A cluster randomized controlled trial aimed at implementation of local quality improvement collaboratives to improve prescribing and test ordering performance of general practitioners: Study Protocol

<p>Abstract</p> <p>Background</p> <p>The use of guidelines in general practice is not optimal. Although evidence-based methods to improve guideline adherence are available, variation in physician adherence to general practice guidelines remains relatively high. The objective for this study is to transfer a quality improvement strategy based on audit, feedback, educational materials, and peer group discussion moderated by local opinion leaders to the field. The research questions are: is the multifaceted strategy implemented on a large scale as planned?; what is the effect on general practitioners' (GPs) test ordering and prescribing behaviour?; and what are the costs of implementing the strategy?</p> <p>Methods</p> <p>In order to evaluate the effects, costs and feasibility of this new strategy we plan a multi-centre cluster randomized controlled trial (RCT) with a balanced incomplete block design. Local GP groups in the south of the Netherlands already taking part in pharmacotherapeutic audit meeting groups, will be recruited by regional health officers. Approximately 50 groups of GPs will be randomly allocated to two arms. These GPs will be offered two different balanced sets of clinical topics. Each GP within a group will receive comparative feedback on test ordering and prescribing performance. The feedback will be discussed in the group and working agreements will be created after discussion of the guidelines and barriers to change. The data for the feedback will be collected from existing and newly formed databases, both at baseline and after one year.</p> <p>Discussion</p> <p>We are not aware of published studies on successes and failures of attempts to transfer to the stakeholders in the field a multifaceted strategy aimed at GPs' test ordering and prescribing behaviour. This pragmatic study will focus on compatibility with existing infrastructure, while permitting a certain degree of adaptation to local needs and routines.</p> <p>Trial registration</p> <p>Nederlands Trial Register ISRCTN40008171</p

The Herschel Virgo Cluster Survey: IV. Resolved dust analysis of spiral galaxies

We present a resolved dust analysis of three of the largest angular size spiral galaxies, NGC 4501 and NGC 4567/8, in the Herschel Virgo Cluster Survey (HeViCS) Science Demonstration field. Herschel has unprecedented spatial resolution at far-infrared wavelengths and with the PACS and SPIRE instruments samples both sides of the peak in the far infrared spectral energy distribution (SED).We present maps of dust temperature, dust mass, and gas-to-dust ratio, produced by fitting modified black bodies to the SED for each pixel. We find that the distribution of dust temperature in both systems is in the range ~19 - 22 K and peaks away from the centres of the galaxies. The distribution of dust mass in both systems is symmetrical and exhibits a single peak coincident with the galaxy centres. This Letter provides a first insight into the future analysis possible with a large sample of resolved galaxies to be observed by Herschel.Comment: Letter accepted for publication in A&A (Herschel special issue

The far-infrared view of M87 as seen by the Herschel Space Observatory

The origin of the far-infrared emission from the nearby radio galaxy M87 remains a matter of debate. Some studies find evidence of a far-infrared excess due to thermal dust emission, whereas others propose that the far-infrared emission can be explained by synchrotron emission without the need for an additional dust emission component. We observed M87 with PACS and SPIRE as part of the Herschel Virgo Cluster Survey (HeViCS). We compare the new Herschel data with a synchrotron model based on infrared, submm and radio data to investigate the origin of the far-infrared emission. We find that both the integrated SED and the Herschel surface brightness maps are adequately explained by synchrotron emission. At odds with previous claims, we find no evidence of a diffuse dust component in M87.Comment: 4 pages, 2 figures, proceedings IAU Symposium 275 (Jets at all scales

The Herschel Virgo Cluster Survey: I. Luminosity functions

We describe the Herschel Virgo Cluster Survey (HeViCS) and the first data obtained as part of the Science Demonstration Phase (SDP). The data cover a central 4x4 sq deg region of the cluster. We use SPIRE and PACS photometry data to produce 100, 160, 250, 350 and 500 micron luminosity functions (LFs) for optically bright galaxies that are selected at 500 micron and detected in all bands. We compare these LFs with those previously derived using IRAS, BLAST and Herschel-ATLAS data. The Virgo Cluster LFs do not have the large numbers of faint galaxies or examples of very luminous galaxies seen previously in surveys covering less dense environments.Comment: Letter accepted for publication in A&A (Herschel special issue

The Herschel Virgo Cluster Survey: II. Truncated dust disks in HI-deficient spirals

By combining Herschel-SPIRE observations obtained as part of the Herschel Virgo Cluster Survey with 21 cm HI data from the literature, we investigate the role of the cluster environment on the dust content of Virgo spiral galaxies.We show for the first time that the extent of the dust disk is significantly reduced in HI-deficient galaxies, following remarkably well the observed 'truncation' of the HI disk. The ratio of the submillimetre-to- optical diameter correlates with the HI-deficiency, suggesting that the cluster environment is able to strip dust as well as gas. These results provide important insights not only into the evolution of cluster galaxies but also into the metal enrichment of the intra-cluster medium.Comment: Letter accepted for publication in A&A (Herschel special issue

The Herschel Virgo Cluster Survey: VI. The far-infrared view of M87

The origin of the far-infrared emission from the nearby radio galaxy M87 remains a matter of debate. Some studies find evidence of a far-infrared excess due to thermal dust emission, whereas others propose that the far-infrared emission can be explained by synchrotron emission without the need for an additional dust emission component. We present Herschel PACS and SPIRE observations of M87, taken as part of the science demonstration phase observations of the Herschel Virgo Cluster Survey. We compare these data with a synchrotron model based on mid-infrared, far-infrared, submm and radio data from the literature to investigate the origin of the far-infrared emission. Both the integrated SED and the Herschel surface brightness maps are adequately explained by synchrotron emission. At odds with previous claims, we find no evidence of a diffuse dust component in M87, which is not unexpected in the harsh X-ray environment of this radio galaxy sitting at the core of the Virgo Cluster.Comment: Letter accepted for publication in A&A (Herschel special issue

The Herschel Virgo cluster survey: V. Star-forming dwarf galaxies - dust in metal-poor environments

We present the dust properties of a small sample of Virgo cluster dwarf galaxies drawn from the science demonstration phase data set of the Herschel Virgo Cluster Survey. These galaxies have low metallicities (7.8 < 12 + log(O/H) < 8.3) and star-formation rates < 10^{-1} M_{sun}/yr. We measure the spectral energy distribution (SED) from 100 to 500 um and derive dust temperatures and dust masses. The SEDs are fitted by a cool component of temperature T < 20 K, implying dust masses around 10^{5} M_{sun} and dust-to-gas ratios D within the range 10^{-3}-10^{-2}. The completion of the full survey will yield a larger set of galaxies, which will provide more stringent constraints on the dust content of star-forming dwarf galaxies.Comment: Letter accepted for publication in A&A (Herschel special issue

The Herschel Virgo Cluster Survey: VII. Dust in cluster dwarf elliptical galaxies

We use the Science Demonstration Phase data of the Herschel Virgo Cluster Survey to search for dust emission of early-type dwarf galaxies in the central regions of the Virgo Cluster as an alternative way of identifying the interstellar medium.We present the first possible far-infrared detection of cluster early-type dwarf galaxies: VCC781 and VCC951 are detected at the 10 sigma level in the SPIRE 250 micron image. Both detected galaxies have dust masses of the order of 10^5 Msun and average dust temperatures ~20K. The detection rate (less than 1%) is quite high compared to the 1.7% detection rate for Hi emission, considering that dwarfs in the central regions are more Hi deficient. We conclude that the removal of interstellar dust from dwarf galaxies resulting from ram pressure stripping, harassment, or tidal effects must be as efficient as the removal of interstellar gas.Comment: Letter accepted for publication in A&A (Herschel special issue

The Herschel Exploitation of Local Galaxy Andromeda (HELGA). I: Global far-infrared and sub-mm morphology

We have obtained Herschel images at five wavelengths from 100 to 500 micron of a ~5.5x2.5 degree area centred on the local galaxy M31 (Andromeda), our nearest neighbour spiral galaxy, as part of the Herschel guaranteed time project "HELGA". The main goals of HELGA are to study the characteristics of the extended dust emission, focusing on larger scales than studied in previous observations of Andromeda at an increased spatial resolution, and the obscured star formation. In this paper we present data reduction and Herschel maps, and provide a description of the far-infrared morphology, comparing it with features seen at other wavelengths. We use high--resolution maps of the atomic hydrogen, fully covering our fields, to identify dust emission features that can be associated to M31 with confidence, distinguishing them from emission coming from the foreground Galactic cirrus. Thanks to the very large extension of our maps we detect, for the first time at far-infrared wavelengths, three arc-like structures extending out to ~21, ~26 and ~31 kpc respectively, in the south-western part of M31. The presence of these features, hosting ~2.2e6 Msol of dust, is safely confirmed by their detection in HI maps. Overall, we estimate a total dust mass of ~5.8e7 Msol, about 78% of which is contained in the two main ring-like structures at 10 and 15 kpc, at an average temperature of 16.5 K. We find that the gas-to-dust ratio declines exponentially as a function of the galacto-centric distance, in agreement with the known metallicity gradient, with values ranging from 66 in the nucleus to ~275 in the outermost region. [Abridged]Comment: 15 Pages, 9 Figures. Accepted for publication in Astronomy and Astrophysics. A high resolution version of the paper can be found at http://wazn.ugent.be/jfritz/HelgaI_final.pd

Long-term abatacept treatment for 48 weeks in patients with primary Sjögren's syndrome:The open-label extension phase of the ASAP-III trial

Objective: To investigate treatment efficacy of long-term abatacept treatment in pSS patients. Methods: The single-centre ASAP-III trial consisted of two phases: the randomised, double-blind, placebo-controlled phase (1:1 randomisation) from baseline to week 24, of which results have been published previously, and the open-label extension phase from week 24 to 48, in which all patients received abatacept. Main inclusion criteria were fulfilment of the AECG criteria, positive gland biopsy, disease duration = 5. Long-term treatment effects of abatacept on clinical, patient-reported, glandular and laboratory outcome measures were assessed in patients treated with abatacept from baseline to week 48. Furthermore, Composite of Relevant Endpoints for Sj_ogren's Syndrome (CRESS) response (response on >= 3 of 5 items) was analysed. Results: In patients on abatacept treatment for 48 weeks (n = 40), median ESSDAI improved from baseline 14.0 (IQR 9.0 - 16.8) to 4.0 (2.0 - 8.0) at week 48 (p < 0.001), with 50% of patients reaching low disease activity (ESSDAI < 5) at week 48. Median ESSPRI improved from 7.0 (IQR 5.4-7.7) to 5.0 (3.7-6.7) (p < 0.001). Significant improvement was also seen in dry eye and laboratory tests. Combining response at multiple clinically relevant items, 73% of patients were CRESS responders at week 48. Additional improvement was seen between week 24 and week 48 of abatacept treatment. Conclusion: In the open-label extension phase of the ASAP-III trial, improvement was seen up to 48 weeks of abatacept treatment in clinical, patient-reported, dry eye and laboratory outcomes. The majority of patients were CRESS responders at week 48. (c) 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/