General practitioner views on the determinants of test ordering: a theory-based qualitative approach to the development of an intervention to improve immunoglobulin requests in primary care.

BACKGROUND: Research suggests that variation in laboratory requesting patterns may indicate unnecessary test use. Requesting patterns for serum immunoglobulins vary significantly between general practitioners (GPs). This study aims to explore GP's views on testing to identify the determinants of behaviour and recommend feasible intervention strategies for improving immunoglobulin test use in primary care. METHODS: Qualitative semi-structured interviews were conducted with GPs requesting laboratory tests at Cork University Hospital or University Hospital Kerry in the South of Ireland. GPs were identified using a Health Service Executive laboratory list of GPs in the Cork-Kerry region. A random sample of GPs (stratified by GP requesting patterns) was generated from this list. GPs were purposively sampled based on the criteria of location (urban/rural); length of time qualified; and practice size (single-handed/group). Interviews were carried out between December 2014 and February 2015. Interviews were transcribed verbatim using NVivo 10 software and analysed using the framework analysis method. Emerging themes were mapped to the theoretical domains framework (TDF), which outlines 12 domains that can enable or inhibit behaviour change. The behaviour change wheel and behaviour change technique (BCT) taxonomy were then used to identify potential intervention strategies. RESULTS: Sixteen GPs were interviewed (ten males and six females). Findings suggest that intervention strategies should specifically target the key barriers to effective test ordering, while considering the context of primary care practice. Seven domains from the TDF were perceived to influence immunoglobulin test ordering behaviours and were identified as 'mechanisms for change' (knowledge, environmental context and resources, social/professional role and identity, beliefs about capabilities, beliefs about consequences, memory, attention and decision-making processes and behavioural regulation). Using these TDF domains, seven BCTs emerged as feasible 'intervention content' for targeting GPs' ordering behaviour. These included instructions on how to effectively request the test (how to perform behaviour), information on GPs' use of the test (feedback on behaviour), information about patient consequences resulting from not doing the test (information about health consequences), laboratory/consultant-based advice/education (credible source), altering the test ordering form (restructuring the physical environment), providing guidelines (prompts/cues) and adding interpretive comments to the results (adding objects to the environment). These BCTs aligned to four intervention functions: education, persuasion, environmental restructuring and enablement. CONCLUSIONS: This study has effectively applied behaviour change theory to identify feasible strategies for improving immunoglobulin test use in primary care using the TDF, 'behaviour change wheel' and BCT taxonomy. The identified BCTs will form the basis of a theory-based intervention to improve the use of immunoglobulin tests among GPs. Future research will involve the development and evaluation of this intervention

Meta-analysis of the Sea Change Consultation Reports

Sea Change is a three-year, EU funded, Horizon 2020 project with 17 partners in nine European countries (Belgium, Denmark, Greece, Sweden, France, Ireland, Portugal, Spain and UK). During April and May 2016, eight of these countries (except France) carried out consultations with education stakeholders (classified as incumbents, regulating agencies and challengers, see p. xii) for the purpose of gaining deeper insights into the barriers to teaching 12-19 year olds about the ocean, and to identify options for overcoming these barriers. The Sea Change partners used the method Collective intelligence (CI) to consult with the education stakeholders. The CI method used facilitation and problem solving to harmonise input from education stakeholders from different backgrounds and perspectives. This report was built on the Collective Intelligence consultation work completed and reported in Sea For Society (D2.4 Global Analysis of the SFS Consultation Process from a Social Sciences Perspective), as reported in Domegan et al., 2014

A test of general relativity from the three-dimensional orbital geometry of a binary pulsar

Binary pulsars provide an excellent system for testing general relativity because of their intrinsic rotational stability and the precision with which radio observations can be used to determine their orbital dynamics. Measurements of the rate of orbital decay of two pulsars have been shown to be consistent with the emission of gravitational waves as predicted by general relativity, providing the most convincing evidence for the self-consistency of the theory to date. However, independent verification of the orbital geometry in these systems was not possible. Such verification may be obtained by determining the orientation of a binary pulsar system using only classical geometric constraints, permitting an independent prediction of general relativistic effects. Here we report high-precision timing of the nearby binary millisecond pulsar PSR J0437-4715, which establish the three-dimensional structure of its orbit. We see the expected retardation of the pulse signal arising from the curvature of space-time in the vicinity of the companion object (the `Shapiro delay'), and we determine the mass of the pulsar and its white dwarf companion. Such mass determinations contribute to our understanding of the origin and evolution of neutron stars.Comment: 5 pages, 2 figure

A systematic review and meta-analysis of the diagnostic accuracy of nucleic acid amplification tests in cerebrospinal fluid for tuberculous meningitis

Introduction: Diagnosis of tuberculous meningitis (TBM) is difficult and poses a significant challenge to physicians worldwide. Recently, nucleic acid amplification (NAA) tests have shown promise for diagnosis of TBM, although performance has been variable. We undertook a systematic review and meta-analysis to evaluate the diagnostic accuracy of NAA tests in cerebrospinal fluid (CSF) samples against culture as the reference standard or a combined reference standard (CRS) for TBM.Methods: We searched Embase, PubMed, Web of Science and the Cochrane library for the relevant records. QUADS-2 tool was used to assess the quality assessment of the studies. Diagnostic accuracy measures (i.e. sensitivity and specificity) were pooled with a random effects model. All Statistical analyses were performed with STATA version 14 (Stata Corporation, College Station, TX, USA), Meta-DiSc version 1.4 (Cochrane Colloquium, Barcelona, Spain) and RveMan version 5.3 (Copenhagen: The Nordic Cochrane Centre, the Cochrane Collaboration).Results: Sixty-three studies were included in final analysis, comprising 1381cases of confirmed TBM and 5712 non-TBM controls. These 63 studies were divided into two groups comprising 71 datasets (43 in-house tests and 28 commercial tests) that used culture as the reference standard and 24 datasets (21 in-house tests and 3 commercial tests) that used a CRS. Studies which used a culture reference standard had better pooled summary estimates compared to studies which used CRS. The overall pooled estimates of sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR) of NAA tests against culture were 82% (95% CI: 75-87), 99% (95% CI: 98-99), 58.6 (35.3-97.3) and 0.19 (0.14-0.25), respectively. The pooled sensitivity, specificity, PLR and NLR of NAA tests against CRS were 68% (95% CI: 41-87), 98% (95% CI: 95-99), 36.5 (15.6-85.3) and 0.32 (0.15-0.70), respectively.Conclusion: The analysis has demonstrated that the diagnostic accuracy of NAA tests is currently insufficient to replace culture as a lone diagnostic test. NAA tests may be used in combination with culture due to the advantage of time to result and in scenarios where culture tests are not feasible. Further work to improve NAA tests would benefit from standardized reference standards and the methodology

Using collective intelligence to identify barriers to teaching 12–19 year olds about the ocean in Europe

Since the degradation of the marine environment is strongly linked to human activities, having citizens who appreciate the ocean's influence on them and their influence on the ocean is important. Research has shown that citizens have a limited understanding of the ocean and it is this lack of ocean literacy that needs to change. This study maps the European landscape of barriers to teaching 12–19 year olds about the ocean, through the application of Collective Intelligence, a facilitation and problem solving methodology. The paper presents a meta-analysis of the 657 barriers to teaching about the ocean, highlighting how these barriers are interconnected and influence one another in a European Influence Map. The influence map shows 8 themes: Awareness and Perceived knowledge; Policies and Strategies; Engagement, formal education sector; the Ocean itself; Collaboration; Connections between humans and the ocean and the Blue Economy, having the greatest influence and impact on marine education. “Awareness and Perceived knowledge” in Stage 1, exerts the highest level of overall influence in teaching 12–19 year olds about the ocean. This map and study serves as a roadmap for policy makers to implement mobilisation actions that could mitigate the barriers to teaching about the ocean. Examples of such actions include free marine education learning resources such as e-books, virtual laboratories or hands-on experiments. Thus, supporting educators in taking on the challenge of helping our youth realise that the ocean supports life on Earth is essential for education, the marine and human well-being

Milk: the new sports drink? A Review

There has been growing interest in the potential use of bovine milk as an exercise beverage, especially during recovery from resistance training and endurance sports. Based on the limited research, milk appears to be an effective post-resistance exercise beverage that results in favourable acute alterations in protein metabolism. Milk consumption acutely increases muscle protein synthesis, leading to an improved net muscle protein balance. Furthermore, when post-exercise milk consumption is combined with resistance training (12 weeks minimum), greater increases in muscle hypertrophy and lean mass have been observed. Although research with milk is limited, there is some evidence to suggest that milk may be an effective post-exercise beverage for endurance activities. Low-fat milk has been shown to be as effective, if not more effective, than commercially available sports drinks as a rehydration beverage. Milk represents a more nutrient dense beverage choice for individuals who partake in strength and endurance activities, compared to traditional sports drinks. Bovine low-fat fluid milk is a safe and effective post exercise beverage for most individuals, except for those who are lactose intolerant. Further research is warranted to better delineate the possible applications and efficacy of bovine milk in the field of sports nutrition

Comparison of Network Intrusion Detection Performance Using Feature Representation

P. 463-475Intrusion detection is essential for the security of the components of any network. For that reason, several strategies can be used in Intrusion Detection Systems (IDS) to identify the increasing attempts to gain unauthorized access with malicious purposes including those base on machine learning. Anomaly detection has been applied successfully to numerous domains and might help to identify unknown attacks. However, there are existing issues such as high error rates or large dimensionality of data that make its deployment di cult in real-life scenarios. Representation learning allows to estimate new latent features of data in a low-dimensionality space. In this work, anomaly detection is performed using a previous feature learning stage in order to compare these methods for the detection of intrusions in network tra c. For that purpose, four di erent anomaly detection algorithms are applied to recent network datasets using two di erent feature learning methods such as principal component analysis and autoencoders. Several evaluation metrics such as accuracy, F1 score or ROC curves are used for comparing their performance. The experimental results show an improvement for two of the anomaly detection methods using autoencoder and no signi cant variations for the linear feature transformationS

Static stretching of the hamstring muscle for injury prevention in football codes: a systematic review

Purpose: Hamstring injuries are common among football players. There is still disagreement regarding prevention. The aim of this review is to determine whether static stretching reduces hamstring injuries in football codes. Methods: A systematic literature search was conducted on the online databases PubMed, PEDro, Cochrane, Web of Science, Bisp and Clinical Trial register. Study results were presented descriptively and the quality of the studies assessed were based on Cochrane’s ‘risk of bias’ tool. Results: The review identified 35 studies, including four analysis studies. These studies show deficiencies in the quality of study designs. Conclusion: The study protocols are varied in terms of the length of intervention and follow-up. No RCT studies are available, however, RCT studies should be conducted in the near future

Identifying models of delivery, care domains and quality indicators relevant to palliative day services: a scoping review protoco

Abstract Background With an ageing population and increasing numbers of people with life-limiting illness, there is a growing demand for palliative day services. There is a need to measure and demonstrate the quality of these services, but there is currently little agreement on which aspects of care should be used to do this. The aim of the scoping review will be to map the extent, range and nature of the evidence around models of delivery, care domains and existing quality indicators used to evaluate palliative day services. Methods Electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials) will be searched for evidence using consensus development methods; randomised or quasi-randomised controlled trials; mixed methods; and prospective, longitudinal or retrospective case-control studies to develop or test quality indicators for evaluating palliative care within non-residential settings, including day hospices and community or primary care settings. At least two researchers will independently conduct all searches, study selection and data abstraction procedures. Meta-analyses and statistical methods of synthesis are not planned as part of the review. Results will be reported using numerical counts, including number of indicators in each care domain and by using qualitative approach to describe important indicator characteristics. A conceptual model will also be developed to summarise the impact of different aspects of quality in a palliative day service context. Methodological quality relating to indicator development will be assessed using the Appraisal of Indicators through Research and Evaluation (AIRE) tool. Overall strength of evidence will be assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Final decisions on quality assessment will be made via consensus between review authors. Discussion Identifying, developing and implementing evidence-based quality indicators is critical to the evaluation and continued improvement of palliative care. Review findings will be used to support clinicians and policymakers make decisions on which quality indicators are most appropriate for evaluating day services at the patient and service level, and to identify areas for further research