Systematic reanalysis of copy number losses of uncertain clinical significance

BACKGROUND

Reanalysis of exome/genome data improves diagnostic yield. However, the value of reanalysis of clinical array comparative genomic hybridisation (aCGH) data has never been investigated. Case-by-case reanalysis can be challenging in busy diagnostic laboratories.

METHODS AND RESULTS

We harmonised historical postnatal clinical aCGH results from ~16 000 patients tested via our diagnostic laboratory over ~7 years with current clinical guidance. This led to identification of 37 009 copy number losses (CNLs) including 33 857 benign, 2173 of uncertain significance and 979 pathogenic. We found benign CNLs to be significantly less likely to encompass haploinsufficient genes compared with the pathogenic or CNLs of uncertain significance in our database. Based on this observation, we developed a reanalysis pipeline using up-to-date disease association data and haploinsufficiency scores and shortlisted 207 CNLs of uncertain significance encompassing at least one autosomal dominant disease-gene associated with haploinsufficiency or loss-of-function mechanism. Clinical scientist reviews led to reclassification of 15 CNLs of uncertain significance as pathogenic or likely pathogenic. This was ~0.7% of the starting cohort of 2173 CNLs of uncertain significance and 7.2% of 207 shortlisted CNLs. The reclassified CNLs included first cases of CNV-mediated disease for some genes where all previously described cases involved only point variants. Interestingly, some CNLs could not be reclassified because the phenotypes of patients with CNLs seemed distinct from the known clinical features resulting from point variants, thus raising questions about accepted underlying disease mechanisms.

CONCLUSIONS

Reanalysis of clinical aCGH data increases diagnostic yield.

Effects of Online Unfolding Case Studies on Clinical Reasoning and Academic Performance of Undergraduate Nursing Students

ABSTRACT

A single-episode online case study increases cognitive load in contrast to an unfolding online case study, which decreases cognitive load, improves academic performance, and enhances clinical reasoning. However, online utilization of unfolding case studies is limited. A one-group pretest posttest experimental design was employed with 45 nursing students in a pathophysiology course. Data were collected using Lasater's clinical reasoning scale and quiz scores to assess academic performance. The academic performance and clinical reasoning of nursing students were significantly higher with online unfolding case studies (p < .001), providing support for the use of the online unfolding case study method.

Culturally adapted psychosocial interventions (CaPSI) for early psychosis in a low-resource setting: study protocol for a large multi-center RCT

BACKGROUND

Psychosis treatment guidelines recommend cognitive behaviour therapy (CBT) and family intervention (FI), for all patients with first episode psychosis (FEP), though guidance borrows heavily from literature in adults from high income countries. To our knowledge, there are few randomized controlled trials (RCTs) examining the comparative effect of these commonly endorsed psychosocial interventions in individuals with early psychosis from high-income countries and no such trials from low and middle-income countries (LMICs). The present study aims to confirm the clinical-efficacy and cost-effectiveness of delivering culturally adapted CBT (CaCBT) and culturally adapted FI (CulFI) to individuals with FEP in Pakistan.

METHOD

A multi-centre, three-arm RCT of CaCBT, CulFI, and treatment as usual (TAU) for individuals with FEP (n = 390), recruited from major centres across Pakistan. Reducing overall symptoms of FEP will be the primary outcome. Additional aims will include improving patient and carer outcomes and estimating the economic impact of delivering culturally appropriate psychosocial interventions in low-resource settings. This trial will assess the clinical-efficacy and cost-effectiveness of CaCBT and CulFI compared with TAU in improving patient (positive and negative symptoms of psychosis, general psychopathology, depressive symptoms, quality of life, cognition, general functioning, and insight) and carer related outcomes (carer experience, wellbeing, illness attitudes and symptoms of depression and anxiety).

CONCLUSIONS

A successful trial may inform the rapid scale up of these interventions not only in Pakistan but other low-resource settings, to improve clinical outcomes, social and occupational functioning, and quality of life in South Asian and other minority groups with FEP.

TRIAL REGISTRATION

NCT05814913.

Virtual Skills Teaching of Nursing Students during COVID-19: A Problem-Solving Approach

The COVID-19 pandemic radically affected the whole education system including nursing education. Nursing is a practice-based profession; therefore, it is necessary to transform acquired knowledge into practice. However, in the current situation of the pandemic, the nursing students were unable to learn and practise nursing skills in the skills lab on manikins or simulation. This paper aims to give an overview and practical application of alternative solutions to overcome this situation. Alternatives like virtual skills teaching along with sign-off were sought by using problem-solving approaches to facilitate students' learning and help them to acquire necessary skills timely. Key Words: Virtual skills teaching, Nursing students, Problem-solving approach, COVID-19.

Twelve tips to organise a mock OSCE

The objective structured clinical examination (OSCE) is central to assessing clinical competence in undergraduate and postgraduate exams for medical and allied healthcare professions. A mock OSCE on the other hand is a simulation of the OSCE and a unique learning experience for the examinee. They benefit in a variety of ways; from enhancing their time management skills to receiving feedback that can improve their clinical skills. Unfortunately, opportunities to participate in simulated OSCEs remain limited. Reasons include difficulty in fulfilling organisational requirements and equipment-related costs. Mock OSCEs can be set up by undergraduate students or junior trainees for peers, without senior supervision or direct guidance. This article will discuss 12 tips regarding the arrangement of mock OSCEs to guide organisers, including accessing resources and establishing the content of the exam.

Oxygen Generation Using Catalytic Nano/Micromotors

Gaseous oxygen plays a vital role in driving the metabolism of living organisms and has multiple agricultural, medical, and technological applications. Different methods have been discovered to produce oxygen, including plants, oxygen concentrators and catalytic reactions. However, many such approaches are relatively expensive, involve challenges, complexities in post-production processes or generate undesired reaction products. Catalytic oxygen generation using hydrogen peroxide is one of the simplest and cleanest methods to produce oxygen in the required quantities. Chemically powered micro/nanomotors, capable of self-propulsion in liquid media, offer convenient and economic platforms for on-the-fly generation of gaseous oxygen on demand. Micromotors have opened up opportunities for controlled oxygen generation and transport under complex conditions, critical medical diagnostics and therapy. Mobile oxygen micro-carriers help better understand the energy transduction efficiencies of micro/nanoscopic active matter by careful selection of catalytic materials, fuel compositions and concentrations, catalyst surface curvatures and catalytic particle size, which opens avenues for controllable oxygen release on the level of a single catalytic microreactor. This review discusses various micro/nanomotor systems capable of functioning as mobile oxygen generators while highlighting their features, efficiencies and application potentials in different fields.

Parameters Optimization of Catalytic Tubular Nanomembrane-Based Oxygen Microbubble Generator

A controllable generation of oxygen gas during the decomposition of hydrogen peroxide by the microreactors made of tubular catalytic nanomembranes has recently attracted considerable attention. Catalytic microtubes play simultaneous roles of the oxygen bubble producing microreactors and oxygen bubble-driven micropumps. An autonomous pumping of peroxide fuel takes place through the microtubes by the recoiling microbubbles. Due to optimal reaction–diffusion processes, gas supersaturation, leading to favorable bubble nucleation conditions, strain-engineered catalytic microtubes with longer length produce oxygen microbubbles at concentrations of hydrogen peroxide in approximately ×1000 lower in comparison to shorter tubes. Dynamic regimes of tubular nanomembrane-based oxygen microbubble generators reveal that this depends on microtubes’ aspect ratio, hydrogen peroxide fuel concentration and fuel compositions. Different dynamic regimes exist, which produce specific bubble frequencies, bubble size and various amounts of oxygen. In this study, the rolled-up Ti/Cr/Pd microtubes integrated on silicon substrate are used to study oxygen evolution in different concentrations of hydrogen peroxide and surfactants. Addition of Sodium dodecyl sulfate (SDS) surfactants leads to a decrease of bubble diameter and an increase of frequencies of bubble recoil. Moreover, an increase of temperature (from 10 to 35 °C) leads to higher frequencies of oxygen bubbles and larger total volumes of produced oxygen.

TechCare: Mobile-assessment and therapy for psychosis: An intervention for clients within the early intervention service

Introduction

In the UK, mental illness is a major source of disease burden costing in the region of £105 billion pounds. mHealth is a novel and emerging field in psychiatric and psychological care for the treatment of mental health difficulties such as psychosis.

Objective

To develop an intelligent real-time therapy (iRTT) mobile intervention (TechCare) which assesses participant's symptoms in real-time and responds with a personalised self-help based psychological intervention, with the aim of reducing participant's symptoms. The system will utilise intelligence at two levels:

– intelligently increasing the frequency of assessment notifications if low mood/paranoia is detected;

– an intelligent machine learning algorithm which provides interventions in real-time and also provides recommendations on the most popular selected interventions.

Aim

The aim of the current project is to develop a mobile phone intervention for people with psychosis, and to conduct a feasibility study of the TechCare App.

Methods

The study consists of both qualitative and quantitative components. The study will be run across three strands:

– qualitative work;

– test run and intervention refinement;

– feasibility trial.

Results

Preliminary analysis of qualitative data from Strand 2 (test run and intervention refinement) in-depth interviews with service users (n = 2) and focus group with health professionals (n = 1), highlighted main themes around security of the device, multimedia and the acceptability of psychological interventions being delivered via the TechCare App.

Conclusions

Research in this area can be potentially helpful in addressing the demand on mental health services globally, particularly improving access to psychological interventions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Feasibility study of culturally adapted cognitive behaviour therapy for psychosis in Pakistan

Background

It is becoming well established that CBT is both effective and cost efficient in the treatment of positive and negative symptoms of schizophrenia. However, there is a need to adapt CBT to the cultural, linguistic, and socioeconomic context of diverse cultural groups. We aimed to establish the feasibility of culturally adaptive cognitive behavior therapy for treatment of psychosis in a low-income country.

Methods

This is a rater-blind, randomized, controlled trial of the use of CBT in patients with psychosis from a low-income country. Patients with a DSM-IV diagnosis of schizophreniform disorder were assessed using Positive and Negative Syndrome Scale for Schizophrenia (PANSS), PSYRATS (Psychotic Symptom Rating Scales), and the Insight Scale. Participants were randomized into the intervention group (n = 18) and TAU group (n = 18). The intervention group received 12 weekly sessions of culturally adapted CBT for psychosis (CaCBTp).

Results

There were no significant differences between the two groups at baseline. At three months follow-up, there was a statistically significant improvement in the CaCBTp group on PANSS general Psychopathology subscale, PANSS overall score and Insight scale, as compared to the TAU group. The CaCBTp group had lower scores on PANSS positive, PANSS negative sub-scales, and the two subscales of Psychotic Symptom Rating Scale, but differences were not statistically significant.

Conclusion

Culturally adapted CBT added to pharmacological treatment as usual was acceptable to patients and was helpful in reduction of severity of psychotic symptoms. Adjunctive culturally adapted CBT should be further investigated in this population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Catalytic/magnetic assemblies of rolled-up tubular nanomembrane-based micromotors

Nano/-micromotors self-assembling into static and dynamic clusters are of considerable promise to study smart, interactive, responsive, and adaptive nano/-micromaterials that can mimic spatio-temporal patterns, swarming, and collective behaviors widely observed in nature. Previously, the dynamic self-assembly of bubble-propelled catalytic micromotors initiated by capillary forces has been reported. This manuscript shows novel self-assembly modes of magnetic/catalytic Ti/FeNi/Pt tubular micromotors. When chemical fuel (hydrogen peroxide) is added it is decomposed on contact with Pt catalyst into oxygen and water. Here, the non-bubbling motion and autonomous assembly of catalytic/magnetic nanomembranes, i.e. without nucleation/generation of oxygen bubbles, are shown. Moreover, magnetic Ti/FeNi/Pt micromotors are spun using an external magnetic field and they form dynamic clusters balanced by attractive magnetic and repulsive hydrodynamic interactions. Micromotors form dynamic clusters, undergo precession and rapidly propagate through the solution.

Ti/FeNi/Pt tubular micromotors self-assemble into static and dynamic clusters during catalytic decomposition of hydrogen peroxide and using an external rotational magnetic field.

Evidence of patient beliefs, values, and preferences is not provided in osteoporosis clinical practice guidelines

We examined how patient beliefs, values, and preferences (BVPs) were included and conceptualized in international osteoporosis guidelines. The majority of guidelines did not mention BVPs. When mentioned, BVPs were conceptualized as preference for one medication over another. A broader conceptualization and inclusion of BVPs should be incorporated in osteoporosis guidelines.

INTRODUCTION

Our objectives were to determine (1) the extent to which osteoporosis guidelines reflected patients' beliefs, values, and preferences (BVPs); (2) how BVPs were conceptualized; and (3) the methods used to elicit BVPs in the references cited by the guidelines.

METHODS

We conducted a document analysis of English-language international osteoporosis guidelines based on the International Osteoporosis Foundation website. We examined each guideline and extracted all instances of statements pertaining to BVPs. The statements were reviewed by two independent researchers. Discrepancies in data extraction were resolved by the first author. We developed categories based on five common elements that represented the BVP statements.

RESULTS

Twenty-seven of 70 (39%) guidelines included 95 statements about patient BVPs. Of the 95 statements, 32 statements (14 guidelines) were classified under BVP related to the choice of pharmacotherapy or general treatment, 10 (7 guidelines) under BVP related to adherence to pharmacotherapy or treatment in general, 5 (5 guidelines) under BVP related to financial costs and benefits, 43 (19 guidelines) under other BVP mentioned but not supported by a reference to a primary study or systematic review, and 5 (3 guidelines) under other BVP mentioned and supported by at least one reference to a primary study or systematic review. Twenty-nine references were cited to reflect the BVPs mentioned, including an editorial and quantitative studies.

CONCLUSIONS

Twenty-seven (39%) of the guidelines included mention of patients' BVPs. In 19 guidelines, the importance of BVPs was mentioned but these statements were not supported by references to a primary study or systematic review. BVPs were most often (14 guidelines) conceptualized as preference for one medication over another. We suggest that qualitative data be included as evidence of BVPs in guidelines.

TGF-β1 Causes EMT by Regulating N-Acetyl Glucosaminyl Transferases via Downregulation of Non Muscle Myosin II-A through JNK/P38/PI3K Pathway in Lung Cancer

BACKGROUND

Epithelial to mesenchymal transition (EMT) is a major determinant of cancer metastasis and is closely linked with TGF-β1. Intracellular proteins, including E. Cadherin, N. Cadherin and Vimentin are directly related to EMT that affect cell migration and adhesion; on the other hand, non muscle myosin (NM) has a central role in cytokinesis, migration and adhesion.

OBJECTIVE

We aimed to explore the association of EMT and metastasis with TGF-β1 through regulation of non-muscle myosin II-A (NMII-A) and its interaction with Hexosamine Biosynthesis Pathway (HBP).

METHOD

Protein expression changes were assessed by western blotting and immunofluorescent staining while transcription level changes were assessed by qRT-PCR. EMT was assessed by phenotypic analysis, wound healing, proliferation and transwell migration assay in vitro while in vivo studies were conducted in BALB/c nude mice for lung orthotopic and tail vein metastasis models.

RESULTS

We demonstrated that regulation of JNK/ P38/PI3K by TGF-β1 led to down expression of NMII-A which promoted EMT and lung cancer metastasis. This down expression of NMII-A conversely upregulated the expression of Core 2 N-acetyl Glucosaminyl Transferase mucin type (C2GnT-M) and further facilitated up-regulation and down-regulation of N-acetylglucosaminyltransferase (GnT) -V and -III respectively; moreover, NMII-A K.D cells showed 3 times more tendency to migrate towards brain in vivo.

CONCLUSION

The study reports a novel pathway through which NMII-A negatively regulates EMT and metastasis via up regulation of C2GnT-M, GnT-V and down expression of GnT-III. These findings of lung cancer may further be required to study other cancer types.

TiO2 Nanomembranes Fabricated by Atomic Layer Deposition for Supercapacitor Electrode with Enhanced Capacitance

TiO₂ is a promising environment friendly, low cost, and high electrochemical performance material. However, impediments like high internal ion resistance and low electrical conductivity restrict its applications as electrode for supercapacitor. In the present work, atomic layer deposition was used to fabricate TiO₂ nanomembranes (NMs) with accurately controlled thicknesses. The TiO₂ NMs were then used as electrodes for high-performance pseudocapacitors. Experimental results demonstrated that the TiO₂ NM with 100 ALD cycles had the highest capacitance of 2332 F/g at 1 A/g with energy density of 81 Wh/kg. The enhanced performance was ascribed to the large surface area and the interconnectivity in the case of ultra-thin and flexible NMs. Increased ALD cycles led to stiffer NMs and decreased capacitance. Moreover, one series of two supercapacitors can light up one light-emitting diode with a working voltage of ~ 1.5 V, sufficiently describing its application values.

Development and assessment of a mobile phone-based intervention to reduce maternal depression and improve child health

Introduction

Postnatal depression is known to cause disability and suffering in women and negative consequences both for their infants and their families, with huge costs globally. Several studies from low and middle income countries (LAMIC) have demonstrated that effectively delivered psychological interventions are cost effective for improving maternal and child health, but access to these interventions is limited in both the low and high income countries.

Objective

The objective of the study is to develop and test a mobile phone-based intervention (TechMotherCare), which will include components of cognitive behavioural therapy (CBT) and child development related psychoeducation.

Aim

The aim of the study is to examine the feasibility and acceptability of the TechMotherCare intervention.

Methods

A total of 36 participants will be recruited from health centers in Karachi, Pakistan for this 2-arm randomized pilot study. The TechMotherCare App intervention will be based on principles of CBT and learning-through-play (LTP) a parenting intervention and will assess the real-time depressive symptoms of participants and respond, using intelligent real time therapy (iRTT) dependent on symptoms reported by participants.

Results

Outcome assessments will be completed after 3 months (end of intervention). In-depth qualitative interviews will also be conducted with participants pre- and post-intervention. The trial is ongoing and we will present both the qualitative and quantitative results.

Conclusions

The results of this pilot trial will inform the design of a larger randomised controlled trial using a mobile based technology platform to address the huge treatment gap in LAMICs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Ascorbate prevents placental oxidative stress and enhances birth weight in hypoxic pregnancy in rats

This study isolated the effects of maternal hypoxia independent of changes in maternal nutrition on maternal circulatory and placental molecular indices of oxidative stress and determined whether maternal antioxidant treatment conferred protection. Pregnant rats were subjected to normoxic pregnancy or 13% O2 chronic hypoxia for most of gestation with and without maternal treatment with vitamin C in the drinking water. Maternal hypoxia with and without vitamin C did not affect maternal food or water intake and led to a significant increase in maternal and fetal haematocrit. At gestational day 20, maternal plasma urate and L-cysteine concentrations, and placental levels of 4-hydroxynonenal and heat shock protein 70 were increased while placental heat shock protein 90 levels were decreased in hypoxic pregnancy. The induction of maternal circulatory and placental molecular indices of oxidative stress in hypoxic pregnancies was prevented by maternal treatment with vitamin C. Maternal hypoxia during pregnancy with or without vitamin C increased placental weight, but not total or compartmental volumes. Maternal treatment with vitamin C increased birth weight in both hypoxic and normoxic pregnancies. The data show that maternal hypoxia independent of maternal undernutrition promotes maternal and placental indices of oxidative stress, effects that can be prevented by maternal treatment with vitamin C in hypoxic pregnancy. While vitamin C may not be the ideal candidate of choice for therapy in pregnant women, and taking into consideration differences in ascorbic acid metabolism between rats and humans, the data do underlie that antioxidant treatment may provide a useful intervention to improve placental function and protect fetal growth in pregnancy complicated by fetal hypoxia.

FC16-02 - Workshop: culutrally adapting CBT

There is sufficient evidence to suggest that CBT is an effective treatment for mental health problems. Current evidence suggests that ethnic minorty clients are less likely to engage in psychological interventions. We have adapted CBT for ethnic minorities in the UK. The aim of this workshop is to help the participants to realize the barriers posed by ethnic minority clients in therapy and how to overcome these.

Our work has highlighted that culture, capacity of the system and cognitions and beliefs are the areas which need addressing in this regard. We found that although therapists do not need to make major changes in therapy techniques they need to be aware of issues related to culture and patients beliefs about therapy. This workshop will especially focus on difficult areas such as assessment of ethnic minority clients and their engagement with therapy.

Psychiatric Training in Pakistan

High rates of mental illness, particularly depression have been reported in Pakistan. The health system is both under developed and poorly resourced. It is therefore not surprising that psychiatric training is at its very early stages, at both undergraduate and the postgraduate level. In order to look after the mentally ill patients radical changes need to be implemented in training of doctors. Medical curriculum needs to place more focus on psychiatry. This should not only help junior doctors in understanding the need for psychiatry, but will also prepare them for the challenges they will face as a General Practitioner or a Family Physician. Similarly, postgraduate training can be made more useful by placing more emphasis on community based and primary care psychiatry and psychotherapy; especially family interventions. The training needs to aim towards preparing psychiatrists who are not only clinicians, but can be agents of change in the society, through health education.