Using the Internet to Train Therapists: Randomized Comparison of Two Scalable Methods.

BACKGROUND: One of the major barriers to the dissemination and implementation of psychological treatments is the scarcity of suitably trained therapists. The currently accepted method of training is not scalable. Recently, a scalable form of training, Web-centered training, has been shown to have promise. OBJECTIVE: The goal of our research was to conduct a randomized comparison of the relative effects of independent and supported Web-centered training on therapist competence and investigate the persistence of the effects. METHODS: Eligible therapists were recruited from across the United States and Canada. They were randomly assigned to 1 of 2 forms of training in enhanced cognitive behavior therapy (CBT-E), a multicomponent evidence-based psychological treatment for any form of eating disorder. Independent training was undertaken autonomously, while supported training was accompanied by support from a nonspecialist worker. Therapist competence was assessed using a validated competence measure before training, after 20 weeks of training, and 6 months after the completion of training. RESULTS: A total of 160 therapists expressed interest in the study, and 156 (97.5%) were randomized to the 2 forms of training (81 to supported training and 75 to independent training). Mixed effects analysis showed an increase in competence scores in both groups. There was no difference between the 2 forms of training, with mean difference for the supported versus independent group being -0.06 (95% Cl -1.29 to 1.16, P=.92). A total of 58 participants (58/114, 50.9%) scored above the competence threshold; three-quarters (43/58, 74%) had not met this threshold before training. There was no difference between the 2 groups in the odds of scoring over the competence threshold (odds ratio [OR] 1.02, 95% CI 0.52 to 1.99; P=.96). At follow-up, there was no significant difference between the 2 training groups (mean difference 0.19, 95% Cl -1.27 to 1.66, P=.80). Overall, change in competence score from end of training to follow-up was not significant (mean difference -0.70, 95% CI -1.52 to 0.11, P=.09). There was also no difference at follow-up between the training groups in the odds of scoring over the competence threshold (OR 0.95, 95% Cl 0.34 to 2.62; P=.92). CONCLUSIONS: Web-centered training was equally effective whether undertaken independently or accompanied by support, and its effects were sustained. The independent form of Web-centered training is particularly attractive as it provides a means of training large numbers of geographically dispersed therapists at low cost, thereby overcoming several obstacles to the widespread dissemination of psychological treatments

Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission

Funder: Addenbrooke's Charitable Trust, Cambridge University Hospitals; FundRef: http://dx.doi.org/10.13039/501100002927Significant differences exist in the availability of healthcare worker (HCW) SARS-CoV-2 testing between countries, and existing programmes focus on screening symptomatic rather than asymptomatic staff. Over a 3 week period (April 2020), 1032 asymptomatic HCWs were screened for SARS-CoV-2 in a large UK teaching hospital. Symptomatic staff and symptomatic household contacts were additionally tested. Real-time RT-PCR was used to detect viral RNA from a throat+nose self-swab. 3% of HCWs in the asymptomatic screening group tested positive for SARS-CoV-2. 17/30 (57%) were truly asymptomatic/pauci-symptomatic. 12/30 (40%) had experienced symptoms compatible with coronavirus disease 2019 (COVID-19)>7 days prior to testing, most self-isolating, returning well. Clusters of HCW infection were discovered on two independent wards. Viral genome sequencing showed that the majority of HCWs had the dominant lineage B∙1. Our data demonstrates the utility of comprehensive screening of HCWs with minimal or no symptoms. This approach will be critical for protecting patients and hospital staff

Understanding the process of diagnosis in perinatal mental health: detection of difficulties and service user experience

This volume comprises three chapters. The first chapter is a meta-analysis of the diagnostic accuracy of the Edinburgh Postnatal Depression Scale in detecting depression during the perinatal period. The second chapter is a qualitative study that investigates the experience of women receiving a psychiatric diagnosis during the perinatal period. The third chapter is a press release document, providing an overview of the meta-analysis and qualitative study

Are differences in breeding mechanisms and fertility among populations contributing to rarity in 'Grevillea Rhizomatosa' (Proteaceae)?

Plant breeding systems are seldom studied across the breadth of a species' range. For many systems, this precludes an informed assessment of the evolutionary biology of a species, particularly of the factors that shape fecundity. 'Grevillea rhizomatosa' is a threatened species of shrub known only from a 7 x 8 km area and c. 2000 plants in northern New South Wales, Australia. The species reproduces asexually from rhizomatous suckers, and fruit are only produced in a few populations. Over two flowering seasons, we investigated the extent of sexual reproduction and the mechanisms of infertility in five populations that span the range of the species. Seed were produced in three of the five populations. The breeding system varied among populations from obligate outcrossing to facultative outcrossing to fully sterile. Fruit to flower ratios were below 0.13 in the fertile populations but within the range found in other species of Grevillea. Pollinator limitation was not linked to infertility. Stigmatic opening and receptivity were functional in all populations. Interpopulation crosses using fertile pollen failed to recover fertility in an infertile population. A breakdown in female and male fertility mechanisms was found including a fault in the mechanical release of pollen from anthers

Population Structure and Fecundity in the Putative Sterile Shrub, 'Grevillea rhizomatosa' Olde & Marriott (Proteaceae)

'Grevillea rhizomatosa' Olde & Marriott (Proteaceae) is a threatened species of shrub known only from 12 populations within a 7 x 8 km area within Gibraltar Range and Washpool National Parks, northern New South Wales, Australia. Prior to this study it was believed that the species only reproduced from rhizomatous suckers as seed and fruit were never detected in the wild. A concern for the reproductive and evolutionary potential of the species in the event of a catastrophic disturbance was the basis for an investigation into the reproductive ecology of 'G. rhizomatosa'. Such an event occurred in October 2002 with an intense wildfire affecting most of the populations. Five populations were studied in detail for demography and fecundity prior to this fire and two populations were resurveyed in August 2005. In 2000, 916 individual stems were recorded across these populations and only small to large shrubs were found; no seedlings were recorded. Post-fire response was documented in two populations where plants were found to be resprouting and suckering from underground stems. In the pre-fire surveys of 2000 and 2001 flowering occurred in all populations, but since the fire of October 2002 flowering has only occurred in unburnt habitats. Flowers on shrubs in two of the five populations failed to produce fruit, but low fruit-set (7-13% of flowers) occurred in three populations. Seeds collected from two populations (n = 14) were tested for viability using tetrazolium chloride and were 100% viable. Ramets were detected in all populations and resprouting from underground stems was observed after wildfire. This is the first record of viable seed in this species and fertile populations require specific management to prevent loss of fertile plants. Loss of fertile plants could occur if repeated burning selects for vegetative reproduction and sterile plants

Ketamine as the prototype glutamatergic antidepressant:Pharmacodynamic actions, and a systematic review and meta-analysis of efficacy

The burden of depressive disorders and the frequent inadequacy of their current pharmacological treatments are well established. The anaesthetic and hallucinogenic drug ketamine has provoked much interest over the past decade or so as an extremely rapidly acting antidepressant that does not modify ‘classical’ monoaminergic receptors. Current evidence has shown several ways through which it might exert therapeutic antidepressant actions: blockade of glutamatergic NMDA receptors and relative upregulation of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) subtypes may alter cortical connectivity patterns; through intracellular changes in protein expression, including the proteins mammalian target of rapamycin (mTOR) and brain-derived neurotrophic factor (BDNF); and alteration of intracellular signalling cascades. The clinical evidence demonstrates rapid improvements in mood and suicidal thinking in most participants, although study numbers have generally been small and many trials are unblinded and methodologically weak. There is a small body of work to suggest ketamine might also augment electroconvulsive therapy and potentially have a role as a surgical anaesthetic in depressed patients. A major problem is that the effects of ketamine appear temporary, disappearing after days to weeks (although longer benefits have been sustained in some), and attempts to circumvent this through pharmacological augmentation have been disappointing thus far. These exciting data are providing new insights into neurobiological models of depression, and potentially opening up a new class of antidepressants, but there are significant practical and ethical issues about any future mainstream clinical role it might have

Ketamine and other glutamate receptor modulators for depression in adults

Considering the ample evidence of involvement of the glutamate system in the pathophysiology of depression, pre-clinical and clinical studies have been conducted to assess the antidepressant efficacy of glutamate inhibition, and glutamate receptor modulators in particular. This review focuses on the use of glutamate receptor modulators in unipolar depression

"Tell us what's going on": Exploring the information needs of pregnant and post-partum women in Australia during the pandemic with 'Tweets', 'Threads', and women's views.

IntroductionThe provision of maternity services in Australia has been significantly disrupted in response to the COVID-19 pandemic. Many changes were initiated quickly, often with rapid dissemination of information to women. The aim of this study was to better understand what information and messages were circulating regarding COVID-19 and pregnancy in Australia and potential information gaps.MethodsThis study adopted a qualitative approach using social media and interviews. A data analytics tool (TIGER-C19) was used to extract data from social media platforms Reddit and Twitter from June to July 2021 (in the middle of the third COVID-19 wave in Australia). A total of 21 individual semi-structured interviews were conducted with those who were, or had been, pregnant in Australia since March 2020. Social media data were analysis via inductive content analysis and interview data were thematically analysed.ResultsSocial media provided a critical platform for sharing and seeking information, as well as highlighting attitudes of the community towards COVID-19 vaccines in pregnancy. Women interviewed described wanting further information on the risks COVID-19 posed to themselves and their babies, and greater familiarity with the health service during pregnancy, in which they would labour and give birth. Health providers were a trusted source of information. Communication strategies that allowed participants to engage in real-time interactive discussions were preferred. A real or perceived lack of information led participants to turn to informal sources, increasing the potential for exposure to misinformation.ConclusionIt is vital that health services communicate effectively with pregnant women, early and often throughout public health crises, such as the COVID-19 pandemic. This was particularly important during periods of increased restrictions on accessing hospital services. Information and communication strategies need to be clear, consistent, timely and accessible to reduce reliance on informal and potentially inaccurate sources