Inclusion of ethnic minorities in telehealth trials for type 2 diabetes:Protocol for a systematic review examining prevalence and language issues

BACKGROUND: Type 2 diabetes is common, on the rise, and disproportionately affects ethnic minority groups. Telehealth interventions may mitigate diabetes-related complications, but might under-recruit or even exclude ethnic minorities, in part because of English language requirements. The under-representation of minority patients in trials could threaten the generalizability of the findings, whereby the patients who might stand to benefit most from such interventions are not being included in their evaluation. OBJECTIVE: The aims of this systematic review are twofold: (1) to assess the reporting and prevalence of ethnic minorities in published telehealth trials for type 2 diabetes, including identifying trial features associated with successful patient recruitment; and (2) to determine the proportion of such trials that report English language proficiency as an inclusion/exclusion criterion, including how and why they do so. METHODS: Randomized controlled trials (RCTs) of adults with type 2 diabetes in Western, English-speaking countries that included telehealth interventions targeting diabetes as a primary condition, and those that did not specifically recruit minority groups will be included. Search strategies were devised for indexed and keyword terms capturing type 2 diabetes, telehealth/health technology, and RCTs in English language publications from 2000 to July 2015 in MEDLINE, PsycINFO, EMBASE, CINAHL, and CENTRAL. Reference lists of included studies will also be searched. Two reviewers will independently screen abstracts and full-text articles against inclusion criteria, mediated by a third reviewer if consensus cannot be reached. Data extracted from included studies will be checked by a second reviewer and will be summarized using narrative synthesis. RESULTS: This research is in progress, with findings expected by Spring 2016. CONCLUSIONS: This review will address research reporting and recruitment practices of ethnic minorities in telehealth RCTs for type 2 diabetes. Prevalence estimates will elucidate generalizability of existing research, with implications for researchers, health professionals, and policy makers. Identifying trial or intervention features that appear to facilitate ethnic minority recruitment, as well as language barriers that impede it might suggest ways to improve recruitment in future trials. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews: CRD42015024899; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015024899 (Archived by WebCite at http://www.webcitation.org/6fUMqbJ0f)

The Impact of Modernisation on Sport Policy Delivery in the Home Countries

Ongoing public sector reform is a priority across England and Wales in an era of dwindling budgets. In Wales, public sector reform has recently seen the transfer of local authority sport and leisure services to alternative delivery providers (Leisure Trusts) to preserve local presence, retain employment and create the local authority financial savings. The development by former staff of employee-owned businesses to deliver a viable sport and leisure service is presented as an empowering option by policy makers but the reality equates to ‘enforced partnerships’ and financial support from the local authority scaffolded with contracting and performance indicators which brings into question the nature of the relationships involved and the state’s role in shaping the direction of sport and leisure services through making up subjective individuals The broad aim of this thesis is to develop knowledge through the Foucauldian lens of ‘governmentality’ of local authority responses to the modernisation of their sport and leisure services following wider public sector reform. This thesis uses a mainly qualitative comparative case study approach consisting of ten semi structured interviews and secondary data, across two sites in England and Wales. The research draws attention to the hierarchical nature of the ‘judicial power’ evident in the sport policy process between external funders and Leisure Trusts. Funders relationships are predicated on New Public Management principles, an administrative process designed to maximise efficiencies, grounded in targets and monitoring. Foucault (1972) would argue that NPM is utilised as a ‘a technology of government’ designed to retain a ‘sporting gaze’ over its partner using targeted funding agreements

Assessing the Early Holocene Environment of Northwestern Guyana: An Isotopic Analysis of Human and Faunal Remains

This study used stable carbon δ13C and oxygen δ18O isotope compositions data to assess the extent to which diet breadths of northwestern Guyana changed during the Holocene. We analyzed human bone and enamel remains from seven shell mound sites dating between 7500 and 2600 BP. Our analyses demonstrate some degree of constancy in the availability of C3 plants during the past several thousand years—though we note an increasing reliance on such plants beginning in the Early Holocene. We also document warming intervals during the Early Holocene (Early Archaic), which appear to correlate with dry periods known elsewhere in the central Amazon during this period

Seismic Context Measurements for Induced Seismicity

Vibration measurements for everyday activities and their use for providing context for induced seismicity

No effect of spatial attention on the processing of a motion ensemble: Evidence from Posner cueing

The formation of ensemble codes is an efficient means through which the visual system represents vast arrays of information. This has led to the claim that ensemble representations are formed with minimal reliance on attentional resources. However, evidence is mixed regarding the effects of attention on ensemble processing, and researchers do not always make it clear how attention is being manipulated by their paradigm of choice. In this study, we examined the effects of Posner cueing—a well-established method of manipulating spatial attention—on the processing of a global motion stimulus, a naturalistic ensemble that requires the pooling of local motion signals. In Experiment 1, using a centrally presented, predictive attentional cue, we found no effect of spatial attention on global motion performance: Accuracy in invalid trials, where attention was misdirected by the cue, did not differ from accuracy in valid trials, where attention was directed to the location of the motion stimulus. In Experiment 2, we maximized the potential for our paradigm to reveal any attentional effects on global motion processing by using a threshold-based measure of performance; however, despite this change, there was again no evidence of an attentional effect on performance. Together, our results show that the processing of a global motion stimulus is unaffected when spatial attention is misdirected, and speak to the efficiency with which such ensemble stimuli are processed.This work was supported by an Australian Government Research Training Program scholarship awarded to L. A. T.; an Australian Research Council Future Fellowship [FT170100021] awarded to S. C. G.; and an Australian Research Council Discovery Project [DP190103103] awarded to M. E

Pain-related evoked potentials are modulated across the cardiac cycle

Evidence suggests that the arterial baroreceptors modulate pain. To examine whether cortical processing of nociception is modulated by natural variations in arterial baroreceptor stimulation during the cardiac cycle, peak-to-peak amplitudes of the N2–P2 pain-related potential and pain ratings were recorded in response to noxious laser stimulation at different times during the cardiac cycle in 10 healthy males. Significant variations in the N2–P2 amplitudes occurred across the cardiac cycle, with smaller amplitudes midcycle, indicating that cortical processing of nociception was attenuated during systole compared to diastole. Pain ratings did not vary across the cardiac cycle. These data support the hypothesis that arterial baroreceptors modulate the processing of nociception during each cardiac cycle

Brain-heart pathways to blood pressure-related hypoalgesia

OBJECTIVE: High blood pressure (BP) is associated with reduced pain sensitivity, known as BP-related hypoalgesia. The underlying neural mechanisms remain uncertain, yet arterial baroreceptor signaling, occurring at cardiac systole, is implicated. We examined normotensives using functional neuroimaging (fMRI) and pain stimulation during distinct phases of the cardiac cycle to test the hypothesized neural mediation of baroreceptor-induced attenuation of pain. METHODS: Eighteen participants (10 women; 32.7 ± 6.5 years) underwent BP monitoring over one week at home, and individual pain thresholds were determined in the lab. Subsequently, participants were administered unpredictable painful and non-painful electrocutaneous shocks (stimulus type), timed to occur either at systole or diastole (cardiac phase) in an event-related design. After each trial, participants evaluated their subjective experience. RESULTS: Subjective pain was lower for painful stimuli administered at systole compared to diastole, F1, 2283 = 4.82; p = 0.03. Individuals with higher baseline BP demonstrated overall lower pain perception, F1, 2164 = 10.47; p < 0.0001. Within the brain, painful stimulation activated somatosensory areas, prefrontal cortex, cingulate cortex, posterior insula, amygdala, and the thalamus. Stimuli delivered during systole (concurrent with baroreceptor discharge) activated areas associated with heightened parasympathetic drive. No stimulus type x cardiac phase interaction emerged except for a small cluster located in the right parietal cortex. CONCLUSIONS: We confirm the negative associations between BP and pain, highlighting the antinociceptive impact of baroreceptor discharge. Neural substrates associated with baroreceptor/BP-related hypoalgesia include superior parietal lobule, precentral and lingual gyrus, regions typically involved in the cognitive aspects of pain experience

A Study on Marketing Behaviour of Rural Youth Entrepreneurs among Seven Different Ventures

The study was conducted among 210 rural youth entrepreneurs of seven different ventures in Krishnagiri district to assess their marketing behaviour. The entrepreneurial ventures selected for the study were Sericulture, Mushroom Production, Hi-tech nurseries (Polyhouse), Fruit and flower nursery, Fisheries, Poultry farming and Value addition (Tamarind processing and Millet based cookies).

Cost-effectiveness of telehealth for patients with depression: Evidence from the Healthlines randomised controlled trial

BACKGROUND: Depression is a prevalent long-term condition that is associated with substantial resource use. Telehealth may offer a cost-effective means of supporting the management of people with depression. AIMS: To investigate the cost-effectiveness of a telehealth intervention ('Healthlines') for patients with depression. METHOD: A prospective patient-level economic evaluation conducted alongside a randomised controlled trial. Patients were recruited through primary care, and the intervention was delivered via a telehealth service. Participants with a confirmed diagnosis of depression and PHQ-9 score ≥10 were recruited from 43 English general practices. A series of up to 10 scripted, theory-led, telephone encounters with health information advisers supported participants to effect a behaviour change, use online resources, optimise medication and improve adherence. The intervention was delivered alongside usual care and was designed to support rather than duplicate primary care. Cost-effectiveness from a combined health and social care perspective was measured by net monetary benefit at the end of 12 months of follow-up, calculated from incremental cost and incremental quality-adjusted life years (QALYs). Cost-consequence analysis included cost of lost productivity, participant out-of-pocket expenditure and the clinical outcome. RESULTS: A total of 609 participants were randomised - 307 to receive the Healthlines intervention plus usual care and 302 to receive usual care alone. Forty-five per cent of participants had missing quality of life data, 41% had missing cost data and 51% of participants had missing data on either cost or utility, or both. Multiple imputation was used for the base-case analysis. The intervention was associated with incremental mean per-patient National Health Service/personal social services cost of £168 (95% CI £43 to £294) and an incremental QALY gain of 0.001 (95% CI -0.023 to 0.026). The incremental cost-effectiveness ratio was £132 630. Net monetary benefit at a cost-effectiveness threshold of £20 000 was -£143 (95% CI -£164 to -£122) and the probability of the intervention being cost-effective at this threshold value was 0.30. Productivity costs were higher in the intervention arm, but out-of-pocket expenses were lower. CONCLUSIONS: The Healthlines service was acceptable to patients as a means of condition management, and response to treatment after 4 months was higher for participants randomised to the intervention. However, the positive average intervention effect size was modest, and incremental costs were high relative to a small incremental QALY gain at 12 months. The intervention is not likely to be cost-effective in its current form. DECLARATION OF INTEREST: None. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) licence

A critical review of the cognitive and perceptual factors influencing attentional scaling and visual processing

An important mechanism used to selectively process relevant information in the environment is spatial attention. One fundamental way in which spatial attention is deployed is attentional scaling: the process of focusing attentional resources either narrowly or broadly across the visual field. Although early empirical work suggested that narrowing attention improves all aspects of visual processing, recent studies have demonstrated that narrowing attention can also have no effect or even a detrimental impact when it comes to vision that is thought to be mediated via the magnocellular pathway of the visual system. Here, for the first time, we synthesise empirical evidence measuring the behavioural effects of attentional scaling on tasks gauging the contribution of the major neural pathways of the visual system, with the purpose of determining the potential factors driving these contradictory empirical findings. This analysis revealed that attentional scaling could be best understood by considering the unique methodologies used in the research literature to date. The implications of this analysis for theoretical frameworks of attentional scaling are discussed, and methodological improvements for future research are proposed.This research is supported by Australian Government Research Training Program Scholarships awarded to R.K.L. and L.A.T. This research was supported by an Australian Research Council (ARC) Future Fellowship (FT170100021) awarded to S.C.G, and an ARC Discovery Project (DP190103103) awarded to M.E