An mHealth Intervention (ReZone) to Help Young People Self-Manage Overwhelming Feelings: Cluster-Randomized Controlled Trial

BACKGROUND: Mental health difficulties in young people are increasing, and there is a need for evidence on the effectiveness of digital interventions to increase opportunities for supporting mental health in young people. Such studies are complicated due to issues of implementation and adoption, outcome measurement, and appropriate study designs. OBJECTIVE: The objective of this study was to examine the effectiveness of an mHealth intervention (ReZone) in reducing mental health difficulties in young people. METHODS: The cluster-randomized controlled trial enrolled 409 participants aged 10-15 years, and classes were allocated to ReZone or management as usual. Self-reported questionnaires were completed at baseline and 3-month follow-up. RESULTS: There were no significant differences between the ReZone condition and management as usual in the self-reported outcome measures. However, there were 3467 usage sessions, which corresponds to 16.9 times per student (total of 205 students) in classes allocated to ReZone. CONCLUSIONS: It is essential to publish studies that do not show significant differences, as these findings can still contribute to the literature, help in learning, and inform the direction of future work. The results reported in this paper could be due to a range of reasons, including whether ReZone has the scope to impact change or limitations related to the setting, context, and appropriateness of an RCT. The findings of this study suggest that ReZone was implemented and adopted. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/resprot.7019

An update on UK rheumatology consultant workforce provision: the BSR/ARC Workforce Register 2005–07: assessing the impact of recent changes in NHS provision

Objectives. To describe changes in the provision of rheumatology services, monitor the pattern of inequalities in UK rheumatology service provision since 2005, and to summarize the 3-yr impact of the new National Health Service (NHS) consultant contract and the Musculoskeletal Services Framework in England and Wales

A qualitative exploration of attitudes towards the use of outcome measures in child and adolescent mental health services

The aim of the present research was to explore clinician attitudes to outcome measures and, in particular, the facilitators and barriers to implementing outcome measures. An up-to-date exploration of clinician attitudes is especially needed in the context of recent policies on the implementation of outcome measures in child and adolescent mental health services (CAMHS), and because evidence suggests that there is a disparity between policy recommendations and the use of outcome measures in clinical practice. Semi-structured interviews were conducted with nine CAMHS clinicians from a Mental Health Trust in South London. Two levels of implementation emerged from the analysis: (1) the service level, regarding the implementation of outcome measures across a service to inform service improvement and (2) the session level, regarding the implementation of outcome measures within individual clinical sessions. The present research described training and ongoing support as a crucial facilitator of use at both service and session levels. This included help overcoming local contextual barriers, such as resources, information systems and administrative processes. The research showed that a balance is needed between a mandatory and uniform approach across a service and providing clinicians with support to use outcome measures with all service users for whom they are appropriate

An App to Help Young People Self-Manage When Feeling Overwhelmed (ReZone): Protocol of a Cluster Randomized Controlled Trial

Background: The association between behavioral difficulties and academic attainment is well established. Recent policy advising schools on managing behavior has promoted the early identification of behavioral difficulties. There is also increasing research into mHealth interventions to provide support for emotional and behavioral difficulties for young people. Objective: The primary aim of the proposed research is to examine the effectiveness of an mHealth intervention, ReZone, in reducing emotional and behavioral difficulties in young people. Methods: The protocol is a cluster trial of 12 classes with N=120 students with classes randomized to ReZone or management as usual. Multilevel modeling will be used to compare ReZone versus management as usual accounting for classroom-level variation. Results: Baseline data collection started in February 2017 and ended in April 2017. Follow-up data collection started in April 2017 and ended in June 2017. Conclusions: The proposed research will provide evidence as to whether ReZone is effective at helping young people to self-manage when feeling overwhelmed

Mouth rinsing with a sweet solution increases energy expenditure and decreases appetite during 60 minutes of self-regulated walking exercise

Carbohydrate mouth rinsing can improve endurance exercise performance and is most ergogenic when exercise is completed in the fasted state. This strategy may also be beneficial to increase exercise capacity and the energy deficit achieved during moderate intensity exercise relevant to weight control when performed after an overnight fast. Eighteen healthy men (mean(SD); age 23(4)years, body mass index 23.1(2.4)kg.m-2 ) completed a familiarisation trial and three experimental trials. After an overnight fast, participants performed 60-minutes of treadmill walking at a speed that equated to a rating of perceived exertion of 13 (“fairly hard”). Participants manually adjusted the treadmill speed to maintain this exertion. Mouth rinses for the experimental trials contained either a 6.4% maltodextrin solution with sweetener (CHO), a taste-matched placebo (PLA) or water (WAT). Appetite ratings were collected using visual analogue scales and exercise energy expenditure and substrate oxidation were calculated from online gas analysis. Increased walking distance during CHO and PLA induced greater energy expenditure compared with WAT (mean difference (90% CI); 79(60)kJ; P=0.035; d=0.24 and 90(63)kJ; P=0.024; d=0.27, respectively). Appetite area under the curve was lower in CHO and PLA than WAT (8(6)mm; P=0.042; d=0.43 and 6(8)mm; P=0.201; d=0.32, respectively). Carbohydrate oxidation was higher in CHO than PLA and WAT (7.3(6.7)g; P=0.078; d=0.47 and 10.1(6.5)g; P=0.015; d=0.81, respectively). This study provides novel evidence that mouth rinsing with a sweetened solution may promote a greater energy deficit during moderate exertion walking exercise by increasing energy expenditure and decreasing appetite. A placebo effect may have contributed to these benefits

The Implementation of an mHealth Intervention (ReZone) for the Self-Management of Overwhelming Feelings Among Young People

BACKGROUND: The association between mental health difficulties and academic attainment is well established. There is increasing research on mobile health (mHealth) interventions to provide support for the mental health and education of young people. However, nonadoption and inadequate implementation of mHealth interventions are prevalent barriers to such trials. OBJECTIVE: The aim of this study was to bridge this gap and examine the implementation of an mHealth intervention, ReZone, for young people in schools. METHODS: Preliminary data for 79 students collected as part of a larger trial were analyzed. We additionally conducted postimplementation consultations with teachers. RESULTS: ReZone was used 1043 times by 36 students in the intervention arm during the study period. Postimplementation teacher consultations provided data on implementation strategies, barriers, and facilitators. CONCLUSIONS: Implementation strategies, barriers, and facilitators for digital interventions need to be considered to limit nonadoption and inadequate implementation in larger trials. Important considerations involve tailoring the characteristics of the intervention to the requirements of the intended user group, the technology itself, and the organization in which it is implemented. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number: 13425994; http://www.isrctn.com/ISRCTN13425994

The effect of high altitude on central blood pressure and arterial stiffness

Central arterial systolic blood pressure (SBP) and arterial stiffness are known to be better predictors of adverse cardiovascular outcomes than brachial SBP. The effect of progressive high altitude (HA) on these parameters has not been examined. Ninety healthy adults were included. Central BP and the augmentation index (AI) were measured at the level of the brachial artery (Uscom BP + device) at < 200 m and at 3619, 4600 and 5140 m. The average age of the subjects (70% men) were 32.2±8.7 years. Compared with central arterial pressures, brachial SBP (+8.1±6.4 mm Hg; P < 0.0001) and pulse pressure (+10.9±6.6 mm Hg; P < 0.0001) were significantly higher and brachial diastolic BP was lower (-2.8±1.6 mm Hg; P < 0.0001). Compared with < 200 m, HA led to a significant increase in brachial and central SBP. Central SBP correlated with AI (r=0.50; 95% confidence interval (CI): 0.41-0.58; P < 0.0001) and age (r=0.32; 95% CI: 21-0.41; P < 0.001). AI positively correlated with age (r=0.39; P < 0.001) and inversely with subject height (r=-0.22; P < 0.0001), weight (r=-0.19; P=0.006) and heart rate (r=-0.49; P < 0.0001). There was no relationship between acute mountain sickness scores (Lake Louis Scoring System (LLS)) and AI or central BP. The independent predictors of central SBP were male sex (coefficient, t=4.7; P < 0.0001), age (t=3.6; P=0.004) and AI (t=7.5; P < 0.0001; overall r 2 =0.40; P < 0.0001). Subject height (t=2.4; P=0.02), age (7.4; P < 0.0001) and heart rate (t=11.4; P < 0.0001) were the only independent predictors of AI (overall r 2 =0.43; P < 0.0001). Central BP and AI significantly increase at HA. This rise was influenced by subject-related factors and heart rate but not independently by altitude, LLS or SpO 2

Interactions among mitochondrial proteins altered in glioblastoma

Mitochondrial dysfunction is putatively central to glioblastoma (GBM) pathophysiology but there has been no systematic analysis in GBM of the proteins which are integral to mitochondrial function. Alterations in proteins in mitochondrial enriched fractions from patients with GBM were defined with label-free liquid chromatography mass spectrometry. 256 mitochondrially-associated proteins were identified in mitochondrial enriched fractions and 117 of these mitochondrial proteins were markedly (fold-change &#8805;2) and significantly altered in GBM (p &#8804; 0.05). Proteins associated with oxidative damage (including catalase, superoxide dismutase 2, peroxiredoxin 1 and peroxiredoxin 4) were increased in GBM. Protein–protein interaction analysis highlighted a reduction in multiple proteins coupled to energy metabolism (in particular respiratory chain proteins, including 23 complex-I proteins). Qualitative ultrastructural analysis in GBM with electron microscopy showed a notably higher prevalence of mitochondria with cristolysis in GBM. This study highlights the complex mitochondrial proteomic adjustments which occur in GBM pathophysiology

The British Services Dhaulagiri Medical Research Expedition 2016 : a unique military and civilian research collaboration

The British Service Dhaulagiri Research Expedition took place in March-May 2016. A total of 129 personnel took part in the expedition and were invited to consent to a variety of study protocols investigating adaptation to high altitudes and diagnosis of altitude illness. The study took place in a remote and inhospitable environment at altitudes up to 7500m. This paper gives an overview of the challenges involved, the research protocols investigated and the execution of the expedition in Nepal