Feasibility of a randomized controlled trial of paediatric interdisciplinary pain management using home-based telehealth

Purpose: Chronic pain is common in adolescents. Evidence-based guidelines recommend interdisciplinary treatment, but access is limited by geography. The development of hybrid programs utilizing both face-to-face and videoconference treatment may help overcome this. We developed a 7-week hybrid pediatric interdisciplinary pain program (Hybrid-PIPP) and wished to compare it to individual face-to-face sessions (Standard Care). Our objective was to test the feasibility of a protocol that used a matched pair un-blinded randomized controlled design to investigate the efficacy and cost-effectiveness of the Hybrid-PIPP compared to Standard Care. Patients and Methods: Parent–adolescent dyads were recruited from tertiary pediatric clinics and matched by disability before randomization to minimize allocation bias. The adolescents (aged 11– 17) had experienced primary pain for > 3 months. Hybrid-PIPP involved 11 hrs of group therapy and 4 individual videoconference sessions. Standard care was provided by the same clinical team, using the same treatment model and similar intensity as the Hybrid-PIPP. The intention was to recruit participants for 3 Hybrid-PIPP groups with a comparison stream. Recruitment was ceased after 2 groups due to the high participant disability requiring more intensive intervention. Results: Eighteen dyads were screened and 13 randomized (7 Hybrid-PIPP, 6 Standard Care, 2 unsuitable, 3 unallocated when the study was stopped). The study met a priori feasibility criteria for staff availability; recruitment rate; treatment completion; and data collection. Global satisfaction ratings were similar in both streams (SC median 7, range 5– 9 and Hybrid-PIPP median 8.5, range 5– 10). Challenges were identified in both streams. A future modified Hybrid-PIPP was considered acceptable if the intensity is increased to manage the high level of disability. Standard care was considered inefficient. No adverse events were reported. Conclusion: The study determined that the protocol met a priori feasibility criteria, but to be practicable in a real world, health environment requires significant modifications

Minority environmental activism in Britain: From brixton to the lake district

Historically, the British environmental movement has been devoid of minority participation, but this is changing very slowly, with the emergence of ethnic minority environmental groups and multiracial environmental alliances. These groups have argued that ethnic minorities have little or no access to public funds earmarked for countryside and wildlife preservation issues. They argue that white environmental organizations do not pay attention to the needs of inner-city minority residents and minority access to the countryside. Increased access, community improvement and beautification projects, environmental education, youth training, community garden projects, and issues of environmental racism are all foci of ethnic minority environmental movements. While some white environmentalists have been supportive of them, others have been uncomfortable with them or even hostile to their existence.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43549/1/11133_2004_Article_BF00990102.pd

No patents on life A briefing on the proposed EU Directive on the Legal Protection of Biotechnological Inventions

SIGLEAvailable from British Library Document Supply Centre-DSC:3470.997(1) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

The social and environmental effects of large dams Volume 2; case studies

SIGLEAvailable from British Library Document Supply Centre- DSC:86/08995(Social) / BLDSC - British Library Document Supply CentreGBUnited Kingdo