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

Developing and evaluating interventions to reduce inappropriate prescribing by general practitioners of antibiotics for upper respiratory tract infections: a randomised controlled trial to compare paper-based and web-based modelling experiments

Background: Much implementation research is focused on full-scale trials with little evidence of preceding modelling work. The Medical Research Council Framework for developing and evaluating complex interventions has argued for more and better theoretical and exploratory work prior to a trial as a means of improving intervention development. Intervention modelling experiments (IMEs) are a way of exploring and refining an intervention before moving to a full-scale trial. They do this by delivering key elements of the intervention in a simulation that approximates clinical practice by, for example, presenting general practitioners (GPs) with a clinical scenario about making a treatment decision. Methods: The current proposal will run a full, web-based IME involving 250 GPs that will advance the methodology of IMEs by directly comparing results with an earlier paper-based IME. Moreover, the web-based IME will evaluate an intervention that can be put into a full-scale trial that aims to reduce antibiotic prescribing for upper respiratory tract infections in primary care. The study will also include a trial of email versus postal invitations to participate. Discussion: More effective behaviour change interventions are needed and this study will develop one such intervention and a system to model and test future interventions. This system will be applicable to any situation in the National Health Service where behaviour needs to be modified, including interventions aimed directly at the public. Trial registration: ClinicalTrials (NCT): NCT0120673

An in vitro comparison between two methods of electrical resistance measurement for occlusal caries detection

Because of different measurement techniques and the easier design of the CRM prototype, this in vitro study aimed to compare the diagnostic performance and reproducibility of two electrical methods (Electronic Caries Monitor III, ECM and Cariometer 800, CRM) for occlusal caries detection, and to evaluate the effect of staining/ discoloration of fissures on diagnostic performance. Hundred and seventeen third molars with no apparent occlusal cavitation were selected. Six examiners inspected all specimens independently, using the CRM, and a subgroup of 4 using the ECM. Histological validation using a stereomicroscope was performed after hemisectioning. Intra- and interexaminer reproducibility was assessed by Lin's concordance correlation coefficient (CCC) and Bland and Altman analysis. Diagnostic performance parameters included sensitivity (SE), specificity (SP) and area under the ROC curve (A(z)). The CCC yielded an intra- and interexaminer reproducibility of 0.69/0.62 (ECM) and of 0.79/0.74 (CRM). The mean intra- and interexaminer 95% range of measurements (range between Bland and Altman limits of agreement) given in percentages of the instrument reading were 67%/65% for the ECM and 28%/33% for the CRM. A(z) at the D3-4 level was 0.74 (ECM) and 0.78 (CRM). The CRM showed at least equivalent diagnostic performance to the ECM. However, improvement is still desirable. Diagnostic performance appeared to be enhanced in discolored lesions; however, this may be related to sample lesion distribution characteristics. Copyright (C) 2006 S. Karger AG, Basel

Transonic unsteady airloads on an energy efficient transport wing with oscillating control surfaces

An aspect ratio 10.8 supercritical wing with oscillating control surfaces is described. The wing is instrumental with 252 static orifices and 164 in situ dynamic pressure transducers for studying the effects of control surface deflection on steady and unsteady pressures at transonic speeds. Results from initial wind tunnel tests conducted in the Langley Transonic Dynamics Tunnel are discussed. Unsteady pressure results are presented for two trailing edge control surfaces oscillating separately at the design Mach number of 0.78. Some experimental results are compared with analytical results obtained by using linear lifting surface theory

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

Near-infrared synchrotron emission from the compact jet of GX339-4

We have compiled contemporaneous broadband observations of the black hole candidate X-ray binary GX 339-4 when in the low/hard X-ray state in 1981 and 1997. The data clearly reveal the presence of two spectral components, with thermal and non-thermal spectra, overlapping in the optical -- near-infrared bands. The non-thermal component lies on an extrapolation of the radio spectrum of the source, and we interpret it as optically thin synchrotron emission from the powerful, compact jet in the system. Detection of this break from self-absorbed to optically thin synchrotron emission from the jet allows us to place a firm lower limit on the ratio of jet (synchrotron) to X-ray luminosities of $\geq 5$%. We further note that extrapolation of the optically thin synchrotron component from the near-infrared to higher frequencies coincides with the observed X-ray spectrum, supporting models in which the X-rays could originate via optically thin synchrotron emission from the jet (possibly instead of Comptonisation).Comment: Accepted for publication in ApJ Lette

Helios-2 Vela-Ariel-5 gamma-ray burst source position

The gamma-ray burst of 28 January 1976, one of 18 events thus far detected in interplanetary space with Helios-2, was also observed with the Vela-5A, -6A and the Ariel-5 satellites. A small source field is obtained from the intersection of the region derived from the observed time delays between Helios-2 and Vela-5A and -6A with the source region independently found with the Ariel-5 X-ray detector. This area contains neither any steady X-ray source as scanned by HEAO-A nor any previously catalogued X-ray, radio or infrared sources, X-ray transients, quasars, seyferts, globular clusters, flare stars, pulsars, white dwarfs or high energy gamma-ray sources. The region is however, within the source field of a gamma-ray transient observed in 1974, which exhibited nuclear gamma-ray line structure

Subsonic and transonic pressure measurements on a high-aspect-ratio supercritical-wing model with oscillating control surfaces

A high aspect ratio supercritical wing with oscillating control surfaces is described. The semispan wing model was instrumented with 252 static orifices and 164 in situ dynamic pressure gases for studying the effects of control surface position and sinusoidal motion on steady and unsteady pressures. Data from the present test (this is the second in a series of tests on this model) were obtained in the Langley Transonic Dynamics Tunnel at Mach numbers of 0.60 and 0.78 and are presented in tabular form

Engaging policy in science writing: Patterns and strategies

Many scientific researchers aspire to engage policy in their writing, but translating scientific research and findings into policy discussion often requires an understanding of the institutional complexities of legal and policy processes and actors. To examine how researchers have undertaken that challenge, we developed a set of metrics and applied them to articles published in one of the principal academic publication venues for science and policy—Science magazine’s Policy Forum. We reviewed each Policy Forum article published over a five-year period (2011–15), 220 in all. For each article, we assessed the level of policy content based on presence of a stated policy proposal or position and identification of the relevant policy actors and actions, and recorded attributes such as field of science, field of policy, number of references to legal and policy sources, number of authors from law and policy institutions, and number of citations. We find that a handful of science fields dominate publication frequency, but that all fields have produced publications with high policy engagement. Of the attributes, number of references to law and policy sources is correlated positively with level of engagement, whereas number of law and policy authors was fairly constant across all depths of engagement. Surprisingly, level of policy engagement was negatively correlated with the number of citations an article subsequently received. We offer possible explanations for these results and thoughts for authors, editors, and research institutions interested in facilitating robust engagement of policy in scientific writing

Emerging infectious disease issues in blood safety.

Improvements in donor screening and testing and viral inactivation of plasma derivatives together have resulted in substantial declines in transfusion-transmitted infections over the last two decades. Most recently, nucleic acid testing techniques have been developed to screen blood and plasma donations for evidence of very recent viral infections that could be missed by conventional serologic tests. Nonetheless, the blood supply remains vulnerable to new and reemerging infections. In recent years, numerous infectious agents found worldwide have been identified as potential threats to the blood supply. Several newly discovered hepatitis viruses and agents of transmissible spongiform encephalopathies present unique challenges in assessing possible risks they may pose to the safety of blood and plasma products