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Depression in older people is likely to become a growing global health problem with aging populations. Significant cultural variation exists in beliefs about depression (terminology, symptomatology, and treatments) but data from sub-Saharan Africa are minimal. Low-resource interventions for depression have been effective in low-income settings but cannot be utilized without accurate diagnosis. This study aimed to achieve a shared understanding of depression in Tanzania in older people.
Using a qualitative design, focus groups were conducted with participants aged 60 and over. Participants from rural villages of Kilimanjaro, Tanzania, were selected via randomized sampling using census data. Topic guides were developed including locally developed case vignettes. Transcripts were translated into English from Swahili and thematic analysis conducted.
Ten focus groups were held with 81 participants. Three main themes were developed: a) conceptualization of depression by older people and differentiation from other related conditions (“too many thoughts,” cognitive symptoms, affective and biological symptoms, wish to die, somatic symptoms, and its difference to other concepts); b) the causes of depression (inability to work, loss of physical strength and independence, lack of resources, family difficulties, chronic disease); c) management of depression (love and comfort, advice, spiritual support, providing help, medical help).
This research expands our understanding of how depression presents in older Tanzanians and provides information about lay beliefs regarding causes and management options. This may allow development of culturally specific screening tools for depression that, in turn, increase diagnosis rates, support accurate diagnosis, improve service use, and reduce stigma.
This year 2018 has great historical and current significance for stellar spectral classification. Two hundred years ago in Reggio Emilia, Italy, was born Angelo Secchi, a pioneer of observing and classifying the spectra of stars. At the beginning of the IAU, almost a hundred years ago, one of its original Commissions was entitled the Spectral Classification of Stars, from which was generated Commission 45, Spectral Classification and Multi-band Colour Indices. And seventy-five years ago, was published the system-changing MKK, An Atlas of Stellar Spectra. Through this necessarily brief, historical view we shall recall how spectral classification, supported internationally by the IAU, continually updated its techniques, while remaining anchored to standards. This has ensured that the MK classification process stays very relevant to the initial characterizing of stars in the 21st century era of large spectral surveys.
The number of people living with dementia in sub-Saharan Africa (SSA) is expected to increase rapidly in the coming decades. However, our understanding of how best to reduce dementia risk in the population is very limited. As a first step in developing intervention strategies to manage dementia risk in this setting, we investigated rates of cognitive decline in a rural population in Tanzania and attempted to identify associated factors.
The study was conducted in the rural Hai district of northern Tanzania. In 2014, community-dwelling people aged 65 years and over living in six villages were invited to take part in a cognitive screening program. All participants from four of the six villages were followed-up at two years and cognitive function re-tested. At baseline and follow-up, participants were assessed for functional disability, hypertension, and grip strength (as a measure of frailty). At follow-up, additional assessments of visual acuity, hearing impairment, tobacco and alcohol consumption, and clinical assessment for stroke were completed.
Baseline and follow-up data were available for 327 people. Fifty people had significant cognitive decline at two-year follow-up. Having no formal education, low grip strength at baseline, being female and having depression at follow-up were independently associated with cognitive decline.
This is one of the first studies of cognitive decline conducted in SSA. Rates of decline at two years were relatively high. Future work should focus on identification of specific modifiable risk factors for cognitive decline with a view to developing culturally appropriate interventions.
W49 A is a star-forming region (SFR) found in the constellation of Aquila. It contains 3 active regions: W49 North (W49 N), W49 South West (W49 SW) and W49 South (W49 S). We present preliminary results from two epochs (e-)MERLIN observations of all ground-state OH masers towards the star-forming region (SFR) complex W49 A. The first epoch of observations was done in full-polarization mode with MERLIN in 2005 while the second epoch was obtained only in dual circular polarization during the test observations of the upgraded e-MERLIN in 2013. The overall maser spatial distributions in both epochs are in good agreement. We found several new high velocity maser features up to +34 km s−1 and −28 km s−1. The magnetic field strengths are between 1.1 to 10.8 mG. All three sources show evidence of magnetic field reversal.
Outstanding problems concerning mass-loss from evolved stars include initial wind acceleration and what determines the clumping scale. Reconstructing physical conditions from maser data has been highly uncertain due to the exponential amplification. ALMA and e-MERLIN now provide image cubes for five H2O maser transitions around VY CMa, at spatial resolutions comparable to the size of individual clouds or better, covering excitation states from 204 to 2360 K. We use the model of Gray et al. 2016, to constrain variations of number density and temperature on scales of a few au, an order of magnitude finer than is possible with thermal lines, comparable to individual cloud sizes or locally almost homogeneous regions. We compare results with the models of Decin et al. 2006 and Matsuura et al. 2014 for the circumstellar envelope of VY CMa; in later work this will be extended to other maser sources.
During the red supergiant (RSG) stage of massive star evolution, emission from dust and molecules allows the copious stellar winds to be studied in great detail. This help us understand not only the evolutionary stages of the star (which are highly dependent on mass loss rates), but also the morphology of the eventual supernova remnant. Maser emission from OH and H2O has been mapped with milli-arcsec resolution (using MERLIN and the EVN/global VLBI) around RSG including VY CMa, S Per and VX Sgr. The H2O masers originate in clouds accelerating away from the star and OH mainlines masers interleave the outer parts of the H2O maser shell. Zeeman splitting of OH maser lines reveals the orientation and strength of stellar-centred magnetic fields.
We have measured significant proper motions using the water maser clouds in the outflows from RT Vir (6 epochs) and VX Sgr (2 epochs). In both cases proper motions are measured in the bright emission found perpendicular to the OH emission. This strongly suggests latitude dependent mass-loss with the water masers tracing a dense equatorial outflow and the OH emission tracing a less dense polar outflow. In both cases the rotational velocities are < 1 km s−1 thus ruling out a strongly rotating circumstellar envelope. This suggests the outflow is not shaped by an orbiting companion. In the case of VX Sgr the proper motions are contained in a wedge perpendicular to the measured magnetic field axis, thus strongly suggesting that the magnetic field is helping to shape the mass outflow.
The proper motion results have thrown up a puzzle. For VX Sgr the material is being radially accelerated and material enters the water maser zone at 4 km s−1. This is consistent with the mass loss model of Bowen (1988). However the RT Vir proper motion results show no such radial acceleration. The masers have already received their acceleration before they reach the water maser zone at 3-AU (our numerical models seem to support the small radius). This was probably done in the pulsation zone. The acceleration mechanism is unclear for this source.
Regulatory impact analyses (RIAs) weigh the benefits of regulations against the burdens they impose and are invaluable tools for informing decision makers. We offer 10 tips for nonspecialist policymakers and interested stakeholders who will be reading RIAs as consumers.
1.Core problem: Determine whether the RIA identifies the core problem (compelling public need) the regulation is intended to address.
2.Alternatives: Look for an objective, policy-neutral evaluation of the relative merits of reasonable alternatives.
3.Baseline: Check whether the RIA presents a reasonable “counterfactual” against which benefits and costs are measured.
4.Increments: Evaluate whether totals and averages obscure relevant distinctions and trade-offs.
5.Uncertainty: Recognize that all estimates involve uncertainty, and ask what effect key assumptions, data, and models have on those estimates.
6.Transparency: Look for transparency and objectivity of analytical inputs.
7.Benefits: Examine how projected benefits relate to stated objectives.
8.Costs: Understand what costs are included.
9.Distribution: Consider how benefits and costs are distributed.
10.Symmetrical treatment: Ensure that benefits and costs are presented symmetrically.
Care-home residents with dementia can experience behavioural and psychological symptoms such as aggression, agitation, anxiety, wandering, calling out and sexual disinhibition. Care-home staff have a duty to keep residents safe. However, residents with dementia can pose particular challenges in this area. In this paper, we draw on a study which explored how care-home staff manage dementia-related behaviours. In-depth ethnographic case studies at four separate care homes were conducted in England. These involved interviews with 40 care-home staff and 384 hours of participant observation. Our analysis showed that some residents with dementia experience behaviours which can either create risks for, or negatively impact on, themselves and/or other residents or staff members. It emerged that the consequences of the behaviours, rather than the behaviours themselves, created difficulties for staff. To cope with the risk and impact of behaviours, staff employed multiple strategies such as surveillance, resident placement, restrictions and forced care. Using the data, we explore how actions taken by staff to manage the risk and impact of behaviours in these communal settings relate to residents’ human rights. Our findings have particular relevance for care-home staff who need support and guidance in this area, for service development worldwide and for the global ageing population whose valued human rights may become under threat, if they require long-term care.
In the above article (Paddick, 2017) The corresponding author's details were previously listed incorrectly. The correct details are; contact number +44 191 293 2709 and email address William.firstname.lastname@example.org. The original article has been updated with the correct contact details. The publishers apologise for any inconvenience and confusion this error has caused.
This study aimed to assess the feasibility of a low-literacy adaptation of the Alzheimer’s Disease Assessment Scale – Cognitive (ADAS-Cog) for use in rural sub-Saharan Africa (SSA) for interventional studies in dementia. No such adaptations currently exist.
Tanzanian and Nigerian health professionals adapted the ADAS-Cog by consensus. Validation took place in a cross-sectional sample of 34 rural-dwelling older adults with mild/moderate dementia alongside 32 non-demented controls in Tanzania. Participants were oversampled for lower educational level. Inter-rater reliability was conducted by two trained raters in 22 older adults (13 with dementia) from the same population. Assessors were blind to diagnostic group.
Median ADAS-Cog scores were 28.75 (interquartile range (IQR), 22.96–35.54) in mild/moderate dementia and 12.75 (IQR 9.08–16.16) in controls. The area under the receiver operating characteristic curve (AUC) was 0.973 (95% confidence interval (CI) 0.936–1.00) for dementia. Internal consistency was high (Cronbach’s α 0.884) and inter-rater reliability was excellent (intra-class correlation coefficient 0.905, 95% CI 0.804–0.964).
The low-literacy adaptation of the ADAS-Cog had good psychometric properties in this setting. Further evaluation in similar settings is required.
The majority of older adults with dementia live in low- and middle-income countries (LMICs). Illiteracy and low educational background are common in older LMIC populations, particularly in rural areas, and cognitive screening tools developed for this setting must reflect this. This study aimed to review published validation studies of cognitive screening tools for dementia in low-literacy settings in order to determine the most appropriate tools for use.
A systematic search of major databases was conducted according to PRISMA guidelines. Validation studies of brief cognitive screening tests including illiterate participants or those with elementary education were eligible. Studies were quality assessed using the QUADAS-2 tool. Good or fair quality studies were included in a bivariate random-effects meta-analysis and a hierarchical summary receiver operating characteristic (HSROC) curve constructed.
Forty-five eligible studies were quality assessed. A significant proportion utilized a case–control design, resulting in spectrum bias. The area under the ROC (AUROC) curve was 0.937 for community/low prevalence studies, 0.881 for clinic based/higher prevalence studies, and 0.869 for illiterate populations. For the Mini-Mental State Examination (MMSE) (and adaptations), the AUROC curve was 0.853.
Numerous tools for assessment of cognitive impairment in low-literacy settings have been developed, and tools developed for use in high-income countries have also been validated in low-literacy settings. Most tools have been inadequately validated, with only MMSE, cognitive abilities screening instrument (CASI), Eurotest, and Fototest having more than one published good or fair quality study in an illiterate or low-literate setting. At present no screening test can be recommended.
Cognitive stimulation therapy (CST) is a psychosocial group-based intervention for dementia shown to improve cognition and quality of life with a similar efficacy to cholinesterase inhibitors. Since CST can be delivered by non-specialist healthcare workers, it has potential for use in low-resource environments, such as sub-Saharan Africa (SSA). We aimed to assess the feasibility and clinical effectiveness of CST in rural Tanzania using a stepped-wedge design.
Participants and their carers were recruited through a community dementia screening program. Inclusion criteria were DSM-IV diagnosis of dementia of mild/moderate severity following detailed assessment. No participant had a previous diagnosis of dementia and none were taking a cholinesterase inhibitor. Primary outcomes related to the feasibility of conducting CST in this setting. Key clinical outcomes were changes in quality of life and cognition. The assessing team was blind to treatment group membership.
Thirty four participants with mild/moderate dementia were allocated to four CST groups. Attendance rates were high (85%) and we were able to complete all 14 sessions for each group within the seven week timeframe. Substantial improvements in cognition, anxiety, and behavioral symptoms were noted following CST, with smaller improvements in quality of life measures. The number needed to treat was two for a four-point cognitive (adapted Alzheimer's Disease Assessment Scale-Cognitive) improvement.
This intervention has the potential to be low-cost, sustainable, and adaptable to other settings across SSA, particularly if it can be delivered by non-specialist health workers.
Markarian 273 and Markarian 231 are ultra-luminous IR galaxies which show signs of merger activity. Their radio continuum and spectral line emission has been imaged on scales of tens of parsec using MERLIN. Mrk 273 and Mrk 231 are classed as Seyfert types 2 and 1 respectively. The distribution and velocity gradients shown by OH masers and HI absorption are consistent with material in a rotating disk or ring, with the axis at greater than 45° to the line of sight in Mrk 273, and at less than 45° to the line of sight in Mrk 231. We estimate the amount of mass enclosed and infer its distribution from irregularities in the maser morphologies and comparison with HI and radio continuum data.
The JD 16 was held on August 25, 1997 as one-day session with the title of “Spectroscopy with Large Telescope of Chemically Peculiar Stars”. It was supported by the Division IV and Commissions 14, 27, 29, 36, and 45.
The members of SOC were: G. Alecian, J. Babel, M. Gerbaldi, R. O. Gray, G. Mathys, P. North, M. Takada-Hidai (Chairperson), and J. Zverko (Co-chairperson).
15 talks and 18 contributed posters were presented on six topics of (1) model atmospheres and atomic data, (2) stellar parameters, (3) LTE and NLTE abundance analyses, (4) diffusion processes, (5) magnetic fields, and (6) variabilities. Approximate number of participants amounted to 50 at maximum.