Primary care models for community-dwelling adults with long-term conditions: a scoping review protocol

Funding Information: The authors would like to acknowledge support from the PenCLAHRC Evidence Synthesis Team. Publisher Copyright: © 2019 Joanna Briggs Institute.Objective:This scoping review aims to map primary care models designed to support adults with long-term conditions. The review will analyze the following in relation to the models identified: characteristics, impact reported, implications for practice and outcome measures.Introduction:Robust solutions to support individuals with long-term conditions need to be established in order to increase health service capacity and provide cost-effective solutions while, most importantly, ensuring they receive the best services to live meaningful and productive lives.Inclusion criteria:The concept to be mapped is primary care models used to support adults living with long-term conditions. This may also encompass services not solely designed for people with long-term conditions; however, they will be services that may be the first port of call for this group. Operational a priori criteria have been designed to assist with distinguishing appropriate literature.Methods:Due to the nature of the scoping review, literature from a range of published and unpublished sources will be utilized from 1995 to 2019. Databases to be searched will include: MEDLINE, Embase, PsycINFO, HMIC, CINAHL, Cochrane Database of Systematic Reviews and Web of Science. Appropriate gray literature will be searched, alongside hand searching selected primary care journals, conference abstracts and professional and government bodies. Articles will be restricted to English. Titles and abstracts will be screened by two independent reviewers for assessment against the inclusion criteria. Charting of the data will include details about the population, concept, context, study methods and key findings relevant to the review objective.publishersversionPeer reviewe

Investigation of genome diversity in Antarctic Dry Valley soils

The McMurdo Dry Valleys of South Victoria Land, Antarctica contain some of the most extreme biotopes on earth; extreme to the extent they have long been considered valid Martian analogues. Life within Dry Valley mineral soils, where water contents range from 0.2-5.0% w/w and mean annual temperatures fall below -20 C, must further contend with desiccating winds, diurnal freeze-thaw cycles, and high seasonal UV radiation. Our knowledge to date of the microbiology of this biotope has been restricted to cultivation studies. This study sought to investigate microbial diversity in Antarctic Dry Valley soils using both cultivation and cultivation-independent techniques. Phylogenetically-informative ribosomal RNA gene libraries were generated from Archaea-, Bacteria- and Eukarya- specific PCR products amplified directly fro m DNA extracted from Dry Valley soils. This approach permits a more representative assessment of microbial diversity, as it circumvents the need for cultivation; it is estimated that only 0.1-10% of microorganisms in soil can be cultivated in vitro. Dry Valley soils were found to support a high diversity of bacterial species based upon the analysis of 16S rRNA gene clone sequences, the majority of which showed little similarity to previously cultivated bacteria. The diversity of Archaea and eukaryotes was reduced in comparison, and included members of the non- thermophilic Crenarchaeota and species of fungi respectively. To complement these molecular analyses, bacteria were also cultivated in vitro from Dry Valley soils. Additionally, functional gene diversity was investigated in these soils focusing on integrons and their associated gene cassettes. Using a PCR-based strategy, evidence was obtained for the presence of class 1 integrons in Antarctic soils. Furthermore, a unique aadA gene cassette encoding a streptomycin/spectinomycin adenyltransferase was recovered in this study. These data reveal Dry Valley soils to support a microbial community of considerable genetic diversity, and provide fresh insights into the role of integrons in pristine environments

Biodegradation of high-concentration isopropanol by a solvent-tolerant thermophile, Bacillus pallidus

The aerobic biodegradation of high-concentration, to 24 g l –1 , 2-propanol (IPA) by a thermophilic isolate ST3, identified as Bacillus pallidus , was successfully carried out for the first time. This solvent-tolerant B. pallidus utilized IPA as the sole carbon source within a minimal salts medium. Cultivation was carried out in 100-ml shake flasks at 60°C and compared with cultivation within a 1-l stirred tank reactor (STR). Specific growth rate () was about 0.2 h–1 for both systems, with a maximum cell density of 2.4 x 10 8 cells ml–1 obtained with STR cultivation. During exponential growth and stationary phase, IPA biodegradation rates were found to be 0.14 and 0.02 g l –1h–1, respectively, in shake-flask experiments, whereas corresponding values of 0.09 and 0.018 g l –1h–1 were achievable in the STR. Generation of acetone, the major intermediate in aerobic IPA biodegradation, was also monitored as an indicator of microbial IPA utilization. Acetone levels reached a maximum of 2.2–2.3 g l–1 after 72 and 58 h for 100-ml and 1-l systems, respectively. Both IPA and acetone were completely removed from the medium following 160 and 175 h, respectively, during STR growth, although this was not demonstrated within shake-flask reactions. Growth of B. pallidus on acetone or IPA alone demonstrated that the maximum growth rate () obtainable was 0.247 h–1 at 4 g l–1 acetone and 0.202 h–1 at 8 g l–1 IPA within shake-flask cultivation. These results indicate the potential of the solvent-tolerant thermophile B. pallidus ST3 in the bioremediation of hot solvent-containing industrial waste streams

Degradability of Biodegradable Soil Moisture Sensor Components and Their Effect on Maize (Zea mays L.) Growth

Inexpensive and no-maintenance biodegradable soil moisture sensors could improve existing knowledge on spatial and temporal variability of available soil water at field-scale. Such sensors can unlock the full potential of variable-rate irrigation (VRI) systems to optimize water applications in irrigated cropping systems. The objectives of this study were to assess (i) the degradation of soil moisture sensor component materials and (ii) the effects of material degradation on maize (Zea Mays L.) growth and development. This study was conducted in a greenhouse at Colorado State University, Colorado, USA, by planting maize seeds in pots filled with three growing media (field soil, silica sand, and Promix commercial potting media). The degradation rate of five candidate sensor materials (three blends of beeswax and soy wax, balsa wood, and PHBV (poly(3-hydroxybutyrate-co-3-hydroxyvalerate))) was assessed by harvesting sensor materials at four maize growth stages (30, 60, 90, and 120 days after transplanting). All materials under consideration showed stability in terms of mass and dimension except PHBV. PHBV was degraded entirely within 30 days in soil and Promix, and within 60 days in sand. Balsa wood did now show any significant reduction in mass and dimensions in all growth media. Similarly, there was no significant mass loss across wax blends (p = 0.05) at any growth stage, with a few exceptions. Among the wax blends, 3:1 (beeswax:soy wax) was the most stable blend in terms of mass and dimension with no surface cracks, making it a suitable encapsulant for soil sensor. All materials under consideration did not have any significant effect on maize growth (dry biomass, green biomass, and height) as compared to control plants. These results indicated that 3:1 beeswax:soy wax blend, PHBV, and balsa wood could be suitable candidates for various components of biodegradable soil moisture sensors. </div

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

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

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Recommendations for accelerating open preprint peer review to improve the culture of science

Peer review is an important part of the scientific process, but traditional peer review at journals is coming under increased scrutiny for its inefficiency and lack of transparency. As preprints become more widely used and accepted, they raise the possibility of rethinking the peer-review process. Preprints are enabling new forms of peer review that have the potential to be more thorough, inclusive, and collegial than traditional journal peer review, and to thus fundamentally shift the culture of peer review toward constructive collaboration. In this Consensus View, we make a call to action to stakeholders in the community to accelerate the growing momentum of preprint sharing and provide recommendations to empower researchers to provide open and constructive peer review for preprints

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

BACKGROUND: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. METHODS: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). FINDINGS: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29-146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0- 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25-1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39-1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65-1·60]; p=0·92). INTERPRETATION: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention. FUNDING: British Heart Foundation