Effectiveness trials: critical data to help understand how respiratory medicines really work?
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ABSTRACT:
SUBMITTER: Heddini A
PROVIDER: S-EPMC6352944 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveDebate about the nature of somatoform disorders and their current diagnostic classification has been stimulated by the anticipation of new editions of Diagnostic and Statistical Manual of Mental Disorders and International Statistical Classification of Diseases and Related Health Problems diagnostic classifications. In the current paper, we review systematically the literature on the neuroimaging of somatoform disorders and related conditions with the aim of addressing two specific questions: Is there evidence of altered neural function or structure that is specifically associated with somatoform disorders? What conclusions can we draw from these findings about the etiology of somatoform disorders?MethodsStudies reporting neuroimaging findings in patients with a somatoform disorder or a functional somatic syndrome (such as fibromyalgia) were found using Pubmed, PsycINFO, and EMBASE database searches. Reported structural and functional neuroimaging findings were then extracted to form a narrative review.ResultsA relatively mature literature on symptoms of pain and less developed literatures on conversion and fatigue symptoms were identified. The available evidence indicates that, when compared with nonclinical groups, somatoform diagnoses are associated with increased activity of limbic regions in response to painful stimuli and a generalized decrease in gray matter density; however, methodological considerations restrict the interpretation of these findings.ConclusionsWhereas the neuroimaging literature has provided evidence about the possible mechanisms underlying somatoform disorders, this is not yet sufficient to provide a basis for classification. By adopting a wider variety of experimental designs and a more dynamic approach to diagnosis, there is every reason to be hopeful that neuroimaging data will play a significant role in future taxonomies.
| S-EPMC3044887 | biostudies-literature
Project description:Background: Low health literacy is associated with decreased patient compliance and worse outcomes - with clinicians increasingly relying on printed materials to lower such risks. Yet, many of these documents exceed recommended comprehension levels. Furthermore, patients look increasingly to social media (SoMe) to answer healthcare questions. The character limits built into Twitter encourage users to publish small quantities of text, which are more accessible to patients with low health literacy. The present authors hypothesize that SoMe posts are written at lower grade levels than traditional medical sources, improving patient health literacy. Methods: The data sample consisted of the first 100 original tweets from three trending medical hashtags, leading to a total of 300 tweets. The Flesch-Kincaid Readability Formula (FKRF) was used to derive grade level of the tweets. Data was analyzed via descriptive and inferential statistics. Results: The readability scores for the data sample had a mean grade level of 9.45. A notable 47.6% of tweets were above ninth grade reading level. An independent-sample t-test comparing FKRF mean scores of different hashtags found differences between the means of the following: #hearthealth versus #diabetes (t = 3.15, p = 0.002); #hearthealth versus #migraine (t = 0.09, p = 0.9); and #diabetes versus #migraine (t = 3.4, p = 0.001). Conclusions: Tweets from this data sample were written at a mean grade level of 9.45, signifying a level between the ninth and tenth grades. This is higher than desired, yet still better than traditional sources, which have been previously analyzed. Ultimately, those responsible for health care SoMe posts must continue to improve efforts to reach the recommended reading level (between the sixth and eighth grade), so as to ensure optimal comprehension of patients.
| S-EPMC5381615 | biostudies-literature
Project description:In this manuscript, we discuss relationships between morphology and mechanical strength of carbonized structures, obtained via pyrolysis of polymeric precursors, across multiple length scales, from carbon fibers (CFs) with diameters of 5-10 µm to submicron thick carbon nanofibers (CNFs). Our research points to radial inhomogeneity, skin-core structure, as a size-dependent feature of polyacrylonitrile-based CFs. This inhomogeneity is a surface effect, caused by suppressed diffusion of oxygen and stabilization byproducts during stabilization through skin. Hence, reducing the precursor diameters from tens of microns to submicron appears as an effective strategy to develop homogeneous carbonized structures. Our research establishes the significance of this downsizing in developing lightweight structural materials by comparing intrinsic strength of radially inhomogeneous CFs with that of radially homogeneous CNF. While experimental studies on the strength of CNFs have targeted randomly oriented turbostratic domains, via continuum modeling, we have estimated that strength of CNFs can reach 14 GPa, when the basal planes of graphitic domains are parallel to nanofiber axis. The CNFs in our model are treated as composites of amorphous carbon (matrix), reinforced with turbostratic domains, and their strength is predicted using Tsai-Hill criterion. The model was calibrated with existing experimental data.
| S-EPMC5453203 | biostudies-other
Project description:BackgroundComplex healthcare interventions consist of multiple components which may vary in trials conducted in different populations and contexts. Pooling evidence from trials in a systematic review is challenging because it is unclear which components are needed for effectiveness. The potential is recognised for using recipients' views to explore why some complex interventions are effective and others are not. Methods to maximise this potential are poorly developed.MethodsWe used a novel approach to explore how patients' views may explain the disparity in effectiveness of complex interventions. We used qualitative comparative analysis to explore agreement between qualitative syntheses of data on patients' views and evidence from trialed interventions to increase adherence to treatments. We first populated data matrices to reflect whether the content of each trialed intervention could be matched with suggestions arising from patients' views. We then used qualitative comparative analysis software to identify, by a process of elimination, the smallest number of configurations (patterns) of components that corresponded with patients' suggestions and accounted for whether each intervention was effective or ineffective.ResultsWe found suggestions by patients were poorly represented in interventions. Qualitative comparative analysis identified particular combinations of components corresponding with patients' suggestions and with whether an intervention was effective or ineffective. Six patterns were identified for an effective and four for an ineffective intervention. Two types of patterns arose for the effective interventions, one being didactic (providing clear information or instruction) and the other interactive (focusing on personal risk factors).ConclusionsOur analysis highlights how data on patients' views has the potential to identify key components across trials of complex interventions or inform the content of new interventions to be trialed.
| S-EPMC3693880 | biostudies-literature
Project description:Genome3D (http://www.genome3d.eu) is a collaborative resource that provides predicted domain annotations and structural models for key sequences. Since introducing Genome3D in a previous NAR paper, we have substantially extended and improved the resource. We have annotated representatives from Pfam families to improve coverage of diverse sequences and added a fast sequence search to the website to allow users to find Genome3D-annotated sequences similar to their own. We have improved and extended the Genome3D data, enlarging the source data set from three model organisms to 10, and adding VIVACE, a resource new to Genome3D. We have analysed and updated Genome3D's SCOP/CATH mapping. Finally, we have improved the superposition tools, which now give users a more powerful interface for investigating similarities and differences between structural models.
| S-EPMC4384030 | biostudies-literature
Project description:BackgroundPatient health outcomes improve when learning health care systems use evidence to implement promising services and allocate resources effectively. Here, we examine the unique environment in which Veterans Health Administration (VHA) leadership use evidence and the facilitators and barriers to using evidence synthesis products in decision-making. We end by describing the steps researchers can take to better support the needs of health system leadership.MethodsWe conducted 20 semistructured phone interviews with individuals in VHA leadership positions. We used an inductive approach to identify themes observed across key informant interviews.ResultsKey informants identified several factors that fostered the use of evidence including, timeliness, lack of bias, flexible approaches, and concise reports with a clear bottom line. Barriers included lack of relevant evidence and lack of information on how to translate evidence into practice, resistance to change among providers and within the larger health system, and political pressures to implement therapies or technologies with little evidence or uncertainty. Researchers can foster evidence uptake by developing a review scope and key questions that are important to multiple stakeholders, including frontline clinicians and health system leadership.ConclusionsThe VHA's evidence needs resemble other health systems, but evidence synthesis products should include a translational component to enhance implementation. Resistance to change and political pressures can further hinder the uptake of evidence within VHA.
| S-EPMC6750152 | biostudies-literature
Project description:BackgroundPeople are frequently confronted with untrustworthy claims about the effects of treatments. Uncritical acceptance of these claims can lead to poor, and sometimes dangerous, treatment decisions, and wasted time and money. Resources to help people learn to think critically about treatment claims are scarce, and they are widely scattered. Furthermore, very few learning-resources have been assessed to see if they improve knowledge and behavior.ObjectivesOur objectives were to develop the Critical thinking and Appraisal Resource Library (CARL). This library was to be in the form of a database containing learning resources for those who are responsible for encouraging critical thinking about treatment claims, and was to be made available online. We wished to include resources for groups we identified as 'intermediaries' of knowledge, i.e. teachers of schoolchildren, undergraduates and graduates, for example those teaching evidence-based medicine, or those communicating treatment claims to the public. In selecting resources, we wished to draw particular attention to those resources that had been formally evaluated, for example, by the creators of the resource or independent research groups.MethodsCARL was populated with learning-resources identified from a variety of sources-two previously developed but unmaintained inventories; systematic reviews of learning-interventions; online and database searches; and recommendations by members of the project group and its advisors. The learning-resources in CARL were organised by 'Key Concepts' needed to judge the trustworthiness of treatment claims, and were made available online by the James Lind Initiative in Testing Treatments interactive (TTi) English (www.testingtreatments.org/category/learning-resources).TTi English also incorporated the database of Key Concepts and the Claim Evaluation Tools developed through the Informed Healthcare Choices (IHC) project (informedhealthchoices.org).ResultsWe have created a database of resources called CARL, which currently contains over 500 open-access learning-resources in a variety of formats: text, audio, video, webpages, cartoons, and lesson materials. These are aimed primarily at 'Intermediaries', that is, 'teachers', 'communicators', 'advisors', 'researchers', as well as for independent 'learners'. The resources included in CARL are currently accessible at www.testingtreatments.org/category/learning-resources.ConclusionsWe hope that ready access to CARL will help to promote the critical thinking about treatment claims, needed to help improve healthcare choices.
| S-EPMC5524286 | biostudies-literature
Project description:Over the past few decades, Quality Management System (QMS) and High Performance Work System (HPWS) have emerged as key concepts to enhance organizational effectiveness. All over the globe, majority of contemporary manufacturing and services organizations have applied at least one of these development strategies or even both. This study proposes an integrated framework of QMS and HPWS and empirically investigates the relationship between QMS and HPWS practices and their direct and indirect effects on organizational effectiveness using structural equation modelling (SEM). This research makes a number of significant contributions: (1) The black box of the conjoint implementation is opened up for better appreciation of the interplay of QMS and HPWS practices and their influence on organizational effectiveness (2) The key QMS practices recognized as contributing factor of performance have been classified and examined at two distinct levels i.e. QMS Top Level practices and QMS Core practices (3) The mediating and interaction effects of QMS Core practices and HPWS practices on the relationship of QMS-Top Level practices and organizational effectiveness have been thoroughly investigated. The proposed framework is tested through cross-sectional data from 90 Technical Services Organizations (TSO) operating in Pakistan. The research hypotheses are supported by the test results of the SEM. The findings and implications are discussed along with limitations and future research guidelines.
| S-EPMC7062248 | biostudies-literature
Project description:Several studies have reported evidence of interference between respiratory viruses: respiratory viruses rarely reach their epidemic peak concurrently and there appears to be a negative association between infection with one respiratory virus and co-infection with another. We used results spanning 16 years (2002-2017) of a routine diagnostic multiplex panel that tests for nine respiratory viruses to further investigate these interactions in Victoria, Australia. Time series analyses were used to plot the proportion positive for each virus. The seasonality of all viruses included was compared with respiratory syncytial virus (RSV) and influenza A virus using cross-correlations. Logistic regression was used to explore the likelihood of co-infection with one virus given infection with another. Seasonal peaks were observed each year for influenza A and RSV and less frequently for influenza B, coronavirus and parainfluenza virus. RSV circulated an average of 6 weeks before influenza A. Co-infection with another respiratory virus was less common with picornavirus, RSV or influenza A infection. Our findings provide further evidence of a temporal relationship in the circulation of respiratory viruses. A greater understanding of the interaction between respiratory viruses may enable better prediction of the timing and magnitude of respiratory virus epidemics.
| S-EPMC6625191 | biostudies-literature
Project description:Background. Many families find regular checking of children's heads for head louse infestation too onerous and would prefer to be able to prevent infestation by use of a topical application that deters lice from infesting the head. Identification in the laboratory of a repellent activity for piperonal provided the basis for developing a spray product to repel lice. Methods. A proof of principle field study in Dhaka, Bangladesh, compared the effect of using 2% piperonal spray with that of a placebo in 105 children and adults from three communities with infestation levels close to 100%. All participants were treated for infestation and subsequent incidence of reinfestation monitored daily by investigators. A second randomised, controlled, double blind, study in North London, UK, evaluated the effect of the product in normal use. One hundred and sixty-three children from schools with a high level (20-25%) of infestation were treated and confirmed louse free and randomly divided between 2% piperonal, a placebo spray, and a control group for up to 22 weeks. Parents applied the spray and monitored for infestation. Regular investigator visits confirmed the parental monitoring and replenished supplies of spray. Results. In Dhaka, over 18 days there were only 4 infestations in the piperonal group and 8 in the placebo group. This difference was not significant (p = 0.312). In North London, there were 41 cases of infestation over the course of the study. Although there were fewer infestations in the piperonal group, analysis of time to first infestation showed a no significant (p = 0.4368) difference between groups. Conclusion. Routine use of 2% piperonal spray in communities with a high prevalence of head louse infestation may provide some protection from infestation. However, the difference between use of the product and no active intervention was sufficiently small that regular checking for presence of lice is likely to be a more practical and cost effective approach to prevention of infestation.
| S-EPMC3994642 | biostudies-literature