Unravelling effectiveness of a nurse-led behaviour change intervention to enhance physical activity in patients at risk for cardiovascular disease in primary care: study protocol for a cluster randomised controlled trial

BACKGROUND: Self-management interventions are considered effective in patients with chronic disease, but trials have shown inconsistent results, and it is unknown which patients benefit most. Adequate self-management requires behaviour change in both patients and health care providers. Therefore, the Activate intervention was developed with a focus on behaviour change in both patients and nurses. The intervention aims for change in a single self-management behaviour, namely physical activity, in primary care patients at risk for cardiovascular disease. The aim of this study is to evaluate the effectiveness of the Activate intervention. METHODS/DESIGN: A two-arm cluster randomised controlled trial will be conducted to compare the Activate intervention with care as usual at 31 general practices in the Netherlands. Approximately 279 patients at risk for cardiovascular disease will participate. The Activate intervention is developed using the Behaviour Change Wheel and consists of 4 nurse-led consultations in a 3-month period, integrating 17 behaviour change techniques. The Behaviour Change Wheel was also applied to analyse what behaviour change is needed in nurses to deliver the intervention adequately. This resulted in 1-day training and coaching sessions (including 21 behaviour change techniques). The primary outcome is physical activity, measured as the number of minutes of moderate to vigorous physical activity using an accelerometer. Potential effect modifiers are age, body mass index, level of education, social support, depression, patient-provider relationship and baseline number of minutes of physical activity. Data will be collected at baseline and at 3 months and 6 months of follow-up. A process evaluation will be conducted to evaluate the training of nurses, treatment fidelity, and to identify barriers to and facilitators of implementation as well as to assess participants' satisfaction. DISCUSSION: To increase physical activity in patients and to support nurses in delivering the intervention, behaviour change techniques are applied to change behaviours of the patients and nurses. Evaluation of the effectiveness of the intervention, exploration of which patients benefit most, and evaluation of our theory-based training for primary care nurses will enhance understanding of what works and for whom, which is essential for further implementation of self-management in clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02725203 . Registered on 25 March 2016

Advance Care Planning in the Netherlands

The Dutch health care system fosters a strong public health sector offering accessible generalist care including generalist palliative care. General practitioners are well positioned to conduct ACP, for example, to continue or initiate conversations after hospitalization. However, research shows that ACP conversations are often ad hoc and in frail patients, ACP is often only initiated when admitted to a nursing home by elderly care physicians who are on the staff. Tools that raise awareness of triggers to initiate ACP, screening tools, information brochures, checklists and training have been developed and implemented with funding by national programs which currently focus on implementation projects rather than or in addition to, research. The programs commonly require educational deliverables, patient and public involvement and addressing diversity in patient groups. A major challenge is how to implement ACP systematically and continuously across sectors and disciplines in a way that supports a proactive yet person-centered approach rather than an approach with an exclusive focus on medical procedures. Digital solutions can support continuity of care and communication about care plans. Solutions should fit a culture that prefers trust-based, informal deliberative approaches. This may be supported by involving disciplines other than medicine, such as nursing and spiritual caregiving, and public health approaches.</p

Novel spin-precession method for sensitive EDM searches

We demonstrate a spin-precession method to observe and analyze multi-level coherence between all hyperfine levels in the $X ^2\Sigma^+,N=0$ ground state of barium monofluoride ($^{138}$Ba$^{19}$F). The signal is sensitive to the state-preparation Rabi frequency and external electric and magnetic fields applied in searches for a permanent electric dipole moment (EDM). In the obtained interference spectrum, the electric field and Rabi frequency become observable simultaneously with the EDM. This method reduces systematic biases and the number of auxiliary measurements for such precision measurements

Novel spin-precession method for sensitive EDM searches

We demonstrate a spin-precession method to observe and analyze multi-level coherence between all hyperfine levels in the $X ^2\Sigma^+,N=0$ ground state of barium monofluoride ($^{138}$Ba$^{19}$F). The signal is sensitive to the state-preparation Rabi frequency and external electric and magnetic fields applied in searches for a permanent electric dipole moment (EDM). In the obtained interference spectrum, the electric field and Rabi frequency become observable simultaneously with the EDM. This method reduces systematic biases and the number of auxiliary measurements for such precision measurements

Novel spin-precession method for sensitive EDM searches

We demonstrate a spin-precession method to observe and analyze multi-level coherence between all hyperfine levels in the $X ^2\Sigma^+,N=0$ ground state of barium monofluoride ($^{138}$Ba$^{19}$F). The signal is sensitive to the state-preparation Rabi frequency and external electric and magnetic fields applied in searches for a permanent electric dipole moment (EDM). In the obtained interference spectrum, the electric field and Rabi frequency become observable simultaneously with the EDM. This method reduces systematic biases and the number of auxiliary measurements for such precision measurements

Novel spin-precession method for sensitive EDM searches

We demonstrate a spin-precession method to observe and analyze multi-level coherence between all hyperfine levels in the $X ^2\Sigma^+,N=0$ ground state of barium monofluoride ($^{138}$Ba$^{19}$F). The signal is sensitive to the state-preparation Rabi frequency and external electric and magnetic fields applied in searches for a permanent electric dipole moment (EDM). In the obtained interference spectrum, the electric field and Rabi frequency become observable simultaneously with the EDM. This method reduces systematic biases and the number of auxiliary measurements for such precision measurements

Novel spin-precession method for sensitive EDM searches

We demonstrate a spin-precession method to observe and analyze multi-level coherence between all hyperfine levels in the $X ^2\Sigma^+,N=0$ ground state of barium monofluoride ($^{138}$Ba$^{19}$F). The signal is sensitive to the state-preparation Rabi frequency and external electric and magnetic fields applied in searches for a permanent electric dipole moment (EDM). In the obtained interference spectrum, the electric field and Rabi frequency become observable simultaneously with the EDM. This method reduces systematic biases and the number of auxiliary measurements for such precision measurements

Novel spin-precession method for sensitive EDM searches

We demonstrate a spin-precession method to observe and analyze multi-level coherence between all hyperfine levels in the $X ^2\Sigma^+,N=0$ ground state of barium monofluoride ($^{138}$Ba$^{19}$F). The signal is sensitive to the state-preparation Rabi frequency and external electric and magnetic fields applied in searches for a permanent electric dipole moment (EDM). In the obtained interference spectrum, the electric field and Rabi frequency become observable simultaneously with the EDM. This method reduces systematic biases and the number of auxiliary measurements for such precision measurements

Systematic study and uncertainty evaluation of P, T-odd molecular enhancement factors in BaF

A measurement of the magnitude of the electric dipole moment of the electron (eEDM) larger than that predicted by the Standard Model (SM) of particle physics is expected to have a huge impact on the search for physics beyond the SM. Polar diatomic molecules containing heavy elements experience enhanced sensitivity to parity (P) and time-reversal (T)-violating phenomena, such as the eEDM and the scalar-pseudoscalar (S-PS) interaction between the nucleons and the electrons, and are thus promising candidates for measurements. The NL-eEDM collaboration is preparing an experiment to measure the eEDM and S-PS interaction in a slow beam of cold BaF molecules [P. Aggarwal et al., Eur. Phys. J. D 72, 197 (2018)]. Accurate knowledge of the electronic structure parameters, Wd and Ws, connecting the eEDM and the S-PS interaction to the measurable energy shifts is crucial for the interpretation of these measurements. In this work, we use the finite field relativistic coupled cluster approach to calculate the Wd and Ws parameters in the ground state of the BaF molecule. Special attention was paid to providing a reliable theoretical uncertainty estimate based on investigations of the basis set, electron correlation, relativistic effects, and geometry. Our recommended values of the two parameters, including conservative uncertainty estimates, are 3.13 ±0.12×1024Hzecm for Wd and 8.29 ± 0.12 kHz for W