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Jessica L Bourdon,1 Sidney Judson,1 Gabriella Caporaso,1 Monica F Wright,2 Taylor Fields,1 Nehal P Vadhan,3 Jon Morgenstern4 1Center for Addiction Science, Wellbridge Addiction Treatment and Research, Calverton, NY, USA; 2Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; 3Institute of Behavioral Science, Feinstein Institutes for Medical Research, Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempsted, NY, USA; 4Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempsted, NY, USACorrespondence: Jessica L Bourdon, Center for Addiction Science, Wellbridge Addiction Treatment and Research, 525 Jan Way, Calverton, NY, 11933, USA, Email jbourdon@wellbridge.orgBackground: Quality training is an oft-cited barrier to effective implementation and ongoing delivery of high-quality evidence-based practice (EBP) across fields. This is especially true in the addiction field, but there is little cited evidence for optimal methods to improve EBP in inpatient addiction facilities with minimal resources.Objective: The current paper focuses on evaluating the state of our facility’s group CBT manual and clinical training on the manual in a “realistic” (ie, non-RCT, non-grant-funded) inpatient addiction treatment setting.Methods: Five full-time clinicians volunteered to take part in the study (woman = 60%; Mage = 36.20 years). The study involved a mix of semi-structured interviews and surveys designed to measure seven outcomes (barriers, feasibility, useability, appropriateness, acceptability, burden, trialability).Results: Three themes emerged from the data that impacted the group CBT manual: training, timing, and functionality. Addressing these themes allowed for a new, optimal manual and training procedure to be put into place.Conclusion: The current study highlights that under-resourced inpatient addiction facilities can still methodically utilize implementation approaches to study their EBP, namely CBT. Such an approach will ensure that the highest quality care is being delivered to patients and actively addresses known training barriers that prevent proper EBP delivery.Plain Language Summary: Quality training is a barrier when implementing evidenced-based practice to treat substance use disorders.CBT is a manualized evidence-based practice that is performed at inpatient addiction facilities.An evaluation of the CBT manual was made by an inpatient addiction facility to identify barriers of implementation of EBPs.Identified barriers included training, timing, and functionality.Keywords: cognitive behavioral therapy, addiction, evidence-based practice, inpatient, substance use disorders

Aim: Small fibre neuropathy (SFN) diagnosis represents a challenge for neurologists. The diagnostic gold standard is intraepidermal nerve fibre (IENF) density, but in about 10–20% of patients with symptoms/signs and abnormalities on functional tests, it remains within normal range. We propose an adjunctive parameter to improve the efficiency of skin biopsy diagnosis. Methods: We recruited 31 patients with SFN symptoms/signs, normal nerve conduction study, abnormal quantitative sensory testing and normal IENF density. We also included 31 healthy controls and 31 SFN patients with reduced IENF density as control groups. Results: We measured the distance between consecutive IENFs in the three groups. Mean inter‐fibre distances did not differ between patients with normal counts and healthy controls (66.7 ± 14.5 μm vs. 76.7 ± 13.4 μm; P = 0.052), while the relative standard deviation was significantly (P < 0.001) higher in patients (79.3 ± 29.9) compared to controls (51.6 ± 12.2). Using ROC analysis, we identified an inter‐fibre distance of 350 µm as the measure that better differentiated patients from controls (AUC = 0.85, sensitivity: 74%, specificity: 94%). At least one such segment was also observed in all patients with reduced IENF count. Conclusion: Irregular spatial distribution is an SFN intrinsic feature preceding actual nerve loss. The presence of a stretch of denervated epidermis longer than 350 µm is a parameter able to increase the diagnostic efficiency of skin biopsy. [ABSTRACT FROM AUTHOR]

At Lawrence Livermore National Laboratory, we are developing a new type of accelerator, known as a dielectric wall accelerator, in which compact pulse-forming lines directly apply an accelerating field to the beam through an insulating vacuum boundary. The electrical strength of this insulator may define the maximum gradient achievable in these machines. To increase the system gradient, we use “high-gradient insulators” composed of alternating layers of dielectric and metal for the vacuum insulator. In this paper, we present our recent results from experiment and simulation, including successful testing of a high-gradient insulator in a functioning dielectric wall accelerator cell. Our results indicate that proper high-voltage conditioning of the insulators can delay the onset of flashover, that the observed conditioning consists of both a permanent and a temporary part, and that the insulators’ voltage-holding capability increases with increasing dielectric layer thickness. [ABSTRACT FROM AUTHOR]