SPACE FOR COPD delivered as a maintenance programme on pulmonary rehabilitation discharge: protocol of a randomised controlled trial evaluating the long-term effects on exercise tolerance and mental well-being

Supplementary Data: This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content: Data supplement 1 available at: https://bmjopen.bmj.com/highwire/filestream/246974/field_highwire_adjunct_files/0/bmjopen-2021-055513supp001_data_supplement.pdfCopyright © Author(s) (or their employer(s)) 2022. Introduction The benefits achieved during pulmonary rehabilitation (PR) are known to be sustained for 6-12 months after the initial programme. Several maintenance trials have been conducted but were heterogeneous in terms of duration, frequency and labour cost. There is no consensus on one best strategy. SPACE FOR COPD (Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease) is a home-based self-management programme, which has been shown previously to be effective in primary and secondary care settings and is to be tested here as a maintenance programme. The aim is to evaluate the efficacy of the SPACE FOR COPD programme (manual and group sessions), on exercise tolerance and mental well-being, compared with usual care following PR in patients with COPD. Methods and analysis A prospective, multicentre, single-blinded randomised controlled trial requiring 116 participants with a clinical diagnosis of COPD who have finished PR within 4 weeks will be randomised 1:1 to either a usual care group or a SPACE FOR COPD programme group. The intervention comprises a home-based manual and 4, 2-hour group sessions adopting motivational interviewing techniques over 12 months. The primary outcome is endurance capacity measured by the Endurance Shuttle Walking Test at 12 months. Secondary outcomes are: maximal exercise capacity, health-related quality of life, mood, patient activation, physical activity, lung function and healthcare costs. The measures will be taken at baseline, 6 and 12 months. Patient interviews and staff focus groups will be conducted to explore barriers, facilitators and views about the intervention at the end of the study. A framework analysis will be used for the interpretation of qualitative data. Ethics and dissemination The trial was granted ethical approval from Health Research Authority and Health and Care Research Wales (HCRW19/EM/0267 on 10 October 2019). Results will be made available to all stakeholders through a dissemination event, conferences and peer-reviewed publications. Trial registration number ISRCTN30110012.National Institute for Health Research (NIHR) Research for Patient Benefit Programme, grant number (PB-PG-0317-20032) and supported by the NIHR Leicester Biomedical Research Centre (BRC)- Respiratory

Absence of the spleen(s) in conjoined twins: a diagnostic clue of laterality defects? Radiological study of historical specimens

Laterality defects are quite common in thoracoileopagus and parapagus dicephalus but rare in other types of conjoined twins. To present the presumed laterality defects in cephalothoracoileopagus and prosopothoracoileopagus conjoined twins, based on the unilateral or bilateral absence or duplication of the spleen. Three human anatomical specimens of craniothoracoileopagus (CTIP) twins and one of prosopothoracoileopagus (PTIP) twins were investigated. The specimens were part of the Museum Vrolik collection of the Department of Anatomy and Embryology of the Academic Medical Centre, University of Amsterdam, The Netherlands. The specimens were taken out of their jars and scanned with multidetector CT and volumetric T2-weighted MRI at 1.5 T. The internal anatomy of the specimens was largely in accordance with previous reports. However, there was no recognisable spleen in the right twin in one CTIP specimen, in the left twin in one other CTIP specimen, and in both twins in the third CTIP specimen and in the PTIP specimen. Asplenia and polysplenia are considered reliable indicators of right and left isomerism, respectively. However, three of our four specimens had laterality patterns that did not correspond with those previously reported. Since no other parameters of laterality defects could be verified in these specimens, we concluded that asplenia was unlikely to be caused by laterality defect

Protective Role of False Tendon in Subjects with Left Bundle Branch Block: A Virtual Population Study.

False tendons (FTs) are fibrous or fibromuscular bands that can be found in both the normal and abnormal human heart in various anatomical forms depending on their attachment points, tissue types, and geometrical properties. While FTs are widely considered to affect the function of the heart, their specific roles remain largely unclear and unexplored. In this paper, we present an in silico study of the ventricular activation time of the human heart in the presence of FTs. This study presents the first computational model of the human heart that includes a FT, Purkinje network, and papillary muscles. Based on this model, we perform simulations to investigate the effect of different types of FTs on hearts with the electrical conduction abnormality of a left bundle branch block (LBBB). We employ a virtual population of 70 human hearts derived from a statistical atlas, and run a total of 560 simulations to assess ventricular activation time with different FT configurations. The obtained results indicate that, in the presence of a LBBB, the FT reduces the total activation time that is abnormally augmented due to a branch block, to such an extent that surgical implant of cardiac resynchronisation devices might not be recommended by international guidelines. Specifically, the simulation results show that FTs reduce the QRS duration at least 10 ms in 80% of hearts, and up to 45 ms for FTs connecting to the ventricular free wall, suggesting a significant reduction of cardiovascular mortality risk. In further simulation studies we show the reduction in the QRS duration is more sensitive to the shape of the heart then the size of the heart or the exact location of the FT. Finally, the model suggests that FTs may contribute to reducing the activation time difference between the left and right ventricles from 12 ms to 4 ms. We conclude that FTs may provide an alternative conduction pathway that compensates for the propagation delay caused by the LBBB. Further investigation is needed to quantify the clinical impact of FTs on cardiovascular mortality risk

International Polar Week as an educational activity to boost science–educational links: Portugal as a case study

International Polar Week is an educational activity that has been carried out since the International Polar Year 2007–2008 (known then as International Polar Days). This event, which brings together educators and polar scientists to promote polar science, is generally organised by the Association of Polar Early Career Scientists and Polar Educators International. Here we provide an overview of how International Polar Week started, and describe its implementation in Portugal, a “non-polar” country. We quantify the activities carried out during International Polar Weeks in Portugal between 2012 and 2017, which involved >96,000 students, >200 schools, >1900 educators and 100 polar scientists, with talks and Skype calls by polar scientists being the most frequent activities. Portugal’s International Polar Weeks have involved students, educators and polar scientists from 18 other countries, in particular from the United Kingdom and Brazil. We conclude by providing recommendations to other countries wanting to implement International Polar Weeks

Education on Biodiversity in the Polar Regions

The polar regions are famously associated with extreme temperatures, ice, snow, legendary explorers, indigenous people, polar bears, penguins and other impressive fauna and flora. The past decades have witnessed a revolution in the amount of data collected in the polar regions, with considerable advances in the knowledge of numerous areas, including in polar biodiversity. Educationally, the polar regions can be perfect vehicles to transfer educational concepts related to biodiversity, but unfortunately, the evaluation of the impact of educational activities related to polar biodiversity is scarce. This chapter provides a general review of the importance of the polar regions, the increasing status of polar education in the last decade, examples of polar educational activities on biodiversity, and a resource to stakeholders interested in polar science and education. With pivotal inputs to polar education during the International Polar Year, 2007–2008, three of the most important challenges to be addressed in the future are to assess the needs of polar educators, strengthen the network of information sharing of educational materials (e.g. in a validated, multi-lingual and easily accessible online mode) and to develop robust evaluation of the educational activities. Recent improvements in internet technologies may provide a major source of ideas and the ability to effortlessly spread polar information relevant to biodiversity education

Endocardial fibroelastosis and hypoplasia of the left ventricle in neonates without significant aortic stenosis.

Endocardial fibroelastosis in neonates with hypoplasia of the left ventricle is usually associated with severe aortic stenosis or atresia. In this study three hearts were examined, in which severe hypoplasia of the left ventricular cavity with myocardial hypertrophy and endocardial fibroelastosis were associated with small but non-stenotic subaortic outflow tracts and aortic valves. These features were contrasted with those of neonatal left heart hypoplasia in aortic stenosis and atresia. The index cases were examples of the very rare contracted form of endocardial fibroelastosis

Systematic review of shared decision-making interventions for people living with chronic respiratory diseases

Objective Shared decision-making (SDM) supports patients to make informed and value-based decisions about their care. We are developing an intervention to enable healthcare professionals to support patients’ pulmonary rehabilitation (PR) decision-making. To identify intervention components we needed to evaluate others carried out in chronic respiratory diseases (CRDs). We aimed to evaluate the impact of SDM interventions on patient decision-making (primary outcome) and downstream health-related outcomes (secondary outcome).Design We conducted a systematic review using the risk of bias (Cochrane ROB2, ROBINS-I) and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation) tools.Data sources MEDLINE, EMBASE, PSYCHINFO, CINAHL, PEDRO, Cochrane Central Register of Controlled Trials, the International Clinical Trials Registry Platform Search Portal, ClinicalTrials.gov, PROSPERO, ISRCTN were search through to 11th April 2023.Eligibility criteria Trials evaluating SDM interventions in patients living with CRD using quantitative or mixed methods were included.Data extraction and synthesis Two independent reviewers extracted data, assessed risk of bias and certainty of evidence. A narrative synthesis, with reference to The Making Informed Decisions Individually and Together (MIND-IT) model, was undertaken.Results Eight studies (n=1596 (of 17 466 citations identified)) fulfilled the inclusion criteria.Five studies included components targeting the patient, healthcare professionals and consultation process (demonstrating adherence to the MIND-IT model). All studies reported their interventions improved patient decision-making and health-related outcomes. No outcome was reported consistently across studies. Four studies had high risk of bias, three had low quality of evidence. Intervention fidelity was reported in two studies.Conclusions These findings suggest developing an SDM intervention including a patient decision aid, healthcare professional training, and a consultation prompt could support patient PR decisions, and health-related outcomes. Using a complex intervention development and evaluation research framework will likely lead to more robust research, and a greater understanding of service needs when integrating the intervention within practice.PROSPERO registration number CRD42020169897

Distribution and morphology of ventricular bands in the hearts of ringed seals

In contrast to studies on domestic animals, few reports describe ventricular bands in wildlife, and none in aquatic mammals. Ventricular bands in the endangered Saimaa ringed seal (Pusa hispida saimensis) and the Baltic ringed seal (Pusa hispida botnica) were examined as part of an ongoing research on the comparative anatomy of ringed seal subspecies. The dissections illustrated that a varying number of thin or thick ventricular bands from the papillary muscles to the ventricular walls were visible in the ventricles of all ringed seal specimens examined. The histological appearance of the ventricular bands was characterized by a fibromuscular pattern.Peer reviewe