Herbal medicines:physician's recommendation and clinical evaluation of St.John's Wort for depression

Why some physicians recommend herbal medicines while others do not is not well understood. We undertook a survey designed to identify factors, which predict recommendation of herbal medicines by physicians in Malaysia. About a third (206 out of 626) of the physicians working at the University of Malaya Medical Centre ' were interviewed face-to-face, using a structured questionnaire. Physicians were asked about their personal use of, recommendation of, perceived interest in and, usefulness and safety of herbal medicines. Using logistic regression modelling we identified personal use, general interest, interest in receiving training, race and higher level of medical training as significant predictors of recommendation. St. John's wort is one of the most widely used herbal remedies. It is also probably the most widely evaluated herbal remedy with no fewer than 57 randomised controlled trials. Evidence from the depression trials suggests that St. John's wort is more effective than placebo while its comparative efficacy to conventional antidepressants is not well established. We updated previous meta-analyses of St. John's wort, described the characteristics of the included trials, applied methods of data imputation and transformation for incomplete trial data and examined sources of heterogeneity in the design and results of those trials. Thirty randomised controlled trials, which were heterogeneous in design, were identified. Our meta-analysis showed that St. John's wort was significantly more effective than placebo [pooled RR 1.90 (1.54-2.35)] and [Pooled WMD 4.09 (2.33 to 5.84)]. However, the remedy was similar to conventional antidepressant in its efficacy [Pooled RR I. 0 I (0.93 -1.10)] and [Pooled WMD 0.18 (- 0.66 to 1.02). Subgroup analyses of the placebo-controlled trials suggested that use of different diagnostic classifications at the inclusion stage led to different estimates of effect. Similarly a significant difference in the estimates of efficacy was observed when trials were categorised according to length of follow-up. Confounding between the variables, diagnostic classification and length of trial was shown by loglinear analysis. Despite extensive study, there is still no consensus on how effective St. lohn's wort is in depression. However, most experts would agree that it has some effect. Our meta-analysis highlights the problems associated with the clinical evaluation of herbal medicines when the active ingredients are poorly defined or unknown. The problem is compounded when the target disease (e.g. depression) is also difficult to define and different instruments are available to diagnose and evaluate it.

The Frenchness of Marcel Lefebvre and the Society of St Pius X:a new reading

The case of Marcel Lefebvre and the SSPX deserves fresh perspectives. The current historiography is too franco-centric, obsessed with relatively minor matters, rather than with more substantial ones. This article proposes a new analysis of the SSPX’s political discourses in France and internationally over the last fifteen years and undertakes to reframe the relationship between Lefebvre’s life and his congregation by re-examining his African missionary experiences. Such new perspectives will be helpful as the SSPX moves towards regularisation under the pontificate of Pope Francis.

Theoretical studies of the mid-latitude ionosphere

Following a brief description of the atmosphere and ionosphere in Chapter I we describe how the equations of continuity and momentum for 0+, H+, He+, 0++ are derived from the formulations of St-Maurice and Schunk(1977) and Quegan et al.(1981) in Chapter II. In Chapter III we investigate the nature of the downward flow of protons in a collapsing post-sunset ionosphere. We derive an analytical form for the limiting temperature, we also note the importance of the polarization field term and concluded that the flow will remain subsonic for realistic conditions. The time-dependent behaviour of He+ under sunspot minimum conditions is investigated in Chapter IV. This is achieved by numerical solution of the 0+, H+ and,He+ continuity and momentum equations, treating He+ as a minor ion with 0+ , H+ as major ions. We found that He+ flows upwards during the day-time and downwards during the nighttime. He+ flux tube content reached a maximum on the 8th day of the integration period and started to decreasing. This is due to the large amount of H+ present at the late stages of the integration period which makes He+ unable to diffuse through the H+ layer away from the loss region. In Chapter V we investigate the behaviour of 0++ using sunspot maximum parameters. Although our results support the findings of Geis and Young (1981) that the large amounts of 0++ at the equator are caused mainly by thermal diffusion, the model used by Geis and Young overemphesizes the effect of thermal diffusion. The importance of 0++ - 0+ collision frequency is also noted. In Chapter VI we extend the work of Chapter IV, presenting a comparative study of H and He at sunspot minimum and sunspot maximum.In this last Chapter all three ions, O+ ,H+ and He+ , are treated theoretically as major ions and we concentrate mainly on light ion contents and fluxes. The results of this Chapter indicate that by assuming He+ as a minor ion we under-estimate He+ and over-estimate. H+. Some interesting features concerning the day to day behaviour of the light ion fluxes arise. In particular the day-time H+ fluxes decrease from day to day in contrast to the work of Murphy et al.(1976). In appendix.A we derive some analytical forms for the optical depth so that the models can include a realistic description of photoionization.

The extent and impact of outsourcing:evidence from Germany

The authors use data from several sources, including plant-level data from the manufacturing sector in Germany, to expand the literature on outsourcing. They find that, in Germany, the extent of outsourcing among manufacturing industries is higher than among service industries and that the outsourcing intensity of these industries did not change much between 1995 and 2005. They also find a statistically significantly positive impact of industry-level outsourcing intensity on German plant-level labor productivity for both 2000 and 2005. The estimated economic impact of outsourcing on plant-level productivity is also fairly significant.

Application of staged O2 feeding in the oxidative dehydrogenation of ethylbenzene to styrene over Al2O3 and P2O5/SiO2 catalysts

Drastic improvements in styrene yield and selectivity were achieved in the oxidative dehydrogenation of ethylbenzene by staged feeding of O2. Six isothermal packed bed reactors were used in series with intermediate feeding of O2, while all EB was fed to the first reactor, diluted with helium or CO2 (1:5 molar ratio), resulting in total O2:EB molar feed ratios of 0.2-0.6. The two catalyst samples, γ-Al 2O3 and 5P/SiO2, that were applied both benefitted from this operation mode. The ethylbenzene conversion per stage and the selectivity to styrene were significantly improved. The production of COX was effectively reduced, while the selectivity to other side products remained unchanged. Compared with co-feeding at a total O 2:EB molar feed ratio of 0.6, by staged feeding the EB conversion (+15% points for both catalysts), ST selectivity (+4% points for both samples) and O2 (ST) selectivity (+9% points for γ-Al2O 3 and +17% points for 5P/SiO2) all improved. The ethylbenzene conversion over 5P/SiO2 can be increased from 18% to 70% by increasing the number of reactors from 1 to 6 with each reactor a total amount of O2 of 0.1 without the loss of ST selectivity (93%). For 5P/SiO2 a higher temperature (500 C vs. 450 C for Al 2O3) is required. Essentially more catalyst (5P/SiO 2) was required to achieve full O2 conversion in each reactor. Staged feeding of O2 does not eliminate the existing issues of the catalyst stability both in time-on stream and as a function of the number of catalyst regenerations (5P/SiO2), or the relatively moderate performance (relatively low styrene selectivity for γ-Al2O 3). © 2014 Elsevier B.V.