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Evaluating the effects of the World Health Organization's online intervention ‘iSupport’ to reduce depression and distress in dementia carers: a multi-centre six-month randomised controlled trial in the UK
Full text linkBackground Sustaining the capabilities of dementia carers is a global priority. ‘iSupport’ is a self-guided onlineintervention designed by the World Health Organization (WHO) to reduce mental health problems in dementiacarers. iSupport is undergoing global implementation, however there is an absence of effectiveness evidence. Thisstudy tested the effectiveness of iSupport to reduce distress and depression in dementia carers.Methods A pragmatic randomised controlled trial was conducted in three centres. Adult carers (18+) living in thecommunity were recruited in England, Wales and Scotland and randomly assigned (1:1) through a web-basedsystem to iSupport or usual care. Outcome assessors were masked to allocation. The primary outcomesassessed the difference in distress and depression between baseline and six-months. The target sample sizewas 350 to enable 90% power, significance at 2.5% including 25% attrition (262 completers) on eitheroutcome. Analysis followed the intention-to-treat (ITT) principle. The trial was registered with ISRCTNregistry (17420703).Findings Between 12th November 2021 and 31st March 2023,177 carers (50.3%) were randomised to usual care and175 (49.7%) to iSupport. 263 (74.7%) completed the trial. All were included in the ITT analysis. Mean distress scoresat six-months were 20.0 (SD = 8.3) for usual care and 20.6 (SD = 8.6) for iSupport. The mean difference was 0.16 (95%CI −1.17 to 1.49, p = 0.29) after adjusting for covariates. Mean depression scores at six-months were 9.5 (SD = 7.0) forusual care and 9.8 (SD = 6.5) for iSupport. The mean difference at six-months was −0.54 (95% CI = −1.70 to 0.62,p = 0.44). No serious adverse events were linked to the trial.Interpretation To our knowledge this is the largest trial evaluating a self-guided online intervention in UK dementiacarers, and the first to successfully evaluate the effectiveness of iSupport. The null findings are significant given theongoing global implementation of iSupport by the WHO and the adoption of self-guided interventions intomainstream care delivery as part of digital health transformations.Funding NIHR
Age-dependent phenotypes of cognitive impairment as sequelae of SARS-CoV-2 infection
Full text linkCognitive changes associated with PASC may not be uniform across populations. We conducted individual-level pooled analyses and meta-analyses of cognitive assessments from eight prospective cohorts, comprising 2,105 patients and 1,432 controls from Argentina, Canada, Chile, Greece, India, Italy, Russia, and the UK. The meta-analysis found no differences by country of origin. The profile and severity of cognitive impairment varied by age, with mild attentional impairment observed in young and middle-aged adults, but memory, language, and executive function impairment in older adults. The risk of moderate to severe impairment doubled in older adults. Moderately severe or severe impairment was significantly associated with infection diagnoses (chi-square = 26.57, p ≤ 0.0001) and the severity of anosmia (chi-square = 31.81, p ≤ 0.0001). We found distinct age-related phenotypes of cognitive impairment in patients recovering from COVID-19. We identified the severity of acute illness and the presence of olfactory dysfunction as the primary predictors of dementia-like impairment in older adults
A Social Return on Investment Analysis of Patient-Reported Outcome Measures in Value-Based Healthcare
Full text linkObjectives: There is growing interest in the use of Patient Reported Outcome Measures (PROMs) to improve patient and healthcare service outcomes. This study aimed to measure the social and economic value of PROMs implemented within a VBHC framework.Methods: We conducted a Social-Return on Investment (SROI) analysis in Epilepsy, Heart Failure, and Parkinson’s Disease services, to measure the value generated by PROMs for patients and the healthcare provider. Results: The SROI analysis revealed substantial variation in the value derived from the PROMs intervention across different services. The highest value was observed in Heart Failure with an SROI ratio of 5.55:1, which represents a substantial return on investment for patients and services. In contrast, the Parkinson’s Disease service had small return on investment from PROMs with an SROI ratio of 1.29:1. In Epilepsy, the social value derived from PROMs was proportionally less than the investment made, with an SROI ratio of 0.85:1. Conclusion: These findings demonstrate the complexities of implementing PROMs within a clinical context, and careful consideration is likely needed in selecting suitable services and tailoring the implementation of PROMs to effectively meet specific service and patient requirements. Where PROMs yielded low or no value, the lack of return-on-investment prompts a strategic re-evaluation regarding how PROMs are funded, implemented, and utilized. As the first economic evaluation of PROMs in clinical practice, this study is a novel contribution to the emergent VBHC and PROMs evidence base. Furthermore, the findings from this study will inform recommendations to improve PROMs delivery across Wales.<br/
Phase-Conjugate Feedback Effects in Electrically Pumped Semiconductor Nano-Laser Arrays
Full text linkAn analysis is performed of the response of arrays of semiconductor nano-lasers to phase-conjugate optical feedback. A comparison is made of their response to conventional mirror feedback. It is shown that phase-conjugate feedback induces a quasi-periodic route to chaos. The impact of the Purcell-enhanced spontaneous emission, which is a salient feature of nano-lasers, is also delineated for both phase-conjugate and conventional mirror feedback
Experimental Investigation of a Seamlessly Converged Fiber-Wireless Access Network Employing Free-Running Laser- and Envelope Detection-based mmWave Generation and Detection
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Modelling language attitudes: Attitudinal measurements and linguistic behaviour in two bilingual communities
Full text linkThis paper investigates whether attitudinal measures can predict usage in two bilingual communities with radically different language policies. We compare 163 participants’ (ages 24–36) rates of spontaneous language usage to two attitudinal measures among Welsh—English and Lombard—Italian bilinguals. Usage rates are found to correlate with Matched Guise Technique status scores for Lombard and to predict solidarity scores for Welsh. A different picture emerges from the Implicit Association Test, with scores correlating with usage for Welsh but not for Lombard. We link these findings to the radically different levels of socio-political support associated with the regional/minority languages and the nature of the two attitudinal measures. Our findings suggest that the utility of different attitudinal measures depends partly on socio-political circumstances and on the type of association intrinsically addressed in each measure. These have important implications for both the study of language attitudes and research on language vitality
Photonic-assisted Broadband RF Receivers with Low IF Frequencies Based on Kramers-Kronig Processing
Full text linkA simplified photonic-based Radio Frequency (RF) receiver with a low intermediate frequency (IF) is proposed and experimentally demonstrated by utilizing direct detection and Kramers-Kronig (KK) processing. In the proposed approach, the RF and local oscillator (LO)signals are modulated onto an optical carrier using a dual-drive Mach-Zehnder modulator (DDMZM) biased at a minimum transmission point. The modulated optical signal is then directed to a single photodetector (PD) to produce the IF signal, which is designed to fall within1.5 times the bandwidth of the RF signal. KK processing effectively mitigates the signal-signal beat interference (SSBI) when the frequency gap between the RF signal and the LO signal is 1.5 times less than the bandwidth of the RF signal, thus enabling the generation of a low IF signal. This allows for subsequent processing with a low-speed PD and an analog-to-digital converter operating at a lower sampling rate. Experimental validation using a 16-QAM RFvector signal showsthat KK processing reducesthe error vector magnitude (EVM) of the downconverted 16-QAM signal to 4.61%, compared to 18.57% without it, when no frequency gap exists. This approach provides a streamlined design and straightforward implementation for photonic RF down-conversion