Mean Number Of Participants Research Articles

Feasibility and Acceptability of a Physical Activity Group Program Using telerehabilitation during the COVID-19 Pandemic in Multiple early Intervention for Psychosis Services

BackgroundAlthough physical activity (PA) is beneficial to young people with early psychosis (YEP) to improve physical health and psychiatric symptoms, few YEP initiate and maintain PA. The sports group interventions offered in early psychosis services had to be suspended due to the COVID-19 pandemic. Telehealth has shown promising results in different fields of health services including for patients with mental health disorders. MethodsDescriptive retrospective study aiming to determine the feasibility and acceptability of a telekinesiology intervention among YEP and to describe its multicenter implementation. The PA sessions were delivered to YEP by a kinesiologist and peer support workers. Feasibility was measured by the number of programs approached which referred participants, and the proportion of referred YEP who participated to at least one PA session. Acceptability was measured by the proportion of participants who attended more than one PA session, the number of sessions attended per participant and by surveys on patient satisfaction. ResultsOf the 35 clinics approached, 150 YEP (of 214 referred) from 13 clinics participated to at least one of the 204 telekinesiology sessions (offered 2–3 times/week from May 2020 to May 2022) The mean number per participant was 5.5 sessions. 106 YEP engaged in more than one session (mean of 7.3 sessions per persistent participant). The mean number of participants per session was 4 (1−12). 99 % of the survey respondents were very satisfied/or satisfied with the sessions. ConclusionTelekinesiology appears to be an acceptable and feasible option to be implemented simultaneously in multiple early intervention services.

Anti-vascular endothelial growth factor for proliferative diabetic retinopathy.

Proliferative diabetic retinopathy (PDR) is an advanced complication of diabetic retinopathy that can cause blindness. It consists of the presence of new vessels in the retina and vitreous haemorrhage. Although panretinal photocoagulation (PRP) is the treatment of choice for PDR, it has secondary effects that can affect vision. Anti-vascular endothelial growth factor (anti-VEGF), which produces an inhibition of vascular proliferation, could improve the vision of people with PDR. To assess the effectiveness and safety of anti-VEGFs for PDR and summarise any relevant economic evaluations of their use. We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register; 2022, Issue 6); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov, and the WHO ICTRP. We did not use any date or language restrictions. We last searched the electronic databases on 1 June 2022. We included randomised controlled trials (RCTs) comparing anti-VEGFs to another active treatment, sham treatment, or no treatment for people with PDR. We also included studies that assessed the combination of anti-VEGFs with other treatments. We excluded studies that used anti-VEGFs in people undergoing vitrectomy. Two review authors independently selected studies for inclusion, extracted data, and assessed the risk of bias (RoB) for all included trials. We calculated the risk ratio (RR) or the mean difference (MD), and 95% confidence intervals (CI). We used GRADE to assess the certainty of evidence. We included 15 new studies in this update, bringing the total to 23 RCTs with 1755 participants (2334 eyes). Forty-five per cent of participants were women and 55% were men, with a mean age of 56 years (range 48 to 77 years). The mean glycosylated haemoglobin (Hb1Ac) was 8.45% for the PRP group and 8.25% for people receiving anti-VEGFs alone or in combination. Twelve studies included people with PDR, and participants in 11 studies had high-risk PDR (HRPDR). Twelve studies were of bevacizumab, seven of ranibizumab, one of conbercept, two of pegaptanib, and one of aflibercept. The mean number of participants per RCT was 76 (ranging from 15 to 305). Most studies had an unclear or high RoB, mainly in the blinding of interventions and outcome assessors. A few studies had selective reporting and attrition bias. No study reported loss or gain of 3 or more lines of visual acuity (VA) at 12 months. Anti-VEGFs ± PRP probably increase VA compared with PRP alone (mean difference (MD) -0.08 logMAR, 95% CI -0.12 to -0.04; I2 = 28%; 10 RCTS, 1172 eyes; moderate-certainty evidence). Anti-VEGFs ± PRP may increase regression of new vessels (MD -4.14 mm2, 95% CI -6.84 to -1.43; I2 = 75%; 4 RCTS, 189 eyes; low-certainty evidence) and probably increase a complete regression of new vessels (RR 1.63, 95% CI 1.19 to 2.24; I2 = 46%; 5 RCTS, 405 eyes; moderate-certainty evidence). Anti-VEGFs ± PRP probably reduce vitreous haemorrhage (RR 0.72, 95% CI 0.57 to 0.90; I2 = 0%; 6 RCTS, 1008 eyes; moderate-certainty evidence). Anti-VEGFs ± PRP may reduce the need for vitrectomy compared with eyes that received PRP alone (RR 0.67, 95% CI 0.49 to 0.93; I2 = 43%; 8 RCTs, 1248 eyes; low-certainty evidence). Anti-VEGFs ± PRP may result in little to no difference in the quality of life compared with PRP alone (MD 0.62, 95% CI -3.99 to 5.23; I2 = 0%; 2 RCTs, 382 participants; low-certainty evidence). We do not know if anti-VEGFs ± PRP compared with PRP alone had an impact on adverse events (very low-certainty evidence). We did not find differences in visual acuity in subgroup analyses comparing the type of anti-VEGFs, the severity of the disease (PDR versus HRPDR), time to follow-up (< 12 months versus 12 or more months), and treatment with anti-VEGFs + PRP versus anti-VEGFs alone. The main reasons for downgrading the certainty of evidence included a high RoB, imprecision, and inconsistency of effect estimates. Anti-VEGFs ± PRP compared with PRP alone probably increase visual acuity, but the degree of improvement is not clinically meaningful. Regarding secondary outcomes, anti-VEGFs ± PRP produce a regression of new vessels, reduce vitreous haemorrhage, and may reduce the need for vitrectomy compared with eyes that received PRP alone. We do not know if anti-VEGFs ± PRP have an impact on the incidence of adverse events and they may have little or no effect on patients' quality of life. Carefully designed and conducted clinical trials are required, assessing the optimal schedule of anti-VEGFs alone compared with PRP, and with a longer follow-up.

The Quality of Life of and Social Determinants Affecting Menopausal Women in Aseer's Healthy Cities in Saudi Arabia: A Cross-Sectional Study.

Introduction Menopause is an important period in a woman's life. It is the permanent cessation of menses for 12 months or more. Menopause can develop over a long period of time. The average age for menopause to start is 52 years, but it can begin at any time from age 40 to 58 years. Many symptoms are related to postmenopausal syndrome: hot flashes, irritability, mood swings, insomnia, dry vagina, difficulty concentrating, mental confusion, stress incontinence, urge incontinence, osteoporotic symptoms, depression, headache, and vasomotor symptoms. Quality of life (QOL) has been defined by the World Health Organization (WHO) as an "individual's perceptions of their position in life in the context of the cultural and value systems in which they live and in relation to their goals, expectations, standards, and concerns." Methods A cross-sectional study was conducted among participants from Aseer's Healthy Cities. The sample was calculated using the formula ofSwinscow and Cohen, and a total of 823 main cities were the target sample size. The sample was simply picked at random from October to December 2021. The Menopause Rating Scale (MRS)-related questionnaire is used to evaluatethe symptoms of menopause in people who answer the questions themselves. Result The study included 869 participants, 98.3% of which are Saudi nationals. Of the participants, 82.1% were married. As regards the lifestyle of the participants in the study, 69% live with a husband and children. The mean age of the study participants was 42.5 (standard deviation (SD):8.883) years. The mean number of participants with somatic vasomotor symptoms was 0.74 (SD: 94). The majority of the participants have sleep issues such as difficulty falling asleep, difficulty sleeping through the night, and waking up early (mean: 0.97, SD: 1.3), followed by hot flashes and sweating (mean: 0.65, SD: 1.165), and heart discomfort (mean: 0.63, SD: 12). Psychosocial symptoms are also common (mean: 0.95, SD: 1.16); the majority have depressive moods (mean: 1.09, SD: 1.35), followed byirritability (mean: 0.93, SD: 1.2), and anxiety (mean: 0.84, SD: 1.22). Physical symptoms are also prevalent, with a mean and SD of 0.91 and 1.03, respectively, with bladder problems having a mean and SD of 0.55 and 1.017, respectively. Finally, there were also sexual symptoms (mean: 0.70, SD: 1.09), with sexual problems having a mean and SD of 0.81 and 1.28, respectively. Conclusion The study found a high percentage of unawareness about menopause and a need to improve healthcare access and symptomatic treatment. The regression model of psychosocial risk factors is found to have a significant association with the increase of symptoms and using other medications for any reason, menstrual cycle pattern, and marital status.

Ensuring Superior Reporting of Non-Inferiority Radiotherapy Clinical Trials: A Systematic Review

<h3>Purpose/Objective(s)</h3> Non-inferiority clinical trials are used to investigate whether a new treatment is not worse than a control by an acceptable amount. These new treatments can be more convenient, cost-effective, or tolerable than the standard of care. Although the frequency of this trial design is increasing, the consistency of reporting and interpretation of these trials can vary. The aim of this systematic review was to assess the methodologic quality of non-inferiority radiotherapy clinical trials. <h3>Materials/Methods</h3> A literature search of PubMed, EMBASE and Cochrane databases of randomized controlled radiotherapy trials with non-inferiority hypotheses published in English between January 2000 and July 2021 was performed by an information scientist. Exclusion criteria included study protocols, and follow-up or interim analyses. Records were screened and full texts were reviewed by two authors with discrepancies settled by a third reviewer or by consensus. Descriptive statistics pertaining to study size, primary cancer type, type of comparison, endpoint, and statistical measures were performed. This review was prospectively registered on PROSPERO: CRD42021270644. <h3>Results</h3> Of 260 records identified on initial search, 44 (17%) trials were included after full-text review. The mean number of participants was 876 (IQR: 216.25–912.5). All were published after 2004, and open label. Four (9%) trials were funded by industry. The most common primary cancer type was breast (n=10, 23%). Most studies (n=37, 84%) had 2 treatment arms. The most common types of interventions included altered radiation fractionation (n=13, 30%) and changes to systemic therapy agents (n=10, 23%). Six (14%) studies compared radiation to another treatment modality (e.g., surgery, radiofrequency ablation), and 3 (7%) studies examined the omission of radiation. The most common primary endpoints were progression-free survival (n=12, 27%) and local/regional control (n=12, 27%). Forty (91%) studies reported the non-inferiority margin, and only 5 (11%) studies provided a statistical rationale for the margin. The median non-inferiority margin was 10% (IQR: 5–10%). Sample size calculation was reported in 42 (95%) studies, and 42 (95%) studies reported confidence intervals of the primary endpoint. Both intention-to-treat and per protocol analyses were reported in the majority (52%) of studies. In 23 (52%) trials, a non-inferiority claim of the primary endpoint was reached. <h3>Conclusion</h3> Clinical trials with a non-inferiority design are relatively uncommon in radiation oncology, and have been used for variable types of comparisons and primary endpoints. Standardization of required data to report and statistical methodology would be helpful to ensure proper interpretation of trial results.

Household expenditure of smokers and ex-smokers across socioeconomic groups: results from a large nationwide Australian longitudinal survey

BackgroundCountries with best practice tobacco control measures have experienced significant reductions in smoking prevalence, but socioeconomic inequalities remain. Spending on tobacco products, particularly by low-income groups can negatively affect expenditure on other goods and services. This study aims to compare the household expenditure of adults who smoke tobacco products and those who formerly smoked across socioeconomic groups.MethodsDaily smokers and ex-smokers were compared using the Household, Income and Labour Dynamics in Australia Survey, over 7 waves. Adults who never smoked were not included. Participants were continuing sample members across waves. Mean number of participants per wave was 2505, 25% were smokers and 75% ex-smokers. The expenditure variables investigated included tobacco products, alcohol, motor vehicle fuel, health practitioners, insurance, education, and meals eaten out. Regression models using the generalized estimating equation technique were employed to compare expenditure data aggregated across the waves by Socioeconomic Index for Areas (SEIFA) quintiles of relative socio-economic advantage/disadvantage while accounting for within-participant autocorrelation. Quintiles are ranked by information such as the income, occupation and access to material and social resources of the residents.ResultsSmokers from all quintiles spent significantly less per year on meals out, education and insurance than ex-smokers (p < 0.001). Smokers from quintiles 2–5 spent less on groceries, medicines, and health practitioners (p < 0.01). Smokers from quintiles 1 and 2 (most disadvantaged), spent less on motor vehicle fuel than ex-smokers ($280;95%CI: $126–$434), ($213;95%CI: $82–$344). Smokers from quintiles 2 and 3 spent more on alcohol ($212;95%CI: $86–$339), ($231.8;95%CI: $94–$370) than ex-smokers. Smokers from the least disadvantaged groups spent less on clothing than ex-smokers ($348;95%CI: $476–$221), ($501; 95%CI: $743–$258). Across the whole sample, smokers spent more than ex-smokers on alcohol ($230;95%CI:$95–$365) and less on meals out ($361;95%CI:$216–$379), groceries ($529;95%CI:$277–$781), education ($456;95%CI:$288–$624), medicine ($71;95%CI:$38–$104), health practitioners ($345;95%CI:$245–$444) and insurance ($318;95%CI:$229–$407).ConclusionsSmoking cessation leads to reallocation of spending across all socioeconomic groups, which could have positive impacts on households and their local communities. Less spending on alcohol by ex-smokers across the whole sample could indicate a joint health improvement associated with smoking cessation.

Does group-based trajectory modeling estimate spurious trajectories?

BackgroundGroup-based trajectory modelling (GBTM) is increasingly used to identify subgroups of individuals with similar patterns. In this paper, we use simulated and real-life data to illustrate that GBTM is susceptible to generating spurious findings in some circumstances.MethodsSix plausible scenarios, two of which mimicked published analyses, were simulated. Models with 1 to 10 trajectory subgroups were estimated and the model that minimized the Bayes criterion was selected. For each scenario, we assessed whether the method identified the correct number of trajectories, the correct shapes of the trajectories, and the mean number of participants of each trajectory subgroup. The performance of the average posterior probabilities, relative entropy and mismatch criteria to assess classification adequacy were compared.ResultsAmong the six scenarios, the correct number of trajectories was identified in two, the correct shapes in four and the mean number of participants of each trajectory subgroup in only one. Relative entropy and mismatch outperformed the average posterior probability in detecting spurious trajectories.ConclusionResearchers should be aware that GBTM can generate spurious findings, especially when the average posterior probability is used as the sole criterion to evaluate model fit. Several model adequacy criteria should be used to assess classification adequacy.

Process evaluation of a culturally tailored, mental health program for Vietnamese American dementia caregivers

AbstractBackgroundDementia caregivers (DCGs) have poorer mental health compared to the general population, but research on responding to those needs in culturally diverse populations such as Vietnamese American (VA) DCGs is limited. This study describes the process evaluation of a culturally tailored, evidence‐based skill‐building program, Our Family Journey (OFJ), to reduce stress and depression among VA DCGs in San Jose, California, USA.MethodWe examined process components (program fidelity, dose delivered, dose received, and reach) of an intervention for 60 VA DCGs who were randomly assigned to either the intervention, (OFJ; n=30) or to the control condition (written dementia caregiving information; n=30).ResultTranslated from a 6‐weeks evidence‐based program, the culturally tailored, Vietnamese OFJ was reduced to 4 weeks for optimal attendance and participation (program fidelity). Modifications in content and process were developed with input from the creator of OFJ and a large community‐based organization serving VAs. Cultural tailoring included delivering the program in Vietnamese, with material incorporating culturally appropriate values and activities. For example, pleasant activities included cooking Vietnamese food and doing karaoke rather than the original program’s emphasis on solitary activities (e.g., reading a book). Discussions about filial piety and stigma were included, as these topics were very relevant to VAs (program fidelity). All 4 sessions were conducted as planned for each of the six OFJ cohorts (mean number of participants per cohort was 4.8) (dose delivered and dose received). Accommodations were provided for DCGs as needed – e.g., when they could not attend a session, they were offered the make‐up session. A total of 112 interested persons contacted research staff; 88 were eligible to participate. Final enrollment was 60 caregivers (reach). Feedback from participants included: expanding eligibility criteria to include other family caregivers; incorporating more cultural aspects (e.g., spirituality); and expanding educational topics of interest to DCGs (e.g., age‐related health changes and transitions of care.)ConclusionThe OFJ program is the first randomized controlled trial of a culturally tailored evidence‐based intervention with VA DCGs in the US. Future research should replicate this promising program with suggested modifications to continue to meet the unmet needs of VA DCGs.

The Mystery of Remote Communality: University Students’ and Teachers’ Perceptions During the COVID-19 Pandemic

The aim of this study was to examine how the coronavirus disease (COVID-19) pandemic affected the communality among university personnel and students. Herein, we report the findings from a northern Finnish university in which student (mean number of participants, n = 339) and staff (mean number of participants, n = 133) perceptions and experiences were surveyed. The data (gathered between March 2020 and June 2021 in 7 surveys) included responses to questions about satisfaction with remote and hybrid work and communality. In addition, as the focus of the analysis in this research, we collected the participants’ descriptions of their experiences and thoughts through open-ended questions. The sense of communality among the students, students and teachers, and staff differed, but the appreciation for flexible interactions and availability was similar between the groups. This study discusses the importance of retaining a sense of communality during and after abnormal times on the basis of the reported findings.

The effectiveness of removal from exposure and reduction of exposure for managing occupational asthma: Summary of an updated Cochrane systematic review.

The objective was to update the 2011 Cochrane systematic review on the effectiveness of workplace interventions for the treatment of occupational asthma. A systematic review was conducted with the selection of articles and reports through 2019. The quality of extracted data was evaluated, and meta-analyses were conducted using techniques recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Data were extracted from 26 nonrandomized controlled before-and-after studies. The mean number of participants per study was 62 and the mean follow-up time was 4.5 years. Compared with continued exposure, removal from exposure had an increased likelihood of improved symptoms and change in spirometry. Reduction of exposure also had more favorable results for symptom improvement than continued exposure, but no difference for change in spirometry. Comparing exposure removal to reduction revealed an advantage for removal with both symptom improvement and change in spirometry for the larger group of patients exposed to low-molecular-weight agents. Also, the risk of unemployment was greater for exposure removal versus reduction. Exposure removal and reduction had better outcomes than continued exposure. Removal from exposure was more likely to improve symptoms and spirometry than reduction among patients exposed to low-molecular-weight agents. The potential benefits associated with exposure removal versus reduction need to be weighed against the potential for unemployment that is more likely with removal from exposure. The findings are based on data graded as very low quality, and additional studies are needed to generate higher quality data.

35. A SCOPING REVIEW ON RESIDENT POSTGRADUATE MEDICAL EDUCATION BOOT CAMPS

Background Studies have shown that brief learning experiences, or boot camps, may effectively improve residents to function at a basic level and improve confidence in early postgraduate training and are much more prominently published in the procedural specialties. In those studies, investigators have primarily focused on evaluating whether the boot camp improved clinical skills, knowledge, or confidence levels however, this focus on a survey evaluation methodology, limits the application of these findings in patient care outcomes. Therefore, we sought to assess differences in the setting, size, length, specialty and Kirkpatrick level of evaluation used in boot camps. Methods In consultation with a librarian, we conducted a scoping review on postgraduate boot camps published from 2008 to 2019. Inclusion criteria included boot camps focused on residents and in English language. Exclusion criteria included manuscripts describing boot camps for medical students, fellows, attending faculty, or interdisciplinary health care professionals. Investigators divided the articles equally. Descriptive statistics were used to analyze the data. Results 62/136 articles met criteria for inclusion. 44/62 (70.9%) occurred at a single site. The mean number of participants was 44.5 and the mean length of boot camp was 8.4 days (median = 3 days). Only one published article assessed pediatric residents (see Table 1 frequency of specialty). The highest level of Kirkpatricks level of evaluation that was assessed is as followed: Reaction, 15/62 (24.2%); Learning, 25/62 (40.3%); Behavior, 22/62 (35.5%); Results, 0/62. Conclusion Boot camps continue to primarily be published in procedural specialties, with only one article assessing pediatric residents. Also, investigators continue to report at Kirkpatrick evaluation levels of reaction, learning and behavior while never reporting at the level of results, or actual patient care outcomes. Our data stresses the importance of pediatric investigators to conduct, evaluate, and publish boot camps while striving to design these experiences to assess whether patient care is ultimately improved.

Can cognitive-motor training improve physical functioning and psychosocial wellbeing in nursing home residents? A randomized controlled feasibility study as part of the PROCARE project.

A multi-component training program holds promises for the elderly, but still has to be tested on its feasibility and effect in nursing homes. The aim of this study was (1) to design a multi-component training program which improves physical functioning and psychosocial wellbeing and (2) to evaluate the feasibility of this intervention in nursing home residents. This study is a two-arm, stratified-randomized controlled feasibility trail. Twenty-four nursing home residents (aged 83.7 ± 6.4, 21 women) were divided into an intervention and a waiting-list control group. The intervention group completed a multi-component training (including dual-task, dynamic balance, endurance and strength exercises) for 16weeks (twice per week for 45-60min). Primary outcomes were lower extremity functionality (SPPB), gait performance (GAITRite), health-related quality of life (SF-12) as well as life satisfaction (SWLS). Life satisfaction (SWLS) and physical functioning (SPPB) increased in the intervention group after training whereas the control group showed a decrease. Gait parameters could only be analyzed for n = 5 participants of the intervention group and n = 2 of the control group and showed no time differences for the intervention group. The mean number of participants was 12.5 ± 1.9 per session (attendance ranged between 66% and 90%). A multi-component training seems (1) to lead to clinically relevant improvements in physical functioning as well as in psychosocial wellbeing and (2) to be feasible and well accepted in nursing home residents. Nevertheless, the complexity and progression of the program as well as the testing protocol have to be adapted. Further research should test the effectiveness of this adapted program in a larger sample size.

Glauber model for a small system using the anisotropic and inhomogeneous density profile of a proton

Recent studies reveal that at high energies, collisions of a small system such as $p+p$ gives signatures similar to that widely observed in heavy ion collisions hinting toward the possibility of forming a medium with collective behavior. With this motivation, we have used the Glauber model, which is traditionally applied to heavy ion collisions, in a small system using the anisotropic and inhomogeneous density profile of a proton and found that the proposed model reproduces the charged particle multiplicity distribution of $p+p$ collisions at LHC energies very well. Collision geometric properties such as the mean impact parameter, the mean number of binary collisions ($⟨{N}_{\mathrm{coll}}⟩$), and the mean number of participants ($⟨{N}_{\mathrm{part}}⟩$) at different multiplicities are determined. Having estimated $⟨{N}_{\mathrm{coll}}⟩$, we have calculated the nuclear modificationlike factor (${R}_{\mathrm{HL}}$) in $p+p$ collisions. We also estimated eccentricity and elliptic flow as a function of charged particle multiplicity using the linear response to the initial geometry.

Athens as a Major Congress Destination and the Role of Professional Congress Organizers (PCOs)

The aim of this study was to investigate the factors that contribute to the attraction of major congress events in Athens, Greece and the role of professional congress organizers (PCOs) in this process. To meet this aim we used a questionnaire distributed through Google Forms to 30 PCO executives in the major Athens area. The questionnaire used qualitative and quantitative methods and contained both open and closed answer questions. Results showed that most PCOs organize local events with medical congresses being the main activity (96.7%). The vast majority of PCO’s use the social media or digital marketing to approach clients (with Facebook being the principal tool, 89.7%), as only 33.3% of the Greek PCOs can afford to participate as exponents to major congress tourism exhibitions worldwide because of their small size and limited resources. This means that the role of PCOs in the attraction of major congress events in Athens is limited. Additionally, PCOs revealed that most congresses organized in Athens last only 1-2 days (74%), with a mean number of participants on average about 300 people. Respondents also think that Athens can become a major congress tourism destination as it has certain advantages (good congress infrastructure, excellent weather, priceless archaeological sites, a unique sea front, night life, good shopping places and opportunities for short excursions) that need to be exploited, as well as the Athens Visitor &amp; Conventions Bureau of which they share a positive view. The current study shows that conjoint efforts of the state, the private sector and certain congress tourism stakeholders are needed (adopting advanced development strategies and using intensive marketing tools, including ambassador programs and adequate bidding processes) in order for Athens to attract international congress events and be established as a major congress tourism destination.

Investigating system-level drivers of obesity with adolescents: a group model-building exercise

BackgroundCapturing voices of young people on issues that affect them is crucial for developing effective, relevant public health policies. We report the use of group model building with young people to identify their views on drivers of adolescent obesity. This is the first stage of the Co-Create project, designed to develop—with adolescents—potential interventions to reduce obesity prevalence. MethodsCo-Create uses an innovative, participatory, multi-staged methodology, underpinned by a systems approach. We followed a group model building script to generate causal loop diagrams, with 16-18-year-olds from three UK schools (mean number of participants per school 14), of factors perceived to contribute to diet and physical activity and, therefore, obesity. Schools were recruited using a sampling frame to represent three quartiles from the index of multiple deprivation ranking of local authorities. FindingsAll causal loop diagrams showed that participants identified advertising, the low cost of and easy access to unhealthy food, social media, lack of physical activity, and stress, body image, and other mental health factors as drivers of diet and physical activity and, therefore, obesity. There were no notable differences in themes between the causal loop diagrams. InterpretationUse of group model building, a participatory systems methodology, captures obesity drivers pertinent to young people, the ways these drivers are intertwined, and potential leverage points for action. This process creates a helpful abstraction from individual behaviour by drawing out system-level, rather than individual, drivers of obesity, although findings are limited to the perceptions of participants and these results represent only urban environments. The results from this first stage of the Co-Create project help generate system-level hypotheses on policy responses to obesity that resonate with young people. In subsequent Co-Create workstreams, adolescents will be recruited to explore interventions to be discussed with policy makers and other stakeholders. The potential effects of the co-created, obesity-related interventions will be simulated using systems dynamics modelling. FundingEU Horizon 20/20 research and innovation programme for Sustainable Food Security (grant agreement 774210).

Meet the Expert on Rare Cancer - Social Contribution by Rare Cancer Center -

Abstract Background The difficulty in obtaining the latest information on diseases is a challenge of rare cancer care. Rare Cancer Center began hold seminar sessions entitled: Meet the Expert on Rare Cancer (MtE) through collaboration with CancerNet Japan and Oncolo since 2017. During these sessions, doctors with expertise as lecturers explain each type of rare cancer, with the latest information. Each session is video-recorded and shared through video-streaming on a website. A total of 35 MtE sessions were held with cooperation from more than 20 patient support groups. Methods A questionnaire survey was conducted examine the details of the 35 MtE sessions held within the 2-year period between 2017 and 2018. The study items included: the contents of lectures, number and types of participants, sex ratio, and satisfaction with the seminar. Results The total number of participants during the study period was 1,230. The mean number of participants was 35/session (range: 17 53). Participants were mainly patients (41%) and their families (35%). The most frequent reason for participating in the seminar was to learn about the newest treatment method (66%), followed by to obtain accurate information (65%), and then to collect information regarding rare cancers, which is not sufficiently available (65%) Among all participants, 92% were satisfied with the seminar. The total number of views of the videos (31 sessions) already published online was 54,107 as of December 2018. Conclusion The results confirmed that the seminar providing information on rare cancers is markedly needed. As the number of video-streaming views was nearly 50 times larger than that of participants, there may also be a marked potential need for such seminars. As a future perspective, measures effectively transmit more beneficial and useful information regarding rare cancers will be examined by analyzing responses this questionnaire and video-streaming view frequencies.

Evidence of chronic stroke rehabilitation interventions in activities and participation outcomes: systematic review of meta-analyses of randomized controlled trials.

Stroke is a leading cause of long-term disabilities worldwide. A great deal of meta-analyses of randomized controlled trials (RCTs) address rehabilitation in chronic stroke, several of them with focus on activities and participation, considered critical outcomes of successful rehabilitation. Nevertheless, substantial heterogeneity might exist between studies, the reported associations may be causal, but they might also be flawed, as inherent study biases such as residual confounding and selective reporting of positive results may exaggerate the effect of interventions in chronic phase. Furthermore, most RCTs might focus on specific rehabilitation domains, not paying the same attention to others. Formal evaluation of published systematic reviews of meta-analyses (January 2008 to November 2018) of rehabilitation in chronic phase to 1) assess the strength of evidence: participants, publication biases, heterogeneity, prediction intervals (PIs) 2) grade the evidence to perform qualitative analysis on effects sizes and heterogeneity, 3) perform meta-regressions and sensitivity analysis on relevant covariates 4) map outcomes to activities and participation domain of the World Health Organization's International Classification of Functioning, Disability and Health (ICF). Systematic review on meta-analyses of RCTs addressing activities and participation will be performed in Medline, Web of Science, Scopus, Cochrane and Google Scholar. A total of 97 meta-analyses on 31 different rehabilitation interventions involving 25,275 participants were included. Thirty-nine meta-analyses (40.74%) reported statistically significant findings (P<0.05) in both fixed and random effects sizes. Their magnitude was small in 62.96% cases, moderate in 19.75% and large in 17.28%. Heterogeneity was low in 48,48%, moderate and high in 21.2%. The mean number of participants is 815, far away from the convincing, highly suggestive, or suggestive required evidence levels. All PIs include the null value. Mobility is addressed by 87% of the identified meta-analyses, with 75% of them focusing exclusively in mobility. The findings of this study show a clear need for high quality RCTs examining the effectiveness of rehabilitation interventions addressing activities and participation. The ICF framework may contribute to a holistic approach in chronic stroke rehabilitation, including not only motor functioning but also the ability to participate in everyday life activities.

Emoji-based Live Polling During Weekly Incident Report Review Meetings Reveals Wide Ranging Emotions Among Staff

Just culture is crucial for effective patient safety. Key components of just culture include flattening of hierarchy and open communication. Little is known about the real-time emotional states of staff members during live-review of patient safety incident reports, which may impact these key cultural components. Emojis are an efficient and effective way to communicate emotional states and are ubiquitous in modern telecommunication. We used an emoji-based real-time survey to characterize staff emotions and correlate them to specific features of incident reports. We developed a web-based live polling tool using emojis representing a modified version of Ekman’s basic emotions (happiness, sadness, embarrassment, anger, surprise, disgust, impatience, fear, and confusion). To report emotions, staff selected emojis on their mobile devices during discussion of each near-miss incident during weekly incident report review meetings. Participants were blinded to poll results and included physicians, medical physicists, dosimetrists, radiation therapists, and nurses. Staff position, incident severity, and potential contributing factors discussed in the meeting were recorded independently. Univariate analysis was performed to analyze the relationship between reporting staff position, severity, contributing factors, and reported emotions. All non-happy emotions were considered negative. Fifty-four incident reports were discussed during 5 consecutive weekly incident report review meetings. The mean number of participants per poll was 6 and the average number of reported emotions during each event was 3. Participants most commonly reported feeling happy with the discussion (59%). Only 13% of reports had an unanimous emotional response. There was no association between reported emotion and reporting staff position (p=0.72) or severity of safety event (p=0.81). Certain contributing factors were enriched in incident reports with more negative emotions. Incidents that had >50% negative emotions were more likely to be associated with patient delays (21%), patient setup (17%), and simulation (17%). The most common contributing factor to error was communication (25% overall), but it was not associated with more negative emotions (p=0.2). An emoji-based live poll found that staff report a wide range of emotions while reviewing incident reports. Staff most commonly reported negative emotions for particular categories of incidents, specifically patient setup, simulation, and delays, even though these were not the most common type of incident. Emoji-based surveys may be a helpful tool to identify emotionally negative subjects which can then be addressed in a positive collaborative manner, improving just and safety culture.

Multidisciplinary approach for preventing skeletal-related events in patients with bone metastasis

The prognosis of patients with bone metastasis remains poor. Preventing the development of skeletal-related events (SRE) is essential for maintaining quality of life (QoL). For the purpose of improving QoL, we have performed the multidisciplinary conference for preventing SRE in patients with metastatic bone disease. We here introduce the system and show our conference results. After CT, MRI, RI, and PET/CT scans were surveyed every 2 weeks, a radiologist identified patients who have a high risk of SRE such as fractures. For such cases, treatment strategies were then discussed on the conference in which medical oncologist, radiologists, pathologists, palliative care physician, orthopedists, nurses, and physical therapists take part. After discussion, the treatment strategy including radiotherapy, orthopedic surgery, chemotherapy, and/or observation, was reported to the attending physician. Mean number of participants in each conference was 18. The conference has been held 21 and 37 times in 2015 and 2016, and we discussed 38 and 46 cases in 2015 and 2016, respectively. According to tumor diagnosis, we discussed 21 cases of the lung, 20 of the urinary tract, 8 of the breast, 8 of the gastrointestinal and the colorectal tract, 8 of the head and neck, 5 of unknown primary, 4 of the liver or the bile duct, 2 of the gynecological cancers, 2 of melanoma, and so on. The conference seems to contribute to reduce the frequency of SRE development. A multidisciplinary approach is strongly advocated for preventing SRE and improving QoL in patients with bone metastasis. In addition, we should promote it in not only our institutions but also community medicine.

Femtoscopy in = 5.02 TeV p-Pb collisions with ATLAS

Bose-Einstein correlations between identified charged pions are measured for p+Pb collisions at = 5.02 TeV with the ATLAS detector using a total integrated luminosity of 28 nb−1. Pions are identified using ionisation energy loss measured in the pixel detector. Two-particle correlation functions and the extracted source radii are presented as a function of average transverse pair momentum (kT) and rapidity () as well as collision centrality. Pairs are selected with a rapidity −2 < < 1 and with an average transverse momentum 0.1 < kT < 0.8 GeV. The effect on the two-particle correlation function from jet fragmentation is studied, and a new method for constraining its contributions to the measured correlations is described. The measured source sizes are substantially larger in more central collisions and are observed to decrease with increasing pair kT. A correlation with the local single-particle multiplicity dNch/dy* is demonstrated. The scaling of the extracted radii with the mean number of participants is also used to compare a selection of initial-geometry models. The cross term Rol, which couples radial and longitudinal expansion, is measured as a function of rapidity, and a departure from zero is observed with 4.8 σ combined significance for > −1 in the most central events.

Femtoscopy in √SNN= 5.02 TeVp-Pb collisions withATLAS

Bose-Einstein correlations between identified charged pions are measured for p +Pb collisions at √S NN = 5.02 TeV with the ATLAS detector using a total integrated luminosity of 28 nb−1 . Pions are identified using ionisation energy loss measured in the pixel detector. Two-particle correlation functions and the extracted source radii are presented as a function of average transverse pair momentum (k T ) and rapidity (y ππ *) as well as collision centrality. Pairs are selected with a rapidity −2 ππ * T T . A correlation with the local single-particle multiplicity dN ch /dy * is demonstrated. The scaling of the extracted radii with the mean number of participants is also used to compare a selection of initial-geometry models. The cross term R o1 , which couples radial and longitudinal expansion, is measured as a function of rapidity, and a departure from zero is observed with 4.8 σ combined significance for y ππ * > −1 in the most central events.