922017 research outputs found
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Staff training to improve participant recruitment into surgical randomised controlled trials: a feasibility Study Within A Trial (SWAT) across four host randomised controlled trials simultaneously
No full textObjectiveTo test the feasibility of undertaking a simultaneous Study Within A Trial (SWAT) to train staff who recruit participants into surgical randomised controlled trials (RCTs), by assessing key uncertainties around recruitment, randomisation, intervention delivery and data collection. Study design and settingTwelve surgical RCTs were eligible. Interested sites (clusters) were randomised 1:1, with recruiting staff (surgeons and nurses) offered training or no training. The primary outcome was the feasibility of recruiting sites across multiple surgical trials simultaneously. Secondary outcomes included numbers/types of staff enrolled, attendance at training, training acceptability, confidence in recruiting and participant recruitment rates six months later. ResultsFour RCTs (33%) comprising 91 sites participated. Of these, 29 sites agreed to participate (32%) and were randomised to intervention (15 sites, 29 staff) or control (14 sites, 29 staff). Research nurses attended and found the training to be acceptable; no surgeons attended. In the intervention group, there was evidence of increased confidence when pre and post training scores were compared (mean difference in change 1.42; 95% CI 0.56, 2.27; p = 0.002) – there was no effect on recruitment rate. ConclusionIt was feasible to randomise sites across four surgical RCTs in a simultaneous SWAT design. However, as small numbers of trials and sites participated, and no surgeons attended training, strategies to improve these aspects are needed for future evaluations. Trial registrationISRCTN registry: DISC (ISRCTN18254597), registered on 4th April 2017; PROFHER 2 (ISRCTN76296703), registered on 5th April 2018; IntAct (ISRCTN13334746), registered on 10th April 2017; and START:REACTS (ISRCTN17825590), registered on 5th March 2018. The training SWAT has been submitted to the MRC SWAT repository (SWAT111) <br/
Do we need audiogram-based prescriptions? A systematic review.
No full textOBJECTIVE: Hearing aids are typically programmed using the individual’s audiometric thresholds and verified using real-ear measures. Developments in technology have resulted in a new category of direct-to-consumer devices, which are not necessarily programmed using the individual’s audiometric thresholds. This review aimed to identify whether programming hearing aids using the individual’s validated audiogram-based prescription, and verified using real-ear measures, results in better outcomes for adults with hearing loss.DESIGN: The review was registered in PROSPERO and reported in accordance with PRISMA guidelines.STUDY SAMPLE: After screening more than 1,370 records, seven experimental studies met the eligibility criteria.RESULTS: Studies were categorised under three methods of fitting: (i) comparative fitting evaluating different settings based on the beliefs of the audiologist; (ii) client choice of preset responses; and (iii) self-fit by adjustment. The findings suggest that using a prescription based on the individual’s audiogram improves outcomes relative to the comparative and client choice fitting approaches. Self-adjustment during daily use may produce equivalent (or better) outcomes than an audiogram-based prescription. The quality of evidence for the outcomes ranged from low to very low. CONCLUSIONS: This review has highlighted the dearth of high-quality studies on which to make evidence-based decisions on hearing aid fitting methods. <br/
Save money to lose money? Implications of opting out of a voluntary audit review for a firm’s cost of debt
No full textAn audit review (AR) is a mechanism used by boards to assess the quality of interim financial reports on a timely basis. In Canada, the AR is voluntary, with listed firms mandated to disclose when they choose not to purchase additional audit verification. Given the relatively low cost of an AR, opting out of it can be regarded as a negative signal, especially in the context of lenders’ sensitivity to downside risk. Using a sample of 7,585 firm-year observations from 1,616 public firms in Canada over the period 2004-2015, we document that firms without a voluntary AR have a higher cost of debt than firms with an AR. Furthermore, after firms opt out of the AR, the increase in the cost of debt is accompanied by a rise in discretionary abnormal accruals and managers’ stock-based compensation. Moreover, no-AR firms are more likely to reduce post-switch private borrowing and have lower equity analyst following. Our study is the first to document that although listed borrowers that opt out of an AR have a higher cost of debt financing, they are concurrently able to engage in more earnings management and grant their managers higher stock-based compensation because of lower external monitoring
Introduction for the 5th International Meeting on Internet and Audiology: Special Issue of the American Journal of Audiology
No full textPalliative radiotherapy in cancers of female genital tract: Outcomes and prognostic factors
No full textBackground and purposeMetastatic and incurable cancers of the gynaecological tract (FGTC) represent a major global health burden. Systemic treatment has modest efficacy and radiotherapy is often used for local symptoms. This study combines experience from two large UK centres in palliative radiotherapy for gynaecological cancers. Materials and methodsPooled data from two major centres was analysed. Advanced FGTC patients who received at least one fraction of palliative radiotherapy to the pelvis between 2013 to 2018 were included. Data collected included demographic and tumour details, radiotherapy dose fractionation and details of previous and subsequent treatment. Response was defined in terms of toxicity, symptomatic response and survival. Comorbidities were recorded using a modified ACE 27 score which is adjusted for the presence of uncontrolled FGTC in all the patients.ResultsA total of 184 patients were included for treatment response and toxicity; survival data was available for 165 patients. Subjective response in pre-radiotherapy symptoms was documented in 80.4%. Grade 3 or worse gastrointestinal, urinary and other(vomiting, fatigue, pain ) toxicity incidence was 2.2%, 3.8%, and 2.7% respectively. No statistically significant correlation between the prescribed EQD210 and symptom control or toxicity was seen. 1 year overall survival was 25.1% (median 5.9 months). Absent distant metastases, completion of the intended course of radiotherapy, response to radiotherapy, and receipt of further lines of treatment were independent prognostic factors. Conclusion.Palliative radiotherapy is effective for symptoms of advanced FGTC with low toxicity. The absence of a dose response argues for short low dose palliative radiotherapy schedules to be used.<br/
Two-stage Classification for Detecting Murmurs from Phonocardiograms Using Deep and Expert Features
No full textDetection of heart murmurs from stethoscope sounds is a key clinical technique used to identify cardiac abnormalities. We describe the creation of an ensemble classifier using both deep and hand-crafted features to screen for heart murmurs and clinical abnormality from phonocardiogram recordings over multiple auscultation locations. The model was created by the team Murmur Mia! for the George B. Moody PhysioNet Challenge 2022.Methods: Recordings were first filtered through a gradient boosting algorithm to detect Unknown. We assume that these are related to poor quality recordings, and hence we use input features commonly used to assess audio quality. Two further models, a gradient boosting model and ensemble of convolutional neural networks, were trained using time-frequency features and the mel-frequency cepstral coefficients (MFCC) as inputs, respectively. The models were combined using logistic regression, with bespoke rules toconvert individual recording outputs to patient predictions.Results: On the hidden challenge test set, our classifier scored 0.755 for the weighted accuracy and 14228 for clinical outcome challenge metric. This placed 9/40 and 28/39 on the challenge leaderboard, for each scoring metric, respectively.<br/
Enhanced biosynthesis of Polyhydroxyalkanoates by continuous feeding of volatile fatty acids in Haloferax mediterranei
No full textIn this work, the biosynthesis of poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) in Haloferax mediterranei was enhanced by continuous feeding of volatile fatty acids. Using this strategy, polymer production was doubled to around 5 g L–1 PHBV when compared to pulse-fed fed-batch fermentations. Polymer productivity and yield increased up to 12.8 mg L–1 h–1 and 0.63 g g–1 respectively when the carbon concentration in the fermentation media was kept constant at 0.25 molar. This biopolymer production was achieved in less than half the time when compared to pulse feeding, effectively quadrupling the overall PHA productivity. Control over co-polymer composition was achieved and maintained at around 40 mol% 3-hydroxyvalerate (3HV). A correlation between substrate consumption and cell growth was observed, providing a crucial tool for feeding rate selection in future fermentations. The higher productivity and yield obtained with the novel feeding strategy will be key to future industrial scale PHA production
The effects of smoothing length on the onset of wave breaking inSmoothed Particle Hydrodynamics (SPH) simulations of highlydirectionally spread waves
No full textOcean wave breaking is a difficult-to-model oceanographic process, which has implications forextreme wave statistics, the dissipation of wave energy, and air-sea interaction. Numerical methods capable of reliably simulating real-world directionally spread breaking waves are useful for investigating the physics of wave breaking and for the design of offshore structures and floating bodies. Smoothed Particle Hydrodynamics (SPH) is capable of modelling highly steep and overturning free surfaces, which makes it a promising method for simulating breaking waves. This paper investigates the effect of smoothing length on simulated wave breaking in both following and crossing seas. To do so, we reproduce numerically the experiments of highly directionally spread breaking waves in McAllister et al. [J. Fluid Mech. vol. 860, 2019, pp. 767{786] using a range of normalised smoothing lengths: h=dp =1.4, 1.7, 2.0, 2.3, with h smoothing length and dp particle spacing. The smallest smoothing length we use appears to adversely affect the fidelity of the simulated surface elevation, so that the tallest wave crest observed in experiments is not fully reproduced (coefficient of determination r2 ≈ 0:7). For smoothing lengths h=dp = 1:7, 2:0, and 2:3, the experiments are well reproduced (r2 ≥ 0:88); in these simulations smoothing length predominantly affects the spatial extent and duration of breaking. Qualitative and quantitative comparison of our simulations show that values of h=dp in the range 1:7 - 2 best reproduce the wave breaking phenomena observed in experiments