Collaborative planning approach to inform the implementation of a healthcare manager intervention for hispanics with serious mental illness: a study protocol

Background: This study describes a collaborative planning approach that blends principles of community-based participatory research (CBPR) and intervention mapping to modify a healthcare manager intervention to a new patient population and provider group and to assess the feasibility and acceptability of this modified intervention to improve the physical health of Hispanics with serious mental illness (SMI) and at risk for cardiovascular disease (CVD). Methods: The proposed study uses a multiphase approach that applies CBPR principles and intervention-mapping steps--an intervention-planning approach--to move from intervention planning to pilot testing. In phase I, a community advisory board composed of researchers and stakeholders will be assembled to learn and review the intervention and make initial modifications. Phase II uses a combination of qualitative methods--patient focus groups and stakeholder interviews--to ensure that the modifications are acceptable to all stakeholders. Phase III uses results from phase II to further modify the intervention, develop an implementation plan, and train two care managers on the modified intervention. Phase IV consists of a 12-month open pilot study (N = 30) to assess the feasibility and acceptability of the modified intervention and explore its initial effects. Lastly, phase V consists of analysis of pilot study data and preparation for future funding to develop a more rigorous evaluation of the modified intervention. Discussion: The proposed study is one of the few projects to date to focus on improving the physical health of Hispanics with SMI and at risk for CVD by using a collaborative planning approach to enhance the transportability and use of a promising healthcare manager intervention. This study illustrates how blending health-disparities research and implementation science can help reduce the disproportionate burden of medical illness in a vulnerable population

Anti-tumour necrosis factor discontinuation in inflammatory bowel disease patients in remission: study protocol of a prospective, multicentre, randomized clinical trial

Background: Patients with inflammatory bowel disease who achieve remission with anti-tumour necrosis factor (anti-TNF) drugs may have treatment withdrawn due to safety concerns and cost considerations, but there is a lack of prospective, controlled data investigating this strategy. The primary study aim is to compare the rates of clinical remission at 1?year in patients who discontinue anti-TNF treatment versus those who continue treatment. Methods: This is an ongoing, prospective, double-blind, multicentre, randomized, placebo-controlled study in patients with Crohn?s disease or ulcerative colitis who have achieved clinical remission for ?6?months with an anti-TNF treatment and an immunosuppressant. Patients are being randomized 1:1 to discontinue anti-TNF therapy or continue therapy. Randomization stratifies patients by the type of inflammatory bowel disease and drug (infliximab versus adalimumab) at study inclusion. The primary endpoint of the study is sustained clinical remission at 1?year. Other endpoints include endoscopic and radiological activity, patient-reported outcomes (quality of life, work productivity), safety and predictive factors for relapse. The required sample size is 194 patients. In addition to the main analysis (discontinuation versus continuation), subanalyses will include stratification by type of inflammatory bowel disease, phenotype and previous treatment. Biological samples will be obtained to identify factors predictive of relapse after treatment withdrawal. Results: Enrolment began in 2016, and the study is expected to end in 2020. Conclusions: This study will contribute prospective, controlled data on outcomes and predictors of relapse in patients with inflammatory bowel disease after withdrawal of anti-TNF agents following achievement of clinical remission. Clinical trial reference number: EudraCT 2015-001410-1

Performance of the Cherenkov Telescope Array in the presence of clouds

The Cherenkov Telescope Array (CTA) is the future ground-based observatory for gamma-ray astronomy at very high energies. The atmosphere is an integral part of every Cherenkov telescope. Different atmospheric conditions, such as clouds, can reduce the fraction of Cherenkov photons produced in air showers that reach ground-based telescopes, which may affect the performance. Decreased sensitivity of the telescopes may lead to misconstructed energies and spectra. This study presents the impact of various atmospheric conditions on CTA performance. The atmospheric transmission in a cloudy atmosphere in the wavelength range from 203 nm to 1000 nm was simulated for different cloud bases and different optical depths using the MODerate resolution atmospheric TRANsmission (MODTRAN) code. MODTRAN output files were used as inputs for generic Monte Carlo simulations. The analysis was performed using the MAGIC Analysis and Reconstruction Software (MARS) adapted for CTA. As expected, the effects of clouds are most evident at low energies, near the energy threshold. Even in the presence of dense clouds, high-energy gamma rays may still trigger the telescopes if the first interaction occurs lower in the atmosphere, below the cloud base. A method to analyze very high-energy data obtained in the presence of clouds is presented. The systematic uncertainties of the method are evaluated. These studies help to gain more precise knowledge about the CTA response to cloudy conditions and give insights on how to proceed with data obtained in such conditions. This may prove crucial for alert-based observations and time-critical studies of transient phenomena

The Cherenkov Telescope Array: layout, design and performance

The Cherenkov Telescope Array (CTA) will be the next generation very-high-energy gamma-ray observatory. CTA is expected to provide substantial improvement in accuracy and sensitivity with respect to existing instruments thanks to a tenfold increase in the number of telescopes and their state-of-the-art design. Detailed Monte Carlo simulations are used to further optimise the number of telescopes and the array layout, and to estimate the observatory performance using updated models of the selected telescope designs. These studies are presented in this contribution for the two CTA stations located on the island of La Palma (Spain) and near Paranal (Chile) and for different operation and observation conditions

Sensitivity of the Cherenkov Telescope Array to emission from the gamma-ray counterparts of neutrino events

We investigate the possibility of detection of the VHE gamma-ray counterparts to the neutrino astrophysical sources within the Neutrino Target of Opportunity (NToO) program of CTA using the populations simulated by the FIRESONG software to resemble the diffuse astrophysical neutrino flux measured by IceCube. We derive the detection probability for different zenith angles and geomagnetic field configurations. The difference in detectability of sources between CTA-North and CTA-South for the average geomagnetic field is not substantial. We investigate the effect of a higher night-sky background and the preliminary CTA Alpha layout on the detection probability