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Child labourers are at risk of poorer mental health and once rescued require urgent mental health interventions to ameliorate the long-term impact. In our review, only two published scientific studies evaluated custom-made interventions; other programmes were obtained from non-governmental organisations (NGOs), which need rigorous trial evaluation. We also sought the viewpoints of stakeholders working directly with rescued young people, as well as consulting young people with lived experiences of child labour. We propose that psychoeducational interventions aimed at employees working directly with young people could represent a fruitful approach for low- and middle-income countries in the Asia-Pacific region but also more generally.
Fall armyworm, Spodoptera frugiperda (J. E. Smith) is a polyphagous and highly destructive invasive insect pest of many crops. It was recently introduced into India and widely reported in almost all parts of India. Development of a temperature-based phenology model for predicting its rate of development and distribution will help in understanding the establishment and further spread of introduced invasive insect pests. Development, survival and reproduction parameters of S. frugiperda at six constant temperature conditions (15, 20, 25, 27, 30 and 35°C) were investigated and further validated with data generated under fluctuating temperature conditions. The estimated lower developmental threshold temperatures were 12.1°C for eggs, 11°C for larvae, 12.2°C for pupae, 15.13°C for males and 12.66°C for females. Degree-day (DD) requirements for the development of the different stages of S. frugiperda were 50, 250 and 200 DD for egg, larva and pupa, respectively. The best-fitted functions were compiled for each life stage to yield a phenology model, which was stochastically simulated to estimate the life table parameters. The developed phenology model predicted temperature ranges between 27 and 30°C as favourable for S. frugiperda development, survival and reproduction. The results revealed that maximum net reproductive rate (215.66 females/female/generation) and total fecundity (981.08 individuals/female/generation) were attained at 30°C constant temperature. The mean length of generations decreased from 74.29 days at 15°C to 38.74 days at 30°C. The maximum intrinsic rate of increase (0.138 females/female/day) and shortest doubling time (4.9 days) were also observed at 30°C. Results of simulated life table parameters showed high temperature-dependent development of S. frugiperda and complete development within all the tested constant temperature ranges (15–35°C). Simulated life table parameters for predicting risk indices of S. frugiperda in India indicated a significant increase in activity indices and establishment risk indices with a higher number of generations during future (2050 and 2070) climatic change scenarios compared to present conditions. Our results indicate that India will be highly suitable for the establishment and survival of S. frugiperda in future time periods.
We performed secondary analyses of a postdischarge decolonization trial of MRSA carriers that reduced MRSA infection and hospitalization by 30%. Hospitalized MRSA infection was associated with 7.9 days of non-MRSA antibiotics and CDI in 3.9%. Preventing MRSA infection and associated hospitalization may reduce antibiotic use and CDI incidence.
ABSTRACT IMPACT: This change will improve primary care physicians and pediatrics ability to identify, intervene and prevent obesity related renal damage in the vulnerable population of young adults OBJECTIVES/GOALS: Obesity related glomerulopathy has a reversible stage manifested as hyperfiltration. Early intervention depends on the ability to identify hyperfiltration. Hyperfiltration prevalence is underestimated using the currently recommended formula We investigated whether calculating BSA-adjusted GFR will more readily identify hyperfiltration. METHODS/STUDY POPULATION: We extracted data from a large urban, multi-institutional Electronic Health Records (EHR) clinical data research network to construct an EHR data base of 60,549 women and girls ages 12-21 years from the New York metropolitan area. EGFR was calculated in two ways, 1) according to age appropriate formula, and 2) according to age appropriate formula and adjusted to body surface area (BSA). BMI-for-age values were classified according to the World Health Organization schema and grouped according to the CDC definitions. BSA was calculated according to the Du-Bois formula. Hyperfiltration was defined by a threshold of 135ml/min. The Bland Altman method assessed the agreement between formulas across the different BMI groups. RESULTS/ANTICIPATED RESULTS: Serum creatinine values were similar across different BMI groups. Comparing eGFR values, hyperfiltration rates were similar across BMI groups, ranging between 4%-6.6%. BSA-adjusted GFR was different across BMI groups: hyperfiltration rates were 0.81% for the underweight group, 2.56% for the normal weight, 12.18% for the overweight and 39% in the obese group. This trend of hyperfiltration paralleled the the rise in urine creatinine across BMI groups. DISCUSSION/SIGNIFICANCE OF FINDINGS: BSA-adjusted GFR more sensitively detects hyperfiltration due to obesity than does eGFR. Calculating BSA-adjusted GFR will improve primary care and pediatric physicians’ ability to identify, intervene and prevent early ORG. Changes in body composition may account for the increasing discordance between BSA-adjusted and eGFR as BMI rises.
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for the largest number of invasive infections due to a multidrug-resistant pathogen. Approximately 10% of hospitalized carriers will experience invasive MRSA disease in the year following discharge incurring antibiotic therapy beyond focused treatment of MRSA. Objective: We aimed to quantify the extent of non-MRSA empiric antibiotics incurred by MRSA infections and further assess the risk of Clostridioides difficile Infection (CDI) as a result of treatment of MRSA infection. Methods: The CLEAR Trial was a postdischarge randomized controlled trial of 2,121 MRSA carriers comparing MRSA education alone to education plus repeated decolonization that demonstrated a 30% reduction in MRSA infection and a 17% reduction in all-cause infection attributable to decolonization in the year following hospital discharge (Huang SS, NEJM 2019). We included all hospitalization outcomes due to MRSA infection in the CLEAR Trial with detailed medication administration records to quantify unintended consequences of MRSA infection related to empiric non-MRSA antibiotic use and resultant CDI. Full-text medical records were reviewed with a standardized abstraction form to collect inpatient administered antibiotics and hospital-associated CDI. Results: In total,154 hospitalizations due to MRSA infection with a mean length-of-stay of 10.6 days were identified. During 25 hospitalizations (16.2%), patients received only anti-MRSA antibiotics. During the remaining 129 (83.8%) hospitalizations, patients received a mean of 1.6 distinct non-MRSA antibiotics totaling a mean of 6.6 days of therapy (DOT). Empiric non-MRSA therapy was given for 3.2 DOT before MRSA culture results became available and was continued for an additional 3.4 DOT afterward. Among all 849 non-MRSA DOT, the most common were due to piperacillin-tazobactam (293 DOT, 34.5%), levofloxacin (105 DOT, 12.4%), and metronidazole (93 DOT, 11.0%). Across all 154 hospitalizations, a mean of 5.5 non-MRSA DOT was calculated per MRSA hospitalization, with 6 CDI cases (3.9%) as a direct sequelae of empiric non-MRSA antibiotics provided for MRSA infection. Conclusions: Hospitalization for MRSA infection results in extensive non-MRSA empiric antibiotic therapy both before and after MRSA culture results are known. This antibiotic use is associated with a 3.9% risk of CDI that exceeds the national risk of acquiring CDI (3.2 per 1,000 admissions) by 12-fold during any hospital stay (Barrett ML, AHRQ 2018). The CLEAR Trial findings that postdischarge decolonization reduces MRSA infection and hospitalization by 30% suggests that decolonization may also reduce non-MRSA antibiotic use and CDI in this population.
Originating in China in December 2019, coronavirus disease 2019 (COVID-19) rapidly spread to more than 216 countries in the world by May 2020. Because dentists are at a higher risk of contracting the disease, the present study assessed the fear and anxiety among dental practitioners of becoming infected with COVID-19.
An online cross-sectional questionnaire survey comprising of 9 questions was conducted among dental practitioners of Telangana. Age, gender, qualification, type of practice, years of practice, and place of residence were the demographic variables recorded. The response to each question was recorded in a YES or NO format, and mean fear score was calculated to categorize answers into low and high levels of fear. Comparison of mean fear score was done using t-test for 2 variables and analysis of variance for 3 or more than 3 variables. Multiple logistic regression analysis of the levels of fear with demographic variables was done. P < 0.05 was considered statistically significant.
The mean fear and anxiety score of this study population reported was high 6.57 ± 2.07, with 58.31% of the population presenting with a low level of fear and anxiety. Only qualification (P = 0.045) and gender (P = 0.035) revealed a significant difference in fear to Q7and Q8, respectively. Irrespective of the age, gender, qualification, type of practice, and years in practice, the levels of fear reported in the present study were very similar. Respondents between 41 and 60 y of age (6.70 ± 2.01 y) and those with individual practices (6.70 ± 2.06 y) exhibited high fear scores.
The present study demonstrates cross-sectional data of fear and anxiety among dental practitioners during the COVID-19 outbreak. Heightened levels of fear observed in this study call for a nationwide analysis of fear among dentists and deliberate management strategies for the same.
The term endophenotype was first used by Gottesman to describe a trait that may be intermediate on the chain of causality from genes to diseases. An endophenotype may be neuropathological, neurocognitive, emotional, neuro-physiological or neurobiological in nature. There is dearth of studies about the use of neurocognive dysfunction as endophenotype marker of BPAD, particularly from developing countries.
Aim and Hypothesis-
We aimed to evaluate neurocognitive dysfunctions as endophenotype markers of bipolar affective disorder (BPAD) in first degree relative of BPAD patients. We hypothesized that first degree relative of BPAD patients differ significantly in regard to neurocognitive dysfunction from matched controls.
A cross sectional study was carried out. Sample was drawn from first degree relatives (FDR) of patients of BPAD and controls. After assessment of neurocognitive function first degree relatives of BPAD were compared with controls on measures of attention, verbal working memory, auditory verbal memory, Visuo spatial working memory, visual attention and executive functions.
Results indicated that, first degree relatives of BPAD scored poorly on measures of neurocognition then controls. On conducting comparison over composite neurocognitive score 'we found that cognitive index in combination better discriminate the first degree relatives of BPAD from controls.
Neurocognitive dysfunction on measures of attention, verbal episodic memory, auditory verbal working memory, visuospatial working memory and executive functions significantly differentiated first degree relatives of BPAD patients from controls.
The aim of study was to evaluate the pharmacotherapeutic efficacy of NDGA in experimental paradigm of depression i.e. olfactory bulbectomy (OB) specifically targeting kynurenine pathway.
Materials and method
Depression like behaviours was induced in OB mice and evaluated by assessment of various behavioural (olfactory deficit test, forced swim test, splash test, open field test, sucrose preference test), biochemical (catalase, reduced glutathione, SOD, nitrite, MAO-A, MDA, corticosterone), inflammatory cytokines (TNF- α, IL-1β, IL-6, IFN-γ) levels and alterations in delta sleep was recorded using EEG. Kynurenine pathway metabolites were determined in plasma and brain using HPLC method. After 14 days post-surgery, olfactory bulbectomized (OBX) mice were administered nordihydroguaiaretic acid (5 mg/kg, 10 mg/kg and 25 mg/kg) daily i.p.
We have developed a new HPLC method for simultaneous estimation of monoamines and kynurenine pathway metabolites in plasma and brain samples of mice. Chronic treatment with nordihydroguaiaretic acid significantly restored all behavioural, biochemical and neurochemical alterations in OBX mice and increase in quinolinic acid and decrease in kynurenic acid point out the neurodegeneration hypothesis of depression.
Nordihydroguaiaretic acid showed potent neuropharmacotherapeutic effect in OBX mice by virtue of its strong anti-oxidant, anti-inflammatory, anti-stress and by restoring quinolinic acid levels.
In this paper, a high gain wideband circularly polarized (CP) microstrip antenna is presented for broadband operation. The proposed structure comprised of a partially grounded printed monopole antenna loaded with a split ring resonator and a metallic reflector. By using the metallic reflector surface underneath the patch radiator results in the reflected waves in the same phase with main lobe radiation, thereby improving the gain and it also acts like a secondary radiator to generate wideband CP behavior in the proposed design. A gain enhancement of 4.3 dBi is achieved in the operating frequency band as compared with the design without a metallic reflector. The maximum gain achieved in the presented method is 8.6 dBic over the entire operating range. The proposed design shows a wideband behavior ranging from 4.30 to 9.10 GHz with the 10-dB impedance bandwidth of 71.64%. In addition, the proposed design yielded a broadside right hand CP radiation with a 3-dB axial ratio bandwidth of 33.88% from 4.98 to 7.01 GHz. The proposed antenna is fabricated and experimental results on reflection coefficient, gain, axial ratio, and radiation patterns concede well with simulation results.
A single-centre, single-blinded prospective experimental study was conducted to determine the effectiveness of autologous platelet-rich plasma applied to the tonsillar bed post-operatively in reducing post-operative pain and haemorrhage.
Platelet-rich plasma, prepared prior to surgery, was applied with calcium gluconate to one randomly chosen tonsillar fossa. Pain and haemorrhage were analysed, using a visual analogue scale and a pre-defined grading scale respectively, four times on the day of surgery at 2-hourly intervals, and thrice on the following day.
The pain score and haemorrhage grade on the test side were lower than on the control side. These findings were statistically significant.
This pilot study, conducted in India, revealed valid positive results for a promising new technology. The manual preparation of platelet-rich plasma could be automated in the future to allow a larger sample size.
A cross-sectional study was conducted from 2014 to 2017 in 13 organised pig farms located in eight states of India (Northern, North-Eastern and Southern regions) to identify the risk factors, pathotype and antimicrobial resistance of Escherichia coli associated with pre- and post-weaning piglet diarrhoea. The data collected through questionnaire survey were used to identify the risk factors by univariable analysis, in which weaning status, season, altitude, ventilation in the shed, use of heater/cooler for temperature control in the sheds, feed type, water source, and use of disinfectant, were the potential risk factors. In logistic regression model, weaning and source of water were the significant risk factors. The piglet diarrhoea prevalence was almost similar across the regions. Of the 909 faecal samples collected (North – 310, North-East – 194 and South – 405) for isolation of E. coli, pathotyping and antibiotic screening, 531 E. coli were isolated in MacConkey agar added with cefotaxime, where 345 isolates were extended spectrum β-lactamase (ESBL) producers and were positive for blaCTX-M-1 (n = 147), bla TEM (n = 151), qnrA (n = 98), qnrB (n = 116), qnrS (n = 53), tetA (n = 46), tetB (n = 48) and sul1 (n = 54) genes. Multiple antibiotic resistance (MAR) index revealed that 14 (2.64%) isolates had MAR index of 1. On the virulence screening of E. coli, 174 isolates harboured alone or combination of Stx1, Stx2, eaeA, hlyA genes. The isolates from diarrhoeic and post-weaning samples harboured higher number of virulence genes than non-diarrhoeic and pre-weaning. Alleviating the risk factors might reduce the piglet diarrhoea cases. The presence of multidrug-resistant and ESBL-producing pathogenic E. coli in piglets appears a public health concern.
Use of whole wheat, along with compounded feeds, for poultry feeding is a common practice in many parts of the world. However, studies investigating the use of other grains are limited. In the present study, the influence of including whole maize, with differing hardness, in broiler diets on the performance, nutrient utilisation and digestive tract development was examined. The experimental design was a 3 × 2 factorial arrangement of treatments, evaluating maize hardness (hard, semi-hard or soft) with diets based on ground maize or 115 g/kg whole maize replacing ground maize. The three maize cultivars were ground in a hammer mill to pass through a 4 mm sieve and six diets were developed based on one of the three cultivars. Following mixing, all diets were cold pelleted through a 3 mm die. Each of the six diets was fed to six replicate cages (eight birds per cage) from day 1 to 21 post-hatch. Maize hardness and whole maize inclusion had no effect (P>0.05) on weight gain. Maize hardness influenced (P<0.05) feed intake and feed per gain, while these two parameters were unaffected (P>0.05) by the inclusion of whole maize. The apparent metabolisable energy (AME) was unaffected (P>0.05) by maize hardness and whole maize inclusion. Maize hardness increased the ileal digestibility of nitrogen (P<0.05) and starch (P=0.06). The relative weight of the gizzard was greater (P<0.05) in birds fed hard and semi-hard maize compared to soft maize, and was greater (P<0.05) when whole maize was included. These results indicated that 115 g/kg of ground maize can be replaced by whole maize in broiler starter diets with no adverse effects on growth performance and thus can reduce the cost of feed manufacture.
Introduction: The GridlockED game is a serious game aimed at teaching junior learners about flow and organization in the emergency department(ED). With serious games, the mechanism of learning is thought to be via the gameplay experience. Objectives built into gameplay are aimed at teaching players about a specific concept; in this case, we hoped to teach players about interprofessional collaboration and basic mechanics that drive flow in the ED. However, before a player can be taught, he or she must be engaged and have a positive gameplay experience. From the GridlockED gameplay, we aim to explore how a players gameplay experience related to observed actions while playing the game, including participating in decision making and keeping the team organized. Methods: From April-August 2017, participants were invited to play 4 turns of a GridlockED game session. They were video recorded during gameplay. After playing the game, they were surveyed using the previously derived Game Experience Questionnaire (GEQ) to measure their gameplay experience. The videos were reviewed by two research team members (SH, EJ), tallying various observed game actions. We conducted Pearson correlation between players GEQ total score and their observed actions. Results: A total of 32 participants (13 attendings, 5 senior residents, 10 junior residents, and 4 nurses) played the game. The average total GEQ was 67.2/132 (SD=10.7), suggesting most players had a moderately good gameplay experience. The total GEQ score correlated with component subscores within the questionnaire. Overall observed activity correlated well with each observed action subtype. However, the GEQ total score did not correlate significantly with the total observed action (Pearsons r=0.18,p=0.32). GEQ total score was found to be moderately correlated to an observation that a player participated in determining strategy during gameplay (r=0.36,p=0.04). There was a moderate negative correlation between determining strategy during gameplay and teaching about the game (r=-0.37,p=0.04) or emergency medicine concepts (r=-0.47,p<0.01). Conclusion: The GEQ is internally consistent, but does not have a strong relationship to observed actions, suggesting that game experience does not necessarily correlate with observable actions. This suggests that players may be intellectually stimulated or engaged without necessarily completing any observable actions during gameplay.
Background: Insular cortex involvement as a part of epileptogenic zone is often suspected in the context of operculo-insular semiology and can be confirmed by routine interrogation of the insula with stereo-electroencephalography (SEEG). However the safety and efficacy of insular resections remains unclear. Methods: We reviewed all the patients who underwent insular resection for drug-resistant epilepsy, from 2002 – 2016, in the Calgary Epilepsy Program. Details of the comprehensive pre-surgical evaluation, surgery performed, complications and seizure outcome at the latest follow-up were collected. Results: Fifteen patients (8 males, 7 females) with age range 3 – 41 years were identified. MRI was normal in 9 patients. The decision to resect the Insula was made based on clinical semiology and structural and functional imaging in 6 patients and on SEEG findings in 9 patients. Insular resection was total in 11 and partial in 4 patients. Four (26%) patients had transient hemiparesis and 1 patient had permanent mild upper extremity weakness following total resection. After a mean follow-up period of 45.6 months (range 2 – 150 months), 40% of the patients are seizure free. Conclusions: Insular cortex resections for drug resistant epilepsy can be performed safely and may contribute to additional effectiveness in seizure outcomes in patients with challenging extra-temporal epilepsy.
Background: Exploration of the insular cortex is now commonly considered in patients with refractory epilepsy requiring invasive EEG investigations. The safety and yield of routine insular exploration is uncertain. Methods: All patients (pediatric and adult) who had invasive EEG (iEEG) with insular depth electrode placement, either through SEEG or open implantation, were reviewed. Ictal insular involvement was characterized as primary, secondary or not involved. Results of insular resections were recorded. Results: A total of 173 patients had iEEG of which 26 included insular electrodes (SEEG-18, Open - 8). No complications of placement were identified. Insular involvement was seen in 20 (76%) patients. Primary ictal involvement was identified in 9 (33 %) patients, while secondary spread was noted in 11 (42 %) patients. Six patients went on to have resections including the insular cortex of which 5 patients achieved good seizure control (Engle class I/II). Conclusions: Insular depth electrode placement is a safe and effective adjunct to invasive EEG investigations. Ictal involvement of the insular cortex was commonly identified in our series leading to inclusion of the insula in cortical resections with good seizure control, which may not have been considered without iEEG evidence.
The surfaces of inorganic substrates containing hydroxyl groups can be adapted to a variety of physical and chemical requirements by reaction with cyclic azasilanes. The moderately-strained ring structure of cyclic azasilanes containing adjacent Si and N atoms, along with the high oxophilicity of silicon, enables the high reactivity towards available hydroxyl groups on all siliceous surfaces investigated, including amorphous silica and borosilicate glass. The reaction occurs quantitatively at room temperature, requires no catalyst and has no byproducts. This investigation looks specifically at the reaction kinetics by means of DRIFT spectroscopy and quantifies extent of reaction by TGA. The less sterically-hindered the Si–N bond, the faster the reaction occurs. In all cases, the reaction is essentially complete in less than one minute. This study provides the first confirmation that the rate and extent of reaction without catalysis or byproducts of cyclic azasilanes conforms to the Sharpless requirements for “click chemistry” and can be deemed “click chemistry for surfaces.”
We have demonstrated that pulsed laser deposition (PLD) conditions, i.e. O2 partial pressure (pO2) and temperature (T), enable control over the polarity of resistance switching in PCMO (Pr0.7C0.3MnO3) i.e. unipolar resistive switching (URS) vs. bipolar resistive switching (BRS). We observe by detailed physical characterization that BRS occurs in poly-crystalline thin films while URS is seen in amorphous films – indicating the materials origin of URS vis-a-vis BRS. BRS shows attractive lower voltage operation, no forming and lower variability than URS.