The value of allied health professional research engagement on healthcare performance: a systematic review.

BACKGROUND: Existing evidence suggests that clinician and organisation engagement in research can improve healthcare performance. With the increase in allied health professional (AHP) research activity, it is imperative for healthcare organisations, clinicians, managers, and leaders to understand research engagement specifically within allied health fields. This systematic review aims to examine the value of research engagement by allied health professionals and organisations on healthcare performance. METHODS: This systematic review had a two-stage search strategy. Firstly, the papers from a previous systematic review examining the effect of research engagement in healthcare were screened to identify papers published pre-2012. Secondly, a multi-database search was used to conduct a re-focused update of the previous review, focusing specifically on allied health to identify publications from 2012-2021. Studies which examined the value of allied health research engagement on healthcare performance were included. All stages of the review were conducted by two reviewers independently. Each study was assessed using the appropriate Joanna Briggs Institute critical appraisal tool. A narrative synthesis was completed to analyse the similarities and differences between and within the different study types. RESULTS: Twenty-two studies were included, comprising of mixed research designs, of which six were ranked as high importance. The findings indicated that AHP research engagement appears related to positive findings in improvements to processes of care. The review also identified the most common mechanisms which may link research engagement with these improvements. DISCUSSION: This landmark systematic review and narrative synthesis suggests value in AHP research engagement in terms of both processes of care and more tentatively, of healthcare outcomes. While caution is required because of the lack of robust research studies, overall the findings support the agenda for growing AHP research. Recommendations are made to improve transparent reporting of AHP research engagement and to contribute essential evidence of the value of AHP research engagement. TRIAL REGISTRATION: This systematic review protocol was registered with the international prospective register of systematic reviews, PROSPERO (registration number CRD42021253461 ).

Asymmetry during Functional Movement Screening and injury risk in junior football players: A replication study.

An indicator of movement quality and potential injury risk during Functional Movement Screen (FMS) testing is the presence of asymmetry when comparing the left and right sides of the body. The aim of the study was to investigate the reproducibility of the injury risk model proposed in our previous research (Chalmers et al. 2017; derivation study) that showed an increased injury risk for elite junior Australian football players demonstrating ≥2 asymmetrical FMS subtests. We used a direct replication design. Players underwent pre-season FMS testing, and an injury surveillance system monitored 277 male participants during the subsequent regular season competition. Designated club officials monitored the weekly competition participation of players. The definition of an injury was "a trauma or medical condition which caused a player to miss a competitive game". Cox proportional hazards regression models were used to investigate the relationship between asymmetry and number of games played before first injury (ie, survival time). The level of reproducibility was determined according to statistical significance, effect size, and subjective assessment. Demonstrating asymmetry during FMS testing was not associated with a significant increase in prospective injury risk in the replication study (P > .05). Moreover, effect sizes (hazard ratios) from the derivation dataset were not within the 95% confidence intervals of the respective asymmetry predictor in the replication dataset. Subjectively, researchers were in agreement that the findings from the derivation data were not successfully reproduced. Clinicians and researchers should be cautious about using FMS asymmetry findings to derive injury risk for junior football players.

Oncosis and apoptosis induction by activation of an overexpressed ion channel in breast cancer cells.

The critical role of calcium signalling in processes related to cancer cell proliferation and invasion has seen a focus on pharmacological inhibition of overexpressed ion channels in specific cancer subtypes as a potential therapeutic approach. However, despite the critical role of calcium in cell death pathways, pharmacological activation of overexpressed ion channels has not been extensively evaluated in breast cancer. Here we define the overexpression of transient receptor potential vanilloid 4 (TRPV4) in a subgroup of breast cancers of the basal molecular subtype. We also report that pharmacological activation of TRPV4 with GSK1016790A reduced viability of two basal breast cancer cell lines with pronounced endogenous overexpression of TRPV4, MDA-MB-468 and HCC1569. Pharmacological activation of TRPV4 produced pronounced cell death through two mechanisms: apoptosis and oncosis in MDA-MB-468 cells. Apoptosis was associated with PARP-1 cleavage and oncosis was associated with a rapid decline in intracellular ATP levels, which was a consequence of, rather than the cause of, the intracellular ion increase. TRPV4 activation also resulted in reduced tumour growth in vivo. These studies define a novel therapeutic strategy for breast cancers that overexpress specific calcium permeable plasmalemmal ion channels with available selective pharmacological activators.

B7x/B7-H4 modulates the adaptive immune response and ameliorates renal injury in antibody-mediated nephritis.

Kidney disease is one of the leading causes of death in patients with lupus and other autoimmune diseases affecting the kidney, and is associated with deposition of antibodies as well as infiltration of T lymphocytes and macrophages, which are responsible for initiation and/or exacerbation of inflammation and tissue injury. Current treatment options have relatively limited efficacy; therefore, novel targets need to be explored. The co-inhibitory molecule, B7x, a new member of the B7 family expressed predominantly by non-lymphoid tissues, has been shown to inhibit the proliferation, activation and functional responses of CD4 and CD8 T cells. In this study, we found that B7x was expressed by intrinsic renal cells, and was up-regulated upon stimulation with inflammatory triggers. After passive administration of antibodies against glomerular antigens, B7x(-/-) mice developed severe renal injury accompanied by a robust adaptive immune response and kidney up-regulation of inflammatory mediators, as well as local infiltration of T cells and macrophages. Furthermore, macrophages in the spleen of B7x(-/-) mice were polarized to an inflammatory phenotype. Finally, treatment with B7x-immunoglobulin (Ig) in this nephritis model decreased kidney damage and reduced local inflammation. We propose that B7x can modulate kidney damage in autoimmune diseases including lupus nephritis and anti-glomerular basement membrane disease. Thus, B7x mimetics may be a novel therapeutic option for treatment of immune-mediated kidney disease.

Vaginal delivery can be considered in monochorionic diamniotic twins.

The outcomes of 60 sets of monochorionic diamniotic (MCDA) twins were compared with 218 sets of dichorionic diamniotic (DCDA) twins. The caesarean section rates for MCDA were similar to those for DCDA twins (56.6 versus 53.6%, P > 0.1). Although the number of babies with 5-minute Apgar score of <7 was significantly higher for vaginally delivered MCDA twins compared with that of DCDA twins (12 versus 3.5%, P < 0.001), the umbilical artery pH of <7.2 was similar (20 versus 13%, P > 0.05). Admission to neonatal intensive care unit (NICU) and neonatal mortality were also similar in both groups. Delivery by caesarean section was associated with increased admission to the NICU and neonatal mortality for MCDA twins when compared with vaginal delivery group. From this retrospective cohort study, we can conclude that vaginal delivery for MCDA twins appeared to be a reasonable management option when similar selection criteria for vaginal delivery of DCDA twins were applied.

Extensive cervical spinal cord lesion with late foetal presentation.

Neonatal cervical spinal cord injury occurring in the perinatal period is rare but has been described after both traumatic and atraumatic birth. Recently, a case of atraumatic, late third trimester, pre-labour presentation has been described. We report a second such case, but with important diagnostic differences and outcome. This case showed loss of foetal movements late in the third trimester. This was secondary to an extensive cervical lesion with no history of trauma. This emphasizes the need to consider cervical cord lesions when foetal or postnatal movements are reduced, even in the absence of trauma.

High viral loads despite absence of clinical and pathological findings in cats experimentally infected with feline coronavirus (FCoV) type I and in naturally FCoV-infected cats.

Specified pathogen-free cats were naturally infected with FCoV or experimentally infected with FCoV type I. Seroconversion was determined and the course of infection was monitored by measuring the FCoV loads in faeces, whole blood, plasma and/or monocytes. Tissue samples collected at necropsy were examined for viral load and histopathological changes. Experimentally infected animals started shedding virus as soon as 2 days after infection. They generally displayed the highest viral loads in colon, ileum and mesenteric lymph nodes. Seroconversion occurred 3-4 weeks post infection. Naturally infected cats were positive for FCoV antibodies and monocyte-associated FCoV viraemia prior to death. At necropsy, most animals tested positive for viral shedding and FCoV RNA was found in spleen, mesenteric lymph nodes and bone marrow. Both experimentally and naturally infected cats remained clinically healthy. Pathological findings were restricted to generalized lymphatic hyperplasia. These findings demonstrate the presence of systemic FCoV infection with high viral loads in the absence of clinical and pathological signs.

Evaluation of subunit vaccines against feline immunodeficiency virus infection.

Subunit vaccines prepared against feline immunodeficiency virus (FIV) infection were evaluated in two trials. First, cats were immunized with bacterial expression products of an envelope fragment that contained the V3 neutralization domain of the FIV surface protein fused to either galactokinase (K-SU3) or glutathione-S-transferase (G-SU3). Quantitative and qualitative differences in the humoral immune response were observed with three adjuvants of which Quil A was the best in terms of total and virus neutralizing antibody. Notwithstanding the responses induced, 19 of 20 immunized cats did not resist challenge and became infected. To determine whether priming with a live viral vector would confer protection, cats were inoculated oronasally and subcutaneously with a feline herpesvirus (FHV) mutant expressing the FIV env gene; two booster immunizations followed using the K-SU3 product in either Quil A or a mineral oill Al(OH)3 adjuvant. FIV-specific antibody responses were only weak, and the vaccinates did not withstand challenge with a low dose of homologous virus.

Secretion of bioactive interleukin 1 by rat testicular macrophages in vitro.

The relative capacities for testicular macrophages and resident peritoneal macrophages to secrete the pro-inflammatory cytokine, interleukin 1 (LL-1), in response to stimulation by bacterial lipopolysaccharide (LPS), were compared in vitro. Macrophages were isolated from adult male rat testicular interstitial cells or peritoneal lavage by adherence to glass coverslips or plastic culture dishes. The macrophages were immediately cultured, with or without a maximal dose of LPS (1 mu g/ml), over 24 hours at 32 degrees Celsius. Bioactive LL-1 production was measured by a sensitive thymocyte proliferation bioassay, employing recombinant human LL-1 beta as the reference standard. In comparison with the peritoneal macrophages, testicular macrophages displayed only a very small response to LPS, producing 2.8% of the amount of LL-1 per cell secreted by peritoneal macrophages cultured under identical conditions. Production of authentic LL-1 was confirmed by inhibition of the bioassay response in the presence of human recombinant LL-1 receptor antagonist. A small molecular mass (<10 kDa based on ultrafiltration) inhibitor of LL-1 bioactivity was also present in the medium collected from both cultures, but this inhibitory activity did not account for the differences in activity observed. In cultures of total peritoneal cells under similar conditions, addition of testosterone (10-1,000 ng/ml) did not affect LL-1 production in response to LPS. These data indicate that testicular macrophages have a reduced ability to secrete bioactive IL-1, and they provide further evidence for an altered capacity for immune responses within the testis.

Resolution of generalized dermatophytosis without treatment in dogs.

Natural resolution of generalized dermatophytosis reportedly is common in large-animal species. In dogs with generalized dermatophytosis, antifungal treatment usually is prescribed, because the prevalence of natural resolution of dermatophytosis in dogs is not known. Five dogs, 6 to 18 months old, were diagnosed as having generalized dermatophytosis. Each dog was treated with an inert substance given orally with food, once daily. Signs of disease resolved in 3 of the dogs after 4 to 8 weeks of treatment with the inert substance. Two dogs did not improve, so treatment with ketoconazole was initiated. Resolution was achieved in these 2 dogs after 6 weeks of treatment with ketoconazole.

Ketoconazole for treatment of dermatophytosis in cats.

Twelve cats with generalized dermatophytosis were treated with ketoconazole (10 mg/kg of body weight, PO, with food, q 24 h). This treatment was successful in 8 cats, with resolution of lesions and negative findings on mycologic evaluation after 2 to 10 weeks (median duration, 6 weeks). One additional cat failed to improve initially, but complete resolution was achieved after the dosage of ketoconazole was doubled. Adverse effects in 3 cats included anorexia, weight loss, vomiting, and diarrhea.

New quantum structures.

Structures in which electrons are confined to move in two dimensions (quantum wells) have led to new physical discoveries and technological applications. Modification of these structures to confine the electrons to one dimension (quantum wires) or release them in the third dimension, are predicted to lead to new electrical and optical properties. This article discusses techniques to make quantum wires, and quantum wells of controlled size and shape, from compound semiconductor materials, and describes some of the properties of these structures.

Seroepidemiologic survey of antibodies to Ehrlichia equi in horses of northern California.

The prevalence of antibodies to Ehrlichia equi in horses from the foothill regions of northern California and from the Sacramento valley (non-foothill area) was determined, using an indirect fluorescent antibody test. Horses from foothill regions had a higher prevalence of seropositivity (10.4%) and higher titer (1:10 to 1:80) than did those from non-foothill regions (3.1%; titer less than or equal to 1:10). Fifty percent of healthy horses on a foothill farm enzootic for E equi had titer to E equi, suggesting that infection with E equi can be subclinical. Six veterinarians surveyed from northern California diagnosed clinical E equi infection in 38 horses during 1985-1986 based on clinical signs of infection and observation of E equi inclusion bodies in neutrophils on blood smears.

Demodicosis in two cats seropositive for feline immunodeficiency virus.

Two cats were diagnosed with generalized demodicosis. Serotest results were negative for FeLV and positive for feline immunodeficiency virus. In one cat, demodicosis resolved in response to topical application of lime-sulfur solution, but the other cat was euthanatized.

Long-term efficacy of fenfluramine in treatment of obesity.

42 obese women who lost at least 6 kg after 26 weeks on fenfluramine tablets had their treatment changed to either an equivalent dose of a sustained-release preparation of fenfluramine or matching placebo in double-blind fashion. Of the 21 given placebo all but 2 regained weight over the following year. Of the 21 crossed over to fenfluramine, 8 maintained their weight loss, 7 regained weight, and 6 had to be withdrawn for reasons other than weight gain. Plasma concentrations of fenfluramine and norfenfluramine taken before and 4 weeks after the crossover were similar in both responders and non-responders, but non-responders did not maintain their drug levels for as long as did the responders. Longer controlled administration of fenfluramine will prevent weight regain in some obese women but the hazards of prolonged use remain to be evaluated.

A double-blind evaluation of evening primrose oil as an antiobesity agent.

Evening Primrose Oil (EPO) is a naturally occurring rich source of essential fatty acids, especially linoleic and gamma-linolenic acid. It has been suggested that it has antiobesity properties. This double-blind 12-week study was undertaken in 100 women with substantial obesity: 40 with refractory obesity, and 60 at time of initial referral to a hospital clinic. Seventy-four subjects completed the study. Those treated with EPO were comparable in age and degree of obesity with the placebo-treated group. There was no significant difference in the weight loss achieved by those taking EPO compared with placebo, either in the subjects with refractory obesity or in those treated at time of initial referral. It would appear that any antiobesity property possessed by EPO is clinically insignificant.

Comparison of a modified microagglutination technique for HBsAg with the standard technique and a new RIA system.

A further modification of the standard RPHA technique (Hepatest, Wellcome Reagents) for the detection of HBsAg is described. This modification does not require a centrifugation step which is required by the other modifications that have been described previously and consequently takes a little longer to perform. It does, however, retain the advantages of increased sensitivity and decreased costs which are also features of the other modifications. A series of 939 routine clinical specimens were used to evaluate the method described and to evaluate a new RIA kit for the detection of HBsAg (Hepatube, Wellcome Reagents). Of 53 specimens found to be positive for HBsAg by RIA, 50 (94% were detected by the modified Hepatest RPHA as opposed to 47 (89%) by the standard technique.

A passive haemagglutination test for the detection of antibodies to the contagious equine metritis organism.

A passive haemagglutination test (PHT) which has been developed for the detection of antibodies to the contagious equine metritis organism (CEMO) in serum is described. Samples from each of 30 mares with metritis were positive with titres in the range 256 to 4096. Samples from each of 239 clinically normal mares and 30 colts and fillies believed not to have been exposed to CEMO were negative with titres of less than 256, the majority of samples (97 per cent) showing a titre of 32 or less.