Let's Move with Leon-A qualitative evaluation of a UK digital intervention to improve physical activity in people with a musculoskeletal condition.

OBJECTIVE: This article presents a qualitative evaluation of a 13-week digital intervention, 'Let's Move with Leon', designed to improve physical activity in people with a musculoskeletal condition. STUDY DESIGN: A qualitative evaluation embedded within a randomised controlled trial assessing the effectiveness of the intervention at improving self-reported physical activity. METHODS: A total of 184 participants received the intervention and were asked each week for 13 weeks to provide comment on their use and the usefulness of the digital physical activity behaviour change intervention. In addition, after 13 weeks, 12 participants took part in a semistructured interview to understand their use and the usefulness of the intervention. A thematic analysis was conducted on the combined qualitative data set. RESULTS: A total of 128 of the 184 intervention participants (70.11%) provided at least one qualitative comment over the course of the evaluation (mean number of comments per participant = 5); in total, 674 comments were received. The thematic analysis identified three themes: (1) dipping in and out, (2) one size does not fit all and (3) monitoring and feedback. The qualitative data suggest that participants used the intervention sporadically, dipping in and out due to other commitments, and competing programmes, their changing physical ability, confidence and motivation. Not getting off to a good start was detrimental to use; many wanted to come back to the programme at a more appropriate time. A 'one size fits' approach catered for some but not all participants. Whilst not a predetermined intervention component the act of monitoring levels of activity as a data collection method seemed to encourage physical activity but may also result in negative social comparisons. CONCLUSION: Digital physical activity behaviour change interventions are not one-size-fits-all; personalisation is key. Monitoring of activity by a named person can create commitment. Many dip in and out. Digital physical activity behaviour change interventions could complement physiotherapy exercises for people with musculoskeletal conditions. Signposting to local activities should be considered.

Applying and Assessing Participatory Approaches in an Environmental Flows Case Study.

Environmental flows (e-flows) management takes place within a complex social-ecological system, necessitating the involvement of diverse stakeholders and an appreciation of a range of perspectives and knowledge types. It is widely accepted that incorporating participatory methods into environmental flows decision-making will allow stakeholders to become meaningfully involved, improving potential solutions, and fostering social legitimacy. However, due to substantial structural barriers, implementing participatory approaches can be difficult for water managers. This paper assesses the effectiveness of an e-flows methodology that combines elements of structured decision-making and participatory modeling, whilst constrained by project resources. Three process-based objectives were identified by the group at the start of the process: improving transparency, knowledge exchange, and community ownership. We evaluated the success of the approach according to those objectives using semi-structured interviews and thematic analysis. In evaluating how well the participatory approach achieved the process objectives, we found that at least 80% of respondents expressed positive sentiment in every category (n = 15). We demonstrate that the values-based process objectives defined by the participant group are an effective tool for evaluating participatory success. This paper highlights that participatory approaches can be effective even in resource-constrained environments when the process is adapted to fit the decision-making context.

A new Bihari inequality and initial value problems of first order fractional differential equations.

We prove existence of solutions, and particularly positive solutions, of initial value problems (IVPs) for nonlinear fractional differential equations involving the Caputo differential operator of order α∈(0,1). One novelty in this paper is that it is not assumed that f is continuous but that it satisfies an Lp-Carathéodory condition for some p>1α (detailed definitions are given in the paper). We prove existence on an interval [0, T] in cases where T can be arbitrarily large, called global solutions. The necessary a priori bounds are found using a new version of the Bihari inequality that we prove here. We show that global solutions exist when f(t, u) grows at most linearly in u, and also in some cases when the growth is faster than linear. We give examples of the new results for some fractional differential equations with nonlinearities related to some that occur in combustion theory. We also discuss in detail the often used alternative definition of Caputo fractional derivative and we show that it has severe disadvantages which restricts its use. In particular we prove that there is a necessary condition in order that solutions of the IVP can exist with this definition, which has often been overlooked in the literature.

The effect of population model choice and network topologies on extinction time patterns in dendritic ecological networks.

Models of populations in habitat networks are vital for understanding and linking processes and patterns across individuals, environments, ecological interactions, and population structures. River ecosystem models combine the physical structure of the networks with the biological processes of the organisms using structural and functional models, respectively. Previous studies on dendritic river networks have employed different functional (population) models and either directly claimed or implied that the results illustrate general properties of actual river systems. However, these studies have used different approaches and assumptions when modeling population characteristics and behavior, and it is possible that inferences regarding a system may vary based on the combination of functional model and the spatial structure of a network. This study aims to understand if different functional models in river systems produce substantially different model results and, therefore, whether conclusions are model-dependent. We compare variation in extinction time and occupancy proportion of river networks with linear, trellis, dendritic and ring-lattice topologies, using three population models (uniform, age-class and individual based) and one metapopulation-based (patch-occupancy) model. Dendritic, linear, and trellis structures did not show notable differences among extinction times for any of the four models. The difference between topologies was higher for the patch-occupancy model compared to the three population models. There were significant differences in the variations of patch-occupancy between the metapopulation and the population models, but the three population models of differing complexity produced broadly similar results. Therefore, if the occupancy data is obtained based on local subpopulations, spatial arrangement and connectivity does not appear to be the sole predictor of single-species metapopulation responses. We conclude that the outputs from functional models are robust to assumptions and varying levels of detail as long as they contain at least some detail at the level of individuals within habitat nodes. Also, if we are modeling network-scale populations, models that include at least some detailed information on individuals are a far better choice than considering populations implicitly.

The reach and benefits of a digital intervention to improve physical activity in people with a musculoskeletal condition delivered during the COVID-19 pandemic in the UK.

AIM: To evaluate a digital intervention to improve physical activity in people in the UK with a musculoskeletal condition delivered during movement restrictions brought about because of the COVID-19 pandemic. METHOD: Service evaluation data collected from 26,041 participants over 5 months was assessed against national datasets to understand the reach and representativeness of the digital physical activity intervention. Measures to restrict the movement and interaction of people were in place during these 5 months. Cross-sectional data from 2752 participants across different stages of the 12-week programme assessed levels of physical activity and the components of behaviour as defined by the COM-B model (Capability, Opportunity, Motivation = Behaviour). Regression analysis investigated the relationship between programme stage and physical activity and the components of behaviour. RESULTS: In comparison to the UK population of people with a musculoskeletal condition, the intervention participants were over-represented by females, White, and inactive people. A cross-sectional analysis suggested that the number of participants regularly active increased by programme stage. Scores for the behavioural components of automatic and reflective motivation, physical and psychological capability, and physical opportunity were also improved by programme stage. CONCLUSION: The service evaluation suggests that the digital intervention, designed to improve physical activity in people with a musculoskeletal condition, could be beneficial during measures to restrict movement to slow the spread of infectious disease in those who are already motivated to become or stay active.

Online training resources to aid therapeutic radiographers in engaging in conversations about physical activity and diet: A mixed methods study.

INTRODUCTION: This study explored changes in therapeutic radiographers' (TRs) self-reported knowledge and skills to engage in conversations about physical activity and diet with people living with and beyond cancer following completion of publicly available online courses. METHODS: Participants were randomly assigned to two of five online courses that aim to support health professionals to engage in conversations about physical activity and diet in the oncology setting. Participants rated their agreement with 18 statements related to the COM-B (capability, opportunity and motivation-behaviour) model components following completion of an online course on healthy diet (n = 16) and physical activity (n = 21). Semi-structured telephone interviews (n = 21) were also conducted. Analysis of the interviews was guided by the Theoretical Domains Framework. RESULTS: Overall, the online courses were acceptable and the TRs in this study self-reported improved COM to deliver advice on physical activity and diet. The inclusion of the evidence and scientific rationale on the benefits of diet and physical activity, and also guidance on how to start conversations with patients were highlighted as important features of the courses. Suggestions for adaptations to the nutrition courses included the need for content that accounts for the side effects cancer patients experience while undergoing treatment. To support the implementation of training and the delivery of advice on these topics, multi-disciplinary working, organisational support and guidance around professional role boundaries were highlighted as important. CONCLUSION: Current publicly available online courses on physical activity and diet for oncology health professionals can reduce some barriers among TRs to providing advice to those living with and beyond cancer. IMPLICATIONS FOR PRACTICE: Existing online training courses could be used to support TRs to deliver physical activity and dietary advice in practice. Findings show that these courses can be disseminated within radiotherapy departments. The results also highlight a number of important considerations for the implementation of brief health behaviour advice and online training interventions on physical activity and diet within cancer care.

Timing of surgery for internal fixation of intracapsular hip fractures and complications at 1 year; a 32 year clinical study of 2,366 patients at a single center.

BACKGROUND: Timing of hip fracture surgery for the internal fixation of an intracapsular fracture remains controversial and few studies to date have been able to determine the optimum time to surgery in minimizing osteonecrosis and non-union with intracapsular fractures after fixation. METHODS: Using a local hip fracture database managed by the senior author over a 32 year period, those who underwent osteosynthesis following intracapsular fractures were assessed for risk of development of non-union and osteonecrosis. Multivariate regression analysis was performed focusing on factors that were predictive of complications. Patient demographics, time from injury to surgery, fixation method, fracture pattern and complications at one year were reported. The primary outcome was whether delay to surgery contributed to risk of complications, defined as non-union or osteonecrosis. Secondary outcomes assessed the contribution of other factors to these complications. RESULTS: 2,366 patients were identified with an average age of 74.7 years and 66.5% were female. 1189 (50.3%) of fractures were displaced. 481 (20.3%) had a complication at one year following fixation. 78 (3.3%) were fixed by DHS, 6 (0.3%) by cephalomedullary nail, (1257) 53.1% by cannulated screws and 1025 (43.3%) by Targon® screw. Multivariate regression revealed no significant correlation between delay to surgery and complication rates (OR 0.99, 95% CI 0.99, 1.01, p = 0.55). Significant variables include female sex (OR 2.03, 95% CI 1.58, 2.62, p<0.0001), fracture displacement (OR 4.8, 95% CI 3.79, 6.14, p<0.0001), independent mobility (OR 0.64, 95% CI 0.47, 0.87, p = 0.004) and use of Targon® screws compared to parallel screws (OR 0.61, 95% CI 0.48, 0.76, p<0.0001). CONCLUSIONS: Our study demonstrates no relationship between timing of surgery for fixation of intracapsular fracture and complication rates. Female sex and fracture displacement increased risk of complications whereas independent mobility and use of Targon® screw device in comparison to parallel screws were protective against non-union but not avascular necrosis.

Are multiple-use bottles of chlorhexidine solutions at risk of contamination in joint replacement surgery?

INTRODUCTION: Chlorhexidine gluconate 2% w/v in isopropanol 70% solutions in multiple-use bottles is commonly used in surgery as a cost-effective method for skin disinfection. However, multiple-use bottles risk contamination. This study aims to test whether bacterial contamination of multiple-use bottles or their solutions occurs once open and on use between different patients. METHODS: Consecutive samples were taken each time a chlorhexidine bottle was used over a 7-day study period. Samples were tested using blood culture, agar plate and mass spectrometry. RESULTS: No growth was observed in 52 samples taken from 18 bottles inoculated into blood culture bottles. Four growths on agar plate culture were determined to be contaminants from the sampling process. CONCLUSIONS: This study supports the use of multiple-use bottled chlorhexidine solutions as safe and cost-effective in surgical practice.

An in vitro biofilm model system to facilitate study of microbial communities of the human oral cavity.

The human oral cavity is host to a diverse microbiota. Much of what is known about the behaviour of oral microbes derives from studies of individual or several cultivated species, situations which do not totally reflect the function of organisms within more complex microbiota or multispecies biofilms. The number of validated models that allow examination of the role that biofilms play during oral cavity colonization is also limited. The CDC biofilm reactor is a standard method that has been deployed to study interactions between members of human microbiotas allowing studies to be completed during an extended period under conditions where nutrient availability, and washout of waste products are controlled. The objective of this work was to develop a robust in vitro biofilm-model system from a pooled saliva inoculum to study the development, reproducibility and stability of the oral microbiota. By employing deep sequencing of the variable regions of the 16S rRNA gene, we found that the CDC biofilm reactor could be used to efficiently cultivate microbiota containing all six major phyla previously identified as the core saliva microbiota. After an acclimatisation period, communities in each reactor stabilised. Replicate reactors were predominately populated by a shared core microbiota; variation between replicate reactors was primarily driven by shifts in abundance of shared operational taxonomic units. We conclude that the CDC biofilm reactor can be used to cultivate communities that replicate key features of the human oral cavity and is a useful tool to facilitate studies of the dynamics of these communities.

Influence of handler relationships and experience on health parameters, glucocorticoid responses and behaviour of semi-captive Asian elephants.

Declining wild populations combined with accumulating captive populations of e.g. livestock, pets, draught and zoo animals have resulted in some threatened species with substantial proportions of their populations in captivity. The interactions animals have with humans in captivity depend on handler familiarity and relationship quality and can affect animal health, growth and reproduction with consequences for the success of conservation programmes. However, assessments of how specific human-animal relationships affect a range of physiological and behavioural outcomes are rare. Here, we studied semi-captive Asian elephants with detailed records of elephant-handler (mahout) relationships and veterinary management, allowing assessment of multiple welfare indicators in relation to specific mahout-elephant relationship lengths and mahout experience. These included measures of physiological stress (faecal glucocorticoid metabolite [FGM], heterophil:lymphocyte ratio [H:L]), muscle damage (creatine kinase [CK]), immunological health (total white blood cell count [TWBC]) and behaviour (response to mahout verbal commands). We found no evidence that FGM or H:L related to aspects of the mahout-elephant relationship. Longer overall mahout experience (i.e. years of being a mahout) was linked to increased muscle damage and inflammation, but the lengths of specific mahout-elephant relationships were inversely associated with muscle damage in working-age elephants. Elephants responded more to familiar mahouts in behavioural tasks and faster to mahouts they had known for longer. In summary, our results found little evidence that the mahout-elephant relationship affects physiological stress in this population based on FGM and H:L, but mahout experience and relationships were linked to other physiological responses (CK, TWBC), and elephants require behavioural adjustment periods following mahout changes.

A multi-model approach to assessing the impacts of catchment characteristics on spatial water quality in the Great Barrier Reef catchments.

Water quality monitoring programs often collect large amounts of data with limited attention given to the assessment of the dominant drivers of spatial and temporal water quality variations at the catchment scale. This study uses a multi-model approach: a) to identify the influential catchment characteristics affecting spatial variability in water quality; and b) to predict spatial variability in water quality more reliably and robustly. Tropical catchments in the Great Barrier Reef (GBR) area, Australia, were used as a case study. We developed statistical models using 58 catchment characteristics to predict the spatial variability in water quality in 32 GBR catchments. An exhaustive search method coupled with multi-model inference approaches were used to identify important catchment characteristics and predict the spatial variation in water quality across catchments. Bootstrapping and cross-validation approaches were used to assess the uncertainty in identified important factors and robustness of multi-model structure, respectively. The results indicate that water quality variables were generally most influenced by the natural characteristics of catchments (e.g., soil type and annual rainfall), while anthropogenic characteristics (i.e., land use) also showed significant influence on dissolved nutrient species (e.g., NOX, NH4 and FRP). The multi-model structures developed in this work were able to predict average event-mean concentration well, with Nash-Sutcliffe coefficient ranging from 0.68 to 0.96. This work provides data-driven evidence for catchment managers, which can help them develop effective water quality management strategies.

Non-local second-order boundary value problems with derivative-dependent nonlinearity.

We prove the existence of multiple positive solutions of nonlinear second-order nonlocal boundary value problems with nonlinear term having derivative dependence. We allow the nonlinearity to grow quadratically with respect to derivatives. We obtain a priori bounds for norms of derivatives by using a recently obtained Gronwall-type inequality. Three examples illustrate some of the results. This article is part of the theme issue 'Topological degree and fixed point theories in differential and difference equations'.

Evaluating the Ecological Benefits of Management Actions to Complement Environmental Flows in River Systems.

Globally, many river systems are under stress due to overconsumption of water. Governments have responded with programmes to deliver environmental water to improve environmental outcomes. Although such programmes are essential, they may not be sufficient to achieve all desired environmental outcomes. The benefits of environmental water allocation may be improved using 'complementary measures', which are non-flow-based actions, such as infrastructure works, vegetation management and pest control. The value of complementary measures is recognised globally, but their ecological benefits are rarely well understood, either because there is limited experience with their application, or the importance of context- and location-specific factors make it difficult to generalise benefits. In this study, we developed an approach to evaluate complementary measures at different levels of detail as a mechanism to aid decision-making. For systems that require a rapid, high-level evaluation, we propose a score-based multi-criteria benefit assessment module. If more ecological detail is necessary, we outline a method based on conceptual models, expert elicitation and probability assessment. These results are used to populate a cumulative benefit assessment tool. The tool evaluates the benefits of proposed measures in the wider context by including variables such as flow, dependence on ongoing maintenance and additional ecological values. We illustrate our approach through application to the Murray-Darling Basin, Australia. As many water recovery programmes mature into their evaluation phases, there is an increasing need to evaluate the ecological benefits of including complementary measures in the toolkit available to policy makers.

Postmastectomy Radiation Therapy Planning After Immediate Implant-based Reconstruction Using the European Society for Radiotherapy and Oncology-Advisory Committee in Radiation Oncology Practice Consensus Guidelines for Target Volume Delineation.

AIMS: To evaluate how common radiation therapy techniques perform in the setting of the new European Society for Radiotherapy and Oncology-Advisory Committee in Radiation Oncology Practice (ESTRO-ACROP) delineation recommendations for immediate breast reconstruction (IBR). MATERIALS AND METHODS: Seven Danish radiation therapy centres and six international European centres participated in this project. Two breast cancer cases (one left-sided and one right-sided) with a retropectoral implant were chosen for radiation therapy planning using deep-inspiration breath-hold. Target volumes were delineated according to ESTRO-ACROP delineation recommendations. The centres were asked to plan the cases using any radiation therapy technique according to the Danish Breast Cancer Group plan objectives. RESULTS: In total, 35 treatment plans were collected. Half of the submitted plans, for both the left-sided and the right-sided case, used the field-in-field (FiF) technique (nine for each), a quarter used volumetric arc radiation therapy (VMAT; five for right-sided, four for left-sided) and the remaining quarter was a mix of inverse intensity-modulated radiation therapy (IMRT), helicoidal therapy and hybrid (combined open fields and VMAT) techniques. Mean clinical target volume doses were in the range 99-102% of the prescribed dose. The median FiF mean heart dose (MHD) for right-sided radiation therapy was 1 Gy (range 0.8-3.7) and 5.2 Gy for left-sided radiation therapy (range 2.2-6.5). For right-sided radiation therapy, the median VMAT MHD was 3.42 Gy, for IMRT was 2.3 Gy and for helicoidal therapy was 5.1 Gy. For left-sided radiation therapy, the median VMAT MHD was 6.3 Gy, for IMRT was 7.8 Gy and for helicoidal therapy was 7.3 Gy. CONCLUSIONS: Different radiation therapy techniques could be used to plan radiation therapy in the setting of IBR. FiF provided good coverage with acceptable organ at risk doses. The best dose distribution results as a trade-off between the objectives of target volume coverage and high-dose organ at risk inclusion. The radiation therapy technique affects the interplay between these objectives.

Evaluation of X-ray table mattresses for radiation attenuation and impact on image quality.

INTRODUCTION: Mattresses in the radiology department tend to be an overlooked aspect of imaging equipment. This paper evaluates the radiation attenuation characteristics of mattresses and the effect they have on image quality. METHODS: Thirteen mattresses (from new to 20 years of age) were evaluated. Incident air kerma (IAK) was measured in two conditions, with and without mattress over a range of exposure factors using a digital dosimeter. Image quality was assessed by calculating the inverse image quality factor (IQFinv) using a commercially available phantom (CDRAD) for the same exposure factors. The correlation of age and attenuation and image quality was calculated. RESULTS: Measured IAK and image quality was affected by the addition of a mattress with older mattresses having greater attenuation; there is a moderate/large correlation (0.38-0.51) between age and IAK. IQFinv deteriorated with the addition of a mattress but there was no correlation with age (-0.41 to 0.16). Clinically, there is no impact of any mattress in the study as changes to the exposure factors to account for the attenuation are smaller than the increments in mAs available on X-ray equipment. CONCLUSION: The results indicate that while the presence of a mattress does impact on transmitted radiation and the quality of the image, the clinical impact is insignificant. Attenuation correlates with age but with no clinical significance. There is no correlation between age and image quality. IMPLICATIONS FOR PRACTICE: Quality control tests for attenuation and impact on image quality are not required in clinical practice. The method could be used by manufacturers to test new materials and mattresses and could provide users with specifications of new products.

A simulation-based approach to assess the power of trend detection in high- and low-frequency water quality records.

To provide more precise understanding of water quality changes, continuous sampling is being used more in surface water quality monitoring networks. However, it remains unclear how much improvement continuous monitoring provides over spot sampling, in identifying water quality changes over time. This study aims (1) to assess our ability to detect trends using water quality data of both high and low frequencies and (2) to assess the value of using high-frequency data as a surrogate to help detect trends in other constituents. Statistical regression models were used to identify temporal trends and then to assess the trend detection power of high-frequency (15 min) and low-frequency (monthly) data for turbidity and electrical conductivity (EC) data collected across Victoria, Australia. In addition, we developed surrogate models to simulate five sediment and nutrients constituents from runoff, turbidity and EC. A simulation-based statistical approach was then used to the compare the power to detect trends between the low- and high-frequency water quality records. Results show that high-frequency sampling shows clear benefits in trend detection power for turbidity, EC, as well as simulated sediment and nutrients, especially over short data periods. For detecting a 1% annual trend with 5 years of data, up to 97% and 94% improvements on the trend detection probability are offered by high-frequency data compared with monthly data, for turbidity and EC, respectively. Our results highlight the benefits of upgrading monitoring networks with wider application of high-frequency sampling.

Investigating alternative materials to EPDM for automatic taps in the context of Pseudomonas aeruginosa and biofilm control.

BACKGROUND: Automatic taps use solenoid valves (SVs) which incorporate a rubber (typically EPDM) diaphragm to control water flow. Contaminated SVs can be reservoirs of opportunistic pathogens such as Pseudomonas aeruginosa; an important cause of healthcare-associated infection. AIMS: To investigate the attachment and biofilm formation of P. aeruginosa on EPDM and relevant alternative rubbers to assess the impact on water hygiene in a laboratory model. METHODS: Biofilm formation on EPDM, silicone and nitrile rubber coupons was investigated using a CDC biofilm reactor. SVs incorporating EPDM or nitrile rubber diaphragms were installed on to an experimental water distribution system (EWDS) and inoculated with P. aeruginosa. P. aeruginosa water levels were monitored for 12-weeks. SVs incorporating diaphragms (EPDM, silicone or silver ion-impregnated silicone rubber), pre-colonized with P. aeruginosa, were installed and the effect of flushing as a control measure was investigated. The concentration of P. aeruginosa in the water was assessed by culture and biofilm assessed by culture and microscopy. FINDINGS: Bacterial attachment was significantly higher on nitrile (6.2 × 105 cfu/coupon) and silicone (5.4 × 105 cfu/coupon) rubber than on EPDM (2.9 ×105 cfu/coupon) (P<0.05, N = 17). Results obtained in vitro did not translate to the EWDS where, after 12-weeks in situ, there was no significant difference in P. aeruginosa water levels or biofilm levels. Flushing caused a superficial reduction in bacterial counts after <5 min of stagnation. CONCLUSION: This study did not provide evidence to support replacement of EPDM with (currently available) alternative rubbers and indicated the first sample of water dispensed from a tap should be avoided for use in healthcare settings.

Historical epidemiology and global health history / Epidemiologia histórica e história global da saúde

Abstract The subdiscipline of historical epidemiology holds the promise of creating a more robust and more nuanced foundation for global public health decision-making by deepening the empirical record from which we draw lessons about past interventions. This essay draws upon historical epidemiological research on three global public health campaigns to illustrate this promise: the Rockefeller Foundation's efforts to control hookworm disease (1909-c.1930), the World Health Organization's pilot projects for malaria eradication in tropical Africa (1950s-1960s), and the international efforts to shut down the transmission of Ebola virus disease during outbreaks in tropical Africa (1974-2019).

Resumo A subdisciplina epidemiologia histórica se propõe a criar um alicerce robusto e refinado para o processo de tomada de decisões em saúde pública global, aprofundando registros empíricos que nos ensinam sobre intervenções passadas. Este artigo se baseia na pesquisa epidemiológica histórica de três campanhas globais de saúde pública para ilustrar essa proposta: os esforços da Fundação Rockefeller para controle da ancilostomose (1909-c.1930), os projetos-piloto da Organização Mundial da Saúde para erradicação da malária na África tropical (décadas de 1950-1960), e os esforços internacionais de interrupção da transmissão do vírus Ebola durante surtos na África tropical (1974-2019).

Antimicrobial Activity of the Quinoline Derivative HT61 against Staphylococcus aureus Biofilms.

Staphylococcus aureus biofilms are a significant problem in health care settings, partly due to the presence of a nondividing, antibiotic-tolerant subpopulation. Here we evaluated treatment of S. aureus UAMS-1 biofilms with HT61, a quinoline derivative shown to be effective against nondividing Staphylococcus spp. HT61 was effective at reducing biofilm viability and was associated with increased expression of cell wall stress and division proteins, confirming its potential as a treatment for S. aureus biofilm infections.

A mixed methods process evaluation of a print-based intervention supported by internet tools to improve physical activity in UK cancer survivors.

OBJECTIVE: A waiting list randomised control trial has shown the Move More Pack, a print-based intervention supported by Internet tools, to improve physical activity levels in cancer survivors; however, one-third of them do not improve from the intervention. The objective of this process evaluation is to understand intervention use, the mechanisms of impact, the perceived benefits and the contextual factors influencing these, identifying for whom it is a useful resource. METHODS: The process evaluation used mixed methods, based on guidance from the UK Medical Research Council, including 181 questionnaire responses on intervention use and physical activity improvement over 12 weeks, 56 open-text responses and 17 semistructured interviews. RESULTS: The Move More Pack was suggested to be most useful when delivered towards the start of the cancer journey to those with a positive attitude to fight cancer but with a low level of physical activity, capitalising on a teachable moment. It was suggested that healthcare professionals could support the effective distribution of the Move More Pack. The intervention's printed components were more popular and well used than the Internet tools. Use of the printed intervention components was positively correlated with physical activity improvement but use of the Internet tools was not. Women were more likely to use the intervention's printed components than men. Cancer survivors using the intervention reflected that they had increased confidence and motivation for physical activity and other lifestyle behaviours. CONCLUSION: The Move More Pack should be offered by healthcare professionals, during cancer treatment, when health is salient, to those with a positive attitude to fight cancer but with low levels of physical activity. Use of the intervention's printed components is more likely to improve physical activity than the Internet tools, and the components are more likely to be used by women. The use of Internet tools to support physical activity improvement in cancer survivors requires further investigation.