Adjustment with aphasia after stroke: study protocol for a pilot feasibility randomised controlled trial for SUpporting wellbeing through PEeR Befriending (SUPERB)

Background: Despite the high prevalence of mood problems after stroke, evidence on effective interventions particularly for those with aphasia is limited. There is a pressing need to systematically evaluate interventions aiming to improve wellbeing for people with stroke and aphasia. This study aims to evaluate the feasibility of a peer-befriending intervention. Methods/design: SUPERB is a single blind, parallel group feasibility trial of peer befriending for people with aphasia post-stroke and low levels of psychological distress. The trial includes a nested qualitative study and pilot economic evaluation and it compares usual care (n = 30) with usual care + peer befriending (n = 30). Feasibility outcomes include proportion screened who meet criteria, proportion who consent, rate of consent, number of missing/incomplete data on outcome measures, attrition rate at follow-up, potential value of conducting main trial using value of information analysis (economic evaluation), description of usual care, and treatment fidelity of peer befriending. Assessments and outcome measures (mood, wellbeing, communication, and social participation) for participants and significant others will be administered at baseline, with outcome measures re-administered at 4 and 10 months post-randomisation. Peer befrienders will complete outcome measures before training and after they have completed two cycles of befriending. The qualitative study will use semi-structured interviews of purposively sampled participants (n = 20) and significant others (n = 10) from both arms of the trial, and all peer befrienders to explore the acceptability of procedures and experiences of care. The pilot economic evaluation will utilise the European Quality of life measure (EQ-5D-5 L) and a stroke-adapted version of the Client Service Receipt Inventory (CSRI). Discussion: This study will provide information on feasibility outcomes and an initial indication of whether peer befriending is a suitable intervention to explore further in a definitive phase III randomised controlled trial. Trial registration: ClinicalTrials.gov identifier NCT02947776, registered 28th October 2016

Applicability of ERTS-1 to lineament and photogeologic mapping in Montana: Preliminary report

A lineament map prepared from a mosaic of western Montana shows about 85 lines not represented on the state geologic map, including elements of a northeast-trending set through central western Montana which merit ground truth checking and consideration in regional structural analysis. Experimental fold annotation resulted in a significant local correction to the state geologic map. Photogeologic mapping studies produced only limited success in identification of rock types, but they did result in the precise delineation of a late Cretaceous or early Tertiary volcanic field (Adel Mountain field) and the mapping of a connection between two granitic bodies shown on the state map. Imagery was used successfully to map clay pans associated with bentonite beds in gently dipping Bearpaw Shale. It is already apparent that ERTS imagery should be used to facilitate preparation of a much needed statewide tectonic map and that satellite imagery mapping, aided by ground calibration, provides and economical means to discover and correct errors in the state geologic map

Applicability of ERTS-1 to Montana geology

The author has identified the following significant results. Late autumn imagery provides the advantages of topographic shadow enhancement and low cloud cover. Mapping of rock units was done locally with good results for alluvium, basin fill, volcanics, inclined Paleozoic and Mesozoic beds, and host strata of bentonite beds. Folds, intrusive domes, and even dip directions were mapped where differential erosion was significant. However, mapping was not possible for belt strata, was difficult for granite, and was hindered by conifers compared to grass cover. Expansion of local mapping required geologic control and encountered significant areas unmappable from ERTS imagery. Annotation of lineaments provided much new geologic data. By extrapolating test site comparisons, it is inferred that 27 percent of some 1200 lineaments mapped from western Montana represent unknown faults. The remainder appear to be localized mainly by undiscovered faults and sets of minor faults or joints

How do HMOs Achieve Savings? The Effectiveness of One Organization\u27s Strategies.

To examine how a group practice used organizational strategies rather than provider-level incentives to achieve savings for health maintenance organization (HMO) compared to fee-for-service (FFS) patients. A large group practice with a group model HMO also treating FFS patients. Data sources were all patient encounter records, demographic files, and clinic records covering 3.5 years (1986-1989). The clinic\u27s procedures to record services and charges were identical for FFS and HMO patients. All FFS and HMO patients under age 65 who received any outpatient services during approximately 100,000 episodes of the seven study illnesses were eligible

Theory of the propagation of coupled waves in arbitrarily-inhomogeneous stratified media

We generalize the invariant imbedding theory of the wave propagation and derive new invariant imbedding equations for the propagation of arbitrary number of coupled waves of any kind in arbitrarily-inhomogeneous stratified media, where the wave equations are effectively one-dimensional. By doing this, we transform the original boundary value problem of coupled second-order differential equations to an initial value problem of coupled first-order differential equations, which makes the numerical solution of the coupled wave equations much easier. Using the invariant imbedding equations, we are able to calculate the matrix reflection and transmission coefficients and the wave amplitudes inside the inhomogeneous media exactly and efficiently. We establish the validity and the usefulness of our results by applying them to the propagation of circularly-polarized electromagnetic waves in one-dimensional photonic crystals made of isotropic chiral media. We find that there are three kinds of bandgaps in these structures and clarify the nature of these bandgaps by exact calculations.Comment: 7 pages, 1 figure, to appear in Europhys. Let

Photogeneration Dynamics of a Soliton Pair in Polyacetylene

Dynamical process of the formation of a soliton pair from a photogenerated electron-hole pair in polyacetylene is studied numerically by adopting the SSH Hamiltonian. A weak local disorder is introduced in order to trigger the formation. Starting from an initial configuration with an electron at the bottom of the conduction band and a hole at the top of the valence band, separated by the Peierls gap, the time dependent Schr${\rm \ddot{o}}$ndinger equation for the electron wave functions and the equation of motion for the lattice displacements are solved numerically. After several uniform oscillations of the lattice system at the early stage, a large distortion corresponding to a pair of a soliton and an anti-soliton develops from a point which is determined by the location and type of the disorder. In some cases, two solitons run in opposite directions, leaving breather like oscillations behind, and in other cases they form a bound state emitting acoustic lattice vibrational modes.Comment: 16 pages 7 figure

Management of type 2 diabetes mellitus in people with severe mental illness: an online cross-sectional survey of healthcare professionals

Objectives To establish healthcare professionals’ (HCPs) views about clinical roles, and the barriers and enablers to delivery of diabetes care for people with severe mental illness (SMI). Design Cross-sectional, postal and online survey. Setting Trusts within the National Health Service (NHS), mental health and diabetes charities and professional bodies. Participants HCPs who care for people with type 2 diabetes mellitus (T2DM) and/or SMI in the UK. Primary and secondary outcome measures The barriers, enablers and experiences of delivering T2DM care for people with SMI, informed by the Theoretical Domains Framework (TDF). Results Responders were 273 HCPs, primarily mental health nurses (33.7%) and psychiatrists (32.2%). Only 25% of respondents had received training in managing T2DM in people with SMI. Mental health professionals felt responsible for significantly fewer recommended diabetes care standards than physical health professionals (p<0.001). For those seeing diabetes care as part of their role, the significant barriers to its delivery in the regression analyses were a lack of knowledge (p=0.003); a need for training in communication and negotiation skills (p=0.04); a lack of optimism about the health of their clients (p=0.04) and their ability to manage T2DM in people with SMI (p=0.003); the threat of being disciplined (p=0.02); fear of working with people with a mental health condition (p=0.01); a lack of service user engagement(p=0.006) and a need for incentives (p=0.04). The significant enablers were an understanding of the need to tailor treatments (p=0.04) and goals (p=0.02) for people with SMI. Conclusions This survey indicates that despite current guidelines, diabetes care in mental health settings remains peripheral. Even when diabetes care is perceived as part of a HCP’s role, various individual and organisational barriers to delivering recommended T2DM care standards to people with SMI are experienced

Spectral and polarization effects in deterministically nonperiodic multilayers containing optically anisotropic and gyrotropic materials

Influence of material anisotropy and gyrotropy on optical properties of fractal multilayer nanostructures is theoretically investigated. Gyrotropy is found to uniformly rotate the output polarization for bi-isotropic multilayers of arbitrary geometrical structure without any changes in transmission spectra. When introduced in a polarization splitter based on a birefringent fractal multilayer, isotropic gyrotropy is found to resonantly alter output polarizations without shifting of transmission peak frequencies. The design of frequency-selective absorptionless polarizers for polarization-sensitive integrated optics is outlined

Physical activity self-management interventions for adults with spinal cord injury: Part 1–A systematic review of the use and effectiveness of behavior change techniques

Objectives: To determine which behavior change techniques (BCTs) have been used within leisure time physical activity (LTPA) self-management interventions for persons with spinal cord injury (SCI), and which BCTs were effective for improving LTPA behavior and/or its antecedents. Design: Systematic review informed by the PRISMA guidelines. Methods: A comprehensive literature search was conducted using five databases. Study characteristics were extracted from included articles and intervention descriptions were coded using the BCT Taxonomy V.1. Effectiveness and maintenance of BCTs as well as the level of behavior change theory use in the design of interventions were examined within experimental studies. Results: Thirty-one unique studies were included, 16 of which had an experimental design. Across all 31 studies, a total of 222 BCTs were identified, representing 32 out of a possible 93 BCTs. The most commonly used BCTs related to the core components of self-management (i.e., education, training/rehearsal of psychological strategies, and social support). Examination of the 16 experimental studies revealed that the use of BCTs corresponding to core self-management components were related to significant improvements and maintenance of LTPA outcomes, regardless of the number of BCTs used. Conclusions: This review offers a glimpse into the mechanisms by which self-management interventions lead to behavior change; however, more research is needed to explore and evaluate other elements (e.g., theory use, tailoring, dose, mode of delivery, and provider) that may comprise effective LTPA self-management interventions for persons with SCI. PROSPERO registration number: CRD42016037531