A monitoring and feedback tool embedded in a counselling protocol to increase physical activity of patients with COPD or type 2 diabetes in primary care: study protocol of a three-arm cluster randomised controlled trial

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A monitoring and feedback tool embedded in a counselling protocol to increase physical activity of patients with COPD or type 2 diabetes in primary care: study protocol of a three-arm cluster randomised controlled trial

BACKGROUND: Physical activity is important for a healthy lifestyle. Although physical activity can delay complications and decrease the burden of the disease, the level of activity of patients with chronic obstructive pulmonary disease (COPD) or type 2 Diabetes Mellitus (DM2) is often far from optimal. To stimulate physical activity, a monitoring and feedback tool, consisting of an accelerometer linked to a smart phone and webserver (It’s LiFe! tool), and a counselling protocol for practice nurses in primary care was developed (the Self-management Support Program). The main objective of this study is to measure the longitudinal effects of this counselling protocol and the added value of using the tool. METHODS/DESIGN: This three-armed cluster randomised controlled trial with 120 participants with COPD and 120 participants with DM2 (aged 40–70), compares the counselling protocol with and without the use of the tool (group 1 and 2) with usual care (group 3). Recruitment takes place at GP practices in the southern regions of the Netherlands. Randomisation takes place at the practice level. The intended sample (three arms of 8 practices) powers the study to detect a 10-minute difference of moderate and intense physical activity per day between groups 1 and 3. Participants in the intervention groups have to visit the practice nurse 3–4 times for physical activity counselling, in a 4-6-month period. Specific activity goals tailored to the individual patient's preferences and needs will be set. In addition, participants in group 1 will be instructed to use the tool in daily life. The primary outcome, physical activity, will be measured in all groups with a physical activity monitor (PAM). Secondary outcomes are quality of life, general - and exercise - self-efficacy, and health status. Follow-up will take place after 6 and 9 months. Separately, a process evaluation will be conducted to explore reasons for trial non-participation, and the intervention’s acceptability for participating patients and nurses. DISCUSSION: Results of this study will give insight into the effects of the It’s LiFe! monitoring and feedback tool combined with care from a practice nurse for people with COPD or DM2 on physical activity. TRIAL REGISTRATION: ClinicalTrials.gov: NCT0186797

Practices of ritualization in a Dutch hospice setting

In this article, we explore rituals and ritualized care practices in a hospice in the Netherlands. The research is guided by two research questions. First, we want to know what kind of rituals and ritualized care practices are taking place in the hospice. Second, we aim to understand these practices from a cultural perspective, i.e., to what cultural values do these practices refer? We distinguish five types of ritual: (1) care practices in the morning; (2) meals; (3) care practices in the evening; (4) care practices in the dying phase; (5) a farewell ritual after a patient has died. Ritualization takes place in various degrees and forms, depending on changes in the state of liminality. Analysis of ritualized care practices shows that everyday care practices are enriched with non-instrumental elements that have a strong symbolic meaning, referring to the cultural value of the ‘good death’

Ritualization as Alternative Approach to the Spiritual Dimension of Palliative Care: A Concept Analysis

The spiritual dimension is considered to be a central component of palliative care. However, healthcare professionals have difculties incorporating the spiritual dimension into their everyday practice. We propose a new approach by looking beyond the mere functionality of care practices. Rituals and ritualized practices can serve to express and communicate meanings and values. This article explores how ritualized practices have the ability to open up space for the spiritual dimension of care in the context of palliative care

TRiC controls transcription resumption after UV damage by regulating Cockayne syndrome protein A

Transcription-blocking DNA lesions are removed by transcription-coupled nucleotide excision repair (TC-NER) to preserve cell viability. TC-NER is triggered by the stalling of RNA polymerase II at DNA lesions, leading to the recruitment of TC-NER-specific factors such as the CSA-DDB1-CUL4A-RBX1 cullin-RING ubiquitin ligase complex (CRLCSA). Despite its vital role in TC-NER, little is known about the regulation of the CRLCSA complex during TC-NER. Using conventional and cross-linking immunoprecipitations coupled to mass spectrometry, we uncover a stable interaction between CSA and the TRiC chaperonin. TRiC's binding to CSA ensures its stability and DDB1-dependent assembly into the CRLCSA complex. Consequently, loss of TRiC leads to mislocalization and depletion of CSA, as well as impaired transcription recovery following UV damage, suggesting defects in TC-NER. Furthermore, Cockayne syndrome (CS)-causing mutations in CSA lead to increased TRiC binding and a failure to compose the CRLCSA complex. Thus, we uncover CSA as a TRiC substrate and reveal that TRiC regulates CSA-dependent TC-NER and the development of CS

Transcription-coupled nucleotide excision repair is coordinated by ubiquitin and SUMO in response to ultraviolet irradiation

Cockayne Syndrome (CS) is a severe neurodegenerative and premature aging autosomal-recessive disease, caused by inherited defects in the CSA and CSB genes, leading to defects in transcription-coupled nucleotide excision repair (TC-NER) and consequently hypersensitivity to ultraviolet (UV) irradiation. TC-NER is initiated by lesion-stalled RNA polymerase II, which stabilizes the interaction with the SNF2/SWI2 ATPase CSB to facilitate recruitment of the CSA E3 Cullin ubiquitin ligase complex. However, the precise biochemical connections between CSA and CSB are unknown. The small ubiquitin-like modifier SUMO is important in the DNA damage response. We found that CSB, among an extensive set of other target proteins, is the most dynamically SUMOylated substrate in response to UV irradiation. Inhibiting SUMOylation reduced the accumulation of CSB at local sites of UV irradiation and reduced recovery of RNA synthesis. Interestingly, CSA is required for the efficient clearance of SUMOylated CSB. However, subsequent proteomic analysis of CSA-dependent ubiquitinated substrates revealed that CSA does not ubiquitinate CSB in a UV-dependent manner. Surprisingly, we found that CSA is required for the ubiquitination of the largest subunit of RNA polymerase II, RPB1. Combined, our results indicate that the CSA, CSB, RNA polymerase II triad is coordinated by ubiquitin and SUMO in response to UV irradiation. Furthermore, our work provides a resource of SUMO targets regulated in response to UV or ionizing radiation

The preconditions for image care in disability care:A concept mapping study

Inleiding:Al jaren zijn er in Nederland verschillende initiatieven in de ambulante gehandicaptenzorg met beeldzorg. Echter, van brede implementatie is, ook na de Covid-19 pandemie, nog geen sprake. Mogelijk is er een andere manier van organiseren en implementeren nodig. Het doel van dit onderzoek was de randvoorwaarden in kaart te brengen voor kwalitatief goede beeldzorg voor mensen met een verstandelijke beperking, met behulp van de group concept mapping (GCM) methode. Onder beeldzorg wordt verstaan: zorg en ondersteuning op afstand tussen zorgverlener/begeleider en cliënt.MethodeEen diverse groep deelnemers deed mee aan de GCM procedure, die bestond uit het benoemen van randvoorwaarden in een online brainstorm, deze sorteren en waarderen en het interpreteren van de (door een onderzoekers geanalyseerde) resultaten.ResultatenDe concept map bestaat uit 99 opvattingen in 13 clusters. Genoemde randvoorwaarden gaan over de technologie én over beleid, intern in de organisatie en over wat er nodig is in relatie tot zorggebruikers, zijn/haar naasten, en andere organisaties.ConclusieDe concept map laat zien dat voor een duurzame implementatie van beeldzorg de verschillende randvoorwaarden gecombineerd moeten worden in zowel visie, beleid als uitvoering. Het gaat dan om onder andere applicaties, ICT-infrastructuur en ICT-ondersteuning, om training en scholing van zorgprofessionals, om de aansluiting van beeldzorg bij de behoeften, vragen en capaciteiten van cliënten met een verstandelijke beperking. Betrokkenheid van cliënten en zorgprofessionals daarbij is noodzakelijk

A Formal Proof of PAC Learnability for Decision Stumps

We present a formal proof in Lean of probably approximately correct (PAC) learnability of the concept class of decision stumps. This classic result in machine learning theory derives a bound on error probabilities for a simple type of classifier. Though such a proof appears simple on paper, analytic and measure-theoretic subtleties arise when carrying it out fully formally. Our proof is structured so as to separate reasoning about deterministic properties of a learning function from proofs of measurability and analysis of probabilities.Comment: 13 pages, appeared in Certified Programs and Proofs (CPP) 202

A CSB-PAF1C axis restores processive transcription elongation after DNA damage repair

Bulky DNA lesions in transcribed strands block RNA polymerase II (RNAPII) elongation and induce a genome-wide transcriptional arrest. The transcription-coupled repair (TCR) pathway efficiently removes transcription-blocking DNA lesions, but how transcription is restored in the genome following DNA repair remains unresolved. Here, we find that the TCR-specific CSB protein loads the PAF1 complex (PAF1C) onto RNAPII in promoter-proximal regions in response to DNA damage. Although dispensable for TCR-mediated repair, PAF1C is essential for transcription recovery after UV irradiation. We find that PAF1C promotes RNAPII pause release in promoter-proximal regions and subsequently acts as a processivity factor that stimulates transcription elongation throughout genes. Our findings expose the molecular basis for a non-canonical PAF1C-dependent pathway that restores transcription throughout the human genome after genotoxic stress. The transcription-coupled repair pathway removes transcription-blocking DNA lesions, but how transcription is restored following DNA repair is not clear. Here the authors reveal that the PAF1 complex, while dispensable for the repair process, restores transcription after DNA damage.Cancer Signaling networks and Molecular Therapeutic