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Psychological interventions that are brief, acceptable, effective and can be delivered by non-specialists are especially necessary in low- and middle-income countries, where mental health systems are unable to address the high level of psychosocial needs. Problem Management Plus (PM+) is a five-session intervention designed for those impaired by psychological distress while living in communities affected by adversity. Individual PM+ has demonstrated effectiveness in reducing distress in Kenya and Pakistan, and a group version of PM+ (Group PM+) was effective for conflict-affected women in Pakistan. This paper describes a feasibility and acceptability trial of locally adapted Group PM+ for women and men in an earthquake-affected region of rural Nepal.
In this feasibility cluster randomised controlled trial, participants in the experimental arm were offered five sessions of Group PM+ and participants in the control arm received enhanced usual care (EUC), which entailed brief psycho-education and providing referral options to primary care services with health workers trained in the mental health Gap Action Programme Intervention Guide (mhGAP-IG). A mixed-methods design was used to assess the feasibility and acceptability of Group PM+. Feasibility was assessed with criteria including fidelity and retention of participants. Acceptability was assessed through in-depth interviews with participants, family members, programme staff and other stakeholders. The primary clinical outcome was depression symptoms assessed using the Patient Health Questionnaire (PHQ-9) administered at baseline and 8–8.5 weeks post-baseline (i.e. after completion of Group PM+ or EUC).
We recruited 121 participants (83% women and 17% men), with equal allocation to the Group PM+ and EUC arms (1:1). Group PM+ was delivered over five 2.5–3 hour sessions by trained and supervised gender-matched local non-specialists, with an average attendance of four out of five sessions. The quantitative and qualitative results demonstrated feasibility and acceptability for non-specialists to deliver Group PM+. Though the study was not powered to assess for effectiveness, for all five key outcome measures, including the primary clinical outcome, the estimated mean improvement was larger in the Group PM+ arm than the EUC arm.
The intervention and trial procedures were acceptable to participants, family members, and programme staff. The communities and participants found the intervention to be beneficial. Because feasibility and acceptability were established in this trial, a fully powered randomised controlled trial will be conducted for larger scale implementation to determine the effectiveness of the intervention in Nepal.
The endocannabinoid system (ECS), modulated by metabolites of linoleic acid (LA), is important in regulating cardiovascular function. In pregnancy, LA is vital for foetal development. We investigated the effects of elevated LA in H9c2 cardiomyoblasts in vitro and of a high linoleic acid (HLA, 6.21%) or low linoleic acid (LLA, 1.44%) diet during pregnancy in maternal and offspring hearts. H9c2 cell viability was reduced following LA exposure at concentrations between 300 and 1000 µM. HLA diet decreased cannabinoid receptor type 2 (CB2) mRNA expression in foetal hearts from both sexes. However, HLA diet increased CB2 expression in maternal hearts. The mRNA expression of fatty acid amide hydrolase (FAAH) in foetal hearts was higher in females than in males irrespective of diet and N-acyl phosphatidylethanolamine-specific phospholipase D (NAPE-PLD) mRNA expression showed an interaction between diet and sex. Data indicate that a high LA diet alters cell viability and CB2 expression, potentially influencing cardiac function during pregnancy and development of the offspring’s heart.
Viral pneumonia is an important cause of death and morbidity among infants worldwide. Transmission of non-influenza respiratory viruses in households can inform preventative interventions and has not been well-characterised in South Asia. From April 2011 to April 2012, household members of pregnant women enrolled in a randomised trial of influenza vaccine in rural Nepal were surveyed weekly for respiratory illness until 180 days after birth. Nasal swabs were tested by polymerase chain reaction for respiratory viruses in symptomatic individuals. A transmission event was defined as a secondary case of the same virus within 14 days of initial infection within a household. From 555 households, 825 initial viral illness episodes occurred, resulting in 79 transmission events. The overall incidence of transmission was 1.14 events per 100 person-weeks. Risk of transmission incidence was associated with an index case age 1–4 years (incidence rate ratio (IRR) 2.35; 95% confidence interval (CI) 1.40–3.96), coinfection as initial infection (IRR 1.94; 95% CI 1.05–3.61) and no electricity in household (IRR 2.70; 95% CI 1.41–5.00). Preventive interventions targeting preschool-age children in households in resource-limited settings may decrease the risk of transmission to vulnerable household members, such as young infants.
Langmuir circulation, a key turbulent process in the upper ocean, is mechanistically driven and sustained by imposed atmospheric wind stress and surface wave drift. In addition, and specifically in coastal zones, the presence of a mean current – whether associated with tidal currents or large-scale eddies – generates bottom-boundary-layer shear, which further modulates the physical attributes of coastal-zone Langmuir turbulence. We show that the presence of bottom-boundary-layer shear generated by oblique forcing between the mean current, atmospheric drag, and monochromatic wave field direction changes the orientation of the resultant, large-scale Langmuir cells. A model to predict this resultant orientation, based on salient parameters defining the forcing obliquity, is proposed. We also perform a systematic parametric study to isolate the ‘turning’ influence of salient parameters, which reveals that the resultant Langmuir cell orientation is always intermediate to the imposed forces. In order to provide a rigorous basis for the results, we study terms responsible for sustenance of streamwise vorticity, and provide a theoretical justification for the observed results.
Intellectual disability and autism spectrum disorder (ASD) influence the interactions of a person with their environment and generate economic and socioeconomic costs for the person, their family and society.
To estimate costs of lost workforce participation due to informal caring for people with intellectual disability or autism spectrum disorders by estimating lost income to individuals, lost taxation payments to federal government and increased welfare payments.
We used a microsimulation model based on the Australian Bureau of Statistics' Surveys of Disability, Ageing and Carers (population surveys of people aged 15–64), and projected costs of caring from 2015 in 5-year intervals to 2030.
The model estimated that informal carers of people with intellectual disability and/or ASD in Australia had aggregated lost income of AU$310 million, lost taxation of AU$100 million and increased welfare payments of AU$204 million in 2015. These are projected to increase to AU$432 million, AU$129 million and AU$254 million for income, taxation, and welfare respectively by 2030. The income gap of carers for people with intellectual disability and/or ASD is estimated to increase by 2030, meaning more financial stress for carers.
Informal carers of people with intellectual disability and/or ASD experience significant loss of income, leading to increased welfare payments and reduced taxation revenue for governments; these are all projected to increase. Strategic policies supporting informal carers wishing to return to work could improve the financial and psychological impact of having a family member with intellectual disability and/or ASD.
We present a broad study of linear, clustered, noble gas puffs irradiated with the frequency doubled (527 nm) Titan laser at Lawrence Livermore National Laboratory. Pure Ar, Kr, and Xe clustered gas puffs, as well as two mixed-gas puffs consisting of KrAr and XeKrAr gases, make up the targets. Characterization experiments to determine gas-puff density show that varying the experimental parameter gas-delay timing (the delay between gas puff initialization and laser-gas-puff interaction) provides a simple control over the gas-puff density. X-ray emission (>1.4 keV) is studied as a function of gas composition, density, and delay timing. Xe gas puffs produce the strongest peak radiation in the several keV spectral region. The emitted radiation was found to be anisotropic, with smaller X-ray flux observed in the direction perpendicular to both laser beam propagation and polarization directions. The degree of anisotropy is independent of gas target type but increases with photon energy. X-ray spectroscopic measurements estimate plasma parameters and highlight their difference with previous studies. Electron beams with energy in excess of 72 keV are present in the noble gas-puff plasmas and results indicate that Ar plays a key role in their production. A drastic increase in harder X-ray emissions (X-ray flash effect) and multi-MeV electron-beam generation from Xe gas-puff plasma occurred when the laser beam was focused on the front edge of the linear gas puff.
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.
Improving understanding of the pathogen-specific seasonality of enteric infections is critical to informing policy on the timing of preventive measures and to forecast trends in the burden of diarrhoeal disease. Data obtained from active surveillance of cohorts can capture the underlying infection status as transmission occurs in the community. The purpose of this study was to characterise rotavirus seasonality in eight different locations while adjusting for age, calendar time and within-subject clustering of episodes by applying an adapted Serfling model approach to data from a multi-site cohort study. In the Bangladesh and Peru sites, within-subject clustering was high, with more than half of infants who experienced one rotavirus infection going on to experience a second and more than 20% experiencing a third. In the five sites that are in countries that had not introduced the rotavirus vaccine, the model predicted a primary peak in prevalence during the dry season and, in three of these, a secondary peak during the rainy season. The patterns predicted by this approach are broadly congruent with several emerging hypotheses about rotavirus transmission and are consistent for both symptomatic and asymptomatic rotavirus episodes. These findings have practical implications for programme design, but caution should be exercised in deriving inferences about the underlying pathways driving these trends, particularly when extending the approach to other pathogens.
We present the defect analysis by photoluminescence (PL) spectroscopy of CdSexTe1-x thin films, grown with varying Se content by a co-sputtered deposition method. We observe a peak at 1.203 eV in the CdSexTe1-x film for x = 0.21, which shifts towards higher energies with increase in laser power. This peak was assigned to a donor-to-acceptor (DAP) transition, with a measured j-shift of ∼4.7 meV/decade. Temperature dependent PL intensity measurements confirm that the observed DAP peak involves a shallow defect state of binding energy ∼34.7 meV. In contrast, a free-to-bound (FB) peak at 1.294 eV involving a shallow defect of binding energy ∼18.3 meV was observed in the CdSexTe1-x film for x = 0.14. Additionally, we observe band edge emission at 1.452 eV and 1.448 eV in CdSexTe1-x films for x = 0.14 and x = 0.21 respectively. Our analysis shows that the Se concentration not only changes the band gap energy of the resulting CdSexTe1-x alloy thin film, but also modifies the nature of the dominant observed defect emission.
Methods of obtaining large grain size and high crystallinity in absorber materials play an important role in fabrication of high-performance methylammonium lead iodide (MAPbI3) perovskite solar cells. Here we study the effect of adding small concentrations of Cd2+, Zn2+, and Fe2+salts to the perovskite precursor solution used in the single-step solution fabrication process. Enhanced grain size and crystallinity in MAPbI3 films were obtained by using 0.1% of Cd2+ or Zn2+in the precursor solution. Consequently, solar cells constructed with Cd- and Zn-doped perovskite films show a significant improvement in device performance. These results suggest that the process may be an effective and facile method to fabricate high-efficiency perovskite photovoltaic devices.
Photoluminescence (PL) spectroscopy has been used to study the defect levels in thin film copper indium diselenide (CuInSe2, CIS) which we are developing as the absorber layer for the bottom cell of a monolithically grown perovskite/CuInSe2 tandem solar cell. Temperature and laser power dependent PL measurements of thin film CIS for two different Cu/In ratios (0.66 and 0.80) have been performed. The CIS film with Cu/In = 0.80 shows a prominent donor-to-acceptor peak (DAP) involving a shallow acceptor of binding energy ∼22 meV, with phonon replica at ∼32 meV spacing. In contrast, PL measurement of CIS film for Cu/In = 0.66 taken at 20 K exhibited an asymmetric and broad PL spectrum with peaks at 0.845 eV and 0.787 eV. Laser intensity dependent PL revealed that the observed peaks 0.845 eV and 0.787 eV shift towards higher energy (aka j-shift) at ∼11.7 meV/decade and ∼ 8 meV/decade with increase in laser intensity respectively. The asymmetric and broad spectrum together with large j-shift suggests that the observed peaks at 0.845 eV and 0.787 eV were related to band-to-tail (BT) and band-to-impurity (BI) transition, respectively. Such a band-tail-related transition originates from the potential fluctuation of defect states at low temperature. The appearance of band related transition in CIS film with Cu/In = 0.66 is the indicator of the presence of large number of charged defect states.
OBJECTIVES/SPECIFIC AIMS: Accumulation of cholesterol-laden macrophages in arterial walls leads to atherosclerosis. LXRs induce expression of genes that are atheroprotective in macrophages including CCR7, a chemokine receptor that promotes their emigration from the plaque. CCR7 expression has been shown to be negatively regulated by phosphorylation of LXRα at S198 and is reduced in diabetic mice that show impaired plaque regression. I hypothesized that LXRα phosphorylation at S198 diminishes macrophage emigration from atherosclerotic plaque and contributes to impaired regression in diabetes. METHODS/STUDY POPULATION: Inducible LXRα S198A phosphorylation deficient knock in mouse were used as donors for bone marrow transplantation into mice prone to develop atherosclerosis. Plaques were developed by placing mice on western diet; and regression was induced by lowering their lipid levels. Aortic plaques were then analyzed by using morphometric, histological, and molecular analyses in control and diabetic mice expressing either LXRα WT or LXRα S198A during regression. RESULTS/ANTICIPATED RESULTS: Surprisingly, lack of phosphorylation increased plaque macrophage content and impaired regression under normoglycemic condition; however, it did not exacerbate diabetic regression. Plaques in diabetic mice were associated with increased LXRα S198 phosphorylation. Consistent with this, LXRα phosphorylation is enhanced in macrophages cultured under hyperglycemic conditions indicating glucose-dependent regulation of LXRα phosphorylation. Monocyte trafficking studies reveal that lack of phosphorylation and diabetes independently increase recruitment of monocytes in the plaque that might contribute to increased macrophage content. Importantly, I found that diabetes also increases macrophage retention in the plaque, which is reversed in the absence of phosphorylation. We predict that this increased retention results from inhibition of emigration of plaque macrophages through enhanced phosphorylation in diabetes. DISCUSSION/SIGNIFICANCE OF IMPACT: These findings suggest that inhibiting LXRα phosphorylation could be beneficial in diabetic atherosclerosis to reverse the accumulation of macrophages in the plaque. This study imparts insight on regulation of plaque macrophage trafficking through LXRα S198 phosphorylation.
Here, we investigate the effect of divalent metal (Zn2+, Cd2+ and Hg2+) on the structural and optoelectronic properties of methylammonium lead iodide perovskite materials prepared by the two-step deposition process. The incorporation of Cd2+ significantly improved the grain size, crystallinity, and charge carrier lifetime of CH3NH3PbI3. The inclusion of Hg2+ and Zn2+ improved the grain size compare to the control sample but adversely affected the optoelectronic properties of perovskite films. The Hg- and Zn-based impurities were formed on the surface of the films, which increased the charge trap density and lead to high non-radiative recombination rate. Time resolved photoluminescence measurements indicated that the Cd and Zn point defects do not create deep-level trap states, but the Zn-modified film showed a low lifetime due to morphology changes in the film and particle segregation on the surface.
Resistance to glyphosate in hairy fleabane and horseweed is a problem in
orchards and vineyards in California. Population genetic analyses suggest
that glyphosate resistance evolved multiple times in both species, but it is
unknown if resistance to other herbicides is also present. Two approaches of
research were undertaken to further evaluate herbicide resistance in
Conyza sp. in the perennial crop systems of California.
In the initial study, the distribution of Conyza sp. in the
Central Valley, using a semistructured field survey, was coupled with
evaluation of the presence and level of glyphosate resistance in plants
grown from field-collected seed. In a subsequent study, single-seed
descendants representing distinct genetic groups were self-pollinated in the
greenhouse and these accessions were evaluated for response to glyphosate
and paraquat. Conyza sp. were commonly found throughout the
Central Valley and glyphosate-resistant individuals were confirmed in all
field collections of both species. The level of glyphosate resistance among
field collections varied from 5- to 21-fold compared with 50% glyphosate
resistance (GR50) of the susceptible, with exception of one
region with a GR50 similar to the susceptible. When
self-pollinated accessions from different genetic groups were screened, the
level of glyphosate resistance, on the basis of GR50 values,
ranged from 1.7- to 42.5-fold in hairy fleabane, and 5.9- to 40.3-fold in
horseweed. Three accessions of hairy fleabane from different genetic groups
were also resistant to paraquat (40.1- to 352.5-fold). One
glyphosate-resistant horseweed accession was resistant to paraquat
(322.8-fold), which is the first confirmed case in California. All
paraquat-resistant accessions of Conyza sp. identified so
far have also been resistant to glyphosate, probably because glyphosate
resistance is already widespread in the state. Because glyphosate and
paraquat resistances are found across a wide geographical range and in
accessions from distinct genetic groups, multiple resistant
Conyza sp. likely developed independently several times
In an observational study, we found that healthcare personnel frequently acquired Clostridium difficile on their hands when caring for patients with recently resolved C. difficile infection (CDI) (<6 weeks after treatment) who were no longer under contact precautions. Continuing contact precautions after diarrhea resolves may be useful to reduce transmission.
Infect. Control Hosp. Epidemiol. 2016;37(4):475–477
Hairy fleabane is an important weed in orchards and vineyards of California. Populations of glyphosate-resistant (GR) and glyphosate-paraquat-resistant (GPR) hairy fleabane have been documented in California but very little information is available on the efficacy of other POST herbicides on these populations. Greenhouse and field experiments were conducted to evaluate the efficacy of several POST herbicides registered in almond orchards on GPR, GR, and glyphosate/paraquat-susceptible (GPS) hairy fleabane plants. Plants were treated at the 8- to 12-leaf stage in greenhouse experiments, and at the bolting to flowering stage in field experiments. A sequential application of glyphosate (1,100 g ae ha−1) followed by paraquat (500 g ai ha−1) 14 d later did not control the GPR plants in any of the studies, but was effective in controlling the GR and GPS plants. Glufosinate at 1,050 g ai ha−1 or saflufenacil at 48.8 g ai ha−1 resulted in 90% or greater control of all populations in all studies, whereas glyphosate (1,100 g ae ha−1) + 2,4-D (1,090 g ae ha−1) resulted in inconsistent control (58 to 100%). The GPR population was not resistant to other common POST herbicide modes of action used in California tree nut orchards, and glufosinate and saflufenacil can provide growers effective management options for hairy fleabane in these crops.
Most crop models make use of a nutrient-balance approach for modelling crop response to soil fertility. To counter the vast input data requirements that are typical of these models, the crop water productivity model AquaCrop adopts a semi-quantitative approach. Instead of providing nutrient levels, users of the model provide the soil fertility level as a model input. This level is expressed in terms of the expected impact on crop biomass production, which can be observed in the field or obtained from statistics of agricultural production. The present study is the first to describe extensively, and to calibrate and evaluate, the semi-quantitative approach of the AquaCrop model, which simulates the effect of soil fertility stress on crop production as a combination of slower canopy expansion, reduced maximum canopy cover, early decline in canopy cover and lower biomass water productivity. AquaCrop's fertility response algorithms are evaluated here against field experiments with tef (Eragrostis tef (Zucc.) Trotter) in Ethiopia, with maize (Zea mays L.) and wheat (Triticum aestivum L.) in Nepal, and with quinoa (Chenopodium quinoa Willd.) in Bolivia. It is demonstrated that AquaCrop is able to simulate the soil water content in the root zone, and the crop's canopy development, dry above-ground biomass development, final biomass and grain yield, under different soil fertility levels, for all four crops. Under combined soil water stress and soil fertility stress, the model predicts final grain yield with a relative root-mean-square error of only 11–13% for maize, wheat and quinoa, and 34% for tef. The present study shows that the semi-quantitative soil fertility approach of the AquaCrop model performs well and that the model can be applied, after case-specific calibration, to the simulation of crop production under different levels of soil fertility stress for various environmental conditions, without requiring detailed field observations on soil nutrient content.
The main objective of the present study was to examine the association between dietary Fe intake and dietary predictors of Fe status and Hb concentration among lactating women in Bhaktapur, Nepal. We included 500 randomly selected lactating women in a cross-sectional survey. Dietary information was obtained through three interactive 24 h recall interviews including personal recipes. Concentrations of Hb and plasma ferritin and soluble transferrin receptors were measured. The daily median Fe intake from food was 17·5 mg, and 70 % of the women were found to be at the risk of inadequate dietary Fe intake. Approximately 90 % of the women had taken Fe supplements in pregnancy. The prevalence of anaemia was 20 % (Hb levels < 123 g/l) and that of Fe deficiency was 5 % (plasma ferritin levels < 15 μg/l). In multiple regression analyses, there was a weak positive association between dietary Fe intake and body Fe (β 0·03, 95 % CI 0·014, 0·045). Among the women with children aged < 6 months, but not those with older infants, intake of Fe supplements in pregnancy for at least 6 months was positively associated with body Fe (P for interaction < 0·01). Due to a relatively high dietary intake of non-haem Fe combined with low bioavailability, a high proportion of the women in the present study were at the risk of inadequate intake of Fe. The low prevalence of anaemia and Fe deficiency may be explained by the majority of the women consuming Fe supplements in pregnancy.
WideStrike® Acala cotton is a two-gene, in-plant trait that provides broad-spectrum and season-long control of lepidopteran insect pests, and the varieties available in California also have resistance to glyphosate. There have been indications that WideStrike cotton has some glufosinate tolerance as well, so the level of tolerance to glufosinate needed to be ascertained. A 2-yr (2008 and 2009) study was conducted in California to evaluate the potential crop injury caused by three different rates (0.59, 0.88, and 1.76 kg ai ha−1) of glufosinate–ammonium at four different growth stages (cotyledon, 2-node, 5- to 6-node, and 18- to 19-node stages) of WideStrike Acala cotton. The effects of these treatments on the cotton plants and yield were closely monitored. Glyphosate at 1.54 kg ae ha−1 was applied at all cotton growth stages as a standard application, and a nontreated control was included. The greatest level of injury (58%) was observed with the highest rate of glufosinate applied at both the cotyledon and the two-node stage of cotton. However, injury was less than 10% following glufosinate at 0.59 kg ha−1 applied at the 18- to 19-node stage. The level of injury increased with the higher application rate of glufosinate at all crop growth stages. In 2008 and 2009, the glufosinate treatments had no effect on cotton lint yield. Therefore, the study showed that glufosinate can be applied safely topically at 0.59 kg ha−1 at the cotyledon- to 2-node stage or as POST-directed spray between the 5- to 19-node stages. Although injury occurred at this rate, the plants recovered within 2 to 3 wk of the treatment. Increasing glufosinate rates beyond 0.59 kg ha−1 can increase the possibility of greater crop injury.