Systematic review of hospital readmissions in stroke patients

Background Previous evidence on factors and causes of readmissions associated with high-impact users of stroke is scanty. The aim of the study was to investigate common causes and pattern of short- and long-term readmissions stroke patients by conducting a systematic review of studies using hospital administrative data. Common risk factors associated with the change of readmission rate were also examined. Methods The literature search was conducted from 15th February to 15th March 2016 using various databases, such as Medline, Embase, and Web of Science. Results There were total of 24 studies (n=2,126,617) included in the review. Only 4 studies assessed causes of readmissions in stroke patients with the follow-up duration from 30 days to 5 years. Common causes of readmissions in majority of the studies were recurrent stroke, infections and cardiac conditions. Common patient-related risk factors associated with increased readmission rate were age and history of coronary heart disease, heart failure, renal disease, respiratory disease, peripheral arterial disease and diabetes. Among stroke-related factors, length of stay of index stroke admission was associated with increased readmission rate, followed by bowel incontinence, feeding tube and urinary catheter. Conclusion Although risk factors and common causes of readmission were identified, but none of the previous studies investigated causes and their sequence of readmissions among high-impact stroke users

Transition Property for α\alpha-Power Free Languages with α≥2\alpha\geq 2 and k≥3k\geq 3 Letters

In 1985, Restivo and Salemi presented a list of five problems concerning power free languages. Problem $4$ states: Given $\alpha$-power-free words $u$ and $v$, decide whether there is a transition from $u$ to $v$. Problem $5$ states: Given $\alpha$-power-free words $u$ and $v$, find a transition word $w$, if it exists. Let $\Sigma_k$ denote an alphabet with $k$ letters. Let $L_{k,\alpha}$ denote the $\alpha$-power free language over the alphabet $\Sigma_k$, where $\alpha$ is a rational number or a rational "number with $+$". If $\alpha$ is a "number with $+$" then suppose $k\geq 3$ and $\alpha\geq 2$. If $\alpha$ is "only" a number then suppose $k=3$ and $\alpha>2$ or $k>3$ and $\alpha\geq 2$. We show that: If $u\in L_{k,\alpha}$ is a right extendable word in $L_{k,\alpha}$ and $v\in L_{k,\alpha}$ is a left extendable word in $L_{k,\alpha}$ then there is a (transition) word $w$ such that $uwv\in L_{k,\alpha}$. We also show a construction of the word $w$

Management of Recurrent Pilonidal Sinus through Ayurveda Care and Surgery - A Case Report

Introduction: Pilonidal disease refers to subcutaneous infection occurring in the upper half of the gluteal cleft having no communication in the anal canal. In Ayurveda it can be correlated to Shalyajanya Nadivrana which is described in detail by Acharya Sushrutha. It presents as an acute abscess or chronic wound associated with pus discharge and severe discomfort. In this case report we present 20 years old female patient who reported to the OPD of Shalya SDMCAH with the complains of pain associated with pus discharge at the natal cleft region since two weeks with a history of Z plasty surgery. Methods: The case was managed by surgical excision followed by Kshara Karma, Triphala Prakshalana and dressing with Jatyadi Taila. Internally the patient was administered with Triphala Guggulu and Gandhaka Rasayana. Discussion: Apamarga Kshara helps in removal of unhealthy granulation tissue and cellular debris by sclerosing properties thereby lowering the recurrence rate. Triphala Prakshalana and wound dressing by Jathyadhi Taila fastens the healing process by microcidal effect. Results: The initial complains of pain associated with pus discharge subsided within seven days, while complete healing of the tract was observed within two months. Conclusion:  The surgical approach in contemporary science includes excision with reconstructive flaps (z-plasty). However, the recurrence rate is more and there are increased chances of developing wound infection. Hence in this case excision of sinus followed by apamarga kshara pratisarana was incorporated which showed promising results along with complete healing of the tract

Heat and fluid flow in a scraped-surface heat exchanger containing a fluid with temperature-dependent viscosity

Scraped-surface heat exchangers (SSHEs) are extensively used in a wide variety of industrial settings where the continuous processing of fluids and fluid-like materials is involved. The steady non-isothermal flow of a Newtonian fluid with temperature-dependent viscosity in a narrow-gap SSHE when a constant temperature difference is imposed across the gap between the rotor and the stator is investigated. The mathematical model is formulated and the exact analytical solutions for the heat and fluid flow of a fluid with a general dependence of viscosity on temperature for a general blade shape are obtained. These solutions are then presented for the specific case of an exponential dependence of viscosity on temperature. Asymptotic methods are employed to investigate the behaviour of the solutions in several special limiting geometries and in the limits of weak and strong thermoviscosity. In particular, in the limit of strong thermoviscosity (i.e., strong heating or cooling and/or strong dependence of viscosity on temperature) the transverse and axial velocities become uniform in the bulk of the flow with boundary layers forming either just below the blade and just below the stationary upper wall or just above the blade and just above the moving lower wall. Results are presented for the most realistic case of a linear blade which illustrate the effect of varying the thermoviscosity of the fluid and the geometry of the SSHE on the flow

Spatially Resolved Magnetic Field Structure in the Disk of a T Tauri Star

Magnetic fields in accretion disks play a dominant role during the star formation process but have hitherto been observationally poorly constrained. Field strengths have been inferred on T Tauri stars themselves and possibly in the innermost part of the accretion disk, but the strength and morphology of the field in the bulk of the disk have not been observed. Unresolved measurements of polarized emission (arising from elongated dust grains aligned perpendicular to the field) imply average fields aligned with the disks. Theoretically, the fields are expected to be largely toroidal, poloidal, or a mixture of the two, which imply different mechanisms for transporting angular momentum in the disks of actively accreting young stars such as HL Tau. Here we report resolved measurements of the polarized 1.25 mm continuum emission from HL Tau's disk. The magnetic field on a scale of 80 AU is coincident with the major axis (~210 AU diameter) of the disk. From this we conclude that the magnetic field inside the disk at this scale cannot be dominated by a vertical component, though a purely toroidal field does not fit the data well either. The unexpected morphology suggests that the magnetic field's role for the accretion of a T Tauri star is more complex than the current theoretical understanding.Comment: Accepted for publication in Natur

Interobserver agreement of radiologists assessing the response of rectal cancers to preoperative chemoradiation using the MRI tumour regression grading (mrTRG)

AIM: To investigate whether the magnetic resonance imaging (MRI) tumour regression grading (mrTRG) scale can be taught effectively resulting in a clinically reasonable interobserver agreement (>0.4; moderate to near perfect agreement). MATERIALS AND METHODS: This study examines the interobserver agreement of mrTRG, between 35 radiologists and a central reviewer. Two workshops were organised for radiologists to assess regression of rectal cancers on MRI staging scans. A range of mrTRGs on 12 patient scans were used for assessment. RESULTS: Kappa agreement ranged from 0.14–0.82 with a median value of 0.57 (95% CI: 0.37–0.77) indicating good overall agreement. Eight (26%) radiologists had very good/near perfect agreement (κ>0.8). Six (19%) radiologists had good agreement (0.8≥κ>0.6) and a further 12 (39%) had moderate agreement (0.6≥κ>0.4). Five (16%) radiologists had a fair agreement (0.4≥κ>0.2) and two had poor agreement (0.2>κ). There was a tendency towards good agreement (skewness: 0.92). In 65.9% and 90% of cases the radiologists were able to correctly highlight good and poor responders, respectively. CONCLUSIONS: The assessment of the response of rectal cancers to chemoradiation therapy may be performed effectively using mrTRG. Radiologists can be taught the mrTRG scale. Even with minimal training, good agreement with the central reviewer along with effective differentiation between good and intermediate/poor responders can be achieved. Focus should be on facilitating the identification of good responders. It is predicted that with more intensive interactive case-based learning a κ>0.8 is likely to be achieved. Testing and retesting is recommended

Impact of exciton delocalization on exciton-vibration interactions in organic semiconductors

Organic semiconductors exhibit properties of individual molecules and extended crystals simultaneously. The strongly bound excitons they host are typically described in the molecular limit, but excitons can delocalize over many molecules, raising the question of how important the extended crystalline nature is. Using accurate Green's function based methods for the electronic structure and non-perturbative finite difference methods for exciton-vibration coupling, we describe exciton interactions with molecular and crystal degrees of freedom concurrently. We find that the degree of exciton delocalization controls these interactions, with thermally activated crystal phonons predominantly coupling to delocalized states, and molecular quantum fluctuations predominantly coupling to localized states. Based on this picture, we quantitatively predict and interpret the temperature and pressure dependence of excitonic peaks in the acene series of organic semiconductors, which we confirm experimentally, and we develop a simple experimental protocol for probing exciton delocalization. Overall, we provide a unified picture of exciton delocalization and vibrational effects in organic semiconductors, reconciling the complementary views of finite molecular clusters and periodic molecular solids

Navigating Copper-Atom-Pair Structural Effect inside a Porous Organic Polymer Cavity for Selective Hydrogenation of Biomass-Derived 5-Hydroxymethylfurfural

In recent times, selective hydrogenation of biomass-derived 5-hydroxymethylfurfural (5-HMF) to produce the novel difuranic polyol scaffold 2,5-dihydroxymethylfuran (DHMF) has attracted the interest of the many researchers due to its peculiar symmetrical structure and its widespread application as a monomer for the preparation of cross-linked polyesters and polyurethane. Copper-based catalysts have been explored for selective catalytic hydrogenation; however, hurdles are still associated with the strongly reducing H2 atmosphere and oxidizing C–O bond that make the Cu0 and Cux+ surface active species unstable, limiting the rational design of highly efficient integrated catalyst systems. To address this, herein, we built catalytic systems for 5-HMF hydrogenation with stable and balanced Cu0 and Cux+ active surface species inside the nanocage of a catechol-based porous organic polymer (POP) endowed with large surface areas, impressive stabilities, and spatial restriction inhibiting nanoparticle aggregation. Batch reactor screening identified that a superior catalytic performance (DHMF selectivity of 98%) has been achieved with our newly designed Cu@C-POP at 150 °C temperature and 20 bar H2 pressure, which was also higher than that of other reported copper catalysts. Comprehensive characterization understanding with H2-TPR and X-ray photoelectron spectroscopy (XPS) study revealed that substantially boosted activity is induced by the presence of the bulk CuOx phase and atomically dispersed Cu species incorporating isolated Cu ions, which are further confirmed through the positive binding energy shift of Cu 2p3/2 XPS spectra (∼0.4 eV). The Cu environment in our catalytic systems comprises a predominantly square planar geometry (probably Jahn–Teller distorted OH), which we gleaned from the extended X-ray absorption for fine structure (EXAFS) analysis featuring two adjacent copper atoms with the valence state in between of 0 and +2, as validated by XANES absorption edge positions. EXAFS studies further revealed a lowering of the Cu coordination number for the most active Cu@C-POP-B catalyst, suggesting the presence of metal vacancies. Density functional theory calculations showed that the presence of Cu metal vacancies stabilized the reaction intermediates formed during 5-HMF hydrogenation and decreased the hydrogenation barriers, resulting in an enhanced catalytic activity of the Cu@C-POP-B catalyst

A Delayed Recrudescent Case of Sigmoidocutaneous Fistula due to Diverticulitis

Colocutaneous fistula caused by diverticulitis is relatively rare, and a delayed recrudescent case of colocutaneous fistula is very uncommon. We herein report a rare case of a Japanese 56-year-old male with delayed recrudescent sigmoidocutaneous fistula due to diverticulitis. A colocutaneous fistula was formed after a drainage operation against a perforation of the sigmoid colon diverticulum. After 5 years from treatment, he was admitted to our hospital because of lower abdominal pain. We diagnosed the recrudescent sigmoidocutaneous fistula by abdominal computed tomography and gastrografin enema, and managed the patient with total parenteral nutrition and antibiotics. As the fistula formation did not improve, a low anterior resection with fistulectomy was performed. The postoperative course was uneventful and the patient was discharged. It has been reported that, in fistulas of the skin caused by diverticular disease, complete closure of the fistula by conservative therapy may not be possible. This case also implies the possibility of a recurrence of the fistula even if the conservative treatment was effective. In cases of colocutaneous fistulas due to diverticulitis, radical surgery is considered necessary because of possibility of recurrence of the fistula

Tribological properties of room temperature fluorinated graphite heat-treated under fluorine atmosphere

This work is concerned with the study of the tribologic properties of room temperature fluorinated graphite heat-treated under fluorine atmosphere. The fluorinated compounds all present good intrinsic friction properties (friction coefficient in the range 0.05–0.09). The tribologic performances are optimized if the materials present remaining graphitic domains (influenced by the presence of intercalated fluorinated species) whereas the perfluorinated compounds, where the fluorocarbon layers are corrugated (armchair configuration of the saturated carbon rings) present higher friction coefficients. Raman analyses reveal that the friction process induces severe changes in the materials structure especially the partial re-building of graphitic domains in the case of perfluorinated compounds which explains the improvement of μ during the friction tests for these last materials