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Poor connectivity between diverse resource users and complex wider governance networks is a challenge in environmental governance. Organizations that ‘broker’ interactions among these relationships are expected to improve governance outcomes. Here, we used semi-structured interviews and social network analysis to identify actors in positions to broker coral reef-related information to and from resource users and to assess the performance of these brokers. Representatives (n = 262) of actor groups were interviewed, including local and national government, non-governmental organizations (NGOs), community organizations and resource user groups from 12 communities across four Caribbean countries, to map information-sharing networks and to identify brokers. Broker performance was assessed through separate interviews with coral reef resource users (n = 545). The findings show that marine NGOs were the highest-functioning brokers. Where such local-level organizations were absent, government agencies in reef management roles acted as brokers, but their performance was lower. Actors in brokerage positions did not always effectively share information, with broker performance being positively correlated with network brokerage scores. The results further our understanding of the roles of brokers in different governance contexts. Identifying those in brokerage positions and supporting their roles in connecting local resource users to wider governance networks could encourage functional brokerage and enhance reef management outcomes.
The prevalence of mental health conditions and national suicide rates are increasing in many countries. Lithium is widely and effectively used in pharmacological doses for the treatment and prevention of manic/depressive episodes, stabilising mood and reducing the risk of suicide. Since the 1990s, several ecological studies have tested the hypothesis that trace doses of naturally occurring lithium in drinking water may have a protective effect against suicide in the general population.
To synthesise the global evidence on the association between lithium levels in drinking water and suicide mortality rates.
The MEDLINE, Embase, Web of Science and PsycINFO databases were searched to identify eligible ecological studies published between 1 January 1946 and 10 September 2018. Standardised regression coefficients for total (i.e. both genders combined), male and female suicide mortality rates were extracted and pooled using random-effects meta-analysis. The study was registered with PROSPERO (CRD42016041375).
The literature search identified 415 articles; of these, 15 ecological studies were included in the synthesis. The random-effects meta-analysis showed a consistent protective (or inverse) association between lithium levels/concentration in publicly available drinking water and total (pooled β = −0.27, 95% CI −0.47 to −0.08; P = 0.006, I2 = 83.3%), male (pooled β = −0.26, 95% CI −0.56 to 0.03; P = 0.08, I2 = 91.9%) and female (pooled β = −0.13, 95% CI −0.24 to −0.02; P = 0.03, I2 = 28.5%) suicide mortality rates. A similar protective association was observed in the six studies included in the narrative synthesis, and subgroup meta-analyses based on the higher/lower suicide mortality rates and lithium levels/concentration.
This synthesis of ecological studies, which are subject to the ecological fallacy/bias, supports the hypothesis that there is a protective (or inverse) association between lithium intakes from public drinking water and suicide mortality at the population level. Naturally occurring lithium in drinking water may have the potential to reduce the risk of suicide and may possibly help in mood stabilisation, particularly in populations with relatively high suicide rates and geographical areas with a greater range of lithium concentration in the drinking water. All the available evidence suggests that randomised community trials of lithium supplementation of the water supply might be a means of testing the hypothesis, particularly in communities (or settings) with demonstrated high prevalence of mental health conditions, violent criminal behaviour, chronic substance misuse and risk of suicide.
OBJECTIVES/GOALS: Aims 1&2: Develop (1) and implement (2) online, guided self-help intervention for ED psychopathology and weight reduction. Aim 3: Follow-up to track remission of ED psychopathology and symptoms and WL maintenance at end of treatment and 6-months. METHODS/STUDY POPULATION: N = 60 college students meeting criteria (clinical/sub-clinical binge-type ED with BMI > 25) will complete a baseline survey and then will be randomized into a condition. Students in the intervention group (n = 30) will be offered 8 weeks of an online, guided self-help intervention for ED and WL. Students in the control group (n = 30) will receive an email message to seek support from Student Health Services. All participants will receive follow-ups 9 weeks and 6 months after baseline. Data analysis will compare Eating Disorder Examination Questionnaire (EDE-Q) scores and WL (change in BMI) at all three time-points. Group comparisons will be assessed via two-way mixed-model ANOVA. RESULTS/ANTICIPATED RESULTS: Recruitment is still ongoing. Data collected by the time of the conference will be presented on the poster. DISCUSSION/SIGNIFICANCE OF IMPACT: Online, guided self-help interventions have been used for WL, as well as for treatment of EDs separately, but no program exists to manage these commonly comorbid conditions concurrently. Thus, this pilot study will examine the effectiveness of combined programs to breach this treatment gap.
The early intervention service (EIS) approach is based on therapeutic interactions, which promote service user recovery from first episode psychosis. Collaborative therapeutic work between the service user and case manager depends on good communication. This can be a challenge for people with psychosis as the process of thought can be disrupted or stimulus misinterpreted leading to communication errors.
The objective is to develop an interactive tool that can assist service user's communication of distress, whilst employing a psychoeducational approach to the use of an informal therapeutic measurement scale; subjective units of distress (SUDs) and early warning signs (EWS). The ApTiC mobile intervention will include ten numerically graded emoticons from low to extreme distress. Each emoticon is associated with specific individualised service user descriptors and linked to an individually agreed action plan and level of response to be offered by a staff member.
The aim of the present study will be to examine the feasibility and acceptability of the ApTic mobile intervention in preparation for a larger randomised controlled trial.
Phase one: qualitative research to inform the development of the complimentary tool and mobile app (qualitative). Phase two: a 12-week rater-blinded randomized control trial of ApTiC compared to routine EIS case management (quantitative).
The qualitative data will be presented.
It is expected that once validated, the SUDs based ApTiC will enhance rapport and understanding thus improving the recovery approach to well-being and hopefully preventing relapse or the involvement of the crisis team or hospital admissions.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
We Are All Treaty People is a Canadian play for young audiences (ages eight to twelve) that addresses difficult knowledge, Elders’ story sharing, and contemporary and historical Indigenous–settler relations. This article discusses the contemporary and historical political context of the play and its production, the creation process and its narrative anchors. It argues that through a respectful, Indigenous-led creation process, and structural techniques, the play has the potential to offer hope and healing, and encourage relationships based on knowledge.
Farm-to-school (F2S) local food procurement must be cost-effective to be financially sustainable without policy support. We test, among schools participating in F2S programs, whether market channel procurement strategies for local foods affect schools’ perceptions of whether meal costs decline as a result of F2S participation. Schools that buy local foods exclusively from intermediaries are 7 percentage points less likely to report lower costs from undertaking F2S initiatives. We further demonstrate that the probability that schools source local foods exclusively from intermediaries is influenced by the number of direct marketing farmers in their county.
This paper presents a numerical performance evaluation of the leading edge tubercles hydrofoil with particular focus on a fully turbulent flow regime. Efforts were focused on the setting up of an appropriate numerical approach required for an in-depth analysis of this phenomenon, being able to predict the main flow features and the hydrodynamic performance of the foil when operating at high Reynolds numbers. The numerical analysis was conducted using an improved delayed detached eddy simulation for Reynolds numbers corresponding to the transitional and fully turbulent flow regimes at different angles of attack for the pre-stall and post-stall regimes. The results show that tubercles operating in turbulent flow improve the hydrodynamic performance of the foil when compared to a transitional flow regime. Flow separation was identified behind the tubercle troughs, but was significantly reduced when operating in a turbulent regime and for which we have identified the main flow mechanisms. This finding confirms that the tubercle effect identified in a transitional regime is not lost in a turbulent flow. Furthermore, when the hydrofoil operates in the turbulent flow regime, the transition to a turbulent regime takes place further upstream. This phenomenon suppresses a formation of a laminar separation bubble and therefore the hydrofoil exhibits a superior hydrodynamic performance when compared to the same foil in the transitional regime.
The SUPEREDEN3 study, a phase II randomized controlled trial, suggests that social recovery therapy (SRT) is useful in improving functional outcomes in people with first episode psychosis. SRT incorporates cognitive behavioural therapy (CBT) techniques with case management and employment support, and therefore has a different emphasis to traditional CBT for psychosis, requiring a new adherence tool.
This paper describes the SRT adherence checklist and content of the therapy delivered in the SUPEREDEN3 trial, outlining the frequency of SRT techniques and proportion of participants who received a full therapy dose. It was hypothesized that behavioural techniques would be used frequently, consistent with the behavioural emphasis of SRT.
Research therapists completed an adherence checklist after each therapy session, endorsing elements of SRT present. Data from 1236 therapy sessions were reviewed to determine whether participants received full, partial or no therapy dose.
Of the 75 participants randomized to receive SRT, 57.3% received a full dose, 24% a partial dose, and 18.7% received no dose. Behavioural techniques were endorsed in 50.5% of sessions, with cognitive techniques endorsed in 34.9% of sessions.
This report describes an adherence checklist which should be used when delivering SRT in both research and clinical practice. As hypothesized, behavioural techniques were a prominent feature of the SRT delivered in SUPEREDEN3, consistent with the behavioural emphasis of the approach. The use of this adherence tool would be considered essential for anyone delivering SRT looking to ensure adherence to the model.
OBJECTIVES/SPECIFIC AIMS: Among college students with binge-type eating disorders who are overweight (BMI >25), does use of an online, guided self-help program for EDs combined with healthy weight-loss (WL) methods lead to reductions in ED symptoms and weight loss compared to controls referred to standard in-person treatment (Student Health Services)? Aim 1: Develop online, guided self-help program for intervention of ED psychopathology and weight reduction. Aim 2: Implement online, guided self-help program for intervention of ED psychopathology and weight reduction. Aim 3: Follow-up to track remission of ED psychopathology and symptoms and WL maintenance. METHODS/STUDY POPULATION: Up to N=60 college students who meet the criteria (clinical or sub-clinical binge-type ED and have a BMI > 25) and elect to participate will complete a baseline survey to enroll in the study, then will be randomized into a condition. Students in the intervention group (n=30) will be offered 8 weeks of online, guided self-help intervention for ED and WL. Students in the control group (n=30) will receive an email message encouraging them to seek support from Student Health Services for their WL and eating behavior concerns, along with appropriate contact information. All participants will receive follow-up 9 weeks after completing initial baseline, and a final follow-up survey 6-months after completing their baseline. RESULTS/ANTICIPATED RESULTS: Analysis of intervention and control groups will compare average Eating Disorder Examination Questionnaire (EDEQ) scores and WL (change in BMI) at the end of the intervention (9 weeks) and at 6-month follow-up. Group comparisons will be assessed via two-way mixed model ANOVA. DISCUSSION/SIGNIFICANCE OF IMPACT: Online, guided self-help interventions have been used for WL, as well as for treatment of EDs separately, but no program exists to manage these conditions together. Thus, the use of online intervention for ED psychopathology and WL in individuals with clinical and sub-clinical EDs is the next step. The goal of this study is to implement a program to reduce weight and shape concerns, reduce disordered eating symptoms, such as bingeing, and compensatory behaviors associated with binge-type EDs, while also reducing weight for individuals with EDs and comorbid overweight/obesity. This project will pilot an online, guided self-help ED intervention that offers cognitive behavioral based tools to improve ED symptoms in college students, while also teaching the healthy methods of behavioral WL, for students with clinical/sub-clinical binge-type EDs with comorbid overweight/obesity in order to examine effectiveness of the program compared to referral to Student Health Services for ED and WL concerns. Furthermore, the use of an online, guided self-help intervention is more scalable and can circumvent many of the barriers to traditional in-person treatment.
In September 2016, the annual meeting of the International Union for Quaternary Research’s Loess and Pedostratigraphy Focus Group, traditionally referred to as a LoessFest, met in Eau Claire, Wisconsin, USA. The 2016 LoessFest focused on “thin” loess deposits and loess transportation surfaces. This LoessFest included 75 registered participants from 10 countries. Almost half of the participants were from outside the United States, and 18 of the participants were students. This review is the introduction to the special issue for Quaternary Research that originated from presentations and discussions at the 2016 LoessFest. This introduction highlights current understanding and ongoing work on loess in various regions of the world and provides brief summaries of some of the current approaches/strategies used to study loess deposits.
We report on a loess-paleosol sequence (LPS) near Remizovka, located in the northern Tian Shan piedmont of southeastern Kazakhstan. This site represents a key record for Late Pleistocene climatic fluctuations at the intersection of major northern hemisphere climate subsystems. This paper develops a synthesized dataset of previous conflicting studies at Remizovka by characterizing their (paleo)topographic context, which had remained previously overlooked. Digital elevation models, satellite images, and archival photography characterize recent topographic developments. Two well-developed pedocomplexes, which we investigate in detail and date by luminescence mark the paleotopography during Marine Oxygen Isotope Stage (MIS) 5. Peak dust accumulation rates here occurred during the middle MIS 5 and MIS 4/early MIS 3. These are partially comparable with records from neighboring regions, but not in phase with global ice volume records. This discrepancy may be related to a distinct regional environmental response to larger-scale climatic drivers and local topographic influences on dust deposition patterns. Our findings confirm the potential of the LPS Remizovka to provide high-resolution paleoclimate data for the Late Pleistocene. The three-dimensional stratigraphic reconstruction reinforces the caution required to correctly interpret loess formation processes prior to their interpretation as paleoclimate archives, and provides guidelines for a more suitable approach.
People with traumatic brain injuries (TBIs) commonly report memory impairments which are persistent, debilitating, and reduce quality of life. As part of the Rehabilitation of Memory in Brain Injury trial, a cost-effectiveness analysis was undertaken to examine the comparative costs and effects of a group memory rehabilitation program for people with TBI.
Individual-level cost and outcome data were collected. Patients were randomized to usual care (n=157) or usual care plus memory rehabilitation (n=171). The primary outcome for the economic analysis was the EuroQol-5D quality of life score at 12 months. A UK NHS costing perspective was used. Missing data was addressed by multiple imputation. One-way sensitivity analyses examined the impact of varying different parameters, and the impact of available cases, on base case findings whilst non-parametric bootstrapping examined joint uncertainty.
At 12 months, the intervention was GBP 26.89 (USD 35.76) (SE 249.15) cheaper than usual care; but this difference was statistically non-significant (p=0.914). At 12 months, a QALY loss of −0.007 was observed in the intervention group confidence interval (95% CI: −0.025–0.012) and a QALY gain seen in the usual care group 0.004 (95% CI: -0.017–0.025). This difference was not statistically significant (p=0.442). The base case analysis gave an ICER of GBP 2,445 (USD 3,252) reflecting that the intervention was less effective and less costly compared to usual care. Sensitivity analyses illustrated considerable uncertainty. When joint uncertainty was examined, the probability of the intervention being cost-effective at a willingness-to-pay threshold of GBP 20,000 per QALY gain was 29 percent and 24 percent at GBP 30,000.
Our cost-utility analysis indicates that memory rehabilitation was cheaper but less effective than usual care but these findings must be interpreted in the light of small statistically non–significant differences and considerable uncertainty was evident. The ReMemBrIn intervention is unlikely to be considered cost-effective for people with TBI.