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Objective The aim of this study was to evaluate if the presence of a physician in the neonatal transport team (NTT) affects transport-related outcomes and procedural success. Design Retrospective cohort study with propensity score matching. Setting Canadian national study. Patients Neonatal transports from nontertiary centres between January 2014 and December 2017. Interventions Comparison of transports conducted by NTTs with physicians (MD Group) and without physicians (noMD Group). Main outcome measures The primary outcome was the change in patient acuity as measured by the transport risk index of physiologic severity (TRIPS) score. Secondary outcomes included mortality within 24 hours of NICU admission, clinical complications during transport, procedural success, and stabilization time. Results Among 9,703 eligible cases, 899 neonatal transports attended by NTTs with physicians were compared to 899 neonatal transports without physicians using propensity score matching. No differences were seen in the improvement of TRIPS score or mortality ≤24 hours of NICU admission. The MD Group had more clinical complications (7.7% versus 5.0%, P=0.02). No differences were seen in success rates of invasive procedures. The MD Group had shorter stabilization times. In multivariable analysis, the MD Group was not a significant predictor for the improvement in TRIPS score after adjustment for covariates. Conclusions Neonatal transports conducted by teams including physicians compared to teams without physicians, did not have higher improvement in TRIPS scores and had similar success rates for procedures. These results provide insights for the planning of the structure and training of specialized interfacility neonatal transport programs.

Quality improvement initiatives in neonatology have yielded positive results; however, few programs have demonstrated sustainability. We evaluated an ongoing, national quality improvement initiative (Evidence-based Practice for Improving Quality Phase 3 (EPIQ-3)) on outcomes of preterm neonates with a gestational age (GA) of 220–286weeks (i.e., from 22 weeks and 0 days of gestation to 28 weeks and 6 days of gestation). Data from 7459 neonates admitted to 25 Canadian centers between 2013 and 2017 were studied. Trends in mortality and major morbidities were evaluated. The number of neonates with a GA of 220–236weeks increased from 90 in 2013 to 139 in 2017 without a significant change in any other GA categories. In the entire cohort, the odds of composite outcome of mortality or any major morbidity (adjusted odds ratio (AOR) 0.72, 95% confidence interval (CI) 0.61–0.84) and of necrotizing enterocolitis (AOR 0.66, 95% CI 0.49–0.89) were lower in 2017 than in 2013. When calculated per year, the odds of composite outcome (AOR 0.93, 95% CI 0.89–0.97) and odds of necrotizing enterocolitis (AOR 0.89, 95% CI 0.82–0.96) decreased significantly. Among the subgroup of neonates with a GA of 260–286weeks, the odds of composite outcome (AOR 0.63, 95% CI 0.51–0.79), necrotizing enterocolitis (AOR 0.44, 95% CI 0.26–0.73), and nosocomial infection (AOR 0.64, 95% CI 0.49–0.84) were reduced. The collaborative, multidisciplinary, nationwide EPIQ-3 program improved outcomes of preterm neonates, and the improvement was sustainable over 5 years.

Background Very preterm infants are at high risk of death or severe morbidity. The objective was to determine the significance of severe congenital heart defects ( CHDs ) for these risks. Methods and Results This cohort study included infants from 10 countries born from 2007–2015 at 24 to 31 weeks’ gestation with birth weights CHDs were defined by International Classification of Diseases, Ninth Revision ( ICD‐9 ) and Tenth ( ICD‐10 ) codes and categorized as those compromising systemic output, causing sustained cyanosis, or resulting in congestive heart failure. The primary outcome was in‐hospital mortality. Secondary outcomes were neonatal brain injury, necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity. Adjusted and propensity score–matched odds ratios ( ORs ) were calculated. Analyses were stratified by type of CHD , gestational age, and network. A total of 609 (0.77%) infants had severe CHD and 76 371 without any malformation served as controls. The mean gestational age and birth weight were 27.8 weeks and 1018 g, respectively. The mortality rate was 18.6% in infants with CHD and 8.9% in controls (propensity score–matched OR , 2.30; 95% CI , 1.61–3.27). Severe CHD was not associated with neonatal brain injury, necrotizing enterocolitis, or retinopathy of prematurity, whereas the OR for bronchopulmonary dysplasia increased. Mortality was higher in all types, with the highest propensity score–matched OR (4.96; 95% CI, 2.11–11.7) for CHD causing congestive heart failure. While mortality did not differ between groups at OR for mortality in infants with CHD increased to 10.9 (95% CI, 5.76–20.70) at 31 weeks’ gestational age. Rates of CHD and mortality differed significantly between networks. Conclusions Severe CHD is associated with significantly increased mortality in very preterm infants.

Introduction: South Asians have a high incidence of type 2 diabetes(DM) and cardiovascular disease (CVD). Women with DM may have greater CVD risk compared to men with DM and women without DM. No study has determined whether the incidence or progression of coronary artery calcium (CAC) score, a measure of atherosclerosis burden, differs between South Asian men and women with DM. Hypothesis: We hypothesize that CAC progression is greater in women with DM as compared to men with DM and women without DM. Methods: We used the data from the MASALA study, a community-based prospective cohort of South Asians from 2 clinical sites without CVD at baseline. We conducted a longitudinal analysis of diabetic participants who were reassessed after 5 years and compared with those without diabetes. We classified incident CAC as any CAC at exam 2 in a participant who had no CAC at baseline. To examine the progression of CVD risk factors over time, we compared change in CAC score, waist circumference, systolic and diastolic blood pressure, HbA1c and lipid levels amongst the diabetic and non-diabetic population by sex. We conducted multivariable linear regression models stratified by diabetes status to determine whether sex was independently associated with change in CAC score and other CVD risk factors. Results: Of 749 participants who were seen in follow-up, 176 (23%) had diabetes at baseline, 65% were men, and mean age was 58 years. Approximately 64% women with DM vs. 28% men with DM had CAC=0, and men had higher median CAC score (49 (IQR 0-247) vs. 0 (IQR 0-46, p Conclusion: In this South Asian population, change in CAC score was lower in women with DM than in men with DM, and was comparable to women without DM. These results suggest among South Asians with DM, overall CVD risk may be greater in men than in women.Continued follow-up of the MASALA cohort will determine whether there are sex differences in CVD outcomes.

Objective The objective is to evaluate the association between antibiotic utilization and neurodevelopmental outcomes at 18 to 21 months' corrected age among extremely low gestational age neonates without culture-proven sepsis or necrotizing enterocolitis (NEC). Study Design We conducted a retrospective cohort study of infants born between April 2009 and September 2011 at Result There were 1,373 infants who fulfilled our inclusion criteria. Compared with infants in the lowest AUR quartile (Q1), those in the highest quartile (Q4) had higher odds of death or sNDI (adjusted odds ratio [AOR] = 7.44; 95% confidence interval [CI]: 4.55, 12.2) and death (AOR = 39.3; 95% CI: 16.1, 95.9). Conclusion Our results indicate an association between high AUR and a composite outcome of death or adverse neurodevelopmental outcomes at 18 to 21 months' corrected age.

To examine rates and determinants of mother's own milk (MOM) feeding at hospital discharge in a cohort of infants born very preterm within the Canadian Neonatal Network (CNN).This was a population-based cohort study of infants born at33 weeks of gestation and admitted to neonatal intensive care units (NICUs) participating in the CNN between January 1, 2015, and December 31, 2018. We examined the rates and determinants of MOM use at discharge home among the participating NICUs. We used multivariable logistic regression analysis to identify independent determinants of MOM feeding.Among the 6404 infants born very preterm and discharged home during the study period, 4457 (70%) received MOM or MOM supplemented with formula. Rates of MOM feeding at discharge varied from 49% to 87% across NICUs. Determinants associated with MOM feeding at discharge were gestational age 29-32 weeks compared with26 weeks (aOR 1.56, 95% CI 1.25-1.93), primipara mothers (aOR 2.12, 95% CI 1.86-2.42), maternal diabetes (aOR 0.79, 95% CI 0.66-0.93), and maternal smoking (aOR 0.27, 95% CI 0.19-0.38). Receipt of MOM by day 3 of age was the major predictor of breast milk feeding at discharge (aOR 3.61, 95% CI 3.17-4.12).Approximately two-thirds of infants born very preterm received MOM at hospital discharge, and rates varied across NICUs. Supporting mothers to provide breast milk in the first 3 days after birth may be associated with improved MOM feeding rates at discharge.

BACKGROUND: Preterm birth is the leading cause of morbidity and mortality in children younger than 5 years. We report the changes in neonatal outcomes and care practices among very preterm infants in Canada over 14 years within a national, collaborative, continuous quality-improvement program. METHODS: We retrospectively studied infants born at 23–32 weeks’ gestation who were admitted to tertiary neonatal intensive care units that participated in the Evidence-based Practice for Improving Quality program in the Canadian Neonatal Network from 2004 to 2017. The primary outcome was survival without major morbidity during the initial hospital admission. We quantified changes using process-control charts in 6-month intervals to identify special-cause variations, adjusted regression models for yearly changes, and interrupted time series analyses. RESULTS: The final study population included 50 831 infants. As a result of practice changes, survival without major morbidity increased significantly (56.6% [669/1183] to 70.9% [1424/2009]; adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 1.06–1.10, per year) across all gestational ages. Survival of infants born at 23–25 weeks’ gestation increased (70.8% [97/137] to 74.5% [219/294]; adjusted OR 1.03, 95% CI 1.02–1.05, per year). Changes in care practices included increased use of antenatal steroids (83.6% [904/1081] to 88.1% [1747/1983]), increased rates of normothermia at admission (44.8% [520/1160] to 67.5% [1316/1951]) and reduced use of pulmonary surfactant (52.8% [625/1183] to 42.7% [857/2009]). INTERPRETATION: Network-wide quality-improvement activities that include better implementation of optimal care practices can yield sustained improvement in survival without morbidity in very preterm infants.

To develop and validate an itemized costing algorithm for in-patient neonatal intensive care unit (NICU) costs for infants born prematurely that can be used for quality improvement and health economic analyses.We sourced patient resource use data from the Canadian Neonatal Network database, with records from infants admitted to 30 tertiary NICUs in Canada. We sourced unit cost inputs from Ontario hospitals, schedules of benefits, and administrative sources. Costing estimates were generated by matching patient resource use data to the appropriate unit costs. All cost estimates were in 2017 Canadian dollars and assigned from the perspective of a provincial public payer. Results were validated using previous estimates of inpatient NICU costs and hospital case-cost estimates.We assigned costs to 27 742 infants born prematurely admitted from 2015 to 2017. Mean (SD) gestational age and birth weight of the cohort were 31.8 (3.5) weeks and 1843 (739) g, respectively. The median (IQR) cost of hospitalization before NICU discharge was estimated as $20 184 ($9739-51 314) for all infants; $11 810 ($6410-19 800) for infants born at gestational age of 33-36 weeks; $30 572 ($16 597-$51 857) at gestational age of 29-32 weeks; and $100 440 ($56 858-$159 3867) at gestational age of29 weeks. Cost estimates correlated with length of stay (r = 0.97) and gestational age (r = -0.65). The estimates were consistent with provincial resource estimates and previous estimates from Canada.NICU costs for infants with preterm birth increase as gestation decreases and length of stay increases. Our cost estimates are easily accessible, transparent, and congruent with previous cost estimates.

Neonates born very preterm (before 32 weeks’ gestational age), are a significant public health concern because of their high-risk of mortality and life-long disability. In addition, caring for very preterm neonates can be expensive, both during their initial hospitalization and their long-term cost of permanent impairments. To address these issues, national and regional neonatal networks around the world collect and analyse data from their constituents to identify trends in outcomes, and conduct benchmarking, audit and research. Improving neonatal outcomes and reducing health care costs is a global problem that can be addressed using collaborative approaches to assess practice variation between countries, conduct research and implement evidence-based practices. The International Network for Evaluating Outcomes (iNeo) of neonates was established in 2013 with the goal of improving outcomes for very preterm neonates through international collaboration and comparisons. To date, 10 national or regional population-based neonatal networks/datasets participate in iNeo collaboration. The initiative now includes data on >200,000 very preterm neonates and has conducted important epidemiological studies evaluating outcomes, variations and trends. The collaboration has also surveyed >320 neonatal units worldwide to learn about variations in practices, healthcare service delivery, and physical, environmental and manpower related factors and support services for parents. The iNeo collaboration serves as a strong international platform for Neonatal-Perinatal health services research that facilitates international data sharing, capacity building, and global efforts to improve very preterm neonate care.

Background One of the controversies in the management of twin gestations relates to mode of delivery, especially when the second twin is in a nonvertex presentation (Vertex/nonVertex pairs) and birth is imminent at extremely low gestation. Objective We hypothesized that, for Vertex/nonVertex twins born before 28 weeks’ gestation, cesarean delivery would be associated with a lower risk of adverse neonatal outcomes than trial of vaginal delivery. Our aim was to test this hypothesis by comparing the neonatal outcomes of Vertex/nonVertex twins born before 28 weeks’ gestation by mode of delivery using a large national cohort. Study Design This work is a retrospective cohort study of all twin infants born at 240/7 to 276/7 weeks’ gestation and admitted to level III neonatal intensive care units participating in the Canadian Neonatal Network (2010–2017). Exposure is defined a trial of vaginal delivery for Vertex/nonVertex twins. Nonexposed (control) groups are defined as cases where both twins were delivered by cesarean delivery, either in vertex or nonvertex presentation (control group 1) or owing to the nonvertex presentation of the first twin (control group 2). Outcome measures are defined as a composite of neonatal death, severe neurologic injury, or birth trauma. Results A total of 1082 twin infants (541 twin pairs) met the inclusion criteria: 220 Vertex/nonVertex pairs, of which 112 had a trial of vaginal delivery (study group) and 108 had cesarean delivery for both twins (control group 1); 170 pairs with the first twin in nonvertex presentation, all of which were born by cesarean delivery (control group 2); and 151 pairs with both twins in vertex presentation (vertex or nonvertex). In the study group, the rate of urgent cesarean delivery for the second twin was 30%. The rate of the primary outcome in the study group was 42%, which was not significantly different compared with control group 1 (37%; adjusted relative risk, 0.93; 95% confidence interval, 0.71–1.22) or control group 2 (34%; adjusted relative risk, 1.20; 95% confidence interval, 0.92–1.58). The findings remained similar when outcomes were analyzed separately for the first and second twins. Conclusion For preterm Vertex/nonVertex twins born at

To assess associations between neonatal intensive care unit (NICU)-level patent ductus arteriosus (PDA) treatment rates (pharmacologic or surgical) and neonatal outcomes.This cohort study included infants born at 24-28 weeks of gestation and birth weight1500 g in 2007-2015 in NICUs caring for ≥100 eligible infants in 6 countries. The ratio of observed/expected (O/E) PDA treatment rates was derived for each NICU by estimating the expected rate using a logistic regression model adjusted for potential confounders and network. The primary composite outcome was death or severe neurologic injury (grades III-IV intraventricular hemorrhage or periventricular leukomalacia). The associations between the NICU-level O/E PDA treatment ratio and neonatal outcomes were assessed using linear regression analyses including a quadratic effect (a square term) of the O/E PDA treatment ratio.From 139 NICUs, 39 096 infants were included. The overall PDA treatment rate was 45% in the cohort (13%-77% by NICU) and the O/E PDA treatment ratio ranged from 0.30 to 2.14. The relationship between the O/E PDA treatment ratio and primary composite outcome was U-shaped, with the nadir at a ratio of 1.13 and a significant quadratic effect (P.001). U-shaped relationships were also identified with death, severe neurologic injury, and necrotizing enterocolitis.Both low and high PDA treatment rates were associated with death or severe neurologic injury, whereas a moderate approach was associated with optimal outcomes.

Background: Oral cavity cancer is one of the leading causes of cancer related deaths in developing countries. Most of the failures occur due to locoregional recurrence. The present study was conducted to find out the pattern of recurrences and factors responsible for that in oral cavity squamous cell carcinoma (SCC). Methods: The study was conducted at Gujarat cancer and research institute Ahmedabad, India. Total 260 patients were evaluated in study from year January 2013 to December 2013 retrospectively. Two year follow up was studied to find out the pattern of failure in terms of local, regional (nodal) and systemic. Results: Oral cavity SCC has high chances of local failure when removed inadequately during surgery. Perineural spread, lymphovascular involvement and perinodal spread are important prognostic factors. Conclusions: Most patients of oral cavity cancer present in advanced stages. Close margins and perineural involvement are responsible for local recurrences while perinodal spread and lymphovascular involvement contributes to nodal recurrences. Tobacco consumption is important responsible factor.

Thermal performance of the packed bed solar heat storage system was studied under varying solar and ambient conditions in different months. The insulated packed bed heat storage unit was filled with 8500 kg rock pebbles. The solar collection and heat retrieval efficiency of heat storage system ranged between 36–51% and 75–77%, respectively. Heat retrieval efficiency of the developed packed bed was found better as compared to the packed bed filled with phase change material (PCM). The experimental values were found in good conformity with predicted values of the packed bed temperature and hot air temperature retrieved from the bed.

Background Recent studies have described the bifidobacterial composition of neonates at a species level; however, with advancing technologies we can gain insight into the diversity of the bifidobacterial microbiota residing within the infant gut. Objective To compare species and strain diversity of culturable bifidobacterial populations in faecal samples obtained from healthy term infants on three different feeding regimes. Study design In total, 51 healthy term infants were recruited for this study and divided equally into three different groups (n=17) based on their feeding regime during the first 4 weeks of life. Culturable bifidobacterial populations were analysed at week 1, week 4 and 6 months of age. Isolates were characterised to species level by 16s rRNA-internally transcribed spacer (ITS) gene sequence analysis and to strain level by pulsed field gel electrophoresis (PFGE). Results In total,173 bifidobacterial strains were detected across all three groups from 2295 isolates, 42% (72 of 173) of which were detected in the prebiotic-fed group, followed by 30% (52 of 173) and 28% (49 of 173) in the breastfed and non-prebiotic-fed groups, respectively. Surprisingly, only two of the 51 infants harboured an identical bifidobacterial strain which was not present in the other 49 infants. Prebiotic supplementation in the early neonatal period increased the prevalence of Bifidobacterium longum in infants, in addition to promoting strain diversity. B. longum was the dominant species recovered from all three groups during the first 6 months of life, followed by Bifidobacterium breve and Bifidobacterium bifidum . Conclusions This study reveals a hitherto unknown level of diversity at the strain level among bifidobacteria isolated from different infants and the influence prebiotic formula feeding has on the bifidobacterial population.

The neonatal resuscitation program (NRP) has been developed to educate physicians and other health care providers about newborn resuscitation and has been shown to improve neonatal resuscitation skills. Simulation-based training is recommended as an effective modality for instructing neonatal resuscitation and both low and high-fidelity manikin simulators are used. There is limited research that has compared the effect of low and high-fidelity manikin simulators for NRP learning outcomes, and more specifically on teamwork performance and confidence. The purpose of this study was to examine the effect of using low versus high-fidelity manikin simulators in NRP instruction. A randomized posttest-only control group study design was conducted. Third year undergraduate medical students participated in NRP instruction and were assigned to an experimental group (high-fidelity manikin simulator) or control group (low-fidelity manikin simulator). Integrated skills station (megacode) performance, participant satisfaction, confidence and teamwork behaviour scores were compared between the study groups. Participants in the high-fidelity manikin simulator instructional group reported significantly higher total scores in overall satisfaction (p = 0.001) and confidence (p = 0.001). There were no significant differences in teamwork behaviour scores, as observed by two independent raters, nor differences on mandatory integrated skills station performance items at the p < 0.05 level. Medical students’ reported greater satisfaction and confidence with high-fidelity manikin simulators, but did not demonstrate overall significantly improved teamwork or integrated skills station performance. Low and high-fidelity manikin simulators facilitate similar levels of objectively measured NRP outcomes for integrated skills station and teamwork performance.

Antioxidant vitamins neutralize free radicals and may prevent unwanted free radical cellular damage in the body. Free radicals damage other molecules by removing electrons and destroying deoxyribonucleic acid, or DNA.The thyroid gland is an organ of "oxidative nature" as huge amount of ROS, especially of H2O2, are produced in the thyroid under physiological conditions. Aims- To evaluate the effect of antioxidants on thyroid hormones in rats, fourty wistar were used in this study and with antioxidants namely Vit. C, Vit. E and Turmeric. Methods-The present research work has been undertaken to investigate the free radical scavenging activity and antioxidant status in both hyperthyroid and hypothyroid patients.Adult male Wister rats, weighing around 150-200 gms were used in this research work and under maintained animal care facilities and veterinary supervision. All rats were fed with normal diet (20% protein) and have been administered with known amount of Vitamin C, Vitamin E and turmeric.Results-Samples has been analysed after 15 & 30 days of feeding. Results showed increased levels of thyroxin in rats after 15 days (Vit C-5.2 ± 1.2 NS,Vit E - 5.3 ± 0.5 NS and Turmeric-5.3 ± 0.87 NS).Conclusion-It was observed that the circulating levels of T3 were significantly increased in Vit. C, Vit. E and Turmeric extract treated rats (Table -2 and 3). The thyroid hormones responded to antioxydants indicating the significance of antioxydants for the prevention of occurrence of certain diseases in thyroid gland by protecting biological system against potentially harmful effects of processes or reactions that can cause excessive oxidations.

Excessive antibiotic use has been associated with altered bacterial colonization and may result in antibiotic resistance, fungemia, necrotizing enterocolitis (NEC), and mortality. Exploring the association between antibiotic exposure and neonatal outcomes other than infection-related morbidities may provide insight on the importance of rational antibiotic use, especially in the setting of culture-negative neonatal sepsis.To evaluate the trend of antibiotic use among all hospitalized very low-birth-weight (VLBW) infants across Canada and the association between antibiotic use rates (AURs) and mortality and morbidity among neonates without culture-proven sepsis or NEC.A retrospective cohort study was conducted among VLBW infants (1500 g) admitted to level III neonatal intensive care units between January 1, 2010, and December 31, 2014, using data obtained from the Canadian Neonatal Network database.Duration of antibiotic use during the hospitalization period.The AUR was defined as the number of days an infant was exposed to 1 or more antimicrobial agents divided by the total length of hospital stay. The composite primary outcome was defined as mortality or major morbidity, including any of the following: persistent periventricular echogenicity or echolucency on neuroimaging, chronic lung disease, and stage 3 or higher retinopathy of prematurity. Multivariable regression analysis was used to calculate adjusted odds ratios (aORs) and 95% CIs for the association between AURs and outcomes.Among 13 738 eligible VLBW infants, 11 669 (84.9%) (mean [SD] gestational age, 27.7 [2.5] weeks; 47.4% female) received antibiotics during their hospital course and were included in the study. The annual AUR decreased from 0.29 in 2010 to 0.25 in 2014 (slope for the best-fit line, -0.011; 95% CI, -0.016 to -0.006; P .01), which occurred in parallel with a reduction in the rate of late-onset sepsis from 19.0% in 2010 to 13.8% in 2014 during the same period. Of the 11 669 infants who were treated with antibiotics of varying duration during their hospital stay, 2845 were diagnosed as having sepsis-related complications. Among the remaining 8824 infants without early-onset sepsis, late-onset sepsis, or NEC, a 10% increase in the AUR was associated with an increased odds of the primary composite outcome (aOR, 1.18; 95% CI, 1.13-1.23), mortality (aOR, 2.04; 95% CI, 1.87-2.21), and stage 3 or higher retinopathy of prematurity (aOR, 1.18; 95% CI, 1.06-1.32).Antibiotic use in VLBW infants decreased between 2010 and 2014 in Canada. However, among infants without culture-proven sepsis or without NEC, higher AURs were associated with adverse neonatal outcomes.

Acid-base disturbances are frequently seen in acute kidney injury patients, common being mild anion gap metabolic acidosis. Similarly, electrolyte disturbances like hyponatremia, hyperkalemia, hypocalcemia, and hyperphosphatemia are common in acute kidney injury. Acute kidney injury occurring in intensive, and critical care setting have more complex acid-base and electrolyte disturbances with multiple mechanism and etiology. It is difficult to separate the acid-base effects critical illness from that of acute renal failure and in such setting quantitative physicochemical methods like strong ion difference help to understand the nature of disturbance. This review focuses on nature of acid-base electrolytes disturbances seen in acute kidney injury patients along with its mechanism and etiology.

Background: Schizophrenia is severe disorders and imposes a considerable burden on patients, their families and society. Schizophrenia tends to run in family, like most mental disorder shows complex inheritance. Therefore, it is important to increase our knowledge about the disorder. Cognitive dysfunction is one of the core features of Schizophrenia. This study aims to compare the cognitive function of first degree unaffected relative of patient of schizophrenia and a group of healthy control.Methods: The study include 48 first degree normative relative of patient with Schizophrenia and 48 controls. Compared for age, sex, education level. Cognitive functions of each case and control were assessed using TMT (Trail making Test), Paced auditory serial addition Test (PASAT) and Wisconsin card sorting test (WCST-64).Results: First degree relative performed significantly poorly as compared to controls on Wisconsin card sorting Test-64 (WCST-64). No significant difference was observed in tests performances between first degree relative of Schizophrenia and control group for TMT (trail making test) and Paced auditory serial addition Test (PASAT).Conclusions: The study shows possibility of cognitive impairment in first degree normative relative of Schizophrenia with regards to parameters like poor performance in shifting cognitive sets and poor understanding of test. Nevertheless, it is not clear weather this finding is an enduring trait mark or finding that fluctuates with sample size, nature of case and control.

Objective To assess the impact of variations in the definition of severe neurodevelopmental impairment (NDI) on the incidence of severe NDI and the association with risk factors using the Canadian Neonatal Follow-Up Network cohort. Study design Literature review of severe NDI definitions and application of these definitions were performed in this database cohort study. Infants born at 23-28 completed weeks of gestation between 2009 and 2011 (n = 2187) admitted to a Canadian Neonatal Network neonatal intensive care unit and assessed at 21 months' corrected age were included. The incidence of severe NDI, aORs, and 95% CIs were calculated to express the relationship between risk factors and severe NDI using the definitions with the highest and the lowest incidence rates of severe NDI. Results The incidence of severe NDI ranged from 3.5% to 14.9% (highest vs lowest rate ratio 4.29; 95% CI 3.37-5.47). The associations between risk factors and severe NDI varied depending on the definition used. Maternal ethnicity, employment status, antenatal corticosteroid treatment, and gestational age were not associated consistently with severe NDI. Although maternal substance use, sex, score of neonatal acute physiology >20, late-onset sepsis, bronchopulmonary dysplasia, and brain injury were consistently associated with severe NDI irrespective of definition, the strength of the associations varied. Conclusions The definition of severe NDI significantly influences the incidence and the associations between risk factors and severe NDI. A standardized definition would facilitate site comparisons and scientific communication.

To compare mortality and neurodevelopmental outcomes of outborn and inborn preterm infants born at29 weeks of gestation admitted to Canadian neonatal intensive care units (NICUs).Data were obtained from the Canadian Neonatal Network and Canadian Neonatal Follow-up Network databases for infants born at29 weeks of gestation admitted to NICUs from April 2009 to September 2011. Rates of death, severe neurodevelopmental impairment (NDI), and overall NDI were compared between outborn and inborn infants at 18-21 months of age, corrected for prematurity.Of 2951 eligible infants, 473 (16%) were outborn. Mean birth weight (940 ± 278 g vs 897 + 237 g), rates of treatment with antenatal steroids (53.9% vs 92.9%), birth weight small for gestational age (5.3% vs 9.4%), and maternal college education (43.7% vs 53.9%) differed between outborn and inborn infants, respectively (all P values.01). The median Score for Neonatal Acute Physiology-II (P = .01) and Apgar score at 5 minutes (P .01) were higher in inborn infants. Severe brain injury was more common among outborn infants (25.3% vs 14.7%, P .01). Outborn infants had higher odds of death or severe NDI (aOR 1.7, 95% CI 1.3-2.2), death or overall NDI (aOR 1.6, 95% CI 1.2-2.2), death (aOR 2.1, 95% CI 1.5-3.0), and cerebral palsy (aOR 1.9, 95% CI 1.1-3.3).The composite outcomes of death or neurodevelopmental impairment were significantly higher in outborn compared with inborn infants admitted to Canadian NICUs. Adverse outcomes were mainly attributed to increased mortality and cerebral palsy in outborn neonates.

Background Data regarding the effects of antenatal corticosteroids in twin pregnancies are limited because of the insufficient number of women with twins enrolled in randomized controlled trials on antenatal corticosteroids. Furthermore, the interpretation of available data is limited by the fact that the interval from the administration of antenatal corticosteroids to delivery is greater than 7 days in a large proportion of twins, a factor that has been shown to affect the efficacy of antenatal corticosteroids and has not been controlled for in previous studies. Objective The objective of the study was to compare neonatal mortality and morbidity in preterm twins receiving a complete course of antenatal corticosteroids 1–7 days before birth to those who did not receive antenatal corticosteroids and to compare these outcome effects with those observed in singletons. Study Design We performed a retrospective cohort study using data collected on singleton and twin neonates born between 24 0/7 and 33 6/7 weeks' gestational age and were admitted to tertiary neonatal units in Canada between 2010 and 2014. A comparison of neonatal outcomes between twin neonates who received a complete course of antenatal corticosteroids 1–7 days before birth (n = 1758) and those who did not receive antenatal corticosteroids (n = 758) and between singleton neonates who received a complete course of antenatal corticosteroids 1–7 days before birth (n = 4638) and those did not receive antenatal corticosteroids (n = 2312) was conducted after adjusting for gestational age, sex, hypertension, outborn status, small for gestational age, parity, and cesarean birth. Adjusted odds ratios and 95% confidence intervals for various neonatal outcomes were calculated. Results Administration of a complete course of antenatal corticosteroids within 1–7 days before birth in both twins and singletons was associated with similar reduced odds of neonatal death (for twins adjusted odds ratio 0.42 [95% confidence interval, 0.24–0.76] and for singletons adjusted odds ratios, 0.38 [95% confidence interval, 0.28–0.50]; P = .7 for comparison of twins vs singletons), mechanical ventilation (for twins adjusted odds ratio, 0.47 [95% confidence interval, 0.35–0.63] and for singletons adjusted odds ratio, 0.47 [95% confidence interval, 0.41–0.55]; P = .9), respiratory distress syndrome (for twins adjusted odds ratio, 0.53 [95% confidence interval, 0.40–0.69], and for singletons adjusted odds ratio, 0.54 [95% confidence interval, 0.47–0.62]; P = .9) and severe neurological injury (for twins adjusted odds ratio, 0.50 [95% confidence interval, 0.30–0.83] and for singletons adjusted odds ratio, 0.45 [95% confidence interval, 0.34–0.59]; P = .7). Administration of a complete course of antenatal corticosteroids was not associated with a reduced odds of bronchopulmonary dysplasia, severe retinopathy of prematurity, or necrotizing enterocolitis in both twins and singletons. Conclusion Administration of a complete course of antenatal corticosteroids 1–7 days before birth in twin pregnancies is associated with a clinically significant decrease in neonatal mortality, short-term respiratory morbidity, and severe neurological injury that is similar in magnitude to that observed among singletons.

The paper describes the work done on modelling and simulation of a multistage flash desalination plant containing 15 recovery and 3 rejection stages. Both the steady-state and dynamic simulations have been carried out through the use of SPEEDUP package. In addition, a specifically written FORTRAN program is used for the steady-state simulation based on tridiagonal matrix formulation. Good agreement is achieved by comparing with the vendor supplied as well as actual plant data.

High-Tc superconductor thin films have many important properties for microwave frequency passive device applications. However, for device fabrication it is necessary to deposit uniform defect-free films of YBa2Cu3O7−x (YBCO) over large wafer-size areas. The activated reactive evaporation process has been used successfully to grow YBCO films at relatively low temperatures over large areas. The unique features of the process will be discussed over other popular processes with emphasis on film composition, structure and thickness uniformity.

With increased demand for food quality and health benefits, need for stringent scrutiny on the inspection of agrifood products have become mandatory. In Indian agriculture, the next challenge is to provide an effective, safe viable storage and handling methods particularly in unpredictable weather conditions. This can be done by using appropriate sensors and system to maintain environmental and storage parameters at predefined level by monitoring of the storage space. The paper presents the application of E-nose system along with smart embedded sensor system to study the deterioration of food grains under different stress (temperature, humidity, insects etc.) and room environmental conditions. The food grain conditions are artificially generated and the effects are studied with -Fox 2000 e-nose system. In order to analyze the data of rice, millet, wheat, jawar under different stress conditions, we performed different analysis viz, Principal Component Analysis & Discriminant Factorial Analysis on the acquired Enose data and results obtained are also presented.

Quasioptical millimeter-wave band-pass filters using YBa/sub 2/Cu/sub 3/O/sub 7/ high-T/sub c/ superconducting films were fabricated on MgO and LaAlO/sub 3/ substrates. Transmitted power through the filter was investigated in the 75 GHz to 110 GHz frequency range at temperatures ranging from 15 to 300 K. At 15 K the measured center frequency and the bandwidth of the superconducting filter were 92 GHz and 0.85 GHz, respectively. Measurements of YBa/sub 2/Cu/sub 3/O/sub 7/ filters were compared with similar filters fabricated using gold. At 15 K and 92 GHz, an improvement of 75% in the quality factor of the superconducting filter was obtained compared with a similar gold filter. >

The optical response of YBa2Cu3O7 high Tc superconducting quasi‐optical millimeter wave bandpass filters operating at W band (75–110 GHz) has been investigated under various conditions of illumination. Radiation from a cw Ar+ laser (514.5 nm) and a frequency‐doubled Nd:YAG laser (532.8 nm, 120 ps) was used to induce a shift in the resonant frequency of the filter. A shifted Lorentzian line shape function model was used to estimate the magnitude of the light‐induced changes. Shifts of the filter’s resonance frequency on the order of 0. 1 MHz were induced by the laser effects on the superconductor pair population.

Large size high-resolution liquid crystal displays put severe restriction on metal selection for gate lines where very low resistivity is required. Pure aluminum (Al) could be used of hillocking issues could be resolved. In this paper we demonstrated an Al deposition process on glass substrates with ultra low hillock density after photoresist and dielectric processing. Effects of process parameters such as substrate temperature, substrate roughness, base pressure and underlayer thickness on morphology and texture of aluminum are discussed.

Large grain poly-Silicon (p-Si) films have been evaluated for high speed TFT for flat panel displays [1,2]. It is expected that with good quality p-Si, “System on Glass” products, in which entire electronic circuitry is incorporated directly onto glass are achievable [3]. This approach therefore has the potential to fabricate Integrated AMLCD's (IAMLCD) and bypass conventional Si wafer based products and integrate CMOS circuits with direct view TFT LCD manufacturing. To realize this potential; it is necessary to develop a production process for depositing repeatable, good quality p-Si films on to large area glass substrates.

An 8-year-old boy with large abdominal lump causing upper abdominal fullness is presented. Clinically it mimicked a trichobezoar because of the restricted side-to-side mobility of the lump. The lump, however, had calcification and radiological features of fetus-in-fetu (FIF). At laparotomy, a fetiform mass covered with fatty tissue was delivered out of a retroperitoneally located sac (in the bed of stomach). The fetiform mass had an identifiable upper limb bearing digits, one of them also bearing nail. Though histopathological examination did not reveal the presence of vertebral bodies, an advanced differentiation of the bony ends, bearing cartilage qualified the mass as FIF. There was family history of twinning with the elder siblings being dizygotic twins. The origin and diagnostic criteria of FIF are discussed and reference is made to a high likelihood of a twinning as the preceding event in this case.

One important application of the thin film high temperature superconductors is in the area of passive components for high frequency (microwave) devices. The important parameter that characterizes the ohmic losses in the superconductor film at these frequencies (1–100 GHz) is the surface resistance (Rs). It has been reported earlier that extremely high quality films are required to compete with copper at 100 GHz [1,2]. Films that exhibit excellent Rs values were usually grown by laser ablation at 750–780 ° C on exotic low loss substrates such as LaA1O3. In these films, c-axis orientation was well formed, defects were minimal, Tcs’ were higher than 90 K, Jcs' higher than 106 Amps/cm2 at 77 K etc.. In fact, the films were reported to be nearly single crystal with less than 1% impurities. In this letter we report our results of Rs measurement on 1-2-3 films grown on MgO substrates at 675 ° C, and show that some of the stringent conditions can be met more easily using the low pressure ARE growth process. The process is well established, and has been used successfully to fabricate high quality YBCO films [3, 4].

Etch rate and uniformity are two basic indicators of how rf power is coupled into the wafer. In reactive ion etch of dielectric layers, wafer temperature also appears as a key parameter, due to the innate deposition. When electrostatic chuck is introduced, we have to study and control both rf coupling and wafer temperature to maximize etch rate and minimize nonuniformity. We first review the basics of the electrostatic chuck (e‐chuck) design and operation, and check them against Applied Materials’ polyimide monopolar e‐chuck. Then a simple circuit model is developed and fitted to the experimental results. The model says to have higher etch rate, one needs to couple more energy through the wafer center. This is achieved by using a thicker insulating process kit with low dielectric constant. The uniformity study shows for a given wafer, its etch rate variation across the wafer can be divided into three sections—center, B‐field corner, and very edge of the wafer, and each section is controlled by a key parameter. By optimizing these parameters, we are able to increase the etch rate and decrease its nonuniformity to 1.5% (1σ, 3 mm edge exclusion). Finally, wafer temperatures of both center and edge are studied and the delta between center and edge is reduced to ∼6 °C, and spin‐on‐glass etch rate nonuniformity is reduced to 1σ of 1.88%.

Considerable interest has been aroused in the synthesis of diamond films due to their potential applications in microelectronics and optoelectronics. Although synthesis of diamond films by a variety of chemical and plasma assisted chemical as well as physical vapor deposition techniques has been reported, the practical applications of these coatings are still very few. The basic reason limiting the applications of these coatings is the inability to deposit films with smooth surface morphology and desired optical and electrical properties at acceptable deposition rates. Published work on diamond films is reviewed to highlight the above issues.

Synthesis of silicon nitride films using the activated reactive evaporation (ARE technique was investigated with the objective of obtaining films with a low concentration of hydrogen for the possible application as an encapsulant for annealing compound semiconductors. Silicon was evaporated in a radio frequency (r.f.) excited nitrogen plasma. The effects of deposition conditions and annealing on properties of the films will be discussed.

Various industrial applications have been found for plasma assisted deposition processes in the synthesis of a variety of compound films. These include dielectric, metallic and semiconducting films for microelectronics, optics and optoelectronics, as well as hard carbides and nitrides for cutting and forming tools, sulfides for solid lubricants and solid state batteries, etc. The uniqueness of plasma assisted deposition processes lies in their ability to synthesize complex films at relatively low substrate temperatures. These processes enable film properties to be varied over a wide range by control of the plasma conditions e.g. electron density, energy and distribution function. Therefore, plasma assisted deposition processes have attracted a great deal of interest in recent years. We present a review of plasma assisted deposition techniques currently used in industry, in terms of their potential and their limitations for synthesis of novel materials such as diamond, cubic boron nitride, etc. Results of experimental work in our laboratory are also discussed.

SUMMARY The phenomenon of reduplication of the urethra is a rare congenital anomaly occurring mostly in males. The literature on the subject has been briefly reviewed. Two of our own patients have been reported, one of whom was treated by complete surgical extirpation and the other by injection of sodium morrhuate.