Feasibility of a randomized controlled trial of paediatric interdisciplinary pain management using home-based telehealth

Purpose: Chronic pain is common in adolescents. Evidence-based guidelines recommend interdisciplinary treatment, but access is limited by geography. The development of hybrid programs utilizing both face-to-face and videoconference treatment may help overcome this. We developed a 7-week hybrid pediatric interdisciplinary pain program (Hybrid-PIPP) and wished to compare it to individual face-to-face sessions (Standard Care). Our objective was to test the feasibility of a protocol that used a matched pair un-blinded randomized controlled design to investigate the efficacy and cost-effectiveness of the Hybrid-PIPP compared to Standard Care. Patients and Methods: Parent–adolescent dyads were recruited from tertiary pediatric clinics and matched by disability before randomization to minimize allocation bias. The adolescents (aged 11– 17) had experienced primary pain for > 3 months. Hybrid-PIPP involved 11 hrs of group therapy and 4 individual videoconference sessions. Standard care was provided by the same clinical team, using the same treatment model and similar intensity as the Hybrid-PIPP. The intention was to recruit participants for 3 Hybrid-PIPP groups with a comparison stream. Recruitment was ceased after 2 groups due to the high participant disability requiring more intensive intervention. Results: Eighteen dyads were screened and 13 randomized (7 Hybrid-PIPP, 6 Standard Care, 2 unsuitable, 3 unallocated when the study was stopped). The study met a priori feasibility criteria for staff availability; recruitment rate; treatment completion; and data collection. Global satisfaction ratings were similar in both streams (SC median 7, range 5– 9 and Hybrid-PIPP median 8.5, range 5– 10). Challenges were identified in both streams. A future modified Hybrid-PIPP was considered acceptable if the intensity is increased to manage the high level of disability. Standard care was considered inefficient. No adverse events were reported. Conclusion: The study determined that the protocol met a priori feasibility criteria, but to be practicable in a real world, health environment requires significant modifications

Psychometric properties of the Compulsive Exercise Test in an adolescent eating disorder population

The objective of this study was to evaluate the factor structure, validity, and reliability of the Compulsive Exercise Test (CET) in an adolescent clinical eating disorder population. The data source was the Helping to Outline Paediatric Eating Disorders (HOPE) Project, a prospective ongoing registry study comprising consecutive paediatric tertiary eating disorder referrals. Adolescents (N = 104; 12-17 years) with eating disorders completed the CET and other measures. Factor structure, convergent validity, and internal consistency were evaluated. Despite failing to identify a factor structure, the study provided clear evidence of the multidimensionality of the measure. The total score correlated significantly with measures of eating pathology, perfectionism, and frequency of exercise for shape and weight control (r = 0.32-0.70, ps \u3c 0.05). More research into the multidimensional nature of compulsive exercise in clinical populations is needed, Further, research into compulsive exercise offers promise as an addition to existing cognitive behavioral models and treatments for eating disorders

A comparative study of fragment screening methods on the p38α kinase: new methods, new insights

The stress-activated kinase p38α was used to evaluate a fragment-based drug discovery approach using the BioFocus fragment library. Compounds were screened by surface plasmon resonance (SPR) on a Biacore(™) T100 against p38α and two selectivity targets. A sub-set of our library was the focus of detailed follow-up analyses that included hit confirmation, affinity determination on 24 confirmed, selective hits and competition assays of these hits with respect to a known ATP binding site inhibitor. In addition, functional activity against p38α was assessed in a biochemical assay using a mobility shift platform (LC3000, Caliper LifeSciences). A selection of fragments was also evaluated using fluorescence lifetime (FLEXYTE(™)) and microscale thermophoresis (Nanotemper) technologies. A good correlation between the data for the different assays was found. Crystal structures were solved for four of the small molecules complexed to p38α. Interestingly, as determined both by X-ray analysis and SPR competition experiments, three of the complexes involved the fragment at the ATP binding site, while the fourth compound bound in a distal site that may offer potential as a novel drug target site. A first round of optimization around the remotely bound fragment has led to the identification of a series of triazole-containing compounds. This approach could form the basis for developing novel and active p38α inhibitors. More broadly, it illustrates the power of combining a range of biophysical and biochemical techniques to the discovery of fragments that facilitate the development of novel modulators of kinase and other drug targets. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10822-011-9454-9) contains supplementary material, which is available to authorized users

OT Modeling: The Enterprise Beyond IT

Enterprises are composed of an enormous number of elements (e.g., organizational units, human resources, production processes, and IT systems) typically classified in the business or the IT domain. However, some crucial elements do not belong in either group: they are directly responsible for producing and delivering the company’s goods and services and include all the elements that support day to day operations. Collectively, these elements have been called operational technologies (OT) and have been conspicuously excluded from enterprise modeling (EM) approaches which traditionally have focused on the business and IT dimensions. Evidence of this is the absence of OT elements in languages and metamodels for EM. This is in line with the historical division between IT and OT in organizations that has led to information silos, independent teams, and disparate tech- nologies that only recently have started to be reconciled. Considering that OT is critical to most productive organi- zations, and the benefits that EM brings to its understand- ing and improvement, it makes sense to expand EM to include OT. For that purpose, this paper proposes an extension to ArchiMate 3.0 which includes crucial OT elements. On top of that, this paper also proposes an approach to further expand ArchiMate to address specific industries where more specific OT elements are required. This is illustrated in the paper with an extension for the Oil and Gas case that was validated with experts belonging to five companies in the sector

Minority environmental activism in Britain: From brixton to the lake district

Historically, the British environmental movement has been devoid of minority participation, but this is changing very slowly, with the emergence of ethnic minority environmental groups and multiracial environmental alliances. These groups have argued that ethnic minorities have little or no access to public funds earmarked for countryside and wildlife preservation issues. They argue that white environmental organizations do not pay attention to the needs of inner-city minority residents and minority access to the countryside. Increased access, community improvement and beautification projects, environmental education, youth training, community garden projects, and issues of environmental racism are all foci of ethnic minority environmental movements. While some white environmentalists have been supportive of them, others have been uncomfortable with them or even hostile to their existence.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43549/1/11133_2004_Article_BF00990102.pd

Deployable head restraints. Final report

National Highway Traffic Safety Administration, Washington, D.C.http://deepblue.lib.umich.edu/bitstream/2027.42/503/2/27284.0001.001.pd