Community to clinic navigation to improve diabetes outcomes

Rural residents experience rates of Type 2 Diabetes Mellitus (T2DM) that are considerably higher than their urban or suburban counterparts. Two primary modifiable factors, self-management and formal clinical management, have potential to greatly improve diabetes outcomes. “Community to Clinic Navigation to Improve Diabetes Outcomes,” is the first known randomized clinical trial pilot study to test a hybrid model of diabetes self-management education plus clinical navigation among rural residents with T2DM. Forty-one adults with T2DM were recruited from two federally qualified health centers in rural Appalachia from November 2014–January 2015. Community health workers provided navigation, including helping participants understand and implement a diabetes self-management program through six group sessions and, if needed, providing assistance in obtaining clinic visits (contacting providers\u27 offices for appointments, making reminder calls, and facilitating transportation and dependent care). Pre and post-test data were collected on T2DM self-management, physical measures, demographics, psychosocial factors, and feasibility (cost, retention, and satisfaction). Although lacking statistical significance, some outcomes indicate trends in positive directions, including diet, foot care, glucose monitoring, and physical health, including decreased HbA1c and triglyceride levels. Process evaluations revealed high levels of satisfaction and feasibility. Due to the limited intervention dose, modest program expenditures (~$29,950), and a severely affected population most of whom had never received diabetes education, outcomes were not as robust as anticipated. Given high rates of satisfaction and retention, this culturally appropriate small group intervention holds promise for hard to reach rural populations. Modifications should include expanded recruitment venues, sample size, intervention dosage and longer term assessment

Increasing access to CBT for psychosis patients: a feasibility, randomised controlled trial evaluating brief, targeted CBT for distressing voices delivered by assistant psychologists (GiVE2)

Background: The National Institute for Health and Care Excellence (NICE) recommends that Cognitive Behaviour Therapy for psychosis (CBTp) is offered to all patients with a psychosis diagnosis. However, only a minority of psychosis patients in England and Wales are offered CBTp. This is attributable, in part, to the resource-intensive nature of CBTp. One response to this problem has been the development of CBTp in brief formats that are targeted at a single symptom and the mechanisms that maintain distress. We have developed a brief form of CBTp for distressing voices and reported preliminary evidence for its effectiveness when delivered by highly trained therapists (clinical psychologists). This study will investigate the delivery of this intervention by a cost-effective workforce of assistant psychologists following a brief training and evaluate the acceptability and feasibility of conducting a future, definitive, randomised controlled trial (RCT). Methods: This is a feasibility study for a pragmatic, three-arm, parallel-group, superiority 1:1:1 RCT comparing a Guided self-help CBT intervention for voices and treatment as usual (GiVE) to Supportive Counselling and treatment as usual (SC) to treatment as usual alone (TAU), recruiting across two sites, with blinded post-treatment and follow-up assessments. A process evaluation will quantitatively and qualitatively explore stakeholder experience. Discussion: Expected outcomes will include an assessment of the feasibility of conducting a definitive RCT, and data to inform the calculation of its sample size. If evidence from a subsequent, fully powered RCT suggests that GiVE is clinically and cost-effective when delivered by briefly trained assistant psychologists, CBTp offered in these less resource-intensive forms has the potential to generate benefits for individual patients (reduced distress, enhanced recovery and enhanced quality of life), service-level patient benefit (increased access to evidence-based psychological therapies) and economic benefits to the NHS (in terms of the reduced use of mental health inpatient services). Trial registration: Current Controlled Trials, ISRCTN registration number: 16166070. Registered on 5 February 2019

Coherent Captain Mills: The Search for Sterile Neutrinos

The observation of neutrino oscillations confirms that the active neutrinos (νe, νμ, ντ) are comprised of three mass eigenstates with Δm2 values between 10-3 to 10-5 eV2 . However, a persistent phenomenon has been observed at LSND, MiniBooNE and other shortbaseline experiments (SBE) where Δm2 ~ 1eV2 and is not compatible with the current mixing between mass eigenstates. However, a 4th neutrino, a sterile neutrino (νs) that doesn’t participate in weak interactions could explain the phenomena observed as SBE’s. An experiment has been constructed at TA-53 at Los Alamos National Laboratory to investigate this large Δm2 ~ 1eV2 and determine conclusively whether or not this large Δm2 is due to a “new” sterile neutrino. POSTER PRESENTATION IGNITE AWAR

The implementation of a digital group intervention for individuals with subthreshold borderline personality disorder

Context Systems Training for Emotional Predictability and Problem Solving for Emotional Intensity (STEPPS-EI), a 13-week skills-based group intervention for individuals with subthreshold borderline personality disorder (BPD) has been deemed feasible and clinically effective in primary care [1] [2]. To modernize the service, STEPPS-EI lesson content has recently built onto an eHealth platform (Minddistrict). Due to Covid-19 restrictions, group sessions were additionally delivered remotely via Zoom. This project evaluates the implementation of this digitally blended version of STEPPS-EI within two Sussex Partnership NHS Foundation Trust (SPFT) primary care services. Methods Service users and pracitioners who participated in the first two groups from March to July 2021 were invited to take part in a feasibility evaluation investigating recruitment, retention, and attendance rates, in addition to self-reported symptoms (BSL-23, QuEST), quality of life (ReQoL), system usability, and qualitative and quantitative measures designed to shed light on the experience and opinions of service users and practitioners during the intervention. Service users participating in following groups (from July to December 2021) were invited to share their symptom and quality of life outcome data only. Results 14 service users and 5 practitioners agreed to take part in the primary evaluation. Results suggested that 86% of these service users attended at least 75% of the group sessions, and that service users completed on average 70% of the online material. Usability ratings revealed good gradings for Zoom from all participants, yet lower gradings for Minddistrict. Further analyses revealed a generally positive attitude towards digital STEPPS-EI from all parties and practical suggestions on how to improve the intervention. 11 service users from following groups agreed to share their data. Bayesian analyses were conducted for the data of service users who provided ratings at both timepoints. Evidence was found for a decrease in BSL-23 scores and an increase in ReQoL ratings from baseline to post-intervention. Incomplete self-report data-sets limits conclusions. Conclusions It was found that the implementation of STEPPS-EI delivered in a blended digital format was feasible. The online delivery might increase service users' engagement with the material and group sessions. Yet more training and support on the use of Minddistrict may be required to increase usability. Implications It may be possible to effectively implement digital interventions for individuals with subthreshold BPD. However, more research on the effect of these on symptom outcomes should follow

The U&I study: study protocol for a feasibility randomised controlled trial of a pre-cognitive behavioural therapy digital ‘informed choice’ intervention to improve attitudes towards uptake and implementation of CBT for psychosis

Background: At least 40% of people with psychosis have persistent distressing symptoms despite optimal medication treatment. Cognitive Behaviour Therapy for psychosis (CBTp) is the only NICE recommended individual therapy for psychosis, with effects on symptoms, distress and quality of life. Yet fewer than 20% of service-users receive it and 94% of trusts struggle to provide it. Of those offered it, 22-43% refuse or do not attend. We have developed a new pre-CBTp informed choice intervention to address knowledge and attitudes that influence uptake and implementation and now want to test it in a feasibility trial. Methods: The design is a 2-arm, feasibility RCT, with 1:1 randomisation, stratified by participant group and site. Participants are 40 psychosis patients and 40 clinicians, who are ambivalent towards uptake or implementation of CBTp. Sites are community and inpatient services in Sussex and London. The intervention is a pre-CBT digital psychoeducation intervention designed to address identified knowledge and attitudinal barriers to uptake and implementation of CBTp, incorporating behaviour change mechanisms, and supported by animated introductory, patient and clinician stories. The comparator is the NHS choices website for CBT. The primary aim is to assess clinical feasibility (recruitment, randomization, acceptability, use, delivery, outcome measurement, retention). A secondary aim is a preliminary evaluation of efficacy. Outcomes will be assessed at baseline, post-intervention, and one-month follow up (blind to treatment arm). The primary efficacy outcome is likelihood of offering/taking up CBTp. Secondary outcomes include knowledge and attitudes towards CBTp; illness perceptions; empowerment; psychological wellbeing (patients only); CBTp implementation (clinicians only). Use of the intervention and CBT behaviours during the follow-up period will be recorded, and captured in a feedback questionnaire. Use, acceptability and experience of outcome assessment will be explored in qualitative interviews with participants (n = 6 per group). The efficacy evaluation will report descriptive data, key model parameters and 95% Highest Probability Density intervals in a Bayesian growth model. Discussion: This is the first feasibility trial of a digital ‘informed choice’ decision aid for the implementation of CBTp. If the trial proves feasible and demonstrates preliminary evidence of efficacy, a large multi-site trial will be warranted

A probabilistic approach to mapping the contribution of individual riverine discharges into Liverpool Bay using distance accumulation cost methods on satellite derived ocean-colour data

Assessments of the water quality in coastal zones often rely on indirect indicators from contributing river inputs and the neighbouring ocean. Using a novel combination of distance accumulation cost methods and an ocean-colour product derived from SENTINEL-3 data, we developed a probabilistic method for the assessment of dissolved inorganic nitrogen (DIN) in Liverpool Bay (UK) for the period from 2017 to 2020. Using our approach, we showed the annual and monthly likelihood of DIN exposure from its 12 major contributory rivers. Furthermore, we generated monthly risk maps showing the probability of DIN exposure from all rivers, which revealed a seasonal variation of extent and location around the bay. The highest likelihood of high DIN exposure throughout the year was in the estuarine regions of the Dee, Mersey, and Ribble, along with near-shore areas along the north Wales coast and around the mouth of the rivers Mersey and Ribble. There were seasonal changes in the risk of DIN exposure, and this risk remained high all year for the Mersey and Dee estuary regions. In contrast, for the mouth and near the coastal areas of the Ribble, the DIN exposure decreased in spring, remained low during the summer and early autumn, before displaying an increase during winter. Our approach offers the ability to assess the water quality within coastal zones without the need of complex hydrodynamic models, whilst still having the potential to apportion nutrient exposure to specific riverine inputs. This information can help to prioritise how direct mitigation strategies can be applied to specific river catchments, focusing the limited resources for coastal zone and river basin management