Supervised Treatment in Outpatients for Schizophrenia Plus (STOPS+): Protocol for a cluster randomised trial of a community-based intervention to improve treatment adherence and reduce the treatment gap for schizophrenia in Pakistan

Introduction: There is a significant treatment gap, with only a few community-based services for people with schizophrenia in Low- and Middle-Income countries. Poor treatment adherence in schizophrenia is associated with poorer health outcomes, suicide attempts and death. We previously reported the effectiveness of STOPS (Supervised Treatment in Outpatients for Schizophrenia) for improving treatment adherence in patients with schizophrenia. However, STOPS was evaluated in a tertiary care setting with no primary care involvement, limiting its generalisability to the wider at-risk population. We aim to evaluate the effectiveness of STOPS+ in scaling up the primary care treatment of schizophrenia to a real-world setting. Methods and analysis: The effectiveness of the STOPS+ intervention in improving the level of functioning and medication adherence in patients with schizophrenia in Pakistan will be evaluated using a cluster randomised controlled trial design. We aim to recruit 526 participants from 24 Primary Health Care Centres (PHCs) randomly allocated in 1:1 ratio to STOPS+ intervention and Enhanced Treatment as Usual (ETAU) arms. Participants will be followed-up for 12 months post recruitment. The sample size is estimated for two outcomes (i) The primary clinical outcome is level of functioning, measured using the Global Assessment of Functioning (GAF) scale, and (ii) the primary process outcome is adherence to treatment regimen measured using a validated measure. An intention-to-treat approach will be used for the primary analysis. Ethics and Dissemination: Ethical approval has been obtained from Keele University Ethical Review Panel (ref: MH-190017) and Khyber Medical University Ethical Review Board (ref: DIR-KMU-EB/ST/000648). The results of the STOPS+ trial will be reported in peer reviewed journals and academic conferences and disseminated to local stakeholders and policy makers

Cognitive therapy for depression in tuberculosis treatment: protocol for multicentre pragmatic parallel arm randomised control trial with an internal pilot

Introduction and objectives There is an unmet need to develop high-quality evidence addressing tuberculosis (TB)-related mental health comorbidity, particularly in the context of lower-middle-income countries. This study aims to examine the effectiveness and cost-effectiveness of cognitive behavioural therapy (CBT) versus enhanced treatment as usual (ETAU) in improving depressive symptoms in people with TB and comorbid depression, enhancing adherence with anti-TB treatment (ATT) and its implementation in the real-world setting of Pakistan. Methods We will conduct a pragmatic parallel arm randomised control trial with an internal pilot. A brief psychological intervention based on CBT has been developed using a combination of qualitative and ethnographic studies. The inbuilt pilot trial will have a sample size of 80, while we plan to recruit 560 (280 per arm) participants in the definitive trial. Participants who started on ATT within 1 month of diagnosis for pulmonary and extrapulmonary TB or multidrug resistant TB (MDR-TB) and meeting the criteria for depression on Patient Health Questionnaire-9 (PHQ-9) will be randomised with 1:1 allocation to receive six sessions of CBT (delivered by TB healthcare workers) or ETAU. Data on the feasibility outcomes of the pilot will be considered to proceed with the definitive trial. Participants will be assessed (by a blinded assessor) for the following main trial primary outcomes: (1) severity of depression using PHQ-9 scale (interviewer-administered questionnaire) at baseline, weeks 8, 24 and 32 postrandomisation and (2) ATT at baseline and week 24 at the end of ATT therapy. Ethics and dissemination Ethical approval has been obtained from Keele University Research Ethics Committee (ref: 2023-0599-792), Khyber Medical University Ethical Review Board (ref: DIR/KMU-EB/CT/000990) and National Bioethics Committee Pakistan (ref: No.4–87/NBC-998/23/587). The results of this study will be reported in peer-reviewed journals and academic conferences and disseminated to stakeholders and policymakers. Trial registration number ISRCTN10761003

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Tribological Considerations of Cutting Fluids in Machining Environment: A Review

The paper presents a review to highlight the tribological aspects of cutting fluids in machining environment. In this study, different machining processes viz. turning, grinding, drilling and milling have been considered with a special focus on grinding process. The cutting fluids are primarily used as coolants and lubricants in the various machining processes. Different cutting fluids and the health hazards associated with their use have also been represented in this research article. The paper also highlights the role of work materials and the cutting tool materials from tribology point of view. The literature revealed that the development of biocompatible cutting fluids, recycling of cutting fluids, cutting fluids for high temperature tribological applications, studying the wetability characteristics with addition of nanoparticles, etc. can be taken up as study in order to enhance the tribological properties of the cutting fluids

Wage differentials, employment and globalisation Evidence from an international panel

SIGLEAvailable from British Library Document Supply Centre-DSC:3597.3859(21-98) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Determinants of productivity growth Some international evidence

SIGLEAvailable from British Library Document Supply Centre-DSC:3597.3859(20-98) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Evaluation of Injection Molding Process Parameters for Manufacturing Polyethylene Terephthalate

Quality control is an important aspect in manufacturing process. The quality of product in injection moulding is influenced by injection moulding process parameter. In this study, the effect of injection moulding parameter on defects quantity of PET preform was investigated. Optimizing the parameter of injection moulding process is critical to enhance productivity where parameters must operate at an optimum level for an acceptable performance. Design of Experiment (DOE) by factorial design approach was used to find an optimum parameter setting and reduce the defects. In this case study, Minitab 17 software was used to analyses the data. The selected input parameters were mould hot runner temperature, water cooling chiller temperature 1 and water cooling chiller temperature 2. Meanwhile, the output for the process was defects quantity of the preform. The relationship between input and output of the process was analyzed using regression method and Analysis of Variance (ANOVA). In order to interpolate the experiment data, mathematical modeling was used which consists of different types of regression equation. Next, from the model, 95% confidence level (p-value) was considered and the significant parameter was figured out. This study involved a collaboration with a preform injection moulding company which was Nilai Legasi Plastik Sdn Bhd. The collaboration enabled the researchers to collect the data and also help the company to improve the quality of its production. The results of the study showed that the optimum parameter setting that could reduce the defect quantity of preform was MHR= 88°C, CT1= 24°C and CT2= 27°C. The comparison defect quantity analysis between current companies setting with the optimum setting showed improvement by 21% reduction of defect quantity at the optimum setting. Finally, from the optimization plot, the validation error between the prediction value and experiment was 1.72%. The result proved that quality of products can be improved by using the DOE approach

Evaluation of Injection Molding Process Parameters for Manufacturing Polyethylene Terephthalate

Quality control is an important aspect in manufacturing process. The quality of product in injection moulding is influenced by injection moulding process parameter. In this study, the effect of injection moulding parameter on defects quantity of PET preform was investigated. Optimizing the parameter of injection moulding process is critical to enhance productivity where parameters must operate at an optimum level for an acceptable performance. Design of Experiment (DOE) by factorial design approach was used to find an optimum parameter setting and reduce the defects. In this case study, Minitab 17 software was used to analyses the data. The selected input parameters were mould hot runner temperature, water cooling chiller temperature 1 and water cooling chiller temperature 2. Meanwhile, the output for the process was defects quantity of the preform. The relationship between input and output of the process was analyzed using regression method and Analysis of Variance (ANOVA). In order to interpolate the experiment data, mathematical modeling was used which consists of different types of regression equation. Next, from the model, 95% confidence level (p-value) was considered and the significant parameter was figured out. This study involved a collaboration with a preform injection moulding company which was Nilai Legasi Plastik Sdn Bhd. The collaboration enabled the researchers to collect the data and also help the company to improve the quality of its production. The results of the study showed that the optimum parameter setting that could reduce the defect quantity of preform was MHR= 88°C, CT1= 24°C and CT2= 27°C. The comparison defect quantity analysis between current companies setting with the optimum setting showed improvement by 21% reduction of defect quantity at the optimum setting. Finally, from the optimization plot, the validation error between the prediction value and experiment was 1.72%. The result proved that quality of products can be improved by using the DOE approach

Evaluation of Injection Molding Process Parameters for Manufacturing Polyethylene Terephthalate

Quality control is an important aspect in manufacturing process. The quality of product in injection moulding is influenced by injection moulding process parameter. In this study, the effect of injection moulding parameter on defects quantity of PET preform was investigated. Optimizing the parameter of injection moulding process is critical to enhance productivity where parameters must operate at an optimum level for an acceptable performance. Design of Experiment (DOE) by factorial design approach was used to find an optimum parameter setting and reduce the defects. In this case study, Minitab 17 software was used to analyses the data. The selected input parameters were mould hot runner temperature, water cooling chiller temperature 1 and water cooling chiller temperature 2. Meanwhile, the output for the process was defects quantity of the preform. The relationship between input and output of the process was analyzed using regression method and Analysis of Variance (ANOVA). In order to interpolate the experiment data, mathematical modeling was used which consists of different types of regression equation. Next, from the model, 95% confidence level (p-value) was considered and the significant parameter was figured out. This study involved a collaboration with a preform injection moulding company which was Nilai Legasi Plastik Sdn Bhd. The collaboration enabled the researchers to collect the data and also help the company to improve the quality of its production. The results of the study showed that the optimum parameter setting that could reduce the defect quantity of preform was MHR= 88°C, CT1= 24°C and CT2= 27°C. The comparison defect quantity analysis between current companies setting with the optimum setting showed improvement by 21% reduction of defect quantity at the optimum setting. Finally, from the optimization plot, the validation error between the prediction value and experiment was 1.72%. The result proved that quality of products can be improved by using the DOE approach