An early economic evaluation of Kooth, a web-based mental health platform for children and young people with emerging mental health needs.

Background: "Kooth" is a web-based mental health platform commissioned by the National Health Service (NHS), local authorities, charities, and businesses in the UK. The platform gives children and young people (CYP) access to an online community of peers and a team of counsellors. This study reports an early economic evaluation of the potential benefits of Kooth in the UK. Methods: An early evidence cost calculator was built to estimate the potential costs and savings of implementing Kooth from a UK NHS and crime sector perspective. A decision tree structure was used to track the progress of CYP with emerging mental health needs (EMHN), comparing CYP with access to Kooth to CYP without access to Kooth. The model implemented a 12-month time horizon and followed a typical Kooth contract in relation to costing, engagement, and CYP demographics. Results: The base case results followed a cohort of 2160 CYP. The results of the cost calculator estimated that engagement with Kooth is associated with a cost saving of £469,237 to the NHS across a 12-month time horizon, or £236.15 per CYP with an EMHN. From a combined NHS and UK crime sector perspective, the cost savings increased to £489,897, or £246.54 per CYP with an EMHN. The largest cost savings were provided by an estimated reduction of 5346 GP appointments and 298 antidepressant prescriptions. For this cohort, the model predicted that engagement with Kooth averted 6 hospitalisations due to suicidal ideation and 13 hospitalisations due to self-harm. Furthermore, the number of smokers and binge drinkers was reduced by 20 and 24, respectively. When a crime sector perspective was taken, 3 crimes were averted. Discussion: This early model demonstrates that Kooth has the potential to be a cost-saving intervention from both an NHS and a combined NHS and UK crime sector perspective. Cost savings were provided through aversion in clinical and social outcomes. The model used a conservative approach to balance the uncertainty around assumptions of the intermediate outcomes (GP and medication use). However, it is limited by a paucity of costing data and published evidence relating to the impact of digital mental health platforms.

Comparing instructor-led, video-model, and no-instruction control tutorials for creating single-subject graphs in Microsoft Excel: A systematic replication and extension.

Visual inspection of single-subject data is the primary method for behavior analysts to interpret the effect of an independent variable on a dependent variable; however, there is no consensus on the most suitable method for teaching graph construction for single-subject designs. We systematically replicated and extended Tyner and Fienup (2015) using a repeated-measures between-subjects design to compare the effects of instructor-led, video-model, and no-instruction control tutorials on the graphing performance of 81 master's students with some reported Microsoft Excel experience. Our mixed-design analysis revealed a statistically significant main effect of pretest, tutorial, and posttest submissions for each tutorial group and a nonsignificant main effect of tutorial group. Tutorial group significantly interacted with submissions, suggesting that both instructor-led and video-model tutorials may be superior to providing graduate students with a written list of graphing conventions (i.e., control condition). Finally, training influenced performance on an untrained graph type (multielement) for all tutorial groups.

Iconicity bias and duration.

Descriptions of durational relations can be ambiguous, for example, the description "one meeting happened during another" could mean that one meeting started before the other ended, or it could mean that the meetings started and ended simultaneously. A recent theory posits that people mentally simulate descriptions of durational events by representing their starts and ends along a spatial axis, that is, an iconic representation of time. To draw conclusions from this iconic mental model, reasoners consciously scan it in the direction of earlier to later timepoints. The account predicts an iconicity bias: People should prefer descriptions that are congruent with an iconic scanning procedure-descriptions that mention the starts of events before the ends of events-over logically equivalent but incongruent descriptions. Six experiments corroborated the prediction; they show that iconicity biases in temporal reasoning manifest in cases when reasoners consciously evaluate the durations of events. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Economic evaluation of Optilume, a drug-coated balloon for recurrent anterior male urethral stricture.

Objectives: We aim to conduct an economic evaluation of the Optilume urethral drug-coated balloon (DCB) compared with endoscopic management for the treatment of recurrent anterior male urethral stricture in England. Patients and Methods: A cohort Markov model was developed to estimate the costs and savings to the NHS over a 5-year time horizon of adopting Optilume for the treatment of anterior urethral male stricture versus current endoscopic standard of care. A scenario analysis was conducted which compared Optilume to urethroplasty. Probabilistic and deterministic sensitivity analyses were performed to estimate the impact of uncertainties in model parameters. Results: When compared with current endoscopic standard of care Optilume resulted in an estimated cost saving of £2502 per patient if introduced in the NHS for the treatment of recurrent anterior male urethral stricture. In the scenario analysis, the use of Optilume compared with urethroplasty resulted in an estimated cost saving of £243. Results were robust to changes in individual input parameters as demonstrated in the deterministic sensitivity analyses, with the monthly probability of symptom recurrence associated with endoscopic management the only exception. Probabilistic sensitivity analysis results demonstrated that Optilume was cost saving in 93.4% of model iterations, when running 1000 iterations. Conclusion: Our analysis suggests that the Optilume urethral DCB treatment can be a cost-saving alternative management option for the treatment of recurrent anterior male urethral stricture within the NHS in England.

Growth conditions impact particulate absorption and pigment concentrations in two common bloom forming cyanobacterial species.

Remote sensing using satellite imagery has been promoted as a method to broaden the scale and frequency of cyanobacterial monitoring. This relies on the ability to establish relationships between the reflectance spectra of water bodies and the abundance of cyanobacteria. A challenge to achieving this comes from a limited understanding of the extent to which the optical properties of cyanobacteria vary according to their physiological state and growth environment. The aim of the present study was to determine how growth stage, nutrient status and irradiance affect pigment concentrations and absorption spectra in two common bloom forming cyanobacterial taxa: Dolichospermum lemmermannii and Microcystis aeruginosa. Each species was grown in laboratory batch culture under a full factorial design of low or high light intensity and low, medium, or high nitrate concentrations. Absorption spectra, pigment concentrations and cell density were measured throughout the growth phases. The absorption spectra were all highly distinguishable from each other, with greater interspecific than intraspecific differences, indicating that both D. lemmermannii and M. aeruginosa can be readily differentiated using hyperspectral absorption spectra. Despite this, each species exhibited different responses in the per-cell pigment concentrations with varying light intensity and nitrate exposure. Variability among treatments was considerably higher in D. lemmermannii than in M. aeruginosa, which exhibited smaller changes in pigment concentrations among the treatments. These results highlight the need to understand the physiology of the cyanobacteria and to take caution when estimating biovolumes from reflectance spectra when species composition and growth stage are unknown.

Using a weight of evidence approach to identify sources of microbiological contamination in a shellfish-growing area with "Restricted" classification.

Shellfish-growing areas in rural catchments are occasionally affected by elevated faecal contamination from diffuse sources and may be subject to frequent harvest closures/classification downgrades. We combined traditional risk management methods based on sanitary surveys and monitoring of Escherichia coli in seawater and shellfish with faecal source tracking, bacterial source apportionment, and hydrometeorological modelling to determine the causes of elevated E. coli concentrations contributing to harvest closures in Papanui Inlet (Aotearoa New Zealand). These multiple lines of evidence were used to inform a weight of evidence assessment of bacterial contamination in the inlet. Ruminant livestock was estimated to contribute 80% of the faecal coliform loading. Concentrations of E. coli in seawater were low (≤ 87 MPN 100 ml-1) whilst concentrations in tuaki/cockles/little neck clams (Austrovenus stutchburyi) occasionally exceeded the "Approved" classification limit (230 MPN 100 g-1). The most frequent positive genetic markers in seawater were the seagull (Catellicoccus marimammalium) (54% of seawater samples), and in shellfish, the bovine and seagull markers (both 12.5% of shellfish samples). Solar radiation was negatively correlated with E. coli in tuaki. We found that the growing area is affected by faecal inputs from animal and, to a lesser extent, human (septic tank discharges) sources which elevate contamination to levels detectable in tuaki but not in seawater, particularly in the summer months. The innovative approach can enhance the management of shellfish-growing areas affected by intermittent contamination and enables more targeted action to reduce pollution to improve shellfish water quality.

Temporal explanations.

People can explain phenomena by appealing to temporal relations, for example, you might explain a colleague's absence at a meeting by inferring that their prior meeting ended late. Previous explanatory reasoning research shows that people construct causal explanations to resolve causal conflicts. Accordingly, temporal explanations may help reasoners resolve temporal conflicts, and we describe four experimental tests of the hypothesis (N = 240). Experiment 1 provided participants with conflicting or consistent temporal information and elicited natural responses about what followed. Participants spontaneously provided temporal explanations to resolve inconsistencies, and only a minority of them provided more conservative, direct refutations. Experiments 2 and 3 showed that participants preferred temporal explanations over simpler refutations to resolve conflicts, and Experiment 4 showed that participants judged temporal explanations more probable than refutations, and thereby yielded a novel class of conjunction fallacies. The research is the first to examine patterns in temporal explanatory reasoning. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Differential attainment: how can we close the gap in paediatrics?

Differential attainment is the gap in attainment between different demographic groups undertaking the same assessment. Across the UK, we see differences in outcome in undergraduate and postgraduate medical education on the basis of gender, age, ethnicity and country of primary medical qualification which cannot be explained by a difference in ability. The largest gaps appear when we look at the variation in outcome between UK and international medical graduates (IMGs) and between white British and black, Asian and minority ethnic (BAME) doctors in postgraduate medical education. If we look to postgraduate medical examinations, the differences in attainment are stark and occur across all medical specialties, with paediatrics being no exception. The differences are also seen in the rates of relative success in recruitment to training posts and in a trainee's likelihood of getting a satisfactory outcome at the Annual Review of Competence Progression. Ensuring all doctors reach their full potential is undoubtedly an issue of fairness that is of particular significance to paediatrics as IMGs make up 47% of our medical workforce and 36% of the paediatric workforce identifies as being from a BAME group. It is clear that if we fail to close the gap in differential attainment, there will be both a personal cost to affected individuals, but also a cost to the wider paediatric profession and the children they serve. This paper hopes to summarise the background and causes to differential attainment and look towards possible interventions that might tackle this issue.

Mineralogy affects prokaryotic community composition in an acidic metal mine.

The microbial ecology of acidic mine and sulfide cave ecosystems is well characterised with respect to aquatic communities, typically revealing low taxonomic complexity and dominance by a relatively limited number of cosmopolitan acidophilic bacterial and archaeal taxa. Whilst pH, temperature, and geochemistry are recognised drivers of diversity in these ecosystems, the specific question of a possible influence of substratum mineralogy on microbial community composition remains unanswered. Here we address this void, using 81 subterranean mineral samples from a low temperature abandoned, acidic, sulfide ore mine system at Mynydd Parys (Parys Mountain in English), Wales, UK. Four primary and 15 secondary minerals were identified via x-ray diffraction, each sample containing a maximum of five and an average of two minerals. The mineralogy of primary (e.g. pyrite and quartz) and secondary (e.g. melanterite and pisanite) minerals was significantly correlated with prokaryotic community structure at multiple taxonomic levels, implying that the mineralosphere effect reported in less extreme terrestrial environments is also implicated in driving prokaryotic community composition in extremely acidic, base metal-bearing sulfide mineralisation at Mynydd Parys. Twenty phyla were identified, nine of which were abundant (mean relative abundance >1%). While taxa characteristic of acidic mines were detected, for example Leptospirillum (phylum Nitrospirae), Acidithiobacillus (phylum Proteobacteria), Sulfobacillus (phylum Firmicutes) and Ferroplasma (phylum Euryarchaeota), their abundance in individual samples was highly variable. Indeed, in the majority of the 81 samples investigated the abundance of these and other typical acidic mine taxa was low, with 25% of samples devoid of sequences from recognised acidic mine taxa. Most notable amongst the bacterial taxa not previously reported in such environments were the recently cultivated Muribaculaceae family (phylum Bacteroidetes), which often dominated Mynydd Parys samples regardless of their mineralogical content. Our results pose further questions regarding the mechanisms by which taxa not previously reported in such extreme environments appear to survive in Mynydd Parys, opening up research pathways for exploring the biodiversity drivers underlying microbial community composition and function in extremely acidic mine environments.

'Please help me, I am so miserable!': sexual health, emotions and counselling in teen and young adult problem pages in late 1980s Ireland.

In 1984, the Irish Family Planning Association (IFPA) established a youth group comprised of young volunteers aged between 16 years and 20 years. The IFPA was responding to a perceived need for sexual health advice for young people in the absence of any formal sex education in Irish schools. The group established a telephone helpline and, from late 1987, was commissioned to provide advice columns for two Irish magazines for young people called Hot Press and Fresh The advice columns run by the IFPA youth group provided an important educational and counselling service for young people on matters relating to sexual health and relationships. Letters to the two magazines also attest to a significant degree of ignorance around sexual and reproductive health among young people and the prevalence of risk taking with regard to contraception. Moreover, the letters were often frank and deeply honest about the feelings and emotions experienced by the letter writer. Replies to the letter writers from the IFPA group were sensitive and empathetic, but clear and unambiguous, highlighting the team's approaches to sexual health counselling and 'risk' which were modelled on approaches by British groups such as the Samaritans, Grapevine and Brook. Drawing on the uncatalogued letters received by the youth group, as well as the published replies in the magazine advice columns, this article will shed light on the key sexual health concerns of young Irish people in the late 1980s. Ultimately, it will examine what these queries reveal about the impact of Ireland's social and moral climate on teenagers' emotional health. More broadly, the letters to these magazines illuminate the stigma, shame and silences around these issues in 1980s' Ireland, and highlight the importance of magazines as a source of communication and an outlet for young people to express their emotions relating to sexuality, relationships and sexual health.

Assessing the Validity of the Long-Term Conditions Questionnaire (LTCQ) in Women During Pregnancy and the First Year Following Birth.

Background: The aim of this study was to validate a generic patient-reported outcome measure, the Long-Term Conditions Questionnaire (LTCQ), among pregnant and postpartum women living with a pre-existing long-term condition (LTC). Methods: Cognitive interviews were conducted with women who were currently pregnant or had given birth within the past year and living with a pre-existing LTC (n=11) and with healthcare professionals working in maternal care (n=11) to explore the acceptability of LTCQ items. An online survey was subsequently administered among women who were pregnant or had given birth within the past year and living with a pre-existing LTC (n=718). Tests of validity were performed including assessing correlations between the LTCQ and reference measures, the Well-being in Pregnancy (WiP) Questionnaire and the EuroQol EQ-5D-5L. Internal consistency was assessed using the Cronbach's alpha statistic. Results: All LTCQ items were considered relevant and appropriate for use with women who were pregnant or had given birth within the past year. The most commonly reported LTC among the online survey sample (n=718) was a mental health condition (n=350, 48.7%) followed by joint, bone and connective tissues (n= 212, 29.5%) and gastrointestinal (n=143, 19.9%) condition. Data indicated LTCQ scores behaved in a predictable pattern, demonstrating poorer scores for women reporting a greater number of LTCs; mean (SD) scores, one LTC= 61.86 (17.8), two LTCs= 55.29 (16.0), three LTCs= 49.84 (15.52) and four LTCs= 44.94 (12.2). Poorer scores were also reported for women living with at least one mental health condition compared to those reporting no mental health condition, mean score = 66.18 (SD 16.7) v 48.64 (SD 13.3), p<0.001 respectively. As anticipated, LTCQ scores demonstrated significant correlations in the expected direction with both the EQ-5D-5L and WiP scores. For all LTCQ items, the Cronbach's alpha statistic was 0.93. Conclusion: Data presented here indicate that the LTCQ, which assesses living well with one or more LTC, is suitable for use among pregnant and postpartum women, from both the woman's perspective and from the perspectives of maternity healthcare professionals. Use of the LTCQ would facilitate the identification of unmet needs within this high-risk cohort and support the exploration of how LTCs may affect women throughout the pregnancy and post-natal period. Understanding unmet needs within this cohort of women provides an opportunity to link up specialist care within maternity services and enhance personalised care.

Test-retest reliability of the PDQ-Carer.

INTRODUCTION: The PDQ-Carer is a 29-item measure of health-related quality of life (QoL) for use with carers of people with Parkinson's (PwP). The measure produces a profile of scores across four domains. Previous validation data indicates that the measure possesses sound psychometric properties in terms of validity and internal consistency. An additional important attribute of any measure is test-retest reliability, i.e. the ability to provide stable results over time, presuming that there has been no change in the status of the construct being measured. To date, no assessment of the test-retest reliability of the PDQ-Carer has been undertaken. METHODS: Carers of PwP were recruited via Parkinson's UK. Participants completed the PDQ-Carer online on two occasions, two weeks apart. On second administration participants answered an additional question asking how much, if at all, their QoL had changed over the two week period. Subsequent analyses focused on those carers who reported no change in their QoL. RESULTS: At first administration 142 carers fully completed the PDQ-Carer and at second administration 104 participants with no missing data responded. Seventy four of these participants (71.2%) reported no change in QoL and thus went forward to the final analysis. Intraclass correlation coefficients for each domain were calculated as follows: Social and Personal Activities .97; Anxiety and Depression .95; Self-Care .96; Stress .95 CONCLUSION: Results indicate that the PDQ-Carer demonstrates sound test-retest reliability and can be confidently used by researchers who wish to incorporate it in studies of carers of PwP.

Refinement of the Well-being in Pregnancy (WiP) questionnaire: cognitive interviews with women and healthcare professionals and a validation survey.

BACKGROUND: Measuring positive and negative aspects of well-being during pregnancy and childbirth is important for both healthy women and women who are living with long-term health conditions (LTCs). This study aimed to further refine the Well-being in Pregnancy (WiP) questionnaire and to incorporate LTC specific items where appropriate. METHODS: A multi-method study. Cognitive interviews with pregnant or postpartum women (n = 11) and consultations with healthcare professionals (n = 11) and public representatives (n = 4) were conducted to explore the acceptability of existing WiP items and content. Items were refined and subsequently administered on an online survey (n = 768). Item reduction steps and exploratory factor analysis were performed on survey data. Convergent validity was examined using Pearson correlation coefficients to compare relationships with other included validated assessments. RESULTS: Following amendments to three items, the addition of eight core WiP items and five LTC specific items, a total of 25 items were considered relevant and appropriate for use with pregnant women. Analysis of survey data reduced the questionnaire to 12 items measuring three core WiP scales; 1) Concerns over support after birth, 2) Positive pregnancy and, 3) Confidence about motherhood, and a five item standalone LTC specific scale. All scales demonstrated good validity and internal reliability. Scores for the three core scales moderately correlated with established well-being measures indicating that they were measuring similar, yet distinct concepts. CONCLUSIONS: Analyses confirmed good psychometric properties of the refined WiP questionnaire. The use of pregnancy specific well-being measures, such as the WiP, provide a route into asking women in more detail about how their care may be tailored to support them and also facilitates positive conversations with women about how care and experience of pregnancy and childbirth may be enhanced further.

Evaluating a psychological support service focused on the needs of critical care and theatres staff in the first wave of COVID-19.

BACKGROUND: In response to COVID-19, the authors used clinical psychology resources from their hospital's Pain Medicine Department to provide direct support to critical areas. AIMS: The degree to which the service met the needs of staff and managers between March and August 2020 was evaluated. METHODS: A total of 51 staff were referred. Most were nurses (43%), followed by theatre practitioners (36%), healthcare assistants (9%), consultants (8%), administrative (2%) and support staff (2%). Working status, reason for referral and presenting difficulties at first appointment and outcome were recorded. Staff were sent an anonymous survey following intervention. FINDINGS: Staff reported high rates of burnout, anxiety and low mood, with 22% experiencing exacerbation of pre-existing mental health problems. All staff reported benefit from the intervention and managers provided positive feedback. CONCLUSION: Establishing a supportive service that included psychology benefited both staff and managers at the peak of the pandemic. Recommendations are provided.

Growth at the limits: comparing trace metal limitation of a freshwater cyanobacterium (Dolichospermum lemmermannii) and a freshwater diatom (Fragilaria crotonensis).

Freshwater phytoplankton blooms are increasing in prevalence and there are conflicting views on whether trace metals limit growth of key species and thus bloom formation. The Taupo Volcanic Zone (TVZ), New Zealand, was formed by multiple eruptions of a super-volcano which emitted rhyolitic tephra leaving lakes depleted in trace metals. This provides an opportunity to test the potential of trace metal limitation on freshwater phytoplankton growth under nanomolar concentrations. Growth responses of two algal species isolated from Lake Taupo, Dolichospermum lemmermannii (cyanobacteria) and Fragilaria crotonensis (diatom), to six biologically important trace metals (manganese, iron, zinc, cobalt, copper and molybdenum) were examined in culture experiments. These were conducted at three trace metal concentrations: (1) ambient, (2) two-times ambient, and (3) ten-times ambient concentrations in Lake Taupo. Elevated concentrations of iron significantly increased growth rates and maximum cell densities in D. lemmermannii, whereas no significant concentration dependence was observed for other trace metals. Fragilaria crotonensis showed no significant growth response to elevated concentrations of trace metals. These results highlight the importance of iron as a growth limiting nutrient for cyanobacteria and indicate that even small (twofold) increases in Fe concentrations could enhance cyanobacteria growth rates in Lake Taupo, potentially causing cyanobacterial blooms.

A high-quality reference genome for Fraxinus pennsylvanica for ash species restoration and research.

Green ash (Fraxinus pennsylvanica) is the most widely distributed ash tree in North America. Once common, it has experienced high mortality from the non-native invasive emerald ash borer (EAB; Agrilus planipennis). A small percentage of native green ash trees that remain healthy in long-infested areas, termed "lingering ash," display partial resistance to the insect, indicating that breeding and propagating populations with higher resistance to EAB may be possible. To assist in ash breeding, ecology and evolution studies, we report the first chromosome-level assembly from the genus Fraxinus for F. pennsylvanica with over 99% of bases anchored to 23 haploid chromosomes, spanning 757 Mb in total, composed of 49.43% repetitive DNA, and containing 35,470 high-confidence gene models assigned to 22,976 Asterid orthogroups. We also present results of range-wide genetic variation studies, the identification of candidate genes for important traits including potential EAB-resistance genes, and an investigation of comparative genome organization among Asterids based on this reference genome platform. Residual duplicated regions within the genome probably resulting from a recent whole genome duplication event in Oleaceae were visualized in relation to wild olive (Olea europaea var. sylvestris). We used our F. pennsylvanica chromosome assembly to construct reference-guided assemblies of 27 previously sequenced Fraxinus taxa, including F. excelsior. Thus, we present a significant step forward in genomic resources for research and protection of Fraxinus species.

Debates on family planning and the contraceptive pill in the Irish magazine Woman's Way, 1963-1973.

This article explores discussions of family planning and the contraceptive pill in the popular Irish women's magazine Woman's Way between 1963 and 1973. Contraception was criminalised in Ireland in 1935 and literature relating to birth control was banned under the 1929 Censorship of Publications Act. The contraceptive pill was marketed as a cycle regulator from 1963 until legalization in 1979. This article outlines how women accessed the contraceptive pill, the geographical and class inequalities around this access and how Woman's Way was an important vehicle for debates around the pill. The article assesses what discussions of the contraceptive pill can tell us about marriage dynamics, the role of sympathetic doctors, the power of the Catholic Church. Ultimately, it illustrates how the magazine was an important source of information on family planning for Irish women and how it also enabled women to air their views on the issue.