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This study examined the effectiveness of an integrated care pathway (ICP), including a medication algorithm, to treat agitation associated with dementia.
Design:
Analyses of data (both prospective and retrospective) collected during routine clinical care.
Setting:
Geriatric Psychiatry Inpatient Unit.
Participants:
Patients with agitation associated with dementia (n = 28) who were treated as part of the implementation of the ICP and those who received treatment-as-usual (TAU) (n = 28) on the same inpatient unit before the implementation of the ICP. Two control groups of patients without dementia treated on the same unit contemporaneously to the TAU (n = 17) and ICP groups (n = 36) were included to account for any secular trends.
Intervention:
ICP.
Measurements:
Cohen Mansfield Agitation Inventory (CMAI), Neuropsychiatric Inventory Questionnaire (NPIQ), and assessment of motor symptoms were completed during the ICP implementation. Chart review was used to obtain length of inpatient stay and rates of psychotropic polypharmacy.
Results:
Patients in the ICP group experienced a reduction in their scores on the CMAI and NPIQ and no changes in motor symptoms. Compared to the TAU group, the ICP group had a higher chance of an earlier discharge from hospital, a lower rate of psychotropic polypharmacy, and a lower chance of having a fall during hospital stay. In contrast, these outcomes did not differ between the two control groups.
Conclusions:
These preliminary results suggest that an ICP can be used effectively to treat agitation associated with dementia in inpatients. A larger randomized study is needed to confirm these results.
Changes in antimicrobial use during the pandemic in relation to long-term trends in utilization among different antimicrobial stewardship program models have not been fully characterized. We analyzed data from an integrated health system using joinpoint regression and found temporal fluctuations in prescribing as well as continuation of existing trends.
OBJECTIVES/GOALS: #NAME? METHODS/STUDY POPULATION: Cell culture & protein identification: human T cells were purified from healthy blood, then activated & cultured for 5d. CAR-T cells were collected from infusion bags of cancer patients undergoing CAR-T. Silver staining of naive & activated healthy T-cell lysates was compared; B-II spectrin was upregulated and confirmed by Western blot. Migration assays: naive & activated T-cells were imaged during migration on ICAM-1 and ICAM-1 + CXCL12 coated plates. T-cells were transfected with BII-spectrin cDNA & the chemokine dependence of migration was compared with controls. In-vivo studies: in a melanoma mouse model, BII-spectrin transfected or control T-cells were injected; tumors were followed with serial imaging. Human patient records were examined to correlate endogenous BII-spectrin levels and CAR-T response. RESULTS/ANTICIPATED RESULTS: Activated T-cells downregulate the cytoskeletal protein B-II spectrin compared to naive cells, leading to chemokine-independent migration in in vitro assays and off-target trafficking when CAR-T cells are given in vivo. Restoration of B-II spectrin levels via transfection restores chemokine-dependence of activated T-cells. In a mouse melanoma model, control mice injected with standard activated T-cells showed fewer cells in the tumor site and more cells in the off-target organs (spleen, lungs) when compared to mice injected with B-II spectrin transfected cells. Furthermore, among 3 human patients undergoing CAR-T therapy, those with higher endogenous B-II spectrin levels experienced fewer side-effects, measured by the neurotoxicity and cytokine release syndrome grades. DISCUSSION/SIGNIFICANCE: A major hurdle to widespread CAR-T therapy for cancer is significant, often fatal side-effects. Our work shows that the protein B-II spectrin is downregulated during CAR-T production, and that restoring B-II spectrin levels decreases side-effects while increasing tumor clearance--hopefully translating to better CAR-T regimens for the future.
Estimates of depression in suicidal behavior in South Asia would help to formulate suicide prevention strategies in the region that hasn't been assessed yet.
Objectives
We aimed to systematically assess the prevalence of depression in fatal and non-fatal attempts of suicide in eight South Asian countries.
Methods
We searched Medline, Embase, and PsychINFO by specific search terms to identify articles assessing depression in fatal and non-fatal attempts of suicide in South Asian countries published between 2001 and 2020. Two separate meta-analyses were conducted for fatal and non-fatal attempts. Due to the high heterogeneity of studies (96–98%), random-effects models were used to calculate pooled prevalence rates.
Results
A total of 38 studies was identified from five south Asian countries (India [27], Pakistan [6], Sri Lanka [3], Nepal [1], and Bangladesh [1]). The majority of studies (n = 27) were published after 2010. Twenty-two studies reported non-fatal attempts, and sixteen reported suicide. The prevalence of depression among non-fatal attempts ranged from 14% to 78% where the pooled prevalence rate was 32.7% [95% CI 26–39.3%]. The prevalence of depression among suicides ranged from 8% to 79% where the pooled prevalence estimate was 37.3% [95% CI 26.9–47.6%].
Conclusions
This review revealed the pooled prevalence of depression among fatal and non-fatal suicidal attempts in South Asian countries, which seems to be lower when comparedto the Western countries. However, a cautious interpretation is warranted due to the heterogeneity of study methods, sample size, and measurement of depression.
A common problem in otological surgeries is the persistence of ear discharge in a patient who has undergone middle-ear reconstructive surgery, despite an intact graft. There is a dearth of knowledge in the literature on treatment strategies in such post-operative cases of recalcitrant otorrhoea.
Method
This was a retrospective observational descriptive study conducted on 45 patients who fitted the criteria for recalcitrant post-operative otorrhoea. All 45 patients showed no response to conservative treatment for 14 days from onset of discharge. Therefore, these patients were then given antiseptic ear drops.
Results
Thirty patients out of 45 showed a good response to antiseptic ear drops and achieved a dry ear at the end of the treatment.
Conclusion
In patients with recalcitrant otorrhoea with or without granulations after middle-ear reconstruction surgery, this study found that topical antiseptic ear drops, particularly those using boric acid powder, are more effective than topical antibiotic drops.
Response to lithium in patients with bipolar disorder is associated with clinical and transdiagnostic genetic factors. The predictive combination of these variables might help clinicians better predict which patients will respond to lithium treatment.
Aims
To use a combination of transdiagnostic genetic and clinical factors to predict lithium response in patients with bipolar disorder.
Method
This study utilised genetic and clinical data (n = 1034) collected as part of the International Consortium on Lithium Genetics (ConLi+Gen) project. Polygenic risk scores (PRS) were computed for schizophrenia and major depressive disorder, and then combined with clinical variables using a cross-validated machine-learning regression approach. Unimodal, multimodal and genetically stratified models were trained and validated using ridge, elastic net and random forest regression on 692 patients with bipolar disorder from ten study sites using leave-site-out cross-validation. All models were then tested on an independent test set of 342 patients. The best performing models were then tested in a classification framework.
Results
The best performing linear model explained 5.1% (P = 0.0001) of variance in lithium response and was composed of clinical variables, PRS variables and interaction terms between them. The best performing non-linear model used only clinical variables and explained 8.1% (P = 0.0001) of variance in lithium response. A priori genomic stratification improved non-linear model performance to 13.7% (P = 0.0001) and improved the binary classification of lithium response. This model stratified patients based on their meta-polygenic loadings for major depressive disorder and schizophrenia and was then trained using clinical data.
Conclusions
Using PRS to first stratify patients genetically and then train machine-learning models with clinical predictors led to large improvements in lithium response prediction. When used with other PRS and biological markers in the future this approach may help inform which patients are most likely to respond to lithium treatment.
Meta-granites of the South Delhi Fold Belt, northwestern India, contain spectacular reaction textures formed during the metamorphic replacement of primary minerals. Textural relationships imply that amphibole was replaced sequentially in two stages. Epidote + titanite + quartz symplectite formed syn-tectonically on amphibole grain boundaries/fractures, followed by post-deformational growth of euhedral garnet overprinting amphibole grains. Besides occurring as symplectite grown during deformation, titanite in this rock also developed as a post-tectonic corona around magnetite. Parent magnetite contains exsolutions of ilmenite and/or ultrafine lamellae of Ti-rich oxide (Ti-oxd). Textures involving coronal titanite suggest their formation through a magnetite + ilmenite(/Ti-oxd) + plagioclase → titanite reaction. Compositional attributes and the calculation of the gain versus loss of components during the reaction suggest that the Mn2+ for garnet (XSpss = 0.23–0.29) that grew replacing amphibole was supplied by ilmenite (Mn2+ is 0.118–0.128 apfu) as it disintegrated to form coronal titanite. The redistribution of components between the metamorphic reaction sites connects the texturally unrelated domains and suggests that these zones were in chemical equilibrium during metamorphism. We estimated the P–T conditions of metamorphism for these post-tectonic assemblages as ∼650–700 °C from pseudosection modelling and conventional thermometry. Zircon data from this study suggest that the granitic rock crystallized at 988.8 ± 8.8 Ma. We propose that the metamorphic phases replaced the primary minerals during the mid Neoproterozoic tectonic activity reported from this terrane. The syn-tectonic symplectitic assemblage formed as the temperature increased during prograde metamorphism, and the post-tectonic minerals developed at peak conditions following the cessation of deformation.
The work presented in this research communication was carried out to prepare low calorie synbiotic milk beverage by optimizing water and sugar level and to investigate the effect on its storage ability of different packaging materials (polypropylene, high impact polystyrene, high-density polyethylene and glass). Addition of both water and sugar significantly (P < 0.05) affected the viscosity, probiotic count and sensory properties. Based on the findings, 40% water and 8% sugar level were optimized for the preparation of the beverage. Apparent viscosity and acidity increased whilst pH and probiotic counts declined during storage, irrespective of packaging materials. The prepared beverage remained most acceptable at refrigeration temperature up to a period of 15 and 12 d when packaged in glass and high impact polystyrene, respectively. Furthermore, it retained a minimum recommended level of probiotic (7 log cfu/ml) during storage for 15 d at 4 °C.
We develop some asymptotics for a kernel function introduced by Kohnen and use them to estimate the number of normalised Hecke eigenforms in $S_k(\Gamma _0(1))$ whose L-values are simultaneously nonvanishing at a given pair of points each of which lies inside the critical strip.
A triple-frequency operated concentric annular ring microstrip antenna which is single fed is presented. The proposed antenna with three concentric annular rings and two symmetrical notches on its outer ring and having a cross slot in its ground surface shows triple band at resonance frequency 1.22760, 1.57542, and 2.18 GHz, respectively. At the first two bands (GPS L2 and GPS L1), circular polarization characteristic is observed and the third band observes linear polarization finding its application in Universal Mobile Telecommunication System (UMTS). The complete dimension of the antenna designed and fabricated is only 51.6 × 51.6 × 1.6 mm3. Experimental results depict the proposed antenna gain of 3.31, 3.55, and 3.50 dBi in three bands, respectively, and closely matches with the theoretical results.
Malnutrition among adolescents is often associated with inadequate dietary diversity (DD). We aimed to explore the prevalence of inadequate DD and its socio-economic determinants among adolescent girls and boys in Bangladesh. A cross-sectional survey was conducted during the 2018–19 round of national nutrition surveillance in Bangladesh. Univariate and multivariable logistic regression was performed to identify the determinants of inadequate DD among adolescent girls and boys separately. This population-based survey covered eighty-two rural, non-slum urban and slum clusters from all divisions of Bangladesh. A total of 4865 adolescent girls and 4907 adolescent boys were interviewed. The overall prevalence of inadequate DD was higher among girls (55⋅4 %) than the boys (50⋅6 %). Moreover, compared to boys, the prevalence of inadequate DD was higher among the girls for almost all socio-economic categories. Poor educational attainment, poor maternal education, female-headed household, household food insecurity and poor household wealth were associated with increased chances of having inadequate DD in both sexes. In conclusion, more than half of the Bangladeshi adolescent girls and boys consumed an inadequately diversified diet. The socio-economic determinants of inadequate DD should be addressed through context-specific multisectoral interventions.
Germplasm characterization is essential to estimate variation and identify desirable genotypes for crop improvement. The current study was conducted on eight qualitative and 14 quantitative traits related to growth and floral attributes for characterization and grouping of 54 chrysanthemum genotypes. Wide variability was observed among most of the traits and principal component analysis revealed that the first two principal components explained most of the existing variation (>98%) in germplasm. Genotypic coefficient of variation exhibited a wide range from 9.41% (ratio of leaf length/width) to 105.99% (corolla tube length of ray florets), while phenotypic coefficient of variation varied from 10.49% (ratio of leaf length/width) to 106.38% (corolla tube length of ray florets). Broad sense heritability estimates were higher (>96%) for most of the characters, except for traits such as ratio of leaf length/width and peduncle thickness. Forty-four pair-wise inter-trait combinations showed positive genotypic and phenotypic correlations for 91 possible combinations. D2 analysis revealed that genotypes of clusters I and IV to be highly distinct, and hybridization between them might have better chance to obtain desirable types. D2 analysis confirmed that the cultivars in cluster IV namely, Red D Spoon, Tokyo Soldier, Yellow Reflex and hierarchical clustering showed that the cultivar Tokyo Soldier to be highly diverse. It is recommended to use the above genotypes in crossing programme for obtaining better progenies.
Although the behaviour of fluid-filled vesicles in steady flows has been extensively studied, far less is understood regarding the shape dynamics of vesicles in time-dependent oscillatory flows. Here, we investigate the nonlinear dynamics of vesicles in large amplitude oscillatory extensional (LAOE) flows using both experiments and boundary integral (BI) simulations. Our results characterize the transient membrane deformations, dynamical regimes and stress response of vesicles in LAOE in terms of reduced volume (vesicle asphericity), capillary number (${Ca}$, dimensionless flow strength) and Deborah number (${De}$, dimensionless flow frequency). Results from single vesicle experiments are found to be in good agreement with BI simulations across a wide range of parameters. Our results reveal three distinct dynamical regimes based on vesicle deformation: pulsating, reorienting and symmetrical regimes. We construct phase diagrams characterizing the transition of vesicle shapes between pulsating, reorienting and symmetrical regimes within the two-dimensional Pipkin space defined by ${De}$ and ${Ca}$. Contrary to observations on clean Newtonian droplets, vesicles do not reach a maximum length twice per strain rate cycle in the reorienting and pulsating regimes. The distinct dynamics observed in each regime result from a competition between the flow frequency, flow time scale and membrane deformation time scale. By calculating the particle stresslet, we quantify the nonlinear relationship between average vesicle stress and strain rate. Additionally, we present results on tubular vesicles that undergo shape transformation over several strain cycles. Broadly, our work provides new information regarding the transient dynamics of vesicles in time-dependent flows that directly informs bulk suspension rheology.
Anthracnose caused by Colletotrichum truncatum is a major soybean disease in India. Genetic resistance is the viable option to combat yield losses due to this disease. In the current study, 19 soybean genotypes were evaluated for anthracnose disease resistance at five locations (Medziphema, Palampur, Dharwad, Jabalpur and Indore) for three consecutive years (2017–2019) to identify stable and superior genotypes as resistant sources and to elucidate genotype (G) × environment (E) interactions. Genotype effect, environment effect and G × E interactions were found significant (P < 0.001) where G × E interactions contributed highest (42.44) to the total variation followed by environment (29.71) and genotype (18.84). Through Weighted Average of Absolute Scores (WAASB) stability analysis, PS 1611 (WAASB score = 0.33) was found to be most stable and through WAASBY superiority analysis NRC 128 (WAASBY score = 94.31) and PS 1611 (WAASBY score = 89.43) were found to be superior for mean performance and stability. These two genotypes could be candidate parents for breeding for durable and stable anthracnose resistance. Through principal component analysis, disease score was found to be positively associated with relative humidity, wind speed at 2 m above ground level, effect of temperature on radiation use efficiency and global solar radiation based on latitude and Julian day. Among the five locations, Indore was found to be highly discriminative with the highest mean disease incidence and could differentiate anthracnose-resistant and susceptible genotypes effectively, therefore can be considered an ideal location for breeding for field resistance against anthracnose disease.
Background: Ischemic stroke occurs following trauma-related blunt cerebrovascular injury (BCVI) in up to 20% of cases. Preventative treatment includes antiplatelets, anticoagulants, and/or endovascular treatment (ET), but the optimal choice remains unclear. The objective of this study was to compare the ischemic stroke rate between these three treatments. Methods: Following PRISMA guidelines, we queried the OVID Medline, Embase, Web of Science, and Cochrane Library databases from September 2019 to inception to identify studies reporting treatment-stratified outcomes in BCVI patients. Meta-analysis was performed to compare outcomes between the treatment groups, using odds ratios. Retrospective review of our institutional experience with BCVI outcomes was performed and added to the meta-analysis. Results: Analysis of seven comparative studies of antiplatelets (n=334) versus anticoagulation (n=325) found no significant difference in ischemic stroke rate (OR 1.27, 95%CI 0.40-3.99), but a decrease in hemorrhagic complications (OR 0.38, 95%CI 0.15-1.00). Analysis of seven comparative studies of antiplatelets/anticoagulants (n=805) versus ET (n=235) also found no significant difference in stroke rate (OR 0.71, 95%CI 0.35-1.42). Conclusions: Antiplatelets and anticoagulants were similarly effective in reducing ischemic stroke risk in BCVI, but antiplatelets were better tolerated in this trauma population. The addition of endovascular treatment did not further reduce stroke risk compared to antiplatelets or anticoagulants alone.
Skull base tumors are often intimately involved with critical vascular structures, which can be a barrier to maximal resection. In these cases, cerebral revascularization, including vascular bypass, can be an important adjunct technique. The feasibility of bypass depends on patient history, the anticipated tumor pathology, and characteristics of the cerebral vasculature. These procedures require considerable experience and expertise, and their indications must be well considered before performing them. A number of imaging and interventional studies can help establish the utility and feasibility of bypass preoperatively. Emerging technologies will help to refine the indications and streamline the performance of these challenging procedures. Here, we discuss the historical basis of bypass in skull base tumor surgery, indications in the modern era, the microanatomy of common bypasses, patient selection, and endovascular options for revascularization.
To report the one-year findings of the UK national registry of ENT surgeons with suspected or confirmed coronavirus disease 2019, and the results of a survey on the coronavirus disease 2019 experience of UK ENT trainees.
Method
An online registry was created in April 2020. A separate survey was circulated electronically to all members of the Association of Otolaryngologists in Training.
Results
The registry recorded 98 clinicians with confirmed or suspected coronavirus disease 2019. The majority of infections were reported in the first wave of spring 2020. Two ENT surgeons were hospitalised and one died. The majority suspected workplace exposure, with a significant proportion attributing this to a lack of personal protective equipment at a time before formal guidance had been introduced. Of the ENT trainees surveyed, almost one-third believed that they had contracted coronavirus disease 2019.
Conclusion
This highlights the importance of ongoing risk-reduction measures, including optimal personal protective equipment and vaccination.
The COVID-19 pandemic has placed significant strain on emergency departments (EDs) that were not designed to care for many patients who may be highly contagious. This report outlines how a busy urban ED was adapted to prepare for COVID-19 via 3 primary interventions: (1) creating an open-air care space in the ambulance bay to cohort, triage, and rapidly test patients with suspected COVID-19, (2) quickly constructing temporary doors on all open treatment rooms, and (3) adapting and expanding the waiting room. This description serves as a model by which other EDs can repurpose their own care spaces to help ensure safety of their patients and health care workers.