Benefit/Cost Analysis of U.S. Demining in Ethiopia and Eritrea

A Benefit/Cost (B/C) Analysis is a tool used to compare the rewards reaped by a program to the costs expended to accomplish it. The author discusses the B/C analysis of demining operations in Ethiopia and Eritrea and extrapolates the meaning of the results

Adequacy of Depression Treatment in Spouses of Cancer Survivors: Findings From a Nationally Representative US Survey

Background Recent research suggests that mental health problems in spouses of cancer survivors are associated with worse mental health in the survivors themselves. Adequately treating spousal mental health problems therefore represents an opportunity to improve outcomes for both cancer survivors and their co-surviving family members. Objective Using nationally representative data, this study sought to determine how depression treatment differs between spouses of cancer survivors with depression compared to the general married population and assess rural/urban disparities in treatment. Design The design of the study is cross sectional. Participants Data are from the Medical Expenditures Panel Survey, a household-based survey of US adults; we concatenated data from 2004 to 2013. We identified spouses of cancer survivors (n = 225) and a comparison group of married adults (n = 3678). Main Measures Key measures included depression, guideline concordance of depression treatment (at least four prescriptions related to depression treatment, or at least eight psychotherapy or counseling visits), and sociodemographic characteristics. Logistic regressions evaluated the association between whether their spouse had cancer and receipt of guideline-concordant treatment, controlling for sociodemographic characteristics; secondary analyses included rurality as a moderator. Analyses were weighted to account for the complex sampling design. Key Results Spouses of cancer survivors were 33% less likely to receive guideline-concordant depression treatment than comparison spouses (odds ratio (OR) 0.67, 95% confidence interval (CI) 0.45–0.99), controlling for covariates. Rural-urban disparities were observed: rural spouses of cancer survivors were 72% less likely to receive guideline-concordant treatment (OR 0.28, 95% CI 0.11–0.68) than rural comparison spouses. Spouses of cancer survivors and comparison spouses were no different in their receipt of any treatment versus no treatment. Conclusions Spouses of cancer survivors with depression may be at increased risk of non-guideline-concordant depression treatment, particularly in rural areas. The findings have implications for identifying and educating individuals with depression in primary care and other clinical areas

Peacemakers Along the DMZ: Non-Self Destruct Landmines in the Republic of Korea

The need for landmines in Korea will remain the same without a change in the terrain or the proximity of either the threat or the enemy, unless we successfully find a viable, fully fielded alternative

Cost Effectiveness of the Ethiopian and Eritrean Demining Programs

Long after anti-personnel landmines (AP) were planted to gain military advantage in battle, they continue to destroy lives by killing and maiming civilians and livestock, inhibiting productivity and preventing economies from developing in poor, third world countries. Landmines contribute to political instability in regions vital to the United States. The U. S. Department of State claims that there are approximately 85 to 200 million mines in 63 countries, producing approximately 15,000 casualties per year, an average of 70 people per day, or 500 people every week, most of them innocent civilians (DOS 1994). Of these, an estimated 9,500 people are killed each year (GHE 1995). Both Ethiopia and Eritrea have approximately 500,000-1,000,000 landmines according to the Department of State’s Hidden Killers. According to Mintz, twenty percent of mine victims are children, with about half the victims of the world’s estimated 100 million landmines non-soldiers (Mintz1996), although Bonnie Benwick claims that the estimated number of landmines may be overinflated (Benwick 1998). This paper will attempt to analyze the available data to perform a cost-effectiveness study of the U.S.-sponsored Ethiopian (ET) and Eritrean (ER) Demining Programs. This analysis may eventually be used as evaluation criteria to help determine if the United States should maintain its current level of operations or continue to expand demining into more countries

Modification of space charge transport in nanocrystalline cerium oxide by heterogeneous doping

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Materials Science and Engineering, 2009.Includes bibliographical references (p. 161-170).In the search for new materials for energy conversion and storage technologies such as solid oxide fuel cells, nano-ionic materials have become increasingly relevant because unique physical and transport properties that occur on the nanoscale may potentially lead to improved device performance. Nanocrystalline cerium oxide, in particular, has been the subject of intense scrutiny, as researchers have attempted to link trends in electrical conductivity with the properties of space charge layers within the material. In this thesis, efforts designed to intentionally modify the space charge potential, and thus the space charge profiles and the macroscopic conductivity, are described.Nanocrystalline CeO2 thin films with a columnar microstructure were grown by pulsed laser deposition. A novel heterogeneous doping technique was developed in which thin NiO and Gd203 diffusion sources were deposited on the ceria surface and annealed in the temperature range of 7008000C in order to diffuse the cations into the ceria layer exclusively along grain boundaries. Time-offlight secondary ion mass spectrometry (ToF-SIMS) was utilized to measure the diffusion profiles. A single diffusion mechanism, identified as grain boundary diffusion, was observed. Using the constant source solution to the diffusion equation, grain boundary diffusion coefficients on the order of 10-15 to 10-13 cm2/s were obtained for Ni, as well as Mg diffusion emanating from the underlying substrate. Microfabricated Pt electrodes were deposited on the sample surface, and electrical measurements were made using impedance spectroscopy and two-point DC techniques. The asdeposited thin films displayed a total conductivity and activation energy consistent with reference values in the literature. After in-diffusion, the electrical conductivity decreased by one order of magnitude. Novel electron-blocking electrodes, consisting of dense yttria-stabilized zirconia and porous Pt layers were fabricated in order to deconvolute the ionic and electronic contributions to the total conductivity. In the as-deposited state, the ionic conductivity was determined to be pO2-independent, and the electronic conductivity displayed a slope of -0.30. The ionic transference number in the as-deposited state was 0.34.(cont.) After annealing either with or without a diffusion source at temperatures of 700-8000C, both the ionic and electronic partial conductivities decreased. The ionic transferene numbers with and without a diffusion source were 0.26 and 0.76, respectively. Based on the existing framework of charge transport in polycrystalline materials, carrier profiles associated with the Mott-Schottky and Gouy-Chapman models were integrated in order to predict conductivity values based on parameters such as grain size and the space charge potential. Mott-Schottky profiles with a space charge potential of 0.44V were used to describe the behavior of the ceria thin films in the as-deposited state. It is proposed that annealing at temperatures of 700TC and above resulted in segregation of acceptor impurity ions to the grain boundary, resulting in GouyChapman conditions. The best fit to the annealed data occurred for a space charge potential of 0.35 V: a decrease of approximately 90 mV from the as-deposited state. In addition, a high-conductivity interfacial layer between the CeO2 and substrate was detected and was determined to influence samples with no surface diffusion source to a greater degree than those with NiO or Gd203.by Scott J. Litzelman.Ph.D

PREVALENCE of psychiatric morbidity in a community sample in Western Kenya

Background:About 25% of the worldwide population suffers from mental, neurological and substance use disorders but unfortunately, up to 75% of affected persons do not have access to the treatment they need. Data on the magnitude of the mental health problem in Kenya is scarce. The objectives of this study were to establish the prevalence and the socio-demographic factors associated with mental and substance use disorders in Kosirai division, Nandi County, Western Kenya. Methods:This was a cross sectional descriptive study in which participants were selected by simple random sampling. The sampling frame was obtained from a data base of the population in the study area developed during door-to-door testing and counseling exercises for HIV/AIDS. Four hundred and twenty consenting adults were interviewed by psychologists using the Mini International Neuropsychiatric Interview Version 7 for Diagnostic and Statistical Manual 5th Edition and a researcher-designed social demographic questionnaire. Results:One hundred and ninety one (45%) of the participants had a lifetime diagnosis of at least one of the mental disorders. Of these, 66 (15.7%) had anxiety disorder, 53 (12.3%) had major depressive disorder; 49 (11.7%) had alcohol and substance use disorder. 32 (7.6%) had experienced a psychotic episode and 69 (16.4%) had a life-time suicidal attempt. Only 7 (1.7%) had ever been diagnosed with a mental illness. Having a mental condition was associated with age less than 60 years and having a medical condition. Conclusion:A large proportion of the community has had a mental disorder in their lifetime and most of these conditions are undiagnosed and therefore not treated. These findings indicate a need for strategies that will promote diagnosis and treatment of community members with psychiatric disorders. In order to screen more people for mental illness, we recommend further research to evaluate a strategy similar to the home based counseling and testing for HIV and the use of simple screening tools

The role of community health workers in the surgical cascade: A scoping review

BACKGROUND: Community health workers (CHWs) can increase access to various primary healthcare services; however, their potential for improving surgical care is under-explored. We sought to assess the role of CHWs in the surgical cascade, defined as disease screening, linkage to operative care, and post-operative care. Given the well-described literature on CHWs and screening, we focused on the latter two steps of the surgical cascade. METHODS: We conducted a scoping review of the peer-reviewed literature. We searched for studies published in any language from January 1, 2000 to May 1, 2020 using electronic literature databases including Pubmed/MEDLINE, Web of Science, SCOPUS, and Google Scholar. We included articles on CHW involvement in linkage to operative care and/or post-operative surgical care. Narrative and descriptive methods were used to analyze the data. RESULTS: The initial search identified 145 articles relevant to steps in the surgical cascade. Ten studies met our inclusion criteria and were included for review. In linkage to care, CHWs helped increase surgical enrollment, provide resources for vulnerable patients, and build trust in healthcare services. Post-operatively, CHWs acted as effective monitors for surgical-site infections and provided socially isolated patients with support and linkage to additional services. The complex and wide-ranging needs of surgical patients illustrated the need to view surgical care as a continuum rather than a singular operative event. CONCLUSION: While the current literature is limited, CHWs were able to maneuver complex medical, cultural, and social barriers to surgical care by linking patients to counseling, education, and community resources, as well as post-operative infection prevention services. Future studies would benefit from more rigorous study designs and larger sample sizes to further elucidate the role CHWs can serve in the surgical cascade

Enhancing the Prospects for Palliative Care at the End of Life: A Statewide Educational Demonstration Project to Improve Advance Care Planning

Although patients want to participate in discussions and decisions about their end-of-life care, studies show that providers frequently fail to invite them to explore advanced care preferences or goals for living. The purpose of our demonstration project was to provide education and coaching to individuals, health providers, and organizations across the state of Indiana intended to facilitate these conversations, documenting and honoring individuals' life goals and preferences for care during the final stages of life. Education and training engaged community members as well as healthcare providers to: (1) improve participant comfort and facility discussing end-of-life issues; (2) improve knowledge of healthcare choices, including palliative and hospice care; and (3) prepare all participants to explore and document personal values, life goals, and priorities as well as goals of care. Between January of 2013 and June of 2015, the team educated close to 5,000 participants. Participants' ratings of the quality and perceived usefulness of the educational events ranged from 4 to 5 (using a 5-point scale, with 5 = most effective). Participant comments were overwhelmingly favorable and indicated an intention to put the advance care planning resources, communication skills, knowledge of palliative and hospice care, and personal renewal techniques into practice. Participant motivation to foster advance care planning, discussions of palliative care, and end-of-life conversations was facilitated by the reframing of these conversations as identifying goals of care and priorities for living well during an important stage of life. Successful strategies included helping providers and patients to adopt a broader meaning for “sustaining hope” (not for cure, but for engaging in highly valued activities), developing provider communication skills and comfort in initiating potentially difficult discussions, engaging a new community health workforce who will develop trusting relationships with patients in home-based services, and fostering self-awareness and self-care among palliative care providers

Cancer and quality of life in spousal dyads: spillover in couples with and without cancer-related health problems

Abstract Purpose Poor health of one spouse can adversely influence the partner's health outcomes (Bspillover^). This study aimed to estimate quality of life spillover among spouses and to determine how presence of cancer influenced these effects. Methods We examined data on husband-wife dyads with cancer-related health problems, medical events, or disabilities (n=910) and matched comparison dyads from the 2004-2012 Medical Expenditures Panel Survey, a population-based survey of the USA. Mental and physical health-related quality of life and depressed mood were reported at two time points (T1 and T2, 11 months apart on average). Dyadic multilevel models evaluated the cross-lagged impact of HRQoL and depressed mood at T1 on spouses' HRQoL at T2, controlling for sociodemographics and health conditions. Results Small but statistically significant spillover was observed for mental and physical HRQoL among couples with cancer. Spillover occurred from both the spouse to the survivor and from survivor to spouse. Depressed mood, in particular, showed stronger spillover effects from the spouse to the survivor than the inverse. Similar effects were not observed in dyads without cancer. Conclusions Screening for and treating poor HRQoL and depressed mood concurrently in both cancer survivors, and their spouses may positively influence HRQoL outcomes. Future research is needed to further elucidate these findings and determine whether a concurrent approach to psychosocial care in survivors and their spouses may improve long-term outcomes

Pedagogical Aspects of Applied Software Packages and Computer Technologies Use in Student's Education

Special software development is necessary for successful realization of teachers and students activity. There are two directions of such software development: first is for training process organization and second is for software use in education. General ASP purpose are universal software products intended for user functional tasks operation and it is also widely used in educational process