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Integrating mental health care into HIV services is critical to addressing the high unmet treatment needs for people living with HIV and comorbid major depressive disorder. Introducing routine mental health screening at the primary health care level is a much needed diagonal approach to enhancing HIV care. In low-resource settings with a shortage of mental health care providers, eMental Health may provide a novel opportunity to attenuate this treatment gap and strengthen the health system.
To conduct formative health systems research on the implementation of routine depression screening using a digital tool – Mood in Retroviral Positive Individuals Application Monitoring (MIR + IAM) – in an HIV primary care setting in South Africa.
A Theory of Change (ToC) approach was utilised through individual and group session interviews to design an intervention that is embedded in the local context. Ten experts and local stakeholders were selected from the UK and South Africa. Data were analysed thematically using Atlas.ti to identify interventions, assumptions, barriers and facilitators of implementation.
The participants considered digital depression screening in HIV care services relevant for the improvement of mental health in this population. The six main themes identified from the ToC process were: (1) user experience including acceptability by patients, issues of patient privacy and digital literacy, and the need for a patient-centred tool; (2) benefits of the digital tool for data collection and health promotion; (3) availability of treatment after diagnosis; (4) human and physical resource capacity of primary health care; (5) training for lay health care workers; and (6) demonstration of the intervention's usefulness to generate interest from decision-makers.
Digital depression screening coupled with routine mental health data collection and analysis in HIV care is an applicable service that could improve the mental and physical health outcomes of this population. Careful consideration of the local health system capacity, including both workers and patients, is required. Future research to refine this intervention should focus on service users, government stakeholders and funders.
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.
The in situ and in vitro techniques have been adopted to estimate the degradability of organic matter (OM) in the rumen on the basis that this provides an estimate of ATP for microbial protein synthesis. However this assumption may be incorrect since ATP production requires the fermentation of degraded carbohydrate and Beever (1993) has shown that some degraded hexose can be used synthetically without ATP production. In addition, degraded OM from protein is likely to produce less ATP than the same amount of degraded carbohydrate. The gas production (GP) technique measures end products of fermentation and may be a better guide to ATP production. On the assumption that the in situ and in vitro techniques provide satisfactory estimation of OM degradability, the work discussed here used the GP technique to estimate the effective unfermentable OM fraction of the degraded OM (EUFDOM) for a range of concentrate foods.
Several published reports on the nutritive value of whole-crop wheat (WCW) have been based on estimations from laboratory techniques, some of which were developed for grass silage. However, there is little information on the accuracy of such estimations. Therefore the aim of this study was to evaluate the suitability of predicting the in vivo digestibility of WCW from various less animal-dependent techniques.
Menke et al. (1979), Beuvink et al. (1992) and Theodorou et al. (1994) developed techniques for measuring the time course of gas production of foods fermented in vitro with rumen fluid. These techniques require description of the fermentation profile with an appropriate mathematical model. Although several authors have used these techniques to study the ruminal fermentation of foods, little information is available on the suitability of the model chosen for describing the fermentation profile of the food under study. In this study, the models of Ørskov and McDonald (1979), France et al. (1993) and Beuvink and Kogut (1993) were fitted to the in vitro gas production profiles of 10 whole-crop wheat (WCW) forages (cv. Slepjner) to determine the model most suited to describing the data.
It is widely accepted that robust and accurate in vitro techniques are required to predict the proportion of food nitrogen (N) degraded in the rumen. One such technique is to estimate the solubility of food N. In these experiments, relationships between solvent soluble N and in situ rumen degradability of forage N were investigated.
Samples of 11 fresh grasses (FG) (mainly perennial ryegrass) and their corresponding silages (GS) were used. GS was prepared from material ensiled in laboratory scale silos for 90 days. Prior to the experiments, FG and GS samples were initially hand chopped to approximately 1 cm lengths. In the in situ study a fresh sample equivalent to 0-5 g DM was weighed into polyester bags (pore size 43 μ 200 X 90 mm internal diameter). Duplicate bags for each of FG or GS were incubated in the rumen of three wethers for 0, 3, 8, 16, 24, 45 and 72 h. The incubated residues including the 0 h samples were washed in a washing machine and freeze-dried for 48 h. Rumen degradability characteristics and effective degradability (ED, at rumen outflow rate of 0.08 per h) of N were calculated using the exponential model of Ørskov and McDonald (1979). In vitro solubility of N (S) was determined by incubating for 1 h (at room temperature) the fresh sample (0.5 g on dry matter basis) in each of the four solvents: Borate phosphate buffer (BFB), Durand's buffer (DB), clarified rumen fluid (CRF) and distilled water within a balanced three way factorial design (three operators; four solvents; 11 forages; Deaville et al., 1997). Residues from S were filtered under vacuum and the filter paper plus residue were oven dried for 18 h at 100°C. All samples and residues were analysed for total N using Kjeldahl method (Ministry of Agriculture, Fisheries and Food, 1986). Factorial analysis on the general linear model (Minitab®, 1994) was used in the analysis of variance(ANOVA) for in vitro data and regression analyses of in situ and in vitro data were performed (Minitab®, 1994). Only the regression results are reported here.
At maintenance at least, the whole tract digestibility of several foods in sheep and cattle is similar, consequently much of the information on the nutritive value of dairy cow foods in food composition tables is derived from studies conducted in sheep. However, Adesogan (1996) reported that in whole-crop wheat (WCW), starch digestibility is higher in sheep than in dairy cows. This study examined the validity of using sheep to model the ruminal degradation of WCW in cows by comparing the degradability of dry matter (DM) and nitrogen (N) of urea-treated WCW in both species.
Winter wheat (cv. Hussar) was harvested at 540 g DM per kg and conserved following urea application at target rates of 20 or 40g/kg DM (WCW2 and WCW4 respectively). The degradability of the forages was examined in dairy cows given 6 kg dairy concentrate and grass silage ad libitum and in wethers given 2.4 kg/day of grass silage supplemented with 0.36kg/day of rolled, mineralized barley.
Fat content is one of the main factors affecting the degradability and fermentability characteristics of oil-rich foods estimated by means of the in situ, in vitro and gas production techniques. Filtered fat, considered degraded/fermented, is of limited value to the rumen microbes and may inhibit fermentation. Pre-extraction of oil may be one way to solve this problem. The rumen organic matter degradability (OMD) and fermentability (FOM) of concentrate foods were evaluated in this study with and without oil extraction.
Ruminant feeding standards in Brazil are generally based on systems developed for temperate regions and there is a serious lack of information on grazed tropical pasture which is the main feedstuff. Signal grass (Brachiaria decumbens) represents half of the total cultivated pastures in Brazil (Miles et al., 1996). This study investigated the intake and digestibility by sheep of signal grass hay cut after re-growths of 28 and 56 days to represent the range used in practice in the Brazilian savanna. Lucerne hay was included as a positive control. The hays were offered at two levels of intake to Santa Ines wether sheep.
Production from smallholder owned goats in the semi-arid tropics is constrained by dry season feed shortages. Kid mortality is high and low growth rate of kids weaned at the onset of the dry season delays slaughtering of males and breeding in females. Supplementation with purchased feed is unaffordable so only locally available, probably non-conventional feeds can be considered. In Southern Zimbabwe, the typical natural vegetation in communal grazing areas consists of annual and perennial grasses and trees and shrubs, many of which are Acacia species. In this project tree fruits, from Acacia and other available species were evaluated as dry season protein supplements for goats.
After prolonged exposure to tanniniferous diets, it has been reported that some rumen microorganisms acquire defensive mechanisms against tannins (Brooker et al., 2000) or produce tannin-degrading enzymes. Such rumen microorganisms are said to be “tannin resistant” as their fermentation activity is less inhibited by the presence of tannins in the host’s diet. As acacia pods contain tannins their use as protein supplements for goats in the dry season may require that they be first detannified e.g. by using polyethylene glycol (PEG). However, goats with prior exposure to tanniniferous diets may have developed adaptive mechanisms to deal with tannins. This study, therefore, investigated the need for tannin inactivation in feeds given to ‘adapted’ animals by comparing the effect on the in vitro fermentation of tree pods incubated with and without PEG using rumen fluid from adapted and unadapted goats.
The use of small ruminants, such as sheep, in metabolism studies is more convenient as handling problems are reduced and their maintenance costs are lower, in comparison with cattle. However in vivo digestibility estimates obtained at maintenance are known to differ between these two species. With the increased use of in vitro gas production techniques, to evaluate ruminant feedingstuffs, it is of great importance to identify whether the species from which the rumen fluid inoculum is obtained has a significant influence on the results obtained.
Rumen fluid samples were obtained from a non-lactating Holstein cow (C) and six wether sheep (S) offered the same diet (80 % tropical grass and 20 % dairy concentrate) and prepared so as to have similar dry matter (DM) contents and therefore potentially the microbial mass. Nine substrates (two tropical grasses 1-2, tropical alfalfa 3, barley straw 4, and five temperate grasses 5-9) were examined.
Improvements in management (including health care, preventative strategies and housing design) are one way to decrease the incidence of diseases. However, susceptibility to diseases is heritable and there is interest in selection for disease resitance. Genetic parameters of diseases, such as mastitis and lameness, are required so that these traits can be included in selection programmes. Phenotypes for mastitis and lameness are not expressed on a continuous scale and Gianola (1982) suggested that threshold models are more suitable for such binary traits. Whilst threshold models have been reported as appropriate for the analysis of binary traits they demand more time and greater computing power (Kadarmideen et al., 2000). The objectives of the current analyses were to estimate heritability and repeatability of mastitis and lameness where these traits were treated as binary traits, and to compare the estimates to those obtained in analyses that assumed the traits were continuous (i.e. that ignored the fact that they were “all or nothing” traits).
The use of faecal inoculum in in vitro feed evaluation methods was examined by Balfe (1985). However, there is limited information concerning the chemical composition of faeces and factors affecting this. The chemical composition of faeces may reflect the microbial population and hence its fermentative activity. A knowledge of the faecal composition is essential as this affects the quality of faecal inoculum. The objective of this work was therefore to study the relationships between diet and the chemical composition of faeces using data obtained from sheep.
This paper reviews some of the research that has been carried out at the University of Liverpool where the Flight Science and Technology Research Group has developed its Heliflight-R full-motion research simulator to create a simulation environment for the launch and recovery of maritime helicopters to ships. HELIFLIGHT-R has been used to conduct flight trials to produce simulated Ship-Helicopter Operating Limits (SHOLs). This virtual engineering approach has led to a much greater understanding of how the dynamic interface between the ship and the helicopter contributes to the pilot's workload and the aircraft's handling qualities and will inform the conduct of future real-world SHOL trials. The paper also describes how modelling and simulation has been applied to the design of a ship's superstructure to improve the aerodynamic flow field in which the helicopter has to operate. The superstructure aerodynamics also affects the placement of the ship's anemometers and the dispersion of the ship's hot exhaust gases, both of which affect the operational envelope of the helicopter, and both of which can be investigated through simulation.
Depression and obesity are highly prevalent, and major impacts on public health frequently co-occur. Recently, we reported that having depression moderates the effect of the FTO gene, suggesting its implication in the association between depression and obesity.
To confirm these findings by investigating the FTO polymorphism rs9939609 in new cohorts, and subsequently in a meta-analysis.
The sample consists of 6902 individuals with depression and 6799 controls from three replication cohorts and two original discovery cohorts. Linear regression models were performed to test for association between rs9939609 and body mass index (BMI), and for the interaction between rs9939609 and depression status for an effect on BMI. Fixed and random effects meta-analyses were performed using METASOFT.
In the replication cohorts, we observed a significant interaction between FTO, BMI and depression with fixed effects meta-analysis (β=0.12, P = 2.7 × 10−4) and with the Han/Eskin random effects method (P = 1.4 × 10−7) but not with traditional random effects (β = 0.1, P = 0.35). When combined with the discovery cohorts, random effects meta-analysis also supports the interaction (β = 0.12, P = 0.027) being highly significant based on the Han/Eskin model (P = 6.9 × 10−8). On average, carriers of the risk allele who have depression have a 2.2% higher BMI for each risk allele, over and above the main effect of FTO.
This meta-analysis provides additional support for a significant interaction between FTO, depression and BMI, indicating that depression increases the effect of FTO on BMI. The findings provide a useful starting point in understanding the biological mechanism involved in the association between obesity and depression.
The brain has a high metabolic rate and its metabolism is almost entirely restricted to oxidative utilisation of glucose. These factors emphasise the extreme dependence of neural tissue on a stable and adequate supply of glucose. Whereas initially it was thought that only glucose deprivation (i.e. under hypoglycaemic conditions) can affect brain function, it has become apparent that low-level fluctuations in central availability can affect neural and consequently, cognitive performance. In the present paper the impact of diet-based glycaemic response and glucose regulation on cognitive processes across the lifespan will be reviewed. The data suggest that although an acute rise in blood glucose levels has some short-term improvements of cognitive function, a more stable blood glucose profile, which avoids greater peaks and troughs in circulating glucose is associated with better cognitive function and a lower risk of cognitive impairments in the longer term. Therefore, a habitual diet that secures optimal glucose delivery to the brain in the fed and fasting states should be most advantageous for the maintenance of cognitive function. Although the evidence to date is promising, it is insufficient to allow firm and evidence-based nutritional recommendations. The rise in obesity, diabetes and metabolic syndrome in recent years highlights the need for targeted dietary and lifestyle strategies to promote healthy lifestyle and brain function across the lifespan and for future generations. Consequently, there is an urgent need for hypothesis-driven, randomised controlled trials that evaluate the role of different glycaemic manipulations on cognition.
Avalanche tarns are a particular morphological form of avalanche impact and sixteen of these features are described from the Fiordland region of New Zealand. Average area of the tarns is 11000 m2. Profiles are given for eight of the avalanche paths where such tarns occur. All are found at the base of very steep avalanche tracks (slopes 38–59°), where there are no fans, so that there is an abrupt change of slope with the valley floor. The plunging avalanches which cause the tarns may have a mass of up to 300000 tonnes and impact pressures of more than 600 kN/m2, although no direct measurements are available.