A case series of an off-the-shelf online health resource with integrated nurse coaching to support self-management in COPD

Background: COPD has significant psychosocial impact. Self-management support improves quality of life, but programs are not universally available. IT-based self-management interventions can provide home-based support, but have mixed results. We conducted a case series of an off-the-shelf Internet-based health-promotion program, The Preventive Plan (TPP), coupled with nurse-coach support, which aimed to increase patient activation and provide self-management benefits. Materials and methods: A total of 19 COPD patients were recruited, and 14 completed 3-month follow-up in two groups: groups 1 and 2 with more and less advanced COPD, respectively. Change in patient activation was determined with paired t-tests and Wilcoxon signed-rank tests. Benefits and user experience were explored in semistructured interviews, analyzed thematically. Results: Only group 1 improved significantly in activation, from a lower baseline than group 2; group 1 also improved significantly in mastery and anxiety. Both groups felt significantly more informed about COPD and reported physical functioning improvements. Group 1 reported improvements in mood and confidence. Overall, group 2 reported fewer benefits than group 1. Both groups valued nurse-coach support; for group 1, it was more important than TPP in building confidence to self-manage. The design of TPP and lack of motivation to use IT were barriers to use, but disease severity and poor IT skills were not. Discussion: Our findings demonstrate the feasibility of combining nurse-coach support aligned to an Internet-based health resource, TPP, in COPD and provide learning about the challenges of such an approach and the importance of the nurse-coach role

Uptake, effectiveness and safety of COVID-19 vaccines in individuals at clinical risk due to immunosuppressive drug therapy or transplantation procedures: a population-based cohort study in England

: Background: Immunocompromised individuals are at increased risk of severe COVID-19 outcomes, underscoring the importance of COVID-19 vaccination in this population. The lack of comprehensive real-world data on vaccine uptake, effectiveness and safety in these individuals presents a critical knowledge gap, highlighting the urgency to better understand and address the unique challenges faced by immunocompromised individuals in the context of COVID-19 vaccination. Methods: We analysed data from 12,274,946 people in the UK aged > 12 years from 01/12/2020 to 11/04/2022. Of these, 583,541 (4.8%) were immunocompromised due to immunosuppressive drugs, organ transplants, dialysis or chemotherapy. We undertook a cohort analysis to determine COVID-19 vaccine uptake, nested case–control analyses adjusted for comorbidities and sociodemographic characteristics to determine effectiveness of vaccination against COVID-19 hospitalisation, ICU admission and death, and a self-controlled case series assessing vaccine safety for pre-specified adverse events of interest. Results: Overall, 93.7% of immunocompromised individuals received at least one COVID-19 vaccine dose, with 80.4% having received three or more doses. Uptake reduced with increasing deprivation (hazard ratio [HR] 0.78 [95%CI 0.77–0.79] in the most deprived quintile compared to the least deprived quintile for the first dose). Estimated vaccine effectiveness against COVID-19 hospitalisation 2–6 weeks after the second and third doses compared to unvaccinated was 78% (95%CI 72–83) and 91% (95%CI 88–93) in the immunocompromised population, versus 85% (95%CI 83–86) and 86% (95%CI 85–89), respectively, for the general population. Results showed COVID-19 vaccines were protective against intensive care unit (ICU) admission and death in both populations, with effectiveness of over 92% against COVID-19-related death and up to 95% in reducing ICU admissions for both populations following the third dose. COVID-19 vaccines were generally safe for immunocompromised individuals, though specific doses of ChAdOx1, mRNA-1273 and BNT162b2 raised risks of specific cardiovascular/neurological conditions. Conclusions: COVID-19 vaccine uptake is high in immunocompromised individuals on immunosuppressive drug therapy or who have undergone transplantation procedures, with documented disparities by deprivation. Findings suggest that COVID-19 vaccines are protective against severe COVID-19 outcomes in this vulnerable population, and show a similar safety profile in immunocompromised individuals and the general population, despite some increased risk of adverse events. These results underscore the importance of ongoing vaccination prioritisation for this clinically at-risk population to maximise protection against severe COVID-19 outcomes

Associations between the psychological health of patients and carers in advanced COPD

Objective: Anxiety and depression are highly prevalent in patients with chronic obstructive pulmonary disease (COPD) and their informal carers, and associated with numerous risk factors. However, few studies have investigated these in primary care or the link between patient and carer anxiety and depression. We aimed to determine this association, and factors associated with anxiety and depression in patients, carers, and both in a dyad, in a population-based sample. Methods: Prospective, cross-sectional analysis of data from 119 advanced COPD patients and their carers. Patient and carer scores ≥8 on the Hospital Anxiety and Depression Scale were defined as cases of anxiety and depression; Chi-square, independent-t and Mann-Whitney U tests were used to determine variables significantly associated with these. Patient-carer dyads were categorised into four groups relating to the presence of anxiety or depression: (1) in both the patient and carer, (2) patient only, (3) carer only and (4) neither; factors associated with dyad anxiety or depression were determined with Chi-square, one-way ANOVA and Kruskal-Wallis tests. Results: Prevalence of anxiety and depression was 46.4% (n=52) and 42.9% (n=48) in patients, and 46.0% (n=52) and 23.0% (n=26) in carers, respectively. Patient and carer anxiety and depression were significantly associated. Patient anxiety and depression was also significantly associated with younger age, more physical co-morbidities, more exacerbations, greater dyspnoea, greater fatigue, and poor mastery. Carer anxiety and depression was significantly associated with younger age, being female and separated/divorced/widowed, higher educational level, more physical co-morbidities, unmet support needs, greater subjective caring burden and poor patient mastery. Dyad anxiety or depression was significantly associated with greater patient fatigue. Conclusion: Anxiety and depression of patients and carers are associated. Dyad anxiety or depression was associated with greater patient fatigue. It is necessary to identify and address patient, carer and dyad psychological morbidity in advanced COPD

North Korea: U.S. Relations, Nuclear Diplomacy, and Internal Situation

Although the primary focus of U.S. policy toward North Korea is the nuclear weapons program, there are a host of other issues, which this report explores through an overview of the U.S.-North Korea relationship, including an emphasis on the diplomacy of the Six-Party Talks. Please refer to the list at the end of this report for the full list of CRS reports focusing on other North Korean issues

Enhanced adsorption of cationic and anionic dyes from aqueous solutions by polyacid doped polyaniline

A new high surface area polyaniline (PANI) adsorbent was synthesized by matrix polymerization of aniline in the presence of a polyacid, poly(2-acrylamido-2-methyl-1-propanesulfonic acid) (PAMPSA). Morphological and physicochemical properties of PANI-PAMPSA were characterized by field emission scanning electron microscope (FESEM), Fourier transform infrared spectroscopy (FTIR), X-ray powder diffraction (XRD), nitrogen adsorption/desorption and zeta potential measurement. Adsorption properties were evaluated using methylene blue (MB) and rose bengal (RB) as model dyes.The results showed that PANI-PAMPSA obtained a well-defined porous structure with a specific surface area (126 m2 g−1) over 10 times larger than that of the emeraldine base PANI (PANI-EB) (12 m2 g−1). The maximum adsorption capacities were 466.5 mg g−1 for MB and 440.0 mg g−1 for RB, higher than any other PANI-based materials reported in the literature. The FTIR analysis and zeta potential measurement revealed that the adsorption mechanisms involved π-π interaction and electrostatic interaction. The adsorption kinetics were best described by a pseudo-second-order model, and the adsorption isotherms followed the Langmuir model. The thermodynamic study indicated that the adsorption was a spontaneous endothermic process. Overall, the convenient synthesis and the high adsorption capacity make PANI-PAMPSA a promising adsorbent material for dye removal

Uptake of COVID-19 vaccination in people with blood cancer: Population-level cohort study of 12 million patients in England

BackgroundPeople with blood cancers have increased risk of severe outcomes from COVID-19 and were prioritised for vaccination.MethodsIndividuals in the QResearch database aged 12 years and above on 1st December 2020 were included in the analysis. Kaplan–Meier analysis described time to COVID-19 vaccine uptake in people with blood cancer and other high-risk disorders. Cox regression was used to identify factors associated with vaccine uptake in people with blood cancer.ResultsThe analysis included 12,274,948 individuals, of whom 97,707 had a blood cancer diagnosis. 92% of people with blood cancer received at least one dose of vaccine, compared to 80% of the general population, but there was lower uptake of each subsequent vaccine dose (31% for fourth dose). Vaccine uptake decreased with social deprivation (HR 0.72, 95% CI 0.70, 0.74 for most deprived versus most affluent quintile for first vaccine). Compared with White groups, uptake of all vaccine doses was significantly lower in people of Pakistani and Black ethnicity, and more people in these groups remain unvaccinated.ConclusionsCOVID-19 vaccine uptake declines following second dose and there are ethnic and social disparities in uptake in blood cancer populations. Enhanced communication of benefits of vaccination to these groups is needed

Do patients and carers agree on symptom burden in advanced COPD?

OBJECTIVE: Accurate informal carer assessment of patient symptoms is likely to be valuable for decision making in managing the high symptom burden of COPD in the home setting. Few studies have investigated agreement between patients and carers in COPD. We aimed to assess agreement between patients and carers on symptoms, and factors associated with disagreement in a population-based sample of patients with advanced COPD. PATIENTS AND METHODS: This was a prospective, cross-sectional analysis of data from 119 advanced COPD patients and their carers. Patients and carers separately rated symptoms on a 4-point scale. Wilcoxon signed-rank tests and weighted Cohen's kappa determined differences in patient and carer scores and patient-carer agreement, respectively. We identified characteristics associated with incongruence using Spearman's rank correlation and Mann-Whitney U tests. RESULTS: There were no significant differences between group-level patient and carer scores for any symptom. Patient-carer individual-level agreement was moderate for constipation (k=0.423), just below moderate for diarrhea (k=0.393) and fair for depression (k=0.341), fatigue (k=0.294), anxiety (k=0.289) and breathlessness (k=0.210). Estimation of greater patient symptom burden by carers relative to patients themselves was associated with non-spousal patient-carer relationship, non-cohabitating patients and carers, carer symptoms of anxiety and depression and more carer unmet support needs. Greater symptom burden estimation by the patient relative to the carer was associated with younger patients and longer duration of COPD. CONCLUSION: Overall, agreement between patients and carers was fair to moderate and was poorer for more subjective symptoms. There is a need to encourage open dialogue between patients and carers to promote shared understanding, help patients express themselves and encourage carers to draw attention to symptoms that patients do not report. The findings suggest a need to screen for and address both the psychological morbidities in patients with advanced COPD and their carers and unmet support needs in carers

Effectiveness and safety of COVID-19 vaccination in people with blood cancer

BackgroundPeople with blood cancer have increased risk of severe COVID-19 outcomes and poor response to vaccination. We assessed the safety and effectiveness of COVID-19 vaccines in this vulnerable group compared to the general population.MethodsIndividuals aged ≥12 years as of 1st December 2020 in the QResearch primary care database were included. We assessed adjusted COVID-19 vaccine effectiveness (aVE) against COVID-19-related hospitalisation and death in people with blood cancer using a nested matched case-control study. Using the self-controlled case series methodology, we compared the risk of 56 pre-specified adverse events within 1–28 days of a first, second or third COVID-19 vaccine dose in people with and without blood cancer.FindingsThe cohort comprised 12,274,948 individuals, of whom 81,793 had blood cancer. COVID-19 vaccines were protective against COVID-19-related hospitalisation and death in people with blood cancer, although they were less effective, particularly against COVID-19-related hospitalisation, compared to the general population. In the blood cancer population, aVE against COVID-19-related hospitalisation was 64% (95% confidence interval [CI] 48%−75%) 14–41 days after a third dose, compared to 80% (95% CI 78%−81%) in the general population. Against COVID-19-related mortality, aVE was >80% in people with blood cancer 14–41 days after a second or third dose. We found no significant difference in risk of adverse events 1–28 days after any vaccine dose between people with and without blood cancer.InterpretationOur study provides robust evidence which supports the use of COVID-19 vaccinations for people with blood cancer

Prolonged low flow reduces reactive hyperemia and augments low flow mediated constriction in the brachial artery independent of the menstrual cycle

© 2013 Rakobowchuk et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Non-invasive forearm ischemia-reperfusion injury and low flow induced vascular dysfunction models provide methods to evaluate vascular function. The role of oestrogen, an endogenous anti-oxidant on recovery from ischemia-reperfusion injury has not been evaluated nor has the impact of prolonged low flow on vascular function been established. Eight healthy women (33610 yr) attended the lab during the follicular, ovulatory and mid-luteal phases of their menstrual cycles. After 30 minutes of rest, brachial artery vascular function was assessed by ultrasound measurements of diameter changes during 5 minutes of forearm ischemia and 3 minutes after. Subsequently, a 20-minute forearm ischemia period was completed. Further, vascular function assessments were completed 15, 30 and 45 minutes into recovery. Flow-mediated dilation, lowflow-mediated constriction, and reactive hyperaemia proximal to the area of ischemia were determined. Flow-mediated dilation was reduced at 15 minutes of recovery but recovered at 30 and 45 minutes (PRE: 7.161.0%, POST15:4.560.6%, POST30:5. 560.7% POST45:5.960.4%, p,0.01). Conversely, low-flow mediated constriction increased (PRE: 21.360.4%, POST15: 23.360.6%, POST30: 22.560.5% POST45: 21.560.12%, p,0.01). Reactive hyperaemia was reduced throughout recovery (p,0.05). Data were unaffected by menstrual phase. Prolonged low flow altered vascular function and may relate as much to increased vasoconstriction as with decreased vasodilation. Reductions in anterograde shear and greater retrograde shear likely modulate the brachial artery response, but the reduced total shear also plays an important role. The data suggest substantial alterations in vascular function proximal to areas of ischemia with potential clinical implications following reperfusion.British Heart Foundation (PG/08/060/25340),a Physiological Society summer studentship to SG, and a Wellcome Trust Vacation Studentship to EP

Bortezomib treatment causes long-term testicular dysfunction in young male mice

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