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Are we working (too) comfortably?:The systematic development of an intervention to support workers to move more while working at home
No full textBackgroundCovid-19 accelerated a transformational change in working practices, with a considerable proportion of desk-based workers now engaged in home or hybrid working. Working at home appears to exacerbate the already elevated levels of unhealthy occupational sedentary behaviour, and there is a need to support employees to reduce sedentary behaviour while working at home. The aim of this study was to develop an intervention to support employees to reduce sedentary behaviour when working at home utilising the novel integration of the Six Steps in Quality Intervention Development (6SQuID) and Behaviour Change Wheel (BCW) intervention development frameworks.MethodsWe report on 6SQuID steps 1-5, with the Capability, Opportunity and Motivation influence on Behaviour (COM-B) model integrated into steps 1-4, providing a theoretical organising framework. In step 4, the intervention functions and behaviour change technique elements of the BCW were used to accurately and consistently specify the active ingredients of the intervention. The test and refine phase of 6SQuID (step 5) evaluated the acceptability of elements of the intervention with a sample of Scottish Government employees.ResultsThe causal factors for employee sedentary behaviour while working at home were delineated, and theory of change/action models were constructed. Intervention components were developed to address causal factors and presented as a toolkit on an online platform. These comprised: 1) education on sedentary behaviour, 2) resources to aid intention formation and action planning, 3) strategies to increase movement, and 4) suggestions for support from colleagues/friends/family. Strategies aimed at line managers and organisations to support employees and create an organisational culture that enables employees to move more were also developed. The acceptability testing demonstrated the value of the toolkit format incorporating a suite of strategies, and feedback informed refinement of the toolkit.ConclusionsThis study addresses the urgent need to support employees to reduce sedentary behaviour while working at home. Using the novel application of integrated intervention development frameworks, a comprehensive intervention toolkit has been formulated and preliminarily tested. The toolkit comprises strategies and resources for employees, line managers and organisations. Further feasibility and effectiveness testing with a larger sample is recommended prior to large-scale implementation
Janus kinase (JAK) inhibitor-induced acne in inflammatory bowel disease – an international, multicenter, retrospective cohort study:JAK inhibitor-induced acne
Get PDFBackground and Aims:JAK inhibitor-associated acne is a common but poorly understood adverse event. This study aimed to investigate the epidemiology, clinical characteristics, and treatment outcomes of this condition in patients with inflammatory bowel disease (IBD).Methods:This international, multicenter, retrospective cohort study consecutively enrolled JAK-inhibitor-treated IBD patients who subsequently developed acne. The primary objective was to evaluate the clinical characteristics of acne. Secondary objectives included determining acne prevalence, impact on quality of life, and anti-acne treatment effectiveness.Results:Among 2,183 JAK inhibitor-treated patients with IBD, 272 developed acne. The crude prevalence rates of acne were 15.9% for upadacitinib, 4.3% for tofacitinib, and 1.9% for filgotinib, with dose-dependent relationships observed for upadacitinib and tofacitinib. Acne predominantly affected patients aged 30–50 years; most cases were mild-moderate in severity. A prior history of acne vulgaris was associated with significantly increased odds of developing severe JAK inhibitor–associated acne (OR 4.88, 95% CI 2.88–31.7;p=0.0003) and acne-related skin complications (OR 3.92, 95% CI 1.56–10.11;p=0.004). One-third of patients reported a negative psychosocial impact, and 40% received pharmacological intervention. Eighteen percent of patients who developed acne required JAK inhibitor dose reduction or discontinuation, although most did not have severe disease.Conclusion:This is the first study characterizing this adverse event in JAK inhibitor-treated IBD patients and presents the largest cohort of JAK inhibitor-induced acne cases across all immune-mediated diseases. Acne is a common adverse effect resulting in significant psychological burden. Early identification, proactive counseling, and timely interventions, such as dose reduction or referral to dermatology, are crucial in managing this side effect
Traders, coins and authority in the eleventh-century Rhineland:The toll tariff of Koblenz
Get PDFTolls imposed on trade represent an important point of intersection between trade, coined money, and authority. In this chapter, I re-examine one of the earliest and most detailed post-Roman toll tariffs, the toll tariff of Koblenz in the Rhineland, which was first put into writing in the eleventh century. I argue that the distinction this tariff draws between tolls levied in kind and tolls levied in coin reflect not different zones of monetisation, as previously suggested, but rather the practicalities of how the toll was imposed at different moments in the merchant trading cycle. However, this sensitivity to market considerations was embedded within a particularist, negotiated and non-market logic of extraction that dominated the Koblenz toll as a whole
Managing menopause transition in the workplace:The double-edged sword of flexible work
Get PDFDespite a growing body of literature around menopause at work, our understanding of how menopause symptoms may impact employees over time is limited. Using a longitudinal sample of 679 cis-women, we predicted that the changes in the severity of psychological and physical menopause symptoms would lead to changes in burnout and perceived job performance over a period of six months. Drawing from resource theories, we further explored whether the usefulness of flexible work may moderate these relationships. Our findings showed that women who experienced greater intensification of menopause symptoms experienced an increase in burnout, and women whose symptoms became less intense experienced a decrease in burnout. We also found that those who considered flexible work more useful, experienced a positive change in their perceived job performance, despite suffering from the intensified physical symptoms. Those who perceived such flexible work to be less useful, however, did not exhibit a significant change in their performance over time. In-depth qualitative findings on a sub-sample of 53 women provided nuanced explanations for these results, including exposing a double-edged sword of working flexibly to manage menopause symptoms and potentially detrimental unintended consequences of flexible work during menopause transition
Association of maternal epilepsy with perinatal outcomes, and an exploration of prenatal antiseizure medication: a population-based retrospective cohort study
Get PDFObjective(s): Pregnancy in women with epilepsy is associated with adverse perinatal outcomes, but debate remains as to role of epilepsy and or of prenatal antiseizure medication (ASM). We aimed to investigate the association between maternal epilepsy and perinatal outcomes, and explore the role of prenatal ASM exposure. Methods: Retrospective population-based cohort study using linked routinely-collected health data (Scotland, 2009-2021). We included women with at least one singleton pregnancy. Our exposures included (1) maternal epilepsy, identified using International Classification of Disease Code 10; (2). prenatal ASM, defined as dispensed within the prenatal period. We conducted multi-level multiple regressions accounting for covariates and multiple pregnancies comparing: 1) women with (WWE) and without epilepsy (WWoE), 2) all pregnancies exposed and unexposed to prenatal ASM, 3) Individual prenatal ASM monotherapy vs without ASM.Results: 629,200 pregnancies occurred 2009-2021 (WWE=2,022, WWoE=627,178; with ASM=4,406, without ASM-=624,794). WWE had increased odds of preterm birth, induced labour, caesarean section, preeclampsia, neonatal intensive care unit admission, low birthweight, and 5-minute Apgar score <7. In fully adjusted models, only induced labour aOR 1.17 [95CI 1.02, 1.34] remained associated. Compared to women without ASM, those with ASM had increased odds of preterm birth aOR 1.47 [95CI 1.25, 1.74], induced labour 1.38 [1.25, 1.52], caesarean section 1.14 [1.01, 1.27], neonatal congenital conditions 1.34 [1.04, 1.73], neonatal intensive care unit admission 1.54 [1.33, 1.78], and low birth weight 1.41 1.47 [1.23, 1.75]. Increased odds were also observed for specific ASM monotherapies. Significance: Maternal epilepsy is associated with many adverse perinatal outcomes, but most are driven by prenatal ASM exposure. We postulate joint comprehensive care between obstetricians and epileptologists or other specialists who prescribe ASMs could improve perinatal outcomes. Research into models of care and prescribers and the effect on outcomes is needed. <br/
Confidence, Competence and Cadavers : Improving Self Perception of Practice through Practical Teaching
Get PDFPractical sessions using cadavers are one method of teaching clinical skills en-masse to veterinary students, supporting students to learn the skills and gain the confidence to become Day One Competent Veterinarians. As Confidence and Competence are often conflated in Competence Based Education (CBE) approaches, in this study we used a Pre Post survey design to evaluate 67 student self-ratings of Confidence and Self-Assessed Competence to explore whether a cadaver practical can change student Confidence and Self-Assessed Competence, and how comparable Confidence and Self-Assessed Competence are as measures. In linear mixed effects model, we found that the Practical improved the Overall Confidence score by 0.44 points (95% CI [0.22, 0.66], t(120) = 3.97, p < .001). Self Assessed Competence also increased by 0.60 (95% CI [0.41, 0.79], t(118) = 6.21, p < .001), however, although female students saw their Overall Self-Assessed Competence increase, they showed lower Self Assessed Competence scores by 0.87 points than males (95% CI [- 1.47, -0.28], t(118) = -2.89, p = 0.005). Despite Confidence and Self-Assessed Competence being strongly associated, direct agreement between the measures in a Weighted Kappa test was weak (Pre Practicalweighted = 0.49, [95% CI 0.33, 0.66], Post Practical,weighted = 0.44, [95% CI 0.10, 0.28]). We discuss the implications of these findings
Calcium carbonate deposition in the spicules of the sponge Heteropia glomerosa (Porifera, Calcarea)
Get PDFWe investigated the biomineralization process of calcium carbonate deposition in the spicules of the calcareous sponge Heteropia glomerosa (Porifera, Calcarea). The finely polished spicules, composed of Mg-calcite, present a pattern of concentric lines spaced 400 nm apart when observed by scanning electron microscopy. We showed by electron backscattered diffraction that the whole spicule length has the same crystallographic orientation. Still, misorientation of up to 1.8° in adjacent regions (∼ 2 µm) and a continuous increase in the misalignment of up to 4.5° in regions separated by 300 µm were present. The sponge cells (mainly sclerocytes and pinacocytes) near the mineralization zone contain a high number of vesicles rich in calcium, which could be involved in the spicule biomineralization. We showed by electron and ion microscopies that the spicule growth occurs through the addition calcium carbonate granules, which form near the membrane of the sclerocyte, the cell responsible for biomineralization. The granules were deposited layer by layer on the surface of the spicule, increasing the biomineral thickness. Domains of 1–3 µm containing facets partially connected and surrounded by organic material were observed in an intermediate stage of the spicule growth. Misorientation between these domains was approximately 2°, similar to the misorientation obtained by electron backscattered diffraction, indicating that the spicule is formed by the addition of granules fusing in a predominant orientation
Increased risk of recurrent stroke in patients with impaired kidney function:results of a pooled analysis of individual patient data from the MICON international collaboration
Get PDFBACKGROUND: Patients with chronic kidney disease are at increased risk of stroke and frequently have cerebral microbleeds. Whether such patients also encounter an increased risk of recurrent stroke has not been firmly established. We aimed to determine whether impaired kidney function is associated with the risk of recurrent stroke, and microbleed presence, distribution and severity.METHODS: We used pooled data from the Microbleeds International Collaborate Network to investigate associations of impaired kidney function, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m 2. Our primary outcome was a composite of recurrent ischaemic stroke (IS) and intracranial haemorrhage (ICrH). Secondary outcomes included: (1) individual components of the primary outcome; (2) modification of the primary outcome by microbleed presence or anticoagulant use and (3) microbleed presence, distribution and severity. RESULTS: 11 175 patients (mean age 70.7±12.6, 42% female) were included, of which 2815 (25.2%) had impaired kidney function. Compared with eGFR ≥60, eGFR <60 was associated with a higher risk of the primary outcome (adjusted HR, aHR 1.33 (95% CI 1.14 to 1.56), p<0.001) and higher rates of the recurrent IS (aHR 1.33 (95% CI 1.12 to 1.58)). Reduced eGFR was not associated with ICrH risk (aHR 1.07 (95% CI 0.70 to 1.60)). eGFR was also associated with microbleed presence (adjusted OR, aOR 1.14 (95% CI 1.03 to 1.26)) and severity (aOR 1.17 (95% CI 1.06 to 1.29)). Compared with having no microbleeds, eGFR was lower in those with strictly lobar microbleeds (adjusted mean difference (aMD) -2.10 mL/min/1.73 cm 2 (95% CI -3.39 to -0.81)) and mixed microbleeds (aMD -2.42 (95% CI -3.70 to -1.15)), but not strictly deep microbleeds (aMD -0.67 (95% CI -1.85 to 0.51)). CONCLUSIONS: In patients with IS or transient ischaemic attack, impaired kidney function was associated with a higher risk of recurrent stroke and higher microbleeds burden, compared with those with normal kidney function. Further research is needed to investigate potential additional measures for secondary prevention in this high-risk group.</p
Multicenter, retrospective determination of the clinical utility of screening tests in dogs with immune-mediated hemolytic anemia in the United Kingdom and Ireland
Get PDFBACKGROUND: Potential triggers of immune-mediated hemolytic anemia (IMHA) are often identified, but their frequency and the benefit of extensive screening for these to individual dogs is uncertain.OBJECTIVE: To assess the frequency of non-associative IMHA in dogs undergoing screening in Britain and Ireland and identify where specific tests could be beneficial.ANIMALS: Two hundred twenty-two client-owned dogs with IMHA.METHODS: Multicenter, retrospective cohort study of dogs with IMHA. Medical records and blood, urine, imaging, and pathology reports were reviewed. Cases were assessed for associative IMHA, and multivariable analysis was performed to define those.RESULTS: Associative IMHA was present in 73/222 (33%) dogs. Diagnoses included toxic (24/222, 11%); infectious (17/222, 8%); neoplastic (16/222, 7%) and non-infectious inflammatory (13/222, 6%) conditions. A further 102 dogs (46%) had a finding most likely incidental, with no pertinent findings in 47/222 (21%) dogs. Associative IMHA was more likely as patients aged (odds ratio 1.108 per year, 95% CI: 1.012-1.218, p = 0.03).CONCLUSIONS AND CLINICAL IMPORTANCE: The benefit of extensive diagnostic screening and implication of detected abnormalities remains uncertain for individual dogs with IMHA in Britain and Ireland. However, older dogs are more likely to have pertinent findings after a diagnosis of IMHA.</p
Tuning ProteinMPNN to reduce protein visibility via MHC Class I through direct preference optimization
Get PDFProteinMPNN is widely used in protein design workflows due to its ability to identify amino acid sequences that fold into specific 3D protein structures. In our work, we adjust ProteinMPNN to design proteins for a given 3D protein structure with reduced immune-visibility to cytotoxic T lymphocytes that recognize proteins via the MHC-I pathway. To achieve this, we developed a novel framework that integrates direct preference optimization (DPO)—a tuning method originally designed for large language models—with MHC-I peptide presentation predictions. This approach fosters the generation of designs with fewer MHC-I epitopes while preserving the protein’s original structure. Our results demonstrate that DPO effectively reduces MHC-I visibility without compromising the structural integrity of the proteins
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