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Developing integrated mental health services focused on the needs of children and young people is a key policy goal in England. The THRIVE Framework and its implementation programme, i-THRIVE, are widely used in England. This study examines experiences of staff using i-THRIVE, estimates its effectiveness, and assesses how local system working relationships influence programme success.
Methods
This evaluation uses a quasi-experimental design (10 implementation and 10 comparison sites.) Measurements included staff surveys and assessment of ‘THRIVE-like’ features of each site. Additional site-level characteristics were collected from health system reports. The effect of i-THRIVE was evaluated using a four-group propensity-score-weighted difference-in-differences model; the moderating effect of system working relationships was evaluated with a difference-in-difference-in-differences model.
Results
Implementation site staff were more likely to report using THRIVE and more knowledgeable of THRIVE principles than comparison site staff. The mean improvement of fidelity scores among i-THRIVE sites was 16.7, and 8.8 among comparison sites; the weighted model did not find a statistically significant difference. However, results show that strong working relationships in the local system significantly enhance the effectiveness of i-THRIVE. Sites with highly effective working relationships showed a notable improvement in ‘THRIVE-like’ features, with an average increase of 16.41 points (95% confidence interval: 1.69–31.13, P-value: 0.031) over comparison sites. Sites with ineffective working relationships did not benefit from i-THRIVE (−2.76, 95% confidence interval: − 18.25–12.73, P-value: 0.708).
Conclusions
The findings underscore the importance of working relationship effectiveness in the successful adoption and implementation of multi-agency health policies like i-THRIVE.
NASA’s all-sky survey mission, the Transiting Exoplanet Survey Satellite (TESS), is specifically engineered to detect exoplanets that transit bright stars. Thus far, TESS has successfully identified approximately 400 transiting exoplanets, in addition to roughly 6 000 candidate exoplanets pending confirmation. In this study, we present the results of our ongoing project, the Validation of Transiting Exoplanets using Statistical Tools (VaTEST). Our dedicated effort is focused on the confirmation and characterisation of new exoplanets through the application of statistical validation tools. Through a combination of ground-based telescope data, high-resolution imaging, and the utilisation of the statistical validation tool known as TRICERATOPS, we have successfully discovered eight potential super-Earths. These planets bear the designations: TOI-238b (1.61$^{+0.09} _{-0.10}$ R$_\oplus$), TOI-771b (1.42$^{+0.11} _{-0.09}$ R$_\oplus$), TOI-871b (1.66$^{+0.11} _{-0.11}$ R$_\oplus$), TOI-1467b (1.83$^{+0.16} _{-0.15}$ R$_\oplus$), TOI-1739b (1.69$^{+0.10} _{-0.08}$ R$_\oplus$), TOI-2068b (1.82$^{+0.16} _{-0.15}$ R$_\oplus$), TOI-4559b (1.42$^{+0.13} _{-0.11}$ R$_\oplus$), and TOI-5799b (1.62$^{+0.19} _{-0.13}$ R$_\oplus$). Among all these planets, six of them fall within the region known as ‘keystone planets’, which makes them particularly interesting for study. Based on the location of TOI-771b and TOI-4559b below the radius valley we characterised them as likely super-Earths, though radial velocity mass measurements for these planets will provide more details about their characterisation. It is noteworthy that planets within the size range investigated herein are absent from our own solar system, making their study crucial for gaining insights into the evolutionary stages between Earth and Neptune.
Participant recruitment and retention (R&R) are well-documented challenges in longitudinal studies, especially those involving populations historically underrepresented in research and vulnerable groups (e.g., pregnant people or young children and their families), as is the focus of the HEALthy Brain and Child Development (HBCD) birth cohort study. Subpar access to transportation, overnight lodging, childcare, or meals can compromise R&R; yet, guidance on how to overcome these “logistical barriers” is sparse. This study’s goal was to learn about the HBCD sites’ plans and develop best practice recommendations for the HBCD consortium for addressing these logistical barriers.
Methods:
The HBCD’s workgroups developed a survey asking the HBCD sites about their plans for supporting research-related transportation, lodging, childcare, and meals, and about the presence of institutional policies to guide their approach. Descriptive statistics described the quantitative survey data. Qualitative survey responses were brief, not warranting formal qualitative analysis; their content was summarized.
Results:
Twenty-eight respondents, representing unique recruitment locations across the U.S., completed the survey. The results indicated substantial heterogeneity across the respondents in their approach toward supporting research-related transportation, lodging, childcare, and meals. Three respondents were aware of institutional policies guiding research-related transportation (10.7%) or childcare (10.7%).
Conclusions:
This study highlighted heterogeneity in approaches and scarcity of institutional policies regarding research-related transportation, lodging, childcare, and meals, underscoring the need for guidance in this area to ensure equitable support of participant R&R across different settings and populations, so that participants are representative of the larger community, and increase research result validity and generalizability.
Medical Reserve Corps’ volunteers underwent stop-the-bleed, triage, and disaster preparedness training to improve victim survival of a mass casualty event.
Methods:
Volunteer responses to 16 disaster vignettes were recorded as ‘survived’ if correct, or ‘died’ if incorrect. Volunteers’ characteristics were evaluated based on the health outcomes of the vignette victims via logistic regression.
Results:
Overall, 69 volunteers evaluated 1104 vignette victims. STB training significantly improved survival from 77.2% to 93.2% (P < 0.001). The training did not improve disaster preparedness (75.5% to 73%) nor triage (33.5% to 35.1%). Volunteer first care provider training in psychological first aid improved victim survival from 10.32 (9.6 - 10.9, 95% CI) to 11.9 (11.28 - 12.5, 95% CI). The odds of survival increased when disaster victims received first care from a volunteer who had a positive perception of the public authority’s truthfulness (1.50, range 1.07 - 2.10); stated a willingness to volunteer (1.65, range 1.2 - 2.26); completed psychological first aid training (1.557, range 1.08 - 2.22); or had 4-or-more years of post-secondary education (1.30, range 1.00 - 1.701).
Conclusion:
Psychological first aid training should be a basic requirement for disaster volunteers. Trust in public authority to provide protective public health recommendations increases disaster survival.
As of October 2021, Medical Reserve Corps (MRC) volunteers donated over 2 million h to coronavirus disease 2019 (COVID-19). The Health Belief Model (HBM) is used to understand the value a person places on preventative behavior against the risk of disease. A mixed method, unmatched, prospective case-control study was conducted regarding volunteers’ experience during the pandemic, reasons why these highly trained persons volunteer, what barriers to vaccination they observed, and how they helped others overcome those barriers. The HBM can elucidate the cognitive process to vaccinate. Regression analysis found a person’s attitude (which includes beliefs, peer pressure, preconceptions, unwillingness, and other indicators) is a barrier to vaccination. Service hours increased from 20 to 56 h among volunteers who saw attitude as a barrier to vaccination. Superstition and fear accounted for 99.8% of unvaccinated persons (P < 0.001). Fear was a barrier to protective health behavior. The public health system must do better to build trust as an ongoing endeavor, as even the increased service volunteers provided in response to the observed attitudes, was not enough to stem exponential transmission once the pandemic had begun. Policy-makers and the public health authority should take all necessary steps early in the pandemic to ensure the effectiveness of the vaccination program.
Obesity is highly prevalent and disabling, especially in individuals with severe mental illness including bipolar disorders (BD). The brain is a target organ for both obesity and BD. Yet, we do not understand how cortical brain alterations in BD and obesity interact.
Methods:
We obtained body mass index (BMI) and MRI-derived regional cortical thickness, surface area from 1231 BD and 1601 control individuals from 13 countries within the ENIGMA-BD Working Group. We jointly modeled the statistical effects of BD and BMI on brain structure using mixed effects and tested for interaction and mediation. We also investigated the impact of medications on the BMI-related associations.
Results:
BMI and BD additively impacted the structure of many of the same brain regions. Both BMI and BD were negatively associated with cortical thickness, but not surface area. In most regions the number of jointly used psychiatric medication classes remained associated with lower cortical thickness when controlling for BMI. In a single region, fusiform gyrus, about a third of the negative association between number of jointly used psychiatric medications and cortical thickness was mediated by association between the number of medications and higher BMI.
Conclusions:
We confirmed consistent associations between higher BMI and lower cortical thickness, but not surface area, across the cerebral mantle, in regions which were also associated with BD. Higher BMI in people with BD indicated more pronounced brain alterations. BMI is important for understanding the neuroanatomical changes in BD and the effects of psychiatric medications on the brain.
Mental health issues increased during the COVID - 19 pandemic, especially among children. Our past research efforts found that surveillance data can address a variety of health concerns; that personal psychological awareness impacted ability to cope, and mental health outcomes were improved when survivors were triaged to mental health countermeasures. To build upon our public health efforts, we wanted to see if increased screen time due to remote learning caused by the pandemic influenced school aged children’s mental health.
Methods:
With the hypothesis that excessive time spent isolated during remote learning increased the amount of mental health events in children, we conducted a public health surveillance project on actual diagnoses rather than just symptoms, controlling for historical mental health and emotional disorders.
Results:
The entire cohort of children aged 6 to 17 years were studied over time before and during the pandemic for their medically diagnosed mental health and emotional outcomes by the amount of pandemic induced social isolation.
Conclusions:
After controlling for historical diagnoses and the rate of COVID - 19, the effect of pandemic - induced social isolation had a linear increase on the amount of anxiety, resulting in a 4-fold increase in pandemic social isolation - induced anxiety.
Invasive aquatic plants constantly threaten freshwaters and associated environs globally. Water resource managers frequently seek new control tactics to combat invasive macrophytes, especially when the availability of herbicides registered for submersed plant control is limited. The synthetic auxin herbicide, florpyrauxifen-benzyl, recently registered (2018) for aquatic site applications in the United States, has shown success in controlling several invasive aquatic weeds. Studies were conducted to evaluate responses of native and invasive submersed plants to florpyrauxifen-benzyl under growth chamber conditions to provide insight on the selectivity of varying herbicide concentrations in New Zealand. Florpyrauxifen-benzyl concentrations evaluated ranged from 0.01 to 107.86 µg ai L−1, encompassing the maximum use concentration (48 µg L−1) for submersed plant applications. Dose–response metrics indicated the New Zealand native species watermilfoil [Myriophyllum triphyllum Orchard] was highly sensitive to florpyrauxifen-benzyl following a 21-d static exposure, having a dry weight 50% effective concentration (EC50) value of 1.2 µg L−1. The invasive species oxygen-weed [Lagarosiphon major (Ridley) Moss] and Canadian waterweed (Elodea canadensis Michx.) were less sensitive, with dry weight EC50 values of 35.4 and >107.86 µg L−1, respectively. Brazilian waterweed (Egeria densa Planch.) was most tolerant to the tested concentrations, as EC50 values were not achieved. Overall, results indicate florpyrauxifen-benzyl demonstrates potential for controlling L. major, with further large-scale screening required to confirm control among field site applications. As the native species (M. triphyllum) was most sensitive to florpyrauxifen-benzyl compared with the invasive plant evaluated (I/N ratio indicated >31.3 times more sensitive), any targeted concentration used for invasive plant control for field applications would likely injure the native M. triphyllum plants. Future studies should investigate additional native and invasive species for management guidance and consider how exposure times influence plant response using similar florpyrauxifen-benzyl concentrations tested in the present study.
Evidence of Late Triassic large tetrapods from the UK is rare. Here, we describe a track-bearing surface located on the shoreline near Penarth, south Wales, United Kingdom. The total exposed surface is c. 50 m long and c. 2 m wide, and is split into northern and southern sections by a small fault. We interpret these impressions as tracks, rather than abiogenic sedimentary structures, because of the possession of marked displacement rims and their relationship to each other with regularly spaced impressions forming putative trackways. The impressions are large (up to c. 50 cm in length), but poorly preserved, and retain little information about track-maker anatomy. We discuss alternative, plausible, abiotic mechanisms that might have been responsible for the formation of these features, but reject them in favour of these impressions being tetrapod tracks. We propose that the site is an additional occurrence of the ichnotaxon Eosauropus, representing a sauropodomorph trackmaker, thereby adding a useful new datum to their sparse Late Triassic record in the UK. We also used historical photogrammetry to digitally map the extent of site erosion during 2009–2020. More than 1 m of the surface exposure has been lost over this 11-year period, and the few tracks present in both models show significant smoothing, breakage and loss of detail. These tracks are an important datapoint for Late Triassic palaeontology in the UK, even if they cannot be confidently assigned to a specific trackmaker. The documented loss of the bedding surface highlights the transient and vulnerable nature of our fossil resources, particularly in coastal settings, and the need to gather data as quickly and effectively as possible.
Systemic ventricular end-diastolic pressure is an important haemodynamic variable in adult patients with Fontan circulation. Risk factors associated with elevated end-diastolic pressure have not been clearly identified in this population.
Methods:
All patients > 18 years with Fontan circulation who underwent cardiac catheterisation at our centre between 1/08 and 3/19 were included. Relevant patient variables were extracted. Univariate and multivariate general linear models were analysed to identify variables associated with end-diastolic pressure.
Results:
Forty-two patients were included. Median age was 24.0 years (20.9–29.0) with a body mass index of 23.7 kg/m2 (21.5–29.7). 10 (23.8%) patients had a systemic right ventricle. The median (Interquartile range) and mean pulmonary artery pressure were 11.0 mmHg (9.0–12.0) and 16.0 mmHg (13.0–18.0), respectively. On univariate analysis, end-diastolic pressure was positively associated with body mass index (p < 0.01), age > 25 years (p = 0.04), symptoms of heart failure (p < 0.01), systemic ventricular systolic pressure (p = 0.03), pulmonary artery mean pressure (p < 0.01), and taking diuretics (p < 0.01) or sildenafil (p < 0.01). End-diastolic pressure was negatively associated with aortic saturation (p < 0.01). On multivariate analysis, end-diastolic pressure was positively associated with age ≥ 25 years (p < 0.01), and body mass index (p = 0.04).
Conclusions:
In a cohort of adult patients with Fontan circulation undergoing catheterisation, end-diastolic pressure was positively associated with age ≥ 25 years and body mass index on multivariate analysis. Maintaining a healthy body mass index may offer haemodynamic benefit in adults with Fontan physiology.
The regulation of mutual funds in the United States arguably contains the world’s most extensive system of fiduciary protection, buttressed by elaborate liability rules and a host of procedural protections and mandatory disclosure requirements designed to facilitate investor protection and choice. The intensity of this regulatory structure is a subject of perennial debate, as officials and analysts attempt to balance the cost of compliance and oversight against benefits to investors. Government officials have made numerous accommodations to ameliorate the system’s costs and facilitate industry innovations. But, the burdens of this enhanced system of fiduciary protections for mutual funds remain significant and have encouraged industry participants to evade these legal requirements in a number of ways, such as the creation of alternative vehicles for collective investments and the imbedding of regulated mutual funds into other legal structures that escape the full application of the enhanced system of fiduciary protections for mutual funds. This chapter suggests areas where aspects of mutual fund regulation might appropriately be extended to functionally similar investment vehicles.
Smart contracts have been proposed as a means of revolutionizing transacting between human actors and contributing to blockchain platforms substituting for many current institutions. However, the technical nature of blockchain platforms and smart contracts requires levels of certainty and foresight sufficient for contracts to be complete. We examine the technical and economic characteristics of blockchains and smart contracts to identify sources of uncertainty that may pose challenges to the ability of these technologies to displace existing institutional arrangements, in particular, the courts and other arbitration arrangements. Despite the development of alternative automated blockchain institutions such as the Kleros dispute resolution system, the case for smart contracts and blockchain applications to supplant real-world institutions remains weak. Inherent incompleteness due to limits to information availability, human cognition, and communication means that traditional contract governance institutions will continue to complement blockchain smart contract governance arrangements. The more complex and unique the transaction, the higher the value at risk, the harder to anticipate and precisely specify contingencies and measure and observe outcomes. Furthermore, the longer the time frame between agreement and execution, the less likely it is that smart contracting will be more efficient than traditional contracting.
People with neurodevelopmental disorders often present with challenging behaviours and psychiatric illnesses. Diagnosis and treatment require patients, families and healthcare professionals to work closely together in partnership, acknowledging their respective areas of expertise. Good treatment outcomes should also be underpinned by robust research evidence. Key research priorities are highlighted.
Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.
Analytical transmission electron microscopy (ATEM) and X-ray absorption spectroscopy (XAS) have been used to determine the mineralogy of Pb-P deposits in the roots of the heavy metal tolerant grass cultivar Agrostis capillaris L. cv. Parys Mountain. The deposits have a pyromorphite (Pb5(PO4)3Cl)-type structure and composition although some of the Cl may be substituted by OH. Energy-dispersive mapping under the scanning electron microscope demonstrated that the majority of these deposits are present in the outer cell wall of the epidermis (the outermost layer of root cells). The phosphate composition of these grains contrasts with the phytate (C6H18O24P612−) composition of Zn-P deposits observed in similar electron microscopy studies. The physiological role of heavy metal P deposits is unclear. Heavy metal P precipitates may form actively as a tolerance mechanism to heavy metals or passively, sequestering P in a metabolically inactive form.
Mollusc seashells grow through the local deposition and calcification of material at the shell opening by a soft and thin organ called the mantle. Through this process, a huge variety of shell structures are formed. Previous models have shown that these structural patterns can largely be understood by examining the mechanical interaction between the deformable mantle and the rigid shell aperture to which it adheres. In this paper we extend this modelling framework in two distinct directions. For one, we incorporate a mechanical feedback in the growth of the mollusc. Second, we develop an initial framework to couple the two primary and orthogonal modes of pattern formation in shells, which are termed antimarginal and commarginal ornamentation. In both cases we examine the change in shell morphology that occurs due to the different mechanical influences and evaluate the hypotheses in light of the fossil record.
The discovery of the first electromagnetic counterpart to a gravitational wave signal has generated follow-up observations by over 50 facilities world-wide, ushering in the new era of multi-messenger astronomy. In this paper, we present follow-up observations of the gravitational wave event GW170817 and its electromagnetic counterpart SSS17a/DLT17ck (IAU label AT2017gfo) by 14 Australian telescopes and partner observatories as part of Australian-based and Australian-led research programs. We report early- to late-time multi-wavelength observations, including optical imaging and spectroscopy, mid-infrared imaging, radio imaging, and searches for fast radio bursts. Our optical spectra reveal that the transient source emission cooled from approximately 6 400 K to 2 100 K over a 7-d period and produced no significant optical emission lines. The spectral profiles, cooling rate, and photometric light curves are consistent with the expected outburst and subsequent processes of a binary neutron star merger. Star formation in the host galaxy probably ceased at least a Gyr ago, although there is evidence for a galaxy merger. Binary pulsars with short (100 Myr) decay times are therefore unlikely progenitors, but pulsars like PSR B1534+12 with its 2.7 Gyr coalescence time could produce such a merger. The displacement (~2.2 kpc) of the binary star system from the centre of the main galaxy is not unusual for stars in the host galaxy or stars originating in the merging galaxy, and therefore any constraints on the kick velocity imparted to the progenitor are poor.
In 2013, New York State mandated that, during influenza season, unvaccinated healthcare personnel (HCP) wear a surgical mask in areas where patients are typically present. We found that this mandate was associated with increased HCP vaccination and decreased HCP visits to the hospital Workforce Health and Safety Department with respiratory illnesses and laboratory-confirmed influenza.