Exploring perspectives of people with type-1 diabetes on goalsetting strategies within self-management education and care

Background. Collaborative goal-setting strategies are widely recommended for diabetes self-management support within healthcare systems. Creating self-management plans that fit with peoples’ own goals and priorities has been linked with better diabetic control. Consequently, goal-setting has become a core component of many diabetes selfmanagement programmes such as the ‘Dose Adjustment for Normal Eating (DAFNE) programme’. Within DAFNE, people with Type-1 Diabetes (T1D) develop their own goals along with action-plans to stimulate goal-achievement. While widely implemented, limited research has explored how goal-setting strategies are experienced by people with diabetes.Therefore, this study aims to explore the perspectives of people with T1D on theimplementation and value of goal-setting strategies within DAFNE and follow-up diabetes care. Furthermore, views on barriers and facilitators to goal-attainment are explored.Methods. Semi-structured interviews were conducted with 20 people with T1D who attended a DAFNE-programme. Following a longitudinal qualitative research design, interviews took place 1 week, and 6-8 months after completion of DAFNE. A recurrent cross-sectional approach is applied in which themes will be identified at each time-point using thematic analyses.Expected results. Preliminary identified themes surround the difference in value that participants place on goal-setting strategies, and the lack of support for goal-achievement within diabetes care.Current stage. Data collection complete; data-analysis ongoing.Discussion. Goal-setting strategies are increasingly included in guidelines for diabetes support and have become essential parts of many primary care improvement schemes. Therefore, exploring the perspectives of people with T1D on the value and implementation of goal-setting strategies is vital for their optimal application

Impacts of farmer field schools in the human, social, natural and financial domain : a qualitative review

The Farmer Field School (FFS) is a widely used method seeking to educate farmers to adapt agricultural decisions to diverse and variable field conditions. Out of 218 screened studies, 65 were selected to review the impact of the FFS. An analytical framework was developed with effects (outputs, outcomes and impacts) arranged according to the human, social, natural and financial domains. Impacts on non-participants of the FFS were addressed as peripheral effects. The FFS demonstrated its potential to enhance human, social, natural and financial capital of rural communities. Human capital was built in the form of critical thinking, innovation, confidence, and quality of life. Effects on social capital included mutual trust, bonding, collective action, networking, and emancipation. Natural capital was enhanced through improvements in field practices, food production, agricultural diversification, and food security. Financial capital was enhanced through increased income and profits, savings and loans schemes, with a potential to reduce poverty. The available body of evidence was unbalanced across the capital domains, providing high coverage of the natural domain but low coverage of the human, social and financial domains. In-depth case studies are needed to elucidate the interactions between livelihood assets, and the influences of the policy, institutional and external environment, in order to adjust FFS interventions aiming to optimize their impacts. Considering the positive effects the FFS can have on rural livelihoods, the FFS has potential to contribute to achieving the Sustainable Development Goals. However, quality assurance of the FFS and a balanced evaluation across the capital domains require attention.</p

Effectiveness of physical activity interventions for overweight and obesity during pregnancy: a systematic review of the content of behaviour change interventions

Background Behaviour change techniques (BCTs) employed within PA intervention for pregnant women with a healthy body mass index (BMI) have been previously identified, however, these BCTS may differ for other weight profiles during pregnancy. The aim of this current review was to identify and summarise the evidence for effectiveness of PA interventions on PA levels for pregnant women with overweight and obesity, with an emphasis on the BCTs employed. Methods A systematic review and meta-analysis of PA intervention studies using the PRISMA statement was conducted. Searches were conducted of eight databases in January 2019. Strict inclusion/exclusion criteria were employed. The validity of each included study was assessed using the Cochrane Collaboration’s tool for assessing risk of bias. The primary outcome measure was change in PA levels, subjectively or objectively measured, with physical fitness as a secondary outcome. All intervention descriptions were double coded by two authors using Michie’s et al’s BCT taxonomy V1. Meta-analyses using random effect models assessed the intervention effects on PA. Other PA outcomes were summarised in a narrative synthesis. Results From 8389 studies, 19 met the inclusion criteria 13 of which were suitable for inclusion in a meta-analysis. The remaining 6 studies were described narratively due to insufficient data and different outcome measures reported. In the meta-analysis, comparing interventions to a control group, significant increases were found in the intervention group for metabolic equivalent (SMD 0.39 [0.14, 0.64], Z = 3.08 P = 0.002) and physical fitness (VO2 max) (SMD 0.55 [0.34, 0.75], Z = 5.20 P = < 0.001). Of the other six, five studies reported an increase in PA for the intervention group versus the control with the other study reporting a significant decrease for women in their 3rd trimester (p = 0.002). ‘Self-monitoring of behaviour’ was the most frequently used BCTs (76.5%), with ‘social support’ being newly identified for this pregnant population with overweight or obesity. Conclusions This review identified a slight increase in PA for pregnant women with overweight and obesity participating in interventions. However, due to the high risk of bias of the included studies, the results should be interpreted with caution. PA measures should be carefully selected so that studies can be meaningfully compared and standardised taxonomies should be used so that BCTs can be accurately assessed

Maximizing farm-level uptake and diffusion of biological control innovations in today’s digital era

When anthropologists interviewed Honduran and Nepali smallholders in the mid-1990s, they were told that “Insects are a terrible mistake in God’s creation” and “There’s nothing that kills them, except for insecticides”. Even growers who maintained a close bond with nature were either entirely unaware of natural pest control, or expressed doubt about the actual value of these services on their farm. Farmers’ knowledge, beliefs and attitudes towards pests and natural enemies are of paramount importance to the practice of biological control, but are all too often disregarded. In this study, we conduct a retrospective analysis of the extent to which social science facets have been incorporated into biological control research over the past 25 years. Next, we critically examine various biological control forms, concepts and technologies using a ‘diffusion of innovations’ framework, and identify elements that hamper their diffusion and farm-level uptake. Lastly, we introduce effective observation-based learning strategies, such as farmer field schools to promote biological control, and list how those participatory approaches can be further enriched with information and communication technologies (ICT). Although biological control scientists have made substantial technological progress and generate nearly 1000 papers annually, only a fraction (1.4%) of those address social science or technology transfer aspects. To ease obstacles to enhanced farmer learning about biological control, we describe ways to communicate biological control concepts and technologies for four divergent agricultural knowledge systems (as identified within a matrix built around ‘cultural importance’ and ‘ease of observation’). Furthermore, we describe how biological control innovations suffer a number of notable shortcomings that hamper their farm-level adoption and subsequent diffusion, and point at ways to remediate those by tactical communication campaigns or customized, (ICT-based) adult education programs. Amongst others, we outline how video, smart phones, or tablets can be used to convey key ecological concepts and biocontrol technologies, and facilitate social learning. In today’s digital era, cross-disciplinary science and deliberate multi-stakeholder engagement will provide biocontrol advocates the necessary means to bolster farmer adoption rates, counter-act surging insecticide use, and restore public trust in one of nature’s prime services

A Polymorphism in the Splice Donor Site of ZNF419 Results in the Novel Renal Cell Carcinoma-Associated Minor Histocompatibility Antigen ZAPHIR

Nonmyeloablative allogeneic stem cell transplantation (SCT) can induce remission in patients with renal cell carcinoma (RCC), but this graft-versus-tumor (GVT) effect is often accompanied by graft-versus-host disease (GVHD). Here, we evaluated minor histocompatibility antigen (MiHA)-specific T cell responses in two patients with metastatic RCC who were treated with reduced-intensity conditioning SCT followed by donor lymphocyte infusion (DLI). One patient had stable disease and emergence of SMCY.A2-specific CD8+ T cells was observed after DLI with the potential of targeting SMCY-expressing RCC tumor cells. The second patient experienced partial regression of lung metastases from whom we isolated a MiHA-specific CTL clone with the capability of targeting RCC cell lines. Whole genome association scanning revealed that this CTL recognizes a novel HLA-B7-restricted MiHA, designated ZAPHIR, resulting from a polymorphism in the splice donor site of the ZNF419 gene. Tetramer analysis showed that emergence of ZAPHIR-specific CD8+ T cells in peripheral blood occurred in the absence of GVHD. Furthermore, the expression of ZAPHIR in solid tumor cell lines indicates the involvement of ZAPHIR-specific CD8+ T cell responses in selective GVT immunity. These findings illustrate that the ZNF419-encoded MiHA ZAPHIR is an attractive target for specific immunotherapy after allogeneic SCT