A prospective evaluation of the predictive value of faecal calprotectin in quiescent Crohn’s disease

Background: The faecal calprotectin (FC) test is a non-invasive marker for gastrointestinal inflammation. Aim: To determine whether higher FC levels in individuals with quiescent Crohn’s disease are associated with clinical relapse over the ensuing 12 months.<p></p> Methods: A single centre prospective study was undertaken in Crohn's disease patients in clinical remission attending for routine review. The receiver operating characteristic (ROC) curve for the primary endpoint of clinical relapse by 12 months, based on FC at baseline, was calculated. Kaplan-Meier curves of time to relapse were based on the resulting optimal FC cutoff for predicting relapse.<p></p> Results: Of 97 patients recruited, 92 were either followed up for 12 months without relapsing, or reached the primary endpoint within that period. Of these, 10 (11%) had relapsed by 12 months. The median FC was lower for non-relapsers, 96µg/g (IQR 39-237), than for relapsers, 414µg/g (IQR 259-590), (p=0.005). The area under the ROC curve to predict relapse using FC was 77.4%. An optimal cutoff FC value of 240µg/g to predict relapse of quiescent Crohn’s had sensitivity of 80.0% and specificity of 74.4%. Negative predictive value was 96.8% and positive predictive value was 27.6%. FC≥240μg/g was associated with likelihood of relapse 5.7 (95% CI 1.9-17.3) times higher within 2.3 years than lower values (p=0.002).<p></p> Conclusions: In this prospective dataset, FC appears to be a useful, non-invasive tool to help identify quiescent Crohn’s disease patients at a low risk of relapse over the ensuing 12 months. FC of 240µg/g was the optimal cutoff in this cohort.<p></p&gt

Greater Than the Sum: Systems Thinking in Tobacco control

Tobacco control and public health have evolved into a complex set of interconnected and largely self-organizing systems. Their components include international, national, and local governmental agencies; individual advocacy groups; policy makers; health care professionals; nonprofit foundations; and the general population itself. The issues require the exploration of approaches and methodologies that speak to the evolving, dynamic nature of this systems environment. This monograph focuses on the first two years of the Initiative on the Study and Implementation of Systems (ISIS), which was funded by the National Cancer Institute to examine the potential for systems thinking in tobacco control and public health. ISIS explored the general idea of a systems thinking rubric encompassing a great variety of systems-oriented methodologies and approaches. Four approaches have particular promise for their applicability to tobacco control and public health and thus were chosen as areas for initial investigation: (1) organizing and managing as a system, (2) system dynamics and how to model those dynamics, (3) system networks and their analysis, and (4) systems knowledge and its management and translation. As a transdisciplinary effort that linked both tobacco control stakeholders and systems experts, ISIS combined a number of exploratory projects and case studies within these four approaches with a detailed examination of the potential for systems thinking in tobacco control. Its end product was a set of expert consensus guidelines for the future implementation of systems thinking and systems perspectives for tobacco control and public health.https://cancercontrol.cancer.gov/tcrb/monographs/18/index.htm

Evaluation of satellite and reanalysis-based global net surface energy flux and uncertainty estimates

The net surface energy flux is central to the climate system yet observational limitations lead to substantial uncertainty. A combination of satellite-derived radiative fluxes at the top of atmosphere (TOA) adjusted using the latest estimation of the net heat uptake of the Earth system, and the atmospheric energy tendencies and transports from the ERA-Interim reanalysis are used to estimate surface energy flux globally. To consider snowmelt and improve regional realism, land surface fluxes are adjusted through a simple energy balance approach at each grid point. This energy adjustment is redistributed over the oceans to ensure energy conservation and maintain realistic global ocean heat uptake, using a weighting function to avoid meridional discontinuities. Calculated surface energy fluxes are evaluated through comparison to ocean reanalyses. Derived turbulent energy flux variability is compared with the OAFLUX product and inferred meridional energy transports in the global ocean and the Atlantic are also evaluated using observations. Uncertainties in surface fluxes are investigated using a variety of approaches including comparison with a range of atmospheric reanalysis products. Decadal changes in the global mean and the inter-hemispheric energy imbalances are quantified and present day cross-equator heat transports are reevaluated at 0.22 ± 0.15 PW southward by the atmosphere and 0.32 ± 0.16 PW northward by the ocean considering the observed ocean heat sinks

Knowledge transfer and management in tourism organisations: an emerging research agenda

Authors' final draft version. Final version published in Tourism Management; available online at http://www.sciencedirect.com/This paper reviews current research on knowledge management and knowledge transfer in the context of innovations. Specific attention is focussed on the integration of management perspectives into tourism research. The paper explores some of the key mechanisms and conduits of knowledge transfer within tourism. In doing so it explores such concepts as interlocking directorships, communities of practice, learning regions and labour mobility. There is also an emerging research agenda on knowledge management within tourism but progress is variable with most research being within the hotel sector, where a range of recent studies have examined aspects of knowledge transfer. The paper also draws attention to the need to give closer attention to the nature of innovations within tourism and to consider these in a knowledge management framework

Scaling up complex interventions: insights from a realist synthesis

Preventing chronic diseases, such as cancer, cardiovascular disease and diabetes, requires complex interventions, involving multi-component and multi-level efforts that are tailored to the contexts in which they are delivered. Despite an increasing number of complex interventions in public health, many fail to be ‘scaled up’. This study aimed to increase understanding of how and under what conditions complex public health interventions may be scaled up to benefit more people and populations. A realist synthesis was conducted and discussed at an in-person workshop involving practitioners responsible for scaling up activities. Realist approaches view causality through the linkages between changes in contexts (C) that activate mechanisms (M), leading to specific outcomes (O) (CMO configurations). To focus this review, three cases of complex interventions that had been successfully scaled up were included: Vibrant Communities, Youth Build USA and Pathways to Education. A search strategy of published and grey literature related to each case was developed, involving searches of relevant databases and nominations from experts. Data extracted from included documents were classified according to CMO configurations within strategic themes. Findings were compared and contrasted with guidance from diffusion theory, and interpreted with knowledge users to identify practical implications and potential directions for future research. Four core mechanisms were identified, namely awareness, commitment, confidence and trust. These mechanisms were activated within two broad scaling up strategies, those of renewing and regenerating, and documenting success. Within each strategy, specific actions to change contexts included building partnerships, conducting evaluations, engaging political support and adapting funding models. These modified contexts triggered the identified mechanisms, leading to a range of scaling up outcomes, such as commitment of new communities, changes in relevant legislation, or agreements with new funding partners. This synthesis applies and advances theory, realist methods and the practice of scaling up complex interventions. Practitioners may benefit from a number of coordinated efforts, including conducting or commissioning evaluations at strategic moments, mobilising local and political support through relevant partnerships, and promoting ongoing knowledge exchange in peer learning networks. Action research studies guided by these findings, and studies on knowledge translation for realist syntheses are promising future directions

Knowledge translation training opportunities : global scoping study insights

This brief provides an overview of knowledge translation (KT) and / or research communication training opportunities in post-secondary education curricula worldwide. The study focused on certificate, diploma and post-graduate level KT courses and programs and generated an inventory of those offered in various countries and contexts. In addition, the study considered key advantages and challenges associated with developing KT curricula in low- and middle-income countries (LMICs), and provided suggestions for enhancement of the global KT curriculum inventory

Adaptive Management of Riverine Socio-ecological Systems

If ongoing change in ecosystems and society can render inflexible policies obsolete, then management must dynamically adapt as a counter to perennial uncertainty. This chapter describes a general synthesis of how to make decision-making more adaptive and then explores the barriers to learning in management. We then describe how one such process, known as adaptive management (AM), has been applied in different river basins, on which basis we discuss AM’s strengths and limitations in various resource management contexts

The influence of membrane physical properties on microvesicle release in human erythrocytes

Exposure of human erythrocytes to elevated intracellular calcium causes fragments of the cell membrane to be shed as microvesicles. This study tested the hypothesis that microvesicle release depends on microscopic membrane physical properties such as lipid order, fluidity, and composition. Membrane properties were manipulated by varying the experimental temperature, membrane cholesterol content, and the activity of the trans-membrane phospholipid transporter, scramblase. Microvesicle release was enhanced by increasing the experimental temperature. Reduction in membrane cholesterol content by treatment with methyl-β-cyclodextrin also facilitated vesicle shedding. Inhibition of scramblase with R5421 impaired vesicle release. These data were interpreted in the context of membrane characteristics assessed previously by fluorescence spectroscopy with environment-sensitive probes such as laurdan, diphenylhexatriene, and merocyanine 540. The observations supported the following conclusions: 1) calcium-induced microvesicle shedding in erythrocytes relates more to membrane properties detected by diphenylhexatriene than by the other probes; 2) loss of trans-membrane phospholipid asymmetry is required for microvesicle release

They Are What You Eat: Can Nutritional Factors during Gestation and Early Infancy Modulate the Neonatal Immune Response?

The ontogeny of the human immune system is sensitive to nutrition even in the very early embryo, with both deficiency and excess of macro- and micronutrients being potentially detrimental. Neonates are particularly vulnerable to infectious disease due to the immaturity of the immune system and modulation of nutritional immunity may play a role in this sensitivity. This review examines whether nutrition around the time of conception, throughout pregnancy, and in early neonatal life may impact on the developing infant immune system

A national survey on the patterns of treatment of inflammatory bowel disease in Canada

BACKGROUND: There is a general lack of information on the care of inflammatory bowel disease (IBD) in a broad, geographically diverse, non-clinic population. The purposes of this study were (1) to compare a sample drawn from the membership of a national Crohn's and Colitis Foundation to published clinic-based and population-based IBD samples, (2) to describe current patterns of health care use, and (3) to determine if unexpected variations exist in how and by whom IBD is treated. METHODS: Mailed survey of 4453 members of the Crohn's and Colitis Foundation of Canada. The questionnaire, in members stated language of preference, included items on demographic and disease characteristics, general health behaviors and current and past IBD treatment. Each member received an initial and one reminder mailing. RESULTS: Questionnaires were returned by 1787, 913, and 128 people with Crohn's disease, ulcerative colitis and indeterminate colitis, respectively. At least one operation had been performed on 1159 Crohn's disease patients, with risk increasing with duration of disease. Regional variation in surgical rates in ulcerative colitis patients was identified. 6-Mercaptopurine/Azathioprine was used by 24% of patients with Crohn's disease and 12% of patients with ulcerative colitis (95% CI for the difference: 8.9% – 15%). In patients with Crohn's disease, use was not associated with gender, income or region of residence but was associated with age and markers of disease activity. Infliximab was used by 112 respondents (4%), the majority of whom had Crohn's disease. Variations in infliximab use based on region of residence and income were not seen. Sixty-eight percent of respondents indicated that they depended most on a gastroenterologist for their IBD care. There was significant regional variation in this. However, satisfaction with primary physician did not depend on physician type (for example, gastroenterologist versus general practitioner). CONCLUSION: This study achieved the goal of obtaining a large, geographically diverse sample that is more representative of the general IBD population than a clinic sample would have been. We could find no evidence of significant regional variation in medical treatments due to gender, region of residence or income level. Differences were noted between different age groups, which deserves further attention