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

Participation in the school dinner hall environment: A qualitative observational study of a UK mainstream primary school

Introduction: Children with disabilities should have equal access to participate within school. Participation is affected by contextual factors; the physical environment and people. One important aspect is the school meal. Little is known about school dinner environments and there is no formal guidance. Material and Methods: This was an observational study of one UK mainstream primary school dinner hall. Two one hour lunchtimes were observed with children, aged 5-11 years, (703) and mealtime staff (30). Observations were guided using published frameworks, with descriptions of the physical environment and social interactions noted. Children and mealtime staff were not directly approached. Sound pressure level measurements were taken. Further information was gathered via the school website and the Special Educational Needs Coordinator. Results: This purpose-built school dinner hall had a seating capacity of 231 with a range of different sized furniture. Sound pressure levels reached a maximum of 91dB, above UK standards. It scored negatively on acoustic audit with factors including; open plan space, open doors, hard flooring, talking. The social environment focused on ensuring children ate a meal and on managing behaviour (‘dinner hall rules’). School staff were observed to focus on these aspects e.g. managing queues, wiping tables and reminding children of the rules. School staff did not eat with the children. Conclusion: In this school the children’s ability to participate fully at mealtimes is likely to be limited, particularly for children with disabilities. This study highlights the need for more exploration of this school environment with guidance developed

Large frequency drifts during Type I X-ray bursts

We study the spin-down of a neutron star atmosphere during the Type I X-ray burst in low mass X-ray binaries. Using polar cap acceleration models, we show that the resulting stellar ``wind'' torque on the burning shell due to the flowing charged particles (electrons, protons and ions) from the star's polar caps may change the shell's angular momentum during the burst. We conclude that the net change in the angular momentum of the star's atmosphere can account for rather large frequency drifts observed during Type I X-ray burst.Comment: 8 pages, more discussion adde

High Energy Neutrinos and Photons from Curvature Pions in Magnetars

We discuss the relevance of the curvature radiation of pions in strongly magnetized pulsars or magnetars, and their implications for the production of TeV energy neutrinos detectable by cubic kilometer scale detectors, as well as high energy photons.Comment: 19 pages, 4 figures, to appear in JCA

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

High speed sCMOS-based oblique plane microscopy applied to the study of calcium dynamics in cardiac myocytes

blique plane microscopy (OPM) is a form of light sheet microscopy that uses a single high numerical aperture microscope objective for both fluorescence excitation and collection. In this paper, measurements of the relative collection efficiency of OPM are presented. An OPM system incorporating two sCMOS cameras is then introduced that enables single isolated cardiac myocytes to be studied continuously for 22 seconds in two dimensions at 667 frames per second with 960 × 200 pixels and for 30 seconds with 960 × 200 × 20 voxels at 25 volumes per second. In both cases OPM is able to record in two spectral channels, enabling intracellular calcium to be studied via the probe Fluo-4 AM simultaneously with the sarcolemma and transverse tubule network via the membrane dye Cellmask Orange. The OPM system was then applied to determine the spatial origin of spontaneous calcium waves for the first time and to measure the cell transverse tubule structure at their point of origin. Further results are presented to demonstrate that the OPM system can also be used to study calcium spark parameters depending on their relationship to the transverse tubule structure

Full polar cap cascade scenario: γ\gamma-ray and X-ray luminosities from spin-powered pulsars

We modify polar cap cascade picture to include the ICS of the higher generation pairs. In such a ``full-cascade'' scenario, not only the perpendicular portion of the energy of the pairs goes to high energy radiation via SR, but the parallel portion of the energy of the pairs can also contribute to high energy emission via ICS with the soft thermal photons from either the full neutron star surface or the hot polar cap. An important output of such a scenario is that the soft tail of the ICS spectrum can naturally result in a non-thermal X-ray component which can contribute to the luminosities observed by ROSAT and ASCA. Here we present an analytic description of such a full polar cap cascade scenario within the framework of Harding & Muslimov acceleration model. We present the theoretical predictions of the $\gamma$-ray luminosities, the thermal and non-thermal X-ray luminosities for the known spin-powered X-ray pulsars. Our results show that the observed different dependences of the high energy luminosities on the pulsar spin-down luminosities, i.e., $L_\gamma \propto (L_{\rm sd})^{1/2}$ and $L_x \sim 10^{-3} L_{\rm sd}$, are well reproduced. Our model predicts that the {\em pulsed} soft X-rays in the ROSAT band from most of the millisecond pulsars might be of thermal origin if there is no strong multipole field components near the surfaces of these pulsars.Comment: 23 pages, emulateapj style, final version to appear in the Astrophysical Journa

Associations of blood pressure with body composition among Afro-Caribbean children in Barbados

Despite complex presentation of adult hypertension and a concomitant obesity epidemic, little is known about overweight in relation to blood pressure among Caribbean children. We examined blood pressure in relation to body size in a cross-sectional study of 573 Barbadian children aged 9–10 years (2010-2011).The United States normative blood pressure percentiles were used to identify children with high (≥ 95th percentile) or high normal blood pressure (90th – 95th percentile). The World Health Organization body mass index cut-off points were used to assess weight status. Major findings: Thirty percent of children were overweight/obese. Percentage fat mass differed between girls (20.4%) and boys (17.72%) (p< 0.05). Mean systolic blood pressure among girls was 106.11 (95% CI 105.05, 107.17) mmHg and 105.23 (104.09, 106.38) for boys. The percentages with high or high-normal mean systolic blood pressurewere14.38% (10.47, 18.29) for girls and 8.08% (4.74, 11.41) for boys. Height and body mass index were independent correlates of systolic and diastolic blood pressure. Mean systolic blood pressure was related to lean mass but not fat mass, while diastolic blood pressure was associated with fat mass index and overweight. Principal conclusion: One third of 9-10 year old children in Barbados were overweight/obese and 12% had elevated mean systolic blood pressure. BP was related to body size. These findings signal potential adverse trends in weight gain and BP trends for children growing up in the context of a country that has recently undergone rapid economic transition