924 e-Letters

  • The era of predatory academia.

    We congratulate Wilkinson et al. for their excellent piece of work that assessed the burden of academic spam emails (ASEs) received by the academic grant receivers.1 This paper is very relevant in the current scenario when ‘predatory academia’ is emerging as a potential threat to the ethos and virtuosity of medical research.

    We are all aware of the unsolicited ASEs adorned with flowery language that we routinely receive. On a closer look, these emails follow a certain predictable pattern. These are replete with grammatical errors, are usually asking authors to submit one ‘eminent article’ in order to complete/ inaugurate an issue of their journal, or inviting to be a part of their editorial board or a chairperson in an upcoming conference. These can be quite intimidating when received and read for the first time, and a naïve researcher might in fact like the manner in which these emails are addressed. A little discussion with the senior colleagues and mentors, and a quick trip to the hastily put together, incomplete websites with dual addresses (one of which is usually located in developing countries) and fake editorial boards (usually with pictures of prominent physicians/ surgeons from different specialties put together) shall however, soon make things clear for these young researchers.

    Predatory journals have been now present for more than a decade.1 Previously, the researchers were exposed to these journals, either through their colleagues or, themselve...

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  • This design is even more complex than it is accounted for in the protocol

    With great interest I read the study protocol by Ayre et al. (2019). In contrast to the standard double-randomized design (ref. [21] in the paper), this study includes a third arm in the first stage, the screened arm (in addition to the random arm and the choice arm). What I missed in the protocol, however, is a critical discussion of an important difference between a choice arm and a screened arm: While the choice arm simply reflects the preference of a study participant, the screened arm seeks to diagnose a participant's condition, here health literacy, based on a screening test. Consequently, the allocation depends on the test's diagnostic accuracy. This is nowhere mentioned in the protocol.

    A paper discussing this in the context of the (similarly structured) biomarker strategy design is Kunz, CU, Jaki, T, Stallard, N. An alternative method to analyse the biomarker‐strategy design. Statistics in Medicine. 2018; 37: 4636– 4651. https://doi.org/10.1002/sim.7940

    It may be worthwile to have a look into this article and to discuss this issue when analyzing and reporting the study.

  • Methodological bias in comparison of lactate values between Handheld analyser and Blood gas analyser

    Dear Editor,

    In a recent issue, Graham et al [1] compared the transferability for blood lactate measurement between two assays. These authors raised two conclusions. First, a poor agreement between blood capillary and venous lactate measurements was reported; second, the use of blood capillary lactate measurement for diagnosis purposes was discouraged. From our point of view, this paper presents some methodological bias which do not allow the authors to draw those conclusions. We would like to advance three important considerations to support this claim.

    Firstly, in the same way that laboratory analysers, handheld analysers must be tested for their analytical performances and submitted to periodic quality control check to ensure proper functioning of the equipment, accuracy of measurement and consistent readings. In the report [1], neither analytical performance nor quality control have been mentioned for the handheld analysers.

    Secondly, to confirm a correct agreement between the measurements provided by different devices, the number of patients enrolled appears quite low. Indeed, the devices measurement range must be taken into account [3]. Lactate values ranged from 0.7 to 5.38 mmol.l-1 , and 62.8% of the patients had lactate values < 2 mmol.l-1 while the devices had a measurement lactate range from 0.5 to 25 mmol.l-1. By this way, authors draw their conclusion only with the lower end of the range without considering high blood lactate values. We...

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  • Editor's Note

    After peer review, Cipriani et al were invited to provide a response to the research manuscript. Should Cipriani et al wish to respond to the article we will post their response here.

  • Editor's Note

    BMJ Open has received the comments from Bee Ping Teh and Norzahirah Ahmad on this paper. The authors of the paper have been contacted and have been asked to comment on the accuracy of their response.

    We will update the article if necessary.

  • Re: A systematic assessment of Cochrane reviews and systematic reviews published in high-impact medical journals related to cancer

    We have read with great interest about Goldkuhle et al., ‘A systematic assessment of Cochrane reviews and systematic reviews published in high-impact medical journals related to cancer’ (BMJ Open; accepted on 12 February 2018; doi:10.1136/bmjopen-2017-020869). Hereby we are writing this electronic responses to address the contents of article in following aspects: typographical errors and indistinguishable information highlighted by the original authors.

    There are five typographical errors found in the article that we would like to draw your attention as these could cause confusion to your many readers. The said errors are presented with snapshot image from the original article.

    1) First paragraph of ‘Characteristics of included SRs’ section, under ‘RESULTS’ section, page 5; a numerical value of ‘67/216’ (at line 15) has to be corrected to ‘67/215’ because the total number of included studies for high-impact journal reviews was only 215 studies instead of 216.

    2) At 'Table 1’, under ‘RESULTS’ section, page 6; a numercal value of '318 (9.9)' has to be corrected to ‘318 (91.9)’ as compared to first paragraph of ‘Content of included SRs’ section, under ‘RESULTS’ section, page 5, line 1. This is because the percentage value of 318 out of 346 is 91.9% (approximate) instead of 9.9.

    3) At 'Results’ section, under ‘ABSTRACT’ section, page 1, line 15; a numerical value of ‘6.52 (range 0-143)’ is different from mean number of citations...

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  • Photo-sensitive epilepsy caused by strobe lights, etc, at religious services

    I'm just a real person, commenting on much I've seen in my real life.

    I enjoyed the article about Seizures that may be caused by strobe lights at club parties.

    It should be noted that Photo-sensitive Epileptic seizures can also be caused by some types of religious services, including Pentecostal-type Christian church services. These services can also cause seizures with thumpy-thump trick-bass music, and certain types of incense or scented candles.

    Church of God in Christ (COGIC),
    Assembly of God,
    United Pentecostal Church,
    White Dove,
    many non-demoninationals, etc., all make use of:
    strobe lights;
    other types of lights (various speeds and colors);
    fast, thumpy, jittering or swaying musical rhythms;
    fast, thumpy, jittering or swaying body-movement rhythms;
    galloping floor pulses, sometimes combined with ultra-slow floor pulses, tricked out as if caused by a strobe-"Sound" machine (whether music-caused, or from a separate vibrating machine);
    and/or sometimes scents,
    in order to make the congregation ultra, extra excited to bring the people into the "Spirit".

    I've visited some types of these services, partly out of curiosity, since I was a teen. Including even an Assembly of God funeral at which people started wiggling and laughing, I assume due to the bright flashing lights and percussion rhythms.

    Some charismatic-type services are quiete...

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  • Low birth weight as a risk for thinness and obesity

    To the editor,
    In a recent article, Chen et al.1 reported the association of low birth weight with future thinness and severe obesity. These findings are important for recognition of the risks of low birth weight, but further discussion of the underlying meaning is required.
    Body mass index (BMI) generally increases rapidly during the first year of life, and then subsequently decreases and reaches a nadir at around 6 years of age. Thereafter, BMI increases again throughout childhood, and this second rise is referred to as the adiposity rebound2. Early adiposity rebound is a known risk factor for future obesity2,3, and even if BMI is low at the age of adiposity rebound, children who experience early adiposity rebound may become obese4. This means that a person can be thin in their youth and obese at an older age.
    Low birth weight is also a known risk factor for early adiposity rebound5. Therefore, this phenomenon of changes in weight may be common among low birth weight infants, and some of the thin children in Chen et al.1 may ultimately become obese. To examine this hypothesis, it would be of interest to compare the mean ages and the distributions of subjects in Chen et al.1 who are thin and those with severe obesity. We believe that the thin subjects will have a younger mean age.
    This information would help to explain the results of the study. A longitudinal study would then be warranted to develop a better understanding of the risks associated wi...

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  • Response to: 'closing the stable doors after the horse has bolted?'

    Dear Rosemary,

    Many thanks for taking the time to read and respond to our recently published article: Protocol for Healthy Habits Happy Homes (4H) Scotland: feasibility of a participatory approach to adaptation and implementation of a study aimed at early prevention of obesity.
    We agree that obesity prevention could and should start as early as reasonably possible (pre-conception/ peri-conception as recommended by WHO ECHO). We also feel (as did WHO ECHO) that we need to continue prevention efforts well beyond infancy and toddlerhood, and if that is the case then we need to have some prevention programmes to offer beyond infancy and toddlerhood: 4H is one potentially useful candidate prevention programme. It is not a question of intervening before/during infancy or later, we need both, with 4H contributing to the early childhood segment of future programmes.
    The maternal and infant nutrition framework in Scotland offers opportunity for a wide range of preventative work to address childhood obesity. Using NHS Tayside (where 4H Scotland took place) as an illustration, the Health Visitor and Family Nurse services hold UNICEF UK baby friendly Gold award, the local neonatal unit hold the UNICEF UK baby friendly award and recently the use and promotion of healthy start vouchers and the breastfeeding friendly Scotland logo has increased. There is a local specialist weight management service offering prevention approaches at tier 1 and management programmes...

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  • Retrospective evaluation of costs and types of medications dispensed to patients discharged from hospital to primary care clinic in Malaysia

    The study reported by Ang et al. is of great interest to healthcare providers, especially in view of its publication in a journal read by a general medical audience. It elegantly delineates two programmes that were launched in Singapore to facilitate the safe transition from acute hospital to the home of patients and aimed to decrease inpatient admissions and emergency department attendances, reduce total inpatient length of stay and diminish expenses of care of patients [1].

    Accordingly, we would like to describe the integrated care transitions programme in Malaysia where stable patients discharged from hospital admissions are referred to designated primary health centres to undergo subsequent care and continuous treatment. For more than a decade, Ministry of Health Malaysia has commenced a service to allow patients to continue their treatment in other referred facilities to ensure patients can obtain continuous supply of their medications.

    Despite the availability of standard guidelines, little is known about current patterns of medications supplied to this group of patients with stable chronic illnesses who receive follow-up care in primary care centres in Malaysia. To address the need for information about the costs and prescribing patterns of chronic medications in primary care settings, we analysed data from an urbanised government-funded health clinic in Selangor, Malaysia and examined the medications associated with the recommended treatment upon hos...

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