Cognitive remediation for schizophrenia: Clinician perspectives on implementation barriers and facilitators

OBJECTIVES

Neurocognitive deficits in schizophrenia have a major impact on functioning; however, they remain poorly targeted by available treatment offerings. Cognitive remediation (CR) is effective in improving neurocognition and functioning. Despite clinical guidelines for schizophrenia recommending CR, it is still not readily available in clinical services and sizeable attrition rates are reported in clinical trials.

METHOD

To elucidate the barriers and facilitators of CR access and engagement, we conducted a mixed methods qualitative-dominant study with 12 clinicians in Australia, in 2021, with 1 hr interviews and additional rating scales completed.

RESULTS

Thematic analysis highlighted four themes (cognitive symptoms, CR intervention, motivation and engagement in CR, and CR implementation), and 14 subthemes. Clinicians emphasized the broad impact of cognitive deficits and outlined pros and cons of different CR approaches. Several factors were suggested as impacting engagement, including motivation assessments/techniques, neurocognitive insight, illness, and demographic factors. Lack of routine implementation in Australia was unanimously espoused and partly explained by a need for cost-effectiveness analyses, remote and flexible delivery, and increasing service resource provision and staff training in CR.

CONCLUSIONS

This study offers key insights into CR access, while recommending methods for optimizing CR implementation and dissemination to improve recovery outcomes of people diagnosed with schizophrenia. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Multisensory hallucinations and other unusual sensory experiences in the context of migraine: a systematic review

OBJECTIVE AND BACKGROUND

Visual auras in migraine have been extensively studied, but less is known about multisensory hallucinations or other unusual sensory experiences, including whether these should be diagnostically considered as part of aura symptoms. The current study aimed to conduct a systematic review and synthesis to bring together existing empirical evidence on these non-visual perceptual experiences, focusing on their phenomenological descriptions and clinical correlates.

METHODS

Forty-eight relevant studies were included based on a systematic search across PsycINFO APA and Web of Science, for peer-reviewed publications in the English language, from 1980 to the present. These comprised a mix of case reports/series (n = 19) and group design studies (n = 29).

RESULTS

Reports of complex multisensory hallucinations, beyond typical established aura symptoms, were numerous and varied in nature. Yet there were limited data on how this related to patient distress and functional interference. Other sensory distortions or hypersensitivities across non-visual domains were also evident, and generally more common in those with established aura symptoms.

CONCLUSION

Our findings provide preliminary evidence that multisensory hallucinations and other unusual perceptual experiences in migraine are likely more common than previously believed. Further investigations are needed to appropriately account for these symptoms within current nosological systems. Increased clinician-patient awareness is important for managing distress (where necessary), and potentially for offering a holistic therapeutic approach to migraine management.

Improving student learning and performance through a continuous flipped anatomy teaching model

The flipped classroom teaching model has been widely used in anatomy education to embrace a blended learning strategy. However, the impact that a continuous flipped classroom teaching model exerts on student learning of human topographic anatomy remains unclear. To address this question, student learning experience and performance were compared between third-year undergraduate students who participated in a continuous flipped anatomy classroom teaching since their first year (n = 65, experimental group) and those under the flipped anatomy teaching model only in their third year (n = 45, control group). A five-point Likert scale learning and teaching survey was conducted to evaluate students' perceptions of the flipped classroom model. Students under a continuous flipped classroom teaching model rated significantly higher on the impact of the flipped model on learning difficult anatomy concepts than the control group (*p = 0.0346). The rating on independent learning remained not statistically different between the two groups, although a trend difference was detected (p = 0.0604). Analysis of learning performance revealed that the experimental group significantly outperformed the control group when answering questions focusing on regional anatomy (*p = 0.0207). No significant difference was identified in students' marks of case-based studies between the two groups. In summary, the results of this study indicate that the flipped classroom model implemented over a long term continues to advance students' learning experience and performance in anatomy, indicating a "dose" effect on active learning. The findings of this study will assist the best practices of the flipped anatomy classroom and develop evidence-informed approaches to advance anatomy education in the future.

Conflict in emergency medicine: A systematic review

BACKGROUND

The emergency department (ED) is a demanding and time-pressured environment where doctors must navigate numerous team interactions. Conflicts between health care professionals frequently arise in these settings. We aim to synthesize the individual-, team-, and systemic-level factors that contribute to conflict between clinicians within the ED and explore strategies and opportunities for future research.

METHODS

Online databases PubMed and Web of Science were systematically searched for relevant peer-reviewed journal articles in English with keywords relating to "conflict" and "emergency department," yielding a total of 29 articles.

RESULTS

Narrative analysis showed that conflict often occurred during referrals or admissions from ED to inpatient or admitting units. Individual-level contributors to conflict include a lack of trust in ED workup and staff inexperience. Team-level contributors include perceptions of bias between groups, patient complexity, communication errors, and difference in practice. Systems-level contributors include high workload/time pressures, ambiguities around patient responsibility, power imbalances, and workplace culture. Among identified solutions to mitigate conflict are better communication training, standardizing admission guidelines, and improving interdepartmental relationships.

CONCLUSIONS

In emergency medicine, conflict is common and occurs at multiple levels, reflecting the complex interface of tasks and relationships within ED.

Perceived comfort and tool usability during robot-assisted and traditional laparoscopic surgery: a survey study

It is known that over half of previously surveyed surgeons performing Robot-Assisted Laparoscopic Surgery (RALS) and three-quarters of those performing Traditional Laparoscopic Surgery (TLS) experience intraoperative pain. This survey study aimed to expand upon the ongoing impact of that pain as well as perceived tool usability associated with TLS and RALS, for which considerably less documentation exists. A survey regarding the presence and impact, either immediate or ongoing, of intraoperative pain and Likert scale questions regarding tool usability was administered to TLS and RALS surgeons on the European Association for Endoscopic Surgery (EAES) mailing list. Prevalence statistics as well as trends based on biological sex and glove size were obtained from the 323 responses. Most respondents were right-handed European males (83-88%) with a medium glove size (55.8%). Moderate or severe shoulder symptoms were experienced by one-third of TLS surgeons. Twenty-one percent of RALS surgeons experienced neck symptoms that impacted their concentration. Small-handed surgeons experienced wrist symptoms significantly more frequently than large-handed surgeons, regardless of modality. RALS was associated with a significantly more optimal back and wrist posture compared to TLS. TLS surgeons reported increased ease with applying and moderating force while operating. These results suggest that intraoperative pain may be severe enough in many cases to interfere with surgeon concentration, negatively impacting patient care. Continuing to understand the relationship between tool usability and comfort is crucial in guaranteeing the health and well-being of both surgeons and patients.

Perfectionism as a moderator of the relationship between orthorexia nervosa and obsessive-compulsive symptoms

PURPOSE

Orthorexia nervosa (ON), a proposed disorder describing an obsessive focus on "healthy" eating, is characterised as having overlapping symptoms with obsessive-compulsive disorder. However, ON/obsessive-compulsive (OC) symptom relationships are inconsistently reported. The current study aimed to investigate if the contribution of OC symptoms and beliefs explain variability in ON symptoms and determine if perfectionism, a transdiagnostic factor, moderates the ON/OC symptom relationship.

METHODS

The study comprised 190 participants (Mage = 28.63, SDage = 9.88; 80% female) recruited via an undergraduate research programme, social media, advocacy organisations, and a participant registry. Participants completed an online questionnaire assessing ON, OC, and perfectionism symptoms.

RESULTS

A linear regression analysis found OC symptoms and beliefs explained 22.9% variability in ON symptoms (p < 0.001, f2 = 0.38) and perfectionism moderated the ON/OC symptom relationship, where higher levels of perfectionism with higher levels of OC symptoms was associated with higher levels of ON symptoms, explaining 2.2% variability (p = .01, f2 = 0.03).

CONCLUSION

OC symptoms appear more common in ON than previous studies indicate. However, the interaction between perfectionism and OC symptoms may drive obsessions in ON. Findings help refine our current understanding of ON phenomenology with implications for ON treatment development. Future research should further explore perfectionism in ON phenomenology.

LEVEL OF EVIDENCE

Level V (Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees).

Electric powered wheelchair control using user-independent classification methods based on surface electromyography signals

Wheelchairs are one of the most popular assistive technology (AT) among individuals with motor impairments due to their comfort and mobility. People with finger problems may find it difficult to operate wheelchairs using the conventional joystick control method. Therefore, in this research study, a hand gesture-based control method is developed for operating an electric-powered wheelchair (EPW). This study selected a comfort-based hand position to determine the stop maneuver. An additional exploration was undertaken to investigate four gesture recognition methods: linear regression (LR), regularized linear regression (RLR), decision tree (DT), and multi-class support vector machine (MC-SVM). The first two methods, LR and RLR, have promising accuracy values of 94.85% and 95.88%, respectively, but each new user must be trained. To overcome this limitation, this study explored two user-independent classification methods: MC-SVM and DT. These methods effectively addressed the finger dependency issue and demonstrated remarkable success in recognizing gestures across different users. MC-SVM has about 99.05% of both precision and accuracy, and the DT has about 97.77% accuracy and precision. All six participants were successful in controlling the EPW without any collisions. According to the experimental results, the proposed approach has high accuracy and can address finger dependency issues.

Integrating digital literacies and scientific communication in a multimedia anatomy group assignment to advance contextual learning

Anatomists are facing a new generation of learners who will study and work in a technology-rich environment. Indeed, digital technologies are tremendously changing how information and knowledge are communicated and retrieved. However, it remains unclear whether an anatomy assessment can be designed to promote contextual learning through integrating a digital communication strategy. To investigate this, assessment methods were diversified in the first-year neuroanatomy and third-year regional anatomy curricula through implementing a multimedia human anatomy group assignment integrating digital literacies and scientific communication. Through completing this multimedia assignment, students demonstrated their anatomy knowledge transfer using a range of approaches. The main mode of presentations chosen in the two anatomy units were non-animated video presentations (~50%), animated video presentations (~30%), storyboards (~10%), podcasts (~3%), and filmed videos (~3%). A 5-point Likert scale learning and teaching survey was conducted for a total of 195 undergraduate health science students to evaluate students' perception of this group assignment. The majority of students (70-80%) strongly agreed or agreed that the multimedia group assignment helped their teamwork skills. Students who produced animated videos significantly outperformed those who adopted the non-animated presentations during the end-of-semester theory examination (p < 0.05). This study demonstrates that an anatomy group assignment integrating digital literacy and scientific communication is an effective assessment strategy associated with a positive learning experience and outcome. This inquiry-based assignment promotes learning through assessment, allowing students to not only consolidate and extend anatomy knowledge but also developing effective digital communication skills, providing new insights into non-didactic anatomy assessments.

Sphingosine 1-Phosphate Lyase in the Developing and Injured Nervous System: a Dichotomy?

Sphingosine 1-phosphate lyase (SPL) is the terminal enzyme that controls the degradation of the bioactive lipid sphingosine 1-phosphate (S1P) within an interconnected sphingolipid metabolic network. The unique metabolic position of SPL in maintaining S1P levels implies SPL could be an emerging new therapeutic target. Over the past decade, an evolving effort has been made to unravel the role of SPL in the nervous system; however, to what extent SPL influences the developing and mature nervous system through altering S1P biosynthesis remains opaque. While congenital SPL deletion is associated with deficits in the developing nervous system, the loss of SPL activity in adults appears to be neuroprotective in acquired neurological disorders. The controversial findings concerning SPL's role in the nervous system are further constrained by the current genetic and pharmacological tools. This review attempts to focus on the multi-faceted nature of SPL function in the mammalian nervous systems, implying its dichotomy in the developing and adult central nervous system (CNS). This article also highlights SPL is emerging as a therapeutic molecule that can be selectively targeted to modulate S1P for the treatment of acquired neurodegenerative diseases, raising new questions for future investigation. The development of cell-specific inducible conditional SPL mutants and selective pharmacological tools will allow the precise understanding of SPL's function in the adult CNS, which will aid the development of a new strategy focusing on S1P-based therapies for neuroprotection.

Factors and consequences associated with intimate partner violence against women in low- and middle-income countries: A systematic review

Intimate Partner Violence (IPV) is a global public health issue, with notably high prevalence rates observed within Low-and Middle-Income Countries (LMICs). This systematic review aimed to examine the risk factors and consequences associated with IPV against women in LMICs. Following PRISMA guidelines, we conducted a systematic review using three databases: Web of Science, ProQuest Central, and Scopus, covering the period from January 2010 to January 2022. The study included only peer-reviewed journal articles in English that investigated IPV against women in LMICs. Out of 167 articles screened, 30 met the inclusion criteria, comprising both quantitative and mixed-method studies. Risk factors of IPV were categorised as: demographic risk factors (23 studies), family risk factors (9 studies), community-level factors (1 studies), and behavioural risk factors (14 studies), while consequences of IPV were categorised as mental health impacts (13 studies), physical impacts (5 studies), and societal impacts (4 studies). In this study, several risk factors were identified including lower levels of education, marriage at a young age, poor wealth indices, rural residential areas, and acceptance of gender norms that contribute to the prevalence of IPV in LMICs. It is essential to address these factors through effective preventive policies and programs. Moreover, this review highlights the necessity of large-scale, high-quality policy-driven research to further examine risk factors and consequences, ultimately guiding the development of interventions aimed at preventing IPV against women in LMICs.

"Take the tablet or don't take the tablet?"-A qualitative study of patients' experiences of self-administering anti-cancer medications related to adherence and managing side effects

PURPOSE

Medication non-adherence is a well-recognised problem in cancer care, negatively impacting health outcomes and healthcare resources. Patient-related factors influencing medication adherence (MA) are complicated and interrelated. There is a need for qualitative research to better understand their underlying interaction processes and patients' needs to facilitate the development of effective patient-tailored complex interventions. This study aimed to explore experiences, perceptions, and needs relating to MA and side effect management of patients who are self-administering anti-cancer treatment.

METHODS

Semi-structured audio-recorded interviews with patients who have haematological cancer were conducted. A comparative, iterative, and predominantly inductive thematic analysis approach was employed.

RESULTS

Twenty-five patients from a specialist cancer hospital were interviewed. While self-administering cancer medications at home, patients' motivation to adhere was affected by cancer-related physical reactions, fears, cancer literacy and beliefs, and healthcare professional (HCP) and informal support. Patients desired need for regular follow-ups from respectful, encouraging, informative, responsive, and consistent HCPs as part of routine care. Motivated patients can develop high adherence and side effect self-management over time, especially when being supported by HCPs and informal networks.

CONCLUSION

Patients with cancer need varied support to medically adhere to and manage side effects at home. HCPs should adapt their practices to meet the patients' expectations to further support them during treatment. We propose a multi-dimensional and technology- and theory-based intervention, which incorporates regular HCP consultations providing tailored education and support to facilitate and maintain patient MA and side effect self-management.

A Semi-Naturalistic, Open-Label Trial Examining the Effect of Prescribed Medical Cannabis on Neurocognitive Performance

BACKGROUND AND OBJECTIVES

Medical cannabis use is increasing in Australia and other jurisdictions, yet little is known about the effects of medical cannabis on cognitive function. Findings from studies of non-medical ('recreational') cannabis may not be applicable to patients using prescribed medical cannabis to manage a health condition.

METHODS

In this semi-naturalistic, open-label trial, patients with various health conditions attended a single laboratory session in which they self-administered a standard dose of prescribed medical cannabis as per instructions on the pharmacy label. We assessed cognitive performance using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and Druid application (app) prior to and following (CANTAB: + 3 h; Druid: + 3 and 5.5 h) medical cannabis self-administration. We also assessed subjective drug effects prior to and following (1, 2 and 4 h) medical cannabis self-administration using a range of 0-10 cm visual analogue scales ('stoned', 'sedated', 'relaxed', 'comfortable', 'anxious' and 'confident'). Data were analyzed using linear fixed-effect models.

RESULTS

Participants (N = 40; 22 females) were prescribed a range of products including orally administered oils (n = 23) and flower for vaporization (n = 17). Participants had a mean (standard deviation [SD]) age of 41.38 (12.66) years and had been using medical cannabis for a mean (SD) of 10.18 (8.73) months. Chronic non-cancer pain was the most common indication for medical cannabis use (n = 20), followed by sleep disorder (n = 18) and anxiety (n = 11). The mean (SD) delta-9-tetrahydrocannabinol (THC)/cannabidiol (CBD) dose administered by participants was 9.61 (8.52) mg/9.15 (10.11) mg among those using an oil, and 37.00 (24.53) mg/0.38 (1.58) mg among those who vaporized flower, respectively. Participants' performance improved over time on the CANTAB Multitasking Test and Rapid Visual Information Processing test (both p-values <0.001). All other changes in cognitive performance measures over time were non-significant (p > 0.05). Vaporization of flower was associated with significantly stronger subjective feelings of 'stoned' and 'sedated' relative to oils (both p < 0.001).

CONCLUSIONS

These findings suggest that prescribed medical cannabis may have minimal acute impact on cognitive function among patients with chronic health conditions, although larger and controlled trials are needed.

Sexual abuse during childhood and all-cause mortality into middle adulthood: an Australian cohort study

OBJECTIVE

To compare mortality from all causes, internal causes (eg, cancers, circulatory and respiratory system diseases), and external causes (eg, suicide, accidents, assault) among people who were sexually abused during childhood with mortality for the general population.

DESIGN

Historical cohort study.

SETTING, PARTICIPANTS

2759 people (2201 women, 79.8%) who had experienced medically assessed contact sexual abuse in Victoria while aged 16 years or younger during 1964-1995, as recorded in Victorian Institute of Forensic Medicine records.

MAIN OUTCOME MEASURES

Mortality rate, based on linked National Death Index data (1980-2020), by five-year age group; sex- and age-standardised mortality ratios; comparison of rates with age- and sex-adjusted rates for the general Victorian population (incident rate ratio [IRR]).

RESULTS

We included 115 deaths of people under 50 years of age in our analysis (4.2% of people sexually abused as children; 79 women, 36 men); 56 deaths were attributed to external, 56 to internal causes (cause of death information missing in three cases). In each age group from 15-19 years, the mortality rates for people sexually abused as children were higher than for the general population; age- and sex-standardised all-cause mortality ratios were highest for people aged 25-29 years (men: 16.5; 95% confidence interval [CI], 11.0-22.0; women: 19.2; 95% CI, 14.3-24.2). The age- and sex-adjusted mortality rate for people sexually abused as children was higher than in the general population for all-cause (IRR, 8.25; 95% CI, 5.92-11.5), internal cause (IRR, 5.92; 95% CI, 3.89-9.01), and external cause deaths (IRR, 12.6; 95% CI, 9.61-16.6); the differences in external cause mortality were greater for people who had experienced penetrative (IRR, 14.9; 95% CI, 10.9-20.5) than for those who had experienced non-penetrative sexual abuse as children (IRR, 8.92; 95% CI, 5.35-14.9).

CONCLUSIONS

Sexual abuse during childhood is associated with higher mortality rates into mid-adulthood. Preventing child sexual abuse and intervening early to reduce the damage it inflicts is not only essential for the welfare of the child, but could also help reduce avoidable deaths later in life.

Does surgeon sex and anthropometry matter for tool usability in traditional laparoscopic surgery? A systematic review and meta-analysis

INTRODUCTION

Hand size, strength, and stature all impact a surgeon's ability to perform Traditional Laparoscopic Surgery (TLS) comfortably and effectively. This is due to limitations in instrument and operating room design. This article aims to review performance, pain, and tool usability data based on biological sex and anthropometry.

METHODS

PubMed, Embase, and Cochrane databases were searched in May 2023. Retrieved articles were screened based on whether a full-text, English article was available in which original results were stratified by biological sex or physical proportions. Article quality was discussed using the Mixed Methods Appraisal Tool (MMAT). Data were summarized in three main themes: task performance, physical discomfort, and tool usability and fit. Task completion times, pain prevalence, and grip style results between male and female surgeons formed three meta-analyses.

RESULTS

A total of 1354 articles were sourced, and 54 were deemed suitable for inclusion. The collated results showed that female participants, predominantly novices, took 2.6-30.1 s longer to perform standardized laparoscopic tasks. Female surgeons reported pain at double the frequency of their male colleagues. Female surgeons and those with a smaller glove size were consistently more likely to report difficulty and require modified (potentially suboptimal) grip techniques with standard laparoscopic tools.

CONCLUSIONS

The pain and stress reported by female or small-handed surgeons when using laparoscopic tools demonstrates the need for currently available instrument handles, including robotic hand controls, to become more size-inclusive. However, this study is limited by reporting bias and inconsistencies; furthermore, most data was collected in a simulated environment. Additional research into how anthropometric tool design impacts the live operating performance of experienced female surgeons would further inform this area of investigation.

I Am More than HIV: A Qualitative Exploration of Factors That Can Strengthen Resilience Among HIV-Positive Gay Men in Australia

Introduction

HIV-positive gay men continue to experience stigma related to sexual orientation and HIV status. Although resilience toward such stressors can be achieved, limited Australian research exists that examines how resilience is strengthened toward these dual stigmas.

Methods

A total of 20 men from Melbourne, Australia, participated in semi-structured interviews between March and October 2019 to explore ways in which they manage such stigmas.

Results

Reflexive thematic analysis identified two primary themes: (1) "intrapersonal control," which relates to individual mind set and lifestyle changes that participants utilized to strengthen resilience; (2) "systemic change," which includes participants' needs for better public health messaging. Findings show resilience was enhanced when proactive approaches to sexual orientation, HIV health appraisal, lifestyle changes, and social support were made. Further, outdated HIV awareness campaigns and a lack of current messaging regarding HIV transmission in the wider community were identified as inhibiting resilience development and promoting stigma among gay men.

Conclusion

The results from this study show ways that Australian gay men strengthen their resilience through both intrapersonal (e.g., self-awareness, reappraisal, and self-efficacy) and external resources (e.g., education and public awareness) and how health care providers and social policy makers could better support the men to achieve this.

Social-Policy Implications

Findings suggest that targeted public health responses are required to compliment the advances made in biomedicine and viral suppression.

Private renters in shared housing: investigating housing conditions and mental well-being in Australia during COVID-19

Lockdowns were the major policy response to COVID-19 containment in many countries, and subsequently many people spent abnormal amounts of time at home. Research has found that housing conditions affected more peoples' mental health during the COVID-19 crisis than prior to it, and vulnerable groups were especially affected. One group that may be particularly vulnerable is private renters in shared housing. Using a socio-economic lens, our research examined to what extent mental well-being outcomes were associated with housing conditions in shared housing under COVID-19 restrictions in Australia. Data about private renters were obtained from the Australian Rental Housing Conditions Dataset (n = 1908), collected in mid-2020 during the easing of the first lockdown restrictions. Respondents living in shared arrangements reported higher levels of worry and anxiety (8.5-13.2%) and loneliness and isolation (3.7-18.3%) compared to other household types. Binary logistic regressions showed that COVID-19-related mental and financial well-being variables were the main contributors in COVID-19-related worry/anxiety and loneliness/isolation models. Accumulated housing problems were the only housing condition measure that was significant in the worry/anxiety model. Participants who had more than two people living in a household felt 1.4 times lonelier/isolated compared to those who lived with four or more people. Males and participants who reported good mental health were less likely to feel COVID-19-related worry/anxiety and loneliness/isolation. Our analysis demonstrates the importance of measures for mental health and income during a pandemic and concludes with recommendations of support for shared housing renters during and beyond crisis events.

Industrial Design education in Australia: a competence analysis across primary, secondary and tertiary education levels

Industrial Design education is poorly understood by laypeople but is present in Australian curricula from primary through to tertiary education levels. Designers and design researchers have long recognised the value of the broad-ranging skills, knowledge fields, and personal qualities design education imparts, but this understanding is generally not shared by the wider community who may see design as surface decoration. This research identifies indicators of value and relevance taken from the twenty-first century competences literature, then measures their presence in four different Industrial Design education settings. Two studies were undertaken. First, Industrial Design educators from primary, secondary, and tertiary levels were surveyed. Then diverse Industrial Design education stakeholders from education and non-education settings were interviewed. The studies gathered both quantitative and qualitative data on the value and relevance of current Industrial Design education in Australia. The result is a comprehensive analysis of the twenty-first century competences present in Australian Industrial Design education, which concludes with recommendations for ways Industrial Design education can benefit twenty-first century learners, as well as ways it should evolve to remain relevant.

Solving the plastic dilemma: the fungal and bacterial biodegradability of polyurethanes

Polyurethane (PU) is a plastic polymer which, due to its various desirable characteristics, has been applied extensively in domestic, industrial and medical fields for the past 50 years. Subsequently, an increasing amount of PU waste is generated annually. PU, like many other plastics, is highly resistant to degradation and is a substantial threat to our environment. Currently PU wastes are handled through conventional disposal techniques such as landfill, incineration and recycling. Due to the many drawbacks of these techniques, a 'greener' alternative is necessary, and biodegradation appears to be the most promising option. Biodegradation has the potential to completely mineralise plastic waste or recover the input materials and better enable recycling. There are hurdles to overcome however, primarily the efficiency of the process and the presence of waste plastics with inherently different chemical structures. This review will focus on polyurethanes and their biodegradation, outlining the difficulty of degrading different versions of the same material and strategies for achieving more efficient biodegradation.

Asian Australian Experiences of Racism During the COVID-19 Pandemic in Victoria: a Preliminary Analysis

Since the outbreak of COVID-19, reports of racism and racial discrimination towards those of an Asian cultural background have increased in culturally diverse countries around the world. The current study sought to gain clarity about Asian Australian experiences of racism by conducting inferential and descriptive analysis of cross-sectional survey data collected from the Australian state of Victoria (n = 436). Building on previous studies which have identified a range of modalities and consequences of COVID-19-related racism, participants were prompted to consider their experiences of racism in the year prior to the outbreak of COVID-19 as well as their experiences during the pandemic on four measures-Direct Experiences of Racism, Vicarious Experiences of Racism (online and in-person), Everyday Racism and Hypervigilance. For the target group (participants with an East or Southeast Asian cultural background resident in Victoria), analysis showed an increase in experiences across three of the four measures, with small to moderate effect sizes, Everyday Racism (r = 0.22), Vicarious Experiences of Racism (r = 0.19) and Hypervigilance (r = 0.43). Analysis demonstrated that the target group experienced a significant increase in online experiences of racism (r = 0.28). These findings shed light on the contradictory findings of previous research on pandemic-related racism in Australia. We show that the pandemic impacted Victorians likely to be perceived as of Chinese background more than other Asian Australians.

Factors Impacting Access and Engagement of Cognitive Remediation Therapy for People with Schizophrenia: A Systematic Review

OBJECTIVES

Neurocognitive deficits are central in schizophrenia. Cognitive remediation has proven effective in alleviating these deficits, with medium effect sizes. However, sizeable attrition rates are reported, with the reasons still uncertain. Furthermore, cognitive remediation is not part of routine mental health care. We conducted a systematic review to investigate factors that influence access and engagement of cognitive remediation in schizophrenia.

METHODS

We systematically searched the PubMed, Web of Science, and PsycINFO databases for peer-reviewed articles including a cognitive remediation arm, access, and engagement data, and participants with schizophrenia spectrum disorders aged 17-65 years old. Duplicates and studies without a distinct cognitive remediation component, protocol papers, single case studies, case series, and reviews/meta-analyses were excluded.

RESULTS

We included 67 studies that reported data on access and engagement, and extracted quantitative and qualitative data. Access data were limited, with most interventions delivered on-site, to outpatients, and in middle- to high-income countries. We found a median dropout rate of 14.29%. Only a small number of studies explored differences between dropouts and completers (n = 5), and engagement factors (n = 13). Dropouts had higher negative symptomatology and baseline self-efficacy, and lower baseline neurocognitive functioning and intrinsic motivation compared to completers. The engagement was positively associated with intrinsic motivation, self-efficacy, perceived usefulness, educational level, premorbid intelligence quotient, baseline neurocognitive functioning, some neurocognitive outcomes, and therapeutic alliance; and negatively associated with subjective cognitive complaints. Qualitative results showed good acceptability of cognitive remediation, with some areas for improvement.

CONCLUSIONS

Overall, access and engagement results are scarce and heterogeneous. Further investigations of cognitive remediation for inpatients, as well as remote delivery, are needed. Future clinical trials should systematically explore attrition and related factors. Determining influential factors of access and engagement will help improve the implementation and efficacy of cognitive remediation, and thus the recovery of people with schizophrenia.

Mechanisms for Combined Hypoxic Conditioning and Divergent Exercise Modes to Regulate Inflammation, Body Composition, Appetite, and Blood Glucose Homeostasis in Overweight and Obese Adults: A Narrative Review

Obesity is a major global health issue and a primary risk factor for metabolic-related disorders. While physical inactivity is one of the main contributors to obesity, it is a modifiable risk factor with exercise training as an established non-pharmacological treatment to prevent the onset of metabolic-related disorders, including obesity. Exposure to hypoxia via normobaric hypoxia (simulated altitude via reduced inspired oxygen fraction), termed hypoxic conditioning, in combination with exercise has been increasingly shown in the last decade to enhance blood glucose regulation and decrease the body mass index, providing a feasible strategy to treat obesity. However, there is no current consensus in the literature regarding the optimal combination of exercise variables such as the mode, duration, and intensity of exercise, as well as the level of hypoxia to maximize fat loss and overall body compositional changes with hypoxic conditioning. In this narrative review, we discuss the effects of such diverse exercise and hypoxic variables on the systematic and myocellular mechanisms, along with physiological responses, implicated in the development of obesity. These include markers of appetite regulation and inflammation, body conformational changes, and blood glucose regulation. As such, we consolidate findings from human studies to provide greater clarity for implementing hypoxic conditioning with exercise as a safe, practical, and effective treatment strategy for obesity.

Do green bonds offer a diversification opportunity during COVID-19?-an empirical evidence from energy, crypto, and carbon markets

The present study is a novel attempt to unravel the connectedness of the green bond with energy, crypto, and carbon markets using the S&P green bond index (RSPGB). We consider MAC global solar energy index (RMGS) and ISE global wind energy index (RIGW) as proxies of the energy market and use bitcoin and the European energy exchange carbon index (REEX) for the cryptocurrency and carbon market. Employing the Diebold and Yilmaz (2012), Baruník and Krehlík (2018), and wavelet coherence econometric techniques, we find that the energy market (RMGS) has the highest connectedness derived from other asset classes, and bitcoin (RBTC) has the least connectedness. Concurrently, we find that the risk transmission is heterogeneous in different scales as the short period has less connectedness than the medium and long run. We conclude that the overall diversification opportunity among green bonds, energy stock, bitcoin, and the carbon market is more in the short-run than in the medium and long-run. In summary, our findings on the green bond market will provide investors, portfolio managers, and policymakers with critical insight into ensuring a sustainable financial market.

Artificial Intelligence and Blockchain Integration in Business: Trends from a Bibliometric-Content Analysis

Artificial intelligence (AI) and blockchain are the two disruptive technologies emerging from the Fourth Industrial Revolution (IR4.0) that have introduced radical shifts in the industry. The amalgamation of AI and blockchain holds tremendous potential to create new business models enabled through digitalization. Although research on the application and convergence of AI and blockchain exists, our understanding of the utility of its integration for business remains fragmented. To address this gap, this study aims to characterize the applications and benefits of integrated AI and blockchain platforms across different verticals of business. Using bibliometric analysis, this study reveals the most influential articles on the subject based on their publications, citations, and importance in the intellectual network. Using content analysis, this study sheds light on the subject's intellectual structure, which is underpinned by four major thematic clusters focusing on supply chains, healthcare, secure transactions, and finance and accounting. The study concludes with 10 application areas in business that can benefit from these technologies.

Numerical study of when and who will get infected by coronavirus in passenger car

In light of the COVID-19 pandemic, it is becoming extremely necessary to assess respiratory disease transmission in passenger cars. This study numerically investigated the human respiration activities' effects, such as breathing and speaking, on the transport characteristics of respiratory-induced contaminants in passenger car. The main objective of the present study is to accurately predict when and who will get infected by coronavirus while sharing a passenger car with a patient of COVID-19 or similar viruses. To achieve this goal, transient simulations were conducted in passenger car. We conducted a 3D computational fluid dynamics (CFD)-based investigation of indoor airflow and the associated aerosol transport in a passenger car. The Eulerian-Eulerian flow model coupled with k-ε turbulence approach was used to track respiratory contaminants with diameter ≥ 1 μm that were released by different passengers within the passenger car. The results showed that around 6.38 min, this is all that you need to get infected with COVID-19 when sharing a poorly ventilated car with a driver who got coronavirus. It also has been found that enhancing the ventilation system of the passenger car will reduce the risk of contracting Coronavirus. The predicted results could be useful for future engineering studies aimed at designing public transport and passenger cars to face the spread of droplets that may be contaminated with pathogens.

Barriers to blockchain adoption for supply chain finance: the case of Indian SMEs

Small and medium enterprises (SMEs) in India are suffering from the long-standing challenges related to asymmetric information, high transaction costs, SMEs’ opacity and limited access to credit. Blockchain technology, which is still in its infancy in terms of adoption in India, can facilitate SMEs to counter these challenges. Fuelled by this motivation, the study aims to investigate the significant barriers to blockchain adoption in supply chain finance practices by Indian SMEs. Using fuzzy-analytic hierarchy process, sensitivity analysis, and fuzzy-decision-making trial and evaluation laboratory this paper identifies the blockchain barriers, prioritises them and examine their cause and effect relationships. The results of the study indicate that technology barriers are the most influential barriers that impede blockchain adoption. The findings will help the policymakers and practitioners to take suitable measures to overcome these barriers and fuel the adoption of blockchain in Indian SMEs.

Inter-relationships among key reproductive health indicators in sub-Saharan Africa focusing on the central role of maternal literacy

BACKGROUND

Indicators of reproductive health (RH) are expected to be both inter-related and associated with key social determinants. As the provision of RH services is usually integrated, the effort to improve one RH component should influence the other components. However, there is a lack of evidence-based models demonstrating the inter-relationships. The purpose of this study was to examine the inter-relationships among key RH indicators and their relationship with women's literacy in sub-Saharan Africa (SSA).

METHODS

Data were sourced from the most recent demographic and health survey conducted between 2010 and 2016 in 391 provinces of 29 SSA countries. We examined seven RH indicators along with women's literacy. The unit of analysis was at the provincial level. Structural equation modelling was used to examine the strength of relationships among these indicators and with women's literacy, using the total standardized effect sizes. Significance tests and 95% confidence intervals (CIs) for these effects were calculated using a bias-corrected bootstrap method.

RESULTS

RH indicators are strongly interrelated and are associated with women's literacy. The strongest relationship is observed between women's literacy rate and the contraception prevalence rate, with a total standardized effect size of 0.79 (95% CI 0.74-0.83). The model of inter-relationships developed in this study may guide the design, implementation and evaluation of RH policies and programmes.

CONCLUSIONS

The key challenge in reducing fertility in SSA is to reduce people fertility desire. This could mainly be addressed by enhancing integrated approaches especially between the education and health sectors.

Blockchain for sustainable supply chain management: trends and ways forward

Blockchain operates on a highly secured framework, and its decentralized consensus has benefits for supply chain sustainability. Scholars have recognized the growing importance of sustainability in supply chains and studied the potential of blockchain for sustainable supply chain management. However, no study has taken stock of high-quality research in this area. To address this gap, this paper aims to provide a state-of-the-art overview of high-quality research on blockchain for sustainable supply chain management. To do so, this paper conducts a systematic literature review using a bibliometric analysis of 146 high-quality articles on blockchain for sustainable supply chain management that have been published in journals ranked “A*”, “A”, and “B” by the Australian Business Deans Council and retrieved from the Scopus database. In doing so, this paper unpacks the most prominent journals, authors, institutions, and countries that have contributed to three major themes in the field, namely blockchain for sustainable business activities, decision support systems using blockchain, and blockchain for intelligent transportation system. This paper also reveals the use of blockchain for sustainable supply chain management across four major sectors, namely food, healthcare, manufacturing, and infrastructure, and concludes with suggestions for future research in each sector.

AI-Based Modeling: Techniques, Applications and Research Issues Towards Automation, Intelligent and Smart Systems

Artificial intelligence (AI) is a leading technology of the current age of the Fourth Industrial Revolution (Industry 4.0 or 4IR), with the capability of incorporating human behavior and intelligence into machines or systems. Thus, AI-based modeling is the key to build automated, intelligent, and smart systems according to today’s needs. To solve real-world issues, various types of AI such as analytical, functional, interactive, textual, and visual AI can be applied to enhance the intelligence and capabilities of an application. However, developing an effective AI model is a challenging task due to the dynamic nature and variation in real-world problems and data. In this paper, we present a comprehensive view on “AI-based Modeling” with the principles and capabilities of potential AI techniques that can play an important role in developing intelligent and smart systems in various real-world application areas including business, finance, healthcare, agriculture, smart cities, cybersecurity and many more. We also emphasize and highlight the research issues within the scope of our study. Overall, the goal of this paper is to provide a broad overview of AI-based modeling that can be used as a reference guide by academics and industry people as well as decision-makers in various real-world scenarios and application domains.

The Spatial Dynamics of Homelessness in Australia: Urbanisation, Intra-City Dynamics and Affordable Housing

While homelessness in Australia has remained relatively stable at the national level, its spatial distribution is becoming more nuanced. This paper draws on homelessness estimates produced by the Australian Bureau of Statistics to explore the spatial dynamics of homelessness in Australia over a fifteen-year period. Building on existing work, we show that homelessness is becoming more urbanised with evidence of spatial convergence, mainly driven by a surge in severe crowding in our major cities. However, when exploring intra-city patterns, we find distinctive intra-city spatial dynamics featuring strong suburbanisation of 'couch surfing' in state capital cities, contrasting with shifts in severe crowding numbers toward middle and inner regions of most state capitals. We argue that these dynamics reflect the retreat of affordable rental housing supply to the outer suburban fringe, and the coping strategies that 'couch surfers' and those aspiring to live in the inner cities are compelled to follow in response to the changing spatial configuration of affordable housing.

Effects of alcohol intoxication on driving performance, confidence in driving ability, and psychomotor function: a randomized, double-blind, placebo-controlled study

RATIONALE

Alcohol-induced driving impairment can occur with any departure from a zero-blood alcohol concentration (BAC). Because intoxication is characterised by impaired judgement, drivers under the influence of alcohol may overestimate their capacity to safely operate a vehicle.

OBJECTIVES

This study examined the effects of alcohol on driving performance, four-choice reaction time (FCRT), and self-rated confidence in driving ability. It specifically focused on alcohol doses equal to commonly enforced legal BAC limits (i.e. 0.05% and 0.08%).

METHODS

A randomized, double-blind, placebo-controlled design was utilised. Seventeen participants were tested in three conditions: placebo and two alcohol conditions aiming for BACs of 0.05% and 0.08%. Participants underwent a baseline FCRT task and a 1-h simulated highway driving task before completing another FCRT task and rated their confidence in their driving ability.

RESULTS

The high and low alcohol dose conditions resulted in a mean BAC of 0.07%, and 0.04%, respectively (n = 17). The high BAC treatment significantly increased standard deviation of lateral position (SDLP) by 4.06 ± 5.21 cm and standard deviation of speed (SDS) by 0.69 ± 0.17 km/h relative to placebo, while confidence in driving ability remained unchanged across treatments. FCRT performance was impaired by the high BAC treatment (all < 0.01), but there we no significant differences between placebo and low BAC conditions.

CONCLUSIONS

The findings of this study show that driving performance and associated psychomotor functioning become significantly impaired below legally permissible driving limits in some jurisdictions. We identified a dissociation between driving performance and subjective awareness of impairment. Despite a significantly diminished driving ability at 0.07% BAC, drivers were unaware of their impairment.

Malaria awareness of adults in high, moderate and low transmission settings: A cross-sectional study in rural East Nusa Tenggara Province, Indonesia

Introduction

The 2009 Indonesian roadmap to malaria elimination indicated that the nation had been progressing towards achieving malaria elimination by 2030. Currently, most of the districts in the western part of Indonesia have eliminated malaria; however, none of the districts in the East Nusa Tenggara Province (ENTP) have met these set targets. This study aimed to investigate the status of malaria awareness of rural adults in the ENTP.

Methods

A community-based cross-sectional study was conducted between October and December 2019 in high, moderate, and low malaria-endemic settings (MESs) in the ENTP. After obtaining informed consent, data were collected using an interviewer-administered structure questionnaire among 1503 participants recruited by a multi-stage cluster sampling method. A malaria awareness index was developed based on ten questions. A binary logistic regression method was applied to investigate the significance of any association between malaria awareness and the different MESs.

Results

The participation rate of the study was 99.5%. Of this number, 51.4% were female and 45.5% had completed primary education. The malaria awareness index was significantly low (48.8%, 95% confidence interval [CI]: 45.2–52.4). Malaria awareness of rural adults residing in low endemic settings was two times higher than for those living in high endemic settings (adjusted odds ratio [AOR]: 2.41, 95% CI: 1.81–3.21) and the basic malaria knowledge of participants living in low malaria-endemic settings was almost four times higher than that in high endemic settings (AOR: 3.75, 95% CI: 2.75–5.11). Of the total participants, 81.3% (95% CI: 79.1–83.5) were aware that malaria could be prevented and 75.1% (95% CI: 72.6–77.6) knew at least one prevention measure. Overall, the awareness of fever as the main symptom of malaria, mosquito bites as the transmission mode of malaria, and seeking treatment within 24 hours of suffering from malaria was poor at 37.9% (95% CI: 33.9–41.9), 59.1% (95% CI: 55.9–62.3), and 46.0% (95% CI: 42.3–49.7), respectively. The poor level of awareness was significantly different amongst the three MESs, with the lowest levels of awareness in the high endemic setting.

Conclusion

Malaria awareness of rural adults needs to be improved to address Indonesia’s national roadmap for malaria elimination. Results indicated that public health programs at a local government level should incorporate the malaria awareness index in their key strategic intervention to address malaria awareness.

A Novel multidimensional Boltzmann neutrino transport scheme for core-collapse supernovae

We introduce a new discrete-ordinate scheme for solving the general relativistic (GR) Boltzmann transport equation in the context of core-collapse supernovae (CCSNe). Our algorithm avoids the need to spell out the complicated advection terms in energy and angle that arise when the transport equation is formulated in spherical polar coordinates, in the comoving frame, or in a GR space-time. We instead approach the problem by calculating the advection of neutrinos across momentum space using an intuitive particle-like approach that has excellent conservation properties and fully accounts for Lorentz boosts, GR effects, and grid geometry terms. In order to avoid the need for a global implicit solution, time integration is performed using a locally implicit Lax-Wendroff scheme that correctly reproduces the diffusion limit. This will facilitate the use of our method on massively parallel distributed-memory architectures. We have verified the accuracy and stability of our scheme with a suite of test problems in spherical symmetry and axisymmetry. To demonstrate that the new algorithm works stably in CCSN simulations, we have coupled it to the GR hydrodynamics code coconut and present a first demonstration run of a [Formula: see text] progenitor with a reduced set of neutrino opacities.

Psychometric evaluation of the modified 19-item Bengali version of WHOQOL scale using Rasch analysis: a cross-sectional study of a rural district in Bangladesh

BACKGROUND

This investigation aims to validate the psychometric properties of the modified 19-item Bengali version World Health Organization Quality of Life (WHOQOL) instrument in a typical healthy rural population in Bangladesh.

METHOD

The cross-sectional investigation collected 300 adults aged 18-85 years from Narail, a rural district of Bangladesh using a multi-stage cluster random sampling technique. Face-to-face interviews were conducted between July and August 2018 using an Android phone installed with a mobile data collection application CommCare. SPSS version 25; IBM. and a Rasch analysis software RUMM2030 were used for analyses.

RESULTS

Results showed good overall fit, as indicated by a significant item-trait interaction with Bonferroni corrected p values, for physical ([Formula: see text] =32.13, p = 0.041), psychological ([Formula: see text] =14.93, p = 0.529), social ([Formula: see text] =12.62, p = 0.397), and environmental ([Formula: see text] =22.01, p = 0.339) domains. Item fit residual (IFR) values for all domains were within the desired limits, indicating no deviation from the expected relationship between the individual items and the rest of the items of the scale. Person fit residual (PFR) values also showed no person misfit among the samples, indicating item threshold are suitable for Rasch analysis. Reliability of the three domains of the 19-item WHOQOL scale was very good as indicated by a person separation index (PSI) = 0.873 and Cronbach's Alpha (CA) = 0.881 for physical domain, PSI = 0.739 and CA = 0.746 for psychological domain, and PSI = 0.753 and CA = 0.781 for environmental domain. The social domain (PSI = 0.650 and CA = 0.669) had below acceptable reliability. All items in each domain had ordered thresholds except one item of the environmental domain. All four domains of the 19-item WHOQOL scale showed unidimensionality and was free from local dependency. Each domain also showed similar functioning for adults and older adults, males and females, no education and at least primary level of education, low and high socio-economic conditions.

CONCLUSION

The 19-item modified WHOQOL scale is confirmed as an efficient screening tool for measuring QoL among healthy rural Bangladeshi people. The scale could be implemented more widely. In particular, validations are required for diseases-specific population in Bangladesh to measure the Health Related Quality of life (HR-QoL) assessments for people suffering from chronic or other diseases.

Inferring a simple mechanism for alpha-blocking by fitting a neural population model to EEG spectra

Alpha blocking, a phenomenon where the alpha rhythm is reduced by attention to a visual, auditory, tactile or cognitive stimulus, is one of the most prominent features of human electroencephalography (EEG) signals. Here we identify a simple physiological mechanism by which opening of the eyes causes attenuation of the alpha rhythm. We fit a neural population model to EEG spectra from 82 subjects, each showing a different degree of alpha blocking upon opening of their eyes. Though it has been notoriously difficult to estimate parameters by fitting such models, we show how, by regularizing the differences in parameter estimates between eyes-closed and eyes-open states, we can reduce the uncertainties in these differences without significantly compromising fit quality. From this emerges a parsimonious explanation for the spectral differences between states: Changes to just a single parameter, p_ei, corresponding to the strength of a tonic excitatory input to the inhibitory cortical population, are sufficient to explain the reduction in alpha rhythm upon opening of the eyes. We detect this by comparing the shift in each model parameter between eyes-closed and eyes-open states. Whereas changes in most parameters are weak or negligible and do not scale with the degree of alpha attenuation across subjects, the change in p_ei increases monotonically with the degree of alpha blocking observed. These results indicate that opening of the eyes reduces alpha activity by increasing external input to the inhibitory cortical population.

One of the most striking features of the human electroencephalogram (EEG) is the presence of neural oscillations in the range of 8-13 Hz. It is well known that attenuation of these alpha oscillations, a process known as alpha blocking, arises from opening of the eyes, though the cause has remained obscure. In this study we infer the mechanism underlying alpha blocking by fitting a neural population model to EEG spectra from 82 different individuals. Although such models have long held the promise of being able to relate macroscopic recordings of brain activity to microscopic neural parameters, their utility has been limited by the difficulty of inferring these parameters from fits to data. Our approach involves fitting eyes-open and eyes-closed EEG spectra in a way that minimizes unnecessary differences in model parameters between the two states. Surprisingly, we find that changes in just one parameter, the level of external input to the inhibitory neurons in cortex, is sufficient to explain the attenuation of alpha oscillations. This indicates that opening of the eyes reduces alpha activity simply by increasing external inputs to the inhibitory neurons in the cortex.

Psychometric evaluation of an interview-administered version of the Kessler 10-item questionnaire (K10) for measuring psychological distress in rural Bangladesh

OBJECTIVE

The aim of this study was to translate, adapt and validate the Kessler 10-item questionnaire (K10) for measuring psychological distress in rural Bangladesh.

DESIGN

Cohort study.

SETTING

Narail district, Bangladesh.

PARTICIPANTS

A random sample of 2425 adults of age 18-90 years was recruited.

OUTCOME MEASURE

Validation of the K10 was the major outcome. Sociodemographic factors were measured to assess if the K10 needed adjustment for factors such as age or gender. The Rasch measurement model was used for the validation, and RUMM 2030 and SPSS V.24 software were used for analyses.

RESULTS

Initial inspection of the total sample showed poor overall fit. A sample size of 300, which is more satiated for Rasch analysis, also showed poor overall fit, as indicated by a significant item-trait interaction (χ²= 262.27, df=40, p<0.001) and item fit residual values (mean=-0.25, SD=2.49). Of 10 items, five items were disordered thresholds, and seven items showed misfit, suggesting problems with the response format and items. After removing three items ('feel tired', 'depressed' and 'worthless') and changing the Likert scale categories from five to four categories, the remaining seven items showed ordered threshold. A revised seven-item scale has shown adequate internal consistency, with no evidence of multidimensionality, no differential item functioning on age and gender, and no signs of local dependency.

CONCLUSIONS

Analysis of the psychometric validity of K10 using the Rasch model showed that 10 items are not appropriate for measuring psychological distress in rural Bangladesh. A modified version of seven items (K7) with four response categories would provide a psychometrically more robust scale than the original K10. The study findings suggest repeating the K7 version in other remote areas for further validation can substantiate an efficient screening tool for measuring psychological distress among the general Bangladeshi population.

Psychological distress and quality of life: rationale and protocol of a prospective cohort study in a rural district in Bangaladesh

INTRODUCTION

A significant proportion of the global burden of disease has been attributed to mental and behavioural disorders. People with mental disorders (MDs) have lower levels of health-related quality of life than those without MDs. Several studies have shown that in low-resource countries, a range of social determinants including poor health literacy is critical in the epidemiological transition of disease outcome. There is a lack of evidence of MDs literacy, the prevalence and risk factors of common mental health conditions, or any validated instruments to measure psychological distress or evaluate the quality of life in rural areas of Bangladesh.

AIMS

The aims of this study are: (1) report the awareness, knowledge, attitudes and practice (KAP) of MDs; (2) estimate the prevalence of and risk factors for psychological distress; (3) measure association of psychological distress and other socio-demographic factors with quality of life and (4) test the feasibility to use Kessler 10-item (K10) and WHO Quality Of Life-BREF (WHOQOL-BREF) questionnaires in rural Bangladesh for measuring psychological distress and quality of life.

METHODS AND ANALYSIS

A sample of 1500 adults aged 18-59 years and 1200 older adults aged 60-90 years will be interviewed from a multistage cluster random sample. Each participant will go through a face-to-face interview to assess their awareness and KAP of MDs. Information about the participant's sociodemographic and socioeconomic status will be collected along with the psychological distress (K10) and quality of life (WHOQOL-BREF) questionnaires. Internal consistency, validity, reliability and item discrimination of K10 and WHOQOL-BREF instruments will be determined by using Rasch analysis and regression techniques.

ETHICS AND DISSEMINATION

Human Ethics Approval was received from the Swinburne University of Technology Human Ethics Committee. Results of this research will be disseminated via scientific forums including peer-reviewed publications and presentations at national and international conferences.

Glutamate/GABA+ ratio is associated with the psychosocial domain of autistic and schizotypal traits

BACKGROUND

The autism and schizophrenia spectra overlap to a large degree in the social and interpersonal domains. Similarly, abnormal excitatory glutamate and inhibitory γ-aminobutyric acid (GABA) neurotransmitter concentrations have been reported for both spectra, with the interplay of these neurotransmitters important for cortical excitation to inhibition regulation. This study investigates whether these neurotransmitter abnormalities are specific to the shared symptomatology, and whether the degree of abnormality increases with increasing symptom severity. Hence, the relationship between the glutamate/GABA ratio and autism and schizophrenia spectrum traits in an unmedicated, subclinical population was investigated.

METHODS

A total of 37 adults (19 female, 18 male) aged 18-38 years completed the Autism Spectrum Quotient (AQ) and Schizotypal Personality Questionnaire (SPQ), and participated in the resting state proton magnetic resonance spectroscopy study in which sequences specific for quantification of glutamate and GABA+ concentration were applied to a right and left superior temporal voxel.

RESULTS

There were significant, moderate, positive relationships between right superior temporal glutamate/GABA+ ratio and AQ, SPQ and AQ+SPQ total scores (p<0.05), SPQ subscales Social Anxiety, No Close Friend, Constricted Affect, Odd Behaviour, Odd Speech, Ideas of Reference and Suspiciousness, and AQ subscales Social Skills, Communication and Attention Switching (p<0.05); increased glutamate/GABA+ coinciding with higher scores on these subscales. Only the relationships between glutamate/GABA+ ratio and Social Anxiety, Constricted Affect, Social Skills and Communication survived multiple comparison correction (p< 0.004). Left superior temporal glutamate/GABA+ ratio reduced with increasing restricted imagination (p<0.05).

CONCLUSION

These findings demonstrate evidence for an association between excitatory/inhibitory neurotransmitter concentrations and symptoms that are shared between the autism and schizophrenia spectra.

Synthetic B-Cell Epitopes Eliciting Cross-Neutralizing Antibodies: Strategies for Future Dengue Vaccine

Dengue virus (DENV) is a major public health threat worldwide. A key element in protection from dengue fever is the neutralising antibody response. Anti-dengue IgG purified from DENV-2 infected human sera showed reactivity against several peptides when evaluated by ELISA and epitope extraction techniques. A multi-step computational approach predicted six antigenic regions within the E protein of DENV-2 that concur with the 6 epitopes identified by the combined ELISA and epitope extraction approach. The selected peptides representing B-cell epitopes were attached to a known dengue T-helper epitope and evaluated for their vaccine potency. Immunization of mice revealed two novel synthetic vaccine constructs that elicited good humoral immune responses and produced cross-reactive neutralising antibodies against DENV-1, 2 and 3. The findings indicate new directions for epitope mapping and contribute towards the future development of multi-epitope based synthetic peptide vaccine.