IAC-DIDAS-N - A Dynamic Interactive Decision Analysis and Support System for Multicriteria Analysis of Nonlinear Models, v.4.0

This paper presents introductive and user documentation -- including extended summary, theoretical manual, short user manual and description of illustrative examples -- for a version of decision analysis and support systems of DIDAS family that is designed for multicriteria analysis of nonlinear models on professional microcomputers. This version has been developed in the years 1986-1990 in the Institute of Automatic Control, Warsaw University of Technology, under a joint research program with the Systems and Decision Sciences Program of IIASA. It can be run on professional microcomputers compatible with IBM-PC-XT or AT (with Hercules Graphics Card, Color Graphics Adapter or Enhanced Graphics Adapter and, preferably, with a numeric coprocessor and a hard disk) and supports graphical representation of results of interactive multicriteria analysis. Moreover, this version called IAC-DIDAS-N is provided with a new nonlinear model generator and editor that support, in an easy standard of a spreadsheet, the definition, edition and symbolic differentiation of nonlinear substantive models for multiobjective decision analysis. A specially introduced standard of defining nonlinear programming models for multiobjective optimization helps to connect the model generator with other parts of the system. Optimization runs involved in interactive, multiobjective decision analysis are performed by a solver, that is, a version of nonlinear programming algorithm specially adapted for multiobjective problems. This algorithm is based on shifted penalty functions and projected conjugate directions techniques similarly as in former nonlinear versions of DIDAS, but it was further developed and several improvements were added. The system is permanently updated and developed. Currently (starting from October 1990) the version 4.0 of the system is released. Most of enhancements added in this version are not directly visible to the user. They influence the efficiency of the system

Protective Contributions against Invasive Streptococcus pneumoniae Pneumonia of Antibody and Th17-Cell Responses to Nasopharyngeal Colonisation

The nasopharyngeal commensal bacteria Streptococcus pneumoniae is also a frequent cause of serious infections. Nasopharyngeal colonisation with S. pneumoniae inhibits subsequent re-colonisation by inducing Th17-cell adaptive responses, whereas vaccination prevents invasive infections by inducing antibodies to S. pneumoniae capsular polysaccharides. In contrast, protection against invasive infection after nasopharyngeal colonisation with mutant S. pneumoniae strains was associated with antibody responses to protein antigens. The role of colonisation-induced Th17-cell responses during subsequent invasive infections is unknown. Using mouse models, we show that previous colonisation with S. pneumoniae protects against subsequent lethal pneumonia mainly by preventing bacteraemia with a more modest effect on local control of infection within the lung. Previous colonisation resulted in CD4-dependent increased levels of Th17-cell cytokines during subsequent infectious challenge. However, mice depleted of CD4 cells prior to challenge remained protected against bacteraemia, whereas no protection was seen in antibody deficient mice and similar protection could be achieved through passive transfer of serum. Serum from colonised mice but not antibody deficient mice promoted phagocytosis of S. pneumoniae, and previously colonised mice were able to rapidly clear S. pneumoniae from the blood after intravenous inoculation. Thus, despite priming for a Th17-cell response during subsequent infection, the protective effects of prior colonisation in this model was not dependent on CD4 cells but on rapid clearance of bacteria from the blood by antibody-mediated phagocytosis. These data suggest that whilst nasopharyngeal colonisation induces a range of immune responses, the effective protective responses depend upon the site of subsequent infectio

Effectiveness of an intervention for reducing sitting time and improving health in office workers: three arm cluster randomised controlled trial

Objectives: To evaluate the effectiveness of an intervention, with and without a height adjustable desk, on daily sitting time, and to investigate the relative effectiveness of the two interventions, and the effectiveness of both interventions on physical behaviours and physical, biochemical, psychological, and work related health and performance outcomes. Design: Cluster three arm randomised controlled trial with follow-up at three and 12 months. Setting: Local government councils in Leicester, Liverpool, and Greater Manchester, UK. Participants: 78 clusters including 756 desk based employees in defined offices, departments, or teams from two councils in Leicester, three in Greater Manchester, and one in Liverpool. Interventions: Clusters were randomised to one of three conditions: the SMART Work and Life (SWAL) intervention, the SWAL intervention with a height adjustable desk (SWAL plus desk), or control (usual practice). Main outcomes measures: The primary outcome measure was daily sitting time, assessed by accelerometry, at 12 month follow-up. Secondary outcomes were accelerometer assessed sitting, prolonged sitting, standing and stepping time, and physical activity calculated over any valid day, work hours, workdays, and non-workdays, self-reported lifestyle behaviours, musculoskeletal problems, cardiometabolic health markers, work related health and performance, fatigue, and psychological measures. Results: Mean age of participants was 44.7 years, 72.4% (n=547) were women, and 74.9% (n=566) were white. Daily sitting time at 12 months was significantly lower in the intervention groups (SWAL −22.2 min/day, 95% confidence interval −38.8 to −5.7 min/day, P=0.003; SWAL plus desk −63.7 min/day, −80.1 to −47.4 min/day, P<0.001) compared with the control group. The SWAL plus desk intervention was found to be more effective than SWAL at changing sitting time (−41.7 min/day, −56.3 to −27.0 min/day, P<0.001). Favourable differences in sitting and prolonged sitting time at three and 12 month follow-ups for both intervention groups and for standing time for the SWAL plus desk group were observed during work hours and on workdays. Both intervention groups were associated with small improvements in stress, wellbeing, and vigour, and the SWAL plus desk group was associated with improvements in pain in the lower extremity, social norms for sitting and standing at work, and support. Conclusions: Both SWAL and SWAL plus desk were associated with a reduction in sitting time, although the addition of a height adjustable desk was found to be threefold more effective. Trial registration: ISRCTN Registry ISRCTN11618007

A cross‐cultural translation and adaptation of the Arabic Cardiac Self‐Efficacy Questionnaire for patients with coronary heart disease

Aim: This study aimed to cross-culturally translate and adapt the Cardiac Self-Efficacy Questionnaire into Arabic and subsequently evaluate the psychometric properties of that translation in a population of Arabic patients. Method: The original English version of the Cardiac Self-Efficacy Questionnaire was translated into Arabic following a process recommended by the World Health Organization. A convenience sample consisting of 268 Jordanian patients with coronary heart disease were recruited from a university-affiliated hospital in Amman, Jordan. Data were collected from August, 2018 until January, 2019. The factor structure, face and content validities, and internal consistency of the Arabic Cardiac Self-Efficacy Questionnaire were evaluated. Results: The factor structure analysis supported a three-factor high-order structure of the Arabic Cardiac Self-Efficacy Questionnaire. Face validity showed that the language used, style and format were clear. The content validity demonstrated a very good content validity index. The reliability was good with ranging from 0.89 to 0.93 for all questionnaire subscales. Conclusion: The Arabic Cardiac Self-Efficacy Questionnaire is a valid and reliable instrument to assess the Cardiac Self-Efficacy of Arabic patients diagnosed with coronary heart disease. Further assessment of the psychometric properties of the Arabic version of the questionnaire with different cardiac problems is now recommended

Time spent in sedentary posture is associated with waist circumference and cardiovascular risk

Background The relationship between metabolic risk and time spent sitting, standing and stepping has not been well established. The present study aimed to determine associations of objectively measured time spent siting, standing and stepping, with coronary heart disease (CHD) risk. Methods A cross-sectional study of healthy non-smoking Glasgow postal workers, n=111 (55 office-workers, 5 women, and 56 walking/delivery-workers, 10 women), who wore activPAL physical activity monitors for seven days. Cardiovascular risks were assessed by metabolic syndrome categorisation and 10-y PROCAM risk. Results Mean(SD) age was 40(8) years, BMI 26.9(3.9)kg/m-2 and waist circumference 95.4(11.9)cm. Mean(SD) HDL-cholesterol 1.33(0.31), LDL-cholesterol 3.11(0.87), triglycerides 1.23(0.64)mmol/l and 10-y PROCAM risk 1.8(1.7)%. Participants spent mean(SD) 9.1(1.8)h/d sedentary, 7.6(1.2)h/d sleeping, 3.9(1.1)h/d standing and 3.3(0.9)h/d stepping, accumulating 14,708(4,984)steps/d in 61(25) sit-to-stand transitions per day. In univariate regressions - adjusting for age, sex, family history of CHD, shift worked, job type and socio-economic status - waist circumference (p=0.005), fasting triglycerides (p=0.002), HDL-cholesterol (p=0.001) and PROCAM-risk (p=0.047) were detrimentally associated with sedentary time. These associations remained significant after further adjustment for sleep, standing and stepping in stepwise regression models. However, after further adjustment for waist circumference, the associations were not significant. Compared to those without the metabolic syndrome, participants with the metabolic syndrome were significantly less active – fewer steps, shorter stepping duration and longer time sitting. Those with no metabolic syndrome features walked &gt;15,000 steps/day, or spent &gt;7h/day upright. Conclusion Longer time spent in sedentary posture is significantly associated with higher CHD risk and larger waist circumference

A three arm cluster randomised controlled trial to test the effectiveness and cost-effectiveness of the SMART work & life intervention for reducing daily sitting time in office workers : study protocol

Background:Office-based workers typically spend 70-85% of working hours, and a large proportion of leisure time, sitting. High levels of sitting have been linked to poor health. There is a need for fully powered randomised controlled trials (RCTs) with long-term follow-up to test the effectiveness of interventions to reduce sitting. This paper describes the methodology of a three-arm cluster RCT designed to determine the effectiveness and cost-effectiveness of the SMART Work &amp; Life intervention, delivered with and without a height-adjustable desk, for reducing daily sitting. Methods/Design:A three-arm cluster RCT of 33 clusters (660 council workers) will be conducted in three areas in England (Leicester; Manchester; Liverpool). Office groups (clusters) will be randomised to the SMART Work &amp; Life intervention delivered with (group 1) or without (group 2) a height-adjustable desk or a control group (group 3). SMART Work &amp; Life includes organisational (e.g., management buy-in, provision/support for standing meetings), environmental (e.g., relocating waste bins, printers), and group/individual (education, action planning, goal setting, addressing barriers, coaching, self-monitoring, social support) level behaviour change strategies, with strategies driven by workplace champions. Baseline, 3, 12 and 24 month measures will be taken. Objectively measured daily sitting time (activPAL3). objectively measured sitting, standing, stepping, prolonged sitting and moderate-to-vigorous physical activity time and number of steps at work and daily; objectively measured sleep (wrist accelerometry). Adiposity, blood pressure, fasting glucose, glycated haemoglobin, cholesterol (total, HDL, LDL) and triglycerides will be assessed from capillary blood samples. Questionnaires will examine dietary intake, fatigue, musculoskeletal issues, job performance and satisfaction, work engagement, occupational and general fatigue, stress, presenteeism, anxiety and depression and sickness absence (organisational records). Quality of life and resources used (e.g. GP visits, outpatient attendances) will also be assessed. We will conduct a full process evaluation and cost-effectiveness analysis. Discussion:The results of this RCT will 1) help to understand how effective an important simple, yet relatively expensive environmental change is for reducing sitting, 2) provide evidence on changing behaviour across all waking hours, and 3) provide evidence for policy guidelines around population and workplace health and well-being. Trial registration: ISRCTN11618007 . Registered on 21 January 2018