It was founded by evangelical abolitionists in 1860. Wheaton College was a stop on the Underground Railroad and graduated one of Illinois' first black college graduates.
BackgroundCommon mental health conditions (CMHCs) such as depression and anxiety often co-occur with noncommunicable diseases (NCDs) like hypertension and diabetes, compounding disability and mortality particularly in low- and middle-income countries (LMICs), with under-resourced health systems. This comorbidity is driven by shared behavioral risk factors including stress, isolation, tobacco use, inactivity, poor diet, and nonadherence to treatment. The World Health Organization recommends evidence-based stress reduction (EBSR), behavioral activation (BA), and motivational interviewing (MI) to address these modifiable risks, but the implementation of such multi-component behavioral interventions in community-based settings remains limited. There is a critical gap in implementation research on how best to deliver these combined interventions through community health workers (CHWs) within public health systems. This study addresses that gap by evaluating the effectiveness, implementation, and scalability of the BEhavioral Community-based COmbined Intervention for MEntal health and noncommunicable diseases (BECOME). The trial assesses clinical outcomes, implementation outcomes using the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework at patient, provider, and health system levels and conducts a comprehensive costing analysis to inform future scale-up.MethodsThis is a stepped-wedge cluster randomized controlled trial involving 20 geographic clusters across two provinces of Nepal and 700 participants aged 40 years and above with at least one CMHC and one NCD. CHWs will be trained to deliver BECOME, comprising EBSR, BA, and MI, while the control period will include enhanced usual care. Primary outcomes include changes in CMHC severity and secondary outcomes include NCD outcomes, behavioral factors, and implementation processes. Focus group discussions and in-depth interviews with CHWs, patients, healthcare providers, and health system leaders will explore intervention acceptability and mechanisms of change. Structured costing analysis will estimate the intervention costs.DiscussionParticipant recruitment began in July 2024 and is currently ongoing. We anticipate completing data collection for the primary outcome measures by January 2027, with the aim of disseminating preliminary findings within the same year. Findings from this study will provide evidence on the effectiveness and feasibility of a CHW-delivered, integrated behavioral intervention, BECOME, for CMHCs and NCDs in LMICs, informing potential scale-up.Trial registrationClinicalTrials.gov, NCT06449521, Registered on 25 April 2024, https://register.clinicaltrials.gov/prs/beta/studies/S000DZJN00000112/recordSummary.
A recent study proposed "gene flooding" as a strategy for controlling invasive populations through repeated introduction of inbred individuals. Their simulations demonstrate that sustained demographic influx can drive collapse of resident alleles under certain conditions. However, the broader dynamical structure governing when such collapse occurs remains unclear. Here, forward-time population genetic simulations were used to examine allele replacement under repeated asymmetric migration in a density-regulated population. Systematic variation of migration intensity revealed that allele replacement does not proceed gradually as migration increases. Instead, the system exhibits a sharp transition separating regimes of resident allele persistence from regimes of rapid allele loss. This threshold behavior remains robust across variation in mating structure and migrant reproductive disadvantage, indicating that demographic influx itself plays a dominant role in governing evolutionary outcomes. These results clarify the conditions under which migration-driven allele replacement may occur for gene flooding to be useful and highlight the potential for nonlinear tipping points in population genetic systems experiencing sustained demographic introduction.
