Reciprocity in global mental health policy

In an attempt to address inequalities and inequities in mental health provision in low and middle-income countries the WHO commenced the Mental Health Gap Action Programme (mhGAP) in 2008. Four years on from the commencement of this programme of work, the WHO has recently adopted the Comprehensive Mental Health Action Plan 2013-2020. This article will critically appraise the strategic direction that the WHO has adopted to address mental health difficulties across the globe. This will include a consideration of the role that the biomedical model of mental health difficulties has had on global strategy. Concerns will be raised that an over-reliance on scaling up medical resources has led to a strengthening of psychiatric hospital-based care, and insufficient emphasis being placed on social and cultural determinants of human distress. We also argue that consensus scientific opinion garnered from consortia of psychiatric ‘experts’ drawn mainly from Europe and North America may not have universal relevance or applicability, and may have served to silence and subjugate local experience and expertise across the globe. In light of the criticisms that have been made of the research that has been conducted into understanding mental health problems in the global south, the article also explores ways in which the evidence-base can be made more relevant and more valid. An important issue that will be highlighted is the apparent lack of reciprocity that exists in the impetus for change in how mental health problems are understood and addressed in low and middle-income countries compared to high-income countries. Whereas there is much focus on the need for change in low and middle-income countries, there is comparatively little critical reflection on practices in high-income countries in the global mental health discourse. We advocate for the development of mental health services that are sensitive to the socio-cultural context in which the services are applied. Despite the appeal of global strategies to promote mental health, it may be that very local solutions are required. The article concludes with some reflections on the strategic objectives identified in the Comprehensive Mental Health Action Plan 2013-2020 and how this work can be progressed in the future

Reciprocity in global mental health policy

In an attempt to address inequalities and inequities in mental health provision in low and middle-income countries the WHO commenced the Mental Health Gap Action Programme (mhGAP) in 2008. Four years on from the commencement of this programme of work, the WHO has recently adopted the Comprehensive Mental Health Action Plan 2013-2020. This article will critically appraise the strategic direction that the WHO has adopted to address mental health difficulties across the globe. This will include a consideration of the role that the biomedical model of mental health difficulties has had on global strategy. Concerns will be raised that an over-reliance on scaling up medical resources has led to a strengthening of psychiatric hospital-based care, and insufficient emphasis being placed on social and cultural determinants of human distress. We also argue that consensus scientific opinion garnered from consortia of psychiatric ‘experts’ drawn mainly from Europe and North America may not have universal relevance or applicability, and may have served to silence and subjugate local experience and expertise across the globe. In light of the criticisms that have been made of the research that has been conducted into understanding mental health problems in the global south, the article also explores ways in which the evidence-base can be made more relevant and more valid. An important issue that will be highlighted is the apparent lack of reciprocity that exists in the impetus for change in how mental health problems are understood and addressed in low and middle-income countries compared to high-income countries. Whereas there is much focus on the need for change in low and middle-income countries, there is comparatively little critical reflection on practices in high-income countries in the global mental health discourse. We advocate for the development of mental health services that are sensitive to the socio-cultural context in which the services are applied. Despite the appeal of global strategies to promote mental health, it may be that very local solutions are required. The article concludes with some reflections on the strategic objectives identified in the Comprehensive Mental Health Action Plan 2013-2020 and how this work can be progressed in the future

Dietary intakes in adult patients with cystic fibrosis–do they achieve guidelines?

AbstractBackground: Most patients with cystic fibrosis (CF) require a higher energy and protein intake than their healthy peer group. There are few data on dietary intakes of adult patients. The aim of this study was to determine nutritional intakes in an adult population with CF. The impact of nutritional intervention and disease on macronutrient intake was examined. Methods: Retrospective cross-sectional analysis of 94 unweighed food diaries at annual review (1995–2000). Energy and protein intakes were compared to the estimated average requirement (EAR) for energy and reference nutrient intake (RNI) for protein. The effect of diet alone, oral supplements, enteral tube feeding, and cystic fibrosis related diabetes (CFRD), on macronutrient intake was examined and impact of pancreatic sufficency (PS) and lung transplantation. Results: Mean energy and protein intakes approached recommended CF guidelines, but in 72% of assessments these values were not achieved. Mean energy and protein intakes for patients on diet alone and protein intake for those with CFRD failed to meet recommendations. Oral supplementation and enteral tube feeding regimens increased energy and protein intake above recommended levels. No group achieved 40% total energy from fat. Patients receiving enteral tube feeds had the highest mean energy and protein intakes but lowest body mass index (BMI) and lung function. Conclusion: Adequate mean energy and protein intakes in adult patients with CF mask subgroups of patients who fail to meet recommendations ie. diet alone, diabetic. Oral supplementation and enteral tube feeding increase energy and protein intake but fail to achieve an adequate BMI level in subjects with a decreased clinical status. Individual nutritional assessment remains essential

Dimerization and Incommensurate Spiral Spin Correlations in the Zigzag Spin Chain: Analogies to the Kondo Lattice

Using the density matrix renormalization group and a bosonization approach, we study a spin-1/2 antiferromagnetic Heisenberg chain with near-neighbor coupling $J_1$ and frustrating second-neighbor coupling $J_2$, particularly in the limit $J_2 >> J_1$. This system exhibits both dimerization and incommensurate spiral spin correlations. We argue that this system is closely related to a doped, spin-gapped phase of the one-dimensional Kondo lattice.Comment: 18 pages, with 13 embedded encapsulated Postscript figures, uses epsf.sty. Corrects a misstatement about the pitch angle, and contains additional reference

Fixing the conformal window in QCD

A physical characterization of Landau singularities is emphasized, which should trace the lower boundary N_f^* of the conformal window in QCD and supersymmetric QCD. A natural way to disentangle ``perturbative'' from ``non-perturbative'' contributions to amplitudes below N_f^* is suggested. Assuming an infrared fixed point persists in the perturbative part of the QCD coupling even below N_f^* leads to the condition \gamma(N_f^*)=1, where \gamma is the critical exponent. Using the Banks-Zaks expansion, one gets 4<N_f^*<6. This result is incompatible with the existence of an analogue of Seiberg duality in QCD. The presence of a negative ultraviolet fixed point is required both in QCD and in supersymmetric QCD to preserve causality within the conformal window. Evidence for the existence of such a fixed point in QCD is provided.Comment: 10 pages, 1 figure, extended version of a talk given at the QCDNET2000 meeting, Paris, September 11-14 2000; main new material added is evidence for negative ultraviolet fixed point in QC

High Speed Visible Light Communication Using Blue GaN Laser Diodes

GaN-based laser diodes have been developed over the last 20 years making them desirable for many security and defence applications, in particular, free space laser communications. Unlike their LED counterparts, laser diodes are not limited by their carrier lifetime which makes them attractive for high speed communication, whether in free space, through fiber or underwater. Gigabit data transmission can be achieved in free space by modulating the visible light from the laser with a pseudo-random bit sequence (PRBS), with recent results approaching 5 Gbit/s error free data transmission. By exploiting the low-loss in the blue part of the spectrum through water, data transmission experiments have also been conducted to show rates of 2.5 Gbit/s underwater. Different water types have been tested to monitor the effect of scattering and to see how this affects the overall transmission rate and distance. This is of great interest for communication with unmanned underwater vehicles (UUV) as the current method using acoustics is much slower and vulnerable to interception. These types of laser diodes can typically reach 50-100 mW of power which increases the length at which the data can be transmitted. This distance could be further improved by making use of high power laser arrays. Highly uniform GaN substrates with low defectivity allow individually addressable laser bars to be fabricated. This could ultimately increase optical power levels to 4 W for a 20-emitter array. Overall, the development of GaN laser diodes will play an important part in free space optical communications and will be vital in the advancement of security and defence applications