Effectiveness of moving on: an Australian designed generic self-management program for people with a chronic illness

Background: This paper presents the evaluation of “Moving On”, a generic self-management program for people with a chronic illness developed by Arthritis NSW. The program aims to help participants identify their need for behavior change and acquire the knowledge and skills to implement changes that promote their health and quality of life. Method: A prospective pragmatic randomised controlled trial involving two group programs in community settings: the intervention program (Moving On) and a control program (light physical activity). Participants were recruited by primary health care providers across the north-west region of metropolitan Sydney, Australia between June 2009 and October 2010. Patient outcomes were self-reported via pre- and post-program surveys completed at the time of enrolment and sixteen weeks after program commencement. Primary outcomes were change in self-efficacy (Self-efficacy for Managing Chronic Disease 6-Item Scale), self-management knowledge and behaviour and perceived health status (Self-Rated Health Scale and the Health Distress Scale). Results: A total of 388 patient referrals were received, of whom 250 (64.4%) enrolled in the study. Three patients withdrew prior to allocation. 25 block randomisations were performed by a statistician external to the research team: 123 patients were allocated to the intervention program and 124 were allocated to the control program. 97 (78.9%) of the intervention participants commenced their program. The overall attrition rate of 40.5% included withdrawals from the study and both programs. 24.4% of participants withdrew from the intervention program but not the study and 22.6% withdrew from the control program but not the study. A total of 62 patients completed the intervention program and follow-up evaluation survey and 77 patients completed the control program and follow- up evaluation survey. At 16 weeks follow-up there was no significant difference between intervention and control groups in self-efficacy; however, there was an increase in self-efficacy from baseline to follow-up for the intervention participants (t=−1.948, p=0.028). There were no significant differences in self-rated health or health distress scores between groups at follow-up, with both groups reporting a significant decrease in health distress scores. There was no significant difference between or within groups in self-management knowledge and stage of change of behaviours at follow-up. Intervention group attenders had significantly higher physical activity (t=−4.053, p=0.000) and nutrition scores (t=2.315, p= 0.01) at follow-up; however, these did not remain significant after adjustment for covariates. At follow-up, significantly more participants in the control group (20.8%) indicated that they did not have a self-management plan compared to those in the intervention group (8.8%) (X2=4.671, p=0.031). There were no significant changes in other self-management knowledge areas and behaviours after adjusting for covariates at follow-up. Conclusions: The study produced mixed findings. Differences between groups as allocated were diluted by the high proportion of patients not completing the program. Further monitoring and evaluation are needed of the impact and cost effectiveness of the program. Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN1260900029821

The role of core and accessory type IV pilus genes in natural transformation and twitching motility in the bacterium Acinetobacter baylyi.

Here we present an examination of type IV pilus genes associated with competence and twitching in the bacterium Acinetobacter baylyi (strain ADP1, BD413). We used bioinformatics to identify potential competence and twitching genes and their operons. We measured the competence and twitching phenotypes of the bioinformatically-identified genes. These results demonstrate that competence and twitching in A. baylyi both rely upon a core of the same type IV pilus proteins. The core includes the inner membrane assembly platform (PilC), a periplasmic assemblage connecting the inner membrane assembly platform to the secretin (ComM), a secretin (ComQ) and its associated pilotin (PilF) that assists with secretin assembly and localization, both cytoplasmic pilus retraction ATPases (PilU, PilT), and pilins (ComP, ComB, PilX). Proteins not needed for both competence and twitching are instead found to specialize in either of the two traits. The pilins are varied in their specialization with some required for either competence (FimT) and others for twitching (ComE). The protein that transports DNA across the inner membrane (ComA) specializes in competence, while signal transduction proteins (PilG, PilS, and PilR) specialize in twitching. Taken together our results suggest that the function of accessory proteins should not be based on homology alone. In addition the results suggest that in A. baylyi the mechanisms of natural transformation and twitching are mediated by the same set of core Type IV pilus proteins with distinct specialized proteins required for each phenotype. Finally, since competence requires multiple pilins as well as both pilus retraction motors PilU and PilT, this suggests that A. baylyi employs a pilus in natural transformation

Reactive design patterns

<p><b>Twitching zones on (a) soft vs. (b) hard agar for multiple twitching phenotypes.</b> On soft agar (0.5%) in panel (a), mutants <i>fimU</i> and <i>comA</i> twitch a comparable amount to the wildtype, while <i>comP</i> and <i>comE</i> are substantially impaired in agreement with <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0182139#pone.0182139.g003" target="_blank">Fig 3</a>. Panel (b) shows the same mutants but now on hard agar (1.5%). In this case all diameters are comparable.</p

Alignment of FimU and FimT pilins from ADP1.

<p>A. The length of the primary sequence is indicated above with Pfam motifs found in both proteins diagrammed below. N = PF07963.11; GspH = PF12019.7. Such motifs are identified using multiple sequence alignments. B. Pairwise alignment of FimU and FimT. Identical amino acids are indicated by a vertical line connecting them while: and. represent higher and lower degrees of chemical similarity between the two amino acids, respectively. Boldface amino acids are part of the Pfam motifs diagrammed in A.</p

Model of the ADP1 type IV pilus with associated competence and signal transduction proteins.

<p>Components of the model are predicted by homology from <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0182139#pone.0182139.t001" target="_blank">Table 1</a> and are supported by data in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0182139#pone.0182139.g003" target="_blank">Fig 3</a>.</p

Protein motif diagrams of the type IV pilin proteins encoded by ADP1.

<p>Length in amino acids is indicated along the top, with pilins diagrammed below. Pilins absolutely required for both twitching and competence are in boldface. Pfam motifs are indicated by filled, labeled boxes. The Pfam motif names are: N = PF07963.11 Prokaryotic N-terminal methylation motif; Pilin = PF00114.18 Pilin (bacterial filament); GspH = PF12019.7 Type II transport protein GspH; PilW = PF16074.4 Type IV Pilus-assembly protein W; PilX_N = PF14341.5 PilX N-terminal; ComP_DUS = PF16732.4 Type IV minor pilin ComP, DNA uptake sequence receptor.</p