To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
• Ward rounds and clinical review meetings should reflect the recovery model for mental health and person centred planning. They play a pivotal role in hospital-based care. They should enhance the quality of patient care, improving communication and address service users’ concerns and problems.
• They should involve users as fully as possible in the development and review of their treatment plan, allow proper planning and evaluation of treatment and facilitate multi-professional training and education.
• This audit is designed to benchmark current practice against proposed standards outlined below.
To establish if the ward review practice in Prof. Benbow's team on Cedar Ward, Penn hospital is in line with the proposed standards and to consider whether the standards are appropriate.
• The sample population includes patients or the cares involved in their care. Data was gathered by means of questionnaires and retrospectively from psychiatric case records between the period 01/001/2008 and 31/12/2008.
• The questionnaires were both respondent and researcher completed. Open and close ended questions were used.
• The findings showed satisfaction with the ward meeting process, but participants identified issues that could be improved upon.
• Audit strength includes clearly defined standards and giving room for additional comments.
• Limitations includes small sample size and poor response from patients and the carers.
Anxiety disorders are highly prevalent in population of European countries. However, the effect of Valproate (depakine-chrono) on generalized anxiety disorder (GAD) has not been studied in a double-blind placebo-controlled design.
Eighty patients (all men) were washout from the all medications. Each patient was randomized to receive either depakine-chrono (40 patients) for 6 weeks or matched placebo (40 patients) in a double-blind manner. Eligible participants, in addition to meeting the DSM-IV criteria for GAD and having a minimum score of 25 and more on the Hamilton Anxiety Scale, were required to be between 18 and 65 years. Response was defined as a 50% reduction in the Hamilton anxiety scale score. Response and side effects with depakine-chrono and placebo were compared by using analysis of variance (ANOVA) and chi-square tests. Six patients did not return for at least one subsequent assessment, leaving 74 patients (36 taking depakine-chrono and 38 taking placebo) in the valuables study group.
Twenty six of the 36 depakine-chrono-treated participants responded by 6 weeks, versus six of the 38 placebo-treated participants (p < 0.001). The most common and problematic side effect in the depakine-chrono group was dizziness and nausea.
The authors believe this to be the first double-blind placebo-controlled randomization study to test the efficacy of a depakine-chrono in the management of anxiety disorders. They need to be replicated in a larger study group.
Devastating floods from July to September 2010 broke all previous records of havoc caused by natural disasters in Pakistan. Flood caused 20 million people to loose their homes, profession and community making them internally displaced. Devastating consequences are still continuous within the country.
To find out the prevalence of anxiety, depression and post-traumatic stress disorder among flood affected Internally Displaced Persons (IDPs) of Sind.
To find out psychiatric morbidity in IDPs so that proper attention should be paid to rehabilitation of these effectees and psychiatric support should be provided specially to those who are more affected by psychological trauma.
Cross sectional study conducted in Razzakabad, an area located in periphery of Karachi. PTSD prevalence was measured using the Harvard Trauma Questionnaire and levels of anxiety and depression were measured using the Hopkins Symptom Checklist-25. SPSS 17 was used for data entry and analysis.
Total 303 subjects were included in this study out of which 55% were females.The total Scores on Hopkins symptoms checklist - 25 (HSCL-25) and on Harvard trauma Questionnaire were significantly high and psychiatric morbidity was present in 42% of the population. The presence of psychological distress was more in females (65.6%) (p = .05).32% of the subjects had symptoms of PTSD.44% of the population was screened positive for anxiety and depression symptoms were present in 39% of the population.
Besides being displaced from their residence exposure to trauma come out to be the important causative factor in creating psychological disturbance among IDPs.
Lymphopenia is common in adults who have had a Fontan operation although its aetiology and clinical implications remain unknown. Previous work suggests an association between lymphopenia and both liver disease and splenomegaly. The objective of this study was to assess the prevalence of lymphopenia in adults with a Fontan circulation and evaluate its associations with risk factors and clinical outcomes. Using a retrospective cohort study design, we studied 73 adult Fontan patients (age 25.0 ± 8.4 years) who had a complete blood count and abdominal imaging performed. Patients with protein-losing enteropathy were excluded. Clinical data were extracted from hospital records. The mean white blood cell count was 6580 ± 220/ml with a mean lymphocyte count of 1223 ± 508/ml. Lymphopenia, defined as lymphocyte count <1000/ml, was present in 23 (32%) patients. Patients with lymphopenia had a lower total white blood cell count (5556 ± 2517 versus 7136 ± 1924/ml, p = 0.009) and a lower platelet count (162 ± 69 versus 208 ± 69 k/ml, p = 0.008). Lymphopenia was also associated with findings of portal hypertension, including splenomegaly (36 versus 14%, p = 0.04), varices (22 versus 6%, p = 0.04), and ascites (39 versus 14%, p = 0.02). Lymphopenia did not correlate with any cardiac imaging, haemodynamic or exercise testing variables. In conclusion, lymphopenia is common in adult Fontan patients and is associated with markers of portal hypertension. Larger studies are needed to better define the relationship between lymphopenia and clinical outcomes.
Postnatal depression is known to cause disability and suffering in women and negative consequences both for their infants and their families, with huge costs globally. Several studies from low and middle income countries (LAMIC) have demonstrated that effectively delivered psychological interventions are cost effective for improving maternal and child health, but access to these interventions is limited in both the low and high income countries.
The objective of the study is to develop and test a mobile phone-based intervention (TechMotherCare), which will include components of cognitive behavioural therapy (CBT) and child development related psychoeducation.
The aim of the study is to examine the feasibility and acceptability of the TechMotherCare intervention.
A total of 36 participants will be recruited from health centers in Karachi, Pakistan for this 2-arm randomized pilot study. The TechMotherCare App intervention will be based on principles of CBT and learning-through-play (LTP) a parenting intervention and will assess the real-time depressive symptoms of participants and respond, using intelligent real time therapy (iRTT) dependent on symptoms reported by participants.
Outcome assessments will be completed after 3 months (end of intervention). In-depth qualitative interviews will also be conducted with participants pre- and post-intervention. The trial is ongoing and we will present both the qualitative and quantitative results.
The results of this pilot trial will inform the design of a larger randomised controlled trial using a mobile based technology platform to address the huge treatment gap in LAMICs.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Arguing that it would serve scholars and practitioners better to view impression management (IM) from a coworker's perspective than from that of an actor's outcomes, this study demonstrates that IM by a coworker triggers a self-serving attributional process. The authors reason that denial of another's relative advantage leads the observing coworker to attribute this behavior to the actor's incompetence, consequently leading to counterproductive behavior toward them in efforts to reduce their own relative disadvantage. Data were collected at T1 and T2 from 142 service sector employees. Our results were consistent with our hypotheses. However, the moderated-mediation models for conditional effects of hostile attributional style were not supported. This study offers an integrated view of previously isolated domains of IM and attribution, suggesting future literature considers a similar perspective for more meaningful investigations.
The main objective of this study is to assure the quality of cervical cancer treatment plans using an electronic portal imaging device (EPID) in RapidArc techniques.
Materials and Methods:
Fifteen cases of cervical cancer patients undergoing RapidArc technique were selected to evaluate the quality assurance (QA) of their treatment. The computed tomography (CT) of each patient was obtained with 3-mm-slice thickness and transferred to the Eclipse treatment planning system. The prescribed dose (PD) of 50·4 Gy with 1·8 Gy per fraction to planning target volume (PTV) was used for each patient. The aim of treatment planning was to achieve 95% of PD to cover 97%, and dose to the PTV should not receive 105% of the PD. All RapidArc plans were created using the AAA algorithm and treated on Varian DHX using 6 MV photon beam, with two full arcs. Gamma analysis was used to evaluate the quality of the treatment plans with accepting criteria of 95% at 3%/3 mm.
In this study, maximum and average gamma values were 2·53 ± 0·409 and 0·195 ± 0·059 showing very small deviation and indicating the smaller difference between both predicted and portal doses. Gamma Area changes from > 0·8 to > 1·2. SD increased to 5·4% and mean standard error increased to 4·67%.
On the basis of these outcomes, we can summarise that the EPID is a useful tool for QA in standardising and evaluating RapidArc treatment plans of cervical cancer in routine clinical practice.
Antenna-pattern measurements obtained from a double-metal supra-terahertz-frequency (supra-THz) quantum cascade laser (QCL) are presented. The QCL is mounted within a mechanically micro-machined waveguide cavity containing dual diagonal feedhorns. Operating in continuous-wave mode at 3.5 THz, and at an ambient temperature of ~60 K, QCL emission has been directed via the feedhorns to a supra-THz detector mounted on a multi-axis linear scanner. Comparison of simulated and measured far-field antenna patterns shows an excellent degree of correlation between beamwidth (full-width-half-maximum) and sidelobe content and a very substantial improvement when compared with unmounted devices. Additionally, a single output has been used to successfully illuminate and demonstrate an optical breadboard arrangement associated with a future supra-THz Earth observation space-borne payload. Our novel device has therefore provided a valuable demonstration of the effectiveness of supra-THz diagonal feedhorns and QCL devices for future space-borne ultra-high-frequency Earth-observing heterodyne radiometers.
The Thinking Healthy Programme (THP) is an evidence-based psychological intervention endorsed by the World Health Organization, tailored for non-specialist health workers in low- and middle-income countries. However, training and supervision of large numbers of health workers is a major challenge for the scale-up of THP. We developed a ‘Technology-Assisted Cascaded Training and Supervision system’ (TACTS) for THP consisting of a training application and cascaded supervision delivered from a distance.
A single-blind, non-inferiority, randomized controlled trial was conducted in District Swat, a post-conflict area of North Pakistan. Eighty community health workers (called Lady Health Workers or LHWs) were randomly assigned to either TACTS or conventional face-to-face training and supervision by a specialist. Competence of LHWs in delivering THP post-training was assessed by independent observers rating a therapeutic session using a standardized measure, the ‘Enhancing Assessment of Common Therapeutic factors’ (ENACT), immediately post-training and after 3 months. ENACT uses a Likert scale to score an observed interaction on 18 dimensions, with a total score of 54, and a higher score indicating greater competence.
Results indicated no significant differences between health workers trained using TACTS and supervised from distance v. those trained and supervised by a specialist face-to-face (mean ENACT score M = 24.97, s.d. = 5.95 v. M = 27.27, s.d. = 5.60, p = 0.079, 95% CI 4.87–0.27) and at 3 months follow-up assessment (M = 44.48, s.d. = 3.97 v. M = 43.63, s.d. = 6.34, p = 0.53, CI −1.88 to 3.59).
TACTS can provide a promising tool for training and supervision of front-line workers in areas where there is a shortage of specialist trainers and supervisors.
Ultra deep desulfurization of liquid fuels such as gasoline/diesel has attracted considerable attention of modern clean fuel research due to strict environmental regulations. Apart from that, SOx produced during combustion, poison the catalytic converter and exhaust emission system. Comparing to conventional catalytic and hydrodesulfurization techniques, adsorptive method for removal of sulfur bearing compounds e.g. thiophene derivatives is a promising approach which does not require hydrogen gas and high temperature. In this study, we used nickel sulfide nanoparticles incorporated poly(methyl methacrylate)-zirconia membranes as potential affinity material for adsorptive extraction of dibenzothiophene from n-hexane. The functionality and surface morphology of synthesized material was examined by Fourier transformation infrared (FTIR) spectroscopy and atomic force microscopy (AFM) images, respectively. The quantitative data regarding adsorptive removal of dibenzothiophene was determined by monitoring the shift in absorbance values of standard solutions before and after treating with synthesized material under ambient conditions. Nickel sulphide nanoparticles exhibited suitable rebinding response for removal of dibenzothiophene down to 1 ppm due to affinity interactions which is useful concerning ultra deep desulfurization. Finally, nickel sulphide nanoparticles were incorporated in poly(methyl methacrylate)-zirconia membrane which showed potential application for adsorptive desulfurization of dibenzothiophene at ambient conditions.
This essay presents the analysis, approach and understanding of the underlying reasons why
females join the “Islamic State in Iraq and Syria” (ISIS), accept its rules and impositions,
play an active role in it, and often actively recruit other women to join ISIS as perceived
by an experienced and savvy communications expert and professional who also took active part
in anti-terrorism campaigns in Pakistan. Previously he was a journalist who gained a deep
understanding of the political and policy-making dynamics in his country. Especially
valuable is the section on the “Way Forward”; that is, how to effectively tackle the
recruitment campaign and methodology of ISIS.
The present study planned to assess the medicinally important plants in the lower Margalla Hills of Islamabad, Pakistan using scanning electron microscopy of their pollens. Both quantitative and qualitative characters of the pollens were analyzed. The shapes of the pollen were prolate, spheroidal, elliptical, and oblate. Exine sculpturing showed rugulate, scabrate, psilate gemmate, and reticulate ornamentation. The people residing in the rural areas are thought to depend, primarily, on medicinal plant resources for many health care needs. A sample of 140 respondents was selected and interviewed by using a stratified random sampling technique. Results showed that the local communities of lower Margalla Hills are highly dependent on plants to treat various ailments, for example, respiratory (28%), digestive (46%) nervous, circulatory and dermatological problems (6% each), and reproductive problems (8%). The continuous dependence of the local community on ethnomedicinally important plants has led to serious degradation of the natural forest of lower Margalla Hills. Priority-based conservation and sustainable use of these forest resources are necessary, and use of alternative resources will also help in the forest conservation.
Dendritic cells (DC) are central regulators of immune responses and professional antigen-presenting cells (APCs) with the unique ability to induce both innate immune responses and a highly specific acquired immunity. DC communicates through chemical and mechanical signals in the initiation and maintenance of immune responses. DC forms immunological synapses with T-cells thus pulling T-cells strings and leading to activation of T-cells. Owing to their properties, DC are often called ‘nature's adjuvants’ and thus have become an important component of any vaccination strategy. Coccidiosis is a major intestinal disease caused by Eimeria spp., affecting economically valuable livestock animals such as chickens and turkeys. Economic losses are associated with decreased productivity in afflicted poultry. Vaccination strategies involving DC have been developed owing to the special properties of these cells in coordinating innate and adaptive immune responses. Vaccination of chickens with exosomes isolated from DC containing parasite antigens (Ags) represents a promising alternative strategy to control avian coccidiosis. In recent years, emergence of new chicken DC has opened a new horizon for the development of new vaccines and DC derived vaccine could be a possible strategy to control coccidiosis in field. This review summarises the current state of knowledge of DC and their specific functions in immunity against avian coccidiosis.
Norwood palliation for patients with single ventricle heart disease is associated with a significant risk for acute kidney injury, which portends a worse prognosis. We sought to investigate the impact of hybrid stage I palliation (Hybrid) on acute kidney injury risk.
This study is a single-centre prospective case–control study of seven consecutive neonates with single ventricle undergoing Hybrid palliation. Levels of serum creatinine and four novel urinary biomarkers, namely neutrophil gelatinase-associated lipocalin, interleukin-18, liver fatty acid-binding protein, and kidney injury molecule-1, were obtained before and after palliation. Acute kidney injury was defined as a ⩾50% increase in serum creatinine within 48 hours after the procedure. Data were compared with a contemporary cohort of 12 neonates with single ventricle who underwent Norwood palliation.
Patients who underwent Hybrid were more likely to be high-risk candidates (86 versus 25%, p=0.01) compared with those who underwent Norwood. Despite similar preoperative serum creatinine levels, there was a trend towards higher levels of postoperative peak serum creatinine (0.7 [0.63, 0.94] versus 0.56 [0.47, 0.74], p=0.06) and rate of acute kidney injury (67 versus 29%, p=0.17) in the Norwood cohort. Preoperative neutrophil gelatinase-associated lipocalin (58.4 [11, 86.3] versus 6.3 [5, 16.2], p=0.07) and interleukin-18 (30.6 [9.6, 167.2] versus 6.3 [6.3, 16.4], p=0.03) levels were higher in the Hybrid cohort. Nevertheless, longitudinal mixed-effect models demonstrated Hybrid palliation to be a protective factor against increased postoperative levels of neutrophil gelatinase-associated lipocalin (estimate −1.8 [−3.0, −9.0], p<0.001) and liver fatty acid-binding protein (−49.3 [−89.7, −8.8], p=0.018).
In this single-centre case–control study, postoperative acute kidney injury risk did not differ significantly by single ventricle stage I treatment strategy; however, postoperative elevation in novel urinary biomarkers, consistent with subclinical kidney injury, was encountered in the Norwood cohort but not in the Hybrid cohort.
Stripe rust, caused by Puccinia striiformis f.sp. tritici (Pst), is an important disease of winter wheat in Central Asia. Stripe rust races contain diverse virulence/avirulence patterns and change rapidly. Therefore the objectives of this research were to: (i) examine current pathotype variability of Pst races collected from Kazakhstan and Uzbekistan and (ii) evaluate stripe rust resistance in leading cultivars and advanced breeding lines targeted to those regions. Analyses of 152 Pst samples showed diverse virulence patterns with avirulence to Yr5, Yr10 and Yr15 being common. Most of identified races are among the rare. Analysis of a mixed Pst population showed 10 distinct pathotypes with frequencies ranged from 1.2 to 8.7%. The virulence patterns ranged from least ‘31–1.5’ and X-1.5 to highly virulent ‘86 + E16’. Seedling evaluation of 62 genotypes using the 10 pathotypes showed variations for resistance. Bunyodkor and Barhayot showed resistance to all pathotypes. Five Yr genes were postulated. Yr1 in KR12-5075, and Yr6 in KR11-03 and KR12-5003 were postulated. Yr5 combined with Yr10 and Yr15 genes were determined in Bunyodkor. The wheat genotypes also showed different levels of resistance in adult plant stage under field conditions. Twenty genotypes showed <20% severity in both Kazakhstan and Uzbekistan. The disease severity on several genotypes differed in this countries, suggesting different Pst populations in the two countries. Several resistant genotypes were identified, which should be further evaluated for release as new varieties or used in breeding programmes. Two resistant lines from this study were identified as new varieties in Georgia and Uzbekistan.
Livestock depredation has particular significance in pastoral societies across the Himalayas. The dynamics of depredation by the snow leopard Panthera uncia and wolf Canis lupus were investigated by means of household surveys in the Hushey Valley, in the Karakoram Mountains of Pakistan. During 2008–2012 90% of the households in the valley lost livestock to snow leopards and wolves, accounting for 0.8 animals per household per year. The cost of depredation per household was equivalent to PKR 9,853 (USD 101), or 10% of the mean annual cash income. The majority (41%) of predation incidents occurred in summer pastures, predominantly at night in open spaces. Of the total number of predation incidents, 60% were attributed to snow leopards and 37% to wolves; in 3% of cases the predator was unknown. As an immediate response to predation the majority of the local people (64%, n = 99) opted to report the case to their Village Conservation Committee for compensation and only 1% preferred to kill the predator; 32% did not respond to predation incidents. The perceived causes of predation were poor guarding (77%), reduction in wild prey (13%), and livestock being the favourite food of predators (10%). The most preferred strategies for predator management, according to the respondents, were enhanced guarding of livestock (72%), followed by increasing the availability of wild prey (18%), and lethal control (10%). Livestock depredation causing economic loss may lead to retaliatory killing of threatened predators. For carnivore conservation and livestock security in this area we recommend improved livestock guarding through collective hiring of skilled shepherds and the use of guard dogs.
This report is regarding a Dutch female with microcephaly, mild intellectual disability (ID), gonadal dysgenesis and dysmorphic facial features with synophrys. Upon genotyping, an ~455 kb de novo deletion encompassing the first exon of NRXN1 was found. Bidirectional sequencing of the coding exons of the NRXN1 alpha isoform was subsequently performed to investigate the possibility of a pathogenic mutation on the other allele, but we could not find any other mutation. Previously, many heterozygous mutations as well as microdeletions in NRXN1 were shown to be associated with ID, autism, schizophrenia, and other psychiatric and psychotic disorders. Our results are in agreement with other reports that show that NRXN1 deletions can lead to ID, microcephaly and mild dysmorphic features. However, this is the first report of gonadal dysgenesis being associated with such deletions. It is not clear whether there is a causal relationship between the NRXN1 deletion and gonadal dysgenesis, but it is of interest that the FSHR gene, which encodes the follicle-stimulating hormone receptor causative correlation that is mutated in ovarian dysgenesis, is located proximal to the NRXN1 gene. Given that most of the females carrying NRXN1 deletions have been diagnosed at a prepubertal age, gynecologic screening of female carriers of a NRXN1 deletion is warranted.
A ternary Nickel foam (NF)–graphene/MnO2/polyaniline (PANI) nanocomposite has been synthesized using green chemistry approach (in situ polymerization). All reactants were dispersed homogeneously in precursor solution in the form of ions and molecules. PANI and MnO2 molecules on the NF–graphene contact each other and are arranged alternately in the composite. Alternative arrangement of PANI and MnO2 nanoparticles separates them and prevents the aggregation of PANI and MnO2 to decrease the particle size of the composite on the surface of NF–graphene. The intermolecule contact improves the conductivity of the composite. The composite showed excellent specific capacitance of 1081 F/g at a scan rate of 1 mV/s and specific capacitance of 815 F/g at a current density of 3 A/g, having excellent cycling stability. Current study provides an alternative pathway to improve the rate capability and cycling stability of nanostructured electrodes, by offering a great promise for their applications in supercapacitors.
We analyze a sample of 20 absorption systems intrinsic to long duration GRB host galaxies at z > 2 forwhich the metallicities are known. We compare the relation between the metallicity and cold gas velocity width for thissample to that of the Damped Lyman-alpha systems (DLAs) in the sight-lines of quasars (QSOs), and find completeagreement. We then compare the redshift evolution of the velocity-metallicity relation of our sample to that of QSODLAsand find that also GRB hosts favour a late onset of this evolution, around a redshift of ~2.6. We compute predicted stellar masses for the GRB host galaxies using the prescription determined from QSO-DLAsamples and compare the measured stellar masses for the four hosts where stellar masses have been determinedfrom SED fits. We find excellent agreement and conclude that, on basis of all available data and tests, long durationGRB-DLA hosts and intervening QSO-DLAs are consistent with being drawn from the same underlying population.
In this paper, a triple-band 1 × 2 and 1 × 4 microstrip patch antenna array for next-generation wireless and satellite-based applications are presented. The targeted frequency bands are 3.6, 5.2 and 6.7 GHz, respectively. Simple design procedures and optimization techniques are discussed to achieve better antenna performance. The antenna is designed and simulated using Agilent ADS Momentum using FR4 substrate (εr = 4.2 and h = 1.66 mm). The main patch of the antenna is designed for 3.6 GHz operation. A hybrid feed technique is used for antenna arrays with quarter-wave transformer-based network to match the impedance from the feed-point to the antenna to 50 Ω. The antenna is optimized to resonate at triple-bands by using two symmetrical slits. The single-element triple-band antenna is fabricated and characterized, and a comparison between the simulated and measured antenna is presented. The achieved simulated impedance bandwidths/gains for the 1 × 2 array are 1.67%/7.75, 1.06%/7.7, and 1.65%/9.4 dBi and for 1 × 4 array are 1.67%/10.2, 1.45%/8.2, and 1.05%/10 dBi for 3.6, 5.2, and 6.7 GHz bands, respectively, which are very practical. These antenna arrays can also be used for advanced antenna beam-steering systems.