Digital psychiatry in low-and-middle-income countries:New developments and the way forward

Low-and middle-income countries(LMICs)bear the greater share of the global mental health burden but are ill-equipped to deal with it because of severe resource constraints leading to a large treatment gap.The remote provision of mental health services by digital means can effectively augment conventional services in LMICs to reduce the treatment gap.Digital psychiatry in LMICs has always lagged behind high-income countries,but there have been encouraging developments in the last decade.There is increasing research on the efficacy of digital psychiatric interventions.However,the evidence is not adequate to conclude that digital psychiatric interventions are invariably effective in LMICs.A striking development has been the rise in mobile and smartphone ownership in LMICs,which has driven the increasing use of mobile technologies to deliver mental health services.An innovative use of mobile technologies has been to optimize task-shifting,which involves delivering mental healthcare services in community settings using non-specialist health professionals.Emerging evidence from LMICs shows that it is possible to use digital tools to train non-specialist workers effectively and ensure that the psychosocial interventions they deliver are efficacious.Despite these promising developments,many barriers such as service costs,underdeveloped infrastructure,lack of trained professionals,and significant disparities in access to digital services impede the progress of digital psychiatry in LMICs.To overcome these barriers,digital psychiatric services in LMICs should address contextual factors influencing the delivery of digital services,ensure collaboration between different stakeholders,and focus on reducing the digital divide.

Breast cancer awareness in reproductive women in the low-and middle-income countries:a scoping review

Objective:This study aimed to assess breast cancer(BC)awareness among reproductive women in low-and middle-income countries(LMICs),identify influencing factors,and propose feasible interventions or programs.Methods:We followed a 5-step process using a modified version of Arksey and O’Malley framework methodology.A comprehensive search was conducted on the Embase,PubMed,and CINAHL electronic databases for literature published within 10 years(from 2012 to 2022).Results:Thirty-three papers published between 2012 and 2020,spanning 18 countries,were included.Of these,45.6%described a good level of knowledge,while 24.2%reported that women at reproductive ages had good awareness.Twelve influencing factors were identified in 3 categories:socio-demographic(family history,personal history,marital status,age,religion,income status,living place,and occupation),personal(self-efficacy,education,and perceived level),and external(advertisements promoting awareness).Educational programs were recommended in most(>72%)of the included studies.Conclusions:While most studies reported high levels of knowledge and awareness,some found low prevalence among certain groups.Factors affecting knowledge and awareness were classified into socio-demographic,personal,and external categories,with socio-demographic factors such as age,education,income,and marital status being the most frequently cited.The studies recommended implementing educational programs,health prevention strategies,and social interventions to increase BC knowledge and awareness.

PAD Class教学模式对英语专业学生写作焦虑影响的实证研究

本研究以英语专业大一120名学生为实验对象,进行了为期16周的实证研究,以探讨PAD class教学模式对英语专业学生写作焦虑的影响。基于《二语写作焦虑量表》调查问卷结果表明:英语专业学生总体焦虑处于中等焦虑水平,PAD Class能有效降低学生的写作总体焦虑,其中课堂焦虑、构思焦虑、自信焦虑明显降低,但回避焦虑没有达到显著水平;PAD Class模式对高中低不同写作水平学生的写作焦虑都有影响,对中、低水平学生的写作焦虑缓解比对高水平学生的影响效果更明显。

Can Social Support be Protective against Depressive Symptoms in Adolescents from 24 Low- and Middle-Income Countries?

Background:Adolescents are highly vulnerable to depressive symptoms worldwide partially because of limited social supports.However,it still remains largely unknown regarding the associations between social support(s)and depressive symptoms among adolescents living in low-and middle-income countries(LMICs).The aim of this study aimed to explore the associations between different types of social support and depressive symptoms in adolescents from LMICs.Methods:Data were retrieved from the Global School-based Health Survey(GSHS)in which 92,551 adolescents(50.6%females)were included with mean of 15.6 years.Depressive symptoms in the past one month as the dependent variable were measured in combination with social support(was measured by“During the past 30 days,how often were most of the students in your school kind and helpful?”).Multivariable logistic regression and meta-analysis of country-wise estimates were performed to investigate the associations between social support and depressive symptoms,and the heterogeneity of the associations across the countries,respectively.Results:The prevalence of depressive symptoms was 30.9%of adolescents from LMICs.Peer support and parental connectedness were two major factors that were significantly associated with depression symptoms in adolescents.However,the associations of peer support and parental connectedness with depressive symptoms were significant in males and females,respectively.The country-wise analysis indicated that varied inconsistency(small to large)across the associations of peer support and parental connectedness with depressive symptoms in adolescents.Conclusion:Results in this study provides multi-national evidence of the protective roles of social support against depressive symptoms among adolescents.However,the association between social support and depression symptoms may be moderated by sex and types of social support.Although we found that social sup-port may be an important protective factor against depressive symptoms in adolescents from LMICs,specifically designed interventions should be implemented based on sex difference and country difference.

Hybrid treatment of varied orthodontic appliances for a patient with skeletal class II and temporomandibular joint disorders:A case report and review of literature

BACKGROUND The relation between orthodontic treatment and temporomandibular disorders(TMDs)is under debate;the management of TMD during orthodontic treatment has always been a challenge.If TMD symptoms occur during orthodontic treatment,an immediate pause of orthodontic adjustments is recommended;the treatment can resume when the symptoms are managed and stabilized.CASE SUMMARY This case report presents a patient(26-year-old,female)with angle class I,skeletal class II and TMDs.The treatment was a hybrid of clear aligners,fixed appliances and temporary anchorage devices(TADs).After 3 mo resting and treatment on her TMD,the patient’s TMD symptom alleviated,but her anterior occlusion displayed deep overbite.Therefore,the fixed appliances with TAD were used to correct the anterior deep-bite and level maxillary and mandibular deep curves.After the levelling,the patient showed dual bite with centric relation and maximum intercuspation discrepancy on her occlusion.After careful examination of temporomandibular joints(TMJ)position,the stable bite splint and Invisible Mandibular Advancement appliance were used to reconstruct her occlusion.Eventually,the improved facial appearance and relatively stable occlusion were achieved.The 1-year follow-up records showed there was no obvious change in TMJ morphology,and her occlusion was stable.CONCLUSION TMD screening and monitoring is of great clinical importance in the TMD susceptible patients.Hybrid treatment with clear aligners and fixed appliances and TADs is an effective treatment modality for the complex cases.

Extensive numerical simulations on competitive growth between the Edwards–Wilkinson and Kardar–Parisi–Zhang universality classes

Extensive numerical simulations and scaling analysis are performed to investigate competitive growth between the linear and nonlinear stochastic dynamic growth systems, which belong to the Edwards–Wilkinson(EW) and Kardar–Parisi–Zhang(KPZ) universality classes, respectively. The linear growth systems include the EW equation and the model of random deposition with surface relaxation(RDSR), the nonlinear growth systems involve the KPZ equation and typical discrete models including ballistic deposition(BD), etching, and restricted solid on solid(RSOS). The scaling exponents are obtained in both the(1 + 1)-and(2 + 1)-dimensional competitive growth with the nonlinear growth probability p and the linear proportion 1-p. Our results show that, when p changes from 0 to 1, there exist non-trivial crossover effects from EW to KPZ universality classes based on different competitive growth rules. Furthermore, the growth rate and the porosity are also estimated within various linear and nonlinear growths of cooperation and competition.

World Class Elite Breaststrokers Downward Kick EMG Muscle Activity of the Gluteus Maximus, Quadriceps Femoris, Hamstring, Gastrocnemius Medialis, Rectus Abdominal, and Erector Spinae

This study analyzed the difference between using a downward breaststroke kick and a horizontal breaststroke kick in a sample of world class elite swimmers.We compared average muscle activity of the gluteus maximus,quadriceps femoris(vastus medialis and rectus femoris),hamstring/long head of the biceps femoris,gastrocnemius medialis,rectus abdominal,and erector spinae when using the downward breaststroke kick technique.We find that when this sample of swimmers utilized the downward breaststroke kick,max speed and velocity per stroke increased,measured by 12,788 EMG samples,where the results are highly correlated to duration of the aerodynamic buoyant force in breaststroke kick technique.The increases in performance observed from measuring the world class elite swimmers is highly correlated to the duration of the kick aerodynamic buoyant force.Among this sample of elite swimmers,the longer a swimmer demonstrates a buoyant force breaststroke kick,the lower the time in a 100 breaststroke.

The Integration Strategy of Class Teacher Management and Mathematics Teaching

The professional and moral education of high school mathematics teachers will make classroom management work better,but their work pressure will also lead to classroom management problems.To do a good job in high school class teacher management and organically integrate it with mathematics teaching,we need to start from two aspects:mathematics teaching class teachers and class teacher work teaching,and penetrate mathematical thinking into daily classroom management,moral education,and classroom culture construction.Based on the attributes of the subject,we guide high school students to reflect after class to stimulate their self-management initiative through the cultivation of qualified class representatives.In addition,it is necessary to skillfully resolve classroom generative problems,change the roles of teachers and students,and integrate classroom management with mathematics teaching.

基于CLASS促进幼儿教师提升师幼互动能力的策略

师幼互动是学前教育课程实施的主要过程,也是学前儿童在幼儿园一日活动中的生活体验、学习体验和情感体验的重要载体。师幼互动的质量对学前教育的质量起决定性作用。CLASS(课堂评价评分系统)不仅可以用来评价课堂师幼互动的质量,还可以用于提升教师师幼互动的能力。基于CLASS,文章提出了一系列提升教师师幼互动能力的相关策略。

Least Squares One-Class Support Tensor Machine

One-class classification problem has become a popular problem in many fields, with a wide range of applications in anomaly detection, fault diagnosis, and face recognition. We investigate the one-class classification problem for second-order tensor data. Traditional vector-based one-class classification methods such as one-class support vector machine (OCSVM) and least squares one-class support vector machine (LSOCSVM) have limitations when tensor is used as input data, so we propose a new tensor one-class classification method, LSOCSTM, which directly uses tensor as input data. On one hand, using tensor as input data not only enables to classify tensor data, but also for vector data, classifying it after high dimensionalizing it into tensor still improves the classification accuracy and overcomes the over-fitting problem. On the other hand, different from one-class support tensor machine (OCSTM), we use squared loss instead of the original loss function so that we solve a series of linear equations instead of quadratic programming problems. Therefore, we use the distance to the hyperplane as a metric for classification, and the proposed method is more accurate and faster compared to existing methods. The experimental results show the high efficiency of the proposed method compared with several state-of-the-art methods.

教师特征对托班师幼互动质量的影响——基于CLASS Toddler的实证研究

构建“数量”和“质量”双重保障的托育服务体系是解决“托育难”“幼无所托”等民生难题以及实现人口发展战略重要配套措施。师幼互动是托育服务质量的核心指标,影响婴幼儿身心发展的多个方面。托班师幼互动质量水平不高,尤其不能提供适宜的学习支持,而教师学历是影响师幼互动质量的重要因素。因此,需要提高托班教师“学历”门槛,建立职前职后“师幼互动”一体化培训体系,重视师幼互动质量的评估,切实提高教师师幼互动能力。

幼儿园体育活动中师幼互动质量分析及策略研究——基于ClASS课堂互动评估系统的观察分析

本研究以ClASS课堂互动评估系统为测量工具,对M市6所幼儿园的31个体育集体教学活动视频进行反复观察,以“情感支持”“班级管理”“教育支持”三个维度为切入点,对案例中的师幼互动质量进行评分和分析,揭示当前幼儿园体育活动中师幼互动水平。研究结果显示,幼儿园体育活动中师幼互动质量整体上处于中上水平;师幼互动各维度间存在相关性、交融性;不同组织形式的体育活动师幼互动质量存在显著差异。在此基础上,提出相关建议院关注情感支持,构建平等亲密的师幼关系;优化教育行为,营造良好的体育活动生态;重视教育支持,促进幼儿高阶思维发展。

Environmental health perspectives for low- and middle-income countries

In recent decades, the ecological environment has been increasingly challenged by the development of global industrialization and urbanization all over the world, even as global attention for health has raised dramatically. Common global environmental issues, such as air pollution and noise pollution, are associated with lasting impacts on health and contribute significantly to the overall burden of disease. Moreover, a global disparity exists between the burden of such environmental health issues and the global resources available to address this issue. To alleviate the environmental health impacts and ensure a sustainable future for human beings, China has made an important contribution to improving access to ecological protection, environmental governance, patriotic health campaigns, smart city construction, and so on. Experiences gained in China may be useful for some other countries, particularly the low- and middle-income countries with limited sources.

Hospitals’responsibility in response to the threat of infectious disease outbreak in the context of the coronavirus disease 2019(COVID-19)pandemic:implications for low-and middle-income countries

The WHO declared the coronavirus disease 2019(COVID-19)outbreak as a public health emergency of international concern on January 30,2020,and then a pandemic on March 11,2020.COVID-19 affected over 200 countries and territories worldwide,with 25,541,380 confirmed cases and 852,000 deaths associated with COVID-19 globally,as of September 1,2020.1 While facing such a public health emergency,hospitals were on the front line to deliver health care and psychological services.The early detection,diagnosis,reporting,isolation,and clinical management of patients during a public health emergency required the extensive involvement of hospitals in all aspects.The response capacity of hospitals directly determined the outcomes of the prevention and control of an outbreak.The COVID-19 pandemic has affected almost all nations and territories regardless of their development level or geographic location,although suitable risk mitigation measures differ between developing and developed countries.In low-and middle-income countries(LMICs),the consequences of the pandemic could be more complicated because incidence and mortality might be associated more with a fragile health care system and shortage of related resources.2-3 As evidenced by the situation in Bangladesh,India,Kenya,South Africa,and other LMICs,socioeconomic status(SES)disparity was a major factor in the spread of disease,potentially leading to alarmingly insufficient preparedness and responses in dealing with the COVID-19 pandemic.4 Conversely,the pandemic might also bring more unpredictable socioeconomic and long-term impacts in LMICs,and those with lower SES fare worse in these situations.This review aimed to summarize the responsibilities of and measures taken by hospitals in combatting the COVID-19 outbreak.Our findings are hoped to provide experiences,as well as lessons and potential implications for LMICs.

小学低学段语文优质课堂师生互动特征研究--基于CLASS 课堂评价打分系统的分析

采用美国弗吉尼亚大学研究团队开发的课堂评价打分系统(CLASS),围绕情感支持、课堂组织、教学支持三个领域及下设的十个维度,对20节小学低学段语文优质课堂的师生互动状况进行深度观察,探索优质课堂环境下师生互动的整体水平及各维度之间的相互关系,并综合量化数据和质性分析得出研究结论。研究发现,小学低学段语文优质课堂在情感支持方面,能较好地激发教师的职业热情,并培养学生自主自立的精神与能力;在课堂组织方面,能以课堂实效为目标,创设高品质的教学活动;在教学支持方面,能营造安全的思维环境,促进师生深度互动。

Infl uence of altitude and tree class on climate-growth relationships in a larch plantation in subtropical China

Precise quantifi cation of climate-growth relationships can make a major contribution to scientifi c forest management.However,whether diff erences in the response of growth to climate at diff erent altitudes remains unclear.To answer this,264 trees of Larix kaempferi from 88 plots,representing diff erent altitudinal ranges(1000-2100 m)and tree classes were sampled and used to develop tree-ring chronologies.Tree-ring growth(TRG)was either positively(dominant)or negatively(intermediate and suppressed)correlated with climate in diff erent tree classes at diff erent altitudes.TRG was strongly correlated with growing season at low altitudes,but was less sensitive to climate at middle altitudes.It was mainly limited by precipitation and was highly sensitive to climate at low altitudes.Climate-growth relationships at high altitudes were opposite compared to those at low altitudes.TRG of dominant trees was more sensitive to climate change compared to intermediate and suppressed trees.Climate factors(annual temperatures;moisture,the number of frost-free days)had diff erent eff ects on tree-ring growth of diff erent tree classes along altitudinal gradients.It was concluded that the increase in summer temperatures decreased water availability,resulting in a signifi cant decline in growth rates after 2005 at lower altitudes.L.kaempferi is suitable for planting in middle altitudes and dominant trees were the best sampling choice for accurately assessing climate-growth relationships.

The Prospects of Blue Economy to Promote Bangladesh into a Middle-Income Country

This paper draws attention to the prospects of sea-based economy to promote Bangladesh in a middle-income country through the sustainable use of marine resources. About three-fourths of the earth is covered by the seas. It plays the vital role in two important functions from ancient time known as the means of communication and the source of huge living and non-living natural resources. At present, the countries are becoming very much concerned about their marine resources to resolve many of the present and future challenges of their economies. Generally for Bangladesh, ocean is contributing a significant role to its overall socio-economic progress through rising up the economic activities across the country and especially to the coastal zone at southern part. This paper investigates how much Bangladesh is capable to take of or handle the challenges to become a middle income country through the Sustainable Development Goals (SDGs). In addition, it has attempted with a closer-look to find out the barriers or limitations of these activities from different angles if exist.

Association between Active School Travel and Depressive Symptoms among 51,702 Adolescents in 26 Low- and Middle-Income Countries

Little is known about the role of active school travel(AST)on mental health among adolescents.Thus,this study aimed to explore the AST-depression association among adolescents aged 12–15 years from 26 low-and middle-income countries(LMICs).Data from the Global School-based Student Health Survey were analyzed in 51,702 adolescents[mean(SD)age 13.8(1.0)years;49.3%boys).Both depressive symptoms and AST were assessed by a single question self-reported measure,respectively.Participants who reported having 5 days or above were considered as AST.Multivariable logistic regression analysis(accounting for sampling weights)was performed while controlling for gender,age,physical activity,sedentary behavior,and food insecurity,and a countrywide meta-analysis was undertaken.The prevalence of depressive symptoms and AST were 30.1%and 37.0%,respectively.Compared with those not having AST,adolescents with AST were less likely to have self-reported depressive symptoms(OR=0.88,95%CI:0.85-0.93)regardless of gender.Countrywide meta-analysis demonstrated that having AST versus not having AST was associated with 12%lower odds for depressive symptoms(OR=0.88;95%CI:0.82-0.94)but with a moderate between-country heterogeneity(I^(2)=59.0%).Based on large samples of adolescents from LMICs,it would be expected that AST may play a critical role in preventing adolescent depression worldwide.However,it is necessary to consider more country-specific factors when implementing AST-related mental health interventions.Future studies should adopt the solid study design to confirm or negate our researchfindings.

ASARA,a prediction model based on Child-Pugh class in hepatocellular carcinoma patients undergoing transarterial chemoembolization

Background:Due to the high heterogeneity among hepatocellular carcinoma(HCC)patients receiving transarterial chemoembolization(TACE),the prognosis of patients varies significantly.The decisionmaking on the initiation and/or repetition of TACE under different liver functions is a matter of concern in clinical practice.Thus,we aimed to develop a prediction model for TACE candidates using risk stratification based on varied liver function.Methods:A total of 222 unresectable HCC patients who underwent TACE as their only treatment were included in this study.Cox proportional hazards regression was performed to select the independent risk factors and establish a predictive model for the overall survival(OS).The model was validated in patients with different Child-Pugh class and compared to previous TACE scoring systems.Results:The five independent risk factors,including alpha-fetoprotein(AFP)level,maximal tumor size,the increase of albumin-bilirubin(ALBI)grade score,tumor response,and the increase of aspartate aminotransferase(AST),were used to build a prognostic model(ASARA).In the training and validation cohorts,the OS of patients with ASARA score≤2 was significantly higher than that of patients with ASARA score>2(P<0.001,P=0.006,respectively).The ASARA model and its modified version“AS(ARA)”can effectively distinguish the OS(P<0.001,P=0.004)between patients with Child-Pugh class A and B,and the C-index was 0.687 and 0.706,respectively.For repeated TACE,the ASARA model was superior to Assessment for Retreatment with TACE(ART)and ALBI grade,maximal tumor size,AFP,and tumor response(ASAR)among Child-Pugh class A patients.For the first TACE,the performance of AS(ARA)was better than that of modified hepatoma arterial-embolization prognostic(mHAP),mHAP3,and ASA(R)models among Child-Pugh class B patients.Conclusions:The ASARA scoring system is valuable in the decision-making of TACE repetition for HCC patients,especially Child-Pugh class A patients.The modified AS(ARA)can be used to screen the ideal candidate for TACE initiation in Child-Pugh class B patients with poor liver function.

Orthodontic-surgical treatment for severe skeletal class Ⅱ malocclusion with vertical maxillary excess and four premolars extraction: A case report

BACKGROUND Patient satisfaction with facial appearance at the end of orthodontic camouflage treatment is very important, especially for skeletal malocclusion. This case report highlights the importance of the treatment plan for a patient initially treated with four-premolar-extraction camouflage, despite indications for orthognathic surgery.CASE SUMMARY A 23-year-old male sought treatment complaining about his unsatisfactory facial appearance. His maxillary first premolars and mandibular second premolars had been extracted, and a fixed appliance had been used to retract his anterior teeth for two years without improvement. He had a convex profile, a gummy smile, lip incompetence, inadequate maxillary incisor inclination, and almost a class I molar relationship. Cephalometric analysis showed severe skeletal class Ⅱ malocclusion(A point-nasion-B point = 11.5°) with a retrognathic mandible(sella-nasion-B point = 75.9°), a protruded maxilla(sella-nasion-A point = 87.4°), and vertical maxillary excess(upper incisor to palatal plane = 33.2 mm). The excessive lingual inclination of the maxillary incisors(upper incisor to nasion-A point line =-5.5°)was due to previous treatment attempts to compensate for the skeletal class Ⅱ malocclusion. The patient was successfully retreated with decompensating orthodontic treatment combined with orthognathic surgery. The maxillary incisors were repositioned and proclined in the alveolar bone, the overjet was increased, and a space was created for orthognathic surgery, including maxillary impaction, anterior maxillary back-setting, and bilateral sagittal split ramus osteotomy to correct his skeletal anteroposterior discrepancy. Gingival display was reduced, and lip competence was restored. In addition, the results remained stable after 2 years. The patient was satisfied with his new profile as well as with the functional malocclusion at the end of treatment.CONCLUSION This case report provides orthodontists a good example of how to treat an adult with severe skeletal class Ⅱ malocclusion with vertical maxillary excess after an unsatisfactory orthodontic camouflage treatment. Orthodontic and orthognathic treatment can significantly correct a patient’s facial appearance.