Abstract
Our aim was to describe the research practices of doctoral students facing a dilemma to research integrity and to assess the impact of inappropriate research environments, i.e. exposure to ...(a) a post-doctoral researcher who committed a Detrimental Research Practice (DRP) in a similar situation and (b) a supervisor who did not oppose the DRP. We conducted two 2-arm, parallel-group randomized controlled trials. We created 10 vignettes describing a realistic dilemma with two alternative courses of action (good practice versus DRP). 630 PhD students were randomized through an online system to a vignette (a) with (n = 151) or without (n = 164) exposure to a post-doctoral researcher; (b) with (n = 155) or without (n = 160) exposure to a supervisor. The primary outcome was a score from − 5 to + 5, where positive scores indicated the choice of DRP and negative scores indicated good practice. Overall, 37% of unexposed participants chose to commit DRP with important variation across vignettes (minimum 10%; maximum 66%). The mean difference 95%CI was 0.17 − 0.65 to 0.99;, p = 0.65 when exposed to the post-doctoral researcher, and 0.79 − 0.38; 1.94, p = 0.16, when exposed to the supervisor. In conclusion, we did not find evidence of an impact of postdoctoral researchers and supervisors on student research practices.
Trial registration:
NCT04263805, NCT04263506 (registration date 11 February 2020).
Abstract Introduction Biliary complications (BC) are one of the most frequent surgical complications after liver transplantation. They include biliary stenosis, leaks, choledocolitiasis and sphincter ...of Oddi dysfunction. These complications can cause graft dysfunction, retrasplantation, or even death. The purpose of this study was to identify factors related to BC. Materials and Methods The medical records of all adult patients who underwent their first liver transplantation in our institution from 2005 to 2013 were reviewed, and any BC that required management was recorded. Cumulative incidence of BC was estimated using Kaplan-Meier. Patient and graft survival was compared using the log-rank test. The Cox regression model was used to establish associated factors. Results Of the 236 patients who underwent liver transplantation, 41 patients (17.8%) developed BC. Cumulative incidence was 12.9%, 17.2%, and 20%, after 1, 3 and 5 years of the transplantation, respectively. Twenty-six cases of biliary stenosis, 11 of leaks, and 4 of choledocolitiasis were identified. Most patients were managed endoscopically (82.9%). There were no differences in patient or graft survival. Discussion Biliary stenosis is the most frequent BC. Patients with higher risk of BC were of blood type AB ( P < .001), had viral hepatitis ( P = .049), or had alcoholic cirrhosis ( P = .036). The success with the endoscopic treatment reduced the need for surgical interventions. Conclusions The incidence of BC in our institution is comparable with the incidence reported in other institutions. Further prospective studies with larger series of patients are warranted to identify other factors associated with development of BC.
The Spanish and Portuguese-Speaking Working Group of the International Society for Forensic Genetics (GHEP-ISFG) has organized a second collaborative exercise on a simulated case of Disaster Victim ...Identification (DVI), with the participation of eighteen laboratories. The exercise focused on the analysis of a simulated plane crash case of medium-size resulting in 66 victims with varying degrees of fragmentation of the bodies (with commingled remains). As an additional difficulty, this second exercise included 21 related victims belonging to 6 families among the 66 missings to be identified. A total number of 228 post-mortem samples were represented with aSTR and mtDNA profiles, with a proportion of partial aSTR profiles simulating charred remains. To perform the exercise, participants were provided with aSTR and mtDNA data of 51 reference pedigrees —some of which deficient—including 128 donors for identification purposes. The exercise consisted firstly in the comparison of the post-mortem genetic profiles in order to re-associate fragmented remains to the same individual and secondly in the identification of the re-associated remains by comparing aSTR and mtDNA profiles with reference pedigrees using pre-established thresholds to report a positive identification. Regarding the results of the post-mortem samples re-associations, only a small number of discrepancies among participants were detected, all of which were from just a few labs. However, in the identification process by kinship analysis with family references, there were more discrepancies in comparison to the correct results. The identification results of single victims yielded fewer problems than the identification of multiple related victims within the same family groups. Several reasons for the discrepant results were detected: a) the identity/non-identity hypotheses were sometimes wrongly expressed in the likelihood ratio calculations, b) some laboratories failed to use all family references to report the DNA match, c) In families with several related victims, some laboratories firstly identified some victims and then unnecessarily used their genetic information to identify the remaining victims within the family, d) some laboratories did not correctly use “prior odds” values for the Bayesian treatment of the episode for both post-mortem/post-mortem re-associations as well as the ante-mortem/post-mortem comparisons to evaluate the probability of identity. For some of the above reasons, certain laboratories failed to identify some victims. This simulated “DNA-led” identification exercise may help forensic genetic laboratories to gain experience and expertize for DVI or MPI in using genetic data and comparing their own results with the ones in this collaborative exercise.
•The GHEP-ISFG has designed a second “DNA-led” DVI exercise in a simulated air crash.•This exercise can be useful for testing DVI using the data and results provided.•The exercise is focused on direct matching and kinship analysis in a Bayesian framework.•This exercise sheds light on problems that a laboratory can face in DVI scenarios.
Abstract
We estimated the degree to which language used in the high-profile medical/public health/epidemiology literature implied causality using language linking exposures to outcomes and action ...recommendations; examined disconnects between language and recommendations; identified the most common linking phrases; and estimated how strongly linking phrases imply causality. We searched for and screened 1,170 articles from 18 high-profile journals (65 per journal) published from 2010–2019. Based on written framing and systematic guidance, 3 reviewers rated the degree of causality implied in abstracts and full text for exposure/outcome linking language and action recommendations. Reviewers rated the causal implication of exposure/outcome linking language as none (no causal implication) in 13.8%, weak in 34.2%, moderate in 33.2%, and strong in 18.7% of abstracts. The implied causality of action recommendations was higher than the implied causality of linking sentences for 44.5% or commensurate for 40.3% of articles. The most common linking word in abstracts was “associate” (45.7%). Reviewers’ ratings of linking word roots were highly heterogeneous; over half of reviewers rated “association” as having at least some causal implication. This research undercuts the assumption that avoiding “causal” words leads to clarity of interpretation in medical research.
Socioeconomic variables impact health outcomes but have rarely been evaluated in critical illness. Low- and middle-income countries bear the highest burden of sepsis and also have significant health ...inequities. In Argentina, public hospitals serve the poorest segment of the population, while private institutions serve patients with health coverage. Our objective was to analyze differences in mortality between public and private hospitals, using Sepsis-3 definitions.
This is a multicenter, prospective cohort study including patients with sepsis admitted to 49 Argentine ICUs lasting 3 months, beginning on July 1, 2016. Epidemiological, clinical, and socioeconomic status variables and hospital characteristics were compared between patients admitted to both types of institutions.
Of the 809 patients included, 367 (45%) and 442 (55%) were admitted to public and private hospitals, respectively. Those in public institutions were younger (56 ± 18 vs. 64 ± 18; p < 0.01), with more comorbidities (Charlson score 2 0-4 vs. 1 0-3; p < 0.01), fewer education years (7 7-12 vs. 12 10-16; p < 0.01), more frequently unemployed/informally employed (30% vs. 7%; p < 0.01), had similar previous self-rated health status (70 50-90 vs. 70 50-90 points; p = 0.30), longer pre-admission symptoms (48 24-96 vs. 24 12-48 h; p < 0.01), had been previously evaluated more frequently in any healthcare venue (28 vs. 20%; p < 0.01), and had higher APACHE II, SOFA, lactate levels, and mechanical ventilation utilization. ICU admission as septic shock was more frequent in patients admitted to public hospitals (47 vs. 35%; p < 0.01), as were infections caused by multiresistant microorganisms. Sepsis management in the ICU showed no differences. Twenty-eight-day mortality was higher in public hospitals (42% vs. 24%; p < 0.01) as was hospital mortality (47% vs. 30%; p < 0.01). Admission to a public hospital was an independent predictor of mortality together with comorbidities, lactate, SOFA, and mechanical ventilation; in an alternative prediction model, it acted as a correlate of pre-hospital symptom duration and infections caused by multiresistant microorganisms.
Patients in public hospitals belonged to a socially disadvantaged group and were sicker at admission, had septic shock more frequently, and had higher mortality. Unawareness of disease severity and delays in the health system might be associated with late admission. This marked difference in outcome between patients served by public and private institutions constitutes a state of health inequity.
Clostridium difficile induces antibiotic-associated diarrhea through the production of toxin A and toxin B; the former toxin has been assumed to
be responsible for the symptoms of the disease. ...Several toxin A-negative strains from C. difficile have recently been isolated from clinical cases and have been reported to produce toxin B variants eliciting an atypical
cytopathic effect. Ultrastructural analysis indicated these toxins induce a rounding cytopathic effect and filopodia-like
structures. Toxin B variants glucosylated R-Ras, and transfection with a constitutively active mutant of this GTPase protected
cells against their cytopathic effect. Treatment of cells with toxin B variants induced detachment from the extracellular
matrix and blockade of the epidermal growth factor-mediated phosphorylation of extracellular-regulated protein kinases, demonstrating
a deleterious effect on the R-Ras-controlled avidity of integrins. Treatment with toxin B variants also induced a transient
activation of RhoA probably because of inactivation of Rac1. Altogether, these data indicate that the cytopathic effect induced
by toxin B variants is because of cell rounding and detachment mediated by R-Ras glucosylation, and the induction of filopodia-like
structures is mediated by RhoA activation. Implications for the pathophysiology of C. difficile -induced diarrhea are discussed.
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