Foot health education for people with rheumatoid arthritis : the practitioner's perspective

Background: Patient education is considered to be a key role for podiatrists in the management of patients with rheumatoid arthritis (RA). Patient education has undoubtedly led to improved clinical outcomes, however no attempts have been made to optimise its content or delivery to maximise benefits within the context of the foot affected by rheumatoid arthritis. The aim of this study was to identify the nature and content of podiatrists' foot health education for people with RA. Any potential barriers to its provision were also explored. Methods: A focus group was conducted. The audio dialogue was recorded digitally, transcribed verbatim and analysed using a structured, thematic approach. The full transcription was verified by the focus group as an accurate account of what was said. The thematic analysis framework was verified by members of the research team to ensure validity of the data. Results: Twelve members (all female) of the north west Podiatry Clinical Effectiveness Group for Rheumatology participated. Six overarching themes emerged: (i) the essence of patient education; (ii) the content; (iii) patient-centred approach to content and timing; (iv) barriers to provision; (v) the therapeutic relationship; and (vi) tools of the trade. Conclusion: The study identified aspects of patient education that this group of podiatrists consider most important in relation to its: content, timing, delivery and barriers to its provision. General disease and foot health information in relation to RA together with a potential prognosis for foot health, the role of the podiatrist in management of foot health, and appropriate self-management strategies were considered to be key aspects of content, delivered according to the needs of the individual. Barriers to foot health education provision, including financial constraints and difficulties in establishing effective therapeutic relationships, were viewed as factors that strongly influenced foot health education provision. These data will contribute to the development of a patient-centred, negotiated approach to the provision of foot health education for people with RA

Gender perspectives on views and preferences of older people on exercise to prevent falls: a systematic mixed studies review

Background: To offer fall prevention exercise programs that attract older people of both sexes there is a need to understand both womens and mens views and preferences regarding these programs. This paper aims to systematically review the literature to explore any underlying gender perspectives or gender interpretations on older peoples views or preferences regarding uptake and adherence to exercise to prevent falls. Methods: A review of the literature was carried out using a convergent qualitative design based on systematic searches of seven electronic databases (PubMed, CINAHL, Amed, PsycINFO, Scopus, PEDro, and OTseeker). Two investigators identified eligible studies. Each included article was read by at least two authors independently to extract data into tables. Views and preferences reported were coded and summarized in themes of facilitators and barriers using a thematic analysis approach. Results: Nine hundred and nine unique studies were identified. Twenty five studies met the criteria for inclusion. Only five of these contained a gender analysis of mens and womens views on fall prevention exercises. The results suggests that both women and men see women as more receptive to and in more need of fall prevention messages. The synthesis from all 25 studies identified six themes illustrating facilitators and six themes describing barriers for older people either starting or adhering to fall prevention exercise. The facilitators were: support from professionals or family; social interaction; perceived benefits; a supportive exercise context; feelings of commitment; and having fun. Barriers were: practical issues; concerns about exercise; unawareness; reduced health status; lack of support; and lack of interest. Considerably more women than men were included in the studies. Conclusion: Although there is plenty of information on the facilitators and barriers to falls prevention exercise in older people, there is a distinct lack of studies investigating differences or similarities in older womens and mens views regarding fall prevention exercise. In order to ensure that fall prevention exercise is appealing to both sexes and that the inclusion of both men and women are encouraged, more research is needed to find out whether gender differences exists and whether practitioners need to offer a range of opportunities and support strategies to attract both women and men to falls prevention exercise.Funding Agencies|Swedish Research Council [2015-03481]; Strategic Research Programme in Care Sciences, Umea University; Karolinska Institute, Sweden; Umea University</p

The home environment and childhood obesity in low-income households: indirect effects via sleep duration and screen time

Background Childhood obesity disproportionally affects children from low-income households. With the aim of informing interventions, this study examined pathways through which the physical and social home environment may promote childhood overweight/obesity in low-income households. Methods Data on health behaviors and the home environment were collected at home visits in low-income, urban households with either only normal weight (n = 48) or predominantly overweight/obese (n = 55) children aged 6–13 years. Research staff conducted comprehensive, in-person audits of the foods, media, and sports equipment in each household. Anthropometric measurements were collected, and children’s physical activity was assessed through accelerometry. Caregivers and children jointly reported on child sleep duration, screen time, and dietary intake of foods previously implicated in childhood obesity risk. Path analysis was used to test direct and indirect associations between the home environment and child weight status via the health behaviors assessed. Results Sleep duration was the only health behavior associated with child weight status (OR = 0.45, 95% CI: 0.27, 0.77), with normal weight children sleeping 33.3 minutes/day longer on average than overweight/obese children. The best-fitting path model explained 26% of variance in child weight status, and included paths linking chaos in the home environment, lower caregiver screen time monitoring, inconsistent implementation of bedtime routines, and the presence of a television in children’s bedrooms to childhood overweight/obesity through effects on screen time and sleep duration. Conclusions This study adds to the existing literature by identifying aspects of the home environment that influence childhood weight status via indirect effects on screen time and sleep duration in children from low-income households. Pediatric weight management interventions for low-income households may be improved by targeting aspects of the physical and social home environment associated with sleep

Segregation of object and background motion in the retina

An important task in vision is to detect objects moving within a stationary scene. During normal viewing this is complicated by the presence of eye movements that continually scan the image across the retina, even during fixation. To detect moving objects, the brain must distinguish local motion within the scene from the global retinal image drift due to fixational eye movements. We have found that this process begins in the retina: a subset of retinal ganglion cells responds to motion in the receptive field centre, but only if the wider surround moves with a different trajectory. This selectivity for differential motion is independent of direction, and can be explained by a model of retinal circuitry that invokes pooling over nonlinear interneurons. The suppression by global image motion is probably mediated by polyaxonal, wide-field amacrine cells with transient responses. We show how a population of ganglion cells selective for differential motion can rapidly flag moving objects, and even segregate multiple moving objects

Greenland ice sheet surface mass loss: recent developments in observation and modeling

Surface processes currently dominate Greenland ice sheet (GrIS) mass loss. We review recent developments in the observation and modelling of GrIS surface mass balance (SMB), published after the July 2012 deadline for the Fifth Assessment Report of the Intergovernmental Panel on Climate Change (IPCC AR5). Since IPCC AR5 our understanding of GrIS SMB has further improved, but new observational and model studies have also revealed that temporal and spatial variability of many processes are still poorly quantified and understood, e.g. bio-albedo, the formation of ice lenses and their impact on lateral meltwater transport, heterogeneous vertical meltwater transport (‘piping’), the impact of atmospheric circulation changes and mixed-phase clouds on the surface energy balance and the magnitude of turbulent heat exchange over rough ice surfaces. As a result, these processes are only schematically or not at all included in models that are currently used to assess and predict future GrIS surface mass loss

MicroRNAs hsa-miR-99b, hsa-miR-330, hsa-miR-126 and hsa-miR-30c: Potential Diagnostic Biomarkers in Natural Killer (NK) Cells of Patients with Chronic Fatigue Syndrome (CFS)/ Myalgic Encephalomyelitis (ME)

Chronic Fatigue Syndrome (CFS/ME) is a complex multisystem disease of unknown aetiology which causes debilitating symptoms in up to 1% of the global population. Although a large cohort of genes have been shown to exhibit altered expression in CFS/ME patients, it is currently unknown whether microRNA (miRNA) molecules which regulate gene translation contribute to disease pathogenesis. We hypothesized that changes in microRNA expression in patient leukocytes contribute to CFS/ME pathology, and may therefore represent useful diagnostic biomarkers that can be detected in the peripheral blood of CFS/ME patients.miRNA expression in peripheral blood mononuclear cells (PBMC) from CFS/ME patients and healthy controls was analysed using the Ambion Bioarray V1. miRNA demonstrating differential expression were validated by qRT-PCR and then replicated in fractionated blood leukocyte subsets from an independent patient cohort. The CFS/ME associated miRNA identified by these experiments were then transfected into primary NK cells and gene expression analyses conducted to identify their gene targets.Microarray analysis identified differential expression of 34 miRNA, all of which were up-regulated. Four of the 34 miRNA had confirmed expression changes by qRT-PCR. Fractionating PBMC samples by cell type from an independent patient cohort identified changes in miRNA expression in NK-cells, B-cells and monocytes with the most significant abnormalities occurring in NK cells. Transfecting primary NK cells with hsa-miR-99b or hsa-miR-330-3p, resulted in gene expression changes consistent with NK cell activation but diminished cytotoxicity, suggesting that defective NK cell function contributes to CFS/ME pathology.This study demonstrates altered microRNA expression in the peripheral blood mononuclear cells of CFS/ME patients, which are potential diagnostic biomarkers. The greatest degree of miRNA deregulation was identified in NK cells with targets consistent with cellular activation and altered effector function

Preliminary findings on the paleomicrobiological study of 400 naturally mummified human remains from upper Nubia

We present 400 mummies excavated from two early Christian burial sites at Kulubnarti, between the 2nd and 3rd cataracts of the Nile in Northern Sudan, prior to the flooding caused by the Aswan Dam. One site was on an island in the Nile dated from 550-750 AD. The other was on the Nile western bank and was in use from c.750-1500 AD. Due to the exceptionally dry climate many of the remains were naturally mummified. Analysis of diet, via chemical examination of hair and of coprolites, had indicated possible deficiencies in vitamins B6, B12, folacin and vitamin C, suggesting iron deficiency. The presence of criba orbitalia, a pathological lesion of the roof of the eye socket (orbit), also suggests iron deficiency anaemia but may also be caused by inflammation. Anaemia is found in several infectious diseases, and severe iron deficiency increases susceptibility to disease. Tuberculosis was widespread in ancient and Roman Egypt, and there was historical contact with Upper Nubia via the Nile. The presence of Acacia pollen in coprolites suggested the possibility of leishmaniasis, as these trees are the habitat of the sand fly vector of the protozoan pathogen. The area is known today for the many infectious diseases afflicting its inhabitants, but were these present in antiquity? We have, therefore, undertaken a study of diseases in Kulubnarti. Initially we looked for evidence of tuberculosis and leishmaniasis. We anticipate shortly broadening the search to include brucellosis, malaria, hepatitis and West Nile fever viruses. Schistosomasis was considered but at this level the Nile flows swiftly and the intermediate host snail is not present so was at present not ocnsidered. Ribs were examined for Mycobacterium tuberculosis DNA, using nested PCR targeting a123 bp sequence on the repetitive element IS6110. Material from the heads of the long bones, possible bone marrow, was examined for Leishmania species using a PCR which amplifies a 119 bp-conserved region of the minicircle kinetoplast DNA. Initial results indicate that M. tuberculosis and Leishmania sp were present in both populations

Guidelines for the deployment and implementation of manufacturing scheduling systems

It has frequently been stated that there exists a gap between production scheduling theory and practice. In order to put theoretical findings into practice, advances in scheduling models and solution procedures should be embedded into a piece of software - a scheduling system - in companies. This results in a process that entails (1) determining its functional features, and (2) adopting a successful strategy for its development and deployment. In this paper we address the latter question and review the related literature in order to identify descriptions and recommendations of the main aspects to be taken into account when developing such systems. These issues are then discussed and classified, resulting in a set of guidelines that can help practitioners during the process of developing and deploying a scheduling system. In addition, identification of these issues can provide some insights to drive theoretical scheduling research towards those topics more in demand by practitioners, and thus help to close the aforementioned gap.Framiñan Torres, JM.; Ruiz García, R. (2012). Guidelines for the deployment and implementation of manufacturing scheduling systems. International Journal of Production Research. 50(7):1799-1812. doi:10.1080/00207543.2011.564670S17991812507Baek, D. H. (1999). A visualized human-computer interactive approach to job shop scheduling. International Journal of Computer Integrated Manufacturing, 12(1), 75-83. doi:10.1080/095119299130489Comesaña Benavides, J. A., & Carlos Prado, J. (2002). Creating an expert system for detailed scheduling. International Journal of Operations & Production Management, 22(7), 806-819. doi:10.1108/01443570210433562Bensana, E. 1986. An expert-system approach to industrial job-shop scheduling. In: Proceedings of the 1986 IEEE international conference on robotics and automation. 1986. Vol. 3, pp.1645–1650.Berglund, M., & Karltun, J. (2007). Human, technological and organizational aspects influencing the production scheduling process. International Journal of Production Economics, 110(1-2), 160-174. doi:10.1016/j.ijpe.2007.02.024Besbes, W., Teghem, J., & Loukil, T. (2010). Scheduling hybrid flow shop problem with non-fixed availability constraints. European J. of Industrial Engineering, 4(4), 413. doi:10.1504/ejie.2010.035652Bhattacharyya, S., & Koehler, G. J. (1998). Learning by Objectives for Adaptive Shop-Floor Scheduling. Decision Sciences, 29(2), 347-375. doi:10.1111/j.1540-5915.1998.tb01580.xBitran, G. R., & Tirupati, D. (1988). OR Practice—Development and Implementation of a Scheduling System for a Wafer Fabrication Facility. Operations Research, 36(3), 377-395. doi:10.1287/opre.36.3.377Buxey, G. (1989). Production scheduling: Practice and theory. European Journal of Operational Research, 39(1), 17-31. doi:10.1016/0377-2217(89)90349-4Chen, J.-F. (2004). Unrelated parallel machine scheduling with secondary resource constraints. The International Journal of Advanced Manufacturing Technology, 26(3), 285-292. doi:10.1007/s00170-003-1622-1Collinot, A., Le Pape, C., & Pinoteau, G. (1988). SONIA: A knowledge-based scheduling system. Artificial Intelligence in Engineering, 3(2), 86-94. doi:10.1016/0954-1810(88)90024-6Cowling, P. (2003). A flexible decision support system for steel hot rolling mill scheduling. Computers & Industrial Engineering, 45(2), 307-321. doi:10.1016/s0360-8352(03)00038-xDudek, R. A., Panwalkar, S. S., & Smith, M. L. (1992). The Lessons of Flowshop Scheduling Research. Operations Research, 40(1), 7-13. doi:10.1287/opre.40.1.7Dumond, E. J. (2005). Understanding and using the capabilities of finite scheduling. Industrial Management & Data Systems, 105(4), 506-526. doi:10.1108/02635570510592398Fox, M. S., & Smith, S. F. (1984). ISIS?a knowledge-based system for factory scheduling. Expert Systems, 1(1), 25-49. doi:10.1111/j.1468-0394.1984.tb00424.xFraminan, J. M., & Ruiz, R. (2010). Architecture of manufacturing scheduling systems: Literature review and an integrated proposal. European Journal of Operational Research, 205(2), 237-246. doi:10.1016/j.ejor.2009.09.026Freed, T., Doerr, K. H., & Chang, T. (2007). In-house development of scheduling decision support systems: case study for scheduling semiconductor device test operations. International Journal of Production Research, 45(21), 5075-5093. doi:10.1080/00207540600818351Gao, C and Tang, L. 2008. A decision support system for color-coating line in steel industry. In: Proceedings of the IEEE international conference on automation and logistics, ICAL 2008. 2008. pp.1463–1468.Grant, T. J. (1986). Lessons for O.R. from A.I.: A Scheduling Case Study. Journal of the Operational Research Society, 37(1), 41-57. doi:10.1057/jors.1986.7Graves, S. C. (1981). A Review of Production Scheduling. Operations Research, 29(4), 646-675. doi:10.1287/opre.29.4.646HALSALL, D. N., MUHLEMANN, A. P., & PRICE, D. H. R. (1994). A review of production planning and scheduling in smaller manufacturing companies in the UK. Production Planning & Control, 5(5), 485-493. doi:10.1080/09537289408919520Higgins, P. G. (1996). Interaction in hybrid intelligent scheduling. International Journal of Human Factors in Manufacturing, 6(3), 185-203. doi:10.1002/(sici)1522-7111(199622)6:33.0.co;2-6Kanet, J. J., & Adelsberger, H. H. (1987). Expert systems in production scheduling. European Journal of Operational Research, 29(1), 51-59. doi:10.1016/0377-2217(87)90192-5Kathawala, Y., & Allen, W. R. (1993). Expert Systems and Job Shop Scheduling. International Journal of Operations & Production Management, 13(2), 23-35. doi:10.1108/01443579310025286Kerr, R. M. (1992). Expert systems in production scheduling: Lessons from a failed implementation. Journal of Systems and Software, 19(2), 123-130. doi:10.1016/0164-1212(92)90063-pKnolmayer, G., Mertens, P., & Zeier, A. (2002). Supply Chain Management Based on SAP Systems. doi:10.1007/978-3-540-24816-3Leachman, R. C., Benson, R. F., Liu, C., & Raar, D. J. (1996). IMPReSS: An Automated Production-Planning and Delivery-Quotation System at Harris Corporation—Semiconductor Sector. Interfaces, 26(1), 6-37. doi:10.1287/inte.26.1.6MACCARTHY, B. L., & LIU, J. (1993). Addressing the gap in scheduling research: a review of optimization and heuristic methods in production scheduling. International Journal of Production Research, 31(1), 59-79. doi:10.1080/00207549308956713McKay, K. N., & Black, G. W. (2007). The evolution of a production planning system: A 10-year case study. Computers in Industry, 58(8-9), 756-771. doi:10.1016/j.compind.2007.02.002McKay, K. N., Safayeni, F. R., & Buzacott, J. A. (1988). Job-Shop Scheduling Theory: What Is Relevant? Interfaces, 18(4), 84-90. doi:10.1287/inte.18.4.84McKay, K. N., Morton, T. E., Ramnath, P., & Wang, J. (2000). ?Aversion dynamics? scheduling when the system changes. Journal of Scheduling, 3(2), 71-88. doi:10.1002/(sici)1099-1425(200003/04)3:23.0.co;2-0MCKAY, K., PINEDO, M., & WEBSTER, S. (2009). PRACTICE-FOCUSED RESEARCH ISSUES FOR SCHEDULING SYSTEMS*. Production and Operations Management, 11(2), 249-258. doi:10.1111/j.1937-5956.2002.tb00494.xMissbauer, H., Hauber, W., & Stadler, W. (2009). A scheduling system for the steelmaking-continuous casting process. A case study from the steel-making industry. International Journal of Production Research, 47(15), 4147-4172. doi:10.1080/00207540801950136Numao, M and Morishita, S. 1989. A scheduling environment for steel-making processes. In: Proceedings of the 5th conference on artificial intelligence applications. 1989. pp.279–286.Olhager, J., & Rapp, B. (1995). Operations Research Techniques in Manufacturing Planning and Control Systems. International Transactions in Operational Research, 2(1), 29-43. doi:10.1111/j.1475-3995.1995.tb00003.xPerez-Gonzalez, P., & Framinan, J. M. (2009). Scheduling permutation flowshops with initial availability constraint: Analysis of solutions and constructive heuristics. Computers & Operations Research, 36(10), 2866-2876. doi:10.1016/j.cor.2008.12.018Pinedo, M., & Yen, B. P.-C. (1997). Annals of Operations Research, 70, 359-378. doi:10.1023/a:1018986524234Portougal, V., & Robb, D. J. (2000). Production Scheduling Theory: Just Where Is It Applicable? Interfaces, 30(6), 64-76. doi:10.1287/inte.30.6.64.11623Reisman, A., Kumar, A., & Motwani, J. (1997). Flowshop scheduling/sequencing research: a statistical review of the literature, 1952-1994. IEEE Transactions on Engineering Management, 44(3), 316-329. doi:10.1109/17.618173Steffen, MS. 1986. A survey of artificial intelligence-based scheduling systems. In: Proceedings of the fall industrial engineering conference. 1986.Storer, R. H., Wu, S. D., & Vaccari, R. (1992). New Search Spaces for Sequencing Problems with Application to Job Shop Scheduling. Management Science, 38(10), 1495-1509. doi:10.1287/mnsc.38.10.1495Tang, L., & Wang, G. (2008). Decision support system for the batching problems of steelmaking and continuous-casting production. Omega, 36(6), 976-991. doi:10.1016/j.omega.2007.11.002T’kindt, V., Billaut, J.-C., Bouquard, J.-L., Lenté, C., Martineau, P., Néron, E., … Tacquard, C. (2005). The e-OCEA project: towards an Internet decision system for scheduling problems. Decision Support Systems, 40(2), 329-337. doi:10.1016/j.dss.2004.04.001Wiers, VCS. 1997. Human–computer interaction in production scheduling: Analysis and design of decision support systems for production scheduling tasks. Ph.D. Thesis, Technische Universiteit Eindhoven, NetherlandsWiers, V. C. S. (2002). A case study on the integration of APS and ERP in a steel processing plant. Production Planning & Control, 13(6), 552-560. doi:10.1080/09537280210160321Wiers, V. C. S., & Van Der Schaaf, T. W. (1997). A framework for decision support in production scheduling tasks. Production Planning & Control, 8(6), 533-544. doi:10.1080/095372897234876Zhang, L., Krishnamurthy, A., Malmborg, C. J., & Heragu, S. S. (2009). Variance-based approximations of transaction waiting times in autonomous vehicle storage and retrieval systems. European J. of Industrial Engineering, 3(2), 146. doi:10.1504/ejie.2009.02360

Use of name recognition software, census data and multiple imputation to predict missing data on ethnicity: application to cancer registry records

<p>Abstract</p> <p>Background</p> <p>Information on ethnicity is commonly used by health services and researchers to plan services, ensure equality of access, and for epidemiological studies. In common with other important demographic and clinical data it is often incompletely recorded. This paper presents a method for imputing missing data on the ethnicity of cancer patients, developed for a regional cancer registry in the UK.</p> <p>Methods</p> <p>Routine records from cancer screening services, name recognition software (Nam Pehchan and Onomap), 2001 national Census data, and multiple imputation were used to predict the ethnicity of the 23% of cases that were still missing following linkage with self-reported ethnicity from inpatient hospital records.</p> <p>Results</p> <p>The name recognition software were good predictors of ethnicity for South Asian cancer cases when compared with data on ethnicity derived from hospital inpatient records, especially when combined (sensitivity 90.5%; specificity 99.9%; PPV 93.3%). Onomap was a poor predictor of ethnicity for other minority ethnic groups (sensitivity 4.4% for Black cases and 0.0% for Chinese/Other ethnic groups). Area-based data derived from the national Census was also a poor predictor non-White ethnicity (sensitivity: South Asian 7.4%; Black 2.3%; Chinese/Other 0.0%; Mixed 0.0%).</p> <p>Conclusions</p> <p>Currently, neither method for assigning individuals to an ethnic group (name recognition and ethnic distribution of area of residence) performs well across all ethnic groups. We recommend further development of name recognition applications and the identification of additional methods for predicting ethnicity to improve their precision and accuracy for comparisons of health outcomes. However, real improvements can only come from better recording of ethnicity by health services.</p

Cost-effectiveness of a mailed educational reminder to increase colorectal cancer screening

<p>Abstract</p> <p>Background</p> <p>Colorectal cancer (CRC) screening rates are low in many areas and cost-effective interventions to promote CRC screening are needed. Recently in a randomized controlled trial, a mailed educational reminder increased CRC screening rates by 16.2% among U.S. Veterans. The aim of our study was to assess the costs and cost-effectiveness of a mailed educational reminder on fecal occult blood test (FOBT) adherence.</p> <p>Methods</p> <p>In a blinded, randomized, controlled trial, 769 patients were randomly assigned to the usual care group (FOBT alone, n = 382) or the intervention group (FOBT plus a mailed reminder, n = 387). Ten days after picking up the FOBT cards, a 1-page reminder with information related to CRC screening was mailed to the intervention group. Primary outcome was number of returned FOBT cards after 6 months. The costs and incremental cost-effectiveness ratio (ICER) of the intervention were assessed and calculated respectively. Sensitivity analyses were based on varying costs of labor and supplies.</p> <p>Results</p> <p>At 6 months after card distribution, 64.6% patients in the intervention group returned FOBT cards compared with 48.4% in the control group (P < 0.001). The total cost of the intervention was $962 or$2.49 per patient, and the ICER was $15 per additional person screened for CRC. Sensitivity analysis based on a 10$13.50 to $16.50 per additional patient screened for CRC.</p> <p>Conclusions</p> <p>A simple mailed educational reminder increases FOBT card return rate at a cost many health care systems can afford. Compared to other patient-directed interventions (telephone, letters from physicians, mailed reminders) for CRC screening, our intervention was more effective and cost-effective.</p