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Hyperthermia is defined as an elevated body temperature above the normal range due to a failure of heat regulatory mechanisms. In addition to its effects on other organ systems, hyperthermia is associated with profound cardiovascular effects. We report the sentinel case of a 6-year-old girl with structurally and electrically normal heart, who presented with life-threatening hyperpyrexia-induced ventricular tachycardia, which was refractory to cardioversion and anti-arrhythmics but responded promptly to cooling. We emphasise the lifesaving role of immediate and aggressive cooling in such patients.
Sialidosis, a rare autosomal recessive disorder, is caused by a deficiency of NEU1 encoded enzyme alpha-N-acetyl neuraminidase. We report a premature male with neonatal-onset type II sialidosis which was associated with left ventricular dysfunction. The clinical presentation and subsequent progression which culminated in his untimely death at 16 months of age are succinctly described. Early-onset cardiovascular involvement as noted in this patient is not well characterised. The case report is supplemented by a comprehensive review of the determinants, characteristics, and the clinical course of cardiovascular involvement in this rare condition.
Non-medical opioid use (NMOU) is a growing crisis. Cancer patients at elevated risk of NMOU (+risk) are frequently underdiagnosed. The aim of this paper was to develop a nomogram to predict the probability of +risk among cancer patients receiving outpatient supportive care consultation at a comprehensive cancer center.
Method
3,588 consecutive patients referred to a supportive care clinic were reviewed. All patients had a diagnosis of cancer and were on opioids for pain. All patients were assessed using the Edmonton Symptom Assessment Scale (ESAS), Screener and Opioid Assessment for Patients with Pain (SOAPP-14), and CAGE-AID (Cut Down-Annoyed-Guilty-Eye Opener) questionnaires. “+risk” was defined as an SOAPP-14 score of ≥7. A nomogram was devised based on the risk factors determined by the multivariate logistic regression model to estimate the probability of +risk.
Results
731/3,588 consults were +risk. +risk was significantly associated with gender, race, marital status, smoking status, depression, anxiety, financial distress, MEDD (morphine equivalent daily dose), and CAGE-AID score. The C-index was 0.8. A nomogram was developed and can be accessed at https://is.gd/soappnomogram. For example, for a male Hispanic patient, married, never smoked, with ESAS scores for depression = 3, anxiety = 3, financial distress = 7, a CAGE score of 0, and an MEDD score of 20, the total score is 9 + 9+0 + 0+6 + 10 + 23 + 0+1 = 58. A nomogram score of 58 indicates the probability of +risk of 0.1.
Significance of results
We established a practical nomogram to assess the +risk. The application of a nomogram based on routinely collected clinical data can help clinicians establish patients with +risk and positively impact care planning.
Thrombosis, especially in the Fontan pathway, is one of the major concerns in patients who underwent Fontan surgery, with reported prevalence of 5–33%. We report a case of thrombus in a rudimentary left ventricle in teenager with no arrhythmia or neurological complications. We also report the special concerns of silent thrombus and role of cardiac MRI in diagnosing an intracardiac thrombus.
By
Ankur Sarin, member of the faculty in the Public Systems Group at the Indian Institute of Management Ahmedabad,
M. S. Sriram, currently Visiting Faculty at the Indian Institute of Management, Bangalore.
Edited by
Devi Vijay, Indian Institute of Management, Calcutta,Rohit Varman, Indian Institute of Management, Calcutta
Markets, today represent not just arenas of exchange but a way of life that organises activities based on values assigned (explicitly or implicitly) by the market (Sandel, 2012). In the veneer of economic objectivity and value neutrality, market-based values continue to displace other values that emphasise different sensitivities and alternate normative forms of organising society. The ecological destruction resulting from the deepening of ‘market societies’ is tangible and increasingly indisputable. And so are the inequalities that appear to be the natural (and perhaps celebrated) outcomes in such societies. While the glaring and pernicious effects have been alarmingly met with indifference and an inertial bias for the status quo, it has also been met with organisations that seek to challenge what is increasingly apparent as a dangerous way of life.
In this chapter, we study organisations seeking to promote social change that forces them to engage with markets, even while they resist the dominant principles characterising the markets in which they work are based. Despite subscribing to visions of development that are clearly inconsistent with those promoted by dominant discourses of market-based development, these organisations have no option but to engage with markets. In doing so, they often have to reject mainstream measures of success and constantly strive to challenge the market structures even as they continue to operate in them and perhaps even depend on them to achieve their goals. Conventional frames of understanding organisations may lead us to unfavourable views of such organisations, in comparison with others who might be operating in the same spaces, with greater alignment with dominant market logics. However, we argue this would be severely underestimating the work such organisations do. Instead, they reflect more on the measures used and the horizons privileged by these measures than the societal and ecological value created by such organisations.
While we do not think that such contestations are limited to only these, the organisations we focus on this chapter are Dastkar Andhra (DA) and its sister organisations: Selco Solar Limited (Formerly, the Solar Electric Light Company, India), Decentralised Cotton Yarn Trust (DCYT) and Pratham Books. The Oxford Dictionary defines contestation as ‘the action or process of disputing or arguing’.
This work investigates the relative contributions to strengthening from twinning, solid-solution, precipitation, and irradiation hardening mechanisms in sputtered Cu–W thin films irradiated to different doses. A nanograin solid solution strengthening mechanism with a linear compositional dependence is observed for the as-grown alloys and for the alloy samples irradiated to 0.5 dpa. Solid solution strengthening is the major strengthening mechanism for Cu99.5W0.5 at all irradiation doses. Irradiation induces precipitation in samples with W concentrations greater than or equal to 1% at doses above ≈0.5 dpa. The growth of 1–4 nm precipitates enhances the hardness of these alloys, and the degree of strengthening is determined by the interparticle spacing. While the alloys exhibit steady-state properties after a relatively low dose (≈1 dpa), the different time scales associated with detwinning and damage accumulation in pure Cu lead transients at higher doses (>5 dpa).
Accelerated junctional rhythm has been reported in children in the setting of acute rheumatic fever; however, we describe a hitherto unreported case of isolated junctional tachycardia in a child with streptococcal pharyngitis, not meeting revised Jones criteria for rheumatic fever. A previously healthy, 9-year-old girl presented to the emergency department with complaints of sore throat, low-grade fever, and intermittent chest pain. She was found to have a positive rapid streptococcal antigen test. The initial electrocardiogram showed junctional tachycardia with atrioventricular dissociation in addition to prolonged and aberrant atrioventricular conduction. An echocardiogram revealed normal cardiac anatomy with normal biventricular function. The patient responded to treatment with amoxicillin for streptococcal pharyngitis. The junctional tachycardia and other electrocardiogram abnormalities resolved during follow-up.
Studies of diet and disease risk in India and among other Asian-Indian populations are hindered by the need for a comprehensive dietary assessment tool to capture data on the wide variety of food and nutrient intakes across different regions and ethnic groups. The nutritional component of the India Health Study, a multicentre pilot cohort study, included 3908 men and women, aged 35–69 years, residing in three regions of India (New Delhi in the north, Mumbai in the west and Trivandrum in the south). We developed a computer-based, interviewer-administered dietary assessment software known as the ‘NINA-DISH (New Interactive Nutrition Assistant – Diet in India Study of Health)’, which consisted of four sections: (1) a diet history questionnaire with defined questions on frequency and portion size; (2) an open-ended section for each mealtime; (3) a food-preparer questionnaire; (4) a 24 h dietary recall. Using the preferred meal-based approach, frequency of intake and portion size were recorded and linked to a nutrient database that we developed and modified from a set of existing international databases containing data on Indian foods and recipes. The NINA-DISH software was designed to be easily adaptable and was well accepted by the interviewers and participants in the field. A predominant three-meal eating pattern emerged; however, patterns in the number of foods reported and the primary contributors to macro- and micronutrient intakes differed by region and demographic factors. The newly developed NINA-DISH software provides a much-needed tool for measuring diet and nutrient profiles across the diverse populations of India with the potential for application in other South Asian populations living throughout the world.
Linear, ring and 3D structures of (ZnTe)n clusters for n = 2–6 are completely optimized using B3LYP/LanL2DZ basis set. The stability, dipole moment and point group for linear, ring and 3D structures are studied. The stability of the clusters is found to increase with the increase in the cluster size. The dipole moment of the cluster depends upon the asymmetry of the atoms in the structure. The HOMO-LUMO gap, electron affinity, ionization potential and stability factor of different isomers for these different structures are also compared and studied. From the observed studies it is found that the electronic and chemical properties are influenced by the electron affinity and HOMO-LUMO gap. The calculated parameters and the results of different structures will provide clear information to fabricate a new material that has commercial importance in the thin film solar cells and optoelectronic devices.
This article discusses the results of transmission electron microscopy (TEM)-based characterization of strontium-doped lead zirconate titanate (PSZT) thin films. The thin films were deposited by radio frequency magnetron sputtering at 300°C on gold-coated silicon substrates, which used a 15 nm titanium adhesion layer between the 150 nm thick gold film and (100) silicon. The TEM analysis was carried out using a combination of high-resolution imaging, energy filtered imaging, energy dispersive X-ray (EDX) analysis, and hollow cone illumination. At the interface between the PSZT films and gold, an amorphous silicon-rich layer (about 4 nm thick) was observed, with the film composition remaining uniform otherwise. The films were found to be polycrystalline with a columnar structure perpendicular to the substrate. Interdiffusion between the bottom metal layers and silicon was observed and was confirmed using secondary ion mass spectrometry. This occurs due to the temperature of deposition (300°C) being close to the eutectic point of gold and silicon (363°C). The diffused regions in silicon were composed primarily of gold (analyzed by EDX) and were bounded by (111) silicon planes, highlighted by the triangular diffused regions observed in the two-dimensional TEM image.
The ablation of strontium-doped lead zirconate titanate (PSZT) and lanthanum-doped lead zirconate titanate (PLZT) films has been examined using a 5 ns pulsed excimer laser. Individual squares were patterned with sides in the range of 10-30 µm using single and multiple pulses. The depth of ablation in PLZT films was higher at all fluences than in PSZT films. The morphology of the etched surfaces has comprised the formation of globules which had diameters of 200-250 nm in PLZT and 1400-1600 nm in PSZT films. The diameter of the globules has been shown to increase with fluence until reaching an approximately constant size at >20 J/cm2 in both types of film. The composition of the films following ablation has been analyzed using x-ray photoelectron spectroscopy (XPS) and energy dispersive x-ray (EDX) spectroscopy.
Significant progress has been made in the development of SiC metal semiconductor field-effect transistors (MESFETs) and monolithic microwave integrated-circuit (MMIC) power amplifiers for high-frequency power applications. Three-inch-diameter high-purity semi-insulating 4H-SiC substrates have been used in this development, enabling high-volume fabrication with improved performance by minimizing surface- and substrate-related trapping issues previously observed in MESFETs. These devices exhibit excellent reliability characteristics, with mean time to failure in excess of 500 h at a junction temperature of 410°C. A sampling of these devices has also been running for over 5000 h in an rf high-temperature operating-life test, with negligible changes in performance. High-power SiC MMIC amplifiers have also been demonstrated with excellent yield and repeatability. These MMIC amplifiers show power performance characteristics not previously available with conventional GaAs technology. These developments have led to the commercial availability of SiC rf power MESFETs and to the release of a foundry process for MMIC fabrication.
We studied the correlation of in and ex situ stress to microstructures during Al-induced crystallization for structures of Al on top (AOT) and Al on bottom (AOB) of amorphous Si (a-Si) on 3000 Å SiO2 coated on Si wafers and found that a-Si deposited on PECVD SiO2 and Al increases the stress compressively, and Al deposited on PECVD SiO2 and on a-Si decreases the stress tensilely. In addition, the stress of AOB structures is in general less than that of AOT structures. Correlation of stress to microstructures indicated that the difference in microstructures between AOT and AOB results from the nature of the layer structures themselves. By using modified Stoney's equation, the lower stress of AOB structures than AOT could be explained with existence of oxide between a-Si and Al for both AOT and AOB structures.
This paper describes the results of extensive performance and reliability characterization of a silicon-based surface micro-machined tunable optical filter. The device comprises a high-finesse Fabry-Perot etalon with one flat and one curved dielectric mirror. The curved mirror is mounted on an electrostatically actuated silicon nitride membrane tethered to the substrate using silicon nitride posts. A voltage applied to the membrane allows the device to be tuned by adjusting the length of the cavity. The device is coupled optically to an input and an output single mode fiber inside a hermetic package. Extensive performance characterization (over operating temperature range) was performed on the packaged device. Parameters characterized included tuning characteristics, insertion loss, filter line-width and side mode suppression ratio. Reliability testing was performed by subjecting the MEMS structure to a very large number of actuations at an elevated temperature both inside the package and on a test board. The MEMS structure was found to be extremely robust, running trillions of actuations without failures. Package level reliability testing conforming to Telcordia standards indicated that key device parameters including insertion loss, filter line-width and tuning characteristics did not change measurably over the duration of the test.
The ferrite with composition Cu0.5Fe2.5O4 was heat treated in air and in reducing atmospheres to different temperatures within the solid solution region confirmed by dynamic high-temperautre x-ray characterization. The samples were quenched in oil and air, and lattice parameter, Curie temperature, and saturation magnetization measurements were completed. The magnetization measurements for these samples showed a maximum 4πMs of 0.7729 and 0.5426 T at 10 and 300 K, respectively. The cationic distribution based on the low-temperature 4πMs measurements is (Cu+0.24Fe3+0.76)A[Cu+0.26Fe3+1.74]BO4 → 4.9 µ B. X-ray-pure Cu0.5Fe2.5O4 samples were also synthesized by slow cooling from the formation temperature to 900 °C in a reducing atmosphere. A temperature–PO2 diagram for the stability of Cu0.5Fe2.5O4 under the conditions of the experiment was determined. Low-temperature 4πMs measurements did not indicate an increase in the Cu+ A site occupancy for the samples cooled to 900 °C in a reducing environment above those samples that were quenched from high temperature. Curie temperatures for all Cu0.5Fe2.5O4 samples ranged from 348 to 369 °C. Lithium additions (0.1 mol/unit formula) to copper ferrite Li0.1Cu0.4Fe2.5O4 decreased the room-temperature 4πMs values to 0.5234 T with a corresponding decrease in the 10 K measurements to 0.7047 T. From the low-temperature magnetization measurements, the distribution was (Cu+0.15Fe3+0.85)A[Cu+0.25Li+0.1Fe3+1.65]BO4 → 4.48 µ B.
The diffraction contrast from dissociated ½<112] superdislocations in γ-TiAl intermetallic alloy cannot always be analyzed using conventional rules of diffraction contrast. In particular, the configuration involving three similar Shockley partials on adjacent planes has often been ruled out due to the absence of fringes indicating the presence of stacking faults. In order to determine the dissociated configuration, weak-beam transmission electron microscope observations of edge-oriented ½<112] superdislocations have been correlated with computer simulated images. Dissociation of these superdislocations into three similar ⅙<112] partial dislocations bounding a superlattice extrinsic and intrinsic stacking fault pair has been consequently determined from these analyses. It has been found that diffraction contrast alone cannot distinguish between the various configurations that lead to the formation of the fault pair, but the formation of an antiphase boundary or complex stacking fault linked dissociation or locking by stair rod dislocations can be ruled out.