DEveloping a Complex Intervention for DEteriorating Patients using Theoretical Modelling (DECIDE study): study protocol

AIM: To develop a theory-based complex intervention (targeting nursing staff), to enhance enablers and overcome barriers to enacting expected behaviour when monitoring patients and responding to abnormal vital signs that signal deterioration. DESIGN: A mixed method design including structured observations on hospital wards, field notes, brief, un-recorded interviews and semi-structured interviews to inform the development of an intervention to enhance practice. METHODS: Semi-structured interviews will be conducted with nursing staff using a topic guide informed by the Theoretical Domains Framework. Semi-structured interviews will be transcribed verbatim and coded deductively into the 14 Theoretical Domains Framework domains and then inductively into 'belief statements'. Priority domains will be identified and mapped to appropriate behaviour change techniques. Intervention content and mode of delivery (how behaviour change techniques are operationalised) will be developed using nominal groups, during which participants (clinicians) will rank behaviour change techniques /mode of delivery combinations according to acceptability and feasibility. Findings will be synthesised to develop an intervention manual. DISCUSSION: Despite being a priority for clinicians, researchers and policymakers for two decades, 'sub-optimal care' of the deteriorating ward patient persists. Existing interventions have been largely educational (i.e., targeting assumed knowledge deficits) with limited evidence that they change staff behaviour. Staff behaviour when monitoring and responding to abnormal vital signs is likely influenced by a range of mediators that includes barriers and enablers. IMPACT: Systematically applying theory and evidence-based methods, will result in the specification of an intervention which is more likely to result in behaviour change and can be tested empirically in future research. This article is protected by copyright. All rights reserved

Life interrupted and life regained? Coping with stroke at a young age

Stroke is a leading cause of disability across the developed world, affecting an increasing number of younger people. In this article, we seek to understand the experience of stroke as a disabling life situation among young people and the strategies that they use to recover and cope. Directed content analysis was conducted from interviews with 17 community-dwelling stroke survivors aged 55 years and younger across the United Kingdom. The sample was drawn from a larger maximum variation sample of stroke survivors. Using the sociological concepts of biographical disruption and biographical repair as a guide, excerpts from the interviews pertaining to aspects of the patients’ life that were interrupted, in addition to how they coped with the changes, were selected and analysed. All individuals described an ‘‘altered sense of self,’’ a theme that included loss of identity, family disruption, and/or loss of valued activities. Individuals sought to adapt their sense of self by seeking external support, by restoring normality, and/or through positive reflection. Despite the adapted self that emerged, most individuals continued to experience impairments. While young stroke survivors adapt to their illness over time, they continue to experience impairments and disruptions in their personal and work lives.Aholistic model of rehabilitation that helps individuals regain the capacity for everyday activities related to work, family life, and leisure can begin to address the emotional ramifications of diseases such as stroke, restore wellness, and work towards minimizing the burden felt by family caregivers and children

Activity Dependent Branching Ratios in Stocks, Solar X-ray Flux, and the Bak-Tang-Wiesenfeld Sandpile Model

We define an activity dependent branching ratio that allows comparison of different time series $X_{t}$. The branching ratio $b_x$ is defined as $b_x= E[\xi_x/x]$. The random variable $\xi_x$ is the value of the next signal given that the previous one is equal to $x$, so $\xi_x=\{X_{t+1}|X_t=x\}$. If $b_x>1$, the process is on average supercritical when the signal is equal to $x$, while if $b_x<1$, it is subcritical. For stock prices we find $b_x=1$ within statistical uncertainty, for all $x$, consistent with an ``efficient market hypothesis''. For stock volumes, solar X-ray flux intensities, and the Bak-Tang-Wiesenfeld (BTW) sandpile model, $b_x$ is supercritical for small values of activity and subcritical for the largest ones, indicating a tendency to return to a typical value. For stock volumes this tendency has an approximate power law behavior. For solar X-ray flux and the BTW model, there is a broad regime of activity where $b_x \simeq 1$, which we interpret as an indicator of critical behavior. This is true despite different underlying probability distributions for $X_t$, and for $\xi_x$. For the BTW model the distribution of $\xi_x$ is Gaussian, for $x$ sufficiently larger than one, and its variance grows linearly with $x$. Hence, the activity in the BTW model obeys a central limit theorem when sampling over past histories. The broad region of activity where $b_x$ is close to one disappears once bulk dissipation is introduced in the BTW model -- supporting our hypothesis that it is an indicator of criticality.Comment: 7 pages, 11 figure

Scattering statistics of rock outcrops: Model-data comparisons and Bayesian inference using mixture distributions

The probability density function of the acoustic field amplitude scattered by the seafloor was measured in a rocky environment off the coast of Norway using a synthetic aperture sonar system, and is reported here in terms of the probability of false alarm. Interpretation of the measurements focused on finding appropriate class of statistical models (single versus two-component mixture models), and on appropriate models within these two classes. It was found that two-component mixture models performed better than single models. The two mixture models that performed the best (and had a basis in the physics of scattering) were a mixture between two K distributions, and a mixture between a Rayleigh and generalized Pareto distribution. Bayes' theorem was used to estimate the probability density function of the mixture model parameters. It was found that the K-K mixture exhibits significant correlation between its parameters. The mixture between the Rayleigh and generalized Pareto distributions also had significant parameter correlation, but also contained multiple modes. We conclude that the mixture between two K distributions is the most applicable to this dataset.Comment: 15 pages, 7 figures, Accepted to the Journal of the Acoustical Society of Americ

Wong-Zakai approximation of solutions to reflecting stochastic differential equations on domains in Euclidean spaces II

The strong convergence of Wong-Zakai approximations of the solution to the reflecting stochastic differential equations was studied in [2]. We continue the study and prove the strong convergence under weaker assumptions on the domain.Comment: To appear in "Stochastic Analysis and Applications 2014-In Honour of Terry Lyons", Springer Proceedings in Mathematics and Statistic

Genetic alterations and cancer formation in a European flatfish at sites of different contamination burdens

Fish diseases are an indicator for marine ecosystem health since they provide a biological end-point of historical exposure to stressors. Liver cancer has been used to monitor the effects of exposure to anthropogenic pollution in flatfish for many years. The prevalence of liver cancer can exceed 20%. Despite the high prevalence and the opportunity of using flatfish to study environmentally induced cancer, the genetic and environmental factors driving tumor prevalence across sites are poorly understood. This study aims to define the link between genetic deterioration, liver disease progression, and anthropogenic contaminant exposures in the flatfish dab (Limanda limanda). We assessed genetic changes in a conserved cancer gene, Retinoblastoma (Rb), in association with histological diagnosis of normal, pretumor, and tumor pathologies in the livers of 165 fish from six sites in the North Sea and English Channel. The highest concentrations of metals (especially cadmium) and organic chemicals correlated with the presence of tumor pathology and with defined genetic profiles of the Rb gene, from these sites. Different Rb genetic profiles were found in liver tissue near each tumor phenotype, giving insight into the mechanistic molecular-level cause of the liver pathologies. Different Rb profiles were also found at sampling sites of differing contaminant burdens. Additionally, profiles indicated that histological “normal” fish from Dogger sampling locations possessed Rb profiles associated with pretumor disease. This study highlights an association between Rb and specific contaminants (especially cadmium) in the molecular etiology of dab liver tumorigenesis

Entropy and Hausdorff Dimension in Random Growing Trees

We investigate the limiting behavior of random tree growth in preferential attachment models. The tree stems from a root, and we add vertices to the system one-by-one at random, according to a rule which depends on the degree distribution of the already existing tree. The so-called weight function, in terms of which the rule of attachment is formulated, is such that each vertex in the tree can have at most K children. We define the concept of a certain random measure mu on the leaves of the limiting tree, which captures a global property of the tree growth in a natural way. We prove that the Hausdorff and the packing dimension of this limiting measure is equal and constant with probability one. Moreover, the local dimension of mu equals the Hausdorff dimension at mu-almost every point. We give an explicit formula for the dimension, given the rule of attachment

An Ice-Core-Based, Late Holocene History for the Transantarctic Mountains, Antarctica

Ice core records (major anions and cations, MSA, oxygen isotopes and particles) developed from two shallow (~200 m depth) sites in the Transantarctic Mountains provide documentation of much of the Holocene paleoenvironmental history of this region. From the more southerly site, Dominion Range, an ~7000-year-long record reveals change in the influence of tropospheric transport to the region. At this site, milder conditions and increased tropospheric inflow prior to ~1500 yr BP are characterized by increased seasalt (ss), terrestrial and marine biogenic inputs. Increased persistence and/or extent of polar stratospheric clouds accompanying generally cooler conditions characterize much of the period since ~1500 yr BP. From the more northerly site, Newall Glacier, the dramatic influence of the retreat of grounded ice from McMurdo Sound dated at[Denton et al., 1989] dominates much of the ice core record. This regional environmental change is documented by massive influxes to the core site of evaporitic salts from areas exposed during low lake level stands. During the past ~150 yr, both Dominion Range and Newall Glacier appear to be experiencing an overall increase in the exposure of ice-free terrain