Assessing Physical Activity and Sleep in Axial Spondyloarthritis: Measuring the Gap.

Patients with axial spondyloarthritis (axSpA) frequently report pain, stiffness, fatigue, and sleep problems, which may lead to impaired physical activity. The majority of reported-on measures evaluating physical activity and sleep disturbance in axSpA are self-reported questionnaires, which can be impacted by patient recall (reporting bias). One objective measure, polysomnography, has been employed to evaluate sleep in patients with axSpA; however, it is an intrusive measure and cannot be used over the long term. More convenient objective measures are therefore needed to allow for the long-term assessment of both sleep and physical activity in patients\u27 daily lives. Wearable technology that utilizes actigraphy is increasingly being used for the objective measurement of physical activity and sleep in various therapy areas, as it is unintrusive and suitable for continuous tracking to allow longitudinal assessment. Actigraphy characterizes sleep disruption as restless movement while sleeping, which is particularly useful when studying conditions such as axSpA in which chronic pain and discomfort due to stiffness may be evident. Studies have also shown that actigraphy can effectively assess the impact of disease on physical activity. More research is needed to establish the usefulness of objective monitoring of sleep and physical activity specifically in axSpA patients over time. This review summarizes the current perspectives on physical activity and sleep quality in patients with axSpA, and the possible role of actigraphy in the future to more accurately evaluate the impact of treatment interventions on sleep and physical activity in axSpA.Funding: Novartis Pharmaceuticals Corporation.Plain Language Summary: Plain language summary available for this article

Erforschung der Zusammenhänge von elterlichem Belastungsempfinden und binnendifferenzierenden digitalen Lernmaterialien in Zeiten der Corona-Pandemie

Die Corona-Pandemie führt zu zahlreichen Herausforderungen für Lehrkräfte und Schüler*innen. Die meist digital aufbereiteten Lernmaterialien sollten vor allem während des Lockdowns nur wenig Unterstützung seitens der Lehrkräfte erfordern und die Schüler*innen größtenteils zum selbstständigen Arbeiten befähigen. Dies bedeutete daher für die Lehrkräfte, möglichst binnendifferenzierendes Material zu entwickeln und digital umzusetzen, was z.T. ganz neue Ansätze erforderte. Auch für Eltern ergab sich durch das Homeschooling eine neue Situation, da sie die Rolle der Lehrkräfte zumindest in Teilen mitübernehmen und ihre Kinder beim Lernen zu Hause unterstützen müssen. In diesem Kontext ist davon auszugehen, dass Eltern durch diese zusätzliche Aufgabe neben ihrer eigenen Berufstätigkeit sowie angesichts nicht immer passgenauer Lernmaterialien für ihre Kinder eine Mehrbelastung erfahren. Dieser Beitrag geht der Thematik des Homeschoolings und der digital zur Verfügung gestellten Materialien nach und greift auf Ergebnisse einer Onlinebefragung von 635 Eltern in Rheinland-Pfalz zurück, die während der Schulschließung durchgeführt wurde. Dabei wird zum einen untersucht, wie das Belastungsempfinden der Eltern in dieser Zeit ausgeprägt ist und welche individuellen Faktoren dieses beeinflussen. Zum anderen wird analysiert, wie das Belastungsempfinden mit der Qualität der bereitgestellten Materialien und der eingeschätzten Medienkompetenz der Lehrkräfte zusammenhängt. Es zeigt sich, dass das Belastungserleben neben persönlichen Unterschieden auch durch die Gestaltung des Lehrmaterials beeinflusst wird

Direct cooling of the catheter tip increases safety for CMR-guided electrophysiological procedures

<p>Abstract</p> <p>Background</p> <p>One of the safety concerns when performing electrophysiological (EP) procedures under magnetic resonance (MR) guidance is the risk of passive tissue heating due to the EP catheter being exposed to the radiofrequency (RF) field of the RF transmitting body coil. Ablation procedures that use catheters with irrigated tips are well established therapeutic options for the treatment of cardiac arrhythmias and when used in a modified mode might offer an additional system for suppressing passive catheter heating.</p> <p>Methods</p> <p>A two-step approach was chosen. Firstly, tests on passive catheter heating were performed in a 1.5 T Avanto system (Siemens Healthcare Sector, Erlangen, Germany) using a ASTM Phantom in order to determine a possible maximum temperature rise. Secondly, a phantom was designed for simulation of the interface between blood and the vascular wall. The MR-RF induced temperature rise was simulated by catheter tip heating via a standard ablation generator. Power levels from 1 to 6 W were selected. Ablation duration was 120 s with no tip irrigation during the first 60 s and irrigation at rates from 2 ml/min to 35 ml/min for the remaining 60 s (Biotronik Qiona Pump, Berlin, Germany). The temperature was measured with fluoroscopic sensors (Luxtron, Santa Barbara, CA, USA) at a distance of 0 mm, 2 mm, 4 mm, and 6 mm from the catheter tip.</p> <p>Results</p> <p>A maximum temperature rise of 22.4°C at the catheter tip was documented in the MR scanner. This temperature rise is equivalent to the heating effect of an ablator's power output of 6 W at a contact force of the weight of 90 g (0.883 N). The catheter tip irrigation was able to limit the temperature rise to less than 2°C for the majority of examined power levels, and for all examined power levels the residual temperature rise was less than 8°C.</p> <p>Conclusion</p> <p>Up to a maximum of 22.4°C, the temperature rise at the tissue surface can be entirely suppressed by using the catheter's own irrigation system. The irrigated tip system can be used to increase MR safety of EP catheters by suppressing the effects of unwanted passive catheter heating due to RF exposure from the MR scanner.</p

Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force

Therapeutic targets have been defined for axial and peripheral spondyloarthritis (SpA) in 2012, but the evidence for these recommendations was only of indirect nature. These recommendations were re-evaluated in light of new insights. Based on the results of a systematic literature review and expert opinion, a task force of rheumatologists, dermatologists, patients and a health professional developed an update of the 2012 recommendations. These underwent intensive discussions, on site voting and subsequent anonymous electronic voting on levels of agreement with each item. A set of 5 overarching principles and 11 recommendations were developed and voted on. Some items were present in the previous recommendations, while others were significantly changed or newly formulated. The 2017 task force arrived at a single set of recommendations for axial and peripheral SpA, including psoriatic arthritis (PsA). The most exhaustive discussions related to whether PsA should be assessed using unidimensional composite scores for its different domains or multidimensional scores that comprise multiple domains. This question was not resolved and constitutes an important research agenda. There was broad agreement, now better supported by data than in 2012, that remission/inactive disease and, alternatively, low/minimal disease activity are the principal targets for the treatment of PsA. As instruments to assess the patients on the path to the target, the Ankylosing Spondylitis Disease Activity Score (ASDAS) for axial SpA and the Disease Activity index for PSoriatic Arthritis (DAPSA) and Minimal Disease Activity (MDA) for PsA were recommended, although not supported by all. Shared decision-making between the clinician and the patient was seen as pivotal to the process. The task force defined the treatment target for SpA as remission or low disease activity and developed a large research agenda to further advance the field

The determinants of conversion rates in SME e-commerce websites

© 2017 Web retailers invest significant resources to improve the proportion of website visitors that make a purchase, also known as the conversion rate. Improving this rate is particularly important to SMEs that have traditionally lagged behind larger firms as they have found it difficult to justify the significant investment involved in website development against the historical low returns associated with an online sales channel. Identifying methods that increase conversion rates reduces these perceived barriers and increases effective SME participation in the growing e-commerce sector. This paper uses 1184 observations from 6 SME websites to identify and analyse the factors, or combination of factors, that improve conversion rates. This is achieved through a process of exploratory regression analysis to select the most relevant determinants and Qualitative Comparative Analysis (QCA) to offer more ‘fine-grained’ detail on the conditions where conversion rates improve. Our findings suggest that a key factor that improves the conversion rate is a strategy that focuses upon either quality or promotion and avoids mixing such attributes within the web site offer