A smartphone-based health care chatbot to promote self-management of chronic pain (SELMA) : pilot randomized controlled trial

Background: Ongoing pain is one of the most common diseases and has major physical, psychological, social, and economic impacts. A mobile health intervention utilizing a fully automated text-based health care chatbot (TBHC) may offer an innovative way not only to deliver coping strategies and psychoeducation for pain management but also to build a working alliance between a participant and the TBHC. Objective: The objectives of this study are twofold: (1) to describe the design and implementation to promote the chatbot painSELfMAnagement (SELMA), a 2-month smartphone-based cognitive behavior therapy (CBT) TBHC intervention for pain self-management in patients with ongoing or cyclic pain, and (2) to present findings from a pilot randomized controlled trial, in which effectiveness, influence of intention to change behavior, pain duration, working alliance, acceptance, and adherence were evaluated. Methods: Participants were recruited online and in collaboration with pain experts, and were randomized to interact with SELMA for 8 weeks either every day or every other day concerning CBT-based pain management (n=59), or weekly concerning content not related to pain management (n=43). Pain-related impairment (primary outcome), general well-being, pain intensity, and the bond scale of working alliance were measured at baseline and postintervention. Intention to change behavior and pain duration were measured at baseline only, and acceptance postintervention was assessed via self-reporting instruments. Adherence was assessed via usage data. Results: From May 2018 to August 2018, 311 adults downloaded the SELMA app, 102 of whom consented to participate and met the inclusion criteria. The average age of the women (88/102, 86.4%) and men (14/102, 13.6%) participating was 43.7 (SD 12.7) years. Baseline group comparison did not differ with respect to any demographic or clinical variable. The intervention group reported no significant change in pain-related impairment (P=.68) compared to the control group postintervention. The intention to change behavior was positively related to pain-related impairment (P=.01) and pain intensity (P=.01). Working alliance with the TBHC SELMA was comparable to that obtained in guided internet therapies with human coaches. Participants enjoyed using the app, perceiving it as useful and easy to use. Participants of the intervention group replied with an average answer ratio of 0.71 (SD 0.20) to 200 (SD 58.45) conversations initiated by SELMA. Participants’ comments revealed an appreciation of the empathic and responsible interaction with the TBHC SELMA. A main criticism was that there was no option to enter free text for the patients’ own comments. Conclusions: SELMA is feasible, as revealed mainly by positive feedback and valuable suggestions for future revisions. For example, the participants’ intention to change behavior or a more homogenous sample (eg, with a specific type of chronic pain) should be considered in further tailoring of SELMA

Partizipativ mit Firmand*innen : Pfarreien und Kirchgemeinden ökologischer gestalten

Im Jahr 2015 veröffentlichte Papst Franziskus die Enzyklika «Laudato si’» mit dem Untertitel «über die Sorge für das gemeinsame Haus», mit der er seine Sorge über den Zustand der Erde zum Ausdruck bringt. Die katholische Kirche im Kanton Zürich setzt sich auf verschiedenen Ebenen mit diesen Themen auseinander und möchte die unterschiedlichen Akteur*innen auf Stufe Pfarrei und Kirchgemeinde für Themen der Ökologie und Biodiversität sensibilisieren. Eine dieser Gruppen sind die Firmand*innen - Jugendliche, die sich im Kanton Zürich mit 17 Jahren auf den Firmweg begeben. Das Ziel dieser Arbeit ist es konkrete Ideenvorschläge für den Firmweg im ökologischen Bereich aufzuzeigen, welche für die rund 100 katholischen Pfarreien im Kanton Zürich praktikabel sind. Dabei geht diese Arbeit auf die zwei nachfolgenden Fragestellungen ein: Wie kann nachhaltige Entwicklung mit dem Fokus auf Ökologie in Pfarreien und Kirchgemeinden mit Firmand*innen umgesetzt werden? Mit welchen Methoden können die Denk- und Handlungsprozesse der Firmand*innen, in Bezug auf Ökologie, im kirchlichen Kontext in Gang gesetzt werden? Um diese Fragestellungen zu beantworten, wird eine explorative Vorgehensweise gewählt bei der vor allem das Prinzip von «Versuch und Irrtum» angewendet und somit Erfolge und Misserfolge laufend reflektiert werden. Weitere angewandte Methoden sind: Literaturrecherchen, Gespräche, Interviews sowie die Teilnahme an Fachtagungen. Des Weiteren zeigen die Zielgruppen- und Akteuranalyse die Bedürfnisse und den Einfluss der Akteur*innen in Bezug auf die Projektidee auf. Als Resultate sind mit «plant’n’chill», «Actionbound» und «Fotofalle» drei praktikable, für die Pfarreien individuell anpassbare Ideenvorschläge entstanden. Als weiteren Schritt kann die Plattform «Pfannenfertig» der Jugendseelsorge Zürich ihr Angebot um ökologische Themen erweitern. Damit sich Jugendliche im kirchlichen Rahmen mit ökologischen Projekten einbringen (höchste Partizipationsstufe), kann ein Fonds zur finanziellen Unterstützung ihrer Ideen eingerichtet werden. Ursprünglich war geplant, die Ideenfindung und Umsetzung einer Projektidee partizipativ mit Firmand*innen zu erarbeiten. Aufgrund des Coronavirus war dies im Rahmen dieser Bachelorarbeit nicht vollständig umsetzbar

Unconventional order-disorder phase transition in improper ferroelectric hexagonal manganites

The improper ferroelectricity in YMnO$_3$ and other related multiferroic hexagonal manganites are known to cause topologically protected ferroelectric domains that give rise to rich and diverse physical phenomena. The local structure and structural coherence across the ferroelectric transition, however, were previously not well understood. Here we reveal the evolution of the local structure with temperature in YMnO$_3$ using neutron total scattering techniques, and interpret them with the help of first-principles calculations. The results show that, at room temperature, the local and average structures are consistent with the established ferroelectric $P6_3cm$ symmetry. On heating, both local and average structural analyses show striking anomalies from $\sim 800$ K up to the Curie temperature consistent with increasing fluctuations of the order parameter angle. These fluctuations result in an unusual local symmetry lowering into a \textit{continuum of structures} on heating. This local symmetry breaking persists into the high-symmetry non-polar phase, constituting an unconventional type of order-disorder transition.Comment: 10 pages, 5 figure

Charged domain walls in improper ferroelectric hexagonal manganites and gallates

Ferroelectric domain walls are attracting broad attention as atomic-scale switches, diodes and mobile wires for next-generation nanoelectronics. Charged domain walls in improper ferroelectrics are particularly interesting as they offer multifunctional properties and an inherent stability not found in proper ferroelectrics. Here we study the energetics and structure of charged walls in improper ferroelectric YMnO$_3$, InMnO$_3$ and YGaO$_3$ by first principles calculations and phenomenological modeling. Positively and negatively charged walls are asymmetric in terms of local structure and width, reflecting that polarization is not the driving force for domain formation. The wall width scales with the amplitude of the primary structural order parameter and the coupling strength to the polarization. We introduce general rules for how to engineer $n$- and $p$-type domain wall conductivity based on the domain size, polarization and electronic band gap. This opens the possibility of fine-tuning the local transport properties and design $p$-$n$-junctions for domain wall-based nano-circuitry.Comment: 10 pages, 6 figures, Supp. Info. available on reques

A Coursebook in a Trilingual Classroom: To Use or not to Use

Coursebook use has proved to be a controversial issue in methodology. In this paper we refer to different writing on this subject, and take the argument a step further. As the way out, we look at an aspect of teaching English as a foreign language (EFL) that sooner or later every teacher comes up against – a need to write his/her materials. As our research has shown, this becomes of major importance in a trilingual classroom. Here, we also refer to some of the theoretical positions underlying third language acquisition (TLA)

The effect of superior pedicle breast reductions on breast sensation

The aim of this study was to assess nipple, areola and breast skin sensation after breast reductions with two different superior pedicle techniques: a short, vertical scar technique compared to a long, inverted-T scar technique. Thirty-six women with a vertical technique (group I) and ten women with an inverted-T technique (group II) with a resection weight of ≤500g per breast completed their 1-year follow-up. The four modalities used to evaluate sensation were pressure with Semmes-Weinstein filaments, vibration with a vibrometer, and temperature and pain perception on a qualitative basis. The evaluation revealed that 1-year after breast reduction, the sensation was either reduced, unaltered, or improved in both groups. In the nipple, the mean sensation was markedly reduced throughout all qualities in both groups with the exception of pain, which was enhanced. In the areola, the mean sensation was also reduced in all qualities in both groups. In the quadrants of the skin, mean sensation was improved in terms of pressure and vibration in group I (8.3% normal pressure values preoperatively vs. 70% normal pressure values postoperatively) but reduced in the lower quadrant of the skin in group II with the inverted-T scar. This reduction of pressure was also significant (p = 0.04) in comparison with group I. Apart from this difference between the two groups, this study showed that in breast reductions with a superior pedicle technique, the long-scar technique did not lead to a greater reduction of sensation in the nipple and areola than the short-scar techniqu

Theorizing status distance: rethinking the micro theories of representation and diversity in public organizations

Through bringing the concept of status distance to representative bureaucracy and diversity management literature, this article develops new hypotheses that can guide future studies on representation and diversity in public organizations. First, including status distance brings consideration of the tensions that minority representation creates between integration within the workforce and the pressures on minority bureaucrats to actively represent clientele. Second, the way status distance plays out in the interaction of bureaucrats with co-workers and citizen-clients depends on characteristics of the national and organizational environment and type of service

Accelerated Partial Breast Irradiation: Using the CyberKnife as the Radiation Delivery Platform in the Treatment of Early Breast Cancer

We evaluate the CyberKnife (Accuray Incorporated, Sunnyvale, CA, USA) for non-invasive delivery of accelerated partial breast irradiation (APBI) in early breast cancer patients. Between 6/2009 and 5/2011, nine patients were treated with CyberKnife APBI. Normal tissue constraints were imposed as outlined in the National Surgical Adjuvant Breast and Bowel Project B-39/Radiation Therapy Oncology Group 0413 (NSABP/RTOG) Protocol (Vicini and White, 2007). Patients received a total dose of 30 Gy in five fractions (group 1, n = 2) or 34 Gy in 10 fractions (group 2, n = 7) delivered to the planning treatment volume (PTV) defined as the clinical target volume (CTV) +2 mm. The CTV was defined as either the lumpectomy cavity plus 10 mm (n = 2) or 15 mm (n = 7). The cavity was defined by a T2-weighted non-contrast breast MRI fused to a planning non-contrast thoracic CT. The CyberKnife Synchrony system tracked gold fiducials sutured into the cavity wall during lumpectomy. Treatments started 4–5 weeks after lumpectomy. The mean PTV was 100 cm3 (range, 92–108 cm3) and 105 cm3 (range, 49–241 cm3) and the mean PTV isodose prescription line was 70% for groups 1 and 2, respectively. The mean percent of whole breast reference volume receiving 100 and 50% of the dose (V100 and V50) for group 1 was 11% (range, 8–13%) and 23% (range, 16–30%) and for group 2 was 11% (range, 7–14%) and 26% (range, 21–35.0%), respectively. At a median 7 months follow-up (range, 4–26 months), no acute toxicities were seen. Acute cosmetic outcomes were excellent or good in all patients; for those patients with more than 12 months follow-up the late cosmesis outcomes were excellent or good. In conclusion, the lack of observable acute side effects and current excellent/good cosmetic outcomes is promising. We believe this suggests the CyberKnife is a suitable non-invasive radiation platform for delivering APBI with achievable normal tissue constraints