Process evaluation of the Walk Well study : a cluster-randomised controlled trial of a community based walking programme for adults with intellectual disabilities

Background: Walking interventions can be effective in encouraging sedentary populations to become more active; however, limited research has explored the effectiveness of walking interventions for adults with intellectual disabilities. This process evaluation explored the delivery of a community based walking intervention for adults with intellectual disabilities. Methods: Walk Well was a single-blind cluster randomised controlled trial of a 12-week physical activity consultation-led walking intervention. 102 participants were randomised to the Walk Well intervention or a waiting list control group. Participants in the intervention group received three physical activity consultations with a walking advisor at baseline, 6 & 12-weeks. They were encouraged to use a pedometer to set goals and monitor their daily step count. Primary outcome was change in daily step count at 12-weeks. Process evaluation measures included qualitative interviews with key stakeholders (n = 6) and quantifiable data collected as part of the intervention. Additional process data were extracted from a sub-set of qualitative interviews with participants and carers (n = 20). Data were analysed for process information related to context, recruitment and retention, reach, implementation, and fidelity. Results: Walk Well was not effective in significantly increasing levels of physical activity. The process evaluation did, however, highlight several important areas for consideration in future studies, including: a successful recruitment and retention strategy reaching a representative sample of adults with intellectual disabilities in the community; feasible and (for most) enjoyable methods of engaging adults with intellectual disabilities in activities to support behaviour change; potential need for greater intervention duration and frequency of contact; advantages and disadvantages of using pedometers as a behaviour change tool; the need for strategies which engage carers in supporting participants; and the complex issue of ‘freedom of choice’ in relation to lifestyle behaviours and study participation. Conclusions: Walking interventions for adults with intellectual disabilities can be feasibly delivered in the community in relation to reach, recruitment, retention and intervention fidelity. More intensive intervention methods need to be explored as well as strategies to engage and motivate carers in their support of participants

BEAT-IT:comparing a behavioural activation treatment for depression in adults with intellectual disabilities with an attention control : study protocol for a randomised controlled trial

BACKGROUND: Depression appears to be more enduring amongst people with intellectual disabilities, suggesting that it is a more chronic problem or more poorly managed in this population. This is not helped by a lack of evidence about the effectiveness of psychological therapies for people who have intellectual disabilities and depression. Behavioural activation, which aims to counteract depression by increasing individuals' level of meaningful activity and their exposure to positive reinforcers, has proven to be as effective as cognitive behavioural therapy in the general population. Given that this therapy makes fewer communicative demands and focuses on activity, it was thought that behavioural activation would be both accessible and apt for people with intellectual disabilities, who are often socially marginalised. METHODS/DESIGN: This study is a multi-centre single-blind randomised controlled trial of behavioural activation versus a self-help attention control intervention for depression in adults with mild/moderate intellectual disabilities. The study has an internal pilot in one centre, to establish that recruitment can be built up and sustained at the required level, before being rolled out across the other sites. One hundred sixty-six participants will be randomly assigned to the behavioural activation or self-help interventions, which will be delivered to individuals with mild to moderate intellectual disabilities, accompanied by someone who provides them with regular support. Both interventions are manualised and will be delivered over a period of approximately 4 months. The primary outcome measure will be the Glasgow Depression Scale, a self-report measure which is completed at baseline and 4 and 12 months post-randomisation. Secondary outcomes include measures of participants' activity levels, proxy reports of depressive symptoms, and cost-effectiveness. DISCUSSION: The study will provide evidence about the effectiveness of behavioural activation for depression, adapted for people who have mild/moderate intellectual disabilities, and will inform the delivery of psychological therapies to people with intellectual disabilities in practice. TRIAL REGISTRATION: Date trial registered: Nov. 13, 2012; trial registration number: ISRCTN 09753005

The relationship between moral development, distorted cognitions and social problem solving amongst men with intellectual disabilities who have a history of criminal offending

Aim: Little is known about the self-rated health status of people with co-morbid autism and intellectual disabilities (ID) in whole country populations. This paper will present analysis of: self-rated general health status, demographic factors, and prevalence of other disabilities for people with co-morbid autism and ID, as well as people with autism only. Method: We analysed data from Scotland’s Census 2011, and generated descriptive statistics. Results: People with co-morbid autism and ID (n=5,709)comprised 0.1% of the total population of Scotland (n=5,295,403) and 18 .0% of the whole population of people with autism in Scotland(n=31,712) across all ages. Only 2,863 (50.1%) people with co-morbid autism and ID rated their health as good or very good, compared with 19,97 1 (76.8%) of all people with autism only. Conclusions: Health is poorer for people with c o-morbid autism and ID than for people with autism only. Further analysis will explore the impact of individual and household characteristics on the health o f people with co-morbid autism and ID

Management and prevalence of long-term conditions in primary health care for adults with intellectual disabilities compared with the general population: a population-based cohort study

Background: In the UK, general practitioners/family physicians receive pay for performance on management of long-term conditions, according to best-practice indicators. Method: Management of long-term conditions was compared between 721 adults with intellectual disabilities and the general population (n = 764,672). Prevalence of long-term conditions was determined, and associated factors were investigated via logistic regression analyses. Results: Adults with intellectual disabilities received significantly poorer management of all long-term conditions on 38/57 (66.7%) indicators. Achievement was high (75.1%–100%) for only 19.6% of adults with intellectual disabilities, compared with 76.8% of the general population. Adults with intellectual disabilities had higher rates of epilepsy, psychosis, hypothyroidism, asthma, diabetes and heart failure. There were no clear associations with neighbourhood deprivation. Conclusions: Adults with intellectual disabilities receive poorer care, despite conditions being more prevalent. The imperative now is to find practical, implementable means of supporting the challenges that general practices face in delivering equitable care

Structure of forage sward with Urochloa brizantha cultivars under shading

Este estudio evaluó la estructura de pastos sembrados con Urochloa brizantha cv. BRS Paiaguas y BRS Piata bajo el sistema de sombra de eucalipto, fertilizados vía foliar al inicio de las temporadas seca y lluviosa. El experimento siguió un diseño de bloques al azar con un arreglo factorial de 4×2×2 (4 niveles de fertilizantes foliares × 2 sistemas × 2 temporadas). Los resultados se analizaron utilizando el GLIMMIX PROC de la Universidad SAS, mientras que las medias se compararon mediante la prueba de t al 5 %. El fertilizante foliar tuvo un efecto significativo (P≤0.05) en la producción de brotes del cv. BRS Paiaguas bajo sombra, mientras que los niveles de 3 y 6 L/ha produjeron las menores masas (P≤0.05). Las masas del forraje y raíz fueron afectadas significativamente (P≥0.05) por los sistemas y las temporadas, mientras que la masa de la materia muerta no fue influenciada por las temporadas. El sistema de sombra resultó en una masa de la materia muerta significativamente menor (P≤0.05) para ambos cultivares y masas de hojas y tallos mayores (P≤0.05) para el cv. BRS Piata. En la temporada de lluvias, las masas de hojas y tallos fueron mayores (P≤0.05). La fertilización foliar con hasta 6 L/ha favoreció el control del tallo en el cv. BRS Paiaguas bajo sombra. Las masas resultantes de forraje, materia muerta y raíz permiten concluir que los cultivares se adaptaron bien a la sombra y a la temporada seca.This study evaluated the structure of swards planted with Urochloa brizantha cv. BRS Paiaguas and BRS Piata under the eucalyptus shading system, fertilized via foliar at the beginning of the dry and rainy seasons. The experiment followed a randomized block design with a 4×2×2 (4 leaf fertilizer levels × 2 systems × 2 seasons) factorial arrangement. The results were analyzed using the GLIMMIX PROC of SAS University while means were compared by the T-test at 5%. Foliar fertilizer had a significant (P≤0.05) effect on cv. BRS Paiaguas stem mass under shading while the 3 and 6 L/ha levels produced the lowest (P≤0.05) masses. The forage and root masses were not significantly affected (P≥0.05) by the systems and seasons whereas the dead material mass was not influenced by the seasons. The shading system resulted in (P≤0.05) significantly lower dead material mass for both cultivars and higher (P≤0.05) leaf and stem masses for the cv. BRS Piata. In the rainy season, leaf and stem masses were greater (P≤0.05). Foliar fertilization up to 6 L/ha favored the stem control in cv. BRS Paiaguas under shading. The resulting masses of forage, dead material, and root allow concluding that the cultivars adapted well to the shading and dry season

A qualitative exploration of participants' experiences of taking part in a walking programme:Perceived benefits, barriers, choices and use of intervention resources

Background: Adults with Intellectual Disabilities (ID) experience significant inequalities and tend to be more sedentary and less physically active than the wider population. Walking programmes are an effective way to increase physical activity (PA) but have not been used in studies involving adults with ID. Method: 19 adults with ID participated in semi-structured interviews or focus groups exploring their experiences of taking part in a walking programme (Walk Well). Data were coded using thematic analysis. Results: Four overarching themes emerged: perceived benefits of taking part in the programme, perceived drawbacks/ barriers, walking choices and using the Walk Well resources. Whilst there was not a significant increase in walking for all, the participants reported positive experiences of taking part in the programme. Self-monitoring proved difficult for some, particularly reading the daily step-count recorded on the pedometer and writing it in the diary. Carers also played an important role in facilitating and preventing behaviour change in adults with ID. Conclusion: Additional barriers prevent many adults with ID from participating in PA. Capturing participant experiences provides important information for designing effective and equitable health improvement programmes

Walk well:a randomised controlled trial of a walking intervention for adults with intellectual disabilities: study protocol

Background - Walking interventions have been shown to have a positive impact on physical activity (PA) levels, health and wellbeing for adult and older adult populations. There has been very little work carried out to explore the effectiveness of walking interventions for adults with intellectual disabilities. This paper will provide details of the Walk Well intervention, designed for adults with intellectual disabilities, and a randomised controlled trial (RCT) to test its effectiveness. Methods/design - This study will adopt a RCT design, with participants allocated to the walking intervention group or a waiting list control group. The intervention consists of three PA consultations (baseline, six weeks and 12 weeks) and an individualised 12 week walking programme. A range of measures will be completed by participants at baseline, post intervention (three months from baseline) and at follow up (three months post intervention and six months from baseline). All outcome measures will be collected by a researcher who will be blinded to the study groups. The primary outcome will be steps walked per day, measured using accelerometers. Secondary outcome measures will include time spent in PA per day (across various intensity levels), time spent in sedentary behaviour per day, quality of life, self-efficacy and anthropometric measures to monitor weight change. Discussion - Since there are currently no published RCTs of walking interventions for adults with intellectual disabilities, this RCT will examine if a walking intervention can successfully increase PA, health and wellbeing of adults with intellectual disabilities

PRODUÇÃO E VALOR NUTRITIVO DE CAPIM-PIATÃ SUBMETIDO À ADUBAÇÃO ORGÂNICA E QUÍMICA

A adubação orgânica pode ser utilizada de forma sustentável visando o fornecimento de nutrientes as plantas. No entanto, são restritas as informações referentes às doses a serem aplicadas. Objetivou-se avaliar o desenvolvimento e valor nutritivo de capim-piatã recebendo diferentes níveis de biofertilizante (0, 1,0, 2,0, 3,0 e 4,0 L de biofertilizante líquido de esterco bovino por vaso) e diferentes condições de adubação química (dose zero – controle, com aplicação de 50 e 100% da recomendação de adubação química). O biofertilizante associado ou não com adubação química proporcionou aumentos na massa de forragem, massa de raiz e altura final das plantas e redução da razão parte aérea:raiz. A concentração proteína bruta foi influenciada pelos níveis de biofertilizante aplicado, na ausência de adubação química. As concentrações de fibra em detergente neutro e fibra em detergente ácido responderam de forma quadrática aos níveis de biofertilizante utilizado, quando foram associadas a 100% da dose recomendada de adubação química.  Quando 50% da recomendação adubação química foi utilizada a fibra em detergente ácido aumentou linearmente. A utilização de biofertilizante pode ser uma alternativa promissora em substituição total ou parcial da adubação química, melhorando o desenvolvimento e valor nutritivo do capim- piatã na implantação.Palavras-chave: biofertilização; Brachiaria brizantha cv. BRS Piatã; desenvolvimento sustentável. PRODUCTION AND NUTRITIVE VALUE OF PIATÃ PALISADE GRASS SUBMITTEDTO ORGANIC AND CHEMICAL FERTILIZATION ABSTRACT: Organic fertilization can be used sustainably in providing nutrients to plants. However, information regarding the doses to be applied is restricted. The objective was to evaluate the development and nutritional value of piatã palisade grass receiving different levels of biofertilizer (0, 1.0, 2.0, 3.0 and 4.0 L of liquid bovine manure biofertilizer) and different conditions of chemical fertilization (zero dose - control, applying 50 and 100% of the chemical fertilization recommendation). The biofertilizer associated or not with chemical fertilization provided increases in forage mass, root mass and final plant height and reduced shoot: root ratio. The crude protein concentration was influenced by the levels of biofertilizer applied in the absence of chemical fertilization. The concentrations of neutral detergent fiber and acid detergent fiber concentrations responded quadratically to the levels of biofertilizer used, when they were associated with 100% of the recommended chemical fertilizer dose. When 50% of the chemical fertilizer recommendation was used the acid detergent fiber increased linearly. The use of biofertilizer can be a promising alternative in total or partial substitution of chemical fertilization, improving the development and nutritional value of the piatã palisade grass at implantation.Keywords: biofertilization; Brachiaria brizantha cv. BRS Piatã; sustainable development

Broadband Squeezed Microwaves and Amplification with a Josephson Traveling-Wave Parametric Amplifier

Squeezing of the electromagnetic vacuum is an essential metrological technique used to reduce quantum noise in applications spanning gravitational wave detection, biological microscopy, and quantum information science. In superconducting circuits, the resonator-based Josephson-junction parametric amplifiers conventionally used to generate squeezed microwaves are constrained by a narrow bandwidth and low dynamic range. In this work, we develop a dual-pump, broadband Josephson traveling-wave parametric amplifier that combines a phase-sensitive extinction ratio of 56 dB with single-mode squeezing on par with the best resonator-based squeezers. We also demonstrate two-mode squeezing at microwave frequencies with bandwidth in the gigahertz range that is almost two orders of magnitude wider than that of contemporary resonator-based squeezers. Our amplifier is capable of simultaneously creating entangled microwave photon pairs with large frequency separation, with potential applications including high-fidelity qubit readout, quantum illumination and teleportation