High fidelity full sized human patient simulation manikins: Effects on decision making skills of nursing students

Background: The continued use of high fidelity full sized human patient simulation manikins (HF-HPSMs) for developing decision making skills of nursing students has led to growing research focusing its value on student learning and decision making skills. Methods: In October 2012, a cross-sectional survey using the 24-item Nurse Decision-Making Instrument was used to explore the decision making process of 232 pre-registration nursing students (age 22.0 + 5.4; 83.2% female) in Singapore. Results: The independent samples t-tests demonstrated three significant predictive indicators. These indicators include: prior experience in high fidelity simulation based on pre-enrolled nursing course (t = 70.6, p = .001), actual hands-on practice (t = 69.66, p < .005) and active participation in debrief (t = 70.11, p < .005). A complete experience based on role-playing followed by active discussion in debrief was a significant contributor to the decision making process (t = 73.6667, p < .005). However, the regression model indicated active participation in debrief as a significant variable which explained its development (t = 12.633, p < .005). Conclusions: This study demonstrated the usefulness of active participation in simulation learning for an analytic- intuitive approach to decision making, however active participation in debrief was a more important influencing element than role-playing. In situations where resources are limited for students to experience hands-on role-playing, peer reviewing and feedback on others’ experiences could benefit students, just as much. However, further study is warranted to determine the development of HF-HPSMs as a pedagogic tool for enhancing the decision making process of nursing students

Dietary treatment of Crohn’s disease: perceptions of families with children treated by exclusive enteral nutrition, a questionnaire survey

Background: Diet is strongly associated with the aetiology of Crohn’s Disease (CD) and exclusive enteral nutrition (EEN) is the primary induction treatment in paediatric CD. This study explored opinions around the use of EEN and alternative novel, solid food-based diets (SFDs) expressed by paediatric patients with CD, previously treated with EEN and their parents. Methods: This anonymous questionnaire surveyed families of CD patients treated with EEN over 1 year. Two questionnaire forms were completed; one asking the patients’ opinions and another referring to their main carer. This questionnaire explored participants’ demographic characteristics; acceptability of a repeat EEN course to treat a future flare (EEN repeat); their opinion on how difficult EEN would be compared to an example SFD; and their intention to participate in a future clinical trial assessing the therapeutic efficacy of an SFD in CD. Results: Forty-one families of CD patients were approached with 29 sending replies (71%). Most of our participants were positive on completing another EEN course, however the majority would choose an SFD alternative (Patients: 66, Parents:72%). Both patients and their parents rated EEN to be more difficult to adhere to compared to an example SFD (p < 0.05), and their ratings were strongly correlated (EEN:r = 0.83, SFD:r = 0.75, p < 0.001). The majority of our respondents would agree to participate in a clinical trial assessing an SFD’s effectiveness (Patients:79, Parents:72%) for the management of active CD. Conclusions: While patients with CD and their families would accept an EEN repeat, the majority would prefer an SFD alternative. CD families surveyed are supportive of the development of solid food-based dietary treatments

Antibody-Based Ticagrelor Reversal Agent in Healthy Volunteers.

BACKGROUND: Ticagrelor is an oral P2Y12 inhibitor that is used with aspirin to reduce the risk of ischemic events among patients with acute coronary syndromes or previous myocardial infarction. Spontaneous major bleeding and bleeding associated with urgent invasive procedures are concerns with ticagrelor, as with other antiplatelet drugs. The antiplatelet effects of ticagrelor cannot be reversed with platelet transfusion. A rapid-acting reversal agent would be useful. METHODS: In this randomized, double-blind, placebo-controlled, phase 1 trial, we evaluated intravenous PB2452, a monoclonal antibody fragment that binds ticagrelor with high affinity, as a ticagrelor reversal agent. We assessed platelet function in healthy volunteers before and after 48 hours of ticagrelor pretreatment and again after the administration of PB2452 or placebo. Platelet function was assessed with the use of light transmission aggregometry, a point-of-care P2Y12 platelet-reactivity test, and a vasodilator-stimulated phosphoprotein assay. RESULTS: Of the 64 volunteers who underwent randomization, 48 were assigned to receive PB2452 and 16 to receive placebo. After 48 hours of ticagrelor pretreatment, platelet aggregation was suppressed by approximately 80%. PB2452 administered as an initial intravenous bolus followed by a prolonged infusion (8, 12, or 16 hours) was associated with a significantly greater increase in platelet function than placebo, as measured by multiple assays. Ticagrelor reversal occurred within 5 minutes after the initiation of PB2452 and was sustained for more than 20 hours (P\u3c0.001 after Bonferroni adjustment across all time points for all assays). There was no evidence of a rebound in platelet activity after drug cessation. Adverse events related to the trial drug were limited mainly to issues involving the infusion site. CONCLUSIONS: In healthy volunteers, the administration of PB2452, a specific reversal agent for ticagrelor, provided immediate and sustained reversal of the antiplatelet effects of ticagrelor, as measured by multiple assays. (Funded by PhaseBio Pharmaceuticals; ClinicalTrials.gov number, NCT03492385.)

Anatomic brain asymmetry in vervet monkeys.

Asymmetry is a prominent feature of human brains with important functional consequences. Many asymmetric traits show population bias, but little is known about the genetic and environmental sources contributing to inter-individual variance. Anatomic asymmetry has been observed in Old World monkeys, but the evidence for the direction and extent of asymmetry is equivocal and only one study has estimated the genetic contributions to inter-individual variance. In this study we characterize a range of qualitative and quantitative asymmetry measures in structural brain MRIs acquired from an extended pedigree of Old World vervet monkeys (n = 357), and implement variance component methods to estimate the proportion of trait variance attributable to genetic and environmental sources. Four of six asymmetry measures show pedigree-level bias and one of the traits has a significant heritability estimate of about 30%. We also found that environmental variables more significantly influence the width of the right compared to the left prefrontal lobe

Building trust in real-world data: lessons from INSIGHT, the UK's health data research hub for eye health and oculomics

PURPOSE OF REVIEW: In this review, we consider the challenges of creating a trusted resource for real-world data in ophthalmology, based on our experience of establishing INSIGHT, the UK's Health Data Research Hub for Eye Health and Oculomics. RECENT FINDINGS: The INSIGHT Health Data Research Hub maximizes the benefits and impact of historical, patient-level UK National Health Service (NHS) electronic health record data, including images, through making it research-ready including curation and anonymisation. It is built around a shared 'north star' of enabling research for patient benefit. INSIGHT has worked to establish patient and public trust in the concept and delivery of INSIGHT, with efficient and robust governance processes that support safe and secure access to data for researchers. By linking to systemic data, there is an opportunity for discovery of novel ophthalmic biomarkers of systemic diseases ('oculomics'). Datasets that provide a representation of the whole population are an important tool to address the increasingly recognized threat of health data poverty. SUMMARY: Enabling efficient, safe access to routinely collected clinical data is a substantial undertaking, especially when this includes imaging modalities, but provides an exceptional resource for research. Research and innovation built on inclusive real-world data is an important tool in ensuring that discoveries and technologies of the future may not only favour selected groups, but also work for all patients

Protocol of the PLeural Effusion and Symptom Evaluation (PLEASE) study on the pathophysiology of breathlessness in patients with symptomatic pleural effusions

Introduction: Pleural effusion is a common clinical problem that can complicate many medical conditions. Breathlessness is the most common symptom of pleural effusion of any cause and the most common reason for pleural drainage. However, improvement in breathlessness following drainage of an effusion is variable; some patients experience either no benefit or a worsening of their breathlessness. The physiological mechanisms underlying breathlessness in patients with a pleural effusion are unclear and likely to be multifactorial with patient-related and effusion-related factors contributing. A comprehensive study of the physiological and symptom responses to drainage of pleural effusions may provide a clearer understanding of these mechanisms, and may identify predictors of benefit from drainage. The ability to identify those patients whose breathlessness will (or will not) improve after pleural fluid drainage can help avoid unnecessary pleural drainage procedures, their associated morbidities and costs. The PLeural Effusion And Symptom Evaluation (PLEASE) study is a prospective study to comprehensively evaluate factors contributing to pleural effusion-related breathlessness. Methods and analysis: The PLEASE study is a single-centre prospective study of 150 patients with symptomatic pleural effusions that require therapeutic drainage. The study aims to identify key factors that underlie breathlessness in patients with pleural effusions and develop predictors of improvement in breathlessness following effusion drainage. Participants will undergo evaluation pre-effusion and post-effusion drainage to assess their level of breathlessness at rest and during exercise, respiratory and other physiological responses as well as respiratory muscle mechanics. Pre-drainage and post-drainage parameters will be collected and compared to identify the key factors and mechanisms that correlate with improvement in breathlessness. Ethics and dissemination: Approved by the Sir Charles Gairdner Group Human Research Ethics Committee (HREC number 2014-079). Registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000820404). Results will be published in peer-reviewed journals and presented at scientific meetings

Probing the Intermediate-Age Globular Clusters in NGC 5128 from Ultraviolet Observations

We explore the age distribution of the globular cluster (GC) system of the nearby elliptical galaxy NGC 5128 using ultraviolet (UV) photometry from Galaxy Evolution Explorer (GALEX) observations, with UV - optical colors used as the age indicator. Most GCs in NGC 5128 follow the general trends of GCs in M31 and Milky Way in UV - optical color-color diagram, which indicates that the majority of GCs in NGC 5128 are old similar to the age range of old GCs in M31 and Milky Way. A large fraction of spectroscopically identified intermediate-age GC (IAGC) candidates with ~ 3-8 Gyr are not detected in the FUV passband. Considering the nature of intermediate-age populations being faint in the far-UV (FUV) passband, we suggest that many of the spectroscopically identified IAGCs may be truly intermediate in age. This is in contrast to the case of M31 where a large fraction of spectroscopically suggested IAGCs are detected in FUV and therefore may not be genuine IAGCs but rather older GCs with developed blue horizontal branch stars. Our UV photometry strengthens the results previously suggesting the presence of GC and stellar subpopulation with intermediate age in NGC 5128. The existence of IAGCs strongly indicates the occurrence of at least one more major star formation episode after a starburst at high redshift.Comment: 8 pages, 3 figures, accepted for ApJ Lette

Lyman alpha emitting galaxies at 0.2 < z < 0.35 from GALEX spectroscopy

The GALEX (Galaxy Evolution Explorer) spectroscopic survey mode, with a resolution of about 8 A in the FUV (1350 - 1750 A) and about 20 A in the NUV (1950 - 2750 A) is used for a systematic search of Ly-a emitting galaxies at low redshift. This aims at filling a gap between high-redshift surveys and a small set of objects studied in detail in the nearby universe. A blind search of 7018 spectra extracted in 5 deep exposures (5.65 sq.deg) has resulted in 96 Ly-a emitting galaxy candidates in the FUV domain, after accounting for broad-line AGNs. The Ly-a EWs (equivalent width) are consistent with stellar population model predictions and show no trends as a function of UV color or UV luminosity, except a possible decrease in the most luminous that may be due to small-number statistics. Their distribution in EW is similar to that at z about 3 but their fraction among star-forming galaxies is smaller. Avoiding uncertain candidates, a sub-sample of 66 objects in the range 0.2 < z < 0.35 has been used to build a Ly-a LF (luminosity function). The incompleteness due to objects with significant Ly-a emission but a UV continuum too low for spectral extraction has been evaluated. A comparison with H-a LF in the same redshift domain is consistent with an average Ly-a/H-a of about 1 in about 15 % of the star-forming galaxies. A comparison with high-redshift Ly-a LFs implies an increase of the Ly-a luminosity density by a factor of about 16 from z about 0.3 to z about 3. By comparison with the factor 5 increase of the UV luminosity density in the same redshift range, this suggests an increase of the average Ly-a escape fraction with redshift.Comment: 18 pages, 9 figures, accepted for publication in Ap