The study showed that a coaching strategy had a positive effect on maternal-infant interaction in this sample. Future research is needed to test coaching interventions in conjunction with other strategies targeted to promote maternal-infant responsiveness and to reduce PPDS.
Household air pollution is ranked the 9(th) largest Global Burden of Disease risk (Forouzanfar et al., The Lancet 2015). People, particularly urban dwellers, typically spend over 90% of their daily time indoors, where levels of air pollution often surpass those of outdoor environments. Indoor air quality (IAQ) standards and approaches for assessment and control of indoor air require measurements of pollutant concentrations and thermal comfort using conventional instruments. However, the outcomes of such measurements are usually averages over long integrated time periods, which become available after the exposure has already occurred. Moreover, conventional monitoring is generally incapable of addressing temporal and spatial heterogeneity of indoor air pollution, or providing information on peak exposures that occur when specific indoor sources are in operation. This article provides a review of new air pollution sensing methods to determine IAQ and discusses how real-time sensing could bring a paradigm shift in controlling the concentration of key air pollutants in billions of urban houses worldwide. We also show that besides the opportunities, challenges still remain in terms of maturing technologies, or data mining and their interpretation. Moreover, we discuss further research and essential development needed to close gaps between what is available today and needed tomorrow. In particular, we demonstrate that awareness of IAQ risks and availability of appropriate regulation are lagging behind the technologies.
Background
The NHLBI-sponsored Sickle Cell Disease Clinical Research Network (SCDCRN) conducted a multi-center, acute intervention randomized clinical trial of two methods of Patient Controlled Analgesia for acute pain. This trial was terminated early due to low enrollment. We analyzed the perceived barriers and recruitment difficulties as reported by the coordinators and principal investigators.
Methods
Participating sites completed a missed eligibility log of subjects admitted in pain crisis throughout the study and a survey at the end of the trial. The survey covered site-specific factors, policies, and procedures in study implementation, recruitment strategies, and eligibility factors. The New England Research Institutes (NERI) collected de-identified surveys from 31 respondents at 29 of 31 participating sites.
Results
From December 2009 to June 2010, 1116 patient encounters for SCD and pain occurred at participating institutions: 38 subjects were enrolled (14 pediatric and 24 adults) and 34 completed the trial, below the projected 278 subjects. Fourteen sites enrolled subjects and seventeen did not. Recruitment barriers included insufficient staff, subject ineligibility or in too much pain to consent, competing protocols, and concerns regarding pain control. Recruitment methods were referrals from urgent care, SCD clinics and in house databases. No use of media or outside physicians was reported.
Conclusion
We identified multiple barriers to patient accrual including short duration of enrollment period, protocol design, complex dosing schedule, requirement for staff availability during week-end and after hours, multiple departments’ involvement, protocol acceptance, eligibility criteria, competing protocols, and limited staff. Each of these areas should be targeted for intervention in order to plan and conduct successful future clinical trials.
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