Public Involvement in research within care homes: Benefits and challenges in the APPROACH Study

Public involvement in research (PIR) can improve research design and recruitment. Less is known about how PIR enhances the experience of participation and enriches the data collection process. In a study to evaluate how UK care homes and primary health care services achieve integrated working to promote older people’s health, PIR was integrated throughout the research processes. Objectives This paper aims to present one way in which PIR has been integrated into the design and delivery of a multi-site research study based in care homes. Design A prospective case study design, with an embedded qualitative evaluation of PIR activity. Setting and Participants Data collection was undertaken in six care homes in three sites in England. Six PIR members participated: all had prior personal or work experience in care homes. Data Collection Qualitative data collection involved discussion groups, and site-specific meetings to review experiences of participation, benefits and challenges, and completion of structured fieldwork notes after each care home visit. Results PIR members supported: recruitment, resident and staff interviews and participated in data interpretation. Benefits of PIR work were resident engagement that minimised distress and made best use of limited research resources. Challenges concerned communication and scheduling. Researcher support for PIR involvement was resource intensive. Discussion and Conclusions Clearly defined roles with identified training and support facilitated involvement in different aspectsPublic Involvement in Research members of the research team: Gail Capstick, Marion Cowie, Derek Hope, Rita Hewitt, Alex Mendoza, John Willmott. Also the involvement of Steven Iliffe and Heather Gag

Large Polarization and Susceptibilities in Artificial Morphotropic Phase Boundary PbZr1−xTixO3 Superlattices

The ability to produce atomically precise, artificial oxide heterostructures allows for the possibility of producing exotic phases and enhanced susceptibilities not found in parent materials. Typical ferroelectric materials either exhibit large saturation polarization away from a phase boundary or large dielectric susceptibility near a phase boundary. Both large ferroelectric polarization and dielectric permittivity are attained wherein fully epitaxial (PbZr0.8Ti0.2O3)n/(PbZr0.4Ti0.6O3)2n (n = 2, 4, 6, 8, 16 unit cells) superlattices are produced such that the overall film chemistry is at the morphotropic phase boundary, but constitutive layers are not. Long- (n ≥ 6) and short-period (n = 2) superlattices reveal large ferroelectric saturation polarization (Ps = 64 µC cm−2) and small dielectric permittivity (εr ≈ 400 at 10 kHz). Intermediate-period (n = 4) superlattices, however, exhibit both large ferroelectric saturation polarization (Ps = 64 µC cm−2) and dielectric permittivity (εr = 776 at 10 kHz). First-order reversal curve analysis reveals the presence of switching distributions for each parent layer and a third, interfacial layer wherein superlattice periodicity modulates the volume fraction of each switching distribution and thus the overall material response. This reveals that deterministic creation of artificial superlattices is an effective pathway for designing materials with enhanced responses to applied bias

Effective health care for older people resident in care homes: the optimal study protocol for realist review

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Care homes in the UK rely on general practice for access to specialist medical and nursing care as well as referral to therapists and secondary care. Service delivery to care homes is highly variable in both quantity and quality. This variability is also evident in the commissioning and organisation of care home-specific services that range from the payment of incentives to general practitioners (GPs) to visit care homes, to the creation of care home specialist teams and outreach services run by geriatricians. No primary studies or systematic reviews have robustly evaluated the impact of these different approaches on organisation and resident-level outcomes. Our aim is to identify factors which may explain the perceived or demonstrated effectiveness of programmes to improve health-related outcomes in older people living in care homes. Methods/Design: A realist review approach will be used to develop a theoretical understanding of what works when, why and in what circumstances. Elements of service models of interest include those that focus on assessment and management of residents’ health, those that use strategies to encourage closer working between visiting health care providers and care home staff, and those that address system-wide issues about access to assessment and treatment. These will include studies on continence, dignity, and speech and language assessment as well as interventions to promote person centred dementia care, improve strength and mobility, and nutrition. The impact of these interventions and their different mechanisms will be considered in relation to five key outcomes: residents’ medication use, use of out of hours’ services, hospital admissions (including use of Accident and Emergency) and length of hospital stay, costs and user satisfaction. An iterative three-stage approach will be undertaken that is stakeholder-driven and optimises the knowledge and networks of the research team. Discussion: This realist review will explore why and for whom different approaches to providing health care to residents in care homes improves access to health care in the five areas of interest. It will inform commissioning decisions and be the basis for further research. This systematic review protocol is registered on the PROSPERO database reference number: CRD42014009112NIHR Health Services & Delivery Research Programme. Project number 11/1021/0

Engaging fathers and grandmothers to improve maternal and child dietary practices: Planning a community-based study in western Kenya

Fathers and grandmothers are key family influencers who have an impact on maternal and child health. This paper describes the planning, design, and implementation of a four-phased evaluation study on the impact of engaging fathers or grandmothers in improving diets of mothers and feeding practices of infants and young children in a rural setting in western Kenya. The study used a quasi-experimental, non-equivalent comparison group design with pre- and post-test observations. It tested the hypothesis that families participating in activities to engage fathers or grandmothers have better knowledge and adopt better practices related to maternal nutrition and complementary feeding than families for which nutrition messages are targeted only to mothers. Information generated from previous formative research was used to design culturally relevant interventions for fathers and grandmothers. Interventions included separate but parallel peer education dialogue groups with fathers and grandmothers. They were held twice a month, and family bazaars and special fathers’ days at local clinics were held once per month. The study team selected the dialogue-based group methodology, including promotion of social support actions, because it engages participants to actively discuss new information and experiences providing social support rather than passively receive information. Community health extension workers and Ministry of Health nutritionists provided supportive supervision and monitoring of the dialogue group activities. Father and grandmother interventions were implemented in two separate sub-locations of Kenya’s former Western Province, and the program effects were compared to findings in a population with a similar socioeconomic background living in a similar sub-location in the same province. An examination of the study implementation methodology provides useful insights into practical issues that need to be addressed in programs seeking to engage key household influencers of maternal nutrition and infant and young child feeding behaviours. Results showed that the dialogue group methodology, formative research to inform intervention design, use of the existing Ministry of Health community health unit structure to provide critical support supervision, and actions that motivated peer mentors were key factors for successful implementation of the study intervention.Keywords: Maternal nutrition, infant feeding, complementary feeding, grandmother, father, design, formative researc

Higgs Messengers

We explore the consequences of the Higgs fields acting as messengers of supersymmetry breaking. The hidden-sector paradigm in the gauge mediation framework is relaxed by allowing two types of gauge-invariant, renormalizable operators that are typically discarded: direct coupling between the Higgses and supersymmetry breaking singlets, and Higgs-messenger mixing terms. The most important phenomenological consequence is a flavor-dependent shift in sfermion masses. This is from a one-loop contribution, which we compute for a general set of weak doublet messengers. We also study a couple of explicit models in detail, finding that precision electroweak constraints can be satisfied with a spectrum significantly different from that of gauge mediation.Comment: 20 pages, 5 figure

Feedback control architecture and the bacterial chemotaxis network.

PMCID: PMC3088647This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Bacteria move towards favourable and away from toxic environments by changing their swimming pattern. This response is regulated by the chemotaxis signalling pathway, which has an important feature: it uses feedback to 'reset' (adapt) the bacterial sensing ability, which allows the bacteria to sense a range of background environmental changes. The role of this feedback has been studied extensively in the simple chemotaxis pathway of Escherichia coli. However it has been recently found that the majority of bacteria have multiple chemotaxis homologues of the E. coli proteins, resulting in more complex pathways. In this paper we investigate the configuration and role of feedback in Rhodobacter sphaeroides, a bacterium containing multiple homologues of the chemotaxis proteins found in E. coli. Multiple proteins could produce different possible feedback configurations, each having different chemotactic performance qualities and levels of robustness to variations and uncertainties in biological parameters and to intracellular noise. We develop four models corresponding to different feedback configurations. Using a series of carefully designed experiments we discriminate between these models and invalidate three of them. When these models are examined in terms of robustness to noise and parametric uncertainties, we find that the non-invalidated model is superior to the others. Moreover, it has a 'cascade control' feedback architecture which is used extensively in engineering to improve system performance, including robustness. Given that the majority of bacteria are known to have multiple chemotaxis pathways, in this paper we show that some feedback architectures allow them to have better performance than others. In particular, cascade control may be an important feature in achieving robust functionality in more complex signalling pathways and in improving their performance

Nucleoside Analogue Reverse Transcriptase Inhibitors Differentially Inhibit Human LINE-1 Retrotransposition

Intact LINE-1 elements are the only retrotransposons encoded by the human genome known to be capable of autonomous replication. Numerous cases of genetic disease have been traced to gene disruptions caused by LINE-1 retrotransposition events in germ-line cells. In addition, genomic instability resulting from LINE-1 retrotransposition in somatic cells has been proposed as a contributing factor to oncogenesis and to cancer progression. LINE-1 element activity may also play a role in normal physiology. LINE-1 retrotransposition reporter assay, we evaluated the abilities of several antiretroviral compounds to inhibit LINE-1 retrotransposition. The nucleoside analogue reverse transcriptase inhibitors (nRTIs): stavudine, zidovudine, tenofovir disoproxil fumarate, and lamivudine all inhibited LINE-1 retrotransposition with varying degrees of potencies, while the non-nucleoside HIV-1 reverse transcriptase inhibitor nevirapine showed no effect.Our data demonstrates the ability for nRTIs to suppress LINE-1 retrotransposition. This is immediately applicable to studies aimed at examining potential roles for LINE-1 retrotransposition in physiological processes. In addition, our data raises novel safety considerations for nRTIs based on their potential to disrupt physiological processes involving LINE-1 retrotransposition

Phylogeography of Japanese encephalitis virus:genotype is associated with climate

The circulation of vector-borne zoonotic viruses is largely determined by the overlap in the geographical distributions of virus-competent vectors and reservoir hosts. What is less clear are the factors influencing the distribution of virus-specific lineages. Japanese encephalitis virus (JEV) is the most important etiologic agent of epidemic encephalitis worldwide, and is primarily maintained between vertebrate reservoir hosts (avian and swine) and culicine mosquitoes. There are five genotypes of JEV: GI-V. In recent years, GI has displaced GIII as the dominant JEV genotype and GV has re-emerged after almost 60 years of undetected virus circulation. JEV is found throughout most of Asia, extending from maritime Siberia in the north to Australia in the south, and as far as Pakistan to the west and Saipan to the east. Transmission of JEV in temperate zones is epidemic with the majority of cases occurring in summer months, while transmission in tropical zones is endemic and occurs year-round at lower rates. To test the hypothesis that viruses circulating in these two geographical zones are genetically distinct, we applied Bayesian phylogeographic, categorical data analysis and phylogeny-trait association test techniques to the largest JEV dataset compiled to date, representing the envelope (E) gene of 487 isolates collected from 12 countries over 75 years. We demonstrated that GIII and the recently emerged GI-b are temperate genotypes likely maintained year-round in northern latitudes, while GI-a and GII are tropical genotypes likely maintained primarily through mosquito-avian and mosquito-swine transmission cycles. This study represents a new paradigm directly linking viral molecular evolution and climate