Development and validation of a patient-centred outcome measure for young adults with paediatric hip conditions: the ‘Quality of Life, concerns and impact measure

Purpose: To develop and validate a patient-centered, evaluative outcome measure to assess patient-significant and identified impacts of the three pediatric hip conditions (the “Quality of Life, Concerns and Impact Measure” (QoLC&I)), for use by patients and clinicians in discussions over treatment options and the evaluation of treatment and post-operative rehabilitation. Patients and methods: The measure was developed through a qualitative study, via two web-based forums (patient narratives, n=84) and one specialist orthopedic adult hip clinic (conducting interviews, n=38). The draft (1) measure was piloted in an asynchronous webbased discussion group forum; following revision, it was piloted with a group of clinicians and patients to assess its patient and clinical utility, face and content validity. The final, refined prototype measure (QoLC&I, draft 3) was subjected to psychometric evaluation. Results: A total of 230 patients provided useable data for the psychometric analysis: 70% (160) had a confirmed diagnosis of Developmental Dysplasia of the Hip, 15% (35) Perthes, 11% (26) Slipped Upper Femoral Epiphyses; 4% (9) PHC not stated. The scale showed good acceptability (few missing items, good spread, low floor/ceiling effects), relevance (76% stating they would find the measure useful in their discussions with clinicians), and good internal consistency (Cronbach’s α=0.98; average ICC=0.98). Hypotheses on convergent validity (with the General Health Questionnaire, to measure depression, and the International Hip Outcome Tool Short Form, to measure quality of life) and divergent validity (with the General Self-Efficacy Scale, to measure coping) were confirmed. Conclusion: The 64-item QoL&CI measure is a practical and valid measure addressing areas of clinical and patient significance and has potential value to assist patients and clinicians in discussions about treatment choices and treatment progress. Future research will address further psychometric testing (test–retest validity and responsiveness to change), in additional sites, and embedding the measure into clinical practice

Enhancing health literacy and behavioural change within a tele-care education and support intervention for people with type 2 diabetes

Background  Behavioural change interventions for persons with chronic illness draw on a variety of theoretical approaches including motivational interviewing and shared decision making. Health literacy provides an additional, potentially powerful explanatory framework to guide research and practice. Objective To examine the changes in the depth and detail of diabetes-related knowledge and confidence for persons with type 2 diabetes. Design  Two-year, prospective, observational study, using questionnaire data at two time points (baseline and 2 years later) and in-depth interviews with a theoretically selected subsample. Setting and participants A total of 319 patients initially recruited from a deprived urban area in north-west England Intervention  Dedicated tele-carer education and support, tailored to the individual circumstances of the patient. Main outcome measures Perceptions of confidence, levels of empowerment, learning for self-care and most helpful aspects of the intervention. Results  Over 90% expressed confidence in keeping their blood sugar controlled, and high levels of perceived empowerment (mean = 4.25; 95% CI, 4.17–4.33) were found. Changes in the depth and detail of diabetes-related knowledge and confidence, from the specific to the more general, were observed and enhanced competence in translating knowledge into practice. Discussion and conclusions  The intervention, built within a developed working partnership between tele-carer and patient, operated at two levels: health literacy, enhancing knowledge, developing personal skills and enabling self-control; and socio-psychological behavioural change, tailored to individuals within their socio-economic environments, enabling increased motivation and supportive problem-solving. Both approaches find reflection in the findings and provide powerful explanatory lenses to interrogate the data

Test-retest reliability and clinical and research validity of the 'quality of life impact and concerns' (QoLI&C) measure

Abstract: Hip dysplasia is a significant public health issue, representing the single largest cause for total hip arthroplasty in young adults. To gain insight into patient concerns and the impact of hip dysplasia on young adults, we developed a patient-centred outcome measure, the ‘Quality of Life Impact and Concerns’ (QoLI&C) measure. This short report provides additional evidence on test–retest reliability and suggests refinements to the measure to enhance its research and clinical utility. Keywords: acetabular dysplasia, developmental dysplasia of the hip, paediatric hip conditions, test–retest reliability, psychometric validation Hip dysplasia is a significant public health issue, representing the single largest cause for total hip arthroplasty in young adults.1 Acetabular dysplasia (AD) in young adults arises from residual childhood developmental dysplasia of the hip (DDH) and adolescent-onset acetabular dysplasia.2 Significantly, these young adults are experiencing chronic pain, insomnia,3 difficulty in walking and effects on social relationships at a time when they would normally be going to university, starting a career and/or having a family.4 To provide insight into patient-perceived and patient-significant concerns of hip dysplasia and its impact on everyday life, we developed a novel measure, the “Quality of Life Impact and Concerns” (QoLI&C) measure, and provided evidence on its psychometric features, in particular, its acceptability to patients, face and content validity, reliability and supportive evidence of construct validity.5 This short report provides additional evidence to support the validity of the QoLI&C measure, exploring its test-retest reliability. The report also draws attention to some deficiencies in the published measure, namely, repeated or similarly phrased or poorly phrased items. The revised measure is presented, along with ways to best use the measure to enhance its research and clinical utility

Experimental manipulation of immune-mediated disease and its fitness costs for rodent malaria parasites

<p>Abstract</p> <p>Background</p> <p>Explaining parasite virulence (harm to the host) represents a major challenge for evolutionary and biomedical scientists alike. Most theoretical models of virulence evolution assume that virulence arises as a direct consequence of host exploitation, the process whereby parasites convert host resources into transmission opportunities. However, infection-induced disease can be immune-mediated (immunopathology). Little is known about how immunopathology affects parasite fitness, or how it will affect the evolution of parasite virulence. Here we studied the effects of immunopathology on infection-induced host mortality rate and lifetime transmission potential – key components of parasite fitness – using the rodent malaria model, <it>Plasmodium chabaudi chabaudi</it>.</p> <p>Results</p> <p>Neutralizing interleukin [IL]-10, an important regulator of inflammation, allowed us to experimentally increase the proportion of virulence due to immunopathology for eight parasite clones. <it>In vivo </it>blockade of the IL-10 receptor (IL-10R) with a neutralizing antibody resulted in a shorter time to death that was independent of parasite density and was particularly marked for normally avirulent clones. This suggests that IL-10 induction may provide a pathway to avirulence for <it>P. c. chabaudi</it>. Despite the increased investment in transmission-stage parasites observed for some clones in response to IL-10R blockade, experimental enhancement of immunopathology incurred a uniform fitness cost to all parasite clones by reducing lifetime transmission potential.</p> <p>Conclusion</p> <p>This is the first experimental study to demonstrate that infection-induced immunopathology and parasite genetic variability may together have the potential to shape virulence evolution. In accord with recent theory, the data show that some forms of immunopathology may select for parasites that make hosts less sick.</p

Southern Ocean Overturning Compensation in an Eddy-Resolving Climate Simulation

The Southern Ocean’s Antarctic Circumpolar Current (ACC) and meridional overturning circulation (MOC) response to increasing zonal wind stress is, for the first time, analyzed in a high-resolution (0.1° ocean and 0.25° atmosphere), fully coupled global climate simulation using the Community Earth System Model. Results from a 20-yr wind perturbation experiment, where the Southern Hemisphere zonal wind stress is increased by 50% south of 30°S, show only marginal changes in the mean ACC transport through Drake Passage—an increase of 6% [136–144 Sverdrups (Sv; 1 Sv ≡ 10^6 m^3 s^(−1))] in the perturbation experiment compared with the control. However, the upper and lower circulation cells of the MOC do change. The lower cell is more affected than the upper cell with a maximum increase of 64% versus 39%, respectively. Changes in the MOC are directly linked to changes in water mass transformation from shifting surface isopycnals and sea ice melt, giving rise to changes in surface buoyancy forcing. The increase in transport of the lower cell leads to upwelling of warm and salty Circumpolar Deep Water and subsequent melting of sea ice surrounding Antarctica. The MOC is commonly supposed to be the sum of two opposing components: a wind- and transient-eddy overturning cell. Here, the transient-eddy overturning is virtually unchanged and consistent with a large-scale cancellation of localized regions of both enhancement and suppression of eddy kinetic energy along the mean path of the ACC. However, decomposing the time-mean overturning into a time- and zonal-mean component and a standing-eddy component reveals partial compensation between wind-driven and standing-eddy components of the circulation

Constructive control of quantum systems using factorization of unitary operators

We demonstrate how structured decompositions of unitary operators can be employed to derive control schemes for finite-level quantum systems that require only sequences of simple control pulses such as square wave pulses with finite rise and decay times or Gaussian wavepackets. To illustrate the technique it is applied to find control schemes to achieve population transfers for pure-state systems, complete inversions of the ensemble populations for mixed-state systems, create arbitrary superposition states and optimize the ensemble average of dynamic observables.Comment: 28 pages, IoP LaTeX, principal author has moved to Cambridge University ([email protected]

Antibiotic therapy and risk of early-onset colorectal cancer: A national case-control study

INTRODUCTION: Antibiotic use has emerged as a risk factor for colorectal neoplasia and is hypothesized as a contributor to the rising incidence of colorectal cancer under age 50 years or early-onset colorectal cancer (EOCRC). However, the impact of antibiotic use and risk of EOCRC is unknown. METHODS: We conducted a population-based case-control study of CRC among individuals aged ≥18 years in the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO) cohort (2006-2016). The primary outcome was EOCRC. A secondary outcome was CRC at any age. Incident CRC was pathologically confirmed, and for each, up to 5 population-based controls were matched on age, sex, county of residence, and calendar year. We assessed prescriptions until 6 months before CRC diagnosis. Conditional logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). RESULTS: We identified 54,804 cases of CRC (2,557 EOCRCs) and 261,089 controls. Compared with none, previous antibiotic use was not associated with EOCRC risk after adjustment for potential confounders (aOR 1.06, 95% CI: 0.96, 1.17) with similarly null findings when stratified by anatomic tumor site. In contrast, previous antibiotic use was weakly associated with elevated risk for CRC at any age (aOR 1.05, 95% CI: 1.02, 1.07). A potential but modest link between broad-spectrum antibiotic use and EOCRC was observed (aOR 1.13, 95% CI: 1.02, 1.26). DISCUSSION: We found no conclusive evidence that antibiotics are associated with EOCRC risk. Although antibiotic use was weakly associated with risk of CRC at any age, the magnitude of association was modest, and the study period was relatively short