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Objective: Clinicians' fears of taking away patients' hope is one of the barriers to advance care planning (ACP). Research on how ACP supports hope is scarce. We have taken up the challenge to specify ways in which ACP conversations may potentially support hope. Methods: In an international qualitative study, we explored ACP experiences of patients with advanced cancer and their personal representatives (PRs) within the cluster-randomised control ACTION trial. Using deductive analysis of data obtained in interviews following the ACP conversations, this substudy reports on a theme of hope. A latent thematic analysis was performed on segments of text relevant to answer the research question. Results: Twenty patients with advanced cancer and 17 PRs from Italy, the Netherlands, Slovenia, and the United Kingdom were participating in post-ACP interviews. Three themes reflecting elements that provide grounds for hope were constructed. ACP potentially supports hope by being (I) a meaningful activity that embraces uncertainties and difficulties (II) an action towards an aware and empowered position (III) an act of mutual care anchored in commitments. Conclusion: Our findings on various potentially hope supporting elements of ACP conversations provide a constructive way of thinking about hope in relation to ACP that could inform practice.

Pseudorabies virus (PRV), in the family Herpesviridae, is a pathogen of Aujeszky's disease, which causes great economic losses to the pig industry. Recent outbreaks of Pseudorabies imply that new control measures are urgently needed. The present study shows that kaempferol is a candidate drug for controlling PRV infection, as it possesses the ability to inhibit PRV replication in a dose-dependent manner in vitro. Kaempferol at a concentration of 52.40 µmol L−1 could decrease PRV-induced cell death by 90%. With an 50% inhibitory concentration (IC50) value of 25.57 µmol L−1 kaempferol was more effective than acyclovir (positive control) which has an IC50 value of 54.97 µmol L−1. A mode of action study indicated that kaempferol inhibited viral penetration and replication stages, decreasing viral loads by 4- and 30-fold, respectively. Addition of kaempferol within 16 h post infection (hpi) could significantly inhibit virus replication, and viral genome copies were decreased by almost 15-fold when kaempferol was added at 2 hpi. Kaempferol regulated the NF-κB and MAPKs signaling pathways involved in PRV infection and changed the levels of the target genes of the MAPKs (ATF-2 and c-Jun) and NF-κB (IL-1α, IL-1β and IL-2) signaling pathways. The findings of the current study suggest that kaempferol could be an alternative measure to control PRV infection.

Background: People with advanced cancer often suffer from various symptoms, which can arise from the cancer itself and its treatment, the illness experience, and/or co-morbid conditions. Important patient-reported outcomes such as functional status, symptom severity, and quality of life (QoL) might differ between countries, as countries vary with regard to contextual factors such as their healthcare system. Purpose: To assess self-reported emotional functioning, physical functioning, symptoms, and overall QoL in patients with advanced lung or colorectal cancer from six European countries, particularly in relation to their country of residence. Methods: We used baseline patient data from the ACTION trial, including socio-demographic and clinical data as well as patient-reported data regarding functioning, symptoms, and overall QoL (EORTC QLQ-C15-PAL). Results: Data from 1117 patients (55% lung cancer stage III/IV, 45% colorectal cancer stage IV) were used. The highest (worst) average symptom score was found for fatigue. We found similarities but also important differences in the outcomes across countries. The best scores (the highest for emotional functioning and QoL, the lowest for symptoms) were reported by Dutch and Danish patients. Belgian patients reported relatively low emotional functioning. Conclusion: The optimization of functioning, symptom relief, and overall QoL should be important objectives of healthcare professionals who take care of patients with advanced cancer. There are similarities, but also substantial differences across countries in functional status, symptoms, and overall QoL. Policymakers should take these differences into account and invest in offering health care catered to the needs of their population.

Background Preterm infants have high rates of morbidity, especially from late-onset sepsis and necrotising enterocolitis. Lactoferrin is an anti-infective milk protein that may act through effects on gut bacteria, metabolites and epithelial cell function. The impact of supplemental lactoferrin in reducing late-onset sepsis was explored in the Enteral LactoFerrin In Neonates (ELFIN) trial. Objectives The Mechanisms Affecting the Gut of Preterm Infants in Enteral feeding (MAGPIE) study was nested within the ELFIN trial and aimed to determine the impact of lactoferrin on gut microbiota and bacterial function, and changes preceding disease onset. We aimed to explore impacts on the stool bacteria and faecal/urinary metabolome using gas and liquid chromatography–mass spectrometry, and explore immunohistological pathways in resected tissue. Methods Preterm infants from 12 NHS hospitals were enrolled in the study, and daily stool and urine samples were collected. Local sample collection data were combined with ELFIN trial data from the National Perinatal Epidemiology Unit, Oxford. The longitudinal impact of lactoferrin in healthy infants was determined, and samples that were collected before disease onset were matched with samples from healthy control infants. Established, quality-controlled 16S ribonucleic acid, gas chromatography–mass spectrometry and liquid chromatography–mass spectrometry analyses were conducted. Validated databases and standardised workflows were used to identify bacteria and metabolites. Tissue samples from infants undergoing surgery and matched controls were analysed. Results We recruited 479 preterm infants (mean gestation of 28.4 ± 2.3 weeks) and collected > 33,000 usable samples from 467 infants. 16S ribonucleic acid bacterial analysis was conducted on samples from 201 infants, of whom 20 had necrotising enterocolitis and 51 had late-onset sepsis, along with samples from healthy matched controls to explore longitudinal changes. The greatest change in relative bacterial abundance over time was observed in Staphylococcus, which decreased from 42% at aged 7–9 days to only 2% at aged 30–60 days (p R 2 = 0.005; p = 0.04). Staphylococcus (p Haemophilus (p Lactobacillus (p = 0.01) showed greater mean relative abundance in the placebo group than in the lactoferrin group. Gas chromatography–mass spectrometry and liquid chromatography–mass spectrometry analyses showed that lactoferrin had limited impact on the metabolome. Liquid chromatography–mass spectrometry showed significant metabolite differences between necrotising enterocolitis or late-onset sepsis infants and healthy controls. The resected gut tissue analysis revealed 82 differentially expressed genes between healthy and necrotic tissue. Limitations Although we recruited a large number of infants, collecting daily samples from every infant is challenging, especially in the few days immediately preceding disease onset. Conclusion We conducted a large mechanistic study across multiple hospital sites and showed that, although lactoferrin significantly decreased the level of Staphylococcus and other key pathogens, the impact was smaller than those of other clinical variables. Immunohistochemistry identified multiple inflammatory pathways leading to necrotising enterocolitis and showed that the use of NHS pathology archive tissue is feasible in the context of a randomised controlled trial. Future work We observed significant changes in the stool and urinary metabolome in cases preceding late-onset sepsis or necrotising enterocolitis, which provide metabolic targets for a future mechanistic and biomarker study. Trial registration Current Controlled Trials ISRCTN12554594. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a Medical Research Council (MRC) and National Institute for Health Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 14. See the NIHR Journals Library website for further project information.

Background Limited information is available on how mobile health (mHealth) application (app) technology on mother and child health (MCH) is developed. This research aimed (a) to explore the process of developing mobile apps for MCH community-based services in the Indonesian setting of Pos Pelayanan Terpadu (Posyandu/Integrated Health Service Post), (b) to determine the feasibility of using the app by community health workers (CHWs), and (c) to evaluate the scalability of the mobile app at the national level in Indonesia. Methods A hybrid method was used to synergistically combine the action research principles and mixed methods comprising qualitative and quantitative methods. This study was conducted in the Pasawahan District, Purwakarta, Indonesia, from 2017 to 2019. Content analysis, coding, and categorizing were performed using NVivo 12 Pro for transcribed data. The Wilcoxon test (2018 and 2019) was conducted using STATA 15 Special Edition. Results (1) The use of a CHW notebook for data entry into the Posyandu Information System book delayed the data reporting process, resulting in the need to develop a mobile app. (2) There were significant differences in CHWs’ knowledge (p = 0.000) and skills (p = 0.0097) on training (2018) and Posyandu phases (2019). (3) A total of 964 Posyandu have been registered in the Posyandu mobile app from almost all provinces in Indonesia. Conclusions The three-year hybrid approach includes the crucial phases that are necessary to develop a mobile app that is more user-friendly and can act as a substitute for CHWs’ book. Hence, its implementation is promising for use at the national level.

This study focuses on the loss of youth and talent as one of the most pressing social justice issues leading to unsustainable and inequitable development in rural communities. With the backdrop of the rapid decline in the young rural population and loss of local tacit knowledge, we question how to balance rural sustainability through place-based critical pedagogy by integrating rural societies, agri-economics, and cultural landscapes. To confront the crisis of a loss of young rural talent and local wisdom, interdisciplinary professors from the National Taiwan University initiated place-based pedagogical action research from winter 2011 to winter 2019. This interdisciplinary place-based pedagogy approach supported hundreds of students and educators by nurturing socio-cultural and economic networks that benefit both urban universities and rural communities. Using the curriculum outcomes of this study, we propose the concept of “Knowledge-Ties Youth Rural Sustainability” (KYRS). The KYRS framework addresses two questions: (1) how to bring young talent to rural everyday landscapes in order to sustain rural livelihoods, and (2) how to integrate rural tacit knowledge with contemporary sciences to create new technologies that sustain the environment. The KYRS framework serves as a pedagogical action research blueprint for university educators encountering similar rural challenges and opportunities to those faced by the National Taiwan University in Pinglin.

Health Lens Analysis (HLA) is a tool to facilitate collaboration among diverse community stakeholders. We employed HLA as part of a community-based participatory research (CBPR) and action study to mitigate the negative health effects of traffic-related air pollution TRAP and ultrafine particles (UFPs) in Somerville, MA. HLA is a Health in All Policies tool with previously limited implementation in a North American context. As part of the HLA, community and academic partners engaged residents from across near-highway neighborhoods in a series of activities designed to identify health concerns and generate recommendations for policies and projects to improve health over an 18-month planning period. Noise barriers, which may reduce TRAP exposure among residents in addition to reducing traffic noise, were seen as an acceptable solution by community stakeholders. We found HLA to be an effective means to engage stakeholders from across sectors and diverse community residents in critical discourse about the health impacts of near-roadway exposures. The iterative process allowed the project team to fully explore the arguments for noise barriers and preferred health interventions, while building a stakeholder base interested in the mitigation of TRAP, thus creating a shared language and understanding of the issue.

This action research examined the roles of writing instruction involving metacognitive and critical thinking strategy on the improvement of argumentative writing skills of college students in Indonesia. Argumentative writing is one of the pivotal topics among researchers investigating ways to improve college-level writing. This study involved 88 students of three parallel classes enrolled in the writing skill development course. Employing Kemmis and McTaggart’s (1988, 2014) model of action research, this study employed a three-cycle action study in one semester, covering four stages of learning tasks: understanding of the problem, monitoring of students’ learning activities, problem-solving, assessment, and conclusion drawing. Each cycle provided learning exercises of metacognitive and critical thinking to hone the students’ argumentative writing skills. Referring to critical skill criteria as a baseline, the analysis found that employing metacognitive and critical thinking processes in the instructional treatments enabled the students to improve their argumentative writing skills. The finding indicates a pivotal role of incorporating metacognition in writing instruction as a strategy to improve college-level writing skills.

Background/aims Serious adverse event reporting guidelines have largely been developed for pharmaceutical trials. There is evidence that serious adverse events, such as psychological distress, can also occur in non-pharmaceutical trials. Managing serious adverse event reporting and monitoring in palliative care non-pharmaceutical trials can be particularly challenging. This is because patients living with advanced malignant or non-malignant disease have a high risk of hospitalisation and/or death as a result of progression of their disease rather than due to the trial intervention or procedures. This paper presents a number of recommendations for managing serious adverse event reporting that are drawn from two palliative care non-pharmacological trials. Methods The recommendations were iteratively developed across a number of exemplar trials. This included examining national and international safety reporting guidance, reviewing serious adverse event reporting procedures from other pharmacological and non-pharmacological trials, a review of the literature and collaboration between the ACTION study team and Data Safety Monitoring Committee. These two groups included expertise in oncology, palliative care, statistics and medical ethics and this collaboration led to the development of serious adverse event reporting procedures. Results The recommendations included; allowing adequate time at the study planning stage to develop serious adverse event reporting procedures, especially in multi-national studies or research naïve settings; reviewing the level of trial oversight required; defining what a serious adverse event is in your trial based on your study population; development and implementation of standard operating procedures and training; refining the reporting procedures during the trial if necessary and publishing serious adverse events in findings papers. Conclusions There is a need for researchers to share their experiences of managing this challenging aspect of trial conduct. This will ensure that the processes for managing serious adverse event reporting are continually refined and improved so optimising patient safety. Trial registration ACTION trial registration number: ISRCTN63110516 (date of registration 03/10/2014). Namaste trial registration number: ISRCTN14948133 (date of registration 04/10/2017).

Background Missing data are common in end-of-life care studies, but there is still relatively little exploration of which is the best method to deal with them, and, in particular, if the missing at random (MAR) assumption is valid or missing not at random (MNAR) mechanisms should be assumed. In this paper we investigated this issue through a sensitivity analysis within the ACTION study, a multicenter cluster randomized controlled trial testing advance care planning in patients with advanced lung or colorectal cancer. Methods Multiple imputation procedures under MAR and MNAR assumptions were implemented. Possible violation of the MAR assumption was addressed with reference to variables measuring quality of life and symptoms. The MNAR model assumed that patients with worse health were more likely to have missing questionnaires, making a distinction between single missing items, which were assumed to satisfy the MAR assumption, and missing values due to completely missing questionnaire for which a MNAR mechanism was hypothesized. We explored the sensitivity to possible departures from MAR on gender differences between key indicators and on simple correlations. Results Up to 39% of follow-up data were missing. Results under MAR reflected that missingness was related to poorer health status. Correlations between variables, although very small, changed according to the imputation method, as well as the differences in scores by gender, indicating a certain sensitivity of the results to the violation of the MAR assumption. Conclusions The findings confirmed the importance of undertaking this kind of analysis in end-of-life care studies.

International audience; Background: Percutaneous coronary intervention (PCI)-related myonecrosis is frequent and can affect the long-term prognosis of patients. To our knowledge, ticagrelor has not been evaluated in elective PCI and could reduce periprocedural ischaemic complications compared with clopidogrel, the currently recommended treatment. The aim of the ALPHEUS study was to examine if ticagrelor was superior to clopidogrel in reducing periprocedural myocardial necrosis in stable coronary patients undergoing high-risk elective PCI.Methods: The ALPHEUS study, a phase 3b, randomised, open-label trial, was done at 49 hospitals in France and Czech Republic. Patients with stable coronary artery disease were eligible for the study if they had an indication for PCI and at least one high-risk characteristic. Eligible patients were randomly assigned (1:1) to either ticagrelor (180 mg loading dose, 90 mg twice daily thereafter for 30 days) or clopidogrel (300-600 mg loading dose, 75 mg daily thereafter for 30 days) by use of an interactive web response system, and stratified by centre. The primary outcome was a composite of PCI-related type 4 (a or b) myocardial infarction or major myocardial injury and the primary safety outcome was major bleeding, both of which were evaluated within 48 h of PCI (or at hospital discharge if earlier). The primary analysis was based on all events that occurred in the intention-to-treat population. The trial was registered with ClinicalTrials.gov, NCT02617290.Findings: Between Jan 9, 2017, and May 28, 2020, 1910 patients were randomly assigned at 49 sites, 956 to the ticagrelor group and 954 to the clopidogrel group. 15 patients were excluded from the ticagrelor group and 12 from the clopidogrel group. At 48 h, the primary outcome was observed in 334 (35%) of 941 patients in the ticagrelor group and 341 (36%) of 942 patients in the clopidogrel group (odds ratio [OR] 0·97, 95% CI 0·80-1·17; p=0·75). The primary safety outcome did not differ between the two groups, but minor bleeding events were more frequently observed with ticagrelor than clopidogrel at 30 days (105 [11%] of 941 patients in the ticagrelor group vs 71 [8%] of 942 patients in the clopidogrel group; OR 1·54, 95% CI 1·12-2·11; p=0·0070).Interpretation: Ticagrelor was not superior to clopidogrel in reducing periprocedural myocardial necrosis after elective PCI and did not cause an increase in major bleeding, but did increase the rate of minor bleeding at 30 days. These results support the use of clopidogrel as the standard of care for elective PCI.Funding: ACTION Study Group and AstraZeneca.

BackgroundYouth-led Participatory Action Research (YPAR) involves children throughout the process of developing and implementing interventions. Combining YPAR with a structural approach for designing and planning interventions, such as Intervention Mapping (IM), may further improve implementation and effectiveness of interventions. This paper describes how YPAR and IM were combined in the Kids in Action study.MethodsThe Kids in Action study aims to improve health behaviors of 9–12-year old children living in a low socioeconomic neighborhood in Amsterdam, by co-designing interventions with these children. At each of four schools 6–8 children (N = 18–24 total per year) and two academic researchers formed participatory groups that met weekly or every fortnight during two school years. An IM expert panel advised the participatory groups on the application of IM.ResultsFollowing the IM protocol, we conducted a participatory needs assessment with children, parents and professionals, in IM-step 1. In IM-step 2, the IM expert panel constructed matrices of program objectives, and the children provided feedback. In collaboration with children programs were designed and produced using an iterative process during IM-steps 3–4. In IM-step 5, the participatory groups and professional community partners designed the implementation plan. Finally, in IM-step 6, the protocol of the process and effect evaluation – executed by academic researchers with input from children – was developed.ConclusionsBy combining YPAR and IM, several interventions have been developed and implemented, varying from a school water policy to extracurricular sports activities. Sharing responsibility with children was challenging when combining IM with YPAR. In YPAR children are given as much autonomy as possible, while traditional IM development work is primarily done by academic researchers. Strengths in combining IM and YPAR include the involvement of the end-users - children - throughout the process while at the same time developing interventions based on existing evidence. Time-management, a multidisciplinary team, and flexibility are important conditions when combining IM with YPAR. A strong community project group, with professionals who were willing to help children develop and execute their ideas, was an important success factor. This study can serve as an example to other YPAR studies developing interventions using the IM protocol.

The authors conducted a study related to using English in learning mathematics, for grade 7 junior high school students in a private national plus school. The purpose of this study was for the reader to open up further insights related to the topic. This study was carried out with experimental design, by doing different treatment between classes in the same level. The subjects of the study consisted of 63 students spread into three classes; 7A, 7B, and 7C. Class 7C was a control group, using Bahasa Indonesia (mother tongue) in learning Mathematics. Class 7A and 7B were the experimental groups, where 7A was in English and 7B used bilingual (English and Indonesian). Results of the study include the following; using English is not detrimental to the students in mark achievement that is shown by the average of the final mark of Mathematics that is not significantly different. The challenges that arise from learning Mathematics need to be reviewed from the process, readiness, independence, motivation of students and needs to be followed up critically so that students can achieve better results. Short and long-term programs need to be created and observed in order to support the learning process of Mathematics for students, such as training teachers to be able to teach mathematics in English, in supporting action study by teachers, managed by the school.

Combining ability and nature of gene interaction that contribute to seed yield and its attributing traits in Indian mustard were investigated using 60 hybrids developed by crossing three females (lines) with twenty males (testers) in a Line x Tester mating system. The results revealed that GCA and SCA ratio (σ2GCA/σ2SCA) was less than unity for all the traits except for days to 50 % flowering. This indicated that non-additive components played relatively greater role in the inheritance of all the traits except days to 50 % flowering for which greater role of additive components was found. The estimate of GCA effects indicated that the parents GM-2, NRCM-120, PAB-9511 and IC-261670 were identified as good general combiners indicating their ability in transmitting additive genes in the desirable direction to their progenies. The hybrids viz., GM-2 x PYM-7 (10.81), GM-3 x NUDH-45-1 (10.70) and GM-3 x PAB-9511 (8.36) were found to be the best specific crosses for seed yield per plant. Among these hybrids, GM-2 x PTM-7 was also recorded significant sca effects in desired direction for number of primary branches per plant, number of secondary branches per plant and number of siliquae per plant, while GM-3 x NUDH-45-1 also exhibited significant sca effects for number of primary branches per plant, number of secondary branches per plant, number of siliquae per plant, siliquae length and oil content. Therefore, these hybrids can be further exploited for selection of transgressive segregants.

Abatacept retention rates were evaluated in the French cohort in the prospective ACTION study (2010-2013), which included patients with moderate-to-severe rheumatoid arthritis managed in everyday clinical practice and started on intravenous abatacept therapy.Two-year abatacept retention rates were evaluated in 455 patients classified according to treatment line, body mass index (BMI), and status for rheumatoid factor (RF) and anti-citrullinated peptide antibody (ACPA).After 2 years, the overall abatacept retention rate was 44%. The retention rate was non-significantly higher in the patients with vs. without a history of unresponsiveness to at least one biologic (48.1% vs. 41.8%, respectively). No significant retention rate differences were found across BMI categories (444 patients;25, 45.5%; ≥25 to30, 48.9%; and ≥30, 36.6%). Neither were any significant differences demonstrated according to RF and ACPA status (RF+ and ACPA+, 45.7%; RF+ or ACPA+, 43.8%; and FR- and ACPA-, 39.1%).The 44% 2-year retention rate in the French ACTION cohort supports the usefulness of abatacept therapy. In this study, retention was not associated with treatment line, BMI, or antibody status.

Background In oncology, Health Care Professionals often experience conducting Advance Care Planning (ACP) conversations as difficult and are hesitant to start them. A structured approach could help to overcome this. In the ACTION trial, a Phase III multi-center cluster-randomized clinical trial in six European countries (Belgium, Denmark, Italy, the Netherlands, Slovenia, United Kingdom), patients with advanced lung or colorectal cancer are invited to have one or two structured ACP conversations with a trained facilitator. It is unclear how trained facilitators experience conducting structured ACP conversations. This study aims to understand how facilitators experience delivering the ACTION Respecting Choices (RC) ACP conversation. Methods A qualitative study involving focus groups with RC facilitators. Focus group interviews were recorded, transcribed, anonymized, translated into English, and thematically analysed, supported by NVivo 11. The international research team was involved in data analysis from initial coding and discussion towards final themes. Results Seven focus groups were conducted, involving 28 of in total 39 trained facilitators, with different professional backgrounds from all participating countries. Alongside some cultural differences, six themes were identified. These reflect that most facilitators welcomed the opportunity to participate in the ACTION trial, seeing it as a means of learning new skills in an important area. The RC script was seen as supportive to ask questions, including those perceived as difficult to ask, but was also experienced as a barrier to a spontaneous conversation. Facilitators noticed that most patients were positive about their ACTION RC ACP conversation, which had prompted them to become aware of their wishes and to share these with others. The facilitators observed that it took patients substantial effort to have these conversations. In response, facilitators took responsibility for enabling patients to experience a conversation from which they could benefit. Facilitators emphasized the need for training, support and advanced communication skills to be able to work with the script. Conclusions Facilitators experienced benefits and challenges in conducting scripted ACP conversations. They mentioned the importance of being skilled and experienced in carrying out ACP conversations in order to be able to explore the patients’ preferences while staying attuned to patients’ needs. Trial registration International Standard Randomised Controlled Trial Number registry 63110516 (ISRCTN63110516) per 10/3/2014.

Summary Obesity is a chronic disease with a significant and growing impact on Canadians. The “Awareness, Care and Treatment In Obesity MaNagement” (ACTION) Study investigated perceptions, attitudes and perceived barriers to obesity management among Canadian people with obesity (PwO), healthcare providers (HCPs) and employers. In this study adult PwO (body mass index ≥30 kg/m2, based on self‐reported height/weight), HCPs (physicians and allied HCPs managing PwO) and employers (≥20 employees; offering health insurance), completed online surveys between 3 August and 11 October 2017 in a cross‐sectional design. Survey respondents (N = 2545) included 2000 PwO, 395 HCPs and 150 employers. Obesity was viewed as a “chronic medical condition” by most PwO (60%), HCPs (94%) and employers (71%) and deemed to have a large impact on overall health (74%, 78%, 81%, respectively). Many PwO (74%) believed weight management was their own responsibility. While PwO (55%) reportedly knew how to manage their weight, only 10% reported maintaining ≥10% weight reduction for >1 year. Despite low success rates, the most commonly reported effective long‐term weight loss methods tried and/or recommended were “improvements in eating habits” (PwO 38%; HCP 63%) and “being more active” (PwO 39%; HCP 54%). PwO and HCPs reported very different perceptions of the quality and content of their interaction during obesity management discussions. These findings highlight the communication gaps and misunderstanding between PwO, HCPs and employers. This underscores the importance of, and need for, evidence‐based management of obesity and a collaborative approach and understanding of the complex nature of this chronic disease.

Background There is limited evidence for the effectiveness of social media to promote healthy behaviour among Indigenous Australians, including to reduce smoking. Social media has significant potential to stimulate interpersonal influence to quit, however an important knowledge gap is how and what content people choose to share with friends and family. This paper explores the decision making processes of community members for sharing tobacco control content with family and friends on Facebook. Methods Community researchers were paid to choose and share at least one tobacco control post per week for a period of 6 months on their personal Facebook page. They documented reasons for their choices, which were coded and analysed to determine features of messages most likely to be shared, and salient considerations in the decision-making process. Results Posts which are child-focused, feature Indigenous content, and are perceived as practical, relevant and credible, with a direct and unambiguous message, were most likely to be shared. Posts which included disgusting imagery about health impacts, were focused on the environment, or were ambiguous or sarcastic were less likely to be shared. Decisions were also based on whether content was perceived to contain new information, to be helpful for their friends, and to be consistent with the participant’s online identity, as well as the perceived sensitivity of content. The potential impact on expensive mobile data for videos was also a factor. Conclusions When designing tobacco control messages to be shared on social media, health promoters should take into account how information will align with positive self-image and can contribute to social capital among the intended audience, and generate interpersonal engagement. Content should complement, rather than attempt to replicate, some message features that are effective on traditional broadcast media. This study shows the potential for health services to incorporate a strategy of using paid local social media ‘champions’ or ‘ambassadors’ to disseminate tobacco control messages on Facebook through community networks.

In general, Indonesian lessons in the eyes of easy and considered trivial by students and even teachers themselves. This view has many implications for the less treatment of Indonesian subjects, making them less profitable for the development of the learning process and causing problems. This condition has an impact on the low student's daily test score, with an average of 55 so as not to achieve the completeness of learning (KKM) that has been implemented school 75. Therefore required a research action that aims to improve the learning process and improve learning outcomes by using Discussion methods. The formulation of the research are: "Whether the application of Discussion method can improve the learning outcomes of Indonesian students of Class VI SDN. 03 Perawang Barat in academic year 2014/2015?”. Subjek were students of class VI SDN. 03 PerawangBarat which amounted to 30 students. This action study was conducted in 2 cycles, each cycle consisting of 2 meetings. The research procedure consists of planning, execution, observation and reflection with research instrument in the form of learning device that is RPP, LKS, obsevation sheet of teacher and student. In the first cycle of student learning achievement reaches KKM as many as 19 students (63,27%). And on the second cycle student learning outcomes increased to 29 students (96.42%). From the results of this study can be concluded that the application of discussion methods can improve the learning outcomes of Indonesian students of Class VI SDN. 03 Perawang Barat in academic year 2014/2015.

Methicillin-resistant Staphylococcus aureus (MRSA) infections are well-known as a significant global health challenge. In this study, twenty-two congeners of the natural antibiotic rhodomyrtosone B (RDSB) were synthesized with the aim of specifically enhancing the structural diversity through modifying the pendant acyl moiety. The structure–activity relationship study against various MRSA strains revealed that a suitable hydrophobic acyl tail in the phloroglucinol scaffold is a prerequisite for antibacterial activity. Notably, RDSB analogue 11k was identified as a promising lead compound with significant in vitro and in vivo antibacterial activities against a panel of hospital mortality-relevant MRSA strains. Moreover, compound 11k possessed other potent advantages, including breadth of the antibacterial spectrum, rapidity of bactericidal action, and excellent membrane selectivity. The mode of action study of compound 11k at the biophysical and morphology levels disclosed that 11k exerted its MRSA bactericidal action by membrane superpolarization resulting in cell lysis and membrane disruption. Collectively, the presented results indicate that the novel modified RDSB analogue 11k warrants further exploration as a promising candidate for the treatment of MRSA infections.

Purpose: In this action study, researchers worked with a team of interdisciplinary practitioners to co-develop knowledge and practice in a medical unit of a large urban hospital in Canada. An appreciative inquiry approach was utilized to guide the project. This article specifically focuses on examining the research experiences of practitioners and their accounts on how the research influenced their practice development to enact person-centered care. Method: The project took place in the hospital’s medical unit. A total of 50 staff participants attended focus groups including nursing staff, allied health practitioners, unit leaders, and physicians. One senior hospital administrator was interviewed individually. In total, 36 focus groups were conducted to bring participants together to co-vision and co-develop person-centered care. Results: Analysis of the data produced three themes: (a) appreciating the power of co-inquiry, (b) building team capacity, and (c) continuous development. Furthermore, 10 key enablers for engaging staff in the research process were developed from the data. A conceptual tool, “team Engagement Action Making” (TEAM) has been created to support others to do similar work in practice development. Conclusion: An appreciative inquiry approach has the potential to address gaps in knowledge by revealing ways to take action. Future research should further investigate how the appreciative inquiry approach may be used to support bridging research and practice.

This work based on the mechanism action study of sodium gluconate (SG) for ordinary mild steel used for cooling water system treatment. In the first time, we evaluated the temperature effect on the scale inhibition of SG using statistic scale inhibition method. Result showed that the inhibition efficiency became more important with increasing temperature, at great concentration (10 −2 and 10 −3 M). This can be explained by forming of stable complex SG–Ca 2+ . In the second time, the present work focuses on the study of operational parameters and corrosion products effect on SG performance using potentiodynamic polarization and electrochemical impedance spectroscopic method. The obtained results show that SG is a very good inhibitor for corrosion and scale and remains effective in the presence of corrosion products. For this study we were proposed a mechanism action for SG on metallic surface. In addition, the SG keeps its effectiveness in a more aggressive medium such as 3% NaCl. Finally, to complete the formulation, we added a not oxidizing biocide (CTAB) to SG. The results obtained show that SG remains its effective.

Undang-undang No.2 Tahun 1989 tentang Sistem Pen-didikan Nasional mengamanatkan madrasah ditransformasi dari lembaga pendidikan agama menjadi sekolah yang berciri agama Islam. Pada status yang baru madrasah harus bekerja keras memenuhi tuntutan stakeholders . Penelitian tentang transformasi Madrasah Aliyah (MA) ini menggunakan pendekatan kualitatif. Hasil penelitian adalah ada enam masalah yang diidentifikasi yaitu (1) kapasitas manajemen, (2) kurikulum, (3) keterbatasan SDM, (4) orientasi akademik, (5) ujian nasional, (6) otonomi daerah. Secara kelembagaan, MA ada tiga tipe, yaitu MA Plus, MA Salf Tafaqqubfiddin, dan MA dengan pembelajaran ke-agamaan lebih banyak. Ada tiga model yang diaplikasikan yaitu institusional sebagai model utama, model sain terintegrasi, dan model manajemen terpadu. Penerapan model tersebut perlu memperhatikan kesesuaian karakter, konteks, dan setting MA. Kata kunci: transformasi, madrasah, pendidikan Islam, tipologi model ______________________________________________________________ TRANSFORMATION OF MADRASAH IN NATIONAL EDUCATION SYSTEM Abstract According to 1989 Education System Act No. 2, and 1990 Government Regulation No. 28, Madrassas as edu-cational institutions have transform from educational religion to “Schools Characterized by the Islamic teachings”. With this new status, the madrassas entered into a new phase of struggle, from their legal status into meeting the needs and the expectations of their stakeholders. In case of implementation of its transformation, the result of this qualitative – phenol-menology approach, there were identified six problems of MA: (1) management capacity, (2) curriculum, (3) limited human resources, (4) academic orientation and science dichotomy (5) national examination, and (6) local government autonomy. Institutionally there are three major types of MA: (1) MA plus, (2) MA Salaf – Tafaqquh fiddin , (3) MA enriched with religious teachings. Based on the problems identified and the types of MA put into consideration, three models are offered as the results of social action study, i.e. (1) institutional model – streaming model, (2) integrated science model, and (3) integrated management model. The result of this study is methodologically idiographic, and the compatibility of these models depend upon the appropriateness of the characters, context and setting of an MA. Keywords: transformation, madrasah, Islamic education, tipology, model

Objective To assess the impact of baseline body mass index (BMI) on the efficacy and retention of intravenous abatacept at 6 months in biologic-naive patients with rheumatoid arthritis (RA). Methods This was a 6-month analysis of a 2-year, non-interventional, international, prospective study. Baseline characteristics, clinical response and retention rates were compared by BMI subgroup: underweight/normal, overweight and obese ( 2 , respectively). Results BMI was reported in 643/672 (96%) patients: 264 (41%) were underweight/normal, 224 (35%) overweight and 155 (24%) obese. At baseline, the obese group had more active disease (mean [95% confidence intervals] 28-joint Disease Activity Score [C-reactive protein; derived] 4.6 [4.5, 4.7], 4.8 [4.7, 5.0] and 5.1 [4.9, 5.2] for underweight/normal, overweight and obese groups, respectively), a higher prevalence of metabolic disorders, a greater proportion of women and a lower proportion of patients with rheumatoid factor positivity. There were no significant differences in the percentages of patients achieving a good/moderate European League Against Rheumatism response by BMI group (80.7, 86.1 and 77.0% for underweight/normal, overweight and obese groups, respectively; P = 0.178). Overall retention rates at 6 months did not differ across groups (89, 92 and 89% for underweight/normal, overweight and obese groups, respectively; log-rank P = 0.382). After adjustment for baseline characteristics, BMI was not significantly associated with risk of discontinuation (reference BMI 2 ; hazard ratio [95% confidence intervals] 0.46 [0.22, 0.99] and 0.69 [0.34, 1.41] for overweight and obese patients, respectively). Conclusion BMI does not impact abatacept clinical response or retention in biologic-naive patients with RA.

Background Older people represent a significant proportion of patients admitted to hospital. Their care compared to younger patients is more challenging, length of stay is longer, risk of hospital-acquired problems higher and the risk of being re-admitted within 28 days greater. This study aims to compare a Community In-Reach and Care Transition (CIRACT) service with Traditional Hospital Based rehabilitation (THB-Rehab) provided to the older person. The CIRACT service differs from the THB-rehab service in that they are able to provide more intensive hospital rehabilitation, visiting patients daily, and are able to continue with the patient’s rehabilitation following discharge allowing a seamless, integrated discharge working alongside community providers. A pilot comparing the two services showed that the CIRACT service demonstrated reduced length of stay and reduced re-admission rates when analysed over a four-month period. Methods/Design This trial will evaluate the clinical and cost-effectiveness of the CIRACT service, conducted as a randomised controlled trial (RCT) with an integral qualitative mechanism and action study designed to provide the explanatory and theoretical components on how the CIRACT service compares to current practice. The RCT element consists of 240 patients over 70 years of age, being randomised to either the THB therapy group or the CIRACT service following an unplanned hospital admission. The primary outcome will be hospital length of stay from admission to discharge from the general medical elderly care ward. Additional outcome measures including the Barthel Index, Charlson Co-morbidity Scale, EuroQoL-5D and the modified Client Service Receipt Inventory will be assessed at the time of recruitment and repeated at 91 days post-discharge. The qualitative mechanism and action study will involve a systematic programme of organisational profiling, observations of work processes, interviews with key informants and care providers and tracking of participants. In addition, a within-trial economic evaluation will be undertaken comparing the CIRACT and THB-rehab services to determine cost-effectiveness. Discussion The outcome of the study will inform clinical decision-making, with respect to allocation of resources linked to hospital discharge planning and re-admissions, in a resource intensive and growing group of patients. Trial registration Registered with the ISRCTN registry (ISCRCTN94393315) on 25 April 2013 (version 3.1, 11 September 2014). Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0551-2) contains supplementary material, which is available to authorized users.

Paper presents a part of results obtained in 1998 within action study of the psychological effects of war traumatisation in Republika Srpska. Special attention is paid to the additional impact of multiple exposure to war sufferings regarding the degree of the traumatisation (the loss of loved ones, direct life threat, the participation in combats, and the testimony of the death of other people). 229 persons were assessed in 8 towns of Republika Srpska. The comparison of the results of refugees and domicile persons at the Reaction Index - Revised speaks in favour of their significantly higher vulnerability even after three years after the end of war. Total degree of the traumatisation, as well as the symptoms of intrusion, avoidance, and hyper-arousal are significantly more frequent. In 42.5% of refugees (in relation to 26.7% of domicile persons) there is PTSP risk. The intensification of criteria proves that 17% of refugees are at high risk (in relation to 5.2% of the domiciled). It is obvious, that refuge presents traumatic event for many people, and not only chronic burden. The results suggest that the effect of direct jeopardy, combat stress, and the testimony of somebody else?s death are fading in time, but that the culmination of tangible, social, and human losses in refuge is serious risk factor for mental health.

Background The use of assisted conception (AC) has been associated with higher risk of adverse perinatal outcome. Few data are available on the outcome of AC-neonates when pregnancy ends before 32 weeks of gestational age. The aim of this study was to compare the short-term outcome of AC- and naturally conceived preterm infants

Emanating from the ground-breaking Library Impact Data Project, the aim of the Roving Librarian project first initiated in 2011 was to offer personalised help outside of the traditional library to library non users in social or academic settings using Android and the iPad tablets. It was thought that the portability and flexibility of these devices would allow staff to reach students and help them at their point of need. To test out this premise, an action study was carried out to examine the use of tablets and their suitability in facilitating the roving librarian project as well as evaluate roving as a vehicle for teaching information literacy on the move. Data was collected through peer observation, individual reflections and a questionnaire conducted with subject librarians to find out more about their usage of the tablet and to ascertain whether they have found it conducive in roving. The project demonstrated that the affordances of both devices enabled librarians to provide personalized mobile help to students whilst building stronger relationships and arguably having the type of conversations about library resources and facilities that would not have happened if staff had stayed within the physical library building.

Many studies exist about open innovation as transfer of innovations inside and outside of the firm or as joint projects in collaborative partnerships. In this paper, we investigate the matchmaking between innovation seekers and innovation providers, with the focus on asymmetric partnerships between incumbent large companies and young entrepreneurial firms. In particular, we introduce the matchmaking problem as a multi-sided market with different internal and external agents and describe the phenomenon. Furthermore, the matching process on a multi-sided market is presented based on existing literature and an in-depth participatory action study.

Objectives: In elderly individuals, little is known about changes in different anthropometric measures with respect to mortality. We examined the association between changes in eight anthropometric measures and mortality in an elderly population. Design: Longitudinal study including baseline measurements in 1988-1990 and repeated measures in 1993. Setting: European towns. Participants: A total of 1061 older adults born in 1913-1918 from the Survey in Europe on Nutrition and the Elderly, A Concerted Action study were included in this study. Measurements: Weight, body mass index, waist circumference, waist to hip ratio, waist to height ratio, mid-upper arm circumference (MUAC), triceps skinfold thickness, and corrected arm muscle area were taken during both measurements. Results: A Cox regression model was used to examine the association between anthropometric changes (divided into quintiles, smallest change - reference category) and all-cause and cardiovascular disease mortality over approximately 6 years of follow-up, adjusted for baseline measurement of application, age, sex, smoking, education, physical activity, and major chronic diseases. A decrease in weight (>= 3.2 kg), waist circumference (>= 3.1 cm), and MUAC (>= 1.6 cm and 0.6-1.6 cm) were (near) significantly associated with an all-cause mortality risk of 1.48 (95% CI: 0.99-2.20), 1.52 (95% CI: 1.01-2.31), 1.81 (95% CI: 1.17-2.79), and 1.66 (95% CI: 1.10-2.49), respectively. Also for MUAC, an increase (>= 1.3 cm) was significantly associated with an increased all-cause and cardiovascular disease mortality risk [hazard ratio, 1.52 (95% CI: 1.00-2.31) and 1.94 (95% CI: 1.00-3.75), respectively]. Conclusion: Associations were observed for decreases in only 3 of 8 anthropometric measures and all-cause mortality. Decreases in MUAC had the strongest association with mortality and was the only measure in which an increase also was associated with mortality. This suggests a role for MUAC in the prediction of mortality in elderly individuals. Published by Elsevier Inc. on behalf of the American Medical Directors Association, Inc.

Patients with stage 2 systolic hypertension require sizable blood pressure (BP) reductions to achieve recommended targets. This randomized double-blind study compared a single-pill combination of the direct renin inhibitor aliskiren and hydrochlorothiazide (aliskiren/HCTZ) with HCTZ monotherapy in older patients (older than 55 years) with systolic BP ≥160 mm Hg and

Introduction Patients with systolic heart failure often have concomitant left ventricular (LV) diastolic dysfunction. Although in animal models diastolic dysfunction is associated with worsening exercise capacity and prognosis, information regarding these relationships in patients with established systolic heart failure (HF) is sparse. Methods HF-ACTION was a large, multicenter National Institutes of Health–funded trial of exercise training in systolic HF (LV ejection fraction [LVEF] ≤35%) and included detailed Doppler-echocardiographic (echo) and cardiopulmonary exercise testing at baseline. We tested the hypothesis that echo measures of LV diastolic function predict key cardiopulmonary exercise outcomes, including aerobic exercise capacity (peak exercise oxygen consumption, VO 2 ), distance in the 6-minute walk test (6MWD), and ventilatory efficiency (VE/VCO 2 slope) in patients with systolic HF. Results Overall, 2,331 patients (28% women, median age 59 years, median LVEF 25%) were enrolled. There were significant bivariate correlations between echo diastolic function variables and peak VO 2 (inverse) and VE/VCO 2 slope (direct) that were strongest for ratio of early diastolic peak transmitral (MV) to myocardial tissue velocity (E/E'), peak MV early-to-late diastolic velocity ratio (E/A), and left atrial dimension (range of absolute r = 0.16-0.28). Both MV E/A and E/E' were more strongly related to all 3 exercise variables than was LVEF. The relationships of E/A and E/E' with 6MWD were weaker than with peak VO 2 or VE/VCO 2 slope. A multivariable model with peak VO 2 as the dependent variable, which included MV E/A and 9 demographic predictors including age, sex, race, body mass index, and New York Heart Association class, explained 40% of the variation in peak VO 2 , with MV E/A explaining 6% of the variation. Including LVEF in the model explained less than an additional 1% of the variance in peak VO 2 . In a multivariable model for VE/VCO 2 slope, MV E/A was the strongest independent echo predictor, explaining 10% of the variance. The relationship of LV diastolic function variables with 6MWD was weaker than with peak VO 2 or VE/VCO 2 slope. Conclusion In patients with systolic HF, LV early diastolic function is a modest independent predictor of aerobic exercise capacity and appears to be a better predictor than LVEF.

International audience; Theories of action study what an actor do, in a given situation, in order to achieve consequence or objectives. Argyris and Schon made a distinction between espoused theories - those that an individual claims to follow - and theories-in-use - those that can be inferred from action -. In the software engineering field, software processes and practices constitute the espoused theory, since it is what engineers claim to follow. But what engineers - and especially apprentices - do may reveal a different theory-in-use. The capstone project provides students, working in groups, with the possibility to reflect on her/his action and that may help making explicit theories-in-use. The course of action theory considers the observable aspect of the actor's activity, i.e., what is presentable, accountable and commentable. The course-of-action observatory collects data on the courses-of-action. This observatory connects continuous observations and recordings of the agents' behavior, the provoked verbalizations of these agents in activity and the agents' comments in self confrontation with recordings of their behavior. A case study, based on the activity of a team of 6 young software engineer apprentices is used to illustrate the building and the data collecting of the course-of-action observatory and the self-reconstruction of apprentices' activity. As primary results of this work, we may think that self-observing and self-analyzing software engineer's activity help to reveal her/his theory-in-use - what governs engineers' behavior and tends to be tacit structures - and it may help them to learn more suitable theories-in-use, thus contributing to improve productivity and performance. In the special case of apprenticeship learning, it may form a part of an appropriate education intended to develop a reflective attitude.

The first European Quality Control Concerted Action study was organized to assess the ability of laboratories to detect Chlamydia trachomatis in a panel of urine samples by nucleic acid amplification tests (NATs). The panel consisted of lyophilized urine samples, including three negative, two strongly positive, and five weakly positive samples. Ninety-six laboratories in 22 countries participated with a total of 102 data sets. Of 204 strongly positive samples 199 (97.5%) were correctly reported, and of 506 weakly positive samples 466 (92.1%) were correctly reported. In 74 (72.5%) data sets correct results were reported on all samples, and 17 data sets (16.7%) showed either one false-negative or one false-positive result. In another 11 data sets, two or more incorrect results were reported, and two data sets reported a false-positive result on one negative sample. The Roche COBAS Amplicor test was performed in 44 (43%) data sets, the Abbott LCx assay was performed in 31 (30%) data sets, the Roche Amplicor manual assay was performed in 9 (9%) data sets, an in-house PCR was performed in 9 (9%) data sets, the Becton Dickinson ProbeTec ET assay was performed in 5 (4.9%) data sets, and the GenProbe TMA assay was performed in 4 (3.9%) data sets. The results of the Roche Amplicor manual (95.6% correct), COBAS Amplicor (97.0%), and Abbott LCx (94.8%) tests were comparable ( P = 0.48). The results with the in-house PCR, BD ProbeTec ET, and GenProbe TMA tests were reported correctly in 88.6, 98, and 92.5% of the tests, respectively. Freeze-drying of clinical urine specimens proved to be a successful method for generating standardized, stable, and easy-to-transport samples for the detection of C. trachomatis by using NATs. Although the results, especially the specificity, for this proficiency panel were better than most quality control studies, sensitivity problems occurred frequently, underlining the need for good laboratory practice and reference reagents to monitor the performance of these assays.

Retrospective analyses of specific subgroups of patients from the database of the ACTION study have evaluated the effectiveness of a nifedipine gastrointestinal therapeutic system (GITS) on clinical outcomes. These subgroups included those patients receiving: 1) full "optimal" therapy at baseline; 2) full "optimal" therapy at baseline but excluding renin angiotensin system (RAS)-blocking drugs; 3) treatment with nifedipine GITS who were not treated with RAS blockers versus those treated with RAS blockers but not nifedipine GITS.Analyses were performed on an intention-to-treat basis. Treatment groups were compared by log-rank test without adjustment for covariates. Hazard ratios with 95% confidence intervals were obtained using Cox proportional hazards models with treatment allocation as the only covariate.2461 patients randomized in ACTION were receiving optimal therapy (beta blockers, nitrates, aspirin, statins) excluding RAS blockers at baseline. There were reductions associated with nifedipine GITS compared with placebo in all prespecified endpoints but statistical significance was only achieved for debilitating stroke (48%; P0.02) and coronary angiography (14%; P0.05). These benefits were paralleled by a -4.1 and -2.8 mmHg difference between the groups for systolic and diastolic blood pressure, respectively. Patients randomized to nifedipine GITS but no RAS blockers (n=2966) when compared to those receiving RAS blockers but no nifedipine GITS (n=880) had highly statistically significant reductions in cardiovascular events (22%), new-onset heart failure (53%), and debilitating stroke (45%). However, the groups differed in their baseline characteristics.Addition of nifedipine GITS to the treatment regimen of selected patient groups with symptomatic coronary artery disease results in a significant reduction of cardiovascular morbidity. While the interpretation of these subgroup analyses must obviously be cautious, there is a clear message relating to "best practice" treatment of angina, which suggests that "reliance" on RAS blockade may be misplaced and greater attention should be directed towards control of blood pressure.

Background A better understanding of health-related quality of life (HRQoL) and psychological distress in cancer survivors can raise awareness, promote the development of policies in cancer survivorship care, and facilitate better targeted use of limited resources in low- and middle-income countries (LMICs). The main objectives of this paper were therefore to assess HRQoL and the prevalence of psychological distress amongst cancer survivors in Southeast Asia and identify risk factors of these outcomes. Methods The ACTION study was a longitudinal study in eight LMICs in Southeast Asia with 5249 first time cancer survivors followed up at 1 year after diagnosis. HRQoL was assessed using the EORTC QLQ-C30 and EQ-5D. Psychological distress (anxiety and depression) was assessed using the Hospital Anxiety and Depression Scale. General linear models and multiple logistic regression were used to identify independent predictors of HRQoL and psychological distress. Results One year after diagnosis, the mean EORTC QLQ-C30 global health score for survivors was 66.2 out of 100 (SD 22.0), the mean index score on the EQ-5D was 0.74 (SD 0.23), 37% of survivors had at least mild levels of anxiety, and 46% showed at least mild levels of depression. Poorest HRQoL and highest prevalence of anxiety and depression were seen in patients with lung cancer and lymphomas, while highest scores and least psychological distress were seen in female patients with breast and cervical cancer. The most significant predictor of poor HRQoL and psychological distress outcomes was cancer stage at diagnosis. Age, co-morbidities, treatment, and several socioeconomic factors were associated with HRQoL and psychological distress. Conclusions Cancer survivors in LMICs in Southeast Asia have impaired HRQoL and substantial proportions have psychological distress. Patients with advanced cancer stages at diagnosis and those in a poor socioeconomic position were most at risk of such poor outcomes. Supportive interventions for cancer patients that address wider aspects of patient wellbeing are needed, as well as policies that address financial and other barriers to timely treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12916-016-0768-2) contains supplementary material, which is available to authorized users.

Background Rates of chronic pain are rising sharply in the United States and worldwide. Presently, there is evidence of racial disparities in pain treatment and treatment outcomes in the United States but few interventions designed to address these disparities. There is growing consensus that chronic musculoskeletal pain is best addressed by a biopsychosocial approach that acknowledges the role of psychological and environmental factors, some of which differ by race. Methods/Design The primary aim of this randomized controlled trial is to test the effectiveness of a non-pharmacological, self-regulatory intervention, administered proactively by telephone, at improving pain outcomes and increasing walking among African American patients with hip, back and knee pain. Participants assigned to the intervention will receive a telephone counselor delivered pedometer-mediated walking intervention that incorporates action planning and motivational interviewing. The intervention will consist of 6 telephone counseling sessions over an 8–10 week period. Participants randomly assigned to Usual Care will receive an informational brochure and a pedometer. The primary outcome is chronic pain-related physical functioning, assessed at 6 months, by the revised Roland and Morris Disability Questionnaire, a measure recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). We will also examine whether the intervention improves other IMMPACT-recommended domains (pain intensity, emotional functioning, and ratings of overall improvement). Secondary objectives include examining whether the intervention reduces health care service utilization and use of opioid analgesics and whether key contributors to racial/ethnic disparities targeted by the intervention mediate improvement in chronic pain outcomes Measures will be assessed by mail and phone surveys at baseline, three months, and six months. Data analysis of primary aims will follow intent-to-treat methodology. Discussion We will tailor our intervention to address key contributors to racial pain disparities and examine the effects of the intervention on important pain treatment outcomes for African Americans with chronic musculoskeletal pain. Trial registration ClinicalTrials.gov: NCT01983228. Registered 6 November 2013.