Making sense of complexity in context and implementation: the Context and Implementation of Complex Interventions (CICI) framework.

BACKGROUND: The effectiveness of complex interventions, as well as their success in reaching relevant populations, is critically influenced by their implementation in a given context. Current conceptual frameworks often fail to address context and implementation in an integrated way and, where addressed, they tend to focus on organisational context and are mostly concerned with specific health fields. Our objective was to develop a framework to facilitate the structured and comprehensive conceptualisation and assessment of context and implementation of complex interventions. METHODS: The Context and Implementation of Complex Interventions (CICI) framework was developed in an iterative manner and underwent extensive application. An initial framework based on a scoping review was tested in rapid assessments, revealing inconsistencies with respect to the underlying concepts. Thus, pragmatic utility concept analysis was undertaken to advance the concepts of context and implementation. Based on these findings, the framework was revised and applied in several systematic reviews, one health technology assessment (HTA) and one applicability assessment of very different complex interventions. Lessons learnt from these applications and from peer review were incorporated, resulting in the CICI framework. RESULTS: The CICI framework comprises three dimensions-context, implementation and setting-which interact with one another and with the intervention dimension. Context comprises seven domains (i.e., geographical, epidemiological, socio-cultural, socio-economic, ethical, legal, political); implementation consists of five domains (i.e., implementation theory, process, strategies, agents and outcomes); setting refers to the specific physical location, in which the intervention is put into practise. The intervention and the way it is implemented in a given setting and context can occur on a micro, meso and macro level. Tools to operationalise the framework comprise a checklist, data extraction tools for qualitative and quantitative reviews and a consultation guide for applicability assessments. CONCLUSIONS: The CICI framework addresses and graphically presents context, implementation and setting in an integrated way. It aims at simplifying and structuring complexity in order to advance our understanding of whether and how interventions work. The framework can be applied in systematic reviews and HTA as well as primary research and facilitate communication among teams of researchers and with various stakeholders

New consistency index based on inertial operating speed

The occurrence of road crashes depends on several factors, with design consistency (i.e., conformance of highway geometry to drivers' expectations) being one of the most important. A new consistency model for evaluating the performance of tangent-to-curve transitions on two-lane rural roads was developed. This model was based on the inertial consistency index (ICI) defined for each transition. The ICI was calculated at the beginning point of the curve as the difference between the average operating speed on the previous 1-km road segment (inertial operating speed) and the actual operating speed at this point. For the calibration of the ICI and its thresholds, 88 road segments, which included 1,686 tangent-to-curve transitions, were studied. The relationship between those results and the crash rate associated with each transition was analyzed. The results showed that the higher the ICI was, the higher the crash rate; thus, the probability of accidents increased. Similar results were obtained from the study of the relationship between the ICI and the weighted average crash rate of the corresponding group of transitions. A graphical and statistical analysis established that road consistency might be considered good when the ICI was lower than 10 km/h, poor when the ICI was higher than 20 km/h, and fair otherwise. A validation process that considered 20 road segments was performed. The ICI values obtained were highly correlated to the number of crashes that had occurred at the analyzed transitions. Thus, the ICI and its consistency thresholds resulted in a new approach for evaluation of consistency.The authors thank the Center for Studies and Experimentation of Public Works of the Spanish Ministry of Public Works, which partially subsidized the data collection, for obtaining the empirical operating speed profiles used in the validation process. The authors also thank the General Directorate of Public Works of the Infrastructure and Transportation Department of the Valencian government, the Valencian Province Council, and the General Directorate of Traffic of the Ministry of the Interior of the Government of Spain for their cooperation in data gathering.García García, A.; Llopis Castelló, D.; Camacho Torregrosa, FJ.; Pérez Zuriaga, AM. (2013). New consistency index based on inertial operating speed. Transportation Research Record. (2391):105-112. doi:10.3141/2391-10S1051122391Ng, J. C. ., & Sayed, T. (2004). Effect of geometric design consistency on road safety. Canadian Journal of Civil Engineering, 31(2), 218-227. doi:10.1139/l03-090Gibreel, G. M., Easa, S. M., Hassan, Y., & El-Dimeery, I. A. (1999). State of the Art of Highway Geometric Design Consistency. Journal of Transportation Engineering, 125(4), 305-313. doi:10.1061/(asce)0733-947x(1999)125:4(305)Hassan, Y. (2004). Highway Design Consistency: Refining the State of Knowledge and Practice. Transportation Research Record: Journal of the Transportation Research Board, 1881(1), 63-71. doi:10.3141/1881-08Polus, A., & Mattar-Habib, C. (2004). New Consistency Model for Rural Highways and Its Relationship to Safety. Journal of Transportation Engineering, 130(3), 286-293. doi:10.1061/(asce)0733-947x(2004)130:3(286)Cafiso, S., Di Graziano, A., Di Silvestro, G., La Cava, G., & Persaud, B. (2010). Development of comprehensive accident models for two-lane rural highways using exposure, geometry, consistency and context variables. Accident Analysis & Prevention, 42(4), 1072-1079. doi:10.1016/j.aap.2009.12.015Zuriaga, A. M. P., García, A. G., Torregrosa, F. J. C., & D’Attoma, P. (2010). Modeling Operating Speed and Deceleration on Two-Lane Rural Roads with Global Positioning System Data. Transportation Research Record: Journal of the Transportation Research Board, 2171(1), 11-20. doi:10.3141/2171-0

Garden varieties: how attractive are recommended garden plants to butterflies?

One way the public can engage in insect conservation is through wildlife gardening, including the growing of insect-friendly flowers as sources of nectar. However, plant varieties differ in the types of insects they attract. To determine which garden plants attracted which butterflies, we counted butterflies nectaring on 11 varieties of summer-flowering garden plants in a rural garden in East Sussex, UK. These plants were all from a list of 100 varieties considered attractive to British butterflies, and included the five varieties specifically listed by the UK charity Butterfly Conservation as best for summer nectar. A total of 2659 flower visits from 14 butterfly and one moth species were observed. We performed a principal components analysis which showed contrasting patterns between the species attracted to Origanum vulgare and Buddleia davidii. The “butterfly bush” Buddleia attracted many nymphalines, such as the peacock, Inachis io, but very few satyrines such as the gatekeeper, Pyronia tithonus, which mostly visited Origanum. Eupatorium cannibinum had the highest Simpson’s Diversity score of 0.75, while Buddleia and Origanum were lower, scoring 0.66 and 0.50 respectively. No one plant was good at attracting all observed butterfly species, as each attracted only a subset of the butterfly community. We conclude that to create a butterfly-friendly garden, a variety of plant species are required as nectar sources for butterflies. Furthermore, garden plant recommendations can probably benefit from being more precise as to the species of butterfly they attract

The Fundamental Diagram of Pedestrian Movement Revisited

The empirical relation between density and velocity of pedestrian movement is not completely analyzed, particularly with regard to the `microscopic' causes which determine the relation at medium and high densities. The simplest system for the investigation of this dependency is the normal movement of pedestrians along a line (single-file movement). This article presents experimental results for this system under laboratory conditions and discusses the following observations: The data show a linear relation between the velocity and the inverse of the density, which can be regarded as the required length of one pedestrian to move. Furthermore we compare the results for the single-file movement with literature data for the movement in a plane. This comparison shows an unexpected conformance between the fundamental diagrams, indicating that lateral interference has negligible influence on the velocity-density relation at the density domain $1 m^{-2}<\rho<5 m^{-2}$. In addition we test a procedure for automatic recording of pedestrian flow characteristics. We present preliminary results on measurement range and accuracy of this method.Comment: 13 pages, 9 figure

Gemcitabine and oxaliplatin (GEMOX) in gemcitabine refractory advanced pancreatic adenocarcinoma: a phase II study

Gemcitabine and oxaliplatin (GEMOX) are active as first-line therapy against advanced pancreatic cancer. This study aims to evaluate the activity and tolerability of this combination in patients refractory to standard gemcitabine (GEM). A total of 33 patients (median age of 57) were included with locally advanced and metastatic evaluable diseases, who had progressed during or following GEM therapy. The GEMOX regimen consisted of 1000 mg m−2 of GEM at a 100-min infusion on day 1, followed on day 2 by 100 mg m−2 of oxaliplatin at a 2-h infusion; a cycle that was given every 2 weeks. All patients received at least one cycle of GEMOX (median 5; range 1–29). Response by 31 evaluable patients was as follows: PR: 7/31(22.6%), s.d. ⩾8 weeks: 11/31(35.5%), s.d. <8 weeks: 1/31(3.2%), PD: 12/31(38.7%). Median duration of response and TTP were 4.5 and 4.2 months, respectively. Median survival was 6 months (range 0.5–21). Clinical benefit response was observed in 17/31 patients (54.8%). Grade III/IV non-neurologic toxicities occurred in 12/33 patients (36.3%), and grade I, II, and III neuropathy in 17(51%), 3(9%), and 4(12%) patients, respectively. GEMOX is a well-tolerated, active regimen that may provide a benefit to patients with advanced pancreatic cancer after progression following standard gemcitabine treatment

Analysis of Transportation Networks Subject To Natural Hazards – insights from a Colombian case

ABSTRACT: This study provides an applied framework to derive the connectivity reliability and vulnerability of inter-urban transportation systems under network disruptions. The proposed model integrates statistical reliability analysis to find the reliability and vulnerability of transportation networks. Most of the modern research in this field has focused on urban transportation networks where the primary concerns are guaranteeing predefined standards of capacity and travel time. However, at a regional and national level, especially in developing countries, the connectivity of remote populations in the case of disaster is of utmost importance. The applicability of the framework is demonstrated with a case study in the state of Antioquia, Colombia, using historical records from the 2010-2011 rainy season, an aspect that stands out and gives additional support compared to previous studies that considers simulated data from assumed distributions. The results provide significant insights to practitioners and researchers for the design and management of transportation systems and route planning strategies under this type of disruptions

High expression of CXCR4 may predict poor survival in resected pancreatic adenocarcinoma

Chemokines and their receptors are involved in tumourigenicity and clinicopathological significance of chemokines receptor expression in pancreatic adenocarcinoma (PA) is not fully understood. This study was conducted to determine patients' outcome according to the expressions of CXCR4, CXCR7 and HIF-1α after resection of PA. Immunohistochemistry for CXCR4, CXCR7 and HIF-1α expressions as well as cell proliferative index (Ki-67) was conducted in 71 resected (R0) PA and their 48 related lymph nodes (LN) using tissue microarray. CXCR4 and CXCR7 expressions were positively correlated to HIF-1α suggesting a potential role of HIF-1α in CXCR4 and CXCR7 transcription activation. Patients with CXCR4high tumour expression had shorter OS than those with low expression (median survival: 9.7 vs 43.2 months, P=0.0006), a higher risk of LN metastases and liver recurrence. In multivariate analysis, high CXCR4 expression, LN metastases and poorly differentiated tumour are independent negative prognosis factors. In a combining analysis, patients with CXCR4low/CXCR7low tumour had a significantly shorter DFS and OS than patients with a CXCR7high/CXCR4high tumour. CXCR4 in resected PA may represent a valuable prognostic factor as well as an attractive target for therapeutic purpose

Insect threats and conservation through the lens of global experts

While several recent studies have focused on global insect population trends, all are limited in either space or taxonomic scope. As global monitoring programs for insects are currently not implemented, inherent biases exist within most data. Expert opinion, which is often widely available, proves to be a valuable tool where hard data are limited. Our aim is to use global expert opinion to provide insights on the root causes of potential insect declines worldwide, as well as on effective conservation strategies that could mitigate insect biodiversity loss. We obtained 753 responses from 413 respondents with a wide variety of spatial and taxonomic expertise. The most relevant threats identified through the survey were agriculture and climate change, followed by pollution, while land management and land protection were recognized as the most significant conservation measures. Nevertheless, there were differences across regions and insect groups, reflecting the variability within the most diverse class of eukaryotic organisms on our planet. Lack of answers for certain biogeographic regions or taxa also reflects the need for research in less investigated settings. Our results provide a novel step toward understanding global threats and conservation measures for insects.Peer reviewe