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L’Association Santé Mentale en Afrique de l’Ouest est née d’une collaboration avec l’ONG Béninoise « Saint-Camille ». Cette association fondée par Grégoire Ahongbonon œuvre depuis près de 30 ans, en Côte d’Ivoire et au Bénin pour soustraire les malades psychiatriques au sort qui leur est le plus souvent réservé en l’absence de soins : l’errance pathologique dans les métropoles du continent et l’enchaînement physique à des arbres ou des murs à l’écart des villages dans les campagnes. La maladie mentale reste en effet un sujet tabou dans ces sociétés marquées par des croyances séculaires autour de la sorcellerie et de l’envoûtement. L’action de l’ONG Saint-Camille s’inscrit aussi dans un contexte de pénurie de structures soignantes (un seul hôpital psychiatrique au Bénin par exemple). On peut ainsi regretter la quasi-absence de politiques de développement de réseaux de soins psychiatriques en Afrique de l’Ouest, tant du point de vu des gouvernements que des grandes ONG médicales internationales, pour qui la psychiatrie n’est pas une priorité. Aujourd’hui ce sont plus de 20 000 malades qui ont été accueillis dans les 8 centres de soins d’ONG St-Camille en Côte d’Ivoire et au Bénin, et qui ont pu être réinsérés dans leurs familles, au prix d’une lutte incessante contre les représentations de la maladie mentale encore en cours dans cette partie du monde. L’association Santé Mentale en Afrique de l’Ouest, organisée autour de soignants du centre hospitalier Le Mas Careiron à Uzès (30) est engagée dans un partenariat avec l’ONG Saint-Camille et développe les actions suivantes :
– soutien financier envers ses partenaires africains pour l’achat de médicaments psychotropes ;
– aide à la formation en santé mentale ;
– organisation de missions de bénévolat en santé mentale en Afrique de l’Ouest ;
– organisation de rencontres et débats autour du thème de la santé mentale en Afrique.
Dark-field x-ray microscopy is intended for the acquisition of three -dimensional (3D) movies of the nanostructure (grains, domains, and dislocations) and the associated local strain within bulk materials. It is analogous to dark-field electron microscopy in that an objective lens magnifies diffracting features of the sample. The use of high-energy synchrotron x-rays, however, means that these microstructural features can be large and deeply embedded. The spatial and angular resolution is on the order of 100 nm and 0.001°, respectively, and full maps can be recorded in seconds to minutes. Four applications of the technique are presented—domain switching in ferroelectrics, processing of metals, microstructural characterization of biominerals, and visualization of dislocations. The ability to directly characterize complex, multiscale phenomena in situ—and in 3D—is a key step toward formulating and validating multiscale models that account for the entire heterogeneity of materials.
Multimorbidity may impose an overwhelming burden on patients with psychosis and is affected by gender and age. Our aim is to study the independent role of familial liability to psychosis as a risk factor for multimorbidity.
We performed the study within the framework of the Genetic Risk and Outcome of Psychosis (GROUP) project. Overall, we compared 1024 psychotic patients, 994 unaffected siblings and 566 controls on the prevalence of 125 lifetime diseases, and 19 self-reported somatic complaints. Multimorbidity was defined as the presence of two or more complaints/diseases in the same individual. Generalized linear mixed model (GLMM) were used to investigate the effects of gender, age (adolescent, young, older) and familial liability (patients, siblings, controls) and their interactions on multimorbidity.
Familial liability had a significant effect on multimorbidity of either complaints or diseases. Patients had a higher prevalence of multimorbidity of complaints compared to siblings (OR 2.20, 95% CI 1.79–2.69, P < 0.001) and to controls (3.05, 2.35–3.96, P < 0.001). In physical health multimorbidity, patients (OR 1.36, 95% CI 1.05–1.75, P = 0.018), but not siblings, had significantly higher prevalence than controls. Similar finding were observed for multimorbidity of lifetime diseases, including psychiatric diseases. Significant results were observed for complaints and disease multimorbidity across gender and age groups.
Multimorbidity is a common burden, significantly more prevalent in patients and their unaffected siblings. Familial liability to psychosis showed an independent effect on multimorbidity; gender and age are also important factors determining multimorbidity.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
Getting a better understanding of the evolution and nucleosynthetic yields of the most metal-poor stars (Z ≲ 10−5) is critical because they are part of the big picture of the history of the primitive universe. Yet many of the remaining unknowns of stellar evolution lie in the birth, life, and death of these objects. We review stellar evolution of intermediate-mass Z ≤ 10−5 models existing in the literature, with a particular focus on the problem of their final fates. We emphasise the importance of the mixing episodes between the stellar envelope and the nuclearly processed core, which occur after stars exhaust their central He (second dredge-up and dredge-out episodes). The depth and efficiency of these episodes are critical to determine the mass limits for the formation of electron-capture SNe. Our knowledge of these phenomena is not complete because they are strongly affected by the choice of input physics. These uncertainties affect stars in all mass and metallicity ranges. However, difficulties in calibration pose additional challenges in the case of the most metal-poor stars. We also consider the alternative SN I1/2 channel to form SNe out of the most metal-poor intermediate-mass objects. In this case, it is critical to understand the thermally pulsing Asymptotic Giant Branch evolution until the late stages. Efficient second dredge-up and, later, third dredge-up episodes could be able to pollute stellar envelopes enough for the stars to undergo thermal pulses in a way very similar to that of higher initial Z objects. Inefficient second and/or third dredge-up may leave an almost pristine envelope, unable to sustain strong stellar winds. This may allow the H-exhausted core to grow to the Chandrasekhar mass before the envelope is completely lost, and thus let the star explode as an SN I1/2. After reviewing the information available on these two possible channels for the formation of SNe, we discuss existing nucleosynthetic yields of stars of metallicity Z ≤ 10−5 and present an example of nucleosynthetic calculations for a thermally pulsing Super-Asymptotic Giant Branch star of Z = 10−5. We compare theoretical predictions with observations of the lowest [Fe/H] objects detected. The review closes by discussing current open questions as well as possible fruitful avenues for future research.
Radiocarbon (14C or carbon-14, half-life 5730 yr) is a key radionuclide in the assessment of the safety of a geological disposal facility (GDF) for radioactive waste. In particular, the radiological impact of gaseous carbon-14 bearing species has been recognized as a potential issue. Irradiated steels are one of the main sources of carbon-14 in the United Kingdom’s radioactive waste inventory. However, there is considerable uncertainty about the chemical form(s) in which the carbon-14 will be released. The objective of the work was to measure the rate and speciation of carbon-14 release from irradiated 316L(N) stainless steel on leaching under high-pH anoxic conditions, representative of a cement-based near field for low-heat generating wastes. Periodic measurements of carbon-14 releases to both the gas phase and to solution were made in duplicate experiments over a period of up to 417 days. An initial fast release of carbon-14 from the surface of the steel is observed during the first week of leaching, followed by a drop in the rate of release at longer times. Carbon-14 is released primarily to the solution phase with differing fractions released to the gas phase in the two experiments: about 1% of the total release in one and 6% in the other. The predominant dissolved carbon-14 releases are in inorganic form (as 14C-carbonate) but also include organic species. The predominant gas-phase species are hydrocarbons with a smaller fraction of 14CO (which may include some volatile oxygen-containing carbon-species). The experiments are continuing, with final sampling and termination planned after leaching for a total of two years.
Properties of dwarf galaxies formed and evolved in the lowest density environment remain largely unexplored and poorly understood. Especially this concerns the low-mass end (Mbar < 109M⊙). We overview the results of systematic study of a hundred void dwarfs from the nearby Lynx-Cancer void. We describe the ongoing project aiming to form Nearby Void galaxy sample (R < 25 Mpc) over the whole sky. 1354 objects with distances less than 25 Mpc fall within 25 voids delineated by 460 luminous galaxies/groups. The void major sizes range from 13 to 37 Mpc. 1088 of 1354 void galaxies reside deeply in voids, having distances to the nearest luminous neighbour of 2–11 Mpc. 195 nearest void galaxies reside in the Local Volume. We summarize the main statistical properties of the new sample and outline the prospects of study of both, the void dwarf properties and the fine structure of voids.
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interest
Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
The Neotoma Paleoecology Database is a community-curated data resource that supports interdisciplinary global change research by enabling broad-scale studies of taxon and community diversity, distributions, and dynamics during the large environmental changes of the past. By consolidating many kinds of data into a common repository, Neotoma lowers costs of paleodata management, makes paleoecological data openly available, and offers a high-quality, curated resource. Neotoma’s distributed scientific governance model is flexible and scalable, with many open pathways for participation by new members, data contributors, stewards, and research communities. The Neotoma data model supports, or can be extended to support, any kind of paleoecological or paleoenvironmental data from sedimentary archives. Data additions to Neotoma are growing and now include >3.8 million observations, >17,000 datasets, and >9200 sites. Dataset types currently include fossil pollen, vertebrates, diatoms, ostracodes, macroinvertebrates, plant macrofossils, insects, testate amoebae, geochronological data, and the recently added organic biomarkers, stable isotopes, and specimen-level data. Multiple avenues exist to obtain Neotoma data, including the Explorer map-based interface, an application programming interface, the neotoma R package, and digital object identifiers. As the volume and variety of scientific data grow, community-curated data resources such as Neotoma have become foundational infrastructure for big data science.
The Murchison Widefield Array, and its recently developed Voltage Capture System, facilitates extending the low-frequency range of pulsar observations at high-time and -frequency resolution in the Southern Hemisphere, providing further information about pulsars and the ISM. We present the results of an initial time-resolved census of known pulsars using the Murchison Widefield Array. To significantly reduce the processing load, we incoherently sum the detected powers from the 128 Murchison Widefield Array tiles, which yields ~10% of the attainable sensitivity of the coherent sum. This preserves the large field-of-view (~450 deg2 at 185 MHz), allowing multiple pulsars to be observed simultaneously. We developed a WIde-field Pulsar Pipeline that processes the data from each observation and automatically folds every known pulsar located within the beam. We have detected 50 pulsars to date, 6 of which are millisecond pulsars. This is consistent with our expectation, given the telescope sensitivity and the sky coverage of the processed data (~17 000 deg2). For 10 pulsars, we present the lowest frequency detections published. For a subset of the pulsars, we present multi-frequency pulse profiles by combining our data with published profiles from other telescopes. Since the Murchison Widefield Array is a low-frequency precursor to the Square Kilometre Array, we use our census results to forecast that a survey using the low-frequency component of the Square Kilometre Array Phase 1 can potentially detect around 9 400 pulsars.
New drugs and treatments for diseases caused by intracellular pathogens, such as leishmaniasis and the Leishmania species, have proved to be some of the most difficult to discover and develop. The focus of discovery research has been on the identification of potent and selective compounds that inhibit target enzymes (or other essential molecules) or are active against the causative pathogen in phenotypic in vitro assays. Although these discovery paradigms remain an essential part of the early stages of the drug R & D pathway, over the past two decades additional emphasis has been given to the challenges needed to ensure that the potential anti-infective drugs distribute to infected tissues, reach the target pathogen within the host cell and exert the appropriate pharmacodynamic effect at these sites. This review will focus on how these challenges are being met in relation to Leishmania and the leishmaniases with lessons learned from drug R & D for other intracellular pathogens.
Little is known about the current views and practices of healthcare professionals (HCPs) in Sub-Saharan Africa (SSA) regarding delivery of hospital palliative care. The present qualitative study explored the views of nursing staff and medical professionals on providing palliative and end-of-life care (EoLC) to hospital inpatients in Tanzania.
Focus group discussions were conducted with a purposive sample of HCPs working on the medical and pediatric wards of the Kilimanjaro Christian Medical Centre, a tertiary referral hospital in northern Tanzania. Transcriptions were coded using a thematic approach.
In total, 32 healthcare workers were interviewed via 7 focus group discussions and 1 semistructured interview. Four major themes were identified. First, HCPs held strong views on what factors were important to enable individuals with a life-limiting diagnosis to live and die well. Arriving at a state of “acceptance” was the ultimate goal; however, they acknowledged that they often fell short of achieving this for inpatients. Thus, the second theme involved identifying the “barriers” to delivering palliative care in hospital. Another important factor identified was difficulty with complex communications, particularly “breaking bad news,” the third theme. Fourth, participants were divided about their personal preferences for “place of EoLC,” but all emphasized the benefits of the hospital setting so as to enable better symptom control.
Significance of results:
Despite the fact that all the HCPs interviewed were regularly involved in providing palliative and EoLC, they had received limited formal training in its provision, although they identified such training as a universal requirement. This training gap is likely to be present across much of SSA. Palliative care training, particularly in terms of communication skills, should be comprehensively integrated within undergraduate and postgraduate education. Research is needed to develop culturally appropriate curricula to equip HCPs to manage the complex communication challenges that occur in caring for a diverse inpatient group with palliative care needs.
During puberty young people undergo significant hormonal changes which affect metabolism and, subsequently, health. Evidence suggests there is a period of transient pubertal insulin resistance, with this effect greater in girls than boys. However, the response to everyday high and low glycaemic index (GI) meals remains unknown. Following ethical approval, forty adolescents consumed a high GI or low GI breakfast, in a randomised cross-over design. Capillary blood samples were taken during a 2-h postprandial period, examining the glycaemic and insulinaemic responses. Maturity offset and homoeostatic model assessment (HOMA) were also calculated. The glycaemic response to the breakfasts was similar between boys and girls, as shown by similar peak blood glucose concentrations and incremental AUC (IAUC) following both high and low GI breakfasts (all P>0·05). Girls exhibited a higher peak plasma insulin concentration 30 min post-breakfast following both high GI (P=0·043, g=0·69) and low GI (P=0·010, g=0·84) breakfasts, as well as a greater IAUC following high GI (P=0·041, g=0·66) and low GI (P=0·041, g=0·66) breakfasts. HOMA was positively correlated with the insulinaemic responses (all P<0·0005) and maturity offset (P=0·037). The findings of the present study suggest that pubertal insulin resistance affects the postprandial insulinaemic responses to both high and low GI meals. Specifically, girls exhibit a greater insulinaemic response than boys to both meals, despite similar glycaemic responses. This study is the first to report the glycaemic and insulinaemic responses to everyday meals in boys and girls, supporting the recommendation for young people to base their diet on low GI carbohydrates.
To study the association between gastrointestinal colonization of carbapenemase-producing Enterobacteriaceae (CPE) and proton pump inhibitors (PPIs).
We analyzed 31,526 patients with prospective collection of fecal specimens for CPE screening: upon admission (targeted screening) and during hospitalization (opportunistic screening, safety net screening, and extensive contact tracing), in our healthcare network with 3,200 beds from July 1, 2011, through December 31, 2015. Specimens were collected at least once weekly during hospitalization for CPE carriers and subjected to broth enrichment culture and multiplex polymerase chain reaction.
Of 66,672 fecal specimens collected, 345 specimens (0.5%) from 100 patients (0.3%) had CPE. The number and prevalence (per 100,000 patient-days) of CPE increased from 2 (0.3) in 2012 to 63 (8.0) in 2015 (P<.001). Male sex (odds ratio, 1.91 [95% CI, 1.15–3.18], P=.013), presence of wound or drain (3.12 [1.70–5.71], P<.001), and use of cephalosporins (3.06 [1.42–6.59], P=.004), carbapenems (2.21 [1.10–4.48], P=.027), and PPIs (2.84 [1.72–4.71], P<.001) in the preceding 6 months were significant risk factors by multivariable analysis. Of 79 patients with serial fecal specimens, spontaneous clearance of CPE was noted in 57 (72.2%), with a median (range) of 30 (3–411) days. Comparing patients without use of antibiotics and PPIs, consumption of both antibiotics and PPIs after CPE identification was associated with later clearance of CPE (hazard ratio, 0.35 [95% CI, 0.17–0.73], P=.005).
Concomitant use of antibiotics and PPIs prolonged duration of gastrointestinal colonization by CPE.
A 4-m telescope for mm-wave observations, particularly of spectral lines, was erected in mid-1976 at Epping by Krupp Ltd., Rheinhausen. A cooled mixer receiver was installed on the telescope in April 1977 and a series of test observations made during the remainder of the year, subject to the availability of the receiver and the multi-channel filter bank which were shared with the Parkes 64-m telescope.
Carbapenem-resistant Acinetobacter baumannii (CRAB) with diverse multilocus sequence typing emerged among our nursing home residents (6.5%) with a high background rate of MRSA (32.2%). Rectal swabs yielded a higher rate of CRAB detection than axillary or nasal swabs. Bed-bound status, use of adult diapers, and nasogastric tube were risk factors for CRAB colonization.