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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.
A total of 1840 brine shrimps (Artemia franciscana) were examined for cestode larvae at monthly intervals between November 2015 and June 2016. Of these, 663 (36.03%) specimens were infected with cysticercoids of seven cestode species in numbers between one and sixteen. During the first four months of examination, the percentage of infected shrimps was low but rose significantly with increasing temperatures in March, reaching maximum values in May. Flamingolepis liguloides and Flamingolepis flamingo showed the highest prevalence overall, at 25.3 and 10.7%, respectively. The intensity of infection was 1–10 and 1–4 cysticercoids, respectively. Eurycestus avoceti, Wardium stellorae, Gynandrotaenia stammeri, Anomotaenia tringae and Confluaria podicipina occurred at lower prevalence of 4.5, 3.2, 1.7, 0.3 and 0.05%, respectively. Up to four species were detected in one host.
Introduction: Inadequate pain management in children is ubiquitous in the emergency department (ED). As the current national opioid crisis has highlighted, physicians are caught between balancing pain management and the risk of long term opioid dependence. This study aimed to describe pediatric emergency physicians (PEPs) willingness to prescribe opioids to children in the ED and at discharge. Methods: A unique survey tool was created using published methodology guidelines. Information regarding practices, knowledge, attitudes, perceived barriers, facilitators and demographics were collected. The survey was distributed to all physician members of Pediatric Emergency Research Canada (PERC), using a modified Dillmans Tailored Design method, from October to December 2017. Results: The response rate was 49.7% (124/242); 53% (57/107) were female, mean age was 43.6 years (+/− 8.7), and 58% (72/124) had pediatric emergency subspecialty training. The most common first line ED pain medication was ibuprofen for mild, moderate and severe musculoskeletal injury (MSK-I)-related pain (94.4% (117/124), 89.5% (111/124), and 62.9% (78/124), respectively). For moderate and severe MSK-I, intranasal fentanyl was the most common opioid for first (35.5% (44/124) and 61.3% (76/124), respectively) and second line pain management (41.1% (51/124) and 20.2% (25/124), respectively). 74.8% (89/119) of PEPs reported that an opioid protocol would be helpful, specifically for morphine, fentanyl, and hydromorphone. Using a 0-100 scale, physicians minimally worried about physical dependence (13.3 +/−19.3), addiction (16.6 +/−19.8), and diversion of opioids (32.8+/−26.4) when prescribing short-term opioids to children. They reported that the current opioid crisis minimally influenced their willingness to prescribe opioids (30.0 +/−26.2). Physicians reported rarely (36%; 45/125) or never (28%; 35/125) completing a screening risk assessment prior to prescribing opioids. Conclusion: Ibuprofen remains the most common medication recommended for MSK-I pain in the ED and at discharge. Intranasal fentanyl was the top opioid for all pain intensities. PEPs are minimally concerned regarding dependence, addiction, and the current opioid crisis when prescribing short-term opioids to children. There is an urgent need for robust evidence regarding the dependence and addiction risk for children receiving short term opioids in order to create knowledge translation tools for ED physicians. Opioid specific protocols for both in the ED and at discharge would likely improve physician comfort in responsible and adequate pain management for children.
Salinity gradient is an enormous source of clean energy. A process for potential generation from an ionic concentration gradient produced in single and multicell assembly is presented. The ionic gradient is created using a fuel cell type cell with a micro-porous ion exchange membrane, both anionic (AEM) and cationic (CEM). Various salinity gradients, Salt : Fresh, from 100 : 0 to 16000 : 0 was established using NaCl solution, in the electrode chambers. A potential of 20 mV/cm to 25 mV/cm can be realized at ambient temperatures and pressures for a bipolar AEM/CEM cell. The performance was optimized for various static and dynamic flow rates of the saline and fresh water. The cell performance can further be optimized for Membrane Electrode System (MES) morphology. A multicell unit was assembled and the results presented for various conditions like concentration gradients, flow rates and pressure. The thermodynamic and electrical efficiency needs to be evaluated for various gradients and flow rates. The relation with number of valance electrons/ ion and the potential generated changes for various dynamic condition of salinity. The higher the salinity gradient the larger is the potential generated. This is limited by the membrane characteristics. There exists a monotonic relation between the number of valence electron/ion/unit time and the potential generated up to about 16000 concentration. The membrane characteristics have been studied for optimal ion crossover for various gradients and flow. The graph between ln (gradient) versus Voltage provides insights into this process. This presents a very cost effective and clean process of energy conversion.
Mahseer are popularly regarded by anglers as the king of freshwater fishes, and are valued across the Himalayan and South-east Asian regions. In India, mahseer are important game fish. Mahseer populations and their habitats face a range of anthropogenic threats, however, including unregulated fishing and habitat fragmentation as a result of hydro-development projects. Catch-and-release angling for mahseer attracts both national and international anglers and could provide information about rivers while generating revenue for regional economies. In this context, we evaluated catch-and-release angling records from rivers that flow within two Indian reserves (the Ramganga and Jia Bharali Rivers in Corbett and Nameri Tiger Reserves, respectively). Golden mahseer Tor putitora in the Ramganga and golden and chocolate mahseer Neolissochilus hexagonolepis in the Jia Bharali were the most frequently caught fish species. Catch data suggested these game fish populations are probably not negatively affected by angling activities. Interviews with stakeholders highlighted support for catch-and-release angling, mainly because of its perceived economic benefits. The data obtained in this research could potentially assist with both fish conservation and the protection of associated aquatic ecosystems.
Near-shore recent benthic foraminifera from three ecologically important (Olive Ridley turtle congregation sites) but vulnerable sites encompassing 23 sampling stations (12 in Rushikulya, 5 in Devi and 6 in Gahirmatha) along coastal Orissa, north-west Bay of Bengal (BoB) in India were studied for the first time for their composition, distribution and assemblage patterns. Thirty-nine species of benthic foraminifers (from 6 orders and 23 families) were identified of which all 39 were present in Rushikulya, 22 in Devi and 12 in Gahirmatha with abundance ranging from 35–2620 individuals/10 cm3 in the sediments. The communities across the sites were dominated by eurytopic rotalids followed by miliolids and textularids. Benthic foraminifer assemblages were found to be dominated by Ammonia species complex (up to 38% in Rushikulya, 64% in Devi and 22% in Gahirmatha). Agglutinated foraminifers were infrequent in the sediments (7 species in Rushikulya, 4 species in Devi and 3 in Gahirmatha) on the other hand, being dominated by Quinqueloculina agglutinans in Rushikulya and Trochammina macrescens and Ammobaculites agglutinans in Devi and Gahirmatha. The substrates along the study sites were found mostly to be sand dominated and in some of the stations sediment composition influenced the foraminifer distribution pattern. The present findings on the assemblage patterns of benthic foraminifers from three coastal settings in Orissa along the BoB are comparable with previous reports from other sandy coastal ecosystems in the world. Overall these data provide valuable insights into the distribution and assemblage patterns of benthic foraminifers from the BoB coastal regions.
The exponential Euler spline curves of Schoenberg are used to derive the correctness of cardinal interpolation by shifted univariate B-splines and the “metric condition” on the bi-infinite Toeplitz matrix of interpolation. Additional monotonicity properties of the associated symbol for interpolation in each of its parameters are also given.
Sixty per cent of the global elderly population live in low-and middle-income countries, and this proportion was expected to rise to 70% by 2010 (International Institute of Ageing, 2001; Ferri et al, 2005). The 2001 Indian census found over 70 million people aged 60 years or more (considered senior citizens according to the Indian National Policy on Older Persons). Most of those senior citizens live with younger family members and are dependent on them for financial and social support. Hence, any physiological and psychological changes in the older family members affect the younger supportive members as well.
The small, isolated populations of the Nicobar megapode Megapodius nicobariensis, currently categorized as Vulnerable on the IUCN Red List, on the Nicobar islands in the Indian Ocean have declined by c. 70% since 1994. The 2004 tsunami is believed to be the major cause of this decline. The populations of megapodes on the islands of Megapode and Trax were wiped out by the tsunami. I estimate from a 2006 survey that 395–790 breeding pairs of the Nicobar megapode now survive on the coasts of the various islands compared to 2,318–4,056 pairs in 1994. The tsunami also adversely influenced nest-site selection and mound-nest ecology: > 50% of mounds were found closer to the shore in 2006 than in 1994, probably because of loss of suitable habitat, and they may become inundated with seawater during high tides. Most of the mound-nests found were constructed after the tsunami and were significantly smaller in volume than those present in 1994. Restoration of suitable habitat is critical for the long-term viability of the Nicobar megapode. However, post-tsunami impacts such as the creation of large-scale plantations in coastal areas, which are encroaching upon megapode habitat, may be severe. Because of the decline in numbers and habitat destruction and hunting the Nicobar megapode probably now qualifies for categorization as Endangered on the IUCN Red List.
Decision-making in agricultural production is a complex process in which many risks need to be con-sidered for an informed decision to be made. In many parts of the world, weather and climate are one of the biggest production risks and uncertainty factors impacting on agricultural systems performance and management. Farmers around the world, especially those in the developing countries, have been trying to adapt to the variable weather and climate conditions through various risk-management strategies. Improved weather and climate information, supplied to the farming community in a timely manner, can greatly assist the farmers in their operational decisions.
During an Inter-Regional Workshop on Improving Agrometeorological Bulletins in Barbados in October 2001, participants recommended that a dedicated web server be developed for distributing agrometeorological products from WMO members. Subsequently, an Expert Group Meeting on Internet Applications for Agrometeorological Products was held in Washington, DC, during May 2002, to discuss the practical steps needed to develop this web server. Discussions from this meeting led to the development of the World AgroMeteorological Information Service (WAMIS). WAMIS is a dedicated web server on which countries and organisations can place their agrometeorological bulletins and advisories. Provision of such a central location for agrometeorological information enables users to quickly and easily evaluate various bulletins and gain insight into improving their own bulletins. Also, these bulletins represent the expert knowledge of the individual countries and provide the possibility to assess extreme events and disasters in a historical perspective, especially when an archive of bulletins is present. Placement of agrometeorological bulletins on WAMIS also increases the visibility of the National Meteorological/Hydrological Services (NMHS). In March 2005, a tools and resources section was added to WAMIS to provide users with additional papers, links to software tools, Internet links, and other resources to help improving their agrometeorological bulletins and advisories and services.
Agrometeorological information and services from the National Meteorological and Hydrological Services (NMHSs) are increasingly being demanded by the farming community to cope more efficiently with climate variability and the increasing incidence of extreme meteorological events such as droughts, floods, frosts and wind erosion. While considerable advances have been made in the collection, archiving and analysis of weather and climate data, their transformation into information that can be readily used by the farm sector has lagged behind, especially in developing countries where such information needs are the greatest. One of the important reasons is the lack of adequate interaction with the user community in assessing the appropriate dissemination and communication procedures that can enhance the value of the agrometeorological information and services. A brief review of the present status of dissemination and communication of agrometeorological information by the NMHSs and associated agencies in different regions around the world is presented. A description of the user communities for agrometeorological information and their varying needs is also presented. Opportunities and challenges in the dissemination and communication of agrometeorological information by the NMHSs are described with suitable examples which emphasize that continued improvements are necessary to make agrometeorological information more accessible and useful to the user community.
Background. We carried out a large randomized trial of a brief form of cognitive therapy, manual-assisted cognitive behaviour therapy (MACT) versus treatment as usual (TAU) for deliberate self-harm.
Method. Patients presenting with recurrent deliberate self-harm in five centres were randomized to either MACT or (TAU) and followed up over 1 year. MACT patients received a booklet based on cognitive behaviour therapy (CBT) principles and were offered up to five plus two booster sessions of CBT from a therapist in the first 3 months of the study. Ratings of parasuicide risk, anxiety, depression, social functioning and global function, positive and negative thinking, and quality of life were measured at baseline and after 6 and 12 months.
Results. Four hundred and eighty patients were randomized. Sixty per cent of the MACT group had both the booklet and CBT sessions. There were seven suicides, five in the TAU group. The main outcome measure, the proportion of those repeating deliberate self-harm in the 12 months of the study, showed no significant difference between those treated with MACT (39%) and treatment as usual (46%) (OR 0·78, 95% CI 0·53 to 1·14, P=0·20).
Conclusion. Brief cognitive behaviour therapy is of limited efficacy in reducing self-harm repetition, but the findings taken in conjunctin with the economic evaluation (Byford et al. 2003) indicate superiority of MACT over TAU in terms of cost and effectiveness combined.
We describe the neuropsychiatry outreach clinic in west Kent and review referrals to the clinic over a 4-year period. By comparing the referral pattern of west Kent with adjacent health authorities we show how an outreach clinic can influence the number of neuropsychiatric referrals.
Referrals from west Kent increased from 87 in the 4-year period prior to the outreach clinic to 255 in the 4-year period that the clinic has been in existence. Forty-nine of these patients were first assessed in the outreach clinic. The number of referrals from east Surrey and east Sussex remained low in the same period.
An outreach clinic provides access to specialist expertise and increases local awareness of specialist services. Similar outreach clinics in other areas may enhance the clinical care of patients who are currently not being referred to neuropsychiatry.
Fortification of salt with iron has been developed by the National Institute of Nutrition (NIN) as a strategy for the control of iron deficiency anaemia (IDA) in India, similar to iodization of salt for control of iodine deficiency disorders (IDD). Stability of the iron fortified salt (IFS), its bioavailability and organoleptic evaluation of food items containing the IFS have been demonstrated. Acceptability and effectiveness of the IFS in school children and in multicentric community trials have been demonstrated. With the introduction of universal iodization of salt as a national policy in 1988, NIN has developed a formulation for double fortification (DFS) of salt with iodine and iron. The stability of the nutrients under laboratory conditions along with their bioavailability were found to be good but varying with the quality of salt used. The DFS has been evaluated in controlled trials in tribal communities and in residential school children. The findings of these studies are discussed. Overall, in these trials, DFS effectively controlled iodine deficiency but a clear impact on reducing anaemia was not demonstrated. In residential schoolchildren, increased urinary excretion of iodine as well as reduced anaemia were observed. The quality of salt has been found to be an important determinant of the stability of iodine in DFS. Further evaluation of this potentially important intervention is in progress.
The regional cerebral blood flow (rCBF) response to the Wisconsin Card Sort Test (WCST) has been used to assess the functional integrity of the prefrontal cortex in patients with schizophrenia.
In this study, patients were divided into two groups according to whether they had made few or many perseverative errors on a modified version of the WCST. A control group consisted of normal volunteers. The groups were then compared with respect to rCBF response to WCST activation.
rCBF was measured during administration of a modified version of the WCST and during a card sorting control task, using single photon emission computerised tomography (SPECT).
Performance of the modified WCST was associated with a widespread and substantial increase in rCBF, particularly in the frontal region. The poorly performing group of patients with schizophrenia showed only a modest increase in rCBF in the left anterior cingulate region.
Subjects with schizophrenia are able to respond to specific neuropsychological challenge with activation of the frontal regions.
A comprehensive study was conducted over a 4-year period (1984–87)
to evaluate the water use,
growth and yield responses of pearl millet (Pennisetum glaucum
(L.) R. Br.) cv. CIVT grown with and
without fertilizer (30 kg P2O5 and 45 kg N ha−1)
at the ICRISAT Sahelian Centre, Sadoré, Niger. Our
study showed significant year and fertilizer effects on the growth and
yield of millet at the study site.
Observed year effects were primarily due to the variations in the amount
and distribution of rainfall
in relation to the potential demand for water. During 1984, 1985 and 1987,
total rainfall was below
the long term average, while in 1986 it was above average. While the onset
of rains (relative to the
average date of onset) was early from 1984 to 1986, in 1987 the sowings
were delayed by as much as
33 days. Of all the four years, the separation between the treatments in
the cumulative evaporation
is most evident for 1984, which was a drought year with below-average rainfall
in all the months from
June to September. Cumulative evaporation patterns in 1985 and 1986 were
similar because of regular
rains and high average rainfall per rainy day from June to October. In
1987, sowings were delayed
until 15 July and only 6·9 mm of rainfall was received per rainy
day in July. Hence cumulative
evaporation was initially low and showed a significant increase only after
two significant rain events
in early August. There was a large response to fertilizer in all the years
as small additions of fertilizer
phosphate increased the soluble phosphate in the soil. Fertilizer application
resulted in a small
increase in water use (7–14%) in all years except 1987. Increased
yield due to the application of
fertilizer was accompanied by an increase in the water-use efficiency (WUE)
in all the four years with
the largest increase in 1985. The beneficial effect of fertilizers could
be attributed to the rapid early
growth of leaves which can contribute to reduction of soil evaporative
losses and increased WUE.
Over the four seasons, average increase in the WUE due to the addition
of fertilizer was 84%.
The response of four cowpea (Vigna unguiculata(L.) Walp.) cultivars to the warm, semi-arid tropical environment at the ICRISAT Sahelian Center at Sadore, Niger was studied during 1985 and 1986 interms of leaf area index (LAI), dry matter (DM) accumulation, net photosynthesis, stomatal conductance, total water use and yield. Among the three improved cultivars, IT82D–716 is early and erect, cv. IT83S–947 is early and spreading and cv. TVX4659–03E is a medium-duration, highyielding, dual-purpose type. The local cv. Sadore Local is a long-duration, photosensitive, spreading type used mainly for fodder. In both years, Sadore Local recorded the highest LAI. IT82D–716 and IT83S–947 produced < 1·3 t/ha of DM in both years, whereas TVX 4659–03E produced > 2 t/ha of DM and proved superior to Sadore Local in partitioning DM into pods. The four cultivars did not differ significantly either in stomatal conductance or in net phytosynthetic rates. Observed maximum photosynthetic rates of c. 20 μmol/m2/s lie at the bottom of the range 21–38 μmol/m2/s reported for 31 cowpea genotypes in an earlier study. Photosynthetic rates increased with increasing photon flux density. TVX4659–03E had an advantage in total seed plus fodder yields while the local cultivar gave significantly greater fodder yields in both years. Seed and fodder yields, as well as water-use efficiency, confirmed the advantages offered by the dual-purpose cultivar TVX4659–03E. Future breeding efforts in the Sahel should focus on dual-purpose (grain/fodder) cowpea types.