RESUMEN
Background: Adolescents in Sub-Saharan Africa are disproportionately affected by the HIV epidemic. Comorbid depression is prevalent among adolescents living with HIV (ALWH) and poses numerous challenges to HIV care engagement and retainment. We present a pilot trial designed to investigate feasibility, fidelity, and acceptability of an adapted and an enhanced Friendship Bench intervention (henceforth: AFB and EFB) in reducing depression and improving engagement in HIV care among ALWH in Malawi. Methods: Design:: Participants will be randomized to one of three conditions: the Friendship Bench intervention adapted for ALWH (AFB, n=35), the Friendship Bench intervention enhanced with peer support (EFB, n=35), or standard of care (SOC, n=35). Recruitment is planned for early 2024 in four clinics in Malawi.Participants:: Eligibility criteria (1) aged 13-19; (2) diagnosed with HIV (vertically or horizontally); (3) scored ≥ 13 on the self-reported Beck's Depression Inventory (BDI-II); (4) living in the clinic's catchment area with intention to remain for at least 1 year; and (5) willing to provide informed consent.Interventions:: AFB includes 6 counseling sessions facilitated by young, trained non-professional counselors. EFB consists of AFB plus integration of peer support group sessions to facilitate engagement in HIV care. SOC for mental health in public facilities in Malawi includes options for basic supportive counseling, medication, referral to mental health clinics or psychiatric units at tertiary care hospitals for more severe cases.Outcomes:: The primary outcomes are feasibility, acceptability, and fidelity of the AFB and EFB assessed at 6 months and 12 months and compared across 3 arms. The secondary outcome is to assess preliminary effectiveness of the interventions in reducing depressive symptoms and improving HIV viral suppression at 6 months and 12 months. Discussion: This pilot study will provide insights into youth-friendly adaptations of the Friendship Bench model for ALWH in Malawi and the value of adding group peer support for HIV care engagement. The information gathered in this study will lead to a R01 application to test our adapted intervention in a large-scale cluster randomized controlled trial to improve depression and engagement in HIV care among ALWH.
RESUMEN
Implementing microelectromechanical system (MEMS) resonators calls for detailed microscopic understanding of the devices, such as energy dissipation channels, spurious modes, and imperfections from microfabrication. Here, we report the nanoscale imaging of a freestanding super-high-frequency (3 - 30 GHz) lateral overtone bulk acoustic resonator with unprecedented spatial resolution and displacement sensitivity. Using transmission-mode microwave impedance microscopy, we have visualized mode profiles of individual overtones and analyzed higher-order transverse spurious modes and anchor loss. The integrated TMIM signals are in good agreement with the stored mechanical energy in the resonator. Quantitative analysis with finite-element modeling shows that the noise floor is equivalent to an in-plane displacement of 10 fm/âHz at room temperatures, which can be further improved under cryogenic environments. Our work contributes to the design and characterization of MEMS resonators with better performance for telecommunication, sensing, and quantum information science applications.
RESUMEN
Sediment is an important pollutant for Lake Erie and its tributaries as a carrier of other substances and as a pollutant in its own right. Environmental managers have called for major reductions in sediment loadings in Lake Erie tributaries. In this study, 30-yr (1975-2005) datasets with daily resolution are analyzed to identify and interpret trends in sediment concentrations and loads in major US tributaries to Lake Erie. The Maumee and Sandusky Rivers in agricultural northwest Ohio show continual decreases throughout this period, but the River Raisin shows increases, especially in the last decade. The urban and forested Cuyahoga River shows little trend before 2000 but shows increases since then. The mostly forested Grand River shows strong decreases before 1995, little change thereafter until the early 2000s, and then increases. In most cases, the greatest decreases or smallest increases, depending on the river, are associated with summer and fall and with low flow conditions, whereas the smallest decreases or greatest increases are associated with the spring and with high flow conditions. Analysis of concentration-flow relationships indicates that these changes are not due to weather but reflect positive and negative anthropogenic influences. Sediment decreases in the northwestern Ohio tributaries seem to reflect the successful use of agricultural practices to reduce erosion and prevent sediment loss. Opportunities for further reductions in sediment loads and concentrations lie in better management of sediment losses during winter and spring.
