Factors affecting patient recruitment to trials:qualitative research in general practice

BACKGROUND: Patient recruitment to clinical research is often challenging and, when inadequate, can result in delayed or underpowered studies. Recruitment problems were experienced during a study of women with heavy menstrual bleeding in general practice (the MIRA trial). Although efforts were made to reduce the burden of the study for those participating, patient recruitment was still an issue. AIM: To identify the barriers and facilitators associated with patient recruitment to clinical trials, as experienced by GPs. DESIGN & SETTING: A qualitative study was performed in Dutch general practice, using semi-structured interviews. METHOD: GPs participating in the MIRA trial were selected by purposive sampling and interviewed until saturation was reached. Three independent researchers performed data coding and thematic analysis. Consensus on the identified themes was reached by discussion among the researchers. RESULTS: Sixteen GPs were interviewed. The following factors were noted to influence recruitment: the incidence of the disease under study; awareness of the study; attitude towards scientific research; perceived burden for the patient; usual care by the GP; time investment; characteristics of the GP and their practice; and patient experience of research participation. CONCLUSION: The identified barriers and facilitators associated with patient recruitment highlight the areas in which future studies can be improved. Indeed, benefits could be gained by simply ensuring that study procedures are clear, by requiring limited (time) investment from the GP, and by investing in personal communication and reminders to keep the GP motivated and interested. Placing greater importance on scientific research during the GP training programme could also serve as a means to motivate future GPs to integrate scientific research in their clinical practice

Family Outcomes After the Pediatric Intensive Care Unit: A Scoping Review

Background: Intensivists are increasingly attuned to the post-discharge outcomes experienced by families because patient recovery and family outcomes are interdependent after childhood critical illness. In this scoping review of international contemporary literature, we describe the evidence of family effects and functioning post-PICU as well as outcome measures used in order to identify strengths and weaknesses in the literature.Methods: We reviewed all articles published between 1970 and 2017 in PubMed, EMBASE, PsycINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL), or the Cochrane Controlled Trials Registry. Our search used a combination of terms for the concept of “critical care/illness” combined with additional terms for the pre-specified domains of social, cognitive, emotional, physical, health-related quality of life (HRQL), and family functioning.Results: We identified 71 articles reporting on the post-PICU experience of more than 2,400 parents and 3,600 families of PICU survivors in 8 countries. These articles used 101 different metrics to assess the various aspects of family outcomes; 34 articles also included open-ended interviews. Overall, most families experienced significant disruption in at least 5 out of 6 of our family outcomes subdomains, with themes of decline in mental health, physical health, family cohesion, and family finances identified. Almost all articles represented relatively small, single-center or disease-specific observational studies. There was disproportionate representation of families of higher socioeconomic status and Caucasian race, and there was much more data about mothers compared to fathers. There was also very limited information regarding outcomes for siblings and extended family members after a child’s PICU stay. Conclusions: Significant opportunities remain for research exploring family functioning after PICU discharge. We recommend that future work include more diverse populations with respect to the critically ill child as well as family characteristics, include more intervention studies, and enrich existing knowledge about outcomes for siblings and extended family

Relationship between odor intensity estimates and COVID-19 prevalence prediction in a Swedish population

International audienceIn response to the coronavirus disease 2019 (COVID-19) pandemic, countries have implemented various strategies to reduce and slow the spread of the disease in the general population. For countries that have implemented restrictions on its population in a stepwise manner, monitoring of COVID-19 prevalence is of importance to guide the decision on when to impose new, or when to abolish old, restrictions. We are here determining whether measures of odor intensity in a large sample can serve as one such measure. Online measures of how intense common household odors are perceived and symptoms of COVID-19 were collected from 2440 Swedes. Average odor intensity ratings were then compared to predicted COVID-19 population prevalence over time i

Past, Present, and Future of Human Chemical Communication Research

Although chemical signaling is an essential mode of communication in most vertebrates, it has long been viewed as having negligible effects in humans. However, a growing body of evidence shows that the sense of smell affects human behavior in social contexts ranging from affiliation and parenting to disease avoidance and social threat. This article aims to (a) introduce research on human chemical communication in the historical context of the behavioral sciences; (b) provide a balanced overview of recent advances that describe individual differences in the emission of semiochemicals and the neural mechanisms underpinning their perception, that together demonstrate communicative function; and (c) propose directions for future research toward unraveling the molecular principles involved and understanding the variability in the generation, transmission, and reception of chemical signals in increasingly ecologically valid conditions. Achieving these goals will enable us to address some important societal challenges but are within reach only with the aid of genuinely interdisciplinary approaches

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts

Design of an adaptable serious game for multiple stakeholder perspectives

The world is becoming increasingly digital. People have become used to learning and interacting with the world around them through technology, accelerated even further by the Covid-19 pandemic. This is especially relevant to the generation currently entering education systems and the workforce. Considering digital aids and methods of learning are important for future learning. The increasing online learning needs open the case for integrating digital learning aspects such as serious gaming within education and training systems. Learning factories fall amongst the education and training systems that can benefit from integration with digital learning extensions. Digital capabilities such as digital twins and models further enable the exploration of integrating digital serious games as an extension of learning factories. Since learning factories are meant for a range of different learning, training, and research purposes, such serious games need to be adaptable across stakeholder perspectives to maximize the value gained from the time and cost invested into such design and development. Research into the development of adaptive serious games for multiple stakeholder perspectives must first determine whether such development can be developed that reaches the objectives set for different included stakeholder perspectives. The purpose of this research is to investigate this at the hand of the practical development of a digital adaptive serious game for stakeholder perspectives

Objective Relationship Between Sleep Apnea and Frequency of Snoring Assessed by Machine Learning

International audienceStudy Objectives: Snoring is perceived to be directly proportional to sleep apnea severity, especially obstructive sleep apnea (OSA), but this notion has not been thoroughly and objectively evaluated, despite its popularity in clinical practice. This might lead to overdiagnosis or underdiagnosis of OSA. The goal of this study is to examine this notion and objectively quantify the relationship between sleep apnea and snoring detected using advanced signal processing algorithms. Methods: We studied adults referred for polysomnography, from which the apnea-hypopnea index (AHI) was derived. Breath sounds were recorded simultaneously, from which snoring was accurately quantified using acoustic analysis of breath sounds and machine-learning computer algorithms. The snore index (SI) was calculated as the number of snores per hour of sleep. Results: In 235 patients, the mean AHI was 20.2 ± 18.8 and mean SI was 320.2 ± 266.7 events/h. On the one hand, the overall correlation between SI and AHI was weak but significant (r = .32, P < .0001). There was a significant stepwise increase in SI with increasing OSA severity, but with a remarkable overlap in SI among OSA severity categories. On the other hand, SI had weak negative correlation with central AHI (r = −.14, P = .035). SI had modest positive and negative predictive values for OSA (0.63 and 0.62 on average, respectively) and good sensitivity but low specificity (0.91 and 0.31 on average, respectively) attributed to the large number of snorers without OSA. Conclusions: Snoring on its own is probably of limited usefulness in assessing sleep apnea presence and severity, because of its weak relationship with AHI. Thus, the complaint of snoring should be interpreted with caution to avoid unnecessary referrals for sleep apnea testing. Conversely, clinicians should be aware of the possibility of missing diagnosis of patients with sleep apnea who have minimal snoring

Solute and particle retention in a small grazing antelope, the blackbuck (Antilope cervicapra)

Digesta retention patterns have been suggested to play a major role in ruminant diversification. Two major digestion types have been proposed, termed ‘cattle-type’ and ‘moose-type’, that broadly correspond to the feeding categories of grazers and intermediate feeders on the one, and browsers on the other hand.Wemeasured and calculated the mean retention time (MRT) of a solute and a particle (<2mm) marker in the gastrointestinal tract (GIT) and the reticulorumen (RR) of a small grazer, the Indian blackbuck (Antilope cervicapra, n = 5, body mass of 26 ± 4 kg) and an intermediate feeder, the nilgai (Boselaphus tragocamelus, n = 5, body mass of 168 ± 21 kg). MRTsolute and MRTparticle were 29 ± 4.1 h and 60 ± 6.6 h in blackbuck and 28 ± 2.5 h and 54±8.9 h in the nilgai for the GIT, and 14±1.7 h, 45±5.0 h, 19±2.0 h and 45±8.4 h for the RR, respectively. With a selectivity factor (SF, the ratio of MRTparticle to MRTsolute) in the RR of 3.2 ± 0.28 for blackbuck and 2.3 ± 0.36 for nilgai, both species are clearly in the category of ‘cattle-type’ ruminants. In particular, the high SFRR of blackbuck, in spite of its small body size, is remarkable, and leads to specific predictions on the RR anatomy of this species (such as a particularly large omasum), which can be tested in further studies. The adaptive value of a high SFRR is mainly considered as an increase in microbial productivity in the RR