An audit of head trauma care and mortality

Objective: To analyze the factors contributing to deaths from head trauma by using standardized assessment parameters and to provide a peer-review of head injury deaths with focus on identifying deficiencies and analyzing contributory factors.Design: Descriptive study.Place and duration of study: The study was carried out at the Emergency, Aga Khan University Hospital during January 1998 to December 1999.Subjects and method: One hundred and three patients above the age of 15 years presenting alive to the Aga Khan University Hospital (AKUH) emergency with head injury were included in this study. Identified deaths data was reviewed by the Hospital Trauma Peer Review Committee and consensus arrived at for categorization of deaths. The potential deficiencies in care were identified and final recommendations made. The data was computed on CDC Trauma Registry (V 3.0) and SPSS (V 8.0).Results: Mean age was 31.9 years (n=103) with predominant male population (4:1). Severe head injury (GCS\u3c8) accounted for 21.3 % (n=22) of all cases with a total number of deaths being 12.6 % (n=13). Deaths were categorized preventable in 3 cases with non-preventable and potentially preventable in 4 and 6 cases respectively. Road traffic accidents were the predominant mechanism (n=8) in all deaths (n=13). The time interval in relation to mortality was biphasic, most deaths occurring either within 24 hours or between 3-7 days of injury. Inappropriate pre-hospital treatment, pre-hospital delays and inappropriate mode of transportation without inter-hospital communication were the process-related defects in pre-hospital care with major determinant of deaths outside AKUH (n=5). Prolonged emergency stay, delayed intensive care availability were the process-related deficiencies whereas inappropriate initial resuscitation, inappropriate initial head injury management were provider-related deficiencies in in-hospital care.Conclusion: Transfer of inappropriately managed patients, lapses in inter-hospital communications, delayed transfers were identified as the major pre-hospital factors whereas lack of ICU beds, portable ventilators in emergency room, delays in CT scan facilities were the deficiencies in the hospital services. Opportunities for improvement in head trauma care are needed to focus on initial resuscitation and appropriate surgical management

The natural history of peanut sensitization and allergy in a birth cohort

Information on the natural history of peanut-induced allergic sensitization (PAS) and clinical peanut allergy (PA) remains limited. Most previous studies selected children who were given a diagnosis of PA, which does not provide the population perspective and probably ignores those with low levels of sensitization.1,2 There are no population-based studies on the natural history of PAS or PA. To provide a population perspective, we used the Isle of Wight birth cohort (n = 1456) and determined the natural history of PAS and PA, focusing on incidence, persistence, and remission

Anisotropic plasticity mechanisms in a newly synthesised High Entropy Alloy investigated using atomic simulations and nanoindentation experiments

This work used atomic simulations and nanoindentation experiments to investigate hardness, modulus alongside sub-surface crystal defects and dislocation mediated plasticity mechanisms leading to anisotropic pile up and local entropy variation in high entropy alloys. The experimental campaign began from Thermo-Calc phase prediction of Ni25Cu18.75Fe25Co25Al6.25 HEA which followed experimental synthesis of the material using arc melting method and experimental nanoindentation using a Berkovich indenter under load-controlled conditions. Through MD simulations, the value of h_f/h_max in monocrystalline HEA was consistently found to be larger than 0.7 which suggested pile-up behaviour to dominate and sink-in behaviour to be unlikely. In the case of (110) and polycrystalline HEA substrates, the elastic work in the indentation hysteresis loop was seen to be larger than the (100) and the (111) orientations which explains that the (110) orientation substrate showed least elastic modulus and hardness while the (111) monocrystalline HEA showed the highest elastic modulus and hardness. From the simulations, a “lasso” type loop on the (110) orientation and cross-over of shear loops on the other orientations accompanied by dislocations of type 1/6 (Shockley), 1/2 (perfect), 1/3 (Hirth), 1/6 (Stair rod) and 1/3 (Frank partials) were seen to manifest an early avalanche of competing plasticity events. The defects accompanying these dislocations in the sub-surface were identified to be FCC intrinsic stacking faults (ISF), adjacent intrinsic stacking faults (quad faults), coherent ∑3 twin boundary and a coherent twin boundary next to an intrinsic stacking fault (triple fault). The EBSD analysis applied to the MD data showed that the (210) orientation and the family of directions were seemed to be preferable to plastically deform the FCC phased Ni25Cu18.75Fe25Co25Al6.25 HEA

Curvature condensation and bifurcation in an elastic shell

We study the formation and evolution of localized geometrical defects in an indented cylindrical elastic shell using a combination of experiment and numerical simulation. We find that as a symmetric localized indentation on a semi-cylindrical shell increases, there is a transition from a global mode of deformation to a localized one which leads to the condensation of curvature along a symmetric parabolic crease. This process introduces a soft mode in the system, converting a load-bearing structure into a hinged, kinematic mechanism. Further indentation leads to twinning wherein the parabolic crease bifurcates into two creases that move apart on either side of the line of symmetry. A qualitative theory captures the main features of the phenomena and leads to sharper questions about the nucleation of these defects.Comment: 4 pages, 5 figures, submitted to Physical Review Letter

Association between healthy eating in pregnancy and allergic status of the offspring in childhood

During the past few decades there has been a steady increase in the prevalence of noncommunicable diseases, including allergic disease. Changing lifestyle and subsequent diet may explain this increase seen in the prevalence of atopic disease. Epidemiologic evidence also suggests that diet may be key in the prevention of allergic disease. [1] There are 3 important characteristics in terms of the maternal diet that have been investigated for the prevention of allergic disease: (1) the role of particular nutrients, such as vitamins (A, D, and E), zinc, and fatty acids; (2) the role of particular foods, such as fruits and vegetables and fish; and (3) the total dietary intake, such as a Mediterranean diet or a healthy diet. Research using the healthy eating index tool, specific to the pregnancy diet, found no association between overall healthy eating score and recurrent wheeze in infants at the age of 3 years. [2] However, maternal intake of celery and citrus fruit specifically has been associated with an increased risk of sensitization to food allergens in 2-year-olds. [3] One case-control study found no effect of consumption of fish, butter, and margarine on the development of atopic sensitization in the offspring of allergic mothers; however, a protective effect of fish intake (2–3 times a week or more) was identified in the nonallergic mothers' group with the risk of food sensitization in the offspring reduced by greater than a third. [4] Thus, the question is whether the associations seen are due to the individual nutrients or foods or whether it is part of an overall nutritional composition of the weaning diet. In this study, we aimed to investigate whether maternal diet, specifically seafood intake during pregnancy, is associated with the infant's allergic outcomes in a well-characterized birth cohort with allergy at 3 and 10 years of age

SAMADroid: A Novel 3-Level Hybrid Malware Detection Model for Android Operating System

© 2013 IEEE. For the last few years, Android is known to be the most widely used operating system and this rapidly increasing popularity has attracted the malware developer's attention. Android allows downloading and installation of apps from other unofficial market places. This gives malware developers an opportunity to put repackaged malicious applications in third-party app-stores and attack the Android devices. A large number of malware analysis and detection systems have been developed which uses static analysis, dynamic analysis, or hybrid analysis to keep Android devices secure from malware. However, the existing research clearly lags in detecting malware efficiently and accurately. For accurate malware detection, multilayer analysis is required which consumes large amount of hardware resources of resource constrained mobile devices. This research proposes an efficient and accurate solution to this problem, named SAMADroid, which is a novel 3-level hybrid malware detection model for Android operating systems. The research contribution includes multiple folds. First, many of the existing Android malware detection techniques are thoroughly investigated and categorized on the basis of their detection methods. Also, their benefits along with limitations are deduced. A novel 3-level hybrid malware detection model for Android operating systems is developed, that can provide high detection accuracy by combining the benefits of the three different levels: 1) Static and Dynamic Analysis; 2) Local and Remote Host; and 3) Machine Learning Intelligence. Experimental results show that SAMADroid achieves high malware detection accuracy by ensuring the efficiency in terms of power and storage consumption

N′-(3,4-Dichloro­benzyl­idene)-5-methyl-1-(4-nitro­phen­yl)-1H-1,2,3-triazole-4-carbohydrazide

In the title compound, C17H12Cl2N6O3, the 1H-1,2,3-triazole ring [maximum deviation = 0.003 (1) Å] forms dihedral angles of 34.08 (6) and 28.38 (6)°, respectively, with the nitro- and dichloro-substituted benzene rings. The dihedral angle between the benzene rings is 6.68 (5)°. In the crystal, C—H⋯O hydrogen bonds link the mol­ecules into chains running parallel to the a axis

Prevalence and cumulative incidence of food hyper-sensitivity in the first 10 years of life

Background - Prevalence, incidence and natural history of food hypersensitivity (FHS) and its trends in an unselected cohort of older children are unclear.Methods - A birth cohort born on the Isle of Wight (UK) between 2001 and 2002 was followed up prospectively. Children were clinically examined and skin prick tested at set times and invited for food challenges when indicated. At 10 years of age, children were also invited for a blood test.Results - A total of 969 children were recruited at 12 weeks of pregnancy, and 92.9%, 88.5%, 91.6% and 85.3% were assessed at 1, 2, 3 and 10 years. Prevalence of sensitization to any allergen over 10 years was 186 of 969 (19.2%; 95% CI: 16.84–21.8) and 108 of 969 (11.2%; 95% CI: 9.31–13.29) children were sensitized to at least one predefined food allergen. Excluding wheat (due to cross-reactivity with pollen), 40 of 969 (4.1%; 95% CI: 3.19–5.32) children were sensitized to a predefined food allergen. Using food challenges and/or a good clinical history, the cumulative incidence of food hypersensitivity (FHS) in the first decade of life was 64 of 947 (6.8%, 95% CI: 5.2–8.4), while the prevalence of FHS at 10 years was 30 of 827 (3.6%, 95% CI: 2.54–5.15). The vast majority, 25 of 827 (3.0%, 95% CI: 1.8–4.2), suffered from IgE-mediated food allergy, while 5 of 827 (0.6%, 95% CI: 0.07–1.3) had non-IgE-mediated food allergy/food intolerance.Conclusions - By the age of 10 years, 6.8% of children suffered from FHS based on food challenges and a good clinical history. There was a large discrepancy between reported and diagnosed FHS

Changing prevalence of wheeze, rhinitis and allergic sensitisation in late childhood: findings from 2 Isle of Wight birth cohorts’ 12-years apart

Background: While the prevalence of asthma in children is decreasing or remaining the same, time-trends in the prevalence of rhinitis in children are not known. Understanding sensitisation trends may help inform about trends in asthma and rhinitis prevalence.Objective: To assess time -trends of wheeze, rhinitis and aero-allergen sensitisation prevalence at 10 years of age we compared two birth cohorts established 12 years apart. To gain insight into differences in disease prevalence we assessed association of family-history, early life exposures and sensitisation with wheeze and rhinitis in each cohort.Methods: The IoW (Isle-of-Wight) and FAIR (Food-Allergy-and-Intolerance-Research) unselected birth cohorts were established in 1989 and 2001 in IoW. Identical ISAAC questionnaire and Skin Prick test data were collected and compared at 10 years of age.Results: Over the 12 year period from 2001 to 2012, prevalence of lifetime-wheeze, current-wheeze, and those ever-treated-for-asthma decreased by 15.9% (45.5-vs-29.6,p<0.001), 3.9% (18.9-vs-15, p=0.020) and 8.2% (31.7-vs-23.5, p=0.001) respectively. Conversely, current-rhinitis and lifetime-rhinitis prevalence increased by 5.5% (22.6-vs-28.1, p=0.004) and 13% (18.6-vs-31.7, p<0.001) respectively. Atopic status remained stable, however house dust mite (HDM) sensitisation decreased by 5.6% (19.2-vs-13.6, p=0.004) and grass sensitisation increased by 3.5% (12.9-vs-16.4, p=0.054). Male-sex, parental history of asthma and HDM sensitisation were significantly associated with lifetime-wheeze in both cohorts while maternal smoking during pregnancy was a significant risk factor only in the earlier IoW-cohort. Parental history of rhinitis and grass sensitisation were significantly associated with lifetime-rhinitis in both cohorts while HDM sensitisation was significant only for the IoW-cohort.Conclusion: Contrasting changes were noted with falling wheeze and HDM sensitisation but rising rhinitis and grass sensitisation prevalence. Changing prevalence of aero-allergen sensitisations may explain the different time trends observed in these cohorts