Who benefits most from participating in chronic disease self-management programs?

Objectives: To quantify the benefits that people receive from participating in self-management courses and identify subgroups that benefit most.
Research Design: People with a wide range of chronic conditions attending self-management courses (N=1,341 individuals) were administered the generic Health Education Impact Questionnaire (HEI-Q). Data were collected before the first session (baseline) and at the end of courses (follow-up) resulting in 842 complete responses. The median (interquartile range) age was 64 (54 to 73) years and most participants were female (75%). Outcomes were categorized as Substantial improvement (Effect Size, ES ≥ 0.5), Minimal/No change (ES -0.49 to 0.49) and Substantial decline (ES ≤ -0.5).
Results: On average, one third of participants reported substantial benefits after attending a self-management course. Proportions of participants reporting substantial benefits ranged from 49% in Skill and technique acquisition to 27% in Health service navigation. Stratification by gender, age and education showed that younger participants were more likely to benefit, particularly young women. No further subgroup differences were observed.
Conclusions: Given that the health of people with chronic diseases tends to decline, this evaluation is reassuring in that about one third of participants coming from a wide range of backgrounds receive substantial improvements in their self-management skills.

A parallel-group, randomised controlled trial of a multimedia, self-directed, coping skills training intervention for patients with cancer and their partners: design and rationale

Introduction:

The development of a conceptual model and self-reported measure of occupational health and safety vulnerability

Injuries at work have a substantial economic and societal burden. Often groups of labour market participants, such as young workers, recent immigrants or temporary workers are labelled as being "vulnerable" to work injury. However, defining groups in this way does little to enable a better understanding of the broader factors that place workers at increased risk of injury. In this paper we describe the development of a new measure of occupational health and safety (OH&S) vulnerability. The purpose of this measure was to allow the identification of workers at increased risk of injury, and to enable the monitoring and surveillance of OH&S vulnerability in the labour market. The development included a systematic literature search, and conducting focus groups with a variety of stakeholder groups, to generate a pool of potential items, followed by a series of steps to reduce these items to a more manageable pool. The final measure is 29-item instrument that captures information on four related, but distinct dimensions, thought to be associated with increased risk of injury. These dimensions are: hazard exposure; occupational health and safety policies and procedures; OH&S awareness; and empowerment to participate in injury prevention. In a large sample of employees in Ontario and British Columbia the final measure displayed minimal missing responses, reasonably good distributions across response categories, and strong factorial validity. This new measure of OH&S vulnerability can identify workers who are at risk of injury and provide information on the dimensions of work that may increase this risk. This measurement could be undertaken at one point in time to compare vulnerability across groups, or be undertaken at multiple time points to examine changes in dimensions of OH&S vulnerability, for example, in response to a primary prevention intervention.

A pilot, multisite, randomized controlled trial of a self-directed coping skills training intervention for couples facing prostate cancer : accrual, retention, and data collection issues

PURPOSE: To examine the acceptability of the methods used to evaluate Coping-Together, one of the first self-directed coping skill intervention for couples facing cancer, and to collect preliminary efficacy data. METHODS: Forty-two couples, randomized to a minimal ethical care (MEC) condition or to Coping-Together, completed a survey at baseline and 2 months after, a cost diary, and a process evaluation phone interview. RESULTS: One hundred seventy patients were referred to the study. However, 57 couples did not meet all eligibility criteria, and 51 refused study participation. On average, two to three couples were randomized per month, and on average it took 26 days to enrol a couple in the study. Two couples withdrew from MEC, none from Coping-Together. Only 44 % of the cost diaries were completed, and 55 % of patients and 60 % of partners found the surveys too long, and this despite the follow-up survey being five pages shorter than the baseline one. Trends in favor of Coping-Together were noted for both patients and their partners. CONCLUSIONS: This study identified the challenges of conducting dyadic research, and a number of suggestions were put forward for future studies, including to question whether distress screening was necessary and what kind of control group might be more appropriate in future studies.

Impact of sport context and support on the use of a self-report measure for athlete monitoring

Athlete self-report measures (ASRM) are a popular method of athlete monitoring in high-performance sports. With increasing recognition and accessibility, ASRM may potentially be utilized by athletes from diverse sport contexts. The purpose of the present study was to improve understanding of ASRM implementation across different sport contexts by observing uptake and compliance of a newly implemented ASRM over 16 weeks, and investigating the perceived roles and factors influencing implementation. Athletes (n=131) completed an electronic survey at baseline and week 16 on their perceptions and experiences with ASRM implementation respectively. Despite initial interest, only 70 athletes attempted to use the ASRM. Of these athletes, team sport athletes who were supported by their coach or sports program to use the ASRM were most compliant (p < 0.001) with a mean compliance of 84 ± 21 %. Compliance for self-directed individual and team sport athletes was 28 ± 40 % and 8 ± 18 % respectively. Self-directed athletes were motivated to monitor themselves, and rated desired content and minimal burden as key factors for initial and ongoing compliance. Supported athletes were primarily motivated to comply for the benefit of their coach or sports program rather than themselves, however rated data output as a key factor for their continued use. Factors of the measure outweighed those of the social environment regardless of sport context, however the influence of social environmental factors should not be discounted. The findings of the present study demonstrate the impact of sport context on the implementation of an ASRM and the need to tailor implementation strategies accordingly. Key pointsAthletes perceive ASRM and the factors influencing implementation differently. Therefore, to encourage compliance, it is important to tailor implementation strategies to the athlete and their sport context to increase appeal and minimize unappealing factors.Athletes using an ASRM on their own accord typically favor a measure which meets their needs and interests, with minimal burden.Athletes using an ASRM under the direction and support of their coach or sports program typically favor feedback and a positive social environment.

Scalar bosons in minimal and ultraminimal technicolor: Masses, trilinear couplings, and widths

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Semi-synthetic minimal cells: Biochemical, physical, and technological aspects

The construction of synthetic cells is one of the major goals of bioengineering. The most successful approach consists in the encapsulation of biochemical materials (DNA, RNA, enzymes, etc.) inside lipid vesicles (liposomes), mimicking a cell structure. In this contribution, that also aims at introducing the reader to 'chemical synthetic biology,' we describe the current state of the art of 'semi-synthetic minimal cells' (SSMCs), namely, cell-like structures containing the minimal number of biological compounds that are required to reconstruct a function of interest. We will first describe how the concept of the minimal cell was originated and its relation with the theory of autopoiesis, then we review the most advanced results focused on genetic/metabolic networks inside liposomes. Next, we emphasize that relevance of physical aspects (too often neglected) that impact on the solute entrapment process, and finally we discuss new technological trends in SSMC research that will probably allow their future use in biotechnology. © 2013 Copyright © 2013 Elsevier Inc. All rights reserved.

Design of custom-shaped vascularized tissues using microtissue spheroids as minimal building units

Tissue engineering strategies are gathering clinical momentum in regenerative medicine and are expected to provide excellent opportunities for therapy for difficult-to-treat human pathologies. Being aware of the requirement to produce larger artificial tissue implants for clinical applications, we used microtissues, produced using gravity-enforced self-assembly of monodispersed primary cells, as minimal tissue units to generate scaffold-free vascularized artificial macrotissues in custom-shaped agarose molds. Mouse myoblast, pig and human articular-derived chondrocytes, and human myofibroblast (HMF)-composed microtissues (microm3 scale) were amalgamated to form coherent macrotissue patches (mm3 scale) of a desired shape. Macrotissues, assembled from the human umbilical vein endothelial cell (HUVEC)-coated HMF microtissues, developed a vascular system, which functionally connected to the chicken embryo's vasculature after implantation. The design of scaffold-free vascularized macrotissues is a first step toward the scale-up and production of artificial tissue implants for future tissue engineering initiatives.

Clean intermittent self-catheterization: a burden for the patient?

AIM: To assess patients' perception of clean intermittent self-catheterization (CISC) for voiding dysfunction. PATIENTS AND METHODS: A total of 101 patients performing CISC because of voiding dysfunction were invited to participate in this questionnaire survey. The response rate was 91% (92/101). RESULTS: The mean time over which CISC was performed was 5 years (standard deviation (SD) +/- 6.3) and the mean frequency of CISC per day was three times (SD +/- 2). Almost 80% (72/92) of the patients perceived CISC as easy or very easy and CISC did not interfere at all or interfered a little bit with work or other regular daily activities in more than 80% (76/92). Almost 90% (80/92) reported no or minimal pain while performing CISC. This did not interfere at all or interfered a little bit with work or other regular daily activities in almost 90% (80/92). Quality of life improved considerably due to CISC in more than 60% (56/92) and 12% (11/92) complained of a deterioration. In multivariable analysis, severe pain performing CISC (odds ratio 20.9, 95% confidence interval 1.7-259.9, P = 0.018) was the only factor that predicted poor quality of life. CONCLUSIONS: The majority of patients considered CISC to be an easy and painless procedure which did not interfere with daily activities. Consequently, quality of life improved in more than 60% of the patients. Therefore, CISC does not appear to be a burden for the patient and, from a patient's perspective, can be recommended.

Internet-Based Guided Self-Help for Several Anxiety Disorders: A Randomized Controlled Trial Comparing a Tailored With a Standardized Disorder-Specific Approach

Internet-delivered self-help with minimal therapist guidance has shown promising results for a number of diagnoses. Most of the evidence comes from studies evaluating standardized disorder-specific treatments. A recent development in the field includes transdiagnostic and tailored Internet-based treatments that address comorbid symptoms and a broader range of patients. This study evaluated an Internet-based tailored guided self-help treatment, which targeted symptoms of social anxiety disorder, panic disorder with or without agoraphobia, and generalized anxiety disorder. The tailored treatment was compared both with standardized disorder-specific Internet-based treatment and with a wait-list control group. Both active treatment conditions were based on cognitive-behavioral therapy and lasted for 8 weeks. A total of 132 individuals meeting diagnostic criteria for at least one of the anxiety disorders were randomly assigned to 1 of the 3 conditions. Both treatment groups showed significant symptom reductions as compared with the wait-list control group on primary disorder-unspecific measures of anxiety, depression, and general symptomatology and on secondary anxiety disorder-specific measures. Based on the intention-to-treat sample, mean between-group effect sizes were d = 0.80 for the tailored treatment and d = 0.82 for the standardized treatment, versus wait-list controls. Treatment gains were maintained at 6-month follow-up. No differences were found between the 2 active treatment conditions on any of the measures, including a telephone-administered diagnostic interview conducted at posttreatment. The findings suggest that both Internet-based tailored guided self-help treatments and Internet-based standardized treatments are promising treatment options for several anxiety disorders

An examination of spirituality, self efficacy, and smoking cessation among adults in Houston, Texas

Over the past decade there has been a growing interest in the association between spirituality and health outcomes. Little is known about the role of spirituality among adult smokers who are motivated to stop smoking. The purpose of this dissertation is to examine the relations among immutable individual differences, spirituality, and self efficacy among adults motivated to stop smoking. The first paper of this dissertation systematically reviewed literature to measure the concordance between spirituality and smoking status among adults in the United States. The second paper of this dissertation explored the association between spirituality and smoking cessation. We hypothesized that higher levels of spirituality were positively associated with smoking cessation. The third paper of this dissertation examined the association between perceived self efficacy and spirituality. We hypothesized that both high levels of self efficacy and spirituality were positively associated with smoking cessation.^ A total of 152 citations were identified based on the preliminary search of databases and reference lists. After a preliminary title- and abstract-based review, 17 full text articles were retrieved for further assessment. Of these, eight met the criteria for inclusion. Results of the systematic review suggest that there is inconsistent evidence to support or refute an association between spirituality and smoking status among adults.^ Smokers (N = 200) at least 18 years of age enrolled in a minimal contact smoking cessation intervention in Houston, Texas completed questionnaires. To examine our hypotheses we conducted cross-sectional analyses of responses to questions included in selected baseline questions and the final in-person visit three weeks post-quit day. Results of the logistic regression analyses indicated that individuals with higher levels of spirituality and self efficacy were significantly more likely to abstain from smoking. The positive association is also evident when controlling for employment, income, race, education, and nicotine dependence. The interaction between self efficacy and spirituality was not statistically significant in predicting smoking abstinence.^ Recommendations for future research and implications for smoking cessation interventions are discussed. Further research in this area would benefit from using standard measures of abstinence, recruiting larger and more diverse populations, and using longitudinal study designs.^

Harmony: Towards automated self-adaptive consistency in cloud storage

In just a few years cloud computing has become a very popular paradigm and a business success story, with storage being one of the key features. To achieve high data availability, cloud storage services rely on replication. In this context, one major challenge is data consistency. In contrast to traditional approaches that are mostly based on strong consistency, many cloud storage services opt for weaker consistency models in order to achieve better availability and performance. This comes at the cost of a high probability of stale data being read, as the replicas involved in the reads may not always have the most recent write. In this paper, we propose a novel approach, named Harmony, which adaptively tunes the consistency level at run-time according to the application requirements. The key idea behind Harmony is an intelligent estimation model of stale reads, allowing to elastically scale up or down the number of replicas involved in read operations to maintain a low (possibly zero) tolerable fraction of stale reads. As a result, Harmony can meet the desired consistency of the applications while achieving good performance. We have implemented Harmony and performed extensive evaluations with the Cassandra cloud storage on Grid?5000 testbed and on Amazon EC2. The results show that Harmony can achieve good performance without exceeding the tolerated number of stale reads. For instance, in contrast to the static eventual consistency used in Cassandra, Harmony reduces the stale data being read by almost 80% while adding only minimal latency. Meanwhile, it improves the throughput of the system by 45% while maintaining the desired consistency requirements of the applications when compared to the strong consistency model in Cassandra.

Peptide interfacial adsorption is kinetically limited by the thermodynamic stability of self association

We present a study of the adsorption of two peptides at the octane–water interface. The first peptide, Lac21, exists in mixed monomer–tetramer equilibrium in bulk solution with an appreciable monomer concentration. The second peptide, Lac28, exists as a tetramer in solution, with minimal exposed hydrophobic surface. A kinetic limitation to interfacial adsorption exists for Lac28 at moderate to high surface coverage that is not observed for Lac21. We estimate the potential energy barrier for Lac28 adsorption to be 42 kJ/mol and show that this is comparable to the expected free energy barrier for tetramer dissociation. This finding suggests that, at moderate to high surface coverage, adsorption is kinetically limited by the availability of interfacially active monomeric “domains” in the subinterfacial region. We also show how the commonly used empirical equation for protein adsorption dynamics can be used to estimate the potential energy barrier for adsorption. Such an approach is shown to be consistent with a formal description of diffusion–adsorption, provided a large potential energy barrier exists. This work demonstrates that the dynamics of interfacial adsorption depend on protein thermodynamic stability, and hence structure, in a quantifiable way.

Raw data of SCADCP (self-contained Acoustic Doppler Current Profiler) from three moorings in the Eastern Weddell Sea, 2005-2008

The success of any efforts to determine the effects of climate change on marine ecosystems depends on understanding in the first instance the natural variations, which contemporarily occur on the interannual and shorter time scales. Here we present results on the environmental controls of zooplankton distribution patterns and behaviour in the eastern Weddell Sea, Southern Ocean. Zooplankton abundance and vertical migration are derived from the mean volume backscattering strength (MVBS) and the vertical velocity measured by moored acoustic Doppler current profilers (ADCPs), which were deployed simultaneously at 64°S, 66.5°S and 69°S along the Greenwich Meridian from February, 2005, until March, 2008. While these time series span a period of full three years they resolve hourly changes. A highly persistent behavioural pattern found at all three mooring locations is the synchronous diel vertical migration (DVM) of two distinct groups of zooplankton that migrate between a deep residence depth during daytime and a shallow depth during nighttime. The DVM was closely coupled to the astronomical daylight cycles. However, while the DVM was symmetric around local noon, the annual modulation of the DVM was clearly asymmetric around winter solstice or summer solstice, respectively, at all three mooring sites. DVM at our observation sites persisted throughout winter, even at the highest latitude exposed to the polar night. Since the magnitude as well as the relative rate of change of illumination is minimal at this time, we propose that the ultimate causes of DVM separated from the light-mediated proximal cue that coordinates it. In all three years, a marked change in the migration behaviour occurred in late spring (late October/early November), when DVM ceased. The complete suspension of DVM after early November is possibly caused by the combination of two factors: (1) increased availability of food in the surface mixed layer provided by the phytoplankton spring bloom, and (2) vanishing diurnal enhancement of the threat from visually oriented predators when the illumination is quasi-continuous during the polar and subpolar summer. Zooplankton abundance in the water column, estimated as the mean MVBS in the depth range 50-300 m, was highest end of summer and lowest mid to end winter on the average annual cycle. However, zooplankton abundance varied several-fold between years and between locations. Based on satellite and in situ data of chlorophyll and sea ice as well as on hydrographic measurements, the interannual and spatial variations of zooplankton mean abundance can be explained by differences in the magnitude of the phytoplankton spring bloom, which develops during the seasonal sea ice retreat. Whereas the vernal ice melt appears necessary to stimulate the blooming of phytoplankton, it is not the determinator of the blooms magnitude, its areal extent and duration. A possible explanation for the limitation of the phytoplankton bloom in some years is top-down control. We hypothesise that the phytoplankton spring development can be curbed by grazing when the zooplankton had attained high abundance by growth during the preceding summer.

Quantifying short-term dynamics of Parkinson's disease using self-reported symptom data from an internet social network

Background: Parkinson’s disease (PD) is an incurable neurological disease with approximately 0.3% prevalence. The hallmark symptom is gradual movement deterioration. Current scientific consensus about disease progression holds that symptoms will worsen smoothly over time unless treated. Accurate information about symptom dynamics is of critical importance to patients, caregivers, and the scientific community for the design of new treatments, clinical decision making, and individual disease management. Long-term studies characterize the typical time course of the disease as an early linear progression gradually reaching a plateau in later stages. However, symptom dynamics over durations of days to weeks remains unquantified. Currently, there is a scarcity of objective clinical information about symptom dynamics at intervals shorter than 3 months stretching over several years, but Internet-based patient self-report platforms may change this. Objective: To assess the clinical value of online self-reported PD symptom data recorded by users of the health-focused Internet social research platform PatientsLikeMe (PLM), in which patients quantify their symptoms on a regular basis on a subset of the Unified Parkinson’s Disease Ratings Scale (UPDRS). By analyzing this data, we aim for a scientific window on the nature of symptom dynamics for assessment intervals shorter than 3 months over durations of several years. Methods: Online self-reported data was validated against the gold standard Parkinson’s Disease Data and Organizing Center (PD-DOC) database, containing clinical symptom data at intervals greater than 3 months. The data were compared visually using quantile-quantile plots, and numerically using the Kolmogorov-Smirnov test. By using a simple piecewise linear trend estimation algorithm, the PLM data was smoothed to separate random fluctuations from continuous symptom dynamics. Subtracting the trends from the original data revealed random fluctuations in symptom severity. The average magnitude of fluctuations versus time since diagnosis was modeled by using a gamma generalized linear model. Results: Distributions of ages at diagnosis and UPDRS in the PLM and PD-DOC databases were broadly consistent. The PLM patients were systematically younger than the PD-DOC patients and showed increased symptom severity in the PD off state. The average fluctuation in symptoms (UPDRS Parts I and II) was 2.6 points at the time of diagnosis, rising to 5.9 points 16 years after diagnosis. This fluctuation exceeds the estimated minimal and moderate clinically important differences, respectively. Not all patients conformed to the current clinical picture of gradual, smooth changes: many patients had regimes where symptom severity varied in an unpredictable manner, or underwent large rapid changes in an otherwise more stable progression. Conclusions: This information about short-term PD symptom dynamics contributes new scientific understanding about the disease progression, currently very costly to obtain without self-administered Internet-based reporting. This understanding should have implications for the optimization of clinical trials into new treatments and for the choice of treatment decision timescales.