Recruitment activities for a nationwide, population-based, group-randomized trial: the VA MI-Plus study

Abstract Background The Veterans Health Administration (VHA) oversees the largest integrated healthcare system in the United States. The feasibility of a large-scale, nationwide, group-randomized implementation trial of VHA outpatient practices has not been reported. We describe the recruitment and enrollment of such a trial testing a clinician-directed, Internet-delivered intervention for improving the care of postmyocardial infarction patients with multiple comorbidities. Methods With a recruitment goal of 200 eligible community-based outpatient clinics, parent VHA facilities (medical centers) were recruited because they oversee their affiliated clinics and the research conducted there. Eligible facilities had at least four VHA-owned and -operated primary care clinics, an affiliated Institutional Review Board (IRB), and no ongoing, potentially overlapping, quality-improvement study. Between December 2003 and December 2005, in two consecutive phases, we used initial and then intensified recruitment strategies. Results Overall, 48 of 66 (73%) eligible facilities were recruited. Of the 219 clinics and 957 clinicians associated with the 48 facilities, 168 (78%) clinics and 401 (42%) clinicians participated. The median time from initial facility contact to clinic enrollment was 222 days, which decreased by over one-third from the first to the second recruitment phase (medians: 323 and 195 days, respectively; p < .001), when more structured recruitment with physician recruiters was implemented and a dedicated IRB manager was added to the coordinating center staff. Conclusions Large group-randomized trials benefit from having dedicated physician investigators and IRB personnel involved in recruitment. A large-scale, nationally representative, group-randomized trial of community-based clinics is feasible within the VHA or a similar national healthcare system.http://deepblue.lib.umich.edu/bitstream/2027.42/112896/1/13012_2010_Article_417.pd

Recruitment activities for a nationwide, population-based, group-randomized trial: the VA MI-Plus study

BACKGROUND: The Veterans Health Administration (VHA) oversees the largest integrated healthcare system in the United States. The feasibility of a large-scale, nationwide, group-randomized implementation trial of VHA outpatient practices has not been reported. We describe the recruitment and enrollment of such a trial testing a clinician-directed, Internet-delivered intervention for improving the care of postmyocardial infarction patients with multiple comorbidities. METHODS: With a recruitment goal of 200 eligible community-based outpatient clinics, parent VHA facilities (medical centers) were recruited because they oversee their affiliated clinics and the research conducted there. Eligible facilities had at least four VHA-owned and -operated primary care clinics, an affiliated Institutional Review Board (IRB), and no ongoing, potentially overlapping, quality-improvement study. Between December 2003 and December 2005, in two consecutive phases, we used initial and then intensified recruitment strategies. RESULTS: Overall, 48 of 66 (73%) eligible facilities were recruited. Of the 219 clinics and 957 clinicians associated with the 48 facilities, 168 (78%) clinics and 401 (42%) clinicians participated. The median time from initial facility contact to clinic enrollment was 222 days, which decreased by over one-third from the first to the second recruitment phase (medians: 323 and 195 days, respectively; p \u3c .001), when more structured recruitment with physician recruiters was implemented and a dedicated IRB manager was added to the coordinating center staff. CONCLUSIONS: Large group-randomized trials benefit from having dedicated physician investigators and IRB personnel involved in recruitment. A large-scale, nationally representative, group-randomized trial of community-based clinics is feasible within the VHA or a similar national healthcare system

Growth and survival of sockeye salmon (Oncorhynchus nerka) from Karluk Lake and River, Alaska, in relation to climatic and oceanic regimes and indices, 1922–2000

We examined whether the relationship between climate and salmon production was linked through the effect of climate on the growth of sockeye salmon (Oncorhynchus nerka) at sea. Smolt length and juvenile, immature, and maturing growth rates were estimated from increments on scales of adult sockeye salmon that returned to the Karluk River and Lake system on Kodiak Island, Alaska, over 77 years, 1924–2000. Survival was higher during the warm climate regimes and lower during the cool regime. Growth was not correlated with survival, as estimated from the residuals of the Ricker stock-recruitment model. Juvenile growth was correlated with an atmospheric forcing index and immature growth was correlated with the amount of coastal precipitation, but the magnitude of winter and spring coastal downwelling in the Gulf of Alaska and the Pacific Northwest atmospheric patterns that influence the directional bifurcation of the Pacific Current were not related to the growth of Karluk sockeye salmon. However, indices of sea surface temperature, coastal precipitation, and atmospheric circulation in the eastern North Pacific were correlated with the survival of Karluk sockeye salmon. Winter and spring precipitation and atmospheric circulation are possible processes linking survival to climate variation in Karluk sockeye salmon

The political economy of competitiveness and social mobility

Social mobility has become a mainstream political and media issue in recent years in the United Kingdom. This article suggests that part of the reason for this is that it can serve as a mechanism to discuss policy concerns that appear to be about social justice without questioning important aspects of neo-liberal political economy. The article charts the policy rhetoric on social mobility under both New Labour and the current Coalition Government. It is argued first that under New Labour the apparent commitment to social mobility was in fact subsumed beneath the pursuit of neo-liberal competitiveness, albeit imperfectly realised in policy. Second, the article suggests that under the Coalition Government the commitment to raising levels of social mobility has been retained and the recently published Strategy for Social Mobility promises that social mobility is what the Coalition means when it argues that the austerity programme is balanced with ‘fairness’. Third, however, the Strategy makes clear that the Coalition define social mobility in narrower terms than the previous government. It is argued here that in narrowing the definition the connection with the idea of competitiveness, while still clearly desirable for the Coalition, is weakened. Fourth, a brief analysis of the Coalition's main policy announcements provides little evidence to suggest that even the narrow definition set out in the Strategy is being seriously pursued. Fifth, the international comparative evidence suggests that any strategy aimed at genuinely raising the level of social mobility would need to give much more serious consideration to narrowing levels of inequality. Finally, it is concluded that when considered in the light of the arguments above, the Strategy for Social Mobility – and therefore ‘Fairness’ itself – is merely a discursive legitimation of the wider political economy programme of austerity

Multiple uncontrolled conditions and blood pressure medication intensification: an observational study

Abstract Background Multiple uncontrolled medical conditions may act as competing demands for clinical decision making. We hypothesized that multiple uncontrolled cardiovascular risk factors would decrease blood pressure (BP) medication intensification among uncontrolled hypertensive patients. Methods We observed 946 encounters at two VA primary care clinics from May through August 2006. After each encounter, clinicians recorded BP medication intensification (BP medication was added or titrated). Demographic, clinical, and laboratory information were collected from the medical record. We examined BP medication intensification by presence and control of diabetes and/or hyperlipidemia. 'Uncontrolled' was defined as hemoglobin A1c &#8805; for diabetes, BP &#8805; 140/90 mmHg (&#8805; 130/80 mmHg if diabetes present) for hypertension, and low density lipoprotein cholesterol (LDL-c) &#8805; 130 mg/dl (&#8805; 100 mg/dl if diabetes present) for hyperlipidemia. Hierarchical regression models accounted for patient clustering and adjusted medication intensification for age, systolic BP, and number of medications. Results Among 387 patients with uncontrolled hypertension, 51.4% had diabetes (25.3% were uncontrolled) and 73.4% had hyperlipidemia (22.7% were uncontrolled). The BP medication intensification rate was 34.9% overall, but higher in individuals with uncontrolled diabetes and uncontrolled hyperlipidemia: 52.8% overall and 70.6% if systolic BP &#8805; 10 mmHg above goal. Intensification rates were lowest if diabetes or hyperlipidemia were controlled, lower than if diabetes or hyperlipidemia were not present. Multivariable adjustment yielded similar results. Conclusions The presence of uncontrolled diabetes and hyperlipidemia was associated with more guideline-concordant hypertension care, particularly if BP was far from goal. Efforts to understand and improve BP medication intensification in patients with controlled diabetes and/or hyperlipidemia are warranted.http://deepblue.lib.umich.edu/bitstream/2027.42/78266/1/1748-5908-5-55.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78266/2/1748-5908-5-55.pdfPeer Reviewe

The Expression of Power in ICT's Knowledge Enterprise: An Empirical Illustration of Computing's Colonial Impulse

ICT globalization continues to spread hardware, software, and accompanying technologies, so too does knowledges and trainings on those ICTs. This knowledge migration process has been linked by scholars to a ‘colonial impulse’ inherent in computing as a knowl- edge enterprise, which incorporates into broader colonizing forces. Through simultaneous explorations of dual case studies with a tribal ISP in California and an educational organization that works with indigenous First Nations communities in British Columbia, we depict how power circulates in this process, both empowering and disempowering communities. We then offer a brief argument for the need to foreground methods and approaches to disentangling these contradicting forces

Adaptive optics tracking and pushing system for space debris manoeuvre

As space debris in lower Earth orbits are accumulating, techniques to lower the risk of space debris collisions must be developed. Within the context of the Space Environment Research Centre (SERC), the Australian National University (ANU) is developing an adaptive optics system for tracking and pushing space debris. The strategy is to pre-condition a laser launched from a 1.8 m telescope operated by Electro Optics Systems (EOS) on Mount Stromlo, Canberra and direct it at an object to perturb its orbit. Current progress towards implementing this experiment, which will ensure automated operation between the telescope and the adaptive optics system, will be presented.The authors would like to acknowledge the support of the Cooperative Research Centre for Space Environment Management (SERC Limited) through the Australian Government’s Cooperative Research Centre Programm

Processes in model slopes made of mixtures of wettable and water repellent sand: Implications for the initiation of debris flows in dry slopes

Debris flows in slopes initially dry, such as post-wildfire debris flows, are initiated by surface runoff and sediment bulking due to reduced infiltration. Soil water repellency, extreme dry soils, and loose, cohesionless materials influence their initiation. The exact link between these features, the resulting infiltration processes and the initiation mechanism of a debris flow remains unclear. Here, we examine the relation between soil particle wettability and slope processes in physical models. Flume experiments were conducted in 10% increments of mass ratios of wettable to water repellent sand, subjected to artificial rainfall with monitoring of soil water content, pore water pressure, sediment and water discharge and failure mode. To date, wettability was considered only for the water repellent end, because it reduces infiltration, enhancing surface runoff. This study demonstrates that slight wettability changes, in the full wettable to water repellent range, impact a variety of slope processes. The two extremes, fully wettable and water repellent gave opposite responses, retrogressive slides for infiltration-initiated in wettable sand and erosion by surface runoff in water repellent sand. The transition was dominated by surface runoff and preferential flow, yielding a combination of erosion and slides. From the tests, a continuous capping effect generated by water repellency was a necessary condition for erosion and sand bulking i.e., the generation of runoff-initiated debris flows. The sensitivity of the model slope response to artificial rainfall was particularly acute at high ratios of wettable to water repellent sand. For mixtures above a critical ratio of wettable to water repellent sand, the measurements with an index test revealed a fully wettable material despite differences in the infiltration, saturation and pore water pressure built-up trends. Implications for post-wildfire debris flows and debris flows in slopes initially dry in general are discussed.postprin