Sex assignment in conditions affecting sex development

The newborn infant with atypical genitalia presents a challenging clinical scenario and requires expert input. There have been appreciable advances in our knowledge of the underlying causes that may lead to a mere difference or a more serious disorder of sex development (DSD), the natural history of conditions, as well as the short and long-term complications of these conditions themselves, together with the clinical interventions that are associated with these conditions. With this information, the DSD expert can be more confident when discussing options with the parents of the newborn infant. By working within a multidisciplinary team, the expert should be able to support the family whilst individualising the management plan so that it is also cognizant of the shifts in societal attitudes and expectations around concepts of diversity and openness. It is, therefore, likely that the practice of assigning sex, especially in those cases where sex assignment is unclear on expert assessment, will continue to show temporal, social and geographical variations. It is imperative that clinical data for rare conditions such as these are collected in a standardized format and shared through a common registry so that any evidence that is used for future shifts in practice has a stronger foundation than that which is currently available

Comparison of effectiveness and safety of ketamine with midazolam against higher dose of ketamine as procedural sedation for lumbar puncture in paediatric leukaemic patients

INTRODUCTION: Children with leukaemia undergo several invasive procedures. Sedation is used to make these procedures more comforting to the patient as it is necessary for successful outcome. However sedatives can have devastating effects. In our centre as well as others, combination of ketamine with midazolam has been used for years without specific protocol. OBJECTIVE: To compare the effectiveness and safety of combination ketamine and midazolam against higher dose of ketamine as procedural sedation for lumbar puncture in paediatric leukemic patients. METHOD: A total of 29 paediatric leukaemia patients underwent 58 lumbar punctures in a double blinded crossover clinical trial. The 2 regimes compared were KM regime who received combined intravenous midazolam 0.1mg per kg with ketamine 1mg per kg against K2 regime who received higher dose of intravenous ketamine i.e. 2mg per kg. The main outcomes measured were time to achieve the desired sedation (Ramsay level of sedation at 6), time to complete lumbar puncture, time to regain consciousness (Aldrete recovery score of at least 8) and adverse effects. RESULTS: Twenty seven patients (93%) were successfully sedated with each of the regimens. Mean time taken for sedation and mean time to be fully conscious after sedation were significantly less (p value <0.05) in K2 regime. Mean time taken for sedation in K2 regime was 7.56 minutes (SD 4.4) and in KM regime it was 8.74 minutes (SD 3.6). Mean time to be fully conscious was 132 minutes (SD 93.5) for K2 regime while it took 173 minutes (SD 88.8) for patients in KM regime. There is no statistically significant difference in mean time taken to complete LP between the 2 regimes (P=0.06). Two patients in K2 regime developed tachycardia and one patient had pain after procedure while no patient in KM regimen had either of these. Five patients from either of the groups had desaturation. This was not statistically significant (McNemer Test 0.250) but it could be clinically relevant. Eight patients (30%) in KM regime required top-up doses of ketamine and 7 patients (26%) required top-up doses of ketamine in K2 regime. CONCLUSION: Ketamine as a sole agent is as effective and safe as combination of midazolam and ketamine. It should be considered in procedural sedation for lumbar puncture in paediatric leukemic patients. It has faster induction and reversibility but it cause more adverse reactions and do not reduce time taken for lumbar puncture. An initial dose of 2mg per kg is safe to be used with another top up dose of 0.5mg per kg. Top up doses are frequently required

Development of an Integrated Incident and Transit Priority Management Control System

The aim of this thesis is to develop a distributed adaptive control system which can work standalone for a single intersection to handle various boundary conditions of recurrent, non-recurrent congestion, transit signal priority and downstream blockage to improve the overall network in terms of productivity and efficiency. The control system uses link detectors’ data to determine the boundary conditions of all incoming and exit links. Four processes or modules are deployed. The traffic regime state module estimates the congestion status of the link. The incident status module determines the likelihood of an incident on the link. The transit priority module estimates if the link is flagged for transit priority based on the transit vehicle location and type. Finally, the downstream blockage module scans all downstream links and determines their recurrent blockage conditions. Three different urban incident detection models (General Regression Model, Neuro-Fuzzy Model and Binary Logit Model) were developed in order to be adopted for the incident status module. Among these, the Binary Logit Model was selected and integrated with the signal control logic. The developed Binary Logit Model is relatively stable and performs effectively under various traffic conditions, as compared to other algorithms reported in the literature. The developed signal control logic has been interfaced with CORSIM micro-simulation for rigorous evaluations with different types of signal phase settings. The proposed system operates in a manner similar to a typical pre-timed signal (with split or protected phase settings) or a fully actuated signal (with splitphase arrangement, protected phase, or dual ring phase settings). The control decisions of this developed control logic produced significant enhancement to productivity (in terms of Person Trips and Vehicle Trips) compared with the existing signal control systems in medium to heavily congested traffic demand conditions for different types of networks. Also, more efficient outcomes (in terms of Average Trip Time/Person and delay in seconds/vehicle) is achieved for relatively low to heavy traffic demand conditions with this control logic (using Split Pre-timed). The newly developed signal control logic yields greater productivity than the existing signal control systems in a typical congested urban network or closely spaced intersections, where traffic demand could be similarly high on both sides at peak periods. It is promising to see how well this signal control logic performs in a network with a high number of junctions. Such performance was rarely reported in the existing literature. The best performing phase settings of the newly developed signal control were thoroughly investigated. The signal control logic has also been extended with the logic of pre-timed styled signal phase settings for the possibility of enhancing productivity in heavily congested scenarios under a closely spaced urban network. The performance of the developed pre-timed signal control signal is quite impressive. The activation of the incident status module under the signal control logic yields an acceptable performance in most of the experimental cases, yet the control logic itself works better without the incident status module with the Split Pre-timed and Dual Actuated phase settings. The Protected Pre-timed phase setting exhibits benefits by activating the incident status module in some medium congested demand

Assessing osteoporosis in the young adult

Osteoporosis in the young adult is a relatively rare phenomenon, and its diagnosis needs careful assessment of the affected person. The emphasis in the assessment of bone health is gradually shifting from a simple quantitative assessment of bone mineral density to one that includes bone quality. This may be particularly important in the young adult, where the aetiological cause of osteoporosis may be a primary genetic condition or secondary to another chronic condition

Assessing Environmental Externalities of the US Coal Base Load Electric Utility Industry Using Data Enveloping Analysis

This paper attempts to address two issues. First, is how to objectively measure carbon dioxide emissions from the generation of electricity that uses predominantly coal. Second, is how to incorporate these ‘environmental’ variables into an efficiency model. Using a technique called Data Enveloping Analysis (DEA) a non-parametric piecewise surface (or frontier) over the data is constructed, so as to be able to calculate technical efficiencies (which I call environmental efficiency) relative to this surface. These ‘environmental efficiency’ measures are analyzed. The technique utilized in this study may be extended to calculate each agent’s allocative and scale efficiencies in order to calculate a shadow price for carbon dioxide emissions and to formulate a preliminary permits scheme for carbon dioxide emissions generated by electric utilities

EFFECTS OF GRINDING CYCLES AND TEMPERATURE ON THE PHYSICAL AND ENGINEERING PROPERTIES OF MIRHA IN CONCRETE

Rice is one of the primary sources of foods especially for human needs and it covers about 1% of the earth’s surface. Nowadays, about 600 million tons of rice paddies are produced in a year. The annual production of the main sources is approximately about 120 million of tones whereby it remains about 20% of husk

Reliable Detection of Bone Alterations: Developing a Reproducible CT Texture Analysis Pipeline

Develop a robust and reproducible pipeline for texture analysis of CT scans to detect microarchitectural changes in bone structure near orthopaedic implant

On The Development Of Novel Multifunctional Max Reinforced Metals (MRMS) Matrix Composites

This work illustrates the synthesis and characterization of novel MAX reinforced metals (MRMs) composites. These composites were tested for their mechanical and tribological performance in ambient temperature. Synthesis and characterization of Bi-Ti3SiC2 and Ag-Ti3SiC2 was studied in Chapter 2. Both composites showed an enhancement in their mechanical and tribological behavior. For example, the addition of 20% Ti3SiC2 decreased the wear rate (WR) by ~12 times in Ag and ~33 times in Bi comparing with the pristine metal. In Chapter 3, Bi-Cr2AlC composites were studied and results had been compared to Bi-Ti3SiC2 composites. The addition of 10 vol% Cr2AlC was able to decrease the WR of Bi-composites by ~100 times as compared to the Bi metal. Chapter 4 reports the current progress of synthesis and tribological behavior of Al-V2AlC, Al-Ti3SiC2 and Al-Cr2AlC composites. The addition of MAX phase particulates enhanced the hardness and compressive yield strength of all the compositions. Al-V2AlC, Al-Ti3SiC2 and Al-Cr2AlC exhibit better tribological behavior compared with pure Al. The WR decreased significantly from 0.25 mm3/N.m to 1.1 X 10-3 mm3/N.m in Al-30%V2AlC. Similarly, the addition of Ti3SiC2 decreased the WR to 7.3 X 10-4 mm3/N.m in the Al-10%Ti3SiC2. In Chapter 5, comprehensive conclusion of this thesis and the future scope of study is discussed. Briefly, the addition of MAX phases has beneficial effects on the mechanical and the tribological behavior. However, there is an optimum concentration where the best results are found. That is mainly due to the nature of these phases where they perform much better at higher temperatures rather than room temperature