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1. To standardize and implement ICP for service users attending DNCC CAMHS team in accordance with the established policy.
2. To achieve greater involvement of service users/parents in ICP.
3. To standardize and improve treatment of care involving all members of one team.
Every patient should have a care plan. Each care plan has a set of needs and goals. These are agreed between the service user and key worker and are assessed and measured frequently. Consultation with each service user/parents, as far as practicable is important. Specification of treatment and care required in accordance with best practice should be recorded. Identification of the necessary resources should be recorded and discussed with service user and key worker. Records kept in one composite set of documentation, and a signed copy should be made available to the service user/parents.
First Cycle commenced 15th October 2019. 166 files were selected from CAMHS team. Data were collected from clinical records from time of admission into CAMHS service to the time of audit. The audit report was prepared on the 6th December 2019, and intervention discussed at the multidisciplinary team meeting and wider DNCC CAMHS academic meeting. Second Cycle 23rd March 2020. 30 files randomly selected and audited. Data were collected by Dr Uchechukwu Egbuta, Mr Cillian Howley, Dr Anitha Selvarajoo, under supervision of Dr Muhammad Iqbal and Dr Diana Meskauskaite.
Method of data input/analysis is IBM SPSS.
For each ICP, the following were looked at: Files with ICP, Identifiable key worker, Formulation, Goals, Action plan, Copy of ICP to young person/parents, Next Review Date, Projected discharge date.
Overall compliance shows 62% in first cycle, and 68% in second cycle after intervention.
There was a 6% quality improvement of ICPs in terms of overall compliance in applying the various components of ICP.
Each service user should have an individual care plan. Each individual care plan should be measured regularly. To develop a therapeutic individual care plan, a formulation of the case from history taking is essential looking at the bio-psychosocial model and should be service user focused. Care plans are part of clinical governance, therefore continuous re-audit every three months was recommended. The follow-up audit will be carried out by the multidisciplinary team members.
Drought tolerance is a highly complex trait and one of the important components of yield stability in wheat. An experiment was therefore conducted to study the drought tolerance status of 14 high-yielding wheat varieties based on morphological characteristics under a randomized complete block design following factorial arrangement with three replications. Variety × Treatment × Year interactions of wheat genotypes were studied for various morphological traits under normal and drought stress conditions for 2 years in plants grown in pots. Significant differences were observed among the 14 varieties of wheat. Sutlej-86 was found to be highly affected by drought, with maximum reductions in plant height, spike length and number of spikelets/spike. The variety with the maximum tolerance to drought was Bahawalpur-97; this variety also had the lowest reductions in the number of fertile tillers/plant, the number of spikelets/spike, spike weight, the number of grains/spike, 1000-grain weight, grain yield/spike, total biomass and stress susceptibility and tolerance indices. Stronger correlations among the studied attributes under drought stress over normal conditions further highlighted drought stress adversities. The studied traits are thus recognized as drought tolerance indicators for varietal selection, and varieties showing less reduction under drought could be used as a standard check in breeding programmes to identify lineages with drought tolerance and could be recommended for drought-stressed areas.
This paper presents a polarization-independent 11-bit chipless RFID tag based on frequency-selective surface which has been designed for encoding and relative humidity (RH) sensing applications. The 10 exterior U-shaped resonators are used for item encoding whereas Kapton has been incorporated with the interior resonator for RH sensing. This radio-frequency identification (RFID) tag operates in S- and C-frequency bands. The proposed design offers enhanced fractional bandwidth up to 88% with the density of 4.46 bits/cm2. Both single- and dual-layer tags have been investigated. The simulated results are in good agreement with measured results and a comparison with existing literature is presented to show the performance. Simple geometry, high code density, large frequency signature bandwidth, high magnitude bit, high radar cross-section, and angular stability for more than 75° are the unique outcomes of the proposed design. In addition, RH sensing has been achieved by integrating the Kapton on the same RFID tag.
To report a single-institution experience of intensity-modulated radiotherapy (IMRT) and RapidArc treatment plans for the patients treated with low grade mucoepidermoid carcinoma (MEC) of the salivary gland while sparing the organs at risk (OARs) within tolerance limits.
Material and Methods:
Twenty-five patients with MEC were selected to develop and analyse the treatment plans using both of the techniques. Dose distributions were calculated using Eclipse treatment planning system (Varian Medical Systems, Palo Alto, CA). Plans were generated to deliver the dose of 6000 cGy in 30 fractions. For IMRT, seven angle plans were used and for RapidArc, two half arcs were used with the same 6 MV photon beam. Quality of treatment plans was evaluated by using parameters such as, coverage, conformity index (CI), homogeneity index (HI), gradient index (GI), unified dosimetry index (UDI), dose volume histogram, delivery time and OARs sparing for IMRT and RapidArc plans.
The analysis revealed that IMRT and RapidArc coverages are 0·90 and 0·94, respectively; CIs are 1·15 and 1·10, respectively; HIs are 1·12 and 1·07, respectively; GIs are 0·94 and 0·98, respectively. Average UDI values for RapidArc and IMRT are 1·09 and 1·11, respectively. Integral dose comparison shows better OAR sparing for RapidArc. RapidArc plans have the shorter beam on time (45%) in comparison with IMRT plans.
Planning constraints were achieved in both techniques. However, RapidArc showed better quality treatment plan, OARs sparing and shorter delivery time as compared to IMRT.
The prevalence of dementia is rising in low-resource countries, where specialist memory services are almost non-existent. The COVID-19 pandemic has created opportunities for innovative remote healthcare. Research shows a lack of dementia literacy and help-seeking behaviour for memory-related problems among older adults in South Asian countries. This paper proposes a remote memory service model and virtual dementia training in South Asian countries, called Memory First Aid (MFA). MFA offers help to a person experiencing memory difficulties until appropriate professional help is received. The MFA course is a 12-h webinar-based package consisting of four weekly modules. It covers dementia awareness and clinical features. The aim is to develop a non-medical workforce able to screen and assess older people with suspected dementia.
A comparative study was performed about the plan parameters and quality indices between volumetric arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) for the treatment of high-risk prostate cancer patients. The aim of this retrospective study was to compare the two methods of external beam radiotherapy IMRT and VMAT in terms of plan quality and efficacy.
Material and method:
Fifteen high-risk prostate patients were planned for radiotherapy using 6 MV photon. Three dose levels were contoured having Planning Tumour Volume 1 (PTV1 = 48 Gy), Planning Tumour Volume 2 (PTV2 = 57.6 Gy) and Planning Tumour Volume 3 (PTV3 = 60 Gy). Setup margins were given using the CHIP trial method. The prescribed PTV3 dose was 60 Gy in 20 fractions which is biologically equivalent to 74 Gy in 37 fractions using α/β = 3. In case of IMRT, seven fixed beam angles 30, 60, 105, 180, 255, 300 and 330 were used and the dose was optimised using the sliding window method. In case of rapid arc technique, one or two full arcs were used for dose optimisation while keeping all the dose constraints and other planning parameters same used in IMRT. The plan evaluation parameters and Organ at risks (OARs) doses were calculated using a dose volume histogram (DVH).
The average D2, D5, D95 and PTVmean for PTV3 were 61.22, 61.13, 58.12, 60.00 Gy and 62.41 62.24 59.53 61.12 Gy for IMRT and VMAT, respectively. The averages V60 for bladder and V30 for rectum were 22.81, 25 and 67, 65% for IMRT and VMAT, respectively. The average homogeneity index (HI), conformity index (CI) and gradient index (GI) were 1.04, 1.4833, 14.79 and 1.04, 1.704, 7.89 for IMRT and VMAT, respectively.
VMAT takes less dose-delivery time and lesser number of monitoring units than IMRT, thus it compensates the intrafractional movements during dose delivery. The Dose GI in VMAT was much better than IMRT. This indicates sharper dose fall off near the normal tissue. No other major differences were observed in terms of plan evaluation parameters between IMRT and VMAT techniques. So, we conclude that VMAT technique is more efficient than IMRT in terms of plan quality and dose delivery.
Social anxiety is common among adolescents in Pakistan and is associated with low self-esteem. Among the recommended treatments, cognitive behavioural therapy (CBT) is effective, and self-help approaches are encouraged.
To determine the effectiveness of culturally adapted CBT-based guided self-help (CACBT-GSH) intervention, using a manual ‘Khushi aur Khatoon’, for treating social anxiety when added to treatment as usual (TAU) compared with TAU only.
A total of 76 adolescents with social anxiety aged 13–16 years from six schools in Multan, Pakistan were recruited into this randomized controlled trial. Participants were divided into intervention and control groups in a 1:1 ratio. Social anxiety, self-esteem and fear of negative evaluation were assessed through the Liebowtiz Social Anxiety Scale for children and adolescents, the Rosenberg Self-Esteem Scale and the Brief Fear of Negative Evaluation, respectively, at baseline and at the end of the study. Guided self-help using culturally adapted CBT (CACBT)-based self-help manual (eight sessions, one session per week) was provided to the intervention group. The effect of the CACBT-GSH intervention was analysed with ANCOVA.
There was a statistically significant difference between the intervention and the control groups in favour of intervention. Participants in the intervention group showed reduced symptoms of social anxiety (p < .001), fear of negative evaluation (p < .001) and enhanced self-esteem (p < .001).
The study demonstrated the effectiveness of CACBT-based guided self-help intervention in treating social anxiety and addressing the symptoms associated with it.
Short duration cotton (Gossypium hirsutum L.) cultivar may be more profitable for the growers, as it will have shortened critical growth window for drought, heat and insect pests. Therefore, in the present research work, two cotton advance lines IUB-71 and IUB-73 along with an approved cotton cultivar IUB-13 were tested under four different sowing dates i.e. S1 (25th April), S2 (10th May), S3 (25th May) and S4 (10th June) in 2017 and 2018 under field condition. Field layout was RCBD factorial with four sowing dates as one factor and three cotton genotypes as another factor with three replications. Data were recorded for plant height, total number of nodes, bolls per plant, seed cotton yield (SCY), above ground fresh biomass (AGFB) and harvest index (HI). An overall decreasing trend with increasing sowing dates was observed in all the traits except HI that relatively increased in all the three genotypes. Within each sowing date, a higher value for each trait was observed for genotype IUB-73 except for AGFB might be due to higher reproductive allocation. It is concluded that IUB-73 due to superior SCY and HI specifically under late planting is best fit for short cotton seasons with reduced critical window for cotton management.
A spoofing attack on a global navigation satellite system (GNSS) receiver is a threat to a significant community of GNSS users due to the high stakes involved. This paper investigates the use of slope based metrics for the detection of spoofing. The formulation of slope based metrics involves monitoring correlators along with tracking correlators in the receiver's channel, which are slaved to the prompt tracking correlator. In this study, using some candidate metrics, detectors have been formed through the analysis of simulated spoofing attacks. A theoretical variance of each metric has also been calculated as a reference for the threshold. A threshold is estimated using the measured variance from the clean signals, for specific false alarm rate. By using the measured threshold, detectors are formed based on slope metrics. These detectors have been tested using TEXBAT data. The results show that the differential slope metrics have good performance. The results have also been compared with some other techniques of spoofing detection.
Drought stress negatively affects the cotton production all over the world. The negative impact of drought varies for different species due to some morphological and root attributes that help some species to better stand under drought. But the extent of disturbance varies for different cotton species. To find out such variation, two cotton species (Gossypium hirsutum and Gossypium arboreum) were studied under normal and drought conditions for 2 years. Two genotypes for each species were included, i.e. PC-1 and COMILLA (G. arboreum) and IUB-13 and IUB-65 (G. hirsutum). The experiment was laid out under a completely randomized design following factorial arrangement. Genotype × treatment × year interaction of cotton genotypes was studied for different root, morphological, physiological and fibre-related traits. Traits such as above ground dry biomass, above ground fresh biomass, chlorophyll contents, leaf area, seed cotton yield, sympodial branches/plant, fibre strength and ginning out-turn were higher in G. hirsutum genotypes as compared to G. arboreum genotypes. However less reduction under drought in all above mentioned traits was recorded for G. arboreum, than G. hirsutum. Furthermore, root traits; primary root length, lateral root numbers, root fresh weight and root dry weight were enriched under drought condition in G. arboreum genotypes than in G. hirsutum genotypes, which is a clear manifestation of higher drought tolerance ability in G. arboreum genotypes transferrable to G. hirsutum genotypes through interspecific crossing or other means.
Drawing on social exchange and emotional regulation perspectives, this study investigates the role of emotional suppression in reducing the detrimental effects of workplace ostracism on organizational learning. Based on the responses of 162 participants from the financial industry, and with the application of moderated mediation analysis, the findings demonstrate that workplace ostracism is mediated by employee silence, which has a negative effect on organizational learning. Interestingly, however, the results exhibit that emotional suppression operates as a buffer between workplace ostracism, employee silence and organizational learning, which leads to the achievement of organizational learning motives. Therefore, the silent employees, who experience workplace ostracism, may still be contributing toward organizational learning, if they are proficient in suppressing their emotions. Given that, the study implies that emotional suppression is fundamentally important to reduce the injurious outcomes of workplace ostracism, in the contemporary organizational settings, particularly with regard to organizational learning.
The main objective of this study is to assure the quality of cervical cancer treatment plans using an electronic portal imaging device (EPID) in RapidArc techniques.
Materials and Methods:
Fifteen cases of cervical cancer patients undergoing RapidArc technique were selected to evaluate the quality assurance (QA) of their treatment. The computed tomography (CT) of each patient was obtained with 3-mm-slice thickness and transferred to the Eclipse treatment planning system. The prescribed dose (PD) of 50·4 Gy with 1·8 Gy per fraction to planning target volume (PTV) was used for each patient. The aim of treatment planning was to achieve 95% of PD to cover 97%, and dose to the PTV should not receive 105% of the PD. All RapidArc plans were created using the AAA algorithm and treated on Varian DHX using 6 MV photon beam, with two full arcs. Gamma analysis was used to evaluate the quality of the treatment plans with accepting criteria of 95% at 3%/3 mm.
In this study, maximum and average gamma values were 2·53 ± 0·409 and 0·195 ± 0·059 showing very small deviation and indicating the smaller difference between both predicted and portal doses. Gamma Area changes from > 0·8 to > 1·2. SD increased to 5·4% and mean standard error increased to 4·67%.
On the basis of these outcomes, we can summarise that the EPID is a useful tool for QA in standardising and evaluating RapidArc treatment plans of cervical cancer in routine clinical practice.
The main objective of this research work is to compare the dosimertic effect on lower and upper oesophagus cancer treatment using 3D conformal radiotherapy as well as to evaluate the doses administered to the organs at risk.
Materials and methods
In this study, a cohort of 30 oesophageal cancer patients between the ages of 45 and 67 years registered during March 2017 to February 2018 was considered. These patients were treated through 3D conformal radiotherapy using four-field technique. Beam energy of 15 MV from Varian DHX linear accelerator was used. The given 30 patients were divided into two groups. The 1st group of 15 patients with upper oesophagus cancer was prescribed 5000 cGy doses, and the 2nd group of remaining 15 patients with lower oesophagus cancer was prescribed 4500 cGy. Computed tomography scans of every patient were obtained and then transmitted to Eclipse TPS for generating treatment plans. All radiotherapy plans were evaluated through various dosimetric indices. Statistical analysis software SPSS was utilised to get the values of means standard error and standard deviation of these indices for the treatment plan evaluation.
Uniformity index (UI) calculated for first group of patients showed difference of 7·4% from ideal value. A difference of 7% between ideal and calculated UI value was observed in 2nd group of patients. The values of other dosimetric indices like coverage, homogeneity, moderate dose homogeneity index (mDHI) and radical dose homogeneity index (rDHI) were found in limits specified by the Radiation Therapy and Oncology Group. The maximum difference of 6% was observed between the coverage mean values of 1st and 2nd group treatment plans.
For oesophageal cancer, 3D conformal radiotherapy using four-field treatment plans shows homogeneous distribution of dose around the target and limits the dose to organ at risk.
This study reported the justification and selection of acceptable γ criteria with respect to low (6 MV) and high (15 MV) photon beams for intensity-modulated radiation therapy quality assurance (IMRT QA) using the Gafchromic external beam therapy 3 (EBT3) film.
Materials and methods
Five-field step-and-shoot IMRT was used to treat 16 brain IMRT patients using the dual-energy DHX-S linear accelerator (Varian Medical System, Palo Alto, CA, USA). Dose comparisons between computed values of the treatment planning system (TPS) and Gafchromic EBT3 film were evaluated based on γ analysis using the Film QA Pro software. The dose distribution was analysed with gamma area histograms (GAHs) generated using different γ criteria (3%/2 mm, 3%/3 mm and 5%/3 mm) for the 6 and 15 MV photon beams, to optimise the best distance-to-agreement (DTA) criteria with respect to the beam energy.
From the comparison between the dose distributions acquired from the TPS and EBT3 film, a DTA criterion of 3%/2 mm showed less dose differences (DDs) with passing rates up to 93% for the 6 MV photon beams, while for the 15 MV a relaxed DTA criterion of 5%/3 mm was consistent with the DD acceptability criteria with a 95% passing rate.
Our results suggested that high-energy photon beams required relaxed DTA criteria for the brain IMRT QA, while low-energy photon beams showed better results even with tight DTA criteria.
To verify dose delivery and quality assurance of volumetric-modulated arc therapy (VMAT) for head and neck (H&N) cancer.
The Imaging and Radiation Oncology Core Houston (IROC-H) H&N phantom with thermoluminescent dosimeters (TLDs) and films, were imaged with computed tomography scan and the reconstructed image was transferred to pinnacle treatment planning system (TPS). On TPS, the planning target volume (PTV), secondary target volume (STV) and organ at risk (OAR) were delineated manually and a treatment plan was made. The dose constraints were determined for the concerned organs according to IROC-H prescription. The treatment plan was optimised using adoptive convolution algorithm to improve dose homogeneity and conformity. The dose calculation was performed using C.C Convolution algorithm and a Varian True Beam linear accelerator was used to deliver the treatment plan to the H&N phantom. The delivered radiation dose to the phantom was measured through TLDs and GafChromic external beam radiotherapy 2 (EBT2) films. The dosimetric performance of the VMAT delivery was studied by analysing percent dose difference, isodose line profile and gamma analysis of the TPS-computed dose and linac-delivered doses.
The percent dose difference of 3.8% was observed between the planned and measured doses of TLDs and a 1.5-mm distance to agreement (DTA) was observed by comparing isodose line profiles. Passed the gamma criteria of 3%/3 mm was with good percentages.
The dosimetric performance of VMAT delivery for a challenging H&N radiotherapy can be verified using TLDs and films embedded in an anthropomorphic H&N phantom.
This work reports our study to commission a radiochromic film dosimetry system using the timely EBT3 film. We carried out dosimetric evaluations on different characteristics of photon beams (e.g., flatness, symmetry and penumbra) in radiation dose delivery.
Materials and Methods
A Varian linear accelerator producing 6 and 15 MV photon beams with 120 multi-leaf collimator was used in this study. PTW ionisation chamber was used to measure the beam characteristics such as symmetry, flatness and penumbra and these measurements were used to commission the radiochormic EBT3 film dosimetry system. The results of irradiated films were analysed using the radiochromic film QA Pro software 2016.
The measured film doses were analysed at two different colour channels (green and red) using two scanning geometries (i.e., upper or lower side of film facing the scanner light source) at two dose levels (10 and 40 Gy). The difference between the ionisation chamber and film results was found insignificant and within the acceptable range as per the World Health Organisation standard.
Results of the comparison between the ionisation chamber and film measurements show that our radiochormic EBT3 film dosimetry system is reliable and cost-effective in the output measurement of a linear accelerator. Our measurements confirm that our EBT3 film dosimetry agreed well with the ionisation chamber, and can be used as a re-validation tool for linear accelerator quality control.
The purpose of this study was to analyse the comparison of intensity-modulated radiation therapy quality assurance (IMRT QA) using Gafchromic® EBT3 film, Electronic portal imaging device (EPID) and MapCHECK®2.
Pretreatment authentication is the main apprehension in advanced radiation therapy treatment plans such as IMRT.
Materials and methods
A total of 20 patients were planned on Eclipse treatment planning system using 6 and 15 MV separately.
Gamma index of EBT3 film results shows the following average passing rates: 97% for 6 MV and 96·6% for 15 MV using criteria of ±5% of 3 mm, ±3% of 3 mm and ±3% of 2 mm for brain. However, by using ±5% of 3 mm and ±3% of 3 mm criteria, the average passing rates were 95·4% on 6 MV and 95·2% on 15 MV for prostate. For EPID, the results show the average passing rates as 97·8% for 6 MV and 97·2% for 15 MV in for brain. In cases in which ±5% of 3 mm and ±3% of 3 mm were used, the average passing rates were 96·6% for 6 MVand 96·1% for 15 MV for prostate. MapCHECK®2 results show average passing rates of 96·4% for 6 and 96·2% for 15 MV, respectively, for brain using criteria of ±5% of 3 mm, ±3% of 3 mm and ±3% of 2 mm, whereas for ±5% of 3 mm and ±3% of 3 mm the average rates are 95·2% for 6 and 94·7% for 15 MV in prostate.
The EPID results are better than the other methods, and hence EPID can be used effectively for IMRT pretreatment verifications.
To determine the feasibility of an anthropomorphic breast polyurethane-based three-dimensional (3D) dosimeter with cavity to measure dose distributions and skin dose for a commercial strut-based applicator strut-adjusted volume implant (SAVI™) 6–1.
Materials and methods
An anthropomorphic breast 3D dosimeter was created with a cavity to accommodate the SAVI™ strut-based device. 2 Gy was prescribed to the breast dosimeter having D95 to planning target volume evaluation (PTV_EVAL) while limiting 125% of the prescribed dose to the skin. Independent dose distribution verification was performed with GAFCHROMIC® EBT2 film. The dose distribution from the 3D dosimeter was compared to the distributions from commercial brachytherapy treatment planning system (TPS) and film. Point skin doses, line profiles and dose–volume histogram (DVHs) for the skin and PTV_EVAL were compared.
The maximum difference in skin dose for TPS and the 3D dosimeter was 4% whereas 41% between the TPS and EBT2 film. The maximum dose difference for line profiles between TPS, 3D dosimeter, and film was 4·1%. DVHs of skin and PTV_EVAL for TPS and 3D dosimeter differed by a maximum of 4% at 5 mm depth and skin differed by a maximum 1·5% between TPS and 3D dosimeter. The criterion for gamma analysis comparison was 92·5% at ±5%±3 mm criterion. The TPS demonstrated at least ±5% comparability in predicting dose to the skin, PTV_EVAL and normal breast tissue.
3D anthropomorphic polyurethane dosimeter with cavity gives comparable results to the TPS dose predictions and GAFCHROMIC® EBT2 film results in the context of HDR brachytherapy.
In the recent years, many benchmark author profiling corpora have been developed for various genres including Twitter, social media, blogs, hotel reviews and e-mail, etc. However, no such standard evaluation resource has been developed for Short Messaging Service (SMS), a popular medium of communication, which is very useful for author profiling. The primary aim of this study is to develop a large multilingual (English and Roman Urdu) benchmark SMS-based author profiling corpus. The proposed corpus contains 810 author profiles, wherein each profile consists of an aggregation of SMS messages as a single document of an author, along with seven demographic traits associated with each author profile: gender, age, native language, native city, qualification, occupation and personality type (introvert/extrovert). The secondary aims of this study include the following: (1) annotating the proposed corpus for code-switching annotations at the lexical level (approximately 0.69 million tokens are manually annotated for code-switching) and (2) applying the stylometry-based method (groups of sixty-four features) and the content-based method (twelve features) for gender identification in order to demonstrate how our proposed corpus can be used for the development and evaluation of various author profiling methods. The results show that the content-based character 5-gram feature outperformed all the other features by obtaining the accuracy score of 0.975 and F1 score of 0.947 for gender identification while using the entire corpus. Furthermore, our proposed corpora (SMS–AP–18 and code-switched SMS–AP–18) are freely and publicly available for research purpose.