Retrospective Evaluation of the Epidemiology and Practice Variation of Dexmedetomidine Use in Invasively Ventilated Pediatric Intensive Care Admissions, 2007-2013

OBJECTIVES: The study assessed dexmedetomidine utilization and practice variation over time in ventilated pediatric intensive care unit (PICU) patients; and evaluated differences in hospital outcomes between high- and low-dexmedetomidine utilization hospitals. STUDY DESIGN: This serial cross-sectional analysis used administrative data from PICU admissions in the pediatric health information system (37 US tertiary care pediatric hospitals). Included admissions from 2007 to 2013 had simultaneous dexmedetomidine and invasive mechanical ventilation charges, <18 years of age, excluding neonates. Patient and hospital characteristics were compared as well as hospital-level severity-adjusted indexed length of stay (LOS), charges, and mortality. RESULTS: The utilization of dexmedetomidine increased from 6.2 to 38.2 per 100 ventilated PICU patients among pediatric hospitals. Utilization ranged from 3.8 to 62.8 per 100 in 2013. Few differences in patient demographics and no differences in hospital-level volume/severity of illness measures between high- and low-utilization hospitals occurred. No differences in hospital-level, severity-adjusted indexed outcomes (LOS, charges, and mortality) were found. CONCLUSION: Wide practice variation in utilization of dexmedetomidine for ventilated PICU patients existed even as use has increased sixfold. Higher utilization was not associated with increased hospital charges or reduced hospital LOS. Further work should define the expected outcome benefits of dexmedetomidine and its appropriate use

Low temperature magnetic and magnetocaloric studies in YCr0.85Mn0.15O3 ceramic

We have investigated low temperature magnetic and magnetocaloric properties of manganese (Mn) doped YCr0.85Mn0.15O3 (YCMO) polycrystalline compound, synthesized via solid state reaction route. The lattice volume was found to increase in comparison to that of pristine YCrO3 (YCO) compound. On the other hand, the paramagnetic-antiferromagnetic Néel temperature (TN ∼ 132 K) was found to be lower than that for YCO ceramic. On cooling below TN, under field cooled (FC) mode with an applied magnetic field of 0.02 T, magnetization flipped the polarity from positive to negative at Tcomp = 62 K. Furthermore, the magnetization switching temperature, defined as compensation temperature, exhibited field dependency and decreased with increasing field. Besides, the magnetization reversal phenomenon disappeared under higher applied magnetic field values. For the first time, the magnetocaloric effect for this compound was measured near 36 K through the parameters like magnetic entropy change (−ΔS) = ∼0.186 J kg−1 K−1 and the relative cooling power (RCP) ∼ 6.65 J kg−1, under an applied field of 5 T.publishe

Extensive intraductal component positive carcinoma of breast: two year study with special reference to ER/PR/HER2NEU/Ki67 in a tertiary care centre of Barak Valley

Background: Extensive intraductal component positive carcinoma (EICPC) of breast is defined by Schnitt et al as-A. 25% or more of Ductal carcinoma in situ (DCIS) is present along the invasive lesion and DCIS is also present outside the area of invasive carcinoma. B. EICPC also include carcinomas in which DCIS is associated with a “small” (approximately 10 mm or less) invasive carcinoma or carcinomas. In Extensive Intraductal Carcinoma (EIDC) most of the cases were associated with recurrence when surgical margin status is not evaluated or focally involved. Our objective was to study the prevalence of EIDC and expression of estrogen receptor (ER)/progesterone receptor (PR)/human epidermal growth factor (HER2NEU)/Ki67(antigen identified by monoclonal antibody KI67) in those cases.Methods: It was a retrospective cross sectional study conducted over a period of 2017 to August 2019.All the histologically confirmed cases of EIDC was retrieved from the institute.Results: Out of 65 cases of invasive carcinoma 17 (26.1%) cases were positive for EICPC. Age of patients ranged from 27 to 73years with mean age of 43 years and 5 patients (29.4%) were postmenopausal. Most of the cases  i.e. 6(35.2%) had a ER+/PR+/HER2NEU- status with most of the cases having high 6(47%)Ki-67 index. According to the BLOOM RICHARDSON GRADING 14 cases were grade II (82.3%) and 3 cases were grade I (17.7%) and in pT and pN staging majority were stage pT1 - 7 (41.1%). Most of the cases were mastectomy cases 11 (64.4%) with a base free status except in one lumpectomy case where margin was involved.Conclusions: In this study majority of the cases were ER+//PR+/HER2NEU- with most of the cases having high Ki67 index. Evaluation of EIDC, along with the negative margin status is important to prevent recurrence

Menstrual hygiene practices and related infections among adolescent girls of an urban poor locality

Background: Hygienic practices during menstruation are of considerable importance, as it has a health impact in terms of increased vulnerability to infections. Menstrual hygiene management is a special problem for adolescent girls, particularly when attending school due to limited or lack of access to safe sanitary pads and good sanitary facilities. Government of India under RMNCH+A programme, introduced priority intervention for menstrual hygiene to prevent hygiene related infections.Objectives: (1) To assess the knowledge regarding menstrual hygiene among adolescent girls. (2) To assess the menstrual hygiene practices & related infections among the adolescent girls.Methods: A cross-sectional study was conducted among 330 adolescent girls who had attained menarche and residents of an urban poor locality Yarab Nagar, which comes under the field practice area of KIMS, Bangalore. Data regarding socio demographic details and menstrual hygiene practices was obtained in a pre- designed, semi structured proforma. All the subjects were examined for any related infections from a trained female doctor. The data was analysed in Microsoft Excel using mean & percentages.Results: The mean age of the study subjects was 13.63 ± 5.76 years. Majority i.e., 306 (92.7%) of them used sanitary pads; whereas, 24 (7.3%) used old clothes as an absorbent during menstruation. Similarly, 98% cleaned the external genitalia with water during menstruation. The common infections related to menstruation were contact dermatitis (7.2%), candidiasis (5.4%) & UTI (3.5%).Conclusion: The knowledge and practice regarding menstrual hygiene was inadequate among the adolescent girls; and this inadequate hygienic practices has led to infections

Interhemispheric communication during haptic self-perception

During the haptic exploration of a planar surface, slight resistances against the hand's movement are illusorily perceived as asperities (bumps) in the surface. If the surface being touched is one's own skin, an actual bump would also produce increased tactile pressure from the moving finger onto the skin. We investigated how kinaesthetic and tactile signals combine to produce haptic perceptions during self-touch. Participants performed two successive movements with the right hand. A haptic force-control robot applied resistances to both movements, and participants judged which movement was felt to contain the larger bump. An additional robot delivered simultaneous but task-irrelevant tactile stroking to the left forearm. These strokes contained either increased or decreased tactile pressure synchronized with the resistance-induced illusory bump encountered by the right hand. We found that the size of bumps perceived by the right hand was enhanced by an increase in left tactile pressure, but also by a decrease. Tactile event detection was thus transferred interhemispherically, but the sign of the tactile information was not respected. Randomizing (rather than blocking) the presentation order of left tactile stimuli abolished these interhemispheric enhancement effects. Thus, interhemispheric transfer during bimanual self-touch requires a stable model of temporally synchronized events, but does not require geometric consistency between hemispheric information, nor between tactile and kinaesthetic representations of a single common object

A two years study of histopathological spectrum of skin adnexal tumors in a tertiary care centre of Southern Assam, India

Background: Skin adnexal tumors (SAT) encompass a wide spectrum of benign and malignant tumors that differentiate toward one or more adnexal structures found in normal skin. Overall incidence of SATs is low yet they can be challenging to diagnose. Our study aims at analysis of histopathological spectrum of various SATs according to age, sex and anatomic locations along with histopathological features.Methods: It was a retrospective cross-sectional study conducted over a period of 2 years from June 2017 to May 2019. All cases were retrieved from department registries and analyzed.Results: Out of the total 4013 biopsies, 25 cases were diagnosed as SATs comprising 44% of tumors with eccrine sweat gland differentiation followed by tumors showing hair follicle differentiation (32%), sebaceous differentiation (16%) and apocrine gland differentiation (8%). The age ranged from 4 years to 68 years and male: female ratio was 1:1.5. Most of the tumors were benign (84%) while only 16% were malignant. Pilomatricoma (19%) was the most common benign tumor while sebaceous carcinoma (75%) was the most common malignant tumor.Conclusions: Skin adnexal tumors are relatively rare neoplasm. Malignant cases are less common than benign ones. Histopathology is quite essential for diagnostic point of view

Nurse practitioner coverage is associated with a decrease in length of stay in a pediatric chronic ventilator dependent unit

AIM: To hypothesize a dedicated critical care nurse practitioner (NP) is associated with a decreased length of stay (LOS) from a pediatric chronic ventilator dependent unit (PCVDU). METHODS: We retrospectively reviewed patients requiring care in the PCVDU from May 2001 through May 2011 comparing the 5 years prior to the 5 years post implementation of the critical care NP in 2005. LOS and room charges were obtained. RESULTS: The average LOS decreased from a median of 55 d [interquartile range (IQR): 9.8-108.3] to a median of 12 (IQR: 4.0-41.0) with the implementation of a dedicated critical care NP (P < 1.0001). Post implementation of a dedicated NP, a savings of 25738049 in room charges was noted over 5 years. CONCLUSION: Our data demonstrates a critical care NP coverage model in a PCVDU is associated with a significantly reduced LOS demonstrating that the NP is an efficient and likely cost-effective addition to a medically comprehensive service

SEPARATION OF CHOPPED NETTLE MATERIAL ON PLANE SIEVE LENGTH

The paper presents the results of several experimental researches regarding to a separation mixture of dried and chopped nettle fragments on a dimensional separator of medicinal plants, equipped with oscillating flat sieves. Three parameters were varied (material flow rate, sieves angle of inclination and oscillations sieves frequency). For separation process description along chopped vegetal material sieves, the experimental results have been tested by Rosin-Rammler distribution law

Testing and development of transfer functions for weighing precipitation gauges in WMO-SPICE

Weighing precipitation gauges are used widely for the measurement of all forms of precipitation, and are typically more accurate than tipping-bucket precipitation gauges. This is especially true for the measurement of solid precipitation; however, weighing precipitation gauge measurements must still be adjusted for undercatch in snowy, windy conditions. In WMO-SPICE (World Meteorological Organization Solid Precipitation InterComparison Experiment), different types of weighing precipitation gauges and shields were compared, and adjustments were determined for the undercatch of solid precipitation caused by wind. For the various combinations of gauges and shields, adjustments using both new and previously existing transfer functions were evaluated. For most of the gauge and shield combinations, previously derived transfer functions were found to perform as well as those more recently derived. This indicates that wind shield type (or lack thereof) is more important in determining the magnitude of wind-induced undercatch than the type of weighing precipitation gauge. It also demonstrates the potential for widespread use of the previously developed transfer functions. Another overarching result was that, in general, the more effective shields, which were associated with smaller unadjusted errors, also produced more accurate measurements after adjustment. This indicates that although transfer functions can effectively reduce measurement biases, effective wind shielding is still required for the most accurate measurement of solid precipitation