Developing a group intervention to manage fatigue in rheumatoid arthritis through modifying physical activity

© 2019 The Author(s). Background: Fatigue is a major symptom of rheumatoid arthritis (RA). There is some evidence that physical activity (PA) may be effective in reducing RA fatigue. However, few PA interventions have been designed to manage fatigue and there is limited evidence of end-user input into intervention development. The aim of this research was to co-design an intervention to support self-management of RA fatigue through modifying PA. Methods: A series of studies used mixed methodological approaches to co-design a fatigue management intervention focused on modifying PA based on UK Medical Research Council guidance, and informed by the Behaviour Change Wheel theoretical framework. Development was based on existing evidence, preferences of RA patients and rheumatology healthcare professionals, and practical issues regarding intervention format, content and implementation. Results: The resulting group-based intervention consists of seven sessions delivered by a physiotherapist over 12 weeks. Each session includes an education and discussion session followed by supervised PA chosen by the participant. The intervention is designed to support modification and maintenance of PA as a means of managing fatigue. This is underpinned by evidence-based behaviour change techniques that might support changes in PA behaviour. Intervention delivery is interactive and aims to enhance capability, opportunity and motivation for PA. Conclusion: This study outlines stages in the systematic development of a theory-based intervention designed through consultation with RA patients and healthcare professionals to reduce the impact of RA fatigue. The feasibility of future evaluation of the intervention should now be determined

Implementing pelvic floor muscle training in women's childbearing years: A critical interpretive synthesis of individual, professional, and service issues

Antenatal pelvic floor muscle training (PFMT) may be effective for the prevention and treatment of urinary and fecal incontinence both in pregnancy and postnatally, but it is not routinely implemented in practice despite guideline recommendations. This review synthesizes evidence that exposes challenges, opportunities, and concerns regarding the implementation of PFMT during the childbearing years, from the perspective of individuals, healthcare professionals (HCPs), and organizations.MethodsCritical interpretive synthesis of systematically identified primary quantitative or qualitative studies or research syntheses of women's and HCPs attitudes, beliefs, or experiences of implementing PFMT.ResultsFifty sources were included. These focused on experiences of postnatal urinary incontinence (UI) and perspectives of individual postnatal women, with limited evidence exploring the views of antenatal women and HCP or wider organizational and environmental issues. The concept of agency (people's ability to effect change through their interaction with other people, processes, and systems) provides an over?arching explanation of how PFMT can be implemented during childbearing years. This requires both individual and collective action of women, HCPs, maternity services and organizations, funders and policymakers.ConclusionNumerous factors constrain women's and HCPs capacity to implement PFMT. It is unrealistic to expect women and HCPs to implement PFMT without reforming policy and service delivery. The implementation of PFMT during pregnancy, as recommended by antenatal care and UI management guidelines, requires policymakers, organizations, HCPs, and women to value the prevention of incontinence throughout women's lives by using low?risk, low?cost, and proven strategies as part of women's reproductive health

Moving through Motherhood:Involving the Public in Research to Inform Physical Activity Promotion throughout Pregnancy and Beyond

open access articleInformation received by women regarding physical activity during and after pregnancy often lacks clarity and may be conflicting and confusing. Without clear, engaging, accessible guidance centred on the experiences of pregnancy and parenting, the benefits of physical activity can be lost. We describe a collaborative process to inform the design of evidence-based, user-centred physical activity resources which reflect diverse experiences of pregnancy and early parenthood. Two iterative, collaborative phases involving patient and public involvement (PPI) workshops, a scoping survey (n = 553) and stakeholder events engaged women and maternity, policy and physical activity stakeholders to inform pilot resource development. These activities shaped understanding of challenges experienced by maternity and physical activity service providers, pregnant women and new mothers in relation to supporting physical activity. Working collaboratively with women and stakeholders, we co-designed pilot resources and identified important considerations for future resource development. Outcomes and lessons learned from this process will inform further work to support physical activity during pregnancy and beyond, but also wider health research where such collaborative approaches are important. We hope that drawing on our experiences and sharing outcomes from this work provide useful information for researchers, healthcare professionals, policy makers and those involved in supporting physical activity behaviour

RELICS: High-Resolution Constraints on the Inner Mass Distribution of the z=0.83 Merging Cluster RXJ0152.7-1357 from strong lensing

Strong gravitational lensing (SL) is a powerful means to map the distribution of dark matter. In this work, we perform a SL analysis of the prominent X-ray cluster RXJ0152.7-1357 (z=0.83, also known as CL 0152.7-1357) in \textit{Hubble Space Telescope} images, taken in the framework of the Reionization Lensing Cluster Survey (RELICS). On top of a previously known $z=3.93$ galaxy multiply imaged by RXJ0152.7-1357, for which we identify an additional multiple image, guided by a light-traces-mass approach we identify seven new sets of multiply imaged background sources lensed by this cluster, spanning the redshift range [1.79-3.93]. A total of 25 multiple images are seen over a small area of ~0.4 $arcmin^2$, allowing us to put relatively high-resolution constraints on the inner matter distribution. Although modestly massive, the high degree of substructure together with its very elongated shape make RXJ0152.7-1357 a very efficient lens for its size. This cluster also comprises the third-largest sample of z~6-7 candidates in the RELICS survey. Finally, we present a comparison of our resulting mass distribution and magnification estimates with those from a Lenstool model. These models are made publicly available through the MAST archive.Comment: 15 Pages, 7 Figures, 4 Tables Accepted for publication in Ap

Moving through Motherhood: Involving the Public in Research to Inform Physical Activity Promotion throughout Pregnancy and Beyond.

Information received by women regarding physical activity during and after pregnancy often lacks clarity and may be conflicting and confusing. Without clear, engaging, accessible guidance centred on the experiences of pregnancy and parenting, the benefits of physical activity can be lost. We describe a collaborative process to inform the design of evidence-based, user-centred physical activity resources which reflect diverse experiences of pregnancy and early parenthood. Two iterative, collaborative phases involving patient and public involvement (PPI) workshops, a scoping survey (n = 553) and stakeholder events engaged women and maternity, policy and physical activity stakeholders to inform pilot resource development. These activities shaped understanding of challenges experienced by maternity and physical activity service providers, pregnant women and new mothers in relation to supporting physical activity. Working collaboratively with women and stakeholders, we co-designed pilot resources and identified important considerations for future resource development. Outcomes and lessons learned from this process will inform further work to support physical activity during pregnancy and beyond, but also wider health research where such collaborative approaches are important. We hope that drawing on our experiences and sharing outcomes from this work provide useful information for researchers, healthcare professionals, policy makers and those involved in supporting physical activity behaviour

Parental experiences of supporting children with clinically significant post-traumatic distress: a qualitative study of families accessing psychological services

The aim of this study was to investigate the experiences of parents in providing support to their child following trauma exposure in cases where children are experiencing clinically significant levels of post-traumatic distress. Qualitative interviews were conducted with parents whose child was exposed to a trauma and referred for psychological treatment. Parents reported considerable anxiety in coping with their child’s post-traumatic distress. Avoidance of trauma-related discussions was encouraged due to concerns that non-avoidant approaches may worsen children’s post-trauma difficulties. Nonetheless, parents were often sensitive to their child’s distress and offered reassurance and other forms of support. Many barriers existed to accessing psychological treatment, and perceptions of inadequate guidance from therapists on supporting child adjustment contributed to parental distress. The results illustrate the strategies used by parents in supporting their child post-trauma and may assist mental health professionals in providing acceptable guidance to parents following child trauma

RELICS: A Very Large (θE∼40"\theta_{E}\sim40") Cluster Lens -- RXC J0032.1+1808

Extensive surveys with the \textit{Hubble Space Telescope} (HST) over the past decade, targeting some of the most massive clusters in the sky, have uncovered dozens of galaxy-cluster strong lenses. The massive cluster strong-lens scale is typically \theta_{E}\sim10\arcsec to \sim30-35\arcsec, with only a handful of clusters known with Einstein radii \theta_{E}\sim40\arcsec or above (for $z_{source}=2$, nominally). Here we report another very large cluster lens, RXC J0032.1+1808 ($z=0.3956$), the second richest cluster in the redMapper cluster catalog and the 85th most massive cluster in the Planck Sunyaev-Zel'dovich catalog. With our Light-Traces-Mass and fully parametric (dPIEeNFW) approaches, we construct strong lensing models based on 18 multiple images of 5 background galaxies newly identified in the \textit{Hubble} data mainly from the \textit{Reionization Lensing Cluster Survey} (RELICS), in addition to a known sextuply imaged system in this cluster. Furthermore, we compare these models to Lenstool and GLAFIC models that were produced independently as part of the RELICS program. All models reveal a large effective Einstein radius of \theta_{E}\simeq40\arcsec ($z_{source}=2$), owing to the obvious concentration of substructures near the cluster center. Although RXC J0032.1+1808 has a very large critical area and high lensing strength, only three magnified high-redshift candidates are found within the field targeted by RELICS. Nevertheless, we expect many more high-redshift candidates will be seen in wider and deeper observations with \textit{Hubble} or \emph{JWST}. Finally, the comparison between several algorithms demonstrates that the total error budget is largely dominated by systematic uncertainties.Comment: 23 pages, accepted for publication in Ap

RELICS: Strong Lensing analysis of the galaxy clusters Abell S295, Abell 697, MACS J0025.4-1222, and MACS J0159.8-0849

We present a strong-lensing analysis of four massive galaxy clusters imaged with the Hubble Space Telescope in the Reionization Lensing Cluster Survey. We use a Light-Traces-Mass technique to uncover sets of multiply images and constrain the mass distribution of the clusters. These mass models are the first published for Abell S295 and MACS J0159.8-0849, and are improvements over previous models for Abell 697 and MACS J0025.4-1222. Our analysis for MACS J0025.4-1222 and Abell S295 shows a bimodal mass distribution supporting the merger scenarios proposed for these clusters. The updated model for MACS J0025.4-1222 suggests a substantially smaller critical area than previously estimated. For MACS J0159.8-0849 and Abell 697 we find a single peak and relatively regular morphology, revealing fairly relaxed clusters. Despite being less prominent lenses, three of these clusters seem to have lensing strengths, i.e. cumulative area above certain magnification, similar to the Hubble Frontier Fields clusters (e.g., A($\mu>5$) $\sim 1-3$ arcmin$^2$, A($\mu>10$) $\sim 0.5-1.5$ arcmin$^2$), which in part can be attributed to their merging configurations. We make our lens models publicly available through the Mikulski Archive for Space Telescopes. Finally, using Gemini-N/GMOS spectroscopic observations we detect a single emission line from a high-redshift $J_{125}\simeq25.7$ galaxy candidate lensed by Abell 697. While we cannot rule out a lower-redshift solution, we interpret the line as Ly$\alpha$ at $z=5.800\pm 0.001$, in agreement with its photometric redshift and dropout nature. Within this scenario we measure a Ly$\alpha$ rest-frame equivalent width of $52\pm22$ \AA, and an observed Gaussian width of $117\pm 15$ km/s.Comment: 23 pages, 16 figures; V2, accepted for publication in Ap

Complete Set of Elastic Moduli of a Spin-Crossover Solid: Spin-State Dependence and Mechanical Actuation

Molecular spin crossover complexes are promising candidates for mechanical actuation purposes. The relationships between their crystal structure and mechanical properties remain, however, not well understood. In this study, combining high pressure synchrotron Xray diffraction and nuclear inelastic scattering measurements, we assessed the effective macroscopic bulk modulus (11.5 ± 2.0 GPa), Young’s modulus (10.9 ± 1.0 GPa) and Poisson’s ratio (0.34 ± 0.04) of the spin crossover complex [FeII(HB(tz)3)2] (tz = 1,2,4-triazol-1-yl) in its low spin state. Crystal structure analysis revealed a pronounced anisotropy of the lattice compressibility, which was correlated with the difference in spacing between the molecules in different crystallographic directions. Switching the molecules from the low spin to the high spin state leads to a remarkable drop of the Young’s modulus to 7.1 ± 0.5 GPa, which was also assessed in thin film samples by means of micromechanical measurements. These results are in agreement with the high cooperativity of the spin crossover in this compound and highlight its application potential in terms of recoverable stress (21 ± 1 MPa) and work density (15 ± 6 mJ/cm3)