Effectiveness and cost-effectiveness of an educational intervention for practice teams to deliver problem focused therapy for insomnia: rationale and design of a pilot cluster randomised trial

Background: Sleep problems are common, affecting over a third of adults in the United Kingdom and leading to reduced productivity and impaired health-related quality of life. Many of those whose lives are affected seek medical help from primary care. Drug treatment is ineffective long term. Psychological methods for managing sleep problems, including cognitive behavioural therapy for insomnia (CBTi) have been shown to be effective and cost effective but have not been widely implemented or evaluated in a general practice setting where they are most likely to be needed and most appropriately delivered. This paper outlines the protocol for a pilot study designed to evaluate the effectiveness and cost-effectiveness of an educational intervention for general practitioners, primary care nurses and other members of the primary care team to deliver problem focused therapy to adult patients presenting with sleep problems due to lifestyle causes, pain or mild to moderate depression or anxiety. Methods and design: This will be a pilot cluster randomised controlled trial of a complex intervention. General practices will be randomised to an educational intervention for problem focused therapy which includes a consultation approach comprising careful assessment (using assessment of secondary causes, sleep diaries and severity) and use of modified CBTi for insomnia in the consultation compared with usual care (general advice on sleep hygiene and pharmacotherapy with hypnotic drugs). Clinicians randomised to the intervention will receive an educational intervention (2 × 2 hours) to implement a complex intervention of problem focused therapy. Clinicians randomised to the control group will receive reinforcement of usual care with sleep hygiene advice. Outcomes will be assessed via self-completion questionnaires and telephone interviews of patients and staff as well as clinical records for interventions and prescribing. Discussion: Previous studies in adults have shown that psychological treatments for insomnia administered by specialist nurses to groups of patients can be effective within a primary care setting. This will be a pilot study to determine whether an educational intervention aimed at primary care teams to deliver problem focused therapy for insomnia can improve sleep management and outcomes for individual adult patients presenting to general practice. The study will also test procedures and collect information in preparation for a larger definitive cluster-randomised trial. The study is funded by The Health Foundation

Validation of the questionnaire on beliefs about medication with type 2 diabetic patients

O presente trabalho teve como objectivo validar o Questionário Crenças sobre a Medicação, que avalia Crenças Gerais e Crenças Específicas, estudando suas propriedades psicométricas em uma amostra de 387 pacientes diabéticos tipo 2. O estudo de validade para as Crenças Gerais revelou uma solução de um factor, com um alfa de 0,76, e para as Crenças Específicas, dois factores – Necessidades e Preocupações –, com um alfa de 0,77 e 0,69 respectivamente. Quanto à validade de constructo, verificou-se uma relação entre as Crenças Gerais e a subescala Necessidades das Crenças Específicas com Adesão à Medicação, avaliada pela Escala de Avaliação de Aderência Médica. O instrumento apresenta boas qualidades psicométricas para ser utilizado em pacientes diabéticos tipo 2.The present paper focused on the validation of the Questionnaire on Beliefs about Medication, which assesses both General Beliefs and Specific Beliefs. The psychometric properties of the instrument were analyzed on a sample of 387 type 2 diabetic patients. The validity study for General Beliefs found a unifactorial solution, with an alpha of .76, and for Specific Beliefs, a two-factor solution – Necessities and Concern –, with an alpha of .77 and .69, respectively. In terms of construct validity, a relationship between General Beliefs, subscale Necessities from Specific Beliefs, and adherence to medication, as evaluated by Medical Adherence Rating Scale, was found. The instrument presents good psychometric qualities to be used in type 2 diabetic patients.Fundação para a Ciência e Tecnologia (FCT

Electronic Structure and Bonding of Icosahedral Core-Shell Gold-Silver Nanoalloy Clusters Au_(144-x)Ag_x(SR)_60

Atomically precise thiolate-stabilized gold nanoclusters are currently of interest for many cross-disciplinary applications in chemistry, physics and molecular biology. Very recently, synthesis and electronic properties of "nanoalloy" clusters Au_(144-x)Ag_x(SR)_60 were reported. Here, density functional theory is used for electronic structure and bonding in Au_(144-x)Ag_x(SR)_60 based on a structural model of the icosahedral Au_144(SR)_60 that features a 114-atom metal core with 60 symmetry-equivalent surface sites, and a protecting layer of 30 RSAuSR units. In the optimal configuration the 60 surface sites of the core are occupied by silver in Au_84Ag_60(SR)_60. Silver enhances the electron shell structure around the Fermi level in the metal core, which predicts a structured absorption spectrum around the onset (about 0.8 eV) of electronic metal-to-metal transitions. The calculations also imply element-dependent absorption edges for Au(5d) \rightarrow Au(6sp) and Ag(4d) \rightarrow Ag(5sp) interband transitions in the "plasmonic" region, with their relative intensities controlled by the Ag/Au mixing ratio.Comment: 4 figure

An Analytic Study of the Professional Development Research in Early Childhood Education

The goal of this study was to examine empirical research on the design, delivery, and measurement of the effects of professional development (PD) for early childhood educators in order to provide insight into what the field has accomplished as well as suggest directions for future PD programs and research. Through the use of rigorous inclusion criteria outlined by S. M. Wilson, R. E. Floden, and J. Ferrini-Mundy (2001), 73 studies were included and analyzed. On average, 25% (M = 12.68, SD = 9.99) of references in each study were specifically about PD. The majority of studies (n = 39) targeted some form of language and literacy instruction, whereas only 5 studies targeted math and 1 study targeted science. A total of 35 different delivery mechanisms were used to provide PD, with 40 studies including some form of coaching and 45 including training workshops. The studies used a wide range of methods to measure PD-related outcomes: 51% (n = 37) of studies examined changes in teacher practice, 18% (n = 13) measured changes in teachers’ knowledge, 40% (n = 29) measured changes in children’s learning, and 11% (n = 8) measured changes in children’s behavior. Practice or Policy: Based on the results of this study, there are 4 major ways in which PD for early childhood educators can be developed. Researchers and providers of PD should (a) continue to draw from multiple resources to inform PD implementation designs, (b) include more diversity in the content of instruction targeted by PD, (c) experiment with innovative formats for delivering PD, and (d) create better means of evaluating PD

Protocol for the saMS trial (supportive adjustment for multiple sclerosis): a randomized controlled trial comparing cognitive behavioral therapy to supportive listening for adjustment to multiple sclerosis

BackgroundMultiple Sclerosis (MS) is an incurable, chronic, potentially progressive and unpredictable disease of the central nervous system. The disease produces a range of unpleasant and debilitating symptoms, which can have a profound impact including disrupting activities of daily living, employment, income, relationships, social and leisure activities, and life goals. Adjusting to the illness is therefore particularly challenging. This trial tests the effectiveness of a cognitive behavioural intervention compared to supportive listening to assist adjustment in the early stages of MS.MethodsThis is a two arm randomized multi-centre parallel group controlled trial. 122 consenting participants who meet eligibility criteria will be randomly allocated to receive either Cognitive Behavioral Therapy or Supportive Listening. Eight one hour sessions of therapy (delivered over a period of 10 weeks) will be delivered by general nurses trained in both treatments. Self-report questionnaire data will be collected at baseline (0 weeks), mid-therapy (week 5 of therapy), post-therapy (15 weeks) and at six months (26 weeks) and twelve months (52 weeks) follow-up. Primary outcomes are distress and MS-related social and role impairment at twelve month follow-up. Analysis will also consider predictors and mechanisms of change during therapy. In-depth interviews to examine participants’ experiences of the interventions will be conducted with a purposively sampled sub-set of the trial participants. An economic analysis will also take place. DiscussionThis trial is distinctive in its aims in that it aids adjustment to MS in a broad sense. It is not a treatment specifically for depression. Use of nurses as therapists makes the interventions potentially viable in terms of being rolled out in the NHS. The trial benefits from incorporating patient input in the development and evaluation stages. The trial will provide important information about the efficacy, cost-effectiveness and acceptability of the interventions as well as mechanisms of psychosocial adjustment.Trial registrationCurrent Controlled Trials ISRCTN91377356<br/

Chemical analysis of the superatom model for sulfur-stabilized gold nanoparticles

The superatom model for nanoparticle structure is shown to be inadequate for the prediction of the thermodynamic stability of gold nanoparticles. The observed large HOMO-LUMO gaps for stable nanoparticles predicted by this model are, for sulfur-stabilized gold nanoparticles, attributed to covalent interactions of the metal with thiyl adsorbate radicals rather than ionic interactions with thiolate adsorbate ions, as is commonly presumed. In particular, gold adatoms in the stabilizing layer are shown to be of Au(0) nature, subtle but significantly different from the atoms of the gold core owing to the variations in the proportion of gold-gold and gold-sulfur links that form. These interactions explain the success of the superatom model in describing the electronic structure of both known and informatory nanoparticle compositions. Nanoparticle reaction energies are, however, found not to correlate with the completion of superatom shells

Achievement of target gain larger than unity in an inertial fusion experiment.

On December 5, 2022, an indirect drive fusion implosion on the National Ignition Facility (NIF) achieved a target gain G_{target} of 1.5. This is the first laboratory demonstration of exceeding "scientific breakeven" (or G_{target}>1) where 2.05 MJ of 351 nm laser light produced 3.1 MJ of total fusion yield, a result which significantly exceeds the Lawson criterion for fusion ignition as reported in a previous NIF implosion [H. Abu-Shawareb et al. (Indirect Drive ICF Collaboration), Phys. Rev. Lett. 129, 075001 (2022)PRLTAO0031-900710.1103/PhysRevLett.129.075001]. This achievement is the culmination of more than five decades of research and gives proof that laboratory fusion, based on fundamental physics principles, is possible. This Letter reports on the target, laser, design, and experimental advancements that led to this result

Using quantile regression to investigate racial disparities in medication non-adherence

<p>Abstract</p> <p>Background</p> <p>Many studies have investigated racial/ethnic disparities in medication non-adherence in patients with type 2 diabetes using common measures such as medication possession ratio (MPR) or gaps between refills. All these measures including MPR are quasi-continuous and bounded and their distribution is usually skewed. Analysis of such measures using traditional regression methods that model mean changes in the dependent variable may fail to provide a full picture about differential patterns in non-adherence between groups.</p> <p>Methods</p> <p>A retrospective cohort of 11,272 veterans with type 2 diabetes was assembled from Veterans Administration datasets from April 1996 to May 2006. The main outcome measure was MPR with quantile cutoffs Q1-Q4 taking values of 0.4, 0.6, 0.8 and 0.9. Quantile-regression (QReg) was used to model the association between MPR and race/ethnicity after adjusting for covariates. Comparison was made with commonly used ordinary-least-squares (OLS) and generalized linear mixed models (GLMM).</p> <p>Results</p> <p>Quantile-regression showed that Non-Hispanic-Black (NHB) had statistically significantly lower MPR compared to Non-Hispanic-White (NHW) holding all other variables constant across all quantiles with estimates and p-values given as -3.4% (p = 0.11), -5.4% (p = 0.01), -3.1% (p = 0.001), and -2.00% (p = 0.001) for Q1 to Q4, respectively. Other racial/ethnic groups had lower adherence than NHW only in the lowest quantile (Q1) of about -6.3% (p = 0.003). In contrast, OLS and GLMM only showed differences in mean MPR between NHB and NHW while the mean MPR difference between other racial groups and NHW was not significant.</p> <p>Conclusion</p> <p>Quantile regression is recommended for analysis of data that are heterogeneous such that the tails and the central location of the conditional distributions vary differently with the covariates. QReg provides a comprehensive view of the relationships between independent and dependent variables (i.e. not just centrally but also in the tails of the conditional distribution of the dependent variable). Indeed, without performing QReg at different quantiles, an investigator would have no way of assessing whether a difference in these relationships might exist.</p