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Introduction: Abdominal pain is one of the most frequent reasons for an emergency department (ED) visit. Most cases are functional and no therapy has proven effective. Our objective was to determine if hyoscine butylbromide (HBB) (BuscopanTM) is effective for children who present to the ED with functional abdominal pain. Methods: We conducted a randomized, blinded, superiority trial comparing HBB 10 mg plus acetaminophen placebo to oral acetaminophen 15 mg/kg (max 975 mg) plus HBB placebo using a double-dummy approach. We included children 8-17 years presenting to the ED at London Health Sciences Centre with colicky abdominal pain rated >40 mm on a 100 mm visual analog scale (VAS). The primary outcome was VAS pain score at 80 minutes post-administration. Secondary outcomes included adverse effects; caregiver satisfaction with pain management using a five-item Likert scale; recidivism and missed surgical diagnoses within 24-hours of discharge. Analysis was based on intention to treat. Results: We analyzed 225 participants (112 acetaminophen; 113 HBB). The mean (SD) age was 12.4 (3.0) years and 148/225 (65.8%) were females. Prior to enrollment, the median (IQR) duration of pain prior was 2 (4.5) hours and analgesia was provided to 101/225 (44.9%) of participants. The mean (SD) pre-intervention pain scores in the acetaminophen and HBB groups were 62.7 (15.9) mm and 60.3 (17.3) mm, respectively. At 80 minutes, the mean (SD) pain scores in the acetaminophen and HBB groups were 30.1 (28.8) mm and 29.4 (26.4) mm, respectively and there were no significant differences adjusting for pre-intervention scores (p = 0.96). The median (IQR) caregiver satisfaction was high in the acetaminophen [5 (2)] and HBB [5 (1)] groups (p = 0.79). The median (IQR) length of stay between acetaminophen [235 (101)] and HBB [234 (103)] was not significantly different (p = 0.53). The proportion of participants with a return visit for abdominal pain was 4/112 (3.5%) in the acetaminophen group and 6/113 (5.3%) in the HBB group. The most common adverse effect was nausea (9% in each group) and there were no significant differences in adverse effects between acetaminophen (26/112, 23.2%) and HBB (31/113, 27.4%) (p = 0.52). There were no missed surgical diagnoses. Conclusion: For children with presumed functional abdominal pain who present to the ED, both acetaminophen and HBB produce a clinically important (VAS < 30 mm) reduction in pain and should be routinely considered in this clinical setting.
Introduction: Acute aortic syndrome (AAS) is a time sensitive aortic catastrophe that is often misdiagnosed. There are currently no Canadian guidelines to aid in diagnosis. Our goal was to adapt the existing American Heart Association (AHA) and European Society of Cardiology (ESC) diagnostic algorithms for AAS into a Canadian evidence based best practices algorithm targeted for emergency medicine physicians. Methods: We chose to adapt existing high-quality clinical practice guidelines (CPG) previously developed by the AHA/ESC using the GRADE ADOLOPMENT approach. We created a National Advisory Committee consisting of 21 members from across Canada including academic, community and remote/rural emergency physicians/nurses, cardiothoracic and cardiovascular surgeons, cardiac anesthesiologists, critical care physicians, cardiologist, radiologists and patient representatives. The Advisory Committee communicated through multiple teleconference meetings, emails and a one-day in person meeting. The panel prioritized questions and outcomes, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations. The algorithm was prepared and revised through feedback and discussions and through an iterative process until consensus was achieved. Results: The diagnostic algorithm is comprised of an updated pre test probability assessment tool with further testing recommendations based on risk level. The updated tool incorporates likelihood of an alternative diagnosis and point of care ultrasound. The final best practice diagnostic algorithm defined risk levels as Low (0.5% no further testing), Moderate (0.6-5% further testing required) and High ( >5% computed tomography, magnetic resonance imaging, trans esophageal echocardiography). During the consensus and feedback processes, we addressed a number of issues and concerns. D-dimer can be used to reduce probability of AAS in an intermediate risk group, but should not be used in a low or high-risk group. Ultrasound was incorporated as a bedside clinical examination option in pre test probability assessment for aortic insufficiency, abdominal/thoracic aortic aneurysms. Conclusion: We have created the first Canadian best practice diagnostic algorithm for AAS. We hope this diagnostic algorithm will standardize and improve diagnosis of AAS in all emergency departments across Canada.
It is a well-known result of Sanov (5) that groups of exponent pk (p prime) satisfy the th Engel congruence (definition below). Recently, an alternative proof of this has been given by Glauberman, Krause, and Struik (3). Bruck (2) has conjectured that such groups satisfy the th Engel congruence. In this note we go some way towards proving this.
Oscillating two-stream instability (OTSI) of a high amplitude laser or a plasma wave is investigated in plasmas with strongly coupled ions. It is shown that in some parameter regime, the pressure of strongly coupled ions becomes negative, which leads to enhance the bunching of ion and concomitant destabilization of OTSI. Applications of these results to ion accelerator and inertial confinement fusion experiments are discussed.
Energy gain of electron beams in bubble regime of the laser wakefield accelerator can be optimized by improving the acceleration length, radial accelerating and focusing force, number of monoenergetic electrons trapped inside the bubble, and increasing dephasing length. In order to enlarge the dephasing length, the phase velocity of the plasma wave can be increased by optimizing the plasma density profile. We report the estimation of dephasing length using plasma density distribution with the flat and linear-upward profile using two-dimensional particle-in-cell simulations. The size of wakefield bubble depends on the plasma density. With a positive plasma density gradient, the size of bubble decreases. The front and trail part of wake bubble will have different phase velocity in plasma density gradient region. After density transition in constant density region, the bubble elongates and the velocity of the back part of the bubble increases so that the accelerated electron phase synchronizes with the phase of the plasma wave. In a result, the electron acceleration length enhances to improve the beam quality.
To directly observe healthcare workers in a nursing home setting to measure frequency and duration of resident contact and infection prevention behavior as a factor of isolation practice
SETTING AND PARTICIPANTS
Healthcare workers in 8 VA nursing homes in Florida, Maryland, Massachusetts, Michigan, Washington, and Texas
Over a 15-month period, trained research staff without clinical responsibilities on the units observed nursing home resident room activity for 15–30-minute intervals. Observers recorded time of entry and exit, isolation status, visitor type (staff, visitor, etc), hand hygiene, use of gloves and gowns, and activities performed in the room when visible.
A total of 999 hours of observation were conducted across 8 VA nursing homes during which 4,325 visits were observed. Residents in isolation received an average of 4.73 visits per hour of observation compared with 4.21 for nonisolation residents (P<.01), a 12.4% increase in visits for residents in isolation. Residents in isolation received an average of 3.53 resident care activities per hour of observation, compared with 2.46 for residents not in isolation (P<.01). For residents in isolation, compliance was 34% for gowns and 58% for gloves. Healthcare worker hand hygiene compliance was 45% versus 44% (P=.79) on entry and 66% versus 55% (P<.01) on exit for isolation and nonisolation rooms, respectively.
Healthcare workers visited residents in isolation more frequently, likely because they required greater assistance. Compliance with gowns and gloves for isolation was limited in the nursing home setting. Adherence to hand hygiene also was less than optimal, regardless of isolation status of residents.
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.
We present an approach that allows a robot to generate trajectories to perform a set of instances of a task using few physical trials. Specifically, we address manipulation tasks which are highly challenging to simulate due to complex dynamics. Our approach allows a robot to create a model from initial exploratory experiments and subsequently improve it to find trajectory parameters to successfully perform a given task instance. First, in a model generation phase, local models are constructed in the vicinity of previously conducted experiments that explain both task function behavior and estimated divergence of the generated model from the true model when moving within the neighborhood of each experiment. Second, in an exploitation-driven updating phase, these generated models are used to guide parameter selection given a desired task outcome and the models are updated based on the actual outcome of the task execution. The local models are built within adaptively chosen neighborhoods, thereby allowing the algorithm to capture arbitrarily complex function landscapes. We first validate our approach by testing it on a synthetic non-linear function approximation problem, where we also analyze the benefit of the core approach features. We then show results with a physical robot performing a dynamic fluid pouring task. Real robot results reveal that the correct pouring parameters for a new pour volume can be learned quite rapidly, with a limited number of exploratory experiments.
We describe the performance of the Boolardy Engineering Test Array, the prototype for the Australian Square Kilometre Array Pathfinder telescope. Boolardy Engineering Test Array is the first aperture synthesis radio telescope to use phased array feed technology, giving it the ability to electronically form up to nine dual-polarisation beams. We report the methods developed for forming and measuring the beams, and the adaptations that have been made to the traditional calibration and imaging procedures in order to allow BETA to function as a multi-beam aperture synthesis telescope. We describe the commissioning of the instrument and present details of Boolardy Engineering Test Array’s performance: sensitivity, beam characteristics, polarimetric properties, and image quality. We summarise the astronomical science that it has produced and draw lessons from operating Boolardy Engineering Test Array that will be relevant to the commissioning and operation of the final Australian Square Kilometre Array Path telescope.
We have obtained simultaneous observations of single pulses from the bright pulsars B0329+54 and B1133+16 at two frequencies in full polarization and a total of four frequencies in total power only. Here is a summary of our fantastic results!
Refractive Interstellar Scintillation (RISS) effects on pulsar signals are powerful techniques for discriminating between different models that have been proposed for the power spectrum of plasma density fluctuations in the Interstellar Medium (ISM; e.g. Rickett 1990). The nature of the spectrum is considered to be a major input for understanding the underlying mechanism of interstellar plasma turbulence. Data from our long-term pulsar scintillation observations using the Ooty Radio Telescope (ORT) at 327 MHz are used to investigate the nature of the spectrum in the Local Interstellar Medium (LISM; region within ∼ 1 kpc of the Sun). Dynamic scintillation spectra were obtained for 18 pulsars in the DM range 3–35 pc cm−3 at ∼10–100 epochs spanning ∼100–1000 days during 1993–1995 (Bhat et al. 1999). From these observations, various scintillation properties and the ISM parameters are estimated with accuracies much better than that which has been possible from most earlier data. The time series of parameters, viz., decorrelation bandwidth (vd), scintillation time scale (τd) and the drift slope of intensity scintillation patterns, and pulsar flux density are used to study various observable effects of Interstellar Scintillation, based on which the spectral form is inferred over the spatial scale range ∼ 107 m to ∼ 1013 m.
Pulsation is ubiquitous among chemically normal A-type stars, but comparatively rare among chemically peculiar Am and Ap stars of the same temperature range. The conventional explanation for this is that diffusion produces the surface abundance anomalies in the Am and Ap stars, and also drains He from the He-II ionisation zone, thus quenching the κ-mechanism that drives δ Scuti pulsation. The pulsating Am and Ap stars exhibit dichotomous pulsation characteristics. The Am stars (and related stars) exhibit low-overtone δ Scuti pulsation, with amplitudes ranging from a few mmag to 0.1 mag. The pulsating Ap stars exhibit high-overtone pulsation with periods in the range 6-16 min and Johnson B semi-amplitudes typically ≤ 5 mmag. These stars are referred to as rapidly oscillating Ap stars, or ‘roAp’ stars (the see review by Martinez & Kurtz 1995).
Results from new observations of pulsars using the Ooty Radio Telescope (ORT) are used for investigating the structure of the Local Interstellar Medium (LISM). The observations show anomalous scintillation effects towards several nearby pulsars, and these are modeled in terms of large-scale spatial inhomogeneities in the distribution of plasma density fluctuations in the LISM. A 3-component model, where the Solar neighbourhood is surrounded by a shell of enhanced plasma turbulence, is proposed for the LISM. The inferred scattering structure is strikingly similar to the Local Bubble. Further, analysis based on recent scintillation measurements show evidence for enhanced scattering towards pulsars located in the general direction of the Loop I Superbubble. The model for the LISM has been further extended by incorporating the scattering due to turbulent plasma associated with Loop I.
Latino Americans are a rapidly growing ethnic group in the United States. The characteristics of glioblastoma in this population is poorly studied. We have evaluated the data of 47,540 glioblastoma patients from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. This SEER data from 1973-2000 includes up to 13 cancer registries. For 2001 to 2011, the data has improved geographic coverage with 18 registries encompassing 28% of the U.S. population.
Latinos have a lower incidence of GBM than non-Latino Whites. Gender distribution is similar. The total SEER data show that Latinos present slightly younger and have a higher incidence of giant cell glioblastoma and gliosarcoma than non-Latino Whites. Despite higher rates of radiation therapy, the one year survival rate (34.7%) for non-Latino White populations is less than for Latinos (39.0%, p <0.001). Subset analyses (2001-2011) of all the above parameters show similar results except for gliosarcoma incidence. A literature search does not identify MGMT or IDH1 data regarding Latino Americans.
We have assessed 2 prognostic markers in 30 Latino glioblastoma patients. MGMT methylation is present in 24% and IDH1 mutation is found in 12.5%. Our preliminary data suggests that Latinos may have a greater incidence of MGMT unmethylated tumors. Younger age may possibly contribute to improved survival in Latinos but the underlying molecular basis is unresolved.
A large-amplitude plasma beat-wave driven by two lasers (differing in frequencies equal to the plasma frequency) can accelerate the plasma electrons to a higher energy level. As the plasma beat-wave grows, it becomes susceptible to oscillating two-stream instability. The decayed sideband plasma wave couples with the pump wave to divert its energy by the instability, and saturates it. The saturated amplitude of the plasma beat-wave traps the electrons more effectively to accelerate them to higher energy. The saturation of plasma beat-wave amplitude is shown to have a significant effect in an electron energy gain.
This paper describes the system architecture of a newly constructed radio telescope – the Boolardy engineering test array, which is a prototype of the Australian square kilometre array pathfinder telescope. Phased array feed technology is used to form multiple simultaneous beams per antenna, providing astronomers with unprecedented survey speed. The test array described here is a six-antenna interferometer, fitted with prototype signal processing hardware capable of forming at least nine dual-polarisation beams simultaneously, allowing several square degrees to be imaged in a single pointed observation. The main purpose of the test array is to develop beamforming and wide-field calibration methods for use with the full telescope, but it will also be capable of limited early science demonstrations.
We present the results from nearly three years of monitoring of the variations in dispersion measure (DM) along the line-of-sight to 11 millisecond pulsars using the Giant Metrewave Radio Telescope (GMRT). These results demonstrate accuracies of single epoch DM estimates of the order of 5 × 10−4 cm−3 pc. A preliminary comparison with the Parkes Pulsar Timing Array (PPTA) data shows that the measured DM fluctuations are comparable. We show effects of DM variations due to the solar wind and solar corona and compare with the existing models.