Guided Act and Feel Indonesia (GAF-ID) – Internet-based behavioral activation intervention for depression in Indonesia: study protocol for a randomized controlled trial

Background: Depression is a leading cause of disease burden across the world. However, in low-middle income countries (LMICs), access to mental health services is severely limited because of the insufficient number of mental health professionals available. The WHO initiated the Mental Health Gap Action Program (mhGAP) aiming to provide a coherent strategy for closing the gap between what is urgently needed and what is available in LMICs. Internet-based treatment is a promising strategy that can be made available to a large number of people now that Internet access is increasing rapidly throughout the world. The present study will investigate whether such an Internet-based treatment for depression is effective in Indonesia.  Methods: An Internet-based behavioral activation treatment, with support by lay counselors who will provide online feedback on the assignments and supportive phone contact to encourage participants to work in the program (Guided Act and Feel Indonesia/GAF-ID), is compared to an online-delivered minimal psychoeducation without any support (psychoeducation/PE). Initial assessment for inclusion is based on a Patient Health Questionnaire-9 (PHQ-9) score of at least 10 and meeting criteria for major depressive disorder or persistent depressive disorder as assessed using the Structured Clinical Interview for DSM-5 (SCID-5). Participants with depression (N=312) will be recruited and randomly assigned to GAF-ID or PE. Overall assessments will be done at baseline, post intervention (10 weeks from baseline) and follow-ups (3 months and 6 months from baseline). The primary outcome is the reduction of depression symptoms as measured by the PHQ-9 after 10 weeks from baseline.  Discussion: To our knowledge, this is the first study in Indonesia that examines the effectiveness of an Internet-based intervention for depression in a randomized controlled trial. The hope is that it can serve as a starting point for bridging the mental health gap in Indonesia and other LMICs. Trial registration: Nederlands Trial Register ( www.trialregister.nl ): NTR5920 , registered on 1 July 2016

How hummingbirds hum: acoustic holography of hummingbirds during maneuvering flight

Hummingbirds make a characteristic humming sound when they flaptheir wings. The physics and the biological significance of hummingbird aeroacoustics is still poorly understood. We used acoustic holography and high-speed cameras to determine the acoustic field of six hummingbirds while they either hovered stationary in front of a flower or maneuvered to track flower motion. We used a robotic flower that oscillated either laterally or longitudinally with a linear combination of 20 different frequencies between 0.2 and 20 Hz, a range that encompasses natural flower vibration frequencies in wind. We used high-speed marker tracking to dissect the transfer function between the moving flower, the head, and body of the bird. We also positioned four acoustic arrays equipped with 2176 microphones total above, below, and in front of the hummingbird. Acoustic data from the microphones were back-propagated to planes adjacent to the hummingbird to create the first real-time holograms of the pressure field a hummingbird generates in vivo. Integration of all this data offers insight into how hummingbirds modulate the acoustic field during hovering and maneuvering flight

Smoking Cessation has no Influence on Quality of Life in Patients with Peripheral Arterial Disease 5 Years Post-vascular Surgery

AbstractObjectivesSmoking is an important modifiable risk factor in patients with peripheral arterial disease (PAD). We investigated differences in quality of life (QoL) between patients who quitted smoking during follow-up and persistent smokers.DesignCohort study.MethodsData of 711 consecutively enrolled patients undergoing vascular surgery were collected in 11 hospitals in the Netherlands. Smoking status was obtained at baseline and at 3-year follow-up. A 5-year follow-up to measure QoL was performed with the EuroQol-5D (EQ-5D) and Peripheral Arterial Questionnaire (PAQ).ResultsAfter adjusting for clinical risk factors, patients, who quit smoking within 3 years after vascular surgery, did not report an impaired QoL (EQ-5D: odds ratio (OR) = 0.63, 95% confidence interval (CI) = 0.28–1.43; PAQ: OR = 0.76, 95% CI = 0.35–1.65; visual analogue scale (VAS): OR = 0.88, 95% CI = 0.42–1.84) compared with patients, who continued smoking. Current smokers were significantly more likely to have an impaired QoL (EQ-5D: OR = 1.86, 95% CI = 1.09–3.17; PAQ: OR = 1.63, 95% CI = 1.00–2.65), although no differences in VAS scores were found (OR = 1.17, 95% CI = 0.72–1.90).ConclusionsThere was no effect of smoking cessation on QoL in PAD patients undergoing vascular surgery. Nevertheless, given the link between smoking, complications and mortality in this patient group, smoking cessation should be a primary target in secondary prevention

ADAM17 and EGFR regulate IL-6 receptor and amphiregulin mRNA expression and release in cigarette smoke-exposed primary bronchial epithelial cells from patients with chronic obstructive pulmonary disease (COPD)

Aberrant activity of a disintegrin and metalloprotease 17 (ADAM17), also known as TACE, and epidermal growth factor receptor (EGFR) has been suggested to contribute to chronic obstructive pulmonary disease (COPD) development and progression. The aim of this study was to investigate the role of these proteins in activation of primary bronchial epithelial cells differentiated at the air–liquid interface (ALI-PBEC) by whole cigarette smoke (CS), comparing cells from COPD patients with non-COPD. CS exposure of ALI-PBEC enhanced ADAM17-mediated shedding of the IL-6 receptor (IL6R) and the EGFR agonist amphiregulin (AREG) toward the ba

Elements of care that matter:Perspectives of families with multiple problems

The severe and often persistent problems of families with multiple problems (FMP) call for better understanding of how interventions can improve outcomes in these families. Perspectives of FMP on the crucial elements of interventions may strongly support improvement by providing cues on how to realize positive change. We therefore explored the views of parents and children in FMP regarding helpful and less helpful elements of various interventions. We interviewed 24 parents and 4 children about their perspectives, using a semi-structured interview guide comprising themes that were chosen by the target group. Participants reported 11 elements that contribute to the effectiveness of care, categorized under three main themes: the characteristics of the practitioner, the content of interventions, and the structure of interventions. The perspectives of FMP show the following activities to be promising: routine reflection on the non-judgmental and positive approach of practitioners, more direct focus on children, focus on the underlying cause of behavior, activation of families’ social network, the school and other professionals around the family, and creation of more possibilities for long-term and flexible support. Perspectives of FMP on the content and provision of care should be better embedded in interventions. This may help to tailor interventions to their wishes and needs, which in turn can contribute to more positive outcomes of care

Further validation of the peripheral artery questionnaire:Results from a peripheral vascular surgery survey in the Netherlands

AbstractObjectivesPeripheral arterial disease (PAD) is associated with adverse cardiovascular events and can significantly impair patients' health status. Recently, marked methodological improvements in the measurement of PAD patients' health status have been made. The Peripheral Artery Questionnaire (PAQ) was specifically developed for this purpose. We validated a Dutch version of the PAQ in a large sample of PAD patients.DesignCross-sectional study.MethodsThe Dutch PAQ was completed by 465 PAD patients (70% men, mean age 65±10 years) participating in the Euro Heart Survey Programme. Principal components analysis and reliability analyses were performed. Convergent validity was documented by comparing the PAQ with EQ-5D scales.ResultsThree factors were discerned; Physical Function, Perceived Disability, and Treatment Satisfaction (factor loadings between 0.50 and 0.90). Cronbach's α values were excellent (mean α=0.94). Shared variance of the PAQ domains with EQ-5D scales ranged from 3 to 50%.ConclusionsThe Dutch PAQ proved to have good measurement qualities; assessment of Physical Function, Perceived Disability, and Treatment Satisfaction facilitates the monitoring of patients' perceived health in clinical research and practice. Measuring disease-specific health status in a reliable way becomes essential in times were a wide array of treatment options are available for PAD patients

Physics and Technology Research for Liquid-Metal Divertor Development, Focused on a Tin-Capillary Porous System Solution, at the OLMAT High Heat-Flux Facility

The operation of the Optimization of Liquid Metal Advanced Targets (OLMAT) facility began in April 2021 with the scientific objective of exposing liquid-metal plasma facing components (PFCs) to the particle and power fluxes provided by one of the hydrogen neutral beam injectors of the TJ-II stellarator. The system can deliver heat fluxes from 5 to 58 MW m−2 of high energy hydrogen neutral particles (≤ 33 keV) with fluxes up to 1022m2s−1 (containing an ion fraction ≤ 33% in some instances), pulsed operation of 30–150 ms duration and repetition rates up to 2 min−1. These characteristics enable OLMAT as a high heat flux (HHF) facility for PFC evaluation in terms of power exhaust capabilities, thermal fatigue and resilience to material damage. Additionally, the facility is equipped with a wide range of diagnostics that includes tools for analyzing the thermal response of the targets as well as for monitoring atomic/plasma physics phenomena. These include spectroscopy, pyrometry, electrical probing and visualization (fast and IR cameras) units. Such particularities make OLMAT a unique installation that can combine pure technological PFC research with the investigation of physical phenomena such as vapor shielding, thermal sputtering, the formation/characterization of plasma plumes with significant content of evaporated metal and the detection of impurities in front of the studied targets. Additionally, a myriad of surface characterization techniques as SEM/EDX for material characterization of the exposed PFC prototypes are available at CIEMAT. In this article, first we provide an overview of the current facility upgrade in which a high-power CW laser, that can be operated in continuous and pulsed modes (0.2–10 ms), dump and electrical (single Langmuir) probe embedded on the target surface have been installed. This laser operation will allow simulating more relevant heat loading scenarios such as nominal steady-state divertor heat fluxes (10–20 MW m−2 in continuous mode) and transients including ELM loading and disruption-like events (ms time scales and power densities up to GW m−2 range). The work later focuses on the more recent experimentation (2022 fall campaign) where a 3D printed Tungsten (W) Capillary Porous System (CPS) target, with approximated 30 μm pore size and a 37% porosity and filled with liquid tin. This porous surface was a mock-up of the PFC investigated in the ASDEX Upgrade divertor manipulator. The target composed with this element was eventually exposed to a sequence of shots with the maximum heat flux that OLMAT provides (58 ± 14 MWm−2). Key questions as resilience to dry-out and particle ejection of the liquid metal layer, its refilling, the induced damage/modification of the porous W matrix and the global performance of the component are addressed, attempting to shed light on the issues encountered with the PFC at tokamak scale testing.</p