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Hypnic Headache are is a very rare primary headaches that affect the elderly, with an average age of 60 years. Research in the areas of neurophysiology and treatment options for Hypnic Headache are necessary in order to better understand, and improve outcomes for this rare headache disorder.
Mr. X is a 70-year-old patient, has been presenting with the complaints of headache during sleep at night for the last 1 year. The Headache started after 3 to 4 hours after falling asleep. Due to headache, he wakes up from sleep around 03:00 to 04:00 am almost every night and his headache persist for 30 to 40 minutes. After waking up from sleep he keeps himself busy with religious activity and the headache gradually resolves. He then goes back to bed again.
Mr. X also informed that, the headache is dull in nature and located in left temporo occipital region. It is not associated with photophobia, phonophobia, nausea, vomiting, tearing or discomfort in the leg. He gives no history of early morning headache or day time headache, sleep disorder, snoring or sleep apnea. He has no past history of trauma to the head, fainting attack, unconsciousness, weakness or paralysis of limbs, seizures or non-epileptic seizures. He is an non-smoker, non-alcoholic, non-hypertensive & non-diabetic person.
On general examination, his heart rate is 70 beats/min, blood pressure 138/68 mm of Hg. There are no anemia, jaundice or oedema present in him. His both lung fields are clear. On neurological examinations there are nothing abnormality detected. His Serological investigations, CBC (Complete Blood Count) FBS (Fasting Blood Glucose), lipid profile are within normal limit. CT scan of the brain is normal. There are no cerebral atrophy or volume loss compatible with age.
Mr. X was treated by several general practitioners with paracetamol, diclofenac sodium, mefenamic acid, tramadol hydrochloride. He used these drugs either singly or in combinations. But with this treatment there were no significant improvement occurs. Mr. X is scared and depressed for his sleep time headache.
Hypnic headache is a very rare headache disorder. It occurs in age groups over 60 years. It is occur at night during in sleep and waking the patient up, hence the name of it “alarm clock headache”. It is commonly unilateral and lasts for 15 minutes to 4 hours. Hypnic headache commonly dull or throbbing in character and does not make the patient restless, unlike in Cluster Headache. After waking up from sleep, most patients engage in some activity. Hypnic headache is not associated with rhinorrhea, tearing and ptosis. Diagnosis is mainly clinical. Secondary causes headache must be excluded. International Classification of Headache Disorders 3rd Edition (ICHD-3)-beta provides diagnostic criteria for hypnic headache. Pathophysiology of hypnic headache is not clearly identified. Usual treatment options of Hypnic headache includes bed time coffee, lithium carbonate, indomethacin. Our patient fulfil all the criteria of Hypnic headache and he fells improvement with Indomethacin 50 mg in devided doses.
Hypnic Headache is a very rare type of primary headache. It should be diagnosed only after other secondary causes of headache have been excluded. Caffeine, lithium carbonate, flunarizine, indomethacin, used to treat the patient of Hypnic Headache. Lack of study and awareness about these disorders can lead to delays in diagnosis and treatment. Clinical trials are needed to find out proper treatment, but it will be difficult to perform because of the rareness of this disorder.
Evidence shows that research-active trusts have better clinical patient outcomes. Psychiatric trainees are required to develop knowledge and skills in research techniques and critical appraisal to enable them to practice evidence-based medicine and be research-active clinicians. This project aimed to evaluate and improve the support for developing research competencies available to general adult psychiatry higher trainees (HT) in the North-West of England.
General Adult HT in the North–West of England completed a baseline survey in November 2019 to ascertain trainee's experience of research training provision. The following interventions were implemented to address this feedback:
A trainee research handbook was produced, containing exemplar activies for developing research competencies and available training opportunities, supervisors and active research studies.
The trainee research representative circulated research and training opportunities between November 2019 – August 2020.
Research representatives held a trainee Question and Answer session in September 2020.
All General Adult HT were asked to complete an electronic survey in November 2020 to evaluate the effect of these interventions.
18 General Adult HT completed the baseline survey in November 2019. 29.4% of trainees thought they received enough information on research competencies and 88.9% wanted more written guidance. 38.9% of trainees knew who to contact about research within their NHS Trust and 33.3% were aware of current research studies. Identified challenges for meeting research competencies included lack of time, difficulty identifying a mentor and topic and accessibility of projects.
20 General Adult HT completed the repeat survey in November 2020. 50% of trainees wanted to be actively involved in research and 35% wanted to develop evidence-based medicine skills. A minority of trainees aimed to complete only the minimum ARCP requirements. All trainees thought the handbook was a useful resource for meeting research competencies and would recommend it to other trainees. In trainees who received the handbook, 94.7% thought they had received adequate support on meeting research competencies and 94.7% knew who to contact about research in their trust. 68.4% of trainees would like further written guidance on meeting research competencies. Trainees highlighted ongoing practical difficulties with engaging with research and concern about lacking required skills for research.
Trainees are motivated to engage with research on various different levels, not purely for ARCP purposes. Simple interventions can help trainees feel adequately supported with meeting research competencies. Further work to support trainee involvement in research and improve trainee confidence in engaging with research is required.
In the UK, people with severe mental illness at a greater risk of poor physical health and have higher premature mortality than the general population, highlighting the importance of responding to physical health problems among patients suffering from psychiatric conditions. However, training for staff on inpatient psychiatric units to meet patients’ physical health needs is sometimes overlooked and has not always been effective.
According to NICE Clinical Guideline 25 (2005) and NPSA Rapid Response Report (2008/RRR010), staff on any psychiatric inpatient setting must be capable of monitoring, measurement, and interpretation of vital signs. They must have both adequate information and skills to identify signs indicating worsening of patients’ health and respond effectively to severely ill patients.
Hence, we aim to re-audit the results of a similar audit carried out in 2016 to review the level of medical emergency training (in terms of life support training) of clinical staff across the inpatient psychiatric wards at our local hospital - Stepping Hill Hospital- in Stockport.
Our hypothesis is that there will be a gap in meeting the required standards for training.
A questionnaire including 6 questions (role of the staff member, level of their life support training, when was their training last updated, whether they know the location of the crash trolley, whether they know the local hospital emergency number and whether they should resuscitate the patient if their training is out of date) was given to staff on acute inpatient psychiatric units in Stepping Hill Hospital.
The sample included 49 staff members from all the 3 wards included in the audit. The level of training of nursing staff on the 3 wards was meeting standards except for nursing staff who were new to the wards or coming back to work from prolonged leaves. There was also a gap identified in the level of training of other staff members on the ward as well as on the remaining standards measured by the audit.
A gap was identified in meeting the required standards of training on the inpatient psychiatric units. Reasons identified for this gap are mainly due to the fact that new or bank staff are asked to cover the wards without providing them with appropriate training and without orientating them about the location of different equipments and policies on the ward.
Little is known about mental health risk factors in medical residents and doctors in Sub-Saharan Africa. Residents are at a greater risk of developing depression, stress and substance abuse than the general public owing to the stressful nature of their medical training. Poor mental health in residents leads to decreased clinical efficiency and training satisfaction; it can also lead to substance dependence, self-harm and suicide.Our primary aim was to ascertain depression prevalence among medical residents in Kenya's largest national teaching and referral hospital. Secondary aims were to analyze how depression was associated with perceived stress, perceived social support, substance use, and educational environment.
Self report questionnaires were administered in this cross-sectional survey to 338 residents covering eight specialties (Medicine, Psychiatry, Paediatrics, Obstetrics/Gynaecology, Anaesthesia, General Surgery, Cardiothoracic Surgery, and Ear Nose Throat Surgery). In addition to key sociodemographics, the Centres for Epidemiology Depression Scale - Revised, Perceived Stress Scale, Multidimensional Scale of Perceived Social Support, Alcohol, Smoking and Substance Involvement Screening Test, and Postgraduate Hospital Educational Environment Measure were used.
The mean participant age was 31.8 years and 53.4% were males. Most residents (70.4%) reported mild/no depressive symptoms 12.7% had moderate, and 16.9% had severe symptoms.High social support (71.8%) and moderate stress (61.6%) were reported by most residents. Almost half (46.3%) rated their educational environment as being more positive than negative. Out of 238 respondents 11.3% were at moderate risk of health and other problems due to cocaine use, while 13.3% (out of 240 respondents) were at risk due to alcohol. On bivariate analyses, we found significant correlations between depression, perceived stress, substance use, perceived social support, and educational environment. Multivariate analysis revealed that depression was strongly associated with: fewer hours of sleep (β = -0.683, p = 0.002), high perceived stress (β = 0.709, p < 0.001) and low perceived social support (β = -2.19, p < 0.001).
High perceived social support, low perceived stress, and less sleep were significantly associated with lower depression scores. A large proportion of residents were at risk of developing depression (29.6%). There were high levels of perceived social support (71.8%). A concerning proportion of residents used substances like alcohol and cocaine. This work is one of few that describe the mental health of an important and understudied population group in an LMIC. Priority must be given to protect and promote the mental health of such a vulnerable group.
Data collection and analysis were funded by Kenyatta National Hospital.
After the WHO declaration of the COVID-19 pandemic intense scuffling against novel coronavirus was observed and established fatal in most regions of the world. High fatality rate and socioeconomic downfall affected the health of non victimized individuals and consequently, health care measures, scheduled clinical and hospital visits avoided by the population hence the adaptation of self-medication proved as the mere troubleshooter for the general population as a swift safeguard for the further possible vulnerable situation. The present study is designed to observe the adaptability of self-medication with pros and cons due to the involved factors of fear of coronavirus, among the general population and for purpose, a questionnaire on the Zenodo-scale was developed and asked to respond from adults and teens after taking consensus, that further analyzed through IBM SPSS Statistics Version 26.
The outcome study was amazingly found with high compliance with self-medication among the focused population during the period of COVID. Estimated results showed highly significant correlation 0.000, p< 0.05 between the adaptation of self-medication and pandemic situation, which was estimated from Chi-square and Fisher tests. However, the fear of coronavirus made the practice or malpractice a survival of fittest, an embedded ability of human nature.
Early police transport (PT) of penetrating trauma patients has the potential to improve survival rates for trauma patients. There are no well-established guidelines for the transport of blunt trauma patients by PT currently.
This study examines the association between the survival rate of blunt trauma patients and the transport modality (police versus ground ambulance).
A retrospective, matched cohort study was conducted using the National Trauma Data Bank (NTDB). All blunt trauma patients transported by police to trauma centers were identified and matched (one-to-four) to patients transported by ground Emergency Medical Services (EMS) for analysis. Descriptive analysis was carried out. This was followed by comparing all patients’ characteristics and their survival rates in terms of the mode of transportation.
Out of the 2,469 patients with blunt injuries, EMS transported 1,846 patients and police transported 623 patients. Most patients were 16-64 years of age (86.2%) with a male predominance (82.5%). Fall (38.4%) was the most common mechanism of injury with majority of injuries involving the head and neck body part (64.8%). Fractures were the most common nature of injury (62.1%). The overall survival rate of adult blunt trauma patients was similar for both methods of transportation (99.2%; P = 1.000).
In this study, adult blunt trauma patients transported by police had similar outcomes to those transported by EMS. As such, PT in trauma should be encouraged and protocolized to improve resource utilization and outcomes further.
Community responses are important for the management of early-phase outbreaks of coronavirus disease 2019 (COVID-19). Perceived susceptibility and severity are considered key elements that motivate people to adopt nonpharmaceutical interventions. This study aimed to (i) explore perceived susceptibility and severity of the COVID-19 pandemic, (ii) examine the practice of nonpharmaceutical interventions, and (iii) assess the potential association of perceived COVID-19 susceptibility and severity with the practice of nonpharmaceutical interventions among people living in Afghanistan.
A cross-sectional design was used, using online surveys disseminated from April to May 2020. Convenience sampling was used to recruit the participants of this study. The previously developed scales were used to assess the participants’ demographic information, perceived risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and perceived severity of COVID-19. Multivariate analyses were conducted to assess the potential association of perceived COVID-19 susceptibility and severity with the practice of nonpharmaceutical interventions.
The Internet was the main source for obtaining COVID-19 information among participants in this study. While 45.8% of the participants believed it was “very unlikely” for them to get infected with COVID-19, 76.7% perceived COVID-19 as a severe disease. Similarly, 37.5% believed the chance of being cured if infected with COVID-19 is “unlikely/very unlikely.” The majority of participants (95.6%) perceived their health to be in “good” and “very good” status. Overall, 74.2% mentioned that they stopped visiting public places, 49.7% started using gloves, and 70.4% started wearing a mask. Participants who believed they have a low probability of survival if infected with COVID-19 were more likely to wear masks and practice hand washing.
It appears that communities’ psychological and behavioral responses were affected by the early phase of the COVID-19 pandemic in Afghanistan, especially among young Internet users. The findings gained from a timely behavioral assessment of the community might be useful to develop interventions and risk communication strategies in epidemics within and beyond COVID-19.
How are development zones “made” in conflict-affected borderlands? Addressing this question, this chapter explores the transformation of the Myanmar-China border town of Muse since 1988. Despite ongoing armed conflict in northern Myanmar, Muse has become the country’s most important border development zone and today handles more than 80% of licit overland Myanmar-China trade. It is also a key border hub in China's Belt and Road Initiative. Policy narratives typically claim that borderland development and regional economic integration offer an antidote to violence, criminality, and illegal practices. This chapter challenges these narratives. It demonstrates how long-standing forms of informal public authority and illegality have become deeply embedded in the technologies of governance that have underpinned Muse's rise.
Keywords: illicit economies, borderland development, informal governance, militias, illegal drugs, Belt and Road Initiative
Informal Governance and Illegality in the Making of Borderland Development Zones
Since the late 1980s, borderland regions across Southeast Asia have increasingly been reimagined as zones of economic opportunity that have the potential to stimulate national and regional development. Development discourses have promoted the “opening up” of “marginal” spaces to markets and capital alongside political projects aimed at consolidating state control over territories where the reach of the state has historically been weak and contested. Borderlands have become the subject of concerted efforts by national governments to expand cross-border flows of trade and investment and convert borderland spaces into sites of resource extraction and production (Barney 2009; Eilenberg 2012; Eilenberg 2014; Nyíri 2012; Taylor 2016; Woods 2011; van Schendel and de Maaker 2014). However, in many parts of Southeast Asia the rise of borderland development zones is being mapped onto long-standing histories of unresolved armed conflict, fragmented sovereignty, and illegal cross-border flows. How are development zones “made” in conflict-affected borderlands? What forms of territorialisation underpin the making of development zones in these contested spaces? What forms of public authority emerge to govern borderland development zones and whose interests do they serve? And how do long-standing histories of illicit border trade, fragmented sovereignty, and unresolved armed conflicts shape governance structures and everyday life in these development zones?
This chapter sets out to address these questions by analysing the rise of the Myanmar-China border town of Muse in northern Shan State in the period since the late 1980s and current plans to establish Myanmar's first official border special economic zone (SEZ) in the city.
In this paper, we develop a theory to establish that the thermo-osmotic (TOS) effects, induced by the application of an axial temperature gradient, lead to a massive enhancement in liquid transport in nanochannels grafted with charged polyelectrolyte (PE) brushes. We quantify the TOS transport by quantifying the induced electric field and the induced TOS flow field. The different components of the electric field, namely the ionic component, the thermal component and the osmotic component, as well as the contributions of different ions to these components, are quantified. Furthermore, we express the TOS velocity as a combination of chemiosmotic (COS), thermal and electro-osmotic (EOS) components. The COS and the thermal components augment each other and the overall strength and direction of the TOS flow are dictated by the direction and the relative strength of the EOS component. Most importantly, we compare the cases of brush-grafted nanochannels with those of the brush-free nanochannels of identical surface charge densities: the TOS transport is massively augmented in the brush-grafted nanochannels attributed to the combination of the localization of the electric double layer (EDL) (and hence any body force that depends on the EDL charge density) away from the nanochannel wall (i.e. the location of the maximum drag force) and the presence of a possible molecular slip (experienced by the liquid) along the brush surface.
The Hkakabo Razi Landscape, in northern Kachin, Myanmar, is one of the largest remaining tracts of intact forest in South-east Asia. In 2016, we undertook a survey in its southern margins to assess bat diversity, distribution and ecology and evaluate the importance of the area for global bat conservation. Two collecting trips had taken place in the area in 1931 and 1933, with four bat species reported. We recorded 35 species, 18 of which are new for Kachin. One species, Murina hkakaboraziensis, was new to science and three, Megaerops niphanae, Phoniscus jagorii, Murina pluvialis, were new records for Myanmar. Our findings indicate high bat diversity in Hkakabo Razi; although it comprises only 1.7% of Myanmar's land area, it is home to 33.6% of its known bat species. This emphasizes Hkakabo Razi's importance for conserving increasingly threatened, forest-interior bats, especially in the families Kerivoulinae and Murininae. There is also a high diversity of other mammals and birds within the Hkakabo Razi Landscape, which supports its nomination as a World Heritage Site.
We introduce pinta, a pipeline for reducing the upgraded Giant Metre-wave Radio Telescope (uGMRT) raw pulsar timing data, developed for the Indian Pulsar Timing Array experiment. We provide a detailed description of the workflow and usage of pinta, as well as its computational performance and RFI mitigation characteristics. We also discuss a novel and independent determination of the relative time offsets between the different back-end modes of uGMRT and the interpretation of the uGMRT observation frequency settings and their agreement with results obtained from engineering tests. Further, we demonstrate the capability of pinta to generate data products which can produce high-precision TOAs using PSR J1909
3744 as an example. These results are crucial for performing precision pulsar timing with the uGMRT.
The British Columbia Farmers’ Market Nutrition Coupon Program (FMNCP) provides low-income households with coupons valued at $21/week for 16 weeks to purchase healthy foods in farmers’ markets. Our objective was to explore FMNCP participants’ experiences of accessing nutritious foods, and perceived programme outcomes.
The current study used qualitative description methodology. Semi-structured interviews were conducted with FMNCP participants during the 2019 farmers' market season. Directed content analysis was used to analyse the data, whereby the five domains of Freedman et al.’s framework of nutritious food access provided the basis for an initial coding scheme. Data that did not fit within the framework’s domains were coded inductively.
One urban and two rural communities in British Columbia, Canada.
Twenty-eight adults who were participating in the FMNCP.
Three themes emerged: autonomy and dignity, social connections and community building, and environmental and programmatic constraints. Firstly, the programme promoted a sense of autonomy and dignity through financial support, increased access to high-quality produce, food-related education and skill development and mitigating stigma and shame. Secondly, shopping in farmers' markets increased social connections and fostered a sense of community. Finally, participants experienced limited food variety in rural farmers' markets, lack of transportation and challenges with redeeming coupons.
Participation in the FMNCP facilitated access to nutritious foods and enhanced participants’ diet quality, well-being and health. Strategies such as increasing the amount and duration of subsidies and expanding programmes may help improve participants’ experiences and outcomes of farmers' market food subsidy programmes.
The predator–prey-transmitted cestode Taenia hydatigena infects a wide range of definitive and intermediate hosts all over the world. Domestic and sylvatic cycles of transmission are considered as well. The parasite has considerable economic importance, particularly in sheep. Here, the molecular characters of T. hydatigena cysticerci in sheep from the Nile Delta, Egypt were investigated for the first time. For this purpose, 200 sheep carcasses and their offal were inspected at the municipal abattoir, Dakahlia governorate, Egypt. Cysticerci of T. hydatigena were collected and molecularly characterized employing the mitochondrial 12S rRNA gene. Cysticerci were found in 42 (21%) sheep, mostly attached to the omenti, mesenteries and livers. After molecular confirmation, nine isolates were sequenced displaying six different haplotypes. Analysis of the T. hydatigena 12S rRNA nucleotide sequences deposited in GenBank revealed 55 haplotypes out of 69 isolates, displaying high haplotype (0.797) and low nucleotide (0.00739) diversities. For the Tajima D neutrality index, a negative value (−2.702) was determined, indicating the population expansion of the parasite. Additionally, global data summarized in this study should be useful to set up effective control strategies against this ubiquitous parasite.
This study examined the effects of zinc chloride (ZnCl2) and sodium selenite (Na2SeO3) supplementation in maturation medium on in vitro maturation (IVM) rate, oxidative biomarkers and gene expression in buffalo oocytes. Ovaries from a slaughterhouse were aspirated and good quality cumulus–oocyte complexes (COCs) with at least four layers of compact cumulus cells and evenly granulated dark ooplasm were selected. COCs were randomly allocated during IVM (22 h) to one of four treatment groups: (1) control maturation medium (basic medium), or basic medium supplemented with (2) ZnCl2 (1.5 µg/ml), (3) Na2SeO3 (5 µg/l), or (4) ZnCl2 + Na2SeO3 (1.5 µg/ml + 5 µg/l, respectively). Oocytes were denuded after 22 h of IVM in the first four replicates. Specimens were fixed and stained to evaluate the stage of nuclear maturation. The spent medium was collected for biochemical assays of total antioxidant capacity (TAC), malondialdehyde (MDA) and hydrogen peroxide concentrations. A second four replicates were used for COCs for RNA extraction. The expression levels of antioxidant (SOD1, GPX4, CAT and PRDX1), antiapoptotic (BCL2 and BCL-XL) and proapoptotic (BAX and BID) genes were measured. Supplementation with ZnCl2 and Na2SeO3 during IVM increased the ratio of oocytes reaching metaphase II at 22 h, increased TAC and decreased MDA and H2O2 concentrations in the maturation medium (P < 0.05). Moreover, beneficial effects were associated with complementary changes in expression patterns of antioxidative, antiapoptotic and proapoptotic genes, suggesting lower oxidative stress and apoptosis. Supplementation medium with zinc chloride and sodium selenite improves the maturation rate, reduces oxidative stress and increases expression levels of antioxidative and antiapoptotic genes.