Finleyalbertsen6539
130±14/75±10 mmHg), and asleep (123±15/68±6 mmHg vs. 120±17/66±9 mmHg) periods between the control and isometric sessions, respectively (p>0.05). In conclusion, an isometric biceps exercise session does not elicit an acute antihypertensive effect in adults with hypertension, which suggests that its prescription to improve the acute BP control is limited.Glaucoma poses the second largest cause of severe visual impairment and loss of vision worldwide. Despite the progress in both pharmaceutical and surgical treatments, the attempts to decrease intraocular pressure and prevent progression of glaucomatous optic neuropathy fail in many cases. Hence there is a high demand for additional complementary methods, which can reduce intraocular pressure and improve ocular blood flow as well as mental well-being. On the basis of literature research, the study results published so far on the effectiveness of psychotherapeutical methods in glaucoma therapy will be presented here. The methods of autogenic training, hypnosis and music therapy have already been demonstrated to have a positive effect on intraocular pressure, ocular blood flow and psychological well-being of patients affected by glaucoma. With these methods being not only effective but also cost-efficient, free of side effects and easily administered, they could gain importance in terms of an adjuvant treatment option for patients with glaucoma. However, regular ophthalmological examinations still remain obligatory.Inherited retinal dystrophies (IRD) have been studied since their recognition by Franz Donders and Albrecht von Graefe. It nevertheless took 100 years for a causal therapy to take shape in the form of gene therapy The approval of Voretigen Neparvovec (VN) for the treatment of hereditary retinal dystrophies due to RPE65 mutations was thus a significant milestone - for the era of personalised medicine in general and ophthalmology in particular. The clinical management around gene therapy applications is complex and requires the cooperation of various experts as a multidisciplinary team. This article describes the requirements, challenges, approaches, and open questions regarding the surgical aspects of gene therapy for retinal dystrophies. The first part outlines the standard surgical treatment. Based on this standard, alternative approaches are indicated for each individual step and their value discussed. Knowledge gaps are defined and in the outlook we speculate on future developments.
Little has been published about the choroidal vascular changes that occur years after radiation exposure. The aim of this study was to review the histological changes observed in the choroidal vasculature following radiotherapy for uveal melanoma.
Records from a single institution were retrospectively reviewed from June 7, 2007 to June 7, 2017; 101 patients with a diagnosis of uveal melanoma that underwent enucleation had their records reviewed. Out of these, a total of 26 eyes had undergone plaque brachytherapy prior to enucleation, which had been performed at a mean time of 7.2 years (range from 0 years to 30 years) after the initial plaque placement. A histopathologic analysis was conducted on all 26 eyes with special emphasis on the choroidal changes. Of these 26 eyes, 18 demonstrated evidence of radiation-induced vasculopathy.
Of the 18 eyes, 10/18 (55%) had radiation retinopathy and 16/18 (89%) had radiation choroidal vasculopathy. One patient had a phthisical eye, and the choroid could not be evamilar to the clinical spectrum of CNV, PCV, and RAP.
Since home confinement for novel coronavirus disease 2019 (COVID-19) pandemic began, pediatric visits to the emergency department (ED) have decreased, including consultation for abdominal pain. Our aim is to investigate the incidence of complicated acute appendicitis (AA; peritonitis or appendicular mass) during confinement for COVID-19 pandemic and to compare it with the previous 5 years.
A retrospective study was performed in children with AA who underwent surgery between March 9 and April 13 from 2015 to 2020; patients were divided into six groups according to the year of surgery. We analyzed demographic variables, time from onset of symptoms, mean hospital stay, cumulative incidence, and incidence rate of complicated appendicitis.
A total of 168 patients were included with no differences in the number of patients, gender, and age between groups. Patients in 2020 (COVID-19 group) presented longer symptom progression time (46.8 hours;
= 0.046), higher rate of complicated appendicitis (48.4%;
= 0.004), longer mean hospital stay (4.9 days;
< 0.001), increased cumulative incidence (8.27 cases per 100,000 children per 0.1 years;
< 0.001), and increased incidence rate of complicated appendicitis (83 cases per 100,000 children;
< 0.001) when compared with other groups.
Delayed ED visit of children with AA during home confinement lead to an increased rate of complicated appendicitis. It is crucial to make parents aware of the importance of early diagnosis and treatment of abdominal pain.
Delayed ED visit of children with AA during home confinement lead to an increased rate of complicated appendicitis. It is crucial to make parents aware of the importance of early diagnosis and treatment of abdominal pain.The aim of this article is to outline the correct demonstration of the fetal corpus callosum with 3D ultrasound between 18 and 40 weeks of gestation. An abdominal or transvaginal 3D transducer can be used for acquisition of the fetal brain depending on the position of the fetus. The best demonstration of the corpus callosum can be achieved, when the volume with the corpus callosum is acquired from a sagittal or parasagittal sectional plane of the brain. Once the volume is stored in the memory, the multiplanar mode allows manipulation in all three dimensions until the exact median plane is seen, showing the corpus callosum as a hypo- or anechoic curved structure. Volume acquisition of the brain from an axial plane of the fetal head - typically used for biometrical measurements of the head diameters - is not recommended for clinical evaluation of the corpus callosum because the reconstructed median plane does not reveal the margins and the structure of the corpus callosum precisely. Other display modes such as volume contrast imaging (VCI), OmniView-VCI, and tomographic display may also be used for demonstration of the corpus callosum. However, these display modes only provide the operator with good image quality of the corpus callosum if the fetal brain was acquired from a sagittal and not from an axial plane. CONCLUSION 3D ultrasound is an excellent clinical tool for the exact presentation of the fetal corpus callosum because it allows volume manipulation of the fetal head in all three dimensions with precise demonstration of the median plane of the brain.Thromboinflammation is a still not well-understood phenomenon, which has recently come to the foreground as a function of its relevance in the pathophysiology of coronavirus disease 2019 (COVID-19). The patient described in the present case report exhibited acute fever, giant urticaria, elevated acute phase reactants, and very high d-dimer levels, thus characterizing thromboinflammation. She was diagnosed as a COVID-19 suspect case, which was not confirmed; urticarial vasculitis was ruled out. Homeopathic treatment was started with the earliest clinical manifestations, resulting in rapid and drastic reduction of inflammation and hypercoagulability within the first 12 hours, and full recovery on 10-day follow-up assessment. This case demonstrates the effectiveness of homeopathy in a severe acute disorder, and points to the need to include laboratory testing in homeopathic clinical assessment to achieve an accurate picture of disease, and to avoid the risk of passing over life-threatening disorders.Protein tyrosine phosphatase 1B plays a significant role in type 2 diabetes mellitus and other diseases and is therefore considered a new drug target. Within this study, an acetone extract from the lichen Stereocaulon evolutum was identified to possess strong protein tyrosine phosphatase 1B inhibition in a cell-free assay (IC50 of 11.8 µg/mL). Fractionation of this bioactive extract led to the isolation of seven known molecules belonging to the depsidones and the related diphenylethers and one new natural product, i.e., 3-butyl-3,7-dihydroxy-5-methoxy-1(3H)-isobenzofurane. The isolated compounds were evaluated for their inhibition of protein tyrosine phosphatase 1B. Two depsidones, lobaric acid and norlobaric acid, and the diphenylether anhydrosakisacaulon A potently inhibited protein tyrosine phosphatase 1B with IC50 values of 12.9, 15.1, and 16.1 µM, respectively, which is in the range of the protein tyrosine phosphatase 1B inhibitory activity of the positive control ursolic acid (IC50 of 14.4 µM). Molecular simulations performed on the eight compounds showed that i) a contact between the molecule and the four main regions of the protein is required for inhibitory activity, ii) the relative rigidity of the depsidones lobaric acid and norlobaric acid and the reactivity related to hydrogen bond donors or acceptors, which interact with protein tyrosine phosphatase 1B key amino acids, are involved in the bioactivity on protein tyrosine phosphatase 1B, iii) the cycle opening observed for diphenylethers decreased the inhibition, except for anhydrosakisacaulon A where its double bond on C-8 offsets this loss of activity, iv) the function present at C-8 is a determinant for the inhibitory effect on protein tyrosine phosphatase 1B, and v) the more hydrogen bonds with Arg221 there are, the more anchorage is favored.Plants of the genus Hypericum, commonly known as "St. John's wort" ("spathohorto" or "valsamo" in Greek), have been used since antiquity for their therapeutic properties. Wild-harvested Hypericum plants are still popular today in herbal medicines, commercially exploited due to their bioactive compounds, hypericin and hyperforin, which have antidepressant, antimicrobial and antiviral activity. Species identification of commercial products is therefore important and DNA barcoding, a molecular method that uses small sequences of organisms' genome as barcodes, can be useful in this direction. In this study, we collected plants of the genus Hypericum that grow wild in North-Eastern Greece and explored the efficiency of matK, and trnH-psbA regions as DNA barcodes for their identification. We focused on 5 taxa, namely H. aucheri, H. montbretii, H. olympicum, H. perforatum subsp. perforatum, and H. thasium, the latter a rare Balkan endemic species collected for the first time from mainland Greece. matK (using the genus-specific primers designed herein), trnH-psbA, and their combination were effectively used for the identification of the 5 Hypericum taxa and the discrimination of different H. perforatum subsp. perforatum populations. These barcodes were also able to discriminate Greek populations of H. perforatum, H. aucheri, H. montbretii, and H. olympicum from populations of the same species growing in other countries.Actinomycosis is an infectious disease caused by gram-positive, facultative anaerobic bacteria, which in most cases manifests itself in the cervicofacial area and often has a dentogenic focus. The clinical presentation ranges from acute abscess to chronically fistulating soft tissue processes. Early diagnosis and an appropriate therapeutic approach including a combination of extensive antibiotic treatment and, if necessary, surgical intervention are critical. This article presents five cases of actinomycete infections, which are intended to illustrate the variety of clinical presentations, the problems on the way to the correct diagnosis and possible therapeutic courses.
Low levels of SHBG have become a marker for insulin resistance and diabetes. Babies born to mothers who are obese, have diabetes, or smoke during pregnancy are at greater risk of developing obesity and diabetes later in life.
To examine the impact of maternal obesity, diabetes and smoking on SHBG levels in newborns.
This cross-sectional study is part of an ongoing multicenter, longitudinal study.
98 healthy newborns and their parents, including 16 mothers with diabetes and 31 mothers with a smoking history.
Cord blood and second day venipuncture samples were collected for measurement of SHBG and insulin.
Babies born to mothers with diabetes had lower SHBG levels in cord blood [14.0 (8.9-20.4) vs. 19.6 (14.9-25.1) nmol/L; p=0.011] and on day 2 [18.8 (12.6-21.2) vs. 22.9 (17.1-29.1) nmol/L; p=0.015] than controls. Maternal diabetes remained negatively associated with SHBG levels in cord blood (p=0.02) and on day 2 (p=0.04) when adjusted for mothers' age, smoking status, pre-pregnancy weight and weight gain during pregnancy. SHBG levels in cord blood and day 2 samples were similar in babies born to mothers who were overweight-obese but not diabetic vs. normal weight, or were smokers when compared to non-smokers.
SHBG levels are lower in newborns born to mothers with diabetes than without diabetes, and may be a marker for babies' life-long risk for abnormal metabolic health. On the other hand, the adverse effects of tobacco smoke on the fetus do not appear to directly influence SHBG levels.
SHBG levels are lower in newborns born to mothers with diabetes than without diabetes, and may be a marker for babies' life-long risk for abnormal metabolic health. On the other hand, the adverse effects of tobacco smoke on the fetus do not appear to directly influence SHBG levels.
Limited data exist concerning differences in concussion-education exposure and how education exposures relate to care seeking and symptom disclosure, specifically by National Collegiate Athletic Association Division I student-athletes.
To investigate demographic characteristics associated with concussion-education exposure and examine whether overall education exposure (yes versus no) and education-source exposure number (multiple sources versus a single source) affect concussion care-seeking and disclosure factors in Division I student-athletes.
Cross-sectional study.
Classroom or online survey.
Division I student-athletes (n = 341).
Frequencies and proportions were computed for sex, race, school year, sport, and concussion history across concussion-education groups. Prevalence ratios (PRs) and 95% CIs were calculated to quantify the associations between student-athlete characteristics and (1) overall concussion-education exposure and (2) source-exposure number. Separate multivariable linear regred PR = 0.82; 95% CI = 0.68, 0.99). Overall concussion-education exposure was significantly associated with more favorable perceived social norms surrounding concussion care seeking (adjusted MD = 1.37; 95% CI = 0.13, 2.61).
These findings highlighted the potential differences in overall concussion-education exposure and provide clinicians with information on groups who may benefit from additional targeted education.
These findings highlighted the potential differences in overall concussion-education exposure and provide clinicians with information on groups who may benefit from additional targeted education.
Mentoring has been identified as an important method of supporting newly credentialed athletic trainers (ATs) during their transition to practice. Gaining a better understanding of this relationship could provide valuable insights that may assist employers and professional programs in developing a plan to better facilitate the transition.
To examine which aspects of the mentoring relationship provided the most benefit during transition to practice of newly certified ATs.
Qualitative study.
Individual phone interviews.
A total of 13 ATs who graduated from a professional master's program, were certified from February through July 2016, and obtained employment from July through August of 2016 participated in this study (6 women, 7 men; age = 26 ± 3 years; work settings included professional sports, college, secondary and middle school, and clinic). Data saturation guided the number of participants.
Phone interviews using a semistructured interview guide were conducted at 3, 8, and 12 months of work e
Newly credentialed ATs should seek a mentor who will be available to communicate in various ways and will provide regular and constructive feedback. Future researchers should investigate how mentoring relationships influence other aspects of the transition to practice, such as patient care, overall job performance, turnover, and satisfaction.Aside from the Christmas season, another cultural period that stimulates abundant tourism and travel in the Philippines is the Lenten season. Hence, this season is a major setback in the containment of the coronavirus disease 2019. Fasting and abstinence, acts which mark the Lenten season, are closely tied up with the Filipino cultural value of pagtitimpi in that both promote restraint and self-denial. Ultimately, this article suggests that reinterpreting pagtitimpi can be crucial in controlling the virus.A stability-indicating reverse phase high-performance liquid chromatography method was developed and validated for simultaneous quantification of apremilast (APL) and betamethasone dipropionate (BD) in bulk as well as drug loaded microsponges. Various mobile phase systems were screened to check the system suitability followed by force degradation analysis to determine APL and BD stability under varying stress conditions. A central composite design model was used to optimize the column temperature and flow rate using Design Expert® (9.0.1). One factor at a time approach with five independent factors were used to validate the robustness of the method. Finally, APL and BD were precisely and accurately quantified from drug loaded microsponges using the validated method. A favorable separation of APL and BD was obtained on a Phenomenex® Luna C18 column using a mixture of 50 mM phosphate buffer containing 0.1% triethylamine (pH 6.1) and acetonitrile (6040%v/v) as mobile phase. Both the drugs were found to be stable when exposed to stressors such as heat-, light-, alkali-, acid- and peroxide-induced degradation. The calibration curves were found to be linear with appreciable limit of detection and limit of quantification. Recovery and percentage relative standard deviation of peak areas for APL and BD were found to be less then 2.0% and 99-100% in bulk drug solution and less then 2.0% and 99-103% in microsponge formulation, respectively. Statistical analysis using analysis of variance indicated that the model was significant (P less then 0.001). Hence, the developed method can be effectively used to quantify APL and BD, both in bulk as well as microsponge formulations.
The doctor of athletic training (DAT) degree has recently been introduced into academe. Limited literature exists regarding how individuals with this degree can become part of an athletic training faculty.
To identify department chairs' perceptions of the DAT degree and determine whether they viewed the degree as viable when hiring new faculty within a postbaccalaureate professional athletic training program.
Cross-sectional study.
Online survey instrument.
A total of 376 department chairs who had oversight of Commission on Accreditation of Athletic Training Education athletic training programs were invited to participate. Of these, 190 individuals (50.5%) accessed the survey, and 151 of the 190 department chairs (79.5%) completed all parts of the survey.
A Web-based survey instrument consisted of several demographic questions and 4-point Likert-scale items related to perceptions of the DAT degree. Independent variables were degree qualifications, advanced degree requirements, institutional contro for athletic trainers with the DAT degree in clinical practice settings.
Department chairs recognized the DAT degree as a viable degree qualification for teaching in professional athletic training programs. Future researchers should examine the need for athletic trainers with the DAT degree in clinical practice settings.
Researchers have traditionally used motion capture to quantify discrete biomechanical data points (peak values) during hop testing. However, these analyses restrict the evaluation to a single time point (ie, certain percentage of stance) and provide only a narrow view of movement. Applying more comprehensive analyses may help investigators identify important characteristics that are masked by the discrete analyses often used to screen patients for activity.
To examine the utility of functional data analyses to reveal asymmetries that are undetectable using discrete (ie, single time point) evaluations in participants with a history of anterior cruciate ligament reconstruction (ACLR) who achieved clinical hop symmetry.
Cross-sectional study.
Laboratory.
Fifteen participants with unilateral ACLR (age = 21 ± 3 years, time from surgery = 4 ± 3 years) and 15 control participants without ACLR (age = 23 ± 2 years).
Lower extremity biomechanics during the triple-hop-for-distance task for the ACLR and contrnt and source of asymmetries that can be used by clinicians and researchers alike to guide clinical decision making.
Despite achieving hop-distance symmetry, the ACLR limbs absorbed less power. Although this information was revealed using the discrete analyses, underlying asymmetries at the ankle and hip were masked. Using functional data analyses, we found interlimb asymmetries at the ankle, knee, and hip throughout ground contact and more fully elucidated the extent and source of asymmetries that can be used by clinicians and researchers alike to guide clinical decision making.Oesophageal cancer is the sixth commonest cause of overall cancer mortality. Clinical staging utilizes multiple imaging modalities to guide treatment and prognostication. T2N0 oesophageal cancer is a treatment threshold for neoadjuvant therapy. Data on accuracy of current clinical staging tests for this disease subgroup are conflicting. We performed a meta-analysis of all primary studies comparing clinical staging accuracy using multiple imaging modalities (index test) to histopathological staging following oesophagectomy (reference standard) in T2N0 oesophageal cancer. Patients that underwent neoadjuvant therapy were excluded. Electronic databases (MEDLINE, Embase, Cochrane Library) were searched up to September 2019. The primary outcome was diagnostic accuracy of combined T&N clinical staging. Publication date, first recruitment date, number of centers, sample size and geographical location main histological subtype were evaluated as potential sources of heterogeneity. The search strategy identified 1,199 studies. Twenty studies containing 5,213 patients met the inclusion criteria. Combined T&N staging accuracy was 19% (95% CI, 15-24); T staging accuracy was 29% (95% CI, 24-35); percentage of patients with T downstaging was 41% (95% CI, 33-50); percentage of patients with T upstaging was 28% (95% CI, 24-32) and percentage of patients with N upstaging was 34% (95% CI, 30-39). Significant sources of heterogeneity included the number of centers, sample size and study region. T2N0 oesophageal cancer staging remains inaccurate. A significant proportion of patients were downstaged (could have received endotherapy) or upstaged (should have received neoadjuvant chemotherapy). These findings were largely unchanged over the past two decades highlighting an urgent need for more accurate staging tests for this subgroup of patients.The carcinogenic compound N-nitrososarcosine (NSAR) is found in foods and tobacco products, and its quantification is of great interest. Although the presence of two stereoisomers, E- and Z-NSAR, is well-known, individual investigation of the isomers has not been reported so far. The present study by liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS) reveals that (i) the mass spectrometric responses of the isomers differ by a factor of approximately two and (ii) the isomer ratio is unstable in freshly prepared standard solutions. As a consequence, NSAR concentrations determined by LC-ESI-MS/MS are biased if those facts are not taken into account. The method described here overcomes the difficulty of stereospecific response by adjusting the isomer ratio and was applied to 100 tobacco products and fully validated for moist and dry snuff reference materials showing expanded measurement uncertainties of ~20% and limits of quantification of ~20 ng/g.The aim of this study was to compare the estimated public medical care cost of measures to address metallic dental restorations (MDRs) for head and neck radiotherapy using high-energy mega-voltage X-rays. This was considered a first step to clarify which MDR measure was more cost-effective. We estimated the medical care cost of radiotherapy for two representative MDR measures (i) with MDR removal or (ii) without MDR removal (non-MDR removal) using magnetic resonance imaging and a spacer. A total of 5520 patients received head and neck radiation therapy in 2018. The mean number of MDRs per person was 4.1 dental crowns and 1.3 dental bridges. The mean cost per person was estimated to be 121 720 yen for MDR removal and 54 940 yen for non-MDR removal. Therefore, the difference in total public medical care cost between MDR removal and non-MDR removal was estimated to be 303 268 800 yen. Our results suggested that non-MDR removal would be more cost-effective than MDR removal for head and neck radiotherapy. In the future, a national survey and cost-effectiveness analysis via a multicenter study are necessary; these investigations should include various outcomes such as the rate of local control, status of oral mucositis, frequency of hospital visits and efforts of the medical professionals.In the present analytical approach, beta-alanine (ALA) and tris-(hydroxyl methyl) aminomethane (TRIS) were investigated as peak modifiers due to their water solubility and their possible peak modifying a property. These reagents were tested for their efficacy on the elution of aceclofenac (ACF) and haloperidol hydrochloride (HLC) from C18 column (250 mm × 4.6 mm, 5 μ) equipped with a photodiode array detector. The test reagents were investigated at 0.25 ± 0.05% concentration with a varying % aqueous composition on elution efficacy of HLC and ACF. The added ALA/TRIS in the mobile phase significantly (P less then 0.05) improvised the symmetrical elution of HLC with 3-fold theoretical plates increase (P less then 0.05) and 10-fold reduced capacity factor as compared to the control run. For ACF, the shoulder effect observed for ACF peak was eliminated. The optimized mobile phase was a combination of acetonitrile and water containing 0.25% beta-alanine/TRIS (pH 3.5 with ortho-phosphoric acid) at the ratio of 7030 and 6040% v/v, respectively, for ACF and HLC. The method was validated as per ICHQ2 guidelines. The column performance was tested for reproducibility in non-peak modifier applications and revealed a null effect on the column, thus these agents are relatively less toxic to HPLC columns.
Understanding time loss resulting from sport-related concussion (SRC) within individual sports allows high school athletic trainers to provide accurate and evidence-based clinical information. Currently, research regarding patterns of clinical recovery outcomes in high school student-athletes across sports is lacking.
To describe the time to authorized unrestricted return to participation (RTP) after SRC in a large cohort of high school student-athletes in a variety of sports using a time-to-event analysis.
Descriptive epidemiology study.
Aggregate injury and player exposure data from the Michigan High School Athletic Association Head Injury Reporting System.
High school student-athletes.
Dates for SRC injury events and authorized unrestricted RTP were entered into the Head Injury Reporting System for each case and were used to calculate time to unrestricted RTP. Survival analysis indicated the time to authorized RTP for males and females in weekly increments across sports and academic years. Sepa results from this multisite, state-based injury surveillance system indicated that it is not abnormal for high school student-athletes to take longer than 14 days to fully recover from an SRC. This information may be useful for educating high school student-athletes and sport stakeholders, normalizing SRC recovery trajectory perceptions, and establishing realistic RTP timeline expectations.A simple and sensitive method was proposed for choline, carnitine, acetylcarnitine (ACa) and acetylcholine (ACh) separation in feed, blood and urine of animals by using ion chromatography (IC) and detection by tandem mass spectrometry (MS/MS). Analytes were extracted using a mixture of acetonitrile and water, purified by C18 solid-phase extraction columns, separated via IC with an IonPac SCS-1 column and detected by an MS/MS detector by using isotopic internal standards for quantification. The effects of different chromatographic parameters on the separation were also investigated. Under optimal conditions, the recovery was >90%, with the relative standard deviations of less then 15%. The proposed method was highly reliable for the simultaneous determination of choline, carnitine, ACa and ACh in feed, blood and urine.
A growing body of observational evidence supports the value of ceftazidime-avibactam (CAZ-AVI) in managing infections caused by carbapenem-resistant Enterobacteriaceae.
We retrospectively analyzed observational data on use and outcomes of CAZ-AVI therapy for infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) strains. Multivariate regression analysis was used to identify variables independently associated with 30-day mortality. Results were adjusted for propensity score for receipt of CAZ-AVI combination regimens versus CAZ-AVI monotherapy.
The cohort comprised 577 adults with bloodstream infections (n = 391) or nonbacteremic infections involving mainly the urinary tract, lower respiratory tract, and intra-abdominal structures. All received treatment with CAZ-AVI alone (n = 165) or with ≥1 other active antimicrobials (n = 412). The all-cause mortality rate 30 days after infection onset was 25% (146/577). There was no significant difference in mortality between patietential survival benefits of prolonging CAZ-AVI infusions to ≥3 hours.
To explore the self-perceived preparedness and clinical proficiency in headache diagnosis and management of Australian chiropractic students in senior years of study.
Australian chiropractic students in the 4th (n = 134) and 5th year (n = 122) of 2 chiropractic university programs were invited to participate in an online cross-sectional survey. Descriptive analyses were conducted for all variables. Post hoc analyses were performed using simple linear regression to evaluate the relationship between self-perceived preparedness and correctness of headache diagnosis and management scores.
Australian chiropractic students in senior years demonstrated moderate overall levels of self-perceived preparedness and proficiency in their ability to diagnose and manage headache disorders. Final-year students had a slightly higher self-perceived preparedness and proficiency in headache diagnosis and management compared to those students in the 4th year of study. There was no relationship between self-perceived preparedness and correctness of headache diagnosis and management for either 4th- or 5th-year chiropractic students.
Our findings suggest that there may be gaps in graduate chiropractic student confidence and proficiency in headache diagnosis and management. These findings call for further research to explore graduate chiropractic student preparedness and proficiency in the diagnosis and management of headache disorders.
Our findings suggest that there may be gaps in graduate chiropractic student confidence and proficiency in headache diagnosis and management. These findings call for further research to explore graduate chiropractic student preparedness and proficiency in the diagnosis and management of headache disorders.
A selective and sensitive liquid chromatography-tandem mass spectrometer (LC-MS/MS) method has been developed for the quantification of 1,1-dimethyl-3-hydroxy-pyrrolidinium bromide impurity in glycopyrrolate oral solution.
The LC-MS/MS analysis was done on X Bridge HILIC (100×4.6mm, 5μm) analytical column, and the mobile phase used was10mM ammonium formate with 0.2% formic acid as mobile phase-A and acetonitrile as mobile phase-B with a gradient programme of 5.0min. The flow rate used was 1.2mL/min. Triple quadrupole mass detector coupled to positive electrospray ionization operated in multiple reactions monitoring mode was used for the quantification at m/z 116.10±0.5.
Retention time of impurity was found ~3.2min. The method was validated in terms of specificity, linearity, accuracy, precision, range, limit of detection, limit of quantitation (LOQ) and robustness. Relative standard deviation (RSD) for system suitability was found 1.3%. Calibration plot was linear over the range of 0.050-2.000μg/mL. Limit of detection and limit of quantification were found 0.017 and 0.051μg/mL, respectively. The intra- and inter-day precision RSD was 2.3% and the obtained recovery at LOQ to 200% was in between 86.7 and 107.4%.
The low RSD values and high recoveries of the method confirm the suitability of the method.
The low RSD values and high recoveries of the method confirm the suitability of the method.The activity concentration of soil samples of Bureti sub-county was measured using thallium-activated sodium iodide detector. To ascertain the level of radiation hazard to the public, gamma radiation dose rates were also estimated. The average activity concentration due to 40K, 226Ra and 232Th for soil samples are 1164 ± 70, 106 ± 8 and 79 ± 5 Bqkg-1, respectively. An average dose rate of 145 ± 10 nGyh-1 was recorded, which is about 2.5 times higher than the world average value of 60 nGyh-1(UNSCEAR). On the other hand, an average outdoor effective dose of 0.35 ± 0.02 mSvy-1 was measured, which is lower than the ICRP safety limit of 1 mSvy-1. This shows that the radiation hazards from naturally occurring terrestrial radionuclides in Bureti is low and therefore human radiation exposure is within the accepted limits.
Inadequate hip range of motion (ROM) and isometric strength (ISO) may interfere with energy flow through the kinetic chain and result in increased injury susceptibility.
To examine the relationship of hip ROM and ISO with energy flow through the trunk and pitching-arm segments during the windmill softball pitch in youth athletes. A subsequent purpose was to examine the relationship between energy flow and pitch speed.
Descriptive laboratory study.
University research laboratory.
A sample of 29 youth softball pitchers (age = 11.2 ± 1.3 years, height = 155.0 ± 10.4 cm, mass = 53.2 ± 12.6 kg).
Bilateral hip internal-rotation and external-rotation (ER) ROM and ISO were measured. Net energy outflow and peak rates of energy outflow from the distal ends of the trunk, humerus, and forearm were calculated for the acceleration phase of the windmill softball pitch, and pitch speed was measured.
Regression analysis revealed an effect of drive-hip ER ISO on the net energy flow out of the distal ends of the the windmill softball pitch, emphasizing the importance of hip and lower body strength in executing the whole-body windmill pitch. Overall, energy-flow analysis is an interesting new way to analyze pitching mechanics and will aid in furthering our understanding of performance and injury risk in windmill softball pitching.The deep population history of East Asia remains poorly understood owing to a lack of ancient DNA data and sparse sampling of present-day people1,2. Here we report genome-wide data from 166 East Asian individuals dating to between 6000 BC and AD 1000 and 46 present-day groups. Hunter-gatherers from Japan, the Amur River Basin, and people of Neolithic and Iron Age Taiwan and the Tibetan Plateau are linked by a deeply splitting lineage that probably reflects a coastal migration during the Late Pleistocene epoch. We also follow expansions during the subsequent Holocene epoch from four regions. First, hunter-gatherers from Mongolia and the Amur River Basin have ancestry shared by individuals who speak Mongolic and Tungusic languages, but do not carry ancestry characteristic of farmers from the West Liao River region (around 3000 BC), which contradicts theories that the expansion of these farmers spread the Mongolic and Tungusic proto-languages. Second, farmers from the Yellow River Basin (around 3000 BC) probablyharian Indo-European languages. Two later gene flows affected western Mongolia migrants after around 2000 BC with Yamnaya and European farmer ancestry, and episodic influences of later groups with ancestry from Turan.Comparison of tritium volume activity (VA) rates in objects of environment in the Mayak Production Association (Mayak PA) affected area in the period from 2014 to 2015 with tritium VA rates in the same or similar objects of environment measured in the period from 2001 to 2013. Water samples from environmental objects-precipitations, ponds, wells-were the material for this research. Tritium VA in various environmental objects was measured using liquid scintillation method. The results were processed using parametric and nonparametric methods of statistical analysis. In samples collected in 2014-15 from open reservoirs located in Mayak PA affected area tritium VA was 1.4 times lower than the level of tritium VA in water samples from the same reservoirs collected in 2001-03. There was no statistically significant difference between tritium VA in water samples from the same open reservoirs collected in periods 2009-12 and 2014-15. Tritium VA in the water sample from production reservoir R-2 (lake Kyzyltash) in 20 of 2001-03 to 2014-15 as well as decrease of the levels of tritium VA in samples of daily precipitation from 2007 to 2014 could be an evidence of possible decrease of tritium atmospheric emission from Mayak PA.As a bourgeoning class of 2D materials, MXenes have recently attracted significant attention within heterogeneous catalysis for promoting reactions such as hydrogen evolution and C-H activation. However, the catalytic activity of MXenes is highly dependent on the structural configuration including termination groups and their distribution. Therefore, understanding the relation between the structure and the activity is desired for the rational design of MXenes as high-efficient catalysts. Here, we present that the correlation between the structure and activity of Ti2CT2(T is a combination of O, OH and/or F) MXenes for C-H activation can be linked by a quantitative descriptor the hydrogen affinity (EH). A linear correlation is observed between the mean hydrogen affinity and the overall ratio of O terminations (xO) in Ti2CT2MXenes, in which hydrogen affinity increases as thexOdecreases, regardless to the species of termination groups. In addition, the hydrogen affinity is more sensitive to the presence of OH termination than F terminations. Moreover, the linear correlation between the hydrogen affinity and the activity of Ti2CT2MXenes for C-H activation of both -CH3and -CH2- groups can be extended to be valid for all three possible termination groups. Such a correlation provides fast prediction of the activity of general Ti2CT2MXenes, avoiding tedious activation energy calculations. We anticipate that the findings have the potential to accelerate the development of MXenes for heterogeneous catalysis applications.Objective. Nested into slow oscillations (SOs) and modulated by their up-states, spindles are electrophysiological hallmarks of N2 sleep stage that present a complex hierarchical architecture. However, most studies have only described spindles in basic statistical terms, which were limited to the spindle itself without analyzing the characteristics of the pre-spindle moments in which the SOs are originated. The aim of this study was twofold (a) to apply spectral and temporal measures to the pre-spindle and spindle periods, as well as analyze the correlation between them, and (b) to evaluate the potential of these spectral and temporal measures in future automatic detection algorithms.Approach. An automatic spindle detection algorithm was applied to the overnight electroencephalographic recordings of 26 subjects. Ten complementary features (five spectral and five temporal parameters) were computed in the pre-spindle and spindle periods after their segmentation. These features were computed independently in eac of automatic spindle detectors, in which the analysis of the pre-spindle period becomes relevant for improving their performance. From the clinical point of view, these features may serve as novel precision therapeutic targets to enhance spindle production with the aim of improving memory, cognition, and sleep quality in healthy and clinical populations. The results evidence the need for characterizing spindles in terms beyond power and the spindle period itself to more dynamic measures and the pre-spindle period. Physiologically, these findings suggest that spindles are more than simple oscillations, but nonstable oscillatory bursts embedded in the complex pre-spindle dynamics.Dithieno[2,3-d;2',3'-d']benzo[1,2-b;4,5-b']dithiophenes (DTBDT) is a kind of prospective candidate for constructing donor-π-acceptor (D-π-A) copolymer donors applied in organic solar cells but is restricted due to its relatively poor photovoltaic performance compared with benzo[1,2-b;4,5-b']dithiophenes (BDT)-based analog. Herein, three conjugated polymers (PE51,PE52andPE53)-based DTBDT and benzo[d][1,2,3]triazole (BTA) bearing different lengths of alkyl side chain were designed and synthesized. The change in alkyl chain length can obviously affect the energy level distribution, molecular stacking, miscibility and morphology with the non-fullerene acceptor ofY6. PolymerPE52with a moderate alkyl chain realized the highest short-current density (JSC) and fill factor (FF) of 25.36 mA cm-2and 71.94%, respectively. Compared with BDT-based analogJ52-Cl, the significantly enhanced crystallinity and intermolecular interaction ofPE52had effectively boosted the charge transport characteristic and optimized the surface morphology, thereby increasing the power conversion efficiency from 12.3% to an impressive 14.6%, which is the highest value among DTBDT-based and BTA-based polymers. Our results show that not only could high efficiency be achieved via using DTBDT as a D unit, but the length of the alkyl chain on BTA has a significant impact on the photovoltaic performance.Bioceramic morphology plays a crucial role in bone repair and regeneration. It is extensively utilized in bone scaffold synthesis due to its better biological system activity and biocompatibility. Here, ultra-long tricalcium phosphate (UTCP) was synthesized with the assistance of the ultrasonication method. The UTCP was modified as a scaffold by the reinforcement of a methacrylate chitosan (MAC) polymer. The functionality of UTCP, UTCP/MAC, and methotrexate (MTX)-loaded composites was characterized through Fourier transform infrared spectroscopy. The crystalline natures are investigated by x-ray diffraction, and the results show the UTCP crystalline phase is not altered after the reinforcement of the MAC polymer and loading of MTX drugs. The morphological analyses were observed through electron microscopic analysis, and polymer-coated rod structures were observed. The UTCP/MAC composite mechanical stress was increased from 1813 Pa of UTCP to 4272 Pa. MTX loading and release at 79.0% within 3 h and 76.15% at 20 h, respectively, were achieved. The UTCP/MAC and UTCP/MAC/MTX's osteoblast-like (MG-63) cell viability was investigated, and the MTX-loaded UTCP/MAC composite exhibits good viability behavior up to 96.0% in 14 d. The results confirm the higher compatibility of the composite and profitable cell growth. It may be suitable for bone implantation preparation, and it helps in faster regeneration of bone tissue afterin vivoand clinical evaluation.Strong magnetic interfacial coupling in van der Waals heterostructures is important for designing novel electronic devices. Besides the most studied transition metal dichalcogenides (TMDCs) materials, we demonstrate that the valley splitting can be activated in two-dimensional tetragonald0metal oxide, SnO, via the magnetic proximity effect by EuBrO. In SnO/EuBrO, the valley splitting of SnO can reach ∼46 meV, which is comparable to many TMDCs and equivalent to an external magnetic field of 800 T. In addition, the valley splitting can be further enhanced by adjusting interlayer distance and applying uniaxial strains. A design principle of new spintronic device based on this unique electronic structure of SnO/EuBrO has been proposed. Our findings indicate that SnO is a promising material for future valleytronics applications.Full Heusler alloys present martensitic transition and shape memory effect related phenomena and several technological applications can be envisaged. One promising area is the magnetocaloric effect (MCE) as the magnetic and structural transitions combine to produce a large isothermal entropy and adiabatic temperature change useful for heating and cooling applications. In this work, we study a Ni-(Mn, Cu)-(Ga, Al) Heusler alloy family which has a giant MCE when the chemical composition is fine-tuned to bring the temperature of the second-order magnetic transition close the first-order structural one. Our results show that, for a certain range of copper concentration, the samples show interesting physical properties captured by calorimetric, microscopy imaging, and magnetization measurements, leading to a high MCE with minimized hysteresis.Defects caused by the structural disorder of perovskites and voltage loss resulting from mismatched band structure are important issues to address to improve the performance of carbon-based perovskite solar cells. Different from the conventional approaches of additive-based passivation of perovskite precursors and introducing a hole-transport layer between the perovskite layer and carbon electrode, herein we report a defect-healing method using phenethyl ammonium iodide (PEAI) treatment and band-structure modification using high-work-function inorganic copper phthalocyanine (CuPc). Because of its relatively smoother surfaces and lower defect content, the optimized device after PEAI-based passivation of the perovskite achieves a power conversion efficiency (PCE) of 11.74%. The PCE is further raised to 13.41% through the auxiliary energy-level matching and high hole extraction abilities of the CuPc-modified carbon electrode. The best-performing device exhibits excellent moisture tolerance and thermal stability with minor current density-voltage hysteresis.In this paper, we propose inverting logic-in-memory (LIM) cells comprising silicon nanowire feedback field-effect transistors with steep switching and holding characteristics. The timing diagrams of the proposed inverting LIM cells under dynamic and static conditions are investigated via mixed-mode technology computer-aided design simulation to verify the performance. The inverting LIM cells have an operating speed of the order of nanoseconds, an ultra-high voltage gain, and a longer retention time than that of conventional dynamic random access memory. The disturbance characteristics of half-selected cells within an inverting LIM array confirm the appropriate functioning of the random access memory array.The ZnO nanostructure-based Organic LEDs and Perovskite LEDs, due to their suitable electrical and optical properties can utilize in the optoelectronic industry. A combination of the ZnO nanorods and nanotubes with various types of polymers or hybrid perovskites leads to better waveguide and transportation of carriers. Therefore, more efficient LEDs are offered to the industry. In this research, four devices, including ZnO nanorod (nanotube)/ MEH-PPV (CH3NH3PbI3) LEDs, are simulated by SIVACO TCAD software. To deeper understand the impact of applying nanorod and nanotube in hybrid heterostructures, the ab-initio study has been investigated and the electronic structure, density of state, absorption coefficient and dielectric function of these nanostructures have been scrutinized. Subsequently, the obtained data has been utilized in the Silvaco simulation part, and characteristics such as current-voltage curve, light power-voltage curve, electroluminescence (EL) spectra, and radiative recombination rate of four devices have been investigated. By employing the combination of the perovskite layer and ZnO nanotube, the turn-on voltage of simulated devices has been deceased from 13.7 V to 1.1 V. Moreover, a drastic increment in UV emission from devices based on ZnO nanotube can be seen, which stems from occurring the whispering gallery mode and low defects of nanotubes compared to nanorod. A red-shift causing by the reduction of the bandgap of nanostructures can be observed in EL spectra, too.Objective.To develop an automated system to classify the severity of hypoxic-ischaemic encephalopathy injury (HIE) in neonates from the background electroencephalogram (EEG).Approach. By combining a quadratic time-frequency distribution (TFD) with a convolutional neural network, we develop a system that classifies 4 EEG grades of HIE. The network learns directly from the two-dimensional TFD through 3 independent layers with convolution in the time, frequency, and time-frequency directions. Computationally efficient algorithms make it feasible to transform each 5 min epoch to the time-frequency domain by controlling for oversampling to reduce both computation and computer memory. The system is developed on EEG recordings from 54 neonates. Then the system is validated on a large unseen dataset of 338 h of EEG recordings from 91 neonates obtained across multiple international centres.Main results.The proposed EEG HIE-grading system achieves a leave-one-subject-out testing accuracy of 88.9% and kappa of 0.84 on the development dataset. Accuracy for the large unseen test dataset is 69.5% (95% confidence interval, CI 65.3%-73.6%) and kappa of 0.54, which is a significant (P less then 0.001) improvement over a state-of-the-art feature-based method with an accuracy of 56.8% (95% CI 51.4%-61.7%) and kappa of 0.39. Performance of the proposed system was unaffected when the number of channels in testing was reduced from 8 to 2-accuracy for the large validation dataset remained at 69.5% (95% CI 65.5%-74.0%).Significance.The proposed system outperforms the state-of-the-art machine learning algorithms for EEG grade classification on a large multi-centre unseen dataset, indicating the potential to assist clinical decision making for neonates with HIE.
