Personalized Deep Learning for Substance Use in Hawaii: Protocol for a Passive Sensing and Ecological Momentary Assessment Study

BACKGROUND

Artificial intelligence (AI)-powered digital therapies that detect methamphetamine cravings via consumer devices have the potential to reduce health care disparities by providing remote and accessible care solutions to communities with limited care solutions, such as Native Hawaiian, Filipino, and Pacific Islander communities. However, Native Hawaiian, Filipino, and Pacific Islander communities are understudied with respect to digital therapeutics and AI health sensing despite using technology at the same rates as other racial groups.

OBJECTIVE

In this study, we aimed to understand the feasibility of continuous remote digital monitoring and ecological momentary assessments in Native Hawaiian, Filipino, and Pacific Islander communities in Hawaii by curating a novel data set of longitudinal Fitbit (Fitbit Inc) biosignals with the corresponding craving and substance use labels. We also aimed to develop personalized AI models that predict methamphetamine craving events in real time using wearable sensor data.

METHODS

We will develop personalized AI and machine learning models for methamphetamine use and craving prediction in 40 individuals from Native Hawaiian, Filipino, and Pacific Islander communities by curating a novel data set of real-time Fitbit biosensor readings and the corresponding participant annotations (ie, raw self-reported substance use data) of their methamphetamine use and cravings. In the process of collecting this data set, we will gain insights into cultural and other human factors that can challenge the proper acquisition of precise annotations. With the resulting data set, we will use self-supervised learning AI approaches, which are a new family of machine learning methods that allows a neural network to be trained without labels by being optimized to make predictions about the data. The inputs to the proposed AI models are Fitbit biosensor readings, and the outputs are predictions of methamphetamine use or craving. This paradigm is gaining increased attention in AI for health care.

RESULTS

To date, more than 40 individuals have expressed interest in participating in the study, and we have successfully recruited our first 5 participants with minimal logistical challenges and proper compliance. Several logistical challenges that the research team has encountered so far and the related implications are discussed.

CONCLUSIONS

We expect to develop models that significantly outperform traditional supervised methods by finetuning according to the data of a participant. Such methods will enable AI solutions that work with the limited data available from Native Hawaiian, Filipino, and Pacific Islander populations and that are inherently unbiased owing to their personalized nature. Such models can support future AI-powered digital therapeutics for substance abuse.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/46493.

Internationalization of higher medical education in the post-COVID-19 era

COVID-19 pandemic has caused disruption in higher medical education and healthcare worldwide. To thrive in times of uncertainty, medical higher education institutions have to adapt to the post-COVID-19 era and innovate its international activities. To make a difference in societies locally, nationally and internationally, they will have to enhance their global presence. Internationalization is the best way to the exchanging of knowledge, enhancement of the medical curriculum, and mobilization of talent and resources for research and teaching. To remain competitive, universities will need to expand their international activities. This paper highlights several suggestions to enhance internationalization of medical higher education institutions in the post-COVID-19 era.

Eco-friendly synthesis of ZnO-nanoparticles using Phoenix dactylifera L. polyphenols: physicochemical, microstructural, and functional assessment

Recently, nanoparticles (NPs) synthesis has evolved into a green nanotechnology field, requiring more eco-synthesis of nanoparticles due to the high costs of other chemical-physical methods. Among the most commonly used...

Improving Knowledge and Attitudes About Child Trauma Among Parents and Staff in Head Start Programs

Background

Early childhood represents a sensitive developmental period when trauma-informed care may mitigate the effects of trauma on developmental and health outcomes. However, few interventions use a low-literacy scalable approach to improve child trauma knowledge and attitudes among parents and early childcare and education caregivers.

Methods

Representatives from 24 early head start (EHS) and head start (HS) agencies attended a 2 day online train-the trainer session and then delivered a child trauma and resilience training to staff at their sites, with the option to deliver a similar training to parents. Baseline and 3 month post-training surveys assessed participant knowledge and attitudes regarding childhood trauma and resilience. Paired T-tests and chi2 analyses assessed changes in responses over time.

Results

Thousand five hundred sixty seven staff from 24 agencies and 443 parents from 7 agencies completed baseline and follow up surveys. Over 55% of parents reported their child had experienced at least one adverse childhood experience. Staff and parents had high knowledge regarding causes of trauma at baseline. Both staff and parents, demonstrated significant improvements in identifying symptoms of child trauma. Staff also improved knowledge of resiliency and toxic stress. Parents reported more positive attitudes towards trauma-informed parenting practices.

Conclusion

This is the first training on childhood trauma among EHS/HS providers and parents using a low literacy train-the-trainer approach. Results suggest a potentially promising methodology with broad dissemination potential to prepare and train the one million plus teachers and caregivers in center-based settings and the parents and families who access them to recognize and respond to child trauma.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10995-022-03473-8.

A comparison of child and adolescent psychiatry in the Far East, the Middle East, and Southeast Europe

INTRODUCTION

Despite the high proportion of children and adolescents living in low- and middle-income countries, 95% of all specialized child and adolescent mental health resources are located in high-income countries. To strengthen child and adolescent mental health services (CAMHS), first it is necessary to complete an assessment of the available services and training programs to determine what is needed, particularly in regions with young populations, such as Southeast Europe, the Far East, and the Middle East. The aim of this article is to compare the status of child and adolescent psychiatry (CAP) training programs and the workforce in CAMHS in three geographical regions, to identify similar problems, highlight success stories, and to make recommendations for future studies.

METHODS

This study compared CAP training programs and CAMHS workforce using the World Psychiatric Association, CAP Section's regional studies data.

RESULTS

This study included data from 44 countries: 18 countries in the Far East, 15 countries in the Middle East, and 11 countries in Southeast Europe. There were significant differences both within, and between, the three included regions with regards to availability and infrastructure of CAP training programs. Besides Greece, all included countries reported the need for more child and adolescent psychiatrists and allied child and adolescent mental health professionals.

DISCUSSION

There is an urgent need for more qualified child and adolescent psychiatrists and allied professionals in a very large group of countries in three different geographic regions with great differences in religion, culture, and economy.

FCSlib: an open-source tool for fluorescence fluctuation spectroscopy analysis for mobility, number and molecular brightness in R

SUMMARY

FCSlib is an open-source R tool for fluorescence fluctuation spectroscopy data analysis. It encompasses techniques such as Fluorescence Correlation Spectroscopy, Number and Brightness, Pair Correlation Function and Pair Correlation of Molecular Brightness.

AVAILABILITY AND IMPLEMENTATION

Source code available at https://cran.r-project.org/web/packages/FCSlib/ for Linux, Windows and macOS platforms. Sample data as well as a user's guide are available at https://github.com/FCSlib/FCSlib.

SUPPLEMENTARY INFORMATION

Supplementary data are available at Bioinformatics online.

Fishers' perception of the interaction between the South American sea lions and the Chinook salmon fishery in southern Chile

We studied how the South American sea lion (SASL, Otaria flavescens) interacts with the operation of an artisanal fishery of Chinook salmon, a non-native species in Chile, using a combination of biological and social approaches, including a valuation by fishers about this interaction. During austral summer of 2019, an observer onboard artisanal fishing boats characterized the attack behavior of SASLs to gillnet-captured Chinook salmon during 33 hauls and analyzed which factors may affect the intensity of attacks. To analyze the relationship between fishers and SASLs, a Likert scale about the perception and views about nature was applied. A total of 23 interviews—including 35 open and 16 closed questions—with fishers were conducted to describe how they perceived the interactions with SASLs. Interactions with SASLs were recorded in 35% of the fishing events and varied depending on both operational factors, such as the number of boats, as well as environmental factors, such as moon’s luminosity. Even though SASL interactions resulted in seven fish (~ 70 kg) damaged of a total catch of 2815 kg (2.5%) during the survey, boats with a damaged catch by SASL lost up to 11% of their revenue. This is consistent with 87% of the interviewed fishers who considered that the conflict with the SASL negatively impacts their activity and results in economic losses. A negative perception towards SASLs likely results from personal experience and revenue loss, even though impacts of SASL interactions at the scale of the entire fishery may be less important. While older fishers with less formal education have a productivist and instrumental focus, younger fishers with a more sustainable and conservationist view of fishing offer an opportunity to lead an improved local understanding of the relationship between salmon, SASLs, and humans.

The Implementation of the WHO Mental Health Gap Intervention Guide (mhGAP-IG) in Ukraine, Armenia, Georgia and Kyrgyz Republic

Despite the increasing burden of mental disorders, a lot of people worldwide suffer a gap in receiving necessary care in these countries. To close this gap, the WHO has developed mhGAP training modules aimed at scaling up mental health and substance use disorders services, especially in low- and middle-income countries. This article presents the experience of implementing the Mental Health Gap Action Programme (mhGAP) in Ukraine, Armenia, Georgia, and Kyrgyz Republic. Data were gathered from an electronic questionnaire administered to representatives from higher educational institutions where the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) was implemented in existing curricula for medical students, interns, and residents in family medicine and neurology, practicing physicians, and master's program in mental health students. More than 700 students went through the programs that provided the feedback. Evaluations of program effectiveness mainly involved standard discipline tests or pre- and post-tests proposed in the mhGAP trainer manual. This finding suggested that mhGAP-IG can be successfully adapted and implemented both on undergraduate and on postgraduate education levels and among medical and nonmedical specialists. Future evaluations need to more definitively assess the clinical effectiveness of mhGAP-IG implementation.

Preliminary results of a network meta-analysis on the efficacy of long-acting injectable antipsychotics in schizophrenia

Introduction

Long-acting injectable antipsychotics (LAIs) are currently the most effective alternative for patients with schizophrenia who exhibit poor adherence. Although a recent meta-analysis reported similar efficacy between first and second-generation LAIs, these results were only based on 3 studies due to the limited number of head-to-head comparisons.

Objectives

Present the preliminary results of a network meta-analysis on the comparative efficacy of LAIs in schizophrenia.

Methods

Studies were obtained from a previous study, where we carried out a systematic search from until May 2019 in various databases. Included trials of adults with schizophrenia compared the efficacy of LAI vs LAI or placebo through the Positive and Negative Syndrome Scale (PANSS). Efficacy was evaluated through the mean differences (MD) from baseline to endpoint in the PANSS total scores. Network meta-analysis was performed in MetaInsight through direct and indirect comparisons using a Bayesian approach.

Results

from 12 studies are presented in Figures 1 and 2. All LAIs except zuclopenthixol were more effective than placebo. There were no significant differences between LAIs except for aripiprazole and risperidone, which were more efficacious than zuclopenthixol. The largest change occurred with aripiprazole LAI, but was not significantly higher than haloperidol.

Figure 1. Comparison of treatment pairs. Effect sizes are presented as MD and 95% confidence intervals (*p<0.05).

Figure 1. Overall change in symptoms

Conclusions

Preliminary results from a network meta-analysis also suggest that in the long-term haloperidol decanoate is equally effective in overall symptom changes compared to other LAIs. Further analyses are needed to obtain a better perspective on these drugs.

Disclosure

No significant relationships.

Cervical cancer, human papillomavirus (HPV), and HPV vaccination: exploring gendered perspectives, knowledge, attitudes, and cultural taboos among Mexican American adults

Background: Gendered perspectives may be particularly important in shaping norms and values around HPV and HPV vaccination, as previous research suggests that sexuality taboos (e.g. promiscuity) may contribute to low perceived risk among adolescent and young adult Hispanic females. However, research to date focuses primarily on Hispanic mothers, adolescent females, and women of HPV vaccine-eligible age. Hispanic father's perspectives are relatively unknown despite father's important role in shaping norms for their female children. Objective: To close this gap, this study examines gendered perspectives in knowledge, beliefs, and attitudes about HPV and HPV vaccination from Hispanic parents (mothers and fathers), women of vaccine-eligible age (18-26 years old), and women eligible for Pap Test screening (>26 years old) living in two counties along the Texas-Mexico border. Design: We conducted eight focus groups. Research staff transcribed audio recordings verbatim and uploaded them into Atlas(ti) 5.0 for analysis. The research team analyzed the data for content, meaning, patterns and themes using the constant comparison approach. Results: Perspectives were highly gendered. Women's (all groups combined) beliefs focused on misconceptions around how the HPV virus is contracted (e.g. toilet surfaces). Women also linked HPV-related sexual risk to adultery and indiscretion of male partners. Fathers (men) were more likely to link risk to female promiscuity. Fathers also worried that HPV vaccination might increase promiscuity. All groups believe that HPV vaccination is a way to protect Hispanic females in the face of beliefs around sexual behavior and risk of contracting HPV. Conclusion: Results suggest gendered differences in risk beliefs concerning HPV among Hispanics living along the Texas-Mexico border. Researchers can use these findings to address barriers to HPV vaccination, as well as to create culturally appropriate prevention messages that may help reduce disparities in HPV among Hispanic women.

Evaluation of smart gelatin matrices for the development of scaffolds via 3D bioprinting

Throughout history, different techniques have been used for the development of scaffolds for Tissue Engineering. Among them, three-dimensional (3D) printing for this application has been recently enhanced due to its ease in defining the structure of the material. In this sense, a novel potential alternative could be the development of a three-part device whose leading utility is to improve the introduction of the scaffold in a bioreactor. Thus, the device consists of a polycaprolactone support on which smart gelatin (GE) matrix, and finally, on top, a collagen (C) scaffold. This gelatin matrix is included to integrate the scaffold into the support, but once both are assembled, it must be removed, leaving only the support and the scaffold. Thus, in the present work, a small gelatin matrix has been evaluated. To this end, matrices with different gelatin percentages were studied, evaluating their mechanical and morphological properties at different temperatures (22 and 37 °C) to control their deposition and elimination. The results show the high application of this smart matrix for the development of scaffolds via 3D bioprinting for Tissue Engineering.

Statistical control of processes applied to geometric uncertainties for CTV expansion margins determination in prostate cancer patients treated with VMAT: a prospective study in 57 patients

PURPOSE

To study the control graphs applicability for the geometric uncertainties of VMAT treatments in prostate cancer patients, and their use to verify the hypothesis of the data obtained randomness, to apply the margins of Van Herk expression.

MATERIAL AND METHODS

During the first 5 days of treatment, and then once a week, a Kv CBCT was performed, compared with the simulation CT and adjusted the displacements, to determine the inter-fraction errors. Immediately after radiation therapy, another CBCT was performed (for intra-fraction errors). With these data, the X, R position control charts have been made. The patients, not maintained the deviations within the charts control limits, were called "anomalies". Then, we compared the deviations and margins calculated with the van Herk expression for all patients and for those without anomalies.

RESULTS

The margins determined show appreciable differences if there were calculated for the total set of patients or for the set of them without anomalies in the control charts. For the overall set of patients, the lateral, longitudinal, and vertical margins were 0.45 cm, 0.52 cm, 0.56 cm, while for the set of patients without anomalies were 0.29 cm, 0.35 cm, and 0.38 cm.

CONCLUSIONS

The use of control charts allows tracking geometric deviations both inter and intra-fraction, variability real-time control and to detect situations in which it can change for non-random reasons, and require immediate investigation. Maintaining geometric deviations in the control state decreases the margins needed to administer a high dose to CTV in a high percentage of cancer prostate patients.

Discount Rate Determination for Economic Evaluations in HTA in the Philippines

To inform the development of a reference case for economic evaluation, we explored various approaches to determine a base case discount rate and rate options for discounting benefits and costs.

We conducted literature review and expert consultations to list approaches to determine base case discount rates, noting the advantages and disadvantages of each approach. The same methods were used to identify whether different discount rates would be applied to costs and benefits. We computed a social rate of time preference using the Ramsey formula: rc = ρ+μg, where ρ = pure rate of time preference μ= elasticity of the marginal utility of consumption and g= growth rate in per capita income. We assumed ρ = 1%, μ = 1.4% consistent with international practice, but used actual g of the Philippines of 4.5%. We compared this with the official social discount rate and with rate most commonly used internationally. These options were presented to the Philippine Health Technology Assessment Council for decisionmaking.

Based on reviewed literature, 10 out of 22 countries used a 3.0% to 3.5% discount rate while 18 countries from the same pool applied equal discount rates for both costs and outcomes. The official social discount rate (SDR) prescribed by the Philippine National Economic Development Authority is 10% for all social investments. Upon input of the values, rc was calculated at 7%, which is above the international norm but below the official rate. Four discount rate options were identified: 3%, 3.5%, 7% and 10%.

Evidence suggested using a discount rate higher than 3% to 3.5% for low-to-middle income countries. A more conservative rate based on the Ramsey formula of 7% base case discount rate was selected in performing economic evaluations. Sensitivity analysis was set between 3% and 10% to allow benchmarking with international practice and with the official SDR, respectively. Given Philippines' early HTA implementation phase, it was agreed to subject these rates to regular review.

Key messages

Setting a discount rate in economic evaluations is a crucial process for HTA institutionalization. Discount rate determination heavily relies on decision context a country considers most relevant.

WHO Mental Health Gap Action Programme Intervention Guide (mhGAP-IG): the first pre-service training study

Background

Despite the increasing burden of mental, neurological, and substance use (MNS) disorders, a significant treatment gap for these disorders continues to exist across the world, and especially in low- and middle-income countries. To bridge the treatment gap, the World Health Organization developed and launched the Mental Health Gap Action Programme (mhGAP) and the mhGAP Intervention Guide (mhGAP-IG) to help train non-specialists to deliver care. Although the mhGAP-IG has been used in more than 100 countries for in-service training, its implementation in pre-service training, that is, training prior to entering caregiver roles, is very limited.

Aim of the study

The aim of this study was to collect and present information about the global experience of academic institutions that have integrated WHO’s mhGAP-IG into pre-service training.

Methods

A descriptive cross-sectional study was conducted using an electronic questionnaire, from December 2018 to June 2019.

Results

Altogether, eleven academic institutions across nine countries (Mexico, Nigeria, Liberia, Sierra Leone, Somaliland, Armenia, Georgia, Ukraine and Kyrgyzstan) participated in this study. Five of the institutions have introduced the mhGAP-IG by revising existing curricula, three by developing new training programmes, and three have used both approaches. A lack of financial resources, a lack of support from institutional leadership, and resistance from some faculty members were the main obstacles to introducing this programme. Most of the institutions have used the mhGAP-IG to train medical students, while some have used it to train medical interns and residents (in neurology or family medicine) and nursing students. Use of the mhGAP-IG in pre-service training has led to improved knowledge and skills to manage mental health conditions. A majority of students and teaching instructors were highly satisfied with the mhGAP-IG.

Conclusions

This study, for the first time, has collected evidence about the use of WHO’s mhGAP-IG in pre-service training in several countries. It demonstrates that the mhGAP-IG can be successfully implemented to train a future cadre of medical doctors and health nurses.

Clusters formation and fragmentation of nitromethane at 266 nm

We carry out experiments on the fragmentation of nitromethane by multiphoton absorption at the wavelength 266 nm. This was conducted in a reflectron (Jordan), modified in the laboratory. Due to the large number of fragments, special care has been taken into the calibration of the system, in the simultaneity between the laser pulse and the sample, and the associated electronics to ensure that produced fragment spectra arise from the interaction laser-sample. We emphasize the next aspects of the method:•

Simple design for introducing a gas sample at laser interaction region to facilitate the cluster formation

•

Astonishing number of fragments produced by multiphoton absorption.

Child and adolescent psychiatry training and services in the Middle East region: a current status assessment

Mental health is a key component of health, yet appropriate care is limited. Evidence concerning child and adolescent mental health has predominantly come from western countries, while the Middle East region, with a large youth population, has reported very little on it. This original, cross-sectional study of child and adolescent psychiatry in the Middle East provides an assessment of current postgraduate programs, services and what is needed to build workforce capacity. Academic psychiatrists from 16 Middle East countries were invited to form a Consortium to map current postgraduate training as one of the determinants of available child and adolescent psychiatry services, identify gaps in the distribution of child and adolescent psychiatrists, and propose potential steps to improve access to child and adolescent mental health care. The study collected data from 15 of the 16 countries invited (no data provided from Yemen). The study revealed underdeveloped child and adolescent psychiatry academic systems throughout the region. Despite recognition of the specialty in a majority of the countries (11/15), only six countries had established a designated child and adolescent psychiatry training program. The overall shortage of child and adolescent mental health specialists varied, yet all Consortium members reported a need for additional child and adolescent psychiatry specialists and allied professionals. Lack of child and adolescent psychiatry specialized programs in place throughout the region has evidently contributed to the shortage of qualified child and adolescent mental health workforce in the Middle East.

Pollen Resources Used by Two Species of Stingless Bees (Meliponini) in a Tropical Dry Forest of Southern Ecuador

Pollinators are crucial for ecosystem functionality; however, little is known about the plant species used by some of these, such as stingless bees. In this study, for the first time, pollen resources used by Melipona mimetica Cockerell (Hymenoptera: Apidae: Meliponini) and Scaptotrigona sp. Moure (Hymenoptera: Apidae: Meliponini) were identified through analysis of corbicular pollen found on worker bees in a dry forest in southern Ecuador. In total, 68 pollen types were identified belonging to 31 botanical families. The most represented plant families were Fabaceae (16%), Malvaceae (7%), and Boraginaceae (7%). Both stingless bee species exhibited a polylectic behavior, with an average of 16 pollen types collected by individual bees. Differences in abundances of pollen types collected by each species indicated distinct uses for these two bee species.

Improving network approaches to the study of complex social-ecological interdependencies

Achieving effective, sustainable environmental governance requires a better understanding of the causes and consequences of the complex patterns of interdependencies connecting people and ecosystems within and across scales. Network approaches for conceptualizing and analyzing these interdependencies offer one promising solution. Here, we present two advances we argue are needed to further this area of research: (i) a typology of causal assumptions explicating the causal aims of any given network-centric study of social-ecological interdependencies; (ii) unifying research design considerations that facilitate conceptualizing exactly what is interdependent, through what types of relationships, and in relation to what kinds of environmental problems. The latter builds on the appreciation that many environmental problems draw from a set of core challenges that re-occur across contexts. We demonstrate how these advances combine into a comparative heuristic that facilitates leveraging case-specific findings of social-ecological interdependencies to generalizable, yet context-sensitive, theories based on explicit assumptions of causal relationships.

Prevalence of Burnout in Medical and Surgical Residents: A Meta-Analysis

The burnout syndrome is characterized by emotional exhaustion, depersonalization, and reduced personal achievement. Uncertainty exists about the prevalence of burnout among medical and surgical residents. Associations between burnout and gender, age, specialty, and geographical location of training are unclear. In this meta-analysis, we aimed to quantitatively summarize the global prevalence rates of burnout among residents, by specialty and its contributing factors. We searched PubMed, PsycINFO, Embase, and Web of Science to identify studies that examined the prevalence of burnout among residents from various specialties and countries. The primary outcome assessed was the aggregate prevalence of burnout among all residents. The random effects model was used to calculate the aggregate prevalence, and heterogeneity was assessed by I² statistic and Cochran's Q statistic. We also performed meta-regression and subgroup analysis. The aggregate prevalence of burnout was 51.0% (95% CI: 45.0-57.0%, I² = 97%) in 22,778 residents. Meta-regression found that the mean age (β = 0.34, 95% CI: 0.28-0.40, p < 0.001) and the proportion of males (β = 0.4, 95% CI = 0.10-0.69, p = 0.009) were significant moderators. Subgroup analysis by specialty showed that radiology (77.16%, 95% CI: 5.99-99.45), neurology (71.93%, 95% CI: 65.78-77.39), and general surgery (58.39%, 95% CI: 45.72-70.04) were the top three specialties with the highest prevalence of burnout. In contrast, psychiatry (42.05%, 95% CI: 33.09-51.58), oncology (38.36%, 95% CI: 32.69-44.37), and family medicine (35.97%, 95% CI: 13.89-66.18) had the lowest prevalence of burnout. Subgroup analysis also found that the prevalence of burnout in several Asian countries was 57.18% (95% CI: 45.8-67.85); in several European countries it was 27.72% (95% CI: 17.4-41.11) and in North America it was 51.64% (46.96-56.28). Our findings suggest a high prevalence of burnout among medical and surgical residents. Older and male residents suffered more than their respective counterparts.

Shaping the future of child and adolescent psychiatry

Child and adolescent psychiatry is in a unique position to respond to the growing public health challenges associated with the large number of mental disorders arising early in life, but some changes may be necessary to meet these challenges. In this context, the future of child and adolescent psychiatry was considered by the Section on Child and Adolescent Psychiatry of the World Psychiatric Association (WPA CAP), the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP), the World Association for Infant Mental Health (WAIMH), the International Society for Adolescent Psychiatry and Psychology (ISAPP), the UN Special Rapporteur on the Right to Health, representatives of the WHO Department of Mental Health and Substance Abuse, and other experts. We take this opportunity to outline four consensus priorities for child and adolescent psychiatry over the next decade: increase the workforce necessary for providing care for children, adolescents and families facing mental disorders; reorienting child and adolescent mental health services to be more responsive to broader public health needs; increasing research and research training while also integrating new research finding promptly and efficiently into clinical practice and research training; Increasing efforts in advocacy.

Experimental Observation of Proton Bunch Modulation in a Plasma at Varying Plasma Densities

We give direct experimental evidence for the observation of the full transverse self-modulation of a long, relativistic proton bunch propagating through a dense plasma. The bunch exits the plasma with a periodic density modulation resulting from radial wakefield effects. We show that the modulation is seeded by a relativistic ionization front created using an intense laser pulse copropagating with the proton bunch. The modulation extends over the length of the proton bunch following the seed point. By varying the plasma density over one order of magnitude, we show that the modulation frequency scales with the expected dependence on the plasma density, i.e., it is equal to the plasma frequency, as expected from theory.

Experimental Observation of Plasma Wakefield Growth Driven by the Seeded Self-Modulation of a Proton Bunch

We measure the effects of transverse wakefields driven by a relativistic proton bunch in plasma with densities of 2.1×10^{14} and 7.7×10^{14}  electrons/cm^{3}. We show that these wakefields periodically defocus the proton bunch itself, consistently with the development of the seeded self-modulation process. We show that the defocusing increases both along the bunch and along the plasma by using time resolved and time-integrated measurements of the proton bunch transverse distribution. We evaluate the transverse wakefield amplitudes and show that they exceed their seed value (<15  MV/m) and reach over 300  MV/m. All these results confirm the development of the seeded self-modulation process, a necessary condition for external injection of low energy and acceleration of electrons to multi-GeV energy levels.

Child and adolescent psychiatry in the Far East: A 5-year follow up on the Consortium on Academic Child and Adolescent Psychiatry in the Far East (CACAP-FE) study

AIM

Data pertaining to child and adolescent psychiatry (CAP) training systems are limited as extant research has mostly been derived from one-time data collection. This 5-year follow-up survey collects updated information on CAP training systems in the Far East, allowing for the tracking of system changes over the past 5 years.

METHODS

Data were obtained from 18 countries, or functionally self-governing areas, in the Far East, 17 of which were also included in the original study. An online questionnaire was completed by leading CAP professionals in each country. Questions were expanded in the present study to capture the contents of CAP training.

RESULTS

When compared to data from the original study, there has been progress in CAP training systems in the last 5 years. Specifically, there has been an increase in the number of countries with CAP training programs and national guidelines for the training. In addition, the number of CAP departments/divisions affiliated with academic institutions/universities has increased. Findings from 12 of 18 countries in the present study provide data on clinical contents. All informants of the present study reported the need for more child and adolescent psychiatrists and allied professionals.

CONCLUSION

Despite progress in CAP training systems over the last 5 years, the need for more professionals in child and adolescent mental health care in all the relevant areas in this region have yet to be adequately addressed. Continued national efforts and international collaborations are imperative to developing and sustaining new CAP training systems while facilitating improvements in existing programs.

Behaviour of the Contact Phase of Blood Coagulation in the Adult Respiratory Distress Syndrome (ARDS)

In order to assess the role of the kallikrein-kinin (K-K) system in the pathogenesis of the adult respiratory distress syndrome (ARDS) we have prospectively determined coagulation contact phase, blood gas and hemodynamic parameters in patients with ARDS at 0, 36 and 72 h from diagnosis.

Compared to normal values, significantly lower mean levels of factor XII (71.4 ± 9.8%, p <0.0005), prekallikrein (PPK) (52 ± 5.7%, p <0.0005), high molecular weight kininogen (HMWK) (73 ± 2%, p <0.0005) and α2-macroglobulin (α2-M) (51 ± 7.1%, p <0.0005) were found in ARDS patients.

The functional kallikrein inhibitory activity (KKI) and Cr esterase inhibitor antigenic (CIINH) were significantly higher in these patients (113.2 ± 5, p <0.005 and 124.7 ± 7.6, p <0.0005 respectively) compared with normal values during the entire study period.

The KKI/CIINH ratio decreased significantly in our ARDS patients at 0, 36 and 72 h (p <0.025; p <0.05 and p <0.005 respectively).

We found a significant correlation between PPK levels and oxigenation index (r = 0.69, p <0.001), PPK and the static thoracic compliance values (r = 0.64, p <0.001). There was also a significant correlation between PPK levels and Qs/Qt (r = -0.89, p <0.001). ARDS patients that survived presented a stability in the PPK values in successive tests. Nevertheless non-survivors showed a progressive decrease in PPK levels during the follow-up period.

Our results suggest that the plasma kallikrein system becomes activated during ARDS and that this activation might increase the lung vessels’ permeability. In addition, PPK levels are in our opinion a useful prognostic parameter in predicting the outcome of ARDS patients.

Consumer acceptability of beef from two sexes supplemented with essential oil mix

Essential oils are natural extracts from plants which can be included in cattle diets as an alternative to additives, such as ionophores, to improve the shelf life of meat. The aim of this study was to evaluate the sensory acceptability of meat from 57 crossbred (1/2 Angus–1/2 Nellore) animals of different sexes [heifers n = 30, and young bulls n = 27], finished in feedlot with isoenergetic and isonitrogenous diets, which differed in the level of supplementation (0.0, 3.5 or 7.0 g/animal/day) with a commercial mix of essential oils (Mixoil®) from seven plants: oregano, garlic, lemon, rosemary, thyme, eucalyptus and sweet orange. The Longissimus thoracis muscle, aged for 24 h, was evaluated by 120 consumers who scored tenderness acceptability, flavour acceptability and overall acceptability using a hedonic 9-point scale. The inclusion of essential oils affected tenderness acceptability and flavour acceptability (P ≤ 0.01), with a tendency (P < 0.10) for overall acceptability. Meat from heifers was more appreciated by consumers than that from young bulls in all attributes (P ≤ 0.001), however, different groups of consumers had different preferences. The inclusion of a mix of essential oils in beef diets was well accepted by consumers, and could improve the acceptability of meat from young bulls, when is added at a concentration of 3.5 g/animal/day during the last 4 months of fattening.

Comparing and Contrasting the Use of Problem-Based Learning in Child and Adolescent Psychiatry Programs

OBJECTIVE

Problem-based learning (PBL) is one of the core components of medical education. To facilitate the spread and use of PBL in child and adolescent psychiatry (CAP) fellowship training, a special interest study group (SISG) was formed at the American Academy of Child and Adolescent Psychiatry (AACAP). Different approaches to the implementation of PBL between programs represented at the SISG are compared in this report.

METHODS

The authors distributed a survey to SISG participants after the 2015 annual AACAP meeting, which gathered information about the different approaches programs use to implement PBL in graduate medical education.

RESULTS

Six CAP training programs responded to the survey, providing descriptions of the structure and content of PBL seminars. Programs chose to include a wide variety of topics in PBL courses and approach course organization in a number of ways. To the degree that PBL draws from identified reference texts, programs were similar in selecting definitive textbooks, practice parameters, and seminal articles.

CONCLUSIONS

This small pilot study is intended to provide a snapshot of the state of PBL implementation in CAP fellowship programs. It reflects that programs can incorporate PBL in a variety of ways, tailored to the needs of the institution. Future directions of research include assessment of resident satisfaction with PBL, impact on resident education, and identifying successful methods of implementation of PBL.

Experience in the treatment of osseous hydatidosis

Osseous hydatidosis is a very uncommon disease which often recurs after treatment. There is no well-established effective method of management. Radical excision may produce serious mutilation and often fails to control the disease. We have used oral mebendazole as adjuvant treatment in four patients. Two also underwent radical excision, one had received limited excision elsewhere and the other did not have operative treatment. The patients who underwent radical excision and the other who did not have an operation became and remain free of symptoms and are serologically negative.A combination of excision and treatment with mebendazole may have a role in the management of this complex disease.