An Observational study to assess Immediate hemodynamic outcomes in patients undergoing percutaneous Transvenous mitral commissurotomy in Our Institution

BACKGROUND AND OBJECTIVES: Several studies conducted on the prevalence of rheumatic heart disease reported a prevalence of 34.54/1000 in India. Furthermore, demands for adequate medical therapies are expanding with increasing use of Percutaneous transvenous mitral valvuloplasty. In comparison to the surgical mitral commissurotomy Percutaneous mitral valvotomy has shown better success rates, comparable restenosis rates, larger valve area and long term durability. The most widely used echocardiographic parameter for patient selection for PTMC, is the Wilkins score which we follow in our institute. Our study aims to analyse the immediate hemodynamic outcomes in patients undergoing Percutaneous mitral valvotomy in our institute selected by specific clinical and echo criteria. METHODS: In this following hospital based observational study, fifty patients who were admitted as inpatients for the above procedure in the department of cardiology, who met the inclusion and exclusion cirteria were followed up during intraoperative and postoperative period. Immediate functional outcome of the procedure in terms of hemodynamic improvement was assessed by measuring the percentage of improvement in mitral valve orifice area, Left atrial pressure and mitral valve peak gradient. RESULTS: Out of the 50 patients who were included in the study group 64% were in 21-40 age group, 78% were females, 52% have symptoms and NYHA II, 48% have symptoms in NYHA class III, 0% in NYHA class I & IV. All the patients had wilkins score of 8 or below. 84% Patients had no atrial fibrillation. Even though lower age group, female sex, no atrial fibrillation and lower NYHA class seemed to have better outcomes the association was not statistically significant. The association between wilkins score and outcome with regard to all three parameters was statistically significant. CONCLUSION: PTMC is the procedure of choice for the management of uncomplicated and pliable mitral stenosis. Even though Echocardiographic scores are not the only parameters determining the outcome of PTMC, they still have a significant role in patient selection for PTMC

The Need for Effective Early Behavioral Family Interventions for Children with Attention Deficit Hyperactivity Disorder (ADHD)

There is a pressing need for the development of effective early family intervention programs for children showing Attention Deficit Hyperactivity Disorder (ADHD) behaviours with Conduct Disorder (CD) or Oppositional Defiant Disorder (ODD) behaviours. Previous research has indicated that children with ADHD are at risk of developing comorbid CD or ODD behaviours. In addition, it has been shown that ODD or CD behaviours in childhood tend to persist and to have adverse effects on later social adjustment. However, ODD or CD behaviours are not necessary concomitants of ADHD, and it has been demonstrated that behavioural intervention can have both short- and long term beneficial effects for children showing early signs of ODD or CD behaviours. In short term, behavioural family interventions may be able to reduce oppositional behaviour, particularly in the preschool years. In the long term, early intervention has shown to reduce the incidence of later antisocial behaviour in children at risk for this developmental trajectory. In this paper, it will be argued that behavioural family interventions have not been effectively utilised or promulgated in the community for children with ADHD despite the demonstrated efficacy of these types of interventions. A model of a multilevel system of intervention that can be tailored to the individual family’s needs is presented

Size-controlled synthesis of monodispersed gold nanoparticles via carbon monoxide gas reduction

An in depth analysis of gold nanoparticle (AuNP) synthesis and size tuning, utilizing carbon monoxide (CO) gas as a reducing agent, is presented for the first time. The sizes of the AuNPs are tunable from ~4 to 100 nm by altering the concentration of HAuCl4 and inlet CO gas-injection flow rate. It is also found that speciation of aqueous HAuCl4, prior to reduction, influences the size, morphology, and properties of AuNPs when reduced with CO gas. Ensemble extinction spectra and TEM images provide clear evidence that CO reduction offers a high level of monodispersity with standard deviations as low as 3%. Upon synthesis, no excess reducing agent remains in solution eliminating the need for purification. The time necessary to synthesize AuNPs, using CO, is less than 2 min

Not your average job: Measuring farm labor in Tanzania

Understanding the constraints to agricultural growth in Africa relies on the accurate measurement of smallholder labor. Yet, serious weaknesses in these statistics persist. The extent of bias in smallholder labor data is examined by conducting a randomized survey experiment among farming households in rural Tanzania. Agricultural labor estimates obtained through weekly surveys are compared with the results of reporting in a single end-of-season recall survey. The findings show strong evidence of recall bias: people in traditional recall-style modules reported working up to four times as many hours per person-plot as those reporting labor on a weekly basis. Recall bias manifests both in the intensive and extensive margins of labor reporting: while hours are over-reported in recall, the number of people and plots active in agricultural work are under-reported. The evidence suggests that this recall bias is driven not only by failures in memory, but also by the mental burdens of reporting on highly variable agricultural work patterns to provide a typical estimate. All things equal, studies suffering from this bias would understate agricultural labor productivity

High-Throughput Label-Free Isolation of Heterogeneous Circulating Tumor Cells and CTC Clusters from Non-Small-Cell Lung Cancer Patients.

(1) Background: Circulating tumor cell (CTC) clusters are emerging as clinically significant harbingers of metastases in solid organ cancers. Prior to engaging these CTC clusters in animal models of metastases, it is imperative for technology to identify them with high sensitivity. These clusters often present heterogeneous surface markers and current methods for isolation of clusters may fall short. (2) Methods: We applied an inertial microfluidic Labyrinth device for high-throughput, biomarker-independent, size-based isolation of CTCs/CTC clusters from patients with metastatic non-small-cell lung cancer (NSCLC). (3) Results: Using Labyrinth, CTCs (PanCK+/DAPI+/CD45-) were isolated from patients (n = 25). Heterogeneous CTC populations, including CTCs expressing epithelial (EpCAM), mesenchymal (Vimentin) or both markers were detected. CTCs were isolated from 100% of patients (417 +/- 1023 CTCs/mL). EpCAM- CTCs were significantly greater than EpCAM+ CTCs. Cell clusters of \u3e/=2 CTCs were observed in 96% of patients-of which, 75% were EpCAM-. CTCs revealed identical genetic aberrations as the primary tumor for RET, ROS1, and ALK genes using fluorescence in situ hybridization (FISH) analysis. (4) Conclusions: The Labyrinth device recovered heterogeneous CTCs in 100% and CTC clusters in 96% of patients with metastatic NSCLC. The majority of recovered CTCs/clusters were EpCAM-, suggesting that these would have been missed using traditional antibody-based capture methods

Pedagogic inclusion in professional education : challenges and possibilities?

This thesis describes a qualitative, interview-based case study of the experiences of adult female learners accessing/reaccessing Higher Education following a Widening Participation (WP) route on a part-time Physiotherapy undergraduate course and an accelerated Masters course in Occupational Therapy at a single HEI. The research questioned student and staff perceptions of and attitudes to study, and to what extent the HEI had adapted its pedagogic approaches to accommodate student learning preferences. Data are drawn from discussions with sixteen participants, comprising four students and four tutors on each course. The research outcomes revealed a tension between the tutors' theoretically and ideologically driven views on teaching and learning, which included responding to diverse student needs, and the more pragmatic orientations of the students and their tutors. These were underpinned in the students' case by the financial need to gain a qualification in spite of the constraints of time and family life, and on the tutors' and institution's part by the need to attract student numbers and to meet completion targets in spite of shortages of time, staffing and space. Analysis of the responses of students and tutors draws on Bernstein's theory of recontextualisation, in which ideas such as WP undergo significant transformations first in the official policy process then when they are put into practice. The study also draws on Bernstein's account of pedagogic identities, which describe how teachers and institutions negotiate teaching and learning processes within the competing demands of market forces, mandated policy and their own local ideologies and circumstances. In its exploration of the meaning of WP and its underpinning rationales, the research suggests that the pragmatic approach of the institution has the effect of widening access in terms of course eligibility but failing to offer correspondingly inclusive pedagogies, more flexible curricula, or adequate student support services

BSHI guideline: HLA matching and donor selection for haematopoietic progenitor cell transplantation

A review of the British Society for Histocompatibility and Immunogenetics (BSHI) Guideline ‘HLA matching and donor selection for haematopoietic progenitor cell transplantation’ published in 2016 was undertaken by a BSHI appointed writing committee. Literature searches were performed and the data extracted were presented as recommendations according to the GRADE nomenclature

Identification of Pik3ca mutation as a genetic driver of prostate cancer that cooperates with Pten loss to accelerate progression and castration-resistant growth

Genetic alterations that potentiate PI3K signalling are frequent in prostate cancer, yet how different genetic drivers of the PI3K cascade contribute to prostate cancer is unclear. Here, we report PIK3CA mutation/amplification correlates with poor prostate cancer patient survival. To interrogate the requirement of different PI3K genetic drivers in prostate cancer, we employed a genetic approach to mutate Pik3ca in mouse prostate epithelium. We show Pik3caH1047R mutation causes p110-dependent invasive prostate carcinoma in-vivo. Furthermore, we report PIK3CA mutation and PTEN loss co-exist in prostate cancer patients, and can cooperate in-vivo to accelerate disease progression via AKT-mTORC1/2 hyperactivation. Contrasting single mutants that slowly acquire castration-resistant prostate cancer (CRPC), concomitant Pik3ca mutation and Pten loss caused de-novo CRPC. Thus, Pik3ca mutation and Pten deletion are not functionally redundant. Our findings indicate that PIK3CA mutation is an attractive prognostic indicator for prostate cancer that may cooperate with PTEN loss to facilitate CRPC in patients