The psychometric performance of generic preference-based measures for patients with pressure ulcers

© 2015 Palfreyman and Mulhern. Background: Pressure ulcers are wounds that result from reduced mobility, and can have a significant impact on morbidity, mortality and quality of life. As pressure ulcers are a consequence of a wide range of conditions and interventions, it is unclear whether the best means of capturing the quality of life impacts is via generic or condition specific Patient Reported Outcome Measures (PROMs). The aim of this study was to investigate the psychometric performance of the generic EQ-5D and SF-6D amongst patients identified as having or being at risk of developing pressure ulceration. Methods: A survey of patients who were using pressure relieving mattresses and other equipment was undertaken within inpatient and community settings using a handheld tablet and postal survey. Data on EQ-5D-3L, SF-12 (used to calculate SF-6D), an EQ-5D dignity bolt-on question, demographic and wound specific questions were collected. Convergent validity was assessed using Spearman's correlations, and agreement using Bland-Altman plots. Known group validity was assessed by examining whether the instruments discriminated between different pressure ulcer severity groups. Multivariate linear regression was used to examine the impact of a range of pressure ulcer related variables. Results: The total number of participants was 307, including 273 from the acute setting (52% response rate) and 41 from the community (32%). SF-6D and EQ-5D were moderately correlated (0.61), suggesting that both instruments were capturing similar quality of life impacts. Both measures were able to significantly discriminate between groups based on the ulcer grade. Presence of a pressure ulcer and number of comorbidities were significant explanatory variables of EQ-5D and SF-6D score. Conclusions: The results suggest that generic PROMs can effectively capture the impact of pressure ulcers on quality of life, although there are significant challenges in collecting data from this group of patients related to poor clinical condition and mental capacity. The most effective method for obtaining survey data was through the hand held devices and interviewers

Temporal Evolution of the Vela Pulsar's Pulse Profile

The mechanisms of emission and changes in rotation frequency ('glitching') of the Vela pulsar (J0835-4510) are not well understood. Further insight into these mechanisms can be achieved by long-term studies of integrated pulse width, timing residuals, and bright pulse rates. We have undertaken an intensive observing campaign of Vela and collected over 6000 hours of single pulse data. The data shows that the pulse width changes with time, including marked jumps in width after micro-glitches (frequency changes). The abundance of bright pulses also changes after some micro-glitches, but not all. The secular changes in pulse width have three possible cyclic periods, that match with X-ray periodicities of a helical jet that are interpreted as free precession.Comment: 6 pages, 8 figures. Accepted for publication in The Astrophysical Journa

Detection of Gamma-Ray Emission from the Vela Pulsar Wind Nebula with AGILE

Pulsars are known to power winds of relativistic particles that can produce bright nebulae by interacting with the surrounding medium. These pulsar wind nebulae (PWNe) are observed in the radio, optical, x-rays and, in some cases, also at TeV energies, but the lack of information in the gamma-ray band prevents from drawing a comprehensive multiwavelength picture of their phenomenology and emission mechanisms. Using data from the AGILE satellite, we detected the Vela pulsar wind nebula in the energy range from 100 MeV to 3 GeV. This result constrains the particle population responsible for the GeV emission, probing multivavelength PWN models, and establishes a class of gamma-ray emitters that could account for a fraction of the unidentified Galactic gamma-ray sources.Comment: Accepted by Science; first published online on December 31, 2009 in Science Express. Science article and Supporting Online Material are available at http://www.sciencemag.or

A Second Chromatic Timing Event of Interstellar Origin toward PSR J1713+0747

The frequency dependence of radio pulse arrival times provides a probe of structures in the intervening media. Demorest et al. was the first to show a short-term (~100–200 days) reduction in the electron content along the line of sight to PSR J1713+0747 in data from 2008 (approximately MJD 54750) based on an apparent dip in the dispersion measure of the pulsar. We report on a similar event in 2016 (approximately MJD 57510), with average residual pulse-arrival times ≈−3.0, −1.3, and −0.7 μs at 820, 1400, and 2300 MHz, respectively. Timing analyses indicate possible departures from the standard ν −2 dispersive-delay dependence. We discuss and rule out a wide variety of potential interpretations. We find the likeliest scenario to be lensing of the radio emission by some structure in the interstellar medium, which causes multiple frequency-dependent pulse arrival-time delays

Mental health of women and children experiencing family violence in conflict settings: a mixed methods systematic review

Background: Armed conflict has significant impacts on individuals and families living in conflict-affected settings globally. Scholars working to prevent violence within families have hypothesised that experiencing armed conflict leads to an increase in family violence and mental health problems. In this review, we assessed the prevalence of family violence in conflict settings, its association with the mental health of survivors, moderating factors, and the importance of gender relations. // Methods: Following PRISMA guidelines, we systematically reviewed quantitative and qualitative studies that assessed the prevalence of family violence and the association between family violence and mental health problems, within conflict settings (PROSPERO reference CRD42018114443). // Results: We identified 2605 records, from which 174 full text articles were screened. Twenty-nine studies that reported family violence during or up to 10 years after conflict were eligible for inclusion. Twenty one studies were quantitative, measuring prevalence and association between family violence and mental health problems. The studies were generally of high quality and all reported high prevalence of violence. The prevalence of violence against women was mostly in the range of 30–40%, the highest reported prevalence of physical abuse being 78.9% in Bosnia and Herzegovina. For violence against children, over three-quarters had ever experienced violence, the highest prevalence being 95.6% in Sri Lanka. Associations were found with a number of mental health problems, particularly post-traumatic stress disorder. The risk varied in different locations. Eight qualitative studies showed how men’s experience of conflict, including financial stresses, contributes to their perpetration of family violence. // Conclusions: Family violence was common in conflict settings and was associated with mental health outcomes, but the studies were too heterogenous to determine whether prevalence or risk was greater than in non-conflict settings. The review highlights an urgent need for more robust data on perpetrators, forms of family violence, and mental health outcomes in conflict-affected settings in order to help understand the magnitude of the problem and identify potential solutions to address it

Burkholderia cenocepacia ET12 strain activates TNFR1 signalling in cystic fibrosis airway epithelial cells

Burkholderia cenocepacia is an important pulmonary pathogen in individuals with cystic fibrosis (CF). Infection is often associated with severe pulmonary inflammation, and some patients develop a fatal necrotizing pneumonia and sepsis (‘cepacia syndrome’). The mechanisms by which this species causes severe pulmonary inflammation are poorly understood. Here, we demonstrate that B. cenocepacia BC7, a potentially virulent representative of the epidemic ET12 lineage, binds to tumour necrosis factor receptor 1 (TNFR1) and activates TNFR1-related signalling pathway similar to TNF-α, a natural ligand for TNFR1. This interaction participates in stimulating a robust IL-8 production from CF airway epithelial cells. In contrast, BC45, a less virulent ET12 representative, and ATCC 25416, an environmental B. cepacia strain, do not bind to TNFR1 and stimulate only minimal IL-8 production from CF cells. Further, TNFR1 expression is increased in CF airway epithelial cells compared with non-CF cells. We also show that B. cenocepacia ET12 strain colocaizes with TNFR1 in vitro and in the lungs of CF patients who died due to infection with B. cenocepacia, ET12 strain. Together, these results suggest that interaction of B. cenocepacia , ET12 strain with TNFR1 may contribute to robust inflammatory responses elicited by this organism.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73011/1/j.1462-5822.2007.01029.x.pd

Patient-reported outcome measures in patients with peripheral artery disease: Protocol for a systematic review

Peripheral arterial disease (PAD) results in reduced health-related quality of life and significant functional impairment. Patient-reported outcome measures (PROMs) are important when considering the impact of treatments and management strategies in patients with PAD. A variety of studies have reported the use of different PROMs in patients with PAD. However, PROMs should provide valid and reliable findings to help in healthcare decision-making. The aim of this proposed systematic review is to comprehensively evaluate the psychometric properties of PROMs developed and/ or validated in patients with PAD

Prescribing for the management of venous leg ulceration

Venous leg ulceration affects a large proportion of the elderly population and can have a profound impact on quality of life. Most patients with leg ulcers receive care from community nurses who are principally responsible for prescribing decisions in the management of venous leg ulceration. There is evidence to support the use of potable tap water for cleansing. Evidence supports the use of compression bandaging or compression hosiery for all patients with adequate arterial supply to the lower leg. There is also good evidence to support the prescription of oral pentoxifylline, preferably as an adjunct to compression or, for patients unable to tolerate compression, as a stand-alone therapy. The evidence base for dressings is less robust, but simple low-cost, low-adherent dressings are a reasonable first-line choice for under-compression

Modelling an Untended Scottish Forest Ecosystem Utilising Standard and Customised Software

The Heron Wood Reserve in Peeblesshire, Scotland is a 7.5-hectare wood, left untended tofacilitate investigation into a natural Scottish Forest Ecosystem. Data on fungal fruiting have been collectedsince 1994, and since November 2000 physico-chemical and biotic experiments on soil and forest litter havealso been conducted with the aim to construct and integrate a number of simulation sub-models of the variousecological systems present in an untended Scottish woodland. Important systems for modelling includepatterns of fungal succession, habitat characteristics and fungal biochemical patterns. For example, Glomalin,a protein secreted by arbuscular mycorrhizal fungi, is believed to bind soil particles together in stablestructures called aggregates. During the last 40 years, nearly one third of the world\u27s arable land was lost byerosion, with a current loss rate of more than 10 million hectares per year [Pimentel et al. 1995, Science, 267,1117-1123]. Modelling this system facilitates the understanding of a paramount component of soil ecology.A large volume of data has been collected so computer software is used for the storage and handling of data.Microsoft Access is the database used for storage, Microsoft Excel is the spreadsheet used for variouscalculations and customised software written in Microsoft Visual Basic and Microsoft VBA allowscommercially unavailable statistical tests to be carried out, and the quick display of data in a suitable manner.Model Maker software is used to construct and test models formulated from the data and ultimately tofacilitate the running of various simulations to make predictions within these important ecological subsystems