Improving quality of mother-infant relationship and infant attachment in socioeconomically deprived community in South Africa: randomised controlled trial

Objective To assess the efficacy of an intervention designed to improve the mother-infant relationship and security of infant attachment in a South African peri-urban settlement with marked adverse socioeconomic circumstances. Design Randomised controlled trial. Setting Khayelitsha, a peri-urban settlement in South Africa. Participants 449 pregnant women. Interventions The intervention was delivered from late pregnancy and for six months postpartum. Women were visited in their homes by previously untrained lay community workers who provided support and guidance in parenting. The purpose of the intervention was to promote sensitive and responsive parenting and secure infant attachment to the mother. Women in the control group received no therapeutic input from the research team. Main outcome measures Primary outcomes: quality of mother-infant interactions at six and 12 months postpartum; infant attachment security at 18 months. Secondary outcome: maternal depression at six and 12 months. Results The intervention was associated with significant benefit to the mother-infant relationship. At both six and 12 months, compared with control mothers, mothers in the intervention group were significantly more sensitive (6 months: mean difference=0.77 (SD 0.37), t=2.10, P<0.05, d=0.24; 12 months: mean difference=0.42 (0.18), t=-2.04, P<0.05, d=0.26) and less intrusive (6 months: mean difference=0.68 (0.36), t=2.28, P<0.05, d=0.26; 12 months: mean difference=-1.76 (0.86), t=2.28, P<0.05, d=0.24) in their interactions with their infants. The intervention was also associated with a higher rate of secure infant attachments at 18 months (116/156 (74%) v 102/162 (63%); Wald=4.74, odds ratio=1.70, P<0.05). Although the prevalence of maternal depressive disorder was not significantly reduced, the intervention had a benefit in terms of maternal depressed mood at six months (z=2.05, P=0.04) on the Edinburgh postnatal depression scale). Conclusions The intervention, delivered by local lay women, had a significant positive impact on the quality of the mother-infant relationship and on security of infant attachment, factors known to predict favourable child development. If these effects persist, and if they are replicated, this intervention holds considerable promise for use in the developing world. Trial registration Current Controlled Trials ISRCTN25664149.

Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial

Objectives To evaluate the effectiveness of integrated motivational interviewing and cognitive behaviour therapy in addition to standard care for patients with psychosis and a co-morbid substance use problem. Design Two-centre, open, rater-blind randomised controlled trial Setting UK Secondary Care Participants 327 patients with clinical diagnoses of schizophrenia, schizophreniform or schizoaffective disorder and DSM-IV diagnoses of drug and/or alcohol dependence or abuse Interventions Participants were randomly allocated to integrated motivational interviewing and cognitive behaviour therapy or standard care. Therapy has two phases. Phase one – “motivation building” – concerns engaging the patient, then exploring and resolving ambivalence for change in substance use. Phase two –“Action” – supports and facilitates change using cognitive behavioural approaches. Up to 26 therapy sessions were delivered over one year. Main outcomes The primary outcome was death from any cause or admission to hospital in the 12 months after therapy. Secondary outcomes were frequency and amount of substance use (Timeline Followback), readiness to change, perceived negative consequences of use, psychotic symptom ratings, number and duration of relapses, global assessment of functioning and deliberate self harm, at 12 and 24 months, with additional Timeline Followback assessments at 6 and 18 months. Analysis was by intention-to-treat with robust treatment effect estimates. Results 327 participants were randomised. 326 (99.7%) were assessed on the primary outcome, 246 (75.2%) on main secondary outcomes at 24 months. Regarding the primary outcome, there was no beneficial treatment effect on hospital admissions/ death during follow-up, with 20.2% (33/163) of controls and 23.3% (38/163) of the therapy group deceased or admitted (adjusted odds-ratio 1.16; P= 0.579; 95% confidence interval 0.68 to 1.99). For secondary outcomes there was no treatment effect on frequency of substance use or perceived negative consequences, but a statistically significant effect of therapy on amount used per substance-using day (adjusted odds-ratios: (a) for main substance 1.50; P=0.016; 1.08 to 2.09, (b) all substances 1.48; P=0.017; 1.07 to 2.05). There was a statistically significant treatment effect on readiness to change use at 12 months (adjusted odds-ratio 2.05; P=0.004; 1.26 to 3.31), not maintained at 24 months. There were no treatment effects on assessed clinical outcomes. Conclusions Integrated motivational interviewing and cognitive behaviour therapy for people with psychosis and substance misuse does not improve outcome in terms of hospitalisation, symptom outcomes or functioning. It does result in a reduction in amount of substance use which is maintained over the year’s follow up. Trial registration Current Controlled Trials: ISRCTN14404480

A randomised controlled trial of positive memory training for the treatment of depression within schizophrenia

Abstract Background: Depression is highly prevalent within individuals diagnosed with schizophrenia, and is associated with an increased risk of suicide. There are no current evidence based treatments for low mood within this group. The specific targeting of co-morbid conditions within complex mental health problems lends itself to the development of short-term structured interventions which are relatively easy to disseminate within health services. A brief cognitive intervention based on a competitive memory theory of depression, is being evaluated in terms of its effectiveness in reducing depression within this group. Methods/Design: This is a single blind, intention-to-treat, multi-site, randomized controlled trial comparing Positive Memory Training plus Treatment as Usual with Treatment as Usual alone. Participants will be recruited from two NHS Trusts in Southern England. In order to be eligible, participants must have a DSM-V diagnosis of schizophrenia or schizo-affective disorder and exhibit at least a mild level of depression. Following baseline assessment eligible participants will be randomly allocated to either the Positive Memory Training plus Treatment as Usual group or the Treatment as Usual group. Outcome will be assessed at the end of treatment (3-months) and at 6-month and 9-month post randomization by assessors blind to group allocation. The primary outcome will be levels of depression and secondary outcomes will be severity of psychotic symptoms and cost-effectiveness. Semi-structured interviews will be conducted with all participants who are allocated to the treatment group so as to explore the acceptability of the intervention. Discussion: Cognitive behaviour therapy is recommended for individuals diagnosed with schizophrenia. However, the number of sessions and length of training required to deliver this intervention has caused a limit in availability. The current trial will evaluate a short-term structured protocol which targets a co-morbid condition often considered of primary importance by service users. If successful the intervention will be an important addition to current initiatives aimed at increasing access to psychological therapies for people diagnosed with severe mental health problems. Trial registration: Current Controlled Trials. ISRCTN99485756. Registered 13 March 2014.

Treatment of child anxiety in the context of maternal anxiety disorder: a randomised controlled trial and economic analysis

Background Cognitive–behavioural therapy (CBT) for childhood anxiety disorders is associated with modest outcomes in the context of parental anxiety disorder. Objectives This study evaluated whether or not the outcome of CBT for children with anxiety disorders in the context of maternal anxiety disorders is improved by the addition of (i) treatment of maternal anxiety disorders, or (ii) treatment focused on maternal responses. The incremental cost-effectiveness of the additional treatments was also evaluated. Design Participants were randomised to receive (i) child cognitive–behavioural therapy (CCBT); (ii) CCBT with CBT to target maternal anxiety disorders [CCBT + maternal cognitive–behavioural therapy (MCBT)]; or (iii) CCBT with an intervention to target mother–child interactions (MCIs) (CCBT + MCI). Setting A NHS university clinic in Berkshire, UK. Participants Two hundred and eleven children with a primary anxiety disorder, whose mothers also had an anxiety disorder. Interventions All families received eight sessions of individual CCBT. Mothers in the CCBT + MCBT arm also received eight sessions of CBT targeting their own anxiety disorders. Mothers in the MCI arm received 10 sessions targeting maternal parenting cognitions and behaviours. Non-specific interventions were delivered to balance groups for therapist contact. Main outcome measures Primary clinical outcomes were the child’s primary anxiety disorder status and degree of improvement at the end of treatment. Follow-up assessments were conducted at 6 and 12 months. Outcomes in the economic analyses were identified and measured using estimated quality-adjusted life-years (QALYs). QALYS were combined with treatment, health and social care costs and presented within an incremental cost–utility analysis framework with associated uncertainty. Results MCBT was associated with significant short-term improvement in maternal anxiety; however, after children had received CCBT, group differences were no longer apparent. CCBT + MCI was associated with a reduction in maternal overinvolvement and more confident expectations of the child. However, neither CCBT + MCBT nor CCBT + MCI conferred a significant post-treatment benefit over CCBT in terms of child anxiety disorder diagnoses [adjusted risk ratio (RR) 1.18, 95% confidence interval (CI) 0.87 to 1.62, p = 0.29; adjusted RR CCBT + MCI vs. control: adjusted RR 1.22, 95% CI 0.90 to 1.67, p = 0.20, respectively] or global improvement ratings (adjusted RR 1.25, 95% CI 1.00 to 1.59, p = 0.05; adjusted RR 1.20, 95% CI 0.95 to 1.53, p = 0.13). CCBT + MCI outperformed CCBT on some secondary outcome measures. Furthermore, primary economic analyses suggested that, at commonly accepted thresholds of cost-effectiveness, the probability that CCBT + MCI will be cost-effective in comparison with CCBT (plus non-specific interventions) is about 75%. Conclusions Good outcomes were achieved for children and their mothers across treatment conditions. There was no evidence of a benefit to child outcome of supplementing CCBT with either intervention focusing on maternal anxiety disorder or maternal cognitions and behaviours. However, supplementing CCBT with treatment that targeted maternal cognitions and behaviours represented a cost-effective use of resources, although the high percentage of missing data on some economic variables is a shortcoming. Future work should consider whether or not effects of the adjunct interventions are enhanced in particular contexts. The economic findings highlight the utility of considering the use of a broad range of services when evaluating interventions with this client group. Trial registration Current Controlled Trials ISRCTN19762288. Funding This trial was funded by the Medical Research Council (MRC) and Berkshire Healthcare Foundation Trust and managed by the National Institute for Health Research (NIHR) on behalf of the MRC–NIHR partnership (09/800/17) and will be published in full in Health Technology Assessment; Vol. 19, No. 38.

Efficiency in the loading of a sodium magneto-optical trap from alkali metal dispensers

We study the loading of sodium atoms into a magneto-optical trap from current-controlled sodium metal dispensers. Contrary to what was previously reported [V. Wippel, C. Binder, W. Huber, L Windholz, M. Allegrini, F. Fuso, E. Arimondo, Eur. Phys. J. D 17 (2001) 2851 we demonstrate a significantly higher number of trapped atoms that make Na dispensers a feasible source of atoms for cold-atom studies. The inherent rise in pressure that naturally arises from metal dispensers as they are heated to release atoms is partially controlled by placing the metal dispensers near the pumping port where an ion pump is connected. We also study the effects of placing the sodium dispensers at different distances from the main vacuum chamber where the atoms are trapped and the effectiveness of using a Zeeman slower to cool the atoms as they emerge from the dispensers. We observe trapping of up to 1.9 x 10(8) atoms, which is significantly higher by almost three orders of magnitude than previously reported experiments. (C) 2008 Elsevier B.V. All rights reserved.

Use of Photovoltaic on an E-bike? : A Feasibility Study

In recent years the number of bicycles with e-motors has been increased steadily. Within the pedelec – bikes where an e-motor supports the pedaling – a special group of transportation bikes has developed. These bikes have storage boxes in addition to the basic parts of a bike. Due to the space available on top of those boxes it is possible to install a PV system to generate electricity which could be used to recharge the battery of the pedelec. Such a system would lead to grid independent charging of the battery and to the possibility of an increased range of motor support. The feasibility of such a PV system is investigated for a three wheeled pedelec delivered by the company BABBOE NORDIC.The measured data of the electricity generation of this mobile system is compared to the possible electricity generation of a stationary system.To measure the consumption of the pedelec different tracks are covered, and the energy which is necessary to recharge the bike battery is measured using an energy logger. This recharge energy is used as an indirect measure of the electricity consumption. A PV prototype system is installed on the bike. It is a simple PV stand alone system consisting of PV panel, charge controller with MPP tracker and a solar battery. This system has the task to generate as much electricity as possible. The produced PV current and voltage aremeasured and documented using a data logger. Afterwards the average PV power is calculated. To compare the produced electricity of the on-bike system to that of a stationary system, the irradiance on the latter is measured simultaneously. Due to partial shadings on the on-bike PV panel, which are caused by the driver and some other bike parts, the average power output during riding the bike is very low. It is too low to support the motor directly. In case of a similar installation as the PV prototype system and the intention always to park the bike on a sunny spot an on-bike system could generate electricity to at least partly recharge a bike battery during one day. The stationary PV system using the same PV panel could have produced between 1.25 and 8.1 times as much as the on-bike PV system. Even though the investigation is done for a very specific case it can be concluded that anon-bike PV system, using similar components as in the investigation, is not feasible to recharge the battery of a pedelec in an appropriate manner. The biggest barrier is that partial shadings on the PV panel, which can be hardly avoided during operation and parking, result in a significant reduction of generated electricity. Also the installation of the on-bike PV system would lead to increased weight of the whole bike and the need for space which is reducing the storage capacity. To use solar energy for recharging a bike battery an indirect way is giving better results. In this case a stationary PV stand alone system is used which is located in a sunny spot without shadings and adjusted to use the maximum available solar energy. The battery of the bike is charged using the corresponding charger and an inverter which provides AC power using the captured solar energy.

A multicentre randomized controlled trial of an empowerment-inspired intervention for adolescents starting continuous subcutaneous insulin infusion : a study protocol

Background. Continuous subcutaneous insulin infusion (CSII) treatment among children with type 1 diabetes is increasing in Sweden. However, studies evaluating glycaemic control in children using CSII show inconsistent results. Omitting bolus insulin doses using CSII may cause reduced glycaemic control among adolescents. The distribution of responsibility for diabetes self-management between children and parents is often unclear and needs clarification. There is much published support for continued parental involvement and shared diabetes management during adolescence. Guided Self-Determination (GSD) is an empowerment-based, person-centred, reflection and problem solving method intended to guide the patient to become self-sufficient and develop life skills for managing difficulties in diabetes self-management. This method has been adapted for adolescents and parents as Guided Self-Determination-Young (GSD-Y). This study aims to evaluate the effect of an intervention with GSD-Y in groups of adolescents starting on insulin pumps and their parents on diabetes-related family conflicts, perceived health and quality of life (QoL), and metabolic control. Here, we describe the protocol and plans for study enrolment. Methods. This study is designed as a randomized, controlled, prospective, multicentre study. Eighty patients between 12-18 years of age who are planning to start CSII will be included. All adolescents and their parents will receive standard insulin pump training. The education intervention will be conducted when CSII is to be started and at four appointments in the first 4 months after starting CSII. The primary outcome is haemoglobin A1c levels. Secondary outcomes are perceived health and QoL, frequency of blood glucose self-monitoring and bolus doses, and usage of carbohydrate counting. The following instruments will be used to evaluate perceived health and QoL: Disabkids, 'Check your health', the Diabetes Family Conflict Scale and the Swedish Diabetes Empowerment Scale. Outcomes will be evaluated within and between groups by comparing data at baseline, and at 6 and 12 months after starting treatment. Results and discussion. In this study, we will assess the effect of starting an insulin pump together with the model of Guided Self-Determination to determine whether this approach leads to retention of improved glycaemic control, QoL, responsibility distribution and reduced diabetes-related conflicts in the family. Trial registration: Current controlled trials: ISRCTN22444034

Effect of facilitation of local maternal-and-newborn stakeholder groups on neonatal mortality : cluster-randomized controlled trial

BACKGROUND: Facilitation of local women's groups may reportedly reduce neonatal mortality. It is not known whether facilitation of groups composed of local health care staff and politicians can improve perinatal outcomes. We hypothesised that facilitation of local stakeholder groups would reduce neonatal mortality (primary outcome) and improve maternal, delivery, and newborn care indicators (secondary outcomes) in Quang Ninh province, Vietnam. METHODS AND FINDINGS: In a cluster-randomized design 44 communes were allocated to intervention and 46 to control. Laywomen facilitated monthly meetings during 3 years in groups composed of health care staff and key persons in the communes. A problem-solving approach was employed. Births and neonatal deaths were monitored, and interviews were performed in households of neonatal deaths and of randomly selected surviving infants. A latent period before effect is expected in this type of intervention, but this timeframe was not pre-specified. Neonatal mortality rate (NMR) from July 2008 to June 2011 was 16.5/1,000 (195 deaths per 11,818 live births) in the intervention communes and 18.4/1,000 (194 per 10,559 live births) in control communes (adjusted odds ratio [OR] 0.96 [95% CI 0.73-1.25]). There was a significant downward time trend of NMR in intervention communes (p = 0.003) but not in control communes (p = 0.184). No significant difference in NMR was observed during the first two years (July 2008 to June 2010) while the third year (July 2010 to June 2011) had significantly lower NMR in intervention arm: adjusted OR 0.51 (95% CI 0.30-0.89). Women in intervention communes more frequently attended antenatal care (adjusted OR 2.27 [95% CI 1.07-4.8]). CONCLUSIONS: A randomized facilitation intervention with local stakeholder groups composed of primary care staff and local politicians working for three years with a perinatal problem-solving approach resulted in increased attendance to antenatal care and reduced neonatal mortality after a latent period. TRIAL REGISTRATION: Current Controlled Trials ISRCTN44599712. Please see later in the article for the Editors' Summary.

Comparação do desempenho de duas bombas acopladas diretamente a geradores fotovoltaicos

No Brasil, assim como em outros países que recebem abundantes quantidades de radiação solar durante todo o ano, há um grande potencial para os sistemas que usam a tecnologia fotovoltaica para promover o bombeamento de água. Entretanto, a escolha dos conjuntos de motores e bombas mais adequados para cada situação passa pela análise do desempenho dos sistemas de bombeamento. Portanto, devem ser analisadas tanto as melhores configurações de geradores fotovoltaicos destinados a operar os conjuntos formados pelos motores e bombas, quanto às eficiências das bombas e da conversão fotovoltaica. Nesse trabalho são apresentadas medidas e comparações do desempenho de dois sistemas de bombeamento diretamente acoplados a geradores fotovoltaicos. Para tanto, foi construída uma bancada destinada a realizar uma série de experimentos. Um dos sistemas usou uma bomba centrífuga acoplada a um gerador fotovoltaico formado por três módulos fotovoltaicos. O outro, utilizou uma bomba volumétrica de diafragma acoplada a um único módulo fotovoltaico. Os experimentos foram conduzidos em duas etapas distintas. A primeira foi feita com os motores acoplados a uma fonte de potência em corrente contínua e serviu para a determinação das curvas de desempenho de cada uma das bombas, das curvas dos sistemas, assim como das curvas de corrente (I) e de tensão (V) de cada um dos motores que acionavam as bombas. A segunda foi realizada com os sistemas acoplados diretamente aos geradores fotovoltaicos. A determinação da configuração dos geradores fotovoltaicos destinados a acionar os diferentes sistemas de bombeamento em análise nesse trabalho foi feita por meio da sobreposição das curvas de corrente e tensão dos motores e dos módulos fotovoltaicos. A parte experimental, estando os sistemas acoplados aos geradores, constou de medidas realizadas em intervalos de tempo de cinco segundos, para cada bomba e em várias alturas, das seguintes variáveis: temperatura ambiente, irradiância, temperatura dos módulos, corrente e tensão do motor, rotação do motor, temperatura da água, diferencial de pressão entre entrada e saída da bomba e vazão. As diversas alturas foram simuladas por meio da abertura e/ou fechamento de uma válvula de controle de vazão colocada na extremidade tubulação de descarga, operada manualmente. Os procedimentos adotados nessa dissertação permitiram caracterizar os sistemas de bombeamento propostos, assim como determinar quais os arranjos mais adequados para operar cada sistema. Verificou-se que o melhor arranjo para operar o conjunto motor e bomba centrífuga foi aquele formado por três módulos fotovoltaicos ligados em paralelo, enquanto que a melhor opção para operar o conjunto motor e bomba de diafragma foi com somente um módulo fotovoltaico. De posse dos dados medidos foi possível determinar as eficiências: instantâneas, máximas instantâneas e diárias da conversão fotovoltaica assim como dos conjuntos motores e bombas, em diferentes alturas. Relativamente à conversão fotovoltaica, verificou-se que o conjunto motor e bomba centrífuga operou com eficiência instantânea máxima de 5,74% e eficiência diária de 4,70%, enquanto que o conjunto motor e bomba volumétrica de diafragma operou com eficiência instantânea máxima de 7,66% e eficiência diária de 5,82%. Relativamente à eficiência dos conjuntos motores e bombas, verificou-se que o conjunto motor e bomba centrífuga operou com eficiência instantânea máxima de 19,19% e eficiência diária de 16,79%, enquanto que o conjunto motor e bomba volumétrica de diafragma operou com eficiência instantânea máxima de 38,88% e eficiência diária de 34,30%. Verificou-se ainda que a altura foi determinante na eficiência do conjunto motor e bomba centrífuga e pouco influenciou na eficiência do conjunto motor e bomba de diafragma. Além dessas, outras considerações sobre o comportamento dos sistemas de bombeamento ao longo de um dia também foram ser registrados, tais como: limiares de irradiância para início e final de vazão, correntes de pico ou de arranque dos motores e correntes de início de vazão ou escoamento.

Fabrication of novel light-emitting devices based on green-phosphor/conductive-polymer composites

We report on light-emitting devices based on a green-phosphor compound (Mn-doped zinc silicate, Zn2SiO4: Mn) dispersed in a conductive polymeric blend (poly-o-methoxyaniline/polyvinylene fluoride, POMA/PVDF-TrFE). The devices exhibited high luminance in the green, good stability and homogeneous brilliance over effective areas up to 5 cm(2). The electroluminescence (EL) spectrum presented essentially the same characteristics as the photoluminescence (PL) and cathodoluminescence spectra, indicating that the light emission originates from decay of the same excited species, regardless of the excitation source. Operating characteristics were analyzed with current density - voltage (J - V) and luminance voltage ( L - V) curves to investigate the nature of the electroluminescence of the active material, which is still not completely understood.

The effect of TiO(2) on the microstructural and electrical properties of low voltage varistor based on (Sn,Ti)O(2) ceramics

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Harmonic content identification based on neural method for single phase power systems

An alternative method is presented in this paper to identify the harmonic components of non-linear loads in single phase power systems based on artificial neural networks. The components are identified by analyzing the single phase current waveform in time domain in half-cycle of the ac voltage source. The proposed method is compared to the fast Fourier transform. Simulation and experimental results are presented to validate the proposed approach.

Bandgap voltage reference with low susceptibility to electromagnetic interference (EMI)

In this paper, the susceptibility of a current-mode bandgap voltage reference to electromagnetic interference (EMI) superimposed to the power supply is investigated by simulation. Designed for AMS 0.35 CMOS process, the circuit provides a stable voltage reference in the temperature range of -40-150°C. When EMI disturbances are present, the circuit exhibits only 6.7 mV of offset for interfering signals in the frequency range of 150 kHz-1 GHz. © 2011 ACM.

Projeto de um oscilador controlado por corrente com configuração em anel, tecnologia CMOS e melhoria no ruído de fase

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Desempenho de um algoritmo backward-forward sweep de cálculo de fluxo de potência

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)