Translation to practice: a randomised controlled study of an evidenced based booklet targeted at breast care nurses in the United Kingdom

BACKGROUND: In the United Kingdom (UK), it was documented that a problem of knowledge transfer existed within the speciality of breast-cancer care, thus depriving patients of receiving optimal care. Despite increasingly robust research evidence indicating recommendation of whole body exercise for people affected by breast cancer, commensurate changes to practice were not noted amongst breast-care nurses (BCNs). AIM: To evaluate the effect of a targeted booklet, Exercise and Breast Cancer: A Booklet for Breast-Care Nurses, on changes in knowledge, reported practice, and attitudes of BCNs in the UK. METHOD: A prospective, experimental approach was used for designing a pre- and post-test randomised controlled study. Comparisons of knowledge, reported practice, and attitudes based on responses to a questionnaire were made at two time-points in two groups of BCNs (control and experimental). The unit of randomisation and analysis was hospital clusters of BCNs. The sample comprised 92 nurses from 62 hospitals. Analysis consisted of descriptive statistics and clustered regression techniques: clustered logistic regression for knowledge items, clustered linear regression for knowledge scores, ologit for attitude and reported practice items, and clustered multiple regression for paired and multiple variable analysis. RESULTS: A statistically significant increase in knowledge and changes in reported practice and attitudes were found. Robust variables affecting knowledge acquisition were: promotion of health, promotion of exercise, and understanding how exercise can reduce cancer-related fatigue. DISCUSSION: The study has shown that evidence-based printed material, such as an information booklet, can be used as an effective research dissemination method when developed for needs, values, and context of a target audience. CONCLUSIONS: This practical approach to research dissemination could be replicated and applied to other groups of nurses.</p

Self-help interventions for anxiety disorders: An overview.

Anxiety disorders are highly prevalent and are associated with a marked impairment in quality of life and a huge economic cost to society. Unfortunately, a considerable number of people who struggle with anxiety do not seek or receive adequate treatment. Self-help interventions have been proposed to constitute a relatively cheap, effective, efficient, and low-threshold intervention for anxiety disorders. This paper offers a critical discussion of their advantages and disadvantages and the evidence for their effectiveness. We conclude that guided self-help can play a major role in mental health care for patients with anxiety disorders. However, several research questions need to be answered before broad-scale dissemination is possible. The Internet will continue to play a prominent role in the further development of this field of research and clinical practice

New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2,3,4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

Longitudinal variability of mesospheric temperatures during equinox at middle and high latitudes

Airglow emission and temperature observations by the wind imaging interferometer (WINDII) on the upper atmosphere research satellite (UARS) and ground-based stations revealed a rapid 2-day rise in the nighttime emission rate in springtime followed by a subsequent decrease in the magnitude, which was termed 'springtime transition'. A rapid temperature enhancement was also revealed in the average annual temperature at 87 kin height, employing observations from 1991 to 1997 and more recent temperature data from 1998 to 1999. Large amplitude perturbations in mesospheric Na-lidar and OH rotational temperatures at 87 km around the autumnal equinox at mid-latitudes were also reported. Recently it has been suggested that the observed fall perturbation is a signature of mesospheric planetary waves of zonal wavenumber 1 (hereafter a wave 1) in the Northern hemisphere. The current study extends earlier work on mesospheric temperatures from the WINDII/UARS experiment and complementary ground-based observations to examine global spatial and temporal characteristics of the equinox transition at 87 km height. A 7-year climatology at middle and high latitudes, 40-60degreesN is presented revealing a V-shaped signature of temperature decrease with amplitude of similar to25 K below the annual mean and a duration of 3-4 weeks depending on the year, following fall equinox (Day 257-284). Satellite and ground-based temperature observations were successfully combined to infer tidal information, a key to the interpretation of the results obtained. After accounting for the diurnal tidal perturbation a distinct planetary wave structure was revealed at latitudes from 45degreesN to 65degreesN. Longitudinal temperature variations show a drop at 140-180degreesE on Day 264 at 50degreesN which extends to at least 60degreesN accompanied by wave signatures. Spectral analysis indicated planetary waves with waves 1 and 2 planetary perturbations maximizing on Day 263-265 (September 20-22). Various waveforms were also identified (waves 3-6) from which a waveform with a wavenumber 4 appeared to be the third most persistent wave signature during the period with a period of about 4 days. The spectral analysis also revealed a depressed planetary wave activity following fall equinox. It is concluded that the observed temperature perturbation is the likely result of in situ generated gravity waves at 87 km superposed on the planetary wave 1 propagating upwards from below enhanced by the reversal of zonal mean wind flow at equinox

Relative intensities of middle atmosphere waves

Climatologies of gravity waves, quasi-stationary planetary waves, and tides are compared in the upper stratosphere, mesosphere, and lower thermosphere. Temperature standard deviations from zonal means are used as proxies for wave activity. The sum of the waves is compared to directly measured total temperature fluctuations. The resulting difference is used as a proxy for traveling planetary waves. A preliminary climatology for these waves is proposed. A ranking of the four wave types in terms of their impact on the total wave state of the atmosphere is achieved, which is dependent on altitude and latitude. At extratropical latitudes, gravity waves mostly play a major role. Traveling planetary waves are found to play a secondary role. Quasi-stationary planetary waves and tides yield a lesser contribution there. Vertical profiles of total temperature fluctuations show a sharp vertical gradient change("kink" or "bend") in the mesosphere. This is interpreted in terms of a change of wave damping, and the concept of a "wave turbopause" is suggested. The altitude of this wave turbopause is found to be mostly determined by the relative intensities of gravity waves and planetary waves. The turbopause is further analyzed, including earlier mass spectrometer data. It is found that the wave turbopause and the mass spectrometer turbopause occur rather close together. The turbopause forms a layer about 8 km thick, and the data suggest an additional 3 km mixing layer on top