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We aimed to translate and cross-culturally adapt the Supportive and Palliative Care Indicators Tool-4ALL (SPICT-4ALL) for use in the Tamil healthcare context.
Methods
The translation and cross-cultural adaptation of the SPICT-4ALL (2023 version) were conducted using the TRAPD model (Translation, Review, Adjudication, Pretesting, and Documentation). Cross-cultural adaptation used a modified Delphi-technique. Twelve participants, including mid-level healthcare workers from primary care and palliative care settings and lay people from India and Sri Lanka, scored the items on the tool. Agreement on scores was assessed, and focus group discussion (FGD) was used to reach consensus.
Results
Delphi panel agreement was 34% initially but reached 100% with minor changes to items in the translated version after the FGD. Thematic analysis found SPICT-4ALL in Tamil is user-friendly and accessible for proactive identification of palliative care needs, facilitates person-centered care planning, and enhances interdisciplinary coordination.
Significance of results
SPICT-4ALL-Tamil 2023 is the translated and cross-culturally adapted version for use in the Tamil healthcare context. This will enable and empower mid-level health workers within the primary and secondary care settings and people not in the healthcare field to identify individuals with palliative care needs. Further research to validate and study acceptability of the tool and its impact on patient outcomes is warranted.
The dhole Cuon alpinus is a large canid that is categorized as Endangered on the IUCN Red List and at risk of global extinction. Information on the spatial distribution of suitable habitat is important for conservation planning but is largely unavailable. We quantified the spatial distribution of potential range as well as the relative probability of dhole occurrence across large parts of the species’ global range. We used the MaxEnt algorithm to produce a multi-scale environmental niche model based on 24 environmental variables and dhole occurrence data from 12 countries. We identified three regions where dhole conservation should be focused: western India, central India, and across the Himalayan foothills through Southeast Asia. Connectivity between suitable areas was poor, so coordinated action among these regions should be a priority. For instance, transboundary dhole conservation initiatives across the Himalayas from southern China, Myanmar, north-east India, Nepal and Bhutan need to be initiated. We also highlight the value of improving dhole population viability on unprotected land and increasing monitoring in the northern parts of its historic distribution, in particular in areas within mainland China.
Observational studies suggest that 25-hydroxy vitamin D (25(OH)D) concentration is inversely associated with pain. However, findings from intervention trials are inconsistent. We assessed the effect of vitamin D supplementation on pain using data from a large, double-blind, population-based, placebo-controlled trial (the D-Health Trial). 21 315 participants (aged 60–84 years) were randomly assigned to a monthly dose of 60 000 IU vitamin D3 or matching placebo. Pain was measured using the six-item Pain Impact Questionnaire (PIQ-6), administered 1, 2 and 5 years after enrolment. We used regression models (linear for continuous PIQ-6 score and log-binomial for binary categorisations of the score, namely ‘some or more pain impact’ and ‘presence of any bodily pain’) to estimate the effect of vitamin D on pain. We included 20 423 participants who completed ≥1 PIQ-6. In blood samples collected from 3943 randomly selected participants (∼800 per year), the mean (sd) 25(OH)D concentrations were 77 (sd 25) and 115 (sd 30) nmol/l in the placebo and vitamin D groups, respectively. Most (76 %) participants were predicted to have 25(OH)D concentration >50 nmol/l at baseline. The mean PIQ-6 was similar in all surveys (∼50·4). The adjusted mean difference in PIQ-6 score (vitamin D cf placebo) was 0·02 (95 % CI (−0·20, 0·25)). The proportion of participants with some or more pain impact and with the presence of bodily pain was also similar between groups (both prevalence ratios 1·01, 95 % CI (0·99, 1·03)). In conclusion, supplementation with 60 000 IU of vitamin D3/month had negligible effect on bodily pain.
We present the data and initial results from the first pilot survey of the Evolutionary Map of the Universe (EMU), observed at 944 MHz with the Australian Square Kilometre Array Pathfinder (ASKAP) telescope. The survey covers $270 \,\mathrm{deg}^2$ of an area covered by the Dark Energy Survey, reaching a depth of 25–30 $\mu\mathrm{Jy\ beam}^{-1}$ rms at a spatial resolution of $\sim$11–18 arcsec, resulting in a catalogue of $\sim$220 000 sources, of which $\sim$180 000 are single-component sources. Here we present the catalogue of single-component sources, together with (where available) optical and infrared cross-identifications, classifications, and redshifts. This survey explores a new region of parameter space compared to previous surveys. Specifically, the EMU Pilot Survey has a high density of sources, and also a high sensitivity to low surface brightness emission. These properties result in the detection of types of sources that were rarely seen in or absent from previous surveys. We present some of these new results here.
We evaluated the performance of three serological tests – an immunoglobulin G indirect enzyme linked immunosorbent assay (iELISA), a Rose Bengal test and a slow agglutination test (SAT) – for the diagnosis of bovine brucellosis in Bangladesh. Cattle sera (n = 1360) sourced from Mymensingh district (MD) and a Government owned dairy farm (GF) were tested in parallel. We used a Bayesian latent class model that adjusted for the conditional dependence among the three tests and assumed constant diagnostic accuracy of the three tests in both populations. The sensitivity and specificity of the three tests varied from 84.6% to 93.7%, respectively. The true prevalences of bovine brucellosis in MD and the GF were 0.6% and 20.4%, respectively. Parallel interpretation of iELISA and SAT yielded the highest negative predictive values: 99.9% in MD and 99.6% in the GF; whereas serial interpretation of both iELISA and SAT produced the highest positive predictive value (PPV): 99.9% in the GF and also high PPV (98.9%) in MD. We recommend the use of both iELISA and SAT together and serial interpretation for culling and parallel interpretation for import decisions. Removal of brucellosis positive cattle will contribute to the control of brucellosis as a public health risk in Bangladesh.
We are a group of researchers and clinicians with collective experience in child survival, nutrition, cognitive and social development, and treatment of common mental conditions. We join together to welcome an expanded definition of child development to guide global approaches to child health and overall social development. We call for resolve to integrate maternal and child mental health with child health, nutrition, and development services and policies, and see this as fundamental to the health and sustainable development of societies. We suggest specific steps toward achieving this objective, with associated global organizational and resource commitments. In particular, we call for a Global Planning Summit to establish a much needed Global Alliance for Child Development and Mental Health in all Policies.
Development disorders and delays are recognised as a public health priority and included in the WHO mental health gap action programme (mhGAP). Parents Skills Training (PST) is recommended as a key intervention for such conditions under the WHO mhGAP intervention guide. However, sustainable and scalable delivery of such evidence based interventions remains a challenge. This study aims to evaluate the effectiveness and scaled-up implementation of locally adapted WHO PST programme delivered by family volunteers in rural Pakistan.
Methods.
The study is a two arm single-blind effectiveness implementation-hybrid cluster randomised controlled trial. WHO PST programme will be delivered by ‘family volunteers’ to the caregivers of children with developmental disorders and delays in community-based settings. The intervention consists of the WHO PST along with the WHO mhGAP intervention for developmental disorders adapted for delivery using the android application on a tablet device. A total of 540 parent-child dyads will be recruited from 30 clusters. The primary outcome is child's functioning, measured by WHO Disability Assessment Schedule – child version (WHODAS-Child) at 6 months post intervention. Secondary outcomes include children's social communication and joint engagement with their caregiver, social emotional well-being, parental health related quality of life, family empowerment and stigmatizing experiences. Mixed method will be used to collect data on implementation outcomes. Trial has been retrospectively registered at ClinicalTrials.gov (NCT02792894).
Discussion.
This study addresses implementation challenges in the real world by incorporating evidence-based intervention strategies with social, technological and business innovations. If proven effective, the study will contribute to scaled-up implementation of evidence-based packages for public mental health in low resource settings.
Trial registration.
Registered with ClinicalTrials.gov as Family Networks (FaNs) for Children with Developmental Disorders and Delays. Identifier: NCT02792894 Registered on 6 July 2016.
Any plant not sown from seed is often labeled a weed in improved pastures of New Zealand. Most improved pastures are a mix of perennial ryegrass and white clover but generally are infested with broadleaf weeds. Changes in forage production due to individual weeds were determined using measurements of perennial ryegrass and white clover before and after dairy cattle, beef cattle, or sheep grazing under, near, and far from individual plants of six rosette-forming weed species throughout a growing season. The larger weeds, bull thistle and musk thistle, reduced the amount of forage utilized 42 and 72%, respectively, in beef cattle– and sheep-grazed hill-country pastures. Forage production under and near Canada thistle, hedge mustard, broadleaf plantain, and hairy buttercup in a dairy pasture was greater (136, 140, 178, and 450%, respectively) than in the control areas. Although the dairy pasture was grazed following recommended grazing procedures, our results indicate that this grazing system was not maximizing forage yield potentials of perennial ryegrass and white clover and that these weeds served as an indicator that the pasture was being overgrazed.
This paper considers four alternative sets of actions that a pilot may use to recover an aeroplane from the stall. These actions: those published by the UK CAA and the US FAA, as well as a power delayed sequence and a pitch delayed sequence, were evaluated on 14 single engine piston aeroplane types. In a limited number of types (five in cruise configuration, two in landing configuration) the pitch delayed recovery gave a safe response and least height loss, but in a greater number of types (six and eight in cruise and landing configurations respectively) it resulted in further post-stall uncommanded motion. The other sets of actions all gave a consistent recovery from the stall, but the least height loss in recovery was also consistently the CAA sequence of simultaneous full power and nose-down pitching input, which normally resulted in approximately two thirds the height loss of the FAA’s pitch first then power method, which in turn resulted in about 90% of the height loss of the trialled power delayed recovery. Additionally the CAA recovery gave the least variation in height loss during stall recovery. It was also found that all of the aeroplane types evaluated except for one microlight aeroplane of unusual design, displayed a pitch-up with increased power in the normal (pre-stall) flight regime. Reducing this to separate components it was therefore shown that pitch control is of primary importance and should be used to provide immediate stall recovery. The thrust control can additionally be used as early as possible to minimise height loss, but if the thrust control is used before the pitch control in the stall or post-stall flight regime, there is some risk of subsequent loss of control. Finally, from the discussion on stall recovery methods, questions for Regulatory Authorities are put forward that should address the current practices.
Sexual minorities experience excess psychological ill health globally, yet the UK data exploring reasons for poor mental health among sexual minorities is lacking. This study compares the prevalence of a measure of well-being, symptoms of common mental disorder (CMD), lifetime suicidal ideation, harmful alcohol and drug use among inner city non-heterosexual and heterosexual individuals. It is the first UK study which aims to quantify how much major, everyday and anticipated discrimination; lifetime and childhood trauma; and coping strategies for dealing with unfair treatment, predict excess mental ill health among non-heterosexuals. Further, inner city and national outcomes are compared.
Methods.
Self-report survey data came from the South East London Community Health study (N = 1052) and the Adult Psychiatric Morbidity Survey (N = 7403).
Results.
Adjustments for greater exposure to measured experiences of discrimination and lifetime and childhood trauma had a small to moderate impact on effect sizes for adverse health outcomes though in fully adjusted models, non-heterosexual orientation remained strongly associated with CMD, lifetime suicidal ideation, harmful alcohol and drug use. There was limited support for the hypothesis that measured coping strategies might mediate some of these associations. The inner city sample had poorer mental health overall compared with the national sample and the discrepancy was larger for non-heterosexuals than heterosexuals.
Conclusions.
Childhood and adult adversity substantially influence but do not account for sexual orientation-related mental health disparities. Longitudinal work taking a life course approach with more specific measures of discrimination and coping is required to further understand these associations. Sexual minorities should be considered as a priority in the design and delivery of health and social services.
Psychiatric in-patients are at high risk of suicide. Recent reductions in bed numbers in many countries may have affected this risk but few studies have specifically investigated temporal trends. We aimed to explore trends in psychiatric in-patient suicide over time.
Method
A prospective study of all patients admitted to National Health Service (NHS) in-patient psychiatric care in England (1997–2008). Suicide rates were determined using National Confidential Inquiry and Hospital Episode Statistics (HES) data.
Results
Over the study period there were 1942 psychiatric in-patient suicides. Between the first 2 years of the study (1997, 1998) and the last 2 years (2007, 2008) the rate of in-patient suicide fell by nearly one-third from 2.45 to 1.68 per 100 000 bed days. This fall in rate was observed for males and females, across ethnicities and diagnoses. It was most marked for patients aged 15–44 years. Rates also fell for the most common suicide methods, particularly suicide by hanging on the ward (a 59% reduction). Although the number of post-discharge suicides fell, the rate of post-discharge suicide may have increased by 19%. The number of suicide deaths in those under the care of crisis resolution/home treatment teams has increased in recent years to approximately 160 annually.
Conclusions
The rate of suicide among psychiatric in-patients in England has fallen considerably. Possible explanations include falling general population rates, changes in the at-risk population or improved in-patient safety. However, a transfer of risk to the period after discharge or other clinical settings such as crisis resolution teams cannot be ruled out.
Ultrahigh axial magnetic fields have been compressed and measured in a gas-puff Z pinch. A 0·5-MA, 2–cm-radius annular gas-puff Z pinch with a 3-minute repetition rate was imploded radially onto an axial seed field, causing the field to compress. Axial magnetic field compressions up to 180 and peak magnetic fields up to 1·6 MG were measured. Faraday rotation of an argon laser (515·4 nm) in a quartz fiber on axis was the principal magnetic field diagnostic. Other diagnostics included a nitrogen laser interferometer, x-ray diodes, and magnetic field probes.
The magnetic field compression results are consistent with simple snowplow and self-similar analytic models, which are presented. The axial magnetic fields strongly affect the Z pinch dynamics. Even small axial fields help stabilize the pinches, some of which exhibit several stable radial bounces during a current pulse.
The method of compressing axial fields in a gas-puff Z pinch is extrapolable to the order of 100 MG. Scaling laws are presented. Potential applications of ultrahigh axial fields in Z pinches are discussed for x-ray lasers, inertial confinement fusion, and collimated sources of gamma radiation.
A computer program is developed using the classical oscillator model of Hans W. Verleur [1] to study the transmittance and reflectance spectra of pre- and post radiation damaged optical components such as color glass filters, multilayer bandpass filters and band reject filters irradiated by one megárad gamma radiation from a 60Co source. In the classical oscillator model, the complex dielectric constant ε(ω) is represented as the sum of classical oscillators with oscillator strength Si, resonance frequency ωi, linewidth Γi and high frequency dielectric constant ε∞ which are the adjustable parameters to fit the experimental transmittance and reflectance data over a limited range of frequency. The parameters have physical significance in the lattice vibrational region. In the spectral regions corresponding to electronic transitions, the spectra can be fitted accurately with no physical meaning associated with the parameters. The present work has concentrated on the calculations of the optical constants n and k of the radiation damaged optical components to determine the effects of 60Co gamma radiation on the optical constants of both films and substrates in these components.
Dry etching can introduce defects into the material being etched. Simple expressions for both sidewall and top surface defect distributions may be obtained by assuming that the defects are introduced according to a phenomenological source function. Calculations of conductance based on these expressions are found to describe very well measurements on dry-etched wires and epilayers. Mechanisms by which defects can penetrate into the sample are discussed. The role of sample heating and defect diffusion is examined. In-situ measurements of sample temperature during a dry-etch run indicate that simple diffusion is insufficient to account entirely for the observed damage. Instead, dry-etch damage may arise from other mechanisms such as by knock-on replacement collisions, or via a channeling effect. A more complex form of diffusion may also affect the final damage distribution.
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