Clinical psychology in rural general practice: a national pilot of a new model of collaborative mental health service delivery

ABSTRACT Approximately 23% of Australians suffer from a mental disorder in a twelve month. period. The vast majority of mental health service delivery is undertaken in primary care by General Practitioners (GPs). Current research evidence indicates that a combined pharmacological and psychological approach is required for maintained improvement in the treatment of depression, with appropriate evidence-based psychological interventions on their own proving effective in a large number of cases. Lack of public funding of psychological services has meant that many patients in need are unable to access appropriate psychological interventions. This thesis reports on research undertaken on behalf of the Commonwealth Government of Australia into the effectiveness of providing clinical psychology services in the primary care setting as an adjunct to previously available primary medical services. A collaborative model of treatment involving GPs and Clinical Psychologists was trialed in three geographic locations in Australia: Bathurst, Ballarat and Armidale entailing the placement of Clinical Psychology Registrars (later year interns) in the primary care setting. A controlled trial was undertaken in which patients’ levels of improvement on a number of mental health indices were monitored and compared with a control group of patients surveyed in the General Practice waiting room. In addition, added parameters of patient, GP and Clinical Psychology Registrar satisfaction with the model were included as part of the study. Findings indicated that whilst GP treatment of patients alone resulted on average across groups in significant gains on measured indices, those undertaking collaborative care involving both GPs and Clinical Psychologists improved significantly more than those receiving medical care alone. A matched-pair analysis of 47 patients confirmed this, highlighting significantly greater gains from the additional clinical psychological intervention and further validating the effectiveness of the collaborative care model. Follow-up patient, Clinical Psychology Registrar and GP satisfaction surveys indicated highly positive perceptions of the model of collaborative care as a treatment, training and adjunctive care framework. All results indicated clear “value added” for the collaborative model when compared to traditional medical care alone. Having obtained positive results from the research phase of the project, and in light of the current lack of a much-needed systemic perspective in which practitioners and their professional associations become involved in the political arena and policy formulation, a Submission to the Federal Minister of Health and Ageing was written prior to the 2004 Health Budget summarizing the positive results, the applied implications of the collaborative care framework and emphasising the need for inclusion of Clinical Psychology as a profession under primary care public health funding. Further Submissions were written to the Prime Minister in early 2006 prior to the Council of Australian Governments Meetings at which mental health service delivery reform was on the agenda. The current policy developments and service delivery changes occurring since the inception of the research project are discussed in the final chapter of the thesis

Ab initio data-analytics study of carbon-dioxide activation on semiconductor oxide surfaces

The excessive emissions of carbon dioxide (CO2) into the atmosphere threaten to shift the CO2 cycle planet-wide and induce unpredictable climate changes. Using artificial intelligence (AI) trained on high-throughput first principles based data for a broad family of oxides, we develop a strategy for a rational design of catalytic materials for converting CO2 to fuels and other useful chemicals. We demonstrate that an electron transfer to the π-antibonding orbital of the adsorbed molecule and the associated bending of the initially linear molecule, previously proposed as the indicator of activation, are insufficient to account for the good catalytic performance of experimentally characterized oxide surfaces. Instead, our AI model identifies the common feature of these surfaces in the binding of a molecular O atom to a surface cation, which results in a strong elongation and therefore weakening of one molecular C-O bond. This finding suggests using the C-O bond elongation as an indicator of CO2 activation. Based on these findings, we propose a set of new promising oxide-based catalysts for CO2 conversion, and a recipe to find more

Composition and structure of Pd nanoclusters in SiOx_x thin film

The nucleation, distribution, composition and structure of Pd nanocrystals in SiO$_2$ multilayers containing Ge, Si, and Pd are studied using High Resolution Transmission Electron Microscopy (HRTEM) and X-ray Photoelectron Spectroscopy (XPS), before and after heat treatment. The Pd nanocrystals in the as deposited sample seem to be capped by a layer of PdO$_x$. A 1-2 eV shift in binding energy was found for the Pd-3d XPS peak, due to initial state Pd to O charge transfer in this layer. The heat treatment results in a decomposition of PdO and Pd into pure Pd nanocrystals and SiO$_2$

Hydrogen induced optically-active defects in silicon photonic nanocavities

This work was supported by Era-NET NanoSci LECSIN project coordinated by F. Priolo, by the Italian Ministry of University and Research, FIRB contract No. RBAP06L4S5 and by the EPSRC UKSp project. Partial financial support by the Norwegian Research Council is also acknowledged.We demonstrate intense room temperature photoluminescence (PL) from optically active hydrogen- related defects incorporated into crystalline silicon. Hydrogen was incorporated into the device layer of a silicon on insulator (SOI) wafer by two methods: hydrogen plasma treatment and ion implantation. The room temperature PL spectra show two broad PL bands centered at 1300 and 1500 nm wavelengths: the first one relates to implanted defects while the other band mainly relates to the plasma treatment. Structural characterization reveals the presence of nanometric platelets and bubbles and we attribute different features of the emission spectrum to the presence of these different kind of defects. The emission is further enhanced by introducing defects into photonic crystal (PhC) nanocavities. Transmission electron microscopy analyses revealed that the isotropicity of plasma treatment causes the formation of a higher defects density around the whole cavity compared to the ion implantation technique, while ion implantation creates a lower density of defects embedded in the Si layer, resulting in a higher PL enhancement. These results further increase the understanding of the nature of optically active hydrogen defects and their relation with the observed photoluminescence, which will ultimately lead to the development of intense and tunable crystalline silicon light sources at room temperature.Publisher PDFPeer reviewe

Role of C and P Sites on the Chemical Activity of Metal Carbide and Phosphides: From Clusters to Single-Crystal Surfaces

Transition metal carbides and phosphides have shown tremendous potential as highly active catalysts. At a microscopic level, it is not well understood how these new catalysts work. Their high activity is usually attributed to ligand or/and ensemble effects. Here, we review recent studies that examine the chemical activity of metal carbide and phosphides as a function of size, from clusters to extended surfaces, and metal/carbon or metal/phosphorous ratio. These studies reveal that the C and P sites in these compounds cannot be considered as simple spectators. They moderate the reactivity of the metal centers and provide bonding sites for adsorbates

The Dawn of Open Access to Phylogenetic Data

The scientific enterprise depends critically on the preservation of and open access to published data. This basic tenet applies acutely to phylogenies (estimates of evolutionary relationships among species). Increasingly, phylogenies are estimated from increasingly large, genome-scale datasets using increasingly complex statistical methods that require increasing levels of expertise and computational investment. Moreover, the resulting phylogenetic data provide an explicit historical perspective that critically informs research in a vast and growing number of scientific disciplines. One such use is the study of changes in rates of lineage diversification (speciation - extinction) through time. As part of a meta-analysis in this area, we sought to collect phylogenetic data (comprising nucleotide sequence alignment and tree files) from 217 studies published in 46 journals over a 13-year period. We document our attempts to procure those data (from online archives and by direct request to corresponding authors), and report results of analyses (using Bayesian logistic regression) to assess the impact of various factors on the success of our efforts. Overall, complete phylogenetic data for ~60% of these studies are effectively lost to science. Our study indicates that phylogenetic data are more likely to be deposited in online archives and/or shared upon request when: (1) the publishing journal has a strong data-sharing policy; (2) the publishing journal has a higher impact factor, and; (3) the data are requested from faculty rather than students. Although the situation appears dire, our analyses suggest that it is far from hopeless: recent initiatives by the scientific community -- including policy changes by journals and funding agencies -- are improving the state of affairs

Internalization of Formyl Peptide Receptor in Leukocytes Subject to Fluid Stresses

Human leukocytes retract pseudopods under normal physiologic levels of fluid shear stress even in the absence of any other mediator. To gain more detailed understanding of the mechanisms that regulate this cell behavior, we exposed leukocytes to a steady state laminar shear field in a flow chamber and computed the fluid stresses distribution on the surface of individual cells with and without pseudopod. The surface fluid stress distribution on such cell is quite inhomogeneous. We hypothesized that the local fluid stresses on the cell surface serve to regulate pseudopod retraction by way of membrane receptors, especially the formyl peptide receptor (FPR). Comparison of the receptor distribution and the stress distribution over the surface of the cells indicates that the membrane fluid stress alone is not directly correlated with the extent of regional pseudopod retraction, giving further support to the hypothesis that membrane receptors are involved in the mechanotransduction of leukocytes. We observed that after exposure to fluid shear the FPR was internalized to a small intracellular compartment. This internalization appears to be independent of the original location of the receptor on the surface of the cell and the FPR appears to be more derived from multiple locations on the cell, with both higher and lower fluid stresses. The evidence suggests that FPR involvement in the pseudopod-retraction process is not limited to cell surface regions with the highest fluid shear stress, but rather a more global occurrence over the majority of the cell membrane

Systematic review of studies generating individual participant data on the efficacy of drugs for treating soil-transmitted helminthiases and the case for data-sharing

Preventive chemotherapy and transmission control (PCT) by mass drug administration is the cornerstone of the World Health Organization (WHO)’s policy to control soil-transmitted helminthiases (STHs) caused by Ascaris lumbricoides (roundworm), Trichuris trichiura (whipworm) and hookworm species (Necator americanus and Ancylostama duodenale) which affect over 1 billion people globally. Despite consensus that drug efficacies should be monitored for signs of decline that could jeopardise the effectiveness of PCT, systematic monitoring and evaluation is seldom implemented. Drug trials mostly report aggregate efficacies in groups of participants, but heterogeneities in design complicate classical meta-analyses of these data. Individual participant data (IPD) permit more detailed analysis of drug efficacies, offering increased sensitivity to identify atypical responses potentially caused by emerging drug resistance

Oceanic biogeochemical characteristic maps identified with holistic use of satellite, model and data

This is the final published version.Ocean province level plankton community exhibit heterogeneity across Arctic, Nordic, Atlantic Gyre and Southern Ocean provinces. GreenSeas research is an international FP7 consortium that includes Arctic, Atlantic and Southern Ocean based research teams who are analysing the planktonic ecosystem. We are looking at how the planktonic ecosystem responds to environmental and climate change. Using Earth Observation monitoring data we report new results on identifying generic plankton characteristics observable at a province level, and also touch on spatial and temporal trends that are evident using a holistic analysis framework. Using advanced statistical methods this framework compares and combines Earth Observation information together with an in-situ Oceanic plankton Analytical Database and up to 40 year ocean general circulation biogeochemical model (OGCBM) time series of the equivalent plankton and sea-state measures of this system. Specifically, we outline the use of the GreenSeas Analytical Database, which is a harmonised set of Oceanic in-situ plankton and sea-state measures covering different cruises and time periods. The Analytical Database information ranges from plankton community, primary production, nutrient cycling to physical sea state temperature and salinity measures. The combined analysis utilises current, 10 year+ Earth Observations of ocean colour and sea surface temperature metrics and interprets these together with biogeochemical model outputs from PELAGOS, ERSEM & NORWECOM model runs to help identify planktonic based biomes. Generic planktonic characteristic maps that are equivalently observable in both the Earth Observations and numerical models are reported on. Both ocean surface and sub-surface signals are analysed together with relevant Analytical Database biome extracts. We present the current results of this inter-comparison & discuss challenges of identifying the province level plankton dominance with the satellite, model and data. In particular we discuss the strategic importance of systematically analysing the knowledge present in the existing key long term Oceanic observation platforms through such holistic analysis frameworks. These maps help to enhance and improve current biogeochemical models, our understanding of the plankton community structure and predictions used for future assessment of climate change