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Natural remission from common mental disorders (CMDs), in the absence of intervention, varies greatly. The situation in India is unknown.
Aims
This study examined individual, village and primary health centre (PHC)-level determinants for remission across two rural communities in north and south India and reports natural remission rates.
Method
Using pre-intervention trial data from 44 PHCs in Andhra Pradesh and Haryana, adults ≥18 years were screened for CMDs. Screen-positive people (Patient Health Questionnaire-9 Item (PHQ9) or Generalised Anxiety Disorder-7 Item (GAD7) score ≥10, or a score ≥2 on the self-harm PHQ9 question) were re-screened after 5–7 months (mean). Remission was defined <5 scores on both PHQ9 and GAD7 and <2 score on self-harm. Multilevel Poisson regression models with random effects at individual, village and PHC levels were developed for each state to identify factors associated with remission. Time to re-screening was included as offset in regression models.
Results
Of 100 013 people in Andhra Pradesh and 69 807 people in Haryana, 2.4% and 7.1%, respectively, were screen positive. At re-screening, remission rate in Andhra Pradesh was 82.3% (95% CI 77.5–87.4%) and 59.4% (95% CI 55.7–63.3%) in Haryana. Being female, increasing age and higher baseline depression and anxiety scores were associated with lower remission rates. None of the considered village- and PHC-level factors were found to be associated with remission rate, after adjusting for individual-level factors.
Conclusion
Natural remission for CMDs vary greatly in two Indian states and are associated with complex, multilevel factors. Further research is recommended to better understand natural remission.
The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS) will be held in Washington DC, USA, from Saturday, 26 August, 2023 to Friday, 1 September, 2023, inclusive. The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery will be the largest and most comprehensive scientific meeting dedicated to paediatric and congenital cardiac care ever held. At the time of the writing of this manuscript, The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery has 5,037 registered attendees (and rising) from 117 countries, a truly diverse and international faculty of over 925 individuals from 89 countries, over 2,000 individual abstracts and poster presenters from 101 countries, and a Best Abstract Competition featuring 153 oral abstracts from 34 countries. For information about the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery, please visit the following website: [www.WCPCCS2023.org]. The purpose of this manuscript is to review the activities related to global health and advocacy that will occur at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery.
Acknowledging the need for urgent change, we wanted to take the opportunity to bring a common voice to the global community and issue the Washington DC WCPCCS Call to Action on Addressing the Global Burden of Pediatric and Congenital Heart Diseases. A copy of this Washington DC WCPCCS Call to Action is provided in the Appendix of this manuscript. This Washington DC WCPCCS Call to Action is an initiative aimed at increasing awareness of the global burden, promoting the development of sustainable care systems, and improving access to high quality and equitable healthcare for children with heart disease as well as adults with congenital heart disease worldwide.
Schizophrenia is a chronic psychiatric illness with symptoms in positive, negative and cognitive domain.The interplay of dietary folic acid intake with common genetic variants that influence folate metabolism, has potential implications for Schizophrenia pathogenesis and treatment.Therefore, it’s deficiency has been identified as a risk factor for Schizophrenia through epidemiologic, biochemical and gene association studies.
Objectives
1-To assess the efficacy of folic acid supplementation on severity of symptoms and overall functional status of patients
2-To assess the correlation of serum folate levels with symptom severity and overall functional status of patients
Methods
A randomized control trial study was carried out in the inpatient department of a psychiatric tertiary care centre on 40 participants (29 males and 11 females)who were between the ages of 18 – 55 years,met diagnostic criteria for Schizophrenia (ICD 10) and had at least 2 years of illness duration while those with a co-morbid psychiatric illness, medical illness and substance abuse were excluded. The participants were then randomly allocated into two groups (experimental Group A which received 5mg folic/day along with anti psychotic drugs and control Group B which received only anti psychotic drugs) and followed up for 3 months. Blood sample for measuring serum folate level was obtained from the experimental group at the beginning and at the end of the study period. Scales applied were Positive and Negative Syndrome Scale(PANSS) for symptom severity and Global Assessment of Functioning scale(GAF) for overall functional status.
Results
A significant difference (p value< 0.05) was observed in PANSS scores at the end of the study between experimental group and control group( table 1) and also in GAF scores between both the groups after 3 months(table 2). At the end of the study period,a strong negative correlation(r= -0.9) was found between serum folate level and total PANSS score in the experimental group (figure 1) while the correlation between GAF score and serum folate level was strongly positive (r= 0.8) (figure 2).Table 1
PANSS (3 Month)
Group A(n=20)
Group B (n=20)
P value
Positive
16.8±2.80
22.9±3.37
0.036
Negative
14.3±3.32
15.1±2.61
0.18
General
17.95±2.52
21.85±3.18
0.0001
Total
45.95±3.41
58±3.49
0.00249
Table 2
GAF
Group A(n=20)
Group B (n=20)
P value
0 MONTH
23.25±3.43
22.7±2.90
0.3
3 MONTH
65.75±4.22
44.9±7.09
0.0256
Image:
Image 2:
Conclusions
Our study is among the few to use a randomized controlled study design for assessing the effect of folic acid supplementation on severity of symptoms and global functioning in Schizophrenia,strongly suggesting the use of folic acid as an adjuvant treatment for Schizophrenia.
Pulmonary arterial compliance, the dynamic component of pulmonary vasculature, remains inadequately studied in patients with left to right shunts. We sought to study the pulmonary arterial compliance in patients with left to right shunt lesions and its utility in clinical decision-making.
Materials and methods:
In this single-centre retrospective study, we reviewed cardiac catheterisation data of consecutive patients of left to right shunt lesions catheterised over one year. In addition to the various other parameters, pulmonary arterial compliance was calculated, as indexed pulmonary flow (Qpi) / (Heart rate × pulse pressure in the pulmonary artery). RC time was also calculated, as the product of pulmonary arterial compliance and pulmonary vascular resistance index. Patients were divided into “operable,” “borderline,” and “inoperable” based on the decision of the treating team, and the pulmonary arterial compliance values were evaluated in these groups to study if it can be utilised to refine the operability decision.
Results:
298 patients (Median age 16 years, 56% <18 years) with various acyanotic shunt lesions were included. Overall, the pulmonary arterial compliance varied with Qpi, pulmonary artery mean pressure, and pulmonary vascular resistance index, but did not vary with age, type of lesion, or transpulmonary gradients. The median pulmonary arterial compliance in patients with normal pulmonary artery pressure (Mean pulmonary artery pressure less than 20 mmHg) was 4.1 ml/mmHg/m2 (IQR 3.2). The median pulmonary arterial compliance for operable patients was 2.67 ml/mmHg/m2 (IQR 2.2). Median pulmonary arterial compliance was significantly lower in both inoperable (0.52 ml/mmHg/m2, IQR 0.34) and borderline (0.80 ml/mmHg/m2, IQR 0.36) groups when compared to operable patients (p < 0.001). A pulmonary arterial compliance value lower than 1.18 ml/mmHg/m2 identified inoperable patients with high sensitivity and specificity (95%, AUC 0.99). However, in borderline cases, assessment by this value did not agree with empirical clinical assessment.
The median RC time for the entire study population was 0.47 S (IQR 0.30). RC time in operable patients was significantly lower than that in the inoperable patients (Median 0.40 IQR 0.23 in operable, 0.73 0.25 in inoperable patients (p < 0.001).
Conclusions:
Addition of pulmonary arterial compliance to the routine haemodynamic assessment of patients with shunt lesions may improve our understanding of the pulmonary circulation and may have clinical utility.
In this article, a meander line-shaped pentaband (2.18–2.24, 2.38–2.46, 2.65–2.70, 3.10–3.32, 3.38–3.46 GHz) four-element multiple-input–multiple-output antenna is presented. The proposed antenna is also circularly polarized in two bands (at 2.2 and 2.4 GHz) with dual-polarization like right-handed at port 1 or 3 and left-handed at port 2 or 4, which is widely used for mobile satellite services (MSS) and Internet of Things applications. This antenna is designed and fabricated with compact size 50 × 70 × 1.6 mm3 on the FR-4 substrate with good diversity performance in pentaband. Simulated results of antenna-like return loss, isolation, and parameters-related diversity have also been tested experimentally in a controlled environment, which is within the permissible limit. The designed antenna will be appropriate for MSS, industrial scientific and medical (ISM), broadband radio services and educational broadband services, WiMAX radio location services, and amateur radio services. Meanwhile, specific absorption rate of the designed antenna has been examined in an empirical environment for the Fresnel radiating near-field applications.
In this paper, a ultra-wideband (UWB) bandpass filter with stopband characteristics is presented using a multi-mode resonator (MMR) technique. An MMR is formed by loading three dumbbell-shaped (Mickey and circular) shunt stubs placed in the center and two symmetrical locations from ports, respectively. Three circular and arrowhead defected ground structures on the ground plane are introduced to achieve UWB bandwidth with a better roll-off rate. The proposed filter exhibits stopband characteristics from 10.8 to 20 GHz with a 0.4 dB return loss. The group delay and roll-off rate of the designed filter are <0.30 ns in the passband and 16 dB/GHz at lower and higher cut-off frequencies, respectively. The dimension of the filter is 0.74λg × 0.67λg mm2 and was fabricated on a cost-effective substrate. All simulated results are verified through the experimental results.
We sought to examine the influence of clinically severe lower respiratory tract infection on pulmonary artery pressure in children having CHD with post-tricuspid left-to-right shunt, as it may have physiological and clinical implications. In a prospective single-centre observational study, 45 children with post-tricuspid left-to-right shunt and clinically severe lower respiratory tract infection were evaluated during the illness and 2 weeks after its resolution. Pulmonary artery systolic pressure was estimated non-invasively using shunt gradient by echocardiography and systolic blood pressure measured non-invasively.
Median pulmonary artery systolic pressure during lower respiratory tract infection was only mildly (although statistically significantly) elevated during lower respiratory tract infection [60 (42–74) versus 53 (40–73) mmHg, (p < 0.0001)]. However, clinically significant change in pulmonary artery systolic pressure defined as the increase of >10 mmHg was present in only 9 (20%) patients. In the absence of hypoxia or acidosis, only a small minority (9%, n = 4) showed significant pulmonary artery systolic pressure rise >10 mmHg. In the absence of hypoxia or acidosis, severe lower respiratory tract infection in patients with acyanotic CHD results in only mild elevation of pulmonary artery systolic pressure in most of the patients.
Aerosol generation during temporal bone surgery caries the risk of viral transmission. Steps to mitigate this problem are of particular importance during the coronavirus disease 2019 pandemic.
Objective
To quantify the effect of barrier draping on particulate material dispersion during temporal bone surgery.
Methods
The study involved a cadaveric model in a simulated operating theatre environment. Particle density and particle count for particles sized 1–10 μ were measured in a simulated operating theatre environment while drilling on a cadaveric temporal bone. The effect of barrier draping to decrease dispersion was recorded and analysed.
Results
Barrier draping decreased counts of particles smaller than 5 μ by a factor of 80 in the operating theatre environment. Both particle density and particle count showed a statistically significant reduction with barrier draping (p = 0.027).
Conclusion
Simple barrier drapes were effective in decreasing particle density and particle count in the operating theatre model and can prevent infection in operating theatre personnel.
We conducted an analysis of the key factors triggering cost-sharing mechanisms to understand the status of out-of-pocket (OOP) healthcare expense in the United States (US), Europe, and emerging markets and better appreciate the implications of OOP healthcare expense on patients’ health management.
Methods
A review of literature and databases including The Organisation for Economic Co-operation and Development (OECD) and World Bank was performed to understand different cost-sharing mechanisms, factors triggering OOP expenditure and the country-wise trends of OOP expenditure. Additionally, the impact of OOP expenditure on healthcare budget and on patients in terms of medication adherence, uptake of newer therapies and generic substitution was explored.
Results
The findings reveal that patients are concerned about rising healthcare OOP costs, and we observed an increase of 134 percent in the number of articles published on OOP from 2005 to 2017. The percentage of household spending that goes OOP as healthcare expense is higher in Brazil, Russia, India, and China (BRIC countries; ~11 percent) compared to France, Germany, Italy, United Kingdom, US, Japan, and Canada (G7 countries; ~2 percent). In addition, OOP expenditure increased with age (1.9 percent of take home income in 55-64 age group versus 1.2 percent in 18-25 age group) and is higher in the low-income population (2.8 percent of take home income versus 1 percent in high-income group). Whereas, increasing OOP expenditure reduces the overall healthcare expenditure due to generic substitution (28 percent reduction) and reduction in excessive consumption of supplementary medicines, it also reduces patient adherence (~20 percent decline in dispensed prescriptions) and may foster a reluctance to adopt newer therapies.
Conclusions
The population groups most impacted by increasing OOP expense are the older population, those in the low-income bracket and in poorer countries. While OOP expense may help in the effective and judicious utilization of healthcare system resources and medicines usage, its implementation requires a cautious and considered approach.
Dust vortices with a void at the centre are reported in this paper. The role of the spatial variation of the plasma potential in the rotation of dust particles is studied in a parallel plate glow discharge plasma. Probe measurements reveal the existence of a local potential minimum in the region of formation of the dust vortex. The minimum in the potential well attracts positively charged ions, while it repels the negatively charged dust particles. Dust rotation is caused by the interplay of the two oppositely directed ion drag and Coulomb forces. The balance between these two forces is found to play a major role in the radial confinement of the dust particles above the cathode surface. Evolution of the dust vortex is studied by increasing the discharge current from 15 to 20 mA. The local minimum of the potential profile is found to coincide with the location of the dust vortex for both values of discharge currents. Additionally, it is found that the size of the dust vortex as well as the void at the centre increases with the discharge current.
We have studied, the relationship between monthly variations of average counting rates of cosmic ray intensity (CRI) at Moscow super neutron monitoring station with mid cut-off rigidities (~2.42 GV), and the solar radio flux at 10.7cm (F10.7) and sunspot number (SSN) during the solar cycles 22 − 24. The F10.7cm (2800 MHz) and SSN is an excellent indicator of solar activity for the study period. We have investigated the patterns of long-term and mid-term periodicities of SSN and F10.7, using Fast Fourier Transform (FFT) technique. We have observed the time-lag between ascending phase of CRI with F10.7cm and SSN during solar cycles 22 − 24.
Measurements of local plasma parameters in dusty plasma are crucial for understanding the physics issues related to such systems. The Langmuir probe, a small electrode immersed in the plasma, provides such measurements. However, designing of a Langmuir probe system in a dusty plasma environment demands special consideration. First, the probe has to be miniaturized enough so that its perturbation on the ambient dust structure is minimal. At the same time, the probe dimensions must be such that a well-defined theory exists for interpretation of its characteristics. The associated instrumentation must also support the measurement of current collected by the probe with high signal to noise ratio. The most important consideration, of course, comes from the fact that the probes are prone to dust contamination, as the dust particles tend to stick to the probe surface and alter the current collecting area in unpredictable ways. This article describes the design and operation of a Langmuir probe system that resolves these challenging issues in dusty plasma. In doing so, first, different theories that are used to interpret the probe characteristics in collisionless as well as in collisional regimes are discussed, with special emphasis on application. The critical issues associated with the current–voltage characteristics of Langmuir probe obtained in different operating regimes are discussed. Then, an algorithm for processing these characteristics efficiently in presence of ion-neutral collisions in the probe sheath is presented.
In recent years a number of intergovernmental initiatives have been activated in order to enhance the capacity of countries to improve access to essential medicines, particularly for mental disorders. In May 2013 the 66th World Health Assembly adopted the World Health Organization (WHO) Comprehensive Mental Health Action Plan 2013–2020, which builds upon the work of WHO's Mental Health Gap Action Programme. Within this programme, evidence-based guidelines for mental disorders were developed, including recommendations on appropriate use of medicines. Subsequently, the 67th World Health Assembly adopted a resolution on access to essential medicines, which urged Member States to improve national policies for the selection of essential medicines and to promote their availability, affordability and appropriate use.
Methods.
Following the precedent set by these important initiatives, this article presents eleven actions for improving access and appropriate use of psychotropic medicines.
Results.
A 4 × 4 framework mapping actions as a function of the four components of access – selection, availability, affordability and appropriate use – and across four different health care levels, three of which belong to the supply side and one to the demand side, was developed. The actions are: developing a medicine selection process; promoting information and education activities for staff and end-users; developing a medicine regulation process; implementing a reliable supply system; implementing a reliable quality-control system; developing a community-based system of mental health care and promoting help-seeking behaviours; developing international agreements on medicine affordability; developing pricing policies and a sustainable financing system; developing or adopting evidence-based guidelines; monitoring the use of psychotropic medicines; promoting training initiatives for staff and end-users on critical appraisal of scientific evidence and appropriate use of psychotropic medicines.
Conclusions.
Activating these actions offers an unique opportunity to address the broader issue of increasing access to treatments and care for mental disorders, as current lack of attention to mental disorders is a central barrier across all domains of the 4 × 4 access framework.
The knowledge about the position of the detached shock and the aerodynamic forces acting upon a booster front during upper stage (sustainer) jet impingement on a separated booster is needed in connection with the problem of stage separation in the atmosphere for a multistage launch vehicle. The jet flow is squeezed in by the free-stream and characterised by a non-uniform transverse variation of flow properties. The flow field analysis of a trailing blunt body in such a non-uniform flow has been limited to experimental studies only. Most of the prior analytical treatments were restricted to the study of the effect of free-stream non-uniformities such as source flow and wake-like free-stream velocities on blunt bodies. A somewhat related problem of supersonic, underexpanded jet impingement upon an infinite flat plate in the absence of external stream has been studied by Belov et al and Gummer and Hunt.
The discovery of graphene based materials has led to significant advancement in several different areas. The large surface area, nanoporous structure and availability of delocalized electron network provide a unique opportunity for purification of solvents via adsorption, absorption or simple trapping. This makes graphene based materials as potential candidates for purification and desalination of water. Here we report synthesis of 3D porous network of oxidized graphene for purification of sea water. The membranes fabricated using these frameworks are hierarchically linked intrinsically defected oxidised graphene sheets by long micro-channels and capable of filtering small ions such as Na+ and Cl-. These are easy to fabricate, reusable and economically viable especially for point of use application. We finally show a fabricated device using membrane made from these 3D networks of oxidized graphene.
Various promising applications such as acoustic cloaking, sub-wavelength imaging, acoustic wave manipulation, transmission or reflection control etc. are feasible because of the ability of manipulating sounds and vibrations using artificially engineered “Acoustics meta-materials”. Recent works on space-coiling acoustic metamaterials show their extreme constitutive parameters like large refractive index, double negativity and zero mass density. Three dimensional structures have a wide application in sub-wavelength broadband acoustic wave suppression due to huge attenuation. Here we report the study of propagated and transmitted wave through 3D acoustic metamaterials structure using finite element method. Our simulations on 3D structure show a huge absorption/damping over few hundreds kilohertz frequency range.
In a quasineutral plasma, electrons undergo collective oscillations, known as plasma oscillations, when perturbed locally. The oscillations propagate due to finite temperature effects. However, the wave can lose the phase coherence between constituting oscillators in an inhomogeneous plasma (phase mixing) because of the dependence of plasma oscillation frequency on plasma density. The longitudinal electric field associated with the wave may be used to accelerate electrons to high energies by exciting large amplitude wave. However when the maximum amplitude of the wave is reached that plasma can sustain, the wave breaks. The phenomena of wave breaking and phase mixing have applications in plasma heating and particle acceleration. For detailed experimental investigation of these phenomena a new device, inverse mirror plasma experimental device (IMPED), has been designed and fabricated. The detailed considerations taken before designing the device, so that different aspects of these phenomena can be studied in a controlled manner, are described. Specifications of different components of the IMPED machine and their flexibility aspects in upgrading, if necessary, are discussed. Initial results meeting the prerequisite condition of the plasma for such study, such as a quiescent, collisionless and uniform plasma, are presented. The machine produces δnnoise/n ⩽ 1%, Luniform ~ 120 cm at argon filling pressure of ~10−4 mbar and axial magnetic field of B = 1090 G.
Guanylate kinase, a nucleoside monophosphate kinase of Brugia malayi which is involved in reversible transfer of phosphate groups from ATP to GMP, was cloned, expressed and characterized. The native molecular mass of BmGK was found to be 45 kDa as determined by size exclusion chromatography and glutaraldehyde cross-linking which revealed that the protein is homodimer in nature. This is a unique characteristic among known eukaryotic GKs. GMP and ATP served as the most effective phosphate acceptor and donor, respectively. Recombinant BmGK utilized both GMP and dGMP, as substrates showing Km values of 30 and 38 μm, respectively. Free Mg+2 (un-complexed to ATP) and GTP play a regulatory role in catalysis of BmGK. The enzyme showed higher catalytic efficiency as compared with human GK and showed ternary complex (BmGK-GMP-ATP) formation with sequential substrate binding. The secondary structure of BmGK consisted of 45% α-helices, 18% β-sheets as revealed by CD analysis. Homology modelling and docking with GMP revealed conserved substrate binding residues with slight differences. Differences in kinetic properties and oligomerization of BmGK compared with human GK can provide the way for design of parasite-specific inhibitors.
Glucose-6-phosphate dehydrogenase (G6PD), a regulatory enzyme of the pentose phosphate pathway from Brugia malayi, was cloned, expressed and biochemically characterized. The Km values for glucose-6-phosphate and nicotinamide adenine dinucleotide phosphate (NADP) were 0·25 and 0·014 mm respectively. The rBmG6PD exhibited an optimum pH of 8·5 and temperature, 40 °C. Adenosine 5′ [γ-thio] triphosphate (ATP-γ-S), adenosine 5′ [β,γ-imido] triphosphate (ATP-β,γ-NH), adenosine 5′ [β-thio] diphosphate (ADP-β-S), Na+, K+, Li+ and Cu++ ions were found to be strong inhibitors of rBmG6PD. The rBmG6PD, a tetramer with subunit molecular weight of 75 kDa contains 0·02 mol of SH group per mol of monomer. Blocking the SH group with SH-inhibitors, led to activation of rBmG6PD activity by N-ethylmaleimide. CD analysis indicated that rBmG6PD is composed of 37% α-helices and 26% β-sheets. The unfolding equilibrium of rBmG6PD with GdmCl/urea showed the triphasic unfolding pattern along with the highly stable intermediate obtained by GdmCl.
Pigeonpea is an important legume crop of the semi-arid tropics. In India, pigeonpea is mostly grown in areas prone to waterlogging, resulting in major production losses. It is imperative to identify genotypes that show tolerance at critical crop growth stages to prevent these losses. A selection of 272 diverse pigeonpea accessions was evaluated for seed submergence tolerance for different durations (0, 120, 144, 168 and 192 h) under in vitro conditions in the laboratory. All genotypes exhibited high (0·79–0·98) survival rates for up to 120 h of submergence. After 192 h of submergence, the hybrids as a group exhibited significantly higher survival rates (0·79) than the germplasm (0·71), elite breeding lines (0·68) and commercial varieties (0·58). Ninety-six genotypes representing the phenotypic variation observed during laboratory screening were further evaluated for waterlogging tolerance at the early seedling stage using pots, and survival rates were recorded for 8 days after completion of the stress treatment. Forty-nine of these 96 genotypes, representing the phenotypic variation for waterlogging tolerance, were chosen in order to evaluate their performance under natural field conditions. The following cultivated varieties and hybrids were identified as tolerant after three levels of testing (in vitro, in pots and in the field): ICPH 2431, ICPH 2740, ICPH 2671, ICPH 4187, MAL 9, LRG 30, Maruti, ICPL 20128, ICPL 332, ICPL 20237, ICPL 20238, Asha and MAL 15. These materials can be used as sources of waterlogging tolerance in breeding programmes.