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Background: There are significant challenges in ensuring sufficient clinician participation in quality improvement training. Clinician capability has been identified as a barrier to the delivery of evidence-based care. Clinician training is an effective strategy to address this barrier, however, there are significant challenges in ensuring adequate clinician participation in training. This study aimed to assess the extent of participation by antenatal clinicians in evidence-based training to address alcohol consumption during pregnancy, and to assess differences in participation by profession.Methods: A 7-month training initiative based on six evidence-based principles was implemented in a maternity service in New South Wales, Australia. Descriptive statistics described participation in training (% attending: any training; six evidence-based principles of training; all principles). Regression analyses examined differences by profession.Results: Almost all antenatal clinicians participated in some training (182/186; 98%); 69% participated in ≥1 h of training (μ = 88.2mins, SD:56.56). The proportion of clinicians participating in training that satisfied each of the six principles ranged from 35% (training from peers and experts) to 82% (training was educational and instructional). Only 7% participated in training that satisfied all principles. A significantly higher proportion of midwifery compared to medical clinicians participated in training satisfying five of the six training principles.Conclusions: A training initiative based on evidence-based principles resulted in almost all clinicians receiving some training and 69% participating in at least 1 h of training. Variability between professions suggests training needs to be tailored to such groups. Further research is required to determine possible associations with care delivery outcomes.Trial Registration: Australian and New Zealand Clinical Trials Registry, No. ACTRN12617000882325 (date registered: 16/06/2017). [ABSTRACT FROM AUTHOR]

In order to contribute in the research activities related to heat treatment of metals and other engineering materials, a laboratory scale heat treatment furnace is essentially required. Among several other types of furnaces, electric heat treatment furnace is said to be most useful. It is provided with a programmable controller which precisely controls heating rate, soaking time and cooling rate. The controller also helps in keeping the heat treatment safe by emergency turnoff facility. This manuscript reports the indigenous designing and development of electrical heat treatment furnace, which not only provides enormous learning to fresh graduates but also saved a handsome amount, which could have spent in purchasing same article from commercial market. In this paper, the sequential procedure of furnace designing and development is being shared with the engineering community so that the researchers of under developed countries may save their esteemed educational and research funds. [ABSTRACT FROM AUTHOR]

Largely depending on meltwater from the Hindukush-arakoram-imalaya, withdrawals from the upper Indus basin (UIB) contribute to half of the surface water availability in Pakistan, indispensable for agricultural production systems, industrial and do- mestic use and hydropower generation,Despite such importance, a comprehensive assessment of prevailing state of relevant climatic variables determining the water availability is largely missing,Against this background, we present a comprehensive hydroclimatic trend analysis over the UIB, including for the first time observations from highaltitude automated weather stations,We analyze trends in maximum, minimum and mean temperatures (Tx, Tn, and Tavg, respectively), diurnal temperature range (DTR) and precipitation from 18 stations (1250-4500ma.s.l.) for their overlapping period of record (1995-2012), and separately, from six stations of their long term record (1961- 2012),We apply Mann-Kendall test on serially independent time series to assess existence of a trend while true slope is estimated using Sen's slope method,Further, we statistically assess the spatial scale (field) significance of local climatic trends within ten identified sub-regions of UIB and analyze whether the spatially significant (field significant) climatic trends qualitatively agree with a trend in discharge out of corresponding sub-region,Over the recent period (1995-2012), we find a well agreed and mostly field significant cooling (warming) during monsoon season i.e,July-October (March-May and November), which is higher in magnitude relative to long term trends (1961-2012),We also find general cooling in Tx and a mixed response in Tavg during the winter season and a year round decrease in DTR, which are in direct contrast to their long term trends,The observed decrease in DTR is stronger and more significant at high altitude stations (above 2200ma.s.l.), and mostly due to higher cooling in Tx 25 than in Tn,Moreover, we find a field significant decrease (increase) in late-monsoonal precipitation for lower (higher) latitudinal regions of Himalayas (Karakoram and Hindukush), whereas an increase in winter precipitation for Hindukush, western- and whole Karakoram, UIB-Central, UIB-West, UIB-West-upper and whole UIB regions,We find spring warming (field significant in March) and drying (except for Karakoram and its sub-regions), and subsequent rise in early-melt season flows,Such early melt response together with effctive cooling during monsoon period subsequently resulted in a substantial drop (weaker increase) in discharge out of higher (lower) latitudinal regions (Himalaya and UIB-West-lower) during late-melt season, particularly during July,These discharge tendencies qualitatively diff to their long term trends for all regions, except for UIB-West-upper, western-Karakorum and Astore,The observed hydroclimatic trends, being driven by certain changes in the monsoonal system and westerly disturbances, indicate dominance (suppression) of nival (glacial) runoff regime, altering substantially the overall hydrology of UIB in future,These findings largely contribute to address the hydroclimatic explanation of the "Karakoram Anomaly". [ABSTRACT FROM AUTHOR]

In this paper we assess the snow cover and its dynamics for the western river basins of the Indus River system (IRS) and their sub-basins located in Afghanistan, China, India and Pakistan for the period 2001-2012. First, we validate the Moderate Resolution Imaging Spectroradiometer (MODIS) daily snow products from Terra (MOD10A1) and Aqua (MYD10A1) against the Landsat Thematic Mapper/ Enhanced Thematic Mapper plus (TM/ETM+) data set, and then improve them for clouds by applying a validated non-spectral cloud removal technique. The improved snow product has been analysed on a seasonal and annual basis against different topographic parameters (aspect, elevation and slope). Our results show a decreasing tendency for the annual average snow cover for the westerlies-influenced basins (upper Indus basin (UIB), Astore, Hunza, Shigar and Shyok) and an increasing tendency for the monsoon-influenced basins (Jhelum, Kabul, Swat and Gilgit). Seasonal average snow cover decreases during winter and autumn, and increases during spring and summer, which is consistent with the observed cooling and warming trends during the respective seasons. Sub-basins at relatively higher latitudes/ altitudes show higher variability than basins at lower latitudes/middle altitudes. Northeastern and northwestern aspects feature greater snow cover. The mean end-of-summer regional snow line altitude (SLA) zones range from 3000 to 5000ma.s.l. for all basins. Our analysis provides an indication of a descending end-of-summer regional SLA zone for most of the studied basins, which is significant for the Shyok and Kabul basins, thus indicating a change in their water resources. Such results are consistent with the observed hydro-climatic data, recently collected local perceptions and glacier mass balances for the investigated period within the UIB. Moreover, our analysis shows a significant correlation between winter season snow cover and the North Atlantic Oscillation (NAO) index of the previous autumn. Similarly, the inter-annual variability of spring season snow cover and spring season precipitation explains well the inter-annual variability of the summer season discharge from most of the basins. These findings indicate some potential for the seasonal stream flow forecast in the region, suggesting snow cover as a possible predictor. [ABSTRACT FROM AUTHOR]

C- C motif chemokine receptor-5 ( CCR5) is a pro-inflammatory receptor that binds to chemokines and facilitates the entry of the R5 strain of HIV-1. A number of polymorphisms were identified within the promoter and coding regions of the CCR 5 gene, some of which have been found to affect the protein expression and thus receptor function. Although several CCR 5 polymorphisms were shown to vary widely in their distribution among different ethnic populations, there has been no study addressing the potential variants of the CCR 5 gene in the Omani population. The aim of this study was to identify the polymorphic sites that exist within the CCR 5 gene in Omanis. Blood samples were collected from 89 Omani adult individuals, and genomic DNA was amplified by polymerase chain reaction and sequenced to identify the polymorphic sites. The distribution of the detected variants was examined and compared with the previously published data. Four new indels were detected of 32 variable positions, −2973A/-, −2894A/-, −2827 TA/- and −2769T/-, and all were located in the 5′ UTR. Furthermore, two new mutations, −2248G/A and +658A/G, were observed for the first time; the −2248G/A was detected in the intron 1 region in one subject and +658A/G in the coding region of the CCR 5 in another subject. In silico analysis showed that the novel variations in the 5′ UTR may have effects on the transcription factor binding sites. Therefore, this study demonstrates the presence of two new SNPs and four novel indels in the CCR 5 gene in the Omani population. Our findings support the wide spectrum of genetic diversity reported within the CCR 5 gene region among different ethnic groups. [ABSTRACT FROM AUTHOR]

In this paper we assess the snow cover and its dynamics for the western river basins of the Indus River System (IRS) and their sub-basins located in Afghanistan, China, India and Pakistan for the period 2001-2012. Moderate Resolution Imaging Spectro-radiometer (MODIS) daily snow products from Terra (MOD) and Aqua (MYD) have been first improved and then analysed on seasonal and annual basis against different topographic parameters (aspect, elevation and slope). Our applied cloud filtering technique has reduced the cloud cover from 37% (MOD) and 43% (MYD) to 7%, thus improving snow cover estimates from 7% (MOD) and 5% (MYD) to 14% for the area of interest (AOI) during the validation period (2004). Our results show a decreasing tendency for the annual average snow cover for the westerlies-influenced basins (Upper Indus Basin, Astore, Hunza, Shigar, Shyok) and an increasing tendency for the monsoon-influenced basins (Jhelum, Kabul, Swat and Gilgit). Regarding the seasonal snow cover, decrease during winter and autumn and increase during spring and summer has been found, which is consistent with the observed cooling and warming trends during the respective seasons. Sub-basins at relatively higher latitude/altitude show higher variability than basins at lower latitude/mid-altitude. Northeastern and north-western aspects feature larger snow cover. The mean regional snow line altitude (SLA) zones range between 3000 and 5000ma.s.l. for all basins. Our analysis provides an indication of a decrease in the regional SLA zone, thus indicating a change in the water resources of the studied basins, particularly for the Upper Indus Basin (UIB). Such results are consistent with the observed hydro-climate data, recently collected local perceptions and glacier mass balances for the investigated period. Moreover, our analysis suggests some potential for the seasonal stream flow forecast as a significant negative correlation has been detected for the inter-annual variability of winter snow cover and value of the North Atlantic Oscillation (NAO) index of the previous autumn. [ABSTRACT FROM AUTHOR]

In this study, we investigate how PCMDI/CMIP3 general circulation models (GCMs) represent the seasonal properties of the hydrological cycle in four major South and Southeast Asian river basins (Indus, Ganges, and Brahmaputra and Mekong). First, we examine the skill of GCMs by analysing their simulations for the XX century climate (1961-2000) under present-day forcing, and then we analyse the projected changes for the corresponding XXI and XXII century climates under SRESA1B scenario. CMIP3 GCMs show a varying degree of skill in simulating the basic characteristics of the monsoonal precipitation regimes of the Ganges, Brahmaputra and Mekong basins, while the representation of the hydrological cycle over the Indus basin is poor in most cases, with few GCMs not capturing the monsoon signal at all. Although the models' outputs feature a remarkable spread for the monsoonal precipitations, a satisfactory representation of the western mid-latitude precipitation regime is instead observed. Similarly, most of the models exhibit a satisfactory agreement for the basin-integrated runoff in winter and spring, while the spread is large for the runoff during the monsoon season. For future climate scenarios, winter (spring) P - E decreases over all four (Indus and Ganges) basins due to decrease in precipitation associated with the western midlatitude disturbances. Consequently, the spring (winter) runoff drops (rises) for the Indus and Ganges basins. Such changes indicate a shift from rather glacial and nival to more pluvial runoff regimes, particularly for the Indus basin. Furthermore, the rise in the projected runoff along with the increase in precipitations during summer and autumn indicates an intensification of the summer monsoon regime for all study basins. [ABSTRACT FROM AUTHOR]

We investigate how the climate models contributing to the PCMDI/CMIP3 dataset describe the hydrological cycle over four major South and Southeast Asian river basins (Indus, Ganges, Brahmaputra and Mekong) for the 20th, 21st (13 models) and 22nd (10 models) centuries. For the 20th century, some models do not seem to conserve water at the river basin scale up to a good degree of approximation. The simulated precipitation minus evaporation (P -E), total runoff (R) and precipitation (P) quantities are neither consistent with the observations nor among the models themselves. Most of the models underestimate P - E for all four river basins, which is mainly associated with the underestimation of precipitation. This is in agreement with the recent results on the biases of the representation of monsoonal dynamics by GCMs. Overall, a modest inter-model agreement is found only for the evaporation and inter-annual variability of P - E. For the 21st and 22nd centuries, models agree on the negative (positive) changes of P - E for the Indus basin (Ganges, Brahmaputra and Mekong basins). Most of the models foresee an increase in the inter-annual variability of P - E for the Ganges and Mekong basins, thus suggesting an increase in large low-frequency dry/wet events. Instead, no considerable future change in the inter-annual variability of P - E is found for the Indus and Brahmaputra basins. [ABSTRACT FROM AUTHOR]

The objective of the study is to investigate the anti-snake venom activities of a local plant, Hibiscus aethiopicus L. The H. aethiopicus was dried and extracted with ethanol. Different assays were performed according to standard techniques, to evaluate the plant's acute toxicity and its antivenom activities. The results of evaluating the systemic acute toxicity of the H. aethiopicus extract using "oral and intra-peritoneal" route were normal even at the highest dose (24 g/kg) tested. All guinea pigs (n = 3) when treated with venoms E. c. sochureki (75 μg) alone induced acute skin haemorrhage. In contrast, all guinea pigs (n = 18) treated with both venom and the plant extract at a concentration between 500 and 1000 mg/kg showed no signs of haemorrhage. Moreover, all guinea pigs (n = 18) treated with venom and the plant extract below 400 mg/kg showed acute skin haemorrhage. All guinea pigs treated with venom E. c. sochureki (75 μg) alone induced acute skin haemorrhage after both 24 and 32 hours. In contrast, all guinea pigs treated with both venom and the plant extract (administered independently) at concentrations between 500 and 1000 mg/kg showed no signs of haemorrhage after 32 hours. However, after 24 hours all tested guinea pigs showed less inhibition (<60%) compared to that obtained after 32 hours. The outcome of this study reflects that the extract of H. aethiopicus plant may contain an endogenous inhibitor of venom induced local haemorrhage. [ABSTRACT FROM AUTHOR]

The objective of the study is to investigate whether the Hibiscus aethiopicus L. plant has neutralization activity against venoms of two clinically important snakes. The H. aethiopicus was dried and extracted with water. Different assays were performed to evaluate the plant's acute toxicity and its anti-snake venom activities. The results showed that H. aethiopicus extract alone had no effect on the viability of C2C12 muscle cells, but significantly (P < .05) protected muscle cells against the toxic effects of E. ocellatus venom at 55, 150, and 300 μg/mL. The maximum protective effect of the extract was exhibited at 75 μg/mL. The extract significantly (P < .001) inhibited the cytotoxic effects of E. ocellatus venom at 300 μg/mL. All rabbits (n = 10) and guinea pigs (n = 10) were alive after the two weeks of given the lethal dosage 16 g/Kg of the H. aethiopicus extract herbal solution. No abnormal behaviour was observed of both groups of animals. All guinea pigs (n = 3) treated with venoms alone (5mg/kg) died. However, all guinea pigs (n = 21) treated with venom (5mg/kg) and the extract (400 to 1000 mg/kg) survived. Guinea pigs (n = 3) treated with Naja n. nigricollis venom alone (2.5 mg/kg) and guinea pigs (n = 21) venom with the extract (400 to 1000 mg/kg) died. The H. aethiopicus completely (100%) blocked the haemorrhagic activity of E. ocellatus in the egg embryo at 3.3mg/mL of extract. These findings suggest that H. aethiopicus may contain an endogenous inhibitor of venom-induced haemorrhage. [ABSTRACT FROM AUTHOR]

Envenoming by Echis saw-scaled viper is the leading cause of death and morbidity in Africa due to snake bite. Despite its medical importance, there have been few investigations into the toxin composition of the venom of this viper. Here, we report the cloning of cDNA sequences encoding four groups or isoforms of the haemostasis-disruptive Serine protease proteins (SPs) from the venom glands of Echis ocellatus. All these SP sequences encoded the cysteine residues scaffold that form the 6-disulphide bonds responsible for the characteristic tertiary structure of venom serine proteases. All the Echis ocellatus EoSP groups showed varying degrees of sequence similarity to published viper venom SPs. However, these groups also showed marked intercluster sequence conservation across them which were significantly different from that of previously published viper SPs. Because viper venom SPs exhibit a high degree of sequence similarity and yet exert profoundly different effects on the mammalian haemostatic system, no attempt was made to assign functionality to the new Echis ocellatus EoSPs on the basis of sequence alone. The extraordinary level of interspecific and intergeneric sequence conservation exhibited by the Echis ocellatus EoSPs and analogous serine proteases from other viper species leads us to speculate that antibodies to representative molecules should neutralise (that we will exploit, by epidermal DNA immunization) the biological function of this important group of venom toxins in vipers that are distributed throughout Africa, the Middle East, and the Indian subcontinent. [ABSTRACT FROM AUTHOR]

The purpose of this case report is to describe the effects of a cortisone injection and a conservative, non-operative physical therapy approach in a patient with anterior instability of the glenohumeral joint. A 73-year-old, right-handed male was referred to physical therapy following a right shoulder subluxation, resulting in pain and decreased function in the right upper extremity. A baseline examination indicating significant pain and right shoulder dysfunction resulted in an initial Western Ontario Shoulder Instability Index(WOSI)score of 1619. The patient was seen for 22 visits divided into Phase I and Phase II. Phase II began following a cortisone injection received after visit 15. Physical Therapy intervention consisted of shoulder pendulum exercises, active ROM, Maitland mobilization, strengthening of rotator cuff and thoracic musculature, electrical stimulation and cryotherapy. WOSI scores at baseline, the conclusion of Phase I and II, and one month post discharge were recorded. They were 1487(8%improvement), 116(93%improvement), and 83(95%improvement), respectively. Percent improvement was calculated based on the initial WOSI score. The patient's WOSI score at discharge(end of Phase II)was similar to his self-report of improvement(95%). Results of the WOSI at the conclusion of Phase I and Phase II suggest that the anti-inflammatory and analgesic effects of a cortisone injection were critical components in the patient's recovery. These findings may indicate the appropriateness of such an injection in cases with significant pain and inflammation when a more traditional, conservative approach to anterior glenohumeral joint instability proves ineffective. [ABSTRACT FROM AUTHOR]

The purpose of this case report was to explore the application of conservative management in an individual with a large rotator cuff tear. Often patients with such an extensive injury are recommended for surgery. The patient was a 76-years-old female with a primary diagnosis of a large tear in the supraspinatus, after falling down her steps. The patient underwent physical therapy 3 times a week for 7 weeks (19 visits). The interventions consisted of modalities and therapeutic exercise. Outcome measures included the Shoulder pain and Disability Index (SPADI), and the Short Form-12 (SF-12). Each was implemented at the initial examination, 3 1/2 weeks, and 7 weeks. The SPADI increased, showing a 78% improvement in function. There was an overall increase in the physical component scale of the SF-12 by the 7th week, showing an 86% increase from the initial score. The use of conservative treatment may be an effective method for restoring function in patients with large rotator cuff tears. The great percentile changes as shown by the outcome measures suggests overall functional improvements in this patient. There have been few studies to support the use of conservative treatment for patients with large rotator cuff tears. However, further research needs to be done on this type of intervention with different levels of pre-injury function. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe the point prevalence of gait limitations among elderly women participating in community health screenings. Ninety-six community-dwelling women (mean age = 75.2 years) participated. Individuals were considered to have limitations if: (1) they self-reported their health limiting them when walking 'a block,' 'several blocks,' or 'more than one mile,' or (2) their speed over 7.62 meters was below 1.22 meters/second. More elders were identified with limitations by self-report (n = 54) than by gait speed (n = 36). Using both methods, 66 elders (68.8%) were noted to have gait limitations. Interestingly, there was poor agreement (kappa = .152) between self-report and gait speed as indicators of gait limitations. Thirty women who reported walking limitations did not appear limited by virtue of the speed test and 12 women who reported no limitations did not surpass the speed criterion. If nonobvious limitations are to be identified in women attending health screenings, both self-report and measured speed may be better than either indicator alone. [ABSTRACT FROM AUTHOR]

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