To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Adolescents with depression need access to culturally relevant psychological treatment. In many low- and middle-income countries treatments are only accessible to a minority. We adapted group interpersonal therapy (IPT) for adolescents to be delivered through schools in Nepal. Here we report IPT's feasibility, acceptability, and cost.
We recruited 32 boys and 30 girls (aged 13–19) who screened positive for depression. IPT comprised of two individual and 12 group sessions facilitated by nurses or lay workers. Using a pre-post design we assessed adolescents at baseline, post-treatment (0–2 weeks after IPT), and follow-up (8–10 weeks after IPT). We measured depressive symptoms with the Depression Self-Rating Scale (DSRS), and functional impairment with a local tool. To assess intervention fidelity supervisors rated facilitators' IPT skills across 27/90 sessions using a standardised checklist. We conducted qualitative interviews with 16 adolescents and six facilitators post-intervention, and an activity-based cost analysis from the provider perspective.
Adolescents attended 82.3% (standard deviation 18.9) of group sessions. All were followed up. Depression and functional impairment improved between baseline and follow-up: DSRS score decreased by 81% (95% confidence interval 70–95); functional impairment decreased by 288% (249–351). In total, 95.3% of facilitator IPT skills were rated superior/satisfactory. Adolescents found the intervention useful and acceptable, although some had concerns about privacy in schools. The estimate of intervention unit cost was US $96.9 with facilitators operating at capacity.
School-based group IPT is feasible and acceptable in Nepal. Findings support progression to a randomised controlled trial to assess effectiveness and cost-effectiveness.
The demand for cobalamin (vitamin B12) and folate is increased during pregnancy, and deficiency during pregnancy may lead to complications and adverse outcomes. Yet, the status of these micronutrients is unknown in many populations. We assessed the concentration of cobalamin, folate and their functional biomarkers, total homocysteine (tHcy) and methylmalonic acid (MMA), in 561 pregnant women enrolled in a community-based randomised controlled trial in Bhaktapur, Nepal. Plasma concentrations of cobalamin, folate, tHcy and MMA were measured and a combined indicator of vitamin B12 status (3cB12) was calculated. We report mean or median concentrations and the prevalence of deficiency according to commonly used cut-offs, and assessed their association with indicators of socio-economic status, and maternal and dietary characteristics by linear regression. Among the women at gestational week less than 15, deficiencies of cobalamin and folate were seen in 24 and 1 %, respectively. Being a vegetarian was associated with lower plasma cobalamin, and a higher socio-economic status was associated with a better micronutrient status. We conclude that cobalamin deficiency defined by commonly used cut-offs was common in Nepalese women in early pregnancy. In contrast, folate deficiency was rare. As there is no consensus on cut-off points for vitamin B12 deficiency during pregnancy, future studies are needed to assess the potential functional consequences of these low values.
Psychological interventions that are brief, acceptable, effective and can be delivered by non-specialists are especially necessary in low- and middle-income countries, where mental health systems are unable to address the high level of psychosocial needs. Problem Management Plus (PM+) is a five-session intervention designed for those impaired by psychological distress while living in communities affected by adversity. Individual PM+ has demonstrated effectiveness in reducing distress in Kenya and Pakistan, and a group version of PM+ (Group PM+) was effective for conflict-affected women in Pakistan. This paper describes a feasibility and acceptability trial of locally adapted Group PM+ for women and men in an earthquake-affected region of rural Nepal.
In this feasibility cluster randomised controlled trial, participants in the experimental arm were offered five sessions of Group PM+ and participants in the control arm received enhanced usual care (EUC), which entailed brief psycho-education and providing referral options to primary care services with health workers trained in the mental health Gap Action Programme Intervention Guide (mhGAP-IG). A mixed-methods design was used to assess the feasibility and acceptability of Group PM+. Feasibility was assessed with criteria including fidelity and retention of participants. Acceptability was assessed through in-depth interviews with participants, family members, programme staff and other stakeholders. The primary clinical outcome was depression symptoms assessed using the Patient Health Questionnaire (PHQ-9) administered at baseline and 8–8.5 weeks post-baseline (i.e. after completion of Group PM+ or EUC).
We recruited 121 participants (83% women and 17% men), with equal allocation to the Group PM+ and EUC arms (1:1). Group PM+ was delivered over five 2.5–3 hour sessions by trained and supervised gender-matched local non-specialists, with an average attendance of four out of five sessions. The quantitative and qualitative results demonstrated feasibility and acceptability for non-specialists to deliver Group PM+. Though the study was not powered to assess for effectiveness, for all five key outcome measures, including the primary clinical outcome, the estimated mean improvement was larger in the Group PM+ arm than the EUC arm.
The intervention and trial procedures were acceptable to participants, family members, and programme staff. The communities and participants found the intervention to be beneficial. Because feasibility and acceptability were established in this trial, a fully powered randomised controlled trial will be conducted for larger scale implementation to determine the effectiveness of the intervention in Nepal.
To measure the role of water, sanitation and hygiene (WASH) practices on recovery from stunting and assess the role of timing of stunting on the reversal of this phenomenon
Data from the MAL-ED multi-country birth cohort study was used for the current analysis. Generalised linear mixed-effects models were used to estimate the probability of reversal of stunting with WASH practice and timing of stunting as the exposures of interest.
Seven different countries across three continents.
A total of 612 children <2 years of age.
We found that not WASH practice but timing of stunting had statistically significant association with recovery from stunting. In comparison with the children who were stunted at 6 months, children who were stunted at 12 months had 1·9 times (β = 0·63, P = 0·03) more chance of recovery at 24 months of age. And, children who were stunted at 18 months of age even had higher odds (adjusted OR = 3·01, β = 1·10, P < 0·001) of recovery than children who were stunted at 6 months. Additionally, mother’s height (β = 0·59, P = 0·04) and household income (β = 0·02, P < 0·05) showed statistically significant associations with the outcome.
The study provided evidence for the role of timing of stunting on the recovery from the phenomenon. This novel finding indicates that the programmes to promote linear growth should be directed at the earliest possible timepoints in the course of life.
When tuberculosis (TB) and depression co-occur, there is greater risk for comorbidities, disability, suffering, and health-related costs. Depression is also associated with poor treatment adherence in patients with TB. The major aim of this study was to assess the symptoms of depression and associated factors among TB patients currently receiving directly observed treatment short-course (DOTS) treatment.
A cross-sectional study was conducted among TB patients currently undergoing treatment in 27 DOTS centers in three districts of Kathmandu Valley. The study included 250 TB patients within 2 months of treatment initiation, aged 18 years and above. The previously validated Nepali Patient Health Questionnaire (PHQ-9) was used to screen for depression and semi-structured interviews were conducted to collect socio-demographic information and other factors related to TB and/or depression. Data analysis was conducted using IBM SPSS Statistics version 20.
The study found the mean PHQ Score to be 2.84 (s.d. 4.92, range 0–25). Among the respondents, 10% (n = 25) had PHQ-9 scores ⩾10, suggestive of probable depression. Multivariate linear regression indicated that depressive symptoms were significantly associated with being separated/widowed/divorced (p = 0.000) and having lower education (0.003). In addition, smoking (p = 0.02), alcohol use (p = 0.001), and experience of side effects from TB medications (p = 0.001) were risk factors for higher PHQ-9 scores.
Our findings suggest that patients on TB treatment have higher risk of depression and efforts should be made by the National Tuberculosis Program to address this issue.
Viral pneumonia is an important cause of death and morbidity among infants worldwide. Transmission of non-influenza respiratory viruses in households can inform preventative interventions and has not been well-characterised in South Asia. From April 2011 to April 2012, household members of pregnant women enrolled in a randomised trial of influenza vaccine in rural Nepal were surveyed weekly for respiratory illness until 180 days after birth. Nasal swabs were tested by polymerase chain reaction for respiratory viruses in symptomatic individuals. A transmission event was defined as a secondary case of the same virus within 14 days of initial infection within a household. From 555 households, 825 initial viral illness episodes occurred, resulting in 79 transmission events. The overall incidence of transmission was 1.14 events per 100 person-weeks. Risk of transmission incidence was associated with an index case age 1–4 years (incidence rate ratio (IRR) 2.35; 95% confidence interval (CI) 1.40–3.96), coinfection as initial infection (IRR 1.94; 95% CI 1.05–3.61) and no electricity in household (IRR 2.70; 95% CI 1.41–5.00). Preventive interventions targeting preschool-age children in households in resource-limited settings may decrease the risk of transmission to vulnerable household members, such as young infants.
Langmuir circulation, a key turbulent process in the upper ocean, is mechanistically driven and sustained by imposed atmospheric wind stress and surface wave drift. In addition, and specifically in coastal zones, the presence of a mean current – whether associated with tidal currents or large-scale eddies – generates bottom-boundary-layer shear, which further modulates the physical attributes of coastal-zone Langmuir turbulence. We show that the presence of bottom-boundary-layer shear generated by oblique forcing between the mean current, atmospheric drag, and monochromatic wave field direction changes the orientation of the resultant, large-scale Langmuir cells. A model to predict this resultant orientation, based on salient parameters defining the forcing obliquity, is proposed. We also perform a systematic parametric study to isolate the ‘turning’ influence of salient parameters, which reveals that the resultant Langmuir cell orientation is always intermediate to the imposed forces. In order to provide a rigorous basis for the results, we study terms responsible for sustenance of streamwise vorticity, and provide a theoretical justification for the observed results.
We present a broad study of linear, clustered, noble gas puffs irradiated with the frequency doubled (527 nm) Titan laser at Lawrence Livermore National Laboratory. Pure Ar, Kr, and Xe clustered gas puffs, as well as two mixed-gas puffs consisting of KrAr and XeKrAr gases, make up the targets. Characterization experiments to determine gas-puff density show that varying the experimental parameter gas-delay timing (the delay between gas puff initialization and laser-gas-puff interaction) provides a simple control over the gas-puff density. X-ray emission (>1.4 keV) is studied as a function of gas composition, density, and delay timing. Xe gas puffs produce the strongest peak radiation in the several keV spectral region. The emitted radiation was found to be anisotropic, with smaller X-ray flux observed in the direction perpendicular to both laser beam propagation and polarization directions. The degree of anisotropy is independent of gas target type but increases with photon energy. X-ray spectroscopic measurements estimate plasma parameters and highlight their difference with previous studies. Electron beams with energy in excess of 72 keV are present in the noble gas-puff plasmas and results indicate that Ar plays a key role in their production. A drastic increase in harder X-ray emissions (X-ray flash effect) and multi-MeV electron-beam generation from Xe gas-puff plasma occurred when the laser beam was focused on the front edge of the linear gas puff.
We present the defect analysis by photoluminescence (PL) spectroscopy of CdSexTe1-x thin films, grown with varying Se content by a co-sputtered deposition method. We observe a peak at 1.203 eV in the CdSexTe1-x film for x = 0.21, which shifts towards higher energies with increase in laser power. This peak was assigned to a donor-to-acceptor (DAP) transition, with a measured j-shift of ∼4.7 meV/decade. Temperature dependent PL intensity measurements confirm that the observed DAP peak involves a shallow defect state of binding energy ∼34.7 meV. In contrast, a free-to-bound (FB) peak at 1.294 eV involving a shallow defect of binding energy ∼18.3 meV was observed in the CdSexTe1-x film for x = 0.14. Additionally, we observe band edge emission at 1.452 eV and 1.448 eV in CdSexTe1-x films for x = 0.14 and x = 0.21 respectively. Our analysis shows that the Se concentration not only changes the band gap energy of the resulting CdSexTe1-x alloy thin film, but also modifies the nature of the dominant observed defect emission.
Methods of obtaining large grain size and high crystallinity in absorber materials play an important role in fabrication of high-performance methylammonium lead iodide (MAPbI3) perovskite solar cells. Here we study the effect of adding small concentrations of Cd2+, Zn2+, and Fe2+salts to the perovskite precursor solution used in the single-step solution fabrication process. Enhanced grain size and crystallinity in MAPbI3 films were obtained by using 0.1% of Cd2+ or Zn2+in the precursor solution. Consequently, solar cells constructed with Cd- and Zn-doped perovskite films show a significant improvement in device performance. These results suggest that the process may be an effective and facile method to fabricate high-efficiency perovskite photovoltaic devices.
Photoluminescence (PL) spectroscopy has been used to study the defect levels in thin film copper indium diselenide (CuInSe2, CIS) which we are developing as the absorber layer for the bottom cell of a monolithically grown perovskite/CuInSe2 tandem solar cell. Temperature and laser power dependent PL measurements of thin film CIS for two different Cu/In ratios (0.66 and 0.80) have been performed. The CIS film with Cu/In = 0.80 shows a prominent donor-to-acceptor peak (DAP) involving a shallow acceptor of binding energy ∼22 meV, with phonon replica at ∼32 meV spacing. In contrast, PL measurement of CIS film for Cu/In = 0.66 taken at 20 K exhibited an asymmetric and broad PL spectrum with peaks at 0.845 eV and 0.787 eV. Laser intensity dependent PL revealed that the observed peaks 0.845 eV and 0.787 eV shift towards higher energy (aka j-shift) at ∼11.7 meV/decade and ∼ 8 meV/decade with increase in laser intensity respectively. The asymmetric and broad spectrum together with large j-shift suggests that the observed peaks at 0.845 eV and 0.787 eV were related to band-to-tail (BT) and band-to-impurity (BI) transition, respectively. Such a band-tail-related transition originates from the potential fluctuation of defect states at low temperature. The appearance of band related transition in CIS film with Cu/In = 0.66 is the indicator of the presence of large number of charged defect states.
The present study aimed to assess infant and young child feeding (IYCF) practices and the tracking of dietary diversity score (DDS), intakes of Fe- and vitamin A-rich foods and meal frequency in a peri-urban area in Nepal. Furthermore, to explore whether sociodemographic factors were associated with tracking patterns of these IYCF practices.
Longitudinal study. Monthly food intake was measured by 24 h recall. Four time slots were used (9–12, 13–16, 17–20 and 21–24 months). Tracking of IYCF practices was investigated using generalized estimating equations (GEE) models and Cohen’s weighted kappa. Multinominal logistic regression was used to identify determinants for tracking of the IYCF practices.
Bhaktapur municipality, Nepal.
Children (n 229) aged 9–24 months, randomly selected.
Prevalence of minimum meal frequency was higher than for minimum dietary diversity at all time slots. Tracking based on absolute measures (GEE models) was moderate for DDS (0·48) and meal frequency (0·53), and low for intakes of Fe- (0·23) and vitamin A-rich (0·35) foods. Tracking based on rank measured was moderate for DDS and meal frequency, and fair for Fe- and vitamin A-rich foods. Low socio-economic status significantly increased the odds (OR; 95 % CI) of tracking of low v. high DDS (3·31; 1·44, 7·60) and meal frequency (3·46; 1·54, 7·76).
Low tracking for intakes of Fe- and vitamin A-rich foods implies that interventions to improve these IYCF practices must address underlying causes for irregular intake to have sustainable effects.
The electrical characteristics of Au/Ni/Ti/ n-SiC contacts have been examined as a function of implant dose (1013-1014 ions/cm2) at 5 KeV and temperature of annealing (750-1000 °C). Measurements of specific contact resistance, ρc, were approximately constant at lower implant doses until increasing at 1 x 1015 ions/cm2 for both C and P ions. Annealing at a temperature of 1000 °C has reduced the value of ρc by an order of magnitude to ∼1 x 10-6 Ω.cm2 at implant doses of 1013-1014 ions/cm2. Auger Electron Spectroscopy (AES) has shown that annealing at 1000 °C resulted in a strong indiffusion of the metallization layers at the interface.
Here, we investigate the effect of divalent metal (Zn2+, Cd2+ and Hg2+) on the structural and optoelectronic properties of methylammonium lead iodide perovskite materials prepared by the two-step deposition process. The incorporation of Cd2+ significantly improved the grain size, crystallinity, and charge carrier lifetime of CH3NH3PbI3. The inclusion of Hg2+ and Zn2+ improved the grain size compare to the control sample but adversely affected the optoelectronic properties of perovskite films. The Hg- and Zn-based impurities were formed on the surface of the films, which increased the charge trap density and lead to high non-radiative recombination rate. Time resolved photoluminescence measurements indicated that the Cd and Zn point defects do not create deep-level trap states, but the Zn-modified film showed a low lifetime due to morphology changes in the film and particle segregation on the surface.
In an observational study, we found that healthcare personnel frequently acquired Clostridium difficile on their hands when caring for patients with recently resolved C. difficile infection (CDI) (<6 weeks after treatment) who were no longer under contact precautions. Continuing contact precautions after diarrhea resolves may be useful to reduce transmission.
Infect. Control Hosp. Epidemiol. 2016;37(4):475–477
A dynamic optimization model is used to compare the profitability of silvopasture with traditional cattle ranching in south Florida. Silvopasture can reduce phosphorus runoff from cattle ranching—a major environmental concern for Lake Okeechobee and the Everglades. Silvopasture can also sequester carbon, thereby offsetting global climate change. The effectiveness of phosphorus runoff taxes and carbon sequestration payments for inducing landowners to adopt silvopasture is investigated. We find that phosphorus taxes alone would not induce landowners to adopt silvopasture. However, payments to landowners to sequester carbon, alone or in conjunction with phosphorus runoff taxes, can make silvopasture financially competitive with traditional ranching.
We used the open-ended contingent valuation method to elicit willingness to pay (WTP) for day visitors and extended visitors on the Ocala National Forest (ONF), Florida. A Tobit model specification was applied to account for the issues involved with censored WTP bids. The results reveal that visitors would pay more for improved recreational facilities at the ONF. In particular, our estimates show that visitors would pay $1 million for basic facilities, $1.9 million for moderate improvements, and $2.5 million for more improvements.
Recreational hunting has been an attractive enterprise for some ranchers who are interested in supplementing their income from cattle. Ranchland attributes—such as parcel size, tree cover, and proximity to urban centers—are expected to influence hunters' preferences and, thus, hunting lease payments. We estimated the effects of these attributes on hunting revenues using a hedonic model. The results reveal that trees and vegetation cover on ranchlands have a positive impact on hunting revenues, indicating opportunities for silvopasture practices. Those ranchers in Florida who maintain about 22% trees and other vegetation cover receive $16.15 per acre per year from hunting leases, but doubling the cover would generate only an additional $3.20 per acre per year.