An equivalence evaluation of a nurse-moderated group-based internet support program for new mothers versus standard care: a pragmatic preference randomised controlled trial

BACKGROUND: All mothers in South Australia are offered a clinic or home-visit by a Child and Family Health community nurse in the initial postnatal weeks. Subsequent support is available on request from staff in community clinics and from a telephone helpline. The aim of the present study is to compare equivalence of a single clinic-based appointment plus a nurse-moderated group-based internet intervention when infants were aged 0-6 months versus a single home-visit together with subsequent standard services (the latter support was available to mothers in both study groups). METHODS/DESIGN: The evaluation utilised a pragmatic preference randomised trial comparing the equivalence of outcomes for mothers and infants across the two study groups. Eligible mothers were those whose services were provided by nurses working in one of six community clinics in the metropolitan region of Adelaide. Mothers were excluded if they did not have internet access, required an interpreter, or their nurse clinician recommended that they not participate due to issues such as domestic violence or substance abuse. Randomisation was based on the service identification number sequentially assigned to infants when referred to the Child and Family Health Services from birthing units (this was done by administrative staff who had no involvement in recruiting mothers, delivering the intervention, or analyzing results for the study). Consistent with design and power calculations, 819 mothers were recruited to the trial. The primary outcomes for the trial are parents' sense of competence and self-efficacy measured using standard self-report questionnaires. Secondary outcomes include the quality of mother-infant relationships, maternal social support, role satisfaction and maternal mental health, infant social-emotional and language development, and patterns of service utilisation. Maternal and infant outcomes will be evaluated using age-appropriate questionnaires when infants are aged <2 months (pre-intervention), 9, 15, and 21 months. DISCUSSION: We know of no previous study that has evaluated an intervention that combines the capacity of nurse and internet-based services to improve outcomes for mothers and infants. The knowledge gained from this study will inform the design and conduct of community-based postnatal mother and child support programs. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12613000204741.Alyssa CP Sawyer, John Lynch, Kerrie Bowering, Debra Jeffs, Jenny Clark, Christine Mpundu-Kaambwa and Michael G Sawye

A comparison of adolescent and adult health state values for the Child Health Utility-9D using profile case best worst scaling

The main objective of this study was to compare and contrast adolescent and adult values for the Child Health Utility-9D (CHU9D), a new generic preference based measure of health related quality of life designed for application in the economic evaluation of treatment and preventive programmes for children and adolescents. Previous studies have indicated that there may be systematic differences in adolescent and adult values for identical health states but have failed to use a common valuation technique. An on-line survey including a series of best worst scaling discrete choice experiment questions for health states defined by the CHU9D, was administered to two general population samples comprising adults and adolescents respectively. The results highlight potentially important age related differences in the values attached to CHU9D dimensions. Adults, in general, placed less weight upon impairments in mental health (worried, sad, annoyed) and more weight upon moderate to severe levels of pain relative to adolescents. The source of values (adults or adolescents) has important implications for economic evaluation and may impact significantly upon health care policy. Profile case best worst scaling offers a promising approach for the elicitation and comparison of health state values across population groups.Financial support from a Flinders University seeding grant and an Australian NHMRC Project Grant 1021899 entitled 'Adolescent values for the economic evaluation of adolescent health care treatment and preventive programs' is gratefully acknowledged

Relationships between the home environment and physical activity and dietary patterns of preschool children: a cross-sectional study

Objective: To assess relationships between characteristics of the home environment and preschool children's physical activity and dietary patterns. Methods: Homes of 280 preschool children were visited and information obtained by direct observation and parent interview regarding physical and nutritional characteristics of the home environment. Children's physical activity, sedentary behaviour and dietary patterns were measured using standardised parent-report questionnaires. Associations were analysed using analysis of variance and correlation. Results: Parental physical activity (p = 0.03–0.008), size of backyard (p = 0.001) and amount of outdoor play equipment (p = 0.003) were associated with more outdoor play. Fewer rules about television viewing (p < 0.001) and presence of playstation (p = 0.02) were associated with more indoor sedentary time. Higher fruit and vegetable intake was associated with restricting children's access to fruit juice (p = 0.02) and restricting high fat/sugar snacks (p = 0.009). Lower intake of noncore foods was associated with restricting children's access to fruit juice (p = 0.007), cordial/ carbonated drinks (p < 0.001) and high fat/sugar snacks (p = 0.003). Lower fruit and vegetable intake was associated with reminding child to 'eat up' (p = 0.007) and offering food rewards to eat main meal (p = 0.04). Higher intake of non-core foods was associated with giving food 'treats' (p = 0.03) and offering food rewards to eat main meal (p = 0.04). The availability of food groups in the home was associated with children's intake of these foods (fruit and vegetables, p < 0.001; fat in dairy, p = <0.001; sweetened beverages, p = 0.004–<0.001; non-core foods, p = 0.01–<0.001). Conclusion: Physical attributes of the home environment and parental behaviours are associated with preschool children's physical activity, sedentary behaviour and dietary patterns. Many of these variables are modifiable and could be targeted in childhood obesity prevention and management.Nicola J Spurrier, Anthea A Magarey, Rebecca Golley, Fiona Curnow and Michael G Sawye

Associations between teacher-reported school climate and depressive symptoms in Australian adolescents : a 5-year longitudinal study.

Adolescent depression is serious and common. As adolescents spend approximately 15,000 h in school, this setting is a logical place to seek etiological factors. Research suggests there are negative associations between school climate and adolescent depressive symptoms. However, such studies typically use student reports of both climate and depressive symptoms; this is problematic because common method variance results when the same individual provides information on all variables, contributing to overestimations of associations between depressive symptoms and school climate. Therefore, the purpose of this study is to examine the association between teacher-reported school climate and adolescent-reported depressive symptoms. Thus, 2545 Australian high school students participated in this 5-year longitudinal study. Students completed a measure of depressive symptoms annually; their teachers (N = 882) completed a questionnaire to evaluate the quality of the school environment (i.e., safe/orderly and supportive relationships). Multi-group latent growth models revealed that more positive teacher-reported school climate was cross-sectionally associated with fewer student-reported depressive symptoms in both boys and girls, although this association was significantly stronger for girls. Longitudinally, positive school climate was associated with lower depressive symptoms but a higher rate of change of symptoms for both boys and girls. The overall findings are consistent with previous findings with student-reported school climate. However, the gender difference and the directionality of the longitudinal association between school climate and depressive symptoms over time demonstrate that additional studies of mechanisms by which school climate is connected to adolescents’ depressive symptoms are needed

Associations between teacher-reported school climate and depressive symptoms in Australian adolescents : a 5-year longitudinal study.

Adolescent depression is serious and common. As adolescents spend approximately 15,000 h in school, this setting is a logical place to seek etiological factors. Research suggests there are negative associations between school climate and adolescent depressive symptoms. However, such studies typically use student reports of both climate and depressive symptoms; this is problematic because common method variance results when the same individual provides information on all variables, contributing to overestimations of associations between depressive symptoms and school climate. Therefore, the purpose of this study is to examine the association between teacher-reported school climate and adolescent-reported depressive symptoms. Thus, 2545 Australian high school students participated in this 5-year longitudinal study. Students completed a measure of depressive symptoms annually; their teachers (N = 882) completed a questionnaire to evaluate the quality of the school environment (i.e., safe/orderly and supportive relationships). Multi-group latent growth models revealed that more positive teacher-reported school climate was cross-sectionally associated with fewer student-reported depressive symptoms in both boys and girls, although this association was significantly stronger for girls. Longitudinally, positive school climate was associated with lower depressive symptoms but a higher rate of change of symptoms for both boys and girls. The overall findings are consistent with previous findings with student-reported school climate. However, the gender difference and the directionality of the longitudinal association between school climate and depressive symptoms over time demonstrate that additional studies of mechanisms by which school climate is connected to adolescents’ depressive symptoms are needed

An Erupting Classical Nova in a Globular Cluster of M87

Only one certain classical nova eruption has ever been detected inside a globular cluster - nova 1860 A.D. (T Sco) in M80. During a survey of M87 we have detected an erupting star coincident (to within 0.08 pixels) with a globular cluster of that giant elliptical galaxy. We are able to discount variables in the foreground or background of M87. The light curve and color of the erupting star match those expected for a nova at the distance of M87. The chance superposition of an M87 field nova on the globular cluster is very unlikely but cannot be completely ruled out.Our detection hints at a globular cluster nova frequency $f \sim .004$ novae/cluster/year, much higher than previous observations have suggested

Engineered 2D Ising interactions on a trapped-ion quantum simulator with hundreds of spins

The presence of long-range quantum spin correlations underlies a variety of physical phenomena in condensed matter systems, potentially including high-temperature superconductivity. However, many properties of exotic strongly correlated spin systems (e.g., spin liquids) have proved difficult to study, in part because calculations involving N-body entanglement become intractable for as few as N~30 particles. Feynman divined that a quantum simulator - a special-purpose "analog" processor built using quantum particles (qubits) - would be inherently adept at such problems. In the context of quantum magnetism, a number of experiments have demonstrated the feasibility of this approach. However, simulations of quantum magnetism allowing controlled, tunable interactions between spins localized on 2D and 3D lattices of more than a few 10's of qubits have yet to be demonstrated, owing in part to the technical challenge of realizing large-scale qubit arrays. Here we demonstrate a variable-range Ising-type spin-spin interaction J_ij on a naturally occurring 2D triangular crystal lattice of hundreds of spin-1/2 particles (9Be+ ions stored in a Penning trap), a computationally relevant scale more than an order of magnitude larger than existing experiments. We show that a spin-dependent optical dipole force can produce an antiferromagnetic interaction J_ij ~ 1/d_ij^a, where a is tunable over 0<a<3; d_ij is the distance between spin pairs. These power-laws correspond physically to infinite-range (a=0), Coulomb-like (a=1), monopole-dipole (a=2) and dipole-dipole (a=3) couplings. Experimentally, we demonstrate excellent agreement with theory for 0.05<a<1.4. This demonstration coupled with the high spin-count, excellent quantum control and low technical complexity of the Penning trap brings within reach simulation of interesting and otherwise computationally intractable problems in quantum magnetism.Comment: 10 pages, 10 figures; article plus Supplementary Material

What’s Next for Acute Heart Failure Research?

Each year over one million patients with acute heart failure (AHF) present to a United States emergency department (ED). The vast majority are hospitalized for further management. The length of stay and high postdischarge event rate in this cohort have changed little over the past decade. Therapeutic trials have failed to yield substantive improvement in postdischarge outcomes; subsequently, AHF care has changed little in the past 40 years. Prior research studies have been fragmented as either “inpatient” or “ED-based.” Recognizing the challenges in identification and enrollment of ED patients with AHF, and the lack of robust evidence to guide management, an AHF clinical trials network was developed. This network has demonstrated, through organized collaboration between cardiology and emergency medicine, that many of the hurdles in AHF research can be overcome. The development of a network that supports the collaboration of acute care and HF researchers, combined with the availability of federally funded infrastructure, will facilitate more efficient conduct of both explanatory and pragmatic trials in AHF. Yet many important questions remain, and in this document our group of emergency medicine and cardiology investigators have identified four high-priority research areas