The importance of service-users' perspectives: A systematic review of qualitative evidence reveals overlooked critical features of weight management programmes.

BACKGROUND: Extensive research effort shows that weight management programmes (WMPs) targeting both diet and exercise are broadly effective. However, the critical features of WMPs remain unclear. OBJECTIVE: To develop a deeper understanding of WMPs critical features, we undertook a systematic review of qualitative evidence. We sought to understand from a service-user perspective how programmes are experienced, and may be effective, on the ground. SEARCH STRATEGY: We identified qualitative studies from existing reviews and updated the searches of one review. INCLUSION CRITERIA: We included UK studies capturing the views of adult WMP users. DATA EXTRACTION AND SYNTHESIS: Thematic analysis was used inductively to code and synthesize the evidence. MAIN RESULTS: Service users were emphatic that supportive relationships, with service providers or WMP peers, are the most critical aspect of WMPs. Supportive relationships were described as providing an extrinsic motivator or "hook" which helped to overcome barriers such as scepticism about dietary advice or a lack confidence to engage in physical activity. DISCUSSION AND CONCLUSIONS: The evidence revealed that service-users' understandings of the critical features of WMPs differ from the focus of health promotion guidance or descriptions of evaluated programmes which largely emphasize educational or goal setting aspects of WMPs. Existing programme guidance may not therefore fully address the needs of service users. The study illustrates that the perspectives of service users can reveal unanticipated intervention mechanisms or underemphasized critical features and underscores the value of a holistic understanding about "what happens" in complex psychosocial interventions such as WMPs

Weight management programmes: Re-analysis of a systematic review to identify pathways to effectiveness.

BACKGROUND: Previous systematic reviews of weight management programmes (WMPs) have not been able to account for heterogeneity of effectiveness within programmes using top-down behavioural change taxonomies. This could be due to overlapping causal pathways to effectiveness (or lack of effectiveness) in these complex interventions. Qualitative comparative analysis (QCA) can help identify these overlapping pathways. METHODS: Using trials of adult WMPs with dietary and physical activity components identified from a previous systematic review, we selected the 10 most and 10 least effective interventions by amount of weight loss at 12 months compared to minimal treatment. Using intervention components suggested by synthesis of studies of programme user views, we labelled interventions as to the presence of these components and, using qualitative comparative analysis, developed pathways of component combinations that created the conditions sufficient for interventions to be most effective and least effective. RESULTS: Informed by the synthesis of views studies, we constructed 3 truth tables relating to quality of the user-provider relationship; perceived high need for guidance from providers; and quality of the relationship between peers in weight management programmes. We found effective interventions were characterized by opportunities to develop supportive relationships with providers or peers, directive provider-led goal setting and components perceived to foster self-regulation. CONCLUSIONS: Although QCA is an inductive method, this innovative approach has enabled the identification of potentially critical aspects of WMPs, such as the nature of relationships within them, which were previously not considered to be as important as more concrete content such as dietary focus

Review of NASA In-Space Propulsion Technology Program Inflatable Decelerator Investments

The NASA In-Space Propulsion Technology (ISPT) Program is managed by the NASA Headquarters Science Mission Directorate and is implemented by the Marshall Space Flight Center in Huntsville, Alabama. The ISPT objective is to fund development of promising in- space propulsion technologies that can decrease flight times, decrease cost, or increase delivered payload mass for future science missions. Before ISPT will invest in a technology, the Technology Readiness Level (TRL) of the concept must be estimated to be at TRL 3. A TRL 3 signifies that the technical community agrees that the feasibility of the concept has been proven through experiment or analysis. One of the highest priority technology investments for ISPT is Aerocapture. The aerocapture maneuver uses a planetary atmosphere to reduce or alter the speed of a vehicle allowing for quick, propellantless (or using very little propellant) orbit capture. The atmosphere is used as a brake, transferring the energy associated with the vehicle s high speed into thermal energy. The ISPT Aerocapture Technology Area (ATA) is currently investing in the development of advanced lightweight ablative thermal protection systems, high temperature composite structures, and heat-flux sensors for rigid aeroshells. The heritage of rigid aeroshells extends back to the Apollo era and this technology will most likely be used by the first generation aerocapture vehicle. As a second generation aerocapture technology, ISPT is investing in three inflatable aerodynamic decelerator concepts for planetary aerocapture. They are: trailing ballute (balloon-parachute), attached afterbody ballute, and an inflatable aeroshell. ISPT also leverages the NASA Small Business Innovative Research Program for additional inflatable decelerator technology development. In mid-2004 ISPT requested an independent review of the three inflatable decelerator technologies funded directly by ISPT to validate the TRL and to identify technology maturation concerns. An independent panel with expertise in advanced thin film materials, aerothermodynamics, trajectory design, and inflatable structures was convened to assess the ISPT investments. The panel considered all major technical subsystems including materials, aerothermodynamics, structural dynamics, packaging, and inflation systems. The panel assessed the overall technology readiness of inflatable decelerators to be a 3 and identified fluid-structure interaction, aeroheating, and structural adhesives to be of highest technical concern

Sarcospan Regulates Cardiac Isoproterenol Response and Prevents Duchenne Muscular Dystrophy-Associated Cardiomyopathy.

BackgroundDuchenne muscular dystrophy is a fatal cardiac and skeletal muscle disease resulting from mutations in the dystrophin gene. We have previously demonstrated that a dystrophin-associated protein, sarcospan (SSPN), ameliorated Duchenne muscular dystrophy skeletal muscle degeneration by activating compensatory pathways that regulate muscle cell adhesion (laminin-binding) to the extracellular matrix. Conversely, loss of SSPN destabilized skeletal muscle adhesion, hampered muscle regeneration, and reduced force properties. Given the importance of SSPN to skeletal muscle, we investigated the consequences of SSPN ablation in cardiac muscle and determined whether overexpression of SSPN into mdx mice ameliorates cardiac disease symptoms associated with Duchenne muscular dystrophy cardiomyopathy.Methods and resultsSSPN-null mice exhibited cardiac enlargement, exacerbated cardiomyocyte hypertrophy, and increased fibrosis in response to β-adrenergic challenge (isoproterenol; 0.8 mg/day per 2 weeks). Biochemical analysis of SSPN-null cardiac muscle revealed reduced sarcolemma localization of many proteins with a known role in cardiomyopathy pathogenesis: dystrophin, the sarcoglycans (α-, δ-, and γ-subunits), and β1D integrin. Transgenic overexpression of SSPN in Duchenne muscular dystrophy mice (mdx(TG)) improved cardiomyofiber cell adhesion, sarcolemma integrity, cardiac functional parameters, as well as increased expression of compensatory transmembrane proteins that mediate attachment to the extracellular matrix.ConclusionsSSPN regulates sarcolemmal expression of laminin-binding complexes that are critical to cardiac muscle function and protects against transient and chronic injury, including inherited cardiomyopathy

Applying the behaviour change technique (BCT) taxonomy v1: a study of coder training.

Behaviour Change Technique Taxonomy v1 (BCTTv1) has been used to detect active ingredients of interventions. The purpose of this study was to evaluate effectiveness of user training in improving reliable, valid and confident application of BCTTv1 to code BCTs in intervention descriptions. One hundred sixty-one trainees (109 in workshops and 52 in group tutorials) were trained to code frequent BCTs. The following measures were taken before and after training: (i) inter-coder agreement, (ii) trainee agreement with expert consensus, (iii) confidence ratings and (iv) coding competence. Coding was assessed for 12 BCTs (workshops) and for 17 BCTs (tutorials). Trainees completed a course evaluation. Methods improved agreement with expert consensus (p < .05) but not inter-coder agreement (p = .08, p = .57, respectively) and increased confidence for BCTs assessed (both p < .05). Methods were as effective as one another at improving coding competence (p = .55). Training was evaluated positively. The training improved agreement with expert consensus, confidence for BCTs assessed, coding competence but not inter-coder agreement. This varied according to BCT.This work was carried out as part of the Behavior Change Technique Taxonomy project funded by the Medical Research Council via its Methodology panel [G0901474/1].This is the accepted manuscript version. The final publication is available from Springer at http://link.springer.com/article/10.1007%2Fs13142-014-0290-

End-user involvement in a systematic review of quantitative and qualitative research of non-pharmacological interventions for attention deficit hyperactivity disorder delivered in school settings: reflections on the impacts and challenges.

JOURNAL ARTICLEBACKGROUND: The benefits of end-user involvement in health-care research are widely recognized by research agencies. There are few published evaluations of end-user involvement in systematic reviews. OBJECTIVES: (i) Describe end-user involvement in a complex mixed-methods systematic review of ADHD in schools, (ii) reflect on the impact of end-user involvement, (iii) highlight challenges and benefits experienced and (iv) provide suggestions to inform future involvement. METHODS: End-users were involved in all stages of the project, both as authors and as members of an advisory group. In addition, several events were held with groups of relevant end-users during the project. RESULTS: End-user input (i) guided the direction of the research, (ii) contributed to a typology of interventions and outcomes, (iii) contributed to the direction of data analysis and (iv) contributed to the robustness of the syntheses by demonstrating the alignment of interim findings with lived experiences. Challenges included (i) managing expectations, (ii) managing the intensity of emotion, (iii) ensuring that involvement was fruitful for all not just the researcher, (iv) our capacity to communicate and manage the process and (v) engendering a sense of involvement amongst end-users. CONCLUSIONS: End-user involvement was an important aspect of this project. To minimize challenges in future projects, a recognition by the project management team and the funding provider that end-user involvement even in evidence synthesis projects is resource intensive is essential to allow appropriate allocation of time and resources for meaningful engagement.NIHR HTA programmeNIHRExeter NHS Foundation Trus

Non-pharmacological interventions for ADHD in school settings: an overarching synthesis of systematic reviews

OBJECTIVE: This overarching synthesis brings together the findings of four systematic reviews including 138 studies focused on non-pharmacological interventions for ADHD used in school settings. These reviews considered the effectiveness of school-based interventions for ADHD, attitudes toward and experience of school-based interventions for ADHD, and the experience of ADHD in school settings. METHOD: We developed novel methods to compare the findings across these reviews inductively and deductively. RESULTS: Key contextual issues that may influence the effectiveness and implementation of interventions include the relationships that pupils with ADHD have with their teachers and peers, the attributions individuals make about the etiology of ADHD, and stigma related to ADHD or intervention attendance. CONCLUSION: Although we found some positive effects for some outcomes and intervention categories, heterogeneity in effect size estimates and research evidence suggests a range of diverse contextual factors potentially moderate the implementation and effectiveness of school-based interventions for ADHD.National Institute for Health Research Health Technology Assessment (NIHR HTA) programNIHR Collaboration for Leadership in Applied HealthResearch and Care South West Peninsula (PenCLAHRC

Risky Business: An Examination of Probation Officers\u27 Attitudes towards Risk Assessment

Over the past ten years, the concept of risk has moved to centre stage in criminological spheres. Risk assessment and the concern for effective management of offenders while safe guarding public safety has become a core issue for criminal justice agencies. This research focuses on risk assessment and probation practice in Ireland. In particular, the attitudes of practicing basic grade probation officers\u27 working on adult community teams in Dublin are examined to gain insight into the complexities experienced by probation officers. Specifically, the research aims to highlight the consequences of adopting standardised risk tools on probation practice. The research discusses current theoretical arguments on the influence of risk in criminal justice and outlines the impact of risk discourse on probation practice in Ireland and elsewhere. Using a mix of qualitative and quantitative methods of data collection, probation officers\u27 attitudes are examined and presented thematically in order to highlight key issues facing probation officers when making risk decisions. The findings identify positive and negative consequences of adopting risk tools and points to the continued salience of clinical judgement over actuarial methods of risk assessment. It is argued that due to a lack of information and inadequate training, probation officers are placed in positions of failure. It is suggested that in order to improve accountability and credibility of the probation service, defensible decisions regarding risk assessment are paramount