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

In-season training load quantification of one-, two- and three-game week schedules in a top European professional soccer team

Top European soccer teams that play in UEFA competitions often participate in one, two- or three-games per week. Therefore, it is necessary to ensure optimal match-day performance and full recovery. The aim of this study was to quantify internal and external training load (TL) within five microcycles: M1 and M2 - one-game weeks; M3 and M4 - two-game weeks; M5 - three-game week). Thirteen elite soccer players participated in this study. A global positioning system (GPS) was used to measure the total distance covered and distances of different exercise training zones (1-5), the session ratings of perceived exertion (s-RPE) scores and the amount of creatine kinase (CK) created during daily training sessions for the 2015-2016 in-season period. The data were analysed with respect to the number of days prior to a given match. The main results indicate that there was a significant difference in training intensity for zone 1 between M2 and M4 (4010.2 ± 103.5 and 4507.6 ± 133.0 m, respectively); a significant difference in training intensity for zone 3 between M1 and M5 (686.1 ± 42.8 and 801.2 ± 61.2 m, respectively); a significant difference in the duration of the training sessions and matches between M2 and M5 (69.2 ± 2.1 and 79.6 ± 2.3) and M3 and M5 (69.7 ± 1.0 and 79.6 ± 2.3); and finally, there was a significant difference in CK between M3 and M2 (325.5 ± 155.0 and 194.4 ± 48.9). Moreover, there was a significant decrease in TL in the last day prior to a match, for all microcycles and all variables. There was no significant difference with respect to s-RPE. This study provides the first report of daily external and internal TLs and weekly accumulated load (training sessions and match demands) during one, two, and three-game week schedules in a group of elite soccer players. Expected significant differences are found in daily and accumulated loads for within- and between-game schedules. A similar pattern is exhibited for one- and two-game week microcycles regarding the day before the match, which exhibits a decrease in all variables. Despite the different number of games played per week, TL remain similar between microcycles for zone 2 and 5, plus s-RPE.This project was supported by the National Funds through FCT—Portuguese Foundation for Science and Technology (UID/DTP/04045/2013) and the European Fund for Regional Development (FEDER) allocated by European Union through the COMPETE 2020 Programme (POCI-01-0145-FEDER-006969)—competitiveness and internationalization (POCI). The authors disclose funding received for this work from any of the following organizations: National Institutes of Health (NIH); Welcome Trust; Howard Hughes Medical Institute (HHMI); and other(s).info:eu-repo/semantics/publishedVersio

A Partial Allocation Local Search Matheuristic for Solving the School Bus Routing Problem with Bus Stop Selection

This paper addresses the school bus routing problem with bus stop selection, which jointly handles the problems of determining the set of bus stops to visit, allocating each student to one of these bus stops and computing the routes that visit the selected bus stops, so that the total routing cost is minimized and the walking distance of the students is limited by a given value. A fast and efficient matheuristic is developed based on an innovative approach that first partially allocates the students to a set of active stops that they can reach, and computes a set of routes that minimizes the routing cost. Then, a refining process is performed to complete the allocation and to adapt the routes until a feasible solution is obtained. The algorithm is tested on a set of benchmark instances. The computational results show the efficiency of the algorithm in terms of the quality of the solutions yielded and the computing time

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

Fipronil/(S)-methoprene spot-on to control fleas on cats in a field trial in Spain

The study was conducted in order to evaluate the effect of a fipronil/(S)-methoprene formulation against fleas on naturally infested cats. The study involved a population of 89 cats distributed among 24 veterinary practices in 9 regions of Spain. The product was applied according to label instructions on days 0, 30 and 60. Animals underwent parasitological and clinical assessments on day 0 and thereafter in monthly intervals (every 30 days) until day 90. Ctenocephalides felis was the most abundant species (98.9% of all fleas collected), and flea abundance on Day 0 was associated with the hair type, the location of the household, and the time elapsed from the last anti-flea treatment. Fipronil/(S)-methoprene demonstrated high efficacy and induced the reduction of clinical signs related to the presence of fleas. Clinical signs and flea abundance decreased significantly throughout time (P=0.001) with an efficacy rate of 72.6% at Day 30, 88.4% at Day 60 and 93.9% at Day 90. A high level of flea control and a remission of the clinical signs related to presence of fleas were observed on cats following 3 monthly applications a fipronil/(S)-methoprene formulation