RESPOND – A patient-centred programme to prevent secondary falls in older people presenting to the emergency department with a fall: Protocol for a mixed methods programme evaluation.

Background Programme evaluations conducted alongside randomised controlled trials (RCTs) have potential to enhance understanding of trial outcomes. This paper describes a multi-level programme evaluation to be conducted alongside an RCT of a falls prevention programme (RESPOND). Objectives 1) To conduct a process evaluation in order to identify the degree of implementation fidelity and associated barriers and facilitators. 2) To evaluate the primary intended impact of the programme: participation in fall prevention strategies, and the factors influencing participation. 3) To identify the factors influencing RESPOND RCT outcomes: falls, fall injuries and ED re-presentations. Methods/ Design Five hundred and twenty eight community-dwelling adults aged 60–90 years presenting to two EDs with a fall will be recruited and randomly assigned to the intervention or standard care group. All RESPOND participants and RESPOND clinicians will be included in the evaluation. A mixed methods design will be used and a programme logic model will frame the evaluation. Data will be sourced from interviews, focus groups, questionnaires, clinician case notes, recruitment records, participant-completed calendars, hospital administrative datasets, and audio-recordings of intervention contacts. Quantitative data will be analysed via descriptive and inferential statistics and qualitative data will be interpreted using thematic analysis. Discussion The RESPOND programme evaluation will provide information about contextual and influencing factors related to the RCT outcomes. The results will assist researchers, clinicians, and policy makers to make decisions about future falls prevention interventions. Insights gained are likely to be transferable to preventive health programmes for a range of chronic conditions

Sleeping trees and sleep-related behaviours of the siamang (Symphalangus syndactylus) in a tropical lowland rainforest, Sumatra, Indonesia

Sleeping tree selection and related behaviours of a family group and a solitary female siamang (Symphalangus syndactylus) were investigated over a 5-month period in northern Sumatra, Indonesia. We performed all day follows, sleeping tree surveys and forest plot enumerations in the field. We tested whether: (1) physical characteristics of sleeping trees and the surrounding trees, together with siamang behaviours, supported selection based on predation risk and access requirements; (2) the preferences of a solitary siamang were similar to those of a family group; and (3) sleeping site locations within home ranges were indicative of home range defence, scramble competition with other groups or other species, or food requirements. Our data showed that (1) sleeping trees were tall, emergent trees with some, albeit low, connectivity to the neighbouring canopy, and that they were surrounded by other tall trees. Siamangs showed early entry into and departure from sleeping trees, and slept at the ends of branches. These results indicate that the siamangs’ choice of sleeping trees and related behaviours were strongly driven by predator avoidance. The observed regular reuse of sleeping sites, however, did not support anti-predation theory. (2) The solitary female displayed selection criteria for sleeping trees that were similar to those of the family group, but she slept more frequently in smaller trees than the latter. (3) Siamangs selected sleeping trees to avoid neighbouring groups, monopolise resources (competition), and to be near their last feeding tree. Our findings indicate selectivity in the siamangs’ use of sleeping trees, with only a few trees in the study site being used for this purpose. Any reduction in the availability of such trees might make otherwise suitable habitat unsuitable for these highly arboreal small apes

Progress in the Preclinical Discovery and Clinical Development of Class I and Dual Class I/IV Phosphoinositide 3-Kinase (PI3K) Inhibitors

The phosphoinositide 3-kinases (PI3Ks) constitute an important family of lipid kinase enzymes that control a range of cellular processes through their regulation of a network of signal transduction pathways, and have emerged as important therapeutic targets in the context of cancer, inflammation and cardiovascular diseases. Since the mid-late 1990s, considerable progress has been made in the discovery and development of small molecule ATP-competitive PI3K inhibitors, a number of which have entered early phase human trials over recent years from which key clinical results are now being disclosed. This review summarizes progress made to date, primarily on the discovery and characterization of class I and dual class I/IV subtype inhibitors, together with advances that have been made in translational and clinical research, notably in cancer

Long-term changes to the frequency of occurrence of British moths are consistent with opposing and synergistic effects of climate and land-use changes

1. Species’ distributions are likely to be affected by a combination of environmental drivers. We used a data set of 11 million species occurrence records over the period 1970–2010 to assess changes in the frequency of occurrence of 673 macro-moth species in Great Britain. Groups of species with different predicted sensitivities showed divergent trends, which we interpret in the context of land-use and climatic changes. 2. A diversity of responses was revealed: 260 moth species declined significantly, whereas 160 increased significantly. Overall, frequencies of occurrence declined, mirroring trends in less species-rich, yet more intensively studied taxa. 3. Geographically widespread species, which were predicted to be more sensitive to land use than to climate change, declined significantly in southern Britain, where the cover of urban and arable land has increased. 4. Moths associated with low nitrogen and open environments (based on their larval host plant characteristics) declined most strongly, which is also consistent with a land-use change explanation. 5. Some moths that reach their northern (leading edge) range limit in southern Britain increased, whereas species restricted to northern Britain (trailing edge) declined significantly, consistent with a climate change explanation. 6. Not all species of a given type behaved similarly, suggesting that complex interactions between species’ attributes and different combinations of environmental drivers determine frequency of occurrence changes. 7. Synthesis and applications. Our findings are consistent with large-scale responses to climatic and land-use changes, with some species increasing and others decreasing. We suggest that land-use change (e.g. habitat loss, nitrogen deposition) and climate change are both major drivers of moth biodiversity change, acting independently and in combination. Importantly, the diverse responses revealed in this species-rich taxon show that multifaceted conservation strategies are needed to minimize negative biodiversity impacts of multiple environmental changes. We suggest that habitat protection, management and ecological restoration can mitigate combined impacts of land-use change and climate change by providing environments that are suitable for existing populations and also enable species to shift their ranges

On the Cauchy problem for the debar operator

We present new results concerning the solvability, of lack thereof, in the Cauchy problem for the debar operator, with initial values assigned on a weakly pseudoconvex hypersurface, and provide illustrative examples.Comment: This is the final version, which is appearing in Arkiv foer Mathemati

Field localization in warped gauge theories

We present four-dimensional gauge theories that describe physics on five-dimensional curved (warped) backgrounds, which includes bulk fields with various spins (vectors, spinors, and scalars). Field theory on the AdS$_5$ geometry is examined as a simple example of our formulation. Various properties of bulk fields on this background, e.g., the mass spectrum and field localization behavior, can be achieved within a fully four-dimensional framework. Moreover, that gives a localization mechanism for massless vector fields. We also consider supersymmetric cases, and show in particular that the conditions on bulk masses imposed by supersymmetry on warped backgrounds are derived from a four-dimensional supersymmetric theory on the flat background. As a phenomenological application, models are shown to generate hierarchical Yukawa couplings. Finally, we discuss possible underlying mechanisms which dynamically realize the required couplings to generate curved geometries.Comment: 24 pages, 12 figures; more explanation of nonuniversal gauge couplings added, typos corrected, references update

Electron Exchange Coupling for Single Donor Solid-State Qubits

Inter-valley interference between degenerate conduction band minima has been shown to lead to oscillations in the exchange energy between neighbouring phosphorus donor electron states in silicon \cite{Koiller02,Koiller02A}. These same effects lead to an extreme sensitivity of the exchange energy on the relative orientation of the donor atoms, an issue of crucial importance in the construction silicon-based spin quantum computers. In this article we calculate the donor electron exchange coupling as a function of donor position incorporating the full Bloch structure of the Kohn-Luttinger electron wavefunctions. It is found that due to the rapidly oscillating nature of the terms they produce, the periodic part of the Bloch functions can be safely ignored in the Heitler-London integrals as was done by Koiller et. al. [Phys. Rev. Lett. 88,027903(2002),Phys. Rev. B. 66,115201(2002)], significantly reducing the complexity of calculations. We address issues of fabrication and calculate the expected exchange coupling between neighbouring donors that have been implanted into the silicon substrate using an 15keV ion beam in the so-called 'top down' fabrication scheme for a Kane solid-state quantum computer. In addition we calculate the exchange coupling as a function of the voltage bias on control gates used to manipulate the electron wavefunctions and implement quantum logic operations in the Kane proposal, and find that these gate biases can be used to both increase and decrease the magnitude of the exchange coupling between neighbouring donor electrons. The zero-bias results reconfirm those previously obtained by Koiller.Comment: 10 Pages, 8 Figures. To appear in Physical Review

Measuring and modelling microclimatic air temperature in a historically degraded tropical forest

Climate change is predicted to cause widespread disruptions to global biodiversity. Most climate models are at the macroscale, operating at a ~1 km resolution and predicting future temperatures at 1.5–2 m above ground level, making them unable to predict microclimates at the scale that many organisms experience temperature. We studied the efects of forest structure and vertical position on microclimatic air temperature within forest canopy in a historically degraded tropical forest in Sikundur, Northern Sumatra, Indonesia. We collected temperature measurements in ffteen plots over 20 months, alongside vegetation structure data from the same ffteen 25×25 m plots. We also performed airborne surveys using an unmanned aerial vehicle (UAV) to record canopy structure remotely, both over the plot locations and a wider area. We hypothesised that old-growth forest structure would moderate microclimatic air temperature. Our data showed that Sikundur is a thermally dynamic envi ronment, with simultaneously recorded temperatures at diferent locations within the canopy varying by up to~15 °C. Our models (R2=0.90 to 0.95) showed that temperature diferences between data loggers at diferent sites were largely determined by variation in recording height and the amount of solar radiation reaching the topmost part of the canopy, although strong interactions between these abiotic factors and canopy structure shaped microclimate air temperature variation. The impacts of forest degradation have smaller relative influence on models of microclimatic air temperature than abiotic factors, but the loss of canopy density increases temperature. This may render areas of degraded tropical forests unsuitable for some forest dwelling species with the advent of future climate chang

An optimal gap theorem

By solving the Cauchy problem for the Hodge-Laplace heat equation for $d$-closed, positive $(1, 1)$-forms, we prove an optimal gap theorem for K\"ahler manifolds with nonnegative bisectional curvature which asserts that the manifold is flat if the average of the scalar curvature over balls of radius $r$ centered at any fixed point $o$ is a function of $o(r^{-2})$. Furthermore via a relative monotonicity estimate we obtain a stronger statement, namely a `positive mass' type result, asserting that if $(M, g)$ is not flat, then $\liminf_{r\to \infty} \frac{r^2}{V_o(r)}\int_{B_o(r)}\mathcal{S}(y)\, d\mu(y)>0$ for any $o\in M$