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Protocol for a cluster randomised controlled trial comparing structured Follow-up And Monitoring Of new Users of NHS hearing aids to usual care: The FAMOUS Trial
Get PDFBackground: Hearing loss is a prevalent condition that impacts on social, mental and physical health, and has a significant economic burden. Hearing aids can improve the quality of life for those living with hearing loss; however, low and inconsistent use remains common. Within the National Health Service (NHS), follow-up care for new hearing aid users is highly variable and often lacks structure, which may contribute to low use. The FAMOUS trial investigates whether a structured care model for follow-up, combined with evidence-based behaviour change interventions, improves hearing aid use compared to usual care. Methods: FAMOUS is a multi-centre, two-arm parallel-group cluster randomised controlled trial (CRCT) with integral internal pilot, economic, and process evaluations. The trial involves 36 NHS audiology services and compares two types of follow-up for new adult hearing aid users: structured care, which includes personalised action plans, early monitoring, and routine follow-up at 6weeks post-fitting, to usual care, which includes the offer of a follow-up 6–12weeks after fitting. Recruitment is conducted through participating services over 3 months, with pseudo-anonymised routine data collected from electronic medical records of all patients who attend. Consent and outcomes are then collected from patients at 12weeks post-fitting. For patients who provide consent to future contact, the primary outcome (self-reported daily hearing aid use) is collected at 12months post-fitting. Secondary outcomes (quality-of-life (QoL), hearing-related disability, and economic measures) are collected at both timepoints. Qualitative interviews with a subset of patients and hearing professionals in the intervention arm will assess the acceptability and implementation of the intervention. Statistical analyses, including mixed-effects regression modelling, will be conducted under an intention-to-treat framework. Discussion: FAMOUS addresses a critical evidence gap regarding the potential benefits of follow-up care for new hearing aid users. If the intervention is successful, it can be rolled out nationally using existing facilities with limited impact on resources, identified in the economic analysis, and would improve hearing aid use and quality of life for those living with hearing loss. Trial registration: Prospectively registered with the International Standard Randomised Controlled Trial Number (ISRCTN) 10589817.Date of registration: 01/09/2022
Patient perception of a community - based thumb osteoarthritis group: A qualitative service evaluation
No full textIntroduction: Base of thumb osteoarthritis (OA) is a common degenerative condition, causing pain, stiffness, weakness and functional limitations. Most patients initially present to their GP. It is important that patients have timely access to therapy interventions. A base of thumb OA group was established within a U.K. inner-city location, as part of a community musculoskeletal therapy service. The group aligned with international clinical guidelines, providing a treatment package including exercise, educational advice and behaviour change strategies. Methods: A prospective qualitative service evaluation was undertaken, with an aim of understanding patients’ experiences and views about the base of thumb OA group. Focus groups were undertaken with six patient participants and were recorded, transcribed and analysed thematically. Results: Participants were positive about the impact of the group on self-management of their condition. Participants recognised the complex nature of base of thumb OA and felt that the group provided holistic support. Participants expressed a need for long term support. From a practical perspective participants described some lack of clarity regarding the clinical pathway and referral routes and a lack of support during the waiting period. Participants expressed a preference for face-to-face care delivery. Discussion: Participants appeared supportive of the base of thumb OA group. It appears that such groups can be delivered in a community setting. Some practical service design and delivery lessons were learned. Further research would expand this relatively small scale, pragmatic service evaluation
NSAID ingestion augments training‐induced muscle hypertrophy and differentially affects muscle mRNA expression, but not strength gains, in trained men
Get PDFNon-steroidal anti-inflammatory drugs (NSAIDs) are widely overused in sports. The temporal effects of combined NSAID consumption and resistance exercise training (RET) on muscle cross-sectional area (CSA), volume and targeted mRNA transcripts (n = 93) were quantified. Seventeen trained males (24.5 ± 1.1 years, body mass index (BMI) 24.2 ± 0.7 kg/m2) consumed either placebo (PLA; n = 8) or diclofenac (75 mg, NSAID; n = 9) daily for 12 weeks and performed 3×30 maximal, isokinetic knee extensions in the non-dominant leg (90°/s) thrice each week. Quadriceps muscle CSA and volume were measured at baseline, 28 days and 84 days (3T MRI). Vastus lateralis biopsies were obtained at baseline, 24 h, 7 days, 28 days and 84 days for mRNA abundance measurements (RT-PCR microfluidic cards). Work output throughout RET was no different between groups. Muscle CSA was increased from baseline in both groups at 28 days (PLA 4.3 ± 2.5%, P = 0.039; NSAID 4.6 ± 3.7%, P = 0.011), but only in the NSAID group at 84 days (PLA 3.9 ± 0.8%, NSAID 8.6 ± 5.3%; P < 0.001; NSAID vs. PLA, P = 0.038), and was paralleled by muscle volume changes. RET increased isometric strength (∼40%–50%), but gains were no different between groups. Based on mRNA expression changes several cellular functions associated with muscle mass and metabolic regulation were altered in both groups throughout RET and were greater in NSAID at 28 and 84 days. NSAID intervention produced greater muscle hypertrophy than PLA, which occurred between 28 and 84 days of RET and was paralleled by more pronounced muscle mRNA changes. These collective events were not accompanied by greater strength gains, suggesting that using NSAIDs alongside RET may not be optimal for enhancing sports performance
Regression Discontinuity Designs in Epidemiology: A Practical Guide
Get PDFQuasi-experimental approaches are used routinely in clinical epidemiological research to enable causal treatment/intervention effect estimation from observational data. One such approach is the regression discontinuity design (RDD): a method to estimate a causal effect in situations when a treatment or intervention is assigned to individuals according to an externally defined decision rule, based on a continuous, individual-level “assignment variable”. RDDs were developed originally for use in econometrics but their use in clinical epidemiology is increasing, particularly with the widening availability of electronic health records and the use of rule-based treatment/intervention decisions. In particular, an RDD can be a useful method to assess the effectiveness of clinical decision making. In this paper, we provide an overview of the RDD, describing the method and key assumptions that permit its use in observational clinical data. We outline the common continuity-based and local randomisation RDDs and demonstrate how these can be fitted in both R and Stata. A worked example is presented of an RDD to estimate the treatment effect of statins on low density lipoprotein (LDL) cholesterol level, when statins are prescribed according to a rule based on a cardiovascular disease risk score
Long-term trends in obesity and overweight in women in Ghana from 2003–2023
Get PDFBackground: In Ghana, overweight and obesity prevalence among women (20-49 years) reached 50% in 2022, increasing from 40% in 2014. This study aims to understand what has driven previous trends in overweight and obesity among women of reproductive age in Ghana and to predict future trends that can help inform policy making and public health surveillance. Methods: We used data from the Ghana Demographic and Health Survey (DHS) containing information on women of reproductive age (aged 15 to 49 years). Data collected between 2003 and 2022 provided cohorts born between 1953 and 2007. Age-period-cohort (APC) analysis was used to disentangle the effects of age, time, and generation on trends in the odds of obesity and overweight. Results: The prevalence of overweight and obesity increases during the study period, especially with age, in all cohorts. In the APC analysis, the odds of obesity increase with age until age 42–43 years (odds ratio (OR): 9.37; 95% confidence interval (CI): 5.63–15.59, compared to 20–21 year olds) before levelling out. Accounting for age and birth cohort, the odds of overweight and obesity increase significantly over time between 2003 and 2015 (overweight OR: 1.76; 95% CI: 1.47–2.11, obesity OR: 2.27; 95% CI: 1.77–2.91), after which the effect levels out and appears to stabilise. There is no effect of birth cohort on the odds of overweight or obesity. Conclusions: Although high, the increasing odds of obesity and overweight in Ghana appears to be stabilising. However, the increasing odds of obesity with age, suggest that an ageing population could mean that the prevalence will increase into the future
‘Everyone Needs a Hug’: A Lifeworld-Led Approach to Recognise and Maintain the Person of Care Recipients Living With Advanced Dementia
Get PDFA most crucial aspect in dementia care is recognising and maintaining the person behind the dementia condition. Yet, it has been found that caring for people living with advanced dementia risk becoming mere techniques and undervaluing the significance of inter-embodied relationships. This can lead to that the unique person of those receiving the care becomes overlooked and undermined. Research suggests how the care recipients’ unique person fruitfully can be recognised via identifying humanising caring relations in their everyday lives. Thus, it is necessary to explore how formal caregivers engage in care that support people living with advanced dementia as human beings, which is the aim of this study. Following Galvin and Todres’ existential lifeworld-led approach to care, the lived experience of formal caregivers’ humanisation of their care recipients were explored through participant observations and semi-structured interviews at two nursing homes specialised in advanced dementia; both methods were granted ethical approval from a research ethics committee. Based on the lifeworld-led theory we found four ways within formal caregivers’ experience to be able to humanise care recipients living with advanced dementia, which can be described as: The continuity of self, The touch of the world, The kindred understanding, and The invisible bond. We argue that it is not enough just replicating such caring ways in order to deliver humanisation in advanced dementia care, but require of the caregiver to engage in a genuine human relation with those for whom they care. Such engagement in recognising and supporting the intrinsic humanness of the care recipient can guide a more humanly sensitive care practice that recognises and maintains the unique person behind the advanced dementia condition
The Effect of Educational and Economic Deprivation on Fairtrade Coffee and Chocolate Purchasing
Get PDFIntroduction & BackgroundEthical consumption has, generally, increased over the past 20 years in line with access to information. However, little research exists that explicitly ties access to information with ethical purchasing. What research does exist suggests a major obstacle to ethical purchasing is financial means, but this explanation leaves a “intention-behaviour gap” that is typically explained as a lack of moral motivation, but this may not be the case.Objectives & ApproachThe purpose of this study was to explore how key deprivation indicators, such as the Index of Multiple Deprivation (IMD), and IMD subdomains of Income and Education, affect one well-known, highly visible aspect of ethical purchasing: Fairtrade (specifically, chocolate and coffee products across all price points available in most stores). By utilising anonymised customer data from a major UK supermarket and mapping this data onto neighborhood-level deprivation scores, a probabilistic assessment of the effects of these areas of deprivation was carried out.Relevance to Digital FootprintsBy using transactional data from over 450,000 customer’s supermarket loyalty cards, this study shows how access to education may play a role in promoting ethical consumerism. This work was carried out with the goal of promoting a more environmentally and socially conscious type of consumption.ResultsOverall IMD and Income deprivation indices were inversely related to fairtrade purchasing up to the 5th decile of deprivation (i.e. most deprived areas purchased fewer Fairtrade products) before plateauing. Education deprivation showed an inverse relationship across all deciles, demonstrating that educational deprivation acts as a major predictor of Fairtrade purchasing even when the effect of income is kept separate. More educational access means more Fairtrade purchasing across coffee and chocolate products.Conclusions & ImplicationsThis analysis of real-world shopping data shows that educational deprivation, which can affect access to information, is a major factor that predicts ethical purchasing. Though we can’t infer causation, these findings suggest that organisations wishing to promote ethical consumption may benefit from addressing informational/educational roadblocks rather than assuming ethical consumption is just a problem of wealth and moral motivation
Flexibility from Medium Duration Energy Storage: Task 42 of the IEA Technology Collaboration Programme on Energy Storage
Get PDFAdrenal Aldosterone Synthase Expression Imaging in Primary Aldosteronism
Get PDFIn this pilot study, a method of imaging in primary aldosteronism was developed with the use of an aldosterone synthase (CYP11B2)–specific 18F-labeled radioligand for use with positron-emission tomography
Hyperpixels: pixel filter arrays of multivariate optical elements for optimized spectral imaging
Get PDFSpectral imaging systems are critical for revealing new information about the structure and composition of diverse samples, but traditional approaches that use generic ‘bandpass’ spectral filters are sub-optimal in challenging scenarios with low data signal-to-noise ratio (SNR). To address this, we introduce the concept of hyperpixels: a novel, compact, application-specific spectral filter array approach compatible with integration atop CMOS image sensors. Each element of a hyperpixel filter array is engineered to selectively transmit specific spectral components optimized for the target application, analogous to arrays of multivariate optical elements designed for analyte sensing. Hyperpixels achieve spectral tailoring through precise height engineering of multiple sub-pixel Fabry-Perot resonators covering each pixel area. Building on our earlier work exploring the feasibility of this approach, we present the first experimental validation of this concept. First, we develop a design framework based on matched filter theory and demonstrate its effectiveness by creating a set of 4 hyperpixels optimized to discriminate among 4 distinct spectral reflectance targets. Fabricated 2 × 2 arrays of hyperpixels are compared to optimal bandpass filter arrays through both spectral and imaging characterization. Our results demonstrate that hyperpixels outperform optimal bandpass filters in separating spectral components, achieving a 2.4× improvement in unmixing matrix condition number (p = 0.031) based on measured spectra, and a 3.47× reduction (p = 0.020) in condition number during imaging experiments. Importantly, simulations confirm that this advantage is robust even in the presence of significant fabrication errors. These findings demonstrate the superior spectral discrimination capability of hyperpixels over traditional approaches. With straightforward customization, scalable fabrication, and compatibility with CMOS sensors, hyperpixels offer a highly versatile solution for real-time imaging. Potential use cases include micro-endoscopy, capsule endoscopy, industrial inspection, and machine vision, where compact form factors and ability to handle low raw SNR are critical. Future improvements in design and fabrication will further enhance performance, enabling new possibilities for application-specific spectral imaging
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