Summary A potential carbon capture and storage (CCS) fill-and-spill mega-fairway is here identified in UKCS Quadrants 43-44, by combining regional wellbore data with 3D seismic interpretation and migration modelling. In the study area, the Triassic Bunter Sandstone reservoir shows consistent thicknesses (90-216 m) and prospective core-based porosities and permeabilities (11-28%, 9-669 mD). A connected reservoir is suggested regionally from consistent, near-hydrostatic aquifer pressure gradients (~0.51 psi/ft) and leakage is mitigated through a thick, laterally-effective top seal. Structural closures in the area are generally less than the CO2 column heights necessary to breach the seal. At least eleven mapped closures are shown to link together into the proposed regional fill-and-spill “Silverpit CCS Fairway”. If filled to spill, these traps could cumulatively host up to 7.9 Gt of CO2, three times that of the proposed Endurance CCS Field. Through management of the injection and fill-spill strategy, this fairway could be future-proofed in relation to CO2 spill hazards, whilst possibly requiring less ‘injector hubs’ to fill the traps. Migration spill-point modelling along the fairway may also inform the placement of permanent, cost-effective multi-physics seabed system for leakage and migration monitoring. Exploiting fill-and-spill fairways for CCS is a new concept with vast potential applicability globally.

Abstract Introduction The climate is changing for end-of-life care. The NIH has sponsored major initiatives for research and education to “guarantee the quality of care provided to the dying indivi...

Cognitive behavioral stress management groups have been shown to be decrease psychological symptoms and increase adaptive coping in breast cancer patients, but dissemination of this effective intervention has been challenging. The goal of the present project was to develop an online cognitive behavioral stress management intervention for early stage breast cancer survivors and evaluate its effectiveness using a 2 group×3 time randomized, waitlist-controlled design. Intervention and waitlist control group participants were assessed at three time points: at baseline; at 10weeks, after which only intervention participants had used the workbook; and at 20weeks, after which both groups had used the workbook. Results indicate that at 10weeks intervention participants showed improved self-efficacy for coping with their cancer and for regulating negative mood and lower levels of cancer-related post-traumatic symptoms as compared to the control group, suggesting that an internet stress management intervention could be effective for helping breast cancer patients increase their confidence in their ability to cope with stress.

This article describes the historical context, technical challenges, and main implementation techniques used by VMware Workstation to bring virtualization to the x86 architecture in 1999. Although virtual machine monitors (VMMs) had been around for decades, they were traditionally designed as part of monolithic, single-vendor architectures with explicit support for virtualization. In contrast, the x86 architecture lacked virtualization support, and the industry around it had disaggregated into an ecosystem, with different vendors controlling the computers, CPUs, peripherals, operating systems, and applications, none of them asking for virtualization. We chose to build our solution independently of these vendors. As a result, VMware Workstation had to deal with new challenges associated with (i) the lack of virtualization support in the x86 architecture, (ii) the daunting complexity of the architecture itself, (iii) the need to support a broad combination of peripherals, and (iv) the need to offer a simple user experience within existing environments. These new challenges led us to a novel combination of well-known virtualization techniques, techniques from other domains, and new techniques. VMware Workstation combined a hosted architecture with a VMM. The hosted architecture enabled a simple user experience and offered broad hardware compatibility. Rather than exposing I/O diversity to the virtual machines, VMware Workstation also relied on software emulation of I/O devices. The VMM combined a trap-and-emulate direct execution engine with a system-level dynamic binary translator to efficiently virtualize the x86 architecture and support most commodity operating systems. By relying on x86 hardware segmentation as a protection mechanism, the binary translator could execute translated code at near hardware speeds. The binary translator also relied on partial evaluation and adaptive retranslation to reduce the overall overheads of virtualization. Written with the benefit of hindsight, this article shares the key lessons we learned from building the original system and from its later evolution.

BackgroundNonadherence to prescribed medication regimens is a substantial barrier to the pharmacological management of alcohol use disorders. The availability of low-cost, sustainable interventions that maximize medication adherence would likely lead to improved treatment outcomes. Mobile health (mHealth) technologies are increasingly being adopted as a method of delivering behavioral health interventions and represent a promising tool for adherence interventions. We are evaluating a cell-phone–based intervention called AGATE that seeks to enhance adherence with regular text-messaging.Methods/DesignA randomized controlled effectiveness trial in the context of an eight-week open label naltrexone efficacy trial delivered in a naturalistic clinical setting. Treatment-seeking heavy drinkers (N = 105) are currently being recruited and randomly assigned to the AGATE intervention or a control condition. Daily measures of alcohol use and medication side effects are being recorded via cell phone in both conditions. Additionally, participants randomized to the AGATE condition receive medication reminders via SMS text message according to a schedule that adjusts according to their level of adherence.DiscussionResults from this trial will provide initial information about the feasibility and efficacy of mHealth interventions for improving adherence to alcohol pharmacotherapies.Trial RegistrationNCT01349985.

Research has shown that cognitive and behavioral therapies can effectively improve quality of life in chronic pain patients. Unfortunately, many patients lack access to cognitive and behavioral therapy treatments. We developed a pilot version of an interactive online intervention to teach self-management skills for chronic lower back pain, a leading cause of disability and work absenteeism. The objective of this randomized, controlled trial was to evaluate its efficacy. Individuals with chronic lower back pain were recruited over the Internet, screened by phone, and randomly assigned to receive access to the intervention (Wellness Workbook; WW) either immediately (intervention group) or after a 3-week delay (wait-list control). Participants (n=141, 83% female, 23% minority) were asked to complete the WW over 3 weeks. Self-report measures of pain, disability, disabling attitudes and beliefs, self-efficacy for pain control, and mood regulation were completed at baseline, week 3, and week 6. Controlling for baseline individual differences in the outcome measures, multivariate analysis of covariance revealed that, at week 3, the intervention group scored better than the wait-list control group on all outcomes, including pain severity ratings. At week 6, after both groups had been exposed to the WW, there were no differences between groups. Use of this pilot intervention seems to have had positive effects on a number of pain-related outcomes, including disability. Future research will evaluate the effectiveness of the completed intervention, with particular attention to quality of life and disability.

Benefits of empirically supported interventions hinge on clinician skill, particularly for motivational interviewing (MI). Existing MI skill assessments are limited with respect to validity (e.g., self-report) and practicality (e.g., coding session tapes). To address these limitations, we developed and evaluated two versions of a web-based assessment of MI skills, the Computer Assessment of Simulated Patient Interviews (CASPI). Ninety-six counselors from the community and 24 members of the Motivational Interviewing Network of Trainers (MINT) completed the CASPI (N = 120), in which they verbally responded via microphones to video clips comprising three 9-item vignettes. Three coders used an emergent coding scheme, which was compared with alternative MI skills measures. CASPI demonstrated excellent internal consistency when averaging across two or three vignettes (α's = .86-.89). Intraclass correlations were above .40 for most items. Confirmatory factor analyses supported a correlated three-factor model: MI-consistent, resistance-engendering, and global change talk orientation rating. Means and factor loadings were invariant across forms (i.e., the two alternative versions of CASPI), and factor loadings were invariant across subgroup (i.e., community counselor or MINT member). Test-retest reliability was good for MI-consistent and resistance-engendering scores (r = .74 and .80, respectively) but low for change talk orientation (r = .29) unless coder was taken into account (r = .69). CASPI showed excellent construct and criterion-related validity. CASPI represents a promising method of assessing MI skills. Future studies are needed to establish its performance in real-world contexts.

Tobacco quitlines (QLs) provide effective evidence-based tobacco cessation counseling, yet they remain underutilized. Barriers to utilization include the lack of referrals by health care providers who typically have little knowledge about QLs and low self-efficacy for providing tobacco interventions. In order to educate providers about QLs, referral methods and tobacco interventions, a case-based online CME/CE program, Refer2Quit (R2Q), was developed. R2Q includes QL education and intervention and referral skills training tailored to provider type (eg, physician, nurse, dental provider, pharmacist) and work setting (eg, emergency, outpatient, inpatient). A module teaching motivational enhancement strategies was also included. Four health care organizations in Washington State participated in a study examining the effects of R2Q training on fax referral rates in an interrupted times series. Attitudes and self-efficacy toward delivering tobacco interventions was also assessed. Participants were a mix of provider types, including prescribers (20.1%), RNs (46.7%), and others (33.2%). Health care sites that participated in the study increased the fax referral rates (odds ratio [OR] 2.86, confidence interval [CI] 1.52-6.00) as well as rates of referrals that converted to actual quitline registrations (OR 2.73, CI 1.0-7.4). Providers who completed the training expressed significantly more positive attitudes and improved self-efficacy for delivering tobacco services. At follow-up most providers reported increased delivery of tobacco interventions and QL referrals, although only 17% reported increased rates of fax referral. Our study suggests that online education builds skills, improves knowledge, and thus increases the number and quality of fax referrals made to QLs by health care providers. Providers nonetheless reported ongoing barriers to providing tobacco services and referral, including lack of reimbursement and patient unwillingness to accept a referral.

: Treatment fidelity pertains to the methodological strategies used to monitor and enhance the reliability and validity of behavioral interventions. Approaches to establishing treatment fidelity in Web-based interventions differ from those used in interventions that are delivered in person. : The aim of this study was to describe a methodology for ensuring treatment fidelity in a Web-based cognitive behavioral stress management intervention. : The intervention Coping With Cancer Workbook, adapted for Web-based delivery from an in-person intervention, was tested in a randomized controlled trial with 123 breast cancer survivors. Strategies for ensuring treatment fidelity were implemented and assessed. : The National Institutes of Health Behavior Change Consortium Treatment Fidelity Guidelines were relevant to establishing treatment fidelity for the Web-based intervention. : Web-based delivery of behavioral interventions is both a strength and a threat to treatment fidelity. Investigators must be cognizant of the elements of treatment fidelity and implement strategies to monitor and improve the reliability and validity of Web-based interventions.