A phase III, multi-centre, double-masked randomised controlled trial of adjunctive intraocular and peri-ocular steroid (triamcinolone acetonide) versus standard treatment in eyes undergoing vitreoretinal surgery for open globe trauma (ASCOT): statistical analysis plan.

BACKGROUND: Open globe ocular trauma complicated by intraocular scarring (proliferative vitreoretinopathy) is a relatively rare, blinding, but potentially treatable condition for which, at present, surgery is often unsatisfactory and visual results frequently poor. To date, no pharmacological adjuncts to surgery have been proven to be effective. The aim of the Adjunctive Steroid Combination in Ocular Trauma (ASCOT) randomised controlled trial is to determine whether adjunctive steroid (triamcinolone acetonide), given at the time of surgery, can improve the outcome of vitreoretinal surgery in patients with open globe ocular trauma. This article presents the statistical analysis plan for the main publication as approved and signed off by the Trial Steering Committee prior to the first data extraction for the Data Monitoring Committee meeting report. METHODS/DESIGN: ASCOT is a pragmatic, multi-centre, parallel-group, double-masked randomised controlled trial. The aim of the study is to recruit from 20-25 centres in the United Kingdom and randomise 300 eyes (from 300 patients) into two treatment arms. Both groups will receive standard surgical treatment and care; the intervention arm will additionally receive a pre-operative steroid combination (triamcinolone acetonide) into the vitreous cavity consisting of 4 mg/0.1 ml and 40 mg/1 ml sub-Tenon's. Participants will be followed for 6 months post-surgery. The primary outcome is the proportion of patients achieving a clinically meaning improvement in visual acuity in the study eye at 6 months after initial surgery, defined as a 10 letter score improvement in the ETDRS (the standard scale to test visual acuity). TRIAL REGISTRATION: ISRCTN30012492 . Registered on 5 September 2014. EudraCT2014-002193-37 . Registered on 5 September 2014

Safety at Schools: Identifying the Costs Associated with the Necessary Safeguards for Arming Educators

Editors’ note: The Rural Educator publishes a policy brief each issue, intended to explore topics pertinent to rural education policy and advocacy. The issue of school safety is particularly timely, especially for rural schools. We believe this essay, based on surveys of school leaders in Colorado, takes a unique perspective by examining the financial costs that might be associated with policies to place guns in schools

COPe-support - a multi-component digital intervention for family carers for people affected by psychosis: study protocol for a randomized controlled trial.

BACKGROUND: Psychosis often causes significant distress and impacts not only in the individuals, but also those close to them. Many relatives and friends ('carers') provide long-term support and need resources to assist them. We have co-produced a digital mental health intervention called COPe-support (Carers fOr People with Psychosis e-support) to provide carers with flexible access to high quality psychoeducation and interactive support from experts and peers. This study evaluates the effectiveness of COPe-support to promote mental wellbeing and caregiving experiences in carers. METHODS: This study is a single-blind, parallel arm, individually randomized controlled trial (RCT) comparing COPe-support, with attention control. Both groups continue to receive usual care. COPe-support provides interactive web-based psychoeducation on psychosis-related issues, wellbeing-promotion and network support through forums. The attention-control is a non-interactive online information resource pack. Carers living in England are eligible if they provide at least weekly support to a family member or close friend affected by psychosis, and use internet communication (including emails) daily. All trial procedures are run online, including collection of outcome measurements which participants will directly input into our secure platform. Following baseline assessment, a web-based randomization system will be used to allocate 360 carers to either arm. Participants have unlimited access to the allocated condition for 40 weeks. Data collection is at three time points (10, 20, and 40 weeks after randomization). Analyses will be conducted by trial statisticians blinded to allocation. The primary outcome is mental wellbeing measured by Warwick Edinburgh Mental Wellbeing Scale (WEMWBS), at 20 weeks. As well as an intention-to-treat analysis, a complier average causal effect (CACE) analysis will be conducted to estimate the intervention effect in participants who have accessed COPe-support content twice or more. The secondary objectives and analysis will examine other health and caregiving-related outcomes and explore mechanisms. In a process evaluation, we will interview 20% of the intervention arm participants regarding the acceptability of COPe-support. We will explore in detail participants' usage patterns. DISCUSSION: The results of this trial will provide valuable information about the effectiveness of COPe-support in promoting wellbeing and caregiving experiences in carers. TRIAL REGISTRATION: The RCT is registered with the Current Controlled Trials registration (ISRCTN 89563420, registration date: 02/03/2018)

Compressibility of CeMIn5Ce M In_5 and Ce2MIn8Ce_2 M In_8 (M = Rh, Ir and Co) Compounds

The lattice parameters of the tetragonal compounds Ce$M$In$_{5}$ and Ce$_{2}M$In$_{8}$($M=$Rh, Ir and Co) have been studied as a function of pressure up to 15 GPa using a diamond anvil cell under both hydrostatic and quasihydrostatic conditions at room temperature. The addition of $M$In$_{2}$ layers to the parent CeIn$_{3}$ compound is found to stiffen the lattice as the 2-layer systems (average of bulk modulus values $B_{0}$ is 70.4 GPa) have a larger $B_{0}$ than CeIn$_{3}$ (67 GPa), while the 1-layer systems with the are even stiffer (average of $B_{0}$ is 81.4 GPa). Estimating the hybridization using parameters from tight binding calculations shows that the dominant hybridization is $fp$ in nature between the Ce and In atoms. The values of $V_{pf}$ at the pressure where the superconducting transition temperature $T_{c}$ reaches a maximum is the same for all Ce$M$In$_{5}$ compounds. By plotting the maximum values of the superconducting transition temperature $T_{c}$ versus $c/a$ for the studied compounds and Pu-based superconductors, we find a universal $T_{c}$ versus $c/a$ behavior when these quantities are normalized appropriately. These results are consistent with magnetically mediated superconductivity.Comment: Updated version resubmitted to Phys. Rev.

Incorporating parent, former patient, and clinician perspectives in the design of a national UK double-cluster, randomised controlled trial addressing uncertainties in preterm nutrition

Background: Comparative effectiveness randomised controlled trials are powerful tools to resolve uncertainties in existing treatments and care processes. We sought parent and patient perspectives on the design of a planned national, double-cluster randomised controlled trial (COLLABORATE) to resolve two longstanding uncertainties in preterm nutrition. Methods: We used qualitative focus groups and interviews with parents, former patients and clinicians. We followed the Consolidated Criteria for Reporting Qualitative Research checklist and conducted framework analysis, a specific methodology within thematic analysis. Results: We identified support for the trial’s methodology and vision, and elicited themes illustrating parents’ emotional needs in relation to clinical research. These were: relieving the pressure on mothers to breastfeed; opt-out consent as reducing parent stress; the desire for research to be a partnership between clinicians, parents and researchers; the value of presenting trial information in a collaborative tone; and in a format that allows assimilation by parents at their own pace. We identified anxiety and cognitive dissonance among some clinicians in which they recognised the uncertainties that justify the trial but felt unable to participate because of their strongly held views. Conclusions: The early involvement of parents and former patients identified the centrality of parents’ emotional needs in the design of comparative effectiveness research. These insights have been incorporated into trial enrolment processes and information provided to participants. Specific outputs were a two-sided leaflet providing very brief as well as more detailed information, and use of language that parents perceive as inclusive and participatory. Further work is warranted to support clinicians to address personal biases that inhibit trial participation

Human Dermal Microvascular Endothelial Cells Produce Matrix Metalloproteinases in Response to Angiogenic Factors and Migration

Matrix metalloproteinases (MMPs) are a family of inducible enzymes that degrade extracellular matrix components, allowing cells to traverse connective tissue structures efficiently. Specific tissue inhibitors (TIMPs) function as physiologic inhibitors of MMP activity. Because neovascularization may require various proteinases, we characterized the profile of metalloenzyme production by microvascular endothelial cells (MEC) and the modulation of expression by phorbol esters (PMA) and by the physiologically relevant cytokines tumor necrosis factor-α (TNF-α), basic fibroblast growth factor, and interferon-γ. MMP expression by MEC and large-vessel human umbilical vein endothelial cells (HUVEC) was determined by enzyme-linked immunosorbent assay, immunoprecipitation, Northern hybridization, and transfection assays. Constitutive expression of MMPs by endothelial cells was low. PMA stimulated the production of collagenase, stromelysin, 92-kDa gelatinase, and TIMP-1 in both endothelial cell types. TIMP-2 was constitutively expressed by MEC and HUVEC, but was down-regulated by PMA. TNF-α induced an endothelial-cell-specific up-regulation of collagenase with a concomitant inhibition of PMA-induced TIMP-1 up-regulation, a response that is distinct from that of fibroblasts. Interferon-γ up-regulated TIMP-1 production by MEC and blocked PMA and TNT-induced up-regulation of collagenase. Northern hybridization assays showed pretranslational control of PMA-, basic fibroblast growth factor-, and TNF-α–induced MM.P expression. Collagenase-promoter CAT constructs containing 2.28 kb of the 5' region of the collagenase gene demonstrated transcriptional regulation. The potential physiologic relevance of such regulation was shown in an in vitro migration assay. MEC were stimulated to migrate by wounding and exposure to TNF-α. Collagenase mRNA was prominently expressed by the migrating cells, as shown by in situ hybridization. In sum, MEC have a unique profile of MMP expression and regulation compared with other cell types, which may be important for wound healing and angiogenesis, particularly during the early phase of migration

Segmented Band Mechanism for Itinerant Ferromagnetism

We introduce a novel mechanism for itinerant ferromagnetism, which is based on a simple two-band model, and using numerical and analytical methods, we show that the Periodic Anderson Model (PAM) contains this mechanism. We propose that the mechanism, which does not assume an intra-atomic Hund's coupling, is present in both the iron group and some $f$ electron compounds

Heat capacity studies of Ce and Rh site substitution in the heavy fermion antiferromagnet CeRhIn_5;: Short-range magnetic interactions and non-Fermi-liquid behavior

In heavy fermion materials superconductivity tends to appear when long range magnetic order is suppressed by chemical doping or applying pressure. Here we report heat capacity measurements on diluted alloyes of the heavy fermion superconductor CeRhIn_5;. Heat capacity measurements have been performed on CeRh_{1-y}Ir_{y}In_5; (y <= 0.10) and Ce_{1-x}La_{x}Rh_{1-y}Ir_{y}In_5; (x <= 0.50) in applied fields up to 90 kOe to study the affect of doping and magnetic field on the magnetic ground state. The magnetic phase diagram of CeRh_{0.9}Ir_{0.1}In_5; is consistent with the magnetic structure of CeRhIn_5; being unchanged by Ir doping. Doping of Ir in small concentrations is shown to slightly increase the antiferromagnetic transition temperature T_{N} (T_{N}=3.8 K in the undoped sample). La doping which causes disorder on the Ce sublattice is shown to lower T_{N} with no long range order observed above 0.34 K for Ce_{0.50}La_{0.50}RhIn_5;. Measurements on Ce_{0.50}La_{0.50}RhIn_5; show a coexistence of short range magnetic order and non-Fermi-liquid behavior. This dual nature of the Ce 4f-electrons is very similar to the observed results on CeRhIn_5; when long range magnetic order is suppressed at high pressure.Comment: 8 pages, 9 figure

Localized f electrons in CexLa1-xRhIn5: dHvA Measurements

Measurements of the de Haas-van Alphen effect in CexLa1-xRhIn5 reveal that the Ce 4f electrons remain localized for all x, with the mass enhancement and progressive loss of one spin from the de Haas-van Alphen signal resulting from spin fluctuation effects. This behavior may be typical of antiferromagnetic heavy fermion compounds, inspite of the fact that the 4f electron localization in CeRhIn5 is driven, in part, by a spin-density wave instability.Comment: 4 pages, 4 figures, submitted to PR

Comparison of the Pathogenic Potential of Campylobacter jejuni, C. upsaliensis and C. helveticus and Limitations of Using Larvae of Galleria mellonella as an Infection Model

Campylobacter enteritis in humans is primarily associated with C. jejuni/coli infection. Other species cause campylobacteriosis relatively infrequently; while this could be attributed to bias in diagnostic methods, the pathogenicity of non-jejuni/coli Campylobacter spp. such as C. upsaliensis and C. helveticus (isolated from dogs and cats) is uncertain. Galleria mellonella larvae are suitable models of the mammalian innate immune system and have been applied to C. jejuni studies. This study compared the pathogenicity of C. jejuni, C. upsaliensis, and C. helveticus isolates. Larvae inoculated with either C. upsaliensis or C. helveticus showed significantly higher survival than those inoculated with C. jejuni. All three Campylobacter species induced indistinguishable histopathological changes in the larvae. C. jejuni could be isolated from inoculated larvae up to eight days post-inoculation whereas C. upsaliensis and C. helveticus could only be isolated in the first two days. There was a significant variation in the hazard rate between batches of larvae, in Campylobacter strains, and in biological replicates as random effects, and in species and bacterial dose as fixed effects. The Galleria model is applicable to other Campylobacter spp. as well as C. jejuni, but may be subject to significant variation with all Campylobacter species. While C. upsaliensis and C. helveticus cannot be considered non-pathogenic, they are significantly less pathogenic than C. jejuni