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Crenidens macracanthus was originally described in 1874 based on a single specimen collected from Chennai (Madras), south-east coast of India. In 1875, the species was synonymized with C. indicus without citing any valid reason. Since then, no taxonomic studies have been attempted for the genus Crenidens, except in 2013 the species was resurrected from synonymy and redescribed as a valid species based on the holotype and non-type specimen. In view of the fact that C. macracanthus is a poorly known species, it is redescribed based on examination of 30 additional specimens of 105.8–162.2 mm SL, collected from Puri, Odisha, north-east coast of India (Bay of Bengal) from 2017–2019, using morphological and molecular examinations. Our study provides a detailed morphological description, first colour photographs and phylogenetic analysis using COI barcodes of the species. The study has expanded the range in several morpho-meristic characters in comparison with the type and non-type specimens described earlier. The species in fresh condition can be easily distinguished from its two congeners (C. crenidens and C. indicus) by the yellowish tip of the lower caudal-fin lobe. Our study has also extended the distribution range of C. indicus (previously known only from the north-eastern Arabian Sea) to the eastern Indian Ocean, based on examination of a preserved specimen collected from Tuticorin, Tamil Nadu.
Opioid use disorder is a major public health crisis, and evidence suggests ways of better serving patients who live with opioid use disorder in the emergency department (ED). A multi-disciplinary team developed a quality improvement project to implement this evidence.
The intervention was developed by an expert working group consisting of specialists and stakeholders. The group set goals of increasing prescribing of buprenorphine/naloxone and providing next day walk-in referrals to opioid use disorder treatment clinics. From May to September 2018, three Alberta ED sites and three opioid use disorder treatment clinics worked together to trial the intervention. We used administrative data to track the number of ED visits where patients were given buprenorphine/naloxone. Monthly ED prescribing rates before and after the intervention were considered and compared with eight nonintervention sites. We considered whether patients continued to fill opioid agonist treatment prescriptions at 30, 60, and 90 days after their index ED visit to measure continuity in treatment.
The intervention sites increased their prescribing of buprenorphine/naloxone during the intervention period and prescribed more buprenorphine/naloxone than the controls. Thirty-five of 47 patients (74.4%) discharged from the ED with buprenorphine/naloxone continued to fill opioid agonist treatment prescriptions 30 days and 60 days after their index ED visit. Thirty-four patients (72.3%) filled prescriptions at 90 days.
Emergency clinicians can effectively initiate patients on buprenorphine/naloxone when supports for this standardized evidence-based care are in place within their practice setting and timely follow-up in community is available.
Background: Since January 1, 2016 2358 people have died from opioid poisoning in Alberta. Buprenorphine/naloxone (bup/nal) is the recommended first line treatment for opioid use disorder (OUD) and this treatment can be initiated in emergency departments and urgent care centres (EDs). Aim Statement: This project aims to spread a quality improvement intervention to all 107 adult EDs in Alberta by March 31, 2020. The intervention supports clinicians to initiate bup/nal for eligible individuals and provide rapid referrals to OUD treatment clinics. Measures & Design: Local ED teams were identified (administrators, clinical nurse educators, physicians and, where available, pharmacists and social workers). Local teams were supported by a provincial project team (project manager, consultant, and five physician leads) through a multi-faceted implementation process using provincial order sets, clinician education products, and patient-facing information. We used administrative ED and pharmacy data to track the number of visits where bup/nal was given in ED, and whether discharged patients continued to fill any opioid agonist treatment (OAT) prescription 30 days after their index ED visit. OUD clinics reported the number of referrals received from EDs and the number attending their first appointment. Patient safety event reports were tracked to identify any unintended negative impacts. Evaluation/Results: We report data from May 15, 2018 (program start) to September 31, 2019. Forty-nine EDs (46% of 107) implemented the program and 22 (45% of 49) reported evaluation data. There were 5385 opioid-related visits to reporting ED sites after program adoption. Bup/nal was given during 832 ED visits (663 unique patients): 7 visits in the 1st quarter the program operated, 55 in the 2nd, 74 in the 3rd, 143 in the 4th, 294 in the 5th, and 255 in the 6th. Among 505 unique discharged patients with 30 day follow up data available 319 (63%) continued to fill any OAT prescription after receiving bup/nal in ED. 16 (70%) of 23 community clinics provided data. EDs referred patients to these clinics 440 times, and 236 referrals (54%) attended their first follow-up appointment. Available data may under-report program impact. 5 patient safety events have been reported, with no harm or minimal harm to the patient. Discussion/Impact: Results demonstrate effective spread and uptake of a standardized provincial ED based early medical intervention program for patients who live with OUD.
The aim of this study was to audit the practise of Lithium monitoring on all patients over the age of 65 years, over a one-year period in North Tyneside General Hospital, against the recommended standards, and re-auditing the following year.
During the audit; data was collected from the medical notes of all patients prescribed Lithium, over 65 years in North Tyneside General Hospital. This was from January 2004 - January 2005. The standards used were the recommendations of The British National Formulary. The monitoring of urea, electrolytes, TSH and Lithium were recorded. The presence of an ECG, documentation of side effects, information leaflets’ distribution and patients lost to follow up were noted. Following the audit, recommendations were made and prescribing Consultants were informed. A re-audit was conducted on all patients on Lithium the next year from January 2006 - June 2006, using the same designed tool.
22 patient's notes were audited and 29 notes re-audited. 41% were males and 59% females in the audit, with similar distribution in the re-audit. 54% were between 65-75 years and 45% over the age of 75years in the audit. 41% and 59% respectively in the re-audit. Blood monitoring followed the standards in 86% in the audit and 95% in the re-audit. 32% had documentation of side effects in the audit, increasing to 72% in the re-audit. While 23% patients were lost to follow up in the audit, all were followed up in the re-audit.
The re-audit encouragingly showed significant improvement in practise.
The theoretical investigation of shocks and solitary structures in a dense quantum plasma containing electrons at finite temperature, nondegenerate cold electrons, and stationary ions has been carried out. A linear dispersion relation is derived for the corresponding electron acoustic waves. The solitary structures of small nonlinearity have been studied by using the standard reductive perturbation method. We have considered collisions to be absent, and the shocks arise out of viscous force. Furthermore, with the help of a standard reductive perturbation technique, a KdV–Burger equation has been derived and analyzed numerically. Under limiting cases, we have also obtained the KdV solitary profiles and studied the parametric dependence. The results are important in explaining the many phenomena of the laser–plasma interaction of dense plasma showing quantum effects.
To assess the effect of tranexamic acid on intra-operative bleeding and surgical field visualisation.
Fifty patients undergoing various endoscopic ear surgical procedures, including endoscopic tympanoplasty, endoscopic atticotomy or mastoidectomy, endoscopic ossiculoplasty, and endoscopic stapedotomy, were randomly assigned to: a study group that received tranexamic acid or a control group which received normal saline. The intra-operative bleeding and operative field visualisation was graded using the Das and Mitra endoscopic ear surgery bleeding and field visibility score, which was separately analysed for the external auditory canal and the middle ear.
The Das and Mitra score was better (p < 0.05) in the group that received tranexamic acid as a haemostat when working in the external auditory canal; with respect to the middle ear, no statistically significant difference was found between the two agents. Mean values for mean arterial pressure, heart rate and surgical time were comparable in both groups, with no statistically significant differences.
Tranexamic acid appears to be an effective haemostat in endoscopic ear surgery, thus improving surgical field visualisation, especially during manipulation of the external auditory canal soft tissues.
This chapter reviews the systematics of partial melting of mantle lithologies – like peridotite and eclogite – in the presence of carbon dioxide. It discusses the composition of mantle-derived magmas generated in the presence of carbon dioxide and whether magmas erupted on Earth’s surface resemble carbonated magmas from the mantle. It reviews how the production of carbon dioxide-rich magma in the mantle varies as a function of tectonic settings – beneath continents and oceans and in subduction zones – and time.
Field experiments were carried out in order to investigate if brown manuring (BM) using Sesbania plants can be used to control weeds in maize, especially Cyperus rotundus (Experiment I), and further to optimize the BM technology through appropriate Sesbania seed rate (S), 2,4-D application time (T) and dose (D) (Experiment II). Each BM treatment received a pre-emergence application of pendimethalin 1.0 kg a.i./ha. Experiment I showed that the BM practice using 15 kg/ha Sesbania seed and 2,4-D 0.50 kg a.i./ha applied at 25 DAS led to better control of weeds, especially C. rotundus and higher maize grain yield. Further optimization studies (Experiment II) indicated that among the factors S, T and D, the BM combination S~25 kg/ha, D~0.50 kg a.i./ha and T~25 DAS (i.e. S25T25D0.50) resulted in lowest weed density (3.1/m2) and dry weight (3.8 g/m2) and highest weed control index (89.2%) at 60 days after sowing (DAS) which was at par with another BM practice S15T25D0.50. However, the later BM combination led to significantly higher maize productivity (5.25 t/ha) and profitability (net returns (NR) $878/ha), which were 103 and 280% higher, respectively, than the weedy check (WC). The Sesbania seed rate S~15 kg/ha gave 7% higher maize grain yield and 12% higher NR than its corresponding level S~25 kg/ha. Therefore, Sesbania BM with 15 kg seeds/ha and 2,4-D at 0.50 kg a.i/ha applied at 25 DAS can be recommended for effective and eco-friendly weed management in maize, which would provide higher maize grain yield and enhance farmers' profitability.
In this paper, longitudinal and lateral-directional aerodynamic characterisation of the Cropped Delta Reflex Wing (CDRW) configuration–based unmanned aerial vehicle is carried out by means of full-scale static wind-tunnel tests followed by full-scale flight testing. A predecided set of longitudinal and lateral/directional manoeuvres is performed to acquire the respective flight data, using a dedicated onboard flight data acquisition system. The compatibility of the acquired dynamics is quantified, in terms of scale factors and biases of the measured variables, using Kinematic consistency check. Maximum likelihood (ML), least squares and newly emerging neural Gauss–Newton (NGN) methods were implemented for a wing-alone delta configuration, mainly to capture the dynamic derivatives for both longitudinal and lateral directional cases. Estimated damping and weak dynamic derivatives, which are in general challenging to capture for a wing alone configuration, are consistent using ML and NGN methods. Validation of the estimated parameters with aerodynamic model is performed by proof-of-match exercise and are presented therein.
Terminal heat stress leads to sizeable yield loss in late-sown wheat in tropical environments. Several synthetic compounds are known to counteract plant stress emanating from abiotic factors. A field experiment was conducted in Sabour (eastern India) during 2013–2016 to investigate the field efficacy of two synthetic compounds, calcium chloride (CaCl2) and arginine, for improving grain yield of two contrasting wheat cultivars (DBW 14 and K 307) facing terminal heat stress. For this, foliar spray of 18.0 mM CaCl2 at booting (CCB) or anthesis (CCA), 9.0 mM CaCl2 at both booting and anthesis (CCB+A), 2.5 mM arginine at booting (ARGB) or anthesis (ARGA) and 1.25 mM arginine at both booting and anthesis (ARGB+A) treatments along with no-spray and water-spray treatments were evaluated in late-sown wheat. The highest grain yield was recorded in treatment CCB+A, followed by CCA and ARGB+A. However, the effect of these compounds was marginal on grain yield when applied only at the booting stage. Grains/ear and thousand-grain weight were found to be the critical determinants for yield in late-sown wheat. During the anthesis to grain filling period, flag-leaf chlorophyll degradation and increase in relative permeability in no-spray treatment were 34–36% and 29–52%, respectively, but these values were reduced considerably in CCB+A treatment followed CCA. Thus, foliar spray of 9.0 mM CaCl2 both at booting and anthesis stages may be recommended for alleviating the negative impacts of terminal heat stress in late-sown wheat and improving its productivity (>13%).
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.
The detection of a neutron star merger by the Advanced Laser Interferometer Gravitational-Wave Observatory and Advanced Virgo gravitational wave detectors, and the subsequent detection of an electromagnetic counterpart have opened a new era of transient astronomy. With upgrades to the Advanced Laser Interferometer Gravitational-Wave Observatory and Advanced Virgo detectors and new detectors coming online in Japan and India, neutron star mergers will be detected at a higher rate in the future, starting with the O3 observing run which will begin in early 2019. The detection of electromagnetic emission from these mergers provides vital information about merger parameters and allows independent measurement of the Hubble constant. The Australian Square Kilometre Array Pathfinder is expected to become fully operational in early 2019, and its 30 deg2 field of view will enable us to rapidly survey large areas of sky. In this work we explore prospects for detecting both prompt and long-term radio emission from neutron star mergers with Australian Square Kilometre Array Pathfinder and determine an observing strategy that optimises the use of telescope time. We investigate different strategies to tile the sky with telescope pointings in order to detect radio counterparts with limited observing time, using 475 simulated gravitational wave events. Our results show a significant improvement in observing efficiency when compared with a naïve strategy of covering the entire localisation above some confidence threshold, even when achieving the same total probability covered.
The problem of unsteady boundary layer flow of a nanofluid over a stretching surface is studied. Heat transfer due to melting is analyzed. Using a similarity transformation the governing coupled nonlinear partial differential equations of the model are reduced to a system of nonlinear ordinary differential equations, and then solved numerically by a Runge-Kutta method with a shooting technique. Dual solutions are observed numerically and their characteristics are analyzed. The effects of the pertinent parameters such as the acceleration parameter, the Brownian motion parameter, the thermophoresis parameter, the Prandtl number and the Lewis number on the velocity, temperature and concentration fields are discussed. Also the effects of these parameters on the skin friction coefficient, the Nusselt number and the Sherwood number are analyzed through graphs. It is observed that the melting phenomenon has a significant effect on the flow, heat and mass transfer characteristics.
Crystal structure analysis of a pyrazole carboxylic acid derivative, 5-(trifluoromethyl)-1-phenyl-1H-pyrazole-4-carboxylic acid (1) has been carried out from laboratory powder X-ray diffraction data. The crystal packing in the pyrazole carboxylic acid derivative exhibits an interplay of strong O–H…O, C–H…N and C–H…F hydrogen bonds to generate a three-dimensional molecular packing via the formation of R22(8) and R22(9) rings. Molecular electrostatic potential calculations indicated that carbonyl oxygen, pyrazole nitrogen and fluorine atoms to be the strongest acceptors. The relative contribution of different interactions to the Hirshfeld surface of pyrazole carboxylic acid and a few related structures retrieved from CSD indicates that H…H, N…H and O…H interactions can account for almost 70% of the Hirsfeld surface area in these compounds.
We report the synthesis and optical properties of pure ZnS and Ag doped ZnS nanostructures. ZnS(Ag) was synthesized by using the hydrothermal technique and later annealed at different temperatures under vacuum conditions. It was observed that the photoluminescence (PL) emission from the ZnS(Ag) nanostructures can be easily tuned from the blue (445 nm) to green (530 nm) region of visible light by varying the annealing temperature. This tunability has been attributed to the introduction of excess sulfur vacancy states, which is evident from the PL excitation spectra. This observed change in the PL emission wavelength can be highly beneficial in the imaging screens where ZnS is regularly used and can be easily interfaced with the silicon photodiodes showing maximum sensitivity at 550 nm.
Building on the recent advances in next-generation sequencing, the integration of genomics, proteomics, metabolomics, and other approaches hold tremendous promise for precision medicine. The approval and adoption of these rapidly advancing technologies and methods presents several regulatory science considerations that need to be addressed. To better understand and address these regulatory science issues, a Clinical and Translational Science Award Working Group convened the Regulatory Science to Advance Precision Medicine Forum. The Forum identified an initial set of regulatory science gaps. The final set of key findings and recommendations provided here address issues related to the lack of standardization of complex tests, preclinical issues, establishing clinical validity and utility, pharmacogenomics considerations, and knowledge gaps.
An electron acoustic super solitary wave has been derived using the Sagdeev pseudopotential technique for a four component magnetized plasma consisting of the beam and bulk fluid electrons and two ions with Maxwell Boltzmann distributions. This is the first theoretical report of a super solitary wave in a magnetized plasma which has no direct association with the singularity of the pseudopotential. It shows a narrow and spiky subwell near the low potential which causes the lateral inversion of the wiggle for the bipolar electric field vis-á-vis the unmagnetized plasma. An analytical formalism was developed to identify these novel kinds of super solitary waves and their transition processes have been characterized. It was observed that the super solitary wave is directly influenced by the singularity of the pseudopotential lying in the vicinity of the solution. The first ever prediction of the electron acoustic super solitary wave raises the possibility of its application to the interpretation of the satellite observations of the electrostatic field data.
BACKGROUND: Adult medulloblastomas account for less than 1% of adult neoplasms. They are challenging to treat due to their rarity and the heterogeneity of treatment options, all of which have limited evidence. In this retrospective review, we examined cases of adult medulloblastoma diagnosed in Alberta during a 70-year period. METHODS: We reviewed the charts of patients diagnosed with medulloblastoma between 1944 and 2014. We performed Cox and logistic regression analysis to elucidate features that may influence recurrence risk and survival. RESULTS: We found 86 and analyzed 78 cases. The median age at diagnosis was 27 (range 16 to 71). Most were male (68%). Most had surgery (92%). By COG risk stratification, 54% were standard risk while 21% were poor risk. RT was administered to 85% of patients, and craniospinal irradiation (CSI) to 81%. Chemotherapy was administered to 48%. Median survival was 4.4 years from diagnosis (range 0 to 20). At last follow-up, 39% were alive and recurrence-free. Patients who had CSI and posterior fossa boost had longer survival (p=0.047 and<0.01, respectively) and were less likely to recur (p=0.041 and<0.01). Chemotherapy was also associated with decreased recurrence (p=0.025). CONCLUSIONS: Medulloblastomas carry a significant recurrence risk, especially for patients who had subtotal resection. CSI and posterior fossa boost were associated with fewer recurrences and improved survival. COG risk stratification, Chang staging, desmoplastic histology, vermian location, 4th ventricle involvement, tumor enhancement, presence of hydrocephalus and cerebrospinal fluid (CSF) involvement are not significantly prognostic.