Explore the vast range of titles available.

BackgroundEliciting patient concerns and listening carefully to them contributes to patient-centered care. Yet, clinicians often fail to elicit the patient’s agenda and, when they do, they interrupt the patient’s discourse.ObjectiveWe aimed to describe the extent to which patients’ concerns are elicited across different clinical settings and how shared decision-making tools impact agenda elicitation.Design and ParticipantsWe performed a secondary analysis of a random sample of 112 clinical encounters recorded during trials testing the efficacy of shared decision-making tools.Main MeasuresTwo reviewers, working independently, characterized the elicitation of the patient agenda and the time to interruption or to complete statement; we analyzed the distribution of agenda elicitation according to setting and use of shared decision-making tools.Key ResultsClinicians elicited the patient’s agenda in 40 of 112 (36%) encounters. Agendas were elicited more often in primary care (30/61 encounters, 49%) than in specialty care (10/51 encounters, 20%); p = .058. Shared decision-making tools did not affect the likelihood of eliciting the patient’s agenda (34 vs. 37% in encounters with and without these tools; p = .09). In 27 of the 40 (67%) encounters in which clinicians elicited patient concerns, the clinician interrupted the patient after a median of 11 seconds (interquartile range 7–22; range 3 to 234 s). Uninterrupted patients took a median of 6 s (interquartile range 3–19; range 2 to 108 s) to state their concern.ConclusionsClinicians seldom elicit the patient’s agenda; when they do, they interrupt patients sooner than previously reported. Physicians in specialty care elicited the patient’s agenda less often compared to physicians in primary care. Failure to elicit the patient’s agenda reduces the chance that clinicians will orient the priorities of a clinical encounter toward specific aspects that matter to each patient.

Earth’s transient climate response (TCR) quantifies the global mean surface air temperature change due to a doubling of atmospheric CO2 concentration after 70 years of a compounding 1% per year increase. TCR is highly correlated with near-term climate projections, and thus of relevance for climate policy, but remains poorly constrained in part due to uncertainties in the representation of key physical processes in Earth System Models (ESMs). Within state-of-the-art ESMs participating in the Coupled Model Intercomparison Project (CMIP6), the TCR range (1.1 ∘C–2.9 ∘C) is too wide to offer useful guidance to policymakers. Similarly, the sixth report of the Intergovernmental Panel on Climate Change, while not solely reliant on ESMs for its TCR assessment, produced a very likely range of 1.2 ∘C–2.4 ∘C. To complement earlier, ESM-based, estimates, we here present a new TCR estimate of 2.17 (1.72–2.77) ∘C (95% confidence interval), derived based on a statistical relationship between surface air temperature and observational proxies for its main drivers, i.e. changes in atmospheric greenhouse gases and aerosols. We show that, within uncertainty, this method correctly diagnoses TCR from 20 CMIP6 ESMs if the same input variables are taken from the ESMs that are available from observations. This increases confidence in the new observation-based central estimate and range, which is respectively higher and narrower than the mean and spread of the estimates from the entire ensemble of CMIP6. Many ESM-based estimates tend to produce TCRs lower than the observational range reported here. Our findings suggest that a misrepresentation of the aerosol cooling effect could be the cause of this discrepancy. Further, the revised TCR estimate suggests a downward revision of the remaining carbon budgets aligned with the overarching goal of the Paris agreement.

Background A plant-based diet protects against chronic oxidative stress-related diseases. Dietary plants contain variable chemical families and amounts of antioxidants. It has been hypothesized that plant antioxidants may contribute to the beneficial health effects of dietary plants. Our objective was to develop a comprehensive food database consisting of the total antioxidant content of typical foods as well as other dietary items such as traditional medicine plants, herbs and spices and dietary supplements. This database is intended for use in a wide range of nutritional research, from in vitro and cell and animal studies, to clinical trials and nutritional epidemiological studies. Methods We procured samples from countries worldwide and assayed the samples for their total antioxidant content using a modified version of the FRAP assay. Results and sample information (such as country of origin, product and/or brand name) were registered for each individual food sample and constitute the Antioxidant Food Table. Results The results demonstrate that there are several thousand-fold differences in antioxidant content of foods. Spices, herbs and supplements include the most antioxidant rich products in our study, some exceptionally high. Berries, fruits, nuts, chocolate, vegetables and products thereof constitute common foods and beverages with high antioxidant values. Conclusions This database is to our best knowledge the most comprehensive Antioxidant Food Database published and it shows that plant-based foods introduce significantly more antioxidants into human diet than non-plant foods. Because of the large variations observed between otherwise comparable food samples the study emphasizes the importance of using a comprehensive database combined with a detailed system for food registration in clinical and epidemiological studies. The present antioxidant database is therefore an essential research tool to further elucidate the potential health effects of phytochemical antioxidants in diet.

Elevated body mass index (BMI) is heritable and associated with many health conditions that impact morbidity and mortality. The study of the genetic association of BMI across a broad range of common disease conditions offers the opportunity to extend current knowledge regarding the breadth and depth of adiposity-related diseases. We identify 906 (364 novel) and 41 (6 novel) genome-wide significant loci for BMI among participants of European (N~1.1 million) and African (N~100,000) ancestry, respectively. Using a BMI genetic risk score including 2446 variants, 316 diagnoses are associated in the Million Veteran Program, with 96.5% showing increased risk. A co-morbidity network analysis reveals seven disease communities containing multiple interconnected diseases associated with BMI as well as extensive connections across communities. Mendelian randomization analysis confirms numerous phenotypes across a breadth of organ systems, including conditions of the circulatory (heart failure, ischemic heart disease, atrial fibrillation), genitourinary (chronic renal failure), respiratory (respiratory failure, asthma), musculoskeletal and dermatologic systems that are deeply interconnected within and across the disease communities. This work shows that the complex genetic architecture of BMI associates with a broad range of major health conditions, supporting the need for comprehensive approaches to prevent and treat obesity. Elevated body mass index is heritable and associated with many health conditions that impact morbidity and mortality. Here, the authors identify greater than 900 genetic loci for body mass index (BMI) and find over 300 diagnoses associated with increasing BMI.

Mutations affecting the expression of dystrophin result in progressive loss of skeletal muscle function and cardiomyopathy leading to early mortality. Interestingly, clinical studies revealed no correlation in disease severity or age of onset between cardiac and skeletal muscles, suggesting that dystrophin may play overlapping yet different roles in these two striated muscles. Since dystrophin serves as a structural and signaling scaffold, functional differences likely arise from tissue-specific protein interactions. To test this, we optimized a proteomics-based approach to purify, identify and compare the interactome of dystrophin between cardiac and skeletal muscles from as little as 50 mg of starting material. We found selective tissue-specific differences in the protein associations of cardiac and skeletal muscle full length dystrophin to syntrophins and dystrobrevins that couple dystrophin to signaling pathways. Importantly, we identified novel cardiac-specific interactions of dystrophin with proteins known to regulate cardiac contraction and to be involved in cardiac disease. Our approach overcomes a major challenge in the muscular dystrophy field of rapidly and consistently identifying bona fide dystrophin-interacting proteins in tissues. In addition, our findings support the existence of cardiac-specific functions of dystrophin and may guide studies into early triggers of cardiac disease in Duchenne and Becker muscular dystrophies.

To the Editor—Severe acute respiratory coronavirus virus 2 (SARS-CoV-2) is primarily spread through respiratory droplets with increased risk of transmission in households and congregate settings.1–3 Asymptomatic and presymptomatic transmission of SARS-CoV-2 have also made containment difficult.1,4 Inpatient psychiatry units present unique challenges in controlling infectious disease outbreaks.5,6 Here, we describe the management of a coronavirus disease 2019 (COVID-19) outbreak on an inpatient psychiatry unit, highlighting unique considerations for this patient population. Inpatient Psychiatric Control Interventions Implemented during Outbreak General Patient Level Environmental Level Specific to the Psychiatric Population ▪ Surgical masks for all patients ▪ Surgical masks and eye protection for all employees ▪ Symptom screening patient and staff daily ▪ Increase patient compliance to hand hygiene ▪ Restrict all visitors ▪ Increase frequency of cleaning in shared spaces ▪ Bleach cleaning daily ▪ Enhanced terminal cleaning: ○ Change curtains ○ Deep cleaning with bleach ○ Ultraviolet (UV) light disinfection ▪ Adhere to safety measures for patient masking (ie, no metal nose clips or ties) ▪ Limit number of patients per group therapy session to five and physically distance ▪ Stagger patient meal times ▪ Reduce shared patient supplies The outbreak lasted for a total of 27 days, with the last cases confirmed on day 20. [...]asymptomatic patients and staff were not tested at the time of this outbreak due to limited global testing capacity early in the pandemic.

Aims/hypothesisType 2 diabetes is a growing global public health challenge. Investigating quantitative traits, including fasting glucose, fasting insulin and HbA1c, that serve as early markers of type 2 diabetes progression may lead to a deeper understanding of the genetic aetiology of type 2 diabetes development. Previous genome-wide association studies (GWAS) have identified over 500 loci associated with type 2 diabetes, glycaemic traits and insulin-related traits. However, most of these findings were based only on populations of European ancestry. To address this research gap, we examined the genetic basis of fasting glucose, fasting insulin and HbA1c in participants of the diverse Population Architecture using Genomics and Epidemiology (PAGE) Study.MethodsWe conducted a GWAS of fasting glucose (n = 52,267), fasting insulin (n = 48,395) and HbA1c (n = 23,357) in participants without diabetes from the diverse PAGE Study (23% self-reported African American, 46% Hispanic/Latino, 40% European, 4% Asian, 3% Native Hawaiian, 0.8% Native American), performing transethnic and population-specific GWAS meta-analyses, followed by fine-mapping to identify and characterise novel loci and independent secondary signals in known loci.ResultsFour novel associations were identified (p < 5 × 10−9), including three loci associated with fasting insulin, and a novel, low-frequency African American-specific locus associated with fasting glucose. Additionally, seven secondary signals were identified, including novel independent secondary signals for fasting glucose at the known GCK locus and for fasting insulin at the known PPP1R3B locus in transethnic meta-analysis.Conclusions/interpretationOur findings provide new insights into the genetic architecture of glycaemic traits and highlight the continued importance of conducting genetic studies in diverse populations.Data availabilityFull summary statistics from each of the population-specific and transethnic results are available at NHGRI-EBI GWAS catalog (https://www.ebi.ac.uk/gwas/downloads/summary-statistics).

This study’s objective was to assess maintenance of treatment effects 3 months after completion of a 12-week Pivotal Response Treatment (PRT) parent education group. Families who completed the active treatment (N = 23) were followed for an additional 12 weeks to measure changes in language and cognitive skills. Results indicated a significant improvement in frequency of functional utterances, with maintenance at 3-month follow-up [F(2, 21): 5.9, p  = .009]. Children also made significant gains on the Vineland Communication Domain Standard Score [F(2, 12):11.74, p  = .001] and the Mullen Scales of Early Learning Composite score [F(1, 20) = 5.43, p  = .03]. These results suggest that a brief PRT parent group intervention can lead to improvements in language and cognitive functioning that are maintained 12 weeks post treatment.