Early versus Later Anticoagulation for Stroke with Atrial Fibrillation

BACKGROUND

The effect of early as compared with later initiation of direct oral anticoagulants (DOACs) in persons with atrial fibrillation who have had an acute ischemic stroke is unclear.

METHODS

We performed an investigator-initiated, open-label trial at 103 sites in 15 countries. Participants were randomly assigned in a 1:1 ratio to early anticoagulation (within 48 hours after a minor or moderate stroke or on day 6 or 7 after a major stroke) or later anticoagulation (day 3 or 4 after a minor stroke, day 6 or 7 after a moderate stroke, or day 12, 13, or 14 after a major stroke). Assessors were unaware of the trial-group assignments. The primary outcome was a composite of recurrent ischemic stroke, systemic embolism, major extracranial bleeding, symptomatic intracranial hemorrhage, or vascular death within 30 days after randomization. Secondary outcomes included the components of the composite primary outcome at 30 and 90 days.

RESULTS

Of 2013 participants (37% with minor stroke, 40% with moderate stroke, and 23% with major stroke), 1006 were assigned to early anticoagulation and 1007 to later anticoagulation. A primary-outcome event occurred in 29 participants (2.9%) in the early-treatment group and 41 participants (4.1%) in the later-treatment group (risk difference, -1.18 percentage points; 95% confidence interval [CI], -2.84 to 0.47) by 30 days. Recurrent ischemic stroke occurred in 14 participants (1.4%) in the early-treatment group and 25 participants (2.5%) in the later-treatment group (odds ratio, 0.57; 95% CI, 0.29 to 1.07) by 30 days and in 18 participants (1.9%) and 30 participants (3.1%), respectively, by 90 days (odds ratio, 0.60; 95% CI, 0.33 to 1.06). Symptomatic intracranial hemorrhage occurred in 2 participants (0.2%) in both groups by 30 days.

CONCLUSIONS

In this trial, the incidence of recurrent ischemic stroke, systemic embolism, major extracranial bleeding, symptomatic intracranial hemorrhage, or vascular death at 30 days was estimated to range from 2.8 percentage points lower to 0.5 percentage points higher (based on the 95% confidence interval) with early than with later use of DOACs. (Funded by the Swiss National Science Foundation and others; ELAN ClinicalTrials.gov number, NCT03148457.).

Impurity metallic conduction below the critical concentration of metal-insulator transition in Fe1-xCoxSi

Analysis on very detailed measurements of resistivity (ρ) and thermoelectric power (S) of magnetic impurity (Co) substituted iron silicide (FeSi) has been presented in this report. The impurity valence electrons of Co dominate the whole physical properties at low temperatures below 35 K, below the critical concentrationx_c(≈0.02). The negative thermopower and the positive slope in the resistivity at low temperatures are exciting and show that the system is not entirely insulator below the critical concentration of metal-insulator transition (x_c). So, due to the external impurity electrons, the system's magnetic ground state could change considerably compared to the parent compound FeSi. This report may help unveil the interesting low-temperature transport properties betweenx= 0 andx= 0.04 (Fe1-xCo_xSi). Two band model and variable range hopping model were employed to explain the low-temperature electrical and thermal transport properties.

The effects of apixaban on clot characteristics in atrial fibrillation: A novel pharmacodynamic biomarker

Atrial fibrillation (AF) is a major risk factor for stroke. We aim to characterize AF patients and the effects of apixaban therapy in terms of clot microstructure using gel point analysis, a novel biomarker. Seventy-eight patients were included in the study, 50 Stroke with AF (AF-S), and 28 AF without stroke (AF). Pre- and post-anticoagulation samples were collected: gel point (GP) analysis was performed to obtain (i) TGP (the time taken to reach the GP or the clot formation time) and (ii) d_{f ,} the fractal dimension of the clot, a quantification of clot fibrin microstructure at the GP. At baseline, the AF-S group had a d_f  = 1.70 (±0.05) and TGP = 306 (±73 s). The AF group had a df = 1.70 ± 0.05 and TGP = 346 ± 78 s, showing a significantly shortened TGP in the stroke group (p = .008). For both groups, apixaban significantly prolonged TGP, p = .005, but resulted in no change in df. Apixaban prolonged clotting time while having no significant impact on the blood's ability to form stable clots (no change in d_f ). This indicates that apixaban provides protection from the formation of thrombi by reducing clotting kinetics.

Covid-19 Opens up domestic market for Indian shrimp

COVID-19 pandemic presents both a challenge and an opportunity to the Indian shrimp sector. With revitalizing the institutional arrangements and redirecting the focus, the Indian shrimp industry can flourish just by adapting to the needs of the local demand, even when the export prospects are uncertain. This paper takes a historical perspective of Indian shrimp farming and exports and suggests a domestic alternative/supplementary market for Indian farmed shrimp, resulting from COVID-19.

1103 How to Report Noise in The Operating Theatre

Introduction

The reporting of operating theatre noise in the surgical literature dates back almost 50 years. The existing standards for noise and sound reporting in healthcare settings is heterogenous and there is a need for greater uniformity of reporting to support our growing understanding of the significance of communication and human factors on surgical performance.

Method

This presentation summarizes the existing Surgical and Acoustic Engineering industrial expertise to provide a narrative review of literature, grey reports and guidelines and then demonstrates appropriate reporting standards during Noise level recording in an operating theatre environment.

Results

We describe LAmax, LA90and LAeq expected levels. We compare our own theatre noise levels against these recommended standards for comparison. This presentation also suggests a suitable “ambient noise” (LAeq 65dB) level over which any communication devices or communication studies should benchmark when developing interventions to overcome noise in the operating theatre.

Conclusions

This paper proposes possible unified reporting standards and expected sound pressure levels against which future studies in this field could benchmark.

Effects of oral anticoagulation for atrial fibrillation after spontaneous intracranial haemorrhage in the UK: a randomised, open-label, assessor-masked, pilot-phase, non-inferiority trial

BACKGROUND

Oral anticoagulation reduces the rate of systemic embolism for patients with atrial fibrillation by two-thirds, but its benefits for patients with previous intracranial haemorrhage are uncertain. In the Start or STop Anticoagulants Randomised Trial (SoSTART), we aimed to establish whether starting is non-inferior to avoiding oral anticoagulation for survivors of intracranial haemorrhage who have atrial fibrillation.

METHODS

SoSTART was a prospective, randomised, open-label, assessor-masked, parallel-group, pilot phase trial done at 67 hospitals in the UK. We recruited adults (aged ≥18 years) who had survived at least 24 h after symptomatic spontaneous intracranial haemorrhage, had atrial fibrillation, and had a CHA2DS2-VASc score of at least 2. Web-based computerised randomisation incorporating a minimisation algorithm allocated participants (1:1) to start or avoid long-term (≥1 year) full treatment dose open-label oral anticoagulation. The participants assigned to start oral anticoagulation received either a direct oral anticoagulant or vitamin K antagonist, and the group assigned to avoid oral anticoagulation received standard clinical practice (antiplatelet agent or no antithrombotic agent). The primary outcome was recurrent symptomatic spontaneous intracranial haemorrhage, and was adjudicated by an individual masked to treatment allocation. All outcomes were ascertained for at least 1 year after randomisation and assessed in the intention-to-treat population of all randomly assigned participants, using Cox proportional hazards regression adjusted for minimisation covariates. We planned a sample size of 190 participants (one-sided p=0·025, power 90%, allowing for non-adherence) based on a non-inferiority margin of 12% (or adjusted hazard ratio [HR] of 3·2). This trial is registered with ClinicalTrials.gov (NCT03153150) and is complete.

FINDINGS

Between March 29, 2018, and Feb 27, 2020, consent was obtained at 61 sites for 218 participants, of whom 203 were randomly assigned at a median of 115 days (IQR 49-265) after intracranial haemorrhage onset. 101 were assigned to start and 102 to avoid oral anticoagulation. Participants were followed up for median of 1·2 years (IQR 0·97-1·95; completeness 97·2%). Starting oral anticoagulation was not non-inferior to avoiding oral anticoagulation: eight (8%) of 101 in the start group versus four (4%) of 102 in the avoid group had intracranial haemorrhage recurrences (adjusted HR 2·42 [95% CI 0·72-8·09]; p=0·152). Serious adverse events occurred in 17 (17%) participants in the start group and 15 (15%) in the avoid group. 22 (22%) patients in the start group and 11 (11%) patients in the avoid group died during the study.

INTERPRETATION

Whether starting oral anticoagulation was non-inferior to avoiding it for people with atrial fibrillation after intracranial haemorrhage was inconclusive, although rates of recurrent intracranial haemorrhage were lower than expected. In view of weak evidence from analyses of three composite secondary outcomes, the possibility that oral anticoagulation might be superior for preventing symptomatic major vascular events should be investigated in adequately powered randomised trials.

FUNDING

British Heart Foundation, Medical Research Council, Chest Heart & Stroke Scotland.

Unconventional impurity band conduction and carrier dynamics in Ni substituted FeSi

Analysis of the resistivity, thermoelectric power, and heat capacity of Fe1-xNixSi is presented in this report. In-spite of Ni having two extra valence electrons as compared to Fe, the physical properties are observed to be dominated by holes. In this report, we have explained this unusual hole dominant scenario by a modified two narrow-band model. According to this model, the impurity electrons which are nearer to conduction band get shifted towards lower energy level thereby leaving holes around the Fermi level, and hence a hole dominated scenario at low temperatures. Due to this hole like density of states around the Fermi level, the nickel substitution could only produce a weak ferromagnetic behavior. Such a picture may assist in understanding the thermopower of similar systems i.e. Ni substituted on Fe site, such as Fe2-xNixVAl. We have also found that the activation energy derived from resistivity and thermoelectric power decreases with increasing Ni concentration.

NWChem: Past, present, and future

Specialized computational chemistry packages have permanently reshaped the landscape of chemical and materials science by providing tools to support and guide experimental efforts and for the prediction of atomistic and electronic properties. In this regard, electronic structure packages have played a special role by using first-principle-driven methodologies to model complex chemical and materials processes. Over the past few decades, the rapid development of computing technologies and the tremendous increase in computational power have offered a unique chance to study complex transformations using sophisticated and predictive many-body techniques that describe correlated behavior of electrons in molecular and condensed phase systems at different levels of theory. In enabling these simulations, novel parallel algorithms have been able to take advantage of computational resources to address the polynomial scaling of electronic structure methods. In this paper, we briefly review the NWChem computational chemistry suite, including its history, design principles, parallel tools, current capabilities, outreach, and outlook.

Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial

BACKGROUND

Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects.

METHODS

FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762.

FINDINGS

Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839-1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26-6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38-2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months.

INTERPRETATION

Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function.

FUNDING

UK Stroke Association and NIHR Health Technology Assessment Programme.

Echocardiographic and electrocardiographic presentations of patients with endomyocardial biopsy-proven cardiac amyloidosis

OBJECTIVE

Cardiac amyloidosis is under diagnosed and its prevalence is unknown. This is a retrospective, nonrandomised, single centre study of patients with endomyocardial biopsy-proven cardiac amyloidosis focusing on their echocardiographic and electrocardiogram (ECG) presentations. This is the first case series in Malaysia on this subject.

METHODS

We identified all of our endomyocardial biopsyproven cardiac amyloidosis patients from January 2010 to January 2018 and reviewed their medical records. All patients echocardiographic and ECG findings reviewed and analysed comparing to basic mean population value.

RESULTS

In total there are 13 biopsy-proven cardiac amyloidosis patients. All of the biopsies shows light chain (AL) amyloid. Majority of the patients (8, 61.5%) is male, and most of our patients (8, 61.5%) is Chinese. All seven patients on whom we performed deformation imaging have apical sparing pattern on longitudinal strain echocardiogram. Mean ejection fraction is 49.3%, (SD=7.9). All patients have concentric left ventricular hypertrophy and right ventricular hypertrophy. Diastolic dysfunction was present in all of our patients with nine out of 13 patients (69.2%) having restrictive filling patterns (E/A ≥2.0 E/e' ≥15). On electrocardiogram, 12 (92%) patients have prolonged PR interval (median 200ms, IQR 76.50ms) and 9 (69.2%) patients have pseudoinfarct pattern.

CONCLUSION

Echocardiography plays an important role in diagnosing cardiac amyloidosis. The findings of concentric left ventricular hypertrophy with preserved ejection fraction without increased in loading condition should alert the clinician towards its possibility. This is further supported by right ventricular hypertrophy and particularly longitudinal strain imaging showing apical sparing pattern.

Challenges in reducing TIA clinic waiting times from 9 to 3 days in an acute Welsh hospital

A patient impact project which successfully reduced the transient ischaemic attack (TIA) clinic waiting time from 9 to 3 days in an acute Welsh hospital, revealing the challenges faced and how alternative thinking and team work improved care given to our service users. Evaluating current situation, careful planning with multiple brainstorming meetings, 4 N chart and driver diagram with change ideas laid the foundation for this service improvement. Run charts, statistical process control and Pareto charts helped to identify the issues that are hindering the progress, which when rectified, reduced the clinic waiting times. Avoiding clinic cancellations by cross covering TIA clinics with mutual agreement among consultants and redeployment of ward staff to support clinics resulted in a positive impact to the patients. The average waiting time to see a patient in TIA clinic dropped from 9 days to just 3 days as a result of this, reflecting the hard-working and proactive nature of a team following a collaborative leadership journey. The service improvement initiative for ‘avoiding clinic cancellations’ was implemented in January 2017 and has reduced our waiting times by three times. Repeat analysis by six monthly Plan Do Study Act cycles revealed that this improvement is sustained.

A simple model for electrical charge in globular macromolecules and linear polyelectrolytes in solution

We present a model for calculating the net and effective electrical charge of globular macromolecules and linear polyelectrolytes such as proteins and DNA, given the concentration of monovalent salt and pH in solution. The calculation is based on a numerical solution of the non-linear Poisson-Boltzmann equation using a finite element discretized continuum approach. The model simultaneously addresses the phenomena of charge regulation and renormalization, both of which underpin the electrostatics of biomolecules in solution. We show that while charge regulation addresses the true electrical charge of a molecule arising from the acid-base equilibria of its ionizable groups, charge renormalization finds relevance in the context of a molecule’s interaction with another charged entity. Writing this electrostatic interaction free energy in terms of a local electrical potential, we obtain an “interaction charge” for the molecule which we demonstrate agrees closely with the “effective charge” discussed in charge renormalization and counterion-condensation theories. The predictions of this model agree well with direct high-precision measurements of effective electrical charge of polyelectrolytes such as nucleic acids and disordered proteins in solution, without tunable parameters. Including the effective interior dielectric constant for compactly folded molecules as a tunable parameter, the model captures measurements of effective charge as well as published trends of pKa shifts in globular proteins. Our results suggest a straightforward general framework to model electrostatics in biomolecules in solution. In offering a platform that directly links theory and experiment, these calculations could foster a systematic understanding of the interrelationship between molecular 3D structure and conformation, electrical charge and electrostatic interactions in solution. The model could find particular relevance in situations where molecular crystal structures are not available or rapid, reliable predictions are desired.

Measured electrical charge of SiO2 in polar and nonpolar media

We present measurements of the net electrical surface charge of silicon dioxide (SiO₂) in contact with solvents of dielectric constants between 5 and 80. Our experimental approach relies on observing the thermal motion of single silica particles confined in an electrostatic fluidic trap created by SiO₂ surfaces. We compare the experimentally measured functional form of the trapping potential with that from free energy calculations and thereby determine the net surface charge in the system. Our findings clearly demonstrate that contrary to popular perception, even in the absence of surfactants, the net electrical charge of ionizable surfaces in contact with apolar solvents can be large enough to lead to significant repulsive forces. A charge regulation model for SiO₂ surfaces with a single tunable parameter explains our measurements. This model may find general applicability in estimating the net charge of ionizable surfaces, given system parameters such as the dissociation or association constants of the ionizable groups and the pH, ionic strength, and dielectric constant of the solvent phase.

Production of Enzymes From Agricultural Wastes and Their Potential Industrial Applications

Enzymatic hydrolysis is the significant technique for the conversion of agricultural wastes into valuable products. Agroindustrial wastes such as rice bran, wheat bran, wheat straw, sugarcane bagasse, and corncob are cheapest and plentifully available natural carbon sources for the production of industrially important enzymes. Innumerable enzymes that have numerous applications in industrial processes for food, drug, textile, and dye use have been produced from different types of microorganisms from agricultural wastes. Utilization of agricultural wastes offers great potential for reducing the production cost and increasing the use of enzymes for industrial purposes. This chapter focuses on economic production of actinobacterial enzymes from agricultural wastes to make a better alternative for utilization of biomass generated in million tons as waste annually.

Marine Microbial Amylases: Properties and Applications

Amylases are crucial enzymes which hydrolyze internal glycosidic linkages in starch and produce as primary products dextrins and oligosaccharides. Amylases are classified into α-amylase, β-amylase, and glucoamylase based on their three-dimensional structures, reaction mechanisms, and amino acid sequences. Amylases have innumerable applications in clinical, medical, and analytical chemistries as well as in food, detergent, textile, brewing, and distilling industries. Amylases can be produced from plants, animals, and microbial sources. Due to the advantages in microbial production, it meets commercial needs. The pervasive nature, easy production, and wide range of applications make amylase an industrially pivotal enzyme. This chapter will focus on amylases found in marine microorganisms, their potential industrial applications, and how these enzymes can be improved to the required bioprocessing conditions.

Extremozymes from Marine Actinobacteria

Marine microorganisms that have the possibility to survive in diverse conditions such as extreme temperature, pH, pressure, and salinity are known as extremophiles. They produce biocatalysts so named as extremozymes that are active and stable at extreme conditions. These enzymes have numerous industrial applications due to its distinct properties. Till now, only a fraction of microorganisms on Earth have been exploited for screening of extremozymes. Novel techniques used for the cultivation and production of extremophiles, as well as cloning and overexpression of their genes in various expression systems, will pave the way to use these enzymes for chemical, food, pharmaceutical, and other industrial applications.

What is the publication rate for presentations given at the British Academic Conference in Otolaryngology (BACO)?

OBJECTIVES

The publication rate of some large academic meetings such as the American Academy of Otolaryngology-Head and Neck Surgery has been reported as 32%. We aimed to compare the rate of publication at the British Academic Conference in Otolaryngology (BACO) to allow surveillance of research activity in the United Kingdom (UK).

DESIGN AND SETTING

The abstract records of both BACO 2009 and 2012 were examined. The MEDLINE database was searched using PubMed (http://www.ncbi.nlm.nih.gov/pubmed) and an iterative approach. We recorded time to publication as well as the authors' region and journal.

MAIN OUTCOME MEASURES

publication rate by conference, region and journal.

RESULTS

Twice the number of presentations were made at BACO 2012 (n = 814) compared to BACO 2009 (n = 387). Absolute numbers of publications were 158 in 2012 and 92 in 2009. Overall, the publication rate dropped from 24% overall in 2009 to 19% in 2012. This difference in proportions was not significant (P = 0.08). The number of abstracts accepted for BACO 2012 doubled from BACO 2009 in nearly every subspecialty category, except the general/training category, which trebled. For both conferences, head and neck was the largest subspecialty abstract category, as well as the largest subspecialty publication category.

CONCLUSIONS

This study showed that the majority of abstracts presented at BACO 2009 and 2012 did not progress to publication. The rate of publication was similar to that seen in other general ENT meetings but do not compare favourably to the 69% rate seen for presentations made at the Otorhinolaryngological Research Society (ORS). The large increase in accepted abstracts at BACO 2012 may reflect growing competition for entry to specialist training.

A re-appraisal of publication rates of scientific papers presented at the Otorhinolaryngology Research Society meetings

OBJECTIVES

To review the rate of publication of papers in peer-reviewed journals after oral presentations at the Otorhinolaryngology Research Society meetings between 1996 and 2013 and to compare trends with the previous review (1979-1995).

DESIGN

Literature review.

SETTING

Merseyside ENT Research Collaborative.

PARTICIPANTS

The abstracts of presentations at Otorhinolaryngology Research Society meetings are published in Clinical Otolaryngology. A structured search of PubMed was undertaken to identify published Otorhinolaryngology Research Society presentations.

MAIN OUTCOME MEASURES

Publication rates.

RESULTS

A total of 460 abstracts were identified. The interobserver reliability among reviewers was 98%. Of the total, 259 (56.3%) abstracts were published in peer-reviewed journals. The average time from Otorhinolaryngology Research Society presentation to publication was 27.7 months (median 23), which was not significantly different from the previous review. Publication by subspeciality was as follows: head and neck (45.6%), otology (30.5%), rhinology (22%) and others (1.9%). Most published Otorhinolaryngology Research Society presentations were published in Clinical Otolaryngology (22.4%), followed by the Journal of Laryngology and Otology (8.1%) and the Laryngoscope (7.3%). Clinical research was the most common category of abstracts being presented at Otorhinolaryngology Research Society meetings, followed by laboratory-based research. Over half (56.5%) of laboratory research presented were head and neck themed, while otology and rhinology predominated clinical research presentations. Over half (52.1%) of Otorhinolaryngology Research Society abstracts originated from units in the North of England. Bristol presented the most abstracts (30.1%), followed by Newcastle (25.1%).

CONCLUSIONS

The publication rate of Otorhinolaryngology Research Society presentations remains high and many are subsequently published in high-impact factor otolaryngology journals. More Otorhinolaryngology Research Society presentations are now published in American and European journals.

Spatio-temporal dynamics of mosquitoes in stream pools of a biosphere reserve of Southern Western Ghats, India

The spatial and temporal dynamics of mosquitoes in stream pools were examined in a biosphere reserve of the Southern Western Ghats, India. The immature mosquitoes in stream pools were collected from stream substrates of bedrock pool, boulder cavity and sand puddle. The collected larvae and pupae were reared and identified. In total, 16 species from four genera of mosquitoes were collected. The mosquito species from Culex and Anopheles were predominantly occurred. The bedrock pool had the highest diversity and abundance of mosquitoes. The statistical analyses showed that the substrate specificity and the seasons were positively related to the distribution of mosquitoes rather than spatial pattern. This study described the spatial and temporal pattern of mosquitoes in stream pools of the Southern Western Ghats. This information would be helpful to National Vector borne disease control program for surveillance and control.

Simulium (Gomphostilbia) (Diptera: Simuliidae) from Southern Western Ghats, India: two new species and DNA barcoding

Two new species of Simulium (Gomphostilbia) (Diptera: Simuliidae) are described on the basis of reared adult, pupal and larval specimens collected from Southern Western Ghats India. The morphological data of two new species S. (Gomphostilbia) panagudiense sp. n. and S. (Gomphostilbia) kottoorense sp. n. are assigned to the batoense species group in the subgenus Gomphostilbia. S. (Gomphostilbia) panagudiense sp.n. is characterized in the female by having the scutum without longitudinal vitta and arms of the genital fork wide basally and in the pupa by the stalk of ventral pair medium-long. S. (Gomphostilbia) kottoorense sp.n. is characterized by the arm of genital fork tapered near apex in the female and style in medial view 0.63 times as long as coxite in the male. Phylogeny of members in the genus Simulium was reconstructed based on DNA barcoding gene (cytochrome oxidase c subunit I). Tree analysis using new technology and maximum likelihood analyses are congruent with evidence of two new species in the subgenus Gomphostilbia and separated from other species.

Technical Efficiency of Shrimp Farming in Andhra Pradesh: Estimation and Implications

Shrimp farming is a key subsector of Indian aquaculture which has seen a remarkable growth in the past decades and has a tremendous potential in future. The present study analyzes the technical efficiency of the shrimp famers of East Godavari district of Andhra Pradesh using the Stochastic Production Frontier Function with the technical inefficiency effects. The estimates mean technical efficiency of the farmers was 93.06 % which means the farmers operate at 6.94 % below the production frontier production. Age, education, experience of the farmers and their membership status in farmers associations and societies were found to have a significant effect on the technical efficiency. The variation in the technical efficiency also confirms the differences in the extent of adoption of the shrimp farming technology among the farmers. Proper technical training opportunities could facilitate the farmers to adopt the improved technologies to increase their farm productivity.

Predicting outcome after hip fracture: using a frailty index to integrate comprehensive geriatric assessment results

INTRODUCTION

hip fracture is expensive in terms of mortality, hospital length of stay (LOS) and consequences for independence. Poor outcome reflects the vulnerability of patients who typically sustain this injury, but the impact of different comorbidities and impairments is complex to understand. We consider this in a prospective cohort study designed to examine how a patients' frailty index (FI) predicts outcome.

METHODOLOGY

consecutive patients with low trauma hip fracture were assessed, excluding only those unfit for surgery. Comprehensive Geriatric Assessment (CGA) findings were used to derive a FI for each patient, which was examined alongside other assessment and outcome data from our National Hip Fracture Database (NHFD) submission for these individuals.

RESULTS

we describe 178 patients; mean age 81 years, 73.5% female. The mean FI was 0.34 (SD = 0.16), and logistic regression identified abbreviated mental test score and FI as the strongest predictors of poor outcome. When patients were stratified by FI, 56 (31.5%) were in the low-frailty group (FI ≤0.25), 58 (32.5%) in intermediate (FI >0.25-0.4), and 64 (36%) in the high-FI group (FI >0.4). All the patients in the low-FI group returned to their original residence within a mean of 21.6 days. The mean LOS for the intermediate group was 36.3 days compared with 67.8 days in the high-FI group (P < 0.01) while 30-day mortality was 3.4% for the intermediate group compared with 17.2% for the high-FI group (P < 0.001).

CONCLUSIONS

individual CGA findings proved disappointing as outcome predictors, while FI turned out to be a better predictor of mortality, 30-day residence and length of inpatient stay.