Participating in CaMKIN : impact on patients

Introduction: Managing long-term health conditions is a global challenge, which has necessitated developing innovative ways to deliver patient centred care. Social media allow patients to access and share personal experiences and peer support, with potential to feed back into the patient-centred development and improvement of healthcare services. The Cheshire and Merseyside Kidney Information Network (CaMKIN) was established in 2019 as part of the Kidney Information Network (KIN), providing CKD patients 24-hour online access to information and support regarding their condition. Methods A novel digital method (Vasilica et al., 2021) of a dataset retrieved from a CaMKIN patient Facebook micro-community (1,119 posts and 5,266 comments), complemented by a survey (61 CaMKIN members). The digital methods steps involved a framework analysis to create themes and subthemes, directed analysis of data, familiarisation and sense making. Findings Analysis of data identified four major themes and an additional 13 subthemes of impact. Patients used the group to ‘improve understanding of their condition’ (theme 1) through sharing useful information, accessing information from lived experiences and organizing Q&A with health professionals. The micro-community formed a peer support network with both, in person and online peer to peer support. This support extended to ‘encouragement of self-management of health’ (theme 2), including managing diet and fitness. Group members created their own healthy choices weight loss accountability group, adopting a supportive ‘weight watchers’ style. They encouraged each other to take proactive steps in self-managing their health recommending people to contact renal team or ring emergency line where necessary. CaMKIN positively contributed to ‘improved health and wellbeing outcomes’ (theme 3), by providing a safe space to air frustrations, quell anxieties, and support each other’s mental health. This was important during the COVID_19 pandemic. CaMKIN provided patients a ‘safe environment, outside clinical settings’ (theme 4), to share and receive health information related to their kidney disease or treatment. Throughout the pandemic, the group discussed or clarified information (with professionals on the network), reducing demand on the local services through the self-organisation that occurred within the group. Survey results reinforced the Facebook dataset findings; most respondents benefited from access to health care information (86.9 %), which made them feel more informed about their condition (77.1%). Patients received valuable support from peers (75.4%). Almost half of respondents agreed that it reduced isolation and it contributed to management of mental health (48.8%). Conclusion This innovative micro-community helps CKD patients understand their condition better and improve health awareness through information sharing (peer and professionally developed) and peer support that contribute to increased self-management. Demonstrated through self-reported mechanisms, CaMKIN improved mental health and reduced social isolation. During the pandemic it offered patients a safe environment to develop understanding of the volatile situation to manage their health safely. The data provides insight into an untapped opportunity, recommendations include utilising the CAMKIN to further develop service provision and communication between hospitals and patients. Further research is required to roll out and evaluate embedding KIN into local service provision, and developing a patient network at a regional and national level

Keratinocyte growth factor in acute lung injury to reduce pulmonary dysfunction – a randomised placebo-controlled trial (KARE): study protocol

Abstract Background Acute lung injury is a common, devastating clinical syndrome associated with substantial mortality and morbidity with currently no proven therapeutic interventional strategy to improve patient outcomes. The objectives of this study are to test the potential therapeutic effects of keratinocyte growth factor for patients with acute lung injury on oxygenation and biological indicators of acute inflammation, lung epithelial and endothelial function, protease:antiprotease balance, and lung extracellular matrix degradation and turnover. Methods/design This will be a prospective, randomised, double-blind, allocation-concealed, placebo-controlled, phase 2, multicentre trial. Randomisation will be stratified by presence of severe sepsis requiring vasopressors. Patients in an ICU fulfilling the American–European Consensus Conference Definition of acute lung injury will be randomised in a 1:1 ratio to receive an intravenous bolus of either keratinocyte growth factor (palifermin, 60 μg/kg) or placebo (0.9% sodium chloride solution) daily for a maximum of 6 days. The primary endpoint of this clinical study is to evaluate the efficacy of palifermin to improve the oxygenation index at day 7 or the last available oxygenation index prior to patient discontinuation from the study.A formal statistical analysis plan has been constructed. Analyses will be carried out on an intention-to-treat basis. A single analysis is planned at the end of the trial. P = 0.05 will be considered statistically significant and all tests will be two-sided. For continuously distributed outcomes, differences between groups will be tested using independent-sample t tests, analysis of variance and analysis of covariance with transformation of variables to normality or nonparametric equivalents. The trial will be reported in line with the Consolidated Standards of Reporting Trials (Consort 2010 guidelines). Trial registration http://ISRCTN9569067

Are researchers deliberately bypassing the technology transfer office? An analysis of TTO awareness

Most universities committed to the commercialization of academic research have established technology transfer offices (TTOs). Nonetheless, many researchers bypass these TTOs and take their inventions directly to the marketplace. While TTO bypassing has typically been portrayed as deliberate and undesirable behavior, we argue that it could be unintentional as many researchers may simply be unaware of the TTO’s existence. Taking an information-processing perspective and using data on 3250 researchers in 24 European universities, we examine researcher attributes associated with TTO awareness. Our evidence confirms that only a minority of researchers are aware of the existence of a TTO at their university. TTO awareness is greater among researchers who possess experience as entrepreneurs, closed many research and consulting contracts with industry partners, conduct research in medicine, engineering or life sciences, or occupy postdoctoral positions. Policy implications of these findings are discussed

The study of Priapulus caudatus reveals conserved molecular patterning underlying different gut morphogenesis in the Ecdysozoa

Background The digestive systems of animals can become highly specialized in response to their exploration and occupation of new ecological niches. Although studies on different animals have revealed commonalities in gut formation, the model systems Caenorhabditis elegans and Drosophila melanogaster, which belong to the invertebrate group Ecdysozoa, exhibit remarkable deviations in how their intestines develop. Their morphological and developmental idiosyncrasies have hindered reconstructions of ancestral gut characters for the Ecdysozoa, and limit comparisons with vertebrate models. In this respect, the phylogenetic position, and slow evolving morphological and molecular characters of marine priapulid worms advance them as a key group to decipher evolutionary events that occurred in the lineages leading to C. elegans and D. melanogaster. Results In the priapulid Priapulus caudatus, the gut consists of an ectodermal foregut and anus, and a mid region of at least partial endodermal origin. The inner gut develops into a 16-cell primordium devoid of visceral musculature, arranged in three mid tetrads and two posterior duplets. The mouth invaginates ventrally and shifts to a terminal anterior position as the ventral anterior ectoderm differentially proliferates. Contraction of the musculature occurs as the head region retracts into the trunk and resolves the definitive larval body plan. Despite obvious developmental differences with C. elegans and D. melanogaster, the expression in P. caudatus of the gut-related candidate genes NK2.1, foxQ2, FGF8/17/18, GATA456, HNF4, wnt1, and evx demonstrate three distinct evolutionarily conserved molecular profiles that correlate with morphologically identified sub-regions of the gut. Conclusions The comparative analysis of priapulid development suggests that a midgut formed by a single endodermal population of vegetal cells, a ventral mouth, and the blastoporal origin of the anus are ancestral features in the Ecdysozoa. Our molecular data on P. caudatus reveal a conserved ecdysozoan gut-patterning program and demonstrates that extreme morphological divergence has not been accompanied by major molecular innovations in transcriptional regulators during digestive system evolution in the Ecdysozoa. Our data help us understand the origins of the ecdysozoan body plan, including those of C. elegans and D. melanogaster, and this is critical for comparisons between these two prominent model systems and their vertebrate counterparts

Defining phenotypes and treatment effect heterogeneity to inform acute respiratory distress syndrome and sepsis trials: secondary analyses of three RCTs

Background Sepsis and acute respiratory distress syndrome are two heterogeneous acute illnesses with high risk of death and for which there are many ‘statistically negative’ randomised controlled trials. We hypothesised that negative randomised controlled trials occur because of between-participant differences in response to treatment, illness manifestation (phenotype) and risk of outcomes (heterogeneity). Objectives To assess (1) heterogeneity of treatment effect, which tests whether or not treatment effect varies with a patient’s pre-randomisation risk of outcome; and (2) whether or not subphenotypes explain the treatment response differences in sepsis and acute respiratory distress syndrome demonstrated in randomised controlled trials. Study population We performed secondary analysis of two randomised controlled trials in patients with sepsis [i.e. the Vasopressin vs Noradrenaline as Initial Therapy in Septic Shock (VANISH) trial and the Levosimendan for the Prevention of Acute oRgan Dysfunction in Sepsis (LeoPARDS) trial] and one acute respiratory distress syndrome multicentre randomised controlled trial [i.e. the Hydroxymethylglutaryl-CoA reductase inhibition with simvastatin in Acute lung injury to Reduce Pulmonary dysfunction (HARP-2) trial], conducted in the UK. The VANISH trial is a 2 × 2 factorial randomised controlled trial of vasopressin (Pressyn AR®; Ferring Pharmaceuticals, Saint-Prex, Switzerland) and hydrocortisone sodium phosphate (hereafter referred to as hydrocortisone) (EfcortesolTM; Amdipharm plc, St Helier, Jersey) compared with placebo. The LeoPARDS trial is a two-arm-parallel-group randomised controlled trial of levosimendan (Simdax®; Orion Pharma, Espoo, Finland) compared with placebo. The HARP-2 trial is a parallel-group randomised controlled trial of simvastatin compared with placebo. Methods To test for heterogeneity of the effect on 28-day mortality of vasopressin, hydrocortisone and levosimendan in patients with sepsis and of simvastatin in patients with acute respiratory distress syndrome. We used the total Acute Physiology And Chronic Health Evaluation II (APACHE II) score as the baseline risk measurement, comparing treatment effects in patients with baseline APACHE II scores above (high) and below (low) the median using regression models with an interaction between treatment and baseline risk. To identify subphenotypes, we performed latent class analysis using only baseline clinical and biomarker data, and compared clinical outcomes across subphenotypes and treatment groups. Results The odds of death in the highest APACHE II quartile compared with the lowest quartile ranged from 4.9 to 7.4, across the three trials. We did not observe heterogeneity of treatment effect for vasopressin, hydrocortisone and levosimendan. In the HARP-2 trial, simvastatin reduced mortality in the low-APACHE II group and increased mortality in the high-APACHE II group. In the VANISH trial, a two-subphenotype model provided the best fit for the data. Subphenotype 2 individuals had more inflammation and shorter survival. There were no treatment effect differences between the two subphenotypes. In the LeoPARDS trial, a three-subphenotype model provided the best fit for the data. Subphenotype 3 individuals had the greatest inflammation and lowest survival. There were no treatment effect differences between the three subphenotypes, although survival was lowest in the levosimendan group for all subphenotypes. In the HARP-2 trial, a two-subphenotype model provided the best fit for the data. The inflammatory subphenotype was associated with fewer ventilator-free days and higher 28-day mortality. Limitations The lack of heterogeneity of treatment effect and any treatment effect differences between sepsis subphenotypes may be secondary to the lack of statistical power to detect such effects, if they truly exist. Conclusions We highlight lack of heterogeneity of treatment effect in all three trial populations. We report three subphenotypes in sepsis and two subphenotypes in acute respiratory distress syndrome, with an inflammatory phenotype with greater risk of death as a consistent finding in both sepsis and acute respiratory distress syndrome. Future work Our analysis highlights the need to identify key discriminant markers to characterise subphenotypes in sepsis and acute respiratory distress syndrome with an observational cohort study. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a MRC and National Institute for Health Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 10. See the NIHR Journals Library website for further project information