Feasibility and Fit of a Mental Health Promotion Program for LGBTQ+ Youth

This study evaluated the feasibility and fit of a mental health promotion and violence prevention program adapted for LGBTQ+ youth (ages 14-18). The pilot program included 16 30-minute sessions and was implemented in 8 gender and sexuality alliances (GSAs) and one community youth group setting. Extensive feedback was collected from 11 facilitators via session tracking sheets, ongoing email communication, an implementation survey, and a focus group; and from 7 youth who participated in a variety of feedback activities during a 2-day post-program workshop. Results indicated a strong interest in formalized programming, challenges related to its delivery in GSAs, and significant issues with its content. Facilitators and youth advocated for the program to be more affirmative, include youth-centered notions of identities and expressions, be trauma-informed, include a wider range of relationships, and adopt a youth-led approach

The length of time's arrow

An unresolved problem in physics is how the thermodynamic arrow of time arises from an underlying time reversible dynamics. We contribute to this issue by developing a measure of time-symmetry breaking, and by using the work fluctuation relations, we determine the time asymmetry of recent single molecule RNA unfolding experiments. We define time asymmetry as the Jensen-Shannon divergence between trajectory probability distributions of an experiment and its time-reversed conjugate. Among other interesting properties, the length of time's arrow bounds the average dissipation and determines the difficulty of accurately estimating free energy differences in nonequilibrium experiments

Medical Tourism in the Tropics: New Regulation is Needed to Tackle Equity and Quality Concerns in Barbados

Medical tourism is on the rise as many patients travel overseas to seek private medical care that is either more expensive, unavailable or requires long waiting periods in their home country. Barbados, a small Caribbean island actively planning for medical tourism industry development, faces common challenges affecting destination countries such as degraded local access to healthcare, and possible brain drain of domestic medical workers. To address such concerns, the government must navigate both legal and ethical obstacles to develop effective regulatory mechanisms for their emerging medical tourism sector.  &nbsp

Inbound Medical Tourism to Barbados: A Qualitative Examination of Local Lawyers’ Prospective Legal and Regulatory Concerns

Background Enabled by globalizing processes such as trade liberalization, medical tourism is a practice that involves patients’ intentional travel to privately obtain medical care in another country. Empirical legal research on this issue is limited and seldom based on the perspectives of destination countries receiving medical tourists. We consulted with diverse lawyers from across Barbados to explore their views on the prospective legal and regulatory implications of the developing medical tourism industry in the country. Methods We held a focus group in February 2014 in Barbados with lawyers from across the country. Nine lawyers with diverse legal backgrounds participated. Focus group moderators summarized the study objective and engaged participants in identifying the local implications of medical tourism and the anticipated legal and regulatory concerns. The focus group was transcribed verbatim and analyzed thematically. Results Five dominant legal and regulatory themes were identified through analysis: (1) liability; (2) immigration law; (3) physician licensing; (4) corporate ownership; and (5) reputational protection. Conclusions Two predominant legal and ethical concerns associated with medical tourism in Barbados were raised by participants and are reflected in the literature: the ability of medical tourists to recover medical malpractice for adverse events; and the effects of medical tourism on access to health care in the destination country. However, the participants also identified several topics that have received much less attention in the legal and ethical literature. Overall this analysis reveals that lawyers, at least in Barbados, have an important role to play in the medical tourism sector beyond litigation – particularly in transactional and gatekeeper capacities. It remains to be seen whether these findings are specific to the ecology of Barbados or can be extrapolated to the legal climate of other medical tourism destination countries

A feasibility, randomised controlled trial of a complex breathlessness intervention in idiopathic pulmonary fibrosis (BREEZE-IPF): study protocol

Introduction Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive lung disease that causes breathlessness and cough that worsen over time, limiting daily activities and negatively impacting quality of life. Although treatments are now available that slow the rate of lung function decline, trials of these treatments have failed to show improvement in symptoms or quality of life. There is an immediate unmet need for evidenced-based interventions that improve patients' symptom burden and make a difference to everyday living. This study aims to assess the feasibility of conducting a definitive randomised controlled trial of a holistic, complex breathlessness intervention in people with IPF. Methods and analysis The trial is a two-centre, randomised controlled feasibility trial of a complex breathlessness intervention compared with usual care in patients with IPF. 50 participants will be recruited from secondary care IPF clinics and randomised 1:1 to either start the intervention within 1 week of randomisation (fast-track group) or to receive usual care for 8 weeks before receiving the intervention (wait-list group). Participants will remain in the study for a total of 16 weeks. Outcome measures will be feasibility outcomes, including recruitment, retention, acceptability and fidelity of the intervention. Clinical outcomes will be measured to inform outcome selection and sample size calculation for a definitive trial. Ethics and dissemination Yorkshire and The Humber – Bradford Leeds Research Ethics Committee approved the study protocol (REC 18/YH/0147). Results of the main trial and all secondary end-points will be submitted for publication in a peer-reviewed journal

Measurements of a low temperature mechanical dissipation peak in a single layer of Ta2O5 doped with TiO2

Thermal noise arising from mechanical dissipation in oxide coatings is a major limitation to many precision measurement systems, including optical frequency standards, high resolution optical spectroscopy and interferometric gravity wave detectors. Presented here are measurements of dissipation as a function of temperature between 7 K and 290 K in ion-beam sputtered Ta2O5 doped with TiO2, showing a loss peak at 20 K. Analysis of the peak provides the first evidence of the source of dissipation in doped Ta2O5 coatings, leading to possibilities for the reduction of thermal noise effects

Vegetation Type and Decomposition Priming Mediate Brackish Marsh Carbon Accumulation Under Interacting Facets of Global Change

Coastal wetland carbon pools are globally important, but their response to interacting facets of global change remain unclear. Numerical models neglect species-specific vegetation responses to sea level rise (SLR) and elevated CO2 (eCO2) that are observed in field experiments, while field experiments cannot address the long-term feedbacks between flooding and soil growth that models show are important. Here, we present a novel numerical model of marsh carbon accumulation parameterized with empirical observations from a long-running eCO2 experiment in an organic rich, brackish marsh. Model results indicate that eCO2 and SLR interact synergistically to increase soil carbon burial, driven by shifts in plant community composition and soil volume expansion. However, newly parameterized interactions between plant biomass and decomposition (i.e. soil priming) reduce the impact of eCO2 on marsh survival, and by inference, the impact of eCO2 on soil carbon accumulation

Correlations between the mechanical loss and atomic structure of amorphous TiO2-doped Ta2O5 coatings

<p>Highly reflective dielectric mirror coatings are critical components in a range of precision optics applications including frequency combs, optical atomic clocks, precision interferometry and ring laser gyroscopes. A key limitation to the performance in these applications is thermal noise, arising from the mechanical loss of the coatings. The origins of the mechanical loss from these coatings is not well understood.</p> <p>Recent work suggests that the mechanical loss of amorphous Ta2O5 coatings can drop by as much as 40% when it is doped with TiO2. We use a combination of electron diffraction data and atomic modelling using molecular dynamics to probe the atomic structure of these coatings, and examine the correlations between changes in the atomic structure and changes in the mechanical loss of these coatings. Our results show the first correlation between changes in the mechanical loss and experimentally measured changes in the atomic structure resulting from variations in the level of TiO2 doping in TiO2-doped Ta2O5 coatings, in that increased homogeneity at the nearest-neighbour level appears to correlate with reduced mechanical loss. It is demonstrated that subtle but measurable changes in the nearest-neighbour homogeneity in an amorphous material can correlate with significant changes in macroscopic properties.</p&gt

Navigating Physicians’ Ethical and Legal Duties to Patients Seeking Unproven Interventions Abroad

Medical tourism (MT), the practice of traveling to another country to access medical care that is paid for out of pocket, has received considerable attention in the Canadian news media.Media and industry information sources, which are commonly accessed by medical tourists, might inadequately inform Canadians about MT safety concerns. As a result, there is concern among Canadian physicians and health and safety professionals that prospective medical tourists might not be well placed to make informed decisions about their care. As gatekeepers in the health care system and the first source of interaction between the health care system and patients, family physicians are well positioned to inform Canadians about these safety risks