The prevalence of cocaine-associated chest pain in a London hospital

Objectives: To determine the prevalence of cocaine misuse in patients presenting to an Accident and Emergency department with chest pain. 4 of 12 FAEM abstracts www.emjonline.co

Learning medical alarms whilst performing other tasks.

Two studies are reported which first observe, and then attempt to replicate, the cognitive demands of intensive care unit (ICU) activity whilst concurrently learning audible alarms. The first study, an observational study in an ICU ward, showed that the alarms are very frequent and co-occur with some activities more than others. The three most frequently observed activities observed in the ICU were drugs (calculation, preparation and administration), patient observation and talking. The cognitive demands of these activities were simulated in a second, laboratory-based experiment in which alarms were learned. The results showed that performance in the alarm task generally improved as participants were exposed to more repetitions of those alarms, but that performance decrements were observed in the secondary tasks, particularly when there were two or three of them. Some confusions between the alarms persisted to the end of the study despite prolonged exposure to the alarms, confusions which were likely caused by both acoustic and verbal labelling similarities. PRACTITIONER SUMMARY: The cognitive demands of working in an ICU were observed and simulated whilst alarms were learned. Alarms should generally avoid sharing similar rhythmic (and other) characteristics. The simulation task described here could be used for testing alarm learning without requiring a clinical environment

Acoustic characterization of crack damage evolution in sandstone deformed under conventional and true triaxial loading

We thank the Associate Editor, Michelle Cooke, and the reviewers, Ze'ev Reches and Yves Guéguen, for useful comments which helped to improve the manuscript. We thank J.G. Van Munster for providing access to the true triaxial apparatus at KSEPL and for technical support during the experimental program. We thank R. Pricci for assistance with technical drawings of the apparatus. This work was partly funded by NERC award NE/N002938/1 and by a NERC Doctoral Studentship, which we gratefully acknowledge. Supporting data are included in a supporting information file; any additional data may be obtained from J.B. (e-mail: [email protected]).Peer reviewedPublisher PD

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

Identity and parentage of two alpine grape cultivars from Switzerland (Vitis vinifera L. Lafnetscha and Himbertscha)

Four closely related white grape cultivars from the Western Alps (Switzerland) - Humagne Blanc, Completer, Lafnetscha and Himbertscha - and three putative relatives or synonyms - Gouais Blanc, Plantscher and Bordeaux Blanc - were analyzed with up to 50 microsatellite markers. Humagne Blanc and Completer are ancient cultivars from the Haut-Valais and Graubünden regions, respectively. Lafnetscha and Himbertscha are lesser-known cultivars scarcely cultivated in Haut-Valais. Lafnetscha is frequently considered as synonym of Completer. Himbertscha might be related to Gouais Blanc, one of the parents of Chardonnay, Gamay, etc. Plantscher, a putative synonym of Lafnetscha, is scarcely cultivated in Haut-Valais (Switzerland) and Bordeaux Blanc (or Gros Bourgogne) is a cultivar of unknown origin (despite its names) cultivated in Switzerland. Our results allowed us to determine the true-to-type Lafnetscha and confirmed that Lafnetscha is not a synonym of Completer. Plantscher is not a synonym of Lafnetscha but a synonym of Bordeaux Blanc (or Gros Bourgogne) and is a likely parent or progeny of the Hungarian Furmint. Himbertscha is not related to Gouais Blanc and shares at least one allele at each locus with Humagne Blanc, providing strong evidence of a parent/progeny relationship. Given that Humagne Blanc is an older cultivar, we propose that it is the parent of Himbertscha. Alleles at 49 out of 50 microsatellite loci are consistent with Lafnetscha being the progeny of Completer and Humagne Blanc. The exception is a 10-base pair discrepancy at one locus (VVMD 36), most likely due to the occurrence of a null allele, since this parentage is supported at other markers by very high likelihood ratios. With Lafnetscha = Completer x Humagne Blanc, we present the second grape cultivar parentage showing a multiple repeat discrepancy at one locus. This study emphasizes that one multiple repeat unit discrepancy is not sufficient to reject a parentage, and that the greater is the number of loci, the greater are the chances to encounter null alleles or clonal mutations

Information Technology, Social Networking, and Controlling Behaviors Among Adolescent Girls Involved in Dating Violence

Hypothesis: Girls with dating violence (DV) histories will report high levels of involvement in social networking and information technology (SNIT) as well as frequent engagement in controlling behaviors via SNIT

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