Protocol for a randomised controlled trial investigating the effectiveness of an online e health application for the prevention of Generalised Anxiety Disorder

BACKGROUND Generalised Anxiety Disorder (GAD) is a highly prevalent psychiatric disorder. Effective prevention in young adulthood has the potential to reduce the prevalence of the disorder, to reduce disability and lower the costs of the disorder to the community. The present trial (the WebGAD trial) aims to evaluate the effectiveness of an evidence-based online prevention website for GAD. METHODS/DESIGN The principal clinical question under investigation is the effectiveness of an online GAD intervention (E-couch) using a community-based sample. We examine whether the effect of the intervention can be maximised by either human support, in the form of telephone calls, or by automated support through emails. The primary outcome will be a reduction in symptoms on the GAD-7 in the active arms relative to the non active intervention arms. DISCUSSION The WebGAD trial will be the first to evaluate the use of an internet-based cognitive behavioural therapy (CBT) program contrasted with a credible control condition for the prevention of GAD and the first formal RCT evaluation of a web-based program for GAD using community recruitment. In general, internet-based CBT programs have been shown to be effective for the treatment of other anxiety disorders such as Post Traumatic Stress Disorder, Social Phobia, Panic Disorder and stress in clinical trials; however there is no evidence for the use of internet CBT in the prevention of GAD. Given the severe shortage of therapists identified in Australia and overseas, and the low rates of treatment seeking in those with a mental illness, the successful implementation of this protocol has important practical outcomes. If found to be effective, WebGAD will provide those experiencing GAD with an easily accessible, free, evidence-based prevention tool which can be promoted and disseminated immediately

Social networks : the future for health care delivery

With the rapid growth of online social networking for health, health care systems are experiencing an inescapable increase in complexity. This is not necessarily a drawback; self-organising, adaptive networks could become central to future health care delivery. This paper considers whether social networks composed of patients and their social circles can compete with, or complement, professional networks in assembling health-related information of value for improving health and health care. Using the framework of analysis of a two-sided network – patients and providers – with multiple platforms for interaction, we argue that the structure and dynamics of such a network has implications for future health care. Patients are using social networking to access and contribute health information. Among those living with chronic illness and disability and engaging with social networks, there is considerable expertise in assessing, combining and exploiting information. Social networking is providing a new landscape for patients to assemble health information, relatively free from the constraints of traditional health care. However, health information from social networks currently complements traditional sources rather than substituting for them. Networking among health care provider organisations is enabling greater exploitation of health information for health care planning. The platforms of interaction are also changing. Patient-doctor encounters are now more permeable to influence from social networks and professional networks. Diffuse and temporary platforms of interaction enable discourse between patients and professionals, and include platforms controlled by patients. We argue that social networking has the potential to change patterns of health inequalities and access to health care, alter the stability of health care provision and lead to a reformulation of the role of health professionals. Further research is needed to understand how network structure combined with its dynamics will affect the flow of information and potentially the allocation of health care resources

Equation of state and Goldstone-mode effects of the three-dimensional O(2) model

We investigate numerically the three-dimensional O(2) model on 8^3-160^3 lattices as a function of the magnetic field H. In the low-temperature phase we verify the H-dependence of the magnetization M induced by Goldstone modes and determine M in the thermodynamic limit both by extrapolation and by chiral perturbation theory. This enables us to calculate the corresponding critical amplitude. At T_c the critical scaling behaviour of the magnetization as a function of H is used to determine another critical amplitude. In both cases we find negative corrections-to-scaling. Our low-temperature results are well described by the perturbative form of the model's magnetic equation of state, with coefficients determined nonperturbatively from our data. The O(2) scaling function for the magnetization is found to have a smaller slope than the one for the O(4) model.Comment: 15 pages, Latex2e, Fig.6b replaced, several comments and two references added, final version for Phys. Lett.

Cycling Stability of Calcium-Impregnated Vermiculite in Open Reactor Used as a Thermochemical Storage Material

Recent research into thermochemical storage (TCS) materials has highlighted their promising potential for seasonal building heating, through energy capture and release during dehydration and hydration cycling. A common TCS material used throughout this investigation was calcium chloride (CaCl2)-impregnated vermiculite-based salt in matrix (SIM). This material was assessed for its robustness during charging and discharging cycles to assess its behavior and in terms of energy stability and chemical stability; the results of which showed consistent volumetric energy density and maximum temperature changes over seven cycles. The calcium SIM did, however, show a decline in leachable Ca content, which was presumed to be a result of stabilization within the vermiculite, and chloride concentration showed little change over the course of the study. Real-time visualization using a high-resolution microscope of calcium SIM particles showed a salt phase change and migration of liquid salt into the valleys of the lamella. A novel cobalt chloride (CoCl2) SIM was used to visualize the hydration path across the particle, through distinct color changes depending on hydration state. The results indicated that the topography of the vermiculite played a significant role in the passive hydration modeling

Improving the Corrosion Performance of Organically Coated Steel Using a Sol–Gel Overcoat

Organically coated steels are widely used in applications in which they are subjected to the natural environment and therefore require excellent corrosion resistance. Organic clearcoats are typically employed as a barrier that improves the overall corrosion resistance; however, they are typically derived from fossil fuel-based feedstock. A more sustainable alternative could be possible using sol–gel coatings. The application of a simple tetraethoxysilane (TEOS)-based sol–gel was applied to polyurethane-coated steels using a spray coater. The concentration of TEOS was altered to produce coatings containing either 2.5% or 10%. The 10% TEOS resulted in dense, homogeneous coatings that offered a significant improvement in corrosion resistance compared to an uncoated substrate. Whereas the 2.5% TEOS coatings were inhomogeneous and porous, which indicated a limitation of concentration required to produce a uniform coating. The successful demonstration of using a simple TEOS-based coating to improve the corrosion resistance of organically coated steel highlights the potential for further investigation into the use of sol–gels for these applications

Effect of Central Nervous System Metastases on Treatment Discontinuation and Survival in Older Women Receiving Trastuzumab for Metastatic Breast Cancer

Background. Trastuzumab improves survival in HER2-positive women with metastatic breast cancer (MBC). The consequences of longer survival include a higher likelihood of additional metastases, including those in the central nervous system (CNS). The effect of CNS metastases on both trastuzumab discontinuation and survival in older patients has not been described. Patients and Methods. We used the Surveillance Epidemiology and End Results (SEER) Medicare data to identify a cohort of 562 women age 66 or older with MBC who were diagnosed between January 1, 2000 and December 31, 2005, free of CNS metastases, and initiated trastuzumab after MBC diagnosis. Time to discontinuation and time to death were analyzed using proportional hazards models. Results. Newly diagnosed CNS metastases were associated with both higher risk of trastuzumab discontinuation (relative hazard [RH] = 1.78, 95% CI 1.11–2.87) and higher risk of death (RH = 2.49, 95% CI 1.84–3.37). The incidence rate of new CNS metastases was comparable among various sites of metastasis (10.7 to 14.7 per 1,000 patient-months), except for bone which was higher (24.1 per 1,000). Conclusion. The diagnosis of CNS metastases was associated with an increase in both the likelihood of discontinuing trastuzumab therapy as well as the risk of death

Correlation lengths and scaling functions in the three-dimensional O(4) model

We investigate numerically the transverse and longitudinal correlation lengths of the three-dimensional O(4) model as a function of the external field H. From our data we calculate the scaling function of the transverse correlation length, and that of the longitudinal correlation length for T>T_c. We show that the scaling functions do not only describe the critical behaviours of the correlation lengths but encompass as well the predicted Goldstone effects, in particular the H^{-1/2}-dependence of the transverse correlation length for T<T_c. In addition, we determine the critical exponent delta=4.824(9) and several critical amplitudes from which we derive the universal amplitude ratios R_{chi}=1.084(18), Q_c=0.431(9), Q_2^T=4.91(8), Q_2^L=1.265(24) and U_{xi}^c=1.99(1). The last result supports a relation between the longitudinal and transverse correlation functions, which was conjectured to hold below T_c but seems to be valid also at T_c.Comment: 24 pages, 13Ps-figures, Latex2e,one page added,version to appear in Nucl. Phys. B[FS

Protocol for a randomised controlled trial investigating the effectiveness of an online e health application for the prevention of Generalised Anxiety Disorder

Background: Generalised Anxiety Disorder (GAD) is a highly prevalent psychiatric disorder. Effective prevention in young adulthood has the potential to reduce the prevalence of the disorder, to reduce disability and lower the costs of the disorder to the community. The present trial (the WebGAD trial) aims to evaluate the effectiveness of an evidence-based online prevention website for GAD.Methods/Design: The principal clinical question under investigation is the effectiveness of an online GAD intervention (E-couch) using a community-based sample. We examine whether the effect of the intervention can be maximised by either human support, in the form of telephone calls, or by automated support through emails. The primary outcome will be a reduction in symptoms on the GAD-7 in the active arms relative to the non active intervention arms.Discussion: The WebGAD trial will be the first to evaluate the use of an internet-based cognitive behavioural therapy (CBT) program contrasted with a credible control condition for the prevention of GAD and the first formal RCT evaluation of a web-based program for GAD using community recruitment. In general, internet-based CBT programs have been shown to be effective for the treatment of other anxiety disorders such as Post Traumatic Stress Disorder, Social Phobia, Panic Disorder and stress in clinical trials; however there is no evidence for the use of internet CBT in the prevention of GAD. Given the severe shortage of therapists identified in Australia and overseas, and the low rates of treatment seeking in those with a mental illness, the successful implementation of this protocol has important practical outcomes. If found to be effective, WebGAD will provide those experiencing GAD with an easily accessible, free, evidence-based prevention tool which can be promoted and disseminated immediately.Trial Registration: Controlled-trials.com: ISRCTN76298775

Conformally invariant bending energy for hypersurfaces

The most general conformally invariant bending energy of a closed four-dimensional surface, polynomial in the extrinsic curvature and its derivatives, is constructed. This invariance manifests itself as a set of constraints on the corresponding stress tensor. If the topology is fixed, there are three independent polynomial invariants: two of these are the straighforward quartic analogues of the quadratic Willmore energy for a two-dimensional surface; one is intrinsic (the Weyl invariant), the other extrinsic; the third invariant involves a sum of a quadratic in gradients of the extrinsic curvature -- which is not itself invariant -- and a quartic in the curvature. The four-dimensional energy quadratic in extrinsic curvature plays a central role in this construction.Comment: 16 page