The DiReCT study - improving recruitment into clinical trials: a mixed methods study investigating the ethical acceptability, feasibility and recruitment yield of the cohort multiple randomised controlled trials design

This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record.RESULTS: We obtained a favourable ethical opinion from the UK Health Research Authority. Clinicians approached 131/752 (17%) potentially eligible participants for consent. Of these 131, 84 (64%) initially consented to be contacted by a researcher and all but one consented to being randomised into future trials. We confirmed consent for 71 (54%) of participants approached by clinicians, of whom 69 (53%) consented to being randomised into hypothetical future trials, 9% (69/752) of all potentially eligible patients. The interviewed clinicians described issues impacting on their ability to recruit participants in terms of clinical concerns for patient wellbeing, work pressure, their views of both general research and the specific DiReCT study, and how they viewed patients' responses to being offered participation in the study.NIHREuropean Science Foundation Research Network Programme ‘REFLECTION

Does the User Behavior effect the Productivity of Hammer Drilling? : Analysis of the Influences of Feed and Lateral Force

The objective of this study was to investigate the relationship between feed and lateral force with productivity in hammer drilling. Necessary user forces and vibration caused by hammer drilling leads to user fatigue and long-term injuries. Through an increase in productivity, the stress duration and thus injuries caused can be reduced. The user, who influences productivity, applies lateral forces in addition to the feed force during hammer drilling. Their influence and interaction with the feed force on productivity has not yet been investigated. In this study, a total of 1152 boreholes were performed on an automated test bench. Along with the feed and lateral forces, the setup, consisting of hammer drill and drill bit model, was varied in order to investigate interaction effects as well as discuss transferability of the findings. The productivity was evaluated by the rate of penetration (ROP). It was observed that the ROP decreased with increasing lateral forces (p < .001, r = 0.315) and increased with increasing feed force. The detailed courses of these relationships were setup-specific. At low feed forces, the feed and lateral force interacted on the ROP. The investigated relationships indicate an efficient operating range depending on the user forces and setup used, which enables a reduction of the user\u27s stress duration. The findings help engineers develop power tools that provide more efficient and hence less fatiguing work, making them more ergonomic for the user

Factors on Vibrational Harm during Hammer Drilling : Influences of Lateral Force, Feed Force, Hammer Drill and Drill Bit Type

When using hammer drills, the user is exposed to vibrations which can cause damage to the body. Those vibrations can be affected by external factors such as feed forces, which can increase the degree of damage to the user. However, currently there is a lack of knowledge as to whether the lateral forces applied by the user also have an influence on the technical system and whether these influences depend on the system. For this reason, a study with 1152 test runs was carried out on a test rig to investigate the relationship between the feed force and the lateral force as a function of the hammer drill setup on the vibrations at the hammer drill housing and main handle. The experiment showed that the feed (p = < .001, up to r = 0.57) and lateral (p = < .001, up to r = 0.77) forces had an influence on the vibrations of the hammer drill. However, these depended strongly on the technical system and hence cannot be generalized. Furthermore, it was proven that the impact frequency of the hammer drill was reduced by increasing both the feed force (p = < .001, r = 0.55) and the lateral force (p = < .001, r = 0.23). The findings can not only be used by engineers and scientists to further develop vibration standards, but also to design more ergonomic hammer drills. Hence, the vibration decoupling of hammer drills should be redesigned so that lateral forces do not lead to an increase in vibrations that are harmful to the user

"A non-person to the rest of the world": experiences of social isolation amongst severely impaired people with multiple sclerosis.

PURPOSE: To gain insight into the experiences of, and potential solutions to, social isolation amongst severely impaired people with multiple sclerosis. METHODS: A phenomenological research approach using face-to-face, in-depth semi-structured, audio-recorded interviews. Data were transcribed and analyzed thematically. RESULTS: Sixteen severely impaired people with multiple sclerosis were interviewed (Expanded Disability Status Scale >6.5); aged 38-72 years, nine female, time since diagnosis ranged 3-30 years). Four key themes were generated in line with the study objectives, each with further sub-themes. The themes were (1) Definitions of isolation (2) Causes of isolation (3) Impact of isolation, and (4) Potential eases of isolation. CONCLUSIONS: Data portrayed social isolation as complex and multi-factorial in its definitions, its causes, and its impact. Isolation is not just about being lonely or left on one's own, but represents a spiral of impacts. Physical deterioration can lead to reduced choice and control regarding access to, and interaction with others and society, affecting personal identity. Sometimes this leads to further self-isolation. Personalised psychosocial support, with improved ease of access, focused on helping people with severe multiple sclerosis regain a sense of self and their place in the world may ease social isolation. Implications for rehabilitation People with severe multiple sclerosis can experience a sense of powerlessness, a lack of choice and control over daily life, leading to changes in self-identity and social isolation. Peoples' experiences are very personal, and any approach to help deal with social isolation needs to be based in considering how to think positively about how life can be lived and how to make that work. Multiple sclerosis support groups should not be assumed to alleviate feelings of social isolation. Interventions should focus on personalized psychosocial input aimed at helping the person with multiple sclerosis regain a sense of self and their place in the world

Identifying core strategies and mechanisms for spreading a national medicines optimisation programme across England-a mixed-method study applying qualitative thematic analysis and Qualitative Comparative Analysis

BACKGROUND: Achieving widespread adoption of innovations across health systems remains a challenge. Past efforts have focused on identifying and classifying strategies to actively support innovation spread (replicating an innovation across sites), but we lack an understanding about the mechanisms which such strategies draw on to deliver successful spread outcomes. There is also no established methodology to identify core strategies or mechanisms which could be replicated with fidelity in new contexts when spreading innovations. We aimed to understand which strategies and mechanisms are connected with successful spread using the case of a national medicines optimisation programme in England. METHODS: The study applied a comparative mixed-method case study approach. We compared spread activity in 15 Academic Health Science Networks (AHSN) in England, applied to one innovation case, Transfers of Care Around Medicines (TCAM). We followed two methodological steps: (1) qualitative thematic analysis of primary data collected from 18 interviews with AHSN staff members to identify the strategies and mechanisms and related contextual determinants and (2) Qualitative Comparative Analysis (QCA) combining secondary quantitative data on spread outcome and qualitative themes from step 1 to identify the core strategies and mechanisms. RESULTS: We identified six common spread strategy-mechanism constructs that AHSNs applied to spread the TCAM national spread programme: (1) the unique intermediary position of the AHSN as "honest broker" and local networking organisation, (2) the right capacity and position of the spread facilitator, (3) an intersectoral and integrated stakeholder engagement approach, (4) the dynamic marriage of the innovation with local health and care system needs and characteristics, (5) the generation of local evidence, and (6) the timing of TCAM. The QCA resulted in the core strategy/mechanism of a timely start into the national spread programme in combination with the employment of a local, senior pharmacist as an AHSN spread facilitator. CONCLUSIONS: By qualitatively comparing experiences of spreading one innovation across different contexts, we identified common strategies, causal mechanisms, and contextual determinants. The QCA identified one core combination of two strategies/mechanisms. The identification of core strategies/mechanisms and common pre-conditional and mediating contextual determinants of a specific innovation offers spread facilitators and implementers a priority list for tailoring spread activities

New Physics at the LHC. A Les Houches Report: Physics at TeV Colliders 2009 - New Physics Working Group

We present a collection of signatures for physics beyond the standard model that need to be explored at the LHC. First, are presented various tools developed to measure new particle masses in scenarios where all decays include an unobservable particle. Second, various aspects of supersymmetric models are discussed. Third, some signatures of models of strong electroweak symmetry are discussed. In the fourth part, a special attention is devoted to high mass resonances, as the ones appearing in models with warped extra dimensions. Finally, prospects for models with a hidden sector/valley are presented. Our report, which includes brief experimental and theoretical reviews as well as original results, summarizes the activities of the "New Physics" working group for the "Physics at TeV Colliders" workshop (Les Houches, France, 8-26 June, 2009).Comment: 189 page

Les Houches 2011: Physics at TeV Colliders New Physics Working Group Report

We present the activities of the "New Physics" working group for the "Physics at TeV Colliders" workshop (Les Houches, France, 30 May-17 June, 2011). Our report includes new agreements on formats for interfaces between computational tools, new tool developments, important signatures for searches at the LHC, recommendations for presentation of LHC search results, as well as additional phenomenological studies.Comment: 243 pages, report of the Les Houches 2011 New Physics Group; fix three figure

Use of media and public-domain Internet sources for detection and assessment of plant health threats

Event-based biosurveillance is a recognized approach to early warning and situational awareness of emerging health threats. In this study, we build upon previous human and animal health work to develop a new approach to plant pest and pathogen surveillance. We show that monitoring public domain electronic media for indications and warning of epidemics and associated social disruption can provide information about the emergence and progression of plant pest infestation or disease outbreak. The approach is illustrated using a case study, which describes a plant pest and pathogen epidemic in China and Vietnam from February 2006 to December 2007, and the role of ducks in contributing to zoonotic virus spread in birds and humans. This approach could be used as a complementary method to traditional plant pest and pathogen surveillance to aid global and national plant protection officials and political leaders in early detection and timely response to significant biological threats to plant health, economic vitality, and social stability. This study documents the inter-relatedness of health in human, animal, and plant populations and emphasizes the importance of plant health surveillance