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BACKGROUND With many digital (mental) health interventions (DHI) failing to engage clients for enough time to demonstrate substantive changes to their wellbeing and with only 2% of all digital solutions on App Stores having undergone randomised controlled trials, the rising demand for mental health prevention and early intervention care is not being met. Young adults in particular struggle to find digital wellbeing apps that suit their needs. OBJECTIVE The present study explored the effects of eQuoo—an evidence-based mental health game which teaches psychological skills through gamification—on resilience, depression, anxiety, and attrition in student population. METHODS In total, 1,166 student participants from 180 universities in the United Kingdom participated a 5-week, three-armed randomised controlled trial. The three groups consisted of eQuoo, a treatment as usual evidence-based cognitive behavioural health app called Sanvello, and a no-intervention waitlist. The Rugged Resilience Scale, the GAD7, and the PHQ8 were administered to all participants at baseline and going forward every 7 days until completion. RESULTS A repeated measures analysis of variance (ANOVA) revealed statistically significant increases in resilience in the test group compared with both control groups over 5 weeks. The app also significantly decreased anxiety and depression. With 65% adherence, eQuoo retained 42% more participants than the control groups. CONCLUSIONS eQuoo shows that gamifying prevention and early digital health interventions are effective, scalable, and low-cost solutions for the support of young adults that is available on all leading mobile platforms. Meeting the client where they currently were had a powerful positive impact on the viability of a promising platform. CLINICALTRIAL German Clinical Trials Register (DRKS) Number: DRKS00027638

Aerosol deposition (AD) is a thick-film deposition process that can produce films tens to hundreds of micrometers thick with densities greater than 95% of the bulk at room temperature. However, the precise mechanisms of bonding and densification are still under debate. To better understand and predict deposition, a self-consistent approach is employed that combines computational fluid dynamics (CFD), finite element (FE) modeling, and experimental observation of particle impact to improve the understanding of particle flight, impact, and adhesion in the AD process. First, deposition is performed with a trial material to form a film. The process parameters are fed into a CFD model that refines the particle flow and impact velocity for a range of sizes. These values are in turn used to inform the FE parameters to model the fracture and adhesion of the particle on the substrate. The results of FE modeling are compared to SEM images of fractured particles to complete a self-consistent numerical and experimental understanding of the AD process. Additional FE and CFD simulations are used to study how process parameters, materials, and particle parameters affect the deposition process and how the developed tools can be used to optimize deposition efficiency.

In the wake of the 2016 referendum, the idea that ‘imperial nostalgia’ motivated the Leave vote became a staple of academic commentary. Yet such claims suffer from four important flaws. They are us...

Remimazolam (RMZ) is a new and ultra‐fast‐acting, short‐duration intravenous benzodiazepine, a drug class associated with abuse potential. This trial was designed to compare the abuse potential of remimazolam with placebo and midazolam (MDZ), a well‐characterized member of the same pharmacological class in healthy, recreational drug users 18‐55 years‐of‐age, who demonstrated good drug tolerance and were able to discriminate between midazolam and placebo. At equipotent intravenous doses selected to produce effects ranging from mild/moderate to relatively strong sedation without loss of consciousness (RMZ: 5, 10 mg versus MDZ: 2.5, 5 mg), peak scores (Emax or Emin, respectively) for drug liking, good/bad/any effects, and sedation (drowsiness and relaxation) were significantly greater than placebo for both active drugs and were broadly comparable between RMZ and MDZ. In contrast, areas under the effect‐time curves (TA_AUE) were notably lower for RMZ versus MDZ, particularly for measures of good and any effects, reflecting the shorter duration of action and consistent with the more rapid observed plasma clearance for RMZ versus MDZ and the lack of an active RMZ metabolite. Scores for willingness to take drug again were also lower for RMZ versus MDZ, but not significantly so. We concluded that the abuse potential of RMZ is comparable to or lower than that of MDZ, a drug known to have a low potential for intravenous abuse.

Alternative Payment Models (APMs) piloted by the Centers for Medicare and Medicaid Services (CMS) such as ACO Realizing Equity, Access and Community Health (REACH) seek to improve care and quality of life among seriously ill populations (SIP). Days at Home (DAH) was proposed for use in this model to evaluate organizational performance. It is important to assess the utility and feasibility of person-centered outcomes measures, such as DAH, as CMS seeks to advance care models for seriously ill beneficiaries. We leverage existing Accountable Care Organization (ACO) contracts to evaluate the feasibility of ACO-level DAH measure and examine characteristics associated with ACOs with more DAH.We calculated DAH for Medicare fee-for-service beneficiaries aged 68 and over who were retrospectively attributed to a Medicare ACO between 2014 and 2018 and met the seriously ill criteria. We then aggregated to the ACO level DAH for each ACO's seriously ill beneficiaries and risk-adjusted this aggregated measure. Finally, we evaluated associations between risk-adjusted DAH per person-year and ACO, beneficiary, and market characteristics.ACOs' seriously ill beneficiaries spent an average of 349.3 risk-adjusted DAH per person-year. Risk-adjusted ACO variation, defined as the interquartile range, was 4.21 days (IQR = 347.32-351.53). Beneficiaries of ACOs are composed of a less racially diverse beneficiary cohort, opting for two-sided risk models, and operating in markets with fewer hospital and Skilled Nursing Facility beds had more DAH.Substantial variation across ACOs in the DAH measure for seriously ill beneficiaries suggests the measure can differentiate between high and low performing provider groups. Key to the success of the metric is accurate risk adjustment to ensure providers have adequate resources to care for seriously ill beneficiaries. Organizational factors, such as the ACO size and level of risk, are strongly associated with more days at home.

Temperate coastal marine waters are often thermally stratified from spring through fall but can be dynamic and disrupted by tidal currents and wind-driven upwelling. These mixing events introduce deeper, cooler water with a higher partial pressure of CO2 (pCO2), and its associated microbial communities to the surface. Anecdotally, these events impact shellfish hatcheries and farms, warranting improved understanding of changes in composition and activity of marine microbial communities in relation to environmental processes. To characterize both compositional and functional changes associated with abiotic factors, here we generate a reference metatranscriptome from the Strait of Georgia over representative seasons and analyze metatranscriptomic profiles of the microorganisms present within intake water containing different pCO2 levels at a shellfish hatchery in British Columbia from June through October. Abiotic factors studied include pH, temperature, alkalinity, aragonite, calcite and pCO2. Community composition changes were observed to occur at broad taxonomic levels, and most notably to vary with temperature and pCO2. Functional gene expression profiles indicated a strong difference between early (June-July) and late summer (August-October) associated with viral activity. The taxonomic data suggests this could be due to the termination of cyanobacteria and phytoplankton blooms by viral lysis in the late season. Functional analysis indicated fewer differentially expressed transcripts associated with abiotic variables (e.g., pCO2) than with the temporal effect. Microbial composition and activity in these waters varies with both short-term effects observed alongside abiotic variation as well as long-term effects observed across seasons. The analysis of both taxonomy and functional gene expression simultaneously in the same samples by environmental RNA (eRNA metatranscriptomics) provided a more comprehensive view for monitoring water bodies than either would in isolation.

Looking back on the Edwardian suffrage campaign, the militant suffragette Annie Kenney thought it ‘more like a religious revival than a political movement’. Its language and iconography were steeped in Christian imagery, yet the religious arguments for enfranchisement have rarely received close attention. This article shows how campaigners grappled with patriarchal readings of Genesis, St Paul and the traditions of the Church to construct a Christian case for equality. It focuses, in particular, on the Church League for Women’s Suffrage, an Anglican organisation boasting nearly 6,000 members by 1914. Inspired by the incarnational theology of Charles Gore, the League recruited over 500 clergy and eight bishops, convinced that enfranchisement was not merely compatible with, but actively demanded by, the teaching of Christ. Activists preached sermons, wrote pamphlets and debated theology in the religious press, establishing a powerful theological case for reform. Using the League as a case-study, the article explores the wider relationship between gender ideology and religious thought, at a time when Christianity was the central referent of British culture. Interrogating the religious roots of ‘militancy’, it shows how the conception of suffragism as a spiritual struggle collapsed any easy distinction between ‘religion’ and ‘politics’, establishing prayer, worship and Biblical exegesis as weapons of political warfare. The churches, it is concluded, did not simply respond to changing ideas about sex and gender; they were themselves sites of new thinking about the roles of men and women, forming one of the many tributaries that fed the flood-tide of feminist thought.

Over the ‘long’ 19th century, British politics underwent a quiet revolution: a revolution, not in its governing institutions, but in the ideas that underpinned them. In little more than a century, the idea of ‘democracy’—once a term of abuse, from which even radical politicians sought to disassociate themselves—established itself as the civic religion of British politics: the one authority against which there could be no court of appeal. Like other religions, democracy spawned a variety of sects and denominations, each of which sought to defend it against false democratic creeds: ranging from ‘social democracy’ and ‘industrial democracy’ to ‘Tory democracy’, ‘the property-owning democracy’, and ‘the democracy of the market’. The result, paradoxically, was to establish democracy both as the universal principle of British politics and as its central battlefield: an idea to which all paid tribute, but which seemed permanently under siege. This article explores the peculiar voyage of British democratic thought over the 19th and 20th centuries, focusing on its usage as an instrument of political warfare. The first section charts its emergence as the most potent challenge to the dominant narratives of the early-19th century: Whig constitutionalism and ‘reform’. A second section then charts the absorption of democracy into the core narratives of British political thought, while exploring the very different ends to which its authority could be put. A final section identifies three narrative battlegrounds for democracy in the 19th century, opening up fault lines that continue to structure British politics in the present.

Effective communication of safety information for visitors to national parks and other protected areas is essential, particularly where the potential consequences of incidents are severe. Signs are often the primary communication tool for safety messages in national parks. Compliance-based approaches to safety signs using standards drawn from occupational safety are common, though empirical research into the effectiveness of safety signs in national parks and protected areas generally remains limited. To encourage a more pro-active approach to visitor safety, this paper offers an alternative by proposing and field-testing best practice principles (BPPs) for safety signs in parks. It first presents a literature review of safety sign research that, together with consideration of the current policy and practice of leading protected area management agencies, underpinned the development of three sets of BPPs for communicating safety messages. The set of BPPs that focused on safety signs in national parks were then field-tested in two Australian states. The results point to the theoretical as well as the practical value of best practice principles. In particular, they help reveal why and how particular signs are effective at communicating safety messages. From a management perspective, the BPPs offer a holistic yet contextually-adaptable approach to benchmarking and evaluation. The three sets of BPPs also draw attention to the importance of both a coordinated interpretation and communication approach and an overarching risk management framework in which the use of safety signage is embedded. Management implications ● The paper presents best practice principles for safety signage and communication for managing visitor risk in protected areas. In addition the following aspects should be considered to enhance the effectiveness of warning concepts: ● Insights into the target audience including the respective awareness of risks and cultural differences in the various countries of origin. ● Familiarity with and perception of possible risks within different visitor segments. ● Familiarity with the presented communication means (illustrations, language, colors). ● Information prior to the stay to avoid inappropriate expectations and increase the awareness of possible risks.

The central goal of this chapter is to present an outline of the plan and current status of an effort to connect Additive Manufacturing (AM) process parameters with parameters describing the functional performance of produced parts. The term “functional performance” here represents primarily mechanical or thermal or electrochemical performance. The described effort represents an overview of the main research activities within a new multi-year grand-challenge project initiated at the US Naval Research Laboratory (US-NRL) in late 2016, in collaboration with groups from various academic institutions.

Accountable care organizations (ACOs) need confidence in their return on investment to implement changes in care delivery that prioritize seriously ill and high-cost Medicare beneficiaries. The objective of this study was to characterize spending on seriously ill beneficiaries in ACOs with Medicare Shared Savings Program (MSSP) contracts and the association of spending with ACO shared savings. The population included Medicare fee-for-service beneficiaries identified with serious illness (N = 2,109,573) using the Medicare Master Beneficiary Summary File for 100% of ACO-attributed beneficiaries linked to MSSP beneficiary files (2014-2016). Lower spending for seriously ill Medicare beneficiaries and risk-bearing contracts in ACOs were associated with achieving ACO shared savings in the MSSP. For most ACOs, the seriously ill contribute approximately half of the spending and constitute 8%-13% of the attributed population. Patient and geographic (county) factors explained $2,329 of the observed difference in per beneficiary per year spending on seriously ill beneficiaries between high- and low-spending ACOs. The remaining $12,536 may indicate variation as a result of potentially modifiable factors. Consequently, if 10% of attributed beneficiaries were seriously ill, an ACO that moved from the worst to the best quartile of per capita serious illness spending could realize a reduction of $1,200 per beneficiary per year for the ACO population overall. Though the prevalence and case mix of seriously ill populations vary across ACOs, this association suggests that care provided for seriously ill patients is an important consideration for ACOs to achieve MSSP shared savings.

Polycrystalline solids can exhibit material properties that differ significantly from those of equivalent single-crystal samples, in part, because of a spontaneous redistribution of mobile point defects into so-called space-charge regions adjacent to grain boundaries. The general analytical form of these space-charge regions is known only in the dilute limit, where defect-defect correlations can be neglected. Using kinetic Monte Carlo simulations of a three-dimensional Coulomb lattice gas, we show that grain-boundary space-charge regions in non-dilute solid electrolytes exhibit overscreening -- damped oscillatory space-charge profiles -- and underscreening -- decay lengths that are longer than the corresponding Debye length and that increase with increasing defect-defect interaction strength. Overscreening and underscreening are known phenomena in concentrated liquid electrolytes, and the observation of functionally analogous behaviour in solid electrolyte space-charge regions suggests that the same underlying physics drives behaviour in both classes of systems. We therefore expect theoretical approaches developed to study non-dilute liquid electrolytes to be equally applicable to future studies of solid electrolytes.

Television – as a form of representation, a space of affect, and an instrument of identity production – is a growing force in shaping perceptions of and views on international immigration. While geographers have examined the ways in which films, documentaries, and social media engage with the so-called ‘migrant crisis’ in Europe, there has been little work on fictional TV series as a force in world-building and place-making against the spectre of ‘unchecked migration’. Building on recent research on televisual interventions into the issues of migration, (b)orders, and securitisation, this article interrogates HBO Europe’s Norwegian-language sf series Beforeigners. With a focus on fantastical constructions of spatiality against temporality, the primary focus of this article is on the ways in which near-future science fiction engages with ontological insecurities around integration, xenophobia, and territorial belonging. This is accomplished by engaging the ‘temporal turn’ in cultural geography, which is increasingly focused on linking time, space, and migrant lives/bodies. Recognising TV series’ contributions to cultural, social, and political transformations that are of geographical significance, this essay seeks to expand and complicate scholarship on the suasive power of migrant representation on the small screen.

The present work reports on the results of tension tests conducted on 316L stainless steel specimens extracted out of thin-walled boxes produced by powder jet additive manufacturing. The specimens were minimally processed to study the potential effects of the manufacturing process on the apparent mechanical properties rather than identifying the properties of the resulting bulk material. Statistical analysis is performed and presented in an attempt to identify correlations between the manufacturing parameters and the apparent mechanical properties. The mechanical properties of interest are Young’s modulus, the yield stress (measured at the 0.2% level), the ultimate stress, and the failure strain.

This article explores enablers and inhibitors of emotional engagement between visitors and Tasmanian devils at Healesville Sanctuary, Australia. A qualitative research approach was utilized includi...

Purpose Remimazolam is a novel and ultra-short-acting sedative currently developed for intravenous use in procedural sedation, general anesthesia, and ICU sedation. However, intravenous administration is not always appropriate, depending on the patient or setting. This study evaluated intranasal administration as a potential alternative route. Methods The study used a randomized, double-blind, 9 period cross-over design to compare the pharmacokinetics, pharmacodynamics, and safety of single intranasal doses of 10, 20, and 40 mg remimazolam (as powder or solution) with intranasal placebo and 4 mg intravenous remimazolam. Results Intranasal remimazolam powder had a consistent absolute bioavailability of approximately 50%; Tmax was 10 min; AUC and Cmax were dose-proportional. The higher doses of intranasal solution, however, resulted in decreasing bioavailability and loss of dose-proportionality in AUC and Cmax despite complete drug absorption due to partial swallowing of dose and the resulting first-pass effect. Pharmacodynamics were generally consistent with PK. Peak effects (drowsiness, relaxation, any, memory, response time) were in similar ranges after intranasal (10 to 40 mg) as intravenous (4 mg) dosing and were partially, but not consistently, dose-related. Safety results were generally consistent with other benzodiazepines; however, intranasal remimazolam (but not placebo) caused nasal discomfort/pain, in some cases even severe. Conclusions Intranasal administration of remimazolam was safe and caused sedative effects. However, the severe pain and discomfort caused by intranasal remimazolam prohibit its use by this route of administration, at least with the currently available intravenous formulation.

Traumatic brain injury analysis in humans is exceedingly difficult due to the intrusive methods by which data can be collected; thus, many researchers commonly implement animal surrogates. However, ethical concerns and cost limit the scope of these tests on animal subjects too. Computational models, which provide an alternative method to data collection, are not constrained by these concerns and are able to generate significant amounts of data in relatively short time. This paper shows how the data generated from models of a human and pig head can be used towards developing interspecies correspondence rules for blast overpressure effects. The blast overpressure is simulated using an explosive of known weight and standoff distance and injury is evaluated using criteria in published literature. Results indicate that equivalent blasts in the human and pig produce significantly different injuries, and when equating total injured brain volume, the locations of injury in the brain vary between the species. Charge weight and total injured brain volume are related using a linear regression of the data such that a known injury in the pig or known blast can be used to predict injury or the blast experienced by a human, thus creating a correspondence between the species.

Shape memory alloy actuators deliver high forces while being compact and reliable, making them ideal for consideration in aerospace applications. Induction heating of shape memory alloy actuators, specifically tubes that twist about the longitudinal axis, has recently been studied experimentally and computationally using finite element analysis. Reduced-order models for the torsional behavior of shape memory alloy tubes and induction heating of general metallic tubes exist, and thus, it is possible for these thermal and mechanical models to be combined and numerically solved. This work develops and implements an engineering model for inductively heated shape memory alloy tubes based on the reduction of the governing partial differential equations in space and time to an ordinary differential equation in time. An example solution is compared to finite element analysis results and agrees well. Finally, the ordinary differential equation is linearized and solved analytically. The linearized model agrees well with the nonlinear ordinary differential equation and finite element model.

Introduction to an special issue (guest edited by me) called "Shooting Niagara - and After? The Second Reform Act and its World"

Assessing combat helmet ballistic performance is a costly endeavor using either an experimental or a computational process. Experimental assessment requires many iterations and helmets to acquire a sufficient data set. To circumvent this, computational simulation is incorporated into the design process to supplement a few experiments. However, due to the complex constitutive response of the helmet (anisotropic elasticity, plasticity, damage initiation and evolution, and failure), it is computationally costly to run many ballistic impact simulations. The goal of this work is to develop a computer-aided design (cad) software to rapidly analyze combat helmets undergoing a ballistic impact. The software considers a representative mix of potential threats, helmet geometry modifications and additions, brain functional anatomy, and injury considerations. The resulting software demonstrates that a given helmet can be analyzed in a matter of minutes on a standard desktop computer and parametric studies can be completed in a matter of hours. The results of the cad software show how helmet design parameters such as helmet shell materials, geometry, and ceramic appliques all affect helmet ballistic performance.