Defining success in bushfire management: critical moments in the 2012-13 ACT bushfire season

The 2012-13 Australian Capital Territory fire season saw no loss of life, no major property loss and minimal environmental damage. It was therefore successful according to the main aims of bushfire management. This outcome hinged on a few critical moments when, due to a combination of strategy and good fortune, things went right. This case study demonstrates how influential chance can be in determining the outcome of bushfires and this in turn begs the question: should agencies be held responsible for factors that are beyond human control? It is proposed that holding agencies responsible for outcomes that are not entirely within their control, acts to reduce community resilience because it implicitly removes the onus on individuals to take personal responsibility; a vital component for good outcomes

Understandings of mental health, disclosure, help-seeking and psychological adaptation among Asian international students studying in Scotland : a sequential multi-method study

International students often face psychosocial, academic, financial and adaptation challenges within the Higher Education (HE) environment that may impact on their mental health. The current study explored the understandings and experiences of Asian international students (AISs) in terms of mental health, disclosure, help-seeking and adaptation specific to cultural relocation within Scotland. A sequential multi-method approach was adopted consisting of two studies: (1) a qualitative study using individual semi-structured interviews with AISs (n=10) (Study 1) and (2) a cross-section survey comparing AISs and non-AISs (n=172) in terms of mental health literacy and psychological adaptation within the Scottish context (Study 2). Qualitative data were audio recorded, transcribed, and analysed using a thematic approach. Quantitative data were analysed using regression and mediation analysis. Study 1 revealed three themes: (1) Negative beliefs, stigma and fear of judgment impacting on understandings and disclosure of mental health issues, (2) Adaptation and acculturation difficulties (lack of sense of belonging), and (3) Barriers in communication and social disconnection. Study 2 showed that AISs reported lower levels of mental health literacy, which in turn resulted in poorer psychological adaption compared to non-AISs. Supporting AISs in HE institutions involves challenging negative judgements surrounding mental health, increasing mental health literacy and addressing barriers in overcoming adaptation, acculturation and communication difficulties that may inhibit disclosure and help-seeking behaviour. The importance of mental health policies, supports and services in embracing culturally diverse understandings of mental health, challenging stigma and having culturally competent staff supporting student mental health within a multicultural learning environment is emphasised

WELLFOCUS PPT – modified positive psychotherapy to improve well-being in psychosis: study protocol for a pilot randomised controlled trial

BACKGROUND: The promotion of well-being is an important goal of recovery oriented mental health services. No structured, evidence-based intervention exists that aims to increase the well-being in people with severe mental illness such as psychosis. Positive psychotherapy (PPT) is a promising intervention for this goal. Standard PPT was adapted for use with people with psychosis in the UK following the Medical Research Council framework for developing and testing complex interventions, resulting in the WELLFOCUS Model describing the intended impact of WELLFOCUS PPT. This study aims to test the WELLFOCUS Model, by piloting the intervention, trial processes, and evaluation strategy. METHODS/DESIGN: This study is a non-blinded pragmatic pilot RCT comparing WELLFOCUS PPT provided as an 11-session group therapy in addition to treatment as usual to treatment as usual alone. Inclusion criteria are adults (aged 18–65 years) with a main diagnosis of psychosis who use mental health services. A target sample of 80 service users with psychosis are recruited from mental health services across the South London and Maudsley NHS Foundation Trust. Participants are randomised in blocks to the intervention and control group. WELLFOCUS PPT is provided to groups by specifically trained and supervised local therapists and members of the research team. Assessments are conducted before randomisation and after the group intervention. The primary outcome measure is well-being assessed by the Warwick-Edinburgh Mental Well-being Scale. Secondary outcomes include good feelings, symptom relief, connectedness, hope, self-worth, empowerment, and meaning. Process evaluation using data collected during the group intervention, post-intervention individual interviews and focus groups with participants, and interviews with trial therapists will complement quantitative outcome data. DISCUSSION: This study will provide data on the feasibility of the intervention and identify necessary adaptations. It will allow optimisation of trial processes and inform the evaluation strategy, including sample size calculation, for a future definitive RCT. TRIAL REGISTRATION: Current Controlled Trials ISRCTN04199273 – WELLFOCUS study: an intervention to improve well-being in people with psychosis, Date registered: 27 March 2013, first participant randomised on 26 April 2013

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Identifying phenotypic and physiological subgroups of preschoolers with autism spectrum disorder

BackgroundTo understand the emergence of symptoms in autism spectrum disorder (ASD), we need to identify the mechanisms that underpin the development of core social skills. Mounting evidence indicates that young children with later ASD attend less to other people, which could compromise learning opportunities with cascading effects. Passive looking behaviour does not tell us about engagement with visual information, but measures of physiological arousal can provide information on the depth of engagement. In the current study, we use heart rate (HR) and heart rate variability (HRV) to measure engagement with social dynamic stimuli in ASD.MethodsSixty-seven preschoolers with ASD and 65 typical developing preschoolers between 2 and 4 years of age participated in a study where HR was measured during viewing of social and non-social videos. Using latent profile analyses, more homogeneous subgroups of children were created based on phenotype and physiology.ResultsPreschool-aged children with ASD, regardless of their non-verbal, verbal and social competencies, do not differ in overall HR or HRV compared to TD children. However, the ASD group showed a larger increase in HR (more disengagement) than the TD group to later-presented social stimuli. Phenotypic and physiological profiles showed this was primarily the case for children with below average verbal and non-verbal skills, but not necessarily those with more ASD symptoms.ConclusionChildren with ASD, especially a subgroup showing moderate cognitive delays, show an increase in HR to social stimuli over time; this may reflect difficulties re-engaging with social information when attention is waning

Heart rate mean and variability as a biomarker for phenotypic variation in preschoolers with autism spectrum disorder

Interest in autonomic arousal in autism spectrum disorder (ASD) is increasing; however, reliability of these measures in ASD is unknown, and previously reported associations with social and cognitive abilities are inconsistent. This study assesses heart rate (HR) and HR variability (HRV) in preschoolers with ASD or typical development (TD) while they passively watched naturalistic videos. Measurement reliability, group differences, and the relationship with social and cognitive abilities were evaluated. Seventy one ASD and 66 TD children (2-4 years) provided cardiac data from two sessions. Test-retest intraclass correlations of HR and HRV over a 3-week period were moderate to good in both groups. Groups did not differ in mean level of HR or HRV. Intra-individual variability of HR between video segments within a session was higher in the ASD group, but intraclass correlations of this metric were low. Higher HR related to better language skills in TD children, but not after accounting for age and nonverbal ability. Higher HRV related to better expressive and receptive language in ASD children after controlling for age and nonverbal ability. HR/HRV were not related to social or executive functioning skills and did not explain any additional variance in abilities at a 12-month follow-up visit. In summary, variation in language abilities is associated with HR in the TD group and HRV in the ASD group. While preliminary, these results are promising for consideration of autonomic control as a biomarker for individual differences in ASD and may help us understand the mechanisms that contribute to communication skills. Autism Research 2019, 12: 39-52. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Cardiac activity, such as heart rate and heart rate variability, is linked to a wide range of psychological functions. This study shows that there is an association between heart rate and heart rate variability and language skills in young children with autism spectrum disorder (ASD). These results may help us understand what underlies individual differences in developmental abilities in young children with ASD

Design of an arrangement of cubic magnets for a quasi-axisymmetric stellarator experiment

The usage of permanent magnets to shape the confining field of a stellarator has the potential to reduce or eliminate the need for non-planar coils. As a proof-of-concept for this idea, we have developed a procedure for designing an array of cubic permanent magnets that works in tandem with a set of toroidal-field coils to confine a stellarator plasma. All of the magnets in the design are constrained to have identical geometry and one of three polarization types in order to simplify fabrication while still producing sufficient field accuracy. We present some of the key steps leading to the design, including the geometric arrangement of the magnets around the device, the procedure for optimizing the polarizations according to three allowable magnet types, and the choice of magnet types to be used. We apply these methods to design an array of rare-Earth permanent magnets that can be paired with a set of planar toroidal-field coils to confine a quasi-axisymmetric plasma with a toroidal magnetic field strength of about 0.5 T on axis.Consult the file README.txt for a more detailed description of the contents