Stress hyperglycemia exacerbates inflammatory brain injury after stroke.

Post-stroke hyperglycemia occurs in 30% - 60% of ischemic stroke patients as part of the systemic stress response, but neither clinical evidence nor pre-clinical studies indicate whether post-stroke hyperglycemia affects stroke outcome. Here we investigated this issue using a mouse model of permanent ischemia. Mice were maintained either normoglycemic or hyperglycemic during the interval of 17 - 48 hours after ischemia onset. Post-stroke hyperglycemia was found to increase infarct volume, blood-brain barrier disruption, and hemorrhage formation, and to impair motor recovery. Post-stroke hyperglycemia also increased superoxide formation by peri-infarct microglia/macrophages. In contrast, post-stroke hyperglycemia did not increase superoxide formation or exacerbate motor impairment in p47 phox-/- mice, which cannot form an active superoxide-producing NADPH oxidase-2 complex. These results suggest that hyperglycemia occurring hours-to-days after ischemia can increase oxidative stress in peri-infarct tissues by fueling NADPH oxidase activity in reactive microglia/macrophages, and by this mechanism contribute to worsened functional outcome.

Perinatal Women's Perspectives of, and Engagement in, Digital Emotional Well-Being Training: Mixed Methods Study.

BACKGROUND: Psychological distress in the early postpartum period can have long-lasting deleterious effects on a mother's well-being and negatively affect her infant's development. Intervention approaches based in contemplative practices such as mindfulness and loving-kindness and compassion are intended to alleviate distress and cultivate well-being and can be delivered effectively as digital mental health interventions (DMHIs). OBJECTIVE: To understand the feasibility of engaging perinatal women in digital interventions, this study aimed to document participants' experiences in the Mums Minds Matter (MMM) study, a pilot randomized controlled trial comparing mindfulness, loving-kindness and compassion, and progressive muscle relaxation training delivered in a digital format and undertaken during pregnancy. To assess the different stages of engagement during and after the intervention, we adapted the connect, attend, participate, enact (CAPE) framework that is based on the idea that individuals go through different stages of engagement before they are able to enact change. METHODS: The MMM study was nested within a longitudinal birth cohort, The ORIGINS Project. We aimed to recruit 25 participants per randomization arm. Data were collected sequentially during the intervention through regular web-based surveys over 8 weeks, with opportunities to provide regular feedback. In the postintervention phase, qualitative data were collected through purposive sampling. RESULTS: Of 310 eligible women, 84 (27.1% [connect rate]) enrolled to participate in MMM. Of the remaining 226 women who did not proceed to randomization, 223 (98.7%) failed to complete the baseline surveys and timed out of eligibility (after 30 weeks' gestation), and 3 (1.3%) displayed high psychological distress scores. Across all program groups, 17 (20% [attend rate]) of the 84 participants actively opted out, although more may have disengaged from the intervention but did not withdraw. The main reasons for withdrawal were busy life and other priorities. In this study, we assessed active engagement and ongoing skills use (participate and enact) through postintervention interviews. We undertook 15 participant interviews, conducted 1 month to 3 months after the intervention. Our results provide insights into participant barriers and enablers as well as app changes, such as the ability to choose topics, daily reminders, case studies, and diversity in sounds. Implementing a DMHI that is brief, includes frequent prompts or nudges, and is easily accessible is a key strategy to target perinatal women. CONCLUSIONS: Our research will enable future app designs that are sufficiently nuanced to maximize the uptake, engagement, and application of mental health skills and contemplative practices in the perinatal period. Providing convenient access to engaging and effective prevention programs is critical and should be part of prenatal self-care. Our research underscores the appeal and feasibility of digital intervention approaches based in contemplative practices for perinatal women. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) 12620000672954p; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000672954p. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/19803.

The ORIGINS Project Biobank: A Collaborative Bio Resource for Investigating the Developmental Origins of Health and Disease.

Early onset Non-Communicable Diseases (NCDs), including obesity, allergies, and mental ill-health in childhood, present a serious and increasing threat to lifelong health and longevity. The ORGINS Project (ORIGINS) addresses the urgent need for multidisciplinary efforts to understand the detrimental multisystem impacts of modern environments using well-curated large-scale longitudinal biological sample collections. ORGINS is a prospective community birth cohort aiming to enrol 10,000 pregnant people and follow each family until the children reach 5 years of age. A key objective is to generate a comprehensive biorepository on a sub-group of 4000 families invited to contribute blood, saliva, buccal cells, urine, stool, hair, house dust, cord blood, placenta, amniotic fluid, meconium, breastmilk, and colostrum over eight timepoints spanning the antenatal period and early childhood. Uniquely, ORIGINS includes a series of nested sub-projects, including interventions and clinical trials addressing different aspects of health. While this adds complexity as the project expands, it provides the opportunity for comparative studies. This research design promotes a multidisciplinary, multisystem approach to biological sample collection, analysis, and data sharing to ensure more integrated perspectives and solutions. This paper details the evolving protocol of our collaborative biobanking concept. Further, we outline our future visions for local, national, and ultimately international, comparative, and collaborative opportunities to advance our understanding of early onset NCDs and the opportunities to improve health outcomes for future generations.

Time-out for well-being: A mixed methods evaluation of attitudes and likelihood to engage in different types of online emotional well-being programmes in the perinatal period.

BACKGROUND: Positive maternal mental health during the perinatal period contributes to general well-being and positive emotional bonds with the child, encouraging an optimal developmental trajectory. Online interventions to enhance maternal well-being and develop coping skills, such as meditation-based interventions, can be a low-cost way to improve mother and child outcomes. However, this depends on end-user engagement. To date, there is limited evidence about women's willingness to engage and preferences for online programmes. OBJECTIVES: This study explored pregnant women's attitudes towards and likelihood to undertake minimal online well-being training programmes (mindfulness, self-compassion, or general relaxation), engagement barriers and enablers, and programme structure preferences. DESIGN: A mixed methods triangulation design was undertaken using a validating quantitative model. Quantile regressions were applied to the quantitative data. Content analysis was undertaken for the qualitative data. METHODS: Consenting pregnant women (n = 151) were randomized equally to read about three online programme types. Participants were sent an information leaflet, tested by a consumer panel prior to distribution. RESULTS: Participants generally held positive attitudes about all three types of interventions, with no statistically significant differences in preferences between programme types. Participants appreciated the importance of mental health and were receptive to fostering skills to support their emotional well-being and stress management. The most frequent perceived barriers were lack of time, tiredness, and forgetfulness. Programme structure preferences indicated one to two modules per week, less than 15 min in duration, and over 4 weeks. Programme functionality, such as regular reminders and easy accessibility, is important to end users. CONCLUSION: Our findings reinforce the importance of determining participant preferences in designing and communicating engaging interventions for perinatal women. This research contributes to the understanding of population-based interventions that can be provided as simple, scalable, cost-effective, and home-based activities in pregnancy for the benefit of individuals, their families, and society more broadly.

Toward the fabrication of a 5-µm-resolution Wolter microscope for the National Ignition Facility (invited).

Advancements in computer-controlled polishing, metrology, and replication have led to an x-ray mirror fabrication process that is capable of producing high-resolution Wolter microscopes. We present the fabrication and test of a nickel-cobalt replicated full-shell x-ray mirror that was electroformed from a finely figured and polished mandrel. This mandrel was designed for an 8-m source-to-detector-distance microscope, with 10× magnification, and was optimized to reduce shell distortions that occur within 20 mm of the shell ends. This, in combination with an improved replication tooling design and refined bath parameters informed by a detailed COMSOL Multiphysics® model, has led to reductions in replication errors in the mirrors. Mandrel surface fabrication was improved by implementing a computer-controlled polishing process that corrected the low-frequency mandrel figure error and achieved <2.0 nm RMS convergence error. X-ray tests performed on a pair of mirror shells replicated from the mandrel have demonstrated <10 µm full-width at half-maximum (FWHM) spatial resolution. Here, we discuss the development process, highlight results from metrology and x-ray testing, and define a path for achieving a program goal of 5 µm FWHM resolution.

Understanding Engagement in Digital Mental Health and Well-being Programs for Women in the Perinatal Period: Systematic Review Without Meta-analysis.

BACKGROUND: Pregnancy and the postnatal period can be a time of increased psychological distress, which can be detrimental to both the mother and the developing child. Digital interventions are cost-effective and accessible tools to support positive mental health in women during the perinatal period. Although studies report efficacy, a key concern regarding web-based interventions is the lack of engagement leading to drop out, lack of participation, or reduced potential intervention benefits. OBJECTIVE: This systematic review aimed to understand the reporting and levels of engagement in studies of digital psychological mental health or well-being interventions administered during the perinatal period. Specific objectives were to understand how studies report engagement across 4 domains specified in the Connect, Attend, Participate, and Enact (CAPE) model, make recommendations on best practices to report engagement in digital mental health interventions (DMHIs), and understand levels of engagement in intervention studies in this area. To maximize the utility of this systematic review, we intended to develop practical tools for public health use: to develop a logic model to reference the theory of change, evaluate the studies using the CAPE framework, and develop a guide for future data collection to enable consistent reporting in digital interventions. METHODS: This systematic review used the Cochrane Synthesis Without Meta-analysis reporting guidelines. This study aimed to identify studies reporting DMHIs delivered during the perinatal period in women with subclinical mood symptoms. A systematic database search was used to identify relevant papers using the Ovid Platform for MEDLINE, PsycINFO, EMBASE, Scopus, Web of Science, and Medical Subject Headings on Demand for all English-language articles published in the past 10 years. RESULTS: Searches generated a database of 3473 potentially eligible studies, with a final selection of 16 (0.46%) studies grouped by study design. Participant engagement was evaluated using the CAPE framework and comparable variables were described. All studies reported at least one engagement metric. However, the measures used were inconsistent, which may have contributed to the wide-ranging results. There was insufficient reporting for enactment (ie, participants' real-world use of intervention skills), with only 38% (6/16) of studies clearly recording longer-term practice through postintervention interviews. The logic model proposes ways of conceptualizing and reporting engagement details in DMHIs more consistently in the future. CONCLUSIONS: The perinatal period is the optimal time to intervene with strength-based digital tools to build positive mental health. Despite the growing number of studies on digital interventions, few robustly explore engagement, and there is limited evidence of long-term skill use beyond the intervention period. Our results indicate variability in the reporting of both short- and long-term participant engagement behaviors, and we recommend the adoption of standardized reporting metrics in future digital interventions. TRIAL REGISTRATION: PROSPERO CRD42020162283; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=162283.

Comparison of Experiences in Two Birth Cohorts Comprising Young Families with Children under Four Years during the Initial COVID-19 Lockdown in Australia and the UK: A Qualitative Study.

This study aims to understand the experience and impact of the initial COVID-19 lockdown in young families with children aged below 4 years. Free text questions were administered to participants in the ORIGINS (Australia) and Born in Bradford (UK) cohort studies to collect qualitative information on worries, concerns and enjoyable experiences during the pandemic. A total of 903 (400 for ORIGINS and 503 for BiB) participants completed the two surveys during April 2020. Despite varying in geography, levels of socio-economic disadvantage and their situational context during the pandemic, respondents from both cohorts reported similar worries and challenges during the lockdown period, including: employment/finances, health anxiety, mental health and social isolation, caring for children and child development. Families across the globe experienced both positive and negative immediate impacts of COVID-19. Population-based data can be used to inform the development of support services, public health campaigns and universal interventions to assist families in future health crises.

Can Positive Mindsets Be Protective Against Stress and Isolation Experienced during the COVID-19 Pandemic? A Mixed Methods Approach to Understanding Emotional Health and Wellbeing Needs of Perinatal Women.

The aim of this study was to explore the relationship between emotional health and wellbeing and support needs of perinatal women during the COVID-19 pandemic, and to understand their experiences and need for support. This is a potentially vulnerable group and a critical developmental phase for women and infants. A mixed methods design was used to collect quantitative and qualitative data that provided a robust insight into their unique needs. A total of 174 women who were either pregnant or post-birth participated. The main findings demonstrated that women in this cohort experienced varying levels of stress and isolation but also positive experiences. Exploring the relationship between mental health (perceived stress and wellbeing) and resilience (mindfulness and self-compassion) revealed an association between positive mental health and higher levels of mindfulness and self-compassion. Positive mindsets may be protective against psychological distress for the mother and her child, suggesting that meditation-based or similar training might help support expectant and post-birth mothers during times of crisis, such as a pandemic. This information could be used to make recommendations for future planning for practitioners and policymakers in preparing for prospective infection waves, pandemics, or natural disasters, and could be used to develop targeted tools, support, and care.

Developmental Origins of Health and Disease (DOHaD): The importance of life-course and transgenerational approaches.

With well-established evidence that early life conditions have a profound influence on lifespan and health-span, new interventional birth cohorts are examining ways to optimise health potential of individuals and communities. These are aimed at going beyond preventing disease, to the conditions that facilitate flourishing from an early age. Covering diverse domains, local community projects, such as The ORIGINS Project, are taking a broader approach to the protective and buffering factors that enhance resilience and reduce allostatic load, such as building nature relatedness, interpersonal relationships, mindfulness, and positive emotions. Such cohorts aim to address how 'upstream' approaches will have flow on effects to the 'historical' risk targets (such as poor nutrition, physical inactivity, and stress) by influencing these core behaviours through better relationships with self, community, and the environment. In addition to scientific pursuit, interventional cohorts can contribute to solutions ineverycommunity - nourishing individuals and communities towards positive change.

Does Neonatal Imitation Exist? Insights From a Meta-Analysis of 336 Effect Sizes.

Neonatal imitation is a cornerstone in many theoretical accounts of human development and social behavior, yet its existence has been debated for the past 40 years. To examine possible explanations for the inconsistent findings in this body of research, we conducted a multilevel meta-analysis synthesizing 336 effect sizes from 33 independent samples of human newborns, reported in 26 articles. The meta-analysis found significant evidence for neonatal imitation (d = 0.68, 95% CI = [0.39, 0.96], p < .001) but substantial heterogeneity between study estimates. This heterogeneity was not explained by any of 13 methodological moderators identified by previous reviews, but it was associated with researcher affiliation, test of moderators (QM) (15) = 57.09, p < .001. There are at least two possible explanations for these results: (a) Neonatal imitation exists and its detection varies as a function of uncaptured methodological factors common to a limited set of studies, and (2) neonatal imitation does not exist and the overall positive result is an artifact of high researcher degrees of freedom.

A stochastic model of jaguar abundance in the Peruvian Amazon under climate variation scenarios.

The jaguar (Panthera onca) is the dominant predator in Central and South America, but is now considered near-threatened. Estimating jaguar population size is difficult, due to uncertainty in the underlying dynamical processes as well as highly variable and sparse data. We develop a stochastic temporal model of jaguar abundance in the Peruvian Amazon, taking into account prey availability, under various climate change scenarios. The model is calibrated against existing data sets and an elicitation study in Pacaya Samiria. In order to account for uncertainty and variability, we construct a population of models over four key parameters, namely three scaling parameters for aquatic, small land, and large land animals and a hunting index. We then use this population of models to construct probabilistic evaluations of jaguar populations under various climate change scenarios characterized by increasingly severe flood and drought events and discuss the implications on jaguar numbers. Results imply that jaguar populations exhibit some robustness to extreme drought and flood, but that repeated exposure to these events over short periods can result in rapid decline. However, jaguar numbers could return to stability-albeit at lower numbers-if there are periods of benign climate patterns and other relevant factors are conducive.

Comparing Web-Based Mindfulness With Loving-Kindness and Compassion Training for Promoting Well-Being in Pregnancy: Protocol for a Three-Arm Pilot Randomized Controlled Trial.

BACKGROUND: Promoting psychological well-being and preventing distress among pregnant women is an important public health goal. In addition to adversely impacting the mother's health and well-being, psychological distress in pregnancy increases the risk of poor pregnancy outcomes, compromises infant socioemotional development and bonding, and heightens maternal and child vulnerability in the postpartum period. Mindfulness and compassion-based interventions show potential for prevention and early intervention for perinatal distress. As there is an established need for accessible, scalable, flexible, and low-cost interventions, there is increased interest in the delivery of these programs on the web. This project aims to pilot a three-arm randomized controlled trial (RCT) to determine the feasibility of a full-scale RCT comparing 2 web-based interventions (mindfulness vs loving-kindness and compassion) with a web-based active control condition (progressive muscle relaxation). OBJECTIVE: The primary objective of this study is to assess the feasibility of an RCT protocol comparing the 3 conditions delivered on the web as a series of instructional materials and brief daily practices over a course of 8 weeks. The second objective is to explore the experiences of women in the different intervention conditions. The third objective is to estimate SD values for the outcome measures to inform the design of an adequately powered trial to determine the comparative efficacy of the different conditions. METHODS: Pregnant women (n=75) participating in a longitudinal birth cohort study (the ORIGINS project) will be recruited to this study from 18 weeks of gestational age. We will assess the acceptability and feasibility of recruitment and retention strategies and the participants' engagement and adherence to the interventions. We will also assess the experiences of women in each of the 3 intervention conditions by measuring weekly changes in their well-being and engagement with the program and by conducting a qualitative analysis of postprogram interviews. RESULTS: This project was funded in September 2019 and received ethics approval on July 8, 2020. Enrollment to the study will commence in September 2020. Feasibility of a full-scale RCT will be assessed using ADePT (a process for decision making after pilot and feasibility trials) criteria. CONCLUSIONS: If the study is shown to be feasible, results will be used to inform future full-scale RCTs. Evidence for flexible, scalable, and low-cost interventions could inform population health strategies to promote well-being and reduce psychological distress among pregnant women. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry Number 12620000672954p; http://anzctr.org.au/ACTRN12620000672954p.aspx. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/19803.

Introducing the ORIGINS project: a community-based interventional birth cohort.

Objectives Non-communicable diseases (NCDs) pose the greatest threat to human health globally. The dramatic rise in early onset NCDs - such as childhood obesity, the allergy epidemic and an increasing burden of mental ill health in children and youth - reflect the profound early impact of modern environments on developing systems. The ORIGINS Project is a research platform enabling world class investigation of early antecedent pathways to NCDs, and how to curtail these. As well as facilitating strategic long-term research capacity, ORIGINS is a pipeline for short-term productivity through a series of clinical trials, early interventions, mechanistic studies, and targeted research questions to improve maternal and paternal health and the early environment. Methods ORIGINS is a decade-long collaborative initiative between the Joondalup Health Campus (JHC) and the Telethon Kids Institute (TKI) to establish a Western Australian (WA) birth cohort of 10,000 families, enrolled during pregnancy. It is currently funded to follow up participating children and their families to five years of age. Comprehensive data and biological samples are collected from participants at up to 15 different timepoints, from the first antenatal clinic visit. In the process, ORIGINS is creating a major research platform, consisting of an extensive, world class biobank and databank. Of key strength and novelty, ORIGINS includes a series of harmonised nested sub-projects integrated with clinical and diagnostic services and providing real-time feedback to improve the health of individuals and the community. Conclusions At its core, ORIGINS aims to improve the health and quality of life of the next generation through improved pathways to optimise the early environment and reduce adversity by promoting primary prevention, early detection and early intervention. This dynamic, interactive, community-based project not only provides novel research capacity, productivity, collaboration and translational impact on future generations - it is also anticipated to have flow on benefits for community engagement, cohesion and purpose. This will provide a sentinel example for tailored replication in other communities around the world as part of interconnected grass root strategies to improve planetary health.

Sexual Experimentation in Heterosexual, Bisexual, Lesbian/Gay, and Questioning Adolescents From Ages 11 to 15.

To examine adolescent sexuality development, we analyzed data from a British cohort study (N = 5,070), which assessed the same 12-14 sexual activities at ages 11, 12, 13, and 15, and sexual orientation identity at age 15. The sexual activities ranged from low (e.g., cuddling), moderate (e.g., kissing), to high (e.g., sexual intercourse) intensity. We found that most adolescents having sexual activities of low-to-moderate intensity with same-sex individuals also had them with other-sex individuals, and adolescents having other-sex contacts of low intensity often reported them nonexclusively. Furthermore, other-sex and same-sex sexual activities did not reliably distinguish between sexual orientation identities. Sex differences in these phenomena were absent or small. These findings suggest that many adolescents have low-intensity nonexclusive sexual behaviors.

Physical aggression toward teachers: Antecedents, behaviors, and consequences.

School violence is a significant public health concern that occurs in many forms. Physical aggression can cause serious bodily injury and long-term negative effects, and both teachers and students experience significant rates of physical aggression. There are few studies examining teachers' experiences of physical aggression. Studies that go beyond prevalence are limited, and we know little about the triggers and consequences that surround these incidents. This qualitative investigation used an antecedent-behavior-consequence (A-B-C) framework to understand how incidents of physical aggression directed toward teachers unfold. The sample included 193 elementary and secondary teachers who completed an anonymous, online survey and described events leading up to and following their experiences with physical aggression. Using conventional content analysis, we identified common antecedents, such as breaking up fights, discipline, and directives, and common consequences, such as student removal, school staff involvement, positive outcomes, and inaction. Further analyses revealed seven common A-B-C patterns among physical aggression incidents that are highlighted and discussed. Utility of the A-B-C framework for teacher-directed violence is described, along with implications for research, practice, and policy. Exploring the context surrounding incidents of physical aggression directed against teachers provides useful information for violence prevention and interventions.

Creation across culture: Children's tool innovation is influenced by cultural and developmental factors.

Prior research suggests that human children lack an aptitude for tool innovation. However, children's tool making must be explored across a broader range of tasks and across diverse cultural contexts before we can conclude that they are genuinely poor tool innovators. To this end, we investigated children's ability to independently construct 3 new tools using distinct actions: adding, subtracting, and reshaping. We tested 422 children across a broad age range from 5 geographic locations across South Africa (N = 126), Vanuatu (N = 190), and Australia (N = 106), which varied in their levels of exposure to Westernized culture. Children were shown a horizontal, transparent tube that had a sticker in its middle. Children were sequentially given each incomplete tool, which when accurately constructed could be used to push the sticker out of the tube. As predicted, older children were better at performing the innovation tasks than younger children across all cultures and innovation actions. We also found evidence for cultural variation: While all non-Western groups performed similarly, the Western group of children innovated at higher rates. However, children who did not innovate often adopted alternate methods when using the tools that also led to success. This suggests that children's innovation levels are influenced by the cultural environment, and highlights the flexibility inherent in human children's tool use. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Full-shell x-ray optics development at NASA Marshall Space Flight Center.

NASA's Marshall Space Flight Center (MSFC) maintains an active research program toward the development of high-resolution, lightweight, grazing-incidence x-ray optics to serve the needs of future x-ray astronomy missions such as Lynx. MSFC development efforts include both direct fabrication (diamond turning and deterministic computer-controlled polishing) of mirror shells and replication of mirror shells (from figured, polished mandrels). Both techniques produce full-circumference monolithic (primary + secondary) shells that share the advantages of inherent stability, ease of assembly, and low production cost. However, to achieve high-angular resolution, MSFC is exploring significant technology advances needed to control sources of figure error including fabrication- and coating-induced stresses and mounting-induced distortions.

An experimental examination of object-directed ritualized action in children across two cultures.

Ritualized actions are common in daily life, and prevalent across cultures. Adults have been shown, under experimental conditions, to treat objects subjected to ritualized action as special and different relative to objects subjected to non-ritualized action. Similarly, children as young as 4, are sensitive to ritualized actions-frequently reproducing such actions at high fidelity. The current cross-cultural experiment attempts to extend existing findings among two culturally distinct groups of children with regard to object-directed rituals. We predicted that children's preference for a reward would be influenced by ritualized action (but not non-ritualized action). Over two trials we presented children in Australia (N = 93; mean age = 6.03 years, SD = 2.07 years) and Vanuatu (N = 109; mean age = 6.13 years, SD = 1.96 years) with two identical rewards, which was either subjected to ritualized action or non-ritualized action. Contrary to previous findings among adults, ritualized action did not influence children's preference for a reward. We frame the current results in the context of socially relevant group rituals, and discuss the implications for both wider theory and methods. We conclude with a call for pre-registered replications.

Exploring the costs and effectiveness of the Drug and Alcohol Withdrawal Network: a home-based alcohol and other drug withdrawal service.

The Drug and Alcohol Withdrawal Network (DAWN) is a home-based withdrawal service based in Perth, Western Australia. Literature on outcomes, costs and client attitudes towards this type of home-based detoxification in Australia is sparse. Therefore, this study assessed these factors for clients enrolled over a 5-year period (July 2011-June 2016). Client experience was explored through semi-structured interviews with 10 clients. Over the study period, 1800 clients (54% male, mean age 38 years) were assessed, and there were 2045 episodes of care. Although most first-episode clients (52%) listed alcohol as the primary drug of concern, the proportion listing methamphetamine increased from 4% in 2011-12 to 23% in 2015-16. In 94% (n=639) of withdrawal detoxification episodes with completed surveys, clients used their 'drug of primary concern' most days or more often at baseline; this had reduced to 23% (n=149) at the conclusion of detoxification. Five-year direct costs were A$4.8million. Clients valued the person-centred holistic approach to care, including linking with other health providers. Barriers included low awareness of the program and difficulties finding an appropriate support person. Further exploration of cost-effectiveness would substantiate the apparently lower per client cost, assuming medical suitability for both programs, for home-based relative to inpatient withdrawal.