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Background: Canadian Stroke Guidelines recommend that Transient Ischemic Attack (TIA) patients at highest risk of stroke recurrence should undergo immediate vascular imaging. Computed tomography angiography (CTA) of the head and neck is recommended over carotid doppler because it allows for enhanced visualization of the intracranial and posterior circulation vasculature. Imaging while patients are in the emergency department (ED) is optimal for high-risk patients because the risk of stroke recurrence is highest in the first 48 hours. Aim Statement: At our hospital, a designated stroke centre, less than 5% of TIA patients meet national recommendations by undergoing CTA in the ED. We sought to increase the rate of CTA in high risk ED TIA patients from less than 5% to at least 80% in 10 months. Measures & Design: We used a multi-faceted approach to improve our adherence to guidelines including: 1) education for staff ED physicians; 2) agreements between ED and radiology to facilitate rapid access to CTA; 3) agreements between ED and neurology for consultations regarding patients with abnormal CTA; and 4) the creation of an electronic decision support tool to guide ED physicians as to which patients require CTA. We measured the rate of CTA in high risk patients biweekly using retrospective chart review of patients referred to the TIA clinic from the ED on a biweekly basis. As a balancing measure, we also measured the rate of CTA in non-high risk patients. Evaluation/Results: Data collection is ongoing. An interim run chart at 19 weeks shows a complete shift above the median after implementation, with CTA rates between 70 and 100%. At the time of submission, we had no downward trends below 80%, showing sustained improvement. The CTA rate in non-high risk patients did also increase. Disucssion/Impact: After 19 weeks of our intervention, 112 (78.9%) of high risk TIA patients had a CTA, compared to 10 (9.8%) in the 19 weeks prior to our intervention. On average, 10-15% of high risk patients will have an identifiable lesion on CTA, leading to immediate change in management (at minimum, an inpatient consultation with neurology). Our multi-faceted approach could be replicated in any ED with the engagement and availability of the same multi-disciplinary team (ED, radiology, and neurology), access to CTA, and electronic orders.
Forage sorghum is an important component of the fodder supply chain in the arid and semi-arid regions of the world because of its high productivity, ability to utilize water efficiently and adaptability to a wide range of climatic conditions. Identification of high-yielding stable genotypes (G) across environments (E) is challenging because of the complex G × E interactions (GEI). In the present study, the performance of 16 forage sorghum genotypes over seven locations across the rainy seasons of 2010 and 2011 was investigated using GGE biplot analysis. Analysis of variance revealed the existence of significant GEI for fodder yield and all eight associated phenotypic traits. Location accounted for a higher proportion of the variation (0·72–0·91), while genotype contributed only 0·06–0·21 of total variation in different traits. Genotype-by-location interactions contributed 0·02–0·13 of total variation. Promising genotypes for fodder yield and each of the associated traits could be identified effectively using a graphical biplot approach. The majority of test locations were highly correlated. A ‘Which-won-where’ study partitioned the test locations into two mega-environments (MEs): ME1 was represented by five locations with COFS 29 as the best genotype, while ME2 had two locations with S 541 as the best genotype. The existence of two MEs suggested a need for location-specific breeding. Genotype-by-trait biplots indicated that improvement for forage yield could be achieved through indirect selection for plant height, leaf number and early vigour.
Ear cartilage piercing is increasingly popular and has a significant complication rate. Contrary to popular belief, there are no minimum qualifications required to practice ear piercing. This study evaluated ear cartilage piercing practices in London, UK.
Practitioners at 25 piercing parlours completed a telephone questionnaire assessing piercing practice.
Ninety-six per cent of practitioners were aware of the risk of infection post-piercing. Four per cent, 12 per cent and 0 per cent of practitioners were aware of keloid scarring, hypertrophic scarring and cauliflower ear respectively. No practitioners were aware of any other complications. Their consent forms did not document any ear cartilage complications. Twenty-eight per cent of participants advised clients to seek medical attention following a complication. Forty per cent did not provide written post-piercing guidance.
Piercing practitioners were insufficiently aware of ear cartilage piercing complications. It is unlikely that informed consent was obtained prior to piercing. The post-piercing practice of the majority of parlours did not follow published national guidance.
On June 13, 2012, a group of key stakeholders, leaders, and national experts on tuberculosis (TB), occupational health, and laboratory science met in Atlanta, Georgia, to focus national discussion on the higher than expected positive results occurring among low-risk, unexposed healthcare workers undergoing serial testing with interferon-γ release assays (IGRAs). The objectives of the meeting were to present the latest clinical and operational research findings on the topic, to discuss evaluation and treatment algorithms that are emerging in the absence of national guidance, and to develop a consensus on the action steps needed to assist programs and physicians in the interpretation of serial testing IGRA results. This report summarizes its proceedings.
This paper reports on two rare cases of neonatal airway lesions with differing aetiology that were successfully managed by surgery, and provides a review of the literature on neonatal stridor and airway lesions.
In the first case report, a newborn presented with a nasopharyngeal teratoma. In the second case report, a newborn presented with a congenital laryngeal saccular cyst. Difficulties in the diagnosis of these lesions, and surgical and anaesthetic challenges in their management are discussed.
Every case of neonatal airway distress must be evaluated and the cause of stridor needs to be established. It is important that rare lesions such as teratomas and laryngeal cysts are not overlooked; a high index of suspicion for these congenital anomalies is necessary. These airway lesions should be managed in an institutional setting by a multidisciplinary team.
To investigate the effects of adenotonsillectomy on the quality of life of children under three years of age with obstructive sleep apnoea. To our knowledge, there have been no previously published studies on this topic.
Thirty-nine children under three years of age and treated with adenotonsillectomy for obstructive sleep apnoea met the inclusion criteria. A quality of life questionnaire was adapted from the validated, six-item instrument developed by de Serres et al. (2000). The questionnaire assessed improvement in specific domains following adenotonsillectomy. Carers scored each domain on a point scale ranging from ‘none’ (0) to ‘couldn't be more’ (6).
The quality of life of all children improved after surgery. The greatest mean improvement scores were in the domains of care-giver concern, physical suffering and sleep disturbance. The modal questionnaire score was 4 and the overall mean questionnaire score was 4.2.
Adenotonsillectomy provides measurable improvements in quality of life for children under three years of age with obstructive sleep apnoea.
A house to house survey was done from October 1972 to March 1974, covering 52952 individuals of urban population at Lucknow and 50156 individuals of rural population of Unnao district, to find out the incidence of polio-like paralysis in our population. Among 12874 urban children up to 8 years old 8·2/1000 had polio-like paralysis while 4·6/1000 children of the rural population of 13554 children were affected. The incidence was significantly higher in the urban population. In the preschool age group almost 1 out of every 100 children was affected. A higher number of children were affected during 1968–9 and 1971–2, though it did not reach epidemic proportion. The findings show that paralytic polio is a serious problem in our country where poliomyelitis is endemic: this is contrary to the views generally held so far.
Burn rates of various nano-energetic composites were measured by two techniques; on-chip method and conventional optical method. A comparison is presented to confirm the validity of on-chip method. On-chip initiators were prepared using platinum heater films and nanoenergetic composites. Thin film Pt heaters were fabricated with different dimensions and ignition delay was studied using a nano-energetic composite of CuO nano-rods and Al-nano-particles. The ignition delay as a function of electrical power is presented for the same energetic composite. Heater with smaller surface area is found to be more efficient, which may be due to the lower heat losses.
Current approaches of mixing fuel and oxidizer nanoparticles or adding fuel nanoparticles to oxidizer gel lead to an overall reduced interfacial area of contact between them and thus, limit their burn rates severely. We have developed an approach of self-assembling fuel nanoparticles around an oxidizer matrix using a monofunctional polymer, poly(4)-vinyl pyridine (P4VP). The polymer has been used to accomplish binding of fuel and oxidizer in a molecularly engineered manner. We use composite of Al-nanoparticles and CuO nanorods for executing this self-assembly. TEM images of this composite confirms the self-assembly of Al-nanoparticles around the oxidizer nanorods. The burn rate of self-assembled composite has been found significantly higher than that of the composite prepared by simple mixing.
We have calculated J-V characteristics of an organic conducting sample (containing traps) including the Poole-Frenkel Effect (PFE). Both shallow and exponentially distributed traps are considered. We show that our approach is equivalent to combining the effect of trapping and using the field dependent mobility in one unified model. For shallow single level or shallow Gaussian traps, inclusion of PFE or using the (well-known) field dependent mobility gives the same dependence of current on voltage at a given temperature. However the value of zero field mobility µ0 comes out to be different. We have fabricated and measured the J-V curves of the ITO/MEH-OPV5/Al diodes. An extremely fast rise with voltage V is observed at small voltages, which can be interpreted either by the Schottky contact limited Shockley like current or by bulk space charge limited current with PFE. The correct mechanism can be determined by making J-V measurements at different temperatures.
Two techniques for sexing adults of the white pine weevil Pissodes strobi Peck are described. Both techniques are based on the external anatomy of the terminal segments of the abdomen as viewed with a dissecting microscope.
An estimate of the effect of light bending and redshift on pulsar beam characteristics has been made using a weak Kerr metric for the case of a 1.4 M⊙ neutron star with a radius in the range 6-10 km and rotation periods of 1.56 ms and 33 ms, respectively. Assuming that the pulsar emission has the form of a narrow conical beam directed away from the surface and is located within two stellar radii, the beam is found to be widened by a factor of ≤ 2 and to suffer a reduction in the intensity (flattening of the profile) by an order of magnitude or less. The effect is largest for the most rapidly rotating the neutron stars. For an emission region located beyond 20 km, the flattening is generally insignificant. The pulse profile is slightly asymmetrical due to dragging of the inertial frames. For millisecond periods, aberration tends to reverse the flattening effect of space-time curvature by narrowing the pulse and can completely overcome it for emission from a location beyond ≃30km. Although the pulse must slightly brighten up, a large redshift factor overcomes this effect to keep the pulse flattened for all neutron star radii considered here.
A patient complaining of dysphagia was diagnosed as suffering from a fracture of the hyoid bone. The fracture was fixed using the modern technique of tension band wiring. There was subsequent relief of the symptoms. A review of the literature and our perspective is included.
Experiments were conducted in wheat planted in microplots at Hisar and Sirsa in Haryana state, India, to observe and simulate the depth distribution of moisture content, electrical conductivity in 1:2 soil-water extract (EC 1:2), and exchangeable sodium percentage (ESP) of soils after irrigation with water of high electrical conductivity (12–19 dS/m) and sodium adsorption ratio (20–80 (mmol/1)0·5). The three simulation models used differed in the procedure of estimation of evapotranspiration (models I and II, Reddy 1983; model III, Arora et al. 1987). In general, the means of the experimental moisture content profiles decreased and those of EC 1:2 and ESP increased with irrigation at both locations. Statistical analysis showed an overall good agreement between the experimental and simulated values of moisture content, EC 1:2 and ESP; the accuracy of simulation of the models followed the order model II = model III > model I, for moisture content and EC 1:2, but was identical for ESP.
It is proved that if G is a connected cubic graph of order p all of whose bridges lie on r edge-disjoint paths of G, then every maximum matching of G contains at least P/2 − └2r/3┘ edges. Moreover, this result is shown to be best possible.
A simple yet effective field screening technique for estimating drought tolerance is described. It involves growing plants in sloping plots which are opposite each other and connected to sub-channels lined with polyethylene sheet. The slopes are designed to achieve instant surface run-off and the sub-channels connected to a main channel for rapid drainage of rain-water. Stress is created at different stages of crop growth by manipulating the timing of irrigation and covering the soil surface with polyethylene sheeting. The technique proved effective even in the monsoon season which is characterized by irregular intensity and distribution of rainfall. Data on six characters for 80 genotypes of pearl millet grown in six artificially created environments representing different levels of moisture stress are discussed. The ‘slope’ technique was effective in creating different levels of moisture stress at various stages of crop growth and in distinguishing categories of genotypes by their relative drought tolerance.
Significant differences were found between 20 chickpea cultivars and four locations in respect of the concentration of protein in the seeds. Cultivar x location interactions were also significant. The average protein concentration among cultivars varied from 18.5 to 23.2% and among locations from 18.3 to 22.7%. Correlations between seed protein concentration and seed yield and seed size were very small. Protein concentration was influenced by available nitrogen in the soil.
Thirty-six rams of Chokla breed of about 1–1½12 years of age were randomly divided into six groups and were fed for 4 months on a basal ration of Cynodon dactylon grass or its hay ad libitum. One group acted as the control, while the rations of the remaining groups were respectively supplemented with 250 g of a concentrate mixture, 250 g of lucerne hay, mg CoCl2.6H2O, 10 mg CuSO4.5H2O and 1 mg CoCl2. 6H2O plus 10 mg CuSO4. 5H2O per animal per day. The mean copper, sulphur and cobalt ingestion in the different groups respectively ranged from.1 to 9·7, 475 to 2030 and 0·10 to 0·53 mg per animal per day. The copper, sulphur, fibre diameter, staple length, medullation percentage, crimp per cm and staining grade were not significantly (P > 0·05) affected by the different dietary treatments. The wool copper was strongly correlated with wool sulphur (r = + 0·79) and both were inversely correlated with fibre diameter and medullation percentage. Wool sulphur, but not wool copper, was inversely correlated with staple length. Wool copper, but not wool sulphur, was inversely correlated with the staining grade of canary coloured wool. Staining grade was inversely correlated with fibre diameter as well as crimps per cm. The results suggest that copper plays an intrinsic role in the marshalling of the sulphur component of wool and in the synthetic mechanism of the wool fibre. A suggestion has been made that copper may be playing a biochemical part in the physiological processes causing canary coloration in Indian wools.
In a previous paper ((l)) the authors gave the solution for the two-dimensional circular inclusion problem in a medium containing a circular cavity. This paper seeks to solve the more general problem of a similar inclusion when the cavity is replaced by an inhomogeneity which could be of a different elastic material. The solution consists in finding three sets of suitable complex potential functions ø(z) and ψ(z) for three regions: the inhomogeneity, the inclusion and the rest of the material. The solution depends upon the evaluation of the complex potentials for a material containing the inhomogeneity when on the former a finite force is acting at some fixed point. It may be noted that two sets of ø(z) and ψ(z) have to be found in this case: one for the inhomogeneity and the other for the rest of the material. This may be taken as an auxiliary problem.