A randomised controlled trial of pelvic floor muscle training for stages I and II pelvic organ prolapse

Abstract Forty-seven women participated in a pilot study for a multi-centre randomized controlled trial of the effectiveness of pelvic floor muscle training (PFMT) for women with prolapse. Women with symptomatic stage I or II prolapse [measured by Pelvic Organ Prolapse Quantification (POP-Q)] were randomized to a 16-week physiotherapy intervention (PFMT and lifestyle advice; n=23) or a control group receiving a lifestyle advice sheet (n=24). Symptom severity and quality of life were measured via postal questionnaires. Blinded POP-Q was performed at baseline and follow-up. Intervention women had significantly greater improvement than controls in prolapse symptoms (mean score decrease 3.5 versus 0.1, p=0.021), were significantly more likely to have an improved prolapse stage (45% versus 0%, p=0.038) and were significantly more likely to say their prolapse was better (63% versus 24%, p=0.012). The data support the feasibility of a substantive trial of PFMT for prolapse. A multi-centre trial is underway.This study was funded by the Chief Scientist Office, Scottish Government (CZH/4/95)

L’envergure du poète dans la pensée de George Sand

George Sand, née Aurore Dupin (1804-1876), est une des écrivaines les plus prolifiques de la monarchie de Juillet (1830-1848). Son œuvre monumentale s’intéresse à une myriade de sujets, qui sont souvent étudiés dans la perspective de l’idéal. Sand s’intéresse entre autres à la notion de poète-artiste, qui désigne un artiste idéal. Cette notion, propre à cette période, se distingue de celle du poète, qui est écrivain. Alors que la signification de la notion de poète-écrivain est arrêtée, le poète-artiste fait l’objet d’une définition vague et subjective. Pour sa part, Sand considère que le poète-artiste désigne à la fois un artiste et un philosophe. Cette proposition, qui est clairement émise, constitue un axe central à toute la pensée artistique qu’elle développe. C’est ce qui est exploré dans le présent travail, à travers trois thématiques de la pensée artistique de George Sand. Ces thématiques feront chacune l’objet d’un chapitre. La notion de la fraternité des arts sera d’abord étudiée. Cette thématique typiquement romantique, omniprésente dans les écrits de Sand, perçoit les différentes disciplines comme formant un tout. Ensuite, il sera question de la hiérarchie des arts : George Sand considère que la musique est la discipline supérieure, comparativement à certains de ses contemporains qui accordent plutôt ce titre à la poésie. Enfin, George Sand perçoit une figure de génie à travers ses écrits, qui s’approche de l’artiste idéal. Toutes ces thématiques sont étudiées en étroite relation avec les visions habituelles de l’époque, soit la monarchie de Juillet.George Sand, born Aurore Dupin (1804-1876), was one of the most prolific writers of the July Monarchy (1830-1848). Her monumental work focuses on a myriad of subjects, which are often studied from the perspective of the ideal. Among other things, Sand was interested in the notion of the poet-artist, which refers to an ideal artist. This notion, specific to this period, is distinguished from the other poet, which is a writer. While the meaning of the notion of poet-writer is well determined, that of poet-artist is subject to a vague and subjective definition. For her part, Sand considers that the poet-artist designates both an artist and a philosopher. This proposition, which is clearly stated, constitutes a central axis to all the artistic thought that she develops. This is what is explored in the present work, through three themes of George Sand's artistic thought. Each chapter is devoted to one of these themes, with an attempt to organize the artistic thought of Sand. The theme of the brotherhood of the arts will be studied first. This typically romantic theme, omnipresent in Sand's writings, perceives the different disciplines as forming a whole. Then, the hierarchy of arts will be reviewed: George Sand considers that music is the superior discipline, compared to some of her contemporaries who believe that poetry is the superior discipline. Finally, George Sand perceives a figure of genius in her writings, which comes close to the ideal artist. All these themes are studied in close relation to the usual visions found under the July Monarchy

Three behavior change theory–informed randomized studies within a trial to improve response rates to trial postal questionnaires

IQuaD was funded by the NIHR HTA (project 09/01/45). INTERVAL was funded by the NIHR HTA (project 06/35/99). No additional funding was obtained to conduct the randomised studies with the trials. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The Health Services Research Unit is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.Peer reviewedPostprin

Using re-randomisation designs to increase the efficiency and applicability of retention studies within trials: a case study

BACKGROUND: Poor retention in randomised trials can lead to serious consequences to their validity. Studies within trials (SWATs) are used to identify the most effective interventions to increase retention. Many interventions could be applied at any follow-up time point, but SWATs commonly assess interventions at a single time point, which can reduce efficiency. METHODS: The re-randomisation design allows participants to be re-enrolled and re-randomised whenever a new retention opportunity occurs (i.e. a new follow-up time point where the intervention could be applied). The main advantages are as follows: (a) it allows the estimation of an average effect across time points, thus increasing generalisability; (b) it can be more efficient than a parallel arm trial due to increased sample size; and (c) it allows subgroup analyses to estimate effectiveness at different time points. We present a case study where the re-randomisation design is used in a SWAT. RESULTS: In our case study, the host trial is a dental trial with two available follow-up points. The Sticker SWAT tests whether adding the trial logo's sticker to the questionnaire's envelope will result in a higher response rate compared with not adding the sticker. The primary outcome is the response rate to postal questionnaires. The re-randomisation design could double the available sample size compared to a parallel arm trial, resulting in the ability to detect an effect size around 28% smaller. CONCLUSION: The re-randomisation design can increase the efficiency and generalisability of SWATs for trials with multiple follow-up time points

Parallel CRISPR-Cas9 screens clarify impacts of p53 on screen performance

CRISPR-Cas9 genome engineering has revolutionised high-throughput functional genomic screens. However, recent work has raised concerns regarding the performance of CRISPR-Cas9 screens using TP53 wild-type human cells due to a p53-mediated DNA damage response (DDR) limiting the efficiency of generating viable edited cells. To directly assess the impact of cellular p53 status on CRISPR-Cas9 screen performance, we carried out parallel CRISPR-Cas9 screens in wild-type and TP53 knockout human retinal pigment epithelial cells using a focused dual guide RNA library targeting 852 DDR-associated genes. Our work demonstrates that although functional p53 status negatively affects identification of significantly depleted genes, optimal screen design can nevertheless enable robust screen performance. Through analysis of our own and published screen data, we highlight key factors for successful screens in both wild-type and p53-deficient cells

Communication and virtual visiting for families of patients in intensive care during the COVID-19 pandemic:A UK National Survey

© 2021 by the American Thoracic Society. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0.https://creativecommons.org/licenses/by-nc-nd/4.0/Rationale: Restriction or prohibition of family visiting intensive care units (ICUs) during the coronavirus disease (COVID-19) pandemic poses substantial barriers to communication and family- and patient-centered care. Objectives: To understand how communication among families, patients, and the ICU team was enabled during the pandemic. The secondary objectives were to understand strategies used to facilitate virtual visiting and associated benefits and barriers. Methods: A multicenter, cross-sectional, and self-administered electronic survey was sent (June 2020) to all 217 UK hospitals with at least one ICU. Results: The survey response rate was 54%; 117 of 217 hospitals (182 ICUs) responded. All hospitals imposed visiting restrictions, with visits not permitted under any circumstance in 16% of hospitals (28 ICUs); 63% (112 ICUs) of hospitals permitted family presence at the end of life. The responsibility for communicating with families shifted with decreased bedside nurse involvement. A dedicated ICU family-liaison team was established in 50% (106 ICUs) of hospitals. All but three hospitals instituted virtual visiting, although there was substantial heterogeneity in the videoconferencing platform used. Unconscious or sedated ICU patients were deemed ineligible for virtual visits in 23% of ICUs. Patients at the end of life were deemed ineligible for virtual visits in 7% of ICUs. Commonly reported benefits of virtual visiting were reducing patient psychological distress (78%), improving staff morale (68%), and reorientation of patients with delirium (47%). Common barriers to virtual visiting were related to insufficient staff time, rapid implementation of videoconferencing technology, and challenges associated with family members’ ability to use videoconferencing technology or access a device. Conclusions: Virtual visiting and dedicated communication teams were common COVID-19 pandemic innovations addressing the restrictions to family ICU visiting, and they resulted in valuable benefits in terms of patient recovery and staff morale. Enhancing access and developing a more consistent approach to family virtual ICU visits could improve the quality of care, both during and outside of pandemic conditions.Peer reviewedFinal Published versio

An Exploration of the Professional and Leader Identity of IT Professionals Transitioning to a Permanent Hybrid Role: A Longitudinal Investigation

Purpose – The purpose of this study is to explore the role of professional and leader identity and the maintenance of identity, through identity work as IT professionals transitioned to a permanent hybrid role. This study therefore contributes to the under-researched area of permanent transition to a hybrid role in the context of IT, where there is a requirement to enact both the professional and leader roles together. Design/ methodology/ approach – The study utilised a longitudinal design and two qualitative methods (interviews and reflective diaries) to gather data from 17 IT professionals transitioning to hybrid roles. Findings – The study findings reveal that IT professionals engage in an ongoing process of reconciliation of professional and leader identity as they transition to a permanent hybrid role, and they construct hybrid professional-leader identities while continuing to value their professional identity. They experience professional-leader identity conflict resulting from reluctance to reconcile both professional and leader identities. They used both integration and differentiation identity work tactics to ameliorate these tensionsOriginality/value – The longitudinal study design, the qualitative approaches used and the unique context of the participants provides a dynamic and deep understanding of the challenges involved in performing hybrid roles in the context of IT

Effect of multivitamin and multimineral supplementation on cognitive function in men and women aged 65 years and over : a randomised controlled trial

Background: Observational studies have frequently reported an association between cognitive function and nutrition in later life but randomised trials of B vitamins and antioxidant supplements have mostly found no beneficial effect. We examined the effect of daily supplementation with 11 vitamins and 5 minerals on cognitive function in older adults to assess the possibility that this could help to prevent cognitive decline. Methods: The study was carried out as part of a randomised double blind placebo controlled trial of micronutrient supplementation based in six primary care health centres in North East Scotland. 910 men and women aged 65 years and over living in the community were recruited and randomised: 456 to active treatment and 454 to placebo. The active treatment consisted of a single tablet containing eleven vitamins and five minerals in amounts ranging from 50–210 % of the UK Reference Nutrient Intake or matching placebo tablet taken daily for 12 months. Digit span forward and verbal fluency tests, which assess immediate memory and executive functioning respectively, were conducted at the start and end of the intervention period. Risk of micronutrient deficiency at baseline was assessed by a simple risk questionnaire. Results: For digit span forward there was no evidence of an effect of supplements in all participants or in sub-groups defined by age or risk of deficiency. For verbal fluency there was no evidence of a beneficial effect in the whole study population but there was weak evidence for a beneficial effect of supplementation in the two pre-specified subgroups: in those aged 75 years and over (n 290; mean difference between supplemented and placebo groups 2.8 (95% CI -0.6, 6.2) units) and in those at increased risk of micronutrient deficiency assessed by the risk questionnaire (n 260; mean difference between supplemented and placebo groups 2.5 (95% CI -1.0, 6.1) units). Conclusion: The results provide no evidence for a beneficial effect of daily multivitamin and multimineral supplements on these domains of cognitive function in community-living people over 65 years. However, the possibility of beneficial effects in older people and those at greater risk of nutritional deficiency deserves further attention.Peer reviewedPublisher PD

Outbreak of Serogroup W135 Meningococcal Disease after the Hajj Pilgrimage, Europe, 2000

The 2000 Hajj (March 15–18) was followed by an outbreak of Neisseria meningitidis W135 2a: P1.2,5 in Europe. From March 18 to July 31, 2000, some 90 cases of meningococcal infection were reported from nine countries, mostly the United Kingdom (UK) and France; 14 cases were fatal. Although most early cases were in pilgrims, the outbreak spread to their contacts and then to those with no known pilgrim contact. In France and the UK, the outbreak case-fatality rate was compared with the rate reported from national surveillance. The risk of dying during this outbreak was higher in France and the UK, although the difference was not statistically significant. Prophylaxis for all pilgrims and their household contacts was offered in France; in the UK and other European countries, prophylaxis was recommended only for close contacts. No difference in transmission rates following intervention was detected between France and the UK