Training health visitors in cognitive behavioural and person-centred approaches for depression in postnatal women as part of a cluster randomised trial and economic evaluation in primary care: the PoNDER trial

Aim: This paper aims to describe the training preparation for health visitors who took part in the intervention arm of a cluster randomised controlled trial and economic evaluation of training for health visitors – the POstNatal Depression Economic evaluation and Randomised (the PoNDER) trial. A secondary aim is to make available, by electronic links, the training manuals developed for and used for the cognitive behavioural approach (CBA) and the person-centred approach (PCA) training for the health visitors. The paper is of relevance to health visitors, general practitioners, nurse practitioners, midwives, clinical psychologists, mental health nurses, community psychiatric nurses, counsellors, and service commissioners. Background: The trial clinical outcomes have been published, indicating the pragmatic effectiveness of the package of training for health visitors to identify depressive symptoms and provide a psychologically informed intervention. The training was associated with a reduction in depressive symptoms at six months postnatally among intervention group women and some evidence of a benefit for the intervention group for some of the secondary outcomes at 18 months follow-up. Methods: The two experimental interventions examined in the PoNDER trial built upon promising work on the potential for psychological interventions to help women recover from postnatal depression as an alternative to pharmaceutical interventions and to address the limitations of previous research in the area. Findings: The package of health visitor training comprised the development of clinical skills in assessing postnatal women and identifying depressive symptoms, and the delivery of a CBA or a PCA for eligible women. This was the largest trial a health visitor intervention and of postnatal depression ever conducted. We are aware of no other rigorously performed trial that has published details of an extensively tested training programme for the benefit of health-care professionals and clients

Patch-burn grazing increases habitat heterogeneity and biodiversity of small mammals in managed rangelands

Citation: Ricketts, A. M., & Sandercock, B. K. (2016). Patch-burn grazing increases habitat heterogeneity and biodiversity of small mammals in managed rangelands. Ecosphere, 7(8). doi:10.1002/ecs2.1431Habitat heterogeneity is a key driver of biodiversity in many ecosystems. Wildlife inhabiting the native prairies of North America evolved in a heterogeneous mosaic of habitat conditions created by fire and grazing by native ungulates. Current rangeland management practices in the tallgrass prairie ecosystem evenly distribute fire and grazing across management units and promote homogeneous habitat conditions. Patch-burn grazing is a rangeland management strategy that seeks to restore heterogeneity to rangelands via fire-grazing interactions. Our 3.5-year study tested the effects of patch-burn grazing on habitat heterogeneity and small mammal community dynamics in the Flint Hills ecoregion of eastern Kansas. To study the ecological effects of patch-burn grazing, we sampled habitat conditions and the small mammal community. We assessed habitat conditions once each growing season in a negative control that was annually burned and grazed, a positive control that was burned every four years and ungrazed, and within each of three units of a patch-burn grazing experiment (PBG) managed with rotational fire. Habitat conditions were significantly different among treatments, and a principal components analysis showed that the patch-burn grazing treatment had higher canopy cover of forbs and habitat heterogeneity than our two control units. To sample the small mammal community, we conducted monthly live trapping of small mammals on two randomly located trap grids in each of our two controls and three units of our PBG treatment. Small mammal diversity was significantly higher in the patch-burn grazing treatment and in the positive control, vs. the negative control. Moreover, a canonical correspondence analysis showed that a fire-grazing interaction was the major driver structuring small mammal communities. Patch-burn grazing is an effective strategy for restoring heterogeneity to vegetative structure and composition, and can increase biodiversity of small mammals in managed rangelands in the tallgrass prairie ecosystem. © 2016 Ricketts and Sandercock

Candidates registered for reasonable adjustments underperform compared to other candidates in the national undergraduate Prescribing Safety Assessment: Retrospective cohort analysis (2014-2018).

AIMS: Candidates with disabilities are eligible for reasonable adjustments (RA) while undertaking the national Prescribing Safety Assessment (PSA). The PSA is a novel open-book, time-constrained, multiformat assessment that may pose challenges to candidates with dyslexia and other disabilities. METHODS: Retrospective cohort analysis of 36 140 UK candidates undertaking first-sitting of the PSA (2014-2018). RESULTS: Of the 36 140 candidates, 9.1% (3284) were registered for RA. The RA group had lower pass rates (absolute difference 1.94%, 95% confidence interval 1.01-2.87%; P < .001) and assessment scores (1.16 percentage marks, 95% confidence interval 0.83-1.48; P < .001) compared with the non-RA group. This absolute difference is small relative to overall variability. This difference persists after adjusting for confounding factors (medical school and paper), and was present for all 8 different question types. The attainment gap within each medical school is negatively correlated with the school's overall performance, both in terms of pass rate (P < .001) and scores (P = .01). The RA group were also less likely to perceive the PSA as an appropriate test, having easy to follow layout/presentation or clear/unambiguous questions, even after adjusting for candidate performance. CONCLUSION: This analysis identifies slight differences in academic performance of candidates requiring RA in a national undergraduate assessment. The study is limited by the unavailability of data on ethnicity, sex, age, diagnosis and time of diagnosis. While further research is required to determine the cause of the attainment gap, this study emphasises the need to maintain a careful review on the fairness and validity of all aspects of the assessment

A methodology to extract outcomes from routine healthcare data for patients with locally advanced non-small cell lung cancer

BACKGROUND: Outcomes for patients in UK with locally advanced non-small cell lung cancer (LA NSCLC) are amongst the worst in Europe. Assessing outcomes is important for analysing the effectiveness of current practice. However, data quality is inconsistent and regular large scale analysis is challenging. This project investigates the use of routine healthcare datasets to determine progression free survival (PFS) and overall survival (OS) of patients treated with primary radical radiotherapy for LA NSCLC. METHODS: All LA NSCLC patients treated with primary radical radiotherapy in a 2 year period were identified and paired manual and routine data generated for an initial pilot study. Manual data was extracted information from hospital records and considered the gold standard. Key time points were date of diagnosis, recurrence, death or last clinical encounter. Routine data was collected from various data sources including, Hospital Episode Statistics, Personal Demographic Service, chemotherapy data, and radiotherapy datasets. Relevant event dates were defined by proxy time points and refined using backdating and time interval optimization. Dataset correlations were then tested on key clinical outcome indicators to establish if routine data could be used as a reliable proxy measure for manual data. RESULTS: Forty-three patients were identified for the pilot study. The manual data showed a median age of 67 years (range 46- 89 years) and all patients had stage IIIA/B disease. Using the manual data, the median PFS was 10.78 months (range 1.58-37.49 months) and median OS was 16.36 months (range 2.69-37.49 months). Based on routine data, using proxy measures, the estimated median PFS was 10.68 months (range 1.61-31.93 months) and estimated median OS was 15.38 months (range 2.14-33.71 months). Overall, the routine data underestimated the PFS and OS of the manual data but there was good correlation with a Pearson correlation coefficient of 0.94 for PFS and 0.97 for OS. CONCLUSIONS: This is a novel approach to use routine datasets to determine outcome indicators in patients with LA NSCLC that will be a surrogate to analysing manual data. The ability to enable efficient and large scale analysis of current lung cancer strategies has a huge potential impact on the healthcare system

A methodology to extract outcomes from routine healthcare data for patients with locally advanced non-small cell lung cancer

BACKGROUND: Outcomes for patients in UK with locally advanced non-small cell lung cancer (LA NSCLC) are amongst the worst in Europe. Assessing outcomes is important for analysing the effectiveness of current practice. However, data quality is inconsistent and regular large scale analysis is challenging. This project investigates the use of routine healthcare datasets to determine progression free survival (PFS) and overall survival (OS) of patients treated with primary radical radiotherapy for LA NSCLC. METHODS: All LA NSCLC patients treated with primary radical radiotherapy in a 2 year period were identified and paired manual and routine data generated for an initial pilot study. Manual data was extracted information from hospital records and considered the gold standard. Key time points were date of diagnosis, recurrence, death or last clinical encounter. Routine data was collected from various data sources including, Hospital Episode Statistics, Personal Demographic Service, chemotherapy data, and radiotherapy datasets. Relevant event dates were defined by proxy time points and refined using backdating and time interval optimization. Dataset correlations were then tested on key clinical outcome indicators to establish if routine data could be used as a reliable proxy measure for manual data. RESULTS: Forty-three patients were identified for the pilot study. The manual data showed a median age of 67 years (range 46- 89 years) and all patients had stage IIIA/B disease. Using the manual data, the median PFS was 10.78 months (range 1.58-37.49 months) and median OS was 16.36 months (range 2.69-37.49 months). Based on routine data, using proxy measures, the estimated median PFS was 10.68 months (range 1.61-31.93 months) and estimated median OS was 15.38 months (range 2.14-33.71 months). Overall, the routine data underestimated the PFS and OS of the manual data but there was good correlation with a Pearson correlation coefficient of 0.94 for PFS and 0.97 for OS. CONCLUSIONS: This is a novel approach to use routine datasets to determine outcome indicators in patients with LA NSCLC that will be a surrogate to analysing manual data. The ability to enable efficient and large scale analysis of current lung cancer strategies has a huge potential impact on the healthcare system

Investigation into the effects of high-Z nano materials in proton therapy

High-Z nano materials have been previously shown to increase the amount of dose deposition within the tumour due to an increase in secondary electrons. This study evaluates the effects of high-Z nano materials in combination with protons, and the impact of proton energy, nanoparticle material and concentration. These effects were studied in silico through Monte Carlo simulation and experimentally through a phantom study, with particular attention to macroscale changes to the Bragg peak in the presence of nanoparticles. Three nanoparticle materials were simulated (gold, silver and platinum) at three concentrations (0.01, 0.1 and 6.5 mg ml(-1)) at two clinical proton energies (60 and 226 MeV). Simulations were verified experimentally using Gafchromic film measurements of gold nanoparticles suspended in water at two available high concentrations (5.5 mg ml(-1) and 1.1 mg ml(-1)). A significant change to Bragg peak features was evident, where at 226 MeV and 6.5 mg ml(-1), simulations of gold showed a 4.7 mm longitudinal shift of the distal edge and experimentally at 5.5 mg ml(-1), a shift of 2.2 mm. Simulations showed this effect to be material dependent, where platinum having the highest physical density caused the greatest shift with increasing concentration. A dose enhancement of 6%  ±  0.05 and 5%  ±  0.15 (60 MeV and 226 MeV, respectively) was evident with gold at 6.5 mg ml(-1) to water alone, compared to the 21%  ±  0.53 observed experimentally as dose to film with 5.5 mg ml(-1) of gold nanoparticles suspended in water at 226 MeV. The introduction of nanoparticles has strong potential to enhance dose in proton therapy, however the changes to the Bragg peak distribution that occur with high concentrations need to be accounted for to ensure tumour coverage

The light curve of a transient X-ray source

The Ariel-V satellite monitored the X-ray light curve of A1524-62 almost continuously from 40 days prior to maximum light until its disappearance below the effective experimental sensitivity. The source exhibited maximum light on approximately 4 December 1974, at a level of 0.9 the apparent magnitude of the Crab Nebula in the energy band 3-6 keV. Although similar to previously reported transient sources with a decay time constant of approximately 2 months, the source exhibited an extended, variable pre-flare on-state of about 1 month at a level of greater than approximately 0.1 maximum light. The four bright (greater than 0.2 of the Crab Nebula) transient sources observed during the first half-year of Ariel-V operation are indicative of a galactic disk distribution, and a luminosity at maximum in excess of 10 to the 37th power ergs/sec

The 1996 Soft State Transitions of Cygnus X-1

We report continuous monitoring of Cygnus X-1 in the 1.3 to 200 keV band using ASM/RXTE and BATSE/CGRO for about 200 days from 1996 February 21 to 1996 early September. During this period Cygnus X-1 experienced a hard-to-soft and then a soft-to-hard state transition. The low-energy X-ray (1.3-12 keV) and high-energy X-ray (20-200 keV) fluxes are strongly anti-correlated during this period. During the state transitions flux variations of about a factor of 5 and 15 were seen in the 1.3-3.0 keV and 100-200 keV bands, respectively, while the average 4.8-12 keV flux remains almost unchanged. The net effect of this pivoting is that the total 1.3-200 keV luminosity remained unchanged to within about 15%. The bolometric luminosity in the soft state may be as high as 50-70% above the hard state luminosity, after color corrections for the luminosity below 1.3 keV. The blackbody component flux and temperature increase in the soft state is probably caused by a combination of the optically thick disk mass accretion rate increase and a decrease of the inner disk radius.Comment: 18 pages, 1 PostScript figure. Accepted for ApJ