The OPERA trial : a protocol for the process evaluation of a randomised trial of an exercise intervention for older people in residential and nursing accommodation

Background: The OPERA trial is large cluster randomised trial testing a physical activity intervention to address depression amongst people living in nursing and residential homes for older people. A process evaluation was commissioned alongside the trial and we report the protocol for this process evaluation. Challenges included the cognitive and physical ability of the participants, the need to respect the privacy of all home residents, including study non-participants, and the physical structure of the homes. Evaluation activity had to be organised around the structured timetable of homes, leaving limited opportunities for data collection. The aims of this process evaluation are to provide findings that will assist in the interpretation of the clinical trial results, and to inform potential implementation of the physical activity intervention on a wider scale. Methods/design: Quantitative data on recruitment of homes and individuals is being collected. For homes in the intervention arm, data on dose and fidelity of the intervention delivered; including individual rates of participation in exercise classes are collected. In the control homes, uptake and delivery of depression awareness training is monitored. These data will be combined with qualitative data from an in-depth study of a purposive sample of eight homes (six intervention and two control). Discussion: Although process evaluations are increasingly funded alongside trials, it is still rare to see the findings published, and even rarer to see the protocol for such an evaluation published. Process evaluations have the potential to assist in interpreting and understanding trial results as well as informing future roll-outs of interventions. If such evaluations are funded they should also be reported and reviewed in a similar way to the trial outcome evaluation

Implementation of a local principal curves algorithm for neutrino interaction reconstruction in a liquid argon volume

A local principal curve algorithm has been implemented in three dimensions for automated track and shower reconstruction of neutrino interactions in a liquid argon time projection chamber. We present details of the algorithm and characterise its performance on simulated data sets.Comment: 14 pages, 17 figures; typing correction to Eq 5, the definition of the local covariance matri

Survival and Home Range Estimates of Pen-Raised Northern Bobwhites in Buffer Strip and Non-Buffer Strip Habitats

We investigated the effect of agricultural buffer strips on survival and home range estimates of pen-raised northern bobwhites (Colinus virginianus) at Tudor Farms on the Eastern Shore of Maryland. In September 2000 we released groups of bobwhites into 9 buffer strip (treatment) areas and 9 non-buffer strip (control) areas among 11 agricultural farms. Each group consisted of 4 radiomarked bobwhites and 26 non-radiomarked bobwhites. To maintain contact with the established coveys, additional radiomarked bobwhites (n = 177) were introduced into the coveys as radiomarked birds died. Survival for bobwhites released in buffer strip areas was lower (P \u3c 0.001) than survival in non-buffer strip areas. None of the radiomarked bobwhites released in the buffer strip areas survived past 27 weeks, whereas 11% of radiomarked bobwhites in non-buffer strip areas survived to 27 weeks and 1 bird survived to 41 weeks. Predation was the primary mortality factor (88%), followed by unknown causes (7%), stress (2%), hunting (2%), and road kill (1%). Mean fall and winter home range (95% minimum convex polygon) for 21 bobwhite coveys was 24.2 +- 3.5 ha, ranging from 1.7 to 65.8 ha. Home range areas of bobwhite coveys in buffer strips (n = 12, x¯ +- 15.0 2.7 ha) was significantly smaller (P = 0.002) than non-buffer strip coveys (n = 9, x¯ = 36.4 +- 4.9 ha). We conclude that the smaller home ranges in buffer strip areas seem to indicate better habitat quality; however, high mortality rates of pen-raised bobwhites limited our ability to confirm this

Calculating partial expected value of perfect information via Monte Carlo sampling algorithms

Partial expected value of perfect information (EVPI) calculations can quantify the value of learning about particular subsets of uncertain parameters in decision models. Published case studies have used different computational approaches. This article examines the computation of partial EVPI estimates via Monte Carlo sampling algorithms. The mathematical definition shows 2 nested expectations, which must be evaluated separately because of the need to compute a maximum between them. A generalized Monte Carlo sampling algorithm uses nested simulation with an outer loop to sample parameters of interest and, conditional upon these, an inner loop to sample remaining uncertain parameters. Alternative computation methods and shortcut algorithms are discussed and mathematical conditions for their use considered. Maxima of Monte Carlo estimates of expectations are biased upward, and the authors show that the use of small samples results in biased EVPI estimates. Three case studies illustrate 1) the bias due to maximization and also the inaccuracy of shortcut algorithms 2) when correlated variables are present and 3) when there is nonlinearity in net benefit functions. If relatively small correlation or nonlinearity is present, then the shortcut algorithm can be substantially inaccurate. Empirical investigation of the numbers of Monte Carlo samples suggests that fewer samples on the outer level and more on the inner level could be efficient and that relatively small numbers of samples can sometimes be used. Several remaining areas for methodological development are set out. A wider application of partial EVPI is recommended both for greater understanding of decision uncertainty and for analyzing research priorities

Antigen depot is not required for alum adjuvanticity

Alum adjuvants have been in continuous clinical use for more than 80 yr. While the prevailing theory has been that depot formation and the associated slow release of antigen and/or inflammation are responsible for alum enhancement of antigen presentation and subsequent T- and B-cell responses, this has never been formally proven. To examine antigen persistence, we used the chimeric fluorescent protein EαGFP, which allows assessment of antigen presentation in situ, using the Y-Ae antibody. We demonstrate that alum and/or CpG adjuvants induced similar uptake of antigen, and in all cases, GFP signal did not persist beyond 24 h in draining lymph node antigen-presenting cells. Antigen presentation was first detectable on B cells within 6–12 h of antigen administration, followed by conventional dendritic cells (DCs) at 12–24 h, then finally plasmacytoid DCs at 48 h or later. Again, alum and/or CpG adjuvants did not have an effect on the magnitude or sequence of this response; furthermore, they induced similar antigen-specific T-cell activation in vivo. Notably, removal of the injection site and associated alum depot, as early as 2 h after administration, had no appreciable effect on antigen-specific T- and B-cell responses. This study clearly rules out a role for depot formation in alum adjuvant activity

Copyright and cultural work: an exploration

This article first discusses the contemporary debate on cultural “creativity” and the economy. Second, it considers the current state of UK copyright law and how it relates to cultural work. Third, based on empirical research on British dancers and musicians, an analysis of precarious cultural work is presented. A major focus is how those who follow their art by way of “portfolio” work handle their rights in ways that diverge significantly from the current simplistic assumptions of law and cultural policy. Our conclusions underline the distance between present top-down conceptions of what drives production in the cultural field and the actual practice of dancers and musicians

Story in health and social care

This paper offers a brief consideration of how narrative, in the form of people‟s own stories, potentially figures in health and social care provision as part of the impulse towards patient-centred care. The rise of the epistemological legitimacy of patients‟ stories is sketched here. The paper draws upon relevant literature and original writing to consider the ways in which stories can mislead as well as illuminate the process of making individual treatment care plans

Frequencies and patterns of microbiology test requests from primary care in Oxfordshire, UK, 2008-2018: a retrospective cohort study of electronic health records to inform point of care testing

Objectives: To inform point-of-care test (POCT) development, we quantified the primary care demand for laboratory microbiology tests by describing their frequencies overall, frequencies of positives, most common organisms identified, temporal trends in testing and patterns of cotesting on the same and subsequent dates. Design: Retrospective cohort study. Setting: Primary care practices in Oxfordshire. Participants :393 905 patients (65% female; 49% aged 18–49). Primary and secondary outcome measures The frequencies of all microbiology tests requested between 2008 and 2018 were quantified. Patterns of cotesting were investigated with heat maps. All analyses were done overall, by sex and age categories. Results: 1 596 752 microbiology tests were requested. Urine culture±microscopy was the most common of all tests (n=673 612, 42%), was mainly requested without other tests and was the most common test requested in follow-up within 7 and 14 days. Of all urine cultures, 180 047 (27%) were positive and 172 651 (26%) showed mixed growth, and Escherichia coli was the most prevalent organism (132 277, 73% of positive urine cultures). Antenatal urine cultures and blood tests in pregnancy (hepatitis B, HIV and syphilis) formed a common test combination, consistent with their use in antenatal screening. Conclusions: The greatest burden of microbiology testing in primary care is attributable to urine culture ± microscopy; genital and routine antenatal urine and blood testing are also significant contributors. Further research should focus on the feasibility and impact of POCTs for these specimen types

A Suborbital Payload for Soft X-ray Spectroscopy of Extended Sources

We present a suborbital rocket payload capable of performing soft X-ray spectroscopy on extended sources. The payload can reach resolutions of ~100(lambda/dlambda) over sources as large as 3.25 degrees in diameter in the 17-107 angstrom bandpass. This permits analysis of the overall energy balance of nearby supernova remnants and the detailed nature of the diffuse soft X-ray background. The main components of the instrument are: wire grid collimators, off-plane grating arrays and gaseous electron multiplier detectors. This payload is adaptable to longer duration orbital rockets given its comparatively simple pointing and telemetry requirements and an abundance of potential science targets.Comment: Accepted to Experimental Astronomy, 12 pages plus 1 table and 17 figure

Basins of attraction on random topography

We investigate the consequences of fluid flowing on a continuous surface upon the geometric and statistical distribution of the flow. We find that the ability of a surface to collect water by its mere geometrical shape is proportional to the curvature of the contour line divided by the local slope. Consequently, rivers tend to lie in locations of high curvature and flat slopes. Gaussian surfaces are introduced as a model of random topography. For Gaussian surfaces the relation between convergence and slope is obtained analytically. The convergence of flow lines correlates positively with drainage area, so that lower slopes are associated with larger basins. As a consequence, we explain the observed relation between the local slope of a landscape and the area of the drainage basin geometrically. To some extent, the slope-area relation comes about not because of fluvial erosion of the landscape, but because of the way rivers choose their path. Our results are supported by numerically generated surfaces as well as by real landscapes