Implicit self-comparisons against others could bias quality of life assessments

Objectives: To explore how patient-reported health related quality of life (HRQL) and global health status are affected by use of differing personal reference frames. We hypothesised that implicit comparisons against self at an earlier time, against healthy peers or against ill patients would greatly affect patients’ response values. Study design and setting: Patients in a randomised trial for treatment of Paget’s disease completed annual HRQL questionnaires. Supplementary questions were appended, asking the patients whether they were aware of having made implicit comparisons. Results: The majority of patients reported considering themselves a year ago (31% at baseline), themselves before becoming ill (23%) or other healthy people (24%), with similar proportions during follow up. Mean HRQL scores varied substantially according to the declared frame of reference, with differences as big as 19% of the scale score, or a standardised mean effect size of 0.74 standard deviations. Conclusion: Reported reference frames were associated with effects of similar magnitude to the differences in HRQL that are regarded as clinically important. This may be of particular concern in trials that andomise patients to management in different settings, such as treatment at home / in hospital, or surgery / chemotherapy, and might bias or obscure HRQL differences

Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease and cancer : a systematic review and meta-analysis

We thank Associate Professor Andrew Grey for helping to resolve discrepancies in data extraction and interpretation for cardiovascular events and cancer events. We thank trialists from 16 studies for clarifying or providing additional information for this review [Andrews 2011, Aveyard 2016, Bennett 2012, de Vos 2014, Finnish Diabetes Prevention Study 2009, Goodwin 2014, Green 2015, Horie 2016, Hunt (FFIT) 2014, Katula 2013, Li (Da Qing) 2014, Logue 2005, Ma 2013, O’Neil 2016, Rejeski (CLIP) 2011, Uusitupa 1993] and also others who provided information, but their trials were later found not to fulfil our inclusion criteria. Funding: The Health Services Research Unit is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate.Peer reviewedPublisher PD

Relative effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of localised prostate cancer : a systematic review and mixed treatment comparison meta-analysis

© 2013 The Authors. BJU International © 2013 BJU International.Peer reviewedPublisher PD

Analyses and comparison of counter-movement jump performance and self-rated recovery in state under-18s Australian Rules Football players during a national championship

Recovery of team sport athletes during multiple competitive games is an important area for strength and conditioning coaches to monitor as it facilitates for athletes to be ready to perform (11,13). Utilising athletic performance data in conjunction with self-rated reporting measures can help determine if in fact a player or team has recovered sufficiently or shown a trend towards recovery prior to a competitive match (11). Positive improvement in recovery variables can provide confidence in the effectiveness of recovery methods used and assist in determining the training schedule in order to positively manipulate the fitness-fatigue relationship (3). Various methods of analysing the recovery of athletes have been reported in the literature and are available to the strength and conditioning coach. These include subjective, self-rated scales and perceived level of recovery questionnaires (11,12,13). Athletic performance measures during exercises such as the counter movement jump (CMJ) have also been analysed, predominantly utilising force plates to obtain kinetic data. (5,13,14). However, such equipment can be difficult to transport, requires continual calibration and is costly to purchase. A linear transducer can provide important information on CMJ variables in the assessment of athletic movements and due to its size and portability could serve as a valuable tool to assist strength and conditioning coaches, (8,10), and potentially enable the monitoring of recovery. Previous studies have investigated the fatigue effects of competitive games in various sports (11,13,14) including Australian Rules Football (AFL) at the senior elite league level (5, 6). To the authors&rsquo; knowledge, however, there is yet to be a study investigating the recovery response in AFL players, specifically in players 18 years and under competing in the National Under 18s Championships. Australian Rules football is an extremely physically demanding and fatiguing sport where players participate in games time exceeding 120 minutes duration, covering large distances (~12-18km, position dependent) with many high intensity efforts performed at random times throughout the game (2,6,16). Hence, it would seem pertinent to analyse the fatigue effects of competitive matches in an Australian Rules Under-18&rsquo;s National Championship and the subsequent recovery from these games. The aim of this study was to analyse and compare two self-rated subjective measures of recovery; they being muscle soreness (MS) of the lower body, overall perceived total recovery (TR), and the performance measure of peak velocity (PV) obtained from a CMJ analysed with a linear transducer. Data collection occurred between rounds four and five of the Australian Football League Under-18&rsquo;s National Championship, representing a four-day recovery analysis period between matches.<br /

Does weight management research for adults with severe obesity represent them? Analysis of systematic review data

Acknowledgments We thank the members of the REBALANCE Project and Advisory Groups for their contributions to the REBALANCE Project. We thank Shaun Treweek and Heidi Gardner, Health Services Research Unit, University of Aberdeen, for helpful discussions on trial generalisability and inclusion of underserved groups. Funding National Institute for Health Research Health Technology Assessment Programme (project number: 15/09/04).Peer reviewedPublisher PD

Multiple immunofluorescence labelling of formalin-fixed paraffin-embedded (FFPE) tissue

<p>Abstract</p> <p>Background</p> <p>Investigating the expression of candidate genes in tissue samples usually involves either immunohistochemical labelling of formalin-fixed paraffin-embedded (FFPE) sections or immunofluorescence labelling of cryosections. Although both of these methods provide essential data, both have important limitations as research tools. Consequently, there is a demand in the research community to be able to perform routine, high quality immunofluorescence labelling of FFPE tissues.</p> <p>Results</p> <p>We present here a robust optimised method for high resolution immunofluorescence labelling of FFPE tissues, which involves the combination of antigen retrieval, indirect immunofluorescence and confocal laser scanning microscopy. We demonstrate the utility of this method with examples of immunofluorescence labelling of human kidney, human breast and a tissue microarray of invasive human breast cancers. Finally, we demonstrate that stained slides can be stored in the short term at 4°C or in the longer term at -20°C prior to images being collected. This approach has the potential to unlock a large in vivo database for immunofluorescence investigations and has the major advantages over immunohistochemistry in that it provides higher resolution imaging of antigen localization and the ability to label multiple antigens simultaneously.</p> <p>Conclusion</p> <p>This method provides a link between the cell biology and pathology communities. For the cell biologist, it will enable them to utilise the vast archive of pathology specimens to advance their <it>in vitro </it>data into <it>in vivo </it>samples, in particular archival material and tissue microarrays. For the pathologist, it will enable them to utilise multiple antibodies on a single section to characterise particular cell populations or to test multiple biomarkers in limited samples and define with greater accuracy cellular heterogeneity in tissue samples.</p

A qualitative study of the allergy testing experiences, views and preferences of adult patients

Background Patients can be tested for IgE sensitivities with in vivo or in vitro testing, but patients’ experiences of different allergy test modalities have not been studied. The objective of this study was to investigate adult patients’ experiences, views and preferences for allergy testing, exploring skin prick testing and allergen-specific IgE testing. Methods A qualitative study of adults attending out-patients for investigation of a suspected allergy. A purposive, convenience sample identified participants and semi-structured interviews were conducted, face to face or by telephone. Interviews were recorded and transcribed verbatim. Thematic content analysis was used to explore patients’ experiences. Results 23 patients were interviewed. The characteristics of skin prick tests particularly valued were the immediacy and visibility of results, which enabled testing and interpretation to be achieved within a single clinic appointment. In vitro testing offered patients simplicity and procedural speed, necessitating only a single puncture site, and was perceived to be a superior test as it was conducted in a laboratory. Conclusions The patient preferred method of allergy testing was skin prick testing rather than in vitro allergen specific IgE testing. However, most patients were accepting of either testing modality because their desire to confirm or exclude an allergic trigger overrode any perceived disadvantages of the test method

Systematic reviews of and integrated report on the quantitative, qualitative and economic evidence base for the management of obesity in men

&lt;b&gt;Background&lt;/b&gt;&lt;p&gt;&lt;/p&gt; Obesity increases the risk of many serious illnesses such as coronary heart disease, type 2 diabetes and osteoarthritis. More men than women are overweight or obese in the UK but men are less likely to perceive their weight as a problem and less likely to engage with weight-loss services.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Objective&lt;/b&gt;&lt;p&gt;&lt;/p&gt; The aim of this study was to systematically review evidence-based management strategies for treating obesity in men and investigate how to engage men in obesity services by integrating the quantitative, qualitative and health economic evidence base.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Data sources&lt;/b&gt;&lt;p&gt;&lt;/p&gt; Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, the Database of Abstracts of Reviews of Effects and the NHS Economic Evaluation Database were searched from inception to January 2012, with a limited update search in July 2012. Subject-specific websites, reference lists and professional health-care and commercial organisations were also consulted.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Review methods&lt;/b&gt;&lt;p&gt;&lt;/p&gt; Six systematic reviews were conducted to consider the clinical effectiveness, cost-effectiveness and qualitative evidence on interventions for treating obesity in men, and men in contrast to women, and the effectiveness of interventions to engage men in their weight reduction. Randomised controlled trials (RCTs) with follow-up data of at least 1 year, or any study design and length of follow-up for UK studies, were included. Qualitative and mixed-method studies linked to RCTs and non-randomised intervention studies, and UK-based, men-only qualitative studies not linked to interventions were included. One reviewer extracted data from the included studies and a second reviewer checked data for omissions or inaccuracies. Two reviewers carried out quality assessment. We undertook meta-analysis of quantitative data and a realist approach to integrating the qualitative and quantitative evidence synthesis.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Results&lt;/b&gt;&lt;p&gt;&lt;/p&gt; From a total of 12,764 titles reviewed, 33 RCTs with 12 linked reports, 24 non-randomised reports, five economic evaluations with two linked reports, and 22 qualitative studies were included. Men were more likely than women to benefit if physical activity was part of a weight-loss programme. Reducing diets tended to produce more favourable weight loss than physical activity alone (mean weight change after 1 year from a reducing diet compared with an exercise programme -3.2 kg, 95% CI -4.8 kg to -1.6 kg). The type of reducing diet did not affect long-term weight loss. A reducing diet plus physical activity and behaviour change gave the most effective results. Low-fat reducing diets, some with meal replacements, combined with physical activity and behaviour change training gave the most effective long-term weight change in men [-5.2 kg (standard error 0.2 kg) after 4 years]. Such trials may prevent type 2 diabetes in men and improve erectile dysfunction. Although fewer men joined weight-loss programmes, once recruited they were less likely to drop out than women (difference 11%, 95% CI 8% to 14%). The perception of having a health problem (e.g. being defined as obese by a health professional), the impact of weight loss on health problems and desire to improve personal appearance without looking too thin were motivators for weight loss amongst men. The key components differ from those found for women, with men preferring more factual information on how to lose weight and more emphasis on physical activity programmes. Interventions delivered in social settings were preferred to those delivered in health-care settings. Group-based programmes showed benefits by facilitating support for men with similar health problems, and some individual tailoring of advice assisted weight loss in some studies. Generally, men preferred interventions that were individualised, fact-based and flexible, which used business-like language and which included simple to understand information. Preferences for men-only versus mixed-sex weight-loss group programmes were divided. In terms of context, programmes which were cited in a sporting context where participants have a strong sense of affiliation showed low drop out rates and high satisfaction. Although some men preferred weight-loss programmes delivered in an NHS context, the evidence comparing NHS and commercial programmes for men was unclear. The effect of family and friends on participants in weight-loss programmes was inconsistent in the evidence reviewed - benefits were shown in some cases, but the social role of food in maintaining relationships may also act as a barrier to weight loss. Evidence on the economics of managing obesity in men was limited and heterogeneous.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Limitations&lt;/b&gt;&lt;p&gt;&lt;/p&gt; The main limitations were the limited quantity and quality of the evidence base and narrow outcome reporting, particularly for men from disadvantaged and minority groups. Few of the studies were undertaken in the UK.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusions&lt;/b&gt;&lt;p&gt;&lt;/p&gt; Weight reduction for men is best achieved and maintained with the combination of a reducing diet, physical activity advice or a physical activity programme, and behaviour change techniques. Tailoring interventions and settings for men may enhance effectiveness, though further research is needed to better understand the influence of context and content. Future studies should include cost-effectiveness analyses in the UK setting

Role of regional extension and uplift in the Plio-Pleistocene evolution of the Aksu Basin, SW Turkey

The Aksu Basin, within the Isparta Angle area of SW Turkey, documents Plio-Pleistocene crustal processes at the interface between the Tauride Mountains and the Eastern Mediterranean Sea. Basin sedimentation began in the Late Miocene, following an earlier history of emplacement of Mesozoic allochthonous units (Antalya Complex), Miocene basin development and localized Late Miocene compression (Aksu Phase). Late Miocene-Early Pliocene transtension deformed the Aksu Basin, exploiting pre-existing zones of structural weakness. During Early-Mid-Pliocene, muddy sediments accumulated in a shallow shelf sea (<150 m deep), open to the Mediterranean Sea to the south. Regression in the Late Pliocene then resulted in coarse deltaic progradation. Mature erosion surfaces developed on adjacent elevated areas throughout the Pliocene and were accompanied by fanglomerate deposition along the high-relief western margin of the basin. East-west extension then formed the present Aksu Basin as a N-S half graben in the Late Pliocene-early Pleistocene associated with greatly enhanced fluvial downcutting. Accumulation of very extensive (600 km2) and locally thick (up to 250 m) cool-water Antalya tufa deposits then followed, prior to glacial times. Initial localized lacustrine carbonate deposition was followed by development of mainly algal carbonates that are thickest in the west. The terraced nature of the tufa (terraces at 300, 250, 100 m above present sea level) is explained in terms of fluvial processes. Regional comparisons suggest a two-stage history for the Aksu Basin: first, Late Miocene-Early Pliocene transtension and subsidence; secondly, Late Pliocene-Early Pleistocene rifting and marginal uplift. The overall tectonic setting reflects interplay between supra-subduction zone extension and tectonic 'escape' of Anatolia westwards towards the Aegean