Detailed systematic analysis of recruitment strategies in randomised controlled trials in patients with an unscheduled admission to hospital

ObjectivesTo examine the design and findings of recruitment studies in randomised controlled trials (RCTs) involving patients with an unscheduled hospital admission (UHA), to consider how to optimise recruitment in future RCTs of this nature.DesignStudies within the ORRCA database (Online Resource for Recruitment Research in Clinical TriAls;www.orrca.org.uk) that reported on recruitment to RCTs involving UHAs in patients &gt;18 years were included. Extracted data included trial clinical details, and the rationale and main findings of the recruitment study.ResultsOf 3114 articles populating ORRCA, 39 recruitment studies were eligible, focusing on 68 real and 13 hypothetical host RCTs. Four studies were prospectively planned investigations of recruitment interventions, one of which was a nested RCT. Most recruitment papers were reports of recruitment experiences from one or more ‘real’ RCTs (n=24) or studies using hypothetical RCTs (n=11). Rationales for conducting recruitment studies included limited time for informed consent (IC) and patients being too unwell to provide IC. Methods to optimise recruitment included providing patients with trial information in the prehospital setting, technology to allow recruiters to cover multiple sites, screening logs to uncover recruitment barriers, and verbal rather than written information and consent.ConclusionThere is a paucity of high-quality research into recruitment in RCTs involving UHAs with only one nested randomised study evaluating a recruitment intervention. Among the remaining studies, methods to optimise recruitment focused on how to improve information provision in the prehospital setting and use of screening logs. Future research in this setting should focus on the prospective evaluation of the well-developed interventions to optimise recruitment.</jats:sec

Serious mental health diagnoses in children on the child protection register: a record linkage study.

Children with experience of maltreatment, abuse or neglect are known to have a higher prevalence of poor mental health. Child Protection Services identify children most at risk of harm and in need of intervention. Mental healthcare usage in this population is not well understood as registration data is not routinely linked to health records. We undertook data linkage to describe the population on the register, their mental healthcare usage and to calculate age- and sex-specific incidence rates of mental health outcomes. We analysed records from the Aberdeen City Council Child Protection Register and for mental health prescribing and referrals to child and adolescent mental health services (CAMHS) for the NHS Grampian region between 1st January 2012 and 31st December 2022. We identified 1,498 individuals with a Child Protection Register registration, of which 70% were successfully matched to health records. 20% of registrations occurred before birth and the median age of registration was 3 years. 10.1% of children with a registration ever received a mental health prescription, 5.1% for treatment of attention deficit hyperactivity disorder and 1.7% for treatment of depression. 18.9% received a referral to specialist outpatient Child and Adolescent Mental Health Services. Age- and sex- standardised incidence rates for mental health prescribing and referrals are higher for children with a child protection registration compared to the general population. Children identified as being at significant risk of harm and involved with child protection services are at greater risk of seeking or receiving professional mental health support than their peers. Clinical services should investigate additional ways to support this population’s mental well-being as a priority. Efforts to reduce the exposure of children to potentially harmful environments at a societal level should also be pursued

Comparing Common Techniques for Calculating Parasite Prevalence

Raccoons (Procyon lotor) are the final host for raccoon roundworms (Baylisascaris procyonis). Raccoon roundworm is the leading cause of a dangerous neurological disease, known as larva migrans encephalopathy. Diagnostic tools for detecting the presence of B. procyonis within a raccoon population include necropsy, fecal flotation, and latrine analysis. Necropsies yield the highest measure of prevalence, with fecal flotation and latrine analysis often underestimating infection rates. We necropsied 225 raccoons gathered from 10 townships of Clark and Greene Counties in Ohio. We collected fecal samples from 95 raccoons negative for B. procyonis at necropsy. We suspended the feces in Sheather’s solution to float any eggs, and prepared slides from this solution. Nearly 14% of raccoons negative at necropsy for B. procyonis possessed eggs in their feces. We used a chi squared test for equality of distributions to determine the likelihood that a positive fecal analysis is related to B. procyonis prevalence or to the area in which the raccoon was trapped. These data will help us determine how well fecal analyses estimate parasite prevalence

Does Baylisascaris procyonis Phylogeny Correlate with That of the Raccoon (Procyon lotor)

Baylisacaris procyonis, commonly known as the raccoon roundworm, is a parasite that inhabits the small intestine of the North American raccoon (Procyon lotor). Although humans do not typically become the definitive host, humans can become infected through handling soil containing eggs. B. procyonis can induce serious health complications in cases of human infection, including degenerative retinal and behavioral changes, coma, and even death. High prevalence of B. procyonis in a raccoon population increases the probability of transference to human hosts. In our study, we analyzed the genetic structure of B. procyonis harvested from raccoons of southwestern Ohio, and compared this to the genetic structure of the raccoons they inhabited. It is our hypothesis that the genetic structuring of the roundworms is the same as the genetic structuring of the raccoons. We isolated DNA from the roundworms using the method outlined in the DNA Minikit (Qiagen). Our research team isolated DNA from each roundworm sample and sent it to the Plant-Microbe Genomics Facility at The Ohio State University for gene amplification and sequencing. We built phylogenetic trees using these sequences, and compared these trees to some constructed for the raccoons. The correlations drawn between the raccoon and B. procyonis phylogenetic trees will help us better understand the relationship between the two species

Baylisascaris procyonis Impacts Raccoon (Procyon lotor) Diets

Raccoons (Procyon lotor) are the definitive host for raccoon roundworms (Baylisascaris procyonis). Raccoon roundworm is responsible for a dangerous neurological disease known as larva migrans encephalopathy. Raccoons are omnivorous animals and rely on various food items. Dietary analyses help determine how a raccoon changes its diet in response to environmental features. Raccoons eat whatever food resource is most convenient and abundant. Parasite infections can potentially affect host eating habits in order to keep the host alive and active longer. In this study, we analyzed the diets of necropsied raccoons from ten townships of Clark and Greene Counties by examining their stomach contents. We categorized stomach contents by separating out plant material, vertebrate tissue, and invertebrate tissue. We measured the total stomach mass and the mass of plant material alone in order to compare and obtain a percentage of plant material in the raccoons’ diet. We conducted two chi-squared tests for equality of distributions. We tested the null hypotheses that raccoons from townships with high prevalence (\u3e60%) have the same vertebrate tissue and plant tissue prevalence as raccoons from townships with low roundworm prevalence

Does Baylisascaris procyonis Impact Raccoon (Procyon lotor) Genetics?

Raccoons (Procyon lotor) are the final host for raccoon roundworms (Baylisascaris procyonis). Raccoon roundworm is the leading cause of a dangerous neurological disease, known as larva migrans encephalopathy. Phylogenetic trees illustrate co-evolutionary events between species living in a symbiotic relationship with each other. Throughout the coevolution of host and parasite, many aspects of a population affect the way the members interact with one another and with symbiotic species. In order to evaluate the relationship between host and parasite in regards to diet, we isolated DNA from intestinal wall tissue, amplified a portion of exon 2 from MHC II, and sent our samples to Ohio State University for sequencing. We calculated heterozygosities for the nine townships we surveyed. We used a chi-squared test for equality of distributions to test whether raccoons from townships with above 60% prevalence have different heterozygosity for this locus than other raccoons. These data will help us to understand the relationship between raccoons and raccoon roundworm

Baylisascaris procyonis prevalence in raccoons (Procyon lotor) and its relation to landscape features

Raccoons (Procyon lotor) are the final host for raccoon roundworm (Baylisascaris procyonis). Raccoon roundworm is the leading cause of a dangerous neurological disease known as larva migrans encephalopathy. Land fragmentation occurs when natural environments are broken up by urban or agricultural landscapes. Raccoons thrive in urban environments, while raccoons in agricultural settings forage over larger areas than raccoons in urban settings do. Land fragmentation affects concentrations of B. procyonis parasites in intermediate hosts. We calculated the prevalence of raccoon roundworm in 9 townships of Greene and Clark Counties by necropsying 226 raccoon intestines. Prevalence is defined as the number of raccoons infected with roundworm divided by the total number of raccoons sampled. We determined that the prevalence of B. procyonis from Beavercreek township is significantly lower than the other townships (χ2 = 25.19, p-value = 0.0007). Prevalence of raccoon roundworm in this region is lower than many areas in the Midwestern United States, suggesting the need for further research to determine reasons for the lower prevalence in the Ohio region

Mouse models of rhinovirus-induced disease and exacerbation of allergic airway inflammation

Rhinoviruses cause serious morbidity and mortality as the major etiological agents of asthma exacerbations and the common cold. A major obstacle to understanding disease pathogenesis and to the development of effective therapies has been the lack of a small-animal model for rhinovirus infection. Of the 100 known rhinovirus serotypes, 90% (the major group) use human intercellular adhesion molecule-1 (ICAM-1) as their cellular receptor and do not bind mouse ICAM-1; the remaining 10% (the minor group) use a member of the low-density lipoprotein receptor family and can bind the mouse counterpart. Here we describe three novel mouse models of rhinovirus infection: minor-group rhinovirus infection of BALB/c mice, major-group rhinovirus infection of transgenic BALB/c mice expressing a mouse-human ICAM-1 chimera and rhinovirus-induced exacerbation of allergic airway inflammation. These models have features similar to those observed in rhinovirus infection in humans, including augmentation of allergic airway inflammation, and will be useful in the development of future therapies for colds and asthma exacerbations

Pulling back the curtain on shocks and star formation in NGC 1266 with Gemini-NIFS

We present Gemini near-infrared integral field spectrograph K-band observations of the central 400 pc of NGC 1266, a nearby (D ≈ 30 Mpc) post-starburst galaxy with a powerful multiphase outflow and a shocked interstellar medium. We detect seven H2 rovibrational emission lines excited thermally to T ∼ 2000 K, and weak Brγ emission, consistent with a fast continuous shock (or C-shock). With these bright H2 lines, we observe the spatial structure of the shock with an unambiguous tracer for the first time. The Brγ emission is concentrated in the central ≲100 pc, indicating that any remaining star formation in NGC 1266 is in the nucleus, while the surrounding cold molecular gas has little ongoing star formation. Though it is unclear what fraction of this Brγ emission is from star formation or the active galactic nuclei (AGN), assuming it is entirely due to star formation we measure an instantaneous star formation rate of 0.7 M ⊙ yr−1, though the star formation rate may be significantly higher in the presence of additional extinction. NGC 1266 provides a unique laboratory to study the complex interactions between AGN, outflows, shocks, and star formation, all of which are necessary to unravel the evolution of the post-starburst phase