Development of a Core Outcome Set for Studies on Obesity in Pregnant Patients (COSSOPP): a study protocol

BACKGROUND

Maternal obesity is a risk factor for adverse maternal, fetal, and neonatal events. Numerous clinical trials are currently exploring the effectiveness of antenatal and peripartum interventions in improving pregnancy outcomes that can in future inform clinical practice. However, the heterogeneity in outcome reporting limits our ability to compare outcomes across studies, and there is a lack of stakeholder representation in outcome choice. A pragmatic solution to this problem is the development of a core outcome set (COS) that defines the minimum criteria for outcome reporting in clinical trials undertaken in this population, arrived at by the involvement of relevant stakeholders.

METHODS

The development of a COS for studies on obesity in pregnant patients (COSSOPP) will comprise five steps. First, a systematic review of published literature will identify the long list of outcomes, their definitions and measurements if applicable, and outcome reporting quality. This will be followed by a meta-synthesis of qualitative studies with patients, and qualitative interviews in Toronto with patients, clinicians, researchers, hospital administrators, and policy-makers, to identify novel outcomes that were not obtained through systematic review. Third, the long list of outcomes will be narrowed down through online Delphi surveys involving an international group of patients and relevant stakeholders. This will be followed by a face-to-face consensus meeting with representatives of all stakeholder groups to arrive at a consensus on the final COS. Finally, in order to determine how the identified core outcomes should be measured, we will conduct another literature review and Delphi process.

DISCUSSION

COSSOPP will engage patients, clinicians, researchers, and other relevant stakeholders in determining the core set of outcomes that should be reported and measured in order to harmonize outcome reporting in studies evaluating the effectiveness of antepartum and peripartum interventions in obese pregnant women. This protocol provides a detailed overview of the steps involved in the development of a COS, to guide researchers in developing COS within their areas of specialization. COMET CORE OUTCOME SET REGISTRATION: http://www.comet-initiative.org/studies/details/939 .

The effects of backgrounding system on growing and finishing performance and carcass characteristics of beef steers

The objective of this 2-yr study was to evaluate growing and finishing performance as well as carcass characteristics of spring-born steers backgrounded on 3 different systems, using feedstuffs readily available in the Midwest: 1) grazing corn residue and being supplemented with dried distillers plus solubles at 2.68 kg DM/steer 6 d/wk (RESIDUE), 2) grazing a late summer-planted oat-brassica forage mix (CCROP), or 3) being fed a corn silage-based diet in a drylot (DRYLOT). Steers ( = 715) were stratified by BW (278 kg ± 23 in yr 1 and 291 kg ± 91 in yr 2) and assigned to treatment and replicate (4 replications per treatment per yr). Steers assigned to DRYLOT were fed a corn silage-based diet for 54 d in yr 1 and 52 d in yr 2 before being transitioned to the finishing diet. Steers assigned to RESIDUE and those assigned to CCROP grazed 65 d in yr 1 and 66 d in yr 2 and then were fed a corn silage-based diet for 21 d in yr 1 and 33 d in yr 2 before being transitioned to the finishing diet. During backgrounding, the ADG (SEM 0.022) of steers assigned to DRYLOT (1.48 kg/d) was greater ( < 0.01) than that of steers assigned to both CCROP (1.05 kg/d) and RESIDUE (0.87 kg/d) and ADG of steers assigned to CCROP was greater ( < 0.01) than that of steers assigned to RESIDUE. At the start of the finishing period, BW of steers assigned to CCROP (381 kg) was greater ( < 0.01, SEM 2.5) than that of steers assigned to DRYLOT (361 kg) and RESIDUE (366 kg). The finishing period lasted 160 d for all treatments. Both 12th-rib fat ( = 0.89) and calculated yield grade ( = 0.39) did not differ among treatments. Finishing G:F of steers assigned to DRYLOT (0.162 kg/kg) was greater ( < 0.01, SEM 0.0015) than that of steers assigned to RESIDUE (0.153 kg/kg) and CCROP (0.153 kg/kg), which did not differ ( = 0.79). In yr 1, HCW of steers assigned to CCROP (402 kg) was greater ( < 0.01, SEM 2.1) than that of steers assigned to both RESIDUE (389 kg) and DRYLOT (391 kg), which did not differ ( = 0.40). This difference in HCW is most likely a result of differences in BW at the start of the finishing phase in yr 1. However in yr 2, HCW of steers assigned to CCROP (400 kg) and RESIDUE (397 kg) did not differ ( = 0.26, SEM 2.1) but were greater ( < 0.01) than that of steers assigned to DRYLOT (367 kg), despite the fact that steers assigned to RESIDUE entered the finishing phase at a lighter BW than steers assigned to CCROP. Marbling was greater ( = 0.01, SEM 3.9) for steers assigned to DRYLOT (429) than for steers assigned to RESIDUE (414), although steers assigned to CCROP (424) were not different ( ≥ 0.10) from steers assigned to DRYLOT or RESIDUE. When cost and price scenarios from the last 5 yr were conducted, no treatment appeared to be consistently superior in terms of cost of gain or net return. Therefore, all 3 systems appear to be viable options for producers.

Experiences of work among people with disabilities who are HIV-positive in Zambia

This paper focuses on accounts of how having a disability and being HIV-positive influences experiences of work among 21 people (12 women, 9 men) in Lusaka, Zambia. In-depth semi-structured interviews were conducted in English, Bemba, Nyanja, or Zambian sign language. Descriptive and thematic analyses were conducted. Three major themes were generated. The first, a triple burden, describes the burden of having a disability, being HIV-positive, and being unemployed. The second theme, disability and HIV is not inability, describes participants' desire for work and their resistance to being regarded as objects of charity. Finally, how work influences HIV management, describes the practicalities of working and living with HIV. Together these themes highlight the limited options available to persons with disabilities with HIV in Lusaka, not only secondary to the effects of HIV influencing their physical capacity to work, but also because of the attendant social stigma of being a person with a disability and HIV-positive.

Does vibration training reduce the fall risk profile of frail older people admitted to a rehabilitation facility? A randomised controlled trial

PURPOSE

To determine the effect of Vibration Training (VT) on functional ability and falls risk among a group of frail older people admitted to an inpatient rehabilitation unit in a regional hospital in New Zealand.

METHOD

A randomized controlled trial of 56 participants (mean 82.01 years in the intervention group and 81.76 years in the control group). VT targeting lower limb muscles with a frequency 30-50 Hz occurred three times per week until discharge. Amplitude progressively increased from 2 to 5 mm to allow the programme to be individually tailored to the participant. The control group received usual care physiotherapy sessions. Outcome measures were: Physiological profile assessment (PPA); and Functional Independence measure (FIM) and Modified Falls Efficacy Scale (MFES).

RESULTS

There was a statistically significant difference observed between the two groups in terms of FIM score (F = 5.09, p = 0.03) and MFES (F = 3.52, p = 0.007) but no difference was observed in terms of PPA scores (F = 0.96, p = 0.36).

CONCLUSIONS

Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of VT in conjunction with usual care physiotherapy in terms of improved functional ability. The study design and the small dosage of VT provided may have precluded any change in falls risk among participants.

IMPLICATIONS FOR REHABILITATION

Vibration training (VT) may assist in reducing the risk of falling among at risk older people. Current pressures on health systems (ageing population, reduced hospital length of stay) necessitate the development of innovative strategies to maximise the rehabilitation potential of older people. Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of vibration training in conjunction with usual care physiotherapy in terms of improved functional ability.

Tooth wear, body mass index and management options for edentulous black flying-foxes (Pteropus alecto Gould) in the Townsville district, north Queensland, Australia

OBJECTIVE

We investigated the relationship between a body mass index and tooth wear in the black flying-fox (Pteropus alecto Gould) to provide guidance on management of edentulous individuals by wildlife carers and veterinarians.

METHODS

Flying-foxes brought into care because of injury were weighed, their forearms measured and the state of their teeth evaluated. Measurements were analysed by Chi-square, ANOVA, t-tests and regression to identify any relationship between the body mass index and the condition of canine and molar teeth, as well as in relation to sex and season.

RESULTS

There was no statistically significant relationship between a bat's dentition state and the body mass index being used.

CONCLUSIONS

In Townsville, the black flying-fox appears to experience a rapid decline in dental condition over time. Despite this, there is little indication that loss of teeth results in a decline in body condition. We attribute this to the dominance of floral foods in the bats' diet in Townsville and a lesser importance of hard fruit that requires intact dentition for consumption. Edentulousness on its own is not sufficient reason to euthanase black flying-foxes in either Townsville or similar relatively dry localities where blossom dominates the flying-fox diet.

Seeing voices of health disparity: evaluating arts projects as influence processes

Arts-informed approaches are increasingly popular as vehicles for research, knowledge translation and for engaging key stakeholders on topics of health and health care. This paper describes an evaluation of a multimedia art installation intended to promote awareness of health disparities as experienced by homeless persons living in Toronto (Canada). The objective of the evaluation was to determine whether the installation had an impact on audience members, and if so, to understand its influence on viewers' perspectives on homelessness and the health concerns of homeless persons. Key themes were identified through the analysis of direct observational data of viewer interactions with the exhibit and qualitative interviews with different audience members after the exhibit. The four key themes were: (1) Promoting recognition of common humanity between viewers and viewed (challenging previously held assumptions and stereotypes, narrowing perceived social distance); (2) functions fulfilled (or potentially fulfilled) by the exhibit: raising awareness, educational applications, and potential pathways by which the exhibit could serve as a call to social action; (3) stories that prompt more stories: the stories within the exhibit (coupled with the interview questions) prompted further sharing of stories amongst the evaluation respondents, highlighting the iterative nature of such approaches. Respondents told of recognizing similarities in the experiences recounted in the exhibit with their own interactions with homeless persons; (4) strengths and weaknesses identified: including aesthetic features, issues of audience 'reach' and the importance of suitable venues for exhibition. Theoretically informed by narrative analysis and visual anthropology, this evaluation demonstrates that arts-informed 'interventions' are highly complex and work in subtle ways on viewers, allowing them to re-imagine the lives of others and identify points of common interest. It also problematizes our assumptions about which outcomes matter and why.

Are residents of downtown Toronto influenced by their urban neighbourhoods? Using concept mapping to examine neighbourhood characteristics and their perceived impact on self-rated mental well-being

Background

There is ample evidence that residential neighbourhoods can influence mental well-being (MWB), with most studies relying on census or similar data to characterize communities. Few studies have actively investigated local residents’ perceptions.

Methods

Concept mapping was conducted with residents from five Toronto neighbourhoods representing low income and non-low income socio-economic groups. These residents participated in small groups and attended two sessions per neighbourhood. The first session (brainstorming) generated neighbourhood characteristics that residents felt influenced their MWB. A few weeks later, participants returned to sort these neighbourhood characteristics and rate their relative importance in affecting residents’ ‘good’ and ‘poor’ MWB. The data from the sorting and rating groups were analyzed to generate conceptual maps of neighbourhood characteristics that influence MWB.

Results

While agreement existed on factors influencing poor MWB (regardless of neighbourhood, income, gender and age), perceptions related to factors affecting good MWB were more varied. For example, women were more likely to rank physical beauty of their neighbourhood and range of services available as more important to good MWB, while men were more likely to cite free access to computers/internet and neighbourhood reputation as important. Low-income residents emphasized aesthetic attributes and public transportation as important to good MWB, while non-low-income residents rated crime, negative neighbourhood environment and social concerns as more important contributors to good MWB.

Conclusion

These findings contribute to the emerging literature on neighbourhoods and MWB, and inform urban planning in a Canadian context.

Designing and evaluating a web-based self-management site for patients with type 2 diabetes--systematic website development and study protocol

Background

Given that patients provide the majority of their own diabetes care, patient self-management training has increasingly become recognized as an important strategy with which to improve quality of care. However, participation in self management programs is low. In addition, the efficacy of current behavioural interventions wanes over time, reducing the impact of self-management interventions on patient health. Web-based interventions have the potential to bridge the gaps in diabetes care and self-management.

Methods

Our objective is to improve self-efficacy, quality of life, self-care, blood pressure, cholesterol and glycemic control and promote exercise in people with type 2 diabetes through the rigorous development and use of a web-based patient self-management intervention. This study consists of five phases: (1) intervention development; (2) feasibility testing; (3) usability testing; (4) intervention refinement; and (5) intervention evaluation using mixed methods. We will employ evidence-based strategies and tools, using a theoretical framework of self-efficacy, then elicit user feedback through focus groups and individual user testing sessions. Using iterative redesign the intervention will be refined. Once finalized, the impact of the website on patient self-efficacy, quality of life, self-care, HbA1c, LDL-cholesterol, blood pressure and weight will be assessed through a non-randomized observational cohort study using repeated measures modeling and individual interviews.

Discussion

Increasing use of the World Wide Web by consumers for health information and ongoing revolutions in social media are strong indicators that users are primed to welcome a new era of technology in health care. However, their full potential is hindered by limited knowledge regarding their effectiveness, poor usability, and high attrition rates. Our development and research agenda aims to address these limitations by improving usability, identifying characteristics associated with website use and attrition, and developing strategies to sustain patient use in order to maximize clinical outcomes.

Community re-engagement and interprofessional education: the impact on health care providers and persons living with stroke

PURPOSE

This study evaluated the impact of an educational intervention that integrates concepts of a community re-engagement framework (CR) and interprofessional collaboration (IPC) on health care providers' (HCP) practice with persons living with stroke (PLS).

METHOD

A mixed-methods design was used in which HCPs (n = 67) and PLS (n = 29) participated from 9 organizations across the care continuum. Pre- and postintervention surveys and interviews were conducted with the HCPs. One-on-one interviews with stroke clients were also conducted pre and post intervention. Quantitative responses were analyzed in SPSS (Chicago, Illinois, USA) for descriptive frequencies and differences between pre- and postintervention groups. Qualitative open-ended responses were thematically coded using NVivo7.

RESULTS

Significant increases occurred in HCPs' knowledge of CR, confidence levels in working with PLS, enhanced understanding of the complex needs of PLS, and positive self-reported impacts on practice. PLS reported positive perceptions of care pre and post intervention.

CONCLUSIONS

The intervention provided HCPs with a common language and framework to work collaboratively and holistically in delivering care consistent with stroke best practices.

Search for doubly charged Higgs boson pair production in pp¯ collisions at √s=1.96 TeV

We present a search for pair production of doubly charged Higgs bosons in the processes qq¯→H(++)H(--) decaying through H(±±)→τ(±)τ(±),μ(±)τ(±),μ(±)μ(±). The search is performed in pp¯ collisions at a center-of-mass energy of √s = 1.96 TeV using an integrated luminosity of up to 7.0 fb(-1) collected by the D0 experiment at the Fermilab Tevatron Collider. The results are used to set 95% C.L. limits on the pair production cross section of doubly charged Higgs bosons and on their mass for different H(±±) branching fractions. Models predicting different H(±±) decays are investigated. Assuming B(H(±±)→τ(±)τ(±))=1 yields an observed (expected) lower limit on the mass of a left-handed H(L)(±±) boson of 128 (116) GeV and assuming B(H(±±)→μ(±)τ(±))=1 the corresponding limits are 144 (149) GeV. In a model with B(H(±±)→τ(±)τ(±))=B(H(±±)→μ(±)τ(±))=B(H(±±)→μ(±)μ(±))=1/3, we obtain M(H(L)(±±))>130 (138) GeV.

Wγ production and limits on anomalous WWγ couplings in pp collisions at sqrt[s] = 1.96 TeV

We measure the cross section and the difference in rapidities between photons and charged leptons for inclusive W(→lν) + γ production in eγ and μγ final states. Using data corresponding to an integrated luminosity of 4.2  fb(-1) collected with the D0 detector at the Fermilab Tevatron Collider, the measured cross section times branching fraction for the process pp → Wγ + X → lνγ + X and the distribution of the charge-signed photon-lepton rapidity difference are found to be in agreement with the standard model. These results provide the most stringent limits on anomalous WWγ couplings for data from hadron colliders: -0.4<Δκ(γ)<0.4 and -0.08<λ(γ)<0.07 at the 95% C.L.

Search for a fermiophobic and standard model Higgs boson in diphoton final states

We present a search for the standard model Higgs boson and a fermiophobic Higgs boson in the diphoton final states based on 8.2  fb(-1) of pp collisions at sqrt[s]=1.96  TeV collected with the D0 detector at the Fermilab Tevatron Collider. No excess of data above background predictions is observed and upper limits at the 95% C.L. on the cross section multiplied by the branching fraction are set which are the most restrictive to date. A fermiophobic Higgs boson with a mass below 112.9 GeV is excluded at the 95% C.L.

Search for neutral minimal supersymmetric standard model Higgs bosons decaying to tau pairs produced in association with b quarks in pp collisions at √s = 1.96 TeV

We report results from a search for neutral Higgs bosons produced in association with b quarks using data recorded by the D0 experiment at the Fermilab Tevatron Collider and corresponding to an integrated luminosity of 7.3 fb(-1). This production mode can be enhanced in several extensions of the standard model (SM) such as in its minimal supersymmetric extension (MSSM) at high tanβ. We search for Higgs bosons decaying to tau pairs with one tau decaying to a muon and neutrinos and the other to hadrons. The data are found to be consistent with SM expectations, and we set upper limits on the cross section times branching ratio in the Higgs boson mass range from 90 to 320 GeV/c(2). We interpret our result in the MSSM parameter space, excluding tanβ values down to 25 for Higgs boson masses below 170 GeV/c(2).

Precision measurement of the ratio B(t→Wb)/B(t→Wq) and extraction of V(tb)

We present a measurement of the ratio of top quark branching fractions R=B(t→Wb)/B(t→Wq), where q can be a d, s, or b quark, in the lepton+jets and dilepton tt final states. The measurement uses data from 5.4 fb(-1) of pp collisions collected with the D0 detector at the Fermilab Tevatron Collider. We measure R=0.90±0.04, and we extract the Cabibbo-Kobayashi-Maskawa (CKM) matrix element |V(tb)| as |V(tb)|=0.95±0.02, assuming unitarity of the 3×3 CKM matrix.

Search for a fourth generation t' Quark in p ̄p collisions at √s = 1.96 TeV

We present a search for pair production of a fourth generation t' quark and its antiparticle, followed by their decays to a W boson and a jet, based on an integrated luminosity of 5.3 fb(-1) of proton-antiproton collisions at √s = 1.96  TeV collected by the D0 Collaboration at the Fermilab Tevatron Collider. We set upper limits on the t' ̄t' production cross section that exclude at the 95% C.L. a t' quark that decays exclusively to W+jet with a mass below 285 GeV. We observe a small excess in the μ+jets channel which reduces the mass range excluded compared to the expected limit of 320 GeV in the absence of a signal.

Precise measurement of the top quark mass in the dilepton channel at D0

We measure the top quark mass (m(t)) in p ̄p collisions at a center of mass energy √s = 1.96 TeV using dilepton t ̄t→W(+)bW(-) ̄b→ℓ(+)ν(ℓ)bℓ(-) ̄ν(ℓ) ̄b events, where ℓ denotes an electron, a muon, or a tau that decays leptonically. The data correspond to an integrated luminosity of 5.4 fb(-1) collected with the D0 detector at the Fermilab Tevatron Collider. We obtain m(t)=174.0±1.8(stat)±2.4(syst) GeV, which is in agreement with the current world average m(t)=173.3±1.1 GeV. This is currently the most precise measurement of m(t) in the dilepton channel.