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Poor transition planning contributes to discontinuity of care at the child–adult mental health service boundary (SB), adversely affecting mental health outcomes in young people (YP). The aim of the study was to determine whether managed transition (MT) improves mental health outcomes of YP reaching the child/adolescent mental health service (CAMHS) boundary compared with usual care (UC).
A two-arm cluster-randomised trial (ISRCTN83240263 and NCT03013595) with clusters allocated 1:2 between MT and UC. Recruitment took place in 40 CAMHS (eight European countries) between October 2015 and December 2016. Eligible participants were CAMHS service users who were receiving treatment or had a diagnosed mental disorder, had an IQ ⩾ 70 and were within 1 year of reaching the SB. MT was a multi-component intervention that included CAMHS training, systematic identification of YP approaching SB, a structured assessment (Transition Readiness and Appropriateness Measure) and sharing of information between CAMHS and adult mental health services. The primary outcome was HoNOSCA (Health of the Nation Outcome Scale for Children and Adolescents) score 15-months post-entry to the trial.
The mean difference in HoNOSCA scores between the MT and UC arms at 15 months was −1.11 points (95% confidence interval −2.07 to −0.14, p = 0.03). The cost of delivering the intervention was relatively modest (€17–€65 per service user).
MT led to improved mental health of YP after the SB but the magnitude of the effect was small. The intervention can be implemented at low cost and form part of planned and purposeful transitional care.
This study aims to evaluate the expectation of and need for psychological counselling among primary care attender in a practice where the majority of patients are of Asian origin.
All consecutive adult patients attending 10 surgeries per week (assess 20 patients per surgery) asked to participate in the study. Patients were asked to complete 2 questionnaires:
1. Demographic data
In one month period 127 patients completed two questionnaires.
About 60% of Asian patient preferred to talk to either general practitioner or friend or relative whereas half of the European patient preferred to talk to GP and only 2 would talk to a friend or relative. 15% of Asian preferred to see male professional, but 60% of European preferred the same. Similar number reported that if they were suffering from anxiety or depression they would prefer taking tablets from their general practitioner. 25% of Asian preferred to see a counsellor or therapist of their own background whereas 40% of European patient preferred the same.
There is very little information, if any, on ethnic minority views about the type of services they would like to receive. This study has demonstrated that there is unmet needs with regards to gender and preference for professional from similar ethnic background. There is a need to merge patient need and preference in an efficacious manner also for the services to change and develop in a planned and efficacious consumer lead rather than provider lead.
B-vitamin insufficiency is associated with depression but it is uncertain if treatment with these is effective in prevention or treatment.
Objectives and Aims
1. To determine if daily supplementation with B-vitamins enhances response to antidepressants.
2. Systematic review and meta-analysis of randomised, placebo-controlled trials of B-vitamins for depressive symptoms in adults.
1. The B-VITAGE trial is a 52 week randomised, double-blind, placebo-controlled trial of citalopram together with vitamin B12, B6 and folic acid in older adult participants with major depression.
2. Systematic review of 13 eligible trials of B-vitamin supplementation for the reduction, remission and prevention of clinically significant depressive symptoms.
Remission was achieved by 78.1% and 79.4% of participants treated with placebo (n=76) and vitamins (n=77) by week 12 (p=0.328), and by 75.8% and 85.5% at week 52 (effect of intervention over 52 weeks: odds ratio, OR=2.49; 95% confidence interval, 95%CI=1.12,5.51). The risk of subsequent relapse among those who had achieved remission of symptoms at week 12 was lower in the vitamin group (OR=0.33, 95%CI=0.12,0.94).
Short-term use of vitamins did not improve depressive symptoms in adults with major depression treated with antidepressants (standardised mean difference=-0.12, 95% CI=-0.45,0.22), but more prolonged consumption decreased the risk of relapse (OR=0.33, 95%CI=0.12,0.94) and the onset of clinically significant symptoms in people at risk (risk ratio=0.65, 95%CI=0.43,0.98).
Short-term use of B-vitamins does not appear to benefit depressive symptoms although longer use may enhance and sustain antidepressant response and decrease the risk of relapse or onset of clinically significant depression.
Anaemia affects approximately 69 % of Indian children aged 6–12 months, with Fe deficiency (ID) being a common cause. The effectiveness of micronutrient-fortified infant cereal in improving Fe status and neurodevelopment was evaluated in non-anaemic and mildly anaemic Indian infants. An intervention group (IC) enrolled at age 6 months consumed 50 g/d of rice-based cereal providing 3·75 mg Fe/d as ferrous fumarate for 6 months (n 80) and was compared with a matched static cross-sectional control group (CG) without intervention enrolled at age 12 months (n 80). Mean Hb was higher in IC (118·1 (sd 10·2) g/l) v. CG (109·5 (sd 16·4) g/l) at age 12 months (adjusted mean difference: 9·7 g/l; 95 % CI 5·1, 14·3; P < 0·001), while geometric mean serum ferritin tended to be higher (27·0 (–1 sd 13·4, +1 sd 54·4) v. 20·3 (–1 sd 7·5, +1 sd 55·0) ng/ml); P = 0·085) and soluble transferrin receptor was lower (1·70 (–1 sd 1·19, +1 sd 2·43) v. 2·07 (–1 sd 1·29, +1 sd 3·33) mg/l; P = 0·014). Anaemia (23 v. 45 %; P = 0·007) and ID (17 v. 40 %; P = 0·003) were lower in IC v. CG. Bayley Scales of Infant and Toddler Development Third Edition scores for language (P = 0·003), motor development (P = 0·018), social-emotional (P = 0·004) and adaptive behaviour (P < 0·001), but not cognitive development (P = 0·980), were higher in IC v. CG. No significant difference in anthropometric Z-scores was observed between the groups. Consuming a micronutrient-fortified infant cereal daily for 6 months during complementary feeding promoted better Fe status while reducing the risk for anaemia and ID and was associated with superior neurodevelopmental scores.
Treatment of Visceral Leishmaniasis (VL), a neglected tropical disease, is very challenging with few treatment options. Long duration of treatment and drug toxicity further limit the target of achieving VL elimination. Chemotherapy remains the treatment of choice. Single dose of liposomal amphotericin B (LAmB) and multidrug therapy (LAmB + miltefosine, LAmB + paromomycin (PM), or miltefosine + PM) are recommended treatment regimen for treatment of VL in Indian sub-continent. Combination therapy of pentavalent antimonials (Sbv) and PM in East Africa and LAmB in the Mediterranean region/South America remains the treatment of choice. Various drugs having anti-leishmania properties are in preclinical phase and need further development. An effective treatment and secondary prophylaxis of HIV-VL co-infection should be developed to decrease treatment failure and drug resistance.
Cosmopolites sordidus (Germar), commonly known as banana corm weevil, is an important economic pest in Asia that can cause severe yield loss depending upon the stage at which infestation occurs. In spite of its economic importance, little is known about the population structure of this pest in India. Random amplified polymorphic DNA (RAPD) and amplified fragment length polymorphism (AFLP) were used to characterize the population genetic structure of C. sordidus collected from five hot spot locations in India. Nineteen RAPD primers and five selective AFLP primer combinations generated 147 and 304 amplification products, respectively. UPGMA dendrograms generated with both marker systems failed to reveal populations clustered based on geographic distance, which was confirmed by the Mantel test, which did not show a strong correlation between genetic distance and geographic distance. Values of indices of genetic identity showed that the populations were closely related. Though the gene flow estimate (Nm) between the populations was 0.469, suggesting restricted gene flow, the populations are not genetically distinct. These observations suggest that the range expansion of this banana pest in India has taken place through transport of infested corms and plant material, resulting in genetically close populations that are geographically distinct. These results provide important information on the population structure of this pest in India, which will aid in designing suitable strategies for its control and management, especially with respect to insecticide resistance.
Demodex canis infestation in dogs remains one of the main challenges in veterinary dermatology. The exact pathogenesis of canine demodicosis is unknown but an aberration in immune status is considered very significant. No studies have underpinned the nexus between induction of demodicosis and neural immunosuppressive pathways so far. We have evaluated the involvement of cholinergic pathways in association with cytokines regulation as an insight into the immuno-pathogenesis of canine demodicosis in the present study. Remarkable elevations in circulatory immunosuppressive cytokine interleukin-10 and cholinesterase activity were observed in dogs with demodicosis. Simultaneously, remarkable reduction in circulatory pro-inflammatory cytokine tumour necrosis factor-alpha level was observed in dogs with demodicosis. Findings of the present study evidently suggest that Demodex mites might be affecting the cholinergic pathways to induce immunosuppression in their host and then proliferate incessantly in skin microenvironment to cause demodicosis.
In this paper we present closed-form expressions for the distribution of the virtual (actual) queueing time for the BMAP/R/1 and BMAP/D/1 queues, where `R' represents a class of distributions having rational Laplace‒Stieltjes transforms. The closed-form analysis is based on the roots of the underlying characteristic equation. Numerical aspects have been tested for a variety of arrival and service-time distributions and results are matched with those obtained using the matrix-analytic method (MAM). Further, a comparative study of computation time of the proposed method with the MAM has been carried out. Finally, we also present closed-form expressions for the distribution of the virtual (actual) system time. The proposed method is analytically quite simple and easy to implement.
We highlight the recent experimental results on laser-driven radiative shock waves of astrophysical interests using kJ PALS laser facility. The generated shock is probed instantaneously by X-ray laser (λ = 21.2 nm) showing an unambiguous shock structure that includes both the post-shock and the precursor.
High temperature stress at critical growth stages is a major risk factor for wheat in many wheat growing areas globally. Developing weather indices relating to yield reductions in wheat is an urgent requirement for weather-index-based crop insurance. The objectives of the present study were to: (i) identify critical phenological stage(s) for heat stress, (ii) quantify the impact of heat stress at critical growth stage(s) and (iii) work out thresholds of temperature for obtaining above average, average and below average yield of wheat. For achieving these objectives, 11 years’ experimental data for three cultivars (HD-2285, K-8804 and K-9107) under three sowing dates at the Kanpur Centre located in the Indo-Gangetic Plains of Uttar Pradesh, India were used. Among the eight phenological stages, the milk stage (growth stage 73) was identified as most sensitive for high maximum and minimum temperatures to adversely affect yield. The rate of yield reduction with unit increase in maximum and minimum temperatures (°C) was found to be highest in K-8804 and lowest in HD-2285. The optimum ranges of maximum temperature during anthesis, milk, dough and maturity stages are 19·7–21·9, 24·2–26·5, 26·1–28·8 and 29·5–30·8 °C, respectively and those for minimum temperature are 4·3–6·2, 8·3–9·7, 11·5–12·4 and 13·0–15·1 °C, respectively. The thresholds of temperature during critical stages and quantification of heat stress on yield will be of use in devising weather-index-based crop insurance products in wheat and also for breeding temperature-stress-resistant genotypes. This method of devising weather indices in the present study can be used in other crops and regions of the world as an adaptation strategy for climate change.
To quantify the effect of thermal stress and photothermal quotient (PTQ) on yield components, eleven years experimental data of three cultivars (HD-2285, K-8804 and K-9107) under three sowing dates at Kanpur centre were analysed. Number of grains per ear (NG), grain weight per ear (GW) and 1000-grain weight (TG) were identified as prime yield contributing components in HD-2285, K-8804 and K-9107, respectively. GW was highly sensitive to maximum temperature (MXT) while NG was sensitive to minimum temperature (MNT) during jointing (JNT) to anthesis (ATS) as well as the total growing season in all the cultivars. In both HD-2285 and K-8804, optimum MXT and MNT during JNT to ATS are 22.7–24.6 and 7.0–7.9 °C, respectively for obtaining maximum NG. Optimum MXT for GW ranged from 15.8–17.3 °C during tillering (TLR) to JNT stage in K-8804 and K-9107 while it was 20.4 °C during JNT to ATS stage in HD-2285. MXT, MNT and PTQ of 23.6 °C, 9.2 °C and 25 MJ/m2/day/ °C, respectively during JNT to ATS in K-9107 were found optimum for higher TG.
Morningglories are summer annual or perennial dicots, and are troublesome weeds in sugarcane cultivated in northern India. If not controlled, they may compete with sugarcane, interfere in the harvest operation, and reduce yields. Managing morningglories in sugarcane continues to be a serious challenge for sugarcane growers. Field experiments were conducted during the 3-yr period from 2007 to 2009 to evaluate herbicides applied PRE and POST for control of morningglories in sugarcane. The herbicides applied PRE included diuron, metribuzin, and atrazine at 1.6, 1.4, and 1.0 kg ai ha−1, respectively, applied alone or followed by 2,4-D amine salt (0.58 or 1.16 kg ae ha−1) or 2,4-D sodium salt (0.8 or 1.6 kg ae ha−1) applied POST. Herbicides applied PRE controlled morningglories ≤ 87% at 15 d after treatment (DAT); however, control reduced to ≤ 56% at 90 DAT. Control improved when herbicides applied PRE were followed by POST application of 2,4-D amine or sodium salt. For example, diuron applied PRE followed by 2,4-D amine salt applied POST at any rate provided 100% control of morningglories at 15 and 30 DAT. At 90 d after POST application, control ranged from 68 to 82% with the PRE followed by POST herbicides, compared to 0% control when metribuzin or atrazine were applied PRE alone. The density and biomass of morningglories was also reduced to zero in treatments that included 2,4-D amine salt. The number of millable canes, cane height, and single cane weight was superior in PRE followed by POST herbicide treatments compared to herbicides applied PRE alone. Maximum cane yield was recorded for the treatments that included 2,4-D amine or sodium salt compared to only PRE treatments, and it was usually comparable with the nontreated weed-free control. It is concluded that a combination of PRE and POST herbicides were effective for control of morningglories; however, more research is required to evaluate other herbicides and their tank mix partners for control of morningglories in sugarcane.
The aim of this study was to evaluate the CD4+/CD8+ ratio in peripheral blood of dogs with localized and generalized demodicosis. Sixteen dogs were examined, 8 with localized and 8 with generalized demodicosis, while 8 healthy dogs were used as controls. Peripheral blood was obtained and CD4+ and CD8+ T cells were determined by flow cytometry. Significantly higher numbers of CD8+ T cells and lower numbers of CD4+ T cells were found in dogs with generalized demodicosis compared to dogs with localized demodicosis and healthy controls. Significantly higher numbers of CD8+ T cells and lower numbers of CD4+ T cells were also found in dogs with localized demodicosis compared to healthy controls. The CD4+/CD8+ ratio was also found to be significantly lower in dogs with generalized demodicosis in comparison with dogs with localized demodicosis and healthy controls. It is concluded that significant alteration in the CD4+/CD8+ ratio may be implicated in the pathogenesis of generalized canine demodicosis.
We study the complexity of supergranular cells using the intensity patterns obtained at the Kodaikanal solar observatory during the solar maximum. Our data consists of visually identified supergranular cells, from which a fractal dimension D is obtained according to the relation P ∝ AD/2 where A is the area and P is the perimeter of the cells. We find a difference in the fractal dimension between the active and the quiet region cells which is conjectured to be due to the magnetic activity level.
In this work, TOPO(tri-octyl phosphine oxide)/TOP(tri-octyl phosphine)-capped cadmium selenide (CdSe) quantum dots (QD's) of varied sizes (5–9 nm) prepared at different input Cd:Se precursor ratio's (1:1–2:1) using chemical route were dispersed in conducting polymer matrices viz poly[2-methoxy,5-(2-ethyl-hexyloxy)-1,4-phenylene vinylene] (MEH-PPV) and poly(3-hexylthiophene) (P3HT) respectively. The properties of polymer:CdSe nanocomposites are evaluated by means of photoluminescence (PL), UV-VIS absorption, Raman, Fourier transform infrared (FTIR), transmission electron microscopy (TEM) and atomic force microscopy (AFM) techniques respectively. The emission and structural properties of polymer-CdSe nanocomposites are found to be dependent on their morphology. The better quality of smallest sized CdSe QD's (size ~5 nm) in conjunction with regioregular P3HT polymer, leads to higher photostability of P3HT:CdSe QD's nanocomposites as compared to that for corresponding MEH-PPV:CdSe nanocomposites, thus making it as an attractive candidate for hybrid solar cells application.
A house to house survey was done from October 1972 to March 1974, covering 52952 individuals of urban population at Lucknow and 50156 individuals of rural population of Unnao district, to find out the incidence of polio-like paralysis in our population. Among 12874 urban children up to 8 years old 8·2/1000 had polio-like paralysis while 4·6/1000 children of the rural population of 13554 children were affected. The incidence was significantly higher in the urban population. In the preschool age group almost 1 out of every 100 children was affected. A higher number of children were affected during 1968–9 and 1971–2, though it did not reach epidemic proportion. The findings show that paralytic polio is a serious problem in our country where poliomyelitis is endemic: this is contrary to the views generally held so far.
In the present study rubella HI antibodies were determined in cases of congenital malformation and bad obstetric history to determine the role of rubella in such cases in India, as it has been reported to be rare in Japan in contrast to Western countries. The incidence of antibodies was statistically significant in cases of congenital eye, c.n.s., visceral and miscellaneous malformations and cases of spontaneous abortion and still-birth compared with controls of matching age groups. This is further supported by the demonstration of IgM antibodies in seven cases of congenital malformations and ten cases of spontaneous abortion. Our findings show that congenital rubella is not rare in India.
High dose hydrogen implantation-induced blistering phenomena in GaN and AlN have been investigated for potential thin film layer transfer applications. GaN and AlN were implanted with 100 keV H2+ ions with various ion doses in the range of 5´1016 to 2.5´1017 cm−2. After implantation the samples were annealed at higher temperatures up to 800°C in order to observe the formation of surface blisters. In the case of GaN only those samples that were implanted with a dose of 1.3´1017 cm−2 or higher showed surface blistering after post-implantation annealing. For AlN the samples those were implanted with a dose of 1.0´1017 or 1.5´1017 cm−2 displayed surface blistering after post-implantation annealing. Cross-sectional transmission electron microscopy was utilized to observe the microscopic defects that eventually cause surface blistering. Large area microcracks, as revealed in the XTEM images, were clearly observed in the case of both GaN and AlN after post-implantation annealing. A comparison of the hydrogen implantation-induced blistering in GaN and AlN has also been presented.