Evaluation of an internet-accessed STI testing (e-STI testing) and results service in two London boroughs

Background: Internet-accessed STI (e-STI) testing is recommended in England to expand access to STI testing services, particularly among high-risk groups. Yet the evidence for the effectiveness of this testing modality is limited. This thesis aimed to address this evidence gap, by evaluating the effects of an e-STI testing and results service (SH:24) on STI diagnoses and STI testing uptake, when delivered alongside usual care in two London boroughs. Theoretical premise of thesis: In line with theory-driven approaches to evaluation, I developed an explanatory framework outlining hypothesised change processes that may be triggered by the intervention. I adopted a critical realist conceptualisation of causal mechanisms and I drew on the ‘candidacy’ lens to conceptualise change processes in relation to access and utilisation of STI testing services. I then used this framework to situate the evaluation findings. Methods: This evaluation was based on a randomised controlled trial (RCT). 2,072 individuals aged 16–30 years, resident in Lambeth and Southwark, with at least one sexual partner in the previous 12 months and willing to take an STI test, were recruited in community settings. Participants were allocated to an e-STI testing service (intervention) or to a website with signposting to local sexual health clinics (control). The e-STI testing service provided postal self-sampling kits for chlamydia, gonorrhoea, HIV and syphilis. Results were delivered via text message or phone, and participants were signposted to local clinics for confirmatory testing and treatment as necessary. Results: The published trial results are as follows: 1,031 participants in the intervention group and 1,032 control group were included in the analyses. At 6 weeks, 50.0% of the intervention group completed an STI test compared to 26.6% in the control group (relative risk, RR 1.87, 95% confidence interval 1.63 to 2.15, p<0.001). 2.8% of the intervention v 1.4% in the control were diagnosed with an STI (RR 2.10, 95% confidence interval 0.94 to 4.70, p=0.079). The effect on the proportion of participants treated was 1.1% in the intervention v 0.7% in the control (RR 1.72, 95% confidence interval 0.71 to 4.16, p=0.231). Secondary analyses (unpublished at the time of writing) demonstrated that the intervention was effective for uptake of STI testing among a subsample of participants who had never previously tested for STIs. Conclusions: The findings lend weight to national policies in England, which promote e-STI testing as a means to increase utilisation of STI testing services, particularly among groups who do not use conventional services. While the results support the candidacy model’s processual framing of health care utilisation, further research is required to understand how the construct of candidacy is recognised and negotiated within a digital service environment by different socio-demographic groups. In addition, larger trials are needed to assess outcomes later in the cascade of care

A shortened version of the Dementia Drivers’ Screening Assessment

Introduction: Cognitive tests are used to inform recommendations about the safety of people with dementia to continue driving. The Dementia Drivers’ Screening Assessment (DDSA) is a neuropsychological battery designed to assist in this process. However, it is lengthy to administer and requires materials from various test batteries. Aims: The primary aim of this study was to develop a shortened version of the DDSA for individuals with dementia. Methods: Data on participants with dementia from two studies were analysed. These participants were all drivers with dementia who were identified by community mental health teams and psychiatrists. Each participant was assessed on the DDSA and also assessed on-road by an ‘approved driving instructor’ using the Nottingham Neurological Driving Assessment. Results: This study analysed 102 participants, who had a mean age of 74.0 (SD=7.7) years and of whom 80 (78%) were men. Twenty three drivers were judged to be unsafe and 79 safe. The agreement between the short version and on-road assessment was 79%. The assessment was better at detecting safe drivers than unsafe drivers. Conclusion: The findings suggested that the shortened DDSA is suitable for participants who are unable or do not wish to undergo lengthier assessment

Up-scaling, formative phases, and learning in the historical diffusion of energy technologies

The 20th century has witnessed wholesale transformation in the energy system marked by the pervasive diffusion of both energy supply and end-use technologies. Just as whole industries have grown, so too have unit sizes or capacities. Analysed in combination, these unit level and industry level growth patterns reveal some consistencies across very different energy technologies. First, the up-scaling or increase in unit size of an energy technology comes after an often prolonged period of experimentation with many smaller-scale units. Second, the peak growth phase of an industry can lag these increases in unit size by up to 20 years. Third, the rate and timing of up-scaling at the unit level is subject to countervailing influences of scale economies and heterogeneous market demand. These observed patterns have important implications for experience curve analyses based on time series data covering the up-scaling phases of energy technologies, as these are likely to conflate industry level learning effects with unit level scale effects. The historical diffusion of energy technologies also suggests that low carbon technology policies pushing for significant jumps in unit size before a ‘formative phase’ of experimentation with smaller-scale units are risky

Development and initial validation of the bronchiectasis exacerbation and symptom tool (BEST)

BACKGROUND: Recurrent bronchiectasis exacerbations are related to deterioration of lung function, progression of the disease, impairment of quality of life, and to an increased mortality. Improved detection of exacerbations has been accomplished in chronic obstructive pulmonary disease through the use of patient completed diaries. These tools may enhance exacerbation reporting and identification. The aim of this study was to develop a novel symptom diary for bronchiectasis symptom burden and detection of exacerbations, named the BEST diary. METHODS: Prospective observational study of patients with bronchiectasis conducted at Ninewells Hospital, Dundee. We included patients with confirmed bronchiectasis by computed tomography, who were symptomatic and had at least 1 documented exacerbation of bronchiectasis in the previous 12\u2009months to participate. Symptoms were recorded daily in a diary incorporating cough, sputum volume, sputum colour, dyspnoea, fatigue and systemic disturbance scored from 0 to 26. RESULTS: Twenty-one patients were included in the study. We identified 29 reported (treated exacerbations) and 23 unreported (untreated) exacerbations over 6-month follow-up. The BEST diary score showed a good correlation with the established and validated questionnaires and measures of health status (COPD Assessment Test, r =\u20090.61, p =\u20090.0037, Leicester Cough Questionnaire, r =\u2009-\u20090.52,p =\u20090.0015, St Georges Respiratory Questionnaire, r =\u20090.61,p &lt;\u20090.0001 and 6\u2009min walk test, r =\u2009-\u20090.46,p =\u20090.037). The mean BEST score at baseline was 7.1 points (SD 2.2). The peak symptom score during exacerbation was a mean of 16.4 (3.1), and the change from baseline to exacerbation was a mean of 9.1 points (SD 2.5). Mean duration of exacerbations based on time for a return to baseline symptoms was 15.3\u2009days (SD 5.7). A minimum clinically important difference of 4 points is proposed. CONCLUSIONS: The BEST symptom diary has shown concurrent validity with current health questionnaires and is responsive at onset and recovery from exacerbation. The BEST diary may be useful to detect and characterise exacerbations in bronchiectasis clinical trials

Language and social/emotional problems identified at a universal developmental assessment at 30 months

Non peer reviewedPublisher PD

Neurodevelopmental disorders

Recent technological advances allow us to measure how the infant brain functions in ways that were not possible just a decade ago. Although methodological advances are exciting, we must also consider how theories guide research: what we look for and how we explain what we find. Indeed, the ways in which research findings are interpreted affects the design of policies, educational practices, and interventions. Thus, the theoretical approaches adopted by scientists have a real impact on the lives of children with neurodevelopmental disorders (NDDs) and their families, as well as on the wider community. Here, we introduce and compare two theoretical approaches that are used to understand NDDs: the neuropsychological account and neuroconstructivism. We show how the former, adult account, is inadequate for explaining NDDs and illustrate this using the examples of Williams syndrome and specific language impairment. Neuroconstructivism, by contrast, focuses on the developing organism and is helping to change the way in which NDDs are investigated. Whereas neuropsychological static approaches assume that one or more ‘modules’ (e.g., visuospatial ability in Williams syndrome) are impaired while the rest of the system is spared (e.g., language in Williams syndrome), neuroconstructivism proposes that basic‐level deficits have subtle cascading effects on numerous domains over development. Neuroconstructivism leads researchers to embrace complexity by establishing large research consortia to integrate findings at multiple levels (e.g., genetic, neural, cognitive, environmental) across developmental time