Pharmacological and non-pharmacological treatments for the Neonatal Abstinence Syndrome (NAS).

Neonatal abstinence syndrome is defined by signs and symptoms of withdrawal that infants develop after intrauterine maternal drug exposure. All infants with documented in utero opioid exposure, or a high pre-test probability of exposure should have monitoring with a standard assessment instrument such as a Finnegan Score. A Finnegan score of \u3e8 is suggestive of opioid exposure, even in the absence of declared use during pregnancy. At least half of infants in most locales can be treated without the use of pharmacologic means. For this reason, symptom scores will drive the decision for pharmacologic therapy. Nevertheless, all infants, regardless of initial manifestations, should be first be managed with non-pharmacologic approaches which in turn, should not be considered as the sole alternative to drug therapy, but rather, as the base upon which all patients are treated. Those who continue to have symptoms despite supportive care should be pharmacologically treated, which in the most severe cases, is life-saving

Can Gravitational Instantons Really Constrain Axion Inflation?

Axions play a central role in inflationary model building and other cosmological applications. This is mainly due to their flat potential, which is protected by a global shift symmetry. However, quantum gravity is known to break global symmetries, the crucial effect in the present context being gravitational instantons or Giddings-Strominger wormholes. We attempt to quantify, as model-independently as possible, how large a scalar potential is induced by this general quantum gravity effect. We pay particular attention to the crucial issue which solutions can or cannot be trusted in the presence of a moduli-stabilisation and a Kaluza-Klein scale. An important conclusion is that, due to specific numerical prefactors, the effect is surprisingly small even in UV-completions with the highest possible scale offered by string theory. As we go along, we discuss in detail Euclidean wormholes, cored and extremal instantons, and how the latter arise from 5d Reissner-Nordstrom black holes. We attempt to dispel possible doubts that wormholes contribute to the scalar potential by an explicit calculation. We analyse the role of stabilised dilaton-like moduli. Finally, we argue that Euclidean wormholes may be the objects satisfying the Weak Gravity Conjecture extended to instantons

Microwave system for in-situ curing of concrete repair

This paper presents some results of the FP7 MCure project on the development of a prototype system for microwave curing of concrete and concrete repair. Microwave curing of concrete provides higher early age strength compared to normally cured concrete. A prototype microwave curing system has been developed based on laboratory results on microwave curing of concrete repair materials. Subsequently, field trials were carried out to validate the Pre-Industrial Prototype system by testing elements of four commercial repair materials and a CEM II cement concrete. The prototype control system was used to record data such as surface temperature of concrete, moisture content of concrete and output power of the magnetron. In addition, the relationships between microwave output power, temperature and volume of repair of the field trials were derived and compared with the laboratory results. The prototype microwave system performed effectively. Slabs of dimensions 1 m x 1 m and depths up to 64 mm were microwave cured to temperature up to 45 ◦C for the predetermined time

Characterisation and pore structure analysis of mortar incorporating valorised rice husk ash

Physical, chemical, and mineralogical characterisation of as-received rice husk ash (RHA) samples sourced from four rice-growing regions (North, South, East, and West) of India is presented. Valorised RHA was obtained through controlled combustion at two temperature ranges (600–700◦ C and 650–700◦ C) of husks from the North in an industry set up. Valorisation efficacy has been tested through comparative characterisation of the valorised RHAs with the as-received RHAs from the four regions. Blending of 15% valorised RHA (in the beneficiated state) by weight of cement had no adverse effect on compressive strength even though water–binder ratio of the blended mortar had to be increased by 14% to achieve flow of the control cement mortar. Compared with the control cement mortar, porosity of the mortar blended with the beneficiated RHA measured using mercury intrusion porosimetry (MIP) increased by up to 10% primarily due to an increase in the number of large mesopores (0.01–0.05 μm)

TINJAUAN KRIMINOLOGIS TERHADAP TINDAK PIDANA INCEST DENGAN KORBAN ANAK(STUDI KASUS DI LAPAS KLAS IIA BANDA ACEH)

ABSTRAKTRI KARUNIA PUTRI AMELIA,TINJAUAN KRIMINOLOGIS TERHADAP 2015 TINDAK PIDANA INCEST DENGAN KORBAN ANAK (STUDI KASUS DI LAPAS KLAS IIA BANDA ACEH)Fakultas Hukum Universitas Syiah Kuala(v,54),pp.,bibl(Dr. DAHLAN ALI., S.H., M.Hum., M.Kn.,)Salah satu kejahatan yang sering terjadi adalah tindak pidana perkosaan. Tindak pidana perkosaan merupakan salah satu dari tindak pidana terhadap kesusilaan. Dalam Bab XIV dalam Buku II KUHP memuat kejahatan terhadap kesusilaan yang tersebar pada pasal 281 hingga 303 KUHP. Di dalamnya yang dimaksud dengan kesusilaan sebagian besar berkaitan dengan seksualitas. Salah satu jenis kelainan seksual adalah hubungan seks yang dilakukan secara paksa bersama seseorang yang masih ada hubungan darah yaitu incest, dan yang biasanya menjadi korban ialah anak-anak. Incest sebagaimana dirumuskan dalam kamus besar bahasa Indonesia adalah hubungan seksual antara orang-orang yang bersaudara dekat yang dianggap melanggar adat, hukum dan agama. Sanksi mengenai incest dengan korban anak dapat dilihat dalam Pasal 81 dan Pasal 82 Undang-Undang No. 23 Tahun 2002 Tentang Perlindungan Anak.Penelitian ini bertujuan untuk menjelaskan faktor penyebab terjadinya tindak pidana incest, dan untuk mengetahui upaya yang perlu dilakukan untuk menanggulangi tindak pidana incest di provinsi Aceh.Untuk memperoleh data dalam penelitian skripsi ini, dilakukan penelitian pustaka (library research) dan penelitian lapangan (field research) yang dilaksanakan di Banda Aceh dengan lokasi penelitian pada Lembaga Pemasyarakatan Klas IIA dengan tipe penelitian deskriptif yaitu menganalisis data yang diperoleh dari studi lapangan dan kepustakaan dengan cara menjelaskan dan menggambarkan kenyataan objek. Hasil penelitian menunjukkan bahwa faktor-faktor penyebab terjadinya tindak pidana incest adalah: Faktor rendahnya pendidikan dan ekonomi, Faktor lingkungan atau tempat tinggal, Faktor alkohol, Faktor kurangnya pemahaman terhadap agama, dan Peranan korban. Penanggulangan tindak pidana incest dapat dilakukan dengan cara mengadakan pelayanan emergency call kepada masyarakat, mengadakan pengedukasian bagi para orang tua, dan juga pembinaan mental kepada pelaku dan korban tindak pidana incest.Disarankan kepada pemerintah agar hendaknya memperbanyak wadah tempat pengaduan untuk masyarakat, serta diadakan penyuluhan hukum agar dapat menumbuhkan kesadaran masyarakat untuk benar-benar mentaati hukum. Selain itu disarankan agar sistem pembuktian dalam kasus perkosaan dapat lebih permudah, khususnya incest.Banda Ace

Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage: Proposal of an Evidence-Based Combined Clinical and Imaging Reference Standard

Aneurysmal subarachnoid hemorrhage is associated with high morbidity and mortality, with delayed neurologic deficits from delayed cerebral ischemia contributing to a large portion of the adverse outcomes in this patient population. There is currently no consensus reference standard for establishing the diagnosis of delayed cerebral ischemia either in the research or clinical settings, ultimately limiting strategies for preventing delayed infarction and permanent neurologic deficits. There are currently both clinical and imaging-based criteria for the diagnosis of delayed neurologic deficits and vasospasm, respectively, however, neither clinical nor angiographic assessment alone has been shown to identify patients who develop adverse outcomes from delayed infarction. Thus, the purpose of this work is to propose a 3-tiered combined imaging and clinical reference standard based on evidence from the literature to standardize the diagnosis of delayed cerebral ischemia, both to allow consistency across research studies and to ultimately improve outcomes in the clinical setting

Appropriate Use of CT Perfusion following Aneurysmal Subarachnoid Hemorrhage: A Bayesian Analysis Approach

These investigators evaluated the test characteristics of CTP in patients with SAH for detection of delayed cerebral ischemia. Ninety-seven patients were assessed with CTP for ischemia and with DSA for vasospasm. The authors concluded that positive CTP findings identified patients who should be carefully considered for induced hypertension, hypervolemia, and hemodilution and/or intra-arterial therapy while negative CTP findings are useful in guiding a no-treatment decision. BACKGROUND AND PURPOSE: In recent years CTP has been used as a complementary diagnostic tool in the evaluation of delayed cerebral ischemia and vasospasm. Our aim was to determine the test characteristics of CTP for detecting delayed cerebral ischemia and vasospasm in SAH, and then to apply Bayesian analysis to identify subgroups for its appropriate use. MATERIALS AND METHODS: Our retrospective cohort comprised consecutive patients with SAH and CTP performed between days 6 and 8 following aneurysm rupture. Delayed cerebral ischemia was determined according to primary outcome measures of infarction and/or permanent neurologic deficits. Vasospasm was determined by using DSA. The test characteristics of CTP and its 95% CIs were calculated. Graphs of conditional probabilities were constructed by using Bayesian techniques. Local treatment thresholds (posttest probability of delayed cerebral ischemia needed to initiate induced hypertension, hypervolemia, and hemodilution or intra-arterial therapy) were determined via a survey of 6 independent neurologists. RESULTS: Ninety-seven patients with SAH were included in the study; 39% (38/97) developed delayed cerebral ischemia. Qualitative CTP deficits were seen in 49% (48/97), occurring in 84% (32/38) with delayed cerebral ischemia and 27% (16/59) without. The sensitivity, specificity, and positive and negative predictive values (95% CI) for CTP were 0.84 (0.73-0.96), 0.73 (0.62-0.84), 0.67 (0.51-0.79), and 0.88 (0.74-0.94), respectively. A subgroup of 57 patients underwent DSA; 63% (36/57) developed vasospasm. Qualitative CTP deficits were seen in 70% (40/57), occurring in 97% (35/36) with vasospasm and 23% (5/21) without. The sensitivity, specificity, and positive and negative predictive values (95% CI) for CTP were 0.97 (0.92-1.0), 0.76 (0.58-0.94), 0.88 (0.72-0.95), and 0.94 (0.69-0.99), respectively. Treatment thresholds were determined as 30% for induced hypertension, hypervolemia, and hemodilution and 70% for intra-arterial therapy. CONCLUSIONS: Positive CTP findings identify patients who should be carefully considered for induced hypertension, hypervolemia, and hemodilution and/or intra-arterial therapy while negative CTP findings are useful in guiding a no-treatment decision

Heightened immune response to autocitrullinated porphyromonas gingivalis peptidylarginine deiminase: a potential mechanism for breaching immunologic tolerance in rheumatoid arthritis

Background: Rheumatoid arthritis (RA) is characterised by autoimmunity to citrullinated proteins, and there is increasing epidemiologic evidence linking Porphyromonas gingivalis to RA. P gingivalis is apparently unique among periodontal pathogens in possessing a citrullinating enzyme, peptidylarginine deiminase (PPAD) with the potential to generate antigens driving the autoimmune response. Objectives: To examine the immune response to PPAD in patients with RA, individuals with periodontitis (PD) and controls (without arthritis), confirm PPAD autocitrullination and identify the modified arginine residues. Methods: PPAD and an inactivated mutant (C351A) were cloned and expressed and autocitrullination of both examined by immunoblotting and mass spectrometry. ELISAs using PPAD, C351A and another P gingivalis protein arginine gingipain (RgpB) were developed and antibody reactivities examined in patients with RA (n=80), individuals with PD (n=44) and controls (n=82). Results: Recombinant PPAD was a potent citrullinating enzyme. Antibodies to PPAD, but not to Rgp, were elevated in the RA sera (median 122 U/ml) compared with controls (median 70 U/ml; p<0.05) and PD (median 60 U/ml; p<0.01). Specificity of the anti-peptidyl citrullinated PPAD response was confirmed by the reaction of RA sera with multiple epitopes tested with synthetic citrullinated peptides spanning the PPAD molecule. The elevated antibody response to PPAD was abolished in RA sera if the C351A mutant was used on ELISA. Conclusions: The peptidyl citrulline-specific immune response to PPAD supports the hypothesis that, as a bacterial protein, it might break tolerance in RA, and could be a target for therapy

Controlled Exposure Study of Air Pollution and T-Wave Alternans in Volunteers without Cardiovascular Disease

Background: Epidemiological studies have assessed T-wave alternans (TWA) as a possible mechanism of cardiac arrhythmias related to air pollution in high-risk subjects and have reported associations with increased TWA magnitude. Objective: In this controlled human exposure study, we assessed the impact of exposure to concentrated ambient particulate matter (CAP) and ozone (O:3) on T-wave alternans in resting volunteers without preexisting cardiovascular disease. Methods: Seventeen participants without preexisting cardiovascular disease were randomized to filtered air (FA), CAP (150 μg/m3), O3 (120 ppb), or combined CAP + O3 exposures for 2 hr. Continuous electrocardiograms (ECGs) were recorded at rest and T-wave alternans (TWA) was computed by modified moving average analysis with QRS alignment for the artifact-free intervals of 20 beats along the V2 and V5 leads. Exposure-induced changes in the highest TWA magnitude (TWAMax) were estimated for the first and last 5 min of each exposure (TWAMax_Early and TWAMax_Late respectively). ΔTWAMax (Late–Early) were compared among exposure groups using analysis of variance. Results: Mean ± SD values for ΔTWA:Max were –2.1 ± 0.4, –2.7 ± 1.1, –1.9 ± 1.5, and –1.2 ± 1.5 in FA, CAP, O3, and CAP + O3 exposure groups, respectively. No significant differences were observed between pollutant exposures and FA. Conclusion: In our study of 17 volunteers who had no preexisting cardiovascular disease, we did not observe significant changes in T-wave alternans after 2-hr exposures to CAP, O:3, or combined CAP + O3. This finding, however, does not preclude the possibility of pollution-related effects on TWA at elevated heart rates, such as during exercise, or the possibility of delayed responses

Understanding esports-related betting and gambling: a systematic review of the literature

Esports gambling has steadily grown in popularity alongside esports itself. While research has been increasing in the field of esports-related gambling, no study has yet reviewed the relevant literature on esports gambling. The present study aimed to comprehensively review all empirical research conducted in the wider field of esports gambling. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was undertaken using PsycINFO, PubMed, Scopus, and Web of Science databases. Only empirical studies were included and were also assessed for potential biases using the ROBUST guidelines. A total of 30 studies from eight countries were included in the review. Esports gamblers were found more likely to be young males, likely to score high on problematic gambling scales, and likely to belong to households speaking a non-English language at home in English speaking countries. Esports gamblers are a unique type of gambling population, with rare characteristics and behaviors compared to other types of gamblers. Given the limited number of studies, there is a need for further research in this field to understand these populations, as well as the need for longitudinal research