BackgroundUrinary tract infections (UTIs) are one of the most common bacterial infections managed in general practice. Many women with symptoms of uncomplicated UTI may not benefit meaningfully from antibiotic treatment, but the evidence base is complex and there is no suitable shared decision-making resource to guide antibiotic treatment and symptomatic care for use in general practice consultations.AimTo develop an evidence-based, shared decision-making intervention leaflet to optimise management of uncomplicated UTI for women aged <65 years in the primary care setting.Design and settingQualitative telephone interviews with GPs and patient focus group interviews.MethodIn-depth interviews were conducted to explore how consultation discussions around diagnosis, antibiotic use, self-care, safety netting, and prevention of UTI could be improved. Interview schedules were based on the Theoretical Domains Framework.ResultsBarriers to an effective joint consultation and appropriate prescribing included: lack of GP time, misunderstanding of depth of knowledge and miscommunication between the patient and the GP, nature of the consults (such as telephone consultations), and a history of previous antibiotic therapy.ConclusionConsultation time pressures combined with late symptom presentation are a challenge for even the most experienced of GPs: however, it is clear that enhanced patient–clinician shared decision making is urgently required when it comes to UTIs. This communication should incorporate the provision of self-care, safety netting, and preventive advice to help guide patients when to consult. A shared decision-making information leaflet was iteratively co-produced with patients, clinicians, and researchers at Public Health England using study data.

Background:

The negative effect of adverse childhood experiences (ACEs) on physical and mental health has led to calls for routine screening for ACEs in primary care settings. We aimed to examine the association between maternal ACEs and children’s behaviour problems (externalizing and internalizing) at age 5 in the context of other known predictors.

Some years ago, I entered a completely unfamiliar world. This was a landscape that clinicians deal with every day but for the individual suspected of having lung cancer, it can appear hostile and scary, often misrepresented by outdated imagery, information and television portrayal. Lung cancer is not awash with celebrities admitting to having it or grand fundraising campaigns like other conditions. Despite many changes in the treatment landscape, it's still generally much more stigmatised than other cancers.

Balamuthia mandrillaris is an under-reported, pathogenic free-living amoeba that causes Balamuthia amoebic encephalitis (BAE) and cutaneous skin infections. Although cutaneous infections are not typically lethal, BAE with or without cutaneous involvement is usually fatal. This is due to the lack of drugs that are both efficacious and can cross the blood-brain barrier. We aimed to discover new leads for drug discovery by screening the open-source Medicines for Malaria Venture (MMV) Malaria Box and MMV Pathogen Box, with 800 compounds total. From an initial single point screen at 1 and 10 μM, we identified 54 hits that significantly inhibited the growth of B. mandrillaris in vitro. Hits were reconfirmed in quantitative dose-response assays and 23 compounds (42.6%) were confirmed with activity greater than miltefosine, the current standard of care.

We report the diagnostic challenges and the clinical course of a patient with an extraordinary presentation of B-lymphoblastic leukemia (B-ALL) with eosinophilia. We identified a novel ZBTB20-JAK2 gene fusion as a chimeric RNA transcript using the Archer platform. This gene fusion from the same patient was recently identified by Peterson et al. (2019) at the genomic level using a different sequencing technology platform. The configuration of this gene fusion predicts the production of a kinase-activating JAK2 fusion protein, which would normally lead to a diagnosis of Philadelphia chromosome–like B-ALL (Ph-like B-ALL). However, the unusual presentation of eosinophilia led us to demonstrate the presence of this gene fusion in nonlymphoid hematopoietic cells by fluorescence in situ hybridization (FISH) studies with morphologic correlation. Therefore, we believe this disease, in fact, represents blast crisis arising from an underlying myeloid neoplasm with JAK2 rearrangements. This case illustrates the difficulty in differentiating Ph-like B-ALL and myeloid/lymphoid neoplasm with eosinophilia and gene rearrangements (MLN-EGR) in blast crisis. As currently defined, the diagnosis of MLN-EGR relies on the hematologic presentations and the identification of marker gene fusions (including PCM1-JAK2, ETV6-JAK2, and BCR-JAK2). However, these same gene fusions, when limited to B-lymphoblasts, also define Ph-like B-ALL. Yet, our case does not conform to either condition. Therefore, the assessment for lineage restriction of gene rearrangements to reflect the pathophysiologic difference between B-ALL and MLN-EGR in blast crisis is likely a more robust diagnostic approach and allows the inclusion of MLN-EGR with novel gene fusions.

Background:

The success of multisite collaborative research relies on effective data collection, harmonization, and aggregation strategies. Data Coordination Centers (DCC) serve to facilitate the implementation of these strategies. The utility of a DCC can be particularly relevant for research on rare diseases where collaboration from multiple sites to amass large aggregate datasets is essential. However, approaches to building a DCC have been scarcely documented.

Mammographic breast density is a strong risk factor for breast cancer. We comprehensively investigated the associations of body mass index (BMI) change from ages 10, 18, and 30 to age at mammogram with mammographic breast density in postmenopausal women. We used multivariable linear regression models, adjusted for confounders, to investigate the associations of BMI change with volumetric percent density, dense volume, and nondense volume, assessed using Volpara in 367 women. At the time of mammogram, the mean age was 57.9 years. Compared with women who had a BMI gain of 0.1–5 kg/m² from age 10, women who had a BMI gain of 5.1–10 kg/m² had a 24.4% decrease [95% confidence interval (CI), 6.0%–39.2%] in volumetric percent density; women who had a BMI gain of 10.1–15 kg/m² had a 46.1% decrease (95% CI, 33.0%–56.7%) in volumetric percent density; and women who had a BMI gain of >15 kg/m² had a 56.5% decrease (95% CI, 46.0%–65.0%) in volumetric percent density. Similar, but slightly attenuated associations were observed for BMI gain from ages 18 and 30 to age at mammogram and volumetric percent density. BMI gain over the life course was positively associated with nondense volume, but not dense volume. We observed strong associations between BMI change over the life course and mammographic breast density. The inverse associations between early-life adiposity change and volumetric percent density suggest that childhood adiposity may confer long-term protection against postmenopausal breast cancer via its effect of mammographic breast density.

Consistently, the field of genetic counseling has advocated that parents be advised to defer elective genetic testing of minors until adulthood to prevent a range of potential harms, including stigma, discrimination, and the loss of the child's ability to decide for him- or herself as an adult. However, consensus around the policy of "defer-when-possible" obscures the extent to which this norm is currently under siege. Increasingly, routine use of full or partial genome sequencing challenges our ability to control what is discovered in childhood or, when applied in a prenatal context, even before birth. The expansion of consumer-initiated genetic testing services challenges our ability to restrict what is available to minors. As the barriers to access crumble, medical professionals should proceed with caution, bearing in mind potential risks and continuing to assess the impact of genetic testing on this vulnerable population.

Prof. Jason Pomeroy talks about the rise of the digital economy and its impact on the workplace.

In order to find the right accommodation, asking questions and answering them are essential. According to BankBazaar, you definitely need to answer the following 6 important questions before buying a home.

If you’re excited and in good shape to buy a home, self-made millionaire Barbara Corcoran says these are the five steps for you to take.

If you do not want to pay appraisal fee to the third party nor incur losses, here are 4 ways to determine value of a property yourself before entering a transaction.

Condo projects are now mushrooming across the country, becoming the favorite choice of most urban residents. However, to choose the right one which will make you satisfy, you need to find answers to the following 20 questions.

Home moving is surely a hassle. Luckily, a little preparation work can mean the difference between a minor headache and an all-out life takeover.

The decision to list your home for resale is a big one. No doubt it came about after much thought, weighing pros and cons, and series of long discussions. However, once you decide to put your home on the market, get ready for the next big discussion: interior design.

One of the most dramatic changes you can make to effectively boost value of your home is giving your kitchen some renovations.

Normally, you put your property on the market but the estate agent is the one who actually sells it to buyers. It is a critical decision to choose the right agent and protect you from any future trouble. The questions below may help you.

Paint your home blue before selling it, as the color brings a sense of peace, softness. Many people love blue and it may help you sell home more quickly.

London’s leading real estate agents Daniel Cobb have revealed top 10 simple tricks to add values to your home and sell it faster, The Sun reported.

What’s keeping your house from finding its next owner? In order to speed up the selling process, consider every little thing like clutter in the house.

Every home seller wants to sell it fast and reach as many buyers as possible. Here are some tips to make your listing stand out to potential buyers from the crowd.

As a home seller, everyone wants to sell their home quickly at the highest price. Five simple tips below can help you.

Your home’s value will not be added when you try to take care of your garden, gilded handles in bathroom or swimming pool. In fact, home buyers pay attention to more useful items.

For many people, home is the biggest investment. However, not many of them know about value of a home and things that can ruin it such as bad decorations, noisy neighbors or an unfortunately-placed sinkhole.

When you are confident that your home does not need any major repairs that will stop a buyer’s home inspection, you can focus on easy updates to make your home more attractive to buyers.

If you make a mistake during the listing process, you might end up getting less than your home is worth or find that it takes significantly longer to sell your home than it should.

You are preparing your home for sale? Don’t forget to make some small repairs since they can make a big difference both in terms of interest levels and offer prices for the home.

Home selling can be an emotional process, so don’t make it even tougher by letting your emotions run the process. Make sure that you don’t fall into any of these four of the most common home selling mistakes.

Business Insider asked real-estate agents across the U.S., and they point out 11 reason that prevent your home from being sold.

Finding a home that satisfies all your requirement has been a difficult task, but for many people, selling home is even more difficult. Lots of sellers have to sell their homes at a cheaper price than they expected before and accept a loss. To avoid being troubled with the sale and make it faster, follow guides in the Infographic below for the best preparation before selling your home.

Every seller wants his homes to be sold smoothly and quickly with the highest possible price. However, there are still houses which have been listed on the market for months without any potential buyer because the sellers make one, or maybe more, of the following popular mistakes:

Home buyers or sellers normally face many difficulties and obstacles that need time and effort to overcome. To save time, avoid risks and make the purchase faster and smoother, most people hire real estate agents for effective advice and assistance.