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Introduction: Opioid overdoses (OODs) have become a public health emergency, yet little is known about their long-term outcomes following an OD. We determined the one-year all-cause mortality and associated risk factors in a cohort of patients treated in an urban emergency department (ED) for an OOD. Methods: We reviewed records of all patients who visited St. Paul's Hospital ED from January 2013 to August 2017 and had a discharge diagnosis of OOD or had received naloxone in the ED as per pharmacy records. Patients with a suspected OOD were identified on structured chart review. A patient's first visit for an OOD during the study period was used as the index visit, with subsequent visits excluded. The primary outcome was mortality during the year after the index visit. Mortality was assessed by linking patient electronic medical records with Vital Statistics data. Deaths that occurred in the ED on the index visit were excluded. Patients admitted to hospital following ED treatment were included in this study. We described patient characteristics, calculated mortality rates, and used Cox regression to identify risk factors. Results: A total of 2239 patients visited the ED for an OOD during the study period, with a median patient age of 37 years (IQR 29, 49). Males comprised 73% of patients, while 28% had no fixed address, and 21% received take-home naloxone at the index visit. In total, 137 patients (6.1%) died within 1 year of the index visit. Eighty-one deaths (3.6%) occurred within 6 months, including 24 deaths (1.1%) that occurred within 1 month. The highest mortality rate occurred in 2017, with 8.0% of patients entering the cohort that year dying within 1 year. Gender did not significantly impact mortality risk. A Cox regression analysis controlled for gender, housing status, and whether take-home naloxone was provided at the index visit indicated that advancing age (adjusted hazards ratio [AHR] 1.03; 95%CI: 1.01-1.04 for each year increase in age) and the index visit calendar year (AHR 1.30; 95%CI: 1.10-1.54 for each yearly increase in the study period) were significant factors for mortality within 1 year. Conclusion: The mortality rate following an opioid OD treated in the ED is high, with over 6% of patients in our study dying within 1 year. The rising mortality risk with increasing calendar year may reflect the growing harms of fentanyl-related OODs. Patients visiting the ED for an OOD should be considered high risk and offered preventative treatment and referrals prior to discharge.
Background: When measuring young Duchenne Muscular Dystrophy (DMD) patients’ health-related quality of life (HRQoL), parent-proxy reports are heavily relied on. Therefore, it is imperative that the relationship between parent-proxy and child self-report HRQoL is understood. This study examined the level of agreement between children and their parent-proxy rating of the child’s HRQoL. Methods: We used FOR-DMD clinical trial baseline data. HRQoL, measured using the PedsQL inventory, was reported by 178 parent and child (ages 4 to 7 years) dyads. Intracorrelation coefficients (ICC) measured absolute agreement while paired t-tests determined differences in the average HRQoL ratings between groups. Results: The level of agreement between child and parent-proxy ratings of HRQoL was poor for the generic PedsQL scale (ICC: 0.29) and its subscales; and, similarly low for the neuromuscular disease module (ICC:0.16). On average, parents rated their child’s HRQoL as poorer than the children rated themselves in all scales except for psychosocial and school functioning. Conclusions: Child and parent-proxy HRQoL ratings are discordant in this study sample, as occurs in other chronic pediatric diseases. This should be taken into account when interpreting clinical and research HRQoL findings in this population. Future studies should examine reasons for parents’ perception of poorer HRQoL than that reported by their children.
Bovine calf scours reported to be caused by multiple aetiologies resulting in heavy mortality in unweaned calves and huge economic loss to the dairy farmers. Among these, cryptosporidiosis is an emerging waterborne zoonoses and one of the important causes of neonatal calf diarrhoea. Poor immune response coupled with primary cryptosporidial infections predispose neonatal calves to multiple secondary infections resulting in their deaths. In the present study, faecal samples from 100 diarrhoeic calves randomly picked up out of 17 outbreaks of bovine calf diarrhoea in periurban Ludhiana, Punjab in Northern India were subjected to conventional (microscopy, modified Zeihl–Neelsen (mZN) staining) and immunological and molecular techniques (faecal antigen capture ELISA and PCR) for detection of primary Cryptosporidium parvum infection as well as other frequently reported concurrent pathogens, viz. rotavirus and coronavirus, Salmonella spp., Escherichia coli, Clostridium perfringens and Eimeria spp. The faecal antigen capture ELISA and PCR revealed 35% prevalence of C. parvum in contrast to 25% by mZN staining with a relatively higher prevalence (66·7%) in younger (8–14-day-old) calves. The detection rate of the other enteropathogens associated with C. parvum was 45·71% for C. perfringens followed by Salmonella spp (40·0%), rotavirus (36·0%), coronavirus (16·0%), E. coli (12·0%) and Eimeria spp (4·0%) The sensitivity for detection of C. parvum by ELISA and mZN staining in comparison to PCR was 97·14% and 72·72%, respectively. An important finding of the study was that C. parvum alone was found in only 10% of the diarrhoeic faecal samples, whereas, majority of the samples (90%) showed mixed infections ranging from a combination of two to five agents. This is the first documentary proof of C. parvum and associated pathogens responsible for severe periurban outbreaks of bovine calf diarrhoea culminating in heavy mortality from Northern India.
Gas-source molecular beam epitaxy (GSMBE) has been developed into a useful tool for the growth of both optical and electronic device structures. In this paper, we report on the use of tertiarybutylarsine (TBA) and tertiarybutylphosphine (TBP) in GSMBE for the growth of electronic device structures with state-of-the-art performance. Device structures based on both the In0.48Ga0.52P/GaAs and In0.53Ga 0.47As/InP lattice matched materials systems are described. The GSMBE system is based on the use of elemental Group-rn sources and employs thermal crackers for precracking TBA and TBP. Dopant sources include both elemental (Sn and Be) and vapor (CBr4 and SiBr4) sources. Device structures fabricated in the In0.48Ga0.52P/GaAs materials system include single- and double- heterojunction bipolar transistors (SHBTs and DHBTs). Device structures fabricated in the In0.53Ga0.47As/InP materials system include SHBTs, DHBTs, heterojunction field effect transistors (HFETs), and both planar and lateral resonant tunneling diodes (RTDs.) Vertically integrated HFET and multi-RTD heterostructures for high speed logic/memory are also described.
The roadmap for silicon device technology has been drawn, extending to the year 2010, and featuring a CMOS transistor with a gate length of 0.07 μm . Beyond this point, silicon heterojunctions could provide a means to further device scaling. Silicon heterojunctions could also bring new devices to the silicon substrate including light emitters and detectors, and resonant tunneling diodes (RTDs). Today SiGe/Si and SiGeC/Si heterojunctions are receiving the greatest attention, but heterojunctions now being developed to realize silicon RTDs are increasing the heterojunction options for silicon-based quantum-well and optical devices. Here we outline the fundamental device requirements for silicon optical and tunneling devices and describe progress on silicon heterojunction development towards demonstration of silicon-based RTDs. Materials now under study include, ZnS, crystalline oxides and nitrides; new processes could provide methods for forming crystalline materials over amorphous barriers.
Chengappa KNR, Turkin SR, Schlicht PJ, Murphy SL, Brar JS, Fagiolini A, Houck PR, Garbutt RG, Fredrick N. A Pilot, 15-month, randomised effectiveness trial of Risperidone long acting injection (RLAI) versus oral atypical antipsychotic agents (AAP) in persons with bipolar disorder.
Long-acting injectible antipsychotic agents are rarely considered in the treatment of bipolar patients [bipolar disorder (BPD)]. We posited that BPD patients receiving risperidone long-acting injections [Risperidone long-acting injections (RLAIs)] would experience fewer negative clinical events than those receiving oral atypical antipsychotic agents (AAP).
Adult BPD patients in a hypomanic, manic or mixed episode were randomised to either oral risperdone followed by RLAI (n = 23) or an AAP (n = 25) for 15 months. Any mood stabilizers were continued. An independent clinician board declared any clinical events that occurred but the treatment assignment was concealed.
Nine of the 48 patients who participated in this study did not improve, leaving 39 patients in 1-year extension. RLAI patients received the following bi-weekly dosages: 25 mg (n = 9), 37.5 mg (n = 8), and 50 mg (n = 6). The AAP group included aripiprazole (n = 11, 15–30 mg/day), quetiapine (n = 8, 300–700 mg/day), olanzapine (n = 5, 15–25 mg/day), and ziprasidone, (n = 1, 160 mg/day). In total, 47 clinical events were declared. The RLAI-treated group experienced significantly fewer clinical events (mean: 0.86 ± 0.73) compared with the AAP group (1.61 ± 1.29), t = 2.29, d.f. = 37, p = 0.028 (95% CI = 0.087–1.421). Of all, 50% of the AAP subjects gained ≥ 7% of their baseline body weight as did 38% of the RLAI-treated patients.
RLAI-treated patients experienced significantly fewer negative clinical events. Further exploration should focus on which subtypes of BPD patients might benefit from RLAI treatment. Weight gain in BPD subjects requires clinical attention. Limitations include an open design, small sample size and the inability to conclude on whether this strategy is useful for depressive episodes.
Changes in global biodiversity at the genetic level have proved difficult to determine for most organisms because of lack of standardized, repeated or historical data; this hampers the attempts to meet the convention on biological diversity (CBD) 2010 targets of reducing loss of genetic diversity, particularly of crop species. For rice, where germplasm and genetic data have been collected throughout South and Southeast Asia over many decades, contrary to popular opinion, we have been unable to detect a significant reduction of available genetic diversity in our study material. This absence of a decline may be viewed positively; over the 33-year timescale of our study, genetic diversity amongst landraces grown in traditional agricultural systems was still sufficiently abundant to be collected for ex situ conservation. However, if significant genetic erosion does take place in the future as a result of accelerating global warming and/or major changes in land use or agricultural practices, will it be catastrophic or gradual, and how will it be detected? We have shown a strong link between numbers of landraces collected (and therefore extant) and genetic diversity; hence, we have a clear indicator to detect loss of genetic diversity in the future. Our findings lend considerable support for ex situ conservation of germplasm; the more than substantial genetic resources already in genebanks are now safe. On the other hand, it is the germplasm growing in farmers' fields, continually adapting genetically to changing environmental conditions and evolving novel genetic forms, whose future has been much less certain but can now be effectively monitored using our criteria.
In 1998, Indian regulatory agencies approved the registration of CGA 184927, MON 37500, and fenoxaprop for postemergence control of isoproturon-resistant littleseed canarygrass. Herbicides used in rice and wheat before 1998 were generally mixed with sand or urea and were applied by hand. Foliar pesticide spray applications consisted primarily of insecticides and fungicides that were applied to high-value crops. These pesticides were often sprayed to runoff with backpack sprayers that were equipped with single hollow-cone or flood nozzles. Applicators walked through the fields, swinging the wands in sweeping motions resulting in uneven pesticide distribution and overapplication. The newly registered postemergence herbicides were applied with the same equipment and in the same fashion. After these applications, control of littleseed canarygrass was strikingly inconsistent, and the growers blamed the lack of control on the manufacturers. It was later clear that basic understanding of the application techniques was lacking. In response to this, an application training workshop was organized and conducted in India and Nepal in 2000. The workshops focused on teaching the participants how to use and fabricate multiple-nozzle booms, the importance of flat-fan nozzles, calibration, drift avoidance, and applicator safety. To date, approximately 3,000 farmers, extension agents, scientists, and industry representatives have attended more than 30 workshops. The participants were unanimously enthusiastic about the value of the workshops. Although simplistic, the adoption of this technology will significantly decrease the amounts of herbicides applied and will increase efficacy and efficiency.
Serum concentrations of anti-hippocampal antibodies and in vitro production of the lymphokine interleukin-2 (IL-2) in response to phytohaemagglutinin (PHA) stimulation were determined using an enzyme immunoassay in 49 schizophrenic patients and 41 healthy controls. Decrease in IL-2 production, a finding frequently associated with many autoimmune diseases, was associated with an elevation in anti-hippocampal antibody optical density (AHA-OD) in schizophrenic patients. Although some control subjects had elevated antibody levels, this elevation was not associated with decreased IL-2 production. Low IL-2 production is well known to be a state marker associated with active autoimmune disease. We suggest that production of hippocampal antibody is a trait marker of vulnerability to autoimmune diseases. Thus, our finding of low IL-2 production in patients with high concentrations of hippocampal antibody is compatible with the possibility that such patients have an ongoing autoimmune process.
Potassium concentrations in various plant parts of cotton (Gossypium hirsutum L.) at different growth stages were determined in field experiments in Punjab, India, in 1987, for plots fertilized at sowing and flowering, and these were compared with the final seed cotton yield. The optimum time of sampling for predicting relative yield depends on the time of K fertilizer application: if applied at sowing, plants should be sampled before the peak flowering stage (70 days after sowing, DAS); if applied at flowering (50 DAS), plants should be sampled 90–115 DAS. Critical K concentrations (% K. in dry matter) in the plant parts measured at different growth stages were 3·26 in the petioles of the third leaf from the top at flower initiation; 0·69 and 0·90 in blades and petioles of a lower leaf (first or second healthy leaf from the bottom of plant) respectively, and 2·60 in the petioles of the third leaf (young, fully mature leaf from the top of the plant) at peak flowering stage; 0·85 in blades of the third leaf, 0·53 and 0·50 in blades and petioles of a lower leaf, respectively, at the boll development stage; 0·70 and 2·85 in blades and petioles of the third leaf and 0·68 in petioles of a lower leaf at boll opening stage.
Laboratory and glasshouse experiments were conducted to study P release kinetics and uptake of P by wheat (Trilicum, aestivum L.) in ten benchmark soils of Punjab (India). Phosphorus desorption, determined by successive extraction with 0·01 m-CaCl2 solution, was lower in calcareous soils (group I) than in non-calcareous soils (group II). Desorption of surface P in soils followed pseudo-first-order kinetics. The values of the kinetic constant of desorption and the radial diffusion coefficient of P increased with the amount of added P in soils.
A significant linear relationship between cumulative desorbed P and both dry-matter yield and P uptake indicated that the rate of release of P from the solid matrix is important in determining P uptake by wheat crop. Phosphate uptake was less dependent on the initial solution P concentration than on the rate of phosphate release.
In a long-term experiment with maize-wheat rotation, no response to zinc application was observed, even after 13 years of cropping though the status of zinc had decreased to a deficient level (0.35 mg/kg; DTPA). A study was, therefore, planned to find the reasons for lack of response, and the zinc fractions in the soil were analysed to assess their contribution to plant growth. All the zinc fractions other than organic zinc decreased as a result of continuous cropping without zinc application. Depletion was from the 0-30 cm layer and mainly from acid-soluble and weakly adsorbed Zn fractions. Applied zinc remained mainly in the 0-30 cm layer as acid soluble and weakly adsorbed Zn pools. All the fractions were strongly related to each other. The acid-soluble zinc fraction contributed 54 % to zinc uptake by the crops. Thus release of zinc from this pool was perhaps the main reason for lack of response to zinc.
Eight cultivars of peas (Pisum sativum L.) were evaluated for six traits in a diallel experiment using regression coefficients, correlations and combining ability estimates. Regression coefficient was high, indicating large additive effects for 100-grain weight. Yield was significantly and positively correlated with plant height, number of pods per plant and 100-grain weight, indicating that selection for either of these would result in higher yield. The best index of yield among the traits studied was number of pods per plant. Significant general combining ability (GCA) variances and specific combining ability (SCA) variances were observed. GCA variances were larger than SCA variances except for yield, suggesting predominance of additive gene effects.
A diallel analysis of flowering time, pod number, 100-seed weight and yield of six cultivars of Cajanus cajan (L.) Millsp. was studied. Additive inheritance was important in determining flowering time, but the dominance component was higher than the additive component, and over-dominance was observed for pod number, 100-seed weight and yield. Heritability estimates for all the traits except flowering time were quite low, and the bulk population method of breeding was suggested for early segregating generations. The graphical analysis of the diallel cross was in close agreement with the findings from variance component analysis. It is suggested that the best cross would be that between two parents chosen on the basis of their low g.c.a. for flowering time and their high g.c.a. for other traits.
The habit of growth of pigeon-pea cultivars was greatly affected by environmental changes. The effect was greatest in the highest yielding cultivar, Pant A2, for the characters plant width, number of pods/main branch, number of pods/plant, grain yield and plant weight. In the late-sown crop the ‘vegetative sink’ was affected more than the ‘generative sink’. T21 was the outstanding yielder under late-sown conditions. It is suggested that a rotation of mungbean–pigeon pea–wheat can be grown in 1 year, with profitable returns.
Increased public awareness in recent years regarding environmental pollution has generated concern over the disposal of household, commercial, industrial, animal, and agricultural wastes. In most cases, utilization of these wastes is not feasible because of high recovery costs. The substantial quantities involved often preclude disposal by landfills and their burning contributes to air pollution. One such case is the environmental pollution caused from disposal of grass seed residue by open field burning in Oregon.
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