Feasibility of mHealth technology use among a sample of isolated rural men at high risk for cardiovascular disease

Purpose/Hypothesis: Isolated rural men are considered a health disparities group at high risk for cardiovascular disease. The increasing availability of technologies for self-monitoring for healthy eating, activity and weight loss (ie mHealth) may show promise for engaging rural men in lifestyle modification. This study investigated the feasibility of men from rural isolated areas to use a fitness monitor with text messaging support over a 3- week period. The study examined the men’s daily monitor use for tracking activity and eating, and assessed via written survey, their perspectives about mHealth. Number of Subjects: Twelve men, ages 40 to 69, from a US Department of Agriculture defined isolated rural area, participated. These men were a purposive sample originally recruited to participate in a focus group about their perceptions of the utility of mHealth. The men (50.9 6 8.6 yrs) had a baseline BMI of 25 to 44 kg/m2 (34.8 6 6.6 kg/m2). Eligibility included having cell/smartphones capable of sending/ receiving text messages, access to a computer, willing to use a fitness monitor and have research personnel access the men’s logs. Materials/Methods: Men participated in 2 visits at a community center located within 70 miles of their residence, at baseline and 3 weeks. Assessments included baseline health histories and vital sign biomarkers. The men received training using the fitness monitor with supporting technologies (cell/ smartphone and computer) and were asked to wear the monitor daily for 3 weeks. Men received 1–3 text messages/day for 3 weeks for reminders, education and motivation for self-monitoring. At visit 2, men completed post-intervention surveys about their fitness monitoring. Descriptive data were used for analysis. Results: Men were overweight (n 5 3) or obese (n 5 9) and most (9/12) were hypertensive with only four being treated with medications. One man was hypertensive stage 2 under no treatment and another was pre-hypertensive. Nine of 12 men wore the monitor during all 21 days, two wore it 9 and 15 days respectively and one lost the monitor. Survey data of the 12 men revealed seven checking their step count more than 5 times/day, 6 reported using the associated smart phone app and seven used the optional sleep log feature. Eleven of 12 men manually entered food into the log and most (9/12) did this on $15 days. Ten men indicated the log was helpful in learning about eating; though only 3 indicated it was easy to log food. All men reported reading reminder and motivational text messages sent during the study and 11 plan to continue using the fitness monitor. Conclusions: Men were not well managed for blood pressure or overweight/obesity. Both the log records and the survey results indicated that using fitness monitors was feasible and acceptable among this population. Clinical Relevance: Using mHealth appears feasible as an action-oriented tool for therapists to recommend for lifestyle self-monitoring in isolated rural men. The findings reinforce the important role of therapists in routinely assessing vital signs and making referrals as appropriate

Mobile Technology Intervention for Weight Loss in Rural Men: Protocol for a Pilot Pragmatic Randomised Controlled Trial

INTRODUCTION: Men who are overweight or obese in the rural Midwestern USA are an unrepresented, at-risk group exhibiting rising rates of cardiovascular disease, poor access to preventive care and poor lifestyle behaviours that contribute to sedentary lifestyle and unhealthy diet. Self-monitoring of eating and activity has demonstrated efficacy for weight loss. Use of mobile technologies for self-monitoring eating and activity may address rural men\u27s access disparities to preventive health resources and support weight loss. Our pilot trial will assess the feasibility and acceptability of two mobile applications for weight loss in rural men to inform a future, full-scale trial. METHODS AND ANALYSIS: A 6-month randomised controlled trial with contextual evaluation will randomise 80 men using a 1:1 ratio to either a Mobile Technology Plus (MT+) intervention or a basic Mobile Technology (MT) intervention in rural, midlife men (aged 40-69 years). The MT+ intervention consists of a smartphone self-monitoring application enhanced with discussion group (Lose-It premium), short message service text-based support and Wi-Fi scale. The MT group will receive only a self-monitoring application (Lose-It basic). Feasibility and acceptability will be evaluated using number of men recruited and retained, and evaluative focus group feedback. We seek to determine point estimates and variability of outcome measures of weight loss (kg and % body weight) and improved dietary and physical activity behaviours (Behavioral Risk Factor Surveillance System (BRFSS) physical activity and fruit and vegetable consumption surveys, data from Lose-It! application (kcal/day, steps/day)). Community capacity will be assessed using standard best practice methods. Descriptive content analysis will evaluate intervention acceptability and contextual sensitivity. ETHICS AND DISSEMINATION: This protocol was approved by the University of Nebraska Medical Center Institutional Review Board (IRB# 594-17-EP). Dissemination of findings will occur through ClinicalTrials.gov and publish pilot data to inform the design of a larger clinical trial. TRIAL REGISTRATION NUMBER: NCT03329079; preresults. Protocol V.10, study completion date 31 August 2020. Roles and responsibilities funder: NIH/NINR Health Disparities Section 1R15NR017522-01

The Melbourne Study of Psychoanalytic Psychotherapy III: Patients' and psychotherapists’ perspectives on progress and challenges

Qualitative exploration of the experience of psychoana-lytic psychotherapy complemented the quantitative eval-uation of mental health and life functioning improvements in the Melbourne Study of Psychoanalytic Psychotherapy. Twice-weekly treatment was offered to adults for 2years by the private sector Glen Nevis Clinic for Psychoanalytic Psychotherapy, established by the Victorian Association of Psychoanalytic Psychotherapists as a subsidized, low-cost community service over 8years. This paper is the second of two presenting the qualitative arm of the study, involv-ing in-depth narrative interviews with patients and psycho-therapists. Analysis of 143 transcripts further contributes to evidence of the Reach, Effectiveness, Adoption, Imple-men tation and Maintenance of psychoanalytic psycho-therapy in a community setting. The first qualitative paper reports themes concerning patient expectations of psycho-therapy and perspectives of both patients and psychother-apists on the experience and benefits of the treatment. This paper reports what was perceived by participants as facili-tative or challenging for therapeutic progress, illuminating how experiences of the nature of psychoanalytic psycho-therapy may have affected the Implementation, Effectivenessand Maintenance of the program. The most notable facilita-tive factors emerging were the exploratory, insight-oriented nature of the work, elements of the patient-psychotherapist relationship, and the frame of the treatment. Challenges were also often seen as inherent to Effectiveness; however, proposing the frame of 2-year treatment, as both an expecta-tion and a limit, probably inhibited program Reach, Adoptionand overall Implementation. The limitations and strengths of the qualitative arm of the research, together with implica-tions for further investigation, are discussed

The Melbourne Study of Psychoanalytic Psychotherapy II: Patients' and psychotherapists' perspectives on expectations, therapeutic experience and benefits

The naturalistic, longitudinal Melbourne Study of Psycho-analytic Psychotherapy was conducted in a subsidized community clinic established by the Victorian Association of Psychoanalytic Psychotherapists as a demonstration project operating over 8years. It offered lower SES adults twice-weekly psychoanalytic psychotherapy for 2years. An independent research program used the RE-AIM planning and evaluation framework to investigate the Reach, Effectiveness, Adoption, Implementation and Maintenance of the service. Complementary quantitative and qualitative methodologies studied mental health and general-life functioning outcomes and underlying processes of treatment. Two papers pres-ent the qualitative arm of the research, exploring the lived experience of the psychotherapy, reported contemporane-ously and retrospectively by patients and psychotherapists. This first paper details the qualitative design and methods employed. In-depth semi-structured narrative interviews during psychotherapy, upon completion at 2years, and at an additional 8-month follow-up point for patients, were conducted. Analysis of the narrative transcripts of 143 participant interviews revealed themes regarding patient expectations of treatment and the perceptions of both patients and psychotherapists of the long-term psychoana-lytic psychotherapy experience and its benefits. Narratives thus provided evidence of the Reach, Effectiveness, Adoption, Implementation and Maintenance of the service. The findings enrich understanding of the effective processes underlying the outcomes of the quantitative arm of the study reported separately. The second qualitative paper presents the find-ings concerning participants' experiences of facilitative and challenging aspects of the treatment, as well as the implica-tions of the qualitative findings overall

The Melbourne Study of Psychoanalytic Psychotherapy low‐cost clinic I: Implementation, mental health and life functioning gains

The Melbourne Study of Psychoanalytic Psychother-apy examined the implementation, lived experience, and perceived therapeutic gains of psychoanalytic psychother-apy in a low-cost, private-sector community clinic. A first in Australia, this 8-year demonstration project allowed natural-istic study of the impact and process of intensive, long-term, time-limited psychoanalytic psychotherapy delivered to self-referred adults by clinicians with a common theoretical frame of practice. Presented in three papers, the research employed the RE-AIM planning and evaluation framework, using complementary quantitative and qualitative methods, to study the psychotherapy service in terms of Reach, Effec-tiveness, Adoption, Implementation and Maintenance. This first paper reports the Reach of the program to be 67% for those presenting for assessment for psychoanalytic psycho-therapy, with Adoption of the full 2-year treatment program being 60%. Improvements in mental health and life function-ing provided quantitative evidence of Effectiveness for those completing the 2-year treatment program, with Maintenanceat 8-month follow-up. Patient age, gender and personality

Astro2020 APC White Paper: The Early Career Perspective on the Coming Decade, Astrophysics Career Paths, and the Decadal Survey Process

In response to the need for the Astro2020 Decadal Survey to explicitly engage early career astronomers, the National Academies of Sciences, Engineering, and Medicine hosted the Early Career Astronomer and Astrophysicist Focus Session (ECFS) on October 8-9, 2018 under the auspices of Committee of Astronomy and Astrophysics. The meeting was attended by fifty six pre-tenure faculty, research scientists, postdoctoral scholars, and senior graduate students, as well as eight former decadal survey committee members, who acted as facilitators. The event was designed to educate early career astronomers about the decadal survey process, to solicit their feedback on the role that early career astronomers should play in Astro2020, and to provide a forum for the discussion of a wide range of topics regarding the astrophysics career path. This white paper presents highlights and themes that emerged during two days of discussion. In Section 1, we discuss concerns that emerged regarding the coming decade and the astrophysics career path, as well as specific recommendations from participants regarding how to address them. We have organized these concerns and suggestions into five broad themes. These include (sequentially): (1) adequately training astronomers in the statistical and computational techniques necessary in an era of "big data", (2) responses to the growth of collaborations and telescopes, (3) concerns about the adequacy of graduate and postdoctoral training, (4) the need for improvements in equity and inclusion in astronomy, and (5) smoothing and facilitating transitions between early career stages. Section 2 is focused on ideas regarding the decadal survey itself, including: incorporating early career voices, ensuring diverse input from a variety of stakeholders, and successfully and broadly disseminating the results of the survey

Physics case for an LHCb Upgrade II - Opportunities in flavour physics, and beyond, in the HL-LHC era

The LHCb Upgrade II will fully exploit the flavour-physics opportunities of the HL-LHC, and study additional physics topics that take advantage of the forward acceptance of the LHCb spectrometer. The LHCb Upgrade I will begin operation in 2020. Consolidation will occur, and modest enhancements of the Upgrade I detector will be installed, in Long Shutdown 3 of the LHC (2025) and these are discussed here. The main Upgrade II detector will be installed in long shutdown 4 of the LHC (2030) and will build on the strengths of the current LHCb experiment and the Upgrade I. It will operate at a luminosity up to 2×1034 cm−2s−1, ten times that of the Upgrade I detector. New detector components will improve the intrinsic performance of the experiment in certain key areas. An Expression Of Interest proposing Upgrade II was submitted in February 2017. The physics case for the Upgrade II is presented here in more depth. CP-violating phases will be measured with precisions unattainable at any other envisaged facility. The experiment will probe b → sl+l−and b → dl+l− transitions in both muon and electron decays in modes not accessible at Upgrade I. Minimal flavour violation will be tested with a precision measurement of the ratio of B(B0 → μ+μ−)/B(Bs → μ+μ−). Probing charm CP violation at the 10−5 level may result in its long sought discovery. Major advances in hadron spectroscopy will be possible, which will be powerful probes of low energy QCD. Upgrade II potentially will have the highest sensitivity of all the LHC experiments on the Higgs to charm-quark couplings. Generically, the new physics mass scale probed, for fixed couplings, will almost double compared with the pre-HL-LHC era; this extended reach for flavour physics is similar to that which would be achieved by the HE-LHC proposal for the energy frontier

LHCb upgrade software and computing : technical design report

This document reports the Research and Development activities that are carried out in the software and computing domains in view of the upgrade of the LHCb experiment. The implementation of a full software trigger implies major changes in the core software framework, in the event data model, and in the reconstruction algorithms. The increase of the data volumes for both real and simulated datasets requires a corresponding scaling of the distributed computing infrastructure. An implementation plan in both domains is presented, together with a risk assessment analysis