It has been widely established that depressed mood states and clinical depression, as well as a range of other psychiatric disorders, are associated with a relative difficulty in accessing specific ...autobiographical information in response to emotion-related cue words on an Autobiographical Memory Test (AMT;
J. M. G. Williams & K. Broadbent, 1986
). In 8 studies the authors examined the extent to which this relationship is a function of impaired executive control associated with these mood states and clinical disorders. Studies 1-4 demonstrated that performance on the AMT is associated with performance on measures of executive control, independent of depressed mood. Furthermore, Study 1 showed that executive control (as measured by verbal fluency) mediated the relationship between both depressed mood and a clinical diagnosis of eating disorder and AMT performance. Using a stratified sample in Study 5, the authors confirmed the positive association between depressed mood and impaired performance on the AMT. Studies 6-8 involved experimental manipulations of the parameters of the AMT designed to further indicate that reduced executive control is to a significant extent driving the relationship between depressed mood and AMT performance. The potential role of executive control in accounting for other aspects of the AMT literature is discussed.
We identified a dominant missense mutation in the SCN transcription factor Zfhx3, termed short circuit (Zfhx3Sci), which accelerates circadian locomotor rhythms in mice. ZFHX3 regulates transcription ...via direct interaction with predicted AT motifs in target genes. The mutant protein has a decreased ability to activate consensus AT motifs in vitro. Using RNA sequencing, we found minimal effects on core clock genes in Zfhx3Sci/+ SCN, whereas the expression of neuropeptides critical for SCN intercellular signaling was significantly disturbed. Moreover, mutant ZFHX3 had a decreased ability to activate AT motifs in the promoters of these neuropeptide genes. Lentiviral transduction of SCN slices showed that the ZFHX3-mediated activation of AT motifs is circadian, with decreased amplitude and robustness of these oscillations in Zfhx3Sci/+ SCN slices. In conclusion, by cloning Zfhx3Sci, we have uncovered a circadian transcriptional axis that determines the period and robustness of behavioral and SCN molecular rhythms.
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•Zfhx3 missense mutation underlies the short circuit (Zfhx3Sci) circadian phenotype•Zfhx3Sci reduces the ability of ZFHX3 to activate transcription via AT motifs•Zfhx3Sci phenotype is associated with decreased activation of AT motif in neuropeptide promoters•Circadian activation in SCN reveals AT motif as a new clock-regulated transcriptional axis
A transcription factor expressed in discrete adult hypothalamic nuclei, including the suprachiasmatic nucleus, regulates circadian locomotor rhythms in vivo through the expression of distinct neuropeptidergic genes to ensure robust synchronous oscillations and circadian rhythms.
The home is becoming a key location for healthcare delivery, including the use of technology driven by autonomous systems (AS) to monitor and support healthcare plans. Using the example of a smart ...mirror, this paper describes the outcomes of focus groups with people with multiple sclerosis (MS; n = 6) and people who have had a stroke (n = 15) to understand their attitudes towards the use of AS for healthcare in the home. Qualitative data were analysed using a thematic analysis. The results indicate that the use of such technology depends on the level of adaptability and responsiveness to users’ specific circumstances, including their relationships with the healthcare system. A smart mirror would need to support manual entry, responsive goal setting, the effective aggregation of data sources and integration with other technology, have a range of input methods, be supportive rather than prescriptive in messaging, and give the user full control of their data. The barriers to its adoption include a perceived lack of portability and practicality, a lack of accessibility and inclusivity, a sense of redundancy, feeling overwhelmed by multiple technological devices, and a lack of trust in data sharing. These results inform the development and deployment of future health technologies based on the lived experiences of people with health conditions who require ongoing care.
Reflections on RRI in “TAS for Health at Home” Jäger, Nils; Dowthwaite, Liz; Barnard, Pepita ...
Journal of responsible technology,
December 2022, 2022-12-00, 2022-12-01, Letnik:
12
Journal Article
Recenzirano
Odprti dostop
•We describe challenges of RRI in a multi-disciplinary research team and reflect on our own solutions to them.•We discuss the home as a special place for the delivery of autonomous healthcare systems ...with unique RRI challenges.•We describe a path toward technology development, following RRI principles.
We reflect on our experiences using Responsible Research and Innovation (RRI) in the project “TAS for Health at Home”. Driven by a multi-disciplinary research team that consisted of experts in mental health, stroke rehabilitation, management of multiple sclerosis, human factors, human-computer interaction, privacy, cybersecurity, architecture, and Patient and Public Involvement (PPI) groups, the project aimed at eliciting user perceptions of autonomous systems supporting healthcare regimes at home. We discuss the home as a unique place to consider RRI approaches and reflect on the actual process of carrying out RRI within the project, including the multi-disciplinarity of the project, our engagement with PPI groups, and how we involved the wider community concerned with Trustworthy Autonomous Systems (TAS). We conclude by summarising our reflections and providing a first step towards RRI-based guidelines for developing healthcare technology for the home.
The prognosis of early-onset pre-eclampsia (before 34 weeks' gestation) is variable. Accurate prediction of complications is required to plan appropriate management in high-risk women.
To develop and ...validate prediction models for outcomes in early-onset pre-eclampsia.
Prospective cohort for model development, with validation in two external data sets.
Model development: 53 obstetric units in the UK. Model transportability: PIERS (Pre-eclampsia Integrated Estimate of RiSk for mothers) and PETRA (Pre-Eclampsia TRial Amsterdam) studies.
Pregnant women with early-onset pre-eclampsia.
Nine hundred and forty-six women in the model development data set and 850 women (634 in PIERS, 216 in PETRA) in the transportability (external validation) data sets.
The predictors were identified from systematic reviews of tests to predict complications in pre-eclampsia and were prioritised by Delphi survey.
The primary outcome was the composite of adverse maternal outcomes established using Delphi surveys. The secondary outcome was the composite of fetal and neonatal complications.
We developed two prediction models: a logistic regression model (PREP-L) to assess the overall risk of any maternal outcome until postnatal discharge and a survival analysis model (PREP-S) to obtain individual risk estimates at daily intervals from diagnosis until 34 weeks. Shrinkage was used to adjust for overoptimism of predictor effects. For internal validation (of the full models in the development data) and external validation (of the reduced models in the transportability data), we computed the ability of the models to discriminate between those with and without poor outcomes (
-statistic), and the agreement between predicted and observed risk (calibration slope).
The PREP-L model included maternal age, gestational age at diagnosis, medical history, systolic blood pressure, urine protein-to-creatinine ratio, platelet count, serum urea concentration, oxygen saturation, baseline treatment with antihypertensive drugs and administration of magnesium sulphate. The PREP-S model additionally included exaggerated tendon reflexes and serum alanine aminotransaminase and creatinine concentration. Both models showed good discrimination for maternal complications, with anoptimism-adjusted
-statistic of 0.82 95% confidence interval (CI) 0.80 to 0.84 for PREP-L and 0.75 (95% CI 0.73 to 0.78) for the PREP-S model in the internal validation. External validation of the reduced PREP-L model showed good performance with a
-statistic of 0.81 (95% CI 0.77 to 0.85) in PIERS and 0.75 (95% CI 0.64 to 0.86) in PETRA cohorts for maternal complications, and calibrated well with slopes of 0.93 (95% CI 0.72 to 1.10) and 0.90 (95% CI 0.48 to 1.32), respectively. In the PIERS data set, the reduced PREP-S model had a
-statistic of 0.71 (95% CI 0.67 to 0.75) and a calibration slope of 0.67 (95% CI 0.56 to 0.79). Low gestational age at diagnosis, high urine protein-to-creatinine ratio, increased serum urea concentration, treatment with antihypertensive drugs, magnesium sulphate, abnormal uterine artery Doppler scan findings and estimated fetal weight below the 10th centile were associated with fetal complications.
The PREP-L model provided individualised risk estimates in early-onset pre-eclampsia to plan management of high- or low-risk individuals. The PREP-S model has the potential to be used as a triage tool for risk assessment. The impacts of the model use on outcomes need further evaluation.
Current Controlled Trials ISRCTN40384046.
The National Institute for Health Research Health Technology Assessment programme.
Summary
Objective
Women with pre‐eclampsia have elevated circulating levels of soluble fms‐like tyrosine kinase‐1 (sFlt‐1). Statins can reduce sFlt‐1 from cultured cells and improve pregnancy outcome ...in animals with a pre‐eclampsia‐like syndrome. We investigated the effect of pravastatin on plasma sFlt‐1 levels during pre‐eclampsia.
Design
Blinded (clinician and participant), proof of principle, placebo‐controlled trial.
Setting
Fifteen UK maternity units.
Population
We used a minimisation algorithm to assign 62 women with early‐onset pre‐eclampsia (24+0–31+6 weeks of gestation) to receive pravastatin 40 mg daily (n = 30) or matched placebo (n = 32), from randomisation to childbirth.
Primary outcome
Difference in mean plasma sFlt‐1 levels over the first 3 days following randomisation.
Results
The difference in the mean maternal plasma sFlt‐1 levels over the first 3 days after randomisation between the pravastatin (n = 27) and placebo (n = 29) groups was 292 pg/ml (95% CI −1175 to 592; P = 0.5), and over days 1–14 was 48 pg/ml (95% CI −1009 to 913; P = 0.9). Women who received pravastatin had a similar length of pregnancy following randomisation compared with those who received placebo (hazard ratio 0.84; 95% CI 0.50–1.40; P = 0.6). The median time from randomisation to childbirth was 9 days (interquartile range IQR 5–14 days) for the pravastatin group and 7 days (IQR 4–11 days) for the placebo group. There were three perinatal deaths in the placebo‐treated group and no deaths or serious adverse events attributable to pravastatin.
Conclusions
We found no evidence that pravastatin lowered maternal plasma sFlt‐1 levels once early‐onset pre‐eclampsia had developed. Pravastatin appears to have no adverse perinatal effects.
Tweetable
Pravastatin does not improve maternal plasma sFlt‐1 or placental growth factor levels following a diagnosis of early preterm pre‐eclampsia #clinicaltrial finds.
Tweetable
Pravastatin does not improve maternal plasma sFlt‐1 or placental growth factor levels following a diagnosis of early preterm pre‐eclampsia #clinicaltrial finds.
Reduced specificity of autobiographical memories retrieved to word cues on the Autobiographical Memory Test (AMT) is associated with increased posttraumatic stress in traumatized samples. Theoretical ...debates concerning the dominant influences on this effect have focused on affect regulation, whereby specific personal information is avoided more by those experiencing greater distress, versus compromised executive control, whereby increased distress is associated with an inability to set aside inappropriately general responses on the AMT. The present study compared these 2 views in a correlational design using a reversed version of the AMT (the AMT-R) for which trauma-exposed participants (
N
= 36) had to generate general memories from the past and avoid specific memories. An emphasis on the role of affect regulation would predict that distress would be associated with reduced specificity (as in the standard AMT), whereas emphasis on the role of executive control would predict that this relationship would be reversed. The data supported the affect regulation account, with greater posttraumatic stress being associated with reduced memory specificity.
Objective
To identify outcomes relevant to women with lived experience of pre‐eclampsia.
Design
Qualitative interview study.
Setting
A national study conducted in the United Kingdom.
Sample
Purposive ...sample of women with lived experience of pre‐eclampsia.
Methods
Thematic analysis of qualitative interview transcripts.
Results
Thirty women with lived experience of pre‐eclampsia were interviewed. Thematic analysis identified 71 different treatment outcomes. Fifty‐nine of these had been previously reported by pre‐eclampsia trials. Outcomes related to maternal and neonatal morbidity, commonly reported by pre‐eclampsia trials, were frequently discussed by women with lived experience of pre‐eclampsia. Twelve outcomes had not been previously reported by pre‐eclampsia trials. When compared with published research, it was evident that the outlook of women with lived experience of pre‐eclampsia was broader. They considered pre‐eclampsia in relation to the ‘whole’ person and attached special significance to outcomes relating to emotional wellbeing and the future health, development and wellbeing of their offspring.
Conclusions
Selecting, collecting and reporting outcomes relevant to women with pre‐eclampsia should ensure that future pre‐eclampsia research has the necessary reach and relevance to inform clinical practice. Future core outcome set development studies should use qualitative research methods to ensure that the long list of potential core outcomes holds relevance to patients.
Tweetable
What do women want? A national study identifies key treatment outcomes for women with pre‐eclampsia. Next step: @coreoutcomes for #preeclampsia @NIHR_DC.
Tweetable
What do women want? A national study identifies key treatment outcomes for women with pre‐eclampsia. Next step: @coreoutcomes for #preeclampsia @NIHR_DC.
This article includes Author Insights, a video available at https://vimeo.com/rcog/authorinsights15616
Unmanaged cancer symptoms and treatment-related side effects can compromise long-term clinical outcomes and health-related quality of life. Health information technologies such as web-based platforms ...offer the possibility to supplement existing care and optimize symptom management.
This paper describes the development and usability of a web-based symptom management platform for cancer patients and survivors that will be implemented within a large health system.
A web-based symptom management platform was designed and evaluated via one-on-one usability testing sessions. The System Usability Scale (SUS), After Scenario Questionnaire (ASQ), and qualitative analysis of semistructured interviews were used to assess program usability.
Ten cancer survivors and five cancer center staff members participated in usability testing sessions. The mean score on the SUS was 86.6 (SD 14.0), indicating above average usability. The mean score on the ASQ was 2.5 (SD 2.1), indicating relatively high satisfaction with the usability of the program. Qualitative analyses identified valued features of the program and recommendations for further improvements.
Cancer survivors and oncology care providers reported high levels of acceptability and usability in the initial development of a web-based symptom management platform for cancer survivors. Future work will test the effectiveness of this web-based platform.
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