Co-creating safe spaces: Study protocol for translational research on innovative alternatives to the emergency department for people experiencing emotional distress and/or suicidal crisis.

INTRODUCTION: Safe spaces are an alternative to emergency departments, which are often unable to provide optimum care for people experiencing emotional distress and/or suicidal crisis. At present, there are several different safe space models being trialled in Australia. However, research examining the effectiveness of safe space models, especially in community settings, is rare. In this paper, we present a protocol for a study in which we will investigate the implementation, effectiveness, and sustainability of safe space models as genuine alternatives for people who might usually present to the emergency department or choose not to access help due to past negative experiences. MATERIAL AND METHODS: We will use a mixed methods, co-designed study design, conducted according to the principles of community-based participatory research to obtain deep insights into the benefits of different safe space models, potential challenges, and facilitators of effective practice. We developed the study plan and evaluation framework using the RE-AIM framework, and this will be used to assess key outcomes related to reach, effectiveness, adoption, implementation, and maintenance. Data collection will comprise quantitative measures on access, use, satisfaction, (cost) effectiveness, distress, and suicidal ideation; and qualitative assessments of service implementation, experience, feasibility, acceptability, community awareness, and the fidelity of the models to service co-design. Data will be collected and analysed concurrently throughout the trial period of the initiatives. DISCUSSION: This study will enable an extensive investigation of safe spaces that will inform local delivery and provide a broader understanding of the key features of safe spaces as acceptable and effective alternatives to hospital-based care for people experiencing emotional distress and/or suicidal crisis. This study will also contribute to a growing body of research on the role and benefits of peer support and provide critical new knowledge on the successes and challenges of service co-design to inform future practice.

Evaluation of Lethal Fish Sampling and the Nonlethal Alternative Under the Canadian Metal and Diamond Mining Environmental Effects Monitoring Program.

The Environmental Effects Monitoring (EEM) program, federally mandated to metal and diamond mines and mills in Canada, aims to ensure that fish, fish use, and their environment are sufficiently protected by the Metal and Diamond Mining Effluent Regulations (MDMER). Concerns have been raised regarding lethal fish sampling conducted for the program and the potential risk to fish populations. This study endeavored to calculate the extent of fish sacrificed during lethal EEM fish surveys to provide a more informed characterization for stakeholders. By extrapolating data from 28 studies conducted at 8 metal mines in Saskatchewan between 2004 and 2017, it was conservatively estimated that 60 060 ± 19 978 fish have been sacrificed for the program nationwide since its promulgation in 2002. This is almost 2 times greater than guidance recommendations due to numerous factors. Challenges faced when implementing the nonlethal fish population survey alternative were also evaluated, and some of these included data interpretation inconsistencies due to the lack of critical effect sizes (CES) included in the regulations for nonlethal effect endpoints, and reliance on capturing young of the year fish to assess the prescribed effect endpoints. Finally, a case study conducted to evaluate the congruity of lethal and nonlethal fish population survey results identified that the effect endpoints often produced conflicting conclusions for the same response variable. Ultimately, this study highlights that in order to strengthen and promote the use of nonlethal fish sampling as an alternate to the current standard of conducting lethal fish population surveys under the EEM program, the effect endpoints, study designs, and adoption of CES need to be thoroughly evaluated and included in the MDMER. If nonlethal sampling designs adequately provide the required data and meet program objectives, then there would be no need to continue sacrificing fish for the Canadian metal and diamond mining EEM program. Integr Environ Assess Manag 2019;00:1-10. © 2019 SETAC.

Can natural variability trigger effects on fish and fish habitat as defined in environment Canada's metal mining environmental effects monitoring program?

The Metal Mining Effluent Regulations (MMER) took effect in 2002 and require most metal mining operations in Canada to complete environmental effects monitoring (EEM) programs. An "effect" under the MMER EEM program is considered any positive or negative statistically significant difference in fish population, fish usability, or benthic invertebrate community EEM-defined endpoints. Two consecutive studies with the same statistically significant differences trigger more intensive monitoring, including the characterization of extent and magnitude and investigation of cause. Standard EEM study designs do not require multiple reference areas or preexposure sampling, thus results and conclusions about mine effects are highly contingent on the selection of a near perfect reference area and are at risk of falsely labeling natural variation as mine related "effects." A case study was completed to characterize the natural variability in EEM-defined endpoints during preexposure or baseline conditions. This involved completing a typical EEM study in future reference and exposure lakes surrounding a proposed uranium (U) mine in northern Saskatchewan, Canada. Moon Lake was sampled as the future exposure area as it is currently proposed to receive effluent from the U mine. Two reference areas were used: Slush Lake for both the fish population and benthic invertebrate community surveys and Lake C as a second reference area for the benthic invertebrate community survey. Moon Lake, Slush Lake, and Lake C are located in the same drainage basin in close proximity to one another. All 3 lakes contained similar water quality, fish communities, aquatic habitat, and a sediment composition largely comprised of fine-textured particles. The fish population survey consisted of a nonlethal northern pike (Esox lucius) and a lethal yellow perch (Perca flavescens) survey. A comparison of the 5 benthic invertebrate community effect endpoints, 4 nonlethal northern pike population effect endpoints, and 10 lethal yellow perch effect endpoints resulted in the observation of several statistically significant differences at the future exposure area relative to the reference area and/or areas. When the data from 2 reference areas assessed for the benthic invertebrate community survey were pooled, no significant differences in effect endpoints were observed. These results demonstrate weaknesses in the definition of an "effect" used by the MMER EEM program and in the use of a single reference area. Determination of the ecological significance of statistical differences identified as part of EEM programs conducted during the operational period should consider preexisting (background) natural variability between reference and exposure areas.

Implementing interpersonal and social rhythm therapy for mood disorders across a continuum of care.

OBJECTIVE: Interpersonal and social rhythm therapy (IPSRT) is an evidence-based psychotherapy for mood disorders. The goal of this quality improvement initiative was to demonstrate feasibility of implementing IPSRT across the continuum of outpatient and inpatient care within an academic medical center. METHODS: A multidisciplinary work group was convened to implement IPSRT in outpatient (N=48), inpatient (N=602), and intensive outpatient (N=68) programs of an academic medical center. Quality improvement performance markers (including symptoms and group attendance rates) were collected. RESULTS: Institutional preference for group treatments required adaptation of IPSRT from an individual to group psychotherapy format. Iterative problem solving and protocol development resulted in models of group IPSRT appropriate for each level of care. Performance outcome markers were favorable, indicating feasibility of implementation. CONCLUSIONS: At a single, multisite, urban, academic medical center, IPSRT proved a feasible evidence-based psychotherapy for implementation across levels of care in routine practice.

Eye and head movement alterations in naïve progressive addition lens wearers.

AIMS: To examine adaptation to progressive addition lenses (PALs) by investigating eye and head movement strategies of individuals naïve to PAL wear; to determine whether adaptation is a short-term change in strategy or is maintained with continued PAL wear; to determine if adaptation strategies are different between PAL designs. METHODS: Ten presbyopic individuals participated in a double-blind crossover study. Participants wore one PAL design for < or = 4 weeks, had approximately 1 week without PAL wear and then wore the second PAL for < or = 4 weeks. Eye and head movements were recorded at the beginning and end of each period of PAL wear in response to several visual tasks. Visual tasks were a flash discrimination task at 2 m and 40 cm, and reading text aloud. Quantitative analysis was undertaken for eye and head movement dynamics (latency, duration, peak velocity, etc.). Categorical analysis used eye and head movement metrics to classify participants as eye-movers, head-movers or mixed at each visit. RESULTS: There was significant between-participant variability. A number of eye/head movement parameters exhibited carry-over effects. The number of vertical head movements for the distance task showed a significant increase between the first and second visit (F(1,9) = 5.578; p = 0.042), irrespective of lens design. Categorical analysis showed that participants employed task dependent strategies for all tasks. Participants that altered their strategy tended to include more head movements. Seven of the 10 participants preferred the second PAL worn. CONCLUSIONS: Participants recruited more head movements for flash discrimination tasks and for reading text during adaptation to PAL wear. The many and various eye and head movement parameters analysed were unable to discriminate differences dependent on PAL design.

1H MRS brain measures and acute lorazepam administration in healthy human subjects.

The effects of acute lorazepam administration on 1H magnetic resonance spectroscopy (MRS) in vivo brain spectra were examined in the left dorsolateral prefrontal cortex (L-DLPFC) of healthy human subjects. We wanted to examine whether lorazepam administration would result in significant changes in the levels of 1H-MRS metabolites in this brain region. Ten healthy controls underwent a short echo-time 1H-MRS session immediately before, and a second one 1 h after lorazepam administration (2mg/orally). The measured 1H-metabolites included N-acetyl-aspartate, phosphocreatine+creatine, trimethylamines, myo-inositol, glutamate, and glutamine, which were expressed as absolute values and ratios. No significant differences were found after lorazepam administration for any of the measured metabolite levels or ratios (paired t-tests, p >.05). This study demonstrated that lorazepam can potentially be utilized to acutely sedate psychiatric subjects during in vivo 1H-MRS sessions, as it does not appear to produce significant changes in the 1H-MRS spectra in this specific brain region.