A comparative study on effects of intrathecal ropivacaine plus dexmedetomidine versus ropivacaine plus clonidine

Background: Subarachnoid block is a safe and effective alternative to general anaesthesia when surgical site is located on the lower extremities, perineum or lower body wall. Spinal anaesthesia produces intense sensory and motor blockade as well as sympathetic blockade. Intrathecal α-2-agonists are used as adjuvant drugs to local anaesthetics successfully over the last decade .They potentiate the effect of local anaesthetic and decrease the required doses. Clonidine is a partial α-2-adrenorecptor agonist used intrathecally, with a well- established record of efficacy and safety. Its addition to local anaesthetics prolongs the duration of both motor and sensory spinal blockade. Dexmedetomidine is an α-2-adrenorecptor agonist. It has α-2/α1 selectivity ratio which is eight times higher than that of Clonidine. With this background, this study was conducted to compare the effects of intrathecal Ropivacaine plus Dexmedetomidine versus Ropivacaine plus Clonidine during procedures. Methods: The present prospective study was carried out in the Department of Anaesthesiology, M.G.M. Medical College and M.Y. Hospital, Indore (M.P.), India. Study period was from June 2011 to July 2012. Patient were randomly allocated to one of the following three group in a double blinded fashion based on computer generated code: Ropivacaine (R), Ropivacaine + Dexmedetomidine (D); Ropivacaine + Clonidine (C). Nominal categorical data between study groups were compared using the Chi – squared test or Fisher’s exact test as appropriate. p<0.05 was considered to be significant. Results: In all age groups patients were equally distributed in three Groups. Mean time taken for the onset of sensory and motor block was quite low in group D patients. Thereby showing statistically highly significant difference in onset of sensory and motor blocks (P<0.001). Whereas mean duration of sensory and motor block was also quite prolonged in group D patients. (p<0.001) There is significant difference between all the three groups. Conclusion: In conclusion our study shows that intrathecal Dexmedetomidine or Clonidine added with isobaric Ropivacaine produces rapid and prolonged sensory and motor block as compared to plain Ropivacaine.

A framework for cascading payment and content exchange within P2P systems

Advances in computing technology and the proliferation of broadband in the home have opened up the Internet to wider use. People like the idea of easy access to information at their fingertips, via their personal networked devices. This has been established by the increased popularity of Peer-to-Peer (P2P) file-sharing networks. P2P is a viable and cost effective model for content distribution. Content producers require modest resources by today's standards to act as distributors of their content and P2P technology can assist in further reducing this cost, thus enabling the development of new business models for content distribution to realise market and user needs. However, many other consequences and challenges are introduced; more notably, the issues of copyright violation, free-riding, the lack of participation incentives and the difficulties associated with the provision of payment services within a decentralised heterogeneous and ad hoc environment. Further issues directly relevant to content exchange also arise such as transaction atomicity, non-repudiation and data persistence. We have developed a framework to address these challenges. The novel Cascading Payment Content Exchange (CasPaCE) framework was designed and developed to incorporate the use of cascading payments to overcome the problem of copyright violation and prevent free-riding in P2P file-sharing networks. By incorporating the use of unique identification, copyright mobility and fair compensation for both producers and distributors in the content distribution value chain, the cascading payments model empowers content producers and enables the creation of new business models. The system allows users to manage their content distribution as well as purchasing activities by mobilising payments and automatically gathering royalties on behalf of the producer. The methodology used to conduct this research involved the use of advances in service-oriented architecture development as well as the use of object-oriented analysis and design techniques. These assisted in the development of an open and flexible framework which facilitates equitable digital content exchange without detracting from the advantages of the P2P domain. A prototype of the CasPaCE framework (developed in Java) demonstrates how peer devices can be connected to form a content exchange environment where both producers and distributors benefit from participating in the system. This prototype was successfully evaluated within the bounds of an E-learning Content Exchange (EIConE) case study, which allows students within a large UK university to exchange digital content for compensation enabling the better use of redundant resources in the university

Is England's public health nutrition system in crisis? A qualitative analysis of the capacity to feed all in need during the COVID-19 pandemic

Methodology: An exploratory methodology was adopted to examine experiences relating to capability and capacity among formal and informal helpers within the PHN domain. An online survey, mainly open-ended questions, was used to capture experiences over the period 2010 - 2020. A mixed sampling strategy, including snowball and convenience sampling, via social media and social network contact-sharing approaches, was adopted. Data was analysed using an inductive thematic approach. Results: A total of 89 participants representing the PHN system in England were recruited over two months. Three main themes and eight sub-themes were identified. The first reflected unequivocal accounts of the impact of austerity and the inability of PHN services to meet demand for food security. The second articulated capacity and capability issues within the system, with geographical variations in service delivery, and a lack of connectivity between central, local government, and third sector providers. These were attributed to widening nutrition and health inequalities. Participants felt that the government needed to invest more technical and financial resources to support public health nutrition. They also felt that schools could play a larger role at local level, but there was a need for a clear national recovery plan, setting out a comprehensive and fully supported national strategy to eradicate food insecurity in England Conclusions: Further in-depth research is needed to continue to track the impact of recovery strategies on food insecure people and the capacity of the PHN system. Urgent investment in the capacity and coordination of PHN services is needed to support food insecure people in England. The UK could include the ratification of the right to food in national laws, in line with global commitments already agreed to by the UK State Party

A New Cosmological Model: Exploring the Evolution of the Universe and Unveiling Super-Accelerated Expansion

In this paper, we present a cosmological model designed to study the evolution of the universe based on a new parametrization of the deceleration parameter. The model considers a spatially flat, homogeneous, and isotropic Friedmann-Lema\^itre-Robertson-Walker (FLRW) universe filled with radiation, dark matter (DM), and dark energy (DE). We derive the Friedmann equations and the energy conservation equation for the universe, accounting for separate conservation equations for radiation, DM, and DE. Our proposed deceleration parameter is given by a formula involving constants $H_{0}$, $\Omega_{r0}$, $\Omega_{m0}$, $q_{2}$, $q_{1}$, $q_{0}$, $\alpha$ and $\beta$. which we subsequently fit to observational data. To assess the model's viability, we compare it with a diverse range of observational data, including cosmic chronometers, type Ia supernovae, baryon acoustic oscillations, and cosmic microwave background measurements. Employing the chi-square statistic and a Markov Chain Monte Carlo (MCMC) method, we estimate the best-fit values for the free parameters and investigate the constraints imposed by observational data on the model. Our results indicate that our cosmological model provides an excellent fit to the observed data and exhibits a remarkable agreement with the standard $\Lambda$CDM paradigm at higher redshifts. However, the most intriguing discovery lies in the model's prediction of a super-accelerated expansion in the distant future, in contrast to the de Sitter phase predicted by $\Lambda$CDM. This implies the presence of dark energy driving the universe's accelerated expansion. These findings suggest that our proposed cosmological model offers a compelling alternative to the $\Lambda$CDM paradigm, shedding new light on the nature of dark energy and the future fate of the cosmos.Comment: 10 figures, 2 table

Capacitated Vehicle Routing with Non-Uniform Speeds

The capacitated vehicle routing problem (CVRP) involves distributing (identical) items from a depot to a set of demand locations, using a single capacitated vehicle. We study a generalization of this problem to the setting of multiple vehicles having non-uniform speeds (that we call Heterogenous CVRP), and present a constant-factor approximation algorithm. The technical heart of our result lies in achieving a constant approximation to the following TSP variant (called Heterogenous TSP). Given a metric denoting distances between vertices, a depot r containing k vehicles with possibly different speeds, the goal is to find a tour for each vehicle (starting and ending at r), so that every vertex is covered in some tour and the maximum completion time is minimized. This problem is precisely Heterogenous CVRP when vehicles are uncapacitated. The presence of non-uniform speeds introduces difficulties for employing standard tour-splitting techniques. In order to get a better understanding of this technique in our context, we appeal to ideas from the 2-approximation for scheduling in parallel machine of Lenstra et al.. This motivates the introduction of a new approximate MST construction called Level-Prim, which is related to Light Approximate Shortest-path Trees. The last component of our algorithm involves partitioning the Level-Prim tree and matching the resulting parts to vehicles. This decomposition is more subtle than usual since now we need to enforce correlation between the size of the parts and their distances to the depot

In vitro faecal fermentation of Tritordeum breads and its effect on the human gut health

Spontaneous fermentation of Tritordeum flour enhances the nutritional potential of this hybrid cereal. However, the effect of consumption of Tritordeum sourdough bread (SDB) on gut health remains to be elucidated. This study investigated the effect of in vitro digestion and faecal fermentation of SDB compared to that of traditional baker's yeast (BYB) Tritordeum bread. After 24-h anaerobic faecal fermentation, both SDB and BYB (1% w/v) induced an increase in the relative abundances of Bifidobacterium, Megasphaera, Mitsuokella, and Phascolarctobacterium genera compared to baseline, while concentrations of acetate and butyrate were significantly higher at 24 h for SDB compared to those for BYB. Integrity of intestinal epithelium, as assessed through in vitro trans-epithelial electrical resistance (TEER) assay, was slightly increased after incubation with SDB fermentation supernatants, but not after incubation with BYB fermentation supernatants. The SDB stimulated in vitro mucosal immune response by inducing early secretion of inflammatory cytokines, IL-6 and TNF-α, followed by downregulation of the inflammatory trigger through induction of anti-inflammatory IL-10 expression. Overall, our findings suggest that Tritordeum sourdough can modulate gut microbiota fermentation activity and positively impact the gut health

Approximability of Capacitated Network Design

In the capacitated survivable network design problem (Cap- SNDP), we are given an undirected multi-graph where each edge has a capacity and a cost. The goal is to find a minimum cost subset of edges that satisfies a given set of pairwise minimum-cut requirements. Unlike its classical special case of SNDP when all capacities are unit, the approximability of Cap-SNDP is not well understood; even in very restricted settings no known algorithm achieves a o(m) approximation, where m is the number of edges in the graph. In this paper, we obtain several new results and insights into the approximability of Cap-SNDP. We give an O(log n) approximation for a special case of Cap-SNDP where the global minimum cut is required to be at least R, by rounding the natural cut-based LP relaxation strengthened with valid knapsackcover inequalities. We then show that as we move away from global connectivity, the single pair case (that is, when only one pair (s, t) has positive connectivity requirement) captures much of the difficulty of Cap-SNDP: even strengthened with KC inequalities, the LP has an Ω(n) integrality gap. Furthermore, in directed graphs, we show that single pair Cap-SNDP is 2log1−3 n-hard to approximate for any fixed constant δ \u3e 0. We also consider a variant of the Cap-SNDP in which multiple copies of an edge can be bought: we give an O(log k) approximation for this case, where k is the number of vertex pairs with non-zero connectivity requirement. This improves upon the previously known O(min{k, log Rmax})-approximation for this problem when the largest minimumcut requirement, namely Rmax, is large. On the other hand, we observe that the multiple copy version of Cap-SNDP is Ω(log log n)-hard to approximate even for the single-source version of the problem

Colored Non-Crossing Euclidean Steiner Forest

Given a set of $k$-colored points in the plane, we consider the problem of finding $k$ trees such that each tree connects all points of one color class, no two trees cross, and the total edge length of the trees is minimized. For $k=1$, this is the well-known Euclidean Steiner tree problem. For general $k$, a $k\rho$-approximation algorithm is known, where $\rho \le 1.21$ is the Steiner ratio. We present a PTAS for $k=2$, a $(5/3+\varepsilon)$-approximation algorithm for $k=3$, and two approximation algorithms for general~$k$, with ratios $O(\sqrt n \log k)$ and $k+\varepsilon$