The Impact of Video-Based Microinterventions on Attitudes Toward Mental Health and Help Seeking in Youth: Web-Based Randomized Controlled Trial.

BACKGROUND Mental health (MH) problems in youth are prevalent, burdening, and frequently persistent. Despite the existence of effective treatment, the uptake of professional help is low, particularly due to attitudinal barriers. OBJECTIVE This study evaluated the effectiveness and acceptability of 2 video-based microinterventions aimed at reducing barriers to MH treatment and increasing the likelihood of seeking professional help in young people. METHODS This study was entirely web based and open access. The interventions addressed 5 MH problems: generalized anxiety disorder, depression, bulimia, nonsuicidal self-injury, and problematic alcohol use. Intervention 1 aimed to destigmatize and improve MH literacy, whereas intervention 2 aimed to induce positive outcome expectancies regarding professional help seeking. Of the 2435 participants who commenced the study, a final sample of 1394 (57.25%) participants aged 14 to 29 years with complete data and sufficient durations of stay on the video pages were randomized in a fully automated manner to 1 of the 5 MH problems and 1 of 3 conditions (control, intervention 1, and intervention 2) in a permuted block design. After the presentation of a video vignette, no further videos were shown to the control group, whereas a second, short intervention video was presented to the intervention 1 and 2 groups. Intervention effects on self-reported potential professional help seeking (primary outcome), stigma, and attitudes toward help seeking were examined using analyses of covariance across and within the 5 MH problems. Furthermore, we assessed video acceptability. RESULTS No significant group effects on potential professional help seeking were found in the total sample (F2,1385=0.99; P=.37). However, the groups differed significantly with regard to stigma outcomes and the likelihood of seeking informal help (F2,1385=3.75; P=.02). Furthermore, separate analyses indicated substantial differences in intervention effects among the 5 MH problems. CONCLUSIONS Interventions to promote help seeking for MH problems may require disorder-specific approaches. The study results can inform future research and public health campaigns addressing adolescents and young adults. TRIAL REGISTRATION German Clinical Trials Register DRKS00023110; https://drks.de/search/de/trial/DRKS00023110

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Herstellung thermisch gespritzter Schichten mit optimierten Spannungseigenschaften

Gasturbines are widely used in stationary applications for power generation as well as in aero applications due to their high efficiency. The use of ceramic thermal barrier coatings (TBC) on the thermally high loaded turbine components allows either to increase the gas inlet temperature and therefore the efficiency of the system or to increase the lifetime of the system while maintaining the gas inlet temperature on it´s initial level. The ceramic thermal barrier coatings are typically deposited by atmospheric plasma spraying (APS) or electron beam – physical vapor deposition (EB-PVD). While the latter leads to microstructures with beneficial strain tolerance, the APS scores with it´s high deposition rates and the lower thermal conductivity due to the lamellar structure of these coatings perpendicular to the loading direction. Several factors occur during high temperature operation of the gasturbines that can increase the stiffness of the thermal barrier coating, influence the stresses within the thermal barrier coating, and finally may lead to delamination of the coating. The residual stress state of the as-sprayed coating can have an important effect on the behavior of the coating in operation. The in situ measurement of the sample´s curvature during the atmospheric plasma spraying process allows the evaluation of the residual stress evolution during the process and the determination of the residual stress depth profiles in the as-sprayed coatings. However, determination of the change of the stress depth profile in operation is not possible by this technique. The incremental hole-drilling method on the other hand is a widely used technique to determine residual stress depth profiles in the near surface region of components. By a comparison of the two measurement techniques for as-sprayed coatings the enhancement of the incremental hole-drilling method on coating systems is aspired. This finally enables the determination of the change of the residual stress states within the coating, the substrate and especially at the interface between the coating and the substrate by the thermo-mechanical loadings occuring in operation. A fundamental understanding of the interaction between the coating microstructure and the stress evolution is required to enable specific fabrication of coatings with well defined residual stress states. The investigation of these interrelations is aim of the present work. For this purpose, the different particle conditions in the plasma plume were evaluated in this work. Therefore, measurements of the temperature and velocity of single particles along the plasma plume were performed and combined with a simulation of the particle trajectories and the heat transfer between plasma and particles. Experimental studies of single splats deposited on mirror-polished substrates showed a high variety of splat morphologies that were classified into four basic splat-types to allow a systematic evaluation. The formation of these splat-types was linked to distinct particle and substrate conditions. The introduced particle melting degrees enabled the quantification of the relative fractions of the different particle conditions and, consequently, the relative fractions of the splat-types based on the particle temperature measurements. The formation of the coating and the connected properties was interpreted as the statistical distribution of the impact of single particles with various conditions. It was further shown that the properties of the deposited coating exhibit a distinct correlation to the distributions of the particle conditions. This is in particular the case for the coating porosity, which influences the Young´s modulus and the stress evolution. While the Young´s modulus of the coating is well defined by the porosity and the bonding between the single splats, the stress evolution exhibits more complex relations. The stress evolution in a single splat is dominated by the occurrence of various plastic effects (stress relaxation factors) depending on statistical factors, and therefore an exact prediction is hardly possible. An exemplary description was conducted based on existing analytical models and own finite element and analytical calculations. The layering of the single splats during the coating formation process was interpreted in the context of the statistic distribution of the different splat-types. However, it was not possible to completely describe the stress evolution by the influencing parameters used in this investigation. Since the impact frequency of the splats showed an effect on the stress evolution, the influence of the interface temperature between the single splats during deposition on the stress relaxation factors is supposed to play a key role. The outcome of this work can be used as starting point for the fabrication of atmospheric plasma sprayed coatings with well defined residual stress states. This offers the possibility to optimize the residual stress states in terms of the operation conditions as well as the fabrication of suitable samples for the enhancement of the incremental hole-drilling method on coating systems