An Investigation into Non-medical Prescribing within Oncology

There is currently limited published evidence exploring aspects of oncology Non-Medical Prescribing (NMP) practice. To explore the opinions and recommendations of NMPs on oncology NMP practice, two focus groups were held with pharmacist and nurse NMPs (one per professional group). Participants were asked to discuss aspects of their current NMP practice including collaboration and post-qualifying training. The opinions and recommendations of medical prescribers and senior managers on NMP practice within oncology were explored using a focus group for consultant oncologists and a semi-structured interview (SSI) for a registrar. Medical prescribers were asked to discuss aspects of current NMP practice including collaboration and training. Three organisational senior managers were then interviewed to explore the themes previously identified from medical prescriber data. The NMP training theme was then explored within two further studies. The experiences, opinions and recommendations of multi-professional NMPs on post-qualifying NMP training were explored within separate one-to-one SSIs (three nurse, three pharmacist and three radiographer NMPs). NMP participants were asked to discuss aspects of NMP training such as current NMP training received, further training and support requirements. Within the final study, the opinions and recommendations of consultant oncologists on post-qualifying NMP training were explored using an electronic survey. Participants were asked questions around key themes previously identified within the previous study, such as competence, support, experience related to training requirements and training methods. This research programme explored aspects of NMP practice identified by stakeholders involved in oncology NMP practice. Key findings included the nurse prescriber ‘dual’ role, appropriate placement of NMPs in practice, and lack of time and funding for NMP development. The need for NMP organisational governance strategies were suggested and a draft NMP post-qualifying training matrix related to experience. Recommendations included implementation of lead NMP roles, a stakeholder NMP support network and an organisation-led NMP training programme

A global analysis of the impact of COVID-19 stay-at-home restrictions on crime

The implementation of COVID-19 stay-at-home policies was associated with a considerable drop in urban crime in 27 cities across 23 countries. More stringent restrictions over movement in public space were predictive of larger declines in crime. The stay-at-home restrictions to control the spread of COVID-19 led to unparalleled sudden change in daily life, but it is unclear how they affected urban crime globally. We collected data on daily counts of crime in 27 cities across 23 countries in the Americas, Europe, the Middle East and Asia. We conducted interrupted time series analyses to assess the impact of stay-at-home restrictions on different types of crime in each city. Our findings show that the stay-at-home policies were associated with a considerable drop in urban crime, but with substantial variation across cities and types of crime. Meta-regression results showed that more stringent restrictions over movement in public space were predictive of larger declines in crime.Peer reviewe

Prognostic factors in patients admitted to an urban teaching hospital with COVID-19 infection

Background: Severe COVID-19 infection results in a systemic inflammatory response (SIRS). This SIRS response shares similarities to the changes observed during the peri-operative period that are recognised to be associated with the development of multiple organ failure. Methods: Electronic patient records for patients who were admitted to an urban teaching hospital during the initial 7-week period of the COVID-19 pandemic in Glasgow, U.K. (17th March 2020—1st May 2020) were examined for routine clinical, laboratory and clinical outcome data. Age, sex, BMI and documented evidence of COVID-19 infection at time of discharge or death certification were considered minimal criteria for inclusion. Results: Of the 224 patients who fulfilled the criteria for inclusion, 52 (23%) had died at 30-days following admission. COVID-19 related respiratory failure (75%) and multiorgan failure (12%) were the commonest causes of death recorded. Age ≥ 70 years (p < 0.001), past medical history of cognitive impairment (p ≤ 0.001), previous delirium (p < 0.001), clinical frailty score > 3 (p < 0.001), hypertension (p < 0.05), heart failure (p < 0.01), national early warning score (NEWS) > 4 (p < 0.01), positive CXR (p < 0.01), and subsequent positive COVID-19 swab (p ≤ 0.001) were associated with 30-day mortality. CRP > 80 mg/L (p < 0.05), albumin < 35 g/L (p < 0.05), peri-operative Glasgow Prognostic Score (poGPS) (p < 0.05), lymphocytes < 1.5 109/l (p < 0.05), neutrophil lymphocyte ratio (p ≤ 0.001), haematocrit (< 0.40 L/L (male)/ < 0.37 L/L (female)) (p ≤ 0.01), urea > 7.5 mmol/L (p < 0.001), creatinine > 130 mmol/L (p < 0.05) and elevated urea: albumin ratio (< 0.001) were also associated with 30-day mortality. On multivariate analysis, age ≥ 70 years (O.R. 3.9, 95% C.I. 1.4–8.2, p < 0.001), past medical history of heart failure (O.R. 3.3, 95% C.I. 1.2–19.3, p < 0.05), NEWS > 4 (O.R. 2.4, 95% C.I. 1.1–4.4, p < 0.05), positive initial CXR (O.R. 0.4, 95% C.I. 0.2–0.9, p < 0.05) and poGPS (O.R. 2.3, 95% C.I. 1.1–4.4, p < 0.05) remained independently associated with 30-day mortality. Among those patients who tested PCR COVID-19 positive (n = 122), age ≥ 70 years (O.R. 4.7, 95% C.I. 2.0—11.3, p < 0.001), past medical history of heart failure (O.R. 4.4, 95% C.I. 1.2–20.5, p < 0.05) and poGPS (O.R. 2.4, 95% C.I. 1.1–5.1, p < 0.05) remained independently associated with 30-days mortality. Conclusion: Age ≥ 70 years and severe systemic inflammation as measured by the peri-operative Glasgow Prognostic Score are independently associated with 30-day mortality among patients admitted to hospital with COVID-19 infection

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

The influence of bedrock river morphology and alluvial cover on gravel entrainment: Part 1. Pivot angles and surface roughness

Sediment entrainment in bedrock rivers is a key process for river incision and landscape evolution. Bedrock riverbeds are typically comprised of both exposed bedrock and alluvial patches, meaning grains can be entrained from positions on both surfaces. The critical shear stress needed to entrain a grain will be affected by the topography that the grain is located on, as it determines grain pivot angle and exposure, and impacts the local flow profile. The aim of this pair of articles is to determine how the properties of bedrock surfaces with and without sediment cover affect the grain-scale geometry of sediment grains, and consequently their critical shear stress. We report experiments using 3D-printed scaled replicas of fluvial bedrock surfaces, with 0 to 100% additional sediment cover. For each surface, grain pivot angles were measured using a tilt table. In this first article, we report how surface roughness and grain pivot angle vary between surfaces and with different amounts of sediment cover, and we explore the relationship between pivot angles and different metrics for measuring surface roughness. We find that: (1) surface roughness is not necessarily a linear combination of the individual roughness of bedrock and alluvial areas, and the underlying bedrock topography can still influence surface roughness at 100% sediment cover; (2) pivot angles generally, but not always, decrease with increasing grain size relative to surface roughness; (3) changes in pivot angles with increasing sediment cover are best explained by changes in surface roughness at spatial scales comparable to the grain size; and (4) pivot angles are also best explained by roughness metrics that incorporate the direction of roughness with respect to the tilt direction, and the surface inclination. This work provides new insights into the processes behind grain entrainment in bedrock rivers that are critical for determining how landscapes may evolve

Does Soil Contribute to the Human Gut Microbiome?

Soil and the human gut contain approximately the same number of active microorganisms, while human gut microbiome diversity is only 10% that of soil biodiversity and has decreased dramatically with the modern lifestyle. We tracked relationships between the soil microbiome and the human intestinal microbiome. We propose a novel environmental microbiome hypothesis, which implies that a close linkage between the soil microbiome and the human intestinal microbiome has evolved during evolution and is still developing. From hunter-gatherers to an urbanized society, the human gut has lost alpha diversity. Interestingly, beta diversity has increased, meaning that people in urban areas have more differentiated individual microbiomes. On top of little contact with soil and feces, hygienic measures, antibiotics and a low fiber diet of processed food have led to a loss of beneficial microbes. At the same time, loss of soil biodiversity is observed in many rural areas. The increasing use of agrochemicals, low plant biodiversity and rigorous soil management practices have a negative effect on the biodiversity of crop epiphytes and endophytes. These developments concur with an increase in lifestyle diseases related to the human intestinal microbiome. We point out the interference with the microbial cycle of urban human environments versus pre-industrial rural environments. In order to correct these interferences, it may be useful to adopt a different perspective and to consider the human intestinal microbiome as well as the soil/root microbiome as ‘superorganisms’ which, by close contact, replenish each other with inoculants, genes and growth-sustaining molecules

Lexical access in semantic variant PPA: Evidence for a post-semantic contribution to naming deficits

International audienceThe most salient clinical symptom of semantic variant primary progressive aphasia (PPA) is a profound and pervasive anomia. These patients' naming impairments have been shown to reflect in large part a domain-general deterioration of conceptual knowledge that impacts both linguistic and non-linguistic processing. However, it is possible that post-semantic stages of lexical access may also contribute to naming deficits. To clarify the stages at which lexical access breaks down in semantic variant PPA, eleven French-speaking patients were asked to name objects, and were then queried for semantic, lexical-syntactic, and word form information pertaining to the items they could not name. Specifically, our goal was to determine whether patients can access intermediate representations known as lemmas, which mediate the arbitrary mapping between semantic representations and word forms (phonological and orthographic forms). The French language was chosen for this study because nouns in French are marked for grammatical gender, a prototypical type of lexical-syntactic information, represented at the level of the lemma. Access to word form information is also dependent on lemma access under some theoretical views. We found that six of the eleven patients showed partial access to either lexical-syntactic properties of unnamed items (grammatical gender), word form information (initial letter), or both. Access to these types of information suggests that a lemma has been retrieved, implying a breakdown at the post-semantic stage of word form retrieval. Our results suggest that although degraded conceptual knowledge is the main cause of naming deficits in semantic variant PPA, in some patients, a post-semantic component also contributes to the impairment

Iron and Immunity

Iron is an essential nutrient for most life on Earth because it functions as a crucial redox catalyst in many cellular processes. However, when present in excess iron can lead to the formation of harmful hydroxyl radicals. Hence, the cellular iron balance must be tightly controlled. Perturbation of iron homeostasis is a major strategy in host-pathogen interactions. Plants use iron-withholding strategies to reduce pathogen virulence or to locally increase iron levels to activate a toxic oxidative burst. Some plant pathogens counteract such defenses by secreting iron-scavenging siderophores that promote iron uptake and alleviate iron-regulated host immune responses. Mutualistic root microbiota can also influence plant disease via iron. They compete for iron with soil-borne pathogens or induce a systemic resistance that shares early signaling components with the root iron-uptake machinery. This review describes the progress in our understanding of the role of iron homeostasis in both pathogenic and beneficial plant-microbe interactions

Iron and Immunity

Iron is an essential nutrient for most life on Earth because it functions as a crucial redox catalyst in many cellular processes. However, when present in excess iron can lead to the formation of harmful hydroxyl radicals. Hence, the cellular iron balance must be tightly controlled. Perturbation of iron homeostasis is a major strategy in host-pathogen interactions. Plants use iron-withholding strategies to reduce pathogen virulence or to locally increase iron levels to activate a toxic oxidative burst. Some plant pathogens counteract such defenses by secreting iron-scavenging siderophores that promote iron uptake and alleviate iron-regulated host immune responses. Mutualistic root microbiota can also influence plant disease via iron. They compete for iron with soil-borne pathogens or induce a systemic resistance that shares early signaling components with the root iron-uptake machinery. This review describes the progress in our understanding of the role of iron homeostasis in both pathogenic and beneficial plant-microbe interactions