Efficiency of using community organisations as catalysts for recruitment to continence promotion trials

This article is available open access through the publisher’s website from the link below. Copyright @ 2012 The Authors.Background - A major challenge for determining the effectiveness of community-based continence promotion campaigns is recruitment of a representative sample of incontinent participants who have not previously sought care. Purpose - To evaluate the efficiency of engaging community organisations as catalysts for recruitment of community-dwelling older women with incontinence to the ‘Continence across Continents’ randomised controlled trial. Methods - Seniors’ and women’s community-based organisations throughout the United Kingdom were solicited by telephone or email to assist recruitment for an open-label cluster randomised controlled trial testing three experimental continence promotion interventions and a control intervention for incontinent older women. Women aged 60 years and older who experienced at least weekly urinary incontinence and who had never sought treatment were eligible to participate. The response rate of the organisations and enrolment rate of eligible participants attending the continence promotion workshops were recorded. Differences in recruitment efficiency by intervention group were ascertained using analysis of variance statistics. Results - We contacted 408 community organisations over a 1-year period. Seventy organisations (17%) agreed to host a workshop, 249 (61%) did not provide a response, and 89 (22%) refused. Workshops were administered in a group format to 61 organisations (15%); 667 women attended, 583 (87%) submitted the screening questionnaire, and 437 (66%) met eligibility criteria for inclusion. A total of 192 women consented to participate in the trial, yielding a 44% recruitment efficiency among workshop attendees known to be eligible, with no significant difference in enrolment rates between groups. However, the mean participant recruitment rate per number of attendees at each workshop was only 29%, varying substantially between groups from 19% to 37%, with the lowest rate observed for the control group. The mean annual recruitment rate expressed as the number of enrolled participants per community organisation contacted was 0.5. Limitations - Reasons for women’s non-response were not collected. The findings may be country specific. Conclusions - The recruitment rate for a continence promotion trial among older women known to be eligible and attending workshops hosted by local community organisations was high (44%). Strategies are needed to bolster community organisations’ involvement in health promotion trials in general and for continence issues in particular

Discovery of Two Relativistic Neutron Star-White Dwarf Binaries

We have discovered two recycled pulsars in relativistic orbits as part of the first high-frequency survey of intermediate Galactic latitudes. PSR J1157-5112 is a 44 ms pulsar and the first recycled pulsar with an ultra-massive (M > 1.14 Mo) white dwarf companion. Millisecond pulsar J1757-5322 is a relativistic circular-orbit system which will coalesce due to the emission of gravitational radiation in less than 9.5 Gyr. Of the ~40 known circular orbit pulsars, J1757-5322 and J1157-5112 have the highest projected orbital velocities. There are now three local neutron-star/white-dwarf binaries that will coalesce in less than a Hubble time, implying a large coalescence rate for these objects in the local Universe. Systems such as J1141-6545 (Kaspi et al. 2000) are potential gamma-ray burst progenitors and dominate the coalescence rate, whilst lighter systems make excellent progenitors of millisecond pulsars with planetary or ultra-low mass companions.Comment: 4 pages, to appear in ApJ Letters. Uses aastex v 5.0, emulateapj5.sty, apjfonts.st

Effectiveness of continence promotion for older women via community organisations: A cluster randomised trial

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/Objectives: The primary objective of this cluster randomised controlled trial was to compare the effectiveness of the three experimental continence promotion interventions against a control intervention on urinary symptom improvement in older women with untreated incontinence recruited from community organisations. A second objective was to determine whether changes in incontinence-related knowledge and new uptake of risk-modifying behaviours explain these improvements. Setting: 71 community organisations across the UK. Participants: 259 women aged 60 years and older with untreated incontinence entered the trial; 88% completed the 3-month follow-up. Interventions: The three active interventions consisted of a single 60 min group workshop on (1) continence education (20 clusters, 64 women); (2) evidence-based self-management (17 clusters, 70 women); or (3) combined continence education and self-management (17 clusters, 61 women). The control intervention was a single 60 min educational group workshop on memory loss, polypharmacy and osteoporosis (17 clusters, 64 women). Primary and secondary outcome measures: The primary outcome was self-reported improvement in incontinence 3 months postintervention at the level of the individual. The secondary outcome was change in the International Consultation on Incontinence Questionnaire (ICIQ) from baseline to 3-month follow-up. Changes in incontinence-related knowledge and behaviours were also assessed. Results: The highest rate of urinary symptom improvement occurred in the combined intervention group (66% vs 11% of the control group, prevalence difference 55%, 95% CI 43% to 67%, intracluster correlation 0). 30% versus 6% of participants reported significant improvement respectively (prevalence difference 23%, 95% CI 10% to 36%, intracluster correlation 0). The number-needed-to-treat was 2 to achieve any improvement in incontinence symptoms, and 5 to attain significant improvement. Compared to controls, participants in the combined intervention reported an adjusted mean 2.05 point (95% CI 0.87 to 3.24) greater improvement on the ICIQ from baseline to 3-month follow-up. Changes in knowledge and self-reported risk-reduction behaviours paralleled rates of improvement in all intervention arms. Conclusions: Continence education combined with evidence-based self-management improves symptoms of incontinence among untreated older women. Community organisations represent an untapped vector for delivering effective continence promotion interventions.Canadian Institutes of Health Research – Institute on Aging and the Economic and Social Research Council (UK

A Dirichlet process mixture regression model for the analysis of competing risk events

We develop a regression model for the analysis of competing risk events. The joint distribution of the time to these events is flexibly characterized by a random effect which follows a discrete probability distribution drawn from a Dirichlet Process, explaining their variability. This entails an additional layer of flexibility of this joint model, whose inference is robust with respect to the misspecification of the distribution of the random effects. The model is analysed in a fully Bayesian setting, yielding a flexible Dirichlet Process Mixture model for the joint distribution of the time to events. An efficient MCMC sampler is developed for inference. The modelling approach is applied to the empirical analysis of the surrending risk in a US life insurance portfolio previously analysed by Milhaud and Dutang (2018). The approach yields an improved predictive performance of the surrending rates.</p

Missing Data Imputation with High-Dimensional Data

Imputation of missing data in high-dimensional datasets with more variables P than samples N, (Formula presented.), is hampered by the data dimensionality. For multivariate imputation, the covariance matrix is ill conditioned and cannot be properly estimated. For fully conditional imputation, the regression models for imputation cannot include all the variables. Thus, the high dimension requires special imputation approaches. In this article, we provide an overview and realistic comparisons of imputation approaches for high-dimensional data when applied to a linear mixed modeling (LMM) framework. We examine approaches from three different classes using simulation studies: multiple imputation with penalized regression, multiple imputation with recursive partitioning and predictive mean matching; and multiple imputation with Principal Component Analysis (PCA). We illustrate the methods on a real case study where a multivariate outcome (i.e., an extracted set of correlated biomarkers from human urine samples) was collected and monitored over time and we discuss the proposed methods with more standard imputation techniques that could be applied by ignoring either the multivariate or the longitudinal dimension. Our simulations demonstrate the superiority of the recursive partitioning and predictive mean matching algorithm over the other methods in terms of bias, mean squared error and coverage of the LMM parameter estimates when compared to those obtained from a data analysis without missingness, although it comes at the expense of high computational costs. It is worthwhile reconsidering much faster methodologies like the one relying on PCA.</p

Dwelling Quietly in the Rich Club: Brain Network Determinants of Slow Cortical Fluctuations

For more than a century, cerebral cartography has been driven by investigations of structural and morphological properties of the brain across spatial scales and the temporal/functional phenomena that emerge from these underlying features. The next era of brain mapping will be driven by studies that consider both of these components of brain organization simultaneously -- elucidating their interactions and dependencies. Using this guiding principle, we explored the origin of slowly fluctuating patterns of synchronization within the topological core of brain regions known as the rich club, implicated in the regulation of mood and introspection. We find that a constellation of densely interconnected regions that constitute the rich club (including the anterior insula, amygdala, and precuneus) play a central role in promoting a stable, dynamical core of spontaneous activity in the primate cortex. The slow time scales are well matched to the regulation of internal visceral states, corresponding to the somatic correlates of mood and anxiety. In contrast, the topology of the surrounding "feeder" cortical regions show unstable, rapidly fluctuating dynamics likely crucial for fast perceptual processes. We discuss these findings in relation to psychiatric disorders and the future of connectomics.Comment: 35 pages, 6 figure

Is the Bursting Radio-source GCRT J1745-3009 a Double Neutron Star Binary ?

GCRT J1745-3009 is a peculiar transient radio-source in the direction of the Galactic Center. It was observed to emit a series of ~ 1 Jy bursts at 0.33 GHz, with typical duration ~ 10 min and at apparently regular intervals of ~ 77 min. If the source is indeed at the distance of the Galactic Center as it seems likely, we show that its observational properties are compatible with those expected from a double neutron star binary, similar to the double pulsar system J0737-3039. In the picture we propose the (coherent) radio emission comes from the shock originating in the interaction of the wind of the more energetic pulsar with the magnetosphere of the companion. The observed modulation of the radio signal is the consequence of an eccentric orbit, along which the separation between the two stars varies. This cyclically drives the shock inside the light cylinder radius of the less energetic pulsar.Comment: 5 pages, 3 figures, accepted for publication in The Astrophysical Journal Letters, comment on geodetic precession adde