Co-designing the InnoWell Platform to deliver the right mental health care first time to regional youth.

OBJECTIVE: Building upon earlier research, a person-centred technology-enabled solution (the InnoWell Platform) is being co-designed and implemented into regional youth primary mental health services to improve clinical safety and service quality. DESIGN: Co-design methodologies of service pathway mapping and participatory design workshops as well as usability testing guide the development and implementation of the InnoWell Platform. SETTING AND PARTICIPANTS: headspace centres on the North Coast of New South Wales and their associated communities. MAIN OUTCOME MEASURES: Participation in co-design methodologies, implementation and uptake, identification of youth mental health care needs, and service provision. RESULTS: Nine service pathway mapping (N = 81 participants) and 10 participatory design (N = 48) workshops and usability testing sessions (N = 30) with youth, their supportive others, health professionals, service managers and administrators have been conducted. Four headspace centres have implemented the InnoWell Platform. To date, 120 youth are using the platform and 96 have completed an initial multidimensional assessment. Of these, the majority reported moderate-to-high psychological distress and a quarter reported experiencing high suicidal thoughts and behaviours with subsequent earlier provision of care. Young people have independently commenced recommended online tools and collaborated on clinical care options with their health professionals. CONCLUSIONS: Preliminary findings support co-design methodologies for the development of person-centred technology-enabled solutions embedded within youth primary mental health services in regional Australia. The findings further demonstrate that such solutions may improve clinical safety and service quality, which in turn may facilitate the delivery of the right care, first time!

Testing the generality of above-ground biomass allometry across plant functional types at the continent scale.

Accurate ground-based estimation of the carbon stored in terrestrial ecosystems is critical to quantifying the global carbon budget. Allometric models provide cost-effective methods for biomass prediction. But do such models vary with ecoregion or plant functional type? We compiled 15 054 measurements of individual tree or shrub biomass from across Australia to examine the generality of allometric models for above-ground biomass prediction. This provided a robust case study because Australia includes ecoregions ranging from arid shrublands to tropical rainforests, and has a rich history of biomass research, particularly in planted forests. Regardless of ecoregion, for five broad categories of plant functional type (shrubs; multistemmed trees; trees of the genus Eucalyptus and closely related genera; other trees of high wood density; and other trees of low wood density), relationships between biomass and stem diameter were generic. Simple power-law models explained 84-95% of the variation in biomass, with little improvement in model performance when other plant variables (height, bole wood density), or site characteristics (climate, age, management) were included. Predictions of stand-based biomass from allometric models of varying levels of generalization (species-specific, plant functional type) were validated using whole-plot harvest data from 17 contrasting stands (range: 9-356 Mg ha(-1) ). Losses in efficiency of prediction were <1% if generalized models were used in place of species-specific models. Furthermore, application of generalized multispecies models did not introduce significant bias in biomass prediction in 92% of the 53 species tested. Further, overall efficiency of stand-level biomass prediction was 99%, with a mean absolute prediction error of only 13%. Hence, for cost-effective prediction of biomass across a wide range of stands, we recommend use of generic allometric models based on plant functional types. Development of new species-specific models is only warranted when gains in accuracy of stand-based predictions are relatively high (e.g. high-value monocultures).

Assessing the Association Between Electrical Stimulation Dose, Subsequent Cognitive Function and Depression Severity in Patients Receiving Bilateral Electroconvulsive Therapy for Major Depressive Disorder.

OBJECTIVE: To assess the relationship between electrical stimulation administered to patients undergoing bilateral electroconvulsive therapy (ECT) and subsequent measures of cognitive function and depression severity. METHODS: Stimulus dose titrated patients receiving bilateral ECT were assessed with the Cambridge Neuropsychological Test Automated Battery (CANTAB) Spatial Recognition Memory test and Montgomery Asberg Depression Rating Scale (MADRS) at baseline, after 4 ECT treatments and on course completion. Changes in CANTAB and MADRS scores were assessed in relation to electrical dosage, initial stimulus dose, and demographic variables using linear mixed models. RESULTS: Data pertained to 143 patients (mean age, 56.85 [SD, 14.94], 43% male). Median change in CANTAB score was -10% (-20% to 5%) after 4 ECT treatments and -10% (-20% to 5%) at course completion. Median change in MADRS score was -22 (-33 to -13) after 4 ECT treatments and -14 (-25 to -7) at course completion. Electrical dosage had no effect on CANTAB or MADRS change scores either after 4 treatments or course completion. Improvement in CANTAB score at end of course was associated with female sex (P < 0.05), higher intelligence quotient (P = 0.01), and age. After 4 treatments, improvement in CANTAB score was associated with younger age (P < 0.001) and higher intelligence quotient (P < 0.01). Improved MADRS score at course completion was associated with older age (P < 0.001 at end of course and after 4 treatments). CONCLUSIONS: Electroconvulsive therapy has significant antidepressant and cognitive effects which are not associated with the total electrical dose administered. Other, unalterable variables, such as age and sex, have an influence on these effects.

Using technology to deliver cancer follow-up: a systematic review.

BACKGROUND: People with cancer receive regular structured follow up after initial treatment, usually by a specialist in a cancer centre. Increasing numbers of cancer survivors prompts interest in alternative structured follow-up models. There is worldwide evidence of increasing interest in delivering cancer follow-up using technology. This review sough evidence supporting the use of technology in cancer follow-up from good quality randomised controlled trials. METHOD: A search strategy was developed to identify randomised controlled trials and reviews of randomised trials of interventions delivering some aspect of structured cancer follow-up using new technologies. Databases searched were: All EBM Reviews; Embase; Medline (No Revisions); Medline (Non-Indexed Citations), and CAB Abstracts. Included articles were published in English between 2000 and 2014. Key words were generated by the research question. Papers were read independently and appraised using a standardised checklist by two researchers, with differences being resolved by consensus [J Epidemiol Community Health, 52:377-384, 1998]. Information was collected on the purpose, process, results and limitations of each study. All outcomes were considered, but particular attention paid to areas under consideration in the review question. RESULTS: The search strategy generated 22879 titles. Following removal of duplicates and abstract review 17 full papers pertaining to 13 randomised controlled studies were reviewed. Studies varied in technologies used and the elements of follow-up delivered, length of follow-up, tumour type and numbers participating. Most studies employed only standard telephone follow-up. Most studies involved women with breast cancer and included telephone follow-up. Together the results suggest that interventions comprising technology had not compromised patient satisfaction or safety, as measured by symptoms, health related quality of life or psychological distress. There was insufficient evidence to comment on the cost effectiveness of technological cancer follow-up interventions. CONCLUSIONS: Modern technology could deliver cancer follow-up that is acceptable and safe. More research is required to develop cancer follow-up systems which exploit modern technology, which should be assessed using randomised trials, with consistent outcomes, so that evidence on the acceptability, safety, cost effectiveness and impact in quality of life of technological follow-up can accumulate and be made available to patients, professionals and policy makers.

Altered patterns of abdominal muscle activation in patients with chronic low back pain.

This study investigated patterns of abdominal muscle recruitment during the abdominal drawing in manoeuvre in subjects with chronic low back pain (CLBP) and radiological diagnosis of spondylolysis or spondylolisthesis. Data were collected using surface electromyography from 12 physically active subjects with CLBP and 10 controls. The control subjects displayed an ability to preferentially activate internal oblique with minimal activation of upper rectus abdominis during the action of drawing in the abdominal wall. The group with CLBP were unable to achieve this. This finding may reflect the presence of neuromuscular dysfunction in this group. Further study is required to investigate if these findings are linked to the ability of patients with CLBP to provide dynamic stability of their lumbar spine.