We sought to understand the main ethical considerations when conducting clinical trials in the prehospital ambulance based setting. A systematic review of the literature on randomised controlled trials in ambulance settings was undertaken. A search of eight databases identified published studies involving recruitment of ambulance service users. Four independent authors undertook abstract and full-text reviews to determine eligibility and extract relevant data. The data extraction concentrated on ethical considerations, with any discussion of ethics being included for further analysis. The resultant data were combined to form a narrative synthesis. In all, 56 papers were identified as meeting the inclusion criteria. Issues relating to consent were the most significant theme identified. Type of consent differed depending on the condition or intervention being studied. The country in which the research took place did not appear to influence the type of consent, apart from the USA where exception from consent appeared to be most commonly used. A wide range of terms were used to describe consent. Consent was the main ethical consideration in published ambulance based research. A range of consent models were used ranging from informed consent to exception from consent (waiver of consent). Many studies cited international guidelines as informing their choice of consent model but diverse and sometimes confused terms were used to describe these models. This suggests that standardisation of consent models and the terminology used to describe them is warranted.
This study explores Bangladesh's mental health services from an individual- and system-level perspective and provides insights and recommendations for strengthening it's mental health system. We conducted 13 in-depth interviews and 2 focus group discussions. Thirty-one participants were recruited using a combination of purposive and snowball sampling methods. All interviews and group discussions were audio-recorded and transcribed, and key findings were translated from Bengali to English. Data were coded manually and analysed using a thematic and narrative analysis approach. Stakeholders perceived scarcity of service availability at the peripheral level, shortage of professionals, weak referral systems, lack of policy implementation and regulatory mechanisms were significant challenges to the mental health system in Bangladesh. At the population level, low levels of mental health literacy, high societal stigma, and treatment costs were barriers to accessing mental healthcare. Key recommendations included increasing the number of mental health workers and capacity building, strengthening regulatory mechanisms to enhance the quality of care within the health systems, and raising awareness about mental health. Introducing measures that relate to tackling stigma, mental health literacy as well as building the capacity of the health workforce and governance systems will help ensure universal mental health coverage.
This study explores Bangladesh's mental health services from an individual- and system-level perspective and provides insights and recommendations for strengthening it's mental health system. We conducted 13 in-depth interviews and 2 focus group discussions. Thirty-one participants were recruited using a combination of purposive and snowball sampling methods. All interviews and group discussions were audio-recorded and transcribed, and key findings were translated from Bengali to English. Data were coded manually and analysed using a thematic and narrative analysis approach. Stakeholders perceived scarcity of service availability at the peripheral level, shortage of professionals, weak referral systems, lack of policy implementation and regulatory mechanisms were significant challenges to the mental health system in Bangladesh. At the population level, low levels of mental health literacy, high societal stigma, and treatment costs were barriers to accessing mental healthcare. Key recommendations included increasing the number of mental health workers and capacity building, strengthening regulatory mechanisms to enhance the quality of care within the health systems, and raising awareness about mental health. Introducing measures that relate to tackling stigma, mental health literacy as well as building the capacity of the health workforce and governance systems will help ensure universal mental health coverage.
Abstract OBJECTIVE Image maps of Fractional Tumor Burden (FTB), derived from dynamic susceptibility contrast (DSC) perfusion MRI, provide clinically meaningful information for glioma treatment management. The goal of this study was to determine if presurgical FTB is predictive of overall survival (OS) in high-grade glioma (HGG) classified according to WHO 2016 criteria. METHODS Standardized relative cerebral blood volume (sRCBV) maps were created and co-registered with T1+C images using Horos (Version 4.0.0) and Imaging Biometrics software (Version 21.05) (Elm Grove, WI). Enhancing tumor volumes were determined from calibrated pre/post T1 difference (dT1) maps. Tissue-validated sRCBV thresholds were used to create FTB class maps within enhancing lesion with red regions (sRCBV > 1.556) indicating a high probability of vascular tumor, blue regions (sRCBV< 1.0) indicating avascular (non-tumor) tissue and yellow representing tissue with a lower probability of vascular tumor. FTB volume fractions (FTBv) for all vascular tumor (sRCBV >1.0) or the most vascular tumor (sRCBV > 1.566) were determined. Subjects were separated by MGMT methylation status. GraphPad Prism statistical software (Version 9.3.1) was used for Kaplan Meier survival analysis at 12 and 24 months with patients stratified by median FTBv. RESULTS Forty-one subjects (23 males, 18 females) with a median age of 59.45 years were included. Median 12-month and overall survival of unmethylated groups stratified by FTBv (rCBV > 1.0) of 8.33cc was 10.69 and 15.35 months (p=.0453; p=.0317). Unmethylated subjects stratified with FTBv (rCBV > 1.566) of 7.13cc had a median survival of 10.69 and 15.20 with short- and long-term survival distinguished at 12 months (p=0.0033), 24 months (p=0.0002) and overall (p=0.0002). No significant difference in survival was found between the methylated subgroups with FTBv (rCBV > 1.0) or FTBv (rCBV > 1.566) stratified analyses. CONCLUSION These results demonstrate that pre-surgical FTBv is predictive of OS in newly diagnosed unmethylated high-grade glioma.
Literature is usually produced by members of the dominant classes in society and represent ideas as seen from their social as well as cultural position. Subaltern people have long been relatively powerless in presenting themselves in the literary world. They have not been better represented, rather socially and politically misrepresented. Georg Gugelberger has noted that critical theory and research is being created on the margins between literary theory and anthroplogy and that in its exploration of literature, it is involved in the “construction of differences that are the necessary cultural dimensions of empire- differences which make it possible to distinguish the colonized from the colonizer”(4). Gayatri Spivak calls this kind of Western writing as the “othering discourse”, a mistaken belief called “error-as- truth” syndrome. Gugelberger also points out that the educational system needs to be aware of the hegemonic fabrication of such literatures. John Beverley suggests that the best way to approach the subaltern is through testimonial literature. Gugelberger considers Chinua Achebe’s Things Fall Apart published in 1959, as the originating point of testimonies. According to him the writing of the novel set up the nailing of the canonical literature as a “misrepresentation of African reality”(5) by creators of literature from the “centre”. Achebe’s work is considered a “corrective efffort”(5). Testimonial narrative has come a long way ever since and it does not write to the past but with the future. Latin American testimonial discourse was born in Cuba in the mid- and late 1960’s with Miguel Barnet’s The Autobiography of a Runaway Slave in 1967. This form of expression soon developed in Mexico, Bolivia, Guatemala, Nicaragua, El Salvador and Honduras. Miguel Marmol is one very significant testimonial writers from El Salvador. Testimonial literatures alter the balance between the centre and the periphery reconfiguring the global cultural differences pushing the margins to the center. Third world liberation activities have helped the production of this genre, to produce thought and action in the west since testimonial discourses have to be located in the cultural spaces, like the Cuban Revolution. George Yudice defines Testimonial literature as “an authentic narrative, told by a witness who is moved to narrate by the urgency of a situation (eg. war, oppression, revolution, etc.)”. Yudice also explains: […] the testimonialista gives his or her personal testimony “directly,” addressing a specific interlocutor. As in the works of Elvia Alvarado (1987), Rigoberta Menchu (1983), and Domitila Barrios de Chungara
Insomnia is a prevalent and distressing sleep disorder. Multicomponent cognitive-behavioural therapy is the recommended first-line treatment, but access remains extremely limited, particularly in primary care where insomnia is managed. One principal component of cognitive-behavioural therapy is a behavioural treatment called sleep restriction therapy, which could potentially be delivered as a brief single-component intervention by generalists in primary care.
Abstract This study explores Bangladesh’s mental health services from an individual- and system-level perspective and provides insights and recommendations for strengthening it’s mental health system. We conducted 13 in-depth interviews and 2 focus group discussions. Thirty-one participants were recruited using a combination of purposive and snowball sampling methods. All interviews and group discussions were audio-recorded and transcribed, and key findings were translated from Bengali to English. Data were coded manually and analysed using a thematic and narrative analysis approach. Stakeholders perceived scarcity of service availability at the peripheral level, shortage of professionals, weak referral systems, lack of policy implementation and regulatory mechanisms were significant challenges to the mental health system in Bangladesh. At the population level, low levels of mental health literacy, high societal stigma, and treatment costs were barriers to accessing mental healthcare. Key recommendations included increasing the number of mental health workers and capacity building, strengthening regulatory mechanisms to enhance the quality of care within the health systems, and raising awareness about mental health. Introducing measures that relate to tackling stigma, mental health literacy as well as building the capacity of the health workforce and governance systems will help ensure universal mental health coverage.
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