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Acute tonsillitis represents a significant proportion of admissions to ENT departments nationally. Given current hospital pressures, it is vital to look for safe alternatives to admission. This study explores the safe management of patients in an ambulatory medical unit, without the need for admission.
A retrospective review of 48 patients’ notes was carried out. Following the development and implementation of a guideline for acute tonsillitis, a prospective re-audit of 41 patients was carried out, measuring length of stay, overnight admissions and re-admissions.
The rate of overnight admission following implementation of the guideline fell from 0.75 to 0.29, and average length of stay dropped from 19.2 to 9.5 hours. There were two re-admissions in each cycle of the audit, which represents a non-significant increase.
The tonsillitis guideline has significantly reduced admissions and length of stay. Re-admissions remain low, demonstrating that this is a safe and cost-effective intervention.
A substantial and continual economic loss within the pig industry is the 5-20% pre-weaning mortality rate that occurs during the neonatal period (MLC, 2002). The principal causes of piglet death are low birth weight in conjunction with insufficient amounts of body fat reserves (Herpin et al., 1993; Varley, 1995). Studies by Rooke et al. (2000) have demonstrated that the fatty acid profiles of the sows diet during late pregnancy and lactation is an important factor influencing piglet performance. The benefits of dietary manipulations aimed at improving piglet survival, however, remain controversial. The aim of this study was to examine the effect of supplementing the maternal diet with palm and/or soya oil during late gestation on piglet growth performance.
Early nutrition of the neonatal pig has a major impact on its survival and subsequent development (Cieslak et al., 1983). The success of maternal nutrition trials has been limited in improving the survival and growth performance of piglets. Milk yield and composition has been altered (Jackson et al., 1995; Averette et al., 1999), which subsequently enhanced piglet health and growth performance but feeding supplemental fat had little or no effect on the birth weight of piglets. The aim of this study was to examine the effect of supplementing palm and/or soya oil directly to the piglet on its subsequent growth performance.
It is increasingly essential for medical researchers to be literate in statistics, but the requisite degree of literacy is not the same for every statistical competency in translational research. Statistical competency can range from ‘fundamental’ (necessary for all) to ‘specialized’ (necessary for only some). In this study, we determine the degree to which each competency is fundamental or specialized.
We surveyed members of 4 professional organizations, targeting doctorally trained biostatisticians and epidemiologists who taught statistics to medical research learners in the past 5 years. Respondents rated 24 educational competencies on a 5-point Likert scale anchored by ‘fundamental’ and ‘specialized.’
There were 112 responses. Nineteen of 24 competencies were fundamental. The competencies considered most fundamental were assessing sources of bias and variation (95%), recognizing one’s own limits with regard to statistics (93%), identifying the strengths, and limitations of study designs (93%). The least endorsed items were meta-analysis (34%) and stopping rules (18%).
We have identified the statistical competencies needed by all medical researchers. These competencies should be considered when designing statistical curricula for medical researchers and should inform which topics are taught in graduate programs and evidence-based medicine courses where learners need to read and understand the medical research literature.
A series of research reports has indicated that the use of substances such as cannabis, alcohol and tobacco are higher in youth at clinical high risk (CHR) of developing psychosis than in controls. Little is known about the longitudinal trajectory of substance use, and findings on the relationship between substance use and later transition to psychosis in CHR individuals are mixed.
At baseline and 6- and 12-month follow-ups, 735 CHR and 278 control participants completed the Alcohol and Drug Use Scale and a cannabis use questionnaire. The longitudinal trajectory of substance use was evaluated with linear mixed models.
CHR participants endorsed significantly higher cannabis and tobacco use severity, and lower alcohol use severity, at baseline and over a 1-year period compared with controls. CHR youth had higher lifetime prevalence and frequency of cannabis, and were significantly younger upon first use, and were more likely to use alone and during the day. Baseline substance use did not differentiate participants who later transitioned to psychosis (n = 90) from those who did not transition (n = 272). Controls had lower tobacco use than CHR participants with a prodromal progression clinical outcome and lower cannabis use than those with a psychotic clinical outcome at the 2-year assessment.
In CHR individuals cannabis and tobacco use is higher than in controls and this pattern persists across 1 year. Evaluation of clinical outcome may provide additional information on the longitudinal impact of substance use that cannot be detected through evaluation of transition/non-transition to psychosis alone.
Mental health literacy is foundational for mental health promotion, prevention, stigma reduction and care. Integrated school mental health literacy interventions may offer an effective and sustainable approach to enhancing mental health literacy for educators and students globally.
Through a Grand Challenges Canada funded initiative called ‘An Integrated Approach to Addressing the Issue of Youth Depression in Malawi and Tanzania’, we culturally adapted a previously demonstrated effective Canadian school mental health curriculum resource (the Guide) for use in Malawi, the African Guide: Malawi version (AGMv), and evaluated its impact on enhancing mental health literacy for educators (teachers and youth club leaders) in 35 schools and 15 out-of-school youth clubs in the central region of Malawi. The pre- and post-test study designs were used to assess mental health literacy – knowledge and attitudes – of 218 educators before and immediately following completion of a 3-day training programme on the use of the AGMv.
Results demonstrated a highly significant and substantial improvement in knowledge (p < 0.0001, d = 1.16) and attitudes (p < 0.0001, d = 0.79) pertaining to mental health literacy in study participants. There were no significant differences in outcomes related to sex or location.
These positive results suggest that an approach that integrates mental health literacy into the existing school curriculum may be an effective, significant and sustainable method of enhancing mental health literacy for educators in Malawi. If these results are further found to be sustained over time, and demonstrated to be effective when extended to students, then this model may be a useful and widely applicable method for improving mental health literacy among both educators and students across Africa.
The High Throughput Experimentation (HTE) project of the Joint Center for Artificial Photosynthesis (JCAP, http://solarfuelshub.org/) performs accelerated discovery of new earth-abundant photoabsorbers and electrocatalysts. Through collaboration within the DOE solar fuels hub and with the broader research community, the new materials will be utilized in devices that efficiently convert solar energy, water and carbon dioxide into transportation fuels. JCAP-HTE builds high-throughput pipelines for the synthesis, screening and characterization of photoelectrochemical materials. In addition to a summary of these pipelines, we will describe several new screening instruments for high throughput (photo-)electrochemical measurements. These instruments are not only optimized for screening against solar fuels requirements, but also provide new tools for the broader combinatorial materials science community. We will also describe the high throughput discovery, follow-on verification, and device implementation of a new quaternary metal oxide catalyst. This rapid technology development from discovery to device implementation is a hallmark of the multi-faceted JCAP research effort.
Patient emotion, behaviour, and symptoms may explain avoidance of the daily programming on an acute psychiatric inpatient treatment milieu. We compared changes of emotion, behaviour, and symptoms among acutely ill psychiatric inpatients assigned to Behavioural Activation Communication (BAC), a newly designed milieu program, and those assigned to a unit representing treatment as usual (TAU).
Participants included 144 adult inpatients treated between January 2011 and July 2011 at two similar psychiatric units at a medical centre. Psychiatric patients were assigned to either the BAC or the TAU unit based bed availability. At admission and discharge, patients completed the Brief Symptom Inventory, Positive Affect and Negative Affect Scale, and the Checklist of Unit Behaviors.
A comparison of BAC and TAU patients showed greater relative change on positive affect and of behavioural activation with the daily programming.
The BAC program is associated with a significant increase of positive emotion and activation of inpatients.
Consumption of fruits and vegetables has been investigated for their role in the prevention of many chronic conditions. Among the fruits, mango provides numerous bioactive compounds such as carotenoids, vitamin C and phenolic compounds, which have been shown to have antioxidant and anti-inflammatory properties. The present study examined the effects of dietary supplementation of freeze-dried mango pulp, in comparison with the hypolipidaemic drug, fenofibrate, and the hypoglycaemic drug, rosiglitazone, in reducing adiposity and alterations in glucose metabolism and lipid profile in mice fed a high-fat (HF) diet. Male C57BL/6J mice were randomly divided into six treatment groups (eight to nine/group): control (10 % energy from fat); HF (60 % energy from fat); HF+1 or 10 % freeze-dried mango (w/w); HF+fenofibrate (500 mg/kg diet); HF+rosiglitazone (50 mg/kg diet). After 8 weeks of treatment, mice receiving the HF diet had a higher percentage body fat (P = 0·0205) and epididymal fat mass (P = 0·0037) compared with the other treatment groups. Both doses of freeze-dried mango, similar to fenofibrate and rosiglitazone, prevented the increase in epididymal fat mass and the percentage of body fat. Freeze-dried mango supplementation at the 1 % dose improved glucose tolerance as shown by approximately 35 % lower blood glucose area under the curve compared with the HF group. Moreover, freeze-dried mango lowered insulin resistance, as indicated by the homeostasis model assessment of insulin resistance, to a similar extent as rosiglitazone and modulated NEFA. The present findings demonstrate that incorporation of freeze-dried mango in the diet of mice improved glucose tolerance and lipid profile and reduced adiposity associated with a HF diet.
We have studied the structural and magnetic properties of La0.7Sr0.3Mn1-xNixO3 (x=0.05, 0.10, 0.20, 0.30, and 0.40) perovskites using x-ray and neutron diffraction and magnetic measurements. To our knowledge, there exists no neutron diffraction data available for this group of perovskite compositions. Neutron (λ = 1.479Å) and x-ray (λ = 1.5481Å; Cu Kα) powder diffraction indicate that for x ≥ 0.1 all samples are two-phase with a rhombohedral perovskite structure (space group R-3c) and a small amount of NiO (space group Fm3m). Neutron diffraction data for the perovskite phase at 12K and 300K show ferromagnetic ordering for x ≤ 0.2 and antiferromagnetic ordering for x = 0.4. However, for x = 0.3, neutron diffraction data at 12K show coexisting ferromagnetic and antiferromagnetic ordering while at 300K no magnetic ordering is found. Magnetic measurements indicate that the Curie temperature decreases with increasing Ni content. The NiO phase for all samples was found to have antiferromagnetic ordering at 12K and 300K. The magnetic measurements are consistent with the neutron diffraction data and together indicate long-range magnetic ordering for samples at low temperature and transitions from ferromagnetic to paramagnetic to antiferromagnetic ordering for samples at room temperature.
We briefly review some recent results on the steady-state and transient electron transport that occurs within bulk wurtzite zinc oxide. These results were obtained using an ensemble semi-classical three-valley Monte Carlo simulation approach. They showed that for electric field strengths in excess of 180 kV/cm, the steady-state electron drift velocity associated with bulk wurtzite zinc oxide exceeds that associated with bulk wurtzite gallium nitride. The transient electron transport that occurs within bulk wurtzite zinc oxide was studied by examining how electrons, initially in thermal equilibrium, respond to the sudden application of a constant electric field. These transient electron transport results demonstrated that for devices with dimensions smaller than 0.1 μm, gallium nitride based devices will offer the advantage, owing to their superior transient electron transport, while for devices with dimensions greater than 0.1 μm, zinc oxide based devices will offer the advantage, owing to their superior high-field steady-state electron transport.
The design, control, and actuation of legged robots that walk is well established, but there remain unsolved problems for legged robots that run. In this work, dynamic principles are used to develop a set of heuristics for controlling bipedal running and acceleration. These heuristics are then converted into control laws for two very different bipedal systems: one with a high-inertia torso and prismatic knees and one with a low-inertia torso, articulated knees, and mechanical coupling between the knee and ankle joints. These control laws are implemented in simulation to achieve stable steady-state running, accelerating, and decelerating. Stable steady-state running is also achieved in a planar experimental system with a semiconstrained torso.
Delafossite-type CuAlO2 thin films have been deposited by radio frequency (RF) reactive sputtering on sapphire using a CuAlO2 ceramic target. A study of structural and optical properties was performed on films of varying deposition parameters such as substrate temperature and oxygen partial pressure and also post annealing. The crystalline phase in the films was identified to be the delafossite structure by x-ray diffraction. The optical properties, such as the wavelength dependence of the transmittance and the band gap, were determined. The average transmittance is 80% in the wavelength range of 400-1500 nm and the band gap is 3.81 eV.
Pacific Northwest Laboratory (PNL) has fabricated cerium-activated lithium silicate scintillating fibers via a hot-downdraw process. These fibers, which, as produced, typically have a transmission length (e−1 length) of greater than 2 meters, are found to undergo aging when subjected to room air. The aging, which is complete in a few weeks, reduces the transmission length to the order of 0.5 meter. Because of the high alkali content of the glass (on the order of 20-30 mole % lithia), we have attributed this aging to aqueous corrosion at the polymer cladding/glass interface. Changes in transmission with chemical treatment of the surface support the corrosion model. Fiber transmission performance has been preserved by modifying the hot-downdraw to a double crucible to produce glass-on-glass waveguides.
Central to nanofabrication is the ability to transfer a pattern from an imaging layer to a device or structure. At the smallest dimensions (<20 nm), thin resists or imaging layers have been used exclusively. The transfer of a pattern that is formed in a thin layer resist presents severe technological challenges to resist materials development. A novel approach based on self-assembling monomolecular layer resists is demonstrated with two organosilane films, formed from (aminoethylaminomethyl)phenethyltrimethoxysilane (PEDA) and 4-chloromethylphenyltrichlorosilane (CMPTS). The molecules have separate chemical functionalities for binding to a Si substrate and for promoting chemistry leading to catalysis and the growth of an electroless plated metal film. STM lithographic exposure destroys the ability of the molecule to bind to a catalyst, which initiates an electroless metallization. This forms the basis for a selective imaging and the pattern transfer process. A 25 nm thick Ni layer acts as a very robust etch mask, even as the unmasked regions of Si are etched as deep as 5 μm by reactive ion etching with SF6. With our process 15 nm lines with 3.3 nm edge roughness have been fabricated in the plated Ni and etched into the underlying Si. The development of the resist process and the STM lithography will be described and the resolution of the approach will be discussed.
Thin films of MgIn2O4 spinel, which is a recently discovered TCO material, were deposited on MgO (100) surface by PLD. The thin films were prepared under low oxygen partial pressure to enhance formation of oxygen vacancies, from which carrier electrons were generated. X-ray analyses and AFM observations suggest epitaxial growth of the grains with diameter of 100∼200nm. The grains showed strong orientations both along the normal of the thin film and in plane. Epitaxial growth of the spinel was also confirmed by high-resolution transmission electron microscopic observations. The lattice image of the interface region suggests formation of structural imperfections such as dislocations, grain boundaries and amorphous phase in significant fraction. Strong optical absorption due to electron carriers was detected in near infrared region. Very large Burnstein-Moss shift was observed in ultraviolet region, and the optical band gap was estimated to be 4.3eV. DC conductivity observed was 4.5×103Scm−1, which is the highest value reported for the material so far. Concentration and Hall mobility of carrier electrons were found to be 2.1×1021cm−3 and 14cm2V−1s−1, respectively.