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To study the effect of baclofen in preventing drug use in persons with cannabis misuse.
An open label study to asses the effect of baclofen in treating persons with cannabis dependence (ICD-10 criteria) with assessments of outcome every month for a period of three months.
20 male subjects (mean age of 29.70 ± 10.19 years) with a mean age at development of dependence of 20.75 ± 09.34 years and mean duration of cannabis use of 89.40 ± 57.41 months, were treated with baclofen (mean dose of 33.75 ± 04.83 mg./day). At three months 12 subjects (60%) completely stopped, 6 subjects (30%) decreased the frequency and 2 subjects (10%) continued the same frequency of the cannabis intake.
Our findings provide preliminary support for the use of baclofen in maintaining abstinence and improving outcome in patients with cannabis dependence.
The prevalence of aDHD in adult population has been estimated at 2.5%. Higher rates (23.9%) have been reported among adult mental health service ( aMHS) users.
To estimate the prevalence of aDHD among adult MH users in west county Ireland.
all consecutive patients attending any of 5 Sligo/Leitrim aMHS were invited to participate. Participants completed the adult aDHD Self-Report Scale ( aSRS) and the wender Utah Rating Scale (WURS). Clinical notes were reviewed to identify those with preexisting aDHD diagnosis. Exclusion criteria applied were: age: less 18 or above 65, illiterate, non-English speaking patients.
From 792 attending the clinics, n = 59 (47 aged above 65, 10 severe learning difficulties and 2 non-English speaking) were excluded. Ninety-three (11.7%) decline to participate, giving a total of n = 640 (87% eligible response rate). Mean age was 41.27 (SD: 12.8), and 336 (52.5%) were females. Three had diagnosis of aDHD. Two hundred and thirteen (33.8%) met criteria on the WURS for childhood onset aDHD and 238 (37.5%) participants met caseness on the aSRS. applying more stringent criteria of scoring on both scales, suggested 125 (19.5%) with unrecognised aDHD.
While recall bias (WURS) and the possibility of overlapping symptoms with other major psychiatric disorders in adulthood need to be considered, the use of both screening reduces these confounders and suggests a very high rate of aDHD. Given the low number previously identified, this becomes a clinical priority, both to offset the negative trajectories associated with untreated aDHD, but also to effect optimal treatments in comorbid conditions.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
We undertook a quality improvement project to address challenges with pulmonary artery catheter (PAC) line maintenance in a setting of low-baseline central-line infection rates. We observed a subsequent reduction in Staphylococcal PAC line infections and a trend toward a reduction in overall PAC infection rates over 1 year.
Suicide is a relatively common event in those seeking psychiatric care. However, its impact is nonetheless traumatic and devastating for those involved in the care of the patient. Community mental health teams (CMHTs) address every aspect of a patient’s life, which creates a unique relationship between the team and the patient. Patient suicide can have serious, detrimental effects on individual team members, on the functioning of the team itself and on the care of other patients in the aftermath of such an event. In spite of this, there are limited protocols to guide CMHTs in this situation. This article seeks to emphasise the impact of patient suicide on CMHTs as a specific entity. It highlights the need for more research in this area, in order to direct the formation of more coherent local and national guidelines.
Elderly patients have been consistently shown to receive suboptimal therapy for cancers of the head and neck. This study was performed to determine the peri-operative outcomes of these patients and compare them with those of younger patients.
In this retrospective analysis, 115 patients aged 70 years or more undergoing major surgery for head and neck cancers were matched with 115 patients aged 50–60 years, and univariate analysis was performed.
Elderly patients had a reduced performance status (p < 0.001) and more co-morbid illnesses (p = 0.007), but a comparable intra-operative course. They had a longer median hospital stay (p = 0.016), longer intensive care unit stay (p = 0.04), longer median tracheostomy dependence (p = 0.04) and were more often discharged with feeding tubes (p < 0.001). They also had a higher incidence of post-operative non-fatal cardiac events (p = 0.045).
Elderly patients with good performance status should receive curative-intent surgery. Although hospital stay and tube dependence are longer, morbidity and mortality are comparable with younger patients.
Background: Despite advances in neonatal care, neonates with moderate to severe HIE are at high risk of mortality and morbidity. we report the impact of a dedicated NNCC team on short term mortality and morbidities. Methods: A retrospective cohort study on neonates with moderate to serve HIE between July 1st 2008 and December 31st 2017. primary outcome : a composite of death and/or brain injury on MRI. Secondary outcomes: rate of cooling, length of hospital stay, anti-seizure medication burden, and use of inotropes. A regression analysis was done adjusting for gestational age, birth weight, gender, out-born status, Apgar score at 10 minutes, cord blood pH, and HIE clinical staging Results: 216 neonates were included, 109 before NNCC implementation, and 107 thereafter. NNCC program resulted in reduction in the primary outcome (AOR: 0.28, CI: 0.14-0.54, p<0.001) and brain injury (AOR: 0.28, CI: 0.14-0.55, p<0.001). It decreased average length of stay/infants by 5 days (p=0.03), improved cooling rate (73% compared to 93% , p <0.001), reduced: seizure misdiagnosis (71% compared to 23%, P <0.001), anti-seizure medication burden (P = 0.001), and inotrope use (34% compared to 53%, p=0.004) Conclusions: NNCC program decreased mortality and brain injury , shortened the length of hospital stay and improved care of neonates with significant HIE.
This study estimates the symptomatology of attention deficit–hyperactivity disorder (ADHD) in adult mental health services (AMHS) outpatient clinics.
All consecutive patients attending any of the outpatients’ clinics in Sligo/Leitrim AMHS were invited to participate. Participants completed the Adult ADHD Self-Report Scale (ASRS) and the Wender Utah Rating Scale (WURS) self-report. Clinical notes were reviewed to identify those with a pre-existing ADHD diagnosis.
From 822 attending the clinics, 62 did not meet inclusion criteria, 97 declined to participate and 29 had incomplete data in either of the screening scales, leaving 634 (77%) eligible for full study analysis. Mean age was 40.38 (s.d.: 12.85), and 326 (51.4%) were females. In total, 215 (33.9%) screened positive on the WURS for childhood onset ADHD and 219 (34.5%) participants scored positive on the ASRS. Applying a more stringent criteria of scoring above cut-offs on both scales, suggested 131 (20.7%) screened positive on both. Only three (2.3%) had a prior clinical diagnosis.
This preliminary study suggests the possibility of relatively higher rates of ADHD in a general AMHS than previously thought, however, given the possibility of overlapping symptoms with other major psychiatric disorders in adulthood and recall bias further research is needed before drawing firm conclusions.
The government publishes 3 different public report surgical site infection (SSI) metrics, all called standardized infection ratios (SIRs), that impact perceived hospital quality. We conducted a non-random cross-sectional observational pilot study of 20 California hospitals that voluntarily submitted colon surgery and SSI data. Discordant SIR values, leading to contradictory conclusions, occurred in 35% of these hospitals.
Docetaxel, cisplatin plus 5-fluorouracil is an efficacious induction regimen but is more toxic than cisplatin plus 5-fluorouracil. This study aimed to determine whether docetaxel and cisplatin without 5-fluorouracil maintains efficacy while decreasing toxicity.
A multicenter non-comparative pilot study of locally advanced squamous cell carcinoma of the head and neck was performed. Patients received primary therapy comprising three cycles of 75 mg/m2 docetaxel and 75 mg/m2 cisplatin followed by concurrent chemoradiotherapy. The primary endpoint was the response rate to the docetaxel and cisplatin induction regimen.
A total of 26 patients were enrolled: of these, 23 (88.5 per cent) received all three docetaxel and cisplatin cycles. Common grade 3–4 adverse events were febrile neutropenia (19.2 per cent of patients), diarrhoea (19.2 per cent) and non-neutropenic infection (15.4 per cent). The overall response rate to docetaxel and cisplatin induction chemotherapy was 65.4 per cent. A total of 23 patients (88.5 per cent) subsequently received chemoradiotherapy with a median radiotherapy dose of 70 Gy. The response rate to chemoradiotherapy was 73 per cent. At a median follow up of 44 months, the 3-year progression-free survival and overall survival rates were 62 per cent and 69 per cent, respectively.
Docetaxel and cisplatin induction chemotherapy is a feasible induction regimen with comparable efficacy to docetaxel, cisplatin and 5-fluorouracil induction chemotherapy.
The analysis of axial dispersion of solute is presented in a pulsatile flow of Casson fluid through a tube in the presence of interfacial mass transport due to irreversible first-order reaction catalysed by the tube wall. The theory of dispersion is studied by employing the generalized dispersion model proposed by Sankarasubramanian & Gill (Proc. R. Soc. Lond. A, vol. 333 (1592), 1973, pp. 115–132). This dispersion model describes the whole dispersion process in terms of three effective transport coefficients, i.e. exchange, convection and dispersion coefficients. In the present study, the effects of yield stress of Casson fluid
, wall absorption parameter
, amplitude of fluctuating pressure component
and Womersley frequency parameter
on the dispersion process are discussed under the influence of pulsatile pressure gradient. In a pulsatile flow, the plug flow radius changes during the period of oscillation and it has an effect on the dispersion process. Even with the Casson fluid model also, in an oscillatory flow, for small values of
, the dispersion coefficient
is positive, but when the value of
is as large as 3,
takes both positive and negative values due to the fluctuations in the velocity profiles. This nature becomes more predominant for
. It is observed that initially, for small time, the amplitude and magnitude of fluctuations of
becomes more rapid and increases with time but it decreases after certain time and reaches a non-transient state for large time. Like in the case of Newtonian model, double frequency period for
is observed at small time for large values of
with the Casson model for blood. It is seen that critical time for which
reaches a non-transient state is independent of
but is dependent on
. It is also observed that the axial distribution of mean concentration
of solute depends on
. But the effect of
is not very significant. This dispersion model in non-Newtonian pulsatile flow can be applied to study the dispersion process in the cardiovascular system and blood oxygenators.
Global patterns of copy number variations (CNVs) in chromosomes are required to understand the dynamics of genome organization and complexity. For this study, analysis was performed using the Affymetrix Genome-Wide Human SNP Array 6.0 chip and CytoScan High-Density arrays. We identified a total of 44 109 CNVs from 1715 genomes with a mean of 25 CNVs in an individual, which established the first drafts of population-specific CNV maps providing a rationale for prioritizing chromosomal regions. About 19 905 ancient CNVs were identified across all chromosomes and populations at varying frequencies. CNV count, and sometimes CNV size, contributed to the bulk CNV size of the chromosome. Population specific lengthening and shortening of chromosomal length was observed. Sex bias for CNV presence was largely dependent on ethnicity. Lower CNV inheritance rate was observed for India, compared to YRI and CEU. A total of 33 candidate CNV hotspots from 5382 copy number (CN) variable region (CNVR) clusters were identified. Population specific CNV distribution patterns in p and q arms disturbed the assumption that CNV counts in the p arm are less common compared to long arms, and the CNV occurrence and distribution in chromosomes is length independent. This study unraveled the force of independent evolutionary dynamics on genome organization and complexity across chromosomes and populations.
Copy number variations (CNVs) alter the transcriptional and translational levels of genes by disrupting the coding structure and this burden of CNVs seems to be a significant contributor to phenotypic variations. Therefore it was necessary to assess the complexities of CNV burden on the coding genome. A total of 1715 individuals from 12 populations were used for CNV analysis in the present investigation. Analysis was performed using Affymetrix Genome-Wide Human SNP Array 6·0 chip and CytoScan High-Density arrays. CNVs were more frequently observed in the coding region than in the non-coding region. CNVs were observed vastly more frequently in the coding region than the non-coding region. CNVs were found to be enriched in the regions containing functional genes (83–96%) compared with the regions containing pseudogenes (4–17%). CNVs across the genome of an individual showed multiple hits across many genes, whose proteins interact physically and function under the same pathway. We identified varying numbers of proteins and degrees of interactions within protein complexes of single individual genomes. This study represents the first draft of a population-specific CNV genes map as well as a cross-populational map. The complex relationship of CNVs on genes and their physically interacting partners unravels many complexities involved in phenotype expression. This study identifies four mechanisms contributing to the complexities caused by the presence of multiple CNVs across many genes in the coding part of the genome.
This paper discusses tensile testing of small samples of nanocrystalline Al6061-T6 alloy obtained from an unusual application of machining as a severe plastic deformation process. Ultrafine grained (UFG) shavings obtained from plane-strain cutting show higher hardness than the bulk material in agreement with existing literature. Application of restricted contact tools and extrusion-machining was explored to obtain shavings with minimum curvature to aid in tensile test specimen preparation. A novel method to prepare small tensile test specimens from these shavings has been described. During the tensile testing of UFG material, strains were measured using digital image correlation of natural speckles on the specimen. Specimens made from the UFG material had higher tensile strength and yield stress than the bulk, while ductility was lower. Lower values of Young's modulus were observed during the tensile testing of small specimens made from UFG as well as bulk material.
Mid-Infrared optofluidics based silicon sensor platforms are demonstrated. Silicon is a great candidate for mid-infrared optofluidics for the following reasons: (1) Silicon has a broad transmission window up to 7 um (2) Silicon offers CMOS compatible and monolithic fabrication (3) Silicon has high chemical resistance that can withstand high temperature, acid/base solution and organic solvents. (4) Silicon is a non-toxic environmentally friendly material. The fabricated mid-infrared optofluidic sensor can replace bulky instruments, such as FTIR, with a lab-on-a-chip system, while achieving much higher sensitivity.
One dimensional photonic crystal 1D-PhC silicon waveguide resonators with quality factor, Q∼105, are demonstrated at mid-infrared wavelengths between 2 um to 5 um. Silicon has several advantages for mid-infrared applications including its broad mid-infrared transmission spectrum which extends out to 9 um, CMOS compatible fabrication processing, and ease of electronic-photonic integration. The proposed resonators are composed of photonic crystal cavities with optimized (i) lattice parameter a, (ii) cavity width w and (iii) hole radius r. Finite difference time domain (FDTD) simulations are used to adjust these three parameters, a, w, and r, to select a resonant frequency of interest within the mid-infrared spectral range. Due to the high quality factor Q, these PhC silicon waveguide resonators have much higher sensitivity as chemical sensors and have the potential to replace bulky instruments such as an FTIR.
In the present study, a centric diatom Chaetoceros minimus is reported for the first time from the Indian waters. This record will contribute to the phytoplankton checklist of Indian seas. Morphological characteristics and distribution of the species are provided.