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Looked-after children are at risk of suboptimal attachment patterns and reactive attachment disorder (RAD). However, access to interventions varies widely, and there are no evidence-based interventions for RAD.
Aims
To modify an existing parenting intervention for children with RAD in the UK foster care setting, and test the feasibility of conducting a randomised controlled trial (RCT) of the modified intervention.
Method
The intervention was modified with expert input and tested on a case series. A feasibility and pilot RCT compared the new intervention with usual care. Foster carers and children in their care aged ≤6 years were recruited across nine local authorities, with 1:1 allocation and blind post-treatment assessments. The modified intervention was delivered in-home by trained mental health professionals over 4–6 months. Children were assessed for RAD symptoms, attachment quality and emotional/behavioural difficulties, and foster carers were assessed for sensitivity and stress.
Results
Minimal changes to the intervention programme were necessary, and focused on improving its suitability for the UK foster care context. Recruitment was challenging, and remained below target despite modifications to the protocol and the inclusion of additional sites. Thirty families were recruited to the RCT; 15 were allocated to each group. Most other feasibility outcomes were favourable, particularly high numbers of data and treatment completeness. The revised intervention was positively received by practitioners and foster carers.
Conclusions
A large-scale trial may be feasible, but only if recruitment barriers can be overcome. Dedicated resources to support recruitment within local authorities and wider inclusion criteria are recommended.
Stroke education is a key factor in minimising secondary stroke risk, yet worldwide stroke education rates are low. Technology has the potential to increase stroke education accessibility. One technology that could be beneficial is augmented reality (AR). We developed and trialled a stroke education lesson using an AR application with stroke patients and significant others.
Methods:
A feasibility study design was used. Following development of the AR stroke education lesson, 19 people with stroke and three significant others trialled the lesson then completed a customised mixed method questionnaire. The lesson involved narrated audio while participants interacted with a model brain via a tablet. Information about participant recruitment and retention, usage, and perceptions were collected.
Results:
Fifty-eight percent (n = 22) of eligible individuals consented to participate. Once recruited, 100% of participants (n = 22) were retained. Ninety percent of participants used the lesson once. Most participants used the application independently (81.82%, n = 18), had positive views about the lesson (over 80% across items including enjoyment, usefulness and perception of the application as a good learning tool) and reported improved confidence in stroke knowledge (72.73%, n = 16). Confidence in stroke knowledge post-lesson was associated with comfort using the application (p = 0.046, Fisher’s exact test) and perception of the application as a good learning tool (p = 0.009, Fisher’s exact test).
Conclusions:
Technology-enhanced instruction in the form of AR is feasible for educating patients and significant others about stroke. Further research following refinement of the lesson is required.
This chapter explores what apocalyptic thought shares with ideal theory, with a focus on our grounds for believing any proposed account of the ideal society. As John Rawls understands it, ideal theory is based on plausible reasons that others should accept, whereas religious belief is unsuitable to collectively guide society. Some, though, have questioned Rawls’s confidence in ideal theory, and this chapter draws on social science research to place these criticisms on firmer ground. It outlines an argument for why future uncertainty makes it impossible to offer a plausible defense of ideal theory. As a result, ideal theory, like religious belief, ultimately must rest on faith. Though ideal theory must abandon aspirations of outlining an ideal to collectively guide society, there is still a potential role for it as a source of utopian hope.
The acceptability, feasibility and possible benefits of the Adult Version of TBT-S were evaluated in a multi-center open trial administered in an intensive 5-day group format for adults with AN and their Supports conducted at the University of California San Diego Eating Disorders Program for Treatment and Research and The Center for Balanced Living in Columbus, OH. Preliminary results of open trials of the SE-AN and Young Adult Versions of TBT-S are promising and suggest this novel treatment is feasible and acceptable. To establish treatment efficacy, fully-powered randomized controlled trials are necessary.
Why would secular thinkers find in Christian apocalyptic beliefs – often dismissed as bizarre – appealing tools for interpreting politics? This chapter aims to unpack that puzzle. A helpful approach for understanding apocalyptic thought’s appeal is the lens of ideal theory, which tries to imagine the best and most just society. Ideal theory faces a daunting task: outlining a goal that is both utopian and feasible. To be worth striving for, the ideal must be utopian and possess sufficient moral appeal to justify the transition costs needed to achieve it. Yet the ideal also must be feasible, since it is difficult to justify dedicating limited resources to pursue the impossible. These competing goals result in a catch-22: a more utopian ideal is a less feasible moral goal, which diminishes reasons to strive for it, but a more modest and feasible ideal is a less appealing moral goal, which also diminishes reasons to strive for it. What I call cataclysmic apocalyptic thought proposes a way out of this dilemma. It embraces a utopian goal and declares it feasible by pointing to crisis as the vehicle to wipe away corruption and bring the seemingly impossible within reach.
Section E seeks to show how the law on the conduct of hostilities that would apply in relation to the use of conventional weapons also applies in respect of nuclear weapon operations. The Rules and Commentaries deal with persons participating in the hostilities, who are distinguished from protected civilians, and with specific issues of naval and air warfare. The Rules and Commentaries on nuclear targeting address the notion of ‘attack’, the principle of distinction, prohibited nuclear attacks, the definition of military objectives, proportionality and active and passive precautions. As to methods of nuclear warfare, the Section addresses perfidy and ruses, the improper use of protective indicators and emblems, as well as the concept of zones. The Section further includes Rules and Commentaries on persons and objects entitled to specific protection and on the protection of the natural environment in times of armed conflict.
Cognitive–behavioural therapy (CBT) is recommended for all patients with psychosis, but is offered to only a minority. This is attributable, in part, to the resource-intensive nature of CBT for psychosis. Responses have included the development of CBT for psychosis in brief and targeted formats, and its delivery by briefly trained therapists. This study explored a combination of these responses by investigating a brief, CBT-informed intervention targeted at distressing voices (the GiVE intervention) administered by a briefly trained workforce of assistant psychologists.
Aims
To explore the feasibility of conducting a randomised controlled trial to evaluate the clinical and cost-effectiveness of the GiVE intervention when delivered by assistant psychologists to patients with psychosis.
Method
This was a three-arm, feasibility, randomised controlled trial comparing the GiVE intervention, a supportive counselling intervention and treatment as usual, recruiting across two sites, with 1:1:1 allocation and blind post-treatment and follow-up assessments.
Results
Feasibility outcomes were favourable with regard to the recruitment and retention of participants and the adherence of assistant psychologists to therapy and supervision protocols. For the candidate primary outcomes, estimated effects were in favour of GiVE compared with supportive counselling and treatment as usual at post-treatment. At follow-up, estimated effects were in favour of supportive counselling compared with GiVE and treatment as usual, and GiVE compared with treatment as usual.
Conclusions
A definitive trial of the GiVE intervention, delivered by assistant psychologists, is feasible. Adaptations to the GiVE intervention and the design of any future trials may be necessary.
Increasing demand for commercial air travel is projected to have additional environmental impact through increased emissions from fuel burn. This has necessitated the improvement of aircraft propulsion technologies and proposal of new concepts to mitigate this impact. The hybrid-electric aircraft propulsion system has been identified as a potential method to achieve this improvement. However, there are many challenges to overcome. One such challenges is the combination of electrical power sources and the best strategy to manage the power available in the propulsion system. Earlier methods reviewed did not quantify the mass and efficiency penalties incurred by each method, especially at system level. This work compares three power management approaches on the basis of feasibility, mass and efficiency. The focus is on voltage synchronisation and adaptation to the load rating. The three methods are the regulated rectification, the generator field flux variation and the buck-boost. This comparison was made using the propulsion system of the propulsive fuselage aircraft concept as the reference electrical configuration. Based on the findings, the generator field flux variation approach appeared to be the most promising, based on a balance of feasibility, mass and efficiency, for a 2.6MW system.
Global justice must be deliberated rather than just analysed, asserted, and advocated. The concluding chapter recapitulates the main arguments of the book, then reflects critically on the feasibility of democratizing global justice, especially when it comes to the practical proposals for institutional design developed in earlier chapters. An important shift toward more inclusive global governance processes has occurred in recent years and this may pave the way for a more defensible global order. This shift is in contrast to the democratic retreats that have occurred in many national governments. Global governance processes, while still far from deliberative and democratic ideals, have become more inclusive and participatory over time, as we have seen in the case of the Sustainable Development Goals. Promoting global deliberative democracy would be the natural next step. The pursuit of global justice requires deliberative global democratization.
Neuropsychological assessment via video conferencing has been proposed during the COVID-19 pandemic. Existing literature has demonstrated feasibility and acceptance of neuropsychological measures administered by videoconference, although few studies have examined feasibility and patient acceptance of TNP visits directly to patients’ homes (DTH-TNP).
Methods:
We modified a previously published patient satisfaction survey for DTH-TNP and developed a clinician feasibility survey to examine experiences during DTH-TNP.
Results:
Seventy-two patients (age range: preschool-geriatric) evaluated by DTH-TNP for cognitive problems at an academic medical center responded to voluntary surveys between April 20, 2020, and August 19, 2020, and 100% indicated satisfaction. Fifty-nine percent of patients reported limitations (e.g., technological concern) during the appointment. 134 clinician surveys were collected and indicated that clinicians achieved the goal of their appointment in 90% of encounters.
Conclusions:
These qualitative data suggest that patients and clinicians found DTH-TNP to be satisfactory during the COVID-19 pandemic, while also recognizing limitations of the practice. These results are limited in that voluntary surveys are subject to bias. They support the growing body of literature suggesting that DTH-TNP provides a valuable service, though additional research to establish reliability and validity is needed.
This chapter offers practical guidance for funding language revitalization projects, particularly for language activists and community members. Some organizations devoted to endangered languages provide grants for revitalization efforts; funding may also be available from government bodies (mainly in the US and Canada) and other grants and scholarships. For smaller projects, crowd funding and other community initiatives have the additional benefits of raising awareness of the language revitalization program and involving the wider community. The factors that reviewers consider in assessing formal funding proposals are discussed, including the importance, feasibility and design of the project; the applicant’s connection to the community and ability to complete the work; and the appropriateness of the budget, including guidance on common budget categories and expenses. The capsule reports on a survey investigating attitudes of NGOs in Guatemala towards language revitalization; local organizations and institutions with a vested interest in local people were more likely to provide practical and financial support for revitalization initiatives.
This trial examined the feasibility, acceptability, and effect sizes of clinical outcomes of an intervention that combines inhibitory control training (ICT) and implementation intentions (if-then planning) to target binge eating and eating disorder psychopathology.
Methods
Seventy-eight adult participants with bulimia nervosa or binge eating disorder were randomly allocated to receive food-specific, or general, ICT and if-then planning for 4 weeks.
Results
Recruitment and retention rates at 4 weeks (97.5% and 79.5%, respectively) met the pre-set cut-offs. The pre-set adherence to the intervention was met for the ICT sessions (84.6%), but not for if-then planning (53.4%). Binge eating frequency and eating disorder psychopathology decreased in both intervention groups at post-intervention (4 weeks) and follow-up (8 weeks), with moderate to large effect sizes. There was a tendency for greater reductions in binge eating frequency and eating disorders psychopathology (i.e. larger effect sizes) in the food-specific intervention group. Across both groups, ICT and if-then planning were associated with small-to-moderate reductions in high energy-dense food valuation (post-intervention), food approach (post-intervention and follow-up), anxiety (follow-up), and depression (follow-up). Participants indicated that both interventions were acceptable.
Conclusions
The study findings reveal that combined ICT and if-then planning is associated with reductions in binge eating frequency and eating disorder psychopathology and that the feasibility of ICT is promising, while improvements to if-then planning condition may be needed.
The Handbook of Behavior Change is the first wide-ranging compendium of theory- and evidence-based research and practice on behavior change. It provides scientists, students, and practitioners with the current evidence on behavior change and expert advice on how to develop, evaluate, and implement behavior change interventions. The handbook also sets an agenda for future research on behavior change theory and practice across multiple behaviors, contexts, and populations. This chapter outlines emerging issues and future research directions arising from the handbook. The chapter stresses the importance of theory development, including the need for greater emphasis on ecological and social theories; clearer descriptions and operationalizations of behavior change theories; and increased application of interdisciplinary approaches. Future research on intervention development should conduct more comprehensive intervention fidelity assessments; adopt novel means to improve the translation, feasibility, and optimization of interventions; ensure consideration of ethical issues in behavior change research; routinely evaluate mechanisms of action in behavior change interventions; and apply complex systems approaches to behavior change. “Best-practice” guidance on behavior change should consider emerging methods and approaches to behavior change; implement trials to evaluate the long-term maintenance of behavior change; and develop core curricula on behavior change to educate the next generation of scientists and practitioners.
To assess the feasibility, patient and clinician acceptability and test-retest reliability of the Mini-International Neuropsychiatric Interview (MINI) used by non-psychiatrists in an acute psychiatric ward.
Method
Of 268 consecutive patients included in a cross-sectional study, 176 (66%) completed MINI, and were compared to patients not interviewed. Patients and clinicians were questioned about the interview, using Visual Analogue Scales (VAS). For 38 patients, test-retest reliability was assessed with Cohen's kappa and observed agreement.
Results
MINI was not feasible for all patients. Among factors associated with not being interviewed were early discharge, psychosis, substance use and involuntary admissions. Although evaluations by patients and clinicians completing the postinterview questionnaire varied, MINI was generally perceived as being useful and feasible. Psychotic symptoms were associated with a less positive experience with MINI for both patients and clinicians. In the test-retest analyses, kappa values indicated excellent agreement for six diagnoses, fair to good for six and poor for seven, whereas observed agreement was 75% or above for all disorders.
Conclusion
Among patients admitted to an acute psychiatric ward willing and able to complete the interview, MINI was well accepted by patients and clinicians, and has moderately good test-retest reliability.
The Douglas–Rachford method is a splitting method frequently employed for finding zeros of sums of maximally monotone operators. When the operators in question are normal cone operators, the iterated process may be used to solve feasibility problems of the following form: Find $x\in \bigcap _{k=1}^{N}S_{k}$. The success of the method in the context of closed, convex, nonempty sets $S_{1},\ldots ,S_{N}$ is well known and understood from a theoretical standpoint. However, its performance in the nonconvex context is less well understood, yet it is surprisingly impressive. This was particularly compelling to Jonathan M. Borwein who, intrigued by Elser, Rankenburg and Thibault’s success in applying the method to solving sudoku puzzles, began an investigation of his own. We survey the current body of literature on the subject, and we summarize its history. We especially commemorate Professor Borwein’s celebrated contributions to the area.
Sample sizes of welfare assessment protocols must warrant to reflect prevalences on-farm properly – regardless of farm size. Still, solely a fixed sample size was specified for the Welfare Quality® protocol for sows and piglets. The present study investigated whether animals may be assessed from only one body side as applied in the protocol and whether the pre-set sample size of 30 animals mirrors the prevalences of the animal-based indicators on-farm in the gestation unit considering different farm sizes. All indicators were assessed for both sides of an animal’s body by one observer on 13 farms in Germany, which were visited five times within 10 months. The farm visits were treated as independent since different animals were housed in the gestation units. The number of sows in the gestation units varied between 18 and 549 animals. The comparison of sides was carried out calculating exact agreement between animals’ sides and a Wilcoxon signed-rank test (W). The results signified that it is sufficient to assess the animal from one side (exact agreement: 88.3% to 99.5%, except for bursitis (70.0%); W: P-values 0.14 to 0.92). However, if side preferences existed in the indicator bursitis a potential bias must be considered. In the following, the sample size was evaluated by comparing samples’ prevalences against true prevalence, that is, the prevalence of all observed animals in the gestation unit in each farm visit. Therefore, subsets of data were generated by applying simple random sampling without replacement. The samples randomly included the animals’ right or left sides. Linear regression was rated as appropriate provided: coefficient of determination R2 ≥ 0.90, slope = 1 and intercept = 0 signifying exact agreement. The results revealed that the sample size required by the protocol and the application of calculation formulas are solely appropriate to mirror the prevalences of frequent indicators in the gestation unit, for example, bursitis (mean prevalence 34.4%). Using a proportion of animals, for example, a sample of 30% of all observed animals in a farm visit, pointed out that proportions must increase with indicators’ underlying prevalence narrowing 0.00%. Local infections (mean prevalence 13.3%) needed samples including 60% of all observed animals in each farm visit, whereas vulva lesions (mean prevalence 7.28%) only reached accuracy with the inclusion of 70% of the animals. Indicators with a mean prevalence of <1% were not analysed but can most likely only be ascertained by the assessment of all animals.
Investigate the feasibility of identifying a well-defined treatment group and a comparable reference group in clinical register data.
Background:
There is insufficient knowledge on how to avert neck/back pain from turning chronic or to impair work ability. The Swedish Government implemented a national multimodal rehabilitation (MMR) programme in primary care intending to promote work ability, reduce sick leave and increase return to work. Since randomised control trial data for effect is lacking, it is important to evaluate existing observational data from clinical settings.
Methods:
We identified all unique patients with musculoskeletal pain (MSP) diagnoses undergoing the MMR programme in primary care in the Skåne Health care Register (n = 2140) during 2010–2011. A reference cohort in primary care (n = 56 300) with similar MSP diagnoses, same ages and the same level of sick leave before baseline was identified for the same period. The reference cohort received ordinary care and treatment in primary care. The final study group consisted of 603 eligible MMR patients and 2874 eligible reference patients. Socio-economic and health-related baseline data including sick leave one year before up to two years after baseline were compared between groups.
Findings:
There were significant socio-economic and health differences at baseline between the MMR and the reference patients, with the MMR group having lower income, higher morbidity and more sick leave days. Sick leave days per year decreased significantly in the MMR group (118–102 days, P < 0.001) and in the reference group (50–42 days, P < 0.001) from one year before baseline to two years after.
Conclusions:
It was not feasible to identify a comparable reference group based on clinical register data. Despite an ambitious attempt to limit selection bias, significant baseline differences in socio-economic and health were present. In absence of randomised trials, effects of MMR cannot be sufficiently evaluated in primary care.
Tendencies to attend to threatening cues in the environment and to interpret ambiguous situations with negative/hostile intent maintain and may even precipitate internalizing and externalizing problems in young people with a history of maltreatment. Challenging maladaptive information-processing styles using cognitive bias modification (CBM) training may reduce symptoms.
Aims:
To investigate the acceptability of CBM training in nine young people attending alternate education provision units in the UK, and 10 young people living in out-of-home care institutions in Nepal with a history of maltreatment.
Method:
CBM training consisted of five sessions of training over a 2-week period; each training session consisted of one module targeting attention biases and one module targeting interpretation biases for threat. A feedback form administered after training measured acceptability. Pre- and post-intervention measures of internalizing and externalizing symptoms were also taken.
Results:
Most young people (89%) found the training helpful and 84% found the training materials realistic. There were reductions in many symptom domains, but with individual variation. Although limited by the lack of a control condition, we established generalizability of acceptability across participants from two cultural settings.
Conclusions:
Replication of these findings in larger feasibility randomized controlled trials with measures of attention and interpretation bias before and after intervention, are needed to assess the potential of CBM in reducing anxiety symptoms and its capacity to engage targeted mechanisms.
Outpatient interventions for adult anorexia nervosa typically have a modest impact on weight and eating disorder symptomatology. This study examined whether adding a brief online intervention focused on enhancing motivation to change and the development of a recovery identity (RecoveryMANTRA) would improve outcomes in adults with anorexia nervosa.
Methods
Participants with anorexia nervosa (n = 187) were recruited from 22 eating disorder outpatient services throughout the UK. They were randomised to receiving RecoveryMANTRA in addition to treatment as usual (TAU) (n = 99; experimental group) or TAU only (n = 88; control group). Outcomes were measured at end-of-intervention (6 weeks), 6 and 12 months.
Results
Adherence rates to RecoveryMANTRA were 83% for the online guidance sessions and 77% for the use of self-help materials (workbook and/or short video clips). Group differences in body mass index at 6 weeks (primary outcome) were not significant. Group differences in eating disorder symptoms, psychological wellbeing and work and social adjustment (at 6 weeks and at follow-up) were not significant, except for a trend-level greater reduction in anxiety at 6 weeks in the RecoveryMANTRA group (p = 0.06). However, the RecoveryMANTRA group had significantly higher levels of confidence in own ability to change (p = 0.02) and alliance with the therapist at the outpatient service (p = 0.005) compared to the control group at 6 weeks.
Conclusions
Augmenting outpatient treatment for adult anorexia nervosa with a focus on recovery and motivation produced short-term reductions in anxiety and increased confidence to change and therapeutic alliance.