Anthropology, Brokerage and Collaboration in the development of a Tongan Public Psychiatry: Local Lessons for Global Mental Health

The Global Mental Health (GMH) movement has revitalised questions of the translatability of psychiatric concepts and the challenges of community engagement in countries where knowledge of the biomedical basis for psychiatric diagnosis is limited or challenged by local cultural codes. In Tonga, the local psychiatrist Dr Puloka has successfully established a publicly accessible psychiatry that has raised admission rates for serious mental illness and addressed some of the stigma attached to diagnosis. On the basis of historical analysis and ethnographic fieldwork with healers, doctors and patients since 1998, this article offers an ethnographic contextualization of the development and reception of three key interventions during the 1990s inspired by traditional healing and reliant on the translation of psychiatric terms and diagnosis. Dr Puloka’s use of medical anthropological and transcultural psychiatry research informed a community engaged brokerage between the implications of psychiatric nosologies and local needs. As such it reveals deficiencies in current polarised positions on the GMH project and offers suggestions to address current challenges of the Global Mental Health movement

Direct air capture based on ionic liquids: From molecular design to process assessment

Direct air capture is a key carbon dioxide removal technology to mitigate climate change and keep the global average temperature rise below 1.5–2 °C. This work addresses for the first time the use of ionic liquids for direct air capture connecting their material design by molecular simulation to process modelling. First, 26 different ionic liquids were designed through quantum chemical calculations and their isotherms were computed to identify those with a positive cyclic working capacity at conditions relevant for direct air capture. Then, the most promising ionic liquids were assessed via process simulations in Aspen Plus. A wide range of operating configurations were screened by modifying the key process variables: air velocity (1 – 3 m/s), solvent mass flow (5 – 50 t/h) and temperature (293 – 323 K), and regeneration pressure (0.1 – 1 bar) and temperature (373 – 393 K). Exergy, energy and productivity were computed to detect optimal operating conditions; moreover, a simplified economic analysis was carried out to highlight the major cost components. The direct air capture system based on [P66614][Im] exhibited the most exergy (5.44 – 16.73 MJ/kg) and energy (15.15 – 35.42 MJ/kg) efficiency for similar productivity (0.5 – 1.3 kg/(m3·h)) thanks to its enhanced cyclic capacity (0.6 – 0.3 mol/kg). The minimum exergy required by [P66614][Im]-based DAC process is slightly better than alkali scrubbing (6.21 MJ/kg) and in line with amine (5.59 MJ/kg) scrubbing. In addition, the assessed DAC process has a theoretical potential to operate in the range of 200 $/tCO2 under reasonable energy and plant expenses. We conclude this work providing guidelines to address future development of direct air capture technologies based on ionic liquidsThe authors are grateful to Ministerio de Ciencia e Innovacion ´ of Spain (project PID2020-118259RB-I00) and Comunidad de Madrid (project P2018/EMT4348) for financial suppor

The Presence of a Best Friend Buffers the Effects of Negative Experiences

The goal of the current study was to examine how the presence of a best friend might serve as protection against the effect of negative experiences on global self-worth and the hypothalamic-pituitary-adrenocortical axis (HPA axis). A total of 103 English-speaking male (n = 55) and female (n = 48) participants from Grade 5 (M = 10.27 years) and Grade 6 (M = 11.30 years) completed booklets about their experiences that occurred 20 min previously and how they felt about themselves at the moment, and they provided saliva multiple times per day over the course of 4 consecutive days. Having a best friend present during an experience significantly buffered the effect of the negativity of the experience on cortisol and global self-worth. When a best friend was not present, there was a significant increase in cortisol and a significant decrease in global self-worth as the negativity of the experience increased. When a best friend was present, there was less change in cortisol and global self-worth due to the negativity of the experience

Exploring substance use and HIV treatment factors associated with neurocognitive impairment among people living with HIV/AIDS

Neurocognitive (NC) impairment remains prevalent among people living with HIV (PLWH) and may be exacerbated by alcohol and drug use. This cross-sectional study assesses the degree to which alcohol and other drug use, time from HIV diagnosis to treatment, and years living with HIV affect three areas of NC functioning among HIV-seropositive adults. NC functioning in 370 PLWH living in Miami, FL was assessed using the Auditory Verbal Learning Test, the Short Category Test, Booklet Format, and the Color Trails Test 2 (CTT2). Participants reported the number of days using alcohol, marijuana, and cocaine over the previous 3 months, the number of known years living with HIV and length of time from HIV diagnosis to seeking care. Bivariate linear regression and multivariate linear regression were used to test associations between independent and dependent variables. Mean scores on NC measures were significantly lower than published norms; 39% of participants scored ≥1 standard deviation below normative sample means on \u3e2 NC tests. No significant associations were found between alcohol or cocaine use and any NC measure. Years living with HIV was associated with CTT2 in the bivariate analysis (β = 1.031; p = 0.007). In multivariate analysis, each day of marijuana use and years living with HIV were associated with a 0.32 (p = 0.05) point and 1.18 (p = 0.03) points poorer performance score on the CTT2, respectively. Results suggest that both marijuana use and duration of HIV infection may affect cognitive functioning among PLWH in ways that may impair their ability to follow important treatment guidance

Colorectal Adenomas

Carta a l'editor com a resposta al document: https://doi.org/10.1056/NEJMra1513581In his review article, Strum (March 17 issue)1 provides data on the overall prevalence of colorectal adenomas in the United States and risk factors for these lesions. It is well established that patients with Streptococcus bovis–group infective endocarditis are at high risk for colorectal cancer.2 Although a strong relationship between Enterococcus faecalis endocarditis and colorectal adenomas is suspected, robust data are lacking

Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study.

Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice

DNA structure directs positioning of the mitochondrial genome packaging protein Abf2p

The mitochondrial genome (mtDNA) is assembled into nucleo-protein structures termed nucleoids and maintained differently compared to nuclear DNA, the involved molecular basis remaining poorly understood. In yeast (Saccharomyces cerevisiae), mtDNA is a similar to 80 kbp linear molecule and Abf2p, a double HMG-box protein, packages and maintains it. The protein binds DNA in a non-sequence-specific manner, but displays a distinct 'phased-binding' at specific DNA sequences containing poly-adenine tracts (A-tracts). We present here two crystal structures of Abf2p in complex with mtDNA-derived fragments bearing A-tracts. Each HMG-box of Abf2p induces a 90. bend in the contacted DNA, causing an overall U-turn. Together with previous data, this suggests that U-turn formation is the universal mechanism underlying mtDNA compaction induced by HMG-box proteins. Combining this structural information with mutational, biophysical and computational analyses, we reveal a unique DNA binding mechanism for Abf2p where a characteristic N-terminal flag and helix are crucial for mtDNA maintenance. Additionally, we provide the molecular basis for A-tract mediated exclusion of Abf2p binding. Due to high prevalence of Atracts in yeast mtDNA, this has critical relevance for nucleoid architecture. Therefore, an unprecedented A-tract mediated protein positioning mechanism regulates DNA packaging proteins in the mitochondria, and in combination with DNA-bending and U-turn formation, governs mtDNA compaction

Exploring the Conformational Landscape of Bioactive Small Molecules

By using a combination of classical Hamiltonian replica exchange with high-level quantum mechanical calculations on more than one hundred drug-like molecules, we explored here the energy cost associated with binding of drug-like molecules to target macromolecules. We found that, in general, the drug-like molecules present bound to proteins in the Protein Data Bank (PDB) can access easily the bioactive conformation and in fact for 73% of the studied molecules the bioactiveconformation is within 3kBT from the most-stable conformation in solution as determined by DFT/SCRF calculations. Cases with large differences between the most-stable and the bioactive conformations appear in ligands recognized by ionic contacts, or very large structures establishing many favorable interactions with the protein. There are also a few cases where we observed a non-negligible uncertainty related to the experimental structure deposited in PDB. Remarkably, the rough automatic force field used here provides reasonable estimates of the conformational ensemble of drugs in solution. The outlined protocol can be used to better estimate the cost of adopting the bioactive conformation