Evaluation of yttrium-90 positron emission tomography dosimetry

Purpose: Radioembolization is a novel treatment which utilizes the liver\u27s unique dual system blood supply to trap yttrium-90 (90Y) microspheres in microvasculature near liver tumors. Radioembolization dose planning and dosimetry are based on crude, inaccurate assumptions due to the lack of knowledge of patient specific 90Y microsphere distribution. In recent years, the very small 3.1867e-5 internal pair production decay branch of 90Y has been shown to allow for positron emission tomography (PET) imaging following radioembolization. This work explores the accuracy and limitation of 90Y PET imaging due to the extremely low signal to noise (SNR) ratio associated with 90Y and verifies the accuracy of using these PET images for 3-dimensional (3D) dosimetry. ^ Material and Methods: PET acquisitions of a phantom containing 90Y filled cylindrical inserts were acquired to determine quantitative accuracy of the PET images to measure 90Y activity. Numerous reconstruction algorithms were used to determine the optimal protocol to balance image noise and accuracy. A GATE model of the PET scanner was used to evaluate the origin of prompt signal and random noise coincidence counts in these PET acquisitions. PET images were converted to dose maps using standard S-kernel convolution. Polymer gel dosimetry was used to validate the 3D dose map results. Furthermore, PET, with associated CT images, were used as input data into MC simulations to model dose rates surrounding patients for future patient release studies. A Siemens® Biograph 64 TruePoint PET/CT was used for all acquisitions and reconstructions. ^Results: The phantom study determined Siemens® OSEM-PSF algorithm, known as TrueX, with 2 iterations and 14 subsets had the optimal balance of noise and accuracy. Using this reconstruction algorithm, the PET images were found to accurately measure activity and calculated dose within 10% when 90Y concentration was above the minimum detectable concentrations (MDC) of 1 MBq/ml. However, this reconstruction algorithm was shown to have a positive bias in areas where concentration was below the MDC due to truncation of negative sinogram bin values caused by statistical noise in the random correction. Polymer gel dosimetry verified the accuracy of PET dose maps but also identified a limitation in cases of highly gradient distributions due to the PET spatial resolution spreading of measured activity. Additionally, external dose rates were found to be accurately predicted through use of 90Y PET/CT images as inputs into a MC simulation.Conclusion: Research in 90Y PET/CT has quickly been expanding over recent years as a feasible method to provide liver distribution of 90Y following radioembolization. This study demonstrates the accuracy and limitations of the use of these 90Y PET/CT images in patient specific qualitative dosimetry

Social marketing to encourage initiation and continuation of breastfeeding in Penhill and Pinehurst, Swindon

Executive Summary• NHS Swindon has targets to increase the initiation and duration of breastfeeding to 6-8 weeks and beyond. A number of interventions have been implemented to increase local breastfeeding prevalence, including the UNICEF Baby Friendly Initiative and the family nurse partnership. • Traditional health education approaches on their own do not appear to have much impact. Our own work and indicative results elsewhere position co-creation as a potentially highly effective strategy to use within deprived communities; its potential to embed behaviour change sustainably is clear. • Integrating programmes that address cultural perceptions of breastfeeding with targeted work aimed directly at vulnerable segments, which in turn are co-ordinated with strong ante and post-natal support, education programmes and peer supported group sessions will maximise the chances of increasing breastfeeding. • The UWE project team recruited women and some family members to individual interviews and women from four different categories (pregnant, did not breastfeed, tried breastfeeding but gave up and breastfed beyond 6-8 weeks) to focus groups. In total, 28 individuals took part in the project. Participants were asked a range of questions designed to elicit information about norms surrounding infant feeding, how decisions about feeding were reached, individual’s knowledge concerning the benefits of breastfeeding and social and private attitudes towards breastfeeding. • The norm in both Pinehurst and Penhill is to bottle feed babies. Mothers gained knowledge about breastfeeding for a range of sources, but the timing and volume of NHS leaflets could be problematic. The main reason given for breastfeeding was the associated health benefits for babies. The main reason given for bottle feeding were convenience and ease of feeding in public. • Following these interviews, six professionals involved in services for mothers and babies were interviewed. This cohort was selected to include managers and practitioners from the midwifery and health visiting services for Penhill and Pinehurst. • Lack of support for breastfeeding women is a problem. Contributing factors were thought to include lack of resources in the wider health and social care context, particularly with regard to home visits in the first month after birth. Provision of information appears to rely heavily on written literature, which women may not read. A coherent and integrated service was seen as the ideal to support and promote breastfeeding, but there was some concern expressed about how well the support workers and healthcare professionals worked together. • The general consensus is that there is very little community engagement in these areas and many women are unwilling to access locally based groups where they might learn about breastfeeding or observe other mothers breastfeeding. • Co-creation as an approach depends upon engaging and involving community members, and with levels of involvement and interaction in these communities so low, it was agreed to proceed with a continued focus on breastfeeding interventions, with Uscreates leading on designing and developing ideas, making and directing decisions and activity, and audience members contributing feedback and thoughts. The co-creation process was adapted to be delivered one to one with mobile researchers visiting mothers at home. • A design exercise facilitated mothers to build up a description of the ideal support service along a number of descriptors. This activity led to the plan to re-design and re-launch the Breastmates service. This existing breastfeeding support service satisfied most of the requirements for an ideal service that mothers had described. These characteristics guided the re-design of the Breastmates offering to include home visits, and to promote both online and telephone support for urgent needs. • Uscreates carried out a co-creation process with women in order to re-design the existing Breastmates brand and marketing materials. The marketing combined several support avenues and channels within one identity, presenting a more united front, and giving women a choice of how to access support. • The overall recommendation after the pilot phase is to continue to use the co-created Breastmates brand, and roll this out across Swindon. With face to face engagement and promotion having the biggest impact on uptake and attendance, continue with this as the primary focus for promotion activities. • The other attendant promotion components (Facebook, Breastmates site, Textmagic) should be tweaked as per the recommendations above, and continue as low cost methods to increase general awareness of Breastmates, and provide a professional and unified means of reinforcing messages delivered by the face to face activity

A systematic review and narrative synthesis of inclusive health and social care research with people with intellectual disabilities: How are co‐researchers involved and what are their experiences?

Background: Using inclusive research methods with people with intellectual disabilities is increasingly common. A recent consensus statement identified key elements when conducting and reporting inclusive research with people with intellectual disabilities. This review identifies the range of health and social care research topics using inclusive research methodologies, systematically appraises the involvement of researchers with intellectual disabilities, and identifies facilitators and barriers to inclusive research. Researchers' experiences of engaging with inclusive research are synthesised. Method: Seventeen empirical studies focused upon inclusive health and social care research were identified. The associated inclusive research methodologies employed, and the stages in which researchers with intellectual disabilities were involved, along with the experiences of researchers with and without intellectual disabilities were synthesised. Results: Papers focused on a broad range of health and social care topics and largely employed qualitative or mixed‐methods designs. Researchers with intellectual disabilities were frequently involved with data collection, analysis and dissemination. Facilitators of inclusive research comprised sharing power, team working, having sufficient resources and making research methodologies accessible. Conclusions: Researchers with intellectual disabilities are involved in a wide range of methodologies and research tasks. How the added value of inclusive research is measured and its impact on outcomes, require consideration

A systematic review and narrative synthesis of inclusive research involving people with intellectual disabilities : implications for health research [search strategy]

Aims This review aims to identify the range of inclusive research conducted with people with intellectual disabilities and identify the models and theories on which these are based. The experiences of people with intellectual disabilities engaging with this research will also be synthesised. The review will also identify any barriers and facilitators to the engagement of people with intellectual disabilities in inclusive research methodologies. The quality of this literature will be appraised. Review Question How are people with intellectual disabilities involved in inclusive research and what theories underpin this research? What are the experiences of stakeholders (including people with intellectual disabilities) of these inclusive research methodologies? Bibliographic databases The following electronic databases were searched: AMED (HDAS), BNI (HDAS), CINAHL (HDAS), Education Research Complete (EBSCO), EMBASE (HDAS), MedLine (HDAS), PsychINFO (HDAS) and Web of Science on 11 October 2021. No search filters were used. Grey Literature and Registries The following sources of the grey literature were initially searched on 18 November. Google scholar (https://scholar.google.com/) was searched using the terms (intellectual disability OR learning disability) AND inclusive research. The first 100 results were screened for inclusion, and no new articles were identified as relevant. The British Library EThOS database of dissertations was searched using the search terms (‘learning disability’ OR ‘intellectual disability’) AND ‘inclusive research’. This returned 8 results, none of which met inclusion criteria. Restrictions on language None Search dates 2000 - present Searches will be re-run prior to the final analysis Yes Types of study All including grey literature Condition or domain being studied Inclusive research with adults with intellectual disabilitie

Psychological therapies for people with intellectual disabilities : an updated systematic review and meta-analysis

Objective The aim of this systematic review and meta-analysis (PROSPERO 2020 CRD42020169323) was to evaluate the efficacy of psychological therapy for people with intellectual disabilities. Method A comprehensive literature search yielded 22,444 studies which were screened for eligibility. Studies were eligible for inclusion if a psychological therapy was delivered to people with intellectual disabilities compared to a group who did not receive the therapy. Thirty-three controlled trials were eligible for inclusion in the review, with 19 included within a DerSimonian-Laird random effects meta-analysis. Subgroup analysis was completed by clinical presentation, and by comparing randomised trials to non-randomised trials, and group-based to individually delivered psychotherapy. Results Following the removal of outliers, psychological therapy for a range of mental health problems was associated with a small and significant effect size, g = 0.43, 95% CI [0.20, 0.67], N = 698. There was evidence of heterogeneity and bias due to studies with small sample sizes and a lack of randomisation. Non-randomised studies were associated with a large effect size, g = 0.90, 95% CI [0.47, 1.32], N = 174, while randomised studies were associated with a small effect size, g = 0.36, 95% CI [0.17, 0.55], N = 438, excluding outliers. Individually delivered psychological therapy was associated with a small and non-significant effect size, g = 0.32, 95% CI [−0.01, 0.65], N = 146, while group-based interventions were associated with a small and significant effect size, g = 0.37, 95% CI [0.05, 0.68], N = 361, again, excluding outliers. Psychological therapy for anger was associated with a moderate effect size, g = 0.60, 95% CI [0.26, 0.93], N = 324, while treatment for depression and anxiety was associated with a small and non-significant effect size, g = 0.38, 95% CI [−0.10, 0.85], N = 216, after outliers were removed. Conclusions Studies are fraught with methodological weaknesses limiting the ability to make firm conclusions about the effectiveness of psychological therapy for people with intellectual disabilities. Improved reporting standards, appropriately powered and well-designed trials, and greater consideration of the nature and degree of adaptations to therapy are needed to minimise bias and increase the certainty of conclusions

A systematic review and narrative synthesis of mental imagery tasks in people with an intellectual disability : implications for psychological therapies

Mental imagery is recognised for its role in both psychological distress and wellbeing, with mental imagery techniques increasingly being incorporated into psychological interventions. In this systematic review and narrative synthesis (PROSPERO 2021: CRD42021240930), we identify and evaluate the evidence base for the phenomenon and phenomenology of mental imagery in people with intellectual disabilities, to ascertain the applicability of such interventions for this population. Electronic searches of nine databases and grey literature identified relevant publications. Two reviewers independently assessed titles and abstracts of retrieved records (n = 8609) and full-text articles (n = 101) against eligibility criteria. Data were extracted and quality appraised. Forty-one papers met our eligibility criteria. The quality and designs were variable. Mental imagery was facilitated through ensuring participants understood tasks, providing opportunity to rehearse tasks (including using concrete prompts) and using scaffolding to help participants elaborate their responses. People with intellectual disabilities can engage with mental imagery, with appropriate adaptations, although the associated phenomenology has not been thoroughly investigated. Mental imagery interventions may be useful for people with intellectual disabilities with appropriate modifications

A comparison of variate pre-selection methods for use in partial least squares regression: a case study on NIR spectroscopy applied to monitoring beer fermentation

This work investigates four methods of selecting variates from near-infrared (NIR) spectra for use in partial least squares (PLS) regression models to predict biomass and chemical changes during beer fermentation. The fermentation parameters studied were ethanol concentration, specific gravity (SG), optical density (OD) and dry cell weight (DCW). The four selection methods investigated were: Simple, where a fingerprint region is chosen manually; CovProc, a covariance procedure where variates are introduced based on the magnitude of the 1st PLS vector coefficients; CovProc-SavGo, a modification to CovProc where the window size of a Savitzky-Golay filter applied to the spectra is also optimised; and Genetic Algorithm (GA), where variates are selected based on the frequency of appearance in 8-variate multiple linear regression models found from repeated execution of the GA routine. The analysis found that all four methods produced good predictive models. The GA approach produced the lowest standard error in prediction (SEP) based on leave-one-out cross validation (LOO-CV), although this advantage was not reflected in the standard error in validation values, SEV, where all four models performed comparably. From this work, we would recommend using the Simple approach if a suitable fingerprint region can be identified, and using CovProc otherwise

Identifying evidence of effectiveness in the co-creation of research: a systematic review and meta-analysis of the international healthcare literature.

This is a pre-copyedited, author-produced version of an article accepted for publication in Journal of Public Health, following peer review. The version of record: Kristoffer Halvorsrud, Justyna Kucharska, Katherine Adlington, Katja Rüdell, Eva Brown Hajdukova, James Nazroo, Maria Haarmans, James Rhodes, Kamaldeep Bhui, Identifying evidence of effectiveness in the co-creation of research: a systematic review and meta-analysis of the international healthcare literature, Journal of Public Health, fdz126, https://doi.org/10.1093/pubmed/fdz126 is available online at: https://doi.org/10.1093/pubmed/fdz126.BACKGROUND: To investigate and address the evidence gap on the effectiveness of co-creation/production in international health research. METHODS: An initial systematic search of previous reviews published by 22 July 2017 in Medline, Embase, PsycINFO, Scopus and Web of Science. We extracted reported aims, elements and outcomes of co-creation/production from 50 reviews; however, reviews rarely tested effectiveness against intended outcomes. We therefore checked the reference lists in 13 included systematic reviews that cited quantitative studies involving the public/patients in the design and/or implementation of research projects to conduct meta-analyses on their effectiveness using standardized mean difference (SMD). RESULTS: Twenty-six primary studies were included, showing moderate positive effects for community functions (SMD = 0.56, 95%CI = 0.29-0.84, n = 11) and small positive effects for physical health (SMD = 0.25, 95%CI = 0.07-0.42, n = 9), health-promoting behaviour (SMD = 0.14, 95%CI = 0.03-0.26, n = 11), self-efficacy (SMD = 0.34, 95%CI = 0.01-0.67, n = 3) and health service access/receipt (SMD = 0.36, 95%CI = 0.21-0.52, n = 12). Non-academic stakeholders that co-created more than one research stage showed significantly favourable mental health outcomes. However, co-creation was rarely extended to later stages (evaluation/dissemination), with few studies specifically with ethnic minority groups. CONCLUSIONS: The co-creation of research may improve several health-related outcomes and public health more broadly, but research is lacking on its longer term effects

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

La autonomía en la práctica de enfermería

La autonomía ha sido vista como un indicador de la profesionalización de la disciplina. La autonomía de enfermería ha sido identificada como una variable importante que afecta la percepci ón de la enfermera en relación con su satisfacción en el trabajo, los ambientes positivos de su práctica profesional y la calidad del cuidado de enfermería. La suposición de que un aspecto clave de la autonom ía de enfermería es actuar con un juicio y práctica independiente, fue cuestionada en un estudio interpretativo que exploró la forma como las enfermeras entienden la autonomía en su práctica clínica y en su trabajo. Este artículo describe el proyecto de investigación, y explora el énfasis que hacen las enfermeras sobre los aspectos inherentes al ejercicio de la autonomía en su trabajo clínico. Las descripciones de sus relaciones con los médicos, colegas y directores de enfermería, ofrecen muchos ejemplos en los cuales la práctica autó- noma puede ser respaldada y fortalecida. Este artículo también discute estas posibilidades para que este concepto se pueda llevar a cabo en tres áreas claves: crear ambientes de práctica que enriquezcan la pericia clínica y la toma de decisiones; hacer posible que las enfermeras practiquen, aplicando todas sus capacidades educativas, sus experiencias y competencias; y fortalecer la práctica multidisciplinaria con colaboración