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BackgroundMental ill-health is the leading cause of disability worldwide. Moreover, 75% of mental health conditions emerge between the ages of 12 and 25 years. Unfortunately, due to lack of resources and limited engagement with services, a majority of young people affected by mental ill-health do not access evidence-based support. To address this gap, our team has developed a multimodal, scalable digital mental health service (Enhanced Moderated Online Social Therapy [MOST+]) merging real-time, clinician-delivered web chat counseling; interactive user-directed online therapy; expert and peer moderation; and peer-to-peer social networking. ObjectiveThe primary aim of this study is to ascertain the feasibility, acceptability, and safety of MOST+. The secondary aims are to assess pre-post changes in clinical, psychosocial, and well-being outcomes and to explore the correlations between system use, perceived helpfulness, and secondary outcome variables. MethodsOverall, 157 young people seeking help from a national youth e-mental health service were recruited over 5 weeks. MOST+ was active for 9 weeks. All participants had access to interactive online therapy and integrated web chat counseling. Additional access to peer-to-peer social networking was granted to 73 participants (46.5%) for whom it was deemed safe. The intervention was evaluated via an uncontrolled single-group study. ResultsOverall, 93 participants completed the follow-up assessment. Most participants had moderate (52/157, 33%) to severe (96/157, 61%) mental health conditions. All a priori feasibility, acceptability, and safety criteria were met. Participants provided mean scores of ≥3.5 (out of 5) on ease of use (mean 3.7, SD 1.1), relevancy (mean 3.9, SD 1.0), helpfulness (mean 3.5, SD 0.9), and overall experience (mean 3.9, SD 0.8). Moreover, 98% (91/93) of participants reported a positive experience using MOST+, 82% (70/93) reported that using MOST+ helped them feel better, 86% (76/93) felt more socially connected using it, and 92% (86/93) said they would recommend it to others. No serious adverse events or inappropriate use were detected, and 97% (90/93) of participants reported feeling safe. There were statistically significant improvements in 8 of the 11 secondary outcomes assessed: psychological distress (d=−0.39; P

Rationale & Objective: Planning and delivering treatment pathways that integrate end-of-life care, frailty assessment, and enhanced supportive care is a service priority. Despite this, people with kidney failure are less likely to have an advance care plan and receive hospice and palliative care compared with other chronic illness populations. This is linked to health professionals feeling unskilled initiating conversations around future treatment and care options. This article describes research underpinning the development of a guide for kidney health professionals discussing end-of-life and advance care planning options with people with kidney failure and family members. Study Design: The study comprised 2 parts: an initial cross-sectional qualitative approach using in-depth interviews with older adults with kidney failure and (bereaved) carers followed by resource development with input from multiple stakeholders. Setting & Participants: Older adults with kidney failure and (bereaved) carers recruited from 2 renal units in the North of England and by online advertisements with national United Kingdom-based kidney patient charities. Resource development included input from co-applicants, independent advisory committee, patient and public involvement team, multidisciplinary health professionals and academics in the United Kingdom and Denmark. Analytical Approach: Thematic analysis was used to analyze the data. Results: Twenty-seven people were interviewed: older adults with kidney failure (n = 18), carers (n = 5), bereaved carers (n = 4). Five themes are described: the context within which end-of-life conversations take place, preferences for end-of-life treatment and care, family members’ role and needs in supporting people with kidney failure at the end-of-life, expectations and experience of dialysis treatment, and beliefs and experiences of death and dying. Limitations: Participants were mainly White, British, and receiving hemodialysis. Conclusions: People with (lived) experience of kidney failure informed a guide which aims to build on health professionals existing skills and improve confidence having conversations about future treatment and care. Kidney teams have expressed interest implementing the guide in practice and within their broader communications training packages. Plain-Language Summary: Delivering treatment pathways integrating end-of-life care, frailty assessment, and enhanced supportive care is a service priority. Despite this, people with kidney failure are less likely to have an advance care plan and receive hospice and palliative care compared with other chronic illness populations. This article describes how people with (lived) experience of kidney failure informed a guide to build on health professionals existing skills and improve confidence having conversations about future treatment and care. The study comprised 2 parts: cross-sectional qualitative approach using in-depth interviews with older adults with kidney failure and (bereaved) carers followed by resource development with input from coapplicants, an independent advisory committee, a patient and public involvement team, multidisciplinary health professionals, and academics.

In this article we address the debate on regional skills formation systems in Africa. We draw on the social ecosystems model (SEM) developed by Hodgson and Spours to analyse data from four case studies that reflect the complexities of African economies, rural and urban, formal and informal. The SEM model helps us focus on the three dimensions of a strong skills ecosystem: collaboration between a range of actors, key institutions and system leaders within the region (the horizontal); top-down policies, regulations, and funding streams that enable or constrain the regional skills ecosystem (the vertical); and the points where these two interact, often through mediation activities. In the case of the last of these three, our cases point to the importance of nurturing organisations which can provide SEM leadership, particularly in more fragile ecosystems. Yet, in none of the cases, are public vocational institutions playing the strong anchor role envisaged in the model. The significance of the paper lies in three ways it develops the SEM in relation to regional skills ecosystems. First, we problematise the notion of a facilitatory state and place it within wider national and global webs of power. Second, we insist that the local or regional is always embedded in and networked into myriad national and international levels. This requires a more complex understanding of how social skills ecosystems operate. Third, the notion of an anchor institution requires further elaboration. In most social ecosystems these institutions need to be built or strengthened and a clearer understanding is required of the processes of institutionalisation and what mechanisms make it possible to build this capacity and sustain it over time.

The SDGs mark the clearest global acceptance yet that the previous approach to development was unsustainable. In VET, UNESCO has responded by developing a clear account of how a transformed VET must be part of a transformative approach to development. It argues that credible, comprehensive skills systems can be built that can support individuals, communities, and organisations to generate and maintain enhanced and just livelihood opportunities. However, the major current theoretical approaches to VET are not up to this challenge. In the context of Africa, we seek to address this problem through a presentation of literatures that contribute to the theorisation of this new vision. They agree that the world is not made up of atomised individuals guided by a "hidden hand". Rather, reality is heavily structured within political economies that have emerged out of contestations and compromises in specific historical and geographical spaces. Thus, labour markets and education and training systems have arisen, characterised by inequalities and exclusions. These specific forms profoundly influence individuals' and communities' views about the value of different forms of learning and working. However, they do not fully define what individuals dream, think and do. Rather, a transformed and transformative VET for Africa is possible.

This study investigated how the air-bladder offloading mode of the Orbiter by Kalogon wheelchair cushion (Orbiter) affected blood flow in the gluteal region of non-disabled subjects. The hypothesis was that the cushion's offloading mode would improve blood flow, resulting in reduced reactive hyperemia when compared to the static setting, or Loaded Control (LC). Furthermore, the study proposed a technique using a high-resolution image laser speckle contrast system to measure blood flow in the gluteal area. Two procedures were carried out, one with the participant sitting on a cushion in LC, and the second, the cushion was set to offloading mode. Blood flow was measured through data imaging after each procedure. Three trials were performed, starting and ending in different cushion bladders. Customized algorithms were used to select regions of interest on the images for calculations. The Wilcoxon Signed-Rank Test was conducted to compare the offloads and loaded control values of each region of interest. Results were considered significant at α = 0.05. Ten healthy, non-disabled adults participated in the study, seven females and three males. There were no significant differences among the participants. However, results showed that seven subjects tended to decrease reactive hyperemia in the offload sequence of trial when the last two bladders offloaded were the sacrum followed by the right ischial tuberosity. The high-resolution imager showed that the Orbiter Offloads helped reduce reactive hyperemia in seven subjects, potentially improving blood flow. More research is necessary to comprehend the mechanisms of these effects fully. • The cushion's offload sequence showed less reactive hyperemia than the static mode. • The offloading from the sacrum and right IT showed a lower reactive hyperemia. • The blood flow imager allowed a better understanding of blood flow perfusion in large area. [ABSTRACT FROM AUTHOR]

Objective: The primary objective was to determine the acceptability, feasibility and safety of a novel digital intervention (Entourage) for young people with prominent social anxiety symptoms, with a particular focus on the engagement of young men. The secondary aim was to explore whether the intervention was associated with clinically significant improvements to clinical and social variables known to co-occur with social anxiety. Method: A multidisciplinary team comprising of mental health clinicians, researchers, young adult fiction writers, a comic artist and young people with a lived experience of social anxiety developed the Entourage platform in collaboration. Entourage combines evidence-based therapeutic techniques for social anxiety with an engaging, social-media-based interface that allows users to build social connections, while also receiving expert clinical moderation and support from peer workers. Acceptability, feasibility and safety outcomes of Entourage were tested in a 12-week pilot study with 89 young people (48.3% male; age M = 19.8 years, SD = 3.3 years). Eligible participants were recruited via liaison with four headspace early-intervention centres in north-western Melbourne. Results: 56.8% of the sample reported social anxiety symptoms in the severe or very severe range at baseline. Results demonstrated the Entourage intervention was feasible, safe, and potentially acceptable, with 98.6% of participants reporting they would recommend Entourage to another young person experiencing social anxiety. Usage results were also comparable across male and non-male participants. Results showed that young people reliably and significantly improved on clinical and social variables. In particular, young males showed a clinically significant improvement on social anxiety symptoms (d = 0.79, p

Serum accumulation of the gut microbial metabolite trimethylamine N-oxide (TMAO) is associated with high caloric intake and type 2 diabetes (T2D). Impaired pancreatic β-cell function is a hallmark of diet-induced T2D, which is linked to hyperglycemia and hyperlipidemia. While TMAO production via the gut microbiome-liver axis is well defined, its molecular effects on metabolic tissues are unclear, since studies in various tissues show deleterious and beneficial TMAO effects. We investigated the molecular effects of TMAO on functional β-cell mass. We hypothesized that TMAO may damage functional β-cell mass by inhibiting β-cell viability, survival, proliferation, or function to promote T2D pathogenesis. We treated INS-1 832/13 β-cells and primary rat islets with physiological TMAO concentrations and compared functional β-cell mass under healthy standard cell culture (SCC) and T2D-like glucolipotoxic (GLT) conditions. GLT significantly impeded β-cell mass and function by inducing oxidative and endoplasmic reticulum (ER) stress. TMAO normalized GLT-mediated damage in β-cells and primary islet function. Acute 40µM TMAO recovered insulin production, insulin granule formation, and insulin secretion by upregulating the IRE1α unfolded protein response to GLT-induced ER and oxidative stress. These novel results demonstrate that TMAO protects β-cell function and suggest that TMAO may play a beneficial molecular role in diet-induced T2D conditions.

Major depressive disorder (MDD) has a high prevalence and relapse rate among young people. For many individuals depression exhibits a severe course, and it is therefore critical to invest in innovative online interventions for depression that are cost-effective, acceptable and feasible. At present, there is a scarcity of research reporting on qualitative data regarding the subjective user experience of young people using social networking-based interventions for depression. This study provides in-depth qualitative insights generated from 38 semi-structured interviews, and a follow-up focus group, with young people (15–25 years) after the implementation of a moderated online social therapy intervention for depression relapse prevention (“Rebound”). Exploratory analysis identified patterns of content from interview data related to three main themes: 1) preferred content compared to perceived helpfulness of the online platform, 2) interest in social networking, and 3) protective environment. Two clear groups emerged; those who perceived the social networking component of the intervention as the most helpful component; and those who preferred to engage in therapy content, receiving individualized content suggested by moderators. The Rebound intervention was shown to be acceptable for young people with major depression. Integration of social networking features appears to enhance intervention engagement for some young people recovering from depression.

Abstract For many threatened species the rate and drivers of population decline are difficult to assess accurately: species’ surveys are typically restricted to small geographic areas, are conducted over short time periods, and employ a wide range of survey protocols. We addressed methodological challenges for assessing change in the abundance of an endangered species. We applied novel methods for integrating field and interview survey data for the critically endangered Bornean orangutan (Pongo pygmaeus), allowing a deeper understanding of the species’ persistence through time. Our analysis revealed that Bornean orangutan populations have declined at a rate of 25% over the last 10 years. Survival rates of the species are lowest in areas with intermediate rainfall, where complex interrelations between soil fertility, agricultural productivity, and human settlement patterns influence persistence. These areas also have highest threats from human-wildlife conflict. Survival rates are further positively associated with forest extent, but are lower in areas where surrounding forest has been recently converted to industrial agriculture. Our study highlights the urgency of determining specific management interventions needed in different locations to counter the trend of decline and its associated drivers.

VIX, a ticker symbol for Volatility Index, measures the implied annual volatility of at-the-money SP500 Index Options. Conventional wisdom presumes VIX to measure the magnitude (positive or negative) of possible movements in future equity prices, with movements being a positive function of VIX. This research investigates the nature of the relationship between VIX and SP500 volatility, and answers the question as to whether that relationship is linear or nonlinear. Based on this research paper, the authors conclude that the realized SP500 volatility is nonlinear, and grows with the level of VIX at an increasing rate. The nonlinearity relationship between VIX and SP500 has enormous implications for investment management and hedging in the financial markets.

In the world of finance and portfolio management, “beta” refers to the sensitivity of a security’s return, to the sensitivity of the “market” portfolio and is an indication of the level of systematic risk, i.e., the amount of risk that a company’s equity shares with the entire market. Correct values for beta are crucial for institutional portfolio managers, as the client contract almost always calls for a portfolio beta approximately equal to 1.0. Typically, beta is estimated using Ordinary Least Squares, but OLS is reliant on some very stringent assumptions. Here, betas are computed and compared using OLS and four robust regression algorithms. Minimum sum regression is identified as the superior robust regression algorithm to estimate beta. Keywords: Financial Beta, Ordinary Least Squares, Robust Regression, Portfolio Management. JEL Classification: C21, G11

Background: It is well established that social anxiety disorder (SAD) is a significant clinical problem for individuals with a psychotic disorder. Comorbid social anxiety in individuals with psychosis has been associated with poorer premorbid functioning, increased depression, and a reduced quality of life. Cognitive behavior therapy (CBT) is recommended for people with psychosis as a first-line psychological treatment; however, its focus and evaluation primarily revolves around reducing psychotic symptoms and not necessarily targeting comorbid social anxiety symptoms. We developed a novel online social cognitive behavioral intervention (entitled EMBRACE) specifically designed to treat social anxiety symptoms in first episode psychosis (FEP).Methods: The key clinical and engagement features of the intervention were established through integrating evidence-based material derived from 1) CBT-based treatment models for SAD, 2) relevant literature findings related to psychosis and its clinical correlates (e.g., shame, social rank, and its relationship with social anxiety and paranoia), 3) feedback from youth focus groups in order to inform a user-centered intervention design, and 4) a highly multidisciplinary collaborative development approach to design therapy comics.Results: A detailed description of the final version of the 12-week online social intervention to treat social anxiety in FEP is presented.Conclusion: The EMBRACE intervention was designed to provide young people with the necessary skills and confidence to overcome social anxiety within a supportive, safe online space. By design, it allows young people the opportunity to practice their newly learnt skills to connect with others and in doing so, learn to embrace their true authentic selves.

Field studies have been, and continue to be, important contributors to theunderstanding of great ape cognition-especially with regard to questions of cognitiveecology or the key cognitive challenges in the evolution of primate intelligence. Theyare also critical to resolving a current debate, whether human enculturation boosts greatapes' cognition, because only studies of problem-solving in feral contexts can resolvethe question of whether abilities are higher in enculturated than non-enculturated greatapes. To this debate, this paper offers findings from observational field studies on freerangingrehabilitant orangutans' cognitive capabilities, as revealed in their foodprocessing and arboreal positioning, and on the possible social transmission of thatexpertise. These findings are combined with published findings on wild andenculturated great apes as a basis for assessing the effects of human enculturation ongreat ape cognition. This assessment joins several others in showing that free-ranginggreat apes independently achieve cognition of the same order of complexity asenculturated great apes, in concluding that claims for the effects of human enculturationare likely inflated, and in suggesting that the basis for the effectiveness of humanenculturation is that great apes normally "enculturate" themselves.

Teaching on the philosophies of evaluation as part of a pilot introductory course of a new diploma programme jointly sponsored by the United Nations (UN) Evaluation Group and the United Nations Staff College, the author compared and contrasted the "rationalistic" paradigm with the "naturalistic" paradigm on the basis of ontology, epistemology, and methodology and suggested an alternative "non-Western" paradigm. Course evaluations criticized this concept as insufficiently developed; this article challenges those criticisms. Using the five basic axioms cited by Guba and Lincoln in "Epistemological and Methodological Bases of Naturalistic Inquiry," the author compares and contrasts an Eastern paradigm of evaluation to the rationalistic and naturalistic paradigms, and offers suggestions for methodological practices that one who subscribes to such a paradigm might follow. (Contains 1 table.)

Water isotope-enabled coupled atmosphere–ocean climate models allow for exploration of the relative contributions to coral stable oxygen isotope (δ18Ocoral) variability arising from sea surface temperature (SST) and the isotopic composition of seawater (δ18Osw). The unforced behaviour of the isotope-enabled HadCM3 coupled general circulation model suggests that the extent to which inter-annual δ18Osw variability contributes to that in model δ18Ocoral is strongly spatially dependent, ranging from being negligible in the eastern equatorial Pacific to accounting for 50% of δ18Ocoral variance in parts of the western Pacific. In these latter cases, a significant component of the inter-annual δ18Osw variability is correlated to that in SST, meaning that local calibrations of the effective local δ18Ocoral–SST relationships are likely to be essential. Furthermore, the relationship between δ18Osw and SST can be non-linear, such that the model interpretation of central and western equatorial Pacific δ18Ocoral in the context of a linear dependence on SST alone leads to overestimation (by up to 20%) of the SST anomalies associated with large El Niño events. Intra-model evaluation of a salinity-based pseudo-coral approach shows that such an approach captures the first-order features of the model δ18Osw behaviour. However, the utility of the pseudo-corals is limited by the extent of spatial variability seen within the modelled slopes of the temporal salinity–δ18Osw relationship.

This issue has presented seven previous chapters on international program evaluation standards. Chapter One defined terms and identified major themes. Subsequent chapters examined evaluation standards created in North America, Europe, and Africa; those contemplated in Australasia; and the evaluation standards created by the European Commission and CARE International. This chapter summarizes three broad issues that cut across these other chapters and discusses implications for the continuing development of program evaluation standards in an international context.

Fish ectoparasites are introduced to water bodies or aquaculture systems along with their hosts. Argulid fish lice can survive off-host for a given time, and in spite of quarantine measures might also be introduced via the transfer of water. However, they must cope with varying abiotic conditions without access to food. We investigated the effect of temperature (5 to 28oC) on the off-host survival time of Argulus japonicus, an invasive species which is apparently increasing its distribution, and compared this with the European A. foliaceus. A clear effect of temperature on the off-host survival time of all stages of both species was demonstrated. Larval and juvenile A. japonicus survived up to 9 days at 22oC and in the case of adults up to 13 days at 15oC. By comparison, larval A. foliaceus survived up to 5 days at 15oC, adults up to 14 days at 9oC and juveniles up to 7 days at 9oC and 15oC. Thus, A. japonicus is more resistant to starvation at higher temperatures under controlled off-host conditions and A. foliaceus is more resistant to starvation at lower temperatures. Infectivity of A. japonicus decreased linearly with the time spent off-host after 2 days for larvae and 4 days for adults. Temperature only had a significant effect on the infectivity of both developmental stages after 24 hours off-host between 13–23oC for larvae and 13–18oC for adults. In conclusion both species can potentially survive off-host periods in water transports for up to 13–14 days as adults. Their survival is shorter as larvae. This study demonstrates that transportation of water has the potential to introduce Argulus species [Current Zoology 57 (6): 828–835, 2011].

Describes efforts to build a worldwide evaluation community, noting events that resulted in an almost 200% growth in the number of regional and national evaluation organizations in slightly more than 1 year. Profiles some national and regional evaluation organizations that participated in a recent evaluation meeting and suggests some alternative for the future of international evaluation. (SLD)

Offers a series of reflections on the theoretical bases of language teaching viewed from the perspective of the New Technologies (NT), and proposes a reconfiguration of the pedagogical triangle. In light of the tremendous impact of NT, different ways of treating the four language skills in traditional and virtual environments are considered. (Author/VWL)

Background/importance There is heterogeneity among the outcomes used in regional anesthesia research. Objective We aimed to produce a core outcome set for regional anesthesia research. Methods We conducted a systematic review and Delphi study to develop this core outcome set. A systematic review of the literature from January 2015 to December 2019 was undertaken to generate a long list of potential outcomes to be included in the core outcome set. For each outcome found, the parameters such as the measurement scale, timing and definitions, were compiled. Regional anesthesia experts were then recruited to participate in a three-round electronic modified Delphi process with incremental thresholds to generate a core outcome set. Once the core outcomes were decided, a final Delphi survey and video conference vote was used to reach a consensus on the outcome parameters. Results Two hundred and six papers were generated following the systematic review, producing a long list of 224 unique outcomes. Twenty-one international regional anesthesia experts participated in the study. Ten core outcomes were selected after three Delphi survey rounds with 13 outcome parameters reaching consensus after a final Delphi survey and video conference. Conclusions We present the first core outcome set for regional anesthesia derived by international expert consensus. These are proposed not to limit the outcomes examined in future studies, but rather to serve as a minimum core set. If adopted, this may increase the relevance of outcomes being studied, reduce selective reporting bias and increase the availability and suitability of data for meta-analysis in this area. [ABSTRACT FROM AUTHOR]