Developing a scalable training model in global mental health: pilot study of a video-assisted training Program for Generalist Clinicians in Rural Nepal.

BackgroundIn low- and middle-income countries, mental health training often includes sending few generalist clinicians to specialist-led programs for several weeks. Our objective is to develop and test a video-assisted training model addressing the shortcomings of traditional programs that affect scalability: failing to train all clinicians, disrupting clinical services, and depending on specialists.MethodsWe implemented the program -video lectures and on-site skills training- for all clinicians at a rural Nepali hospital. We used Wilcoxon signed-rank tests to evaluate pre- and post-test change in knowledge (diagnostic criteria, differential diagnosis, and appropriate treatment). We used a series of 'Yes' or 'No' questions to assess attitudes about mental illness, and utilized exact McNemar's test to analyze the proportions of participants who held a specific belief before and after the training. We assessed acceptability and feasibility through key informant interviews and structured feedback.ResultsFor each topic except depression, there was a statistically significant increase (Δ) in median scores on knowledge questionnaires: Acute Stress Reaction (Δ = 20, p = 0.03), Depression (Δ = 11, p = 0.12), Grief (Δ = 40, p < 0.01), Psychosis (Δ = 22, p = 0.01), and post-traumatic stress disorder (Δ = 20, p = 0.01). The training received high ratings; key informants shared examples and views about the training's positive impact and complementary nature of the program's components.ConclusionVideo lectures and on-site skills training can address the limitations of a conventional training model while being acceptable, feasible, and impactful toward improving knowledge and attitudes of the participants

Measurement of Two-Photon Exchange Effect by Comparing Elastic e ± p Cross Sections

Background: The electromagnetic form factors of the proton measured by unpolarized and polarized electron scattering experiments show a significant disagreement that grows with the squared four-momentum transfer (Q2) . Calculations have shown that the two measurements can be largely reconciled by accounting for the contributions of two-photon exchange (TPE). TPE effects are not typically included in the standard set of radiative corrections since theoretical calculations of the TPE effects are highly model dependent, and, until recently, no direct evidence of significant TPE effects has been observed. Purpose: We measured the ratio of positron-proton to electron-proton elastic-scattering cross sections in order to determine the TPE contribution to elastic electron-proton scattering and thereby resolve the proton electric form factor discrepancy. Methods: We produced a mixed simultaneous electron-positron beam in Jefferson Lab\u27s Hall B by passing the 5.6-GeV primary electron beam through a radiator to produce a bremsstrahlung photon beam and then passing the photon beam through a convertor to produce electron-positron pairs. The mixed electron-positron (lepton) beam with useful energies from approximately 0.85 to 3.5 GeV then struck a 30-cm-long liquid hydrogen (LH2) target located within the CEBAF Large Acceptance Spectrometer (CLAS). By detecting both the scattered leptons and the recoiling protons, we identified and reconstructed elastic scattering events and determined the incident lepton energy. A detailed description of the experiment is presented. Results: We present previously unpublished results for the quantity R2γ , the TPE correction to the elastic-scattering cross section, at Q2 ≈ 0.85 and 1.45 GeV2 over a large range of virtual photon polarization ɛ . Conclusions: Our results, along with recently published results from VEPP-3, demonstrate a nonzero contribution from TPE effects and are in excellent agreement with the calculations that include TPE effects and largely reconcile the form-factor discrepancy up to Q2 ≈ 2 GeV2 . These data are consistent with an increase in R2γ with decreasing ɛ at Q2 ≈ 0.85 and 1.45 GeV2 . There are indications of a slight increase in R2γ with Q2

How Accessible Was Information about H1N1 Flu? Literacy Assessments of CDC Guidance Documents for Different Audiences

We assessed the literacy level and readability of online communications about H1N1/09 influenza issued by the Centers for Disease Control and Prevention (CDC) during the first month of outbreak. Documents were classified as targeting one of six audiences ranging in technical expertise. Flesch-Kincaid (FK) measure assessed literacy level for each group of documents. ANOVA models tested for differences in FK scores across target audiences and over time. Readability was assessed for documents targeting non-technical audiences using the Suitability Assessment of Materials (SAM). Overall, there was a main-effect by audience, F(5, 82) = 29.72, P<.001, but FK scores did not vary over time, F(2, 82) = .34, P>.05. A time-by-audience interaction was significant, F(10, 82) = 2.11, P<.05. Documents targeting non-technical audiences were found to be text-heavy and densely-formatted. The vocabulary and writing style were found to adequately reflect audience needs. The reading level of CDC guidance documents about H1N1/09 influenza varied appropriately according to the intended audience; sub-optimal formatting and layout may have rendered some text difficult to comprehend

Enhancing Federated Cloud Management with an Integrated Service Monitoring Approach

Cloud Computing enables the construction and the provisioning of virtualized service-based applications in a simple and cost effective outsourcing to dynamic service environments. Cloud Federations envisage a distributed, heterogeneous environment consisting of various cloud infrastructures by aggregating different IaaS provider capabilities coming from both the commercial and the academic area. In this paper, we introduce a federated cloud management solution that operates the federation through utilizing cloud-brokers for various IaaS providers. In order to enable an enhanced provider selection and inter-cloud service executions, an integrated monitoring approach is proposed which is capable of measuring the availability and reliability of the provisioned services in different providers. To this end, a minimal metric monitoring service has been designed and used together with a service monitoring solution to measure cloud performance. The transparent and cost effective operation on commercial clouds and the capability to simultaneously monitor both private and public clouds were the major design goals of this integrated cloud monitoring approach. Finally, the evaluation of our proposed solution is presented on different private IaaS systems participating in federations. © 2013 Springer Science+Business Media Dordrecht

Cross sections for the γp→K*+Λ and γp→K*+Σ0 reactions measured at CLAS

The first high-statistics cross sections for the reactions γp→K*+Λ and γp→K*+Σ0 were measured using the CLAS detector at photon energies between threshold and 3.9 GeV at the Thomas Jefferson National Accelerator Facility. Differential cross sections are presented over the full range of the center-of-mass angles, and then fitted to Legendre polynomials to extract the total cross section. Results for the K*+Λ final state are compared with two different calculations in an isobar and a Regge model, respectively. Theoretical calculations significantly underestimate the K*+Λ total cross sections between 2.1 and 2.6 GeV, but are in better agreement with present data at higher photon energies

A comparison of forward and backward pp pair knockout in 3He(e,e'pp)n

Measuring nucleon-nucleon Short Range Correlations (SRC) has been a goal of the nuclear physics community for many years. They are an important part of the nuclear wavefunction, accounting for almost all of the high-momentum strength. They are closely related to the EMC effect. While their overall probability has been measured, measuring their momentum distributions is more difficult. In order to determine the best configuration for studying SRC momentum distributions, we measured the $^3$He$(e,e'pp)n$ reaction, looking at events with high momentum protons ($p_p > 0.35$ GeV/c) and a low momentum neutron ($p_n< 0.2$ GeV/c). We examined two angular configurations: either both protons emitted forward or one proton emitted forward and one backward (with respect to the momentum transfer, $\vec q$). The measured relative momentum distribution of the events with one forward and one backward proton was much closer to the calculated initial-state $pp$ relative momentum distribution, indicating that this is the preferred configuration for measuring SRC.Comment: 8 pages, 9 figures, submitted to Phys Rev C. Version 2 incorporates minor corrections in response to referee comment

Measurement of the neutron F2 structure function via spectator tagging with CLAS

We report on the first measurement of the F2 structure function of the neutron from semi-inclusive scattering of electrons from deuterium, with low-momentum protons detected in the backward hemisphere. Restricting the momentum of the spectator protons to < 100 MeV and their angles to < 100 degrees relative to the momentum transfer allows an interpretation of the process in terms of scattering from nearly on-shell neutrons. The F2n data collected cover the nucleon resonance and deep-inelastic regions over a wide range of Bjorken x for 0.65 < Q2 < 4.52 GeV2, with uncertainties from nuclear corrections estimated to be less than a few percent. These measurements provide the first determination of the neutron to proton structure function ratio F2n/F2p at 0.2 < x < 0.8 with little uncertainty due to nuclear effects.Comment: 6 pages, 3 page

Precision measurements of g1g_1 of the proton and the deuteron with 6 GeV electrons

The inclusive polarized structure functions of the proton and deuteron, g1p and g1d, were measured with high statistical precision using polarized 6 GeV electrons incident on a polarized ammonia target in Hall B at Jefferson Laboratory. Electrons scattered at lab angles between 18 and 45 degrees were detected using the CEBAF Large Acceptance Spectrometer (CLAS). For the usual DIS kinematics, Q^2>1 GeV^2 and the final-state invariant mass W>2 GeV, the ratio of polarized to unpolarized structure functions g1/F1 is found to be nearly independent of Q^2 at fixed x. Significant resonant structure is apparent at values of W up to 2.3 GeV. In the framework of perturbative QCD, the high-W results can be used to better constrain the polarization of quarks and gluons in the nucleon, as well as high-twist contributions