BRCA testing in women with breast cancer is cost-effective and is associated with reduced risk of cancer and improved survival. Extending testing to cover family members of affected women who test positive improves cost-effectiveness beyond restricting testing to affected women only.

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The membrane properties and conduction velocities of antidromically activated medial septum‐diagonal band (MS‐DB) neurons were examined using whole‐cell recordings in a longitudinally cut rat brain slice preparation containing the MS‐DB and the dorsal fornix. MS‐DB neurons were divided into three groups according to their action potential characteristics and firing properties. Slow firing neurons displayed a broad action potential followed by a prominent after‐hyperpolarization. Burst firing neurons, when depolarized from hyperpolarized holding potentials, exhibited a high‐frequency burst of spikes on the crest of a slow depolarizing potential. Fast firing neurons did not fire bursts of spikes when depolarized from hyperpolarized holding potentials. Eighteen MS‐DB neurons were identified as septohippocampal by antidromic activation. Of the septohippocampal neurons, four were slow firing neurons, five were burst firing neurons and nine were fast firing neurons. The mean axon conduction velocities of these neurons fell into two significant groups, termed slow conducting and fast conducting. Slow firing septohippocampal neurons had significantly slower conduction velocities than either fast firing or burst firing neurons (P < 0.05), being 0.7 ± 0.5 ms−1 for slow firing neurons and 2.9 ± 2.0 and 2.0 ± 1.4 ms−1 for burst firing and fast firing neurons, respectively. On the basis of previous evidence which has linked firing properties with the neurochemical identities of the neurons, we propose that the slow firing septohippocampal neurons are cholinergic whereas the burst firing and fast firing septohippocampal neurons are GABAergic.

Physical rehabilitation following arthroscopic rotator cuff repair has conventionally involved a 4- to 6-week period of immobilization; there are two schools of thought regarding activity level during this period. Some authors encourage early, more aggressive rehabilitation along with the use of a continuous passive motion device; others propose later, more conservative rehabilitation. Although some studies report trends in improved early range of motion, pain relief, and outcomes scores with aggressive rehabilitation following rotator cuff repair, no definitive consensus exists supporting a clinical difference resulting from rehabilitation timing in the early stages of healing. Rehabilitation timing does not affect outcomes after 6 to 12 months postoperatively. Given the lack of information regarding which patient groups benefit from aggressive rehabilitation, individualized patient care is warranted.

BackgroundAbstracts and plain language summaries (PLS) are often the first, and sometimes the only, point of contact between readers and systematic reviews. It is important to identify how these summaries are used and to know the impact of different elements, including the authors’ conclusions. The trial aims to assess whether (a) the abstract or the PLS of a Cochrane Review is a better aid for midwifery students in assessing the evidence, (b) inclusion of authors’ conclusions helps them and (c) there is an interaction between the type of summary and the presence or absence of the conclusions.MethodsEight hundred thirteen midwifery students from nine universities in the UK and Ireland were recruited to this 2 × 2 factorial trial (abstract versus PLS, conclusions versus no conclusions). They were randomly allocated to one of four groups and asked to recall knowledge after reading one of four summary formats of two Cochrane Reviews, one with clear findings and one with uncertain findings. The primary outcome was the proportion of students who identified the appropriate statement to describe the main findings of the two reviews as assessed by an expert panel.ResultsThere was no statistically significant difference in correct response between the abstract and PLS groups in the clear finding example (abstract, 59.6 %; PLS, 64.2 %; risk difference 4.6 %; CI −0.2 to 11.3) or the uncertain finding example (42.7 %, 39.3 %, −3.4 %, −10.1 to 3.4). There was no significant difference between the conclusion and no conclusion groups in the example with clear findings (conclusions, 63.3 %; no conclusions, 60.5 %; 2.8 %; −3.9 to 9.5), but there was a significant difference in the example with uncertain findings (44.7 %; 37.3 %; 7.3 %; 0.6 to 14.1, p = 0.03). PLS without conclusions in the uncertain finding review had the lowest proportion of correct responses (32.5 %). Prior knowledge and belief predicted student response to the clear finding review, while years of midwifery education predicted response to the uncertain finding review.ConclusionsAbstracts with and without conclusions generated similar student responses. PLS with conclusions gave similar results to abstracts with and without conclusions. Removing the conclusions from a PLS with uncertain findings led to more problems with interpretation.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0214-8) contains supplementary material, which is available to authorized users.

Objective A growing number of evaluation frameworks have emerged over recent years addressing the unique benefits and risk profiles of new classes of digital health technologies (DHTs). This systematic review aims to identify relevant frameworks and synthesize their recommendations into DHT-specific content to be considered when performing Health Technology Assessments (HTAs) for DHTs that manage chronic noncommunicable disease at home. Methods Searches were undertaken of Medline, Embase, Econlit, CINAHL, and The Cochrane Library (January 2015 to March 2020), and relevant gray literature (January 2015 to August 2020) using keywords related to HTA, evaluation frameworks, and DHTs. Included framework reference lists were searched from 2010 until 2015. The EUNetHTA HTA Core Model version 3.0 was selected as a scaffold for content evaluation. Results Forty-four frameworks were identified, mainly covering clinical effectiveness (n = 30) and safety (n = 23) issues. DHT-specific content recommended by framework authors fell within 28 of the 145 HTA Core Model issues. A further twenty-two DHT-specific issues not currently in the HTA Core Model were recommended. Conclusions Current HTA frameworks are unlikely to be sufficient for assessing DHTs. The development of DHT-specific content for HTA frameworks is hampered by DHTs having varied benefit and risk profiles. By focusing on DHTs that actively monitor/treat chronic noncommunicable diseases at home, we have extended DHT-specific content to all nine HTA Core Model domains. We plan to develop a supplementary evaluation framework for designing research studies, undertaking HTAs, and appraising the completeness of HTAs for DHTs.

The posterior pituitary gland contains a potent PRL-releasing factor (PRF). The aim of this study was to determine whether this PRF was involved in the luteotropic PRL surges of early pregnancy. The posterior pituitary was removed from a group of rats at least 4 weeks before the experiment (LOBEX). LOBEX rats were tested for diabetes insipidus and checked postmortem for the absence of posterior lobes. Plasma samples were taken from these chronically LOBEX rats as well as from sham-operated and unoperated controls beginning at noon on day 3 of pregnancy and continuing for 3 days at times most likely to demonstrate the twice daily surges of PRL secretion. PRL in all groups was basal (less than 12 ng/ml) at noon and rose to a diurnal peak at 1800 h. While the unoperated and sham-operated controls then displayed a clear nocturnal surge of PRL, peaking at 300-400 ng/ml at 0300 h, LOBEX rats had a significantly attenuated peak of 102.7 +/- 17.7 ng/ml (P less than 0.001). On subsequent nights the nocturnal peaks were similarly attenuated in LOBEX rats, averaging 80.3 and 42.1 ng/ml on days 5 and 6, respectively. LOBEX rats all had normal sized litters, but lactation yields were depressed. These data support the hypothesis that the posterior pituitary secretes a potent PRL-releasing factor because its removal partially blocked the mating-induced nocturnal surge of PRL.