Therapy-based exercise from the perspective of adult patients: a qualitative systematic review conducted using an ethnographic approach

© The Author(s) 2019.Objectives: Many patients do not meet recommended levels of therapy-based exercise. This review aims to explore how adult patients view being prescribed therapy-based exercise, the information/education they are given and receive and if/how they independently practise and adhere. Design: A qualitative systematic review conducted using an ethnographic approach and in accordance with the PRISMA statement. Sources: PubMed, CINAHL, SCOPUS and EMBASE databases (01 January 2000–31 December 2018). Methods: Qualitative studies with a focus on engagement/adherence with therapy-based exercise were included. Data extraction and quality appraisal were undertaken by two reviewers. Results were discussed and data synthesized. Results: A total of 20,294 titles were screened, with data extracted from 39 full texts and data from 18 papers used to construct three themes. ‘The Guidance received’ suggests that the type of delivery desired to support and sustain engagement was context-dependent and individually situated. ‘The Therapist as teacher’ advocates that patients see independent therapy-based exercise as a shared activity and value caring, kind and professional qualities in their therapist. ‘The Person as learner’ proposes that when having to engage with and practise therapy-based exercise because of ill-health, patients often see themselves as new learners who experience fear and uncertainty about what to do. Patients may have unacknowledged ambivalences about learning that impact on engagement and persistence. Conclusion: The quality of the interaction between therapists and patients appears integral to patients engaging with, and sustaining practice of, rehabilitation programmes. Programmes need to be individualized, and health care professionals need to take patients’ previous experiences and ambivalences in motivation and empowerment into account.Peer reviewe

Planning for tomorrow whilst living for today: the views of people with dementia and their families on Advance Care Planning

Background: Advance care planning (ACP) is increasingly prominent in many countries; however, the evidence base for its acceptability and effectiveness is limited especially in conditions where cognition is impaired, as in dementia. Method: This qualitative study used semi-structured interviews with people with mild to moderate dementia (n = 17) and family carers (n = 29) to investigate their views about planning for their future generally and ACP specifically. Results: People with dementia and their families make a number of plans for the future. Most people undertook practical, personal, financial, and legal planning. However participants did not make formal advance care plans with the exception of appointing someone to manage their financial affairs. Five barriers to undertaking ACP were identified: lack of knowledge and awareness, difficulty in finding the right time, a preference for informal plans over written documentation, constraints on choice around future care, and lack of support to make choices about future healthcare. Conclusions: Health and social care professionals can build on people's preferences for informal planning by exploring the assumptions underlying them, providing information about the possible illness trajectory and discussing the options of care available. Health and social care professionals also have a role to play in highlighting the aspects of ACP which seem to be most relevant to the wishes and aspirations of people with dementia

Visual Sensory Experiences From the Viewpoint of Autistic Adults

Although previous research has investigated altered sensory reactivity in autistic individuals, there has been no specific focus on visual sensory experiences, particularly in adults. Using qualitative methods, this study aimed to characterize autistic visual sensory symptoms, contextualize their impact and document any associated coping strategies. A total of 18 autistic adults took part in four focus groups which involved questions around visual experiences, the impact of these on daily life, and strategies for their reduction. Transcripts of each session were thematically analyzed allocating six key themes. Participants described a range of visual hypersensitivities, including to light, motion, patterns and particular colors, which contributed to distraction and were frequently part of a wider multisensory issue. Such experiences had significant negative impacts on personal wellbeing and daily life with participants describing fatigue, stress and hindrances on day-to-day activities (e.g., travel and social activities). However, the degree of understanding that participants had about their visual experiences influenced their emotional response, with greater understanding reducing concern. Participants employed a variety of coping strategies to overcome visual sensory experiences but with varied success. Discussions also highlighted that there may be a poor public understanding of sensory issues in autism affecting how well autistic individuals are able manage their sensory symptoms. In summary, autistic adults expressed significant concern about their visual experiences and there is a need to improve understanding of visual experiences on a personal and public level as well as for developing potential support

Exploring the relationship between extracurricular activities and student self-efficacy within university.

This exploratory study addresses a gap in the literature for the potential in assessing domain-specific self-efficacy within the context of Higher Education (HE). Focusing on HE students’ participation in extracurricular activities (ECAs), the study builds on the authors’ previous research which recognised the impact of ECAs on HE students’ lived experiences. An initial sample of two hundred and ninety-four students from a from a post-92 Higher Education Institution (HEI) in the North of England (UK) completed a survey designed to measure self-concepts of student self-efficacy, encompassing academic and social tasks, and fifty-four of those students completed a follow-up survey. The key finding was that there is a positive association between involvement in certain ECAs and self-efficacy in students within the university context. Furthermore, the results indicate a relationship between engagement with certain ECA-types and specific domains of self-efficacy. These findings have important implications in that supporting students to develop higher levels of self-efficacy specific to the university setting could have an impact on key HE outcomes, such as employability. Further research needs to be undertaken to establish if there is a causal link between involvement in ECAs and the development of self-efficacy whilst at university

CLEAR I: Ages and Metallicities of Quiescent Galaxies at 1.0<z<1.8\mathbf{1.0 < z < 1.8} Derived from Deep Hubble Space Telescope Grism Data

We use deep \textit{Hubble Space Telescope} spectroscopy to constrain the metallicities and (\editone{light-weighted}) ages of massive ($\log M_\ast/M_\odot\gtrsim10$) galaxies selected to have quiescent stellar populations at $1.0<z<1.8$. The data include 12--orbit depth coverage with the WFC3/G102 grism covering $\sim$ $8,000<\lambda<11,500$~\AA\, at a spectral resolution of $R\sim 210$ taken as part of the CANDELS Lyman-$\alpha$ Emission at Reionization (CLEAR) survey. At $1.0<z<1.8$, the spectra cover important stellar population features in the rest-frame optical. We simulate a suite of stellar population models at the grism resolution, fit these to the data for each galaxy, and derive posterior likelihood distributions for metallicity and age. We stack the posteriors for subgroups of galaxies in different redshift ranges that include different combinations of stellar absorption features. Our results give \editone{light-weighted ages of $t_{z \sim 1.1}= 3.2\pm 0.7$~Gyr, $t_{z \sim 1.2}= 2.2\pm 0.6$~Gyr, $t_{z\sim1.3}= 3.1\pm 0.6$~Gyr, and $t_{z\sim1.6}= 2.0 \pm 0.6$~Gyr, \editone{for galaxies at $z\sim 1.1$, 1.2, 1.3, and 1.6. This} implies that most of the massive quiescent galaxies at $168$\% of their stellar mass by a redshift of $z>2$}. The posteriors give metallicities of \editone{$Z_{z\sim1.1}=1.16 \pm 0.29$~$Z_\odot$, $Z_{z\sim1.2}=1.05 \pm 0.34$~$Z_\odot$, $Z_{z\sim1.3}=1.00 \pm 0.31$~$Z_\odot$, and $Z_{z\sim1.6}=0.95 \pm 0.39$~$Z_\odot$}. This is evidence that massive galaxies had enriched rapidly to approximately Solar metallicities as early as $z\sim3$.Comment: 32 pages, 23 figures, Resubmited to ApJ after revisions in response to referee repor

Multiple transcriptome mining coupled with tissue specific molecular cloning and mass spectrometry provide insights into agatoxin-like peptide conservation in decapod crustaceans

Over the past decade, in silico genome and transcriptome mining has led to the identification of many new crustacean peptide families, including the agatoxin-like peptides (ALPs), a group named for their structural similarity to agatoxin, a spider venom component. Here, analysis of publicly accessible transcriptomes was used to expand our understanding of crustacean ALPs. Specifically, transcriptome mining was used to investigate the phylogenetic/structural conservation, tissue localization, and putative functions of ALPs in decapod species. Transcripts encoding putative ALP precursors were identified from one or more members of the Penaeoidea (penaeid shrimp), Sergestoidea (sergestid shrimps), Caridea (caridean shrimp), Astacidea (clawed lobsters and freshwater crayfish), Achelata (spiny/slipper lobsters), and Brachyura (true crabs), suggesting a broad, and perhaps ubiquitous, conservation of ALPs in decapods. Comparison of the predicted mature structures of decapod ALPs revealed high levels of amino acid conservation, including eight identically conserved cysteine residues that presumably allow for the formation of four identically positioned disulfide bridges. All decapod ALPs are predicted to have amidated carboxyl-terminals. Two isoforms of ALP appear to be present in most decapod species, one 44 amino acids long and the other 42 amino acids in length, both likely generated by alternative splicing of a single gene. In carideans, a gene or terminal exon duplication appears to have occurred, with alternative splicing producing four ALPs, two 44 and two 42 amino acid isoforms. The identification of ALP precursor-encoding transcripts in nervous system-specific transcriptomes (e.g., Homarus americanus brain, eyestalk ganglia, and cardiac ganglion assemblies, finding confirmed using RT-PCR) suggests that members of this peptide family may serve as locally-released and/or hormonally-delivered neuromodulators in decapods. Their detection in testis- and hepatopancreas-specific transcriptomes suggests that members of the ALP family may also play roles in male reproduction and innate immunity/detoxification

Interaction of Oral Bacteria With Gingival Epithelial Cell Multilayers

Primary gingival epithelial cells were cultured in multilayers as a model for the study of interactions with oral bacteria associated with health and periodontal disease. Multilayers maintained at an air-liquid interface in low calcium medium displayed differentiation and cytokeratin properties characteristic of junctional epithelium. Multilayers were infected with fluorescently labeled Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum or Streptococcus gordonii, and bacterial association was determined by confocal microscopy and quantitative image analysis. P. gingivalis invaded intracellularly and spread cell to cell. A. actinomycetemcomitans and F. nucleatum remained extracellular and showed intercellular movement through the multilayer. S. gordonii remained extracellular and predominantly associated with the superficial cell layer. None of the bacterial species disrupted barrier function as measured by transepithelial electrical resistance. P. gingivalis did not elicit secretion of proinflammatory cytokines. However, A. actinomycetemcomitans and S. gordonii induced IL-1β, TNF-α, IL-6 and IL-8 secretion; and F. nucleatum stimulated production of IL-1β and TNF-α. A. actinomycetemcomitans, F. nucleatum and S. gordonii, but not P. gingivalis, increased levels of apoptosis after 24 h infection. The results indicate that the organisms with pathogenic potential were able to traverse the epithelium, while the commensal bacteria did not. In addition, distinct host responses characterized the interaction between the junctional epithelium and oral bacteria

The mass evolution of the first galaxies: stellar mass functions and star formation rates at 4<z<74 < z < 7 in the CANDELS GOODS-South field

We measure new estimates for the galaxy stellar mass function and star formation rates for samples of galaxies at $z \sim 4,~5,~6~\&~7$ using data in the CANDELS GOODS South field. The deep near-infrared observations allow us to construct the stellar mass function at $z \geq 6$ directly for the first time. We estimate stellar masses for our sample by fitting the observed spectral energy distributions with synthetic stellar populations, including nebular line and continuum emission. The observed UV luminosity functions for the samples are consistent with previous observations, however we find that the observed $M_{UV}$ - M$_{*}$ relation has a shallow slope more consistent with a constant mass to light ratio and a normalisation which evolves with redshift. Our stellar mass functions have steep low-mass slopes ($\alpha \approx -1.9$), steeper than previously observed at these redshifts and closer to that of the UV luminosity function. Integrating our new mass functions, we find the observed stellar mass density evolves from $\log_{10} \rho_{*} = 6.64^{+0.58}_{-0.89}$ at $z \sim 7$ to $7.36\pm0.06$ $\text{M}_{\odot} \text{Mpc}^{-3}$ at $z \sim 4$. Finally, combining the measured UV continuum slopes ($\beta$) with their rest-frame UV luminosities, we calculate dust corrected star-formation rates (SFR) for our sample. We find the specific star-formation rate for a fixed stellar mass increases with redshift whilst the global SFR density falls rapidly over this period. Our new SFR density estimates are higher than previously observed at this redshift.Comment: 28 pages, 23 figures, 2 appendices. Accepted for publication in MNRAS, August 7 201

Durable Response After Tisagenlecleucel in Adults With Relapsed/Refractory Follicular Lymphoma: ELARA Trial Update

Tisagenlecleucel is approved for adults with relapsed/refractory (r/r) follicular lymphoma (FL) in the ≥3rd-line setting. The primary analysis (median follow-up: 17 months) of the Phase II ELARA trial (ClinicalTrials.gov identifier: NCT03568461) reported high response rates and excellent safety profile in extensively pretreated patients with r/r FL. Here we report longer-term efficacy, safety, pharmacokinetic, and exploratory biomarker analyses after a median follow-up of 29 months. As of March 29, 2022, 97 patients with r/r FL (grades 1-3A) after ≥2 lines of therapy or who relapsed after autologous stem cell transplant received tisagenlecleucel infusion (0.6-6×108 CAR+ viable T cells). Bridging chemotherapy was allowed. Baseline clinical factors, tumor microenvironment (TME), blood soluble factors, and circulating blood cells were correlated with clinical response. Cellular kinetics were assessed by quantitative polymerase chain reaction. Median progression-free survival (PFS), duration of response (DOR), and overall survival (OS) were not reached after 29 months median follow-up (IQR, 22.2-37.7). Estimated 24-month PFS, DOR, and OS rates in all patients were 57.4% (95% CI, 46.2-67), 66.4% (95% CI, 54.3-76), and 87.7% (95% CI, 78.3-93.2). Complete response rate and overall response rate were 68.1% (95% CI, 57.7-77.3) and 86.2% (95% CI, 77.5-92.4), respectively. No new safety signals or treatment-related deaths were reported. Low levels of tumor-infiltrating LAG3+CD3+ exhausted T-cells and higher baseline levels of naïve CD8+ T-cells were associated with improved outcomes. Tisagenlecleucel continued to demonstrate highly durable efficacy and a favorable safety profile in this extended follow-up of 29 months in patients with r/r FL enrolled in ELARA