An Introduction to Local and Global Health Behaviors Using a Collaborative Online International Learning Exchange

Collaborative Online International Learning (COIL), uses technology to facilitate the engagement of students from different countries in collaborative coursework and sharing of cultural perspectives. The existing literature concerning COIL exchanges points to the need to further explore student satisfaction and engagement with such exchange projects, and whether course learning outcomes are being achieved. This practice paper describes a COIL exchange between students of health psychology at Mary Immaculate College, Ireland, and Sacred Heart University, in the United States. During this 10-week project students were required to engage in synchronous and asynchronous activities. Following the completion of the COIL project, students were given a questionnaire to assess their course satisfaction and whether learning outcomes were achieved. Findings indicate that students were satisfied with the exchange and learning outcomes were met. Overall, COIL may serve as another teaching approach to help students learn course specific material, understand multicultural viewpoints, and enhance their professional skill set

Subjective and Objective Assessment of Taste and Smell Sensation in Advanced Cancer

Context: Taste and smell abnormalities (TSA) occur throughout the cancer trajectory regardless of cancer primary site and contribute to cancer-associated malnutrition. TSA etiology is poorly understood. Tumor-related inflammation is a possible cause. Objective: This study examined the prevalence, characteristics, and severity of TSA in advanced cancer and explored the relationship between TSA and nutritional status. No previous study combined subjective and objective measures for both taste and smell assessment in this population. Method: Consecutive advanced cancer hospice patients were recruited. A modified version of the “Taste and Smell Survey” assessed subjective TSA. Validated taste strips and “Sniffin’ Sticks” were the objective measures. The abridged patient-generated subjective global assessment evaluated nutritional status. Results: A 93% prevalence of TSA in 30 patients with advanced cancer was identified. When subjective and objective evaluations were combined, 28 had taste abnormalities, 24 smell abnormalities, and 24 both. Taste changes included “persistent bad taste” (n ¼ 18) and changes in how basic tastes were perceived. Half reported smell was not “as strong” as prediagnosis, while more than half (n ¼ 16) had an objective smell abnormality. Most (97%) were at risk of malnutrition. Fatigue, dry mouth, early satiety, and anorexia were common nutrition-impact symptoms. No statistically significant relationship was found between TSA and malnutrition scores. Conclusions: TSA were highly prevalent. Subjective taste and smell changes did not always accord with objective TSA, suggesting both assessments are valuable. TSA characteristics varied, and particular foods tasted and smelled different and were not enjoyed as before. TSA are common, high-impact problems in advanced cancer

Global MYCN Transcription Factor Binding Analysis in Neuroblastoma Reveals Association with Distinct E-Box Motifs and Regions of DNA Hypermethylation

BACKGROUND: Neuroblastoma, a cancer derived from precursor cells of the sympathetic nervous system, is a major cause of childhood cancer related deaths. The single most important prognostic indicator of poor clinical outcome in this disease is genomic amplification of MYCN, a member of a family of oncogenic transcription factors. METHODOLOGY: We applied MYCN chromatin immunoprecipitation to microarrays (ChIP-chip) using MYCN amplified/non-amplified cell lines as well as a conditional knockdown cell line to determine the distribution of MYCN binding sites within all annotated promoter regions. CONCLUSION: Assessment of E-box usage within consistently positive MYCN binding sites revealed a predominance for the CATGTG motif (p\u3c0.0016), with significant enrichment of additional motifs CATTTG, CATCTG, CAACTG in the MYCN amplified state. For cell lines over-expressing MYCN, gene ontology analysis revealed enrichment for the binding of MYCN at promoter regions of numerous molecular functional groups including DNA helicases and mRNA transcriptional regulation. In order to evaluate MYCN binding with respect to other genomic features, we determined the methylation status of all annotated CpG islands and promoter sequences using methylated DNA immunoprecipitation (MeDIP). The integration of MYCN ChIP-chip and MeDIP data revealed a highly significant positive correlation between MYCN binding and DNA hypermethylation. This association was also detected in regions of hemizygous loss, indicating that the observed association occurs on the same homologue. In summary, these findings suggest that MYCN binding occurs more commonly at CATGTG as opposed to the classic CACGTG E-box motif, and that disease associated over expression of MYCN leads to aberrant binding to additional weaker affinity E-box motifs in neuroblastoma. The co-localization of MYCN binding and DNA hypermethylation further supports the dual role of MYCN, namely that of a classical transcription factor affecting the activity of individual genes, and that of a mediator of global chromatin structure

A time-kill assay study on the synergistic bactericidal activity of pomegranate rind extract and Zn (II) against Methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, Escherichia coli, and Pseudomonas aeruginosa

There is a need for new antimicrobial systems due to increased global resistance to current antimicrobials. Pomegranate rind extract (PRE) and Zn (II) ions both possess a level of antimicrobial activity and work has previously shown that PRE/Zn (II) in combination possesses synergistic activity against Herpes simplex virus and Micrococcus luteus. Here, we determined whether such synergistic activity extended to other, more pathogenic, bacteria. Reference strains of methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, Escherichia coli, and Pseudomonas aeruginosa were cultured and subjected to challenge by PRE, Zn (II), or PRE + Zn (II), in time-kill assays. Data were obtained independently by two researchers using different PRE preparations. Statistically significant synergistic activity for PRE + Zn (II) was shown for all four bacterial strains tested compared to untreated controls, although the extent of efficacy and timescales varied. Zn (II) exerted activity and at 1 h, it was not possible to distinguish with PRE + Zn (II) combination treatment in all cases. PRE alone showed low activity against all four bacteria. Reproducible synergistic bactericidal activity involving PRE and Zn (II) has been confirmed. Potential mechanisms are discussed. The development of a therapeutic system that possesses demonstrable antimicrobial activity is supported which lends itself particularly to topical delivery applications, for example MRSA infections

Maternal outcomes and risk factors for COVID-19 severity among pregnant women.

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Individual differences in the impact of attentional bias training on cardiovascular responses to stress

Introduction. The present research examines the effect of threat-related attentional bias - the tendency to direct attention towards information in the environment that is threatening or negative -on anxiety responses to stress. Three methodological refinements were incorporated to help advance understanding of the effects of threat-related attentional bias on anxiety responses when exposed to stress. Firstly, attentional bias for threat-related information was experimentally manipulated prior to stress exposure in order to examine the direction of the relationship between threat-related attentional bias and anxiety responding to stress. Secondly, physiological indices of anxiety, in the form of cardiovascular parameters, were employed to provide objective measurement of anxiety responses to stress, thereby addressing the existing reliance in the literature on subjective measures of anxiety (i.e., self-report measures). Thirdly, individual differences in personality were examined in order to assess the influence, if any, of individual temperaments on the adoption of an attentional bias and on subsequent anxiety responding when presented with a stress task. Methods. Three empirical studies are reported. In a sample of 77 female college students, Study 1 examined the influence of an attentional bias intervention that trained attention either towards or away from threatening linguistic stimuli on anxiety responses to a stress task, and considered the role of individual differences in personality on this effect. In Study 2, in order to address limitations in ecological validity associated with linguistic stimuli, a sample of 68 female college students completed an attention training protocol involving emotionally positive and emotionally threatening photorealistic facial stimuli before completing a standard stress task. In Study 3, 80 female college students were presented with an attention training protocol similar to that employed in Study 1 but in which the linguistic stimuli were replaced with photorealistic facial stimuli. Results. Study 1 indicated that attentional bias manipulation causally affected physiological indices of anxiety responding to stress. Participants with high neuroticism who completed the negative training intervention and participants with low neuroticism who completed the anti-negative training intervention showed increased systolic blood pressure responding to stress. When neuroticism was replaced with psychoticism in the analyses, the same pattern of findings was evident. In Study 2, priming participants with emotionally threatening facial images causally affected their subsequent anxiety response to stress. Individual differences in psychoticism, but not neuroticism, determined the precise nature of these effects. In Study 3, there was no effect of training on anxiety responses to stress but participants¿ responses to the protocol in general were again dependent on individual differences in personality. A vascular hemodynamic response profile was evident for participants with high neuroticism in response to the stress task and for participants with high psychoticism at the post-intervention time point prior to the stressor. Conclusions. The findings affirm cognitive approaches to anxiety which suggest that an attentional bias for threat-related information is a causal factor in the experience of exaggerated anxiety responding to stress. Anxiety responding to stress in those who were trained to attend towards threatening information as compared to those trained to direct their attention away from threatening information was only seen to differ when both individual differences in personality and physiological variables were considered. As such, between-group differences in anxiety were evident for physiological but not for self-report measures of anxiety and were contingent on individual differences in personality. These findings highlight the importance of individual differences and physiological variables in establishing the relationship between threat-related attentional bias and exaggerated anxiety responding to stress

Description of factors associated with medication errors in an HIV ambulatory care setting (DEFEAT Study)

Objective: The purpose of the DEFEAT Study was to better characterize medication errors in patients infected with HIV and identify the risk factors associated with these errors. Method: The DEFEAT Study was cross-sectional by design. Pharmacists conducted patient interviews in order to obtain best possible medication histories. Two pharmacists independently evaluated the medication profiles of each patient for therapeutic appropriateness. Medication errors were classified by severity using the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Index for Categorizing Medication Errors. Risk factors for the number of errors per patient were identified using Poisson regression. Risk factors for error severity were identified using a proportional odds model. Results: Pharmacists interviewed 151 patients and identified a total of 1,699 errors; 224 errors reached patients, of which 133 required intervention. Possible risk factors included certain medication classes, such as chemotherapy, erectile dysfunction drugs, inhalers and anti-infectives; the number of concomitant medications; the number of over-the-counter products; years since HIV diagnosis; history of cardiovascular disease; and collecting prescriptions from more than one pharmacy. Conclusions: In this sample of ambulatory patients with HIV, pharmacists identified a high number of medication errors that reached patients. Further research will focus on developing systems-based approaches to improve medication safety practices.Objectif: L'objectif de l'étude DEFEAT est de mieux définir les erreurs de médication chez les patients infectés par le VIH, et d'identifier les facteurs de risque associés à ces erreurs. Méthode: Des pharmaciens ont fait des entrevues avec les patients pour obtenir la meilleure histoire médicamenteuse possible. Deux pharmaciens ont indépendamment évalué les profils médicamenteux de chaque patient pour vérifier leur conformité aux indications thérapeutiques. Les erreurs médicamenteuses ont été classées par ordre de sévérité en utilisant l'index de catégorisation des erreurs médicamenteuses du « Conseil National pour le signalement et la prévention des erreurs médicamenteuses » (Le NCC MERP). Les facteurs de risque pour le nombre d'erreurs par patient ont été identifiés en utilisant la régression Poisson. Les facteurs de risque pour la sévérité des erreurs ont été identifiés en utilisant un modèle chance proportionné. Résultats: Les pharmaciens ont interrogé 151 patients, et identifié un total de 1699 erreurs; 224 erreurs s'étendaient aux patients, dont 133 ont nécessité une intervention. Les facteurs de risque possibles incluaient certaines classes de médicaments, tels ceux utilisés en chimiothérapie, pour les dysfonctions érectiles, les inhalateurs et anti-infectieux, le nombre de médicaments concomitants, le nombre de produit vente libre, le nombre d'années écoulées depuis le diagnostic de VIH, histoire de maladie cardio-vasculaire, et le fait d'avoir des prescriptions dans plus d'une pharmacie. Conclusions: Dans cet échantillon de patients infectés par le VIH, les pharmaciens ont identifié un nombre élevé d'erreurs médicamenteuses atteignant les patients. Des recherches plus poussées se concentreront sur le développement d'approches basées par système pour améliorer les pratiques de médications sécuritaires

Twenty Years of Collaboration to Sort out Phage Mu Replication and Its Dependence on the Mu Central Gyrase Binding Site

For 20 years, the intricacies in bacteriophage Mu replication and its regulation were elucidated in collaboration between Ariane Toussaint and her co-workers in the Laboratory of Genetics at the Université Libre de Bruxelles, and the groups of Martin Pato and N. Patrick Higgins in the US. Here, to honor Martin Pato's scientific passion and rigor, we tell the history of this long-term sharing of results, ideas and experiments between the three groups, and Martin's final discovery of a very unexpected step in the initiation of Mu replication, the joining of Mu DNA ends separated by 38 kB with the assistance of the host DNA gyrase.SCOPUS: ed.jinfo:eu-repo/semantics/publishe