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Background: The effectiveness of ketamine as adjunctive or monotherapy for post-intubation sedation in adults with trauma on mechanical ventilation is unclear. Methods: A rapid review of systematic reviews of randomized controlled trials, then randomized controlled trials or observational studies was conducted searching three electronic databases (PubMed, Embase, Cochrane Library) and one clinical trial registry on June 1, 2022. We used a prespecified protocol following Cochrane rapid review methods. Results: We identified eight systematic reviews of randomized controlled trials and observational studies. Among the included reviews, only the most relevant, up to date, highest quality-assessed reviews and reviews that reported on critical outcomes were considered. Adjunctive ketamine showed a morphine sparing effect (MD −13.19 µmg kg–1 h–1, 95 % CI −22.10 to −4.28, moderate certainty of evidence, 6 RCTs), but no to little effect on midazolam sparing effect (MD 0.75 µmg kg–1 h–1, 95 % CI −1.11 to 2.61, low certainty of evidence, 6 RCTs) or duration of mechanical ventilation in days (MD −0.17 days, 95 % CI −3.03 to 2.69, moderate certainty of evidence, 3 RCTs).Adjunctive ketamine therapy may reduce mortality (OR 0.88, 95 % CI 0.54 to 1.43, P = 0.60, very low certainty of evidence, 5 RCTs, n = 3076 patients) resulting in 30 fewer deaths per 1000, ranging from 132 fewer to 87 more, but the evidence is very uncertain. Ketamine results in little to no difference in length of ICU stay (MD 0.04 days, 95 % CI −0.12 to 0.20, high certainty of evidence, 5 RCTs n = 390 patients) or length of hospital stay (MD −0.53 days, 95 % CI −1.36 to 0.30, high certainty of evidence, 5 RCTs, n = 277 patients).Monotherapy may have a positive effect on respiratory and haemodynamic outcomes, however the evidence is very uncertain. Conclusion: Adjunctive ketamine for post-intubation analgosedation results in a moderate meaningful net benefit but there is uncertainty for benefit and harms as monotherapy.

The shear modulus (G) is the parameter commonly used to describe soil stiffness and to calculate shear deformations at small-to-moderate strains (γ<0.5%). The material damping ratio (D) is the parameter commonly used along with G to analyze the response of the geotechnical materials to dynamic shearing motions. The following four sets of empirical models are presented in this study: (1) small-strain shear modulus (Gmax), (2) nonlinear shear modulus (G/Gmax–logγ) relationships, (3) small-strain material damping ratio (Dmin), and (4) nonlinear material damping ratio relationships (D–logγ). The associated database included all traceable uncemented soil specimens tested in the Soil and Rock Dynamics Laboratory at The University of Texas at Austin using the combined resonant column and torsional shear (RCTS) equipment since the late 1980s. The effects of soil type, index properties, density, confining state, and strain level on the shear modulus and material damping ratio have been quantified through multivariable regression analyses performed in a staged manner. The staged outcomes provide options of models with user-preferred levels of complexity and corresponding accuracy. In conclusion, these empirical models for Gmax , G/Gmax–logγ relationships, Dmin , and D–logγ relationships perform well in fitting the database and can be applied to predict the shear behavior of uncemented soils at small-to-moderate strains (γ<0.5%). [ABSTRACT FROM AUTHOR]

In this work, we present the cubic crystal elastic constants of a fully crystallized white dwarf stellar core. Elastic constants were calculated utilizing modal analysis of three-dimensional single-layer and stratified multi-layer crystalline core models. The models were generated using a Fortran based forward calculation algorithm in combination with a finite element modeling software program and were based on the parameters associated with the pulsating crystallized white dwarf BPM 37093. The calculated cubic crystal elastic constants, in comparison with elastic parameters of theoretical Coulomb crystal models of white dwarf matter, differed by, at most, a few orders of magnitude. In addition, the crystallized stellar core elastic parameters produced associated vibrational modes and frequencies that are consistent with the periodicity observed in BPM 37093. [ABSTRACT FROM AUTHOR]

Amyloidosis gets its name from the starchy amorphous appearance of the amyloid that is deposited in body tissues in this disorder. Amyloid deposits are revealed by the birefringence they show when stained with appropriate dyes. (Birefringence is the unequal transmission of light in different directions; a birefringent object may look green from one direction and red from another.) It has become clear that this physical property does not distinguish amyloid as a chemically distinct substance. Rather, the term 'amyloid' refers to any of a number of chemically different deposits that have these physical properties. Amyloid may consist of a variety of different proteins: transthyretin, antibody light chains, serum amyloid A, cystatin C, apolipoprotein A-I, and procalcitonin. The amyloid observed in senile plaques is composed of amyloid beta protein. The amyloid deposited in body tissues in most systemic amyloid disorders is mostly composed of either antibody light chains or transthyretin. In some families, amyloidosis is inherited; in such cases, death often comes 5-to-15 years after onset, as critical organs such as the heart become burdened with an excess of amyloid deposits. In some families, the predominant symptoms early in the course of the disease result from amyloid deposits in the peripheral nerves; this particular disorder is called familial amyloidotic polyneuropathy (FAP). The majority of cases of FAP result from the deposition of amyloid composed of transthyretin. In a genetic investigation of 29 unrelated individuals with transthyretin FAP, five mutations were identified in the transthyretin gene in 11 individuals, which may account for the disorder; two of the mutations are new. FAP sometimes begins with symptoms in the arms or the legs. Sometimes the largest nerve fibers are affected first and other times smaller nerve fibers are involved. It has been conjectured that these different features of disease onset are the result of different underlying FAP mutations. However, in the present series of patients, different onset features occurred in patients with the same mutation, indicating that the differences among patients cannot be accounted for entirely on the basis of this gene. (Consumer Summary produced by Reliance Medical Information, Inc.)

Presents information on a study which considered a simple expression for sheath and presheath potentials provided for anode, cathode and electrically floating plasma-facing surfaces. Theory; Simple expressions; Conclusions.

ABSTRACT: The U.S. Bureau of the Census projects that by 2006, the service sector will employ 74 percent of the workforce. This case illustrates why a major segment of the [...]

The main objective of this paper is to describe the teaching and learning methods of English as a foreign or second language. Teaching of English as a foreign language not only take place in India but also in other English-speaking countries for those who are immigrated to foreign countries for work or any other reasons. There are many teaching and learning techniques involved to make English language as a simple one. Teaching techniques such as Communicative language teaching, Situational language teaching, Task based language teaching. Learning techniques like Community language learning, Cooperative language learning, Total physical response, Audio lingual method, etc., The acronym for teaching of English as foreign language (TEFL) is Teaching English as a Second language (TESL). English language is a non-native language and it can be understood only with the help of some activities such as Drill activities, conducting puzzles, quiz, etc., Language teachers should give some practice to students through interaction to one another and correcting errors and grammatical mistakes which will be easier to the students to capture the techniques of English language. [ABSTRACT FROM AUTHOR]

The relationship between verb retrieval abilities and speaking proficiency level was tested using Action Naming Test on 80 neurologically healthy individuals and 8 persons with aphasia where all the participants were Kannada-English Bilinguals. Action naming test was administered in both the languages on all the participants (neurologically healthy individuals and persons with aphasia). All the participants performed better in Kannada than English. Significant difference between the performances in Kannada and English was seen only for neurologically healthy individuals because of the variation in the proficiency of L1 and L2. Further the Action Naming Test scores and proficiency rating were correlated for both neurologically healthy individuals and persons with aphasia separately. For neurologically healthy individuals, there was a highly positive correlation between the second language speaking proficiency and total scores of Action Naming Test, but there was no significant correlation between the second language speaking proficiency and total scores of Action Naming Test in persons with aphasia. Hence the findings of the present study showed that there could have been a direct relationship between speaking proficiency and retrieval of verbs at least for neurologically healthy individuals. [ABSTRACT FROM AUTHOR]