Challenges and opportunities in the science of research to practice: lessons learned from a randomized controlled trial of a sexual risk-reduction intervention for psychiatric patients in a public mental health system

Objective: Human immunodeficiency virus (HIV) prevention efficacy trials with psychiatric patients have been conducted in research settings in high-resourced countries, establishing short-term efficacy for reducing sexual risk behavior. None has been implemented within systems of care. In the last decade, overcoming this research-to-practice gap has become a focus of implementation science. This paper describes the first and only HIV Prevention intervention trial for psychiatric patients conducted in real-world outpatient psychiatric settings facilitated by trained clinic-based providers. Methods: The HIV Prevention intervention, which uses the Information-Motivation-Behavioral Skills model to achieve sexual risk-reduction, was rigorously adapted to the local context and clinic services' needs. Participants from eight clinics were randomized to HIV Prevention or Health Promotion conditions. Results: HIV Prevention participants showed significant improvement in Information-Motivation-Behavioral domains; in this group, behavioral intentions were associated with significantly fewer unprotected sex occasions, but reduction of unprotected sex occasions was similar in both conditions. Conclusion: Our trial was conducted before implementation studies became widely funded. Transporting an intervention to a new culture or into real-world practice settings may require adaptations. Our results demonstrate that clear guidelines are needed regarding whether to conduct efficacy, effectiveness, and/or implementation research as the most appropriate next step. Clinical trial registration: NCT00881699

Ceramic Microbial Fuel Cells Stack: Power generation in standard and supercapacitive mode

© 2018 The Author(s). In this work, a microbial fuel cell (MFC) stack containing 28 ceramic MFCs was tested in both standard and supercapacitive modes. The MFCs consisted of carbon veil anodes wrapped around the ceramic separator and air-breathing cathodes based on activated carbon catalyst pressed on a stainless steel mesh. The anodes and cathodes were connected in parallel. The electrolytes utilized had different solution conductivities ranging from 2.0 mScm-1 to 40.1 mScm-1, simulating diverse wastewaters. Polarization curves of MFCs showed a general enhancement in performance with the increase of the electrolyte solution conductivity. The maximum stationary power density was 3.2 mW (3.2 Wm-3) at 2.0 mScm-1 that increased to 10.6 mW (10.6 Wm-3) at the highest solution conductivity (40.1 mScm-1). For the first time, MFCs stack with 1 L operating volume was also tested in supercapacitive mode, where full galvanostatic discharges are presented. Also in the latter case, performance once again improved with the increase in solution conductivity. Particularly, the increase in solution conductivity decreased dramatically the ohmic resistance and therefore the time for complete discharge was elongated, with a resultant increase in power. Maximum power achieved varied between 7.6 mW (7.6 Wm-3) at 2.0 mScm-1 and 27.4 mW (27.4 Wm-3) at 40.1 mScm-1

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29–39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

Cell structural reorganization during induction of androgenesis in isolated microspore cultures of triticale [xTriticosecale Wittm.]

Upon stress treatment, isolated microspores of triticale (×Triticosecale Wittm.) were directed towards sporophytic development (androgenesis). We used fluorescence microscopy to study the cell structural reorganization associated with the process. Changes in the developmental pathway coincided with the character of the microtubular cytoskeleton configuration, the number and direction of nuclear divisions, changes in vacuolization, the distribution of mitochondria, ER and starch grains, and the architecture of new cell wall formation. A band of diffused fluorescence surrounding the nucleus was observed before the first symmetric division of microspores. This structure most likely represents a preprophase band (PPB). Successive mitotic divisions within the microspore wall led to the formation of multinucleate or multicellular structures consisting of one or two domains of cells differing in size. They were later released from the sporoderm and continued further development with features typical for a monocotyledonous embryo. The pattern of internal architecture of androgenic structures depended on their developmental phase. Before and after release from the microspore wall, cortical microtubules (MTs) exhibited various configurations without preferential orientation. They formed a denser network in the region opposite to the sporoderm rupture site. Released multicellular structures showed both intensely fluorescing cortical MTs and more dispersed endoplasmic MTs radiating along the cytoplasmic strands from the nuclear region to the cell cortex. Up to globular stage, isotropically expanding cells of androgenic embryos showed a random pattern of MTs. This is the first report that successive events of androgenic development of triticale microspores are associated with MT reorganization. The results support the view that changes in cytoskeleton architecture are critical during induction of androgenesis