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To address the challenges of capacity fading and poor electronic conductivity of hard carbons as anode in Li-ion batteries (LIBs), we report here the catalytic graphitization of resorcinol–formaldehyde xerogel (RFX)-derived hard carbon via a single-step synthesis by incorporating two transition metal catalysts (Co and Ni) with different loadings (5 and 10%) at a modest temperature of 1100 °C. Loading of both the catalysts affects the extent of graphitization and other physiochemical properties that have a direct influence on the anodic performance of as graphitized RFX-derived hard carbon. A 10% Ni catalyst in RFX-derived carbon induces the highest degree of graphitization of 81.4% along with partial amorphous carbon and nickel phases. This improved crystallinity was conducive enough to facilitate rapid electron and Li-ion transfer while the amorphous carbon phase contributed to higher specific capacity, resulting in overall best anodic performance as ever reported for RFX-derived carbon. A specific capacity of 578 mAh/g obtained after 210 cycles at 0.2 C with coulombic efficiency greater than 99% confirms the potential of graphitized RFX-derived carbon as an anode for high-performance LIBs.
As the pathophysiology of Covid-19 emerges, this paper describes dysphagia as a sequela of the disease, including its diagnosis and management, hypothesised causes, symptomatology in relation to viral progression, and concurrent variables such as intubation, tracheostomy and delirium, at a tertiary UK hospital.
During the first wave of the Covid-19 pandemic, 208 out of 736 patients (28.9 per cent) admitted to our institution with SARS-CoV-2 were referred for swallow assessment. Of the 208 patients, 102 were admitted to the intensive treatment unit for mechanical ventilation support, of which 82 were tracheostomised. The majority of patients regained near normal swallow function prior to discharge, regardless of intubation duration or tracheostomy status.
Dysphagia is prevalent in patients admitted either to the intensive treatment unit or the ward with Covid-19 related respiratory issues. This paper describes the crucial role of intensive swallow rehabilitation to manage dysphagia associated with this disease, including therapeutic respiratory weaning for those with a tracheostomy.
Interventional neuroradiology (INR) has evolved from a hybrid mixture of daring radiologists and iconoclastic neurosurgeons into a multidisciplinary specialty, which has become indispensable for cerebrovascular and neurological centers worldwide. This manuscript traces the origins of INR and describes its evolution to the present day. The focus will be on cerebrovascular disorders including aneurysms, stroke, brain arteriovenous malformations, dural arteriovenous fistulae, and atherosclerotic disease, both intra- and extracranial. Also discussed are cerebral vasospasm, venolymphatic malformations of the head and neck, tumor embolization, idiopathic intracranial hypertension, inferior petrosal venous sinus sampling for Cushing’s disease, and spinal interventions. Pediatric INR has not been included and deserves a separate, dedicated review.
Diet has a major influence on the composition and metabolic output of the gut microbiome. Higher-protein diets are often recommended for older consumers; however, the effect of high-protein diets on the gut microbiota and faecal volatile organic compounds (VOC) of elderly participants is unknown. The purpose of the study was to establish if the faecal microbiota composition and VOC in older men are different after a diet containing the recommended dietary intake (RDA) of protein compared with a diet containing twice the RDA (2RDA). Healthy males (74⋅2 (sd 3⋅6) years; n 28) were randomised to consume the RDA of protein (0⋅8 g protein/kg body weight per d) or 2RDA, for 10 weeks. Dietary protein was provided via whole foods rather than supplementation or fortification. The diets were matched for dietary fibre from fruit and vegetables. Faecal samples were collected pre- and post-intervention for microbiota profiling by 16S ribosomal RNA amplicon sequencing and VOC analysis by head space/solid-phase microextraction/GC-MS. After correcting for multiple comparisons, no significant differences in the abundance of faecal microbiota or VOC associated with protein fermentation were evident between the RDA and 2RDA diets. Therefore, in the present study, a twofold difference in dietary protein intake did not alter gut microbiota or VOC indicative of altered protein fermentation.
Coronavirus disease 2019 personal protective equipment has been reported to affect communication in healthcare settings. This study sought to identify those challenges experimentally.
Bamford–Kowal–Bench speech discrimination in noise performance of healthcare workers was tested under simulated background noise conditions from a variety of hospital environments. Candidates were assessed for ability to interpret speech with and without personal protective equipment, with both normal speech and raised voice.
There was a significant difference in speech discrimination scores between normal and personal protective equipment wearing subjects in operating theatre simulated background noise levels (70 dB).
Wearing personal protective equipment can impact communication in healthcare environments. Efforts should be made to remind staff about this burden and to seek alternative communication paradigms, particularly in operating theatre environments.
We analyze optimal budget allocations to acquire protected areas for carbon storage while balancing risk and return from protection under economic growth uncertainty in a local community. Our study is the first to explore how risk of uncertain economic growth affects cost of protected area acquisition using real estate values at the parcel level, enabling us to estimate the site-specific opportunity cost of carbon storage. The Pareto optimal trade-off frontier between the expected carbon storage benefit and its variance provides a continuum of risk-return combinations. The pattern of the trade-off relationship implies that risk mitigation is less costly in terms of foregone expected benefit when risk is higher than when it is lower. Our results also find that the difference in cluster-specific budget allocations between the strong economic growth scenario and the weak economic growth scenario subsequently decreases between the point of expected benefit maximization and the point of variance minimization. Our findings of optimal hectares of land for protected area acquisition for carbon storage and corresponding benefits and costs serve as an empirically informed knowledge base to help a local community prioritize acquisition of potential protected areas for carbon storage under economic growth uncertainty.
of this 2-staged study were to assess knowledge gain of medical students following an individual episode of patient-centred teaching. Participant satisfaction was also assessed.
The education of medical students is an important role for trained medics using adabtable teaching methods, appropriate to the demands of students and medical universities. Delivery of patient-centred teaching in UK is ad-hoc, minimal and not standardised. However, medical education still tends to be delivered in the in-patient environment, where there is little supervision and students often have to identify patients on their own. Paucity exists in the evidence of whether bedside teaching assists in knowledge gain.
In Derby, a Patient-centred clinic was developed in 2008. We conducted a pre-intervention/post-intervention comparison study to measure the knowledge gained during a teaching session. Participants were medical students from University of Nottingham, and in-patients at the Unit. Following this, standards were set and assessing questions were changed to multiple choice style questions in January 2010.
show that there is an immediate knowledge gain, of an average of 22%. Students are satisfied with this method of teaching and patients have felt that their input has been valued. The second part of the study has confirmed these findings.
The study demonstrates usefulness of patient-centred education in improving clinical knowledge. Adoption of this form of teaching will benefit not only medical students in their psychiatry placement in Derby, but also the wider medical student population. This method can also be implemented in other acute medical specialties.
Though a number of agents are available to treat acute manic episode but either because of their comparable efficacy to lithium or their dose related side effects, need for better agent is always being felt.
To study the efficacy and side effect profile of lamotrigine and its double blind comparison with lithium in acute mania.
We recruited 50 patients with diagnosis of manic episode according to DSM-IV and were divided into two groups. One group was given lamotrigine 100mg and another lithium 900mg in a double blind fashion. Patints were assessed subsequently on BPRS, CMRS,UKU side effect scale and CGI till next 28 days.
Subjects in lamotrigine group did not show much improvement at the end of 4th week as compared to lithium group. Side effect profile of both groups were in accordance with reported literature except that 61.9% patients in lamotrigine group showed weight loss. Also rash were found in only 3.5% of the lamotrigine group even with such a rapid escalation of the dose.
We found that lamotrigine is ineffective in case of acute manic episode when compared with lithium.
Clinical correspondence between general practitioners and specialists remains fundamental to the process of referral from primary care and transmission of management advice from consultants.
Discrepancies over medication records for patients with mental illness living in community were highlighted by a previous audit and recommendation for improvement were accepted and implemented by the trust.
An audit of the documentation of patient's medications in the Psychiatric clinic letters compared to the general practitioners records was done two years back and several recommendations were made to improve the communication.
The aim of this study was to examine if the recommendations from the previous audit was implemented and if the quality of communication about medication conveyed by the Psychiatrist to the General Practitioner improved.
Latest Psychiatric clinic letter of 50 patients were randomly selected from the computer database and they were checked against the latest GP records.The expectation is that the Psychiatric and GP records would correspond 100%.
This re-audit revealed most of the recommendations from the previous audit were implemented and as a result of that, the numbers of errors were reduced. However there were still significant errors detected including wrong medication, omission and incorrect dosage, schedule and frequency.
Drug users have an increased rate of developing physical health problems, such as Hepatitis, HIV, skin infection, tuberculosis, lymphatic system, and tissue and vein damage. The nature of drug use makes it difficult to integrate IV drug users into a managed care system and monitoring of their physical health is difficult to achieve. An audit was conducted in a suburban population in the west midland region of the United Kingdom, where intravenous drug use is prevalent. The first part of the audit highlighted that despite increased morbidity in this population, physical health monitoring was incomplete, inaccurate and sometimes completely lacking. Recommendations were made, which included attaching a pro-forma to the assessment form, to enhance accurate and complete documentation of physical health monitoring.
To determine whether the recommendations are being followed. To re-establish the detection rate of medical co morbidity in IDUs.
30 injecting drug users have randomly been selected from the computer database. Case notes of these patients are being checked for quality of documentation, and whether the pro-forma for physical health monitoring is being completed. Drug workers will be contacted to verify the findings.
Previous results have shown that 80% of patients had some documentation, 20% had good quality health documentation and 60% was found to meet standards. We will expect to see an improvement in these figures, and 100% completion of the pro-formas.
Physical health monitoring is vital in this patient population and means to improve this should be employed globally.
Schizophrenia is a mental disorder characterized by social problems and disorders of thought, behaviour and cognitive functions. These impaired cognitive functions may be associated with alterations in resting state functional connectivity in schizophrenia. Therefore, the present study has been carried out to determine the resting state functional brain connectivity changes associated with schizophrenia in all the resting state networks (RSNs) using independent component analysis approach (ICA) and dual-regression based approach.
The objective of this study was to investigate the aberrant resting-state functional connectivity patterns in schizophrenia patients as compared to healthy controls.
35 schizophrenia patients and 31 healthy controls were recruited for the study and scanned by using resting state functional magnetic resonance (rsfMRI). Pre-processing and post-processing of the resting state functional data were performed using the FMRI Expert Analysis Tool (FEAT), which is a part of FSL (FMRIB's Software Library, www.fmrib. ox.ac.uk/fsl).
Our results showed significantly decreased functional connectivity in the regions of left fronto-parietal network, lateral visual network, medial visual network, motor network and default mode network (DMN) in schizophrenia patients as compared with healthy controls.
The overall findings suggest that the alterations in these resting state network connectivity may, in part, contribute to the impairments in cognitive functions associated with schizophrenia. These findings also suggest that aberrant resting state network connectivity contributes to regional functional pathology in schizophrenia and bears significance for core symptoms.
Prevalence and incidence rates of both Hepatitis B and C is on the rise in United Kingdom, and worldwide. Intravenous drug users (IVDU) are particularly at risk due to their chaotic lifestyle. Testing enables early treatment, and vaccination is an effective method of prevention.
Assess awareness of screening and vaccination programmes (VP) amongst IVDUs, and willingness to engage in these if they were available and accessible.
Our sample population was IVDUs presenting to a Community Substance Misuse team, in central England and the criteria we assessed were: whether they admitted to needle-sharing, awareness of screening and VPs, previous screening and vaccination history, and willingness to engage in VPs.
Data was collected through a performa with related questions, after identifying and communicating to key workers; and presented in graphs. We looked at the first 100 responses.
More than a third of IVDU in the population shared needles, one-third had not even been tested for Hep B/C, a half had been immunised. Most of them are aware of the risks, and would agree to the immunisation programme if available, at Lantern House.
Prevalence of IVDU presenting to a Substance Misuse clinic is quite high. Screening and vaccination against Hepatitis of IVDU is lacking, despite it being feasible, necessary and acceptable by patients. Screening for the disease will aid diagnosis and hence early treatment, and will create a gateway for prevention by using VPs.
Headache is a common complaint among adolescents and is associated with several comorbid conditions particularly anxiety and depression. Transdiagnostic cognitive behavior therapy (TCBT) is an alternative approach to third wave CBT. It attempts to address multiple diagnoses at the same time while focusing on shared pathology and common processes (McEvoy et al., 2009).
To develop a group transdiagnostic cognitive behavior therapy intervention module for adolescents with comorbid headache and anxiety disorder and to evaluate the module in terms of feasibility, acceptance and efficacy.
A TCBT intervention module for headache and anxiety disorder for use with adolescents was developed. Fifteen adolescents diagnosed with comorbid headache and anxiety disorder were recruited from the outpatient psychiatric clinic at AIIMS, New Delhi. Baseline, mid-and post- intervention assessments was done on Youth Self Report, M.I.N.I KID, Anxiety Disorders Interview Schedule, STAI – Y, CDI – 2, Headache Diary, Headache Impact Test (HIT) and Global Assessment Scale for Children (CGAS). TCBT was carried out over a period of 12 weeks with one group session per week for each of the three groups.
85% participants showed clinically significant improvement as rated on scores on STAI-Y, HIT and CGAS. Qualitative interpretation of headache diary showed significant decrease in the frequency, intensity and duration of headache for all participants.
TCBT module was found to be feasible, acceptable and efficacious leading to significant symptom reduction.
Possible benefits of TCBT as pertaining to the Indian context along with barriers are further discussed.
Deinotheriidae Bonaparte, 1845 is a family of browsing proboscideans that were widespread in the Old World during the Neogene. From Miocene deposits in the Indian subcontinent, deinotheres are known largely from dental remains. Both large and small species have been described from the region. Previously, only small deinothere species have been identified from Kutch in western India. In the fossiliferous Tapar beds in Kutch, dental remains have been referred to the small species Deinotherium sindiense Lydekker, 1880, but the specimens are too fragmentary to be systematically diagnostic. Here, we describe a large p4 of a deinothere from the Tapar beds and demonstrate that it is morphologically most similar to Deinotherium indicum Falconer, 1845, a large species of deinothere, thereby confirming the identity of deinotheres at Tapar. Deinotherium indicum from Tapar is larger than other deinotheres identified from Kutch and is the first occurrence of the species in the region. This new specimen helps constrain the age of the Tapar beds to the Tortonian and increases the biogeographic range of this species—hitherto only known from two localities on the subcontinent. This specimen also highlights the morphological diversity of South Asian deinothere p4s and allows us to reassess dental apomorphies used to delimit Indian deinothere species. Lastly, we argue that by the late Miocene, small deinotheres in Kutch were replaced by the large Deinotherium indicum.
To assess the effect of tranexamic acid in head and neck surgical procedures.
A prospective, double-blind and randomised, parallel group, placebo-controlled clinical trial was conducted. Ninety-two patients undergoing various head and neck surgical procedures were randomised. Subjects received seven infusions of coded drugs (tranexamic acid or normal saline) starting at the time of skin closure. Haematological, biochemical, blood loss and other parameters were observed by the staff, who were blinded to patients’ group allocation (case or control).
Patients were analysed on the basis of type of surgery. Fifty patients who had undergone surgical procedures, including total thyroidectomy, total parotidectomy, and various neck dissections with or without primary tumour excision, were included in the first group. The second group comprised 41 patients who had undergone hemithyroidectomy, lobectomy or superficial parotidectomy. There was no statistical difference in blood parameters between both groups. There was a reduction in post-operative drain volume, but this was not significant.
Although this prospective, randomised, placebo-controlled clinical trial found a reduction in post-operative drain volume in tranexamic acid groups, the difference was not statistically significant between the various head and neck surgical procedure groups.
There is an established link between birth parameters and risk of adult-onset cancers. The Developmental Origins of Health and Disease concept provides potential underlying mechanisms for such associations, including intrauterine exposure to endogenous hormones (androgens and estrogens), insulin-like growth factors, etc. However, there is conflicting evidence on the association between birth parameters and the cancer mortality risk. Therefore, we aimed to review and analyse the available data on the association linking birth weight and birth length with cancer mortality. Eleven studies were identified, published until April 2019. A significant association between birth weight and the prognosis of cancer (overall) was found (relative risk, RR 1.06, 95% confidence interval, CI: 1.01, 1.11), with low heterogeneity (I2 = 27.7%). In addition, higher birth weight was associated with poorer prognosis of prostate cancer (RR 1.21, 95% CI: 1.02, 1.44). However, the association of birth weight with breast cancer mortality risk in women was not significant (RR 1.16, 95% CI: 0.93, 1.44), which might be due to high statistical heterogeneity (I2 = 67.9%). Birth length was not associated with cancer mortality risk (RR 1.0, 95% CI: 0.90–1.11). It might be inferred that birth parameters are not associated with cancer mortality as strongly as with the risk of developing cancer. Also, the association between birth parameters and cancer mortality risk is not uniform and varies according to its subtypes, and study characteristics/design. This highlights the need for further prospective studies.