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Poor waste management is increasingly becoming a major challenge for municipalities, globally. Unlike previous waste management studies in Nigeria, this study examines the implications of waste management to regional greenhouse gas emissions based on awareness levels and perception of urban inhabitants. Benin City was divided into four residential zones: core, intermediate, suburban, and planned estates. Blocking was utilized to collect data from a total of 2720 randomly selected inhabitants through a self-administered survey. Results reveals low awareness level in terms of indiscrimination dumping of waste, thereby promoting sustainable mitigation and adaptation measures region-wide. It is imperative to integrate various aspects of regional government services such as infrastructure, urban planning and development, socioeconomics, public health, and regulation enforcement. Waste management policy is strengthened via working groups, community, and regional authorities.

Preschool aged children with autism spectrum disorder (ASD) have marked deficits in pretend play that impede interactions with typically developing peers in inclusive early childhood settings. This study aimed to teach three young children with ASD to engage in pretend play behaviors with their peers. A multiple probe across participants experimental design was used to evaluate the effects of joint video modeling on scripted and unscripted verbalizations and scripted and unscripted play actions of children with ASD. The participants showed improvement on unscripted verbalizations during pretend play with typically developing peers in an inclusive early childhood setting.

Recent publications on digital health technologies highlight the importance of ‘responsible’ use. References to the concept of responsibility are, however, frequently made without providing clear definitions of responsibility, thus leaving room for ambiguities. Addressing these uncertainties is critical since they might lead to misunderstandings, impacting the quality and safety of healthcare delivery. Therefore, this study investigates how responsibility is interpreted in the context of using digital health technologies, including artificial intelligence (AI), telemonitoring, wearables and mobile apps. We conducted a scoping review with a systematic search in PubMed, Web of Science, Embase, CINAHL and Philosopher’s Index. A total of 34 articles were included and categorized using a theoretical framework of responsibility aspects, and revealed two main findings. First, we found that digital health technologies can expand and shift existing ‘role responsibilities’ among caregivers, patients and technology. Second, moral responsibility is often equated with liability or accountability, without clear justification. Articles describe new ways in which physicians can be held accountable, particularly in the context of AI, and discuss the emergence of a ‘responsibility gap’ where no-one can be fully responsible for AI-generated outcomes. The literature also shows that m-Health technologies can increase patients’ accountability for their own health. However, there was limited discussion in the reviewed literature on whether these attributions of accountability are appropriate. We conclude with implications for practice and suggestions for expanding the theoretical framework of moral responsibility, recommending further study on responsibility of collectives and artificial entities, and on the role of virtue in digital health.

By engaging with family members through video-chat technology, children with autism spectrum disorder (ASD) may access additional opportunities to develop social connections to build familial cohesion and access emotional support. The purpose of this study was to evaluate a behavioral intervention package in teaching social conversation via video-chat. Using a non-concurrent multiple-baseline across participants with an embedded alternating treatments design, three seven-year-old males with ASD were taught two variations of a social conversation. Their conversation skills generalized to unfamiliar adults, some of whom had no prior experience with children with ASD. When visual supports were removed, participants appropriately varied their social conversations. Social conversations continued to occur 2 weeks following the completion of the study. Results and implications are discussed.

We previously conducted a series of conceptual replications to parse out which—and to what degree—adaptations and individualized supports were needed for children to access and learn early reading skills using Headsprout®. Here we developed a systematic decision-making process for providing levels of support to individuals with autism who require additional instruction in order to access and/or advance through Headsprout®. Using a series of single-case AB, ABC, and multiple-baseline designs we examined strategies from our previous research and additional strategies iteratively developed during the study on six students with autism, all of whom demonstrated progression through Headsprout® and increased reading skills. We provide practical implications for teachers and suggestions to research these supports with other computer-based programs.

The composition, ecology and environmental conditions of mesophotic coral ecosystems near the lower limits of their bathymetric distributions remain poorly understood. Here we provide the first in-depth assessment of a lower mesophotic coral community (60–100 m) in the Southern Caribbean through visual submersible surveys, genotyping of coral host-endosymbiont assemblages, temperature monitoring and a growth experiment. The lower mesophotic zone harbored a specialized coral community consisting of predominantly Agaricia grahamae , Agaricia undata and a “deep-water” lineage of Madracis pharensis , with large colonies of these species observed close to their lower distribution limit of ~90 m depth. All three species associated with “deep-specialist” photosynthetic endosymbionts ( Symbiodinium ). Fragments of A. grahamae exhibited growth rates at 60 m similar to those observed for shallow Agaricia colonies (~2–3 cm yr −1 ), but showed bleaching and (partial) mortality when transplanted to 100 m. We propose that the strong reduction of temperature over depth (Δ5°C from 40 to 100 m depth) may play an important contributing role in determining lower depth limits of mesophotic coral communities in this region. Rather than a marginal extension of the reef slope, the lower mesophotic represents a specialized community and as such warrants specific consideration from science and management.

Meta-analyses link childhood trauma to depression, mania, anxiety disorders, and psychosis. It is unclear, however, whether these outcomes truly represent distinct disorders following childhood trauma, or that childhood trauma is associated with admixtures of affective, psychotic, anxiety and manic psychopathology throughout life. We used data from a representative general population sample (NEMESIS-2, n = 6646), of whom respectively 1577 and 1120 had a lifetime diagnosis of mood or anxiety disorder, as well as from a sample of patients with a diagnosis of schizophrenia (GROUP, n = 825). Multinomial logistic regression was used to assess whether childhood trauma was more strongly associated with isolated affective/psychotic/anxiety/manic symptoms than with their admixture. In NEMESIS-2, largely comparable associations were found between childhood trauma and depression, mania, anxiety and psychosis. However, childhood trauma was considerably more strongly associated with their lifetime admixture. These results were confirmed in the patient samples, in which it was consistently found that patients with a history of childhood trauma were more likely to have a combination of multiple symptom domains compared to their non-traumatized counterparts. This pattern was also found in exposed individuals who did not meet criteria for a psychotic, affective or anxiety disorder and who did not seek help for subclinical psychopathology. Childhood trauma increases the likelihood of a specific admixture of affective, anxiety and psychotic symptoms cutting across traditional diagnostic boundaries, and this admixture may already be present in the earliest stages of psychopathology. These findings may have significant aetiological, pathophysiological, diagnostic and clinical repercussions.

Morbidity and mortality from dengue virus (DENV) is rapidly growing in the large populations of south Asia. Few formal evaluations of candidate dengue vaccine candidates have been undertaken in India, Pakistan, or Bangladesh. Tetravalent vaccines must be tested for safety and immunogenicity in all age groups and in those previously exposed and naive to DENV infections. TV005 is a live, attenuated tetravalent dengue vaccine. We evaluated the safety and immunogenicity of a single dose of TV005 across age groups in dengue-endemic Bangladesh. We performed a randomised, placebo-controlled age de-escalating clinical trial of TV005 at a single clinical site in dengue-endemic Dhaka, Bangladesh, following a technology transfer from the USA. Healthy (as determined by history, clinical examination, and safety laboratory test results) volunteers aged 1–50 years were randomly assigned 3:1 (stratified by four age groups) to receive a single dose of TV005 vaccine or placebo. Participants were followed up for 3 years. The study was double blind and was unmasked at day 180; outcome assessors, clinic staff, and volunteers remained blind throughout. Primary outcomes were safety, evaluated per-protocol as proportion of volunteers with solicited related adverse events of any severity through 28 days post dosing, and post-vaccination seropositivity by day 180 using serotype-specific neutralising antibodies (PRNT50 ≥10). Secondary outcomes included viremia, impact of past dengue exposure, and durability of antibody responses. This study is registered with Clinicaltrials.gov, NCT02678455, and is complete. Between March 13, 2016, and Feb 14, 2017, 192 volunteers were enrolled into four age groups (adults [18–50 years; 20 male and 28 female], adolescents [11–17 years; 27 male and 21 female], children [5–10 years; 15 male and 33 female], and young children [1–4 years; 29 male and 19 female]) with 48 participant per group. All participants were Bangladeshi. Vaccination was well tolerated and most adverse events were mild. Rash was the most common vaccine-associated solicited adverse event, in 37 (26%) of 144 vaccine recipients versus six (12%) of 48 placebo recipients; followed by fever in seven (5% of 144) and arthralgias in seven (6% of 108), which were only observed in vaccine recipients. Post-vaccine, volunteers of all ages (n=142) were seropositive to most serotypes with 118 (83%) seropositive to DENV 1, 141 (99%) to DENV 2, 137 (96%) to DENV 3, and 124 (87%) to DENV 4, overall by day 180. Post-vaccination, viraemia was not consistently found and antibody titres were higher (10–15-fold for DENV 1–3 and 1·6-fold for DENV 4) in individuals with past dengue exposure compared with the dengue-naive participants (DENV 1 mean 480 [SD 4·0] vs 32 [2·4], DENV 2 1042 [3·2] vs 105 [3·1], DENV 3 1406 [2·8] vs 129 [4·7], and DENV 4 105 [3·3] vs 65 [3·1], respectively). Antibody titres to all serotypes remained stable in most adults (63–86%) after 3 years of follow-up. However, as expected for individuals without past exposure to dengue, titres for DENV 1, 3, and 4 waned by 3 years in the youngest (1–4 year old) cohort (69% seropositive for DENV 2 and 22–28% seropositive for DENV 1, 3, and 4). With 3 years of follow-up, the single-dose tetravalent dengue vaccine, TV005, was well tolerated and immunogenic for all four serotypes in young children to adults, including individuals with no previous dengue exposure. National Institutes of Health–National Institute of Allergy and Infectious Diseases Intramural Research Program and Johns Hopkins University. For the Bangla translation of the abstract see Supplementary Materials section.

Alcohol consumption, smoking and mood disorders are leading contributors to the global burden of disease and are highly comorbid. Yet, their interrelationships have remained elusive. The aim of this study was to examine the multi-cross-sectional and longitudinal associations between (change in) smoking and alcohol use and (change in) number of depressive symptoms. In this prospective, longitudinal study, 6646 adults from the general population were included with follow-up measurements after 3 and 6 years. Linear mixed-effects models were used to test multi-cross-sectional and longitudinal associations, with smoking behaviour, alcohol use and genetic risk scores for smoking and alcohol use as independent variables and depressive symptoms as dependent variables. In the multi-cross-sectional analysis, smoking status and number of cigarettes per day were positively associated with depressive symptoms ( < 0.001). Moderate drinking was associated with less symptoms of depression compared to non-use ( = 0.011). Longitudinally, decreases in the numbers of cigarettes per day and alcoholic drinks per week as well as alcohol cessation were associated with a reduction of depressive symptoms ( = 0.001-0.028). Results of genetic risk score analyses aligned with these findings. While cross-sectionally smoking and moderate alcohol use show opposing associations with depressive symptoms, decreases in smoking behaviour as well as alcohol consumption are associated with improvements in depressive symptoms over time. Although we cannot infer causality, these results open avenues to further investigate interventions targeting smoking and alcohol behaviours in people suffering from depressive symptoms.