14 research outputs found

    Factors Affecting Master’s Counseling Students Pursuing Doctoral Degrees

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    Leadership identity is the most critical challenge for mental health counseling students. The Council for Accreditation of Counseling and Related Educational Programs (CACREP) does not mandate courses in leadership development. This quantitative study investigated master’s level mental health counselor student leadership identity and factors for pursuing a doctoral degree. Results indicated that the variable gender predicted socially responsible leadership yet did not predict intent to pursue a doctoral degree. Based on these results, master’s level counseling students could benefit from leadership curriculum as preparation for leadership positions within the field and influence pursuance of higher learning. Recommended Citation Godfrey, C. A. (2020, October 1-2). Factors affecting master’s counseling students pursuing doctoral degrees [Poster presentation]. Walden University Research Conference 2020 (online). https://scholarworks.waldenu.edu/researchconference/2020/posters/28

    Leadership Skill Development in Master’s-Level Counselor Education

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    Student leadership identity is fast becoming one of the most critical challenges educational institutions face today. However, mental health counselors may be limited in the amount of education and training received as they become leaders in the field. There is currently no known mandate at the master’s level for leadership embedded within the counseling curriculum in the educational environment, although research suggests otherwise. The purpose of this correlational predictive empirical study was to investigate leadership identity characteristics as measured by the Socially Responsible Leadership Scale, Revision 2 (SLRS-R2), moderated by demographic factors. Multiple regression analysis was used to determine outcome measures of the SLRS-R2 relating to leadership. Conclusions and suggestions for future practice regarding leadership skill development are provided

    Lessons learned and study results from HIVCore, an HIV implementation science initiative

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    Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138261/1/jia21261.pd

    Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

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    Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

    Neuropsychiatric manifestations and sleep disturbances with dolutegravir-based antiretroviral therapy versus standard of care in children and adolescents: a secondary analysis of the ODYSSEY trial

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    BACKGROUND: Cohort studies in adults with HIV showed that dolutegravir was associated with neuropsychiatric adverse events and sleep problems, yet data are scarce in children and adolescents. We aimed to evaluate neuropsychiatric manifestations in children and adolescents treated with dolutegravir-based treatment versus alternative antiretroviral therapy. METHODS: This is a secondary analysis of ODYSSEY, an open-label, multicentre, randomised, non-inferiority trial, in which adolescents and children initiating first-line or second-line antiretroviral therapy were randomly assigned 1:1 to dolutegravir-based treatment or standard-of-care treatment. We assessed neuropsychiatric adverse events (reported by clinicians) and responses to the mood and sleep questionnaires (reported by the participant or their carer) in both groups. We compared the proportions of patients with neuropsychiatric adverse events (neurological, psychiatric, and total), time to first neuropsychiatric adverse event, and participant-reported responses to questionnaires capturing issues with mood, suicidal thoughts, and sleep problems. FINDINGS: Between Sept 20, 2016, and June 22, 2018, 707 participants were enrolled, of whom 345 (49%) were female and 362 (51%) were male, and 623 (88%) were Black-African. Of 707 participants, 350 (50%) were randomly assigned to dolutegravir-based antiretroviral therapy and 357 (50%) to non-dolutegravir-based standard-of-care. 311 (44%) of 707 participants started first-line antiretroviral therapy (ODYSSEY-A; 145 [92%] of 157 participants had efavirenz-based therapy in the standard-of-care group), and 396 (56%) of 707 started second-line therapy (ODYSSEY-B; 195 [98%] of 200 had protease inhibitor-based therapy in the standard-of-care group). During follow-up (median 142 weeks, IQR 124–159), 23 participants had 31 neuropsychiatric adverse events (15 in the dolutegravir group and eight in the standard-of-care group; difference in proportion of participants with ≄1 event p=0·13). 11 participants had one or more neurological events (six and five; p=0·74) and 14 participants had one or more psychiatric events (ten and four; p=0·097). Among 14 participants with psychiatric events, eight participants in the dolutegravir group and four in standard-of-care group had suicidal ideation or behaviour. More participants in the dolutegravir group than the standard-of-care group reported symptoms of self-harm (eight vs one; p=0·025), life not worth living (17 vs five; p=0·0091), or suicidal thoughts (13 vs none; p=0·0006) at one or more follow-up visits. Most reports were transient. There were no differences by treatment group in low mood or feeling sad, problems concentrating, feeling worried or feeling angry or aggressive, sleep problems, or sleep quality. INTERPRETATION: The numbers of neuropsychiatric adverse events and reported neuropsychiatric symptoms were low. However, numerically more participants had psychiatric events and reported suicidality ideation in the dolutegravir group than the standard-of-care group. These differences should be interpreted with caution in an open-label trial. Clinicians and policy makers should consider including suicidality screening of children or adolescents receiving dolutegravir

    Dolutegravir twice-daily dosing in children with HIV-associated tuberculosis: a pharmacokinetic and safety study within the open-label, multicentre, randomised, non-inferiority ODYSSEY trial

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    Background: Children with HIV-associated tuberculosis (TB) have few antiretroviral therapy (ART) options. We aimed to evaluate the safety and pharmacokinetics of dolutegravir twice-daily dosing in children receiving rifampicin for HIV-associated TB. Methods: We nested a two-period, fixed-order pharmacokinetic substudy within the open-label, multicentre, randomised, controlled, non-inferiority ODYSSEY trial at research centres in South Africa, Uganda, and Zimbabwe. Children (aged 4 weeks to <18 years) with HIV-associated TB who were receiving rifampicin and twice-daily dolutegravir were eligible for inclusion. We did a 12-h pharmacokinetic profile on rifampicin and twice-daily dolutegravir and a 24-h profile on once-daily dolutegravir. Geometric mean ratios for trough plasma concentration (Ctrough), area under the plasma concentration time curve from 0 h to 24 h after dosing (AUC0–24 h), and maximum plasma concentration (Cmax) were used to compare dolutegravir concentrations between substudy days. We assessed rifampicin Cmax on the first substudy day. All children within ODYSSEY with HIV-associated TB who received rifampicin and twice-daily dolutegravir were included in the safety analysis. We described adverse events reported from starting twice-daily dolutegravir to 30 days after returning to once-daily dolutegravir. This trial is registered with ClinicalTrials.gov (NCT02259127), EudraCT (2014–002632-14), and the ISRCTN registry (ISRCTN91737921). Findings: Between Sept 20, 2016, and June 28, 2021, 37 children with HIV-associated TB (median age 11·9 years [range 0·4–17·6], 19 [51%] were female and 18 [49%] were male, 36 [97%] in Africa and one [3%] in Thailand) received rifampicin with twice-daily dolutegravir and were included in the safety analysis. 20 (54%) of 37 children enrolled in the pharmacokinetic substudy, 14 of whom contributed at least one evaluable pharmacokinetic curve for dolutegravir, including 12 who had within-participant comparisons. Geometric mean ratios for rifampicin and twice-daily dolutegravir versus once-daily dolutegravir were 1·51 (90% CI 1·08–2·11) for Ctrough, 1·23 (0·99–1·53) for AUC0–24 h, and 0·94 (0·76–1·16) for Cmax. Individual dolutegravir Ctrough concentrations were higher than the 90% effective concentration (ie, 0·32 mg/L) in all children receiving rifampicin and twice-daily dolutegravir. Of 18 children with evaluable rifampicin concentrations, 15 (83%) had a Cmax of less than the optimal target concentration of 8 mg/L. Rifampicin geometric mean Cmax was 5·1 mg/L (coefficient of variation 71%). During a median follow-up of 31 weeks (IQR 30–40), 15 grade 3 or higher adverse events occurred among 11 (30%) of 37 children, ten serious adverse events occurred among eight (22%) children, including two deaths (one tuberculosis-related death, one death due to traumatic injury); no adverse events, including deaths, were considered related to dolutegravir. Interpretation: Twice-daily dolutegravir was shown to be safe and sufficient to overcome the rifampicin enzyme-inducing effect in children, and could provide a practical ART option for children with HIV-associated TB

    Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial.

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    BACKGROUND: Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. METHODS: We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-for-age Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-to-treat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940. FINDINGS: Between Nov 22, 2012, and March 27, 2015, 5280 pregnant women were enrolled from 211 clusters. 3686 children born to HIV-negative mothers were assessed at age 18 months (884 in the standard of care group from 52 clusters, 893 in the IYCF group from 53 clusters, 918 in the WASH group from 53 clusters, and 991 in the IYCF plus WASH group from 51 clusters). In the IYCF intervention groups, the mean length-for-age Z score was 0·16 (95% CI 0·08-0·23) higher and the mean haemoglobin concentration was 2·03 g/L (1·28-2·79) higher than those in the non-IYCF intervention groups. The IYCF intervention reduced the number of stunted children from 620 (35%) of 1792 to 514 (27%) of 1879, and the number of children with anaemia from 245 (13·9%) of 1759 to 193 (10·5%) of 1845. The WASH intervention had no effect on either primary outcome. Neither intervention reduced the prevalence of diarrhoea at 12 or 18 months. No trial-related serious adverse events, and only three trial-related adverse events, were reported. INTERPRETATION: Household-level elementary WASH interventions implemented in rural areas in low-income countries are unlikely to reduce stunting or anaemia and might not reduce diarrhoea. Implementation of these WASH interventions in combination with IYCF interventions is unlikely to reduce stunting or anaemia more than implementation of IYCF alone. FUNDING: Bill & Melinda Gates Foundation, UK Department for International Development, Wellcome Trust, Swiss Development Cooperation, UNICEF, and US National Institutes of Health.The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 and OPP113707); UK Department for International Development; Wellcome Trust, UK (093768/Z/10/Z, 108065/Z/15/Z and 203905/Z/16/Z); Swiss Agency for Development and Cooperation; US National Institutes of Health (2R01HD060338-06); and UNICEF (PCA-2017-0002)

    -151 - ASPECTS OF SPECIES RICHNESS AND SEASONALITY OF AMPHIBIANS AND REPTILES IN THE COASTAL BARRIER ISLAND OF BRASS (NIgERIA)

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    suMMARY. -The ecology of the communities of amphibians and reptiles are nearly unknown in the coastal barrier island forests of the Niger Delta, southern Nigeria. In this paper, we examine aspects of species richness and phenology of amphibians and reptiles at several sites of Brass Island, one of the main coastal barrier islands of Nigeria. We employed a suite of field methods to capture specimens, and performed an equal field effort during both dry and wet seasons. Overall, we captured 31 species belonging to 17 families. For amphibians, we collected one species of Pipidae and Ranidae, and two of Ptychadenidae, Bufonidae, and Hyperoliidae. For reptiles, we captured one species of Agamidae, Varanidae, Chamaeleonidae, Typhlopidae, Viperidae, and Pelomedusidae, two of Boidae, Testudinidae and Crocodylidae, three of Scincidae and Elapidae, and five of Colubridae sensu lato. Fewer species were found in coastal barrier island forests than in swamp forests, mangroves or derived savannas of the Niger Delta. There was no clear seasonal effect on reptile abundance and diversity (but most species were found essentially by dry season), whereas for amphibians there was a strong seasonal effect, with higher abundances and species diversity found in wet season

    Aspects of species richness and seasonality of amphibians and reptiles in the Coastal Barrier Island of Brass (Nigeria)

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    Summary. — The ecology of the communities of amphibians and reptiles are nearly unknown in the coastal barrier island forests of the Niger Delta, southern Nigeria. In this paper, we examine aspects of species richness and phenology of amphibians and reptiles at several sites of Brass Island, one of the main coastal barrier islands of Nigeria. We employed a suite of field methods to capture specimens, and performed an equal field effort during both dry and wet seasons. Overall, we captured 31 species belonging to 17 families. For amphibians, we collected one species of Pipidae and Ranidae, and two of Ptychadenidae, Bufonidae, and Hyperoliidae. For reptiles, we captured one species of Agamidae, Varanidae, Chamaeleonidae, Typhlopidae, Viperidae, and Pelomedusidae, two of Boidae, Testudinidae and Crocodylidae, three of Scincidae and Elapidae, and five of Colubridae sensu lato. Fewer species were found in coastal barrier island forests than in swamp forests, mangroves or derived savannas of the Niger Delta. There was no clear seasonal effect on reptile abundance and diversity (but most species were found essentially by dry season), whereas for amphibians there was a strong seasonal effect, with higher abundances and species diversity found in wet season.RĂ©sumĂ©. — Aspects de la richesse spĂ©cifique et de la saisonnalitĂ© des amphibiens et reptiles de l’üle-barriĂšre cĂŽtiĂšre de Brass (NigĂ©ria). — L’écologie des communautĂ©s d’amphibiens et de reptiles des forĂȘts des Ăźles-barriĂšres cĂŽtiĂšres du delta du Niger, sud du NigĂ©ria, est pratiquement inconnue. Dans cet article nous examinons la richesse spĂ©cifique et la saisonnalitĂ© des amphibiens et reptiles en divers sites de l’üle de Brass, l’une des principales Ăźles-barriĂšres du NigĂ©ria. Nous avons utilisĂ© une sĂ©rie de mĂ©thodes pour capturer des spĂ©cimens et conduire un effort de terrain Ă©quilibrĂ© durant les saisons sĂšche et humide. En tout, 31 espĂšces appartenant Ă  17 familles ont Ă©tĂ© capturĂ©es. En ce qui concerne les amphibiens, nous avons collectĂ© une espĂšce pour les PipidĂ©s et les RanidĂ©s, deux pour les PtychadĂ©nidĂ©s, BufonidĂ©s et HyperoliidĂ©s. En reptiles, nous avons capturĂ© une espĂšce pour les AgamidĂ©s, VaranidĂ©s, ChamaelĂ©onidĂ©s, TyphlopidĂ©s, VipĂ©ridĂ©s et PĂ©lomĂ©dusidĂ©s, deux pour les BoĂŻdĂ©s, TestudinidĂ©s et CrocodylidĂ©s, trois pour les ScincidĂ©s et ElapidĂ©s, cinq pour les ColubridĂ©s sensu lato. Moins d’espĂšces ont Ă©tĂ© trouvĂ©es dans les forĂȘts d’üle-barriĂšre cĂŽtiĂšre que dans les forĂȘts marĂ©cageuses, mangroves ou savanes dĂ©rivĂ©es du delta du Niger. Il n’est pas apparu d’effet saison clair sur l’abondance et la diversitĂ© des reptiles (mais la plupart des espĂšces ont essentiellement Ă©tĂ© trouvĂ©es en saison sĂšche) alors que, pour les amphibiens, un tel effet s’est avĂ©rĂ© fort, avec de plus fortes abondances et diversitĂ©s spĂ©cifiques en saison des pluies.Akani Godfrey C., Luiselli Luca, Ogbeibu Anthony E., Onwuteaka John N., Chuku Edith, Osakwe J.A, Bombi Pierluigi, Amuzie Charity C., Uwagbae Michael, Gijo Harry A. Aspects of species richness and seasonality of amphibians and reptiles in the Coastal Barrier Island of Brass (Nigeria). In: Revue d'Écologie (La Terre et La Vie), tome 65, n°2, 2010. pp. 151-161
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