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In this work, the authors developed SiC(10 nm)/Ag/SiC(10 nm) thin films showing an electroforming-free resistive switching (RS) effect with a switching ratio of 102. The observed RS effect is attributed to charging and discharging of Ag nanoparticles in the film layer. Further, SiC/Ag/SiC film shows an excellent endurance and retention as well as a good thermal stability of RS characteristics. It is also identified that the switching ratio is invariant but the switching voltage of the device greatly depends on the Ag nanoparticles concentration and the operation temperature of the device. Therefore, SiC/Ag/SiC thin films are attractive for next-generation memory devices with enhanced durability.
Conventional planar manipulators have their links in a single plane. Increasing payload at the end effector/mobile platform can induce high stress in the links due to the cantilever nature of links. Thus, it limits the total vertical load that can be applied on the mobile platform. In contrast to the links in conventional planar parallel mechanisms, non-planar links are proposed in this paper, that is, links are made inclined to the horizontal plane and non-planar legs are constructed. Though the links are made non-planar, the end effectors’ planar motion is retained. For studying the application of such non-planar links in planar manipulators, new models of inertia, stiffness and leg dynamics have to be developed. In this article, these models are developed by the static analysis of the planar manipulators with non-planar links, and the performance is compared with the corresponding conventional planar manipulators.
In this study, AA5083-reinforced multiwalled carbon nanotubes (MWCNT) nanocomposites were selected as the alternate material for a redundant articulated robot (RAR) design by varying the composition of MWCNT wt%. By assigning AA5083-reinforced MWCNT as a custom material to the parts of RAR developed by Solid Works and exported to MATLAB/SimMechanics platform to convert the model into multi-body system blocks. The dynamic parameter torque was observed utilising simulation capability in a SimMechanics second-generation environment. The simulation results inferred that AA5083 reinforced with increased wt% of MWCNT has better properties suitable for RAR design.
Nipah virus (NiV) outbreak occurred in Kozhikode district, Kerala, India in 2018 with a case fatality rate of 91% (21/23). In 2019, a single case with full recovery occurred in Ernakulam district. We described the response and control measures by the Indian Council of Medical Research and Kerala State Government for the 2019 NiV outbreak. The establishment of Point of Care assays and monoclonal antibodies administration facility for early diagnosis, response and treatment, intensified contact tracing activities, bio-risk management and hospital infection control training of healthcare workers contributed to effective control and containment of NiV outbreak in Ernakulam.
The prevalence of substance use among pregnant women varies widely. The reported prevalence varies between 0.2 and 15% for alcohol, between 1.8% and 15% for cannabis, and between 0.3% and 9.5% for cocaine. The reported prevalence of opiate use during pregnancy ranges from 1.6% to 8.5%. The prevalence varies widely because of differences in the methods of assessment, gestational period of assessment and population characteristics. There is clear evidence that substance use in this population is an issue of real and serious concern. Most pregnant women stop or reduce their substance use during pregnancy and this might be an opportune moment for detection and treatment.
We report the prevalence of smoking, drinking and illicit substance use among 420 women attending for 20 week antenatal ultrasound scan in a UK University Hospital is reported. Routine antenatal recording of substance use among this population is compared with a focused interview and objective measurements for substance use. Change in use of substances in relation to pregnancy is also reported.
Though a number of agents are available to treat acute manic episode but either because of their comparable efficacy to lithium or their dose related side effects, need for better agent is always being felt.
To study the efficacy and side effect profile of lamotrigine and its double blind comparison with lithium in acute mania.
We recruited 50 patients with diagnosis of manic episode according to DSM-IV and were divided into two groups. One group was given lamotrigine 100mg and another lithium 900mg in a double blind fashion. Patints were assessed subsequently on BPRS, CMRS,UKU side effect scale and CGI till next 28 days.
Subjects in lamotrigine group did not show much improvement at the end of 4th week as compared to lithium group. Side effect profile of both groups were in accordance with reported literature except that 61.9% patients in lamotrigine group showed weight loss. Also rash were found in only 3.5% of the lamotrigine group even with such a rapid escalation of the dose.
We found that lamotrigine is ineffective in case of acute manic episode when compared with lithium.
An understanding of the epidemiology of alcohol and drug use in young women is important to appreciate the considerable morbidity and mortality associated with it and to understand the impact of such use on offspring. Although abstention rates are consistently higher among women than men in general substance misuse is increasing in young women. Differences in definitions, measurement techniques, availability, social acceptability and affordability partly explain the great variability in reported prevalence rates. Alcohol exposure among pregnant women varies from 0.2% to 14.8%. An Australian national survey revealed that nearly half of pregnant and / or breast-feeding women up to 6 months postpartum were using alcohol. A Swedish study reported risky use of alcohol during the first 6 weeks of pregnancy, at 15%. Cannabis use among pregnant women varies from 1.8% to 15%. The reported prevalence of opiate use during pregnancy ranges from 1.65% to 8.5%. Cocaine use among pregnant women is reported to be between 0.3% and 9.5%. Most pregnant women stop or reduce their substance use during pregnancy and this might be an opportune moment for detection and treatment. Substance use tends to increase sharply in the postpartum period with adverse consequences for mother and baby. Perinatal substance misuse interventions can reduce adverse neonatal outcomes. On the basis of the relatively high rate of substance use disorders during pregnancy and postpartum period, effective screening and intervention strategies should be implemented.
Prevalence: Substance use in young women (16-24 years old) has increased in the last decade. Twenty-four per cent of young women aged 16-24 are 'heavy drinkers' (defined as more 6 units in a day on at least one day in the previous week). Several studies conducted in the UK in the 1990s on different populations of pregnant women demonstrated nicotine use in about a third of pregnant women, cannabis use in about 11%, opiate use in less than 2% and cocaine use is about 1%. Other studies confirmed that 10.6-15.6% of antenatal women will be using substances other than tobacco in the first trimester and when objective measures on women in labour were reported about 3.5% had evidence of substances other than tobacco. Consequences: It is estimated that at least a quarter of a million children are growing up in homes where one or both parents have drug problems which may expose them to social and environmental hazards in the UK. The National Confidential Enquiry into Maternal Deaths found that the overall leading cause of pregnancy related death is psychiatric disorder, and 8% of all mothers who died were substance users especially young disadvantaged women who were up to 20 times more likely to die than those from advantaged groups. Impact on the fetus: Studies on the impact of substance misuse on the fetal growth remains relatively under-researched. Smoking in pregnancy is associated with low birth weight, shorter length and increased perinatal mortality. Apart from fetal alcohol syndrome, a major cause of preventable learning disability. Some studies report that cannabis using mothers are some likely to have preterm delivery, minor physical abnormalities, reduced birth length and weight; cocaine use is associated with placental abruption while heroin use is associated with reduced birth weight. There is very little recent research on this topic in the UK. Screening and assessment tools: The variation in reported prevalence is related to different methods of assessment from self report to meconium analysis. Few studies have used objective measures or structured interviews. Studies were also undertaken at different gestational stages in different settings. Substance use in women is underdetected in maternity units and recent robust information on prevalence is not available. In light of the above, this presentation will present a prevalence survey undertaken to establish the nature and extent of substance misuse in pregnant women presenting for scans at 20 weeks gestation.
Previously, we reported the clinical efficacy of MPH-LA in adult ADHD evaluated in a 40-week, randomised, double-blind, placebo-controlled, multicentre core study [comprising of dose confirmation (9-week), real-life dose optimisation (5-week) and maintenance of effect phases (6- month)] (Atten Defic Hyperact Disord. 2013;(5):219–220). Here, we report the long-term efficacy from the 26-week extension phase of the same study.
During the extension phase, patients initiated treatment with MPH-LA 20 mg/day (oral, once daily capsules); uptitrated to optimal dose of 40, 60 or 80 mg/day in increments of 20 mg/week. Change in DSM-IV ADHD rating scale (RS) and SDS total scores at the end of study, were evaluated from the baseline of maintenance of effect phase of the core study and the baseline of extension phase.
At the end of the extension phase, the mean change in DSM-IV ADHD RS and SDS total scores from baseline of the maintenance of effect phase was −0.9 and −1.4 points respectively; and from baseline of extension phase was −7.2 and −4.8 respectively (Table). No new or unexpected safety concerns were observed during the extension phase.
MPH-LA continued to maintain clinical efficacy in adult ADHD patients over long-term.
Table DSM-IV ADHD RS, SDS total scores and change from baseline at the end of extension phase
Asylum seekers and refugees experience psychological distress at various phases, such as during pre-migration, migration and post-migration. In the post-migration phase, the period of asylum process has many risk factors for severe mental health implications.
The aim of this study was to identify research evidence that suggest asylum process as a cause of psychological distress among the forced migrants in the United Kingdom (UK).
The study was carried out by searching the NHS database for the relevant information and interviewing asylum seekers and refugees.
The literature search identified several relevant studies in this area. However, only one study was found as the most relevant for my study focus. The study was ‘Psychological distress and the asylum process: a longitudinal study of forced migrants in Ireland’ by Ryan et al. The qualitative data gathered from the interviews of forced migrants showed a strong link between the asylum process and mental distress.
This research strongly suggests that the asylum process does contain many risk factors causing psychological distress among the asylum seekers. In particular, the restrictions from freedom to work or study, and the constant fear of deportation are the key stressors identified. Increasing the mental health awareness of all personal who come into contact with forced migrants could prevent severe psychological consequences. These points should be taken into consideration for improving the asylum policy and training medical and non-medical staff who may encounter forced migrants.
Schizophrenia is a mental disorder characterized by social problems and disorders of thought, behaviour and cognitive functions. These impaired cognitive functions may be associated with alterations in resting state functional connectivity in schizophrenia. Therefore, the present study has been carried out to determine the resting state functional brain connectivity changes associated with schizophrenia in all the resting state networks (RSNs) using independent component analysis approach (ICA) and dual-regression based approach.
The objective of this study was to investigate the aberrant resting-state functional connectivity patterns in schizophrenia patients as compared to healthy controls.
35 schizophrenia patients and 31 healthy controls were recruited for the study and scanned by using resting state functional magnetic resonance (rsfMRI). Pre-processing and post-processing of the resting state functional data were performed using the FMRI Expert Analysis Tool (FEAT), which is a part of FSL (FMRIB's Software Library, www.fmrib. ox.ac.uk/fsl).
Our results showed significantly decreased functional connectivity in the regions of left fronto-parietal network, lateral visual network, medial visual network, motor network and default mode network (DMN) in schizophrenia patients as compared with healthy controls.
The overall findings suggest that the alterations in these resting state network connectivity may, in part, contribute to the impairments in cognitive functions associated with schizophrenia. These findings also suggest that aberrant resting state network connectivity contributes to regional functional pathology in schizophrenia and bears significance for core symptoms.
Recent epidemiology studies have reported the prevalence of adult ADHD to be approximately 4%, however approved treatments are limited.
Primary objectives were to confirm the clinically-effective and safe dosage range of MPH-LA in adults with ADHD and evaluate the 6-month maintenance of effect.
Treatment Period (TP) 1: Patients were randomized to double-blind placebo, MPH-LA 40, 60, or 80 mg/day for 9- weeks (3-week titration, 6-week fixed-dose) to evaluate change in DSM-IV ADHD-RS and Sheehan Disability Scale (SDS) total score in TP1. TP2: 5-week titration to individual optimal dose. TP3: Patients were randomized to their optimal dose or placebo for 6-months double-blind withdrawal period to evaluate percentage of treatment failures during TP3.
Improvement from baseline in total score on the DSM-IV ADHD-RS and SDS was significantly greater than placebo for all MPH-LA dose levels (table). Patients treated with MPH-LA had significantly lower treatment failure rates (21.34%) compared to placebo in TP3 (49.6%; odds-ratio (95%CI=0.3 (0.2, 0.4); p< 0.0001). The safety results were consistent with the established safety profile for MPH-LA.
[Improvement by week 9: DSM-IV ADHD-RS and SDS].
N=Full Analysis Set for TP1 (All randomized patients receiving one dose of study drug in TP1)
MPH-LA administered at 40-80mg/day demonstrated superior ADHD symptom control and reduction in functional impairment compared to placebo and demonstrated maintenance of effect over 6 months. No unexpected adverse events were observed.
Mental Illness is a very unique and intimate experience. Over the ages various art forms, particularly writing have been used to document experiences of mental illness. Though the history of Psychiatry is a feature of mainstream Psychiatric training, complementary study of literature and its relevance to mental illness is underused.
To undertake an exploratory search of writing as tool to reflect the phenomenology of mental illness and to evaluate the role of medical humanities in understanding and coping mental illness.
To present an explorative review of a selection of poems and prose by authors with mental illness who have written in English Language.
We conducted a comprehensive search of online databases including the Madness and Literature Network (UK), Medical Humanities Resource Database (UK), the Arts Literature and Medicine Database (US) and other popular books.
We compare various extracts by well known authors along with the lesser known contemporary accounts of writers to evaluate the role of writing.
There is a long tradition of writing about depression mental illness in the canon of English literature. Compared to autobiographical writing about depression, it is difficult to identify many autobiographical accounts of severe mental illness. Examples of writing projects illustrate that people with severe mental illness, and with dementia, may use the support of others to produce creative writing. It may be useful to Psychiatrists in training, and to wider society, to reflect on the creative agency inherent in their writing.
In the UK, blood investigations ordered by the Mental Health Trust are usually carried out by Acute hospitals. The results are not immediately accessible by the staff of Mental Health Trusts on the computer due to confidentiality and lack of shared software access between trusts. This has a significant impact on care management of psychiatric patients often resulting in delay in clinical decisions.
We encountered similar problem where the results of the tests ordered by the staff were not immediately accessible to them, as these investigations are carried out by the local acute hospital. To address this issue a project was chartered.
Of the project was to develop a protocol between the trusts so that the staff of Mental Health Trust could access the results of investigation on local computers as soon as they become available and to evaluate its impact on service.
A steering committee including Specialty Registrar, Pharmacist and Matron was constituted. The committee met regularly and evolved strategy with representatives of the Acute Trust. The main concern of the Acute Trust was patient confidentiality and software access. Following regular meetings and correspondence shared-protocol was developed.
It was agreed that the acute trust would install the software on all mental health trust computers. The staff would be trained to use the software and access results. To address the issue of confidentiality, flowchart of sponsorships of the shared-protocol was developed. Accordingly, all the medics would be sponsored for access by Medical Director, Nursing Staff by Matron and Pharmacists by Chief Pharmacist. This protocol ensured that all the staff trained are accounted and IT department could monitor any unauthorised access of data.
We have noticed a big improvement in the quality of clinical practice as a result. Unnecessary delays in clinical decisions have been avoided. We feel such a shared-protocol could be developed in other hospitals that are faced with similar access issues.
Exhaustive literature is available in the portrayal of mental illness in the English language films. However no major studies are available around the portrayal of mental health in Bollywood movies which in fact is consumed by nearly 25-30% of the world population.
in the era of unprecedented growth in visual medium, we wish to study the portrayal of mental illness in Bollywood cinema and how effective this medium is to create awareness around mental health and stigma.
Literature search with a specific purpose to identify any available literature on mental illness in South Asian cinema was undertaken. to create a synthesis of portrayal of mental illness, its impact on cultural consumption with its advantages and deficiencies. This was followed by a listing a cluster reviews of Bollywood films that have characters with mental health problems to identify how these illustrate both the condition and reactions to them.
These findings were compared with the literature surrounding mental health and the Indian culture to show if the perceptions correlate. The information was collated to see any patterns and 6 such patterns were identified.
Recognising these motifs are crucial for public and clinician alike in contact with the population open to the influence of these films to not only understand the phenomenology of mental illness in this populace but also some of unique cultural factors, medication, stigma and charting out appropriate management plan. (On-going)
The details of the synthetic factors will be presented in the results and discussion.
The safety profile of MPH-LA in the paediatric population has been well studied. However, there are very limited studies reporting safety of MPH-LA in adults. We present the safety profile of MPH-LA in adults and from a pooled analysis in children.
Data from 3 multiple-dose, double-blind, placebo-controlled studies of 7-12 weeks duration in children with ADHD; MPH-LA (10-80mg/d) (n=314) & placebo (n=318) (aged 6-12 yrs in 2 studies &13-17 yrs in one study) were pooled for this analysis. In addition, data from 722 adult patients, 18-60 yrs of age with ADHD receiving MPH-LA 40-80 mg/d (n=542) or placebo (n=180) from double-blind dose confirmation phase of 9-week duration from one study was included in the analysis.
Common adverse events (AEs) reported by both adult and paediatric ADHD patients were decreased appetite, headache, nasopharyngitis, nausea, and insomnia (Table). Incidence of serious AEs (SAEs) was low with MPH-LA in both adults (0.7%) and children (0.6%) compared with placebo group (1.1% in adults and 0.3% in children).
Our findings show that safety profile of MPH-LA in adults is similar to that observed in the paediatric population.
Adverse events (>5%) by preferred term in multiple dose, placebo-controlled studies In adult and paedlatrlc ADHD patients
Most common AEs
MPH-LA N=542, n (%)
Placebo N=1B0, n (%)
MPH-LA N=314, n (%)
Placebo N=31S, n (%)
Total number of patients with anyAE
Analysis data set: Safety population of double-blind dose confirmation phase of 9-week duration conducted in adult ADHD patients and pooled safety population from 3 paediatric studies.
Accounts of empire in postcolonial critique largely remain silent on colonial relations internal to the United Kingdom, tending to elide the work of Scots, Irish, and Welsh within a solely English imperial enterprise. This article draws on recent reevaluations of the Scottish role in empire to outline the ambivalent place of Britain’s “Celtic Fringe” in its global hegemony. Focusing on eighteenth-century cartography and Scottish accounts of African exploration, it argues that the aesthetic practice of colonial control developed in Scotland established a pattern imperial agents could repeat in overseas territories. The colonization of the “White Highlands” in Kenya, it suggests, relied on aesthetic forms that originated in the landscape of the Scottish Highlands. By focusing on landscape's influence in a constellation of fields—in aesthetics, cartography, and natural history—this article also moves toward an understanding of landscape as a form of aisthesis, a “regime of sense perception.”
To assess the general cardiac health of inpatients in acute psychiatric units and to evaluate the practice of ECG use in this setting.
Overall cardiac risk is assessed using QRISK2. Clinically significant ECG abnormality detection by psychiatric teams are compared with same by cardiologist.
Ten percent of patients (n = 113) admitted to five acute psychiatric wards during a period of 13 months across three hospital sites, covering a population of 1.1 million, were randomly selected. Electronic health care records were used to collect all data, in the form of typed entries and scanned notes. An experienced cardiologist, blind to the psychiatrist assessments, performed ECG analysis. The QRISK2 online calculator was used to calculate 10-year cardiovascular risk as recommended by NIHR, UK.
A score of 10% or more indicates a need for further intervention to lower risk.13.5% of patients had a QRISK2 score of 10–20%, 5.2% had a score of 20–30%, and 1 patient had a QRISK2 score > 30%. In total, 19.7% had a QRISK2 of 10% or greater. A total of 2.9% had prolonged QTC interval (> 440 ms), with 2.9% having a borderline QTC (421–440). A total of 34.3% of ECGs were identified by the ward doctors as abnormal, with action being taken on 41.6% of these abnormal ECGs. Cardiologist analysis identified 57.1% of ECGs with abnormalities of potential clinical significance.
One in five patients admitted to psychiatry wards have poor cardiac health requiring interventions. Though QTC interval prolongation is rare, half of patients may have abnormal ECGs that require further analysis.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The Nilgiri tahr Nilgiritragus hylocrius is an Endangered species of mountain ungulate endemic to the Western Ghats of India, a biodiversity hotspot. Habitat fragmentation, hunting and a restricted range are the major threats to this species. Although several surveys have assessed the species’ status, a population estimate based on a scientifically robust method is needed. We used the double-observer method to estimate the population of the Nilgiri tahr in the Anamalai Tiger Reserve, a protected area in the Western Ghats. We walked 257 km of transects across the Reserve, covering 36 grassland blocks (i.e. clusters of montane grasslands that were relatively separate from each other). We counted a minimum of 422 individuals in 28 groups, and estimated the tahr population in the study area to be 510 individuals (95% CI 300–858) in 35 groups. The male:female ratio was 0.71 and the young:female ratio was 0.56. Comparing our estimate with previous surveys suggests that the Nilgiri tahr population in Anamalai Tiger Reserve is stable. We found the double-observer survey method to be appropriate for population estimation and long-term monitoring of this species, and make recommendations for improved field protocols to facilitate the implementation of the method in the tropical mountains of the Western Ghats. Our findings suggest that the Reserve harbours 20–25% of the global population of the Nilgiri tahr, highlighting the area's importance for the conservation of this species.