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A 15-day compulsory rotatory rural psychiatry posting was introduced into the MD psychiatry curriculum at NIMHANS to orient trainees to the functioning of community mental health services.
Objectives
To capture the views and subjective experiences of the 32 residents posted in rural psychiatry services under District Mental Health Program (DMHP) using qualitative interviews.
Methods
In-depth qualitative interviews were conducted to understand the residents’ experience in various aspects of the community psychiatry posting. The interviews were audiotaped and later, transcribed. Thematic analysis of transcripts was done.
Results
The analyzed data was converted into 41 codes and 12 themes. The themes related to positive experiences were good clinical exposure and skills to practice in low-resource settings, focus on preventive mental health care, enhanced communication, administration, leadership skills, and increased empathy. After training, the residents also reported gaining insights into the attitude of policy-makers and increased interest and confidence to practice in a rural setting. The themes highlighting the perceived challenges ranged from personal reasons, such as food or transportation, to professional ones like stigma, limited resources, a burdensome amount of paperwork, limited availability of psychotropics, and communication barriers. Residents who expressed interest in practicing rural psychiatry in the future cited a good wage, higher levels of self-satisfaction, confidence, and an emotional connection to their native place as motivating factors. Those who did not want to join DMHP had concerns such as not having adequate skills for working in a low resource setting, compromised basic needs, superiors not being sensitive to mental health issues, additional non-psychiatric work, job instability and lack of academic and research opportunities.
Conclusions
The posting to nearby DMHP centers was feasible and contributed positively to the training experience of the residents. Positive experiences, challenges, and other lessons learned by these residents could help them plan their career in rural psychiatry. It was found that both the residents and the DMHP team contributed to each other’s growth. This posting was likely to boost residents’ confidence to work in rural settings and could also aid in easing the crisis of lack of community-based mental health experts. The authors advocate for the national implementation of such rural psychiatry posting.
The objective of the present work is to estimate the performance of a turbojet engine during Fluidic Thrust Vectoring (FTV) employed by injecting the secondary-jet at the throat of a convergent nozzle. The nozzle performance maps and effective nozzle throat area obtained from experiments are coupled with the performance of a conventional engine (without FTV) using an iterative algorithm developed as a part of this work. The performance is estimated for different flow rates of secondary-jet sourced either from a separate compressor or the engine’s compressor. During FTV, the operating point shifted towards the surge line with increased turbine entry temperature. The desired and obtained vector angles and thrust magnitudes are different. At high secondary-jet flow rates, the turbine operation moved out of its performance map. These aspects should be incorporated while integrating the FTV at the system level, thus, asserting the importance of FTV studies coupled with engine performance.
We present a collection of double-lobed sources towards a $20\,\mathrm{deg}^2$ area of the Cygnus region at the northern sky, observed at 325 and 610 MHz with the Giant Metrewave Radio Telescope. The 10$^{\prime\prime}$ resolution achieved at 325 MHz is 5.5 times better than previous studies, while at 610 MHz, these are the first results ever of such a large area, mapped with 6$^{\prime\prime}$ angular resolution. After a thorough visual inspection of the images at the two bands, we found 43 double-lobed source candidates, proposed as such due to the presence of 2 bright peaks, within a few arcminutes apart, joined by a bridge or a central nucleus. All but two are presented here as a double-lobed candidates for the first time. Thirty nine of the candidates were covered at both bands, and we provide the spectral index information for them. We have searched for positional coincidences between the detected sources/components and other objects from the literature, along the electromagnetic spectrum. Twenty-three candidates possess radio counterpart(s), 12 present infrared counterparts, and 1 showed an overlapping X-ray source. We analysed each candidate considering morphology, counterparts, and spectral indices. Out of the 43 candidates, 37 show characteristics compatible with an extragalactic nature, 2 of probably Galactic origin, 3 remain as dubious cases, though with feature(s) compatible with an extragalactic nature, and the remaining one, evidence of physically unrelated components. The median spectral index of the 40 putative extragalactic sources is $-1.0$. Their celestial surface density at 610 MHz resulted in $1.9\,\mathrm{per\ deg}^2$, across a region lying at the Galactic plane.
The remnant phase of a radio galaxy begins when the jets launched from an active galactic nucleus are switched off. To study the fraction of radio galaxies in a remnant phase, we take advantage of a $8.31$ deg$^2$ subregion of the GAMA 23 field which comprises of surveys covering the frequency range 0.1–9 GHz. We present a sample of 104 radio galaxies compiled from observations conducted by the Murchison Widefield Array (216 MHz), the Australia Square Kilometer Array Pathfinder (887 MHz), and the Australia Telescope Compact Array (5.5 GHz). We adopt an ‘absent radio core’ criterion to identify 10 radio galaxies showing no evidence for an active nucleus. We classify these as new candidate remnant radio galaxies. Seven of these objects still display compact emitting regions within the lobes at 5.5 GHz; at this frequency the emission is short-lived, implying a recent jet switch off. On the other hand, only three show evidence of aged lobe plasma by the presence of an ultra-steep-spectrum ($\alpha<-1.2$) and a diffuse, low surface brightness radio morphology. The predominant fraction of young remnants is consistent with a rapid fading during the remnant phase. Within our sample of radio galaxies, our observations constrain the remnant fraction to $4\%\lesssim f_{\mathrm{rem}} \lesssim 10\%$; the lower limit comes from the limiting case in which all remnant candidates with hotspots are simply active radio galaxies with faint, undetected radio cores. Finally, we model the synchrotron spectrum arising from a hotspot to show they can persist for 5–10 Myr at 5.5 GHz after the jets switch of—radio emission arising from such hotspots can therefore be expected in an appreciable fraction of genuine remnants.
Massive, early-type stars have been detected as radio sources for many decades. Their thermal winds radiate free–free continuum and in binary systems hosting a colliding-wind region, non-thermal emission has also been detected. To date, the most abundant data have been collected from frequencies higher than 1 GHz. We present here the results obtained from observations at 325 and 610 MHz, carried out with the Giant Metrewave Radio Telescope, of all known Wolf-Rayet and O-type stars encompassed in area of $\sim$15 sq degrees centred on the Cygnus region. We report on the detection of 11 massive stars, including both Wolf-Rayet and O-type systems. The measured flux densities at decimeter wavelengths allowed us to study the radio spectrum of the binary systems and to propose a consistent interpretation in terms of physical processes affecting the wide-band radio emission from these objects. WR 140 was detected at 610 MHz, but not at 325 MHz, very likely because of the strong impact of free–free absorption (FFA). We also report—for the first time—on the detection of a colliding-wind binary system down to 150 MHz, pertaining to the system of WR 146, making use of complementary information extracted from the Tata Institute of Fundamental Research GMRT Sky Survey. Its spectral energy distribution clearly shows the turnover at a frequency of about 600 MHz, that we interpret to be due to FFA. Finally, we report on the identification of two additional particle-accelerating colliding-wind binaries, namely Cyg OB2 12 and ALS 15108 AB.
We present a detailed analysis of the radio galaxy PKS $2250{-}351$, a giant of 1.2 Mpc projected size, its host galaxy, and its environment. We use radio data from the Murchison Widefield Array, the upgraded Giant Metre-wavelength Radio Telescope, the Australian Square Kilometre Array Pathfinder, and the Australia Telescope Compact Array to model the jet power and age. Optical and IR data come from the Galaxy And Mass Assembly (GAMA) survey and provide information on the host galaxy and environment. GAMA spectroscopy confirms that PKS $2250{-}351$ lies at $z=0.2115$ in the irregular, and likely unrelaxed, cluster Abell 3936. We find its host is a massive, ‘red and dead’ elliptical galaxy with negligible star formation but with a highly obscured active galactic nucleus dominating the mid-IR emission. Assuming it lies on the local M–$\sigma$ relation, it has an Eddington accretion rate of $\lambda_{\rm EDD}\sim 0.014$. We find that the lobe-derived jet power (a time-averaged measure) is an order of magnitude greater than the hotspot-derived jet power (an instantaneous measure). We propose that over the lifetime of the observed radio emission (${\sim} 300\,$Myr), the accretion has switched from an inefficient advection-dominated mode to a thin disc efficient mode, consistent with the decrease in jet power. We also suggest that the asymmetric radio morphology is due to its environment, with the host of PKS $2250{-}351$ lying to the west of the densest concentration of galaxies in Abell 3936.
Systematic assessment of risks is an essential component of care in psychiatric mother baby units. Self-harm, infant neglect and harm or the vulnerable physical health of both mother and infant may all pose risks.
Aim
Development of a risk assessment tool and risk assessment among mother-infant dyads at a MBU in Bangalore, India.
Methods
Based on data from 200 admissions, doctors and nurses of the unit developed a 15-item tool for risk assessment. Risk was assessed by both nurses and doctors among 58 consecutive mothers admitted to the unit. Risk domains included risks to self, to infant, related to infant health and feeding and violence faced by mother. Frequencies of various risks were calculated. Nurses’ risk assessments were compared to the residents’ risk assessments.
Results
The mean age of the mothers was 25 (±4) years, age of infant 4 (±4) months and duration of episode was 4 (±14) months. Diagnoses included acute polymorphic psychosis (30%), BPAD (27%) and depression (21%). 47% had high suicidal risk and 28% had made an attempt in the current episode. 22% had expressed ideas of infant harm and 24% had physically harmed the infant. 48% of mothers had been physically violent. Multiple risks were seen in 47%. Doctors were able to identify risks more often than nurses.
Conclusion
Risks for self-harm, infant harm and related to infant health were high. Systematic risk assessment by both nurses and doctors is important in an MBU to ensure adequate care for the mother infant dyad.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The Indian Supreme Court has been called “the most powerful court in the world” for its wide jurisdiction, its expansive understanding of its own powers, and the billion plus people under its authority. Yet scholars and policy makers have a very uneven picture of the court’s functioning: deep knowledge about the more visible, “high-profile” cases but very little about more mundane, but far more numerous and potentially equally important, decisions. This chapter aims to address this imbalance with a rigorous, empirical account of the Court’s decisions from 2010 to 2015. We use the most extensive original dataset of Indian Supreme Court opinions yet created to provide a broad, quantitative overview of the social identity of the litigants that approach the court, the types of matters they bring to the court, the levels of success that different groups of litigants have before the Court, and the opinion-writing patterns of the various judges of the Supreme Court. This analysis provides foundational facts for the study of the Court and its role in progressive social change.
Introduction: We previously reported that a targeted knowledge translation (KT) intervention was associated with a trend towards increased awareness and knowledge of the Choosing Wisely Canada (CWC) emergency medicine (EM) recommendations. We wished to assess if the intervention changed physician practice, specifically looking at the imperative “do not order lumbar XRs for non-traumatic low back pain unless red flags exist”. Methods: A departmental KT initiative was implemented in April 2016 and consisted of a 1-hour seminar reviewing the CWC-EM recommendations, access to a video cast, departmental posters, and a before and after awareness survey. The effectiveness of our intervention was assessed by analyzing the frequency of lumbar XR imaging conducted for low back pain before and after the introduction of our intervention at a tertiary teaching hospital emergency department. All patient visits for the complaint of low back pain were included. The rates of XR imaging from June 2014 to September 2014 for the pre-intervention period and June 2016 to September 2016 for the post-intervention period were collected and analyzed using Fisher exact tests. A sample size of 683 was required to detect a 5% change with an alpha of 0.05 and a power of 80%. Results: Baseline characteristics of patients were similar for the pre- and post-intervention periods. There was a total of 781 patient visits for low back pain in June to September 2014 and 672 in June to September 2016. The XR imaging rate for low back pain increased from 12% (95% CI 9.9-14.5) to 16.2% (95% CI 13.6-19.2) following the intervention (p=0.023). Conclusion: We previously demonstrated a trend towards increased awareness and knowledge of the CWC EM recommendations following a knowledge translation initiative. Baseline XR imaging rates for low back pain were lower than what has been reported. We observed that our intervention was associated with an increased frequency of imaging for low back pain. This may be due to a contrarian effect. We feel this calls into question the role of knowledge translation initiatives where physician practice already closely adheres to pre-established recommendations.
Introduction: Choosing Wisely is an innovative approach to address physician and patient attitudes towards low value medical tests; however, a knowledge translation (KT) gap exists. We aimed to quantify the baseline familiarity of emergency medicine (EM) physicians with the Choosing Wisely Canada (CWC) EM recommendations. We then assessed whether a structured KT initiative affected knowledge and awareness. Methods: Physicians working in urban (tertiary teaching hospital, Saint John, NB) and rural (community teaching hospital, Waterville, NB) emergency departments were asked to participate in a survey assessing awareness and knowledge of the first five CWC EM recommendations before an educational intervention. The intervention consisted of a 1-hour seminar reviewing the recommendations, access to a video cast and departmental posters. Knowledge was assessed by asking respondents to identify 80% or more of the recommendations correctly. Physicians were surveyed again at a 6-month follow up period. The Fisher exact test was used for statistical analyses. A sample size of 36 was required to detect a 30% change with an alpha of 0.05 and a power of 80%. Results: At the urban site, 16 of 25 (64%) physicians responded to the pre- and 14 of 26 (53.8%) responded to the post-intervention survey. Awareness of the EM recommendations did not increase significantly (81.3% pre; 95% CI 56.2-94.2 vs. 92.9% post; 66.4-99.9; p=0.60). There was a weak trend towards improved knowledge with 62.5% (38.5-81.6) of physicians responding correctly initially, and 85.7% (58.8-97.2; p=0.23) after the intervention. At the rural site, 8 of 11 (72.7%) physicians responded to the pre- and post-intervention survey. There was a trend towards improved awareness, (25% pre; 6.3-59.9 vs. 75% post; 40.1-93.7; p=0.13), with 50% (21.5-78.5) responding correctly pre, and 87.5% (50.8-99.9; p=0.28) after the intervention. Conclusion: We have described the current awareness and knowledge of the CWC EM recommendations. Limited by our small sample size, we report a trend towards increased awareness and knowledge at 6 months following our KT initiative in a rural setting where there was a low baseline awareness. At the urban site where baseline knowledge was high, changes seen were less significant. Further work will look at the effectiveness of our initiative on physician practice.
Two global (re-)emerging zoonoses, leptospirosis and hantavirus infections, are clinically indistinguishable. Thirty-one patients, hospitalized in Sri Lanka for acute severe leptospirosis, were after exclusion of other potentially involved pathogens, prospectively screened with IgM ELISA for both pathogens. Of these, nine (29·0%) were positive for leptospirosis only, one (3·2%) for hantavirus only, seven (22·5%) for both pathogens concomitantly, whereas 13 (41·9%) remained negative for both. Moreover, in a retrospective study of 23 former patients, serologically confirmed for past leptospirosis, six (26·0%) were also positive in two different IgG ELISA hantavirus formats. Surprisingly, European Puumala hantavirus (PUUV) results were constantly higher, although statistically not significantly different, than Asian Hantaan virus (HTNV), suggesting an unexplained cross-reaction, since PUUV is considered absent throughout Asia. Moreover, RT–PCR on all hantavirus IgM ELISA positives was negative. Concomitant leptospirosis-hantavirus infections are probably heavily underestimated worldwide, compromising epidemiological data, therapeutical decisions, and clinical outcome.
Objective: The paucity of evidence and wide variation among communities creates challenges for developing congressionally mandated national performance standards for public health preparedness. Using countermeasure dispensing as an example, we present an approach for developing standards that balances national uniformity and local flexibility, consistent with the quality of evidence available.
Methods: We used multiple methods, including a survey of community practices, mathematical modeling, and expert panel discussion.
Results: The article presents recommended dispensing standards, along with a general framework that can be used to analyze tradeoffs involved in developing other preparedness standards.
Conclusions: Standards can be developed using existing evidence, but would be helped immensely by a stronger evidence base.
(Disaster Med Public Health Preparedness. 2010;4:285-290)
We have successfully prepared La0.5Sr0.5MnO3nanowires using a novel hydrothermal synthesis process and studied their magnetic and magnetocaloric properties. The system exhibits an inverse magnetocaloric effect (IMCE) around 175 K indicating presence of significant AFM correlation. The MCE study reveals a clear paramagnetic (PM) to ferromagnetic (FM) transition near room temperature (T ~ 325K) which is followed by onset of AFM at lower temperatures. The development of the FM-like magnetic state at low temperature is attributed to the enhanced double exchange (DE) driven ferromagnetism in AFM state as predicted by recent theoretical studies.
The origin of life and the origin of the Universe are among the most important problems of science and they might be inextricably linked. Hydro-gravitational-dynamics cosmology predicts hydrogen–helium gas planets in clumps as the dark matter of galaxies, with millions of planets per star. This unexpected prediction is supported by quasar microlensing of a galaxy and a flood of new data from space telescopes. Supernovae from stellar over-accretion of planets produce the chemicals (C, N, O, P, etc.) and abundant liquid-water domains required for first life and the means for wide scattering of life prototypes. Life originated following the plasma-to-gas transition between 2 and 20 Myr after the big bang, while planetary core oceans were between critical and freezing temperatures, and interchanges of material between planets constituted essentially a cosmological primordial soup. Images from optical, radio and infrared space telescopes suggest life on Earth was neither first nor inevitable.