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Our systematic review aims to synthesise the evidence on interventions targeting improvement in patient adherence to psychological treatments for common mental disorders. A search was conducted on six electronic databases using search terms under the following concepts: common mental disorders, adherence, psychological treatments and controlled trial study design. Due to the heterogeneity in intervention content and outcomes evaluated in the included studies, a narrative synthesis was conducted. Risk of bias was assessed using the Cochrane Risk of Bias Version 2 tool for randomised controlled trials and the Cochrane ROBINS-I tool for non-randomised controlled trials. The search yielded 23 distinct studies with a total sample size of 2,779 participants. All studies were conducted in high-income or upper-middle-income countries. Interventions to improve patient adherence to psychological treatments included reminders and between-session engagement (e.g., text messages), motivational interviewing, therapy orientation (e.g., expectation-setting) and overcoming structural barriers (e.g., case management). Interventions from 18 out of 23 studies were successful in improving at least one primary adherence outcome of interest (e.g., session attendance). Some studies also reported an improvement in secondary outcomes – six studies reported an improvement in at least one clinical outcome (e.g., depression), and three studies reported improvements in at least one measure of well-being or disability (e.g., days spent in in-patient treatment). By incorporating these interventions into psychological treatment services, therapists can better engage with and support their patients, potentially leading to improved mental health outcomes and overall well-being.
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.
To design a meditation protocol and test its feasibility, acceptability and efficacy in conjunction with yoga training (YT) for persons with schizophrenia (SZ).
Methods:
The meditation protocol consisted of Anapana (observing normal respiration) and Yoga Nidra (supine, restful awareness). In a single-blind randomised controlled trial, medicated and clinically stable outpatients diagnosed with SZ were randomised to receive treatment as usual (TAU), TAU augmented with YT or TAU augmented with meditation and yoga training (MYT) for 3 weeks (N = 145). Acceptability, clinical, social and cognitive functions were assessed after 3-week and 3-month post-randomisation using within-group and between-group analyses with repeated measures multivariate tests.
Results:
No group-wise differences in compliance, study discontinuation, major/serious side effects or adverse events were noted. For six assessed clinical variables, the direction of changes were in the desired direction and the effect sizes were greater in the MYT group compared with the TAU group at both time points. Changes in social function variables were greater at 3 months than at 3 weeks. Nominally significant improvement in individual cognitive domains were noted in all groups at both time points. All effect sizes were in the small to medium range.
Conclusion:
MYT is feasible and acceptable and shows modest benefits for persons with SZ. MYT can also improve quality of life and clinical symptoms. Larger studies of longer duration are warranted.
Depression is a global public health problem with highest rates in women in low income countries including Pakistan. Paediatricians may be a resource to help with maternal depression. Little is known in low income countries about the prevalence of depression and its social correlates in mothers of children attending paediatric clinics.
Methods
Using cross-sectional design consecutive women attending the paediatric clinic were screened using the Edinburgh Postnatal Depression Scale (n=185). Women scoring 12 or more (n=70) and a random sample of low scorers (n=16) were interviewed using the Clinical Interview Schedule Revised (CIS-R) to confirm the diagnosis of depression, the Oslo scale was used to measure social stress and EQ-5D for health related quality of life.
Results
The prevalence of maternal depression was 51%. The mean age of the sample was 26 years. Depressed mothers were more likely to be living in a joint family household, they were less educated and they and their husbands were less likely to be employed. The depressed mothers had more financial difficulties and they were more likely to sleep hungry during the last month due to financial problems. The depressed mothers had less social support and poorer quality of life compared to non depressed mothers.
Conclusion
Maternal depression in this health care setting is high and it is associated with social stress and poor social support. Paediatric appointments may be an opportunity for care and care delivery for maternal depression.
To quantitatively test the hypothesis that older patients have increased thyroarytenoid muscle atrophy by comparing thyroarytenoid muscle volumes across different age groups.
Methods
A retrospective chart review was conducted. The study included 111 patients with no history of laryngeal pathology. Two investigators reviewed magnetic resonance imaging studies of these patients and manually traced the thyroarytenoid muscles on multiple slices bilaterally. Thyroarytenoid muscle volumes were then computed using imaging analysis software. Patients were stratified into three age groups (18–50 years, 51–64 years, and 65 years or older) for comparison.
Results
Intra- and inter-rater reliabilities were excellent for all measurements (intraclass correlation co-efficient > 0.90). There was no statistically significant difference in the mean volumes of left and right thyroarytenoid muscles in all age and gender groups.
Conclusion
Given the lack of statistically significant difference in thyroarytenoid muscle volume between age groups on magnetic resonance imaging, the prevailing assumption that age-related thyroarytenoid muscle atrophy contributes to presbyphonia should be re-examined.
The hedging practices survey took place towards the end of 2015 in the final few months prior to Solvency II regulations coming into force. At the point of completing the survey we would expect that companies would have largely transitioned their hedging approaches to work in a Solvency II environment. There may be some cases where further changes were planned but not implemented at the point of completing the survey. Further, as familiarity with working under the new regulations increases, approaches are expected to continue to develop over time. The working party hopes that this report is useful in summarising industry attitudes at this point in time and as a comparator in future years. Before launching the survey we did have several conjectures of what we may expect to see in the results. Some proved true, for some it was difficult to glean any strong conclusion from the data, and there were one or two where results countered what we expected to see.
Climate projections, especially at decadal to century scales, rely on physics- based computer models. While the models have generated useful information about global warming and hydrology, “the sad truth of climate science is that the most crucial information is the least credible” (Schiermeier 2010). The possible reasons include intrinsic variability of the climate system as well as our lack of understanding of the physics and the inability to include known physics within the current generation of computer models. Data sciences, ranging from statistics and signal processing to machine learning and nonlinear dynamics, continue to help fill some of the crucial gaps in climate. We hypothesize that these data science solutions can be improved if they are driven by physical knowledge, especially when this knowledge cannot be incorporated in current climate models because they are incomplete or incompatible. We have called this paradigm Physics-Guided Data Mining (PGDM) (Ganguly et al. 2014). In addition to motivating and introducing PGDM, this chapter presents three case studies on precipitation, based on our prior work. Statistical downscaling, which generates higher- resolution projections from lower- resolution model simulations, benefits from a blend of sparse learning techniques with physically motivated covariates (Das et al. 2014; 2015). Multimodal uncertainty quantification shows the potential to improve when physical relations with ancillary variables are considered together with historical skills and future consensus, within a Bayesian framework (Ganguly et al. 2013; Kodra 2014a; Smith et al. 2009). Characterization of internal variability and associated model performance benefit from data- driven analysis of multi- initial condition ensembles, combined with physical understanding of oceanic indices and their initializations (Kodra et al. 2012). The proposed PGDM paradigm, illustrated through our prior publications, shows the potential to bridge crucial knowledge gaps in climate science and help in translation to water resources impacts.
The Grand Water Challenge
Our planet and society continue to be critically shaped by water. In the 21st century and beyond, water is without question among the major clear and present challenges facing the world (Hall et al. 2014). Water in the atmospheric column is perhaps the most important of all the greenhouse gases and causes the most significant uncertainties in our understanding and projections of climate variability and change. Water in the oceans is critical for the survival of the majority of species while water towers in glaciers sustain riverine systems.
A field experiment was carried out at the farm of Indian Agricultural Research Institute, New Delhi to quantify the effect of elevated carbon dioxide (CO2) and different levels of N fertiliser application on nitrous oxide (N2O) and carbon dioxide (CO2) emissions from soil under maize. The experiment included five treatments: 60 kg N ha−1 under ambient CO2 (385 ppm) in open plots, 120 kg N ha−1 under ambient CO2 (385 ppm) in open plots, 160 kg N ha−1 under ambient CO2 (385 ppm) in open plots, 120 kg N ha−1 under ambient CO2 (385 ppm) in open top chambers (OTC) and 120 kg N ha−1 under elevated CO2 (500 ± 50 ppm) in the OTC. Peaks of N2O flux were observed after every dose of N application. Cumulative N2O emission was 13% lower under ambient CO2 as compared to the elevated CO2 concentrations. There was an increase in CO2 emissions with application of N from 60 kg ha−1 to 160 kg ha−1. Higher yield and root biomass was observed under higher N treatment (160 kg N ha−1). There was no significant increase in maize yield under elevated CO2 as compared to ambient CO2. The carbon emitted was more than the carbon fixed under elevated CO2 as compared to ambient CO2 levels. The carbon efficiency ratio (C fixed/C emitted) was highest in ambient CO2 treatment in the OTC.
The findings of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study and the Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS) called previous trials of antipsychotics into question, including pre-licensing trials. Concerns regarding methodological robustness and quality of reporting increased. This systematic review aimed to examine the quality of reporting of phase II and III trials for new antipsychotics in the aftermath of the CATIE and CUtLASS studies.
Method
Electronic searches were conducted in EMBASE, Medline and Cochrane databases and also ClinicalTrials.gov for antipsychotic trials (published between January 2006 and February 2012). Phase II and III randomized controlled trials (RCTs) for iloperidone, asenapine, paliperidone, olanzapine, lurasidone and pomaglumetad methionil were selected for schizophrenia and schizoaffective disorder. The reporting of the methodology was evaluated in accordance with Consolidated Standards of Reporting Trials (CONSORT) guidelines.
Results
Thirty-one articles regarding 32 studies were included. There was insufficient reporting of design in 47% of studies and only 13% explicitly stated a primary hypothesis. Exclusion criteria were poorly reported for diagnosis in 22% of studies. Detail regarding comparators, particularly placebos, was suboptimal for 56% of studies, and permitted concomitant medication was often not reported (19%). Randomization methods were poorly described in 56% of studies and reporting on blinding was insufficient in 84% of studies. Sample size calculations were insufficiently reported in 59% of studies.
Conclusions
The quality of reporting of phase II and III trials for new antipsychotics does not reach the standards outlined in the CONSORT guidelines. Authors often fail to adequately report design and methodological processes, potentially impeding the progress of research on antipsychotic efficacy. Both policymakers and clinicians require high quality reporting before decisions are made regarding licensing and prescribing of new antipsychotics.
Principles of Optics is one of the classic science books of the twentieth century, and probably the most influential book in optics published in the past 40 years. The new edition is the first ever thoroughly revised and expanded edition of this standard text. Among the new material, much of which is not available in any other optics text, is a section on the CAT scan (computerized axial tomography), which has revolutionized medical diagnostics. The book also includes a new chapter on scattering from inhomogeneous media which provides a comprehensive treatment of the theory of scattering of scalar as well as of electromagnetic waves, including the Born series and the Rytov series. The chapter also presents an account of the principles of diffraction tomography - a refinement of the CAT scan - to which Emil Wolf, one of the authors, has made a basic contribution by formulating in 1969 what is generally regarded to be the basic theorem in this field. The chapter also includes an account of scattering from periodic potentials and its connection to the classic subject of determining the structure of crystals from X-ray diffraction experiments, including accounts of von Laue equations, Bragg's law, the Ewald sphere of reflection and the Ewald limiting sphere, both generalized to continuous media. These topics, although originally introduced in connection with the theory of X-ray diffraction by crystals, have since become of considerable relevance to optics, for example in connection with deep holograms. Other new topics covered in this new edition include interference with broad-band light, which introduces the reader to an important phenomenon discovered relatively recently by Emil Wolf, namely the generation of shifts of spectral lines and other modifications of spectra of radiated fields due to the state of coherence of a source. There is also a section on the so-called Rayleigh-Sommerfield diffraction theory which, in recent times, has been finding increasing popularity among optical scientists. There are also several new appendices, including one on energy conservation in scalar wavefields, which is seldom discussed in books on optics. The new edition of this standard reference will continue to be invaluable to advanced undergraduates, graduate students and researchers working in most areas of optics.
Ganjam is an important sheep breed in the Orissa State in the eastern region of India. They are reared mainly for meat. The present study was conducted to characterize the Ganjam breed both phenotypically and genotypically at the DNA level using microsatellite markers. A survey was conducted in the breeding tract to study the habitat, body biometry, management practices and reproductive and productive performance of Ganjam sheep. A total of 604 animals were studied for morphological characteristics. The animals are medium sized with hairy fleece. Their coat colour varies from brown to dark tan. The average flock size is 35. Measurements were recorded for body weight, body length, height at withers, chest girth, ear length and horn length in 366 adult animals. A set of 25 microsatellite markers was used to assess the genetic variability in 50 DNA samples extracted from randomly collected blood samples of unrelated Ganjam sheep across their breeding tract. A total of 137 alleles were identified across the 25 markers. The allele diversity (5.48), mean observed heterozygosity (0.623) and gene diversity (0.685) estimates elucidated substantial genetic diversity within the Ganjam breed. The Mode Shift Test implied that a reduction in the effective population size or a recent genetic bottleneck was very unlikely in this indigenous breed of sheep. The within population inbreeding estimate values for the investigated population (0.087) showed a low rate of inbreeding.
A total of 675 stdrains of Salmonella bareilly received from different parts of India and France during 1959–92 were phage typed using six bacteriophages. Overall ttypability achieved was 90·8% with 23 distinctphage types excluding a group of untypable strains. Phage types have been defined in octal code. Simpson's coefficient was applied for diversity index having a value of 0·839. This system was found to be reproducible, stable and epidemiologically useful.
Isoenzymes of alcohol (ADH), malate (MDH), glutamate (GDH) and isocitrate (IDH) dehydrogenases, and a fast migrating esterase (EST-l) were separated by disk electrophoresis from dry seed extracts of diploid, tetraploid, hexaploid and octaploid species or amphiploids belonging to the subtribe Triticinae. Only ADH and EST-l isoenzymes showed inter-species variation; the other dehydrogenases, which show stringent substrate specificities (‘critical’ enzymes), revealed the same pattern in all diploid and polyploid species. The qualitative zymogram studies showed that (1) the number of variant enzyme bands increased with the level of ploidy, (2) the amphiploid isoenzyme pattern was additive of the parental species, (3) enhancement in the number of bands was due to the presence of not only parental bands, but also hybrid bands formed by association between heteromonomers. Quantitative data were obtained by densitometry of the enzyme bands as well as spectrophotometric measurements of enzyme activity in crude extracts. Increase in the level of enzyme activity was observed with ploidy level. In spite of the evidence that all duplicate/triplicate genes are expressed, increased enzyme activity observed in the polyploid species was not proportional to the level of ploidy or expected gene dosage. On the basis of ADH and EST-l zymograms obtained in 2 × and 4 × wheat, probable zymograms for these enzymes in the B-genome donor to 4 × wheat were extrapolated. Neither Ae. speltoides nor Ae. bicornis showed the extrapolated ADH pattern. Amphiploids involving Ae. speltoides and Triticum monococcum or T. aegilopoides fully reproduced the EST-l zymogram of 4 × wheat, but not the ADH. Ae. bicornis × T. aegilopoides amphiploid showed an ADH zymogram similar to that of 4 × wheat, but the EST-l bands were different.
The gravitational instability of a two-component plasma has been studied here to include simultaneously the effects of neutral gas friction, finite ion Larmor radius, magnetic resistivity and Hall currents. The viscosities of the two components of the plasma have also been taken into account. The mode of the transverse as well as the longitudinal wave propagation have been discussed. The dispersion relations have been obtained for both these cases and numerical calculations have been performed to obtain the dependence of the growth rate of the gravitationally unstable mode on the various physical parameters involved. For the transverse mode of propagation, it is found that the growth rate of the unstable mode increases with magnetic resistivity and with the ratio of the densities of two components. The influence of the magnetic resistivity is, therefore, destabilizing on this mode of wave propagation. The viscosities of the two components are found to have a stabilizing influence on the growth rate in this case since it is found that the increase of hte viscosity effects reduces the growth rate. For the longitudinal mode also it is found that the effects of viscosities as well as that of neutral gas friction are stabilizing. The magnetic resistivity does not affect the growth rate since the equation determining the growth rate is found to be independent of this effect.
Gold eyelid implantation is widely considered the procedure of choice to reanimate the upper eyelid in paralytic lagophthalmos. Commercially supplied implants are not readily available in all places and are sometimes cumbersome to import.
Objective:
We aimed to devise a method whereby every surgeon performing gold eyelid implantation could have easy and quick access to the implant. Furthermore, we aimed to develop a means of creating an implant of the exact weight required for complete eyelid closure.
Study design and setting:
A prospective study was performed from 1997 to 2005 in a tertiary research hospital, involving 50 subjects requiring gold upper eyelid implantation and using the technique in question.
Results:
Only patients with a minimum follow up of one year were included in the study group. Symptoms improved in 96 per cent of subjects, who were able to dispense with eyedrops and eye ointments. Visual acuity improved in 92 per cent of patients. There were two extrusions amongst the early cases.
Conclusion and significance:
Customised gold eyelid implantation offers an alternative in regions where commercial implants are not easily obtained.
The films of 1-(3-hydroxypropylamino)-9,10-anthraquinone (1) obtained by Hot Wall Epitaxy technique (HWE) have been studied for their morphological and electrical properties. The films were deposited on to the glass substrate at different temperatures kept at pressure of ~1.33 × 10−3 Pa. The powder X-ray diffraction (XRD) spectra show the polycrystalline nature of the films. The crystallanity of the films increases with the increase in film deposition temperature. Scanning electron microscope (SEM) shows that the molecules of 1 undergo uniform aggregation to form blade type crystallites with width 5.2–11.8 μm and length 32.6–90 μm at substrate temperature 348 K. The conduction in these films is ohmic in nature and both the increase in substrate temperature during film deposition and increase in absolute temperature of the films during conductivity measurement resulted in increased conductivity. The band gap lies in the range 1.25–1.44 eV