Comparability of (post-concussion) symptoms across time in individuals after traumatic brain injury: results from the CENTER-TBI study

Post-concussion symptoms often occur after TBI, persist and cause disabilities. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) is widely used in this population, but little is known about the comparability of the symptoms over time, i.e., longitudinal measurement invariance (MI). The objectives of this study were to analyze the longitudinal MI of RPQ symptoms from three to twelve months after TBI and to find factors related to RPQ symptoms. The study involved 1023 individuals after TBI who took part in the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study and completed the RPQ at three, six and twelve months postinjury. Longitudinal confirmatory factor analysis showed that the three-factor structure (somatic, emotional and cognitive) remains stable within one year after TBI. Linear mixed models revealed that sex, injury cause and prior psychiatric problems were related to the RPQ three-factor structure as well as to the RPQ total score. The study strengthens evidence for the RPQ’s factorial structure stability within one year after TBI and identifies sex, injury cause and prior psychiatric problems as important factors that may help clinicians to prevent future complications of symptomatology after TBI.CENTER-TBI was supported by the European Union 7th Framework program (EC grant 602150). Additional funding was obtained from the Hannelore Kohl Stiftung (Germany), from OneMind (USA) and from Integra LifeSciences Corporation (USA). The funders of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report

Health-related Quality of Life 12 months after severe traumatic brain injury: A prospective nationwide cohort study

OBJECTIVE: To assess health-related quality of life in individuals with severe traumatic brain injury at 12 months post-injury, applying the Quality of Life after Brain Injury (QOLIBRI) instrument, and to study the relationship between injury-related factors, post-injury functioning and health-related quality of life. Design/subjects: The study is part of a prospective, Norwegian multicentre study of adults (≥ 16 years old) with severe traumatic brain injury, as defined by a Glasgow Coma Scale score of 3–8 during the first 24 h post-injury. A total of 126 patients were included. METHODS: Socio-demographic data and injury severity variables were collected. Functioning at 3 and 12 months was assessed with the Glasgow Outcome Scale Extended (GOSE), the Functional Independence Measure (FIM), the Rivermead Post-concussion Questionnaire (RPQ), and the Hospital Anxiety and Depression Scale (HADS). Hierarchical regression analysis was applied. RESULTS: Mean QOLIBRI score was 68.5 (standard deviation = 18.8). Predictors of the QOLIBRI in the final regression model were: employment status (p = 0.05), GOSE (p = 0.05), RPQ (p < 0.001) and HADS (p < 0.001). The adjusted R2 showed that the model explained 64.0% of the variance in the QOLIBRI score. CONCLUSION: Symptom pressure and global functioning in the sub-acute phase of traumatic brain injury and psychological distress in the post-acute phase are important for health-related quality of life at 12 months post-injury. These domains should be the focus in rehabilitation aiming to improve health-related quality of life in patients with severe traumatic brain injury

Tributa ya

En la actualidad las empresas están en constante crecimiento y necesitan del apoyo de herramientas tecnológicas para actualizarse y seguir vigentes en el mercado. Al respecto, hemos identificado que el proceso de declaración de impuestos es la columna vertebral de casi todas las empresas formales y constituidas, las cuales están obligadas a esta clase de tributación y muchas de ellas son las microempresas que no cuentan con mucha experiencia, por ello surge la necesidad de poder realizar esta delegación a un personal capacitado. Sin embargo, en su gran mayoría esto no suele suceder, ya que no se contrata a este tipo de personal por falta de tiempo o dinero. Para solucionar esta problemática, se creó Tributa.Ya, un aplicativo móvil que ayudará a los microempresarios a declarar y pagar impuestos de una manera rápida y sencilla. Además, Tributa.Ya te brinda las opciones de cronogramas de pagos y asesorías con el propósito de hacer crecer los emprendimientos. Al culminar el periodo operacional de Tributa.Ya Va ser rentable, ya que, en base a los indicadores analizados como el VAN, TIR y PRD, se sabe que el valor actual neto es de S/. 419,649, el periodo de recupero de la inversión de tres años y una tasa interna de retorno de 146%. En base a estos indicadores nos permiten afirmar que nuestro proyecto es viable y dará una alta rentabilidad a los inversionistas, por lo que concluimos que va ser recomendable invertir en Tributa.Ya.Currently, companies are constantly growing and need the support of technological tools to update themselves and remain current in the market. In this regard, we have identified that the tax filing process is the backbone of almost all formal and incorporated companies, which are obliged to this type of taxation and many of them are micro-companies that do not have much experience, therefore The need arises to be able to carry out this delegation to a trained staff. However, for the most part this does not usually happen, since this type of staff is not hired due to lack of time or money. To solve this problem, Tributa.Ya was created, a mobile application that will help micro entrepreneurs to declare and pay taxes quickly and easily. In addition, Tributa.Ya already offers you the options of payment schedules and consultancies with the purpose of making businesses grow. At the end of Tributa.Ya operational period, it will already be profitable, since, based on the indicators analyzed such as the NPV, IRR and PRD, it is known that the net present value is S/ 437,921.06. the payback period of the investment of two years and an internal rate of return of 131.22%. Based on these indicators, they allow us to affirm that our project is viable and will give investors a high return, so we conclude that it will be advisable to invest in Tributa.Ya.Trabajo de investigació

A 2 R_⊕ Planet Orbiting the Bright Nearby K Dwarf Wolf 503

Since its launch in 2009, the Kepler telescope has found thousands of planets with radii between that of Earth and Neptune. Recent studies of the distribution of these planets have revealed a gap in the population near 1.5–2.0 R⊕, informally dividing these planets into "super-Earths" and "sub-Neptunes." The origin of this division is difficult to investigate directly because the majority of planets found by Kepler orbit distant, dim stars and are not amenable to radial velocity follow-up or transit spectroscopy, making bulk density and atmospheric measurements difficult. Here, we present the discovery and validation of a newly found 2.03^(+0.08)_(-0.07) R⊕ planet in direct proximity to the radius gap, orbiting the bright (J = 8.32 mag), nearby (D = 44.5 pc) high proper motion K3.5V star Wolf 503 (EPIC 212779563). We determine the possibility of a companion star and false positive detection to be extremely low using both archival images and high-contrast adaptive optics images from the Palomar observatory. The brightness of the host star makes Wolf 503b a prime target for prompt radial velocity follow-up, and with the small stellar radius (0.690 ± 0.025R⊙), it is also an excellent target for HST transit spectroscopy and detailed atmospheric characterization with JWST. With its measured radius near the gap in the planet radius and occurrence rate distribution, Wolf 503b offers a key opportunity to better understand the origin of this radius gap as well as the nature of the intriguing populations of "super-Earths" and "sub-Neptunes" as a whole

A 2 Earth Radius Planet Orbiting the Bright Nearby K-Dwarf Wolf 503

Since its launch in 2009, the Kepler telescope has found thousands of planets with radii between that of Earth and Neptune. Recent studies of the distribution of these planets have revealed a rift in the population near 1.5-2.0$R_{\bigoplus}$, informally dividing these planets into "super-Earths" and "sub-Neptunes". The origin of this division is not well understood, largely because the majority of planets found by Kepler orbit distant, dim stars and are not amenable to radial velocity follow-up or transit spectroscopy, making bulk density and atmospheric measurements difficult. Here, we present the discovery and validation of a newly found $2.03^{+0.08}_{-0.07}~R_{\bigoplus}$ planet in direct proximity to the radius gap, orbiting the bright ($J=8.32$~mag), nearby ($D=44.5$~pc) high proper motion star Wolf 503 (EPIC 212779563). We classify Wolf 503 as a K3.5V star and member of the thick disc population. We determine the possibility of a companion star and false positive detection to be extremely low using both archival images and high-contrast adaptive optics images from the Palomar observatory. The brightness of the host star makes Wolf 503b a prime target for prompt radial velocity follow-up, HST transit spectroscopy, as well as detailed atmospheric characterization with JWST. With its measured radius near the gap in the planet radius and occurrence rate distribution, Wolf 503b offers a key opportunity to better understand the origin of this radius gap as well as the nature of the intriguing populations of "super-Earths" and "sub-Neptunes" as a whole

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Rehabilitation and outcomes after complicated vs uncomplicated mild TBI:results from the CENTER-TBI study

Background: Despite existing guidelines for managing mild traumatic brain injury (mTBI), evidence-based treatments are still scarce and large-scale studies on the provision and impact of specific rehabilitation services are needed. This study aimed to describe the provision of rehabilitation to patients after complicated and uncomplicated mTBI and investigate factors associated with functional outcome, symptom burden, and TBI-specific health-related quality of life (HRQOL) up to six months after injury. Methods: Patients (n = 1379) with mTBI from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study who reported whether they received rehabilitation services during the first six months post-injury and who participated in outcome assessments were included. Functional outcome was measured with the Glasgow Outcome Scale – Extended (GOSE), symptom burden with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and HRQOL with the Quality of Life after Brain Injury – Overall Scale (QOLIBRI-OS). We examined whether transition of care (TOC) pathways, receiving rehabilitation services, sociodemographic (incl. geographic), premorbid, and injury-related factors were associated with outcomes using regression models. For easy comparison, we estimated ordinal regression models for all outcomes where the scores were classified based on quantiles. Results: Overall, 43% of patients with complicated and 20% with uncomplicated mTBI reported receiving rehabilitation services, primarily in physical and cognitive domains. Patients with complicated mTBI had lower functional level, higher symptom burden, and lower HRQOL compared to uncomplicated mTBI. Rehabilitation services at three or six months and a higher number of TOC were associated with unfavorable outcomes in all models, in addition to pre-morbid psychiatric problems. Being male and having more than 13 years of education was associated with more favorable outcomes. Sustaining major trauma was associated with unfavorable GOSE outcome, whereas living in Southern and Eastern European regions was associated with lower HRQOL. Conclusions: Patients with complicated mTBI reported more unfavorable outcomes and received rehabilitation services more frequently. Receiving rehabilitation services and higher number of care transitions were indicators of injury severity and associated with unfavorable outcomes. The findings should be interpreted carefully and validated in future studies as we applied a novel analytic approach. Trial registration: ClinicalTrials.gov NCT02210221.</p

Cancer therapy shapes the fitness landscape of clonal hematopoiesis.

Acquired mutations are pervasive across normal tissues. However, understanding of the processes that drive transformation of certain clones to cancer is limited. Here we study this phenomenon in the context of clonal hematopoiesis (CH) and the development of therapy-related myeloid neoplasms (tMNs). We find that mutations are selected differentially based on exposures. Mutations in ASXL1 are enriched in current or former smokers, whereas cancer therapy with radiation, platinum and topoisomerase II inhibitors preferentially selects for mutations in DNA damage response genes (TP53, PPM1D, CHEK2). Sequential sampling provides definitive evidence that DNA damage response clones outcompete other clones when exposed to certain therapies. Among cases in which CH was previously detected, the CH mutation was present at tMN diagnosis. We identify the molecular characteristics of CH that increase risk of tMN. The increasing implementation of clinical sequencing at diagnosis provides an opportunity to identify patients at risk of tMN for prevention strategies

Shorter courses of parenteral antibiotic therapy do not appear to influence response rates for children with acute hematogenous osteomyelitis: a systematic review

BACKGROUND: Acute hematogenous osteomyelitis (AHO) occurs primarily in children and is believed to evolve from bacteremia followed by localization of infection to the metaphysis of bones. Currently, there is no consensus on the route and duration of antimicrobial therapy to treat AHO. METHODS: We conducted a systematic review of a short versus long course of treatment for AHO due primarily to Staphylococcus aureus in children aged 3 months to 16 years. We searched Medline, Embase and the Cochrane trials registry for controlled trials. Clinical cure rate at 6 months was the primary outcome variable, and groups receiving less than 7 days of intravenous therapy were compared with groups receiving one week or longer of intravenous antimicrobials. RESULTS: 12 eligible prospective studies, one of which was randomized, were identified. The overall cure rate at 6 months for the short course of intravenous therapy was 95.2% (95% CI = 90.4, 97.7) compared to 98.8% (95% CI = 93.6, 99.8) for the longer course of therapy. There was no significant difference in the duration of oral therapy between the two groups. CONCLUSIONS: Given the potential increased morbidity and cost associated with longer courses of intravenous therapy, this finding should be confirmed through a randomized controlled equivalence trial

Cancer therapy shapes the fitness landscape of clonal hematopoiesis.

Acquired mutations are pervasive across normal tissues. However, understanding of the processes that drive transformation of certain clones to cancer is limited. Here we study this phenomenon in the context of clonal hematopoiesis (CH) and the development of therapy-related myeloid neoplasms (tMNs). We find that mutations are selected differentially based on exposures. Mutations in ASXL1 are enriched in current or former smokers, whereas cancer therapy with radiation, platinum and topoisomerase II inhibitors preferentially selects for mutations in DNA damage response genes (TP53, PPM1D, CHEK2). Sequential sampling provides definitive evidence that DNA damage response clones outcompete other clones when exposed to certain therapies. Among cases in which CH was previously detected, the CH mutation was present at tMN diagnosis. We identify the molecular characteristics of CH that increase risk of tMN. The increasing implementation of clinical sequencing at diagnosis provides an opportunity to identify patients at risk of tMN for prevention strategies