The trial is owned by the team, not by an individual:A qualitative study exploring the role of teamwork in recruitment to randomised controlled trials in surgical oncology

BACKGROUND: Challenges exist in recruitment to trials involving interventions delivered by different clinical specialties. Collaboration is required between clinical specialty and research teams. The aim of this study was to explore how teamwork influences recruitment to a multicentre randomised controlled trial (RCT) involving interventions delivered by different clinical specialties. METHODS: Semi-structured interviews were conducted in three centres with a purposeful sample of members of the surgical, oncology and research teams recruiting to a feasibility RCT comparing definitive chemoradiotherapy with chemoradiotherapy and surgery for oesophageal squamous cell carcinoma. Interviews explored factors known to influence healthcare team effectiveness and were audio-recorded and thematically analysed. Sampling, data collection and analysis were undertaken iteratively and concurrently. RESULTS: Twenty-one interviews were conducted. Factors that influenced how team working impacted upon trial recruitment were centred on: (1) the multidisciplinary team (MDT) meeting, (2) leadership of the trial, and (3) the recruitment process. The weekly MDT meeting was reported as central to successful recruitment and formed the focus for creating a ‘study team’, bringing together clinical and research teams. Shared study leadership positively influenced healthcare professionals’ willingness to participate. Interviewees perceived their clinical colleagues to have strong treatment preferences which led to scepticism regarding whether the treatments were being described to patients in a balanced manner. CONCLUSIONS: This study has highlighted a number of aspects of team functioning that are important for recruitment to RCTs that span different clinical specialties. Understanding these issues will aid the production of guidance on team-relevant issues that should be considered in trial management and the development of interventions that will facilitate teamwork and improve recruitment to these challenging RCTs. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number (ISRCTN): ISRCTN89052791

Reconstructing the Narrative: The Usurpation of Nikephoros Bryennios the Elder

This paper traces the usurpation of Nikephoros Bryennios the elder, 1077/8 AD, by examining narratives from three Byzantine historians: Michael Attaleiates, John Skylitzes, and Nikephoros Bryennios the younger. For the most part, modern scholars have focussed on investigating successful usurpation candidates who managed to rise to imperial power. For this period, this included Nikephoros Botaneiates and Alexios Komnenos. Key questions are often asked, such as how usurpers managed to succeed and why did they choose to undertake a course of usurpation, often resulting in a narrative of justification and legitimacy.[1] For this period, albeit from Neville (2012) on Nikephoros Bryennios, appreciation has not been given to usurpers who failed.[2] This paper will provide a chronology of Nikephoros Bryennios’ usurpation, and how these three authors depict the incident, the correlations and differences between them, and lastly, preliminary thoughts why Bryennios’ usurpation failed compared to his successful contemporaries

Testing Lorentz Invariance with Neutrinos from Ultrahigh Energy Cosmic Ray Interactions

We have previously shown that a very small amount of Lorentz invariance violation (LIV), which suppresses photomeson interactions of ultrahigh energy cosmic rays (UHECRs) with cosmic background radiation (CBR) photons, can produce a spectrum of cosmic rays that is consistent with that currently observed by the Pierre Auger Observatory (PAO) and HiRes experiments. Here, we calculate the corresponding flux of high energy neutrinos generated by the propagation of UHECR protons through the CBR in the presence of LIV. We find that LIV produces a reduction in the flux of the highest energy neutrinos and a reduction in the energy of the peak of the neutrino energy flux spectrum, both depending on the strength of the LIV. Thus, observations of the UHE neutrino spectrum provide a clear test for the existence and amount of LIV at the highest energies. We further discuss the ability of current and future proposed detectors make such observations.Comment: final version to appear in Astroparticle Physic

Three nested randomized controlled trials of peer only or multiple stakeholder group feedback within Delphi surveys during core outcome and information set development

Top 10 items rated essential in round 1. (DOCX 17 kb

Methodological overview of systematic reviews to establish the evidence base for emergency general surgery

BACKGROUND: The evidence for treatment decision‐making in emergency general surgery has not been summarized previously. The aim of this overview was to review the quantity and quality of systematic review evidence for the most common emergency surgical conditions. METHODS: Systematic reviews of the most common conditions requiring unplanned admission and treatment managed by general surgeons were eligible for inclusion. The Centre for Reviews and Dissemination databases were searched to April 2014. The number and type (randomized or non‐randomized) of included studies and patients were extracted and summarized. The total number of unique studies was recorded for each condition. The nature of the interventions (surgical, non‐surgical invasive or non‐invasive) was documented. The quality of reviews was assessed using the AMSTAR checklist. RESULTS: The 106 included reviews focused mainly on bowel conditions (42), appendicitis (40) and gallstone disease (17). Fifty‐one (48·1 per cent) included RCTs alone, 79 (74·5 per cent) included at least one RCT and 25 (23·6 per cent) summarized non‐randomized evidence alone. Reviews included 727 unique studies, of which 30·3 per cent were RCTs. Sixty‐five reviews compared different types of surgical intervention and 27 summarized trials of surgical versus non‐surgical interventions. Fifty‐seven reviews (53·8 per cent) were rated as low risk of bias. CONCLUSION: This overview of reviews highlights the need for more and better research in this field

Surgical ward rounds in England: a trainee-led multi-centre study of current practice

BACKGROUND: Recent guidance advocates daily consultant-led ward rounds, conducted in the morning with the presence of senior nursing staff and minimising patients on outlying wards. These recommendations aim to improve patient management through timely investigations, treatment and discharge. This study sought to evaluate the current surgical ward round practices in England. METHODS: Information regarding timing and staffing levels of surgical ward rounds was collected prospectively over a one-week period. The location of each patient was also documented. Two surgical trainee research collaboratives coordinated data collection from 19 hospitals and 13 surgical subspecialties. RESULTS: Data from 471 ward rounds involving 5622 patient encounters was obtained. 367 (77.9%) ward rounds commenced before 9am. Of 422 weekday rounds, 190 (45%) were consultant-led compared with 33 of the 49 (67%) weekend rounds. 2474 (44%) patients were seen with a nurse present. 1518 patients (27%) were classified as outliers, with 361 ward rounds (67%) reporting at least one outlying patient. CONCLUSION: Recommendations for daily consultant-led multi disciplinary ward rounds are poorly implemented in surgical practice, and patients continue to be managed on outlying wards. Although strategies may be employed to improve nursing attendance on ward rounds, substantial changes to workforce planning would be required to deliver daily consultant-led care. An increasing political focus on patient outcomes at weekends may prompt changes in these areas

The impact of interactions, bars, bulges, and AGN on star formation efficiency in local massive galaxies

Using observations from the GASS and COLD GASS surveys and complementary data from SDSS and GALEX, we investigate the nature of variations in gas depletion time observed across the local massive galaxy population. The large and unbiased COLD GASS sample allows us to assess the relative importance of galaxy interactions, bar instabilities, morphologies and the presence of AGN in regulating star formation efficiency. Both the H2 mass fraction and depletion time vary as a function of the distance of a galaxy from the main sequence in the SFR-M* plane. The longest gas depletion times are found in below-main sequence bulge-dominated galaxies that are either gas-poor, or else on average less efficient than disk-dominated galaxy at converting into stars any cold gas they may have. We find no link between AGN and these long depletion times. The galaxies undergoing mergers or showing signs of morphological disruptions have the shortest molecular gas depletion times, while those hosting strong stellar bars have only marginally higher global star formation efficiencies as compared to matched control samples. Our interpretation is that depletion time variations are caused by changes in the ratio between the gas mass traced by the CO(1-0) observations, and the gas mass in high density star-forming cores, with interactions, mergers and bar instabilities able to locally increase pressure and raise the ratio of efficiently star-forming gas to CO-detected gas. Building a sample representative of the local massive galaxy population, we derive a global Kennicutt-Schmidt relation of slope 1.18+/-0.24, and observe structure within the scatter around this relation, with galaxies having low (high) stellar mass surface densities lying systematically above (below) the mean relation, suggesting that gas surface density is not the only parameter driving the global star formation ability of a galaxy.Comment: 19 pages, 12 figures, accepted for publication in Ap

COLD GASS, an IRAM legacy survey of molecular gas in massive galaxies: I. Relations between H2, HI, stellar content and structural properties

We are conducting COLD GASS, a legacy survey for molecular gas in nearby galaxies. Using the IRAM 30m telescope, we measure the CO(1-0) line in a sample of ~350 nearby (D=100-200 Mpc), massive galaxies (log(M*/Msun)>10.0). The sample is selected purely according to stellar mass, and therefore provides an unbiased view of molecular gas in these systems. By combining the IRAM data with SDSS photometry and spectroscopy, GALEX imaging and high-quality Arecibo HI data, we investigate the partition of condensed baryons between stars, atomic gas and molecular gas in 0.1-10L* galaxies. In this paper, we present CO luminosities and molecular hydrogen masses for the first 222 galaxies. The overall CO detection rate is 54%, but our survey also uncovers the existence of sharp thresholds in galaxy structural parameters such as stellar mass surface density and concentration index, below which all galaxies have a measurable cold gas component but above which the detection rate of the CO line drops suddenly. The mean molecular gas fraction MH2/M* of the CO detections is 0.066+/-0.039, and this fraction does not depend on stellar mass, but is a strong function of NUV-r colour. Through stacking, we set a firm upper limit of MH2/M*=0.0016+/-0.0005 for red galaxies with NUV-r>5.0. The average molecular-to-atomic hydrogen ratio in present-day galaxies is 0.3, with significant scatter from one galaxy to the next. The existence of strong detection thresholds in both the HI and CO lines suggests that "quenching" processes have occurred in these systems. Intriguingly, atomic gas strongly dominates in the minority of galaxies with significant cold gas that lie above these thresholds. This suggests that some re-accretion of gas may still be possible following the quenching event.Comment: Accepted for publications in MNRAS. 32 pages, 25 figure

Panmicrobial oligonucleotide array for diagnosis of infectious diseases

To facilitate rapid, unbiased, differential diagnosis of infectious diseases, we designed GreeneChipPm, a panmicrobial microarray comprising 29,455 sixty-mer oligonucleotide probes for vertebrate viruses, bacteria, fungi, and parasites. Methods for nucleic acid preparation, random primed PCR amplification, and labeling were optimized to allow the sensitivity required for application with nucleic acid extracted from clinical materials and cultured isolates. Analysis of nasopharyngeal aspirates, blood, urine, and tissue from persons with various infectious diseases confirmed the presence of viruses and bacteria identified by other methods, and implicated Plasmodium falciparum in an unexplained fatal case of hemorrhagic feverlike disease during the Marburg hemorrhagic fever outbreak in Angola in 2004-2005