Intervention fidelity: developing an experience-based model for rehabilitation research

This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record.Background Intervention fidelity is concerned with the extent to which interventions are implemented as intended. Consideration of fidelity is essential if the conclusions of effectiveness studies are to be credible, but little attention has been given to it in the rehabilitation literature. We describe our experiences addressing fidelity in the development of a rehabilitation clinical trial, and consider how an existing model of fidelity may be employed in rehabilitation research. Methods We used a model and methods drawn from the psychology literature to investigate how fidelity might be maximised during the planning and development of a stroke rehabilitation trial. We considered fidelity in intervention design, provider training, and the behaviour of providers and participants. We also evaluated methods of assessing fidelity during a trial. Results We identified strategies to help address fidelity in our trial protocol, along with their potential strengths and limitations. We incorporated these strategies into a model of fidelity that is appropriate to the concepts and language of rehabilitation. Conclusion A range of strategies are appropriate to help maximise and measure fidelity in rehabilitation research. Based on our experiences, we propose a model of fidelity and provide recommendations to inform the growing literature of fidelity in this discipline.National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsul

BRIGHT METAL-POOR STARS FROM THE HAMBURG/ESO SURVEY. II. A CHEMODYNAMICAL ANALYSIS

We obtain estimates of stellar atmospheric parameters for a previously published sample of 1777 relatively bright (9 < B <14) metal-poor candidates from the Hamburg/ESO Survey. The original Frebel et al. analysis of these stars was able to derive estimates of [Fe/H] and [C/Fe] only for a subset of the sample, due to limitations in the methodology then available. A new spectroscopic analysis pipeline has been used to obtain estimates of T[subscript eff], log, g, [Fe/H], and [C/Fe] for almost the entire data set. This sample is very local—about 90% of the stars are located within 0.5 kpc of the Sun. We consider the chemodynamical properties of these stars in concert with a similarly local sample of stars from a recent analysis of the Bidelman and MacConnell "weak metal" candidates by Beers et al. We use this combined sample to identify possible members of the halo stream of stars suggested by Helmi et al. and Chiba & Beers, as well as stars that may be associated with stripped debris from the putative parent dwarf of the globular cluster Omega Centauri, suggested to exist by previous authors. We identify a clear increase in the cumulative frequency of carbon-enhanced metal-poor (CEMP) stars with declining metallicity, as well as an increase in the fraction of CEMP stars with distance from the Galactic plane, consistent with previous results. We also identify a relatively large number of CEMP stars with kinematics consistent with the metal-weak thick-disk population, with possible implications for its origin.National Science Foundation (U.S.) (CAREER Grant AST 12-55160)Massachusetts Institute of Technology. Silverman (1968) Family Career Development Professorshi

Uninterested youth? Young people's attitudes towards party politics in Britain

Following the outcome of the 2001 and 2005 General Elections, when the numbers of abstainers outweighed the numbers of Labour voters on both occasions, much attention has focused upon the state of British democracy and how to enthuse the electorate, especially young people. While the government is exploring ways to make the whole process of voting easier, it may be failing to tackle the real problem - that youth appear to find the business of politics uninviting and irrelevant. This paper examines data derived from a nationwide survey of over 700 young people in order to shed light on what lies at the heart of young people's apparent disengagement from formal politics in Britain - political apathy or a sense of political alienation. The findings reveal that they support the democratic process, but are sceptical of the way the British political system is organised and led, and are turned off by politicians and the political parties. However, there is no uniform youth orientation to politics, and the data indicate that views differ according to social class, educational history, and also gender. However both ethnicity and region of the country in which young people live seem to have little influence in structuring political attitudes and behaviour

Glycolytic and Gluconeogenic Growth of \u3cem\u3eEscherichia coli\u3c/em\u3e O157:H7 (EDL933) and \u3cem\u3eE. coli\u3c/em\u3e K-12 (MG1655) in the Mouse Intestine

Escherichia coli EDL933, an O157:H7 strain, is known to colonize the streptomycin-treated CD-1 mouse intestine by growing in intestinal mucus (E. A. Wadolkowski, J. A. Burris, and A. D. O\u27Brien, Infect. Immun. 58:2438-2445, 1990), but what nutrients and metabolic pathways are employed during colonization has not been determined. In this study, when the wild-type EDL933 strain was fed to mice along with an EDL933 ΔppsA ΔpckA mutant, which is unable to utilize tricarboxylic acid cycle intermediates and gluconeogenic substrates for growth, both strains colonized the mouse intestine equally well. Therefore, EDL933 utilizes a glycolytic substrate(s) for both initial growth and maintenance when it is the only E. coli strain fed to the mice. However, in the presence of large numbers of MG1655, a K-12 strain, it is shown that EDL933 utilizes a glycolytic substrate(s) for initial growth in the mouse intestine but appears to utilize both glycolytic and gluconeogenic substrates in an attempt to maintain colonization. It is further shown that MG1655 predominantly utilizes glycolytic substrates for growth in the mouse intestine whether growing in the presence or absence of large numbers of EDL933. Data are presented showing that although small numbers of EDL933 grow to large numbers in the intestine in the presence of large numbers of MG1655 when both strains are fed to mice simultaneously, precolonization with MG1655 affords protection against subsequent colonization by EDL933. Moreover, in mice that are precolonized with EDL933, small numbers of MG1655 are able to grow rapidly in the intestine and EDL933 is eliminated. In situ hybridization experiments using E. coli-specific rRNA probes showed that while MG1655 is found only in mucus, EDL933 is found both in mucus and closely associated with intestinal epithelial cells. The data are discussed with respect to competition for nutrients and to the protection that some intestinal commensal E. coli strains might afford against infection by O157:H7 strains

Carbon nutrition of \u3cem\u3eEscherichia coli\u3c/em\u3e in the mouse intestine

Whole-genome expression profiling revealed Escherichia coli MG1655 genes induced by growth on mucus, conditions designed to mimic nutrient availability in the mammalian intestine. Most were nutritional genes corresponding to catabolic pathways for nutrients found in mucus. We knocked out several pathways and tested the relative fitness of the mutants for colonization of the mouse intestine in competition with their wild-type parent. We found that only mutations in sugar pathways affected colonization, not phospholipid and amino acid catabolism, not gluconeogenesis, not the tricarboxylic acid cycle, and not the pentose phosphate pathway. Gluconate appeared to be a major carbon source used by E. coli MG1655 to colonize, having an impact on both the initiation and maintenance stages. N-acetylglucosamine and N-acetylneuraminic acid appeared to be involved in initiation, but not maintenance. Glucuronate, mannose, fucose, and ribose appeared to be involved in maintenance, but not initiation. The in vitro order of preference for these seven sugars paralleled the relative impact of the corresponding metabolic lesions on colonization: gluconate \u3e N-acetylglucosamine \u3e N-acetylneuraminic acid = glucuronate \u3e mannose \u3e fucose \u3e ribose. The results of this systematic analysis of nutrients used by E. coli MG1655 to colonize the mouse intestine are intriguing in light of the nutrient-niche hypothesis, which states that the ecological niches within the intestine are defined by nutrient availability. Because humans are presumably colonized with different commensal strains, differences in nutrient availability may provide an open niche for infecting E. coli pathogens in some individuals and a barrier to infection in others

Radio Galaxy Zoo: CLARAN - A deep learning classifier for radio morphologies

The upcoming next-generation large area radio continuum surveys can expect tens of millions of radio sources, rendering the traditional method for radio morphology classification through visual inspection unfeasible.We present CLARAN-Classifying Radio sources Automatically with Neural networks - a proof-of-concept radio source morphology classifier based upon the Faster Region-based Convolutional Neutral Networks method. Specifically, we train and test CLARAN on the FIRST and WISE (Wide-field Infrared Survey Explorer) images from the Radio Galaxy Zoo Data Release 1 catalogue. CLARAN provides end users with automated identification of radio source morphology classifications from a simple input of a radio image and a counterpart infrared image of the same region. CLARAN is the first open-source, endto- end radio source morphology classifier that is capable of locating and associating discrete and extended components of radio sources in a fast (&lt;200 ms per image) and accurate (=90 per cent) fashion. Future work will improve CLARAN's relatively lower success rates in dealing with multisource fields and will enable CLARAN to identify sources on much larger fields without loss in classification accuracy

'It is like a tomato stall where someone can pick what he likes': structure and practices of female sex work in Kampala, Uganda.

BACKGROUND: Effective interventions among female sex workers require a thorough knowledge of the context of local sex industries. We explore the organisation of female sex work in a low socio-economic setting in Kampala, Uganda. METHODS: We conducted a qualitative study with 101 participants selected from an epidemiological cohort of 1027 women at high risk of HIV in Kampala. Repeat in-depth life history and work practice interviews were conducted from March 2010 to June 2011. Context specific factors of female sex workers' day-to-day lives were captured. Reported themes were identified and categorised inductively. RESULTS: Of the 101 women, 58 were active self-identified sex workers operating in different locations within the area of study and nine had quit sex work. This paper focuses on these 67 women who gave information about their involvement in sex work. The majority had not gone beyond primary level of education and all had at least one child. Thirty one voluntarily disclosed that they were HIV-positive. Common sex work locations were streets/roadsides, bars and night clubs. Typically sex occurred in lodges near bars/night clubs, dark alleyways or car parking lots. Overall, women experienced sex work-related challenges at their work locations but these were more apparent in outdoor settings. These settings exposed women to violence, visibility to police, a stigmatising public as well as competition for clients, while bars provided some protection from these challenges. Older sex workers tended to prefer bars while the younger ones were mostly based on the streets. Alcohol consumption was a feature in all locations and women said it gave them courage and helped them to withstand the night chill. Condom use was determined by clients' willingness, a woman's level of sobriety or price offered. CONCLUSIONS: Sex work operates across a variety of locations in the study area in Kampala, with each presenting different strategies and challenges for those operating there. Risky practices are present in all locations although they are higher on the streets compared to other locations. Location specific interventions are required to address the complex challenges in sex work environments

Impact of long-term quorum sensing inhibition on uropathogenic Escherichia coli.

BACKGROUND: Quorum sensing is an extracellular bacterial communication system used in the density-dependent regulation of gene expression and development of biofilms. Biofilm formation has been implicated in the establishment of catheter-associated urinary tract infections and therefore quorum sensing inhibitors (QSIs) have been suggested as anti-biofilm catheter coating agents. The long-term effects of QSIs in uropathogens is, however, not clearly understood. OBJECTIVES: We evaluated the effects of repeated exposure to the QSIs cinnamaldehyde, (Z)-4-bromo-5(bromomethylene)-2(5H)-furanone-C30 (furanone-C30) and 4-fluoro-5-hydroxypentane-2,3-dione (F-DPD) on antimicrobial susceptibility, biofilm formation and relative pathogenicity in eight uropathogenic Escherichia coli (UPEC) isolates. METHODS: MICs, MBCs and minimum biofilm eradication concentrations and antibiotic susceptibility were determined. Biofilm formation was quantified using crystal violet. Relative pathogenicity was assessed in a Galleria mellonella model. To correlate changes in phenotype to gene expression, transcriptomic profiles were created through RNA sequencing and variant analysis of genomes was performed in strain EC958. RESULTS: Cinnamaldehyde and furanone-C30 led to increases in susceptibility in planktonic and biofilm-associated UPEC. Relative pathogenicity increased after cinnamaldehyde exposure (4/8 isolates), decreased after furanone-C30 exposure (6/8 isolates) and varied after F-DPD exposure (one increased and one decreased). A total of 9/96 cases of putative antibiotic cross-resistance were generated. Exposure to cinnamaldehyde or F-DPD reduced expression of genes associated with locomotion, whilst cinnamaldehyde caused an increase in genes encoding fimbrial and afimbrial-like adhesins. Furanone-C30 caused a reduction in genes involved in cellular biosynthetic processes, likely though impaired ribonucleoprotein assembly. CONCLUSIONS: The multiple phenotypic adaptations induced during QSI exposure in UPEC should be considered when selecting an anti-infective catheter coating agent

The Milky Way Tomography With SDSS. III. Stellar Kinematics

We study Milky Way kinematics using a sample of 18.8 million main-sequence stars with r 20 degrees). We find that in the region defined by 1 kpc < Z < 5 kpc and 3 kpc < R < 13 kpc, the rotational velocity for disk stars smoothly decreases, and all three components of the velocity dispersion increase, with distance from the Galactic plane. In contrast, the velocity ellipsoid for halo stars is aligned with a spherical coordinate system and appears to be spatially invariant within the probed volume. The velocity distribution of nearby (Z < 1 kpc) K/M stars is complex, and cannot be described by a standard Schwarzschild ellipsoid. For stars in a distance-limited subsample of stars (< 100 pc), we detect a multi-modal velocity distribution consistent with that seen by HIPPARCOS. This strong non-Gaussianity significantly affects the measurements of the velocity-ellipsoid tilt and vertex deviation when using the Schwarzschild approximation. We develop and test a simple descriptive model for the overall kinematic behavior that captures these features over most of the probed volume, and can be used to search for substructure in kinematic and metallicity space. We use this model to predict further improvements in kinematic mapping of the Galaxy expected from Gaia and the Large Synoptic Survey Telescope.NSF AST-615991, AST-0707901, AST-0551161, AST-02-38683, AST-06-07634, AST-0807444, PHY05-51164NASA NAG5-13057, NAG5-13147, NNXO-8AH83GPhysics Frontier Center/Joint Institute for Nuclear Astrophysics (JINA) PHY 08-22648U.S. National Science FoundationMarie Curie Research Training Network ELSA (European Leadership in Space Astrometry) MRTN-CT-2006-033481Fermi Research Alliance, LLC, United States Department of Energy DE-AC02-07CH11359Alfred P. Sloan FoundationParticipating InstitutionsJapanese MonbukagakushoMax Planck SocietyHigher Education Funding Council for EnglandMcDonald Observator

A reporting tool for practice guidelines in healthcare: the RIGHT Statement

The quality of reporting of practice guidelines is often poor and there is no widely accepted guidance or standards for the reporting of practice guidelines in healthcare. An international working group (the RIGHT working group) was therefore established to address this gap. The group followed an existing framework for developing health research reporting guidelines and the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network approach. We developed a checklist and an explanation and elaboration document. The RIGHT checklist includes 22 items that we consider essential for good reporting of practice guidelines. These items encompass basic information (items 1-4), background (items 5-9), evidence (items 10-12), recommendations (items 13-15), review and quality assurance (items 16-17), funding and declaration and management of interests (items 18-19), and other information (items 20-22). The RIGHT checklist can assist developers when reporting their guidelines, support journal editors and peer reviewers when considering guideline reports, and help healthcare practitioners understand and implement a guideline