Measuring refugees' capabilities: translation, adaptation, and valuation of the OxCAP-MH into Juba Arabic for use among South Sudanese male refugees in Uganda

BACKGROUND

Forcibly displaced populations are highly vulnerable to psychosocial distress and mental disorders, including alcohol misuse. In an ongoing trial that seeks to develop a transdiagnostic intervention addressing psychological distress and alcohol use disorders among conflict-affected populations, we will carry out a cost-effectiveness evaluation using a capability-based Oxford Capabilities Mental Health (OxCAP-MH) measure. The OxCAP-MH is a 16-item questionnaire developed from the Capability Approach, that covers multiple domains of functioning and welfare. The aim of the current paper is to present the results of the translation, cultural adaptation and valuation of the OxCAP-MH into Juba Arabic for South Sudanese refugees living in Uganda. We adhered to the official Translation and Linguistic Validation process of the OxCAP-MH. To carry out the translation, the Concept Elaboration document, official English version of the OxCAP-MH, and the Back-Translation Review Template were used. Four independent translators were used for forward and back translations. The reconciled translated version was then piloted in two focus group discussions (N = 16) in Rhino refugee settlement. A most important to least important valuation of the sixteen capability domains covered in the OxCAP-MH was also done.

RESULTS

The Juba Arabic version of the OxCAP-MH was finalized following a systematic iterative process. The content of the Juba Arabic version remained unchanged, but key concepts were adapted to ensure cultural acceptability, feasibility, and comprehension of the measure in the local context of Rhino refugee settlement. Most participants had low levels of literacy and required support with filling in the tool. Participants suggested an additional capability that is currently not reflected in the OxCAP-MH, namely access to food. Furthermore, discussions around the valuation exercise of the sixteen domains led to two separate importance scales, which showed relevant differences.

CONCLUSIONS

In this context, the OxCAP-MH was considered culturally acceptable. The valuation exercise proved cognitively demanding. Participants voiced confusion over how to answer the questions on the OxCAP-MH instrument due to low levels of literacy. These concerns invite consideration for future research to consider how measures such as the OxCAP-MH can be made more accessible to individuals with low literacy rates in resource poor settings.

Methods for think-aloud interviews in health-related resource-use research: the PECUNIA RUM instrument

BACKGROUND

The think-aloud (TA) approach is a qualitative research method that allows for gaining insight into thoughts and cognitive processes. It can be used to incorporate a respondent's perspective when developing resource-use measurement (RUM) instruments. Currently, the application of TA methods in RUM research is limited, and so is the guidance on how to use them. Transparent publication of TA methods for RUM in health economics studies, which is the aim of this paper, can contribute to reducing the aforementioned gap.

METHODS

Methods for conducting TA interviews were iteratively developed by a multi-national working group of health economists and additional qualitative research expertise was sought. TA interviews were conducted in four countries to support this process. A ten-step process was outlined in three parts: Part A 'before the interview' (including translation, recruitment, training), Part B 'during the interview' (including setting, opening, completing the instrument, open-ended questions, closing), and part C 'after the interview' (including transcription and data analysis, trustworthiness).

CONCLUSIONS

This manuscript describes the step-by-step approach for conducting multi-national TA interviews with potential respondents of the PECUNIA RUM instrument. It increases the methodological transparency in RUM development and reduces the knowledge gap of using qualitative research methods in health economics.

Activation-Free Sulfonyl Fluoride Probes for Fragment Screening

SuFEx chemistry is based on the unique reactivity of the sulfonyl fluoride group with a range of nucleophiles. Accordingly, sulfonyl fluorides label multiple nucleophilic amino acid residues, making these reagents popular in both chemical biology and medicinal chemistry applications. The reactivity of sulfonyl fluorides nominates this warhead chemotype as a candidate for an external, activation-free general labelling tag. Here, we report the synthesis and characterization of a small sulfonyl fluoride library that yielded the 3-carboxybenzenesulfonyl fluoride warhead for tagging tractable targets at nucleophilic residues. Based on these results, we propose that coupling diverse fragments to this warhead would result in a library of sulfonyl fluoride bits (SuFBits), available for screening against protein targets. SuFBits will label the target if it binds to the core fragment, which facilitates the identification of weak fragments by mass spectrometry.

[The interoperability of IIEF-5 with EPIC-26 : Sexual function after radical prostatectomy]

BACKGROUND

In the past, the IIEF‑5 (International Index of Erectile Function 5 ) was predominantly used to measure erectile function in prostate cancer patients. Following international developments, the domain "sexuality" of the EPIC-26 (Expanded Prostate Cancer Index Composite 26) is increasingly used in Germany.

OBJECTIVE

The aim of this work is to create a practicable comparison of the domain "sexuality" of the EPIC-26 with the IIEF‑5 for treatment in Germany. This is particularly necessary for the evaluation of historical patient collectives.

MATERIALS AND METHODS

For the evaluation, 2123 patients with prostate cancer confirmed by biopsy from 2014-2017 who completed both the IIEF‑5 and the EPIC-26 were considered. Linear regression analyses are calculated to convert IIEF‑5 sum scores to EPIC-26 sexuality domain scores.

RESULTS

The correlation between IIEF‑5 and the EPIC-26 domain score "sexuality" was 0.74, suggesting a high degree of content convergence between the constructs measured. While the standard error of the predicted values is relatively small, the prediction intervals are very wide. For example, for the critical IIEF‑5 value of 22, the predicted value is 78.88 with a 95% prediction interval of 55.09 to 102.66.

CONCLUSION

IIEF‑5 and the Sexuality scale of the EPIC-26 measure a similar construct. The analysis shows that conversion of individual values is associated with great uncertainty. However, at the group level, the observed EPIC-26 "sexuality" score could be predicted quite accurately. This opens up the possibility of comparing the erectile function of cohorts of patients/test persons, even if this was collected with different measuring instruments.

Agricultural spider decline: long-term trends under constant management conditions

There is widespread evidence for a worldwide trend of insect decline, but we have much fewer data about recent temporal trends in other arthropod groups, including spiders. Spiders can be hypothesised to similarly decline because of trophic dependence on insects and being equally sensitive to local and global environmental changes. Background trends in arthropod populations can be verified if we decouple large-scale environmental transitions, such as climate change, from local factors. To provide a case study on baseline spider community trends, we observed changes in the spider community of an unsprayed alfalfa field and its margin 23 years apart under largely unchanged local conditions. We aimed to determine whether there are changes in spider abundance, species richness and mean species characteristics. Spider abundance per unit effort decreased dramatically, by 45% in alfalfa and by 59% in the margin, but species richness and most characteristics remained unchanged. Community composition in both habitats shifted and became more similar by the current study period. The population decline was especially marked in certain farmland species. We propose that in the absence of local causative factors, spider abundance decline in our study indicates a reduction of spider populations at landscape and regional scales.

Novel Erlotinib-Chalcone Hybrids Diminish Resistance in Head and Neck Cancer by Inducing Multiple Cell Death Mechanisms

In a search for novel therapeutic options for head and neck squamous cell carcinomas (HNSCCs) generally treated with limited therapeutic success, we synthesized a series of novel erlotinib-chalcone molecular hybrids with 1,2,3-triazole and alkyne linkers and evaluated them for their anticancer activity on Fadu, Detroit 562 and SCC-25 HNSCC cell lines. Time- and dose-dependent cell viability measurements disclosed a significantly increased efficiency of the hybrids compared to the 1:1 combination of erlotinib and a reference chalcone. The clonogenic assay demonstrated that hybrids eradicate HNSCC cells in low micromolar concentrations. Experiments focusing on potential molecular targets indicate that the hybrids trigger the anticancer effect by a complementary mechanism of action that is independent of the canonical targets of their molecular fragments. Confocal microscopic imaging and real-time apoptosis/necrosis detection assay pointed to slightly different cell death mechanisms induced by the most prominent triazole- and alkyne-tethered hybrids (6a and 13, respectively). While 6a featured the lowest IC₅₀ values on each of the three HNSCC cell lines, in Detroit 562 cells, this hybrid induced necrosis more markedly compared to 13. The therapeutic potential indicated by the observed anticancer efficacy of our selected hybrid molecules validates the concept of development and justifies further investigation to reveal the underlying mechanism of action.

Evaluating the implementation of a multi-level mHealth study to improve hydroxyurea utilization in sickle cell disease

Background

Sickle Cell Disease (SCD) is a progressive genetic disease that causes organ damage and reduces longevity. Hydroxyurea is an underutilized evidence-based medication that reduces complications and improves survival in SCD. In a multi-site clinical trial, part of the NIH-funded Sickle Cell Disease Implementation Consortium (SCDIC), we evaluate the implementation of a multi-level and multi-component mobile health (mHealth) patient and provider intervention to target the determinants and context of low hydroxyurea use. Given the complexity of the intervention and contextual variability in its implementation, we combined different behavioral and implementation theories, models, and frameworks to facilitate the evaluation of the intervention implementation. In this report, we describe engagement with stakeholders, planning of the implementation process, and final analytical plan to evaluate the implementation outcomes.

Methods

During 19 meetings, a 16-member multidisciplinary SCDIC implementation team created, conceived, and implemented a project that utilized Intervention Mapping to guide designing an intervention and its evaluation plan. The process included five steps: (1) needs assessment of low hydroxyurea utilization, (2) conceptual framework development, (3) intervention design process, (4) selection of models and frameworks, and (5) designing evaluation of the intervention implementation.

Results

Behavioral theories guided the needs assessment and the design of the multi-level mHealth intervention. In designing the evaluation approach, we combined two implementation frameworks to best account for the contextual complexity at the organizational, provider, and patient levels: (1) the Consolidated Framework for Implementation Research (CFIR) that details barriers and facilitators to implementing the mHealth intervention at multiple levels (users, organization, intervention characteristics, broader community), and (2) the Technology Acceptance Model (TAM), a conceptual model specific for explaining the intent to use new information technology (including mHealth). The Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) framework was used to measure the outcomes.

Discussion

Our research project can serve as a case study of a potential approach to combining different models/frameworks to help organize and plan the evaluation of interventions to increase medication adherence. The description of our process may serve as a blueprint for future studies developing and testing new strategies to foster evidence-based treatments for individuals living with SCD.

International comparability of reference unit costs of education services: when harmonizing methodology is not enough (PECUNIA project)

BACKGROUND

Health problems can lead to costs in the education sector. However, these costs are rarely incorporated in health economic evaluations due to the lack of reference unit costs (RUCs), cost per unit of service, of education services and of validated methods to obtain them. In this study, a standardized unit cost calculation tool developed in the PECUNIA project, the PECUNIA RUC Template for services, was applied to calculate the RUCs of selected education services in five European countries.

METHODS

The RUCs of special education services and of educational therapy were calculated using the information collected via an exploratory gray literature search and contact with service providers.

RESULTS

The RUCs of special education services ranged from €55 to €189 per school day. The RUCs of educational therapy ranged from €6 to €25 per contact and from €5 to €35 per day. Variation was observed in the type of input data and measurement unit, among other.

DISCUSSION

The tool helped reduce variability in the RUCs related to costing methodology and gain insights into other aspects that contribute to the variability (e.g. data availability). Further research and efforts to generate high quality input data are required to reduce the variability of the RUCs.

Methodological advancements in costing methods for (public) health economic evaluations: results from the European PECUNIA project

(Public) health economic evaluations face significant problems regarding the standardization and comparability of their methods. In addition, at least a quarter of the total direct cost impact of healthcare interventions affects other economic sectors. International methods and tools are lacking for the rigorous and comparable assessment of the costs and outcomes of (public) health care from a societal perspective. The H2020 PECUNIA project (grant No 779292) brought together ten partners from six countries (AT/DE/ES/HU/NL/UK) between 2018 and 2021 aiming to improve the comparability and feasibility of multi-sectoral, multi-national health economic evaluations in Europe. A multi-step, mixed methods approach was used following a new harmonized costing concept to develop new methods and tools for the standardised identification, definition, measurement and valuation of costs in multiple sectors (health care, social care, (criminal) justice, education, employment and productivity, and patient, family and informal care), and for the broader, harmonised, supra-national assessment of outcomes using selected mental disorders as illustrative examples. This presentation will summarise the relevant advances in costing methods, give an overview of the developed tools that are now publicly available (www.pecunia-project.eu/tools), and discuss the lessons learned regarding how far it is possible to harmonize costing evidence with standardised tools in Europe, and what the necessary future research directions may be.

Left atrial anatomical variations correlate with atrial fibrillation sources near the left atrial ridge

Funding Acknowledgements

Type of funding sources: None.

Background

Anatomical variations and characteristics of the left atrium (LA) may have a previously undescribed effect on source locations in atrial fibrillation (AF). Electrographic flow (EGF) mapping is a novel method used to estimate cardiac action potential flow in the atria that can detect AF sources in patients with persistent AF. The EGF technology offers a revolutionary mapping possibility for AF, however, it is not commercially available yet.

Purpose

This is the first study aiming to investigate the relationship between anatomical characteristics of the LA and non-PV sources detected by EGF in patients with persistent AF.

Methods

We collected cardiac computed tomography (CT) and EGF data from patients who underwent radiofrequency catheter ablation (CA) for persistent AF. EGF mapping creates a spatial and temporal reconstruction of electric potentials derived from endocardial unipolar electrograms. By analyzing EGF maps obtained during CA procedures, we localized non-PV sources in the LA. Patients with individual stable sources with a source activity above threshold (leading source present in more than > 26% of the time) were classified as having an S-Type EGF signature with source-dependent AF. Patients with no stable active source pattern and no leading source with a source activity above threshold were characterized as having a C-Type EGF signature consistent with source-independent AF. We assessed LA anatomical characteristics including size, LAA length, LAA ostial diameter, trajectory of the left superior pulmonary vein (LSPV) and its relation to the LAA on cardiac CT scans. Abutting LAA-LSPV was defined as cases when the LSPV touched the posterior aspect of LAA, and the maximal distance between the two structures was less than 2 mm. Those cases where the distance between LAA and LSPV was more than 2 mm were defined as non-abutting LAA-LSPV.

Results

Thirty patients were included in this study (mean age 62.4±6.8 years):23 patients had an S-Type EGF signature (77%), and 7 patients had a C-Type EGF signature (23%). We identified 10 patients with AF sources near the LA ridge, while twenty patients had no leading source near the LA ridge. LA anatomical characteristics, LAA length and ostial diameter showed no correlation with the presence of a leading source near the ridge. We described 19 patients with abutting LAA-LSPV, and 11 patients with non-abutting LAA-LSPV. Three out of 19 patients presented with a leading source near ridge in the abutting LAA-LSPV group, while 7 out of 11 patients presented with a leading source near ridge in the non-abutting LAA-LSPV group (p=0.01).

Conclusion

Our data suggests that non-abutting LAA-LSPV is associated with the presence of AF sources near the LA ridge.

Association of daily coffee consumption with cardiovascular health – results from the UK Biobank

Background

There are conflicting reports on the association of coffee consumption with cardiovascular (CV) health. The UK Biobank is a prospective cohort study including data for half a million middle-aged individuals.

Purpose

We studied the association of daily coffee consumption with all-cause and CV mortality, and incidence of the major CV diseases in the UK Biobank. In a subgroup of participants who underwent cardiovascular magnetic resonance (CMR), we evaluated the association between regular coffee intake and cardiac structure and function parameters.

Methods

UK Biobank cohort of participants without clinically manifested heart disease at the time of recruitment were included. Regular coffee intake was categorized into 3 groups: zero, light-to-moderate (0.5–3 cups/day) and high (>3 cups/day) coffee drinkers. We estimated association of daily coffee consumption with incident outcomes using multivariable Cox-regression models (median follow-up of 11 years) and, in the subset with CMR data, with left and right ventricular (LV, RV) end-systolic and end-diastolic volumes, LV mass, and LV/RV stroke volume using multivariable linear regression. Models were adjusted for potential confounders and mediators, including: age, sex, non-European ethnicities, body mass index, smoking, physical activity, Townsend deprivation index, alcohol, meat, fruit and vegetable intake, hypertension, diabetes mellitus, and cholesterol level.

Results

We included 468,629 individuals (mean age 56.2±8.1 years, 44.2% male). Among them, 22.1% did not consume coffee on a regular basis, 58.4% had 0.5–3 cups per day and 19.5% had >3 cups per day. After adjustment for potential confounders and mediators, compared to non-coffee drinkers, light-to-moderate coffee drinking was associated with lower risk of all-cause mortality (HR=0.88, p<0.001), CV mortality (HR=0.83, p=0.006), and incident stroke (HR=0.79; p=0.037). CMR data were available in 30,650 participants. In multivariable analysis, compared to non-coffee drinkers, both the light-to-moderate and high coffee consuming categories, were associated with significantly increased LV and RV ventricular end-systolic (β=0.91 and 1.64 for LV and 1.10 and 1.72 for RV), end-diastolic (β=2.21 and 3.28 for LV and 2.24 and 3.35 for RV) and stroke volumes (β=1.31 and 1.64 for LV and 1.15 and 1.63 for RV), as well as greater LV mass (β=0.78 and 1.64; all p<0.001).

Conclusion

In this large study of the UK Biobank population, regular coffee consumption of up to 3 cups per day was associated with favorable cardiovascular outcomes, in particular, decreased all-cause and CV mortality and stroke incidence. Regular coffee consumption was also associated with a pattern of CMR metrics in keeping with the reverse of age-related cardiac alterations.

Funding Acknowledgement

Type of funding sources: None.

Left atrial appendage size is a marker of atrial fibrillation recurrence after radiofrequency catheter ablation in patients with persistent atrial fibrillation

Background

Catheter ablation is an established therapy for rhythm control in patients with drug-refractory atrial fibrillation (AF), however, recurrence is frequent particularly in persistent AF. There are no consistently confirmed predictors of AF recurrence after catheter ablation. The left atrial appendage (LAA) potentially plays an important role in AF recurrence, although the exact mechanism and pathophysiology are still unclear.

Purpose

We aimed to study whether LAA volume (LAAV) and function influence the long-term recurrence of AF after point-by-point radiofrequency catheter ablation, depending on AF type.

Methods

AF patients who underwent point-by-point radiofrequency catheter ablation after preprocedural cardiac computed tomography (CT) and transthoracic and transesophageal echocardiography (TEE) were included in this retrospective analysis. LAAV and LAA orifice area were measured by CT and LAA flow velocity assessed by TEE and was used as a surrogate marker of LAA function. Uni- and multivariable Cox proportional hazard regression models were performed to determine the predictors of AF recurrence.

Results

In total, 561 AF patients (61.9±10.2 years, 34.9% females) were included in the study. Recurrence of AF was detected in 40.8% of the cases (34.6% in patients with paroxysmal and 53.5% in those with persistent AF) with a median recurrence-free time of 22.7 [9.3–43.1] months. Patients with AF recurrence had significantly higher body surface area-indexed left atrial volume (iLAV), LAAV and LAA orifice area, as compared to those without recurrence. Moreover, patients with persistent AF had significantly higher iLAV, LAAV, LAA orifice area and lower LAA flow velocity, than those with paroxysmal AF. After adjustment for the main cardiovascular risk factors and comorbidities left ventricular ejection fraction (LVEF) <50% (HR=2.17; 95% CI=1.38–3.43; p<0.001) and LAAV (HR=1.06; 95% CI=1.01–1.12; p=0.029) were independently associated with AF recurrence in persistent AF, while no independent predictors could be identified in paroxysmal AF.

Conclusions

The current study demonstrates that beyond left ventricular systolic dysfunction, LAA enlargement is associated with higher rate of AF recurrence after catheter ablation in persistent AF, but not in patients with paroxysmal AF. Our results suggest that preprocedural assessment of LVEF and LAAV might contribute to optimal patient selection and aid to improve long-term results of ablation procedures in patients with persistent AF.

Funding Acknowledgement

Type of funding sources: None.

Adverse coronary plaque characteristics are more common in patients with diabetes

Introduction

Diabetes mellitus (DM) is associated with increased cardiovascular morbidity and mortality. However, there is a lack of data about the prevalence of adverse coronary artery plaques characteristics in patients with DM.

Purpose

In our study we aimed to compare the prevalence of adverse atherosclerotic coronary artery plaque characteristics between patients with and without DM.

Methods

We have analyzed the data of patients who underwent coronary computed tomography angiography (CCTA) between October 2012 and December 2020. Our exclusion criteria were coronary anomaly, congenital or other structural heart disease, previous revascularization or heart transplantation, non-diagnostic image quality and no available data on the presence of DM. Patients were divided into two groups based on the presence of DM.

Results

In total, 11,357 patients were included in our study. Prevalence of DM was 14.5%. There were significant differences in age (63.2±9.5 vs 58.1±12.2 years, p<0.001) and major cardiovascular risk factors such as hypertension, dyslipidemia and smoking between the two groups (all p<0.05). We have measured higher coronary artery calcium score in patients with DM vs. without DM (424.3±744.0 vs 174.2±794.6, p<0.001). Obstructive coronary artery disease (stenosis >70%) was more frequent in the DM group (24.6% vs 10.5%, p<0.001). While 29.6% of patients without DM had at least one plaque with adverse characteristics, this rate was 38.9% in those with DM (positive remodeling: 19.6% vs 26.1%, low attenuation: 7.6% vs 10.2%, spotty calcium: 16.9% vs 21.6%, napkin-ring sign: 1.7% vs 2.6%, all p<0.05).

Conclusions

The prevalence of severe coronary artery stenosis and coronary plaques with adverse characteristics was higher in patients with DM. Multivariate analysis is needed to further explore this association.

Funding Acknowledgement

Type of funding sources: None.