Adapting an Osteoarthritis Peer Mentorship Intervention for Remote Delivery to People Experiencing Socioeconomic Disadvantage: A Multi-Method Approach.

Background Osteoarthritis (OA) is a common musculoskeletal condition which can cause debilitating pain and other symptoms. OA is more prevalent, and the impact is greater, among people experiencing socioeconomic disadvantage. While peer support is a recommended strategy for addressing these health inequalities, evidence in this area is limited. We previously developed and feasibility tested an in-person OA peer mentorship intervention in a group with limited diversity. This study adapted the intervention for remote delivery to people experiencing socioeconomic disadvantage. Methods This multi-method study was informed by the ADAPT guidance. Focus groups and interviews were conducted with 20 adults with hip/knee OA experiencing socioeconomic disadvantage to explore barriers and enablers to engagement with remote OA peer mentorship. The findings and project team members' suggestions informed provisional adaptations. The intervention was further adapted and finalised through two participatory workshops conducted with five people with relevant lived experience, four community organisation representatives, and six Patient and Public Involvement (PPI) representatives; and four intervention delivery practice runs undertaken by four PPI representatives. Findings A wide range of barriers and enablers were identified to two target behaviours – using self-management strategies and attending remote OA peer mentorship sessions. The identified barriers/enablers and additional study activities led to various adaptations. These spanned the delivery and content of the peer mentor training, mentorship sessions, and supporting resources. The adapted intervention consists of six 1-h self-management support sessions delivered remotely by a trained peer mentor. The remote format is flexible, with support available for addressing barriers related to making videoconferencing calls. Conclusions This study rigorously and systematically adapted an in-person OA peer mentorship intervention for remote delivery to people experiencing socioeconomic disadvantage. Employing a multi-method approach with diverse partners was key to identifying what adaptations were required. Patient or Public Contribution PPI representatives played a central role in this study as project team members (two individuals), Project Advisory Group members (three individuals), and wider PPI group members (six additional individuals). This extensive PPI aimed to ensure the adapted OA peer mentorship intervention is useful, acceptable, and accessible to the people it aims to benefit. Trial Registration ISRCTN registration of the overall project was obtained on 18 May 2023 (ISRCTN78088278)

Association of metformin, sulfonylurea and insulin use with brain structure and function and risk of dementia and Alzheimer's disease: Pooled analysis from 5 cohorts

Objective To determine whether classes of diabetes medications are associated with cognitive health and dementia risk, above and beyond their glycemic control properties. Research design and methods Findings were pooled from 5 population-based cohorts: the Framingham Heart Study, the Rotterdam Study, the Atherosclerosis Risk in Communities (ARIC) Study, the Aging GeneEnvironment Susceptibility-Reykjavik Study (AGES) and the Sacramento Area Latino Study on Aging (SALSA). Differences between users and non-users of insulin, metformin and sulfonylurea were assessed in each cohort for cognitive and brain MRI measures using linear regression models, and cognitive decline and dementia/AD risk using mixed effect models and Cox regression analyses, respectively. Findings were then pooled using meta-analytic techniques, including 3,590 individuals with diabetes for the prospective analysis. Results After adjusting for potential confounders including indices of glycemic control, insulin use was associated with increased risk of new-onset dementia (pooled HR (95% CI) = 1.58 (1.18, 2.12);p = 0.002) and with a greater decline in global cognitive function (β = -0.014 ±0.007;p = 0.045). The associations with incident dementia remained similar after further adjustment for renal function and excluding persons with diabetes whose treatment was lifestyle change only. Insulin use was not related to cognitive function nor to brain MRI measures. No significant associations were found between metformin or sulfonylurea use and outcomes of brain function and structure. There was no evidence of significant betweenstudy heterogeneity. Conclusions Despite its advantages in controlling glycemic dysregulation and preventing complications, insulin treatment may be associated with increased adverse cognitive outcomes possibly due to a greater risk of hypoglycemia

The Concise Guide to PHARMACOLOGY 2023/24: Ion channels.

The Concise Guide to PHARMACOLOGY 2023/24 is the sixth in this series of biennial publications. The Concise Guide provides concise overviews, mostly in tabular format, of the key properties of approximately 1800 drug targets, and over 6000 interactions with about 3900 ligands. There is an emphasis on selective pharmacology (where available), plus links to the open access knowledgebase source of drug targets and their ligands (https://www.guidetopharmacology.org/), which provides more detailed views of target and ligand properties. Although the Concise Guide constitutes almost 500 pages, the material presented is substantially reduced compared to information and links presented on the website. It provides a permanent, citable, point-in-time record that will survive database updates. The full contents of this section can be found at http://onlinelibrary.wiley.com/doi/10.1111/bph.16178. Ion channels are one of the six major pharmacological targets into which the Guide is divided, with the others being: G protein-coupled receptors, nuclear hormone receptors, catalytic receptors, enzymes and transporters. These are presented with nomenclature guidance and summary information on the best available pharmacological tools, alongside key references and suggestions for further reading. The landscape format of the Concise Guide is designed to facilitate comparison of related targets from material contemporary to mid-2023, and supersedes data presented in the 2021/22, 2019/20, 2017/18, 2015/16 and 2013/14 Concise Guides and previous Guides to Receptors and Channels. It is produced in close conjunction with the Nomenclature and Standards Committee of the International Union of Basic and Clinical Pharmacology (NC-IUPHAR), therefore, providing official IUPHAR classification and nomenclature for human drug targets, where appropriate

Primordial Nucleosynthesis for the New Cosmology: Determining Uncertainties and Examining Concordance

Big bang nucleosynthesis (BBN) and the cosmic microwave background (CMB) have a long history together in the standard cosmology. The general concordance between the predicted and observed light element abundances provides a direct probe of the universal baryon density. Recent CMB anisotropy measurements, particularly the observations performed by the WMAP satellite, examine this concordance by independently measuring the cosmic baryon density. Key to this test of concordance is a quantitative understanding of the uncertainties in the BBN light element abundance predictions. These uncertainties are dominated by systematic errors in nuclear cross sections. We critically analyze the cross section data, producing representations that describe this data and its uncertainties, taking into account the correlations among data, and explicitly treating the systematic errors between data sets. Using these updated nuclear inputs, we compute the new BBN abundance predictions, and quantitatively examine their concordance with observations. Depending on what deuterium observations are adopted, one gets the following constraints on the baryon density: OmegaBh^2=0.0229\pm0.0013 or OmegaBh^2 = 0.0216^{+0.0020}_{-0.0021} at 68% confidence, fixing N_{\nu,eff}=3.0. Concerns over systematics in helium and lithium observations limit the confidence constraints based on this data provide. With new nuclear cross section data, light element abundance observations and the ever increasing resolution of the CMB anisotropy, tighter constraints can be placed on nuclear and particle astrophysics. ABRIDGEDComment: 54 pages, 20 figures, 5 tables v2: reflects PRD version minor changes to text and reference