well as lower Osteocalcin levels were predictors of ESA resistance.&lt;/p&gt; &lt;p&gt;Conclusions: Easily obtainable clinical parameters and routine laboratory parameters can predict ESA resistance in diabetic hemodialysis patients with good discrimination. Specific biomarkers did not meaningfully further improve the risk prediction of ESA resistance. Routinely assessed data can be used in clinical practice to stratify patients according to the risk of ESA resistance, which may help to assign appropriate treatment strategies.&lt;/p&gt

Use of a pressure sensing sheath: comparison with standard means of blood pressure monitoring in catheterization procedures

PURPOSE: Monitoring of blood pressure (BP) during procedures is variable, depending on multiple factors. Common methods include sphygmomanometer (BP cuff), separate radial artery catheterization, and side port monitoring of an indwelling sheath. Each means of monitoring has disadvantages, including time consumption, added risk, and signal dampening due to multiple factors. We sought an alternative approach to monitoring during procedures in the catheterization laboratory. METHODS: A new technology involving a 330 microm fiberoptic sensor embedded in the wall of a sheath structure was tested against both radial artery catheter and sphygmomanometer readings obtained simultaneous with readings recorded from the pressure sensing system (PSS). Correlations and Bland-Altman analysis were used to determine whether use of the PSS could substitute for these standard techniques. RESULTS: The results indicated highly significant correlations in systolic, diastolic, and mean arterial pressures (MAP) when compared against radial artery catheterization (p \u3c 0.0001), and MAP means differed by \u3c 4%. Bland-Altman analysis of the data suggested that the sheath measurements can replace a separate radial artery catheter. While less striking, significant correlations were seen when PSS readings were compared against BP cuff readings. CONCLUSIONS: The PSS has competitive functionality to that seen with a dedicated radial artery catheter for BP monitoring and is available immediately on sheath insertion without the added risk of radial catheterization. The sensor is structurally separated from the primary sheath lumen and readings are unaffected by device introduction through the primary lumen. Time delays and potential complications from radial artery catheterization are avoided

Optimising recruitment to the HAND-1 RCT feasibility study:integration 1 of the QuinteT Recruitment Intervention (QRI)

© 2020, The Author(s). Background: Recruitment to randomised controlled trials (RCTs) can be challenging, with most trials not reaching recruitment targets. Randomised feasibility studies can be set up prior to a main trial to identify and overcome recruitment obstacles. This paper reports on an intervention—the QuinteT Recruitment Intervention (QRI)—to optimise recruitment within a randomised feasibility study of surgical treatments for patients with Dupuytren’s contracture (the HAND-1 study). Methods: The QRI was introduced in 2-phases: phase 1 sought to understand the recruitment challenges by interviewing trial staff, scrutinising screening logs and analysing audio-recorded patient consultations; in phase 2 a tailored plan of action consisting of recruiter feedback and training was delivered to address the identified challenges. Results: Two key recruitment obstacles emerged: (1) issues with the recruitment pathway, in particular methods to identify potentially eligible patients and (2) equipoise of recruiters and patients. These were addressed by liaising with centres to share good practice and refine their pathway and by providing bespoke feedback and training on consent discussions to individual recruiters and centres whilst recruitment was ongoing. The HAND-1 study subsequently achieved its recruitment target. Conclusions: Transferable lessons learnt from the QRI in the feasibility study will be implemented in the definitive RCT, enabling a “head start” in the tackling of wider issues around screening methods and consent discussions in the set up/early recruitment study phases, with ongoing QRI addressing specific issues with new centres and recruiters. Findings from this study are likely to be relevant to other surgical and similar trials that are anticipated to encounter issues around patient and recruiter equipoise of treatments and variation in recruitment pathways across centres. The study also highlights the value of feasibility studies in fine-tuning design and conduct issues for definitive RCTs. Embedding a QRI in an RCT, at feasibility or main stage, offers an opportunity for a detailed and nuanced understanding of key recruitment challenges and the chance to address them in “real-time” as recruitment proceeds

Advanced EFL learners' beliefs about language learning and teaching: a comparison between grammar, pronunciation, and vocabulary

This paper reports on the results of a study exploring learners’ beliefs on the learning and teaching of English grammar, pronunciation and vocabulary at tertiary level. While the importance of learners’ beliefs on the acquisition process is generally recognized, few studies have focussed on and compared learners’ views on different components of the language system. A questionnaire containing semantic scale and Likert scale items probing learners’ views on grammar, pronunciation and vocabulary was designed and completed by 117 native speakers of Dutch in Flanders, who were studying English at university. The analysis of the responses revealed that (i) vocabulary was considered to be different from grammar and pronunciation, both in the extent to which an incorrect use could lead to communication breakdown and with respect to the learners’ language learning strategies, (ii) learners believed in the feasibility of achieving a native-like proficiency in all three components, and (iii) in-class grammar, pronunciation and vocabulary exercises were considered to be useful, even at tertiary level. The results are discussed in light of pedagogical approaches to language teaching