To apply the UK Medical Research Council (MRC) framework for development and evaluation of trials... more To apply the UK Medical Research Council (MRC) framework for development and evaluation of trials of complex interventions to a primary healthcare intervention to promote secondary prevention of coronary heart disease. Case report of intervention development. First, literature relating to secondary prevention and lifestyle change was reviewed. Second, a preliminary intervention was modeled, based on literature findings and focus group interviews with patients (n = 23) and staff (n = 29) from 4 general practices. Participants' experiences of and attitudes toward key intervention components were explored. Third, the preliminary intervention was pilot-tested in 4 general practices. After delivery of the pilot intervention, practitioners evaluated the training sessions, and qualitative data relating to experiences of the intervention were collected using semistructured interviews with staff (n = 10) and patient focus groups (n = 17). Literature review identified 3 intervention compo...
ABSTRACT There is significant potential for health psychology to inform the development of health... more ABSTRACT There is significant potential for health psychology to inform the development of health behaviour-change interventions. Yet many behavioural interventions reported in the literature are not informed by theory, fail to make explicit how theoretical constructs are operationalised and/or do not describe behaviour-change techniques in enough detail to enable replication. This paper outlines one example of a behaviour-change intervention that was informed by psychological theory, and attempts to make its constructs and techniques explicit. The intervention described is one component of a larger, multifaceted intervention study, called SPHERE, which is targeting organisational, educational and behavioural aspects of primary care on the island of Ireland to improve secondary prevention of coronary heart disease. This paper describes the development of an intervention to improve primary care practitioners’ ability to facilitate patients with coronary heart disease improve their lifestyles. The paper reviews health psychology theories in the area of behaviour change, and desribes the process of intervention development and refinement. The paper ends with suggestions about making health psychology theory more accessible to interventionists.
Background: Recruitment and retention of patients and healthcare providers in randomised controll... more Background: Recruitment and retention of patients and healthcare providers in randomised controlled trials (RCTs) is important in order to determine the effectiveness of interventions. However, failure to achieve recruitment targets is common and reasons why a particular recruitment strategy works for one study and not another remain unclear. We sought to describe a strategy used in a multicentre RCT in primary care, to report researchers' and participants' experiences of its implementation and to inform future strategies to maximise recruitment and retention.
Background: Patient reported outcome measures (PROMs) are used to evaluate lifestyle intervention... more Background: Patient reported outcome measures (PROMs) are used to evaluate lifestyle interventions but little is known about differences between patients returning valid and invalid responses, or of potential for bias in evaluations. We aimed to examine the characteristics of patients who returned valid responses to lifestyle questionnaires compared to those whose responses were invalid for evaluating lifestyle change.
Objective To test the effectiveness of a complex intervention designed, within a theoretical fram... more Objective To test the effectiveness of a complex intervention designed, within a theoretical framework, to improve outcomes for patients with coronary heart disease.Design Cluster randomised controlled multicentre trial.Setting General practices in Northern Ireland and the Republic of Ireland, regions with different healthcare systems.Participants 903 patients with established coronary heart disease registered with one of 48 practices.Intervention Tailored care plans for
The following paper describes the results of a baseline study to assess the status of crisis mana... more The following paper describes the results of a baseline study to assess the status of crisis management preparedness in public school districts in three southern states in the United States. Self-reported responses were collected by distributing a 22 question self-reporting survey to all school districts and systems in the states of Tennessee, North Carolina and Georgia. Threats by students were indicated as requiring district team activation by 40% of responding districts. This baseline study indicated that 95% of responding districts have some type of district crisis management plan, 77% have a district crisis management team and 88% have a part-or full-time director designated for crisis situation. While these initial findings sound promising, the low number of districts (less than 50%) self-reporting at least one full day of training in the last year and no full-scale drill is indicative of a very low level of crisis preparedness. This lack of preparedness reported in combination with the relatively high level of crisis incidents, such as student deaths, violence (fights), weapons on campus, and student threats, gives rise for concern, and districts should pay special attention to increasing future training efforts and performing more full-scale drills. Overall, crisis plans should be improved in order to ensure adequate school district crisis preparedness. #
Pleiotrophin (PTN) is a heparin-binding protein with multiple activities in cell growth, migratio... more Pleiotrophin (PTN) is a heparin-binding protein with multiple activities in cell growth, migration and differentiation mediated through multiple receptors. In mammals, PTN expression in trophoblast is found exclusively in the human and in some of the apes in which an endogenous retrovirus upstream of the first coding exon generates a phylogenetically new trophoblast-specific promoter associated with exon UV3. To understand the functions of ERV promoter-mediated trophoblastic PTN expression in pregnancy, we correlated the expression of PTN and its receptors anaplastic lymphoma kinase (ALK), receptor protein tyrosine phosphatase beta/zeta (RPTPbeta/zeta), and Syndecan-1 and Syndecan-3 (SDC1 and SDC3) with key developmental processes in first-trimester human placentation. In an extensive survey of cell lines and primary tissues, we found that trophoblastic transcription of PTN is initiated exclusively from the ERV promoter, whereas decidual expression is initiated at the phylogenetically ancient U1 exon-associated promoter. Using immunohistochemistry, we found that different patterns of overlapping expression of PTN and its receptors occur in different trophoblast subtypes. Notably, a role in angiogenesis is supported by expression of PTN and its receptors in villous mesenchyme, fetal macrophages and villus core fetal vessels. PTN staining of extravillous cytotrophoblasts and the syncytial microvillous membrane is consistent with increasing levels of PTN, as measured by ELISA, in the maternal bloodstream as pregnancy progresses.
ABSTRACT The Journal of Comorbidity was launched in 2011 and has since become established as a hi... more ABSTRACT The Journal of Comorbidity was launched in 2011 and has since become established as a high-quality journal that publishes open-access, peer-reviewed articles, with a focus on advancing the clinical management of patients with comorbidity/multimorbidity. To further enhance research quality and reporting of studies in this field, the journal is now offering authors the opportunity to publish a summary of their study protocols – a move designed to generate interest and raise awareness in ongoing clinical research and to enable researchers to detail their methodologies in order that replication by scientific peers is possible.
DIAMOND is a state of the art 3 GeV synchrotron light source that will be available to users in 2... more DIAMOND is a state of the art 3 GeV synchrotron light source that will be available to users in 2007(1). Considerable further progress has been made on the accelerator physics design of the storage ring, booster and other associated injector systems. Detailed analysis of injection processes, lifetime, coupling, instabilities, feedback systems and dynamic aperture have been undertaken driven by the
We describe the methodology used to create a register of clinical prediction rules relevant to pr... more We describe the methodology used to create a register of clinical prediction rules relevant to primary care. We also summarize the rules included in the register according to various characteristics. To identify relevant articles, we searched the MEDLINE database (PubMed) for the years 1980 to 2009 and supplemented the results with searches of secondary sources (books on clinical prediction rules) and personal resources (eg, experts in the field). The rules described in relevant articles were classified according to their clinical domain, the stage of development, and the clinical setting in which they were studied. Our search identified clinical prediction rules reported between 1965 and 2009. The largest share of rules (37.2%) were retrieved from PubMed. The number of published rules increased substantially over the study decades. We included 745 articles in the register; many contained more than 1 clinical prediction rule study (eg, both a derivation study and a validation study)...
Prenatal alcohol exposure (PAE) causes distinctive facial characteristics in some pregnancies and... more Prenatal alcohol exposure (PAE) causes distinctive facial characteristics in some pregnancies and not others; genetic factors may contribute to this differential vulnerability. Ethanol disrupts multiple events of neural crest development, including induction, survival, migration, and differentiation. Animal models and genomic approaches have substantially advanced our understanding of the mechanisms underlying these facial changes. PAE during gastrulation produces craniofacial changes corresponding with human fetal alcohol syndrome. These result because PAE reduces prechordal plate extension and suppresses sonic hedgehog, leading to holoprosencephaly and malpositioned facial primordia. Haploinsufficiency in sonic hedgehog signaling increases vulnerability to facial deficits and may influence some PAE pregnancies. In contrast, PAE during early neurogenesis produces facial hypoplasia, preceded by neural crest reductions due to significant apoptosis. Factors mediating this apoptosis include intracellular calcium mobilization, elevated reactive oxygen species, and loss of trophic support from β-catenin/calcium, sonic hedgehog, and mTOR signaling. Genome-wide SNP analysis links PDGFRA with facial outcomes in human PAE. Multiple genomic-level comparisons of ethanol-sensitive and - resistant early embryos, in both mouse and chick, independently identify common candidate genes that may potentially modify craniofacial vulnerability, including ribosomal proteins, proteosome, RNA splicing, and focal adhesion. In summary, research using animal models with genome-level differences in ethanol vulnerability, as well as targeted loss-and gain-of-function mutants, has clarified the mechanisms mediating craniofacial change in PAE. The findings additionally suggest that craniofacial deficits may represent a gene-ethanol interaction for some affected individuals. Genetic-level changes may prime individuals toward greater sensitivity or resistance to ethanol's neurotoxicity.
The aim of the SPHERE study is to design, implement and evaluate tailored practice and personal c... more The aim of the SPHERE study is to design, implement and evaluate tailored practice and personal care plans to improve the process of care and objective clinical outcomes for patients with established coronary heart disease (CHD) in general practice across two different health systems on the island of Ireland.
Background: Developing complex interventions for testing in randomised controlled trials is of in... more Background: Developing complex interventions for testing in randomised controlled trials is of increasing importance in healthcare planning. There is a need for careful design of interventions for secondary prevention of coronary heart disease (CHD). It has been suggested that integrating qualitative research in the development of a complex intervention may contribute to optimising its design but there is limited evidence of this in practice. This study aims to examine the contribution of qualitative research in developing a complex intervention to improve the provision and uptake of secondary prevention of CHD within primary care in two different healthcare systems.
To apply the UK Medical Research Council (MRC) framework for development and evaluation of trials... more To apply the UK Medical Research Council (MRC) framework for development and evaluation of trials of complex interventions to a primary healthcare intervention to promote secondary prevention of coronary heart disease. Case report of intervention development. First, literature relating to secondary prevention and lifestyle change was reviewed. Second, a preliminary intervention was modeled, based on literature findings and focus group interviews with patients (n = 23) and staff (n = 29) from 4 general practices. Participants' experiences of and attitudes toward key intervention components were explored. Third, the preliminary intervention was pilot-tested in 4 general practices. After delivery of the pilot intervention, practitioners evaluated the training sessions, and qualitative data relating to experiences of the intervention were collected using semistructured interviews with staff (n = 10) and patient focus groups (n = 17). Literature review identified 3 intervention compo...
ABSTRACT There is significant potential for health psychology to inform the development of health... more ABSTRACT There is significant potential for health psychology to inform the development of health behaviour-change interventions. Yet many behavioural interventions reported in the literature are not informed by theory, fail to make explicit how theoretical constructs are operationalised and/or do not describe behaviour-change techniques in enough detail to enable replication. This paper outlines one example of a behaviour-change intervention that was informed by psychological theory, and attempts to make its constructs and techniques explicit. The intervention described is one component of a larger, multifaceted intervention study, called SPHERE, which is targeting organisational, educational and behavioural aspects of primary care on the island of Ireland to improve secondary prevention of coronary heart disease. This paper describes the development of an intervention to improve primary care practitioners’ ability to facilitate patients with coronary heart disease improve their lifestyles. The paper reviews health psychology theories in the area of behaviour change, and desribes the process of intervention development and refinement. The paper ends with suggestions about making health psychology theory more accessible to interventionists.
Background: Recruitment and retention of patients and healthcare providers in randomised controll... more Background: Recruitment and retention of patients and healthcare providers in randomised controlled trials (RCTs) is important in order to determine the effectiveness of interventions. However, failure to achieve recruitment targets is common and reasons why a particular recruitment strategy works for one study and not another remain unclear. We sought to describe a strategy used in a multicentre RCT in primary care, to report researchers' and participants' experiences of its implementation and to inform future strategies to maximise recruitment and retention.
Background: Patient reported outcome measures (PROMs) are used to evaluate lifestyle intervention... more Background: Patient reported outcome measures (PROMs) are used to evaluate lifestyle interventions but little is known about differences between patients returning valid and invalid responses, or of potential for bias in evaluations. We aimed to examine the characteristics of patients who returned valid responses to lifestyle questionnaires compared to those whose responses were invalid for evaluating lifestyle change.
Objective To test the effectiveness of a complex intervention designed, within a theoretical fram... more Objective To test the effectiveness of a complex intervention designed, within a theoretical framework, to improve outcomes for patients with coronary heart disease.Design Cluster randomised controlled multicentre trial.Setting General practices in Northern Ireland and the Republic of Ireland, regions with different healthcare systems.Participants 903 patients with established coronary heart disease registered with one of 48 practices.Intervention Tailored care plans for
The following paper describes the results of a baseline study to assess the status of crisis mana... more The following paper describes the results of a baseline study to assess the status of crisis management preparedness in public school districts in three southern states in the United States. Self-reported responses were collected by distributing a 22 question self-reporting survey to all school districts and systems in the states of Tennessee, North Carolina and Georgia. Threats by students were indicated as requiring district team activation by 40% of responding districts. This baseline study indicated that 95% of responding districts have some type of district crisis management plan, 77% have a district crisis management team and 88% have a part-or full-time director designated for crisis situation. While these initial findings sound promising, the low number of districts (less than 50%) self-reporting at least one full day of training in the last year and no full-scale drill is indicative of a very low level of crisis preparedness. This lack of preparedness reported in combination with the relatively high level of crisis incidents, such as student deaths, violence (fights), weapons on campus, and student threats, gives rise for concern, and districts should pay special attention to increasing future training efforts and performing more full-scale drills. Overall, crisis plans should be improved in order to ensure adequate school district crisis preparedness. #
Pleiotrophin (PTN) is a heparin-binding protein with multiple activities in cell growth, migratio... more Pleiotrophin (PTN) is a heparin-binding protein with multiple activities in cell growth, migration and differentiation mediated through multiple receptors. In mammals, PTN expression in trophoblast is found exclusively in the human and in some of the apes in which an endogenous retrovirus upstream of the first coding exon generates a phylogenetically new trophoblast-specific promoter associated with exon UV3. To understand the functions of ERV promoter-mediated trophoblastic PTN expression in pregnancy, we correlated the expression of PTN and its receptors anaplastic lymphoma kinase (ALK), receptor protein tyrosine phosphatase beta/zeta (RPTPbeta/zeta), and Syndecan-1 and Syndecan-3 (SDC1 and SDC3) with key developmental processes in first-trimester human placentation. In an extensive survey of cell lines and primary tissues, we found that trophoblastic transcription of PTN is initiated exclusively from the ERV promoter, whereas decidual expression is initiated at the phylogenetically ancient U1 exon-associated promoter. Using immunohistochemistry, we found that different patterns of overlapping expression of PTN and its receptors occur in different trophoblast subtypes. Notably, a role in angiogenesis is supported by expression of PTN and its receptors in villous mesenchyme, fetal macrophages and villus core fetal vessels. PTN staining of extravillous cytotrophoblasts and the syncytial microvillous membrane is consistent with increasing levels of PTN, as measured by ELISA, in the maternal bloodstream as pregnancy progresses.
ABSTRACT The Journal of Comorbidity was launched in 2011 and has since become established as a hi... more ABSTRACT The Journal of Comorbidity was launched in 2011 and has since become established as a high-quality journal that publishes open-access, peer-reviewed articles, with a focus on advancing the clinical management of patients with comorbidity/multimorbidity. To further enhance research quality and reporting of studies in this field, the journal is now offering authors the opportunity to publish a summary of their study protocols – a move designed to generate interest and raise awareness in ongoing clinical research and to enable researchers to detail their methodologies in order that replication by scientific peers is possible.
DIAMOND is a state of the art 3 GeV synchrotron light source that will be available to users in 2... more DIAMOND is a state of the art 3 GeV synchrotron light source that will be available to users in 2007(1). Considerable further progress has been made on the accelerator physics design of the storage ring, booster and other associated injector systems. Detailed analysis of injection processes, lifetime, coupling, instabilities, feedback systems and dynamic aperture have been undertaken driven by the
We describe the methodology used to create a register of clinical prediction rules relevant to pr... more We describe the methodology used to create a register of clinical prediction rules relevant to primary care. We also summarize the rules included in the register according to various characteristics. To identify relevant articles, we searched the MEDLINE database (PubMed) for the years 1980 to 2009 and supplemented the results with searches of secondary sources (books on clinical prediction rules) and personal resources (eg, experts in the field). The rules described in relevant articles were classified according to their clinical domain, the stage of development, and the clinical setting in which they were studied. Our search identified clinical prediction rules reported between 1965 and 2009. The largest share of rules (37.2%) were retrieved from PubMed. The number of published rules increased substantially over the study decades. We included 745 articles in the register; many contained more than 1 clinical prediction rule study (eg, both a derivation study and a validation study)...
Prenatal alcohol exposure (PAE) causes distinctive facial characteristics in some pregnancies and... more Prenatal alcohol exposure (PAE) causes distinctive facial characteristics in some pregnancies and not others; genetic factors may contribute to this differential vulnerability. Ethanol disrupts multiple events of neural crest development, including induction, survival, migration, and differentiation. Animal models and genomic approaches have substantially advanced our understanding of the mechanisms underlying these facial changes. PAE during gastrulation produces craniofacial changes corresponding with human fetal alcohol syndrome. These result because PAE reduces prechordal plate extension and suppresses sonic hedgehog, leading to holoprosencephaly and malpositioned facial primordia. Haploinsufficiency in sonic hedgehog signaling increases vulnerability to facial deficits and may influence some PAE pregnancies. In contrast, PAE during early neurogenesis produces facial hypoplasia, preceded by neural crest reductions due to significant apoptosis. Factors mediating this apoptosis include intracellular calcium mobilization, elevated reactive oxygen species, and loss of trophic support from β-catenin/calcium, sonic hedgehog, and mTOR signaling. Genome-wide SNP analysis links PDGFRA with facial outcomes in human PAE. Multiple genomic-level comparisons of ethanol-sensitive and - resistant early embryos, in both mouse and chick, independently identify common candidate genes that may potentially modify craniofacial vulnerability, including ribosomal proteins, proteosome, RNA splicing, and focal adhesion. In summary, research using animal models with genome-level differences in ethanol vulnerability, as well as targeted loss-and gain-of-function mutants, has clarified the mechanisms mediating craniofacial change in PAE. The findings additionally suggest that craniofacial deficits may represent a gene-ethanol interaction for some affected individuals. Genetic-level changes may prime individuals toward greater sensitivity or resistance to ethanol's neurotoxicity.
The aim of the SPHERE study is to design, implement and evaluate tailored practice and personal c... more The aim of the SPHERE study is to design, implement and evaluate tailored practice and personal care plans to improve the process of care and objective clinical outcomes for patients with established coronary heart disease (CHD) in general practice across two different health systems on the island of Ireland.
Background: Developing complex interventions for testing in randomised controlled trials is of in... more Background: Developing complex interventions for testing in randomised controlled trials is of increasing importance in healthcare planning. There is a need for careful design of interventions for secondary prevention of coronary heart disease (CHD). It has been suggested that integrating qualitative research in the development of a complex intervention may contribute to optimising its design but there is limited evidence of this in practice. This study aims to examine the contribution of qualitative research in developing a complex intervention to improve the provision and uptake of secondary prevention of CHD within primary care in two different healthcare systems.
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Papers by Susan Smith