Measurement of left atrial size as a predictor of severity of illness in sickle cell disease.

BACKGROUND: Sickle cell disease (SCD) is characterized by microvascular occlusion which leads to multiorgan damage, including left ventricular diastolic dysfunction. Left ventricular diastolic dysfunction has been shown to be an independent risk factor for death in SCD patients. Left atrial dilation (LAD) has been used as a surrogate marker for identification of left ventricular diastolic dysfunction. OBJECTIVE: Investigate the association of LAD, as determined by echocardiography, with increased disease burden in SCD as reflected by increased emergency department (ED) utilization, increased hemolysis markers, and worsening anemia. METHODS: A retrospective cohort study of patients from a single university hospital were selected from a national registry. Age, sickle cell phenotype, echocardiogram findings, ED utilization, baseline hemoglobin, and lab values needed for calculation of hemolytic index were recorded for each patient. Patients were then stratified into two distinct groups based on the presence or absence of LAD to compare ED utilization, baseline hemoglobin and hemolytic index between the two groups. RESULTS: 129 patients met the criteria for inclusion with 88 having normal left atrial volume and 41 with LAD. There was a higher percentage of high ED utilizers in the LAD group compared to the normal left atrial volume group [34% vs. 17%, p = 0.03]. Average hemoglobin was lower in the LAD group compared with the normal left atrial volume group [mean 8.57 g/dL vs. 9.47 g/dL, p = 0.011]. The mean hemolytic index was higher in the LAD group when compared with the normal left atrial volume group [0.44 vs. -0.21, p < 0.001]. CONCLUSIONS: LAD was associated with higher ED utilization, lower hemoglobin level, and more hemolysis in patients with SCD.

Content and Commentary: HPV Vaccine and YouTube.

STUDY OBJECTIVE: Human papillomavirus (HPV) vaccination has shown efficacy, however, many vaccine-eligible persons remain unvaccinated. YouTube is a popular video-sharing platform with several topics, including the HPV vaccine. Our purpose was to examine the tone of YouTube videos toward the HPV vaccine, accuracy of the information displayed, and content of commentary. DESIGN: In this observational study we investigated publicly available content regarding the HPV vaccine on the video-sharing Web site YouTube (www.youtube.com). Videos and comments were collected between June 22, 2014 and December 19, 2014. A total of 35 videos, with the 100 most recent comments for each video were collected and coded by a single researcher. A 25% subsample were coded by a second researcher to ensure inter-rater agreement of greater than 80%. SETTING, PARTICIPANTS, AND INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Videos were evaluated for 4 types of information: descriptive information, tone toward the vaccine (anti- or pro-vaccine), content, and commentary content, sorted according to 11 frequently identified themes. RESULTS: Most videos were negative in tone toward the vaccine. The tone of the video was not a predictor of video popularity. Pro-vaccine videos were 4 times more likely to report information accurately than anti-vaccine videos. Anti-vaccine videos were more likely to report information incorrectly and omit information. The most frequent commentary themes were concerning serious side effects, conspiracy theories, and vaccines generally being unhealthy. CONCLUSION: The Internet is an important resource for the general population; widely viewed YouTube videos contain erroneous and incomplete information. Anti-vaccine ideology is prevalent in video content and commentary.

Research methodologies in informed consent studies involving surgical and invasive procedures: time to re-examine?

OBJECTIVE: We conducted a review of informed consent studies involving surgical and invasive procedures and report the degree to which current research targets a broader scope of patient outcomes beyond comprehension. METHODS: Using PubMed, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medical Database, we identified 97 articles for review. Six members coded articles and generated scores of study design quality. RESULTS: The mean quality score (10.7 out of a total score of 20) was low. Most studies were single institution-based, relying on one-time data collections. Randomly assigning subjects to study conditions, using power analysis to determine subject numbers, and reporting psychometric evidence, such as reliability and validity, were not widely reported. Most frequently targeted patient outcomes were knowledge, understanding and satisfaction. Core informed consent outcomes (e.g. capacity, voluntariness, decision making) and emotional factors (e.g. anxiety) were not extensively addressed. CONCLUSION: Informed consent research may benefit from applying qualitative methods to more directly tap into patients' beliefs and decisions by eliciting in patients' own words their emotions and reasoning around processing informed consent content. PRACTICE IMPLICATIONS: Research that addresses patient perspectives toward surgical interventions should tap into underexplored ethical and emotional factors that shape decision making.

Expanding the diversity of mycobacteriophages: insights into genome architecture and evolution.

Mycobacteriophages are viruses that infect mycobacterial hosts such as Mycobacterium smegmatis and Mycobacterium tuberculosis. All mycobacteriophages characterized to date are dsDNA tailed phages, and have either siphoviral or myoviral morphotypes. However, their genetic diversity is considerable, and although sixty-two genomes have been sequenced and comparatively analyzed, these likely represent only a small portion of the diversity of the mycobacteriophage population at large. Here we report the isolation, sequencing and comparative genomic analysis of 18 new mycobacteriophages isolated from geographically distinct locations within the United States. Although no clear correlation between location and genome type can be discerned, these genomes expand our knowledge of mycobacteriophage diversity and enhance our understanding of the roles of mobile elements in viral evolution. Expansion of the number of mycobacteriophages grouped within Cluster A provides insights into the basis of immune specificity in these temperate phages, and we also describe a novel example of apparent immunity theft. The isolation and genomic analysis of bacteriophages by freshman college students provides an example of an authentic research experience for novice scientists.