Phase 1 pilot study of e-mail support for people with long term conditions using the Internet

BACKGROUND: Use of the Internet for people with Long Term Conditions (LTCs) can have a positive effect on knowledge, social support, behavioural and clinical outcomes, yet there is concern that a \u27digital divide\u27 prevents some patients from benefitting. While some patients do not have access to the Internet, others that do may still lack expertise or the confidence to make full use of it. The aim of this pilot study was to develop an intervention and test methods for a definitive randomised controlled trial (RCT) of anonymous personal online email support for patients in this latter group. METHODS: Recruitment success was evaluated by the number and appropriateness of participants recruited. A personalised e-health support intervention was developed. The provisional primary outcome was the extent to which the Internet affected the participants\u27 confidence in dealing with their LTC. Primary outcome, seven process measures and two secondary outcomes measures were evaluated for completeness of data and sensitivity to detect changes. RESULTS: Thirty nine participants were recruited, 29 after personally receiving a leaflet, seven via email advertising, and three via leaflets left in waiting areas. Most participants (61%) were aged over 60. The majority (21/38) rated themselves as experienced Internet users although only 5/38 had used discussion forums for their LTC. Piloting the intervention identified support needed as: (i) technical help with some websites, (ii) advice about issues such as anonymity, (iii) help in judging information quality, (iv) identification of relevant information (via \u27Information Prescriptions\u27), (v) motivational support to try new sites. Attrition was fairly high: 20/39 completed follow up questionnaires. Three process measures showed ceiling effects and two had too many missing values to be useable. CONCLUSION: E-health support is a promising way of addressing the problems faced by older generation e-health seekers. Face-to-face leaflet distribution recruited sufficient numbers but additional locations other than hospital should be tried to recruit Internet novices with LTCs. An RCT is feasible and necessary to evaluate the potential benefits of anonymous email support. Our methods could be used by other researchers studying Internet use by people with LTCs

Chapter 19: Vulnerability of coastal and estuarine habitats in the Great Barrier Reef to climate change

This chapter attempts to address the vulnerability of the CEM in the Great Barrier Reef region to global climate change. It does not consider individual habitats (eg reefs or seagrasses) but goes beyond the individual species and habitat assessments, to consider impacts on the whole coastal marine community complex, and the ecological processes that support its functioning.This is Chapter 19 of Climate change and the Great Barrier Reef: a vulnerability assessment. The entire book can be found at http://hdl.handle.net/11017/13

Disrupting Sleep: The Effects of Sleep Loss on Psychotic Experiences Tested in an Experimental Study With Mediation Analysis

Our view is that insomnia may be a causal factor in the occurrence of psychotic experiences such as paranoia and hallucinations. However, the causal relationship is not established. The aim of the study was to investigate the causal role of insomnia in psychotic experiences via a sleep restriction manipulation. The study was a within-subjects crossover design that included a planned mediation analysis. Sixty-eight nonclinical volunteers underwent a sleep loss condition (restricted to 4 h sleep for 3 nights) and a control condition (standard sleep) in randomized order in 2 consecutive weeks, with a weekend washout period. Psychotic experiences (paranoia, hallucinations, grandiosity, and cognitive disorganization) and candidate mediating variables (negative affect and related processes, working memory, decision making, and perceptual processing) were assessed before and after each condition. Actigraphy verified an average sleep duration of 5 h 15 min in the sleep loss condition, vs 6 h 58 min in the control condition. After the sleep loss condition, relative to the control condition, participants reported significant increases in paranoia, hallucinations, and cognitive disorganization, with no significant changes in grandiosity. The sleep loss condition was also associated with significant increases in negative affect, negative self and other cognitions, worry, and working memory impairment. Mediation analyses indicated that changes in psychotic experiences were mediated by changes in negative affect and related processes, but not memory impairment. The overall conclusion is that insomnia has a causal role in the occurrence of certain psychotic experiences, and that a key route is via negative affect

Collaborative learning about e-health for mental health professionals and service users in a structured anonymous online short course: pilot study.

BACKGROUND: Professionals are interested in using e-health but implementation of new methods is slow. Barriers to implementation include the need for training and limited awareness or experience. Research may not always convince mental health professionals (MHPs). Adding the 'voice' of mental health service users (MHSUs) in collaborative learning may help. Involving MHSUs in face-face education can be difficult. We had previously been unable to engage MHPs in online discussion with MHSUs. Here we assessed the feasibility of short online courses involving MHSUs and MHPs. METHODS: We ran three e-health courses, comprising live interactive webcast, week's access to a discussion forum, and final live interactive webcast. We recruited MHPs via posters, newsletters, and telephone from a local NHS trust, and online via mailing lists and personal contacts from NHS trusts and higher education. We recruited MHSUs via a previous project and an independent user involvement service. Participants were presented with research evidence about e-health and asked to discuss topics using professional and lived experience. Feasibility was assessed through recruitment and attrition, participation, and researcher workloads. Outcomes of self-esteem and general self-efficacy (MHSUs), and Internet self-efficacy and confidence (MHPs) were piloted. RESULTS: Online recruiting was effective. We lost 15/41 from registration to follow-up but only 5/31 that participated in the course failed to complete follow-up. Nineteen MHPs and 12 MHSUs took part and engaged with each other in online discussion. Feedback was positive; three-quarters of MHPs indicated future plans to use the Internet for practice, and 80% of MHSUs felt the course should be continued. Running three courses for 31 participants took between 200 to 250 hours. Before and after outcome measures were completed by 26/31 that participated. MHP Internet self-efficacy and general Internet confidence, MHSU self-esteem and general self-efficacy, all seemed reliable and seemed to show some increase. CONCLUSIONS: Collaborative learning between MHSUs and MHPs in a structured online anonymous environment over a one-week course is feasible, may be more practical and less costly than face-face methods, and is worthy of further study

Can interventions that aim to decrease Lyme disease hazard at non-domestic sites be effective without negatively affecting ecosystem health? A systematic review protocol

Background Lyme disease (LD) is the most commonly reported, broadly distributed vector-borne disease of the northern temperate zone. It is transmitted by ticks and, if untreated, can cause skin, cardiac, nervous system and musculoskeletal disease. The distribution and incidence of LD is increasing across much of North America and Western Europe. Interventions to decrease exposure to LD hazard by encouraging behavioural change have low acceptance in high risk groups, and a safe, effective human LD vaccine is not presently available. As a result, habitat level interventions to decrease LD hazard itself (i.e. levels of infected ticks) have been proposed. However, some interventions may potentially negatively affect ecosystem health, and consequentially be neither desirable, nor politically feasible. This systematic review will catalogue interventions that aim to reduce LD hazard at non-domestic sites, and examine the evidence supporting those which are unlikely to negatively affect ecosystem health. Methods The review will be carried out in two steps. First, a screening and cataloguing stage will be conducted to identify and characterise interventions to decrease LD hazard at non-domestic sites. Secondly, the subset of interventions identified during cataloguing as unlikely to negatively affect ecosystem health will be investigated. In the screening and cataloguing step literature will be collected through database searching using pre-chosen search strings, hand-searching key journals and reviewing the websites of public health bodies. Further references will be identified by contacting stakeholders and researchers. Article screening and assessment of the likely effects of interventions on ecosystem health will be carried out independently by two reviewers. A third reviewer will be consulted if disagreements arise. The cataloguing step results will be presented in tables. Study quality will then be assessed independently by two reviewers, using adapted versions of established tools developed in healthcare research. These results will be presented in a narrative synthesis alongside tables. Though a full meta-analysis is not expected to be possible, if sub-groups of studies are sufficiently similar to compare, a partial meta-analysis will be carried out

Habitat-dependent outdoor recreation and conservation organizations can enable recreational fishers to contribute to conservation of coastal marine ecosystems

Stakeholder engagement is essential to conserve ecosystems and associated biodiversity. Outdoor recreation specialists represent stakeholder groups that often rely on specific healthy ecosystems and have unique incentives to contribute to conservation and stewardship. We introduce the concept of habitat-dependent outdoor recreation conservation organizations (HDORCOs) and their potential to harness outdoor recreation enthusiasm to achieve ecosystem-scale conservation objectives. We identify potential roles for HDORCOs in nurturing pro-environmental attitudes and facilitating stewardship behavior among recreationists, focusing on examples from recreational fishing specialists and coastal marine ecosystems. While HDORCOs have achieved conservation outcomes in a range of settings, transferability across recreational specializations and ecological, cultural, socioeconomic, and governance contexts could remain challenging and potentially requires further development of the HDORCO concept. Communication with HDORCOs is one strategy to enhance engagement of recreationists, stakeholder groups not traditionally associated with pro-environmental behavior, in ecosystem-scale conservation efforts

A case-control study of the possible association between oral contraceptives and malignant melanoma.

In a case-control study, we investigated 169 women aged 15-49 years with malignant melanoma notified to the Oxford and South Western cancer registries during the years 1971-1976, together with 507 matched controls. Data about medical, reproductive, drug and smoking histories were obtained both by reviewing general practitioner (GP) records and from the women themselves by postal questionnaires. There was no significant evidence of any overall increase in the risk of melanoma in oral contraceptive (OC) users (data from GP records-ever use vs never use, relative risk (RR) 1.34, 95% confidence limits 0.92-1.96; corresponding data from postal questionnaires-RR 1.13, limits 0.73-1.75). However, although not significant, the risk estimated from data in the postal questionnaires was higher in women who had used OCs for 5 years or more (use greater than or equal to 5 years vs never use, RR 1.57, limits 0.83-3.03). Previously demonstrated risk factors for melanoma, such as fair skin, blond or red hair and Celtic origin were found to be commoner in the cases than in the controls. Data from the Oxford/Family Planning Association contraceptive study were also examined. Unexpectedly there was a strong suggestion of a negative association between OC use and melanoma risk, but the analysis was based on only 12 women with the disease

Environmental flow requirements of estuaries: providing resilience to current and future climate and direct anthropogenic changes

Estuaries host unique biodiversity and deliver a range of ecosystem services at the interface between catchment and the ocean. They are also among the most degraded ecosystems on Earth. Freshwater flow regimes drive ecological processes contributing to their biodiversity and economic value, but have been modified extensively in many systems by upstream water use. Knowledge of freshwater flow requirements for estuaries (environmental flows or E-flows) lags behind that of rivers and their floodplains. Generalising estuarine E-flows is further complicated by responses that appear to be specific to each system. Here we critically review the E-flow requirements of estuaries to 1) identify the key ecosystem processes (hydrodynamics, salinity regulation, sediment dynamics, nutrient cycling and trophic transfer, and connectivity) modulated by freshwater flow regimes, 2) identify key drivers (rainfall, runoff, temperature, sea level rise and direct anthropogenic) that generate changes to the magnitude, quality and timing of flows, and 3) propose mitigation strategies (e.g., modification of dam operations and habitat restoration) to buffer against the risks of altered freshwater flows and build resilience to direct and indirect anthropogenic disturbances. These strategies support re-establishment of the natural characteristics of freshwater flow regimes which are foundational to healthy estuarine ecosystems

Automatic sorting of Dwarf Minke Whale underwater images

Abstract: Apredictableaggregationofdwarfminkewhales(Balaenopteraacutorostratasubspecies) occurs annually in the Australian waters of the northern Great Barrier Reef in June–July, which has been the subject of a long-term photo-identification study. Researchers from the Minke Whale Project (MWP) at James Cook University collect large volumes of underwater digital imagery each season (e.g., 1.8TB in 2018), much of which is contributed by citizen scientists. Manual processing and analysis of this quantity of data had become infeasible, and Convolutional Neural Networks (CNNs) offered a potential solution. Our study sought to design and train a CNN that could detect whales from video footage in complex near-surface underwater surroundings and differentiate the whales from people, boats and recreational gear. We modified known classification CNNs to localise whales in video frames and digital still images. The required high classification accuracy was achieved by discovering an effective negative-labelling training technique. This resulted in a less than 1% false-positive classification rate and below 0.1% false-negative rate. The final operation-version CNN-pipeline processed all videos (with the interval of 10 frames) in approximately four days (running on two GPUs) delivering 1.95 million sorted images

Synthesis of current knowledge of the biophysical impacts of dredging and disposal on the Great Barrier Reef: report of an Independent Panel of Experts

[Extract] This report provides an independent synthesis of the current knowledge of the effects of dredging and sediment disposal on the physico-chemical environment and the biological values of the Great Barrier Reef World Heritage Area (World Heritage Area), as assessed by an Expert Panel. Dredging and sediment disposal can change the physical and chemical environment and affect the biological values of the World Heritage Area. Many of these effects will be context dependent and will differ between locations, types and extent of dredging and sediment disposal activities. The Expert Panel's evaluation identified the following key direct and indirect effects