How good are GPs at adhering to a pragmatic trial protocol in primary care? Results from the ADDITION-Cambridge cluster-randomized pragmatic trial

Objective: To assess the fidelity of general practitioners’ (GP) adherence to a long term pragmatic trial protocol. Design: Retrospective analyses of electronic primary care records of participants in the pragmatic cluster-randomised ADDITION (Anglo-Danish-Dutch Study of Intensive Treatment In People with Screen Detected Diabetes in Primary Care)-Cambridge trial, comparing intensive multi-factorial treatment (IT) vs. routine care (RC). Data were collected from the date of diagnosis until December 2010. Setting: Primary care surgeries in the East of England Study sample/participants: A subsample (n=189, RC-arm: n=99, IT-arm: n=90) of patients from the ADDITION-Cambridge cohort (867 patients), consisting of 40-69 year old patients with screen detected diabetes mellitus. Interventions: In the RC-arm treatment was delivered according to concurrent treatment guidelines. Surgeries in the IT-arm received funding for additional contacts between GPs/nurses and patients, and GPs were advised to follow more intensive treatment algorithms for the management of glucose, lipids and blood pressure and aspirin therapy than in the RC-arm. Outcome measures: The number of annual contacts between patients and GPs/nurses, the proportion of patients receiving prescriptions for cardio-metabolic medication in years 1 to 5 after diabetes diagnosis, and the adherence to prescription algorithms. Results: The difference in the number of annual GP contacts (β=0.65) and nurse contacts (β=-0.15) between the study arms was small and insignificant. Patients in the IT-arm were more likely to receive glucose-lowering (OR=3.27), ACE-inhibiting (OR=2.03) and lipid-lowering drugs (OR=2.42, all p-values<0.01) than patients in the RC-arm. The prescription adherence varied between medication classes, but improved in both trial arms over the 5 year follow-up. Conclusions: The adherence of GPs to different aspects of the trial protocol was mixed. Background changes in health care policy need to be considered as they have the potential to dilute differences in treatment intensity and hence incremental effect. Clinical trial number: ISRCTN8676908

Association of psychological distress, quality of life and costs with carpal tunnel syndrome severity: a crosssectional analysis of the PALMS cohort

Objectives: The PALMS study is designed to identify prognostic factors for outcome from corticosteroid injection and surgical decompression for carpal tunnel syndrome (CTS) and predictors of cost over 2 years. The aim of this paper is to explore the cross-sectional association of baseline patient-reported and clinical severity with anxiety, depression, health-related quality of life and costs of CTS in patients referred to secondary care. Methods: Prospective, multi-centre cohort study initiated in 2013. We collected baseline data on patientreported symptom severity (CTS-6), psychological status (HADS), hand function (Michigan Hand Questionnaire) comorbidities, EQ5D-3L and sociodemographic variables. Nerve conduction tests classified patients into five severity grades (mild to very severe). Data were analysed using a general linear model. Results: 753 patients with CTS provided complete baseline data. Multivariable linear regression adjusting for age, sex, ethnicity, duration of CTS, smoking status, alcohol consumption, employment status, body mass index and comorbidities showed a highly statistically significant relationship between CTS-6 and anxiety, depression and the EQ-5D (p<0.0001 in each case). Likewise, a significant relationship was observed between electrodiagnostic severity and anxiety (p=0.027) but not with depression (p=0.986) or the EQ-5D (p=0.257). NHS and societal costs in the 3 months prior to enrolment were significantly associated with self-reported severity (p<0.0001) but not with electrodiagnostic severity. Conclusions: Patient-reported symptom severity in carpal tunnel syndrome is significantly and positively associated with anxiety, depression, health-related quality of life and NHS and societal costs even when adjusting for age, gender, body mass index, comorbidities, smoking, drinking and occupational status. In contrast there is little or no evidence of any relationship with objectively derived CTS severity. Future research is needed to understand the impact of approaches and treatments that address psychosocial stressors as well as biomedical factors on relief of symptoms from carpal tunnel syndrome.CJH was funded by the National Institute for Health Research (NIHR) through a NIHR Senior Research Fellowship. ECFW is funded by the NIHR Cambridge Biomedical Research Centre

The carbon-to-oxygen ratio: implications for the spectra of hydrogen-dominated exoplanet atmospheres (article)

This is the author accepted manuscript. The final version is available from OUP via the DOI in this recordThe dataset associated with this publication is in ORE at https://doi.org/10.24378/exe.1223We present results from one-dimensional atmospheric simulations investigating the effect of varying the carbon-to-oxygen (C/O) ratio on the thermal structure, chemical composition and transmission and emission spectra, for irradiated hydrogendominated atmospheres. We find that each of these properties of the atmosphere are strongly dependent on the individual abundances (relative to hydrogen) of carbon and oxygen. We confirm previous findings that different chemical equilibrium compositions result from different sets of element abundances but with the same C/O ratio. We investigate the effect of this difference in composition on the thermal structure and simulated spectra. We also simulate observations using the PandExo tool and show that these differences are observationally significant with current (i.e. Hubble Space Telescope) and future (i.e. James Webb Space Telescope) instruments. We conclude that it is important to consider the full set of individual element abundances, with respect to hydrogen, rather than the ratios of only two elements, such as the C/O ratio, particularly when comparing model predictions with observed transmission and emission spectra.Science and Technology Facilities CouncilLeverhulme Trus

Magneto-optical studies of the correlation between interface microroughness parameters and the photoluminescence line shape in GaAs/Ga0.7Al0.3As quantum wells

In this work we analyze the relation between the interface microroughness and the full width at half maximum (FWHM) of the photoluminescence (PL) spectra for a GaAs/Ga0.7Al0.3As multiple quantum well (QW) system. We show that, in spite of the complex correlation between the microscopic interface-defects parameters and the QW optical properties, the Singh and Bajaj model [Appl. Phys. Lett. 44, 805 (1984)] provides a good quantitative description of the excitonic PL-FWHM. [S0163-1829(99)01424-1].6031519152

A Decision Analysis Evaluating Screening for Kidney Cancer Using Focused Renal Ultrasound

Background Screening for renal cell carcinoma (RCC) has been identified as a key research priority; however, no randomised control trials have been performed. Value of information analysis can determine whether further research on this topic is of value. Objective To determine (1) whether current evidence suggests that screening is potentially cost effective and, if so, (2) in which age/sex groups, (3) identify evidence gaps, and (4) estimate the value of further research to close those gaps. Design, setting, and participants A decision model was developed evaluating screening in asymptomatic individuals in the UK. A National Health Service perspective was adopted. Intervention A single focused renal ultrasound scan compared with standard of care (no screening). Outcome measurements and statistical analysis Expected lifetime costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER), discounted at 3.5% per annum. Results and limitations Given a prevalence of RCC of 0.34% (0.18–0.54%), screening 60-yr-old men resulted in an ICER of £18 092/QALY (€22 843/QALY). Given a prevalence of RCC of 0.16% (0.08–0.25%), screening 60-yr-old women resulted in an ICER of £37 327/QALY (€47 129/QALY). In the one-way sensitivity analysis, the ICER was <£30 000/QALY as long as the prevalence of RCC was ≥0.25% for men and ≥0.2% for women at age 60 yr. Given the willingness to pay a threshold of £30 000/QALY (€37 878/QALY), the population-expected values of perfect information were £194 million (€244 million) and £97 million (€123 million) for 60-yr-old men and women, respectively. The expected value of perfect parameter information suggests that the prevalence of RCC and stage shift associated with screening are key research priorities. Conclusions Current evidence suggests that one-off screening of 60-yr-old men is potentially cost effective and that further research into this topic would be of value to society. Patient summary Economic modelling suggests that screening 60-yr-old men for kidney cancer using ultrasound may be a good use of resources and that further research on this topic should be performed

Erratum: A library of ATMO forward model transmission spectra for hot Jupiter exoplanets

This is the final version. Available from OUP via the DOI in this recordThe article to which this is the erratum is in ORE at http://hdl.handle.net/10871/30324The paper ‘A library of ATMO forward model transmission spectra for hot Jupiter exoplanets’ was published in MNRAS 474, 4, 5158–5185. In the original manuscript (Goyal et al. 2018), we presented a grid of forward model transmission spectra for hot Jupiter exoplanets. However, we recently identified an error in the treatment of rainout in our 1D atmosphere model ATMO. The correction of this error led to changes in the equilibrium chemical abundances using rainout condensation and thereby the transmission spectra. We note that this error only affects the online library2,3 that includes rainout condensation, the library with local condensation (without rainout) is unaffected. We further note that the gas phase equilibrium scheme used in ATMO has been compared by Drummond et al. (2016) with the analytical schemes of Burrows & Sharp (1999) and Heng & Tsai (2016). The gas phase chemistry with and without local condensation has also been verified in Baudino et al. (2017) against the petitCODE (Mollière et al. 2015, 2017) and Exo-REM (Baudino et al. 2015) models. Therefore, issues with the previous version of the grid were confined to the implementation of rainout

Computing the Expected Value of Sample Information Efficiently: Practical Guidance and Recommendations for Four Model-Based Methods

Value of information (VOI) analyses can help policy makers make informed decisions about whether to conduct and how to design future studies. Historically a computationally expensive method to compute the expected value of sample information (EVSI) restricted the use of VOI to simple decision models and study designs. Recently, 4 EVSI approximation methods have made such analyses more feasible and accessible. Members of the Collaborative Network for Value of Information (ConVOI) compared the inputs, the analyst's expertise and skills, and the software required for the 4 recently developed EVSI approximation methods. Our report provides practical guidance and recommendations to help inform the choice between the 4 efficient EVSI estimation methods. More specifically, this report provides: (1) a step-by-step guide to the methods' use, (2) the expertise and skills required to implement the methods, and (3) method recommendations based on the features of decision-analytic problems

Influence of the temperature on the carrier capture into self-assembled InAs/GaAs quantum dots

Photoluminescence (PL) spectroscopy and atomic-force microscopy (AFM) were used to investigate the size evolution of InAs quantum dots on GaAs(001) as a function of the amount of InAs material. Different families of islands were observed in the AFM images and unambiguously identified in the PL spectra, together with the signal of the wetting layer. PL measurements carried out at low and intermediate temperatures showed a thermal carrier redistribution among dots belonging to different families. The physical origin of this behavior is explained in terms of the different temperature dependence of the carrier-capture rate into the quantum dots. At high temperatures, an enhancement of the total PL-integrated intensity of the largest-sized quantum dots was attributed to the increase of diffusivity of the photogenerated carriers inside the wetting layer. (C) 2003 American Institute of Physics.931016279628