Research priorities for young people with cancer : a UK priority setting partnership with the James Lind Alliance

OBJECTIVES: To conduct a UK-wide survey of young people who have experienced cancer, carers and professionals, to identify and prioritise research questions to inform decisions of research funders and support the case for research with this unique cancer population. DESIGN: James Lind Alliance Priority Setting Partnership. SETTING: UK health service and community. METHODS: A steering group oversaw the initiative and partner organisations were recruited. Unanswered questions were collected in an online survey. Evidence searching verified uncertainties. An interim survey was used to rank questions prior to a final prioritisation workshop. PARTICIPANTS: Young people aged 13-24 years with a current or previous cancer diagnosis, their families, friends, partners and professionals who work with this population. RESULTS: Two hundred and ninety-two respondents submitted 855 potential questions. Following a refining process and removal of 'out of scope' questions, 208 unique questions remained. Systematic evidence checking identified seven answered questions and 16 were the subject of ongoing studies. The interim survey was completed by 174 participants. The top 30 questions were prioritised at a workshop attended by 25 young people, parents and multidisciplinary professionals. The top three priorities are: (1) What psychological support package improves psychological well-being, social functioning and mental health during and after treatment? (2) What interventions, including self-care, can reduce or reverse adverse short-term and long-term effects of cancer treatment? (3) What are the best strategies to improve access to clinical trials? The remaining questions reflect the complete cancer pathway: new therapies, life after cancer, support, education/employment, relapse and end-of-life care. CONCLUSIONS: We have identified shared research priorities for young people with cancer using a rigorous, person-centred approach involving stakeholders typically not involved in setting the research agenda. The breadth of priorities suggest future research should focus on holistic and psychosocial care delivery as well as traditional drug/biology research

The use of triclosan-coated sutures to prevent surgical site infections : a systematic review and meta-analysis of the literature

Introduction and objectives Surgical site infections (SSIs) represent a common and serious complication of all surgical interventions. Microorganisms are able to colonise sutures that are implanted in the skin, which is a causative factor of SSIs. Triclosan-coated sutures are antibacterial sutures aimed at reducing SSIs. Our objective is to update the existing literature by systematically reviewing available evidence to assess the effectiveness of triclosan-coated sutures in the prevention of SSIs. Methods A systematic review of EMBASE, MEDLINE, AMED (Allied and complementary medicine database) and CENTRAL was performed to identify full text randomised controlled trials (RCTs) on 31 May 2019. Intervention Triclosan-coated sutures versus non-triclosan-coated sutures. Primary outcome Our primary outcome was the development of SSIs at 30 days postoperatively. A meta-analysis was performed using a fixed-effects model. Results Twenty-five RCTs were included involving 11 957 participants. Triclosan-coated sutures were used in 6008 participants and non triclosan-coated sutures were used in 5949. Triclosan-coated sutures significantly reduced the risk of SSIs at 30 days (relative risk 0.73, 95% CI 0.65 to 0.82). Further sensitivity analysis demonstrated that triclosan-coated sutures significantly reduced the risk of SSIs in both clean and contaminated surgery. Conclusion Triclosan-coated sutures have been shown to significantly reduced the risk of SSIs when compared with standard sutures. This is in agreement with previous work in this area. This study represented the largest review to date in this area. This moderate quality evidence recommends the use of triclosan-coated sutures in order to reduce the risk of SSIs particularly in clean and contaminated surgical procedures

Deep-Learning-Based Multivariate Pattern Analysis (dMVPA): A Tutorial and a Toolbox

In recent years, multivariate pattern analysis (MVPA) has been hugely beneficial for cognitive neuroscience by making new experiment designs possible and by increasing the inferential power of functional magnetic resonance imaging (fMRI), electroencephalography (EEG), and other neuroimaging methodologies. In a similar time frame, “deep learning” (a term for the use of artificial neural networks with convolutional, recurrent, or similarly sophisticated architectures) has produced a parallel revolution in the field of machine learning and has been employed across a wide variety of applications. Traditional MVPA also uses a form of machine learning, but most commonly with much simpler techniques based on linear calculations; a number of studies have applied deep learning techniques to neuroimaging data, but we believe that those have barely scratched the surface of the potential deep learning holds for the field. In this paper, we provide a brief introduction to deep learning for those new to the technique, explore the logistical pros and cons of using deep learning to analyze neuroimaging data – which we term “deep MVPA,” or dMVPA – and introduce a new software toolbox (the “Deep Learning In Neuroimaging: Exploration, Analysis, Tools, and Education” package, DeLINEATE for short) intended to facilitate dMVPA for neuroscientists (and indeed, scientists more broadly) everywhere

Barriers and facilitators of loaded self-managed exercises and physical activity in people with patellofemoral pain: understanding the feasibility of delivering a multicentred randomised controlled trial, a UK qualitative study.

There is an emergent body of evidence supporting exercise therapy and physical activity in the management of musculoskeletal pain. The purpose of this study was to explore potential barriers and facilitators with patients and physiotherapists with patellofemoral pain involved in a feasibility randomised controlled trial (RCT) study. The trial investigated a loaded self-managed exercise intervention, which included education and advice on physical activity versus usual physiotherapy as the control. Qualitative study, embedded within a mixed-methods design, using semi-structured interviews. A UK National Health Service physiotherapy clinic in a large teaching hospital. Purposively sampled 20 participants within a feasibility RCT study; 10 patients with a diagnosis of patellofemoral pain, aged between 18 and 40 years, and 10 physiotherapists delivering the interventions. In respect to barriers and facilitators, the five overlapping themes that emerged from the data were: (1) locus of control; (2) belief and attitude to pain; (3) treatment expectations and preference; (4) participants' engagement with the loaded self-managed exercises and (5) physiotherapists' clinical development. Locus of control was one overarching theme that was evident throughout. Contrary to popular concerns relating to painful exercises, all participants in the intervention group reported positive engagement. Both physiotherapists and patients, in the intervention group, viewed the single exercise approach in a positive manner. Participants within the intervention group described narratives demonstrating self-efficacy, with greater internal locus of control compared with those who received usual physiotherapy, particularly in relation to physical activity. Implementation, delivery and evaluation of the intervention in clinical settings may be challenging, but feasible with the appropriate training for physiotherapists. Participants' improvements in pain and function may have been mediated, in some part, by greater self-efficacy and locus of control. ISRCTN35272486; Pre-results

CD101 genetic variants modify regulatory and conventional T cell phenotypes and functions.

We recently reported that the risk of sexually acquired HIV-1 infection is increased significantly by variants in the gene encoding CD101, a protein thought to modify inflammatory responses. Using blood samples from individuals with and without these variants, we demonstrate that CD101 variants modify the prevalence of circulating inflammatory cell types and show that CD101 variants are associated with increased proinflammatory cytokine production by circulating T cells. One category of CD101 variants is associated with a reduced capacity of regulatory T cells to suppress T cell cytokine production, resulting in a reduction in the baseline level of immune quiescence. These data are supported by transcriptomics data revealing alterations in the intrinsic regulation of antiviral pathways and HIV resistance genes in individuals with CD101 variants. Our data support the hypothesis that CD101 contributes to homeostatic regulation of bystander inflammation, with CD101 variants altering heterosexual HIV-1 acquisition by facilitating increased prevalence and altered function of T cell subsets

Language Acquisition Also Needs Non-Connectionist Models

Rethinking innateness is a timely volume which forcefully demonstrates the importance of modelling in understanding development, ‘innateness’, and the nature of change. It provides an inspiring vision of what developmental psychology could one day be like, linking behaviour and biology via connectionist models. However, Rispoli's worry about the book's potential for detrimental polarization does not seem unfounded. One aspect of the book that deserves comment in this respect is the focus on connectionism to the exclusion of other types of model. It is unclear from Rethinking innateness itself whether this exclusion of other approaches merely stems from the legitimate desire to write a focused book, or whether it possibly reflects an actively held view that connectionism is the one true approach to modelling development. Regardless of the authors' intentions, the role of connectionism in relation to other computational approaches is an issue which is particularly pertinent to the study of language acquisition. To clarify straightaway, I not only concur with Elman et al. on the central role of modelling, but also strongly believe that the task of the cognitive scientist is not complete until one has an account of how a particular process is realised in a neural architecture. These two commitments give connectionist models a central role. But they do not make connectionism the exclusive modelling tool for the study of language acquisition, nor necessarily the best path to currently pursue. The reasons for this are twofold. The first is a matter of research strategy. It is possible that more rapid progress and greater success might be made if one starts with high-level models which give less immediate regard to matters of implementation

MondoA regulates gene expression in cholesterol biosynthesis-associated pathways required for zebrafish epiboly

The glucose-sensing Mondo pathway regulates expression of metabolic genes in mammals. Here, we characterized its function in the zebrafish and revealed an unexpected role of this pathway in vertebrate embryonic development. We showed that knockdown of mondoa impaired the early morphogenetic movement of epiboly in zebrafish embryos and caused microtubule defects. Expression of genes in the terpenoid backbone and sterol biosynthesis pathways upstream of pregnenolone synthesis was coordinately downregulated in these embryos, including the most downregulated gene nsdhl. Loss of Nsdhl function likewise impaired epiboly, similar to MondoA loss of function. Both epiboly and microtubule defects were partially restored by pregnenolone treatment. Maternal-zygotic mutants of mondoa showed perturbed epiboly with low penetrance and compensatory changes in the expression of terpenoid/sterol/steroid metabolism genes. Collectively, our results show a novel role for MondoA in the regulation of early vertebrate development, connecting glucose, cholesterol and steroid hormone metabolism with early embryonic cell movements

Analysis Of Preservice Teacher And Instructor Technology Uses And Beliefs

In our technology-immersed society in which information is central to the economy, citizens should be fluent with technology and possess 21st century skills that support responsible and effective technology use (e.g., Lin, 2000; P21, 2009). Given the role of public education in creating citizenry with the skills society needs, these qualities should be developed at the K-12 level. This is best done if teachers integrate technology into their lessons (e.g., ISTE, 2008; NCES, 2002). However, research shows that inservice teachers are not integrating technology enough because of negative attitudes, poor confidence, inadequate education, a conflicted teaching philosophy, and other barriers (e.g., Ertmer, 1999). Some suggest that this may change because the current generation of preservice teachers, presumed to be technology-savvy digital natives, will not face these barriers (e.g., Prensky, 2001, 2005). Contrasting research shows that this generation is not uniformly technical, and that what knowledge they have does not transfer to professional settings (e.g., Oblinger & Oblinger, 2005). Furthermore, preservice teachers may be even less technically-inclined than their peers, making them more likely to face the same barriers as inservice teachers (e.g., Lei, 2009; Salentiny, 2010). Preservice education instructors may also face these barriers, and thus are unable to break the cycle (e.g., Ertmer, 2005). If we are to encourage technology integration, we must understand more about the technology characteristics of preservice teachers, their instructors, and the barriers (e.g., attitudes and beliefs) they face. To determine how to avoid preservice level barriers, research needs to explore these technology characteristics. This will help determine whether barriers are present or developing during preservice education. 198 preservice teachers and 21 instructors at a Midwestern university were surveyed about technology use and beliefs. In addition, nine preservice teachers and three instructors were interviewed as follow up to this survey. Results indicate that preservice teachers and instructors display positive attitudes about technology, but only mid-level confidence in their skills with it. Factors that could lead to barriers were found. Instructors believed it was important for preservice teachers to learn pedagogical skills with technology. Implications for preservice education are discussed

The distinctiveness of Lesbian, Gay, Bisexual (LGB) persons affected by cancer treatment and impact on personhood: a participatory research study

Background Delivering person-centred care is National Health Service policy within Scotland and advocated by the World Health Organisation. At present the needs and experiences of Lesbian, Gay and Bisexual (LGB) persons affected by cancer are not fully understood and they cannot be assured of healthcare delivered in a non-judgmental way. Methods This research is underpinned by person-centred philosophy with participatory research principles, using a devised Impact on Personhood Participatory Inquiry Framework (IPPIF). The researcher worked in-depth with nine LGB participants and their support persons exploring the impact of cancer treatment on aspects of personhood (i.e. long-term wellbeing and identity). The researcher worked with participants to co-create methods of exploration of how cancer treatment had impacted on them. Findings Participants’ accounts revealed a broad range of issues that both corroborate and build on existing evidence. LGB persons in this research explored context specific disorienting dilemmas in their own care experience, focusing on coming to terms with their diagnosis, negative experiences of care, and coping with the effects of treatments. Participants reflected on the impact of their treatments on their own self which included attitudes towards being labelled, reconciling intersectionality, and coming to terms with their sexual orientation. Participants discussed the development of new relationships and building confidence in new roles after treatment. Conclusions LGB persons were found to have distinct care experiences and needs related to cancer across a variety of areas. The main findings of this research provide an evidence base for this assertion, and were used to develop a national practitioner guide with the participants and key stakeholders. The guide was aimed at raising awareness of the needs of LGB persons affected by cancer and improving the care experience. Key words Person-centred Care; LGB Cancer Experience; Radiotherapy Treatment; Participatory Research; Patient Experienc

The influence of dealers' perceptions on the buying and selling of Islamic bonds

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