Adolescent engagement in a stepped care, transdiagnostic mental health intervention delivered in Indian schools.

Given the relationship between poor engagement and worse treatment outcomes, improving engagement has been the focus of attention in recent years. Engagement is a particular challenge among minoritized and otherwise challenged youth, such as those from socioeconomically disadvantaged groups, including youth in low- and middle-income countries (LMICs), where they face lower levels of access to resources, including mental health treatment. The present study describes engagement challenges that arose in an uncontrolled pre-post evaluation of a school-based, modular, multi-problem, stepped-care intervention delivered in urban Indian communities. Specifically, the study aimed to (1) characterize barriers and facilitators of youth treatment engagement; and (2) evaluate treatment acceptability and fit of treatment from the youth perspective. Youth participants completed semi-structured interviews, which were transcribed and coded using thematic analysis. Participants described numerous facilitators to engagement (e.g., positive therapeutic relationship) and reported high overall satisfaction with the intervention, while also identifying barriers to engagement (e.g., concerns about confidentiality) and offering suggestions to increase fit and acceptability (e.g., more visually appealing treatment materials). Findings highlight ways in which engagement can be enhanced and implementation supports improved to maximize treatment effectiveness among minoritized and disadvantaged youth in LMICs. Supplementary Information: The online version contains supplementary material available at 10.1007/s44202-024-00154-1.

Impact of ultraviolet-B radiation on early-season morpho-physiological traits of indica and japonica rice genotypes.

Ultraviolet (UV)-B radiation is considered one of the major detrimental rays coming from the Sun. UV-B radiation has a harmful impact on plant growth and development. The effect of UV-B radiation was studied on 64 rice (Oryza sativa L.) genotypes during the vegetative season. An equal number of genotypes from the japonica (50%) and indica (50%) subspecies were phenotyped using the Soil-Plant-Atmosphere-Research (SPAR) units. The 10 kJ UV-B was imposed 12 days after planting (DAP) and continued for three weeks (21 d). Based on the combined ultraviolet-B radiation response index (CUVBRI) for each genotype, the 64 rice genotypes were classified into sensitive, moderately sensitive, moderately tolerant, and tolerant. Various shoot traits, such as plant height, tiller, and leaf numbers, were measured. We also studied critical root phenological traits like root volume, diameter, tips, and forks. Out of all the studied shoot traits, leaf area showed maximum reduction for both indica (54%) and japonica (48%). Among the root traits, root length decreased by negligible (1%) for indica as compared to japonica (5%), while root crossing and forks showed a maximum decline for japonica (37 and 42%), respectively. This study is timely, meaningful, and required because it will help breeders select a tolerant or sensitive rice line for better yield and production under abiotic stresses.

Chlorophyll fluorescence is a potential indicator to measure photochemical efficiency in early to late soybean maturity groups under changing day lengths and temperatures.

In this study, we employed chlorophyll a fluorescence technique, to indicate plant health and status in response to changing day lengths (photoperiods) and temperatures in soybean early and late maturity groups. Chlorophyll a fluorescence study indicates changes in light reactions in photosystem II. Experiments were performed for 3-day lengths (12.5, 13.5, and 14.5 h) and five temperatures (22/14°C, 26/18°C, 30/22°C, 34/26°C, and 40/32°C), respectively. The I-P phase declined for changing day lengths. Active reaction centers decreased at long day length for maturity group III. We observed that low temperatures impacted the acceptor side of photosystem II and partially impacted electron transport toward the photosystem I end electron acceptor. Results emphasized that higher temperatures (40/32°C) triggered damage at the oxygen-evolving complex and decreased electron transport and photosynthesis. We studied specific leaf areas and aboveground mass. Aboveground parameters were consistent with the fluorescence study. Chlorophyll a fluorescence can be used as a potential technique for high-throughput phenotyping methods. The traits selected in the study proved to be possible indicators to provide information on the health status of various maturity groups under changing temperatures and day lengths. These traits can also be deciding criteria for breeding programs to develop inbreed soybean lines for stress tolerance and sensitivity based on latitudinal variations.

Coach-Supported Versus Self-guided Digital Training Course for a Problem-solving Psychological Intervention for Nonspecialists: Protocol for a Pre-Post Nested Randomized Controlled Trial.

BACKGROUND: Psychosocial interventions delivered by nonspecialists can be effective at reducing common adolescent mental health problems in low-resource settings. However, there is a lack of evidence on resource-efficient methods for building capacity to deliver these interventions. OBJECTIVE: The objective of this study is to evaluate the effects of a digital training (DT) course, delivered in a self-guided format or with coaching, on nonspecialists' competency to deliver a problem-solving intervention intended for adolescents with common mental health problems in India. METHODS: We will conduct a pre-post study with a nested parallel, 2-arm, individually randomized controlled trial. The study aims to recruit 262 participants, randomized 1:1 to receive either a self-guided DT course or a DT course with weekly individualized coaching provided remotely by telephone. In both arms, the DT will be accessed over 4 to 6 weeks. Participants will be nonspecialists (ie, without prior practice-based training in psychological therapies) recruited from among university students and affiliates of nongovernmental organizations in Delhi and Mumbai, India. RESULTS: Outcomes will be assessed at baseline and 6 weeks post randomization using a knowledge-based competency measure that incorporates a multiple-choice quiz format. The primary hypothesis is that self-guided DT will lead to increased competency scores among novices with no prior experience of delivering psychotherapies. The secondary hypothesis is that digital training with coaching will have an incremental effect on competency scores compared with DT alone. The first participant was enrolled on April 4, 2022. CONCLUSIONS: The study will address an evidence gap on the effectiveness of training methods for nonspecialist providers of adolescent mental health interventions in low-resource settings. The findings from this study will be used to support wider efforts to scale up evidence-based mental health interventions for young people. TRIAL REGISTRATION: ClinicalTrials.gov NCT05290142; https://clinicaltrials.gov/ct2/show/NCT05290142. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41981.

Feasibility and Acceptability of a Remote Stepped Care Mental Health Programme for Adolescents during the COVID-19 Pandemic in India.

Remote mental health services were rapidly deployed during the COVID-19 pandemic, yet there is relatively little contemporaneous evidence on their feasibility and acceptability. This study assessed the feasibility and acceptability of a stepped care mental health programme delivered remotely by lay counsellors to adolescents in New Delhi, India, during a period of 'lockdown'. The programme consisted of a brief problem-solving intervention ("Step 1") followed by a tailored behavioural module ("Step 2") for non-responders. We enrolled 34 participants (M age = 16.4 years) with a self-identified need for psychological support. Feasibility and acceptability were assessed through quantitative process indicators and qualitative interviews (n = 17 adolescents; n = 5 counsellors). Thirty-one (91%) adolescents started Step 1 and 16 (52%) completed the planned Step 1 protocol. Twelve (75%) of the Step 1 completers were non-responsive. Eight (67%) non-responsive cases started Step 2, all of whom met response criteria when reassessed at 12 weeks post-enrolment. Adolescents favoured voice-only sessions over video-calls due to privacy concerns and difficulties accessing suitable devices. Counsellors noted challenges of completing remote sessions within the allotted time while recognising the importance of supervision for developing competence in new ways of working. Both adolescents and counsellors discussed the importance of working collaboratively and flexibly to fit around individual preferences and circumstances. Disentangling pandemic-specific barriers from more routine challenges to remote delivery should be a focus of future research.

Developing knowledge-based psychotherapeutic competencies in non-specialist providers: A pre-post study with a nested randomised controlled trial of a coach-supported versus self-guided digital training course for a problem-solving psychological intervention in India.

We evaluated a digital learning programme for non-specialists to develop knowledge-based competencies in a problem-solving intervention for adolescents to examine the overall impact of training on knowledge-based competencies among learners; and to compare the effects of two training conditions (self-guided digital training with or without coaching) in a nested parallel, two-arm, individually randomised controlled trial. Eligible participants were 18 or older; fluent in Hindi or English; able to access digital training; and had no prior experience of delivering structured psychotherapies. 277 participants were enrolled from 31 March 2022 to 19 June 2022 of which 230 (83%) completed the study. There was a significant increase in competency score from pre-training (Mean = 7.01, SD = 3.29) to post-training (Mean = 8.88, SD = 3.80), 6 weeks after the pre-training assessment. Knowledge competency scores showed larger increase among participants randomised to the coaching arm (AMD = 1.09, 95% CI 0.26-1.92, p = 0.01) with an effect size (d) of 0.33 (95% CI 0.08-0.58). More participants completed training in the coaching arm (n = 96, 69.6%) compared to the self-guided training arm (n = 56, 40.3%). In conclusion, a coach-supported remote digital training intervention is associated with enhanced participation by learners and increased psychotherapeutic knowledge competencies.

A qualitative analysis of collaborative efforts to build a school-based intervention for multiple common adolescent mental health difficulties in India.

Introduction: In low- and middle-income countries (LMICs), the gap between need for mental health (MH) treatment and access to services is stark, particularly among children and adolescents. In service of addressing this treatment gap, the current study provides an in-depth illustration of later-stage collaborative design of a school-based, transdiagnostic MH intervention in New Delhi and Goa, India, using a combination of contextual insights from local stakeholders and knowledge derived from the global evidence base. Methods: Using an inductive-deductive approach to qualitative thematic analysis, we examined coded data from qualitative sources related to experiences of developing and implementing an intervention prototype. These sources included notes from meetings attended by treatment development team members and providers, written feedback on protocol materials (e.g., provider manual, student handouts), field notes reflecting researcher observations, and minutes from weekly clinical supervision meetings. Results: Results revealed that codes involving cultural/contextual considerations, protocol material and content, and intervention complexity arose consistently throughout treatment development and across document types, illustrating their central role in finalizing protocol design. Discussion: These findings have implications for the future of mental health treatment development and implementation globally.

A pilot study to evaluate feasibility and acceptability of training mental health workers in India to select case-specific intervention procedures within a dynamic modular treatment designed for a low-resource setting.

RATIONALE, AIMS AND OBJECTIVES: A key consideration in designing scalable solutions for improving global mental health involves balancing the need for interventions to be uncomplicated for mental health workers (MHWs) and the need for the intervention to be widely applicable to many clients. Often these needs are in competition, since interventions are routinely simplified by removing procedures or reducing their dynamic responsivity, which in turn lowers their overall utility in serving large, clinically diverse populations. The principal aim of this pilot study involved evaluating the feasibility and acceptability of a brief strategy designed to delegate problem classification and practice selection to MHWs operating within a flexible, modular, cognitive behavioural protocol. A secondary aim involved gathering data on which to base a hypothesis regarding the potential effectiveness of this strategy. METHOD: Within an open trial, an educationally diverse sample of local MHWs in India (N = 18) reviewed fictional case vignettes, classified mental health problems, and then selected practices before and after a two-hour training that included a one-page decision-making resource. Feasibility was measured by assessing the integrity of the study protocol and training, the measurement and administration of questionnaires as well as study recruitment and completion. Acceptability of the intervention was measured by MHW-perceived performance, ease of use, value, importance, and intention for continued use. Decision-making accuracy was assessed by comparing MHWs' clinical decisions with criteria established through consensus among psychologists with expertise in modular protocols. RESULTS: Results suggested high feasibility and acceptability on all metrics. Secondary analysis revealed that MHW's decision-making accuracy and confidence also significantly improved, providing a basis for the hypothesis that this brief approach is useful for building MHW capacity in low-resource settings. CONCLUSION: Overall these findings provide initial support for these methods and potential training outcomes to test within a larger, randomized controlled trial.

Role of arbuscular mycorrhizal fungi as an underground saviuor for protecting plants from abiotic stresses.

To increase food production, prevalent agricultural malpractices such as intensive use of fertilizers and pesticides have led to degradation of the ecosystem. In this situation, there is a need to encourage eco-friendly and sustainable methods for improving crop production under ever increasing abiotic stress conditions. One such method can be through use of arbuscular mycorrhizal fungi (AMF or AM fungi). Soil microorganisms such as AMF serve as a link between plants and the soil resources. AMF represent a key functional group of soil microbiota that is fundamental for soil fertility, crop productivity, yield, quality and ecosystem resilience. AMF potentially increases bioavailability of water as well as various micro- and macro- nutrients which enhances production of plant photosynthates. In plants, inoculation with AMF led to increased photochemical efficiency ultimately resulting in enhanced plant growth. In this review we have summarized amelioration of drought or water scarcity, salt stress, increasing temperature or high temperature and heavy metal stresses etc. in crop plants by AMF through its effects on various physiological and biochemical processes including photosynthesis. The review also highlights AMF induced tolerance and adaptive mechanisms which protect crops from stresses. We conclude the review with a discussion of unseen issues and suggestions for future researches.

Effect of High-Temperature Stress on Plant Physiological Traits and Mycorrhizal Symbiosis in Maize Plants.

Increasing high temperature (HT) has a deleterious effect on plant growth. Earlier works reported the protective role of arbuscular mycorrhizal fungi (AMF) under stress conditions, particularly influencing the physiological parameters. However, the protective role of AMF under high-temperature stress examining physiological parameters with characteristic phospholipid fatty acids (PLFA) of soil microbial communities including AMF has not been studied. This work aims to study how high-temperature stress affects photosynthetic and below-ground traits in maize plants with and without AMF. Photosynthetic parameters like quantum yield of photosystem (PS) II, PSI, electron transport, and fractions of open reaction centers decreased in HT exposed plants, but recovered in AMF + HT plants. AMF + HT plants had significantly higher AM-signature 16:1ω5cis neutral lipid fatty acid (NLFA), spore density in soil, and root colonization with lower lipid peroxidation than non-mycorrhizal HT plants. As a result, enriched plants had more active living biomass, which improved photosynthetic efficiency when exposed to heat. This study provides an understanding of how AM-mediated plants can tolerate high temperatures while maintaining the stability of their photosynthetic apparatus. This is the first study to combine above- and below-ground traits, which could lead to a new understanding of plant and rhizosphere stress.

Effectiveness and costs associated with a lay counselor-delivered, brief problem-solving mental health intervention for adolescents in urban, low-income schools in India: 12-month outcomes of a randomized controlled trial.

BACKGROUND: Psychosocial interventions for adolescent mental health problems are effective, but evidence on their longer-term outcomes is scarce, especially in low-resource settings. We report on the 12-month sustained effectiveness and costs of scaling up a lay counselor-delivered, transdiagnostic problem-solving intervention for common adolescent mental health problems in low-income schools in New Delhi, India. METHODS AND FINDINGS: Participants in the original trial were 250 school-going adolescents (mean [M] age = 15.61 years, standard deviation [SD] = 1.68), including 174 (69.6%) who identified as male. Participants were recruited from 6 government schools over a period of 4 months (August 20 to December 14, 2018) and were selected on the basis of elevated mental health symptoms and distress/functional impairment. A 2-arm, randomized controlled trial design was used to examine the effectiveness of a lay counselor-delivered, problem-solving intervention (4 to 5 sessions over 3 weeks) with supporting printed booklets (intervention arm) in comparison with problem solving delivered via printed booklets alone (control arm), at the original endpoints of 6 and 12 weeks. The protocol was modified, as per the recommendation of the Trial Steering Committee, to include a post hoc extension of the follow-up period to 12 months. Primary outcomes were adolescent-reported psychosocial problems (Youth Top Problems [YTP]) and mental health symptoms (Strengths and Difficulties Questionnaire [SDQ] Total Difficulties scale). Other self-reported outcomes included SDQ subscales, perceived stress, well-being, and remission. The sustained effects of the intervention were estimated at the 12-month endpoint and over 12 months (the latter assumed a constant effect across 3 follow-up points) using a linear mixed model for repeated measures and involving complete case analysis. Sensitivity analyses examined the effect of missing data using multiple imputations. Costs were estimated for delivering the intervention during the trial and from modeling a scale-up scenario, using a retrospective ingredients approach. Out of the 250 original trial participants, 176 (70.4%) adolescents participated in the 12-month follow-up assessment. One adverse event was identified during follow-up and deemed unrelated to the intervention. Evidence was found for intervention effects on both SDQ Total Difficulties and YTP at 12 months (YTP: adjusted mean difference [AMD] = -0.75, 95% confidence interval [CI] = -1.47, -0.03, p = 0.04; SDQ Total Difficulties: AMD = -1.73, 95% CI = -3.47, 0.02, p = 0.05), with stronger effects over 12 months (YTP: AMD = -0.98, 95% CI = -1.51, -0.45, p < 0.001; SDQ Total Difficulties: AMD = -1.23, 95% CI = -2.37, -0.09; p = 0.03). There was also evidence for intervention effects on internalizing symptoms, impairment, perceived stress, and well-being over 12 months. The intervention effect was stable for most outcomes on sensitivity analyses adjusting for missing data; however, for SDQ Total Difficulties and impairment, the effect was slightly attenuated. The per-student cost of delivering the intervention during the trial was $3 United States dollars (USD; or $158 USD per case) and for scaling up the intervention in the modeled scenario was $4 USD (or $23 USD per case). The scaling up cost accounted for 0.4% of the per-student school budget in New Delhi. The main limitations of the study's methodology were the lack of sample size calculations powered for 12-month follow-up and the absence of cost-effectiveness analyses using the primary outcomes. CONCLUSIONS: In this study, we observed that a lay counselor-delivered, brief transdiagnostic problem-solving intervention had sustained effects on psychosocial problems and mental health symptoms over the 12-month follow-up period. Scaling up this resource-efficient intervention is an affordable policy goal for improving adolescents' access to mental health care in low-resource settings. The findings need to be interpreted with caution, as this study was a post hoc extension, and thus, the sample size calculations did not take into account the relatively high attrition rate observed during the long-term follow-up. TRIAL REGISTRATION: ClinicalTrials.gov NCT03630471.

Regulation of Photosystem II Heterogeneity and Photochemistry in Two Cultivars of C4 Crop Sugarcane Under Chilling Stress.

In subtropical regions, chilling stress is one of the major constraints for sugarcane cultivation, which hampers yield and sugar production. Two recently released sugarcane cultivars, moderately chilling tolerant Guitang 49 and chilling tolerant Guitang 28, were selected. The experiments were conducted in the controlled environment, and seedlings were exposed to optimum (25°C/15°C), chilling (10°C/5°C), and recovery (25°C/15°C) temperature conditions. PSII heterogeneity was studied in terms of reducing side and antenna size heterogeneity. Under chilling, reducing side heterogeneity resulted in increased number of QB non-reducing centers, whereas antenna side heterogeneity resulted in enhanced number of inactive ß centers in both cultivars, but the magnitude of change was higher in Guitang 49 than Guitang 28. Furthermore, in both cultivars, quantum efficiency of PSII, status of water splitting complex, and performance index were adversely affected by chilling, along with reduction in net photosynthesis rate and nighttime respiration and alterations in leaf optical properties. The extents of negative effect on these parameters were larger in Guitang 49 than in Guitang 28. These results reveal a clear differentiation in PSII heterogeneity between differentially chilling tolerant cultivars. Based on our studies, it is concluded that PSII heterogeneity can be used as an additional non-invasive and novel technique for evaluating any type of environmental stress in plants.

A randomized controlled trial of mindfulness-based cognitive therapy vs stress management training for obsessive-compulsive disorder.

BACKGROUND: Recently, mindfulness-based therapies have emerged as a treatment modality for OCD, but there is sparse controlled data. We report the efficacy of mindfulness-based cognitive therapy (MBCT) in treating OCD in comparison with stress management training (SMT). METHODS: 60 outpatients with DSM-IV-TR OCD attending a specialty OCD clinic were randomly assigned in 1:1 ratio to either MBCT (n=30) or SMT (n= 30). Both the groups received 12 weekly sessions of assigned intervention. An independent blind rater assessed the primary outcome measure at baseline and at the end of 12 weeks. RESULTS: Significantly greater proportion of patients responded to MBCT than to SMT (80% vs. 27%, P <0.001). In the linear mixed-effects modelling for intent-to-treat analysis, there was a significant reduction in the illness severity measured using the Yale-Brown Obsessive-Compulsive Scale, obsessive beliefs of 'responsibility/threat estimation' and 'perfectionism/intolerance of uncertainty' measured using the Obsessive Beliefs Questionnaire and anxiety. LIMITATIONS: Small sample size with a relatively high attrition in the control group. Lack of a cognitive behaviour therapy (CBT) control group. CONCLUSIONS: Mindfulness-based cognitive therapy is efficacious in the treatment of OCD. Future studies should compare MBCT with CBT in larger representative samples and also examine the sustainability of change in longitudinal studies.

Design process and protocol description for a multi-problem mental health intervention within a stepped care approach for adolescents in India.

This paper documents the collaborative design of a mental health intervention for adolescents in India with anxiety, depression, or anger-related concerns. The process was characterized by three phases of formative activities: (1) an intensive review of the service context, (2) selection of an overall design strategy (e.g., whether to choose existing evidence-based treatments or build new treatments in context), and (3) a period of prototyping, testing, and refining. Each phase resulted in specific outputs, which were, respectively, (1) a detailed articulation of values and preferences (setting expectations for what the ideal protocol should be), (2) a set of build parameters representing a blueprint that managed strategic compromises for this context, and (3) a working protocol. We outline the steps of this design process, summarize data from an open-trial clinical case series, and illustrate the resulting working protocol, which will be tested in a future larger trial. We conclude with insights and observations likely to be relevant to protocol design activity in a variety of contexts, most particularly those in low-and-middle-income countries such as India.

Effectiveness of a brief lay counsellor-delivered, problem-solving intervention for adolescent mental health problems in urban, low-income schools in India: a randomised controlled trial.

BACKGROUND: Mental health problems are a leading cause of disability in adolescents worldwide. Problem solving is a well-tested mental health intervention in many populations. We aimed to investigate the effectiveness of a brief, transdiagnostic problem-solving intervention for common adolescent mental health problems when delivered by non-specialist school counsellors in New Delhi, India. METHODS: This randomised trial was done in six government-run schools (three all-boys schools, two all-girls schools, and one co-educational school) that serve low-income communities. We recruited participants from grades 9 to 12 (ages 12-20 years) by selecting students with persistently elevated mental health symptoms accompanied by distress or functional impairment. Clinical eligibility criteria were assessed by research assistants using the Hindi-language version of the Strengths and Difficulties Questionnaire (SDQ), with reference to locally validated borderline cutoff scores of 19 or greater for boys and 20 or greater for girls on the SDQ Total Difficulties scale, an abnormal score of 2 or more on the SDQ Impact scale, and persistence of more than 1 month on the SDQ Chronicity index. Participants were randomly allocated (1:1) to problem solving delivered through a brief (2-3 week) counsellor-led intervention with supporting printed materials (intervention group), or problem solving delivered via printed booklets alone (control group). Primary outcomes were adolescent-reported mental health symptoms (SDQ Total Difficulties scale) and idiographic psychosocial problems (Youth Top Problems [YTP]) at 6 weeks. Primary analyses were done on an intention-to-treat basis at the 6-week endpoint. The trial is registered with ClinicalTrials.gov, NCT03630471. FINDINGS: Participants were enrolled between Aug 20, and Dec 4, 2018. 283 eligible adolescents were referred to the trial, and 251 (89%) of these were enrolled (mean age 15·61 years; 174 [69%] boys). 125 participants were allocated to each group (after accounting for one participant in the intervention group who withdrew consent after randomisation). Primary outcome data were available for 245 (98%) participants. At 6 weeks, the mean YTP scores were 3·52 (SD 2·66) in the intervention group and 4·60 (2·75) in the control group (adjusted mean difference -1·01, 95% CI -1·63 to -0·38; adjusted effect size 0·36, 95% CI 0·11 to 0·61; p=0·0015). The mean SDQ Total Difficulties scores were 17·48 (5·45) in the intervention group and 18·33 (5·45) in the control group (-0·86, -2·14 to 0·41; 0·16, -0·09 to 0·41; p=0·18). We observed no adverse events. INTERPRETATION: A brief lay counsellor-delivered problem-solving intervention combined with printed booklets seemed to have a modest effect on psychosocial outcomes among adolescents with diverse mental health problems compared with problem-solving booklets alone. This counsellor-delivered intervention might be a suitable first-line intervention in a stepped care approach, which is being evaluated in ongoing studies. FUNDING: Wellcome Trust.

Development of a transdiagnostic, low-intensity, psychological intervention for common adolescent mental health problems in Indian secondary schools.

BACKGROUND: The PRIDE programme aims to establish a suite of transdiagnostic psychological interventions organised around a stepped care system in Indian secondary schools. This paper describes the development of a low-intensity, first-line component of the PRIDE model. METHOD: Contextual and global evidence informed an intervention 'blueprint' with problem solving as the primary practice element. Successive iterations were tested and modified across two pilot cohort studies (N = 45; N = 39). Participants were aged 13-20 years and presenting with elevated mental health symptoms in New Delhi schools. RESULTS: The first iteration of the intervention, based on a guided self-help modality, showed promising outcomes and user satisfaction when delivered by psychologists. However, delivery was not feasible within the intended 6-week schedule, and participants struggled to use materials outside 'guidance' sessions. In Pilot 2, a modified counsellor-led problem-solving intervention was implemented by less experienced counsellors over a 3-4 week schedule. Outcomes were maintained, with indications of enhanced feasibility and acceptability. High demand was observed across both pilots, leading to more stringent eligibility criteria and a modified sensitisation plan. DISCUSSION: Findings have shaped a first-line intervention for common adolescent mental health problems in low-resource settings. A forthcoming randomised controlled trial will test its effectiveness.

The effectiveness of a low-intensity problem-solving intervention for common adolescent mental health problems in New Delhi, India: protocol for a school-based, individually randomized controlled trial with an embedded stepped-wedge, cluster randomized controlled recruitment trial.

BACKGROUND: Conduct, anxiety, and depressive disorders account for over 75% of the adolescent mental health burden globally. The current protocol will test a low-intensity problem-solving intervention for school-going adolescents with common mental health problems in India. The protocol also tests the effects of a classroom-based sensitization intervention on the demand for counselling services in an embedded recruitment trial. METHODS/DESIGN: We will conduct a two-arm, individually randomized controlled trial in six Government-run secondary schools in New Delhi. The targeted sample is 240 adolescents in grades 9-12 with persistent, elevated mental health symptoms and associated distress/impairment. Participants will receive either a brief problem-solving intervention delivered over 3 weeks by lay counsellors (intervention) or enhanced usual care comprised of problem-solving booklets (control). Self-reported adolescent mental health symptoms and idiographic problems will be assessed at 6 weeks (co-primary outcomes) and again at 12 weeks post-randomization. In addition, adolescent-reported distress/impairment, perceived stress, mental wellbeing, and clinical remission, as well as parent-reported adolescent mental health symptoms and impact scores, will be assessed at 6 and 12 weeks post-randomization. We will also complete a parallel process evaluation, including estimations of the costs of delivering the interventions. An embedded recruitment trial will apply a stepped-wedge, cluster (class)-randomized controlled design in 70 classes across the six schools. This will evaluate the added effect of a classroom-based sensitization intervention over and above school-level sensitization activities on the primary outcome of referral rate into the host trial. Other outcomes will be the proportion of referrals eligible to participate in the host trial, proportion of self-generated referrals, and severity and pattern of symptoms among referred adolescents in each condition. Power calculations were undertaken separately for each trial. A detailed statistical analysis plan will be developed separately for each trial prior to unblinding. DISCUSSION: Both trials were initiated on 20 August 2018. A single research protocol for both trials offers a resource-efficient methodology for testing the effectiveness of linked procedures to enhance uptake and outcomes of a school-based psychological intervention for common adolescent mental health problems. TRIAL REGISTRATION: Both trials are registered prospectively with the National Institute of Health registry ( www.clinicaltrials.gov ), registration numbers NCT03633916 and NCT03630471 , registered on 16th August, 2018 and 14th August, 2018 respectively).

Arbuscular Mycorrhizal fungi (AMF) protects photosynthetic apparatus of wheat under drought stress.

Drought stress (DS) is amongst one of the abiotic factors affecting plant growth by limiting productivity of crops by inhibiting photosynthesis. Damage due to DS and its protection by Arbuscular Mycorrhizal fungi (AMF) was studied on photosynthetic apparatus of wheat (Triticum aestivum) plants in pot experiments. DS was maintained by limiting irrigation to the drought stressed (DS) and AMF + DS plants. Relative Water content (RWC) was measured for leaf as well as soil to ensure drought conditions. DS plants had minimum RWC for both leaf and soil. AMF plants showed increased RWC both for leaf and soil indicating that AMF hyphae penetrated deep into the soil and provided moisture to the plants. In Chl a fluorescence induction curve (OJIP), a declined J-I and I-P phase was observed in DS plants. Efficacy of primary photochemistry declined in DS plants as result of DS, while AMF plants showed maximum photochemistry. DS leads to declined quantum efficiency of PSI and PSII in DS plants while it was restored in AMF + DS plants. Electron transport (ETRI and ETRII) decreased while quantum yield of non-photochemical quenching Y(NPQ) increased as a result of drought stress. CEF around PSI increased in DS-stressed plants. Efficient PSI complexes decreased in DS plants while in case of AMF plants PSI complexes were able to perform PSI photochemistry significantly. Thus, it is concluded that drought stress-induced damage to the structure and function of PSII and PSI was alleviated by AMF colonization.

Improved photosynthetic efficacy of maize (Zea mays) plants with arbuscular mycorrhizal fungi (AMF) under high temperature stress.

In this study, pot experiments were performed to investigate the effects of high temperature stress (44 °C) in maize plants colonized with and without arbuscular mycorrhizal fungi (AMF). Various parameters characterizing photosynthetic activity were measured in order to estimate the photosynthetic efficiency in maize plants. It was observed that density of active reaction centers of PSII, quantum efficiency of photosystem II (PSII), linear electron transport, excitation energy trapping, performance index, net photosynthesis rate increased in AMF (+) plants at 44 °C ±â€¯0.2 °C. Efficiency of primary photochemical reaction (represented as Fv/Fo) increased in AMF (+) plants as compared to AMF (-) plants. AMF seems to have protected water splitting complex followed by enhanced primary photochemistry of PSII under high temperature. Basic morphological parameters like leaf width, plant height and cob number increased in AMF (+) plants as compared to AMF (-) plants. AMF (+) plants grew faster than AMF (-) plants due to larger root systems. Chl content increased in AMF (+) plants as compared to AMF (-) maize plants. AMF hyphae likely increased Mg uptake which in turn increased the total chlorophyll content in AMF (+) maize plants. This subsequently led to a higher production in photosynthate and biomass. Thus AMF (+) plants have shown better photosynthesis performance as compared to AMF (-) maize plants under high temperature stress.

Mindfulness-based cognitive therapy in patients with late-life depression: A case series.

Depression is the most common mental illness in the elderly, and cost-effective treatments are required. Therefore, this study is aimed at evaluating the effectiveness of a mindfulness-based cognitive therapy (MBCT) on depressive symptoms, mindfulness skills, acceptance, and quality of life across four domains in patients with late-onset depression. A single case design with pre- and post-assessment was adopted. Five patients meeting the specified inclusion and exclusion criteria were recruited for the study and assessed on the behavioral analysis pro forma, geriatric depression scale, Hamilton depression rating scale, Kentucky inventory of mindfulness skills, Acceptance and Action Questionnaire II, The World Health Organization quality of life Assessment Brief version (WHOQO-L-BREF). The therapeutic program consisted of education regarding the nature of depression, training in formal and informal mindfulness meditation, and cognitive restructuring. A total of 8 sessions over 8 weeks were conducted for each patient. The results of this study indicate clinically significant improvement in the severity of depression, mindfulness skills, acceptance, and overall quality of life in all 5 patients. Eight-week MBCT program has led to reduction in depression and increased mindfulness skills, acceptance, and overall quality of life in patients with late-life depression.