Perspectives on the INternational CLassification of Diseases, 11th Revision (ICD-11); an international qualitative study to Understand and improve mental health Diagnosis using expertise by Experience: INCLUDE Study

Developed in collaboration with the WHO Department of Mental Health and Substance Abuse, this study conducted in the UK, India, and the US, integrated feedback from mental health service users into the development of the chapter on mental, behavioural, and neurodevelopmental disorders for the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11). The ICD-11 is set for approval by the World Health Assembly in May, 2019. As a reporting standard and diagnostic classification system it will be highly influential on the policy, clinical practice, and research that affect mental health service users; yet this is the first study to systematically seek and collate service user perspectives on a major classification and diagnostic guideline. Focus groups were used to collect feedback on five diagnoses: depressive episode, generalised anxiety disorder, schizophrenia, bipolar type 1 disorder, and personality disorder. Participants were given the official draft diagnostic guidelines and a parallel lay translation. Data were thematically analysed. This formed the basis of co-produced recommendations for the WHO, which included features that could be added or revised to better reflect lived experience and changes to language that was confusing or objectionable to service users. The findings also indicated that an accessible lay language version of the ICD-11 could be beneficial for service users and their supporters

A framework to conceptualize personal recovery from eating disorders: A systematic review and qualitative meta-synthesis of perspectives from individuals with lived experience

Background: An extensive literature exists describing treatment interventions and recovery from eating disorders (EDs); however, this body of knowledge is largely symptom-based and from a clinical perspective and thus limited in capturing perspectives and values of individuals with lived experience of an ED. In this study, we performed a systematic review to coproduce a conceptual framework for personal recovery from an ED based on primary qualitative data available in published literature. Methods: A systematic review and qualitative meta-synthesis approach was used. Twenty studies focusing on ED recovery from the perspective of individuals with lived experience were included. The studies were searched for themes describing the components of personal recovery. All themes were analyzed and compared to the established connectedness; hope and optimism about the future; identity; meaning in life; and empowerment (CHIME) and Substance Abuse and Mental Health Services Administration (SAMHSA) frameworks of recovery, which are applicable to all mental disorders. Themes were labeled and organized into a framework outlining key components of the ED personal recovery process. Results: Supportive relationships, hope, identity, meaning and purpose, empowerment, and self-compassion emerged as the central components of the recovery process. Symptom recovery and its relationship to the personal recovery process are also significant. Discussion: Individuals with lived experience of EDs noted six essential elements in the personal ED recovery process. This framework is aligned with several of the key components of the CHIME and SAMHSA frameworks of recovery, incorporating person-centered elements of the recovery process. Future research should validate these constructs and develop instruments (or tools) that integrate the lived experiences into a measurement of recovery from an ED

Randomized Controlled Trial to Evaluate an Internet‐Based Self‐Management Program in Systemic Sclerosis

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/148240/1/acr23595.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148240/2/acr23595_am.pd

Langoulant Report

The Interim Report confirmed that the Territory faces serious financial challenges and is currently in the unsustainable position of borrowing to fund recurrent activities and interest costs.Executive summary -- 1. Interim Report summary and stakeholder engagement -- Summary of interim report -- Stakeholder engagement and consultation -- 2. The Territory economy -- The economy today and how we go here -- Medium-term economic forecasts -- Economic development -- Budget repair and the economy -- 3. New fiscal strategy -- Current strategy -- New fiscal strategy -- 4. Pathway to surplus -- Whats needs to change -- Major challenges -- 5. Budget repair reforms -- Goal 1. Accountability and transparency -- Goal 2. Financial management -- Goal 3. Workforce sustainability and capability -- Goal 4. Organisational efficiency and strategic alignment -- Goal 5. Evidence-based decision-making -- Goal 6. Digital transformation -- Goal 7. Revenue optimisation -- 6. Reform implementation and monitoring -- Implementation -- Monitoring and governance -- Attachments -- A. Fiscal Strategy Panel terms of reference -- B. Summary of recommendations.Made available via the Publications (Legal Deposit) Act 2004 (NT)

Coral reef evolution on rapidly subsiding margins

A series of well-developed submerged coral reefs are preserved in the Huon Gulf (Papua New Guinea) and around Hawaii. Despite different tectonics settings, both regions have experienced rapid subsidence (2–6 m/ka) over the last 500 ka. Rapid subsidence, combined with eustatic sea-level changes, is responsible for repeated drowning and backstepping of coral reefs over this period. Because we can place quantitative constraints on these systems (i.e., reef drowning age, eustatic sea-level changes, subsidence rates, accretion rates, basement substrates, and paleobathymetry), these areas represent unique natural laboratories for exploring the roles of tectonics, reef accretion, and eustatic sea-level changes in controlling the evolution of individual reefs, as well as backstepping of the entire system. A review of new and existing bathymetric, radiometric, sedimentary facies and numerical modeling data indicate that these reefs have had long, complex growth histories and that they are highly sensitive, recording drowning not only during major deglaciations, but also during high-frequency, small-amplitude interstadial and deglacial meltwater pulse events. Analysis of five generalized sedimentary facies shows that reef drowning is characterized by a distinct biological and sedimentary sequence. Observational and numerical modeling data indicate that on precessional (20 ka) and sub-orbital timescales, the rate and amplitude of eustatic sea-level changes are critical in controlling initiation, growth, drowning or sub-aerial exposure, subsequent re-initiation, and final drowning. However, over longer timescales (> 100–500 ka) continued tectonic subsidence and basement substrate morphology influence broad scale reef morphology and backstepping geometries. Drilling of these reefs will yield greatly expanded stratigraphic sections compared with similar reefs on slowly subsiding, stable and uplifting margins, and thus they represent a unique archive of sea-level and climate changes, as well as a record of the response of coral reefs to these changes over the last six glacial cycles

Randomized Controlled Trial to Evaluate an Internet-Based Self-Management Program in Systemic Sclerosis.

OBJECTIVE:In a pilot study, our group showed that an internet-based self-management program improves self-efficacy in systemic sclerosis (SSc). The objective of the current study was to compare an internet-based self-management program to a patient-focused educational book developed to assess measures of self-efficacy and other patient-reported outcomes in patients with SSc. METHODS:We conducted a 16-week randomized, controlled trial. RESULTS:Of the 267 participants who completed baseline questionnaires and were randomized to the intervention (internet: www.selfmanagescleroderma.com) or control (book) group, 123 participants (93%) in the internet group and 124 participants (94%) in the control group completed the 16-week randomized controlled trial (RCT). The mean ± SD age of all participants was 53.7 ± 11.7 years, 91% were women, and 79.4% had some college or a higher degree. The mean ± SD disease duration after diagnosis of SSc was 8.97 ± 8.50 years. There were no statistical differences between the 2 groups for the primary outcome measure (Patient-Reported Outcomes Measurement Information System Self-Efficacy for Managing Symptoms: mean change of 0.35 in the internet group versus 0.94 in the control group; P = 0.47) and secondary outcome measures, except the EuroQol 5-domain instrument visual analog scale score (P = 0.05). Internet group participants agreed that the self-management modules were of importance to them, the information was presented clearly, and the website was easy to use and at an appropriate reading level. CONCLUSION:Our RCT showed that the internet-based self-management website was not statistically superior to an educational patient-focused book in improving self-efficacy and other measures. The participants were enthusiastic about the content and presentation of the self-management website