The clinical and cost effectiveness of internet-delivered self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS): Study protocol for a randomised controlled trial with ethnically diverse family carers

Background: Following the successful completion of feasibility and acceptability studies of internet-delivered self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS), a full-scale randomised controlled trial (RCT) evaluating its clinical and cost effectiveness will be conducted. This paper describes the design and protocol for a multi-site, parallel, single-blind, 2-arm RCT evaluating the clinical and cost effectiveness of iACT4CARERS plus treatment-as-usual (TAU) in comparison to TAU alone for reducing anxiety in family carers of people with dementia.// Methods: 496 family carers aged ≥18 years, who are caring for a person with dementia, will be recruited from national healthcare services, general practices and community groups in England. Participants randomised to the intervention arm will receive iACT4CARERS over 12 weeks. Participants will complete outcome measures at baseline (0 weeks) and at 12-weeks and 24-weeks post-randomisation. The primary outcome and timepoint will be anxiety at 12 weeks. Secondary outcomes will include psychological flexibility, depression, and cost-effectiveness (cost per quality adjusted life years). Primary analyses will be by intention-to-treat and data will be analysed using linear mixed models. Fidelity and quality of implementation will be assessed and contextual factors associated with variation in outcomes identified in a process evaluation.// Conclusion: If iACT4CARERS is found to be effective and affordable, this self-help intervention, including minimal contact with minimally trained therapists, has the potential to be rolled out widely within healthcare services in the UK, reducing inequality in access to psychological services among this population.// Clinical trials registration: ISRCTN registry identifier ISRCTN45995725

Incorporating the COM-B Model for Behavior Change into an Agent-Based Model of Smoking Behaviors: An Object-Oriented Design

Modeling trajectories in cigarette smoking prevalence, initiation and quitting for populations and subgroups of populations is important for policy planning and evaluation. This paper proposes an agent-based model (ABM) design for simulating the smoking behaviors of a population using the Capability, Opportunity, Motivation - Behavior (COM-B) model. Capability, Opportunity and Motivation are modeled as latent composite attributes which are composed of observable factors associated with smoking behaviors. Three forms of the COM-B model are proposed to explain the transitions between smoking behaviors: initiating regular smoking uptake, making a quit attempt and quitting successfully. The ABM design follows object-oriented principles and extends an existing generic software architecture for mechanism-based modeling. The potential of the model to assess the impact of smoking policies is illustrated and discussed

Network Analysis of Ecological Momentary Assessment Exploring the Role of Online and Offline Social Comparisons in the Mood and Wellbeing of Undergraduate Students

Whilst research suggests online social comparisons may be detrimental to wellbeing, little is known about the underlying temporal dynamics. Here we used Ecological Momentary Assessment to sample 100 undergraduate students’ experiences five times per day for 21 consecutive days, in conjunction with network analysis, to map dynamic interactions between (upward) online and offline social comparisons and multiple indicators of wellbeing. Contemporaneous, temporal, and between-subjects networks were estimated. Whilst online comparisons predicted lower self-esteem in the contemporaneous network, online comparisons predicted subsequent increases in positive, and decreases in negative, affect. In contrast, associations between offline social comparisons and poorer wellbeing were seen in all networks, and for multiple indices of wellbeing. Consistent with a two-step model of social comparisons, the findings suggest the effects of online comparisons may operate differently at different times-scales, and further, that offline comparisons may be more strongly related to poor wellbeing, with a potential causal association

Guideline-Directed Medical Therapy in Nonagenarians and Centenarians (≥90 Years Old) After First-Onset Myocardial Infarction - A National Registry Study

BACKGROUND: Guideline-directed medical therapies (GDMT) - beta-blockers, antiplatelet drugs, lipid-lowering drugs, and renin-angiotensin system agents have been associated with reduced risk of mortality after acute myocardial infarction (AMI). However, this survival benefit conferred by GDMTs in nonagenarians and centenarians (≥90 years old) is not well-defined. METHODS: We investigated restricted mean survival times of patients ≥90 years old with first-onset AMI treated with GDMTs from 2007 to 2020 in the Singapore Myocardial Infarction Registry. Primary analyses involved stratification by the number of GDMTs prescribed at discharge, with derivation of pairwise restricted mean survival ratios free from all-cause mortality at 1-year, 3-years and 5-years. Secondary analyses evaluated individual GDMTs within combinations of 1-3 GDMTs. RESULTS: The analysis included 3,264 patients: 0 GDMTs (561 patients, 17.2%), 1-2 GDMTs (1,294 patients, 39.6%), 3 GDMTs (904 patients, 27.7%), and 4 GDMTs (505 patients, 15.5%), with median follow-up duration of 5.71 years. Patients who received 4 GDMTs at discharge were younger, had more comorbidities, were more likely to be smokers, and to undergo PCI than those prescribed fewer GDMTs. A greater number of GDMT classes at discharge was associated with longer survival free from all-cause mortality at 1, 3, and 5 years. Each drug class within combinations of 1-3 GDMTs were associated with significant survival benefit at all time points, except for beta-blockers. CONCLUSION: Prescription of any number of GDMTs to nonagenarians and centenarians after first-onset AMI is associated with significant survival benefit

Cross-agency working when conducting a pragmatic RCT for older victims of crime: our experiences and lessons learned

BACKGROUND: With the population ageing, more victims of community crime are likely to be older adults. The psychological impact of crime on older victims is significant and sustained, but only feasibility trials have been published regarding potential interventions. The integration of public health and care services and cross-agency working is recommended, but there is little information on how this should be undertaken. Our recent Victim Improvement Package (VIP) randomised controlled trial (RCT) involved cross-agency collaboration between our university, a police service and a mental health charity. However, as the VIP trial only managed to recruit 131 out of 226 participants, we hope our reflections will help those wishing to conduct research in this population. METHODS: The trial management group (authors) and partners organisations identified the challenges and lessons learned from conducting the VIP trial in which the police identified and screened victims of reported community crime, aged 65 years or over, for distress. In the VIP trial, three screening methods were used: (1) visits by safer neighbourhood teams (SNTs), (2) police telephone screening and (3) employment of a university researcher embedded within the police service. Staff from the mental health charity were trained to deliver a manualised cognitive-behaviourally informed Victim Improvement Package (VIP) to be compared against treatment as usual (TAU). LESSONS LEARNED: Factors promoting successful screening included simple IT systems, building rapport with the police and maintaining contact with participants. However, policy and staff changes within the police service and altered public confidence in the police compromised screening. The delivery of therapy was impaired by waiting times, therapist availability and the quality of therapy. Conducting research within an existing busy clinical service was challenging, but the COVID-19 pandemic demonstrated the acceptability and feasibility of offering online therapy to older victims. CONCLUSION: SNT screening was an effective way to identify distressed victims, but service demands question whether it is viable for working police staff and the delivery of the therapy proved challenging in the context of a traditional RCT. Ways in which to strengthen research in this pioneering area of work are discussed

Changing public perceptions of alcohol, alcohol harms and alcohol policies: A multi-methods study to develop novel framing approaches

Background and aims: Public perceptions of alcohol and its related harms and policies are shaped by multiple discourses and can influence behaviour and policy support. As part of a FrameWorks-informed project to test framing approaches to improve public understanding and support for evidence-based alcohol policies in the UK, this research aimed to (i) summarise relevant evidence; (ii) compare how public understanding of alcohol harms differs from those of academic and charity experts; and (iii) develop novel framing approaches. // Methods: (1) a literature review including systematic, scoping and targeted components to understand previous evidence on effective framing from behaviour change, UK alcohol policy and FrameWorks literatures; (2) comparison of public views of alcohol harms and policies from four focus groups (n = 20) with those of public health experts; (3) an iterative process involving workshops and stakeholder consultation to develop 12 novel framing approaches. // Results: We found no previous study that directly tested framing approaches for alcohol policy advocacy. Our narrative summary of 35 studies found that explaining diverse harms may be important, whereas framing that engenders empathy, emphasises dependence or invokes a sense of crisis may be less effective. In focus groups, the public linked alcohol to pleasure/socialising, whilst understandings of harm focused on severe alcohol problems and individual deficits of biology or personality, with policy proposals focused mainly on treatment/support services. Public health experts highlighted more diverse harms and solutions, emphasising environmental and commercial causes. Comparison of public and expert views yielded six tasks for novel framing approaches to deepen public understanding. The team co-developed initial framing ideas (n = 31), before finalising 12 narrative framing approaches based on values (n = 5), metaphors (n = 3) and explanation (n = 4). // Conclusions: In the United Kingdom, public and expert understandings of alcoholrelated harms, causes and solutions differ. Along with prior evidence, these differences can inform novel framing approaches designed to deepen public understanding

More Than the Sum of Its Parts: Disrupted Core Periphery of Multiplex Brain Networks in Multiple Sclerosis

Disruptions to brain networks, measured using structural (sMRI), diffusion (dMRI), or functional (fMRI) MRI, have been shown in people with multiple sclerosis (PwMS), highlighting the relevance of regions in the core of the connectome but yielding mixed results depending on the studied connectivity domain. Using a multilayer network approach, we integrated these three modalities to portray an enriched representation of the brain's core-periphery organization and explore its alterations in PwMS. In this retrospective cross-sectional study, we selected PwMS and healthy controls with complete multimodal brain MRI acquisitions from 13 European centers within the MAGNIMS network. Physical disability and cognition were assessed with the Expanded Disability Status Scale (EDSS) and the symbol digit modalities test (SDMT), respectively. SMRI, dMRI, and resting-state fMRI data were parcellated into 100 cortical and 14 subcortical regions to obtain networks of morphological covariance, structural connectivity, and functional connectivity. Connectivity matrices were merged in a multiplex, from which regional coreness-the probability of a node being part of the multiplex core-and coreness disruption index (κ)-the global weakening of the core-periphery structure-were computed. The associations of κ with disease status (PwMS vs. healthy controls), clinical phenotype, level of physical disability (EDSS ≥ 4 vs. EDSS < 4), and cognitive impairment (SDMT z-score < -1.5) were tested within a linear model framework. Using random forest permutation feature importance, we assessed the relative contribution of κ in the multiplex and single-layer domains, in addition to conventional MRI measures (brain and lesion volumes), in predicting disease status, physical disability, and cognitive impairment. We studied 1048 PwMS (695F, mean ± SD age: 43.3 ± 11.4 years) and 436 healthy controls (250F, mean ± SD age: 38.3 ± 11.8 years). PwMS showed significant disruption of the multiplex core-periphery organization (κ = -0.14, Hedges' g = 0.49, p < 0.001), correlating with clinical phenotype (F = 3.90, p = 0.009), EDSS (Hedges' g = 0.18, p = 0.01), and SDMT (Hedges' g = 0.30, p < 0.001). Multiplex κ was the only connectomic measure adding to conventional MRI in predicting disease status and cognitive impairment, while physical disability also depended on single-layer contributions. In conclusion, we show that multilayer networks represent a biologically and clinically meaningful framework to model multimodal MRI data, with disruption of the core-periphery structure emerging as a potential connectomic biomarker for disease severity and cognitive impairment in PwMS

What do *I*, as a student, think of my own work? Using summative self-assessment in a large technical module

Self-assessment is a reflective practice enabling learners to evaluate their understanding (McMillan and Hearn, 2008). When fostering metacognitive processes, it can enhance learning by improving intrinsic motivation, understanding and learning strategies (Stanton, Sebesta and Dunlosky, 2021). The benefits for using self-assessment as a summative practice remains debated (for example, Andrade, 2019; Nieminen and Tuohilampi, 2020a; León, Panadero and García-Martínez, 2023). This paper presents the results of a summative self-assessment, on an undergraduate, larger (>100 students), technical module. The developed assessment on the module required submission of a critical self-assessment report around the technical work (i.e., portfolio) completed by students. Along with self-assessment, a combination of contract and negotiated marking was included into the assessment to encourage students’ early engagement with learning. It required completing weekly tutorials, a mid-term formative assessment, and submission of portfolio for an exhibition. The summative self-assessment comprised of a reflective, critical report around student engagement with learning as well as the quality of their completed portfolio. This paper outlines the thematic analysis of the interviews and survey results of the learners. It highlights the perceived benefits and concerns voiced around a summative self-assessment. Some of the results highlight the reduction in stress levels and greater depth of critical assessment of students’ own work. The paper offers practitioners an example on integrating summative self-assessment into teaching by [a] combining elements of contract assessment and negotiated marking, and [b] providing space for students to explore individual learning paths scaffolded through feedback

Licensing and niche competition in spermatogenesis: mathematical models suggest complementary regulation of tissue maintenance

To maintain and regenerate adult tissues after injury, division and differentiation of tissue-resident stem cells must be precisely regulated. It remains elusive which regulatory strategies prevent exhaustion or overgrowth of the stem cell pool, whether there is coordination between multiple mechanisms, and how to detect them from snapshots. In Drosophila testes, somatic stem cells transition to a state that licenses them to differentiate, but remain capable of returning to the niche and resuming cell division. Here, we build stochastic mathematical models for the somatic stem cell population to investigate how licensing contributes to homeostasis. We find that licensing, in combination with differentiation occurring in pairs, is sufficient to maintain homeostasis and prevent stem cell extinction from stochastic fluctuations. Experimental data have shown that stem cells are competing for niche access, and our mathematical models demonstrate that this contributes to the reduction in the variability of stem cell numbers but does not prevent extinction. Hence, a combination of both regulation strategies, licensing with pairwise differentiation and competition for niche access, may be needed to reduce variability and prevent extinction simultaneously