Beyond the trial: A systematic review of real-world uptake and engagement with digital self-help interventions for depression, low mood, or anxiety

Background: Digital self-help interventions (including online or computerized programs and apps) for common mental health issues have been shown to be appealing, engaging, and efficacious in randomized controlled trials. They show potential for improving access to therapy and improving population mental health. However, their use in the real world, that is, as implemented (disseminated) outside of research settings, may differ from that reported in trials, and implementation data are seldom reported. Objective: We aimed to review peer-reviewed articles reporting user uptake and/or ongoing use, retention, or completion data (hereafter ‘usage data’ or, for brevity, ‘engagement’) from implemented pure self-help (unguided) digital interventions for depression, anxiety, or the enhancement of mood. Methods: We conducted a systematic search of the Scopus, Embase, MEDLINE, and PsychINFO databases for studies reporting user uptake and/or usage data from implemented digital self-help interventions for the treatment or prevention of depression or anxiety, or the enhancement of mood, from 2002 to 2017. Additionally, we screened the reference lists of included articles, citations of these articles, and the titles of articles published in Internet Interventions, Journal of Medical Internet Research (JMIR), and JMIR Mental Health since their inception. We extracted data indicating the number of registrations or downloads and usage of interventions. Results: After the removal of duplicates, 970 papers were identified, of which ten met the inclusion criteria. Hand-searching identified one additional article. The included articles reported on seven publically available interventions. There was little consistency in the measures reported. The number of registrants or downloads ranged widely, from eight to over 40,000 per month. From 21% to 88% of users engaged in at least minimal use (e.g. used the intervention at least once or completed one module or assessment), while 7–42% engaged in moderate use (completing between 40% and 60% of modular fixed-length programs or continuing to use apps after four weeks). Indications of completion or sustained use (completion of all modules or the last assessment or continuing to use apps after six weeks or more) varied from 0.5% to 28.6%. Conclusions: Available data suggest that uptake and engagement vary widely among the handful of implemented digital self-help apps and programs which have reported this, and that usage may vary from that reported in trials. Implementation data should be routinely gathered and reported to facilitate improved uptake and engagement, arguably among the major challenges in digital health

Lessons lost in sentencing: Welding individualised justice to indigenous justice

Indigenous offenders are heavily over-represented in the Australian and Canadian criminal justice systems. In the case of R v Gladue, the Supreme Court of Canada held that sentencing judges are to recognise the adverse systemic and background factors that many Aboriginal Canadians face and consider all reasonable alternatives to imprisonment in light of this. In R v Ipeelee, the Court reiterated the need to fully acknowledge the oppressive environment faced by Aboriginal Canadians throughout their lives and the importance of sentencing courts applying appropriate sentencing options. In 2013, the High Court of Australia handed down its decision in Bugmy v The Queen. The Court affirmed that deprivation is a relevant consideration and worthy of mitigation in sentencing. However, the Court refused to accept that judicial notice should be taken of the systemic background of deprivation of many Indigenous offenders. The High Court also fell short of applying the Canadian principle that sentencing should promote restorative sentences for Indigenous offenders, given this oft-present deprivation and their over-representation in prison. In this article, we argue that Bugmy v The Queen represents a missed opportunity by the High Court to grapple with the complex interrelationship between individualised justice and Indigenous circumstances in the sentencing of Indigenous offenders

Defect Detection in Bonded Structures Using the Reverberant Wavefield

With the increasing use of adhesives in the automotive, aerospace, and manufacturing industries, there is a growing interest in developing nondestructive methods for locating defects in adhesive bonds. While conventional techniques which utilize ultrasonic waves and Lamb waves are likely candidates for obtaining high resolution images of defects, these methods may not be practical for assembly line applications where the time required to scan the bonds and the access to the bonds are often limited. The objective of this work is to develop an approach for detecting defects in bonds that requires only a limited number of measurements of the reverberant acoustic wavefield (i.e., waves that are multiply scattered off the boundaries of the structure) made over a band of frequencies

A fault-tolerant multiprocessor architecture for aircraft, volume 1

A fault-tolerant multiprocessor architecture is reported. This architecture, together with a comprehensive information system architecture, has important potential for future aircraft applications. A preliminary definition and assessment of a suitable multiprocessor architecture for such applications is developed

Star Formation in Galaxy Mergers with Realistic Models of Stellar Feedback and the Interstellar Medium

We use hydrodynamic simulations with detailed, explicit models for stellar feedback to study galaxy mergers. These high-resolution (∼1 pc) simulations follow the formation and destruction of individual giant molecular clouds (GMC) and star clusters. We find that the final starburst is dominated by in situ star formation, fuelled by gas which flows inwards due to global torques. The resulting high gas density results in rapid star formation. The gas is self-gravitating, and forms massive (≲1010 M⊙) GMC and subsequently super star clusters (with masses up to 108 M⊙). However, in contrast to some recent simulations, the bulk of new stars which eventually form the central bulge are not born in super-clusters which then sink to the centre of the galaxy. This is because feedback efficiently disperses GMC after they turn several per cent of their mass into stars. In other words, most of the mass that reaches the nucleus does so in the form of gas. The Kennicutt–Schmidt law emerges naturally as a consequence of feedback balancing gravitational collapse, independent of the small-scale star formation microphysics. The same mechanisms that drive this relation in isolated galaxies, in particular radiation pressure from infrared photons, extend, with no fine-tuning, over seven decades in star formation rate (SFR) to regulate star formation in the most extreme starburst systems with densities ≳104 M⊙ pc−2. This feedback also drives super-winds with large mass-loss rates; however, a significant fraction of the wind material falls back on to the discs at later times, leading to higher post-starburst SFRs in the presence of stellar feedback. This suggests that strong active galactic nucleus feedback may be required to explain the sharp cut-offs in SFR that are observed in post-merger galaxies. We compare the results to those from simulations with no explicit resolution of GMC or feedback [‘effective equation-of-state’ (EOS) models]. We find that global galaxy properties are similar between EOS and resolved-feedback models. The relic structure and mass profile, and the total mass of stars formed in the nuclear starburst are quite similar, as is the morphological structure during and after mergers (tails, bridges, etc.). Disc survival in sufficiently gas rich mergers is similar in the two cases, and the new models follow the same scalings as derived for the efficiency of disc re-formation after a merger as derived from previous work with the simplified EOS models. While the global galaxy properties are similar between EOS and feedback models, subgalaxy-scale properties and the SFRs can be quite different: the more detailed models exhibit significantly higher star formation in tails and bridges (especially in shocks), and allow us to resolve the formation of super star clusters. In the new models, the star formation is more strongly time-variable and drops more sharply between close passages. The instantaneous burst enhancement can be higher or lower, depending on the details of the orbit and initial structural properties of the galaxies; first-passage bursts are more sensitive to these details than those at the final coalescence