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Robust personal protective equipment is essential in preventing the transmission of coronavirus disease 2019 to head and neck surgeons who are routinely involved in aerosol generating procedures.
This paper describes the collective experience, across 3 institutes, of using a reusable half-face respirator in 72 head and neck surgery cases.
Cost analysis was performed to demonstrate the financial implications of using a reusable respirator compared to single-use filtering facepiece code 3 masks.
The reusable respirator is a cost-effective alternative to disposable filtering facepiece code 3 respirators. Supplying reusable respirators to individual staff members may increase the likelihood of them having appropriate personal protective equipment during their clinical duties.
Internally displaced persons (IDPs) reach almost 6% of Georgia's total population. They were uprooted by the military conflicts in Abkhazia and South Ossetia in the 1990s and the brief but intensive war with Russia in 2008.
To examine the patterns of mental disorders and functional disability among conflict-affected populations in Georgia.
The study used a cross-sectional household survey design with multi-stage random sampling IDPs and “returnees” (IDPs who have returned to their original villages). Disorders of PTSD, depression, anxiety, and their co-morbidity, were measured, along with functional disability. A range of questions on exposure to violent and traumatic events and demographic and socio-economic characteristics were included. Descriptive and multivariate regression analyses were used.
Of 3600 respondents, 24% were recorded with PTSD, 14% with depression, 11% with anxiety. 30% of all respondents had ≥1 condition and 6% had all 3. Factors significantly associated with the mental disorders and their comorbidity included greater frequency of exposure to traumatic events, female gender, older age, displacement status, low levels of neighbourhood support, poor community conditions, and a bad economic situation. PTSD mediated the influence of traumatic events on outcomes of depression and anxiety. All 3 disorders significant influenced functional disability.
The study provides the most comprehensive data on mental health problems among conflict-affected populations in Georgia. It highlights the persisting burden of poor mental health and the associated characteristics, and the significant impact of mental disorders on functional disability. It calls for greater access to needs-driven mental health services.
The Genomics Used to Improve DEpresssion Decisions (GUIDED) trial assessed outcomes associated with combinatorial pharmacogenomic (PGx) testing in patients with major depressive disorder (MDD). Analyses used the 17-item Hamilton Depression (HAM-D17) rating scale; however, studies demonstrate that the abbreviated, core depression symptom-focused, HAM-D6 rating scale may have greater sensitivity toward detecting differences between treatment and placebo. However, the sensitivity of HAM-D6 has not been tested for two active treatment arms. Here, we evaluated the sensitivity of the HAM-D6 scale, relative to the HAM-D17 scale, when assessing outcomes for actively treated patients in the GUIDED trial.
Outpatients (N=1,298) diagnosed with MDD and an inadequate treatment response to >1 psychotropic medication were randomized into treatment as usual (TAU) or combinatorial PGx-guided (guided-care) arms. Combinatorial PGx testing was performed on all patients, though test reports were only available to the guided-care arm. All patients and raters were blinded to study arm until after week 8. Medications on the combinatorial PGx test report were categorized based on the level of predicted gene-drug interactions: ‘use as directed’, ‘moderate gene-drug interactions’, or ‘significant gene-drug interactions.’ Patient outcomes were assessed by arm at week 8 using HAM-D6 and HAM-D17 rating scales, including symptom improvement (percent change in scale), response (≥50% decrease in scale), and remission (HAM-D6 ≤4 and HAM-D17 ≤7).
At week 8, the guided-care arm demonstrated statistically significant symptom improvement over TAU using HAM-D6 scale (Δ=4.4%, p=0.023), but not using the HAM-D17 scale (Δ=3.2%, p=0.069). The response rate increased significantly for guided-care compared with TAU using both HAM-D6 (Δ=7.0%, p=0.004) and HAM-D17 (Δ=6.3%, p=0.007). Remission rates were also significantly greater for guided-care versus TAU using both scales (HAM-D6 Δ=4.6%, p=0.031; HAM-D17 Δ=5.5%, p=0.005). Patients taking medication(s) predicted to have gene-drug interactions at baseline showed further increased benefit over TAU at week 8 using HAM-D6 for symptom improvement (Δ=7.3%, p=0.004) response (Δ=10.0%, p=0.001) and remission (Δ=7.9%, p=0.005). Comparatively, the magnitude of the differences in outcomes between arms at week 8 was lower using HAM-D17 (symptom improvement Δ=5.0%, p=0.029; response Δ=8.0%, p=0.008; remission Δ=7.5%, p=0.003).
Combinatorial PGx-guided care achieved significantly better patient outcomes compared with TAU when assessed using the HAM-D6 scale. These findings suggest that the HAM-D6 scale is better suited than is the HAM-D17 for evaluating change in randomized, controlled trials comparing active treatment arms.
Headucate is a pioneering student-led society at the University of East Anglia (UEA), founded in 2012. Mental health stigma exists widely and is a well-known barrier to accessing support. This presents a need for education and raising awareness about mental illness.
The goal is to spread mental health awareness locally, measured by school outreach and events organised. This is achievable through Headucate's collaboration with the university and schools to convey the message each year.
Headucate aims to raise mental health awareness and tackle stigma, with the intention of reaching the university, schools locally and communities nationally.
Headucate delivers workshops for secondary schools. This involves interactive sessions to stimulate discussions about mental health and illness, and where to find help. Additionally, there are university-held talks from a variety of guest speakers who are experts in this field.
It has expanded beyond medical students to involve the whole university, with a shared interest in mental health awareness. Research conducted by Headucate in 2014-2015 has indicated there is a statistically significant (P < 0.001) increase in the knowledge about mental illness and knowing where to get help following school workshops.
The success has transformed from starting as an idea into one of UEA's largest student societies which will continue to expand. Future goals include a mental health awareness campaign and collaborating with student groups at the university, to host events that link mental health to other causes. Furthermore, Headucate is hoping to expand outreach to the elderly community.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Flucytosine, CAS #2022-85-7, crystallizes in the tetragonal space group P41212 (#94) with a = 6.643768(27), c = 23.89009(10) Å, V = 1054.500(7) Å3, and Z = 8. In this work, the sample was obtained from the United States Pharmacopeial Convention (USP) Lot #R03100 and analyzed as-received. The room temperature (295 K) crystal structure was refined using synchrotron (λ = 0.412826 Å) powder diffraction data and optimized using the density functional theory (DFT). When looking down the a-axis, the crystal structure consists of multiple ribbon-like structures stacked into columns. The powder X-ray diffraction pattern of the compound has been submitted to ICDD® for inclusion in the Powder Diffraction File™ (PDF®). The agreement of the Rietveld-refined and DFT-optimized structures is good, with the largest difference in the external amine group with an overall root mean displacement of 0.056 Å. There is also evidence of unit cell expansion at higher temperatures, as the volume of the unit cell at 298 K was 1.6–1.9% greater than the two unit cells obtained at 150 K. A N–H⋯O hydrogen bond exists in the inter-ribbon region between the flucytosine molecules, resulting in a 3D hydrogen bond network.
Research from high-income countries has implicated travel distance to mental health services as an important factor influencing treatment-seeking for mental disorders. This study aimed to test the extent to which travel distance to the nearest depression treatment provider is associated with treatment-seeking for depression in rural India.
We used data from a population-based survey of adults with probable depression (n = 568), and calculated travel distance from households to the nearest public depression treatment provider with network analysis using Geographic Information Systems (GIS). We tested the association between travel distance to the nearest public depression treatment provider and 12 month self-reported use of services for depression.
We found no association between travel distance and the probability of seeking treatment for depression (OR 1.00, 95% CI 0.98–1.02, p = 0.78). Those living in the immediate vicinity of public depression treatment providers were just as unlikely to seek treatment as those living 20 km or more away by road. There was evidence of interaction effects by caste, employment status and perceived need for health care, but these effect sizes were generally small.
Geographic accessibility – as measured by travel distance – is not the primary barrier to seeking treatment for depression in rural India. Reducing travel distance to public mental health services will not of itself reduce the depression treatment gap for depression, at least in this setting, and decisions about the best platform to deliver mental health services should not be made on this basis.
This chapter continues the scenario from the chapter on Hepatic Portoenterostomy or Kasai Procedure. The pathophysiology of end stage liver disease is reviewed with its specific effects on the individual organ systems. The authors provide a detailed explanation of the pre-operative evaluation for patients requiring liver transplantation. A detailed description of the 3 main phases of liver transplantation is presented with attention to the related anesthetic considerations.
This chapter provides an overview of the surgical treatment for biliary atresia, the Hepatic Portoenterostomy or Kasai Procedure. The pathophysiology of biliary atresia is reviewed as it related to the organ systems effected. The signs and symptoms of neonatal liver failure are discussed including the development of hepatorenal and hepatopulmonary syndromes. The chapter provides an overview of the surgical aspects and anesthetic concerns related to the Kasai procedure. The chapter provides a segue into the chapter on liver transplantation.
This chapter, provides an overview for pediatric upper extremity nerve blocks. The authors describe the nerve distribution and ultrasound Sonoanatomy for the common upper extremity blocks (interscalene, supraclavicular, infraclavicular and axillary nerve blocks. Indications and contraindications as well as discussion of perineural catheters are discussed.
This chapter, reviews the basics of lower extremity innervation and the commonly performed regional anesthetic blocks. Through a case of lower extremity trauma, the author provides an overview of the available regional techniques with anatomic and ultrasound descriptions for their performance.
Irregular breakfast consumption and food timing patterns in relation to weight status and inflammation were investigated in a cross-sectional manner among 644 participants in the Cancer Prevention Study-3 Diet Assessment Sub-study. Breakfast consumption, and the individual means and the intra-individual standard deviation (isd) of time at first intake of the day, duration of daily intake window and midpoint of daily intake window were collected via six 24-h recalls and examined in relation to BMI, waist circumference (WC) and inflammation (glycoprotein acetyl (GlycA)). Compared with consuming breakfast on all six recalls, linear regression models showed those who consumed breakfast on 4 or 5 of the days had a 1·29 (95 % CI 0·19, 2·38) and 1·64 (95 % CI 0·12, 3·16) kg/m2 higher BMI; no association was found for consuming breakfast ≤3 d. At 1 h later, the average time of first intake was associated with a 0·44 (95 % CI 0·04, 0·84) kg/m2 higher BMI. A 1-h increase in the isd of first intake was associated with a 1·12 (95 % CI 0·49, 1·75) kg/m2 higher BMI; isd in duration and midpoint of intake window were significant prior to additional adjustment for isd in the first intake. One-hour increases in isd for the first intake time (β: 0·15; 95 % CI 0·04, 0·26) and the midpoint of intake window (β: 0·16; 95 % CI 0·02, 0·31) were associated with higher GlycA. No associations were observed for WC independent of BMI. The results provide evidence that irregularity in breakfast consumption and daily intake timing patterns, particularly early in the day, may be related to weight status and inflammation.
There is limited evidence of the safety and impact of task-shared care for people with severe mental illnesses (SMI; psychotic disorders and bipolar disorder) in low-income countries. The aim of this study was to evaluate the safety and impact of a district-level plan for task-shared mental health care on 6 and 12-month clinical and social outcomes of people with SMI in rural southern Ethiopia.
In the Programme for Improving Mental health carE, we conducted an intervention cohort study. Trained primary healthcare (PHC) workers assessed community referrals, diagnosed SMI and initiated treatment, with independent research diagnostic assessments by psychiatric nurses. Primary outcomes were symptom severity and disability. Secondary outcomes included discrimination and restraint.
Almost all (94.5%) PHC worker diagnoses of SMI were verified by psychiatric nurses. All prescribing was within recommended dose limits. A total of 245 (81.7%) people with SMI were re-assessed at 12 months. Minimally adequate treatment was received by 29.8%. All clinical and social outcomes improved significantly. The impact on disability (standardised mean difference 0.50; 95% confidence interval (CI) 0.35–0.65) was greater than impact on symptom severity (standardised mean difference 0.28; 95% CI 0.13–0.44). Being restrained in the previous 12 months reduced from 25.3 to 10.6%, and discrimination scores reduced significantly.
An integrated district level mental health care plan employing task-sharing safely addressed the large treatment gap for people with SMI in a rural, low-income country setting. Randomised controlled trials of differing models of task-shared care for people with SMI are warranted.
In recent years, research into novel plant protection strategies with endophytic entomopathogenic fungi has increased markedly. However, current applications of these fungi are mostly not supported by targeted formulation strategies which should enhance fungal establishment in close proximity to plant tissue and promote endophytism. Further drawbacks are low stability of fungal propagules during drying and storage, difficult handling as well as high dosages and costs per hectare. Formulation has the potential to substantially improve all of these characteristics to come closer to implementation of these fungi in integrated pest management. This chapter reviews the currently available literature on application of formulated endophytic entomopathogenic fungi via sprays, seed treatments, and sowing of granules and beads. It further addresses future trends in formulation science to overcome current challenges of endophytic entomopathogenic fungi regarding consistent efficacy particularly under field conditions.
Schools are important settings for increasing reach and uptake of adolescent mental health interventions. There is limited consensus on the focus and content of school-based mental health services (SBMHSs), particularly in low-resource settings. This study elicited the views of diverse stakeholders in two urban settings in India about their priorities and preferences for SBMHSs.
We completed semi-structured interviews and focus group discussions with adolescents (n = 191), parents (n = 9), teachers (n = 78), school counsellors (n = 15), clinical psychologists/psychiatrists (n = 7) in two urban sites in India (Delhi and Goa). Qualitative data were obtained on prioritized outcomes, preferred content and delivery methods, and indicated barriers.
All stakeholders indicated the need for and acceptability of SBMHSs. Adolescents prioritized resolution of life problems and exhibited a preference for practical guidance. Parents and teachers emphasized functional outcomes and preferred to be involved in interventions. In contrast, adolescents' favored limited involvement from parents and teachers, was related to widespread concerns about confidentiality. Face-to-face counselling was deemed to be the most acceptable delivery format; self-help was less frequently endorsed but was relatively more acceptable if blended with guidance or delivered using digital technology. Structured sensitization was recommended to promote adolescent's engagement. Providers endorsed a stepped care approach to address different levels of mental health need among adolescents.
SBMHSs are desired by adolescents and adult stakeholders in this setting where few such services exist. Sensitization activities are required to support implementation. School counsellors have an important role in identifying and treating adolescents with different levels of mental health needs, and a suite of interventions is needed to target these needs effectively and efficiently.