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Imad Badran,1,2 Alice Bruynseels,1,3 Salim Khan,2 Freda Sii,1,3 Peter Shah1,3–51Ophthalmology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK; 2Department for Therapies and Public Health, Birmingham City University, Birmingham, UK; 3Birmingham Institute for Glaucoma Research, Institute for Translational Medicine, Birmingham, UK; 4Institute of Ophthalmology, University College London, London, UK; 5Centre for Health and Social Care Improvement, School of Health and Wellbeing, University of Wolverhampton, Wolverhampton, UKPurpose: Self-care in chronic disease is increasingly important. In glaucoma services, there is an unmet need for a self-care tool such as a patient passport. This study aims to evaluate adoption of a new self-care tool, the Glaucoma Patient Passport (GPP) within a tertiary hospital glaucoma service.Patients and methods: The GPP was designed following consultation exercises between patients and clinicians at the first and second UK National Glaucoma Think Tanks. A patient questionnaire, comprising a mixed methods quantitative and qualitative research approach was used to explore the utility of GPP, patient attitude to GPP and barriers to adoption, 6 months after GPP receipt.Results: GPP feedback was received from 62 patients. On-going utilization of the GPP after receipt was high, at 84%, with patients most commonly using the GPP at home, to “look for information.” Seventy-three percent reported improved knowledge of glaucoma care since using the GPP, with two-thirds (63%) reporting that the GPP had improved their glaucoma care. Three main themes were identified in exploring barriers to GPP adoption; clinician involvement in GPP use, GPP size, and GPP use in visual impairment.Conclusion: Implementation and adoption of the world’s first GPP were a success. GPP utility was high and patient attitudes were predominantly positive, with improved self-care. However, several areas were identified for future GPP improvement. The GPP has the potential to improve patient self-care in glaucoma, bridging the care gap created by the increased workload in glaucoma services.Keywords: chronic disease, self-care, patient passport, ophthalmology

In integral-cycle triggering mode of voltage control, subharmonic as well as higher order harmonic components are generated in the load voltage waveforms of a three-phase system. These harmonic components are found to be unbalanced in phase displacement. The correction of the unbalanced phase displacement angles of a particular subharmonic or higher order harmonic for this type of triggering is investigated to solve the limitation of use of this important type of control as a drive and many other industrial applications. In this research a new phase shifting technique is proposed to correct the unbalanced phase displacement angles in the three-phase system. This technique depends on shifting the waveforms of either phase B or phase C or both by multiples of 2[Pi]. A microprocessor-based harmonic phase shifter is designed and tested with three-phase resistive and induction motor loads. It is found that there is a well agreement between the theoretical and experimental results and it is believed that the major problem of harmonics phase unbalances associated with the integral-cycle triggering mode of thyristors when used with three-phase circuits have been solved in the present research. Key words: Harmonics, integral cycle control, power electronics, phase angle correction, phase shifter, ac motor speed control, INTRODUCTION Load voltage control by means of switching a pair of inverse parallel connected thyristors or triac is well established. It is customary to use modes of thyristor triggering known [...]

Several electric power companies are now forecasting electric loads based on conventional methods. However, since the relationship between loads and factors influencing these loads is nonlinear, it is difficult to identify its nonlinearity by using conventional methods. Most of papers deal with 24-h-ahead load forecasting or next day peak load forecasting. These methods forecast the demand power by using forecasted temperature as forecast information. But, when the temperature curves change rapidly on the forecast day, loads change greatly and forecast error would be going to increase. Typically, load forecasting can be long-term, medium-term, short-term or very short-term. This paper concentrates on short-term load forecasting and partially on medium-term load forecasting applying regression models. Key words: Load forecasting, [R.sup.2] value, regression models, least square, INTRODUCTION The operation of modern power systems is usually associated with a variety of operations planning procedures. Operations planning encompass methodologies and decision processes by which an electric power system [...]

Theprimary decomposition of 1,3-disilacyclobutane (DSCB) on a tungstenfilament and its secondary gas-phase reactions in a hot-wire chemicalvapor deposition (CVD) reactor have been studied using laser ionizationmass spectrometry. Under the collision-free conditions, DSCB decomposeson the W filament to produce H2molecules with an activationenergy of 43.6 ± 4.1 kJ·mol–1. With thehelp of the isotope labeling and chemical trapping methods, the mechanisticdetails in the secondary gas-phase reactions important in the hot-wireCVD reactor setup have been examined. The dominant pathway has beendemonstrated to be the insertion of the cyclic 1,3-disilacyclobut-1-ylidene,generated by exocyclic Si–H bond rupture, into the Si–Hbond in DSCB to form 1,1′-bis(1,3-disilacyclobutane) (174 amu).The successful trapping of 1,3-disilacyclobut-1-ylidene by both 1,3-butadieneand trimethylsilane provides compelling evidence for the existenceof this cyclic silylene species in the hot-wire CVD reactor with DSCB.Other reactions operating in the reactor include the DSCB cycloreversionto form silene and the ring opening of DSCB via 1,2-H shift to producesilene/methylsilylene and 1-methylsilene/silylene. The introductionof an additional Si atom in the four-membered ring monosilacyclobutanemolecule has caused two major changes in the reaction chemistry assumedby DSCB: (1) The endocyclic cycloreversion reactions that dominatein the decomposition of monosilacyclobutane molecules only play amuch less important role in the dissociation of DSCB; and (2) theexocyclic bond cleavages are promoted in DSCB due to the ring stabilizationcaused by the introduction of one additional Si atom. [ABSTRACT FROM AUTHOR]

The kinetics and thermochemistry of the decompositionpathwaysfor 1,3-disilacyclobutane (1,3-DSCB) in the gas phase were studiedusing the second-order Møller–Plesset (MP2) perturbationtheory and coupled cluster methods with single, double, and perturbativetriple excitations (CCSD(T)). The reactions examined include 2 + 2cycloreversion to form two silenes by either a concerted or a stepwisemechanism, 1,1-, 1,2-, and 1,3-H2elimination, and thering-opening initiated by 1,2-H shift to form an open-chain 1,3-disilabut-1-ylidene,which undergoes further decomposition to produce two pairs of silene/silylenespecies. The structures of the transition states for the concertedand the stepwise 2 + 2 cycloreversion pathways are found to resembleclosely those reported for the head-to-tail and head-to-head dimerization,respectively. Comparison of the activation barriers demonstrates unambiguouslythat the stepwise cycloreversion (ΔH0‡= 66.1kcal/mol) is favored over the concerted one (ΔH0‡=77.3 kcal/mol). A new pathway was established from the 1,4-diradicalintermediate in the stepwise cycloreversion to form 1-silylmethylsilenevia 1,3-H shift. The concerted 1,1-H2elimination is shownto have the lowest activation barrier of all H2eliminationreactions. Overall, the 1,2-H shift in 1,3-DSCB with concerted ring-openingto form 1,3-disilabut-1-ylidene is the most kinetically and thermodynamicallyfavorable decomposition pathway, both at 0 and 298 K. [ABSTRACT FROM AUTHOR]

Background: Fluorescence quenching is an interesting phenomenon with the potential to be applied across various fields. The mechanism is commonly used across analytical applications for monitoring the concentration of trace substances. Naphthalimide and its family of compounds are commonly used as fluorescent detectors. This work investigated an analytical technique through which naphthalimide-based dyes could be quantified. A commercial A/C leak detector was used as the dye and Cu 2+ ions as the quencher. Experiments were also conducted to investigate the effect of temperature on quenching. To study the mechanism of quenching further, density functional theory (DFT) was used., Results: The method detection limit obtained in this work is 1.7 × 10 -6  mol/L. The results from the quenching experiments demonstrated a pattern which fit a modified Stern-Volmer (SV) model, with an R 2 value of 0.9886. From the experiments on the effect of temperature, a dynamic quenching behavior was observed given the emission spectra demonstrated an inverse relationship with temperature., Conclusions: The quenching of the commercial A/C dye by Cu 2+ ions can be used to develop a rapid and sensitive detection method for metal ions such as Cu 2+ , and for future fabrication of chemosensors for Cu 2+ ., (© 2023. The Author(s).)

Several approaches, including plasmid transfection and viral vectors, were used to deliver genes into cells for therapeutic and experimental purposes. However, due to the limited efficacy and questionable safety issues, researchers are looking for better new approaches. Over the past decade, graphene has attracted tremendous attention in versatile medical applications, including gene delivery, which could be safer than the traditional viral vectors. This work aims to covalently functionalize pristine graphene sheets with a polyamine to allow the loading of plasmid DNA (pDNA) and enhance its delivery into cells. Graphene sheets were successfully covalently functionalized with a derivative of tetraethylene glycol connected to polyamine groups to improve their water dispersibility and capacity to interact with the pDNA. The improved dispersibility of the graphene sheets was demonstrated visually and by transmission electron microscopy. Also, it was shown by thermogravimetric analysis that the degree of functionalization was about 58%. Moreover, the surface charge of the functionalized graphene was +29 mV as confirmed by zeta potential analysis. The complexion of f-graphene with pDNA was achieved at a relatively low mass ratio (10 : 1). The incubation of HeLa cells with f-graphene loaded with pDNA that encodes enhanced green fluorescence protein (eGFP) resulted in the detection of fluorescence signal in the cells within one hour. f-Graphene showed no toxic effect in vitro . Density functional theory (DFT) and quantum theory of atoms in molecules (QTAIM) calculations revealed strong binding with Δ H 298 = 74.9 kJ mol -1 . QTAIM between the f-graphene and a simplified model of pDNA. Taken together, the developed functionalized graphene could be used for the development of a new non-viral gene delivery system., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Water pollution by emerging pollutants such as pharmaceutical and personal care products is one of today's biggest challenges. The presence of these emerging contaminants in water has raised increasing concern due to their frequent appearance and persistence in the aquatic ecosystem and threat to health and safety. The antidiabetic drug glimepiride, GPD, is among these compounds, and it possesses adverse effects on human health if not carefully administered. Several conventional processes were proposed for the elimination of these persistent contaminants, and adsorption is among them. Therefore, in this study, the adsorptive removal of GPD from water using multi-walled carbon nanotubes (MWCNT) supported on silica was explored on a fixed-bed column. The effects of bed-height, solution pH, and flow rate on the adsorptive removal of GPD were investigated. The obtained adsorption parameters using Sips, Langmuir, and Freundlich models were used to investigate the continuous adsorption. The results showed that the drug removal is improved with the increasing bed height; however, it decreased with the flow rate. The effect of pH indicated that the adsorption is significantly affected and increased in acidic medium. The convection-dispersion model coupled with Freundlich isotherm was developed and used to describe the adsorption breakthrough curves. The maximum adsorption capacity (q m ) was 275.3 mg/g, and the axial dispersion coefficients were ranged between 3.5 and 9.0 × 10 5 m 2 /s. The spent adsorbent was successfully regenerated at high pH by flushing with NaOH.

Objectives: The evolution of community pharmacist education is guided by successive reforms. They aim to reduce the gap between academic education and community pharmacy practice but the perception regarding these reforms is poorly documented. The present study describes the cross-perceptions between community pharmacists, pharmacy students and academics teachers regarding the gap between academic education and community pharmacy practice, and, therefore, the essential knowledges and skills for the community pharmacy practice., Methods: This study was conducted between April 2017 and April 2018 using an electronic survey for community pharmacists, academic teachers and pharmacy students. The results were discussed regarding previous studies with the aim to detect improvement points and vigilance related points., Results: This study shows that the pharmacy education program remains to be improved: 77% of respondents believe that there is a significant gap between the initial education program and the community pharmacy practice., Conclusions: This cross-perception helps to better identify the several ways to improve the points of vigilance and the associated-barriers. All the propositions by the three groups of respondents prior ask for a better definition of the needed skills for community pharmacy practice before determine the most important knowledges and pedagogic methods to reach these. All these propositions seem consistent with reducing the gap between pharmacy education and community pharmacy practice but they also raise several questions about unicity of the pharmacy graduation in France., (Copyright © 2020 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

Pharmaceutical compounds are emerging contaminants that have been detected in surface water across the world. Because conventional wastewater treatment plants are not designed to treat such pollutants, new technologies are needed to degrade and oxidize such contaminants. The newly developed oxy-cracking process was utilized to treat the antidiabetic drug, metformin. The process, which involved partial oxidation of metformin in alkaline aqueous medium, proved to decompose the drug into small organic molecules, with minimum emission of CO 2 , therefore, increasing its biodegradability and removal from industrial treatment plants. The reaction gaseous products were probed by online gas chromatography. The liquid phase before and after oxy-cracking was analyzed for total carbon content by TOC and gas chromatography mass spectrometry. The products formed from the nitrogen-rich drug included ammonia, amines, amidines, and urea derivatives. A reaction mechanism for the oxy-cracking process is proposed. Because the hydroxyl radical (˙OH) is believed to play a central role in the oxy-cracking process, the mechanism is initiated by ˙OH attacks on metformin, followed by single decomposition or isomerization steps into stable products. The reactions were investigated using density functional theory calculations and validated using high quality 2 nd order Møller-Plesset perturbation theory energy calculations., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

The [2+2] cycloreversion of silacyclobutane (SCB) and its two methyl-substituted derivatives, 1-methyl-1-silacyclobutane (MSCB) and 1,1-dimethyl-1-silacyclobutane (DMSCB), were studied using ab initio quantum chemistry calculations. The second-order Møller-Plesset (MP2) perturbation theory, complete active space self-consistent field (CASSCF), and coupled clusters methods were used to explore both the concerted and the stepwise cycloreversions of the three molecules. In addition to the orbital symmetry-forbidden supra-supra [2 s +2 s ] transition state, a new orbital symmetry-allowed supra-antara [2 s +2 a ] transition state was discovered for the concerted route for all three molecules. Both methyl substitution and temperature play a role in the kinetic competition between the [2 s +2 s ] and [2 s +2 a ] routes. At 0 and 298 K, the concerted [2 s +2 a ] cycloreversion is kinetically more favorable than the [2 s +2 s ] cycloreversion for SCB, but the opposite is true for MSCB and DMSCB. With increasing temperatures to above 600 and 1800 K, the [2 s +2 a ] cycloreversion becomes more favorable for MSCB and DMSCB, respectively. The methyl substitutions on Si atoms also affect the stability of the diradical intermediate formed by Si-C bond rupture, leading to a less stable diradical with increasing methyl groups.

The reaction kinetics of the decomposition of 1-methylsilacyclobutane (MSCB) in a hot wire chemical vapor deposition (HWCVD) reactor was investigated. The stable reaction products were monitored using vacuum ultraviolet laser single photon ionization in tandem with time-of-flight mass spectrometry. Steady-state approximation was used to determine the rate constants of three individual decomposition pathways of MSCB, i.e., cycloreversion to form ethene and methylsilene (R1), ring opening to form propene and methylsilylene (R2), and exocyclic Si-CH 3 bond cleavage to form ˙CH 3 radicals (R3). The activation energies (E a ) for R2 and R3 in a HWCVD reactor were determined to be 86.6 kJ mol -1 and 106 kJ mol -1 , respectively. The fact that these E a values are close to those obtained for the MSCB decomposition on metal surfaces under collision-free conditions indicates that the heterogeneous reactions on the hot wire surface govern the gas-phase reaction kinetics in the HWCVD reactor. In addition, the E a values obtained from a theoretical study of the decomposition kinetics using ab initio calculations at the CCSD(T)/6-311++G(3d,2p)//MP2/6-311++G(d,p) level were 62.9 kcal mol -1 (i.e., 263 kJ mol -1 ), 62.0 kcal mol -1 (i.e., 259 kJ mol -1 ), and 86.2 kcal mol -1 (i.e., 361 kJ mol -1 ) for R1, R2, and R3, respectively. The much lower experimental E a values compared with those from the theoretical calculations clearly suggest that the tungsten filament in the HWCVD reactor catalyzed the decomposition.

Objectives: In this case series, we describe the acute clinical impact and tolerability of rapid titration of clozapine for treatment of refractory irritability in five hospitalized youth with developmental disability. We offer this descriptive report in an effort to expand the evidence base guiding treatment of refractory aggression in this population., Methods: Five youth with developmental disability and severe irritability were admitted to a 10-bed psychiatric crisis stabilization unit where they received thorough psychiatric and medical evaluation. Informed consent was obtained in each case, and each patient underwent rapid titration onto clozapine. Clozapine monitoring guidelines were followed for all patients throughout treatment, and clinical severity at baseline and improvement with treatment was measured by use of the Clinical Global Impressions-Severity scale (CGI-S) and the Clinical Global Impressions-Improvement scale (CGI-I)., Results: One female and four males diagnosed with developmental disability and at least one other psychiatric diagnosis, mean age of 13.1 ± 2.1 years, and mean CGI-S at baseline of 5.8, each received clozapine treatment by rapid titration. The mean therapeutic total daily dose of clozapine was 380 ± 200 mg. All patients demonstrated acute clinical improvement with the mean final CGI-I of 2.0, or "much improved.", Conclusion: These initial results support the potential utility of clozapine rapid titration for treatment of severe refractory irritability in youth with developmental disability. These patients tolerated clozapine treatment in the short term. Future studies are needed to thoroughly evaluate the long-term safety of clozapine treatment in this population.

The successful use of Dexmedetomidine as the main anesthetic agent for three pediatric patients with tracheomalacia presenting for different kinds of urgent operations is described. Patients were kept spontaneously breathing without intubation during their whole procedures. Surgical conditions were adequate, and hemodynamic and respiratory profiles were within baseline limits.

Introduction: During surgery, anesthetists take extra care to prevent patient awareness done mainly under general anesthesia either by using inhalational or intravenous medications. However, patients in the ICU mainly those on ventilatory support with intubation and sedation, pass through lot of psychological stress and frustration. Most of the times this stress phenomenon is not documented in the general intensive care. This is the first report in our general ICU., Aim of This Study: Assessment of this stress phenomenon in order to avoid it in future, and to elicit proper consensus regarding its existence and offer methods of re-solution., Methods: Seventy patients aged (20-60) years were interviewed one day after discharge from the ICU, about their memory of events during their stay. Patients with head injury, CNS infection and those who were disoriented at the time of interview were excluded from the study. The remaining 55 patients were oriented as to place and time. Intravenous morphine was used for analgesia as required, while sedation was achieved using midazolam and morphine infusions in appropriate doses as decided by the attending doctors and nurses, to achieve appropriate Ramsay sedation score. Questions asked were patient's memory of events and their distressing experiences regarding pain, anxiety, dreams, fear, noises, and other discomforts. The same questions were repeated 5 days later., Results: The sample of patients were representative of our regular ICU admissions in their age group, APACHE II score and duration of stay. The most distressing experiences recalled were: Anxiety (68%), discomfort from endotracheal tube (60%), fear (54%), pain (52%), discomfort from N/G tube (48%), difficulty in communicating (33%), dreams and hallucinations (31%), discomfort from physiotherapy (24%), noise (15%), insomnia (13%), thirst (10%), muscle paralysis (100%), some of these like anxiety, fear, dreams, hallucinations and insomnia had continued since discharge in 6% of patients. None of the studied experiences correlated with age, sex or with the APACHE II score. On interviewing the patient 5 days later, there were no significant change in their responses., Conclusion: Our sedation and analgesia in the ICU is not enough to prevent unpleasant experiences, mainly those related to patient awareness. More work is still needed i.e. using sedation measuring systems, to improve our sedation and analgesia in the ICU.

Objective: A digital endotracheal cuff inflator and pressure monitor were tested under clinical conditions on 150 patients in the intensive care., Methods: Patients were either intubated with endotracheal tubes or had tracheostomies, and were spontaneously breathing or artificially ventilated. Patients were divided into three groups. Group A had the endotracheal tube or tracheostomy cuff inflated randomly by a syringe and tested later by the Cuff Mate. Group B had the cuffs inflated by a syringe till air leak just disappeared on a hand-bagged positive pressure inspiration. Group C had the cuff inflated by the Cuff Mate till air leak just disappeared on a hand bagged positive pressure inspiration. In all three groups, cuff pressure measurement and inflation were done using the Cuff Mate., Results: Higher mean tracheal cuff pressures were recorded in Group A, in comparison with the other two groups, while smaller differences were observed between Group B and C., Conclusion: Using the Cuff Mate to inflate cuffs till no air leak, in addition to simultaneous monitoring of the cuff pressure to prevent excessive cuff pressure, decreases the ischemic damage that is caused by overinflated cuffs. Cuff pressures should be kept below that causing obstruction to the tracheal mucosal blood flow so as to avoid prolonged overinflated cuffs in intensive care patients.

Midazolam has been studied as an induction agent compared to thiopentone in forty patients. Few drawbacks were noted, but these included a fall in systolic and diastolic blood pressures, respiratory upsets and longer induction and recovery times compared to thiopentone. The difference between these two agents is statistically significant. The midazolam group took a longer time (after discontinuation of inhalational anesthetics) to respond to commands and perform certain tasks during the process of recovery. We concluded that thiopentone is preferable to midazolam as an induction agent.

This is a case report of pneumomediastinum and surgical emphysema following the use of venturi jet ventilation during microlaryngoscopy. The patient recovered spontaneously and no active measures were taken. A review of the literature was made for the complications of the venturi jet system during this procedure and precautions for avoiding these complications were stressed.

A programmed study on the effect of sodium thiopentone and midazolam on systemic blood pressure, pulse rate and intraocular pressure was done on sixty patients. A significant increase of all parameters was found after one minute. These values became less increased after three minutes. After five minutes a significant decrease of systolic and diastolic pressure, and intraocular pressure, as well normalization of pulse rate was found for both groups. A comparison between the results of both groups show that the systolic pressure was more significantly increased under the effects of midazolam than thiopentone. In contrast to this, pulse rate and introcular pressure showed similar changes in both groups.

One hundred twenty patients undergoing elective endoscopies were studied. They were allocated into three groups and accordingly they received Diazepam, Flunitrazepam and Midazolam. The effect of these drugs on the task performance of the patient's memory, anxiety and sedation level were assessed using objective tests. Cardiovascular and respiratory parameters were also assessed. All observations were subjected to student's t-test and chi squared assessment. We concluded that there are no major differences between the three drugs in the dosage used. However, the Midazolam group showed faster recovery, more sedation, less pain on injection than the Diazepam group. As for the cardiovascular system, there was a tendency for hypotension and tachycardia in all groups. Patients in the Midazolam group had more amnesia as compared to the other groups.

We report a case of tetanus following thermal injury in an 18-month-old girl who had been immunized with the usual triple vaccine and had received a booster dose for tetanus at 15 months of age. She had been admitted initially to a general district hospital and remained there for 10 days before being transferred to the University Hospital. Despite the unparalleled effectiveness and safety of tetanus toxoid, the administration of antitetanus serum (tetanus antitoxin) for patients with suspicious symptoms or wounds grossly contaminated with soil is often highly desirable. A schema of prophylaxis and management of patients with tetanus is provided.