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In early October 2014, 7 months after the 2014–2015 Ebola epidemic in West Africa began, a cluster of reported deaths in Koinadugu, a remote district of Sierra Leone, was the first evidence of Ebola virus disease (Ebola) in the district. Prior to this event, geographic isolation was thought to have prevented the introduction of Ebola to this area. We describe our initial investigation of this cluster of deaths and subsequent public health actions after Ebola was confirmed, and present challenges to our investigation and methods of overcoming them. We present a transmission tree and results of whole genome sequencing of selected isolates to identify the source of infection in Koinadugu and demonstrate transmission between its villages. Koinadugu's experience highlights the danger of assuming that remote location and geographic isolation can prevent the spread of Ebola, but also demonstrates how deployment of rapid field response teams can help limit spread once Ebola is detected.
Evidence-based psychosocial treatments for schizophrenia founded on Western belief systems and values may not be efficacious in different cultures without adaptation. This systematic review analyses the nature and outcomes of culturally-adapted psychosocial interventions in schizophrenia, examining how interventions have been adapted, their efficacy and what features drive heterogeneity in outcome.
Articles identified by searching electronic databases from inception to 3 March 2016, reference lists and previous reviews were independently screened by two authors for eligible controlled trials. Data on the nature of adaptations was analysed inductively using thematic analyses. Meta-analyses were conducted using random effects models to calculate effect sizes (Hedges’ g) for symptoms.
Forty-six studies with 7828 participants were included, seven adapted for minority populations. Cultural adaptations were grouped into nine themes: language, concepts and illness models, family, communication, content, cultural norms and practices, context and delivery, therapeutic alliance, and treatment goals. Meta-analyses showed significant post-treatment effects in favour of adapted interventions for total symptom severity (n = 2345, g: −0.23, 95% confidence interval (CI) −0.36 to −0.09), positive (n = 1152, g: −0.56, 95% CI −0.86 to −0.26), negative (n = 855, g: −0.39, 95% CI −0.63 to −0.15), and general (n = 525, g: −0.75, CI −1.21 to −0.29) symptoms.
The adaptation process can be described within a framework that serves as a benchmark for development or assessment of future adaptations. Culturally adapted interventions were more efficacious than usual treatment in proportion to the degree of adaptation. There is insufficient evidence to show that adapted interventions are better than non-adapted interventions. Features of context, intervention and design influenced efficacy. Investigating whether adaptation improves efficacy, most importantly amongst ethnic minorities, requires better designed trials with comparisons against unadapted interventions.
Soybean is a leading oilseed crop in India, which contains about 40% of protein and 20% of oil. Core collection will accelerate the management and utilization of soybean genetic resources in breeding programmes. In the present study, eight agromorphological traits of 3443 soybean germplasm were analysed for the development of core collection using the principal component score (PCS) strategy and the power core method. The PCS strategy yielded core collection (CC1) of 576 accessions, which accounted for 16.72% of the entire collection (EC). The analysis based on the power core programme resulted in CC2 of 402 accessions, which accounted for 11.67% of the EC. Statistical analysis showed similar trends for the mean and range estimated in both core collections and EC. In addition, the variance, standard deviation and coefficient of variance were in general higher in core collections than in the EC. The correlations observed in the EC in general were preserved in core collections. A total of 311 and 137 unique accessions were found in CC1 and CC2 in addition to 265 accessions that were found to be common in both core collections. These 265 common accessions were the most diverse core sets, which accounted for 7.64% of the EC. We proposed to constitute an integrated core collection (ICC) by integrating both common and unique accessions. The ICC comprised 713 accessions, which accounted for about 20.62% of the EC. Statistical analysis indicated that the ICC captured maximum variation than CC1 and CC2. Therefore, the ICC can be extensively evaluated for a large number of economically important traits for the identification of desirable genotypes and for the development of mini core collection in soybean.
The Royal College of Psychiatrists is considering how best to introduce a post-MRCPsych-examination assessment (‘exit examination’) in anticipation of external pressures to ensure patient safety through the use of such assessments. The Psychiatric Trainees' Committee conducted an online survey to gather the views of psychiatrists regarding the possible format and content of this examination in the hope that this information can be used to design a satisfactory assessment.
Of the 2082 individuals who started the survey, 1735 completed all sections (83.3%). Participants included consultants and trainees from a range of subspecialties. There was general agreement that the content and structure of the exit examination should include assessment of clinical and communication skills.
UK psychiatrists believe that an exit assessment should focus on clinical and communication skills. It should assess both generic and subspecialty-specific competencies and incorporate a mixture of assessment techniques.
Drinking raw date palm sap is the primary route of Nipah virus (NiV) transmission from bats to people in Bangladesh; subsequent person-to-person transmission is common. During December 2010 to March 2011, we investigated NiV epidemiology by interviewing cases using structured questionnaires, in-depth interviews, and group discussions to collect clinical and exposure histories. We conducted a case-control study to identify risk factors for transmission. We identified 43 cases; 23 were laboratory-confirmed and 20 probable. Thirty-eight (88%) cases died. Drinking raw date palm sap and contact with an infected person were major risk factors; one healthcare worker was infected and for another case transmission apparently occurred through contact with a corpse. In absence of these risk factors, apparent routes of transmission included drinking fermented date palm sap. For the first time, a case was detected in eastern Bangladesh. Identification of new epidemiological characteristics emphasizes the importance of continued NiV surveillance and case investigation.
This study investigated improvements in quality of life associated with eight weeks of montelukast and/or intranasal steroid treatment for moderate to severe allergic rhinitis.
A single-centre, prospective, randomised, double-blind, placebo-controlled study was carried out. Assessments were made using the Rhinoconjunctivitis Quality of Life Questionnaire and symptom scales.
A total of 128 patients (aged 13–51 years) were randomly assigned to one of two groups. In the montelukast group, patients were treated with montelukast tablets and fluticasone propionate nasal spray (n = 64). In the placebo group, treatment comprised a placebo and fluticasone propionate. The results showed significant improvements in symptom scores and quality of life scores for both groups after one month and two months of treatment, compared with baseline values; these improvements were significantly greater for the montelukast group compared with the placebo group. The mean number of loratadine tablets taken by each patient during the study period was only 0.73 for the montelukast group compared with 9 for the placebo group.
The combination of montelukast tablets and fluticasone propionate nasal spray improved symptom control and overall quality of life for moderate to severe allergic rhinitis patients.
In May 2009, we investigated a hospital outbreak of pandemic H1N1 (pH1N1) infection among healthcare personnel (HCP). Thirteen (65%) of 20 HCP with pH1N1 infection had healthcare-associated cases, which were primarily attributed to transmission among HCP. Eleven (55%) of HCP with pH1N1 infection worked for 1 day or more after the onset of illness. Personnel working with mild illness may have contributed to transmission among HCP.
The phase transformations occurring on quenching and subsequent aging of a Cu-Al-Ni β phase alloy have been studied using transmission electron microscopy, x-ray diffraction and optical microscopy. Quenching produces an ordered solid solution, β1, based on the DO3 structure of Cu3A1. X-ray and electron diffraction show satellite diffraction peaks. On aging, these satellite peaks disappear and the parent phase undergoes a martensitic transformation. It is suggested that the parent phase undergoes a process of phase separation through the mechanism of spinodal decomposition before the martensitic transformation occurs. The martensitic transformation shows isothermal kinetics for which a transformation diagram is presented. Prolonged aging results in the formation of equilibrium phases.
Painful physical symptoms (PPS) are both common and reduce the likelihood of remission in major depressive disorder (MDD), based upon results of clinical trials in selected populations. Whether PPS significantly contribute to poorer treatment outcome overall in primary or specialty psychiatric care settings remains unclear.
Out-patients (n=2876) with MDD were treated in the first step of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial with citalopram up to 60 mg/day for up to 14 weeks. Presence of painful symptoms, as well as severity of depression, physical illness, and demographic and treatment factors were examined. Time to and overall rates of remission were analysed in relation to the presence of PPS.
Of the participants, 80% complained of PPS. These patients, both in primary and specialty psychiatric settings, had significantly lower remission rates and took longer to remit. Increasing severity of PPS was associated with greater physical illness burden, lower socio-economic status, absence of private insurance and being female, African-American or Hispanic. After adjustment for these factors, patients with PPS no longer had significantly poorer treatment outcomes.
Presence and severity of PPS is an indicator of MDD that may have poorer treatment outcome with an initial selective serotonin reuptake inhibitor. These poorer treatment outcomes are multifactorial, however, and are not explained by the presence and severity of pain per se.
Many patients with major depressive disorder (MDD) who experience full symptomatic remission after antidepressant treatment still have residual depressive symptoms. We describe the types and frequency of residual depressive symptoms and their relationship to subsequent depressive relapse after treatment with citalopram in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial.
Participants in primary (n=18) and psychiatric (n=23) practice settings were openly treated with citalopram using measurement-based care for up to 14 weeks and follow-up for up to 1 year. We assessed 943 (32.8% of 2876) participants who met criteria for remission to determine the proportions with individual residual symptoms and any of the nine DSM-IV criterion symptom domains to define a major depressive episode. At each visit, the 16-item Quick Inventory of Depressive Symptomatology, Self-Report (QIDS-SR16) and the self-report Frequency, Intensity, and Burden of Side Effects Rating (FIBSER) scale were used to assessed depressive symptoms and side-effects respectively.
More than 90% of remitters had at least one residual depressive symptom (median=3). The most common were weight increase (71.3%) and mid-nocturnal insomnia (54.9%). The most common residual symptom domains were sleep disturbance (71.7%) and appetite/weight disturbance (35.9%). Those who remitted before 6 weeks had fewer residual symptoms at study exit than did later remitters. Residual sleep disturbance did not predict relapse during follow-up. Having a greater number of residual symptom domains was associated with a higher probability of relapse.
Patients with remission of MDD after treatment with citalopram continue to experience selected residual depressive symptoms, which increase the risk of relapse.
We report an extremely rare case of metachronous inflammatory myofibroblastic tumour in the temporal bone.
Case report and review of the world literature on metachronous inflammatory myofibroblastic tumour.
Inflammatory myofibroblastic tumour in the temporal bone is rare, and metachronous inflammatory myofibroblastic tumour in the temporal bone has never been reported in the English medical literature. We report a case of inflammatory myofibroblastic tumour in the right temporal bone in a 27-year-old woman presenting with right-sided otalgia and progressive hearing loss. A metachronous lesion was discovered in the left temporal bone one year later. The patient underwent surgical excision of the tumour via canal wall down mastoidectomy for both lesions. Long term steroids were prescribed after both surgical procedures. At follow up three years after the last procedure, the patient remained free of disease.
To the best of our knowledge, this is the first reported case of metachronous inflammatory myofibroblastic tumour in the temporal bone.
We have study the effect of Tin impurity and Swift heavy ion irradiation on
the optical properties of the chalcogenide thin films. Thin films are
prepared by thermal evaporation technique and irradiated by swift heavy ion
beam of 60 MeV Si5+ ion with influence of 5 × 1012 ions/cm2. The SHI induced structural and optical changes in the thin films due to
which optical band gap decrease. Reduction of the optical band gap is may be
due to increase the defect states near to the band tails in the band gap on
Elliptic jets have decided advantages for technological applications over circular jets;
this paper explores further advantages achieved by jet forcing due to self-excitation.
Using hot-wire measurements and flow visualization, we have studied an elliptic
whistler (i.e. self-excited) air jet of 2:1 aspect ratio which, in contrast to an elliptic jet
issuing from a contoured nozzle, displays no axis switching, but significantly increased
spread in the major-axis plane. Its near-field mass entrainment is considerably higher
(by as much as 70%) than that of a non-whistling jet. Flow visualization reveals
unexpected dynamics of the elliptic vortical structures in the whistler jet compared to
that in the non-whistling jet. Vortices rolled up from the lip of the elliptic pipe impinge
onto the collar, producing secondary vortices; interaction of these two opposite-signed
vortices is shown to cause the different behaviour of the whistler jet.
The subharmonic resonance phenomenon is studied using hot-wire measurements and flow visualization in an initially laminar shear layer forced with two-frequencies for various choices of the fundamental frequency f and its subharmonic f/2 with controlled initial phase difference ϕin between them. We explore the effects of the controlling parameters, namely: (i) forcing frequencies and their initial amplitudes, (ii) initial phase difference ϕin, and (iii) detuning (i.e. when the second forcing frequency is slightly different from f/2). While several of our experimental observations support predictions based on weakly nonlinear theory, others do not. We explain our data in terms of vortex dynamics concepts.
The dynamics of the preferred mode structure in the near field of an elliptic jet have been investigated using hot-wire measurements. A 2:1 aspect ratio jet with an initially turbulent boundary layer and a constant momentum thickness all around the nozzle exit perimeter was used for this study. Measurements were made in air at a Reynolds number ReDe (≡ UeDe/v) = 3.5 × 104. Controlled longitudinal excitation at the preferred mode frequency (StDe ≡ fDe/Ue = 0.4) induced periodic formation of structures, allowing phase-locked measurements with a local trigger hot wire. The dynamics of the organized structure are examined from educed fields of coherent vorticity and incoherent turbulence in the major and minor symmetry planes at five successive phases of evolution, and are also compared with corresponding data for a circular jet. Unlike in a circular jet, azimuthally fixed streamwise vortices (ribs) form without the aid of azimuthal forcing. The three-dimensional deformation of elliptic vortical structures and the rib formation mechanism have also been studied through direct numerical simulation. Differential self-induced motions due to non-uniform azimuthal curvature and the azimuthally fixed ribs produce greater mass entrainment in the elliptic jet than in a circular jet. The turbulence production mechanism, entrainment and mixing enhancement, and time-average measures and their modification by excitation are also discussed in terms of coherent structure dynamics and the rib-roll interaction. Various phase-dependent and time-average turbulence measures documented in this paper should serve as target data for validation of numerical simulations and turbulence modelling, and for design and control purposes in technological applications. Further details are given by Husain (1984).