Beyond the screen – The potential of smartphone apps and immersive technologies in exposure-based interventions for phobias

Specific phobias are extremely common among adults. They are characterized by strong emotional reactions and avoidance behavior when exposed to the feared stimuli. Specifically fears concerning heights or animals such as spiders are highly prevalent, followed by fear of social situations such as fear of public speaking. The gold standard in treating specific phobias is exposure-based therapy. However, exposure-based therapy is limited in its practicability in clinical routine and poses a high hurdle for affected individuals. Virtual and augmented reality (VR/AR) smartphone apps offer attractive platforms to simulate exposure situations and by that increase the accessibility of mental health services in general. Thus, novel smartphone-based treatments hold the potential to facilitate the dissemination of exposure-based treatments for specific phobias. The studies presented as part of this thesis aimed at investigating three newly developed interventions for fear of heights, fear of public speaking and fear of spiders, using the currently available advanced technologies. In the first study (Bentz et al., 2021), a stand-alone, automated and gamified VR exposure app Easyheights was developed using 360° images. The app’s effectiveness to reduce fear of heights and avoidance behavior was investigated in a randomized controlled trial in an adult population with clinical and subclinical fear of heights. The repeated use of the app led to reduced fear and avoidance behavior in a real-life situation on a tower. For the second study (Müller, Fehlmann et al., 2022), the developed stand-alone, automated and gamified VR exposure app Fearless Speech aimed at reducing public speaking anxiety (PSA) and avoidance of eye contact. A virtual audience with 360° videos was used for the exposure and gaze control for the eye contact training. The app was investigated in a randomized controlled trial in healthy adults with subclinical PSA. After the repeated use of the app, participants showed reduced fear and improved eye contact in a real-life speech situation. The third study (Zimmer et al., 2021) examined the developed stand-alone, automated and gamified AR exposure app Phobys. In comparison to VR, AR has only recently been introduced to clinical research. The app was designed to reduce fear, disgust and avoidance behavior in adults with clinical and subclinical fear of spiders. The results of the randomized controlled trial showed that repeatedly using the app led to reduced fear, disgust and avoidance behavior in a real-life situation with a real spider. The results of these studies support the potential of stand-alone, automated VR and AR interventions delivered through smartphone apps. The developed apps allow for a high-quality user experience with a highly realistic environment, gaze control for an easy navigation as well as the possibility of interaction. In addition, gamification elements foster engagement with the apps. All three investigated apps offer low-threshold and low-cost treatment for individuals affected by specific phobias. Testing the effectiveness of these newly developed apps in real-life settings sets them apart from previous studies. Hence, this thesis highlights the potential of using smartphone apps with immersive technologies to advance and disseminate exposure-based treatments for specific phobias

What does it take to make integrated care work? A ‘cookbook’ for large-scale deployment of coordinated care and telehealth

The Advancing Care Coordination & Telehealth Deployment (ACT) Programme is the first to explore the organisational and structural processes needed to successfully implement care coordination and telehealth (CC&TH) services on a large scale. A number of insights and conclusions were identified by the ACT programme. These will prove useful and valuable in supporting the large-scale deployment of CC&TH. Targeted at populations of chronic patients and elderly people, these insights and conclusions are a useful benchmark for implementing and exchanging best practices across the EU. Examples are: Perceptions between managers, frontline staff and patients do not always match; Organisational structure does influence the views and experiences of patients: a dedicated contact person is considered both important and helpful; Successful patient adherence happens when staff are engaged; There is a willingness by patients to participate in healthcare programmes; Patients overestimate their level of knowledge and adherence behaviour; The responsibility for adherence must be shared between patients and health care providers; Awareness of the adherence concept is an important factor for adherence promotion; The ability to track the use of resources is a useful feature of a stratification strategy, however, current regional case finding tools are difficult to benchmark and evaluate; Data availability and homogeneity are the biggest challenges when evaluating the performance of the programmes

SOCIO-POLITICAL AND NATURAL-ECOLOGICAL FACTORS INFLUENCING URBAN FOREST MANAGEMENT IN MASSACHUSETTS

The management of urban forest systems is a complex interaction of social-ecological elements where biophysical factors interact with social aspects including policy decision-makers, managers, and municipal and private-sector employees. In the New England states, tree wardens are the local officials responsible for the preservation, maintenance, and stewardship of the public trees of a municipality. In-person qualitative research interviews were conducted with 50 tree wardens throughout Massachusetts to understand position duties, responsibilities, and professional challenges at the community-level. Qualitative research interviews were also conducted with chairs from 13 volunteer urban tree committees across Massachusetts. The value of employing qualitative methodologies in urban forestry, such as research interviews, as a mechanism to inform Extension professionals of stakeholder needs was also explored and further defined. Clearly emergent themes were identified from interview data and explored through analysis and comparison with existing literature. Tree wardens are typically housed in a municipal department, routinely interact with a number of local organizations, including urban tree committees, and are concerned about emergent plant health issues of importance including Asian longhorned beetle (Anaplophora glabripennis), emerald ash borer (Agrilus planipennis), and hemlock woolly adelgid (Adelges tsugae) (HWA). Since eastern hemlock (Tsuga canadensis) is one of only four native coniferous trees of ornamental importance in the Northeast U.S., and coniferous trees are notoriously underplanted in the urban environment, the ecology and natural history of its native and invasive insect and disease pests were reviewed in detail. These included HWA, elongate hemlock scale (Fiorinia externa), and shoestring root rot (Armillariaspp.). The use of pest resistant plant material – a strategy known to arborists and urban foresters as employing host plant resistance (HPR) – with applicability of HWA-resistant hemlock trees as potential substitutes for eastern hemlock plantings was explored. It was determined that HWA-resistant Chinese hemlock (Tsuga chinensis) would make a suitable surrogate ornamental planting for eastern hemlock in the urban environment

Exploring Topics and Genres in Storytime Books: A Text Mining Approach

Objective – While storytime programs for preschool children are offered in nearly all public libraries in the United States, little is known about the books librarians use in these programs. This study employed text analysis to explore topics and genres of books recommended for public library storytime programs. Methods – In the study, the researchers randomly selected 429 children books recommended for preschool storytime programs. Two corpuses of text were extracted from the titles, abstracts, and subject terms from bibliographic data. Multiple text mining methods were employed to investigate the content of the selected books, including term frequency, bi-gram analysis, topic modeling, and sentiment analysis. Results – The findings revealed popular topics in storytime books, including animals/creatures, color, alphabet, nature, movements, families, friends, and others. The analysis of bibliographic data described various genres and formats of storytime books, such as juvenile fiction, rhymes, board books, pictorial work, poetry, folklore, and nonfiction. Sentiment analysis results reveal that storytime books included a variety of words representing various dimensions of sentiment. Conclusion – The findings suggested that books recommended for storytime programs are centered around topics of interest to children that also support school readiness. In addition to selecting fictionalized stories that will support children in developing the academic concepts and socio-emotional skills necessary for later success, librarians should also be mindful of integrating informational texts into storytime programs

End-to-End Intelligent Framework for Rockfall Detection

Rockfall detection is a crucial procedure in the field of geology, which helps to reduce the associated risks. Currently, geologists identify rockfall events almost manually utilizing point cloud and imagery data obtained from different caption devices such as Terrestrial Laser Scanner or digital cameras. Multi-temporal comparison of the point clouds obtained with these techniques requires a tedious visual inspection to identify rockfall events which implies inaccuracies that depend on several factors such as human expertise and the sensibility of the sensors. This paper addresses this issue and provides an intelligent framework for rockfall event detection for any individual working in the intersection of the geology domain and decision support systems. The development of such an analysis framework poses significant research challenges and justifies intensive experimental analysis. In particular, we propose an intelligent system that utilizes multiple machine learning algorithms to detect rockfall clusters of point cloud data. Due to the extremely imbalanced nature of the problem, a plethora of state-of-the-art resampling techniques accompanied by multiple models and feature selection procedures are being investigated. Various machine learning pipeline combinations have been benchmarked and compared applying well-known metrics to be incorporated into our system. Specifically, we developed statistical and machine learning techniques and applied them to analyze point cloud data extracted from Terrestrial Laser Scanner in two distinct case studies, involving different geological contexts: the basaltic cliff of Castellfollit de la Roca and the conglomerate Montserrat Massif, both located in Spain. Our experimental data suggest that some of the above-mentioned machine learning pipelines can be utilized to detect rockfall incidents on mountain walls, with experimentally proven accuracy

Beneficiation of Iron Ore

Wide reserves of iron ore is found in India. Due to the high quality of iron ore available in India, large deposits of Banded Haematite Jasper (BHJ) are left unused because of the presence of silica in unwanted quantity. ROM is put through washing to remove the clayey matter due to the presence of alumina and silica in iron ore leading to slime generation which are disposed of in tailing ponds. Slime in these tailing ponds contains iron values in the range of 45-60%. Appropriate beneficiation process has to be advanced to reduce the waste generation in mines and for the sustainable growth of the iron ore industry some. Major reason for difficulty in beneficiation of BHJ is revealed from characterization studies which show the intergrowth of haematite and quartz. Presence of Kaolonite is proved with the aid of mineralogical studies. For the separation of alumina from iron ore Beneficiation studies have to be carried out

EQUITY-BASED CHILDHOOD IMMUNIZATION POLICY-MAKING IN URBAN PUBLIC HEALTH UNITS ACROSS THE CANADIAN PRAIRIES: A COMPARATIVE STUDY

Inequities in childhood immunization coverage rates increase the risk of disease outbreaks among vulnerable populations. This study assessed inequities in childhood measles, mumps and rubella (MMR) immunization coverage of four major cities across the Canadian prairies and the public health practices that were deployed to reduce inequities. One-dose by age-two MMR coverage rate inequities-over-time-measurements, and a policy-based inquiry into public health practices between 2009 and 2015 were conducted for each case study city. The results show that there were substantial differences in inequities between the provinces. The Saskatchewan case cities both exhibited low but increasing coverage rates, and large but reducing coverage inequities, over the study period. The Albertan case cities exhibited high coverage rates throughout the study period, with predominantly low inequities, except at a neighborhood-coverage level, in both cities. These results suggest that there are provincial differences in immunization policy and programming practices. For the Saskatchewan cases, geographically-based epidemiology, visual management initiatives, and targeted interventions led to successful public health efforts to reduce coverage inequities. Reminder-based interventions were reported as successful initiatives to increase coverage rates across all cases. Finally, in Alberta, a measles outbreak occurred during the study period, and the subsequent intensive efforts in Calgary differentially reached high-income and high home-ownership neighborhoods. Overall, the study suggests that when public health units detect local MMR coverage inequities and make intentional evidence-based efforts, they can be successful in reducing MMR coverage inequities

Development and application of a platform for harmonisation and integration of metabolomics data

Integrating diverse metabolomics data for molecular epidemiology analyses provides both opportuni- ties and challenges in the field of human health research. Combining patient cohorts may improve power and sensitivity of analyses but is challenging due to significant technical and analytical vari- ability. Additionally, current systems for the storage and analysis of metabolomics data suffer from scalability, query-ability, and integration issues that limit their adoption for molecular epidemiological research. Here, a novel platform for integrative metabolomics is developed, which addresses issues of storage, harmonisation, querying, scaling, and analysis of large-scale metabolomics data. Its use is demonstrated through an investigation of molecular trends of ageing in an integrated four-cohort dataset where the advantages and disadvantages of combining balanced and unbalanced cohorts are explored, and robust metabolite trends are successfully identified and shown to be concordant with previous studies.Open Acces

Authentic alignment : toward an Interpretative Phenomenological Analysis (IPA) informed model of the learning environment in health professions education

It is well established that the goals of education can only be achieved through the constructive alignment of instruction, learning and assessment. There is a gap in research interpreting the lived experiences of stakeholders within the UK learning environment toward understanding the real impact – authenticity – of curricular alignment. This investigation uses a critical realist framework to explore the emergent quality of authenticity as a function of alignment.This project deals broadly with alignment of anatomy pedagogy within UK undergraduate medical education. The thread of alignment is woven through four aims: 1) to understand the alignment of anatomy within the medical curriculum via the relationships of its stakeholders; 2) to explore the apparent complexity of the learning environment (LE); 3) to generate a critical evaluation of the methodology, Interpretative Phenomenological Analysis as an approach appropriate for realist research in the complex fields of medical and health professions education; 4) to propose a functional, authentic model of the learning environment.Findings indicate that the complexity and uncertainty inherent in the LE can be reflected in spatiotemporal models. Findings meet the thesis aims, suggesting: 1) the alignment of anatomy within the medical curriculum is complex and forms a multiplicity of perspectives; 2) this complexity is ripe for phenomenological exploration; 3) IPA is particularly suitable for realist research exploring complexity in HPE; 4) Authentic Alignment theory offers a spatiotemporal model of the complex HPE learning environment:the T-icosa