Protocol for a randomised controlled trial investigating the effectiveness of an online e health application for the prevention of Generalised Anxiety Disorder

BACKGROUND Generalised Anxiety Disorder (GAD) is a highly prevalent psychiatric disorder. Effective prevention in young adulthood has the potential to reduce the prevalence of the disorder, to reduce disability and lower the costs of the disorder to the community. The present trial (the WebGAD trial) aims to evaluate the effectiveness of an evidence-based online prevention website for GAD. METHODS/DESIGN The principal clinical question under investigation is the effectiveness of an online GAD intervention (E-couch) using a community-based sample. We examine whether the effect of the intervention can be maximised by either human support, in the form of telephone calls, or by automated support through emails. The primary outcome will be a reduction in symptoms on the GAD-7 in the active arms relative to the non active intervention arms. DISCUSSION The WebGAD trial will be the first to evaluate the use of an internet-based cognitive behavioural therapy (CBT) program contrasted with a credible control condition for the prevention of GAD and the first formal RCT evaluation of a web-based program for GAD using community recruitment. In general, internet-based CBT programs have been shown to be effective for the treatment of other anxiety disorders such as Post Traumatic Stress Disorder, Social Phobia, Panic Disorder and stress in clinical trials; however there is no evidence for the use of internet CBT in the prevention of GAD. Given the severe shortage of therapists identified in Australia and overseas, and the low rates of treatment seeking in those with a mental illness, the successful implementation of this protocol has important practical outcomes. If found to be effective, WebGAD will provide those experiencing GAD with an easily accessible, free, evidence-based prevention tool which can be promoted and disseminated immediately

The association between suicidal ideation and increased mortality from natural causes

Background: Despite strong evidence for increased suicide mortality among individuals experiencing thoughts of suicide, the effect of suicidal ideation on increased natural mortality has not been evaluated. The present study aimed to assess whether there is excess mortality from all natural causes or from specific natural causes that is attributable to suicidal ideation. Adjustments were made for a range of demographic, mental health and physical health measures to examine evidence for specific mechanisms of the relationship. Method: A community-based Australian cohort of 861 older adults was followed for up to 17 years. Vital status and cause of death were ascertained from a national death registry. Results: After adjusting for demographics, physical health and mental health, presence of suicidal ideation was associated with a 23% increase in the risk of mortality from natural causes (p=0.034). The increased mortality was largely attributable to heart disease deaths (hazard ratio=1A3, p=0.041). Limitations: There was a limited number of deaths from respiratory disease or stroke, and modest rates of suicidal ideation in the cohort. Assessment of suicidal ideation was brief, while adjustment for mental health symptoms relied on non-diagnostic measures. Conclusions: Although the relationship between suicidal ideation and mortality from natural causes was partly explained by physical and mental health status, thoughts of suicide independently accounted for an increased risk of mortality. Further research should examine whether this relationship is mediated by poorer health behaviours among individuals experiencing thoughts of suicide. (C) 2013 Elsevier B.V. All rights reserved

Spatial and Temporal Patterns of Small-Scale Mixing in Drake Passage

Temperature and salinity profiles obtained with expendable CTD probes throughout Drake Passage between February 2002 and July 2005 are analyzed to estimate turbulent diapycnal eddy diffusivities to a depth of 1000 m. Diffusivity values are inferred from density/temperature inversions and internal wave vertical strain. Both methods reveal the same pattern of spatial variability across Drake Passage; diffusivity estimates from inversions exceed those from vertical strain by a factor of 3 over most of Drake Passage. The Polar Front (PF) separates two dynamically different regions. Strong thermohaline intrusions characterize profiles obtained north of the PF. South of the PF, stratification is determined largely by salinity, and temperature is typically unstably stratified between 100- and 600-m depth. In the upper 400 m, turbulent diapycnal diffusivities are O(10^(−3) m2 s^(−1)) north of the PF but decrease to O(10^(−4) m2 s^(−1)) or smaller south of the PF. Below 400 m diffusivities typically exceed 10^(−4) m^2 s^(−1). Diffusivities decay weakly with depth north of the PF, whereas diffusivities increase with depth and peak near the local temperature maximum south of the PF. The meridional pattern in near-surface mixing corresponds to local maxima and minima of both wind stress and wind stress variance. Near-surface diffusivities are also found to be larger during winter months north of the PF. Wind-driven near-inertial waves, strong mesoscale eddy activity, and double-diffusive convection are suggested as possible factors contributing to observed mixing pattern

The ANU WellBeing study: a protocol for a quasi-factorial randomised controlled trial of the effectiveness of an Internet support group and an automated Internet intervention for depression

BACKGROUND Recent projections suggest that by the year 2030 depression will be the primary cause of disease burden among developed countries. Delivery of accessible consumer-focused evidenced-based services may be an important element in reducing this burden. Many consumers report a preference for self-help modes of delivery. The Internet offers a promising modality for delivering such services and there is now evidence that automated professionally developed self-help psychological interventions can be effective. By contrast, despite their popularity, there is little evidence as to the effectiveness of Internet support groups which provide peer-to-peer mutual support. METHODS/DESIGN Members of the community with elevated psychological distress were randomised to receive one of the following: (1) Internet Support Group (ISG) intervention, (2) a multi-module automated psychoeducational and skills Internet Training Program (ITP), (3) a combination of the ISG and ITP, or (4) an Internet Attention Control website (IAC) comprising health and wellbeing information and question and answer modules. Each intervention was 12 weeks long. Assessments were conducted at baseline, post-intervention, 6 and 12 months to examine depressive symptoms, social support, self-esteem, quality of life, depression literacy, stigma and help-seeking for depression. Participants were recruited through a screening postal survey sent to 70,000 Australians aged 18 to 65 years randomly selected from four rural and four metropolitan regions in Australia. DISCUSSION To our knowledge this study is the first randomised controlled trial of the effectiveness of a depression ISG. TRIAL REGISTRATION Current Controlled Trials ISRCTN65657330.This study was funded by a National Health and Medical Research Council Project Grant 471435 to KG, HC and AM. KG is supported by NHMRC Fellowship No. 525413 and HC is supported by Fellowship No. 525411

Improving confidence in hands-on scientific skills post-pandemic

BACKGROUND AND AIMS For undergraduate science classes, practical activities serve to reinforce theory; familiarise students with a scientific laboratory; promote laboratory techniques and technical dexterity; and facilitate peer-to-peer learning and interaction (Kemm & Dantas, 2007; Rice et al., 2009). In comparison to other disciplines, practical classes and hands-on skills are an essential part of face-to-face teaching (Anderton et al., 2021). The impact of the COVID-19 pandemic is now obvious in science-based disciplines with some students having studied two thirds of their degree online. The consequence of not providing opportunities to use equipment, handle instruments, and physically see reactions and specimens while learning online, has increased anxiety and knocked confidence of students returning to face-to-face study.  Academics are having to teach basic hands-on skills that students were not able to practice early in their programs. This project, funded by the Australian Council of Deans of Science, aimed to identify the key core competencies for scientific skills across disciplines from a student and academic perspective; co-create appropriate resources to supplement and support learning of hands-on skills for these competencies; and improve student confidence in developing their hands-on skills. DESIGN AND METHODS Core scientific skills and preference of learning style during the pandemic were identified by surveying academics and students in science-based disciplines. This information was used to inform a co-creation workshop where academics and students worked together to blueprint resources to support learning of key hands-on skills. Researchers of this project supported the development of resources in their scientific discipline with expertise from professional staff. The effectiveness of resources, in supporting learning of core hands-on scientific skills to improve student confidence, will be reviewed in a focus group where students will trial the resources while completing scientific tasks. RESULTS AND CONCLUSIONS Students and academics ranked lab safety, calculations, keeping a lab book and data analysis as the most required hands-on scientific skills. The most favoured resources to support them were instructional videos produced by staff or peers, hands-on practice sessions outside of structured class time and quizzes. Students also found text resources and regular Zoom meetings important to their online learning. Interestingly, the required hands-on skills did not explicitly need to be taught face-to-face for students to master the skill. In addition, academics also used data sets, photos and computer simulations to teach hands-on skills online with an overall 50% engagement from students. Students were most impacted by not being able to handle equipment (45.5%) which caused a lack of confidence (44%) in their hands-on skills. Both academics and students believed this could be supported by authentic videos and practice sessions where there is no time limit or assessment pressure to learn a skill. This may improve student engagement in scientific courses and reduce the skills gap for those students who studied during the pandemic. REFERENCES Anderton, R. S., Vitali, J., Blackmore, C., W. & Bakeberg, M.C. (2021). Flexible Teaching and Learning Modalities in Undergraduate Science amid the COVID-19 pandemic, Frontiers in Education, 5:609703. Kemm R. E., & Dantas, A. M. (2007). Research-led learning in biological science practical activities: supported by student-centered e-learning. Federation of American Societies for Experimental Biology. 21, A220–A220. Rice, J. W., Thomas, S. M., O’Toole, P., & Pannizon, D. (2009). Tertiary Science Education in the 21st Century (pp. 136). Melbourne, Australia: Australian Learning and Teaching Council

Hierarchical screening for multiple mental disorders

Background: There is a need for brief, accurate screening when assessing multiple mental disorders. Two-stage hierarchical screening, consisting of brief pre-screening followed by a battery of disorder-specific scales for those who meet diagnostic criteria, may increase the efficiency of screening without sacrificing precision. This study tested whether more efficient screening could be gained using two-stage hierarchical screening than by administering multiple separate tests. Method: Two Australian adult samples (N=1990) with high rates of psychopathology were recruited using Facebook advertising to examine four methods of hierarchical screening for four mental disorders: major depressive disorder, generalised anxiety disorder, panic disorder and social phobia. Results: Using K6 scores to determine whether full screening was required did not increase screening efficiency. However, pre-screening based on two decision tree approaches or item gating led to considerable reductions in the mean number of items presented per disorder screened, with estimated item reductions of up to 54%. The sensitivity of these hierarchical methods approached 100% relative to the full screening battery. Limitations: Further testing of the hierarchical screening approach based on clinical criteria and in other samples is warranted. Conclusions: The results demonstrate that a two-phase hierarchical approach to screening multiple mental disorders leads to considerable increases efficiency gains without reducing accuracy. Screening programs should take advantage of prescreeners based on gating items or decision trees to reduce the burden on respondents. (C) 2013 Elsevier B.V. All rights reserved

What is operative? Conceptualizing neuralgia: Neuroma, compression neuropathy, painful hyperalgesia, and phantom nerve pain

Neuralgia, or nerve pain, is a common presenting complaint for the hand surgeon. When the nerve at play is easily localized, and the cause of the pain is clear (eg, carpal tunnel syndrome), the patient may be easily treated with excellent results. However, in more complex cases, the underlying pathophysiology and cause of neuralgia can be more difficult to interpret; if incorrectly managed, this leads to frustration for both the patient and surgeon. Here we offer a way to conceptualize neuralgia into 4 categories-compression neuropathy, neuroma, painful hyperalgesia, and phantom nerve pain-and offer an illustrative clinical vignette and strategies for optimal management of each. Further, we delineate the reasons why compression neuropathy and neuroma are amenable to surgery, while painful hyperalgesia and phantom nerve pain are not

The effectiveness of an online support group for members of the community with depression: a randomised controlled trial

Background: Internet support groups (ISGs) are popular, particularly among people with depression, but there is little high quality evidence concerning their effectiveness. Aim: The study aimed to evaluate the efficacy of an ISG for reducing depressive symptoms among community members when used alone and in combination with an automated Internet-based psychotherapy training program. Method: Volunteers with elevated psychological distress were identified using a community-based screening postal survey. Participants were randomised to one of four 12-week conditions: depression Internet Support Group (ISG), automated depression Internet Training Program (ITP), combination of the two (ITP+ISG), or a control website with delayed access to ecouch at 6 months. Assessments were conducted at baseline, post-intervention, 6 and 12 months. Results: There was no change in depressive symptoms relative to control after 3 months of exposure to the ISG. However, both the ISG alone and the combined ISG+ITP group showed significantly greater reduction in depressive symptoms at 6 and 12 months follow-up than the control group. The ITP program was effective relative to control at post-intervention but not at 6 months. Conclusions: ISGs for depression are promising and warrant further empirical investigation.The trial was funded by a National Health and Medical Research Council Project Grant 471435. KG is supported by NHMRC Fellowship No. 525413 and HC is supported by Fellowship No. 525411. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Cliff Roosting by Migrant Semipalmated Sandpipers, Calidris pusilla, at Farrier's Cove, Shepody Bay, New Brunswick

An observation of Semipalmated Sandpipers roosting on a cliff face in Shepody Bay, New Brunswick, suggests changes from “traditional” roosting sites. Sandpipers may be altering their roosting patterns due to pressures from avian predators such as the recent, and successful, re-introduction of the Peregrine Falcon

Protocol for a randomised controlled trial investigating the effectiveness of an online e health application for the prevention of Generalised Anxiety Disorder

Background: Generalised Anxiety Disorder (GAD) is a highly prevalent psychiatric disorder. Effective prevention in young adulthood has the potential to reduce the prevalence of the disorder, to reduce disability and lower the costs of the disorder to the community. The present trial (the WebGAD trial) aims to evaluate the effectiveness of an evidence-based online prevention website for GAD.Methods/Design: The principal clinical question under investigation is the effectiveness of an online GAD intervention (E-couch) using a community-based sample. We examine whether the effect of the intervention can be maximised by either human support, in the form of telephone calls, or by automated support through emails. The primary outcome will be a reduction in symptoms on the GAD-7 in the active arms relative to the non active intervention arms.Discussion: The WebGAD trial will be the first to evaluate the use of an internet-based cognitive behavioural therapy (CBT) program contrasted with a credible control condition for the prevention of GAD and the first formal RCT evaluation of a web-based program for GAD using community recruitment. In general, internet-based CBT programs have been shown to be effective for the treatment of other anxiety disorders such as Post Traumatic Stress Disorder, Social Phobia, Panic Disorder and stress in clinical trials; however there is no evidence for the use of internet CBT in the prevention of GAD. Given the severe shortage of therapists identified in Australia and overseas, and the low rates of treatment seeking in those with a mental illness, the successful implementation of this protocol has important practical outcomes. If found to be effective, WebGAD will provide those experiencing GAD with an easily accessible, free, evidence-based prevention tool which can be promoted and disseminated immediately.Trial Registration: Controlled-trials.com: ISRCTN76298775