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List, J. A. (2024). Optimally generate policy-based evidence before scaling. Nature, 626(7999), 491–499. https://doi.org/10.1038/s41586-023-06972-y

Social scientists have increasingly turned to the experimental method to understand human behaviour. One critical issue that makes solving social problems difficult is scaling up the idea from a small group to a larger group in more diverse situations. The urgency of scaling policies impacts us every day, whether it is protecting the health and safety of a community or enhancing the opportunities of future generations. Yet, a common result is that, when we scale up ideas, most experience a ‘voltage drop’— that is, on scaling, the cost–benefit profile depreciates considerably. Here I argue that, to reduce voltage drops, we must optimally generate policy-based evidence. Optimality requires answering two crucial questions: what information should be generated and in what sequence. The economics underlying the science of scaling provides insights into these questions, which are in some cases at odds with conventional approaches. For example, there are important situations in which I advocate flipping the traditional social science research model to an approach that, from the beginning, produces the type of policy-based evidence that the science of scaling demands. To do so, I propose augmenting efficacy trials by including relevant tests of scale in the original discovery process, which forces the scientist to naturally start with a recognition of the big picture: what information do I need to have scaling confidence?



NIA approved concepts from the January 2024 National Advisory Council on Aging (NACA). Please note that not all concepts will necessarily end up converting to a Notice of Funding Opportunity (NOFO). Here are BSR-relevant approved concepts:

Job Opportunities in NIA's Division of Behavioral and Social Research

New Behavioral and Social Science Funding Opportunities from NIA and NIH   
  • The USC AD/ADRD Resource Center for Minority Aging Research (RCMAR) Scientist is currently accepting applications for junior scientists to fund one-year research pilot projects. Pilot projects with a focus on cognitive decline and/or Alzheimer’s disease and related dementias are encouraged. Learn more and submit a letter of intent and CV by February 16, 2024.

  • The University of Texas at Austin Center on Aging and Population Sciences (CAPS) is requesting pilot projects on LGBTQ+ population aging. Learn more and submit proposal by February 16, 2024.

  • The Columbia University AD/ADRD RCMAR Center is soliciting pilot proposals that address the fundamental causes of AD/ADRD disparities (racism, sexism, classism, and homophobia) using multiple levels of analysis (environmental, sociocultural, behavioral, and biological). Learn more, submit a letter of intent by February 21, 2024, and submit a full proposal on March 8, 2024.

  • The Network on Education, Biosocial Pathways, and Dementia across Diverse Population is soliciting pilot proposals that will advance science in the education—dementia relationship. Learn more and submit proposal by February 26, 2024 at 11:59 PM ET.

  • The University of California, San Francisco (UCSF) RCMAR Center requests applications for the 2024 CADC Scientist Program.  Those selected will conduct a one-year pilot study to investigate research questions within the scope of CADC’s goals among older Black/African American, Latino/a/x, Asian American, Pacific Islander, Native American/American Indian populations, sexual and gender minorities of any race/ethnicity, or the intersection of disability and those populations. Learn more and submit an application by March 1, 2024, at 5 PM PST.

  • The NIA IMPACT Collaboratory is currently accepting applications for pilot ePCTs that test non-pharmacological interventions embedded in health care system(s) for people living with AD/ADRD and their care partners. All applications must make a convincing case that the pilot ePCT proposed can be scaled up to a full-scale Stage IV effectiveness ePCT as the next step.  Learn more and submit a letter of intent by March 3, 2024, at 5 PM ET.

  • The Rutgers University AD/ADRD RCMAR Center is requesting pilot proposals that focus on the intersection of AD/ADRD-related psychosocial risk factors, detection, and health outcomes involving older Asian Americans. Learn more and apply by April 1, 2024, by 11:59 PM ET.

Bergman M, Markowitz JC, Kronish IM, Agarwal S, Fisch C, Eder-Moreau E, Neria Y. Acceptance and mindfulness-based exposure therapy (AMBET) for PTSD after cardiac arrest: an open feasibility trial. Journal of clinical psychiatry.


Background: Posttraumatic stress disorder (PTSD) is prevalent after surviving sudden cardiac arrest (SCA). SCA-induced PTSD is associated with increased mortality and cardiovascular risk, yet no psychotherapeutic treatment has been developed and tested for this population. Exposure therapy is standard treatment for PTSD, but its safety and efficacy remain unconfirmed for SCA survivors: current protocols do not address their specific disease course and have high attrition. Mindfulness-based interventions are typically well-tolerated and have shown promise in reducing PTSD symptoms from other traumas.

Objective: This study sought to determine feasibility, safety, and preliminary efficacy of acceptance and mindfulness-based exposure therapy (AMBET), a novel SCA-specific psychotherapy protocol combining mindfulness and exposure-based interventions with cardiac focused psychoeducation to reduce symptoms and improve health behaviors in patients with post-SCA PTSD.

Methods: We conducted an open feasibility pilot study from January 2021 to April 2022 with a small sample (N = 11) of SCA survivors meeting DSM-5 PTSD criteria. AMBET comprised eight 90-minute remotely delivered individual sessions. Clinical evaluators assessed PTSD symptoms using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) at baseline, midpoint, posttreatment, and 3-month follow-up.

Results: Ten (91%) of 11 enrolled patients completed treatment. Satisfaction was high and patients reported no adverse events. PTSD symptoms significantly improved statistically (P < .001) and clinically with large effect sizes (g = 1.34–2.21) and treatment gains sustained at 3-month follow-up. Posttreatment, 80% of completers (n = 8) showed significant treatment response, 70% (n = 7) with PTSD diagnostic remission. No patient reported symptom increases.

Conclusions: This initial trial found AMBET feasible, safe, and potentially efficacious in reducing PTSD following SCA. These encouraging pilot results warrant further research.


Birk J, Cumella R, Lopez-Veneros D, Agarwal S, Kronish IM. Feasibility of a remote heart rate variability biofeedback intervention for reducing anxiety in cardiac arrest survivors: a pilot trial. Contemporary clinical trials communications.

Background: Heart rate variability biofeedback (HRVB) is a promising non-pharmacologic approach for reducing anxiety. This intervention's feasibility needs testing in psychologically distressed cardiac patients for whom heart-related anxiety is a core concern. To enhance scalability and convenience, remote delivery of HRVB also needs to be assessed. Accordingly, we evaluated the feasibility of remote HRVB in survivors of cardiac arrest (CA) with elevated CA-related psychological distress.

Methods

The intervention was comprised of daily sessions of diaphragmatic paced breathing and real-time monitoring of cardiac activity guided by a smartphone app and heart rate monitor. This single-arm feasibility trial assessed the percentage of eligible contacted patients who consented and engaged in the study and the self-reported acceptability, feasibility, appropriateness, and usability of the intervention. Exploratory analyses assessed pre-to-post changes in trait anxiety, negative affect, cardiac-related interoceptive fear, and resting-state HRV.

Results

Of 12 eligible CA survivors contacted, 10 enrolled. All 10 patients completed the virtual study visits and the majority (>50 %) of prescribed training sessions. Ninety percent reported good scores for intervention acceptability and feasibility, and 80 % reported good scores for its appropriateness and usability for reducing fear. Trait anxiety decreased significantly pre-to-post intervention. There were no changes in negative affect, interoceptive fear, or resting state HRV.

Conclusion

A remotely delivered HRVB intervention was acceptable, feasible, and useable for cardiac patients with CA-related psychological distress. A phase 2 randomized controlled trial evaluating the efficacy of HRVB on cardiac patients’ psychological distress, health behaviors, and autonomic dysfunction may be warranted.


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