HIV testing services (HTS) are the first steps in reaching the UNAIDS 95-95-95 goals to achieve and maintain low HIV incidence. Evaluating the effectiveness of different demand creation interventions ...to increase uptake of efficient and effective HTS is useful to prioritize limited programmatic resources. This review was undertaken to inform World Health Organization (WHO) 2019 HIV testing guidelines and assessed the research question, "Which demand creation strategies are effective for enhancing uptake of HTS?" focused on populations globally.
The following electronic databases were searched through September 28, 2021: PubMed, PsycInfo, Cochrane CENTRAL, CINAHL Complete, Web of Science Core Collection, EMBASE, and Global Health Database; we searched IAS and AIDS conferences. We systematically searched for randomized controlled trials (RCTs) that compared any demand creation intervention (incentives, mobilization, counseling, tailoring, and digital interventions) to either a control or other demand creation intervention and reported HTS uptake. We pooled trials to evaluate categories of demand creation interventions using random-effects models for meta-analysis and assessed study quality with Cochrane's risk of bias 1 tool. This study was funded by the WHO and registered in Prospero with ID CRD42022296947. We screened 10,583 records and 507 conference abstracts, reviewed 952 full texts, and included 124 RCTs for data extraction. The majority of studies were from the African (N = 53) and Americas (N = 54) regions. We found that mobilization (relative risk RR: 2.01, 95% confidence interval CI: 1.30, 3.09, p < 0.05; risk difference RD: 0.29, 95% CI 0.16, 0.43, p < 0.05, N = 4 RCTs), couple-oriented counseling (RR: 1.98, 95% CI 1.02, 3.86, p < 0.05; RD: 0.12, 95% CI 0.03, 0.21, p < 0.05, N = 4 RCTs), peer-led interventions (RR: 1.57, 95% CI 1.15, 2.15, p < 0.05; RD: 0.18, 95% CI 0.06, 0.31, p < 0.05, N = 10 RCTs), motivation-oriented counseling (RR: 1.53, 95% CI 1.07, 2.20, p < 0.05; RD: 0.17, 95% CI 0.00, 0.34, p < 0.05, N = 4 RCTs), short message service (SMS) (RR: 1.53, 95% CI 1.09, 2.16, p < 0.05; RD: 0.11, 95% CI 0.03, 0.19, p < 0.05, N = 5 RCTs), and conditional fixed value incentives (RR: 1.52, 95% CI 1.21, 1.91, p < 0.05; RD: 0.15, 95% CI 0.07, 0.22, p < 0.05, N = 11 RCTs) all significantly and importantly (≥50% relative increase) increased HTS uptake and had medium risk of bias. Lottery-based incentives and audio-based interventions less importantly (25% to 49% increase) but not significantly increased HTS uptake (medium risk of bias). Personal invitation letters and personalized message content significantly but not importantly (<25% increase) increased HTS uptake (medium risk of bias). Reduced duration counseling had comparable performance to standard duration counseling (low risk of bias) and video-based interventions were comparable or better than in-person counseling (medium risk of bias). Heterogeneity of effect among pooled studies was high. This study was limited in that we restricted to randomized trials, which may be systematically less readily available for key populations; additionally, we compare only pooled estimates for interventions with multiple studies rather than single study estimates, and there was evidence of publication bias for several interventions.
Mobilization, couple- and motivation-oriented counseling, peer-led interventions, conditional fixed value incentives, and SMS are high-impact demand creation interventions and should be prioritized for programmatic consideration. Reduced duration counseling and video-based interventions are an efficient and effective alternative to address staffing shortages. Investment in demand creation activities should prioritize those with undiagnosed HIV or ongoing HIV exposure. Selection of demand creation interventions must consider risks and benefits, context-specific factors, feasibility and sustainability, country ownership, and universal health coverage across disease areas.
Official dietary guidelines for athletes are unanimous in their recommendation of high carbohydrate (CHO) intakes in routine or training diets. These guidelines have been criticised on the basis of a ...lack of scientific support for superior training adaptations and performance, and the apparent failure of successful athletes to achieve such dietary practices. Part of the problem rests with the expression of CHO intake guidelines in terms of percentage of dietary energy. It is preferable to provide recommendations for routine CHO intake in grams (relative to the body mass of the athlete) and allow flexibility for the athlete to meet these targets within the context of their energy needs and other dietary goals. CHO intake ranges of 5 to 7 g/kg/day for general training needs and 7 to 10 g/kg/day for the increased needs of endurance athletes are suggested. The limitations of dietary survey techniques should be recognised when assessing the adequacy of the dietary practices of athletes. In particular, the errors caused by under-reporting or undereating during the period of the dietary survey must be taken into account. A review of the current dietary survey literature of athletes shows that a typical male athlete achieves CHO intake within the recommended range (on a g/kg basis). Individual athletes may need nutritional education or dietary counselling to fine-tune their eating habits to meet specific CHO intake targets. Female athletes, particularly endurance athletes, are less likely to achieve these CHO intake guidelines. This is due to chronic or periodic restriction of total energy intake in order to achieve or maintain low levels of body fat. With professional counselling, female athletes may be helped to find a balance between bodyweight control issues and fuel intake goals. Although we look to the top athletes as role models, it is understandable that many do not achieve optimal nutrition practices. The real or apparent failure of these athletes to achieve the daily CHO intakes recommended by sports nutritionists does not necessarily invalidate the benefits of meeting such guidelines. Further longitudinal studies of training adaptation and performance are needed to determine differences in the outcomes of high versus moderate CHO intakes. In the meantime, the recommendations of sports nutritionists are based on plentiful evidence that increased CHO availability enhances endurance and performance during single exercise sessions.
Lung cancer is the third most common type of cancer in the UK, with nearly 50 000 new cases diagnosed a year. Treatments for lung cancer have improved in recent years with the advent of new surgical ...and radiotherapy techniques and the increased use of immunotherapies. These advances have resulted in increasing numbers of patients surviving beyond the completion of their treatment. Lung cancer patients are now not dying from their cancer diagnosis, but from other co-existing pathologies. Lung cancer patients commonly present with multiple comorbidities. Mitigating the effects of poor lifestyles and changing behaviours may improve the efficacy of treatments, reduce side-effects and improve the quality of life for lung cancer patients. Published evidence supports the use of interventions to manage behavioural habits, to optimise the health of patients. There is no consensus as to what, when or how to embed these into the patient pathway. Supporting patients before, during and after their cancer treatments to increase activity, eat well and stop smoking have been seen to decrease side-effects and improve patient outcomes and wellbeing. The challenge is to provide a package of interventions that is acceptable to patients and fits within the patient pathway so as not to conflict with diagnostic and therapeutic activities. This article reviews where we are today with providing behavioural support to optimise the health of lung cancer patients undergoing treatment.
•Patients are surviving their cancer treatments and are living with their comorbidities.•Optimising the health of lung cancer patients will reduce treatment side effects and improve the quality of life.•How and when should lifestyle interventions be offered to lung cancer patients?.
The OSIRIS‐REx Asteroid Sample Return Mission is the third mission in National Aeronautics and Space Administration (NASA)'s New Frontiers Program and is the first U.S. mission to return samples from ...an asteroid to Earth. The most important decision ahead of the OSIRIS‐REx team is the selection of a prime sample‐site on the surface of asteroid (101955) Bennu. Mission success hinges on identifying a site that is safe and has regolith that can readily be ingested by the spacecraft's sampling mechanism. To inform this mission‐critical decision, the surface of Bennu is mapped using the OSIRIS‐REx Camera Suite and the images are used to develop several foundational data products. Acquiring the necessary inputs to these data products requires observational strategies that are defined specifically to overcome the challenges associated with mapping a small irregular body. We present these strategies in the context of assessing candidate sample sites at Bennu according to a framework of decisions regarding the relative safety, sampleability, and scientific value across the asteroid's surface. To create data products that aid these assessments, we describe the best practices developed by the OSIRIS‐REx team for image‐based mapping of irregular small bodies. We emphasize the importance of using 3‐D shape models and the ability to work in body‐fixed rectangular coordinates when dealing with planetary surfaces that cannot be uniquely addressed by body‐fixed latitude and longitude.
Plain Language Summary
The OSIRIS‐REx Asteroid Sample Return Mission must map asteroid (101955) Bennu using the OSIRIS‐REx Camera Suite. Here we present the techniques that are established to accomplish this goal. Mapping helps us find the best place on the surface of Bennu from which to gather a sample. Because asteroids are small bodies with weak gravitational fields, maneuvering a spacecraft around them can be challenging. Considering these complexities, we have found ways to gather images of Bennu needed for creating maps. Additionally, due to the irregular shape of many asteroids, producing 2‐D maps in terms of latitude and longitude may be insufficient for describing their surface geography. To that end, we have developed software that is capable of creating and displaying image maps in 3‐D.
Key Points
The OSIRIS‐REx Asteroid Sample Return Mission performs image‐based mapping of (101955) Bennu to aid in the selection of a sample‐site
We develop observational strategies to perform mapping to address the challenges associated with surveying a small body
We identify pitfalls and best practices for mapping images of small bodies with large concavities, elongated axes, or overhanging terrain
Engaging with patients when designing a clinical or research project is beneficial; feedback from the intended audience provides invaluable insight form the patients’ perspective. Working with ...patients can result in developing successful research grants and interventions. The benefit of including the voice of the patient in the Yorkshire Cancer Research funded PREHABS study is described in this article.
Patients were included in the PREHABS study from inception to completion. The Theory of Change methodology was used to provide a framework to implement patient feedback to refine the study intervention.
In total, 69 patients engaged with the PREHABS project. Two patients were recruited as co-applicants on the grant and were members on the Trial Management Group. Six patients attended the pre application workshop and provided feedback on their lived experiences of being a lung cancer patient. Commentary from the patients influenced the interventions selected and the design of the prehabs study.
Following ethical approval (21/EE/0048) and informed written consent, 61 patients were recruited into the PREHABS study between October 2021 and November 2022. The breakdown of recruited patients was 19 males: mean age 69.1 years (SD 8.91) and 41 females; mean age 74.9 years (SD 8.9).
It is practicable and beneficial to include patients at all stages of designing and delivering a research study. Patient feedback can help refine the study interventions to allow for maximum acceptance, recruitment and retention.
Including patients in the design of radiotherapy research studies can provide invaluable insight that can support the selection and delivery of interventions that are acceptable to the patient cohort.
Aims
Basal insulin peglispro (BIL), a novel PEGylated basal insulin with a large hydrodynamic size, has a delayed absorption and reduced clearance that prolongs the duration of action. The current ...study compared the effects of BIL and insulin glargine (GL) on endogenous glucose production (EGP), glucose disposal rate (GDR) and lipolysis in patients with type 1 diabetes.
Materials and Methods
This was a randomized, open‐label, four‐period, crossover study. Patients received intravenous infusions of BIL and GL, each at two dose levels selected for partial and maximal suppression of EGP, during an 8 to 10 h euglycemic clamp procedure with d‐3‐3H glucose.
Results
Following correction for equivalent human insulin concentrations (EHIC), low‐dose GL infusion resulted in similar EGP at the end of the clamp compared to low‐dose BIL infusion (GL/BIL ratio of 1.03) but a higher GDR (GL/BIL ratio of 2.42), indicating similar hepatic activity but attenuated peripheral activity of BIL. Consistent with this, the EHIC‐corrected GDR/EGP at the end of the clamp was 1.72‐fold greater for GL than BIL following low‐dose administration. At the lower dose of BIL and GL (concentrations in the therapeutic range), BIL produced less suppression of lipolysis compared with GL as indicated by free fatty acid and glycerol levels at the end of the clamp.
Conclusions
Compared with GL, BIL restored the hepato‐peripheral insulin action gradient seen in normal physiology via its peripherally restricted action on target tissues related to carbohydrate and lipid metabolism.
We determined the effect of fat adaptation on metabolism and performance during 5 h of cycling in seven competitive athletes who consumed a standard carbohydrate (CHO) diet for 1 day and then either ...a high-CHO diet (11 g. kg(-1)x day(-1) CHO, 1 g x kg(-1) x day(-1) fat; HCHO) or an isoenergetic high-fat diet (2.6 g x kg(-1) x day(-1) CHO, 4.6 g x kg(-1) x day(-1) fat; fat-adapt) for 6 days. On day 8, subjects consumed a high-CHO diet and rested. On day 9, subjects consumed a preexercise meal and then cycled for 4 h at 65% peak O(2) uptake, followed by a 1-h time trial (TT). Compared with baseline, 6 days of fat-adapt reduced respiratory exchange ratio (RER) with cycling at 65% peak O(2) uptake 0.78 +/- 0.01 (SE) vs. 0.85 +/- 0.02; P < 0.05. However, RER was restored by 1 day of high-CHO diet, preexercise meal, and CHO ingestion (0.88 +/- 0.01; P < 0.05). RER was higher after HCHO than fat-adapt (0.85 +/- 0.01, 0.89 +/- 0.01, and 0.93 +/- 0.01 for days 2, 8, and 9, respectively; P < 0.05). Fat oxidation during the 4-h ride was greater (171 +/- 32 vs. 119 +/- 38 g; P < 0.05) and CHO oxidation lower (597 +/- 41 vs. 719 +/- 46 g; P < 0.05) after fat-adapt. Power output was 11% higher during the TT after fat-adapt than after HCHO (312 +/- 15 vs. 279 +/- 20 W; P = 0.11). In conclusion, compared with a high-CHO diet, fat oxidation during exercise increased after fat-adapt and remained elevated above baseline even after 1 day of a high-CHO diet and increased CHO availability. However, this study failed to detect a significant benefit of fat adaptation to performance of a 1-h TT undertaken after 4 h of cycling.
In early 2019, NASA's OSIRIS-REx (Origins, Spectral Interpretation, Resource Identification, and Security–Regolith Explorer) mission surveyed asteroid (101955) Bennu with a collection of instruments, ...including the OSIRIS-REx Camera Suite (OCAMS) PolyCam imager. Using PolyCam panchromatic images, we constructed a globally controlled basemap of Bennu at an approximate ground sample distance of 5 cm with a mean spatial accuracy of ~30 cm. The basemap was photometrically normalized using a Minneart phase angle correction. New mapping methods were developed to combine images of Bennu's irregular shape and extremely rough surface into a nearly seamless mosaic. Here we present the global basemap of Bennu and discuss the image processing techniques used to construct a high-resolution mosaic of an irregular small body.
•We produced a global basemap of asteroid Bennu at a ground sample distance of 5 cm.•New methods were developed to deal with Bennu's rough surface and irregular shape.•Images were rectified to a 3D digital terrain model with a mean facet size of 80 cm.•Images were photometrically normalized to 30° phase angle using a Minneart model.•Overlaps were masked along natural feature boundaries for a nearly seamless result.
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