Most Dutch adolescents aged 16 to 18 engage in binge drinking. Previous studies have investigated how parenting dimensions and alcohol-specific parenting practices are related to adolescent alcohol consumption. Mixed results have been obtained on both dimensions and practices, highlighting the complexity of untangling alcohol-related factors. The aim of this study was to investigate (1) whether parents’ reports of parenting dimensions and alcohol-specific parenting practices, adolescents’ perceptions of these dimensions and practices, or a combination are most informative to identify binge drinkers, and (2) which of these parenting dimensions and alcohol-specific parenting practices are most informative to identify binge drinkers.Survey data of 499 adolescent-parent dyads were collected. The computational technique of data mining was used to allow for a data driven exploration of nonlinear relationships. Specifically, a binary classification task, using an alternating decision tree, was conducted and measures regarding the performance of the classifiers are reported after a 10-fold cross-validation.Depending on the parenting dimension or practice, parents’ reports correctly identified the drinking behaviour of 55.8 %  up to 70.2 % (using rules) of adolescents. Adolescents’ perceptions were best at identifying binge drinkers whereas parents’ perceptions were best at identifying non-binge drinkers.Of the parenting dimensions and practices, rules are particularly informative in understanding drinking behaviour. Adolescents’ perceptions and parents’ reports are complementary as they can help identifying binge drinkers and non-binge drinkers respectively, indicating that surveying specific aspects of adolescent-parent dynamics can improve our understanding of complex addictive behaviours. This left Dutch parents in the situation that their children were allowed to buy alcoholic beverages, while parents were still responsible for their child’s health and behaviour (as they were only considered to be an adult as of the age of 18). In such a situation, both parenting in general as well as alcohol-specific parenting practices become highly important.Binge drinking among adolescents  is associated with poor school performance and involvement in other health risk behaviours such as riding with a driver who had been drinking, being a victim of dating violence, and using illicit drugs . In the First, parenting can be viewed more generally as a constellation of attitudes and beliefs that create an emotional climate and determine the interactions between parent and child . The curSecond, there are alcohol-specific parenting practices, such as setting rules and communicating with children about alcohol. These are goal-directed behaviours used by parents to influence their children’s behaviours . In adolescents, perceiving that parents did not approve of drinking was associated with lower levels of heavy episodic drinking . In anotdata mining to explain the complex mechanisms underlying binge drinking  and have the potential to fit numerous interactions that cannot be handled as efficiently with either traditional regression techniques or other pattern centered methods” . Moreover, adolescents from other countries are allowed to buy alcohol at the age of 16  . InvestiOf the parenting dimensions and practices, rules are particularly informative in understanding drinking behaviour. Adolescents’ perceptions and parents’ reports are complementary as they can help identifying binge drinkers and non-binge drinkers respectively, indicating that surveying specific aspects of adolescent-parent dynamics can improve our understanding of complex addictive behaviours.


We propose to optimize adiabatic and pulse train saturation pulses for quantitative T1 mapping to have <1 % absolute residual longitudinal magnetization (|MZ/M0|) over ranges of B0 and 1 scale factor) inhomogeneity found at 1.5 T and 3 T.Quantitative saturation-recovery based T0 (±120 Hz) and 1 values, field inhomogeneities  technique with a standard 90°-90°-90° and an optimized 6-pulse train.Design parameters for an adiabatic BIR4-90 pulse were optimized for improved performance within 1.5 T BZ/M0 in phantoms had excellent agreement with simulations over a wide range of B0 and Z/M0| to <1 %, a 5.8× reduction compared to a reference BIR4-90. An optimized 3-pulse train achieved a maximum residual |MZ/M0| <1 % for the 1.5 T optimization range compared to 11.3 % for a standard 90°-90°-90° pulse train, while a 6-pulse train met this target for the wider 3 T ranges of B0 and 1 maps were more spatially homogeneous with 6-pulse train SASHA than the reference 90°-90°-90° SASHA in both human and animal studies.Measured residual MZ/M0| in phantom experiments, enabling greater accuracy in quantitative saturation recovery T1 imaging.Adiabatic and pulse train saturation pulses optimized for different constraints found at 1.5 T and 3 T achieved <1 % residual |MThe online version of this article (doi:10.1186/s12968-015-0187-0) contains supplementary material, which is available to authorized users. Several methods for T1 quantification in the heart are based on multiple image acquisitions with variable saturation recovery times such as the saturation recovery turbo flash (SRTFL) }, where η is the saturation efficiency and residual (signed) MZ/M0 is equal to 1-η. These acquisitions were repeated 9 times with the flip angles of the saturation RF pulses scaled by 40–120 % to emulate the effect of varied Saturation pulse efficiency was calculated using a gradient echo sequence with 3.79 ms TE, 3000 ms TR, 90° flip angle, and other parameters as above. Images were acquired without a saturation pulse and with 4 saturation recovery times (TS = 10–40 ms) for each of the 5 saturation pulses, where TS is defined as the time from the end of the last RF pulse in the saturation and the middle of the imaging excitation RF pulse. A saturation efficiency map was generated by fitting acquired data to {Signal = A*[1 - ηexp and relaxation values emulating myocardium  and blood  at 1.5 T [1 error with two parameter fitting as previously described [x) for π/90 < x < π/2. Simulations used actual RF pulse waveforms and the transverse magnetization (MXY) at the centre k-space readout as the image signal intensity. T1 values were calculated by fitting simulated data to a 2-parameter exponential recovery model with assumed ideal saturation.Bloch equation simulations of the SASHA sequence were performed with a range of residual Mat 1.5 T . Typical2 field of view, and 10 mm slice thickness. Saturation recovery images were acquired for the 90°-90°-90°, 1.5 T 4-pulse, 3 T 6-pulse, reference BIR4-90, and optimized BIR4-90 saturation pulses with a 7.5 ms saturation recovery time, defined from the end of the last saturation RF pulse to the center of the first imaging RF pulse. A proton density image was acquired with the same pulse sequence parameters. All images were obtained in short-axis and 4-chamber orientations, acquired in diastasis with end-expiratory breath-holds.Saturation efficiency was assessed in 3 human volunteers on a Siemens 3 T MAGNETOM Skyra MRI scanner  using a single-shot centrically ordered gradient echo sequence. Volunteers provided written informed consent and the study was approved by the University of Virginia Health System Institutional Review Board. Typical sequence parameters were: 1.14/2.31 ms TE/TR, 10° flip angle, 128 × 90 matrix, 400 × 281 mmZ/M0 was calculated as the ratio of the saturation recovery image to the proton density image.Saturation recovery images were processed using a phase-sensitive reconstruction using the proton density image phase as a reference in order to avoid Rician noise bias. The residual M2 field of view, 10 mm slice thickness, 2 saturation bands on the chest and back to reduce the field of view, and 15 repetitions per flip angle. All images were registered and a 45° and I90° are the signal intensities from the 45° and 90° flip angle images respectively.e method  with sin1 maps were collected using SASHA with 90°-90°-90°, optimized BIR4-90, and 6-pulse saturation and MOLLI with an optimized adiabatic inversion pulse [Ton pulse  in diaston pulse  and MOLL1 mapping was performed on a 66 kg swine on a Siemens 3 T Skyra MRI scanner using the SASHA and MOLLI [1 mapping sequences. SASHA was acquired using both 90°-90°-90° and 6-pulse saturation with a 45° imaging flip angle and VFA modulation. MOLLI used an optimized inversion pulse with a 20° imaging flip angle. A Myocardial Tnd MOLLI  T1 mappi1 field strength was calculated for 379 subjects on the Siemens MAGNETOM Skyra platform and 230 subjects on the Siemens MAGNETOM Aera platform. A maximum B1 field strength of 14 μT was achievable on the 3 T Skyra platform in >98 % of subjects, while 26.9 μT was achievable on the 1.5 T Aera platform in >99 % of subjects. At a B1 strength of 14 μT, a 90° rectangular pulse is 419 μs and the full width half maximum effective B1 scaling is ±1334 Hz.The maximum B1 field of 20.6 μT, swept over ±7 kHz, with ζ = 22 and tan(κ) = 18. This design is longer and has a lower maximum B1 compared to the reference BIR4-90 pulse that has a 4.00 ms duration and a maximum B1 of 25.1 μT, resulting in lower relative peak RF energy and power  achieved the target residual |MZ/M0| of <1 %, while 6 pulses (115°-90°-125°-85°-176°-223°) were necessary to achieve this target for the 3 T optimization range due to the larger Z/M0| increased rapidly outside of the optimization region. Minor off-resonance and T1 effects were also observed, but did not have a consistent trend over the range , but residual |MZ/M0| increases rapidly for T1 values shorter than 25 ms for all pulse trains, with divergent behavior depending on the Z/M0| exceeding 15 % for a 50 ms T1. The 3 T 6-pulse train maintains |MZ/M0| < 1 % for T1 greater than 186 ms at ±240 Hz and for T1 greater than 140 ms at ±120 Hz. The optimized BIR4-90 pulse had the best performance at short T1 values, with 1.6 % residual |MZ/M0| at 25 ms.Simulated residual M2 relaxation on residual MZ/M0 are shown for the optimized 3 T 6-pulse train and BIR4-90 saturation pulses in Fig. 2 relaxation and the optimized BIR4-90 pulse had less than a 1 % change in residual MZ/M0 for T2 values from 25 to 250 ms.The effects of T1 and T2 of the bottle phantom was measured to be 316 ms and 274 ms respectively using spin echo experiments, and the intrinsic 0 and 0 and The TZ/M0 , and 6 pulse (3 T) trains respectively.Experimentally measured residual MZ/M0 and simulated T1 errors in the SASHA sequence. SASHA T1s are generally underestimated with incomplete saturation, with a 1.3–1.6 % increase in 2-parameter SASHA T1 error for every 1 % change in residual MZ/M0. A higher heart rate of 100 bpm results in greater SASHA T1 errors for native (pre-contrast) T1/T2 values compared to 60 bpm, with negligible effects for post-contrast values. Overall, 2-parameter model fitting results in greater T1 error dependence on residual MZ/M0 than 3-parameter fitting, particularly for the lower post-contrast T1/T2 values.Figure Z/M0 maps from one subject are shown in Fig. Z/M0 values for the 90°-90°-90° and reference BIR4-90 pulses. A similar spatial pattern was observed in all subjects, although there was considerable variability in Z/M0 than the reference BIR4-90 pulse in the myocardium (2.8 ± 1.1 % vs 6.1 ± 3.1 %) as well as in the blood pool. The 6-pulse train had the lowest overall residual MZ/M0 in the myocardium (1.8 ± 0.3 %) and significantly more uniform saturation over the entire body .Calculated in-vivo T1 and 1 values from the 90°-90°-90° SASHA and MOLLI sequences show a >50 % artifactual decrease in the lateral wall, spatially coinciding with reduced 1 values using the 6-pulse SASHA sequence were more spatially uniform across both the myocardium  and the overall field of view.Parametric TZ/M0| for the wide ranges of 0 inhomogeneities expected at these field strengths, while imposing the typical peak B1 field amplitude limitations measured on 1.5 T and 3 T scanners. New pulses were shown to have significantly improved saturation performance as compared to current standard pulses. Measured saturation performance in phantoms had excellent agreement with simulations and in-vivo experiments demonstrated the superior performance of the proposed 6-pulse train saturation pulse. T1 maps calculated using SASHA with proposed 6-pulse train saturation showed greater spatial homogeneity than the reference pulse in both human and swine studies.In this study, adiabatic BIR4-90 and pulse train saturation designs were optimized for 1.5 T and 3 T with the objective of achieving <1 % residual |MZ/M0| over the 1.5 T optimization range of B0 and 1 field strength and resulting SAR. Although the required B1 of 20.6 μT was achievable on the 1.5 T MRI systems used here, the 14 μT B1 limit at 3 T reduces the effective flip angle and saturation performance. In the 3 T human study, the optimized BIR4-90 SASHA had 1.6 % shorter myocardial T1 values than 6-pulse SASHA, consistent with T1 underestimation from slightly larger residual MZ/M0.Experimental data in this study shows the reference BIR4-90 saturation pulse has relatively poor performance with low Z/M0| by a factor of 5.7× from the best order permutation to the worst. The evaluation of all permutations of an unordered flip angle set in the minimization subroutine provided a straightforward means of considering flip angle ordering while avoiding trapping within local minima. This is likely to provide a more optimal solution than the previous minimization approach which considered ordering only in the final stage [The ordering of flip angles in saturation pulse trains was found to be important, with a reduction in the maximum residual |Mal stage .Z/M0 in a phantom closely matched simulations for both the adiabatic BIR4-90 pulses as well as all saturation pulse trains, confirming the validity of the Bloch equation simulations used in the design process.Pulse trains were designed for expected ranges of entclass1pt{minimaZ/M0| by 14×, meeting the target of <1 %. The 4-pulse train has even better performance with <0.25 % peak residual magnetization , with minimal additional time and SAR.For the The design  studies , 14, 21.Z/M0| of 0.27 %) and only 1.4× greater peak RF power compared to the 90°-90°-90° reference pulse train. The relatively short RF pulse durations used in the pulse trains resulted in a wide range of B0 insensitivity for all pulse train designs, with a negligible drop in measured performance at ±450 Hz  than in the left ventricle, but the difference was much lower (57 ± 13 ms) with 6-pulse SASHA which had more spatially uniform saturation. This remaining difference between the left and right ventricular blood with 6-pulse SASHA is comparable to a difference of ~80 ms between atrial and venous blood with a 0.42 hematocrit previously reported at 3 T [1 values compared to SASHA are consistent with known influences of factors such as T2, magnetization transfer, and off-resonance on the MOLLI sequence [Simulations of 2-parameter fitting with SASHA data show increased sensitivity to saturation pulse performance compared to 3-parameter fitting. In human studies, there was consistently lower d at 3 T . Shorter1 values for both the 90°-90°-90° SASHA and MOLLI sequences while 6-pulse SASHA had spatially homogenous T1s. SASHA with a 6-pulse saturation may provide more reliable T1 measurements in pre-clinical large animal studies at 3 T, but further study is needed to determine the impact on the quantification of myocardial fibrosis.Substantially larger Gradient spoiler design and its effect on the possible formation of stimulated echoes were not studied in detail. The proposed spoiler design utilizes relatively large gradient areas played in multiple directions, with care taken to avoid duplicate gradient areas. While no stimulated echo artifacts were observed in our data, a more systematic study of stimulated echo formation is warranted.Z/M0 was measured in-vivo using images with a saturation recovery time of 7.5 ms, which was the minimal duration due to the length of post-saturation spoiler gradient for the reference BIR4-90 pulse. Calculated residual MZ/M0 values are likely to have a small positive bias due to T1 recovery during this duration. Although centric ordering was used, T1 recovery during the readout results in a further positive bias and may explain the larger residual MZ/M0 in the LV myocardium compared to the blood pool it encloses.Residual MIn-vivo measurements in this study were limited to 3 human subjects and a single animal. However, the magnitude and spatial pattern of terature  and \docZ/M0| at 1.5 T, only the optimized 6-pulse train met the criteria for B0 and 1 values, and This study has described the optimization of saturation pulses and validated their performance in both phantom experiments and in-vivo studies. While an optimized BIR4-90 design and a 3-pulse train were able to meet the design criteria of <1 % residual |M


Most studies on alcohol consumption carried out in Sri Lanka are limited to single/few provinces in the island. The objective of this study was to determine the prevalence, patterns and correlates of alcohol consumption among a larger sample of adults in Sri Lanka.This cross-sectional study was conducted in seven of all nine provinces in Sri Lanka, between 2005 and 2006. A nationally representative sample of 5000 adults aged ≥18 years was selected using multi-stage random cluster sampling. Data of 4532 participants were collected using an interviewer administered questionnaire. Data analysis included chi-squared test, multiple logistic regression analysis and Spearman correlation using Stata/SE 10.0  software package.Males were 40%; mean age was 46.1 years (±15.1). The overall, urban and rural prevalence (95% CI) of current drinking was 23.7% (21.7 – 25.7), 29.5% (25.7 – 33.3) and 22.2% (19.8 – 24.7) respectively (p = 0.001). Current  and former  drinking was much higher in males. The highest prevalence of drinking in males (58.9%) and females (2.2%) was in the 30 – 39 and <20 year age groups respectively. Lowest prevalence in men (24.6%) and women (0%) was in the >70 years age-group. Hazardous drinking was seen in 5.2% of men and 0.02% of women. Male sex, urban living and current smoking correlated with both current and hazardous drinking. Lower level of education, and age >70 years positively correlated with hazardous drinking.Alcohol is predominantly a problem in Sri Lankan males. In males, both current and hazardous drinking positively correlated with urban living, white collar occupation, Burgher ethnicity and current smoking. Hazardous drinking positively correlated with lower level of education and older age. The data shown here are useful in planning interventions simultaneously targeting alcohol and tobacco. According to the World Health Organization (WHO) estimations; two billion people worldwide consume alcohol and 76.3 million are afflicted with diagnosable alcohol use disorders . The WHOCocos nucifera), palmyrah (Borassus flabellifer) or ‘;Kitul’ (Caryota urens). The use of alcoholic spirits became popular after Sri Lanka was colonized by the Europeans: starting with the Portuguese in 1505, followed by the Dutch and the English. This trend continued since gaining independence in 1948 [Sri Lanka is a middle income country with a population of 20 million people . HistoriAccording to the WHO Gender, Alcohol and Culture: An International Study (GENACIS) in 2002 n = 1201), 53.1% of the men and 6.4% of women in Sri Lanka were current drinkers  . Few oth01, 53.1%Sri Lanka is undergoing a rapid socio-demographic transition ,18. A stThe Sri Lanka Diabetes and Cardiovascular Study (SLDCS) was conducted by the Diabetes Research Unit of the University of Colombo with the Oxford Centre for Diabetes Endocrinology and Metabolism UK, and was approved by the Ethical Review committee of the Faculty of Medicine - University of Colombo, Sri Lanka. All participants provided informed written consent. Data collection was between August 2005 and September 2006.SLDCS was conducted, in seven of all nine provinces in Sri Lanka and included non-institutionalized adults aged 18 years and above (≥18 years). The sample was selected using a cross sectional multistage random cluster sampling method. The total sample frame was approximately 14 million adults, ≥18 years of age living in 12 018 ‘;Village Officer’ units . A final sample size of 5000 was calculated after adjusting for an estimated non-response rate of 25%. Probability-proportional to-size (PPS) technique was used to determine the sample sizes for individual provinces and rural and urban sectors in each province. The total sample was recruited from 100 clusters, where clusters were selected by a computer-generated random number list from the ‘;Village Office Units’. Fifty households from each cluster were selected to ensure a wider representation of the population. Selected households were visited by the study team and simple random selection of participants was done after informed verbal consent. An eligible adult, aged ≥18 years was selected from all eligible adults of each consenting household. Those who were pregnant, acutely ill or who declined participation were excluded. Detailed method of sampling and data collection has been reported previously .Temporary data collection centers were established within each cluster. The selected subjects were invited to visit the centers at a predetermined date and time. Privacy and confidentiality was strictly maintained during data collection. An interviewer administered questionnaire  either every day or on some days at the time of the study, within the preceding 6 months. Those who had successfully quit at least 6 months before the data collection were considered ‘;ex-smokers’ and those who have not smoked tobacco were considered ‘;never smokers’ .Sinhalese are the predominant ethnic group in Sri Lanka, followed by the Sri Lankan Tamils (Descendants from South India over many centuries) and Sri Lankan Moor (descendants of Arab traders who are followers of Islam). Plantation Tamil (People arrived from South India during the last century for Tea and Rubber plantation) and Burgher (Descendants of Dutch settlers) are other minority groups.Income levels were categorized based on monthly family income in Sri Lankan rupees (LKR). International Standard Classification of Occupation (ISCO 88) was used to categorize the occupation of the participants. Educational level was divided into three categories based on number of years of full time education (school or higher education). Urban and rural sectors were selected according to the categorization by the Sri Lankan Government.All data were double-entered and cross checked for consistency. Data were analyzed using the survey commands in Stata/SE 10.0  software package taking into account the stratified cluster sampling . SamplinAmong the 5000 selected, 4532 participated in the study with a response rate of 91%. This report is based on 4491 participants with complete data. The mean age of the sample was 46.13 ± 15.1 years. Males were 40% n = 1788) of the total sample and 17.7% of them were from the urban sector. In the study sample 85.4% were Sinhalese, 3.6% Sri Lankan Tamil, 3.8% Plantation Tamil, 6.9% Sri Lankan Moor and 0.3% were others. According to the 2001 census in Sri Lanka, urban population was 15% and the proportionate population sizes of Sinhalese (82%), Sri Lankan Tamils (4.3%), Plantation Tamils (5.1%), Sri Lankan Moor (7.9%) and others (0.7%) closely resembled the distribution in the sample [8 of the Overall, 65.7%  were lifetime abstainers . The total prevalence of current and former alcohol use was 23.7%  and 10.6% (95% CI 9.4 – 11.9%) respectively  was in the 30 – 39 year age group while those more than 70 years had the lowest, with the prevalence declining after 60 years of age Table . In womeAmong the current drinkers in this study, 80% consumed less than 7 units of alcohol per week . Only one woman reported consuming more than 7 units per week in the whole sample. Among drinking men, 79% consumed less than 7 units per week. However, the second highest prevalence was seen in the >21 units category. Both overall and males drinking at intermediate levels were less than these two categories. In this sample, the prevalence of overall, male and female hazardous drinking were 2.5% , 5.2% (95% CI 3.9 – 6.4%) and 0.02% (95% CI 0.018 – 0.055%) respectively  Table . In contHazardous drinking was very low in women. In men, the pattern of hazardous drinking was different to the pattern of current drinking among different levels of education. The group with the lowest level of education among males had the highest prevalence (8.5%) of hazardous drinking. Male ‘;senior managers and officials’ had the highest levels of hazardous drinking (11.1%) followed by the ‘;elementary occupations’ (7.3%). There were no participants with hazardous drinking among male ‘;professionals’ and only a few from ‘;armed forces’. Among the income categories; in males, higher prevalence of hazardous alcohol consumption was seen both in lower and higher income groups with the middle income groups having a lower prevalence.Among the current smokers 70.1% were also drinking alcohol with 9.8% drinking at hazardous levels Table . Among tSince the number of female drinkers was very low, results of multiple logistic regression analysis are presented with adjusted odds ratios (OR) only for males. Current drinking was strongly associated with middle level of education (OR) 1.4 (95% CI 0.9-1.8) and high monthly income (OR) 2.2 (95% CI 0.8-5.9) (Table 9) Table . HazardoThe current alcohol use among males and females was 48.1% and 1.2% respectively. According to this study 65.7% were lifetime abstainers. A similar large study, conducted by the WHO for the World Health Survey (WHS -2003) in 2003 reported prevalence of 83.4%, 32.5% and 1.8% for overall abstinence, male current drinking and female current drinking respectively . TherefoAccording to the WHS -2003, the overall, male and female lifetime abstinence in India was 89.6%, 80.2% and 98.4% respectively . AnotherOur study showed that the middle aged males and young females have higher frequencies of drinking. The age specific alcohol consumption among males in our study is similar to the WHO GENACIS study conducted in Sri Lanka in 2002 and many other regional studies ,28-30. HAccording to our data, the majority of Sri Lankan adults; 79% of men and almost all women who consume alcohol drink less than 7 units per week on average. These data are similar to the previous findings from the WHO GENACIS study . In contIn the present study the highest prevalence of drinking in males was seen in those with medium level of education. In women, the highest current drinking was in those with the highest level of education. In contrast the hazardous drinking in males was highest in those with the lowest level of education. Our data for current drinking and education in males compares with the previous data from the WHO GENACIS study but was different in women in whom the highest prevalence of drinking was in those with middle level of education . SimilarAmong the different income groups, current drinking was higher in those with higher levels of income both in men and women. In contrast among males, hazardous drinking was equally high in both the higher and lower income groups with middle income groups having the lower prevalence. This has not been described in the previous studies on alcohol in Sri Lanka but similar pattern has been described both for current drinking and high risk drinking among the Australians . In contThe current smoking prevalence is 38.0% among males and 0.1% among females older than 18 years in Sri Lanka . Our stuThe main strength of this study is the recruitment of a representative sample via cluster sampling with good response rate (91%). There are several limitations. Due to the prevailed war situation in the North and the East, the data on Sri Lankan Tamil and Moor ethnicities living on the other parts of the country may not represent the real picture on those ethnic groups. Comparisons and conclusions on certain ethnicities and occupations could have been affected due to the effect of small sample size. We classified those who have been drinking within the preceding six months as current drinkers. In other studies this was usually one year. This can underestimate the prevalence of current drinking compared to other studies. Alcohol is a social taboo especially among women in Sri Lanka. Therefore, there is a possibility of under reporting of current drinking among women although we used experienced and trained interviewers. Anecdotally there are small isolated pockets of high prevalence of female drinking in the North Western province in Sri Lanka. These pockets were not selected in the random selection process in our study. However since this is a very minor proportion of the overall Sri Lankan population, the effect on the overall results would be minimal. The alcohol content in illicit beverages is not standardized and, this may affect the accuracy of the calculation of units. Unavailability of drinking status of the 9% non-responders, recording only the total units of alcohol without the types of alcoholic drink and the drinking frequencies during data collection were among the other limitations.The findings shown in this study have several implications in the management and prevention of alcohol use among adults in Sri Lanka. Nearly 50% of the males are current drinkers. This is unacceptably high in a predominantly Asian Buddhist culture which discourages use of alcohol according to the religion and cultural norms. The high prevalence of drinking in the higher social strata  both among men and women shows increasingly high acceptance of drinking even among women. These patterns can set unacceptable examples among wider community in Sri Lanka. Although highly educated people tend to avoid hazardous drinking, higher percentages of them continue to be current drinkers. In contrast higher percentages of poor and less educated indulged in hazardous drinking although the overall prevalence of alcohol consumption was lower than the highly educated. We feel that this can trigger a vicious cycle of increasing poverty, violence, fragmentation of families and other harmful consequences of alcohol abuse in the poor and less educated segments in the society compared to the educated. All highly educated were not rich, as income levels do not always increase with the level of education in Sri Lanka . This explains why hazardous and current drinking was evenly spread over all income categories. Multiple factors may have contributed to higher current drinking in the urban educated groups. They have a higher disposable income, more opportunities for consumption in terms of social gatherings, and also use alcohol as a means of socializing during business meetings.The associations between smoking and drinking indicate that those who continue one habit continues the other and those who give up tend to give up both. This phenomenon needs to be taken into consideration in future preventive programmes on smoking and drinking cessation and prevention.In summary, this study has presented new data on alcohol consumption epidemiology for Sri Lankan adults with insights to preventive action. There has been a change in the patterns of alcohol use in women with the prevalence being higher in the younger, more educated and affluent women compared to the previous studies. Nearly half of the adult males consume alcohol in Sri Lanka. Future action on prevention and control of alcohol use needs to focus on these new data and the risk factors for drinking in the Sri Lankan population. Effective interventions to prevent the rising prevalence of drinking in males and in educated high income women, will most likely help avert an epidemic of drinking in Sri Lanka.WHO: World Health Organisation; GENACIS: Gender, Alcohol and Culture: An International Study; SLDCS: Sri Lanka Diabetes and Cardiovascular Study; LKR: Sri Lankan Rupees; ISCO: International Standard Classification of Occupation; USA: Untied States of America; UK: United Kingdom.The authors declare that they have no competing interests.PK participated in the design of the study, data collection, examining the participants, performed the statistical analysis and drafted the manuscript. NK, AR did data collection, examining the participants and helped to draft the manuscript. CR, RS, DM participated in its design and helped to draft the manuscript. All authors read and approved the final manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/14/612/prepubSri Lanka Diabetes and Cardiovascular diseases Study (SLDCS) -Questionnaire. Interviewer administered questionnaire used to collect data.Click here for fileQuantification of Units of alcohol consumed within a week. Annexure to the main questionnaire. Each interviewer carried this annexure to help calculate the units of alcohol consumed.Click here for fileCalculation of the number of units of different types of alcohol in Sri Lanka- Reference table carried by each interviewer.Click here for file


During a pilot project in Tanzania’s Iringa region, more than 2,000 male infants were circumcised in less than 2 years in 8 facilities, representing 16.4% of all male births in those facilities. The age of the infant at circumcision and the time of return for follow-up visits varied significantly between urban and rural dwellers. Early infant male circumcision (EIMC) outreach activities and use of health outposts for follow-up visits should be explored to overcome these geographic barriers. EIMC programs will also require targeted investments in demand creation, especially among fathers, to expand and thrive in traditionally non-circumcising settings such as Iringa. During a pilot project in Tanzania’s Iringa region, more than 2,000 male infants were circumcised in less than 2 years in 8 facilities, representing 16.4% of all male births in those facilities. The age of the infant at circumcision and the time of return for follow-up visits varied significantly between urban and rural dwellers. Early infant male circumcision (EIMC) outreach activities and use of health outposts for follow-up visits should be explored to overcome these geographic barriers. EIMC programs will also require targeted investments in demand creation, especially among fathers, to expand and thrive in traditionally non-circumcising settings such as Iringa. Iringa region of Tanzania has had great success reaching targets for voluntary medical male circumcision (VMMC). Looking to sustain high coverage of male circumcision, the government introduced a pilot project to offer early infant male circumcision (EIMC) in Iringa in 2013. From April 2013 to December 2014, a total of 2,084 male infants were circumcised in 8 health facilities in the region, representing 16.4% of all male infants born in those facilities. Most circumcisions took place 7 days or more after birth. The procedure proved safe, with only 3 mild and 3 moderate adverse events . Overall, 93% of infants were brought back for a second-day visit and 71% for a seventh-day visit. These percentages varied significantly by urban and rural residence . Mothers were more likely than fathers to have received information about EIMC. However, fathers tended to be key decision makers regarding circumcision of their sons. This suggests the importance of addressing fathers with behavioral change communication about EIMC. Successes in scaling up VMMC services in Iringa did not translate into immediate acceptability of EIMC. EIMC programs will require targeted investments in demand creation to expand and thrive in traditionally non-circumcising settings such as Iringa. Four more sites were added in April 2014 . From thIn the pilot program, EIMC services were offered in the outpatient reproductive and child health (RCH) services and conducted by health care providers who routinely provide services in the RCH or maternity ward. Counseling on EIMC, using standardized information from job aids, took place during antenatal care (ANC), maternity care, and/or postpartum care as well as during well-baby visits. Parents who heard of EIMC through counseling, community workers, or radio advertisements requested to have their child circumcised and were given appointments. Before the circumcision, parents/guardians were individually counseled on the risks and benefits of EIMC, offered HIV testing and counseling for themselves and their infants, informed about postoperative care, and asked to sign a written consent statement authorizing the procedure. The services were offered 3 to 5 days a week, depending on the facility. Parents were instructed to bring their infants back for follow-up on day 2 and day 7 after the circumcision procedure.Iringa region was selected to host the EIMC pilot program as it was near to achieving the adult VMMC targets. It was unclear to what extent the gains in adult VMMC would translate into support for infant male circumcision; historically, the non-Muslim communities of Iringa region do not circumcise male infants. This paper presents findings from a quantitative and qualitative study conducted among users of the EIMC services and parents and guardians in the communities surrounding the EIMC pilot facilities. Demographic characteristics of clients in the EIMC pilot program are described, including the timing of circumcision and attendance at follow-up visits, as well as key qualitative findings associated with EIMC decision making. This paper aims to provide information to help guide rollout of EIMC services in Tanzania and similar settings in sub-Saharan Africa.We conducted a cross-sectional study, using qualitative and quantitative methods, from May through August 2014. We conducted qualitative interviews with parents and guardians of EIMC clients in the 4 original pilot facilities as well as a review of EIMC patient files. The MOHSW and the regional authorities participated in selecting the EIMC pilot facilities, based on facility assessments that considered the number of deliveries in facilities (preference was given to higher volume), available human resources, availability of space, and capability for instrument processing/sterilization.The qualitative component of the study took place between May and August 2014 in the original 4 pilot facilities: Ipogolo Health Centre, Iringa Regional Referral Hospital, Tosamaganga Hospital, and Ilula Lutheran Hospital.Study participants were parents/guardians receiving antenatal care service, parents/guardians of infants circumcised in the EIMC facilities, and parents/guardians who brought their male infants to RCH services and received information about EIMC but chose not to have the infants circumcised within 60 days of birth. We invited study participants to attend focus group discussions (FGDs). We conducted separate FGDs with the parents/guardians who had the infants circumcised through EIMC services (EIMC acceptors) and with parents/guardians who decided not to circumcise the infants through EIMC services (EIMC non-acceptors).Parents and guardians who were recruited for the study during ANC services were followed over time until 2 months after the birth of the infants; they were then grouped in the FGDs as acceptors or non-acceptors, depending on their decision to circumcise the infants. All study participants were 18 years old or older, lived within a study health facility catchment area, and consented to participate in the research. We held 24 FGDs, with a range of 4 to 10 participants per FGD and an average of 7 participants. In all, 165 people took part in FGDs .EIMC acceptors were recruited for FGDs on the day that the infants were circumcised and given an FGD appointment for a date within 2 weeks. They received reminders about the FGD 7 days after the circumcision, when parents or guardians brought the infants for the EIMC day 7 follow-up visit. FGD appointments for EIMC non-acceptors were scheduled within 2 weeks of recruitment.Experienced and trained researchers conducted the FGDs in Kiswahili, using separate structured FGD guides for EIMC acceptors and for EIMC non-acceptors. These guides used open-ended questions to explore perspectives on decision making about EIMC.,The training for all study staff included research ethics and informed consent. All discussions were audio recorded, transcribed in Kiswahili, and then translated into English. Codes were grouped into categories, and emerging themes were then identified iteratively following the principles of grounded theory.Stata Statistical Software: Release 13. College Station, TX: StataCorp LP). Variables of interest included location of birth, location of circumcision, number of days of age at circumcision, follow-up appointments at 2 days and 7 days, rural versus urban residence of the mother, HIV status of the mother, and adverse events occurring during or after circumcision.The quantitative component of the study involved reviewing the records of EIMC clients in all 8 pilot facilities . During the pilot project, providers filled in MOHSW-approved EIMC client record forms, which were kept at each facility. These records were stripped of identifiers and entered into a program monitoring database. The de-identified client records were pulled from the program database and imported for analysis into Stata statistical software (StataCorp. 2013. 2) tests for statistical significance of the observed difference. We conducted bivariate logistic regression to determine the odds of returning to the clinic for the infant’s follow-up care among mothers residing in urban locations and those in rural locations. The outcome variable was whether the infant was brought back for the follow-up visit, and the independent/predictive variable was rural/urban residence.Using Stata, we conducted both descriptive analysis and bivariate logistic regression. Descriptive analysis was used to determine mean age of the infants and standard deviation. We used frequencies to describe key characteristics of EIMC clients, with comparisons among facilities, by urban and rural residence, and by infant’s age at circumcision. For comparison of 2 proportions, we used chi-square  and the Tanzania National Institute of Medical Research (NIMR/HQ/R.8a/Vol.IX/1684) conducted ethical oversight of the study with support from the Iringa regional medical authorities.P<.001) (P<.001) .Of the 12,678 male infants born in the 8 facilities, 16.4% were circumcised through the pilot program.As As P<.001). The greatest difference, however, was seen in attendance at the day 7 follow-up visit; 49.9% among rural mothers compared with 82.2% among urban mothers (P<.001). On the day of circumcision, 77.5% of the infants were brought by mothers or female guardians alone , and 22.5% were brought by both parents . Rural-dwelling parents were more likely to bring the infant together   .More than three-quarters (78%) of parents/guardians had heard of these services in a health facility setting, most often the labor and delivery ward  and the RCH clinic . Another 14% said they had heard about these services from the radio, 5% from a friend or relative, and 3% from a peer educator .More than three-quarters of parents/guardians had heard of EIMC services in a health facility.Six adverse events occurred among the 2,084 circumcisions conducted in the pilot project, for an overall AE rate of 0.4%. All AEs occurred during the circumcision procedure (intraoperatively). They included mild bleeding (n = 3), moderate bleeding (n = 1), and mild/excessive skin removal (n = 2). The AEs, which occurred in 2 of the 8 pilot facilities, occurred in procedures performed by assistant medical officers (2 AEs) and nurses (4 AEs). All AEs resolved completely. All providers performing EIMC in the pilot project had attended a competence-based 5-day training using a WHO Manual for EIMC.The quotes from themes presented in this paper address decision making. Other themes that emerged, including gender and satisfaction, will be presented in upcoming papers.In keeping with the program model, participants in the FGDs said that when the mother had been counseled on EIMC as part of her RCH services, she was the one who provided information about EIMC to her partner as part of the family decision-making process. This was heard from both the female and male FGD participants: Most male “acceptors” indicated that they had heard about EIMC from their wives.I got the [EIMC-related] information from my wife after she was advised by the doctors here. —EIMC male acceptor, Iringa Referral HospitalAlthough women were characterized as bringing information about EIMC into the home, more than 80% of women in both the acceptor and non-acceptor FGDs referred to the father as the decision maker about whether the child would be circumcised.It’s true that dads are the problem. If the man says the child won’t be circumcised till he turns 2 years, it will be like that no matter what. And I have no power to force it other way ‘round. —EIMC female non-acceptor, Iringa Referral HospitalMore than 80% of women said the father was the decision maker about their infant’s circumcision.Among female non-acceptors, more than 60% in FGDs indicated that they had wanted their son to be circumcised, but the father refused.I feel badly.… I wanted to circumcise him soon after birth, but his father refused because he said he is still young, wait until he grows up. —EIMC female non-acceptor, Ipogolo Health CentreAmong some acceptors, decision makers involved the extended family, including the grandparents.First of all I talked to my husband. Secondly I talked with parents of both sides who are in-laws…. When they all agreed, then I made a decision to circumcise him.… Because this child has a grandfather and a grandmother. Everything should be shared with these elders. —EIMC female acceptor, Iringa Referral HospitalFGD participants, particularly male non-acceptors, described 3 notable misconceptions. These were: (1) fear of suturing and resulting injury to the penis (a misconception since the EIMC procedure does not include suturing), (2) fear that the foreskin would be taken for witchcraft or another purpose, and (3) fear that the penis would not grow properly without the foreskin. Some male non-acceptors also equated the EIMC procedure with traditional circumcision, in which, typically, no pain medication is given.Not knowing how an infant is circumcised, as far as I know it, circumcision is done by operation. Now, stitching is where my fears lie, taking into account the delicacy of the infant’s skin … if the skin is to be stitched, I can’t imagine the type of stitches that are used! —EIMC male non-acceptor, Iringa Referral HospitalThey believe that the things that are cut might be taken to people who know how to use them … Maybe some people who have superstitious beliefs might have been asked to bring the child’s foreskin. —EIMC female acceptor, Ipogolo Health CentreHe does not want his son to be circumcised while he is still young, because if you do so his reproductive organs won’t grow at all. —EIMC female non-acceptor, Iringa Referral HospitalFor some fathers who volunteered the information that they had undergone traditional circumcision, the recollections of their experience made them decide against their sons’ circumcision. None of these fathers were aware that EIMC is performed using devices and with pain medication.I was circumcised traditionally in the bush without anesthesia, without anything, you see? … Nowadays one is circumcised by using scissors, unlike in old days where a knife or something else was used … If you recall the way you were circumcised and think of your child going through the same process, you think, “Let him grow a bit.” —EIMC male non-acceptor, Ipogolo Health CentreIt is true that I opposed this circumcision … The reason for me to have such an argument is that I myself was circumcised [traditionally] when I was about 15 years old. … I can remember that there was a kid of about 5 years in the group. … In my observation he suffered, and I reached the conclusion that my parents had done the right thing when they decided that I should be circumcised [at an older age]. —EIMC male non-acceptor, Ipogolo Health CentreIn the pilot project in Iringa region, 16.4%  of all male infants delivered in the 8 health facilities were circumcised. In larger hospitals, coverage tended to be lower , although greater numbers of infants were circumcised because of the larger patient population. In facilities with relatively low delivery volume, there was greater coverage—more than 25%. It is likely that human resource constraints limited the number of circumcisions performed per day at facilities with a high volume of deliveries.Human resource constraints may have limited the number of circumcisions performed per day at facilities with a high volume of deliveries.The majority of the EIMCs were performed in the WHO-recommended window between 0 and 60 days after birth,P<.001). Because there is a limited window for EIMC (24 hours to 60 days after birth), there may be benefits for parents to seek services earlier; if the procedure needs to be delayed due to health facility constraints or ineligibility that may resolve over time , there may still be an opportunity to seek EIMC before the 60-day time frame. Although attendance at follow-up visits was very high among both groups for the 48-hour visit, infants with mothers who reported urban residence were 3.8 times more likely to return for a second follow-up visit. This may be attributable to barriers to health care access faced by rural residents. The service delivery model designed for EIMC following the pilot project must address urban and rural differences in access to services. These differences may affect potential EIMC outreach and logistics needed to ensure good follow-up rates; there may be a need to use rural health outposts for EIMC follow-up among rural residents.Urban and rural residence played a role in the age of the infant at circumcision and the time of return for follow-up visits. EIMC generally occurred later for infants from urban areas than for those from rural areas  brought their child for circumcision between 8 and 60 days, meaning that the parents brought them back to the facility rather than having the infant circumcised before discharge from delivery. Despite WHO’s recommendation that the infant stay in the health facility for 24 hours after birth,,,This analysis focused on characteristics of families and infants and EIMC decision making. Gains in cultural acceptance of VMMC have been documented in Iringa region. Accounts suggest that circumcision has become socially desirable for a variety of reasons.The reasons that non-acceptors declined EIMC were quite different from those noted as barriers to VMMC.Fathers were the least exposed to messages about EIMC from health care providers but held greater decision-making power and had the most misconceptions about EIMC. This finding parallels findings in Kenya, where fathers were reported to be the primary decision makers regarding EIMC in 66% of the couples interviewed.A very low proportion (<10%) of EIMCs were performed on infants who were born at home. Reaching male infants who are born at home with EIMC will eventually become an important—and programmatically challenging—goal because approximately half of Tanzanian women deliver their babies at home.The study had a few limitations. Qualitative findings are limited to the original 4 facilities, but the pilot project expanded to include 4 additional facilities during the course of the study, so the quantitative data for all 8 sites were included in this analysis. However, it should be noted that the communities served by the original 4 facilities have a sociodemographic profile that is similar to that of the 4 additional facilities, so we would expect similar responses. Our strata for analyzing age at circumcision were based on “best guess” estimates, which considered the immunization schedule and assumptions about convenience of travel with a newborn.EIMC services were introduced with a high level of safety in Iringa region, but it was noted that successes in scaling up VMMC did not translate into immediate acceptability of EIMC. Babies born at home comprised less than 7% of the infants circumcised in the pilot project. Care-seeking behavior associated with EIMC, including age of the infant at circumcision and time of return for follow-up visits, varied significantly between urban and rural dwellers. Strategies such as EIMC outreach activities and the use of rural health outposts for follow-up visits to overcome geographic barriers should be explored when planning to expand EIMC services.Reaching male infants who are born at home will eventually become an important—and programmatically challenging—goal.The majority of mothers heard about EIMC at a health facility rather than from radio messages or from community members. This highlights an important need and opportunity for expansion of community education and awareness-raising for EIMC via media outlets such as radio. It is particularly important that EIMC information and counseling reach men as well as women. Integrating EIMC counseling into services for prevention of mother-to-child transmission of HIV should be explored, because these services provide an opportunity for men and women to be counseled together. Women attending ANC should be encouraged to address the issue of EIMC with their partners and family early in their pregnancies. Based on our findings, targeted behavior change communication should be directed to fathers; using community forums to educate men about EIMC may be a good platform to explore.


Current approaches for estimating social mixing patterns and infectious disease transmission at mass gatherings have been limited by various constraints, including low participation rates for volunteer-based research projects and challenges in quantifying spatially and temporally accurate person-to-person interactions. We developed a proof-of-concept project to assess the use of automated video analysis for estimating contact rates of attendees of the GameFest 2013 event at Rensselaer Polytechnic Institute (RPI) in Troy, New York.Video tracking and analysis algorithms were used to estimate the number and duration of contacts for 5 attendees during a 3-minute clip from the RPI video. Attendees were considered to have a contact event if the distance between them and another person was ≤1 meter. Contact duration was estimated in seconds. We also simulated 50 attendees assuming random mixing using a geo-spatially accurate representation of the same GameFest location.The 5 attendees had an overall median of 2 contact events during the 3-minute video clip (range: 0–6). Contact events varied from less than 5 seconds to the full duration of the 3-minute clip. The random mixing simulation was visualized and presented as a contrasting example.We were able to estimate the number and duration of contacts for 5 GameFest attendees from a 3-minute video clip that can be compared to a random mixing simulation model at the same location. The next phase will involve scaling the system for simultaneous analysis of mixing patterns from hours-long videos and comparing our results with other approaches for collecting contact data from mass gathering attendees. During the response to the emerging 2009 H1N1 influenza pandemic, public health officials leveraged infectious disease models to develop a range of pandemic scenarios to explore the impact of social distancing measures on mitigating influenza transmission. However, essential components of infectious disease models were frequently based on constant or random contact rates and mixing patterns of infectious and susceptible members of the population. Better quantification of individual contact rates and mixing patterns will become increasingly important as public health officials require more accurate infectious disease models for refining or validating pandemic mitigation strategies, including decisions regarding when to postpone or cancel mass gatherings [Mass gatherings can create environments highly conducive for influenza transmission through virus-containing respiratory droplets and possibly through fomites, due to the spatial and temporal congregation of infectious and susceptible individuals . FactorsNew techniques for analyzing video recordings have recently been used for evaluating vehicular traffic flow and airport security –14. The We used arrays of networked video cameras to record attendees of the GameFest event at RPI in Troy, NY. The event, which was held in RPI’s Experimental Media and Performing Arts Center (EMPAC) on April 26-27, 2013, had approximately 400 attendees. GameFest provided the chance for RPI students to demonstrate their work in game design and simulations to the public, the gaming industry, and other students and faculty.EMPAC is a multipurpose facility with several large studio rooms and auditoriums used for concerts, art installations, research projects, and public events. Eight ceiling-mounted video cameras were placed at two locations (four in Studio 1 and four in the mezzanine) where participants visited display booths according to their level of interest. The video cameras were calibrated to capture distinct but overlapping fields of view such that the entire space in each location was recorded. Each camera recorded 4 hours of video on April 27, the second day of the event.et al.[For this proof-of-concept project, we randomly selected a 3-minute clip of video recordings from Studio 1 for analysis. Video analysis techniques were used to detect and track multiple subjects by measuring the optical flow of low-level features  using Matlab programming –13. The In this proof-of-concept project, we also explored the use of IMPACT, an existing Oak Ridge National Laboratory (ORNL) platform, for conducting random mixing simulations , includiAs with other public venues at RPI, EMPAC uses video cameras for security purposes. Therefore, the attendees at GameFest had no assumptions of privacy. The project video cameras were ceiling-mounted, and the low-level feature tracking could not be used to identify attendees. Since the attendees were only imaged from above at a public event, and were not personally identifiable, no consent was collected from the attendees, and their motions were natural. We received permission for camera installation and filming from EMPAC staff and GameFest event organizers. This project was reviewed and approved by the Institutional Review Boards at RPI and Oak Ridge Associated Universities. The Human Subjects Research Office at the Centers for Disease Control and Prevention determined that this was an evaluation project and, therefore, exempt from IRB review.The 5 attendees had an overall median of 2 contact events during the 3-minute video clip (range: 0-6) Figure . ContactDue to existing limitations in capturing mixing patterns at mass gatherings, we developed a proof-of-concept project to assess the use of video recordings for estimating contact rates at the GameFest event in Troy, New York, in 2013. We used video analysis to estimate the number and duration of contacts for 5 event attendees. The project suggests that video tracking and analysis may be feasible for generating contact parameters in a spatially and temporally accurate way, but more work is needed to assess this approach in larger and more diverse mass gathering settings , 16, 17.Most noteworthy is that we were able to record 100% of attendees within each selected location at the GameFest event, while avoiding direct contact with or creating additional burden for the attendees. This is a possible advantage compared to other approaches, including the use of remote sensors, for to capturing contact data from mass gathering attendees. Remote sensors are small devices, worn on a lanyard or belt that can capture interactions with others also wearing the device, and have been used to generate social mixing patterns in school settings. However, a large proportion of the target population is typically needed in order to accurately describe person-to-person interactions, which is dependent on volunteer participation. Researchers using radiofrequency identification devices to capture contact data from conference participants in France achieved a 30% participation rate . Due to Remote sensors and similar devices can also get lost, damaged, or lose power, all potentially impacting data quality . Though For the proof-of-concept project, we defined a contact event if the distance between the selected attendee and another person was ≤1 meter. Using this definition, our 5 attendees had a median of 2 contact events during the 3-minute video clip. Coding changes in Matlab programming for further analysis of the video recordings can increase the contact definition to less than or equal to 2 meters, the commonly used threshold for influenza transmission through respiratory droplets [Age is an important predictor for a number of infectious diseases, including influenza . During While video analysis could provide important information on social mixing at mass gatherings, computer capacity could be a constraining factor , 23. OurOur proof-of-concept project used a 3-minute clip from a single video camera. The ability to stitch together the frames and track participants across multiple cameras with a high level of precision will be required –14. ThisScaling up our video analysis will focus on identifying key locations and time frames likely to be representative of social mixing patterns across the mass gathering venue. Complete and simultaneous coverage  is likely infeasible due to computational requirements. However, for the purpose of estimating contact rates for modeling infectious disease transmission, complete attendee coverage may not be required. The durations of contacts across a subset of mass gathering attendees  could be sufficient to explain infectious disease transmission dynamics , 16.Following completion of the analysis of the GameFest event video recordings and refinement of the automated analysis process, we propose to implement a larger study to compare the video analysis results with other approaches for contact rate estimation. Assessment of mixing patterns in school settings has used a combination of contact surveys and remote sensors over one or more days , 24. We The results of the initial IMPACT simulation of attendee interactions assuming random mixing in Studio 1 can serve as a baseline and be compared with future simulations using statistical distributions of the number and duration of contacts derived from the analysis of video recordings from GameFest. These results have the potential to help public health professionals determine whether precise contact parameter estimates are needed for simulations, or whether assumptions of random mixing could provide valid approximations for exploring infectious disease transmission at certain types of gatherings . IMPACT allows users to modify both micro- and macro- environments of a real or hypothetical setting, and therefore can be used for simulating mixing patterns and transmission dynamics at other mass gatherings –17.Available evidence suggests that restricting mass gatherings in addition to implementing other social distancing measures  could help mitigate pandemic influenza transmission . This evOur project demonstrated the use of video analysis to estimate contact rates of 5 attendees at a mass gathering. The next phase of work will involve scaling the system for simultaneous analysis of hours-long video recordings. Comparing the results of our approach with other methods for contact rate estimation could assist in further refinement of our video analysis techniques. The generated contact parameters may help improve computer simulations of influenza transmission at a mass gathering using IMPACT or other modeling applications, with the goal of identifying effective prevention and control strategies, including whether a mass gathering should be postponed or cancelled during a pandemic.


Yet, there has been little investigation to what extent drinking behavior of young adults changes The impact of changes in living arrangement, education/employment, income, and deprivation on changes in average weekly alcohol units of consumption and frequency of hazardous drinking sessions per month in young adults was investigated. In total, 1,260 respondents of the New Zealand longitudinal Survey of Family, Income and Employment (SoFIE) aged 18-24 years at baseline were included.Young adults who moved from a family household into a single household experienced an increase of 2.32 (95% CI 1.02 to 3.63) standard drinks per week, whereas those young adults who became parents experienced a reduction in both average weekly units of alcohol  and in the frequency of hazardous drinking sessions per month . A one unit increase in individual deprivation in young adulthood was associated with a 0.48 (95% CI 0.10 to 0.86) unit increase in average alcohol consumption and a modest increase in the frequency of hazardous drinking sessions .This analysis suggests that changes in living arrangement and individual deprivation are associated with changes in young adult’s drinking behaviors. Alcohol harm-minimization interventions therefore need to take into account the social and economic context of young people’s lives to be effective. TheseThere is a growing body of longitudinal research on the association between social and economic predictors in early childhood or adolescence with hazardous alcohol use outcomes in young adulthood–13. The changes in both social and economic exposure measures and changes in drinking behaviors within young adulthood using methods that control for time-invariant unobserved confounders[However, there exists a gap in this literature. Although some studies examined trajectories over time in either exposure measures or outcome measures, most longitudinal studies have not investigated the impact of founders–16. UsinThe few studies that have investigated the association between changes in social factors within young adulthood with changes in young adult’s drinking behaviors have shown that moving out of the family home and moving in with a spouse–19 or beIn this study, based in New Zealand where highest hazardous drinking rates are observed in young adulthood, we estiThe present study is a longitudinal analysis of wave 3 (2004/05), 5 (2006/07) and 7 (2008/09) from SoFIE. In short, SoFIE is a nationally representative longitudinal survey of the usually resident population living in private dwellings in New Zealand and was conducted between 2002 and 2010. In annureference category)[A young adults living arrangement was classified at each wave as living in a family household in a child role (ategory), living ategory), living ategory), living ategory), or liviategory).reference category)[A respondent’s education and employment status was classified as follows: enrolled in education  and not employed (ategory), enrolleategory), not in ategory), or emplategory). EmploymAnnual personal income was derived by combining gross annual incomes from employment earnings, self-employment earnings, government transfers, interest from bank and/or other accounts, personal investments, private superannuation and pension schemes, and other regular or irregular received income sources. Personal income was adjusted for inflation and log-transformed prior to modelling.Area deprivation was measured using NZDep 2001, a census based measure of area deprivation in New Zealand which uses an index of nine census variables  averaged across about 100 people living in the smallest census enumeration area (i.e. meshblock), and classified into deciles. Each reIndividual level of deprivation was measured using the New Zealand Individual Deprivation Index (NZiDep), which is a composite score from eight items such as not being able to afford fruit and vegetables or using a food bank. It was As part of the SoFIE health module in waves 3, 5 and 7, all young adults were asked if they had consumed an alcoholic drink in the past 12 months. If they answered ‘yes’ respondents were asked how many days in the last four weeks they had consumed alcohol and how many standard drinks they consumed on a typical day. A standard drink was defined using standard definitions, as a can or small bottle of beer, a small glass of wine or a single nip of spirits. This inIt has been suggested that frequency of hazardous alcohol consumption sessions or drunkenness is the best indicator of hazardous drinking behavior in young adults. RespondAll analyses were conducted using individual unit data  in SAS Enterprise Guide 4.3 in the Statistics New Zealand data laboratory, Wellington. Fixed effects models, applied to longitudinal data, control for all time-invariant confounding, both measured and unmeasured, by using only the changes in exposure occurring within individuals to estimate the outcome. Therefore, effect estimates are not biased by unmeasured heterogeneity –16. In tAlcohol and Young People: A Descriptive Analysis of Changes in Alcohol use in Young New Zealanders from the Statistics New Zealand Longitudinal Survey of Family Income and Employment (SoFIE) and the SoFIE-Health sub-Study, forthcoming). The distribution of drinking among 18-24 year old respondents at baseline (wave 3) and at wave 5 (aged 20-26) and wave 7 (aged 22-28), and transitions between waves, is shown in Table In a previous descriptive report, we have shown higher levels of drinking in 15-24 year old males and females who did not have a school qualification, or lived in a flatting situation or in a one person household, whereas young respondents who were inactive in the labour force reported lower levels of alcohol consumption  at wave 3 was 87.5%, and this remained stable over time. Very few (between 4 - 5%) young adults stopped or started drinking between waves. The mean overall average weekly alcohol consumption among young adults was stable at 7 to 8 units a week across waves. The large standard deviations reflect the wide and skewed distribution.Approximately 50% of the young adult drinkers reported hazardous drinking sessions at least once per month. Over half of the 18-24 year old respondents at wave 3 changed the frequency of hazardous drinking between waves, but these were equally split between moving into more or less frequent hazardous drinking. The mean number of hazardous drinking episodes per month was stable at 1.9 to 1.8 per month across waves 3, 5 and 7.Table Table We ran separate crude models for changes in each of the social and economic exposure variables  on changes in average weekly alcohol consumption. There was a significant association between changes in living arrangement and individual deprivation with changes in average weekly alcohol consumption. No statistical effect of changes in the other exposure variables on average weekly alcohol consumption was found in the crude models. The impact of changes in living arrangement, and individual deprivation remained significant in the fully adjusted model. The transition over time from living in a family household (in a child role) to living in a one person household was associated with an increase in the average weekly units of alcohol consumption , whereas moving in with a partner or spouse was associated with a decrease in units of alcohol consumption . In addition, moving into a family household in a parent role (i.e. becoming parent) was associated with a large reduction in units of alcohol consumption per week . Experiencing an increase of one unit in self-reported individual deprivation was associated with a small, but significant increase in alcohol consumption .Table Changes in living arrangement, and both individual and area deprivation were significantly associated with changes in the frequency of hazardous drinking in the crude models. In the full model, the effect size for area deprivation was unchanged (0.06), but with a slight widening of the confidence interval to include the null. As shown for the changes in average weekly alcohol consumption models, if a respondent moved into a family household in the parent role (i.e. becoming a parent), the frequency of hazardous drinking decreased significantly by more than one hazardous drinking session per month . Moving into a couple household was also associated with a decrease in the frequency of hazardous drinking episodes per month . We also found a 0.25 increase in the monthly frequency of hazardous drinking for young adults who experienced an increase in self-reported individual deprivation by one unit .In this paper, we examined the influence of changes in a range of social and economic factors  on changes in average weekly alcohol consumption and frequency of hazardous drinking sessions in young adulthood while adjusting for unmeasured confounding through fixed effect regression methods. To date, most studies on drinking behavior in adolescents or young adults have assessed the associations cross-sectionally, 28. OthAn original contribution of the present study, compared to previous literature, was separating out the living arrangements of individuals not living at home into living with unmarried partner, with other flatmates or living on their own. Consistent with expectation, the transition from living in a family household (in a child role) into living in a one person household was associated with an increase in the average weekly consumption of alcohol, but no association with frequency of hazardous drinking was found. On the contrary, we found patterns of decreased alcohol consumption and reduced frequency of hazardous drinking for young adults who moved in with their spouse or defacto partner. The latter finding has previously been reported in other studies–19.Moving into a family household in the parent role (i.e. becoming a parent) was associated with a decreased pattern of alcohol consumption and frequency of hazardous drinking sessions. Other studies have also reported that moving into parenthood is associated with decreased alcohol use in larger adult cohorts with a wider age range, 33. OurThe only economic factor that was associated with changes in drinking behaviors was the self-reported measure of individual deprivation, where increases in deprivation were significantly associated with increases in weekly alcohol consumption and frequency of hazardous drinking. This subjective measure of individual deprivation potentially measures a wider spectrum of both social and economic well-being as it is comprised out of measures such as being able to afford fruit and vegetables, using a food bank, or the need to borrow money for day-to-day needs and has A major strength of this study was repeatedly assessing the same cohort of young adults over time, where all time-invariant confounders (unmeasured heterogeneity), such as early childhood exposures, intelligence, and personality are controlled for in fixed effects regression analysis. HoweverThe original SoFIE study population was a nationally representative sample of New Zealand households. The health module which included the questions on drinking behavior, however, was only collected in waves 3, 5 and 7. We have previously shown that younger people of lower socioeconomic status or Māori or Pacific ethnicity were more likely to drop out of SoFIE. Hence, It is important to recognize that our findings rely on some of the underlying constructs of fixed-effects regression modelling. Only information on young adults who experienced change in their exposure variables between waves has contributed to the estimates of short-term change in both average weekly alcohol consumption and frequency of hazardous drinking. We can, therefore, not draw any conclusions on young adults who continuously live in a one person or couple household, or who are in the parent role for a longer period of time or live in circumstances of high individual deprivation continuously. Nor can we draw any conclusions on whether the short-term increases or decreases in (observed) average alcohol consumption or frequency in hazardous drinking, lasts over a longer period of time.Our findings suggest, and confirm findings of previous studies, that becoming a parent or moving in with a partner or spouse in young adulthood may act as protective factors with regard to alcohol use. Moving into a one person household appears to be associated with at least a short-term increase in the average alcohol consumption of those who move into young adulthood. Moving into more deprivation appears to be associated with an increase in both average weekly alcohol consumption and the frequency of hazardous drinking in young adults. Although more longitudinal research needs to be conducted, a preliminary conclusion from this work is that education on safe drinking should target young people who experience ‘major’ life transitions such as leaving the family home into living alone or moving into more individual deprivation.Ethics approval was obtained for the SoFIE Health module from the University of Otago Ethics Committee.


Piercing-sucking insects are major vectors of plant viruses causing significant yield losses in crops. Functional genomics of plant resistance to these insects would greatly benefit from the availability of high-throughput, quantitative phenotyping methods.Nasonovia ribisnigri (Mosely), biotype Nr:0, and revealed quantitative resistance in Arabidopsis accession Co-2 against Myzus persicae (Sulzer). The video tracking platform was benchmarked against Electrical Penetration Graph (EPG) recordings and aphid population development assays. The use of leaf discs instead of intact plants reduced the intensity of the resistance effect in video tracking, but sufficiently replicated experiments resulted in similar conclusions as EPG recordings and aphid population assays. One video tracking platform could screen 100 samples in parallel.We have developed an automated video tracking platform that quantifies aphid feeding behaviour on leaf discs to assess the level of plant resistance. Through the analysis of aphid movement, the start and duration of plant penetrations by aphids were estimated. As a case study, video tracking confirmed the near-complete resistance of lettuce cultivar ‘Corbana’ against Automated video tracking can be used to screen large plant populations for resistance to aphids and other piercing-sucking insects.The online version of this article (doi:10.1186/s13007-015-0044-z) contains supplementary material, which is available to authorized users. More than 100 aphid species (Aphididae) are economically significant pest insects and most crops are host to at least one species . AlthougArabidopsis thaliana, and lettuce cultivars, Lactuca sativa, in combination with the green peach aphid, Myzus persicae (Sulzer), and the black-currant lettuce aphid, Nasonovia ribisnigri (Mosely) (Hemiptera: Aphididae), respectively.Here, we present the methodology and validation of image-based tracking of aphid feeding behaviour. Automated video tracking was introduced in the early 1990s and has since been used in many animal behaviour studies -41. Vide−1 , movements around the fixated mouth resulted in a higher tangential velocity, and therefore required a higher velocity threshold.Automated video tracking of aphid feeding behaviour was performed using video tracking software and a stationary camera mounted above 20 no-choice arenas. We introduced one aphid onto each arena, consisting of an agar substrate almost completely covered by a leaf disc, and recorded 20 arenas simultaneously with a frame rate of 25 frames sM. persicae aphids scored by hand, 88% was detected with video tracking . Nevertheless, the recorded number and duration of probes were highly correlated to human observations . Other parameters, such as distance moved, were also highly correlated with feeding behaviour in general, but were less informative with regard to long probes .To test the accuracy of the platform, we performed automated video tracking and human observations simultaneously. A camera was attached to a stereo microscope to deliver a side-view on the arena for manual scoring of probes . The near-complete resistance of Corbana lettuce against N. ribisnigri biotype Nr:0 was detected in more than 80% of the cases with 15 replicates of 4 hours of video observations. Subtle differences in resistance in Arabidopsis were more difficult to detect when video observations were shorter than 8 hours . Overall, video tracking required similar observation durations as EPG recording, but a larger sample size to detect significant plant effects  and costs . In this study, automated video tracking was used to study aphid feeding behaviour, but it could as well be applied to track the behaviour of other piercing-sucking insects. We recommend to validate the velocity thresholds for each species first, by checking several video files by hand. As shown here with two aphid species, size and velocity can differ and will affect the accuracy of probe estimations. When studying plants with thick or dark leaves, increased resolution, better (macro) lenses, and lateral light sources instead of backlight can help to improve the detection of insects. We worked with EthoVision XT video tracking and analysis software, but other programs or programming environments, such as MatLab and ImageJ, could as well serve as robust video tracking tools ,40,54.N. ribisnigri biotype Nr:0. Although video tracking requires more replicates to identify resistant plants than the conventional EPG technique, it can screen many samples simultaneously in a confined space. In addition, computerized data acquisition reduces laborious exercises, such as annotation of electrical patterns or counting of aphid populations, and only little plant material is required which can be advantageous when studying segregating populations with only one plant per genotype. These features make automated video tracking a valuable phenotyping method for screening large plant populations for resistance to piercing-sucking insects that are serious pests in our crops.The aim of this study was to develop a high-throughput method to screen large plant populations for resistance to aphids and other piercing-sucking insects. For the first time it is shown that automated video tracking of aphid body movement can be used to estimate how often the insects are penetrating plant tissue and are reaching the vascular bundle. The use of leaf discs instead of intact plants enhanced the throughput of the video tracking platform, but EPG recording illustrated that resistance effects were partially lost in leaf discs. Nevertheless, we could identify both intermediate and extreme levels of resistance with video tracking. In Arabidopsis accession Co-2, we found a quantitative resistance level. This was confirmed in additional bioassays, suggesting the involvement of constitutive or rapidly activated resistance mechanisms in both epidermis/mesophyll and phloem, resulting in a small detrimental effect on the aphid population. The video tracking platform also confirmed the near-complete resistance of the lettuce cultivar Corbana to Arabidopsis thaliana (L.) Heynh., plants were grown for 4–5 weeks in pots (5 cm diameter) with pasteurized potting soil  in a climate room at 21 ± 1°C, 50-70% relative humidity, an 8/16 h day/night cycle, and a light intensity of 200 μmol m−2 s−1. Four natural accessions of Arabidopsis were used throughout this study: Col-0 (CS76113), Van-0 (CS76297), Co-2 (CS28163) and Sanna-2 (CS76223). Seeds were acquired from the European Arabidopsis Stock Centre and propagated by the Laboratory of Genetics, Wageningen University.Arabidopsis, Lactuca sativa (L.), cultivars Corbana (resistant) and Terlana (susceptible) were grown for 3 to 4 weeks in a greenhouse compartment at a temperature of 20 ± 3°C during the day and 18 ± 3°C during the night, 50-70% relative humidity and a 14/10 h day/night cycle using artificial lighting. Seeds were acquired from Enza Zaden bv. Myzus persicae (Sulzer) aphids were reared in a climate room on radish plants at 19°C, 50-70% relative humidity and a 16/8 h day/night cycle. Nasonovia ribisnigri (Mosely) biotype Nr:0 aphids were reared on the susceptible lettuce cultivar Terlana in a greenhouse compartment at a temperature of 20 ± 3°C during the day and 18 ± 3°C during the night, 50-70% relative humidity, and a 14/10 h day/night cycle.Lettuce, Aphid behaviour was recorded with an analogue, monochrome camera  with a varifocal lens  mounted above the arenas  and a side-view camera attached to a stereo microscope (20-40 × magnification), capturing close-up recording of proboscis and antennae movements of M. persicae aphids  was used for automated video tracking of aphid feeding behaviour in multiple arenas simultaneously ,55. SubjM. persicae aphid and an Arabidopsis leaf disc, by both the top-view and side-view camera. Aphids were starved between 30 minutes and three hours before the experiment. Recordings with the top-view camera were performed at two distances: capturing 20 arenas with 275 pixels per mm2, and capturing 35 arenas with 155 pixels per mm2. Leaf discs of 6 mm in diameter were cut just below the leaf apex of 4–5 week old Col-0 and Van-0 plants. The Observer® XT 10 software  was used for manual scoring of probes. Probe starts were manually recorded when body movement stopped, the proboscis was touching the leaf and antennae moved backwards. If the aphid’s proboscis was obscured, body arrestment on the leaf disc with subsequent backward movement of antennae was defined as a probe start [To validate automated tracking of probes with manual scoring, we used a camera mounted on a stereo microscope 20-40×) with a side-view on a single arena (n = 16) . Leaf discs of 6 mm in diameter were made just below the apex of intermediately aged leaves. Aphid survival was checked the day after recording. Subject detection was checked after data acquisition on 6 time points across the video. Three samples with no or low quality detection were excluded from the analysis. Video tracking of winged N. ribisnigri biotype Nr:0 on lettuce cultivars Terlana and Corbana was performed with 4 mm leaf discs . In view of the large contour of winged N. ribisnigri aphids, we used arenas with leaf discs of 4 mm diameter and a 3–4 mm leaf edge-to-wall distance in order to have a clear distinction between aphids on the leaf disc and aphids on agar or the arena wall. Leaf discs were made near the leaf base of the third oldest leaf, next to the mid vein. None of the aphids had died the day after recording. Five samples with no or low quality detection were excluded from the analysis. The response variable “duration not moving” was measured using a start velocity of 0.3 mm/s and a stop velocity of 0.02 mm/s. Velocities were averaged across 5 frames, using a sample rate of 5 frames per second.In each recording twenty arenas were tracked simultaneously for 8 hours, with a frame rate of 25 sM. persicae, was analysed with EPG recording on two natural accessions of Arabidopsis, Co-2 and Sanna-2, during 8-hour observations. EPG recording was made on both intact plants  and leaf discs , using direct currents (DC) according to the methodology of ten Broeke et al. [N. ribisnigri biotype Nr:0 on lettuce cultivars Corbana and Terlana has been made in a previous study by ten Broeke et al. [Feeding behaviour of the green peach aphid, e et al. . An elece et al. . Each ree et al.  (8-hour M. persicae neonate (0 to 24 h old) was transferred to each Arabidopsis plant in a climate chamber . In the first assay 2.5-week-old plants were infested, in the second assay 3.5-week-old plants. A soap-diluted water barrier prevented aphids from moving between plants. Six, seven, and eight days after introduction the presence of the aphid and its offspring was checked. None of the aphids developed wings. 14 Days after infestation the number of aphids was counted per plant. Plants without an adult aphid 8 days after introduction, and plants without any adults or neonates 14 days after introduction were excluded from the analysis .One 4 random draws were taken from a normal distribution with the mean and standard deviation of a response variable of the Arabidopsis-M. persicae and lettuce-N. ribisnigri data sets (Additional file M. persicae on Arabidopsis accession Col-0 (data set n = 53, replicate levels n = 15 and n = 20, two variables, P < 0.025, Additional file In simulations, 10t-test or, when data were not normally distributed with a Wilcoxon signed ranks matched pairs test. Correlations were tested with a Pearson correlation test or, when data were not normally distributed, with a Spearman correlation test. For benchmarking of video tracking against EPGs with susceptible and resistant Arabidopsis and lettuce lines and for the reproduction assay, response variables were tested with a Student’s t-test, or when the data were not normally distributed with a Mann–Whitney U test. Walking activity of aphids was tested across 8 time bins of 1 hour. The distance moved was not normally distributed and, therefore, transformed to ranks ranging from the lowest to highest value within the complete data set. A mixed linear model was applied on the ranks, using plant line, time bin, and plant line x time bin interaction as fixed effects and plant/aphid individual as a random effect.An R script was written to calculate response variables of video tracking, such as the total number and total duration of short and long probes in each observation and for each hour (Additional file