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This paper reports on: (1) an evaluation of a common elements treatment approach (CETA) developed for comorbid presentations of depression, anxiety, traumatic stress, and/or externalizing symptoms among children in three Somali refugee camps on the Ethiopian/Somali border, and (2) an evaluation of implementation factors from the perspective of staff, lay providers, and families who engaged in the intervention.
This project was conducted in three refugee camps and utilized locally validated mental health instruments for internalizing, externalizing, and posttraumatic stress (PTS) symptoms. Participants were recruited from either a validity study or from referrals from social workers within International Rescue Committee Programs. Lay providers delivered CETA to youth (CETA-Youth) and families, and symptoms were re-assessed post-treatment. Providers and families responded to a semi-structured interview to assess implementation factors.
Children who participated in the CETA-Youth open trial reported significant decreases in symptoms of internalizing (d = 1.37), externalizing (d = 0.85), and posttraumatic stress (d = 1.71), and improvements in well-being (d = 0.75). Caregivers also reported significant decreases in child symptoms. Qualitative results were positive toward the acceptability and appropriateness of treatment, and its feasibility.
This project is the first to examine a common elements approach (CETA: defined as flexible delivery of elements, order, and dosing) with children and caregivers in a low-resource setting with delivery by lay providers. CETA-Youth may offer an effective treatment that is easier to implement and scale-up versus multiple focal interventions. A fullscale randomized clinical trial is warranted.
Adult ventilator-associated event (VAE) definitions include ventilator-associated conditions (VAC) and subcategories for infection-related ventilator-associated complications (IVAC) and possible ventilator-associated pneumonia (PVAP). We explored these definitions for children.
Pediatric, cardiac, or neonatal intensive care units (ICUs) in 6 US hospitals
Patients ≤18 years old ventilated for ≥1 day
We identified patients with pediatric VAC based on previously proposed criteria. We applied adult temperature, white blood cell count, antibiotic, and culture criteria for IVAC and PVAP to these patients. We matched pediatric VAC patients with controls and evaluated associations with adverse outcomes using Cox proportional hazards models.
In total, 233 pediatric VACs (12,167 ventilation episodes) were identified. In the cardiac ICU (CICU), 62.5% of VACs met adult IVAC criteria; in the pediatric ICU (PICU), 54.2% of VACs met adult IVAC criteria; and in the neonatal ICU (NICU), 20.2% of VACs met adult IVAC criteria. Most patients had abnormal white blood cell counts and temperatures; we therefore recommend simplifying surveillance by focusing on “pediatric VAC with antimicrobial use” (pediatric AVAC). Pediatric AVAC with a positive respiratory diagnostic test (“pediatric PVAP”) occurred in 8.9% of VACs in the CICU, 13.3% of VACs in the PICU, and 4.3% of VACs in the NICU. Hospital mortality was increased, and hospital and ICU length of stay and duration of ventilation were prolonged among all pediatric VAE subsets compared with controls.
We propose pediatric AVAC for surveillance related to antimicrobial use, with pediatric PVAP as a subset of AVAC. Studies on generalizability and responsiveness of these metrics to quality improvement initiatives are needed, as are studies to determine whether lower pediatric VAE rates are associated with improvements in other outcomes.
The objective of this study was to evaluate the impact of a brief parenting intervention, ‘Parents Make the Difference‘(PMD), on parenting behaviors, quality of parent-child interactions, children's cognitive, emotional, and behavioral wellbeing, and malaria prevention behaviors in rural, post-conflict Liberia.
A sample of 270 caregivers of children ages 3–7 were randomized into an immediate treatment group that received a 10-session parent training intervention or a wait-list control condition (1:1 allocation). Interviewers administered baseline and 1-month post-intervention surveys and conducted child-caregiver observations. Intent-to-treat estimates of the average treatment effects were calculated using ordinary least squares regression. This study was pre-registered at ClinicalTrials.gov (NCT01829815).
The program led to a 55.5% reduction in caregiver-reported use of harsh punishment practices (p < 0.001). The program also increased the use of positive behavior management strategies and improved caregiver–child interactions. The average caregiver in the treatment group reported a 4.4% increase in positive interactions (p < 0.05), while the average child of a caregiver assigned to the treatment group reported a 17.5% increase (p < 0.01). The program did not have a measurable impact on child wellbeing, cognitive skills, or household adoption of malaria prevention behaviors.
PMD is a promising approach for preventing child abuse and promoting positive parent-child relationships in low-resource settings.
The study of molecules in space, known as astrochemistry or molecular astrophysics, is a rapidly growing field. Molecules exist in a wide range of environments in both gaseous and solid form, from our own solar system to the distant early universe. To astronomers, molecules are indispensable and unique probes of the physical conditions and dynamics of regions in which they are detected, especially the interstellar medium. In particular, the many stages of both low-mass and high-mass star formation are better understood today thanks to the analysis of molecular observations. Molecules can also yield a global picture of the past and present of sources. Moreover, molecules affect their environment by contributing to the heating and cooling processes that occur.
An outbreak of cryptosporidiosis occurred in the Isle of Thanet during December 1990 and January 1991. A total of 47 cases ranging in age from 2 months to 85 years were identified in residents from the Margate, Broadstairs and Ramsgate areas, with dates of onset of illness from 3 December to 14 January. A case-control study demonstrated a strong statistical association between illness and the consumption of unboiled tap water from a particular source, with evidence of a dose–response relationship. Although no cryptosporidial oocysts were identified in samples of untreated or treated water taken during the investigation, the results were consistent with the view that the source of infection was treated river water which was used to supplement borehole water.
Thin fluorescent organic fibers are used to collect short wavelength sunlight, convert it to longer wavelengths and illuminate photovoltaic (PV) arrays. Using this approach, miniature and lightweight PV arrays have been fabricated. The incoming light is collected by many fibers and mixed before reaching the PV array. Thus homogenous illumination is provided even with partially shadowed fibers, which can cover a large area and can be arranged in a form of a fabric. The PV array itself can be located in any (even dark) place.
In this work we developed and tested high-performance miniature 21 mm2 AlGaAs/GaAs monolithic arrays consisting of 6 cells connected in series. Output electric power density of 75 mW/cm2 and an open-circuit voltage about 6 V was measured outdoors for the arrays integrated with a bundle of 0.25 – 1.00 mm thick polystyrene fibers. The influence of PV array output parameters on the fluorescent fiber diameter, length, as well as on bandgap and design of solar cells is discussed.
We present the results on investigation and analysis of photoluminescence (PL) dynamics of quaternary AlInGaN epilayers and AlInGaN/AlInGaN multiple quantum wells (MQWs) grown by a novel pulsed metalorganic chemical vapor deposition (PMOCVD). The emission peaks in both AlInGaN epilayers and MQWs show a blueshift with increasing excitation power density. The PL emission of quaternary samples is attributed to recombination of carriers/excitons localized at band-tail states. The PL decay time increases with decreasing emission photon energy, which is a characteristic of localized carrier/exciton recombination due to alloy disorder. The obtained properties of AlInGaN materials grown by a PMOCVD are similar to those of InGaN. This indicates that the AlInGaN system is promising for ultraviolet applications such as the InGaN system for blue light emitting diode and laser diode applications.
Although the folate metabolic pathway in malaria parasites is a major chemotherapeutic target, resistance to currently available antifolate drugs is an increasing problem. This pathway, however, includes a number of enzymes that, to date, have not been characterized despite their potential for clinical exploitation. As a step towards evaluation of additional targets in this pathway, we report the isolation and characterization of 3 new genes that encode homologues of GTP cyclohydrolase I (GTP-CH), dihydrofolate synthase/folylpolyglutamate synthase (DHFS/FPGS) and serine hydroxymethyltransferase (SHMT). The genes encoding GTP-CH and SHMT are unambiguously assigned to chromosome 12, while that for DHFS/FPGS is tentatively assigned to chromosome 13. All 3 genes are expressed in blood-stage parasites, yielding transcripts of which only ca 60–70% is accounted for by coding sequence. All 3 of the proteins predicted to be encoded by these genes display sequence differences compared to the human host homologues that may be of functional significance. These data bring the complement of cloned genes that encode activities in the pathway to seven, leaving only the gene encoding dihydroneopterin aldolase (DHNA) to be identified in the route from GTP to folate synthesis and folate turnover in the thymidylate cycle.
A point mutation in codon 540 of the dihydropteroate synthetase
gene affecting sulfadoxine resistance has previously
been found in parasites from patients with Plasmodium falciparum
Here, we investigated 4 methods of identifying
this mutation in clinical specimens and established a reliable quantitative
assay to estimate the percentage of resistant type
in mixed infections. A diagnostic PCR assay based on allele-specific
amplification was developed, which clearly typed the
clinical specimens examined. The mutation in codon 540 introduces an
additional FokI cleavage site which provided a
second method to differentiate mutant from wild type, where the former
gives rise to 2 characteristic fragments of 538 and 326 bp that are absent
the latter. To calibrate quantitatively the ratio of alleles in mixed samples,
artificial mixes containing 2 plasmid DNAs, one carrying the mutation and
other a wild-type insert. When 32P-labelling
was employed, the allele-specific PCR assay could detect the level of resistant
in a mixture down to 0·1–1%, while
for the restriction enzyme/PCR analysis, the figure was approximately
Furthermore, neither fluorescent dye-labelled terminator nor dye-labelled
cycle sequencing was able to detect the mutant allele if it was present
than 20–30%. We conclude that the allele-specific PCR assay is the
most sensitive method of detecting the codon 540
mutation in P. falciparum dhps, and the method of choice for
estimating the composition of mixed samples.
The combination of pyrimethamine and sulfadoxine (PSD or
Fansidar) represents one of the most important chemo-
therapeutic agents currently used to treat falciparum malaria. To
investigate the molecular basis of resistance to PSD,
reliable in vitro drug assays are required to permit
correlation of resistance levels with different genotypes. We describe
here protocols that permit accurate evaluation of IC50 values
for sulfadoxine (SDX) inhibition of Plasmodium falciparum.
Historically, tests for this drug have suffered from poor reproducibility
and extreme variability in reported values. We
have examined a series of variables, including serum-containing
versus serum-free media, erythrocyte source, pre-test
growth conditions, test components and post-test processing. We define
conditions which better control the levels of the
drug antagonists folate and p-aminobenzoate, yielding
reproducible differences between lines of P. falciparum with
differing alleles of the dihydropteroate synthetase gene, which encodes
the target enzyme of SDX. We also use this assay
to demonstrate a marked difference in the response of different parasite
lines to antagonism of SDX inhibition by
exogenous folate. The ability to measure reliable IC50
values for SDX inhibition should greatly facilitate further
experiments to explore the molecular basis of Fansidar resistance.
Progress on mid-infrared photodetectors fabricated by the liquid phase epitaxial growth of GaInAsSb, InAsSbP, and AlGaAsSb on GaSb and InAs substrates is reported. GaInAsSb p/n and p-i-n detectors, InAsSbP p/n detectors and AlGaAsSb/GaInAsSb avalanche photodiode (APD) structures were fabricated. Preliminary results indicate that these devices can have higher detectivity with lower cooling requirements than commercially available detectors in the same wavelength range. Infrared p/n junction detectors made from GaInAsSb and InAsSbP showed cut-off wavelengths of 2.3.μm and 2.8. μm respectively. Room temperature background noiselimited detectivity (D*BLIP) of 4 × 1010 cmHz1/2/W for GaInAsSb detectors and 4 × 108 cmHz1/2/W for InAsSbP was measured. Room-temperature avalanche multiplication gain of 20 was measured on AlGaAsSb/GaInAsSb avalanche photodiodes.
Voluntary food intake (VFI) of chopped timothy hay and metabolic rate were each measured in each month of the year in six non-breeding ewes of each of three breeds. Metabolic rate was measured using indirect calorimetry over a range of food intakes and adjusted for intake to an estimated maintenance metabolic rate (MMR). The breeds compared were the Dorset Horn (DT), Scottish Blackface (BF) and Shetland (SH), the first being less seasonal in reproductive and other characteristics than the other two which are hill or northern latitude breeds. There was significant overall variation between months in VFI which was higher in the summer (July to September) than in the winter (December to February) months (P < 0·001). There was a significant breed × month interaction (P < 0·01), the seasonal effect being most strongly observed in the BF and SH ewes, whose VFI in summer was proportionately 0-1 greater than the year-round mean but was 0-1 lower in the winter. The DT ewes showed much less seasonal variation in VFI. There was no overall difference in VFI between breeeds (DT: 43-7; BF: 49-5; SH: 48-1 g dry matter per M075 live weight per day, P > 0·1). Although MMR varied significantly between months (P < 0·001), there was no systematic variation between summer and winter. There was no significant breed × month interaction, but the MMR differed significantly (P < 0·001) between breeds giving a high overall MMR in BF (DT: 322-7; BF: 356-6; SH: 324-5 kf/kg M0·75 per day). No significant correlation existed (P > 0·05) between the monthly mean MMR and VFI in any of the breeds. The causal relationship between seasonal cycles of basal metabolic rate and VFI is questioned.
The Interview Schedule for Social Interactions (ISSI) was used to assess the social environment of 65 British inner-city patients suffering from severe neurotic disorder; all patients were offered a 12-week course of intensive day treatment with an educational and psychodynamic basis. Compared with a general population in Canberra, the neurosis sufferers had lower (morbid) scores on the ISSI for the extent and quality of their social relationships. Of the 34 subjects who completed treatment and attended for the post-treatment investigation, 21 attained a PSE score below the level for ‘caseness'. Twenty-five subjects who attended for follow-up at 18–24 months had improved significantly on all four of the standard ISSI measures, although they had not done so immediately after treatment. This suggests that although symptoms may improve at the time of treatment, social relationships improve only over several months.
The need for structural materials that can withstand severe environments up to 4000°F has promulgated the investigation of sol-gel derived ceramic and composite coatings on carbon/carbon composite materials. Alumina and zirconia sols have been deposited via thermophoresis on carbon/carbon substrates.
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