Longitudinal Outcomes of a Resident Academic Administrator, Clinician Educator Track.

OBJECTIVE: As clinician educator tracks continue to gain popularity in graduate medical education, this report aims to fill a gap in the literature by providing a 14-year update on professional outcomes of participants in a psychiatry residency academic administrator, clinician educator (AACE) track and to compare these outcomes to non-track participants. METHODS: An anonymous web-based survey querying professional achievements was distributed to all graduates of a psychiatry residency training program from 2009 to 2022. Outcomes of AACE track participants and non-track participants were compared. RESULTS: Of 228 alumni contacted, 61% responded (n = 140). Eighty-seven percent of track participants responded (n = 74) while 41% of non-track participants responded (n = 45). Of track participants, 63% practice in academic settings with 57% having held administrative leadership roles, 49% educational leadership roles, and 39% national or regional leadership roles. Track graduates were academically engaged with 70% reporting at least one publication, 89% at least one presentation, and 93% attending at least one national meeting. In comparison, 31% of non-track participants practice in academic settings with 44% having held administrative, 29% educational, and 20% national or regional leadership roles. Thirty-nine percent have at least one publication, 75% at least one presentation, and 90% attended at least one national meeting. When compared to non-track participants, track participants were significantly more likely to have an academic affiliation and a higher number of publications and were more likely to hold national or regional leadership roles. CONCLUSIONS: Track participants demonstrate longitudinal career success as clinician educators and academic administrators more so than non-track participants.

Curves and kinematics: Relationship between the force-time curve and landing ability.

Anterior cruciate ligament (ACL) injuries have a significant impact on athletic performance and long-term quality of life. Force plates and qualitative screening tools are feasible and effective screening methods to identify abnormal movement quality associated with increased injury risk. Comparing qualitative assessments of landing ability with force-time curves, may detect unique differences between safe and high-risk athletic movement patterns. The aim of this study was to determine low- and high-risk landing ability from qualitive landing assessments and to examine the resulting force-time curves using functional principal component analysis (fPCA). Thirty-one healthy academy athletes (10 males and 21 females) completed double- and single-leg dominant and non-dominant jump-landing-rebound tasks. All movements were filmed in multiple-planes, and vertical ground reaction forces (vGRF) were simultaneously collected. The Landing Error Scoring System (LESS) and Single-Leg Landing Error Scoring System (SL-LESS) were used to score landing footage. From these scores, athletes were categorized into low-risk and high-risk groups for further analysis. fPCA was used to examine differences between landing quality groups force-time curves. Compared to high-risk landers, low-risk landers demonstrated significantly longer contact times across all movements. Scores from fPC1 revealed safe and high-risk landing techniques expose athletes to significantly different loading patterns during double- and single-leg dominant movements. A significant positive relationship was observed between fPC1 and LESS scores, however this relationship was not observed in both single-leg landing scores. Where possible incorporating curve analysis methods like fPCA into multi-faceted screening approaches may help practitioners uncover unique insights into athletic loading strategies.

Predicting Treatment Interruption Among People Living With HIV in Nigeria: Machine Learning Approach.

BACKGROUND: Antiretroviral therapy (ART) has transformed HIV from a fatal illness to a chronic disease. Given the high rate of treatment interruptions, HIV programs use a range of approaches to support individuals in adhering to ART and in re-engaging those who interrupt treatment. These interventions can often be time-consuming and costly, and thus providing for all may not be sustainable. OBJECTIVE: This study aims to describe our experiences developing a machine learning (ML) model to predict interruption in treatment (IIT) at 30 days among people living with HIV newly enrolled on ART in Nigeria and our integration of the model into the routine information system. In addition, we collected health workers' perceptions and use of the model's outputs for case management. METHODS: Routine program data collected from January 2005 through February 2021 was used to train and test an ML model (boosting tree and Extreme Gradient Boosting) to predict future IIT. Data were randomly sampled using an 80/20 split into training and test data sets, respectively. Model performance was estimated using sensitivity, specificity, and positive and negative predictive values. Variables considered to be highly associated with treatment interruption were preselected by a group of HIV prevention researchers, program experts, and biostatisticians for inclusion in the model. Individuals were defined as having IIT if they were provided a 30-day supply of antiretrovirals but did not return for a refill within 28 days of their scheduled follow-up visit date. Outputs from the ML model were shared weekly with health care workers at selected facilities. RESULTS: After data cleaning, complete data for 136,747 clients were used for the analysis. The percentage of IIT cases decreased from 58.6% (36,663/61,864) before 2017 to 14.2% (3690/28,046) from October 2019 through February 2021. Overall IIT was higher among clients who were sicker at enrollment. Other factors that were significantly associated with IIT included pregnancy and breastfeeding status and facility characteristics (location, service level, and service type). Several models were initially developed; the selected model had a sensitivity of 81%, specificity of 88%, positive predictive value of 83%, and negative predictive value of 87%, and was successfully integrated into the national electronic medical records database. During field-testing, the majority of users reported that an IIT prediction tool could lead to proactive steps for preventing IIT and improving patient outcomes. CONCLUSIONS: High-performing ML models to identify patients with HIV at risk of IIT can be developed using routinely collected service delivery data and integrated into routine health management information systems. Machine learning can improve the targeting of interventions through differentiated models of care before patients interrupt treatment, resulting in increased cost-effectiveness and improved patient outcomes.

The pollen virome of wild plants and its association with variation in floral traits and land use.

Pollen is a unique vehicle for viral spread. Pollen-associated viruses hitchhike on or within pollen grains and are transported to other plants by pollinators. They are deposited on flowers and have a direct pathway into the plant and next generation via seeds. To discover the diversity of pollen-associated viruses and identify contributing landscape and floral features, we perform a species-level metagenomic survey of pollen from wild, visually asymptomatic plants, located in one of four regions in the United States of America varying in land use. We identify many known and novel pollen-associated viruses, half belonging to the Bromoviridae, Partitiviridae, and Secoviridae viral families, but many families are represented. Across the regions, species harbor more viruses when surrounded by less natural and more human-modified environments than the reverse, but we note that other region-level differences may also covary with this. When examining the novel connection between virus richness and floral traits, we find that species with multiple, bilaterally symmetric flowers and smaller, spikier pollen harbored more viruses than those with opposite traits. The association of viral diversity with floral traits highlights the need to incorporate plant-pollinator interactions as a driver of pollen-associated virus transport into the study of plant-viral interactions.

In-Season Nutrition Strategies and Recovery Modalities to Enhance Recovery for Basketball Players: A Narrative Review.

Basketball players face multiple challenges to in-season recovery. The purpose of this article is to review the literature on recovery modalities and nutritional strategies for basketball players and practical applications that can be incorporated throughout the season at various levels of competition. Sleep, protein, carbohydrate, and fluids should be the foundational components emphasized throughout the season for home and away games to promote recovery. Travel, whether by air or bus, poses nutritional and sleep challenges, therefore teams should be strategic about packing snacks and fluid options while on the road. Practitioners should also plan for meals at hotels and during air travel for their players. Basketball players should aim for a minimum of 8 h of sleep per night and be encouraged to get extra sleep during congested schedules since back-to back games, high workloads, and travel may negatively influence night-time sleep. Regular sleep monitoring, education, and feedback may aid in optimizing sleep in basketball players. In addition, incorporating consistent training times may be beneficial to reduce bed and wake time variability. Hydrotherapy, compression garments, and massage may also provide an effective recovery modality to incorporate post-competition. Future research, however, is warranted to understand the influence these modalities have on enhancing recovery in basketball players. Overall, a strategic well-rounded approach, encompassing both nutrition and recovery modality strategies, should be carefully considered and implemented with teams to support basketball players' recovery for training and competition throughout the season.

Mycobacterium leprae-helminth co-infections and vitamin D deficiency as potential risk factors for leprosy: A case-control study in south-eastern Brazil.

BACKGROUND: Evidence suggests that biological mechanisms involved in helminth infections and vitamin deficiencies increase susceptibility to other infections. The aim of this study was to investigate the associations of helminth co-infection and select micronutrient deficiencies with leprosy using a case-control design. METHODS: From 2016 to 2018, individuals aged ≥3 years were recruited at clinics in and around Governador Valadares, Minas Gerais, Brazil in three groups: cases of leprosy, household contacts and community-matched (non-contact) controls. Helminths were diagnosed through stool Kato Katz examination and serum reactivity to anti-soluble adult worm antigen preparation IgG4. Serum ferritin, 25-OH vitamin D and retinol concentrations were measured. Multi-variate logistic regression was conducted to identify associations with active leprosy. RESULTS: Seventy-nine cases of leprosy, 96 household contacts and 81 non-contact controls were recruited; 48.1% of participants were male with a median age of 40 years. Helminths were found in 7.1% of participants on Kato Katz test, all but one of which were Schistosoma mansoni, and 32.3% of participants were positive for S. mansoni serology. On multi-variate analysis, cases were more likely to be infected with helminths (diagnosed by stool) than household contacts [adjusted odds ratio (aOR) 8.69, 95% confidence interval (CI) 1.50-50.51]. Vitamin D deficiency was common, and was more likely in cases compared with non-contact controls (aOR 4.66, 95% CI 1.42,-15.33). Iron deficiency was not associated with leprosy, and vitamin A deficiency was not detected. CONCLUSION: These associations suggest that the immune consequences of schistosomiasis and vitamin D deficiency may increase the risk of active leprosy. Comorbid conditions of poverty deserve further study as addressing co-infections and nutritional deficiencies could be incorporated into programmes to improve leprosy control.

A drop landing screening approach to monitor an individual using functional data analysis: An ACL injury case study.

OBJECTIVES: To explore the practicality of using functional principal components analysis (fPCA) and intra-athlete z-score changes for individual athlete monitoring post-ACL injury and surgery. DESIGN: A single athlete case study using within-athlete repeated measures in the context of applied athlete monitoring. METHODS: Using single leg (left) drop landing (3 landings per session) onto a force plate, the athlete completed 6 sessions prior (healthy) and 3 sessions post-ACL injury/surgery. Maximum vertical ground reaction force (vGRF), time to stabilisation (TTS) and outputs from fPCA (fPC scores) for the healthy sessions were used to develop intra-athlete means and standard deviations for each variable. Post-surgery measures were given z-scores relative to the healthy mean and standard deviation for each variable. The standard normal deviate (z = 1.96) was used as a threshold to flag landings that could be indicative of changes in movement behaviour. RESULTS: Maximum vGRF revealed no post-surgery trials that exceeded the standard normal deviate threshold based on the healthy data. TTS identified one landing post-surgery that exceeded the threshold. Scores for fPC2, fPC3 and fPC4 revealed landings that exceeded the threshold, with fPC4 demonstrating landings greater than the threshold for every trial (except two) post-surgery. CONCLUSIONS: Including fPCA identified significant and stable changes to the landing strategy (particularly within fPC4). When used in conjunction with other measures such as maximum vGRF and TTS, fPCA has the potential to provide meaningful insights into athlete monitoring models regarding changes to movement characteristics after injury.

Gazing into the anthosphere: considering how microbes influence floral evolution.

The flower is the hallmark of angiosperms and its evolution is key to their diversification. As knowledge of ecological interactions between flowers and their microbial communities (the anthosphere) expands, it becomes increasingly important to consider the evolutionary impacts of these associations and their potential eco-evolutionary dynamics. In this Viewpoint we synthesize current knowledge of the anthosphere within a multilevel selection framework and illustrate the potential for the extended floral phenotype (the phenotype expressed from the genes of the plant and its associated flower microbes) to evolve. We argue that flower microbes are an important, but understudied, axis of variation that shape floral trait evolution and angiosperm reproductive ecology. We highlight knowledge gaps and discuss approaches that are critical for gaining a deeper understanding of the role microbes play in mediating plant reproduction, ecology, and evolution.

Effect of Body Composition on Physiological Responses to Cold-Water Immersion and the Recovery of Exercise Performance.

PURPOSE: To explore the influence of body composition on thermal responses to cold-water immersion (CWI) and the recovery of exercise performance. METHODS: Male subjects were stratified into 2 groups: low fat (LF; n = 10) or high fat (HF; n = 10). Subjects completed a high-intensity interval test (HIIT) on a cycle ergometer followed by a 15-min recovery intervention (control [CON] or CWI). Core temperature (Tc), skin temperature, and heart rate were recorded continuously. Performance was assessed at baseline, immediately post-HIIT, and 40 min postrecovery using a 4-min cycling time trial (TT), countermovement jump (CMJ), and isometric midthigh pull (IMTP). Perceptual measures (thermal sensation [TS], total quality of recovery [TQR], soreness, and fatigue) were also assessed. RESULTS: Tc and TS were significantly lower in LF than in HF from 10 min (Tc, LF 36.5°C ± 0.5°C, HF 37.2°C ± 0.6°C; TS, LF 2.3 ± 0.5 arbitrary units [a.u.], HF 3.0 ± 0.7 a.u.) to 40 min (Tc, LF 36.1°C ± 0.6°C, HF 36.8°C ±0.7°C; TS, LF 2.3 ± 0.6 a.u., HF 3.2 ± 0.7 a.u.) after CWI (P < .05). Recovery of TT performance was significantly enhanced after CWI in HF (10.3 ± 6.1%) compared with LF (3.1 ± 5.6%, P = .01); however, no differences were observed between HF (6.9% ±5.7%) and LF (5.4% ± 5.2%) with CON. No significant differences were observed between groups for CMJ, IMTP, TQR, soreness, or fatigue in either condition. CONCLUSION: Body composition influences the magnitude of Tc change during and after CWI. In addition, CWI enhanced performance recovery in the HF group only. Therefore, body composition should be considered when planning CWI protocols to avoid overcooling and maximize performance recovery.

Influence of body composition on physiological responses to post-exercise hydrotherapy.

This study examined the influence of body composition on temperature and blood flow responses to post-exercise cold water immersion (CWI), hot water immersion (HWI) and control (CON). Twenty-seven male participants were stratified into three groups: 1) low mass and low fat (LM-LF); 2) high mass and low fat (HM-LF); or 3) high mass and high fat (HM-HF). Experimental trials involved a standardised bout of cycling, maintained until core temperature reached 38.5°C. Participants subsequently completed one of three 15-min recovery interventions (CWI, HWI, or CON). Core, skin and muscle temperatures, and limb blood flow were recorded at baseline, post-exercise, and every 30 min following recovery for 240 min. During CON and HWI there were no differences in core or muscle temperature between body composition groups. The rate of fall in core temperature following CWI was greater in the LM-LF (0.03 ± 0.01°C/min) group compared to the HM-HF (0.01 ± 0.001°C/min) group (P = 0.002). Muscle temperature decreased to a greater extent during CWI in the LM-LF and HM-LF groups (8.6 ± 3.0°C) compared with HM-HF (5.1 ± 2.0°C, P < 0.05). Blood flow responses did not differ between groups. Differences in body composition alter the thermal response to post-exercise CWI, which may explain some of the variance in the responses to CWI recovery.

Core Temperature Responses to Cold-Water Immersion Recovery: A Pooled-Data Analysis.

PURPOSE: To examine the effect of postexercise cold-water immersion (CWI) protocols, compared with control (CON), on the magnitude and time course of core temperature (Tc) responses. METHODS: Pooled-data analyses were used to examine the Tc responses of 157 subjects from previous postexercise CWI trials in the authors' laboratories. CWI protocols varied with different combinations of temperature, duration, immersion depth, and mode (continuous vs intermittent). Tc was examined as a double difference (ΔΔTc), calculated as the change in Tc in CWI condition minus the corresponding change in CON. The effect of CWI on ΔΔTc was assessed using separate linear mixed models across 2 time components (component 1, immersion; component 2, postintervention). RESULTS: Intermittent CWI resulted in a mean decrease in ΔΔTc that was 0.25°C (0.10°C) (estimate [SE]) greater than continuous CWI during the immersion component (P = .02). There was a significant effect of CWI temperature during the immersion component (P = .05), where reductions in water temperature of 1°C resulted in decreases in ΔΔTc of 0.03°C (0.01°C). Similarly, the effect of CWI duration was significant during the immersion component (P = .01), where every 1 min of immersion resulted in a decrease in ΔΔTc of 0.02°C (0.01°C). The peak difference in Tc between the CWI and CON interventions during the postimmersion component occurred at 60 min postintervention. CONCLUSIONS: Variations in CWI mode, duration, and temperature may have a significant effect on the extent of change in Tc. Careful consideration should be given to determine the optimal amount of core cooling before deciding which combination of protocol factors to prescribe.

Cold-Water Immersion for Athletic Recovery: One Size Does Not Fit All.

The use of cold-water immersion (CWI) for postexercise recovery has become increasingly prevalent in recent years, but there is a dearth of strong scientific evidence to support the optimization of protocols for performance benefits. While the increase in practice and popularity of CWI has led to multiple studies and reviews in the area of water immersion, the research has predominantly focused on performance outcomes associated with postexercise CWI. Studies to date have generally shown positive results with enhanced recovery of performance. However, there are a small number of studies that have shown CWI to have either no effect or a detrimental effect on the recovery of performance. The rationale for such contradictory responses has received little attention but may be related to nuances associated with individuals that may need to be accounted for in optimizing prescription of protocols. To recommend optimal protocols to enhance athletic recovery, research must provide a greater understanding of the physiology underpinning performance change and the factors that may contribute to the varied responses currently observed. This review focuses specifically on why some of the current literature may show variability and disparity in the effectiveness of CWI for recovery of athletic performance by examining the body temperature and cardiovascular responses underpinning CWI and how they are related to performance benefits. This review also examines how individual characteristics (such as physique traits), differences in water-immersion protocol (depth, duration, temperature), and exercise type (endurance vs maximal) interact with these mechanisms.

The effectiveness of simple psychological and physical activity interventions for high prevalence mental health problems in young people: A factorial randomised controlled trial.

BACKGROUND: The prevalence and burden of disease of depression and anxiety disorders in young people necessitates effective early intervention strategies. The aim of this study was to evaluate the effectiveness of low-intensity interventions (problem solving therapy (PST) and physical activity promotion) in young people (15-25 years) with mild-moderate depression and/or anxiety. METHOD: A 2×2 factorial randomised controlled trial (RCT) with factors of PST versus supportive counselling (control) and behavioural activation physical activity versus lifestyle psychoeducation (control). Help-seeking participants (n=176) were randomised to receive up to 6 manualised intervention sessions. Primary outcomes were post-intervention depressive symptoms (Beck Depression Inventory-II (BDI-II), anxiety symptoms (Beck Anxiety Inventory), and Montgomery-Åsberg Depression Rating Scale (MADRS)). Trial registration ACTRN12608000550303. RESULTS: Depression symptoms were significantly reduced in the physical activity group compared to psychoeducation (BDI-II: d=0.41 (95% CI: 0.07-0.76); MADRS: d=0.48 (95% CI: 0.13-0.82), but not post-intervention anxiety symptoms. PST was not superior to supportive counselling, nor were any interactions between interventions significant. LIMITATIONS: As self reported levels of physical activity did not significantly differ between baseline and end-point in those randomised to the physical activity intervention, it is unclear as to whether some form of physical activity not measured in the trial may have led to the difference in depression symptoms. CONCLUSIONS: PST was not superior to supportive counselling in reducing depression and anxiety symptoms in young people. Participants who received the physical activity intervention reported the greatest reduction in depression symptoms, however further research is required to establish the mechanism of action and to determine its effectiveness as an adjunct intervention in routine clinical practice.

Species tree estimation of diploid Helianthus (Asteraceae) using target enrichment.

PREMISE OF THE STUDY: The sunflower genus Helianthus has long been recognized as economically significant, containing species of agricultural and horticultural importance. Additionally, this genus displays a large range of phenotypic and genetic variation, making Helianthus a useful system for studying evolutionary and ecological processes. Here we present the most robust Helianthus phylogeny to date, laying the foundation for future studies of this genus. METHODS: We used a target enrichment approach across 37 diploid Helianthus species/subspecies with a total of 103 accessions. This technique garnered 170 genes used for both coalescent and concatenation analyses. The resulting phylogeny was additionally used to examine the evolution of life history and growth form across the genus. KEY RESULTS: Coalescent and concatenation approaches were largely congruent, resolving a large annual clade and two large perennial clades. However, several relationships deeper within the phylogeny were more weakly supported and incongruent among analyses including the placement of H. agrestis, H. cusickii, H. gracilentus, H. mollis, and H. occidentalis. CONCLUSIONS: The current phylogeny supports three major clades including a large annual clade, a southeastern perennial clade, and another clade of primarily large-statured perennials. Relationships among taxa are more consistent with early phylogenies of the genus using morphological and crossing data than recent efforts using single genes, which highlight the difficulties of phylogenetic estimation in genera known for reticulate evolution. Additionally, conflict and low support at the base of the perennial clades may suggest a rapid radiation and/or ancient introgression within the genus.

Resolving phylogenetic relationships of the recently radiated carnivorous plant genus Sarracenia using target enrichment.

The North American carnivorous pitcher plant genus Sarracenia (Sarraceniaceae) is a relatively young clade (<3 million years ago) displaying a wide range of morphological diversity in complex trapping structures. This recently radiated group is a promising system to examine the structural evolution and diversification of carnivorous plants; however, little is known regarding evolutionary relationships within the genus. Previous attempts at resolving the phylogeny have been unsuccessful, most likely due to few parsimony-informative sites compounded by incomplete lineage sorting. Here, we applied a target enrichment approach using multiple accessions to assess the relationships of Sarracenia species. This resulted in 199 nuclear genes from 75 accessions covering the putative 8-11 species and 8 subspecies/varieties. In addition, we recovered 42kb of plastome sequence from each accession to estimate a cpDNA-derived phylogeny. Unsurprisingly, the cpDNA had few parsimony-informative sites (0.5%) and provided little information on species relationships. In contrast, use of the targeted nuclear loci in concatenation and coalescent frameworks elucidated many relationships within Sarracenia even with high heterogeneity among gene trees. Results were largely consistent for both concatenation and coalescent approaches. The only major disagreement was with the placement of the purpurea complex. Moreover, results suggest an Appalachian massif biogeographic origin of the genus. Overall, this study highlights the utility of target enrichment using multiple accessions to resolve relationships in recently radiated taxa.

Does hydrotherapy help or hinder adaptation to training in competitive cyclists?

PURPOSE: Cold water immersion (CWI) may be beneficial for acute recovery from exercise, but it may impair long-term performance by attenuating the stimuli responsible for adaptation to training. We compared effects of CWI and passive rest on cycling performance during a simulated cycling grand tour. METHODS: Thirty-four male endurance-trained competitive cyclists were randomized to CWI for four times per week for 15 min at 15°C or control (passive recovery) groups for 7 d of baseline training, 21 d of intensified training, and an 11-d taper. Criteria for completion of training and testing were satisfied by 10 cyclists in the CWI group (maximal aerobic power, 5.13 ± 0.21 W·kg; mean ± SD) and 11 in the control group (5.01 ± 0.41 W·kg). Each week, cyclists completed a high-intensity interval cycling test and two 4-min bouts separated by 30 min. CWI was performed four times per week for 15 min at 15°C. RESULTS: Between baseline and taper, cyclists in the CWI group had an unclear change in overall 4-min power relative to control (2.7% ± 5.7%), although mean power in the second effort relative to the first was likely higher for the CWI group relative to control (3.0% ± 3.8%). The change in 1-s maximum mean sprint power in the CWI group was likely beneficial compared with control (4.4% ± 4.2%). Differences between groups for the 10-min time trial were unclear (-0.4% ± 4.3%). CONCLUSION: Although some effects of CWI on performance were unclear, data from this study do not support recent speculation that CWI is detrimental to performance after increased training load in competitive cyclists.

Genetic differentiation, structure, and a transition zone among populations of the pitcher plant moth Exyra semicrocea: implications for conservation.

Pitcher plant bogs, or carnivorous plant wetlands, have experienced extensive habitat loss and fragmentation throughout the southeastern United States Coastal Plain, resulting in an estimated reduction to <3% of their former range. This situation has lead to increased management attention of these habitats and their carnivorous plant species. However, conservation priorities focus primarily on the plants since little information currently exists on other community members, such as their endemic arthropod biota. Here, we investigated the population structure of one of these, the obligate pitcher plant moth Exyra semicrocea (Lepidoptera: Noctuidae), using mitochondrial cytochrome c oxidase subunit I (COI) gene sequences. Examination of 221 individuals from 11 populations across eight southeastern US states identified 51 unique haplotypes. These haplotypes belonged to one of two divergent (∼1.9-3.0%) lineages separated by the Mississippi alluvial plain. Populations of the West Gulf Coastal Plain exhibited significant genetic structure, contrasting with similarly distanced populations east of the Mississippi alluvial plain. In the eastern portion of the Coastal Plain, an apparent transition zone exists between two regionally distinct population groups, with a well-established genetic discontinuity for other organisms coinciding with this zone. The structure of E. semicrocea appears to have been influenced by patchy pitcher plant bog habitats in the West Gulf Coastal Plain as well as impacts of Pleistocene interglacials on the Apalachicola-Chattahoochee-Flint River Basin. These findings, along with potential extirpation of E. semicrocea at four visited, but isolated, sites highlight the need to consider other endemic or associated community members when managing and restoring pitcher plant bog habitats.

An evaluation of Well Ways, a family education programme for carers of people with a mental illness.

OBJECTIVES: Family education programmes aim to improve the well-being of carers of people with a mental illness. We evaluated the effectiveness of one such programme, Well Ways, in reducing negative care-giving consequences. METHOD: We employed a pre-post design to evaluate the effectiveness of Well Ways in a naturalistic setting using a sample of carers of people with a mental illness. The Involvement Evaluation Questionnaire, a measure of care-giving consequences including worrying, tension, urging and supervision, and incorporating the General Health Questionnaire-12 (GHQ-12), was completed by 459 carers before and after participation in Well Ways. RESULTS: Participants' worrying, tension, urging and distress (GHQ-12) were significantly lower following completion of the programme. These improvements were maintained at 3 and 6 month follow up. Carers of people with a psychotic disorder experienced significantly greater reductions in worrying than did other carers. Females reported significantly greater reductions in tension than did males. CONCLUSIONS: Findings indicated support for the effectiveness of the Well Ways programme in reducing negative care-giving consequences for families of people with a mental illness. Given the evidence of poor psychological health and negatively appraised family relationships observed at baseline, these findings highlight the need for programmes such as Well Ways.