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Between the eighth and eleventh centuries, many defining features of classical Sunni Islam began to take shape. Among these was the formation of medieval Sunnism around the belief in the unimpeachable orthodoxy of four eponymous founders and their schools of law. In this original study, Ahmad Khan explores the history and cultural memory of one of these eponymous founders, Abū Ḥanīfa. Showing how Abū Ḥanīfa evolved from being the object of intense religious exclusion to a pillar of Sunni orthodoxy, Khan examines the concepts of orthodoxy and heresy, and outlines their changing meanings over the course of four centuries. He demonstrates that orthodoxy and heresy were neither fixed theological categories, nor pious fictions, but instead were impacted by everything from law and politics, to society and culture. This book illuminates the significant yet often neglected transformations in Islamic social, political and religious thought during this vibrant period.
It was not only human lives that were annihilated during the days of political violence unleashed in the northeastern localities of India's capital New Delhi in late February of 2020. Words, too, were/are being massacred in (mis)characterizing that violence. Analytically, at stake is this fundamental issue: without correct naming, we can understand neither the violence nor its past or future. It is not mere verbal gymnastics; naming is critical to the diagnosis of the problem as also to its prevention. Indeed on naming rests, in many ways, life as well as death. To safeguard the chastity of language, and my own ethical integrity, I will, therefore, not call the violence in Delhi a riot, as it was widely called then as well as subsequently. Let me name it what it truly is: a pogrom.
This essay anthropologically explores the crucial subject of the politics of naming over longue durée. In so doing, it puts forward an original argument (see later) that seldom has much of social science literature made, definitely not in the ways enunciated, executed, and demonstrated here. This argument is derived from as well as extends my larger monographic work on political violence (Ahmad forthcoming). Given the space limit and specific aims of this essay in the present volume, it is not feasible to lay bare full detail of my claim here. In part, this is also because the regnant doxa my argument is positioned against is not limited to a specific field of inquiry, discipline, or a set of authors. My contention instead pertains to the very ubiquitous nationalist epistemology to which almost every discipline, field, or most authors pledge their affiliation, albeit not identically (Ahmad 2011). This nationalist epistemology as a knowledge/power matrix with Hindu Orientalism as its lynchpin is, moreover, international. Academic knowledge in ‘post-colonial’ India is heavily indebted to and informed by what I call Hindu Orientalism, a set of practices and repertoires, which draws on, updates, and recasts historical European Orientalism (especially its branch of Indology) to organize intellectual production, circulation, and dissemination under the overarching banner of nationalism (Ahmad 2021a). Theoretically, nationalism is thus not an antithesis of Orientalism (Breckenridge and van der Veer 1993).
During the COVID-19 pandemic, many service lines needed to be transformed to enable more telemedicine and virtual consultations. This enabled seamless care across many service boundaries as all services adapted to operate virtually. During COVID-19, the mental health of many patients deteriorated. With easing of restrictions, we wanted the patient voice to be heard and to ensure our service was patient-centred. We undertook a service evaluation to understand our patients preferences. Our cross-sectional study evaluated patient preferences for their care which we felt was important as earlier during pandemic, patients did not have the choice to choose between virtual vs face-to-face consultations. We felt this was important to our patients so they could exercise choice of consultation and this would enable the patient voice to be heard.
591 patients across three practices in primary care were identified from the Serious Mental Illness (SMI) and on the depression register. They were asked about their preference of care: telemedicine vs face-to-face consultations. Using a simple questionnaire, in order to record their preference on the patient screen. Of these a total of 495 patients (83%) participated in the study.
Of the 495 respondents, 308 (52%) declined virtual telemedicine consultations and 175 (29%) patients were content with virtual consultations. Of the 175 patients who wanted telemedicine were 20 to 40 years of age. Reasons given included convenience (allows family and work commitment) and overall time management (reluctancy to travel). The 308 patients (52%) wanted face-to-face consultations because they wanted human contact, validation of their mental health problems, reassurance and were uncomfortable about discussions on the phone. They also had poor mobility especially the elderly who chose traditional models of care.
As services are restored to the new norm of patient care, patient choice should remain paramount if services are to remain patient centric. During the COVID-19 pandemic, many services transformed to virtual consultation of necessity without recognising the impact on patients themselves. Patients with serious mental health and depression are inherently vulnerable and our evaluation goes to show that despite the popularity of telemedicine. Patient choice should enable patients to access face-to-face care for greater patient satisfaction.
There was an initial QIP done in 2019 highlighting the deviation and deficits from ECTAS Guidelines. We tried to make positive change by introducing checklists and assessments. We were able to reach our goal but noted that collating information was a time taking task. More ever, documents were not always accessible as patients come to Mid Essex ECT clinic from other parts of Trust as well as from Private inpatient settings which meant that we did not have records for those patients. We noticed clear lack of communication between out of area referring and treating clinician regarding treating team's view about patient progress, assessment results and recommendations for future ECT need, which we thought could be improved by generating discharge summary of each patient as end of treatment.
We conducted retrospective audit for all treated patients in ECT clinic in 2020(n = 18,re-audited in 2021 and 2022(n = 13) to see documentation, including Consent documents; Form 5(consent) in case of capacity, T4/T6/S62, Documentation of Memory assessment, as well as MADRS assessment before and during the procedure. We started generating ECT discharge summaries in November 2021 and collected data for all patients (13) till 6th February 2022.
Documentation of Legal Status: 5% in 2020 vs.100% in 2021* and 2022
Written consent /form 5: 95% in 2020 vs. 100% in 2021* and 2022
Documented Mini-ACE: 5% in 2020 vs. 100% in 2021* and 2022
Doc. MADRS assessment; 0% in 2020 vs. 100% in 2021* and 2022
*(excluding patients who did not complete the treatment)
The audit results of 2020 showed improvement however assessments done during treatment were not accessible to referring clinicians or to patients. Introduction of discharge summary helped to give snapshot of patient's weekly progress, weekly objective assessment scores which helped the referring clinicians to get idea about patient's improvement and resulted in improved communication as well as patient and carer satisfaction.
Small actions can have big impact on the way patient care is delivered. We believe that going through process of auditing helped us to improve our practice and make a positive change in terms of delivering better care.
The Oxford City and NE Oxon Adult Mental Health Team (AMHT) is an adult mental health team receiving referrals from GPs for most cases suspected to have a mental health illness requiring secondary mental health services’ input in Oxford city. In January 2020, the team was remodelled with care coordinators working in separate functions based on the duration AMHT support was required for, i.e. an assessment team and a treatment team, but with medics covering both functions of the team. This quality improvement project examines AMHT referrals over 2020/21, hypothesising a reduction in the proportion of inappropriate referrals following the remodelling compared to a 2018/19 pre-remodelling audit.
The project covers a total of 2803 referrals the team has received from 13/01/2020 to 12/01/2021. The outcomes measured included the number of inappropriate referrals returned to the GP, referrals only requiring a single assessment, the proportion of these referrals as university students in Oxford, and the diagnostic groupings of the referrals in students vs non-students. These outcomes were measured pre- and during the COVID-19 pandemic over 2020/21.
A reduction in the total number of referrals to the team was noted over 2020/21 but this was compared to an 11 month audit in 2018/2019. During the study period, 19.5% (546/2803) of referrals were deemed inappropriate compared to 21% of referrals received in 2018/2019. Of 2803 referrals, 14.7% (97/658) were inappropriate pre-COVID-19 vs 20.9% (449/2145) during the pandemic. Of the total number of referrals, 32.9% were returned to the GP following a single assessment.
The top 3 diagnostic categories in ‘non-students’ were mood/affective disorders (33.7%), anxiety/stress related disorders (17.2%), and neurodevelopmental disorders (7.8% total - ADHD was 3%). A significant increase in ADHD referrals and mood disorders amongst students compared to non-students is notable with the top 3 diagnostic categories for students being mood/affective (24.7%), neurodevelopmental disorders (19.5% - ADHD 17.7%), and anxiety/stress related disorders (13.4%). Students constituted 26% of the total number of referrals.
It was notable that during the pandemic there was a higher proportion of inappropriate referrals.
Our project demonstrates a reduction in the proportion of inappropriate referrals sent to the AMHT following remodelling as compared to 2018/19. Further work is necessary to elucidate the contributing factors and reduce inappropriate referrals even further. An innovation is planned to automate the logging of referral outcomes to expedite a re-audit.
Antimicrobial resistance (AMR) is a global priority with significant clinical and economic consequences. Multidrug-resistant (MDR) Pseudomonas aeruginosa is one of the major pathogens associated with significant morbidity and mortality. In healthcare settings, the evaluation of prevalence, microbiological characteristics, as well as mechanisms of resistance is of paramount importance to overcome associated challenges.
Consecutive clinical specimens of P. aeruginosa were collected prospectively from 5 acute-care and specialized hospitals between October 2014 and September 2017, including microbiological, clinical characteristics and outcomes. Identification and antimicrobial susceptibility test were performed using the BD Phoenix identification and susceptibility testing system, matrix-assisted laser desorption ionization–time-of-flight mass spectrometry (MALDI-TOF MS), and minimum inhibitory concentration (MIC) test strips. Overall, 78 selected MDR P. aeruginosa isolates were processed for whole-genome sequencing (WGS).
The overall prevalence of MDR P. aeruginosa isolates was 5.9% (525 of 8,892) and showed a decreasing trend; 95% of cases were hospital acquired and 44.8% were from respiratory samples. MDR P. aeruginosa demonstrated >86% resistance to cefepime, ciprofloxacin, meropenem, and piperacillin-tazobactam but 97.5% susceptibility to colistin. WGS revealed 29 different sequence types: 20.5% ST235, 10.3% ST357, 7.7% ST389, and 7.7% ST1284. ST233 was associated with bloodstream infections and increased 30-day mortality. All ST389 isolates were obtained from patients with cystic fibrosis. Encoded exotoxin genes were detected in 96.2% of isolates.
MDR P. aeruginosa isolated from clinical specimens from Qatar has significant resistance to most agents, with a decreasing trend that should be explored further. Genomic analysis revealed the dominance of 5 main clonal clusters associated with mortality and bloodstream infections. Microbiological and genomic monitoring of MDR P. aeruginosa has enhanced our understanding of AMR in Qatar.
Lithium is an effective mood stabiliser for the treatment of the bipolar disorder. Its utility is not restricted to acute mania and prophylactic treatment of the bipolar disorder. Another well-known indication for its use is the treatment of refractory depression. Lithium can cause several adverse effects, and typically the side effects are dose-related. Unlike antipsychotic medications, lithium is rarely associated with drug-induced Parkinsonism.
We present a case of 78 years old gentleman who was assessed due to complaints suggestive of cognitive impairment. His past psychiatric history revealed that he was admitted to a psychiatric inpatient unit with a diagnosis of treatment-resistant depression in 1991. Lithium therapy was commenced during this admission, and he remained on lithium for 27 years. The patient was clinically stable in terms of the symptoms of depression; however, he reported bilateral postural tremors 20 years after the initiation of lithium therapy. Initially, he was diagnosed with lithium-induced tremor; however, in the following months, his symptoms had worsened, and he developed new motor disturbances, although the serum levels of lithium were within the therapeutic range. On examination, he had classic parkinsonian signs of shuffling gait, muscle rigidity in all four limbs and freezing of gait. DaT-SPECT imaging clarified the diagnosis as drug-induced Parkinsonism. As the daily lithium dosage was stopped, the patient's motor symptoms improved significantly; nevertheless, some of the symptoms persisted.
The pathophysiological mechanism behind lithium-induced Parkinsonism is unclear. The condition may develop with or without frank lithium toxicity and have diverse presentations. Literature suggests that the risk factors for lithium-induced Parkinsonism appear to be the patients' age, duration of lithium therapy, and serum lithium levels. It has been suggested that older patients have a more permeable blood-brain barrier and decreased renal clearance; hence, serum lithium levels can appear therapeutic, but brain lithium levels may be much higher. Pharmacokinetic drug-drug interactions might also contribute; thus, careful monitoring is essential.
Drug-induced Parkinsonism improves with discontinuation of the offending medication; however, 10% of patients will develop a persistent and progressive parkinsonian syndrome.
This report aims to emphasise the need to consider lithium-induced Parkinsonism when Parkinson Disease symptoms appear in chronic lithium users and close monitoring of lithium levels in geriatric populations. It is essential to recognise the condition, avoid misdiagnosis and prevent inappropriate use of anti-dopaminergic medications.
CT is an accepted non-invasive imaging tool to assess the coronary arteries in adults; however, its utilisation in children is limited by high heart rate and lack of standardised protocol. We sought to assess diagnostic quality and factors that affect image quality of CT in assessing coronary artery lesions in Kawasaki patients less than 18 years of age.
CT coronary angiography was performed on patients with Kawasaki disease diagnosed with coronary aneurysm or suspected to have coronary stenosis. Studies were performed using electrocardiogram-gated protocols. General anaesthesia was used in patients who were not cooperative for breathing control. Heart rate, image quality, and effective radiation dose were documented.
Fifty-two Kawasaki patients underwent CT coronary angiography to assess coronary artery lesions. Median heart rate was 88 beats per minute (range 50–165 beats/minute). Image quality was graded as excellent in 34 (65%) patients, good in 17 (32%), satisfactory in 1, and poor in 1 patient. Coronary artery aneurysm was found in 25 (bilateral = 6, unilateral = 19, multiple = 11). Thrombus was found in 11 patients resulting in partial and total occlusion in 8 and 3 patients, respectively. Coronary stenosis was noted in 2 patients. The effective radiation dose was 1.296 millisievert (median 0.81 millisievert). Better diagnostic imaging quality was significantly related to lower heart rate (p = 0.007).
Electrocardiogram-triggered CT coronary angiography provides a good diagnostic assessment of coronary artery lesions in children with Kawasaki disease.
Intensity-modulated radiation therapy (IMRT) has revolutionised the way head and neck cancers can be treated. It allows for a more conformal treatment plan when compared to 3D conformal radiation therapy. In paediatric patients, however, IMRT continues to deliver higher doses than desirable. Proton beam therapy on the other hand has the potential to further spare organs-at-risk.
A 16-year-old boy with a left-sided paraganglioma of the left base of skull manifested by headaches, neck pain and tongue cramping was simulated, planned and treated with proton therapy with significant contralateral organ-at-risk sparing.
For this patient, dosimetric plan comparison between photon and proton plans clearly showed better sparing of contralateral organs-at-risk with protons. The contralateral parotid gland received a mean dose of 386·3 cGy with photons, whereas it received 1·3 cGy (CGE) in the proton plan.
The dosimetric advantage of proton beam over photon beam therapy has successfully been demonstrated in this case study for a paediatric patient with a head and neck tumour. Sparing of contralateral structures is especially important in paediatric patients who are at a greater risk of secondary malignancies due to possible long life expectancy.
The incidence of prosthetic valve implantation is increasing in the paediatric population. Prosthetic valve thrombosis leading to obstruction could potentially be a life-threatening complication. There is a debate regarding optimal management of this complication, and there is limited use of thrombolytic therapy in childhood in the setting of valve thrombosis.
We aim to share our experience of successfully using fibrinolytic therapy in terms of alteplase for paediatric prosthetic mitral valve thrombosis and to propose a management algorithm.
This retrospective analysis of the database was conducted at our hospital including patients who underwent thrombolysis (alteplase) for prosthetic mitral valve thrombosis from June, 2011 to June, 2021. A total of 10 patients with 20 attempts of alteplase infusion were found in our record.
Alteplase was successful in 19 attempts to relieve valve thrombosis. The safe and effective dose of alteplase was between 0.1 and 0.3 mg/kg/hour. There were no associated major bleeding complications and alteplase was administered either by central or peripheral line.
Thrombolysis by alteplase infusion was found to be successful in relief of prosthetic mitral valve thrombosis in paediatric population without major bleeding complications.
Using 61 stories from design educators from different countries, this paper presents (1) the design competencies being fostered at different levels of education, (2) the practices (approaches, techniques, methods and tools) used to facilitate teaching and learning, (3) the ‘non-design’ competencies being fostered, and (4) the impact of COVID 19. Our findings highlight design education is not only used to teach students how to design, but also to kindle productive attitudes, behaviours and mindsets that give them the ability to address a wide range of challenges.
This study aims to look at the trends in our head and neck cancer patient population over the past 5 years with an emphasis on the past 2 years to evaluate how the coronavirus disease 2019 (COVID-19) pandemic has impacted our disparities and availability of care for patients, especially those living in rural areas. An additional aim is to identify existing disparities at our institution in the treatment of head and neck patients and determine solutions to improve patient care.
Materials and Methods:
A retrospective chart review was performed to identify patients who were consulted and subsequently treated with at least one fraction of radiation therapy at our institution with palliative or curative intent. Patient demographic information was collected including hometown, distance from the cancer centre based on zip-codes and insurance information and type of appointment (in-person or telehealth). Rural–urban continuum codes were used to determine rurality.
A total of 490 head and neck cancer patients (n = 490) were treated from 2017 to 2021. When broken down by year, there were no significant trends in patient population regarding travel distance or rurality. Roughly 20–30% of our patients live in rural areas and about 30% have a commute > 50 miles for radiation treatment. A majority of our patients rely on public insurance (68%) with a small percentage of those uninsured (4%). Telehealth visits were rare prior to 2019 and rose to 5 and 2 visits in 2020 and 2021, respectively.
Head and neck cancer patients, despite rurality or distance from a cancer centre, may present with alarmingly enough symptoms despite limitations and difficulties with seeking medical attention even during the COVID-19 pandemic in 2020. However, providers must be aware of these potential disparities that exist in the rural population and seek to address these.
A study was conducted to collect and characterize the indigenous Kala zeera (Bunium persicum Boiss. Fedtsch.) accessions from the hills of northwestern Himalayan sates of Jammu and Kashmir, Himachal Pradesh and Uttarakhand. Around 1000 accessions were collected during this exploration mission, out of which diversity of 252 accessions was established through morphological characterization. The morpho-agronomic characterization and the analysis of trait data revealed significant variability in number of branches per plant, number of umbelets per umbel, number of seeds per plant, seed yield per plant and 1000 seed weight. The collection and characterization of these diverse accessions can prove useful in future Kala zeera improvement programmes in the world as this is the first such comprehensive report of the crop from northwestern Himalayan region of India.
The present study was undertaken to estimate the (co)variance components and genetic parameters of body weights recorded in Landlly piglets from birth to weaning at weekly intervals (w0 to w6). The data pertained to body weights of 2462 piglets, born to 91 sires and 159 dams across different generations during a 7-year period from 2014 to 2020. Five animal models (I–V), differentiated by inclusion or exclusion of maternal effects with or without covariance between maternal and direct genetic effects, were fitted on the data using the Bayesian algorithm. The analyses were implemented by Gibbs sampling in the BLUPF90 program and Markov chain Monte Carlo (MCMC) methodology was used to draw samples of posterior distribution pertaining to (co)variance components. Based on deviance information criteria (DIC), model V with inclusion of direct additive genetic, direct maternal genetic and permanent environmental effect of dam as random factors along with covariance between direct additive and maternal effects best fitted the data on pre-weaning traits (w0 to w5). Whereas, model I incorporating only the direct additive genetic effect best fitted the weaning weight (w6) data in Landlly piglets. The posterior mean estimates of direct heritability under the best models for W0 to W6 were 0.13, 0.19, 0.29, 0.13, 0.26, 0.32 and 0.46, respectively. Inclusion of the maternal component helped in better partitioning of variance for different body weights in Landlly piglets. The maternal heritability ranged from 0.06 to 0.14, while the litter heritability ranged from 0.11 to 0.15 for pre-weaning weights (W0 to W5) under the best-fit models. The influence of maternal environment was greater than maternal genetic effect from birth to 4th week of age. The results implied that variations in body weight of Landlly pigs were genetically controlled to moderate levels (especially w2 and w4) with contributions from direct additive and maternal genotype that can be exploited by designing efficient breeding programmes.
This research focuses on a collision-free real-time motion planning system for unmanned aerial vehicles (UAVs) in complex three-dimensional (3D) dynamic environments based on generalized potential force functions. The UAV must survive in such a complex heterogeneous environment while tracking a dynamic target and avoiding multiple stationary or dynamic obstacles, especially at low hover flying conditions. The system framework consists of two parts. The first part is the target tracking part employing a generalized extended attractive potential force into 3D space. In contrast, the second part is the obstacle avoidance part employing a generalized extended repulsive potential force into 3D space. These forces depend on the relative position and relative velocity between the UAV and respective obstacles. As a result, the UAV is attracted to a moving or stationary target and repulsed away from moving or static obstacles simultaneously in 3D space. Accordingly, it changes its altitude and projected planner position concurrently. A real-time implementation for the system is conducted in the SPACE laboratory to perform motion planning in 3D space. The system performance is validated in real-time experiments using three platforms: two parrot bebop drones and one turtlebot robot. The pose information of the vehicles is estimated using six Vicon cameras during real-time flights. The demonstrated results show the motion planning system’s effectiveness. Also, we propose a successful mathematical solution of the local minima problem associated with the potential field method in both stationary and dynamic environments.
To counter the insect infestation, plants respond with wide-ranging and highly dynamic biochemical reactions. Of these, the anti-oxidative activity is poorly understood. The red palm weevil (RPW) Rhynchophorus ferrugineus (Oliver), one of the most widespread pests in Pakistan, prefers to infest date palm Phoenix dactylifera. Our present study investigated the feeding preference of RPW to 11 different date palm cultivars and the results suggested that the Hillawi cultivar was most preferred. Greater infestation rate, fecundity and hatching rate were also recorded from Hillawi and Mozawati than other cultivars. No significant decreases were observed in chlorophyll a, chlorophyll b, total chlorophylls and carotenoids of RPW-infested Hillawi cultivar over un-infested control. In contrast, the contents of enzymatic antioxidants including phenols, proline, hydrogen peroxide, anthocyanin, malondialdehyde, ascorbic acid and glycine betaine showed a drastic increase after RPW infestation, and there was enhanced superoxide dismutase, peroxidase and catalase activities. Furthermore, we recorded the increase of total protein and sugar contents in RPW-infested date palms. These findings offer valuable insight into the antioxidative molecular mechanism of date palms under RPW attack and may contribute to the breeding of insect-resistant crops.
OBJECTIVES/GOALS: The spectrum of disease caused by SARS-CoV-2 ranges from asymptomatic detection to severe illness, with varying presentations by age. Therefore, we aimed to compare the clinical characteristics between children and adults with SARS-CoV-2. METHODS/STUDY POPULATION: From March 20, 2020, to August 18, 2021, we conducted SARS-CoV-2 surveillance in individuals from metropolitan Nashville, TN. Children with multisystem inflammatory syndrome were excluded. Analyses were restricted to individuals with SARS-CoV-2 infection confirmed by detection of viral RNA in nasal specimens using reverse-transcription quantitative polymerase chain reaction (RT-qPCR) and/or by detection of serum IgG to the SARS-CoV-2 spike and nucleocapsid proteins using enzyme-linked immunosorbent assay (ELISA). Those with negative RT-qPCR results, but a positive ELISA within 4-6 weeks of symptom onset, were classified as SARS-CoV-2 positive. Clinical characteristics between children and adults were compared with Pearson’s chi square. Illness duration was compared using Kaplan Meier estimators. RESULTS/ANTICIPATED RESULTS: Overall, 426/826 (49%) individuals (children: 57 [13%); adults: 369 [87%]) were SARS-CoV-2 positive, with median ages of 12 and 41 years, respectively. Most individuals were female (54%) and white, non-Hispanic (79%). Compared to adults, children were more likely to be asymptomatic (children: 16% vs. adults: 5%; p=0.001). In contrast, symptomatic adults were more likely to report cough (71% vs. 56%), wheezing (21% vs. 8%), shortness of breath (45% vs. 19%), ageusia (67% vs. 23%), and anosmia (64% vs 27%) than symptomatic children (p<0.05). Mean illness duration was shorter in children than adults: 7 days (95% CI: 5.1, 8.9) vs. 14 days (95% CI: 12.4,15.0), respectively. A total of 5% (18/352) of adults reported symptoms lasting ? 4 weeks (range: 31-96 days), whereas all symptoms in children resolved by 31 days. DISCUSSION/SIGNIFICANCE: Overall, children with SARS-CoV-2 present with a shorter and milder disease course compared to adults. Further studies are needed to understand SARS-CoV-2 illness severity across the lifespan.