Perceptions of mental health providers of the barriers and facilitators of using and engaging youth in digital mental-health-enabled measurement based care.

Objectives: Increased rates of mental health disorders and substance use among youth and young adults have increased globally, furthering the strain on an already burdened mental health system. Digital solutions have been proposed as a potential option for the provision of timely mental health services for youth, with little research exploring mental health professional views about using such innovative tools. In Alberta, Canada, we are evaluating the implementation and integration of a digital mental health (dMH) platform into existing service pathways. Within this paper we seek to explore mental health professionals' perceptions of the barriers and facilitators that may influence their utilization of digital MH-enabled measurement-based care (MBC) with the youth who access their services. Methods: A qualitative, descriptive methodology was used to inductively generate themes from focus groups conducted with mental health professionals from specialized mental health services and primary care networks in Alberta. Results: As mental health professionals considered the barriers and facilitators of using dMH with youth, they referenced individual and family barriers and facilitators to consider. Providers highlighted perceived barriers, including: first, cultural stigma, family apprehension about mental health care, and parental access to dMH and MBC as deterrents to providers adopting digital platforms in routine care; second, perceptions of increased responsibility and liability for youth in crisis; third, perception that some psychiatric and neurodevelopmental disorders in youth are not amenable to dMH; fourth, professionals contemplated youth readiness to engage with dMH-enabled MBC. Participants also highlighted pertinent facilitators to dMH use, noting: first, the suitability of dMH for youth with mild mental health concerns; second, youth motivated to report their changes in mental health symptoms; and lastly, youth proficiency and preference for dMH options. Conclusions: By identifying professionals' perceptions of barriers and facilitators for youth users, we may better understand how to address misconceptions about who is eligible and appropriate for dMH through training and education.

Family carer and professional perceptions of the potential use of telehealth for behavioural support.

BACKGROUND: Telehealth (i.e. the use of technology across distance) is widespread in many fields. Although its use for behavioural support for people with intellectual or developmental disabilities (IDD) is emerging, there are no known studies examining stakeholder perceptions of this. METHODS: A four-round Delphi consultation was conducted with 11 professionals and six family carers of children with IDD to generate consensus on what would influence participants' use of telehealth for behavioural support. Data were collected prior to the coronavirus pandemic. RESULTS: Thirty-six items reached consensus for professionals (26 advantages and 10 disadvantages/barriers) and 22 for family carers (8 advantages and 14 disadvantages/barriers). A range of solutions were also identified for the disadvantages/barriers. CONCLUSIONS: Participants were willing to use telehealth for behavioural support. However, disadvantages/barriers need to be addressed, and guidelines relating to the use of telehealth in this field are needed. We report a number of practice recommendations including combining telehealth with in-person supports where possible, incorporating video technologies, and considering client perspectives and confidence with telehealth methodologies.

A specialised pollination system using nectar-seeking thynnine wasps in Caladenia nobilis (Orchidaceae).

Caladenia is a diverse Australian genus that is exceptional among orchids in having both species pollinated by food-seeking and sexually deceived insects. Here, we investigated the pollination of Caladenia nobilis, a species predicted to be food-deceptive due to its large, cream-coloured and apparently nectarless flowers. Pollinator observations were made using experimental clumps of flowers. Measurements of floral colour were undertaken with a spectrometer, nectar was tested using GC-MS, and reproductive success was quantified for 2 years. While C. nobilis attracted nine species of insect, only males of the thynnine wasp Rhagigaster discrepans exhibited the correct size and behaviour to remove and deposit pollen. Male R. discrepans attempted to feed from the surface of the labellum, often crawling to multiple flowers, but showed no evidence of sexual attraction. Most flowers produced little or no nectar, although some may provide enough sucrose to act as a meagre reward to pollinators. Floral colouration was similar to a related Caladenia species pollinated by sexual deception, although the sexually deceptive species had a dull-red labellum. Reproductive success was generally low and highly variable between sites and years. In addition to most visitors being of inappropriate size for pollinia removal, the lack of response to the orchid by several co-occurring species of thynnine wasp suggests filtering of potential pollinators at the attraction phase. Our discovery of a pollination strategy that may be intermediate between food deception and food reward raises the question, how many putatively rewardless orchids actually produce meagre amounts of nectar?

Adherence to Adjuvant Endocrine Therapy in Christchurch Women with Early Breast Cancer.

AIMS: To assess adherence to adjuvant endocrine therapy by a real-world cohort of women in Christchurch and to determine any associated factors. MATERIALS AND METHODS: Records were retrieved of all women newly diagnosed with early breast cancer and registered on the Christchurch Breast Cancer Patient Register over 4 years from June 2009. Demographic and pathological factors, dates of starting and stopping endocrine therapies and reported side-effects were collected. The proportion remaining on endocrine therapy was analysed by Kaplan-Meier curve; Cox regression analysis was used to identify independent factors influencing adherence. RESULTS: Of 1213 women, 1018 (83.9%) had oestrogen receptor-positive tumours, of whom 674 (66.2%) started adjuvant endocrine therapy, including 62 (9.2%) neoadjuvantly. Uptake was 52.4% of those with T1 tumours, 89% with T2 tumours, 93% with T3/T4 tumours, 92.7% with node-positive tumours and 49.7% with node-negative tumours. The initial endocrine therapy was an aromatase inhibitor in 254 (38%) and tamoxifen for 412 (61%). At 1 year, 90% remained adherent, at 2 years 84%, at 3 years 81%, at 4 years 76%, at 4.5 years 71% and at 5 years 50%, with a median duration of 60 months (56-64 months, 95% confidence interval) and a median follow-up of 33 months. Overall, 135 (20%) women stopped treatment for adverse events or poor tolerability. A longer persistence with endocrine therapy was associated with node-positive tumours (hazard ratio 1.38, P = 0.003), but not first hormone used; aromatase inhibitor compared with tamoxifen, P = 0.76. CONCLUSION: Adjuvant endocrine therapy use fell to 50% by 5 years, limiting possible survival benefits, providing support for efforts to increase compliance.

Church-based Health Promotion in Jamaica for the Ageing Population / Promoción de la Salud Patrocinada por la Iglesia en Jamaica para la Población en Envejecimiento

ABSTRACT High-quality management of health conditions is critical among the ageing population as this group is more likely to have experienced health ailments. To eliminate the disproportionate number of African American seniors suffering health conditions and to encourage healthy behaviours, churches within the African American community have initiated health promotion programmes and services. Some of the available health education programmes started out as pilot projects and now function on a regular basis. Given the success of the accessible church- based health promotion programmes (CBHPs), health organizations and agencies now support and encourage these programmes for disease risk populations (ie African Americans and Hispanic communities). Accordingly, health agencies across the United States of America (US) recognize the need to promote healthier habits among African Americans and other vulnerable groups as statistics continue to show a gap within the US healthcare system. A CBHPP appears to be more practical for specific populations given that the promotions are often designed with cultural relevancy. The following commentary proposes similar faith-based health promotions in Jamaica as a means to provide and to make more available delivery of healthcare and quality of life in the ageing Jamaican population.

RESUMEN La gestión de alta calidad para crear condiciones de salud es crítica entre la población en envejecimiento, ya que este grupo presenta mayor probabilidad de haber experimentado dolencias de salud. A fin de eliminar el número desproporcionado de adultos mayores afroamericanos que padecen condiciones de salud y fomentar comportamientos saludables, las iglesias de la comunidad afroamericana han iniciado programas y servicios de promoción de la salud. Algunos de los programas de educación para la salud comenzaron como proyectos piloto y ahora funcionan de manera regular. Dado el éxito de la accesibilidad de los programas de promoción de la salud promovidos por la iglesia (PPSI), las organizaciones y agencias de salud ahora apoyan y estimulan estos programas para las poblaciones con riesgo de enfermedad (es decir, las comunidades afroamericanas e hispánicas). Por consiguiente, las agencias de salud por todos los Estados Unidos de América (USA) reconocen la necesidad de promover hábitos más saludables entre los afroamericanos y otros grupos vulnerables, por cuanto las estadísticas continúan mostrando una brecha en el sistema de salud de los Estados Unidos. Un PPSI parece ser más práctico para poblaciones específicas, dado que las promociones se diseñan a menudo atendiendo a aspectos culturales. El siguiente comentario propone para Jamaica similares promociones de salud basadas en la fe, como un medio de proporcionar y hacer más accesible el cuidado de la salud y la calidad de vida para la población jamaicana en proceso de envejecimiento.

Long-term increases in soil carbon due to ecosystem fertilization by atmospheric nitrogen deposition demonstrated by regional-scale modelling and observations.

Fertilization of nitrogen (N)-limited ecosystems by anthropogenic atmospheric nitrogen deposition (Ndep) may promote CO2 removal from the atmosphere, thereby buffering human effects on global radiative forcing. We used the biogeochemical ecosystem model N14CP, which considers interactions among C (carbon), N and P (phosphorus), driven by a new reconstruction of historical Ndep, to assess the responses of soil organic carbon (SOC) stocks in British semi-natural landscapes to anthropogenic change. We calculate that increased net primary production due to Ndep has enhanced detrital inputs of C to soils, causing an average increase of 1.2 kgCm-2 (c. 10%) in soil SOC over the period 1750-2010. The simulation results are consistent with observed changes in topsoil SOC concentration in the late 20th Century, derived from sample-resample measurements at nearly 2000 field sites. More than half (57%) of the additional topsoil SOC is predicted to have a short turnover time (c. 20 years), and will therefore be sensitive to future changes in Ndep. The results are the first to validate model predictions of Ndep effects against observations of SOC at a regional field scale. They demonstrate the importance of long-term macronutrient interactions and the transitory nature of soil responses in the terrestrial C cycle.

Cerebellar Transcranial Direct Current Stimulation (ctDCS): A Novel Approach to Understanding Cerebellar Function in Health and Disease.

The cerebellum is critical for both motor and cognitive control. Dysfunction of the cerebellum is a component of multiple neurological disorders. In recent years, interventions have been developed that aim to excite or inhibit the activity and function of the human cerebellum. Transcranial direct current stimulation of the cerebellum (ctDCS) promises to be a powerful tool for the modulation of cerebellar excitability. This technique has gained popularity in recent years as it can be used to investigate human cerebellar function, is easily delivered, is well tolerated, and has not shown serious adverse effects. Importantly, the ability of ctDCS to modify behavior makes it an interesting approach with a potential therapeutic role for neurological patients. Through both electrical and non-electrical effects (vascular, metabolic) ctDCS is thought to modify the activity of the cerebellum and alter the output from cerebellar nuclei. Physiological studies have shown a polarity-specific effect on the modulation of cerebellar-motor cortex connectivity, likely via cerebellar-thalamocortical pathways. Modeling studies that have assessed commonly used electrode montages have shown that the ctDCS-generated electric field reaches the human cerebellum with little diffusion to neighboring structures. The posterior and inferior parts of the cerebellum (i.e., lobules VI-VIII) seem particularly susceptible to modulation by ctDCS. Numerous studies have shown to date that ctDCS can modulate motor learning, and affect cognitive and emotional processes. Importantly, this intervention has a good safety profile; similar to when applied over cerebral areas. Thus, investigations have begun exploring ctDCS as a viable intervention for patients with neurological conditions.

Regulation of the alternative pathway of complement modulates injury and immunity in a chronic model of dextran sulphate sodium-induced colitis.

The role of complement in inflammatory bowel disease (IBD) has been studied primarily using acute models, and it is unclear how complement affects processes in more relevant chronic models of IBD in which modulation of adaptive immunity and development of fibrosis have pathogenic roles. Using mice deficient in C1q/mannose-binding lectin (MBL) or C3, we demonstrated an important role for these opsonins and/or the classical pathway C3 convertase in providing protection against mucosal injury and infection in a model of chronic dextran sulphate sodium (DSS)-induced colitis. In contrast, deficiency of the alternative pathway (fB(-/-) mice) had significantly less impact on injury profiles. Consequently, the effect of a targeted inhibitor of the alternative pathway was investigated in a therapeutic protocol. Following the establishment of colitis, mice were treated with CR2-fH during subsequent periods of DSS treatment and acute injury (modelling relapse). CR2-fH significantly reduced complement activation, inflammation and injury in the colon, and additionally reduced fibrosis. Alternative pathway inhibition also altered the immune response in the chronic state in terms of reducing numbers of B cells, macrophages and mature dendritic cells in the lamina propria. This study indicates an important role for the alternative pathway of complement in the pathogenesis and the shaping of an immune response in chronic DSS-induced colitis, and supports further investigation into the use of targeted alternative pathway inhibition for the treatment of IBD.

A novel protocol allowing oral delivery of a protein complement inhibitor that subsequently targets to inflamed colon mucosa and ameliorates murine colitis.

While there is evidence of a pathogenic role for complement in inflammatory bowel disease, there is also evidence for a protective role that relates to host defence and protection from endotoxaemia. There is thus concern regarding the use of systemic complement inhibition as a therapeutic strategy. Local delivery of a complement inhibitor to the colon by oral administration would ameliorate such concerns, but while formulations exist for oral delivery of low molecular weight drugs to the colon, they have not been used successfully for oral delivery of proteins. We describe a novel pellet formulation consisting of cross-linked dextran coated with an acrylic co-polymer that protects the complement inhibitor CR2-Crry from destruction in the gastrointestinal tract. CR2-Crry containing pellets administered by gavage, were characterized using a therapeutic protocol in a mouse model of dextran sulphate sodium (DSS)-induced colitis. Oral treatment of established colitis over a 5-day period significantly reduced mucosal inflammation and injury, with similar therapeutic benefit whether or not the proton pump inhibitor, omeprazole, was co-administered. Reduction in injury was associated with the targeting of CR2-Crry to the mucosal surface and reduced local complement activation. Treatment had no effect on systemic complement activity. This novel method for oral delivery of a targeted protein complement inhibitor will reduce systemic effects, thereby decreasing the risk of opportunistic infection, as well as lowering the required dose and treatment cost and improving patient compliance. Furthermore, the novel delivery system described here may provide similar benefits for administration of other protein-based drugs, such as anti-tumour necrosis factor-α antibodies.

The lunar apatite paradox.

Recent discoveries of water-rich lunar apatite are more consistent with the hydrous magmas of Earth than the otherwise volatile-depleted rocks of the Moon. Paradoxically, this requires H-rich minerals to form in rocks that are otherwise nearly anhydrous. We modeled existing data from the literature, finding that nominally anhydrous minerals do not sufficiently fractionate H from F and Cl to generate H-rich apatite. Hydrous apatites are explained as the products of apatite-induced low magmatic fluorine, which increases the H/F ratio in melt and apatite. Mare basalts may contain hydrogen-rich apatite, but lunar magmas were most likely poor in hydrogen, in agreement with the volatile depletion that is both observed in lunar rocks and required for canonical giant-impact models of the formation of the Moon.

Enhanced recovery after surgery program for elective abdominal surgery at three Victorian hospitals.

The aim of this study was to evaluate the anaesthesia care of an enhanced recovery after surgery (ERAS) program for patients having abdominal surgical in Victorian hospitals. The main outcome measure was the number of ERAS items implemented following introduction of the ERAS program. Secondary endpoints included process of care measures, outcomes and hospital stay. We used a before-and-after design; the control group was a prospective cohort (n=154) representing pre-existing practice for elective abdominal surgical patients from July 2009. The introduction of a comprehensive ERAS program took place over two months and included the education of surgeons, anaesthetists, nurses and allied health professionals. A post-implementation cohort (n=169) was enrolled in early 2010. From a total of 14 ERAS-recommended items, there were significantly more implemented in the post-ERAS period, median 8 (interquartile range 7 to 9) vs 9 (8 to 10), P <0.0001. There were, however, persistent low rates of intravenous fluid restriction (25%) and early removal of urinary catheter (31%) in the post-ERAS period. ERAS patients had less pain and faster recovery parameters, and this was associated with a reduced hospital stay, geometric mean (SD) 5.7 (2.5) vs 7.4 (2.1) days, P=0.006. We found that perioperative anaesthesia practices can be readily modified to incorporate an enhanced recovery program in Victorian hospitals.

Combining surveillance and expert evidence of viral hemorrhagic septicemia freedom: a decision science approach.

The ability to combine evidence streams to establish disease freedom or prioritize surveillance is important for the evaluation of emerging diseases, such as viral hemorrhagic septicemia virus (VHSV) IVb in freshwater systems of the United States and Canada. Waterways provide a relatively unconstrained pathway for the spread of VHSV; and structured surveillance for emerging disease in open systems has many challenges. We introduce a decision framework for estimating VHSV infection probability that draws from multiple evidence streams and addresses challenges associated with the assessment of emerging disease. Using this approach, historical and risk-based evidence, whether empirical or expert-derived, supplement surveillance data to estimate disease probability. Surveillance-based estimates of VHSV prevalence were described using beta distributions. Subjective likelihood ratios (LRs), representing contextual risk, were elicited by asking experts to estimate the predicted occurrence of risk factors among VHSV-affected vs. VHSV-unaffected watersheds. We used the odds form of Bayes' theorem to aggregate expert and surveillance evidence to predict the risk-adjusted posterior probability of VHSV-infection for given watersheds. We also used LRs representing contextual risk to quantify the time value of past surveillance data. This evidence aggregation model predicts disease probability from the combined assessment of multiple sources of information. The method also provides a flexible framework for iterative revision of disease freedom status as knowledge and data evolve.

New approaches to structure-based discovery of dengue protease inhibitors.

Dengue virus (DENV), a member of the family Flaviviridae, presents a tremendous threat to global health since an estimated 2.5 billion people worldwide are at risk for epidemic transmission. DENV infections are primarily restricted to sub-tropical and tropical regions; however, there is concern that the virus will spread into new regions including the United States. There are no approved antiviral drugs or vaccines to combat dengue infection, although DENV vaccines have entered Phase 3 clinical trials. Drug discovery and development efforts against DENV and other viral pathogens must overcome specificity, efficacy, safety, and resistance challenges before the shortage of licensed drugs to treat viral infections can be relieved. Current drug discovery methods are largely inefficient and thus relatively ineffective at tackling the growing threat to public health presented by emerging and remerging viral pathogens. This review discusses current and newly implemented structure-based computational efforts to discover antivirals that target the DENV NS3 protease, although it is clear that these computational tools can be applied to most disease targets.

Impacts of dystocia on health and survival of dairy calves.

The objectives of this study were to determine incidence of stillbirths and heifer-calf morbidity and mortality, and their association with dystocia on 3 Colorado dairies. A total of 7,380 calvings produced 7,788 calves on 3 Colorado dairy operations between October 1, 2001, and November 5, 2002. Dystocia score and calf status (alive vs. dead) were recorded at calving. Calves that were born alive, but died before 24 h of age, also were recorded as stillborn. Heifer calves were monitored for 120 d to evaluate morbidity and mortality. More than half (51.2%) of calves born to primiparous dams, compared with 29.4% of calves born to multiparous dams, required assistance during calving. A larger percentage of bull calves (40.0%) required assistance compared with heifer calves (33.0%). Proportion of stillborn calves was 8.2% overall, with bull calves, twin calves, calves born to primiparous dams, and those born to dams having dystocia having a larger stillbirth percentage compared with heifer calves, singletons, calves born to multiparous dams, and unassisted calvings, respectively. Multiple logistic regression models were constructed to evaluate stillbirths and heifer health while accounting for the clustering of calves within dairy. The models included dystocia score, parity, and season of calving as explanatory variables for heifer events and also calf gender, and single or twin birth for the stillbirth models. Heifer calves born to dams having severe dystocia had greater odds of stillbirth [odds ratio (OR) = 20.7] and treatment of respiratory disease (OR = 1.7), digestive disease (OR = 1.3), and overall heifer mortality (OR = 6.7). Calf gender and dam parity interacted with calving ease to affect stillbirths. For calves having severe dystocia, heifer calves and calves born to multiparous dams were at increased risk of stillbirth compared with bull calves and calves born to primiparous dams, respectively. Survival analysis demonstrated that severe dystocia was associated with stillbirths and deaths up to 30 d of age. Relatively simple interventions have the potential to significantly reduce the impact of dystocia on calf mortality and morbidity on dairy farms. Education of farm management and personnel in strategies to reduce dystocia and its effect on calf health should be a priority according to the results of this study.

Upregulation of two BH3-only proteins, Bmf and Bim, during TGF beta-induced apoptosis.

Transforming growth factor-beta (TGFbeta)-activated signalling pathways can lead to apoptosis, growth arrest or promotion of malignant behaviour, dependent on cellular context. The molecular mechanisms involved in TGFbeta-induced apoptosis remain controversial; although changes in gene expression are thought to be pivotal to the process, several different candidate apoptotic initiators and mediators have been proposed. Smad4, a critical component of the TGFbeta-induced transcriptional machinery, is shown here to be essential for induction of apoptosis. Gene expression analysis identified the proapoptotic Bcl-2 family members, Bmf and Bim, as induced by TGFbeta, dependent on both Smad4 and p38 function and the generation of reactive oxygen species. TGFbeta-induced Bmf and Bim localize to cellular membranes implicated in apoptosis. Inhibition of the TGFbeta-induced expression of both these proteins together provides significant protection of cells from apoptosis. The TGFbeta-triggered cell death programme thus involves induction of multiple BH3-only proteins during the induction of apoptosis.