Contamination in complex healthcare trials:the falls in care homes (FinCH) study experience

BACKGROUND: Trials are at risk of contamination bias which can occur when participants in the control group are inadvertently exposed to the intervention. This is a particular risk in rehabilitation studies where it is easy for trial interventions to be either intentionally or inadvertently adopted in control settings. The Falls in Care Homes (FinCH) trial is used in this paper as an example of a large randomised controlled trial of a complex intervention to explore the potential risks of contamination bias. We outline the FinCH trial design, present the potential risks from contamination bias, and the strategies used in the design of the trial to minimise or mitigate against this. The FinCH trial was a multi-centre randomised controlled trial, with embedded process evaluation, which evaluated whether systematic training in the use of the Guide to Action Tool for Care Homes reduced falls in care home residents. Data were collected from a number of sources to explore contamination in the FinCH trial. Where specific procedures were adopted to reduce risk of, or mitigate against, contamination, this was recorded. Data were collected from study e-mails, meetings with clinicians, research assistant and clinician network communications, and an embedded process evaluation in six intervention care homes. During the FinCH trial, there were six new falls prevention initiatives implemented outside the study which could have contaminated our intervention and findings. Methods used to minimise contamination were: cluster randomisation at the level of care home; engagement with the clinical community to highlight the risks of early adoption; establishing local collaborators in each site familiar with the local context; signing agreements with NHS falls specialists that they would maintain confidentiality regarding details of the intervention; opening additional research sites; and by raising awareness about the importance of contamination in research among participants. CONCLUSION: Complex rehabilitation trials are at risk of contamination bias. The potential for contamination bias in studies can be minimized by strengthening collaboration and dialogue with the clinical community. Researchers should recognise that clinicians may contaminate a study through lack of research expertise

Sports mega-events – three sites of contemporary political contestation

This article discusses the contemporary politics of sports mega-events, involving the Olympic Games and Fédération Internationale de Football Association (FIFA) Men’s Football World Cup Finals as well as other lower ‘order’ sports megas, taking two main forms: the promotional and the protest. There is a politics in, and a politics of, sports mega-events. The former focuses on the internal politics of the organizing bodies, such as the International Olympic Committee and FIFA. This form of politics has been written about elsewhere, and hence, there is no detailed discussion in this article about it. Instead this article offers a brief discussion of the range and number of sports mega-events since 2000, an assessment of the contemporary politics of sports mega-events, a focus on three main sites of political contestation – rights, legacy and labour, and finally, it offers conclusions about research into the politics of sports mega-events

The role of virtual reality in built environment education

This study builds upon previous research on the integration of Virtual Reality (VR) within the built environment curriculum and aims to investigate the role of VR and three-dimensional (3D) computer modelling on learning and teaching in a school of the built environment. In order to achieve this aim, a number of academic experiences were analysed to explore the applicability and viability of 3D computer modelling and VR into built environment subject areas. Although two-dimensional (2D) representations have been greatly accepted by built environment professions and education, 3D computer representations and VR applications, offering interactivity and immersiveness, are not yet widely accepted. The study attempts to understand the values and challenges of integrating visualisation technologies into built environment teaching and investigates tutors’ perceptions, opinions and concerns with respect to these technologies. The study reports on the integration process and considers how 3D computer modelling and VR technologies can combine with, and extend, the existing range of learning and teaching methods appropriate to different disciplines and programme areas

Rotating Dilaton Black Holes

It is shown that an arbitrarily small amount of angular momentum can qualitatively change the properties of extremal charged black holes coupled to a dilaton. In addition, the gyromagnetic ratio of these black holes is computed and an exact rotating black string solution is presented.Comment: 14 page

T Pyxidis: The First Cataclysmic Variable with a Collimated Jet

We present the first observational evidence for a collimated jet in a cataclysmic variable system; the recurrent nova T Pyxidis. Optical spectra show bipolar components of H$\alpha$ with velocities $\sim 1400 km/s$, very similar to those observed in the supersoft X-ray sources and in SS 433. We argue that a key ingredient of the formation of jets in the supersoft X-ray sources and T Pyx (in addition to an accretion disk threaded by a vertical magnetic field), is the presence of nuclear burning on the surface of the white dwarf.Comment: 10 pages 2 figures to appear in ApJ Letter

Understanding the patterns, characteristics and trends in the housing sector labour force-AHURI Final Report No.208

The focus of this study is the national policy problem of the gap between housing supply and demand, as identified and monitored by the National Housing Supply Council. Research to date has not focused upon the spatial distribution of labour supply and demand of the housing sector labour force (HSLF). Also research to date has not distinguished between labour engaged in building new dwellings and labour engaged in undertaking alterations and additions. In addressing this research gap, this Final Report presents the summative output of the AHURI research project entitled: Understanding the patterns, characteristics and trends in the housing sector labour force in Australia. It follows the publication of the Positioning Paper for the project (Dalton et al. 2011a).This chapter has presented a response to the secondary research question: What are the temporal dimensions of the HSLF as a whole and the new build and alterations and additions sub-sectors? It first described the categories, containing records of workers who worked in the housing industry, which were used to interrogate the census data. Using these categories, the data presented showed that, in aggregate, the size of the HSLF grew in the period 2001-06. In Victoria, the workforce grew from 72 000 to 89 000, an increase of 23 per cent in the five-year period 2001-06. The 44 per cent growth in the Queensland workforce was almost twice that of Victoria for the same period when it grew from 53 000 to 77 000. This aggregate data was then split to distinguish between workers who worked on 'new build' housing and those who worked on 'alterations and additions'. The results of this splitting showed that there had been growth in both sub-sectors. The rate of growth in the alterations and additions sub-sector was greater than for the new build sector, although this growth was from a lower base

Short-term effects of deep ploughing on soil C stocks following renewal of a dairy pasture in New Zealand

In New Zealand’s high producing permanent pastures the topsoil constitutes a large reservoir of soil organic carbon (SOC), which shows a marked stratification with depth. As consequence, sub-surface layers can contain 10 times less carbon than the surface soil. In permanent pastures with high carbon inputs, the formation and decomposition of these surface SOC stocks are often at equilibrium and C storage shows little change over time. Pastoral based dairy systems utilising ryegrass plus clover cultivars require renewal every 7-10 years to avoid reversion to less productive grasses. This may involve spring cultivation (either no-till, shallow till or full cultivation), summer forage cropping and autumn re-grassing. It has been hypothesised that SOC stocks can be increased by inverting the soil profile at pasture renewal through infrequent (once in 25-30 years) deep mouldboard ploughing (up to 30 cm depth). Increased C sequestration occurs when the new grass quickly rebuilds SOC stocks in the new topsoil (exposed low C sub-soil) at a rate faster than the decomposition of SOC in the rich former topsoil transferred to depth (now below 15 cm). However, benefits form accelerated C storage may be offset if crop and pasture production is adversely affected by the ploughing event (e.g., as result of compaction or excessive drainage). Hence, the aim of this work was to assess the short-term effects of infrequent inversion tillage of long-term New Zealand pastoral-based dairy soils under summer crop management and autumn re-grassing. An imperfectly drained Typic Fragiaqualf under dairy grazing was deep ploughed (approx. 25 cm) and re-sown with turnip in October 2016; other treatments included were shallow (< 10 cm) cultivation and no-till. The site was core sampled (0-40 cm) before cultivation and after 5 months of turnip growth to assess changes in SOC. Plant growth, herbage quality, and nutrient leaching were monitored during the 5-month period; root growth was assessed at the end of the crop rotation. Full cultivation transferred SOC below 10 cm depth, as expected. Soil bulk density decreased whereas root mass increased (10-20 cm depth; P < 0.05) under deep cultivation only. Besides, losses of mineral N were attenuated under deep tillage, resulting in a relative increase in crop yield. The potential for infrequent inversion tillage increasing soil C sequestration as a greenhouse gas (GHG) mitigation tool is currently being tested at other sites in New Zealand

Melioidosis–a disease of socioeconomic disadvantage

Background There is growing recognition of the contribution of the social determinants of health to the burden of many infectious diseases. However, the relationship between socioeconomic status and the incidence and outcome of melioidosis is incompletely defined. Methods All residents of Far North Queensland, tropical Australia with culture-proven melioidosis between January 1998 and December 2020 were eligible for the study. Their demographics, comorbidities and socioeconomic status were correlated with their clinical course. Socioeconomic status was determined using the Socio-Economic Indexes for Areas (SEIFA) Index of Relative Socio-economic Disadvantage score, a measure of socioeconomic disadvantage developed by the Australian Bureau of Statistics. Socioeconomic disadvantage was defined as residence in a region with a SEIFA score in the lowest decile in Australia. Results 321 eligible individuals were diagnosed with melioidosis during the study period, 174 (54.2%) identified as Indigenous Australians; 223/321 (69.5%) were bacteraemic, 85/321 (26.5%) required Intensive Care Unit (ICU) admission and 37/321 (11.5%) died. 156/321 (48.6%) were socioeconomically disadvantaged, compared with 56603/269002 (21.0%) of the local general population (p<0.001). Socioeconomically disadvantaged patients were younger, more likely to be female, Indigenous, diabetic or have renal disease. They were also more likely to die prior to hospital discharge (26/156 (16.7%) versus 11/165 (6.7%), p = 0.002) and to die at a younger age (median (IQR) age: 50 (38–68) versus 65 (59–81) years, p = 0.02). In multivariate analysis that included age, Indigenous status, the presence of bac-teraemia, ICU admission and the year of hospitalisation, only socioeconomic disadvantage (odds ratio (OR) (95% confidence interval (CI)): 2.49 (1.16–5.35), p = 0.02) and ICU admission (OR (95% CI): 4.79 (2.33–9.86), p<0.001) were independently associated with death. Conclusion Melioidosis is disease of socioeconomic disadvantage. A more holistic approach to the delivery of healthcare which addresses the social determinants of health is necessary to reduce the burden of this life-threatening disease

Dynamics of Line-Driven Winds from Disks in Cataclysmic Variables. I. Solution Topology and Wind Geometry

We analyze the dynamics of 2-D stationary, line-driven winds from accretion disks in cataclysmic variable stars. The driving force is that of line radiation pressure, in the formalism developed by Castor, Abbott & Klein for O stars. Our main assumption is that wind helical streamlines lie on straight cones. We find that the Euler equation for the disk wind has two eigenvalues, the mass loss rate and the flow tilt angle with the disk. Both are calculated self-consistently. The wind is characterized by two distinct regions, an outer wind launched beyond four white dwarf radii from the rotation axis, and an inner wind launched within this radius. The inner wind is very steep, up to 80 degrees with the disk plane, while the outer wind has a typical tilt of 60 degrees. In both cases the ray dispersion is small. We, therefore, confirm the bi-conical geometry of disk winds as suggested by observations and kinematical modeling. The wind collimation angle appears to be robust and depends only on the disk temperature stratification. The flow critical points lie high above the disk for the inner wind, but close to the disk photosphere for the outer wind. Comparison with existing kinematical and dynamical models is provided. Mass loss rates from the disk as well as wind velocity laws are discussed in a subsequent paper.Comment: 21 pages, 10 Postscript figures; available also from http://www.pa.uky.edu/~shlosman/publ.html. Astrophysical Journal, submitte