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Child psychiatric service is a novel approach in Bangladesh but has proved its efficacy within a short time.
To describe how a developing country has established sustainable child psychiatric services by using limited resources effectively.
Discuss the service delivery model and recent achievements in child psychiatry in Bangladesh as well as the limitations and strengths.
Effective policy making, capacity building and community based survey are the turning point of the development of child psychiatry in Bangladesh. The prevalence of child mental disorders found 18.4% in a community based survey. By the efforts of few visionary psychiatrists the wing of child psychiatry has established in Bangabandhu Sheikh Mujib Medical University (BSMMU) and separate department named ‘Child Adolescent and Family Psychiatry’ has formed in National Institute of Mental Health (NIMH), Dhaka. Center for Neurodevelopment and Autism in Children (CNAC) also established in BSMMU with the mission to serve the children with neurodevelopmental disabilities, to increase awareness and to train the professionals. From 2008 the Child Guidance Clinic of national Institute of Mental Health Dhaka served more than three thousand children with any mental disorders.
According to the current scenario we can comment that the future prospect of child psychiatry in Bangladesh is promising. In spite of very limited resources the child psychiatry is going ahead to set an example for other developing countries in the context of sustainable service delivery model.
Bangladesh is a disaster prone country. According to one record during last 100 years, there had been 75 severe cyclones and floods in Bangladesh. On the other hand as many as 1200 kilometer of river banks are under active erosion in every year. The government of Bangladesh, nongovernmental organizations, members of the civil society, the health professionals – all of them have chalked out their programme embedded with economic relief and assistance. At best, some sort of medical aid in the form of medicine and physical treatment and recovery are extended to the affected people. The severity of mental and psychological trauma and casualties had always remained beyond their imagination. For the first time in the history of Bangladesh, multiple teams consisted of psychiatrists, psychologists, social workers and other support service staffs rushed to the Cyclone affected area to estimate the need for psychosocial care and for providing management on 2007. In 2013 a multistoried has collapsed in Bangladesh and died more than thousand peoples. Currently, the National Plan for Disaster Management 2010-2015 keeps no space for the people who ardently need post disaster psychosocial care. Consequently, the mental health care professionals are strongly lobbying for inclusion of post-disaster psychosocial rehabilitation service within the National Plan for Disaster Management. Mainstream health professionals specially the primary health care providers should be brought under coverage of a full-fledged training course on disaster psychiatry. In addition, infrastructure development and administrative reform is urgently required in this arena.
While lithium is well known for its neurotoxicity, there are very few publications about lithium-induced acute dystonic reaction. We are presenting a clinical case of lithium-induced acute intermittent dystonic reaction in a patient with schizoaffective disorder (SAD). The patient is a 69-year-old African-American male with a long history of SAD, who was treated for many years with ziprasidone and divalproex and was admitted with SAD exacerbation. Due to increased QTC interval, we switched patient to lurasidone. After 2 weeks, due to increased ammonia level, divalproex was switched to lithium (600 mg loading dose and then 450 mg twice/day). Three days later, patient developed a series of intermittent episodes of acute dystonia, manifested as mutism, dysarthria, upper and lower extremity muscle rigidity, dysphagia, and tremor (Table 1). Dystonic reactions responded to benztropine. Eventually, lithium was discontinued and patient did well on a combination of carbamazepine and olanzapine. In this case, we would like to emphasize not only the intermittent but also the atypical presentation of acute dystonic reactions with involvement of large muscle groups, the resemblance to NMS, and a “spectrum” of dystonic reactions rather than one clear-cut presentation. We can only speculate the role lurasidone played in this presentation but reoccurrence of dysarthria on day 54 after lithium was restarted points to its major role.
Table not available.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
This paper reports on an ultra-wideband low-noise distributed amplifier (LNDA) in a transferred-substrate InP double heterojunction bipolar transistor (DHBT) technology which exhibits a uniform low-noise characteristic over a large frequency range. To obtain very high bandwidth, a distributed architecture has been chosen with cascode unit gain cells. Each unit cell consists of two cascode-connected transistors with 500 nm emitter length and ft/fmax of ~360/492 GHz, respectively. Due to optimum line-impedance matching, low common-base transistor capacitance, and low collector-current operation, the circuit exhibits a low-noise figure (NF) over a broad frequency range. A 3-dB bandwidth from 40 to 185 GHz is measured, with an NF of 8 dB within the frequency range between 75 and 105 GHz. Moreover, this circuit demonstrates the widest 3-dB bandwidth operation among all reported single-stage amplifiers with a cascode configuration. Additionally, this work has proposed that the noise sources of the InP DHBTs are largely uncorrelated. As a result, a reliable prediction can be done for the NF of ultra-wideband circuits beyond the frequency range of the measurement equipment.
There is limited evidence on ethnic differences in personality disorder prevalence rates. We compared rates of people with personality disorder admitted to hospital in East London from 2007 to 2013.
Of all people admitted to hospital, 9.7% had a personality disorder diagnosis. The admission rate for personality disorder has increased each year. Compared with White subjects, personality disorder was significantly less prevalent among Black and other minority ethnic (BME) groups. Personality disorder was diagnosed in 20% of forensic, 11% of general adult, 8% of adolescent and 2% of old-age in-patients.
The increasing number of personality disorder diagnoses year on year indicates the increasing impact of personality disorder on in-patient services. It is important to identify and appropriately manage patients with a personality disorder diagnosis due to the significant strain they place on resources. The reasons for fewer admissions of BME patients may reflect alternative service use, a truly lower prevalence rate or under-detection.
The aim of this study was to investigate the socioeconomic and demographic factors influencing the body mass index (BMI) of non-pregnant married Bangladeshi women of reproductive age. Secondary (Hierarchy) data from the 2011 Bangladesh Demographic and Health Survey, collected using two-stage stratified cluster sampling, were used. Two-level linear regression analysis was performed to remove the cluster effect of the variables. The mean BMI of married non-pregnant Bangladeshi women was 21.60±3.86 kg/m2, and the prevalence of underweight, overweight and obesity was 22.8%, 14.9% and 3.2%, respectively. After removing the cluster effect, age and age at first marriage were found to be positively (p<0.01) related with BMI. Number of children was negatively related with women’s BMI. Lower BMI was especially found among women from rural areas and poor families, with an uneducated husband, with no television at home and who were currently breast-feeding. Age, total children ever born, age at first marriage, type of residence, education level, level of husband’s education, wealth index, having a television at home and practising breast-feeding were found to be important predictors for the BMI of married Bangladeshi non-pregnant women of reproductive age. This information could be used to identify sections of the Bangladeshi population that require special attention, and to develop more effective strategies to resolve the problem of malnutrition.
We conducted a longitudinal assessment in 466 underweight and 446 normal-weight children aged 6–24 months living in the urban slum of Dhaka, Bangladesh to determine the association between vitamin D and other micronutrient status with upper respiratory tract infection (URI) and acute lower respiratory infection (ALRI). Incidence rate ratios of URI and ALRI were estimated using multivariable generalized estimating equations. Our results indicate that underweight children with insufficient and deficient vitamin D status were associated with 20% and 23–25% reduced risk of URI, respectively, compared to children with sufficient status. Underweight children, those with serum retinol deficiency were at 1·8 [95% confidence interval (CI) 1·4–2·4] times higher risk of ALRI than those with retinol sufficiency. In normal-weight children there were no significant differences between different vitamin D status and the incidence of URI and ALRI. However, normal-weight children with zinc insufficiency and those that were serum retinol deficient had 1·2 (95% CI 1·0–1·5) times higher risk of URI and 1·9 (95% CI 1·4–2·6) times higher risk of ALRI, respectively. Thus, our results should encourage efforts to increase the intake of retinol-enriched food or supplementation in this population. However, the mechanisms through which vitamin D exerts beneficial effects on the incidence of childhood respiratory tract infection still needs further research.
The West African 2014 Ebola outbreak has highlighted the need for a better information network. Hybrid information networks, an integration of both hierarchical and formalized command control-driven and community-based, or ad hoc emerging networks, could assist in improving public health responses. By filling the missing gaps with social media use, the public health response could be more proactive rather than reactive in responding to such an outbreak of global concern. This article provides a review of the current social media use specifically in this outbreak by systematically collecting data from ProQuest Newsstand, Dow Jones Factiva, Program for Monitoring Emerging Diseases (ProMED) as well as Google Trends. The period studied is from 19 March 2014 (first request for information on ProMED) to 15 October 2014, a total of 31 weeks. The term ‘Ebola’ was used in the search for media reports. The outcome of the review shows positive results for social media use in effective surveillance response mechanisms – for improving the detection, preparedness and response of the outbreak – as a complement to traditional, filed, work-based surveillance approach.
The increasing rate of outbreaks in humans of zoonotic diseases requires detailed examination of the education, research, and practice of animal health and its connection to human health. This study investigated the collaboration network of different fields engaged in conducting zoonotic research from a transdisciplinary perspective.
Examination of the dynamics of this network for a 33-year period from 1980 to 2012 is presented through the development of a large scientometric database from Scopus. In our analyses we compared several properties of these networks, including density, clustering coefficient, giant component, and centrality measures over time. We also elicited patterns in different fields of study collaborating with various other fields for zoonotic research.
We discovered that the strongest collaborations across disciplines are formed among the fields of medicine; biochemistry, genetics, and molecular biology; immunology and microbiology; veterinary; agricultural and biological sciences; and social sciences. Furthermore, the affiliation network is growing overall in terms of collaborative research among different fields of study such that more than two-thirds of all possible collaboration links among disciplines have already been formed.
Our findings indicate that zoonotic research scientists in different fields (human or animal health, social science, earth and environmental sciences, engineering) have been actively collaborating with each other over the past 11 years. (Disaster Med Public Health Preparedness. 2015;9:496–503)
New theoretical and practical approaches were used to determine the outcome of complex interorganizational networks during the 2009 H1N1 outbreak in Australia.
Seventy health professionals from different skill sets and organizational positions who participated in the 2009 swine influenza H1N1 outbreak in Australia were surveyed. Interviews were designed to collect both qualitative and quantitative data to build a comprehensive and in-depth understanding of the dynamics of interorganizational networks that evolve during the coordinated response to the H1N1 outbreak. Three main components of network theory, ie, degree centrality, connectedness, and tie strength, were used to construct a performance model for assessing networks of preparedness and response.
We observed that increasing communication frequency and diversifying the tiers of the interorganizational links enhanced the overall network’s performance in the case of formal coordination. Network measures such as centrality, connectedness, and tie strength were relevant and resulted in improving the entire network’s performance during the outbreak.
In the context of a disease outbreak in a complex environment and a large geographical area, this investigation has provided a new perspective for understanding how the structure of a collaborative network of personnel affects the performance of the overall network. (Disaster Med Public Health Preparedness. 2015;9:155-165)
Foodborne disease outbreaks are increasingly being seen as a greater concern by public health authorities. It has also become a global research agenda to identify improved pathways to coordinating outbreak detection. Furthermore, a significant need exists for timely coordination of the detection of potential foodborne disease outbreaks to reduce the number of infected individuals and the overall impact on public health security. This study aimed to offer an effective approach for coordinating foodborne disease outbreaks. First, we identify current coordination processes, complexities, and challenges. We then explore social media surveillance strategies, usage, and the power of these strategies to influence decision-making. Finally, based on informal (social media) and formal (organizational) surveillance approaches, we propose a hybrid information network model for improving the coordination of outbreak detection. (Disaster Med Public Health Preparedness. 2015;9:186-198)
Growth of GaN on Si(111) and Ge coated Si(111) using pulsed electron beam deposition (PED) process is reported. GaN was deposited on Si(111) and Ge/Si(111) at 600°C in an N2 environment without any surface pre-treatment such as pre-nitridation. X-ray diffraction confirmed that c-plane oriented GaN was grown. Photoluminescence showed near-band-edge emission, the intensity of which was improved with hydrogen passivation. Electrical characterization showed n-type conductivity with room temperature electron mobilities in the range of 300 cm2/V-sec.
Cadmium Zinc Telluride (CZT) semiconductor crystal properties have been studied extensively with a focus on correlations to their radiation detector performance. The need for defect-free CZT crystal is imperative for optimal detector performance. Extended defects like Tellurium (Te) inclusions, twins, sub-grain boundaries, and dislocations are common defects found in CZT crystals; they alter the electrical properties and, therefore, the crystal's response to high energy radiation. In this research we studied the extended defects in CZT crystals from two separate ingots grown using the low-pressure Bridgman technique. We fabricated several detectors cut from wafers of two separate ingots by dicing, lapping, polishing, etching and applying gold metal contacts on the main surfaces of the crystals. Using infrared (IR) transmission microscope we analyzed the defects observed in the CZT detectors, showing three dimensional scans and plot size distributions of Te inclusions, twins and sub-grain boundaries observed in particular regions of the CZT detectors. We characterized electrical properties of the detectors by measuring bulk resistivity and detector response to gamma radiation. We observed that CZT detectors with more extended defects showed poor opto-electrical properties compared to detectors with fewer defects.
CZT is a semiconductor material that promises to be a good candidate for uncooled gamma radiation detectors. However, to date, we are yet to overcome the technological difficulties in production of large size, defect-free CZT crystals. The most common problem is accumulation of Tellurium precipitates as microscopic inclusions. These inclusions influence the charge collection through charge trapping and electric field distortion. We employed high energy transmission X-ray diffraction techniques to study the quality of the CdZnTe crystals grown by Bridgman Technique. Crystallinity and defects within two different growth set-ups, i.e. with and without choked seeding, were compared by imaging the crystal orientation topography with white beam X-ray diffraction topography (WBXDT). The X-ray diffraction topography results show high correlation with large-area infrared transmission images of the crystals. Grain boundaries that are highly decorated with Te inclusions are observed. Characteristic Te inclusion arrangements as a result of growth conditions are discussed. We also measured the electronic properties of the detectors fabricated from ingots grown using two Bridgman processes, and observed a reduction in electrical resistivity of choked-seeding-grown CdZnTe crystals. Our results show that although choked seeding technique holds a promise in the realization of high quality mono-crystalline CdZnTe, current growth parameters must be improved to obtain defect-free crystals. These results are helpful to attain optimal seeding process for Bridgman-growth of large single crystals of CdZnTe.
We sought to examine the factors associated with bacteraemia and their outcome in children with pneumonia and severe acute malnutrition (SAM). All SAM children of either sex, aged 0–59 months, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh with radiologically confirmed pneumonia from April 2011 to July 2012 were enrolled (n = 405). Comparison was made between pneumonic SAM children with (cases = 18), and without (controls = 387) bacteraemia. The death rate was significantly higher in cases than controls (28% vs. 8%, P < 0·01). In logistic regression analysis, after adjusting for potential confounders, the SAM children with pneumonia and bacteraemia more often had a history of lack of bacillus Calmette-Guérin (BCG) vaccination (odds ratio 7·39, 95% confidence interval 1·67–32·73, P < 0·01). The results indicate the importance of continuation of BCG vaccination which may provide benefit beyond its primary purpose.
Early onset of menarche has been shown to be associated with breast cancer and ischaemic heart disease. Studies on age at menarche of the Malaysian population are poorly documented. This study aimed to determine the influence of anthropometric and socio-demographic factors on the age at menarche of university students in Malaysia. Data were obtained in 2010–11 from 961 students between the ages of 18 and 25 years from the University of Malaya using stratified sampling, and multiple regression analysis was applied. Sixty-three per cent of students reached menarche at the age of 12 or 13 years, with the mean and median of age at menarche being 12.45±1.17 and 12.01 years, respectively. Menarcheal age was positively associated with height (p<0.05) and negatively associated with BMI (p<0.001). Students from urban areas attained menarche earlier than those from rural areas (p<0.05). Students from small-sized families attained menarche earlier than those from larger families (p<0.05). First-born students experienced menarche earlier than those who were seventh-born or later. Obese and overweight students reached menarche earlier than students who were underweight or of normal weight (p<0.01). The variations in age at menarche among the Malaysian ethnic groups were statistically insignificant. The results suggest that heavier and first-born students from small families are more likely to attain menarche earlier than their counterparts.
Body mass index (BMI) is a good indicator of nutritional status in a population. In underdeveloped countries like Bangladesh, this indicator provides a method that can assist intervention to help eradicate many preventable diseases. This study aimed to report on changes in the BMI of married Bangladeshi women who were born in the past three decades and its association with socio-demographic factors. Data for 10,115 married and currently non-pregnant Bangladeshi women were extracted from the 2007 Bangladesh Demographic and Health Survey (BDHS). The age range of the sample was 15–49 years. The mean BMI was 20.85±3.66 kg/m2, and a decreasing tendency in BMI was found among birth year cohorts from 1972 to 1992. It was found that the proportion of underweight females has been increasing in those born during the last 20 years of the study period (1972 to 1992). Body mass index increased with increasing age, education level of the woman and her husband, wealth index, age at first marriage and age at first delivery, and decreased with increasing number of ever-born children. Lower BMI was especially pronounced among women who were living in rural areas, non-Muslims, employed women, women not living with their husbands (separated) or those who had delivered at home or non-Caesarean delivery.
Rabies is a major public health problem in Bangladesh, where most of the population live in rural areas. However, there is little epidemiological information on rabies in rural Bangladesh. This study was conducted in 30 upazilas (subdistricts) covering all six divisions of the country, to determine the levels of rabies and animal bites in Bangladesh. The total population of these upazilas was 6 992 302. A pretested questionnaire was used and data were collected by interviewing the adult members of families. We estimated that in Bangladesh, 166 590 [95% confidence interval (CI) 163 350–170 550] people per year are bitten by an animal. The annual incidence of rabies deaths in Bangladesh was estimated to be 1·40 (95% CI 1·05–1·78)/100 000 population. By extrapolating this, we estimated that 2100 (95% CI 1575–2670) people die annually from rabies in Bangladesh. More than three-quarters of rabies patients died at home. This community-based study provides new information on rabies epidemiology in Bangladesh.
To determine the accuracy of fine needle aspiration cytology conducted within a standard ENT out-patients service (rather than a one-stop neck lump clinic), and also to assess the value of ultrasound guidance during fine needle aspiration cytology.
Retrospective study of all patients undergoing fine needle aspiration cytology of a neck lump, from 2005 to 2008 in Leeds teaching hospitals.
Main outcome measures:
Accuracy of fine needle aspiration cytology, compared with the corresponding histology report of the original surgical specimen, and non-diagnostic fine needle aspiration cytology rates with and without ultrasound.
Fine needle aspiration cytology yielded the following respective sensitivity, specificity and accuracy rates: 85, 91 and 87 per cent for lymph nodes; 80, 93 and 89 for salivary glands; and 52, 80 and 69 for thyroid. The proportion of non-diagnostic procedures was 28 per cent, both with and without ultrasound guidance.
Cytologist-led fine needle aspiration cytology would have reduced the time to diagnosis and the number of clinic visits per patient. Fine needle aspiration cytology was accurate for predicting malignancy in salivary gland and lymph node lesions, and for diagnosing lymph node pathology. Study results did not support the use of ultrasound guidance during fine needle aspiration cytology.