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Aortic arch obstruction and/or coarctation of aorta is uncommon (5–20%) in balanced atrioventricular septal defects. Although technically challenging, prenatal diagnosis of aortic arch obstruction in atrioventricular septal defect is critical for delivery planning and improves prenatal counselling regarding the timing of cardiac surgery. We sought to identify prenatal predictors of coarctation of aorta in atrioventricular septal defect.
Methods:
Retrospective review of patients prenatally diagnosed with atrioventricular septal defect at two institutions.
Results:
Ninety-five fetuses with atrioventricular septal defect were identified and sufficient outcome data and diagnostic acoustic windows were available in 62. Six patients (10%) had coarctation of aorta after birth. Among the 38 patients with Trisomy 21, four (11%) had coarctation of aorta. On multivariable analysis, the proximal transverse aortic arch z score and ratio of left:right atrioventricular valve were independent predictors of coarctation of aorta with good interobserver reproducibility. Either proximal transverse aortic arch z score < −2, or ratio of left:right atrioventricular valve <0.7, predicted aortic arch obstruction with 100% sensitivity and 89% specificity.
Conclusion:
Proximal transverse aortic arch z score and lower ratio of left:right atrioventricular valve diameter are independent predictors of postnatal coarctation of aorta in fetal patients with atrioventricular septal defect. The next step is the prospective application of these parameters to create an algorithm directing fetal counselling in terms of delivery location, and expected timing of surgical interventions.
A knowledge, attitudes and control practices (KAP)-based study on ticks and tick-borne diseases (TTBD) and resistance development in ticks was conducted in Dhar district of Madhya Pradesh covering 200 livestock owners using a questionnaire. Based on our scoring criteria, results indicated only 25% (19.16–31.60) respondents possessing basic knowledge of TTBDs while 75% (68.40–80.84) respondents were not aware of TBDs. Due to lack of proper awareness of TTBDs, about 1.28 times more respondents (OR 95% CI 0.42–3.86) were having heavy tick infestations in their animals. However, about 36.5% (29.82–43.58) respondents showed a favourable attitude towards the adoption of different tick control practices; consequently, their animals showed low-level infestation. Amongst various feeding systems for animals, a mixed type of feeding system was mostly adopted by 57.5% respondents followed by manger system (37.5%) while grazing was the least adopted method (5%). Results indicated that the grazing animals were 6 times (OR 95% CI 2.93–12.28) more susceptible to ticks and possessed heavy tick infestation. Resistance status of collected tick isolates of Rhipicephalus microplus and Hyalomma anatolicum was assessed and revealed that both tick species were found resistant to deltamethrin. The goals of this study were to assess some of the underlying causes of ticks and TBD in livestock in Dhar district of Madhya Pradesh state using the KAP survey and resistance characterization of ticks.
Twelve lacustrine sediment samples from a relict lake in the Kalla Glacier valley were co-dated using AMS radiocarbon (14C) and infrared stimulated luminescence (IRSL) dating methods. In general, the radiocarbon ages of bulk organic matter were older by a minimum of 1500 years compared to (age depth) modeled luminescence ages after fading corrections. This is observed for the first time in the lake sediments of High Himalayan Crystalline zone. A combination of lipid n-alkane data, Raman spectra and geochemical proxies suggested that this was due to ancient organic carbon (OCancient) that is a mixture of pre-aged (OCpre-aged) and petrogenic (OCpetro) organic carbon within older glacial moraine debris that served as sediment source to the lake. Raman spectra suggest the presence of moderate to highly graphitized OCpetro in all the profile samples. The OCpetro contributed 0.064 ± 0.032% to the sediment and the lake stored 2.5 ± 0.7 Gg OCpetro at variable rates during the last 16 kyr, with the mean burial flux 160 kg OCpetro yr−1. This study implies (1) employing another independent dating method in addition to radiocarbon method using bulk sediment organic matter, if the carbon content is low, to observe any discrepancy, and (2) a need to investigate on the fate of OCpetro as many such small lakes become relict in this region.
The diagnosis of functional constipation (FC) relies on patient-reported outcomes evaluated as criteria based on the clustering of symptoms. Although the ROME IV criteria for FC diagnosis is relevant for a multicultural population(1), how an individual’s lifestyle, environment and culture may influence the pathophysiology of FC remains a gap in our knowledge. Building on insights into mechanisms underpinning disorders of gut-brain interactions (formerly functional gastrointestinal disorders) in the COMFORT Cohort(2), this study aimed to investigate the differences in gastrointestinal (GI) symptom scores among participants with FC in comparison to healthy controls between Chinese and non-Chinese New Zealanders. The Gastrointestinal Understanding of Functional Constipation In an Urban Chinese and Urban non-Chinese New Zealander Cohort (GUTFIT) study was a longitudinal cohort study, which aimed to determine a comprehensive profile of characteristics and biological markers of FC between Chinese and non-Chinese New Zealanders. Chinese (classified according to maternal and paternal ethnicity) or non-Chinese (mixed ethnicities) adults living in Auckland classified as with or without FC based on ROME IV were enrolled. Monthly assessment (for 3 months) of GI symptoms, anthropometry, quality of life, diet, and biological samples were assessed monthly over March to June 2023. Demographics were obtained through a self-reported questionnaires and GI symptoms were assessed using the Gastrointestinal Symptom Rating Scale (GSRS) and Structured Assessment of Gastrointestinal Symptoms Scale (SAGIS). This analysis is a cross-sectional assessment of patient-reported outcomes of GI symptoms. Of 78 enrolled participants, 66 completed the study (male, n = 10; female, n = 56) and were distributed across: Chinese with FC (Ch-FC; n = 11), Chinese control (Ch-CON; n = 19), non-Chinese with FC (NCh-FC; n = 16), non-Chinese control (NCh-CON; n = 20). Mean (SD) age, body mass index, and waist circumference were 40 ± 9 years, 22.7 ± 2.5 kg/m2, and 78.0 ± 7.6 cm, respectively. Ethnicity did not impact SAGIS domain scores for GI symptoms (Ethnicity x FC severity interaction p>0.05). Yet, the constipation symptoms domain of the GSRS was scored differently depending on ethnicity and FC status (Ethnicity x FC interaction p<0.05). In post hoc comparison, NCh-FC tended to have higher GSRS constipation severity scores than Ch-FC (3.4 ± 1.0 versus 3.8 ± 0.8 /8, p<0.1) Although constipation symptom severity tended to be higher in NCh-FC, on the whole, ethnicity did not explain variation in this cohort. FC status was a more important predictor of GI symptoms scores. Future research will assess differences in symptom burden to explore ethnicity-specific characteristics of FC.
Distinct pathophysiology has been identified with disorders of gut-brain interactions (DGBI), including functional constipation (FC)(1,2), yet the causes remain unclear. Identifying how modifiable factors (i.e., diet) differ depending on gastrointestinal health status is important to understand relationships between dietary intake, pathophysiology, and disease burden of FC. Given that dietary choices are culturally influenced, understanding ethnicity-specific diets of individuals with FC is key to informing appropriate symptom management and prevention strategies. Despite distinct genetic and cultural features of Chinese populations with increasing FC incidence(3), DGBI characteristics are primarily described in Caucasian populations(2). We therefore aimed to identify how dietary intake of Chinese individuals with FC differs to non-Chinese individuals with FC, relative to healthy controls. The Gastrointestinal Understanding of Functional Constipation In an Urban Chinese and Urban non-Chinese New Zealander Cohort (GUTFIT) study was a longitudinal case-control study using systems biology to investigate the multi-factorial aetiology of FC. Here we conducted a cross-sectional dietary intake assessment, comparing Chinese individuals with FC (Ch-FC) against three control groups: a) non-Chinese with FC (NCh-FC) b) Chinese without FC (Ch-CON) and c) non-Chinese without FC (NCh-CON). Recruitment from Auckland, New Zealand (NZ) identified Chinese individuals based on self-identification alongside both parents self-identifying as Chinese, and FC using the ROME IV criteria. Dietary intake was captured using 3-day food diaries recorded on consecutive days, including one weekend day. Nutrient analysis was performed by Foodworks 10 and statistical analysis with SPSS using a generalised linear model (ethnicity and FC status as fixed factors). Of 78 enrolled participants, 66 completed the study and 64 (39.4 ± 9.2 years) completed a 3-day food diary at the baseline assessment. More participants were female (84%) than male (16%). FC and ethnicity status allocated participants into 1 of 4 groups: Ch-FC (n = 11), Ch-CON (n = 18), NCh-FC (n = 16), NCh-CON (n = 19). Within NCh, ethnicities included NZ European (30%), non-Chinese Asian (11%), Other European (11%), and Latin American (2%). Fibre intake did not differ between Ch-FC and NCh-FC (ethnicity × FC status interaction p>0.05) but was independently lower overall for FC than CON individuals (21.8 ± 8.7 versus 27.0 ± 9.7 g, p<0.05) and overall for Ch than NCh (22.1 ± 8.0 versus 27.0 ± 10.4 g, p<0.05). Carbohydrate, protein, and fat intakes were not different across groups (p>0.05 each, respectively). In the context of fibre and macronutrient intake, there is no difference between Ch-FC and NCh-FC. Therefore, fibre and macronutrients are unlikely to contribute to potential pathophysiological differences in FC between ethnic groups. A more detailed assessment of dietary intake concerning micronutrients, types of fibre, or food choices may be indicated to ascertain whether other dietary differences exist.
The Eastern Gangetic Plains are a densely populated region of South Asia with comparatively low productivity yet a strong potential to intensify production to meet growing food demands. Conservation agriculture-based sustainable intensification (CASI) has gained academic and policy traction in the region, yet despite considerable promotional activities, uptake remains limited. Based on emerging evidence delving beyond a binary classification of adoption, this qualitative study seeks to explore the experiences and perspectives of smallholder farmers who express positive sentiments about CASI, yet have not progressed to (autonomous) adoption. After thematic coding of semi-structured interviews with 44 experimenting farmers and 38 interested non-users, ten common themes emerged that explain why farmers stagnate in their adoption process. Seven of the ten themes were non-specific to CASI and would constraint promotion and uptake of any agri-system change, highlighting the need for contextual clarity when promoting practice changes in smallholder systems. We summaries this to propose the ‘four T's’ that are required to be addressed to enable agricultural change in smallholder systems: Targeting; Training; Targeted incentives; and Time. Through this more nuanced evaluation approach, we argue the need for a stronger focus on enabling environments rather than technological performance evaluations generically, if promotional efforts are to be successful and emerging sustainable intensification technologies are to be adopted by smallholder farmers.
Class and social disadvantage have long been identified as significant factors in the etiology and epidemiology of psychosis. Few studies have explicitly examined the impact of intersecting social disadvantage on long-term employment and financial independence.
Methods
We applied latent class analysis (LCA) to 20-year longitudinal data from participants with affective and non-affective psychosis (n = 256) within the Chicago Longitudinal Research. LCA groups were modeled using multiple indicators of pre-morbid disadvantage (parental social class, educational attainment, race, gender, and work and social functioning prior to psychosis onset). The comparative longitudinal work and financial functioning of LCA groups were then examined.
Results
We identified three distinct latent classes: one comprised entirely of White participants, with the highest parental class and highest levels of educational attainment; a second predominantly working-class group, with equal numbers of Black and White participants; and a third with the lowest parental social class, lowest levels of education and a mix of Black and White participants. The latter, our highest social disadvantage group experienced significantly poorer employment and financial outcomes at all time-points, controlling for diagnosis, symptoms, and hospitalizations prior to baseline. Contrary to our hypotheses, on most measures, the two less disadvantaged groups did not significantly differ from each other.
Conclusions
Our analyses add to a growing literature on the impact of multiple forms of social disadvantage on long-term functional trajectories, underscoring the importance of proactive attention to sociostructural disadvantage early in treatment, and the development and evaluation of interventions designed to mitigate ongoing social stratification.
This paper describes the implementation of curricula for Liberia's first-ever psychiatry training programme in 2019 and the actions of the only two Liberian psychiatrists in the country at the time in developing and executing a first-year postgraduate psychiatry training programme (i.e. residency) with support from international collaborators. It explores cultural differences in training models among collaborators and strategies to synergise them best. It highlights the assessment of trainees’ (residents’) basic knowledge on entry into the programme and how it guided immediate and short-term priority teaching objectives, including integrated training in neuroscience and neurology. The paper describes the strengths and challenges of this approach as well as opportunities for continued growth.
Substance use is a complex condition with multidimensional determinants. The present study aims to find the prevalence and determinants of substance use among young people attending primary healthcare centers in India.
Methods
A multicentric cross-sectional study was conducted across 15 states in India on 1,630 young people (10–24 years) attending primary health centers. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to capture data on substance use. The degree of substance involvement was assessed and multivariate regression analysis was conducted to determine the risk factors of substance use.
Results
The prevalence of substance use was 32.8%, with a median substance initiation age of 18 years. Among the substance users, 75.5% began before completing adolescence. Tobacco (26.4%), alcohol (26.1%) and cannabis (9.5%) were commonly consumed. Sociodemographic determinants included higher age, male gender, urban residence, positive family history, northeastern state residence and lower socioeconomic class. Over 80% of users had moderate or high involvement.
Conclusions
High substance use prevalence among young people in Indian healthcare centers underscores the urgency of targeted intervention. Insights on determinants guide effective prevention strategies for this complex public health issue.
In the present paper, filamentous structure formation, associated turbulent spectrum, and density cavity formation phenomena have been investigated for low-β plasma applicable to the auroral region. A set of dimensionless equations governing the dynamics of three dimensionally propagating inertial Alfvén wave (3D-IAW) and perpendicularly propagating magnetosonic wave (PMSW) has been developed. Ponderomotive force due to 3D-IAW has been included in the dynamics of the PMSW. Numerical simulation has been performed to study the nonlinear coupling of these two waves. From the obtained results, we found that the field intensity localization takes place which may further lead to the additional dissipation/turbulence process for particle heating and acceleration in space plasma. The associated turbulent spectrum is obtained with scaling nearly k−4.28 at smaller scales (in the dissipation range). Relevance of the obtained results with the observations reported by various spacecrafts such as Hawkeye and Heos 2 has been discussed. Also, density fluctuations (depletion) of ∼0.10 n0 are calculated, which are consistent with the FAST spacecraft observation reported.
Rice cultivation in hills is challenged by sub-optimum weather conditions, low soil fertility, low temperature and moisture stress which impedes in attaining high productivity. To address this, four studies were carried out at ICAR Sikkim Centre, Gangtok, India to evaluate relative performance of local organic cultivars and conventionally bred varieties under an organic farming system. Conventionally bred varieties yielded significantly higher (45%) than local cultivars under recommended timely sown conditions whereas local cultivars showed superiority in grain yield under late sown conditions coinciding with low temperature during flowering to grain filling. Genotypes did not show significant interaction when organic or conventional production conditions were compared. For grain yield, there was a significant variation for variety × year interaction under organic system. Local organic cultivars had reduced grain yield and associated traits under rainfed upland conditions. Panicles per unit area had a significant positive association with grain yield in all production environments (organic lowland, organic upland, conventional lowland and conventional upland). Overall, the study indicates using local cultivars as donors for specific stress tolerance traits in background of high yielding genotypes to enhance rice yields sustainably under organic system in hills.
Cannabis (aka marijuana) is the most frequently consumed illicit substance worldwide, and a subset of frequent cannabis smokers (up to 30%) develop dependence. A less well-known consequence of cannabis dependence is withdrawal syndrome, characterized by a time-dependent constellation of symptoms (Lafaye et al. Dialogues Clin Neurosci 2017;19(3), 309-316).
Objectives
This study aims to prospectively assess the course of cannabis withdrawal symptoms within a controlled inpatient detoxification setting and to correlate the severity of withdrawal symptoms with the serum levels of neurotransmitters (NT).
Methods
N=45 treatment-seeking chronic cannabis dependents (assessed by ICD-10) were enrolled, and their withdrawal symptoms were assessed prospectively from admission (Day-0) to 28 days using Marijuana withdrawal checklist (MWC). Sociodemographic characteristics and self-reported drug use histories were reported. Serum levels of dopamine, serotonin, norepinephrine, epinephrine, and cortisol were measured. Cannabis abstinence symptoms were assessed daily using MWC for 4 weeks, and serum neurotransmitter levels were analyzed at admission (Day 0), 7, 14, 21, and 28. Comparison between groups was done using Friedman’s test. Correlation between NT level and MWC scores was performed using linear regression spearman correlation analysis
Results
The follow-up NT levels from Day 0 to 28 showed a significant (p<0.05) decrease in serotonin and dopamine, whereas epinephrine levels showed a significant increase (Fig 1) with the course of withdrawal. Withdrawal symptoms like decreased appetite, sweating, and craving were significantly and positively correlated with serotonin, dopamine, and epinephrine NT levels (Fig 2).
Image:
Image 2:
Conclusions
Findings support the presence of clinically significant cannabis withdrawal symptoms with NT levels in subjects with cannabis dependence seeking substance abuse treatment. The data of this study determine the relationship between observed withdrawal symptoms and changes in brain chemistry and evaluate its possible utility as a predictor of relapse.
Schizophrenia is one of the major neuropsychiatric disorders affecting 1% of the population worldwide. Neuroinflammation, neurodevelopment, and oxidative stress are some of the crucial factors that can contribute to the pathogenesis of Schizophrenia. The Klotho gene is an antiaging gene whose dysregulated expression can lead to Schizophrenia and aging-like symptoms in patients. Klotho gene expression is regulated by miRNA- 339, which might lead to expression changes of the klotho gene in schizophrenia patients.
Objectives
This study aimed to determine the role of miRNA- 339-5p in the regulation of Klotho gene expression and its circulatory levels in Schizophrenia
Methods
A total of 60 diagnosed patients with Schizophrenia per ICD 10 study subjects and 30 healthy controls were recruited for this study from the outpatient department of psychiatry of All India Institute of Medical Sciences, Jodhpur. Written informed consent was taken from all the study participants. All participants were given the right to withdraw from the study at any point in time. The institutional ethics committee of AIIMS, Jodhpur, approved this study. The expression analysis of the klotho gene and miRNA – 339-5p was performed using a reverse transcription polymerase chain reaction. The relative fold change expression was calculated by Livaak’s method ( 2^-double delta ct).
Results
In Schizophrenia cases, serum Klotho protein levels were higher than healthy controls, though non-significant. We observed that the klotho gene was upregulated (figure 1), and miRNA- 339- 5p was downregulated (figure 2) compared to the healthy control.
Image:
Image 2:
Conclusions
The present study is the first to evaluate the klotho gene expression and correlate it with miRNA- 339- 5p. Our study found increased expression of the klotho gene in Schizophrenia patients as compared to the controls. In this study, we also observed that miRNA- 339- 5p was downregulated, which correlates with the klotho gene expression inversely. However, these are the preliminary findings due to less sample size and need to be replicated in the large sample size for further confirmation.
This pilot study provides preliminary insights into whether Latino preschool children living in an emerging Latino community (ELC) are meeting recommendations for healthy diet and activity behaviours and whether those behaviours are associated with sociodemographic or home environment variables. Secondary data analysis was conducted utilising cross-sectional baseline survey data from ANDALE Pittsburgh, a home-based intervention study. Measures included parent-reported information on child dietary intake, screen time and the home environment, and objectively measured physical activity and anthropometry. χ2 and Fischer's exact tests were used to determine associations. The study was conducted in an ELC in western Pennsylvania in the US. Fifty-one Latina mothers (age: 33⋅5 ± 6⋅1 years; 63 % Mexican origin; 86 % low acculturation) and their children (age: 3⋅9 ± 1⋅3 years; 55 % male) 2–5 years of age. On average, children consumed 2⋅25 ± 1⋅44 cups of fruits/vegetables, viewed 98⋅7 ± 74⋅2 min of screen time, accumulated 12⋅9 ± 2⋅9 min/h of total physical activity and consumed 15⋅5 ± 26⋅0 kcals of sugar-sweetened beverages per day. Forty-one percent met the fruit/vegetable recommendation, 54 % met the screen time recommendation, 27 % met the physical activity recommendation and 58 % met the sugary drink recommendation. Country of origin (P = 0⋅032) and acculturation (P = 0⋅048) were significantly associated with children meeting sugary drink recommendations. No other relationships were significant. The proportion of children in this sample meeting diet and activity recommendations was mixed. More research with larger sample sizes is needed in ELCs to identify effective intervention strategies for improving health behaviours.
Sustainability of maize production systems is threatened by poor economic returns and resource intensiveness. Therefore, an experiment was conducted at the ICAR-Indian Agricultural Research Institute, New Delhi during 2016–17 to 2017–18 to assess the effect of tillage and microbial inoculantsintegrated phosphorus (P) management on productivity, quality, economic outcome and energy dynamics of maize. Three tillage practices viz., CT–R (conventional tillage with no residue), ZT–R (zero tillage with no residue) and ZT + R (zero tillage with wheat crop residue at 2.5 Mg/ha) were assigned in main plots and five P management practices viz., P1 (control–NK as per recommendation, but no P), P2 (17.2 kg P/ha), P3 (17.2 kg P/ha + PSB), P4 (17.2 kg P/ha + compost inoculants) and P5 (34.4 kg P/ha) were allocated in subplots in three times replicated split-plot design. The maximum grain yield (5.96 Mg/ha), protein content (9.13%), protein yield (546 kg/ha) and gross energy returns (209 × 103 MJ/ha) were recorded under ZT + R while higher benefit: cost ratio (B: C ratio – the amount of economic gain per unit investment) (1.53) and energy efficiency (12.5) was noticed under ZT–R. Among the P management practices, the application of 34.4 kg P/ha recorded the highest grain yield (6.45 Mg/ha), protein content (9.34%), protein yield (603 kg/ha), B: C ratio (1.65) and energy efficiency (10.1). The results suggested that the application of P at the rate of 34.4 kg/ha under ZT + R is an economically robust approach for the quality maize production in semi-arid region.
OBJECTIVES/GOALS: Development of a user friendly home kit that enables kidney transplant recipients to process urine at home and post the lysate containing RNA to a Core Laboratory would simplify urinary cell mRNA profiling and facilitate longitudinal monitoring. We report our home processing protocol and investigation of its diagnostic performance characteristics. METHODS/STUDY POPULATION: We developed a home processing protocol (HPP) consisting of urine filtration and lysis of urinary cells, both performed at home by the kidney transplant recipients (KTR) themselves, followed by isolation of total RNA from the lysate and mRNA enrichment using a silica-membrane-based cartridge, both performed at the Core Laboratory. Using the HPP, total RNA was isolated from kidney allograft biopsy-matched urines and absolute copy numbers of CD3εmRNA, CXCL10 mRNA, and 18S rRNA, components of the Clinical Trials in Organ Transplantation 04 (CTOT-04) three-gene TCMR diagnostic signature, and urinary cell BKV VP1 mRNA copy number, were measured using customized RT-qPCR assays. RESULTS/ANTICIPATED RESULTS: CTOT-04 three-gene TCMR diagnostic signature scores in urine processed using HPP discriminated KTR with TCMR (12 TCMR biopsies from 11 KTR) from KTR with no TCMR/BKVN (29 No TCMR/No BKVN biopsies from 29 KTR) (P=0.0005, Mann-Whitney test), and AUROC was 0.84 (95% CI, 0.69 to 0.98). TCMR was diagnosed with sensitivity of 67% (95% CI, 35 to 89) at a specificity of 86% (95% CI, 67 to 95) using the CTOT-04 validated cutpoint of -1.213 (P=0.0016,Fisher exact test). BKV VP1 mRNA copy number in urine processed with HPP discriminated KTR with BKVN (n=7) from KTR with no TCMR/BKVN (n=29) and AUROC was 1.0 (95% CI, 1.00 to 1.00). BKVN was diagnosed with a sensitivity of 86% (95% CI, 42 to 99) at specificity of 100% (95% CI, 85 to 100) with the previously validated cutpoint of 6.5x10^8 BKV VP1 mRNA copies/μg of RNA (P DISCUSSION/SIGNIFICANCE: Urine processed using the HPP predicted TCMR and BKVN in KTR. The HPP represents not only a significant advance towards portability of urinary cell mRNA profiling but also should improve patient management by minimizing visits for urine collection.
Conservation agriculture-based sustainable intensification (CASI) is gaining prominence as an agricultural pathway to poverty reduction and enhancement of sustainable food systems among government and development actors in the Eastern Gangetic Plains (EGP) of South Asia. Despite substantial investment in research and extension programs and a growing understanding of the agronomic, economic and labor-saving benefits of CASI, uptake remains limited. This study explores farmer experiences and perspectives to establish why farmers choose not to implement CASI systems despite a strong body of recent scientific evidence establishing the benefits of them doing so. Through thematic coding of semi-structured interviews, key constraints are identified, which establishes a narrative that current households' resources are insufficient to enable practice change, alongside limited supporting structures for resource supplementation. Such issues create a dependency on subsidies and outside support, a situation that is likely to impact any farming system change given the low-risk profiles of farmers and their limited resource base. This paper hence sets out broad implications for creating change in smallholder farming systems in order to promote the adoption of sustainable agricultural technologies in resource-poor smallholder contexts, especially with regard to breaking the profound poverty cycles that smallholder farmers find themselves in and which are unlikely to be broken by the current set of technologies promoted to them.
‘POD Adventures’ is a gamified problem-solving intervention delivered via smartphone app, and supported by non-specialist counsellors for a target population of secondary school students in India during the COVID-19 pandemic.
Aims
To evaluate the feasibility and acceptability of undertaking a randomised controlled trial of POD Adventures when delivered online with telephone support from counsellors.
Method
We conducted a parallel, two-arm, individually randomised pilot-controlled trial with 11 secondary schools in Goa, India. Participants received either the POD Adventures intervention delivered over 4 weeks or usual care comprising information about local mental health services and national helplines. Outcomes were assessed at two timepoints: baseline and 6 weeks post-randomisation.
Results
Seventy-nine classroom sensitisation sessions reaching a total of 1575 students were conducted. Ninety-two self-initiated study referrals (5.8%) were received, but only 11 participants enrolled in the study. No intervention arm participants completed the intervention. Outcomes at 6 weeks were not available for intervention arm participants (n = 5), and only four control arm participants completed outcomes. No qualitative interviews or participant satisfaction measures were completed because participants could not be reached by the study team.
Conclusions
Despite modifications to address barriers arising from COVID-19 restrictions, online delivery was not feasible in the study context. Low recruitment and missing feasibility and acceptability data make it difficult to draw conclusions about intervention engagement and indicative clinical outcomes. Prior findings showing high uptake, adherence and engagement with POD Adventures when delivered in a school-based context suggest that an online study and delivery posed the biggest barriers to study participation and engagement.