Protocol for the ROSE sustainment (ROSES) study, a sequential multiple assignment randomized trial to determine the minimum necessary intervention to maintain a postpartum depression prevention program in prenatal clinics serving low-income women

Background: More research on sustainment of interventions is needed, especially return on investment (ROI) studies to determine cost-benefit trade-offs for effort required to sustain and how much is gained when effective programs are sustained. The ROSE sustainment (ROSES) study uses a sequential multiple assignment randomized (SMART) design to evaluate the effectiveness and cost-effectiveness of a stepwise approach to sustainment of the ROSE postpartum depression prevention program in 90 outpatient clinics providing prenatal care to pregnant women on public assistance. Postpartum depression (PPD) is common and can have lasting consequences. Outpatient clinics offering prenatal care are an opportune place to provide PPD prevention because most women visit while pregnant. The ROSE (Reach Out, Stay Strong, Essentials for mothers of newborns) program is a group educational intervention to prevent PPD, delivered during pregnancy. ROSE has been found to reduce cases of PPD in community prenatal settings serving low-income pregnant women. Methods: All 90 prenatal clinics will receive enhanced implementation as usual (EIAU; initial training + tools for sustainment). At the first time at which a clinic is determined to be at risk for failure to sustain (i.e., at 3, 6, 9, 12, and 15 months), that clinic will be randomized to receive either (1) no additional implementation support (i.e., EIAU only), or (2) low-intensity coaching and feedback (LICF). If clinics receiving LICF are still at risk at subsequent assessments, they will be randomized to either (1) EIAU + LICF only, or (2) high-intensity coaching and feedback (HICF). Additional follow-up interviews will occur at 18, 24, and 30 months, but no implementation intervention will occur after 18 months. Outcomes include (1) percent sustainment of core program elements at each time point, (2) health impact (PPD rates over time at each clinic) and reach, and (3) ROI (costs and cost-effectiveness) of each sustainment step. Hypothesized mechanisms include sustainment of capacity to deliver core elements and engagement/ownership. Discussion: This study is the first randomized trial evaluating the ROI of a stepped approach to sustainment, a critical unanswered question in implementation science. It will also advance knowledge of implementation mechanisms and clinical care for an at-risk population

Epigenetic and Genetic Factors Predict Women's Salivary Cortisol following a Threat to the Social Self

10.1371/journal.pone.0048597PLoS ONE711

Non-equilibrium doping of amorphous chalcogenides

The doping of amorphous chalcogenides to control their electronic properties, and specifically change the dominant charge carrier type from holes to electrons, has been a major research challenge for many years. Generally attempts to achieve this through doping during the glass forming phase have been frustrated by autocompensation effects mediated via charged defects resulting in Fermi level pinning. To date progress in this area has remained limited to Bi and Pb-doped GeX (X = S, Se, Te) systems where high doping levels (6-11%) have shown carrier type reversal (CTR) from p-type to n-type.We have readdressed the issue of CTR in amorphous chalcogenides by exploring the concept of non-equilibrium doping, corresponding to the introduction of dopants into the glass matrix following the formation of the network. To achieve this we utilize ion-implantation thereby enabling doping with a wide choice of ion species into any solid chalcogenide system. A number of amorphous chalcogenides systems have been studied including GeX, Ge2Sb2Te5 and GaLaS-based glasses deposited onto substrates via sputtering to form thin films. The structural, electrical and optical properties of the doped systems have been studied in detail revealing their significant modification and aiding understanding of the effect of non-equilibrium doping on these various systems. In particular a series of fabricated chalcogenide/n(p)-type Si devices enable detailed examination of the role of trap states in determining the electrical properties.We demonstrate the success of our non-equilibrium doping approach through achieving CTR in the GeX systems as lower doping concentrations than previously shown possible using conventional approaches. Furthermore, we demonstrate CTR for the first time in a non-GeX system, demonstrating the fabrication of pn-junction devices which are characterized for their electronic and optical behavior

Optical and electronic properties of bismuth-implanted glasses

Photoluminescence (PL) and excitation spectra of Bi melt-doped oxide and chalcogenide glasses are very similar, indicating the same Bi center is present. When implanted with Bi, chalcogenide, phosphate and silica glasses, and BaF2 crystals, all display characteristically different PL spectra to when Bi is incorporated by melt-doping. This indicates that ion implantation is able to generate Bi centers which are not present in samples whose dopants are introduced during melting. Bi-related PL bands have been observed in glasses with very similar compositions to those in which carrier-type reversal has been observed, indicating that these phenomena are related to the same Bi centers, which we suggest are interstitial Bi2+ and Bi clusters

Er femtidens primærhelsetjeneste digital, fysisk eller hybrid? En studie av en ny, digital helsetjeneste i møte med det etablerte helsevesenet.

Photoluminescence (PL) and excitation spectra of Bi melt doped oxide and chalcogenide glasses are very similar, indicating the same Bi center is present. When implanted with Bi, chalcogenide, phosphate and silica glass, and BaF2 crystal all display characteristically different PL spectra to when Bi is incorporated by melt-doping. This indicates that ion implantation is able to generate Bi centers which are not present in samples whose dopants are introduced during melting. Bi-related PL bands have been observed in glasses with very similar compositions to those in which carrier-type reversal has been observed, indicating that these phenomena are related to the same Bi centers, which we suggest are interstitial Bi2+ and Bi clusters