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An early economic evaluation to inform the translation into clinical practice of a spectroscopic liquid biopsy for the detection of brain cancer. Two specific aims are (1) to update an existing economic model with results from a prospective study of diagnostic accuracy and (2) to explore the potential of brain tumor-type predictions to affect patient outcomes and healthcare costs.
A cost-effectiveness analysis from a UK NHS perspective of the use of spectroscopic liquid biopsy in primary and secondary care settings, as well as a cost–consequence analysis of the addition of tumor-type predictions was conducted. Decision tree models were constructed to represent simplified diagnostic pathways. Test diagnostic accuracy parameters were based on a prospective validation study. Four price points (GBP 50-200, EUR 57-228) for the test were considered.
In both settings, the use of liquid biopsy produced QALY gains. In primary care, at test costs below GBP 100 (EUR 114), testing was cost saving. At GBP 100 (EUR 114) per test, the ICER was GBP 13,279 (EUR 15,145), whereas at GBP 200 (EUR 228), the ICER was GBP 78,300 (EUR 89,301). In secondary care, the ICER ranged from GBP 11,360 (EUR 12,956) to GBP 43,870 (EUR 50,034) across the range of test costs.
The results demonstrate the potential for the technology to be cost-effective in both primary and secondary care settings. Additional studies of test use in routine primary care practice are needed to resolve the remaining issues of uncertainty—prevalence in this patient population and referral behavior.
Instability to Tollmien–Schlichting waves is one of the primary routes to transition to turbulence for two-dimensional boundary layers in quiet disturbance environments. Cancellation of Tollmien–Schlichting waves using surface heating was first demonstrated in the experiments of Liepmann et al. (J. Fluid Mech., vol. 118, 1982, pp. 187–200) and Liepmann & Nosenchuck (J. Fluid Mech., vol. 118, 1982, pp. 201–204). Here we consider a similar theoretical formulation that includes the effects of localised (unsteady) wall heating/cooling. The resulting problem is closely related to that of Terent'ev (Prikl. Mat. Mekh., vol. 45, 1981, pp. 1049–1055; Prikl. Mat. Mekh., vol. 48, 1984, pp. 264–272) on the generation of Tollmien–Schlichting waves by a vibrating ribbon, but with thermal effects. The nonlinear receptivity problem based on triple-deck scales is formulated and the linearised version solved both analytically as well as numerically. The most significant result is that the wall heating/cooling function can be chosen such that there is no pressure response to the disturbance, meaning there is no generation of Tollmien–Schlichting waves. Numerical calculations substantiate this with an approximation based on the exact analytical result. Previous numerical studies of the unsteady triple-deck equations have shown difficulties in capturing the convective wave packet that develops in the initial-value problem and we show that these arise from the choice of time steps as well as the range of the Fourier modes taken.
In a RCT of family psychoeducation, 47 carers of 34 patients were allocated to one of three groups; Multifamily Group Psychoeducation, Solution Focussed Group Therapy or Treatment as Usual. Carers in both the MFGP intervention and the SFGP arm demonstrated greater knowledge and reduction in burden than those in the TAU arm.
Diabetes mellitus is reaching epidemic proportions globally and is associated with a number of long-term central nervous system complications in older diabetic adults which are potentially modifiable. Improving diabetic brain health literacy among the public, diabetic individuals and healthcare staff has the potential to reduce the incidence of such complications as depression, cognitive impairment and dementia, leading to healthier ageing.
To establish diabetic brain health literacy levels among the general public, healthcare professionals and diabetic outpatient attendees using a knowledge questionnaire.
A self-administered questionnaire was made available to the public for completion via an Irish website. An adapted questionnaire was disseminated among medicine for the elderly nursing staff and diabetes outpatient attendees in a large urban teaching hospital in Dublin, Ireland. Questions assessed knowledge of potential brain health diabetic complications and garnered pertinent demographic information.
Graph 1- Knowledge of potential brain health complications of diabetes.
Graph 2 – Knowledge of potential non-central nervous system complications of diabetes
This study demonstrates poor knowledge among the public of the increased risk of brain health complications in older diabetic adults. Nursing staff members had greater knowledge and diabetic patients had the greatest, but less than satisfactory knowledge. This contrasts with greater awareness of non-brain diabetic complications such as eye disease and neuropathy among all three groups. Results suggest a need for expansion of health literacy campaigns to promote awareness, and to highlight potentially modifiable risk factors to aid in disease prevention, control and prevention of brain health complications.
Clinical Enterobacteriacae isolates with a colistin minimum inhibitory concentration (MIC) ≥4 mg/L from a United States hospital were screened for the mcr-1 gene using real-time polymerase chain reaction (RT-PCR) and confirmed by whole-genome sequencing. Four colistin-resistant Escherichia coli isolates contained mcr-1. Two isolates belonged to the same sequence type (ST-632). All subjects had prior international travel and antimicrobial exposure.
FFQ, food diaries and 24 h recall methods represent the most commonly used dietary assessment tools in human studies on nutrition and health, but food intake biomarkers are assumed to provide a more objective reflection of intake. Unfortunately, very few of these biomarkers are sufficiently validated. This review provides an overview of food intake biomarker research and highlights present research efforts of the Joint Programming Initiative ‘A Healthy Diet for a Healthy Life’ (JPI-HDHL) Food Biomarkers Alliance (FoodBAll). In order to identify novel food intake biomarkers, the focus is on new food metabolomics techniques that allow the quantification of up to thousands of metabolites simultaneously, which may be applied in intervention and observational studies. As biomarkers are often influenced by various other factors than the food under investigation, FoodBAll developed a food intake biomarker quality and validity score aiming to assist the systematic evaluation of novel biomarkers. Moreover, to evaluate the applicability of nutritional biomarkers, studies are presently also focusing on associations between food intake biomarkers and diet-related disease risk. In order to be successful in these metabolomics studies, knowledge about available electronic metabolomics resources is necessary and further developments of these resources are essential. Ultimately, present efforts in this research area aim to advance quality control of traditional dietary assessment methods, advance compliance evaluation in nutritional intervention studies, and increase the significance of observational studies by investigating associations between nutrition and health.
Traditionally, personalised nutrition was delivered at an individual level. However, the concept of delivering tailored dietary advice at a group level through the identification of metabotypes or groups of metabolically similar individuals has emerged. Although this approach to personalised nutrition looks promising, further work is needed to examine this concept across a wider population group. Therefore, the objectives of this study are to: (1) identify metabotypes in a European population and (2) develop targeted dietary advice solutions for these metabotypes. Using data from the Food4Me study (n 1607), k-means cluster analysis revealed the presence of three metabolically distinct clusters based on twenty-seven metabolic markers including cholesterol, individual fatty acids and carotenoids. Cluster 2 was identified as a metabolically healthy metabotype as these individuals had the highest Omega-3 Index (6·56 (sd 1·29) %), carotenoids (2·15 (sd 0·71) µm) and lowest total saturated fat levels. On the basis of its fatty acid profile, cluster 1 was characterised as a metabolically unhealthy cluster. Targeted dietary advice solutions were developed per cluster using a decision tree approach. Testing of the approach was performed by comparison with the personalised dietary advice, delivered by nutritionists to Food4Me study participants (n 180). Excellent agreement was observed between the targeted and individualised approaches with an average match of 82 % at the level of delivery of the same dietary message. Future work should ascertain whether this proposed method could be utilised in a healthcare setting, for the rapid and efficient delivery of tailored dietary advice solutions.
Research shows that cognitive rehabilitation (CR) has the potential to improve goal performance and enhance well-being for people with early stage Alzheimer’s disease (AD). This single subject, multiple baseline design (MBD) research investigated the clinical efficacy of an 8-week individualised CR intervention for individuals with early stage AD.
Three participants with early stage AD were recruited to take part in the study. The intervention consisted of eight sessions of 60–90 minutes of CR. Outcomes included goal performance and satisfaction, quality of life, cognitive and everyday functioning, mood, and memory self-efficacy for participants with AD; and carer burden, general mental health, quality of life, and mood of carers.
Visual analysis of MBD data demonstrated a functional relationship between CR and improvements in participants’ goal performance. Subjective ratings of goal performance and satisfaction increased from baseline to post-test for three participants and were maintained at follow-up for two. Baseline to post-test quality of life scores improved for three participants, whereas cognitive function and memory self-efficacy scores improved for two.
Our findings demonstrate that CR can improve goal performance, and is a socially acceptable intervention that can be implemented by practitioners with assistance from carers between sessions. This study represents one of the promising first step towards filling a practice gap in this area. Further research and randomised-controlled trials are required.
A substantial literature has reported that stress negatively impacts on cognitive processes. As dementia caregiving can be stressful, it has been hypothesized that the challenges of dementia care may increase caregivers’ own vulnerability to cognitive decline. Prefrontal processes are thought to be most vulnerable to stress; however, few studies have examined whether greater caregiver stress predicts poorer executive dysfunction, and no previous research has considered potential moderators of this relationship. We examined (1) whether greater psychological stress mediated a relationship between caregiver stress exposure and executive functioning and (2) whether greater self-efficacy and cognitive reserve (CR) moderated this relationship.
Spousal dementia caregivers (n = 253) completed the Neuropsychiatric Inventory Questionnaire (stress exposure), the Perceived Stress Scale, the National Adult Reading Test (CR), the Fortinsky dementia-specific caregiver self-efficacy scale, and the Color Trails Test (executive functioning). Moderated mediation was tested using the PROCESS macro. Age, gender, and dementia risk factors were included as covariates.
Greater stress exposure indirectly predicted executive functioning through psychological stress. Stronger relationships between greater psychological stress and poorer executive functioning were observed among caregivers with lower CR; there was no evidence that self-efficacy moderated the relationship between stress exposure and psychological stress.
Our findings are in line with the idea that greater psychological stress in response to challenges associated with dementia care predicts poorer caregiver executive functioning, particularly among caregivers with low CR. However, these findings are cross sectional; it is also possible that poorer executive functioning contributes to greater caregiver stress.
This Survey gathered information from a representative sample of the Australian child population aged 5–14 years to describe the oral health status of the population and factors related to use of dental services and dental behaviours, as well as associated individual, family, and community factors such as the sociodemographic characteristics of the child's household.
Surveys provide a means of measuring a population's characteristics, self-reported and observed behaviour, and needs. Unlike a census, where all members of a population are studied, sample surveys gather information from only a portion of a population of interest. In a statistically valid survey, the sample is objectively chosen so that each member of the population will have a known non-zero chance of selection. Only then can the results be reliably projected from the sample to the population.
Surveys, however, are not exempt of errors (or bias), which can occur when some segments of the population do not participate in the survey. As not all Australian children were included in this Survey, there is potential that the sample does not accurately represent the population of interest.
Errors due to sampling depend on the sample selection strategy and can be measured statistically. Variability inherent to the sampling process is expressed using the 95% confidence interval. On the other hand, non-sampling error or bias is more problematic because it is more difficult to measure and control. Bias due to non-participation occurs when the participants differ from the non-participants or the targeted population in one or more characteristics. The potential for bias due to non-participation or non-response can be explored by examining key sociodemographic characteristics of the Survey sample, and comparing them with known characteristics of the target population.
As outlined in Chapter 3, this Survey employed rigorous sampling procedures to achieve a representative sample of the Australian child population aged 5–14 years. The procedures used to derive survey weights for this Survey reflect the standards of best practice for weighting complex survey data, and are procedures used by leading statistical agencies. Procedures used to derive survey weights ensure valid estimates and inferences of the target child population can be made. The methodologies employed in the Survey will minimise any potential bias, which will be assessed in this chapter.
This study explored how coping with war-related traumatic events in Sierra Leone impacted mental health outcomes among 529 youth (aged 10–17 at baseline; 25% female) using longitudinal data from three time points (Time 1 in 2002, Time 2 in 2004, and Time 3 in 2008). We examined two types of coping items (approach and avoidance); used multiple regression models to test their relations with long-term mental health outcomes (internalizing behaviors, externalizing behaviors, adaptive/prosocial behaviors, and posttraumatic stress symptoms); and used mediation analyses to test whether coping explained the relation between previous war exposures (being raped, death of parent(s), or killing/injuring someone during the war) and those outcomes. We found that avoidance coping items were associated with lower internalizing and posttraumatic stress behaviors at Time 3, and provided some evidence of mediating the relation between death of parent(s) during the war and the two outcomes mentioned above. Approach coping was associated with higher Time 3 adaptive/prosocial behaviors, whereas avoidance coping was associated with lower Time 3 adaptive/prosocial behaviors. Avoidance coping may be a protective factor against mental illness, whereas approach coping may be a promotive factor for adaptive/prosocial behaviors in war-affected societies. This study has important implications for designing and implementing mental health interventions for youth in postconflict settings.
The current study investigated use of a controlled misting environment to simulate field conditions that have been implicated in high levels of the malting barley defect, grain skinning. More than 200 spring barley varieties were assessed to identify those varieties that were particularly resistant or susceptible to the defect. Relationships between skinning severity and the traits ear length, floret number, grain number and grain weight were examined among the varieties. In a panel of seven varieties chosen as treatment controls, misting was found to significantly increase skinning severity. The misting treatment had no effect on measured ear traits of these varieties. Among the 200 varieties grown under the misting treatment, there was a continuous spectrum of skinning severities, which were not correlated with ear length, floret number, grain number or grain weight. Using the misting treatment, differences in susceptibility to grain skinning could be determined among varieties. As the misting treatment did not affect measured ear traits, and no correlation was found between ear traits and skinning severity among varieties, the effect of misting on skinning severity must be mediated through other physiological characteristics.
Peer volunteers can be key to delivering effective social cognitive interventions due to increased potential for social modeling. We consulted peer volunteers who had just taken part in an 8-week social and nutritional mealtime intervention with older adults living alone, to seek their evaluation of the intervention.
Semi-structured focus groups were used with a total of 21 volunteers (17 female) and two facilitators. Thematic analysis was used to interrogate the data.
Six themes (16 sub-themes) are discussed. Peer volunteers described the importance of the socializing aspect of the intervention, of pairing considerations and compatibility in peer interventions, of considering the needs of the participant, of benefits to the volunteers, and of the practical considerations of conducting an intervention. Volunteers also discussed considerations for future research and services for older adults living alone.
Volunteers found their involvement in the intervention to be personally beneficial, and revealed some valuable considerations for the researchers to take forward to future research. Results are pertinent to intervention design and could inform future social cognitive and other peer-oriented interventions for older adults living alone.
Several studies suggest that neighborhood deprivation is a unique risk factor in child and adolescent development of problem behavior. We sought to examine whether previously established intervention effects of the Family Check-Up (FCU) on child conduct problems at age 7.5 would persist through age 9.5, and whether neighborhood deprivation would moderate these effects. In addition, we examined whether improvements in parent–child interaction during early childhood associated with the FCU would be related to later reductions in child aggression among families living in the highest risk neighborhoods. Using a multisite cohort of at-risk children identified on the basis of family, child, and socioeconomic risk and randomly assigned to the FCU, intervention effects were found to be moderated by neighborhood deprivation, such that they were only directly present for those living at moderate versus extreme levels of neighborhood deprivation. In addition, improvements in child aggression were evident for children living in extreme neighborhood deprivation when parents improved the quality of their parent–child interaction during the toddler period (i.e., moderated mediation). Implications of the findings are discussed in relation to the possibilities and possible limitations in prevention of early problem behavior for those children living in extreme and moderate levels of poverty.