The myth of patient centrality in integrated care: the case of back pain services

Purpose: The purpose of this paper is to critically examine the extent of patient centrality within integrated chronic back pain management services and compare policy rhetoric with practice reality. Context: Integrated chronic back pain management services. Data sources: We have drawn on theories of integration and context specific journals related to integration and pain management between 1966 and 2006 to identify evidence of patient centrality within integrated chronic pain management services. Discussions: Despite policy rhetoric and guidelines which promote ‘patient centrality’ within multidisciplinary services, we argue that evaluations of these services are scant. Many papers have focussed on the assessment of pain in multidisciplinary services as opposed to the patients' experience of these services. Conclusions: A latent measure of the reality of its magnitude needs to be captured through analysis of the patient's perspectives. Capturing patients' thoughts about integrated services will promote patient centrality and support the reality rather than endorse the rhetoric

Guest editorial : Social prescribing

Journal guest editorial article

A Century of Legacy Phosphorus Dynamics in a Large Drainage Basin

There is growing evidence that the release of phosphorus (P) from legacy stores can frustrate efforts to reduce P loading to surface water from sources such as agriculture and human sewage. Less is known, however, about the magnitude and residence times of these legacy pools. Here we constructed a budget of net anthropogenic P inputs to the Baltic Sea drainage basin and developed a three-parameter, two-box model to describe the movement of anthropogenic P though temporary (mobile) and long-term (stable) storage pools. Phosphorus entered the sea as direct coastal effluent discharge and via rapid transport and slow, legacy pathways. The model reproduced past waterborne P loads and suggested an similar to 30-year residence time in the mobile pool. Between 1900 and 2013, 17 and 27 Mt P has accumulated in the mobile and stable pools, respectively. Phosphorus inputs to the sea have halved since the 1980s due to improvements in coastal sewage treatment and reductions associated with the rapid transport pathway. After decades of accumulation, the system appears to have shifted to a depletion phase; absent further reductions in net anthropogenic P input, future waterborne loads could decrease. Presently, losses from the mobile pool contribute nearly half of P loads, suggesting that it will be difficult to achieve substantial near-term reductions. However, there is still potential to make progress toward eutrophication management goals by addressing rapid transport pathways, such as overland flow, as well as mobile stores, such as cropland with large soil-P reserves.Peer reviewe

Opportunities to reduce nutrient inputs to the Baltic Sea by improving manure use efficiency in agriculture

While progress has been made in reducing external nutrient inputs to the Baltic Sea, further actions are needed to meet the goals of the Baltic Sea Action Plan (BSAP), especially for the Baltic Proper, Gulf of Finland, and Gulf of Riga sub-basins. We used the net anthropogenic nitrogen and phosphorus inputs (NANI and NAPI, respectively) nutrient accounting approach to construct three scenarios of reduced NANI-NAPI. Reductions assumed that manure nutrients were redistributed from areas with intense animal production to areas that focus on crop production and would otherwise import synthetic and mineral fertilizers. We also used the Simple as Necessary Baltic Long Term Large Scale (SANBALTS) model to compare eutrophication conditions for the scenarios to current and BSAP-target conditions. The scenarios suggest that reducing NANI-NAPI by redistributing manure nutrients, together with improving agronomic practices, could meet 54-82% of the N reductions targets (28-43 kt N reduction) and 38-64% P reduction targets (4-6.6 kt P reduction), depending on scenario. SANBALTS output showed that even partial fulfillment of nutrient reduction targets could have ameliorating effects on eutrophication conditions. Meeting BSAP targets will require addressing additional sources, such as sewage. A common approach to apportioning sources to external nutrients loads could enable further assessment of the feasibility of eutrophication management targets.Peer reviewe

R : An exploratory study into the relationship between playing at home or away and concussion

Primary Objective: To investigate the effect of home and away game travel on risk of concussion across different levels of rugby union. Research Design: Exploration study across school, university, and professional rugby teams. Methods and Procedures: Retrospective analysis of concussion incidence and symptomology of surveillance data and prospective data collection for potential concussions via surveys. Data was collected from school rugby teams (n = 344 matches, over 2 years), a university rugby (n = 6 matches), and a professional rugby team (n = 64 matches, over two seasons). Main Outcomes and Results: School level rugby had an increased prevalence of concussions in away matches (p = 0.02). Likewise, there was a significant increase (p < 0.05) in concussions at away matches in university rugby. In addition, the professional rug by team had significant differences in recovery times and symptoms with away fixtures, including longer recovery times (p < 0.01), more initial symptoms (p < 0.01), as well as greater and more severe symptoms at 48 hours (p < 0.05). Conclusions: This research highlights an increased prevalence of concussion in school and university aged rugby players away from home, as well as increased symptoms, symptom severity, and recovery times in professional rugby player

Tomographic Separation of Composite Spectra. VIII. The Physical Properties of the Massive Compact Binary in the Triple Star System HD 36486 (delta Orionis A)

Double-lined spectroscopic orbital elements have recently been found for the central binary in the massive triple, delta Orionis A based on radial velocities from cross-correlation techniques applied to IUE high dispersion spectra and He I 6678 spectra obtained at Kitt Peak. The primary and secondary velocity amplitudes were found to be 94.9 +/- 0.6 km/s and 186 +/- 9 km/s respectively. Tomographic reconstructions of the primary and secondary stars' spectra confirm the O9.5 II classification of the primary and indicate a B0.5 III type for the secondary. The widths of the UV cross-correlation functions are used to estimate the projected rotational velocities, Vsin i = 157 +/- 6 km/s and 138 +/- 16 km/s for the primary and secondary, respectively implying that both stars rotate faster than their orbital motion. We used the spectroscopic results to make a constrained fit of the Hipparcos light curve of this eclipsing binary, and the model fits limit the inclination to the range between 67 and 77 degrees. The i = 67 degrees solution, which corresponds to a near Roche-filling configuration, results in a primary mass of 11.2 solar masses and a secondary mass of 5.6 solar masses, both of which are substantially below the expected masses for stars of their luminosity. This binary may have experienced a mass ratio reversal caused by Case A Roche lobe overflow, or the system may have suffered extensive mass loss through a binary interaction, perhaps during a common envelope phase, in which most of the primary's mass was lost from the system rather than transferred to the secondary.Comment: 27 pages, 15 figures in press, the Astrophysical Journal, February 1, 200

Reporting of ethical considerations in clinical trials in Chinese nursing journals

Background: It is acknowledged that publishers now require all primary research papers to demonstrate that they have obtained ethical approval for their research. Objectives: To assess the rate of reporting of ethical approval in clinical trials in core nursing journals in mainland China. Research design: A retrospective observational study. Participants: All clinical trials published in all of the 12 core nursing periodicals from 2016 edition China Science and Technology Journal Citation Report (core version) between 2013 and 2016 were retrieved by hand to explicate rate of reporting ethical approval and informed consent. Ethical considerations: The study did not require approval from the research ethics committee as it did not involve human subjects or records. Results: In total, 40,278 papers were published in 12 nursing periodicals between 2013 and 2016. Out of these, 9488 (23.6%) focused on clinical trials. Informed consent obtained from patients or the legally authorized representative was reported in 51.8% of clinical trials. Notably, only 27.4% of clinical trials reported that they had obtained written consent. Furthermore, 25.9% of clinical trials described ethical approval; however, the rate of reporting informed consent and ethical approval in these 12 nursing journals in China during 4 years from 2013 to 2016 improved markedly, with 38.1%, 44.0%, 59.0% and 66.6%, respectively (p<0.001), and 17.6%, 21.9%, 28.6% and 35.8%, respectively (p<0.001). In addition, both reporting informed consent and reporting written informed consent had a positive significant correlation with the reporting ethical approval (p<0.05 or p<0.01). Conclusion: Chinese scientific nursing journals have improved the rate of reporting informed consent and ethical approval in clinical trials during the last 4 years. However, it should be noted that nearly half of clinical trials still did not report either ethical approval or whether informed consent was obtained. Efforts from editors, researchers, sponsors and authors are needed to ensure the transparency of ethical scrutiny and adherence to ethical guidelines in publishing clinical trials in Chinese nursing journals

Development of a highly sensitive liquid biopsy platform to detect clinically-relevant cancer mutations at low allele fractions in cell-free DNA.

INTRODUCTION: Detection and monitoring of circulating tumor DNA (ctDNA) is rapidly becoming a diagnostic, prognostic and predictive tool in cancer patient care. A growing number of gene targets have been identified as diagnostic or actionable, requiring the development of reliable technology that provides analysis of multiple genes in parallel. We have developed the InVision™ liquid biopsy platform which utilizes enhanced TAm-Seq™ (eTAm-Seq™) technology, an amplicon-based next generation sequencing method for the identification of clinically-relevant somatic alterations at low frequency in ctDNA across a panel of 35 cancer-related genes. MATERIALS AND METHODS: We present analytical validation of the eTAm-Seq technology across two laboratories to determine the reproducibility of mutation identification. We assess the quantitative performance of eTAm-Seq technology for analysis of single nucleotide variants in clinically-relevant genes as compared to digital PCR (dPCR), using both established DNA standards and novel full-process control material. RESULTS: The assay detected mutant alleles down to 0.02% AF, with high per-base specificity of 99.9997%. Across two laboratories, analysis of samples with optimal amount of DNA detected 94% mutations at 0.25%-0.33% allele fraction (AF), with 90% of mutations detected for samples with lower amounts of input DNA. CONCLUSIONS: These studies demonstrate that eTAm-Seq technology is a robust and reproducible technology for the identification and quantification of somatic mutations in circulating tumor DNA, and support its use in clinical applications for precision medicine

Reporting of ethical approval and informed consent in clinical research published in leading nursing journals : a retrospective observational study

Background: Ethical considerations play a prominent role in the protection of human subjects in clinical research. To date the disclosure of ethical protection in clinical research published in the international nursing journals has not been explored. Our research objective was to investigate the reporting of ethical approval and informed consent in clinical research published in leading international nursing journals. Methods: This is a retrospective observational study. All clinical research published in the five leading international nursing journals from the SCI Journal Citation Reports between 2015 and 2017 were retrieved to evaluate for evidence of ethical review. Results: A total of 2041 citations have been identified from the contents of all the five leading nursing journals that were published between 2015 and 2017. Out of these, 1284 clinical studies have been included and text relating to ethical review has been extracted. From these, most of prospective clinical studies (87.5%) discussed informed consent. Only half of those (52.9%) reported that written informed consent had been obtained; few (3.6%) reported oral consent, and few (6.8%) used other methods such as online consent or completion and return of data collection (such as surveys) to denote assent. Notably, 36.2% of those did not describe the method used to obtain informed consent and merely described that “consent was obtained from participants or participants agreed to join in the research”. Furthermore, whilst most of clinical studies (93.7%) mentioned ethical approval; 92.5% of those stated the name of ethical committee and interestingly, only 37.1% of those mentioned the ethical approval reference. The rates of reporting ethical approval were different between different study type, country, and whether financial support was received (all P<0.05). Conclusion: The reporting of ethics in leading international nursing journals demonstrates progress, but improvement of the transparency and the standard of ethical reporting in nursing clinical research is required