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Shape-memory abnormalities are seen in some nitinol atrial septal occluders. Variably described as cobra-head, tulip, and others, their incidence, mechanisms, clinical impact, and outcome have not been systematically analysed.
We retrospectively reviewed all consecutive device closures in the last 6 years for deformations. Type and size of the occluder, deployment technique, size, and angulation/kinking of the delivery sheath were analysed. Procedural success, duration, and other complications were studied.
A total of 112 devices (11.8%) among 950 occluders used in 936 patients showed deformities. Fourteen of 936 received 2 devices. Deformities were transient and self-correcting in 40%. Multivariate analysis showed significant associations with oversized sheaths (p = 0.004), kinked/angulated sheaths (p < 0.001), special deployment techniques (p < 0.001), and twist in the device waist (p = 0.011). Despite more frequent deformities with Figulla (15.6%) and Amplatzer (13.9%) occluders than Cera occluders (6.6%) and larger devices (>24 mm – 14.6%) than smaller devices (less than or equal to 24 mm – 9.7%), they were not significant on multivariate analysis. In vivo manipulations corrected most deformities; nineteen needed in vitro reformations and four needed a change of device. Despite prolongation of the procedure, repeated attempts (mean 2.76 ± 1.7 attempts, with a range from 1 to 9 attempts), and supraventricular tachycardia in two patients, there were no serious adverse effects.
Deformations were frequent in 11.8% of atrial septal occluders on a targeted search. Oversized and angulated/kinked sheaths, special techniques like pulmonary vein deployment and twist in device waist during procedure predisposed to deformities. While most deformities were corrected with manipulations, removal of the device was infrequently needed and change of device was rarely required. Long procedural time and multiple attempts for deployment did not affect procedural success.
Leafy spurge (Euphorbia esula L.) is an invasive perennial weed infesting range and recreational lands of North America. Previous research and omics projects with E. esula have helped develop it as a model for studying many aspects of perennial plant development and response to abiotic stress. However, the lack of an assembled genome for E. esula has limited the power of previous transcriptomics studies to identify functional promoter elements and transcription factor binding sites. An assembled genome for E. esula would enhance our understanding of signaling processes controlling plant development and responses to environmental stress and provide a better understanding of genetic factors impacting weediness traits, evolution, and herbicide resistance. A comprehensive transcriptome database would also assist in analyzing future RNA-seq studies and is needed to annotate and assess genomic sequence assemblies. Here, we assembled and annotated 56,234 unigenes from an assembly of 589,235 RNA-seq-derived contigs and a previously published Sanger-sequenced expressed sequence tag collection. The resulting data indicate that we now have sequence for >90% of the expressed E. esula protein-coding genes. We also assembled the gene space of E. esula by using a limited coverage (18X) genomic sequence database. In this study, the programs Velvet and Trinity produced the best gene-space assemblies based on representation of expressed and conserved eukaryotic genes. The results indicate that E. esula contains as much as 23% repetitive sequences, of which 11% are unique. Our sequence data were also sufficient for assembling a full chloroplast and partial mitochondrial genome. Further, marker analysis identified more than 150,000 high-quality variants in our E. esula L-RNA–scaffolded, whole-genome, Trinity-assembled genome. Based on these results, E. esula appears to have limited heterozygosity. This study provides a blueprint for low-cost genomic assemblies in weed species and new resources for identifying conserved and novel promoter regions among coordinately expressed genes of E. esula.
The present study compared executive dysfunction among children with attention-deficit/hyperactivity disorder (ADHD) after traumatic brain injury (TBI), also called secondary ADHD (S-ADHD), pre-injury ADHD and children with TBI only (i.e., no ADHD). Youth aged 6–16 years admitted for TBI to five trauma centers were enrolled (n=177) and evaluated with a semi-structured psychiatric interview scheduled on three occasions (within 2 weeks of TBI, i.e., baseline assessment for pre-injury status; 6-months and 12-months post-TBI). This permitted the determination of 6- and 12-month post-injury classifications of membership in three mutually exclusive groups (S-ADHD; pre-injury ADHD; TBI-only). Several executive control measures were administered. Unremitted S-ADHD was present in 17/141 (12%) children at the 6-month assessment, and in 14/125 (11%) children at 12-months post-injury. The study found that children with S-ADHD exhibited deficient working memory, attention, and psychomotor speed as compared to children with pre-injury ADHD. Furthermore, the children with S-ADHD and the children with TBI-only were impaired compared to the children with pre-injury ADHD with regard to planning. No group differences related to response inhibition emerged. Age, but not injury severity, gender, or adaptive functioning was related to executive function outcome. Neuropsychological sequelae distinguish among children who develop S-ADHD following TBI and those with TBI only. Moreover, there appears to be a different pattern of executive control performance in those who develop S-ADHD than in children with pre-injury ADHD suggesting that differences exist in the underlying neural mechanisms that define each disorder, underscoring the need to identify targeted treatment interventions. (JINS, 2014, 20, 971–981)
A hand operated benchtop stamping press was developed to conduct research on microscale hole fabrication in polymer membranes for applications as scaffolds in tissue engineering. A biocompatible and biodegradable polymer, poly(ε-caprolactone), was selected for micropunching. Membranes between 30 μm and 50 μm thick were fabricated by hot melt extrusion, but could not be stamped with a 200 μm circular punch at room temperature, regardless of die clearance due to excessive strain to fracture. This problem was overcome by cooling the membrane and die sets with liquid nitrogen to take advantage of induced brittle behavior below the polymer’s glass transition temperature. While cooled, 203 μm hole patterns were successfully punched in 33 μm thick poly(ε-caprolactone) membranes with 11% die clearance, achieving 71% porosity.
To examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders.
Data were from the World Health Organization (WHO) World Mental Health (WMH) surveys. Representative household samples were interviewed face to face in 24 countries. Reasons to initiate and continue treatment were examined in a subsample (n = 636 78) and analyzed at different levels of clinical severity.
Among those with a DSM-IV disorder in the past 12 months, low perceived need was the most common reason for not initiating treatment and more common among moderate and mild than severe cases. Women and younger people with disorders were more likely to recognize a need for treatment. A desire to handle the problem on one's own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%). Attitudinal barriers were much more important than structural barriers to both initiating and continuing treatment. However, attitudinal barriers dominated for mild-moderate cases and structural barriers for severe cases. Perceived ineffectiveness of treatment was the most commonly reported reason for treatment drop-out (39.3%), followed by negative experiences with treatment providers (26.9% of respondents with severe disorders).
Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide.
In this global study we sought to estimate the degree to which a family member might feel embarrassed when a close relative is suffering from an alcohol, drug, or mental health condition (ADMC) versus a general medical condition (GMC). To date, most studies have considered embarrassment and stigma in society and internalized by the afflicted individual but have not assessed family embarrassment in a large-scale study.
In 16 sites of the World Mental Health Surveys (WMHS), standardized assessments were completed including items on family embarrassment. Site matching was used to constrain local socially shared determinants of stigma-related feelings, enabling a conditional logistic regression model that estimates the embarrassment close relatives may hold in relation to family members affected by an ADMC, a GMC, or both conditions.
There was a statistically robust association such that subgroups with an ADMC-affected relative were more likely to feel embarrassed compared to subgroups with a relative affected by a GMC (p < 0.001), even with covariate adjustments for age and sex.
The pattern of evidence from this research is consistent with conceptual models for interventions that target individual- and family-level stigma-related feelings of embarrassment as possible obstacles to effective early intervention and treatment for an ADMC. Macro-level interventions are under way but micro-level interventions may also be required among family members, along with care for each person with an ADMC.
The UBVRI photometric follow-up of SN 2011fu has been initiated a few days after the explosion, shows a rise followed by steep decay in all bands and shares properties very similar to that seen in case of SN 1993J, with a possible detection of the adiabatic cooling phase at very early epochs. The spectral modeling performed with SYNOW suggests that the early-phase line velocities for H and Fe ii features were ~ 16000 km s−1 and ~ 14000 km s−1, respectively. Studies of rare class of type IIb SNe are important to understand the evolution of the possible progenitors of core-collapse SNe in more details.
A retrospective case–case control study was conducted, including 60 cases with daptomycin-nonsusceptible vancomycin-resistant enterococci (DNS-VRE) matched to cases with daptomycin-susceptible VRE and to uninfected controls (1:1:3 ratio). Immunosuppression, presence of comorbid conditions, and prior exposure to antimicrobials were independent predictors of DNS-VRE, although prior daptomycin exposure occurred rarely. In summary, a case–case control study identified independent risk factors for the isolation of DNS-VRE: immunosuppression, multiple comorbid conditions, and prior exposures to cephalosporines and metronidazole.
Suicide is a leading cause of death worldwide; however, little
information is available about the treatment of suicidal people, or about
barriers to treatment.
To examine the receipt of mental health treatment and barriers to care
among suicidal people around the world.
Twenty-one nationally representative samples worldwide
(n=55 302; age 18 years and over) from the World
Health Organization's World Mental Health Surveys were interviewed
regarding past-year suicidal behaviour and past-year healthcare use.
Suicidal respondents who had not used services in the past year were
asked why they had not sought care.
Two-fifths of the suicidal respondents had received treatment (from 17%
in low-income countries to 56% in high-income countries), mostly from a
general medical practitioner (22%), psychiatrist (15%) or
non-psychiatrist (15%). Those who had actually attempted suicide were
more likely to receive care. Low perceived need was the most important
reason for not seeking help (58%), followed by attitudinal barriers such
as the wish to handle the problem alone (40%) and structural barriers
such as financial concerns (15%). Only 7% of respondents endorsed stigma
as a reason for not seeking treatment.
Most people with suicide ideation, plans and attempts receive no
treatment. This is a consistent and pervasive finding, especially in
low-income countries. Improving the receipt of treatment worldwide will
have to take into account culture-specific factors that may influence the
process of help-seeking.
Although Injury is being looked into as a major public health problem in India, most of the data coming is mortality related data from the National Crime Records Bureau and projections based on that data. There is complete absence if injury related data both surveillance data as well as outcome based data. Apex Trauma Center, All India Institute of Medical Sciences, New Delhi is one of the pioneering centers to understand the need to record the injury related data of all trauma cases which are admitted to the Apex Center, thus establishing a first of its kind hospital based Trauma Registry in India. This trauma registry will serve as a means for collating trauma data that will further help in the evaluation, prevention, and research of trauma care and can be used for quality control and planning future research and injury prevention activities, in India. Later, the center has an objective of networking all regional hospitals for data collection with an aim to establish a National Trauma Registry. Although several trauma registry software's exist from Western hemisphere but the Apex Trauma Center decided to formulate and designed its own Trauma Registry form and develop the related software which includes: Basic Identification; Demographic profile; Brought by personnel and vehicle; Condition at time of arrival; ED Interventions; Detailed Diagnosis; Definitive Procedures; Disposition/ Outcome The Trauma registry is being maintained, under the leadership of a Faculty and the data is collected and entered by the Trauma Nurse Coordinators, who follow the patient from admission to discharge. The data collection for the JPNATC Trauma Registry had started w.e.f. April 2009, but initially there were usual problems of data loss and non-availability of data. This has been overcome gradually and we hope that the registry will attain its full potential in another year or so.
There is an upward trend in facial injuries following changes in population pattern, increasing industrialization and urbanization, hence maxillofacial trauma is becoming a burden and a leading medical problem in emergency rooms worldwide.
A retrospective study of patients with maxillofacial fractures seen and treated at the Jai Parkash Narayan Apex Trauma Center, AIIMS, New Delhi, India between January 2007 to June 2010. Data extracted from the patients' records include aetiology, age, sex, types and sites of fractures, treatment modality and concomitant injuries.
There were 795 fractures of the maxillofacial skeleton and 86 concomitant injuries from 542 patients. Road traffic accident (56.8%) was the most common aetiologic factor, followed by falls (22.3%) and fights (18.5%). The age range was from 3 years to 75 years (mean = 34.7) with a peak incidence in the 3rd decade with a male–female sex ratio of 3.7:1. The most common location of maxillofacial fractures was the mandible 615(77%) and middle third 205(23%). With regards to mandibular fractures, the body (29.6%) was the commonest sites, followed by the angle (24.4%), ramus (19.5%), dentoalveolar (14.6%), symphysis (11.0%), condyle (0.8%) while in the middle third, the nasal bone (36.7%) was the most common, followed by zygomatic bone (27.8), Lefort II (14.4), Lefort I (7.8%), dentoalveolar (10.0%) and Lefort III (3.3%). Majority of the patients were treated by Open reduction and internal fixation (70.6). Concomitant injuries were 10.8% with orthopaedic injuries accounting for the majority (63.9%). Head injury was associated with 16.3 % of cases.
Maxillofacial fractures are on the increase. We advocate the establishment of regionalized trauma centers with basic training available to all surgical residents for initial emergency room management.
Gyps vulture populations across the Indian subcontinent collapsed in the 1990s and continue to decline. Repeated population surveys showed that the rate of decline was so rapid that elevated mortality of adult birds must be a key demographic mechanism. Post mortem examination showed that the majority of dead vultures had visceral gout, due to kidney damage. The realisation that diclofenac, a non-steroidal anti-inflammatory drug potentially nephrotoxic to birds, had become a widely used veterinary medicine led to the identification of diclofenac poisoning as the cause of the decline. Surveys of diclofenac contamination of domestic ungulate carcasses, combined with vulture population modelling, show that the level of contamination is sufficient for it to be the sole cause of the decline. Testing on vultures of meloxicam, an alternative NSAID for livestock treatment, showed that it did not harm them at concentrations likely to be encountered by wild birds and would be a safe replacement for diclofenac. The manufacture of diclofenac for veterinary use has been banned, but its sale has not. Consequently, it may be some years before diclofenac is removed from the vultures' food supply. In the meantime, captive populations of three vulture species have been established to provide sources of birds for future reintroduction programmes.
We have carried out a multi-wavelength study of the star forming region NGC 1893 to make a comprehensive exploration of the effects of massive stars on low mass star formation. Using deep optical U BV RI broad band, Hα narrow band photometry and slit-less spectroscopy along with archival data from the surveys such as 2MASS, MSX, IRAS and NVSS, we have studied the region to understand the star formation scenario in the region.
GaN films have been grown homoepitaxially by MOCVD on MBE-grown GaN template layers, using both porous and nonporous SiC substrates. The effect of the porous SiC substrates on dislocations in the MBE and MOCVD GaN layers has been studied using TEM and x-ray characterization. A reduction in dislocation density from ≥1×1010 cm-2 in the MBE template to 2.5×109 cm-2 at the top of the MOCVD film is found, with similar final values in the MOCVD films for both porous and nonporous substrates. We discuss various mechanisms by which dislocation density is reduced in the MOCVD layers.
We have explored the growth of GaN on porous SiC substrates by plasma-assisted molecular beam epitaxy. The porous 4H- and 6H-SiC(0001) substrates used in this study contain 10 to 100-nm sized pores and a thin skin layer at the surface. This skin layer was partially removed prior to the growth by H-etching. Transmission electron microscopy (TEM) observations indicate that the epitaxial GaN growth initiates from the surface areas between pores, and the exposed surface pores tend to extend into GaN as open tubes and trap Ga droplets. Plan-view TEM observations indicate that the GaN layers grown on porous substrates contain fewer dislocations than layers grown on non-porous substrates by roughly a factor of two. The GaN layers grown on a porous SiC substrate were also found to be mechanically more relaxed than those grown on non-porous substrates; electron diffraction patterns indicate that the former are free of misfit strain or are even in tension after cooling to room temperature.