bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating patient attitudes and barriers towards smart technology for cardiac monitoring: results from a prospective multicentre study
Authors: Koshy Anoop N , Ko Jefferson , Sajeev Jithin K , Rajakariar Kevin , Roberts Louise , Cooke Jennifer , Teh Andrew W
Published: September 2019

Objectives

Remote assessment of heart rate and rhythm using smart technology (ST) holds promise in screening and monitoring of atrial fibrillation (AF). However, patient engagement is paramount to the success of ST interventions.

Methods

We assessed the attitudes and potential barriers towards ST for arrhythmia monitoring in an elderly, multimorbidity cohort. Consecutive inpatients were recruited across three hospitals and administered a standardised survey regarding attitudes towards ST for arrhythmia detection.

Results

Of 363 participants (median age 68 years (IQR: 55–80 years), mean CHA2DS2VASC score 3±2), 68.9% were interested in ST for cardiac monitoring. Those with underlying AF (n=112) and younger (<65 years) patients were more likely to be interested in using ST for cardiac monitoring (p for both <0.001). Complexity (71.1%) of ST was identified as a major barrier to its adoption, particularly in older participants (p=0.02). While only 52% of participants trusted the accuracy of ST, over 90% would seek medical attention based on aberrant readings.

Conclusion

We report a high level of interest among an older, high-risk patient cohort in using ST for cardiac monitoring. Despite a level of distrust in these devices, abnormal readings would still prompt the overwhelming majority of patients to seek medical attention. This highlights a need for physicians to validate the accuracy and clinical effectiveness of ST-derived physiological measurements, an area which remains unclear due to the paucity of trials.

Trial registration number

ACTRN: 12616991374459.
Longitudinal Study of music Therapy’s Effectiveness for Premature infants and their caregivers (LongSTEP): protocol for an international randomised trial
Authors: Ghetti Claire , Bieleninik Łucja , Hysing Mari , Kvestad Ingrid , Assmus Jörg , Romeo Renee , Ettenberger Mark , Arnon Shmuel , Vederhus Bente Johanne , Söderström Gaden Tora , Gold Christian
Published: September 2019

Introduction

Preterm birth has major medical, psychological and socioeconomic consequences worldwide. Music therapy (MT) has positive effects on physiological measures of preterm infants and maternal anxiety, but rigorous studies including long-term follow-up are missing. Drawing on caregivers’ inherent resources, this study emphasises caregiver involvement in MT to promote attuned, developmentally appropriate musical interactions that may be of mutual benefit to infant and parent. This study will determine whether MT, as delivered by a qualified music therapist during neonatal intensive care unit (NICU) hospitalisation and/or in home/municipal settings following discharge, is superior to standard care in improving bonding between primary caregivers and preterm infants, parent well-being and infant development.

Methods and analysis

Design:international multicentre, assessor-blind, 2×2 factorial, pragmatic randomised controlled trial; informed by a completed feasibility study.Participants:250 preterm infants and their parents.Intervention:MT focusing on parental singing specifically tailored to infant responses, will be delivered during NICU and/or during a postdischarge 6-month period.Primary outcome:changes in mother–infant bonding at 6-month corrected age (CA), as measured by the Postpartum Bonding Questionnaire.Secondary outcomes: mother–infant bonding at discharge and at 12-month CA; child development over 24 months; and parental depression, anxiety and stress, and infant rehospitalisation, all over 12 months.

Ethics and dissemination

The Regional Committees for Medical and Health Research Ethics approved the study (2018/994/REK Nord, 03 July 2018). Service users were involved in development of the study and will be involved in implementation and dissemination. Dissemination of findings will apply to local, national and international levels.

Trial registration number

NCT03564184
A comprehensive validation of very early rule-out strategies for non-ST-segment elevation myocardial infarction in emergency departments: protocol for a multicentre prospective cohort study
Authors: Tada Masafumi , Azuma Hiroyuki , Yamada Naoki , Kano Ken-ichi , Nagai Hideya , Maeda Shigenobu , Ishida Hiroshi , Aoyama Takahiko , Okada Ryota , Kawano Takahisa , Kobuchi Taketsune , Uzui Hiroyasu , Matano Hideyuki , Iwasaki Hose , Maeno Koji , Shimada Yoshimitsu , Yoshida Hiroyuki , Ando Masaki , Murakami Yoshimasa , Iwakami Naotsugu , Kishimoto Sanae , Iwami Taku , Tada Hiroshi , Chapman Andrew , Mills Nicholas , Hayashi Hiroyuki , Furukawa Toshi A , Watanabe Norio
Published: September 2019

Introduction

Recent advances in troponin sensitivity enabled early and accurate judgement of ruling-out myocardial infarction, especially non-ST elevation myocardial infarction (NSTEMI) in emergency departments (EDs) with development of various prediction-rules and high-sensitive-troponin-based strategies (hs-troponin). Reliance on clinical impression, however, is still common, and it remains unknown which of these strategies is superior. Therefore, our objective in this prospective cohort study is to comprehensively validate the diagnostic accuracy of clinical impression-based strategies, prediction-rules and hs-troponin-based strategies for ruling-out NSTEMIs.

Methods and analysis

In total, 1500 consecutive adult patients with symptoms suggestive of acute coronary syndrome will be prospectively recruited from five EDs in two tertiary-level, two secondary-level community hospitals and one university hospital in Japan. The study has begun in July 2018, and recruitment period will be about 1 year. A board-certified emergency physician will complete standardised case report forms, and independently perform a clinical impression-based risk estimation of NSTEMI. Index strategies to be compared will include the clinical impression-based strategy; prediction rules and hs-troponin-based strategies for the following types of troponin (Roche Elecsys hs-troponin T; Abbott ARCHITECT hs-troponin I; Siemens ADVIA Centaur hs-troponin I; Siemens ADVIA Centaur sensitive-troponin I). The reference standard will be the composite of type 1 MI and cardiac death within 30 days after admission to the ED. Outcome measures will be negative predictive value, sensitivity and effectiveness, defined as the proportion of patients categorised as low risk for NSTEMI. We will also evaluate inter-rater reliability of the clinical impression-based risk estimation.

Ethics and dissemination

The study is approved by the Ethics Committees of the Kyoto University Graduate School and Faculty of Medicine and of the five hospitals where we will recruit patients. We will disseminate the study results through conference presentations and peer-reviewed journals.
The Children and Young People’s Health Partnership Evelina London Model of Care: process evaluation protocol
Authors: Satherley Rose-Marie , Green Judith , Sevdalis Nick , Newham James Joseph , Elsherbiny Mohamed , Forman Julia , Wolfe Ingrid , Lingam Raghu
Published: September 2019

Introduction

Children and young people (CYP) in the UK have poor health outcomes, and there is increasing emergency department and hospital outpatient use. To address these problems in Lambeth and Southwark (two boroughs of London, UK), the local Clinical Commissioning Groups, Local Authorities and Healthcare Providers formed The Children and Young People’s Health Partnership (CYPHP), a clinical-academic programme for improving child health. The Partnership has developed the CYPHP Evelina London model, an integrated healthcare model that aims to deliver effective, coordinated care in primary and community settings and promote better self-management to over approximately 90 000 CYP in Lambeth and Southwark. This protocol is for the process evaluation of this model of care.

Methods and analysis

Alongside an impact evaluation, an in-depth, mixed-methods process evaluation will be used to understand the barriers and facilitators to implementing the model of care. The data collected mapped onto a logic model of how CYPHP is expected to improve child health outcomes. Data collection and analysis include qualitative interviews and focus groups with stakeholders, a policy review and a quantitative analysis of routine clinical and administrative data and questionnaire data. Information relating to the context of the trial that may affect implementation and/or outcomes of the CYPHP model of care will be documented.

Ethics and dissemination

The study has been reviewed by NHS REC Cornwall & Plymouth (17/SW/0275). The findings of this process evaluation will guide the scaling up and implementation of the CYPHP Evelina London Model of Care across the UK. Findings will be disseminated through publications and conferences, and implementation manuals and guidance for others working to improve child health through strengthening health systems.

Trial registration number

NCT03461848
Key stakeholders’ perspectives and experiences with defining, identifying and displaying gaps in health research: a qualitative study protocol
Authors: Nyanchoka Linda , Tudur-Smith Catrin , Porcher Raphaël , Hren Darko
Published: September 2019

Introduction

Identifying research gaps can inform the design and conduct of health research, practice and policies by informing the current body of evidence. Audiences including researchers, clinical guideline developers, clinicians, policymakers, research regulatory bodies, funders and patients/the public can also benefit from understanding the status of research and research gaps to make informed choices. This study aims to explore how key informants define research gaps and characterise methods/practices used to identify and display gaps in health research to inform future research practice and policies.

Methods and analysis

This is an exploratory qualitative study using semi-structured in-depth interviews. The participants will be recruited by purposive sampling from initiatives and organisations previously identified in a scoping review on methods to identify, prioritise and display gaps in health research. We anticipate performing up to 28 interviews with the different key informant groups who are involved in using evidence to inform health policy, practice and research. Interviews will be thematically analysed as outlined by Braun and Clarke. The qualitative data-analysis software NVivo V.12 Pro will be used to aid data management and analysis.

Discussion

This is the protocol for a follow-up study that aims to complement and enrich the findings of the scoping review on methods to identify, prioritise and display gaps in health research. The overall project aims to develop methodological guidance for describing, identifying and displaying gaps in health research.

Ethics and dissemination

The research obtained ethical approval from the University of Liverpool, UK. The findings will be disseminated via conferences, meetings (organised by the Methods in Research on Research project), peer-reviewed publications and lay magazines because the study participants will include the public/patients.
How patient acceptability affects access to breast reconstruction: a qualitative study
Authors: Retrouvey Helene , Zhong Toni , Gagliardi Anna R , Baxter Nancy N , Webster Fiona
Published: September 2019

Objectives

There has been limited research on the acceptability of breast reconstruction (BR) to breast cancer patients. We performed interviews to explore breast cancer patients’ acceptability of BR.

Design

Qualitative study.

Setting

Recruitment from six Ontario hospitals across the province (Toronto, Ottawa, Hamilton, London, Thunder Bay and Windsor) as well as key breast cancer organisations between November 2017 and June 2018.

Participants

Women of any age with a diagnosis of breast cancer planning to undergo or having undergone a mastectomy with or without BR.

Intervention

Sixty-minute semi-structured interviews were analysed using qualitative descriptive methodology that draws on inductive thematic analysis.

Outcome

In the telephone interviews, participants discussed their experience with breast cancer and accessing BR, focusing on the acceptability of BR as a surgical option post-mastectomy.

Results

Of the 28 participants, 11 had undergone BR at the time of the interview, 5 at the time of mastectomy and 6 at a later date. Four inter-related themes were identified that reflected women’s evolving ideas about BR as they progressed through different stages of their disease and treatment. The themes we developed were: (1) cancer survival before BR, (2) the influence of physicians on BR acceptability, (3) patient’s shift to BR acceptance and (4) women’s need to justify BR. For many women, access to BR surgery became more salient over time, thus adding a temporal element to the existing access framework.

Conclusion

In our study, women’s access to BR was negatively influenced by the poor acceptability of this surgical procedure. The acceptability of BR was a complex process taking place over time, from the moment of breast cancer diagnosis to BR consideration. BR access may be improved through enhancing patient acceptability of BR. We suggest adapting the current access to care frameworks by further developing the concept of acceptability.
Timing of device reimplantation and reinfection rates following cardiac implantable electronic device infection: a systematic review and meta-analysis
Authors: Chew Derek , Somayaji Ranjani , Conly John , Exner Derek , Rennert-May Elissa
Published: September 2019

Objectives

Initial management of cardiac implantable electronic device (CIED) infection requires removal of the infected CIED system and treatment with systemic antibiotics. However, the optimal timing to device reimplantation is unknown. The aim of this study was to quantify the incidence of reinfection after initial management of CIED infection, and to assess the effect of timing to reimplantation on reinfection rates.

Design

Systematic review and meta-analysis.

Interventions

A systematic review and meta-analysis was performed of studies published up to February 2018. Inclusion criteria were: (a) documented CIED infection, (b) studies that reported the timing to device reimplantation and (c) studies that reported the proportion of participants with device reinfection. A meta-analysis of proportions using a random effects model was performed to estimate the pooled device reinfection rate.

Primary and secondary outcome measures

The primary outcome measure was the rate of CIED reinfection. The secondary outcome was all-cause mortality.

Results

Of the 280 screened studies, 8 met inclusion criteria with an average of 96 participants per study (range 15–220 participants). The pooled incidence rate of device reinfection was 0.45% (95% CI, 0.02% to 1.23%) per person year. A longer time to device reimplantation >72 hours was associated with a trend towards higher rates of reinfection (unadjusted incident rate ratio 4.8; 95% CI 0.9 to 24.3, p=0.06); however, the meta-regression analysis was unable to adjust for important clinical covariates. There did not appear to be a difference in reinfection rates when time to reimplantation was stratified at 1 week. Heterogeneity was moderate (I2=61%).

Conclusions

The incident rate of reinfection following initial management of CIED infection is not insignificant. Time to reimplantation may affect subsequent rates of device reinfection. Our findings are considered exploratory and significant heterogeneity limits interpretation.

PROSERO registration number

CRD4201810960.
Health-related preferences of older patients with multimorbidity: the protocol for an evidence map
Authors: González-González Ana Isabel , Schmucker Christine , Blom Jeanet , van den Akker Marjan , Nguyen Truc Sophia , Nothacker Julia , Meerpohl Joerg J , Röttger Kristian , Wegwarth Odette , Hoffmann Tammy , Straus Sharon E , Gerlach Ferdinand M , Muth Christiane
Published: September 2019

Introduction

Interaction of conditions and treatments, complicated care needs and substantial treatment burden make patient–physician encounters involving multimorbid older patients highly complex. To optimally integrate patients’ preferences, define and prioritise realistic treatment goals and individualise care, a patient-centred approach is recommended. However, the preferences of older patients, who are especially vulnerable and frequently multimorbid, have not been systematically investigated with regard to their health status. The purpose of this evidence map is to explore current research addressing health-related preferences of older patients with multimorbidity, and to identify the knowledge clusters and research gaps.

Methods and analysis

To identify relevant research, we will conduct searches in the electronic databases MEDLINE, EMBASE, PsycINFO, PSYNDEX, CINAHL, Social Science Citation Index, Social Science Citation Index Expanded and the Cochrane library from their inception. We will check reference lists of relevant articles and carry out cited reference research (forward citation tracking). Two independent reviewers will screen titles and abstracts, check full texts for eligibility and extract the data. Any disagreement will be resolved and consensus reached with the help of a third reviewer. We will include both qualitative and quantitative studies, and address preferences from the patients’ perspectives in a multimorbid population of 60 years or older. There will be no restrictions on the publication language. Data extraction tables will present study and patient characteristics, aim of study, methods used to identify preferences and outcomes (ie, type of preferences). We will summarise the data using tables and figures (ie, bubble plot) to present the research landscape and to describe clusters and gaps.

Ethics and dissemination

Due to the nature of the proposed evidence map, ethics approval will not be required. Results from our research will be disseminated by means of specifically prepared materials for patients, at relevant (inter)national conferences and via publication in peer-reviewed journals.
Investigating the mechanism of impact of the Quality Premium initiative on antibiotic prescribing in primary care practices in England: a study protocol
Authors: Anyanwu Philip Emeka , Tonkin-Crine Sarah , Borek Aleksandra , Costelloe Ceire
Published: September 2019

Introduction

The persistent development and spread of resistance to antibiotics remain an important public health concern in the UK and globally. About 74% of antibiotics prescribed in England in 2016 was in primary care. The Quality Premium (QP) initiative that rewards Clinical Commissioning Groups (CCGs) financially based on the quality of specific health services commissioned is one of the National Health Service (NHS) England interventions to reduce antimicrobial resistance through reduced prescribing. Emerging evidence suggests a reduction in antibiotic prescribing in primary care practices in the UK following QP initiative. This study aims to investigate the mechanism of impact of this high-cost health-system level intervention on antibiotic prescribing in primary care practices in England.

Methods and analysis

The study will constitute secondary analyses of antibiotic prescribing data for almost all primary care practices in England from the NHS England Antibiotic Quality Premium Monitoring Dashboard and OpenPrescribing covering the period 2013 to 2018. The primary outcome is the number of antibiotic items per Specific Therapeutic group Age-sex Related Prescribing Unit (STAR-PU) prescribed monthly in each practice or CCG. We will first conduct an interrupted time series using ordinary least square regression method to examine whether antibiotic prescribing rate in England has changed over time, and how such changes, if any, are associated with QP implementation. Single and sequential multiple-mediator models using a unified approach for the natural direct and indirect effects will be conducted to investigate the relationship between QP initiative, the potential mediators and antibiotic prescribing rate with adjustment for practice and CCG characteristics.

Ethics and dissemination

This study will use secondary data that are anonymised and obtained from studies that have either undergone ethical review or generated data from routine collection systems. Multiple channels will be used in disseminating the findings from this study to academic and non-academic audiences.
Mapping the concept, content and outcome of wilderness therapy for childhood cancer survivors: protocol for a scoping review
Authors: Jong Miek C , Lown Anne , Schats Winnie , Otto Heather Rose , Jong Mats
Published: September 2019

Introduction

Long-term childhood cancer survivors are at risk for frailty and have significant health-related issues in adulthood. Various health promotion interventions have been proposed to enhance quality of life including wilderness therapy, which applies the impact of nature on health in a therapeutic context. Previous studies have described positive outcomes linked with various wilderness-related therapies for cancer survivors. However, there is no clarity on the role these therapies play in childhood cancer. The current scoping review aims to systematically map the concept, content and outcome of wilderness therapy for childhood cancer survivors.

Methods and analysis

This review will be guided by the Joanna Briggs Institute Reviewers’ manual for scoping reviews. A systematic literature search using medical subject headings (MeSH) and text words related to wilderness therapy and childhood cancer survivors will be performed in EMBASE, ERIC, Medline, Psycinfo, CINAHL, Scopus, Web of Science, SPORTDiscus and Svemed+, Sociological Abstracts, supplemented by grey literature searches. Eligible quantitative and qualitative studies will be screened, included, assessed for quality and extracted for data by two reviewers independently. Results will be described in a narrative style, reported in extraction tables and diagrams, and where appropriate in themes and text.

Ethics and dissemination

This study describes a protocol for a scoping review that will undertake secondary analysis of data already published in literature and is therefore exempt from medical ethical review. The scoping review will inform understanding of the benefits and risks of wilderness therapy for childhood cancer survivors, their families, practitioners, clinicians and researchers, and will help elucidate the steps necessary for building its evidence base going forward. Results will be published in a peer-reviewed scientific journal.
Associations between active travel and diet: cross-sectional evidence on healthy, low-carbon behaviours from UK Biobank
Authors: Smith Michaela A , Boehnke Jan Rasmus , Graham Hilary , White Piran C L , Prady Stephanie L
Published: September 2019

Objectives

To examine whether there are associations between active travel and markers of a healthy, low-carbon (HLC) diet (increased consumption of fruit and vegetables (FV), reduced consumption of red and processed meat (RPM)).

Design

Cross-sectional analysis of a cohort study.

Settings

Population cohort of over 500 000 people recruited from 22 centres across the UK. Participants aged between 40 and 69 years were recruited between 2006 and 2010.

Participants

412 299 adults with complete data on travel mode use, consumption of FV and RPM, and sociodemographic covariates were included in the analysis.

Exposure measures

Mutually exclusive mode or mode combinations of travel (car, public transport, walking, cycling) for non-work and commuting journeys.

Outcome measures

Consumption of FV measured as portions per day and RPM measured as frequency per week.

Results

Engaging in all types of active travel was positively associated with higher FV consumption and negatively associated with more frequent RPM consumption. Cycling exclusively or in combination with walking was most strongly associated with increased dietary consumption of FV and reduced consumption of RPM for both non-work and commuting journeys. Overall, the strongest associations were between non-work cycling and FV consumption (males: adjusted OR=2.18, 95% CI 2.06 to 2.30; females: adjusted OR=2.50, 95% CI 2.31 to 2.71) and non-work cycling and RPM consumption (males: adjusted OR=0.57, 95% CI 0.54 to 0.60; females: adjusted OR=0.54, 95% CI 0.50 to 0.59). Associations were generally similar for both commuting and non-work travel, and were robust to adjustment with sociodemographic and behavioural factors.

Conclusions

There are strong associations between engaging in active travel, particularly cycling, and HLC dietary consumption, suggesting that these HLC behaviours are related. Further research is needed to better understand the drivers and dynamics between these behaviours within individuals, and whether they share common underlying causes.
Patient experience of treatment decision making for wet age-related macular degeneration disease: a qualitative study in China
Authors: Bian Wei , Wan Junli , Tan Mingqiong , Wu Xiaoqing , Su Jun , Wang Lihua
Published: September 2019

Objectives

This study aimed to investigate the experience of patients with wet age-related macular degeneration (wAMD) in treatment decision-making process.

Design

A descriptive qualitative study was designed by using semistructured interviews, and the data analysis was conducted with the thematic analysis approach.

Participants and setting

A convenient and purposive sample of 21 participants diagnosed with wAMD was recruited from May 2018 to September 2018. The study was conducted in the Eye Clinic of Southwest Hospital of Army Medical University in Chongqing located in the southwest of China.

Results

The mean age of the participants was 64.48 years (ranging 50–81 years), and the duration of the disease ranged from 6 months to 48 months. Four major themes were identified from the original data analysis. These themes included facing the darkness (choosing from light and darkness and living in pain), constraints on decision making (doctor-oriented decision making, inadequacy of options and time), weighing alternatives (family influence, financial burden and maintaining social function) and decision-making support (professional decision-making assistance and peer support).

Conclusion

This is a qualitative study attempting to explore the patient experience of treatment decision making for wAMD disease in China. Previous literature has focused on treatment effect and symptoms, rather than the individual experience and the wide contexts from a sociocultural perspective. Further studies, such as cross-sectional studies, can be used to describe the status and determine the influencing factors of decision0making process, so as to develop an impact factor model of decision making and to formulate an intervention for patients with wAMD.
Leg ischaemia management collaboration (LIMb): study protocol for a prospective cohort study at a single UK centre
Authors: Houghton John S M , Nduwayo Sarah , Nickinson Andrew T O , Payne Tanya J , Sterland Sue , Nath Mintu , Gray Laura J , McMahon Greg S , Rayt Harjeet S , Singh Sally J , Robinson Thompson G , Conroy Simon P , Haunton Victoria J , McCann Gerry P , Bown Matthew J , Davies Robert S M , Sayers Rob D
Published: September 2019

Introduction

Severe limb ischaemia (SLI) is the end stage of peripheral arterial occlusive disease where the viability of the limb is threatened. Around 25% of patients with SLI will ultimately require a major lower limb amputation, which has a substantial adverse impact on quality of life. A newly established rapid-access vascular limb salvage clinic and modern revascularisation techniques may reduce amputation rate. The aim of this study was to investigate the 12-month amputation rate in a contemporary cohort of patients and compare this to a historical cohort. Secondary aims are to investigate the use of frailty and cognitive assessments, and cardiac MRI in risk-stratifying patients with SLI undergoing intervention and establish a biobank for future biomarker analyses.

Methods and analysis

This single-centre prospective cohort study will recruit patients aged 18–110 years presenting with SLI. Those undergoing intervention will be eligible to undergo additional venepuncture (for biomarker analysis) and/or cardiac MRI. Those aged ≥65 years and undergoing intervention will also be eligible to undergo additional frailty and cognitive assessments. Follow-up will be at 12 and 24 months and subsequently via data linkage with NHS Digital to 10 years postrecruitment. Those undergoing cardiac MRI and/or frailty assessments will receive additional follow-up during the first 12 months to investigate for perioperative myocardial infarction and frailty-related outcomes, respectively. A sample size of 420 patients will be required to detect a 10% reduction in amputation rate in comparison to a similar sized historical cohort, with 90% power and 5% type I error rate. Statistical analysis of this comparison will be by adjusted and unadjusted logistic regression analyses.

Ethics and dissemination

Ethical approval for this study has been granted by the UK National Research Ethics Service (19/LO/0132). Results will be disseminated to participants via scientific meetings, peer-reviewed medical journals and social media.

Trial registration number

NCT04027244.
Living strategies for disability in men ageing with HIV in Ontario, Canada: a longitudinal qualitative study
Authors: Solomon Patricia , O'Brien Kelly K , McGuff Rebecca , Sankey Michelle
Published: September 2019

Objectives

To examine the living strategies used by older men living with HIV to deal with the episodic nature of disability and associated uncertainty, over time.

Design

Qualitative longitudinal study in which men living with HIV were interviewed on four occasions over 20 months.

Setting

Men were recruited from HIV community organisations in Canada.

Participants

14 men with a median age of 57.5 years and median time since diagnosis of 21.5 years.

Results

Five themes depict the living strategies used to deal with the episodic nature of disability and uncertainty over time. Actively engaging in problem-solving by prioritising and modifying activities and avoiding stress, advocating for support, being positive and future oriented, engaging in healthy pursuits and providing social support to others helped men to mitigate their disability. By following participants over time, we were able to gather insights into triggers of episodes of disability, and perceptions of the success of implementing their living strategies and avoiding uncertainty.

Conclusions

Participants used living strategies to deal with uncertainty and mitigate episodes of disability over time. This study supports the importance of programmes that promote self-management for older men living with HIV through helping them identify triggers of disability, set realistic goals and problem-solve. These may help build self-efficacy, increase sense of control, and decrease feelings of uncertainty and episodes of disability.
Long-term efficacy and safety of secukinumab 150 mg in ankylosing spondylitis: 5-year results from the phase III MEASURE 1 extension study
Authors: Baraliakos Xenofon , Braun Juergen , Deodhar Atul , Poddubnyy Denis , Kivitz Alan , Tahir Hasan , Van den Bosch Filip , Delicha Evie-Maria , Talloczy Zsolt , Fierlinger Anke
Published: September 2019

Objective

This study aimed to report end-of-study results on efficacy and safety of secukinumab 150 mg through 5 years in patients with ankylosing spondylitis (AS; MEASURE 1 extension trial (NCT01863732)).

Methods

After the 2-year core trial, 274 patients receiving subcutaneous secukinumab 150 or 75 mg (following intravenous loading or initial placebo treatment to 16/24 weeks) every 4 weeks were invited to enter the 3-year extension study. Dose escalation from 75 to 150 mg (approved dose) was allowed at or after week 156 based on the judgement of the treating physician. Assessments at week 260 (5 years) included Assessment of SpondyloArthritis international Society (ASAS) 20/40 and other efficacy outcomes. Data are presented as observed. Safety assessment included all patients who received ≥1 dose of study treatment.

Results

Of the 274 patients who entered the extension study, 84% (230/274) completed 5 years of treatment. ASAS20/40 responses were 78.6/65.2%, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 50 response was 63.4% and mean (±SD) BASDAI total score was 2.6±1.76 with secukinumab 150 mg at 5 years. Improvements in efficacy outcomes were sustained through 5 years. A total of 82 patients on secukinumab 75 mg (56.2%) had their dose escalated to 150 mg after week 168; ASAS40, ASAS-PR, ASAS 5/6 and BASDAI50 responses were improved in patients whose dose was escalated from secukinumab 75 to 150 mg. Secukinumab was well tolerated with a safety profile consistent over the course of the study.

Conclusions

Secukinumab 150 mg provided sustained efficacy across multiple domains of AS with a favourable and consistent safety profile through 5-year treatment. Over 50% of patients required dose escalation from 75 to 150 mg and efficacy improved in these patients.
The effect of sucrose-induced osmotic stress on the sensitivity ofEscherichia colito bacteriocins
Authors: Polyudova Tatyana , Eroshenko Daria , Korobov Vladimir
Published: September 2019

Bacteriocins are antimicrobial peptides, produced by Gram-positive bacteria such as lactococci and staphylococci, that have limited bactericidal action against Gram-negative bacteria. The aim of this paper was to study the sensitivity of three strains of Escherichia coli to bacteriocins: nisin (as Nisaplin®) and two staphylococcal peptides (warnerin and hominin) during sucrose-induced osmotic stress. We found that all peptides in a 0.3 g·mL−1sucrose solution significantly reduced the number of viable E. coli. The most pronounced antibacterial effect was achieved by nisin against E. coli K-12 (3 log reduction). Slightly less bactericidal effects were observed with warnerin (1 mg·mL−1) and hominin (1 mg·mL−1) in sucrose solution. The lytic activity of staphylococcal peptides was detected by decreased optical density and viable cell counts. Moreover, it was confirmed by the increased amount of DNA and protein in the medium and the morphological changes detected by atomic force microscopy after 20 h of treatment. Zymographic analysis revealed the release of lytic enzymes from E. coli cells after treatment with staphylococcal peptides and sucrose. These results indicated that the antimicrobial action of peptides can be extended to Gram-negative bacteria via combination with high concentrations of sucrose.
RELATIONAL LEADERSHIP AND REGIONAL DEVELOPMENT: A CASE STUDY ON NEW AGRICULTURE VENTURES IN UGANDA
Authors: FISCHER DOMINIK
Published: September 2019

The purpose of this study is to analyze the importance of relational leadership for a social business initiative in rural Uganda. The author follows the case of the Hope Development Initiative (HDI) that supports (i) female farmers to become entrepreneurs as well as (ii) the development of the region. The study aims to illuminate relational leadership theory, particularly how it is applied in a specific context. Data were gathered during a ten-day research expedition to Northern Uganda. The study first presents obstacles the HDI faces in terms of lack of resources as well as socio-cultural dynamics limiting its organizational processes. Afterward, a framework of HDI’s processes of relational leadership serves to analyze and structure the results, thereby demonstrating how HDI actors manage to circumvent these obstacles based on building relationships with critical actors from the stakeholder environment. The case indicates that relational leadership should be seen as one of the most critical organizational capabilities to access resources for value creation in rural Uganda when actors from the stakeholder environment hold these required resources. The study demonstrates how relational leadership incorporating actors from the stakeholder environment on the micro level affects the success of the respective organization and development of the region on the macro level.
Spatial Structure Preserving Feature Pyramid Network for Semantic Image Segmentation
Authors: Yuan Yuan , Fang Jie , Lu Xiaoqiang , Feng Yachuang
Published: September 2019

Recently, progress on semantic image segmentation is substantial, benefiting from the rapid development of Convolutional Neural Networks. Semantic image segmentation approaches proposed lately have been mostly based on Fully convolutional Networks (FCNs). However, these FCN-based methods use large receptive fields and too many pooling layers to depict the discriminative semantic information of the images. Specifically, on one hand, convolutional kernel with large receptive field smooth the detailed edges, since too much contexture information is used to depict the “center pixel.” However, the pooling layer increases the receptive field through zooming out the latest feature maps, which loses many detailed information of the image, especially in the deeper layers of the network. These operations often cause low spatial resolution inside deep layers, which leads to spatially fragmented prediction. To address this problem, we exploit the inherent multi-scale and pyramidal hierarchy of deep convolutional networks to extract the feature maps with different resolutions and take full advantages of these feature maps via a gradually stacked fusing way. Specifically, for two adjacent convolutional layers, we upsample the features from deeper layer with stride of 2 and then stack them on the features from shallower layer. Then, a convolutional layer with kernels of 1× 1 is followed to fuse these stacked features. The fused feature preserves the spatial structure information of the image; meanwhile, it owns strong discriminative capability for pixel classification. Additionally, to further preserve the spatial structure information and regional connectivity of the predicted category label map, we propose a novel loss term for the network. In detail, two graph model-based spatial affinity matrixes are proposed, which are used to depict the pixel-level relationships in the input image and predicted category label map respectively, and then their cosine distance is backward propagated to the network. The proposed architecture, called spatial structure preserving feature pyramid network, significantly improves the spatial resolution of the predicted category label map for semantic image segmentation. The proposed method achieves state-of-the-art results on three public and challenging datasets for semantic image segmentation.
Optimal Sparsification for Some Binary CSPs Using Low-Degree Polynomials
Authors: Jansen Bart M. P. , Pieterse Astrid
Published: September 2019

This article analyzes to what extent it is possible to efficiently reduce the number of clauses in NP-hard satisfiability problems without changing the answer. Upper and lower bounds are established using the concept of kernelization. Existing results show that if NP ⊈ coNP/poly, no efficient preprocessing algorithm can reduce
n
-variable instances of
cnf-sat
with 
d
literals per clause to equivalent instances with 
O
(
n

d
−ε

) bits for any ε > 0. For the N
ot
-A
ll
-E
qual sat
problem, a compression to size 
Õ
(
n

d
−1

) exists. We put these results in a common framework by analyzing the compressibility of CSPs with a binary domain. We characterize constraint types based on the minimum degree of multivariate polynomials whose roots correspond to the satisfying assignments, obtaining (nearly) matching upper and lower bounds in several settings. Our lower bounds show that not just the number of constraints, but also the encoding size of individual constraints plays an important role. For example, for E
xact
S
atisfiability
with unbounded clause length it is possible to efficiently reduce the number of constraints to 
n
+1, yet no polynomial-time algorithm can reduce to an equivalent instance with 
O
(
n
2−ε
) bits for any  ε > 0, unless NP ⊆ coNP/poly.
Influenza A Virus Subpopulations and Their Implication in Pathogenesis and Vaccine Development
Authors: Ghorbani Amir , Ngunjiri John M. , Lee Chang-Won
Published: September 2019

The concept of influenza A virus (IAV) subpopulations emerged approximately 75 years ago, when Preben von Magnus described “incomplete” virus particles that interfere with the replication of infectious virus. It is now widely accepted that infectious particles constitute only a minor portion of biologically active IAV subpopulations. The IAV quasispecies is an extremely diverse swarm of biologically and genetically heterogeneous particle subpopulations that collectively influence the evolutionary fitness of the virus. This review summarizes the current knowledge of IAV subpopulations, focusing on their biologic and genomic diversity. It also discusses the potential roles IAV subpopulations play in virus pathogenesis and live attenuated influenza vaccine development.
Spatial Population Genetics: It's About Time
Authors: Bradburd Gideon S. , Ralph Peter L.
Published: September 2019

Many important questions about the history and dynamics of organisms have a geographical component: How many are there, and where do they live? How do they move and interbreed across the landscape? How were they moving a thousand years ago, and where were the ancestors of a particular individual alive today? Answers to these questions can have profound consequences for our understanding of history, ecology, and the evolutionary process. In this review, we discuss how geographic aspects of the distribution, movement, and reproduction of organisms are reflected in their pedigree across space and time. Because the structure of the pedigree is what determines patterns of relatedness in modern genetic variation, our aim is to thus provide intuition for how these processes leave an imprint in genetic data. We also highlight some current methods and gaps in the statistical toolbox of spatial population genetics.
Proteasome Inhibitor Drugs
Authors: Fricker Lloyd D.
Published: September 2019

Proteasomes are large, multicatalytic protein complexes that cleave cellular proteins into peptides. There are many distinct forms of proteasomes that differ in catalytically active subunits, regulatory subunits, and associated proteins. Proteasome inhibitors are an important class of drugs for the treatment of multiple myeloma and mantle cell lymphoma, and they are being investigated for other diseases. Bortezomib (Velcade) was the first proteasome inhibitor to be approved by the US Food and Drug Administration. Carfilzomib (Kyprolis) and ixazomib (Ninlaro) have recently been approved, and more drugs are in development. While the primary mechanism of action is inhibition of the proteasome, the downstream events that lead to selective cell death are not entirely clear. Proteasome inhibitors have been found to affect protein turnover but at concentrations that are much higher than those achieved clinically, raising the possibility that some of the effects of proteasome inhibitors are mediated by other mechanisms.
Central growth hormone action regulates metabolism during pregnancy
Authors: Teixeira Pryscila D. S. , Couto Gisele C. , Furigo Isadora C. , List Edward O. , Kopchick John J. , Donato Jose
Published: September 2019

The maternal organism undergoes numerous metabolic adaptations to become prepared for the demands associated with the coming offspring. These metabolic adaptations involve changes induced by several hormones that act at multiple levels, ultimately influencing energy and glucose homeostasis during pregnancy and lactation. Previous studies have shown that central growth hormone (GH) action modulates glucose and energy homeostasis. However, whether central GH action regulates metabolism during pregnancy and lactation is still unknown. In the present study, we generated mice carrying ablation of GH receptor (GHR) in agouti-related protein (AgRP)–expressing neurons, in leptin receptor (LepR)–expressing cells or in the entire brain to investigate the role played by central GH action during pregnancy and lactation. AgRP-specific GHR ablation led to minor metabolic changes during pregnancy and lactation. However, while brain-specific GHR ablation reduced food intake and body adiposity during gestation, LepR GHR knockout (KO) mice exhibited increased leptin responsiveness in the ventromedial nucleus of the hypothalamus during late pregnancy, although their offspring showed reduced growth rate. Additionally, both Brain GHR KO and LepR GHR KO mice had lower glucose tolerance and glucose-stimulated insulin secretion during pregnancy, despite presenting increased insulin sensitivity, compared with control pregnant animals. Our findings revealed that during pregnancy central GH action regulates food intake, fat retention, as well as the sensitivity to insulin and leptin in a cell-specific manner. Together, the results suggest that GH acts in concert with other “gestational hormones” to prepare the maternal organism for the metabolic demands of the offspring.
Using Partial Directed Coherence to Study Alpha-Band Effective Brain Networks during a Visuospatial Attention Task
Authors: Zhao Zongya , Wang Chang
Published: September 2019

Previous studies have shown that the neural mechanisms underlying visual spatial attention rely on top-down control information from the frontal and parietal cortexes, which ultimately amplifies sensory processing of stimulus occurred at the attended location relative to those at unattended location. However, the modulations of effective brain networks in response to stimulus at attended and unattended location are not yet clear. In present study, we collected event-related potentials (ERPs) from 15 subjects during a visual spatial attention task, and a partial directed coherence (PDC) method was used to construct alpha-band effective brain networks of two conditions (targets at attended and nontargets at unattended location). Flow gain mapping, effective connectivity pattern, and graph measures including clustering coefficient (C), characteristic path length (L), global efficiency (Eglobal), and local efficiency (Elocal) were compared between two conditions. Flow gain mapping showed that the frontal region seemed to serve as the main source of information transmission in response to targets at attended location while the parietal region served as the main source in nontarget condition. Effective connectivity pattern indicated that in response to targets, there existed obvious top-down connections from the frontal, temporal, and parietal cortexes to the visual cortex compared with in response to nontargets. Graph theory analysis was used to quantify the topographical properties of the brain networks, and results revealed that in response to targets, the brain networks were characterized by significantly smaller characteristic path length and larger global efficiency than in response to nontargets. Our findings suggested that smaller characteristic path length and larger global efficiency could facilitate global integration of information and provide a substrate for more efficient perceptual processing of targets at attended location compared with processing of nontargets at ignored location, which revealed the neural mechanisms underlying visual spatial attention from the perspective of effective brain networks and graph theory for the first time and opened new vistas to interpret a cognitive process.