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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.
This service evaluation was conducted to find out: (1) if mixed gender accommodation in eating disorder units is perceived to be helpful or unhelpful for recovery, and (2) if men were being discriminated against by the implementation of the 2010 Department of Health (DoH) guidelines on the elimination of mixed gender wards. All 32 in-patient units accredited on the Quality Network for Eating Disorders were contacted via a survey.
We received 38 responses from professionals from 26 units and 53 responses from patients (46 female, 7 male) from 7 units. Four units had closed admissions to male patients due to DoH guidelines.
We found that it is possible to provide admission for men with eating disorders, while respecting the single gender accommodation rules, and that doing so is likely to be helpful for both genders and prevents discrimination against men.
The final stages of low-mass stellar evolution are characterized by significant mass loss due to stellar pulsations during the AGB phase, which lead to the development of planetary nebulae. Molecular masers of H2O, SiO, and ground state OH transitions are commonly detected in oxygen-rich late-type stars (OH/IR objects). In contrast, excited OH maser transitions are rare. We discuss our study of the carbon-rich pre-planetary nebula CRL618 (a prototypical post-AGB star). Observations conducted in May 2008 with the 305m Arecibo Telescope resulted in the first detection of a 4765MHz OH maser line in a late-type stellar object; the detection was confirmed a few months later also with Arecibo. Subsequent observations in 2015 and 2017 resulted in non-detection of the 4765MHz OH line. Our observations indicate that the 4765MHz OH maser in CRL 618 is highly variable, possibly tracing a short-lived phenomenon during the development of a pre-planetary nebula.
Measurements of local plasma parameters in dusty plasma are crucial for understanding
the physics issues related to such systems. The Langmuir probe, a small electrode
immersed in the plasma, provides such measurements. However, designing of a Langmuir
probe system in a dusty plasma environment demands special consideration. First, the
probe has to be miniaturized enough so that its perturbation on the ambient dust
structure is minimal. At the same time, the probe dimensions must be such that a
well-defined theory exists for interpretation of its characteristics. The associated
instrumentation must also support the measurement of current collected by the probe
with high signal to noise ratio. The most important consideration, of course, comes
from the fact that the probes are prone to dust contamination, as the dust particles
tend to stick to the probe surface and alter the current collecting area in
unpredictable ways. This article describes the design and operation of a Langmuir
probe system that resolves these challenging issues in dusty plasma. In doing so,
first, different theories that are used to interpret the probe characteristics in
collisionless as well as in collisional regimes are discussed, with special emphasis
on application. The critical issues associated with the current–voltage
characteristics of Langmuir probe obtained in different operating regimes are
discussed. Then, an algorithm for processing these characteristics efficiently in
presence of ion-neutral collisions in the probe sheath is presented.
To examine where residents in an area with limited access to healthy foods (an urban food desert) purchased healthier and less healthy foods.
Food shopping receipts were collected over a one-week period in 2013. These were analysed to describe where residents shopped for food and what types of food they bought.
Two low-income, predominantly African-American neighbourhoods with limited access to healthy foods in Pittsburgh, PA, USA.
Two hundred and ninety-three households in which the primary food shoppers were predominantly female (77·8 %) and non-Hispanic black (91·1 %) adults.
Full-service supermarkets were by far the most common food retail outlet from which food receipts were returned and accounted for a much larger proportion (57·4 %) of food and beverage expenditures, both healthy and unhealthy, than other food retail outlets. Although patronized less frequently, convenience stores were notable purveyors of unhealthy foods.
Findings highlight the need to implement policies that can help to decrease unhealthy food purchases in full-service supermarkets and convenience stores and increase healthy food purchases in convenience stores.
This study aimed to develop a functional model of subglottic stenosis by inducing direct airway irritation in transplanted mouse laryngotracheal complexes.
Laryngotracheal complexes from C57BL/6 mice were harvested and divided into three groups: uninjured, mechanically injured and chemically injured. Donor laryngotracheal complexes from each group were placed in dorsal subcutaneous pockets of recipient mice. Each week, the transplanted laryngotracheal complexes were harvested, and tissues were fixed, sectioned, and stained with haematoxylin and eosin. Representative slides were reviewed by a blinded pathologist, to determine the formation of granulation tissue, and graded as to the degree of granulation formation.
Direct airway irritation induced granulation tissue formation under the disrupted epithelium of airway mucosa; this was seen as early as two weeks after chemical injury.
Results indicate that granulation tissue formation in a murine model may be an efficient tool for investigating the development and treatment of subglottic stenosis.
In this paper, the design and test of a single-chip RF pulse-width modulator and driver (PWMD) aimed at exciting a high-power class-E GaN high-power stage at 435 MHz is described. For the required buffer size, avoiding potential ringing of the pulses within the buffer structure presents a major challenge in the design process. Therefore, a smaller test chip capable of driving capacitive loads of up to 5 pF was initially designed, fabricated, and tested. An approach based on three-dimensional electromagnetic simulations was used to validate the test results and offers excellent simulation accuracy. Based on the results obtained for test chip an enlarged PWMD chip capable of driving a 40 W high-power stage has been designed and tested on passive loads representing the targeted final stage.
In a quasineutral plasma, electrons undergo collective oscillations, known as plasma oscillations, when perturbed locally. The oscillations propagate due to finite temperature effects. However, the wave can lose the phase coherence between constituting oscillators in an inhomogeneous plasma (phase mixing) because of the dependence of plasma oscillation frequency on plasma density. The longitudinal electric field associated with the wave may be used to accelerate electrons to high energies by exciting large amplitude wave. However when the maximum amplitude of the wave is reached that plasma can sustain, the wave breaks. The phenomena of wave breaking and phase mixing have applications in plasma heating and particle acceleration. For detailed experimental investigation of these phenomena a new device, inverse mirror plasma experimental device (IMPED), has been designed and fabricated. The detailed considerations taken before designing the device, so that different aspects of these phenomena can be studied in a controlled manner, are described. Specifications of different components of the IMPED machine and their flexibility aspects in upgrading, if necessary, are discussed. Initial results meeting the prerequisite condition of the plasma for such study, such as a quiescent, collisionless and uniform plasma, are presented. The machine produces δnnoise/n ⩽ 1%, Luniform ~ 120 cm at argon filling pressure of ~10−4 mbar and axial magnetic field of B = 1090 G.
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.
A noteworthy feature of the current global crisis has been the failure of most mainstream analysts (unlike heterodox economists such as Patnaik 2008 and Kregel 1998 and 2008, among others) to predict its onset, estimate its duration and severity or lay bare the mechanisms that contributed to its unfolding. This weakness of telescopic and analytical faculty has been most evident with respect to developing Asia, especially China and India. Even as the global crisis and its effects were being recognized with a lag, Asian developing countries – and these two countries in particular – were seen as the potential shock absorbers in the global system, with predictions that their persisting expansion and relatively high rates of growth would prevent the global downturn from becoming a meltdown (Bergsten 2008; Kohn 2008). Such arguments were reinforced by econometric studies (e.g. Kose et al. 2008), which found evidence of divergence of business cycles across developed and emerging market economies in the period of globalization.
Three features of the economic performance of China and India were seen to warrant this assessment. The first was the superior performance in gross domestic product (GDP) and productivity growth over more than a decade of these two economies, especially China, as compared to developed countries such as the USA (Table 5.1). It was argued that this higher growth must have resulted from mechanisms other than just stimuli linked to global integration. Demographic features, potentially large domestic markets and ‘favourable’ policy environments were typically offered as alternative forces driving growth (Goldman Sachs 2007).
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.
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.
We show a novel, bioengineered, moldable platform for bone regeneration composed of porous bionanocomposite scaffolds made of components that are normally found in bone tissue (calcium, collagen, carbonate, sodium, and phosphorous). To accommodate high- or low-stress environments, the hardness and modulus (stiffness) of these scaffolds can be tuned in a wide range in Megapascal (MPa) to Gigapascal (GPa) regions, while maintaining the required viscoelasticity. Our approach to control the mechanical properties is based on a new formulation of mineralized bioscaffolds by incorporation of calcium carbonate in which, calcium and phosphorous are in the form of calcite, calcium polyphosphate (CPP) and hydroxyapatite (HAP). The variation in the calcium carbonate concentration allows tuning of calcite/CPP contents in the bioscaffold to tailor the degree of mineralization and mechanical and viscoelastic properties that closely match those of natural bone. Our results demonstrate an ideal framework for new bone scaffold designs for advanced bone substitute applications.
Global food security could be imperilled by the combined pressures from the effects of continually evolving climatic conditions, demographics and other socio-economic factors, the demands of the livestock, bioenergy and fibre industries for food-based substrates, the static or decreasing availability of natural resources for agriculture and the impracticality of increased use of economically and environmentally costly agricultural inputs. The optimal harnessing of plant genetic resources for food and agriculture (PGRFA) in manners that translate their repertoire of hidden potentials into significantly enhanced crop productivities has been severally identified as crucial to achieving the required considerably significant increases in food production. The scope of the problems and the plausible means for addressing them compel the devising of novel and more efficient ways for deploying PGRFA in need-based crop improvement programmes. We posit a continuum approach to the management of PGRFA which links seamlessly the effective conservation and access to PGRFA through their use in developing superior and resilient crop varieties to the provision of their high-quality seeds and planting materials to the growers. To achieve the mainstreaming of this paradigm, we propose the institutionalization of overarching national PGRFA strategies that prescribe result-oriented action plans spanning above three components of the management of PGRFA for a country's priority crops. We also describe the strategy as a means for identifying and assigning responsibilities to critical stakeholders and providing for the governance of all aspects of PGRFA activities over specific time frames. Steps to developing and adopting a national PGRFA strategy are also suggested.
Multiferroics, the study of materials which possess ferromagnetic and ferroelectric ordering in a single phase, has become an area of prominent research. Moreover, this behavior has been extensively studied in materials which possess a perovskite crystal structure such as BiFeO3 and YMnO3. Due to their weak saturation magnetic moment, many rare-earth orthoferrites are currently of extreme interest. Utilizing a solid-state reaction between Y2O3 and Fe2O3 we have developed the rare-earth orthoferrite YFeO3 and conducted a bulk material study to determine this material’s availability for thin film multiferroic research. The absence of Y2O3 and Fe2O3 impurities was confirmed using Copper-Kα XRD. Examination of the dependence of the magnetization M on the temperature T was conducted to determine the reliability of multiferroic behavior across varying temperatures in conjunction with the investigation of the dependence of M on the electric field strength H. Results clearly display ferromagnetic behavior in our bulk material, providing ample evidence that our bulk material is an excellent candidate for thin film studies. Future studies on multiferroic YFeO3 thin films grown via pulsed laser deposition on Lanthanum Aluminate substrates will be conducted. Detailed data will be provided via XRD and SQUID to confirm magnetic properties while impurities are non-existent in our thin films.
We explore expected polarization signatures in thermal X-ray emission from magnetized neutron stars. We study the interplay between the photospheres of ordinary and extraordinary modes, and the vacuum resonance. We consider propagation in the neutron star magnetosphere. We identify distinct regimes of magnetic field strengths, and summarize their polarization signatures.
We are discussing the state of the art of X-ray polarization detection techniques in this conference, so that it is important to remind ourselves of the expected X-ray polarization properties of various astrophysical objects. In this paper, we give a brief overview of the expected X-ray polarization signatures of magnetic neutron stars found in diverse situations, e.g. in accretion-powered pulsars, low-mass X-ray binaries (LMXBs), recycled pulsars, isolated neutron stars and finally the fascinating magnetars. We concentrate here only on some aspects of the basic physics of radiation propagation around magnetized neutron stars which lead to some basic, expected polarization features in the X-rays which we consider relatively robust. Accordingly, our discussion here is qualitative. Quantitative aspects of a few of these features have been described by other participants of the conference, and detailed calculations on some other aspects will be reported elsewhere.
The X-ray emission we are concerned with here is basically thermal emission from the surface of the neutron star, powered by accretion or otherwise. This radiation propagates through the neutron-star atmosphere, then through the accretion columns over the magnetic poles of the neutron star if it is an accreting one, and finally through the neutron-star magnetosphere.
We consider a stochastic control model driven by a fractional Brownian motion. This model is a formal approximation to a queueing network with an ON-OFF input process. We study stochastic control problems associated with the long-run average cost, the infinite-horizon discounted cost, and the finite-horizon cost. In addition, we find a solution to a constrained minimization problem as an application of our solution to the long-run average cost problem. We also establish Abelian limit relationships among the value functions of the above control problems.