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We present the case of a female teenager who sustained nitrous oxide burns to the medial aspect of both thighs from contact with a nitrous oxide canister being used to fill balloons. There was a delay in presentation as the injury was not initially recognised. These burns were initially assessed as being superficial partial-thickness burns but took a prolonged time to heal despite regular wound care. This was complicated by a lack of adherence to recommended treatment for much of the patient care as well as the patient testing positive for COVID-19 during their management, which prevented surgery and significantly extended time to healing. While small numbers of similar cases have been previously described this is the first reported case outside of the Netherlands and in a child. Being aware of such cases ensures early referral to specialist burn care for appropriate management to give patients the best possible outcome.

Abstract. Background: Mishara and Martin (2012) reported decreases in suicides 12 years after implementation of a police suicide prevention program. Aims: We aimed to determine whether suicide decreases were sustained 10 years later. Method: We examined coroners’ investigations of police deaths from 2009 through 2018. Results: From 2009 to 2018, Montreal suicide rates increased but this was not significantly different from the previous 12 years and the rate for other Quebec police remained significantly higher than Montreal ( p < .006). The 22-year Montreal postprogram rate was significantly lower than the preprogram rate ( p < .002), and the 22-year rate for other police during the same years was not significantly different from earlier. Limitations: Uncontrolled factors may have influenced the rates, including the 11% increase in women in the Montreal police. The observed mean aging of the Montreal police personnel would have been expected to bias toward finding increases in suicides. However, the maintenance of decreases in suicide rates was observed. Conclusion: The decrease in suicides observed 12 years after the program was sustained for another 10 years, and appears related to the program. Rates for comparable police remained higher. A continuing comprehensive suicide prevention program tailored to the context may reduce suicides for extended time periods.

The Freiburg index of post-TIPS survival (FIPS) score was recently demonstrated to improve prediction of post-TIPS mortality relative to existing standards. As this score was derived from a German cohort over an extended time period, it is unclear if performance will translate well to other settings. This study aimed to externally validate the FIPS score in a large Veterans Affairs (VA) cohort over two separate eras of TIPS-related care. This was a retrospective cohort study of patients with cirrhosis who underwent TIPS placement in the VA from 2008 to 2020. Cox regression models for post-TIPS survival were constructed using FIPS, MELD, MELD-Na, or CTP scores as predictors. Discrimination (Harrell’s C) and calibration (joint tests of calibration curve slope and intercept) were evaluated for each score. A stratified analysis was performed for time periods between 2008–2013 and 2014–2020. The cohort of 1,274 patients was 97.3% male with mean age 60.9 years and mean MELD-Na 14. The FIPS score demonstrated the highest overall discrimination versus MELD, MELD-Na, and CTP (0.634 vs. 0.585, 0.626, 0.612, respectively). However, in the modern treatment era (2014–2020), the FIPS score performed similarly to MELD-Na. Additionally, the FIPS score demonstrated poor calibration at one-month and six-month post-TIPS timepoints (joint p = 0.04 and 0.004, respectively). MELD, MELD-Na, and CTP were well-calibrated at each timepoint (each joint p > 0.05). The FIPS score performed similarly to MELD-Na in the modern TIPS treatment era and demonstrated regions of poor calibration. Future models derived with contemporary data may improve prediction of post-TIPS mortality.

Purpose of the ReviewThis article aims to provide an update on the designation of stroke centers, neurointerventionalist demand, and cost-effectiveness of stroke thrombectomy in the United States.Recent FindingsThere are now more than 1,660 stroke centers certified by national accrediting bodies in the United States, 306 of which are designated as thrombectomy-capable or comprehensive stroke centers. Considering the amount of nationally certified centers and the number of patients with acute stroke eligible for thrombectomy, each center would be responsible for 64 to 104 thrombectomies per year. As a result, there is a growing demand placed on neurointerventionalists, who have the ability to alter the trajectory of large vessel occlusive strokes. Numbers needed to achieve functional independence after stroke thrombectomy at 90 days range from 3.2 to 7.4 patients in the early time window and 2.8 to 3.6 patients in the extended time window in appropriately selected candidates. With the low number needed to treat, in a variety of valued-based calculations and cost-effectiveness analyses, stroke thrombectomy has proved to be both clinically effective and cost-effective.SummaryAdvancements in the early recognition and treatment of stroke have been paralleled by a remodeling of health care systems to ensure best practices in a timely manner. Stroke center–accrediting bodies provide oversight to safeguard these standards. As successful trial data from high volume centers transform into real-world experience, we must continue to re-evaluate cost-effectiveness, strike a balance between sufficient case volumes to maintain clinical excellence vs the burden and burnout associated with call responsibilities, and improve access to care for all.

During hydraulic fracturing treatment, huge quantities of gel are pumped into the formation to initiate the fracture, maintain it open and transport the proppant. The fracture dimensionless conductivity (Fcd) is a key parameter to optimize the fracturing design, to estimate the productivity Index (PI) and the folds of increase (FOI). However, these parameters are affected by the gel residues which decrease the fracture conductivity; thus, the proppant cleanup is a very important step to avoid additional damage caused by fracturing fluid due to high gel concentration and the extended time of gel staying in the fracture before cleanup. Throughout the life of Hassi Messaoud, Algeria field, hydraulic fracturing technique has been aggressively used mainly in four producing formations in the Cambrian, with hard formation characteristics, an average permeability range and low reservoir pressure (0.15–0.45 psi/ft) and high stress value between 6000 and 9000 psi. In this paper, an experimental simulation is applied using a self-made cell to determine the effect of different parameters on the fracture conductivity under various bottom-hole conditions where different variables were used: effect of Proppant type, guar gel concentration, temperature, breaker concentration and closure pressure at extended time. An important drop in fracture conductivity was observed varied between 10 and 80% under stresses at interval of 2000 psi and 8000 psi, gel concentration up to 200 lb/1000 gal at extended time and temperature.

Purpose: Chronic neck pain is the most prevalent work-related musculoskeletal injury among surgeons. Urologists may be at higher risk of neck injury due to extended time spent operating in deep ana...

Background:. Intravenous thrombolysis (IVT) is an effective way for treating acute ischemic stroke (AIS). However, its effects have not been established among AIS patients with unclear stroke symptoms or with stroke onset for >4.5 h. Methods:. We searched PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials and Google Scholar databases for randomized controlled trials that compared IVT (IVT group) and placebo or usual care (control group [CG]) in AIS patients with disease onset for >4.5 h. The outcomes of interest included the favorable functional outcome (defined as modified Rankin Scale [mRS] scores 0–1) at 90 days, the functional independence (defined as mRS scores 0–2) at 90 days, proportion of patients with symptomatic intracerebral hemorrhage (sICH) and death at 90 days. We assessed the risk of bias using the Cochrane tool. Pre-specified subgroup analyses were performed by age (≤70 years or >70 years), National Institute of Health Stroke Scale (NIHSS, ≤10 or >10) and time window (4.5–9.0 h or >9.0 h). Results:. Four trials involving 848 patients were eligible. The risk of bias of included trials was low. Patients in the IVT group were more likely to achieve favorable functional outcomes (45.8% vs. 36.7%; OR 1.48, 95% CI 1.12–1.96) and functional independence (63.8% vs. 55.7%; OR 1.43, 95% CI 1.08–1.90) at 90 days, but had higher risk of sICH (3.0% vs. 0.5%; OR 5.28, 95% CI 1.35–20.68) at 90 days than those in the CG. No significant difference in death at 90 days was found between the two groups (7.0% vs. 4.1%; OR 1.80; 95% CI 0.97–3.34). Conclusions:. Use of IVT in patients with extended time window may improve their functional outcomes at 90 days, although IVT may induce increased risk of sICH. Care of these patients should well balance the potential benefits and harms of IVT.

This study evaluates phytoecdysteroid (PE) biosynthesis stability and the effect of methyl jasmonate (MJ) on changing their accumulation over 25 subculture cycles of Silene linicola hairy roots. High performance liquid chromatography was used to determine PE content. We find a significant change in the biosynthesis level of PEs as a whole, as well as individual components such as 20-hydroxyecdysone (20E) and turkesterone, under prolonged cultivation of S. linicola hairy roots. The maximum 20E content was observed in a sample of the 7th subcultivation cycle (0.189%), whereas the maximum level of turkesterone—the 9th cycle (0.044%). We found that without application of MJ, the main component of total PEs in hairy roots becomes 20E during the 7th to 25th subcultivation cycles, with percentages of 51.9; 25.4; 79.1 and ~ 100% in 7th, 9th, 21st and 25th cycles, respectively. Using the elicitor changes this pattern. The smallest ratio of 20E to the PE sum was 8.2% and turkesterone becomes the major component (53%), detected during the 9th passage treated with MJ. Our data suggest that total PE and individual component content should be monitored along with 20E level, as biosynthetic activity of these components in S. linicola hairy roots varies with cultivation stage.

Background and Purpose: Recent studies using automated perfusion imaging software have identified adults most likely to benefit from reperfusion therapies in extended time windows. The time course of penumbral tissue is poorly characterized in childhood arterial ischemic stroke (AIS). We explore the feasibility of using automated perfusion-diffusion imaging software to characterize penumbra in childhood AIS. Methods: An observational cohort study of children with acute unilateral AIS presenting to our institution. Diffusion-weighted imaging and dynamic susceptibility contrast perfusion magnetic resonance imaging performed within 72 hours of symptom onset were necessary for inclusion. Perfusion-diffusion mismatch was estimated using RAPID software. Ischemic core was defined as apparent diffusion coefficient −6 mm 2 /s and hypoperfusion as Tmax >6 seconds. Favorable mismatch profile was defined as core volume Results: Twenty-nine children (median 8 years old, interquartile range, 4.4–14.6) were included (26 unilateral middle cerebral artery and 3 unilateral cerebellar infarcts). Median Pediatric National Institutes of Health Stroke Scale was 4 (interquartile range, 3–11). Most cases had cryptogenic (n=11) or focal cerebral arteriopathy (n=9) causes. Median time-to-imaging =13.7 hours (interquartile range, 7.5–25.3). RAPID detected an ischemic core in 19 (66%) patients. In the remaining cases, the mean apparent diffusion coefficient values were mostly higher than the threshold as the majority of these presentations were delayed (median >21 hours) and infarct volumes were small ( Conclusions: This study demonstrates it is feasible to rapidly assess perfusion-diffusion mismatch in childhood AIS using automated software. Favorable mismatch profiles, using adult-based parameters, persisted beyond the standard 4.5 hours window for thrombolysis, suggesting potential therapeutic benefit of RAPID use. Further work is required to determine the utility of perfusion-based imaging to guide clinical decision making, whether adult thresholds require modification in childhood AIS, and to investigate the effect of time-delay and cause on mismatch characteristics.

Monte Carlo tree search (MCTS) is being effectively used in many domains, but acquiring good results from building larger trees takes time that can in many cases be impractical. In this article, we show that parallelizing the tree building process using multiple independent trees (root parallelization) can improve results when limited time is available, and compare these results to other parallelization techniques and to results obtained from running for an extended time. We obtained our results using MCTS in the domain of computer Go, which has the most mature implementations. Compared to previous studies, our results are more precise and statistically significant.

Biomaterial implants for the sustained delivery of therapeutics can be utilized to deliver drugs at near-constant rates over extended time frames to provide an alternative to daily oral medications. The biomaterials used to construct these systems, however, are often not bioresorbable and thus require a secondary surgery for removal from the body, and fabrication of these systems may require the use of harsh chemical solvents. To address these shortcomings, a fabrication process was developed to generate biodegradable drug reservoir systems from regenerated silk fibroin protein solution (23% w/v). The tubular systems, with an inner diameter of 2.0 mm and wall thickness < 250µm, were developed using an all-aqueous solution-gel-solid phase transition curing process. Two different clinically-relevant therapeutics were released at near-constant rates for 30 days (> 100µg/day). The protein secondary structure of the devices consisted of 40% crystalline beta sheet. Mechanically, radial compression (1mm/min) of unloaded systems demonstrated Young’s moduli similar to cancellous (spongy) bone (100 to 250 MPa) and the systems showed good recovery under cyclic compression (to 17.5% strain). The devices could be generated in complex shapes (e.g., hollow cylinders) via an additive molding process, offering the potential for drug delivery but also for broader applications in tissue engineering and diagnostics.

Deep networks have been shown to achieve impressive accuracy for some medical image analysis tasks where large datasets and annotations are available. However, tasks involving learning over new sets of classes arriving over extended time is a different and difficult challenge due to the tendency of reduction in performance over old classes while adapting to new ones. Controlling such a 'forgetting' is vital for deployed algorithms to evolve with new arrivals of data incrementally. Usually, incremental learning approaches rely on expert knowledge in the form of manual annotations or active feedback. In this paper, we explore the role that other forms of expert knowledge might play in making deep networks in medical image analysis immune to forgetting over extended time. We introduce a novel framework for mitigation of this forgetting effect in deep networks considering the case of combining ultrasound video with point-of-gaze tracked for expert sonographers during model training. This is used along with a novel weighted distillation strategy to reduce the propagation of effects due to class imbalance.

This research discusses the selection of financing submissions for BPRS Magetan customers in the covid-19 pandemic situation. This study aims to determine the criteria for obtaining financing and how BPRS Magetan policy suppresses high financing applications amid the covid-19 pandemic. This study used a descriptive qualitative method by collecting data by conducting in-depth interviews with 14 respondents from BPRS and financing customers. This study stated that BPRS Magetan added the emphasis of analysis in selecting customer members' financing with the 5C method and BI Check. BPRS emphasizes selection analysis in customer human resource, customer creativity, and customer innovation to develop its business. BPRS Magetan is expected to provide leeway by giving a more extended time and simplifying the disbursement process during the covid-19 pandemic in the form of collateral relief.

Background and purposeThe optimal selection methodology for stroke thrombectomy beyond 6 hours remains to be established.MethodsReview of a prospectively collected database of thrombectomy patients with anterior circulation strokes, adequate CT perfusion (CTP) maps, National Institute of Health Stroke Scale (NIHSS)≥10 and presenting beyond 6 hours from January 2014 to October 2018. Patients were categorised according to five selection paradigms: DAWN clinical-core mismatch (DAWN-CCM): between age-adjusted NIHSS and CTP core, DEFUSE 3 perfusion imaging mismatch (DEFUSE-3-PIM): between CTP-derived perfusion defect (Tmax >6 s lesion) and ischaemic core volumes and three non-contrast CT Alberta Stroke Program Early CT Score (ASPECTS)-based criteria: age-adjusted clinical-ASPECTS mismatch (aCAM): between age-adjusted NIHSS and ASPECTS, eloquence-adjusted clinical ASPECTS mismatch (eCAM): ASPECTS 6–10 and non-involvement of the right M6 and left M4 areas and standard clinical ASPECTS mismatch (sCAM): ASPECTS 6–10.Results310 patients underwent analysis. DEFUSE-3-PIM had the highest proportion of qualifying patients followed by sCAM, eCAM, aCAM and DAWN-CCM (93.5%, 92.6%, 90.6%, 90% and 84.5%, respectively). Patients meeting aCAM, eCAM, sCAM and DAWN-CCM criteria had higher rates of 90-day good outcome compared with their non-qualifying counterparts(43.2% vs 12%,p=0.002; 42.4% vs 17.4%, p=0.02; 42.4% vs 11.2%, p=0.009; and 43.7% vs 20.5%, p=0.007, respectively). There was no difference between patients meeting DEFUSE-3-PIM criteria versus not(40.8% vs 31.3%,p=0.45). In multivariate analysis, all selection modalities except for DEFUSE-3-PIM were independently associated with 90-day good outcome.ConclusionsASPECTS-based selection paradigms for late presenting and wake-up strokes ET have comparable proportions of qualifying patients and similar 90-day functional outcomes as DAWN-CCM and DEFUSE-3-PIM. They also might lead to better outcome discrimination. These could represent a potential alternative for centres where access to advanced imaging is limited.

Our goal was to investigate the long-term clinical course of juvenile myoclonic epilepsy (JME) in a cohort of patients and to identify prognostic factors for refractoriness and seizure relapse after anti-seizure medications (ASMs) withdrawal. A literature review is also presented to consolidate and compare our findings with the previously reported cases.We retrospectively studied a series of patients diagnosed with JME with 15 years or more of evolution. We collected clinical, neurophysiological and neuroimaging data from patients who met defined inclusion and exclusion criteria.Study involved 61 patients (65.5% female) with mean age at study of 37.6 years, and mean age at its outset of 14.8 years. Median follow-up was 31.0 years (mean 28.9, range 15-53). They presented more frequently with a combination of myoclonic and generalized tonic-clonic seizures (GTCS) (65.6%). Sixty-five percent of patients (n = 40) had a 5-year terminal remission with a mean age at last seizure of 27.4 years. Thirty-two percent of seizure-free patients (n = 13) withdrew ASMs: 6 out of 13 had a recurrence of the seizures while 7 remained seizure-free (mean age at ASMs withdrawal 21.0 versus 35.7 years, p 0.05). In the multivariate model, a high GTCS frequency at onset (p = 0.026) was a prognostic factor of drug resistance.JME is often regarded as a benign epileptic syndrome, although a quarter of the individuals have refractory epilepsy. The possibility of withdrawing ASMs in patients who have been free of seizures over an extended time seems feasible.

This paper attempts to show a relationship between Soil Conservation Service (SCS) parameter curve number (CN), potential evapotranspiration (PET), and time duration (D) using the data of four Ethiopian watersheds. CN values were determined for various durations from observed rainfall-runoff data, and PET was derived for different watersheds utilizing the Thornthwaite method employing temperature data. The results indicate that the CN values decline exponentially with increasing PET and duration D and vice versa for all three wetness conditions of the watersheds. This study confirmed that as the duration upsurges, the CN values diminution due to the more extended time accessible for water loss in the watershed. The proposed simple model based on CN-PET-Duration also strongly supports the derived relationship for all watersheds for three wetness conditions. This relationship is also useful for the estimation of PET from the available published CN values.

Background The clinical efficacy of mechanical thrombectomy has been unequivocally demonstrated in multiple randomized clinical trials. However, these studies were performed in carefully selected centers and utilized strict inclusion criteria. Aim We aimed to assess the clinical effectiveness of mechanical thrombectomy in a prospective registry. Methods A total of 2008 patients from 76 sites across 12 countries were enrolled in a prospective open-label mechanical thrombectomy registry. Patients were categorized into the corresponding cohorts of the SWIFT-Prime, DAWN, and DEFUSE 3 trials according to the basic demographic and clinical criteria without considering specific parenchymal imaging findings. Baseline and outcome variables were compared across the corresponding groups. Results As compared to the treated patients in the actual trials, registry-derived patients tended to be younger and had lower baseline ASPECTS. In addition, time to treatment was earlier and the use of intravenous tissue plasminogen activator (IV-tPA) and general anesthesia were higher in DAWN- and DEFUSE-3 registry derived patients versus their corresponding trials. Reperfusion rates were higher in the registry patients. The rates of 90-day good outcome (mRS0-2) in registry-derived patients were comparable to those of the patients treated in the corresponding randomized clinical trials (SWIFT-Prime, 64.5% vs. 60.2%; DAWN, 50.4% vs. 48.6%; Beyond-DAWN: 52.4% vs. 48.6%; DEFUSE 3, 52% vs. 44.6%, respectively; all P > 0.05). Registry-derived patients had significant less disability than the corresponding randomized clinical trial controls (ordinal modified Rankin Scale (mRS) shift odds ratio (OR), P Conclusion Our study provides favorable generalizability data for the safety and efficacy of thrombectomy in the “real-world” setting and supports that patients may be safely treated outside the constraints of randomized clinical trials.

Tracking the occurrence of a broad variety of chemicals in the aquatic environment at a high temporal resolution over extended time periods is challenging. Here, we present a transportable platform...

Objectives: The aim of the study was to examine the unique contributions of age to objectively measure driving frequency and dangerous driving behaviors in healthy older adults after adjusting for executive function (EF). Method: A total of 28 community-dwelling older adults (mean age = 82.0 years, standard deviation [SD] = 7.5) without dementia who were in good physical health and enrolled in a longitudinal aging study completed several EF and clinical self-report measures at baseline. Participants subsequently had a sensor installed in their vehicle for a mean of 208 (SD = 38, range = 127–257) days. Results: Participants drove for an average of 54 min per day. Mixed-effects models indicated that after controlling for EF, older age was associated with less time driving per day, decreased number of trips, and less nighttime driving. Age was not associated with hard brakes or hard accelerations. Discussion: After accounting for EF, greater age is associated with higher driving self-regulation but not dangerous driving behaviors in healthy older adults. Future studies should recruit larger samples and collect sensor-measured driving data over a more extended time frame to better determine how and why these self-regulation changes take place.

Since 1982, children's hospices in the UK have provided services where families can care for their children at the end of life (EOL) in a less medicalised environment. More recently, the services of many children's hospices have extended to newborn babies and their families. This paper explores the experiences of three families (five parents) who availed of children's hospices services when their babies required a palliative approach to care. Early diagnosis of a life-limiting condition in pregnancy allowed advanced care planning and enabled parental participation in decision-making before birth. A homely environment, as well as constant support and a sensitive approach from expert staff encouraged parental involvement in all aspects of their baby's care whilst in hospice. Extended time with their baby after death enabled parents to feel connected with their infant. The holistic and family-centred approach to care from children's hospices is highly valued by parents of newborn babies.

Context: Self-medication in healthcare is becoming an increasingly important area. However, risks such as misdiagnosis, inappropriate drug dosage, extended time of use, drug interactions and polypharmacy are also associated with it. Aims: The present cross-sectional study aims to study the prevalence of self-medication and its associated factors among engineering students. Setting and Design: The present cross-sectional study was conducted in an engineering college in Chennai. Materials and Methods: A total of 199 participants were studied. A pretested semi-structured questionnaire including general information and specific questions regarding the prevalence of self-medication and its associated factors was given to the study participants and were instructed to fill them. Statistical Analysis Used: Data were recorded and analysed in the excel spreadsheet using SPSS software version 16 and Chi-square test was used to perform interferential statistical analysis. Results: 199 engineering students were studied, ranging from 1st year to 4th year between the age group of 17–25 years. From the data collected, 154 (77.4%) participants said they had been on self-medications before and 45 (22.6%) participants said they have never been on self-medication. Conclusions: From this study we come to a conclusion that the prevalence of self-medication among the engineering students in sub-urban Chennai is high that is 77.4%. The parameters frequently linked with self-medication are the type of illness and the easy access to drugs. Since self-medication is at an alarming rate, the need of the hour is to educate the youth to ensure healthy practice.

The nighttime light (NTL) satellite data have been widely used to investigate the urbanization process. The Defense Meteorological Satellite Program Operational Linescan System (DMSP-OLS) stable nighttime light data and Suomi National Polar-orbiting Partnership Visible Infrared Imaging Radiometer Suite (NPP-VIIRS) nighttime light data are two widely used NTL datasets. However, the difference in their spatial resolutions and sensor design requires a cross-sensor calibration of these two datasets for analyzing a long-term urbanization process. Different from the traditional cross-sensor calibration of NTL data by converting NPP-VIIRS to DMSP-OLS-like NTL data, this study built an extended time series (2000–2018) of NPP-VIIRS-like NTL data through a new cross-sensor calibration from DMSP-OLS NTL data (2000–2012) and a composition of monthly NPP-VIIRS NTL data (2013–2018). The proposed cross-sensor calibration is unique due to the image enhancement by using a vegetation index and an auto-encoder model. Compared with the annual composited NPP-VIIRS NTL data in 2012, our product of extended NPP-VIIRS-like NTL data shows a good consistency at the pixel and city levels with R2 of 0.87 and 0.95, respectively. We also found that our product has great accuracy by comparing it with DMSP-OLS radiance-calibrated NTL (RNTL) data in 2000, 2004, 2006, and 2010. Generally, our extended NPP-VIIRS-like NTL data (2000–2018) have an excellent spatial pattern and temporal consistency which are similar to the composited NPP-VIIRS NTL data. In addition, the resulting product could be easily updated and provide a useful proxy to monitor the dynamics of demographic and socioeconomic activities for a longer time period compared to existing products. The extended time series (2000–2018) of nighttime light data is freely accessible at https://doi.org/10.7910/DVN/YGIVCD (Chen et al., 2020).

There were 37 longwall faces operating in mines in the United States in 2019. The average panel width for these longwalls was approximately 368.5 m (1209 ft). This translates to a range of approximately 170–240 shields per longwall, depending upon the width of shield. The movement of longwall shields is a significant contributor to respirable dust overexposures to longwall operators. Foam is expected to have the potential to reduce this shield dust generation. The foam is applied to the area on the roof between the coal face and the shield tip after the shearer passes. In this study, the longwall shield dust simulator was used to test three foam agents for their ability to control dust from longwall shield movements. Results showed that at low-velocity ventilation (≈ 3.0 m/s (600 fpm)) all foam agents were able to produce dust reduction levels of at least 45%. At high-velocity ventilation (≈ 5.1 m/s (1000 fpm)), the reductions were lower and more variable, ranging from being undeterminable for one foam agent to having 46%–63% reductions for the other two foam agents, with one instance of an increase in dust concentration. Overall, the use of foam agents can provide longwall shield dust control. Important factors are roof coverage and the ability of foam to remain on the roof for extended time periods.

Dermatophytosis is a common self limiting zoonotic fungal disease which coused by infection of certain types of dermatophyte (1,2).that fungi of 3 fundamental genera specifically, Microsporum, Trichophyton and epidermophyton. We wont wait its self limiting cause it Causes economic losses. That disease spread fastly amoung all existing dogs and may be owners. And take an extended time in treatment. Dermatophytosis is generally called as ringworm. And that is visibly portrayed by multi-focal alopecia and hulls on the skin with a selected formation (3,4). This infection has gained specific attention publicly health, because it distributed all over the world. After touching the contaminated items or specimens, similar to hair, soil or outside on the epidermal layer of diseased animals, infection of dermatophytosis in human happen –(5). We have noted a big increase in annual cases od dermatophytosis in all species humans and animals particularly dogs&cats (6). Scientists noted that dermatophytosis's cases are more predominant in little and female cat than male cat. In Indonesia, much researches has been done on dogs shows that : in Yogyakarta, Indonesia (34%) of dogs were positive of dermatophytosis (7). While that number ranges from 20%to30% in Europe (8). The results of different investigations recognized that main species causing dermatophytosis in small animals is microsporum-canis in 81.8%to97% of total cases (1,2,6). The occurrence of zoonotic dermatophytes, in dogs&cats and human compared with different species, m. Canis was the most awesome (60%) (9). We can modulate the immune-response by giving significant level of cortisol throughout along period.

This article reviews the most up-to-date evidence-based recommendations pertaining to breast and upper chest conditions, specifically for the sports medicine physician. Because of the unique circumstances of the team physician, they can see a wide breadth of pathology. Athletes may not have a primary care physician and may prefer to present to their team physician for breast and upper chest conditions. It is often more comfortable and convenient for athletes to seek treatment in the team setting. Therefore, it is important that the medical professional be aware of not only common pathology but also of that which is rarer. Any delay in evaluation can result in unnecessary morbidity and lead to complications or extended time lost from sport. Consequently, it also is important to facilitate an atmosphere encouraging early presentation and workup.

This study investigated the extent to which an extended time limit in an argumentative writing test affects the quality of argumentation in L2 writing. Thirty-two adult ESL learners each wrote two ...

Constructing an efficient photocatalyst for H2 production generally requires the integration of several functional features in and on a semiconductor platform. This is conventionally done by a classic step-by-step synthesis. Here, we report the self-assembly of an amorphous titania nanotube based system when illuminated for extended time in suitable aqueous solutions. Over time, not only photodeposition of a co-catalyst can take place, but also in situ crystallization and morphology changes occur that can provide a higher H2 production than observed for a classically assembled photocatalyst.

Human curiosity about the mysteries in outer space has driven humans to organize space explorations. Space missions and polar region solicitations require the use of new energy storage technologies with excellent tolerance to extremely low temperatures and the capability to operate efficiently for an extended time. In this context, it is urgent to explore new approaches and concepts to address the critical challenges via mechanistic understanding of new electrochemical reactions and phenomena in diverse scenarios. This paper presents how electrode and electrolyte materials in supercapacitor (SC) cells operate at extremely low temperatures. The critical challenges related to engineering such SCs and the major breakthroughs that overcome these problems are presented. In addition, the effects of different electrolytes (e.g., aqueous, organic, and ionic liquids (ILs)) on the ion accessibility, interfacial charge transfer, and transport kinetics in SC cells under cold conditions are discussed. This review is expected to contribute to the development of high-performance SC cells that can function at severe temperatures by providing insight into the key challenges and guidelines that facilitate future work.

Hepatic uptake clearance has been measured in suspended human hepatocytes (SHH). Plated human hepatocytes (PHH) after short-term culturing are increasingly employed to study hepatic transport driven mainly by its higher throughput. To know pros/cons of both systems, the hepatic uptake clearances of several organic anion transporting polypeptide 1B substrates were compared between PHH and SHH by determining the initial uptake velocities or through dynamic model-based analyses. For cerivastatin, pitavastatin and rosuvastatin, initial uptake clearances (PSinf) obtained using PHH were comparable to those using SHH, while cell-to-medium concentration (C/M) ratios were 2.7- to 5.4-fold higher. For pravastatin and dehydropravastatin, hydrophilic compounds with low uptake/cellular binding, their PSinf and C/M ratio in PHH were 1.8- to 3.2-fold lower than those in SHH. These hydrophilic substrates are more prone to wash-off during the uptake study using PHH, which may explain the apparently lower uptake than SHH. The C/M ratios obtained using PHH were stable over an extended time, making PHH suitable to estimate the C/M ratios and hepatocyte-to-medium unbound concentration ratios (Kp,uu). In conclusion, PHH is useful in evaluating hepatic uptake/efflux clearances and Kp,uu of OATP1B substrates in a high-throughput manner, however, a caution is warranted for hydrophilic drugs with low uptake/cellular binding.

Background and Purpose: Contrast-enhanced noninvasive angiography and perfusion imaging are recommended to identify eligible patients for endovascular therapy (EVT) in extended time windows (>6 hours or wake-up). If eligible, additional intraarterial contrast exposure will occur during EVT. We aimed to study the renal safety in the DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke) population, selected with contrast-enhanced multimodal Imaging and randomized to EVT versus medical management. Methods: In the randomized DEFUSE 3 trial population, we compared changes in serum creatinine between baseline (before randomization) and 24 hours later. The primary outcome was the relative change in creatinine level between baseline and 24 hours in the EVT versus medical arm. The secondary outcome was a comparison between computed tomography (CT) versus magnetic resonance imaging selection in the EVT arm. The safety outcome was a comparison of the proportion of patients with criteria for contrast-associated kidney injury in the EVT versus medical arm and a comparison between CT versus magnetic resonance imaging selection in the EVT arm. Results: In the DEFUSE 3 population (n=182, age 69±13, 51% female), mean creatinine decreased from a baseline of 0.98±0.33 mg/dL to 0.88±0.28 mg/dL at 24 hours ( P P =0.294. Absolute decrease −0.08±0.18 in EVT versus −0.12±0.18 in medical, P =0.135; Among patients treated with EVT, there was no difference in 24-hour creatinine level changes between patients who were selected with CT angiography/CT perfusion (−0.08±0.18) versus magnetic resonance imaging (−0.07±0.19), P =0.808 or 6.8% reduction versus 4.8%, P =0.696. In the EVT arm, contrast-associated kidney injury was encountered in 4 out of 91 (4.4%) versus 2/90 (2.2%) in the medical arm P =0.682. In the EVT arm, contrast-associated kidney injury was evenly distributed between magnetic resonance imaging (1/22, 4.6%) versus CT 3 out of 69 (4.4%), P =1.0. Conclusions: Perfusion imaging before EVT was not associated with evidence of decline in renal function. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02586415.

Sports ultrasound (US) is a rapidly advancing and expanding field, where "hands-on" education and real-time instructor feedback are paramount in developing this skill. In light of a global pandemic and limited access to instructors and educational conferences, sports US education must adapt to continue to teach future ultrasonographers. Virtual US education, conducted using various virtual meeting platforms not only allows for continued didactic education but also can virtually recreate the "hands-on" training sessions with live, immediate instructor feedback that is necessary for acquiring competence. Additionally, using these methods, sports US conferences can continue in a virtual manner, sports US education can expand remote areas, and collaboration among distant experts may increase, all without the cost of travel and extended time away from work. While immediately relevant because of the COVID-19 pandemic, virtual US methods may continue to be beneficial as sports US education and collaboration continue to expand.

Purpose Long total waiting times (TWT) experienced by patients during a clinic visit have a significant adverse effect on patient’s satisfaction. Our aim was to use big data simulations of a patient scheduling calendar and its effect on TWT in a general ophthalmology clinic. Based on the simulation, we implemented changes to the calendar and verified their effect on TWT in clinical practice. Design and methods For this retrospective simulation study, we generated a discrete event simulation (DES) model based on clinical timepoints of 4.401 visits to our clinic. All data points were exported from our clinical warehouse for further processing. If not available from the electronic health record, manual time measurements of the process were used. Various patient scheduling models were simulated and evaluated based on their reduction of TWT. The most promising model was implemented into clinical practice in 2017. Results During validation of our simulation model, we achieved a high agreement of mean TWT between the real data (229 ± 100 min) and the corresponding simulated data (225 ± 112 min). This indicates a high quality of the simulation model. Following the simulations, a patient scheduling calendar was introduced, which, compared with the old calendar, provided block intervals and extended time windows for patients. The simulated TWT of this model was 153 min. After implementation in clinical practice, TWT per patient in our general ophthalmology clinic has been reduced from 229 ± 100 to 183 ± 89 min. Conclusion By implementing a big data simulation model, we have achieved a cost-neutral reduction of the mean TWT by 21%. Big data simulation enables users to evaluate variations to an existing system before implementation into clinical practice. Various models for improving patient flow or reducing capacity loads can be evaluated cost-effectively.

BACKGROUND: Refractory venous leg ulcers (VLUs) often require extended time to heal, and they carry a high risk of recurrence. This case study describes our experiences with a patient with a VLU refractory to multiple treatment strategies who was successfully treated with Manuka honey. CASE: Mr S. was a 76-year-old man with multiple comorbid conditions and hypersensitivity to silver-based compounds, who developed 3 VLUs of his right lower extremity. He experienced 90 days of unsuccessful treatments using an iodized cadexomer ointment, hydrodetersive fiber dressings, hydrocolloid meshes, compression therapy, and antibiotic treatment without progression toward wound healing. We then initiated treatment with Manuka honey and continued compression therapy. His primary VLU was completely epithelialized within 38 days, and an adjacent VLU also showed progression toward healing. Mr S. reported clinically relevant improvement in wound-related pain at 17 days. CONCLUSION: The use of Manuka honey proved effective in this patient with a VLU refractory to other treatment strategies.

Conspicuous colors may signal individual quality if high-quality individuals produce more elaborate colors or have a greater capacity to invest in color maintenance. We investigate these hypotheses using repeated within-individual observations and experimentally induced color production in a wild bird, the superb fairy-wren (Malurus cyaneus). Male superb fairy-wrens undergo an annual molt from brown, nonbreeding plumage to an ultraviolet-blue and black breeding plumage. Color maintenance is especially relevant for this species because structural, ultraviolet-blue plumage colors are particularly susceptible to fading. Further, only the most sexually attractive males molt to breeding plumage early (before spring) and thereby keep their colors for an extended time before the breeding season. Our results show that (i) sexually attractive, early-molting males do not have higher quality breeding colors and (ii) breeding colors are not impacted by experimentally inducing males to molt early and while in low body condition. We found that (iii) breeding colors do not fade but remain consistent or become more saturated within individuals over time. Despite this, (iv) males do not spend more time preening while in breeding plumage. Instead, males keep their colors in pristine condition by re-molting parts of their breeding plumage throughout the breeding season, suggesting an alternative, potential cost of maintaining ornamental colors. We conclude that variation in structural breeding colors is unlikely to indicate individual quality in superb fairy-wrens.

Introduction: FFP contains the labile as well as stable components of the coagulation, fibrinolytic and complement systems. The use of plasma and its products has increased manifold over the four decades. In blood transfusion service, the primary goal of quality is 'transfusion of safe unit of blood.' Aim of the Study: To ensure that the prepared fresh frozen plasma (FFP) consistently met the requirements for quality and to find out the potency and possible extension of shelf life of fresh frozen plasma once thawed and refrozen within stipulated period. Materials and Methods: 66 units of FFP prepared by Platelet Rich Plasma (PRP) method were divided into two groups. Group 1 comprised of 33 samples, which were tested on 0 day, last week of 12th month and last week of 18th month. Group 2 comprised of remaining 33 units which were tested on 0 day, thawed and tested on 1st week of 12th month and were again refrozen within 12 hours of thawing. Later, the refrozen units were again retested on the last week of 12th month. All the FFP units were evaluated as per the DGHS Guidelines. Results: Group 1: The quality of fresh frozen plasma stored at -30OC for 12 months adhered to quality parameters but on extended storage period (-30OC for 18 months) showed non-compliance to the standardized quality control. Group 2: Refrozen thawed plasma complied with all quality parameters. Discussion: Fibrinogen and Factor VIII levels, which were representative of stable and labile factors respectively, were within normal limits in both the study groups when stored at standardized temperature and time, but showed non-compliance to the standardized quality control at extended time. Refrozen thawed plasma retained all coagulation factors. These findings were in concordance with the DGHS Standards and various other studies. Conclusion: Fresh Frozen Plasma should be used judiciously and if thawed plasma is not used for some reasons, it should not be discarded. The thawed FFP can b

Orientation tuning is a fundamental response property of V1 neurons and has been extensively studied with single-/multiunit recording and intrinsic signal optical imaging. Long-term 2-photon calcium imaging allows simultaneous recording of hundreds of neurons at single neuron resolution over an extended time in awake macaques, which may help elucidate V1 orientation tuning properties in greater detail. We used this new technology to study the microstructures of orientation functional maps, as well as population tuning properties, in V1 superficial layers of 5 awake macaques. Cellular orientation maps displayed horizontal and vertical clustering of neurons according to orientation preferences, but not tuning bandwidths, as well as less frequent pinwheels than previous estimates. The orientation tuning bandwidths were narrower than previous layer-specific single-unit estimates, suggesting more precise orientation selectivity. Moreover, neurons tuned to cardinal and oblique orientations did not differ in quantities and bandwidths, likely indicating minimal V1 representation of the oblique effect. Our experimental design also permitted rough estimates of length tuning. The results revealed significantly more end-stopped cells at a more superficial 150 μm depth (vs. 300 μm), but unchanged orientation tuning bandwidth with different length tuning. These results will help construct more precise models of V1 orientation processing.

Este artículo intenta presentar un desarrollo general del teatro independiente en la ciudad de Santa Fe, Argentina, hacia las décadas de 1960-1980. Se destaca la formación de una comunidad teatral en el seno de articulaciones socio-políticas complejas, como ser vínculos de clases medias variadas y una relación ambivalente con las reparticiones estatales, incluso en los períodos dictatoriales. Ese marco temporal extendido permite relativizar y al mismo tiempo afirmar la excepcionalidad de la última dictadura militar, destacando los canales por los que pudieron expresarse subjetividades disidentes en el contexto de una gubernamentalidad autoritaria.

The occurrence of elevated temperatures within landfills is a challenging issue for landfill operators to detect and correct. Little is known regarding the causes of elevated temperatures (ETs) or the number of landfills currently operating under such conditions. Therefore, the goal of this research was to determine which landfills within Florida have been impacted by ETs, and to develop a more complete understanding of the factors that may lead to these landfills becoming elevated temperature landfills (ETLFs). Historical landfill gas wellhead data, waste deposition reports, and landfill site geometry were collected for 27 landfill cells through the Florida Department of Environmental Protection electronic document management system, OCULUS database and from landfill operators and owners. These data were evaluated to quantify the characteristics that result in landfills having ‘elevated’ temperatures. Gas data included landfill gas temperatures and methane, carbon dioxide, and balance gas content. Furthermore, landfill maps were created in ArcGIS to observe spatial distribution of ETs in landfills over time. Upon analysis of the landfill gas wellhead data, it was discovered that 74% of studied landfill cells had ET readings; regulatory limits specify a maximum allowable gas temperature of 55 °C (131 °F). It was discovered that 37% of landfill cells contained MSW ash; of these cells, 90% of them are considered ETLFs. ETLF cells are on-average double the site area and approximately 6 m deeper than the average non-ETLF cell. Furthermore, results suggest that heat propagation in most landfills is limited; however, heat propagation is possible if gas wells are turned off for an extended time period.

Extended time to complete course examinations is the most commonly provided accommodation to students with disabilities in postsecondary institutions. However, there is a paucity of studies that examine the use and influence of extended time in true testing situations. The present study examined test accommodation used by 596 students with disabilities at a large research university. These students completed a total of 3,726 exams in 1,517 unique courses. Results indicated that extended time was used in approximately half of the tests, and of these, a nearly there was an even split between the use of less than and more than 50% additional time. In a statistical model predicting whether a participant used extended time at least once in a course, having a learning disability, having attention-deficit/hyperactivity disorder (ADHD), and taking a science, technology, engineering, and mathematics (STEM) course were statistically significant predictors of whether a participant used extended time in a course. Implications and areas for future research are presented.

BackgroundThe Zero Suicide framework is a system-wide approach to prevent suicides in health services. It has been implemented worldwide but has a poor evidence-base of effectiveness.AimsTo evaluate the effectiveness of the Zero Suicide framework, implemented in a clinical suicide prevention pathway (SPP) by a large public mental health service in Australia, in reducing repeated suicide attempts after an index attempt.MethodA total of 604 persons with 737 suicide attempt presentations were identified between 1 July and 31 December 2017. Relative risk for a subsequent suicide attempt within various time periods was calculated using cross-sectional analysis. Subsequently, a 10-year suicide attempt history (2009–2018) for the cohort was used in time-to-recurrent-event analyses.ResultsPlacement on the SPP reduced risk for a repeated suicide attempt within 7 days (RR = 0.29; 95% CI 0.11–0.75), 14 days (RR = 0.38; 95% CI 0.18–0.78), 30 days (RR = 0.55; 95% CI 0.33–0.94) and 90 days (RR = 0.62; 95% CI 0.41–0.95). Time-to-recurrent event analysis showed that SPP placement extended time to re-presentation (HR = 0.65; 95% CI 0.57–0.67). A diagnosis of personality disorder (HR = 2.70; 95% CI 2.03–3.58), previous suicide attempt (HR = 1.78; 95% CI 1.46–2.17) and Indigenous status (HR = 1.46; 95% CI 0.98–2.25) increased the hazard for re-presentation, whereas older age decreased it (HR = 0.92; 95% CI 0.86–0.98). The effect of the SPP was similar across all groups, reducing the risk of re-presentation to about 65% of that seen in those not placed on the SPP.ConclusionsThis paper demonstrates a reduction in repeated suicide attempts after an index attempt and a longer time to a subsequent attempt for those receiving multilevel care based on the Zero Suicide framework.