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To evaluate the utility of pre-operative transtympanic electrically evoked auditory brainstem responses and post-operative neural response telemetry in auditory neuropathy spectrum disorder patients.
Four auditory neuropathy spectrum disorder patients who had undergone cochlear implantation and used it for more than one year were studied. All four patients underwent pre-operative transtympanic electrically evoked auditory brainstem response testing, intra-operative and post-operative (at 3, 6 and 12 months after switch-on) neural response telemetry, and out-patient cochlear implant electrically evoked auditory brainstem response testing (at 12 months).
Patients with better waveforms on transtympanic electrically evoked auditory brainstem response testing showed superior performance after one year of implant use. Neural response telemetry and electrically evoked auditory brainstem response measures improved in all patients.
Inferences related to cochlear implantation outcomes can be based on the waveform of transtympanic electrically evoked auditory brainstem responses. Robust transtympanic electrically evoked auditory brainstem responses suggest better performance. Improvements in electrically evoked auditory brainstem responses and neural response telemetry over time indicate that electrical stimulation is favourable in auditory neuropathy spectrum disorder patients. These measures provide an objective way to monitor changes and progress in auditory pathways following cochlear implantation.
To determine the incidence of nasolacrimal duct injury after functional endoscopic sinus surgery radiologically, using computed tomography.
Fifty patients of either sex who underwent functional endoscopic sinus surgery were evaluated for nasolacrimal duct injury by computed tomography. Computed tomography was conducted pre-operatively, and post-operatively at the end of four weeks, and nasolacrimal duct injury was analysed.
The prevalence of nasolacrimal duct injury dehiscence was 1.16 per cent, with a similar incidence of 1.16 per cent for nasolacrimal duct injury post-operatively. However, no cases of symptomatic nasolacrimal duct injury were recorded.
Computed tomography scan is an effective, non-invasive method to evaluate nasolacrimal duct injury following functional endoscopic sinus surgery, in accordance with evidence-based medicine.
The design and the early commissioning of the ELI-Beamlines laser facility’s 30 J, 30 fs, 10 Hz HAPLS (High-repetition-rate Advanced Petawatt Laser System) beam transport (BT) system to the P3 target chamber are described in detail. It is the world’s first and with 54 m length, the longest distance high average power petawatt (PW) BT system ever built. It connects the HAPLS pulse compressor via the injector periscope with the 4.5 m diameter P3 target chamber of the plasma physics group in hall E3. It is the largest target chamber of the facility and was connected first to the BT system. The major engineering challenges are the required high vibration stability mirror support structures, the high pointing stability optomechanics as well as the required levels for chemical and particle cleanliness of the vacuum vessels to preserve the high laser damage threshold of the dielectrically coated high-power mirrors. A first commissioning experiment at low pulse energy shows the full functionality of the BT system to P3 and the novel experimental infrastructure.
Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.
Crenidens macracanthus was originally described in 1874 based on a single specimen collected from Chennai (Madras), south-east coast of India. In 1875, the species was synonymized with C. indicus without citing any valid reason. Since then, no taxonomic studies have been attempted for the genus Crenidens, except in 2013 the species was resurrected from synonymy and redescribed as a valid species based on the holotype and non-type specimen. In view of the fact that C. macracanthus is a poorly known species, it is redescribed based on examination of 30 additional specimens of 105.8–162.2 mm SL, collected from Puri, Odisha, north-east coast of India (Bay of Bengal) from 2017–2019, using morphological and molecular examinations. Our study provides a detailed morphological description, first colour photographs and phylogenetic analysis using COI barcodes of the species. The study has expanded the range in several morpho-meristic characters in comparison with the type and non-type specimens described earlier. The species in fresh condition can be easily distinguished from its two congeners (C. crenidens and C. indicus) by the yellowish tip of the lower caudal-fin lobe. Our study has also extended the distribution range of C. indicus (previously known only from the north-eastern Arabian Sea) to the eastern Indian Ocean, based on examination of a preserved specimen collected from Tuticorin, Tamil Nadu.
The practice of psychiatry throws multitude of ethical challenges and dilemmas for a clinician in making decisions. Historically, doctors follow the well-established principles of medical ethics – namely justice, autonomy, beneficience and non-maleficience in medical practice. Along with these, clinical practice in psychiatry in England and Wales is governed by the principles outlined in the Mental Health Act 1983.
Whilst general ethical guidances are available as principles mentioned above, there are no clear directives in a complex clinical presentation when the various principles are in conflict themselves. Example, it is difficult to assess whether autonomy takes precedence over beneficience or vice versa when they are in conflict. In such cases, clinicians are left to exercise their own judgment.
We undertook a literature search to look for instances of published cases about hierarchy in different principles of medical ethics in the context of complex clinical presentations in psychiatry that pose conflict in the aforementioned principles. The results are outlined. We illustrate this in relation to a complex clinical presentation we came across in our practice that deals with detention, capacity and consent. The case exemplifies conflict is different ethical principles.
Psychiatric practice is complex without set rule. No clear consensus exists in the application of ethical principles specifically when they appear to be conflict. It is imperative there is a debate to agree on a hierarchy of ethical principles such that practitioners bias and prejudices are not brought in to practice in times of ethical conflicts.
In the UK, blood investigations ordered by the Mental Health Trust are usually carried out by Acute hospitals. The results are not immediately accessible by the staff of Mental Health Trusts on the computer due to confidentiality and lack of shared software access between trusts. This has a significant impact on care management of psychiatric patients often resulting in delay in clinical decisions.
We encountered similar problem where the results of the tests ordered by the staff were not immediately accessible to them, as these investigations are carried out by the local acute hospital. To address this issue a project was chartered.
Of the project was to develop a protocol between the trusts so that the staff of Mental Health Trust could access the results of investigation on local computers as soon as they become available and to evaluate its impact on service.
A steering committee including Specialty Registrar, Pharmacist and Matron was constituted. The committee met regularly and evolved strategy with representatives of the Acute Trust. The main concern of the Acute Trust was patient confidentiality and software access. Following regular meetings and correspondence shared-protocol was developed.
It was agreed that the acute trust would install the software on all mental health trust computers. The staff would be trained to use the software and access results. To address the issue of confidentiality, flowchart of sponsorships of the shared-protocol was developed. Accordingly, all the medics would be sponsored for access by Medical Director, Nursing Staff by Matron and Pharmacists by Chief Pharmacist. This protocol ensured that all the staff trained are accounted and IT department could monitor any unauthorised access of data.
We have noticed a big improvement in the quality of clinical practice as a result. Unnecessary delays in clinical decisions have been avoided. We feel such a shared-protocol could be developed in other hospitals that are faced with similar access issues.
Schizophrenia is one of the psychotic mental disorders, characterized by social problems and disorders of thought, behaviour, motor and cognitive functions such as long-term memory, verbal memory, executive functioning and vigilance etc. However, the relation between structural and functional alterations in schizophrenia remains unclear. Therefore, the present study sought to investigate whether functional alterations in schizophrenia are also associated with structural brain aberrations directly in related brain regions or in anatomically closely connected areas.
The current study was conducted to investigate the possible relationship between functional and structural changes for a simple motor task in schizophrenics.
16 controls and 16 schizophrenic patients were chosen for the study. The structural and functional MRI scans were acquired using 3 Tesla whole-body MRI system with a 16 channel head array coil. For fMRI, a block paradigm with alternating blocks of motor task (right finger tapping; 120 taps/min) and rest was carried out. Pre-processing and post-processing of MRI scans were performed using SPM8 software.
The fMRI study showed relatively less activation in the left precentral and postcentral gyrus and right cerebellum in schizophrenic patients as compared to controls during finger tapping task. Voxel-based morphometry (VBM) revealed grey matter decreases in the left precentral and postcentral gyrus and left middle frontal gyrus while white matter decreases in the right cerebellum and right inferior temporal gyrus of schizophrenics as compared to controls.
The present study provides strong evidence for an association between motor functional deficits and structural alterations in schizophrenic patients as compared to controls.
Psychiatry is a multidisciplinary practice with professionals from diverse backgrounds and training contributing to holistic management plan. Despite, this long established model, and policy support to develop education consortia integral to service planing across, health and social care boundaries, there exists no regular model in modern day clinical practice to share knowledge, skills and expertise amongst different professional groups in a structured manner.
In this context, we developed a Combined Educational Activity (CEA) programme amongst various disciplines. Professionals including Nurses, Doctors, Occupational Therapists, Psychologists, Pharmacists and Support Workers were invited to meet once a fortnight during an extended hand over session of one hour to openly share their knowledge and expertise on complex clinical cases and other relevant topics in the fashion of clinical senate.
After three months a survey was undertaken – A Likert questionnaire was distributed amongst the attendees to collect feedback on the content, structure, utility and criticism of the programme. The results of the survey are outlined in detail.
It was perceived that the Combined Educational Activity (CEA) was effective in sharing knowledge and expertise between professionals and also to reduce negative prejudices against various disciplines and appreciate better each member’s contributions to the overall clinical care. There was overall positive feedback about the programme and each member felt valued for their contribution in their clinical role. Further, it also helped We feel replicating and refining this model across teams would be beneficial in overall clinical care and staff morale in multidisciplinary practice.
Online learning has become an increasingly expected and popular component for education of the modern-day adult learner, including the medical provider. In light of the recent coronavirus pandemic, there has never been more urgency to establish opportunities for supplemental online learning. Heart University aims to be “the go-to online resource” for e-learning in CHD and paediatric-acquired heart disease. It is a carefully curated open access library of paedagogical material for all providers of care to children and adults with CHD or children with acquired heart disease, whether a trainee or a practising provider. In this manuscript, we review the aims, development, current offerings and standing, and future goals of Heart University.
In this paper, longitudinal and lateral-directional aerodynamic characterisation of the Cropped Delta Reflex Wing (CDRW) configuration–based unmanned aerial vehicle is carried out by means of full-scale static wind-tunnel tests followed by full-scale flight testing. A predecided set of longitudinal and lateral/directional manoeuvres is performed to acquire the respective flight data, using a dedicated onboard flight data acquisition system. The compatibility of the acquired dynamics is quantified, in terms of scale factors and biases of the measured variables, using Kinematic consistency check. Maximum likelihood (ML), least squares and newly emerging neural Gauss–Newton (NGN) methods were implemented for a wing-alone delta configuration, mainly to capture the dynamic derivatives for both longitudinal and lateral directional cases. Estimated damping and weak dynamic derivatives, which are in general challenging to capture for a wing alone configuration, are consistent using ML and NGN methods. Validation of the estimated parameters with aerodynamic model is performed by proof-of-match exercise and are presented therein.
Introduction: Abdominal pain is one of the most frequent reasons for an emergency department (ED) visit. Most cases are functional and no therapy has proven effective. Our objective was to determine if hyoscine butylbromide (HBB) (BuscopanTM) is effective for children who present to the ED with functional abdominal pain. Methods: We conducted a randomized, blinded, superiority trial comparing HBB 10 mg plus acetaminophen placebo to oral acetaminophen 15 mg/kg (max 975 mg) plus HBB placebo using a double-dummy approach. We included children 8-17 years presenting to the ED at London Health Sciences Centre with colicky abdominal pain rated >40 mm on a 100 mm visual analog scale (VAS). The primary outcome was VAS pain score at 80 minutes post-administration. Secondary outcomes included adverse effects; caregiver satisfaction with pain management using a five-item Likert scale; recidivism and missed surgical diagnoses within 24-hours of discharge. Analysis was based on intention to treat. Results: We analyzed 225 participants (112 acetaminophen; 113 HBB). The mean (SD) age was 12.4 (3.0) years and 148/225 (65.8%) were females. Prior to enrollment, the median (IQR) duration of pain prior was 2 (4.5) hours and analgesia was provided to 101/225 (44.9%) of participants. The mean (SD) pre-intervention pain scores in the acetaminophen and HBB groups were 62.7 (15.9) mm and 60.3 (17.3) mm, respectively. At 80 minutes, the mean (SD) pain scores in the acetaminophen and HBB groups were 30.1 (28.8) mm and 29.4 (26.4) mm, respectively and there were no significant differences adjusting for pre-intervention scores (p = 0.96). The median (IQR) caregiver satisfaction was high in the acetaminophen [5 (2)] and HBB [5 (1)] groups (p = 0.79). The median (IQR) length of stay between acetaminophen [235 (101)] and HBB [234 (103)] was not significantly different (p = 0.53). The proportion of participants with a return visit for abdominal pain was 4/112 (3.5%) in the acetaminophen group and 6/113 (5.3%) in the HBB group. The most common adverse effect was nausea (9% in each group) and there were no significant differences in adverse effects between acetaminophen (26/112, 23.2%) and HBB (31/113, 27.4%) (p = 0.52). There were no missed surgical diagnoses. Conclusion: For children with presumed functional abdominal pain who present to the ED, both acetaminophen and HBB produce a clinically important (VAS < 30 mm) reduction in pain and should be routinely considered in this clinical setting.
Stereotactic body radiotherapy (SBRT) is widely used for the treatment of stage-I non-small cell lung cancer (NSCLC). Patient-specific motion correlated with 4DCT could be essential for hypofractionated SBRT. All patients undergoing SBRT do not require motion management during the dose delivery. The objective of this study was to evaluate which patient may benefit from Gated SBRT.
Materials and methods
Treatment planning of 20 patients of stage-I NSCLC was analysed. Conventional and 4DCT scans were taken. Internal target volume as well as planning target volume (ITV and PTV) were determined in the CT data sets. PTVall phases created using 4DCT data sets and PTV15mm created using conventional CT data were compared. Also, ITVall phases were compared with ITV created from maximum intensity projections (ITVMIP). Suitability of patients for motion management-based treatment delivery was also evaluated.
The average ITVMIP to ITVall phases ratio is 1·06 indicating good agreement between them. Based on the ratio of intensity projections, 9 out of 17 patients were found suitable for our existing gated treatment.
4D CT is the main requirement in SBRT to identify the patients who can benefit from motion management during the dose delivery.
Grewia tenax locally known as ‘Gangerun’, is an important multipurpose underutilized shrub and potentially threaten species of the Thar Desert of India. Owing to its importance, naturally available germplasm was collected and evaluated for its sustainable utilization in future. Data on individual mother plant, seed characters and soil profile were investigated. Habitat occurrence of G. tenax was found in patches with dominant association of Euphorbia caducifolia across the four districts of western Rajasthan. Individual plant on unprotected area portrayed far lower average height (0.95 m) and canopy area (1.75 m2) than protected area (2.63 m and 13.89 m2) signifying level of browsing pressure on this species in Jaisalmer. Soil samples belonging to Pali region have high organic carbon and low electrical conductivity content than Jaisalmer and Jodhpur. The statistical analysis of seed characters revealed the presence of high coefficient of variation (%) in 100-seed weight (HSW; 27.36) followed by seed length (SL; 8.06) and least in seed breadth (SB; 5.85). The range and mean values of HSW, SL, SB and length:breadth ratio (LBR) were (2.02–7.00 and 3.34 g), (4.36–6.15 and 5.36 mm), (3.73–4.68 and 4.25 mm) and (1.11–1.44 and 1.27), respectively. Significantly positive correlation was observed between SL and LBR (0.73) followed by HSW and SL (0.66). Along with these findings, its economic importance, utilization and conservation are detailed in this paper as to hasten further research on its various aspects for its successful conservation and utilization.
Metal–graphene composites are sought after for various applications. A hybrid light-weight foam of nickel (Ni) and reduced graphene oxide (rGO), called Ni-rGO, is reported here for small molecule oxidations and thereby their sensing. Methanol oxidation and non-enzymatic glucose sensing are attempted with the Ni-rGO foam via electrocatalytically, and an enhanced methanol oxidation current density of 4.81 mA/cm2 is achieved, which is ~1.7 times higher than that of bare Ni foam. In glucose oxidation, the Ni-rGO electrode shows a better sensitivity over bare Ni foam electrode where it could detect glucose linearly over a concentration range of 10 µM to 4.5 mM with a very low detection limit of 3.6 µM. This work demonstrates the synergistic effects of metal and graphene in oxidative processes, and also shows the feasibility of scalable metal–graphene composite inks development for small molecule printable sensors and fuel cell catalysts.
Introduction: In children, acute otitis media (AOM) pain is undertreated. We sought to determine if video discharge instructions were associated with improved symptomatology, functional outcomes, and knowledge compared to a paper handout. Methods: We conducted a randomized controlled superiority trial comparing video discharge instructions (Easy Sketch Pro3TM) on management of pain to a paper handout detailing the same. We included caregivers of children 6 months to 5 years presenting to the emergency department (ED) with a clinical diagnosis of AOM. The primary outcome was symptomatology using the Acute Otitis Media Severity of Symptom (AOM SOS) score between 48 and 72 hours. The 7-item self-report AOM-SOS is scored from 0 to 13 with a higher score indicating more symptomatology. Secondary outcomes included knowledge gain using a 10-item survey, days of daycare/school/work missed, and recidivism. Assuming a minimal clinically important AOM-SOS difference of 2, 90% power, and 5% alpha, 60 individuals/group was needed. Results: 219 caregivers were randomized and 149 completed the 72-hour follow-up (72 paper and 77 video). The median (IQR) AOM-SOS score in the video group (adjusted for pre-intervention AOM-SOS, analgesic and antibiotic use) was significantly lower than paper [8 (7,11) versus 10 (7,13), respectively, p=0.004]. There were no significant differences between video and paper in the mean (SD) knowledge score [9.2 (1.3) versus 8.8 (1.8) correct answers, respectively, p=0.07], mean (SD) number that returned to a health provider [8/77 versus 10/72, respectively, p=0.49), mean (SD) number of daycare/schooldays missed [1.2 (1.5) versus 1.1 (2.1), respectively, p=0.62], and mean (SD) number of workdays missed by caregiver [0.5 (1) versus 0.8 (2), respectively, p=0.05]. Conclusion: Video discharge instructions are associated with less symptomatology compared to a paper handout, are effective for caregiver education in the ED, and should be used routinely.
In this paper we have studied space weather conditions near 53 potentially habitable exoplanets reported in literature using available information on the chromoshperic activity of their host stars and nature of dynamical interactions possible in the respective star-planetary systems.
In this paper, we present a model characterizing the interaction of a radiative shock (RS) with a solid material, as described in a recent paper (Koenig et al., Phys. Plasmas, 24, 082707 (2017)), the new model is then related to recent experiments performed on the GEKKO XII laser facility. The RS generated in a xenon gas cell propagates towards a solid obstacle that is ablated by radiation coming from the shock front and the radiative precursor, mimicking processes occurring in astrophysical phenomena. The model presented here calculates the dynamics of the obstacle expansion, which depends on several parameters, notably the geometry and the temperature of the shock. All parameters required for the model have been obtained from experiments. Good agreement between experimental data and the model is found when spherical geometry is taken into account. As a consequence, this model is a useful and easy tool to infer parameters from experimental data (such as the shock temperature), and also to design future experiments.
A new target design is presented to model high-energy radiative accretion shocks in polars. In this paper, we present the experimental results obtained on the GEKKO XII laser facility for the POLAR project. The experimental results are compared with 2D FCI2 simulations to characterize the dynamics and the structure of plasma flow before and after the collision. The good agreement between simulations and experimental data confirms the formation of a reverse shock where cooling losses start modifying the post-shock region. With the multi-material structure of the target, a hydrodynamic collimation is exhibited and a radiative structure coupled with the reverse shock is highlighted in both experimental data and simulations. The flexibility of the laser energy produced on GEKKO XII allowed us to produce high-velocity flows and study new and interesting radiation hydrodynamic regimes between those obtained on the LULI2000 and Orion laser facilities.
Spiking Neural Networks propose to mimic nature’s way of recognizing patterns and making decisions in a fuzzy manner. To develop such networks in hardware, a highly manufacturable technology is required. We have proposed a silicon-based leaky integrate and fire (LIF) neuron, on a sufficiently matured 32 nm CMOS silicon-on-insulator (SOI) technology. The floating body effect of the partially depleted (PD) SOI transistor is used to store “holes” generated by impact ionization in the floating body, which performs the “integrate” function. Recombination or equivalent hole loss mimics the “leak” functions. The “hole” storage reduces the source barrier to increase the transistor current. Upon reaching a threshold current level, an external circuit records a “firing” event and resets the SOI MOSFET by draining all the stored holes. In terms of application, the neuron is able to show classification problems with reasonable accuracy. We looked at the effect of scaling experimentally. Channel length scaling reduces voltage for impact ionization and enables sharper impact ionization producing significant designability of the neuron. A circuit equivalence is also demonstrated to understand the dynamics qualitatively. Three distinct regimes are observed during integration based on different hole leakage mechanism.