Does the addition of Clonidine to lumbar nerve root blocks improve outcome? A randomised, prospective, single-blinded controlled pilot study

Purpose To evaluate if adding clonidine to a standard nerve root block containing local anaesthetic and steroid improved the outcome of patients with severe lumbar nerve root pain secondary to MRI proven lumbar disc prolapse. Methods We undertook a single blind, prospective, randomised controlled trial evaluating 100 consecutive patients with nerve root pain secondary to lumbar disc prolapse undergoing trans-foraminal epidural steroid injection either with or without the addition of clonidine. 50 patients were allocated to each arm of the study. The primary outcome measure was the avoidance of a second procedure- repeat injection or micro-discectomy surgery. Secondary outcome measures were also studied: pain scores for leg and back pain using a visual analogue scale (VAS), the Roland Morris Disability Questionnaire (RMDQ) and the Measure Your Own Medical Outcome Profile (MYMOP). Follow up was carried out at 6 weeks, 6 months and 1 year. Results No serious complications occurred. Of the 50 patients who received the addition of clonidine, 56% were classified as successful injections, with no further intervention required, as opposed to 40% who received the standard injection. This difference did not reach statistical significance (p=0.109, chi-squared test). All secondary measures showed no statistically significant differences between the groups except curiously, the standard group who had been classified as successful had better leg pain relief than the clonidine group (p=0.026) at 1 year. Conclusions This pilot study has shown a 16% treatment effect with adding clonidine to lumbar nerve root blocks and that it is a safe injectate for this purpose.

Selectivity in the Interaction of Electron Donor and Acceptor Molecules with Graphene and Single-Walled Carbon Nanotubes

Interaction of electron donor and acceptor molecules with graphene samples prepared by different methods as well as with single-walled carbon nanotubes (SWNTs) has been investigated by isothermal titration calorimetry (ITC). The ITC interaction energies of the graphene samples and SWNTs with electron acceptor molecules are higher than those with electron donor molecules. Thus, tetracyanoethylene (TCNE) shows the highest interaction energy with both graphene and SWNTs. The interaction energy with acceptor molecules varies with the electron affinity as well as with the charge-transfer transition energy for different aromatics. Metallic SWNTs interact reversibly with electron acceptor molecules, resulting in the opening of a gap.

A note on the movement of single large liquid bubbles in vertical tubes

The flow of single large liquid bubbles under gravity in closed tubes is studied here for the case when the liquid bubble exhibits micropolar behaviour. The film thickness, velocity profile in the bubble and film, and nonNewtonian effects are studied and compared with those for the correspondingNewtonian fluid. The investigation is restricted to the case where the bubble length is far greater than the tube radius.

Can a single resource support many consumer species

The conclusion that the number of species co-existing within a biological community cannot exceed the number of limiting factors is not valid if we assume that (i) the relative efficiency of two competing species in utilizing a resource is not independent of the resource density, but one species may be more efficient at a lower density and less efficient at a higher density and (ii) there is a spatial or temporal heterogeneity in the density of the resource. This spatial or temporal heterogeneity does not have to be furnished by factors external to the biological community, but may be generated within the biological community itself as in the case of a vertical gradient of light in a plant community. This possibility of a stable co-existence of more than one species in a community limited by a single resource, even when the resource is being supplied uniformly in space and time, is formally demonstrated.

IWGDF guidance on the prevention of foot ulcers in at-risk patients with diabetes

Recommendations - 1 To identify a person with diabetes at risk for foot ulceration, examine the feet annually to seek evidence for signs or symptoms of peripheral neuropathy and peripheral artery disease. (GRADE strength of recommendation: strong; Quality of evidence: low) - 2 In a person with diabetes who has peripheral neuropathy, screen for a history of foot ulceration or lower-extremity amputation, peripheral artery disease, foot deformity, pre-ulcerative signs on the foot, poor foot hygiene and ill-fitting or inadequate footwear. (Strong; Low) - 3 Treat any pre-ulcerative sign on the foot of a patient with diabetes. This includes removing callus, protecting blisters and draining when necessary, treating ingrown or thickened toe nails, treating haemorrhage when necessary and prescribing antifungal treatment for fungal infections. (Strong; Low) - 4 To protect their feet, instruct an at-risk patient with diabetes not to walk barefoot, in socks only, or in thin-soled standard slippers, whether at home or when outside. (Strong; Low) - 5 Instruct an at-risk patient with diabetes to daily inspect their feet and the inside of their shoes, daily wash their feet (with careful drying particularly between the toes), avoid using chemical agents or plasters to remove callus or corns, use emollients to lubricate dry skin and cut toe nails straight across. (Weak; Low) - 6 Instruct an at-risk patient with diabetes to wear properly fitting footwear to prevent a first foot ulcer, either plantar or non-plantar, or a recurrent non-plantar foot ulcer. When a foot deformity or a pre-ulcerative sign is present, consider prescribing therapeutic shoes, custom-made insoles or toe orthosis. (Strong; Low) - 7 To prevent a recurrent plantar foot ulcer in an at-risk patient with diabetes, prescribe therapeutic footwear that has a demonstrated plantar pressure-relieving effect during walking (i.e. 30% relief compared with plantar pressure in standard of care therapeutic footwear) and encourage the patient to wear this footwear. (Strong; Moderate) - 8 To prevent a first foot ulcer in an at-risk patient with diabetes, provide education aimed at improving foot care knowledge and behaviour, as well as encouraging the patient to adhere to this foot care advice. (Weak; Low) - 9 To prevent a recurrent foot ulcer in an at-risk patient with diabetes, provide integrated foot care, which includes professional foot treatment, adequate footwear and education. This should be repeated or re-evaluated once every 1 to 3 months as necessary. (Strong; Low) - 10 Instruct a high-risk patient with diabetes to monitor foot skin temperature at home to prevent a first or recurrent plantar foot ulcer. This aims at identifying the early signs of inflammation, followed by action taken by the patient and care provider to resolve the cause of inflammation. (Weak; Moderate) - 11 Consider digital flexor tenotomy to prevent a toe ulcer when conservative treatment fails in a high-risk patient with diabetes, hammertoes and either a pre-ulcerative sign or an ulcer on the distal toe. (Weak; Low) - 12 Consider Achilles tendon lengthening, joint arthroplasty, single or pan metatarsal head resection, or osteotomy to prevent a recurrent foot ulcer when conservative treatment fails in a high-risk patient with diabetes and a plantar forefoot ulcer. (Weak; Low) - 13 Do not use a nerve decompression procedure in an effort to prevent a foot ulcer in an at-risk patient with diabetes, in preference to accepted standards of good quality care. (Weak; Low)

A single point mutation disrupts the capsid assembly in Sesbania Mosaic Virus resulting in a stable isolated dimer

Protein-protein interactions play a Crucial role in Virus assembly and stability. With the view of disrupting capsid assembly and capturing smaller oligomers, interfacial residue mutations were carried Out in the coat protein gene of Sesbania Mosaic Virus, a T=3 ss (+) RNA plant virus. A single point mutation of a Trp 170 present at the five-fold interface of the virus to a charged residue (Glu or Lys) arrested assembly of virus like particles and resulted in stable Soluble dimers of the capsid Protein. The X-ray crystal structure of one of the isolated dimer mutants - rCP Delta N65W170K was determined to a resolution of 2.65 angstrom. Detailed analysis of the dimeric mutant protein structure revealed that a number of Structural changes take place, especially in the loop and interfacial regions during the course of assembly. The isolated chiller was ``more relaxed'' than the dimer found in the T=3 or T=1 capsids. The isolated dimer does not bind Ca2+ ion and consequently four C-terminal residues are disordered. The FG loop, which interacts with RNA in the Virus, has different conformations in the isolated dimer and the intact Virus Suggesting its flexible nature and the conformational changes that accompany assembly. The isolated choler mutant was much less stable when compared to the assembled capsids, suggesting the importance of inter-subunit interactions and Ca2+ mediated interactions in the stability of the capsids. With this study, SeMV becomes the first icosahedral virus for which X-ray crystal Structures of T=3, T=1 capsids as well as a smaller oligomer of the capsid protein have been determined.

Optimum design of Lanchester damper for a viscously damped single degree of freedom system by using minimum force transmissibility criterion

The problem of optimum design of a Lanchester damper for minimum force transmission from a viscously damped single degree of freedom system subjected to harmonic excitation is investigated. Explicit expressions are developed for determining the optimum absorber parameters. It is shown that for the particular case of the undamped single degree of freedom system the results reduce to the classical ones obtained by using the concept of a fixed point on the transmissibility curves.

Cluster randomised-control trial for an Australian child protection education program: Study protocol for the Learn to be safe with Emmy and friends™

Background Child maltreatment has severe short-and long-term consequences for children’s health, development, and wellbeing. Despite the provision of child protection education programs in many countries, few have been rigorously evaluated to determine their effectiveness. We describe the design of a multi-site gold standard evaluation of an Australian school-based child protection education program. The intervention has been developed by a not-for-profit agency and comprises 5 1-h sessions delivered to first grade students (aged 5–6 years) in their regular classrooms. It incorporates common attributes of effective programs identified in the literature, and aligns with the Australian education curriculum. Methods/Design A three-site cluster randomised controlled trial (RCT) of Learn to be safe with Emmy and friends™ will be conducted with children in approximately 72 first grade classrooms in 24 Queensland primary (elementary) schools from three state regions, over a period of 2 years. Entire schools will be randomised, using a computer generated list of random numbers, to intervention and wait-list control conditions, to prevent contamination effects across students and classes. Data will be collected at baseline (pre-assessment), immediately after the intervention (post-assessment), and at 6-, 12-, and 18-months (follow-up assessments). Outcome assessors will be blinded to group membership. Primary outcomes assessed are children’s knowledge of program concepts; intentions to use program knowledge, skills, and help-seeking strategies; actual use of program material in a simulated situation; and anxiety arising from program participation. Secondary outcomes include a parent discussion monitor, parent observations of their children’s use of program materials, satisfaction with the program, and parental stress. A process evaluation will be conducted concurrently to assess program performance. Discussion This RCT addresses shortcomings in previous studies and methodologically extends research in this area by randomising at school-level to prevent cross-learning between conditions; providing longer-term outcome assessment than any previous study; examining the degree to which parents/guardians discuss intervention content with children at home; assessing potential moderating/mediating effects of family and child demographic variables; testing an in-vivo measure to assess children’s ability to discriminate safe/unsafe situations and disclose to trusted adults; and testing enhancements to existing measures to establish greater internal consistency.

Field-Effect and Frequency Dependent Transport in Semiconductor-Enriched Single-Wall Carbon Nanotube Network Device

The electrical and optical response of a field-effect device comprising a network of semiconductor-enriched single-wall carbon nanotubes, gated with sodium chloride solution is investigated. Field-effect is demonstrated in a device that uses facile fabrication techniques along with a small-ion as the gate electrolyte-and this is accomplished as a result of the semiconductor enhancement of the tubes. The optical transparency and electrical resistance of the device are modulated with gate voltage. A time-response study of the modulation of optical transparency and electrical resistance upon application of gate voltage suggests the percolative charge transport in the network. Also the ac response in the network is investigated as a function of frequency and temperature down to 5 K. An empirical relation between onset frequency and temperature is determined.

Drift mobility of holes in single-crystal beta-AgI

The drift mobility of photoexcited holes in single-crystal beta-AgI has been measured between 260 and 312 °K. In this range the drift mobility µd increased with temperature due to trap-limited behavior. At 300 °K µd=12 cm2/V sec, the concentration and energy of the dominant traps being given by Nt=3×109 to 5×109/cm3 and Et=0.52 to 0.50 eV, respectively. Electron drift mobilities could not be determined due to low electron lifetimes. Journal of Applied Physics is copyrighted by The American Institute of Physics.

A robust initialization scheme for faster convergence of the dichotomous search algorithm for single frequency estimation

The estimation of the frequency of a sinusoidal signal is a well researched problem. In this work we propose an initialization scheme to the popular dichotomous search of the periodogram peak algorithm(DSPA) that is used to estimate the frequency of a sinusoid in white gaussian noise. Our initialization is computationally low cost and gives the same performance as the DSPA, while reducing the number of iterations needed for the fine search stage. We show that our algorithm remains stable as we reduce the number of iterations in the fine search stage. We also compare the performance of our modification to a previous modification of the DSPA and show that we enhance the performance of the algorithm with our initialization technique.

Large Low-Frequency Fluctuations in the Velocity of a Driven Vortex Lattice in a Single Crystal of 2H-NbSe2 Superconductor

The driven state of a well-ordered flux line lattice in a single crystal of 2H-NbSe2 in the time domain has revealed the presence of substantial fluctuations in velocity, with large and distinct time periods (similar to seconds). A superposition of a periodic drive in the driven vortex lattice causes distinct changes in these fluctuations. We propose that prior to the onset of the peak effect there exists a heretofore unexplored regime of coherent dynamics, with unexpected behavior in velocity fluctuations.

Influence of Solvents on the MWCNT/Adhesive Grade Epoxy Nanocomposites Preparation

In this article, the effect of two solvents, namely dimethyl formamide (DMF) and N-methyl pyrrolidone (NMP), on the dispersion effectiveness and the resulting electrical and mechanical properties of multi-walled carbonanotubes (MNCNT) filled structural adhesive grade epoxy nanocomposites was studied. The solvents were used mainly to reduce the viscosity of the resin system to effectively disperse the nanofiller. The dispersion was carried out under vacuum using high energy sonic waves. SEM was undertaken to study the dispersion effectiveness. Electrical resistivity, tensile properties, and glass transition of the nanocomposites were studied. Between DMF and NMP, the former proved better in terms of dispersion effectiveness and the resulting electrical and mechanical properties of the nanocomposites. Addition of MWCNT into AV138M resulted in an increase in glass transition temperature irrespective of the solvent used and in both cases percolation threshold was found with respect to reduction in electrical resistivity of the nanocomposites. Less agglomeration and hence better interaction between CNT and epoxy was observed in the samples prepared using DMF compared with that using NMP.

Computing magnetic anisotropy constants of single molecule magnets

We present here a theoretical approach to compute the molecular magnetic anisotropy parameters, D (M) and E (M) for single molecule magnets in any given spin eigenstate of exchange spin Hamiltonian. We first describe a hybrid constant M (S) valence bond (VB) technique of solving spin Hamiltonians employing full spatial and spin symmetry adaptation and we illustrate this technique by solving the exchange Hamiltonian of the Cu6Fe8 system. Treating the anisotropy Hamiltonian as perturbation, we compute the D (M)and E(M) values for various eigenstates of the exchange Hamiltonian. Since, the dipolar contribution to the magnetic anisotropy is negligibly small, we calculate the molecular anisotropy from the single-ion anisotropies of the metal centers. We have studied the variation of D (M) and E(M) by rotating the single-ion anisotropies in the case of Mn12Ac and Fe-8 SMMs in ground and few low-lying excited states of the exchange Hamiltonian. In both the systems, we find that the molecular anisotropy changes drastically when the single-ion anisotropies are rotated. While in Mn12Ac SMM D (M) values depend strongly on the spin of the eigenstate, it is almost independent of the spin of the eigenstate in Fe-8 SMM. We also find that the D (M)value is almost insensitive to the orientation of the anisotropy of the core Mn(IV) ions. The dependence of D (M) on the energy gap between the ground and the excited states in both the systems has also been studied by using different sets of exchange constants.