Randomised controlled trial of fish oil supplement to treat cancer cachexia

Patients with advanced cancer often suffer from cachexia, a debilitating and complex extreme weight loss syndrome which is also associated with shorter survival times. A pragmatic randomised controlled trial was conducted to determine whether an oral nutritional supplement containing the omega-3 fatty acid eicosapentaenoic acid (EPA) was able to improve quality of life and survival times of patients with advanced solid tumour cancer in a mixed tumour cancer type population

Refugees are a valuable but overlooked economic resource, and it is time to update our approach to migration

The view that welcoming refugees represents a cost to a country's welfare services has become anachronistic; nowadays refugees are increasingly recognised for their high levels of education and skills, and their ability to make an economic contribution to a host country. Yet, most states' approach to migration management prevents displaced people from migrating based on the human capital that they can supply. Australia is trialling a new approach that enables refugees to access skilled migration through employer sponsorship. This article describes the pilot project and suggests ways to encourage employers to view refugees as a valuable solution to workforce shortages

A systematic review of parenting interventions used by social workers to support vulnerable children

This paper reports on the findings from a systematic review of parenting interventions used by social workers to support vulnerable children in the United Kingdom. The study focused on children from birth to 11 years and 11 months based on Munro's rationale for early intervention. From the 423 papers initially identified, twelve met the inclusion criteria for this review. Four common themes were identified: developing relationships, the effectiveness of parenting interventions, societal impact on families and health and psychological concerns. The importance of effective relationships between parents and social workers was identified as key to effective parental interventions but there was limited evidence of improved outcomes for children despite this. A common factor in the studies was the level of parental deprivation which in many cases was associated with a range of mental health issues frequently seen in association with drug and alcohol abuse and domestic violence. The review identified a number of successful outcomes across a range of parenting interventions. However, what was surprising was the limited input from the children themselves within this review. Applying our findings to practice, the authors recommend a number of ways to contribute to the development of parenting interventions

Obtaining the Thermal Structure of Lakes from the Air

The significance of thermal heterogeneities in small surface water bodies as drivers of mixing and for habitat provision is increasingly recognized, yet obtaining three-dimensionally-resolved observations of the thermal structure of lakes and rivers remains challenging. Remote observations of water temperature from aerial platforms are attractive: such platforms do not require shoreline access; they can be quickly and easily deployed and redeployed to facilitate repeated sampling and can rapidly move between target locations, allowing multiple measurements to be made during a single flight. However, they are also subject to well-known limitations, including payload, operability and a tradeoff between the extent and density over which measurements can be made within restricted flight times. This paper introduces a novel aerial thermal sensing platform that lowers a temperature sensor into the water to record temperature measurements throughout a shallow water column and presents results from initial field experiments comparing in situ temperature observations to those made from the UAS platform. These experiments show that with minor improvements, UASs have the potential to enable high-resolution 3D thermal mapping of a ~1-ha lake in 2–3 flights (circa 2 h), sufficient to resolve diurnal variations. This paper identifies operational constraints and key areas for further development, including the need for the integration of a faster temperature sensor with the aerial vehicle and better control of the sensor depth, especially when near the water surface

The development and optimisation of a primary care-based whole system complex intervention (CARE Plus) for patients with multimorbidity living in areas of high socioeconomic deprivation

<B>OBJECTIVES</B> To develop and optimise a primary care-based complex intervention (CARE Plus) to enhance the quality of life of patients with multimorbidity in the deprived areas. <B>METHODS</B> Six co-design discussion groups involving 32 participants were held separately with multimorbid patients from the deprived areas, voluntary organisations, general practitioners and practice nurses working in the deprived areas. This was followed by piloting in two practices and further optimisation based on interviews with 11 general practitioners, 2 practice nurses and 6 participating multimorbid patients. <B>RESULTS</B> Participants endorsed the need for longer consultations, relational continuity and a holistic approach. All felt that training and support of the health care staff was important. Most participants welcomed the idea of additional self-management support, though some practitioners were dubious about whether patients would use it. The pilot study led to changes including a revised care plan, the inclusion of mindfulness-based stress reduction techniques in the support of practitioners and patients, and the stream-lining of the written self-management support material for patients. <B>DISCUSSION</B> We have co-designed and optimised an augmented primary care intervention involving a whole-system approach to enhance quality of life in multimorbid patients living in the deprived areas. CARE Plus will next be tested in a phase 2 cluster randomised controlled trial

Collaboration Between Health Sciences Librarians and Faculty as Reflected by Articles Published in the Journal of the Medical Library Association

A recent study by Higgins and colleagues reports that the Journal of the Medical Library Association (JMLA) had the highest percentage of articles with both librarian and faculty co-authors out of 13 peer-reviewed journals in STEM librarianship and education between 2005 and 2014. A deeper and updated analysis of JMLA research articles and case studies published between 2008 and 2017 revealed that 29% of articles had both librarian and faculty co-authors. The main topics of librarian-faculty collaboration as described in these articles were related to patient and consumer health information and clinical information-seeking and decision-making by healthcare providers. Most faculty co-authors came from the disciplines of biomedical/health informatics and biostatistics and library and information science. The publication of these articles in JMLA provides evidence of health sciences librarians and information specialists’ ability to collaborate with faculty members to advance the knowledgebase and practice of librarianship and the health sciences

Modular cytosine base editing promotes epigenomic and genomic modifications

Prokaryotic and eukaryotic adaptive immunity differ considerably. Yet, their fundamental mechanisms of gene editing via Cas9 and activation-induced deaminase (AID), respectively, can be conveniently complimentary. Cas9 is an RNA targeted dual nuclease expressed in several bacterial species. AID is a cytosine deaminase expressed in germinal centre B cells to mediate genomic antibody diversification. AID can also mediate epigenomic reprogramming via active DNA demethylation. It is known that sequence motifs, nucleic acid structures, and associated co-factors affect AID activity. But despite repeated attempts, deciphering AID’s intrinsic catalytic activities and harnessing its targeted recruitment to DNA is still intractable. Even recent cytosine base editors are unable to fully recapitulate AID’s genomic and epigenomic editing properties. Here, we describe the first instance of a modular AID-based editor that recapitulates the full spectrum of genomic and epigenomic editing activity. Our ‘Swiss army knife’ toolbox will help better understand AID biology per se as well as improve targeted genomic and epigenomic editing

Investing in updating: how do conclusions change when Cochrane systematic reviews are updated?

BACKGROUND: Cochrane systematic reviews aim to provide readers with the most up-to-date evidence on the effects of healthcare interventions. The policy of updating Cochrane reviews every two years consumes valuable time and resources and may not be appropriate for all reviews. The objective of this study was to examine the effect of updating Cochrane systematic reviews over a four year period. METHODS: This descriptive study examined all completed systematic reviews in the Cochrane Database of Systematic Reviews (CDSR) Issue 2, 1998. The latest version of each of these reviews was then identified in CDSR Issue 2, 2002 and changes in the review were described. For reviews that were updated within this time period and had additional studies, we determined whether their conclusion had changed and if there were factors that were predictive of this change. RESULTS: A total of 377 complete reviews were published in CDSR Issue 2, 1998. In Issue 2, 2002, 14 of these reviews were withdrawn and one was split, leaving 362 reviews to examine for the purpose of this study. Of these reviews, 254 (70%) were updated. Of these updated reviews, 23 (9%) had a change in conclusion. Both an increase in precision and a change in statistical significance of the primary outcome were predictive of a change in conclusion of the review. CONCLUSION: The concerns around a lack of updating for some reviews may not be justified considering the small proportion of updated reviews that resulted in a changed conclusion. A priority-setting approach to the updating of Cochrane systematic reviews may be more appropriate than a time-based approach. Updating all reviews as frequently as every two years may not be necessary, however some reviews may need to be updated more often than every two years

Impact of Motivational Interviewing by Social Workers on Service Users - a systematic review

Purpose: This systematic review was undertaken to determine the effectiveness of motivational interviewing (MI), by social workers, on service user outcomes. Methods: A literature search was undertaken between 2007 and 2018. All eligible studies were analyzed using the Critical Appraisal Skills Programme tool. As heterogeneity was high, a narrative synthesis approach was employed, using thematic analysis for categorizing data. Results: Eleven studies met the inclusion criteria and were included in this review. MI had a positive effect on service user experience, but this was not consistent. Training was variable, but the evidence suggests that practitioner’s need ongoing training, supervision, or coaching while providing MI. Discussion: There is a paucity of research examining the impact of MI on children, which was a limitation of this review. There is a need for more qualitative research to surface views and experience of service users to determine why MI is effective