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Researchers’ perspectives on methodological challenges and outcomes selection in interventional studies targeting medication adherence in rheumatic diseases: An OMERACT-Adherence study
No full textBackground: Research on adherence interventions in rheumatology is limited by methodological issues, particularly heterogeneous outcomes. We aimed to describe researchers’ experiences with conducting interventional studies targeting medication adherence in rheumatology and their perspectives on establishing core outcomes.Methods: Semi-structured interviews using audio conference were conducted with researchers who had conducted an adherence study of any design in the past 10 years. Data collection and thematic analysis were performed iteratively, until saturation. Results: We interviewed 13 researchers, most of whom worked in academia and specialized in epidemiology and/or health services research. We identified three themes: 1) improving measurement of adherence (considering all phases of adherence, using appropriate and relevant measures, and establishing clinically meaningful thresholds); 2) challenges in designing and appraising adherence intervention studies (considering the confusion over a plethora of outcomes, difficulties with powering studies to demonstrate meaningful changes, and suboptimal descriptions of adherence interventions in published studies); and 3) advancing outcome assessment in adherence intervention studies (capturing rationale for developing a core domain set as well as recommendations and anticipated challenges by participants). Conclusions: Uniquely gathering perspectives from international adherence researchers, our findings led to researcher-informed recommendations for improving adherence research including specifying the targeted adherence phase in designing interventions and studies and providing a glossary of terms to promote consistency in reporting. We also identified recommendations for developing a core domain set for interventional studies targeting medication adherence including involvement of patients, clinicians, and other stakeholders and methodological and practical considerations to establish rigor and support uptake. <br/
ERS Clinical Practice Guidelines on Treatment of Sarcoidosis
No full textBackground: The major reasons to treat sarcoidosis are to lower the morbidity and mortality risk or to improve quality of life (QoL). The indication for treatment varies depending on which manifestation is the cause of symptoms: lungs, heart, brain, skin, or other manifestations. While glucocorticoids (GC) remain the first choice for initial treatment of symptomatic disease, prolonged use is associated with significant toxicity. GC-sparing alternatives are available. The presented treatment guideline aims to provide guidance to physicians treating the very heterogenous sarcoidosis manifestations.Materials and methods A European Respiratory Society Task Force (TF) committee composed of clinicians, methodologists, and patients with experience in sarcoidosis developed recommendations based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) methodology. The committee developed eight PICO (Patients, Intervention, Comparison, Outcomes) questions and these were used to make specific evidence-based recommendations.Results The TF committee delivered twelve recommendations for seven PICOs. These included treatment of pulmonary, cutaneous, cardiac, and neurologic disease as well as fatigue. One PICO question regarding small fiber neuropathy had insufficient evidence to support a recommendation. In addition to the recommendations, the committee provided information on how they use alternative treatments, when there was insufficient evidence to support a recommendation.Conclusions There are many treatments available to treat sarcoidosis. Given the diverse nature of the disease, treatment decisions require an assessment of organ involvement, risk for significant morbidity, and impact on QoL of the disease and treatment
Micromechanical testing of a thermally grown oxide on a MCrAlY coating
No full textThe stiffness and fracture toughness of a thermally grown oxide (TGO) on a MCrAlY coating were measured by the microcantilever bending technique. TGO cantilevers were prepared by a focused ion beam and bent in-situ by a nanoindenter in a scanning electron microscope. The Young’s modulus and fracture toughness of the TGO were determined to be 352 GPa and 4.4 MPa·m1/2, respectively. The measurement results were compared with mechanical properties of the TGOs and bulk α-Al2O3 ceramics reported in the literature to develop a mechanistic understanding of the microstructural features governing the stiffness and fracture toughness of the TGO
Reduced microbial stability in the active layer is associated with carbon loss under alpine permafrost degradation
No full textClimate warming has led to extensive permafrost degradation, potentially inducing massive soil carbon loss. However, microbially mediated mechanisms responsible for carbon loss from the active layer in degraded permafrost remain unclear. Thus, we investigated how soil microbial communities in the active layer respond to permafrost degradation and influence carbon storage in alpine ecosystems of the Qinghai-Tibet Plateau. Our results reveal that severe degradation of permafrost increased bacterial and fungal dissimilarities and reduced bacterial and archaeal community richness. Microbial community stability also declined, as evidenced by increased microbial community sensitivity to environmental change and a prevalence of destabilizing properties of microbial networks. It was estimated that the increase in microbial dissimilarity was associated with amplified soil organic carbon loss in severely-degraded permafrost. Overall, our study implies significant changes in microbial diversity and stability of the active layer in alpine ecosystems under permafrost degradation, with potential implications for carbon-climate feedbacks
Therapeutic support for young people with learning difficulties: what enables effective practice?
No full textSupporting children and young people’s mental health is a central aim of United Kingdom (UK) government policy, with those with learning difficulties a particularly vulnerable group. This systematic review of research uses published literature to explore how access and participation in therapy might be facilitated for young people with learning difficulties. Twelve studies published 2000-2019 were identified, which described the experiences of access to, and participation in therapy for people with learning difficulties, although notably most of these involved adults. Findings indicated eight themes: pre-therapy, careful contracting, therapy is hard, idiosyncratic needs, therapeutic relationship, group therapy, reviewing therapy and it changed my life. These were organised into three chronological stages: setting up of therapy; therapeutic processes and therapeutic outcomes. A number of strategies that can promote access and participation are suggested for professionals working therapeutically with young people with learning difficulties, around contracting, clear communication, the therapeutic alliance, and the ending of therapy
Members of Parliament are minimally accountable for their issue stances (and they know it)
No full textFor incumbents to be accountable for their issue stances, voters must sanction incumbents whose positions are ‘out of step’ with their own. We test the electoral accountability of British legislators for their stance on Brexit. We find that there is very limited issue accountability. Individuals who disagreed with their representative’s stance on Brexit were three percentage points less likely to vote for them. The aggregate consequences of these individual effects are limited. A one-standard deviation increase in the proportion of constituents agreeing with their incumbent’s Brexit stance is associated with an increase of 0.56 percentage points in incumbent vote share. These effects are ~1.5 times larger when the main challenger has a different Brexit stance to the incumbent. A follow-up survey of Members of Parliament (MPs) shows that MPs’ estimates of the effects of congruence are similar in magnitude. Our findings suggest that issue accountability is conditional in nature and limited in magnitude even for an issue such as Brexit which shouldbe maximally amenable to such effects
The Philosophical Basis of Seeing and Touching Structural Concepts
No full textStructural concepts are fundamentals of civil engineering for students to learn, for lecturers to teach and for engineers to use. Many students however find it difficult to understand structural concepts due to their abstract nature. Seeing and Touching Structural Concepts has been developed as an approach to help civil engineering students gain intuitive (without the need for analysis) understanding of structural concepts taking them from structural elements to whole structures and from theory to practice. The paper explains the philosophical basis of the approach which involves the fundamental ideas and principles underlying the approach and its evolution. This has included the development of over 60 physical models produced in pairs, one with and one without involving a structural concept, to illustrate the effects and the significance of the structural concepts. Over 70 associated cases using structural concepts creatively have been identified from engineering practice. A website, www.structuralconcepts.org, has been developed and two associated books have been published in English and Chinese. Five criteria underpinning the approach of Seeing and Touching Structural Concepts are expressed as Seeking new connections, Exploring new meanings, Evolving into intuitive understanding, Making wide and creative applications and Simplicity (SEEMS), which are demonstrated using examples and synthesised case studies
Comparison of continuous sampling with active noise cancellation and sparse sampling for cortical and subcortical auditory fMRI
No full textPurpose: Detecting sound-related activity using fMRI requires the auditory stimulus to be more salient than the intense background scanner acoustic noise. Various strategies can reduce the impact of scanner acoustic noise including “sparse” temporal sampling with single/clustered acquisitions providing intervals without any background scanner acoustic noise, or active noise cancellation (ANC) during “continuous” temporal sampling which generates an acoustic signal that adds destructively to the scanner acoustic noise substantially reducing the acoustic energy at the participant’s eardrum. Further, multiband fMRI allows multiple slices to be collected simultaneously, thereby reducing scanner acoustic noise in a given sampling period. Methods: 1.5mm isotropic multiband fMRI with sparse sampling (effective TR 9,000ms, acquisition duration 1,962ms) and continuous sampling (TR 2,000ms) with ANC were compared in 15 normally hearing participants. A sustained broadband noise stimulus was presented to drive activation of both sustained and transient auditory responses within subcortical and cortical auditory regions Results: Robust broadband noise-related activity was detected throughout the auditory pathways. Continuous sampling with ANC was found to give a statistically significant advantage over sparse sampling for the detection of the transient (onset) stimulus responses particularly in auditory cortex (p<0.001) and inferior colliculus (p<0.001), whereas gains provided by sparse over continuous ANC for detecting offset and sustained responses were marginal (p~0.05 in superior olivary complex, inferior colliculus, medial geniculate body, and auditory cortex). Conclusions: Sparse and continuous ANC multiband fMRI protocols provide differing advantages for observing the transient (onset and offset) and sustained stimulus responses
DEATHSTAR: Nearby AGB stars with the Atacama Compact Array II. CO envelope sizes and asymmetries:The S-type stars
No full textAims.We aim to constrain the sizes of, and investigate deviations from spherical symmetry in, the CO circumstellar envelopes (CSEs)of 16 S-type stars, along with an additional 7 and 4 CSEs of C-type and M-type AGB stars, respectively.Methods. We map the emission from the CO J = 2–1 and 3–2 lines observed with the Atacama Compact Array (ACA) and its totalpower (TP) antennas, and fit with a Gaussian distribution in the uv- and image planes for ACA-only and TP observations, respectively.The major axis of the fitted Gaussian for the CO(2–1) line data gives a first estimate of the size of the CO-line-emitting CSE. Weinvestigate possible signs of deviation from spherical symmetry by analysing the line profiles, the minor/major axes ratio obtainedfrom visibility fitting, and by investigating the deconvolved images.Results. The sizes of the CO-line-emitting CSEs of low-mass-loss-rate (low-MLR) S-type stars fall between the sizes of C-stars,which are larger, and M-stars, which are smaller, as expected due to the dierences in their respective CO abundances and thedependence of the photodissociation rate on this quantity. The sizes of the low-MLR S-type stars show no dependence on circumstellardensity, as measured by the ratio of the MLR to terminal outflow velocity, irrespective of variability type. The density dependencesteepens for S-stars with higher MLRs. While the CO(2–1) brightness distribution size of the low-density S-stars is in general smallerthan the predicted photodissociation radius (assuming the standard interstellar radiation field), the measured size of a few of the highdensitysources are of the same order as the expected photodissociation radius. Furthermore, our results show that the CO CSEs ofmost of the S-stars in our sample are consistent with a spherically symmetric and smooth outflow. For some of the sources, clear andprominent asymmetric features are observed which are indicative of intrinsic circumstellar anisotropy.Conclusions. As the majority of the S-type CSEs of the stars in our sample are consistent with a spherical geometry, the CO envelopesizes obtained in this paper will be used to constrain detailed radiative transfer modelling to directly determine more accurate MLRestimates for the stars in our sample. For several of our sources that present signs of deviation from spherical symmetry, further highresolution observations would be necessary to investigate the nature and the physical processes behind these asymmetrical structures.This will provide further insight into the mass-loss process and its related chemistry of S-type AGB stars
