Measuring fidelity to behavioural support delivery for smoking cessation and its association with outcomes

BACKGROUND AND AIMS: Behavioural support increases smoking cessation in clinical settings, but effect sizes differ among providers, due possibly to variations in delivery. This study evaluates a measure ('fidelity index') intended to capture fidelity to delivery of content- and interaction-based items of a behavioural support (BS) for smoking cessation and the association of fidelity with quit rates. METHODS: A fidelity index for scoring the adherence and quality domains of a specific BS intervention, '5As for quit', was developed by classifying the intervention components using the taxonomy of behaviour change techniques. The index was applied to code 154 BS sessions audiotaped among 18 chest clinics in Pakistan to assess their fidelity and explore reliability of coding. The association between intervention fidelity and successful quit achieved by the same providers in a previous study was explored using regression analysis. RESULTS: The index represented two domains: adherence to delivery of content-based activities of 5As (37 items) and quality of interaction-based activities (eight items). The intercoder reliability was good for content-based (average Krippendorff's α = 0.80) and moderate for interaction-based (average Krippendorff's α = 0.66) items. Approximately 70% (intraclass correlation coefficient: adherence scores = 0.72, quality scores = 0.71) of variation in BS delivery was contributed by providers, which increased to 97% (g-coefficient: adherence scores = 0.973, quality scores = 0.974) after accounting for other sources of variation. Higher quit rates were positively associated with average quality scores [risk ratio = 2.15; 95% confidence interval (CI) = 1.43-3.24], but negatively associated with average adherence scores (risk ratio = 0.55; 95% CI = 0.40-0.77) within services. CONCLUSIONS: The fidelity index is a reliable measure for quantifying intervention fidelity of delivering smoking cessation behavioural support. Recommended revisions of the fidelity index include incorporation of additional interaction-based items, such as the relational techniques used in motivational interviewing

A Global Modeling Study on Carbonaceous Aerosol Microphysical Characteristics and Radiative Effects

Recently, attention has been drawn towards black carbon aerosols as a short-term climate warming mitigation candidate. However the global and regional impacts of the direct, indirect and semi-direct aerosol effects are highly uncertain, due to the complex nature of aerosol evolution and the way that mixed, aged aerosols interact with clouds and radiation. A detailed aerosol microphysical scheme, MATRIX, embedded within the GISS climate model is used in this study to present a quantitative assessment of the impact of microphysical processes involving black carbon, such as emission size distributions and optical properties on aerosol cloud activation and radiative effects. Our best estimate for net direct and indirect aerosol radiative flux change between 1750 and 2000 is -0.56 W/m2. However, the direct and indirect aerosol effects are quite sensitive to the black and organic carbon size distribution and consequential mixing state. The net radiative flux change can vary between -0.32 to -0.75 W/m2 depending on these carbonaceous particle properties at emission. Taking into account internally mixed black carbon particles let us simulate correct aerosol absorption. Absorption of black carbon aerosols is amplified by sulfate and nitrate coatings and, even more strongly, by organic coatings. Black carbon mitigation scenarios generally showed reduced radiative fluxeswhen sources with a large proportion of black carbon, such as diesel, are reduced; however reducing sources with a larger organic carbon component as well, such as bio-fuels, does not necessarily lead to a reduction in positive radiative flux

The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework

There is evidence that 3.17% of women report posttraumatic stress disorder (PTSD) after childbirth. This meta-analysis synthesizes research on vulnerability and risk factors for birth-related PTSD and refines a diathesis-stress model of its etiology. Systematic searches were carried out on PsychInfo, PubMed, Scopus and Web of Science using PTSD terms crossed with childbirth terms. Studies were included if they reported primary research that examined factors associated with birth-related PTSD measured at least one month after birth. 50 studies (N=21,429) from 15 countries fulfilled inclusion criteria. Pre-birth vulnerability factors most strongly associated with PTSD were depression in pregnancy (.51), fear of childbirth (.41), poor health or complications in pregnancy (r = .38), and a history of PTSD (.39) and counselling (.32). Risk factors in birth most strongly associated with PTSD were negative subjective birth experiences (.59), having an operative birth (assisted vaginal or caesarean, .48), lack of support (-.38), and dissociation (.32). After birth, PTSD was associated with poor coping and stress (.30), and was highly comorbid with depression (.60). Moderator analyses showed that the effect of poor health or complications in pregnancy was more apparent in high-risk samples. The results of this meta-analysis are used to update a diathesis-stress model of the etiology of postpartum PTSD and can be used to inform screening, prevention and intervention in maternity care

Review of the Laguerre-Gauss mode technology research program at Birmingham

Gravitational wave detectors from the advanced generation onwards are expected to be limited in sensitivity by thermal noise of the optics, making the reduction of this noise a key factor in the success of such detectors. A proposed method for reducing the impact of this noise is to use higher-order Laguerre-Gauss (LG) modes for the readout beam, as opposed to the currently used fundamental mode. We present here a synopsis of the research program undertaken by the University of Birmingham into the suitability of LG mode technology for future gravitational wave detectors. This will cover our previous and current work on this topic, from initial simulations and table-top LG mode experiments up to implementation in a prototype scale suspended cavity and high-power laser bench

Broad Band X-Ray Observations of the Narrow Line X-Ray Galaxy NGC 5506

We present a detailed analysis of broad band X-ray data of the Seyfert 2 galaxy NGC5506. 2-10 keV band are detected during a 1-day ASCA observation, while no significant change in the 2-10 keV continuum shape is found. The ASCA spectrum consists of an absorbed power-law, a 'soft excess' below 2 keV, and an Fe K$\alpha$ emission line at 6.4 keV. The 'soft excess' can be well described by either thermal emission from very low abundance material at a temperature kT$\simeq$0.8 keV, or scattered/leaking flux from the primary power-law plus a small amount of thermal emission. Analysis of ROSAT HRI data reveals that the soft X-ray emission is extended on kpc scales in this object, and the extended component may account for most of the soft X-ray excess observed by the ASCA. The result suggests that in this type 2 AGN, the 'soft excess' at least partly comes from an extended region, imposing serious problem for the model in which the source is partially covered. Fe K$\alpha$ profile is complex and can not be satisfactorily modeled by a single gaussian. Models of either double gaussians, or a narrow gaussian plus a line from a relativistic accretion disk viewed at an inclination of about 40$\pm10^\circ$ provide good fits to the data. However, the inclination of the disk can be substantially larger if there is a small amount of excessive Fe K edge absorption. The intermediate inclinations for NLXGs are consistent with the ideas that the inner accretion disk is aligned with the outer obscuring torus.Comment: 8 pages, 5 postscript figures. to appear in Astrophy. J., 1999, April 2

Sterile Neutrinos as Dark Matter

The simplest model that can accomodate a viable nonbaryonic dark matter candidate is the standard electroweak theory with the addition of right-handed or sterile neutrinos. We reexamine this model and find that the sterile neutrinos can be either hot, warm, or cold dark matter. Since their only direct coupling is to left-handed or active neutrinos, the most efficient production mechanism is via neutrino oscillations. If the production rate is always less than the expansion rate, then these neutrinos will never be in thermal equilibrium. However, enough of them may be produced so that they provide the missing mass necessary for closure. We consider a single generation of neutrino fields $\left (\nu_L,\,\nu_R\right )$ with a Dirac mass, $\mu$, and a Majorana mass for the right-handed components only, $M$. For $M\gg \mu$ we show that the number density of sterile neutrinos is proportional to $\mu^2/M$ so that the energy density today is {\it independent of} $M$. However $M$ is crucial in determining the large scale structure of the Universe. In particular, $M\simeq 0.1-1.0 {\rm ~keV}$ leads to warm dark matter and a structure formation scenario that may have some advantages over both the standard hot and cold dark matter scenarios.Comment: 10 pages (1 figure available upon request) phyzzx, FERMILAB-Pub-93/057-

What e-patients want from the doctor-patient relationship: content analysis of posts on discussion boards.

People with long-term conditions are encouraged to take control and ownership of managing their condition. Interactions between health care staff and patients become partnerships with sharing of expertise. This has changed the doctor-patient relationship and the division of roles and responsibilities that traditionally existed, but what each party expects from the other may not always be clear. Information that people with long-term conditions share on Internet discussion boards can provide useful insights into their expectations of health care staff. This paper reports on a small study about the expectations that people with a long-term condition (diabetes) have of their doctors using information gleaned from Internet discussion boards

Improving the Prospects for Detecting Extrasolar Planets in Gravitational Microlensing in 2002

Gravitational microlensing events of high magnification have been shown to be promising targets for detecting extrasolar planets. However, only a few events of high magnification have been found using conventional survey techniques. Here we demonstrate that high magnification events can be readily found in microlensing surveys using a strategy that combines high frequency sampling of target fields with online difference imaging analysis. We present 10 microlensing events with peak magnifications greater than 40 that were detected in real-time towards the Galactic Bulge during 2001 by MOA. We show that Earth mass planets can be detected in future events such as these through intensive follow-up observations around the event peaks. We report this result with urgency as a similar number of such events are expected in 2002.Comment: 11 pages, 3 embedded ps figures including 2 colour, revised version accepted by MNRA

Comparing Cosmic Microwave Background Datasets

To extract reliable cosmic parameters from cosmic microwave background datasets, it is essential to show that the data are not contaminated by residual non-cosmological signals. We describe general statistical approaches to this problem, with an emphasis on the case in which there are two datasets that can be checked for consistency. A first visual step is the Wiener filter mapping from one set of data onto the pixel basis of another. For more quantitative analyses we develop and apply both Bayesian and frequentist techniques. We define the ``contamination parameter'' and advocate the calculation of its probability distribution as a means of examining the consistency of two datasets. The closely related ``probability enhancement factor'' is shown to be a useful statistic for comparison; it is significantly better than a number of chi-squared quantities we consider. Our methods can be used: internally (between different subsets of a dataset) or externally (between different experiments); for observing regions that completely overlap, partially overlap or overlap not at all; and for observing strategies that differ greatly. We apply the methods to check the consistency (internal and external) of the MSAM92, MSAM94 and Saskatoon Ring datasets. From comparing the two MSAM datasets, we find that the most probable level of contamination is 12%, with no contamination only 1.05 times less probable, and 100% contamination strongly ruled out at over 2 X 10^5 times less probable. From comparing the 1992 MSAM flight with the Saskatoon data we find the most probable level of contamination to be 50%, with no contamination only 1.6 times less probable and 100% contamination 13 times less probable. [Truncated]Comment: LaTeX, 16 pages which include 16 figures, submitted to Phys. Rev.