An Integrated Toolkit for the Conservation of Stone-Built Heritage

Rapid in situ diagnosis of damage is a key issue in the preservation of stone-built cultural heritage. This is evident in the increasing number of congresses, workshops and publications dealing with this issue. With this increased activity has come, however, the realisation that for many culturally significant artefacts it is not possible either to remove samples for analysis or to affix surface markers for measurement. It is for this reason that there has been a growth of interest in non-destructive and minimally invasive techniques for characterising internal and external stone condition. With this interest has come the realisation that no single technique can adequately encompass the wide variety of parameters to be assessed or provide the range of information required to identify appropriate conservation. In this paper we describe a strategy to address these problems through the development of an integrated `tool kit' of measurement and analytical techniques aimed specifically at linking object-specific research to appropriate intervention. The strategy is based initially upon the acquisition of accurate three-dimensional models of stone-built heritage at different scales using a combination of millimetre accurate LiDAR and sub-millimetre accurate Object Scanning that can be exported into a GIS or directly into CAD. These are currently used to overlay information on stone characteristics obtained through a combination of Ground Penetrating Radar, Surface Permeametry, Colorimetry and X-ray Fluorescence, but the possibility exists for adding to this array of techniques as appropriate. In addition to the integrated three-dimensional data array provided by superimposition upon Digital Terrain Models, there is the capability of accurate re-measurement to show patterns of surface loss and changes in material condition over time. Thus it is possible to both record and base-line condition and to identify areas that require either preventive maintenance or more significant pre-emptive intervention. In pursuit of these goals the authors are developing, through a UK Government supported collaboration between University Researchers and Conservation Architects, commercially viable protocols for damage diagnosis, condition monitoring and eventually mechanisms for prioritizing repairs to stone-built heritage. The understanding is, however, that such strategies are not age-constrained and can ultimately be applied to structures of any age.

Efficacy of a standard meticillin-resistant Staphylococcus aureus decolonisation protocol in routine clinical practice

Summary

Decolonisation may reduce the risk of meticillin-resistant Staphylococcus aureus (MRSA) infection in individual carriers and prevent transmission to other patients. The aims of this prospective cohort study were to determine the long-term efficacy of a standardised decolonisation regimen and to identify factors associated with failure. Patients colonised with MRSA underwent decolonisation, which was considered to be successful if there was no growth in three consecutive sets of site-specific screening swabs obtained weekly post treatment. If patients were successfully decolonised, follow-up cultures were performed 6 and 12 months later. Of 137 patients enrolled, 79 (58%) were successfully decolonised. Of these 79, 53 (67%) and 44 (56%) remained decolonised at 6 and 12 months respectively. Therefore only 44/137 (32%) patients who completed decolonisation were MRSA negative 12 months later. Outcome was not associated with a particular strain of MRSA. Successful decolonisation was less likely in patients colonised with a mupirocin-resistant isolate (adjusted odds ratio: 0.08; 95% confidence interval: 0.02–0.30), in patients with throat colonisation (0.22; 0.07–0.68) and in patients aged >80 years (0.30; 0.10–0.93) compared with those aged 60–80 years. These findings suggest that although initially successful in some cases, the protocol used did not result in long-term clearance of MRSA carriage for most patients.

Animal foraging from an individual perspective: an object orientated model

A model system, HOOFS (Hierarchical Object Orientated Foraging Simulator), has been developed to study foraging by animals in a complex environment. The model is implemented using an individual-based object-orientated structure. Different species of animals inherit their general properties from a generic animal object which inherits from the basic dynamic object class. Each dynamic object is a separate program thread under the control of a central scheduler. The environment is described as a map of small hexagonal patches, each with their own level of resources and a patch-specific rate of resource replenishment. Each group of seven patches (0th order) is grouped into a Ist order super-patch with seven nth order super-patches making up a n + 1th order super-patch for n up to a specified value. At any time each animal is associated with a single patch. Patch choice is made by combining the information on the resources available within different order patches and super-patches along with information on the spatial location of other animals. The degree of sociality of an animal is defined in terms of optimal spacing from other animals and by the weighting of patch choice based on social factors relative to that based on food availability. Information, available to each animal, about patch resources diminishes with distance from that patch. The model has been used to demonstrate that social interactions can constrain patch choice and result in a short-term reduction of intake and a greater degree of variability in the level of resources in patches. We used the model to show that the effect of this variability on the animal's intake depends on the pattern of patch replenishment. (C) 1998 Elsevier Science B.V. All rights reserved.</p>

The effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle-closure glaucoma (EAGLE): Study protocol for a randomized controlled trial

BACKGROUND: Glaucoma is the leading cause of irreversible blindness. Although primary open-angle glaucoma is more common, primary angle-closure glaucoma (PACG) is more likely to result in irreversible blindness. By 2020, 5·3 million people worldwide will be blind because of PACG. The current standard care for PACG is a stepped approach of a combination of laser iridotomy surgery (to open the drainage angle) and medical treatment (to reduce intraocular pressure). If these treatments fail, glaucoma surgery (eg, trabeculectomy) is indicated. It has been proposed that, because the lens of the eye plays a major role in the mechanisms leading to PACG, early clear lens extraction will improve glaucoma control by opening the drainage angle. This procedure might reduce the need for drugs and glaucoma surgery, maintain good visual acuity, and improve quality of life compared with standard care.EAGLE aims to evaluate whether early lens extraction improves patient-reported, clinical outcomes, and cost-effectiveness, compared with standard care.

METHODS/DESIGN: EAGLE is a multicentre pragmatic randomized trial. All people presenting to the recruitment centres in the UK and east Asia with newly diagnosed PACG and who are at least 50 years old are eligible.The primary outcomes are EQ-5D, intraocular pressure, and incremental cost per quality adjusted life year (QALY) gained. Other outcomes are: vision and glaucoma-specific patient-reported outcomes, visual acuity, visual field, angle closure, number of medications, additional surgery (e.g., trabeculectomy), costs to the health services and patients, and adverse events.A single main analysis will be done at the end of the trial, after three years of follow-up. The analysis will be based on all participants as randomized (intention to treat). 400 participants (200 in each group) will be recruited, to have 90% power at 5% significance level to detect a difference in EQ-5D score between the two groups of 0·05, and a mean difference in intraocular pressure of 1·75 mm Hg. The study will have 80% power to detect a difference of 15% in the glaucoma surgery rate.

TRIAL REGISTRATION: ISRCTN44464607.

Systematic review of the use of behaviour change techniques (BCTs) in home-based cardiac rehabilitation programmes for patients with cardiovascular disease-protocol

BACKGROUND: Cardiovascular diseases (CVDs), including myocardial infarction, heart failure, peripheral arterial disease and strokes, are highly prevalent conditions and are associated with high morbidity and mortality. Cardiac rehabilitation (CR) is an effective form of secondary prevention for CVD but there is a lack of information regarding which specific behaviour change techniques (BCTs) are included in programmes that are associated with improvements in cardiovascular risk factors. This systematic review will describe the BCTs which are utilised within home-based CR programmes that are effective at reducing a spectrum of CVD risk factors.

METHODS/DESIGN: The review will be reported in line with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidance. Randomised and quasi-randomised controlled trials of home-based CR initiated following a vascular event (myocardial infarction, heart failure, peripheral arterial disease and stroke patients) will be included. Articles will be identified through a comprehensive search of MEDLINE, Embase, PsycINFO, Web of Science and Cochrane Database guided by a medical librarian. Two review authors will independently screen articles retrieved from the search for eligibility and extract relevant data, identifying which specific BCTs are included in programmes that are associated with improvements in particular modifiable vascular risk factors.

DISCUSSION: This review will be of value to clinicians and healthcare professionals working with cardiovascular patients by identifying specific BCTs which are used within effective home-based CR. It will also inform the future design and evaluation of complex health service interventions aimed at secondary prevention in CVD.

Systematic evaluation of patient-reported outcome (PRO) protocol content and reporting in UK cancer clinical trials: the EPiC study protocol

Introduction Emerging evidence suggests that patient-reported outcome (PRO)-specific information may be omitted in trial protocols and that PRO results are poorly reported, limiting the use of PRO data to inform cancer care. This study aims to evaluate the standards of PRO-specific content in UK cancer trial protocols and their arising publications and to highlight examples of best-practice PRO protocol content and reporting where they occur. The objective of this study is to determine if these early findings are generalisable to UK cancer trials, and if so, how best we can bring about future improvements in clinical trials methodology to enhance the way PROs are assessed, managed and reported. Hypothesis: Trials in which the primary end point is based on a PRO will have more complete PRO protocol and publication components than trials in which PROs are secondary end points.

Methods and analysis Completed National Institute for Health Research (NIHR) Portfolio Cancer clinical trials (all cancer specialities/age-groups) will be included if they contain a primary/secondary PRO end point. The NIHR portfolio includes cancer trials, supported by a range of funders, adjudged as high-quality clinical research studies. The sample will be drawn from studies completed between 31 December 2000 and 1 March 2014 (n=1141) to allow sufficient time for completion of the final trial report and publication. Two reviewers will then review the protocols and arising publications of included trials to: (1) determine the completeness of their PRO-specific protocol content; (2) determine the proportion and completeness of PRO reporting in UK Cancer trials and (3) model factors associated with PRO protocol and reporting completeness and with PRO reporting proportion.

Ethics and dissemination The study was approved by the ethics committee at University of Birmingham (ERN_15-0311). Trial findings will be disseminated via presentations at local, national and international conferences, peer-reviewed journals and social media including the CPROR twitter account and UOB departmental website (http://www.birmingham.ac.uk/cpro0r).