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Airborne longwave-infrared (LWIR) hyperspectral imagery acquisitions were coordinated with stationary and mobile ground-based in situ measurements of atmospheric ammonia in regions surrounding California’s Salton Sea, an area of commingled intensive animal husbandry and agriculture operations that is encumbered by exceptionally high levels of persistent ammonia and PM2.5 pollution. The goal of this study was to validate remotely sensed ammonia retrievals against ground truth measurements as part of a broader effort to elucidate the behavior of the atmospheric ammonia burden in this area of abundant diffuse and point sources. The nominal 2 m pixel size of the airborne data revealed variability in ammonia concentrations at a diversity of scales within the study area. At this pixel resolution, ammonia plumes emitted by individual facilities could be clearly discriminated and their dispersion characteristics inferred. Several factors, including thermal contrast and atmospheric boundary layer depth, contributed to the overall uncertainty of the intercomparison between airborne ammonia quantitative retrievals and the corresponding in situ measurements, for which agreement was in the 16–37% range under the most favorable conditions. Hence, while the findings attest to the viability of airborne LWIR spectral imaging for quantifying atmospheric ammonia concentrations, the accuracy of ground-level estimations depends significantly on precise knowledge of these atmospheric factors.

Distributions of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and fecal viral biomarkers between solid and liquid phases of wastewater are largely unknown. Herein, distributions of SARS-CoV-2, Pepper Mild Mottle Virus (PMMoV), and F-RNA bacteriophage group II (FRNAPH-II) were determined by viral RNA RT-qPCR. Comparison of viral recovery using three conventional fractionation methods included membrane filtration, a combination of mid-speed centrifugation and membrane filtration, and high-speed centrifugation. SARS-CoV-2 partitioned to the solids fraction in greater abundance compared to liquid fractions in a combination of mid-speed centrifugation and membrane filtration and high-speed centrifugation, but not in membrane filtration method in a particular assay, while fecal biomarkers (PMMoV and FRNAPH-II) exhibited the reciprocal relationship. The wastewater fractionation method had minimal effects on the solids-liquids distribution for all viral and phage markers tested; however, viral RNA load was significantly greater in solid–liquid fractions viral RNA loads compared with the than whole-wastewater PEG precipitation. A RNeasy PowerWater Kit with PCR inhibitor removal resulted in greater viral RNA loads and lesser PCR inhibition compared to a QIAamp Viral RNA Mini Kit without PCR inhibitor removal. These results support the development of improved methods and interpretation of WBE of SARS-CoV-2. • Distribution of SARS-CoV-2 to liquid and solid portions was addressed. • Addressing PCR inhibition is important in wastewater-based epidemiology. • Fraction methods have minimal effect.

Abstract Background The spread of SARS-CoV-2 has been studied at unprecedented levels worldwide. In jurisdictions where molecular analysis was performed on large scales, the emergence and competition of numerous SARS-CoV-2lineages have been observed in near real-time. Lineage identification, traditionally performed from clinical samples, can also be determined by sampling wastewater from sewersheds serving populations of interest. Variants of concern (VOCs) and SARS-CoV-2 lineages associated with increased transmissibility and/or severity are of particular interest. Method Here, we consider clinical and wastewater data sources to assess the emergence and spread of VOCs in Canada retrospectively. Results We show that, overall, wastewater-based VOC identification provides similar insights to the surveillance based on clinical samples. Based on clinical data, we observed synchrony in VOC introduction as well as similar emergence speeds across most Canadian provinces despite the large geographical size of the country and differences in provincial public health measures. Conclusion In particular, it took approximately four months for VOC Alpha and Delta to contribute to half of the incidence. In contrast, VOC Omicron achieved the same contribution in less than one month. This study provides significant benchmarks to enhance planning for future VOCs, and to some extent for future pandemics caused by other pathogens, by quantifying the rate of SARS-CoV-2 VOCs invasion in Canada.

Abstract Background Inpatient rehabilitation services are challenged by increasing demand. Where appropriate, a shift in service models towards more community-oriented approaches may improve efficiency. We aimed to estimate the hypothetical cost of delivering a consensus-based rehabilitation in the home (RITH) model as hospital substitution for patients requiring reconditioning following medical illness, surgery or treatment for cancer, compared to the cost of inpatient rehabilitation. Methods Data were drawn from the following sources: the results of a Delphi survey with health professionals working in the field of rehabilitation in Australia; publicly available data and reports; and the expert opinion of the project team. Delphi survey data were analysed descriptively. The costing model was developed using assumptions based on the sources described above and was restricted to the Australian National Subacute and Non-Acute Patient Classification (AN-SNAP) classes 4AR1 to 4AR4, which comprise around 73% of all reconditioning episodes in Australia. RITH cost modelling estimates were compared to the known cost of inpatient rehabilitation. Where weighted averages are provided, these were determined based on the modelled number of inpatient reconditioning episodes per annum that might be substitutable by RITH. Results The cost modelling estimated the weighted average cost of a RITH reconditioning episode (which mirrors an inpatient reconditioning episode in intensity and duration) for AN-SNAP classes 4AR1 to 4AR4, to be A$11,371, which is 28.1% less than the equivalent weighted average public inpatient cost (of A$15,820). This represents hypothetical savings of A$4,449 per RITH reconditioning substituted episode of care. Conclusions The hypothetical cost of a model of RITH which would provide patients with as comprehensive a rehabilitation service as received in inpatient rehabilitation, has been determined. Findings suggest potential cost savings to the public hospital sector. Future research should focus on trials which compare actual clinical and cost outcomes of RITH for patients in the reconditioning impairment category, to inpatient rehabilitation.

Nicholas Kerry, Ria Chhabra, Jeremy DW Clifton Positive Psychology Center, University of Pennsylvania, Philadelphia, PA, USACorrespondence: Nicholas Kerry, Positive Psychology Center, University of Pennsylvania, 3720 Walnut Street, Philadelphia, PA, USA, Tel +1 215-898-7300, Email nickerry@sas.upenn.eduBackground: Many studies suggest a link between gratitude and life satisfaction, including experimental tests of gratitude interventions. This paper presents a systematic review of recent literature on the influence of gratitude on life satisfaction. The aim of this research is to better understand the nature of the relationship between gratitude and life satisfaction and to evaluate the state of literature.Methodology: A systematic search was conducted using four databases (APA PsycInfo, Scopus, Web of Science, and EBSCO), targeting articles published since 2010. Correlational studies were included if they used the GQ6 measure of gratitude and the Satisfaction With Life Scale (SWLS). Intervention studies were included if they reported effects of a gratitude manipulation on SWLS scores. Forty-four articles (N = 16,529) focusing on gratitude and life satisfaction were ultimately selected. Among the selected studies, 18 employed experimental designs and 26 were cross-sectional studies. Five studies also presented cross-lagged analyses from two or more timepoints.Results: The review indicated a substantial positive correlation between gratitude and life satisfaction. Various potential mediators were also identified, including meaning in life, social support, and self-esteem. Some experimental research suggested that gratitude interventions may increase life satisfaction compared to neutral control conditions, although evidence was mixed. There was stronger evidence for these effects in people from Western countries. However, there is no strong evidence that gratitude interventions outperform positively valenced control conditions. Thus, it is possible that the effects of intervention could be caused by demand- or placebo effects.Conclusion and Recommendation: While it is clear that there is a link between gratitude and life satisfaction, the extent to which gratitude causes life satisfaction and the mechanism underlying that link require further exploration. We suggest that experimental work test effects of changes in gratitude that cannot be explained by placebo- or demand effects. We also encourage more interactive interventions as well as research that investigates third variables that could underlie both gratitude and life satisfaction.Plain Language Summary: People who feel more gratitude tend to be more satisfied with their lives and sometimes report feeling more satisfied after performing gratitude-related tasks such as listing things they are grateful for. However, not all studies find these effects, and there is little evidence that these tasks work better than simply asking people to engage in other positive thoughts. It is also possible that people respond more positively to life satisfaction surveys after these interventions because of expectations, rather than real changes in life satisfaction.Keywords: gratitude, life satisfaction, positive psychology interventions, subjective well-being

Introduction High-quality shared decision-making (SDM) is a priority of health services, but only achieved in a minority of surgical consultations. Improving SDM for surgical patients may lead to more effective care and moderate the impact of treatment consequences. There is a need to establish effective ways to achieve sustained and large-scale improvements in SDM for all patients whatever their background. The ALPACA Study aims to develop, pilot and evaluate a decision support intervention that uses real-time feedback of patients’ experience of SDM to change patients’ and healthcare professionals’ decision-making processes before adult elective surgery and to improve patient and health service outcomes.Methods and analysis This protocol outlines a mixed-methods study, involving diverse stakeholders (adult patients, healthcare professionals, members of the community) and three National Health Service (NHS) trusts in England. Detailed methods for the assessment of the feasibility, usability and stakeholder views of implementing a novel system to monitor the SDM process for surgery automatically and in real time are described. The study will measure the SDM process using validated instruments (CollaboRATE, SDM-Q-9, SHARED-Q10) and will conduct semi-structured interviews and focus groups to examine (1) the feasibility of automated data collection, (2) the usability of the novel system and (3) the views of diverse stakeholders to inform the use of the system to improve SDM. Future phases of this work will complete the development and evaluation of the intervention.Ethics and dissemination Ethical approval was granted by the NHS Health Research Authority North West-Liverpool Central Research Ethics Committee (reference: 21/PR/0345). Approval was also granted by North Bristol NHS Trust to undertake quality improvement work (reference: Q80008) overseen by the Consent and SDM Programme Board and reporting to an Executive Assurance Committee.Trial registration number ISRCTN17951423; Pre-results.

Abstract Background Reconditioning for patients who have experienced functional decline following medical illness, surgery or treatment for cancer accounts for approximately 26% of all reported inpatient rehabilitation episodes in Australia. Rehabilitation in the home (RITH) has the potential to offer a cost-effective, high-quality alternative for appropriate patients, helping to reduce pressure on the acute care sector. This study sought to gain consensus on a model for RITH as hospital substitution for patients requiring reconditioning. Methods A multidisciplinary group of health professionals working in the rehabilitation field was identified from across Australia and invited to participate in a three-round online Delphi survey. Survey items followed the patient journey, and also included items on practitioner roles, clinical governance, and budgetary considerations. Survey items mostly comprised statements seeking agreement on 5-point Likert scales (strongly agree to strongly disagree). Free text boxes allowed participants to qualify item answers or make comments. Analysis of quantitative data used descriptive statistics; qualitative data informed question content in subsequent survey rounds or were used in understanding item responses. Results One-hundred and ninety-eight health professionals received an invitation to participate. Of these, 131/198 (66%) completed round 1, 101/131 (77%) completed round 2, and 78/101 (77%) completed round 3. Consensus (defined as ≥ 70% agreement or disagreement) was achieved on over 130 statements. These related to the RITH patient journey (including patient assessment and development of the care plan, case management and program provision, and patient and program outcomes); clinical governance and budgetary considerations; and included items for initial patient screening, patient eligibility and case manager roles. A consensus-based model for RITH was developed, comprising five key steps and the actions within each. Conclusions Strong support amongst survey participants was found for RITH as hospital substitution to be widely available for appropriate patients needing reconditioning. Supportive legislative and payment systems, mechanisms that allow for the integration of primary care, and appropriate clinical governance frameworks for RITH are required, if broad implementation is to be achieved. Studies comparing clinical outcomes and cost–benefit of RITH to inpatient rehabilitation for patients requiring reconditioning are also needed.

Objective To review guidance, included in written local UK National Health Service (NHS) organisation policies, on information provision and consent for the introduction of new invasive procedures- including surgeries, and devices (IPs/Ds).Design A qualitative documentary analysis of data on patient information provision and consent extracted from policies for the introduction of IP/Ds from NHS organisations in England and Wales.Setting NHS trusts in England and health boards in Wales, UK.Participants Between December 2017 and July 2018, 150 acute trusts in England and 7 health boards in Wales were approached for their policies for the introduction of new IP/Ds. In total, 123 policies were received, 11 did not fit the inclusion criteria and a further policy was included from a trust website resulting in 113 policies included for review.Results From the 113 policies, 22 did not include any statements on informed consent/information provision or lacked guidance on the information to be provided to patients and were hence excluded. Consequently, 91 written local NHS policies were included in the final dataset. Within the guidance obtained, variation existed on disclosure of the procedure’s novelty, potential risks, benefits, uncertainties, alternative treatments and surgeon’s experience. Few policies stated that clinicians should discuss the existing evidence associated with a procedure. Additionally, while the majority of policies referred to patients needing written information, this was often not mandated and few policies specified the information to be included.Conclusions Nearly a fifth of all the policies lacked guidance on information to be provided to patients. There was variability in the policy documents regarding what patients should be told about innovative procedures. Further research is needed to ascertain the information and level of detail appropriate for patients when considering innovative procedures. A core information set including patients’ and clinicians’ views is required to address variability around information provision/consent for innovative procedures.

BackgroundSurgical innovation can lead to important improvements in patient outcomes. Currently, information and knowledge about novel procedures and devices are disseminated informally and in an unstandardized way (eg, through social media). This can lead to ineffective and inefficient knowledge sharing among surgeons, which can result in the harmful repetition of mistakes and delay in the uptake of promising innovation. Improvements are needed in the way that learning in surgical innovation is shared through the development of novel, real-time methods, informed by a contemporary and comprehensive investigation of existing methods. ObjectiveThe aim of this scoping review is to explore the application of existing digital methods for training/education and feedback to surgeons in the context of performing invasive surgical procedures. This work will (1) summarize existing methods for shared learning in surgery and how they are characterized and operationalized, (2) examine the impact of their application, and (3) explore their benefits and barriers to implementation. The findings of this scoping review will inform the development of novel, real-time methods to optimize shared learning in surgical innovation. MethodsThis study will adhere to the recommended guidelines for conducting scoping reviews. A total of 6 different searches will be conducted within multiple sources (2 electronic databases, journals, social media, gray literature, commercial websites, and snowball searches) to comprehensively identify relevant articles and data. Searches will be limited to articles published in the English language within the last 5 years. Wherever possible, a 2-stage study selection process will be followed whereby the eligibility of articles will be assessed through the title, abstract, and full-text screening independently by 2 reviewers. Inclusion criteria will be articles providing data on (1) fully qualified theater staff involved in performing invasive procedures, (2) one or more methods for shared learning (ie, digital means for training/education and feedback), and (3) qualitative or quantitative evaluations of this method. Data will be extracted (10% double data extraction by an independent reviewer) into a piloted proforma and analyzed using descriptive statistics, narrative summaries, and principles of thematic analysis. ResultsThe study commenced in October 2021 and is planned to be completed in 2023. To date, systematic searches were applied to 2 electronic databases (MEDLINE and Web of Science) and returned a total of 10,093 records. The results of this scoping review will be published as open access in a peer-reviewed journal. ConclusionsThis scoping review of methods for shared learning in surgery is, to our knowledge, the most comprehensive and up-to-date investigation that maps current information on this topic. Ultimately, efficient and effective sharing of information and knowledge of novel procedures and devices has the potential to optimize the evaluation of early-phase surgical research and reduce harmful innovation. International Registered Report Identifier (IRRID)PRR1-10.2196/37544

Objective Outcome selection and reporting in studies of novel surgical procedures and devices lacks standardisation, hindering safe and effective evaluation. A core outcome set (COS) to measure and report in all studies of surgical innovation is needed. We explored outcomes in a specific sample of innovative surgical device case studies to identify outcome domains specifically relevant to innovation to inform the development of a COS.Design A targeted review of 11 purposive selected case studies of innovative surgical devices.Methods Electronic database searches in PubMed (July 2018) identified publications reporting the introduction and evaluation of each device. Outcomes were extracted and categorised into domains until no new domains were conceptualised. Outcomes specifically relevant to evaluating innovation were further scrutinised.Results 112 relevant publications were identified, and 5926 outcomes extracted. Heterogeneity in study type, outcome selection and reporting was observed across surgical devices. Categorisation of outcomes was performed for 2689 (45.4%) outcomes into five broad outcome domains. Outcomes considered key to the evaluation of innovation (n=66; 2.5%) were further categorised as surgeon/operator experience (n=40; 1.5%), unanticipated events (n=15, 0.6%) and modifications (n=11; 0.4%).Conclusion Outcome domains unique to evaluating innovative surgical devices have been identified. Findings have been combined with multiple other data sources relevant to the evaluation of surgical innovation to inform the development of a COS to measure and report in all studies evaluating novel surgical procedures/devices.

Tropical montane landscapes harbor diverse flora and fauna, and many species there are ecological specialists with narrow elevational distributions, limited geographic ranges, and small global populations. Along elevational gradients, environmental conditions and community composition change dramatically over small spatial scales. As forests are disturbed and edges formed with modified habitat, natural communities could be affected differently across elevations by the many physical and biotic changes at edges. We asked whether forest edges produced altered patterns of avian species composition along a cloud forest - dry forest gradient on the Pacific slope of the Tilarán mountains in Monteverde, Costa Rica. A strong moisture gradient produces cloud forests near the ridgetops, with a concentration of species endemic to the Costa Rica – Panama highlands that are habitat specialists. We conducted 552 point counts across 110 locations from 1100 to 1800 m elevation, yielding 6586 detections of 115 species in 10 km2 of montane forest. We analyzed differences in species composition and single-species abundances between interior and near-edge forest habitats for species grouped by geographic range size. Species composition changed markedly from forest edge to interior in cloud forest habitats, but not in drier forests downslope. Endemic species, especially in cloud forest, were detected less frequently in mature forest near edges than in mature forest interior, and this difference was more pronounced than for cosmopolitan species. On tropical mountainsides, we can expect habitat-specialist endemic species to be more sensitive to further habitat modification. This sensitivity could limit the resilience of tropical bird communities.

Abstract Background Patients undergoing major cancer surgery frequently require post-acute care for complications and adverse effects. Enhanced recovery after surgery programmes mean that patients are increasingly discharged home earlier. Symptom/complication detection post-discharge is sub-optimal. Systematic patient monitoring post-discharge following surgery may be optimally achieved through routine electronic patient-reported outcome (ePRO) data capture. ePRO systems that employ clinical algorithms to guide management of patients and automatically alert clinicians of clinically-concerning symptoms can improve patient outcomes and decrease hospital admissions. ePRO systems that provide individually-tailored self-management advice and integrate live ePRO data into electronic health records (EHR) may also advance personalised health and patient-centred care. This study aims to develop a hospital EHR-integrated ePRO system to improve detection and management of complications post-discharge following cancer-related surgery. Methods The ePRO system was developed in two phases: (1) Development of a web-based ePRO symptom-report from validated European Organisation for Research and Treatment of Cancer (EORTC) questionnaires, clinical opinion and patient interviews, followed by hospital EHR integration; (2) Development of clinical algorithms triggering symptom severity-dependent patient advice and clinician alerts from: (i) prospectively-collected patient-completed ePRO symptom-report data; (ii) stakeholder meetings; (iii) patient interviews. Patient advice was developed from: (i) clinician-patient telephone consultations and patient interviews; (ii) review of hospital patient information leaflets (PIL) and patient support websites. Results Phase 1, including interviews with 18 patients, identified 35 symptom-report items. In phase 2, 130/300 (43%) screened patients were eligible. 61 (47%) consented to participate and 59 (97%) provided 444 complete self-reports. Stakeholder meetings (9 clinicians, 1 patient/public representative) and patient interviews (n = 66) refined advice/alert accuracy. 15 telephone consultations, 7 patient interviews and review of 28 PILs and 3 patient support websites identified 4 themes to inform self-management advice. Comparisons between ePRO symptom-report data, telephone consultations and clinical events/outcomes (n = 27 patients) further refined clinical algorithms. Conclusions A hospital EHR-integrated ePRO system that alerts clinicians and provides patient self-management advice has been developed to improve the detection and management of problems and complications after discharge following surgery. An ongoing pilot study will inform a multicentre randomised trial to evaluate the effectiveness of the ePRO system compared to usual care.

Remote sensing techniques offer significant potential for generating accurate thick oil slick maps critical for marine oil spill response. However, field validation and methodology assessment challenges remain. Here, we report on an approach to leveraging oil emissions from the Coal Oil Point (COP) natural marine hydrocarbon seepage offshore of southern California, where prolific oil seepage produces thick oil slicks stretching many kilometers. Specifically, we demonstrate and validate a remote sensing approach as part of the Seep Assessment Study (SAS). Thick oil is sufficient for effective mitigation strategies and is set at 0.15 mm. The brightness temperature of thick oil, TBO, is warmer than oil-free seawater, TBW, allowing segregation of oil from seawater. High spatial-resolution airborne thermal and visible slick imagery were acquired as part of the SAS; including along-slick “streamer” surveys and cross-slick calibration surveys. Several cross-slick survey-imaged short oil slick segments that were collected by a customized harbor oil skimmer; termed “collects”. The brightness temperature contrast, ΔTB (TBO − TBW), for oil pixels (based on a semi-supervised classification of oil pixels) and oil thickness, h, from collected oil for each collect provided the empirical calibration of ΔTB(h). The TB probability distributions provided TBO and TBW, whereas a spatial model of TBW provided ΔTB for the streamer analysis. Complicating TBW was the fact that streamers were located at current shears where two water masses intersect, leading to a TB discontinuity at the slick. This current shear arose from a persistent eddy down current of the COP that provides critical steering of oil slicks from the Coal Oil Point. The total floating thick oil in a streamer observed on 23 May and a streamer observed on 25 May 2016 was estimated at 311 (2.3 bbl) and 2671 kg (20 bbl) with mean linear floating oil 0.14 and 2.4 kg m−1 with uncertainties by Monte Carlo simulations of 25% and 7%, respectively. Based on typical currents, the average of these two streamers corresponds to 265 g s−1 (~200 bbl day−1) in a range of 60–340 bbl day−1, with significant short-term temporal variability that suggests slug flow for the seep oil emissions. Given that there are typically four or five streamers, these data are consistent with field emissions that are higher than the literature estimates.

Abstract Background Core outcome set (COS) developers increasingly employ Delphi surveys to elicit stakeholders’ opinions of which outcomes to measure and report in trials of a particular condition or intervention. Research outside of Delphi surveys and COS development demonstrates that question order can affect response rates and lead to ‘context effects’, where prior questions determine an item’s meaning and influence responses. This study examined the impact of question order within a Delphi survey for a COS for oesophageal cancer surgery. Methods A randomised controlled trial was nested within the Delphi survey. Patients and health professionals were randomised to receive a survey including clinical and patient-reported outcomes (PROs), where the PRO section appeared first or last. Participants rated (1–9) the importance of 68 items for inclusion in a COS (ratings 7–9 considered ‘essential’). Analyses considered the impact of question order on: (1) survey response rates; (2) participants’ responses; and (3) items retained at end of the survey. Results In total, 116 patients and 71 professionals returned completed surveys. Question order did not affect response rates among patients, but fewer professionals responded when clinical items appeared first (difference = 31.3%, 95% confidence interval [CI] = 13.6–48.9%, P = 0.001). Question order led to different context effects within patients and professionals. While patients rated clinical items highly, irrespective of question order, more PROs were rated essential when appearing last rather than first (difference = 23.7%, 95% CI = 10.5–40.8%). Among professionals, the greatest impact was on clinical items; a higher percentage rated essential when appearing last (difference = 11.6%, 95% CI = 0.0–23.3%). An interaction between question order and the percentage of PRO/clinical items rated essential was observed for patients (P = 0.025) but not professionals (P = 0.357). Items retained for further consideration at the end of the survey were dependent on question order, with discordant items (retained by one question order group only) observed in patients (18/68 [26%]) and professionals (20/68 [29%]). Conclusions In the development of a COS, participants’ ratings of potential outcomes within a Delphi survey depend on the context (order) in which the outcomes are asked, consequently impacting on the final COS. Initial piloting is recommended with consideration of the randomisation of items in the survey to reduce potential bias. Trial registration The randomised controlled trial reported within this paper was nested within the development of a core outcome set to investigate processes in core outcome set development. Outcomes were not health-related and trial registration was not therefore applicable.

Abstract Background Informed consent (IC) is an ethical and legal prerequisite for trial participation, yet current approaches evaluating participant understanding for IC during recruitment lack consistency. No validated measure has been identified that evaluates participant understanding for IC based on their contributions during consent interactions. This paper outlines the development and formative evaluation of the Participatory and Informed Consent (PIC) measure for application to recorded recruitment appointments. The PIC allows the evaluation of recruiter information provision and evidence of participant understanding. Methods Published guidelines for IC were reviewed to identify potential items for inclusion. Seventeen purposively sampled trial recruitment appointments from three diverse trials were reviewed to identify the presence of items relevant to IC. A developmental version of the measure (DevPICv1) was drafted and applied to six further recruitment appointments from three further diverse trials to evaluate feasibility, validity, stability and inter-rater reliability. Findings guided revision of the measure (DevPICv2) which was applied to six further recruitment appointments as above. Results DevPICv1 assessed recruiter information provision (detail and clarity assessed separately) and participant talk (detail and understanding assessed separately) over 20 parameters (or 23 parameters for three-arm trials). Initial application of the measure to six diverse recruitment appointments demonstrated promising stability and inter-rater reliability but a need to simplify the measure to shorten time for completion. The revised measure (DevPICv2) combined assessment of detail and clarity of recruiter information and detail and evidence of participant understanding into two single scales for application to 22 parameters or 25 parameters for three-arm trials. Application of DevPICv2 to six further diverse recruitment appointments showed considerable improvements in feasibility (e.g. time to complete) with good levels of stability (i.e. test-retest reliability) and inter-rater reliability maintained. Conclusions The DevPICv2 provides a measure for application to trial recruitment appointments to evaluate quality of recruiter information provision and evidence of patient understanding and participation during IC discussions. Initial evaluation shows promising feasibility, validity, reliability and ability to discriminate across a range of recruiter practice and evidence of participant understanding. More validation work is needed in new clinical trials to evaluate and refine the measure further.

Introduction Surgery (oesophagectomy), with neoadjuvant chemo(radio)therapy, is the main curative treatment for patients with oesophageal cancer. Several surgical approaches can be used to remove an oesophageal tumour. The Ivor Lewis (two-phase procedure) is usually used in the UK. This can be performed as an open oesophagectomy (OO), a laparoscopically assisted oesophagectomy (LAO) or a totally minimally invasive oesophagectomy (TMIO). All three are performed in the National Health Service, with LAO and OO the most common. However, there is limited evidence about which surgical approach is best for patients in terms of survival and postoperative health-related quality of life.Methods and analysis We will undertake a UK multicentre randomised controlled trial to compare LAO with OO in adult patients with oesophageal cancer. The primary outcome is patient-reported physical function at 3 and 6 weeks postoperatively and 3 months after randomisation. Secondary outcomes include: postoperative complications, survival, disease recurrence, other measures of quality of life, spirometry, success of patient blinding and quality assurance measures. A cost-effectiveness analysis will be performed comparing LAO with OO. We will embed a randomised substudy to evaluate the safety and evolution of the TMIO procedure and a qualitative recruitment intervention to optimise patient recruitment. We will analyse the primary outcome using a multi-level regression model. Patients will be monitored for up to 3 years after their surgery.Ethics and dissemination This study received ethical approval from the South-West Franchay Research Ethics Committee. We will submit the results for publication in a peer-reviewed journal.Trial registration number ISRCTN10386621.

A multi-year airborne field investigation of remote botanical species identification was conducted involving multiple curated botanical collections. The purpose of the study was to better constrain the observational conditions that most favor remote identification by longwave-infrared spectral imaging and assess the degree to which confidence metrics developed for remote chemical composition determination could be adapted to botanical species classification. Identification success was examined as a function of spatial resolution and viewing obliquity. A key aim was to articulate a procedure for validating inferred species identifications and evaluating the retrieval methodology’s performance for alleviating confusion between species exhibiting spectral similarity at the foliar scale. It was found that several confounding factors degrade confidence in the species identifications to levels that render the approach impractical in the general case. A number of taxa, predominantly evergreen, were nevertheless identified that are amenable to the technique and for which utility may be viable.

The 1999 Hector Mine earthquake ruptured to the surface in eastern California, with >5 m peak right-lateral slip on the Lavic Lake fault. The cumulative offset and geologic slip rate of this fault are not well defined, which inhibits tectonic reconstructions and risk assessment of the Eastern California Shear Zone (ECSZ). With thermal infrared hyperspectral airborne imagery, field data, and auxiliary information from legacy geologic maps, we created lithologic maps of the area using supervised and unsupervised classifications of the remote sensing imagery. We optimized a data processing sequence for supervised classifications, resulting in lithologic maps over a test area with an overall accuracy of 71 ± 1% with respect to ground-truth geologic mapping. Using all of the data and maps, we identified offset bedrock features that yield piercing points along the main Lavic Lake fault and indicate a 1036 +27/−26 m net slip, with 1008 +14/−17 m horizontal and 241 +51/−47 m vertical components. For the contribution from distributed shear, modern off-fault deformation values from another study imply a larger horizontal slip component of 1276 +18/−22 m. Within the constraints, we estimate a geologic slip rate of

Validation of emissivity (ε) retrievals from spaceborne thermal infrared (TIR) sensors typically requires spatial extrapolations over several orders of magnitude for a comparison between centimeter-scale laboratory ε measurements and the common decameter and lower resolution of spaceborne TIR data. In the case of NASA’s Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) temperature and ε separation algorithm (TES), this extrapolation becomes especially challenging because TES was originally designed for the geologic surface of Earth, which is typically heterogeneous even at centimeter and decameter scales. Here, we used the airborne TIR hyperspectral Mako sensor with its 2.2 m/pixel resolution, to bridge this scaling issue and robustly link between ASTER TES 90 m/pixel emissivity retrievals and laboratory ε measurements from the Algodones dune field in southern California, USA. The experimental setup included: (i) Laboratory XRD, grain size, and TIR spectral measurements; (ii) radiosonde launches at the time of the two Mako overpasses for atmospheric corrections; (iii) ground-based thermal measurements for calibration, and (iv) analyses of ASTER day and night ε retrievals from 21 different acquisitions. We show that while cavity radiation leads to a 2% to 4% decrease in the effective emissivity contrast of fully resolved scene elements (e.g., slipface slopes and interdune flats), spectral variability of the site when imaged at 90 m/pixel is below 1%, because at this scale the dune field becomes an effectively homogeneous mixture of the different dune elements. We also found that adsorption of atmospheric moisture to grain surfaces during the predawn hours increased the effective ε of the dune surface by up to 0.04. The accuracy of ASTER’s daytime emissivity retrievals using each of the three available atmospheric correction protocols was better than 0.01 and within the target performance of ASTER’s standard emissivity product. Nighttime emissivity retrievals had lower precision (

Colorectal cancer (CRC) is a major cause of worldwide morbidity and mortality. Surgical treatment is common, and there is a great need to improve the delivery of such care. The gold standard for evaluating surgery is within well-designed randomized controlled trials (RCTs); however, the impact of RCTs is diminished by a lack of coordinated outcome measurement and reporting. A solution to these issues is to develop an agreed standard "core" set of outcomes to be measured in all trials to facilitate cross-study comparisons, meta-analysis, and minimize outcome reporting bias. This study defines a core outcome set for CRC surgery.The scope of this COS includes clinical effectiveness trials of surgical interventions for colorectal cancer. Excluded were nonsurgical oncological interventions. Potential outcomes of importance to patients and professionals were identified through systematic literature reviews and patient interviews. All outcomes were transcribed verbatim and categorized into domains by two independent researchers. This informed a questionnaire survey that asked stakeholders (patients and professionals) from United Kingdom CRC centers to rate the importance of each domain. Respondents were resurveyed following group feedback (Delphi methods). Outcomes rated as less important were discarded after each survey round according to predefined criteria, and remaining outcomes were considered at three consensus meetings; two involving international professionals and a separate one with patients. A modified nominal group technique was used to gain the final consensus. Data sources identified 1,216 outcomes of CRC surgery that informed a 91 domain questionnaire. First round questionnaires were returned from 63 out of 81 (78%) centers, including 90 professionals, and 97 out of 267 (35%) patients. Second round response rates were high for all stakeholders (>80%). Analysis of responses lead to 45 and 23 outcome domains being retained after the first and second surveys, respectively. Consensus meetings generated agreement on a 12 domain COS. This constituted five perioperative outcome domains (including anastomotic leak), four quality of life outcome domains (including fecal urgency and incontinence), and three oncological outcome domains (including long-term survival).This study used robust consensus methodology to develop a core outcome set for use in colorectal cancer surgical trials. It is now necessary to validate the use of this set in research practice.

Refractive errors in vision can be caused by aberrant axial length of the eye, irregular corneal shape, or lens abnormalities. Causes of eye length overgrowth include multiple genetic loci, and visual parameters. We evaluate zebrafish as a potential animal model for studies of the genetic, cellular, and signaling basis of emmetropization and myopia. Axial length and other eye dimensions of zebrafish were measured using spectral domain-optical coherence tomography (SD-OCT). We used ocular lens and body metrics to normalize and compare eye size and relative refractive error (difference between observed retinal radial length and controls) in wild-type and lrp2 zebrafish. Zebrafish were dark-reared to assess effects of visual deprivation on eye size. Two relative measurements, ocular axial length to body length and axial length to lens diameter, were found to accurately normalize comparisons of eye sizes between different sized fish (R2=0.9548, R2=0.9921). Ray-traced focal lengths of wild-type zebrafish lenses were equal to their retinal radii, while lrp2 eyes had longer retinal radii than focal lengths. Both genetic mutation (lrp2) and environmental manipulation (dark-rearing) caused elongated eye axes. lrp2 mutants had relative refractive errors of -0.327 compared to wild-types, and dark-reared wild-type fish had relative refractive errors of -0.132 compared to light-reared siblings. Therefore, zebrafish eye anatomy (axial length, lens radius, retinal radius) can be rapidly and accurately measured by SD-OCT, facilitating longitudinal studies of regulated eye growth and emmetropization. Specifically, genes homologous to human myopia candidates may be modified, inactivated or overexpressed in zebrafish, and myopia-sensitizing conditions used to probe gene-environment interactions. Our studies provide foundation for such investigations into genetic contributions that control eye size and impact refractive errors.

The glaucomas comprise a genetically complex group of retinal neuropathies that typically occur late in life and are characterized by progressive pathology of the optic nerve head and degeneration of retinal ganglion cells. In addition to age and family history, other significant risk factors for glaucoma include elevated intraocular pressure (IOP) and myopia. The complexity of glaucoma has made it difficult to model in animals, but also challenging to identify responsible genes. We have used zebrafish to identify a genetically complex, recessive mutant that shows risk factors for glaucoma including adult onset severe myopia, elevated IOP, and progressive retinal ganglion cell pathology. Positional cloning and analysis of a non-complementing allele indicated that non-sense mutations in low density lipoprotein receptor-related protein 2 (lrp2) underlie the mutant phenotype. Lrp2, previously named Megalin, functions as an endocytic receptor for a wide-variety of bioactive molecules including Sonic hedgehog, bone morphogenic protein 4, retinol-binding protein, vitamin D-binding protein, and apolipoprotein E, among others. Detailed phenotype analyses indicated that as lrp2 mutant fish age, many individuals--but not all--develop high IOP and severe myopia with obviously enlarged eye globes. This results in retinal stretch and prolonged stress to retinal ganglion cells, which ultimately show signs of pathogenesis. Our studies implicate altered Lrp2-mediated homeostasis as important for myopia and other risk factors for glaucoma in humans and establish a new genetic model for further study of phenotypes associated with this disease.

Airborne longwave-infrared (LWIR) hyperspectral imagery acquisitions were coordinated with stationary and mobile ground-based in situ measurements of atmospheric ammonia in regions surrounding California's Salton Sea, an area of commingled intensive animal husbandry and agriculture operations that is encumbered by exceptionally high levels of persistent ammonia and PM2.5 pollution. The goal of this study was to validate remotely sensed ammonia retrievals against ground truth measurements as part of a broader effort to elucidate the behavior of the atmospheric ammonia burden in this area of abundant diffuse and point sources. The nominal 2 m pixel size of the airborne data revealed variability in ammonia concentrations at a diversity of scales within the study area. At this pixel resolution, ammonia plumes emitted by individual facilities could be clearly discriminated and their dispersion characteristics inferred. Several factors, including thermal contrast and atmospheric boundary layer depth, contributed to the overall uncertainty of the intercomparison between airborne ammonia quantitative retrievals and the corresponding in situ measurements, for which agreement was in the 16–37% range under the most favorable conditions. Hence, while the findings attest to the viability of airborne LWIR spectral imaging for quantifying atmospheric ammonia concentrations, the accuracy of ground-level estimations depends significantly on precise knowledge of these atmospheric factors. [ABSTRACT FROM AUTHOR]