To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Numerical analysis was investigated for steady two-dimensional double diffusive mixed convection boundary layer flow over a semi-infinite vertical plate embedded non-Darcy porous medium filled with nanofluid, in presence of thermal dispersion and under convective boundary conditions. The Buongiorno nanofluid model is used, while the porous medium is described by the Darcy-Forchheimer extension. The governing partial differential equations are transformed into four coupled nonlinear ordinary differential equations using an appropriate similarity transformations and the resulting system of equations is then solved numerically by the finite-difference method. Numerical results are presented to illustrate how the physical parameters affect the flow field, temperature, concentration and solid volume fraction profiles. In addition, the variation of heat, mass and nanoparticle transfer rates at the plate are exhibited graphically for different values of pertinent parameters.
The current investigation was carried out to record the final stages of the development of both middle and distal parts of quail ceca, Coturnix coturnix japonica to understand the role of ceca in digestion, immune system, and absorption. The cellular and subcellular structures, including epithelial cell height, microvillus surface area, the proportion of goblet cells, the thickness of muscle layer, and cecum diameter showed great variations during the development. An undeveloped smooth muscularis mucosa was observed for the first time on the ED5. Primordia of glands were observed on the ED7. On the ED15, the middle part exhibited two shapes of mucosal villi: tongue-shaped villi and U-shaped. The plicae and crypts of Lieberkühn were demonstrated on the hatching day. The lymphatic tissues appeared in the wall of both parts of the ceca at the 4 weeks of age. Scanning electron microscopy revealed a great difference in the mucosal surface between different regions. Telocytes were observed in-between the muscle fibers and formed a network during the post-hatching period. Because of fermentation and other bacterial or chemical processes that have been shown to occur in the ceca, this study supports two hypotheses: the cecal development is related to diet and the cecal epithelium act as a site for primary absorption of nutrients or for re-absorption of electrolytes or amino acids derived from the urine.
By 2030, the global Muslim population is expected to reach 2.2 billion people. The representations of Islam and Muslims in the media and academic literature may unconsciously impact how clinicians perceive and approach their Muslim patients. Our study focuses on the emerging Muslim mental health (MMH) literature using bibliometric analysis, specifically social network analysis of word co-occurrence and co-authorship networks of academic publications, to describe how the content of MMH discourse is evolving.
We conducted an Ovid search (including Medline and PsycInfo databases) to identify articles written in English from 2000 to 2015 that had the terms ‘Islam’ and/or ‘Muslim’ in the abstract as well as research conducted in Muslim-majority countries and among Muslim minorities in the rest of the world.
Of the 2652 articles on MMH, the majority (65.6%) focused on describing psychopathology; the minority (11.2%) focused on issues around stigma, religiosity, spirituality, identity, or acculturation. Among the top 15 most frequent terms in abstracts were ‘post-traumatic stress disorder’, ‘violence’, ‘fear’, ‘trauma’, and ‘war’. Social network analysis showed there was little collaborative work across regions.
The challenges of producing MMH research are similar to the challenges faced across global mental health research. Much of the MMH research reflects regional challenges such as the impact of conflict and violence on mental health. Continued efforts to develop global mental health researchers through cross-cultural exchanges, academic journals' dedicated sections and programs for global mental health recruitment, and online training are needed to address the gap in research and collaborations.
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: Intravenous insertion (IVI) is identified by children as extremely painful and the resultant distress can have lasting negative consequences. There is an urgent need to effectively manage such procedures. Our primary objective was to compare the pain and distress of IVI with the addition of humanoid robot-based distraction to standard care, versus standard care alone. Methods: This two-armed randomized controlled trial (RCT) was conducted from April 2017 to May 2018 at the Stollery Children's Hospital emergency department (ED). Children aged 6 to 11 years who required IVI were included. Exclusion criteria included hearing or visual impairments, neurocognitive delays, sensory impairment to pain, previous enrolment, and discretion of the ED clinical staff. Primary outcomes were measured using the Observational Scale of Behavioural Distress-Revised (OSBD-R) (distress) and the Faces Pain Scale-Revised (FPS-R) (pain). A total of 426 pediatric patients were screened and 340 were excluded. Results: We recruited 86 children, of which 55% (47/86) were male; 9% (7/82) were premature at birth; 82% (67/82) had a previous ED visit; 30% (25/82) required previous hospitalization; 78% (64/82) had previous IV placement and 96% (78/81) received topical anesthesia. The mean total OSBD-R score was 1.49 ± 2.36 (standard care) compared to 0.78 ± 1.32 (robot group) (p = 0.047). The median FPS-R during the IV procedure was 4 (IQR 2,6) in the standard care group alone, compared to 2 (IQR 0,4) with the addition of humanoid robot-based distraction (p = 0.10). Change in parental state anxiety pre-procedure versus post-procedure was not significantly different between groups (p = 0.49). Parental satisfaction with the IV start was 93% (39/42) in the robot arm compared to 74% (29/39) in the standard care arm (p = 0.03). Parents were also more satisfied with management of their child's pain in the robot group (95% very satisfied) compared with standard care (72% very satisfied) (p = 0.002). Conclusion: A statistically significant reduction in distress was observed with the addition of robot-based distraction to standard care. Humanoid robot-based distraction therapy reduces distress and to a lesser extent, pain, in children undergoing IVI in the ED. Further trials are required to confirm utility in other age groups and settings.
An iron catalyst supported on the modified Tamazert kaolin has been prepared and tested in catalytic wet peroxide oxidation using phenol and 4-chlorophenol (4-CP) as target compounds (100 mg/L initial concentration). Kaolin is not usually employed as a catalytic support due to its low developed porous structure, but its textural properties may be improved upon calcination and acid and basic treatment. The catalyst was characterized by N2 adsorption–desorption and chemical analysis by total-reflection X-ray fluorescence spectroscopy. The catalytic tests were carried out in a batch reactor with a stoichiometric amount of H2O2. The catalytic efficiency was studied within the temperature range of 25–55°C at an initial pH of 3.3 and 1 g/L catalyst. Complete phenol and 4-CP removal was achieved with no significant differences in phenol and 4-CP conversions within the temperature range tested. Meanwhile, total organic carbon (TOC) reduction was greatly favoured by increasing the temperature, which may be partially attributed to a probable contribution of a homogeneous reaction associated with iron leaching. However, this effect might be of limited significance because the highest concentrations of iron in the liquid phase were below 4.5 and 8.5 mg/L in the experiments with phenol and 4-CP, respectively. At 55°C, TOC was reduced by ~70% after 4 h reaction time, with the remaining by-products corresponding almost completely to low-molecular-weight carboxylic acids of very low ecotoxicity.
Computer-assisted navigation (CAN) improves the accuracy of spinal instrumentation in vertebral fractures and degenerative spine disease; however, it is not widely adopted because of lack of training, high capital costs, workflow hindrances, and accuracy concerns. We characterize shifts in the use of spinal CAN over time and across disciplines in a single-payer health system, and assess the impact of intra-operative CAN on trainee proficiency across Canada.
A prospectively maintained Ontario database of patients undergoing spinal instrumentation from 2005 to 2014 was reviewed retrospectively. Data were collected on treated pathology, spine region, surgical approach, institution type, and surgeon specialty. Trainee proficiency with CAN was assessed using an electronic questionnaire distributed across 15 Canadian orthopedic surgical and neurosurgical programs.
In our provincial cohort, 16.8% of instrumented fusions were CAN-guided. Navigation was used more frequently in academic institutions (15.9% vs. 12.3%, p<0.001) and by neurosurgeons than orthopedic surgeons (21.0% vs. 12.4%, p<0.001). Of residents and fellows 34.1% were fully comfortable using spinal CAN, greater for neurosurgical than orthopedic surgical trainees (48.1% vs. 11.8%, p=0.008). The use of CAN increased self-reported proficiency in thoracic instrumentation for all trainees by 11.0% (p=0.036), and in atlantoaxial instrumentation for orthopedic trainees by 18.0% (p=0.014).
Spinal CAN is used most frequently by neurosurgeons and in academic centers. Most spine surgical trainees are not fully comfortable with the use of CAN, but report an increase in technical comfort with CAN guidance particularly for thoracic instrumentation. Increased education in spinal CAN for trainees, particularly at the fellowship stage and, specifically, for orthopedic surgery, may improve adoption.
To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.
Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.
Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.
In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.
We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.
New excavations at the Jebel Moya cemetery in Sudan reveal extensive evidence for Meroitic-era occupation, providing valuable data on contemporaneous diet, migration, exchange and population composition in sub-Saharan Africa.
Introduction: Intravenous (IV) cannulation is commonly performed in emergency departments (ED), often causing substantial pain and distress. Distraction has been shown to reduce child-reported pain, but there is currently little published about the effects of using iPad technology as a distraction tool. Our primary objective was to compare the reduction of pain and distress using iPad distraction (games, movies, books of the child’s choice) in addition to standard care, versus standard care alone. Methods: This randomized clinical trial, conducted at the Stollery Childrens Hospital ED, recruited children between ages 6 to 11 years requiring IV cannulation. Study arm assignment was performed using REDCaps randomization feature. Due to the nature of the intervention, blinding was not possible for the children, parents or research and ED staff, but the data analyst was blinded to intervention assignment until completion of analysis. Pain, distress, and parental anxiety were measured using the Faces Pain Scale-Revised, the Observed Scale of Behavioural Distress-Revised, and the State Trait Anxiety Inventory, respectively. The pain scores and observed behavioural distress scores were compared using the Mann-Whitney U test. Other co-variates were analyzed using a linear regression analysis. Results: A total of 85 children were enrolled, with 42 receiving iPad distraction and 43 standard care, of which 40 (95%) and 35 (81%) children received topical anesthesia, respectively (p=0.09). There were 40 girls (47.1%) with a mean age of 8.32 +/− 1.61 years. The pain scores during IV cannulation (p=0.35) and the change in pain score during the procedure compared to baseline (p=0.79) were not significantly different between the groups, nor were the observed distress scores during IV cannulation (p=0.09), or the change in observed distress during the procedure compared to baseline (p=0.44). A regression analysis showed children in both groups had greater total behavioural stress if it was their first ED visit (p=0.01), had prior hospitalization experience (p=0.04) or were admitted to hospital during this visit (p=0.007). A previous ED visit, however, was predictive of a greater increase in parental anxiety from baseline (p=0.02). When parents were asked whether they would use the same methods to manage pain for their child, parents of the iPad group were more likely to say yes than were parents of the standard care group (p=0.03). Conclusion: iPad distraction during IV cannulation in school-aged children was not found to decrease pain or distress more than standard care alone, but parents preferred its use. The effects of iPad distraction may have been over-shadowed by potent topical anesthetic effect. Future directions include exploring iPad distraction for other age groups, and studying novel technology such as virtual reality and interactive humanoid robots.
Introduction: In children, acute otitis media (AOM) pain is undertreated. We sought to determine if video discharge instructions were associated with improved symptomatology, functional outcomes, and knowledge compared to a paper handout. Methods: We conducted a randomized controlled superiority trial comparing video discharge instructions (Easy Sketch Pro3TM) on management of pain to a paper handout detailing the same. We included caregivers of children 6 months to 5 years presenting to the emergency department (ED) with a clinical diagnosis of AOM. The primary outcome was symptomatology using the Acute Otitis Media Severity of Symptom (AOM SOS) score between 48 and 72 hours. The 7-item self-report AOM-SOS is scored from 0 to 13 with a higher score indicating more symptomatology. Secondary outcomes included knowledge gain using a 10-item survey, days of daycare/school/work missed, and recidivism. Assuming a minimal clinically important AOM-SOS difference of 2, 90% power, and 5% alpha, 60 individuals/group was needed. Results: 219 caregivers were randomized and 149 completed the 72-hour follow-up (72 paper and 77 video). The median (IQR) AOM-SOS score in the video group (adjusted for pre-intervention AOM-SOS, analgesic and antibiotic use) was significantly lower than paper [8 (7,11) versus 10 (7,13), respectively, p=0.004]. There were no significant differences between video and paper in the mean (SD) knowledge score [9.2 (1.3) versus 8.8 (1.8) correct answers, respectively, p=0.07], mean (SD) number that returned to a health provider [8/77 versus 10/72, respectively, p=0.49), mean (SD) number of daycare/schooldays missed [1.2 (1.5) versus 1.1 (2.1), respectively, p=0.62], and mean (SD) number of workdays missed by caregiver [0.5 (1) versus 0.8 (2), respectively, p=0.05]. Conclusion: Video discharge instructions are associated with less symptomatology compared to a paper handout, are effective for caregiver education in the ED, and should be used routinely.
This work focuses on the syntheses of Zn-enriched PtZn nanoparticle electrocatalysts by solution combustion for ethanol oxidation reaction (EOR). Analytical techniques of x-ray diffraction, transmission electron microscopy (TEM), scanning electron microscopy, TEM/scanning TEM-energy dispersive x-ray spectroscopy, and x-ray photoelectron spectroscopy are used for the characterization of electrocatalysts. Cyclic voltammetry and chronoamperometry are applied for the electrocatalysis of C2H5OH and stability test in an alkaline medium, respectively. Electrochemical data show that PtZn/C has improved electrocatalytic activity by ~2.3 times compared with commercial Pt/C, in addition to having earlier onset potential and better stability for EOR. The variation of fuel amount in the synthesis has affected crystallite sizes, electronic, and electrochemical properties in electrocatalysts.
This article reports the first attempt to test the relevance of buoyancy—the capacity to overcome the setbacks, challenges, and pressures that are part of the ordinary course of school life—for instructed second language (L2) learning. Questionnaire data from 787 college-level L2 learners in South Korea assessed their academic buoyancy and a set of six hypothesized predictors. A two-step cluster analysis of the data identified five prominent L2 learner archetypes, providing evidence for the existence of L2 domain-specific buoyancy profiles. Using structural equation modeling, we examined links among the six predictor variables, buoyancy, and L2 achievement and grade point average (GPA). The results showed that buoyancy significantly predicted both L2 achievement and GPA and mediated the effect of the predictors on these two outcome variables. Buoyancy, thus, captures a dimension of L2 motivation that is conceptually and empirically distinct from existing constructs, and represents an essential yet underexplored capacity for success in language learning.
This work aims to develop simple and cost-effective methods in reduction of Cr(VI) from water to less toxic and easy separated Cr(III) using Titanium dioxide (TiO2).
TiO2 nanoparticles are prepared by a sol-gel method using titanium tetra-chloride and characterized using X-Ray Diffraction (XRD), Scanning electron microscope (SEM), Energy dispersive X-ray Fluorescence spectrometer (EDX) and UV-visible spectroscopy. XRD shows Anatase structure of TiO2 after annealing at 600°C for four hours. The particles size is estimated to be 70 nm using SEM.UV-Visible spectroscopy indicated that TiO2 nanoparticles played important role in decreasing the concentration of Cr (VI) in water samples for different pH range of 1 to 4. The decrease in Cr(VI) concentration after the treatment is ascribed to the reduction caused by the photocatalyst effect that resulted from the presence of TiO2 nanoparticle in water samples under direct exposure to direct sunlight.
Blood eosinophil count is associated with a variety of common complex outcomes in epidemiological observation. The aim of this study was to explore the causal association between determined blood eosinophil count and 20 common complex outcomes (10 metabolic, 6 cardiac, and 4 pulmonary). Through Mendelian randomization, we investigated genetic evidence for the genetically determined eosinophil in association with each outcomes using individual-level LifeLines cohort data (n = 13,301), where a weighted eosinophil genetic risk score comprising five eosinophil associated variants was created. We further examined the associations of the genetically determined eosinophil with those outcomes using summary statistics obtained from genome-wide association study consortia (6 consortia and 14 outcomes). Blood eosinophil count, by a 1-SD genetically increased, was not statistically associated with common complex outcomes in the LifeLines. Using the summary statistics, we showed that a higher genetically determined eosinophil count had a significant association with lower odds of obesity (odds ratio (OR) 0.81, 95% confidence interval (CI) [0.74, 0.89]) but not with the other traits and diseases. To conclude, an elevated eosinophil count is unlikely to be causally associated to higher risk of metabolic, cardiac, and pulmonary outcomes. Further studies with a stronger genetic risk score for eosinophil count may support these results.
Here we report the use of luminescence thermometry to measure the temperature decay from single gold structure into the substrate of AlGaN:Er3+ film. We looked at Er3+ ion photoluminescence upon illumination by modulated 532 nm laser and recorded time-resolved luminescence of 2H11/2 → 4I15/2 and the 4S3/2 → 4I15/2 energy transitions. We calculated the heat generated from gold microdisk and observed the rate of heat dissipation to the environment. We directly calculated the absolute thermal conductivity of 1.7 W/mK for AlGaN: Er3+ film which was in agreement with the literature.
Iranian native fowls are raised for both meat and egg yield. Growth rate and egg production under conventional rearing systems in the villages are very low, Also, in past several decades imports of exotic breeds have increased the risk of extinction native fowl species. Evidence shows that there is good and useful variation in native fowl species for different traits, especially for those of economic importance. The objective of the current study is to estimate genetic parameters for economic traits of Iranian native fowl, so that efficient multi-trait selection programmes can be developed which will maximise economic return and secure genetic diversity.