Study of 1980 Comet Encke-asteroid missions using a spin-stabilized spacecraft. Volume 1: Summary report

As a contribution to improved understanding of early comet exploration options, independent studies were undertaken which resulted in the identification of a number of fast flyby mission options for the 1980 apparition of Encke. The primary impetus for this approach was the prospect of utilizing existing launch vehicles and conventional spacecraft technology. In addition, timely experience and scientific data gained through an early fast flyby could prove valuable in implementing more ambitious succeeding missions, including a flyby of Comet Halley in 1986

Ballistic Missions To Comet Encke In 1980 -A New Phase Of Solar System Exploration

A prime mission candidate for initiating exploration of both a comet and asteroids with unmanned spacecraft is available during the 1980 apparition of the short-period Comet Encke. Direct investigation of such bodies is expected to provide the best insight into conditions existing during the early periods of solar system evolution. A discussion is presented on low-cost ballistic mission options to Comet Encke. Particular emphasis is given to the results of a recentlycompleted study of ballistically-launched, spinstabilized spacecraft for 1980 missions to Comet Encke and the asteroids Geographos and Toro. Characteristics and utilization of a small, separable probe to enhance comet science return are also described. In conclusion, it is shown that the Encke ballistic flyby can provide the necessary technical foundation to support the planning of more advanced Encke follow-on missions as well as the challenging flyby of Comet Halley in 1986

The Effect of Embedding Formative Assessment on Pupil Attainment

Evidence suggests that adapting teaching responsively to pupil assessment can be effective in improving students’ learning. However, existing studies tend to be small-scale, leaving unanswered the question of how such formative assessment can operate when embedded as standard practice. In this study, we present the results of a randomized trial conducted in 140 English secondary schools. The intervention uses light-touch training and support, with most of the work done by teacher-led teaching and learning communities within schools. It is, therefore, well-suited to widespread adoption. In our pre-registered primary analysis, we estimate an effect size of 0.09 on general academic attainment in national, externally assessed examinations. Sensitivity analysis, excluding schools participating in a similar program at baseline, and complier analysis both suggest a larger effect size of 0.11. These results are encouraging for this approach to improving the implementation of formative assessment and, hence, academic attainment. Our findings also suggest that the intervention may help to narrow the gap between high and low prior attainment pupils, although not the gap between those from disadvantaged backgrounds and the rest of the cohort

The effect of embedding formative assessment on pupil attainment

Evidence suggests that adapting teaching responsively to pupil assessment can be effective in improving students’ learning. However, existing studies tend to be small-scale, leaving unanswered the question of how such formative assessment can operate when embedded as standard practice. In this study, we present the results of a randomized trial conducted in 140 English secondary schools. The intervention uses light-touch training and support, with most of the work done by teacher-led teaching and learning communities within schools. It is, therefore, well-suited to widespread adoption. In our pre-registered primary analysis, we estimate an effect size of 0.09 on general academic attainment in national, externally assessed examinations. Sensitivity analysis, excluding schools participating in a similar program at baseline, and complier analysis both suggest a larger effect size of 0.11. These results are encouraging for this approach to improving the implementation of formative assessment and, hence, academic attainment. Our findings also suggest that the intervention may help to narrow the gap between high and low prior attainment pupils, although not the gap between those from disadvantaged backgrounds and the rest of the cohort

Acceptance and Commitment Therapy for people living with motor neuron disease: an uncontrolled feasibility study

Background: Motor neuron disease (MND) is a fatal, progressive neurodegenerative disease that causes progressive weakening and wasting of limb, bulbar, thoracic and abdominal muscles. Clear evidence-based guidance on how psychological distress should be managed in people living with MND (plwMND) is lacking. Acceptance and Commitment Therapy (ACT) is a form of psychological therapy that may be particularly suitable for this population. However, to the authors' knowledge, no study to date has evaluated ACT for plwMND. Consequently, the primary aim of this uncontrolled feasibility study was to examine the feasibility and acceptability of ACT for improving the psychological health of plwMND. Methods: PlwMND aged ≥ 18 years were recruited from 10 UK MND Care Centres/Clinics. Participants received up to 8 one-to-one ACT sessions, developed specifically for plwMND, plus usual care. Co-primary feasibility and acceptability outcomes were uptake (≥ 80% of the target sample [N = 28] recruited) and initial engagement with the intervention (≥ 70% completing ≥ 2 sessions). Secondary outcomes included measures of quality of life, anxiety, depression, disease-related functioning, health status and psychological flexibility in plwMND and quality of life and burden in caregivers. Outcomes were assessed at baseline and 6 months. Results: Both a priori indicators of success were met: 29 plwMND (104%) were recruited and 76% (22/29) attended ≥ 2 sessions. Attrition at 6-months was higher than anticipated (8/29, 28%), but only two dropouts were due to lack of acceptability of the intervention. Acceptability was further supported by good satisfaction with therapy and session attendance. Data were possibly suggestive of small improvements in anxiety and psychological quality of life from baseline to 6 months in plwMND, despite a small but expected deterioration in disease-related functioning and health status. Conclusions: There was good evidence of acceptability and feasibility. Limitations included the lack of a control group and small sample size, which complicate interpretation of findings. A fully powered RCT to evaluate the clinical and cost-effectiveness of ACT for plwMND is underway

Prognostic accuracy of emergency department triage tools for adults with suspected COVID-19: the PRIEST observational cohort study

Background The WHO and National Institute for Health and Care Excellence recommend various triage tools to assist decision-making for patients with suspected COVID-19. We aimed to compare the accuracy of triage tools for predicting severe illness in adults presenting to the ED with suspected COVID-19. Methods We undertook a mixed prospective and retrospective observational cohort study in 70 EDs across the UK. We collected data from people attending with suspected COVID-19 and used presenting data to determine the results of assessment with the WHO algorithm, National Early Warning Score version 2 (NEWS2), CURB-65, CRB-65, Pandemic Modified Early Warning Score (PMEWS) and the swine flu adult hospital pathway (SFAHP). We used 30-day outcome data (death or receipt of respiratory, cardiovascular or renal support) to determine prognostic accuracy for adverse outcome. Results We analysed data from 20 891 adults, of whom 4611 (22.1%) died or received organ support (primary outcome), with 2058 (9.9%) receiving organ support and 2553 (12.2%) dying without organ support (secondary outcomes). C-statistics for the primary outcome were: CURB-65 0.75; CRB-65 0.70; PMEWS 0.77; NEWS2 (score) 0.77; NEWS2 (rule) 0.69; SFAHP (6-point rule) 0.70; SFAHP (7-point rule) 0.68; WHO algorithm 0.61. All triage tools showed worse prediction for receipt of organ support and better prediction for death without organ support. At the recommended threshold, PMEWS and the WHO criteria showed good sensitivity (0.97 and 0.95, respectively) at the expense of specificity (0.30 and 0.27, respectively). The NEWS2 score showed similar sensitivity (0.96) and specificity (0.28) when a lower threshold than recommended was used. Conclusion CURB-65, PMEWS and the NEWS2 score provide good but not excellent prediction for adverse outcome in suspected COVID-19, and predicted death without organ support better than receipt of organ support. PMEWS, the WHO criteria and NEWS2 (using a lower threshold than usually recommended) provide good sensitivity at the expense of specificity. Trial registration number ISRCTN56149622

Efficacy and safety of autologous haematopoietic stem cell transplantation versus alemtuzumab, ocrelizumab, ofatumumab or cladribine in relapsing remitting multiple sclerosis (StarMS): protocol for a randomised controlled trial

Supplementary materials: Supplementary Data are available online at: https://doi.org/10.1136/bmjopen-2023-083582 .Introduction: Autologous haematopoietic stem cell transplantation (aHSCT) is increasingly used as treatment for patients with active multiple sclerosis (MS), typically after failure of disease-modifying therapies (DMTs). A recent phase III trial, ‘Multiple Sclerosis International Stem Cell Transplant, MIST’, showed that aHSCT resulted in prolonged time to disability progression compared with DMTs in patients with relapsing remitting MS (RRMS). However, the MIST trial did not include many of the current high-efficacy DMTs (alemtuzumab, ocrelizumab, ofatumumab or cladribine) in use in the UK within the control arm, which are now offered to patients with rapidly evolving severe MS (RES-MS) who are treatment naïve. There remain, therefore, unanswered questions about the relative efficacy and safety of aHSCT over these high-efficacy DMTs in these patient groups. The StarMS trial (Autologous Stem Cell Transplantation versus Alemtuzumab, Ocrelizumab, Ofatumumab or Cladribine in Relapsing Remitting Multiple Sclerosis) will assess the efficacy, safety and long-term impact of aHSCT compared with high-efficacy DMTs in patients with highly active RRMS despite the use of standard DMTs or in patients with treatment naïve RES-MS. Methods and analysis: StarMS is a multicentre parallel-group rater-blinded randomised controlled trial with two arms. A total of 198 participants will be recruited from 19 regional neurology secondary care centres in the UK. Participants will be randomly allocated to the aHSCT arm or DMT arm in a 1:1 ratio. Participants will remain in the study for 2 years with follow-up visits at 3, 6, 9, 12, 18 and 24 months postrandomisation. The primary outcome is the proportion of patients who achieve ‘no evidence of disease activity’ during the 2-year postrandomisation follow-up period in an intention to treat analysis. Secondary outcomes include efficacy, safety, cost-effectiveness and immune reconstitution of aHSCT and the four high-efficacy DMTs. Ethics and dissemination: The study was approved by the Yorkshire and Humber—Leeds West Research Ethics Committee (20/YH/0061). Participants will provide written informed consent prior to any study specific procedures. The study results will be submitted to a peer-reviewed journal and abstracts will be submitted to relevant national and international conferences. Trial registration number: ISRCTN88667898.Efficacy and Mechanism Evaluation (EME) Programme, an MRC and NIHR partnership

Bridging the age gap in breast cancer: cluster randomized trial of the effects of two decision support interventions for older women with operable breast cancer on quality of life, survival, decision quality, and treatment choices

Background Rates of surgery and adjuvant therapy for breast cancer vary widely between breast units. This may contribute to differences in survival. This cluster RCT evaluated the impact of decision support interventions (DESIs) for older women with breast cancer, to ascertain whether DESIs influenced quality of life, survival, decision quality, and treatment choice. Methods A multicentre cluster RCT compared the use of two DESIs against usual care in treatment decision-making in older women (aged at least ≥70 years) with breast cancer. Each DESI comprised an online algorithm, booklet, and brief decision aid to inform choices between surgery plus adjuvant endocrine therapy versus primary endocrine therapy, and adjuvant chemotherapy versus no chemotherapy. The primary outcome was quality of life. Secondary outcomes included decision quality measures, survival, and treatment choice. Results A total of 46 breast units were randomized (21 intervention, 25 usual care), recruiting 1339 women (670 intervention, 669 usual care). There was no significant difference in global quality of life at 6 months after the baseline assessment on intention-to-treat analysis (difference –0.20, 95 per cent confidence interval (C.I.) –2.69 to 2.29; P = 0.900). In women offered a choice of primary endocrine therapy versus surgery plus endocrine therapy, knowledge about treatments was greater in the intervention arm (94 versus 74 per cent; P = 0.003). Treatment choice was altered, with a primary endocrine therapy rate among women with oestrogen receptor-positive disease of 21.0 per cent in the intervention versus 15.4 per cent in usual-care sites (difference 5.5 (95 per cent C.I. 1.1 to 10.0) per cent; P = 0.029). The chemotherapy rate was 10.3 per cent at intervention versus 14.8 per cent at usual-care sites (difference –4.5 (C.I. –8.0 to 0) per cent; P = 0.013). Survival was similar in both arms. Conclusion The use of DESIs in older women increases knowledge of breast cancer treatment options, facilitates shared decision-making, and alters treatment selection. Trial registration numbers: EudraCT 2015-004220-61 (https://eudract.ema.europa.eu/), ISRCTN46099296 (http://www.controlled-trials.com)