The clinical and cost-effectiveness of a Victim Improvement Package (VIP) for the reduction of chronic symptoms of depression or anxiety in older victims of common crime (the VIP trial): study protocol for a randomised controlled trial.

BACKGROUND: Older people are vulnerable to sustained high levels of psychosocial distress following a crime. A cognitive behavioural therapy (CBT)-informed psychological therapy, the Victim Improvement Package (VIP) may aid recovery. The VIP trial aims to test the clinical and cost-effectiveness of the VIP for alleviating depressive and anxiety symptoms in older victims of crime. METHODS/DESIGN: People aged 65 years or more who report being a victim of crime will be screened by Metropolitan Police Service Safer Neighbourhood Teams within a month of the crime for distress using the Patient Health Questionnaire-2 and the Generalised Anxiety Disorder-2. Those who screen positive will be signposted to their GP for assistance, and re-screened at 3 months. Participants who screen positive for depression and/or anxiety at re-screening are randomised to a CBT informed VIP added to treatment as usual (TAU) compared to TAU alone. The intervention consists of 10 individual 1-h sessions, delivered weekly by therapists from the mental health charity Mind. The primary outcome measure is the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI), used as a composite measure, assessed at 6 months after the crime (post therapy) with a 9-month post-crime follow-up. Secondary outcome measures include the EQ-5D, and a modified Client Service Receipt Inventory. A total of 226 participants will be randomised VIP:TAU with a ratio 1:1, in order to detect a standardised difference of at least 0.5 between groups, using a mixed-effects linear-regression model with 90% power and a 5% significance level (adjusting for therapist clustering and potential drop-out). A cost-effectiveness analysis will incorporate intervention costs to compare overall health care costs and quality of life years between treatment arms. An embedded study will examine the impact of past trauma and engagement in safety behaviours and distress on the main outcomes. DISCUSSION: This trial should provide data on the clinical and cost-effectiveness of a CBT-informed psychological therapy for older victims of crime with anxiety and/or depressive symptoms and should demonstrate a model of integrated cross-agency working. Our findings should provide evidence for policy-makers, commissioners and clinicians responding to the needs of older victims of crime. TRIAL REGISTRATION: International Standard Randomised Controlled Trials Number, ID: ISRCTN16929670. Registered on 3 August 2016

Cognitive behaviour therapy (CBT) for anxiety and depression in adults with mild intellectual disabilities (ID): a pilot randomised controlled trial

Background: Several studies have showed that people with intellectual disabilities (ID) have suitable skills to undergo cognitive behavioural therapy (CBT). Case studies have reported successful use of cognitive behavioural therapy techniques (with adaptations) in people with ID. Modified cognitive behavioural therapy may be a feasible and effective approach for the treatment of depression, anxiety, and other mood disorders in ID. To date, two studies have reported group-based manaulised cognitive behavioural treatment programs for depression in people with mild ID. However, there is no individual manualised programme for anxiety or depression in people with intellectual disabilities. The aims of the study are to determine the feasibility of conducting a randomised controlled trial for CBT in people with ID. The data will inform the power calculation and other aspects of carrying out a definitive randomised controlled trial.Methods: Thirty participants with mild ID will be allocated randomly to either CBT or treatment as usual (TAU). The CBT group will receive up to 20 hourly individual CBT over a period of 4 months. TAU is the standard treatment which is available to any adult with an intellectual disability who is referred to the intellectual disability service (including care management, community support, medical, nursing or social support). Beck Youth Inventories (Beck Anxiety Inventory & Beck Depression Inventory) will be administered at baseline; end of treatment (4 months) and at six months to evaluate the changes in depression and anxiety. Client satisfaction, quality of life and the health economics will be secondary outcomes.Discussion: The broad outcome of the study will be to produce clear guidance for therapists to apply an established psychological intervention and identify how and whether it works with people with intellectual disabilities

Ginzburg-Landau vortex dynamics with pinning and strong applied currents

We study a mixed heat and Schr\"odinger Ginzburg-Landau evolution equation on a bounded two-dimensional domain with an electric current applied on the boundary and a pinning potential term. This is meant to model a superconductor subjected to an applied electric current and electromagnetic field and containing impurities. Such a current is expected to set the vortices in motion, while the pinning term drives them toward minima of the pinning potential and "pins" them there. We derive the limiting dynamics of a finite number of vortices in the limit of a large Ginzburg-Landau parameter, or \ep \to 0, when the intensity of the electric current and applied magnetic field on the boundary scale like \lep. We show that the limiting velocity of the vortices is the sum of a Lorentz force, due to the current, and a pinning force. We state an analogous result for a model Ginzburg-Landau equation without magnetic field but with forcing terms. Our proof provides a unified approach to various proofs of dynamics of Ginzburg-Landau vortices.Comment: 48 pages; v2: minor errors and typos correcte

Acceptance and commitment therapy for adults with advanced cancer (CanACT): study protocol for a feasibility randomised controlled trial

BACKGROUND: One-third of people with cancer experience psychological distress and may suppress distressing thoughts, emotions, and concerns, leading to further problems. Conventional psychological treatments reduce distress by problem solving, but in advanced cancer, when ill health is progressive and death may be approaching, physical and psychological difficulties are complex and have no simple solutions. Acceptance and Commitment Therapy encourages acknowledgement and acceptance of mental experiences, increasing people's ability to work with problems that cannot be solved. Previous pilot work in advanced cancer confirms that distress can be associated with an avoidance of experiencing uncomfortable thoughts and emotions. METHODS/DESIGN: This feasibility randomised controlled trial of Acceptance Commitment Therapy aims to establish parameters for a larger trial. Fifty-four participants with advanced cancer will be randomly allocated to up to eight sessions (each 1 hour) of Acceptance Commitment Therapy or a talking control. Participants will be recruited from those attending outpatient services and hospice day care at three specialist palliative care units in North and East London, United Kingdom. The primary outcome is a measure of functioning in four areas of life (physical, social/family, emotional, and general activity) using the Functional Assessment of Cancer Therapies - General questionnaire at 3 months after randomisation. Secondary outcomes are (i) acceptance using the Acceptance and Action Questionnaire; (ii) psychological distress using the Kessler Psychological Distress Scale; (iii) physical functioning using a timed walk and sit-to-stand test; and (iv) quality of life measures including the Euroqol-5 Dimensions and ICECAP Supportive Care measures. Qualitative data will be collected at 3 months to explore the participants' experiences of the trial and therapy. Data will be collected on the costs of care. DISCUSSION: Data generated on the recruitment, retention, and experience of the interventions and the usefulness of the outcome measures will inform the adaptations required and whether changes in function are consistent with existing data when planning for a sufficiently powered randomised controlled trial. TRIAL REGISTRATION: ISRCTN13841211 (registered 22 July 2015)

Vortex density models for superconductivity and superfluidity

We study some functionals that describe the density of vortex lines in superconductors subject to an applied magnetic field, and in Bose-Einstein condensates subject to rotational forcing, in quite general domains in 3 dimensions. These functionals are derived from more basic models via Gamma-convergence, here and in a companion paper. In our main results, we use these functionals to obtain descriptions of the critical applied magnetic field (for superconductors) and forcing (for Bose-Einstein), above which ground states exhibit nontrivial vorticity, as well as a characterization of the vortex density in terms of a non local vector-valued generalization of the classical obstacle problem.Comment: 34 page

The Transition to a Giant Vortex Phase in a Fast Rotating Bose-Einstein Condensate

We study the Gross-Pitaevskii (GP) energy functional for a fast rotating Bose-Einstein condensate on the unit disc in two dimensions. Writing the coupling parameter as 1 / \eps^2 we consider the asymptotic regime \eps \to 0 with the angular velocity $\Omega$ proportional to (\eps^2|\log\eps|)^{-1} . We prove that if \Omega = \Omega_0 (\eps^2|\log\eps|)^{-1} and $\Omega_0 > 2(3\pi)^{-1}$ then a minimizer of the GP energy functional has no zeros in an annulus at the boundary of the disc that contains the bulk of the mass. The vorticity resides in a complementary `hole' around the center where the density is vanishingly small. Moreover, we prove a lower bound to the ground state energy that matches, up to small errors, the upper bound obtained from an optimal giant vortex trial function, and also that the winding number of a GP minimizer around the disc is in accord with the phase of this trial function.Comment: 52 pages, PDFLaTex. Minor corrections, sign convention modified. To be published in Commun. Math. Phy

Repeated games for eikonal equations, integral curvature flows and non-linear parabolic integro-differential equations

The main purpose of this paper is to approximate several non-local evolution equations by zero-sum repeated games in the spirit of the previous works of Kohn and the second author (2006 and 2009): general fully non-linear parabolic integro-differential equations on the one hand, and the integral curvature flow of an interface (Imbert, 2008) on the other hand. In order to do so, we start by constructing such a game for eikonal equations whose speed has a non-constant sign. This provides a (discrete) deterministic control interpretation of these evolution equations. In all our games, two players choose positions successively, and their final payoff is determined by their positions and additional parameters of choice. Because of the non-locality of the problems approximated, by contrast with local problems, their choices have to "collect" information far from their current position. For integral curvature flows, players choose hypersurfaces in the whole space and positions on these hypersurfaces. For parabolic integro-differential equations, players choose smooth functions on the whole space

Deriving effective models for multiscale systems via evolutionary GammaGamma-convergence

We discuss possible extensions of the recently established theory of evolutionary Gamma convergence for gradient systems to nonlinear dynamical systems obtained by perturbation of a gradient systems. Thus, it is possible to derive effective equations for pattern forming systems with multiple scales. Our applications include homogenization of reaction-diffusion systems, the justification of amplitude equations for Turing instabilities, and the limit from pure diffusion to reaction-diffusion. This is achieved by generalizing the Gamma-limit approaches based on the energy-dissipation principle or the evolutionary variational estimate