Darjeeling

This trial is for adults who have had an acute ischemic stroke caused by a blood clot blocking a brain vessel. It focuses on people whose stroke occurred or was discovered more than 4.5 hours ago, including those who woke up with stroke symptoms. The study aims to find out if the medicine tenecteplase helps recovery when given after this 4.5-hour window, compared to standard medical care. Tenecteplase is already used within 4.5 hours after stroke onset, but this study tests its effect when given later. Participants are randomly assigned to one of two groups one receives a single injection of tenecteplase into a vein, and the other receives the usual standard treatment. Both groups have an equal chance of receiving either treatment. The study lasts about three months, starting with approximately one week of hospital stay. During the study, participants have seven clinical examinations or visits, with the final two visits conducted remotely from home to allow for easier participation. Throughout the study, doctors regularly assess participants recovery using a scale that measures disability and dependence in daily activities. They also monitor overall health and record any side effects. The main outcome measured is the level of recovery 90 days after treatment, comparing the two groups. This includes neurological improvement, bleeding events, and survival over the study period.

This research aims to pilot test a novel, potentially sustainable system where teachers deliver mental health care to adolescents in rural, low-cost private secondary schools in the Darjeeling Himalayas. The study focuses on the Tealeaf-A intervention, adapted from a program originally developed for children, to address the youth mental health crisis by integrating therapy into teachers daily interactions with students. The goal is to see if teachers can effectively deliver this approach and if it leads to improved mental health outcomes for adolescents. The study involves two groups of schools one receiving the Tealeaf-A intervention, where teachers complete six days of training and receive biweekly supervision to deliver care throughout the school year and a comparator group receiving enhanced usual care, which includes two days of training but no supervision. Tealeaf-A includes teacher-led identification of students needing care, behavioral assessments, individualized therapeutic plans called the 4Cs, and collaboration with caregivers, all delivered within the school environment. The intervention emphasizes real-time support and coping skill practice during the school day. Participants, including principals, teachers, students aged 13 to 17, and their guardians, will take part in assessments such as the Youth Self-Report and Teachers Report Form to measure mental health symptoms. Researchers will evaluate implementation outcomes like reach, adoption, and fidelity, as well as clinical effectiveness and maintenance of benefits over time. The study uses a cluster randomized controlled design with mixed methods, including interviews and quantitative measures, with follow-up extending up to 21 months. The total participation spans an academic year with ongoing monitoring and evaluation.