COPe-support - a multi-component digital intervention for family carers for people affected by psychosis: study protocol for a randomized controlled trial.

BACKGROUND: Psychosis often causes significant distress and impacts not only in the individuals, but also those close to them. Many relatives and friends ('carers') provide long-term support and need resources to assist them. We have co-produced a digital mental health intervention called COPe-support (Carers fOr People with Psychosis e-support) to provide carers with flexible access to high quality psychoeducation and interactive support from experts and peers. This study evaluates the effectiveness of COPe-support to promote mental wellbeing and caregiving experiences in carers. METHODS: This study is a single-blind, parallel arm, individually randomized controlled trial (RCT) comparing COPe-support, with attention control. Both groups continue to receive usual care. COPe-support provides interactive web-based psychoeducation on psychosis-related issues, wellbeing-promotion and network support through forums. The attention-control is a non-interactive online information resource pack. Carers living in England are eligible if they provide at least weekly support to a family member or close friend affected by psychosis, and use internet communication (including emails) daily. All trial procedures are run online, including collection of outcome measurements which participants will directly input into our secure platform. Following baseline assessment, a web-based randomization system will be used to allocate 360 carers to either arm. Participants have unlimited access to the allocated condition for 40 weeks. Data collection is at three time points (10, 20, and 40 weeks after randomization). Analyses will be conducted by trial statisticians blinded to allocation. The primary outcome is mental wellbeing measured by Warwick Edinburgh Mental Wellbeing Scale (WEMWBS), at 20 weeks. As well as an intention-to-treat analysis, a complier average causal effect (CACE) analysis will be conducted to estimate the intervention effect in participants who have accessed COPe-support content twice or more. The secondary objectives and analysis will examine other health and caregiving-related outcomes and explore mechanisms. In a process evaluation, we will interview 20% of the intervention arm participants regarding the acceptability of COPe-support. We will explore in detail participants' usage patterns. DISCUSSION: The results of this trial will provide valuable information about the effectiveness of COPe-support in promoting wellbeing and caregiving experiences in carers. TRIAL REGISTRATION: The RCT is registered with the Current Controlled Trials registration (ISRCTN 89563420, registration date: 02/03/2018)

The all-sky distribution of 511 keV electron-positron annihilation emission

We present a map of 511 keV electron-positron annihilation emission, based on data accumulated with the SPI spectrometer aboard ESA's INTEGRAL gamma-ray observatory, that covers approximately 95% of the celestial sphere. 511 keV line emission is significantly detected towards the galactic bulge region and, at a very low level, from the galactic disk. The bulge emission is highly symmetric and is centred on the galactic centre with an extension of 8 deg. The emission is equally well described by models that represent the stellar bulge or halo populations. The disk morphology is only weakly constrained by the present data, being compatible with both the distribution of young and old stellar populations. The 511 keV line flux from the bulge and disk components is 1.05e-3 ph cm-2 s-1 and 0.7e-3 ph cm-2 s-1, respectively, corresponding to a bulge-to-disk flux ratio in the range 1-3. Assuming a positronium fraction of 0.93 this translates into annihilation rates of 1.5e43 s-1 and 3e42 s-1, respectively. The ratio of the bulge luminosity to that of the disk is in the range 3-9. We find no evidence for a point-like source in addition to the diffuse emission, down to a typical flux limit of 1e-4 ph cm-2 s-1. We also find no evidence for the positive latitude enhancement that has been reported from OSSE measurements; our 3 sigma upper flux limit for this feature is 1.5e-4 ph cm-2 s-1. The disk emission can be attributed to the beta+ decay of the radioactive species 26Al and 44Ti. The bulge emission arises from a different source which has only a weak or no disk component. We suggest that Type Ia supernovae and/or low-mass X-ray binaries are the prime candidates for the source of the galactic bulge positrons. Light dark matter annihilation could also explain the observed 511 keV bulge emission characteristics.Comment: accepted for publication in A&

Development of a peer-led, network mapping intervention to improve the health of individuals with severe mental illnesses: protocol for a pilot study.

INTRODUCTION: Adults with severe mental illness (SMI) have reduced life expectancy and many have comorbid physical health conditions. Primary care providers are experiencing increased demands for care for people with SMI. Barriers to accessing physical healthcare have been identified which negatively affect quality of care. We propose that peer support workers (PSWs) could deliver an intervention to service users to promote their physical health by drawing on existing social support. The aim of this research was to pilot a novel PSW-led intervention, including personal well-being network mapping, to improve access to primary care for physical health needs. METHODS AND ANALYSIS: Twenty-four participants will be recruited from community-based mental health teams in two boroughs of London. Each participant will be offered a six-session intervention. Quantitative data will be collected before and after intervention (at 4-month follow-up). Qualitative interviews will be conducted with PSWs after completion of the intervention and with participants at a 4-month follow-up. Some intervention sessions will be observed by a member of the research team. This is a pilot study with a small sample aiming to assess acceptability and feasibility of an intervention. We aim to use the results to refine the existing theory of change and to optimise the intervention and its evaluation in a future randomised controlled trial. This study is strengthened by its potential clinical importance and origin in previous research where service users engaged with well-being network mapping. ETHICS AND DISSEMINATION: This study has been approved by the London-Chelsea Regional Ethics Committee (ref: 17/LO/0585). The findings will be disseminated to participants, the National Health Service trusts that we recruited from, primary care mental health leads, commissioners and in peer-reviewed journals and academic conferences

Selective silicate-directed motility in diatoms

Diatoms are highly abundant unicellular algae that often dominate pelagic as well as benthic primary production in the oceans and inland waters. Being strictly dependent on silica to build their biomineralized cell walls, marine diatoms precipitate 240 × 1012 mol Si per year, which makes them the major sink in the global Si cycle. Dissolved silicic acid (dSi) availability frequently limits diatom productivity and influences species composition of communities. We show that benthic diatoms selectively perceive and behaviourally react to gradients of dSi. Cell speed increases under dSi-limited conditions in a chemokinetic response and, if gradients of this resource are present, increased directionality of cell movement promotes chemotaxis. The ability to exploit local and short-lived dSi hotspots using a specific search behaviour likely contributes to micro-scale patch dynamics in biofilm communities. On a global scale this behaviour might affect sediment–water dSi fluxes and biogeochemical cycling

Les difficultés d’un suivi épidémiologique longitudinal dans les services de santé au travail

INTRODUCTION: This study was designed to describe the difficulties of epidemiological follow-up of employees by occupational health services. METHODS: This study was based on two transverse studies conducted by the Pays de la Loire musculoskeletal disorders (MSD) surveillance network. Eighty-three occupational health physicians included 3,710 employees between 2002 and 2005 and had to review them between 2007 and 2009. Thirteen of these physicians changed jobs and 7 changed geographical sector in the same occupational health service. RESULTS: Another 94 physicians were contacted and 85 agreed to participate in the network. The follow-up rate was 43%: 1,044 employees were reviewed by the physician who saw them on inclusion and 567 employees were reviewed by another physician of the network. The other employees were distributed as follows: 25% were lost to follow-up and their occupational status remained unknown; 23% were still employed with an identified occupational health physician but had not attended a medical visit during the follow-up study; 5% had left the occupational health surveillance system. Only 23 employees refused to participate in the follow-up and 105 employees had a physician who refused to participate. DISCUSSION: There is therefore a considerable mobility of occupational health physicians, which interfered with follow-up despite their good mobilization and a high percentage of employee are lost to follow-up after having left their jobs. More appropriate systems must be set up to follow populations of employees, such as new collaborations with general practitioners

Prediction of impending type 1 diabetes through automated dual-label measurement of proinsulin:C-peptide ratio

Background : The hyperglycemic clamp test, the gold standard of beta cell function, predicts impending type 1 diabetes in islet autoantibody-positive individuals, but the latter may benefit from less invasive function tests such as the proinsulin: C-peptide ratio (PI:C). The present study aims to optimize precision of PI:C measurements by automating a dual-label trefoil-type time-resolved fluorescence immunoassay (TT-TRFIA), and to compare its diagnostic performance for predicting type 1 diabetes with that of clamp-derived C-peptide release. Methods : Between-day imprecision (n = 20) and split-sample analysis (n = 95) were used to compare TT-TRFIA (Auto Delfia, Perkin-Elmer) with separate methods for proinsulin (in-house TRFIA) and C-peptide (Elecsys, Roche). High-risk multiple autoantibody-positive firstdegree relatives (n = 49; age 5-39) were tested for fasting PI:C, HOMA2-IR and hyperglycemic clamp and followed for 20-57 months (interquartile range). Results : TT-TRFIA values for proinsulin, C-peptide and PI:C correlated significantly (r(2) = 0.96-0.99; P<0.001) with results obtained with separate methods. TT-TRFIA achieved better between-day % CV for PI:C at three different levels (4.5-7.1 vs 6.7-9.5 for separate methods). In high-risk relatives fasting PI:C was significantly and inversely correlated ( r(s) = -0.596; P<0.001) with first-phase C-peptide release during clamp ( also with second phase release, only available for age 12-39 years; n = 31), but only after normalization for HOMA2-IR. In ROC- and Cox regression analysis, HOMA2-IR-corrected PI:C predicted 2-year progression to diabetes equally well as clamp-derived C-peptide release. Conclusions : The reproducibility of PI:C benefits from the automated simultaneous determination of both hormones. HOMA2-IR-corrected PI:C may serve as a minimally invasive alternative to the more tedious hyperglycemic clamp test

Generalized instantons in N = 4 super Yang-Mills theory and spinorial geometry

Using spinorial geometry techniques, we classify the supersymmetric solutions of euclidean ${\cal N}=4$ super Yang-Mills theory. These backgrounds represent generalizations of instantons with nontrivial scalar fields turned on, and satisfy some constraints that bear a similarity with the Hitchin equations, and contain the Donaldson equations as a special subcase. It turns out that these constraints can be obtained by dimensional reduction of the octonionic instanton equations, and may be rephrased in terms of a selfduality-like condition for a complex connection. We also show that the supersymmetry conditions imply the equations of motion only partially.Comment: 29 pages, 3 tables. v2: references added. v3: conclusion extended, version published in JHE

Self-interacting Elko dark matter with an axis of locality

This communication is a natural and nontrivial continuation of the 2005 work of Ahluwalia and Grumiller on Elko. Here we report that Elko breaks Lorentz symmetry in a rather subtle and unexpected way by containing a `hidden' preferred direction. Along this preferred direction, a quantum field based on Elko enjoys locality. In the form reported here, Elko offers a mass dimension one fermionic dark matter with a quartic self-interaction and a preferred axis of locality. The locality result crucially depends on a judicious choice of phases.Comment: 14 pages (RevTex

Supersymmetric gyratons in five dimensions

We obtain the gravitational and electromagnetic field of a spinning radiation beam-pulse (a gyraton) in minimal five-dimensional gauged supergravity and show under which conditions the solution preserves part of the supersymmetry. The configurations represent generalizations of Lobatchevski waves on AdS with nonzero angular momentum, and possess a Siklos-Virasoro reparametrization invariance. We compute the holographic stress-energy tensor of the solutions and show that it transforms without anomaly under these reparametrizations. Furthermore, we present supersymmetric gyratons both in gauged and ungauged five-dimensional supergravity coupled to an arbitrary number of vector supermultiplets, which include gyratons on domain walls.Comment: 25 pages, no figures, uses JHEP3.cls. Final version to appear in CQ