Cluster randomised trials in the medical literature: two bibliometric surveys

Background: Several reviews of published cluster randomised trials have reported that about half did not take clustering into account in the analysis, which was thus incorrect and potentially misleading. In this paper I ask whether cluster randomised trials are increasing in both number and quality of reporting. Methods: Computer search for papers on cluster randomised trials since 1980, hand search of trial reports published in selected volumes of the British Medical Journal over 20 years. Results: There has been a large increase in the numbers of methodological papers and of trial reports using the term 'cluster random' in recent years, with about equal numbers of each type of paper. The British Medical Journal contained more such reports than any other journal. In this journal there was a corresponding increase over time in the number of trials where subjects were randomised in clusters. In 2003 all reports showed awareness of the need to allow for clustering in the analysis. In 1993 and before clustering was ignored in most such trials. Conclusion: Cluster trials are becoming more frequent and reporting is of higher quality. Perhaps statistician pressure works

Life-cycle costing of metallic structures

Structural material selection has traditionally been based on Initial material cost. However, growing pressure on the construction industry to consider the longer-term financial and environmental implications of projects is encouraging a more holistic view. Thus, materials with higher initial costs, but which offer cost savings over the life cycle of a structure, are gaining increasing recognition. The life-cycle costs of structures of two such metallic materials, namely aluminium alloy and stainless steel, are compared with those of ordinary structural carbon steel in the present study. Two structural applications - a typical office building and a bridge - are analysed, while offshore applications are briefly discussed. The ratio of initial material cost per tonne was assumed to be 1.0:2.5:4.0 (carbon steel:aluminium alloy:stainless steel). Following a preliminary structural design to current European design standards taking due account of the material densities and structural properties (principally strength and stiffness), it was found that on an initial cost basis, carbon steel offers the most competitive solution for both the building and the bridge. However, considering the additional life-cycle costs including maintenance costs, end-of-life costs and the residual value of the structure (appropriately discounted to present values), the results indicate that carbon steel offers the most competitive life-cycle solution for the office building but delivers the most expensive life-cycle solution for the bridge. Overall, it is concluded that on a whole-life basis aluminium alloy and stainless steel may offer more competitive solutions than carbon steel for bridges and exposed areas of building structures

Simulation of an Optional Strategy in the Prisoner's Dilemma in Spatial and Non-spatial Environments

This paper presents research comparing the effects of different environments on the outcome of an extended Prisoner's Dilemma, in which agents have the option to abstain from playing the game. We consider three different pure strategies: cooperation, defection and abstinence. We adopt an evolutionary game theoretic approach and consider two different environments: the first which imposes no spatial constraints and the second in which agents are placed on a lattice grid. We analyse the performance of the three strategies as we vary the loner's payoff in both structured and unstructured environments. Furthermore we also present the results of simulations which identify scenarios in which cooperative clusters of agents emerge and persist in both environments.Comment: 12 pages, 8 figures. International Conference on the Simulation of Adaptive Behavio

Perceived barriers and enablers to the provision of diabetic retinopathy screening for young adults: a cross-sectional survey of healthcare professionals working in the UK National Diabetic Eye Screening Programme

INTRODUCTION: Diabetic retinopathy screening (DRS) attendance in young adults is consistently below recommended levels. The aim of this study was to conduct a survey of screening providers in the UK Diabetic Eye Screening Programme (DESP) to identify perceived barriers and enablers to DRS attendance in young adults and elicit views on the effectiveness of strategies to improve screening uptake in this population. RESEARCH DESIGN AND METHODS: Members of the British Association of Retinal Screening (n=580) were invited to complete an anonymous online survey in July 2020 assessing agreement with 37 belief statements, informed by the Theoretical Domains Framework (TDF) of behavior change, describing potential barrier/enablers to delivering DRS for young adults and further survey items exploring effectiveness of strategies to improve uptake of DRS. RESULTS: In total, 140 (24%) responses were received mostly from screener/graders (67.1%). There was a high level of agreement that the DESP had a role in improving attendance in young adults (96.4%) and that more could be done to improve attendance (90.0%). The most commonly reported barriers related to TDF domains Social influences and Environmental context and resources including lack of integration of DRS with other processes of diabetes care, which limited the ability to discuss diabetes self-management. Other barriers included access to screening services and difficulties with scheduling appointments. Less than half (46.4%) of respondents reported having a dedicated strategy to improve screening uptake in young adults. Strategies perceived to be effective included: screening within the community; prompts/reminders and integrating eye screening with other diabetes services. CONCLUSIONS: Screening providers were concerned about screening uptake in young adults, although many programs lacked a dedicated strategy to improve attendance. Problems associated with a lack of integration between DRS with other diabetes care processes were identified as a major barrier to providing holistic care to young adults and supporting diabetes self-management

STRUCTURAL BEHAVIOUR OF ELLIPTICAL HOLLOW SECTIONS UNDER COMBINED COMPRESSION AND UNIAXIAL BENDING

The structural behaviour of elliptical hollow sections (EHS) has been examined in previous studies under the isolated loading conditions of pure compression and pure bending. This paper examines the response of EHS under combined compression plus uniaxial bending at the cross-sectional level. Structural performance data were initially generated through a series of laboratory stub column tests with various load eccentricities. The measured geometric and material properties of the test specimens, together with the full load-deformation histories have been reported herein. The test data were supplemented by further results generated through parallel numerical studies. Slenderness parameters and limits for EHS under combined compression plus bending were developed following analytical work. Finally, the experimental and numerical data were used to verify proposed interaction expressions for the design of EHS under combined loading; these have been developed in accordance with Eurocode 3 for ease of future incorporation

CR1 Knops blood group alleles are not associated with severe malaria in the Gambia

The Knops blood group antigen erythrocyte polymorphisms have been associated with reduced falciparum malaria-based in vitro rosette formation (putative malaria virulence factor). Having previously identified single-nucleotide polymorphisms (SNPs) in the human complement receptor 1 (CR1/CD35) gene underlying the Knops antithetical antigens Sl1/Sl2 and McC(a)/McC(b), we have now performed genotype comparisons to test associations between these two molecular variants and severe malaria in West African children living in the Gambia. While SNPs associated with Sl:2 and McC(b+) were equally distributed among malaria-infected children with severe malaria and control children not infected with malaria parasites, high allele frequencies for Sl 2 (0.800, 1,365/1,706) and McC(b) (0.385, 658/1706) were observed. Further, when compared to the Sl 1/McC(a) allele observed in all populations, the African Sl 2/McC(b) allele appears to have evolved as a result of positive selection (modified Nei-Gojobori test Ka-Ks/s.e.=1.77, P-value <0.05). Given the role of CR1 in host defense, our findings suggest that Sl 2 and McC(b) have arisen to confer a selective advantage against infectious disease that, in view of these case-control study data, was not solely Plasmodium falciparum malaria. Factors underlying the lack of association between Sl 2 and McC(b) with severe malaria may involve variation in CR1 expression levels

Sialylation on O-linked glycans protects von Willebrand factor from macrophage galactose lectin mediated clearance

Terminal sialylation determines the plasma half-life of von Willebrand factor (VWF). A role for macrophage galactose lectin (MGL) in regulating hyposialylated VWF clearance has recently been proposed. In this study, we showed that MGL influences physiological plasma VWF clearance. MGL inhibition was associated with a significantly extended mean residence time and 3-fold increase in endogenous plasma VWF antigen levels (P<0.05). Using a series of VWF truncations, we further demonstrated that the A1 domain of VWF is predominantly responsible for enabling the MGL interaction. Binding of both full-length and VWF-A1-A2-A3 to MGL was significantly enhanced in the presence of ristocetin (P<0.05), suggesting that the MGL-binding site in A1 is not fully accessible in globular VWF. Additional studies using different VWF glycoforms demonstrated that VWF O-linked glycans, clustered at either end of the A1 domain, play a key role in protecting VWF against MGLmediated clearance. Reduced sialylation has been associated with pathological, increased clearance of VWF in patients with von Willebrand disease. Herein, we demonstrate that specific loss of α2-3 linked sialylation from O-glycans results in markedly increased MGL-binding in vitro, and markedly enhanced MGL-mediated clearance of VWF in vivo. Our data further show that the asialoglycoprotein receptor (ASGPR) does not have a significant role in mediating the increased clearance of VWF following loss of O-sialylation. Conversely however, we observed that loss of N-linked sialylation from VWF drives enhanced circulatory clearance predominantly via the ASGPR. Collectively, our data support the hypothesis that in addition to regulating physiological VWF clearance, the MGL receptor works in tandem with ASGPR to modulate enhanced clearance of aberrantly sialylated VWF in the pathogenesis of von Willebrand disease

Perspective from a Younger Generation -- The Astro-Spectroscopy of Gisbert Winnewisser

Gisbert Winnewisser's astronomical career was practically coextensive with the whole development of molecular radio astronomy. Here I would like to pick out a few of his many contributions, which I, personally, find particularly interesting and put them in the context of newer results.Comment: 14 pages. (Co)authored by members of the MPIfR (Sub)millimeter Astronomy Group. To appear in the Proceedings of the 4th Cologne-Bonn-Zermatt-Symposium "The Dense Interstellar Medium in Galaxies" eds. S. Pfalzner, C. Kramer, C. Straubmeier, & A. Heithausen (Springer: Berlin

Mobile phone apps for behavioral interventions for at-risk drinkers in Australia: literature Review

Background: The mobile technology era has ushered in the use of mobile phone apps for behavioral intervention for at-risk drinkers. Objective: Our objective was to review recent research relevant to mobile phone apps that can be used for behavioral intervention for at-risk drinkers in Australia. Methods: The inclusion criteria for this review were articles published in peer-reviewed journals from 2001 to 2017 with use of the search terms "smartphone application," "alcohol," "substance," "behavioural intervention," "electronic health," and "mobile health." Results: In total, we identified 103 abstracts, screened 90 articles, and assessed 50 full-text articles that fit the inclusion criteria for eligibility. We included 19 articles in this review. Conclusions: This review highlighted the paucity of evidence-based and empirically validated research into effective mobile phone apps that can be used for behavioral interventions with at-risk drinkers in Australia