Clinical- and cost-effectiveness of a technology-supported and solution-focused intervention (DIALOG plus ) in treatment of patients with chronic depression-study protocol for a multi-site, cluster randomised controlled trial [TACK]

Background Many with an acute depressive disorder go on to develop chronic depression, despite ongoing care. There are few specifically designed interventions to treat chronic depression. DIALOG+, a technology-assisted intervention based on the principles of solution-focused therapy, may be beneficial. It has been shown to be effective as a treatment for patients with psychotic disorders, especially in regards to increasing quality of life. DIALOG+ was designed to be flexibly applied and not diagnosis-specific, aiming to structure communication and generate a personally-tailored care plan. This cluster randomised controlled trial (RCT) is part of a programme of research to adapt and test DIALOG+ for patients with chronic depression. Methods Patients will be eligible for the trial, if they have exhibited symptoms of depression or non-psychotic low mood for at least 2 years, have regular contact with a clinician and have a low subjective quality of life and moderate depressive symptoms. Clinicians, who routinely see eligible patients, will be recruited from a number of sites across NHS England. Clusters will have between 1 and 6 patients per clinician and will be randomised in a 1:1 ratio to either the intervention (DIALOG+) or active control group (treatment as usual + DIALOG scale). Clinicians in the intervention group are trained and asked to deliver the intervention regularly for 12 months. Active control participants receive treatment as usual and are asked to rate their satisfaction with areas of life and treatment on the DIALOG scale at the end of the clinical session. Approximately 112 clinician clusters will be recruited to reach a total patient sample size of 376. Clinical and social outcomes including costs are assessed at baseline and 3, 6 and 12 months post randomisation. The primary outcome will be subjective quality of life at 12 months. Discussion This definitive multi-site, cluster RCT aims to evaluate the clinical- and cost-effectiveness of DIALOG+ for people with chronic depression. If shown to be effective for this patient population it could be used to improve outcomes of mental health care on a larger scale, ensuring that patients with complex and co-morbid diagnoses can benefit. Trial registration ISRCTN11301686. Registered on 13 Jun 2019

Utilization of De-oiled Jatropha Seed Cake for Renewable Gaseous Fuel Production and Digested Slurry for Growing Crops

Bio-methanation potential of de-oiled Jatropha seed cake was tested in a 1,200 l existing pilot plant digester in semi-continuous mode. The plant performance was monitored for 12 months at 15% (w/v) total solid concentration. Biogas production in the range of 229-370 l.kg-1 total solids was achieved in 40-days hydraulic retention time. The biogas produced from de-oiled Jatropha seed cake had higher calorific value as compared to the gas generated from cattle dung, as it had more methane content. The nutrient potential of the digested slurry and its toxicity on plants was studied by a series of pot culture experiments using maize (Zea mays L.) yields as the reference. The results indicated that the experimental digested slurry served as an excellent organic fertilizer, and was non-toxic to the plants