Associations of quality of life, pain, and self-reported arthritis with age, employment, bleed rate, and utilization of hemophilia treatment center and health care provider services: results in adults with hemophilia in the HERO study

INTRODUCTION: Severe hemophilia and subsequent hemophilic arthropathy result in joint pain and impaired health-related quality of life (HRQoL). Assessment of HRQoL in persons with hemophilia (PWH), including underlying factors that drive HRQoL differences, is important in determining health care resource allocation and in making individualized clinical decisions. AIM: To examine potential associations between HRQoL, pain interference, and self-reported arthritis and age, employment, activity, bleed frequency, and hemophilia treatment center and health care professional utilization. METHODS: PWH (age ≥18 years) from ten countries completed a 5-point Likert scale on pain interference over the previous 4 weeks, the EQ-5D-3L scale (mobility, usual activities, self-care, pain/discomfort, anxiety/depression) including a health-related visual analog scale (0-100, coded as an 11-point categorical response). RESULTS: Pain interference (extreme/a lot) was higher in PWH aged \u3e40 years (31%) compared to those aged 31-40 years (27%) or ≤30 years (21%). In an analysis of eight countries with home treatment, PWH who reported EQ-5D mobility issues were less likely to be employed (53% vs 79%, with no mobility issues). Median annual bleed frequency increased with worsening EQ-5D pain or discomfort. The percentage of PWH with inhibitors reporting visual analog scale scores of 80-90-100 was lower (20%) than those without inhibitors (34%). Median bleed frequency increased with pain. Globally, nurse and social worker involvement increased with disability and pain; physiotherapist utilization was moderate regardless of the extent of disability or pain. CONCLUSION: Increased disability and pain were associated with increased age, lower employment, higher reported bleed frequency, and lower HRQoL

Women’s expectations and experiences in maternity care: how do women conceptualise the process of continuity?

Objective: to gain an understanding of how women conceptualise continuity of maternity care. Design: a qualitative study involving in-depth semi-structured interviews and thematic analysis. Setting: a range of urban and rural public hospitals in New South Wales, Australia. Participants: 53 women aged 18-44 years (median age 27 years) receiving maternity care in 2011 - 2012. Findings: responses from women suggested five types of continuity: continuity of staff, continuity of relationship, continuity of information, continuity across pregnancies, and continuity across locations. The types of continuity differed by parity and location. Conclusion and implications for practice: continuity of maternity care has a variety of meanings to women. If healthcare providers are to commit to providing woman-centred maternity care it is important to recognise the diversity of women’s experiences, and ensure that systems of care are flexible and appropriate to women’s circumstances and needs

Women’s expectations and experiences in maternity care: how do women conceptualise the process of continuity?

Objective: to gain an understanding of how women conceptualise continuity of maternity care. Design: a qualitative study involving in-depth semi-structured interviews and thematic analysis. Setting: a range of urban and rural public hospitals in New South Wales, Australia. Participants: 53 women aged 18-44 years (median age 27 years) receiving maternity care in 2011 - 2012. Findings: responses from women suggested five types of continuity: continuity of staff, continuity of relationship, continuity of information, continuity across pregnancies, and continuity across locations. The types of continuity differed by parity and location. Conclusion and implications for practice: continuity of maternity care has a variety of meanings to women. If healthcare providers are to commit to providing woman-centred maternity care it is important to recognise the diversity of women’s experiences, and ensure that systems of care are flexible and appropriate to women’s circumstances and needs

Age-associated modifications of intestinal permeability and innate immunity in human small intestine

The physical and immunological properties of the human intestinal epithelial barrier in aging are largely unknown. Ileal biopsies from young (7–12 years), adult (20–40 years) and aging (67–77 years) individuals not showing symptoms of gastrointestinal (GI) pathologies were used to assess levels of inflammatory cytokines, barrier integrity and cytokine production in response to microbial challenges. Increased expression of interleukin (IL)-6, but not interferon (IFN)γ, tumour necrosis factor (TNF)-α and IL-1β was observed during aging; further analysis showed that cluster of differentiation (CD)11c+ dendritic cells (DCs) are one of the major sources of IL-6 in the aging gut and expressed higher levels of CD40. Up-regulated production of IL-6 was accompanied by increased expression of claudin-2 leading to reduced transepithelial electric resistance (TEER); TEER could be restored in in vitro and ex vivo cultures by neutralizing anti-IL-6 antibody. In contrast, expression of zonula occludens-1 (ZO-1), occludin and junctional-adhesion molecule-A1 did not vary with age and overall permeability to macromolecules was not affected. Finally, cytokine production in response to different microbial stimuli was assessed in a polarized in vitro organ culture (IVOC). IL-8 production in response to flagellin declined progressively with age although the expression and distribution of toll-like receptor (TLR)-5 on intestinal epithelial cells (IECs) remained unchanged. Also, flagellin-induced production of IL-6 was less pronounced in aging individuals. In contrast, TNF-α production in response to probiotics (VSL#3) did not decline with age; however, in our experimental model probiotics did not down-regulate the production of IL-6 and expression of claudin-2. These data suggested that aging affects properties of the intestinal barrier likely to impact on age-associated disturbances, both locally and systemically

Synergistic effects of oncolytic reovirus and docetaxel chemotherapy in prostate cancer

Reovirus type 3 Dearing (T3D) has demonstrated oncolytic activity in vitro, in in vivo murine models and in early clinical trials. However the true potential of oncolytic viruses may only be realized fully in combination with other modalities such as chemotherapy, targeted therapy and radiotherapy. In this study, we examine the oncolytic activity of reovirus T3D and chemotherapeutic agents against human prostate cancer cell lines, with particular focus on the highly metastatic cell line PC3 and the chemotherapeutic agent docetaxel. Docetaxel is the standard of care for metastatic prostate cancer and acts by disrupting the normal process of microtubule assembly and disassembly. Reoviruses have been shown to associate with microtubules and may require this association for efficient viral replication

Outdoor environmental supportiveness and older people’s quality of life:A personal projects approach

We present an approach to exploring the role of environmental supportiveness in contributing to older people’s quality of life (QoL), based on Little’s ecological model (2010) in which individual and situational factors influence the personal projects of salience to individuals. Personal Projects are self-generated and purpose-oriented activities or goals in which an individual is engaged (Little, 1983). The efficacy with which the pursuit of these activities is achieved depends on the nature of the project and the degree to which it is supported by external factors such as the environment. We explore the relationship between the outdoor environment and QoL, drawing on the concept of ‘environmental support’ as presented by Sugiyama and Ward Thompson (2007a). There is a positive relationship between the number of outdoor personal projects older people participated in and measures indicative of their QoL. The relationship between perceived environmental support and QoL measures was significant in projects involving nature but not for other project types

Search for eccentric black hole coalescences during the third observing run of LIGO and Virgo

Despite the growing number of confident binary black hole coalescences observed through gravitational waves so far, the astrophysical origin of these binaries remains uncertain. Orbital eccentricity is one of the clearest tracers of binary formation channels. Identifying binary eccentricity, however, remains challenging due to the limited availability of gravitational waveforms that include effects of eccentricity. Here, we present observational results for a waveform-independent search sensitive to eccentric black hole coalescences, covering the third observing run (O3) of the LIGO and Virgo detectors. We identified no new high-significance candidates beyond those that were already identified with searches focusing on quasi-circular binaries. We determine the sensitivity of our search to high-mass (total mass M>70 M⊙) binaries covering eccentricities up to 0.3 at 15 Hz orbital frequency, and use this to compare model predictions to search results. Assuming all detections are indeed quasi-circular, for our fiducial population model, we place an upper limit for the merger rate density of high-mass binaries with eccentricities 0<e≤0.3 at 0.33 Gpc−3 yr−1 at 90\% confidence level