Doing challenging research studies in a patient centred way: qualitative study to inform a randomised controlled trial in the paediatric emergency care setting

Objective: To inform the design of a randomised controlled trial (called EcLiPSE) to improve the treatment of children with convulsive status epilepticus (CSE). EcLiPSE requires the use of a controversial deferred consent process. Design: Qualitative interview and focus group study. Setting: 8 UK support groups for parents of children who have chronic or acute health conditions and experience of paediatric emergency care. Participants: 17 parents, of whom 11 participated in telephone interviews (10 mothers, 1 father) and 6 in a focus group (5 mothers, 1 father). 6 parents (35%) were bereaved and 7 (41%) had children who had experienced seizures, including CSE. Results: Most parents had not heard of deferred consent, yet they supported its use to enable the progress of emergency care research providing a child's safety was not compromised by the research. Parents were reassured by tailored explanation, which focused their attention on aspects of EcLiPSE that addressed their priorities and concerns. These aspects included the safety of the interventions under investigation and how both EcLiPSE interventions are used in routine clinical practice. Parents made recommendations about the appropriate timing of a recruitment discussion, the need to individualise approaches to recruiting bereaved parents and the use of clear written information. Conclusions: Our study provided information to help ensure that a challenging trial was patient centred in its design. We will use our findings to help EcLiPSE practitioners to: discuss potentially threatening trial safety information with parents, use open-ended questions and prompts to identify their priorities and concerns and clarify related aspects of written trial information to assist understanding and decision-making

How much is '5-a-day'? A qualitative investigation into consumer understanding of fruit and vegetable intake guidelines.

BACKGROUND: Despite the known health benefits of fruit and vegetables (FV), population intakes remain low. One potential contributing factor may be a lack of understanding surrounding recommended intakes. The present study aimed to explore the understanding of FV intake guidelines among a sample of low FV consumers. METHODS: Six semi-structured focus groups were held with low FV consumers (n = 28, age range 19-55 years). Focus groups were recorded digitally, transcribed verbatim and analysed thematically using nvivo (QSR International, Melbourne, Australia) to manage the coded data. Participants also completed a short questionnaire assessing knowledge on FV intake guidelines. Descriptive statistics were used to analyse responses. RESULTS: The discussions highlighted that, although participants were aware of FV intake guidelines, they lacked clarity with regard to the meaning of the '5-a-day' message, including what foods are included in the guideline, as well as what constitutes a portion of FV. There was also a sense of confusion surrounding the concept of achieving variety with regard to FV intake. The sample highlighted a lack of previous education on FV portion sizes and put forward suggestions for improving knowledge, including increased information on food packaging and through health campaigns. Questionnaire findings were generally congruent with the qualitative findings, showing high awareness of the '5-a-day' message but a lack of knowledge surrounding FV portion sizes. CONCLUSIONS: Future public health campaigns should consider how best to address the gaps in knowledge identified in the present study, and incorporate evaluations that will allow the impact of future initiatives on knowledge, and ultimately behaviour, to be investigated

A High Polyphenol Diet Improves Psychological Well-Being: The Polyphenol Intervention Trial (PPhIT).

Mental ill health is currently one of the leading causes of disease burden worldwide. A growing body of data has emerged supporting the role of diet, especially polyphenols, which have anxiolytic and antidepressant-like properties. The aim of the present study was to assess the effect of a high polyphenol diet (HPD) compared to a low polyphenol diet (LPD) on aspects of psychological well-being in the Polyphenol Intervention Trial (PPhIT). Ninety-nine mildly hypertensive participants aged 40-65 years were enrolled in a four-week LPD washout period and then randomised to either an LPD or an HPD for eight weeks. Both at baseline and the end of intervention, participants' lifestyle and psychological well-being were assessed. The participants in the HPD group reported a decrease in depressive symptoms, as assessed by the Beck Depression Inventory-II, and an improvement in physical component and mental health component scores as assessed with 36-Item Short Form Survey. No differences in anxiety, stress, self-esteem or body image perception were observed. In summary, the study findings suggest that the adoption of a polyphenol-rich diet could potentially lead to beneficial effects including a reduction in depressive symptoms and improvements in general mental health status and physical health in hypertensive participants

Children’s views on research without prior consent in emergency situations:a UK qualitative study

Objectives We explored children’s views on research without prior consent (RWPC) and sought to identify ways of involving children in research discussions. Design Qualitative interview study. Setting Participants were recruited through a UK children’s hospital and online advertising. Participants 16 children aged 7–15 years with a diagnosis of asthma (n=14) or anaphylaxis (n=2) with recent (<12 months) experience of emergency care. Results Children were keen to be included in medical research and viewed RWPC as acceptable in emergency situations if trial interventions were judged safe. Children trusted that doctors would know about their trial participation and act in their best interests. All felt that children should be informed about the research following their recovery and involved in discussions with a clinician or their parent(s) about the use of data already collected as well as continued participation in the trial (if applicable). Participants suggested methods to inform children about their trial participation including an animation. Conclusions Children supported, and were keen to be involved in, clinical trials in emergency situations. We present guidance and an animation that practitioners and parents might use to involve children in trial discussions following their recovery

Galaxy Collisions - Dawn of a New Era

The study of colliding galaxies has progressed rapidly in the last few years, driven by observations with powerful new ground and space-based instruments. These instruments have used for detailed studies of specific nearby systems, statistical studies of large samples of relatively nearby systems, and increasingly large samples of high redshift systems. Following a brief summary of the historical context, this review attempts to integrate these studies to address the following key issues. What role do collisions play in galaxy evolution, and how can recently discovered processes like downsizing resolve some apparently contradictory results of high redshift studies? What is the role of environment in galaxy collisions? How is star formation and nuclear activity orchestrated by the large scale dynamics, before and during merger? Are novel modes of star formation involved? What are we to make of the association of ultraluminous X-ray sources with colliding galaxies? To what do degree do mergers and feedback trigger long-term secular effects? How far can we push the archaeology of individual systems to determine the nature of precursor systems and the precise effect of the interaction? Tentative answers to many of these questions have been suggested, and the prospects for answering most of them in the next few decades are good.Comment: 44 pages, 9 figures, review article in press for Astrophysics Update Vol.

Spatially Resolved Ultraviolet, H-alpha, Infrared, and Radio Star Formation in M81

We present Multiband Imaging Photometer for Spitzer (MIPS) observations of M81 at 24, 70, and 160 micron. The grand design nature of M81 is clearly seen, showing two well resolved spiral arms containing numerous bright star forming regions. The MIPS images reveal a significant amount of cold dust associated with the spiral arms. We investigate the variation of the ultraviolet (UV), H-alpha, and infrared (IR) luminosities and star formation rate (SFR) indicators across the face of M81 using the MIPS images and archival UV and H-alpha images. For regions in M81, we find that UV and H-alpha SFRs (uncorrected for dust attenuation) are always lower than the IR SFR. The cause of this behavior is dust attenuation and/or using SFR calibrations appropriate for entire galaxies, not regions in galaxies. The characteristics of the dust attenuation for the regions indicate the dust grains and/or geometry are different from those in starburst galaxies. The behavior of the infrared-radio correlation in M81 is seen to vary from the global average, with variations correlated with the morphology of M81.Comment: 7 pages, 6 embedded figures, paper with full resolution figures available at http://dirty.as.arizona.edu/~kgordon/papers/PS_files/m81_mips.pd

Evolution of the Far-Infrared-Radio Correlation and Infrared SEDs of Massive Galaxies over z = 0 - 2

We investigate the far-infrared-radio correlation (FRC) of stellar-mass-selected galaxies in the Extended Chandra Deep Field South using far-infrared imaging from Spitzer and radio imaging from the Very Large Array and Giant Metre-Wave Radio Telescope. We stack in redshift bins to probe galaxies below the noise and confusion limits. Radio fluxes are K-corrected using observed flux ratios, leading to tentative evidence for an evolution in spectral index. We compare spectral energy distribution (SED) templates of local galaxies for K-correcting FIR fluxes, and show that the data are best fit by a quiescent spiral template (M51) rather than a warm starburst (M82) or ULIRG (Arp220), implying a predominance of cold dust in massive galaxies at high redshift. In contrast we measure total infrared luminosities that are consistent with high star-formation rates. We observe that the FRC index (q) does not evolve significantly over z=0-2 when computed from K-corrected 24 or 160-mum photometry, but that using 70-mum fluxes leads to an apparent decline in q beyond z~1. This suggests some change in the SED at high redshift, either a steepening of the spectrum at rest-frame ~25-35mum or a deficiency at ~70mum leading to a drop in the total infrared/radio ratios. We compare our results to other work in the literature and find synergies with recent findings on the high-redshift FRC, high specific star-formation rates of massive galaxies and the cold dust temperatures in these galaxies.Comment: 21 pages, 13 figures, accepted for publication in MNRA

The impact of bars on the mid-infrared dust emission of spiral galaxies: global and circumnuclear properties

We study the mid-infrared properties of a sample of 69 nearby spiral galaxies, selected to avoid Seyfert activity contributing a significant fraction of the central energetics, or strong tidal interaction, and to have normal infrared luminosities. These observations were obtained with ISOCAM, which provides an angular resolution of the order of 10 arcsec (half-power diameter of the point spread function) and low-resolution spectro-imaging information. Between 5 and 18 microns, we mainly observe two dust phases, aromatic infrared bands and very small grains, both out of thermal equilibrium. On this sample, we show that the global F15/F7 colors of galaxies are very uniform, the only increase being found in early-type strongly barred galaxies, consistent with previous IRAS studies. The F15/F7 excesses are unambiguously due to galactic central regions where bar-induced starbursts occur. However, the existence of strongly barred early-type galaxies with normal circumnuclear colors indicates that the relationship between a distortion of the gravitational potential and a central starburst is not straightforward. As the physical processes at work in central regions are in principle identical in barred and unbarred galaxies, and since this is where the mid-infrared activity is mainly located, we investigate the mid-infrared circumnuclear properties of all the galaxies in our sample. We show how surface brightnesses and colors are related to both the available molecular gas content and the mean age of stellar populations contributing to dust heating. Therefore, the star formation history in galactic central regions can be constrained by their position in a color-surface brightness mid-infrared diagram.Comment: 22 pages, 25 figures, accepted for publication in A&A ; small errors corrected and references update