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Depression and anxiety are widespread globally, with significant treatment gaps in low-resource settings. In Pakistan, where prevalence is high and specialists are scarce, brief psychological interventions by trained lay counsellors show promise. DIALOG+ is a novel technology-assisted, solution-focused approach for leveraging resource-oriented approaches in routine community mental health treatment.
Aims
To explore the feasibility and acceptability of using DIALOG+ for community-based treatment of common mental disorders delivered by non-specialist lay counsellors in a low-resource setting (trial registration: ISRCTN14528579).
Method
An open, uncontrolled trial in community settings in Karachi, Pakistan, was conducted with 40 patients with depression and anxiety visiting two primary care clinics between June 2019 and February 2020. Patients were enrolled for monthly sessions delivered over 6 months by lay counsellors. Subjective quality of life along with symptoms of depression and anxiety were measured at baseline and endline (following the 6-month intervention) on the Manchester Short Assessment of Quality of Life (MANSA) and Aga Khan University Anxiety and Depression Scale (AKUADS). Changes in measures were evaluated before and after the intervention using a t-test analysis. Post-intervention, in-depth interviews were held with patients and lay counsellors to gather insights into their experience of the intervention.
Results
In total, 146 DIALOG+ sessions were conducted with 40 patients. At the 6-month post-intervention assessment, 33 patients showed improved subjective quality of life and reduced self-reported depression and anxiety scores. Patients reported that the intervention helped strengthen the therapeutic relationship with their lay counsellors, helped them track their progress through therapy and enhanced their self-management of negative emotions and behaviours.
Conclusions
Structured communication can help strengthen lay counsellors’ ability to improve therapeutic outcomes of people with common mental disorders in resource-constrained community settings. Future clinical trials are recommended to further evaluate the long-term impact of the DIALOG+ intervention on mental health outcomes.
Despite enormous efforts at healthcare improvement, major challenges remain in achieving optimal outcomes, safety, cost, and value. This Element introduces the concept of learning health systems, which have been proposed as a possible solution. Though many different variants of the concept exist, they share a learning cycle of capturing data from practice, turning it into knowledge, and putting knowledge back into practice. How learning systems are implemented is highly variable. This Element emphasises that they are sociotechnical systems and offers a structured framework to consider their design and operation. It offers a critique of the learning health system approach, recognising that more has been said about the aspiration than perhaps has been delivered. This title is also available as open access on Cambridge Core.
This Element advances a theory of social cues to explain how international institutions legitimize foreign policy. It reframes legitimization as a type of identity politics. Institutions confer legitimacy by sending social cues that exert pressures to conform and alleviate social–relational concerns regarding norm abidance, group participation, and status and image. Applied to the domain of humanitarian wars, the argument implies that liberal democracies vis-à-vis NATO can influence citizens and policymakers within their community, the primary participants of these military operations. Case studies, news media, a survey of policymakers, and survey experiments conducted in multiple countries validate the social cue theory while refuting alternative arguments relating to legality, material burden sharing, Western regionalism, and rational information transmission. The Element provides an understanding of institutional legitimacy that challenges existing perspectives and contributes to debates about multilateralism, humanitarian intervention, and identity. This title is also available as Open Access on Cambridge Core.
The field of criminology is limited by a 'hidden' measurement crisis. It is hidden because scholars either are not aware of the shortcomings of their measures or have implicitly agreed that scales with certain properties merit publication. It is a crisis because the approaches used to construct measures do not employ modern systematic psychometric methods. As a result, the degree to which existing measures have methodological limitations is unknown. The purpose of this Element is to unmask this hidden crisis and provide a case study demonstrating how to build a measure of a prominent criminological construct through modern systematic psychometric methods. Using multiple surveys and item response theory, it develops a ten-item scale of procedural justice in policing. This can be used in primary research and to adjudicate existing measures. The goal is to reveal the nature of the field's measurement crisis and show a strategy for solving it.
A novel high-selectivity ultra-wideband (UWB) balanced bandpass filter (BPF) with harmonic suppression characteristics is proposed. The differential-mode UWB passband is constructed using quarter-wavelength asymmetrical parallel-coupled transmission lines, resulting in sharp filtering selectivity, while common-mode noises are suppressed by loading the T-type stubs. A simple design method of integrating bandstop filter branches into the BPF for third harmonic suppression without increasing the circuit size is described and confirmed. A planar high-selectivity balanced BPF prototype is manufactured and measured at 2.6 GHz with a measured 3-dB fractional bandwidth of 108% to validate the framework principle. More importantly, with third harmonic suppression characteristics, the measured out-of-band rejection is more than 20 dB, spanning 4.35 GHz until 12.4 GHz.
An online survey was distributed to South Dakota stakeholders to understand how noxious weeds are currently being managed. The response rate was 26%; 129 stakeholders completed the survey of the 491 stakeholders who opened the survey. Eighty percent of respondents stated noxious weeds were a problem. Canada thistle (Cirsium arvense), leafy spurge (Euphorbia esula) and absinth wormwood (Artemisia absinthium) were the most common and troublesome but all statewide noxious weeds were reported. Herbicides alone (25%) was the most common singular response to manage noxious weeds, but respondents utilized two (27%) to three (24%) other tactics as well. Most respondents (47%) were somewhat satisfied with management tactics while others were completely satisfied (9%), neither satisfied nor dissatisfied (20%), somewhat unsatisfied (11%), or very unsatisfied (15%). A covariate analysis showed that the more management tactics a stakeholder utilized, the less satisfied they were with control (P < 0.0001). The most common barrier of adopting new tactics was effectiveness (26%) followed by a combination of effectiveness + current production practices + cost + labor (13%). An additional covariate analysis showed that the increase of management tactics increased the barriers of adoption (P = 0.04) and increasing the number of barriers of adoption resulted in stakeholders being dissatisfied with control (P = 0.0003). Overall, the results of the survey suggest that statewide noxious weeds remain a problem, and multiple tactics are used to manage these weeds. However, Extension efforts need to address how to use current and implement new management to increase effectiveness.
The ideating phase of product design is critical, as decisions made here influence the rest of the product’s lifecycle. Usually, early preliminary designs in engineering are created with pen and paper, which are incompatible with the subsequent digital design process. In an effort to find a modeling tool for early designs that provides the creative flexibility of freehand sketching but also the further processability of digital models, this research investigates natural modeling in virtual reality (VR). To do so, a VR modeling method allowing the intuitive creation of preliminary designs as simplified computer-aided design (CAD) models is presented. The main contribution is the evaluation of this natural VR modeling method against freehand sketching in an extensive user study.
In ecological systems, be it a Petri dish or a galaxy, populations evolve from some initial value (say zero) up to a steady-state equilibrium, when the mean number of births and deaths per unit time are equal. This equilibrium point is a function of the birth and death rates, as well as the carrying capacity of the ecological system itself. We show that the occupation fraction versus birth-to-death rate ratio is S-shaped, saturating at the carrying capacity for large birth-to-death rate ratios and tending to zero at the other end. We argue that our astronomical observations appear inconsistent with a cosmos saturated with extraterrestrial intelligences, and thus search for extraterrestrial intelligence optimists are left presuming that the true population is somewhere along the transitional part of this S-curve. Since the birth and death rates are a-priori unbounded, we argue that this presents a fine-tuning problem. Further, we show that if the birth-to-death rate ratio is assumed to have a log-uniform prior distribution, then the probability distribution of the ecological filling fraction is bi-modal – peaking at zero and unity. Indeed, the resulting distribution is formally the classic Haldane prior, conceived to describe the prior expectation of a Bernoulli experiment, such as a technological intelligence developing (or not) on a given world. Our results formally connect the Drake equation to the birth–death formalism, the treatment of ecological carrying capacity and their connection to the Haldane perspective.
The January 6th insurrection at the U.S. capital was an eye-opening moment for many Americans. With the 2024 election cycle in swing, members of the Democratic Party are using January 6th as a rallying call for the need to protect democracy. But were the events of January 6th viewed equally among liberals? We argue that the events of January 6th resonate for a particular demographic well-informed liberal White voters. We argue that liberal minority voters will feel the racial undertones of January 6th more than White liberals. Furthermore, we examine how voters of different races viewed the events of January 6th and how views on race relations impact their perceptions of January 6th. We find that White liberals are less angry about race relations in the aftermath of January 6th, and while they viewed January 6th as an insurrection and blamed Trump and Republicans in Congress for their role, they are less likely to say that racism and White Supremacy motivated the insurrectionists. This paper indicates that race plays a key role in political perceptions, even among those who hold similar political ideologies.
We examined the association between influenza vaccination policies at acute care hospitals and influenza vaccination coverage among healthcare personnel for the 2021–22 influenza season. Mandatory vaccination and masking for unvaccinated personnel were associated with increased odds of vaccination. Hospital employees had higher vaccination coverage than licensed independent practitioners.
Cardiovascular disease (CVD) poses a substantial global health burden, necessitating effective and scalable interventions for primary prevention. Despite the increasing recognition of peer-based interventions in managing chronic diseases, their application in CVD prevention still needs to be explored.
Aims:
We describe the protocol of a quasi-experiment to evaluate the effectiveness of a peer-led digital health lifestyle intervention, MYCardio-PEER, for a low-income community at risk for CVD. This study aims to assess the effectiveness of MYCardio-PEER in improving the participants’ knowledge, lifestyle behaviours and biomarkers related to CVD. Secondarily, we aim to assess the adherence and satisfaction of participants towards MYCardio-PEER.
Methods:
A minimum total sample of 68 low-income community members at risk for CVD will be recruited and allocated either to the control group or the intervention group. Participants in the control group will receive standard lifestyle advice and printed materials for CVD prevention, while the intervention group will participate in the 8-week MYCardio-PEER intervention program. The participants will be assessed at Week 0 (baseline), Week 8 (post-intervention) and Week 20 (post-follow-up).
Discussion:
We anticipate a net improvement in CVD risk score, besides investigating the effectiveness of the intervention program on CVD-related knowledge, biomarkers, and diet and lifestyle behaviours. The successful outcome of this study is essential for various healthcare professionals and stakeholders to implement population-based, cost-effective, and accessible interventions in reducing CVD prevalence in the country.
Is smaller better for economic development? We argue that states’ past population size can be a powerful determinant of current development. Among states that gained independence shortly after World War II, states with smaller populations in their early years of independence had stronger incentives to adopt more open trade policies and employ larger public sectors. These policies “embedded” smaller newly independent states into the global economy during the Cold War, building the foundations for more inclusive economic institutions and greater political stability. When the Cold War ended, smaller newly independent states were more likely to have developed the institutional infrastructure to prosper in the globalizing yet politically volatile early twenty-first century. We test this argument by examining the developmental trajectories of 83 states that became independent between 1946 and 1975. Newly independent states with smaller populations during this period have had on average higher levels and rates of post-Cold War development. They also had more open trade policies and larger public sectors during the Cold War. These policies correlate with more inclusive economic institutions and greater political stability in the post-Cold War era. A comparative case study of Oman and the People’s Democratic Republic of Yemen illustrates the mechanisms linking the size of newly independent states at independence and their post-Cold War development.
Neurology and psychiatry have long been divided as subspecialities of medicine. However, the symptom overlap in central nervous system illness is unmistakable. Medical science has evolved, necessitating a neuropsychiatric approach that is more comprehensive. This editorial briefly outlines the history of neurology and psychiatry and the movement towards a new paradigm.
Onyeama et al have examined the clinical profile of individuals with psychosis and childhood trauma using a stringent approach that yielded selective evidence, affecting power and insight into the specific and differential roles of abuse and neglect in the clinical profile. This commentary puts the findings into a broader meta-analytical context.
This article conceptualises regulatory sandboxes in the food area, considering them as unique spaces with varying degrees of openness. Through an analysis of closed, semi-open and open spaces, it illustrates the regulatory landscape surrounding regulatory sandboxes of novel foods in the EU, particularly focusing on the concept of “placing on the market.” The article contends that the degree of openness of regulatory sandboxes impacts the application of the precautionary principle within these spaces. It explores scenarios where the sandbox tests various aspects of novel foods under EU soft and hard law. The characteristics of the regulatory sandbox (open, semi-open, closed) changes corresponding to what the regulatory sandbox tests in relation to a novel food, eg, a sensory characteristics or safety or other data points, such as effectiveness of labelling. This article contributes to the ongoing discourse on innovation-friendly laws surrounding regulatory frameworks applicable to novel foods in the EU.
In the second half of the ninth century, a new period of confrontation between the Armenian and Byzantine Churches began. The goal of Byzantine religious policy was the abolition of the independence of the Armenian Church and its unification with the imperial Church. In his letters addressed to the ecclesiastical and political leaders of Armenia, the patriarch Photios proposed that they abandon Monophysitism and accept Chalcedonianism. Under this religious veil were disguised the empire's real political, cultural and socio-economic goals. Although Photios could not achieve the final unification of the two Churches, his mission did bring about a temporary religious rapprochement between the Armenians and the Greeks.
Inspired by laboratory experiments showing internal waves generated by a plume impinging upon a stratified fluid layer (Ansong & Sutherland. 2010 J. Fluid Mech.648, 405–434), we perform large eddy simulations in three dimensions to examine the structure and source of internal waves emanating from the top of a plume that rises vertically into stratification whose strength ranges over two orders of magnitude between different simulations. Provided the plume is sufficiently energetic to penetrate into the stratified layer, internal waves are generated with frequencies in a relatively narrow band moderately smaller than the buoyancy frequency. Through adaptations of ray theory including viscosity and use of dynamic mode decomposition, we show that the waves originate from within the turbulent flow rather than at the turbulent/non-turbulent interface between the fountain top and the surrounding stratified fluid.