mHealth: providing a mindfulness app for women with chronic pelvic pain in gynaecology outpatient clinics: qualitative data analysis of user experience and lessons learnt

OBJECTIVES: To determine whether a pre-existing smartphone app to teach mindfulness meditation is acceptable to women with chronic pelvic pain (CPP) and can be integrated into clinical practice within the National Health Service (NHS) CPP pathways, and to inform the design of a potential randomised clinical trial. DESIGN: A prestudy patient and public involvement (PPI) group to collect feedback on the acceptability of the existing app and study design was followed by a three-arm randomised feasibility trial. In addition, we undertook interviews and focus groups with patients and staff to explore app usability and acceptability. We also obtained participant comments on the research process, such as acceptability of the study questionnaires. SETTING: Two gynaecology clinics within Barts Health NHS, London, UK. PARTICIPANTS: Patients with CPP lasting ≥6 months with access to smartphone or personal computer and understanding of basic English. INTERVENTION: The intervention was mindfulness meditation content plus additional pain module delivered by a smartphone app. Active controls received muscle relaxation content from the same app. Passive (waiting list) controls received usual care. MAIN OUTCOME MEASURES: Themes on user feedback, app usability and integration, and reasons for using/not using the app. RESULTS: The use of the app was low in both active groups. Patients in the prestudy PPI group, all volunteers, were enthusiastic about the app (convenience, content, portability, flexibility, ease of use). Women contributing to the interview or focus group data (n=14), from a 'real world' clinic (some not regular app users), were less positive, citing as barriers lack of opportunities/motivation to use the app and lack of familiarity and capabilities with technology. Staff (n=7) were concerned about the potential need for extra support for them and for the patients, and considered the app needed organisational backing and peer acceptance. CONCLUSION: The opinions of prestudy PPI volunteers meeting in their private time may not represent those of patients recruited at a routine clinic appointment. It may be more successful to codesign/codevelop an app with typical users than to adapt existing apps for use in real-world clinical populations. TRIAL REGISTRATION NUMBER: ISRCTN10925965

A decision tool based on bilevel optimization for the allocation of water resources in a hierarchical system

This paper addresses the optimal allocation of water among competing stakeholders during a finite planning horizon. We focus on those water systems where there are two levels of decision making organized according to a hierarchical framework. At the upper level, a central authority allocates water to demand points having regard to environmental and sustainability issues as well as balancing water users' supply/demand. At the lower level of the hierarchy, demand point managers allocate water to users prioritizing economic strategies. On the other hand, when it comes to allocating limited resources that affect public welfare, the authority in charge can also use different political instruments such as fees to influence the decisions made at those levels of decision making that are not directly within its competence. We propose a multiobjective multifollower bilevel optimization problem that aims to fulfill the central authority goals while including the reaction of the demand point managers in terms of optimization problems as constraints. Using the well-known Karush–Kuhn–Tucker approach, we transform the bilevel model into an equivalent multiobjective mixed-integer single-level model for which we provide tight big-M values. For the purpose of showing the versatility of the model, extensive computational experiments on a set of instances have been carried out. The results show that the optimization problem can be solved to optimality in small computing times using off-the-shelf mixed-integer solvers even for complex water systems and long planning periods. In addition, they illustrate the effect of imposing fees on the achievement of the central authority's objectives

Patch behaviour and predictability properties of modelled finite-amplitude sand ridges on the inner shelf

The long-term evolution of shoreface-connected sand ridges is investigated with a nonlinear spectral model which governs the dynamics of waves, currents, sediment transport and the bed level on the inner shelf. Wave variables are calculated with a shoaling-refraction model instead of using a parameterisation. The spectral model describes the time evolution of amplitudes of known eigenmodes of the linearised system. Bottom pattern formation occurs if the transverse bottom slope of the inner shelf, β, exceeds a critical value β<sub>c</sub>. For fixed model parameters the sensitivity of the properties of modelled sand ridges to changes in the number (<i>N</i>−1) of resolved subharmonics (of the initially fastest growing mode) is investigated. For any <i>N</i> the model shows the growth and subsequent saturation of the height of the sand ridges. The saturation time scale is several thousands of years, which suggests that observed sand ridges have not reached their saturated stage yet. The migration speed of the ridges and the average longshore spacing between successive crests in the saturated state differ from those in the initial state. Analysis of the potential energy balance of the ridges reveals that bed slope-induced sediment transport is crucial for the saturation process. In the transient stage the shoreface-connected ridges occur in patches. The overall characteristics of the bedforms (saturation time, final maximum height, average longshore spacing, migration speed) hardly vary with <i>N</i>. However, individual time series of modal amplitudes and bottom patterns strongly depend on <i>N</i>, thereby implying that the detailed evolution of sand ridges can only be predicted over a limited time interval. Additional experiments show that the critical bed slope β<sub>c</sub> increases with larger offshore angles of wave incidence, larger offshore wave heights and longer wave periods, and that the corresponding maximum height of the ridges decreases whilst the saturation time increases

Patch behaviour and predictability propierties of modelled finite-amplitude sand ridges on the inner shelf

The long-term evolution of shoreface-connected sand ridges is investigated with a nonlinear spectral model which governs the dynamics of waves, currents, sediment transport and the bed level on the inner shelf. Wave variables are calculated with a shoaling-refraction model instead of using a parameterisation. The spectral model describes the time evolution of amplitudes of known eigenmodes of the linearised system. Bottom pattern formation occurs if the transverse bottom slope of the inner shelf, β, exceeds a critical value βc. For fixed model parameters the sensitivity of the properties of modelled sand ridges to changes in the number (N−1) of resolved subharmonics (of the initially fastest growing mode) is investigated. For any N the model shows the growth and subsequent saturation of the height of the sand ridges. The saturation time scale is several thousands of years, which suggests that observed sand ridges have not reached their saturated stage yet. The migration speed of the ridges and the average longshore spacing between successive crests in the saturated state differ from those in the initial state. Analysis of the potential energy balance of the ridges reveals that bed slope-induced sediment transport is crucial for the saturation process. In the transient stage the shoreface-connected ridges occur in patches. The overall characteristics of the bedforms (saturation time, final maximum height, average longshore spacing, migration speed) hardly vary with N. However, individual time series of modal amplitudes and bottom patterns strongly depend on N, thereby implying that the detailed evolution of sand ridges can only be predicted over a limited time interval. Additional experiments show that the critical bed slope βc increases with larger offshore angles of wave incidence, larger offshore wave heights and longer wave periods, and that the corresponding maximum height of the ridges decreases whilst the saturation time increases.Postprint (published version

Experimental study of the mechanical transmission of rabbit hemorrhagic disease virus (RHDV2/b) by Aedes Albopictus (Diptera: Clicidae) and Phlebotomus papatasi (diptera: psychodidae); 34447999

Rabbit hemorrhagic disease (RHD) is caused by a lagovirus mainly affecting European rabbits (Oryctolagus cuniculus), although other European and North American lagomorph species are also susceptible to fatal infection by the new viral variant RHDV2/b. In the present work, direct mechanical transmission of the rabbit hemorrhagic disease virus (RHDV2/b variant) by the hematophagous Diptera Aedes albopictus (Skuse) (Diptera: Culicidae) and the sand fly Phlebotomus papatasi (Scopoli) (Diptera: Psychodidae) was tested. For each species, six and three laboratory rabbits were exposed to bites of dipterous females partially fed on RHDV2/b viral suspension 2 h and 24 h prior to exposure, respectively. The rabbits were then monitored for clinical changes and mortality for 35 d, and seroconversion was assessed by indirect ELISA. No rabbit died or showed clinical signs of disease, and seroconversion was recorded in two rabbits challenged with P. papatasi females fed the viral suspension 2 h prior to exposure. The number of RHDV2/b RNA copies/female was higher in Ae. albopictus than in P. papatasi but the decrease over time of RNA load in Ae. albopictus was greater than that in P. papatasi. The results of this study suggest the inability of Ae. albopictus to serve as a direct mechanical vector of RHDV2/b, but sand flies could play a role in the local transmission of RHD. © The Author(s) 2021. Published by Oxford University Press on behalf of Entomological Society of America

Rabbit haemorrhagic disease: Cross-protection and comparative pathogenicity of GI.2/RHDV2/b and GI.1b/RHDV lagoviruses in a challenge trial

European rabbits (Oryctolagus cuniculus) are severely affected by rabbit haemorrhagic disease (RHD). Caused by a lagovirus, the disease leads to losses in the rabbit industry and has implications for wildlife conservation. Past RHD outbreaks have been caused by GI.1/RHDV genotype viruses. A new virus belonging to the GI.2/RHDV2/b genotype emerged in 2010, quickly spreading and replacing the former in several countries; however, limited data are available on its pathogenicity and epidemiological factors. The present work extends these issues and evaluates cross-protection between both genotypes. Ninety-four and 88 domestic rabbits were challenged with GI.2/RHDV2/b and GI.1b/RHDV variant isolates, respectively. Cross-protection was determined by a second challenge on survivors with the corresponding strain. Mortality by GI.2/RHDV2/b was highly variable due to unknown individual factors, whereas mortality by GI.1b/RHDV was associated with age. Mortality in rabbits < 4 weeks old was 84%, higher than previously reported. Cross-protection was not identical between the two viruses because the ratio of mortality rate ratios for the first and second challenges was 3.80 ± 2.68 times higher for GI.2/RHDV2/b than it was for GI.1b/RHDV. Rabbit susceptibility to GI.2/RHDV2/b varied greatly and appeared to be modulated by the innate functionality of the immune response and/or its prompt activation by other pathogens. GI.1b/RHDV pathogenicity appeared to be associated with undetermined age-related factors. These results suggest that GI.2/RHDV2/b may interact with other pathogens at the population level but does not satisfactorily explain the GI.1b/RHDV virus's quick replacement