Autologous Faecal Microbiota Transplantation to Improve Outcomes of Haematopoietic Stem Cell Transplantation: Results of a Single-Centre Feasibility Study.

Haematopoietic stem cell transplantation (HSCT) is a curative approach for blood cancers, yet its efficacy is undermined by a range of acute and chronic complications. In light of mounting evidence to suggest that these complications are linked to a dysbiotic gut microbiome, we aimed to evaluate the feasibility of faecal microbiota transplantation (FMT) delivered during the acute phase after HSCT. Of note, this trial opted for FMT prepared using the individual's own stool (autologous FMT) to mitigate the risks of disease transmission from a donor stool. Adults (>18 years) with multiple myeloma were recruited from a single centre. The stool was collected prior to starting first line therapy. Patients who progressed to HSCT were offered FMT via 3 × retention enemas before day +5 (HSCT = day 0). The feasibility was determined by the recruitment rate, number and volume of enemas administered, and the retention time. Longitudinally collected stool samples were also collected to explore the influence of auto-FMT using 16S rRNA gene sequencing. n = 4 (2F:2M) participants received auto-FMT in 12 months. Participants received an average of 2.25 (1-3) enemas 43.67 (25-50) mL total, retained for an average of 60.78 (10-145) min. No adverse events (AEs) attributed to the FMT were identified. Although the minimum requirements were met for the volume and retention of auto-FMT, the recruitment was significantly impacted by the logistical challenges of the pretherapy stool collection. This ultimately undermined the feasibility of this trial and suggests that third party (donor) FMT should be prioritised.

Patient Perspectives of the Hospital Discharge Process: A Qualitative Study.

Care transitions after hospitalization require communication across care teams, patients, and caregivers. As part of a quality improvement initiative, we conducted qualitative interviews with a diverse group of 53 patients who were recently discharged from a hospitalization within a safety net hospital to explore how patient preferences were included in the hospital discharge process and differences in the hospital discharge experience by race/ethnicity. Four themes emerged from participants regarding desired characteristics of interactions with the discharge team: (1) to feel heard, (2) inclusion in decision-making, (3) to be adequately prepared to care for themselves at home through bedside teaching, (4) and to have a clear and updated discharge timeline. Additionally, participants identified patient-level factors the discharge planning team should consider, including the social context, family involvement, health literacy, and linguistic barriers. Lastly, participants identified provider characteristics, such as a caring and empathetic bedside manner, that they found valuable in the discharge process. Our findings highlight the need for shared decision-making in the discharge planning process to improve both patient safety and satisfaction.

Orthodontic retention experience of university students: A qualitative study.

OBJECTIVE: To explore university students' experience of retention and identify potential barriers and facilitators to long-term adherence. DESIGN: Cross-sectional qualitative study using virtual focus groups. SETTING: University of Leeds. PARTICIPANTS: Dental and non-dental students from the University of Leeds, who had previously undergone orthodontic treatment and had received removable retainers. METHODS: Students were invited to participate via email. Virtual focus groups were undertaken using Microsoft Teams. A topic guide was used to explore the experience of orthodontic retention including factors that influence long-term retainer wear. Focus groups were recorded and analysed using an inductive thematic approach. RESULTS: In total, 23 students participated in four focus groups, including 13 dental students. The period since the end of orthodontic treatment varied from 9 months to 10 years. Of the 23 participants, 8 (35%) were no longer wearing their retainers. Four themes were identified: (1) experience of orthodontic treatment including knowledge of relapse; (2) experience of retainer wear, including motivators and barriers; (3) role of others; and (4) increasing adherence. Key factors influencing use of retainers were the importance placed on maintaining treatment outcomes, awareness of unwanted tooth movement and understanding of the role of the retainer, access to replacement retainers, and ongoing support to encourage retainer wear. Greater knowledge and dental awareness reported by dental students did not necessarily increase adherence. CONCLUSION: Adherence to removable retainer wear is an important aspect of orthodontic treatment but it is recognised that long-term retainer wear is highly variable. The understanding of relapse and retention is variable. Challenges in gaining access to replacement retainers are a common cause of cessation of retainer wear. Dental professionals are perceived to be important in encouraging and supporting retainer wear and individuals reported they would like more follow-up.

End-of-Life Experiences for Cancer Patients Dying in Hospital with COVID-19.

Despite a wealth of research regarding COVID-19, little evidence exists about cancer patients' specific needs and experiences at end-of-life. This study retrospectively describes the care of 34 hospitalised cancer patients dying with COVID-19. The palliative care needs of patients were described. The main domains of end-of-life care service provision were evaluated including treatment of pain and other symptoms, communication and decision making at end-of-life and level of involvement of the palliative care team. Physical symptoms were managed with relatively low doses of end-of-life medications. High levels of patient and family anxiety, however, highlight the complexity of death from a stigmatised disease. Prompt acknowledgement of the vulnerability of advanced cancer patients with COVID-19 can facilitate proactive symptom management, anticipatory communication and enhance family support.

First episode psychosis: A comparison of caregiving appraisals in parents caring for the same child.

BACKGROUND: The first onset of psychosis can be a traumatic event for diagnosed individuals but can also impact negatively on their families. Little is known about how parents of the same child make sense of the illness. In mothers and fathers caring for the same child with early psychosis, the current study assessed their similarities and differences in key areas of their caregiving role. METHODS: Using a cross-sectional design, parental pairs caring for the same child treated within an early intervention in psychosis service, completed self-report measures on their caregiving experiences, illness beliefs, coping styles and affect. RESULTS: Data from 44 mothers and fathers were analysed. Analyses confirmed that parents reported similar levels of emotional dysfunction and conceptualized the illness in broadly similar ways with regard to what they understood the illness to be, their emotional reactions to the illness, perceived illness consequences and beliefs about treatment. Significant differences were identified in their beliefs about the timeline of the illness and reported approaches to coping. CONCLUSIONS: With exception of beliefs about illness timeline and an expressed preference for use of emotion-based coping, parent caregivers of the same child in early psychosis services are likely to report similar illness beliefs and caregiving reactions. Efforts to ensure staff awareness of the potential areas of divergence in parental caregiving appraisals and exploring the implications of the divergence for the caregiving relationship and patient outcomes are indicated.

Interventions to increase patient and family involvement in escalation of care for acute life-threatening illness in community health and hospital settings.

BACKGROUND: There is now a rising commitment to acknowledge the role patients and families play in contributing to their safety. This review focuses on one type of involvement in safety - patient and family involvement in escalation of care for serious life-threatening conditions i.e. helping secure a step-up to urgent or emergency care - which has been receiving increasing policy and practice attention. This review was concerned with the negotiation work that patient and family members undertake across the emergency care escalation pathway, once contact has been made with healthcare staff. It includes interventions aiming to improve detection of symptoms, communication of concerns and staff response to these concerns. OBJECTIVES: To assess the effects of interventions designed to increase patient and family involvement in escalation of care for acute life-threatening illness on patient and family outcomes, treatment outcomes, clinical outcomes, patient and family experience and adverse events. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP) ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform from 1 Jan 2000 to 24 August 2018. The search was updated on 21 October 2019. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and cluster-randomised controlled trials where the intervention focused on patients and families working with healthcare professionals to ensure care received for acute deterioration was timely and appropriate. A key criterion was to include an interactive element of rehearsal, role play, modelling, shared language, group work etc. to the intervention to help patients and families have agency in the process of escalation of care. The interventions included components such as enabling patients and families to detect changes in patients' conditions and to speak up about these changes to staff. We also included studies where the intervention included a component targeted at enabling staff response. DATA COLLECTION AND ANALYSIS: Seven of the eight authors were involved in screening; two review authors independently extracted data and assessed the risk of bias of included studies, with any disagreements resolved by discussion to reach consensus. Primary outcomes included patient and family outcomes, treatment outcomes, clinical outcomes, patient and family experience and adverse events. Our advisory group (four users and four providers) ensured that the review was of relevance and could inform policy and practice. MAIN RESULTS: We included nine studies involving 436,684 patients and family members and one ongoing study. The published studies focused on patients with specific conditions such as coronary artery disease, ischaemic stroke, and asthma, as well as pregnant women, inpatients on medical surgical wards, older adults and high-risk patients with a history of poor self-management. While all studies tested interventions versus usual care, for four studies the usual care group also received educational or information strategies. Seven of the interventions involved face-to-face, interactional education/coaching sessions aimed at patients/families while two provided multi-component education programmes which included components targeted at staff as well as patients/families. All of the interventions included: (1) an educational component about the acute condition and preparedness for future events such as stroke or change in fetal movements: (2) an engagement element (self-monitoring, action plans); while two additionally focused on shared language or communication skills. We had concerns about risk of bias for all but one of the included studies in respect of one or more criteria, particularly regarding blinding of participants and personnel. Our confidence in results regarding the effectiveness of interventions was moderate to low. Low-certainty evidence suggests that there may be moderate improvement in patients' knowledge of acute life-threatening conditions, danger signs, appropriate care-seeking responses, and preparedness capacity between interactional patient-facing interventions and multi-component programmes and usual care at 12 months (MD 4.20, 95% CI 2.44 to 5.97, 2 studies, 687 participants). Four studies in total assessed knowledge (3,086 participants) but we were unable to include two other studies in the pooled analysis due to differences in the way outcome measures were reported. One found no improvement in knowledge but higher symptom preparedness at 12 months. The other study found an improvement in patients' knowledge about symptoms and appropriate care-seeking responses in the intervention group at 18 months compared with usual care. Low-certainty evidence from two studies, each using a different measure, meant that we were unable to determine the effects of patient-based interventions on self-efficacy. Self-efficacy was higher in the intervention group in one study but there was no difference in the other compared with usual care. We are uncertain whether interactional patient-facing and multi-component programmes improve time from the start of patient symptoms to treatment due to low-certainty evidence for this outcome. We were unable to combine the data due to differences in outcome measures. Three studies found that arrival times or prehospital delay time was no different between groups. One found that delay time was shorter in the intervention group. Moderate-certainty evidence suggests that multi-component interventions probably have little or no impact on mortality rates. Only one study on a pregnant population was eligible for inclusion in the review, which found no difference between groups in rates of stillbirth. In terms of unintended events, we found that interactional patient-facing interventions to increase patient and family involvement in escalation of care probably have few adverse effects on patient's anxiety levels (moderate-certainty evidence). None of the studies measured or reported patient and family perceptions of involvement in escalation of care or patient and family experience of patient care. Reported outcomes related to healthcare professionals were also not reported in any studies. AUTHORS' CONCLUSIONS: Our review identified that interactional patient-facing interventions and multi-component programmes (including staff) to increase patient and family involvement in escalation of care for acute life-threatening illness may improve patient and family knowledge about danger signs and care-seeking responses, and probably have few adverse effects on patient's anxiety levels when compared to usual care. Multi-component interventions probably have little impact on mortality rates. Further high-quality trials are required using multi-component interventions and a focus on relational elements of care. Cognitive and behavioural outcomes should be included at patient and staff level.

Encapsulation of Electrically Conductive Apparel Fabrics: Effects on Performance.

Electrically conductive fabrics are achieved by functionalizing with treatments such as graphene; however, these change conventional fabric properties and the treatments are typically not durable. Encapsulation may provide a solution for this, and the present work aims to address these challenges. Next-to-skin wool and cotton knit fabrics functionalized using graphene ink were encapsulated with three poly(dimethylsiloxane)-based products. Properties known to be critical in a next-to-skin application were investigated (fabric structure, moisture transfer, electrical conductivity, exposure to transient ambient conditions, wash, abrasion, and storage). Wool and cotton fabrics performed similarly. Electrical conductivity was conferred with the graphene treatment but decreased with encapsulation. Wetting and high humidity/low temperature resulted in an increase in electrical conductivity, while decreases in electrical conductivity were evident with wash, abrasion, and storage. Each encapsulant mitigated effects of exposures but these effects differed slightly. Moisture transfer changed with graphene and encapsulants. As key performance properties of the wool and cotton fabrics following treatment with graphene and an encapsulant differed from their initial state, use as a patch integrated as part of an upper body apparel item would be acceptable.

Fabrics and Garments as Sensors: A Research Update.

Properties critical to the structure of apparel and apparel fabrics (thermal and moisture transfer, elasticity, and flexural rigidity), those related to performance (durability to abrasion, cleaning, and storage), and environmental effects have not been consistently addressed in the research on fabric sensors designed to interact with the human body. These fabric properties need to be acceptable for functionalized fabrics to be effectively used in apparel. Measures of performance such as electrical conductivity, impedance, and/or capacitance have been quantified. That the apparel/human body system involves continuous transient conditions needs to be taken into account when considering performance. This review highlights gaps concerning fabric-related aspects for functionalized apparel and includes information on increasing the inclusion of such aspects. A multidisciplinary approach including experts in chemistry, electronics, textiles, and standard test methods, and the intended end use is key to widespread development and adoption.

A Cost-Effectiveness Analysis of Stop Smoking Interventions in Substance-Use Disorder Populations.

BACKGROUND: Tobacco smoking is highly prevalent among people attending treatment for a substance-use disorder (SUD). In the United Kingdom, specialist support to stop smoking is largely delivered by a national network of stop smoking services, and typically comprises of behavioral support delivered by trained practitioners on an individual (one-to-one) or group basis combined with a pharmacological smoking-cessation aid. We evaluate the cost-effectiveness of these interventions and compare cost-effectiveness for interventions using group- and individual-based support, in populations under treatment for SUD. METHODS: Economic modeling was used to evaluate the incremental cost-per-quality-adjusted-life-years (QALYs) gained for smoking-cessation interventions compared with alternative methods of quitting for the SUD treatment population. Allowance was made for potentially lower abstinence rates in the SUD population. RESULTS: The incremental cost-per-QALY gained from quit attempts supported through more frequently provided interventions in England ranged from around £4,700 to £12,200. These values are below the maximum cost-effectiveness threshold adopted by policy makers in England for judging whether health programs are a cost-effective use of resources. The estimated cost-per-QALY gained for interventions using group-based behavioral support were estimated to be at least half the magnitude of those using individual support due to lower intervention costs and higher reported quit rates. Conclusions reached regarding the cost-effectiveness of group-based interventions were also found to be more robust to changes in modeling assumptions. CONCLUSIONS: Smoking-cessation interventions were found to be cost-effective when applied to the SUD population, particularly when group-based behavioral support is offered alongside pharmacological treatment. IMPLICATIONS: This analysis has shown that smoking-cessation interventions combining pharmacological treatment with behavioral support can offer a cost-effective method for increasing rates of smoking cessation in populations being treated for a substance-use disorder. This is despite evidence of lower comparative success rates in terms of smoking abstinence in populations with SUD. Our evaluation suggests that medication combined with group-based behavioral support may offer better value for money in this population compared with interventions using individual support, though further evidence on the comparative effectiveness and cost of interventions delivered to SUD treatment populations would facilitate a more robust comparison.

The morphology, physiology and function of suboesophageal neck motor neurons in the honeybee.

We report some of the neural and muscular circuitry that allows honeybees to control head movements. We studied neck motor neurons with cell bodies in the suboesophageal ganglion, axons in the first cervical nerve (IK1) and terminals in neck muscles 44 and 51 (muscle classification: Snodgrass in Smithsonian Misc Coll 103:1-120, 1942). We show that muscle 44 actually comprises five separate bundles of muscle fibres (subunits), while muscle 51 is split into two subunits. Eight motor neurons innervate muscles 44 and 51. Two motor neurons have cell bodies in the ventral-median cell body group (one innervates a subunit in muscle 44, the other a subunit in muscle 51). One motor neuron has a ventrally located contralateral cell body (innervating a subunit in muscle 44) and five have laterally located ipsilateral cell bodies. Of the five lateral cells, one innervates a subunit in muscle 51, three selectively innervate subunits in muscle 44 and one co-innervates a subunit in muscle 44 with the contralateral cell. Extracellular recordings revealed three types of visually driven, direction-selective cell-types in each IK1 tuned for leftward, rightward and downward motion over the eyes. The spatiotemporal tuning of the units is similar to that of other visual interneurons in the bee brain.

Effects of porcine reproductive and respiratory syndrome vaccination in breeding-age animals.

Little is known about the safety and efficacy of extra-label use of the modified live porcine reproductive-and-respiratory syndrome (PRRS) virus vaccine in gestating sows. Our purpose was to determine the impact of vaccination on reproductive performance in 54 herds in Ontario, Manitoba (Canada) and the mid-western United States that were PRRS-positive, PRRS-negative, or concurrently affected by an outbreak of PRRS when initially vaccinated. Majority-vaccinated herds vaccinated > or =50% but <100% of sows at one time, and limit-vaccinated herds vaccinated <50% of sows at one time. Most majority-vaccinated herds did not vaccinate sows in late gestation, and none vaccinated during the initial PRRS outbreak. Numbers of pigs born alive and weaned decreased when pregnant sows were vaccinated. The effect of vaccination on productivity in the gestation following vaccination depended on the vaccination protocol.