Towards the construction of an educational model for dual career parenting:the EMPATIA project

The European Union supports innovative transnational cooperation and practices between Member States on relevant issues in the field of sports, including a balanced combination of higher education and sporting careers of talented and elite athletes (dual career). Ten European academic and sport institutions aimed to construct an educational programme for parents supporting the dual career of their elite athletes. The innovative methodological approach to the co-construction of a parent education based on evidence and eminence of the actual needs of parents in relation to the age, sex, sport typology, competition and academic levels of student-athletes is described. Finally, the potentially far-reaching effects of digital technologies on adult learning and the innovative aspects of a multi-lingual and demand-driven dual career parenting education are envisaged.</p

Feature Selection To Facilitate Surgical Planning From MRI Of Placenta Accreta Spectrum Disorder

Feature Selection Models provide a ranking of pathological MRI markers able to predict the outcome of Placenta Accreta Spectrum Disorder, which could be used to aid in clinical decision-making and improve maternal outcome. The potential being to reduce the workload of radiologists by establishing the most clinically relevant pathological MRI markers that predict outcome. Our results found three pathological markers to have the highest ranking to the outcomes with an average accuracy of 75% using a Random Forest Selection Model and Boruta algorithm

Use of Super Resolution Reconstruction MRI for surgical planning in Placenta Accreta Spectrum Disorder: Case Series

INTRODUCTION: Comprehensive imaging using ultrasound and MRI of placenta accreta spectrum (PAS) aims to prevent catastrophic haemorrhage and maternal death. Standard MRI of the placenta is limited by between-slice motion which can be mitigated by super-resolution reconstruction (SRR) MRI. We applied SRR in suspected PAS cases to determine its ability to enhance anatomical placental assessment and predict adverse maternal outcome. METHODS: Suspected PAS patients (n = 22) underwent MRI at a gestational age (weeks + days) of (32+3±3+2, range (27+1-38+6)). SRR of the placental-myometrial-bladder interface involving rigid motion correction of acquired MRI slices combined with robust outlier detection to reconstruct an isotropic high-resolution volume, was achieved in twelve. 2D MRI or SRR images alone, and paired data were assessed by four radiologists in three review rounds. All radiologists were blinded to results of the ultrasound, original MR image reports, case outcomes, and PAS diagnosis. A Random Forest Classification model was used to highlight the most predictive pathological MRI markers for major obstetric haemorrhage (MOH), bladder adherence (BA), and placental attachment depth (PAD). RESULTS: At delivery, four patients had placenta praevia with no abnormal attachment, two were clinically diagnosed with PAS, and six had histopathological PAS confirmation. Pathological MRI markers (T2-dark intraplacental bands, and loss of retroplacental T2-hypointense line) predicting MOH were more visible using SRR imaging (accuracy 0.73), in comparison to 2D MRI or paired imaging. Bladder wall interruption, predicting BA, was only easily detected by paired imaging (accuracy 0.72). Better detection of certain pathological markers predicting PAD was found using 2D MRI (placental bulge and myometrial thinning (accuracy 0.81)), and SRR (loss of retroplacental T2-hypointense line (accuracy 0.82)). DISCUSSION: The addition of SRR to 2D MRI potentially improved anatomical assessment of certain pathological MRI markers of abnormal placentation that predict maternal morbidity which may benefit surgical planning

HER2-enriched subtype and novel molecular subgroups drive aromatase inhibitor resistance and an increased risk of relapse in early ER+/HER2+ breast cancer

BACKGROUND: Oestrogen receptor positive/ human epidermal growth factor receptor positive (ER+/HER2+) breast cancers (BCs) are less responsive to endocrine therapy than ER+/HER2- tumours. Mechanisms underpinning the differential behaviour of ER+HER2+ tumours are poorly characterised. Our aim was to identify biomarkers of response to 2 weeks’ presurgical AI treatment in ER+/HER2+ BCs. METHODS: All available ER+/HER2+ BC baseline tumours (n=342) in the POETIC trial were gene expression profiled using BC360™ (NanoString) covering intrinsic subtypes and 46 key biological signatures. Early response to AI was assessed by changes in Ki67 expression and residual Ki67 at 2 weeks (Ki672wk). Time-To-Recurrence (TTR) was estimated using Kaplan-Meier methods and Cox models adjusted for standard clinicopathological variables. New molecular subgroups (MS) were identified using consensus clustering. FINDINGS: HER2-enriched (HER2-E) subtype BCs (44.7% of the total) showed poorer Ki67 response and higher Ki672wk (p<0.0001) than non-HER2-E BCs. High expression of ERBB2 expression, homologous recombination deficiency (HRD) and TP53 mutational score were associated with poor response and immune-related signatures with High Ki672wk. Five new MS that were associated with differential response to AI were identified. HER2-E had significantly poorer TTR compared to Luminal BCs (HR 2.55, 95% CI 1.14–5.69; p=0.0222). The new MS were independent predictors of TTR, adding significant value beyond intrinsic subtypes. INTERPRETATION: Our results show HER2-E as a standardised biomarker associated with poor response to AI and worse outcome in ER+/HER2+. HRD, TP53 mutational score and immune-tumour tolerance are predictive biomarkers for poor response to AI. Lastly, novel MS identify additional non-HER2-E tumours not responding to AI with an increased risk of relapse

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Development of an online multilingual educational programme for parents of dual-career athletes: A participatory design

There is a need for educational support structures to empower parents in sustaining talented athletes pursuing academic and sports careers (e. g., dual career). The present work describes the participatory design used to develop a series of educational resources and the subsequent iterations used to evaluate the content of the EMPATIA online education programme for parents of dual-career athletes. Following an ethnographic approach, the project team (18 dual-career experts) engaged in four iterations (i.e., rounds) planned to develop (rounds 1 and 2) educational material from preliminary evidence (systematic literature review) and eminence (focus groups and concept mapping) knowledge and to evaluate the educational programme (round 3 and 4) engaging end users (n = 76) and other stakeholders (9 dual-career experts). The EMPATIA programme was developed and organized in four modules labeled after macro-aspects, parents could ask about dual career: “Why” (the definition and challenges of dual career for athletes and their parents), “What” (insights, guidelines, and suggestions on the parental role in support of student-athletes), “How” (practical advice on planning dual career at sports and academic levels, and post-sports careers), and “Where” (finding legal information or counseling on dual career). Despite overall positive evaluations of the programme, parents of dual-career athletes attributed higher scores with respect to those of dual-career experts. The participatory approach presented in this work enables developers to apply a systematic and multidisciplinary approach toward the creation of educational programmes for parents. The cooperation among dual-career researchers, experts from high-performance centers, Olympic bodies, sports clubs, and parents of elite student-athletes of different sports and nationalities created an educational programme suitable for end users to support parenting athletes in combining their sports and academic careers.</p

Parents about parenting dual career athletes: A systematic literature review.

Objectives: To establish the scientific literature on the parents’ view as supporters of dual career (DC) athletes, and to highlight practical implications for the development of education programmes to empower parents in this role. Method: ology: The systematic literature review included four electronic databases, from which 438 articles published in English between 1999 and 2019 were retrieved. Results: A total of 14 studies achieved the eligibility criteria (i.e., focus on DC, involving parents as participants) for inclusion. Results show that the 14 studies included in the review were characterised by sample sizes 50 parents of individual and/or team sports athletes, involving data collection based on interviews, semi structured interviews focus groups, questionnaires and a survey. A thematic synthesis highlighted a two primary constructs: the individual level and the inter-individual level, respectively. The individual level comprised two main themes: Approach to both Sport and Education, and Stressors and Coping, which included five aspects of parenting. The inter-individual level presented three themes: Relationship with the Athlete; Relationship with the Sport Environment and Relationship with the Academic Environment. Conclusions: Findings highlighted a relevant parental role in supporting DC athletes and partial information on parental support strategies. In conclusions, the limited sample size and typology of sports, and the partial representativeness of countries have impacted the global application of the main findings. Furthermore, the need of an educational programme for parents and the need of regular parents-athlete-teacher/coach engagement were considered crucial to facilitate successful parental interventions at academic and/or sports levels and to limit the potential negative effects of DC parenting

Contribution of avoidable mortality to life expectancy inequalities in Wales: a decomposition by age and by cause between 2002 and 2020

Objectives To explore the contribution of avoidable mortality to life expectancy inequalities in Wales during 2002–2020. Design Observational study. Setting Wales, 2002–20, including early data from the COVID-19 pandemic. Methods We used routine statistics for 2002–2020 on population and deaths in Wales stratified by age, sex, deprivation quintile and cause of death. We estimated the contribution of avoidable causes of death and specific age-categories using the Arriaga decomposition method to highlight priorities for action. Results Life expectancy inequalities rose 2002–20 amongst both sexes, driven by serial decreases in life expectancy amongst the most deprived quintiles. The contributions of amenable and preventable mortality to life expectancy inequalities changed relatively little between 2002 and 2020, with larger rises in non-avoidable causes. Key avoidable mortality conditions driving the life expectancy gap in the most recent period of 2018–2020 for females were circulatory disease, cancers, respiratory disease and alcohol- and drug-related deaths, and also injuries for males. Conclusions Life expectancy inequalities widened during 2002–20, driven by deteriorating life expectancy in the most deprived quintiles. Sustained investment in prevention post-COVID-19 is needed to address growing health inequity in Wales; there remains a role for the National Health Service in ensuring equitable healthcare access to alongside wider policies that promote equity