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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.
We present here the results from observations of pulsed gamma ray emission from the Crab and Vela pulsars for energies above 100 GeV using the atmospheric Cerenkov technique. The results suggest a very steep energy spectrum for gamma rays emitted from pulsars at high energies. Our observations over the last 4 years suggest also that the flux is highly variable with time.
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.
A comparison of the performance of aluminium (Al)-gated thin film transistors (TFTs) is presented in which we varied its sputter deposition conditions, such as deposition temperature, process pressure, and power. Gate films deposited at 30°C/5mTorr/300W yield TFT characteristics with low leakage current (~ 10 fA at low VDS), an ON/OFF ratio better than 108, and a mobility of 1.1 cm2/Vs. In contrast, films deposited at 150°C/10mTorr/400W, yield a significant degradation in leakage current (~ 1 pA) and mobility (0.77 cm2/Vs). The degradation stems from the high surface roughness of the a-SiNx:H gate insulator, and hence the TFT channel, caused by hillock formation on the Al gate. In addition, the high roughness leads to a correspondingly large shift in threshold voltage. After one-hour bias stress of +25 V applied to the gate, the shift in threshold voltage is ΔVT ~ 5 V, as compared to the small shift of ΔVT ~ 2.3 V associated with the smoother gate. Also included in our comparison is a TFT whose Al gate is now capped with 20 nm of molybdenum (Mo) to minimize propagation of the gate surface roughness to the active channel. Its cross sectional topography shows the interface smoothness to be as good or better, to yield improved leakage and stability characteristics.
NANOGLASS®E (NGE) ultra low-k (ULK) dielectric material, with a k-value of
∼2.2, was integrated for 130 nm Cu/ULK interconnect process technology. This
work deals with the characterization of reactive ion etching (RIE) and wet
chemical processing of this film. Blanket films were characterized for etch
rate, surface roughness, k-value change and chemical compatibility. Trench
etching and post etch wet clean processes were developed and optimized
enabling process integration for single damascene structures. Trench etch
processes were evaluated for two etch schemes viz., etching under - photo
resist and etching under hardmask. The details of each scheme will be
described and advantages observed will be discussed. To evaluate effect of
wet clean processes three different formulations were used. After formation
of single damascene wafers, metal comb and serpentine structures were
measured for metal continuity and bridging. Electrical continuity was
achieved for long serpentine structures with 0.18μm/0.18μm line
width/spacing. Based on voltage ramp test results the film was found to be
sensitive to certain plasma etch conditions.
Increase in modulus upon hydration in copolymers of desaminotyrosyl-tyrosine ethyl ester (DTE) and poly(ethylene glycol) (PEG) with iodinated tyrosines, poly(I2DTE-co-PEG carbonate)s, was investigated by varying the fraction and the molecular weight of the hydrophilic PEG component. Water, as expected, acts as plasticizer in polymer with PEG content < 15 wt% and > 30 wt%. But, water has the opposite effect in iodinated polymers with moderate PEG contents, between 15 to 20 wt%: it enhances the Young's modulus. The strength and modulus of hydrated poly(I2DTE-co-15%PEG2K carbonate)s increased by as much as fifteen fold upon hydration. While the decrease in the mechanical properties in most polymeric materials with diluents such water is due to the solvent-induced swelling, the increase in strength and modulus that is observed is most likely due to the reinforcing effect of the increased cross-linking efficiency of the hydrated PEG domains in the iodinated polymer.
Nickel aluminide intermetallic compounds are of interest due to their good high temperature properties. However, they are associated with room temperature brittleness. A method for enhancing the room temperature ductility of polycrystalline NiAI in the composition range of 62-65 at.% by using the martensitic transformation is presented. Transformationinduced ductilities up to 4.5% in specimens with coarse grains have been obtained in our investigation. The effects of Ni concentration, grain size and quenching rate from the parent B2 phase are studied and optimized to induce maximum transformation ductility. The original excellent high temperatu re properties are restored from the ‘soft’ room temperatu re martensitic phase by heating to an appropriate temperature to revert to the equilibrium phases.