Beyond pulmonary rehabilitation: can the PICk UP programme fill the gap? A randomised trial in COPD

INTRODUCTION AND OBJECTIVES

Pulmonary rehabilitation (PR) is a fundamental intervention to manage COPD, however, maintaining its benefits is challenging. Engaging in physical activity might help to prolong PR benefits. This study assessed the efficacy and effectiveness of a personalised community-based physical activity programme to sustain physical activity and other health-related PR benefits, in people with COPD.

MATERIALS AND METHODS

This was a multicentre, assessor blinded, randomised controlled trial. Following 12-weeks of PR, people with COPD were assigned to a six-months personalised community-based physical activity programme (experimental group), or to standard care (control group). Physical activity was assessed via: time spent in moderate to vigorous physical activities per day (primary outcome measure), steps/day and the brief physical activity assessment tool. Secondary outcomes included sedentary behaviour, functional status, peripheral muscle strength, balance, symptoms, emotional state, health-related quality of life, exacerbations and healthcare utilization. Assessments were performed immediately post-PR and after three- and six-months. Efficacy and effectiveness were evaluated using intention-to-treat and per-protocol analysis with linear mixed models.

RESULTS

Sixty-one participants (experimental group: n = 32; control group: n = 29), with balanced baseline characteristics between groups (69.6 ± 8.5 years old, 84 % male, FEV1 57.1 ± 16.7 %predicted) were included. Changes in all physical activity outcomes and in one-minute sit-to-stand were significantly different (P < 0.05) between groups at the six-month follow-up. In the remaining outcomes there were no differences between groups.

CONCLUSIONS

The community-based physical activity programme resulted in better physical activity levels and sit-to-stand performance, six-months after completing PR, in COPD. No additional benefits were observed for other secondary outcomes.

Implementation of virtual pulmonary rehabilitation during the COVID-19 pandemic: Experiences and perceptions of patients and healthcare providers

BACKGROUND

Pulmonary rehabilitation (PR) plays an important role in the management of symptomatic patients with chronic respiratory diseases (CRD). While studies have investigated the feasibility and efficacy of virtual PR (VPR), it is important to understand the experiences of patients and healthcare providers (HCPs) during the rapid digital health transformation that occurred in the COVID-19 pandemic.

OBJECTIVES

To explore the experiences and perspectives of patients and HCPs who participated in VPR during the pandemic.

METHODS

Semi-structured interviews were conducted with CRD patients and HCPs. This study used a qualitative descriptive approach and a team-based inductive thematic analysis.

RESULTS

Participants included 11 HCPs (7 female; 29-55 years) and 19 CRD patients (11 male; 62-83 years; 15 COPD, 4 COPD/ILD). Three major themes and 10 subthemes were identified: i) the pandemic response: a 'trial by fire' (navigating uncertainty, emotional impact of change, shifting practice amid complexity); ii) beyond the emergency: navigating a 'new normal' (eligibility and assessment for VPR, virtual exercise, virtual education and resources, clinical supervision and patient safety); and iii) care beyond boundaries: the implications of using technology for PR (benefits and limitations of technology, psychosocial implications, VPR in the future).

CONCLUSION

The pivot to VPR was acknowledged as positive by both patients and HCPs although both groups were mindful of the implementation challenges. These findings provide insight into the experience of HCPs and patients in introducing VPR in response to the pandemic and will inform future implementation of VPR for individuals with CRD.

Rapid assessment of data systems for COVID-19 vaccination in the WHO African Region

Most countries in Africa deployed digital solutions to monitor progress in rolling out COVID-19 vaccines. A rapid assessment of existing data systems for COVID-19 vaccines in the African region was conducted between May and July 2022, in 23 countries. Data were collected through interviews with key informants, identified among senior staff within Ministries of Health, using a semi-structured electronic questionnaire. At vaccination sites, individual data were collected in paper-based registers in five countries (21.7%), in an electronic registry in two countries (8.7%), and in the remaining 16 countries (69.6%) using a combination of paper-based and electronic registries. Of the 18 countries using client-based digital registries, 11 (61%) deployed the District Health Information System 2 Tracker, and seven (39%), a locally developed platform. The mean percentage of individual data transcribed in the electronic registries was 61% ± 36% standard deviation. Unreliable Internet coverage (100% of countries), non-payment of data clerks' incentives (89%), and lack of electronic devices (89%) were the main reasons for the suboptimal functioning of digital systems quoted by key informants. It is critical for investments made and experience acquired in deploying electronic platforms for COVID-19 vaccines to be leveraged to strengthen routine immunization data management.

Unsupervised physical activity interventions for people with COPD: A systematic review and meta-analysis

INTRODUCTION AND OBJECTIVES

Unsupervised PA interventions might have a role in the management of chronic obstructive pulmonary disease (COPD) but their effectiveness is largely unknown. Thus, we aimed to identify and synthesise data on the effects of unsupervised PA interventions in people with COPD.

MATERIAL AND METHODS

Databases were systematically searched in April 2020, with weekly updates until September 2021. Randomised controlled trials and quasi-experimental studies comparing unsupervised PA with usual care, were included. Primary outcomes were dyspnoea, exercise capacity and physical activity. The effect direction plot was performed to synthesise results. Meta-analysis with forest plots were conducted for the Chronic Respiratory Disease questionnaire - dyspnoea domain (CRQ-D), 6-minute walk distance (6MWD) and incremental shuttle walk distance (ISWD).

RESULTS

Eleven studies with 900 participants with COPD (68±10 years; 58.8% male, FEV1 63.7±15.8% predicted) were included. All interventions were conducted at home, most with daily sessions, for 8-12 weeks. Walking was the most common component. The effect direction plot showed that unsupervised PA interventions improved emotional function, fatigue, health-related quality of life, muscle strength and symptoms of anxiety and depression. Meta-analysis showed statistical, but not clinical, significant improvements in dyspnoea (CRQ-D, MD=0.12, 95% CI 0.09-0.15) and exercise capacity, measured with 6MWD (MD=13.70, 95% CI 3.58-23.83). Statistical and clinical significant improvements were observed in exercise capacity, measured with ISWD (MD=58.59, 95% CI 5.79-111.39). None to minor adverse events and a high adherence rate were found.

CONCLUSIONS

Unsupervised PA interventions benefits dyspnoea and exercise capacity of people with COPD, are safe and present a high adherence rate. Unsupervised PA interventions should be considered for people with COPD who cannot or do not want to engage in supervised PA interventions or as a maintenance strategy of PA levels.

The effect of digital interventions on related health literacy and skills for individuals living with chronic diseases: A systematic review and meta-analysis

BACKGROUND

Chronic diseases are a leading cause of death and disease burden globally. Digital interventions could be an approach to improve patients' ability to find, evaluate, and use health information.

OBJECTIVES

The main objective was to conduct a systematic review to determine the effect of digital interventions on digital health literacy for patients living with chronic disease. Secondary objectives were to provide an overviewof the design and delivery characteristics of interventions that impact digital health literacy in people with chronic disease.

METHODS

Randomized controlled trials examining digital health literacy (and related components) for individuals with cardiovascular disease, chronic lung disease, osteoarthritis, diabetes, chronic kidney disease, and HIV were identified. This review was conducted following the PRIMSA guidelines. Certainty was assessed using GRADE and the Cochrane risk of bias tool. Meta-analyses were conducted using Review Manager 5.1. The protocol was registered on PROSPERO (CRD42022375967).

RESULTS

9386 articles were identified and 17 articles representing 16 unique trials were included. Studies evaluated 5138 individuals with one or more chronic conditions (50% women, ages 42 ± 7-71 ± 12 years). The most targeted conditions were cancer, diabetes, cardiovascular disease, and HIV. Interventions included: skills training, websites, electronic personal health records, remote patient monitoring, and education. The effects of the interventions were related to: (i) digital health literacy, (ii) health literacy, (iii) health information skills, (iv) technology skills and access, and (v) self-management and participation in care. A meta-analysis of three studies identified the effect of digital interventions was better than usual care for eHealth literacy (1.22 [CI 0.55, 1.89], p < 0.001).

CONCLUSIONS

The evidence of the effects of digital interventions on related health literacy is limited. Existing studies reflect the heterogeneity in study design, population, and outcome measures. There is a need for further studies on the effects of digital interventions on related health literacy for individuals with chronic conditions.

Dark Energy Survey Year 1 Results: Cosmological Constraints from Cluster Abundances, Weak Lensing, and Galaxy Correlations

We present the first joint analysis of cluster abundances and auto or cross-correlations of three cosmic tracer fields: galaxy density, weak gravitational lensing shear, and cluster density split by optical richness. From a joint analysis (4×2pt+N) of cluster abundances, three cluster cross-correlations, and the auto correlations of the galaxy density measured from the first year data of the Dark Energy Survey, we obtain Ω_{m}=0.305_{-0.038}^{+0.055} and σ_{8}=0.783_{-0.054}^{+0.064}. This result is consistent with constraints from the DES-Y1 galaxy clustering and weak lensing two-point correlation functions for the flat νΛCDM model. Consequently, we combine cluster abundances and all two-point correlations from across all three cosmic tracer fields (6×2pt+N) and find improved constraints on cosmological parameters as well as on the cluster observable-mass scaling relation. This analysis is an important advance in both optical cluster cosmology and multiprobe analyses of upcoming wide imaging surveys.

Constraints on Dark Matter Properties from Observations of Milky Way Satellite Galaxies

We perform a comprehensive study of Milky Way (MW) satellite galaxies to constrain the fundamental properties of dark matter (DM). This analysis fully incorporates inhomogeneities in the spatial distribution and detectability of MW satellites and marginalizes over uncertainties in the mapping between galaxies and DM halos, the properties of the MW system, and the disruption of subhalos by the MW disk. Our results are consistent with the cold, collisionless DM paradigm and yield the strongest cosmological constraints to date on particle models of warm, interacting, and fuzzy dark matter. At 95% confidence, we report limits on (i) the mass of thermal relic warm DM, m_{WDM}>6.5  keV (free-streaming length, λ_{fs}≲10h^{-1}  kpc), (ii) the velocity-independent DM-proton scattering cross section, σ_{0}<8.8×10^{-29}  cm^{2} for a 100 MeV DM particle mass [DM-proton coupling, c_{p}≲(0.3  GeV)^{-2}], and (iii) the mass of fuzzy DM, m_{ϕ}>2.9×10^{-21}  eV (de Broglie wavelength, λ_{dB}≲0.5  kpc). These constraints are complementary to other observational and laboratory constraints on DM properties.

An evaluation of assumptions underlying respondent-driven sampling and the social contexts of sexual and gender minority youth participating in HIV clinical trials in the United States

Introduction:

Respondent-driven sampling has been an effective sampling strategy for HIV research in many settings, but has had limited success among some youth in the United States. We evaluated a modified RDS approach for sampling Black and Latinx sexual and gender minority youth (BLSGMY) and evaluates how lived experiences and social contexts of BLSGMY youth may impact traditional RDS assumptions.

Methods:

RDS was implemented in three cities to engage BLSGMY in HIV prevention or care intervention trials. RDS was modified to include targeted seed recruitment from venues, internet, and health clinics, and provided options for electronic or paper coupons. Qualitative interviews were conducted among a sub-sample of RDS participants to explore their experiences with RDS. Interviews were coded using RDS assumptions as an analytic framework.

Results:

Between August 2017 and October 2019, 405 participants were enrolled, 1,670 coupons were distributed, with 133 returned, yielding a 0.079 return rate. The maximum recruitment depth was 4 waves among seeds that propagated. Self-reported median network size was 5 (IQR 2–10) and reduced to 3 (IQR 1–5) when asked how many peers were seen in the past 30 days. Qualitative interviews (n=27) revealed that small social networks, peer trust, and targeted referral of peers with certain characteristics challenged network, random recruitment, and reciprocity assumptions of RDS. HIV stigma and research hesitancy were barriers to participation and peer referral.

Conclusions:

Small social networks and varying relationships with peers among BLSGMY challenge assumptions that underlie traditional RDS. Modified RDS approaches, including those that incorporate social media, may support recruitment for community-based research but may challenge assumptions of reciprocal relationships. Research hesitancy and situational barriers must be addressed in recruitment and study designs.

Detection of Cross-Correlation between Gravitational Lensing and γ Rays

In recent years, many γ-ray sources have been identified, yet the unresolved component hosts valuable information on the faintest emission. In order to extract it, a cross-correlation with gravitational tracers of matter in the Universe has been shown to be a promising tool. We report here the first identification of a cross-correlation signal between γ rays and the distribution of mass in the Universe probed by weak gravitational lensing. We use data from the Dark Energy Survey Y1 weak lensing data and the Fermi Large Area Telescope 9-yr γ-ray data, obtaining a signal-to-noise ratio of 5.3. The signal is mostly localized at small angular scales and high γ-ray energies, with a hint of correlation at extended separation. Blazar emission is likely the origin of the small-scale effect. We investigate implications of the large-scale component in terms of astrophysical sources and particle dark matter emission.

Enumeration and Confirmation of Bacillus cereus in Foods: Collaborative Study

A collaborative study was conducted in 15 laboratories to evaluate 2 different techniques for enumerating Bacillus cereus in foods. A direct plating technique using mannitol-egg yolk-polymyxin agar and a most probable number (MPN) technique using trypticase-soy-polymyxin broth were compared for the enumeration of high and low populations of B. cereus in mashed potatoes. The collaborative results showed that the overall mean recovery obtained with the low population level was essentially the same by both techniques. However, the overall mean recovery was significantly higher by the direct plating technique at the high population level. A statistical evaluation of the data also showed that the direct plating technique had better repeatability and reproducibility than did the MFN technique at both the high and low population levels. These results suggest that the MPN technique is suitable for examining foods containing low populations of B. cereus, but that the direct plating technique is preferable for foods that contain a high population of this organism. The confirmatory technique used in the proposed method is reliable for presumptive identification of isolates as B. cereus. The method has been adopted as official first action.

Rappaport-Vassiliadis Medium for Recovery of Salmonellaspp. from Low Microbial Load Foods: Collaborative Study

Twenty-three laboratories participated in a collaborative study to compare the relative effectiveness of Rappaport-Vassiliadis (RV) medium incubated at 42°C, selenite cystine (SC) broth (35°C), and tetrathionate (TT) broth (35 and 43°C) for recovery of Salmonella from the following foods with a low microbial load: dried egg yolk, dry active yeast, ground black pepper, guar gum, and instant nonfat dry milk. For dry active yeast, lauryl tryptose (LT) broth, incubated at 35°C, was used instead of SC broth. All of the foods were artificially inoculated with single Salmonella serovars, that had been lyophilized before inoculation, at high and low target levels of 0.4 and 0.04 colony forming units/g food, respectively. For analysis of 870 test portions, representing all of the foods except yeast, 249 Salmonella-positive test portions were detected by RV medium, 265 by TT broth (43°C), 268 by TT broth (35°C), and 269 by SC broth (35°C). For analysis of 225 test portions of yeast, 79 Salmonella-positive test portions were detected by RV medium, 79 by TT broth (43°C), 84 by TT broth (35°C), and 68 by LT broth (35°C). RV medium was comparable to, or even more effective than, the other selective enrichments for recovery of Salmonella from all of the foods except guar gum. It is recommended that RV (42°C) and TT (35°C) be used with foods that have a low microbial load, except for guar gum for which SC (35°C) and TT (35°C) are recommended.

Detection of CMB-Cluster Lensing using Polarization Data from SPTpol

We report the first detection of gravitational lensing due to galaxy clusters using only the polarization of the cosmic microwave background (CMB). The lensing signal is obtained using a new estimator that extracts the lensing dipole signature from stacked images formed by rotating the cluster-centered Stokes QU map cutouts along the direction of the locally measured background CMB polarization gradient. Using data from the SPTpol 500  deg^{2} survey at the locations of roughly 18 000 clusters with richness λ≥10 from the Dark Energy Survey (DES) Year-3 full galaxy cluster catalog, we detect lensing at 4.8σ. The mean stacked mass of the selected sample is found to be (1.43±0.40)×10^{14}M_{⊙} which is in good agreement with optical weak lensing based estimates using DES data and CMB-lensing based estimates using SPTpol temperature data. This measurement is a key first step for cluster cosmology with future low-noise CMB surveys, like CMB-S4, for which CMB polarization will be the primary channel for cluster lensing measurements.

Cosmological Constraints from Multiple Probes in the Dark Energy Survey

The combination of multiple observational probes has long been advocated as a powerful technique to constrain cosmological parameters, in particular dark energy. The Dark Energy Survey has measured 207 spectroscopically confirmed type Ia supernova light curves, the baryon acoustic oscillation feature, weak gravitational lensing, and galaxy clustering. Here we present combined results from these probes, deriving constraints on the equation of state, w, of dark energy and its energy density in the Universe. Independently of other experiments, such as those that measure the cosmic microwave background, the probes from this single photometric survey rule out a Universe with no dark energy, finding w=-0.80_{-0.11}^{+0.09}. The geometry is shown to be consistent with a spatially flat Universe, and we obtain a constraint on the baryon density of Ω_{b}=0.069_{-0.012}^{+0.009} that is independent of early Universe measurements. These results demonstrate the potential power of large multiprobe photometric surveys and pave the way for order of magnitude advances in our constraints on properties of dark energy and cosmology over the next decade.

Sepsis caused by bloodstream infection in patients in the intensive care unit: the impact of inactive empiric antimicrobial therapy on outcome

BACKGROUND

Sepsis is one of the leading causes of death in the UK.

AIMS

To identify the rate of inactive antimicrobial therapy (AMT) in the intensive care unit (ICU) and whether inactive AMT has an effect on in-hospital mortality, ICU mortality, 90-day mortality and length of hospital stay. A further aim was to identify risk factors for receiving inactive AMT.

METHODS

This was a retrospective observational study conducted at Glasgow Royal Infirmary ICU between January 2010 and December 2013. In total, 12,000 blood cultures were taken over this time period, of which 127 were deemed clinically significant. Multi-variate logistic regression was used to identify risk factors independently associated with mortality. Univariate analysis followed by multi-variate analysis was performed to identify risk factors for receiving inactive AMT.

RESULTS

The rate of inactive AMT was 47% (N = 60). Multi-variate analysis showed that receiving antibiotics within the first 24h of ICU admission led to reduced mortality [relative risk 1.70, 95% confidence interval (CI) 1.19-2.44]. Furthermore, it showed that severity of illness (as defined by SIRS criteria sepsis vs septic shock) increased mortality [odds ratio (OR) 9.87, 95% CI 1.73-55.5]. However, inactive AMT did not increase mortality (OR 1.07, 95% CI 0.47-2.41) or length of hospital stay (53.2 vs 69.1 days, P = 0.348). Fungal bloodstream infection was found to be a risk factor for receiving inactive AMT (OR 5.10, 95% CI 1.29-20.14).

CONCLUSION

Mortality from sepsis is influenced by multiple factors. This study was unable to demonstrate that inactive AMT had an effect on mortality in sepsis.

Anastomosis to the common and proper digital vessels in free flap soft tissue reconstruction of the hand

OBJECTIVE

This study seeks to demonstrate the safety of anastomosing free flaps to the common or proper digital artery, and to the volar or dorsal digital vein in soft tissue reconstruction of the hand; as well, as to discuss the advantages of this technique.

METHODS

Retrospective review of all patients who underwent free flap reconstruction of the hand in two institutions over a period of 5 years.

RESULTS

A total of 29 free flaps (9 great toe pulp, 7 anterolateral thigh, 6 second toe pulp, 4 radial artery perforator, 2 partial medial rectus, 1 lateral arm) in 28 patients met our inclusion criteria. All recipient vessels were the proper or common digital artery and the volar or dorsal digital vein. There was one case of venous congestion that resolved with leeching. There was no partial or total loss of any of the flaps.

CONCLUSION

Anastomosing soft tissue free flaps to the common or proper digital artery, and the volar or dorsal digital vein is a safe and effective approach with numerous advantages that should be considered in the reconstruction of soft tissue defects of the hand. © 2016 Wiley Periodicals, Inc. Microsurgery, 38:21-25, 2018.

Wide-Field Lensing Mass Maps from Dark Energy Survey Science Verification Data

We present a mass map reconstructed from weak gravitational lensing shear measurements over 139  deg2 from the Dark Energy Survey science verification data. The mass map probes both luminous and dark matter, thus providing a tool for studying cosmology. We find good agreement between the mass map and the distribution of massive galaxy clusters identified using a red-sequence cluster finder. Potential candidates for superclusters and voids are identified using these maps. We measure the cross-correlation between the mass map and a magnitude-limited foreground galaxy sample and find a detection at the 6.8σ level with 20 arc min smoothing. These measurements are consistent with simulated galaxy catalogs based on N-body simulations from a cold dark matter model with a cosmological constant. This suggests low systematics uncertainties in the map. We summarize our key findings in this Letter; the detailed methodology and tests for systematics are presented in a companion paper.