The stepped wedge design, under which all trial participants receive the intervention but the order in which the intervention is received is randomised, is potentially useful to rigorously evaluate organisational interventions to improve quality and safety. We use two examples of cluster-randomised steppedwedge trials (DQIP and GP-POLY) to illustrate advantages and disadvantages of the design i...

BACKGROUND We designed a pragmatic stepped-wedge cluster randomized controlled trial in order to evaluate provider-initiated evaluation of household contacts (HCs) of smear positive tuberculosis (TB) cases within a routine TB program in Lima, Peru. METHODS/DESIGN National TB program (NTP) officers of San Juan de Lurigancho District (Lima, Peru) and university-based researchers jointly designe...

OBJECTIVE There are effective treatments of trichotillomania (TTM), but access to expert providers is limited. This study tested a stepped care model aimed at improving access. METHOD Participants were 60 (95% women, 75% Caucasian, 2% Hispanic) adults (M = 33.18 years) with TTM. They were randomly assigned to immediate versus waitlist (WL) conditions for Step 1 (10 weeks of web-based self-hel...

With the re-evaluation and revision of a number of design floods, several embankment overtopping protection systems have been developed and a common technique is the construction of a stepped spillway on the downstream slope. For such moderate slope stepped channels, detailed air–water flow measurements were performed in a large facility with a focus on the rate of energy dissipation, flow resi...

PURPOSE To use functional MR imaging to measure the effect of frequency (pitch), intensity (loudness), and complexity of auditory stimuli on activation in the primary and secondary auditory cortexes. METHODS Multiplanar echo-planar images were acquired in healthy subjects with normal hearing to whom auditory stimuli were presented intermittently. Functional images were processed from the echo...