Recruitment and retention of participants in UK surgical trials: survey of key issues reported by trial staff.

BACKGROUND: Recruitment and retention of participants in surgical trials is challenging. Knowledge of the most common and problematic issues will aid future trial design. This study aimed to identify trial staff perspectives on the main issues affecting participant recruitment and retention in UK surgical trials. METHODS: An online survey of UK surgical trial staff was performed. Respondents were asked whether or not they had experienced a range of recruitment and retention issues, and, if yes, how relatively problematic these were (no, mild, moderate or serious problem). RESULTS: The survey was completed by 155 respondents including 60 trial managers, 53 research nurses, 20 trial methodologists and 19 chief investigators. The three most common recruitment issues were: patients preferring one treatment over another (81·5 per cent of respondents); clinicians' time constraints (78·1 per cent); and clinicians preferring one treatment over another (76·8 per cent). Seven recruitment issues were rated moderate or serious problems by a majority of respondents, the most problematic being a lack of eligible patients (60·3 per cent). The three most common retention issues were: participants forgetting to return questionnaires (81·4 per cent); participants found to be ineligible for the trial (74·3 per cent); and long follow-up period (70·7 per cent). The most problematic retention issues, rated moderate or serious by the majority of respondents, were participants forgetting to return questionnaires (56·4 per cent) and insufficient research nurse time/funding (53·6 per cent). CONCLUSION: The survey identified a variety of common recruitment and retention issues, several of which were rated moderate or serious problems by the majority of participating UK surgical trial staff. Mitigation of these problems may help boost recruitment and retention in surgical trials.

ANTECEDENTES: El reclutamiento y la retención de participantes en los ensayos quirúrgicos es un desafío. Conocer los problemas más habituales y conflictivos ayudará al diseño de futuros ensayos. Este estudio tuvo como objetivo identificar la percepción de los participantes sobre cuáles son los principales problemas que afectan el reclutamiento y la retención de participantes en los ensayos quirúrgicos del Reino Unido. MÉTODOS: Encuesta electrónica a profesionales de la salud que habían participado en ensayos quirúrgicos del Reino Unido. Se preguntó a los encuestados si habían experimentado o no algún problema en temas de reclutamiento o retención y, en caso afirmativo, qué tan conflictivos fueron (ningún problema/problema leve/moderado/grave). RESULTADOS: Completaron la encuesta 155 participantes, de los que 60 eran directores del ensayo, 53 enfermeras de investigación, 20 metodólogos de ensayos y 19 investigadores principales. Los tres problemas más comunes en el reclutamiento fueron: pacientes que prefieren un tratamiento sobre otro (81,5% de los encuestados), escaso tiempo de dedicación de los médicos (78,1%) y médicos que prefieren un tratamiento sobre otro (76,8%). La mayoría de los encuestados calificaron siete problemas de reclutamiento como "moderados" o "graves", siendo el más conflictivo la falta de pacientes elegibles (60,3%). Los tres problemas de retención más habituales fueron: participantes que olvidaron devolver los cuestionarios (81,4%), participantes que no fueron elegibles para el ensayo (74,3%) y el largo período de seguimiento (70,7%). Los problemas de retención más conflictivos, calificados como "moderados" o "graves" por la mayoría de los encuestados, fueron el olvido de los participantes para devolver los cuestionarios (56,4%) y el escaso tiempo/financiación para la enfermera investigadora (53,6%). CONCLUSIÓN: La encuesta identificó una serie de problemas habituales en el reclutamiento y la retención de los pacientes, muchos ellos calificados como "moderados" o "graves" por la mayoría del personal involucrado en los ensayos quirúrgicos del Reino Unido. Mitigar estos problemas puede ayudar a impulsar el reclutamiento y la retención en los ensayos quirúrgicos.

Affine and nonaffine motions in sheared polydisperse emulsions.

We study dense and highly polydisperse emulsions at droplet volume fractions ϕ≥0.65. We apply oscillatory shear and observe droplet motion using confocal microscopy. The presence of droplets with sizes several times the mean size dramatically changes the motion of smaller droplets. Both affine and nonaffine droplet motions are observed, with the more nonaffine motion exhibited by the smaller droplets which are pushed around by the larger droplets. Droplet motions are correlated over length scales from one to four times the mean droplet diameter, with larger length scales corresponding to higher strain amplitudes (up to strains of about 6%).

Missed opportunities for impact in patient and carer involvement: a mixed methods case study of research priority setting.

PLAIN ENGLISH SUMMARY: Healthcare workers want to listen more to patients and their carers in all sorts of areas of healthcare. This can include choosing topics for medical research. We looked at how patients and carers have helped to choose topics for research about type I diabetes. We aimed to find out if, and why, researchers often rejected their choices. We looked at a project which brought together patients, carers and healthcare workers to choose topics for research about type 1 diabetes. The group first asked patients, carers and healthcare workers to suggest ideas for research questions. But the group had to follow rules about what counted as a good research question. Some people's ideas did not count as good research questions, and they were rejected at the start. We looked at who were most likely to have their ideas rejected at the start. We found that patients and carers were most likely to have a suggestion rejected. Then we looked at the rejected questions in detail. They were mostly about curing diabetes, preventing diabetes and understanding how diabetes works. There were also some questions about access to medicines and the quality of care. Researchers should ask patients and carers for help deciding what counts as a good research question from the start of projects like these. We should also think about what might be getting in the way of patients and carers making more of a difference in research. ABSTRACT: Background Patients and carers are increasingly involved in deciding on topics for medical research. However, so far, it has been difficult to gain an accurate picture of the impact of such involvement because of poor reporting and evaluation in published studies to date. This study aimed to explore how a partnership of patients, carers, healthcare professionals and organisations identified questions for future research and why patients and carers had a limited impact on this process. Methods In the first stage of the partnership process, relevant service users and providers (including patients, carers, healthcare professionals and voluntary organisations) were invited to submit suggested research questions about the treatment of type 1 diabetes, via a national online and paper survey. The partnership followed formal protocols that defined a researchable question. This meant that many respondents' suggested research questions were rejected at the start of the process. We analysed survey submissions to find out which groups of respondents were most likely to have their suggestions rejected and what these suggestions were about. Results Five hundred eighty-three respondents submitted 1143 suggested research questions, of which 249 (21.8 %) were rejected at the first stage. Respondents with lived experience of this long-term condition (patients and carers) were more likely than those without lived experience to submit a research question that would be rejected (35.6 vs. 16.5 %; p < 0.0005). Among the rejected questions submitted by patients and carers, there were several key themes: questions about cure, cause and prevention, understanding the disease, healthcare policy and economics. Conclusions In this case study, early decisions about what constituted a researchable question restricted patients' and carers' contributions to priority setting. When discussions about a project's remit take place before service users are involved, researchers risk distorting the potential impact of involvement. Impact assessments should consider not only the differences patients and carers make to research but also the differences they could have made in the absence of systemic barriers. We recommend that initiatives aimed at involving patients and carers in identifying research questions involve them as early as possible, including in decisions about how and why suggested research questions are selected or rejected.

Evidence for the role of cell stiffness in modulation of volume-regulated anion channels.

AIM: To investigate the link between cell stiffness and volume-regulated anion current (VRAC) in aortic endothelium. METHOD: Bovine aortic endothelial cells (BAECs) were exposed to methyl-beta-cyclodextrin (MbetaCD) to deplete cellular cholesterol and the changes in cellular stiffness were measured by micropipette aspiration. VRAC density was measured electrophysiologically in the same cell populations. Furthermore, to probe the effects of cholesterol depletion on the mechanics of 'deep' cytoskeleton, we employ a novel technique to analyse correlated motion of intracellular particles. RESULTS: We show that cholesterol depletion results in cellular stiffening and an upregulation of VRAC density. Replenishing cellular sterol pool with epicholesterol, a chiral analogue of cholesterol, abrogates both of these effects. This indicates that cholesterol sensitivity of both cell mechanics and VRAC are due to changes in the physical properties of the membrane rather than due to specific sterol-protein interactions. We also show that cholesterol depletion increases the stiffness of the 'deep cytoskeleton' and that disruption of actin filaments abolishes both cell stiffening and upregulation of VRAC due to cholesterol depletion. Furthermore, comparing BAECs to human aortic endothelial cells (HAECs), we show that BAECs that are inherently stiffer also develop larger VRACs. CONCLUSIONS: Taken together, our observations suggest an increase in the cytoskeleton stiffness has a facilitatory effect on VRAC development. We suggest that stiffening of the cytoskeleton increases tension in the membrane-cytoskeleton layer and that in turn facilitates VRAC.

Microrheology probes length scale dependent rheology.

We exploit the power of microrheology to measure the viscoelasticity of entangled F-actin solutions at different length scales from 1 to 100 microm over a wide frequency range. We compare the behavior of single probe-particle motion to that of the correlated motion of two particles. By varying the average length of the filaments, we identify fluctuations that dissipate diffusively over the filament length. These provide an important relaxation mechanism of the elasticity between 0.1 and 30 rad/sec.

Stress-dependent elasticity of composite actin networks as a model for cell behavior.

Networks of filamentous actin cross-linked with the actin-binding protein filamin A exhibit remarkable strain stiffening leading to an increase in differential elastic modulus by several orders of magnitude over the linear value. The variation of the frequency dependence of the differential elastic and loss moduli as a function of prestress is consistent with that observed in living cells, suggesting that cell elasticity is always measured in the nonlinear regime, and that prestress is an essential control parameter.

Prestressed F-actin networks cross-linked by hinged filamins replicate mechanical properties of cells.

We show that actin filaments, shortened to physiological lengths by gelsolin and cross-linked with recombinant human filamins (FLNs), exhibit dynamic elastic properties similar to those reported for live cells. To achieve elasticity values of comparable magnitude to those of cells, the in vitro network must be subjected to external prestress, which directly controls network elasticity. A molecular requirement for the strain-related behavior at physiological conditions is a flexible hinge found in FLNa and some FLNb molecules. Basic physical properties of the in vitro filamin-F-actin network replicate the essential mechanical properties of living cells. This physical behavior could accommodate passive deformation and internal organelle trafficking at low strains yet resist externally or internally generated high shear forces.

Microrheology of entangled F-actin solutions.

We measure the viscoelasticity of entangled F-actin over length scales between 1 and 100 microm using one- and two-particle microrheology, and directly identify two distinct microscopic contributions to the elasticity. Filament entanglements lead to a frequency-independent elastic modulus over an extended frequency range of 0.01-30 rad/sec; this is probed with one-particle microrheology. Longitudinal fluctuations of the filaments increase the elastic modulus between 0.1 and 30 rad/sec at length scales up to the filament persistence length; this is probed by two-particle microrheology.

Microrheology, stress fluctuations, and active behavior of living cells.

We report the first measurements of the intrinsic strain fluctuations of living cells using a recently developed tracer correlation technique along with a theoretical framework for interpreting such data in heterogeneous media with nonthermal driving. The fluctuations' spatial and temporal correlations indicate that the cytoskeleton can be treated as a course-grained continuum with power-law rheology, driven by a spatially random stress tensor field. Combined with recent cell rheology results, our data imply that intracellular stress fluctuations have a nearly 1/omega2 power spectrum, as expected for a continuum with a slowly evolving internal prestress.

Rheological microscopy: local mechanical properties from microrheology.

We demonstrate how tracer microrheology methods can be extended to study submicron scale variations in the viscoelastic response of soft materials; in particular, a semidilute solution of lambda-DNA. The polymer concentration is depleted near the surfaces of the tracer particles, within a distance comparable to the polymer correlation length. The rheology of this microscopic layer alters the tracers' motion and can be precisely quantified using one- and two-point microrheology. Interestingly, we found this mechanically distinct layer to be twice as thick as the layer of depleted concentration, likely due to solvent drainage through the locally perturbed polymer structure.

Investigating the microenvironments of inhomogeneous soft materials with multiple particle tracking.

We develop a multiple particle tracking technique for making precise, localized measurements of the mechanical microenvironments of inhomogeneous materials. Using video microscopy, we simultaneously measure the Brownian dynamics of roughly one hundred fluorescent tracer particles embedded in a complex medium and interpret their motions in terms of local viscoelastic response. To help overcome the inherent statistical limitations due to the finite imaging volume and limited imaging times, we develop statistical techniques and analyze the distribution of particle displacements in order to make meaningful comparisons of individual particles and thus characterize the diversity and properties of the microenvironments. The ability to perform many local measurements simultaneously allows more precise measurements even in systems that evolve in time. We show several examples of inhomogeneous materials to demonstrate the flexibility of the technique and learn new details of the mechanics of the microenvironments that small particles explore. This technique extends other microrheological methods to allow simultaneous measurements of large numbers of probe particles, enabling heterogeneous samples to be studied more effectively.

Colloidal interactions in suspensions of rods.

We report direct measurements of entropic interactions of colloidal spheres in suspensions of rodlike fd bacteriophage. We investigate the influence of sphere size, rod concentration, and ionic strength on these interactions. Although the results compare favorably with a recent calculation, small discrepancies reveal entropic effects due to rod flexibility. At high salt concentrations, the potential turns repulsive as a result of viral adsorption on the spheres and viral bridging between the spheres.

Measurement of long-range steric repulsions between microspheres due to an adsorbed polymer.

We have measured the interparticle potential between pairs of micron-sized silica spheres induced by adsorbed polyethylene oxide polymer using a line-scanned optical tweezer. We found this long-range steric repulsion to be exponential over the range of energies (0.1k(B)T-5k(B)T) and polymer molecular weights (452,000-1,580,000) studied, and that the potential scaled with the polymer's radius of gyration R(G). The potential's exponential decay length was about 0.6R(G) and its range was about 4R(G), although both parameters varied significantly from one pair of spheres to another. The potential's exponential prefactor was greater than mean-field predictions.

Two-point microrheology of inhomogeneous soft materials.

We demonstrate a novel method for measuring the microrheology of soft viscoelastic media, based on cross correlating the thermal motion of pairs of embedded tracer particles. The method does not depend on the exact nature of the coupling between the tracers and the medium, and yields accurate rheological data for highly inhomogeneous materials. We demonstrate the accuracy of this method with a guar solution, for which other microscopic methods fail due to the polymer's mesoscopic inhomogeneity. Measurements in an F-actin solution suggest conventional microrheology measurements may not reflect the true bulk behavior.