Palliative Care Initiated in the Emergency Department: A Cluster Randomized Clinical Trial.

Importance: The emergency department (ED) offers an opportunity to initiate palliative care for older adults with serious, life-limiting illness.

Objective: To assess the effect of a multicomponent intervention to initiate palliative care in the ED on hospital admission, subsequent health care use, and survival in older adults with serious, life-limiting illness.

Design, Setting, And Participants: Cluster randomized, stepped-wedge, clinical trial including patients aged 66 years or older who visited 1 of 29 EDs across the US between May 1, 2018, and December 31, 2022, had 12 months of prior Medicare enrollment, and a Gagne comorbidity score greater than 6, representing a risk of short-term mortality greater than 30%.

Neuromuscular electrical stimulation producing low evoked force elicits the repeated bout effect on muscle damage markers of the elbow flexors.

This study examined the repeated bout effect (RBE) on muscle damage markers following two bouts of neuromuscular electrical stimulation (NMES) in untrained individuals. Following familiarization, participants received 45 consecutive NMES to the biceps brachii at an intensity that produced low evoked force for the elbow flexors. Muscle damage markers (maximal voluntary isometric contraction [MVIC], elbow range of motion [ROM], muscle soreness via visual analogue scale [VAS] scores, pressure pain threshold [PPT], and muscle thickness) were measured before (PRE), after (POST), 1 day after (24 POST), and 2 days after (48 POST) NMES.

HoloFood Data Portal: holo-omic datasets for analysing host-microbiota interactions in animal production.

The HoloFood project used a hologenomic approach to understand the impact of host-microbiota interactions on salmon and chicken production by analysing multiomic data, phenotypic characteristics, and associated metadata in response to novel feeds. The project's raw data, derived analyses, and metadata are deposited in public, open archives (BioSamples, European Nucleotide Archive, MetaboLights, and MGnify), so making use of these diverse data types may require access to multiple resources. This is especially complex where analysis pipelines produce derived outputs such as functional profiles or genome catalogues.

Placental alkaline phosphatase (PLAP): Is it exclusively placental?

Background: Adverse pregnancies outcomes present a clinical dilemma in Perinatal medicine. This is partly due to lack of accuracy of current biomarkers to predict high-risk pregnancies at an earlier stage. The placental alkaline phosphatase (PLAP) carrying extracellular vesicles (EVs), and their cargo have been reported as a source of biomarkers for placental health and an indication of pre-eclampsia progression.

Chorionic trophoblast cells demonstrate functionally different phenotypes from placental trophoblasts.

Chorionic trophoblast cells (CTCs) are one of the principal components of the fetal membrane and join with the decidua to form a feto-maternal interface. Recent success in isolating CTCs dealt with two separate questions: (1) The necessity of highly enriched and defined media with inhibitors of oxidative stress and cell transition and their impact on growth and trophoblast phenotype, (2) The functional differences between CTCs and other placental trophoblast lineages of cells (placental cytotrophoblast cells [PTC], and extravillous trophoblast [EVT]). CTCs were cultured either in defined media with various inhibitors or in media from which inhibitors were removed individually.

The experience of loneliness among people with psychosis: Qualitative meta-synthesis.

Background: Loneliness can be a significant challenge for people living with psychosis. We currently lack evidence about how to help with this. Understanding the origins, experience, and impact of loneliness in this group is helpful in developing strategies to reduce it.

Representation of racialised and ethnically diverse populations in multicentre randomised controlled trials of GLP-1 medicines for obesity: a systematic review and meta-analysis of gaps.

Introduction: Trials of GLP-1 (glucagon-like peptide-1) medicines have changed the paradigm of obesity treatment. Diversity in trial participation is imperative considering that obesity disproportionately impacts marginalised populations worldwide. We performed a systematic review and meta-analyses to evaluate the representation of racialised and ethnically diverse populations in randomised controlled trials (RCTs) of GLP-1 medicines for obesity.

Case-control study of clotting differences using ROTEM testing in pregnant patients with early vaginal bleeding.

Background: Vaginal bleeding in early pregnancy is a common presentation in the Emergency Department (ED), often resulting in pregnancy loss. Hypercoagulability exceeding normal physiological changes may be associated with miscarriage, but conventional clotting tests do not reliably detect this effect. Rotational thromboelastometry (ROTEM), which performs a more comprehensive clotting evaluation, may demonstrate coagulopathic abnormalities contributing to vaginal bleeding and miscarriage in early pregnancy that are not present in normal gestation.

Lead exposure at the feto-maternal interface: A cause for concern for fetal membrane trophoblasts.

The integrity of fetal membranes enables biological functions that protect the fetus and maintain the pregnancy. Any compromise in fetal membrane function can predispose a pregnant woman to prelabor rupture of the membranes (pPROM) and subsequently to preterm birth (PTB). Epidemiologic data suggest that lead exposure during pregnancy is one of several risk factors associated with PTB and pPROM.

A multi-omic atlas of human embryonic skeletal development.

Human embryonic bone and joint formation is determined by coordinated differentiation of progenitors in the nascent skeleton. The cell states, epigenetic processes and key regulatory factors that underlie lineage commitment of these cells remain elusive. Here we applied paired transcriptional and epigenetic profiling of approximately 336,000 nucleus droplets and spatial transcriptomics to establish a multi-omic atlas of human embryonic joint and cranium development between 5 and 11 weeks after conception.

A spatial human thymus cell atlas mapped to a continuous tissue axis.

T cells develop from circulating precursor cells, which enter the thymus and migrate through specialized subcompartments that support their maturation and selection. In humans, this process starts in early fetal development and is highly active until thymic involution in adolescence. To map the microanatomical underpinnings of this process in pre- and early postnatal stages, we established a quantitative morphological framework for the thymus-the Cortico-Medullary Axis-and used it to perform a spatially resolved analysis.

Single-cell integration reveals metaplasia in inflammatory gut diseases.

The gastrointestinal tract is a multi-organ system crucial for efficient nutrient uptake and barrier immunity. Advances in genomics and a surge in gastrointestinal diseases has fuelled efforts to catalogue cells constituting gastrointestinal tissues in health and disease. Here we present systematic integration of 25 single-cell RNA sequencing datasets spanning the entire healthy gastrointestinal tract in development and in adulthood.

HOX gene expression in the developing human spine.

Positional coding along the anterior-posterior axis is regulated by HOX genes, whose 3' to 5' expression correlates with location along this axis. The precise utilisation of HOX genes in different human cell types is not fully understood. Here, we use single-cell and spatial-transcriptomics, along with in-situ sequencing, to create a developmental atlas of the human fetal spine.

Distribution and predictors of haemophilia-related costs in the United Kingdom: analysis of the CHESS I and CHESS II burden of illness studies.

Background: Few studies have evaluated direct medical or societal costs of haemophilia in the United Kingdom (UK), and how patient characteristics impact future costs is uncertain. Cost predictors were identified and examined using cross-sectional data from the CHESS I and II studies.

Methods: Patient- and physician-reported outcomes were analysed for UK adult males aged ≤ 65, with haemophilia A or B and no recent clinical trial participation.

"There's no us vs. them, it's just us": a creative approach to centring lived experience within the AVATAR2 trial.

This article describes a Patient and Public Involvement (PPI) led creative workshop space held within a clinical trial of a talking therapy for distressing voices (AVATAR2). PPI adds significant value to clinical research and ensures the work is meaningful to patients and their supporters. However, known issues include tokenism, a common power imbalance between PPI colleagues and researchers and a lack of opportunity for PPI to shape the research.

Ethical considerations related to virtual visiting for families and critically ill patients in intensive care: a qualitative descriptive study.

Background: During the COVID-19 pandemic, virtual visiting technologies were rapidly integrated into the care offered by intensive care units (ICUs) in the UK and across the globe. Today, these technologies offer a necessary adjunct to in-person visits for those with ICU access limited by geography, work/caregiving commitments, or frailty. However, few empirical studies explore the ethical issues associated with virtual visiting.

Blood flow restriction increases motor unit firing rates and input excitation of the biceps brachii during a moderate-load muscle action.

This study examined the effects of blood flow restriction (BFR) on motor unit (MU) behaviour of the biceps brachii (BB) during a single non-exhausting submaximal muscle action. Twenty adults performed maximal voluntary contractions (MVCs) of the elbow flexors, followed by an isometric trapezoidal muscle action at 40% MVC during BFR and control (CON) visits. Surface electromyographic signals recorded from the BB during the 40% MVCs were decomposed.

A "Next Generation" of Pediatric Mental Health Systems.

An optimistic view of the future child/youth mental health system is that it will be oriented toward prevention and shaped by innovations in early detection and treatment of functional problems, coupled with the power of digital technology to provide new ways to help individuals and families monitor their well-being and seek or agree to help as it is needed. These innovations will be deployed within a community-based health care system, centered on primary care that fully implements ideas about continuity and comprehensiveness (including social determinants, substance use, and multigenerational care) that have been around for decades.

Building Collective Power to Advance Maternal and Child Health Equity: Lessons from the New Orleans Maternal and Child Health Coalition.

Objectives: The New Orleans Maternal Child Health Coalition convenes to support and amplify the work of New Orleans-based individuals and organizations working to reduce disparities and protect the health of birthing families in the New Orleans area. The objectives of this qualitative study were to identify successes, challenges, and areas of growth for the Coalition and develop broadly generalizable recommendations for similar groups seeking to mobilize and advance health equity in their own communities.

Methods: Using purposive sampling, we conducted semi-structured interviews with 12 key informants from within and outside of the Coalition.

Brief Risk Communication for Emergency Department Patients With Sustained Asymptomatic Hypertension.

Introduction: Sustained asymptomatic hypertension in ED patients is a powerful predictor of chronic uncontrolled hypertension. In this study, we assess the feasibility of using a storyboard video and communicating real-time cardiovascular imaging results on blood pressure control and primary care engagement.

Methods: This was a prospective observational exploratory sub-study.