Development and Usability Testing of a Computer-Tailored Decision Support Tool for Lung Cancer Screening: Study Protocol

Background: Awareness of lung cancer screening remains low in the screening-eligible population, and when patients visit their clinician never having heard of lung cancer screening, engaging in shared decision making to arrive at an informed decision can be a challenge. Therefore, methods to effectively support both patients and clinicians to engage in these important discussions are essential. To facilitate shared decision making about lung cancer screening, effective methods to prepare patients to have these important discussions with their clinician are needed. Objective: Our objective is to develop a computer-tailored decision support tool that meets the certification criteria of the International Patient Decision Aid Standards instrument version 4.0 that will support shared decision making in lung cancer screening decisions. Methods: Using a 3-phase process, we will develop and test a prototype of a computer-tailored decision support tool in a sample of lung cancer screening-eligible individuals. In phase I, we assembled a community advisory board comprising 10 screening-eligible individuals to develop the prototype. In phase II, we recruited a sample of 13 screening-eligible individuals to test the prototype for usability, acceptability, and satisfaction. In phase III, we are conducting a pilot randomized controlled trial (RCT) with 60 screening-eligible participants who have never been screened for lung cancer. Outcomes tested include lung cancer and screening knowledge, lung cancer screening health beliefs (perceived risk, perceived benefits, perceived barriers, and self-efficacy), perception of being prepared to engage in a patient-clinician discussion about lung cancer screening, occurrence of a patient-clinician discussion about lung cancer screening, and stage of adoption for lung cancer screening. Results: Phases I and II are complete. Phase III is underway. As of July 15, 2017, 60 participants have been enrolled into the study, and have completed the baseline survey, intervention, and first follow-up survey. We expect to have results by December 31, 2017 and to have data analysis completed by March 1, 2018. Conclusions: Results from usability testing indicate that the computer-tailored decision support tool is easy to use, is helpful, and provides a satisfactory experience for the user. At the conclusion of phase III (pilot RCT), we will have preliminary effect sizes to inform a future fully powered RCT on changes in (1) knowledge about lung cancer and screening, (2) perceived risk of lung cancer, (3) perceived benefits of lung cancer screening, (4) perceived barriers to lung cancer screening, (5) self-efficacy for lung cancer screening, and (6) perceptions of being adequately prepared to engage in a discussion with their clinician about lung cancer screening

Shoreline Evolution Chesapeake Bay Shoreline Northampton County, VA

Shoreline evolution is the change in shore position through time. In fact, it is the material resistance of the coastal geologic underpinnings against the impinging hydrodynamic (and aerodynamic) forces. Along the shores of the Chesapeake Bay, it is a process-based response system. The processes at work include winds, waves, tides, and currents, which together provide the energy which shapes and modifies coastlines by eroding, transporting, and depositing sediments. The shore line is commonly plotted and measured to provide a rate of change, but it is as important to understand the geomorphic patterns of change. Shore analysis provides the basis to know how a particular coast has changed through time and how it may proceed in the future. The purpose of this report is to document how the Bay shore of Northampton County, Virginia (Figure 1) has evolved since 1938. Aerial imagery was taken for most of the Bay region beginning that year, and it is this imagery that allows one to assess the geomorphic nature of shore change. Aerial imagery shows how the nature of the coast has changed, how beaches, dunes, bars, and spits have grown or decayed, how barriers have breached, how inlets have changed course, and how one shore type has displaced another or has not changed at all. Shore change is a natural process but, quite often, the impacts of man through shore hardening or inlet stabilization come to dominate a given shore reach. Most of the shore positions will be quantified in this report. Others, particularly very irregular coasts, around inlets, and other areas will be subject to interpretation

Shoreline evolution, Chesapeake Bay shoreline, City of Virginia Beach, Virginia

Shoreline evolution is the change in shore position through time. In fact, it is the material resistance of the coastal geologic underpinnings against the impinging hydrodynamic (and aerodynamic) forces. Along the shores of Chesapeake Bay, it is a process-response system. The processes at work include winds, waves, tides and currents, which shape and modify coastlines by eroding, transporting and depositing sediments. The shore line is commonly plotted and measured to provide a rate of change but it is as important to understand the geomorphic patterns of change. Shore analysis provides the basis to know how a particular coast has changed through time and how it might proceed in the future. The purpose of this report is to document how the Bay shore of Virginia Beach (Figure 1) has evolved since 1937. Aerial imagery was taken for most of the Bay region beginning that year, and it is this imagery that allows one to assess the geomorphic nature of shore change. Aerial imagery shows how the nature of the coast has changed, how beaches, dunes, bars, and spits have grown or decayed, how barriers have breached, how inlets have changed course, and how one shore type has displaced another or has not changed at all. Shore change is a natural process but, quite often, the impacts of man through shore hardening or inlet stabilization come to dominate a given shore reach. Most of the change in shore positions will be quantified in this report. Others, particularly very irregular coasts, around inlets, and other areas will be subject to interpretation

Shoreline Evolution Chesapeake Bay Shoreline City of Norfolk, VA

Shoreline evolution is the change in shore position through time. In fact, it is the material resistance of the coastal geologic underpinnings against the impinging hydrodynamic (and aerodynamic) forces. Along the shores of Chesapeake Bay, it is a process-response system. The processes at work include winds, waves, tides and currents, which together shape and modify coastlines by eroding, transporting and depositing sediments. The shore line is commonly plotted and measured to provide a rate of change, but it is as important to understand the geomorphic patterns of change. Shore analysis provides the basis to know how a particular coast has changed through time and how it might proceed in the future. The purpose of this report is to document how the Chesapeake Bay shore of Norfolk (Figure 1) has evolved since 1937. This is the first year that aerial imagery was taken for most of the Bay region, and it is this imagery that allows one to assess the geomorphic nature of shore change. Aerial imagery shows how the nature of the coast has changed, how beaches, dunes, bars and spits have grown or decayed, how barriers have breached, how inlets have changed course and how one shore type has displaced another or has not changed at all. Shore change is a natural process but, quite often, the impacts of man through shore hardening, beach nourishment or inlet stabilization will come to dominate a given shore reach. Most of the change in shore positions will be quantified in this report. Others, particularly around inlets and very irregular coasts, will be interpreted

The Chesapeake Bay Breakwater Database Project Hurricane Isabel Impacts to Four Breakwater Systems

The Chesapeake Bay Breakwater Database is being developed by personnel in the Virginia Institute of Marine Science’s (VIMS) Shoreline Studies Program for the U.S. Army Corps of Engineers (COE) in order to: 1) document breakwater system performance around Chesapeake Bay relative to predictions 2) develop guidelines for breakwaters in sand limited and fetch limited systems such as estuaries, reservoirs, lakes and bays

Chesapeake Bay Dune Systems: Monitoring

This project is aimed at developing an understanding of detailed beach and dune change. During the course of this monitoring, Hurricane Isabel impacted the coastal plain of Virginia and significantly altered almost all Bay shorelines to one degree or another in September 2003. This is particularly true of shorelines facing north, east, and south since the winds shifted as the storm passed. This event provided an opportunity to measure the changes to natural dune systems around the Bay due to the storm as well as their recovery after the event

Supporting patients to prepare for total knee replacement: evidence-, theory- and person-based development of a ‘Virtual Knee School’ digital intervention

Introduction Digital delivery of pre-operative total knee replacement (TKR) education and prehabilitation could improve patient outcomes pre- and post-operatively. Rigorously developing digital interventions is vital to help ensure they achieve their intended outcomes whilst mitigating their potential drawbacks. Objective To develop a pre-operative TKR education and prehabilitation digital intervention, the ‘Virtual Knee School’ (VKS). Methods The VKS was developed using an evidence-, theory- and person-based approach. This involved a mixed methods design with four phases. The first three focused on planning the VKS. The final phase involved creating a VKS prototype and iteratively refining it through concurrent think-aloud interviews with nine patients who were awaiting/had undergone TKR. Meta-inferences were generated by integrating findings from all the phases. Results Most participants found the VKS prototype acceptable overall and considered it a valuable resource. Conversely, a minority of participants felt the prototype’s digital format or content did not meet their individual needs. Participants’ feedback was used to refine the prototype’s information architecture, design, and content. Two meta-inferences were generated and recommend: 1.Comprehensive pre-operative TKR education and prehabilitation support should be rapidly accessible in digital and non-digital formats. 2.Pre-operative TKR digital interventions should employ computer- and self-tailoring to account for patients’ individual needs and preferences. Conclusions Integrating evidence, theory, and stakeholders’ perspectives enabled the development of a promising VKS digital intervention for patients awaiting TKR. The findings suggest future research evaluating the VKS is warranted and provide recommendations for optimising pre-operative TKR care. Patient or Public contribution Patient and Public Involvement (PPI) was central throughout the project. For example, PPI representatives contributed to the project planning, were valued members of the Project Advisory Group, had key roles in developing the VKS prototype, and helped disseminate the project findings

Content and delivery of pre-operative interventions for patients undergoing total knee replacement: A rapid review

Background: Total knee replacement (TKR) is a common operation typically performed for end-stage knee osteoarthritis. Patients awaiting TKR often have poor health-related quality of life. Approximately 20% of patients experience persistent pain post-TKR. Pre-operative TKR interventions could improve pre- and post-operative outcomes, but future research is required to inform their design. This review aimed to identify and synthesize recent literature on the content and delivery of pre-operative TKR interventions to help guide future research and clinical practice. Methods: This rapid review included randomized trials of pre-operative TKR interventions (‘outcomes studies’) and primary studies exploring patients’ and/or health professionals’ views of pre-operative TKR interventions (‘views studies’). Medline, Embase, PsycINFO, CINAHL and the Cochrane Central Register of Controlled Trials were searched for English language studies published between January 2009 and December 2020. Eligible studies’ reference lists were screened. Studies were appraised using the Mixed Methods Appraisal Tool. The findings were narratively synthesized using a convergent segregated approach. Results: From 3263 records identified, 52 studies were included (29 outcomes studies, 21 views studies, two outcomes/views studies). The studies’ methodological quality varied but was generally highest in qualitative studies. The outcomes studies investigated education (n=5), exercise (n=20), psychological (n=2), lifestyle (n=1) and/or other interventions (n=5). The views studies addressed education (n=20), exercise (n=3), psychological (n=1), lifestyle (n=4) and/or other interventions (n=1). Only three outcomes studies (two randomized controlled trials (RCTs) and a pilot study) compared the effectiveness of intervention components/delivery approaches. The two RCTs’ results suggest that pre-operative TKR exercise interventions are equally effective regardless of whether they include strength or strength plus balance training and whether they are hospital- or home-based. Personal tailoring and using more than one delivery format were associated with improved outcomes and/or perceived as beneficial for multiple intervention types. Conclusions: Definitive evidence on the optimal design of pre-operative TKR interventions is lacking. Personal tailoring and employing multiple delivery formats appear to be valuable design elements. Preliminary evidence suggests that including balance training and hospital versus home delivery may not be critical design elements for pre-operative TKR exercise interventions

Transplacental Transmission of Leishmania infantum as a Means for Continued Disease Incidence in North America

Dogs are a favored feeding source for sand flies that transmit human L. infantum infection. Zoonotic visceral leishmaniasis (ZVL) is an emerging problem in some U.S. dog breeds, with over 20% of at-risk Foxhounds infected. Although classically Leishmania is transmitted by infected sand flies which exist in the United States, no role has yet been determined for vector-borne transmission. Means of ongoing L. infantum transmission in U.S. dogs is unknown. Possibilities include transplacental and horizontal/venereal transmission. Aims for this study were to establish whether transplacental transmission occurred in Leishmania-infected U.S. dogs and determine the effect of this transmission on immune recognition of Leishmania. This novel report describes wide-spread infection as identified by kqPCR in 8 day-old pups born to a naturally-infected, seropositive U.S. dog with no travel history. This is the first report of transplacental transmission of L. infantum in naturally-infected dogs in North America. Evidence that mom-to-pup transmission of ZVL may continue disease in an otherwise non-endemic region has significant implications on current control strategies for ZVL. Determining frequency of vertical transmission and incorporating canine sterilization with vector control may have a more significant impact on ZVL transmission to people in endemic areas than current control efforts

Acute Regulation of Cardiac Metabolism by the Hexosamine Biosynthesis Pathway and Protein O-GlcNAcylation

OBJECTIVE: The hexosamine biosynthesis pathway (HBP) flux and protein O-linked N-acetyl-glucosamine (O-GlcNAc) levels have been implicated in mediating the adverse effects of diabetes in the cardiovascular system. Activation of these pathways with glucosamine has been shown to mimic some of the diabetes-induced functional and structural changes in the heart; however, the effect on cardiac metabolism is not known. Therefore, the primary goal of this study was to determine the effects of glucosamine on cardiac substrate utilization. METHODS: Isolated rat hearts were perfused with glucosamine (0-10 mM) to increase HBP flux under normoxic conditions. Metabolic fluxes were determined by (13)C-NMR isotopomer analysis; UDP-GlcNAc a precursor of O-GlcNAc synthesis was assessed by HPLC and immunoblot analysis was used to determine O-GlcNAc levels, phospho- and total levels of AMPK and ACC, and membrane levels of FAT/CD36. RESULTS: Glucosamine caused a dose dependent increase in both UDP-GlcNAc and O-GlcNAc levels, which was associated with a significant increase in palmitate oxidation with a concomitant decrease in lactate and pyruvate oxidation. There was no effect of glucosamine on AMPK or ACC phosphorylation; however, membrane levels of the fatty acid transport protein FAT/CD36 were increased and preliminary studies suggest that FAT/CD36 is a potential target for O-GlcNAcylation. CONCLUSION/INTERPRETATION: These data demonstrate that acute modulation of HBP and protein O-GlcNAcylation in the heart stimulates fatty acid oxidation, possibly by increasing plasma membrane levels of FAT/CD36, raising the intriguing possibility that the HBP and O-GlcNAc turnover represent a novel, glucose dependent mechanism for regulating cardiac metabolism