Fidelity in complex behaviour change interventions : a standardised approach to evaluate intervention integrity

Objectives: The aim of this study was to (1) demonstrate the development and testing of tools and procedures designed to monitor and assess the integrity of a complex intervention for chronic pain (COping with persistent Pain, Effectiveness Research into Self-management (COPERS) course); and (2) make recommendations based on our experiences. Design: Fidelity assessment of a two-arm randomised controlled trial intervention, assessing the adherence and competence of the facilitators delivering the intervention. Setting: The intervention was delivered in the community in two centres in the UK: one inner city and one a mix of rural and urban locations. Participants: 403 people with chronic musculoskeletal pain were enrolled in the intervention arm and 300 attended the self-management course. Thirty lay and healthcare professionals were trained and 24 delivered the courses (2 per course). We ran 31 courses for up to 16 people per course and all were audio recorded. Interventions: The course was run over three and a half days; facilitators delivered a semistructured manualised course. Outcomes: We designed three measures to evaluate fidelity assessing adherence to the manual, competence and overall impression. Results: We evaluated a random sample of four components from each course (n=122). The evaluation forms were reliable and had good face validity. There were high levels of adherence in the delivery: overall adherence was two (maximum 2, IQR 1.67–2.00), facilitator competence exhibited more variability, and overall competence was 1.5 (maximum 2, IQR 1.25–2.00). Overall impression was three (maximum 4, IQR 2.00–3.00). Conclusions: Monitoring and assessing adherence and competence at the point of intervention delivery can be realised most efficiently by embedding the principles of fidelity measurement within the design stage of complex interventions and the training and assessment of those delivering the intervention. More work is necessary to ensure that more robust systems of fidelity evaluation accompany the growth of complex interventions

Data Representation and Assembly Language Programming The ANT-97 Architecture

In order to understand how a computer is able to manipulate data and perform computations, you must first understand how data is represented by a computer. At the lowest level, the invisible unit of data in a computer is a bit. A bit represents a single binary value, which may be either 1 or 0. In different contexts, a bit value of 1 and 0 may also be referred to as "true" and "false", "yes" and "no", "high" and "low", "set" and "not set", or "on" and "off". The decision to use binary values, rather than something larger (such as decimal values) was not purely arbitrary--it is due in a large part to the relative simplicity of building electronic devices that can manipulate binary values.Engineering and Applied Science

The Montana Vacation Experience Part 2: Interview Summaries

Provides narrative summaries of the 53 interviews representing the researcher’s interpretation of the significant themes within each interview

The Montana Vacation Experience: Part 1

The Montana Vacation Experience is the analysis of in-depth interviews of 53 Montana vacationers. Part 1 provides direct quotes from vacationers in Montana related to their vacation experience. Five themes related to the vacation emerged: trip planning, experiences and activities, motivations, relationship to the environment, and impressions of Montana

The role of octadecanoids and functional mimics in soybean defense responses

Oxylipins of the jasmonate pathway and synthetic functional analogs have been analyzed for their elicitor like activities in an assay based on the induced accumulation of glyceollins, the phytoalexins of soybean (Glycine max L.), in cell suspension cultures of this plant. Jasmonic acid (JA) and its methyl ester showed weak phytoalexininducing activity when compared to an early jasmonate biosynthetic precursor, 12-oxophytodienoic acid (OPDA), as well as to the bacterial phytotoxin coronatine and certain 6-substituted indanoylLisoleucine methyl esters, which all were highly active. Interestingly, different octadecanoids and indanoyl conjugates induced the accumulation of transcripts of various defenserelated genes to different degrees, indicating distinct induction competencies. Therefore, these signaling compounds and mimics were further analyzed for their effects on signal transduction elements, such as the transient enhancement of the cytosolic Ca2+ concentration and MAP kinase activation, which are known to be initiated by a soybean pathogenderived {[}beta]glucan elicitor. In contrast to the {[}beta]glucan elicitor, none of the other compounds tested triggered these early signaling elements. Moreover, endogenous levels of OPDA and JA in soybean cells were shown to be unaffected after treatment with {[}beta]glucans. Thus, OPDA and JA, which are functionally mimicked by coronatine and a variety of 6-substituted derivatives of indanoylLisoleucine methyl ester, represent highly efficient signaling compounds of a lipidbased pathway not deployed in the {[}beta]glucan elicitorinitiated signal transduction

Diazoxide-responsive hyperinsulinemic hypoglycemia caused by HNF4A gene mutations

Objective: The phenotype associated with heterozygous HNF4A gene mutations has recently been extended to include diazoxide responsive neonatal hypoglycemia in addition to maturity-onset diabetes of the young (MODY). To date, mutation screening has been limited to patients with a family history consistent with MODY. In this study, we investigated the prevalence of HNF4A mutations in a large cohort of patients with diazoxide responsive hyperinsulinemic hypoglycemia (HH). Subjects and methods: We sequenced the ABCC8, KCNJ11, GCK, GLUD1, and/or HNF4A genes in 220 patients with HH responsive to diazoxide. The order of genetic testing was dependent upon the clinical phenotype. Results: A genetic diagnosis was possible for 59/220 (27%) patients. KATP channel mutations were most common (15%) followed by GLUD1 mutations causing hyperinsulinism with hyperammonemia (5.9%), and HNF4A mutations (5%). Seven of the 11 probands with a heterozygous HNF4A mutation did not have a parent affected with diabetes, and four de novo mutations were confirmed. These patients were diagnosed with HI within the first week of life (median age 1 day), and they had increased birth weight (median +2.4 SDS). The duration of diazoxide treatment ranged from 3 months to ongoing at 8 years. Conclusions: In this large series, HNF4A mutations are the third most common cause of diazoxide responsive HH. We recommend that HNF4A sequencing is considered in all patients with diazoxide responsive HH diagnosed in the first week of life irrespective of a family history of diabetes, once KATP channel mutations have been excluded

“…not some young tourist”: The male overseas-acquired HIV social research study

As with the trend in the rest of Australia, the majority of HIV diagnoses in Western Australia (WA) over the past 20 years have been amongst men who have sex with men in Australia. However, a differing trend seen more recently in WA has been the number of HIV diagnoses among heterosexual and homosexual men who acquired HIV while overseas compared to other states. The number of Western Australians acquiring HIV overseas has increased from 41 people in 2002-2004 to 91 people in 2005-2007. The upward trend of overseas acquired notifications continued in 2008-2009 (Combs and Giele 2009; DoH (WA) 2009). While the epidemiological data clearly showed an increase in overseas acquired HIV, there was little information on why the increase was occurring. The Male Overseas Acquired HIV Social Research Study investigated the social, cultural, behavioural and cognitive factors which may have contributed to the overseas-acquisition of HIV by male WA residents. The study used a qualitative approach to collecting and analysing data from in depth interviews with men who had acquired HIV while travelling or working overseas. The study was a joint project of the WA Centre for Health Promotion Research, National Centre in HIV Social Research, National Centre in HIV Epidemiology and Clinical Research and the Australian Research Centre in Sex, Health and Society and funded by the Western Australian Department of Health, Sexual Health and Blood Borne Virus Program. Men were recruited through the WA AIDS Council, Royal Perth Hospital, Fremantle Hospital, Northern Territory AIDS and Hepatitis Council and Clinic 34, Darwin. Fourteen men participated in the study during 2008 and 2009

HIV risk among Australian men travelling overseas: networks and context matter

Increasing international mobility presents a risk for communicable disease transmissions. Overseas-acquired HIV infections have been increasingly observed across Australian jurisdictions. This includes a mix of men emigrating from countries with high HIV prevalence and men travelling abroad. There is currently little research exploring international mobility and HIV risk and as a consequence the increase of men acquiring HIV while travelling overseas is poorly understood. This article draws on data from a qualitative study exploring the risk perspectives and experiences of 14 Australian men who acquired HIV while travelling overseas in the years between 2000-2009. Participants articulated a strong desire to distance themselves from the identity of a tourist. Social networks were highlighted as important entry points to engage with other foreign travellers and expatriates. These networks were highly influential and were understood by the participants to provide guidance on how they should negotiate the local scene, including where to meet sex partners. Limited discussion of safe sex and HIV was mentioned in these contexts. The findings suggest that prevalent social norms and social networks play an influential role in how participants negotiate sex and social relations in overseas settings. These networks could potentially provide sites for effective HIV prevention programs. Keywords: male tourists; HIV transmission; social networks; behaviour; sexual risk; HIV preventio

“…not some young tourist”: The male overseas-acquired HIV social research study

As with the trend in the rest of Australia, the majority of HIV diagnoses in Western Australia (WA) over the past 20 years have been amongst men who have sex with men in Australia. However, a differing trend seen more recently in WA has been the number of HIV diagnoses among heterosexual and homosexual men who acquired HIV while overseas compared to other states. The number of Western Australians acquiring HIV overseas has increased from 41 people in 2002-2004 to 91 people in 2005-2007. The upward trend of overseas acquired notifications continued in 2008-2009 (Combs and Giele 2009; DoH (WA) 2009). While the epidemiological data clearly showed an increase in overseas acquired HIV, there was little information on why the increase was occurring. The Male Overseas Acquired HIV Social Research Study investigated the social, cultural, behavioural and cognitive factors which may have contributed to the overseas-acquisition of HIV by male WA residents. The study used a qualitative approach to collecting and analysing data from in depth interviews with men who had acquired HIV while travelling or working overseas. The study was a joint project of the WA Centre for Health Promotion Research, National Centre in HIV Social Research, National Centre in HIV Epidemiology and Clinical Research and the Australian Research Centre in Sex, Health and Society and funded by the Western Australian Department of Health, Sexual Health and Blood Borne Virus Program. Men were recruited through the WA AIDS Council, Royal Perth Hospital, Fremantle Hospital, Northern Territory AIDS and Hepatitis Council and Clinic 34, Darwin. Fourteen men participated in the study during 2008 and 2009

Partitioning the impact of environmental drivers and species interactions in dynamic aquatic communities

© The Author(s), 2019. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Musters, C. J. M., Ieromina, O., Barmentlo, S. H., Hunting, E. R., Schrama, M., Cieraad, E., Vijver, M. G., & van Bodegom, P. M. Partitioning the impact of environmental drivers and species interactions in dynamic aquatic communities. Ecosphere, 10(11), (2019): e02910, doi:10.1002/ecs2.2910.Temperate aquatic communities are highly diverse and seasonally variable, due to internal biotic processes and environmental drivers, including human‐induced stressors. The impact of drivers on species abundance is supposed to differ fundamentally depending on whether populations are experiencing limitations, which may shift over the season. However, an integrated understanding of how drivers structure communities seasonally is currently lacking. In order to partition the effect of drivers, we used random forests to quantify interactions between all taxa and environmental factors using macrofaunal data from 18 agricultural ditches sampled over two years. We found that, over the agricultural season, taxon abundance became increasingly better predicted by the abundances of co‐occurring taxa and nutrients compared to other abiotic factors, including pesticides. Our approach provides fundamental insights in community dynamics and highlights the need to consider changes in species interactions to understand the effects of anthropogenic stressors.The authors are grateful to B. Schaub of Water Board Rijnland for his help, E. Gertenaar for assistance in the fieldwork, M. Wouterse for DOC measurements, and B. Koese for help with taxonomic identification of macrofaunal samples. CM designed the study, did the statistical modeling and analyses, and wrote the draft paper; OI did field sampling and taxonomic identification and constructed the datasets; OI and HB structured the data; EH, MS, ES, MV, and PvB contributed to the study design and the conceptual improvement of the manuscript; all authors substantially revised the subsequent drafts