The importance of integration of stakeholder views in core outcome set development: Otitis Media with Effusion in children with cleft palate

© 2015 Harman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background: Approximately 75% of children with cleft palate (CP) have Otitis Media with Effusion (OME) histories. Evidence for the effective management of OME in these children is lacking. The inconsistency in outcome measurement in previous studies has led to a call for the development of a Core Outcome Set (COS). Despite the increase in the number of published COS, involvement of patients in the COS development process, and methods to integrate the views of patients and health professionals, to date have been limited. Methods and Findings: A list of outcomes measured in previous research was identified through reviewing the literature. Opinion on the importance of each of these outcomes was then sought from key stakeholders: Ear, Nose and Throat (ENT) surgeons, audiologists, cleft surgeons, speech and language therapists, specialist cleft nurses, psychologists, parents and children. The opinion of health professionals was sought in a three round Delphi survey where participants were asked to score each outcome using a bespoke online system. Parents and children were also asked to score outcomes in a survey and provided an in-depth insight into having OME through semi-structured interviews. The results of the Delphi survey, interviews and parent/patient survey were brought together in a final consensus meeting with representation from all stakeholders. A final set of eleven outcomes reached the definition of "consensus in" to form the recommended COS: hearing; chronic otitis media (COM); OME; receptive language skills; speech development; psycho social development; acute otitis media (AOM); cholesteatoma; side effects of treatment; listening skills; otalgia. Conclusions: We have produced a recommendation about the outcomes that should be measured, as a minimum, in studies of the management of OME in children with CP. The development process included input from key stakeholders and used novel methodology to integrate the opinion of healthcare professionals, parents and children

Effects on musculoskeletal pain, work ability and sickness absence in a 1-year randomised controlled trial among cleaners

<p>Abstract</p> <p>Background</p> <p>Only a few workplace initiatives among cleaners have been reported, even though they constitute a job group in great need of health promotion. The purpose of this trial was to evaluate the effect of either physical coordination training or cognitive behavioural training on musculoskeletal pain, work ability and sickness absence among cleaners.</p> <p>Methods</p> <p>A cluster-randomised controlled trial was conducted among 294 female cleaners allocated to either physical coordination training (PCT), cognitive behavioural training (CBTr) or a reference group (REF). Questionnaires about musculoskeletal pain and work ability were completed at baseline and after one year's intervention. Sickness absence data were obtained from the managers' records. Analyses were performed according to the intention-to-treat-principle (ITT).</p> <p>Results</p> <p>No overall reduction in musculoskeletal pain, work ability or sickness absence from either PCT or CBTr compared with REF was found in conservative ITT analyses. However, explorative analyses revealed a treatment effect for musculoskeletal pain of the PCT. People with chronic neck/shoulder pain at baseline were more frequently non-chronic at follow-up after PCT compared with REF (p = 0.05).</p> <p>Conclusions</p> <p>The PCT intervention appeared effective for reducing chronic neck/shoulder pain among the female cleaners. It is recommended that future interventions among similar high-risk job groups focus on the implementation aspects of the interventions to maximise outcomes more distal from the intervention such as work ability and sickness absence.</p> <p>Trial registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN96241850">ISRCTN96241850</a></p

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Social Movements and International Relations: A Relational Framework

Social movements are increasingly recognized as significant features of contemporary world politics, yet to date their treatment in international relations theory has tended to obfuscate the considerable diversity of these social formations, and the variegated interactions they may establish with state actors and different structures of world order. Highlighting the difficulties conventional liberal and critical approaches have in transcending conceptions of movements as moral entities, the article draws from two under-exploited literatures in the study of social movements in international relations, the English School and Social Systems Theory, to specify a wider range of analytical interactions between different categories of social movements and of world political structures. Moreover, by casting social movement phenomena as communications, the article opens international relations to consideration of the increasingly diverse trajectories and second-order effects produced by social movements as they interact with states, intergovernmental institutions, and transnational actors

Fatigue alters lower extremity kinematics during single-leg stop-jump task

Abstract To examine the kinematic characteristics of the hip and knee during a single-leg stop-jump task before and after exercise-to-fatigue, and to determine if the fatigue response is gender-dependent. Lower extremity kinematic measurements were taken of male and female subjects while they performed a sports functional task before and after fatigue developed from exhaustive running. Thirty healthy, physically active subjects (15 males and 15 females) Knee and hip joint kinematics were calculated utilizing three-dimensional video analysis. Each subject performed five single-leg stop-jumps before and after an exercise-to-fatigue bout. All subjects underwent a fatigue protocol using the modified Astrand protocol. Fatigue was verified using the Rating of Perceived Exertion along with the subject&apos;s heart rate. All data were analyzed using two factor (test · gender) repeated measures ANOVA (P \ 0.05). Both males and females demonstrated significantly less maximal knee valgus (P = 0.038) and decreased knee flexion at initial contact (P = 0.009) post-fatigue. No significant differences were identified in hip joint angles between sessions or between sexes. The results show that fatigue developed from exhaustive running alters lower extremity kinematics during a single-leg stop-jump task. The more neutral position in the frontal plane might be an effort to protect the knee. The decrease in knee flexion at initial contact may be an attempt to increase knee stability following fatigue. Our results did not reveal any gender differences in this specific task

Optimization of ultrafast Yb-doped fiber amplifiers to achieve high-quality compressed pulses

We both numerically and experimentally study the performance of nonlinear Yb-doped fiber amplifiers, and demonstrate that there exists an optimum negative prechirp that produces the best-quality compressed pulses

Pelagic habitat: exploring the concept of good environmental status

Marine environmental legislation is increasingly expressing a need to consider the quality of pelagic habitats. This paper uses the European Union marine strategy framework to explore the concept of good environmental status (GES) of pelagic habitat with the aim to build a wider understanding of the issue. Pelagic ecosystems have static, persistent and ephemeral features, with manageable human activities primarily impacting the persistent features. The paper explores defining the meaning of "good", setting boundaries to assess pelagic habitat and the challenges of considering habitat biodiversity in a moving medium. It concludes that for pelagic habitats to be in GES and able to provide goods and services to humans, three conditions should be met: (i) all species present under current environmental conditions should be able to find the pelagic habitats essential to close their life cycles; (ii) biogeochemical regulation is maintained at normal levels; (iii) critical physical dynamics and movements of biota and water masses at multiple scales are not obstructed. Reference points for acceptable levels of each condition and how these may change over time in line with prevailing oceanographic conditions, should be discussed by knowledge brokers, managers and stakeholders. Managers should think about a habitat hydrography rather than a habitat geography. Setting the bounds of the habitats requires a consideration of dimension, scale and gradients. It is likely that to deal with the challenges caused by a dynamic environment and the relevance of differing spatial and temporal scales, we will need to integrate multidisciplinary empirical data sets with spatial and temporal models to assess and monitor progress towards, or displacement from GES of the pelagic habitat

Light microscope observation of circulating human lymphocytes cultured in vitro

The purpose of this work was to study the isolation and a light microscopy technique for cultured lymphocytes. Blood samples were obtained by venipuncture with an anticoagulant added and centrifuged in a Percoll density gradient to separate the leukocytes. Lymphocytes were placed in 25 cm ³ tissue culture flasks at 37ºC. After culturing, they were fixed and stained with the methods used for blood smears. Results showed that not all fixing solutions and stains were an equally good choice for cultured lymphocytes.<br>Os linfócitos são células importantes do sistema imune e têm sido largamente utilizados em estudos morfológicos. Entretanto, a literatura sobre técnicas de preparação dessas células é escassa e antiga, especialmente para linfócitos cultivados in vitro. Portanto, o objetivo desse estudo foi relatar com detalhes as técnicas de isolamento e microscopia de luz de linfócitos mantidos em cultura. Amostras de sangue foram obtidas por punção venosa e centrifugadas em gradiente de densidade de Percoll, para separar os leucócitos. Os linfócitos foram mantidos em frascos de cultura de 25 cm³ a 37ºC. Após a cultura, as células foram fixadas e coradas de acordo com a metodologia utilizada para esfregaços sanguíneos. Nossos resultados mostraram que nem todos os fixadores e corantes utilizados para esfregaços sanguíneos são uma boa escolha para linfócitos cultivados in vitro