Depression affects approximately 60% of people with aphasia 1 year post stroke and is associated with disability, lower quality of life, and mortality. Web-delivered mental health  programs are effective, convenient, and cost-effective for the general population and thus are increasingly used in the management of depression. However, it is unknown if such services are applicable and communicatively accessible to people with poststroke aphasia.The aim of this study was to identify freely available e-mental health programs for depression and determine their applicability and accessibility for people with poststroke aphasia.A Web-based search was conducted to identify and review freely available e-mental health programs for depression. These programs were then evaluated in terms of their (1) general features via a general evaluation tool, (2) communicative accessibility for people with aphasia via an aphasia-specific communicative accessibility evaluation tool, and (3) empirical evidence for the general population and stroke survivors with and without aphasia. The program that met the most general evaluation criteria and aphasia-specific communicative accessibility evaluation criteria was then trialed by a small subgroup of people with poststroke aphasia.A total of 8 programs were identified. Of these, 4 had published evidence in support of their efficacy for use within the general population. However, no empirical evidence was identified that specifically supported any programs’ use for stroke survivors with or without aphasia. One evidence-based program scored at least 80%  on both the general and aphasia-specific communicative accessibility evaluation tools and was subject to a preliminary trial by 3 people with poststroke aphasia. During this trial, participants were either unable to independently use the program or gave it low usability scores on a post-trial satisfaction survey. On this basis, further evaluation was considered unwarranted.Despite fulfilling majority of the general evaluation and aphasia-specific evaluation criteria, the highest rated program was still found to be unsuitable for people with poststroke aphasia. Thus, e-mental health programs require substantial redevelopment if they are likely to be useful to people with poststroke aphasia. Aphasia is a language disorder that can impact a person’s ability to understand and produce spoken language, read, write, calculate, and use gestures . It is aTalk-based psychological interventions, such as cognitive behavioral therapy (CBT), are widely recommended in the treatment of depression -11. Howee-mental health encompasses both e-mental health literacy, which is the provision of information pertaining to the nature and treatment of mental health illnesses, and e-mental health programs, which are structured self-help programs designed to treat or prevent mental health disorders via an interactive interface [e-mental health is a digital form of mental health care and may offer a solution to the accessibility issues of face-to-face therapy commonly encountered by the general population. e-mental health services provide treatment and assistance to people suffering from mental illness via digital platforms such as computers and Web-based programs . The ternterface .In the context of e-mental health, accessibility refers to the ease with which patients can utilize the health care service in proportion to their needs, as well as the usability of the actual technology through which that service is provided . The incThere is a large body of research that supports the use of e-mental health programs for depression; however, this research is generally limited to patients with depression who are otherwise healthy. Although 1 study reported preliminary evidence for computerized CBT (cCBT) in reducing depressive symptoms in people with traumatic brain injury   evaluate the general features of each program, (2) review the published evidence of each program for the general population and for stroke survivors with and without aphasia, (3) evaluate each program’s communicative accessibility for people with poststroke aphasia, and (4) determine which e-mental health program(s) may be most suitable for people with poststroke aphasia. It should also be noted that this study did not aim to evaluate how psychotherapeutic concepts, such as CBT principles and abstract concepts, were presented to users in the context of a broader psychotherapeutic community.In all, 2 previous scoping reviews that evaluated available e-mental health interventions for depression  and anxiA Web-based search for e-mental health interventions for depression was conducted in July 2017. Consistent with previous scoping reviews ,29, the Consistent with a previous scoping review , the firStage 1—general search termsInternet therapy for depressionInternet treatment for depressionInternet help for depressionInternet cognitive behavioral therapy for depressionWeb therapy for depressionWeb treatment for depressionWeb help for depressionWeb cognitive behavioral therapy for depressionOnline therapy for depressionOnline treatment for depressionOnline help for depressionOnline cognitive behavioral therapy for depressionStage 2—aphasia-specific search termsOnline therapy for depression aphasiaOnline therapy for depression after strokeOnline treatment for depression aphasiaOnline treatment for depression after strokeOnline cognitive behavioral therapy for depression aphasiaOnline cognitive behavioral therapy for depression after strokeWebsites were excluded if they (1) provided e-mental health literacy only; (2) offered purely Web-based counseling; (3) were designed for specific populations other than stroke survivors with or without aphasia ; (4) were designed exclusively for adolescents and/or young adults ; or (5) were not available in English. As some programs required users to complete a depression symptom questionnaire to determine whether the program was suitable for the user before creating an account, the authors contacted all program developers asking for research access to the program. Programs were excluded if research access was not granted.In all, 3 separate tools were used to collect and evaluate the data from each program: a data extraction form, a general evaluation tool, and then an aphasia-specific evaluation tool. The authors used the data extraction form to extract relevant information and data from each program, which then underwent evaluation using the general evaluation and the aphasia-specific evaluation tools. The categories within both the general and aphasia-specific evaluation tools contained a set of closed choice (“yes” or “no”) questions. A score of 1 was awarded if the question was answered with a “yes”; a score of 0 was awarded if the question was answered with a “no” or could not be evaluated . Consistent with previous scoping reviews ,29, the With permission from the authors, the data extraction form used in a previous scoping review  was adapTo determine empirical evidence for each program, the authors scrutinized each website for relevant information and searched the program’s name in each of the following databases: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Web of Science. If these methods failed to identify published evidence, the authors contacted the program’s developers to enquire about program efficacy. Data extraction was completed by the first author during July 2017.The general evaluation tool was used to evaluate each e-mental health program in terms of its general features  and empirical evidence  laptop screen at 100% zoom. Spacing of 4 mm or more was considered adequate for people with aphasia, as it is equivalent to the amount of white space measured between the lines of Times New Roman typeface set at 1.5 line spacing. The presence or absence of aphasia-friendly design characteristics, such as the use of bullet points and numbering to establish key points, the use of headings to make important information stand out, and the use of bolding to highlight important information, was also determined.The aphasia-specific evaluation tool was developed by the authors to assess each program in terms of its communicative accessibility for people with poststroke aphasia  or a concurrent medical condition impacting their mental health  as confirmed by self-report.A computer use survey was used to determine participants’ level of computer use before and after aphasia, as well as their reasons for using a computer. This survey was created for a separate study that explored computer use by people with aphasia . With peAn observation form was developed to rate each participant’s level of independence using the selected e-mental health program. Independence was rated for 6 main categories: logging in to a premade account, navigating the program, reading and understanding text, completing interactive activities, completing exercises, and finishing the session. The checklist used a 5-point scale where 1=not at all independent, 2=minimally independent, 3=moderately independent, 4=mostly independent, and 5=totally independent.A satisfaction survey was developed to evaluate participants’ satisfaction with using the e-mental health program, including its accessibility and ease of use. The survey consisted of 16 questions and statements for which participants answered using a 5-point rating scale . There were also opportunities for participants and their family members to add comments about the program.Ethical approval was granted by The University of Queensland Human Research Ethics Committee. All participants provided written informed consent before participation. Participants completed the computer use survey with assistance from their family member, carer, or research assistant, as needed. Individually, each participant then completed 1 module of the selected e-mental health program on a desktop computer. The research assistant observed each participant trialing the e-mental health program while completing the observation form. The research assistant also provided support to the participants by reading aloud informative text, reading aloud instructions, showing participants where to click/type, re-explaining instructions, controlling the mouse, and/or typing for the participants, as required. After trialing the e-mental health program, each participant completed the satisfaction survey with assistance from their family member, carer or research assistant, as needed. Each trial session was video-recorded and rewatched by the research assistant to confirm observations that had been made.In total, 43 websites with e-mental health programs, 30 websites linking to websites with e-mental health programs, and 377 irrelevant websites were identified. After duplicate and irrelevant websites were removed, 41 websites remained, which yielded 44 individual programs. Of those programs, 8 programs met the inclusion and exclusion criteria. An overview of the programs’ website characteristics, program characteristics, and intervention characteristics can be found in Two programs purely targeted depressive symptoms . The program OnTrack—Alcohol and Depression  focused on depression with comorbid alcohol problems. The remaining 5 programs were reported to be designed for people with either depression with or without other conditions, including anxiety, anger, worry, stress and low mood, as well as emotional difficulties related to divorce, separation, bereavement, and loss. One program  specified user suitability criteria, while the remaining programs gave general information about whom the program would be appropriate for. All programs specified that they were designed for adult users, with 2 programs defining a specific age range for users; one being between 26 and 64 years (the Wellbeing Course) and the other being between 18 and 75 years (myCompass). In its program suitability criteria, myCompass specified that users should be able to “read English with ease.” Furthermore, 3 programs had the option to send completion reminders to users via email or text message .Questions to the Expert section, where users could submit questions to be answered by a clinical psychologist. This program also contained forums that were moderated by health educators.All but 2 programs provided unguided therapy. One of the guided programs provided users with free support from a trained therapist via telephone or email (the Wellbeing Course). The user could choose to receive this support weekly or could choose to contact the therapist whenever he or she wished. It was not clear whether the therapist support was optional or whether the user had to contact the therapist at some point, and an attempt to contact the program’s developers was unsuccessful in obtaining this information. The other guided program (Depression Center 4.0) included a All programs claimed to employ CBT, an approach that helps people to identify and challenge negative thought patterns and learn practical self-help strategies . In addiAn initial search through all the programs’ websites for research evidence identified 2 published articles reporting on program efficacy for depression for Moodgym  and myCoNo studies were found that evaluated efficacy of use specifically for stroke survivors with or without aphasia. Due to a technical error in the research portal, 1 RCT included in Moodgym’s meta-analysis unintendedly recruited a number of participants who were later found to have a brain injury or stroke or who were already receiving CBT treatment for bipolar disorder . This RCThe overall scores and corresponding percentages from the general evaluation and aphasia-specific evaluations are outlined in A total of 3 participants with a diagnosis of poststroke aphasia  were recruited. Participants’ demographics, including what and how often they used a computer for pre- and poststroke, are included in The level of independence each participant demonstrated while completing the first module of Moodgym, as observed by the research assistant using the observation form, is available in Participants’ satisfaction ratings of Moodgym, as well as their comments about the program, are provided in This scoping review identified 8 e-mental health programs for depression that are freely available to Australian residents. Of these, 4 programs  have been shown to reduce symptoms of depression within the general population. No empirical evidence was identified that specifically supported any programs’ use for stroke survivors with or without aphasia. However, it was found that e-couch and Moodgym had been evaluated using RCT methodology that included a small number of participants with stroke. Findings from a general and an aphasia-specific evaluation indicated that Moodgym was the only evidence-based program to score at least 80% (16/19 and 16/20) on both evaluations, suggesting that it may be suitable for people with poststroke aphasia. However, when trialing Moodgym, 2 of the 3 participants with aphasia required assistance for more than half of the skills assessed on the observation form, and the other participant who demonstrated higher levels of independence still gave Moodgym low satisfaction and usability scores on the posttrial satisfaction survey. Therefore, despite fulfilling majority of the general evaluation and aphasia-specific evaluation criteria, Moodgym was still found to be unsuitable for people with poststroke aphasia. This also suggests that the aphasia-specific criteria used to initially assess communicative accessibility may not have been sensitive enough to detect suitability for people with poststroke aphasia and thus should be revised if it is to be used in any future research.Consistent with previous findings in the literature, this study found that the programs’ content was usually generic for all users and that the programs themselves tended to be based on CBT, either alone or in combination with other approaches ,29. ThisWhile this review did not identify any new e-mental health programs for depression released since the previous scoping review , it did digital exclusion as a result of their language deficits, age- and stroke-related changes, and lack of premorbid computer and internet skills often attributed to their generally older age [People with poststroke aphasia have previously been identified as being victims of lder age ,66. Howelder age , the reslder age . Thus, ilder age .The communicative accessibility of the reviewed programs for people with poststroke aphasia was initially evaluated against an aphasia-specific evaluation tool. Aphasia-specific evaluation scores ranged from 55% (11/20) to 85% (17/20), with only 3 programs scoring 80% or more . Hence, these findings suggest that while all programs incorporated design features consistent with published aphasia-friendly guidelines and other recommendations, the communicative accessibility of e-mental health programs could potentially be improved to render these programs more appropriate to people with poststroke aphasia. Findings indicated that many programs might be improved by greater use of visuographic supports. For instance, pictures, which directly support the text, have been found to enhance reading comprehension in people with aphasia ,69. For As assessed via the aphasia-specific communicative accessibility evaluation tool, this study found that none of the evaluated programs had an average readability level of 5 or lower, which is the level recommended for people with aphasia . As repoWhile appropriate readability levels of written materials are important, there are other formatting characteristics that can facilitate reading comprehension in people with poststroke aphasia. These include use of large font  , generouDespite the authors’ efforts to be systematic and inclusive in their search for e-mental health programs for depression, it is possible that some programs were missed. The dynamic nature of Web content also means that the identified programs may eventually be changed or discontinued, and new programs will likely be developed in the future. Furthermore, this study excluded paid programs (n=9) and programs for which the authors were not granted research access (n=4). Inclusion of these programs may have yielded different results and thus resulted in different recommendations.The aphasia-specific search terms used in the search strategy were informed by suggestions from clinicians and academics that work with people with poststroke aphasia, rather than people with poststroke aphasia themselves. Future studies investigating how people with poststroke aphasia use the internet to find e-mental health programs, and if their search terms are successful in locating the same programs identified in this review, may also be of benefit.This small trial of people with poststroke aphasia was helpful in determining whether the highest rated e-mental health program was communicatively accessible to people with poststroke aphasia, or not. However, a larger trial of people with poststroke aphasia is paramount in determining which aspects of current e-mental health programs are most accessible, and which aspects need improvement. The use of think-aloud studies, whereby participants’ experiences of the program are captured using multimodal communication, may be one way to identify accessibility facilitators and barriers of such e-mental health programs. Furthermore, if e-mental health programs are to be redesigned or future programs developed specifically for people with poststroke aphasia, end users  should participate in the design and development process to ensure usability within the target population. It is acknowledged that participatory design approaches rely heavily on effective communication between the participants and designers and thus may be challenging for people with poststroke aphasia . HoweverE-mental health services offer convenient and cost-effective interventions that have an ability to reach a more diverse population than traditional face-to-face psychological interventions . Thus, t


Cognitive impairment is prevalent among people with substance problems and a factor affecting retention in treatment. Empirical phenomenography was used to systematically explore how people with cognitive impairment viewed a novel residential rehabilitation program – Project RE PIN – designed with cognitive compensatory behaviour change activities and from a strengths-based approach. Twelve participants took part in semi-structured interviews and cross-case analysis identified the overarching theme of change. Key program elements were the safe environment, structured routines, modified psycho-educational material and staff support. Critical changes that participants attributed to the program were in dealing with their own and others’ emotions, experiencing daily life without drugs or alcohol and reframing their self-view. Fear and anxiety about relapse were common and few participants had strategies or support to cope in the future. This study demonstrates that program activities changed participants’ thoughts, feelings and behaviours about themselves and their substance use. The results indicate that RE-PIN’s modified content and processes can benefit people with cognitive impairments in treatment. The study highlights that some treatment users may be vulnerable to resumption of drug use despite gains made during a residential program and their desire to remain substance-free. Drug and alcohol treatment interventions aim to change a regular harmful behaviour. Current approaches to drug and alcohol treatment predominantly use psycho-social methods, usually cognitive behaviour therapy (CBT), as an adjunct to medication within individual and group counselling and residential rehabilitation programs. Relapse after substance treatment is reported to be commonplace, with studies suggesting 94% of people have used at least once 12 months post-treatment .Behaviour change theories and relapse prevention models identify environmental triggers such as contact with other drug users and drug availability ; psycho-Residential rehabilitation is the most established treatment option for people with severe substance problems . TreatmeCompletion rates in residential rehabilitation vary widely (i.e. 9–75%), averaging approximately 30% . ClientsIn their prevalence study, Allan et al. (2012) defined cognitive impairment as an umbrella term used to refer to the impacts of long-term drug or alcohol use, acquired or traumatic brain injury, intellectual disability, or Foetal Alcohol Spectrum Disorder (FASD) . While eIn recognition of these issues and driven by the imperative to improve treatment retention of people with cognitive impairment, a program entitled ‘Project RE PIN’  [hereafter RE PIN] was developed. To facilitate this novel approach to practice change, the organisation secured philanthropic funding for a project coordinator to synthesize existing evidence of inclusive program models that were suitable for the rehabilitation context and for an independent evaluation of program development.The RE PIN program aimed to enhance the lives of individuals with cognitive impairment and substance problems, by developing, implementing and evaluating a new type of drug and alcohol rehabilitation that was inclusive of people with cognitive impairment. The program was developed using strengths-based principles and person-centered practice because these approaches had been shown to improve treatment retention in some studies , 26. TheThis study aims to understand how a residential substance use rehabilitation program designed to be inclusive of people with cognitive impairment influenced the treatment experience of residents with cognitive impairment. The study was part of a larger project to document the process of developing and implementing RE PIN that sought the perspectives of residents, staff and management.Ethics approval to conduct the research was granted by the UNSW Human Research Ethics Committee in April 2016 (reference number: HC16131). Program materials available from first author on request.Wattlegrove is a 3-month voluntary rehabilitation service for men and women located in regional NSW, Australia. It works with up to 16 people at a time after each resident completes 1–2 weeks of medically supervised withdrawal prior to commencement. A previous study has identified that almost half of Wattlegrove’s residents were likely to have a cognitive impairment and that program completion rates for this group were significantly lower than for residents without a cognitive impairment (10 and 56% respectively) . As a reEmpirical phenomenography was used to systematically explore participants’ experiences of the treatment program. Phenomenography is designed to identify the similarities and differences in participants’ descriptions of the same complex social phenomenon . The pheSixty-seven people took part in the rehabilitation program during the 12-month study period of which 33 were assessed as having a cognitive impairment. Prior to their admission, all residents completed a 7–14-day withdrawal program and were assessed by a medical practitioner as having completed withdrawal. A member of the research team (Author: AM) administered a cognitive screening tool, Addenbrooke’s Cognitive Examination Revised (ACE-R) to all residents during their first week in the program to determine eligibility to participate in the evaluation. The ACE-R is a brief cognitive screening tool that has been used to detect cognitive decline and monitoring cognitive function . AlthougAll eligible residents consented to participate in the study and were invited to an interview to occur eight to ten weeks later, to allow enough time for them to reflect on their experience of the program. Eighteen people agreed to an interview but six had left the program by the interview stage and could not be contacted. A total of 12 residents took part in an interview conducted by a member of the research team (Author: SC). Semi-structured, open-ended interviews took place via computer video link between July 2016–January 2017. Participants were asked to reconfirm consent prior to their interview and consent to record the interview was also provided. Interview topics included: how the person came to be in the program; how well it met their expectations; positive/less positive aspects; how helpful it had been; plans/concerns for the future.The interview transcripts were deductively coded (Author: JA) using the interview schedule to sort the transcripts into initial codes based on the answers to the interview questions Fig. . NVivo sThe concepts of interest were determined by the strengths-based philosophy of the rehabilitation program as being personal change in perceived substance use and how this change was related to the program elements of resources, connections, skills, empowerment and functionality in daily living , 40. AddThe final cross-case analysis identified the overarching theme of change as the coherent concept grounded in the participants’ accounts of the residential rehabilitation experience . Findingn = 33) and those without (n = 34). Both groups were similar in terms of age, gender and Indigenous status; however, they differed in the main drug of concern. Amphetamine was the main drug of concern for residents with cognitive impairment  whereas alcohol was the main drug of concern for residents without cognitive impairment (47% compared to amphetamine 35%). Residents with cognitive impairment were more likely to be younger and to have left school by or before 16 years compared to residents without cognitive impairment. Retention rates were similar across both groups. Residents with cognitive impairment were more likely to complete the program than those without (49 to 41%). However, this was not statistically significant. Almost half of all residents did not complete the program and there was no difference for those with cognitive impairment (47%) and those without (48%). Characteristics of study participants (n = 12).There were similarities and differences between residents with cognitive impairment , suggesting the RE PIN program met their needs equally well. This is a substantial improvement on the retention rate prior to the program introduction, where only 10% of residents with cognitive impairment completed treatment . HoweverParticipants were clear about the environmental and personal triggers that posed a risk of ongoing drug and alcohol use. However, there was less clarity about how treatment could help upon entry to the program. Participants had implicit trust that the treatment program would help reduce their problematic substance use and program philosophy, strategies and techniques were not questioned. This degree of trust puts a significant responsibility on treatment providers to deliver something that works to meet people’s diverse needs and circumstances.Being in a secure rehabilitation environment was perceived as a key safety factor and when that setting was breached by other residents’ drug use or by external factors such as outings, participants described a sense of vulnerability to resumption of drug use. Many expressed fear and anxiety about relapse and concerns about their ability to resist cravings. Drug availability combined with limited self-efficacy are critical factors in relapse and challenges for all those leaving a residential setting , 6, 7. HThe program achieved its aim to deliver a strengths-based approach. Program content and materials were relevant, accessible and applicable to the rehabilitation needs of residents with cognitive impairment. This study confirms earlier research about the benefits of developing skills in communication, reflection, and self-awareness of the impact of moods on triggers to drug use . There wThe results of this descriptive study are specific to the program and participants and therefore cannot be generalized to all residential drug and alcohol treatment. However, the experiences of these participants highlight the changes people experience in a residential program, how they perceive the program content and ways it can be applied. Further research on program outcomes through the administration of standardised instruments at commencement, completion, and 3 months post-treatment would further demonstrate the impact of the program on participants including those without cognitive impairments. Comparing the experiences of people with and without cognitive impairments could clarify which program components have the most impact. More research to establish an evidence-base for best practice in drug and alcohol treatment by comparing resident outcomes attained in this program to those found in conventional residential drug and alcohol treatment programs would be useful for the treatment sector.This study has explored the experiences of people with cognitive impairment in a novel residential substance treatment program. It has demonstrated ways that strengths-based program activities impacted on participants’ self-view and their substance use behaviours. The results describe the way people with cognitive impairment make use of treatment activities and derive benefit from treatment. However, further research is needed to understand how these benefits occur and how they can be maintained. The study also highlighted a vulnerability to relapse post-treatment despite clear intention to remain substance-free and the need for aftercare, particularly for those who lack social support.


Oedemera sexualis in the Japanese Archipelago. Males possess massive hind legs that function as a female‐grasping apparatus, while females possess slender hind legs that are used to dislodge mounting males. Morphometric analyses revealed that male and female body size (elytron length), length and width of the hind femur and tibia, and allometric slopes of these four hind leg dimensions differed significantly among populations. Of these, three traits showed latitudinal variation, namely, male hind femur was stouter; female hind tibia was slenderer, and female body was smaller at lower latitudes than at higher latitudes. Hind leg sizes and shapes, as measured by principal component analysis of these four hind leg dimensions in each sex, covaried significantly between sexes, suggesting coevolutionary diversification in sexual traits. Covariation between sexes was weaker when variation in these traits with latitude was removed. These results suggest that coevolutionary diversification between male and female sexual traits is mediated by environmental conditions that vary with latitude.Sexual traits are subject to evolutionary forces that maximize reproductive benefits and minimize survival costs, both of which can depend on environmental conditions. Latitude explains substantial variation in environmental conditions. However, little is known about the relationship between sexual trait variation and latitude, although body size often correlates with latitude. We examined latitudinal variation in male and female sexual traits in 22 populations of the false blister beetle  The intensity of sexual conflict and the evolutionary response to sexually antagonistic selection are expected to be greater in large and dense populations  is endemic to the Japanese Archipelago and distributed from the southern end of the Ryukyu Islands to the western part of Honshu mainland  in coastal areas from the end of March to June, and the active season of a single population is restricted to about 1–2 months and varies along latitudes. In total, 1,643 individuals  were collected from 22 localities from 2002 to 2016 . All measurements were log10‐transformed prior to subsequent analyses.To evaluate phenotypic variation in sexual traits within and between populations, male and female hind legs were measured, including the hind femur length (FL), hind femur width (FW), hind tibia length (TL), and hind tibia width (TW), using a digital sight imaging controller (Nikon DS‐L2) attached to a binocular microscope to the nearest 0.01 mm  constituted significant outliers with exceptionally narrow male hind FWs . As a result, annual mean, minimum, and maximum temperatures were significantly negatively correlated with latitude, indicating that latitude is a good proxy of climates in this study area  and body size (EL), generalized linear models (GLMs) were constructed with a normal distribution and identity link function, in which one of the traits was used as the objective variable and population was treated as an explanatory variable. Then, two explanatory variables (EL and an interaction between population and EL) were added to the models of hind leg dimensions to examine geographical variation in the relative size of hind leg parts and their allometric slopes. A significant interaction between population and EL was expected if allometric slopes differed among populations.r19 = 0.76–0.97, p < 0.001), only the SMA results are shown. SMA has been frequently used in recent studies on the latitudinal cline of sexual traits  regression, which is simple but was originally used to predict Y from X or to suggest X causes a change in Y, and other types of regression, which determine a best fit line to approximate the relationship between two variables involving errors Smith, . In this2.4r19 = 0.85, p < 0.001, female: r19 = 0.90, p < 0.001; PC2 vs. EL, male: r19 = −0.44, p = 0.057, female: r19 = 0.02, p = 0.93). Therefore, the PC1s and PC2s may represent hind leg sizes and shapes, respectively. These PC scores were used to verify latitudinal variation and covariation between the sexes.Because the femur and tibia of the hind leg constitute a functional unit involved in mating, principal components were calculated to capture overall variation in hind leg morphology. Principal component analysis (PCA) was performed based on the variance–covariance matrix between population mean values of the four hind leg measurements  between sexes was examined by Pearson's correlation coefficients. Additionally, the effect of latitude on coevolutionary diversification between sexes was checked by using correlations between the residuals of the traits from linear regressions on latitude.33.1F21, 857 = 1.43, p = 0.10; TW, F21, 857 = 1.20, p = 0.25; female: FL, F21, 698 = 1.45, p = 0.09; FW, F21, 698 = 1.22, p = 0.23; TL, F21, 698 = 1.24, p = 0.21; and TW, F21, 698 = 0.87, p = 0.63). Allometric slopes estimated in each population (Supporting information Table All the body and hind leg measurements differed significantly among populations Table . Allomet3.2p > 0.151) and was excluded from the final models. Female hind leg PC2 was significantly higher at lower latitudes . Allometric slopes of male FW and TL, which varied significantly among populations, were not significantly associated with latitude  or not significant .Hind leg morphologies significantly covaried between the sexes across populations Figure . The malr19 = 0.50, p = 0.029; male PC2 vs. female EL, r19 = −0.61, p = 0.006; female PC1 vs. male EL, r19 = 0.73, p < 0.001), except for female PC2 . These associations showed that (a) the male hind leg was large and hind femur was slender when the female body was large and that (b) the female hind leg was large when the male body was large. When environmental effects on body size and sexual traits  were removed, the correlation between male PC1 and residual female EL was significant , but not that between residual male PC2 and residual female EL . The correlation between residual female PC2 and male EL remained not significant .Hind leg morphology was significantly associated with the body size of the other sex , suggesting that factors other than latitudinal environmental variation may also be responsible for the variation in this female sexual trait.Although trait variation across geographic regions is a fundamental subject with a long history in evolutionary biology, the processes responsible for geographic variation in sexual traits are still only partially understood  with exceptionally narrow male hind femurs (Supporting information Figure None declared.D.S., C.K., and S.K. conceived the study. D.S., C.K., H.T., S.K., and Y.T. collected the materials. D.S. performed the morphological measurement and analysis. D.S. drafted the manuscript and revised it in cooperation with C.K., H.T., S.K., and Y.T. All authors discussed the results and implications of the study at all stages. Click here for additional data file. Click here for additional data file. Click here for additional data file. Click here for additional data file.


Older Latinos engage in low levels of leisure-time physical activity (LTPA). Dance is a culturally appropriate activity which can be used to increase LTPA levels. We examined middle-aged and older Latinos’ satisfaction with the revised BAILAMOS Latin dance program. Healthy and low actives middle-aged and older Latinos (Mage = 64.89±7.08) were randomized to a 4-month dance program (n=167) or health education (n=166). The dance program consisted of four Latin dance styles . Classes were held twice a week for one hour. A total of 113 participants completed the program. Participants completed a program evaluation about the 4-months program regarding time, duration, settings, instructor, and overall satisfaction. Items were evaluated on a 1 (strongly disagree/very bad) to 4 (strongly agree/excellent) Likert agreement scale. A total of 73 participants evaluated the 4-month dance program. Participants evaluated the program adequacy agreeing or strongly agreeing as far: time, duration and setting (96-98%); instructor’s enthusiasm, quality of instructions, and eager to help (96-100%); dance program’s progression and enjoyment (93-96%); difficulty level (59%). Participants reported they intended to keep dancing by themselves (93%) and would recommend the program to friends and family (98%). Many participants (88%) reported feeling physically excellent or good as a result of the program, 95% found the program excellent or good, and 100% thought the program was worth their time. Overall, the BAILAMOS program evaluation demonstrated high participants’ acceptability and satisfaction. Those results can promote sustained LTPA and provide initial evidence to translation into community settings.


In 2007, South Africa (SA) launched a field epidemiology training program (SAFETP) to enhance its capacity to prevent, detect, and respond to public health threats through training in field epidemiology. The SAFETP began as a collaboration between the SA National Department of Health (NDOH), National Institute for Communicable Diseases (NICD), and the University of Pretoria (UP), with technical and financial support from the U.S. Centers for Disease Control and Prevention (CDC). In 2010, the CDC in collaboration with the NICD, established a Global Disease Detection (GDD) Center in SA, and the SAFETP became a core activity of the GDD center. Similar to other FETPs globally, the SAFETP is a 2-year, competency-based, applied epidemiology training program, following an apprenticeship model of ‘learn by doing’. SAFETP residents spend approximately 25% of the training in classroom-based didactic learning activities, and 75% in field activities to attain core competencies in epidemiology, biostatistics, outbreak investigation, scientific communication, surveillance evaluation, teaching others, and public health leadership. Residents earn a Master’s in Public Health (MPH) degree from UP upon successfully completing a planned research study that serves as a mini-dissertation.Since 2007, SAFETP has enrolled an average of 10 residents each year and, in 2017, enrolled its 11th cohort. During the first 10 years of the program, 98 residents have been enrolled, 89% completed the 2-year program, and of these, 76 (87%) earned an MPH degree. Of those completing the program, 88% are employed in the public health sector, and work at NICD, NDOH, Provincial Health Departments, foreign health institutions, or non-governmental organizations. In the first 10 years of the program, the combined outputs of trainees included over 130 outbreak investigations, more than 150 abstracts presented at national and international scientific conferences, more than 80 surveillance system evaluations, and more than 45 manuscripts published in peer-reviewed scientific journals. The SAFETP is having an impact in building epidemiology capacity for public health in South Africa. Developing methods to directly link and measure the impact of the program is planned for the future. There is increasing worldwide recognition that having applied epidemiology training that leads to the development of skilled personnel who conduct surveillance, investigate outbreaks, estimate disease burden, and evaluate determinants of health and the impacts of public health interventions is essential for every country.  This worStarting in 2007, the South Africa Field Epidemiology Training Program (SAFETP), a 2-year, competency-based training program, was initiated and developed as a collaboration between the South African National Department of Health (NDOH), the National Institute of Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), and the U.S. Centers for Disease Control and Prevention (CDC), to increase field epidemiology capacity for the country. SAFETP uses an established applied epidemiology curriculum, providing an accredited Masters in Public Health (MPH) degree from the University of Pretoria (UP), with mentored competency-based practical field experience. To date, the program has trained 87 health professionals in applied epidemiology. This paper describes the first 10 years of the SAFETP, including the origin and rationale for the program, the training model, accomplishments, challenges encountered, and observations regarding possible future directions of the program.Training in applied field epidemiology at a national level has its origins in the 1950’s with the creation of the Epidemic Intelligence Service (EIS) at CDC.  The creaPublic Health Schools Without Walls” (PHSWOW), to convey both the academic and the applied field components of the training.Beginning in the 1970’s, the applied epidemiology training model of EIS was exported to other countries, often under the name of Field Epidemiology Training Programs (FETP).  These prBeginning in the 2000’s, many other African countries recognized the need for human resource development, not only in epidemiology, but also in laboratory sciences linked to applied epidemiology. During this decade, many African nations hardest hit by the HIV/AIDS pandemic also began receiving substantial resources to combat HIV, and develop the human resources necessary to address the epidemic, from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and its predecessor, the LIFE initiative. In this context, training programs that included content in both field epidemiology and laboratory services were launched in Kenya and Tanzania in 2004–2005, and referred to as Field Epidemiology and Laboratory Training Programs or FELTP. These programs closely resembled the standard FETPs outside of Africa, but included a laboratory component, and were also affiliated with academic institutions awarding a master’s degree, similar to the PHSWOW programs in Uganda and Zimbabwe. These FELTP’s in Kenya and Tanzania quickly became the model for establishing other FELTP’s in Africa.  While FEFollowing establishment of democratic rule in South Africa in the early 1990’s, the country was faced with growing expectations to provide basic health services for all, in the context of substantial racial disparities in economic and health status. The country also reported one of the highest numbers in the world of people living with HIV, high rates of TB and other infectious diseases, as well as a growing chronic disease burden.  In this In 2004, South Africa became one of the 15 PEPFAR focus countries and received the largest PEPFAR budget. The need to build applied epidemiology capacity in South Africa was prioritized to effectively respond to its HIV/AIDS epidemic. In 2005, South African health officials, together with U.S. and locally based CDC officials, planned the development of a South Africa Field Epidemiology and Laboratory Training Program (SAFELTP), which was subsequently launched in 2007. SAFELTP began as an academic degree granting program with a laboratory training component, similar to the Kenya and Tanzanian FELTPs, and supported as a collaboration between the NDOH, NICD, and UP School of Health Systems and Public Health, with technical and financial assistance from U.S. CDC and PEPFAR. The program targeted physicians, nurses, laboratorians, and other allied health professionals with a first degree in the health sciences. Other details regarding the early origins of the program have been previously described. In 2012, the program conducted an external review (unpublished) and the outcome of the review informed the strategic plan of the program. The sustainability of the program, together with increasing its visibility and impact, were listed as key strategic objectives. Moreover, demand for the laboratory component of the program diminished over time and it was observed that laboratory scientists enrolled in FELTP did not return to work in the laboratories following conclusion of the program. In view of this, the laboratory component was removed in 2014, thus the SAFELTP became the SAFETP it is today, and no longer includes a separate laboratory training track.Another major transition occurring during the first 10 years relates to funding for the program. When the program began, the majority of the operating costs were from direct assistance via PEPFAR. Additional resources were provided by the South African NDOH through its allocation of funds to the NICD of the NHLS. In 2010, CDC in collaboration with the NICD, established a Global Disease Detection (GDD) center in South Africa. The GDD center was established as a partnership to improve early detection of health threats that could be regional or global in nature, similar to the 9 other CDC supported GDD centers around the world.  Over timParticipants in the SAFETP develop competencies in several inter-related areas: epidemiology, disease surveillance, biostatistics, data management and analysis, scientific communication, public health leadership, and teaching of others. Residents develop these competencies by elaborating a set of Core Learning Activities (CLAs). The CLAs required to complete the program include: 1) evaluating a surveillance system; 2) analyzing a large data set; 3) developing a protocol for and completing a hypothesis driven research project; 4) submitting abstracts for scientific conferences; 5) a poster or oral presentation at a scientific conference; 6) preparing a bulletin article on a public health topic; 7) preparing a scientific manuscript suitable for publication in a peer-reviewed journal; 8) investigating at least 3 disease outbreaks; 9) conducting workshops or other training activities for others. While developing these CLAs, related protocols, and work products, residents are also trained in the core ethical principles of conducting research involving human subjects. Residents must complete all required CLAs to be eligible for a UP degree. In addition, they must complete a standard academic thesis or a mini-dissertation. For their theses, residents are encouraged to prepare a manuscript formatted as a peer-reviewed journal article, based on one of their CLAs.The SAFETP enrolls a new cohort of residents annually that begin their 2-year training in January, and complete the training in December of the following year. During the 24 months of the program, residents spend the first 5 months in classroom modules at UP or NICD, to gain knowledge and skills needed to develop the required CLAs. In June of each year, the first year residents are then assigned to their field locations and field site supervisor. During the final 18 months of the program, residents develop and complete their CLAs, with assistance from their field supervisor and program mentor.Residents spend approximately 75% of the 2-year training at field placement sites. These sites are selected based on priority health areas where adequate supervision, a suitable work environment, and access to data and other resources are available for completing the CLAs. Residents focus on addressing the priority diseases of the country . In the past, residents have been placed at the National Department of Health, the National Cancer Registry, the University of South Africa (UNISA) Injury and Violence Unit, Health Sciences Research Council (HSRC), and Medical University of South Africa (MEDUNSA) HIV Pharmacovigilance Unit. Other specific field sites may include the NICD, a provincial or municipal health department, or partner ministries such as the Department of Agriculture, Forestry, and Fisheries (DAFF), which is responsible for animal health and many zoonotic disease issues. Field sites interested in hosting a SAFETP resident complete an application form and describe the data and resources they have available to host a resident. Decisions regarding final field placements consider adequacy of data and supervision, local knowledge and language skills of the resident, and priority health areas.The NICD has an Outbreak Response Unit (ORU) staffed by a small number of field epidemiologists who assist provinces and districts in responding to and investigating disease outbreaks. Each SAFETP resident completes a 3–4 week rotation at ORU during their training. The rotation provides supervised opportunities to develop needed knowledge and skills in investigating disease outbreaks. Residents may also complete outbreak investigations during their regular field assignments.Other important components of the training program include a quarterly scientific seminar in which the residents present findings from field investigations; participation at national and international scientific conferences to present accepted work; and supplemental workshops on relevant topics.For completion of the CLAs and UP thesis requirements, residents are supported by a SAFETP assigned mentor and a field supervisor. In addition, GDD provided technical assistance has included a scientific writer, a biostatistician, and a CDC FETP resident adviser, who have provided training and support to all residents in scientific communication, statistical analysis, and epidemiologic field investigation methods. The scientific writer conducts workshops on scientific communication which address the specific requirements of each of the written CLAs. The writer-editor reviews draft written materials and provides one-on-one consultation during the scientific writing process. The biostatistician provides individual consultation regarding survey design, sample size calculation, and statistical analysis.SAFETP has also been an active member of the relevant professional networks for training in field epidemiology. This includes at the global level, the Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET),  and regiThe total number of residents enrolled in SAFETP between 2007 and 2016 is 98 (average 10 residents/year). Of these, 87 (89%) have completed the two-years of residency and of these 87, 76 (87%) have been awarded MPH degrees by the University of Pretoria (as at May 2018)  are working within South Africa  and alumni (n = 7) conducted an evaluation of the National Notifiable Medical Conditions (NMC) surveillance system in the country. The findings from the evaluation have informed the recent re-engineering of the NMC surveillance system for South Africa.SAFETP trainees and graduates have also helped strengthen public health surveillance programs within the country. The trainees have contributed to the design, implementation, and evaluation of various surveillance systems at all levels of the health system. During 2015, a team of SAFETP residents (SAFETP has experienced several challenges over its first decade. The external program review in 2012 confirmed that at least 30% of residents had completed all requirements except the UP thesis, and thus, were not graduating with their MPH on time. UP had always offered a peer-reviewed manuscript as an option instead of a traditional academic thesis. However, the majority of residents had been submitting the traditional academic thesis. The SAFETP adopted the external reviewers’ recommendation and made a first authored, peer-reviewed manuscript compulsory and encouraged residents to use this manuscript as the basis for fulfilling the UP thesis requirement for graduation. SAFETP staff then followed up with individual residents who had previously completed the two year training, but had not achieved the MPH. This involved one-on-one meetings to review their progress in manuscript writing, statistical analysis, and interpretation of their data. As a result, the overall MPH graduation rate went up from 55%, as measured in 2013, to 87% measured in 2018, following the completion of the 2016 cohort.The external evaluation also pointed out that the program was not attracting medical or veterinary graduates for enrollment. Less than 20% of the program participants to date have been medical doctors or veterinarians. Ongoing efforts are underway, working with the leadership of NDOH and DAFF, to facilitate and support more medical and veterinary staff from those agencies to join SAFETP. DAFF is supporting two veterinarians currently in the program. The demand for curative care in South Africa places undue pressure on medical doctors to go into providing clinical services. However, supervisory staff at facility and provincial DOH levels have shown willingness to support nurses and medical scientists to join the program. Fully addressing this issue is an ongoing challenge, however, SAFETP has recently undertaken a series of focus group discussions on field epidemiology for fourth-year medical and veterinary students to increase awareness of the opportunities that the discipline presents.An ongoing program challenge is increasing the quantity and quality of outbreak investigations conducted by the residents. Residents are required to participate in at least three outbreak investigations. Their individual responsibilities in each investigation gradually increase, as their competency in outbreak investigation progresses, so that by the third outbreak, they are expected to lead the investigation. Residents may partially complete their outbreak investigation competency through the ORU. The number of requests, the type of investigations requested, along with ORU staff availability and standardization of the outbreak investigation approach, have been identified as factors leading to variable resident experiences in learning to do outbreak investigations. In general, residents assigned to provinces and districts have an increased likelihood of being involved in outbreak investigations within their jurisdiction. Ongoing efforts are underway to improve the coordination, supervision, and standardization of outbreak reporting and investigation, to better prepare SAFETP residents to acquire this critical competency.SAFETP started with being almost completely funded by the US CDC. Since inception, the NICD has provided office space and other program services such as human resources, information technology, and grants management. In addition, the salary of the Program Director has always been funded by the NICD. A number of residents were financially supported by the NDOH while in the program through contribution of salaries and the provision of study leave. As of April 2016, the NICD became the primary funder of the program and the FETP posts of Senior Epidemiologist, Field Epidemiologist, and Administrator are now included in the NICD organogram staffing plan. Funding for the program comes from the South African Treasury through the NDOH to the NICD. The SAFETP’s funding transition to NICD brings country ownership and sustainability to the program.To facilitate the development and use of field epidemiology practice in the country, SAFETP staff has engaged in certain training and advocacy activities. To launch the program and since inception, SAFETP staff has provided short courses in field epidemiology to provinces and districts that have requested this training. These short courses have served to both market field epidemiology as a core public health discipline, and as a potential screening opportunity for identifying suitable candidates for the 2-year program. Since 2008, SAFETP has conducted approximately 20 basic epidemiology short courses, involving more than 500 participants, from all 9 provinces of South Africa. Recently, the CDC developed Frontline FETP training curriculum has been piloted in South Africa to further strengthen and enhance the existing training curriculum used for epidemiology short course training activities.  Future pThe human resources for health strategy document of the NDOH highlights the need to have a standardized, competency-based, and accredited training program for trainees in epidemiology and biostatistics, with specified career pathways and job opportunities following their training.  To this From 2007 to 2016, SAFETP has matured from an externally supported collaboration, into a South African owned training program for developing applied epidemiologists to address the need for a quality public health system that is effective in detecting, responding to, and preventing health threats to its population. The leadership of SAFETP is forging the program into more formal engagement and deeper integration within the epidemiology and communicable diseases sections of the national and provincial departments of health. Additionally, to ensure that demand and that career pathways are specified, staffing plans with field epidemiology position descriptions must be further developed with principals at the National and Provincial DOH Human Resource Departments and NICD, in collaboration with leads from the Epidemiology SIG. In order to sustain field epidemiology training in the long term, the 10 years of SAFETP illustrates the need for a continued structured programmatic approach, including appropriate curriculum and mentored practicum sites that meet the priority public health conditions of the country.


MS6.4 Menyuan earthquake are estimated using ground-based gravity-change data from 2011 to 2015 in the northeastern Tibetan Plateau. The results show that negative density changes dominate the region between the South Longshou Mountain fault and the Daban Mountain fault except the southeast of this region (the seismic region) during 2011–2012. Positive density changes appeared in the middle crust near the epicenter during 2012–2013 and in the upper and middle crust east of the epicenter approximately 1.5 years before the earthquake (2013–2014), and then negative density changes appeared under and northeast of the epicenter approximately four months before the earthquake (2014–2015). The state of the crustal materials near the seismic region changed from convergence to expansion, in turn, indicating that the characteristics of the deep seismogenic process was corresponding to Amos Nur’s 1974 dilatancy-fluid diffusion model.Geophysical processes of the pre-earthquake activities are difficult to be determined since less pre-seismic signal is observed directly. Crustal density changes derived from the periodical terrestrial gravimetry may provide meaningful deep information for the pre-earthquake cue. In this study, the crustal density changes following the 2016  Relationship between gravity changes and earthquakes was first reported following the 1964 Alaska earthquake3, and then had been attracted much attention. For decades, terrestrial gravity-change data were remarkably employed to investigate the geophysical processes of the earthquakes12. Accordingly, the models related to the earthquake-induced gravity changes, such as the dilatancy mode9 and the dislocation mode15, were proposed to interpret or formulate the earthquake-related deep processes. On account of the unreachability, several remaining questions, such as the seismogenic process, require more available geophysical and geodetic observations on the earth’s surface, as well as the available interpreting methods.Temporal–spatial gravity changes from terrestrial gravimetry have contributed to understanding of the tectonic movements including earthquakes17. The surface vertical deformation and rock density changes are regarded as the most significant patterns for local crustal movement17. Geodetic observation can intuitively present the surface vertical deformation19, while the crustal DCs could not be determined directly. Investigating the crustal DCs should be a starting point to understand the seismogenic process. As a tentative research, Xuan et al.20 suggested that the crustal DCs derived from the temporal-spatial gravity-change data may imply the dynamic information related to the pre-earthquake.The main factor contributing to gravity changes should be crustal mass redistribution, which generally appears in the forms of the crustal deformation and density changes (DCs)MS6.4 Menyuan earthquake ruptured on the Lenglongling (LLL) fault, only 10 km from the largest event since the 26 August 1986 Menyuan MS6.4 earthquake. The epicenter locates at the northeastern Tibetan Plateau (NETP), between the east end of the North Qilian Mountain (NQM) fault and the west end of the Tertiary Menyuan basin. The LLL fault, the western segment of the Haiyuan fault, is a left-lateral strike-slip fault with a small dip-slip component initiating in the late Quaternary, and its late Pleistocene slip rate is estimated at 3–24 mm/yr24. The LLL fault is subjected to an almost NEE-trending compression resulting from the interaction between the Tibetan Plateau and the Alxa block25. Notably, the focal mechanism and source parameters of the 2016 event26 indicated a thrust-type earthquake which is in disaccord with the behavior of the fault19.The 2016 MS6.4 earthquake29, suggesting the dynamic information related to the deep process. In this study, the gravity changes following the Menyuan earthquake with time on a one-year scale in the NETP were used to determine the crustal DCs using 3D gravity inversion method. Based on the DC results, the change characteristics of crustal materials are investigated before this event as well as possible factors contributing to the earthquake.The observed gravity changed from increase to decrease near the LLL fault and surroundings before the 2016 Menyuan 3. When the standard deviation was less than 5 μGals  or after ten steps, the iteration was stopped. Figure The underground domain, from the surface to a depth of 54 km, included nine layers with non-density-change and had been taken as the initial target model. In the model this domain was divided into 8649 prisms of dimensions 11.1 km (east–west direction) by 11.1 km (north–south direction) by 6 km . During the inversion, the densities of the crustal rock changed within ± 0.2 kg/mFigure The DCs during 2012–2013 Fig. . In the The crustal DCs near the epicenter of the 2016 Menyuan earthquake during the periods of 2013–2014 and 2014–2015 Figs. . A distiMost of the intense DCs occurred before the 2016 Menyuan earthquake in the 2014–2015 analysis map Fig. . Positivg = 2πGρΔh, if Δg = 1 μGal and the crustal density ρ = 2670 kg/m3, the vertical deformation Δh should reach ~9 mm. However, the surface uplift in the NETP was < 6 mm/a revealed by the annually levelling measurements30 or ~1.3 mm/a from the GPS solution31. We inferred that the maximum of gravity decrease was < 1 μGal/a, which was too small to account for the observed gravity-change values and could be neglected. Compared with the amplitude of the gravity changes in the NETP, the effects of other factors such as the hydrology were also small28, which also could be inferred from the groundwater storage change of < 10 mm/a  from GRACE observations32. Therefore, in this study we considered the obtained gravity changes as the DC results in the local crustal materials.Firstly, we estimated the contributions from the vertical deformation and hydrology on gravity changes. According to the approximate formula Δ12, and in common, could be explained in terms of the redistribution of the crustal materials17, which represented in two forms: negative and positive DCs. The negative DCs were mainly resulted from when crustal materials shifted from their original location and were not replaced or were replaced by a smaller volume of new material; this process may be considered as expansion of the original crustal material. The positive DC was mainly caused by the materials shifting into the area or convergence of the crust due to tectonic forces. Although this work was a preliminary study, our crustal DC results could generally account for the dynamic process preceding the 2016 Menyuan earthquake. The density changes from the inversion results mainly dominated the upper and middle crustal movement around the seismic region  and of absolute observations , the Liudong Gravimetry Adjustment (LGADJ) software package is used for net adjustment and to obtain the gravity data at each measured gravity points. During the adjustment calculations, the corrections of earth tide, drift of relative gravimeters and atmospheric pressure are addressed according to the convention41. The accuracies of the gravity values at measured points from the net adjustment are almost better than 15 μGals, even better than 10 μGals in most cases, which ensure the reliability of the gravity changes with time at the measured stations. Therefore, gravity-change datasets are regarded as one of the most effective geophysical data for investigating the deep processes before the strong earthquakes12, including the 2016 Menyuan earthquake40.Analysis of the gravity-change data obtained from the gravity network which covers the NETP is an important part of the seismic monitoring program in China. Two types of the periodical repeated gravity observations are carried out by China Earthquake Administration (CEA): absolute gravimetry at the benchmarks and relative gravimetry at every station. The time buckets are from March to May and from July to September every year. More than 100 stations using the FG5(X)/A10 absolute gravimeters within the gravity network in mainland ChinaMS6.4 earthquake. The gravity-change data used for this study were gridded to 0.1° × 0.1° and first-order details of the discrete wavelet transformation were removed to reduce the effects of the high-frequency noise. Negative gravity-change in the northwest segment of LLL fault (east of 101°E) presented in the periods 2011–2012, 2012–2013 and 2013–2014 . The data was processed based on the classical adjustment by using LDADJ software to obtain the gravity values for each measurement period. The one-year time-scale data was used here, which may minimize the annual and semi-annual effects, such as hydrological and atmospheric pressure effects, based on the available data. The gravity differences at every station for two consecutive years were obtained by subtracting the gravity values of the previous year from those of one year. For gravity-change data, many of the standard gravity corrections (e.g. Bouguer and terrain corrections) were not required, because the corrections would be identical for the measurements made at each gravity station every year. Figure 014 Fig. , and the014 Fig. . The epi014 Fig. , subsequ014 Fig. . AlthougM prisms, and the gravity effects caused by the DC at the ith point, Δgi, is the sum of the gravity effect of each prism, given byaij is the element of the kernel matrix A, vj indicates the density change of the jth prism and ei is the ith element of the noise matrix E associated with the observation data. The observation equation Eq. (The underground domain is divided into 43 is the primary algorithm used here to determine the underground density changes. The distribution of the density changes V is determined to minimize the objective function composed of the density changes underground and errors of the observed gravity changes:wvj and wei are weighting functions of the density-change and gravity-change data, respectively. The minimization of the weighted least-squares problem (Eq. (V is equal to zero, whereby the solution following Last and Kubik42 is given byWv and We are the diagonal matrixes composed of wvj and wei in Eq. (A decays with the inverse squared depth. The depth-weighting matrix Wd is introduced to overcome the density mostly concentrated near the surface45, and then the solution Eq. (The compact gravity inversion methodentclass1pt{minimaWv and depth-weighting Wd should speed up the iterative convergence in comparison to using only one of the matrixes. The solution can be obtained directly from Eq. (V0. In this study, the iteration starts from Wv = I and V0 = 0. The numerical test for the availability of the inversion method can be found in the Supplementary Information. Combining the constraint matrixes with the minimum volume from Eq.  for any Numerical test of the inversion method