Thirty-five years later: Long-term effects of the Matlab maternal and child health/family planning program on older women's well-being.

Family planning programs are believed to have substantial long-term benefits for women's health and well-being, yet few studies have established either extent or direction of long-term effects. The Matlab, Bangladesh, maternal and child health/family planning (MCH/FP) program afforded a 12-y period of well-documented differential access to services. We evaluate its impacts on women's lifetime fertility, adult health, and economic outcomes 35 y after program initiation. We followed 1,820 women who were of reproductive age during the differential access period (born 1938-1973) from 1978 to 2012 using prospectively collected data from the Matlab Health and Demographic Surveillance System and the 1996 and 2012 Matlab Health and Socioeconomic Surveys. We estimated intent-to-treat single-difference models comparing treatment and comparison area women. MCH/FP significantly increased contraceptive use, reduced completed fertility, lengthened birth intervals, and reduced age at last birth, but had no significant positive impacts on health or economic outcomes. Treatment area women had modestly poorer overall health (+0.07 SD) and respiratory health (+0.12 SD), and those born 1950-1961 had significantly higher body mass index (BMI) in 1996 (0.76 kg/m2) and 2012 (0.57 kg/m2); fewer were underweight in 1996, but more were overweight or obese in 2012. Overall, there was a +2.5 kg/m2 secular increase in BMI. We found substantial changes in lifetime contraceptive and fertility behavior but no long-term health or economic benefits of the program. We observed modest negative health impacts that likely result from an accelerated nutritional transition among treated women, a transition that would, in an earlier context, have been beneficial.

Optimizing Engagement in Behavioral Parent Training: Progress Toward a Technology-Enhanced Treatment Model.

Low-income families are more likely to have a child with an early-onset Behavior Disorder (BD); yet, socioeconomic strain challenges engagement in Behavioral Parent Training (BPT). This study follows a promising pilot to further examine the potential to cost-effectively improve low-income families' engagement in and the efficiency of BPT. Low-income families were randomized to (a) Helping the Noncompliant Child (HNC; McMahon & Forehand, 2003), a weekly, mastery-based BPT program that includes both the parent and child or (b) Technology-Enhanced HNC (TE-HNC), which includes all of the standard HNC components plus a parent mobile application and therapist web portal that provide between-session monitoring, modeling, and coaching of parent skill use with the goal of improved engagement in the context of financial strain. Relative to HNC, TE-HNC families had greater homework compliance and mid-week call participation. TE-HNC completers also required fewer weeks to achieve skill mastery and, in turn, to complete treatment than those in HNC without compromising parent satisfaction with treatment; yet, session attendance and completion were not different between groups. Future directions and clinical implications are discussed.

Helping the Noncompliant Child: An Updated Assessment of Program Costs and Cost-Effectiveness.

Behavior disorders (BD) in children can lead to delinquency, antisocial behavior, and mental disorders in adulthood. Evidence-based behavioral parent training (BPT) programs have been developed to treat early-onset BDs, yet cost analyses of BPT are deficient. We provide updated estimates of cost and cost-effectiveness of Helping the Noncompliant Child (HNC), a mastery-based BPT, delivered to low-income families. The cost of research-specific activities was $1,152 per family. HNC program delivery costs were $293 per family from a payer perspective, including the cost of therapist time ($275 per family) and non-labor resources, such as supplies and toys ($18 per family). It costs an average of $6 to improve the Eyberg Child Behavior Inventory intensity score by each additional point or $171 to improve it by one standard deviation. The cost of delivering the HNC program appears to compare favorably with the costs of similar BPT programs.

Health and well-being of male international migrants and non-migrants in Bangladesh: A cross-sectional follow-up study.

BACKGROUND: Temporary labor migration is an increasingly important mode of migration that generates substantial remittance flows, but raises important concerns for migrant well-being. The migration and health literature has seen a growing call for longitudinal, binational surveys that compare migrants to relevant non-migrant counterfactual groups in the sending country, in order to answer the basic question "Is migration good for health?" This study compares the health of male international migrants, internal migrants, and non-migrants using a unique representative panel survey of the Matlab subdistrict of Bangladesh. METHODS AND FINDINGS: A cohort of 5,072 respondents born 1958-1992 were interviewed in 1996-1997, and reinterviewed in 2012-2014. Extensive migrant follow-up yielded a 92% reinterview rate. We explored health and income outcomes for respondents who at the time of the follow-up interview were current international migrants (n = 790), returned international migrants (n = 209), internal migrants (n = 1,260), and non-migrants (n = 2,037). Compared to non-migrants, current international migrants were younger (mean 32.9 years versus 35.8 years), had more schooling (7.6 years versus 5.8 years), and were more likely to have an international migrant father (9.7% versus 4.0%) or brother (49.1% versus 30.3%). We estimated multivariate ordinary least squares and logistic regression models controlling for a wide range of control variables measured as far back as 1982. Results show that current international migrants had substantially better health status on factors that likely relate to self-selection such as grip strength and self-rated health. Current international migrants had no excess risk of injury in the past 12 months compared to non-migrants (adjusted mean risk = 6.0% versus 9.3%, p = 0.084). Compared to non-migrants, current international migrants had roughly twice the risk of overweight/obesity (adjusted mean risk = 51.7% versus 23.3%, p < 0.001), obesity (6.9% versus 3.4%, p = 0.012), and stage 1 or higher hypertension (13.0% versus 7.0%, p = 0.014). Compared to internal migrants, current international migrants had significantly higher levels of overweight/obesity (adjusted mean risk = 51.7% versus 37.7%, p < 0.001). Current international migrants showed above average levels of depressive symptoms on a 12-item standardized short-form Center for Epidemiologic Studies Depression Scale (+0.220 SD, 95% CI 0.098-0.342), significantly higher than internal migrants (-0.028 SD, 95% CI -0.111, 0.055; p < 0.001). Depressive symptoms differed significantly from those reported by non-migrants when restricting to items on negative emotions (international migrant score = 0.254 SD, non-migrant score = 0.056 SD, p = 0.004). Key limitations include the descriptive nature of the analysis, the use of both in-person and phone survey data for international migrants, the long recall period for occupational and mental health risk measures, and the coverage of a single out-migration area of origin. CONCLUSIONS: In this study, we observed that international migrants had comparable or lower injury and mortality risks compared to respondents remaining in Bangladesh, due in part to the high risks present in Bangladesh. International migrants also showed higher levels of self-rated health and physical strength, reflective of positive self-selection into migration. They had substantially higher risks of overweight/obesity, hypertension, and depression. Negative health impacts may reflect the effects of both harsh migration conditions and assimilation into host population conditions. Our results suggest the need for bilateral cooperation to improve the health of guest workers.

Customizing the reduction of individual graphene oxide flakes for precise work function tuning with meV precision.

Being able to precisely control the reduction of two-dimensional graphene oxide films will open exciting opportunities for tailor-making the functionality of nanodevices with on-demand properties. Here we report the meticulously controlled reduction of individual graphene oxide flakes ranging from single to seven layers through controlled laser irradiation. It is found that the reduction can be customized in such a precise way that the film thickness can be accurately thinned with sub-nanometer resolution, facilitated by extraordinary temperature gradients >102 K nm-1 across the interlayers of graphene oxide films. Such precisely controlled reduction provides important pathways towards precision nanotechnology with custom-designed electrical, thermal, optical and chemical properties. We demonstrate that this can be exploited to fine tune the work function of graphene oxide films with unprecedented precision of only a few milli electronvolts.

Ultra-Large-Coupling and Spurious-Free SH0 Plate Acoustic Wave Resonators Based on Thin LiNbO3.

This study lays a foundation for the design of the SH0 plate acoustic wave (PAW) resonators based on LiNbO3 plate, and are applicable to the ultra-wideband filters and next-generation tunable filters. The coupling coefficient ( k2 ) of SH0 mode is optimized to as high as 55% and wideband spurious are well controlled by analyzing the propagation characteristics of plate modes in LiNbO3. The SH0 mode is demonstrated to be slowly dispersive and features the superiority of interdigital transducer (IDT)-defining frequency over most other plate modes. On the device level, the transducer types and electrode materials are investigated and compared. In addition, for edge-reflected SH0 resonators, stopband dispersion analysis is provided and the longitudinal ripples are suppressed. For edge-reflected SH0 resonators, a novel perfect edge reflector is proposed with elimination of longitudinal spurious ripples.

An Electronically Driven Improper Ferroelectric: Tungsten Bronzes as Microstructural Analogs for the Hexagonal Manganites.

Since the observation that the properties of ferroic domain walls (DWs) can differ significantly from the bulk materials in which they are formed, it has been realized that domain wall engineering offers exciting new opportunities for nanoelectronics and nanodevice architectures. Here, a novel improper ferroelectric, CsNbW2 O9 , with the hexagonal tungsten bronze structure, is reported. Powder neutron diffraction and symmetry mode analysis indicate that the improper transition (TC = 1100 K) involves unit cell tripling, reminiscent of the hexagonal rare earth manganites. However, in contrast to the manganites, the symmetry breaking in CsNbW2 O9 is electronically driven (i.e., purely displacive) via the second-order Jahn-Teller effect in contrast to the geometrically driven tilt mechanism of the manganites. Nevertheless CsNbW2 O9 displays the same kinds of domain microstructure as those found in the manganites, such as the characteristic six-domain "cloverleaf" vertices and DW sections with polar discontinuities. The discovery of a completely new material system, with domain patterns already known to generate interesting functionality in the manganites, is important for the emerging field of DW nanoelectronics.

Cost Effectiveness of Strategies for Recruiting Low-Income Families for Behavioral Parent Training.

The goal of this study was to assess cost, effectiveness, and cost-effectiveness of recruitment strategies used to engage low-income families of young children with disruptive behavior disorder to participate in a Behavioral Parent Training (BPT) program. For this analysis, we used data on labor and non-labor resources associated with 13 recruitment strategies implemented in February 2014 through February 2016. We assessed the effectiveness of each strategy as the number of families that enrolled into the study. Cost-effectiveness of each recruitment strategy was expressed as cost per family enrolled; analysis was conducted in 2016. We calculated the cost of total recruitment effort for 13 strategies during the 2-year period to be $11,496 with an average cost of $885 per recruitment strategy or $255 per enrolled family. Across strategies, total costs ranged from $25 to $2,540. "University mass e-mail" and "school flyers" resulted in the most phone screens (34 each); however, only 10% of these families enrolled in the study (3 and 4 families, respectively). "Craigslist" was the most effective strategy with 30 families screened and 11 of them enrolling. Three strategies did not yield any participants. The four strategies with the lowest cost per family enrolled were "Facebook page," "Craigslist," "university mass e-mail," and "organization/agency" (< $90). In conclusion, we found that some recruitment strategies were more successful at engaging low-income families to participate in a BPT program than others. Our results indicate that using a combination of recruitment strategies may be the optimal approach for recruiting low-income families.

Large Carrier Mobilities in ErMnO3 Conducting Domain Walls Revealed by Quantitative Hall-Effect Measurements.

Kelvin probe force microscopy (KPFM) has been used to directly and quantitatively measure Hall voltages, developed at conducting tail-to-tail domain walls in ErMnO3 single crystals, when current is driven in the presence of an approximately perpendicular magnetic field. Measurements across a number of walls, taken using two different atomic force microscope platforms, consistently suggest that the active p-type carriers have unusually large room temperature mobilities of the order of hundreds of square centimeters per volt second. Associated carrier densities were estimated to be of the order of 1013 cm-3. Such mobilities, at room temperature, are high in comparison with both bulk oxide conductors and LaAlO3-SrTiO3 sheet conductors. High carrier mobilities are encouraging for the future of domain-wall nanoelectronics and, significantly, also suggest the feasibility of meaningful investigations into dimensional confinement effects in these novel domain-wall systems.

Hierarchical Cascading Algorithm for 2-D FEM Simulation of Finite SAW Devices.

Application of the finite-element method (FEM) for the simulation of surface acoustic wave (SAW) devices has been constrained by the large number of degrees of freedom required, resulting in large memory usage and long computation times. We propose a new 2-D algorithm that takes advantage of the periodic structure typical of SAW devices. The device is partitioned into small, repeatedly occurring building blocks. Only unique building blocks are simulated with FEM. The device geometry is presented as a hierarchical tree of cascading operations, where smaller blocks are combined into larger blocks. This is equivalent to the full FEM simulation of the device, implying the drastic reduction of memory consumption and simulation time for structures with a high degree of periodicity. The method is verified against FEM/BEM-based software. To ensure accurate and efficient simulation, the boundary conditions should be chosen according to the anisotropy of the substrate crystal.

Heart Failure with Preserved Ejection Fraction: Diagnosis and Management.

Heart failure with preserved ejection fraction, also referred to as diastolic heart failure, causes almost one-half of the 5 million cases of heart failure in the United States. It is more common among older patients and women, and results from abnormalities of active ventricular relaxation and passive ventricular compliance, leading to a decline in stroke volume and cardiac output. Heart failure with preserved ejection fraction should be suspected in patients with typical symptoms (e.g., fatigue, weakness, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, edema) and signs (S3 heart sound, displaced apical pulse, and jugular venous distension) of chronic heart failure. Echocardiographic findings of normal ejection fraction with impaired diastolic function confirm the diagnosis. Measurement of natriuretic peptides is useful in the evaluation of patients with suspected heart failure with preserved ejection fraction in the ambulatory setting. Multiple trials have not found medications to be an effective treatment, except for diuretics. Patients with congestive symptoms should be treated with a diuretic. If hypertension is present, it should be treated according to evidence-based guidelines. Exercise and treatment by multidisciplinary teams may be helpful. Atrial fibrillation should be treated using a rate-control strategy and appropriate anticoagulation. Revascularization should be considered for patients with heart failure with preserved ejection fraction and coronary artery disease. The prognosis is comparable to that of heart failure with reduced ejection fraction and is worsened by higher levels of brain natriuretic peptide, older age, a history of myocardial infarction, and reduced diastolic function.

A Review of the Key Considerations in Mental Health Services Research: A Focus on Low-Income Children and Families.

Children have been particularly vulnerable to the economic challenges of the past decade, with half (45 to 51%) of children under the age of 18 living in a low-income home and nearly 22% of those living in poverty. Low-income children are overrepresented in a range of statistics on psychosocial maladjustment issues, but their families are less likely than other socioeconomic groups to participate in mental health services and intervention research. Thus, this review asserts that substantive advances in mental health services and intervention research with low income families must move beyond a between-group, deficit-focused perspective to a more nuanced contemplation of how to: 1) Operationalize the "income" in low-income families; 2) Disentangle the interrelationship of low income, race, and ethnicity; and 3) Optimize recruitment, engagement and retention efforts via sensitivity to the culture of low-income status. Examples of mental health services and intervention research with low-income families will be discussed, and a summary, conclusions, and directions for future research are discussed in the context of these recommendations.