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Current coverage of mental healthcare in low- and middle-income countries is very limited, not only in terms of access to services but also in terms of financial protection of individuals in need of care and treatment.
To identify the challenges, opportunities and strategies for more equitable and sustainable mental health financing in six sub-Saharan African and South Asian countries, namely Ethiopia, India, Nepal, Nigeria, South Africa and Uganda.
In the context of a mental health systems research project (Emerald), a multi-methods approach was implemented consisting of three steps: a quantitative and narrative assessment of each country's disease burden profile, health system and macro-fiscal situation; in-depth interviews with expert stakeholders; and a policy analysis of sustainable financing options.
Key challenges identified for sustainable mental health financing include the low level of funding accorded to mental health services, widespread inequalities in access and poverty, although opportunities exist in the form of new political interest in mental health and ongoing reforms to national insurance schemes. Inclusion of mental health within planned or nascent national health insurance schemes was identified as a key strategy for moving towards more equitable and sustainable mental health financing in all six countries.
Including mental health in ongoing national health insurance reforms represent the most important strategic opportunity in the six participating countries to secure enhanced service provision and financial protection for individuals and households affected by mental disorders and psychosocial disabilities.
Declaration of interest
D.C. is a staff member of the World Health Organization.
We apply two methods to estimate the 21-cm bispectrum from data taken within the Epoch of Reionisation (EoR) project of the Murchison Widefield Array (MWA). Using data acquired with the Phase II compact array allows a direct bispectrum estimate to be undertaken on the multiple redundantly spaced triangles of antenna tiles, as well as an estimate based on data gridded to the uv-plane. The direct and gridded bispectrum estimators are applied to 21 h of high-band (167–197 MHz; z = 6.2–7.5) data from the 2016 and 2017 observing seasons. Analytic predictions for the bispectrum bias and variance for point-source foregrounds are derived. We compare the output of these approaches, the foreground contribution to the signal, and future prospects for measuring the bispectra with redundant and non-redundant arrays. We find that some triangle configurations yield bispectrum estimates that are consistent with the expected noise level after 10 h, while equilateral configurations are strongly foreground-dominated. Careful choice of triangle configurations may be made to reduce foreground bias that hinders power spectrum estimators, and the 21-cm bispectrum may be accessible in less time than the 21-cm power spectrum for some wave modes, with detections in hundreds of hours.
Field studies were conducted in 2016 and 2017 in Clinton, NC, to determine the interspecific and intraspecific interference of Palmer amaranth (Amaranthus palmeri S. Watson) or large crabgrass [Digitaria sanguinalis (L.) Scop.] in ‘Covington’ sweetpotato [Ipomoea batatas (L.) Lam.]. Amaranthus palmeri and D. sanguinalis were established 1 d after sweetpotato transplanting and maintained season-long at 0, 1, 2, 4, 8 and 0, 1, 2, 4, 16 plants m−1 of row in the presence and absence of sweetpotato, respectively. Predicted yield loss for sweetpotato was 35% to 76% for D. sanguinalis at 1 to 16 plants m−1 of row and 50% to 79% for A. palmeri at 1 to 8 plants m−1 of row. Weed dry biomass per meter of row increased linearly with increasing weed density. Individual dry biomass of A. palmeri and D. sanguinalis was not affected by weed density when grown in the presence of sweetpotato. When grown without sweetpotato, individual weed dry biomass decreased 71% and 62% from 1 to 4 plants m−1 row for A. palmeri and D. sanguinalis, respectively. Individual weed dry biomass was not affected above 4 plants m−1 row to the highest densities of 8 and 16 plants m−1 row for A. palmeri and D. sanguinalis, respectively.
Little is known about the household economic costs associated with mental, neurological and substance use (MNS) disorders in low- and middle-income countries.
To assess the association between MNS disorders and household education, consumption, production, assets and financial coping strategies in Ethiopia, India, Nepal, Nigeria, South Africa and Uganda.
We conducted an exploratory cross-sectional household survey in one district in each country, comparing the economic circumstances of households with an MNS disorder (alcohol-use disorder, depression, epilepsy or psychosis) (n = 2339) and control households (n = 1982).
Despite some heterogeneity between MNS disorder groups and countries, households with a member with an MNS disorder had generally lower levels of adult education; lower housing standards, total household income, effective income and non-health consumption; less asset-based wealth; higher healthcare expenditure; and greater use of deleterious financial coping strategies.
Households living with a member who has an MNS disorder constitute an economically vulnerable group who are susceptible to chronic poverty and intergenerational poverty transmission.
Declaration of interest
D.C. is a staff member of the World Health Organization. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy or views of the World Health Organization.
A non-contacting displacement measuring system utilizing focussed x-rays is being developed for use in hostile environments. Ultimately, this method will be used to measure mechnical strain under adverse conditions such as high temperatures, flame, cutting fluids, and gases with high velocity and pressure gradients. The foundation of the technique is the use of xrays, which are immune to the various environmental factors mentioned above. The proposed system uses a highly focussed, intense x-ray line which is scanned across markers that fluoresce secondary radiation. This secondary radiation level is then monitored using a photon detector and marker-focussed line overlap can be discerned. These targets can be used as fiducial markers demarcating a gage length, and the change in pointing angle of the focussed beam at target overlap is used as a measure of relative displacement. The present experimental systemcan consistently resolve 1.27 microns at ambient conditions, and 2.54 microns have been measured at a target temperature of 1900 de-grees F through an open flame. Given the performance of the current apparatus, equipment improvements should permit increases in resolution by a least a factor of 10 and measurements at much higher temperatures are possible.
The X-ray Analytical Science Group at Curtin university of Technology has been developing and evaluating Rietveld pattern-fitting for materials analysis since 1985. The results are reviewed with particular reference to preferred orientation, crystallinity and phase abundance.
Evidence shows benefits of psychological treatments in low-resource countries, yet few government health systems include psychological services.
Evaluating the clinical value of adding psychological treatments, delivered by community-based counsellors, to primary care-based mental health services for depression and alcohol use disorder (AUD), as recommended by the Mental Health Gap Action Programme (mhGAP).
Two randomised controlled trials, separately for depression and AUD, were carried out. Participants were randomly allocated (1:1) to mental healthcare delivered by mhGAP-trained primary care workers (psychoeducation and psychotropic medicines when indicated), or the same services plus individual psychological treatments (Healthy Activity Program for depression and Counselling for Alcohol Problems). Primary outcomes were symptom severity, measured using the Patient Health Questionnaire – 9 item (PHQ-9) for depression and the Alcohol Use Disorder Identification Test for AUD, and functional impairment, measured using the World Health Organization Disability Assessment Schedule (WHODAS), at 12 months post-enrolment.
Participants with depression in the intervention arm (n = 60) had greater reduction in PHQ-9 and WHODAS scores compared with participants in the control (n = 60) (PHQ-9: M = −5.90, 95% CI −7.55 to −4.25, β = −3.68, 95% CI −5.68 to −1.67, P < 0.001, Cohen's d = 0.66; WHODAS: M = −12.21, 95% CI −19.58 to −4.84, β = −10.74, 95% CI −19.96 to −1.53, P= 0.022, Cohen's d = 0.42). For the AUD trial, no significant effect was found when comparing control (n = 80) and intervention participants (n = 82).
Adding a psychological treatment delivered by community-based counsellors increases treatment effects for depression compared with only mhGAP-based services by primary health workers 12 months post-treatment.
As reported from studies conducted in Nepal, between 15% and 57% of adults had ever consumed alcohol and between 1.5% and 25% of adults have alcohol use disorders (AUD). Few studies in Nepal have identified the correlates of consumption or described the help-seeking patterns and stigma among those affected with AUD.
Interviewers administered the Alcohol Use Disorders Identification Test (AUDIT) as part of population-based surveys of adults in Chitwan District between 2013 and 2017. We conducted a secondary analysis to identify sociodemographic and health-related correlates of recent alcohol consumption using the χ2 test, to identify correlates of total AUDIT scores among men who drink using negative binomial regression, and to describe the treatment-seeking and stigma beliefs of men with AUD.
Over half (53.7%, 95% CI 50.4–57.0) of men (n = 1130) recently consumed alcohol, and there were associations between being a drinker with age, religion, caste, education, occupation and tobacco use. Nearly one in four (23.8%, 95% CI 20.2–27.8%) male drinkers screened positive for AUD, and AUDIT scores were associated with age, caste, marital status, occupation, tobacco use, depression, functional status and suicidal ideation. Few (13.3%, 95% CI 11.7–15.0) women (n = 2352) recently consumed alcohol, and 5.3% (95% CI 3.0–9.1) of female drinkers screened positive for AUD. Among AUDIT-positive men, 38% spoke to another person about their problems and 80% had internalized stigma.
This study revealed that nearly one in four men who drink likely have AUD. Higher AUDIT scores were associated with depression, suicidality, dysfunctionality and internalized stigma.
One-dimensional zinc oxide (ZnO) nanostructure arrays show unique semiconducting, piezoelectric, and wetting properties, and how they interact with cells is critical for their biomedical applications. In this work, we prepare ZnO nanorod arrays (ZnO NRAs) and study their interactions with neonatal rat cardiomyocytes either as a substrate or patch. We find that ZnO NRAs can (1) inhibit cell adhesion and spreading as a substrate and (2) selectively kill underneath cells as a patch. We further identify surface nanomorphology as the dominant factor responsible for the inhibitory effect. These discoveries suggest potential application of ZnO NRAs as a cell inhibitory biointerface.
Excavations at several locations in Verteba Cave have uncovered a large amount of human skeletal remains in association with faunal bones and Tripolye material culture. We aim to establish radiocarbon (14C) dates for eight sites and to evaluate whether these deposits are singular events, or slow accumulations over time. 14C measurements, along with stable carbon and nitrogen isotope data from human and faunal remains, were collected from 18 specimens. Stable isotope values were used to evaluate human and animal diet, and whether freshwater reservoir effects offset measured dates. We found diets of the sampled species had limited to no influence from freshwater resources. Human diet appears to be dominated by terrestrial plants and herbivores. Four new sites were identified as Eneolithic. Comparisons of dates from top and bottom strata for two sites (7 and 20) reveal coeval dates, and we suggest that these deposits represent discrete events rather than slow continuous use. Lastly, we identified dates from the Mesolithic (8490±45 BP, 8765±30 BP), Iron Age (2505±20 BP), Slavic state era (1315±25 BP), and Medieval Period (585±15 BP), demonstrating periodic use of the cave by humans prior to and after the Eneolithic.
Field studies were conducted to determine watermelon tolerance and yield response when treated with bicyclopyrone preplant (PREPLANT), POST, and POST-directed (POST-DIR). Treatments consisted of two rates of bicyclopyrone (37.5 and 50 g ai ha–1), fomesafen (175 g ai ha–1), S-metolachlor (802 g ai ha–1), and a nontreated check. Preplant treatments were applied to formed beds 1 d prior to transplanting and included bicyclopyrone (37.5 and 50 g ha–1) and fomesafen (175 g ha–1), and new polyethylene mulch was subsequently laid above treated beds. POST and POST-DIR treatments were applied 14 ± 1 d after watermelon transplanting and included bicyclopyrone (37.5 and 50 g ha–1) POST and POST-DIR, and S-metolachlor (802 g ai ha–1) POST-DIR. POST-DIR treatments were applied to row middles, ensuring that no herbicide contacted watermelon vines or polyethylene mulch. At 2 wk after transplanting (WAT), 15% foliar bleaching was observed in watermelon treated with bicyclopyrone (50 g ha–1) PRE. At 3 WAT, bicyclopyrone (37.5 and 50 g ha–1) POST caused 16% and 17% foliar bleaching and 8% and 9% crop stunting, respectively. At 4 WAT, initial injury had subsided and bicyclopyrone (37.5 and 50 g ha–1) POST caused 4% and 4% foliar bleaching and 4% and 8% crop stunting, respectively. No symptoms of bleaching or stunting were observed at 6- and 8-WAT ratings. Watermelon total yield, marketable yield, total fruit number, marketable fruit number, and average fruit size were unaffected by herbicide treatments. Therefore, registration of bicyclopyrone (37.5 and 50 g ha–1) PREPLANT, POST, and POST-DIR would offer watermelon producers a safe herbicide option and a novel mode of action for weed management.
The earliest durable cooking technologies found in Alaska are stone bowls and griddle stones recovered from the Aleutian Islands. This article aims to identify the function of these artefacts. Molecular and chemical analyses of carbonised residues found on their surfaces confirm that these artefacts were used to process marine resources. Both artefacts have high lipid content and C:N ratios, suggesting they were used to process oily substances. Stable isotope results of individual lipids suggest that they were used to process different sets of resources within the aquatic spectrum as griddle stones have slightly more 13C-depleted lipids than stone bowls, possibly indicating more variable use. Integration of these results with archaeological and ethnographic data leads us to infer that griddle stones were used for cooking a diversity of aquatic resources, possibly with the addition of plant foods, whereas stone bowls were specifically used to render marine mammal fats. We further hypothesize that a sudden peak in stone bowl frequencies at 4000–3000 cal yr BP was connected to a Neoglacial cold spell bringing sea ice conditions to the Aleutian Islands. This may have led to new subsistence strategies in which the rendering of marine mammal fats played a central role.
BACKGROUND: IGTS is a rare phenomenon of paradoxical germ cell tumor (GCT) growth during or following treatment despite normalization of tumor markers. We sought to evaluate the frequency, clinical characteristics and outcome of IGTS in patients in 21 North-American and Australian institutions. METHODS: Patients with IGTS diagnosed from 2000-2017 were retrospectively evaluated. RESULTS: Out of 739 GCT diagnoses, IGTS was identified in 33 patients (4.5%). IGTS occurred in 9/191 (4.7%) mixed-malignant GCTs, 4/22 (18.2%) immature teratomas (ITs), 3/472 (0.6%) germinomas/germinomas with mature teratoma, and in 17 secreting non-biopsied tumours. Median age at GCT diagnosis was 10.9 years (range 1.8-19.4). Male gender (84%) and pineal location (88%) predominated. Of 27 patients with elevated markers, median serum AFP and Beta-HCG were 70 ng/mL (range 9.2-932) and 44 IU/L (range 4.2-493), respectively. IGTS occurred at a median time of 2 months (range 0.5-32) from diagnosis, during chemotherapy in 85%, radiation in 3%, and after treatment completion in 12%. Surgical resection was attempted in all, leading to gross total resection in 76%. Most patients (79%) resumed GCT chemotherapy/radiation after surgery. At a median follow-up of 5.3 years (range 0.3-12), all but 2 patients are alive (1 succumbed to progressive disease, 1 to malignant transformation of GCT). CONCLUSION: IGTS occurred in less than 5% of patients with GCT and most commonly after initiation of chemotherapy. IGTS was more common in patients with IT-only on biopsy than with mixed-malignant GCT. Surgical resection is a principal treatment modality. Survival outcomes for patients who developed IGTS are favourable.
We detail tentative detections of low-frequency carbon radio recombination lines from within the Orion molecular cloud complex observed at 99–129 MHz. These tentative detections include one alpha transition and one beta transition over three locations and are located within the diffuse regions of dust observed in the infrared at 100 μm, the Hα emission detected in the optical, and the synchrotron radiation observed in the radio. With these observations, we are able to study the radiation mechanism transition from collisionally pumped to radiatively pumped within the H ii regions within the Orion molecular cloud complex.
We determine sufficient criteria for the prime spectrum of an ambiskew polynomial algebra R over an algebraically closed field 𝕂 to be akin to those of two of the principal examples of such an algebra, namely the universal enveloping algebra U(sl2) (in characteristic 0) and its quantization Uq(sl2) (when q is not a root of unity). More precisely, we determine sufficient criteria for the prime spectrum of R to consist of 0, the ideals (z − λ)R for some central element z of R and all λ ∈ 𝕂, and, for some positive integer d and each positive integer m, d height two prime ideals P for which R/P has Goldie rank m.
We present a multi-frequency study of the intermediate spiral SAB(r)bc type galaxy NGC 6744, using available data from the Chandra X-Ray telescope, radio continuum data from the Australia Telescope Compact Array and Murchison Widefield Array, and Wide-field Infrared Survey Explorer infrared observations. We identify 117 X-ray sources and 280 radio sources. Of these, we find nine sources in common between the X-ray and radio catalogues, one of which is a faint central black hole with a bolometric radio luminosity similar to the Milky Way’s central black hole. We classify 5 objects as supernova remnant (SNR) candidates, 2 objects as likely SNRs, 17 as H ii regions, 1 source as an AGN; the remaining 255 radio sources are categorised as background objects and one X-ray source is classified as a foreground star. We find the star-formation rate (SFR) of NGC 6744 to be in the range 2.8–4.7 M⊙~yr − 1 signifying the galaxy is still actively forming stars. The specific SFR of NGC 6744 is greater than that of late-type spirals such as the Milky Way, but considerably less that that of a typical starburst galaxy.
We examine how organizational form affects corporate payouts. Conglomerates pay out more than pure plays in both cash dividends and total payouts (cash dividends plus share repurchases). Furthermore, their payouts are more sensitive to cash flows compared to pure-play firms. The sensitivity of payouts to cash flow increases as the cross-segment correlation in a conglomerate decreases. Corporate payouts increase after mergers and acquisitions (M&As), especially among M&As in which acquirers and targets are less correlated. These results suggest that the coinsurance among different divisions of a conglomerate allows them to pay out more cash flow to their shareholders than pure-play firms.