SummaryBackgroundResults of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects.MethodsFOCUS 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.FindingsBetween 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.InterpretationFluoxetine 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.FundingUK Stroke Association and NIHR Health Technology Assessment Programme.

Graphlets are small connected induced subgraphs of a larger graph G. Graphlets are now commonly used to quantify local and global topology of networks in the field. Methods exist to exhaustively enumerate all graphlets (and their orbits) in large networks as efficiently as possible using orbit counting equations. However, the number of graphlets in G is exponential in both the number of nodes and edges in G. Enumerating them all is already unacceptably expensive on existing large networks, and the problem will only get worse as networks continue to grow in size and density. Here we introduce an efficient method designed to aid statistical sampling of graphlets up to size k = 8 from a large network. We define graphettes as the generalization of graphlets allowing for disconnected graphlets. Given a particular (undirected) graphette g, we introduce the idea of the canonical graphette as a representative member of the isomorphism group Iso(g) of g. We compute the mapping , in the form of a lookup table, from all 2k(k − 1)/2 undirected graphettes g of size k ≤ 8 to their canonical representatives , as well as the permutation that transforms g to . We also compute all automorphism orbits for each canonical graphette. Thus, given any k ≤ 8 nodes in a graph G, we can in constant time infer which graphette it is, as well as which orbit each of the k nodes belongs to. Sampling a large number N of such k-sets of nodes provides an approximation of both the distribution of graphlets and orbits across G, and the orbit degree vector at each node.

Activated carbon (AC) is an extremely porous carbonaceous adsorptive substance which has a rigid carbon matrix with high surface area and broad functional groups. The structure is connected by chemical bonds; arranged irregularly, generating a highly porous arrangement of corners, crevices, claps, and cracks between the carbon layers. Activated carbons are produced high-temperature and chemical activation of waste biomass. The pores in the lattice network of activated carbon permit the removal of impurities from gaseous and liquid medium through adsorption. At present, the COVID-19 disease is the prime concern around the whole world because of its exponential infections and death rate. There is no medicine for this virus, and protection is the only remedy to survive from this contagious disease. Using a face mask is one of the best methods to get rid of COVID-19. The mask combined with activated carbon can be beneficial for adsorbing and disinfecting the virus as it is the versatile adsorbent for the elimination of the organic, inorganic, and pathogenic contaminants.

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Environmental Impact Assessment (EIA) is not only about development and protecting environment, but also about public participation during all the process. It is not an exaggeration that public participation is claimed as one of the key indicators of the effectiveness of EIA. Therefore, even in pandemic conditions while development still must go on at the same time, public participation can be avoided in the EIA process. In a wide range of international arrangements and national regulation, there are several guidance in accommodating public participation such as the Aarhus Convention 1998 and Indonesian national regulation. This article compares and analyses those legal procedures in mitigating unexpected conditions. The result shows that both of them are still feasible to be applied even in abnormal circumstances. Some barriers are identified especially related to implementing advanced technology. Therefore, how these aspirations are conveyed and accepted must be done in various alternative ways.

Background: Proof of a circadian rhythm in the occurrence of cerebral infarction and other types of stroke might provide clues to factors which immediately precipitate these events, which in turn might lead to more rational treatments. The aims of the current study were to find out the circadian variation of stroke onset and to determine the risk factors related to circadian variation.Methods: This cross-sectional study was conducted in a tertiary hospital of Bangladesh from July to December 2014 among 67 diagnosed cases of ischemic and hemorrhagic stroke of first attack. Times of onset of stroke and wake-sleep state were recorded.Results: The mean age of the study subjects was 62.1 years, 64.2% were male. Among them, 59.7% had an ischemic stroke and 40.3% had a hemorrhagic stroke. The occurrence of stroke was most common during 6 am to 12 pm (47.8%), followed by 12 am to 6 am (25.4%), 12 pm to 6 pm (17.9%), and 6 pm to 12 am (9.0%). Circadian variation of stroke was homogenous and statistically insignificant in association with age group when categorized as below 65 years and 65 years or above years, sex, smoking habit, and presence or absence of diabetes mellitus, atrial fibrillation, and dyslipidemia. But hypertension and ischemic heart disease (IHD) were significantly associated with circadian variation of stroke. The occurrence of ischemic stroke and hemorrhagic stroke was most common from 6 am to 12 pm (47.5% and 48.1%) respectively. When considered separately, significant circadian variation noted for ischemic stroke and hemorrhagic strokes were also noted.Conclusions: The study contributes further evidence for the circadian variation in the occurrence of ischemic stroke and hemorrhagic stroke. Attempts to prevent their occurrence must take into account this circadian variation.