Development of a self-report measure of capability wellbeing for adults: the ICECAP-A

Purpose The benefits of health and social care are not confined to patient health alone and therefore broader measures of wellbeing may be useful for economic evaluation.\ud This paper reports the development of a simple measure of capability wellbeing for adults (ICECAP-A).\ud Methods In-depth, informant-led, interviews to identify the attributes of capability wellbeing were conducted with 36 adults in the UK. Eighteen semi-structured, repeat interviews were carried out to develop a capability-based descriptive system for the measure. Informants were purposively selected to ensure variation in socio-economic status, age, sex, ethnicity and health. Data analysis was carried out inductively and iteratively alongside interviews, and findings were used to shape the questions in later interviews.\ud Results Five over-arching attributes of capability wellbeing were identified for the measure: ‘‘stability’’,‘‘attachment’’, ‘‘achievement’’, ‘‘autonomy’’ and ‘‘enjoyment’’. One item, with four response categories, was developed for each attribute for the ICECAP-A descriptive system.\ud Conclusions The ICECAP-A capability measure represents a departure from traditional health economics outcome measures, by treating health status as an influence over broader attributes of capability wellbeing. Further work is required to value and validate the attributes and test the sensitivity of the ICECAP-A to healthcare interventions

'He just gave up': an exploratory study into the perspectives of paid carers on supporting older people living in care homes with depression, self-harm, and suicide ideation and behaviours

This study explored the concept of ‘giving up’ from the perspective of care staff working in care homes, and their everyday communication and hidden knowledge concerning what they think about this taboo topic and the context it reflects. Moving to a care home is a major transition where cumulative losses can pose risks to mental health in later life. If not recognised, this vulnerability can lead to depression which extends to suicide ideation and behaviours in the form of self-harm and self-neglect. Care homes are a significant place of care until death, yet a discourse of silence means that self-harm and suicide is under-reported or not attended to with specialist expertise. The layperson’s concept of an older person ‘giving up’ on life is hardly discussed in the literature. This co-produced qualitative study used an inductive approach to explore this phenomenon through focus groups with 33 care staff across four care homes in South-East England. Findings paint a complex picture, highlighting tensions in providing the right support and creating spaces to respond to such challenging situations. ‘Giving up’ requires skilled detailed assessment to respond to risks alongside improved training and support for paid carers, to achieve a more holistic strategy which capitalises on significant relationships within a wider context

High resolution (3 Tesla) MRI-guided conformal brachytherapy for cervical cancer: consequences of different high-risk CTV sizes

Purpose: To evaluate conventional brachytherapy (BT) plans using dose-volume parameters and high resolution (3 Tesla) MRI datasets, and to quantify dosimetric benefits and limitations when MRI-guided, conformal BT (MRIG-CBT) plans are generated. Material and methods: Fifty-five clinical high-dose-rate BT plans from 14 cervical cancer patients were retrospectively studied. All conventional plans were created using MRI with titanium tandem-and-ovoid applicator (T&O) for delivery. For each conventional plan, a MRIG-CBT plan was retrospectively generated using hybrid inverse optimization. Three categories of high risk (HR)-CTV were considered based on volume: non-bulky (\u3c 20 cc), low-bulky (\u3e 20 cc and \u3c 40 cc) and bulky (≥ 40 cc). Dose-volume metrics of D90 of HR-CTV and D2cc and D0.1cc of rectum, bladder, and sigmoid colon were analyzed. Results: Tumor coverage (HR-CTV D90) of the conventional plans was considerably affected by the HR-CTV size. Sixteen percent of the plans covered HR-CTV D90 with the prescription dose within 5%. At least one OAR had D2cc values over the GEC-ESTRO recommended limits in 52.7% of the conventional plans. MRIG-CBT plans showed improved target coverage for HR-CTV D90 of 98 and 97% of the prescribed dose for non-bulky and low-bulky tumors, respectively. No MRIG-CBT plans surpassed the D2cc limits of any OAR. Only small improvements (D90 of 80%) were found for large targets (\u3e 40 cc) when using T&O applicator approach. Conclusions: MRIG-CBT plans displayed considerable improvement for tumor coverage and OAR sparing over conventional treatment. When the HR-CTV volume exceeded 40 cc, its improvements were diminished when using a conventional intracavitary applicator

Spectropolarimetric variability in the repeating fast radio burst source FRB 20180301A

As the sample size of repeating fast radio bursts (FRBs) has grown, an increasing diversity of phenomenology has emerged. Through long-term multi-epoch studies of repeating FRBs, it is possible to assess which phenomena are common to the population and which are unique to individual sources. We present a multi-epoch monitoring campaign of the repeating FRB source 20180301A using the ultra-wideband low (UWL) receiver observations with Murriyang, the Parkes 64-m radio telescope. The observations covered a wide frequency band spanning approximately 0.7--4 GHz, and yielded the detection of 46 bursts. None of the repeat bursts displayed radio emission in the range of 1.8--4 GHz, while the burst emission peaked at 1.1 GHz. We discover evidence for secular trends in the burst dispersion measure, indicating a decline at a rate of $-2.7\pm0.2\,{\rm pc\,cm^{-3}\,yr^{-1}}$. We also found significant variation in the Faraday rotation measure of the bursts across the follow-up period, including evidence of a sign reversal. While a majority of bursts did not exhibit any polarization, those that did show a decrease in the linear polarization fraction as a function of frequency, consistent with spectral depolarization due to scattering, as observed in other repeating FRB sources. Surprisingly, no significant variation in the polarization position angles was found, which is in contrast with earlier measurements reported for the FRB source. We measure the burst rate and sub-pulse drift rate variation and compare them with the previous results. These novel observations, along with the extreme polarization properties observed in other repeating FRBs, suggest that a sub-sample of FRB progenitors possess highly dynamic magneto-ionic environments.Comment: 21 pages, 14 figures; accepted for publication in MNRA

Heavy-Light Mesons with Quenched Lattice NRQCD: Results on Decay Constants

We present a quenched lattice calculation of heavy-light meson decay constants, using non-relativistic (NRQCD) heavy quarks in the mass region of the $b$ quark and heavier, and clover-improved light quarks. The NRQCD Hamiltonian and the heavy-light current include the corrections at first order in the expansion in the inverse heavy quark mass. We study the dependence of the decay constants on the heavy meson mass $M$, for light quarks with the tree level ($c_{SW}$ = 1), as well as the tadpole improved clover coefficient. We compare decay constants from NRQCD with results from clover ($c_{SW}=1$) heavy quarks. Having calculated the current renormalisation constant $Z_A$ in one-loop perturbation theory, we demonstrate how the heavy mass dependence of the pseudoscalar decay constants changes after renormalisation. For the first time, we quote a result for $f_B$ from NRQCD including the full one-loop matching factors at $O(\alpha/M)$.Comment: 45 pages, latex, 24 postscript figure

Women's colposcopy experience and preferences: a mixed methods study

<p>Abstract</p> <p>Background</p> <p>The colposcopy service is a key component in the UK Cervical Screening Programme. Over 120,000 women are referred to the service annually, however up to 25% of women fail to attend their appointment. Little is known about patients' preferences for colposcopic investigation and treatment. This study aims to investigate women's experience of colposcopy, to identify patients' preferences for aspects of appointments within the colposcopy service, and to make suggestions for service improvement.</p> <p>Methods/Design</p> <p>This study has been designed as a two stage, mixed method project. Stage one will involve in-depth interviews with new colposcopy patients to ascertain their experience of colposcopy services. This qualitative stage will generate factors thought to be important by service users in their experience. Stage two will utilise a choice based quantitative technique to identify women's preferences and determine the representativeness of factors generated through the interviews.</p> <p>The initial stage of in-depth interviews will be conducted with patients who are newly referred to colposcopy clinics to investigate the experience that they have of the referral process and appointment attendance. The outcome of these interviews will be analysed qualitatively using Framework analysis. Factors found to be important in women's experience will be extracted and used to construct a choice based questionnaire.</p> <p>The discrete choice experiment (questionnaire) will apply a best-worst technique through scenario-based questions to find women's relative preferences for different aspects of the service. It will be offered to women attending follow-up appointments at two colposcopy clinics in the West Midlands. Women will complete the questionnaire whilst they wait for their appointment, or, if they prefer, will take it home to complete in private. Women who do not attend their appointment will be posted the research information and questionnaire. The questionnaire analysis will use a weighted least squares regression technique for each best/worst pair. The accept/reject 'would you attend this appointment' question will be analysed using a random effects logit model.</p> <p>Discussion</p> <p>Colposcopy is a common procedure and one that is associated with raised anxiety among women experiencing the service. Little is known about women's experience of the service or their preferences for service delivery. The outcomes of the study will comprise a description of women's experience of colposcopy and establishing their preferences for how aspects of the service should be provided. Women's preferences will be fed back to service providers to enable improvements to the service to be made.</p