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Introduction. Many studies in the literature deals with epidemiology, diagnosis and management of spinal tuberculosis but there is scant amount of such data for extraspinal osteoarticular TB. Material and methods. Demographic patient data like age, sex, bone and joint involved, side involved, duration of symptoms was noted. All suspected cases of extra-spinal musculoskeletal TB with positive acid-fast bacilli (AFB) staining or positive cartridge based nucleic acid amplification test (CBNAAT) or histopathological evidence of granulomatous infection and minimum 1 year follow up after completion of 12-month ATT were included in the study. Outcome evaluation was done on the basis of residual pain, range of motion of joint along with deformity of the affected part, if any. Results. A total of 103 patients (55 males, 48 females) were analyzed. The mean duration of treatment was 14.2±2.8 months. The mean age of the patients at presentation was 30.5±18.5 years. The most common site affected was the ankle joint followed by hip and knee. 95 cases (92.2%) were diagnosed by histopathological examination of synovial tissue or material obtained from core biopsy. 90 cases (87.3%) were treated conservatively on oral drugs only while 13 cases (12.7%) were treated operatively. Outcome after completion of ATT were graded as good in 46 (46.9%), fair and poor each in 26 patients (26.5%). Conclusion. Extraspinal osteoarticular TB can be managed effectively by 12-month ATT if diagnosed early. Some cases with advanced arthritis can be salvaged with implant arthroplasty or arthrodesis under cover of ATT.

There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients' (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16-22) and failed intubation in 1 in 312 (95%CI 1 in 169-667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%).

We present undergraduate-friendly instructions on how to produce light pulses propagating through warm Rubidium vapor with speeds less than 400 m/s, i.e., nearly a million times slower than c. We elucidate the role played by electromagnetically induced transparency (EIT) in producing slow light pulses, and discuss how to achieve the required experimental conditions. Various EIT linewidth broadening mechanisms are described. The optical set up is presented, and details provided for preparation of pump, probe, and reference pulses of required size, intensity, temporal width, and polarization purity. We discuss in detail how to adequately magnetically shield the alkali vapor sample. Our instructions include drawings for parts and information on prices and vendors. In the spirit of presenting a stand-alone article for producing slow light, we provide in Supplementary Notes, a detailed semiclassical derivation of EIT and slow light that should be amenable to advanced undergraduates, and details of an auxiliary measurement to ensure the suppression of residual stray magnetic fields below 0.2 milliGauss over the entire laser-atom interaction region., 15 pages, 10 figures (Supplementary Notes: 8 pages, 4 figures)

Context: Blood transfusion services are critical to any hospitals? functioning, and timely blood/ component therapy resuscitation is lifesaving. Yet, few blood delivery turnaround time (TAT) studies have been undertaken. Aims: We assessed blood delivery TAT at our institution before and after implementing an intervention. Settings and Design: This before-after study assessed blood delivery TAT at our institution at baseline (first audit, December 2015 - February 2016); analyzed the causes of any delays and implemented a multipronged organizational, educational and operational remedial actions for risk mitigation for 3 months, aiming to shorten the blood delivery TAT; and then 9 months later assessed the blood delivery TAT again (second audit, November 2017 - December 2017). Methods and Material: For each of the two audits, we assessed three indices that comprise TAT: Response time (time from doctor?s request until blood is ready for collection, T1); processing time (time from the arrival of technician to blood bank and start of paperwork processing at the blood bank?s front desk until actual collection of the blood, T2); and, Transport time (time from blood bank to arrival to operating theatre, T3). Statistical analysis used: The observed proportions for categorical variables were reported as percentage and compared using Chi square test. Results: After implementing the remedial actions, the second audit confirmed considerable improvements across all three components that comprise the blood TAT. The transport time significantly decreased from an initial majority of > 15 mins duration, to a majority of < 15 mins transport time after the second audit; there was a 50% improvement in 30 mins response time; and the percentage of requests processed in < 10 mins were significantly higher after the second audit. Conclusions: Our program and its findings in terms of much improved blood delivery TAT after implementing this quality improvement approach represent an appropriate and effective solution to the challenge of making blood available fast enough to meet true hemorrhagic emergencies. Scopus

Nitrate and nitrite transport across biological membranes is often facilitated by protein transporters that are members of the major facilitator superfamily. Paracoccus denitrificans contains an unusual arrangement whereby two of these transporters, NarK1 and NarK2, are fused into a single protein, NarK, which delivers nitrate to the respiratory nitrate reductase and transfers the product, nitrite, to the periplasm. Our complementation studies, using a mutant lacking the nitrate/proton symporter NasA from the assimilatory nitrate reductase pathway, support that NarK1 functions as a nitrate/proton symporter while NarK2 is a nitrate/nitrite antiporter. Through the same experimental system, we find that Escherichia coli NarK and NarU can complement deletions in both narK and nasA in P. denitrificans, suggesting that, while these proteins are most likely nitrate/nitrite antiporters, they can also act in the net uptake of nitrate. Finally, we argue that primary sequence analysis and structural modelling do not readily explain why NasA, NarK1 and NarK2, as well as other transporters from this protein family, have such different functions, ranging from net nitrate uptake to nitrate/nitrite exchange. This article is protected by copyright. All rights reserved.explain why NasA, NarK1 and NarK2, as well as other transporters from this protein family, have such different functions, ranging from net nitrate uptake to nitrate/nitrite exchange.

Prior studies indicate that enterprise risk management has a vital role on firm performance. Enterprise risk management system helps organizations to reach their goals by reducing uncertainty of their operating environment. In this context, this study aims to discuss and analyze the concept of enterprise risk management in non-profit organizations. The term "risk" for non-profit organizations is defined and different types of risk are examined. The significance and need of managing risk in non-profit organizations are revealed. © 2017, IGI Global.

A GRAVITATIONALLY NON-DEGENERATE BIANCHI TYPE I COSMOLOGICAL MODEL IN GENERAL RELATIVITY

It has been known that carpal tunnel syndrome which is common in adults is usually sporadic and idiopathic. When the inheritance is familial various disorders such as collagen vascular disease, mucopolysaccharidosis, amyloidosis are frequently manifested. It has also been shown in the literature that the carpal tunnel syndrome is always associated with the manifestation of systemic disorder. There are only a few reports which describe the absence of any disorder in patients with carpal tunnel syndrome. The present report deals with a case of 42-year old woman married to a 51-year old man and their marriage was consanguineous one. The patient had bilateral median nerve entrapment at the wrist. Various physical and laboratory tests were conducted to see any evidence of systemic disorder but there was none. Genetic counseling revealed that there were other family members had symptoms consistent with carpal tunnel syndrome. All cases were confirmed electrophysiologically. The mother of propositus, younger sister of propositus, and her 14-year old son and 19-year old daughter of propositus were also confirmed with carpal tunnel syndrome. The plausible modes of inheritance of this genetic disease were discussed.

The optimal gestational age for prenatal screening for neural tube defects and Down syndrome is usually between 15 and 18 weeks. Elevated concentrations of maternal serum alpha-fetoprotein are a diagnostic indication of neural tubal defects where as low levels of alpha-fetoprotein, unconjugated estriol and elevated human chorionic gonadotropin are indication of Down syndrome. Accurate assessment of gestational age at the time of testing for these analytes is very important for the interpretation of the test results. The present report is designed to determine whether gestational age should be based on last menstrual period (LMP) data or ultrasonographic evaluation in the interpretation of maternal serum screening. The present study population consisted of 4,200 women at 15 to 19 weeks gestation. Seventy-seven percent of test interpretations were based on ultrasonographic evaluation of gestational ages. For 56 Down syndrome pregnancies both ultrasonography and LMP dates were available. Whenever the test results were positive for Down syndrome or neural tube defects, the serum samples were collected and again assayed for results. We found both initial and revised screen positive rates for Down syndrome were significantly lower and detection rates for Down syndrome seemed to be higher with ultrasonography (68% vs. 49% for LMP dates). The opposite trend was seen for neural tube defects. Serum-positive rates for neural tube defects were higher for women when gestational age was based on ultrasonographic examination than those women referred with LMP dates. The detection rates for neural tube defects by ultrasonography was slightly lower than those by LMP dates. Our data indicate that ultrasonography is preferred for the effectiveness of maternal serum screening. The ultrasonographic biometric measurement for estimating gestational age for both neural tube defects and Down syndrome screening by biparietal diameter measurement was disassumed.

Background: Operating theatres (OTs) are valuable and costly resources that need to be appropriately designed and stocked for efficient, quality and safe patient care. We assessed the logistic inefficiency including the availability and location layout of necessary supplies across OTs of a high-volume tertiary-care academic medical center. Methods: A blinded observer (anesthesia technologist) was allocated to 10 OTs. For each OT, the availability, quantity and time spent to locate and obtain a set of required items were recorded (baseline values). We then developed an OT mapping plan to determine the specific item/s to be stocked in specific locations, and one OT was standardized to this configuration map. A blinded observer was then allocated to this standardized OT and time spent to obtain the same set of items was again recorded. Six of our regular OTs were then standardized to the same configuration, and the time to obtain the items by a blinded observer were again recorded for each OT. T tests compared the time required to locate items in the standardized OT vs. regular OTs; paired t tests compared the time required in each OT vs. itself before and after standardization. Results: The observer required significantly more time in each of the 10 regular OTs compared to the standardized OT. The time spent by the observer to obtain the required items significantly and considerably decreased in each of 6 OTs after their standardization, compared to the time required before their standardization. Conclusion: This quality improvement project successfully reduced the time required to identify and locate different supplies, which impacts on the efficiency and quality of patient care. For anesthesia staff moving from one anesthetizing location to another within the institution, consistencies in location and number of anesthesia equipment and supplies create higher levels of safety and professionalism. Scopus