Effectiveness and cost-effectiveness of an educational intervention for practice teams to deliver problem focused therapy for insomnia: rationale and design of a pilot cluster randomised trial

Background: Sleep problems are common, affecting over a third of adults in the United Kingdom and leading to reduced productivity and impaired health-related quality of life. Many of those whose lives are affected seek medical help from primary care. Drug treatment is ineffective long term. Psychological methods for managing sleep problems, including cognitive behavioural therapy for insomnia (CBTi) have been shown to be effective and cost effective but have not been widely implemented or evaluated in a general practice setting where they are most likely to be needed and most appropriately delivered. This paper outlines the protocol for a pilot study designed to evaluate the effectiveness and cost-effectiveness of an educational intervention for general practitioners, primary care nurses and other members of the primary care team to deliver problem focused therapy to adult patients presenting with sleep problems due to lifestyle causes, pain or mild to moderate depression or anxiety. Methods and design: This will be a pilot cluster randomised controlled trial of a complex intervention. General practices will be randomised to an educational intervention for problem focused therapy which includes a consultation approach comprising careful assessment (using assessment of secondary causes, sleep diaries and severity) and use of modified CBTi for insomnia in the consultation compared with usual care (general advice on sleep hygiene and pharmacotherapy with hypnotic drugs). Clinicians randomised to the intervention will receive an educational intervention (2 × 2 hours) to implement a complex intervention of problem focused therapy. Clinicians randomised to the control group will receive reinforcement of usual care with sleep hygiene advice. Outcomes will be assessed via self-completion questionnaires and telephone interviews of patients and staff as well as clinical records for interventions and prescribing. Discussion: Previous studies in adults have shown that psychological treatments for insomnia administered by specialist nurses to groups of patients can be effective within a primary care setting. This will be a pilot study to determine whether an educational intervention aimed at primary care teams to deliver problem focused therapy for insomnia can improve sleep management and outcomes for individual adult patients presenting to general practice. The study will also test procedures and collect information in preparation for a larger definitive cluster-randomised trial. The study is funded by The Health Foundation

Sierra Leone fish value chain analysis with special emphasis on Tonkolili District

The USAID-funded Sierra Leone Feed the Future (FtF) Agriculture Project implemented by WorldFish has completed its initial pilot phase (July 2015 to September 2016). During this phase, the project identified and tested interventions to develop integrated agriculture-aquaculture (IAA) farming systems and associated value chains to enhance food, nutrition and livelihood outcomes for rural households in Tonkolili District. This project emphasizes rehabilitation and improvement of fish and rice farming systems combined with nutritious vegetable crops. The assessment of existing fish and rice value chains in Sierra Leone was a key component of this initial phase to improve understanding of current farming systems and identify opportunities for interventions to increase productivity and income and improve nutrition among rural households in Tonkolili District. This report presents the key findings of the fish value chain assessment, with an emphasis on the development of the aquaculture sector and recommendations for potential value chain interventions in marine and freshwater fisheries and aquaculture sectors

Multimodal Approach for Assessing Neuromotor Coordination in Schizophrenia Using Convolutional Neural Networks

This study investigates the speech articulatory coordination in schizophrenia subjects exhibiting strong positive symptoms (e.g. hallucinations and delusions), using two distinct channel-delay correlation methods. We show that the schizophrenic subjects with strong positive symptoms and who are markedly ill pose complex articulatory coordination pattern in facial and speech gestures than what is observed in healthy subjects. This distinction in speech coordination pattern is used to train a multimodal convolutional neural network (CNN) which uses video and audio data during speech to distinguish schizophrenic patients with strong positive symptoms from healthy subjects. We also show that the vocal tract variables (TVs) which correspond to place of articulation and glottal source outperform the Mel-frequency Cepstral Coefficients (MFCCs) when fused with Facial Action Units (FAUs) in the proposed multimodal network. For the clinical dataset we collected, our best performing multimodal network improves the mean F1 score for detecting schizophrenia by around 18% with respect to the full vocal tract coordination (FVTC) baseline method implemented with fusing FAUs and MFCCs.Comment: 5 pages. arXiv admin note: text overlap with arXiv:2102.0705

Investigation of Field Performance and Film Properties of Natural Rubber Latex Preserved with a Novel Chemical

The traditional long-term preservative system of latex has an impact on environmental air pollution by ammonia and leads to the production of carcinogenic nitrosamine substances by tetramethyl thiuram disulfide (TMTD). In this research, ammonia and a novel preservative with a polysulfidic link were compounded and tested as a novel traditional long-term latex preservative system, to overcome the drawbacks of traditional preservative systems. Control samples were prepared with ammonia as the standard preservative. In addition, ammonia and the novel chemical mixed samples were also prepared for investigating the combined effect. After the preservation treatment, the stable nature of field NR latex was evaluated via the Volatile Fatty Acid (VFA) test based on ASTM D 1076 standard. The Dry Rubber Content (DRC) test and Total Solid Content (TSC) test were carried out for VFA calculation purposes based on ISO126:2005 and ASTM D 1076 standards, respectively. The alkalinity test was carried out to maintain the required ammonia content in latex. In the first trial, traditional dispersion preparation of novel chemical dispersion failed due to the large particle size of the novel chemical. Therefore, two different novel chemical dispersions were prepared in the second trial, where dispersions 1 and 2 were prepared with wetting agents and without using a wetting agent, respectively. It was found that 0.020%v/v and 0.025% v/v concentrations of the novel chemical from dispersion 1 allowed the preservation of field NR latex for 8 days. A low concentration (0.015% v/v) of the novel chemical was able to keep latex with good stability for 5 days. The novel chemical dispersion without a wetting agent exhibited a marvelous preservative system to NR latex than with a wetting agent, because the wetting agent creates a barrier between particles of novel chemical and latex particles. The novel preservative acts as a good preservative while reducing the fumes of ammonia being emitted and eliminating the carcinogenic nitrosamine emission from TMTD

Acoustic-to-Articulatory Speech Inversion Features for Mispronunciation Detection of /r/ in Child Speech Sound Disorders

Acoustic-to-articulatory speech inversion could enhance automated clinical mispronunciation detection to provide detailed articulatory feedback unattainable by formant-based mispronunciation detection algorithms; however, it is unclear the extent to which a speech inversion system trained on adult speech performs in the context of (1) child and (2) clinical speech. In the absence of an articulatory dataset in children with rhotic speech sound disorders, we show that classifiers trained on tract variables from acoustic-to-articulatory speech inversion meet or exceed the performance of state-of-the-art features when predicting clinician judgment of rhoticity. Index Terms: rhotic, speech sound disorder, mispronunciation detectionComment: *denotes equal contribution. To appear in Proceedings of the Annual Conference of the International Speech Communication Association, INTERSPEECH 202

Agarose microgel culture delineates lumenogenesis in naive and primed human pluripotent stem cells.

Human periimplantation development requires the transformation of the naive pluripotent epiblast into a polarized epithelium. Lumenogenesis plays a critical role in this process, as the epiblast undergoes rosette formation and lumen expansion to form the amniotic cavity. Here, we present a high-throughput in vitro model for epiblast morphogenesis. We established a microfluidic workflow to encapsulate human pluripotent stem cells (hPSCs) into monodisperse agarose microgels. Strikingly, hPSCs self-organized into polarized epiblast spheroids that could be maintained in self-renewing and differentiating conditions. Encapsulated primed hPSCs required Rho-associated kinase inhibition, in contrast to naive hPSCs. We applied microgel suspension culture to examine the lumen-forming capacity of hPSCs and reveal an increase in lumenogenesis during the naive-to-primed transition. Finally, we demonstrate the feasibility of co-encapsulating cell types across different lineages and species. Our work provides a foundation for stem cell-based embryo models to interrogate the critical components of human epiblast self-organization and morphogenesis

Caregivers’ interactions with health care services: mediator of stress or added strain? Experiences and perceptions of informal caregivers of people with dementia: a qualitative study

Background: There are an estimated 46.8 million people worldwide living with dementia in 2015, being cared for usually by family members or friends (informal caregivers). The challenges faced by informal caregivers often lead to increased levels of stress, burden and risk of care-recipient institutionalisation. Aim: The overarching aim of this study was to explore the experiences and perceptions of informal caregivers of people with dementia when interacting with the health care system, and whether the support received acted as a mediator of caregiver stress. The secondary aim was to investigate healthcare professionals’ views and current practice regarding people with dementia and their interactions with informal caregivers. Method: We employed a qualitative research design, using focus groups and one face-to-face interview with a purposive sample of informal caregivers and healthcare professionals (HCPs) in Lincolnshire, UK. Data were collected between March and July 2015. We used the stress-process model of stress in caregivers as a theoretical framework. Results: We interviewed 18 caregivers and 17 HCPs. Five themes, mapped to the stress-process in caregivers’ model, captured the main challenges faced by caregivers and the type of support they wanted from health care services. Primary stressors included the challenge of diagnosing dementia; caregivers’ needs and expectations of an in-depth knowledge and understanding of dementia from HCPs; and need for carer education. Secondary role strain included lack of support and mismatch of communication and expectations. Caregiver involvement in monitoring care and disease was a potential mediator tool. Conclusions: Fragmentation of dementia care services, lack of training for HCPs and the dearth of information for caregivers means health care services are only partially fulfilling a support role. In turn, lack of support may be intensifying caregiver stress leading to worsening in their health and well-being; thus, potentially increasing the risk of institutionalisation of their care-recipient

Foveal structure and visual function in nanophthalmos and posterior microphthalmos

Background/aims: The reason for visual impairment in patients with nanophthalmos and posterior microphthalmos is not completely understood. Therefore, this study aims to investigate foveal structure, and the impact of demographic, clinical and imaging parameters on best-corrected visual acuity (BCVA) in these conditions. Methods: Sixty-two eyes of 33 patients with nanophthalmos (n=40) or posterior microphthalmos (n=22), and 114 eyes of healthy controls with high-resolution retinal imaging including spectral-domain or swept-source optical coherence tomography images were included in this cross-sectional case-control study. Foveal retinal layer thickness was determined by two independent readers. A mixed-effect model was used to perform structure-function correlations and predict the BCVA based on subject-specific variables. Results: Most patients (28/33) had altered foveal structure associated with loss of foveal avascular zone and impaired BCVA. However, widening of outer nuclear layer, lengthening of photoreceptor outer segments, normal distribution of macular pigment and presence of Henle fibres were consistently found. Apart from the presence of choroidal effusion, which had significant impact on BCVA, the features age, refractive error, axial length and retinal layer thickness at the foveal centre explained 61.7% of the variability of BCVA. Conclusion: This study demonstrates that choroidal effusion, age, refractive error, axial length and retinal layer thickness are responsible for the majority of interindividual variability of BCVA as well as the morphological foveal heterogeneity in patients with nanophthalmos or posterior microphthalmos. This might give further insights into the physiology of foveal development and the process of emmetropisation, and support clinicians in the assessment of these disease entities

Exploring the experiences of having Guillain‐Barré Syndrome: A qualitative interview study

Background: Guillain-Barré syndrome (GBS) is a rare inflammatory disorder affecting the peripheral nerves. Although typically there is full neurological recovery, some people continue to experience residual physical, psychological or social problems longer term. Evidence describing the experiences of people with GBS is limited. Objective: We aimed to explore the experiences of people with GBS in the UK. Design: We used qualitative (face-to-face and telephone) interviews to explore experiences of people with GBS. Audio-recorded data were transcribed verbatim and analysed using the Framework Method supported by NVivo 11. Setting and Participants: We purposively recruited a sample of 16 volunteers with a prior diagnosis of GBS of varying age, sex, ethnicity, location, marital status, time since diagnosis and length of hospital stay to maximize differences in experience. Interviewees were required to have been discharged from hospital, able to give informed consent, able to speak and understand English and currently resident in the United Kingdom. Results: The key themes arising from the analysis were as follows: the importance of early diagnosis; the experiences of inpatient care; the importance of active support for recovery; the need for communication throughout the course of the illness; the need for greater awareness, knowledge and provision of information by health-care staff; and path to achieving function. Conclusion: This is the first qualitative study exploring experiences of people with GBS in the UK through their whole illness journey from onset to recovery. The findings contribute to our understanding of the experiences and support needs of people recovering from GBS

Understanding variation in ambulance service non-conveyance rates: a mixed methods study

Background In England in 2015/16, ambulance services responded to nearly 11 million calls. Ambulance Quality Indicators show that half of the patients receiving a response by telephone or face to face were not conveyed to an emergency department. A total of 11% of patients received telephone advice only. A total of 38% of patients were sent an ambulance but were not conveyed to an emergency department. For the 10 large ambulance services in England, rates of calls ending in telephone advice varied between 5% and 17%. Rates of patients who were sent an ambulance but not conveyed to an emergency department varied between 23% and 51%. Overall non-conveyance rates varied between 40% and 68%. Objective To explain variation in non-conveyance rates between ambulance services. Design A sequential mixed methods study with five work packages. Setting Ten of the 11 ambulance services serving > 99% of the population of England. Methods (1) A qualitative interview study of managers and paramedics from each ambulance service, as well as ambulance commissioners (totalling 49 interviews undertaken in 2015). (2) An analysis of 1 month of routine data from each ambulance service (November 2014). (3) A qualitative study in three ambulance services with different published rates of calls ending in telephone advice (120 hours of observation and 20 interviews undertaken in 2016). (4) An analysis of routine data from one ambulance service linked to emergency department attendance, hospital admission and mortality data (6 months of 2013). (5) A substudy of non-conveyance for people calling 999 with breathing problems. Results Interviewees in the qualitative study identified factors that they perceived to affect non-conveyance rates. Where possible, these perceptions were tested using routine data. Some variation in non-conveyance rates between ambulance services was likely to be due to differences in the way rates were calculated by individual services, particularly in relation to telephone advice. Rates for the number of patients sent an ambulance but not conveyed to an emergency department were associated with patient-level factors: age, sex, deprivation, time of call, reason for call, urgency level and skill level of attending crew. However, variation between ambulance services remained after adjustment for patient-level factors. Variation was explained by ambulance service-level factors after adjustment for patient-level factors: the percentage of calls attended by advanced paramedics [odds ratio 1.05, 95% confidence interval (CI) 1.04 to 1.07], the perception of ambulance service staff and commissioners that advanced paramedics were established and valued within the workforce of an ambulance service (odds ratio 1.84, 95% CI 1.45 to 2.33), and the perception of ambulance service staff and commissioners that senior management was risk averse regarding non-conveyance within an ambulance service (odds ratio 0.78, 95% CI 0.63 to 0.98). Limitations Routine data from ambulance services are complex and not consistently collected or analysed by ambulance services, thus limiting the utility of comparative analyses. Conclusions Variation in non-conveyance rates between ambulance services in England could be reduced by addressing variation in the types of paramedics attending calls, variation in how advanced paramedics are used and variation in perceptions of the risk associated with non-conveyance within ambulance service management. Linking routine ambulance data with emergency department attendance, hospital admission and mortality data for all ambulance services in the UK would allow comparison of the safety and appropriateness of their different non-conveyance rates. Funding The National Institute for Health Research Health Services and Delivery Research programme