The Acceptability of Diagnostic Tests in the United Kingdom.

PurposeIt is increasingly acknowledged that public acceptability should be considered when designing, evaluating, and implementing healthcare interventions; especially for vulnerable groups.Patients and methodsA voluntary, self-reported, anonymous questionnaire with ethical approval and patient and public involvement was distributed online through social media over a 6-month period to explore acceptability of diagnostic tests.ResultsNinety-three individuals replied to the questionnaire, of which the majority were female (89.2%) heterosexual (92.4%) white (81.6%) and resided in England (94.6%). The most encountered diagnostic test was an X-ray (92.4%) and the least encountered test was a bone marrow biopsy with local anaesthetic (0%). A sputum sample test was the most perfectly acceptable investigation (83.8%). One percent of participants felt that the cervical smear test was perfectly acceptable With reference to hysteroscopy, 44% felt a hysteroscopy was perfectly acceptable under general anaesthesia, compared to no participants with local anaesthetic or sedation. Forty one percent of participants felt a diagnostic laparoscopy was perfectly acceptable.ConclusionThe findings from this study provide insight into the acceptability of medical tests from a patient perspective and will inform a more explorative qualitative study to ensure researchers are aiming to produce tests that are sensitive, specific and importantly acceptable

Barriers and facilitators to implementation of mental capacity legislation in care homes for older adults in the United Kingdom: a mixed-methods systematic review.

ObjectiveMental Capacity legislation defines when a person lacks capacity and subsequently supports individuals to make as many decisions as possible for themselves. Whilst frameworks exist, care home staff often feel unsupported with insufficient knowledge and training. This review aimed to understand barriers and facilitators of implementing mental capacity legislation in care homes for older adults in the United Kingdom.MethodsA systematic review was conducted and 3041 potentially relevant studies identified, with 13 studies eligible for inclusion. 11 focused on the Mental Capacity Act (2005) and two on the Adults with Incapacity (Scotland) Act 2000. Barriers and/or facilitators were extracted and subsequently mapped to the Capability, Opportunity and Motivation model and Theoretical Domains Framework.ResultsBarriers included poor access to training, low staff confidence and a lack of understanding about using legislation in context. Conversely, staff reported in-person training using real-life examples, robust organisational policies and processes and respecting person-centred care were key facilitators. Sense-checking conversations were conducted with care home staff (n = 18) to interpret findings in the context of current practice.ConclusionsThis review presents complex and multi-faceted barriers preventing the implementation of mental capacity legislation in care homes for older adults. Whilst care home staff have now started to appreciate the importance of such legislation, insufficient time, resources and an inability to track staff knowledge prevents effective implementation of the law. Future research should explore how staff are trained about legislation and identify best practices

History through children's voices

Elizabeth wrote part of the article as well and helped me select the materials and made the pictures of the archival materiial

Psychosocial factors and the development of childhood overweight and obesity: a UK cohort study.

BackgroundWe examined the role of psychosocial factors in overweight and obesity development.MethodsUK Millennium Cohort Study data of children with normal weight at baseline were analysed. Weight changes were determined from baselines at ages 11 (n = 7979) and 14 (n = 6906) to follow-up at age 17. Baseline individual psychosocial factors were combined into two distinct indexes (caregiver-reported child mental health, child-reported psychosocial well-being). Regression models examined the associations between baseline indexes and individual psychosocial factors and overweight and obesity development (vs. no development) and body mass index (BMI) z-score changes.ResultsWorse child mental health, but not psychosocial well-being, at age 11 was associated with overweight and obesity development (OR = 1.14; 95% CI = 1.02, 1.27) and increased BMI z-scores (β = 0.08; 95% CI = 0.04, 0.12) to age 17. No psychosocial indexes at age 14 predicted the outcomes. Further analyses showed that child mental health at ages 11 vs. 14 was more likely to predict the outcomes. Based on individual factors, externalising symptoms and experiencing peer bullying at age 11 may be important contributors to overweight and obesity development.ConclusionsPoor child mental health at age 11 is associated with overweight and obesity development by age 17. Late childhood/early adolescence may be a sensitive period in which psychosocial factors predict body weight trajectories.ImpactWorse psychosocial factors, particularly poor mental health, at ages 11, but not 14, were associated with overweight and obesity development and increased BMI z-scores by age 17. Late childhood/early adolescence may be a sensitive period for mental health in predicting future weight change. Future research will benefit from exploring this potential sensitive period and understanding potential mechanisms

Short-term increases in rival number improves single mating productivity in male <i>Drosophila</i>.

In variable environments, animals can change their reproductive behaviors and physiology to maximize reproductive returns. Natural environments vary in multifaceted ways, and animals may need to integrate multiple social or physical cues to adopt the most effective behavioral strategy. In a fully factorial 2 × 2 × 2 experiment, we exposed males to three factors: the number of rivals (10 or 30), food availability (present/absent) and mechanical shaking (present/absent). After 60 min of exposure, we recorded the male's mating latency, copulation duration and the number of offspring produced after a single mating. We also noted the latency of the males partner to remate with a stock male 24 h later. When rival number was increased from 10 per vial to 30 per vial, males sired more offspring. Males also varied their copulation duration and mating latency in response to the number of rivals, but in a condition-dependent manner. In the absence of vortexing, males mated for a shorter time when kept with 30 rivals, but the opposite was observed when males were vortexed. When males were fed and held in groups of 30, they took longer to begin mating compared to the other treatments. Our findings are consistent with the idea that male Drosophila integrate social cues to respond to levels of sperm competition and plastically allocate their ejaculate, but we have demonstrated that they can occur more rapidly (1 h) than previously thought (>24 h). Overall, our data highlight that combinatorial approaches can reveal new relationships between environment and behavior

Biopsychosocial Approaches for the Management of Female Chronic Pelvic Pain: A Systematic Review.

Background/objectiveCurrent guidelines recommend biopsychosocial-informed treatment for chronic pelvic pain (CPP). The objective of this systematic review was to describe the available biopsychosocial approaches for the treatment of CPP, and the outcomes reported, to understand how guideline-recommended treatments can be applied.Search strategyMEDLINE, CINAHL, PsycINFO, EMBASE, Emcare, AMED and Cochrane trial registries were searched (inception to 17 November 2023).Selection criteriaCPP Studies in women where the principal treatment modality was a biopsychosocial approach were included. Prospero registration: CRD42022374256.Data collection/analysisData extraction included study setting, population, study design, intervention characteristics and outcome measures and is described via a narrative synthesis.ResultsThe review included 14 RCTs (871 patients) and identified four broad intervention categories (Acceptance Commitment Therapy n = 2, Cognitive Behavioural Therapy n = 6, Mindfulness-based approaches n = 2, and Physiotherapy-based interventions n = 4). Pain science education (PSE) and, exposure/engagement with valued activity were recognised as important aspects of treatment regardless of intervention type. The most utilised outcomes were pain reduction and emotional functioning, with all studies reporting improvements in these domains. Heterogeneity in outcomes prevented efficacy comparison. High risk of bias was identified in six studies (1/4 physiotherapy-based approaches, 2/6 CBT, 1/2 ACT and 2/2 mindfulness-based interventions).ConclusionsCBT and ACT-based biopsychosocial approaches were found effective in reducing pain and improving psychometric outcomes for CPP. Evaluation indicated PSE, and exposure/engagement in valued activity are important components of biopsychosocial management. Outcome heterogeneity needs to be addressed in future trials

Infliximab vs interferon-α in the treatment of Behçet's syndrome: clinical data from the BIO-BEHÇET'S randomized controlled trial.

ObjectivesWhilst biologic therapy is used for Behçet's syndrome of all subtypes refractory to first-line immunomodulation, there has been an absence of high-quality evidence and no predictive biomarkers to optimally inform choice. BIO-BEHÇET'S was a randomized, controlled, head-to-head clinical trial comparing the two most frequently used biologics in active refractory Behçet's.MethodsThis was a Bayesian-designed, pragmatic, standard of care, two-arm, parallel head-to-head trial at four UK centres. Patients with active disease were randomized to infliximab or IFN-α2a, and received follow-up with symptom-directed examination at weeks 12 and 24. The primary outcome was the Behçet's Disease Activity Index (BDAI) at 12 weeks. Secondary outcomes included BDAI at 24 weeks and significant improvement in individual organ systems, including ocular symptoms, oral and genital ulcers, arthritis pain, quality of life, disease activity and steroid use. Biomarkers were also investigated but are reported elsewhere.ResultsSeventy-nine patients were recruited. Both treatments were equally effective, with a mean difference of 0.13 in BDAI (80% confidence interval: -0.19, 0.46). No significant differences were observed for secondary outcomes, though there were clinically significant within-group reductions for each over time. A modest steroid-sparing effect was observed, with complete cessation of steroids in 20% and 44% of those randomized to infliximab and IFN-α2a, respectively. There was a trend for minor benefit in favour of infliximab in terms of tolerability and persistence.ConclusionIn this first reported, high-quality, head-to-head trial of two biologics in Behçet's, both infliximab and IFN-α2a showed comparable short-term clinical efficacy and safety in refractory active disease of all subtypes.Trial registrationEudraCT: 2014-005390-36; ISRCTN: ISRCTN49793874

Clustering to Minimize Cluster-Aware Norm Objectives

We initiate the study of the following general clustering problem. We seek to partition a given set P of data points into k clusters by finding a set X of k centers and assigning each data point to one of the centers. The cost of a cluster, represented by a center x P X, is a monotone, symmetric norm f (called inner norm) of the vector of distances of points assigned to x. The goal is to minimize a norm g (called outer norm) of the vector of cluster costs. This problem, which we call pf, gq-Clustering, generalizes many fundamental clustering problems such as k-Center (i.e., pL∞,L∞q-Clustering), k-Median (i.e., pL1,L1q-Clustering), Min-Sum of Radii (i.e., pL∞,L1q-Clustering), and Min-Load k-Clustering (i.e., pL1,L∞q-Clustering). A recent line of research (Byrka et al. [STOC'18], Chakrabarty, Swamy [ICALP'18, STOC'19], and Abbasi et al. [FOCS'23]) studies norm objectives that are oblivious to the cluster structure such as k-Median and k-Center. In contrast, our problem models cluster-aware objectives including Min-Sum of Radii and Min-Load k-Clustering. Our main results are as follows. First, we design a constant-factor approximation algorithm for ptopℓ,L1q-Clustering where the inner norm (topℓ) sums over the ℓ largest distances. This unifies (up to constant factors) the best known results for k-Median and Min-Sum of Radii. Second, we design a constant-factor approximation for pL∞, Ordq-Clustering where the outer norm is a convex combination of topℓ norms (ordered weighted norm). This generalizes known results for k-Center and Min-Sum of Radii. Obtaining a constant-factor approximation for more general settings that include pL1,L∞q-Clustering (Min-Load k-Clustering) seems challenging because even an opkq-approximation is unknown for this problem. We can still use our two main results to obtain first (although non-constant) approximations for these problems including general monotone, symmetric norms. Our algorithm for ptopℓ,L1q-Clustering relies on a reduction to a novel generalization of k-Median, which we call Ball k-Median. In this problem, we aim at selecting k balls (rather than k centers) and pay for connecting the points to these balls as well as for the (scaled) radii of the balls. To obtain a constant-factor approximation for this problem we unify various algorithmic techniques originally designed for the cluster-oblivious k-Median objective (Jain and Vazirani [JACM 2001], Li and Svensson [STOC'13]) and for the cluster-aware Min-Sum of Radii Objective (Charikar and Panigrahi [STOC'01] and Ahmadian and Swamy [ICALP'16])

Regulatory adverse drug reaction analyses support a temporal increase in psychiatric reactions after initiation of cystic fibrosis combination modulator therapies.

IntroductionDespite improved outcomes for many people with cystic fibrosis, there have been reports of adverse neuropsychiatric effects of modulator therapy. The aim of this research is to define temporal associations in adverse drug reaction (ADR) reports for available CFTR modulators.MethodsMethods include an analysis of the UK Yellow Card Scheme data for ADRs through accessing interactive Drug Analysis Profiles (iDAPs) to define temporal trends in absolute and proportional counts.ResultsSince the introduction of ETI, there has been an increase in the absolute number of psychiatric ADRs reported as well as a statistically significant increase in the proportion of psychiatric ADRs in the pre-ETI and post-ETI periods.ConclusionIn the post-ETI period, psychiatric ADRs are the most prevalent ADR reported via the Yellow Card scheme. Despite an unclear mechanism, there is significant clinical relevance in counselling and monitoring regarding psychiatric effects of CFTR modulator therapy