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A randomised controlled trial of acceptance and commitment therapy plus usual care in comparison to usual care alone for reducing anxiety in older people with treatment-resistant generalised anxiety disorder (CONTACT-GAD): trial protocol
Get PDFBackground
Generalised anxiety disorder (GAD) is the most common anxiety disorder in older people and is characterised by excessive anxiety and worry that is experienced as being difficult to control. Current recommended first-line treatments for GAD include pharmacotherapy and psychological therapy, but some people experience GAD that does not respond to these treatments. Such treatment-resistant GAD (TR-GAD) is associated with numerous negative outcomes in older people. However, evidence-based guidance on how to manage TR-GAD in older people is lacking. Previous research suggests that Acceptance and Commitment Therapy (ACT), tailored to the needs and preferences of older people with TR-GAD, may help reduce anxiety in this population.
Aims
To determine the clinical and cost-effectiveness of tailored ACT plus usual care (UC) in comparison to UC alone for reducing anxiety in older people with TR-GAD.
Methods
The CONTACT-GAD trial is an international, multi-centre, parallel, two-arm RCT with a 9-month internal pilot phase. 296 individuals aged ≥ 60 years with TR-GAD will be recruited from primary and secondary care services (and their equivalent in Australia) and via self-referral at approximately 11 UK sites and 4 Australian sites. TR-GAD will be defined as GAD that has failed to respond adequately to pharmacotherapy and/or psychotherapy, as described in step 3 of the UK's stepped care model for GAD (and its equivalent in Australia). Participants will be randomly allocated to receive up to 14 one-to-one sessions of ACT with a booster session at approximately 3-months post-intervention plus UC or UC alone by an online randomisation system. Participants will complete outcome measures at baseline and 6- and 12-months post-randomisation. The primary outcome will be anxiety at six months. Secondary outcomes will include quality of life, depression, psychological flexibility, resource use, health-related quality of life, capability, adverse events, satisfaction with therapy, personally meaningful behaviour change and engagement in activities. Outcome assessors will be blind to treatment allocation. Primary analyses will be by intention-to-treat, with data being analysed using multi-level modelling.
Discussion
The CONTACT-GAD trial will provide much needed evidence on the management of TR-GAD in older people.
Trial registration
ISRCTN Registry, https://www.isrctn.com/ISRCTN85462326, registered 04/01/2023.
Protocol version
3.0 (09/05/2025)
Piloting a Multimodal Qualitative Approach to Explore EAP Writing Teacher Agency: Methodological Reflections from a Doctoral Study in Bangladesh
Get PDFThis paper offers methodological reflections on a pilot study conducted as part of a doctoral project that explores how English for Academic Purposes (EAP) teachers in Bangladeshi universities construct their teacher agency in teaching academic writing. The pilot aimed to assess the feasibility and relevance of a multimodal qualitative research design incorporating classroom observations, interviews, student focus groups, and a reflective diary. Conducted over a three-week period with one teacher and three student participants, the pilot generated insights that led to refined data collection strategies, more clearly defined ethical procedures, and enhanced researcher reflexivity. Through critical reflection on these adaptations, this paper seeks to contribute to ongoing methodological discussions around piloting context-sensitive, ethically informed, and practically viable approaches in doctoral research. It is expected that the insights shared will be of value to postgraduate researchers planning qualitative fieldwork in comparable higher education contexts
Lipopolysaccharide confinement in the bacterial outer membrane is governed by interactions within the conserved Lipid A anchor
Get PDFThe outer membrane of Gram-negative bacteria is an asymmetric bilayer in which lipopolysaccharide (LPS), the principal component of the outer leaflet, promotes tight packing and ordering of the membrane components that are essential for the barrier and load-bearing functions of this membrane. LPS mobility is known to be restricted in the outer membrane, but this confinement and the underlying biophysical interactions responsible remain to be fully characterized. Here, we apply a bio-orthogonal strategy for in situ site-specific fluorescent labeling of LPS. Using fluorescence microscopy, we quantify LPS lateral confinement in the outer membrane of Escherichia coli and demonstrate that this confinement is independent of oligosaccharide domain structure. We show that LPS assembles into discrete supramolecular structures, and that restricted lateral mobility arises from a combination of divalent cation-mediated electrostatic interactions in the anionic Lipid A headgroup and hydrophobic interactions between acyl chains within the lipid milieu. Magnesium cations exert a greater influence than calcium cations on LPS lateral mobility. These traits are conserved across multiple pathogenic bacterial species, irrespective of O-antigen serotype, showing that LPS confinement is a ubiquitous feature of Gram-negative bacteria
An implementation study of a remote monitoring platform to increase access to specialist care in motor neuron disease
No full textINTRODUCTION: The aim was to examine the engagement and acceptability of Telehealth in MND (TiM) as part of usual care within two specialist centers.
METHODS: Fifty people with MND (pwMND) completed questionnaires. Eight pwMND and carers participated in interviews.
RESULTS: In Shefield, 163 pwMND were invited to TiM with 52% registering and 85% engagement. In Dublin, 98 pwMND were invited to TiM, with 63% registering, and 95% engagement.High levels of acceptability were reported, with users rating TiM as very low in burden. Similar findings were demonstrated within the interviews, with ease of use a strength. However, participants discussed a need for more regular feedback from TiM. Future opportunities relating to integrating TiM with community services were discussed.
DISCUSSION: TiM is feasible and acceptable to pwMND. The high engagement can generate a wealth of data facilitating solution-focused clinical appointments. The study's findings support the further implementation of TiM in other MND services
The gendered landscape of informal caregiving: cohort effects and socioeconomic inequalities in England
No full textWe provide the first detailed cohort analysis of the gender care gap that examines the
association between caregiving provision, individual-level poverty, meso-level
deprivation, and individual circumstances. Using data from the UK Household
Longitudinal Study, we use (i) multilevel mixed-effects logistic regression to provide a
detailed age cohort analysis of the probability of providing informal care by sex; and (ii)
Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)
to provide an intersectional examination of informal carers.
Our results reveal a clear age pattern in caregiving, peaking between ages 60–70
before declining, with earlier-born cohorts showing higher caregiving likelihood at the
same ages than later-born cohorts. The gender care gap is most pronounced among
middle-born cohorts (1969–1978, 1959–1968, and 1949–1958), particularly between
ages 50 and 60. While overall caregiving prevalence is higher among individuals
experiencing poverty and living in deprived areas, the gender care gap is larger among
individuals above the poverty line and in non-deprived areas. Caregiving is primarily
associated with the independent effects of cohort, gender, poverty, and meso-level
deprivation, with limited evidence of multiplicative intersectional effects.
Policy attempts to address the gender care gap need to be mindful of these variations,
not least because they potentially elucidate the potential sources of gender inequalities
in care
Giant injectite complex sand body architecture in the Late Jurassic East Greenland rift
No full textThe geometries of kilometre-scale sandstone injectite complexes, and the models developed for their emplacement, are based on a scarce dataset of Large Sandstone Intrusion Complexes (LSICs). The Hareelv Formation of the Jameson Land Basin (East Greenland) provides the best outcrop example of a large-scale (>4,000 km2) injectite complex within an extensional tectonic setting found globally. Using 3D photogrammetric models and field observations, the large-scale geometries of the Hareelv Formation injectite sand bodies are characterised, and a new model for closed system injectite complexes is proposed. The Hareelv Formation sand bodies are up to 50 m thick and 1-2 km wide. Common features include steps, low-angle discordant wings, host rock rafts, bifurcations, linking-complexes and stockworks. No physical evidence for linkage to the palaeoseabed, or candidate parent units. is present. Therefore, the Hareelv Formation injectites are inferred to have acted as a closed system: self-sourced and dominated by lateral injection. The distribution of the sealing organic rich, laminated host mudstones exerts a primary control on the development of injectites in the Jameson Land Basin and adjacent regions. The self-sourced lateral intrusion processes may provide a more appropriate mechanism for the interpretation of subsurface examples where identification of source units has been uncertain
Development and characterization of foam-mat freeze-dried beetroot powders: Role of carrier agents in foam behavior, powder functionality, and tablet formation
Get PDFThis study investigates the development of foam-mat freeze-dried beetroot powders and examines the role of carrier agents, maltodextrin and xanthan gum, on powder functionality and tablet formation. All formulations contained egg white albumen (5 wt%) as a foaming agent, while compositions varied based on the presence of maltodextrin (5 wt%) and xanthan gum at various concentrations (0.05, 0.1, or 0.2 wt%). Foams were prepared by whipping beetroot juice mixtures, followed by freeze-drying. The addition of maltodextrin slightly improved foam expansion (from ∼450 % to ∼460 %) and foam stability, whereas xanthan gum significantly increased the foam stability, with no drainage observed at 0.1 and 0.2 wt% within 180 min. However, foam expansion decreased to ∼370 % at 0.2 wt% xanthan gum content. Maltodextrin improved flowability (Hausner Ratio, HR: 1.29 vs. 1.32 for control) and reduced hygroscopicity (23.5 % vs. 26.0 %), while xanthan gum increased particle irregularity and cohesiveness, thus leading to higher HR values (up to 1.47) and poorer flow. The inclusion of xanthan gum also reduced powder solubility from ∼92 % down to ∼77 %. Kawakita analysis showed that maltodextrin and xanthan gum reduced plastic deformation and powder compactness. Tablets prepared from these powders exhibited reduced tensile strength and density compared to the control. Color analysis indicated that carrier addition increased lightness (L∗) and decreased redness (a∗), primarily due to pigment dilution and reduced compactness
A mid‐Proterozoic coupled Sr and Li isotope excursion and its potential connection to enhanced weathering and ocean oxygenation at 1.57 Ga
Get PDFChemical weathering is a critical Earth system process that regulates climate, ocean chemistry and the long-term carbon cycle. However, the intensity and variability of chemical weathering remain insufficiently constrained for the mid-Proterozoic (∼1.8‒0.8 Ga), greatly limiting our understanding of the environmental context to early eukaryotic evolution. Here, we report the first coupled positive seawater 87Sr/86Sr (∼0.0007) and δ7Li (∼5‰) isotope excursions of the Mesoproterozoic Era (1.6‒1.0 Ga), which we argue signifies a substantial weathering event at ∼1.57 Ga, characterised by increased silicate weathering rates and decreased weathering congruency. Drawing on independent geological evidence, we posit that enhanced volcanic CO2 degassing, possibly alongside accretional orogenesis, increased denudation rates and invigorated the hydrological cycle, amplifying silicate weathering and secondary clay formation. This weathering pulse broadly coincided with coeval ocean oxygenation and carbon cycle disruption, implicating it in the appearance of the earliest known decimetre-scale, multicellular eukaryotic fossils
Plant traits as potential drivers of timber value in the Dipterocarpaceae
Get PDFSoutheast Asian tropical forests are vital sources of high-value timber and non-timber forest products (NTFPs). This study investigates the relationship between plant traits, wood density, and timber market value within the Dipterocarpaceae family, a critical contributor to the global tropical timber trade and a key structural component of many forests in Southeast Asia. Using a phylogenetic approach, we explored the correlation of morphological and life-history traits with timber price. Our results show that wood density is significantly associated with higher timber prices, and this relationship is strongly influenced by phylogenetic dependence. We found no evidence linking timber value to the conservation status of dipterocarp species, suggesting that economic exploitation does not necessarily correlate with species endangerment. These findings emphasize the importance of understanding the evolutionary patterns driving economically valuable traits in timber species, which can guide sustainable forest management and conservation strategies in Southeast Asia
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