Improving the Single Scalar Consistency Relation

We propose a test of single-scalar inflation based on using the well-measured scalar power spectrum to reconstruct the tensor power spectrum, up to a single integration constant. Our test is a sort of integrated version of the single-scalar consistency relation. This sort of test can be used effectively, even when the tensor power spectrum is measured too poorly to resolve the tensor spectral index. We give an example using simulated data based on a hypothetical detection with tensor-to-scalar ratio $r = 0.01$. Our test can also be employed for correlating scalar and tensor features in the far future when the data is good.Comment: 16 pages, 1 figure, uses LaTeX2e version 2 extensively revised for publicatio

Rapid mapping of schistosomiasis and other neglected tropical diseases in the context of integrated control programmes in Africa

There is growing interest and commitment to the control of schistosomiasis and other so-called neglected tropical diseases (NTDs). Resources for control are inevitably limited, necessitating assessment methods that can rapidly and accurately identify and map high-risk communities so that interventions can be targeted in a spatially-explicit and cost-effective manner. Here, we review progress made with (1) mapping schistosomiasis across Africa using available epidemiological data and, more recently, climate-based risk prediction; (2) the development and use of morbidity questionnaires for rapid identification of high-risk communities of urinary schistosomiasis; and (3) innovative sampling-based approaches for intestinal schistosomiasis, using the lot quality assurance sampling technique. Experiences are also presented for the rapid mapping of other NTDs, including onchocerciasis, loiasis and lymphatic filariasis. Future directions for an integrated rapid mapping approach targeting multiple NTDs simultaneously are outlined, including potential challenges in developing an integrated survey tool. The lessons from the mapping of human helminth infections may also be relevant for the rapid mapping of malaria as its control efforts are intensifie

Can health trainers make a difference with difficult-to-engage clients? A multisite case study

A political attempt in the United Kingdom to address health inequalities in the past decade has been the government’s initiative to employ local health trainers (HTs) or health trainer champions (HTCs) to support disadvantaged individuals with aspects of their health-related behaviors. HT/HTCs provide health-related information and support to individuals with healthy eating, physical activity, and smoking cessation. They undertake community engagement and direct individuals to relevant health services. They differ in that HTs are trained to provide health interventions to individuals or groups and to make referrals to specialist health care services when necessary. This article provides an evaluation of HT/HTCs interventions across three sites, including one prison, one probation service (three teams), and one mental health center. An evaluation framework combining process and outcome measures was employed that used mixed methods to capture data relating to the implementation of the service, including the context of the HT/HTCs interventions, the reactions of their clients, and the outcomes reported. It was found that HT/HTCs interventions were more effective in the prison and mental health center compared with the probation site largely as a result of contextual factors

The person, interactions and environment programme to improve care of people with dementia in hospital: a multisite study

Background: Improving care of people with dementia on acute hospital wards is a policy priority. Person-centred care is a marker of care quality; delivering such care is a goal for service improvement. Objectives: PIE (Person: Interaction; Environment) comprises an observation tool and systematic approach to implement and embed a person-centred approach in routine care for hospitalised patients with dementia. The study aims were to: evaluate PIE as a method to improve the care of older people with dementia on acute hospital wards; and develop insight into what person-centred care might look like in practice in this setting. Methods: We performed a longitudinal comparative case study design in ten purposively selected wards in five Trusts in three English regions; alongside an embedded process evaluation. Data was collected from multiple sources: staff, patients, relatives, organisational aggregate information and documents. Mixed methods were employed: ethnographic observation; interviews and questionnaires; patient case studies (patient observation and conversations ‘in the moment’, interviews with relatives and case records), patient and ward aggregate data. Data was synthesised to create individual case studies of PIE implementation and outcomes in context of ward structure, organisation, patient profile and process of care delivery. Cross case comparison facilitated a descriptive and explanatory account of PIE implementation in context, the pattern of variation, what shaped it and the consequences flowing from it. Quantitative data was analysed using simple descriptive statistics. Qualitative data analysis employed grounded theory methods. Results: The study furthered understanding of dimensions of care quality for older people with dementia on acute hospital wards and the environmental, organisational and cultural factors that shaped delivery. Only two wards fully implemented PIE, sustaining and embedding change over 18 months. The remaining wards either did not install PIE (‘non-implementers’); or were ‘partial implementers’. The interaction between micro-level contextual factors (aspects of leadership (drivers, facilitators, team, networks), fit with strategic initiatives and salience with valued goals) and miso and macro level organisational factors, were the main barriers to PIE adoption. Where implemented, evidence suggests that the programme directly affected improvement in ward practice with positive impact on the experience of patients and caregivers, although the heterogeneity of need and severity of impairment meant that some of the more visible changes did not affect everyone equally. Limitations: Although PIE has potential to improve the care of people with dementia when implemented, findings are indicative only: data on clinical outcomes was not systematically collected; and PIE was not adopted on most study wards. Research implications: Further research is required to identify more precisely the skill-mix and resources necessary to provide person-focused care to hospitalised people with dementia, across the spectrum of need, including those with moderate and severe impairment. Implementing innovations to change practices in complex organisations requires more in-depth understanding of contextual factors that impact the capacity of organisations to absorb and embed new practices