The diagnostic validity and reliability of an internet-based clinical assessment program for mental disorders

BACKGROUND: Internet-based assessment has the potential to assist with the diagnosis of mental health disorders and overcome the barriers associated with traditional services (eg, cost, stigma, distance). Further to existing online screening programs available, there is an opportunity to deliver more comprehensive and accurate diagnostic tools to supplement the assessment and treatment of mental health disorders. OBJECTIVE: The aim was to evaluate the diagnostic criterion validity and test-retest reliability of the electronic Psychological Assessment System (e-PASS), an online, self-report, multidisorder, clinical assessment and referral system. METHODS: Participants were 616 adults residing in Australia, recruited online, and representing prospective e-PASS users. Following e-PASS completion, 158 participants underwent a telephone-administered structured clinical interview and 39 participants repeated the e-PASS within 25 days of initial completion. RESULTS: With structured clinical interview results serving as the gold standard, diagnostic agreement with the e-PASS varied considerably from fair (eg, generalized anxiety disorder: κ=.37) to strong (eg, panic disorder: κ=.62). Although the e-PASS' sensitivity also varied (0.43-0.86) the specificity was generally high (0.68-1.00). The e-PASS sensitivity generally improved when reducing the e-PASS threshold to a subclinical result. Test-retest reliability ranged from moderate (eg, specific phobia: κ=.54) to substantial (eg, bulimia nervosa: κ=.87). CONCLUSIONS: The e-PASS produces reliable diagnostic results and performs generally well in excluding mental disorders, although at the expense of sensitivity. For screening purposes, the e-PASS subclinical result generally appears better than a clinical result as a diagnostic indicator. Further development and evaluation is needed to support the use of online diagnostic assessment programs for mental disorders. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG).

Enhancing the health of medical students : outcomes of an integrated mindfulness and lifestyle program

Medical students experience various stresses and many poor health behaviours. Previous studies consistently show that student wellbeing is at its lowest pre-exam. Little core-curriculum is traditionally dedicated to providing self-care skills for medical students. This paper describes the development, implementation and outcomes of the Health Enhancement Program (HEP) at Monash University. It comprises mindfulness and ESSENCE lifestyle programs, is experientially-based, and integrates with biomedical sciences, clinical skills and assessment. This study measured the program&rsquo;s impact on medical student psychological distress and quality of life. A cohort study performed on the 2006 first-year intake measured effects of the HEP on various markers of wellbeing. Instruments used were the depression, anxiety and hostility subscales of the Symptom Checklist-90-R incorporating the Global Severity Index (GSI) and the WHO Quality of Life (WHOQOL) questionnaire. Pre-course data (T1) was gathered mid-semester and post-course data (T2) corresponded with pre-exam week. To examine differences between T1 and T2 repeated measures ANOVA was used for the GSI and two separate repeated measures MANOVAs were used to examine changes in the subscales of the SCL-90-R and the WHOQOL-BREF. Follow-up t-tests were conducted to examine differences between individual subscales. A total of 148 of an eligible 270 students returned data at T1 and T2 giving a response rate of 55%. 90.5% of students reported personally applying the mindfulness practices. Improved student wellbeing was noted on all measures and reached statistical significance for the depression (mean T1 = 0.91, T2 = 0.78; p = 0.01) and hostility (0.62, 0.49; 0.03) subscales and the GSI (0.73, 0.64; 0.02) of the SCL-90, but not the anxiety subscale (0.62, 0.54; 0.11). Statistically significant results were also found for the psychological domain (62.42, 65.62; p < 0.001) but not the physical domain (69.11, 70.90; p = 0.07) of the WHOQOL. This study is the first to demonstrate an overall improvement in medical student wellbeing during the pre-exam period suggesting that the common decline in wellbeing is avoidable. Although the findings of this study indicate the potential for improving student wellbeing at the same time as meeting important learning objectives, the limitations in study design due to the current duration of follow-up and lack of a control group means that the data should be interpreted with caution. Future research should be directed at determining the contribution of individual program components, long-term outcomes, and impacts on future attitudes and clinical practice.

Development and assessment of an incremental fatigue protocol for contemporary dance

Nine trained contemporary dancers performed a modality-specific, heart-rate-monitored, choreographed fatiguing dance protocol with an assumption of fatigue at volitional exhaustion (RPE 16). Postural stability was assessed as the variability of ground reaction forces and the centre of pressure during the performance of a flat-foot arabesque. Psychological response was assessed using self-reported fatigue, psychological distress (PD), and psychological well-being (PWB) (Subjective Exercise Experience Scale). After reaching RPE 16 in 15.7 ± 2.6 mins, heart rate decreased to the post-warm-up level within 64 ± 9 sec. Variability of ground reaction forces or the centre of pressure was not changed. There were no significant changes in fatigue, psychological distress, or psychological well-being. Within fatigue, there was a significant increase in the item tired (p = 0.04). As supported by the heart rate data and RPE, the protocol achieved an appropriate level of physical demand. No changes in the stability indices were observed, possibly attributed to the rapid recovery in heart rate. The expression of only tiredness suggests the use of a disassociative attentional style by the dancers. The project represents pilot work toward the validation of a monitoring process that supports dancer health and awareness training.

Good practice guidelines for curriculum, supervision and assessment of final year engineering projects and AQF8 learning outcomes

Undergraduate engineering programs require final year students to complete capstone final year projects and demonstrate that they can integrate knowledge, skills and professional graduate attributes developed during the program at Australian Qualification Framework, level 8 (AQF8) outcomes. Literature shows that currently there is no guarantee of consistency for curriculum, supervision and assessment practices of FYEPs. Practices differ greatly between universities and littlework has been initiated that seeks to identify good practice, highlighting the need for the development of guidelines for curriculum, supervision and assessment of FYEPs. This workshop is designed to share and disseminate the good practice guidelines that have been developed on curriculum, supervision and assessment of Final Year Engineering Projects as a part of phase 2 of the project ‘Assessing Final Year Engineering Projects (FYEPs): Ensuring Learning and Teaching Standards and AQF8 Outcomes’ funded by the Australian Office for Learning and Teaching (OLT) with people working in the area of FYEPs. The guidelines typically apply to four year undergraduate engineering degrees with embedded Honours and support achievement of AQF8learning outcomes. The project team has 7 partner Universities – Central Queensland University (the lead), University of Technology Sydney, University of Adelaide, Curtin University, Deakin University, University of Tasmania and RMIT University.Participants will be invited to reflect on and evaluate guidelines and findings derived from FYEP coordinators, supervisors and the wider literature and to consider the ways in which these findings might lead to improvements in their practice.

Monitoring and incentives of executives in risky firms : a test of the association with firm performance

This study investigates the relationship between a firm's risk and the effectiveness of the firm's corporate governance practices. Previous research investigating the relationship between corporate controls and firm performance has been mixed and often weak. Therefore, this study sets out to determine the efficiency of monitoring and incentive contracts given certain characteristics of the firm. That is, the study sets out to determine whether risk firms with higher monitoring and levels of incentives are associated with higher firm performance.
The results of this study of 282 firms demonstrate how the relationship between firm risk and performance is associated with the monitoring and incentive contracts used by these firms. In particular, the results of this study showed that the negative association between risk and firm performance is weakened when firms have stronger monitoring and incentive mechanisms. The particular contribution of this study is to show that the role of corporate governance variables infirm performance should be evaluated in the context of the firm's risk.

Two approaches to workplace flexible delivery and assessment in a rural community

The implementation of forms of flexible delivery and workplace training and assessment in rural areas presents particular difficulties for providers and employers alike. This article discusses some of the outcomes of a case-study research and professional development project undertaken in north-west Victoria. It describes the development and implementation of two different approaches to flexible delivery in the areas of engineering and office administration at Sunraysia Institute of TAFE. These two separate developments reversed the decline in the departments' fortunes and proved to be successful from the perspective of the staff who developed the courses, and the clients-employers and especially the students. The implications of these approaches in terms of catering for the learning preferences and contexts of the students are discussed.

Investment opportunities and leverage: some Australian evidence on the role of board monitoring and director equity ownership

This paper tests the hypothesis that the negative relationship between investment opportunity set (IOS) and debt is moderated by board monitoring and director equity ownership. According to contracting theory, firms with high growth opportunities (high IOS) are associated with lower levels of debt as a result of the asset substitution and the under-investment problem. However, our hypotheses test the conjecture that the negative debt / IOS relationship will be moderated by the proportion of non-executive directors (NEDs) on the board and director equity ownership. NEDs provide higher monitoring which reduces management discretion while director equity ownership provides incentives for managers to maximize the value of the firm. More specifically, we expect that high growth firms with a higher proportion of non-executive directors and director equity ownership are less likely to be associated with asset substitution and under investment. Thus, the negative investment opportunity set / debt relationship will be weaker for firms with higher levels of non-executive directors and high director equity ownership. Data collected from Australian companies support both these two hypotheses. Results have significant implications for corporate finance theory.

Detection of Arabidopsis thaliana AtRAD1 cDNA variants and assessment of function by expression in a yeast rad1 mutant

The Saccharomyces cerevisiae RAD1 and human XPF genes encode a subunit of a nucleotide excision repair endonuclease that also is implicated in some forms of homologous recombination. An Arabidopsis thaliana gene (AtRAD1) encoding the orthologous plant protein has been identified recently. Here we report the isolation of three structurally distinct AtRAD1 cDNAs from A. thaliana leaf tissue RNA. One of the isolates (AtRAD1-1) corresponds to the cDNA previously shown to encode the full-length AtRad1 protein, whereas the other two (AtRAD1-2, AtRAD1-3) differ slightly in size due to variations at the 5′ end of exon 6 or the 3′ end of exon 7, respectively. The sequence differences argue that these cDNAs were probably templated by mRNAs generated via alternative splicing. Diagnostic polymerase chain reaction pointed to the presence of the AtRAD1-1 and AtRAD1-2 but not AtRAD1-3 transcripts in bud and root tissue, and to a fourth transcript (AtRAD1-4), having both alterations identified in AtRAD1-2 and AtRAD1-3, in root tissue. However, the low frequency of detection of AtRAD1-3 and AtRAD1-4 makes the significance of these tissue-specific patterns unclear. The predicted AtRad1-2, AtRad1-3 and AtRad1-4 proteins lack part of the region likely required for endonuclease complex formation. Expression of AtRAD1-2 and AtRAD1-3 in a yeast rad1 mutant did not complement the sensitivity to ultraviolet radiation or the recombination defect associated with the rad1 mutation. These results suggest that alternative splicing may modulate the levels of functional AtRad1 protein.

Contrasting the ironic monitoring and motivational explanations of postsuppressional rebound

Suppressing a thought often results in postsuppressional rebound, that is, a subsequent increase in the incidence of the suppressed thought. The present study was dcsigned to distinguish between two explanations of rebound: Wegner's 1994 ironic monitoring theory and Liberman and Forster's 2000 motivational account. Participants (99 Deakin University students) first suppressed, then expressed, thoughts of a white bear. In some conditions, a delay--presented as occurring either intentionally or unintentionally--between suppression and expression was introduced. In other conditions, participants concurrently completed a memory task and were encouraged to antribute the difficulty of suppression either to this task or to the requirement of suppression. An intentional delay, but not an unintentional delay, reduced rebound, while attributing difficulty to the suppression requirement was associated with greater rebound than was attributing it to the memory task. The results are interpreted as supporting Liberman and Forster's motivational account of rebound.

Rural youth education and support program: the Casterton experience

Young people's lives have been directly and indirectly affected by the dynamics of decline in rural Australia. In early 1999, the Casterton region experienced the suicides of two young people. These events led to the funding of a rural youth education and support program at the town's secondary college. The program adopts a multi-layered approach to reduce risk factors and strengthen the protective factors amongst students at the college through the enhancement of social connectedness, personal safety and freedom, and educational participation. The program provides interventions at the individual, school and community levels through case management, the delivery of group programs and opportunities for community participation. This approach recognises the importance of early intervention and a holistic approach to health and well-being in the student population. This paper provides an overview and preliminary evaluation of the program undertaken in 2002.