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In the healthy brain, homeostatic balance between excitation and inhibition maintains neural stability. Reduced inhibition may explain shared symptoms observed in autism and psychosis. Here we review evidence suggesting that altered levels of gamma-aminobutyric acid (GABA) may underlie both disorders, providing a potential cross-diagnostic therapeutic target.
During the early stages of drop-pool impacts, an air film is temporarily entrapped between the liquid bodies. At low impact velocities, this film can become highly stretched, allowing for contact-free penetration of the drop into the pool. The elongated film never ruptures for the lowest impact velocities, resulting in drop bouncing. For higher impact velocities, the elongated film ruptures to entrain hundreds of micro-bubbles in a process known as Mesler entrainment. At even higher impact velocities, an elongated film never forms as early contact entraps a shorter disk-type film which retracts to one or few central bubbles. In this work we use numerical simulations of water drop-pool impacts along with theoretical analyses to discover a capillary transition that prevents early contact. This transition allows the drop to penetrate further into the pool and provides a pathway for the formation of elongated films. Since Mesler entrainment is only possible if early contact is prevented, we use the occurrence of transition as a criterion to provide an upper boundary for the Mesler entrainment regime. We observe from low
simulations that after transition, the drop spreads on the pool surface, during which the minimum film thickness increases and the film regularizes. Interestingly, we observe the formation of kinks between the centre of the film and the spreading fronts, and find asymptotic scaling laws governing the film thickness. Lastly, by examining the role of liquid viscosity, we shed light on transition dynamics for different liquids.
The optimal management of symptomatic tetralogy of Fallot in neonates and younger infants with unfavourable anatomy is unclear and is further constrained by resource limitations in low and middle income countries.
Retrospective medical record review of infants with tetralogy of Fallot undergoing corrective or palliative procedures between January 2016 and June 2019.
The study included 120 infants; of whom 83 underwent primary complete repair, four underwent surgical palliation, and 33 underwent catheter-based palliation, including balloon pulmonary valvuloplasty (n = 18), right ventricular outflow tract stenting (n = 14), and stenting of the patent arterial duct (n = 1). Infants undergoing catheter-based procedures were younger in age (median 32 days; inter-quartile range (IQR) 7–144 versus 210 days; IQR 158–250), with lower baseline saturation (65 ± 12% versus 87 ± 7%) and had smaller pulmonary artery z-scores compared to the complete repair cohort. Follow-up was available for 31/33 (94%) infants (median 7 months [IQR 4–11]) who underwent trans-catheter palliation; 12 underwent complete repair, 10 are well, awaiting repair, eight required further palliation (catheter: 6; surgical: 2), and one died post-discharge from non-cardiac causes.
Catheter-based palliation is a safe and effective alternative in infants with tetralogy of Fallot who are at high risk for primary surgical repair.
I highlight two important factors particular to less-developed countries that can bias evidence generation and contribute to the ‘voltage drop’ in programme benefits, moving from field research experiments to policy implementation at scale. The first is the non-linear increase in information processing and coordination costs associated with upscaling in less-developed countries, given limited state capacity and rigid organizational hierarchies. The second is political bias in the choice of programmes considered for rigorous evaluation itself, resulting in distorted evidence and policy choice. These two factors raise considerations that complement the economics-based approach outlined by Al-Ubaydli et al. in the quest for more rigorous, evidence-based policy.
OBJECTIVES/GOALS: Human placentation requires complex coordination between maternal and fetal cell types but remains incompletely understood. We hypothesize that uterine natural killer (uNK) cells, an immune cell type that increases in abundance during the implantation window, is essential for appropriate implantation and placentation. METHODS/STUDY POPULATION: We plan to examine stromal cell (SC) decidualization, spiral artery remodeling, and EVT invasion, processes vital for early pregnancy establishment, in the presence or absence of secretory phase uNK cells. Fetal extravillous trophoblasts (EVTs) will be isolated from first trimester pregnancy tissue; maternal SCs, endothelial cells (ECs) and uNK cells will be obtained from secretory phase uterine tissue. SCs will be placed in monoculture and coculture with uNK cells and prolactin will be measured to evaluate decidualization. To study EVT invasion, we will utilize our novel “implantation-on-a-chip” device to determine how addition of uNK cells affects EVT migration through a collagen-matrigel matrix. In this system, we will also examine spiral artery remodeling with or without uNK cells via TUNEL staining. RESULTS/ANTICIPATED RESULTS: We anticipate that uNK cell addition to SCs will lead to a significant increase in SC prolactin levels, suggesting a role of uNK cells in endometrial decidualization. In vitro, we expect the addition of uNK cells will increase EC apoptosis and promote EVT invasion. DISCUSSION/SIGNIFICANCE OF IMPACT: Although decidual NK cells are known to participate in placentation, the role of pre-pregnancy uNK cells is unknown. uNK cell involvement in processes important for the earliest stages of pregnancy would provide a potential marker for abnormal placentation and offer avenues for intervention to decrease placentation associated perinatal morbidity.
High rates of mortality and morbidity result from disasters of all types, including armed conflicts. Overwhelming numbers of casualties with a myriad of illnesses and patterns of injuries are common in armed conflicts, leading to unpredictable workloads for hospital health care providers (HCPs). Identifying domains of hospital HCPs’ core competency for armed conflicts is essential to inform standards of care, educational requirements, and to facilitate the translation of knowledge into safe and quality care.
The objective of this study is to identify the common domains of core competencies among HCPs working in hospitals in armed conflict areas.
A scoping review was conducted using the Joanna Briggs Institute framework. The review considered primary research and peer-reviewed literature from the following databases: Ovid Medline, Ovid EmCare, Embase, and CINAHL, as well as the reference lists of articles identified for full-text review. Eligibility criteria were outlined a priori to guide the literature selection.
Four articles met the inclusion criteria. The studies were conducted in different countries and were published from 2011 through 2017. The methods included three surveys and one Delphi study.
This review maps the scope of knowledge, skills, and attitudes required by HCPs who are practicing in hospitals in areas of major armed conflict. Incorporation of identified core competency domains can improve the future planning, education, and training, and may enhance the HCPs’ response in armed conflicts.
Sleep-wake cycle is one of human biological rhythm highly correlated to well being and general health status.Poor sleep quality, sleep disruption and changes in regular Sleep-wake pattern may cause physical and psychological burden such as impairment in job performance, decreased work efficiency and learning disability.
Health care students trained in medical, nursing and midwifery fields is a population who are at great risk to develop sleep disruption and its subsequent physical and mental morbidity.
The aim of this study was to describe how sleep quality correlated to general health status among 280 health care students.
280 health care students studying in health related fields participated in this cross section study. Pittsburg sleep quality index (PSQI), sleep- wake questionnaire and the general health questionnaire (GHQ) administered to gather data describing sleep quality, sleep wake disruption and the general health status.
Preliminary results showed that 61.4% of subjects defined as poor sleeper. In further co relational analysis there was a significant correlation between sleep quality and general health status (r = .6, p = . 000, n = 280). Regression analysis showed that number of nights with sleep disruption due to shift work or academic needs was a strong predictor for both poor sleep quality and general health status.
In conclusion, Sleep disruption due to shift work or other academic demands is a predictor for poor sleep and its subsequent mental health morbidity, which should be considered as a part of mental health policy for health related college students.
The family is the first universal institutional system that is necessary for human survival and development. The relationship between family members determine predisposition to illness and health.
The purpose of this study is to examine differences in perception between patients with schizophrenia and their normal siblings with regard to family functioning and support.
In this cross sectional study fifty schizophrenic patients admitted in 2 psychiatric hospital in shiraz and their 50 normal siblings were participated. A demographic questionnaire, The Perceived Social Support-Family Scale and Family Assessment Device were completed by participants.
Significant differences were noted in perception of family structure and family support between patients with schizophrenia and their normal siblings (p = 0.001). Score of general family function, problem solving and emotional responsiveness in patients with schizophrenia were significantly lower than their normal siblings (P< 0.001).
Patients with schizophrenia perceive their family structure and support more negatively than their sibling. This difference was more significant in problem solving and emotional responsiveness dimensions. Family psycho education and therapy in patients with schizophrenia must consider these aspects of family dysfunction.
Proper attitudes by medical students can impact on the quality of health care delivered to their patients. Negative attitude toward person with mental illness may form a barrier for patients to receive appropriate care.
The aim of this study is to determine the attitudes of medical students toward mentally ill and to investigate impact of medical education on attitude among medical students.
The study comprised 200 clinical &135 basic science medical students at the medical school of Shiraz university who agreed to participate. Community Attitudes towards the Mentally Ill questionnaire were used to assess attitude toward mental illness The tool focuses on measuring levels of authoritarianism, benevolence, social restrictiveness and community mental health ideology.
There was little difference in attitudes about mental illness Between basic science- and clinical medical student except for restrictiveness (p value< 0.05).This difference also was noted between male and female student with higher restrictiveness in female students . 70% of our student have familiarity with someone who have mental illness . Pearson correlation test show significant correlation between familiarity with mental illness and community ideology sub dimension p value< 0.009.
Our sample overly have positive attitude about mental illness ,but there is no significant positive correlation between years of studying in medical university and attitude about mental illness . Medical school need to develop new curricula to convey scientific information to students and implementing and evaluating suitable programs leading to appropriate attitude development.
This study explored the effectiveness of family psycho education in reducing patients’ symptoms as well as on family caregiver burden, and investigated the relationship between patients’ symptoms and caregiver burden.
Seventy Iranian outpatients with a diagnosis of schizophrenia disorder and their caregivers were randomly allocated to the experimental (n = 35) or control groups (n = 35). Patients in the experimental group received antipsychotic drug treatment and a psycho-educational program was arranged for their caregivers. At baseline, immediately post-intervention and one month later, validated tools were used to assess patients’ clinical status and caregiver burden.
Compared with the control group, the case group showed significantly reduced symptom severity and caregiver burden, immediately post-intervention and one month later.
These results suggest that even short-term Psycho-educational Intervention for family members of patients with schizophrenic disorder can improve the outcomes of patients and their families.
To enhance the performance evaluation of Clinical and Translational Science Award (CTSA) hubs, we examined the utility of advanced bibliometric measures that go beyond simple publication counts to demonstrate the impact of translational research output.
The sampled data included North Carolina Translational and Clinical Science Institute (NC TraCS)-supported publications produced between September 2008 and March 2017. We adopted advanced bibliometric measures and a state-of-the-art bibliometric network analysis tool to assess research productivity, citation impact, the scope of research collaboration, and the clusters of research topics.
Totally, 754 NC TraCS-supported publications generated over 24,000 citation counts by April 2017 with an average of 33 cites per article. NC TraCS-supported research papers received more than twice as many cites per year as the average National Institute of Health-funded research publications from the same field and time. We identified the top productive researchers and their networks within the CTSA hub. Findings demonstrated the impact of NC TraCS in facilitating interdisciplinary collaborations within the CTSA hub and across the CTSA consortium and connecting researchers with right peers and organizations.
Both improved bibliometrics measures and bibliometric network analysis can bring new perspectives to CTSA evaluation via citation influence and the scope of research collaborations.
The aim of this study was to explore the mortality pattern due to Gorkha earthquakes in 2015 and review the response and recovery efforts immediately following the earthquakes.
Data from published reports of the Nepal Police showed over 8000 deaths. These death counts were categorized by gender, ethnicity, and age groups (interval of 5 years). The mortality rate was calculated (per 100 000 population), using the projected population as the denominator as of April 2015.
Children < 10 years and older adults > 55 years showed a higher rate of deaths, with similar trends for the most affected districts. Almost 8 more females’ deaths were reported per 100 000 population compared with their male counterparts. There was a higher death rate from Province 3 with a notable gender difference: Nearly 20 more females’ deaths were reported per 100 000 population compared with their male counterparts. There was a higher death rate in mountains (542.4 per 100 000) compared with hills (55.0 per 100 000) and the southern Terai region (0.96 per 100 000) of Nepal.
Young and older adults, female, and residents of remote, mountainous regions of Nepal were vulnerable to the earthquakes. Future earthquake preparedness should focus on the vulnerable population by age and gender and the geographical accessibility.
Epidemiological studies revealed that 21 to 34 percent of women around the world have been victim of physical assault by their spouse and spouse abuse have been more prevalent in developing countries.
The most common form of violence against women is spousal abuse which is a dangerous factor and leads to serious psychological damages while it is one of the most important causes of suicide in married women.
The study of factors related to spousal abuse in the population where they attempt to suicide is important for recognizing it and preventing spousal abuse, consequently, preventing suicide.
The study was conducted cross-sectional on 360 married women who attempted suicide and referred to Shoshtari Hospital in Shiraz. Instruments for data collection comprised of about spousal abuse questionnaire and demographic cases questionnaire which were filled through interview.
A total of 43.9% of domestic violence prevalence, 61.7% of economic violence, 45.3% of psychological violence, 38.1% of social violence, 38.1% physical violence, 35.9% of sexual violence was reported. There was a relation between spousal abuse and some factors such as: age difference between spouses, wife and husband's education, husband's substance abuse, husband's medical illness, wife's psychiatry disorder, spouses’ obligatory marriage, polygamy and husband's job.
Considering relatively high prevalence of spousal abuse in people who attempted suicide and the relation between some demographic factors with violence, besides regarding spousal abuse as one causes of suicide, the women's screening, particularly those who attempt suicide in regard to spousal abuse and its related factors seems necessary.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Two new species, Begonia bracteolata and Begonia keralensis, are described from the Western Ghats of India. They are placed in the newly created Begonia sect. Flocciferae, along with B. albo-coccinea Hook. and B. floccifera Bedd. Lectotypes are designated for three names within this section. Colour photoplates, illustrations and an identification key to Begonia sect. Flocciferae are also provided.
The extensive use of plastic bags in Nepal has led to growing concern in recent years. We investigate the impact of a municipal plastic bags ban on bags use behavior, based on a field survey carried out among consumers and retailers across selected municipalities. Our results indicate that the effectiveness of the ban critically depends on its enforcement and sanctioning system. In particular, our results suggest that the perceived sanction is a critical determinant of plastic bags use, as a doubling of the perceived sanction could reduce plastic bags use by two-thirds for retailers and by one-half for consumers. While the nominal amount of the fine does not seem to play a role, the probability of being detected appears to play a key role in the perceived sanction. This implies that effective monitoring of the ban by the municipal authorities is critical for the success of the policy.
Nanoemulsion formulation of vitamin D3 have been shown to have better bioavailability than the coarse emulsion preparation in vitro and in vivo animal studies. In the absence of randomised trial in humans, comparing the efficacy of nanotechnology-based miscellised vitamin D3 over conventional vitamin D3, we undertook this study. A total of 180 healthy adults were randomised to receive either micellised (DePura, group A) or conventional vitamin D3 (Calcirol, group B) at a monthly dose of 60 000 IU (1500μg) for 6 months. The outcome parameters were serum 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH), Ca, phosphate, alkaline phosphatase and urinary Ca:creatinine ratio. A total of eighty-nine subjects in group A and seventy-seven in group B completed the trial. Subjects in both the groups had a significant increase in their serum 25(OH)D levels following supplementation (group A: 21·5 (sd 10·9) to 76·7 (sd 18·8) nmol/l (P<0·001); group B: 22·8 (sd 10·4) to 57·8 (sd 16·0) nmol/l (P<0·001)). Participants in micellised group had an additional increase of 20·2 (95 % CI 14·0, 26·4) nmol/l in serum 25(OH)D levels (P<0·001). The difference between the groups was 17·5 (95 % CI 11·8, 23·1) nmol/l, which remained statistically significant (P<0·001) even after adjustment for age and sex. Significant decline in mean serum PTH was observed in both the groups. No hypercalcaemia or hypercalciuria was noted. Although supplementation with both the preparations resulted in a significant rise in serum 25(OH)D levels, micellised vitamin D3 appeared to be more efficacious in achieving higher levels of serum 25(OH)D.
OBJECTIVES/SPECIFIC AIMS: The purpose of the study was to describe patient characteristics associated with subsequent development of bowel ischemia. Primary outcomes were survival to discharge, 30-day and 1-year survival in patients with LVAD who subsequently develop bowel ischemia. Secondary outcomes included characteristics of patients who survive to discharge after bowel ischemia and those who do not. These included markers of patient condition prior to surgical/endoscopic intervention such as lactate levels, ICU admission, ventilator dependence, vasopressor and renal replacement requirements, as well as presence of sepsis. Of these, we predicted that lactate levels and white blood cell count would be significantly elevated pre- and post-operatively in patients who do not recover from bowel ischemic event. We used Mann-Whitney U Test to examine lactate levels between the two groups as our sample size was <30 and therefore necessitated the use of non-parametric testing. METHODS/STUDY POPULATION: In this single-center retrospective study, we analyzed all patients who underwent durable, CF-LVAD implantation at Duke University Medical Center (DUMC) between January 2008 and November 2018. Patients were screened using CPT codes for abdominal surgical exploration or ICD codes for intestinal vascular insufficiency. Final cohort was selected with confirmed diagnosis of intestinal ischemia based on surgical exploration or endoscopic intervention. Patient characteristics including pre-LVAD comorbidities, indication for LVAD implant, and clinical picture prior to bowel ischemic event were collected. Specific characteristics related to bowel ischemia were summarized, including diagnostic imaging, time from imaging study to operative intervention, and intraoperative details. Patient outcomes including survival to discharge, 30-day-, and 1-year survival were summarized. Patients were stratified based on survival to discharge status. Continuous variables were reported as median and interquartile range and compared using Mann-Whitney U test. Categorical variables were reported as proportions and compared using Fisher’s exact test as appropriate. RESULTS/ANTICIPATED RESULTS: A total of 754 patients underwent durable, CF-LVAD implant at DUMC, of which 21 subsequently developed intestinal ischemia (incidence 2.8%). The majority were male (81%) and treated as destination therapy (76.2%). Ten patients (50%) survived to discharge (one remains hospitalized). The proportions of patients receiving HeartMate II (60% vs. 50%, p=1.0), HeartMate III (20% vs. 10%, p=1.0), and HeartWare (20% vs. 40%, p=0.6) were not significantly different between patients who survived to discharge and patients who did not. Median time from LVAD implant to diagnosis of bowel ischemia did not vary significantly between the patient groups (11.5 days, IQR 34.75 vs. 16.5 days, IQR 173.8; p=0.40), nor did the median time from diagnosis to surgical intervention (264.5 minutes, IQR 497.8 vs. 323 minutes, IQR 440, p=0.82). In the 48 hours leading to diagnosis and intervention, renal replacement therapy (50% vs. 0%, p=0.033) was more prevalent in patients who did not survive to discharge. Differences in pre- and post-operative lactate levels were not significantly different in patient groups. A similar pattern of diagnostic study preference emerged from both groups, with CT being the most common (76.2%) followed by KUB (42.9%). Upper endoscopy/colonoscopy was performed in 7 patients (33.3%), of which 5 also had operative exploration. A total of 19 patients underwent abdominal exploration (90.5%). Nine had large bowel resection (42.9%) while 14 had small bowel resection (66.7% with average 75cm removed). Overall survival at 1-year was 33%. For those making it to discharge (n=10), one year survival was 60%. DISCUSSION/SIGNIFICANCE OF IMPACT: This is the first institutional study to our knowledge to describe intestinal ischemia in patients receiving CF-LVAD therapy. Intestinal ischemia in patients receiving CF-LVAD therapy is associated with high mortality and morbidity. Diagnosis of bowel ischemia should be considered in patients presenting with clinical symptoms of bowel ischemia in addition to requirement of renal replacement therapy. Imaging modalities used were dependent on the clinical situation and were not always necessary prior to intervention. Further investigation is warranted to identify predictors of this morbid complication.
In India, there is a lack of information about the adequate daily dose of vitamin D3 supplementation in school children. Hence, we undertook this study to evaluate the adequacy and efficacy of different doses of vitamin D3 in schoolchildren. A total of 1008 vitamin D-deficient (VDD) children, aged 6–16 years with serum 25-hydroxyvitamin D (25(OH)D) levels <50nmol/l, were cluster randomised into three groups (A-344, B-341 and C-232) for supplementation (600, 1000 and 2000 IU daily) of vitamin D3 under supervision for 6 months. Of the 1008 subjects who completed the study, 938 (93 %) were compliant. Baseline and post-supplementation fasting blood and urine samples were evaluated for Ca, phosphates, alkaline phosphatase, 25(OH)D and parathormone and urine Ca:creatinine ratio. The mean age of the subjects was 11·7 (sd 2·4) years, and the overall mean baseline serum 25(OH)D level was 24·3 (SD 9·5)nmol/l. Post-supplementation rise in serum 25(OH)D in compliant group was maximum with 2000 IU (70·0 (SD 30·0)nmol/l), followed by 1000 IU (46·8 (SD 22·5)nmol/l) and 600 IU (36·5 (SD 18·5)nmol/l), and serum 25(OH)D levels of ≥50nmol/l were achieved in 71·5, 81·8 and 92·9 % by groups A, B and C, respectively. Secondary hyperparathyroidism decreased from 31·7 to 8·4 % post-supplementation. Two participants developed hypercalciuria, but none developed hypercalcaemia. Children with VDD benefit maximum with the daily supplementation of 2000 IU of vitamin D3. Whether recommendations of 400 IU/d by Indian Council of Medical Research or 600 IU by Indian Academy of Pediatrics or Institute of Medicine would suffice to achieve vitamin D sufficiency in children with VDD remains debatable.
We use irradiation with 50-MeV Cu-ions to create vortex pinning defects in high-temperature superconducting Y1Ba2Cu3O7-x coated conductors using a beam-rastering approach that allows for the uniform irradiation of large ample areas. Our samples contain barium zirconate nanorods as pre-existing vortex pinning defects. By irradiating the samples at angles of 0o, 15oand 30o from the crystallographic c-axis we explore the interplay between pre-existing and irradiation-induced pinning and find that irradiation at 30o leads to a moderate enhancement of Jc at 5 K at high fields (greater than 2 Tesla). In contrast, Jc was suppressed for all temperatures and fields for other angles of irradiation. Optimized particle irradiation procedures offer a way for improving the performance of high-temperature superconducting wires for use in high magnetic fields without the need for changing wire synthesis protocols.