The space from heart disease intervention for people with cardiovascular disease and distress: a mixed-methods study

BACKGROUND: Poor self-management of symptoms and psychological distress leads to worse outcomes and excess health service use in cardiovascular disease (CVD). Online-delivered therapy is effective, but generic interventions lack relevance for people with specific long-term conditions, such as cardiovascular disease. OBJECTIVE: To develop a comprehensive online CVD-specific intervention to improve both self-management and well-being, and to test acceptability and feasibility. METHODS: Informed by the Medical Research Council (MRC) guidance for the development of complex interventions, we adapted an existing evidence-based generic intervention for depression and anxiety for people with CVD. Content was informed by a literature review of existing resources and trial evidence, and the findings of a focus group study. Think-aloud usability testing was conducted to identify improvements to design and content. Acceptability and feasibility were tested in a cross-sectional study. RESULTS: Focus group participants (n=10) agreed that no existing resource met all their needs. Improvements such as "collapse and expand" features were added based on findings that participants' information needs varied, and specific information, such as detecting heart attacks and when to seek help, was added. Think-aloud testing (n=2) led to changes in font size and design changes around navigation. All participants of the cross-sectional study (10/10, 100%) were able to access and use the intervention. Reported satisfaction was good, although the intervention was perceived to lack relevance for people without comorbid psychological distress. CONCLUSIONS: We have developed an evidence-based, theory-informed, user-led online intervention for improving self-management and well-being in CVD. The use of multiple evaluation tests informed improvements to content and usability. Preliminary acceptability and feasibility has been demonstrated. The Space from Heart Disease intervention is now ready to be tested for effectiveness. This work has also identified that people with CVD symptoms and comorbid distress would be the most appropriate sample for a future randomized controlled trial to evaluate its effectiveness

A silent cry for leadership : organizing for leading (in) clusters

Leadership research so far has neglected clusters as a particular context for leadership, while research on networks and clusters has hardly studied leadership issues. This paper fills this dual gap in the abundant research on leadership on the one hand and on networks/clusters on the other by investigating leadership in photonics clusters from a structuration perspective. Apart from giving an insight into the variety and patterns of leadership practices observed, the paper addresses the dilemma that regional innovation systems such as clusters usually have a critical need of some kind of leadership, but that neither individual nor organizational actors wish to be led. This dilemma can only be ‘managed’ by organizing for leading (in) clusters in a certain way

The Role of Processed Electroencephalography in the Detection and Management of Acute Cerebral Ischemia: A Scoping Review

Processed electroencephalography (pEEG) is increasingly used to titrate the depth of anesthesia. Whether such intra-procedural pEEG monitoring can offer additional information on cerebral perfusion or acute focal or global cerebral ischemia is unknown. This scoping review aimed to provide a narrative analysis of the current literature reporting the potential role of pEEG in adults with acute cerebral ischemia. In keeping with the scoping review methodology, a broad search strategy was defined, including descriptions of encephalography in acute ischemic stroke, carotid endarterectomy, cardiac surgery, and cardiac arrest. Additional screening of citations was conducted by 2 independent assessors. From 310 records, 28 full-text articles met inclusion criteria. Most identified studies were observational in design, and described the diagnostic ability of pEEG to identify cerebral hypoperfusion or its prognostic sensitivity after stroke or carotid surgery. No studies were identified that evaluated pEEG in the specific setting of endovascular therapy for acute ischemic stroke. Low sensitivity associations between pEEG indices and cerebral blood flow were highlighted, which may be influenced by cerebral autoregulatory thresholds. Despite the associations reported in observational studies, this review identified significant uncertainty in the role of pEEG during cerebral ischemia. There is a paucity of high-level observational (cohort or case-control) or randomized trial research examining the possible role of pEEG for the detection and management of cerebral ischemia during acute stroke, including during endovascular therapy, or in other common scenarios of acute cerebral ischemia

The semiology of changing brand image

This article considers the attempted change to the image of an established brand by studying the semiotics within the brand’s historical advertising campaigns. The use of semiotics to study the interpretation of messages is discussed, and the link between interpretation of messages and advertising effectiveness in changing brand image is explored. The authors deconstruct advertisements of a brand to provide a model containing opposing dialectics that may aid managers by highlighting alternative symbolic messages contained in advertisements. Oncwe identified, these alternative symbolic messages may be used to help change brand image and influence advertising effectiveness. Although the study focuses upon a major brand of beer, this is an industry in which there are numerous small firms, and many of those have constrained marketing budgets, and thus need to make sure that their advertising is effective. Equally, entrepreneurial marketing is not to found only in the small firm, and the case study discusses a radical and imaginative brand repositioning of a well established product

PAM50 Breast Cancer Subtyping by RT-qPCR and Concordance with Standard Clinical Molecular Markers

Abstract Background Many methodologies have been used in research to identify the “intrinsic” subtypes of breast cancer commonly known as Luminal A, Luminal B, HER2-Enriched (HER2-E) and Basal-like. The PAM50 gene set is often used for gene expression-based subtyping; however, surrogate subtyping using panels of immunohistochemical (IHC) markers are still widely used clinically. Discrepancies between these methods may lead to different treatment decisions. Methods We used the PAM50 RT-qPCR assay to expression profile 814 tumors from the GEICAM/9906 phase III clinical trial that enrolled women with locally advanced primary invasive breast cancer. All samples were scored at a single site by IHC for estrogen receptor (ER), progesterone receptor (PR), and Her2/neu (HER2) protein expression. Equivocal HER2 cases were confirmed by chromogenic in situ hybridization (CISH). Single gene scores by IHC/CISH were compared with RT-qPCR continuous gene expression values and “intrinsic” subtype assignment by the PAM50. High, medium, and low expression for ESR1, PGR, ERBB2, and proliferation were selected using quartile cut-points from the continuous RT-qPCR data across the PAM50 subtype assignments. Results ESR1, PGR, and ERBB2 gene expression had high agreement with established binary IHC cut-points (area under the curve (AUC) ≥ 0.9). Estrogen receptor positivity by IHC was strongly associated with Luminal (A and B) subtypes (92%), but only 75% of ER negative tumors were classified into the HER2-E and Basal-like subtypes. Luminal A tumors more frequently expressed PR than Luminal B (94% vs 74%) and Luminal A tumors were less likely to have high proliferation (11% vs 77%). Seventy-seven percent (30/39) of ER-/HER2+ tumors by IHC were classified as the HER2-E subtype. Triple negative tumors were mainly comprised of Basal-like (57%) and HER2-E (30%) subtypes. Single gene scoring for ESR1, PGR, and ERBB2 was more prognostic than the corresponding IHC markers as shown in a multivariate analysis. Conclusions The standard immunohistochemical panel for breast cancer (ER, PR, and HER2) does not adequately identify the PAM50 gene expression subtypes. Although there is high agreement between biomarker scoring by protein immunohistochemistry and gene expression, the gene expression determinations for ESR1 and ERBB2 status was more prognostic

Variations in practice adoption:The roles of conscious reflection and discourse

We argue that our understanding of practice adoption has been limited by the prevailing view that variations in adoption stem from consciously made decisions. We counter this position by arguing that a key—and neglected—aspect of the adoption process concerns the level of conscious engagement of those involved. In so doing, we theorize that there are two distinct institutional dimensions necessary for understanding how practice adoption takes place: acceptance and implementation. We develop these dimensions to provide a framework showing that different within-organization responses will be associated with differing levels of acceptance of the need to adopt a practice—the acceptance dimension—and differing levels of conscious reflection during implementation of the practice—the implementation dimension. We then unpack this framework to explain how variations in discourse play a determining role in how practice adoption unfolds. This reveals an interesting institutional paradox: the discursive characteristics that make a practice more easily accepted also reduce the conscious engagement needed for its implementation. We spend the balance of the article developing the implications of our theorizing for understanding the process of practice adoption