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There is a high prevalence of depression among refugee youth in low- and middle-income countries, yet depression trajectories are understudied. This study examined depression trajectories, and factors associated with trajectories, among urban refugee youth in Kampala, Uganda.
Methods
We conducted a longitudinal cohort study with refugee youth aged 16–24 in Kampala, Uganda. We assessed depression using the Patient Health Questionnaire-9 and conducted latent class growth analysis (LCGA) to identify depression trajectories. Sociodemographic and socioecological factors were examined as predictors of trajectory clusters using multivariable logistic regression.
Results
Data were collected from n = 164 participants (n = 89 cisgender women, n = 73 cisgender men, n = 2 transgender persons; mean age: 19.9, standard deviation: 2.5 at seven timepoints; n = 1,116 observations). Two distinct trajectory clusters were identified: “sustained low depression level” (n = 803, 71.9%) and “sustained high depression level” (n = 313, 28.1%). Sociodemographic (older age, gender [cisgender women vs. cisgender men], longer time in Uganda), and socioecological (structural: unemployment, food insecurity; interpersonal: parenthood, recent intimate partner violence) factors were significantly associated with the sustained high trajectory of depression.
Conclusions
The chronicity of depression highlights the critical need for early depression screening with urban refugee youth in Kampala. Addressing multilevel depression drivers prompts age and gender-tailored strategies and considering social determinants of health.
Fast radio bursts (FRBs) are short-duration radio transients that occur at random times in host galaxies distributed all over the sky. Large field of view instruments can play a critical role in the blind search for rare FRBs. We present a concept for an all-sky FRB monitor using a compact all-sky phased array (CASPA), which can efficiently achieve an extremely large field of view of $\sim10^4$ square degrees. Such a system would allow us to conduct a continuous, blind FRB search covering the entire southern sky. Using the measured FRB luminosity function, we investigate the detection rate for this all-sky phased array and compare the result to a number of other proposed large field-of-view instruments. We predict a rate of a few FRB detections per week and determine the dispersion measure and redshift distributions of these detectable FRBs. This instrument is optimal for detecting FRBs in the nearby Universe and for extending the high-end of the FRB luminosity function through finding ultraluminous events. Additionally, this instrument can be used to shadow the new gravitational-wave observing runs, detect high-energy events triggered from Galactic magnetars and search for other bright, but currently unknown transient signals.
Identifying the impact of remittances on household members remaining behind is difficult due to selection into migration. In this paper, we exploit an unexpected embargo on Qatar, the second major destination among Nepali migrants. Using longitudinal data on about 1,500 Nepali households with migrants prior to the embargo, we assess how this shock translates into changes in remittances and development outcomes. We find a 56% reduction in remittances for households with a migrant in Qatar. At least in the months immediately after the shock, such a fall in remittances does not seem to translate into recipient household's welfare. However, we cannot exclude that such effect might materialize in the medium run. That is particularly true for poor and credit-constrained households, especially vulnerable to the remittance windfall and lacking the ability to move their migrants or other household members to other destinations.
Recent years have seen increasing calls by a few scientists, largely from the Global North, to explore “solar geoengineering,” a set of speculative technologies that would reflect parts of incoming sunlight back into space and, if deployed at planetary scale, have an average cooling effect. Numerous concerns about the development of such speculative technologies include the many ecological risks and uncertainties as well as unresolved questions of global governance and global justice. This essay starts with the premise that solar geoengineering at planetary scale is unlikely to be governable in a globally inclusive and just manner. Thus, the ethically sound approach is to pursue governance that leads to the nonuse of planetary solar geoengineering. Yet is such a prohibitory agreement feasible, in the face of possible opposition by a few powerful states and other interests? Drawing on social science research and a host of existing transnational and international governance arrangements, this essay offers three illustrative pathways through which a nonuse norm for solar geoengineering could emerge and become diffused and institutionalized in global politics: (1) civil society-led transnational approaches; (2) regionally led state and civil society hybrid approaches; and (3) like-minded or “Schengen-style” club initiatives led by states.
There is strong evidence for a general psychopathology dimension which captures covariance among all forms of psychopathology, yet its nature and underlying association with personality remain unclear. This study examined the co-development of general psychopathology and four high-risk personality traits: anxiety sensitivity, negative thinking, sensation seeking, and impulsivity. Data from two large Australian school-based randomised controlled trials of substance use prevention programs were analysed (N = 2,083, mean age at baseline = 13.49 years). Adolescents completed self-report measures of psychopathology symptoms and personality at baseline, one-, two-, and three-years post-baseline. Latent curve models with structured residuals, were used to examine the co-development of general psychopathology (extracted from a higher-order model) and personality traits from 13 to 16 years of age, controlling for age, sex, and cohort. Higher than usual levels of anxiety sensitivity and impulsivity were associated with higher than usual levels of general psychopathology at subsequent time points, and higher than usual levels of general psychopathology were associated with higher than usual levels of negative thinking at later time points. Sensation seeking was unrelated to general psychopathology. These findings enhance our understanding of the meaning and validity of general psychopathology, highlighting potential personality-based prevention and intervention targets.
Tourism wildlife interactions are controversial, the debate hinging largely on the compromised welfare of the animals used. Despite this, lion cub (Panthera leo) interactions are popular, and there is a need to understand what motivates interactors to participate in the activity, their perceptions and expectations. We surveyed the attitudes of 300 visitors to three lion cub interaction facilities in South Africa. Whilst 38% of interactors were aware of the controversy around lion cub interactions, 69% desired the experience regardless. It is widely assumed that lion cub interaction opportunities are big attractions, yet 74% of respondents said that they would still have visited if lion cub interactions were not offered. Whilst 84% of interactors felt that their expectations were met, 61% said that the interaction had no impact on them. Several of those interviewed interacted with multiple species, and 34% determined that their favourite engagement was with animals that interacted back voluntarily. Most of those interviewed chose the interaction for their children (69%). Whilst 58% felt the experience was educational, only 2% of these had learnt about the plight of lions in the wild. When asked to reflect on the welfare of the lion cubs they had interacted with, ‘Freedom from discomfort’ was seen as the most important factor, as well as ‘Freedom to express natural behaviour’. Interactions were viewed with a variety of emotions and generated a range of beliefs. We conclude that the findings can be used by facilities to better prepare visitors for the experience, ensuring that interaction animals are better able to serve in their role as ambassador representatives.
Internal and external rotation of the shoulder is often challenging to quantify in the clinic. Existing technologies, such as motion capture, can be expensive or require significant time to setup, collect data, and process and analyze the data. Other methods may rely on surveys or analog tools, which are subject to interpretation. The current study evaluates a novel, engineered, wearable sensor system for improved internal and external shoulder rotation monitoring, and applies it in healthy individuals. Using the design principles of the Japanese art of kirigami (folding and cutting of paper to design 3D shapes), the sensor platform conforms to the shape of the shoulder with four on-board strain gauges to measure movement. Our objective was to examine how well this kirigami-inspired shoulder patch could identify differences in shoulder kinematics between internal and external rotation as individuals moved their humerus through movement patterns defined by Codman’s paradox. Seventeen participants donned the sensor while the strain gauges measured skin deformation patterns during the participants’ movement. One-dimensional statistical parametric mapping explored differences in strain voltage between the rotations. The sensor detected distinct differences between the internal and external shoulder rotation movements. Three of the four strain gauges detected significant temporal differences between internal and external rotation (all p < .047), particularly for the strain gauges placed distal or posterior to the acromion. These results are clinically significant, as they suggest a new class of wearable sensors conforming to the shoulder can measure differences in skin surface deformation corresponding to the underlying humerus rotation.
A long-standing concern in the field of second language acquisition is that replication studies are not only infrequent but also poorly designed, reported, and labeled. This special issue responds to an urgent need for action by showcasing eleven high-quality replication studies. In doing so, this collection highlights exemplary standards in replication study design and reporting. This introduction to the special issue provides readers with a point of reference for what replication research is, including why replication studies are needed, issues about originality and innovation in replication research, how replication studies can be designed and conducted, and recent advances and resources to support future replication efforts in the field. The introduction concludes with an overview of each study in the special issue, highlighting its main components and discussing how the replication strengthens the field and advances knowledge and understanding about the topic.
Mental state verbs (MSVs) describe people’s knowledge, thoughts, feelings and desires, and develop through early childhood. This study used a cross-sectional design and a parental questionnaire to describe the developmental process of MSV use by exploring different trajectories of semantic categories within MSVs. One-hundred-fourteen typically developing, Hebrew-speaking children, ages 1;6–10;0 participated in the study. Their parents completed a questionnaire developed for the current study, which contains MSVs from five semantic categories: desire, emotion, cognition, perception, and psychological, plus physical verbs as a control category. Among them, 58 children (ages 3;2–10;0 years) participated in a narrative task that prompted production of MSVs. Results showed scores increased with age from early childhood to elementary school, demonstrating prolonged development of using MSVs. A minor advantage for girls was found in the younger ages compared with boys. Both, boys and girls had different developmental trajectories for physical, physiological, and desire verbs compared with cognition and emotion verbs. The correlation found between the questionnaire scores and the narrative task supports the validity of the questionnaire for assessing MSV use in children. The results are explained by the complex syntactic structure and abstract meaning of MSVs.
Inappropriate diagnosis and treatment of urinary tract infections (UTIs) contribute to antibiotic overuse. The Inappropriate Diagnosis of UTI (ID-UTI) measure uses a standard definition of asymptomatic bacteriuria (ASB) and was validated in large hospitals. Critical access hospitals (CAHs) have different resources which may make ASB stewardship challenging. To address this inequity, we adapted the ID-UTI metric for use in CAHs and assessed the adapted measure’s feasibility, validity, and reliability.
Design:
Retrospective observational study
Participants:
10 CAHs
Methods:
From October 2022 to July 2023, CAHs submitted clinical information for adults admitted or discharged from the emergency department who received antibiotics for a positive urine culture. Feasibility of case submission was assessed as the number of CAHs achieving the goal of 59 cases. Validity (sensitivity/specificity) and reliability of the ID-UTI definition were assessed by dual-physician review of a random sample of submitted cases.
Results:
Among 10 CAHs able to participate throughout the study period, only 40% (4/10) submitted >59 cases (goal); an additional 3 submitted >35 cases (secondary goal). Per the ID-UTI metric, 28% (16/58) of cases were ASB. Compared to physician review, the ID-UTI metric had 100% specificity (ie all cases called ASB were ASB on clinical review) but poor sensitivity (48.5%; ie did not identify all ASB cases). Measure reliability was high (93% [54/58] agreement).
Conclusions:
Similar to measure performance in non-CAHs, the ID-UTI measure had high reliability and specificity—all cases identified as ASB were considered ASB—but poor sensitivity. Though feasible for a subset of CAHs, barriers remain.
How can we understand the audience agency and securitisation processes that can induce anxiety? The Copenhagen School of security studies conceptualises an audience as possessing political agency which is contingent on their capabilities to respond to securitising moves. Drawing on Anthony Giddens’s approach to ontological security, we argue that there is another type of agency supplementing political agency. Ontological agency refers to exercising control over the stability and continuity of one’s everyday routines and practices to minimise disruption to these routines caused by securitisation. Because routines of day-to-day life are central to bracketing sources of anxiety, people may choose to overlook and not react to securitising moves designating threats and implementing emergency measures that can undermine ontological security. We illustrate the analytical purchase of ontological agency by using unstructured observations of South Korean people’s responses to military practices that securitise North Korea. Our observations reveal that there is latent anxiety regarding North Korea that manifests in varying degrees ranging from inaction when routines are not disrupted by securitisation to outward bursts of emotional reactions and breakdown when securitisation practices disrupt people’s basic routines. This raises implications about the importance of ontological security driving the success or failure of securitisation and the politics of existentialism.
It was identified in the largest graduate unit of the Faculty of Medicine of a major Canadian University that there was a critical unmet curricular need for an introductory statistics and study design course. Based on the collective findings of an external institute review, both quantitative and qualitative data were used to design, develop, implement, evaluate, and refine such a course.
Methods
In response to the identified need and inherent challenges to streamlining curriculum development and instructional design in research-based graduate programs representing many biomedical disciplines, the institute used the analyze, design, develop, implement and evaluate instructional design model to guide the data-driven development and ongoing monitoring of a new study design and statistics course.
Results
The results demonstrated that implementing recommendations from the first iteration of the course (Fall 2021) into the second iteration (Winter 2023) led to improved student learning experience (3.18/5 weighted average (Fall 2021) to 3.87/5 (Winter 2023)). In the second iteration of the course, a self-perceived statistics anxiety test was administered, showing a reduction in statistics anxiety levels after completing the course (2.41/4 weighted average before the course to 1.65/4 after the course).
Conclusion
Our experiences serve as a valuable resource for educators seeking to implement similar improvement approaches in their educational settings. Furthermore, our findings offer insights into tailoring course development and teaching strategies to optimize student learning.
Engaging with personal mental health stories has the potential to help people with mental health difficulties by normalizing distressing experiences, imparting coping strategies and building hope. However, evidence-based mental health storytelling platforms are scarce, especially for young people in low-resource settings.
Objective
This paper presents an account of the co-design of ‘Baatcheet’ (‘conversation’ in Hindi), a peer-supported, web-based storytelling intervention aimed at 16–24-year-olds with depression and anxiety in New Delhi, India.
Methods
Development comprised three stages: (1) establishing a logic model through consultations with a Young People’s Advisory Group (N = 11) and a stakeholder reference group (N = 20); (2) elaborating intervention guiding principles and components through focus group discussions and co-design workshops (N = 42); and (3) user-testing of prototypes.
Results
The developmental process identified key stakeholder preferences for an online, youth-focused mental health storytelling intervention. Baatcheet uses an interactive storytelling website containing a repository of personal stories about young people’s experiences of depression and anxiety. This is offered alongside brief support from a peer.
Conclusions
There are few story-based interventions addressing depression and anxiety for young people, especially in low-resource settings. Baatcheet has the potential to deliver engaging, accessible and timely mental health support to young people. A pilot evaluation is underway.
Executive dysfunction, including working memory deficits, is prominent in posttraumatic stress disorder (PTSD) and can impede treatment effectiveness. Intervention approaches that target executive dysfunction alongside standard PTSD treatments could boost clinical response. The current study reports secondary analyses from a randomized controlled trial testing combined PTSD treatment with a computerized training program to improve executive dysfunction. We assessed if pre-treatment neurocognitive substrates of executive functioning predicted clinical response to this novel intervention.
Methods
Treatment-seeking veterans with PTSD (N = 60) completed a working memory task during functional magnetic resonance imaging prior to being randomized to six weeks of computerized executive function training (five 30-minute sessions each week) plus twelve 50-minute sessions of cognitive processing therapy (CEFT + CPT) or placebo training plus CPT (PT + CPT). Using linear mixed effects models, we examined the extent to which the neurocognitive substrates of executive functioning predicted PTSD treatment response.
Results
Results indicated that veterans with greater activation of working memory regions (e.g. lateral prefrontal and cingulate cortex) had better PTSD symptom improvement trajectories in CEFT + CPT v. PT + CPT. Those with less neural activation during working memory showed similar trajectories of PTSD symptom change regardless of treatment condition.
Conclusions
Greater activity of frontal regions implicated in working memory may serve as a biomarker of response to a novel treatment in veterans with PTSD. Individuals with greater regional responsiveness benefited more from treatment that targeted cognitive dysfunction than treatment that did not include active cognitive training. Clinically, findings could inform our understanding of treatment mechanisms and may contribute to better personalization of treatment.
This study explored the effect of SARS-CoV-2 infection and COVID-19 vaccination during pregnancy on neonatal outcomes among women from the general Dutch population. VASCO is an ongoing prospective cohort study aimed at assessing vaccine effectiveness of COVID-19 vaccination. Pregnancy status was reported at baseline and through regular follow-up questionnaires. As an extension to the main study, all female participants who reported to have been pregnant between enrolment (May–December 2021) and January 2023 were requested to complete an additional questionnaire on neonatal outcomes. Multivariable linear and logistic regression analyses were used to determine the associations between self-reported SARS-CoV-2 infection or COVID-19 vaccination during pregnancy and neonatal outcomes, adjusted for age, educational level, and presence of a medical risk condition. Infection analyses were additionally adjusted for COVID-19 vaccination before and during pregnancy, and vaccination analyses for SARS-CoV-2 infection before and during pregnancy. Of 312 eligible participants, 232 (74%) completed the questionnaire. In total, 196 COVID-19 vaccinations and 115 SARS-CoV-2 infections during pregnancy were reported. Infections were mostly first infections (86; 75%), caused by the Omicron variant (95; 83%), in women who had received ≥1 vaccination prior to infection (101; 88%). SARS-CoV-2 infection during pregnancy was not significantly associated with gestational age (β = 1.7; 95%CI: −1.6–5.0), birth weight (β = 82; −59 to 223), Apgar score <9 (odds ratio (OR): 1.3; 0.6–2.9), postpartum hospital stay (OR: 1.0; 0.6–1.8), or neonatal intensive care unit admission (OR: 0.8; 0.2–3.2). COVID-19 vaccination during pregnancy was not significantly associated with gestational age (β = −0.4; −4.0 to 3.2), birth weight (β = 88; −64 to 240), Apgar score <9 (OR: 0.9; 0.4–2.3), postpartum hospital stay (OR: 0.9; 0.5–1.7), or neonatal intensive care unit admission (OR: 1.6; 0.4–8.6). In conclusion, this study did not find an effect of SARS-CoV-2 infection or COVID-19 vaccination during pregnancy on any of the studied neonatal outcomes among a general Dutch, largely vaccinated, population. Together with data from other studies, this supports the safety of COVID-19 vaccination during pregnancy.
This article examines United Kingdom (UK) parliamentary debates on the adoption of its first post-Brexit, from-scratch free trade agreement (FTA), with Australia. Building on Jessop’s cultural political economy framework, we identify and analyse the economic imaginaries animating UK post-Brexit trade policy debates at this time. We find that an imaginary of what we term ‘competitive free trade’ shaped the UK Government’s approach to the UK–Australia FTA. Meanwhile, the Opposition, much of the House of Lords, and a small number of Conservative Members of Parliament endorsed an alternative ‘embedded free trade’ imaginary. Our analysis suggests that the UK government successfully used the context of an unsettled domestic institutional environment for trade policy post-Brexit in order to negotiate and ratify an FTA with Australia that reflected its competitive free trade imaginary. The article offers an account of UK post-Brexit trade policy that highlights how material, political, and ideational dimensions co-constitute each other in the political economy of trade, and how particular economic imaginaries become reified and dominant at certain junctures.
Substance use disorder (SUD) is a public health crisis in the United States associated with significant economic costs including healthcare, criminal justice, productivity, and mortality and morbidity costs. In this paper, we present a tool for a customizable economic analysis that can be utilized by different recovery program owners and operators within the SUD continuum of care that considers these program’s operating and capital costs, location, size, and success rate. The goal of this tool is to provide owners and operators with an accessible tool that can estimate their individual program’s economic costs, benefits, and return on investment. In applications of the tool, we find that there are significant benefits associated with SUD recovery-oriented services, even with more conservative modeling of recovery benefits. Specifically, we find that a representative recovery housing program in Florida yields a net benefit of $143 million over 20 years with an associated return on investment of $22.19 per dollar invested. Further, we find that the net benefits of different recovery-oriented modalities including a recovery house, a recovery campus, and a residential inpatient program are positive, with returns on investment varying from nearly $22 per dollar invested to $1 per dollar.
Implementation of video call-based cognitive behavioural therapy (CBT) has increased significantly since the COVID-19 pandemic, enabling more flexible delivery, but less is known about user experience and effectiveness. This systematic review and meta-analysis investigated feasibility, acceptability, and effectiveness of individual video call-based CBT for adults with mild to moderate mental health conditions (Prospero CRD42021291055). Medline, Embase, PsycINFO and Web of Science were searched until 4 September 2023. The Effective Public Health Practice Project Quality Assessment Tool (EPHPP) assessed methodological quality of studies. Meta-analysis was conducted in R. Thirty studies (n=3275), published 2000 to 2022, mainly in the USA (n=22/30, 73%), were included. There were 15 randomised control trials, one controlled clinical trial, and 14 uncontrolled studies. Findings indicated feasibility, acceptability and effectiveness (effect size range 0.02–8.30), especially in post-traumatic stress disorder (PTSD) for military populations. Other studies investigated depression, obsessive-compulsive disorder, panic with agoraphobia, insomnia, and anxiety. Studies indicated that initial challenges with video call-based CBT subsided as therapy progressed and technical difficulties were managed with limited impact on care. EPHPP ratings were strong (n=12/30, 40%), moderate (n=12/30, 40%), and weak (n=6/30, 20%). Meta-analysis on 12 studies indicated that the difference in effectiveness of video call-based CBT and in-person CBT in reducing symptoms was not significant (SMD=0.044; CI=–0.086; 0.174). Video calls could increase access to CBT without diminishing effectiveness. Limitations include high prevalence of PTSD studies, lack of standardised definitions, and limited studies, especially those since the COVID-19 pandemic escalated use of video calls.
Key learning aims
This review assesses feasibility, acceptability, and effectiveness of individual video call-based CBT for adults with mild to moderate common mental health conditions, as defined by the ICD-11.
Secondary aims were to assess if the therapeutic relationship is affected and identify any potential training needs in delivering video call-based CBT.
The adjunct meta-analysis quantitatively explored whether video call-based CBT is as effective as in-person interventions in symptom reduction on primary outcome measures by pooling estimates for studies that compare these treatment conditions.
The debates on the ownership of contested cultural objects bring forth questions regarding the representation of history. But might these debates also lead to the fabrication of history? Previous research has analyzed how the British Museum’s anti-restitution position contributes to its distortion of British (Museum) history. Instead, this article considers if – and, if so, how – history is distorted to argue for restitution. It examines the eulogized publication The Brutish Museums (2020) by Oxford professor Dan Hicks asking whether his claims regarding British mass atrocities in the conquest of Benin in 1897 can be substantiated by the documentary evidence. The investigation shows that this is not the case. The article also scrutinizes what the source material reveals about the death toll of the events of 1897. The results of the inquiry question oversimplified notions about culprits and victims in the wake of colonial conquest. It is argued that an incomplete understanding of the past impairs efforts to repair past wrongs and that questions about the ownership of colonial collections could productively be linked with questions about the representation of history, such as whose and which histories are told – or not – through contested objects.