Employing external facilitation to implement cognitive behavioral therapy in VA clinics: a pilot study

<p>Abstract</p> <p>Background</p> <p>Although for more than a decade healthcare systems have attempted to provide evidence-based mental health treatments, the availability and use of psychotherapies remains low. A significant need exists to identify simple but effective implementation strategies to adopt complex practices within complex systems of care. Emerging evidence suggests that facilitation may be an effective integrative implementation strategy for adoption of complex practices. The current pilot examined the use of external facilitation for adoption of cognitive behavioral therapy (CBT) in 20 Department of Veteran Affairs (VA) clinics.</p> <p>Methods</p> <p>The 20 clinics were paired on facility characteristics, and 23 clinicians from these were trained in CBT. A clinic in each pair was randomly selected to receive external facilitation. Quantitative methods were used to examine the extent of CBT implementation in 10 clinics that received external facilitation compared with 10 clinics that did not, and to better understand the relationship between individual providers' characteristics and attitudes and their CBT use. Costs of external facilitation were assessed by tracking the time spent by the facilitator and therapists in activities related to implementing CBT. Qualitative methods were used to explore contextual and other factors thought to influence implementation.</p> <p>Results</p> <p>Examination of change scores showed that facilitated therapists averaged an increase of 19% [95% CI: (2, 36)] in self-reported CBT use from baseline, while control therapists averaged a 4% [95% CI: (-14, 21)] increase. Therapists in the facilitated condition who were not providing CBT at baseline showed the greatest increase (35%) compared to a control therapist who was not providing CBT at baseline (10%) or to therapists in either condition who were providing CBT at baseline (average 3%). Increased CBT use was unrelated to prior CBT training. Barriers to CBT implementation were therapists' lack of control over their clinic schedule and poor communication with clinical leaders.</p> <p>Conclusions</p> <p>These findings suggest that facilitation may help clinicians make complex practice changes such as implementing an evidence-based psychotherapy. Furthermore, the substantial increase in CBT usage among the facilitation group was achieved at a modest cost.</p

Driving of Outer Belt Electron Loss by Solar Wind Dynamic Pressure Structures : Analysis of Balloon and Satellite Data

We present observations of similar to 10-60 min solar wind dynamic pressure structures that drive large-scale coherent similar to 20-100 keV electron loss from the outer radiation belt. A combination of simultaneous satellite and Balloon Array for Radiation-belt Relativistic Electron Losses (BARREL) observations on 11-12 January 2014 shows a close association between the pressure structures and precipitation as inferred from BARREL X-rays. Specifically, the structures drive radial ExB transport of electrons up to 1 Earth radii, modulating the free electron energy available for low-frequency plasmaspheric hiss growth, and subsequent hiss-induced loss cone scattering. The dynamic pressure structures, originating near the Sun and commonly observed advecting with the solar wind, are thus able to switch on scattering loss of electrons by hiss over a large spatial scale. Our results provide a direct link between solar wind pressure fluctuations and modulation of electron loss from the outer radiation belt and may explain long-period modulations and large-scale coherence of X-rays commonly observed in the BARREL data set. Plain Language Summary The Earth's low-density magnetosphere is a region of enclosed magnetic field lines that contains energetic electrons ranging from eV to MeV energies. These populations can be greatly enhanced in response to solar driving. Following enhancements, energetic electron populations are depleted on timescales of hours to days by various processes. One important depletion process occurs when an electromagnetic plasma wave called plasmaspheric hiss, which exists within a high plasma density region called the plasmasphere and its (occasional) radial extension called the plume, scatters energetic electrons into the atmosphere. In this paper, we show that these hiss waves can be switched on by compressions of the magnetosphere which occur in response to similar to 1 hr long pressure structures in the solar wind. These structures originate at or near the Sun and are very common in the solar wind at 1 AU. The newly excited hiss waves scatter electrons into the atmosphere where they are observed on balloon-borne X-ray detectors. Our results suggest that magnetospheric models that predict the loss of electrons from hiss waves may be improved by consideration of solar wind pressure-driven dynamics.Peer reviewe

Human skeletal muscle plasmalemma alters its structure to change its Ca2+-handling following heavy-load resistance exercise

High-force eccentric exercise results in sustained increases in cytoplasmic Ca2+ levels ([Ca2+]cyto), which can cause damage to the muscle. Here we report that a heavy-load strength training bout greatly alters the structure of the membrane network inside the fibres, the tubular (t-) system, causing the loss of its predominantly transverse organization and an increase in vacuolation of its longitudinal tubules across adjacent sarcomeres. The transverse tubules and vacuoles displayed distinct Ca2+-handling properties. Both t-system components could take up Ca2+ from the cytoplasm but only transverse tubules supported store-operated Ca2+ entry. The retention of significant amounts of Ca2+ within vacuoles provides an effective mechanism to reduce the total content of Ca2+ within the fibre cytoplasm. We propose this ability can reduce or limit resistance exercise-induced, Ca2+-dependent damage to the fibre by the reduction of [Ca2+]cyto to help maintain fibre viability during the period associated with delayed onset muscle soreness

Genome-wide analysis of ivermectin response by Onchocerca volvulus reveals that genetic drift and soft selective sweeps contribute to loss of drug sensitivity

Treatment of onchocerciasis using mass ivermectin administration has reduced morbidity and transmission throughout Africa and Central/South America. Mass drug administration is likely to exert selection pressure on parasites, and phenotypic and genetic changes in several Onchocerca volvulus populations from Cameroon and Ghana-exposed to more than a decade of regular ivermectin treatment-have raised concern that sub-optimal responses to ivermectin's anti-fecundity effect are becoming more frequent and may spread.Pooled next generation sequencing (Pool-seq) was used to characterise genetic diversity within and between 108 adult female worms differing in ivermectin treatment history and response. Genome-wide analyses revealed genetic variation that significantly differentiated good responder (GR) and sub-optimal responder (SOR) parasites. These variants were not randomly distributed but clustered in ~31 quantitative trait loci (QTLs), with little overlap in putative QTL position and gene content between the two countries. Published candidate ivermectin SOR genes were largely absent in these regions; QTLs differentiating GR and SOR worms were enriched for genes in molecular pathways associated with neurotransmission, development, and stress responses. Finally, single worm genotyping demonstrated that geographic isolation and genetic change over time (in the presence of drug exposure) had a significantly greater role in shaping genetic diversity than the evolution of SOR.This study is one of the first genome-wide association analyses in a parasitic nematode, and provides insight into the genomics of ivermectin response and population structure of O. volvulus. We argue that ivermectin response is a polygenically-determined quantitative trait (QT) whereby identical or related molecular pathways but not necessarily individual genes are likely to determine the extent of ivermectin response in different parasite populations. Furthermore, we propose that genetic drift rather than genetic selection of SOR is the underlying driver of population differentiation, which has significant implications for the emergence and potential spread of SOR within and between these parasite populations

Search for the Higgs boson in events with missing transverse energy and b quark jets produced in proton-antiproton collisions at s**(1/2)=1.96 TeV

We search for the standard model Higgs boson produced in association with an electroweak vector boson in events with no identified charged leptons, large imbalance in transverse momentum, and two jets where at least one contains a secondary vertex consistent with the decay of b hadrons. We use ~1 fb-1 integrated luminosity of proton-antiproton collisions at s**(1/2)=1.96 TeV recorded by the CDF II experiment at the Tevatron. We find 268 (16) single (double) b-tagged candidate events, where 248 +/- 43 (14.4 +/- 2.7) are expected from standard model background processes. We place 95% confidence level upper limits on the Higgs boson production cross section for several Higgs boson masses ranging from 110 GeV/c2 to 140 GeV/c2. For a mass of 115 GeV/c2 the observed (expected) limit is 20.4 (14.2) times the standard model prediction.Comment: 8 pages, 2 figures, submitted to Phys. Rev. Let

Observation and Mass Measurement of the Baryon Ξb−\Xi^-_b

We report the observation and measurement of the mass of the bottom, strange baryon $\Xi^-_b$ through the decay chain $\Xi^-_b \to J/\psi \Xi^-$, where $J/\psi \to \mu^+ \mu^-$, $\Xi^- \to \Lambda \pi^-$, and $\Lambda \to p \pi^-$. Evidence for observation is based on a signal whose probability of arising from the estimated background is 6.6 x 10^{-15}, or 7.7 Gaussian standard deviations. The $\Xi^-_b$ mass is measured to be $5792.9\pm 2.5$ (stat.) $\pm 1.7$ (syst.) MeV/$c^2$.Comment: Minor text changes for the second version. Accepted by Phys. Rev. Let

Search for New Particles Leading to Z+jets Final States in ppˉp\bar{p} Collisions at s=1.96\sqrt{s}=1.96 TeV

We present the results of a search for new particles that lead to a \Z boson plus jets in $p\bar{p}$ collisions at $\sqrt{s}=1.96$ TeV using the Collider Detector at Fermilab (CDF II). A data sample with a luminosity of 1.06 \ifb\ collected using \Z boson decays to $ee$ and $\mu\mu$ is used. We describe a completely data-based method to predict the dominant background from standard-model \Z+jet events. This method can be similarly applied to other analyses requiring background predictions in multi-jet environments, as shown when validating the method by predicting the background from $W$+jets in \ttbar production. No significant excess above the background prediction is observed, and a limit is set using a fourth generation quark model to quantify the acceptance. Assuming $BR(b' \to b\Z) = 100$ and using a leading-order calculation of the $b'$ cross section, $b'$ quark masses below 268 \gev/c^2 are excluded at 95% confidence level.Comment: To be submitted to PR

First Measurement of the W Boson Mass in Run II of the Tevatron

We present a measurement of the W boson mass using 200/pb of data collected in pbar p collisions at sqrt(s) = 1.96 TeV by the CDF II detector at Run II of the Fermilab Tevatron. With a sample of 63964 W -> e nu candidates and 51128 W -> mu nu candidates, we measure M_W = (80413 +- 34 (stat) +- 34 (syst) = 80413 +- 48) MeV/c^2. This is the most precise single measurement of the W boson mass to date.Comment: published version in PR