Barriers and facilitators to the recruitment of disabled people to clinical trials: a scoping review

Introduction Underrepresentation of disabled groups in clinical trials results in an inadequate evidence base for their clinical care, which drives health inequalities. This study aims to review and map the potential barriers and facilitators to the recruitment of disabled people in clinical trials to identify knowledge gaps and areas for further extensive research. The review addresses the question: ‘What are the barriers and facilitators to recruitment of disabled people to clinical trials?’. Methods The Joanna Briggs Institute (JBI) Scoping review guidelines were followed to complete the current scoping review. MEDLINE and EMBASE databases were searched via Ovid. The literature search was guided by a combination of four key concepts from the research question: (1) disabled populations, (2) patient recruitment, (3) barriers and facilitators, and (4) clinical trials. Papers discussing barriers and facilitators of all types were included. Papers that did not have at least one disabled group as their population were excluded. Data on study characteristics and identified barriers and facilitators were extracted. Identified barriers and facilitators were then synthesised according to common themes. Results The review included 56 eligible papers. The evidence on barriers and facilitators was largely sourced from Short Communications from Researcher Perspectives (N = 22) and Primary Quantitative Research (N = 17). Carer perspectives were rarely represented in articles. The most common disability types for the population of interest in the literature were neurological and psychiatric disabilities. A total of five emergent themes were determined across the barriers and facilitators. These were as follows: risk vs benefit assessment, design and management of recruitment protocol, balancing internal and external validity considerations, consent and ethics, and systemic factors. Conclusions Both barriers and facilitators were often highly specific to disability type and context. Assumptions should be minimised, and study design should prioritise principles of co-design and be informed by a data-driven assessment of needs for the study population. Person-centred approaches to consent that empower disabled people to exercise their right to choose should be adopted in inclusive practice. Implementing these recommendations stands to improve inclusive practices in clinical trial research, serving to produce a well-rounded and comprehensive evidence base

Plasma free amino acid profiles of Boer goat bucks as influenced by two feeding regimens

The aim of the study was to monitor the physiological changes in plasma free amino acid profiles in Boer goats under nutritional restriction. Fifteen Boer goat bucks were allocated to two experimental groups: CG (control), fed Themeda trianda hay, supplemented with maize, molasses and urea ad libitum; and RG (restricted feeding) fed the same hay (80 and 86% of the daily NRC energy and protein requirements, respectively) for 29 days. Animals were weighed and blood collected weekly for determination of plasma free amino acid profiles and the results compared between experimental groups. At the end of the experimental period the CG animals had higher concentrations of alanine, tyrosine and citrulline amino acids. The RG group had higher concentrations of valine, isoleucine, leucine, threonine, methionine, lysine, taurine, ornithine, hydroxyproline and tri-methyl-histidine, while glycine, serine, aspartic acid, glutamic acid, arginine, histidine and proline levels were similar in both groups. From the results it can be concluded that plasma amino acid profiles in the Boer goat were significantly affected by nutritional restriction. The degradation of short carbon chain amino acids is preferred to long carbon chain amino acids for gluconeogenesis in the physiological mechanisms of response to nutritional restriction in Boer goats. Keywords: Boer goat; nutrition; restricted feeding; amino acids South African Journal of Animal Science Vol. 36 (5) 2006: pp.14-1

Classical and quantum N=2 supersymmetric black holes

We use heterotic/type-II prepotentials to study quantum/classical black holes with half the $N=2, D=4$ supersymmetries unbroken. We show that, in the case of heterotic string compactifications, the perturbatively corrected entropy formula is given by the tree-level entropy formula with the tree-level coupling constant replaced by the perturbative coupling constant. In the case of type-II compactifications, we display a new entropy/area formula associated with axion-free black-hole solutions, which depends on the electric and magnetic charges as well as on certain topological data of Calabi--Yau three-folds, namely the intersection numbers, the second Chern class and the Euler number of the three-fold. We show that, for both heterotic and type-II theories, there is the possibility to relax the usual requirement of the non-vanishing of some of the charges and still have a finite entropy.Comment: 28 pages, LaTe

Enteral Nutrition in Preterm Infants: Update of the National Consensus Document

Na presente actualização da recomendação sobre nutrição entérica no recém-nascido pré-termo, da Secção de Neonatologia da Sociedade Portuguesa de Pediatria, é dada especial relevância às necessidades nutricionais do recém-nascido pré-termo, aspetos particulares da nutrição entérica durante o internamento na unidade neonatal, nomeadamente em relação ao momento de iniciar a nutrição entérica, como progredir, modo de administração, especificidades do leite humano pré-termo, sua fortificação, nutrição em situações particulares e nutrição após alta hospitalar. É incluída informação sobre a composição das fórmulas especiais, fortificante e suplemento proteico do leite humano comercializados em Portugal

CANFOR Portuguese version: validation study

This study is embedded in the larger project "Needs Assessment of the Mentally Disordered Prisoners" funded by Fundacao para a Ciencia e Tecnologia (PIC/IC/83257/2007). We acknowledge the General-Director for Prison Services for his authorization, the Prisons' Directors for their support, the medical and non-medical staff who collaborated in this study and detainees for their participation. Special thanks to Dr Ana Cabral for her support inside the prisons and Dr Jorge Pereira for his assistance in manuscript preparation. In memory of our late friend Dr Jose Morais, who collaborated on and supported this study from the beginning.BACKGROUND The increase in prisoner population is a troublesome reality in several regions of the world. Along with this growth there is increasing evidence that prisoners have a higher proportion of mental illnesses and suicide than the general population. In order to implement strategies that address criminal recidivism and the health and social status of prisoners, particularly in mental disordered offenders, it is necessary to assess their care needs in a comprehensive, but individual perspective. This assessment must include potential harmful areas like comorbid personality disorder, substance misuse and offending behaviours. The Camberwell Assessment of Need - Forensic Version (CANFOR) has proved to be a reliable tool designed to accomplish such aims. The present study aimed to validate the CANFOR Portuguese version. METHODS The translation, adaptation to the Portuguese context, back-translation and revision followed the usual procedures. The sample comprised all detainees receiving psychiatric care in four forensic facilities, over a one year period. A total of 143 subjects, and respective case manager, were selected. The forensic facilities were chosen by convenience: one prison hospital psychiatric ward (n=68; 47.6%), one male (n=24; 16.8%) and one female (n=22; 15.4%) psychiatric clinic and one civil security ward (n=29; 20.3%), all located nearby Lisbon. Basic descriptive statistics and Kappa weighted coefficients were calculated for the inter-rater and the test-retest reliability studies. The convergent validity was evaluated using the Global Assessment of Functioning and the Brief Psychiatric Rating Scale scores. RESULTS The majority of the participants were male and single, with short school attendance, and accused of a crime involving violence against persons. The most frequent diagnosis was major depression (56.1%) and almost half presented positive suicide risk. The reliability study showed average Kappa weighted coefficients of 0.884 and 0.445 for inter-rater and test-retest agreement, respectively. The convergent validity study presented highly significant correlations between unmet needs scores, GAF and BPRS scores. CONCLUSIONS The CANFOR Portuguese version revealed similar psychometric properties to the original English version. Moreover, the results of the reliability and validity studies indicate that the tool is appropriate for individual care needs assessment and as a guide for the mental health and social interventions in forensic psychiatric services.publishersversionpublishe

Physical Interactions With Bacteria and Protozoan Parasites Establish the Scavenger Receptor SSC4D as a Broad-Spectrum Pattern Recognition Receptor

Since the pioneering discoveries, by the Nobel laureates Jules Hoffmann and Bruce Beutler, that Toll and Toll-like receptors can sense pathogenic microorganisms and initiate, in vertebrates and invertebrates, innate immune responses against microbial infections, many other families of pattern recognition receptors (PRRs) have been described. One of such receptor clusters is composed by, if not all, at least several members of the scavenger receptor cysteine-rich (SRCR) superfamily. Many SRCR proteins are plasma membrane receptors of immune cells; however, a small subset consists of secreted receptors that are therefore in circulation. We here describe the first characterization of biological and functional roles of the circulating human protein SSC4D, one of the least scrutinized members of the family. Within leukocyte populations, SSC4D was found to be expressed by monocytes/macrophages, neutrophils, and B cells, but its production was particularly evident in epithelial cells of several organs and tissues, namely, in the kidney, thyroid, lung, placenta, intestinal tract, and liver. Similar to other SRCR proteins, SSC4D shows the capacity of physically binding to different species of bacteria, and this opsonization can increase the phagocytic capacity of monocytes. Importantly, we have uncovered the capacity of SSC4D of binding to several protozoan parasites, a singular feature seldom described for PRRs in general and here demonstrated for the first time for an SRCR family member. Overall, our study is pioneer in assigning a PRR role to SSC4D.This work was funded by National Funds through FCT– Fundação para a Ciência e a Tecnologia, I.P., under the projects SRecognite Infect-ERA/0003/2015 and UIDB/04293/ 2020. Individual funding to JT was provided by FCT through CEECIND/02362/2017. MC, RS, and MS were recipients of studentships from FCT, respectively, SFRH/BD/116791/2016, SFRH/BD/110691/2015, and SFRH/BD/133485/2017. This paper is dedicated to our colleague and friend Rui Appelberg (1960-2020). The authors acknowledge the support of the i3S Scientific Platform BioSciences Screening, member of the national infrastructure PPBI–Portuguese Platform of Bioimaging (PPBI-POCI-01-0145-FEDER-022122) and PT-OPENSCREEN. Tissue sections were kindly provided by Amaro Frutuoso, Department of Complementary Means of Diagnosis and Therapy, Service of Pathology, Hospital Pedro Hispano, Matosinhos

Impact of Combined Exercise on Chronic Obstructive Pulmonary Patients' State of Health

AIM: The aim of the study was to evaluate the effectiveness of a 10-week combined training programme (aerobic and strength exercise) compared to an aerobic training programme, and respiratory physiotherapy on COPD patients' health. METHODS: Fifty subjects with moderate to severe COPD were randomly assigned to two groups. Combined group (CG, n=25) who underwent combined training, and aerobic group (AG, n=25) who underwent aerobic training. These were compared with fifty COPD subjects who underwent respiratory physiotherapy, breathing control and bronchial clearance techniques (RP group, n = 50). We evaluated health state through two questionnaires, St. George's Respiratory Questionnaire (SGRQ) and SF-36, at the beginning and at the end of the programme. RESULTS: The CG group showed differences (p<0.0001) in modification rates in state of health compared to the AG and RP groups in the activity (64 ± 9%, 19 ± 7%, 1 ± 15%) , impact (35 ± 5%, 20 ± 18%, 1 ± 14%) and total (41 ± 9%, 26 ± 17%, 1 ± 15%) domains assessed by the SGRQ, and the physical function (109 ± 74%, 22 ± 12%, 0.1 ± 18%), physical role (52 ± 36%, 11 ± 15%, 1.3 ± 21%) and vitality (83 ± 39%, 14 ± 38%) domains assessed by SF-36. CONCLUSION: These results suggest that combined training in subjects with COPD appears to be a more effective method, with better clinical changes, and improvements in health state perception