Combining intensive practice nurse counselling or brief general practitioner advice with varenicline for smoking cessation in primary care: study protocol of a pragmatic randomized controlled trial

Introduction: Combining behavioural support and pharmacotherapy is most effective for smoking cessation and recommended in clinical guidelines. Despite that smoking cessation assistance from the general practitioner can be effective, dissemination of clinical practice guidelines and efforts on upskilling has not lead to the routine provision of smoking cessation advice among general practitioners. Intensive counselling from the practice nurse could contribute to better smoking cessation rates in primary care. However, the effectiveness of intensive counselling from a practice nurse versus usual care from a general practitioner in combination with varenicline is still unknown. Materials and methods: A pragmatic randomized controlled trial was conducted comparing: (a) intensive individual counselling delivered by a practice nurse and (b) brief advice delivered by a general practitioner; both groups received 12-weeks of open-label varenicline. A minimum of 272 adult daily smoking participants were recruited and treated in their routine primary care setting. The primary outcome was defined as prolonged abstinence from weeks 9 to 26, biochemically validated by exhaled carbon monoxide. Data was analysed blinded according to the intention-to-treat principle and participants with missing data on their smoking status at follow-up were counted as smokers. Secondary outcomes included: one-year prolonged abstinence, short-term incremental cost-effectiveness, medication adherence, and baseline predictors of successful smoking cessation. Discussion: This trial is the first to provide scientific evidence on the effectiveness, cost-effectiveness, and potential mechanisms of action of intensive practice nurse counselling combined with varenicline under real-life conditions. This paper explains the methodology of the trial and discusses the pragmatic and/or explanatory design aspects

NFV service dynamicity with a DevOps approach : demonstrating zero-touch deployment & operations

Next generation network services will be realized by NFV-based microservices to enable greater dynamics in deployment and operations. Here, we present a demonstrator that realizes this concept using the NFV platform built in the EU FP7 project UNIFY. Using the example of an Elastic Router service, we show automated deployment and configuration of service components as well as corresponding monitoring components facilitating automated scaling of the entire service. We also demonstrate automatic execution of troubleshooting and debugging actions. Operations of the service are inspired by DevOps principles, enabling quick detection of operational conditions and fast corrective actions. This demo conveys essential insights on how the life-cycle of an NFV-based network service may be realized in future NFV platforms

DevOps for network function virtualisation: an architectural approach

The Service Programming and Orchestration for Virtualised Software Networks (SONATA) project targets both the flexible programmability of software networks and the optimisation of their deployments by means of integrating Development and Operations in order to accelerate industry adoption of software networks and reduce time-to-market for networked services. SONATA supports network function chaining and orchestration, making service platforms modular and easier to customise to the needs of different service providers, and introduces a specialised Development and Operations model for supporting developers

NFV service dynamicity with a DevOps approach : Insights from a use-case realization

This experience paper describes the process of leveraging the NFV orchestration platform built in the EU FP7 project UNIFY to deploy a dynamic network service exemplified by an elastic router. Elasticity is realized by scaling dataplane resources as a function of traffic load. To achieve this, the service includes a custom scaling logic and monitoring capabilities. An automated monitoring framework not only triggers elastic scaling, but also a troubleshooting process which detects and analyzes anomalies, pro-actively aiding both dev and ops personnel. Such a DevOps-inspired approach enables a shorter update cycle to the running service. We highlight multiple learnings yielded throughout the prototype realization, focussing on the functional areas of service decomposition and scaling; programmable monitoring; and automated troubleshooting. Such practical insights will contribute to solving challenges such as agile deployment and efficient resource usage in future NFV platforms

Chronologically dating the early assembly of the Milky Way

The standard cosmological model predicts that galaxies are built through hierarchical assembly on cosmological timescales1,2. The Milky Way, like other disk galaxies, underwent violent mergers and accretion of small satellite galaxies in its early history. Owing to Gaia Data Release 23 and spectroscopic surveys4, the stellar remnants of such mergers have been identified5–7. The chronological dating of such events is crucial to uncover the formation and evolution of the Galaxy at high redshift, but it has so far been challenging due to difficulties in obtaining precise ages for these oldest stars. Here we combine asteroseismology—the study of stellar oscillations—with kinematics and chemical abundances to estimate precise stellar ages (~11%) for a sample of stars observed by the Kepler space mission8. Crucially, this sample includes not only some of the oldest stars that were formed inside the Galaxy but also stars formed externally and subsequently accreted onto the Milky Way. Leveraging this resolution in age, we provide compelling evidence in favour of models in which the Galaxy had already formed a substantial population of its stars (which now reside mainly in its thick disk) before the infall of the satellite galaxy Gaia-Enceladus/Sausage5,6 around 10 billion years ago

Chronologically dating the early assembly of the Milky Way

The standard cosmological model predicts that galaxies are built through hierarchical assembly on cosmological timescales1,2. The Milky Way, like other disk galaxies, underwent violent mergers and accretion of small satellite galaxies in its early history. Owing to Gaia Data Release 23 and spectroscopic surveys4, the stellar remnants of such mergers have been identified5,6,7. The chronological dating of such events is crucial to uncover the formation and evolution of the Galaxy at high redshift, but it has so far been challenging due to difficulties in obtaining precise ages for these oldest stars. Here we combine asteroseismology—the study of stellar oscillations—with kinematics and chemical abundances to estimate precise stellar ages (~11%) for a sample of stars observed by the Kepler space mission8. Crucially, this sample includes not only some of the oldest stars that were formed inside the Galaxy but also stars formed externally and subsequently accreted onto the Milky Way. Leveraging this resolution in age, we provide compelling evidence in favour of models in which the Galaxy had already formed a substantial population of its stars (which now reside mainly in its thick disk) before the infall of the satellite galaxy Gaia-Enceladus/Sausage5,6 around 10 billion years ago

International Coercion, Emulation and Policy Diffusion: Market-Oriented Infrastructure Reforms, 1977-1999

Why do some countries adopt market-oriented reforms such as deregulation, privatization and liberalization of competition in their infrastructure industries while others do not? Why did the pace of adoption accelerate in the 1990s? Building on neo-institutional theory in sociology, we argue that the domestic adoption of market-oriented reforms is strongly influenced by international pressures of coercion and emulation. We find robust support for these arguments with an event-history analysis of the determinants of reform in the telecommunications and electricity sectors of as many as 205 countries and territories between 1977 and 1999. Our results also suggest that the coercive effect of multilateral lending from the IMF, the World Bank or Regional Development Banks is increasing over time, a finding that is consistent with anecdotal evidence that multilateral organizations have broadened the scope of the “conditionality” terms specifying market-oriented reforms imposed on borrowing countries. We discuss the possibility that, by pressuring countries into policy reform, cross-national coercion and emulation may not produce ideal outcomes.http://deepblue.lib.umich.edu/bitstream/2027.42/40099/3/wp713.pd

The impact of a hybrid social marketing intervention on inequities in access, ownership and use of insecticide-treated nets

BACKGROUND: An ITN intervention was initiated in three predominantly rural districts of Eastern Province, Zambia, that lacked commercial distribution and communication infrastructures. Social marketing techniques were used for product and message development. Public sector clinics and village-based volunteers promoted and distributed subsidized ITNs priced at $2.5 per net. A study was conducted to assess the effects of the intervention on inequities in knowledge, access, ownership and use of ITNs. METHODS: A post-test only quasi-experimental study design was used to compare intervention and comparison districts. A total of 2,986 respondents were interviewed. Survey respondents were grouped into four socio-economic (SES) categories: low, medium-low, medium and high. Knowledge, access, ownership and use indicators are compared. Concentration index scores are calculated. Interactions between intervention status and SES help determine how different SES groups benefited from the intervention. RESULTS: Although overall use of nets remained relatively low, post-test data show that knowledge, access, ownership and use of mosquito nets was higher in intervention districts. A decline in SES inequity in access to nets occurred in intervention districts, resulting from a disproportionately greater increase in access among the low SES group. Declines in SES inequities in net ownership and use of nets were associated with the intervention. The largest increases in net ownership and use occurred among medium and high SES categories. CONCLUSION: Increasing access to nets among the poorest respondents in rural areas may not lead to increases in net use unless the price of nets is no longer a barrier to their purchase

Searches for sterile neutrinos with the IceCube detector

The IceCube neutrino telescope at the South Pole has measured the atmospheric muon neutrino spectrum as a function of zenith angle and energy in the approximate 320 GeV to 20 TeV range, to search for the oscillation signatures of light sterile neutrinos. No evidence for anomalous nu(mu) or (nu) over bar (mu) disappearance is observed in either of two independently developed analyses, each using one year of atmospheric neutrino data. New exclusion limits are placed on the parameter space of the 3 + 1 model, in which muon antineutrinos experience a strong Mikheyev-Smirnov-Wolfenstein-resonant oscillation. The exclusion limits extend to sin(2)2 theta(24) <= 0.02 at Delta m(2) similar to 0.3 eV(2) at the 90% confidence level. The allowed region from global analysis of appearance experiments, including LSND and MiniBooNE, is excluded at approximately the 99% confidence level for the global best-fit value of vertical bar U-e4 vertical bar(2)

The IceCube Neutrino Observatory: Instrumentation and Online Systems

The IceCube Neutrino Observatory is a cubic-kilometer-scale high-energy neutrino detector built into the ice at the South Pole. Construction of IceCube, the largest neutrino detector built to date, was completed in 2011 and enabled the discovery of high-energy astrophysical neutrinos. We describe here the design, production, and calibration of the IceCube digital optical module (DOM), the cable systems, computing hardware, and our methodology for drilling and deployment. We also describe the online triggering and data filtering systems that select candidate neutrino and cosmic ray events for analysis. Due to a rigorous pre-deployment protocol, 98.4% of the DOMs in the deep ice are operating and collecting data. IceCube routinely achieves a detector uptime of 99% by emphasizing software stability and monitoring. Detector operations have been stable since construction was completed, and the detector is expected to operate at least until the end of the next decade.Comment: 83 pages, 50 figures; updated with minor changes from journal review and proofin