Barriers and facilitators to the recruitment of disabled people to clinical trials: a scoping review

Introduction Underrepresentation of disabled groups in clinical trials results in an inadequate evidence base for their clinical care, which drives health inequalities. This study aims to review and map the potential barriers and facilitators to the recruitment of disabled people in clinical trials to identify knowledge gaps and areas for further extensive research. The review addresses the question: ‘What are the barriers and facilitators to recruitment of disabled people to clinical trials?’. Methods The Joanna Briggs Institute (JBI) Scoping review guidelines were followed to complete the current scoping review. MEDLINE and EMBASE databases were searched via Ovid. The literature search was guided by a combination of four key concepts from the research question: (1) disabled populations, (2) patient recruitment, (3) barriers and facilitators, and (4) clinical trials. Papers discussing barriers and facilitators of all types were included. Papers that did not have at least one disabled group as their population were excluded. Data on study characteristics and identified barriers and facilitators were extracted. Identified barriers and facilitators were then synthesised according to common themes. Results The review included 56 eligible papers. The evidence on barriers and facilitators was largely sourced from Short Communications from Researcher Perspectives (N = 22) and Primary Quantitative Research (N = 17). Carer perspectives were rarely represented in articles. The most common disability types for the population of interest in the literature were neurological and psychiatric disabilities. A total of five emergent themes were determined across the barriers and facilitators. These were as follows: risk vs benefit assessment, design and management of recruitment protocol, balancing internal and external validity considerations, consent and ethics, and systemic factors. Conclusions Both barriers and facilitators were often highly specific to disability type and context. Assumptions should be minimised, and study design should prioritise principles of co-design and be informed by a data-driven assessment of needs for the study population. Person-centred approaches to consent that empower disabled people to exercise their right to choose should be adopted in inclusive practice. Implementing these recommendations stands to improve inclusive practices in clinical trial research, serving to produce a well-rounded and comprehensive evidence base

Mapping atmospheric pollutants emissions in European countries

In this paper we present a methodology which enables the graphical representation, in a bi-dimensional Euclidean space, of atmospheric pollutants emissions in European countries. This approach relies on the use of Multidimensional Unfolding (MDU), an exploratory multivariate data analysis technique. This technique illustrates both the relationships between the emitted gases and the gases and their geographical origins. The main contribution of this work concerns the evaluation of MDU solutions. We use simulated data to define thresholds for the model fitting measures, allowing the MDU output quality evaluation. The quality assessment of the model adjustment is thus carried out as a step before interpretation of the gas types and geographical origins results. The MDU maps analysis generates useful insights, with an immediate substantive result and enables the formulation of hypotheses for further analysis and modeling

Cutaneous Sarcoma. From Diagnosis to Treatment

O diagnóstico dos sarcomas cutâneos é desafiante, devido à complexidade e heterogeneidade deste grupo de lesões, cuja apresentação nos tecidos superficiais (pele e tecido celular subcutâneo) impõe diagnóstico diferencial obrigatório com tumores benignos e processos inflamatórios. Apesar de serem tumores pouco frequentes alguns tipos assumem grande importância por serem localmente invasivos, com elevada morbi-mortalidade associada, taxas de recidiva local e metastização significativas. Os autores apresentam cinco casos clínico-patológicos de sarcomas cutâneos – sarcoma de Kaposi, dermatofibrossarcoma protuberans, fibroxantoma atípico, leiomiossarcoma e angiossarcoma – e fazem uma breve revisão da literatura sobre os tipos de sarcoma cutâneo com maior interesse na Dermatologia, salientando os aspectos fisiopatológicos, clínicos, histopatológicos e terapêuticos particulares

Halogenated polycyclic aromatic hydrocarbons associated with drinking water disinfection

Introduction: Disinfection by-products (DBPs) have been identified in chlorinated water. This fact justifies the growing concern about the potential health effects of emerging unregulated DBPs, some of which appear to be more genotoxic than the regulated DBPs[1]. Polycyclic aromatic hydrocarbons (PAHs) are among the most persistent contaminants detected in environmental samples such as river sediments and tap water. A few studies have already proven that water disinfection can lead to the formation of halogenated derivatives of PAHs, such as chlorinated and brominated PAHs[2] . The available toxicological studies have shown that these compounds possess, in general, greater mutagenicity than the corresponding parent PAHs. Our research group has also shown that exposure of HepG2 cells to a dose-range of 6-Cl-benzo[a]pyrene (6-ClBaP) and BaP resulted in cytotoxicity above 50 µM and that, at the equimolar doses of 100 and 125 µM, 6-ClBaP was able to induce a significantly higher level of DNA damage than BaP[3] . The present study had two main objectives: 1) identification of the major chlorinated and brominated derivatives of benzo[a]anthracene (BaA) and pyrene (Pyr) formed as disinfection by-products and 2) evaluation of their potential hazard to humans, through the characterization of their potential cytotoxic and genotoxic effects in a human cell line.The authors wish to thank Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa for financial support by the grant BRJ-DSA/2012- Doenças Oncológica

Co-designed FreeRTOS deployed on FPGA

Most embedded systems are bound to real-time constraints. Two of the critical metrics presented in these systems are determinism and latency. Due to growing in complexity of embedded applications, real time operating systems (RTOS) are needed, not only to hide the increasingly complex hardware, but also to provide services to the system’s running tasks. Unfortunately, this new layer on an embedded system puts more pressure on the aforementioned metrics. One of the ways to cope with this problem is to offload RTOS run-time services to the hardware layer. This paper presents a hybrid hardware/software implementation of this technique upon the well known FreeRTOS, improving system’s latency and predictability, by migrating critical runtime services to hardware. The developed hardware accelerators were synthesized on a field-programmable gate array (FPGA), exploiting the point-to-point bus Fast Simplex Link (FSL) to interconnect to the Xilinx’s Microbaze soft-core processor.This work has been supported by FCT - Foundation for Science and Technology within the Project Scope: PEst-OE/EEI/UI0319/2014

Mapping atmospheric pollutant emissions in European countries

WOS:000300110900009 (Nº de Acesso Web of Science)In this paper we present a methodology which enables the graphical representation, in a bi-dimensional Euclidean space, of atmospheric pollutants emissions in European countries. This approach relies on the use of Multidimensional Unfolding (MDU), an exploratory multivariate data analysis technique. This technique illustrates both the relationships between the emitted gases and the gases and their geographical origins. The main contribution of this work concerns the evaluation of MDU solutions. We use simulated data to define thresholds for the model fitting measures, allowing the MDU output quality evaluation. The quality assessment of the model adjustment is thus carried out as a step before interpretation of the gas types and geographical origins results. The MDU maps analysis generates useful insights, with an immediate substantive result and enables the formulation of hypotheses for further analysis and modeling

Plasmodium species mixed infections in two areas of Manhiça District, Mozambique

We compared the distribution patterns of individual Plasmodium species and mixed-species infections in two geographically close endemic areas, but showing environmental differences. Comparisons concerned circulating Plasmodium infections in both human and mosquito vector populations in the dry and wet seasons, at a micro-epidemiological level (households). Both areas revealed a very high overall prevalence of infection, all year-round and in all age groups. Plasmodium falciparum was the predominant species, being found in the vast majority of infected individuals regardless of the presence of other species. Plasmodium malariae and Plasmodium ovale occurred almost exclusively in mixed infections. Seasonal variation in P. malariae prevalence was observed in one area but not in the other. A decrease in P. malariae prevalence concurred with a marked increase of P. falciparum prevalence. However this was strongly dependent on age and when analysing infections at the individual level, a different pattern between co-infecting species was unveiled. Regarding transmission patterns, in both areas, P. falciparum gametocytes predominated in single infections regardless of age and P. malariae gametocyte carriage increased when its overall prevalence decreased

Skin Disease in Liver and Kidney Transplant Recipients Referred to the Department of Dermatology and Venereology

Introdução: Foram descritas várias doenças cutâneas em doentes transplantados, em relação com a terapêutica imunossupressora instituída. Pretendemos caracterizar o espectro clínico das patologias dermatológicas e comparar os diagnósticos entre os doentes transplantados hepáticos e os doentes transplantados renais. Material e Métodos: Estudo descritivo e retrospectivo através da consulta de processos clínicos de todos os doentes submetidos a transplante hepático ou renal entre 2000 - 2010 referenciados à Consulta de Dermatologia e Venereologia. Resultados: Observámos 319 doentes transplantados (23,5%) e apurámos 410 diagnósticos (230 na sub-população com transplante hepático e 180 na sub-população com transplante renal), divididos em quatro grupos: 1) infecções cutâneas; 2) cancro cutâneo ou lesões precursoras; 3) manifestações cutâneas relacionadas com efeitos secundários de fármacos; 4) outras patologias dermatológicas não iatrogénicas. As infecções cutâneas foram as mais observadas (42,2%), em média 32,7 meses após o transplante. Este grupo incluiu 20,5% de infecções fúngicas, 12,7% virais e 8,5% bacterianas. Identificámos patologia tumoral e lesões precursoras em 11,7% dos casos, em média 44,8 meses após o transplante e assumindo maior importância na sub-população com transplante renal (20,6% vs 4,8% nos transplantados hepáticos; P < 0,001). Os transplantados renais apresentaram predomínio de carcinomas espinocelulares (CEC) sobre os casos de carcinomas basocelulares (CBC), numa razão CEC:CBC de 1,3:1 mas nos transplantados hepáticos verificou-se uma razão CBC: carcinomas de 3,5:1. Ocorreram efeitos secundários de fármacos em 10,5% dos casos e outras patologias dermatológicas não iatrogénicas em 35,6%. Discussão: Apesar da patologia tumoral ser a mais referida na literatura, as infecções cutâneas foram as mais observadas na nossa amostra. As diferenças significativas entre as duas sub-populações estudadas podem estar relacionadas com o maior grau de imunossupressão a que os doentes transplantados renais estão sujeitos. Conclusão: Dada a elevada frequência de patologia cutânea nestes doentes é essencial incluir o acesso a consultas de Dermatologia e Venereologia nos cuidados multi-disciplinares pós-transplante

Weakly-supervised classification of HER2 expression in breast cancer haematoxylin and eosin stained slides

Human epidermal growth factor receptor 2 (HER2) evaluation commonly requires immunohistochemistry (IHC) tests on breast cancer tissue, in addition to the standard haematoxylin and eosin (H&E) staining tests. Additional costs and time spent on further testing might be avoided if HER2 overexpression could be effectively inferred from H&E stained slides, as a preliminary indication of the IHC result. In this paper, we propose the first method that aims to achieve this goal. The proposed method is based on multiple instance learning (MIL), using a convolutional neural network (CNN) that separately processes H&E stained slide tiles and outputs an IHC label. This CNN is pretrained on IHC stained slide tiles but does not use these data during inference/testing. H&E tiles are extracted from invasive tumour areas segmented with the HASHI algorithm. The individual tile labels are then combined to obtain a single label for the whole slide. The network was trained on slides from the HER2 Scoring Contest dataset (HER2SC) and tested on two disjoint subsets of slides from the HER2SC database and the TCGA-TCIA-BRCA (BRCA) collection. The proposed method attained 83.3% classification accuracy on the HER2SC test set and 53.8% on the BRCA test set. Although further efforts should be devoted to achieving improved performance, the obtained results are promising, suggesting that it is possible to perform HER2 overexpression classification on H&E stained tissue slides.publishersversionpublishe