467 research outputs found

    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

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    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

    Uncomfortable truths - teamworking under lean in the UK

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    A recent contribution in this journal – Procter, S. and Radnor, Z. (2014) ‘Teamworking under Lean in UK public services: lean teams and team targets in Her Majesty’s Revenue and Customs (HMRC)’ International Journal of Human Resource Management, 25:21, 2978–2995 – provides an account of teamworking in the UK Civil Service, specifically Her Majesty’s Revenue and Customs (HMRC), focused on the relationship between recently implemented lean work organisation and teams and teamworking. Procter and Radnor claim in this work that it delivers a ‘more nuanced’ analysis of lean in this government department and, it follows, of the lean phenomenon more generally. Our riposte critiques their article on several grounds. It suffers from problems of logic and construction, conceptual confusion and definitional imprecision. Methodological difficulties and inconsistent evidence contribute additionally to analytical weakness. Included in our response are empirical findings on teamworking at HMRC that challenge Procter and Radnor’s evidential basis and further reveal the shortcomings of their interpretation

    Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial

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    Background: Intensive antiplatelet therapy with three agents might be more effective than guideline treatment for preventing recurrent events in patients with acute cerebral ischaemia. We aimed to compare the safety and efficacy of intensive antiplatelet therapy (combined aspirin, clopidogrel, and dipyridamole) with that of guideline-based antiplatelet therapy. Methods: We did an international, prospective, randomised, open-label, blinded-endpoint trial in adult participants with ischaemic stroke or transient ischaemic attack (TIA) within 48 h of onset. Participants were assigned in a 1:1 ratio using computer randomisation to receive loading doses and then 30 days of intensive antiplatelet therapy (combined aspirin 75 mg, clopidogrel 75 mg, and dipyridamole 200 mg twice daily) or guideline-based therapy (comprising either clopidogrel alone or combined aspirin and dipyridamole). Randomisation was stratified by country and index event, and minimised with prognostic baseline factors, medication use, time to randomisation, stroke-related factors, and thrombolysis. The ordinal primary outcome was the combined incidence and severity of any recurrent stroke (ischaemic or haemorrhagic; assessed using the modified Rankin Scale) or TIA within 90 days, as assessed by central telephone follow-up with masking to treatment assignment, and analysed by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN47823388. Findings: 3096 participants (1556 in the intensive antiplatelet therapy group, 1540 in the guideline antiplatelet therapy group) were recruited from 106 hospitals in four countries between April 7, 2009, and March 18, 2016. The trial was stopped early on the recommendation of the data monitoring committee. The incidence and severity of recurrent stroke or TIA did not differ between intensive and guideline therapy (93 [6%] participants vs 105 [7%]; adjusted common odds ratio [cOR] 0·90, 95% CI 0·67–1·20, p=0·47). By contrast, intensive antiplatelet therapy was associated with more, and more severe, bleeding (adjusted cOR 2·54, 95% CI 2·05–3·16, p<0·0001). Interpretation: Among patients with recent cerebral ischaemia, intensive antiplatelet therapy did not reduce the incidence and severity of recurrent stroke or TIA, but did significantly increase the risk of major bleeding. Triple antiplatelet therapy should not be used in routine clinical practice

    In Vivo Expression of MHC Class I Genes Depends on the Presence of a Downstream Barrier Element

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    Regulation of MHC class I gene expression is critical to achieve proper immune surveillance. In this work, we identify elements downstream of the MHC class I promoter that are necessary for appropriate in vivo regulation: a novel barrier element that protects the MHC class I gene from silencing and elements within the first two introns that contribute to tissue specific transcription. The barrier element is located in intergenic sequences 3′ to the polyA addition site. It is necessary for stable expression in vivo, but has no effect in transient transfection assays. Accordingly, in both transgenic mice and stably transfected cell lines, truncation of the barrier resulted in transcriptional gene silencing, increased nucleosomal density and decreased histone H3K9/K14 acetylation and H3K4 di-methylation across the gene. Significantly, distinct sequences within the barrier element govern anti-silencing and chromatin modifications. Thus, this novel barrier element functions to maintain transcriptionally permissive chromatin organization and prevent transcriptional silencing of the MHC class I gene, ensuring it is poised to respond to immune signaling

    Three Novel Downstream Promoter Elements Regulate MHC Class I Promoter Activity in Mammalian Cells

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    BACKGROUND: MHC CLASS I TRANSCRIPTION IS REGULATED BY TWO DISTINCT TYPES OF REGULATORY PATHWAYS: 1) tissue-specific pathways that establish constitutive levels of expression within a given tissue and 2) dynamically modulated pathways that increase or decrease expression within that tissue in response to hormonal or cytokine mediated stimuli. These sets of pathways target distinct upstream regulatory elements, have distinct basal transcription factor requirements, and utilize discrete sets of transcription start sites within an extended core promoter. METHODOLOGY/PRINCIPAL FINDINGS: We studied regulatory elements within the MHC class I promoter by cellular transfection and in vitro transcription assays in HeLa, HeLa/CIITA, and tsBN462 of various promoter constructs. We have identified three novel MHC class I regulatory elements (GLE, DPE-L1 and DPE-L2), located downstream of the major transcription start sites, that contribute to the regulation of both constitutive and activated MHC class I expression. These elements located at the 3' end of the core promoter preferentially regulate the multiple transcription start sites clustered at the 5' end of the core promoter. CONCLUSIONS/SIGNIFICANCE: Three novel downstream elements (GLE, DPE-L1, DPE-L2), located between +1 and +32 bp, regulate both constitutive and activated MHC class I gene expression by selectively increasing usage of transcription start sites clustered at the 5' end of the core promoter upstream of +1 bp. Results indicate that the downstream elements preferentially regulate TAF1-dependent, relative to TAF1-independent, transcription

    Density of routinely collected neurology data depends on patient visit type : an investigation using the observational medical outcomes partnership common data model

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    Background: The Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) is a standardised framework for organising healthcare data. This study uses data in the OMOP CDM format to analyse information on neurology patients. Methods: Routinely collected data harmonised to OMOP at a large referral hospital in England were used. A study cohort was defined as patients who attended at least one neurology outpatient appointment between 01 April 2022 and 31 March 2023 (n=23 862). Data collected at all visits to the hospital made by this cohort between 01 April 2021 and 31 March 2024 were extracted. The cohort was then divided into four subcohorts according to appointment types attended: outpatient appointment(s) only (n=15 2); outpatient appointment(s) and inpatient stay(s) (n=2750); outpatient appointment(s) and emergency department attendance(s) (n=1658); outpatient appointment(s), inpatient stay(s) and emergency department attendance(s) (n=4199). Results: We found there to be more data available for patients who had at least one inpatient stay or emergency department attendance than for those with only outpatient appointments. Notably, an average of 0 out of 100 patients in the outpatient only subcohort had a record of a condition, compared with 100 out of 100 patients in the subcohort with outpatient appointments, emergency attendances and inpatient stays. Conclusions: Neurology outpatients have far less data recorded than inpatients or patients attending emergency departments. This disparity arises from the lack of outpatient diagnostic coding and impairs the advancement of research in this area. Using the OMOP CDM structure makes it easy to highlight these differences
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