Using stepped-care approaches within internet-based interventions for youth anxiety: Three case studies.

Background There are a lack of clear guidelines for the dissemination of Internet-based cognitive behaviour therapy (ICBT) for childhood and adolescent anxiety in routine care. While self-guided ICBT has greater reach than therapist-guided ICBT, it is plagued by problems of low program adherence and many young people are not successfully treated. It is important that we identify models of ICBT that are accessible, but provide the right support, at the right time to those who need it. Stepped-care models of ICBT offer one potential solution. Objective This case study examined the application of stepped-care within an ICBT intervention for childhood and adolescent anxiety, in which young people were stepped up from self-guided to therapist-guided ICBT. Methods Three case studies are presented and include young males (aged 11–12 years) who participated in BRAVE Stepped-Care, a new ICBT program incorporating two treatment steps: Step 1 – five sessions of self-guided ICBT and Step 2 – five sessions of therapist-guided ICBT. Participants completed diagnostic assessments at pre- and post-treatment, along with a battery of self-report questionnaires. Step-up requirements were determined at a mid-treatment assessment. Treatment response was determined by change on diagnostic severity and presence of diagnosis and changes in self-reported anxiety symptoms (through T-scores and Reliable Change Indices). Results In-depth examination of the three case studies showed that decisions to step-up from Step 1 to Step 2 were complex and required consideration of program engagement and adherence, as well as changes on self-reported anxiety, behavioural indicators of anxiety and parent perspectives. Results showed that non-responders at mid-treatment who were stepped-up to therapist-guided ICBT after Step 1 were able to increase engagement and response to treatment in Step 2, such that they were free of their primary anxiety diagnosis at post-treatment. Conclusions The findings highlight the importance of early assessment of engagement and non-response within self-guided ICBT programs for youth anxiety and the positive changes that can subsequently occur when therapist-guidance is introduced mid-treatment for non-responders. The efficacy of stepped-care ICBT models needs to be confirmed in larger randomised controlled trials

The Health of Aging Lesbian, Gay and Bisexual Adults in California

Examines rates of diabetes, hypertension, poor mental health, physical disability, and fair or poor self-reported health status among homosexual adults ages 50 to 70 compared with their heterosexual peers. Recommends enhancing policies and practices

Development of resistance to an introduced marine pathogen by a native host

In 1957–1959, the introduced protistan parasite, Haplosporidium nelsoni, killed 90–95% of the oysters (Crassostrea virginica) in lower Delaware Bay and about half of those in the upper bay. Shortly thereafter, H. nelsoni-caused mortality in the wild population of the lower bay declined, approximating that of first-generation selectively bred oysters. For nearly three decades thereafter no further change in survival of the wild population was evident, although steady improvement was achieved by continued selective breeding. Survival of the wild population is thought to have plateaued because the great majority of oysters inhabited the upper bay where they were protected from H. nelsoni infection and selective mortality by low salinity. Consequently, they contributed most of the offspring to the bay population. From 1957 through 1987, H. nelsoni prevalence was cyclic, but overall high (annual maxima of 60 to 85%) in the lower bay. Since 1988, however, prevalence in wild oysters has rarely exceeded 30% anywhere in the bay, even though unselected oysters continue to become heavily infected when exposed, and molecular evidence indicates that the parasite remains present throughout the bay. This apparent second step in the development of resistance in the wild oysters occurred after a drought-associated incursion of H. nelsoni into the upper bay in the mid-1980s. Mortalities were widespread, heavy and more extreme than during the 1957–59 epizootic. Resistant survivors of the second epizootic have apparently repopulated the bay. When compared to unselected stocks, common-garden exposure to H. nelsoni of oysters from both upbay and downbay sites indicates that a high degree of resistance to the development of MSX disease has become widespread in the wild oyster population of Delaware Bay after two major selection events separated by nearly 30 years

Support during birth interacts with prior trauma and birth intervention to predict postnatal post-traumatic stress symptoms

Background: Many women experience childbirth as traumatic and 2% develop post-traumatic stress disorder (PTSD). This study examined the role of health practitioner support and personal control during birth as predictors of PTS symptoms, adjusting for vulnerability factors of prior trauma, depression, control beliefs and birth intervention. It also investigated interactions between support, prior trauma and birth intervention and their association with PTS symptoms. Methods: A prospective longitudinal survey of 138 women recruited from UK NHS maternity clinics. Measures were taken in pregnancy, three-weeks and three-months after the birth. Results: Support and control during birth were not predictive of postnatal PTS symptoms. However, support was predictive of PTS symptoms in a subset of women with prior trauma (beta = -.41, R2 = 16%) at both three-weeks and three-months postpartum. The interaction of birth intervention and support was associated with PTS symptoms three-months after birth, the relationship between support and PTS symptoms was stronger in women experiencing more intervention. Conclusions: Low support from health practitioners is predictive of postnatal PTS symptoms in women who have a history of trauma. Longer-term effects of low support on postnatal PTS symptoms are also found in women who had more intervention during birth

Measuring Hotel Service Quality: Tools for Gaining the Competitive Edge

As the hotel industry grows more competitive, quality guest service becomes an increasingly important part of managers\u27 responsibility measuring the quality of service delivery is facilitated when managers know what types of assessment methods are available to them. The authors present and discuss the following available measurement techniques and describe the situations where they best meet the needs of hotel managers: management observation, employee feedback programs, comment cards, mailed surveys, personal and telephone interviews, focus groups, and mystery shopping

An Introduction to Ecology of Infectious Diseases - Oysters and Estuaries

Infectious diseases are recognized as an important factor regulating marine ecosystems (Harvell et al., 1999, 2002, 2004; Porter et al., 2001; McCallum et al., 2004; Ward and Lafferty, 2004; Stewart et al., 2008; Bienfang et al., 2011). Many of the organisms affected by marine diseases have important ecological roles in estuarine and coastal environments and some are also commercially important. Outbreaks of infectious diseases in these environments, referred to as epizootics, can produce significant population declines and extinctions, both of which threaten biodiversity, food web interactions, and ecosystem productivity (Harvell et al., 2002, 2004)

Leadership and innovators training program for Latvian and Romanian public librarians at the Mortenson Center for international ibrary programs

From 2009 to 2012, the Mortenson Center for International Library Programs (MC) at the University of Illinois Library implemented the Bill & Melinda Gates Foundation’s Global Libraries (GL) Leaders and Innovators Training Program. The purpose of the program was to have a team of library leaders and innovators in Latvia and Romania committed to designing and creating a stronger public library environment. The GL grantees, 3TD, and Biblionet worked with the MC team to administer and support the program. The program included planning visits and agreements, training at the MC, attendance at a U.S. library association conference, development and implementation of group projects, and follow-up visits and training. Twelve Latvian librarians and fifteen Romanian librarians participated in the program. The training was unique for each country group based on the needs identified in the initial visits and discussions with the GL grantees. Each country group was divided into three teams of four to five members. The teams had to develop an idea for a library project, write a proposal, and then implement the project. After submitting a successful proposal, the teams received a small grant. The result was a cohort of enthusiastic and engaged library leaders who implemented group projects that were positively received in their respective communities and by library colleagues around the country. All the librarians reported gains in their skills and knowledge in several topics. New library services were implemented, including working closely with local government, making more active use of technology, reaching out to seniors, and creating spaces for children and teens.published or submitted for publicatio