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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.gray@nhct.nhs.uk. The original article has been updated with the correct contact details. The publishers apologise for any inconvenience and confusion this error has caused.
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.
Methods:
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.
Results:
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.
Conclusions:
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.
Recently, large-scale trials of behavioural interventions have failed to show improvements in pregnancy outcomes. They have, however, shown that lifestyle support improves maternal diet and physical activity during pregnancy, and can reduce weight gain. This suggests that pregnancy, and possibly the whole periconceptional period, represents a ‘teachable moment’ for changes in diet and lifestyle, an idea that was made much of in the recent report of the Chief Medical Officer for England. The greatest challenge with all trials of diet and lifestyle interventions is to engage people and to sustain this engagement. With this in mind, we propose a design of intervention that aims simultaneously to engage women through motivational conversations and to offer access to a digital platform that provides structured support for diet and lifestyle change. This intervention design therefore makes best use of learning from the trials described above and from recent advances in digital intervention design.
As in many other African countries, tobacco in Kenya began as a product of British colonialism. In 1907, British American Tobacco (BAT) established a base in Mombasa, Kenya from which to market and distribute tobacco products in what are now Kenya, Uganda, Tanzania and the Democratic Republic of Congo. The establishment of a market for cigarettes in East Africa prompted the opening of a cigarette factory in Jinja, Uganda. By 1948, it was the largest in the region. After a series of expansions, including the purchase of the East African Tobacco Company in Tanzania, BAT opened a cigarette factory in Nairobi in 1957. Other companies eventually set up their own manufacturing centers. Kenya is currently the cigarette manufacturing and distribution hub for 17 African countries (Wanyonyi and Kimosop nd.; Kweyuh 1994; Patel et al. 2007).
To ensure a steady supply of raw tobacco leaf, BAT and other manufacturers created a system of contract buying with farmers. This involved the creation of tobacco markets, the supply of inputs and access to technical training and credit. These arrangements were modeled on similar systems in place for tea and sugarcane production and stimulated tobacco growing throughout the region. The industry that manufactures tobacco products in Kenya currently draws on tobacco production in Kenya, Uganda, Tanzania and Malawi. Despite international efforts to control tobacco use and production in Africa, the industry is also expanding into new areas such as South Sudan where tobacco production is set to begin on a large scale.
Seven (21%) of 34 patients with a severe DSM-III diagnosis of major depression had red-cell folate levels below 150 ng/ml. This subgroup with folate deficiency had significantly lower CSF 5-hydroxyindoleacetic acid (5HIAA) compared to neurological controls. For all depressed patients red-cell folate was significantly correlated with CSF 5HIAA and homovanillic acid (HVA). CSF tetrahydrobiopterin (BH4) was significantly correlated with CSF 5HIAA and HVA and red-cell folate. Our observations provide further evidence of the links between folate, biopterin and monoamine metabolism in depression.
Device quality single crystals of potassium titanyl phosphate (KTP) have been grown using a top seeded solution growth method which incorporates a crystal weighing facility and which takes advantage of saturation temperatures well below the accepted transition temperature of this material. Weight and crucible temperature data are received and displayed on a monitoring computer in the form of a growth profile. Results obtained from the growth programme are discussed including the effect of very slow cooling (< 0.03 °C/hr) on the control of growth quality and a study of growth defects using x-ray diffraction topography carried out using synchrotron radiation. Variations on the standard K6P4O13 flux were investigated, including the addition of CeO2 to improve optical transmission and the use of K7P3O11 as an alternative growth solution.
The 2-dimensional electron gas (2DEG) in an Al0.6Ga0.4Sb/InAs single quantum well (SQW) is studied using cyclotron resonance (CR) and Shubnikov - de Haas (SdH) techniques. SdH results show spin-splitting in Landau levels at magnetic field strength (B) as low as 1.5T. The effective mass (m*) of the 2DEG was obtained from the peak positions of the CR transmission spectra. The results exhibit oscillatory behavior as a function of B. The m* value extracted from die temperature dependence of the SdH oscillations is in good agreement with the average value of m* obtained from CR measurements. The effective mass is calculated as a function of B using an electron self-energy model based on the Hartree-Fock approximation. The calculated m* values also show oscillatory behavior similar to that of the measured CR m*. Both experiment and theory show that m* maxima are shifted from the integral values (both odd and even) of the filling factors.
The diffusion and activation of implanted boron in silicon during rapid thermal annealing (RTA) has been studied using the analytical techniques of SIMS, TEM, and sheet resistance measurements. Both crystalline and pre-amorphised silicon substrates were investigated. Data analysis in conjunction with a range of numerical models indicates some novel features of boron RTA, as well as accounting for previously observed features. In particular, a large transient diffusion enhancement coupled with an increase of electrical activity, are seen at short anneal times, in the case of crystalline silicon substrates. A non-equilibrium diffusion enhancement of a different type is also seen at much longer times, in both crystalline and pre-amorphised samples implanted to high doses. This second enhancement persists after all the precipitated boron formed on implantation has become substitutional. TEM studies show that the transient enhancement may be associated with the evolution of extended defect structures during the early stages of annealing. Both types of enhancement can be well represented by multiplying the ‘normal’ concentration-dependent diffusivity (with β=0.5) by a factor f>1.
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