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You have just encountered a possible stroke patient. You ask yourself: what should I do first? How do I know it is a stroke? Is it too late to reverse the damage? This book provides integral assistance in answering these critical questions. All content is arranged in chronological order, covering all considerations in assessing and treating patients in the emergency room, stroke unit, and rehabilitation facilities. This new edition offers readers the latest information on stroke treatment, and features brand new chapters on stroke radiology, endovascular therapy, the uncommon causes of stroke, cerebral venous thrombosis, stroke prevention, and the transition to outpatient care. The comprehensive set of appendices contains useful reference information, including dosage algorithms, conversion factors, and stroke scales.
There is a scarcity of specialist trainers and supervisors for psychosocial interventions in low- and middle-income countries. A cascaded model of training and supervision was developed to sustain delivery of an evidence-based peer-delivered intervention for perinatal depression (the Thinking Healthy Programme) in rural Pakistan. The study aimed to evaluate the model.
Mixed methods were employed as part of a randomised controlled trial of the intervention. Quantitative data consisted of the peers' competencies assessed during field training and over the implementation phase of the intervention, using a specially developed checklist. Qualitative data were collected from peers and their trainers through 11 focus groups during the second and third year of intervention rollout.
Following training, 43 peers out of 45 (95%) achieved at least a ‘satisfactory’ level of competency (scores of ⩾70% on the Quality and Competency Checklist). Of the cohort of 45 peers initially recruited 34 (75%) were retained over 3 years and showed sustained or improved competencies over time. Qualitatively, the key factors contributing to peers' competency were use of interactive training and supervision techniques, the trainer–peer relationship, and their cultural similarity. The partnership with community health workers and use of primary health care facilities for training and supervision gave credibility to the peers in the community.
The study demonstrates that lay-workers such as peers can be trained and supervised to deliver a psychological intervention using a cascaded model, thus addressing the barrier of scarcity of specialist trainers and supervisors.
Flavonoids are natural compounds derived from different types of vegetables, fruits, and medicinal herbal plants. Hesperidin, a flavanone (a class of flavonoids) glycoside is found abundantly in citrus fruits such as oranges, lemons tangerines and limes and is known to possess significant benefits, such as anti-inflammatory, anti-stress, antioxidant, growth promoting, anticancer and immunological properties. Hesperidin enhances mucosal and humoral immunity by increasing intestinal intraepithelial lymphocyte numbers, lymphoid organs (thymus, spleen and bursa) indices, as well as improving anti-avian influenza and anti-Newcastle disease antibody titres in poultry. In addition, hesperidin is a strong chain-breaking antioxidant that provides potent cellular antioxidant defence against the damaging effects induced by peroxide hydrogen. As a natural antioxidant, hesperidin could help mitigate heat stress during summer by decreasing heterophil-to-lymphocyte ratios, and quenching reactive oxygen species generated by summer heat stress. The aim of this review was to elucidate the biological effects and health benefits of hesperidin as an alternative of synthetic immune boosters and growth promoters in poultry diets.
The Khyber Pakhtunkhwa province of North-West Pakistan has endured increased levels of violence in recent years. The psychological sequelae of such trauma including the presence of dissociative symptoms has been minimally investigated to date. The study examines psychopathology experienced including the presence of dissociative symptoms, and ascertain what factors are potentially predictive of these symptoms.
Third-level students (n=303) completed psychometric instruments relating to their experience of traumatic events and assessed depression, anxiety and dissociative symptoms.
Symptoms suggestive of post-traumatic stress disorder were evident in 28% of individuals. Symptoms relating to intrusive experiences and alterations in reactivity predicted dissociative, depressive and anxiety symptoms (p<0.01).
Trauma related to violence in this study was associated with significant pathology including dissociative symptoms. Identification and subsequent treatment of dissociative symptoms in individuals who have experienced trauma, may have a significant ameliorating effect on levels of functioning and thus should be included in clinical assessment.
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. The anaesthetic considerations for head and neck cancer surgery are especially challenging given the high burden of concurrent comorbidity in this patient group and the need to share the airway with the surgical team. This paper provides recommendations on the anaesthetic considerations during surgery for head and neck cancer.
• All theatre staff should participate in the World Health Organization checklist process. (R)
• Post-operative airway management should be guided by local protocols. (R)
• Patients admitted to post-operative care units with tracheal tubes in place should be monitored with continuous capnography. Removal for tracheal tubes is the responsibility of the anaesthetist. (R)
• Anaesthetists should formally hand over care to an appropriately trained practitioner in the post-operative or intensive care unit. (G)
• Intensive care unit staff looking after post-operative tracheostomies must be clear about which patients are not suitable for bag-mask ventilation and/or oral intubation in the event of emergencies. (R)
The poultry sector is an important and vibrant segment of agriculture in Pakistan with a significant contribution to the national GDP (1.3%). Commercial poultry production in Pakistan started in the 1960's and has been providing a significant portion of daily proteins to the Pakistani population ever since. During its evolution the industry enjoyed promotional policies of the Government, but has faced several challenges such as disease outbreaks and retail price fluctuations. Despite its important role in the country's economy, not a single scientific study is available on its evolutionary history. The data available in this regard are scattered and lack reliability. This review is an effort to encompass the history of the overall growth of the poultry industry in Pakistan, its present status (2012 statistics) and future directions and challenges. This article may serve as the basic source of information on Pakistan's poultry industry achievements. It will also guide poultry experts and policy makers for developing strategic planning for further growth of the industry.
This paper concerns with the unsteady MHD flow of a second grade fluid between two parallel walls through porous media induced by rectified sine pulses shear stress. The analytical expressions for the velocity field and the adequate shear stress are determined by means of the Laplace transform technique and Fourier cosine and sine transforms and are written as a sum of steady state and transient solutions. The influence of side walls on the fluid motion, the distance between walls for which the velocity of the fluid in the middle of the channel is negligible, and the required time to reach the steady state are presented by graphical illustrations. As the second grade fluid parameter → 0 the problem reduces to the Newtonian fluids performing the same motion.
Silicon (Si) nanowires offer great potential for field ionization (FI) applications due to well-established Si microfabrication methods combined with favorable ionizing properties of Si. Band bending of semiconductors under applied electric fields increases the FI probability, which is not possible with metal-based counterparts. While it has been demonstrated that scaling down the active material geometry can increase the FI efficiency, maximum electric field at the tip of a single nanowire decreases by quenching effect of nearby nanowires. In this work, optimization of Si nanowire geometries for improved FI efficiencies is explored.
Newcastle Disease (ND) is regarded as one of the major diseases of poultry because of the devastating losses that the virulent form of the ND virus can impose on both commercial and domestic chickens. However, the disease can be controlled through the administration of effective vaccines. Almost all the commercially available ND vaccines require refrigeration and begin to deteriorate rapidly after 1-2 hours if left at room temperature (around 25°C). Subsequently, because maintaining an adequate supply of refrigerated facilities may be a difficult task in many countries with unreliable electrical supplies, the development and large scale production of an effective thermostable ND vaccine seems imperative to support the poultry industry. Such vaccines should be resilient to damage associated with either very cold or hot environments so there are no concerns about the viability of the vaccine in response to temperatures fluctuations that can occur in extreme environments when the difference in temperature during cold and warm seasons can vary greatly. In the following review paper, the development of such a vaccine is discussed, including molecular characterisation, organ tropism of vaccine strains, production, as well as administration methods and their efficacy. It addition, the potential payback has been calculated alongside opportunities provided by removing vaccines from cold chain storage.
A simulated Magnox glass which is Mg- and Al- rich was subjected to aqueous corrosion in static mode with deionised water at 90 °C for 7-28 days and assessed using X-Ray Diffraction (XRD), Scanning Electron Microscopy (SEM) with Energy X-Ray Dispersive Spectroscopy (EDS) and Inductively Coupled Plasma – Optical Emission Spectroscopy (ICP-OES). XRD revealed both amorphous phase and crystals in the glass structure. The crystals were Ni and Cr rich spinels and ruthenium oxide. After two weeks of incubation in deionised water, the glass surface was covered by a ∼11 μm thick Si-rich layer whilst mobile elements and transition metals like Na, B, and Fe were strongly depleted. The likely corrosion mechanism and in particular the role of Mg and Al in the glass structure are discussed.
Patients with enlarged lymph nodes present to a number of different specialties and diagnosis is often made following a biopsy.
This study aimed to establish department waiting times for cervical lymph node biopsy, and compare these to the cancer services guidelines.
A retrospective audit was carried out to record patient waiting times (defined as the number of days from referral to biopsy) between May and December 2010. A proforma for referral was introduced. In addition, appointments for biopsies were arranged by a co-ordinator. A prospective re-audit was carried out from March to September 2011.
The first audit showed that national guidelines were not met; there was a median waiting time of 74 days (interquartile range, 47–113). Re-audit demonstrated a significant reduction in waiting times using the proforma; the median waiting time had decreased to 18 days (interquartile range, 9–22).
A proforma for lymph node biopsy and a designated co-ordinator streamlined the service, significantly reducing waiting times. Together, these can aid referral for meeting guidelines and improve patient care.
The mechanisms involved in the formation of titanium (Ti) nanoclusters produced by sputtering and inert gas condensation were investigated experimentally and numerically. Ti nanoclusters were generated inside an ultrahigh vacuum compatible system under different source parameters, i.e., inert gas flow rate (fAr), length of the aggregation region (L), and sputtering discharge power (P). Nanocluster size and yield were measured using a quadrupole mass filter (QMF). The variation of the above source parameters enabled fine-tuning of the nanocluster size and yield. Herein, Ti nanoclusters were produced within the size range 3.0–10.0 nm. The combination between the nanocluster size and yield as a function of source parameters enabled understanding Ti nanocluster formation mechanisms, i.e., three-body and two-body collisions. The results show that two-body collisions dominate nanocluster production at low fAr while the three-body collisions dominate at high fAr. In addition, nanocluster size increases as L increases due to the increase in nanocluster nucleation and growth times. The maximum nanocluster yield was obtained at fAr that maximize the probability of three-body and two-body collisions. Nanoclusters could be produced within an optimum range of the sputtering discharge power wherein the nanocluster size and yield increase with increasing the discharge power as a result of increasing the amount of sputtered material. The experimental results were compared with a theoretical model of nanocluster formation via three-body collision. Detailed understanding of the evolution of size and yield of Ti (and Ti-oxide) nanoclusters is essential for producing nanoclusters that can be utilized for environmental applications such as conversion of carbon dioxide and water vapor into hydrocarbons.
The present study was designed to assess physical activity, sedentary behaviours and dietary habits among adolescents in Kuwait and to compare the differences between genders.
A cross-sectional study was conducted among secondary-school children who participated in the Arab Teens Lifestyle Study (ATLS), a multi-centre collaborative project.
Secondary schools in Kuwait.
Adolescents (463 boys and 443 girls), aged 14–19 years.
Nearly half (44·6 %) of the boys and three-quarters (76·0 %) of the girls did not meet the recommended daily physical activity levels (≥2520 MET-min/week, moderate to vigorous intensity). Nearly all (96·3 % of boys and 96·7 % of girls) adolescents reported spending >2 h/d on screen time, with girls found to spend more time per day watching television (P = 0·02) and using a computer (P < 0·001). The large majority of the adolescents reported skipping breakfast and not having milk and milk products, vegetables and fruit daily, while nearly two-thirds of the boys and girls had sugar-sweetened drinks on more than 3 d/week. Compared with girls, boys reported consuming more fruit (3·4 v. 2·8 times/week, P = 0·001), dairy products (4·5 v. 3·6 times/week, P = 0·001) and energy drinks (1·3 v. 1·1 times/week, P = 0·003).
The majority of the Kuwaiti adolescents, especially girls, do not perform adequate physical activity, spend more time on sedentary activities and have unhealthy dietary practices. The findings emphasize an urgent need for implementing an appropriate intervention for promoting physical activity, healthy eating and reducing sedentary behaviours among these children.
The Ultra-Fast Flash Observatory (UFFO) is a space observatory for optical follow-ups of
gamma ray bursts (GRBs), aiming to explore the first 60 seconds of GRBs optical emission.
UFFO is utilized to catch early optical emissions from GRBs within few sec after trigger
using a Gimbal mirror which redirects the optical path rather than slewing entire
spacecraft. We have developed a 15 cm two-axis Gimbal mirror stage for the UFFO-Pathfinder
which is going to be on board the Lomonosov satellite which is to be launched in 2013. The
stage is designed for fast and accurate motion with given budgets of 3 kg of mass and 3
Watt of power. By employing stepping motors, the slewing mirror can rotate faster than 15
deg/sec so that objects in the UFFO coverage (60 deg × 60 deg) can be targeted in
~1 sec. The obtained targeting resolution is better 2 arcmin using a close-loop
control with high precision rotary encoder. In this presentation, we will discuss details
of design, manufacturing, space qualification tests, as well as performance tests.
The UFFO (Ultra-Fast Flash Observatory) is a GRB detector on board the Lomonosov
satellite, to be launched in 2013. The GRB trigger is provided by an X-ray detector,
called UBAT (UFFO Burst Alarm & Trigger Telescope), which detects X-rays from the GRB
and then triggers to determine the direction of the GRB and then alerts the Slewing Mirror
Telescope (SMT) to turn in the direction of the GRB and record the optical photon fluxes.
This report details the calibration of the two components: the MAPMTs and the YSO crystals
and simulations of the UBAT. The results shows that this design can observe a GRB within a
field of view of ±35° and can trigger in a time scale as short as 0.2 – 1.0 s
after the appearance of a GRB X-ray spike.
The Ultra-Fast Flash Observatory (UFFO) aims to detect the earliest moment of Gamma-Ray
Bursts (GRBs) which is not well known, resulting into the enhancement of GRB mechanism
understanding. The pathfinder mission was proposed to be a scaled-down version of UFFO,
and only contains the UFFO Burst Alert & Trigger Telescope (UBAT) measuring the
X-ray/gamma-ray with the wide-field of view and the Slewing Mirror Telescope (SMT) with a
rapid-response for the UV/optical photons. Once the UBAT detects a GRB candidate with the
position accuracy of 10 arcmin, the SMT steers the UV/optical photons from the candidate
to the telescope by the fast rotatable mirror and provides the early UV/optical photons
measurements with 4 arcsec accuracy. The SMT has a modified Ritchey-Chrètien telescope
with the aperture size of 10 cm diameter including the rotatable mirror and the image
readout by the intensified charge-coupled device. There is a key board called the UFFO
Data Acquisition system (UDAQ) that manages the communication of each telescope and also
of the satellite and the UFFO overall operation. This pathfinder is designed and built
within the limited size and weight of ~20 kg and the low power consumption up to
~30 W. We will discuss the design and performance of the UFFO-pathfinder, and its
integration to the Lomonosov satellite.
The Ultra-Fast Flash Observatory (UFFO), which will be launched onboard the
Lomonosov spacecraft, contains two crucial instruments: UFFO Burst
Alert & Trigger Telescope (UBAT) for detection and localization of Gamma-Ray Bursts
(GRBs) and the fast-response Slewing Mirror Telescope (SMT) designed for the observation
of the prompt optical/UV counterparts. Here we discuss the in-space calibrations of the
UBAT detector and SMT telescope. After the launch, the observations of the standard X-ray
sources such as pulsar in Crab nebula will provide data for necessary calibrations of
UBAT. Several standard stars will be used for the photometric calibration of SMT. The
celestial X-ray sources, e.g. X-ray binaries with bright optical sources
in their close angular vicinity will serve for the cross-calibration of UBAT and SMT.
The Ultra-Fast Flash Observatory (UFFO) Pathfinder for Gamma-Ray Bursts (GRBs) consists
of two telescopes. The UFFO Burst Alert & Trigger Telescope (UBAT) handles the
detection and localization of GRBs, and the Slewing Mirror Telescope (SMT) conducts the
measurement of the UV/optical afterglow. UBAT is equipped with an X-ray detector, analog
and digital signal readout electronics that detects X-rays from GRBs and determines the
location. SMT is equipped with a stepping motor and the associated electronics to rotate
the slewing mirror targeting the GRBs identified by UBAT. First the slewing mirror points
to a GRB, then SMT obtains the optical image of the GRB using the intensified CCD and its
readout electronics. The UFFO Data Acquisition system (UDAQ) is responsible for the
overall function and operation of the observatory and the communication with the satellite
main processor. In this paper we present the design and implementation of the electronics
of UBAT and SMT as well as the architecture and implementation of UDAQ.
One of the unexplored domains in the study of gamma-ray bursts (GRBs) is the early time
phase of the optical light curve. We have proposed Ultra-Fast Flash Observatory (UFFO) to
address this question through extraordinary opportunities presented by a series of small
space missions. The UFFO is equipped with a fast-response Slewing Mirror Telescope that
uses a rapidly moving mirror or mirror array to redirect the optical beam rather than
slewing the entire spacecraft or telescope to aim the optical instrument at the GRB
position. The UFFO will probe the early optical rise of GRBs with sub-second response, for
the first time, opening a completely new frontier in GRB and transient studies. Its fast
response measurements of the optical emission of dozens of GRB each year will provide
unique probes of the burst mechanism and test the prospect of GRB as a new standard
candle, potentially opening up the z > 10 universe. We describe the current limit in
early photon measurements, the aspects of early photon physics, our soon-to-be-launched
UFFO-pathfinder mission, and our next planned mission, the UFFO-100.