Comparative Efficacy of Oral Triclofos in Pediatric Neuroimaging and Other Procedural Sedation: A Systematic Review and Meta-analysis

Sedation is a mandatory part of successfully performing diagnostic and therapeutic  procedures in struggling children or when lying still is a necessity. Many drugs are advocated but there is no consensus on choice of drug , route , dose etc. Practice varies by country, area,  procedure and clinician widely. Oral route is always preferred, for its low cost , safety and non requirement of expert handling by anesthetists. Triclofos is active metabolite of Chloral hydrate sedative anxiolytic. Both lost their ground with inclusion in WHO list of restricted pharmaceuticals in 2010. Unmonitored misuse of drug  was the reasons behind. However Triclofos remained in use in India, and no serious side effects were noted during one time use under medical supervision for procedural sedation in last 20 years. This Systematic review ascertains its safety and efficacy.  Protocol was registered at PROSPERO vide no CRD42021237574. Twenty four  studies with 2337 subjects were included, 18 clinical trials for safety  and efficacy both while 6 observational studies for safety only. Triclofos and oral Midazolam both appeared as preferred drugs for procedural sedation without any statistically significant difference. Triclofos was used in much higher doses in all studies varying  from 2.5 to 5 times higher than recommended dose of 20 mg/kg in Indian books. Preservative free IV midazolam preparation mixed with fruit juice was commonly used orally. No serious side effects were noted for triclofos in any study. We concluded that one time use of triclofos under medical supervision is safe and effective. &nbsp

A comparison of visual analog scale and Wong Baker facial pain scale for pain measurement in post lower caesarean section case

Background: There is various pain measurement tools commonly used to measure pain intensity. However, no single standard exists for quantifying pain in post caesarean section. In our study, we have divided two groups according to use of pain scales and found one scale is more useful than the other in the post caesarean cases.Methods: The study has been conducted in upper India Sugar Exchange Maternity Hospital department of obstetrics and gynaecology, GSVM Medical College, Kanpur for the duration of 18 months starting from February 2014 to August 2015 on 100 women who were operated for lower caesarean section (LSCS) under spinal anesthesia. Women were divided into two groups according to pain scales visual analog scale (VAS) and Wong Baker facial pain scale (WBFPS). All these selected women were studied in details with regards to clinical history, general examination and local examination. Women from respective group were asked to rate their pain intensity on these pain scales. SPSS was used to analyze the data statistically.Results: Using analysis of variance, we found that there is significant relationship within the groups having different parameters at different time interval at different probability level. There is a mutual relationship between the groups at different probability level.Conclusions: The study shows that VAS is the most sensitive and reliable tool to measure post LSCS pain as compared to WBFPS and minimum consumption of rescue analgesia in VAS group to maintain minimum pain score to keep the patient pain free

Erratum: Step energy and step interactions on the reconstructed GaAs(001) surface (Physical Review B - Condensed Matter and Materials Physics (2014) 90 (115314) DOI: 10.1103/PhysRevB.90.115314)

We report here the corrected values for the step energies and the step interactions calculated in our paper for a large set of different step configurations. We have found that one parameter, i.e., the smearing parameter governing the band occupation around the Fermi level, was not converged enough to predict the step properties with sufficient accuracy. Since the surfaces are metallic a smearing function had to be used for the state occupation around the Fermi level. We used the smearing function proposed by Marzari and Vanderbilt. We found that the parameter entering this expression is a particularly sensitive one. The previous paper used a commonly chosen value of 0.02 Ry. However, we found that a much smaller value for this parameter was necessary to obtain well converged values for the surface energies. The convergence of the smearing parameter has been carefully checked. Figure presented

Step energy and step interactions on the reconstructed GaAs(001) surface

Using ab initio total energy calculations we have studied the relation between the step atomic configuration and its properties (step energy, donor/acceptor behavior, and step interaction) on a beta(2)(2 x 4) reconstructed GaAs (001) surface. The results have been tested against the widely used elastic dipole model for the step energy and step interaction considered valid for stress-free surfaces. We have found that acceptor-behaving steps have an attractive interaction and donor-behaving steps have a repulsive interaction in contrast with the elastic dipole model which predicts always a repulsive interaction between like-oriented steps. To account for the attractive interaction we consider the electrostatic dipole interaction having the L-2 scaling with the step distance L and therefore compatible with the standard elastic model. Using a model charge distribution with localized point charges at the step based on the electron counting model we show that the electrostatic step interaction can indeed be generally attractive and of the same order of magnitude of the negative elastic dipole interaction. Our results show however that the usually employed dipole model is unable to account for the repulsive/attractive step interaction between donorlike/acceptorlike steps. Therefore, the ab initio results suggest an important electronic contribution to the step interaction, at least at the short step distances accessible to the first-principles study. Our results explain qualitatively many experimental observations and provide an explanation to the step bunching phenomenon on GaAs(001) induced by doping or by critical growth conditions as due to the stabilization of attractively interacting step structures. These ideas would lead to the development of a bottom-up surface step engineering

Problems arising from a comparison of Buddhist theories of causation with British empiricist ones

This thesis seeks to examine to what extent certain Buddhist theories of causation are comparable with the causal theories of some British empiricist philosophers. The thesis starts with an introduction. Its first chapter critically analyses Hume's causal theory, while the second points out that its similarity with the causal theories of Buddhist logicians such as Santaraksita and Kamalasila. Both Hume and these logicians criticised the concepts of causal efficacy and production, and analysed causal connections merely as relations of unvarying sequence. The third chapter critically analyses Mill's causal theory (and, to a certain extent, that of Berkeley), indicating that cause' is a collective name for a complex set of conditions. The fourth chapter points out that the Buddhist 'Theravada' and 'Sarvastivada' schools anticipated Mill's theory of the multiplicity of conditions. Moreover, the 'Sarvastivadins' introduced concepts similar to that of Mill's 'negative conditions'. We also tried to compare and contrast Russell's theory of 'functional interdependence' with Buddhist causal theories.In addition, we suggested that by different devices the Buddhist philosophers and Mill saved themselves from the inconguity of admitting any arbitrary sequence as a causal sequence. Chapter V tries to prove that the Buddhist formula of the 'twelve-membered dependent Origination' contains the incipient attempts of analysing causation only in terms of 'necessary and sufficeint conditions. Chapter VI shows that the concepts of causation and production are co-extensive. Thus there is a dilemma of explaining causation without production. Realization of this probably led the 'Madhyamika' philosophers to deny causation from the Absolute standpoint. Chapter VII points out that the absence, in Buddhist philosophy, of any distinction - corresponding to that made by some recent Western philosophers - between reasons for actions and causes does not invalidate our comparative study. The appendix to chapter I reiterates Hume's thesis, viz., that causes and effects are not related by logically necessary connections, pointing out that its validity is not disapproved by the recent theories of some philosophers, e.g., Blanshard and Kneale.<p

The doctrine of internal relations with reference to some of the main historical treatments

The introduction consists of a brief statement of the points at issue between the doctrines of internal and external relations together with the programme to be followed in the following chapters. I have tried to make it clear in the introduction that my main concern in the following chapters will be with proffering a critical estimate of the doctrine of internal relations whose claim regarding the internality of all relations seems to me to be unjustified. In the first chapter I have tried to show that Aristotle's treatment of the concept of relation contains in an implicit form the seeds of the doctrine of external relations. An attempt has also been made to show that the origin of two important views which the supporters of the doctrine of external relations claim that the internalists contradict can be traced in the writings of Aristotle. These are that relations are not qualities and that they do not always belong to the essences of things. In the second chapter a refutation of the arguments of Bradley, the chief exponent of the doctrine of internal relations, will put us in a good position to reject the doctrine of internal relations. I have tried to establish in the third chapter that the arguments employed by the internalists other than Bradley also do not stand the test of criticisms. In the conclusion I have reiterated my claim that it is impossible for all relations to be internal. I have also made it clear that I shall not try to answer the question whether, granted this, relations would be all, or only some of them, external, since my chief concern in the present paper is with denying the internality of all relations.<p

A review on ecological degradation, its causes and sustainable development in Delhi, India

Degradation of natural resources and loss of biodiversity (wildlife flora and fauna) is a global problem that affects our society and hampers the economic and social progress of a country towards sustainable development. In developing countries like India, degradation of natural resources is a major threat to socio-economic development. In general, destruction of the environment, biodiversity and nature, has been a major concern in metropolitan cities. Delhi being a metropolitan city and the capital of India, has been facing this problem since 1980’s. However, the situation was not that bad then. Over the years, the environmental degradation has not only led to the loss of natural flora and fauna of Delhi city but has also become a cause of great concern because of its impact on the health of the common citizens of Delhi. Modernization, industrialization and overpopulation are key factors responsible for bringing about a drastic change in Delhi’s biodiversity and natural resources. Keeping in view their multifarious impacts, the Government of Delhi took some measures to restore the ecosystem of the city. However, we still have a long way to go to bring back the natural flora and fauna of the city, clean air, and the natural resources that have been depleted beyond imagination. Government alone cannot bring about the lost glory of Delhi. Each citizen of Delhi is responsible, and there is a need to join hands together and think in a positive direction to make Delhi a safe living place not only for human beings but also the wildlife that once existed in this majestic city

The role of brokers and social identities in the development of capabilities in Global Virtual Teams

While organizations are increasingly relying on global virtual teams (GVTs) to carry out knowledge intensive activities, the understanding of how GVTs develop capabilities is still limited. We explore how GVTs adapt routines and build capabilities, and the role played by brokers and social identities in this process. We interviewed 49 professionals working in fifteen GVTs based in Europe, India, and US, and operating in IT and engineering consulting companies. Our multi-level grounded model highlights that, while brokers help in the creation of mutual knowledge, they reduce the accuracy of perceptions about distant co-workers. Mutual knowledge, combined with limited accuracy of perceptions, diminishes the need to adapt team routines over time. The negative effect of brokers on the creation of team capabilities is reduced when individual professional identities trigger the search for more accurate perceptions of distant colleagues and clients with the objective of adapting team routines and performing more stimulating work. On top of this, organizational identity further enables the process of adaptation of team routines. We conclude with a discussion of theoretical implications on the interplay between operational and social processes in GVTs and team capabilities, as well as practical implications for designing and managing GVTs

Legumes of Forage Value: Their Diversity and Priority for Collection in India

Indian subcontinent is a megacentre of agro-diversity. Legumes have a special place with several native crops and economically important species occurring along forest margins and openings, pastures, grasslands and grazing lands. Several are dual-purpose species for food and feed. However, herbage legumes though major components of grasslands and with a major role in their quality and improvement lack persistence as compared to grasses and their collection, maintenance and conservation assumes importance in the wake of change and loss of habitats of native species and introduction of new germplasm with forage potential. Establishing the correct identity of species is therefore a priority. The major forage legume crops of India (Anon., 2013) belong to Tribes Trifolieae- Trifolium, Medicago, Melilotus among temperate legumes; Phaseoleae- Vigna; and Indigofereae- Cyamopsis tropical, subtropical and arid conditions (Arora and Chandel, 1972). These have a good representation of erect, spreading and viny species with potential for use as forage, soil improvement and use as green manure and often with non-toxic herbage and successfully grown over widely varying environmental conditions making this a morphologically variable and highly diverse germplasm resource. Collecting species of native and introduced species from these habitats that are in a state of flux is important for locating potentially important and unique diversity well adapted to the areas of occurrence. Several species of forage legumes, both native and introduced (Nayar et al., 2014) were represented as reference specimens of plants collected from the wild or grown in experimental conditions at the National Herbarium of Cultivated Plants (acronym: NHCP). An initiative undertaken was to authenticate the identity of these, and work out characters that could be used for field identification

An anatomical study of “Utkshepa Marma” using Cadaveric dissection - Case Report

“Marma” consists of the aggregation of Mamsa, Sira, Snayu, Asthi and Sandhi in which particularly Prana by nature stay that is why injury to Marma leads to respective consequences. Acharya Shushruta mentioned “Vishalyaghna Marma” one of the variety of Marma which comes under the Parinama Prakarena. There are total three “Vishalyaghna Marma” situated in the human body in Urdhwajatrugat Pradesh. “Utkshepa Marma” situated above the Shankh Pradesh (temple) at the hairy margin. Injury to this by foreign body, keeps the person alive as long as it is kept within the wound until it falls down on its own accord. If it is drawn out by force the person dies at once due to sudden loss of Vayu, This is the “Vishalyaghna” effect of “Utkshepa Marma”. Here study explored the “Utkshepa Marma” in term of regional and cadaveric anatomical approach to find the anatomical structures at the site of Marma which is responsible for “Vishalyaghnatva” condition and reassess the applied anatomy of this Marma discussed in classics as well as reviewed in the light of modern medical science with the help of cadaveric dissection