Green-pumped, picosecond MgO:PPLN optical parametric oscillator

We investigate the performance of a magnesium-oxide-doped periodically poled lithium niobate crystal (MgO:PPLN) in an optical parametric oscillator (OPO) synchronously-pumped by 530nm, 20ps, 230MHz pulses with an average power of up to 2W from a frequency-doubled, gain-switched laser diode seed and a multi-stage Yb:fiber amplifier system. The OPO produces ~165mW (signal, 845nm) and ~107mW (idler, 1421nm) of average power for ~1W of pump power and can be tuned from ~800nm to 900nm (signal) and 1.28µm to 1.54µm (idler). Observations of photo-refraction and green-induced infrared absorption (GRIIRA) in different operational regimes of the MgO:PPLN OPO are described and the role of peak intensity and average power are investigated, both with the aim to find the optimal operating regime for pulsed systems

High repetition rate, high pulse energy, Raman shifted wavelength selectable fiber laser source in the visible

We have demonstrated a Raman-shifted wavelength-selectable fiber laser source with fundamental spatial-mode output producing ~1µJ pulse-energy at 1MHz repetition-rate with 1.3ns pulse-width using a large-core photonic crystal fiber

Generation of mode-locked optical pulses at 1035 nm from a fiber Bragg grating stabilized semiconductor laser diode

We report the generation of transform-limited, ~18 ps optical pulses from a fiber Bragg grating (FBG) stabilized semiconductor laser diode. Up to 7.2 pJ of pulse energy and a peak power of 400mW were achieved when operating at a repetition frequency of 832.6 MHz, a multiple of the cavity (diode + FBG) free spectral range (FSR). A small detuning in the repetition frequency resulted in broader optical pulses. We have shown experimentally the transition from a gain-switched regime of operation to mode-locked operation once the injection current modulation frequency is set to match a harmonic of the cavity FSR. The transition also results in a reduction in the timing jitter of the optical pulses

High-energy, near- and mid-IR picosecond pulses generated by a fiber-MOPA-pumped optical parametric generator and amplifier

We report a high-energy picosecond optical parametric generator/amplifier (OPG/A) based on a MgO:PPLN crystal pumped by a fiber master-oscillator-power-amplifier (MOPA) employing direct amplification. An OPG tuning range of 1450-3615nm is demonstrated with pulse energies as high as 2.6µJ (signal) and 1.2µJ (idler). When seeded with a ~100 MHz linewidth diode laser, damage-limited pulse energies of 3.1µJ (signal) and 1.3µJ (idler) have been achieved and the signal pulse time-bandwidth product is improved to ~2 times transform-limited. When seeded with a 0.3nm-bandwidth filtered amplified spontaneous emission source, crystal damage is avoided and maximum pulse energies of 3.8µJ (signal) and 1.7µJ (idler) are obtained at an overall conversion efficiency of 45%

Patients' and healthcare professionals' perspectives on a community-based intervention for schizophrenia in Pakistan: A focus group study.

To explore the perceptions and experiences of schizophrenia from patients, their care givers, health care providers, spiritual and traditional healers to develop a community-based intervention for improving treatment adherence for people with schizophrenia in Pakistan. This qualitative study involved four focus group discussions (FGD) with a total of 26 participants: patients and carers (n = 5), primary care staff (n = 7), medical technicians (n = 8) and traditional and spiritual healers (n = 6). The participants were selected using purposive sampling method. FGDs were audio-recorded and transcribed. A thematic analysis was applied to the data set. The themes identified were (i) Schizophrenia is not merely a biomedical problem: participants believed that poverty and an inferiority complex resulting from social disparity caused schizophrenia and contributed to non-adherence to medications; (ii) Spiritual healing goes hand in hand with the medical treatment: participants regarded spiritual and traditional treatment methods as an inherent part of schizophrenia patients' well-being and rehabilitation; (iii) Services for mental illness: mental health is not covered under primary health in a basic health unit: participants believed that the lack of services, training and necessary medication in primary care are major issues for treating schizophrenia in community; (iv) Barriers to community-based interventions: primary care staff believed that multiple pressures on staff, lack of incentives, non-availability of medication and lack of formal referral pathways resulted in disintegration of dealing with schizophrenia patients in primary care facilities. The study has identified a number of barriers and facilitators to developing and delivering a psychosocial intervention to support people living with schizophrenia in Pakistan. In particular, the importance of involving spiritual and traditional healers was highlighted by our diverse group of stakeholders

Supervised treatment in outpatients for schizophrenia plus (STOPS+): protocol for a cluster randomised trial of a community-based intervention to improve treatment adherence and reduce the treatment gap for schizophrenia in Pakistan

Introduction There is a significant treatment gap, with only a few community-based services for people with schizophrenia in low-income and middle-income countries. Poor treatment adherence in schizophrenia is associated with poorer health outcomes, suicide attempts and death. We previously reported the effectiveness of supervised treatment in outpatients for schizophrenia (STOPS) for improving treatment adherence in patients with schizophrenia. However, STOPS was evaluated in a tertiary care setting with no primary care involvement, limiting its generalisability to the wider at-risk population. We aim to evaluate the effectiveness of STOPS+ in scaling up the primary care treatment of schizophrenia to a real-world setting. Methods and analysis The effectiveness of the STOPS+ intervention in improving the level of functioning and medication adherence in patients with schizophrenia in Pakistan will be evaluated using a cluster randomised controlled trial design. We aim to recruit 526 participants from 24 primary healthcare centres randomly allocated in 1:1 ratio to STOPS+ intervention and enhanced treatment as usual arms. Participants will be followed-up for 12 months postrecruitment. The sample size is estimated for two outcomes (1) the primary clinical outcome is level of functioning, measured using the Global Assessment of Functioning scale and (2) the primary process outcome is adherence to treatment regimen measured using a validated measure. An intention-to-treat approach will be used for the primary analysis. Ethics and dissemination Ethical approval has been obtained from Keele University Ethical Review Panel (ref: MH-190017) and Khyber Medical University Ethical Review Board (ref: DIR-KMU-EB/ST/000648). The results of the STOPS+ trial will be reported in peer-reviewed journals and academic conferences and disseminated to local stakeholders and policymakers

Patients’ and healthcare professionals’ perspectives on a community-based intervention for schizophrenia in Pakistan: A focus group study

Objective: To explore the perceptions and experiences of schizophrenia from patients, their care givers, health care providers, spiritual and traditional healers to develop a community-based intervention for improving treatment adherence for people with schizophrenia in Pakistan. Methods: This qualitative study involved four focus group discussions (FGD) with a total of 26 participants: patients and carers (n = 5), primary care staff (n = 7), medical technicians (n = 8) and traditional and spiritual healers (n = 6). The participants were selected using purposive sampling method. FGDs were audio-recorded and transcribed. A thematic analysis was applied to the data set. Results: The themes identified were (i) Schizophrenia is not merely a biomedical problem: participants believed that poverty and an inferiority complex resulting from social disparity caused schizophrenia and contributed to non-adherence to medications; (ii) Spiritual healing goes hand in hand with the medical treatment: participants regarded spiritual and traditional treatment methods as an inherent part of schizophrenia patients’ well-being and rehabilitation; (iii) Services for mental illness: mental health is not covered under primary health in a basic health unit: participants believed that the lack of services, training and necessary medication in primary care are major issues for treating schizophrenia in community; (iv) Barriers to community-based interventions: primary care staff believed that multiple pressures on staff, lack of incentives, non-availability of medication and lack of formal referral pathways resulted in disintegration of dealing with schizophrenia patients in primary care facilities. Conclusion: The study has identified a number of barriers and facilitators to developing and delivering a psychosocial intervention to support people living with schizophrenia in Pakistan. In particular, the importance of involving spiritual and traditional healers was highlighted by our diverse group of stakeholders

Supervised Treatment in Outpatients for Schizophrenia Plus (STOPS+): Protocol for a cluster randomised trial of a community-based intervention to improve treatment adherence and reduce the treatment gap for schizophrenia in Pakistan

Introduction: There is a significant treatment gap, with only a few community-based services for people with schizophrenia in Low- and Middle-Income countries. Poor treatment adherence in schizophrenia is associated with poorer health outcomes, suicide attempts and death. We previously reported the effectiveness of STOPS (Supervised Treatment in Outpatients for Schizophrenia) for improving treatment adherence in patients with schizophrenia. However, STOPS was evaluated in a tertiary care setting with no primary care involvement, limiting its generalisability to the wider at-risk population. We aim to evaluate the effectiveness of STOPS+ in scaling up the primary care treatment of schizophrenia to a real-world setting. Methods and analysis: The effectiveness of the STOPS+ intervention in improving the level of functioning and medication adherence in patients with schizophrenia in Pakistan will be evaluated using a cluster randomised controlled trial design. We aim to recruit 526 participants from 24 Primary Health Care Centres (PHCs) randomly allocated in 1:1 ratio to STOPS+ intervention and Enhanced Treatment as Usual (ETAU) arms. Participants will be followed-up for 12 months post recruitment. The sample size is estimated for two outcomes (i) The primary clinical outcome is level of functioning, measured using the Global Assessment of Functioning (GAF) scale, and (ii) the primary process outcome is adherence to treatment regimen measured using a validated measure. An intention-to-treat approach will be used for the primary analysis. Ethics and Dissemination: Ethical approval has been obtained from Keele University Ethical Review Panel (ref: MH-190017) and Khyber Medical University Ethical Review Board (ref: DIR-KMU-EB/ST/000648). The results of the STOPS+ trial will be reported in peer reviewed journals and academic conferences and disseminated to local stakeholders and policy makers

A Cohort Study of Serum Bilirubin Levels and Incident Non-Alcoholic Fatty Liver Disease in Middle Aged Korean Workers

BACKGROUND: Serum bilirubin may have potent antioxidant and cytoprotective effects. Serum bilirubin levels are inversely associated with several cardiovascular and metabolic endpoints, but their association with nonalcoholic fatty liver disease (NAFLD) has not been investigated except for a single cross-sectional study in a pediatric population. We assessed the prospective association between serum bilirubin concentrations (total, direct, and indirect) and the risk for NAFLD. METHODS AND FINDINGS: We performed a cohort study in 5,900 Korean men, 30 to 59 years of age, with no evidence of liver disease and no major risk factors for liver disease at baseline. Study participants were followed in annual or biennial health examinations between 2002 and 2009. The presence of fatty liver was determined at each visit by ultrasonography. We observed 1,938 incident cases of NAFLD during 28,101.8 person-years of follow-up. Increasing levels of serum direct bilirubin were progressively associated with a decreasing incidence of NAFLD. In age-adjusted models, the hazard ratio for NAFLD comparing the highest to the lowest quartile of serum direct bilirubin levels was 0.61 (95% CI 0.54-0.68). The association persisted after adjusting for multiple metabolic parameters (hazard ratio comparing the highest to the lowest quartile 0.86, 95% CI 0.76-0.98; P trend = 0.039). Neither serum total nor indirect bilirubin levels were significantly associated with the incidence of NAFLD. CONCLUSIONS: In this large prospective study, higher serum direct bilirubin levels were significantly associated with a lower risk of developing NAFLD, even adjusting for a variety of metabolic parameters. Further research is needed to elucidate the mechanisms underlying this association and to establish the role of serum direct bilirubin as a marker for NAFLD risk

Projected changes of rainfall seasonality and dry spells in a high greenhouse gas emissions scenario

In this diagnostic study we analyze changes of rainfall seasonality and dry spells by the end of the twenty-first century under the most extreme IPCC5 emission scenario (RCP8.5) as projected by twenty-four coupled climate models contributing to Coupled Model Intercomparison Project 5 (CMIP5). We use estimates of the centroid of the monthly rainfall distribution as an index of the rainfall timing and a threshold-independent, information theory-based quantity such as relative entropy (RE) to quantify the concentration of annual rainfall and the number of dry months and to build a monsoon dimensionless seasonality index (DSI). The RE is projected to increase, with high inter-model agreement over Mediterranean-type regions---southern Europe, northern Africa and southern Australia---and areas of South and Central America, implying an increase in the number of dry days up to 1Â month by the end of the twenty-first century. Positive RE changes are also projected over the monsoon regions of southern Africa and North America, South America. These trends are consistent with a shortening of the wet season associated with a more prolonged pre-monsoonal dry period. The extent of the global monsoon region, characterized by large DSI, is projected to remain substantially unaltered. Centroid analysis shows that most of CMIP5 projections suggest that the monsoonal annual rainfall distribution is expected to change from early to late in the course of the hydrological year by the end of the twenty-first century and particularly after year 2050. This trend is particularly evident over northern Africa, southern Africa and western Mexico, where more than 90% of the models project a delay of the rainfall centroid from a few days up to 2Â weeks. Over the remaining monsoonal regions, there is little inter-model agreement in terms of centroid changes