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Rehabilitation Exercise and psycholoGical support After covid-19 InfectioN (REGAIN) : a multi-centre randomised controlled trial
No full textObjectives
The primary objective is to determine which of two interventions: 1) an eight week, online, home-based, supervised, group rehabilitation programme (REGAIN); or 2) a single online session of advice (best-practice usual care); is the most clinically and cost-effective treatment for people with ongoing COVID-19 sequelae more than three months after hospital discharge.
Trial design
Multi-centre, 2-arm (1:1 ratio) parallel group, randomised controlled trial with embedded process evaluation and health economic evaluation.
Participants
Adults with ongoing COVID-19 sequelae more than three months after hospital discharge
Inclusion criteria: 1) Adults ≥18 years; 2) ≥ 3 months after any hospital discharge related to COVID-19 infection, regardless of need for critical care or ventilatory support; 3) substantial (as defined by the participant) COVID-19 related physical and/or mental health problems; 4) access to, and able/supported to use email and internet audio/video; 4) able to provide informed consent; 5) able to understand spoken and written English, Bengali, Gujarati, Urdu, Punjabi or Mandarin, themselves or supported by family/friends.
Exclusion criteria: 1) exercise contraindicated; 2) severe mental health problems preventing engagement; 3) previous randomisation in the present study; 4) already engaged in, or planning to engage in an alternative NHS rehabilitation programme in the next 12 weeks; 5) a member of the same household previously randomised in the present study.
Intervention and comparator
Intervention 1: The Rehabilitation Exercise and psycholoGical support After covid-19 InfectioN (REGAIN) programme: an eight week, online, home-based, supervised, group rehabilitation programme.
Intervention 2: A thirty-minute, on-line, one-to-one consultation with a REGAIN practitioner (best-practice usual care).
Main outcomes
The primary outcome is health-related quality of life (HRQoL) – PROMIS® 29+2 Profile v2.1 (PROPr) – measured at three months post-randomisation.
Secondary outcomes include dyspnoea, cognitive function, health utility, physical activity participation, post-traumatic stress disorder (PTSD) symptom severity, depressive and anxiety symptoms, work status, health and social care resource use, death - measured at three, six and 12 months post-randomisation.
Randomisation
Participants will be randomised to best practice usual care or the REGAIN programme on a 1:1.03 basis using a computer-generated randomisation sequence, performed by minimisation and stratified by age, level of hospital care, and case level mental health symptomatology.
Once consent and baseline questionnaires have been completed by the participant online at home, randomisation will be performed automatically by a bespoke web-based system.
Blinding (masking)
To ensure allocation concealment from both participant and REGAIN practitioner at baseline, randomisation will be performed only after the baseline questionnaires have been completed online at home by the participant. After randomisation has been performed, participants and REGAIN practitioners cannot be blind to group allocation. Follow-up outcome assessments will be completed by participants online at home
Alliance re-evaluation in the context of outside partnering opportunities : decision heuristics and the impact of environmental uncertainty
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Reading the resurrection appearance at the lakeside through lenses of sensing and intuition
Get PDFThis study forms part of a research project designed to test the sensing, intuition, feeling and thinking (SIFT) approach to biblical hermeneutics in respect of a wide range of biblical passages. On this occasion, two contrasting approaches to perceiving (a group of eight sensing types and a group of nine intuitive types) were invited to address two questions to John 21:1–12a: What do you see in this passage? What sparks your imagination in this passage? These two contrasting groups generated characteristically different readings of the same text
Implicit religion, Anglican cathedrals, and spiritual wellbeing : the impact of carol services
Get PDFRooted in the field of cathedral studies, this paper draws into dialogue three bodies of knowledge: Edward Bailey’s notion of implicit religion that, among other things, highlights the continuing traction of the Christian tradition and Christian practice within secular societies; David Walker’s notion of the multiple ways through which in secular societies people may relate to the Christian tradition as embodied within the Anglican Church and John Fisher’s notion of spiritual wellbeing as conceptualised in relational terms. Against this conceptual background, this paper draws on data provided by 1234 participants attending one of the Christmas Eve carol services in Liverpool Cathedral to explore the perceived impact of attendance on the spiritual health of people who do not believe in God and yet feel that Liverpool Cathedral is their cathedral, and it is this sense of belonging that brings them back at Christmas time.
Contribution: Situated within the science of cathedral studies, this paper links in an original way three fields of discourse: Edward Bailey’s notion of implicit religion, David Walker’s notion of the four ways of belonging to God facilitated by the Anglican Church and John Fisher’s conceptualisation and operationalisation of the notion of spiritual wellbeing. The hypothesis developed from this original integration of theoretical perspectives is then tested empirically on data provided by 404 participants at carol services who do not believe in God
Nerine potexvirus 1 : a new potexvirus species detected from nerine in the United Kingdom
No full textWe identified full-length sequence of a potexvirus infecting Nerine plants in the UK. By sequencing viruses in historical collections we have been able to demonstrate that the identified virus, for which we propose the name nerine potexvirus 1, is a potentially novel species in the genus Potexvirus. Analysis of the potexviruses in the historic collections has also enabled us to generate the first full-length sequence of nerine virus X (NVX) to be isolated from Nerine; and to clarify the taxonomy of NVX isolates infecting Nerine and Agapanthus. Analysis of isolates from the historical collections has enabled us to link biological data gathered in the pre-genomic era to specific isolate sequences
Innovations in the repayment structure of microcredit contracts
Get PDFMicrofinance contracts typically require a fixed repayment schedule that, while ensuring repayment discipline, may inhibit entrepreneurship and business growth. In this article, I review the recent developments in the literature studying innovations in the repayment structure of microcredit contracts. Introducing flexible repayment schedules improves business outcomes by allowing microcredit borrowers to increase investment and to respond to income fluctuations to a higher extent. Although financial innovations hold the promise to foster business growth, and evidence suggests that their demand appears concentrated among financially sophisticated borrowers, they are feared to increase credit risk and hence their adoption among microfinance institutions is very limited. I explore potential challenges lenders face in offering these innovations and outline pathways towards a profitable implementation of such contracts
Cross-discipline teaching and learning of cardiology through an augmented reality application
Get PDFUndergraduate health sciences and health professional degree programmes introduce students to common heart diseases and associated treatments, including atrial fibrillation (AF). Our students, second-year biomedical science and pharmacy students, through formal and informal feedback on their learning experience with cardiology, noted AF as the most difficult to comprehend. The learning challenges include electrophysiology and pharmacology aspects of AF. This study, therefore, aims to investigate the potential use of augmented reality (AR) to enhance students’ engagement and understanding of AF. Based upon students’ feedback, and guided by the learning outcomes of our degree programmes, we developed an AR application (App) to teach AF, covering general as well as discipline-specific learning content. The development was done through an iterative process, grounded in the constructivist learning theories. A survey consisting of 13 Likert-scale questions and an open-ended question formulated around user interface principles was conducted to gather students’ feedback of the App. Thirteen per cent of pharmacy students ( This study shows that AR technology has enhanced students’ engagement as well as perception of understanding of AF, specifically in the areas that students find difficult. This authentic learning tool has successfully addressed some of the learning challenges raised by students of both disciplines. Students’ positive feedback suggests that a carefully designed AR App, guided by learning theories, is a suitable and viable option to improve students’ understanding of complex subjects, apart from making learning immersive and engaging
Early childhood multiple or persistent regulatory problems and diurnal salivary cortisol in young adulthood
Get PDFBackground:
Early childhood multiple or persistent regulatory problems (RPs; crying, sleeping, or feeding problems) have been associated with a risk of behavioural problems in young adulthood. It has been suggested that this may be due to the possible influence of early RPs on the functioning of the hypothalamic-pituitary-adrenal (HPA) axis. However, associations between early RPs and HPA-axis activity in young adulthood remain unexplored. Thus, the aim of the current study was to investigate whether early childhood multiple or persistent RPs are associated with diurnal salivary cortisol in young adulthood.
Methods:
At the ages of 5, 20 and 56 months, RPs of 308 children from the Arvo Ylppö Longitudinal Study were assessed via standardized parental interviews and neurological assessments. Multiple RPs were defined as two or three RPs at the age of 5 months and persistent RPs as at least one RP at 5, 20 and 56 months. At the mean age of 25.4 years (SD= 0.6), the participants donated saliva samples for cortisol at awakening, 15 and 30 min thereafter, 10:30 am, at noon, 5:30 pm, and at bedtime during one day. We used mixed model regressions, and generalized linear models for testing the associations, controlling for important covariates.
Results:
Of the 308 children, 61 (19.8%) had multiple or persistent RPs in early childhood: 38 had multiple, and 27 had persistent RPs. Persistent RPs were associated with significantly higher cortisol peak and output in the waking period, and cortisol awakening response. On the other hand, multiple RPs were not associated with salivary cortisol.
Conclusion:
Children displaying persistent RPs throughout early childhood show, over two decades later, increased HPA axis activity in response to awakening stress. This may be one physiological mechanism linking early childhood RPs to adulthood behavioural outcomes