Making and keeping the connection: Improving consumer attitudes and engagement in e-mental health interventions

E-mental health services are internet-based treatment options for mental illness. Potential benefits of e-mental health interventions include increased cost effectiveness, enhanced dissemination of evidence based treatments, and decreased burden on existing healthcare systems (Griffiths, Farrer, & Christensen, 2007). E-mental health services may also overcome various barriers to care such as stigma, accessibility, and socioeconomic status. Despite these benefits, consumer uptake and engagement in e-mental health services remains less than optimal. Available research indicates that consumer attitudes toward e-mental health services are problematic (Klein & Cook, 2010) but may be improved by the provision of information about the services (Casey, Joy & Clough, 2013). Research also suggests that the medium by which this information is delivered may have a significant influence on the efficacy of such interventions (Casey et al., 2013). Similarly, client engagement in e-mental health services is less than optimal, with a weighted average of 31% of clients prematurely ceasing involvement in psychological interventions delivered via the internet (Melville, Casey & Kavanagh, 2010). The current chapter will provide a review and discussion of consumer attitudes toward e-mental health services, as well as the efficacy and use of strategies to improve attitudes and enhance engagement. Recommendations for future research and clinical practice are also provided

Smart designs for smart technologies: research challenges and emerging solutions for scientist-practitioners within e-mental health

Consumers are increasingly likely to access various forms of e-mental health, and there is considerable danger that they may be exposed to untested interventions. Traditional research designs, such as the randomized controlled trial (RCT), are limited in their capacity to match the pace of development and evolving nature of e-mental health. There are a number of unique challenges associated with research into the development and use of technologically based interventions. This article discusses these challenges and examines emerging strategies that may enable clinicians to be more confident when integrating e-mental health in their practices. We argue that greater use of small sample size designs, greater collaboration and research in applied settings, as well as more focused empirical investigation during program development stages are needed. We use a research example of a Smartphone application aimed at the treatment of anxiety disorders to illustrate the procedure, value, and clinical applications of each of the emerging research designs

Using citizen science to monitor bumblebee populations

Bumblebees are important pollinators of crops and wildflowers and are currently in global decline. The main drivers of decline include agricultural intensification, climate change, invasive species, pesticides, parasites and pathogens and it is thought that these multiple stressors act together to impact populations. However, their relative importance is unknown and there are wide knowledge gaps in relation to the current status of species populations and their response to environmental variables such as climate, habitat and land use change. Citizen science offers a potential method of collecting data at a broad enough scale to measure species population responses to environmental stressors and it has successfully been applied to other taxa, particularly UK birds and butterflies. This thesis investigates the use of citizen science to address the current knowledge gaps in the status of UK bumblebee populations by analysing volunteer-collected data on current distribution and abundance trends in relation to habitat and climate change. Results are compared to previous studies to infer long-term changes in population dynamics. The value of applying citizen science methods to bumblebee monitoring is highlighted, revealing evidence for decline of some common species and the recent retraction of rare species to their climatic optima. The main findings reveal a potential impact of climate on the distribution of winter-active bumblebees. They also indicate that, while urban parks and gardens provide refuge for bumblebees in an otherwise impoverished landscape, urbanisation may favour short-tongued generalist species over long-term specialists. The outcomes of this thesis have important management implications for UK bumblebee populations including the need for reassessment of the conservation status of B. soroeensis and the sympathetic management of urban parks and gardens for longtongued specialists through the provision of suitable forage material

The Therapy Attitudes and Process Questionnaire: a brief measure of factors related to psychotherapy appointment attendance

Background: Patient non-attendance and dropout remains problematic in mental health settings. The theory of planned behavior (TPB) has proven useful in understanding such challenges in a variety of healthcare settings, but the absence of an adequate measure in mental health has hampered research in this area. Objective: The aim of the current study was to develop and conduct an initial psychometric investigation of a brief measure, the Therapy Attitudes and Process Questionnaire (TAP), utilizing the TPB to understand factors associated with attendance in mental health settings. Methods: We used a quantitative survey-based design and administered the TAP to 178 adult participants who were engaged in individual or group psychotherapy. A subsample also provided data to assess validity and reliability. Results: A four-factor solution was revealed through exploratory factor analysis and accounted for approximately 75 % of the variance in scores. Factors corresponded to those predicted by the TPB. Analyses supported the reliability, validity, and internal consistency of the measure. Conclusions: Results suggest that the TAP may be a useful tool for examining patients’ attitudes and beliefs about attending psychotherapy appointments. The TAP can be used to better understand patients’ intentions, attitudes, perceptions of behavioral control, and subjective norms relating to psychotherapy attendance. This understanding may facilitate improved outcomes for patients and clinicians

Second language anxiety among Latino American immigrants in Australia

Research into second language anxiety (SLA) has largely focused on second language learners rather than immigrants. However, living in an environment where the target language (TL) is the language of everyday communication may constitute a significant source of anxiety that generalizes beyond the language classroom [Pappamihiel, N. E. 2001. “Moving from the ESL Classroom into the Mainstream: An Investigation of English Language Anxiety in Mexican Girls.” Bilingual Research Journal 25: 31–39. doi:10.1080/15235882.2001.10162783; Rose, Glenda. 2008. “Language Acculturation Anxiety in Spanish Apeaking Adult Immigrants Learning English in the United States.” PhD diss., University of Texas. Available from ProQuest Dissertations and Theses database (UMI No. 3315370); Woodrow, L. 2006. “Anxiety and Speaking English as a Second Language.” RELC Journal 37: 308–328. doi:10.1177/0033688206071315]. This study explored SLA across different social contexts in a sample of 190 adult immigrants from Latin America to Australia who spoke Spanish as their first language (L1) and English as their second language (L2). The aims were to (a) investigate the presence and severity of SLA among L2 long-term immigrants, and (b) examine sources of individual differences in SLA. Results indicated that SLA exists among L2 immigrants at moderate, high and very high levels, and that levels of anxiety vary significantly across social contexts. Self perceived L2 proficiency was found to be the strongest predictor of SLA followed by extroversion and age, with higher scores on all three variables associated with lower SLA. Gender, education level, duration of residency in Australia, and emotional stability did not predict SLA in any of the contexts. These findings suggest that SLA is a significant problem for adult immigrants, permeating most aspects of their everyday lives. Practical implications and recommendations for future research are discussed

Unexpected Widespread Hypophosphatemia and Bone Disease Associated with Elemental Formula Use in Infants and Children

OBJECTIVE: Hypophosphatemia occurs with inadequate dietary intake, malabsorption, increased renal excretion, or shifts between intracellular and extracellular compartments. We noticed the common finding of amino-acid based elemental formula [EF] use in an unexpected number of cases of idiopathic hypophosphatemia occurring in infants and children evaluated for skeletal disease. We aimed to fully characterize the clinical profiles in these cases. METHODS: A retrospective chart review of children with unexplained hypophosphatemia was performed as cases accumulated from various centres in North America and Ireland. Data were analyzed to explore any relationships between feeding and biochemical or clinical features, effects of treatment, and to identify a potential mechanism. RESULTS: Fifty-one children were identified at 17 institutions with EF-associated hypophosphatemia. Most children had complex illnesses and had been solely fed Neocate® formula products for variable periods of time prior to presentation. Feeding methods varied. Hypophosphatemia was detected during evaluation of fractures or rickets. Increased alkaline phosphatase activity and appropriate renal conservation of phosphate were documented in nearly all cases. Skeletal radiographs demonstrated fractures, undermineralization, or rickets in 94% of the cases. Although the skeletal disease had often been attributed to underlying disease, most all improved with addition of supplemental phosphate or change to a different formula product. CONCLUSION: The observed biochemical profiles indicated a deficient dietary supply or severe malabsorption of phosphate, despite adequate formula composition. When transition to an alternate formula was possible, biochemical status improved shortly after introduction to the alternate formula, with eventual improvement of skeletal abnormalities. These observations strongly implicate that bioavailability of formula phosphorus may be impaired in certain clinical settings. The widespread nature of the findings lead us to strongly recommend careful monitoring of mineral metabolism in children fed EF. Transition to alternative formula use or implementation of phosphate supplementation should be performed cautiously with as severe hypocalcemia may develop

‘Remembering as Forgetting’: Organizational commemoration as a politics of recognition

This paper considers the politics of how organizations remember their past through commemorative settings and artefacts. Although these may be seen as ‘merely’ a backdrop to organizational activity, they form part of the lived experience of organizational spaces that its members enact on a daily basis as part of their routes and routines. The main concern of the paper is with how commemoration is bound up in the reflection and reproduction of hierarchies of organizational recognition. Illustrated with reference to two commemorative settings, the paper explores how organizations perpetuate a narrow set of symbolic ideals attributing value to particular forms of organizational membership while appearing to devalue others. In doing so, they communicate values that undermine attempts to achieve equality and inclusion. Developing a recognition-based critique of this process, the discussion emphasizes how commemorative settings and practices work to reproduce established patterns of exclusion and marginalization. To this end, traditional forms of commemorative portraiture that tend to close off difference are contrasted with a memorial garden, in order to explore the potential for an alternative, recognition-based ethics of organizational commemoration that is more open to the Other

Long-Term Follow-up of Hypophosphatemic Bone Disease Associated With Elemental Formula Use: Sustained Correction of Bone Disease After Formula Change or Phosphate Supplementation

In this article, we describe the long-term outcomes of children who were previously reported to have developed hypophosphatemic bone disease in association with elemental formula use. An extended chart review allowed for an updated report of 34 children with regard to severity/duration of bone disease, extent of recovery, and time to correction using radiology reports and biochemical data. After implementation of formula change and/or phosphate supplementation, we found that serum phosphorus concentration increased and serum alkaline phosphatase activity decreased in all patients, normalizing by 6.6 ± 4.0 (mean ± SD) months following diagnosis. The decrease in serum alkaline phosphatase from diagnosis to the time of correction was moderately correlated with the concurrent increase in serum phosphorus (R = 0.48, P < .05). Age at diagnosis significantly correlated with time to resolution (R = 0.51, P = .01). This study supports the earlier report that bone disease associated with hypophosphatemia during elemental formula use responds to formula change and/or phosphate supplementation

Evaluating the Effects of SARS-CoV-2 Spike Mutation D614G on Transmissibility and Pathogenicity.

Global dispersal and increasing frequency of the SARS-CoV-2 spike protein variant D614G are suggestive of a selective advantage but may also be due to a random founder effect. We investigate the hypothesis for positive selection of spike D614G in the United Kingdom using more than 25,000 whole genome SARS-CoV-2 sequences. Despite the availability of a large dataset, well represented by both spike 614 variants, not all approaches showed a conclusive signal of positive selection. Population genetic analysis indicates that 614G increases in frequency relative to 614D in a manner consistent with a selective advantage. We do not find any indication that patients infected with the spike 614G variant have higher COVID-19 mortality or clinical severity, but 614G is associated with higher viral load and younger age of patients. Significant differences in growth and size of 614G phylogenetic clusters indicate a need for continued study of this variant