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Due to the healthcare burden associated with migraines, prompt and effective treatment is vital to improve patient outcomes and ED workflow. This was a prospective, randomized, double-blind trial. Adults who presented to the ED with a diagnosis of migraine from August of 2019 to March of 2020 were included. Pregnant patients, or with renal impairment were excluded. Patients were randomized to receive intravenous magnesium, prochlorperazine, or metoclopramide. The primary outcome was change in pain from baseline on a numeric rating scale (NRS) evaluated at 30 min after initiation of infusion of study drug. Secondary outcomes included NRS at 60 and 120 min, ED length of stay, necessity for rescue analgesia, and adverse effects. A total of 157 patients were analyzed in this study. Sixty-one patients received magnesium, 52 received prochlorperazine, and 44 received metoclopramide. Most patients were white females, and the median age was 36 years. Hypertension and migraines were the most common comorbidities, with a third of the patients reporting an aura. There was a median decrease in NRS at 30 min of three points across all three treatment arms. The median decrease in NRS (IQR) at 60 min was -4 (2-6) in the magnesium group, -3 (2-5) in the metoclopramide group, and -4.5 (2-7) in the prochlorperazine group (p = 0.27). There were no statistically significant differences in ED length of stay, rescue analgesia, or adverse effects. Reported adverse effects were dizziness, anxiety, and akathisia. No significant difference was observed in NRS at 30 min between magnesium, metoclopramide and prochlorperazine.
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Magnesio/uso terapéutico , Metoclopramida/uso terapéutico , Trastornos Migrañosos/tratamiento farmacológico , Proclorperazina/uso terapéutico , Administración Intravenosa , Adulto , Método Doble Ciego , Femenino , Humanos , Magnesio/administración & dosificación , Magnesio/efectos adversos , Masculino , Metoclopramida/administración & dosificación , Metoclopramida/efectos adversos , Persona de Mediana Edad , Satisfacción del Paciente , Proclorperazina/administración & dosificación , Proclorperazina/efectos adversos , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Factores de TiempoRESUMEN
The aim of study was to evaluate whether adequate initial management and safe transfer of paediatric burn patients was carried out in our setup. Patients transferred from other hospitals/ cities to Paediatric Surgery Department, Mayo Hospital were evaluated in this prospective study. Data was entered in a proforma. Around 90.4% patients on presentation had discrepancy in their burn percentage calculation. No intravenous fluids were administered to 75.4% patients and 71.1% patients did not have any intravenous access. Foley's catheter was inserted in 2 patients only though 72.8% needed it. No fasciotomy was performed in 10.5% patients needing it. Two patients needed endotracheal intubation but it was not passed, 49.1% patients were transferred by ambulance and 28.9% patients presented with sepsis. The mortality rate was 38.2%. Initial fluid resuscitation was compared with survival and found significant (p=0.000). This shows that initial burn management, transfer system and referral system is full of errors.
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Quemaduras/terapia , Fluidoterapia/estadística & datos numéricos , Atención al Paciente/normas , Pase de Guardia/normas , Transferencia de Pacientes/normas , Superficie Corporal , Unidades de Quemados , Cateterismo Periférico/estadística & datos numéricos , Niño , Preescolar , Fasciotomía/estadística & datos numéricos , Femenino , Humanos , Lactante , Intubación Intratraqueal/estadística & datos numéricos , Masculino , Estudios Prospectivos , Tasa de Supervivencia , Cateterismo Urinario/estadística & datos numéricosRESUMEN
Recent advancements in chemical graph theory have facilitated a deeper understanding of the relationship between chemical structures and their underlying graphs based upon classical graph theory principles. Quantitative structure-property relationship (QSPR) analysis stands out as a powerful tool for probing chemical graphs. Topological indices, graph invariants assigning numerical values to graphs, play a pivotal role in statistically correlating physical properties, chemical reactivity, and biological activity across diverse chemical structures. The cactus graph (CG) represents a noteworthy family of connected graphs distinguished by the absence of common vertices between cycles. In this study, we focus on establishing the expressions of Zagreb and reverse Zagreb indices in terms of known parameters for cactus graphs. Subsequently, we leverage these indices to conduct QSPR analysis, employing linear and multilinear regression models to investigate the relationship between the properties of chemical structures adorned with cactus-like graphs and the corresponding Zagreb and reverse Zagreb indices.
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Practical group decision-making (DM) problems frequently involve challenging circumstances when attempting to assign appropriate values to the data because of the haziness and uncertainty of the surrounding circumstances. In order to address the ambiguity and imprecision that arise in DM issues, q-rung picture fuzzy sets (q-RPFSs) have a more broader structure. In this research, the criteria importance through intercriteria correlation (CRITIC) and the decision-making trial and evaluation laboratory (DEMATEL) techniques are separately integrated with the multi-attributive border approximation area comparison (MABAC) method. The MABAC method, which measures how far each alternative is from the border approximation area, is very stable and useful for resolving real-world problems. The CRITIC technique calculates the criteria weights by taking into account the relationships between attributes, and the DEMATEL methodology is recognized as the best method for determining how several criteria or factors interact with one another. As a result of these justifications, we made the decision to create the CRITIC-MABAC and DEMATEL-MABAC procedures for q-RPFSs. By using the suggested strategies, the primary goal of this article is to determine the occupational risk that has the greatest impact on the health of a hospital's medical staff. We begin by employing the CRITIC technique to determine the criteria weights. In addition, we calculate the weights of the criteria using the DEMATEL approach. The offered methodologies are investigated for their applicability to determine the most serious occupational hazard for hospital employees. We conducted a comparison with three earlier studies to verify the accuracy of the tactics that are offered.
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The selection of an appropriate mining method is considered as an important tool in the mining design process. The adoption of a mining method can be regarded as a complex multi-attribute group decision-making (MAGDM) problem as it may contain uncertainty and vagueness. The main goal of this paper is to propose an extended multi-objective optimization ratio analysis plus full multiplication form (MULTIMOORA) method that is based on a 2-tuple spherical fuzzy linguistic set (2TSFLS). The MULTIMOORA method under 2TSFL conditinos has been developled as a novel approach to deal with uncertainty in decision-making problems. The proposed work shows that 2TSFLSs contain collaborated features of spherical fuzzy sets (SFSs) and 2-tuple linguistic term sets (2TLTSs) and, hence, can be considered as a rapid and efficient tool to represent the experts' judgments. Thus, the broader structure of SFSs, the ability of 2TLTSs to represent linguistic assessments, and the efficiency of the MULTIMOORA approach have motivated us to present this work. To attain our desired results, we built a normalized Hamming distance measure and score function for 2TSFLSs. We demonstrate the applicability and realism of the proposed method with the help of a numerical example, that is, the selection of a suitable mining method for the Kaiyang phosphate mine. Then, the results of the proposed work are compared with the results of existing methods to better reflect the strength and effectiveness of the proposed work. Finally, we conclude that the proposed MULTIMOORA method within a 2TSFLS framework is quite efficient and comprehensive to deal with the arising MAGDM problems.
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Toma de Decisiones , Lógica Difusa , Incertidumbre , Lingüística/métodosRESUMEN
Physico-chemical parameters and zooplankton were assessed Lal Diggi pond from January to December, 2008. Four groups of zooplankton were recorded. Rotifera constituted the main dominant group in this pond contributing 44.89% of the total zooplankton population followed by Cladocera (30.41%), Copepoda (15.51%) and Ostracoda (4.68%). The highest density of zooplankton was recorded during January and February being 197 and 182 no l(-1) respectively, while the lowest density was recorded during May and June being 64 no l(-1) each could be due to the negative and significant value of correlation between zooplankton and water temperature (r = -0.700). These data is supported by similarity indices which recorded high values during January and February while the lowest values recorded during June and July.
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Zooplancton , Animales , India , Dinámica Poblacional , Zooplancton/clasificaciónRESUMEN
BACKGROUND: Topological indices have numerous implementations in chemistry, biology and a lot of other areas. It is a real number associated with a graph, which provides information about its physical and chemical properties and their correlations. For a connected graph H, the degree distance DD index is defined as DD(H) = Σ{h1,h2}âV(H) [degH(h1)+degH (h2)]dh (h1,h2), where degH (h1)is the degree of vertex h1 and dH (h1,h2) is the distance between h1 and h2 in the graph H. AIM AND OBJECTIVE: In this article, we characterize some extremal trees with respect to degree distance index which has a lot of applications in theoretical and computational chemistry. MATERIALS AND METHODS: A novel method of edge-grafting transformations is used. We discuss the behavior of DD index under four edge-grafting transformations Results: With the help of those transformations, we derive some extremal trees under certain parameters, including pendant vertices, diameter, matching and domination numbers. Some extremal trees for this graph invariant are also characterized Conclusion: It is shown that balanced spider approaches to the smallest DD index among trees having given fixed leaves. The tree Cn,d has the smallest DD index, among all trees of diameter d. It is also proved that the matching number and domination numbers are equal for trees having a minimum DD index.
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The present problem addressed the transient behavior of convective heat and mass transfer characteristics across a curved surface under the influence of exothermic catalytic chemical reactions. The governing non-linear mathematical model wastransformed into a convenient form with the help of a primitive variable formulation. The final primitive formed model wassolved numerically by applying the finite difference method. The analysis of the above said computed numerical data in terms of oscillatory heat transfer, skin friction, and oscillatory mass transfer for various emerging parameters, such as the mixed convection parameter λT, modified mixed convection parameter λc, index parameter n, activation energy parameter E, exothermicparameter ß, temperature relative parameter γ, chemical reaction parameter λ, and Schmidt number Sc is plotted in graphical form. An excellent agreement is depicted for oscillatory heat transfer behavior at the large value of activation energy E. The amplitude of heat transfer and prominent fluctuating response in mass transfer with a certain height is found at each value of the index parameter n with a good alteration. An increase in the activation energy led to an increase in the surface temperature, which yielded more transient heat transfer in the above-said mechanism. The main novelty of the current study is that first, we ensured the numerical results for the steady state heat and fluid flow and then these obtained results wereused in the unsteady part to obtain numerical results for the transient behavior of the heat and mass transfer mechanism.
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The need for multi-attribute decision-making brings more and more complexity, and this type of decision-making extends to an ever wider range of areas of life. A recent model that captures many components of decision-making frameworks is the complex $ q $-rung picture fuzzy set (C$ q $-RPFS), a generalization of complex fuzzy sets and $ q $-rung picture fuzzy sets. From a different standpoint, linguistic terms are very useful to evaluate qualitative information without specialized knowledge. Inspired by the ease of use of the linguistic evaluations by means of 2-tuple linguistic term sets, and the broad scope of applications of C$ q $-RPFSs, in this paper we introduce the novel structure called 2-tuple linguistic complex $ q $-rung picture fuzzy sets (2TLC$ q $-RPFSs). We argue that this model prevails to represent the two-dimensional information over the boundary of C$ q $-RPFSs, thanks to the additional features of 2-tuple linguistic terms. Subsequently, some 2TLC$ q $-RPF aggregation operators are proposed. Fundamental cases include the 2TLC$ q $-RPF weighted averaging/geometric operators. Other sophisticated aggregation operators that we propose are based on the Hamacher operator. In addition, we investigate some essential properties of the new operators. These tools are the building blocks of a multi-attribute decision making strategy for problems posed in the 2TLC$ q $-RPFS setting. Furthermore, a numerical instance that selects an optimal machine is given to guarantee the applicability and effectiveness of the proposed approach. Finally, we conduct a comparison with other existing approaches.
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Lógica Difusa , Lingüística , Toma de Decisiones , Lingüística/métodosRESUMEN
BACKGROUND: The leading cause of line-of-duty death among firefighters is sudden cardiac events. Platelets play a critical role in the formation of an occlusive thrombus during an ischemic event. OBJECTIVE: The purpose of this study was to examine the acute effect of firefighting on platelet number and aggregability. METHODS: Apparently healthy male firefighters (N = 114; age 29.4 ± 7.8 years) participated in 18 minutes of simulated firefighting activity in a training structure that contained live fires. Blood samples were obtained before and after simulated firefighting activity and analyzed for complete blood cell count (CBC), chemistry, and platelet number and function. Platelet function was measured using a PFA-100 analyzer to assess platelet aggregability. RESULTS: As expected, performing firefighting activity resulted in significant increases in heart rate (75 b·min(-1)) and core temperature (0.7 °C), and significant changes in blood chemistry values. The most important finding in this study is that 18 minutes of simulated firefighting caused a 24% increase in platelet number and a significant increase in platelet aggregability. CONCLUSIONS: Firefighting resulted in a significant increase in platelet number and aggregability, indicating that even short bouts of firefighting can increase thrombotic potential in apparently healthy firefighters.
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Plaquetas , Incendios , Calor/efectos adversos , Exposición Profesional/efectos adversos , Estrés Fisiológico , Tromboembolia/etiología , Adaptación Fisiológica , Adulto , Recuento de Células Sanguíneas , Humanos , Masculino , Consumo de Oxígeno , Pruebas de Función Plaquetaria , Factores de RiesgoRESUMEN
The natural convection boundary layer flow of a viscous incompressible fluid with temperature dependent viscosity and thermal conductivity in the presence of exothermic catalytic chemical reaction along a curved surface has been investigated. The governing non dimensional form of equations is solved numerically by using finite difference scheme. The numerical results of velocity profile, temperature distribution and mass concentration as well as for skin friction, heat transfer rate and mass transfer rate are presented graphically and in tabular form for various values of dimensionless parameters those are generated in flow model during dimensionalization. From the obtained results, it is concluded that the exothermic catalytic chemical reactions is associated with temperature dependent viscosity and thermal conductivity. Further, it is concluded that the body shape parameter also plays an important quantitative role for change in velocity profile, temperature field and mass concentration behavior in the presence of exothermic catalytic chemical reaction.
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Convección , Temperatura , Conductividad Térmica , Catálisis , Fricción , ViscosidadRESUMEN
In the current study, the attention is paid on the phenomena of mixed convection flow under the effect of exothermic catalytic chemical reaction along the curved surface. The proposed problem is modeled in nonlinear coupled partial differential equations. In keeping view the principle of homogeneity the dimensional flow model is transformed into dimensionless by using an appropriate scaling. This well arranged form of equations is then discretized with the aid of finite difference method for the numerical solution. The solutions of the considered model are estimated and displayed in the graphs. Here, in the contemporary study variables of physical significance such as velocity profile, temperature distribution and mass concentration are encountered efficiently. The incorporated pertinent dimensionless numbers that is body shape parameter, mixed convection parameter, modified mixed convection parameter, Prandtle number, exothermic parameter, chemical reaction parameter, temperature relative parameter, dimensionless activation energy parameter, and Schmidt number for which variations in the concentrated physical variables are estimated and presented in graphical way. For each boundary conditions computations are performed along the curved surface for different body shape parameter (n) values range from 0 up to 0.5; the obtained results satisfied by the boundary conditions. The velocity profile becomes increasingly more significant for n equal to 1 and due to the uniformly heated surface temperature profile and mass concentration are uniformly distributed.
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OBJECTIVE: Hypoglycemia is associated with a variety of adverse behaviors including fatigue, confusion and social withdrawal. While these clinical symptoms are well characterized, the mechanism of their cause is not understood. Here we investigated how insulin-induced hypoglycemia causes social withdrawal. RESEARCH DESIGN AND METHODS: Male 8-12-week-old C57BL/6J mice were injected intraperitoneally (IP) with or without and/or insulin, norepinephrine (NE) and epinephrine (Epi), terbutaline and butoxamine with subsequent measurement of blood glucose, social withdrawal and plasma catecholamines. RESULTS: Insulin generated (0.75h post-injection) significant hypoglycemia with blood glucose nadirs of 64+/-4 and 48+/-5mg/dl for 0.8 and 1.2units/kg of insulin, respectively. Insulin (0.8 or 1.2units/kg) caused near total social withdrawal at 0.75h with full recovery not occurring until 4h (0.8units/kg) or 8h (1.2units/kg) post-insulin injection. Insulin also caused a marked elevation in plasma catecholamines. Basal 12h fasting NE and Epi were 287+/-38 and 350+/-47pg/ml, respectively. Insulin at 0.8units/kg increased plasma NE and Epi to 994+/-73 and 1842+/-473pg/ml, respectively. Administration of exogenous NE or Epi caused social withdrawal similar in magnitude to insulin. Importantly, administration of the beta-2 adrenergic receptor agonist terbutaline also caused social withdrawal while administration of the beta-2 adrenergic receptor antagonist butoxamine blocked NE-induced social withdrawal. Finally, butoxamine blocked insulin-induced social withdrawal. CONCLUSIONS: These data demonstrate that hypoglycemia-associated social withdrawal is dependent on catecholamines via a beta-2 receptor-mediated pathway.