324 research outputs found
Lensing in the Hercules Supercluster
We report Keck LRIS observations of an arc-like background galaxy near the
center of Abell 2152 (z=0.043), one of the three clusters comprising the
Hercules supercluster. The background object has a redshift z=0.1423 and is
situated 25 arcsec north of the primary component of the A2152 brightest
cluster galaxy (BCG). The object is about 15 arcsec in total length and has a
reddening-corrected R-band magnitude of . Its spectrum
shows numerous strong emission lines, as well as absorption features. The
strength of the H-alpha emission would imply a star formation rate \SFR
\approx 3h^{-2} \msun yr in the absence of any lensing. However, the
curved shaped of this object and its tangential orientation along the major
axis of the BCG suggest lensing. We model the A2152 core mass distribution
including the two BCG components and the cluster potential. We present velocity
and velocity dispersion profile measurements for the two BCG components and use
these to help constrain the potential. The lens modeling indicates a likely
magnification factor of for the lensed galaxy, making A2152 the
nearest cluster in which such significant lensing of a background source has
been observed. Finally, we see evidence for a concentration of early-type
galaxies at near the centroid of the X-ray emission previously
attributed to A2152. We suggest that emission from this background
concentration is the cause of the offset of the X-ray center from the A2152
BCG. The background concentration and the dispersed mass of the Hercules
supercluster could add further to the lensing strength of the A2152 cluster.Comment: Accepted for publication in AJ (January 2001). 9 pages; uses
emulateapj.sty. The all-important "Figure 1" is included here in GIF format;
for a version which includes Figure 1 as a high-resolution Postscript image,
see: http://adcam.pha.jhu.edu/~jpb/a2152.ps.g
The development of a new measure of quality of life in the management of gastro-oesophageal reflux disease: the Reflux Questionnaire.
INTRODUCTION
This paper reports on the development of a new measure of health-related quality of life for use among patients with gastro-oesophageal reflux disease (GORD), funded as part of the REFLUX trial. This is a large UK multi centre trial that aims to compare the clinical and cost effectiveness of minimal access surgery with best medical treatment for patients with GORD within the NHS.
Method Potential items were identified via a series of interviews and focus groups carried out with patients who were receiving/had received medical or surgical treatment for GORD. The final measure consisted of 31 items covering 7 categories (Heartburn; Acid reflux; Wind; Eating and swallowing; Bowel movements; Sleep; Work, physical and social activities). The measure produced two outputs: a quality of life score (RQLS) and five Reflux symptom scores. Reliability (internal consistency), criterion validity with the SF-36 and, sensitivity to change in terms of relationship with reported change in prescribed medication were assessed amongst a sample of 794 patients recruited into the trial.
RESULTS
The measure was shown to be internally consistent, to show criterion validity with the SF-36 and sensitive to changes in patients use of prescribed medication at baseline and 3 month follow-up.
DISCUSSION
The Reflux questionnaire is a new self-administered questionnaire for use amongst patients with GORD. Initial findings suggest that the new measure is valid, reliable, acceptable to respondents and simple to administer in both a clinical and research context
PRimary care rEsponse to domestic violence and abuse in the COvid-19 panDEmic (PRECODE): protocol of a rapid mixed-methods study in the UK
BACKGROUND: The implementation of lockdowns in the UK during the COVID-19 pandemic resulted in a system switch to remote primary care consulting at the same time as the incidence of domestic violence and abuse (DVA) increased. Lockdown-specific barriers to disclosure of DVA reduced the opportunity for DVA detection and referral. The PRECODE (PRimary care rEsponse to domestic violence and abuse in the COvid-19 panDEmic) study will comprise quantitative analysis of the impact of the pandemic on referrals from IRIS (Identification and Referral to Improve Safety) trained general practices to DVA agencies in the UK and qualitative analysis of the experiences of clinicians responding to patients affected by DVA and adaptations they have made transitioning to remote DVA training and patient support. METHODS/DESIGN: Using a rapid mixed method design, PRECODE will explore and explain the dynamics of DVA referrals and support before and during the pandemic on a national scale using qualitative data and over four years of referrals time series data. We will undertake interrupted-time series and non-linear regression analysis, including sensitivity analyses, on time series of referrals to DVA services from routinely collected data to evaluate the impact of the pandemic and associated lockdowns on referrals to the IRIS Programme, and analyse key determinants associated with changes in referrals. We will also conduct an interview- and observation-based qualitative study to understand the variation, relevance and feasibility of primary care responses to DVA before and during the pandemic and its aftermath. The triangulation of quantitative and qualitative findings using rapid analysis and synthesis will enable the articulation of multiscale trends in primary care responses to DVA and complex mechanisms by which these responses have changed during the pandemic. DISCUSSION: Our findings will inform the implementation of remote primary care and DVA service responses as services re-configure. Understanding the adaptation of clinical and service responses to DVA during the pandemic is crucial for the development of evidence-based, effective remote support and referral beyond the pandemic. TRIAL REGISTRATION: PRECODE is an observational epidemiologic study, not an intervention evaluation or trial. We will not be reporting results of an intervention on human participants
Minimal access surgery compared with medical management for chronic gastro-oesophageal reflux disease : UK collaborative randomised trial
ABSTRACT
Objective To determine the relative benefits and risks of laparoscopic fundoplication surgery as an alternative to long term drug treatment for chronic gastro-oesophageal reflux disease (GORD). Design Multicentre, pragmatic randomised trial (with parallel preference groups). Setting 21 hospitals in the United Kingdom.
Participants 357 randomised participants (178 surgical,179 medical) and 453 preference participants (261, 192); mean age 46; 66% men. All participants had documented evidence of GORD and symptoms for >12 months. Intervention The type of laparoscopic fundoplication used was left to the discretion of the surgeon. Those allocated to medical treatment had their treatment reviewed and adjusted as necessary by a local gastroenterologist, and subsequent clinical management was at the discretion of the clinician responsible for care. Main outcome measures The disease specific REFLUX quality of life score (primary outcome), SF-36, EQ-5D, and medication use, measured at time points equivalent to three and 12 months after surgery, and surgical complications. Main results Randomised participants had received drugs for GORD for median of 32 months before trial entry. Baseline REFLUX scores were 63.6 (SD 24.1) and 66.8 (SD 24.5) in the surgical and medical randomised groups, respectively. Of those randomised to surgery, 111 (62%) actually had total or partial fundoplication. Surgical complications were uncommon with a conversion rate of 0.6% and no mortality. By 12 months, 38% (59/154) randomised to surgery (14% (14/104) among those who had fundoplication) were taking reflux medication versus 90% (147/164) randomised medical management. The REFLUX score favoured the randomised surgical group (14.0, 95% confidence interval 9.6 to 18.4; P<0.001). Differences of a third to half of 1 SD in other health status measures also favoured the randomised surgical group. Baseline scores in the preference for surgery group were the worst; by 12 months these were better than in the preference for medical treatment group. Conclusion At least up to 12 months after surgery, laparoscopic fundoplication significantly increased measures of health status in patients with GORD. Trial registration ISRCTN15517081This study was funded by the NIHR Health Technology Assessment Programme (as part of project no. 97/10/99) and the full
project report is published in Health Technology Assessment 2008;12:1/181. The Health Services Research Unit is funded by the Chief Scientist Office of the Scottish Government Health Directorates.Peer reviewe
Bidirectional lipid droplet velocities are controlled by differential binding strengths of HCV Core DII protein
Host cell lipid droplets (LD) are essential in the hepatitis C virus (HCV) life cycle and are targeted by the viral capsid core protein. Core-coated LDs accumulate in the perinuclear region and facilitate viral particle assembly, but it is unclear how mobility of these LDs is directed by core. Herein we used two-photon fluorescence, differential interference contrast imaging, and coherent anti-Stokes Raman scattering microscopies, to reveal novel core-mediated changes to LD dynamics. Expression of core protein’s lipid binding domain II (DII-core) induced slower LD speeds, but did not affect directionality of movement on microtubules. Modulating the LD binding strength of DII-core further impacted LD mobility, revealing the temporal effects of LD-bound DII-core. These results for DII-core coated LDs support a model for core-mediated LD localization that involves core slowing down the rate of movement of LDs until localization at the perinuclear region is accomplished where LD movement ceases. The guided localization of LDs by HCV core protein not only is essential to the viral life cycle but also poses an interesting target for the development of antiviral strategies against HCV
The TANDEM trial: protocol for the process evaluation of a randomised trial of a complex intervention for anxiety and/or depression in people living with chronic obstructive pulmonary disease (COPD)
Background: TANDEM is a randomised controlled trial of a complex healthcare intervention to improve the
psychological and physical health of people living with chronic obstructive pulmonary disease (COPD) and anxiety
and/or depression. Based on health psychology theory set out in a logic model, respiratory health professionals
were recruited and trained to deliver a cognitive behavioural approach intervention (The TANDEM intervention)
under the supervision of senior cognitive behavioural practitioners. Here, we describe the protocol for the process
evaluation commissioned alongside the trial. A realist approach that includes attention to describing contexts and
mechanisms has been adopted.
Methods: We set up a multi-disciplinary team to develop and deliver the process evaluation. The mixed-methods
design incorporates quantitative process data; monitoring of intervention fidelity; qualitative interviews with
patients, carers, health professionals (facilitators) and clinical supervisors about their perspectives on acceptability of
the intervention; and exploration with all stakeholders (including management/policy-makers) on future
implementation. Normalisation process theory (NPT) will inform data collection and interpretation with a focus on
implementation. Quantitative process data will be analysed descriptively. Qualitative interview data will be analysed
before the trial outcomes are known using analytic induction and constant comparison to develop themes.
Findings from the different elements will be reported separately and then integrated.
Conclusion: Detailed description and analysis of study processes in a research trial such as TANDEM enables
research teams to describe study contexts and mechanisms and to examine the relationship with outcomes. In this
way, learning from the trial goes beyond the randomised control trial (RCT) model where effectiveness is prioritised
and makes it possible to explore issues arising for post-trial study implementation.
Trial registration: ISRCTN ISRCTN59537391. Registered on 20 March 2017. Trial protocol version 6.0, 22 April 2018.
Process evaluation protocol version 4.0, 1 November 2020
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Adapting domestic abuse training to remote delivery during the COVID-19 pandemic: perspectives from general practice and support services
BACKGROUND: Identifying and responding to patients affected by domestic violence and abuse (DVA) is vital in primary care. There may have been a rise in the reporting of DVA cases during the COVID-19 pandemic and associated lockdown measures. Concurrently general practice adopted remote working that extended to training and education. IRIS (Identification and Referral to Improve Safety) is an example of an evidence-based UK healthcare training support and referral programme, focusing on DVA. IRIS transitioned to remote delivery during the pandemic.
AIM: To understand the adaptations and impact of remote DVA training in IRIS-trained general practices by exploring perspectives of those delivering and receiving training.
DESIGN AND SETTING: Qualitative interviews and observation of remote training of general practice teams in England were undertaken.
METHOD: Semi-structured interviews were conducted with 21 participants (three practice managers, three reception and administrative staff, eight general practice clinicians, and seven specialist DVA staff), alongside observation of eight remote training sessions. Analysis was conducted using a framework approach.
RESULTS: Remote DVA training in UK general practice widened access to learners. However, it may have reduced learner engagement compared with face-to-face training and may challenge safeguarding of remote learners who are domestic abuse survivors. DVA training is integral to the partnership between general practice and specialist DVA services, and reduced engagement risks weakening this partnership.
CONCLUSION: The authors recommend a hybrid DVA training model for general practice, including remote information delivery alongside a structured face-to-face element. This has broader relevance for other specialist services providing training and education in primary care
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