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The last two decades have witnessed a remarkable reinvention of the role of the neurologist, from an outpatient consultant to a critical presence in the inpatient setting. Spotting a neurologist in an emergency room or intensive care unit is no longer incongruous, rather an expectation of their relatively new roles as acute stroke doctors and neurointensivists. With this shift in patient care setting came a shift in research and many questions that have plagued the neurologic community for decades have resurfaced. The groundbreaking neurophysiologic discoveries of the previous century have armed us with an understanding of how the normal neuron functions. Now, in the inpatient, critically ill population, we once again find ourselves wondering what is happening within the shroud of the skull.
Gac is a dioecious tropical and perennial climber. The fruit is a rich source of carotenoids and is used in traditional cuisine and medicine. Improving propagation methods using simple techniques would increase production and improve conservation in regional areas. This study evaluated temperature requirements for seed germination, the use of rooting hormones to strike female cuttings and the grafting of female scions onto seedling rootstock. Seed germination was optimised between 25 and 35 °C, with a maximum germination percentage of 91% at 30 °C. However, increasing storage time from 6 to 18 months under laboratory conditions (21 ± 1°C and 60% relative humidity) reduced germination and this was associated with seed weight loss, highlighting the need to develop storage guidelines, particularly for the higher temperature and humidity conditions where Gac is grown. Survival of softwood cuttings was improved from 53 to 77% with indole-3-butyric acid (IBA) (3–5 g/L) and semi-hardwood cuttings did not require IBA treatment. Both splice and wedge grafting techniques achieved a survival rate > 53% and with the youngest rootstock (4 and 8 weeks) this increased to > 85%. Further work could investigate the production potential of crops using cuttings and grafted plants.
Fasciola jacksoni is a significant contributor to the health and mortality of Asian elephants, particularly those in Sri Lanka. Despite the impact of fascioliasis on elephant populations, it is a neglected veterinary disease with limited taxonomic understanding. Molecular characterization and phylogenetic analysis of F. jacksoni were carried out to evaluate its suggested basal position in the Fasciolidae. Adult worms were collected during post-mortem of elephants, and eggs were collected from living elephants in National parks across Sri Lanka. Using the mitochondrial genes nicotinamide dehydrogenase subunit 1 (nad1) and cytochrome oxidase subunit 1 (cox1), and a partial 28S ribosomal DNA (28S rDNA), DNA sequences were generated from the F. jacksoni adult and egg material. Maximum likelihood (ML) phylogenetic analyses did not resolve F. jacksoni to be basal to the Fasciolidae. Furthermore, the ML analyses showed that the genus Fasciola was not monophyletic and that F. jacksoni was a sister species to the deer liver fluke Fascioloides magna. A clear framework is required to determine the taxonomic status of F. jacksoni and this current study provides the first detailed application of molecular techniques from multiple hosts across Sri Lanka with the production of reference DNA sequences for this important parasite.
The Lung Cam expanded stratigraphic succession in Vietnam is correlated herein to the Meishan D section in China, the GSSP for the Permian–Triassic boundary. The first appearance datum of the conodont Hindeodus parvus at Meishan defines the Permian–Triassic boundary, and using published graphic correlation, the Permian–Triassic boundary level has been projected into the Lung Cam section. Using time-series analysis of magnetic susceptibility (χ) data, it is determined that H. parvus arrived at Lung Cam ∼18 kyr before the Permian–Triassic boundary. Data indicate that the Lung Cam section is expanded by ∼90 % relative to the GSSP section at Meishan. Given the expanded Lung Cam section, it is possible to resolve the timing of significant events during the Permian–Triassic transition with high precision. These events include major stepped extinctions, beginning at ∼135 kyr and ending at ∼110 kyr below the Permian–Triassic boundary, with a duration of ∼25 kyr, followed by deposition of Lung Cam ash Bed + 13, which is equivalent to Siberian Traps volcanism is graphically correlated to a precession Time-series model, placing onset of this major volcanic event at ~242 kyr before the PTB. The Meishan Beds 25 and 26, at ∼100 kyr before the Permian–Triassic boundary. In addition, the elemental geochemical, carbon and oxygen isotope stratigraphy, and magnetostratigraphy susceptibility datasets from Lung Cam allow good correlation to other Permian–Triassic boundary succession. These datasets are helpful when the conodont biostratigraphy is poorly known in sections with problems such as lithofacies variability, or is undefined, owing possibly to lithofacies exclusions, anoxia or for other reasons. The Lung Pu Permian–Triassic boundary section, ∼45 km from Lung Cam, is used to test these problems.
Introduction: Endotracheal intubation (ETI) is a lifesaving procedure commonly performed by emergency department (ED) physicians that may lead to patient discomfort or adverse events (e.g., unintended extubation) if sedation is inadequate. No ED-based sedation guidelines currently exist, so individual practice varies widely. This study's objective was to describe the self-reported post-ETI sedation practice of Canadian adult ED physicians. Methods: An anonymous, cross-sectional, web-based survey featuring 7 common ED scenarios requiring ETI was distributed to adult ED physician members of the Canadian Association of Emergency Physicians (CAEP). Scenarios included post-cardiac arrest, hypercapnic and hypoxic respiratory failure, status epilepticus, polytrauma, traumatic brain injury, and toxicology. Participants indicated first and second choice of sedative medication following ETI, as well as bolus vs. infusion administration in each scenario. Data was presented by descriptive statistics. Results: 207 (response rate 16.8%) ED physicians responded to the survey. Emergency medicine training of respondents included CCFP-EM (47.0%), FRCPC (35.8%), and CCFP (13.9%). 51.0% of respondents work primarily in academic/teaching hospitals and 40.4% work in community teaching hospitals. On average, responding physicians report providing care for 4.9 ± 6.8 (mean ± SD) intubated adult patients per month for varying durations (39.2% for 1–2 hours, 27.8% for 2–4 hours, and 22.7% for ≤1 hour). Combining all clinical scenarios, propofol was the most frequently used medication for post-ETI sedation (38.0% of all responses) and was the most frequently used agent except for the post-cardiac arrest, polytrauma, and hypercapnic respiratory failure scenarios. Ketamine was used second most frequently (28.2%), with midazolam being third most common (14.5%). Post-ETI sedation was provided by > 98% of physicians in all situations except the post-cardiac arrest (26.1% indicating no sedation) and toxicology (15.5% indicating no sedation) scenarios. Sedation was provided by infusion in 74.6% of cases and bolus in 25.4%. Conclusion: Significant practice variability with respect to post-ETI sedation exists amongst Canadian emergency physicians. Future quality improvement studies should examine sedation provided in real clinical scenarios with a goal of establishing best sedation practices to improve patient safety and quality of care.
Introduction: We examined our local sepsis patient population, and specifically our most vulnerable patients - those presenting to the emergency department (ED) in septic shock - for variables predictive of survival to hospital discharge. We applied the familiar ED paradigm of, “Door to,” to calculate the impact of time to antibiotics against patient survival to hospital discharge. Methods: Retrospective chart review of patients aged > = 18 years, presenting to tertiary care ED between 01 Nov 2014 and 31 Oct 2015. Patients determined to have sepsis if A) > = 2 SIRS criteria and ED suspicion of infection (ED acquisition of blood/urine cultures or antibiotic administration) and/or B) received ED or Hospital discharge diagnosis of sepsis (ICD-10 diagnostic codes A4xx and R65). Patients sub-classified with septic shock if A) triage SBP < = 90mmHg, B) triage MAP < = 65mmHg or C) serum lactate > = 4mmol/L. “Door Time” was defined as the earliest time recorded for the patient encounter, either the time the patient registered in the Emergency Department, or the triage time. A generalized linear model was performed with a binomial distribution using survival to discharge as the response variable. Age, sex, ED arrival method, time to antibiotics, ED serum lactate and ED serum glucose level were the predictor variables. Results: 13506 patient encounters met inclusion criteria (10980 unique patients). Linear regression of time to antibiotics against survival to hospital discharge failed to achieve statistical significance. Linear regression of the secondary outcome variables achieved statistical significance for age and serum lactate level. Per the model, as age increased by 1 year, the odds of dying prior to hospital discharge increased by 3.8% and as serum lactate increased by 1 mmol/L, odds of dying prior to hospital discharge increased by 11.1%. Conclusion: We found no association between time to antibiotic treatment and mortality. Causal relationships require randomized controlled trials, and this analysis contributes to clinical equipoise.
Prenatal sex steroid exposure plays an important role in determining child development. Yet, measurement of prenatal hormonal exposure has been limited by the paucity of newborn/infant data and the invasiveness of fetal hormonal sampling. Here we provide descriptive data from the MIREC-ID study (n=173 girls; 162 boys) on a range of minimally invasive physical indices thought to reflect prenatal exposure to androgens [anogenital distances (AGDs); penile length/width, scrotal/vulvar pigmentation], to estrogens [vaginal maturation index (VMI) – the degree of maturation of vaginal wall cells] or to both androgens/estrogens [2nd-to-4th digit ratio (2D:4D); areolar pigmentation, triceps/sub-scapular skinfold thickness, arm circumference]. VMI was found to be associated with triceps skinfold thickness (β=0.265, P=0.005), suggesting that this marker may be sensitive to estrogen levels produced by adipose tissue in girls. Both estrogenic and androgenic markers (VMI: β=0.338, P=0.031; 2D:4D – right: β=−0.207, P=0.040; left: β=−0.276, P=0.006; AGD-fourchette − β=0.253, P=0.036) were associated with areolar pigmentation in girls, supporting a role for the latter as an index of both androgen and estrogen exposure. We also found AGD-penis (distance from the anus to the penis) to be associated with scrotal pigmentation (β=0.290, P=0.048), as well as right arm circumference (β=0.462, P<0.0001), supporting the notion that these indices may be used together as markers of androgen exposure in boys. In sum, these findings support the use of several physical indices at birth to convey a more comprehensive picture of prenatal exposure to sex hormones.
Oscillations jn "d" vs. sin2ψ plots are due to the inhomogeneous partitioning of strains within the diffracting volume. In polycrystalline specimens, such inhomogeneity can be caused by the elastic incompatibility of neighboring grains or by the inhoniogeneous partitioning of plastic deformation within the diffracting volume. There is, however, little work on the degree of inhomogeneity required to cause a given oscillation, and the relative contribution from the elastic and plastic deformation components to a given oscillation.
The results of an experimental study on residual stresses within the encapsulation layers of electronic components are described. For this study, silicon wafers were coated with a flexibilized cycloaliphatic formulation filled with 30 and 40 (vol.) % of Cu particles. The residual stresses were determined by measuring the radii of curvature of the encapsulated wafers. The stress in the Cu particles at the surface was also measured by X-Ray diffraction. It was seen that the stresses within the structure are primarily macro-stresses, with little stress present within the Cu particles. Comparison of the experimental values to those calculated from linear elasticity theory also indicate relaxation within the composite during curing.
Recent studies indicate that, if the stress/strain field within the irradiated volume in an x-ray stress determination experiment is inhomogeneous, oscillations occur in the interplanar spacing vs. sin2ψ plots. There is, however, little work on the degree of inhomogeneity required to cause a given oscillation, the uniqueness of the stress fields that can cause a given set of oscillations, or the error caused by applying the traditional methods currently in use to oscillatory data.
In this paper, numerical modeling and eiasto-plastic finite element analysis was used to determine the strain fields in the diffracting volume of a polycrystalline sample under load. The elastic strain fields obtained from the analysis were then averaged over the regions that would diffract in an x-ray experiment/and then correlated to x-ray strain data to obtain an idea of the problems described ahove.
We study the inverse boundary value problem for fractional diffusion in a multilayer composite medium. Given data in the right boundary of the second layer, the problem is to recover the temperature distribution in the first layer, which is inaccessible for measurement. The problem is ill-posed and we propose a Fourier spectral approach to achieve Hölder approximations. The convergence analysis is performed in both the
In this paper, we derive geometric and analytic properties of invariant sets, including orbit closures, of a large class of piecewise-affine maps
. We assume that (i)
consists of finitely many affine maps defined on a Borel measurable partition of
, (ii) there is a lattice
that contains all of the mutual differences of the translation vectors of these affine maps, and (iii) all of the affine maps have the same linear part that is an automorphism of
. We prove that finite-volume invariant sets of such piecewise-affine maps always consist of translational tiles relative to this lattice, up to some multiplicity. When the partition is Jordan measurable, we show that closures of bounded orbits of
are invariant and yield Jordan measurable tiles, again up to some multiplicity. In the latter case, we show that compact
-invariant sets also consist of Jordan measurable tiles. We then utilize these results to quantify the rate of convergence of ergodic averages for
in the case of bounded single tiles.
To characterise subjective symptoms in patients undergoing surgical repair of superior semicircular canal dehiscence.
Questionnaires assessing symptom severity and impact on function and quality of life were administered to patients before superior semicircular canal dehiscence surgery, between June 2011 and March 2016. Questionnaire sections included general quality of life, internal amplified sounds, dizziness and tinnitus, with scores of 0–100 points.
Twenty-three patients completed the questionnaire before surgery. Section scores (mean±standard deviation) were: 38.2 ± 25.2 for general quality of life, 52.5 ± 23.9 for internal amplified sounds, 35.1 ± 28.8 for dizziness, 33.3 ± 30.7 for tinnitus, and 39.8 ± 22.2 for the composite score. Cronbach's α statistic averaged 0.93 (range, 0.84–0.97) across section scores, and 0.83 for the composite score.
The Gopen–Yang Superior Semicircular Canal Dehiscence Questionnaire provides a holistic, patient-centred characterisation of superior semicircular canal dehiscence symptoms. Internal consistency analysis validated the questionnaire and provided a quantitative framework for further optimisation in the clinical setting.