A Web-Based Service Delivery Model for Communication Training After Brain Injury: Protocol for a Mixed Methods, Prospective, Hybrid Type 2 Implementation-Effectiveness Study.

BackgroundAcquired brain injuries (ABIs) commonly cause cognitive-communication disorders, which can have a pervasive psychosocial impact on a person's life. More than 135 million people worldwide currently live with ABI, and this large and growing burden is increasingly surpassing global rehabilitation service capacity. A web-based service delivery model may offer a scalable solution. The Social Brain Toolkit is an evidence-based suite of 3 web-based communication training interventions for people with ABI and their communication partners. Successful real-world delivery of web-based interventions such as the Social Brain Toolkit requires investigation of intervention implementation in addition to efficacy and effectiveness.ObjectiveThe aim of this study is to investigate the implementation and effectiveness of the Social Brain Toolkit as a web-based service delivery model.MethodsThis is a mixed methods, prospective, hybrid type 2 implementation-effectiveness study, theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of digital health implementation. We will document implementation strategies preemptively deployed to support the launch of the Social Brain Toolkit interventions, as well as implementation strategies identified by end users through formative evaluation of the Social Brain Toolkit. We will prospectively observe implementation outcomes, selected on the basis of the NASSS framework, through quantitative web analytics of intervention use, qualitative and quantitative pre- and postintervention survey data from all users within a specified sample frame, and qualitative interviews with a subset of users of each intervention. Qualitative implementation data will be deductively analyzed against the NASSS framework. Quantitative implementation data will be analyzed descriptively. We will obtain effectiveness outcomes through web-based knowledge tests, custom user questionnaires, and formal clinical tools. Quantitative effectiveness outcomes will be analyzed through descriptive statistics and the Reliable Change Index, with repeated analysis of variance (pretraining, posttraining, and follow-up), to determine whether there is any significant improvement within this participant sample.ResultsData collection commenced on July 2, 2021, and is expected to conclude on June 1, 2022, after a 6-month sample frame of analytics for each Social Brain Toolkit intervention. Data analysis will occur concurrently with data collection until mid-2022, with results expected for publication late 2022 and early 2023.ConclusionsEnd-user evaluation of the Social Brain Toolkit's implementation can guide intervention development and implementation to reach and meet community needs in a feasible, scalable, sustainable, and acceptable manner. End user feedback will be directly incorporated and addressed wherever possible in the next version of the Social Brain Toolkit. Learnings from these findings will benefit the implementation of this and future web-based psychosocial interventions for people with ABI and other populations.Trial registrationAustralia and New Zealand Clinical Trials Registry ACTRN12621001170819; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001170819, Australia and New Zealand Clinical Trials Registry ACTRN12621001177842; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001177842, Australia and New Zealand Clinical Trials Registry ACTRN12621001180808; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001180808.International registered report identifier (irrid)DERR1-10.2196/31995

Implementation of Web-Based Psychosocial Interventions for Adults With Acquired Brain Injury and Their Caregivers: Systematic Review.

BACKGROUND: More than 135 million people worldwide live with acquired brain injury (ABI) and its many psychosocial sequelae. This growing global burden necessitates scalable rehabilitation services. Despite demonstrated potential to increase the accessibility and scalability of psychosocial supports, digital health interventions are challenging to implement and sustain. The Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework can offer developers and researchers a comprehensive overview of considerations to implement, scale, and sustain digital health interventions. OBJECTIVE: This systematic review identified published, peer-reviewed primary evidence of implementation outcomes, strategies, and factors for web-based psychosocial interventions targeting either adults with ABI or their formal or informal caregivers; evaluated and summarized this evidence; synthesized qualitative and quantitative implementation data according to the NASSS framework; and provided recommendations for future implementation. Results were compared with 3 hypotheses which state that complexity (dynamic, unpredictable, and poorly characterized factors) in most or all NASSS domains increases likelihood of implementation failure; success is achievable, but difficult with many complicated domains (containing multiple interacting factors); and simplicity (straightforward, predictable, and few factors) in most or all domains increases the likelihood of success. METHODS: From a comprehensive search of MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, speechBITE, and neuroBITE, we reviewed primary implementation evidence from January 2008 to June 2020. For web-based psychosocial interventions delivered via standard desktop computer, mobile phone, tablet, television, and virtual reality devices to adults with ABI or their formal or informal caregivers, we extracted intervention characteristics, stakeholder involvement, implementation scope and outcomes, study design and quality, and implementation data. Implementation data were both narratively synthesized and descriptively quantified across all 7 domains (condition, technology, value proposition, adopters, organization, wider system, and their interaction over time) and all subdomains of the NASSS framework. Study quality and risk of bias were assessed using the 2018 Mixed Methods Appraisal Tool. RESULTS: We identified 60 peer-reviewed studies from 12 countries, including 5723 adults with ABI, 1920 carers, and 50 health care staff. The findings aligned with all 3 hypotheses. CONCLUSIONS: Although studies were of low methodological quality and insufficient number to statistically test relationships, the results appeared consistent with recommendations to reduce complexity as much as possible to facilitate implementation. Although studies excluded individuals with a range of comorbidities and sociocultural challenges, such simplification of NASSS domain 1 may have been necessary to advance intervention value propositions (domain 3). However, to create equitable digital health solutions that can be successfully implemented in real-world settings, it is recommended that developers involve people with ABI, their close others, and health care staff in addressing complexities in domains 2 to 7 from the earliest intervention design stages. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020186387; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020186387. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1177/20552076211035988

Affine Toda field theory on a half line

The question of the integrability of real-coupling affine toda field theory on a half-line is addressed. It is found, by examining low-spin conserved charges, that the boundary conditions preserving integrability are strongly constrained. In particular, for the $a_n\ (n>1)$ series of models there can be no free parameters introduced by the boundary condition; indeed the only remaining freedom (apart from choosing the simple condition $\partial_1\phi =0$), resides in a choice of signs. For a special case of the boundary condition, it is argued that the classical boundary bound state spectrum is closely related to a consistent set of reflection factors in the quantum field theory.Comment: 16 pages, TEX (harvmac), DTP-94/7, YITP/U-94-1

Generalized particle dynamics in anti de Sitter spaces: A source for dark energy

We consider the generalized particle dynamics, proposed by us, in brane world formalisms for an asymptotically anti de Sitter background. The present framework results in a new model that accounts for the late acceleration of the universe. An effective Dark Energy equation of state, exhibiting a phantom like behaviour, is generated. The model is derived by embedding the physical FRW universe in a $(4+1)$-dimensional effective space-time, induced by the generalized particle dynamics. We corroborate our results with present day observed cosmological parameters.Comment: 18 pages, 6 figures. Final version to appear in IJMP

Motions and world-line deviations in Einstein-Maxwell theory

We examine the motion of charged particles in gravitational and electro-magnetic background fields. We study in particular the deviation of world lines, describing the relative acceleration between particles on different space-time trajectories. Two special cases of background fields are considered in detail: (a) pp-waves, a combination of gravitational and electro-magnetic polarized plane waves travelling in the same direction; (b) the Reissner-Nordstr{\o}m solution. We perform a non-trivial check by computing the precession of the periastron for a charged particle in the Reissner-Nordstr{\o}m geometry both directly by solving the geodesic equation, and using the world-line deviation equation. The results agree to the order of approximation considered.Comment: 23 pages, no figure

Symmetries of the Dirac operators associated with covariantly constant Killing-Yano tensors

The continuous and discrete symmetries of the Dirac-type operators produced by particular Killing-Yano tensors are studied in manifolds of arbitrary dimensions. The Killing-Yano tensors considered are covariantly constant and realize certain square roots of the metric tensor. Such a Killing-Yano tensor produces simultaneously a Dirac-type operator and the generator of a one-parameter Lie group connecting this operator with the standard Dirac one. The Dirac operators are related among themselves through continuous or discrete transformations. It is shown that the groups of the continuous symmetry can be only U(1) and SU(2), specific to (hyper-)Kahler spaces, but arising even in cases when the requirements for these special geometries are not fulfilled. The discrete symmetries are also studied obtaining the discrete groups Z_4 and Q. The briefly presented examples are the Euclidean Taub-NUT space and the Minkowski spacetime.Comment: 27 pages, latex, no figures, final version to be published in Class. Quantum Gravit

Quantum Mechanics of Yano tensors: Dirac equation in curved spacetime

In spacetimes admitting Yano tensors the classical theory of the spinning particle possesses enhanced worldline supersymmetry. Quantum mechanically generators of extra supersymmetries correspond to operators that in the classical limit commute with the Dirac operator and generate conserved quantities. We show that the result is preserved in the full quantum theory, that is, Yano symmetries are not anomalous. This was known for Yano tensors of rank two, but our main result is to show that it extends to Yano tensors of arbitrary rank. We also describe the conformal Yano equation and show that is invariant under Hodge duality. There is a natural relationship between Yano tensors and supergravity theories. As the simplest possible example, we show that when the spacetime admits a Killing spinor then this generates Yano and conformal Yano tensors. As an application, we construct Yano tensors on maximally symmetric spaces: they are spanned by tensor products of Killing vectors.Comment: 1+32 pages, no figures. Accepted for publication on Classical and Quantum Gravity. New title and abstract. Some material has been moved to the Appendix. Concrete formulas for Yano tensors on some special holonomy manifolds have been provided. Some corrections included, bibliography enlarge

Generalized Killing equations and Taub-NUT spinning space

The generalized Killing equations for the configuration space of spinning particles (spinning space) are analysed. Simple solutions of the homogeneous part of these equations are expressed in terms of Killing-Yano tensors. The general results are applied to the case of the four-dimensional euclidean Taub-NUT manifold.Comment: 10 pages, late