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Low and middle-income countries (LMICs) hold the majority of disease burden attributed to major depressive disorder (MDD). Despite this, there remains a substantial gap for access to evidence-based treatments for MDD in LMICs like Pakistan. Measurement-based care (MBC) incorporates systematic administration of validated outcome measures to guide treatment decision making and is considered a low-cost approach to optimise better clinical outcomes for individuals with MDD but there is a paucity of evidence on the efficacy of MBC in LMICs.
Objectives
This protocol highlights a randomized trial which will include Pakistani outpatients with moderate to severe major depression.
Methods
Participants will be randomised to either MBC (guided by schedule), or standard treatment (guided by clinicians’ judgement), and will be prescribed with paroxetine (10–60mg/day) or mirtazapine (7.5–45mg/day) for 24 weeks. Outcomes will be evaluated by raters blind to study protocol and treatment.
Results
National Bioethics Committee (NBC) of Pakistan has given full ethics approval. The trial is being conducted and reported as per recommendation of the CONSORT statement for RCTs.
Conclusions
With increasing evidence from high-income settings supporting the effectiveness of MBC for MDD, it is now necessary to explore its feasibility, utility. and efficacy in low-resource settings. The results of the proposed trial could inform the development of a low-cost and scalable approach to efficiently optimise outcomes for individuals with MDD in Pakistan.
There is strong association between depression and mortality rates among patients with CHF. Despite the massive burden of cardiac disease as well as that of depression in Pakistan, there is limited data regarding the prevalence of depression in patients suffering from CHF. The aim of this study was to assess prevalence of depression in patients with CHF and to compare the health related quality of life of depressed and non-depressed patients with CHF.
Methods
A total of 1009 patients diagnosed with CHF were recruited from different public hospitals in Karachi, Pakistan. Depression was assessed at baseline using the Beck Depression Inventory (BDI) and health related quality of life was assessed using Euro Qol (EQ-5D).
Results
Of the 1009 participants recruited to the study, 66.4% (n = 670) met the threshold for depression using the BDI measure. Of the depressed patients, 66.7% (n = 447) were male. Preliminary results indicate that participants who were depressed at baseline had poorer health related quality of life on EQ-5D measures as compared to those who were non-depressed (mean EQ-5D descriptive score 10.45 in depressed patients vs 7.37 in non-depressed patients and mean EQ-5D visual scale score 35.09 in depressed patients vs 52.19 in non-depressed patients).
Conclusion
Considering the high prevalence of depression and its serious negative impact on quality of life of patients suffering from chronic physical illness, it is important to design and test culturally adapted psychosocial interventions to reduce depression and improve quality of life for these patients.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Across the history of radiotherapy, with gradual technological progress and various methods of irradiation, the purpose has always been to deliver homogeneously 100% of the prescribed dose to 100% of the target volume containing the identifiable tumour and/or tumour cells potentially present while limiting the dose to adjacent normal tissues.
Material and methods
The formula for triple point conformity scale is: CS3=(V95+V100+V105)/3VT. (a) Lower limit determination: CS3=(VT+0·93 VT+0·0)/3VT=0·643; (b) Upper limit determination: in order to find out an empirical relation in between V105 and VT, we studied over 593 cancer patients of various sites by taking planning target volume as target, and an empirical relation is derived out as: V105/VT=0·0007. Hence, CS3=(VT+VT+0·0007 VT)/3VT=0·6667~0·667.
Result
Upper and lower limits of CS3 have been calculated at 0·643 and 0·667, respectively. Maximum value of CS3 index is recorded 0·656 while minimum value is 0·478.
Discussion
The CS3 scale constitutes an attractive tool because it could facilitate decisions during analysis of various treatment plans proposed for conformal radiotherapy. Its major advantages are its simplicity and integration of multiple parameters.
Conclusion
The triple point conformity scale (CS3) provides better qualitative information about radiotherapy plans as compared to other conformity indices. This study advises the users to use the CS3 scale to evaluate a conformal radiotherapy plan which encompasses a wide range of relevant clinical volumes, and is able to extract qualitative dosimetric information.
Zygogramma bicolorata Pallister is a potential biocontrol agent of Parthenium hysterophorus L. (Asteraceae). This study was carried out to understand the effect of abiotic (temperature and moisture) and biotic factors (age and reproductive status) on the induction and termination of diapause in Z. bicolorata. We also evaluated the effect of diapause on longevity and fecundity of Z. bicolorata. In Z. bicolorata the induction of diapause occurred between the months of July and December. No diapause was observed in May and June, which coincided with the commencement of the monsoon rains. The percentage of diapause induction in Z. bicolorata was found to increase from one generation to another as well as with the age of adults. Diapause significantly increased the fecundity of females as compared to the fecundity in pre-diapause conditions. Soil moisture (80% RH) played an important role in providing the conditions for initiation and termination of diapause. Similarly, 18.4 and 12.5% of diapause adults resumed their activity in 6 and 5 days when exposed to temperatures of 40° and 45° C for 2 h every day, respectively. Exposure of adults to low temperatures, i.e. 5° and 10° C induced 94.3 and 92.5% diapause, respectively, with no adult mortality. Thus, our findings reveal suitable conditions for preventing and inducing diapause in Z. bicolorata, which is of great importance in the suppression of P. hysterophorus. We discuss the implications of these findings in the control of P. hysterophorus.
To examine the associations between serum 25-hydroxyvitamin D (25(OH)D), dietary Ca intake and presence of the metabolic syndrome (MetS).
Design
A stratified cluster sample of a population aged 18–75 years from the Victorian Health Monitor survey.
Setting
Non-institutionalized adults living in private dwellings in Victoria, Australia.
Subjects
Adults (n 3404) with complete data and without type 1 or type 2 diabetes.
Results
Adjusted for sociodemographic factors, physical characteristics and dietary covariates including Ca intake, every 10 nmol/l increase in serum 25(OH)D was significantly associated with decreased odds of MetS (adjusted odds ratio (AOR)=0·85, 95 % CI 0·80, 0·89; P<0·001). Relative to the low 25(OH)D tertile (median 33 nmol/l), there was a progressive decrease in odds of MetS that reached significance with the high 25(OH)D tertile (median 77 nmol/l; AOR=0·35, 95 % CI 0·26, 0·48; P<0·001). Every 500 mg/d increase in Ca intake adjusted for 25(OH)D did not reduce odds of MetS (AOR=0·81, 95 % CI 0·66, 1·06; P=0·141) but approached significance if unadjusted for 25(OH)D in the final model (AOR=0·81, 95 % CI 0·64, 1·02; P=0·073). No significant effect was obtained for tertiles of Ca intake. However, Ca and vitamin D tertile combinations suggested a beneficial effect of high Ca (median 1233 mg/d) only at low and medium 25(OH)D. The high 25(OH)D tertile was associated with significantly decreased odds of MetS regardless of Ca intake.
Conclusions
A high vitamin D status significantly reduced the odds of MetS. A high Ca intake may have a similar favourable outcome but only at lower circulating concentrations of 25(OH)D.
This study aimed to compare the interpretations of temporal bone computed tomography scans by an otologist and a radiologist with a special interest in temporal bone imaging. It also aimed to determine the usefulness of this imaging modality.
Methods:
A head and neck radiologist and an otologist separately reported pre-operative computed tomography images using a structured proforma. The reports were then compared with operative findings to determine their accuracy and differences in interpretations.
Results:
Forty-eight patients who underwent pre-operative computed tomography scans in a 30-month period were identified. Six patients were excluded because complete operative findings had not been recorded. Positive and negative predictive values and accuracy of the anatomical and pathological findings were calculated for 42 patients by both reporters. The accuracy was found to be less than 80 per cent, except for identification of the tegmen and lateral semicircular canal erosion. Overall, there was no significant difference in interpretations of computed tomography scans between reporters. There was a slight difference in interpretation for tympanic membrane retraction, facial canal erosion and lateral semicircular canal fistula and/or erosion.
Conclusion:
Pre-operative computed tomography scanning of the temporal bone is useful for predicting anatomy for surgical planning in patients with chronic otitis media, but its reliability remains questionable.
Demonstrating the equivalence of constructs is a key requirement for cross-cultural empirical research. The major purpose of this paper is to demonstrate how to assess measurement and functional equivalence or invariance using the 9-item, 3-factor Love of Money Scale (LOMS, a second-order factor model) and the 4-item, 1-factor Pay Level Satisfaction Scale (PLSS, a first-order factor model) across 29 samples in six continents (N = 5973). In step 1, we tested the configural, metric and scalar invariance of the LOMS and 17 samples achieved measurement invariance. In step 2, we applied the same procedures to the PLSS and nine samples achieved measurement invariance. Five samples (Brazil, China, South Africa, Spain and the USA) passed the measurement invariance criteria for both measures. In step 3, we found that for these two measures, common method variance was non-significant. In step 4, we tested the functional equivalence between the Love of Money Scale and Pay Level Satisfaction Scale. We achieved functional equivalence for these two scales in all five samples. The results of this study suggest the critical importance of evaluating and establishing measurement equivalence in cross-cultural studies. Suggestions for remedying measurement non-equivalence are offered.
Crimean-Congo haemorrhagic fever (CCHF) is endemic in the southeast of Iran. This study aimed to predict the incidence of CCHF and its related factors and explore the possibility of developing an empirical forecast system using time-series analysis of 13 years’ data. Data from 2000 to 2012 were obtained from the Health Centre of Zahedan University of Medical Sciences, Climate Organization and the Veterinary Organization in the southeast of Iran. Seasonal autoregressive integrated moving average (SARIMA) and Markov switching models (MSM) were performed to examine the potential related factors of CCHF outbreaks. These models showed that the mean temperature (°C), accumulated rainfall (mm), maximum relative humidity (%) and legal livestock importation from Pakistan (LIP) were significantly correlated with monthly incidence of CCHF in different lags (P < 0·05). The modelling fitness was checked with data from 2013. Model assessments indicated that the MSM had better predictive ability than the SARIMA model [MSM: root mean square error (RMSE) 0·625, Akaike's Information Criterion (AIC) 266·33; SARIMA: RMSE 0·725, AIC 278·8]. This study shows the potential of climate indicators and LIP as predictive factors in modelling the occurrence of CCHF. Our results suggest that MSM provides more information on outbreak detection and can be a better predictive model compared to a SARIMA model for evaluation of the relationship between explanatory variables and the incidence of CCHF.
The use of six cowpea varieties highly resistant to Aphis craccivora Koch in grafts (as resistant scion and rootstock) with the susceptible variety Prima indicated the presence of a graft-transmissible chemical involved in the resistance. Wrapping the resistant part in light-proof foil indicated that photosynthesis is involved in the production of the chemical. In a third test, intergrafting is involved in the production of the chemical. In a third test, intergrafting the resistant part with and without leaves confirmed the importance of photosynthesis in the transfer of resistance. Finally, covering the resistance intergrafts with foil showed that the accumulation of the chemical in the stem before the foil was applied was the major source of the graft-transmissible resistance.
Ten patients, predicted to pose a difficult intubation of the trachea, underwent inhalational induction of anaesthesia using sevoflurane. In all 10 cases the airway was secured successfully and the patient proceeded to have the planned operation. In six of the cases the anaesthetist experienced a problem during the induction but in no case did this present any real difficulties or lead to a critical incident. We feel that sevoflurane has a place for inhalational induction in this challenging group of patients.
As part of an extensive and systematic programme to find genetic sources of resistance to Aphis craccivora, a major pest of cowpea, Vigna unguiculata, a total of 181 accessions from the germpiasm collection at the International Institute of Tropical Agriculture were screened in glasshouse tests using a simple visual damage scale. Twenty-four accessions showed considerably reduced damage. To confirm these results on IS selected accessions, aphid population growth over 10 days was recorded. Zero aphids were found on three accessions (310,408-P2 and 801); another six accessions had populations of less than 30, compared with 200–400 on susceptible varieties. The other accessions showed only partial antibiosis and/or tolerance.
The need to accurately predict the response of structures under impact loadings has led to an interest in the mechanical properties of component materials at high rates of loading. The mechanism of cracking and its propagation play an important role in evaluation of the response of fiber reinforced concrete structures subjected to impulsive loading. In the present study, single–edge notched beams were tested under high velocity impact loads. A computer assisted instrumented Charpy test system was employed in performing the impact tests. Development and testing of a new fiber optic sensor, for the determination of internal Crack Opening Displacements (COD) in fiber reinforced concrete is described.
One of the paradoxes of the history of Islam in the twentieth century is that many of the first Muslim socialists were men who at earlier stages in their lives had been devout Muslims, often passionately involved in the fate of Islam throughout the world. In Russia, socialists emerged from various silsila of the Naqshbandi sufi order, most notably the Vaisites of Kazan who fought alongside workers and soldiers in 1917 and 1918. In Indonesia, many sufi shaikhs became Communist party activitsts in the midst of the Sarekat Islam's great pan-Islamic protest of the early 1920S.In India, Muslim socialists came from those who, concerned to defend Islam wherever it was threatened and in particular the institution of the Khilafat, had come to oppose their British masters. These champions of Islam sought help against the British from Muslims outside India; they supported Britain's enemies. A few actually left India in order to join other Muslims in their fight against the British. Their experiences in Afghanistan and Central Asia brought disillusionment. They discovered that others did not share their faith in the brotherhood of Islam; they began to consider other ideologies. Some were convinced by the Bolsheviks, who supported Muslim peoples and opposed the imperialism of the West, that socialism might offer the key to success in their struggle against the British. In the process they discovered similarities between Islamic and Bolshevik ideology, which eased their transition to socialism.
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