Standardised library instruction assessment: an institution-specific approach

Introduction We explore the use of a psychometric model for locally-relevant, information literacy assessment, using an online tool for standardised assessment of student learning during discipline-based library instruction sessions. Method A quantitative approach to data collection and analysis was used, employing standardised multiple-choice survey questions followed by individual, cognitive interviews with undergraduate students. The assessment tool was administered to five general education psychology classes during library instruction sessions. AnalysisDescriptive statistics were generated by the assessment tool. Results. The assessment tool proved a feasible means of measuring student learning. While student scores improved on every survey question, there was uneven improvement from pre-test to post-test for different questions. Conclusion Student scores showed more improvement for some learning outcomes over others, thus, spending time on fewer concepts during instruction sessions would enable more reliable evaluation of student learning. We recommend using digital learning objects that address basic research skills to enhance library instruction programmes. Future studies will explore different applications of the assessment tool, provide more detailed statistical analysis of the data and shed additional light on the significance of overall scores

Cognitive impairment in older patients undergoing colorectal surgery

Background: With increasing numbers of older people being referred for elective colorectal surgery, cognitive impairment is likely to be present and affect many aspects of the surgical pathway. This study is aimed to determine the prevalence of cognitive impairment and assess it against surgical outcomes. Methods: The Montreal Cognitive Assessment (MoCA) was carried out in patients aged more than 65 years. We recorded demographic information. Data were collected on length of hospital stay, complications and 30-day mortality. Results: There were 101 patients assessed, median age was 74 years (interquartile range = 68–80), 54 (53.5%) were women. In total, 58 people (57.4%) ‘failed’ the Montreal Cognitive Assessment test (score ≤ 25). There were two deaths (3.4%) within 30 days of surgery in the abnormal Montreal Cognitive Assessment group and none in the normal group. Twenty-nine (28.7%) people experienced a complication. The percentage of patients with complications was higher in the group with normal Montreal Cognitive Assessment (41.9%) than abnormal Montreal Cognitive Assessment (19.9%) (p = 0.01) and the severity of those complications were greater (chi-squared for trend p = 0.01). The length of stay was longer in people with an abnormal Montreal Cognitive Assessment (mean 8.1 days vs. 5.8 days, p = 0.03). Conclusion: Cognitive impairment was common, which has implications for informed consent. Cognitive impairment was associated with less postoperative complications but a longer length of hospital stay

The First Measurements of Galaxy Clustering from IRAC Data of the Spitzer First Look Survey

We present the first results of the angular auto-correlation function of the galaxies detected by the Infrared Array Camera (IRAC) instrument in the First Look Survey (FLS) of the Spitzer Space Telescope. We detect significant signals of galaxy clustering within the survey area. The angular auto-correlation function of the galaxies detected in each of the four IRAC instrument channels is consistent with a power-law form $w(\theta)=A\theta^{1-\gamma}$ out to \theta = 0.2\arcdeg, with the slope ranging from $\gamma = 1.5$ to 1.8. We estimate the correlation amplitudes $A$ to be $2.95 \times 10^{-3}$, $2.03 \times 10^{-3}$, $4.53 \times 10^{-3}$, and $2.34 \times 10^{-3}$ at \theta=1\arcdeg for galaxies detected in the IRAC 3.6$\mu$m, 4.5$\mu$m, 5.8$\mu$m, and 8.0$\mu$m instrument channels, respectively. We compare our measurements at 3.6$\mu$m with the previous K-band measurements, and discuss the implications of these results.Comment: Accepted for publication in the ApJ Supplements Spitzer Special Issue; 12 pages including 3 figures and 1 tabl

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effects of vitamin D supplementation on endothelial function:a systematic review and meta-analysis of randomised clinical trials

Background: In addition to regulating calcium homoeostasis and bone health, vitamin D influences vascular and metabolic processes including endothelial function (EF) and insulin signalling. This systematic review and meta-analysis of randomised clinical trials (RCTs) were conducted to investigate the effect of vitamin D supplementation on EF and to examine whether the effect size was modified by health status, study duration, dose, route of vitamin D administration, vitamin D status (baseline and post-intervention), body mass index (BMI), age and type of vitamin D.  Methods: We searched the Medline, Embase, Cochrane Library and Scopus databases from inception until March 2015 for studies meeting the following criteria: (1) RCT with adult participants, (2) vitamin D administration alone, (3) studies that quantified EF using commonly applied methods including ultrasound, plethysmography, applanation tonometry and laser Doppler.  Results: Sixteen articles reporting data for 1177 participants were included. Study duration ranged from 4 to 52 weeks. The effect of vitamin D on EF was not significant (SMD: 0.08, 95 % CI −0.06, 0.22, p = 0.28). Subgroup analysis showed a significant improvement of EF in diabetic subjects (SMD: 0.31, 95 % CI 0.05, 0.57, p = 0.02). A non-significant trend was found for diastolic blood pressure (β = 0.02; p = 0.07) and BMI (β = 0.05; p = 0.06).  Conclusions: Vitamin D supplementation did not improve EF. The significant effect of vitamin D in diabetics and a tendency for an association with BMI may indicate a role of excess adiposity and insulin resistance in modulating the effects of vitamin D on vascular function. This remains to be tested in future studies

The Effectiveness of Pharmacological and Non-Pharmacological Interventions for Improving Glycaemic Control in Adults with Severe Mental Illness: A Systematic Review and Meta-Analysis

People with severe mental illness (SMI) have reduced life expectancy compared with the general population, which can be explained partly by their increased risk of diabetes. We conducted a meta-analysis to determine the clinical effectiveness of pharmacological and non-pharmacological interventions for improving glycaemic control in people with SMI (PROSPERO registration: CRD42015015558). A systematic literature search was performed on 30/10/2015 to identify randomised controlled trials (RCTs) in adults with SMI, with or without a diagnosis of diabetes that measured fasting blood glucose or glycated haemoglobin (HbA1c). Screening and data extraction were carried out independently by two reviewers. We used random effects meta-analysis to estimate effectiveness, and subgroup analysis and univariate meta-regression to explore heterogeneity. The Cochrane Collaboration’s tool was used to assess risk of bias. We found 54 eligible RCTs in 4,392 adults (40 pharmacological, 13 behavioural, one mixed intervention). Data for meta-analysis were available from 48 RCTs (n = 4052). Both pharmacological (mean difference (MD), -0.11mmol/L; 95% confidence interval (CI), [-0.19, -0.02], p = 0.02, n = 2536) and behavioural interventions (MD, -0.28mmol//L; 95% CI, [-0.43, -0.12], p<0.001, n = 956) were effective in lowering fasting glucose, but not HbA1c (pharmacological MD, -0.03%; 95% CI, [-0.12, 0.06], p = 0.52, n = 1515; behavioural MD, 0.18%; 95% CI, [-0.07, 0.42], p = 0.16, n = 140) compared with usual care or placebo. In subgroup analysis of pharmacological interventions, metformin and antipsychotic switching strategies improved HbA1c. Behavioural interventions of longer duration and those including repeated physical activity had greater effects on fasting glucose than those without these characteristics. Baseline levels of fasting glucose explained some of the heterogeneity in behavioural interventions but not in pharmacological interventions. Although the strength of the evidence is limited by inadequate trial design and reporting and significant heterogeneity, there is some evidence that behavioural interventions, antipsychotic switching, and metformin can lead to clinically important improvements in glycaemic measurements in adults with SMI

Pain Reduction with Oral Methotrexate in Knee Osteoarthritis; a Randomized Placebo-Controlled Clinical Trial

Background: Treatments for osteoarthritis are limited. Previous small studies suggest the anti-rheumatic drug methotrexate may be a potential treatment for osteoarthritis pain. Objective: To assess symptomatic benefits of methotrexate in knee osteoarthritis. Design: A multi-center, randomized, double-blind, placebo-controlled trial conducted between 13 June 2014 and 8 September 2017. Setting: Fifteen United Kingdom secondary-care musculoskeletal clinics. Participants: 207 participants with symptomatic, radiographic knee osteoarthritis, knee pain (severity ≥4/10) on most days in the last 3-months, with inadequate response to current medication were approached for inclusion. Interventions: Participants were randomized 1:1 to once-weekly oral methotrexate (6-week escalation 10mg-25mg) or matched placebo over 12-months and continued usual analgesia. Measurements: The primary endpoint was average knee pain (numerical rating scale (NRS) 0-10) at 6-months, with 12-month follow-up to assess longer-term response. Secondary endpoints included knee stiffness and function outcomes, and adverse events. Results: 155 participants (64% women, mean age 60.9 years, 50% Kellgren-Lawrence Grade 3-4) were randomized to methotrexate (n=77) or placebo (n=78). Follow-up was 86% (n=134; MTX 66, Placebo 68) at 6-months. Mean(SD) knee pain reduced from 6.4(1.80) at baseline to 5.1(2.32) at 6-months in the MTX group, and from 6.8(1.62) to 6.2(2.30) in the placebo group. The primary intention-to-treat analysis revealed a statistically significant pain reduction of 0.79 NRS points in favour of MTX (95%CI[0.08-1.51];p=0.030). There were also statistically significant treatment-group differences in favour of MTX at 6-months for WOMAC stiffness (0.60 points, 95%CI[0.01-1.18];p=0.045) and function (5.01 points, 95%CI[1.29-8.74],p=0.008). Treatment-compliance analysis supported a dose-response effect. Four unrelated serious adverse events were reported (methotrexate:2, placebo:2). Limitations: Not permitting oral methotrexate to be changed to subcutaneous delivery for intolerance. Conclusions: Oral methotrexate added to usual medications demonstrated statistically significant reduction in knee osteoarthritis pain, stiffness and function at 6-months. Funding Source: Versus Arthritis 20186. Trial registration number: ISRCTN77854383 (https://doi.org/10.1186/ISRCTN77854383); EudraCT: 2013-001689-41 (https://www.clinicaltrialsregister.eu/ctr-search/search?query=eudract_number%3A2013-001689-41

A multi-centre, double-blind, placebo-controlled, randomised trial of combination methotrexate and gefitinib versus methotrexate alone to treat tubal ectopic pregnancies (GEM3): trial protocol

Background Tubal ectopic pregnancy (tEP) is the most common life-threatening condition in gynaecology. Treatment options include surgery and medical management. Stable women with tEPs with pre-treatment serum human chorionic gonadotrophin (hCG) levels  1000 IU/L can take significant time to resolve with methotrexate and require multiple outpatient monitoring visits. In pre-clinical studies, we found that tEP implantation sites express high levels of epidermal growth factor receptor. In early-phase trials, we found that combination therapy with gefitinib, an orally active epidermal growth factor receptor antagonist, and methotrexate resolved tEPs without the need for surgery in over 70% of cases, did not cause significant toxicities, and was well tolerated. We describe the protocol of a randomised trial to assess the efficacy of combination gefitinib and methotrexate, versus methotrexate alone, in reducing the need for surgical intervention for tEPs. Methods and analysis We propose to undertake a multi-centre, double-blind, placebo-controlled, randomised trial (around 70 sites across the UK) and recruit 328 women with tEPs (with pre-treatment serum hCG of 1000–5000 IU/L). Women will be randomised in a 1:1 ratio by a secure online system to receive a single dose of intramuscular methotrexate (50 mg/m2) and either oral gefitinib or matched placebo (250 mg) daily for 7 days. Participants and healthcare providers will remain blinded to treatment allocation throughout the trial. The primary outcome is the need for surgical intervention for tEP. Secondary outcomes are the need for further methotrexate treatment, time to resolution of the tEP (serum hCG ≤ 15 IU/L), number of hospital visits associated with treatment (until resolution or scheduled/emergency surgery), and the return of menses by 3 months after resolution. We will also assess adverse events and reactions until day of resolution or surgery, and participant-reported acceptability at 3 months. Discussion A medical intervention that reduces the need for surgery and resolves tEP faster would be a favourable treatment alternative. If effective, we believe that gefitinib and methotrexate could become standard care for stable tEPs

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice