Publications by authors named "Rachel Thompson"

270 Publications

'Comfort Club': Student-run volunteering on the neonatal intensive care unit.

Clin Teach 2022 Feb 20;19(1):59-62. Epub 2022 Jan 20.

Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

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http://dx.doi.org/10.1111/tct.13448DOI Listing
February 2022

The utility of echocardiography in paediatric patients with musculoskeletal infections and bacteremia.

J Child Orthop 2021 Dec;15(6):577-582

Renee Meyer Luskin Children's Clinic, Orthopaedic Institute for Children, University of California, Los Angeles, California, United States.

Purpose: The clinical utility of echocardiography in the setting of a positive blood culture in paediatric patients presenting with osteomyelitis (OM) and/or septic arthritis (SA).

Methods: Retrospective review between 2013 and 2019: Patients < 18 years with OM, SA or combined infection (OM+SA) were included. Patients were excluded for immunodeficiency, loss of follow-up or penetrating infection. Charts with positive blood cultures were reviewed for echocardiography on that admission. Demographic variables were compared utilizing the Student's -test and Fisher's exact test. A multivariable linear regression model was constructed to examine the association between echocardiography and length of stay, controlling for age, sex, fever, white blood cell (WBC) on admission, antibiotic administration and surgery performed.

Results: Of 157 patients with OM, SA or combined infection, 44 had a positive blood culture. In all, 26 had an echocardiogram, and none showed endocarditis. Echocardiography was independently associated with a 6.2-day length of stay increase. WBC count and surgical intervention demonstrated a trend toward significance in length of stay, with each WBC unit increase associated with a 0.53-day increase. Surgical intervention was associated with an average 6.3-day length of stay decrease.

Conclusion: No patient had a positive echocardiogram, and no changes in management were initiated. However, an echocardiogram increased stay by 6.2 days. In addition to costs associated with increased stay, patients were billed between $1460 and $1700 per echocardiogram. The utility of echocardiograms in the setting of bacteremia associated with musculoskeletal infections in the paediatric population should be re-examined, and guidelines should be updated to reflect the cost-benefit analysis.

Level Of Evidence: III.
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http://dx.doi.org/10.1302/1863-2548.15.210110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8670541PMC
December 2021

What's Important: Coaching.

J Bone Joint Surg Am 2021 Dec 10. Epub 2021 Dec 10.

University of California Los Angeles, Los Angeles, California.

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http://dx.doi.org/10.2106/JBJS.21.01170DOI Listing
December 2021

Impact of Patient-Reported Penicillin Allergy on Antibiotic Prophylaxis and Surgical Site Infection among Colorectal Surgery Patients.

Dis Colon Rectum 2021 Nov 24. Epub 2021 Nov 24.

Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee Department of Surgery, Baylor University Medical Center, Dallas, Texas.

Background: Surgical site infections are a major preventable source of morbidity, mortality, and increased healthcare expenditure following colorectal surgery. Patients with penicillin allergy may not receive the recommended preoperative antibiotics, putting them at increased risk for surgical site infections.

Objective: This study aimed to evaluate the impact of patient-reported penicillin allergy on preoperative antibiotic prophylaxis and surgical site infection rates among patients undergoing major colon and rectal procedures.

Design: Retrospective observational study.

Setting: Tertiary teaching hospital in Dallas.

Patients: Adults undergoing colectomy or proctectomy between July 2012 to July 2019.

Main Outcome Measures: Preoperative antibiotic choice and surgical site infection.

Results: Among 2198 patients included in the study, 12.26% (n=307) reported a penicillin allergy. Patients with penicillin allergy were more likely to be white (82%) and female (54%) (p<0.01). The most common type of allergic reaction reported was rash (36.5%), whereas 7.2% of patients reported anaphylaxis. Patients with self-reported penicillin allergy were less likely to receive beta-lactam antibiotics compared to patients who did not report a penicillin allergy (79.8% vs 96.7%, p<0.001). Overall, there were 143 (6.5%) patients with surgical site infections. On multivariable logistic regression there was no difference in rates of surgical site infection between patients with penicillin allergy vs. those without penicillin allergy (adjusted odds ratio 1.14; 95% confidence interval, 0.71-1.82).

Limitations: Retrospective study design.

Conclusions: Self-reported penicillin allergy among colorectal surgery patients is common, however only a small number of these patients report any serious adverse reactions. Patients with self-reported penicillin allergy are less likely to receive beta-lactam antibiotics and more likely to receive non beta-lactam antibiotics. However, this does not affect the rate of surgical site infection among these patients and patient's penicillin allergy can be safely prescribed non beta-lactam antibiotics without negatively impacting surgical site infection rates. See Video Abstract at http://links.lww.com/DCR/B838 .
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http://dx.doi.org/10.1097/DCR.0000000000002190DOI Listing
November 2021

Risk prediction models for symptomatic patients with bladder and kidney cancer: a systematic review.

Br J Gen Pract 2022 Jan 31;72(714):e11-e18. Epub 2021 Dec 31.

The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge.

Background: Timely diagnosis of bladder and kidney cancer is key to improving clinical outcomes. Given the challenges of early diagnosis, models incorporating clinical symptoms and signs may be helpful to primary care clinicians when triaging at-risk patients.

Aim: To identify and compare published models that use clinical signs and symptoms to predict the risk of undiagnosed prevalent bladder or kidney cancer.

Design And Setting: Systematic review.

Method: A search identified primary research reporting or validating models predicting the risk of bladder or kidney cancer in MEDLINE and EMBASE. After screening identified studies for inclusion, data were extracted onto a standardised form. The risk models were classified using TRIPOD guidelines and evaluated using the PROBAST assessment tool.

Results: The search identified 20 661 articles. Twenty studies (29 models) were identified through screening. All the models included haematuria (visible, non-visible, or unspecified), and seven included additional signs and symptoms (such as abdominal pain). The models combined clinical features with other factors (including demographic factors and urinary biomarkers) to predict the risk of undiagnosed prevalent cancer. Several models ( = 13) with good discrimination (area under the receiver operating curve >0.8) were identified; however, only eight had been externally validated. All of the studies had either high or unclear risk of bias.

Conclusion: Models were identified that could be used in primary care to guide referrals, with potential to identify lower-risk patients with visible haematuria and to stratify individuals who present with non-visible haematuria. However, before application in general practice, external validations in appropriate populations are required.
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http://dx.doi.org/10.3399/BJGP.2021.0319DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8714528PMC
January 2022

Patients with oral preneoplastic lesions and integration of dental pathology referrals.

Am J Otolaryngol 2022 Jan-Feb;43(1):103270. Epub 2021 Oct 20.

Department of Otolaryngology Head and Neck Surgery, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USA.

Purpose: Oral cancers lack standardized monitoring systems. Our institution has developed an active surveillance system which provides detailed monitoring and follow up of patients with oral preneoplastic lesions (OPL). We examined a historic cohort of patients with OPL seen by regional dental professionals and a current cohort of clinic patients. The major aim was to examine follow up practices for biopsy proven dysplasia to gauge appropriateness of an active monitoring system for oral carcinoma.

Materials And Methods: Questionnaires regarding patients with OPL were sent to 285 dentists who had requested oral pathology services from our institution. The follow up practices of 141 dentists were evaluated for patients with OPL. We then examined our current clinic referral patterns for the number of dental referrals after the creation of an oral carcinoma active surveillance clinic.

Results: There were 76.5% (108/141) of patients who received follow up after diagnosis of preneoplastic oral lesions with 14.1% who underwent repeat biopsy. There was a malignant transformation rate of 11.3% including transformation of 42.8% of severe dysplasias into carcinoma within 2 years. After establishment of a dental referral clinic, 21.8% of tumor visits in a six-week period were referred from the regional dental community.

Conclusions: A high rate of transformation of OPL to cancer in this cohort may support a role for joint dental and otolaryngology surveillance of dysplasia with longitudinal follow up.
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http://dx.doi.org/10.1016/j.amjoto.2021.103270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8670077PMC
October 2021

Congenital myasthenic syndrome: Correlation between clinical features and molecular diagnosis.

Eur J Neurol 2021 Nov 8. Epub 2021 Nov 8.

Department of Neurology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil.

Objectives: To present phenotype features of a large cohort of congenital myasthenic syndromes (CMS) and correlate them with their molecular diagnosis.

Methods: Suspected CMS patients were divided into three groups: group A (limb, bulbar or axial weakness, with or without ocular impairment, and all the following: clinical fatigability, electrophysiology compatible with neuromuscular junction involvement and anticholinesterase agents response), group B (limb, bulbar or axial weakness, with or without ocular impairment, and at least one of additional characteristics noted in group A) and group C (pure ocular syndrome). Individual clinical findings and the clinical groups were compared between the group with a confirmed molecular diagnosis of CMS and the group without molecular diagnosis or with a non-CMS molecular diagnosis.

Results: Seventy-nine patients (68 families) were included in the cohort: 48 in group A, 23 in group B and 8 in group C. Fifty-one were considered confirmed CMS (30 CHRNE, 5 RAPSN, 4 COL13A1, 3 DOK7, 3 COLQ, 2 GFPT1, 1 CHAT, 1 SCN4A, 1 GMPPB, 1 CHRNA1), 7 probable CMS, 5 non-CMS and 16 unsolved. The chance of a confirmed molecular diagnosis of CMS was significantly higher for group A and lower for group C. Some individual clinical features, alterations on biopsy and electrophysiology enhanced specificity for CMS. Muscle imaging showed at least mild alterations in the majority of confirmed cases, with preferential involvement of soleus, especially in CHRNE CMS.

Conclusions: Stricter clinical criteria increase the chance of confirming a CMS diagnosis, but may lose sensitivity, especially for some specific genes.
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http://dx.doi.org/10.1111/ene.15173DOI Listing
November 2021

The Utility of Routine Radiographic Monitoring in Pediatric Osteoarticular Infections.

J Pediatr Orthop 2022 Jan;42(1):e34-e38

UCLA Department of Orthopedic Surgery.

Background: Pediatric musculoskeletal (MSK) infections broadly include isolated osteomyelitis (OM), septic arthritis (SA), and combined infections (OM+SA). These diagnoses are often monitored with serum inflammatory markers and serial radiographs to monitor treatment response and development of negative sequelae, despite limited data supporting these practices. The purpose of this study is to evaluate the utility of obtaining serial radiographic follow-up for pediatric osteoarticular infections.

Methods: An institutional review board-approved retrospective review was completed. Children 18 years and below admitted to a single institution with a culture/biopsy-proven diagnosis of OM, SA, or OM+SA. All postdischarge radiographs were reviewed and retrospectively categorized as either routine (scheduled) or reactive. Routine radiographs were obtained regardless of clinical presentation. Reactive radiographs were obtained in patients presenting with the sign of an altered clinical course. Negative sequelae, defined as growth arrest/disturbance, pathologic fracture, recurrent MSK infection, and underlying neoplastic process, were recorded and tracked. Descriptive statistics were used to summarize demographic and outcome variables. Number needed to screen (NNS) was defined as the inverse of the incidence of negative sequelae detected.

Results: A total of 131 patients were included for analysis, with a mean age of 11.9 years (SD: 4.96 y). Ninety (69%) patients were diagnosed and treated for OM, 25 (19%) for SA, and 16 (12%) for combined infections. A total of 329 radiographs were obtained following discharge. Of those obtained, 287 (88%) were routine, resulting in the detection of 2 (0.7%) negative sequelae and a resultant NNS of 143 radiographs (95% confidence interval: 36-573). The remaining 39 were reactive radiographs, resulting in the detection of 2 (5.1%) negative sequelae with an NNS of 20 radiographs (95% confidence interval: 5-78).

Conclusions: While radiographs remain a widely utilized tool to screen for the development of negative sequelae in pediatric osteoarticular infections, they rarely alter management in the absence of other concerning clinical signs or symptoms such as recurrent fevers, swelling of the extremity, or limb deformity. Moreover, routine radiographic surveillance should be replaced with a reactive radiographic protocol.

Level Of Evidence: Level III-retrospective comparative study.
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http://dx.doi.org/10.1097/BPO.0000000000001990DOI Listing
January 2022

To Use or Not to Use a COVID-19 Contact Tracing App: Mixed Methods Survey in Wales.

JMIR Mhealth Uhealth 2021 11 22;9(11):e29181. Epub 2021 Nov 22.

Swansea University, Swansea, United Kingdom.

Background: Many countries remain in the grip of the COVID-19 global pandemic, with a considerable journey still ahead toward normalcy and free mobility. Contact tracing smartphone apps are among a raft of measures introduced to reduce spread of the virus, but their uptake depends on public choice.

Objective: The objective of this study was to ascertain the views of citizens in Wales on their intended use of a COVID-19 contact tracing smartphone app, including self-proposed reasons for or against use and what could lead to a change of decision.

Methods: We distributed an anonymous survey among 4000 HealthWise Wales participants in May 2020. We adopted a mixed methods approach: responses to closed questions were analyzed using descriptive and inferential statistics; open question responses were analyzed and grouped into categories.

Results: A total of 976 (24.4%) people completed the survey. Smartphone usage was 91.5% overall, but this varied among age groups. In total, 97.1% were aware of contact tracing apps, but only 67.2% felt sufficiently informed. Furthermore, 55.7% intended to use an app, 23.3% refused, and 21.0% were unsure. The top reasons for app use were as follows: controlling the spread of the virus, mitigating risks for others and for oneself, and increasing freedoms. The top reasons against app use were as follows: mistrusting the government, concerns about data security and privacy, and doubts about efficacy. The top response for changing one's mind about app use from being willing to being unwilling was that nothing would; that is, they felt that nothing would cause them to become unwilling to use a contact tracing app. This was also the top response for changing one's mind from being unwilling to being willing to use contact tracing apps. Among those who were unsure of using contact tracing apps, the top response was the need for more information.

Conclusions: Respondents demonstrated a keenness to help themselves, others, society, and the government to avoid contracting the virus and to control its spread. However, digital inclusion varied among age groups, precluding participation for some people. Nonetheless, unwillingness was significant, and considering the nature of the concerns raised and the perceived lack of information, policy and decision-makers need to do more to act openly, increase communication, and demonstrate trustworthiness if members of the public are to be confident in using an app.
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http://dx.doi.org/10.2196/29181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8610446PMC
November 2021

Training Medical Students as Peer-Facilitators to Identify Medical Student Mistreatment in the Clerkship Year.

MedEdPORTAL 2021 27;17:11185. Epub 2021 Sep 27.

Assistant Professor, Department of Family Medicine and Medical Sciences and Education, Boston University School of Medicine; Assistant Dean of Curriculum and Instructional Design, Boston University School of Medicine.

Introduction: Data from the Association of American Medical Colleges' Medical School Graduation Questionnaire show persistent trends of medical student mistreatment nationwide. To reduce the barriers and increase actionable reporting of mistreatment, we integrated peer-facilitated learning environment sessions led by a group of trained third- and fourth-year medical students in all core clinical clerkships.

Methods: During the 2018-2019 academic year, third-year medical students were recruited, oriented, and trained to act as facilitators of sessions on mistreatment. The sessions occurred once every clerkship block, using a standardized session introduction and guide. After a 6-month pilot, new medical students were recruited and worked as scribe/facilitator pairs, receiving an additional 1.5-hour training midyear, which was evaluated with a postworkshop survey.

Results: Thirty-eight students implemented 43 peer-facilitated sessions and completed deidentified minutes of each session, which were shared with clerkship directors and the Medical Education Office for review. Survey data from midyear facilitator training indicated that facilitators highly agreed peer-led sessions were an important avenue for students to process experiences of mistreatment (3.9 out of 4), understood barriers to reporting (3.8 out of 4) and definitions of mistreatment (3.6 out of 4), and felt confident to facilitate these sessions (3.6 out of 4).

Discussion: Peer-facilitated sessions offer a method to learn more about student experiences with mistreatment in real time and create a new avenue for communication between faculty and students. Assembling a stable core team of third- and fourth-year students trained in facilitation skills ensures the sustainability and relevance of the program.
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http://dx.doi.org/10.15766/mep_2374-8265.11185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8473588PMC
October 2021

Development of a patient decision aid on subacromial decompression surgery and rotator cuff repair surgery: an international mixed-methods study.

BMJ Open 2021 08 30;11(8):e054032. Epub 2021 Aug 30.

Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.

Objective: To develop and user test a patient decision aid for people with subacromial pain syndrome that presents evidence-based information on the benefits and harms of subacromial decompression surgery and rotator cuff repair surgery.

Design: Mixed-methods study outlining the development of a patient decision aid.

Setting: We assembled a multidisciplinary steering group, and used existing decision aids and decision science to draft the decision aid. Participants were recruited through social media (not restricted by country nor setting), local hospitals and the authors' collaboration network.

Participants: People with shoulder pain and health professionals who manage people with shoulder pain.

Primary And Secondary Outcomes: We interviewed participants to gather feedback on the decision aid, assessed useability and acceptability (using qualitative and quantitative methods) and performed iterative cycles of redrafting the decision aid and reinterviewing participants as necessary. Interview data were analysed using thematic analysis. Quantitative data were summarised descriptively.

Results: We interviewed 26 health professionals (11 physiotherapists, 7 orthopaedic surgeons, 4 general practitioners, 3 chiropractors and 1 osteopath) and 14 people with shoulder pain. Most health professionals and people with shoulder pain rated all aspects of decision aid acceptability as adequate-to-excellent (eg, length, presentation, comprehensibility). Interviews highlighted agreement among health professionals and people with shoulder pain on most aspects of the decision aid (eg, treatment options, summary of benefits, harms and practical issues, questions to ask a health professional, graphics, formatting). However, some aspects of the decision aid elicited divergent views among health professionals (eg, causes and symptoms of shoulder pain, evidence on benefits and harms).

Conclusion: This decision aid could be an acceptable and valuable tool for helping people with subacromial pain syndrome make informed treatment choices. A randomised controlled trial evaluating whether this decision aid reduces people's intentions to undergo shoulder surgery and facilitates informed treatment choices is underway. ACTRN12621000992808.
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http://dx.doi.org/10.1136/bmjopen-2021-054032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8407224PMC
August 2021

Multiple endocrine neoplasia 1: a broad overview.

Ther Adv Chronic Dis 2021 12;12:20406223211035288. Epub 2021 Aug 12.

Department of Surgery, Baylor University Medical Center, Dallas, TX 77030-3411, USA.

This review article discusses the diagnoses and treatment of patients with multiple endocrine neoplasia type 1 (MEN 1). The most common tumors associated with MEN 1 are located in the pancreas, pituitary, and parathyroid glands. Less common tumors include neuroendocrine tumors of the lung and thymus, adrenal tumors, and cutaneous lesions. This article describes the diagnosis, clinical manifestations, treatment, and surveillance of tumors associated with patients who are diagnosed with MEN 1.
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http://dx.doi.org/10.1177/20406223211035288DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8369854PMC
August 2021

Adult Shigatoxin-mediated hemolytic uremic syndrome masked by alcohol use and inflammatory bowel disease.

BMJ Case Rep 2021 Aug 19;14(8). Epub 2021 Aug 19.

Graduate Medical Education, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA

Diagnosing uncommon diseases in individuals with underlying medical conditions can be challenging. Cognitive bias can lead to delayed or missed disease management. We present a case of Shiga-toxin mediated hemolytic uremic syndrome (ST-HUS) in a 46-year-old man with ulcerative colitis and alcohol use disorder who presented with acute alcohol intoxication, non-bloody diarrhoea and coffee ground emesis. He was admitted to the hospital for alcoholic ketoacidosis, alcohol withdrawal and possible upper gastrointestinal bleed, but ultimately, he developed severe thrombocytopaenia, hemolytic anaemia, acute renal failure and prolonged altered mentation. Given that ST-HUS is uncommon in adults, his initial report of diarrhoea was attributed to alcohol use or underlying active ulcerative colitis and not connected to his haematologic abnormalities. He was initially started on plasmapheresis; however, thrombotic microangiopathy work up revealed Shiga-toxin in his stool and ADAMST13 levels within normal limits. Subsequently, he was transitioned to supportive care for management of ST-HUS.
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http://dx.doi.org/10.1136/bcr-2021-244115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8378347PMC
August 2021

Reducing risk of childhood obesity in the wake of covid-19.

BMJ 2021 08 10;374:n1716. Epub 2021 Aug 10.

Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, MA, USA.

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http://dx.doi.org/10.1136/bmj.n1716DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353544PMC
August 2021

National Trends in Total Hip Arthroplasty Bearing Surface Usage in Extremely Young Patients Between 2006 and 2016.

Arthroplast Today 2021 Aug 9;10:51-56. Epub 2021 Jul 9.

Department of Orthopaedic Surgery, UCLA, Santa Monica, CA, USA.

Background: Long-term implant durability is a key concern when considering total hip arthroplasty (THA) in young patients. The ideal bearing surface used in these patients remains unknown. The purpose of this study was to analyze trends in THA bearing surface use from 2006 to 2016 using a large, pediatric national database.

Methods: This was a retrospective review from January 1, 2006, to December 31, 2016, using the Kids' Inpatient Database. International Classification of Diseases, 9 revision and 10 revision codes were used to identify patients who underwent THA and create cohorts based on bearing surfaces: metal-on-metal, metal-on-polyethylene, ceramic-on-polyethylene (CoP), and ceramic-on-ceramic (CoC). Annual utilization of each bearing surface and associated patient and hospital demographics were analyzed.

Results: A total of 1004 THAs were identified during the 11-year study period. The annual number of THAs performed increased by 169% from 2006 to 2016. The mean patient age was 17.1 years. The most prevalent bearing surface used in 2006 was CoC (37.3%), metal-on-metal (31.8%) in 2009, and CoP in 2012 and 2016 (50.6% and 64.8%, respectively). From 2006 to 2016, utilization of CoP increased from 5.0% to 64.8%, representing a 1196% increase over the study period.

Conclusions: The number of THAs performed in pediatric patients is increasing significantly. Although CoC was previously the most commonly used bearing surface in this patient population, CoP is currently the most common. Further investigation is needed to determine whether bearing longevity and clinical outcomes with CoP are superior to other bearing surfaces.
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http://dx.doi.org/10.1016/j.artd.2021.05.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8283017PMC
August 2021

Measuring Patient Experiences of Integration in Health Care Delivery: Psychometric Validation of IntegRATE Under Controlled Conditions.

J Patient Exp 2021 13;8:23743735211007346. Epub 2021 Apr 13.

The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Hanover, NH, USA.

The objective of this study was to assess the psychometric properties of IntegRATE-a 4-item patient-reported measure of integration in health care delivery-under controlled conditions. Adults who reported having received health care in the previous year were exposed to a fictional health care scenario featuring good, mixed, or poor integration on 1 or 2 occasions. They were then asked to imagine themselves as a patient in the scenario and complete IntegRATE and other measures. The data collected were analyzed to assess the discriminative, concurrent, and divergent validity of IntegRATE and its test-retest reliability and responsiveness using both "sum score" and "top score" scoring approaches. Six-hundred people participated in the study with 190 taking part on 2 occasions. The IntegRATE sum score demonstrated discriminative validity, concurrent validity, divergent validity, and responsiveness and partially demonstrated test-retest reliability. The IntegRATE top score demonstrated concurrent validity, divergent validity, and responsiveness and partially demonstrated discriminative validity and test-retest reliability. We conclude that the IntegRATE sum score exhibits encouraging psychometric properties and performs more optimally than the IntegRATE top score.
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http://dx.doi.org/10.1177/23743735211007346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205402PMC
April 2021

Effect of clinical isolate or cleavage site mutations in the SARS-CoV-2 spike protein on protein stability, cleavage, and cell-cell fusion.

J Biol Chem 2021 07 20;297(1):100902. Epub 2021 Jun 20.

Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, Kentucky, USA. Electronic address:

The trimeric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein (S) is the sole viral protein responsible for both viral binding to a host cell and the membrane fusion event needed for cell entry. In addition to facilitating fusion needed for viral entry, S can also drive cell-cell fusion, a pathogenic effect observed in the lungs of SARS-CoV-2-infected patients. While several studies have investigated S requirements involved in viral particle entry, examination of S stability and factors involved in S cell-cell fusion remain limited. A furin cleavage site at the border between the S1 and S2 subunits (S1/S2) has been identified, along with putative cathepsin L and transmembrane serine protease 2 cleavage sites within S2. We demonstrate that S must be processed at the S1/S2 border in order to mediate cell-cell fusion and that mutations at potential cleavage sites within the S2 subunit alter S processing at the S1/S2 border, thus preventing cell-cell fusion. We also identify residues within the internal fusion peptide and the cytoplasmic tail that modulate S-mediated cell-cell fusion. In addition, we examined S stability and protein cleavage kinetics in a variety of mammalian cell lines, including a bat cell line related to the likely reservoir species for SARS-CoV-2, and provide evidence that proteolytic processing alters the stability of the S trimer. This work therefore offers insight into S stability, proteolytic processing, and factors that mediate S cell-cell fusion, all of which help give a more comprehensive understanding of this high-profile therapeutic target.
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http://dx.doi.org/10.1016/j.jbc.2021.100902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8214756PMC
July 2021

Single-event multilevel surgery in cerebral palsy: Value added by a co-surgeon.

Medicine (Baltimore) 2021 Jun;100(24):e26294

National Academy of Medicine Fellowship, American Osteopathic Association, Chicago, IL, USA.

Abstract: The aim of this study was to compare outcomes for single-event multilevel surgery (SEMLS) in cerebral palsy (CP) performed by 1 or 2 attending surgeons.A retrospective review of patients with CP undergoing SEMLS was performed. Patients undergoing SEMLS performed by a single senior surgeon were compared with patients undergoing SEMLS by the same senior surgeon and a consistent second attending surgeon. Due to heterogeneity of the type and quantity of SEMLS procedures included in this study, a scoring system was utilized to stratify patients to low and high surgical burden. The SEMLS events scoring less than 18 points were categorized as low burden surgery and SEMLS scoring 18 or more points were categorized as high burden surgery. Operative time, estimated blood loss, hospital length of stay, and operating room (OR) utilization costs were compared.In low burden SEMLS, 10 patients had SEMLS performed by a single surgeon and 8 patients had SEMLS performed by 2 surgeons. In high burden SEMLS, 10 patients had SEMLS performed by a single surgeon and 12 patients had SEMLS performed by 2 surgeons. For high burden SEMLS, operative time was decreased by a mean of 69 minutes in cases performed by 2 co-surgeons (P = 0.03). Decreased operative time was associated with an estimated savings of $2484 per SEMLS case. In low burden SEMLS, a trend toward decreased operative time was associated for cases performed by 2 co-surgeons (182 vs 221 minutes, P = 0.11). Decreased operative time was associated with an estimated savings of $1404 per low burden SEMLS case. No difference was found for estimated blood loss or hospital length of stay between groups in high and low burden SEMLS.Employing 2 attending surgeons in SEMLS decreased operative time and OR utilization cost, particularly in patients with a high surgical burden. These findings support the practice of utilizing 2 attending surgeons for SEMLS in patients with CP.Level of Evidence: Level III.
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http://dx.doi.org/10.1097/MD.0000000000026294DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8213317PMC
June 2021

When Should Instrumentation to the Pelvis be Considered in Minimally Ambulatory Adolescents With Neuromuscular Scoliosis?

J Pediatr Orthop 2021 Jul;41(Suppl 1):S53-S58

Children's Hospital Colorado, Aurora, CO.

Introduction: The goal of neuromuscular scoliosis (NMS) surgery is to improve sitting balance, facilitate daily care, and alleviate pain. In nonambulatory patients, where sitting balance is key, fusion to the pelvis is usually required. However, in minimally ambulatory patients, fusion to the pelvis remains controversial, and there is considerable practice variability in this patient population. The purpose of this study is to evaluate and summarize the available evidence regarding fusion constructs in minimally ambulatory patients with NMS and to provide expert opinion regarding when fusion to the pelvis should be considered.

Methods: A search of the English literature was performed using PubMed to identify papers pertaining to patients with NMS treated with instrumented posterior spinal fusion. Papers published before 2000, case reports, and level V evidence were excluded.

Results: The authors identified 8 studies for review. The majority included both nonambulatory and minimally ambulatory patients. Structured review of the literature demonstrated fusion to the pelvis may allow for greater curve and pelvic obliquity correction, but it is also associated with increased blood loss and operative time. There is no evidence that fusing to the pelvis decreases ambulatory status in minimally ambulatory patients.

Conclusions: In minimally ambulatory patients with NMS, fusion short of the pelvis may be considered in patients with adequate head control without the presence of hip subluxation or dislocation and when pelvic obliquity is <15 degrees. Fusion to the pelvis is recommended in patients who do not meet these criteria.
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http://dx.doi.org/10.1097/BPO.0000000000001821DOI Listing
July 2021

Linking pre- and post-adoption records for research in anonymised form in a data safe haven: legal implications and support for a social licence.

Int J Popul Data Sci 2020 Oct 23;5(3):1370. Epub 2020 Oct 23.

Centre for Child & Family Justice Research, Lancaster University, Lancaster, LA1 4YW, UK.

Introduction: The long-term health and wellbeing of adoptees is under-researched. One reason for this has been limited data accessibility regarding the adoption process, and another is a practice common in some UK jurisdictions of changing the National Health Service (NHS) number (or equivalent) at adoption, as part of creating the new identity. The SAIL Databank holds data on child and family court cases from Cafcass Cymru, together with children's social care data, and can link these with routine health and administrative data in anonymised form. However, because the linkage key at SAIL is based on an encryption of the NHS number, working with pre- and post-adoption records for longitudinal research remains a major challenge. We set out to explore the legal implications of, and social support for, linking these records for use in anonymised form for longitudinal research.

Methods: We reviewed the main legislation and regulations governing the use of data about adoptees in England and Wales. We gauged support for a social licence in Wales by carrying out interviews with individuals who had been involved in the adoptions process, and by engaging with general public groups for their views. We drew out the main emerging themes and, in combination with the review, propose a way forward.

Results: The legal review indicated that there are provisions in the Family Procedure Rules (England and Wales) and the General Data Protection Regulation that can be relied upon for the lawful processing of adoption data into anonymised form for research. The main points of concern about linking pre- and post-adoption records were privacy, data security, the need to limit the number of organisations involved in data sharing, and re-identification risk. The over-riding message was favourable with longitudinal research seen as strongly beneficial.

Conclusion: This study has indicated that in Wales, there is no legal impediment, nor major objection from individuals involved in the adoptions process, or members of the general public, for the use of adoption data in anonymised form in a data safe haven. This includes the linkage of pre- and post-adoption records to enable novel longitudinal research to take place. The provisos were that robust safeguards must be in place, and that the research should aim to benefit adoptees and to improve policy and practice. We conclude that it is reasonable to proceed with caution to develop practical ways to link pre- and post-adoption records in a data safe haven.
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http://dx.doi.org/10.23889/ijpds.v5i3.1370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8110886PMC
October 2020

Addressing Conflicts of Interest in Health and Medicine: Current Evidence and Implications for Patient Decision Aid Development.

Med Decis Making 2021 10 8;41(7):768-779. Epub 2021 May 8.

Deans Office, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA.

Background: More stringent policies for addressing conflicts of interest have been implemented around the world in recent years. Considering the value of revisiting conflict of interest quality standards set by the International Patient Decision Aid Standards (IPDAS) Collaboration, we sought to review evidence relevant to 2 questions: 1) What are the effects of different strategies for managing conflicts of interest? and 2) What are patients' perspectives on conflicts of interest?

Methods: We conducted a narrative review of English-language articles and abstracts from 2010 to 2019 that reported relevant quantitative or qualitative research.

Results: Of 1743 articles and 118 abstracts identified, 41 articles and 2 abstracts were included. Most evidence on the effects of conflict of interest management strategies pertained only to subsequent compliance with the management strategy. This evidence highlighted substantial noncompliance with prevailing requirements. Evidence on patient perspectives on conflicts of interest offered several insights, including the existence of diverse views on the acceptability of conflicts of interest, the salience of conflict of interest type and monetary value to patients, and the possibility that conflict of interest disclosure could have unintended effects. We identified no published research on the effects of IPDAS Collaboration conflict of interest quality standards on patient decision making or outcomes.

Limitations: Because we did not conduct a systematic review, we may have missed some evidence relevant to our review questions. In addition, our team did not include patient partners.

Conclusions: The findings of this review have implications for the management of conflicts of interest not only in patient decision aid development but also in clinical practice guideline development, health and medical research reporting, and health care delivery.
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http://dx.doi.org/10.1177/0272989X211008881DOI Listing
October 2021

Heterotopic gastric mucosa and intestinal atresia in a neonate.

Proc (Bayl Univ Med Cent) 2021 Jan 22;34(3):369-370. Epub 2021 Jan 22.

Department of Pediatric Surgery, Baylor University Medical Center, Dallas, Texas.

Jejunal atresia is a well-known congenital malformation attributed to in utero ischemic events. Heterotopic gastric mucosa (HGM), or gastric tissue present in a location other than the stomach, is a much rarer congenital anomaly and is generally found in the esophagus or within a Meckel's diverticulum. Identifying both within the same pathologic specimen is truly rare. This report outlines a case of jejunal atresia wherein HGM was identified within postoperative pathology evaluation of the specimen. An early episode of restenosis at the anastomosis prompted operative re-exploration, in which additional HGM was found within the specimen.
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http://dx.doi.org/10.1080/08998280.2021.1872356DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8059888PMC
January 2021

'Every medicine is part poison': a qualitative inquiry into the perceptions and experiences of choosing contraceptive methods of migrant Chinese women living in Australia.

BMC Womens Health 2021 03 8;21(1):100. Epub 2021 Mar 8.

School of Public Health, The University of Sydney, Room 125, Edward Ford Building, Sydney, NSW, 2006, Australia.

Background: In Australia, ethnic Chinese people are one of the largest, youngest and fastest growing overseas-born groups. Yet, little is known about their perceptions of contraceptive methods and their experiences with choosing one. Decisions about contraceptive methods are preference sensitive. Understanding the influencing factors of Chinese migrant women's contraceptive method choice and practices will help cater to their decision-making needs in a culturally sensitive and responsive way.

Methods: A qualitative study design underpinned by critical realism approach was used to explore Chinese migrant women's perceptions and experiences of choosing contraceptive methods. Semi-structured interviews were conducted with 22 women who self-identified as being ethnically Chinese and had been living in Australia for no more than 10 years. The interview guide was adapted from the Ottawa Decision Support Framework. Majority of the interviews were conducted in Mandarin Chinese. Transcribed data was analysed using thematic analysis method.

Results: Four major themes were identified, including: 'every medicine is part poison: hormonal contraceptives cause harm to the body'; 'intrauterine device, a device used in the past for married women'; 'it takes two (or one) to decide, depending on the relationship dynamics and contraception preferences'; and 'it is not necessary to seek medical advice in choosing contraceptive methods'.

Conclusions: Our findings suggest that Chinese migrant women's perceptions and experiences of choosing contraceptive methods are influenced by complex personal, cultural, societal and inter-relational factors. Chinese migrant women were cautious of using hormonal methods due to fears of side-effects, including reduced or absent menstrual bleeding. Women were also reluctant to consider intrauterine devices as options due to associating them with past experiences of other women and themselves and also fears of potential complications. There was a reluctant attitude towards seeking medical advice regarding contraception due to beliefs that needing to use contraception is not an illness requiring treatment. Such findings are likely to be useful in increasing healthcare professionals' and policy makers' understanding of Chinese migrant women's contraceptive method preferences, beliefs and behaviours. They also help to develop culturally and linguistically sensitive strategies, which goes beyond the provision of contraceptive counselling, in assisting Chinese migrant women's decision-making needs.
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http://dx.doi.org/10.1186/s12905-021-01226-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7938530PMC
March 2021

Public involvement & engagement in the work of a data safe haven: a case study of the SAIL Databank.

Int J Popul Data Sci 2020 Aug 24;5(3):1371. Epub 2020 Aug 24.

Swansea University, Singleton Park, Swansea, SA2 8PP.

Background: The SAIL Databank is a data safe haven established in 2007 at Swansea University (Wales). It was set up to create new opportunities for research using routinely-collected health and other public service datasets in linkable anonymised form. SAIL forms the bedrock of other Population Data Science initiatives made possible by the data and safe haven environment.

Aim: The aim of this paper is to provide an overview of public involvement & engagement in connection with the SAIL Databank and related Population Data Science initiatives.

Approach: We have a public involvement & engagement policy for SAIL in the context of Population Data Science. We established a Consumer Panel to provide advice on the work of SAIL and associated initiatives, including on proposed uses of SAIL data. We reviewed the topics discussed and provide examples of advice to researchers. We carried out a survey with members on their experiences of being on the Panel and their perceptions of the work of SAIL. We have a programme of wider public engagement and provide illustrations of this work.

Discussion: We summarise what this paper adds and some lessons learned. In the rapidly developing area of Population Data Science it is important that people feel welcome, that they are encouraged to ask questions and are provided with digestible information and adequate consideration time. Citizens have provided us with valuable anticipated and unanticipated opinions and novel viewpoints. We seek to take a pragmatic approach, prioritising the communication modes that allow maximum public input commensurate with the purpose of the activity.

Conclusion: This paper has set out our policy, rationale, scope and practical approaches to public involvement & engagement for SAIL and our related Population Data Science initiatives. Although there will be jurisdictional, cultural and organizational differences, we believe that the material covered in this paper will be of interest to other data focused enterprises across the world.
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http://dx.doi.org/10.23889/ijpds.v5i3.1371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893854PMC
August 2020

Endometriosis: A Malignant Fingerprint.

J Cancer Res Ther Oncol 2020 Apr 29;8(2). Epub 2020 Dec 29.

Creighton University School of Medicine, Omaha, NE, United States.

Background: Endometriosis is complex, but identifying the novel biomarkers, inflammatory molecules, and genetic links holds the key to the enhanced detection, prediction and treatment of both endometriosis and endometriosis related malignant neoplasia. Here we review the literature relating to the specific molecular mechanism(s) mediating tumorigenesis arising within endometriosis.

Methods: Guidance (e.g. Cochrane) and published studies were identified. The Published studies were identified through PubMed using the systematic review methods filter, and the authors' topic knowledge. These data were reviewed to identify key and relevant articles to create a comprehensive review article to explore the molecular fingerprint associated with in endometriosis-driven tumorigenesis.

Results: An important focus is the link between C3aR1, PGR, ER1, SOX-17 and other relevant gene expression profiles and endometriosis-driven tumorigenesis. Further studies should also focus on the combined use of CA-125 with HE-4, and the role for OVA1/MIA as clinically relevant diagnostic biomarkers in the prediction of endometriosis-driven tumorigenesis.

Conclusions: Elucidating endometriosis' molecular fingerprint is to understand the molecular mechanisms that drive the endometriosis-associated malignant phenotype. A better understanding of the predictive roles of these genes and the value of the biomarker proteins will allow for the derivation of unique molecular treatment algorithms to better serve our patients.
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http://dx.doi.org/10.17303/jcrto.2020.8.206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909468PMC
April 2020

Encounter decision aids to facilitate shared decision-making with women experiencing heavy menstrual bleeding or symptomatic uterine fibroids: A before-after study.

Patient Educ Couns 2021 09 15;104(9):2259-2265. Epub 2021 Feb 15.

The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon NH, USA; Department Obstetrics & Gynaecology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.

Objective: Is the level of shared decision-making (SDM) higher after introduction of a SDM package (including encounter decision aids on treatment options for heavy menstrual bleeding and training for clinicians) than before?.

Methods: This before-after study, performed in OB-GYN practice, compared consultations before and after introduction of a SDM package. The target sample size was 25 patients per group. Women seeking treatment for heavy menstrual bleeding were eligible. After their appointments, patients filled out a three-item patient-reported SDM measure. Treatment discussions were audio-recorded and rated for SDM using Observer OPTION. Consultation transcripts in the 'after' group were checked for adherence to the steps required for intended use of decision aids.

Results: 16 gynaecologists participated. 25 patients participated before introduction of the decision aids and 28 after. The proportion of women reporting optimal SDM was higher after introduction (75 %) than before (50 %;p < 0.001). The mean observer-rated level of SDM was also significantly higher after than before (MD = 12.50,95 % CI 5.53-19.47).

Conclusion: The level of SDM was higher after the introduction of the package than before.

Practice Implications: This study was conducted in a real-life setting in three clinics, both large academic and small rural, offering opportunities for implementation in different type of organizations.
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http://dx.doi.org/10.1016/j.pec.2021.02.027DOI Listing
September 2021

A survey of health care practitioners' attitudes toward shared decision-making for choice of next birth after cesarean.

Birth 2021 06 4;48(2):194-208. Epub 2021 Feb 4.

Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.

Background: Patients with a history of cesarean may benefit from shared decision-making (SDM) interventions, such as patient decision aids, that provide individualized clinical information and help to clarify personal preferences. We sought to understand the factors that influence how care practitioners support choices for mode of birth and what individual and health system factors influence uptake of SDM in routine care.

Methods: We conducted a cross-sectional survey of health care practitioners in British Columbia, Canada (2016-2017). Participants included family physicians, midwives, obstetricians, and registered nurses. We conducted descriptive and inferential analyses of quantitative data and subjected the open-ended survey responses to thematic analysis.

Results: Analysis of survey responses (n = 307) suggested there was no significant association between the size of the participant hospital and their medico-legal concerns about mode of birth. Environmental factors that may influence the use of SDM included the length of time it takes to initiate an emergency cesarean and the timing of when the SDM intervention is introduced to the patient. No participants reported protocols prohibiting VBAC at their hospital. Participants preferred an SDM approach where the pregnant person is involved in making the final decision for mode of birth.

Conclusions: Although maternity care practitioners express attitudes and behaviors that may support SDM for mode of birth after cesarean, implementing SDM using a patient decision aid alone may be challenging because of environmental factors. Our study demonstrates how survey data can aid in identifying how, when, where, for whom, and why an SDM intervention could be implemented.
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http://dx.doi.org/10.1111/birt.12529DOI Listing
June 2021

Communicating Awareness About COVID-19 Through Songs: An Example From Ghana.

Front Public Health 2020 18;8:607830. Epub 2021 Jan 18.

Institute for Health and Aging, School of Nursing, University of California, San Francisco, CA, United States.

Research has shown that music can be used to educate or disseminate information about public health crises. Grounded in the edutainment approach, we explored how songs are being used to create awareness about COVID-19 in Ghana, a sub-Saharan African country. YouTube was searched, and 28 songs met the study inclusion criteria. We conducted a thematic analysis of the song lyrics. Most lyrics were in English, Ghanaian Pidgin English, Akan, Ga, or Dagbani. Reflecting the multilingual population of Ghana, half of the songs contained three languages to convey their message, and only five songs were in one language. Eight themes emerged from the analysis: public health guidelines, COVID-19 is real and not a hoax, COVID-19 is infectious, prayer as method to stop the virus, emotional reaction and disruption of "everyday" activities; verbally expelling the virus, call for unity and collective efforts, and inspiring hope. We show that songs have the potential as a method for rapidly sharing information about emerging public health crises. Even though, it is beyond the scope of this study to draw conclusions about the reception and impact of songs on awareness and knowledge, the study shows that examining song lyrics can still be useful in understanding local attitudes toward COVID-19, as well as strategies for promoting preventive behaviors. We note that additional multidimensional efforts are needed to increase awareness among the general public about the COVID-19 pandemic.
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http://dx.doi.org/10.3389/fpubh.2020.607830DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847897PMC
February 2021

Effect of mutations in the SARS-CoV-2 spike protein on protein stability, cleavage, and cell-cell fusion function.

bioRxiv 2021 Jan 25. Epub 2021 Jan 25.

Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, Kentucky, USA.

The SARS-CoV-2 spike protein (S) is the sole viral protein responsible for both viral binding to a host cell and the membrane fusion event needed for cell entry. In addition to facilitating fusion needed for viral entry, S can also drive cell-cell fusion, a pathogenic effect observed in the lungs of SARS-CoV-2 infected patients. While several studies have investigated S requirements involved in viral particle entry, examination of S stability and factors involved in S cell-cell fusion remain limited. We demonstrate that S must be processed at the S1/S2 border in order to mediate cell-cell fusion, and that mutations at potential cleavage sites within the S2 subunit alter S processing at the S1/S2 border, thus preventing cell-cell fusion. We also identify residues within the internal fusion peptide and the cytoplasmic tail that modulate S cell-cell fusion. Additionally, we examine S stability and protein cleavage kinetics in a variety of mammalian cell lines, including a bat cell line related to the likely reservoir species for SARS-CoV-2, and provide evidence that proteolytic processing alters the stability of the S trimer. This work therefore offers insight into S stability, proteolytic processing, and factors that mediate S cell-cell fusion, all of which help give a more comprehensive understanding of this highly sought-after therapeutic target.
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http://dx.doi.org/10.1101/2021.01.24.428007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852270PMC
January 2021
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