Strategies to improve retention in randomised trials: a Cochrane systematic review and meta-analysis

Objective: To quantify the effect of strategies to improve retention in randomised trials.<p></p> Design: Systematic review and meta-analysis.<p></p> Data sources Sources searched: MEDLINE, EMBASE, PsycINFO, DARE, CENTRAL, CINAHL, C2-SPECTR, ERIC, PreMEDLINE, Cochrane Methodology Register, Current Controlled Trials metaRegister, WHO trials platform, Society for Clinical Trials (SCT) conference proceedings and a survey of all UK clinical trial research units.<p></p> Review: methods Included trials were randomised evaluations of strategies to improve retention embedded within host randomised trials. The primary outcome was retention of trial participants. Data from trials were pooled using the fixed-effect model. Subgroup analyses were used to explore the heterogeneity and to determine whether there were any differences in effect by the type of strategy.<p></p> Results: 38 retention trials were identified. Six broad types of strategies were evaluated. Strategies that increased postal questionnaire responses were: adding, that is, giving a monetary incentive (RR 1.18; 95% CI 1.09 to 1.28) and higher valued incentives (RR 1.12; 95% CI 1.04 to 1.22). Offering a monetary incentive, that is, an incentive given on receipt of a completed questionnaire, also increased electronic questionnaire response (RR 1.25; 95% CI 1.14 to 1.38). The evidence for shorter questionnaires (RR 1.04; 95% CI 1.00 to 1.08) and questionnaires relevant to the disease/condition (RR 1.07; 95% CI 1.01 to 1.14) is less clear. On the basis of the results of single trials, the following strategies appeared effective at increasing questionnaire response: recorded delivery of questionnaires (RR 2.08; 95% CI 1.11 to 3.87); a ‘package’ of postal communication strategies (RR 1.43; 95% CI 1.22 to 1.67) and an open trial design (RR 1.37; 95% CI 1.16 to 1.63). There is no good evidence that the following strategies impact on trial response/retention: adding a non-monetary incentive (RR=1.00; 95% CI 0.98 to 1.02); offering a non-monetary incentive (RR=0.99; 95% CI 0.95 to 1.03); ‘enhanced’ letters (RR=1.01; 95% CI 0.97 to 1.05); monetary incentives compared with offering prize draw entry (RR=1.04; 95% CI 0.91 to 1.19); priority postal delivery (RR=1.02; 95% CI 0.95 to 1.09); behavioural motivational strategies (RR=1.08; 95% CI 0.93 to 1.24); additional reminders to participants (RR=1.03; 95% CI 0.99 to 1.06) and questionnaire question order (RR=1.00, 0.97 to 1.02). Also based on single trials, these strategies do not appear effective: a telephone survey compared with a monetary incentive plus questionnaire (RR=1.08; 95% CI 0.94 to 1.24); offering a charity donation (RR=1.02, 95% CI 0.78 to 1.32); sending sites reminders (RR=0.96; 95% CI 0.83 to 1.11); sending questionnaires early (RR=1.10; 95% CI 0.96 to 1.26); longer and clearer questionnaires (RR=1.01, 0.95 to 1.07) and participant case management by trial assistants (RR=1.00; 95% CI 0.97 to 1.04).<p></p> Conclusions: Most of the trials evaluated questionnaire response rather than ways to improve participants return to site for follow-up. Monetary incentives and offers of monetary incentives increase postal and electronic questionnaire response. Some strategies need further evaluation. Application of these results would depend on trial context and follow-up procedures.<p></p&gt

Particle Acceleration in Dissipative Pulsar Magnetospheres

Pulsar magnetospheres represent unipolar inductor-type electrical circuits at which an EM potential across the polar cap (due to the rotation of their magnetic field) drives currents that run in and out of the polar cap and close at infinity. An estimate ofthe magnitude of this current can be obtained by dividing the potential induced across the polar cap V approx = B(sub O) R(sub O)(Omega R(sub O)/c)(exp 2) by the impedance of free space Z approx eq 4 pi/c; the resulting polar cap current density is close to $n {GJ} c$ where $n_{GJ}$ is the Goldreich-Julian (GJ) charge density. This argument suggests that even at current densities close to the GJ one, pulsar magnetospheres have a significant component of electric field $E_{parallel}$, parallel to the magnetic field, a condition necessary for particle acceleration and the production of radiation. We present the magnetic and electric field structures as well as the currents, charge densities, spin down rates and potential drops along the magnetic field lines of pulsar magnetospheres which do not obey the ideal MHD condition $E cdot B = 0$. By relating the current density along the poloidal field lines to the parallel electric field via a kind of Ohm's law $J = sigma E_{parallel}$ we study the structure of these magnetospheres as a function of the conductivity $sigma$. We find that for $sigma gg OmegaS the solution tends to the (ideal) Force-Free one and to the Vacuum one for$sigma 11 OmegaS. Finally, we present dissipative magnetospheric solutions with spatially variable $sigma$ that supports various microphysical properties and are compatible with the observations

Use of strategies to improve retention in primary care randomised trials: a qualitative study with in-depth interviews

Objective To explore the strategies used to improve retention in primary care randomised trials.<p></p> Design Qualitative in-depth interviews and thematic analysis.<p></p> Participants 29 UK primary care chief and principal investigators, trial managers and research nurses.<p></p> Methods In-depth face-to-face interviews.<p></p> Results Primary care researchers use incentive and communication strategies to improve retention in trials, but were unsure of their effect. Small monetary incentives were used to increase response to postal questionnaires. Non-monetary incentives were used although there was scepticism about the impact of these on retention. Nurses routinely used telephone communication to encourage participants to return for trial follow-up. Trial managers used first class post, shorter questionnaires and improved questionnaire designs with the aim of improving questionnaire response. Interviewees thought an open trial design could lead to biased results and were negative about using behavioural strategies to improve retention. There was consensus among the interviewees that effective communication and rapport with participants, participant altruism, respect for participant's time, flexibility of trial personnel and appointment schedules and trial information improve retention. Interviewees noted particular challenges with retention in mental health trials and those involving teenagers.<p></p> Conclusions The findings of this qualitative study have allowed us to reflect on research practice around retention and highlight a gap between such practice and current evidence. Interviewees describe acting from experience without evidence from the literature, which supports the use of small monetary incentives to improve the questionnaire response. No such evidence exists for non-monetary incentives or first class post, use of which may need reconsideration. An exploration of barriers and facilitators to retention in other research contexts may be justified.<p></p&gt

An intraoperative surprise : occult case of non-functional parathyroid carcinoma

Parathyroid carcinoma (PC) exists in <1% of patients with hyperparathyroidism (Figure 1) and typically presents with a robust constellation of findings that rarely go unnoticed. Mean serum parathyroid hormone (PTH) concentrations are commonly 3-to 10-fold higher than the upper limit of normal with a mean serum calcium concentration that frequently exceeds 14 mg/dL. PCs also tend to metastasize to cervical lymph nodes (30%) which is a distinctly ominous sign when associated with this rare pathology as compared to its benign counterpart, parathyroid adenomas. Non-functioning parathyroid carcinomas (NPC), less than 10% of PCs, are exceptionally rare, and can more closely resemble parathyroid adenoma/hyperplasia on preoperative workup further obscuring diagnosis. This disease represents a unique subset of PCs that are rarely addressed in the literature

Dense stellar matter with trapped neutrinos under strong magnetic fields

We investigate the effects of strong magnetic fields on the equation of state of dense stellar neutrino-free and neutrino-trapped matter. Relativistic nuclear models both with constant couplings (NLW) and with density dependent parameters (DDRH) and including hyperons are considered . It is shown that at low densities neutrinos are suppressed in the presence of the magnetic field. The magnetic field reduces the strangeness fraction of neutrino-free matter and increases the strangeness fraction of neutrino-trapped matter. The mass-radius relation of stars described by these equations of state are determined. The magnetic field makes the overall equation of state stiffer and the stronger the field the larger the mass of maximum mass star and the smaller the baryon density at the center of the star. As a consequence in the presence of strong magnetic fields the possibility that a protoneutron star evolves to a blackhole is smaller.Comment: 18 pages, 13 figures, 5 tables, submitted to J. Phys.

Deep CCD Surface Photometry of Galaxy Clusters I: Methods and Initial Studies of Intracluster Starlight

We report the initial results of a deep imaging survey of galaxy clusters. The primary goals of this survey are to quantify the amount of intracluster light as a function of cluster properties, and to quantify the frequency of tidal debris. We outline the techniques needed to perform such a survey, and we report findings for the first two galaxy clusters in the survey: Abell 1413, and MKW 7 . These clusters vary greatly in richness and structure. We show that our surface photometry reliably reaches to a surface brightness of \mu_v = 26.5 mags per arcsec. We find that both clusters show clear excesses over a best-fitting r^{1/4} profile: this was expected for Abell 1413, but not for MKW 7. Both clusters also show evidence of tidal debris in the form of plumes and arc-like structures, but no long tidal arcs were detected. We also find that the central cD galaxy in Abell 1413 is flattened at large radii, with an ellipticity of $\approx 0.8$, the largest measured ellipticity of any cD galaxy to date.Comment: 58 pages, 24 figures, accepted for publication in the Astrophysical Journal. Version has extremely low resolution figures to comply with 650k limit. High resolution version is available at http://burro.astr.cwru.edu/johnf/icl1.ps.gz Obtaining high resolution version is strongly reccomende

Data mining: a tool for detecting cyclical disturbances in supply networks.

Disturbances in supply chains may be either exogenous or endogenous. The ability automatically to detect, diagnose, and distinguish between the causes of disturbances is of prime importance to decision makers in order to avoid uncertainty. The spectral principal component analysis (SPCA) technique has been utilized to distinguish between real and rogue disturbances in a steel supply network. The data set used was collected from four different business units in the network and consists of 43 variables; each is described by 72 data points. The present paper will utilize the same data set to test an alternative approach to SPCA in detecting the disturbances. The new approach employs statistical data pre-processing, clustering, and classification learning techniques to analyse the supply network data. In particular, the incremental k-means clustering and the RULES-6 classification rule-learning algorithms, developed by the present authors’ team, have been applied to identify important patterns in the data set. Results show that the proposed approach has the capability automatically to detect and characterize network-wide cyclical disturbances and generate hypotheses about their root cause

e±e^\pm Excesses in the Cosmic Ray Spectrum and Possible Interpretations

The data collected by ATIC, PPB-BETS, FERMI-LAT and HESS all indicate that there is an electron/positron excess in the cosmic ray energy spectrum above $\sim$ 100 GeV, although different instrumental teams do not agree on the detailed spectral shape. PAMELA also reported a clear excess feature of the positron fraction above several GeV, but no excess in anti-protons. Here we review the observational status and theoretical models of this interesting observational feature. We pay special attention to various physical interpretations proposed in the literature, including modified supernova remnant models for the $e^\pm$ background, new astrophysical sources, and new physics (the dark matter models). We suggest that although most models can make a case to interpret the data, with the current observational constraints the dark matter interpretations, especially those invoking annihilation, require much more exotic assumptions than some astrophysical interpretations. Future observations may present some ``smoking-gun'' observational tests to differentiate among different models and to identify the correct interpretation to the phenomenon.Comment: 48 pages, including 10 figures and 1 tabel. Invited review to be published in IJMP