Treatment decision-making in heart failure management

Background: Demands for increased patient and public involvement in healthcare has led to changes in policy on decision-making. The shared decision-making (SDM) model is advocated in current health policy and encourages partnership between patients and professionals. Yet limited evidence exists of its effects on clinical outcomes and cost. As a result, a policy-practice divide has emerged. Heart failure management has adopted a more personalised approach to treatment. Yet knowing the treatment that is likely to have the best therapeutic effect does not mean it is right for that individual patient. Patients’ health decisions are influenced by a variety of factors, including their experience of illness and disease beliefs. Professionals need increased understanding of how patients make decisions to support the integration of SDM in to practice. Purpose: This thesis aims to explore different stakeholder perspectives of decision-making in heart failure management and to identify the barriers and facilitators to SDM. Method: A mixed-methods study design involving: Pan-London analyses of multidisciplinary team (MDT) meetings; a qualitative interview study analysed by thematic analysis (Glaser and Strauss, 1967); a Delphi consensus survey. Together these data inform key recommendations to improve communication about treatments and the design of future research. Results: The structures, functions and processes of MDT meetings varied within and across NHS Trusts. Professionals’ assumptions about patient preferences, information needs and approach to decision-making were key barriers to a SDM approach. There was agreement that patients should be involved in treatment decisions, yet there was limited consensus on the priority areas for improvements to practice. Conclusion: Considerable variation exists in the process of treatment decision-making and there is limited concordance between the views of patients, their families and health professionals. Professionals need to tailor their approach to treatment discussions and assess patients health information-sourcing behaviour to better support patient involvement in decision-making.Open Acces

From national monitoring to transnational indicators: reporting and processing of aquatic biology data under the European Environment Agency’s State of the Environment data flow

Biological monitoring data from aquatic ecosystems are collected from European countries on a yearly basis by the European Environment Agency (EEA) through the Water Information System for Europe (WISE). The WISE-SoE (State of Environment) data flows provide indicators of pressures, states and impacts of surface waters and groundwaters on a pan-European scale. The WISE-2 Biology was established to obtain a harmonised flow of biology data reported annually as Ecological Quality Ratios (EQRs) from European surface waters, as a supplement to the mandatory 6-yearly reporting of ecological status of water bodies for the Water Framework Directive. The purposes of this paper are 1) to describe the compilation of national aquatic biology monitoring data indicators and to inform about the public availability of these data, 2) to give an overview of the reported data and indicate the potential for assessments based on these data, and 3) to illustrate the potential for further use of the underlying species abundance data in biodiversity research and assessment. WISE-2 data are reported for the following biological quality elements: phytoplankton, phytobenthos, macrophytes, macroalgae, angiosperms, benthic invertebrates and fish in rivers, lakes, transitional and/or coastal waters. The EQR values represent the deviation from reference conditions. The final processed and quality-checked data are published in EEA’s database Waterbase - Biology, which currently holds data from more than 13,000 waterbodies in 26 countries from the reporting years 2011–2021. Examples of time series aggregated by geographic regions give an indication of the type of trends that can be obtained from the reported data at the nEQR scale. However, the current results are representative only for certain geographic regions with high coverage of water bodies. Within the European research project EuropaBON (Europa Biodiversity Observation Network), the use of WISE-2 data can be leveraged to support biodiversity policy and conservation planning. EuropaBON’s online database provides an overview of how biodiversity monitoring schemes across Europe flows through different integration nodes, to produce Essential Biodiversity Variables and other policy-relevant indicators. Here, we use the EuropaBON visualisation tool to illustrate the WISE-2 as a European integration node for 157 biology datasets via the national integration nodes.publishedVersio

Generative AI Based Adaptive Welcome Messages for Business Chat

Chats with a business entity typically include a welcome message that introduces the entity and sets the tone for the conversation. A well-written welcome message can improve customer satisfaction and can lead to improved outcomes such as higher sales. However, drafting customized welcome messages on an ongoing basis can be time consuming and is a creative challenge. This disclosure describes techniques to automatically generate suggestions for welcome messages using suitable artificial intelligence techniques, such as generative AI models. The generated suggestions are presented to entities such as businesses/merchants that implement online chat functionality. The suggestions are customized for each entity and take into account data about the entity such as current inventory, new merchandise, offers, etc. and contextual factors such as date, time, etc. Updated data about a business may be provided by the business or may be obtained automatically, e.g., by a search engine or large language model (LLM) that analyzes the business website or app, or other data sources about the business. The model may be tuned to include specific kinds of information in the output generated messages

Silicon isotopes reveal a non-glacial source of silicon to Crescent Stream, McMurdo Dry Valleys, Antarctica

In high latitude environments, silicon is supplied to river waters by both glacial and nonglacial chemical weathering. The signal of these two end-members is often obscured by biological uptake and/or groundwater input in the river catchment. McMurdo Dry Valleys streams in Antarctica have no deep groundwater input, no connectivity between streams and no surface vegetation cover, and thus provide a simplified system for us to constrain the supply of dissolved silicon (DSi) to rivers from chemical weathering in a glacial environment. Here we report dissolved Si concentrations, germanium/silicon ratios (Ge/Si) and silicon isotope compositions (d30SiDSi) in Crescent Stream, McMurdo Dry Valleys for samples collected between December and February in the 20142015, 20152016, and 20162017 austral seasons. The d30SiDSi compositions and DSi concentrations are higher than values reported in wet-based glacial meltwaters, and form a narrow cluster within the range of values reported for permafrost dominated Arctic Rivers. High d30SiDSi compositions, ranging from C0.90h to C1.39h, are attributed to (i) the precipitation of amorphous silica during freezing of waters in isolated pockets of the hyporheic zone in the winter and the release of Si from unfrozen pockets during meltwater-hyporheic zone exchange in the austral summer, and (ii) additional Si isotope fractionation via long-term Si uptake in clay minerals and seasonal Si uptake into diatoms superimposed on this winter-derived isotope signal. There is no relationship between d30SiDSi compositions and DSi concentrations with seasonal and daily discharge, showing that stream waters contain DSi that is in equilibrium with the formation of secondary Si minerals in the hyporheic zone. We show that d30SiDSi compositions can be used as tracers of silicate weathering in the hyporheic zone and possible tracers of freeze-thaw conditions in the hyporheic zone. This is important in the context of the ongoing warming in McMurdo Dry Valleys and the supply of more meltwaters to the hyporheic zone of McMurdo Dry Valley streams

Effects of Dietary or Supplementary Micronutrients on Sex Hormones and IGF-1 in Middle and Older Age: A Systematic Review and Meta-Analysis

Observational research suggests that micronutrients may be protective for sarcopenia, a key health issue during ageing, potentially via effects on hormone synthesis and metabolism. We aimed to carry out a systematic review of RCTs investigating effects of increasing dietary or supplemental micronutrient intake on sex hormones and IGF-1 in individuals aged 45 years or older. We searched MEDLINE, EMBASE and Cochrane databases for RCTs reporting the effects of different micronutrients (vitamins A, C, D, or E; carotenoids; iron; copper; zinc; magnesium; selenium; and potassium) on sex hormones or IGF-1. Of the 26 RCTs identified, nine examined effects of vitamin D, nine of multi-nutrients, four of carotenoids, two of selenium, one of zinc, and one of vitamin E. For IGF-1 increasing vitamin D (MD: -0.53 nmol/L, 95% CI: -1.58, 0.52), multi-nutrients (MD: 0.60 nmol/L, 95% CI 􀀀1.12 to 2.33) and carotenoids (MD -1.32 nmol/L; 95% CI -2.76 to 0.11) had no significant effect on circulating concentrations. No significant effects on sex hormones of other micronutrients were found, but data were very limited. All trials had significant methodological limitations making effects of micronutrient supplementation on sex hormones unclear. Further high quality RCTs with physiological doses of micronutrients in people with low baseline intakes or circulating concentrations, using robust methodology, are required to assess effects of supplementation adequately

Initial evidence review - Strategies for encouraging psychological and emotional resilience in response to loneliness 2019

It is now widely accepted that loneliness is influenced by a combination of psychological factors, including attitudes to participating in social interactions and mental health problems, as well as environmental factors such as living far from family and friends and life events and transitions such as bereavement and moving away from home. Despite increased recognition of the importance of individual-level processes and meanings that influence the experience of loneliness, there is a gap in our knowledge of how best to address the psychological factors that contribute to chronic loneliness. In this report, we aim to synthesise information from a range of sources in order to identify the psychological pathways to loneliness and relevant psychological barriers to accessing strategies which target social isolation. The report highlights promising interventions that have potential to target the psychological aspects of loneliness. It makes a series of recommendations to improve understanding and delivery of effective psychological interventions to address loneliness and how the interaction between such strategies and community-based interventions. We conducted an extensive scoping review of the academic literature, including online database searches and broader searches reviewing conference abstracts and reports from the Third Sector. We obtained expert opinions by speaking to relevant stakeholders including people with lived experiences of loneliness, charitable organisations working with people who are experiencing chronic loneliness, and those involved in developing and evaluating interventions to tackle loneliness. Much of the work focused on older adults but we also looked at interventions delivered across the age range. We report the findings from this work, including an overview of the wide range of psychological factors which might explain why some people who are chronically lonely struggle to engage with community strategies and other sources of support that are available. These factors include having mental health problems, personality characteristics and having unhelpful beliefs and behaviours related to social interactions. We recommend that interventions that target either the psychological or social aspects of loneliness should not be provided in isolation, and that multi-modal interventions are likely to be most successful. Further research evidence is needed to evaluate the feasibility, acceptability, effectiveness and cost-effectiveness of delivering psychological interventions in conjunction with community-based strategies. Social prescribing is a potential opportunity for the successful delivery of psycho-social interventions. For example, integration of psychological and community-based support could be promoted by including directories of psychological support in guides to community based resources, and by connecting social prescribing link workers with their local improving access to psychological therapies services. The social psychological approaches such as the Groups 4 Health model (Haslam et al., 2019; Haslam, Cruwys, Haslam, Dingle & Chang, 2016) show promise and potentially could bridge psychological and social understandings of loneliness. There is preliminary research evidence that interventions that address the psychological factors involved in loneliness can be successful, and there are various approaches to addressing these factors across the UK, although many initiatives have not yet been fully evaluated. The strongest research evidence was found for cognitive behavioural interventions, and there are some promising developments, including digital initiatives which are designed to change individuals’ thoughts and feelings about loneliness, that are worthy of further evaluation. We would also recommend that acceptance and commitment therapy is formally evaluated as an intervention for loneliness. We noted that the research base in this area is still underdeveloped and more work is needed to demonstrate which interventions are most accessible to people who are chronically lonely and can feasibly be delivered within NHS and community settings. Research into the potential adverse effects of psychological interventions, individual differences in responsiveness and the longer term impact on loneliness is also needed. It is likely that including measures of loneliness in evaluations of interventions for social anxiety and grief and in routine work with older adults in improving access to psychological therapies services would yield data that will contribute to the growing evidence base in this area. We hope that bringing together the research evidence and expert opinion in this report will increase awareness of the wide range of psychological factors implicated in loneliness and lead to further provision of psychological interventions for loneliness, in combination with community based support for social isolation

Dietary patterns and non-motor symptoms in Parkinson’s: A cross-sectional analysis

Objective: Evidence-based treatment for non-motor symptoms in Parkinson’s (PD) is limited. Lifestyle-based improvements including dietary changes may be a potential management strategy. To investigate the extent to which three dietary indices (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay (MIND), Dietary Inflammation Index (DII), and Healthy Diet Indicator (HDI-2020) are associated with overall and individual non-motor symptom severity amongst individuals with Parkinson’s. Methods: An exploratory cross-sectional analysis of dietary (food frequency questionnaire) and clinical data, including measures of overall non-motor symptom severity, including fatigue, depression, anxiety, apathy, sleep problems, daytime sleepiness, and cognitive impairment.  The relationship between each dietary score and symptom outcome were assessed by linear regression for continuous variables and through general linear model analysis for tertiles of dietary adherence. Results: None of the dietary indices significantly predicted the total non-motor symptom severity score. The HDI predicted a significant decrease in fatigue scores as measured by the NeuroQol fatigue item (standardised β= - .19, p= .022), after adjusting for age, gender, energy intake, years diagnosed, physical activity level, education, and smoking. Self-reported depression symptoms reduced by .17 (standardised β) for each unit increase in HDI score (p= .035), after controlling for age, gender, energy intake and years diagnosed. No other significant associations were evident between dietary scores and any other non-motor symptoms. Conclusion: Our results indicate that fatigue and depression in Parkinson’s may be modified by diet; however more research is needed using a larger sample to replicate these findings

Lack of phenotypic and evolutionary cross-resistance against parasitoids and pathogens in Drosophila melanogaster

BackgroundWhen organisms are attacked by multiple natural enemies, the evolution of a resistance mechanism to one natural enemy will be influenced by the degree of cross-resistance to another natural enemy. Cross-resistance can be positive, when a resistance mechanism against one natural enemy also offers resistance to another; or negative, in the form of a trade-off, when an increase in resistance against one natural enemy results in a decrease in resistance against another. Using Drosophila melanogaster, an important model system for the evolution of invertebrate immunity, we test for the existence of cross-resistance against parasites and pathogens, at both a phenotypic and evolutionary level.MethodsWe used a field strain of D. melanogaster to test whether surviving parasitism by the parasitoid Asobara tabida has an effect on the resistance against Beauveria bassiana, an entomopathogenic fungus; and whether infection with the microsporidian Tubulinosema kingi has an effect on the resistance against A. tabida. We used lines selected for increased resistance to A. tabida to test whether increased parasitoid resistance has an effect on resistance against B. bassiana and T. kingi. We used lines selected for increased tolerance against B. bassiana to test whether increased fungal resistance has an effect on resistance against A. tabida.Results/ConclusionsWe found no positive cross-resistance or trade-offs in the resistance to parasites and pathogens. This is an important finding, given the use of D. melanogaster as a model system for the evolution of invertebrate immunity. The lack of any cross-resistance to parasites and pathogens, at both the phenotypic and the evolutionary level, suggests that evolution of resistance against one class of natural enemies is largely independent of evolution of resistance against the other

The heart failure specialists of tomorrow: a network for young cardiovascular scientists and clinicians

The "Heart failure specialists of Tomorrow" (HoT) group gathers young researchers, physicians, basic scientists, nurses and many other professions under the auspices of the Heart Failure Association of the European Society of Cardiology. After its foundation in 2014, it has quickly grown to a large group of currently 925 members. Membership in this growing community offers many advantages during, before, and after the 'Heart Failure and World Congress on Acute Heart Failure'. These include: eligibility to receive travel grants, participation in moderated poster sessions and young researcher and clinical case sessions, the HoT walk, the career cafe, access to the networking opportunities, and interaction with a large and cohesive international community that constantly seeks multinational collaborations.Peer reviewe

Studies of black diamond as an antibacterial surface for gram negative bacteria: the interplay between chemical and mechanical bactericidal activity

‘Black silicon’ (bSi) samples with surfaces covered in nanoneedles of length ~5 μm were fabricated using a plasma etching process and then coated with a conformal uniform layer of diamond using hot filament chemical vapour deposition to produce ‘black diamond’ (bD) nanostructures. The diamond needles were then chemically terminated with H, O, NH2 or F using plasma treatment, and the hydrophilicity of the resulting surfaces were assessed using water droplet contact-angle measurements, and scaled in the order O > H ≈NH2 >F, with the F-terminated surface being superhydrophobic. The effectiveness of these differently terminated bD needles in killing the Gram-negative bacterium E. coli was semiquantified by Live/Dead staining and fluorescence microscopy, and visualised by environmental scanning electron microscopy. The total number of adhered bacteria was consistent for all the nanostructured bD surfaces at around 50% of the value for the flat diamond control. This, combined with a chemical bactericidal effect of 20–30%, shows that the nanostructured bD surfaces supported significantly fewer viable E. coli than flat surfaces. Moreover, the bD surfaces were particularly effective at preventing the establishment of bacterial aggregates – a precursor to biofilm formation. The percentage of dead bacteria also decreased as a function of hydrophilicity. These results are consistent with a predominantly mechanical mechanism for bacteria death based on the stretching and disruption of the cell membrane, combined with an additional effect from the chemical nature of the surface