To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Background: Buprenorphine/naloxone (bup/nal) is a partial opioid agonist/antagonist and recommended first line treatment for opioid use disorder (OUD). Emergency departments (EDs) are a key point of contact with the healthcare system for patients living with OUD. Aim Statement: We implemented a multi-disciplinary quality improvement project to screen patients for OUD, initiate bup/nal for eligible individuals, and provide rapid next business day walk-in referrals to addiction clinics in the community. Measures & Design: From May to September 2018, our team worked with three ED sites and three addiction clinics to pilot the program. Implementation involved alignment with regulatory requirements, physician education, coordination with pharmacy to ensure in-ED medication access, and nurse education. The project is supported by a full-time project manager, data analyst, operations leaders, physician champions, provincial pharmacy, and the Emergency Strategic Clinical Network leadership team. For our pilot, our evaluation objective was to determine the degree to which our initiation and referral pathway was being utilized. We used administrative data to track the number of patients given bup/nal in ED, their demographics and whether they continued to fill bup/nal prescriptions 30 days after their ED visit. Addiction clinics reported both the number of patients referred to them and the number of patients attending their referral. Evaluation/Results: Administrative data shows 568 opioid-related visits to ED pilot sites during the pilot phase. Bup/nal was given to 60 unique patients in the ED during 66 unique visits. There were 32 (53%) male patients and 28 (47%) female patients. Median patient age was 34 (range: 21 to 79). ED visits where bup/nal was given had a median length of stay of 6 hours 57 minutes (IQR: 6 hours 20 minutes) and Canadian Triage Acuity Scores as follows: Level 1 – 1 (2%), Level 2 – 21 (32%), Level 3 – 32 (48%), Level 4 – 11 (17%), Level 5 – 1 (2%). 51 (77%) of these visits led to discharge. 24 (47%) discharged patients given bup/nal in ED continued to fill bup/nal prescriptions 30 days after their index ED visit. EDs also referred 37 patients with OUD to the 3 community clinics, and 16 of those individuals (43%) attended their first follow-up appointment. Discussion/Impact: Our pilot project demonstrates that with dedicated resources and broad institutional support, ED patients with OUD can be appropriately initiated on bup/nal and referred to community care.
Dust vortices with a void at the centre are reported in this paper. The role of the spatial variation of the plasma potential in the rotation of dust particles is studied in a parallel plate glow discharge plasma. Probe measurements reveal the existence of a local potential minimum in the region of formation of the dust vortex. The minimum in the potential well attracts positively charged ions, while it repels the negatively charged dust particles. Dust rotation is caused by the interplay of the two oppositely directed ion drag and Coulomb forces. The balance between these two forces is found to play a major role in the radial confinement of the dust particles above the cathode surface. Evolution of the dust vortex is studied by increasing the discharge current from 15 to 20 mA. The local minimum of the potential profile is found to coincide with the location of the dust vortex for both values of discharge currents. Additionally, it is found that the size of the dust vortex as well as the void at the centre increases with the discharge current.
A new species, Gentiana arunii D.Maity, S.K.Dey, J.Ghosh & Midday, from alpine pasture in Sikkim Himalaya is described and illustrated, and placed in Gentiana section Chondrophyllae Bunge. The new species is compared morphologically with two related taxa, Gentiana glabriuscula T.N.Ho and Gentiana pluviarum W.W.Sm. subsp. subtilis (Harry Sm.) T.N.Ho.
Most nutritional studies on the development of children focus on mother–infant interactions. Maternal nutrition is critically involved in the growth and development of the fetus, but what about the father? The aim is to investigate the effects of paternal methyl-group donor intake (methionine, folate, betaine, choline) on paternal and offspring global DNA (hydroxy)methylation, offspring IGF2 DMR DNA methylation, and birth weight. Questionnaires, 7-day estimated dietary records, whole blood samples, and anthropometric measurements from 74 fathers were obtained. A total of 51 cord blood samples were collected and birth weight was obtained. DNA methylation status was measured using liquid chromatography-tandem mass spectrometry (global DNA (hydroxy)methylation) and pyrosequencing (IGF2 DMR methylation). Paternal betaine intake was positively associated with paternal global DNA hydroxymethylation (0.028% per 100 mg betaine increase, 95% CI: 0.003, 0.053, P=0.03) and cord blood global DNA methylation (0.679% per 100 mg betaine increase, 95% CI: 0.057, 1.302, P=0.03). Paternal methionine intake was positively associated with CpG1 (0.336% per 100 mg methionine increase, 95% CI: 0.103, 0.569, P=0.006), and mean CpG (0.201% per 100 mg methionine increase, 95% CI: 0.001, 0.402, P=0.049) methylation of the IGF2 DMR in cord blood. Further, a negative association between birth weight/birth weight-for-gestational age z-score and paternal betaine/methionine intake was found. In addition, a positive association between choline and birth weight/birth weight-for-gestational age z-score was also observed. Our data indicate a potential impact of paternal methyl-group donor intake on paternal global DNA hydroxymethylation, offspring global and IGF2 DMR DNA methylation, and prenatal growth.
With the ongoing expansion of palliative care services throughout the United States, meeting the needs of socioeconomically marginalized populations, as in all domains of healthcare, continues to be a challenge. Our specific aim here was to help meet some of these needs through expanding delivery of pain and palliative care services by establishing a new clinic for underserved patients and collecting descriptive data about its operation.
In November of 2014, the National Institutes of Health Clinical Center's Pain and Palliative Care Service (PPCS) launched a bimonthly offsite pain and palliative care outpatient clinic in collaboration with Mobile Medical Care Inc. (MobileMed), a private not-for-profit primary care provider in Montgomery County, Maryland, serving underserved area residents since 1968. Staffed by NIH hospice and palliative medicine clinical fellows and faculty, the clinic provides specialty pain and palliative care consultation services to patients referred by their primary care healthcare providers. A patient log was maintained, charts reviewed, and referring providers surveyed on their satisfaction with the service.
The clinic had 27 patient encounters with 10 patients (6 males, 4 females, aged 23–67) during its first 7 months of operation. The reason for referral for all but one patient was chronic pain of multiple etiologies. Patients had numerous psychosocial stressors and comorbidities. All primary care providers who returned surveys (n = 4) rated their level of satisfaction with the consultation service as “very satisfied” or “extremely satisfied.”
Significance of Results:
This brief descriptive report outlines the steps taken and logistical issues addressed to launch and continue the clinic, the characteristics of patients treated, and the results of quality-improvement projects. Lessons learned are highlighted and future directions suggested for the clinic and others that may come along like it.
The north eastern region (NER) of India receives a high amount of rainfall (2450 mm) both in terms of intensity and frequency. Most of the precipitation goes waste because of improper conservation measures and inadequate rainwater harvesting. Growing a second crop during winter (rabi) season on hill slopes and uplands without moisture conservation measure is almost impossible. A simple and very low-cost technique of in situ soil moisture conservation in maize (Zea mays L.)–toria (Brassica campestris L.) system has been developed using residue of preceding rainy season maize crop and mulching with locally available weed biomass Ambrosia artemisiifolia. Six residue mulching combinations tested were viz. control, Maize stalk cover (MSC), MSC + Ambrosia sp. 5 t/ha, MSC + Ambrosia sp. 10 t/ha, MSC + farmyard manure (FYM) 10 t/ha and MSC + Ambrosia sp. 5 t/ha + poultry manure 5 t/ha under zero tillage (ZT) and conventional tillage (CT) systems. Results showed that in situ residue retention of preceding maize crop along with green biomass of Ambrosia sp., applied before sowing of toria, maintained optimum soil moisture for good growth and higher yield of toria. The soil moisture content was consistently higher under residue mulched plots than that under control. All the residue mulching measures recorded higher crop yield for maize and toria than those observed under residue removal (control). The productivity of toria was enhanced by about 99%, only due to retention of MSC as mulch. Mulching with MSC + Ambrosia sp. 5 t/ha + poultry manure 5 t/ha recorded the highest seed yield of toria (four-year average: 641 kg/ha), which was 228% and 64% higher than no mulching (control) and MSC alone. MSC + FYM 10 t/ha (568.3 t/ha) and MSC + Ambrosia sp. 10 t/ha (517.4 t/ha) were found equally effective and produced significantly higher toria yield than that of control. MSC + Ambrosia mulch 10 t/ha gave the highest net returns and B:C ratio of the maize–toria system. The overall B:C ratios were better under ZT than CT. Thus, the study indicated that the integrated management of crop residues and weed biomass (Ambrosia sp.) under ZT created favourable soil moisture to support double cropping with high yield in hill eco-system of northeastern Indian Himalayas.
In this work, we report the effect of high energy ball milling (HEBM) on Nb doped R2Fe16Nb1 (R= Gd, Er) compounds. The focus of the work is to bring enhancement in magnetic properties of R2Fe17 (2:17) compounds with the ball milling. Specifically, we find that the ball milling increases saturation magnetization, coercivity, and Curie temperature. The increase in the magnetization and Curie temperature upon ball milling is related to the lattice expansion and microstrains while the increase in coercivity is related to the grain refinement.
The OVV blazar 3C 446 was monitored over seven months in 1997 with ground based telescopes and instruments on ESA's Infrared Space Observatory (ISO). The aim was to try to detect variations in the IR and see if these were correlated with optical variations. The object varied in the optical and near-IR during this period, but did not vary in the far-IR. Despite being a factor of ten weaker than in 1983, the optical-IR SED exhibited the same slope. The new far-IR observations from ISO allow us to determine the location of the turnover in the spectrum, caused by synchrotron self-absorption. It occurs just longwards of 100 μm.
India has proposed legislating an upper limit of trans fat in partially hydrogenated vegetable oils and mandating trans fat labelling in an effort to reduce intakes. The objective of the present study was to examine the complexities of regulating trans fat in India by examining the policy processes involved and the perceived implementation challenges.
Semi-structured interviews (n 18) were conducted with key informants from various sectors. Interviewees were asked about sources of trans fat in the food supply, existing policies that may influence trans fats and perceived challenges related to the proposed trans fat regulation, in addition to questions tailored to their area of expertise. Interview data were organised based on common themes.
Interviews were conducted in India.
Interviewees were key informants from various sectors including agriculture, trade, industry and health.
Several themes were identified related to the complexity of regulating trans fat in India. A lack of trans fat awareness, the large unorganised retail sector, a need for suitable alternative products that are both acceptable to consumers and affordable, and a need to build capacity were crucial factors affecting India's ability to successfully regulate trans fat. The limited number of food inspectors will create an additional challenge in terms of enforcement of trans fat regulation.
Although India will face challenges in regulating trans fat, legislating an upper limit of trans fat in partially hydrogenated vegetable oils will likely be the most effective approach to reducing it in the food supply. Ongoing engagement with industry, agriculture, trade and processing sectors will prove essential in terms of product reformulation.
Continuous cultivation of rice–wheat cropping system in the Indo-Gangetic plains is under threat with decline in soil organic carbon (SOC), total factor productivity and overall sustainability. Pulses, an important component of crop diversification, are known to improve soil quality through their unique ability of biological N2 fixation, leaf litter fall and deep root system. Therefore, the effect of inclusion of pulses in the puddled rice system under organic and inorganic amendments on SOC pool and its management indices were evaluated in a long-term experiment after seven cropping cycles. The results indicated that inclusion of pulses in the rice-based system improved the SOC content, being greater in surface soil (0–20 cm) and declining with soil depth. Among the four carbon fractions determined, less labile carbon fraction (Cfrac3) was the dominant fraction in the puddled rice system, particularly under organic treatments, indicating that it is possible to maintain organic carbon for longer time in this system. The rice–wheat–mung bean system resulted in 6% increase in SOC and 85% increase in soil microbial biomass carbon as compared with the conventional rice–wheat system. Application of crop residues, farm yard manure (5 t ha−1) and biofertilisers had greater amount of carbon fractions and carbon management index (CMI) over control and the recommended inorganic (NPKSZnB) treatment in the soil surface, particularly in the system where pulses are included. Interestingly, in the puddled rice system, passive carbon pool is more in surface soil than deeper layers. The relative proportion of active carbon pool in surface layer (0–20 cm) to subsurface layer (20–40 cm) was highest in rice–wheat–rice–chickpea (1.14:1) followed by rice–wheat–mung bean (1.07:1) and lowest in the rice–wheat system (0.69:1). Replacing wheat with chickpea either completely or during alternate year in the conventional rice–wheat system also had positive impact on SOC restoration and CMI. Therefore, inclusion of pulses in the rice-based cropping system and organic nutrient management practices had significant impact on maintaining SOC in an Inceptisol of the Indo-Gangetic plains of India.
The implementation of SiC based sensors and electronics for operation in chemically harsh, high temperature environments depends on understanding the SiO2/SiC interface in field effect devices. We have developed a technique to fabricate wedge polished samples (angle ∼ 1×10−4 rad) that provides access to the SiO2/SiC interface via a surface sensitive probe such as xray photoelectron spectroscopy (XPS). Lateral scanning along the wedge is equivalent to depth profiling. Spatially resolved XPS images of the O 1s and Si 2p core levels were obtained of the interfacial region. Samples consist of device-quality thermally grown oxides on 4H-SiC single crystal substrates. The C 1s spectrum suggests the presence of a graphitic layer on the nominally bare SiC surface following thermal oxidation.
Vapor phase synthesis approaches were employed to produce laminated microstructures with high temperature phases alternated with ductile phase layers for toughness enhancement. Microlaminates of alternating layers of Mo and cosputtered Mo-Si were deposited on a Si substrate using direct current (DC) and radio frequency (RF) sputtering technique. Microstructural evolution and phase formation after diffusion annealing (900°C, 2 hr) was evaluated using cross-sectional transmission electron microscopy (TEM). Heat treating the microlaminates resulted in the growth of a Mo3Si interface phase between Mo and cosputtered layer and conversion of the amorphous cosputtered layer into crystalline Mo5Si3. A higher Si/Mo ratio in the cosputtered layer caused the formation of dispersed Mo5Si3 grains in Mo layer. The residual stress state was measured by monitoring the curvature change of the microlaminates using a laser beam. By decreasing the bilayer thickness to 1/3, the residual stress is reduced by ∼50%.
Electrotextiles have attracted increasing attention in recent years. The combinations of textile structures that are lightweight, flexible, conformable, and strong, with electronics have aroused keen interest from many disciplines. With technological innovations appearing in both textile and electronics, integration of these has started giving benefits. Innovations like the sensate liner, soft switches and smart composites have found many applications in sports, healthcare, military, aerospace engineering, civil engineering and many other fields. The purpose of this paper is to provide an overview of various electrotextile products available and explain their functionality. Additionally, the paper provides a review of future electrotextile products, which are in the developmental phase, and the challenges that need to be addressed by researchers and industry.
Weaving, knitting or placing electronic circuits within a textile matrix offer exciting possibilities for large-scale conformal circuits where the circuit dimensions can be measured on the scale of yards instead of inches. However, compared with conventional printed circuit board circuits, the textile manufacturing process and the electrical/mechanical properties of the fibers used in making the textile place unusual constraints on the electrical performance of textile circuits. In the case of distributed sensors connected via an electronic fabric, signal attenuation and the ability to form reliable interconnections are major challenges. To explore these challenges we have woven and knitted a variety of electrical transmission lines and optical fibers in fabrics to analyze their performance. The formation of interconnects and disconnects between conductors woven in textiles is also discussed, and a passive acoustic array is described as a possible electronic textile application.
This paper describes the development of woven electrical circuits, which are formed by interlacing conducting and non-conducting threads into a woven fabric. Conductive threads in these electrical networks are arranged and woven such that they follow desired electrical circuit designs. Electronic devices can be attached to these electrical networks, which can serve as flexible circuit boards. In these woven circuits, an efficient transfer of current from one conductive yarn to an orthogonal one is achieved by the formation of an effective electrical interconnect at the point of intersection of these yarns. Formation of woven conductive networks also involves disconnect formation or cutting of conductive yarns at certain specified points. Different methods and processes were identified and applied in order to form interconnects and disconnects at specified points of these fabrics. Efficacy of these interconnects was evaluated by DC resistance and AC Signal measurements. The results of these evaluations are reported. The conductive threads woven into these fabric-based circuits were also evaluated for signal integrity issues.
A rapid physical vapor deposition process (PVD) utilizing a high speed rotating substrate and small substrate-to-source spacing has been used to produce bulk sheet of Ti-Al alloys in the compositional range Ti-12% Al to Ti-75% Al1 at a rate of 1–3 μm/minute. Microstructural architectures produced by the method comprise of either fully homogenous phase mixtures of nano-grains, or nanolaminated material, depending on the substrate rotational rate, with lower rotational rate producing a layered microstructure. Defect populations within the as-deposited material are characterized by TEM and SEM, and hot pressing consolidation of the as-deposited material, which retains a grain size < 1000 nm, has been investigated. While indentation hardness of α2+γ(2 phase) alloys exceeded 7 GPa, brittle failure occurred in the elastic regime at nominally lower tensile stress than that for conventionally produced alloys containing Nb and Cr as solute elements. α2+γ alloys can exhibit tensile elongations of more than 100% at 850°C with retention of fine grain size. Elevated temperature failure occurs by the formation of voids in regions of compositional variability in the composite where single phase α2-Ti3Al structure was present.
Diamond-like carbon films (DLC) 10–40 nm thick were deposited on quartz substrates on an interdigitated planar array of 20 μm Ni electrodes already prepared by lithographic techniques. The influence of the adsorbed molecules onte electrical properties of the thin DLC films was investigated. Current and capacitance-voltage characteristics were examined. Charge-based deep level transient spectroscopy (Q-DLTS) was used for study of adsorption and desorption processes. The strong sensitivity of Q-DLTS spectra to the presence of the vapor water and isopropyl alcohol was found. For example, the Q-DLTS signal for some deposited DLC film was changed more then in order in presence of the water vapor. Such strong surface phenomena of the thin DLC films may be exploited in novel gas sensor devices.
The superplastic flow behavior of a near-γ titanium aluminide (Ti-45.5Al-2Cr-2Nb) is determined under uniaxial tension in as-rolled or rolled-and-heat treated conditions (1177°C/4 hr or 1238°C/2 hr). Cavitation characteristics, including cavity growth rates, are established via isothermal, constant strain rate tests conducted at 10−4 to 10−2 s−1 and temperatures between 900°C and 1200°C. Differences in cavitation as a function of initial structure, strain, strain rate and temperature are noted. Cavity growth is found to be largely plasticity controlled. Experimental growth rates are compared with equations that predict rates as a function of strain rate sensitivity. Although the equations assume no coalescence and no nucleation of new cavities, which are experimentally observed, they are useful in predicting actual growth rates.
Mechanical response of interfaces between intermetallic matrices and ductile reinforcements is of considerable interest in intermetallic matrix composite design. A new approach has been developed to study crack initiation at a planar bimaterial interface by loading one of the adjoining phases in compression. A primarily Mode II stress state with different degrees of superimposed tensile and compressive loading develops at the interface as predicted by FEM analysis. This test method has been used to study NiAl/Mo and NiAl/Cr interfaces in model laminates.