Physician documentation of access to firearms in suicidal patients in the emergency department

Introduction: Suicide is the 10th leading cause of death in the United States. An estimated 50% of these deaths are due to firearms. Suicidal ideation (SI) is a common complaint presenting to the emergency department (ED). Despite these facts, provider documentation on access to lethal means is lacking. Our primary aim was to quantify documentation of access to firearms in patients presenting to the ED with a chief complaint of SI.Methods: This was a cross-sectional study of consecutive patients, nearly all of whom presented to an academic, urban ED with SI during July 2014. We collected data from all provider documentation in the electronic health record. Primary outcome assessed was whether the emergency physician (EP) team documented access to firearms. Secondary outcomes included demographic information, preexisting psychiatric diagnoses, and disposition.Results: We reviewed 100 patient charts. The median age of patients was 38 years. The majority of patients had a psychiatric condition. EPs documented access to firearms in only 3% of patient charts.Conclusion: EPs do not adequately document access to firearms in patients with SI. There is a clear need for educational initiatives regarding risk-factor assessment and counseling against lethal means in this patient cohort

Federal Transfers and the Tax efforts of the States in India

The paper has examined the the impact of federal fiscal transfers on the budget of the state (sub-central) governments in India. The relationship between the federal fiscal transfers and the tax efforts of the 14 major Indian states have been anlysed for fifteen years (from 1970-71 to 1984-85)through a panel dadat set. Fixed efeect model and its variants have been employed. The study found that the federal transfers have dampaned the tax efforts of states in India. Hence, a hiher weightaege for the 'tax effort criterion' has been suggested in the vertical devolution formula of the Indian Finance Commission to ensure efficiency.Federal Transfers; Tax Efforts; Fiscal Federalism in India; Efficiency; Vertical fiscal balance

Capillarity-like growth of protein folding nuclei

We analyzed folding routes predicted by a variational model in terms of a generalized formalism of the capillarity scaling theory for 28 two-state proteins. The scaling exponent ranged from 0.2 to 0.45 with an average of 0.33. This average value corresponds to packing of rigid objects.That is, on average the folded core of the nucleus is found to be relatively diffuse. We also studied the growth of the folding nucleus and interface along the folding route in terms of the density or packing fraction. The evolution of the folded core and interface regions can be classified into three patterns of growth depending on how the growth of the folded core is balanced by changes in density of the interface. Finally, we quantified the diffuse versus polarized structure of the critical nucleus through direct calculation of the packing fraction of the folded core and interface regions. Our results support the general picture of describing protein folding as the capillarity-like growth of folding nuclei.Comment: 16 pages,6 figures. Submitted to Proc.Natl.Acad.Sc

The role of a highly conserved eubacterial ribosomal protein in translation quality control

The process of decoding is the most crucial determinant of the quality of protein synthesis. Ribosomal protein L9 was first implicated in decoding fidelity when a mutant version of L9 was found to increase the translation of a T4 phage gene. Later studies confirmed that the absence of L9 leads to increased translational bypassing, frameshifting, and stop codon readthrough. L9 is part of the large subunit of the prokaryotic ribosome and is located more than 90 Å from the site of decoding, making it difficult to envision how it might affect decoding and reading frame maintenance. Twenty years after the identification of L9\u27s putative function, there is no mechanism for how a remotely located L9 improves translation fidelity. This mystery makes our picture of translation incomplete. Despite the high conservation of L9 in eubacteria, E.coli lacking L9 does not exhibit any obvious growth defects. Thus, the evolutionary advantage conferred by L9 in bacteria is masked under laboratory conditions. In order to uncover unique L9-dependent conditions, a library of E. coli mutants was screened to isolate those that rely on L9 for fitness. Interestingly, factors found to be synergistic with L9 had no known role in fidelity. Six independent mutants were isolated, each exhibiting a severe growth defect that is partially suppressed in the presence of L9. One class of L9-dependent mutations was present in an essential ribosome biogenesis factor, Der. Der\u27s established function is in the maturation of the large ribosomal subunit. The identified mutations severely impaired the GTPase activity of Der. Interestingly, L9 did not directly compensate for the defective GTPase activity of mutant Der. The second class of L9-dependent mutations was present in EpmA and EpmB, factors required to post-translationally modify elongation factor, EF-P. EF-P\u27s established function is in the translation of poly-proline containing proteins. EF-P deficient cells were nearly inviable in the absence of L9; however, L9 did not directly influence poly-proline translation. Therefore, in each case, L9 improved cell health without altering the activity of either Der or EF-P. Remarkably, the der mutants required only the N domain of L9, whereas the absence of active EF-P required full-length, wild-type L9 for growth complementation. Thus, each mutant class needed a different aspect of L9\u27s unique architecture. In cells lacking either active EF-P or Der, there was a severe deficiency of 70S ribosomes and the indication of small subunit maturation defects, both of which worsened upon L9 depletion. These results strongly suggest that L9 plays a role in improving ribosome quality and abundance under certain conditions. Overall, the genetic screen lead to the discovery that bacteria need L9 when either of two important translation factors (Der or EF-P) is inactivated. This work has characterized the physiological requirement for L9 in each case and offers a new insight into L9\u27s assigned role in translation fidelity

Preliminary Analysis Framework for State Sustainable Transportation system

Sustainable practices have become the cornerstone of the transportation sector, and widely adopted by many states' transportation agencies. The nerve center of the economic development today circles around resource utilization and energy use. The transportation sector is the bloodline of the U.S economy and sustainability of this sector affects the growth of the economy. Even though sustainable practices have now become the edifice of transportation sectors, the adoption of such practices cannot be quick enough to overcome the ever-increasing demand of resources from the global population. Benchmarking sustainability is the most appropriate method to determine the sustainability of transportation practices. There are numerous rating and benchmarking systems, and most of them follow similar approach and format that outline the sustainability factors (namely, energy, water, land use, air quality, pollution etc.). Such approaches and formats can be found on many sustainable standards and tools such as the Leadership for Energy and Environmental Design (LEED). The purpose of this research is to develop a framework that includes an alternative approach to benchmark the sustainable performances of state transportation systems. The framework focuses on measuring the actual sustainability rather than to develop standard compliance approach similar to LEED rating system. It also focuses on utilizing modified/adjusted quantitative data to determine the sustainability of transportation practices. Such an approach would allow transportation agencies and states to compare and compete with one another

A comparative analysis of parallel prefix adders in 32nm and 45nm static CMOS technology

textBinary adders form a major part in various arithmetic logical operation units including multipliers, dividers and digital signal processors. Parallel prefix adders represent a set of efficient structures for binary addition, greatly suited for VLSI implementation due to their regularity and speed. This report is focused on the comparative analysis of 5 major types of parallel prefix adder frameworks namely Kooge-Stone, Knowles adders, Brent-Kung, Han-Carlson and Ladner-Fischer adders implemented in Synopsys's SAED 32nm static CMOS technology operating at 1.05V for 8-bit, 16-bit and 32-bit input vectors based on power, performance and area (PPA) metrics. The process technology is modeled with 9 metal tracks. Power, performance and area metrics based on circuit simulations are used for comparison. The metrics are compared across SAED 32nm and FreePDK 45nm technology to quantify the impact of technology on architecture.Electrical and Computer Engineerin

The Ultimate Fate of Supercooled Liquids

In recent years it has become widely accepted that a dynamical length scale {\xi}_{\alpha} plays an important role in supercooled liquids near the glass transition. We examine the implications of the interplay between the growing {\xi}_{\alpha} and the size of the crystal nucleus, {\xi}_M, which shrinks on cooling. We argue that at low temperatures where {\xi}_{\alpha} > {\xi}_M a new crystallization mechanism emerges enabling rapid development of a large scale web of sparsely connected crystallinity. Though we predict this web percolates the system at too low a temperature to be easily seen in the laboratory, there are noticeable residual effects near the glass transition that can account for several previously observed unexplained phenomena of deeply supercooled liquids including Fischer clusters, and anomalous crystal growth near T_g

Frailty and use of health and community services by community-dwelling older men: the Concord Health and Ageing in Men Project

Background: frailty is a concept used to describe older people at high risk of adverse outcomes, including falls, functional decline, hospital or nursing home admission and death. The associations between frailty and use of specific health and community services have not been investigated. Methods: the cross-sectional relationship between frailty and use of several health and community services in the last 12 months was investigated in 1,674 community-dwelling men aged 70 or older in the Concord Health and Ageing in Men study, a population-based study conducted in Sydney, Australia. Frailty was assessed using a modified version of the Cardiovascular Health Study criteria. Results: overall, 158 (9.4%) subjects were frail, 679 (40.6%) were intermediate (pre-frail) and 837 (50.0%) were robust. Frailty was associated with use of health and community services in the last 12 months, including consulting a doctor, visiting or being visited by a nurse or a physiotherapist, using help with meals or household duties and spending at least one night in a hospital or nursing home. Frail men without disability in activities of daily living were twice more likely to have seen a doctor in the previous 2 weeks than robust men (adjusted odds ratio 2.04, 95% confidence interval 1.21-3.44), independent of age, comorbidity and socio-economic status. Conclusion: frailty is strongly associated with use of health and community services in community-dwelling older men. The high level of use of medical services suggests that doctors and nurses could play a key role in implementation of preventive intervention

Effect of Fly Ash Fineness on the Performance of Cement Mortar

This paper investigates the effect of fineness of fly ash on the performance of cement mortar. Fly ash from thermal plant is used as partial substitute for cement. Fly ash is used as received and also processed by grinding. The study involves four replacement levels of fly ash into cement at 10%, 20%, 30% and 40% for each mix design. Mortar cubes are tested for strength, water absorption and sorption. Water absorption and sorption show a decreasing trend with the increase of fly ash fineness; whereas the strength increases with the increase of fineness. It is concluded that increasing the fineness of fly ash increases the strength and reduces absorption by 15% and hence is an effective method to improve its performance in cement mortar

Control of root-knot nematode in grapes

In a nematode infested vineyard, application of Aldicarb 2 g a.i. per vine, DBCP 1,2 ml/m2 and Carbofuran 0.6 g a.i. per vine after pruning brought down tne rootknot nematode. A significant increase in number of bunches and yield of fruits was obtained in Aldicarb treatment followed by DBCP, Carbofuran and Tagetes interplanting.Die Bekämpfung von Wurzelgallennematoden bei RebenIn einem mit Meloidogyne incognita verseuchten Wenberg wurde durch Anwendung von Aldicarb (2 g a.W./Rebe), DBCP (1,2 ml/m2) und Carbofuran (0,6 g a.W./Rebe) nach dem Rebschnitt die Befallsdichte der Wurzelgallennematoden stark verringert. Durch Behandlung mit Aldicarb, DBCP und Carbofuran sowie Zwischenpflanzung von Tagetes wurde, mit abnehmender Wirkung in der Reihenfolge der Aufzählung, eine signifikante Steigerung der Traubenzahl und des Traubenertrages erzielt