Establishing an evidenced-based dietetic model of care in haemodialysis using implementation science

To establish an evidence-based dietetics service in an in-centre haemodialysis unit utilising implementation science.The service was developed through the Knowledge-to-Action Framework. The steps of the Action Cycle were addressed through a literature review, identification of evidence-based guidelines, benchmarking and local staff engagement. The theoretical domains framework (TDF) was used to identify barriers/enablers, and behaviour change wheel to determine appropriate interventions. To monitor, evaluate outcomes and assess sustained knowledge use we employed multidisciplinary team engagement and database use. Audit data were collected at baseline, 6 and 12 months on nutrition assessment (Patient-Generated Subjective Global Assessment), intervention timeliness and alignment to dietetic workforce recommendations. Descriptive statistics, McNemar tests and a linear mixed model were applied.Barriers existed in the knowledge, skills, environmental context and resources TDF domains. Suitable interventions were identified with training on nutritional management of haemodialysis patients delivered to 148 nurses, and nutrition management recommendations summarised into local procedural resources. A database to prompt and monitor outcome measures was created and indicated that over 18 months post-service commencement, eligible patients received nutrition assessment at least 6-monthly, aligning with recommendations. Prevalence of malnutrition was 28% (n = 9/32) at baseline, 23% (n = 5/22) at 6 months and 20% (n = 4/20) at 12 months (P = 0.50).We demonstrated benefits to service development and implementation with implementation science providing a structured and methodical approach to translating guidelines into practice. Development of training, resources and prompts for outcome measures has supported the establishment of an evidence-based dietetics service in a haemodialysis unit

The Nucleation and Growth of Calcium Oxalate Monohydrate on Self-Assembled Monolayers (SAMs)

A physical chemical approach was used to study calcium oxalate monohydrate (COM) nucleation and growth on various organic interfaces. Self-assembling monolayers (SAMs), containing derivatized organic functional groups, were designed to mimic various amino acid residues present in both urine and stone matrix macromolecules. Derivatized surfaces include SAMs with terminal methyl, bromo, imidazole, and thiazolidine-carboxylic acid functional groups. Pronounced differences in COM deposition were observed for the various interfaces with the imidazole and thiazolidine surfaces having the greatest effect and the methyl and bromo groups having little or no nucleating potential

A Planetary Companion to gamma Cephei A

We report on the detection of a planetary companion in orbit around the primary star of the binary system $\gamma$ Cephei. High precision radial velocity measurements using 4 independent data sets spanning the time interval 1981--2002 reveal long-lived residual radial velocity variations superimposed on the binary orbit that are coherent in phase and amplitude with a period or 2.48 years (906 days) and a semi-amplitude of 27.5 m s$^{-1}$. We performed a careful analysis of our Ca II H & K S-index measurements, spectral line bisectors, and {\it Hipparcos} photometry. We found no significant variations in these quantities with the 906-d period. We also re-analyzed the Ca II $\lambda$8662 {\AA} measurements of Walker et al. (1992) which showed possible periodic variations with the ``planet'' period when first published. This analysis shows that periodic Ca II equivalent width variations were only present during 1986.5 -- 1992 and absent during 1981--1986.5. Furthermore, a refined period for the Ca II $\lambda$8662 {\AA} variations is 2.14 yrs, significantly less than residual radial velocity period. The most likely explanation of the residual radial velocity variations is a planetary mass companion with $M$ sin $i$ = 1.7 $M_{Jupiter}$ and an orbital semi-major axis of $a_2$ $=$ 2.13 AU. This supports the planet hypothesis for the residual radial velocity variations for $\gamma$ Cep first suggested by Walker et al. (1992). With an estimated binary orbital period of 57 years $\gamma$ Cep is the shortest period binary system in which an extrasolar planet has been found. This system may provide insights into the relationship between planetary and binary star formation.Comment: 19 pages, 15 figures, accepted in Ap. J. Includes additional data and improved orbital solutio

Pregnant Women’s Experiences and Views on an “Opt-Out” Referral Pathway to Specialist Smoking Cessation Support: A Qualitative Evaluation

Introduction: Smoking in pregnancy remains an important and costly public health concern with policy makers worldwide researching methods to aid cessation. UK government guidelines recommend implementation of an ‘opt-out’ (i.e. whether requested or not) referral pathway for pregnant smokers to specialist smoking cessation support using carbon monoxide (CO) screening. This study explores the views of pregnant smokers who experienced this new pathway in one UK hospital trust. Methods Eighteen semi-structured telephone interviews with women who experienced the ‘opt-out’ pathway were undertaken. Data were analysed thematically. Results Three themes were identified relating to expectations, acceptability and impact of the pathway. Women were generally very accepting of the CO testing especially when it met their prior expectations and was perceived as being a routine component of antenatal care. They considered the visual feedback from the CO monitoring improved their motivation to quit. Views on the automatic referral for cessation support were divided with questions raised as to the removal of choice, with many women also expressing dissatisfaction about perceived lack of contact by Stop Smoking Services (SSS) following referral. Conclusion The ‘opt-out’ pathway is potentially an acceptable addition to current practice. The women considered CO monitoring to be the most valuable element of the pathway. Women keen to engage with SSS desired a more efficient system of contact.This article presents independent research funded by the National Institute for Health Research (NIHR) under the Programme Grants for Applied Research programme (RP-PG-0109-10020). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.This is the author accepted manuscript. The final version is available from Oxford University Press via http://dx.doi.org/10.1093/ntr/ntv27

Pregnant women’s experiences and views on an “opt-out” referral pathway to specialist smoking cessation support: a qualitative evaluation

Introduction: Smoking in pregnancy remains an important and costly public health concern with policy makers worldwide researching methods to aid cessation. UK government guidelines recommend implementation of an “opt-out” (ie, whether requested or not) referral pathway for pregnant smokers to specialist smoking cessation support using carbon monoxide (CO) screening. This study explores the views of pregnant smokers who experienced this new pathway in one UK hospital trust. Methods: Eighteen semi-structured telephone interviews with women who experienced the opt-out pathway were undertaken. Data were analyzed thematically. Results: Three themes were identified relating to expectations, acceptability and impact of the pathway. Women were generally very accepting of the CO testing especially when it met their prior expectations and was perceived as being a routine component of antenatal care. They considered the visual feedback from the CO monitoring improved their motivation to quit. Views on the automatic referral for cessation support were divided with questions raised as to the removal of choice, with many women also expressing dissatisfaction about perceived lack of contact by Stop Smoking Services (SSS) following referral. Conclusion: The opt-out pathway is potentially an acceptable addition to current practice. The women considered CO monitoring to be the most valuable element of the pathway. Women keen to engage with SSS desired a more efficient system of contact. Implications: This study presents a unique insight into pregnant women’s views on the implementation of opt-out referrals for smoking cessation. Introducing CO testing and opt-out referrals at the time of antenatal ultrasound examination can potentially increase motivation to stop smoking in pregnancy. The findings demonstrate that facilitating access to SSS was not always achieved, and further refinement is needed to ensure more effective contact procedures. Ensuring all women are fully informed prior to the CO testing may further improve both the impact of the opt-out referral pathway and the chance of successfully engaging with SSS

Next-to-leading order QCD corrections to electroweak Zjj production in the POWHEGBOX

We present an implementation of electroweak Z-boson production in association with two jets at hadron colliders in the POWHEG framework, a method that allows the interfacing of NLO-QCD calculations with parton-shower Monte Carlo programs. We focus on the leptonic decays of the weak gauge boson, and take photonic and non-resonant contributions to the matrix elements fully into account. We provide results for observables of particular importance for the suppression of QCD backgrounds to vector-boson fusion processes by means of central-jet-veto techniques. While parton-shower effects are small for most observables associated with the two hardest jets, they can be more pronounced for distributions that are employed in central-jet-veto studies.Comment: 12 pages, 5 figure

Adherence to Accelerometer Protocols Among Women From Economically Disadvantaged Neighborhoods

Background: Objective measurement of physical activity with accelerometers is a challenging task in community-based intervention research. Challenges include distribution of and orientation to monitors, nonwear, incorrect placement, and loss of equipment. Data collection among participants from disadvantaged populations may be further hindered by factors such as transportation challenges, competing responsibilities, and cultural considerations. Methods: Research staff distributed accelerometers and provided an orientation that was tailored to the population group. General adherence strategies such as follow-up calls, daily diaries, verbal and written instructions, and incentives were accompanied by population-specific strategies such as assisting with transportation, reducing obstacles to wearing the accelerometer, tailoring the message to the participant population, and creating a nonjudgmental environment. Results: Sixty women asked to wear the Actigraph GT1M returned the accelerometer, and 57 of them provided sufficient data for analysis (at least 10 hours a day for a minimum of 4 days) resulting in 95% adherence to the protocol. Participants wore the accelerometers for an average of 5.98 days and 13.15 hours per day. Conclusions: The high accelerometer monitoring adherence among this group of economically disadvantaged women demonstrates that collection of high-quality, objective physical data from disadvantaged populations in field-based research is possible

Evidence for a Long-period Planet Orbiting Epsilon Eridani

High precision radial velocity (RV) measurements spanning the years 1980.8--2000.0 are presented for the nearby (3.22 pc) K2 V star $\epsilon$ Eri. These data, which represent a combination of six independent data sets taken with four different telescopes, show convincing variations with a period of $\approx$ 7 yrs. A least squares orbital solution using robust estimation yields orbital parameters of period, $P$ = 6.9 yrs, velocity $K$-amplitude $=$ 19 {\ms}, eccentricity $e$ $=$ 0.6, projected companion mass $M$ sin $i$ = 0.86 $M_{Jupiter}$, and semi-major axis $a_2$ $=$ 3.3 AU. Ca II H&K S-index measurements spanning the same time interval show significant variations with periods of 3 and 20 yrs, yet none at the RV period. If magnetic activity were responsible for the RV variations then it produces a significantly different period than is seen in the Ca II data. Given the lack of Ca II variation with the same period as that found in the RV measurements, the long-lived and coherent nature of these variations, and the high eccentricity of the implied orbit, Keplerian motion due to a planetary companion seems to be the most likely explanation for the observed RV variations. The wide angular separation of the planet from the star (approximately 1 arc-second) and the long orbital period make this planet a prime candidate for both direct imaging and space-based astrometric measurements.Comment: To appear in Astrophysical Journal Letters. 9 pages, 2 figure