The relationship between sedentary bout duration and glucose in adults with type 2 diabetes

Physical activity is important for blood glucose management in people with Type 2 diabetes (T2D). Little research has explored the relationship between sedentary behaviour and mean glucose and glucose variability in people with T2D using objective and continuous measurements. Aims: To explore the relationship between sedentary bout duration and mean glucose and glucose variability in people with T2D using objective continuous measurement. Methods: 16 participants with T2D managed with diet, Metformin or DPP4 inhibitors were recruited (mean age 64.1±10.9 yr & BMI 29.4±6.9 kg/m2). Participants completed a demographic questionnaire and wore an activPAL accelerometer and FreeStyle Libre continuous glucose monitor for 3-14 days whilst documenting sleep, food and medication. Average proportion of time spent sitting/lying, during the waking day were calculated. Bouts of wake time sedentary behaviour were identified and defined as a period of at least 30 minutes continuous, uninterrupted sitting/lying during the waking day. Correlation analysis was conducted to investigate the relationships between sedentary bout duration and mean glucose, glucose range and glucose coefficient of variation. Results: On average, participants spent 65% of their day sitting/lying, 76% of sedentary bouts were ≥30minutes and 29% of bouts were ≥60minutes. Mean glucose was negatively (r = -0.08, p <0.01) associated with sedentary bout duration. Glucose range (r =0.47, p <0.001) and glucose coefficient of variation (r = 0.26, p <0.001) both positively correlated with sedentary bout duration. Participant characteristics such as age, gender and BMI appear to influence the relationship between sedentary bout duration and glucose response. Conclusions: Results indicate increased sedentary time leads to improved mean glucose and increased glucose variability

A systematic and integrated review of mobile-based technology to promote active lifestyles in people with Type 2 diabetes

Background: An active lifestyle is important for good Type 2 diabetes management. Mobile-based technology is increasingly being used to promote active lifestyles. Aim: To review studies examining the effectiveness, acceptability and feasibility of mobile-based technology for promoting active lifestyles in people with Type 2 diabetes. Methods: An integrated, systematic review method was used to allow inclusion of a variety of study designs. A comprehensive search of electronic databases including; PubMed, Medline, ScienceDirect and ACM Digital Library was conducted to retrieve studies promoting active lifestyles in people with Type 2 diabetes using mobile-based technology (apps and wearable technology). Studies had to assess; effectiveness, acceptability or feasibility of mobile based technology. Studies were categorised as 1)informing, 2)monitoring, 3)provoking or 4)sustaining behaviour. Results: A total of 9 papers from the 7662 sourced met inclusion criteria; 5 studies used smartphone or tablet apps, 1 a diabetes personal digital assistant, 1 a combination of continuous glucose monitor and accelerometer, 1 a pedometer and 1 a website delivered by a smartphone. The effectiveness of technology was assessed in 6 studies, feasibility examined in 3 studies and acceptability in 4 studies. Most (n=5) of the studies examined the effectiveness of using mobile-based technology to provoke lifestyle. The effectiveness of mobile-based technology in monitoring active lifestyles and the feasibility and acceptability of using mobile-based technology to sustained lifestyle change has not been investigated. Conclusions: To maintain health benefit from active lifestyles future research should explore the feasibility and acceptability of mobile based technology monitoring in sustaining active lifestyles

Objective, continuous measurement of sedentary behaviour and glucose in people with type 2 diabetes

Aims: To explore the relationship between daily levels of sitting/lying and glucose in people with Type 2 diabetes (T2D) using objective and continuous measurements. Methods: Ten participants with T2D managed with diet, Metformin or DPP4 inhibitors were recruited (mean age 63.5±9.4 years & BMI 30.8±6.9 kg/cm2). Participants completed a demographic questionnaire and wore an activPAL accelerometer and FreeStyle Libre continuous glucose monitor for 3-14 days whilst documenting sleep, food and medication. Average proportion of time spent sitting/lying, and daily mean glucose during the waking day were calculated. A multiple linear regression was calculated to explore the relationship between time spent sitting/lying, age, BMI, and daily mean glucose. Results: On average, participants spent 67.5% of their day sitting/lying and mean daily glucose was 7.7 (±1.8) mmol/l. Regression analysis suggested a significant effect (F(3,105) = 16.52, p <0.01) for sitting/lying time, age and BMI on daily mean glucose (R2 = 0.30). Participants’ predicted daily mean glucose is equal to -12.23 + 5.14(sitting/lying) + 0.16(age) + 0.21(BMI), with daily mean glucose increasing by 5.14mmol/l for each percent of daily sitting/lying, 0.16mmol/l for each increasing year of age and 0.21mmol/l for each increasing BMI unit. Conclusions: Average sitting/lying time was higher than has previously been reported and percentage sitting/lying time, age and BMI were identified as significant predictors of higher daily mean glucose in people with T2D. Results suggest that increased sedentariness is associated with increased daily mean glucose in those with T2D

E-prehabilitation system of care for teenagers and young adults diagnosed with cancer : study protocol

Background: A diagnosis of cancer in young adulthood can pose many different and unique challenges for individuals. Provision of adequate and appropriate information, care and support for teenagers and young adults around the time of diagnosis is central to their healthcare experience going forward. Appropriate and accessible information provision is critical to ensure young people with cancer feel equipped and empowered to make decisions about, and be involved in, their treatment and recovery throughout their experience; a concept known as prehabilitation. As digital interventions and resources to support TYA with cancer are an increasingly desirable part of healthcare provision, this study will focus on the development of an age and population appropriate (e) electronic-prehabilitation system of care. Objective: An exploratory, co-design research project will inform the development of an e-Prehabilitation system of care to support Teenagers and Young Adults diagnosed with cancer. A collaborative approach to data collection and prototype design will ensure a patient-centred approach is embedded throughout. Methods: Qualitative, co-design utilising surveys, interviews and focus groups with Teenagers and Young Adults, Health Care Professionals and Technologists. Results: This research study is in progress; recruitment and data collection activities have commenced and findings are expected early 2019. Conclusions: The findings from this study will have important implications for informing the future development and evaluation of an e-Prehabilitation system of care to support TYA diagnosed with cancer

A systematic review to assess the quality, feasibility, and efficacy of electronic patient platforms designed to support adolescents and young adults with cancer

Background: A range of innovative websites, mobile technologies, eHealth and mHealth platforms now exist to support Adolescents and Young Adults (AYAs) with cancer. Previous systematic reviews have tended to focus on the identification of technology-driven applications and solutions, yet little attention has been paid to understanding component features of existing platforms. Therefore, a systematic review has been conducted to assess the quality, feasibility, and efficacy of a range of digital health interventions, including websites, mobile technologies, mHealth and eHealth platforms. The review focuses on AYA aged between 13 - 39 years and platforms developed specifically for and targeted at AYA living with or beyond a cancer diagnosis. Design / Methods: A search string was applied to a number of bibliographic databases including MEDLINE, CINHAL and PUBMED. The search strategy included a range of Medical Subject Headings and a range of relevant keywords for the interventions of interest in this review. To allow comprehensive synthesis of studies included in the review, data were extracted, appraised and evaluated. Adapted versions of previously identified coding schematics were used to assess the mode of delivery and quality of patient platforms. Methodological quality of included papers was assessed using the Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields (QualSyst). Results: The review is currently in progress. The review will be completed by the end of 2017 and thus, findings will be known by the time of the CBC Digital Health Conference in 2018. Conclusion: The focus of this systematic review provides a necessary and important step in characterising the potential utility of technology-based interventions for young people with cancer to ensure success in terms of future development and implementation of appropriate and meaningful digital health interventions for this population

ActiveChat : Development of an 8 week school-based intervention to increase motivation for physical activity and reduce sedentary behaviour in secondary school pupils

This poster discusses the development of an 8 week school-based intervention to increase motivation for physical activity and reduce sedentary behaviour in secondary school pupils

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

A História da Alimentação: balizas historiográficas

Os M. pretenderam traçar um quadro da História da Alimentação, não como um novo ramo epistemológico da disciplina, mas como um campo em desenvolvimento de práticas e atividades especializadas, incluindo pesquisa, formação, publicações, associações, encontros acadêmicos, etc. Um breve relato das condições em que tal campo se assentou faz-se preceder de um panorama dos estudos de alimentação e temas correia tos, em geral, segundo cinco abardagens Ia biológica, a econômica, a social, a cultural e a filosófica!, assim como da identificação das contribuições mais relevantes da Antropologia, Arqueologia, Sociologia e Geografia. A fim de comentar a multiforme e volumosa bibliografia histórica, foi ela organizada segundo critérios morfológicos. A seguir, alguns tópicos importantes mereceram tratamento à parte: a fome, o alimento e o domínio religioso, as descobertas européias e a difusão mundial de alimentos, gosto e gastronomia. O artigo se encerra com um rápido balanço crítico da historiografia brasileira sobre o tema

Proceedings of the 3rd Biennial Conference of the Society for Implementation Research Collaboration (SIRC) 2015: advancing efficient methodologies through community partnerships and team science

It is well documented that the majority of adults, children and families in need of evidence-based behavioral health interventionsi do not receive them [1, 2] and that few robust empirically supported methods for implementing evidence-based practices (EBPs) exist. The Society for Implementation Research Collaboration (SIRC) represents a burgeoning effort to advance the innovation and rigor of implementation research and is uniquely focused on bringing together researchers and stakeholders committed to evaluating the implementation of complex evidence-based behavioral health interventions. Through its diverse activities and membership, SIRC aims to foster the promise of implementation research to better serve the behavioral health needs of the population by identifying rigorous, relevant, and efficient strategies that successfully transfer scientific evidence to clinical knowledge for use in real world settings [3]. SIRC began as a National Institute of Mental Health (NIMH)-funded conference series in 2010 (previously titled the “Seattle Implementation Research Conference”; $150,000 USD for 3 conferences in 2011, 2013, and 2015) with the recognition that there were multiple researchers and stakeholdersi working in parallel on innovative implementation science projects in behavioral health, but that formal channels for communicating and collaborating with one another were relatively unavailable. There was a significant need for a forum within which implementation researchers and stakeholders could learn from one another, refine approaches to science and practice, and develop an implementation research agenda using common measures, methods, and research principles to improve both the frequency and quality with which behavioral health treatment implementation is evaluated. SIRC’s membership growth is a testament to this identified need with more than 1000 members from 2011 to the present.ii SIRC’s primary objectives are to: (1) foster communication and collaboration across diverse groups, including implementation researchers, intermediariesi, as well as community stakeholders (SIRC uses the term “EBP champions” for these groups) – and to do so across multiple career levels (e.g., students, early career faculty, established investigators); and (2) enhance and disseminate rigorous measures and methodologies for implementing EBPs and evaluating EBP implementation efforts. These objectives are well aligned with Glasgow and colleagues’ [4] five core tenets deemed critical for advancing implementation science: collaboration, efficiency and speed, rigor and relevance, improved capacity, and cumulative knowledge. SIRC advances these objectives and tenets through in-person conferences, which bring together multidisciplinary implementation researchers and those implementing evidence-based behavioral health interventions in the community to share their work and create professional connections and collaborations