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Coffey T, Duncan E, Morgan H, Gillies K. Developing strategies to address disparities in retention communication during the consent discussion: development of a behavioural intervention. Trials 2023; 24:296. [PMID: 37101245 PMCID: PMC10134580 DOI: 10.1186/s13063-023-07268-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 03/20/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Clinical trials are essential to evidence-based medicine. Their success relies on recruitment and retention of participants: problems with either can affect validity of results. Past research on improving trials has focused on recruitment, with less on retention, and even less considering retention at the point of recruitment, i.e., what retention-relevant information is shared during consent processes. The behaviour of trial staff communicating this information during consent is likely to contribute to retention. So, developing approaches to mitigate issues in retention at the point of consent is necessary. In this study, we describe the development of a behavioural intervention targeting the communication of information important to retention during the consent process. METHODS We applied the Theoretical Domains Framework and Behaviour Change Wheel to develop an intervention aimed at changing the retention communication behaviours of trial staff. Building on findings from an interview study to understand the barriers/facilitators to retention communication during consent, we identified behaviour change techniques that could moderate them. These techniques were grouped into potential intervention categories and presented to a co-design group of trial staff and public partners to discuss how they might be packaged into an intervention. An intervention was presented to these same stakeholders and assessed for acceptability through a survey based on the Theoretical Framework of Acceptability. RESULTS Twenty-six behaviour change techniques were identified with potential to change communication of retention-information at consent. Six trial stakeholders in the co-design group discussed means for implementing these techniques and agreed the available techniques could be most effective within a series of meetings focussed on best practices for communicating retention at consent. The proposed intervention was deemed acceptable through survey results. CONCLUSION We have developed an intervention aimed at facilitating the communication of retention at informed consent through a behavioural approach. This intervention will be delivered to trial staff and will add to the available strategies for trials to improve retention.
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Affiliation(s)
- Taylor Coffey
- Health Services Research Unit, Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Eilidh Duncan
- Health Services Research Unit, Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Heather Morgan
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
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2
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Bunn C, Palmer V, Chng NR, Andersen E, Gray CM, Hunt K, Jelsma JGM, Morgan H, der Sanden MNV, Pereira HV, Philpott M, Roberts GC, Rooksby J, Røynesdal ØB, Silva MN, Sørensen M, Teixeira PJ, van Achterberg T, van de Glind I, van Mechelen W, van Nassau F, van der Ploeg HP, Wyke S. How European Fans in Training (EuroFIT), a lifestyle change program for men delivered in football clubs, achieved its effect: a mixed methods process evaluation embedded in a randomised controlled trial. BMC Public Health 2023; 23:526. [PMID: 36941552 PMCID: PMC10026416 DOI: 10.1186/s12889-023-15419-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/10/2023] [Indexed: 03/22/2023] Open
Abstract
BACKGROUND A randomised trial of European Fans in Training (EuroFIT), a 12-week healthy lifestyle program delivered in 15 professional football clubs in the Netherlands, Norway, Portugal, and the United Kingdom, successfully increased physical activity and improved diet but did not reduce sedentary time. To guide future implementation, this paper investigates how those effects were achieved. We ask: 1) how was EuroFIT implemented? 2) what were the processes through which outcomes were achieved? METHODS We analysed qualitative data implementation notes, observations of 29 of 180 weekly EuroFIT deliveries, semi-structured interviews with 16 coaches and 15 club representatives, and 30 focus group discussions with participants (15 post-program and 15 after 12 months). We descriptively analysed quantitative data on recruitment, attendance at sessions and logs of use of the technologies and survey data on the views of participants at baseline, post program and after 12 months. We used a triangulation protocol to investigate agreement between data from difference sources, organised around meeting 15 objectives within the two research questions. RESULTS We successfully recruited clubs, coaches and men to EuroFIT though the draw of the football club seemed stronger in the UK and Portugal. Advertising that emphasized getting fitter, club-based deliveries, and not 'standing out' worked and attendance and fidelity were good, so that coaches in all countries were able to deliver EuroFIT flexibly as intended. Coaches in all 15 clubs facilitated the use of behaviour change techniques and interaction between men, which together enhanced motivation. Participants found it harder to change sedentary time than physical activity and diet. Fitting changes into daily routines, planning for setbacks and recognising the personal benefit of behaviour change were important to maintain changes. Bespoke technologies were valued, but technological hitches frustrated participants. CONCLUSION EuroFIT was delivered as planned by trained club coaches working flexibly in all countries. It worked as expected to attract men and support initiation and maintenance of changes in physical activity and diet but the use of bespoke, unstable, technologies was frustrating. Future deliveries should eliminate the focus on sedentary time and should use only proven technologies to support self-monitoring and social interaction. TRIAL REGISTRATION ISRCTN81935608, registered 16/06/2015.
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Affiliation(s)
- Christopher Bunn
- School of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK.
| | - Victoria Palmer
- School of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Nai Rui Chng
- School of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Eivind Andersen
- Institute for Sport and Social Science, Norwegian School of Sport Science, Oslo, Norway
| | - Cindy M Gray
- School of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Kate Hunt
- School of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
- Institute for Social Marketing and Health, Faculty of Health and Sports Sciences, University of Stirling, Scotland, UK
| | - Judith G M Jelsma
- Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | - Heather Morgan
- Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK
| | - Maria Nijhuis-van der Sanden
- Radboud Institute for Health Sciences, Radboud University Medical Center, IQ Healthcare, Nijmegen, The Netherlands
| | - Hugo V Pereira
- CIDEFES - Centro de Investigação em Desporto, Faculdade de Educação Física e Desporto da Universidade Lusófona, Educação Física, Exercício e Saúde, Lisbon, Portugal
| | | | - Glyn C Roberts
- Institute for Sport and Social Science, Norwegian School of Sport Science, Oslo, Norway
| | - John Rooksby
- Computer and Information Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Øystein B Røynesdal
- Institute for Sport and Social Science, Norwegian School of Sport Science, Oslo, Norway
- Department of Teacher Education, NLA University College, Bergen, Norway
| | - Marlene N Silva
- CIDEFES - Centro de Investigação em Desporto, Faculdade de Educação Física e Desporto da Universidade Lusófona, Educação Física, Exercício e Saúde, Lisbon, Portugal
- Direcção-Geral da Saúde, Programa Nacional Para a Promoção da Atividade Física, Lisbon, Portugal
| | - Marit Sørensen
- Institute for Sport and Social Science, Norwegian School of Sport Science, Oslo, Norway
| | - Pedro J Teixeira
- CIDEFES - Centro de Investigação em Desporto, Faculdade de Educação Física e Desporto da Universidade Lusófona, Educação Física, Exercício e Saúde, Lisbon, Portugal
| | - Theo van Achterberg
- Department of Public Health and Primary Care, KU Louvain, Academic Centre for Nursing and Midwifery, Louvain, Belgium
| | - Irene van de Glind
- FWG, Department of Researchesearch and Development, Utrecht, The Netherlands
| | - Willem van Mechelen
- Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | - Femke van Nassau
- Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | - Hidde P van der Ploeg
- Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | - Sally Wyke
- School of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
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3
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van Nassau F, Huis A, van de Glind I, Andersen E, Bunn C, Gray CM, Hunt K, Jelsma JGM, van Mechelen W, Morgan H, Røynesdal Ø, Pereira HV, van der Ploeg HP, Roberts GC, Silva MN, Sørensen M, Wyke S, Nijhuis-van der Sanden MWG, van Achterberg T. Factors influencing the implementation of the EuroFIT lifestyle change program in professional football clubs in Europe: a qualitative study in four European countries. Transl Behav Med 2023; 13:212-225. [PMID: 36694360 PMCID: PMC10105865 DOI: 10.1093/tbm/ibac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
This paper investigated facilitators and barriers to implementing the European Football Fans in Training program (EuroFIT) in professional sports clubs in England, the Netherlands, Norway, and Portugal. We analyzed qualitative data collected at clubs that delivered EuroFIT, based on semi-structured interviews with coordinating staff (n = 15), coaches (n = 16), and focus group interviews with participants (n = 108), as well as data from clubs that considered delivering EuroFIT in the future, based on interviews with staff (n = 7) and stakeholders (n = 8). Facilitators for implementation related to the content and structure of the program, its evidence-base, and the context for delivery in the football stadia. Financial and human resources were both facilitators and barriers. Further barriers were mostly practical, relating to human resources and infrastructure. Major differences between countries related to experience and commitment to running community projects, and differences in infrastructure, financing, and human resources. Professional football clubs' ability to support health promotion efforts depended on their ethos and the financial and human resources available to them. Overall, the EuroFIT program was well received by clubs, coaches, participants, and stakeholders, which was reflected by the many facilitators supporting sustained implementation. For sustainable implementation, it is crucial that clubs and their stakeholders engage fully with the EuroFIT program and understand that for an adequate program delivery their views (ethos) and ways of working influence the implementation and thereby the effectiveness of EuroFIT. An important prerequisite for future roll out of EuroFIT would be a strong EuroFIT delivery partner organization to ensure financial and human resources while overseeing and guiding the quality of delivery in clubs.
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Affiliation(s)
- Femke van Nassau
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anita Huis
- Radboud Institute for Health Sciences, Radboud University Medical Center, IQ Healthcare, Nijmegen, The Netherlands
| | - Irene van de Glind
- Radboud Institute for Health Sciences, Radboud University Medical Center, IQ Healthcare, Nijmegen, The Netherlands
| | - Eivind Andersen
- Department of Sport and Social Sciences, NSSS, Institute for Sport and Social Sciences, Oslo, Norway
| | - Christopher Bunn
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - Cindy M Gray
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kate Hunt
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.,Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Judith G M Jelsma
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Willem van Mechelen
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Heather Morgan
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Øystein Røynesdal
- Department of Sport and Social Sciences, NSSS, Institute for Sport and Social Sciences, Oslo, Norway.,Department of Teacher Education, NLA University College, Bergen, Norway.,Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway
| | - Hugo V Pereira
- CIDEFES Faculdade de Educação Física e Desporto, Universidade Lusófona, Lisbon, Portugal.,Faculdade de Motricidade Humana, Centro Interdisciplinar para o Estudo da Performance Humana (CIPER), Universidade de Lisboa, Lisbon, Portugal
| | - Hidde P van der Ploeg
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Glyn C Roberts
- Department of Sport and Social Sciences, NSSS, Institute for Sport and Social Sciences, Oslo, Norway
| | - Marlene N Silva
- CIDEFES Faculdade de Educação Física e Desporto, Universidade Lusófona, Lisbon, Portugal.,Faculdade de Motricidade Humana, Centro Interdisciplinar para o Estudo da Performance Humana (CIPER), Universidade de Lisboa, Lisbon, Portugal
| | - Marit Sørensen
- Department of Sport and Social Sciences, NSSS, Institute for Sport and Social Sciences, Oslo, Norway
| | - Sally Wyke
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Theo van Achterberg
- Department of Public Health and Primary Care, KU Leuven, Academic Centre for Nursing and Midwifery, Leuven, Belgium
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Hudock KM, Collins MS, Imbrogno MA, Kramer EL, Brewington JJ, Ziady A, Zhang N, Snowball J, Xu Y, Carey BC, Horio Y, O’Grady SM, Kopras EJ, Meeker J, Morgan H, Ostmann AJ, Skala E, Siefert ME, Na CL, Davidson CR, Gollomp K, Mangalmurti N, Trapnell BC, Clancy JP. Alpha-1 antitrypsin limits neutrophil extracellular trap disruption of airway epithelial barrier function. Front Immunol 2023; 13:1023553. [PMID: 36703990 PMCID: PMC9872031 DOI: 10.3389/fimmu.2022.1023553] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/30/2022] [Indexed: 01/12/2023] Open
Abstract
Neutrophil extracellular traps contribute to lung injury in cystic fibrosis and asthma, but the mechanisms are poorly understood. We sought to understand the impact of human NETs on barrier function in primary human bronchial epithelial and a human airway epithelial cell line. We demonstrate that NETs disrupt airway epithelial barrier function by decreasing transepithelial electrical resistance and increasing paracellular flux, partially by NET-induced airway cell apoptosis. NETs selectively impact the expression of tight junction genes claudins 4, 8 and 11. Bronchial epithelia exposed to NETs demonstrate visible gaps in E-cadherin staining, a decrease in full-length E-cadherin protein and the appearance of cleaved E-cadherin peptides. Pretreatment of NETs with alpha-1 antitrypsin (A1AT) inhibits NET serine protease activity, limits E-cadherin cleavage, decreases bronchial cell apoptosis and preserves epithelial integrity. In conclusion, NETs disrupt human airway epithelial barrier function through bronchial cell death and degradation of E-cadherin, which are limited by exogenous A1AT.
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Affiliation(s)
- K. M. Hudock
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States,Division of Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States,*Correspondence: K. M. Hudock,
| | - M. S. Collins
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - M. A. Imbrogno
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - E. L. Kramer
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States,Division of Pediatric Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - J. J. Brewington
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States,Division of Pediatric Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - A. Ziady
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States,Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - N. Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - J. Snowball
- Division of Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Y. Xu
- Division of Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States,Divisions of Biomedical Informatics, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - B. C. Carey
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States,Translational Pulmonary Science Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Y. Horio
- Division of Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States,Department of Respiratory Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto-shi, Kumamoto, Japan
| | - S. M. O’Grady
- Departments of Animal Science, University of Minnesota, St. Paul, MN, United States,Department of Integrative Biology and Physiology, University of Minnesota, St. Paul, MN, United States
| | - E. J. Kopras
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - J. Meeker
- Division of Pediatric Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - H. Morgan
- Division of Pediatric Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - A. J. Ostmann
- Division of Pediatric Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - E. Skala
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - M. E. Siefert
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - C. L. Na
- Division of Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - C. R. Davidson
- Division of Pediatric Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - K. Gollomp
- Division of Hematology, Children’s Hospital of Philadelphia, Philadelphia, PA, United States,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - N. Mangalmurti
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States,Pennsylvania Lung Biology Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - B. C. Trapnell
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States,Translational Pulmonary Science Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - J. P. Clancy
- Cystic Fibrosis Foundation, Bethesda, MD, United States
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5
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Ryan M, Morgan H, O'Gallagher K, Demir O, Rahman H, Ellis H, Dancy L, Sado D, Strange J, Melikian N, Marber M, Shah A, De Silva K, Chiribiri A, Perera D. Coronary wave energy to predict functional recovery in patients with ischemic left ventricular dysfunction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Invasive coronary angiography and non-invasive viability testing are the cornerstones of diagnosing and managing ischemic left ventricular dysfunction. At present there is no single test which serves both needs but, if developed, could revolutionise investigation of this condition. Coronary wave intensity analysis (cWIA) interrogates both contractility and microvascular physiology of the subtended myocardium [1,2] and therefore has the potential to fulfil this goal.
Objectives
We hypothesized that cWIA measured during coronary angiography would predict functional recovery with a similar accuracy to late gadolinium enhanced cardiac magnetic resonance imaging (LGE-CMR).
Methods
Patients with a left ventricular ejection fraction ≤40% and extensive coronary disease were enrolled. cWIA, fractional flow reserve and microvascular resistance were assessed with a simultaneous coronary Doppler and pressure-sensing guidewire during cardiac catheterization at rest, during hyperaemia and during low-dose dobutamine stress. Viability was assessed using LGE-CMR. Regional left ventricular function was assessed at baseline and 6-month follow up after optimization of medical therapy +/− revascularization, using transthoracic echocardiography. The primary outcome was regional functional recovery.
Results
Forty participants underwent baseline physiology, LGE-CMR and thirty had echocardiography at baseline and 6 months; 21/42 territories demonstrated functional recovery. Resting backward compression wave energy was significantly greater in recovering than non-recovering territories (−5240±3772 vs. −1873±1605 W m–2 s–1, p=0.099, Figure 1), and had comparable diagnostic accuracy to CMR (area under the curve 0.812 vs. 0.757, p=0.649, Figure 2); a threshold of −2500 W mm–2 s–1 had 86% sensitivity and 76% specificity at predicting recovery. Backward expansion wave energy did not predict recovery. FFR was numerically higher in recovering territories (0.81±0.17 vs. 0.71±0.16, p=0.058), whilst hyperaemic microvascular resistance did not differentiate recovering from non-recovering territories (1.97±0.73 vs. 2.29±1.00, p=0.287). The likelihood of functional recovery was similar in revascularised and non-revascularised territories (15/29 vs. 6/13 respectively, p=0.739). Low-dose dobutamine stress increased the energy of all waves, but did not improve the accuracy of cWIA in predicting recovery. In a regression model, resting backward compression wave energy and optimization of medical therapy predicted functional recovery; fractional flow reserve and hyperemic microvascular resistance did not.
Conclusions
Backward compression wave energy has similar accuracy to LGE-CMR in the prediction of functional recovery. cWIA has the potential to revolutionise the management of ischaemic left ventricular dysfunction, in a manner analogous to the effect of fractional flow reserve on the management of stable angina.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The British Heart Foundation Clinical Research Training Fellowship
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Affiliation(s)
- M Ryan
- King's College London , London , United Kingdom
| | - H Morgan
- King's College London , London , United Kingdom
| | | | - O Demir
- King's College London , London , United Kingdom
| | - H Rahman
- King's College London , London , United Kingdom
| | - H Ellis
- King's College London , London , United Kingdom
| | - L Dancy
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - D Sado
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - J Strange
- Bristol Heart Institute , Bristol , United Kingdom
| | - N Melikian
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - M Marber
- King's College London , London , United Kingdom
| | - A Shah
- King's College London , London , United Kingdom
| | - K De Silva
- King's College London , London , United Kingdom
| | - A Chiribiri
- King's College London , London , United Kingdom
| | - D Perera
- King's College London , London , United Kingdom
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Morgan H, Jones J, Rathod K, O'Dowling R, Pieri C, Antoniou S, Mathur A, Perera D, Jones D. Direct oral anticoagulants compared to vitamin K antagonists for the treatment of left ventricular thrombi. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Left ventricular thrombus (LVT) complicates around one in six cases of acute and chronic left ventricular systolic dysfunction and is associated with an increased risk of stroke, major systemic embolism and death, believed to be ameliorated by anticoagulation. Off-label use of direct oral anticoagulants (DOACs) for LVT has steadily increased, largely based on favourable outcomes in atrial fibrillation and venous thromboembolism, but the safety and efficacy of DOACs versus vitamin K antagonists (VKA) for LVT remains uncertain.
Purpose
The main aim of our study was to compare treatment of LVT with VKA to DOAC, focusing on all-cause mortality, stroke, major systemic emboli and major bleeding.
Methods
We conducted a retrospective observational longitudinal study of patients presenting to two large quaternary centres between 2011 and 2021 with a diagnosis of LVT. Patients were eligible if they had a documented LVT and received anticoagulation with either VKA or DOAC. Baseline data, thrombus characteristics, treatment type and duration, follow up imaging and clinical events were recorded using electronic health care records. Outcome measures included thrombus resolution, stroke and systemic embolism (SSE), major bleeding and mortality.
Results
A total of 955 patients were identified, of whom 901 received treatment with either a VKA (567 pts, 62.9%) or a DOAC (334 pts, 37.1%) and were included in the analysis. Underlying aetiologies included acute myocardial infarction (AMI) (38.3%), chronic ischaemic cardiomyopathy (38.0%) and non-ischaemic cardiomyopathy (23.7%). Rivaroxaban (43.4%) was the most frequently prescribed DOAC followed by apixaban (35.9%), and the remaining on edoxaban (20.7%). AMI related LVT was more commonly treated with DOAC (53.0%) and chronic ischaemic cardiomyopathy with VKA (72.9%).
There was a lower baseline LVEF in the VKA cohort (29.5±13.2 vs 33.1±14.2, p<0.0001). Other demographic features were comparable. Median follow up was 2.5 years (IQR: 1–3.5). There were no differences in follow up duration between the two treatments (p=0.17). Greater rates of thrombus resolution were seen in the DOAC group compared to VKA (1 year: 78.4% vs 51.4%, p<0.0001), with higher rates of persistent thrombus over the follow-up period seen in the VKA group (25.1% vs 12.9%, p<0.0001). Rates of stroke and systemic embolization were similar between the groups (VKA 9.3% vs 9.6% DOAC, p=0.93). Higher rates of bleeding (BARC >3, 8.1% VKA, 3.6% DOAC, p=0.031) (Figure 1A) and mortality (VKA 18.5%, DOAC 10.2%, p=0.001) (Figure 1B) were seen in the VKA group over the follow-up period.
Conclusions
In a large multi-centre registry of LVT of mixed aetiology, anticoagulation with DOAC was associated with earlier and greater rates of thrombus resolution and consequential reduced adverse events (major bleeding and mortality) during follow up. A funding application to support a multi-centre randomised control trial is underway.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): This work was supported by the British Heart Foundation (Fellowship FS/CRTF/21/24190 to HM) and the National Institute for Health Research (Biomedical Research Centre Award to Guy's and St Thomas' NHS FT and King's College London).
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Affiliation(s)
- H Morgan
- Guy's and St Thomas' NHS Trust Hospitals , London , United Kingdom
| | - J Jones
- Barts Health NHS Trust, Cardiology , London , United Kingdom
| | - K Rathod
- Barts Health NHS Trust, Cardiology , London , United Kingdom
| | - R O'Dowling
- Guy's and St Thomas' NHS Trust Hospitals , London , United Kingdom
| | - C Pieri
- Guy's and St Thomas' NHS Trust Hospitals , London , United Kingdom
| | - S Antoniou
- Barts Health NHS Trust, Cardiology , London , United Kingdom
| | - A Mathur
- Barts Health NHS Trust, Cardiology , London , United Kingdom
| | - D Perera
- Guy's and St Thomas' NHS Trust Hospitals , London , United Kingdom
| | - D Jones
- Barts Health NHS Trust, Cardiology , London , United Kingdom
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Collins M, Imbrogno M, Kramer E, Brewington J, Zhang N, Sharon P, Kopras E, Meeker J, Morgan H, Ostmann A, O'Grady S, Trapnell B, Clancy J, Hudock K. 380 Neutrophil extracellular traps disrupt bronchial epithelial barrier function: Alpha-1 antitrypsin to the rescue. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01070-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Coffey T, Duncan E, Morgan H, Gillies K. What influences communication about retention in randomised trials: a multi-trial, theory-based analysis exploring trial staff perspectives. BMC Med Res Methodol 2022; 22:231. [PMID: 36002801 PMCID: PMC9404662 DOI: 10.1186/s12874-022-01708-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/10/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Retention (participants completing a trial) is a persistent, and often under-studied, challenge within clinical trials. Research on retention has focussed on understanding the actions of participants who decide to remain or withdraw from trial participation and developing interventions to target improvements. To better understand how trial staff may influence participants to remain or withdraw from trials, it is important to explore the experiences of staff that recruit and retain said participants and how the process of recruitment impacts retention. METHODS Two qualitative interview studies informed by the Theoretical Domains Framework (TDF) were conducted with staff involved in various stages of clinical trials. The first set of interviews were focussed on staff perceptions about why participants failed to be retained and what helped to keep others engaged in trials, but also explored more generally what strategies or factors contributed to retention in trials. The second set of interviews were focussed on staff perceptions specifically about the recruitment and informed consent process and how that may influence trial retention. All interviews were analysed using the TDF and assigned to relevant behavioural domains according to perceived barriers/facilitators of the target behaviour. Belief statements were generated, summarising the narrative content of related responses within these behavioural domains. These belief statements were further analysed for themes that captured higher order relationships between separate beliefs within and between behavioural domains. RESULTS Twenty-five participants (9 retention staff and 16 recruitment staff) were interviewed. Themes describing the barriers/facilitators to retention broadly, and to communication of retention information at consent, were generated. Four themes on retention broadly and six themes on communication of retention information at consent were identified. Overall, beliefs within all fourteen TDF domains populated these themes. CONCLUSIONS This study explored staff perspectives on retention and how they interpret their behaviour as contributing to retention success. Perspectives varied considerably but several key themes regarding communication were seen consistently. Specific barriers and facilitators within these findings will serve to guide the design of a behavioural intervention aimed at addressing issues within retention. Findings contribute to a notable gap in the literature on staff behaviour in trials and on retention generally.
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Affiliation(s)
- Taylor Coffey
- Health Services Research Unit, Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Eilidh Duncan
- Health Services Research Unit, Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Heather Morgan
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
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Morgan H, Tomlinson O, Williams C. WS14.06 A retrospective, longitudinal analysis of pulmonary function and peak oxygen uptake in children and adults with cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00236-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Turner S, Cotton S, Wood J, Bell V, Raja EA, Scott NW, Morgan H, Lawrie L, Emele D, Kennedy C, Scotland G, Fielding S, MacLennan G, Norrie J, Forrest M, Gaillard EA, de Jongste J, Pijnenburg M, Thomas M, Price D. Reducing asthma attacks in children using exhaled nitric oxide (RAACENO) as a biomarker to inform treatment strategy: a multicentre, parallel, randomised, controlled, phase 3 trial. Lancet Respir Med 2022; 10:584-592. [PMID: 35101183 DOI: 10.1016/s2213-2600(21)00486-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/09/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The benefit of fractional exhaled nitric oxide (FeNO) in guiding asthma treatment is uncertain. We evaluated the efficacy of adding FeNO to symptom-guided treatment in children with asthma versus only symptom-guided treatment. METHODS RAACENO was a multicentre, parallel, randomised, controlled, phase 3 trial done in 35 secondary care centres and 17 primary care recruitment sites (only seven primary care sites managed to recruit patients) in the UK. Patients with a confirmed asthma diagnosis, aged 6-15 years, prescribed inhaled corticosteroids, and who received a course of oral corticosteroids for at least one asthma exacerbation during the 12 months before recruitment were included. Participants were randomly assigned to either FeNO plus symptom-guided treatment (intervention) or symptom-guided treatment alone (standard care) using a 24 h in-house, web-based randomisation system. Participants and the clinical and research teams were not masked to the group allocation. A web-based algorithm gave treatment recommendations based on the Asthma Control Test (ACT) or Childhood ACT (CACT) score; current asthma treatment; adherence to study treatment in the past 3 months; and use of FeNO (in the intervention group). Follow-up occurred at 3-month intervals for 12 months. The primary outcome was any asthma exacerbation treated with oral corticosteroids in the 12 months after randomisation, assessed in the intention-to-treat population. This study is registered with the International Standard Randomised Controlled Trial Registry, ISRCTN67875351. FINDINGS Between June 22, 2017, and Aug 8, 2019, 535 children were assessed for eligibility, 20 were ineligible and six were excluded post-randomisation. 509 children were recruited and at baseline, the mean age of participants was 10·1 years (SD 2·6), and 308 (60·5%) were male. The median FeNO was 21 ppb (IQR 10-48), mean predicted FEV1 was 89·6% (SD 18·0), and median daily dose of inhaled corticosteroids was 400 μg budesonide equivalent (IQR 400-1000). Asthma was partly or fully controlled in 256 (50·3%) of 509 participants. The primary outcome, which was available for 506 (99%) of 509 participants, occurred in 123 (48·2%) of 255 participants in the intervention group and 129 (51·4%) of 251 in the standard care group, the intention-to-treat adjusted odds ratio (OR) was 0·88 (95% CI 0·61 to 1·27; p=0·49). The adjusted difference in the percentage of participants who received the intervention in whom the primary outcome occurred compared with those who received standard care was -3·1% (-11·9% to 5·6%). In 377 (21·3%) of 1771 assessments, the algorithm recommendation was not followed. Adverse events were reported by 27 (5·3%) of 509 participants (15 in the standard care group and 12 in the intervention group). The most common adverse event was itch after skin prick testing (reported by eight participants in each group). INTERPRETATION We found that the addition of FeNO to symptom-guided asthma treatment did not lead to reduced exacerbations among children prone to asthma exacerbation. Asthma symptoms remain the only tool for guiding treatment decisions. FUNDING National Institute for Health Research.
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Affiliation(s)
- Steve Turner
- Royal Aberdeen Children's Hospital, University of Aberdeen, Aberdeen, UK.
| | - Seonaidh Cotton
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jessica Wood
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Victoria Bell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Neil W Scott
- Department of Medical Statistics, University of Aberdeen, Aberdeen, UK
| | - Heather Morgan
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Louisa Lawrie
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - David Emele
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Charlotte Kennedy
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graham Scotland
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Shona Fielding
- Department of Medical Statistics, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Mark Forrest
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Erol A Gaillard
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | | | | | - Mike Thomas
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - David Price
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; Observational and Pragmatic Research Institute, Singapore
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Abstract
OBJECTIVES To identify studies that applied behavioural approaches to issues of recruitment and/or retention to trials; to describe these approaches; and to identify gaps for future research. DESIGN Systematic mapping review of research undertaken in clinical trials within peer-reviewed sources. Review participants were individuals involved in clinical trials, including trial staff, participants, potential participants and former participants. DATA SOURCES MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, Web of Science and ASSIA from inception to 15 January 2020 with no date or language restrictions. ELIGIBILITY CRITERIA Studies within the context of clinical trials reporting the barriers/facilitators to recruitment and retention, or developing/evaluating solutions to said barriers/facilitators, using a behavioural approach. RESULTS 31 articles were included. Recruitment-focused studies (n=22, 71%) represented the majority. Studies tended to focus on participant behaviours (n=22, 71%). Underserved populations (n=11, 35%) were a notable subset of studies. Most studies (n=23, 74%) were exploratory but those that evaluated interventions (n=8, 26%) often did so within underserved populations (n=6). A majority of studies (n=30, 97%) did not specify their behaviours consistent with guidelines from behavioural scientists. The most used approaches were social cognitive theory (n=8, 26%), the theory of planned behaviour (n=6, 19%) and the theoretical domains framework (n=5, 16%). CONCLUSIONS A range of behavioural approaches have been applied to recruitment and retention to trials. The multitude of recruitment research here is consistent with trials research generally and emphasises the need for research into retention. Authors report target behaviours minimally, which is not conducive to replication. Further research should build on lessons here, such as clearly specifying behaviours. Increased methodological rigour and transparency will lead to robust evidence bases and less research waste in poor recruitment and retention. Overall, trials informed by behavioural approaches promises to be efficient and more participant focused.
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Affiliation(s)
- Taylor Coffey
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Eilidh M Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Heather Morgan
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Louisa Lawrie
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Keegan D, Meeker J, Morgan H, O’Shaughnessy R, Brewington J. 617: Chronic cAMP-dependent stimulation results in less activation of elexacaftor/tezacaftor/ivacaftor-corrected F508del CFTR. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)02040-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Franks R, Milidonis X, Morgan H, Ryan M, Perera D, Plein S, Chiribiri A. Myocardial perfusion quantification by CMR for detection of obstructive coronary artery disease in patients with previous coronary artery bypass surgery. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): British Heart Foundation
Background
Coronary artery bypass grafting (CABG) is an established treatment for patients with advanced coronary artery disease (CAD). A subsequent recurrence of symptoms can cause the need for re-assessment of the coronary circulation. The accuracy of visually assessed stress perfusion cardiovascular magnetic resonance (CMR) for the detection of obstructive CAD is reduced in patients with prior CABG. In patients with complex multi-vessel CAD, myocardial perfusion quantification by CMR is superior to visual assessment (VA) for detection of obstructive disease however patients with CABG have been absent from previous studies.
Purpose
This study sought to assess the performance of myocardial perfusion quantification by CMR against invasive coronary angiography (ICA) for detecting obstructive CAD in patients with previous CABG.
Methods
Twenty-nine patients with a history of previous CABG and subsequent clinically indicated perfusion CMR study and invasive coronary angiography were recruited. Patients underwent a dual bolus stress perfusion CMR with late gadolinium enhancement (LGE) imaging at 3 Tesla. Stress myocardial blood flow (MBF) was estimated at the coronary territory level according to the AHA 16 segment model using Fermi function-constrained deconvolution. Segments with transmural LGE were excluded from MBF analysis. Stress perfusion images were analysed visually alongside LGE images and matched perfusion-LGE defects were considered negative. On ICA, coronary territories with lumen stenosis >70% without an unobstructed bypass graft (<70% stenosis) were considered positive.
Results
86/87 coronary territories were suitable for analysis. Sixty-five territories had at least one bypass graft including 32 territories with arterial grafts. 28/86 territories (33%) had obstructive disease on angiography. Territories with obstructive CAD had significantly lower stress MBF than unobstructed territories (1.21 [IQR: 0.96–1.45] vs 1.58 [1.40–1.84] ml/g/min, p < 0.001, Figure 1). Stress MBF had good accuracy to detect coronary territories with obstructive CAD (sensitivity 71%, specificity 84%, area under the curve (AUC) 0.83, p < 0.001, Figure 2A). For visual assessment, sensitivity was 79%, specificity 78% and diagnostic accuracy 78%. When analysis was confined to only territories with bypass grafts, stress MBF had 78% sensitivity, 81% specificity and AUC of 0.85, p < 0.001 (Figure 2B).. In this subgroup, VA had a sensitivity of 78%, specificity of 76% and a 77% diagnostic accuracy.
Conclusions
In patients with previous surgical revascularisation, quantification of stress myocardial blood flow by CMR offers good diagnostic accuracy for the detection and localisation of anatomically significant stenoses. Accuracy is reduced compared with published data in patients without coronary grafts but remains comparable to expert visual assessment.
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Affiliation(s)
- R Franks
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - X Milidonis
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - H Morgan
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Ryan
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - D Perera
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Chiribiri
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
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Nana M, Morgan H, Moore S, Lee Z, Ang E, Piercy CN. P.7 Clopidogrel and the newer antiplatelets with a focus on regional anaesthesia: A systematic review. Int J Obstet Anesth 2021. [DOI: 10.1016/j.ijoa.2021.103005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Assan Ninson E, Morgan H. The Recruitment, Enlistment, and Deployment of HIV-Positive Military Service Members: An Evaluation of South African and U.S. National, Alongside International, Policies. Mil Med 2021; 186:897-902. [PMID: 33929535 DOI: 10.1093/milmed/usab167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/21/2021] [Accepted: 04/20/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Since its detection in the early 1980s, HIV and AIDS have claimed 32.7 million lives. The HIV epidemic continues to plague the world with its most devastating effects felt in Eastern and Southern Africa. The exposure, vulnerability, and impact of HIV have been prominent among military personnel due to environmental, demographic, and socioeconomic characteristics. Policies have been developed to mitigate its exposure, vulnerability, and impact on the military. However, there are disparities across these policies, especially on recruitment, enlistment, and deployment. These contentions inspired this evaluation, which was designed to provide vital information and insights for militaries developing new HIV policies, for example, the Ghana Armed Forces (GAF). MATERIALS AND METHODS Content analyses of key documents and secondary resources from South Africa (SA), the USA, and the United Nations and International Labour Organizations were undertaken. The key documents evaluated included HIV and AIDS policies of the SA National Defence Force (SANDF), the U.S. DoD, UN Department of Peacekeeping Operations, and International Labour Organization (ILO); national HIV and AIDS policies; and legislations of SA and the USA. RESULTS The SANDF policy permits the recruitment of HIV-positive applicants while the U.S. DoD policy does not. Mandatory pre-employment health assessments including HIV testing is conducted for prospective applicants. Again, discrimination against persons living with HIV (PLHIV) is discouraged by national policies and legislations of both countries and the ILO policy. At the same time, the SA national policy permits discrimination based on requirement of the job.On deployment, the SANDF policy explicitly permits deployment of HIV-positive service members, while the U.S. DoD policy cautiously does so. Both policies support mandatory pre-deployment health assessments in line with the UN peacekeeping policy and medical standards even though voluntary confidential HIV counseling and testing is recommended by the UN. All HIV-positive service members are retained and offered treatment and care services; however, the U.S. DoD policy retires unfit service members after 12 months of consecutive non-deployment. Further, the UN policy repatriates service members with pre-existing medical conditions and pays no compensation for death, injury, or illness, which is due to pre-existing medical conditions or not mission-related. CONCLUSIONS First, the contents of the military policies are not very diverse since most militaries do not enlist or deploy PLHIV except few countries including SA. Implementation and interpretation is however inconsistent. Some militaries continue to exclude PLHIV despite the existence of policies that permit their inclusion. Second, discrepancies exist among the military policies, national legislations, and international policies. The UN policy is not coherent and empowers the military to exclude PLHIV. Also, potential costs to be incurred, in the form of compensation and repatriation, seem to be a major factor in the decision to deploy HIV-positive service members. Harmonization of military HIV policies to ensure uniform standards, interpretation, and implementation and the coherence of the UN policy are essential to guide countries developing new policies, for example, GAF.
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Affiliation(s)
- Enoch Assan Ninson
- The School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, Scotland, United Kingdom
| | - Heather Morgan
- Postgraduate Education Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, Scotland, United Kingdom
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Morgan H, Chiu G. Re-evaluation of the Lancashire tier 2 oral surgery triaging service. Br J Oral Maxillofac Surg 2020. [DOI: 10.1016/j.bjoms.2020.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Porter A, Badshah A, Black S, Fitzpatrick D, Harris-Mayes R, Islam S, Jones M, Kingston M, LaFlamme-Williams Y, Mason S, McNee K, Morgan H, Morrison Z, Mountain P, Potts H, Rees N, Shaw D, Siriwardena N, Snooks H, Spaight R, Williams V. Electronic health records in ambulances: the ERA multiple-methods study. Health Serv Deliv Res 2020. [DOI: 10.3310/hsdr08100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Ambulance services have a vital role in the shift towards the delivery of health care outside hospitals, when this is better for patients, by offering alternatives to transfer to the emergency department. The introduction of information technology in ambulance services to electronically capture, interpret, store and transfer patient data can support out-of-hospital care.
Objective
We aimed to understand how electronic health records can be most effectively implemented in a pre-hospital context in order to support a safe and effective shift from acute to community-based care, and how their potential benefits can be maximised.
Design and setting
We carried out a study using multiple methods and with four work packages: (1) a rapid literature review; (2) a telephone survey of all 13 freestanding UK ambulance services; (3) detailed case studies examining electronic health record use through qualitative methods and analysis of routine data in four selected sites consisting of UK ambulance services and their associated health economies; and (4) a knowledge-sharing workshop.
Results
We found limited literature on electronic health records. Only half of the UK ambulance services had electronic health records in use at the time of data collection, with considerable variation in hardware and software and some reversion to use of paper records as services transitioned between systems. The case studies found that the ambulance services’ electronic health records were in a state of change. Not all patient contacts resulted in the generation of electronic health records. Ambulance clinicians were dealing with partial or unclear information, which may not fit comfortably with the electronic health records. Ambulance clinicians continued to use indirect data input approaches (such as first writing on a glove) even when using electronic health records. The primary function of electronic health records in all services seemed to be as a store for patient data. There was, as yet, limited evidence of electronic health records’ full potential being realised to transfer information, support decision-making or change patient care.
Limitations
Limitations included the difficulty of obtaining sets of matching routine data for analysis, difficulties of attributing any change in practice to electronic health records within a complex system and the rapidly changing environment, which means that some of our observations may no longer reflect reality.
Conclusions
Realising all the benefits of electronic health records requires engagement with other parts of the local health economy and dealing with variations between providers and the challenges of interoperability. Clinicians and data managers, and those working in different parts of the health economy, are likely to want very different things from a data set and need to be presented with only the information that they need.
Future work
There is scope for future work analysing ambulance service routine data sets, qualitative work to examine transfer of information at the emergency department and patients’ perspectives on record-keeping, and to develop and evaluate feedback to clinicians based on patient records.
Study registration
This study is registered as Health and Care Research Wales Clinical Research Portfolio 34166.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 10. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Alison Porter
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Anisha Badshah
- Department of Human Resources and Organisational Behaviour, University of Greenwich, London, UK
| | - Sarah Black
- South Western Ambulance Service NHS Foundation Trust, Exeter, UK
| | - David Fitzpatrick
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | | | - Saiful Islam
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Matthew Jones
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Mark Kingston
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Suzanne Mason
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katherine McNee
- South Western Ambulance Service NHS Foundation Trust, Exeter, UK
| | - Heather Morgan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Zoe Morrison
- Aberdeen Business School, Robert Gordon University, Aberdeen, UK
| | | | - Henry Potts
- Centre for Health Informatics and Multiprofessional Education, University College London, London, UK
| | - Nigel Rees
- Pre-Hospital Emergency Research Unit, Welsh Ambulance Service NHS Trust, Swansea, UK
| | - Debbie Shaw
- East Midlands Ambulance Service NHS Trust, Lincoln, UK
| | - Niro Siriwardena
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Helen Snooks
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Rob Spaight
- East Midlands Ambulance Service NHS Trust, Lincoln, UK
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19
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Turner S, Cotton SC, Emele CD, Thomas R, Fielding S, Gaillard EA, de Jongste JC, Morgan H, Neilson AR, Norrie J, Pijnenburg M, Price D, Thomas M. Reducing Asthma Attacks in Children using Exhaled Nitric Oxide as a biomarker to inform treatment strategy: a randomised trial (RAACENO). Trials 2019; 20:573. [PMID: 31585544 PMCID: PMC6778366 DOI: 10.1186/s13063-019-3500-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/05/2019] [Indexed: 11/26/2022] Open
Abstract
Background Childhood asthma is a common condition. Currently there is no validated objective test which can be used to guide asthma treatment in children. This study tests the hypothesis that the addition of fractional exhaled nitric oxide (FENO) monitoring in addition to standard care reduces the number of exacerbations (or attacks) in children with asthma. Methods This is a multi-centre, randomised controlled study. Children will be included of age 6–16 years who have a diagnosis of asthma, currently use inhaled corticosteroids (ICSs) and have had an exacerbation in the previous 12 months. Exclusion criteria include being unable to provide FENO measurement at baseline assessment, having another chronic respiratory condition and being currently treated with maintenance oral steroids. Participants will be recruited in both primary and secondary care settings and will be randomised to either receive asthma treatment guided by FENO plus symptoms (FENO group) or asthma treatment guided by symptoms only (standard care group). Within the FENO group, different treatment decisions will be made dependent on changes in FENO. Participants will attend assessments 3, 6, 9 and 12 months post randomisation. The primary outcome is asthma exacerbation requiring prescription and/or use of an oral corticosteroid over 12 months as recorded by the participant/parent or in general practitioner records. Secondary outcomes include time to first attack, number of attacks, asthma control score and quality of life. Adherence to ICS treatment is objectively measured by an electronic logging device. Participants are invited to participate in a “phenotyping” assessment where skin prick reactivity and bronchodilator response are determined and a saliva sample is collected for DNA extraction. Qualitative interviews will be held with participants and research nurses. A health economic evaluation will take place. Discussion This study will evaluate whether FENO can provide an objective index to guide and stratify asthma treatment in children. Trial registration ISRCTN, ISRCTN67875351. Registered on 12 April 2017. Prospectively registered.
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Affiliation(s)
- S Turner
- Child Health, University of Aberdeen, Aberdeen, UK.
| | - S C Cotton
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - C D Emele
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - R Thomas
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - S Fielding
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - E A Gaillard
- Respiratory Sciences, University of Leicester, Leicester, UK
| | - J C de Jongste
- Department of Paediatric Respiratory Medicine and Allergology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - H Morgan
- Postgraduate Education Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - A R Neilson
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - J Norrie
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - M Pijnenburg
- Department of Paediatric Respiratory Medicine and Allergology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - D Price
- Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore.,Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - M Thomas
- Primary Care and Population Sciences, University of Southampton, Southampton, UK.,NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK
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Adams R, Colmont C, Mukhtar A, Morgan H, Patel GK. A novel oncostatin M/interleukin-31 receptor mutation in familial primary localized cutaneous amyloidosis. Clin Exp Dermatol 2019; 45:254-256. [PMID: 31478212 DOI: 10.1111/ced.14059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/17/2019] [Accepted: 06/28/2019] [Indexed: 11/27/2022]
Affiliation(s)
- R Adams
- European Cancer Stem Cell Research Institute, Cardiff School of Biosciences, Cardiff University, Cardiff, UK
| | - C Colmont
- Molecular and Experimental Medicine, Department of Nephrology, Cardiff University School of Medicine, Cardiff, UK
| | - A Mukhtar
- European Cancer Stem Cell Research Institute, Cardiff School of Biosciences, Cardiff University, Cardiff, UK
| | - H Morgan
- European Cancer Stem Cell Research Institute, Cardiff School of Biosciences, Cardiff University, Cardiff, UK
| | - G K Patel
- European Cancer Stem Cell Research Institute, Cardiff School of Biosciences, Cardiff University, Cardiff, UK
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Kuntz N, Anazodo A, Bowden V, Sender L, Morgan H. Pediatric Cancer Patients' Treatment Journey: Child, Adolescent, and Young Adult Cancer Narratives. J Pediatr Nurs 2019; 48:42-48. [PMID: 31247408 DOI: 10.1016/j.pedn.2019.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The National Cancer Institute has acknowledged that for children, adolescents and young adults (AYAs), cancer is a leading cause of disability and death. This population has unique needs and until we fully understand those needs, we will not be able to provide optimal care. The purpose of this study was to understand the self-reported experience of cancer according to children and AYAs. DESIGN AND METHODS A qualitative descriptive design was used. After obtaining IRB approval, participants were interviewed in Spanish or English. Thirty interviews were conducted with children and AYAs ages 10-22. Questions were asked about the patient's treatment journey and the impact on their lifestyle. The interviews were recorded directly in digital audio files, then transcribed using Verbal Ink®. Themes were derived after the data were organized using Dedoose® and then coded. RESULTS Children and AYAs described the cancer experience as difficult due to activity challenges and disconnection from school. Patients noted that their physical inactivity led to deconditioning. Children and AYAs reported storytelling as a way to cope with newfound disabilities. Patients reported that their illness allowed them to build closer relationships to family. Feelings on other issues arose, such as communication challenges experienced with transition from adult to pediatric hospitals. The value of altruism emerged as a way to provide purpose in their journey. CONCLUSIONS Children and AYAs have particular concerns that the healthcare community needs to address. These qualitative findings have specific recommendations for practice.
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Affiliation(s)
- Nancy Kuntz
- Blood and Bone Marrow Transplant, Hyundai Cancer Institute, CHOC Children's, CA, United States of America.
| | | | - Vicky Bowden
- CHOC Children's, CA, United States of America; Azusa Pacific University, CA, United States of America
| | - Leonard Sender
- Hyundai Cancer Institute, CHOC Children's, CA, United States of America
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Caldwell J, Sepulveda J, Ghosh P, Delp M, Wahl J, Restrepo A, Morgan H, Ulrich B, Patterson N, Rosenthal S, Vega‐Figueroa L, Sadowsky D, McKinley‐Caspanello C, Schwartz K, Muller‐Delp J. Adiponectin‐deficient Mice Demonstrate Impaired Coronary Arteriolar Vasodilation and Subsequent Decline in Cardiac Function. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.833.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - J Wahl
- Florida State UniversityTallahasseeFL
| | | | - H Morgan
- Florida State UniversityTallahasseeFL
| | - B Ulrich
- Florida State UniversityTallahasseeFL
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Williams V, LaFlamme-Williams Y, McNee K, Morgan H, Morrison Z, WW Potts H, Shaw D, Siriwardena N, Snook H, Spaight R, Porter A. PP18 Implementation of electronic patient clinical records in ambulances in the UK: a national survey. Arch Emerg Med 2019. [DOI: 10.1136/emermed-2019-999.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe roll-out of electronic Patient Clinical Records (ePCR) across UK ambulance services has been an important aspect of modernisation. Electronic Records in Ambulances (ERA) is a two-year study which aims to describe the opportunities and challenges of implementing ePCR and associated technology in emergency ambulances.Our study includes a baseline survey of progress implementing ePCR in all UK ambulance services providing a snapshot of current usage.MethodsWe carried out semi-structured telephone interviews with information managers in each ambulance service in the UK. We asked them about the systems in use, the process and current stage of implementation and explored the perceived value of using ePCR. If services did not use ePCR we asked about plans for future introduction.The interviews were transcribed and thematically analysed, by three members of the research team.ResultsWe completed interviews with 22 managers from 13 services. Implementation varied across the UK. Seven services were using electronic records. Four services had adopted electronic records but, at the time of interview, had reverted to paper with the intention of implementing a new ePCR. Two services still used paper but hoped to move to ePCR in the future. Those who had fully implemented ePCR reported mixed success in terms of staff compliance, and in realising the potential benefits offered by ePCR to link with primary and secondary care.Reported benefits of ePCR were largely associated with improved data management for audit and record keeping. Potential improvements to patient care were discussed, but tended to be associated with future planned developments.ImplicationsImplementation of ePCR has proved challenging with wide variation in use between ambulance services. Progress has been erratic, rather than linear, demonstrated by difficulties that services experienced putting ePCR into practice. There is potential for ambulance services in the earlier stages of implementation to learn from the experiences of others.
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Machin L, Bellis KM, Dixon C, Morgan H, Pye J, Spencer P, Williams R. Interprofessional education and practice guide: designing ethics-orientated interprofessional education for health and social care students. J Interprof Care 2018; 33:608-618. [DOI: 10.1080/13561820.2018.1538113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- L.L. Machin
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - K. M. Bellis
- School of Health Sciences, University of Central Lancashire, Preston, UK
| | - C. Dixon
- Doctorate of Clinical Psychology, Lancaster University, Lancaster, UK
| | - H. Morgan
- Department of Sociology, Lancaster University, Lancaster, UK
| | - J. Pye
- Department of Sociology, Lancaster University, Lancaster, UK
| | - P. Spencer
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - R.A. Williams
- Department of Management Science, Lancaster University, Lancaster, UK
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Honrado C, Ciuffreda L, Spencer D, Ranford-Cartwright L, Morgan H. Dielectric characterization of Plasmodium falciparum-infected red blood cells using microfluidic impedance cytometry. J R Soc Interface 2018; 15:rsif.2018.0416. [PMID: 30333248 PMCID: PMC6228484 DOI: 10.1098/rsif.2018.0416] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/05/2018] [Indexed: 02/07/2023] Open
Abstract
Although malaria is the world's most life-threatening parasitic disease, there is no clear understanding of how certain biophysical properties of infected cells change during the malaria infection cycle. In this article, we use microfluidic impedance cytometry to measure the dielectric properties of Plasmodium falciparum-infected red blood cells (i-RBCs) at specific time points during the infection cycle. Individual parasites were identified within i-RBCs using green fluorescent protein (GFP) emission. The dielectric properties of cell sub-populations were determined using the multi-shell model. Analysis showed that the membrane capacitance and cytoplasmic conductivity of i-RBCs increased along the infection time course, due to membrane alterations caused by parasite infection. The volume ratio occupied by the parasite was estimated to vary from less than 10% at earlier stages, to approximately 90% at later stages. This knowledge could be used to develop new label-free cell sorting techniques for sample pre-enrichment, improving diagnosis.
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Affiliation(s)
- C Honrado
- Faculty of Physical Sciences and Engineering, Institute for Life Sciences, University of Southampton, Southampton, UK
| | - L Ciuffreda
- Institute of Infection, Immunity and Inflammation, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - D Spencer
- Faculty of Physical Sciences and Engineering, Institute for Life Sciences, University of Southampton, Southampton, UK
| | - L Ranford-Cartwright
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - H Morgan
- Faculty of Physical Sciences and Engineering, Institute for Life Sciences, University of Southampton, Southampton, UK
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Barwise-Munro R, Morgan H, Turner S. Physician and Parental Decision-Making Prior to Acute Medical Paediatric Admission. Healthcare (Basel) 2018; 6:healthcare6030117. [PMID: 30227652 PMCID: PMC6165442 DOI: 10.3390/healthcare6030117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/29/2018] [Accepted: 09/14/2018] [Indexed: 11/16/2022] Open
Abstract
Background: The number of acute medical paediatric emergency admissions is rising. We undertook qualitative interviews with parents and clinicians to better understand what factors, other than the health status of the child, may influence decision making leading to emergency admission. Methods: Semi-structured interviews were conducted with parents; clinicians working in general practice, out-of-hours or the emergency department (referring clinicians); and doctors working in acute medical paediatrics (receiving clinicians). Results: Ten parents, 7 referring clinicians and 10 receiving clinicians were interviewed. Parents described “erring on the side of caution” when seeking medical opinion and one mentioned anxiety. Among themes seen among referring clinicians, “erring on the side of caution” was also identified as was managing “parental anxiety” and acting on “gut instinct”. Among receiving clinicians, themes included managing parental anxiety and increasing parental expectations of the health service. Conclusions: The study of parent and referring clinician decision-making prior to a hospital admission can identify “teachable moments” where interventions might be delivered to slow or even arrest the rise in short-stay acute medical admissions in Britain and other countries. Interventions could assure parents or referring clinicians that hospital referral is not required and help clinicians understand what they perceive as “parental anxiety”.
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Affiliation(s)
| | - Heather Morgan
- Child Health, University of Aberdeen, Aberdeen AB24 3FX, UK.
- Health Services Research Unit, University of Aberdeen, Aberdeen AB24 3FX, UK.
| | - Steve Turner
- Child Health, Royal Aberdeen Children's Hospital, Aberdeen AB25 2ZG, UK.
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Yeung V, Webber JP, Dunlop EA, Morgan H, Hutton J, Gurney M, Jones E, Falcon-Perez J, Tabi Z, Errington R, Clayton A. Rab35-dependent extracellular nanovesicles are required for induction of tumour supporting stroma. Nanoscale 2018; 10:8547-8559. [PMID: 29693684 DOI: 10.1039/c8nr02417k] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Communication between diseased cells and the microenvironment is a complex yet crucial element in progression of varied pathological processes. Recent studies in cancer highlight an important role for small extracellular nanovesicles secreted by cancer cells as modulators of cancer-associated stroma, leading to enhanced angiogenesis and metastatic priming. The intrinsic factors regulating extracellular nanovesicle biogenesis and secretion are therefore relevant in studies of nano-communication in the cancer milieu. We generated prostate cancer cells bearing stable knockdown of several candidate vesicle regulating factors and examined the impact on cell health, vesicle secretion and on communication with fibroblastic stromal cells. We highlight that RAB11B and RAB35 regulate phenotypically distinct nanovesicle populations, each accounting for only around 20% of the total. Depleting RAB35, but not RAB11B leaves a remaining population of vesicles whose phenotype is insufficient for driving fibroblast to myofibroblast differentiation, leading to attenuated motile behaviours in 3D in vitro models. Co-implantation of tumour cells with stromal fibroblasts in xenografts similarly showed that RAB11B knockdown had little effect on growth rates in vivo. In contrast, significant attenuation in growth, and attenuation of myofibroblasts at the tumour site was evident when using RAB35-knockdown cells. The study concludes that a RAB35 regulated nanovesicle sub-population is particularly important for communication between cancer and stromal cells, and is required for generating a tumour-supportive microenvironment.
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Affiliation(s)
- V Yeung
- Division of Cancer & Genetics, School of Medicine, Cardiff University, Heath Park Heath Park, Cardiff CF14 4XN, UK.
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Marchese D, Reynolds E, Bates ME, Morgan H, Clark SS, Linkov I. Resilience and sustainability: Similarities and differences in environmental management applications. Sci Total Environ 2018; 613-614:1275-1283. [PMID: 28962075 DOI: 10.1016/j.scitotenv.2017.09.086] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 09/09/2017] [Accepted: 09/09/2017] [Indexed: 05/22/2023]
Abstract
In recent years there have been many disparate uses of the terms sustainability and resilience, with some framing sustainability and resilience as the same concept, and others claiming them to be entirely different and unrelated. To investigate similarities, differences, and current management frameworks for increasing sustainability and resilience, a literature review was undertaken that focused on integrated use of sustainability and resilience in an environmental management context. Sustainability was defined through the triple bottom line of environmental, social and economic system considerations. Resilience was viewed as the ability of a system to prepare for threats, absorb impacts, recover and adapt following persistent stress or a disruptive event. Three generalized management frameworks for organizing sustainability and resilience were found to dominate the literature: (1) resilience as a component of sustainability, (2) sustainability as a component of resilience, and (3) resilience and sustainability as separate objectives. Implementations of these frameworks were found to have common goals of providing benefits to people and the environment under normal and extreme operating conditions, with the best examples building on similarities and minimizing conflicts between resilience and sustainability.
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Affiliation(s)
- Dayton Marchese
- US Army Engineer Research and Development Center, US Army Corps of Engineers, 3909 Halls Ferry Road, Vicksburg, 39109, MS, USA
| | - Erin Reynolds
- US Army Engineer Research and Development Center, US Army Corps of Engineers, 3909 Halls Ferry Road, Vicksburg, 39109, MS, USA
| | - Matthew E Bates
- US Army Engineer Research and Development Center, US Army Corps of Engineers, 3909 Halls Ferry Road, Vicksburg, 39109, MS, USA
| | - Heather Morgan
- Headquarters, US Army Corps of Engineers, 441 G Street NW, Washington, 20314, DC, USA
| | - Susan Spierre Clark
- Global Institute of Sustainability, Arizona State University, 800 Cady Mall, Tempe, 85281, AZ, USA
| | - Igor Linkov
- US Army Engineer Research and Development Center, US Army Corps of Engineers, 3909 Halls Ferry Road, Vicksburg, 39109, MS, USA.
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van de Glind I, Bunn C, Gray CM, Hunt K, Andersen E, Jelsma J, Morgan H, Pereira H, Roberts G, Rooksby J, Røynesdal Ø, Silva M, Sorensen M, Treweek S, van Achterberg T, van der Ploeg H, van Nassau F, Nijhuis-van der Sanden M, Wyke S. The intervention process in the European Fans in Training (EuroFIT) trial: a mixed method protocol for evaluation. Trials 2017; 18:356. [PMID: 28750673 PMCID: PMC5531072 DOI: 10.1186/s13063-017-2095-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 07/11/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND EuroFIT is a gender-sensitised, health and lifestyle program targeting physical activity, sedentary time and dietary behaviours in men. The delivery of the program in football clubs, led by the clubs' community coaches, is designed to both attract and engage men in lifestyle change through an interest in football or loyalty to the club they support. The EuroFIT program will be evaluated in a multicentre pragmatic randomised controlled trial (RCT), for which ~1000 overweight men, aged 30-65 years, will be recruited in 15 top professional football clubs in the Netherlands, Norway, Portugal and the UK. The process evaluation is designed to investigate how implementation within the RCT is achieved in the various football clubs and countries and the processes through which EuroFIT affects outcomes. METHODS This mixed methods evaluation is guided by the Medical Research Council (MRC) guidance for conducting process evaluations of complex interventions. Data will be collected in the intervention arm of the EuroFIT trial through: participant questionnaires (n = 500); attendance sheets and coach logs (n = 360); observations of sessions (n = 30); coach questionnaires (n = 30); usage logs from a novel device for self-monitoring physical activity and non-sedentary behaviour (SitFIT); an app-based game to promote social support for physical activity outside program sessions (MatchFIT); interviews with coaches (n = 15); football club representatives (n = 15); and focus groups with participants (n = 30). Written standard operating procedures are used to ensure quality and consistency in data collection and analysis across the participating countries. Data will be analysed thematically within datasets and overall synthesis of findings will address the processes through which the program is implemented in various countries and clubs and through which it affects outcomes, with careful attention to the context of the football club. DISCUSSION The process evaluation will provide a comprehensive account of what was necessary to implement the EuroFIT program in professional football clubs within a trial setting and how outcomes were affected by the program. This will allow us to re-appraise the program's conceptual base, optimise the program for post-trial implementation and roll out, and offer suggestions for the development and implementation of future initiatives to promote health and wellbeing through professional sports clubs. TRIAL REGISTRATION ISRCTN81935608 . Registered on 16 June 2015.
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Affiliation(s)
- I van de Glind
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - C Bunn
- Institute of Health and Wellbeing, College of Social Sciences, 27 Bute Gardens, University of Glasgow, Glasgow, G12 8RS, UK.
| | - C M Gray
- Institute of Health and Wellbeing, College of Social Sciences, 27 Bute Gardens, University of Glasgow, Glasgow, G12 8RS, UK
| | - K Hunt
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, 200 Renfield St, University of Glasgow, Glasgow, G2 3QB, UK
| | - E Andersen
- Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway
| | - J Jelsma
- Department of Public and Occupational Health, and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands
| | - H Morgan
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - H Pereira
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Estrada da Costa, 1495-688, Cruz Quebrada, Portugal
| | - G Roberts
- Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway
| | - J Rooksby
- School of Computing Science, University of Glasgow, Glasgow, G12 8RZ, UK
| | - Ø Røynesdal
- Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway
| | - M Silva
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Estrada da Costa, 1495-688, Cruz Quebrada, Portugal
| | - M Sorensen
- Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway
| | - S Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - T van Achterberg
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - H van der Ploeg
- Department of Public and Occupational Health, and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands
| | - F van Nassau
- Department of Public and Occupational Health, and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands
| | - M Nijhuis-van der Sanden
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - S Wyke
- Institute of Health and Wellbeing, College of Social Sciences, 27 Bute Gardens, University of Glasgow, Glasgow, G12 8RS, UK
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McGrath JS, Honrado C, Spencer D, Horton B, Bridle HL, Morgan H. Analysis of Parasitic Protozoa at the Single-cell Level using Microfluidic Impedance Cytometry. Sci Rep 2017; 7:2601. [PMID: 28572634 PMCID: PMC5454013 DOI: 10.1038/s41598-017-02715-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/18/2017] [Indexed: 11/24/2022] Open
Abstract
At present, there are few technologies which enable the detection, identification and viability analysis of protozoan pathogens including Cryptosporidium and/or Giardia at the single (oo)cyst level. We report the use of Microfluidic Impedance Cytometry (MIC) to characterise the AC electrical (impedance) properties of single parasites and demonstrate rapid discrimination based on viability and species. Specifically, MIC was used to identify live and inactive C. parvum oocysts with over 90% certainty, whilst also detecting damaged and/or excysted oocysts. Furthermore, discrimination of Cryptosporidium parvum, Cryptosporidium muris and Giardia lamblia, with over 92% certainty was achieved. Enumeration and identification of (oo)cysts can be achieved in a few minutes, which offers a reduction in identification time and labour demands when compared to existing detection methods.
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Affiliation(s)
- J S McGrath
- Institute of Biological Chemistry, Biophysics and Bioengineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, EH14 4AS, United Kingdom
| | - C Honrado
- Faculty of Physical Sciences and Engineering and Institute for Life Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - D Spencer
- Faculty of Physical Sciences and Engineering and Institute for Life Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - B Horton
- Moredun Scientific, Pentlands Science Park, Bush Loan, Penicuik, Midlothian, EH26 0PZ, United Kingdom
| | - H L Bridle
- Institute of Biological Chemistry, Biophysics and Bioengineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, EH14 4AS, United Kingdom
| | - H Morgan
- Faculty of Physical Sciences and Engineering and Institute for Life Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom.
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Morgan H. 'Pushed' self-tracking using digital technologies for chronic health condition management: a critical interpretive synthesis. Digit Health 2016; 2:2055207616678498. [PMID: 29942573 PMCID: PMC6001233 DOI: 10.1177/2055207616678498] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 10/18/2016] [Indexed: 11/16/2022] Open
Abstract
Introduction Health policies internationally advocate health services provider support for health services users' 'self-management' of chronic health conditions. Digital technologies are beginning to have a role in delivering such support. 'Pushed' self-tracking of health-related information, including imposed measurement of biomedical and behavioural data, is one approach; however, there is little systematic or discursive research. The aim of this research was to explore factors relevant to the implementation of 'pushed' self-tracking technologies into support for self-management of chronic health conditions interventions. Methods This paper reports a critical interpretive synthesis of studies involving 'pushed' self-tracking using digital technologies to support the self-management of chronic health conditions. The review systematically identified relevant literature, characterised the technologies and discursively explored their implementation and impacts, and human technology interactions. Findings The literature (n = 83), including 'simple' (n = 51) and 'complex' (n = 32) interventions, perhaps unsurprisingly, concentrates on technical and clinical rather than sociological and behavioural perspectives, which limits understanding. Some attention is paid to experiences and views of providers and users about digital technologies implementation and impacts on the delivery of care, for example: consequences of having increased information; compatibility with current systems; implications for personnel; and human-technology negotiations. Conclusions This is a rapidly developing field and early technical and clinical insights are useful. There are opportunities for researchers to explore the sociological and behavioural aspects, and ethical challenges, of implementing 'pushed' self-tracking support programmes too. Detailed multidisciplinary research is needed to understand and guide technical and medical developments that integrate digital technologies into the delivery of care.
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Affiliation(s)
- Heather Morgan
- Health Services Research Unit (HSRU), University of Aberdeen, UK
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Morgan H, Treasure E, Tabib M, Johnston M, Dunkley C, Ritchie D, Semple S, Turner S. An interview study of pregnant women who were provided with indoor air quality measurements of second hand smoke to help them quit smoking. BMC Pregnancy Childbirth 2016; 16:305. [PMID: 27729030 PMCID: PMC5059897 DOI: 10.1186/s12884-016-1062-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 09/06/2016] [Indexed: 11/17/2022] Open
Abstract
Background Maternal smoking can cause health complications in pregnancy. Particulate matter (PM2.5) metrics applied to second hand smoke (SHS) concentrations provide indoor air quality (IAQ) measurements and have been used to promote smoking behaviour change among parents of young children. Here, we present the qualitative results from a study designed to use IAQ measurements to help pregnant women who smoke to quit smoking. Methods We used IAQ measurements in two centres (Aberdeen and Coventry) using two interventions: 1. In Aberdeen, women made IAQ measurements in their homes following routine ultrasound scan; 2. In Coventry, IAQ measurements were added to a home-based Stop Smoking in Pregnancy Service. All women were invited to give a qualitative interview to explore acceptability and feasibility of IAQ measurements to help with smoking cessation. A case study approach using grounded theory was applied to develop a typology of pregnant women who smoke. Results There were 39 women recruited (18 in Aberdeen and 21 in Coventry) and qualitative interviews were undertaken with nine of those women. Diverse accounts of smoking behaviours and experiences of participation were given. Many women reported changes to their smoking behaviours during pregnancy. Most women wanted to make further changes to their own behaviour, but could not commit or felt constrained by living with a partner or family members who smoked. Others could not envisage quitting. Using themes emerging from the interviews, we constructed a typology where women were classified as follows: ‘champions for change’; ‘keen, but not committed’; and ‘can’t quit, won’t quit’. Three women reported quitting smoking alongside participation in our study. Conclusions Pregnant women who smoke remain hard to engage,. Although providing IAQ measurements does not obviously improve quit rates, it can support changes in smoking behaviour in/around the home for some individuals. Our typology might offer a useful assessment tool for midwives. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1062-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heather Morgan
- Research Fellow, Health Services Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Elizabeth Treasure
- Lecturers in Midwifery (Robert Gordon University, Aberdeen), Research Midwives (NHS Grampian), Garthdee, Aberdeen, AB10 7AQ, UK
| | - Mo Tabib
- Lecturers in Midwifery (Robert Gordon University, Aberdeen), Research Midwives (NHS Grampian), Garthdee, Aberdeen, AB10 7AQ, UK
| | - Majella Johnston
- Stop Smoking in Pregnancy Coordinator, Coventry and Warwickshire Partnership Trust, NHS Coventry, Coventry, CV1 4FS, UK
| | - Chris Dunkley
- Stop Smoking in Pregnancy Midwife, Coventry and Warwickshire Partnership Trust, NHS Coventry, Coventry, CV1 4FS, UK
| | - Deborah Ritchie
- Honorary Lecturer in Nursing Studies, University of Edinburgh, Edinburgh, EH8 9YL, UK
| | - Sean Semple
- Senior Lecturer, Respiratory Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZG, UK
| | - Steve Turner
- Senior Lecturer (Clinical), Child Health, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen,, AB25 2ZG, UK
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Wilkinson B, Morgan H, Gondi V, Larson G, Hartsell W, Laramore G, Halasz L, Vargas C, Keole S, Grosshans D, Shih H, Mehta M. Low Levels of Acute Toxicity Associated With Proton Therapy for Low-Grade Glioma: A Proton Collaborative Group Study. Int J Radiat Oncol Biol Phys 2016; 96:E135. [DOI: 10.1016/j.ijrobp.2016.06.930] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Crossland N, Thomson G, Morgan H, MacLennan G, Campbell M, Dykes F, Hoddinott P. Breast pumps as an incentive for breastfeeding: a mixed methods study of acceptability. Matern Child Nutr 2016; 12:726-39. [PMID: 27502101 PMCID: PMC5096021 DOI: 10.1111/mcn.12346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/27/2016] [Accepted: 05/30/2016] [Indexed: 11/30/2022]
Abstract
Increasing breastfeeding rates would improve maternal and child health, but multiple barriers to breastfeeding persist. Breast pump provision has been used as an incentive for breastfeeding, although effectiveness is unclear. Women's use of breast pumps is increasing and a high proportion of mothers express breastmilk. No research has yet reported women's and health professionals' perspectives on breast pumps as an incentive for breastfeeding. In the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study, mixed methods research explored women's and professionals' views of breast pumps as an incentive for breastfeeding. A survey of health professionals across Scotland and North West England measured agreement with ‘a breast pump costing around £40 provided for free on the NHS’ as an incentive strategy. Qualitative interviews and focus groups were conducted in two UK regions with a total of 68 participants (pregnant women, new mothers, and their significant others and health professionals) and thematic analysis undertaken. The survey of 497 health professionals found net agreement of 67.8% (337/497) with the breast pump incentive strategy, with no predictors of agreement shown by a multiple ordered logistic regression model. Qualitative research found interrelated themes of the ‘appeal and value of breast pumps’, ‘sharing the load’, ‘perceived benefits’, ‘perceived risks’ and issues related to ‘timing’. Qualitative participants expressed mixed views on the acceptability of breast pumps as an incentive for breastfeeding. Understanding the mechanisms of action for pump type, timing and additional support required for effectiveness is required to underpin trials of breast pump provision as an incentive for improving breastfeeding outcomes. © 2016 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.
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Affiliation(s)
- Nicola Crossland
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom.
| | - Gill Thomson
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Heather Morgan
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Fiona Dykes
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, United Kingdom
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Sun K, Zeimpekis I, Hu C, Ditshego NMJ, Thomas O, de Planque MRR, Chong HMH, Morgan H, Ashburn P. Effect of subthreshold slope on the sensitivity of nanoribbon sensors. Nanotechnology 2016; 27:285501. [PMID: 27255984 DOI: 10.1088/0957-4484/27/28/285501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
In this work, we investigate how the sensitivity of a nanowire or nanoribbon sensor is influenced by the subthreshold slope of the sensing transistor. Polysilicon nanoribbon sensors are fabricated with a wide range of subthreshold slopes and the sensitivity is characterized using pH measurements. It is shown that there is a strong relationship between the sensitivity and the device subthreshold slope. The sensitivity is characterized using the current sensitivity per pH, which is shown to increase from 1.2% ph(-1) to 33.6% ph(-1) as the subthreshold slope improves from 6.2 V dec(-1) to 0.23 V dec(-1) respectively. We propose a model that relates current sensitivity per pH to the subthreshold slope of the sensing transistor. The model shows that sensitivity is determined only on the subthreshold slope of the sensing transistor and the choice of gate insulator. The model fully explains the values of current sensitivity per pH for the broad range of subthreshold slopes obtained in our fabricated nanoribbon devices. It is also able to explain values of sensitivity reported in the literature, which range from 2.5% pH(-1) to 650% pH(-1) for a variety of nanoribbon and nanowire sensors. Furthermore, it shows that aggressive device scaling is not the key to high sensitivity. For the first time, a figure-of-merit is proposed to compare the performance of nanoscale field effect transistor sensors fabricated using different materials and technologies.
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Affiliation(s)
- K Sun
- Zepler Institute, Electronics & Computer Science, University of Southampton, Southampton, SO17 1BJ, UK
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Case A, Morgan H, Rowley K. Decreasing waiting times for radiotherapy for soft tissue and bone sarcoma at Abertawe Bro Morgannwg University (ABMU) Health Board. Clin Oncol (R Coll Radiol) 2016. [DOI: 10.1016/j.clon.2016.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zeimpekis I, Sun K, Hu C, Ditshego NMJ, Thomas O, de Planque MRR, Chong HMH, Morgan H, Ashburn P. Dual-gate polysilicon nanoribbon biosensors enable high sensitivity detection of proteins. Nanotechnology 2016; 27:165502. [PMID: 26954011 DOI: 10.1088/0957-4484/27/16/165502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
We demonstrate the advantages of dual-gate polysilicon nanoribbon biosensors with a comprehensive evaluation of different measurement schemes for pH and protein sensing. In particular, we compare the detection of voltage and current changes when top- and bottom-gate bias is applied. Measurements of pH show that a large voltage shift of 491 mV pH(-1) is obtained in the subthreshold region when the top-gate is kept at a fixed potential and the bottom-gate is varied (voltage sweep). This is an improvement of 16 times over the 30 mV pH(-1) measured using a top-gate sweep with the bottom-gate at a fixed potential. A similar large voltage shift of 175 mV is obtained when the protein avidin is sensed using a bottom-gate sweep. This is an improvement of 20 times compared with the 8.8 mV achieved from a top-gate sweep. Current measurements using bottom-gate sweeps do not deliver the same signal amplification as when using bottom-gate sweeps to measure voltage shifts. Thus, for detecting a small signal change on protein binding, it is advantageous to employ a double-gate transistor and to measure a voltage shift using a bottom-gate sweep. For top-gate sweeps, the use of a dual-gate transistor enables the current sensitivity to be enhanced by applying a negative bias to the bottom-gate to reduce the carrier concentration in the nanoribbon. For pH measurements, the current sensitivity increases from 65% to 149% and for avidin sensing it increases from 1.4% to 2.5%.
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Affiliation(s)
- I Zeimpekis
- Zepler Institute, Electronics & Computer Science, University of Southampton, Southampton, SO17 1BJ, UK
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Clark J, Holgan N, Craig L, Morgan H, Danielian P, Devereux G. Development and piloting of a food-based intervention to increase vitamin E intake in pregnant women in a randomized controlled trial. Food Sci Nutr 2016; 4:848-851. [PMID: 27826434 PMCID: PMC5090648 DOI: 10.1002/fsn3.353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 01/19/2016] [Accepted: 02/09/2016] [Indexed: 01/08/2023] Open
Abstract
Low maternal vitamin E intake during pregnancy is associated with childhood asthma and a trial is required to test whether increasing maternal vitamin E intake reduces childhood asthma. This study investigated whether such a trial is possible using food to increase vitamin E intake. Three soup varieties with enhanced vitamin E content (16–19 mg/can) from food ingredients were developed. Near identical retail versions (vitamin E 1–4 mg/can) acted as placebo. In a pilot double‐blind randomized controlled trial, pregnant women were randomized 1:1 to enhanced or placebo soups (three tins/week) from 12 weeks gestation to delivery. Vitamin E intake was quantified at 12, 20, and 34 weeks gestation. Qualitative interviews were conducted. 59 women were randomized (29 enhanced, 30 placebo), 28 completed the trial, (15 enhanced, 13 placebo). In women completing the trial, vitamin E intake of the placebo group remained unchanged; 7.09 mg/d (95% CI 5.41–8.77) at 12 weeks, 6.41 mg/d (5.07–7.75) at 20 weeks, and 6.67 mg/d (5.38–7.96) at 34 weeks gestation; vitamin E intake of the enhanced group increased from 6.50 mg/d (5.21–7.79) at 12 weeks to 14.9 mg/d (13.3–16.4) at 20 weeks and 15.2 mg/d (12.9–17.5) at 34 weeks, P < 0.001. Qualitative interviewing provided clear guidance on improving adherence. Although 31 women withdrew at median 19 weeks gestation (interquartile range 16–25), the intervention was consumed by women for 80% of weeks between 12 and 34 weeks gestation and for 63% of weeks between 12 weeks gestation and delivery. In a pilot double‐blind randomized controlled trial (RCT) it is possible to increase maternal vitamin E intake using food ingredients, a further food product is required to improve adherence.
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Affiliation(s)
- Julia Clark
- Public Health Nutrition Research Group University of Aberdeen Aberdeen United Kingdom
| | - Nikki Holgan
- New Product Development Technologist Baxters Food Group Fochabers United Kingdom
| | - Leone Craig
- Public Health Nutrition Research Group University of Aberdeen Aberdeen United Kingdom
| | - Heather Morgan
- Health Services Research Unit University of Aberdeen Aberdeen United Kingdom
| | - Peter Danielian
- Obstetrician Aberdeen Maternity Hospital Aberdeen United Kingdom
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Morgan H, Hoddinott P, Thomson G, Crossland N, Farrar S, Yi D, Hislop J, Moran VH, MacLennan G, Dombrowski SU, Rothnie K, Stewart F, Bauld L, Ludbrook A, Dykes F, Sniehotta FF, Tappin D, Campbell M. Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design. Health Technol Assess 2016; 19:1-522, vii-viii. [PMID: 25897655 DOI: 10.3310/hta19300] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Smoking in pregnancy and/or not breastfeeding have considerable negative health outcomes for mother and baby. AIM To understand incentive mechanisms of action for smoking cessation in pregnancy and breastfeeding, develop a taxonomy and identify promising, acceptable and feasible interventions to inform trial design. DESIGN Evidence syntheses, primary qualitative survey, and discrete choice experiment (DCE) research using multidisciplinary, mixed methods. Two mother-and-baby groups in disadvantaged areas collaborated throughout. SETTING UK. PARTICIPANTS The qualitative study included 88 pregnant women/recent mothers/partners, 53 service providers, 24 experts/decision-makers and 63 conference attendees. The surveys included 1144 members of the general public and 497 health professionals. The DCE study included 320 women with a history of smoking. METHODS (1) Evidence syntheses: incentive effectiveness (including meta-analysis and effect size estimates), delivery processes, barriers to and facilitators of smoking cessation in pregnancy and/or breastfeeding, scoping review of incentives for lifestyle behaviours; (2) qualitative research: grounded theory to understand incentive mechanisms of action and a framework approach for trial design; (3) survey: multivariable ordered logit models; (4) DCE: conditional logit regression and the log-likelihood ratio test. RESULTS Out of 1469 smoking cessation and 5408 breastfeeding multicomponent studies identified, 23 smoking cessation and 19 breastfeeding studies were included in the review. Vouchers contingent on biochemically proven smoking cessation in pregnancy were effective, with a relative risk of 2.58 (95% confidence interval 1.63 to 4.07) compared with non-contingent incentives for participation (four studies, 344 participants). Effects continued until 3 months post partum. Inconclusive effects were found for breastfeeding incentives compared with no/smaller incentives (13 studies) but provider commitment contracts for breastfeeding show promise. Intervention intensity is a possible confounder. The acceptability of seven promising incentives was mixed. Women (for vouchers) and those with a lower level of education (except for breastfeeding incentives) were more likely to disagree. Those aged ≤ 44 years and ethnic minority groups were more likely to agree. Agreement was greatest for a free breast pump and least for vouchers for breastfeeding. Universal incentives were preferred to those targeting low-income women. Initial daily text/telephone support, a quitting pal, vouchers for > £20.00 per month and values up to £80.00 increase the likelihood of smoking cessation. Doctors disagreed with provider incentives. A 'ladder' logic model emerged through data synthesis and had face validity with service users. It combined an incentive typology and behaviour change taxonomy. Autonomy and well-being matter. Personal difficulties, emotions, socialising and attitudes of others are challenges to climbing a metaphorical 'ladder' towards smoking cessation and breastfeeding. Incentive interventions provide opportunity 'rungs' to help, including regular skilled flexible support, a pal, setting goals, monitoring and outcome verification. Individually tailored and non-judgemental continuity of care can bolster women's capabilities to succeed. Rigid, prescriptive interventions placing the onus on women to behave 'healthily' risk them feeling pressurised and failing. To avoid 'losing face', women may disengage. LIMITATIONS Included studies were heterogeneous and of variable quality, limiting the assessment of incentive effectiveness. No cost-effectiveness data were reported. In surveys, selection bias and confounding are possible. The validity and utility of the ladder logic model requires evaluation with more diverse samples of the target population. CONCLUSIONS Incentives provided with other tailored components show promise but reach is a concern. Formal evaluation is recommended. Collaborative service-user involvement is important. STUDY REGISTRATION This study is registered as PROSPERO CRD42012001980. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Heather Morgan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Pat Hoddinott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Gill Thomson
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, UK
| | - Nicola Crossland
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, UK
| | - Shelley Farrar
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Deokhee Yi
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jenni Hislop
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Victoria Hall Moran
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Kieran Rothnie
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Linda Bauld
- The Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Anne Ludbrook
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Fiona Dykes
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, UK
| | - Falko F Sniehotta
- Institute of Health and Society, University of Newcastle, Newcastle, UK
| | - David Tappin
- Perinatal Epidemiology and Child Health Unit, School of Medicine, University of Glasgow, Glasgow, UK
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Morgan H, Thomson G, Crossland N, Dykes F, Hoddinott P. Combining PPI with qualitative research to engage 'harder-to-reach' populations: service user groups as co-applicants on a platform study for a trial. Res Involv Engagem 2016; 2:7. [PMID: 29062508 PMCID: PMC5611582 DOI: 10.1186/s40900-016-0023-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 02/13/2016] [Indexed: 05/22/2023]
Abstract
PLAIN ENGLISH SUMMARY It is recommended that research studies are carried out with or by patients and the public through their involvement from the beginning and in as many stages as possible (known as PPI). Some studies formally invite patients and the public to participate in interviews and focused group discussions to collect views about topics (known as qualitative research). In our study on financial incentives for giving up smoking in pregnancy and breastfeeding, we combined both PPI and qualitative research to include the views of women with a range of experiences of smoking and breastfeeding. We involved two mother and baby groups in disadvantaged areas of North East Scotland and North West England as research partners on our team. First, we asked members to comment on our research plans and documents, which is standard PPI. Second, we asked members to participate in voice recorded discussions, contributing to qualitative research data. These discussions revealed different views from those that we heard through research interviews. They allowed us to develop more relevant research tools and resources. Members also helped us to identify people outside the groups who we could interview. Combining involvement and participation helped us to include the views of a wide range of women from 'harder-to-reach' groups who don't usually take part in research. This was important because the research was intended for women who could benefit from incentives to stop smoking in pregnancy and breastfeed, often present in such groups. Positive continuing relationships and trust improved on involvement or participation alone. BACKGROUND Patient and public involvement (PPI) in all research studies is recommended from the earliest point and in as many stages as possible. Qualitative research is also recommended in the early stages of designing complex intervention trials. Combining both together might enable inclusion of 'harder-to-reach' perspectives from the target population(s), particularly when the research is intended for their benefit. However, the interface between PPI and qualitative research has received little attention. In a multi-disciplinary, mixed methods study to inform the design of incentive trials for smoking cessation in pregnancy and breastfeeding, we combined PPI and qualitative research, with some overlap. Mother and baby groups from two geographically separate disadvantaged areas, with diverse experiences of the smoking and breastfeeding, but no training or previous involvement in research, were recruited as PPI research grant co-applicants. An iterative partnership approach facilitated involvement in research conduct and design across all project phases. Group PPI members were also invited to contribute to more formal qualitative data collection, as and when indicated by the research questions, and emerging analysis. RESULTS We engaged with 'harder-to-reach' women in mother and baby group settings, rather than in academic or home environments. These settings were relaxed and informal, which facilitated rapport-building, disclosures of unexpected information and maintained trust. Twenty-one women participated in standard PPI activities: feedback on study protocols and documents; piloting questionnaires and interview schedules. PPI members voiced some different perspectives from those captured within the qualitative dataset. Nineteen participated in focused qualitative research. Novel aspects were audio recorded PPI discussions, which contributed qualitative data; first, to interpret systematic review findings and construct intervention vignettes for use in the qualitative research; second, to assist with recruitment to improve sample diversity in the formal qualitative dataset; and third, to translate theory and findings presented in a researcher generated logic model into a lay tool. This had face validity for potential trial participants and used the metaphor of a ladder. CONCLUSIONS Combining and overlapping PPI and qualitative research added 'harder-to-reach' contributions, sample diversity, trust and engagement in creative approaches beyond what could be achieved through PPI or qualitative research alone.
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Affiliation(s)
- Heather Morgan
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD Scotland, UK
| | - Gill Thomson
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, PR1 2HE England, UK
| | - Nicola Crossland
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, PR1 2HE England, UK
| | - Fiona Dykes
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, PR1 2HE England, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, FK9 4LA Scotland, UK
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Hoddinott P, Thomson G, Morgan H, Crossland N, MacLennan G, Dykes F, Stewart F, Bauld L, Campbell MK. Perspectives on financial incentives to health service providers for increasing breast feeding and smoking quit rates during pregnancy: a mixed methods study. BMJ Open 2015; 5:e008492. [PMID: 26567253 PMCID: PMC4654300 DOI: 10.1136/bmjopen-2015-008492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To explore the acceptability, mechanisms and consequences of provider incentives for smoking cessation and breast feeding as part of the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study. DESIGN Cross-sectional survey and qualitative interviews. SETTING Scotland and North West England. PARTICIPANTS Early years professionals: 497 survey respondents included 156 doctors; 197 health visitors/maternity staff; 144 other health staff. Qualitative interviews or focus groups were conducted with 68 pregnant/postnatal women/family members; 32 service providers; 22 experts/decision-makers; 63 conference attendees. METHODS Early years professionals were surveyed via email about the acceptability of payments to local health services for reaching smoking cessation in pregnancy and breastfeeding targets. Agreement was measured on a 5-point scale using multivariable ordered logit models. A framework approach was used to analyse free-text survey responses and qualitative data. RESULTS Health professional net agreement for provider incentives for smoking cessation targets was 52.9% (263/497); net disagreement was 28.6% (142/497). Health visitors/maternity staff were more likely than doctors to agree: OR 2.35 (95% CI 1.51 to 3.64; p<0.001). Net agreement for provider incentives for breastfeeding targets was 44.1% (219/497) and net disagreement was 38.6% (192/497). Agreement was more likely for women (compared with men): OR 1.81 (1.09 to 3.00; p=0.023) and health visitors/maternity staff (compared with doctors): OR 2.54 (95% CI 1.65 to 3.91; p<0.001). Key emergent themes were 'moral tensions around acceptability', 'need for incentives', 'goals', 'collective or divisive action' and 'monitoring and proof'. While provider incentives can focus action and resources, tensions around the impact on relationships raised concerns. Pressure, burden of proof, gaming, box-ticking bureaucracies and health inequalities were counterbalances to potential benefits. CONCLUSIONS Provider incentives are favoured by non-medical staff. Solutions which increase trust and collaboration towards shared goals, without negatively impacting on relationships or increasing bureaucracy are required.
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Affiliation(s)
- Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Gill Thomson
- Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, Preston, UK
| | - Heather Morgan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Nicola Crossland
- Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, Preston, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Fiona Dykes
- Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, Preston, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Linda Bauld
- Department of Health Policy and Social Marketing, University of Stirling, Stirling, UK
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Tsaloglou MN, Watson RJ, Rushworth CM, Zhao Y, Niu X, Sutton JM, Morgan H. Real-time microfluidic recombinase polymerase amplification for the toxin B gene of Clostridium difficile on a SlipChip platform. Analyst 2015; 140:258-64. [PMID: 25371968 DOI: 10.1039/c4an01683a] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Clostridium difficile is one of the key bacterial pathogens that cause infectious diarrhoea both in the developed and developing world. Isothermal nucleic acid amplification methods are increasingly used for identification of toxinogenic infection by clinical labs. For this purpose, we developed a low-cost microfluidic platform based on the SlipChip concept and implemented real-time isothermal recombinase polymerase amplification (RPA). The on-chip RPA assay targets the Clostridium difficile toxin B gene (tcdB) coding for toxin B, one of the proteins responsible for bacterial toxicity. The device was fabricated in clear acrylic using rapid prototyping methods. It has six replicate 500 nL reaction wells as well as two sets of 500 nL control wells. The reaction can be monitored in real-time using exonuclease fluorescent probes with an initial sample volume of as little as 6.4 μL. We demonstrated a limit of detection of 1000 DNA copies, corresponding to 1 fg, at a time-to-result of <20 minutes. This miniaturised platform for pathogen detection has potential for use in resource-limited environments or at the point-of-care because of its ease of use and low cost, particularly if combined with preserved reagents.
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Affiliation(s)
- M-N Tsaloglou
- Faculty of Physical Sciences and Engineering, Institute for Life Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
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Mead B, Morgan H, Mann-Knowlton A, Tedeschi L, Sloan C, Lang S, Hines C, Gragg M, Stofer J, Riemann K, Derr T, Heller E, Collins D, Landis P, Linna N, Jones D. Reveromycin A-Induced Apoptosis in Osteoclasts Is Not Accompanied by Necrosis. J Cell Biochem 2015; 116:1646-57. [DOI: 10.1002/jcb.25125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/02/2015] [Indexed: 12/23/2022]
Affiliation(s)
- Brittany Mead
- Division of Natural Sciences; Department of Biology; Indiana Wesleyan University; South Washington Street Marion Indiana
| | - Heather Morgan
- Division of Natural Sciences; Department of Biology; Indiana Wesleyan University; South Washington Street Marion Indiana
| | - Alyssa Mann-Knowlton
- Division of Natural Sciences; Department of Biology; Indiana Wesleyan University; South Washington Street Marion Indiana
| | - Laura Tedeschi
- Division of Natural Sciences; Department of Biology; Indiana Wesleyan University; South Washington Street Marion Indiana
| | - Chris Sloan
- Division of Natural Sciences; Department of Biology; Indiana Wesleyan University; South Washington Street Marion Indiana
| | - Spenser Lang
- Division of Natural Sciences; Department of Biology; Indiana Wesleyan University; South Washington Street Marion Indiana
| | - Cory Hines
- Division of Natural Sciences; Department of Biology; Indiana Wesleyan University; South Washington Street Marion Indiana
| | - Megan Gragg
- Division of Natural Sciences; Department of Biology; Indiana Wesleyan University; South Washington Street Marion Indiana
| | - Jonathan Stofer
- Division of Natural Sciences; Department of Biology; Indiana Wesleyan University; South Washington Street Marion Indiana
| | - Kaitlin Riemann
- Division of Natural Sciences; Department of Biology; Indiana Wesleyan University; South Washington Street Marion Indiana
| | - Tyler Derr
- Division of Natural Sciences; Department of Biology; Indiana Wesleyan University; South Washington Street Marion Indiana
| | - Emily Heller
- Division of Natural Sciences; Department of Biology; Indiana Wesleyan University; South Washington Street Marion Indiana
| | - David Collins
- Division of Natural Sciences; Department of Biology; Indiana Wesleyan University; South Washington Street Marion Indiana
| | - Paul Landis
- Division of Natural Sciences; Department of Biology; Indiana Wesleyan University; South Washington Street Marion Indiana
| | - Nathan Linna
- Division of Natural Sciences; Department of Biology; Indiana Wesleyan University; South Washington Street Marion Indiana
| | - Daniel Jones
- Division of Natural Sciences; Department of Biology; Indiana Wesleyan University; South Washington Street Marion Indiana
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Moran VH, Morgan H, Rothnie K, MacLennan G, Stewart F, Thomson G, Crossland N, Tappin D, Campbell M, Hoddinott P. Incentives to promote breastfeeding: a systematic review. Pediatrics 2015; 135:e687-702. [PMID: 25647672 DOI: 10.1542/peds.2014-2221] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Few women in industrialized countries achieve the World Health Organization's recommendation to breastfeed exclusively for 6 months. Governments are increasingly seeking new interventions to address this problem, including the use of incentives. The goal of this study was to assess the evidence regarding the effectiveness of incentive interventions, delivered within or outside of health care settings, to individuals and/or their families seeking to increase and sustain breastfeeding in the first 6 months after birth. METHODS Searches of electronic databases, reference lists, and grey literature were conducted to identify relevant reports of published, unpublished, and ongoing studies. All study designs published in English, which met our definition of incentives and that were from a developed country, were eligible for inclusion. Abstract and full-text article review with sequential data extraction were conducted by 2 independent authors. RESULTS Sixteen full reports were included in the review. The majority evaluated multicomponent interventions of varying frequency, intensity, and duration. Incentives involved providing access to breast pumps, gifts, vouchers, money, food packages, and help with household tasks, but little consensus in findings was revealed. The lack of high-quality, randomized controlled trials identified by this review and the multicomponent nature of the interventions prohibited meta-analysis. CONCLUSIONS This review found that the overall effect of providing incentives for breastfeeding compared with no incentives is unclear due to study heterogeneity and the variation in study quality. Further evidence on breastfeeding incentives offered to women is required to understand the possible effects of these interventions.
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Affiliation(s)
- Victoria Hall Moran
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, United Kingdom;
| | - Heather Morgan
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - Kieran Rothnie
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - Gillian Thomson
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, United Kingdom
| | - Nicola Crossland
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, United Kingdom
| | - David Tappin
- David Tappin, School of Medicine, University of Glasgow, United Kingdom; and
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, United Kingdom
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Crossland N, Thomson G, Morgan H, Dombrowski SU, Hoddinott P. Incentives for breastfeeding and for smoking cessation in pregnancy: An exploration of types and meanings. Soc Sci Med 2015; 128:10-7. [DOI: 10.1016/j.socscimed.2014.12.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Thomson G, Morgan H, Crossland N, Bauld L, Dykes F, Hoddinott P. Unintended consequences of incentive provision for behaviour change and maintenance around childbirth. PLoS One 2014; 9:e111322. [PMID: 25357121 PMCID: PMC4214733 DOI: 10.1371/journal.pone.0111322] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/19/2014] [Indexed: 11/18/2022] Open
Abstract
Financial (positive or negative) and non-financial incentives or rewards are increasingly used in attempts to influence health behaviours. While unintended consequences of incentive provision are discussed in the literature, evidence syntheses did not identify any primary research with the aim of investigating unintended consequences of incentive interventions for lifestyle behaviour change. Our objective was to investigate perceived positive and negative unintended consequences of incentive provision for a shortlist of seven promising incentive strategies for smoking cessation in pregnancy and breastfeeding. A multi-disciplinary, mixed-methods approach included involving two service-user mother and baby groups from disadvantaged areas with experience of the target behaviours as study co-investigators. Systematic reviews informed the shortlist of incentive strategies. Qualitative semi-structured interviews and a web-based survey of health professionals asked open questions on positive and negative consequences of incentives. The participants from three UK regions were a diverse sample with and without direct experience of incentive interventions: 88 pregnant women/recent mothers/partners/family members; 53 service providers; 24 experts/decision makers and interactive discussions with 63 conference attendees. Maternity and early years health professionals (n = 497) including doctors, midwives, health visitors, public health and related staff participated in the survey. Qualitative analysis identified ethical, political, cultural, social and psychological implications of incentive delivery at population and individual levels. Four key themes emerged: how incentives can address or create inequalities; enhance or diminish intrinsic motivation and wellbeing; have a positive or negative effect on relationships with others within personal networks or health providers; and can impact on health systems and resources by raising awareness and directing service delivery, but may be detrimental to other health care areas. Financial incentives are controversial and generated emotive and oppositional responses. The planning, design and delivery of future incentive interventions should evaluate unexpected consequences to inform the evidence for effectiveness, cost-effectiveness and future implementation.
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Affiliation(s)
- Gill Thomson
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, Lancashire, England
- * E-mail:
| | - Heather Morgan
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland
| | - Nicola Crossland
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, Lancashire, England
| | - Linda Bauld
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, Scotland
| | - Fiona Dykes
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, Lancashire, England
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, Scotland
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Stewart R, Fielden L, Muir Z, McNeil L, Morgan H. 30 * WEIGHT LOSS AND NUTRITIONAL ASSESSMENT IN MOVEMENT DISORDER CLINICS (MDCS) IN THE WEST OF SCOTLAND. Age Ageing 2014. [DOI: 10.1093/ageing/afu124.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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McNeil L, Morgan H, Stewart R, Fielden L, Muir Z. 16 * FALLS ASSESSMENT IN MOVEMENT DISORDER CLINICS IN THE WEST OF SCOTLAND. Age Ageing 2014. [DOI: 10.1093/ageing/afu124.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hoddinott P, Morgan H, MacLennan G, Sewel K, Thomson G, Bauld L, Yi D, Ludbrook A, Campbell MK. Public acceptability of financial incentives for smoking cessation in pregnancy and breast feeding: a survey of the British public. BMJ Open 2014; 4:e005524. [PMID: 25037645 PMCID: PMC4120368 DOI: 10.1136/bmjopen-2014-005524] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 06/22/2014] [Accepted: 06/24/2014] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To survey public attitudes about incentives for smoking cessation in pregnancy and for breast feeding to inform trial design. DESIGN Cross-sectional survey. SETTING AND PARTICIPANTS British general public. METHODS Seven promising incentive strategies had been identified from evidence syntheses and qualitative interview data from service users and providers. These were shopping vouchers for: (1) validated smoking cessation in pregnancy and (2) after birth; (3) for a smoke-free home; (4) for proven breast feeding; (5) a free breast pump; (6) payments to health services for reaching smoking cessation in pregnancy targets and (7) breastfeeding targets. Ipsos MORI used area quota sampling and home-administered computer-assisted questionnaires, with randomised question order to assess agreement with different incentives (measured on a five-point scale). Demographic data and target behaviour experience were recorded. Analysis used multivariable ordered logit models. RESULTS Agreement with incentives was mixed (ranging from 34% to 46%) among a representative sample of 1144 British adults. Mean agreement score was highest for a free breast pump, and lowest for incentives for smoking abstinence after birth. More women disagreed with shopping vouchers than men. Those with lower levels of education disagreed more with smoking cessation incentives and a breast pump. Those aged 44 or under agreed more with all incentive strategies compared with those aged 65 and over, particularly provider targets for smoking cessation. Non-white ethnic groups agreed particularly with breastfeeding incentives. Current smokers with previous stop attempts and respondents who had breast fed children agreed with providing vouchers for the respective behaviours. Up to £40/month vouchers for behaviour change were acceptable (>85%). CONCLUSIONS Women and the less educated were more likely to disagree, but men and women of childbearing age to agree, with incentives designed for their benefit. Trials evaluating reach, impact on health inequalities and ethnic groups are required prior to implementing incentive interventions. TRIAL REGISTRATION NUMBER CRD42012001980.
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Affiliation(s)
- Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Heather Morgan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Gill Thomson
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, UK
| | - Linda Bauld
- Health Policy and Social Marketing, University of Stirling, Stirling, UK
| | - Deokhee Yi
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Anne Ludbrook
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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Jones D, Mead B, Morgan H, Tedeschi L, Sloan C, Lang S, Hines C, Gragg M, Stofer J, Riemann K, Derr T, Heller E, Collins D, Landis P, Linna N. Reveromycin A‐induced apoptosis in osteoclasts is accompanied by decreased NF kappa B levels (663.15). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.663.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Dan Jones
- Biology Indiana Wesleyan UniversityMarionINUnited States
| | - Brittany Mead
- Biology Indiana Wesleyan UniversityMarionINUnited States
| | - Heather Morgan
- Biology Indiana Wesleyan UniversityMarionINUnited States
| | - Laura Tedeschi
- Biology Indiana Wesleyan UniversityMarionINUnited States
| | - Chris Sloan
- Biology Indiana Wesleyan UniversityMarionINUnited States
| | - Spenser Lang
- Biology Indiana Wesleyan UniversityMarionINUnited States
| | - Cory Hines
- Biology Indiana Wesleyan UniversityMarionINUnited States
| | - Megan Gragg
- Biology Indiana Wesleyan UniversityMarionINUnited States
| | | | | | - Tyler Derr
- Biology Indiana Wesleyan UniversityMarionINUnited States
| | - Emily Heller
- Biology Indiana Wesleyan UniversityMarionINUnited States
| | - David Collins
- Biology Indiana Wesleyan UniversityMarionINUnited States
| | - Paul Landis
- Biology Indiana Wesleyan UniversityMarionINUnited States
| | - Nathan Linna
- Biology Indiana Wesleyan UniversityMarionINUnited States
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