Using Assessment Design Decision Framework in understanding the impact of rapid transition to remote education on student assessment in health-related colleges: A qualitative study.

Maintaining integrity and validity with online assessment is a significant issue that is well documented. Overt policies encouraging educators to adopt e-Learning and implement digital services coupled with the dramatic change in the education system in response to the challenges posed by COVID-19, has furthered the demand for evidence-based approaches for the planning and delivery of assessments. This study employed the Assessment Design Decision Framework (ADDF), a theoretical model that considers key aspects of assessment design, to retrospectively investigate from a multi-stakeholder perspective the assessments implemented following the rapid transition to remote learning during the COVID-19 pandemic. One-to-one semi-structured interviews were conducted with faculty and students from the Colleges of Pharmacy, Medicine and Health Sciences. After inductive and deductive thematic analysis three major themes were identified. These reflected on the impact of sudden transition on assessment design and assessment plan; changing assessment environment; and faculty-student assessment related interactions which included feedback. The use of a comprehensive validated framework such as ADDF, to plan assessments can improve validity and credibility of assessments. The strengths of this study lie in the innovative adoption of the ADDF to evaluate assessment design decisions from both an educator and student perspective. Further, the data yielded from this study offers novel validation of the use of ADDF in circumstances necessitating rapid transition, and additionally identifies a need for greater emphasis to be attributed to the significance of timeliness of the various activities that are advocated within the framework

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

Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis.

INTRODUCTION Adolescents living with HIV are subject to multiple co-morbidities, including growth retardation and immunodeficiency. We describe growth and CD4 evolution during adolescence using data from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) global project. METHODS Data were collected between 1994 and 2015 from 11 CIPHER networks worldwide. Adolescents with perinatally acquired HIV infection (APH) who initiated antiretroviral therapy (ART) before age 10 years, with at least one height or CD4 count measurement while aged 10-17 years, were included. Growth was measured using height-for-age Z-scores (HAZ, stunting if <-2 SD, WHO growth charts). Linear mixed-effects models were used to study the evolution of each outcome between ages 10 and 17. For growth, sex-specific models with fractional polynomials were used to model non-linear relationships for age at ART initiation, HAZ at age 10 and time, defined as current age from 10 to 17 years of age. RESULTS A total of 20,939 and 19,557 APH were included for the growth and CD4 analyses, respectively. Half were females, two-thirds lived in East and Southern Africa, and median age at ART initiation ranged from 7 years in sub-Saharan African regions. At age 10, stunting ranged from 6% in North America and Europe to 39% in the Asia-Pacific; 19% overall had CD4 counts <500 cells/mm3 . Across adolescence, higher HAZ was observed in females and among those in high-income countries. APH with stunting at age 10 and those with late ART initiation (after age 5) had the largest HAZ gains during adolescence, but these gains were insufficient to catch-up with non-stunted, early ART-treated adolescents. From age 10 to 16 years, mean CD4 counts declined from 768 to 607 cells/mm3 . This decline was observed across all regions, in males and females. CONCLUSIONS Growth patterns during adolescence differed substantially by sex and region, while CD4 patterns were similar, with an observed CD4 decline that needs further investigation. Early diagnosis and timely initiation of treatment in early childhood to prevent growth retardation and immunodeficiency are critical to improving APH growth and CD4 outcomes by the time they reach adulthood

The epidemiology of adolescents living with perinatally acquired HIV: A cross-region global cohort analysis

Background Globally, the population of adolescents living with perinatally acquired HIV (APHs) continues to expand. In this study, we pooled data from observational pediatric HIV cohorts and cohort networks, allowing comparisons of adolescents with perinatally acquired HIV in “real-life” settings across multiple regions. We describe the geographic and temporal characteristics and mortality outcomes of APHs across multiple regions, including South America and the Caribbean, North America, Europe, sub-Saharan Africa, and South and Southeast Asia. Methods and findings Through the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), individual retrospective longitudinal data from 12 cohort networks were pooled. All children infected with HIV who entered care before age 10 years, were not known to have horizontally acquired HIV, and were followed up beyond age 10 years were included in this analysis conducted from May 2016 to January 2017. Our primary analysis describes patient and treatment characteristics of APHs at key time points, including first HIV-associated clinic visit, antiretroviral therapy (ART) start, age 10 years, and last visit, and compares these characteristics by geographic region, country income group (CIG), and birth period. Our secondary analysis describes mortality, transfer out, and lost to follow-up (LTFU) as outcomes at age 15 years, using competing risk analysis. Among the 38,187 APHs included, 51% were female, 79% were from sub-Saharan Africa and 65% lived in low-income countries. APHs from 51 countries were included (Europe: 14 countries and 3,054 APHs; North America: 1 country and 1,032 APHs; South America and the Caribbean: 4 countries and 903 APHs; South and Southeast Asia: 7 countries and 2,902 APHs; sub-Saharan Africa, 25 countries and 30,296 APHs). Observation started as early as 1982 in Europe and 1996 in sub-Saharan Africa, and continued until at least 2014 in all regions. The median (interquartile range [IQR]) duration of adolescent follow-up was 3.1 (1.5–5.2) years for the total cohort and 6.4 (3.6–8.0) years in Europe, 3.7 (2.0–5.4) years in North America, 2.5 (1.2–4.4) years in South and Southeast Asia, 5.0 (2.7–7.5) years in South America and the Caribbean, and 2.1 (0.9–3.8) years in sub-Saharan Africa. Median (IQR) age at first visit differed substantially by region, ranging from 0.7 (0.3–2.1) years in North America to 7.1 (5.3–8.6) years in sub-Saharan Africa. The median age at ART start varied from 0.9 (0.4–2.6) years in North America to 7.9 (6.0–9.3) years in sub-Saharan Africa. The cumulative incidence estimates (95% confidence interval [CI]) at age 15 years for mortality, transfers out, and LTFU for all APHs were 2.6% (2.4%–2.8%), 15.6% (15.1%–16.0%), and 11.3% (10.9%–11.8%), respectively. Mortality was lowest in Europe (0.8% [0.5%–1.1%]) and highest in South America and the Caribbean (4.4% [3.1%–6.1%]). However, LTFU was lowest in South America and the Caribbean (4.8% [3.4%–6.7%]) and highest in sub-Saharan Africa (13.2% [12.6%–13.7%]). Study limitations include the high LTFU rate in sub-Saharan Africa, which could have affected the comparison of mortality across regions; inclusion of data only for APHs receiving ART from some countries; and unavailability of data from high-burden countries such as Nigeria. Conclusion To our knowledge, our study represents the largest multiregional epidemiological analysis of APHs. Despite probable under-ascertained mortality, mortality in APHs remains substantially higher in sub-Saharan Africa, South and Southeast Asia, and South America and the Caribbean than in Europe. Collaborations such as CIPHER enable us to monitor current global temporal trends in outcomes over time to inform appropriate policy responses

Migraine in women: the role of hormones and their impact on vascular diseases

Migraine is a predominantly female disorder. Menarche, menstruation, pregnancy, and menopause, and also the use of hormonal contraceptives and hormone replacement treatment may influence migraine occurrence. Migraine usually starts after menarche, occurs more frequently in the days just before or during menstruation, and ameliorates during pregnancy and menopause. Those variations are mediated by fluctuation of estrogen levels through their influence on cellular excitability or cerebral vasculature. Moreover, administration of exogenous hormones may cause worsening of migraine as may expose migrainous women to an increased risk of vascular disease. In fact, migraine with aura represents a risk factor for stroke, cardiac disease, and vascular mortality. Studies have shown that administration of combined oral contraceptives to migraineurs may further increase the risk for ischemic stroke. Consequently, in women suffering from migraine with aura caution should be deserved when prescribing combined oral contraceptives

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Updating the approaches to define susceptibility and resistance to anti-tuberculosis agents: implications for diagnosis and treatment

11 páginas, 2 figuras, 1 tablaInappropriately high breakpoints have resulted in systematic false-susceptible AST results to anti-TB drugs. MIC, PK/PD and clinical outcome data should be combined when setting breakpoints to minimise the emergence and spread of antimicrobial resistance.I. Comas was supported by PID2019-104477RB-I00 from the Spanish Science Ministry and by ERC (CoG 101001038)Peer reviewe

Intérêt de l’utilisation de stratégies anti-métaboliques pour le traitement du cancer du sein

Breast cancer is the most common cancer in women. Despite therapeutic advances, the mechanisms of resistance remain the underlying cause of morbidity and mortality. Lipoic acid (LA) is and an essential cofactor of oxidative metabolism via its function in pyruvate dehydrogenase and α-keto dehydrogenase complexes. Its potential therapeutic effects have been well documented in the treatment of pathologies associated with oxidative stress, such as diabetes, atherosclerosis, liver diseases and neurodegenerative diseases. In addition, it has been demonstrated its anticancer effects in various cancers, but its mechanisms of action are not fully understood. My PhD project aims to evaluate the inhibitory effect of LA on the proliferation of various breast cancer cell lines and to study the mechanisms of action likely to be involved in this process. Our results showed that LA inhibits cell proliferation by inhibiting PI3K/Akt and MAPK/ERK proliferative signaling. Our results contributed to a better understanding of the mechanisms of action leading to this anti-proliferative effect of LA. Indeed, we have demonstrated the reduction of the expression of the proprotein convertase, furin, responsible for the maturation of IGF-1R in response to LA resulting the inhibition of the maturation of this receptor. In addition, we have demonstrated that the pro-oxidative effect of LA reduces the the expression of the transcription factor, CREB, which is involved in the induction of furin expression. In conclusion, we demonstrated for the first the following mechanism of action: LA rapidly induces ROS by oxidative phosphorylation that inhibit the expression of the CREB transcription factor. This inhibition then blocks the transcriptional activation of furin, an enzyme that is crucial to allow the passage of the IGF-1R pro-form, which is immature and non-functional, to the mature form, IGF-1R, which is then recruited to the plasma membraneLe cancer du sein est le cancer le plus fréquent chez les femmes. Malgré les progrès thérapeutiques, les mécanismes de résistance restent la cause de la morbidité et de la mortalité. L'acide lipoïque (LA) est un cofacteur essentiel du métabolisme oxydatif via sa fonction dans les complexes de pyruvate déshydrogénase et d'α-céto déshydrogénase. Il a été démontré des effets anticancéreux, mais ses mécanismes d'action ne sont pas entièrement compris. Mon projet de thèse vise à évaluer l’effet inhibiteur de LA sur la prolifération de diverses lignées cellulaires du cancer du sein et d’étudier ses mécanismes. Nos résultats ont montré que LA inhibe la prolifération cellulaire en inhibant les voies de signalisation prolifératives PI3K/Akt et MAPK/ERK. Nos résultats ont contribué à une meilleure compréhension des mécanismes d’action conduisant à cet effet anti-prolifératif de LA. En effet, nous avons mis en évidence la réduction de l’expression de la proprotéine convertase, furine, responsable de la maturation d’IGF-1R en réponse à LA aboutissant in fine à l’inhibition de la maturation de ce récepteur. En outre, nous avons démontré que l’effet pro-oxydant de LA aboutit à la réduction de l’expression du facteur de transcription, CREB, qui est impliqué dans l’induction de l’expression de la furine. En conclusion, nous avons élucidé, pour la première fois, le mécanisme d’action suivant : LA induit rapidement et brutalement des ROS par la phosphorylation oxydative qui vont inhiber l’expression du facteur de transcription CREB. Cette inhibition bloque alors l’activation transcriptionnelle de la furine, qui est cruciale pour permettre le passage de la pro-forme d’IGF-1R, qui est immature et non fonctionnelle, à la forme mature, IGF-1R qui est alors recrutée à la membrane plasmiqu

Interest of the use of anti-metabolic strategies for the treatment of breast cancer

Le cancer du sein est le cancer le plus fréquent chez les femmes. Malgré les progrès thérapeutiques, les mécanismes de résistance restent la cause de la morbidité et de la mortalité. L'acide lipoïque (LA) est un cofacteur essentiel du métabolisme oxydatif via sa fonction dans les complexes de pyruvate déshydrogénase et d'α-céto déshydrogénase. Il a été démontré des effets anticancéreux, mais ses mécanismes d'action ne sont pas entièrement compris. Mon projet de thèse vise à évaluer l’effet inhibiteur de LA sur la prolifération de diverses lignées cellulaires du cancer du sein et d’étudier ses mécanismes. Nos résultats ont montré que LA inhibe la prolifération cellulaire en inhibant les voies de signalisation prolifératives PI3K/Akt et MAPK/ERK. Nos résultats ont contribué à une meilleure compréhension des mécanismes d’action conduisant à cet effet anti-prolifératif de LA. En effet, nous avons mis en évidence la réduction de l’expression de la proprotéine convertase, furine, responsable de la maturation d’IGF-1R en réponse à LA aboutissant in fine à l’inhibition de la maturation de ce récepteur. En outre, nous avons démontré que l’effet pro-oxydant de LA aboutit à la réduction de l’expression du facteur de transcription, CREB, qui est impliqué dans l’induction de l’expression de la furine. En conclusion, nous avons élucidé, pour la première fois, le mécanisme d’action suivant : LA induit rapidement et brutalement des ROS par la phosphorylation oxydative qui vont inhiber l’expression du facteur de transcription CREB. Cette inhibition bloque alors l’activation transcriptionnelle de la furine, qui est cruciale pour permettre le passage de la pro-forme d’IGF-1R, qui est immature et non fonctionnelle, à la forme mature, IGF-1R qui est alors recrutée à la membrane plasmiqueBreast cancer is the most common cancer in women. Despite therapeutic advances, the mechanisms of resistance remain the underlying cause of morbidity and mortality. Lipoic acid (LA) is and an essential cofactor of oxidative metabolism via its function in pyruvate dehydrogenase and α-keto dehydrogenase complexes. Its potential therapeutic effects have been well documented in the treatment of pathologies associated with oxidative stress, such as diabetes, atherosclerosis, liver diseases and neurodegenerative diseases. In addition, it has been demonstrated its anticancer effects in various cancers, but its mechanisms of action are not fully understood. My PhD project aims to evaluate the inhibitory effect of LA on the proliferation of various breast cancer cell lines and to study the mechanisms of action likely to be involved in this process. Our results showed that LA inhibits cell proliferation by inhibiting PI3K/Akt and MAPK/ERK proliferative signaling. Our results contributed to a better understanding of the mechanisms of action leading to this anti-proliferative effect of LA. Indeed, we have demonstrated the reduction of the expression of the proprotein convertase, furin, responsible for the maturation of IGF-1R in response to LA resulting the inhibition of the maturation of this receptor. In addition, we have demonstrated that the pro-oxidative effect of LA reduces the the expression of the transcription factor, CREB, which is involved in the induction of furin expression. In conclusion, we demonstrated for the first the following mechanism of action: LA rapidly induces ROS by oxidative phosphorylation that inhibit the expression of the CREB transcription factor. This inhibition then blocks the transcriptional activation of furin, an enzyme that is crucial to allow the passage of the IGF-1R pro-form, which is immature and non-functional, to the mature form, IGF-1R, which is then recruited to the plasma membran

How the Warburg effect supports aggressiveness and drug resistance of cancer cells?

International audienceCancer cells employ both conventional oxidative metabolism and glycolytic anaerobic metabolism. However, their proliferation is marked by a shift towards increasing glycolytic metabolism even in the presence of O2 (Warburg effect). HIF1, a major hypoxia induced transcription factor, promotes a dissociation between glycolysis and the tricarboxylic acid cycle, a process limiting the efficient production of ATP and citrate which otherwise would arrest glycolysis. The Warburg effect also favors an intracellular alkaline pH which is a driving force in many aspects of cancer cell proliferation (enhancement of glycolysis and cell cycle progression) and of cancer aggressiveness (resistance to various processes including hypoxia, apoptosis, cytotoxic drugs and immune response). This metabolism leads to epigenetic and genetic alterations with the occurrence of multiple new cell phenotypes which enhance cancer cell growth and aggressiveness. In depth understanding of these metabolic changes in cancer cells may lead to the development of novel therapeutic strategies, which when combined with existing cancer treatments, might improve their effectiveness and/or overcome chemoresistance