A proposal to embed patient and public involvement within qualitative data collection and analysis phases of a primary care based implementation study.

BACKGROUND: Patient and public involvement (PPI) is increasingly seen as essential to health service research. There are strong moral and ethical arguments for good quality PPI. Despite the development of guidance aimed at addressing the inconsistent reporting of PPI activities within research, little progress has been made in documenting the steps taken to undertake PPI and how it influences the direction of a study. Without this information, there are minimal opportunities to share learnings across projects and strengthen future PPI practices. The aim of this paper is to present details on the processes and activities planned to integrate PPI into the qualitative research component of a mixed-methods, multi-site study evaluating the implementation of a smart template to promote personalised primary care for patients with multiple long-term conditions. METHODS: This proposal describes the processes and activities planned to integrate PPI into the development and piloting of qualitative data collection tools (topic guides for both practice staff and patients) and a tailored data analysis package developed for PPI members incorporating broad concepts and specific methods of qualitative data analysis. DISCUSSION: Outputs relating to PPI activity may include clear, concise and suitably worded topic guides for qualitative interviews. Piloting of the topic guides via mock interviews will further develop researchers' skills including sensitisation to the experiences of participants being interviewed. Working with PPI members when analysing the qualitative data aims to provide reciprocal learning opportunities and may contribute to improving the overall rigour of the data analysis. The intent of publishing proposed PPI activities within this project is to inform the future delivery of high quality PPI.

Patient and public involvement (PPI) improves healthcare research, however, there is little published evidence of proposed PPI activities within a research study. The aim of this article is to describe the proposed PPI activities which are to be integrated into a study implementing a smart template to promote personalised care for people with multiple long-term conditions within primary care in the United Kingdom. The proposal describes the ways in which PPI members will be included within the data collection and analysis phases of a research study which includes interviews with primary care staff and patients. PPI members will be asked to develop questions for these interviews and to take part in a mock interview whereby a researcher interviews a PPI member. The proposal also provides details on qualitative data analysis workshops which will be specifically developed for PPI members. The impact of PPI activities could include clear, concise and suitably worded questions used within the interviews. Piloting of these questions via mock interviews may enable researchers to further develop their interviewing skills. It is anticipated that involving PPI members when analysing qualitative data will provide opportunities for reciprocal learning and lead to rich interpretations of the data, inclusive of the PPI members' perspectives. Publishing a record of planned PPI activities and potential impacts demonstrates the rationale and considerations made by the team to ensure that involvement in this study is meaningful and has potential benefits for all involved. The team hopes this proposal will support others with the planning and delivery of PPI activities. In future publications, we will reflect on the learnings, challenges, and outcomes from the PPI activities detailed in this proposal.

Accessibility and applicability of physical activity guidelines and recommendations for adults living with long term conditions during COVID-19.

To review the applicability and accessibility of physical activity guidelines for adults living with long-term conditions whilst shielding during the COVID-19. A narrative review with systematic methodology was conducted between 2015 and 2021, with two stages: 1) Search of electronic databases PubMed/Medline, Web of Science, PsycInfo, and Cinahl; 2) search of long-term condition organisations. Sixty-five articles were identified, where nine included specific guidelines during the COVID-19, 28 specific guidelines to individuals living with long-term conditions and 7 identified the utilization of online resources. Twenty-one long-term condition organizations websites were reviewed where all of them included a section regarding physical activity guidelines and seven referred to online and offline accessible resources during COVID-19. Accessibility and applicability were variable across academic databases and long-term conditions organisation websites. Findings could inform long-term condition policy and guidelines development to better and more relevant support people living with long-term conditions to be physically active.

Implementation of a multidisciplinary psychoeducational intervention for Parkinson's disease patients and carers in the community: study protocol.

BACKGROUND: Parkinson's disease progressively limits patients at different levels and as a result family members play a key role in their care. However, studies show lack of an integrative approach in Primary Care to respond to the difficulties and psychosocial changes experienced by them. The aim of this study is to evaluate the effects of a multidisciplinary psychoeducational intervention focusing on improving coping skills, the psychosocial adjustment to Parkinson's disease and the quality of life in patients and family carers in a Primary Care setting. METHODS: This quasi-experimental study with control group and mixed methods was designed to evaluate a multidisciplinary psychoeducational intervention. Based on the study power calculations, 100 people with Parkinson's disease and 100 family carers will be recruited and assigned to two groups. The intervention group will receive the ReNACE psychoeducational intervention. The control group will be given a general educational programme. The study will be carried out in six community-based health centres. The results obtained from the two groups will be collected for evaluation at three time points: at baseline, immediately after the intervention and at 6 months post-intervention. The results will be measured with these instruments: the Quality of Life Scale PDQ-39 for patients and the Scale of Quality of Life of Care-givers SQLC for family carers, and for all participants the Psychosocial Adjustment to Illness scale and the Brief COPE Inventory. Focus groups will be organised with some patients and family carers who will have received the ReNACE psychoeducational intervention and also with the healthcare professionals involved in its development. DISCUSSION: An important gap exists in the knowledge and application of interventions with a psychosocial approach for people with PD and family carers as a whole. This study will promote this comprehensive approach in Primary Care, which will clearly contribute in the existing knowledge and could reduce the burden of PD for patients and family carers, and also in other long-term conditions. TRIAL REGISTRATION: NCT03129425 (ClinicalTrials.gov). Retrospectively registered on April 26, 2017.

Diagnosis and quantification of the iron overload through Magnetic resonance. / Diagnóstico y cuantificación de la sobrecarga férrica mediante resonancia magnética.

There are different magnetic resonance techniques and models to quantify liver iron concentration. T2 relaxometry methods evaluate the iron concentration in the myocardium, and they are able to discriminate all the levels of iron overload in the liver. Signal intensity ratio methods saturate with high levels of liver overload and can not assess iron concentration in the myocardium but they are more accessible and are very standardized. This article reviews, in different clinical scenarios, when Magnetic Resonance must be used to assess iron overload in the liver and myocardium and analyzes the current challenges to optimize the aplication of the technique and to be it included in the clinical guidelines.

Bacterial distribution along a 50 °C temperature gradient reveals a parceled out hot spring environment.

Understanding the distribution of bacteria is a major goal of microbial ecology which remains to be fully deciphered. In this study, a model 50 °C temperature gradient at a Northern Thailand hot spring was analyzed to determine how the bacterial communities were structured in the environment. Communities were examined through 16S rRNA gene amplification, denaturing gradient gel electrophoresis, and sequencing. The two major phyla, Cyanobacteria and Chloroflexi, showed characteristic distributions along the temperature gradient. Different clades were allocated at specific portions of the gradient. Comparisons of the bacterial communities along the temperature gradient showed sharp decreases of similarity at increasing temperature difference. Peaks of maximum richness were observed at 50 and 70 °C. This study contributes to explain how environmental conditions and microbial interactions can influence the distribution of specific bacterial clades and phyla shaping the structure of microbial communities in nature.

[Key elements for patients and caregivers in the process of living with Parkinson's disease]. / Elementos clave en el proceso de convivencia con la enfermedad de Parkinson de pacientes y familiares cuidadores.

BACKGROUND: Parkinson's disease has a considerable impact on people's lives. It is necessary to identify the key elements that influence the process of living with Parkinson's disease so that health professionals can help patients and their relatives to live as well as possible with the changes and limitations produced by the disease. MATERIAL AND METHODS: A qualitative descriptive study was realized. This study corresponded to the first phase of a sequential, exploratory design (mixed method) that in turn included a quantitative phase. A multicentre project was carried out. Convenience sampling was applied to collect data, a semi-structured interview was realized individually with patients and carer-relatives and two questionnaires with patients: the Hoehn & Yahr scale and the PDNMS questionnaire. Content analysis of the interviews and a statistical description of the questionnaires were used. RESULTS: The sample was made up of 46 participants. Three key elements were identified in the process of living with Parkinson's disease: acceptance, adaptation and self-management. These elements conditioned the modes of living with Parkinson's disease: positive living, characterized by feelings of harmony, balance and naturalness; negative living characterized be feelings of frustration, loss of control and self-esteem. CONCLUSIONS: It is essential for health professionals to have a deep understanding of these elements, as well as of the factors that favor or hinder them. To the extent that research in this field progresses and effective interventions are identified, comprehensive patient care will be improved in consonance with the new directives for chronicity.

[The transition process from the intensive care unit to the ward: a review of the literature]. / El proceso de transición de la unidad de cuidados intensivos al área de hospitalización: una revisión bibliográfica.

UNLABELLED: The optimum transition process from the ICU to the ward is key to avoiding the appearance of anxiety in the patient and family, increase of re-admissions in the ICU with the consequent increase in costs and jeopardization to the patient's safety. OBJECTIVE: 1) To identify, study and give a critical presentation of the existing evidence on how patients, families and nurses experience the transition from ICU to the ward; 2) to analyze the possible interventions available for the development of an optimum transition process. METHODOLOGY: A review was made of the evidence available in the main databases. In addition, several journals specialized in Intensive Care were reviewed. Studies with a qualitative, quantitative or mixed approach and reviews on the subject with a systematic methodology or narrative reviews were included. RESULTS: A total of 23 papers were selected for review, 10 of which were qualitative studies, 11 quantitative and two had combined methodology. «Transfer anxiety¼ was identified after the analysis of these articles as one of the recurring aspects. Discrepancies regarding who should take responsibility for the preparation of the transition process and when it should be performed were also found. In the literature reviewed, several interventions have been proposed to facilitate an optimal transition process such as developing information brochures, creating a profile of practicing nursing liaison between the ICU and the ward and ICU discharge report. CONCLUSIONS: This review emphasizes the importance of taking into account the perspectives of patients, families and nurses to perform optimal planning of the transition of the patient from the ICU to the ward to ensure their safety.

[Liver and heart T2* measurement in secondary haemochromatosis]. / Medición del T2* hepático y cardíaco en la hemocromatosis secundaria.

OBJECTIVE: To determine whether there is iron overload by calculating the T2* value in the liver and myocardium in patients with secondary haemochromatosis. To analyse the correlation of the values obtained with the iron levels in blood, with the liver iron concentration (LIC) calculated using magnetic resonance (MR) imaging, and the correlation between them. MATERIAL AND METHODS: A total of 16 patients (13 males, 3 females), with a mean age of 61 years, were included and evaluated in the years 2008 and 2009. Fifteen of them had received multiple transfusions, and one was diagnosed with hereditary sideroblastic anaemia. The measurements included, blood ferritin, LIC by MRI, cardiac function using MRI and the T2* value by means of multi-echo sequences in the liver (TR/TE1/ΔTE/No of echos/α: 21/1,18/1.0/20/35°) and myocardium (26/1.04/0.8/30/60°). A correlation-regression analysis was performed by comparing the cardiac and liver T2* values with the ferritin, LIC and between each of them. RESULTS: A total of 13 patients had ferritin values greater than 1000ng/ml (median/minimum/maximum: 1762/294/3785ng/ml). An increased LIC greater than 80µmol/g (median/minimum/maximum: 125.4/41.2/241.5µmol/g) was observed in 13 patients. In all cases cardiac function was conserved, and in 15 cases the liver T2* value was less than 6.3ms. The myocardium T2* value was less than 20ms. in only one case. A high correlation was observed between the liver T2* values and the LIC (r:-0.912). The correlation was statistically significant between the liver T2* value and ferritin (r:-0.541). The correlations between myocardium T2* and ferritin, myocardium T2* and LIC, and myocardium T2* and liver T2* were not statistically significant. CONCLUSIONS: The liver T2* showed a high correlation with LIC and a statistically significant correlation with ferritin. No association was observed between the myocardium T2* values and ferritin in blood, the LIC or the liver T2* value.

[Patients' self-management of type 2 diabetes: a narrative review]. / El automanejo de los pacientes con diabetes tipo 2: una revisión narrativa.

According to the World Health Organization, the number of people with diabetes mellitus in 2030 will be 366 millions in the whole world, with diabetes mellitus type 2 having the highest prevalence. The current National Chronicity and Diabetes Strategies advocate patients' self-management programs and/or interventions. Nevertheless, lack of knowledge and inadequate attitudes hinder the associative relationship between patients and professionals that is required in these programs. This literature review aims to show the outstanding needs of type 2 diabetes mellitus patients when it comes to managing the illness. Thus, results from this literature review could lay the foundations for the development of effective future programs, helping professionals focus on patients' needs.

Mutualistic growth of the sulfate-reducer Desulfovibrio vulgaris Hildenborough with different carbohydrates.

Desulfovibrio vulgaris Hildenborough genome presents a phosphotransferase system putatively involved in the transport of carbohydrates. However, utilization of sugars by this sulfate-reducing bacterium has never been reported. Herein, we have observed proliferation of D. vulgaris Hildenborough with some carbohydrates, in mutualism with Stenotrophomonas maltophilia, a non-fermentative, gram-negative gammaproteobacterium, or Microbacterium, a gram-positive actinobacterium. These results suggest the importance of feedback interactions between different heterotrophic bacterial species including the alternative for D. vulgaris of exploiting additional organic resources and novel habitats. Thus, D. vulgaris strongly participates in the mineralization of carbohydrates both in complex natural and artificial systems.

Presence and potential role of thermophilic bacteria in temperate terrestrial environments.

Organic sulfur and nitrogen are major reservoirs of these elements in terrestrial systems, although their cycling remains to be fully understood. Both sulfur and nitrogen mineralization are directly related to microbial metabolism. Mesophiles and thermophiles were isolated from temperate environments. Thermophilic isolates were classified within the Firmicutes, belonging to the Geobacillus, Brevibacillus, and Ureibacillus genera, and showed optimum growth temperatures between 50°C and 60°C. Sulfate and ammonium produced were higher during growth of thermophiles both for isolated strains and natural bacterial assemblages. They were positively related to organic nutrient load. Temperature also affected the release of sulfate and ammonium by thermophiles. Quantitative, real-time reverse-transcription polymerase chain reaction on environmental samples indicated that the examined thermophilic Firmicutes represented up to 3.4% of the total bacterial community RNA. Temperature measurements during summer days showed values above 40°C for more than 10 h a day in soils from southern Spain. These results support a potential role of thermophilic bacteria in temperate terrestrial environments by mineralizing organic sulfur and nitrogen ruled by the existence and length of warm periods.

Microbial community fingerprinting by differential display-denaturing gradient gel electrophoresis.

Complex microbial communities exhibit a large diversity, hampering differentiation by DNA fingerprinting. Herein, differential display-denaturing gradient gel electrophoresis is proposed. By adding a nucleotide to the 3' ends of PCR primers, 16 primer pairs and fingerprints were generated per community. Complexity reduction in each partial fingerprint facilitates sample comparison.

CRISPR elements in the Thermococcales: evidence for associated horizontal gene transfer in Pyrococcus furiosus.

The presence and distribution of CRISPR (clustered regularly interspaced short palindrome repeat) elements in the archaeal order Thermococcales were analyzed. Four complete genome sequences from the species Pyrococcus abyssi, P. furiosus, P. horikoshii, and Thermococcus kodakaraensis were studied. A fragment of the genome of P. furiosus was flanked by CRISPR elements upstream and by a single element downstream. The composition of the gene sequences contained in this genome fragment (positions 699013 to 855319) showed significant differences from the other genes in the P. furiosus genome. Differences were observed in the GC content at the third codon positions and the frequency of codon usage between the genes located in the analyzed fragment and the other genes in the P. furiosus genome. These results represent the first evidence suggesting that repeated CRISPR elements can be involved in horizontal gene transfer and genomic differentiation of hyperthermophilic Archaea.

Pigment profiles and bacterial communities from Thailand thermal mats.

Differently colored layers of freshwater hot spring mats at Boekleung (Western Thailand) were studied. Temperatures ranged from over 50 up to 57 degrees C. Two mats were characterized: a laminated mat with a green and a red layers, and a monolayer, greenish-yellow mat. Bacterial communities in green, red, and yellow layers were investigated using molecular, culturing and pigment analysis methods. Pigment profiles covered a wide spectrum from chlorophylls to carotenoids. A green mat layer showed higher relative content of chlorophyll than yellow and red layers which presented higher proportion of carotenoids. Cyanobacterial isolates grow up to 55-56 degrees C and their pigment profiles showed a relatively high content of chlorophylls suggesting the importance of other bacterial groups in the mat pigment profiles. Bacterial communities were analyzed by 16S rDNA surveys showing Cyanobacteria and Chloroflexi as the mayor components of the community. Other significant members were Candidate Division OP10, Bacteroidetes, Planctomycetes and Actinobacteria. These results highlight a major participation of Cyanobacteria and Chloroflexi in thermal mat communities, and the preferential presence of Candidate Division OP10 in green mat layers. Differently colored mat layers showed characteristic bacterial communities which could be discriminated from pigment profiles and molecular surveys.

Is the availability of different nutrients a critical factor for the impact of bacteria on subterraneous carbon budgets?

Bacteria thriving in underground systems, such as karsts, adapt to use a variety of nutrients. Most of these nutrients derive from superficial processes. This study shows that bacteria are able to differentially induce carbonate precipitation or dissolution depending on the availability of nutrients for growth. Different bacterial strains isolated from caves, representing the most common components of these microbial communities, were cultured with different carbon and nitrogen sources (e.g., acetate, glucose, peptone, humic acids) and induced changes in pH were measured during growth. Carbonate can either precipitate or dissolve during bacterial growth. The induction of carbonate precipitates or their dissolution as a function of consumption of specific carbon sources revealed the existence of an active nutrient cycling process in karsts and links nutrients and environmental conditions to the existence of a highly significant carbon sink in subterraneous environments.

Three different phototrophic microbial communities colonizing a single natural shelter containing prehistoric paintings.

Three different cases of deterioration were identified in a single natural shelter containing prehistoric paintings. The microbial communities induced by run-off water, a black crust covering a portion of the shelter, and a cryptoendolithic microbial community, were studied. Molecular analyses based both on DNA and RNA were performed to identify the major components of these microbial communities present and metabolically active, respectively, at the studied location. While similar microbial communities were expected due to the proximity of the studied sites, clearly different communities were detected suggesting that specific microorganisms adapt to different micro-environments. Phototrophic microorganisms represented the major portion of total RNA and DNA in the studied microbial communities. Run-off water induced the presence of a large proportion of putative photosynthetic bacteria belonging to Chloroflexi. Different groups of bacteria were associated to phototrophs and were represented by Alpha, Beta, Delta, and Gammaproteobacteria, Acidobacteria, Actinobacteria, Bacteroidetes, and Planctomycetes. The present study confirms a need for careful monitoring of microbial communities associated to distinct cases of deterioration even within a single location, underlining the interest of phototrophic microorganisms as indicators of colonization on cultural heritage at natural shelters.

Differential microbial communities in hot spring mats from Western Thailand.

The microbial communities of freshwater hot spring mats from Boekleung (Western Thailand) were studied. Temperatures ranged from over 50 up to 57 degrees C. Green-, red-, and yellow colored mat layers were analyzed. In order to detect the major components of the microbial communities constituting the mat as well as the microorganisms showing significant metabolic activity, samples were analyzed using DNA- and RNA-based molecular techniques, respectively. Microbial community fingerprints, performed by denaturing gradient gel electrophoresis (DGGE), revealed clear differences among mat layers. Thermophilic phototrophic microorganisms, Cyanobacteria and Chloroflexi, constituted the major groups in these communities (on average 65 and 51% from DNA and RNA analyses, respectively). Other bacteria detected in the mat were Bacteroidetes, members of the Candidate Division OP10, Actinobacteria, and Planctomycetes. Differently colored mat layers showed characteristic bacterial communities and the major components of the metabolically active fraction of these communities have been identified.

Role of specific microbial communities in the bioavailability of iron in Doñana National Park.

The Doñana National Park contains highly complex microbial communities that play critical roles in the bioavailability and biogeochemical cycling of elements. In this study, we analyzed the formation of Fe-rich films on the surface of shallow waters at Doñana National Park as a model for future applications in bioremediation. Phytoplankton composition and abundance, physicochemical measurements, culture enrichments, and molecular detection of microorganisms were determined during this study. Natural samples were incubated in the laboratory and enrichments producing similar phenomena were obtained. Bacteria belonging to the genera Enterobacter were the major participants in surface Fe-film formation in laboratory enrichments. Film formation was dependent on wind exposure and only those sites protected from the direct influence of wind developed these films. A higher concentration of euglenophytes was found in the proximity of film-covered waters. Available iron (Fe2+) and total Fe concentrations were high (18.8 and 46.6 mg/L, respectively) underneath the surface film, and higher than in film-free waters and pore-sediment water. The concentration of phosphate and its availability were higher in the iron-rich film sediment, as 61% of total P was bound to iron oxy-hydroxides. Our results provide evidence of the link between P and Fe biogeochemical cycling in aquatic systems on sandy soils at the Doñana National Park. In addition, they provide significant insights into the bioavailability of these elements with potential interest in the role of microorganisms for metal sequestration in natural environments and utilization in bioremediation processes.

Statistical differences between relative quantitative molecular fingerprints from microbial communities.

Molecular fingerprints of microbial communities are a common method for the analysis and comparison of environmental samples. The significance of differences between microbial community fingerprints was analyzed considering the presence of different phylotypes and their relative abundance. A method is proposed by simulating coverage of the analyzed communities as a function of sampling size applying a Cramér-von Mises statistic. Comparisons were performed by a Monte Carlo testing procedure. As an example, this procedure was used to compare several sediment samples from freshwater ponds using a relative quantitative PCR-DGGE profiling technique. The method was able to discriminate among different samples based on their molecular fingerprints, and confirmed the lack of differences between aliquots from a single sample.

Metabolically active microbial communities of yellow and grey colonizations on the walls of Altamira Cave, Spain.

AIMS: To determine the major components of total and metabolically active microbial communities of yellow and grey colonizations threatening the conservation of palaeolithic paintings in Altamira Cave (Spain). METHODS AND RESULTS: Micro-organisms present in yellow and grey colonizations were determined from DNA analysis with those showing metabolic activity determined from RNA analysis. Microbial community fingerprints were obtained by denaturing gradient gel electrophoresis (DGGE) and 16S rDNA libraries were constructed from PCR amplified products. Proteobacteria was the most frequent bacterial phylum. Other phyla detected from RNA-based microbial surveys were Acidobacteria, Actinobacteria, Firmicutes, Nitrospirae and Gemmatimonadetes. The detected metabolically active micro-organisms represented only a fraction of the total bacterial community present in the studied colonizations as compared from DGGE analysis. CONCLUSIONS: The major bacterial participants in the development of yellow and grey colonizations in Altamira Cave were determined using RNA-based molecular techniques. Micro-organisms showing undetectable activity represent a potential risk for the conservation of these paintings if environmental conditions experience variations. SIGNIFICANCE AND IMPACT OF THE STUDY: Caves with palaeolithic paintings are affected by microbial deterioration. Assessing the composition of the microbial communities colonizing these caves represents a first stage to understand and control these colonizations.