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Peer mentor training and supervision for a digital adolescent depression treatment in South Africa and Uganda: a mixed-methods evaluation
No full textBackground: Blended digital mental health interventions that combine technology with human support are more effective than standalone treatments. However, limited research has focused on how to train and supervise the personnel delivering human support components. The Kuamsha app, a gamified digital intervention based on Behavioral Activation for adolescent depression, was designed to be paired with low-intensity telephone-based peer support. A structured training and supervision program for peer supporters was co-developed through a series of workshops with mental health professionals and youth with lived experience of mental health challenges in South Africa and Uganda. To the best of our knowledge, this is the first study to evaluate a structured peer mentor model within a digital mental health intervention in any LMIC and one of only a few worldwide.Objective: This study assessed the feasibility, acceptability, and fidelity of a training and supervision program for peer supporters of a digital mental health intervention in South Africa and Uganda.Methods: We conducted a mixed-methods evaluation of the peer mentor program. Quantitative metrics assessed the feasibility of recruitment, retention, and attendance among peer mentors (N=13 in South Africa; N=4 in Uganda) as well as the acceptability of training. Fidelity, adherence, and competence were scored at the session level and converted to percentages of the maximum possible score to facilitate comparison across outcomes. Linear mixed-effects regression models with a random intercept for provider and site were used to estimate adjusted marginal means (95% CI). In-depth interviews and focus group discussions with peer mentors broadened our understanding of program acceptability and explored implementation barriers and facilitators.Results: The peer mentor training and supervision program was feasible and acceptable in both settings, as demonstrated by high recruitment (South Africa: 13/19, 68%; Uganda: 4/4, 100%), retention (South Africa: 9/13, 69%; Uganda: 4/4, 100%), and training attendance rates (89–92% in South Africa, and 100% in Uganda) along with qualitative reports of high satisfaction. All peer mentors met a minimum competency threshold after training (≥50%) with median competency scores of 70.7% (45.8-78.2) in South Africa and 75.4% (73.8-77.3) in Uganda. Independent ratings of call recordings during program implementation indicated high overall fidelity in South Africa (84.7%, 95% CI 80.3–89.0) and Uganda (87.7%, 95% CI 83.4–92.1). Adherence was higher in Uganda than South Africa (adjusted mean difference 13.30 percentage points, 95% CI 8.99–17.61; P<.001), as was competence (adjusted mean difference 4.88 percentage points, 95% CI 1.23–8.53; P=.009). The adjusted mean difference in overall fidelity (3.06 percentage points, 95% CI −0.98–7.10) was not statistically significant (P=.138). Qualitative findings emphasized the value of ongoing supervision and capacity development, as well as interactive training approaches and blended models of training and supervision.Conclusions: Locally adapted training and supervision models can strengthen peer mentor capabilities to support digital interventions. Adequate supervisory capacity and incentive structures are critical to ensure ongoing engagement, retention, and fidelity of peer mentors. In environments with frequent network disruptions, periodic in-person contact between peer mentors and supervisors may enhance fidelity. Future research should explore how peer mentor fidelity (adherence and competence) contributes to user engagement and mental health outcomes.Trial Registration: Pan African Clinical Trials Registry (PACTR202206574814636)
Treating Unmet Needs in Psychiatry (TUNE-UP): targeted service increases out-patient initiations of clozapine
Get PDFBackground: In the UK, clozapine is the only licensed treatment for treatment-resistant schizophrenia (TRS). However, it is underused because initiation is often limited by the need for in-patient admission, which is costly and unattractive to patients. Community clozapine services may address this. Aims: To describe a targeted out-patient clinic (Treating Unmet Needs in Psychiatry (TUNE-UP)) for TRS management and assess its impact on community clozapine initiation rates. Method: We reviewed clozapine titrations of patients under four community mental health teams from September 2021 to January 2025, recording whether titration occurred as in- or out-patient. The TUNE-UP clozapine clinic operated for 12 months (September 2023 to September 2024). Initiation rates during the TUNE-UP period were compared with those when the service was unavailable, using Poisson regression. Clinical outcomes were assessed using scales including the Positive and Negative Syndrome Scale (PANSS). Results: Fifty-one individuals commenced clozapine during the study period. There was a significant increase in the rates of community initiation in the TUNE-UP period (11.0 per year) compared with those outside of this period (1.71 per year; incidence risk ratio 6.42 [95% CI 2.04–20.2, P = 0.0015]). Patients seen by TUNE-UP showed significant improvements in PANSS (n = 6, median improvement 21.5 [95% CI 7.0–33.0], P = 0.03). Conclusions: A specialist service was associated with a significant increase in community clozapine initiations. This approach offers a strategy to improve TRS treatment in the community
Acceptability and feasibility of oral swabs for tuberculosis diagnosis in young children: a qualitative study from Uganda and Peru
Get PDFBackground: Tuberculosis (TB) remains a leading cause of morbidity and mortality in young children, particularly in settings with limited diagnostic capacity. Oral swabs represent a promising alternative specimen type due to their ease of collection, but evidence regarding their acceptability and feasibility remains limited. Methods: This qualitative sub-study was nested within the NOD-pedFEND diagnostic trial evaluating novel tests for pediatric TB. We conducted semi-structured interviews and focus group discussions with 81 participants across Uganda (n = 57) and Peru (n = 24), including caregivers (Uganda, n = 30; Peru, n = 7), healthcare workers (Uganda, n = 23; Peru, n = 12), and National TB Program stakeholders (Uganda, n = 4; Peru, n = 5). Participants were recruited purposively from among those involved in or linked to the parent NOD-pedFEND study. Data were analyzed using thematic analysis. Results: Oral swabs were widely perceived as acceptable due to their non-invasive nature, minimal discomfort, and ease of collection. Caregivers and healthcare workers valued the reduced burden on children compared to more invasive sampling methods. Across both countries, participants expressed concerns about perceived low diagnostic sensitivity in children, particularly when compared with reference standard specimens. Despite these reservations, oral swabs were welcomed as a complementary, rather than substitute, diagnostic modality. Stakeholders highlighted their potential role within future point-of-care diagnostic strategies in low-resource settings. Conclusions: Oral swabs are acceptable and feasible for pediatric TB diagnosis in diverse settings, though concerns about sensitivity persist. Their integration as an add-on test could expand diagnostic access, especially if incorporated into scalable, point-of-care approaches
How Social Media Connects and Divides Us: Psychological Insights and Paths Forward
Get PDFSocial media was once celebrated as a revolutionary space for constructive connection. While it can foster community, amplify marginalised voices and expose users to diverse perspectives, these platforms are also implicated in the rise of polarisation, intergroup conflict and extremist movements. This review examines how social media use can be both beneficial and detrimental, with a focus on the key underlying psychological mechanisms that explain, in part, the effect of social media on inter‐ and intra‐group relations. Drawing on theories of social identity, confirmation bias and moral psychology, we argue that social media platform design interacts with core psychological tendencies in ways that are both constructive and destructive for social groups and society. We conclude by offering actionable insights for platforms, practitioners and users, showing how psychological knowledge can inform interventions aimed at reducing the destructive outcomes of social media—promoting more positive social change in the digital age
ERG phase separation attenuates cellular senescence
Get PDFCentenarians, individuals who reach extreme old age, provide a valuable model for understanding mechanisms associated with healthy aging. Using ATAC-seq and transcriptomic profiling of peripheral blood mononuclear cells from centenarians, we identified a distinct chromatin accessibility landscape linked to exceptional longevity. Integrative analysis highlighted the E-26 transformation-specific (ETS)-related transcription factor ERG as a longevity-associated regulator. Functional studies in human cells showed that ERG forms nuclear condensates through liquid-liquid phase separation, a property associated with altered chromatin organization and reduced expression of senescence-related genes, including CDKN2A. Consistent with these effects, ERG condensation was associated with attenuation of cellular senescence phenotypes. Together, these findings connect epigenomic features observed in centenarians with transcription factor biophysical properties and cellular aging control, highlighting phase separation as a regulatory layer that may contribute to cellular resilience during aging
Stratification-dependent enstrophy-controlled regime in geostrophic turbulence
Get PDFWe experimentally measure geostrophic turbulence in a rotating, differentially heated fluid annulus, which is bounded by convectively driven warm and cold flows at the outer and inner boundaries, respectively. The horizontal kinetic energy spectra exhibit a range at low wavenumber which scales as −3, where k denotes the horizontal wavenumber, with spectral amplitude that correlates with the square of the Brunt–Vaisala frequency at the same heights as the velocity measurements. The observed turbulent state exhibits a forward enstrophy cascade across all scales along with bidirectional energy transfer, which is evidenced by a reversal in the sign of the spectral energy flux at a scale proportional to the internal Rossby radius of deformation. These findings highlight the role of baroclinic instability in shaping the distribution of energy across scales with implications for synoptic-scale turbulent flows near Earth’s tropopause
Calibration of the SNO+ detector using natural radioactivity and first demonstration of multisite discrimination for solar neutrinos
Get PDFA high-precision measurement of the 8B solar neutrino flux in the 2.0 to 6.0 MeV transition region is a key objective in neutrino physics. This region, where the νe survival probabilities are highly sensitive to physics beyond the Standard Model, such as non-standard neutrino interactions or additional neutrino flavors, remains largely unexplored. However, challenges arise due to the high rates of internal 208Tl radioactive backgrounds in liquid scintillator detectors. This thesis introduces multisite event discrimination as an effective method to enhance the precision of 8B solar flux measurements in this background-dominated energy regime. A Bayesian optimization calibration method was developed using internal 214Bi-214Po coincidences to extract clean α and β event samples. These samples were used to build precise models of the scintillation response, leading to the creation of high-accuracy probability density functions (PDFs) for 8B solar flux fitting. For the first time, multisite event discrimination was applied to liquid scintillator data, yielding a 30% improvement in measurement precision when combined with energy PDF information, as compared to fits performed in energy alone. Sensitivity projections for the upcoming SNO+ bisMSB phase, featuring improved light yields and faster timing, show a 17% increase in precision over the current full-fill phase, with position resolution enhanced to 6 cm. While this work marks a significant step towards achieving a high-precision measurement of the 8B solar flux in the transition region, future analyses will integrate multisite, energy, and 212Bi-208Tl coincidence tagging into the likelihood functions, maximizing the information extracted to further refine measurement precision
Symptom Patterns, Recovery, and Impact of Long COVID: Findings From a Longitudinal Survey
Get PDFBackground: Long COVID is a predominantly multisystem, often disabling, condition that develops following SARS-CoV-2 infection. We aimed to characterize the pattern, triggers, and impact of Long COVID symptoms. Methods: Data from a 1-year follow-up of an online survey originally conducted in November 2020 were used. Surveys were coproduced with people living with Long COVID. Participants were adults with Long COVID following confirmed or probable SARS-CoV-2 infection who were not hospitalized in the first 2 weeks of illness. The baseline survey recruited from social media and online support groups using convenience nonprobability sampling. Results: Of the 2210 first survey participants invited, 1153 (52%) responded to the follow-up survey. The mean age was 47.7 years (standard deviation 10.6) with 84% females, 83% UK-based, 78% university-qualified, and 90% reporting good to excellent health before SARS-CoV-2 infection. Median duration of illness was 19.8 months (interquartile range, 19.3–20.1) at follow-up. Only 5% of participants reported full recovery, and 45% reported a constant pattern of illness (as opposed to fluctuating or relapsing) compared to 17% at baseline. An equal proportion reported being unable to work at baseline (20.4%) and follow-up (20.6%). However, a higher proportion reported being made redundant or taking early retirement at follow-up (8.9%) than at baseline (2.2%). Conclusions: This study highlights the prolonged nature of Long COVID as well as the impact on work. This has the potential to widen health inequalities and increase hardship in individuals whose life circumstances and job types may not allow them to make necessary adaptations
Party constitutionalization in socialist regimes
No full textThis article explores the codification of the communist party in 31 constitutions of former and current socialist regimes. It identifies waves of constitutionalizing party socialism paralleling waves of constitutionalizing party democracy. It explores the constitutionalization of leadership, class nature, ideology, program, and activity of the communist party. The article reveals that the socialist constitutions perceive the communist party as a public entity to realize socialist values and principles. It argues that constitutionalizing party socialism is shaped by political elite’s interests: legitimatizing one-party rule, protecting regime security, coordinating party-state-society relations, expressing socialist and nationalist principles and values, and controlling party agencies. However, the contemporary reconstruction of party constitutionalization, as illustrated by the case of Vietnam, suggests that constitutionalizing party socialism is a contentious process involving both top-down control of political elite and bottom-up discursive contestation of the citizens. This article has implications for the historical and continuing influence of the socialist constitutional tradition, the constitutional role of the communist party in current socialist regimes, and a dynamic conception of socialist constitutions