Recruiting Adolescents With Chronic Fatigue Syndrome/Myalgic Encephalomyelitis to Internet-Delivered Therapy: Internal Pilot Within a Randomized Controlled Trial.

BACKGROUND: Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in adolescents is common and disabling. Teenagers in the United Kingdom are more likely to recover if they access specialist care, but most do not have access to a local specialist CFS/ME service. Delivering treatment remotely via the internet could improve access to treatment. OBJECTIVE: This study aims to assess (1) the feasibility of recruitment and retention into a trial of internet-delivered specialist treatment for adolescents with CFS/ME and (2) the acceptability of trial processes and 2 web-based treatments (to inform continuation to full trial). METHODS: This study is an internal pilot for the initial 12 months of a full randomized controlled trial (RCT), with integrated qualitative methods (analysis of recruitment consultations and participant and clinician interviews). Recruitment and treatment were delivered remotely from a specialist pediatric CFS/ME treatment service within a hospital in South West United Kingdom. Adolescents (aged 11-17 years) from across the United Kingdom with a diagnosis of CFS/ME and no access to local specialist treatment were referred by their general practitioner to the treatment center. Eligibility assessment and recruitment were conducted via remote methods (telephone and on the web), and participants were randomized (via a computer-automated system) to 1 of 2 web-based treatments. The trial intervention was Fatigue in Teenagers on the InterNET in the National Health Service, a web-based modular CFS/ME-specific cognitive behavioral therapy program (designed to be used by young people and their parents or caregivers) supported by individualized clinical psychologist electronic consultations (regular, scheduled therapeutic message exchanges between participants and therapist within the platform). The comparator was Skype-delivered activity management with a CFS/ME clinician (mainly a physiotherapist or occupational therapist). Both treatments were intended to last for up to 6 months. The primary outcomes were (1) the number of participants recruited (per out-of-area referrals received between November 1, 2016, to October 31, 2017) and the proportion providing 6-month outcome data (web-based self-report questionnaire assessing functioning) and (2) the qualitative outcomes indicating the acceptability of trial processes and treatments. RESULTS: A total of 89 out of 150 (59.3% of potentially eligible referrals) young people and their parents or caregivers were recruited, with 75 out of 89 (84.2%) providing 6-month outcome data. Overall, web-based treatment was acceptable; however, participants and clinicians described both the advantages and disadvantages of remote methods. No serious adverse events were reported. CONCLUSIONS: Recruiting young people (and their parents or caregivers) into an RCT of web-based treatment via remote methods is feasible and acceptable. Delivering specialist treatment at home via the internet is feasible and acceptable, although some families prefer to travel across the United Kingdom for face-to-face treatment. TRIAL REGISTRATION: ISRCTN 18020851; http://www.isrctn.com/ISRCTN18020851. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-018-2500-3.

Investigating the effectiveness and cost-effectiveness of FITNET-NHS (Fatigue In Teenagers on the interNET in the NHS) compared to Activity Management to treat paediatric chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME): protocol for a randomised controlled trial.

BACKGROUND: Paediatric chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a relatively common and disabling condition. The National Institute for Health and Clinical Excellence (NICE) recommends Cognitive Behavioural Therapy (CBT) as a treatment option for paediatric CFS/ME because there is good evidence that it is effective. Despite this, most young people in the UK are unable to access local specialist CBT for CFS/ME. A randomised controlled trial (RCT) showed FITNET was effective in the Netherlands but we do not know if it is effective in the National Health Service (NHS) or if it is cost-effective. This trial will investigate whether FITNET-NHS is clinically effective and cost-effective in the NHS. METHODS: Seven hundred and thirty-four paediatric patients (aged 11-17 years) with CFS/ ME will be randomised (1:1) to receive either FITNET-NHS (online CBT) or Activity Management (delivered via video call). The internal pilot study will use integrated qualitative methods to examine the feasibility of recruitment and the acceptability of treatment. The full trial will assess whether FITNET-NHS is clinically effective and cost-effective. The primary outcome is disability at 6 months, measured using the SF-36-PFS (Physical Function Scale) questionnaire. Cost-effectiveness is measured via cost-utility analysis from an NHS perspective. Secondary subgroup analysis will investigate the effectiveness of FITNET-NHS in those with co-morbid mood disorders. DISCUSSION: If FITNET-NHS is found to be feasible and acceptable (internal pilot) and effective and cost-effective (full trial), its provision by the NHS has the potential to deliver substantial health gains for the large number of young people suffering from CFS/ME but unable to access treatment because there is no local specialist service. This trial will provide further evidence evaluating the delivery of online CBT to young people with chronic conditions. TRIAL REGISTRATION: ISRCTN registry, registration number: ISRCTN18020851 . Registered on 4 August 2016.

Humans as major geological and geomorphological agents in the Anthropocene: the significance of artificial ground in Great Britain.

Since the first prehistoric people started to dig for stone to make implements, rather than pick up loose material, humans have modified the landscape through excavation of rock and soil, generation of waste and creation of artificial ground. In Great Britain over the past 200 years, people have excavated, moved and built up the equivalent of at least six times the volume of Ben Nevis. It is estimated that the worldwide deliberate annual shift of sediment by human activity is 57,000 Mt (million tonnes) and exceeds that of transport by rivers to the oceans (22,000 Mt) almost by a factor of three. Humans sculpt and transform the landscape through the physical modification of the shape and properties of the ground. As such, humans are geological and geomorphological agents and the dominant factor in landscape evolution through settlement and widespread industrialization and urbanization. The most significant impact of this has been since the onset of the Industrial Revolution in the eighteenth century, coincident with increased release of greenhouse gases to the atmosphere. The anthropogenic sedimentological record, therefore, provides a marker on which to characterize the Anthropocene.

Bioaccessibility of platinum group elements in automotive catalytic converter particulates.

The bioaccessibilities of the platinum group elements (PGE): Rh, Pd, and Pt; and the catalyzator poison, Pb, have been determined in particles derived from milled automotive catalytic converters using a physiologically based extraction test (PBET) that simulates, sequentially, the chemical conditions encountered in the human stomach and intestine. PGE accessibility, relative to total metal concentration, was generally less than a few percent, but increased in the stomach with decreasing pH (from 4 to 1) and/or increasing chloride concentration, and with decreasing particle concentration. In most cases, bioaccessibility increased from the acidic stomach to the neutral, carbonate-rich intestine. Bioaccessibility of Pb displayed similar pH and particle concentration dependencies to PGE in the stomach, but this metal exhibited significantly greater mobilization (up to 80%) overall and a reduction in accessibility from the stomach to intestine. Reaction kinetics of PGE dissolution in the stomach at pH 2.5 were modeled using a combined surface reaction-diffusion controlled mechanism with rate constants of 0.068, 0.031, and 0.015 (microg L(-1))(-1) h(-1) for Rh, Pd, and Pt, respectively. For Pb, however, mobilization proceeded via a different mechanism whose time-dependence was fitted with an empirical, logarithmic equation. Overall, PGE bioaccessibility appeared to be controlled by dissolution rates of metallic nanoparticles in the stomach, and solubility and kinetic constraints on inorganic species (chlorides, hydroxychlorides, and carbanatochlorides) and undefined organic complexes formed in the simulated gastrointestinal tract. Further studies are required to elucidate any effects engendered by the long-term oral exposure of small quantities of these species.