The (Mis)Information Game: A social media simulator

Given the potential negative impact reliance on misinformation can have, substantial effort has gone into understanding the factors that influence misinformation belief and propagation. However, despite the rise of social media often being cited as a fundamental driver of misinformation exposure and false beliefs, how people process misinformation on social media platforms has been under-investigated. This is partially due to a lack of adaptable and ecologically valid social media testing paradigms, resulting in an over-reliance on survey software and questionnaire-based measures. To provide researchers with a flexible tool to investigate the processing and sharing of misinformation on social media, this paper presents The Misinformation Game-an easily adaptable, open-source online testing platform that simulates key characteristics of social media. Researchers can customize posts (e.g., headlines, images), source information (e.g., handles, avatars, credibility), and engagement information (e.g., a post's number of likes and dislikes). The platform allows a range of response options for participants (like, share, dislike, flag) and supports comments. The simulator can also present posts on individual pages or in a scrollable feed, and can provide customized dynamic feedback to participants via changes to their follower count and credibility score, based on how they interact with each post. Notably, no specific programming skills are required to create studies using the simulator. Here, we outline the key features of the simulator and provide a non-technical guide for use by researchers. We also present results from two validation studies. All the source code and instructions are freely available online at https://misinfogame.com .

Impact of Lymphopenia on Definitive Treatment of Locally Advanced Cervical Cancer

PURPOSE/OBJECTIVE(S)

Pre-treatment lymphopenia prior to initiating treatment has been correlated with reduced survival in a number of different cancers. The purpose of this study is to evaluate the association between lymphopenia and survival in women with locally advanced cervical cancer (LACC) treated with primary chemoradiation (CRT).

MATERIALS/METHODS

We retrospectively reviewed patients with LACC treated at a single institution from 2005 - 2021 with available lymphocyte information. Patient and treatment characteristics were recorded including age, tumor size and stage, EBRT dose/fractionation, and brachytherapy dosimetry data. Absolute lymphocyte counts (ALC) were collected prior to initiating CRT and at 3-month intervals following CRT and graded based on severity of lymphopenia using CTCAE v 5.0. Overall survival (OS), progression free survival (PFS), and local control (LC) were calculated from the start of treatment to date of last follow-up. Kaplan-Meier survival analysis was performed to evaluate whether lymphocyte changes were associated with OS, PFS, or LC.

RESULTS

A total of 124 patients met study inclusion criteria with stage IB - IV disease (41 stage I, 41 stage II, 36 stage III, 6 stage IV) and a median follow up of 3.6 years (range 0.2-16.5 years). The median age was 49 years (range 26-77). The median EBRT dose was 45 Gy (range: 26-57.5 Gy) and 44.2% of patients received para-aortic (PA) nodal EBRT (28.8% elective and 15.4% with positive PA nodes). 5-year OS, PFS, and LC were 60.3% (95% CI 51.5-70.7), 47.5% (95% CI 39-58), and 75.5% (95% CI 67.3-82.9), respectively. Pre-treatment lymphopenia (ALC <1000 cells/mm3) was present in 11 (9%) patients. When the total cohort was divided into patients with and without pre-treatment lymphopenia, OS was statistically improved in the patients without baseline lymphopenia, with a 5-year OS of 63.2% (95% CI 53.9-73.9) versus 35.3% (95% CI 14.5-86.3) in the lymphopenia group (p = 0.034). LC also trended to being improved in the patients without lymphopenia, though this did not reach statistical significance in our small sample size of lymphopenic patients, with 5-year LC of 76.8% (95% CI 68.4-84.3) versus 67.5% (05% CI 36.6-93.8), p = 0.45.

CONCLUSION

In this single institution experience of LACC treated with definitive CRT, we found that baseline lymphopenia is associated with inferior OS. Patients with higher pre-CRT ALC may represent a population with more robust immune systems, producing more favorable tumor responses to treatment. Additional studies are warranted to investigate the evolving role of combined EBRT and systemic therapy in LACC.

High parathyroid hormone level as a marker of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis: A systematic review and meta-analysis

BACKGROUND AND AIMS

Studies have suggested that high parathyroid hormone (PTH) was associated with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH), although the results from existing studies are inconsistent. Using systematic review and meta-analysis, we aimed to determine the association of PTH with NAFLD and NASH.

METHODS

Potentially eligible studies were identified from Embase and Medline databases from using search strategy consisting of terms for "NAFLD/NASH", and "PTH". Eligible study must consist of one group of patients with NAFLD/NASH and another group without NAFLD/NASH. The study must provide mean ± SD PTH in both groups. We extracted such data to calculate mean difference (MD). Pooled MD was then calculated by combining MDs of each study using random-effects model. Funnel plot was used to assess for the presence of publication bias.

RESULTS

A total of 388 articles were identified. After systematic review, 12 studies fulfilled the eligibility criteria and were included into the meta-analysis. The meta-analysis of 10 studies revealed the significant association between high PTH and NAFLD, with the pooled MD of 5.479 (95%CI 0.947-10.011, I2 82.4%). The funnel plot was symmetric and did not suggest publication bias. The meta-analysis of 4 studies revealed the non-significant association between high PTH and NASH, with the pooled MD of 11.955 (95%CI -4.703 - 28.614, I2 81.0%).

CONCLUSIONS

High PTH level is significantly associated with NAFLD and can be used as a marker of NAFLD. However, high PTH level is non-significantly associated with NASH. Further studies are needed to increase the sample size and eliminate the confounding factors.

Preference for Male Risk Takers Varies with Relationship Context and Health Status but not COVID Risk

Risk taking is more commonly shown by males than females and has a signalling function, serving to advertise one's intrinsic quality to prospective mates. Previous research has established that male risk takers are judged as more attractive for short-term flings than long-term relationships, but the environmental and socioeconomic context surrounding female preferences for male risk takers has been overlooked. Using a survey instrument, we examined female preferences for male risk takers across 1304 females from 47 countries. We found preferences for physical risk takers to be more pronounced in females with a bisexual orientation and females who scored high on risk proneness. Self-reported health was positively associated with preferences for high risk takers as short-term mates, but the effect was moderated by country-level health, i.e. the association was stronger in countries with poorer health. The security provided by better health and access to health care may allow females to capitalise on the genetic quality afforded by selecting a risk-prone male whilst concurrently buffering the potential costs associated with the risk taker's lower paternal investment. The risk of contracting COVID-19 did not predict avoidance of risk takers, perhaps because this environmental cue is too novel to have moulded our behavioural preferences.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40806-023-00354-3.

Impression formation stimuli: A corpus of behavior statements rated on morality, competence, informativeness, and believability

To investigate impression formation, researchers tend to rely on statements that describe a person’s behavior (e.g., “Alex ridicules people behind their backs”). These statements are presented to participants who then rate their impressions of the person. However, a corpus of behavior statements is costly to generate, and pre-existing corpora may be outdated and might not measure the dimension(s) of interest. The present study makes available a normed corpus of 160 contemporary behavior statements that were rated on 4 dimensions relevant to impression formation: morality, competence, informativeness, and believability. In addition, we show that the different dimensions are non-independent, exhibiting a range of linear and non-linear relationships, which may present a problem for past research. However, researchers interested in impression formation can control for these relationships (e.g., statistically) using the present corpus of behavior statements.

Gesture is the primary modality for language creation

How language began is one of the oldest questions in science, but theories remain speculative due to a lack of direct evidence. Here, we report two experiments that generate empirical evidence to inform gesture-first and vocal-first theories of language origin; in each, we tested modern humans' ability to communicate a range of meanings (995 distinct words) using either gesture or non-linguistic vocalization. Experiment 1 is a cross-cultural study, with signal Producers sampled from Australia (n = 30, M_age = 32.63, s.d. = 12.42) and Vanuatu (n = 30, M_age = 32.40, s.d. = 11.76). Experiment 2 is a cross-experiential study in which Producers were either sighted (n = 10, M_age = 39.60, s.d. = 11.18) or severely vision-impaired (n = 10, M_age = 39.40, s.d. = 10.37). A group of undergraduate student Interpreters guessed the meaning of the signals created by the Producers (n = 140). Communication success was substantially higher in the gesture modality than the vocal modality (twice as high overall; 61.17% versus 29.04% success). This was true within cultures, across cultures and even for the signals produced by severely vision-impaired participants. The success of gesture is attributed in part to its greater universality (i.e. similarity in form across different Producers). Our results support the hypothesis that gesture is the primary modality for language creation.

Maintenance of prior behaviour can enhance cultural selection

Many cultural phenomena evolve through a Darwinian process whereby adaptive variants are selected and spread at the expense of competing variants. While cultural evolutionary theory emphasises the importance of social learning to this process, experimental studies indicate that people's dominant response is to maintain their prior behaviour. In addition, while payoff-biased learning is crucial to Darwinian cultural evolution, learner behaviour is not always guided by variant payoffs. Here, we use agent-based modelling to investigate the role of maintenance in Darwinian cultural evolution. We vary the degree to which learner behaviour is payoff-biased (i.e., based on critical evaluation of variant payoffs), and compare three uncritical (non-payoff-biased) strategies that are used alongside payoff-biased learning: copying others, innovating new variants, and maintaining prior variants. In line with previous research, we show that some level of payoff-biased learning is crucial for populations to converge on adaptive cultural variants. Importantly, when combined with payoff-biased learning, uncritical maintenance leads to stronger population-level adaptation than uncritical copying or innovation, highlighting the importance of maintenance to cultural selection. This advantage of maintenance as a default learning strategy may help explain why it is a common human behaviour.

Socially Situated Transmission: The Bias to Transmit Negative Information is Moderated by the Social Context

Cultural evolutionary theory has identified a range of cognitive biases that guide human social learning. Naturalistic and experimental studies indicate transmission biases favoring negative and positive information. To address these conflicting findings, the present study takes a socially situated view of information transmission, which predicts that bias expression will depend on the social context. We report a large-scale experiment (N = 425) that manipulated the social context and examined its effect on the transmission of the positive and negative information contained in a narrative text. In each social context, information was progressively lost as it was transmitted from person to person, but negative information survived better than positive information, supporting a negative transmission bias. Importantly, the negative transmission bias was moderated by the social context: Higher social connectivity weakened the bias to transmit negative information, supporting a socially situated account of information transmission. Our findings indicate that our evolved cognitive preferences can be moderated by our social goals.

Network Connectivity Dynamics, Cognitive Biases, and the Evolution of Cultural Diversity in Round-Robin Interactive Micro-Societies

The distribution of cultural variants in a population is shaped by both neutral evolutionary dynamics and by selection pressures. The temporal dynamics of social network connectivity, that is, the order in which individuals in a population interact with each other, has been largely unexplored. In this paper, we investigate how, in a fully connected social network, connectivity dynamics, alone and in interaction with different cognitive biases, affect the evolution of cultural variants. Using agent-based computer simulations, we manipulate population connectivity dynamics (early, mid, and late full-population connectivity); content bias, or a preference for high-quality variants; coordination bias, or whether agents tend to use self-produced variants (egocentric bias), or to switch to variants observed in others (allocentric bias); and memory size, or the number of items that agents can store in their memory. We show that connectivity dynamics affect the time-course of variant spread, with lower connectivity slowing down convergence of the population onto a single cultural variant. We also show that, compared to a neutral evolutionary model, content bias accelerates convergence and amplifies the effects of connectivity dynamics, while larger memory size and coordination bias, especially egocentric bias, slow down convergence. Furthermore, connectivity dynamics affect the frequency of high-quality variants (adaptiveness), with late connectivity populations showing bursts of rapid change in adaptiveness followed by periods of relatively slower change, and early connectivity populations following a single-peak evolutionary dynamic. We evaluate our simulations against existing data collected from previous experiments and show how our model reproduces the empirical patterns of convergence.

A Cross-Sectional Test of Sign Creation by Children in the Gesture and Vocal Modalities

Naturalistic studies show that children can create language-like communication systems in the absence of conventional language. However, experimental evidence is mixed. We address this discrepancy using an experimental paradigm that simulates naturalistic sign creation. Specifically, we tested if a sample of 6- to 12-year-old children (52 girls and 56 boys drawn from an urban, predominantly white population in Western Australia) can comprehend and create novel gestural and vocal signs. Experiment 1 tested children's ability to comprehend novel signs. Experiment 2 tested children's ability to create novel signs. Results show that children can comprehend and create gestural and vocal signs, that communication is more successful in the gesture modality, and that older children outperform younger children.

Innovation and enculturation in child communication: a cross-sectional study

How can people achieve successful communication when using novel signs? Previous studies show that iconic signs (i.e. signs that directly resemble their referent) enhance communication success. In this paper, we test if enculturated signs (i.e. signs informed by interlocutors' shared culture) also enhance communication success. Children, who have spent less time in their linguistic community, have less cultural knowledge to inform their sign innovation. A natural prediction is that younger children's signs will be less enculturated, more diverse and less successful compared with older children and adults. We examined sign innovation in children aged between 6 and 12 years (N = 54) and adults (N = 18). Sign enculturation, diversity and iconicity were rated. As predicted, younger children innovated less enculturated and more diverse signs, and communicated less successfully than older children and adults. Sign enculturation and iconicity uniquely contributed to communication success. This is the first study to demonstrate that enculturated signs enhance communication.

Adult Asthma Diagnosis: Physician Reported Challenges in Alberta-Based Primary Care Practices

Introduction

An estimated 8.1% of Canadians adults have asthma. While there are challenges associated with the use of objective measurement of lung function in the diagnosis of asthma, we are uncertain of the barriers that impact the use of objective measures, and have limited understanding of the challenges experienced by primary care providers in diagnosis of asthma. The objectives of this quality improvement initiative were to identify primary care providers’ methods of diagnosing asthma and to identify challenges with diagnosis.

Methods

An online survey was disseminated using a snowball methodology.

Setting

Primary care practices in Alberta, Canada.

Participants

A total of 84 primary care providers completed the survey.

Main Outcome Measures

Participants were asked their ideal and sufficient methods for diagnosing asthma and to identify challenges in their practice related to asthma diagnosis.

Results

They identified full pulmonary function testing (54%), pre- and postbronchodilator spirometry (54%), complete history and physical (42%), peak flow measurement overtime (26%), pulmonary consult (26%), and trial of asthma medication(s) (23%), as ideal methods of diagnosing asthma. The most significant barriers to diagnosis included episodic care–care provided typically during times of worsening symptoms without ongoing preventative/maintenance care (55%), patient follow-up (44%), conflict between clinical impression and pulmonary function results (43%), patient already on asthma medications (43%), and interpreting spirometry/pulmonary function results (39%).

Conclusion

The results of this survey indicate that the majority of primary care providers would choose full pulmonary function testing or pre- and postbronchodilator spirometry as the ideal methods of diagnosing asthma. However, barriers related to the nature of asthma care, patient factors, and challenges with diagnostic testing create challenges. This study also highlights that primary care providers have adapted to challenges in leveraging objective measurement and may rely upon other methods for diagnosis such as trials of medications.

Are People Sensitive to Problems in Communication?

Recent research indicates that interpersonal communication is noisy, and that people exhibit considerable insensitivity to problems in communication. Using a dyadic referential communication task, the goal of which is accurate information transfer, this study examined the extent to which interlocutors are sensitive to problems in communication and use other-initiated repairs (OIRs) to address them. Participants were randomly assigned to dyads (N = 88 participants, or 44 dyads) and tried to communicate a series of recurring abstract geometric shapes to a partner across a text-chat interface. Participants alternated between directing (describing shapes) and matching (interpreting shape descriptions) roles across 72 trials of the task. Replicating prior research, over repeated social interactions communication success improved and the shape descriptions became increasingly efficient. In addition, confidence in having successfully communicated the different shapes increased over trials. Importantly, matchers were less confident on trials in which communication was unsuccessful, communication success was lower on trials that contained an OIR compared to those that did not contain an OIR, and OIR trials were associated with lower Director Confidence. This pattern of results demonstrates that (a) interlocutors exhibit (a degree of) sensitivity to problems in communication, (b) they appropriately use OIRs to address problems in communication, and (c) OIRs signal problems in communication.

Survival of Staphylococcus epidermidis in Propofol and Intralipid in the Dead Space of Intravenous Injection Ports

We tested whether propofol or Intralipid inoculated with Staphylococcus epidermidis would promote bacterial growth within an intravenous (IV) injection hub, a site prone to bacterial contamination. In tubes incubated under optimal conditions, S epidermidis exhibited growth in Intralipid, but not in propofol. In contrast, within the IV hub incubated with either propofol or intralipid at room temperature, S epidermidis bacterial numbers declined with time, and virtually no contamination remained after 12 hours. These data suggest that certain IV lines are inhospitable for S epidermidis.

Treatment, outcomes and costs of asthma exacerbations in Chilean children: a prospective multicenter observational study

OBJECTIVE

To describe potential regional variations in therapies for severe asthma exacerbations in Chilean children and estimate the associated health expenditures.

METHODS

Observational prospective cohort study in 14 hospitals over a one-year period. Children five years of age or older were eligible for inclusion. Days with oxygen supply and pharmacological treatments received were recorded from the clinical chart. A basic asthma hospitalization basket was defined in order to estimate the average hospitalization cost for a single patient. Six months after discharge, new visits to the Emergency Room (ER), use of systemic corticosteroids and adherence to the controller treatment were evaluated.

RESULTS

396 patients were enrolled. Patients from the public health system and from the north zone received significantly more days of oxygen, systemic corticosteroids and antibiotics. Great heterogeneity in antibiotic use among the participating hospitals was found, from 0 to 92.3% (ICC 0.34, 95% CI 0.16-0.52). The use of aminophylline, magnesium sulfate and ketamine varied from 0 to 36.4% between the different Pediatric Intensive Care Units (ICC 0.353, 95% CI 0.010-0.608). The average cost per inpatient was of $1910 USD. 290 patients (73.2%) completed the follow-up six months after discharge. 76 patients (26.2%) were not receiving any controller treatment and nearly a fourth had new ER visits and use of systemic corticosteroids due to new asthma exacerbations.

CONCLUSIONS

Considerable practice variation in asthma exacerbations treatment was found among the participating hospitals, highlighting the poor outcome of many patients after hospital discharge, with an important health cost.

Hospitalizations for asthma exacerbation in Chilean children: A multicenter observational study

BACKGROUND

Asthma hospitalization rates in Chilean children have increased in the last 14 years, but little is known about the factors associated with this.

OBJECTIVE

Describe clinical characteristics of children hospitalized for asthma exacerbation.

METHODS

Observational prospective cohort study in 14 hospitals. Over a one-year period, children five years of age or older hospitalized with asthma exacerbation were eligible for inclusion. Parents completed an online questionnaire with questions on demographic information, about asthma, indoor environmental contaminant exposure, comorbidities and beliefs about disease and treatment. Disease control was assessed by the Asthma Control Test. Inhalation technique was observed using a checklist.

RESULTS

396 patients were enrolled. 168 children did not have an established diagnosis of asthma. Only 188 used at least one controller treatment at the time of hospitalization. 208 parents said they believed their child had asthma only when they had an exacerbation and 97 correctly identified inhaled corticosteroids as anti-inflammatory treatment. 342 patients used the wrong spacer and 73 correctly performed all steps of the checklist.

CONCLUSIONS

Almost half of the patients were not diagnosed with asthma at the time of hospitalization despite having a medical history suggestive of the disease. In the remaining patients with an established diagnosis of asthma potentially modifiable factors like bad adherence to treatment and poor inhalation technique were found. Implementing a nationwide asthma program including continued medical education for the correct diagnosis and follow up of these patients and asthma education for patients and caregivers is needed to reduce asthma hospitalization rates in Chilean children.

Universal Principles of Human Communication: Preliminary Evidence From a Cross-cultural Communication Game

The present study points to several potentially universal principles of human communication. Pairs of participants, sampled from culturally and linguistically distinct societies (Western and Japanese, N = 108: 16 Western-Western, 15 Japanese-Japanese and 23 Western-Japanese dyads), played a dyadic communication game in which they tried to communicate a range of experimenter-specified items to a partner by drawing, but without speaking or using letters or numbers. This paradigm forced participants to create a novel communication system. A range of similar communication behaviors were observed among the within-culture groups (Western-Western and Japanese-Japanese) and the across-culture group (Western-Japanese): They (a) used iconic signs to bootstrap successful communication, (b) addressed breakdowns in communication using other-initiated repairs, (c) simplified their communication behavior over repeated social interactions, and (d) aligned their communication behavior over repeated social interactions. While the across-culture Western-Japanese dyads found the task more challenging, and cultural differences in communication behavior were observed, the same basic findings applied across all groups. Our findings, which rely on two distinct cultural and linguistic groups, offer preliminary evidence for several universal principles of human communication.

How to Create Shared Symbols

Human cognition and behavior are dominated by symbol use. This paper examines the social learning strategies that give rise to symbolic communication. Experiment 1 contrasts an individual-level account, based on observational learning and cognitive bias, with an inter-individual account, based on social coordinative learning. Participants played a referential communication game in which they tried to communicate a range of recurring meanings to a partner by drawing, but without using their conventional language. Individual-level learning, via observation and cognitive bias, was sufficient to produce signs that became increasingly effective, efficient, and shared over games. However, breaking a referential precedent eliminated these benefits. The most effective, most efficient, and most shared signs arose when participants could directly interact with their partner, indicating that social coordinative learning is important to the creation of shared symbols. Experiment 2 investigated the contribution of two distinct aspects of social interaction: behavior alignment and concurrent partner feedback. Each played a complementary role in the creation of shared symbols: Behavior alignment primarily drove communication effectiveness, and partner feedback primarily drove the efficiency of the evolved signs. In conclusion, inter-individual social coordinative learning is important to the evolution of effective, efficient, and shared symbols.

Influence of culture media, pH and temperature on growth and bacteriocin production of bacteriocinogenic lactic acid bacteria

There has been continued interest in bacteriocins research from an applied perspective as bacteriocins have potential to be used as natural preservative. Four bacteriocinogenic lactic acid bacteria (LAB) strains of Lactobacillus curvatus (Arla-10), Enterococcus faecium (JFR-1), Lactobacillus paracasei subsp. paracasei (JFR-5) and Streptococcus thermophilus (TSB-8) were previously isolated and identified in our lab. The objective of this study was to determine the optimal growth conditions for both LAB growth and bacteriocins production. In this study, various growth conditions including culture media (MRS and BHI), initial pH of culture media (4.5, 5.5, 6.2, 7.4 and 8.5), and incubation temperatures (20, 37 and 44 °C) were investigated for LAB growth measured as optical density (OD), bacteriocin activity determined as arbitrary unit and viability of LAB expressed as log CFU ml-1. Growth curves of the bacteriocinogenic LAB were generated using a Bioscreen C. Our results indicated that Arla-10, JFR-1, and JFR-5 strains grew well on both MRS and BHI media at growth temperature tested whereas TSB-8 strain, unable to grow at 20 °C. LAB growth was significantly affected by the initial pH of culture media (p < 0.001) and the optimal pH was found ranging from 6.2 to 8.5. Bacteriocin activity was significantly different in MRS versus BHI (p < 0.001), and the optimal condition for LAB to produce bacteriocins was determined in MRS broth, pH 6.2 at 37 °C. This study provides useful information on potential application of bacteriocinogenic LAB in food fermentation processes.

A low-cost, do-it-yourself data-logging system to record animal activity in laboratory and small-enclosure experiments

With the increasing cost of prepackaged research equipment and restrictions on research budgets, there is a growing need for inexpensive solutions for data collection in laboratory and small enclosures across a range of research topics investigating responses of animals to experimental parameters. We present here a low-cost, modular passive infrared sensor and data-logging system for use in experiments evaluating animal activity and behaviour, easily assembled in a laboratory setting. This system comprises accessible kit-based components purchased from popular electronics suppliers. We present the hardware configuration, software coding, build of materials, circuit diagram and a sample dataset demonstrating that the system collects reliable data that is easily downloaded either through any terminal program, directly from the unit or via an SD card. It is hoped that this ‘freeware’ approach to activity-monitoring equipment will enable laboratory and enclosure-based research to be undertaken more cost-effectively.

Comparing hospital and telephone follow-up for patients treated for stage-I endometrial cancer (ENDCAT trial): a randomised, multicentre, non-inferiority trial

OBJECTIVE

To evaluate the effectiveness of nurse-led telephone follow-up (TFU) for patients with stage-I endometrial cancer.

DESIGN

Multicentre, randomised, non-inferiority trial.

SETTING

Five centres in the North West of England.

SAMPLE

A cohort of 259 women treated for stage-I endometrial cancer attending hospital outpatient clinics for routine follow-up.

METHODS

Participants were randomly allocated to receive traditional hospital based follow-up (HFU) or nurse-led TFU.

MAIN OUTCOME MEASURES

Primary outcomes were psychological morbidity (State Trait Anxiety Inventory, STAI-S) and patient satisfaction with the information provided. Secondary outcomes included patient satisfaction with service, quality of life, and time to detection of recurrence.

RESULTS

The STAI-S scores post-randomisation were similar between groups [mean (SD): TFU 33.0 (11.0); HFU 35.5 (13.0)]. The estimated between-group difference in STAI-S was 0.7 (95% confidence interval, 95% CI -1.9 to 3.3); the confidence interval lies above the non-inferiority limit (-3.5), indicating the non-inferiority of TFU. There was no significant difference between groups in reported satisfaction with information (odds ratio, OR 0.9; 95% CI 0.4-2.1; P = 0.83). Women in the HFU group were more likely to report being kept waiting for their appointment (P = 0.001), that they did not need any information (P = 0.003), and were less likely to report that the nurse knew about their particular case and situation (P = 0.005).

CONCLUSIONS

The TFU provides an effective alternative to HFU for patients with stage-I endometrial cancer, with no reported physical or psychological detriment. Patient satisfaction with information was high, with similar levels between groups.

TWEETABLE ABSTRACT

ENDCAT trial shows effectiveness of nurse-led telephone follow-up for patients with stage-I endometrial cancer.

Impact of the serum- and glucocorticoid-inducible kinase 1 on platelet dense granule biogenesis and secretion

BACKGROUND

Platelet secretion is critical to development of acute thrombotic occlusion. Platelet dense granules contain a variety of important hemostatically active substances. Nevertheless, biogenesis of platelet granules is poorly understood.

OBJECTIVES

Serum- and glucocorticoid-inducible kinase 1 (SGK1) has been shown to be highly expressed in platelets and megakaryocytes, but its role in the regulation of platelet granule biogenesis and its impact on thrombosis has not been investigated so far.

METHODS AND RESULTS

Electron microscopy analysis of the platelet ultrastructure revealed a significant reduction in the number and packing of dense granules in platelets lacking SGK1 (sgk1(-/-) ). In sgk1(-/-) platelets serotonin content was significantly reduced and activation-dependent secretion of ATP, serotonin and CD63 significantly impaired. In vivo adhesion after carotis ligation was significantly decreased in platelets lacking SGK1 and occlusive thrombus formation after FeCl3 -induced vascular injury was significantly diminished in sgk1(-/-) mice. Transcript levels and protein abundance of dense granule biogenesis regulating GTPase Rab27b were significantly reduced in sgk1(-/-) platelets without affecting Rab27b mRNA stability. In MEG-01 cells transfection with constitutively active (S422) (D) SGK1 but not with inactive (K127) (N) SGK1 significantly enhanced Rab27b mRNA levels. Sgk1(-/-) megakaryocytes show significantly reduced expression of Rab27b and serotonin/CD63 levels compared with sgk1(+/+) megakaryocytes. Proteome analysis identified nine further vesicular transport proteins regulated by SGK1, which may have an impact on impaired platelet granule biogenesis in sgk1(-/-) platelets independent of Rab27b.

CONCLUSIONS

The present observations identify SGK1 as a novel powerful regulator of platelet dense granule biogenesis, platelet secretion and thrombus formation. SGK1 is at least partially effective because it regulates transcription of Rab27b in megakaryocytes.