Smooth stable and unstable manifolds for stochastic partial differential equations

Invariant manifolds are fundamental tools for describing and understanding nonlinear dynamics. In this paper, we present a theory of stable and unstable manifolds for infinite dimensional random dynamical systems generated by a class of stochastic partial differential equations. We first show the existence of Lipschitz continuous stable and unstable manifolds by the Lyapunov-Perron's method. Then, we prove the smoothness of these invariant manifolds

The Power of a Team Huddle During the COVID-19 Pandemic

https://openworks.mdanderson.org/edwk22/1001/thumbnail.jp

Cost effectiveness of first-line oral therapies for pulmonary arterial hypertension: A modelling study

Background: In recent years, a significant number of costly oral therapies have become available for the treatment of pulmonary arterial hypertension (PAH). Funding decisions for these therapies requires weighing up their effectiveness and costs. Objective: The aim of this study was to assess the cost effectiveness of monotherapy with oral PAH-specific therapies versus supportive care as initial therapy for patients with functional class (FC) II and III PAH in Canada. Methods: A cost-utility analysis, from the perspective of a healthcare system and based on a Markov model, was designed to estimate the costs and quality-adjusted life-years (QALYs) associated with bosentan, ambrisentan, riociguat, tadalafil, sildenafil and supportive care for PAH in treatment-naïve patients. Separate analyses were conducted for cohorts of patients commencing therapy at FC II and III PAH. Transition probabilities, based on the relative risk of improving and worsening in FC with treatment versus placebo, were derived from a recent network meta-analysis. Utility values and costs were obtained from published data and clinical expert opinion. Extensive sensitivity analyses were conducted. Results: Analysis suggests that sildenafil is the most cost-effective therapy for PAH in patients with FC II or III. Sildenafil was both the least costly and most effective therapy, thereby dominating all other treatments. Tadalafil was also less costly and more effective than supportive care in FC II and III; however, sildenafil was dominant over tadalafil. Even given the uncertainty within the clinical inputs, the probabilistic sensitivity analysis showed that apart from sildenafil and tadalafil, the other PAH therapies had negligible probability of being the most cost effective. Conclusion: The results show that initiation of therapy with sildenafil is likely the most cost-effective strategy in PAH patients with either FC II or III disease.This research was supported by funds from the Canadian Agency for Drugs and Technologies in Health (CADTH)

Autoantibodies to Agrin in Myasthenia Gravis Patients

To determine if patients with myasthenia gravis (MG) have antibodies to agrin, a proteoglycan released by motor neurons and is critical for neuromuscular junction (NMJ) formation, we collected serum samples from 93 patients with MG with known status of antibodies to acetylcholine receptor (AChR), muscle specific kinase (MuSK) and lipoprotein-related 4 (LRP4) and samples from control subjects (healthy individuals and individuals with other diseases). Sera were assayed for antibodies to agrin. We found antibodies to agrin in 7 serum samples of MG patients. None of the 25 healthy controls and none of the 55 control neurological patients had agrin antibodies. Two of the four triple negative MG patients (i.e., no detectable AChR, MuSK or LRP4 antibodies, AChR-/MuSK-/LRP4-) had antibodies against agrin. In addition, agrin antibodies were detected in 5 out of 83 AChR+/MuSK-/LRP4- patients but were not found in the 6 patients with MuSK antibodies (AChR-/MuSK+/LRP4-). Sera from MG patients with agrin antibodies were able to recognize recombinant agrin in conditioned media and in transfected HEK293 cells. These sera also inhibited the agrin-induced MuSK phosphorylation and AChR clustering in muscle cells. Together, these observations indicate that agrin is another autoantigen in patients with MG and agrin autoantibodies may be pathogenic through inhibition of agrin/LRP4/MuSK signaling at the NMJ

Analysis of Difficulty Index, Discrimination Index and Distractor Efficiency in Multiple Choice Questions

Background: The item analysis of multiple-choice questions (MCQs) is an essential tool that can provide input on validity and reliability of items. It helps to identify items, which can be revised or discarded, thus building a quality MCQ bank. Aim: The aim of the study to evaluate the quality of MCQs by analyzing DIF, DI and DE and to find out the association of MCQs having good difficulty and discrimination indices with DE. Method: The study was conducted in the Department of Maternity and Child Health Nursing at the College of Nursing during the academic year 2023, second semester. Students of level six who took the final exam of one-course second-semester academic year 2023, A total of 152 third-year Bachelor of Nursing. The item analysis explored the difficulty index (DIF I) and discrimination index (DI) with distractor effectiveness (DE). Data was kept confidential and the descriptive and inferential statistics will be computed using SPSS 22.0. Results: A total of 50 MCQs, the majority, that is, 74 (82%) MCQs had a good/acceptable level of difficulty with a mean DIF I of 94.94 ± 6.36 (mean ± SD); this indicates that, on average, the MCQs were relatively easy for the students, as the difficulty index is close to 100. The discrimination index, which assesses the ability of the MCQs to differentiate between high and low-performing students, had a mean of 0.11 and a standard deviation of 0.47. This relatively low mean value suggests that the MCQs had limited discriminatory power, meaning they did not effectively distinguish between students with different levels of performance. 150 (75%) were categorized as functional distractors (FDs). These FDs effectively served their purpose by distracting students from selecting the correct answer, challenging their knowledge and understanding. On the other hand, 50 distractors (25%) were classified as non-functional distractors (NFDs). Conclusion: The categorization of the MCQs based on distractor efficiency highlights the importance of having well-constructed and effective distractors. The presence of functional distractors challenges students' decision-making, while non-functional distractors need to be revised or replaced to improve the overall quality of the MCQs. This finding indicates a potential area for improvement in the construction and selection of MCQs to enhance their ability to differentiate student abilitie

SPARC 2017 retrospect & prospects : Salford postgraduate annual research conference book of abstracts

Welcome to the Book of Abstracts for the 2017 SPARC conference. This year we not only celebrate the work of our PGRs but also the 50th anniversary of Salford as a University, which makes this year’s conference extra special. Once again we have received a tremendous contribution from our postgraduate research community; with over 130 presenters, the conference truly showcases a vibrant PGR community at Salford. These abstracts provide a taster of the research strengths of their works, and provide delegates with a reference point for networking and initiating critical debate. With such wide-ranging topics being showcased, we encourage you to exploit this great opportunity to engage with researchers working in different subject areas to your own. To meet global challenges, high impact research inevitably requires interdisciplinary collaboration. This is recognised by all major research funders. Therefore engaging with the work of others and forging collaborations across subject areas is an essential skill for the next generation of researchers

Experiences of Family members of people with Parkinson’s Disease

Background: The people who are close to someone who has Parkinson\u27s disease play a vital role in their everyday lives. It is crucial to support the patient\u27s family members in providing care, adjust to their situation, and make psychosocial adjustments. Objective: This study aimed to find and then compile family carers\u27 accounts of caring for Parkinson\u27s disease (PD) patients. Aim: The purpose of this study is to describe the role that family members play in providing daily care for a family member who has Parkinson\u27s disease and to investigate how family members perceive this role. Conclusion: The themes represented many facets of the lives of family carers impacted by providing care for a member with Parkinson\u27s disease (PD), and these pose questions for oversimplified notions of family caregiving and suitable support networks. The results also point to a number of suggestions for clinical practice

An Overview Of Antidote For Midazolam Overdose, Role Of Clinical Laboratory, Anesthesia And Nursing In The Management

Midazolam is commonly administered as a premedication due to its beneficial properties of inducing amnesia, reducing anxiety, and promoting sedation. Incorrect administration of midazolam at an inappropriate dosage elevates the likelihood of respiratory and circulatory depression. An individual died as a consequence of receiving a 10 mg dosage of intravenous (IV) midazolam during an endoscopic procedure.1 While there is no documented evidence of fatalities resulting from the intramuscular (IM) administration of midazolam, we have encountered two instances of excessive doses of IM midazolam being delivered. Thankfully, there were no issues. However, the occurrences highlighted the reality that certain doctors and nurses may lack the necessary expertise in administering a drug, even if it has been widely used for an extended period of time. Only a few examples have been recorded in the literature where the premedication of IM midazolam was administered at a dosage four times higher than recommended. The sedative effects were extended, however, there was no occurrence of circulatory or respiratory depression, which is fortunate. Both accidents occurred due to the nurse and resident\u27s inadequate familiarity with midazolam. Hence, it is imperative not to assume that all medical personnel possess equivalent experience and expertise regarding frequently utilized medications. It is crucial to thoroughly examine prescriptions and processes, especially for common medications, in order to prevent unintentional overdoses. The clinical laboratory, anesthesia, and nursing play crucial roles in managing patients, including tasks such as identifying drug levels in urine, administering antidotes, performing intubation, and providing more effective therapy with the help of the anesthesia team