Reporting of stepped wedge cluster randomised trials: extension of the CONSORT 2010 statement with explanation and elaboration

This report presents the Consolidated Standards of Reporting Trials (CONSORT) extension for the stepped wedge cluster randomised trial (SW-CRT). The SW-CRT involves randomisation of clusters to different sequences that dictate the order (or timing) at which each cluster will switch to the intervention condition. The statement was developed to allow for the unique characteristics of this increasingly used study design. The guideline was developed using a Delphi survey and consensus meeting; and is informed by the CONSORT statements for individual and cluster randomised trials. Reporting items along with explanations and examples are provided. We include a glossary of terms, and explore the key properties of the SW-CRT which require special consideration in their reporting.This research was funded by the Australian National Health and Medical Research Council (NHMRC) project grant (1108283) and also partly funded by the UK NIHR Collaborations for Leadership in Applied Health Research and Care West Midlands initiative. MDW is funded by a Welcome Trust Senior Investigator award WT097899. JAT is funded by the Medical Research Council Network of Hubs for Trials Methodology Research (MR/L004933/1-P27). JMG holds a Canada Research Chair in Health Knowledge Transfer and Uptake. CW holds a Canada Research Chair. JEM holds an NHMRC Australian Public Health Fellowship (1072366). KH holds an NIHR Senior Research Fellowship (SRF-2017-002)

A qualitative study of speaking out about patient safety concerns in intensive care units

Much policy focus has been afforded to the role of “whistleblowers” in raising concerns about quality and safety of patient care in healthcare settings. However, most opportunities for personnel to identify and act on these concerns are likely to occur much further upstream, in the day-to-day mundane interactions of everyday work. Using qualitative data from over 900 h of ethnographic observation and 98 interviews across 19 English intensive care units (ICUs), we studied how personnel gave voice to concerns about patient safety or poor practice. We observed much low-level social control occurring as part of day-to-day functioning on the wards, with challenges and sanctions routinely used in an effort to prevent or address mistakes and norm violations. Pre-emptions were used to intervene when patients were at immediate risk, and included strategies such as gentle reminders, use of humour, and sharp words. Corrective interventions included education and evidence-based arguments, while sanctions that were applied when it appeared that a breach of safety had occurred included “quiet words”, bantering, public exposure or humiliation, scoldings and brutal reprimands. These forms of social control generally functioned effectively to maintain safe practice. However, they were not consistently effective, and sometimes risked reinforcing norms and idiosyncratic behaviours that were not necessarily aligned with goals of patient safety and high-quality healthcare. Further, making challenges across professional boundaries or hierarchies was sometimes problematic. Our findings suggest that an emphasis on formal reporting or communication training as the solution to giving voice to safety concerns is simplistic; a more sophisticated understanding of social control is needed.This study was funded by the Health Foundation, charity number 286967, and by Mary Dixon-Woods' Wellcome Trust Senior Investigator Award (WT097899)

Serial Flaring in an Active Region: Exploring Why Only One Flare Is Eruptive

Over a four hour period between 2014 June 12–13 a series of three flares were observed within AR 12087. This sequence of flares started with a non-eruptive M-class flare, followed by a non-eruptive C-class flare, and finally ended with a second C-class flare that had an associated filament eruption. In this paper we combine spectroscopic analysis of Interface Region Imaging Spectrometer observations of the Si iv line during the three flares along with a series of nonlinear force-free field (NLFFF) extrapolations in order to investigate the conditions that lead the final flare to be eruptive. From this analysis it is found to be unlikely that the eruption was triggered by either kink instability or by tether-cutting reconnection, allowing the flux rope to rise into a region where it would be susceptible to the torus instability. The NLFFF modeling does, however, suggest that the overlying magnetic field has a fan-spine topology, raising the possibility that breakout reconnection occurring during the first two flares weakened the overlying field, allowing the flux rope to erupt in the subsequent third flare

Observations and Modelling of the Pre-flare Period of the 29 March 2014 X1 Flare

On 29 March 2014, NOAA Active Region (AR) 12017 produced an X1 flare that was simultaneously observed by an unprecedented number of observatories. We have investigated the pre-flare period of this flare from 14:00 UT until 19:00 UT using joint observations made by the Interface Region Imaging Spectrometer (IRIS) and the Hinode Extreme Ultraviolet Imaging Spectrometer (EIS). Spectral lines providing coverage of the solar atmosphere from the chromosphere to the corona were analysed to investigate pre-flare activity within the AR. The results of the investigation have revealed evidence of strongly blue-shifted plasma flows, with velocities up to 200kms−1, being observed 40 minutes prior to flaring. These flows are located along the filament present in the active region and are both spatially discrete and transient. In order to constrain the possible explanations for this activity, we undertake non-potential magnetic field modelling of the active region. This modelling indicates the existence of a weakly twisted flux rope along the polarity inversion line in the region where a filament and the strong pre-flare flows are observed. We then discuss how these observations relate to the current models of flare triggering. We conclude that the most likely drivers of the observed activity are internal reconnection in the flux rope, early onset of the flare reconnection, or tether-cutting reconnection along the filament

Measuring Velocities in the Early Stage of an Eruption: Using “Overlappogram” Data from Hinode EIS

In order to understand the onset phase of a solar eruption, plasma parameter measurements in the early phases are key to constraining models. There are two current instrument types that allow us to make such measurements: narrow-band imagers and spectrometers. In the former case, even narrow-band filters contain multiple emission lines, creating some temperature confusion. With imagers, however, rapid cadences are achievable and the field of view can be large. Velocities of the erupting structures can be measured by feature tracking. In the spectrometer case, slit spectrometers can provide spectrally pure images by "rastering" the slit to build up an image. This method provides limited temporal resolution, but the plasma parameters can be accurately measured, including velocities along the line of sight. Both methods have benefits and are often used in tandem. In this paper we demonstrate for the first time that data from the wide slot on the Hinode EUV Imaging Spectrometer, along with imaging data from AIA, can be used to deconvolve velocity information at the start of an eruption, providing line-of-sight velocities across an extended field of view. Using He ii 256 Å slot data at flare onset, we observe broadening or shift(s) of the emission line of up to ±280 km s−1. These are seen at different locations—the redshifted plasma is seen where the hard X-ray source is later seen (energy deposition site). In addition, blueshifted plasma shows the very early onset of the fast rise of the filament

The Triggering of the 2014 March 29 Filament Eruption

The X1 flare and associated filament eruption occurring in NOAA Active Region 12017 on SOL2014-03-29 has been a source of intense study. In this work, we analyze the results of a series of nonlinear force-free field extrapolations of the flare's pre- and post-flare periods. In combination with observational data provided by the IRIS, Hinode, and Solar Dynamics Observatory missions, we have confirmed the existence of two flux ropes present within the active region prior to flaring. Of these two flux ropes, we find that intriguingly only one erupts during the X1 flare. We propose that the reason for this is due to tether cutting reconnection allowing one of the flux ropes to rise to a torus unstable region prior to flaring, thus allowing it to erupt during the subsequent flare

Učinak atorvastatina na debljinu arterijske intime medije u bolesnika s ishemijskim moždanim udarom

Occlusion of the initial segment of internal carotid artery is the most common reason for vascular events in the brain. The purpose of this study was to investigate the effect of oneyear treatment with atorvastatin on intima-media thickness (IMT) of carotid arteries as a measure of atherosclerosis in stroke patients. In this prospective interventional study, 44 patients with ischemic stroke were investigated. Patients were treated with atorvastatin 40 mg once a day for one year. IMT of carotid arteries was measured by extracranial Doppler ultrasonography in the distal part of the common carotid artery at the beginning of the study, at 6 months and one year of treatment with atorvastatin. The IMT of both right and left carotid arteries decreased after 6- and 12-month atorvastatin treatment. Based on the results of this study, long-term administration of atorvastatin was associated with reduction in carotid artery IMT in patients with ischemic stroke. Such a decrease in IMT may prevent subsequent stroke or cardiovascular events in these patients.Blokada početnog dijela interne karotidne arterije najčešći je razlog vaskularnih ispada u mozgu. Namjera ovoga istraživanja bila je ispitati učinak jednogodišnje terapije atorvastatinom na debljinu intime medije (intima-media thickness, IMT) karotidnih arterija kao mjere ateroskleroze kod bolesnika s moždanim udarom. U ovoj prospektivnoj intervencijskoj studiji ispitana su 44 bolesnika s ishemijskim moždanim udarom. Bolesnici su liječeni atorvastatinom, 40 mg jedanput na dan kroz jednu godinu. IMT karotidnih arterija mjeren je ekstrakranijskom Doppler ultrasonografijom u distalnom dijelu zajedničke karotidne arterije na početku istraživanja te nakon 6 mjeseci i 12 mjeseci liječenja atorvastatinom. Zabilježeno je sniženje IMT i u desnoj i u lijevoj karotidnoj arteriji nakon 6 mjeseci i 12 mjeseci liječenja atorvastatinom. Rezultati ovoga istraživanja pokazuju da je dugotrajno uzimanje atorvastatina bilo udruženo sa smanjenjem IMT karotidnih arterija u bolesnika s ishemijskim moždanim udarom. Takvo sniženje IMT moglo bi spriječiti naknadni moždani udar ili kardiovaskularne ispade kod ovih bolesnika

Monitoring Cognitive and Emotional Processes Through Pupil and Cardiac Response During Dynamic Versus Logical Task

The paper deals with the links between physiological measurements and cognitive and emotional functioning. As long as the operator is a key agent in charge of complex systems, the definition of metrics able to predict his performance is a great challenge. The measurement of the physiological state is a very promising way but a very acute comprehension is required; in particular few studies compare autonomous nervous system reactivity according to specific cognitive processes during task performance and task related psychological stress is often ignored. We compared physiological parameters recorded on 24 healthy subjects facing two neuropsychological tasks: a dynamic task that require problem solving in a world that continually evolves over time and a logical task representative of cognitive processes performed by operators facing everyday problem solving. Results showed that the mean pupil diameter change was higher during the dynamic task; conversely, the heart rate was more elevated during the logical task. Finally, the systolic blood pressure seemed to be strongly sensitive to psychological stress. A better taking into account of the precise influence of a given cognitive activity and both workload and related task-induced psychological stress during task performance is a promising way to better monitor operators in complex working situations to detect mental overload or pejorative stress factor of error

Large tunable valley splitting in edge-free graphene quantum dots on boron nitride

Coherent manipulation of binary degrees of freedom is at the heart of modern quantum technologies. Graphene offers two binary degrees: the electron spin and the valley. Efficient spin control has been demonstrated in many solid state systems, while exploitation of the valley has only recently been started, yet without control on the single electron level. Here, we show that van-der Waals stacking of graphene onto hexagonal boron nitride offers a natural platform for valley control. We use a graphene quantum dot induced by the tip of a scanning tunneling microscope and demonstrate valley splitting that is tunable from -5 to +10 meV (including valley inversion) by sub-10-nm displacements of the quantum dot position. This boosts the range of controlled valley splitting by about one order of magnitude. The tunable inversion of spin and valley states should enable coherent superposition of these degrees of freedom as a first step towards graphene-based qubits

"I'm not being rude, I'd want somebody normal" Adolescents' perception of their peers with Tourette's syndrome; an exploratory study

Background: Tourette’s syndrome (TS) is a highly stigmatised condition, and typically developing adolescents’ motives and reason for excluding individuals with TS have not been examined. Aims: The aim of the study was to understand how TS is conceptualised by adolescents and explore how individuals with TS are perceived by their typically developing peers. Method: Free text writing and focus groups were used to elicit the views of twenty-two year ten students from a secondary school in South East England. Grounded theory was used to develop an analytical framework. Result: Participants’ understanding about the condition was construed from misconceptions, unfamiliarity and unanswered questions. Adolescents who conceived TS as a disorder beyond the individual’s control perceived their peers as being deprived of agency and strength and as straying from the boundaries of normalcy. People with TS were viewed as individuals deserving pity, and in need of support. Although participants maintained they had feelings of social politeness towards those with TS, they would avoid initiating meaningful social relationships with them due to fear of “social contamination”. Intergroup anxiety would also inhibit a close degree of social contact. Participants that viewed those with TS as responsible for their condition expressed a plenary desire for social distance. However, these behavioural intentions were not limited to adolescents that elicited inferences of responsibility to people with TS, indicating that attributional models of stigmatisation may be of secondary importance in the case of TS. Implications for interventions to improve school belonging among youths with TS are discussed