Implementation of self management support for long term conditions in routine primary care settings: cluster randomised controlled trial

ObjectiveTo determine the effectiveness of an intervention to enhance self management support for patients with chronic conditions in UK primary care. Design Pragmatic, two arm, cluster randomised controlled trial.SettingGeneral practices, serving a population in northwest England with high levels of deprivation.Participants5599 patients with a diagnosis of diabetes (n=2546), chronic obstructive pulmonary disease (n=1634), and irritable bowel syndrome(n=1419) from 43 practices (19 intervention and 22 control practices).Intervention Practice level training in a whole systems approach to self management support. Practices were trained to use a range of resources: a tool to assess the support needs of patients, guidebooks on self management, and a web based directory of local self management resources. Training facilitators were employed by the health management organisation.Main Outcome MeasuresPrimary outcomes were shared decision making, self efficacy, and generic health related quality of life measured at 12 months. Secondary outcomes were general health, social or role limitations, energy and vitality, psychological wellbeing, self care activity,and enablement.ResultsWe randomised 44 practices and recruited 5599 patients, representing 43% of the eligible population on the practice lists. 4533 patients (81.0%) completed the six month follow-up and 4076 (72.8%)the 12 month follow-up.No statistically significant differences were found between patients attending trained practices and those attending control practices on any of the primary or secondary outcomes. All effect size estimates were well below the prespecified threshold of clinically important difference

Genome-Wide Linkage Scan of a Pedigree with Familial Hypercholesterolemia Suggests Susceptibility Loci on Chromosomes 3q25-26 and 21q22

BACKGROUND: Familial hypercholesterolemia (FH) is a heritable disorder that can increase the risk of premature coronary heart disease. Studies suggest there are substantial genetic heterogeneities for different populations. Here we tried to identify novel susceptibility loci for FH in a Chinese pedigree. METHODOLOGY/PRINCIPAL FINDINGS: We performed a SNP-based genome-wide linkage scan with the Chinese FH pedigree. Two suggestive linkage loci not previously reported were identified on chromosomes 3q25.1-26.1 (NPL = 9.01, nominal P<0.00001, and simulated occurrence per genome scan = 1.08) and 21q22.3 (NPL = 8.95, nominal P<0.00001, and simulated occurrence per genome scan = 1.26). In the interaction analysis with a trimmed version of the pedigree, we obtained a significantly increased joint LOD score (2.70) compared with that obtained when assuming the two loci uncorrelated, suggesting that more than one locus was involved in this pedigree. Exon screening of two candidate genes ABCG1 and LSS from one of the suggestive region 21q22 didn't report any causative mutations. CONCLUSIONS/SIGNIFICANCES: These results confirm complex etiologies and suggest new genetic casual factors for the FH disorder. Further study of the two candidate regions is advocated

Precision Physics at LEP

1 - Introduction 2 - Small-Angle Bhabha Scattering and the Luminosity Measurement 3 - Z^0 Physics 4 - Fits to Precision Data 5 - Physics at LEP2 6 - ConclusionsComment: Review paper to appear in the RIVISTA DEL NUOVO CIMENTO; 160 pages, LateX, 70 eps figures include

How can Tourist Attractions profit from Augmented Reality?

The benefits, value and potential of Augmented Reality (AR) are widely researched. However, the value of AR is most commonly discussed in relation to enhancing the tourist experience, rather than generating revenue or economic returns. Although AR promises to add value to the visitor experience and generate associated benefits, the financial implications and revenue model for AR implementation remain uncertain and therefore too much of a financial risk for most tourist organisations, typically Small to Medium Sized Enterprises (SMEs) characterised by limited funding. Thus, using the case of UNESCO recognised Geevor Tin Mine Museum, in Cornwall, UK, this study identifies ways in which tourism organisations can profit from AR implementation. Fifty semi-structured interviews with Geevor stakeholders, analysed using content analysis reveal a number of ways AR can be introduced to increase revenue generation and profits, therefore filling a gap in research and minimising the risk for managers and practitioners considering AR implementation

Parallels, prescience and the past: analogical reasoning and contemporary international politics

Analogical reasoning has held a perpetual appeal to policymakers who have often drafted in historical metaphor as a mode of informing decision-making. However, this article contends that since the beginning of the ‘War on Terror’ we have arguably seen the rise of a more potent form of analogy, namely ones that are selected because they fulfil an ideological function. Analogical reasoning as a tool of rational decision-making has increasingly become replaced by analogical reasoning as a tool of trenchant ideologically-informed policy justification. This article addresses three key areas which map out the importance of analogical reasoning to an understanding of developments in contemporary international politics: the relationship between history and politics, in intellectual and policy terms; a critical assessment of the appeal that analogical reasoning holds for policymakers; and the development of a rationale for a more effective use of history in international public policymaking

Pan-Cancer Proteogenomics Characterization of Tumor Immunity

Despite the successes of immunotherapy in cancer treatment over recent decades, less than \u3c10%-20% cancer cases have demonstrated durable responses from immune checkpoint blockade. To enhance the efficacy of immunotherapies, combination therapies suppressing multiple immune evasion mechanisms are increasingly contemplated. To better understand immune cell surveillance and diverse immune evasion responses in tumor tissues, we comprehensively characterized the immune landscape of more than 1,000 tumors across ten different cancers using CPTAC pan-cancer proteogenomic data. We identified seven distinct immune subtypes based on integrative learning of cell type compositions and pathway activities. We then thoroughly categorized unique genomic, epigenetic, transcriptomic, and proteomic changes associated with each subtype. Further leveraging the deep phosphoproteomic data, we studied kinase activities in different immune subtypes, which revealed potential subtype-specific therapeutic targets. Insights from this work will facilitate the development of future immunotherapy strategies and enhance precision targeting with existing agents

Can Charisma Be Taught? Tests of Two Interventions

We tested whether we could teach individuals to behave more charismatically, andwhether changes in charisma affected leader outcomes. In Study 1, a mixed-design fieldexperiment, we randomly assigned 34 middle-level managers to a control or anexperimental group. Three months later, we reassessed the managers using theircoworker ratings (Time 1 raters = 343; Time 2 raters = 321). In Study 2, a within-subjectslaboratory experiment, we videotaped 41 MBA participants giving a speech. We thentaught them how to behave more charismatically, and they redelivered the speech6 weeks later. Independent assessors (n = 135) rated the speeches. Results from thestudies indicated that the training had significant effects on ratings of leader charisma(mean D = .62) and that charisma had significant effects on ratings of leaderprototypicality and emergence...............................................................................................................................

Sensory theories of developmental dyslexia: three challenges for research.

Recent years have seen the publication of a range of new theories suggesting that the basis of dyslexia might be sensory dysfunction. In this Opinion article, the evidence for and against several prominent sensory theories of dyslexia is closely scrutinized. Contrary to the causal claims being made, my analysis suggests that many proposed sensory deficits might result from the effects of reduced reading experience on the dyslexic brain. I therefore suggest that longitudinal studies of sensory processing, beginning in infancy, are required to successfully identify the neural basis of developmental dyslexia. Such studies could have a powerful impact on remediation.This is the accepted manuscript. The final version is available from NPG at http://www.nature.com/nrn/journal/v16/n1/abs/nrn3836.html