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The prenatal period represents a critical time for brain growth and development. These rapid neurological advances render the fetus susceptible to various influences with life-long implications for mental health. Maternal distress signals are a dominant early life influence, contributing to birth outcomes and risk for offspring psychopathology. This prospective longitudinal study evaluated the association between prenatal maternal distress and infant white matter microstructure. Participants included a racially and socioeconomically diverse sample of 85 mother–infant dyads. Prenatal distress was assessed at 17 and 29 weeks’ gestational age (GA). Infant structural data were collected via diffusion tensor imaging (DTI) at 42–45 weeks’ postconceptional age. Findings demonstrated that higher prenatal maternal distress at 29 weeks’ GA was associated with increased fractional anisotropy, b = .283, t(64) = 2.319, p = .024, and with increased axial diffusivity, b = .254, t(64) = 2.067, p = .043, within the right anterior cingulate white matter tract. No other significant associations were found with prenatal distress exposure and tract fractional anisotropy or axial diffusivity at 29 weeks’ GA, or earlier in gestation.
Suicide is one of the leading mental health crises and takes one life every 40 seconds. Four out of every five suicides occur in low- and middle-income countries. Despite religion being a protective factor against suicide, the estimated number of suicides is rapidly increasing in Pakistan.
Our review focuses on the trends of suicide and means of self-poisoning in the past three decades, and the management of commonly used poisons.
We searched two electronic databases (PubMed and PakMediNet) for published English-language studies describing agents used for suicide in different regions of Pakistan. A total of 46 out of 85 papers (N = 54 747 cases) met our inclusion criteria.
Suicidal behaviour was more common among individuals younger than 30 years. Females comprised 60% of those who attempted suicide in our study sample, although the ratio of completed suicides favoured males. There were regional trends in the choice of agent for overdose. Organophosphate poisoning was reported across the nation, with a predominance of cases from the agricultural belt of South Punjab and interior Sindh. Aluminium phosphide (‘wheat pills’) was a preferred agent in North Punjab, whereas paraphenylenediamine (‘kala pathar’) was implicated in deaths by suicide from South Punjab. Urban areas had other means for suicide, including household chemicals, benzodiazepines, kerosene oil and rat poison.
Urgent steps are needed, including psychoeducational campaigns on mental health and suicide, staff training, medical resources for prompt treatment of self-poisoning and updated governmental policy to regulate pesticide sales.
Training based on the Mental Health Gap Action Programme (mhGAP) is being increasingly adopted by countries to enhance non-specialists’ mental health capacities. However, the influence of these enhanced capacities on referral rates to specialised mental health services remains unknown.
We rely on findings from a longitudinal pilot trial to assess the influence of mental health knowledge, attitudes and self-efficacy on self-reported referrals from primary to specialised mental health services before, immediately after and 18 months after primary care physicians (PCPs) participated in an mhGAP-based training in the Greater Tunis area of Tunisia.
Participants included PCPs who completed questionnaires before (n = 112), immediately after (n = 88) and 18 months after (n = 59) training. Multivariable analyses with linear mixed models accounting for the correlation among participants were performed with the SAS version 9.4 PROC MIXED procedure. The significance level was α < 0.05.
Data show a significant interaction between time and mental health attitudes on referrals to specialised mental health services per week. Higher scores on the attitude scale were associated with more referrals to specialised services before and 18 months after training, compared with immediately after training.
Findings indicate that, in parallel to mental health training, considering structural/organisational supports to bring about a sustainable change in the influence of PCPs’ mental health attitudes on referrals is important. Our results will inform the scale-up of an initiative to further integrate mental health into primary care settings across Tunisia, and potentially other countries with similar profiles interested in further developing task-sharing initiatives.
On coronavirus disease 2019 (COVID-19) wards, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid was frequently detected on high-touch surfaces, floors, and socks inside patient rooms. Contamination of floors and shoes was common outside patient rooms on the COVID-19 wards but decreased after improvements in floor cleaning and disinfection were implemented.
Short-term peripheral venous catheter–related bloodstream infection (PVCR-BSI) rates have not been systematically studied in resource-limited countries, and data on their incidence by number of device days are not available.
Prospective, surveillance study on PVCR-BSI conducted from September 1, 2013, to May 31, 2019, in 727 intensive care units (ICUs), by members of the International Nosocomial Infection Control Consortium (INICC), from 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific regions. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System.
We followed 149,609 ICU patients for 731,135 bed days and 743,508 short-term peripheral venous catheter (PVC) days. We identified 1,789 PVCR-BSIs for an overall rate of 2.41 per 1,000 PVC days. Mortality in patients with PVC but without PVCR-BSI was 6.67%, and mortality was 18% in patients with PVC and PVCR-BSI. The length of stay of patients with PVC but without PVCR-BSI was 4.83 days, and the length of stay was 9.85 days in patients with PVC and PVCR-BSI. Among these infections, the microorganism profile showed 58% gram-negative bacteria: Escherichia coli (16%), Klebsiella spp (11%), Pseudomonas aeruginosa (6%), Enterobacter spp (4%), and others (20%) including Serratia marcescens. Staphylococcus aureus were the predominant gram-positive bacteria (12%).
PVCR-BSI rates in INICC ICUs were much higher than rates published from industrialized countries. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs in resource-limited countries.
This study is primarily aimed at the analysis of various dose homogeneity indices (HIs) essential for the evaluation of therapeutic plans by employing intensity-modulated radiation therapy (IMRT) on patients with cervix cancer. Also integral dose (ID) to healthy surrounding organs is computed.
Materials and methods
Effectiveness of different HIs (A, B, C, D) was explored for IMRT plans using 15 MV photon beam. In total, 18 patients were selected at random for treatment of cervix cancer, and dose of 5,040 cGy was delivered in 28 equal fractions.
The study was undertaken to compare four HI formulas and coefficient of determination between each set of HI was known by calculating R2 value. Mean±SD of HI A, HI B, HI C and HI D were 1·12±0·02, 0·13±0·04, 0·10±0·02 and 0·99±0·03, respectively. Mean value of ID for rectum is 3·16 and for bladder is 10·3.
Our data suggested that HI calculated using four formulas provided good plan quality. The results advocate that all the studied HIs can be effectively used for assessment of uniformity inside the target volume. However, values of HI C were closest to ideal value as compared with other three formulas; hence, it is considered a better measure to compute homogeneity of dose within target volume. The ID gives satisfactory results for surrounding normal tissues such as rectum and bladder and significant critical tissue sparing was achieved by using IMRT technique.
This exploration is intended to measure tissue maximum ratios (TMRs) in smaller fields through CC01 detector and to compare CC01 measured TMRs with Pinnacle treatment planning software (TPS) calculated TMRs.
Materials and methods
CC01 compact chamber detector was used to measure TMR in water phantom for 6 and 18 MV beam delivered from Varian linear accelerator. Pinnacle TPS was employed in this study to calculate TMR from the measured percentage depth doses data. CC01 measured TMR data was compared with the calculated TMR data at depths from 5 to 20 cm for field sizes varying from 1 to 10 cm2.
For the smallest given field size of 1 cm2, CCO1 measured 13·95% higher TMR value for 18 MV beam than that for 6 MV beam. At 20 cm depth for 1 cm2 field size, TMR due to 18 MV beam was 52·4% higher than the TMR due to 6 MV beam. For 6 MV beam, the maximum difference appeared between the measured TMR and pinnacle calculated TMR was 2·8% and for 18 MV beam, the maximum difference was 4%.
For both 6 and 18 MV beam, there was good agreement between CC01 measured and Pinnacle calculated TMRs for the field sizes ranging from 1 to 10 cm2. This exploration can be extended to the determination of other dosimetric parameters like TARs, TPRs in small fields.
Drought stress ‘particularly at seedling stage’ causes morpho-physiological differences in wheat which are crucial for its survival and adaptability. In the present study, 209 recombinant inbred lines (RILs) from synthetic wheat (W7984)× ‘Opata’ (also known as SynOpRIL) population were investigated under well-watered and water-limited conditions to identify quantitative trait loci (QTL) for morphological traits at seedling stage. Analysis of variance revealed significant differences (P < 0.01) among RILs, and water treatments for all traits with moderate to high broad sense heritability. Pearson's coefficient of correlation revealed positive correlation among all traits except dry root weight that showed poor correlation with fresh shoot weight (FSW) under water-limited conditions. A high-density linkage map was constructed with 2639 genotyping-by-sequencing markers and covering 5047 cM with an average marker density of 2 markers/cM. Composite interval mapping identified 16 QTL distributed over nine chromosomes, of which six were identified under well-watered and 10 in water-limited conditions. These QTL explained from 4 to 59% of the phenotypic variance. Six QTL were identified on chromosome 7B; three for shoot length under water-limited conditions (QSL.nust-7B) at 64, 104 and 221 cM, two for fresh root weight (QFRW.nust-7B) at 124 and 128 cM, and one for root length (QRL.nust-7B) at 122 cM positions. QFSW.nust-7B appeared to be the most significant QTL explaining 59% of the phenotypic variance and also associated with FSW at well-watered conditions. These QTL could serve as target regions for candidate gene discovery and marker-assisted selection in wheat breeding.
This study aimed to investigate tolerance dose to organs at risk (OARs) as well as degree of conformity and homogeneity for head and neck cancer patients by using simultaneous integrated boost intensity-modulated radiotherapy technique (SIB IMRT).
Materials and methods
This study analysed 15 head and neck cancer patients receiving treatment using inverse planned SIB IMRT technique. Using a beam energy of 6 MV, two dose levels of 70 and 55·4 Gy were used to treat the tumour. Doses of 2 Gy in 35 fractions and 1·68 Gy in 33 fractions were simultaneously delivered for effective planning target volume (PTV1) and boost planning target volume (PTV2), respectively.
Dose distribution in PTV and critical organs lies within tolerance dose guidelines protecting spinal cord, brain stem, optic chiasm, optic nerve, thus reducing the risk of damage to normal tissues. Minor deviation from tolerance limit was observed for parotid glands. This technique provided highly conformal and homogenous dose distribution as well as better sparing of OARs, hence verifying quality assurance results to be satisfactory.
SIB IMRT technique offers best solution for preserving organ function by keeping dose below tolerance level. Treatment of head and neck carcinoma using SIB IMRT is feasible, more efficient, and dose escalation is achieved in a single plan.
Small field dosimetry is complicated and accuracy in the measurement of total scatter factor (TSF) is crucial for dosimetric calculations, in making optimum intensity-modulated radiotherapy plans for treating small target volumes. In this study, we intended to determine the TSF measuring properties of CC01 and CC04 detectors for field sizes ranging from sub-centimetre to the centimetre fields.
Material and methods
CC01 and CC04 chamber detectors were used to measure TSF for 6 and 18 MV photon beam delivered from the linear accelerator, through small fields in a water phantom. Small fields were created by collimator jaws and multi-leaf collimators separately, with field sizes ranging from 0·6 to 10 cm2 and 0·5 to 20 cm2, respectively.
CC01 measured TSF at all the given field sizes created by jaws and multi-leaf collimators for both 6 and 18 MV beams whereas CC04 could not measure TSF for field sizes <1 cm2 due to volume averaging and perturbation effects.
CC01 was shown to be effective for measurement of TSF in sub-centimetre field sizes. CC01 can be employed to measure other dosimetric quantities in small fields using different energy beams.
To deliver radiation doses with higher accuracy, radiation treatment through megavoltage photon beams from linear accelerators, is accepted widely for treating malignancies. Before calibrating the linear accelerators, it is essential to make a complete analysis of all photon beam profile parameters. The main objective of this exploration was to investigate the 6 and 15 MV photon beam profile characteristics to improve the accuracy of radiation treatment plans.
In this exploration, treatment parameters like depth, field size and beam energy were varied to observe their effect on dosimetric characteristics of beam profiles in a water phantom, generated by linear accelerator Varian Clinac.
The results revealed that Dmax and Dmin decreased with increasing depth but increased with increasing field sizes. Both left and right penumbras increased with increasing depth, field size and energy. Homogeneity increased with field size but decreased with depth. Symmetry had no dependence on depth, energy and field size.
All the characteristics of photon beam dosimetry were analysed and the characteristics like homogeneity and symmetry measured by an ion chamber in a water phantom came within clinically acceptable level of 3 and 103%, respectively, thus fulfilled the requirements of standard linear accelerator specifications. This exploration can be extended to the determination of beam profile characteristics of electron and photon beams of other energies at various depths and field sizes for designing optimum treatment plans.
The aim of this study was to evaluate the effect of feeding goats with distilled and non-distilled thyme leaves (Thymus zygis subsp. gracilis) on the physicochemical composition and technological properties of pasteurised goat milk, and on the physicochemical composition, phenolic content, oxidative stability, microbiology, sensory and texture profile of Murcia al Vino goat cheese. One group of goats was fed the basal diet (control), the second and third groups were fed with different levels of distilled (10 and 20%) or non-distilled (3·75 and 7·5%) thyme leaves. Goat milk physicochemical composition was significantly affected by the substitution of 7·5% of basal goat diet with non-distilled thyme leaves (increase in fat, protein, dry matter and PUFA content), while goat milk clotting time was increased significantly by the introduction of 20% distilled thyme leaves, which reduces its technological suitability. Microbiology, sensory and texture profiles were not affected by the introduction of distilled thyme leaves. The introduction of distilled and non-distilled thyme leaves as an alternative feed to diet can lead to an inhibition of lipids oxidation. The introduction of distilled and non-distilled thyme leaves into goat's diet can be successfully adopted as a strategy to reduce feeding costs and to take advantage of the waste from the production of essential oils, minimising waste removing costs and the environmental impact.
Magnetic seizure therapy, in which seizures are elicited with a high-frequency magnetic field, is under development as a new treatment for major depressive disorder. Its use may be justified if it produces the antidepressant effects of electroconvulsive therapy (ECT), coupled with limited cognitive side-effects.
To evaluate the usefulness of a new 100 Hz magnetic seizure therapy device.
We induced seizures with 100 Hz magnetic transcranial stimulation in 11 patients with major depressive disorder during one session of a regular course of ECT. Recovery times after seizures induced by magnetic seizure therapy and ECT were compared.
Seizures could be elicited in 10 of the 11 patients. Stimulation over the vertex produced tonic-clonic activity on 9 out of 11 occasions. Stimulation over the prefrontal midpoint elicited seizures on 3 out of 7 occasions. The mean duration of magnetically induced seizures was 31.3s, ranging from 10 to 86s. All patients had an exceptionally quick recovery of orientation: mean of 7 min 12s (s.d.=2 min 7 s, range 4 min 20s to 9 min 41 s). The recovery times were on average 15 min 35s shorter with magnetic seizure therapy than with ECT in the same patients (paired-samples t-test: P<0.0001). Patients reported feeling less confused after magnetic seizure therapy. Side-effects were confined to myoclonic movements, associated with the use of etomidate.
The new 100Hz magnetic stimulator elicits seizures in the majority of patients when administered over the vertex. Magnetic seizure therapy was associated with shorter recovery times and less confusion following treatment. Subsequent work will be required to assess the safety and effectiveness of magnetic seizure therapy in the treatment of depression.
A unique case of pseudosarcomatous fibrovascular proliferative tissue causing biphasic stridor and simulating a primary subglottic angiosarcoma is reported.
The patient presented with a wheeze and was diagnosed initially with asthma. He subsequently developed worsening biphasic stridor. Flexible nasendoscopy revealed a subglottic mass obstructing the airway. The mass was removed with a carbon dioxide laser and the patient’s condition improved dramatically. The specimen was difficult to interpret histologically and was thought at first to be a novel case of a primary subglottic angiosarcoma. However, the slides were reviewed by expert soft tissue pathologists in the UK and USA, and a final diagnosis of a pseudosarcomatous fibrovascular proliferative lesion was made.
This case highlights the important principle of seeking additional opinions before making a malignant diagnosis in an atypical site. Our report also emphasizes the importance of good clinico-pathological liaison, especially in difficult cases.
We present a detailed analysis of inter- and intraband transitions in GaN/AlN self-organized quantum dots grown on sapphire, silicon (111) and 6H-SiC substrates. Quantum dot samples have been characterized by means of transmission electron microscopy, photoluminescence and photo-induced absorption spectroscopy. Interlevel transitions in the conduction band are observed in the 0.52–0.98 eV energy range, thus covering the telecommunication band. The s-pz absorption is peaked at 0.8 eV (0.52 eV) for samples with dot height of 1.5 nm (6 nm). Calculations show that in bigger dots the transition energy is governed by the value of the internal field.
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