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Problem Management Plus (PM+) is a brief multicomponent intervention incorporating behavioral strategies delivered by lay health workers. The effectiveness of PM+ has been evaluated in randomized controlled trials in Kenya and Pakistan. When developing interventions for large-scale implementation it is considered essential to evaluate their feasibility and acceptability in addition to their efficacy. This paper discusses a qualitative evaluation of PM+ for women affected by adversity in Kenya.
Qualitative interviews were conducted with 27 key informants from peri-urban Nairobi, Kenya, where PM+ was tested. Interview participants included six women who completed PM+, six community health volunteers (CHVs) who delivered the intervention, seven people with local decision making power, and eight project staff involved in the PM+ trial.
Key informants generally noted positive experiences with PM+. Participants and CHVs reported the positive impact PM+ had made on their lives. Nonetheless, potential structural and psychological barriers to scale up were identified. The sustainability of CHVs as unsalaried, volunteer providers was mentioned by most interviewees as the main barrier to scaling up the intervention.
The findings across diverse stakeholders show that PM+ is largely acceptable in this Kenyan setting. The results indicated that when further implemented, PM+ could be of great value to people in communities exposed to adversities such as interpersonal violence and chronic poverty. Barriers to large-scale implementation were identified, of which the sustainability of the non-specialist health workforce was the most important one.
Fossil tree resins preserve a wide range of animals, plants, fungi and microorganisms in microscopic fidelity. Fossil organisms preserved in an individual piece of amber lived at the same time in Earth history and mostly even in the same habitat, but they were not necessarily parts of the same interacting community. Here, we report on an in situ preserved corticolous community from a piece of Miocene Dominican amber which is composed of a lichen, a moss and three species of leafy liverworts. The lichen is assigned to the extant genus Phyllopsora (Ramalinaceae, Lecanoromycetes) and is described as P.magna Kaasalainen, Rikkinen & A. R. Schmidt sp. nov. The moss, Aptychellites fossilis Schäf.-Verw., Hedenäs, Ignatov & Heinrichs gen. & sp. nov., closely resembles the extant genus Aptychella of the family Pylaisiadelphaceae. The three leafy liverworts comprise the extinct Lejeuneaceae species Cheilolejeunea antiqua (Grolle) Ye & Zhu, 2010 and Lejeunea miocenica Heinrichs, Schäf.-Verw., M. A. M. Renner & G. E. Lee sp. nov. and the extinct Radulaceae species Radula intecta M. A. M. Renner, Schäf.-Verw. & Heinrichs sp. nov. The presence of five associated extinct cryptogam species, four of which belong to extant genera, further substantiates the notion of a stasis in morphotype diversity, but a certain turnover of species, in the Caribbean since the early Miocene.
Introduction/Innovation Concept: Medical simulation is becoming increasingly useful for healthcare education. Simulation-based crisis resource management (CRM) has been shown to produce improvements in skill acquisition, communication and team behaviors. Simulation has become a key component of most Family Practice (FP) residency programs and many programs are moving towards developing formal simulation curriculums. The Coastal FP Residency is a relatively new and unique program with a large emphasis on rural medicine. Graduates have gone on to practice in remote areas with less access to supports for critically ill patients. Therefore, an effective simulation curriculum, focused on Emergency Medicine, is of great importance to this program. Methods: To develop our curriculum, Kern’s framework for medical education was selected given its prior success in similar endeavors. The first step of this approach involves a needs assessment, which we accomplished in the form of an online survey. The questionnaire included pre-defined topics pertaining to the training needs of FP Residents destined for Rural Practice with respect to technical skills, CRM skills, specific medical conditions and categories of medical conditions. Classification of answers included multiple choice, 5-point Likert scales as well as an option for free-text answers. The survey was distributed to pre-identified participants including stakeholders/educators within the Coastal FP residency program as well as simulation education leads for FP residencies throughout British Columbia (BC). Current residents, as well as program graduates were also asked to complete the survey. Curriculum, Tool, or Material: The results of this survey were used to develop formal goals and objectives which were in turn used to write or adapt 24 cases for the curriculum. Cases from categories (e.g. Pediatrics) rated as “Extremely Important” on the Likert scale were included proportionally more in the curriculum. The cases were also designed to assess/practice a higher proportion of CRM elements considered important and to address commonly identified difficulties in resuscitation. Cases were developed, where possible, using local or national guidelines and are currently in the stage of peer review (by a minimum of two peers). Conclusion: The curriculum will be implemented in July 2017 and we will transition towards the evaluation phase. Our goal is to develop and distribute formalized needs assessments to rural FP residencies across BC so that they may develop dynamic, formal curriculums of their own.
The up to 60 m thick Neurath Sand (Serravallian, late middle Miocene) is one of several marine sands in the Lower Rhine Basin which were deposited as a result of North Sea transgressive activity in Cenozoic times. The shallow-marine Neurath Sand is well exposed in the Garzweiler open-cast mine, which is located in the centre of the Lower Rhine Basin. Detailed examination of three sediment profiles extending from the underlying Frimmersdorf Seam via the Neurath Sand and through to the overlying Garzweiler Seam, integrating both sedimentological and palaeontological data, has enabled the depositional setting of the area to be reconstructed.
Six subenvironments are recognised in the Neurath Sand, commencing with the upper shoreface (1) sediments characterised by glauconite-rich sands and an extensive biota (Ophiomorpha ichnosp.). These are associated with the silt-rich sands of a transitional subenvironment (2), containing Skolithos linearis, Planolites ichnosp. and Teichichnus ichnosp. These silt-rich sands grade up to the upper shoreface subenvironment (1), which is indicative of an initial regressive trend. The overlying intertidal deposits can be subdivided into a lower breaker zone (3), characterised by ridge-and-runnel systems, and the swash zone (4) where the surge and backwash of waves resulted in the deposition of high-energy laminites. The intertidal deposits were capped by aeolian backshore sediments (5). Extensive root traces present in this latter subenvironment reflect the development of the overlying peatland (i.e. Garzweiler Seam). Within the Garzweiler Seam, restricted sand lenses indicate a lagoonal or estuarine depositional environment (6). Regional correlation with adjacent wells establishes that shallow-marine conditions were widespread across the Lower Rhine Basin in middle Serravallian times. The shoreline profile, characterised by both tidal and wave activity and influenced by fluvial input from the adjacent Rhenish Massif, is indicative of the complexity of the coastal depositional setting within the Lower Rhine Basin.
We describe a versatile infrared camera/spectrograph, IRIS, designed and constructed at the Anglo-Australian Observatory for use on the Anglo-Australian Telescope. A variety of optical configurations can be selected under remote control to provide several direct image scales and a few low-resolution spectroscopic formats. Two cross-dispersed transmission echelles are of novel design, as is the use of a modified Bowen-Burch system to provide a fast f/ratio in the widest-field option. The drive electronics includes a choice of readout schemes for versatility, and continuous display when the array is not taking data, to facilitate field acquisition and focusing.
The linearity of the detector has been studied in detail. Although outwardly good, slight nonlinearities prevent removal of fixed-pattern noise from the data without application of a cubic linearising function.
Specific control and data-reduction software has been written. We describe also a scanning mode developed for spectroscopic imaging.
We present preliminary results of models of terrestrial planet formation using on the one hand classical numerical integration of hundreds of small bodies on CPUs and on the other hand—for comparison—the results of our GPU code with thousands of small bodies which then merge to larger ones. To be able to determine the outcome of collision events we use our smooth particle hydrodynamics (SPH) code which tracks how water is lost during such events.
Cryptosporidium, a parasite known to cause large drinking and recreational water outbreaks, is tolerant of chlorine concentrations used for drinking water treatment. Human laboratory-based surveillance for enteric pathogens detected a cryptosporidiosis outbreak in Baker City, Oregon during July 2013 associated with municipal drinking water. Objectives of the investigation were to confirm the outbreak source and assess outbreak extent. The watershed was inspected and city water was tested for contamination. To determine the community attack rate, a standardized questionnaire was administered to randomly sampled households. Weighted attack rates and confidence intervals (CIs) were calculated. Water samples tested positive for Cryptosporidium species; a Cryptosporidium parvum subtype common in cattle was detected in human stool specimens. Cattle were observed grazing along watershed borders; cattle faeces were observed within watershed barriers. The city water treatment facility chlorinated, but did not filter, water. The community attack rate was 28·3% (95% CI 22·1–33·6), sickening an estimated 2780 persons. Watershed contamination by cattle probably caused this outbreak; water treatments effective against Cryptosporidium were not in place. This outbreak highlights vulnerability of drinking water systems to pathogen contamination and underscores the need for communities to invest in system improvements to maintain multiple barriers to drinking water contamination.
Main Belt Comets (MBCs) have attracted a great deal of interest since their identification as a new class of bodies by Hsieh and Jewitt in 2006. Much of this interest is due to the implication that MBC activity is driven by the sublimation of volatile material (presumed to be water-ice) presenting these bodies as probable candidates for the delivery of a significant fraction of Earth's water. Results of the studies of the dynamics of MBCs suggest that these objects might have formed in-situ as the remnants of the break-up of large icy asteroids. Simulations also show that collisions among MBCs and small objects could have played an important role in triggering the cometary activity of these bodies. Such collisions might have exposed sub-surface water-ice which sublimated and created thin atmospheres and tails around MBCs. In order to drive the effort of understanding the nature of the activation of MBCs, we have investigated these collision processes by simulating the impacts in detail using a smooth particle hydrodynamics (SPH) approach that includes material strength and fracture models. We have carried out simulations for a range of impact velocities and angles, allowing m-sized impactors to erode enough of an MBC's surface to expose volatiles and trigger its activation. Impact velocities were varied between 0.5 km/s and 5.3 km/s, and the projectile radius was chosen to be 1 m. As expected, we observe significantly different crater depths depending on the impact energy, impact angle, and MBC's material strength. Results show that for all values of impact velocity and angle, crater depths are only a few meters, implying that if the activity of MBCs is due to the sublimation of water-ice, ice has to exist in no deeper than a few meters from the surface. We present details of our simulations and discuss the implications of their results.
A compact navigation receiver comprising a decoupled and matched four-element L1-band antenna array with an inter-element separation of a quarter of the free-space wavelength is presented in this paper. We investigate the impact of the decoupling and matching network on the robustness of the navigation receiver. It is observed that in order to achieve high robustness with a compact antenna array, it is necessary to employ a decoupling and matching network, particularly in case of three spatially separated interferers. Furthermore, we study the influence of the polarization impurity of the compact planar antenna array on the equivalent carrier-to-interference-plus-noise ratio (CINR) of the receiver when impinged with different numbers of diametrically polarized interference signals. It is shown that the higher-order modes possess strong polarization impurity, which may halve the available degrees-of-freedom for nulling in the presence of linear-polarized interferers, using a conventional null-steering algorithm. We verify the robustness of the designed compact receiver by means of a complete global-navigation-satellite-system demonstrator. It is shown that the maximum jammer power that is allowed us to maintain the CINR above 38 dBHz with three interferers can be improved by more than 10 dB if a decoupling and matching network is employed.
The aim of this study was to evaluate the purine levels of lambs experimentally infected with Haemonchus contortus. A total of 12 healthy lambs were divided into two groups, composed of 6 animals each: Group A represented the healthy animals (uninfected), while in Group B the animals were infected with 15 000 larvae of H. contortus. Blood was drawn on days 15, 45 and 75 post-infection (PI) in order to perform the purine analysis (ATP, ADP, AMP, adenosine, inosine, hypoxanthine, xanthine and uric acid) by high pressure liquid chromatography (HPLC) in serum. On day 15 PI a significant (P<0·05) increase in the levels of ATP and inosine was observed in the infected animals, unlike the levels of ADP, adenosine, xanthine and uric acid which were reduced. On day 45 PI a significant (P<0·05) increase in the ATP and xanthine levels in infected animals was observed, contrasting with reduced levels of ADP and uric acid. Finally, on day 75 PI an increase occurred in the levels of ATP, adenosine and hypoxanthine in infected lambs, concomitant with a reduction in the levels of ADP and uric acid (P<0·05). These changes in purine levels may influence the inflammatory process and the pathological events.
For advanced high strength steels for automotive application, the time between materials development and regular use in cars, trucks and similar vehicles is rather short. In contradiction to this, hot rolled plates made of high strength low alloy steels which have been developed many years ago still do not find application fields in structural steelwork although they offer impressive mechanical properties. In this paper we argue that inadequate design rules in civil and mechanical engineering prevent such modern high strength steels from displaying their lightweight potential. A technological approach to the problem presented in this paper is to apply damage mechanics models together with probabilistic safety concepts for derivation of new improved safety factors. However, a major obstacle in this process is that these new safety factors will have to be included in the design standards. The development of such standards contains both institutional and epistemic obstacles to including alternative safety models. Taking standardization in Europe as an example, the standardization committee is characterized by both national interest representation and attempts to stimulate European integration and competitiveness. At the epistemic level, different understandings of what counts as evidence for material safety may challenge and postpone adoption of new calculative models. Institutionalization and epistemology thus contribute to a framework for standardization that needs to be questioned in order for new approaches to be accepted. Such questioning cannot be done on the basis of developing new calculation models alone, but needs a clear social component of building coalitions around the inclusion of new considerations, for example those related to sustainability.
Cannabis varies considerably in levels of its two major constituent cannabinoids – (delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Recently, we found evidence that those who smoked cannabis containing detectable levels of CBD had fewer psychotic-like symptoms than those whose cannabis had no CBD. The present study aimed, first, to replicate those findings and, second, to determine whether protective effects of CBD may extend to other harms of cannabis, such as memory impairment and reduced psychological well-being.
A total of 120 current cannabis smokers, 66 daily users and 54 recreational users were classified into groups according to whether analysis of their hair revealed the presence or absence of CBD and high versus low levels of THC. All were assessed on measures of psychosis-like symptoms, memory (prose recall; source memory) and depression/anxiety.
Lower psychosis-like symptoms were found in those whose hair had CBD compared with those without. However, this was seen only in recreational users, who had higher levels of THC in their hair. Higher THC levels in hair were associated with increased depression and anxiety. Prose recall and source memory were poorer in daily users with high THC levels in hair while recognition memory was better in individuals with CBD present in hair.
CBD attenuates the psychotic-like effects of cannabis over time in recreational users. Higher THC negatively impacts on memory and psychological well-being. These findings raise concerns for the harms stemming from use of varieties such as ‘skunk’ (sensimillia), which lack any CBD but currently dominate the supply of cannabis in many countries.
Samples of Fe66Co18B15Si1, Fe40Ni38Mo4B18 and Fe72.6Cr22Al4.8Si0.3Y0.3 metallic glasses were irradiated with a pulsed alexandrite laser (λ=750 nm, τ=60 μs) using different laser fluences. Irradiation-induced structural and property modifications were characterized using Mössbauer spectroscopy. Complementary information was obtained from hysteresis loop measurements and scanning electron microscopy (SEM). The experimental data obtained demonstrate the key role played by the magnetostriction constant in explaining the mechanism of irradiation-induced phase transformations in amorphous magnets.
Using an improved version of the thermal pulse (TP) method for determining electric field profiles and thermal parameters, we have obtained for the first time field profiles in 1.7 μm thick polyimide (PI) films spin-coated on Si wafers. As-coated films were found to have an internal field caused by negative charges within 200 nm of the free (pulsed) surface believed due to electrochemical reactions involving water. The change near the pulsed surface was stable up to 200 °C and would not be switched by applied fields of ±1 V/μm. The charge distribution and the thermal parameters were found to be sensitive to humidity
Rapid Thermal Annealing (RTA) is indispensable for the formation of ultra-shallow source/drain junctions. To improve the annealing conditions, a fundamental understanding of the influences on the diffusion/activation process is necessary. Ion implantations of 1 keV boron at a dose of Φ≈1 I.1015 cm-2 are annealed in a SHS2800E RTP-system under controlled concentrations of oxygen in nitrogen ambient (0-1 ppm up to 1%). Concentration-depth profiles, measured by Secondary Ion Mass Spectroscopy (SIMS), are simulated within the framework of the kickout model involving diffusion enhancement via supersaturation of silicon self-interstitials. The validity of this interpretation is supported by the simulated results which are in good agreement with expenimental data. After RTA for 10 s at 1050°C the junctions are varying within a range of 800Å to 1400Ådepending on the annealing ambient. The results of the simulation yield finite values of self-interstitial supersaturation as a function of the oxygen concentration.
We report the fabrication of an amorphous silicon based fluorescence sensor for miniaturized total analysis systems along with experimental results on optical excitation and detection elements. The pin-photodiode exhibits a dynamic range of 110dB and a room temperature dark current of less than 3000 charge carriers per ms according to a detector area of 0.1256mm2. The spectral response is ranging from 320nm to 780nm with a maximum at 600nm @ 80% quantum efficiency. To provide high sensitivity, the excitation light irradiates the fluid orthogonally to the active sensor detection direction by means of specifically designed microfluidic capillaries filled with e.g. methylene iodide or 1,2-o-dibrombenzene. The liquid core, which is enclosed by solid cladding materials, has been calculated to dimensions of a width of 16.75µm or 59.67µm with a height from 15µm to 50µm according to a number of propagating modes inside of 16 or 57, respectively.