Minimising young children's anxiety through schools (MY-CATS): protocol for a cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of an online parent-led intervention compared with usual school practice for young children identified as at risk for anxiety disorders.

BACKGROUND: Identifying and supporting young children who are at risk of developing anxiety disorders would benefit children, families, and wider society. Elevated anxiety symptoms, inhibited temperament, and high parental anxiety are established risk factors for later anxiety disorders, but it remains unclear who is most likely to benefit from prevention and early intervention programmes. Delivering an online intervention through schools to parents of young children who have one or more of these risks could maximise reach. The primary aim of this trial is to evaluate the effectiveness and cost-effectiveness of delivering an online parent-led intervention, compared with usual school provision only, for children (aged 4-7) identified as at risk for anxiety disorders on the basis of at least one risk factor. We also aim to identify the characteristics of children who do and do not benefit from intervention and mechanisms of change from the intervention. METHODS: The design will be a parallel group, superiority cluster randomised controlled trial, with schools (clusters) randomised to intervention or usual school practice arms in a 1:1 ratio stratified according to level of deprivation within the school. The study will recruit and randomise at least 60 primary/infant schools in England, and on the basis of recruiting 60 schools, we will recruit 1080 trial participants (540 per arm). Parents of all children (aged 4-7) in sampled Reception, Year 1, and Year 2 classes will be invited to complete screening questionnaires. Children who screen positive on the basis of anxiety symptoms, and/or behavioural inhibition, and/or parent anxiety symptoms will be eligible for the trial. Parents/carers of children in schools allocated to the intervention arm will be offered a brief online intervention; schools in both arms will continue to provide any usual support for children and parents throughout the trial. Assessments will be completed at screening, baseline (before randomisation), 6 weeks, 12 weeks, and 12 months post-randomisation. The primary outcome will be the absence/presence of an anxiety disorder diagnosis at 12 months. DISCUSSION: The trial will determine if delivering an online intervention for parents of young children at risk of anxiety disorders identified through screening in schools is effective and cost-effective. TRIAL REGISTRATION: ISRCTN 82398107 . Prospectively registered on Jan. 14, 2021.

Avoiding Implementation Failure in Catchment Landscapes: A Case Study in Governance of the Great Barrier Reef.

Water quality outcomes affecting Australia's Great Barrier Reef (GBR) are governed by multi-level and multi-party decision-making that influences forested and agricultural landscapes. With international concern about the GBR's declining ecological health, this paper identifies and focuses on implementation failure (primarily at catchment scale) as a systemic risk within the overall GBR governance system. There has been limited integrated analysis of the full suite of governance subdomains that often envelop defined policies, programs and delivery activities that influence water quality in the GBR. We consider how the implementation of separate purpose-specific policies and programs at catchment scale operate against well-known, robust design concepts for integrated catchment governance. We find design concerns within ten important governance subdomains that operate within GBR catchments. At a whole-of-GBR scale, we find a weak policy focus on strengthening these delivery-oriented subdomains and on effort integration across these subdomains within catchments. These governance problems when combined may contribute to failure in the implementation of major national, state and local government policies focused on improving water quality in the GBR, a lesson relevant to landscapes globally.

Actual availability of appointments at general practices in regional New South Wales, Australia.

BACKGROUND: There is limited data to inform policy about the availability and costs of primary healthcare at the local level. The objective of this article was to determine the appointment availability and out-of-pocket costs for patients presenting with non urgent conditions to general practices in a regional setting. METHODS: A cross-sectional, census study included all 184 general practices across 12 local government areas in northern New South Wales. Practices were telephoned in a randomised sequence on weekday mornings by a researcher. RESULTS: Twenty-two practices were excluded from the study as these were specialised only services; therefore, the sample size was n = 162. The rate of same-day appointment availability was 47.5% (n = 77/162; range: 11-63%), and bulk-billing availability was 21% (range: 0-50%). The mean out-of-pocket cost was $29.98 (range: $12.95-60.30). DISCUSSION: Availability of primary healthcare and bulk billing across northern New South Wales is highly variable. Areas with low service availability should be targeted by policy.

Risk analysis of the governance system affecting outcomes in the Great Barrier Reef.

The state and trend of the Great Barrier Reef's (GBR's) ecological health remains problematic, influencing United Nations Educational, Scientific and Cultural Organization (UNESCO) statements regarding GBR governance. While UNESCO's concerns triggered separate strategic assessments by the Australian and Queensland governments, there has been no independent and integrated review of the key risks within the overall system of governance influencing GBR outcomes. As a case study of international significance, this paper applies Governance Systems Analysis (GSA), a novel analytical framework that identifies the governance themes, domains and subdomains most likely to influence environmental and socio-economic outcomes in complex natural systems. This GBR-focussed application of GSA identifies governance subdomains that present high, medium, or low risk of failure to produce positive outcomes for the Reef. This enabled us to determine that three "whole of system" governance problems could undermine GBR outcomes. First, we stress the integrative importance of the Long Term Sustainability Plan (LTSP) Subdomain. Sponsored by the Australian and Queensland governments, this subdomain concerns the primary institutional arrangements for coordinated GBR planning and delivery, but due to its recent emergence, it faces several internal governance challenges. Second, we find a major risk of implementation failure in the achievement of GBR water quality actions due to a lack of system-wide focus on building strong and stable delivery systems at catchment scale. Finally, we conclude that the LTSP Subdomain currently has too limited a mandate/capacity to influence several high-risk subdomains that have not been, but must be more strongly aligned with Reef management (e.g. the Greenhouse Gas Emission Management Subdomain). Our analysis enables exploration of governance system reforms needed to address environmental trends in the GBR and reflects on the potential application of GSA in other complex land and sea-scapes across the globe.

Environmental hypoxia but not minor shell damage affects scope for growth and body condition in the blue mussel Mytilus edulis (L.).

The effects of short-term (7 d) exposure to environmental hypoxia (2.11 mg O2 L⁻¹; control: 6.96 mg O2 L⁻¹) and varying degrees of shell damage (1 or 2, 1 mm diameter holes; control: no holes) on respiration rate, clearance rate, ammonia excretion rate, scope for growth (SFG) and body condition index were investigated in adult blue mussels (Mytilus edulis). There was a significant hypoxia-related reduction in SFG (>6.70 to 0.92 J g⁻¹ h⁻¹) primarily due to a reduction in energy acquisition as a result of reduced clearance rates during hypoxia. Shell damage had no significant affect on any of the physiological processes measured or the SFG calculated. Body condition was unaffected by hypoxia or shell damage. In conclusion, minor physical damage to mussels had no effect on physiological energetics but environmental hypoxia compromised growth, respiration and energy acquisition presumably by reducing feeding rates.