Photoluminescence properties of Pb5(PO4)3Br:RE (RE = Dy3+, Eu3+ and Tb3+) phosphor synthesised using solid-state method.

This study describes the luminous properties of Pb5(PO4)3Br doped with RE3+ (RE = Dy3+, Eu3+ and Tb3+) synthesised using the solid-state method. The synthesised phosphor was characterised using Fourier-transform infrared, X-ray diffraction, scanning electron microscopy and photoluminescence measurements. Dy3+-doped Pb5(PO4)3Br phosphor exhibited blue and yellow emissions at 480 and 573 nm, respectively, on excitation at 388 nm. Eu3+-doped Pb5(PO4)3Br phosphor exhibited orange and red emissions at 591 and 614 nm, respectively, on excitation at λex = 396 nm. Pb5(PO4)3Br:Tb3+ phosphor exhibited the strongest green emission at 547 nm on excitation at λex = 380 nm. Additionally, the effect of the concentration of rare-earth ions on the emission intensity of Pb5(PO4)3Br:RE3+ (RE3+ = Dy3+, Eu3+ and Tb3+) phosphors was investigated.

The Standardization of Daruharidradi Ghanavati.

Background: Many effective formulations are available in Ayurveda for various diseases. These formulations are lagging in standardization due to the absence of reference standards, whereas maintaining quality standards of given medicines is the need of an hour. Daruharidradi Ghanvati is one such combination of six herbal drugs containing Daruharidra, Meshshrungi, Vijaysar, Mamajjak, Jambubija, and Methikabij. Each drug is described in various Ayurvedic antidiabetic formulations. Aim: The present study was aimed at setting a standard pharmacognostical and pharmaceutical profile of Daruharidradi Ghanavati. Materials and Methods: The study included the preparation of Daruharidradi Ghanavati using raw drugs. Later, Daruharidradi Ghanavati was subjected to pharmacognostical, physiochemical, and thin-layer chromatography analysis as per standard protocols. Results: The final observations were recorded. Pharmacognostical findings matched with that of individual raw drugs with no major change in the microscopic structure of the raw drugs during the preparation of Ghanavati. Conclusion: The quality of Daruharidradi Ghanavati tablet can be tested by pharmacognostical, physiochemical screening for the observations of the present study.

Animal movement on the hoof and on the cart and its implications for understanding exchange within the Indus Civilisation.

Movement of resources was essential to the survival and success of early complex societies. The sources and destinations of goods and the means of transportation - be it by boats, carts and/or foot - can often be inferred, but the logistics of these movements are inherently more difficult to ascertain. Here, we use strontium isotopic analysis to test hypotheses about the role of animal and animal-powered transport in medium and long-distance movement and exchange, using the Indus Civilization as a case study. Across the wide geographical spread of the Indus Civilisation, there is strong evidence for long-distance exchange of raw materials and finished objects and this process is presumed to involve boats and animal-driven transport, although there is little evidence as to the relative importance of each mode of movement. Strontium isotopic analysis of animal remains from four sites analysed for this study combined with results from nine other sites indicates limited long-distance animal movement between different geological zones within the Indus Civilisation. These findings suggest that individual animals primarily moved short- or medium-distances, though there are several significant exceptions seen in some pigs and cattle found at two large urban sites. We infer that long-distance transport of goods, be it raw materials, finished objects, other goods, or the animals themselves, could have occurred through the use of boats and waterways, by traction animals moving over long distances that did not end up in the archaeological record, and/or by different animals participating in many short to medium-distance movements.

'Green firecrackers' with reduced barium emissions in particulate matter.

Ambient air quality is affected due to the emission of pollutants on a large scale after the bursting of firecrackers. Traditionally in all firecrackers, barium (Ba) compounds are used as oxidizers and also to impart green colour flame. Combustion products of barium compounds are water soluble and readily absorbed by the body affecting human health. Thus, the inherent risk of Ba pollution due to the bursting of firecrackers has consequent health effects. To reduce the ambient air pollution caused due to burning of conventional firecrackers, CSIR NEERI has developed reduced emission firecrackers (green crackers). This is achieved by reducing the amount of chemicals, barium nitrate, shell size and addition of additives such as zeolite and iron oxide. This study aims to specifically investigate the influence of additives on the level of barium in reduced emission firecrackers. Four types of conventional and reduced emission firecrackers were selected and tested inside a firecracker emission testing facility to check the levels of barium in PM10 and PM2.5. The measured mean concentrations of all types of reduced emission crackers (green crackers) provided by fireworks manufacturers show significantly reduced barium concentration by 30-60% compared to conventional crackers depending on the type of firecrackers, shell size and amount of chemicals used. The possible reason for reduced Ba level is attributed to i) reduced usage of Ba(NO3)2 and ii) formation of heavy density compounds, leading to soil fallout.

Synthesis and characterization of aluminium substituted calcium hexaferrite.

Al substituted M type Ca hexaferrite with composition CaAlxFe12-xO19 (x = 0, 0.2, 0.4, 0.6, 0.8) were synthesized by sol gel auto combustion method. The prepared samples were characterized by XRD, SEM, FTIR and VSM. X ray diffraction study shows that the with increasing aluminum ion concentration lattice parameter a decreases from 5.87 Å to 5.83 Å while the lattice parameter c decreases from 22.15 Å to 22.00 Å are well within the range of M type of hexaferrite. The crystallite size of the particles decreases from 74.36nm to 62.12nm are suitable for magnetic recording. Morphology of the particles from SEM images was hexagonal platelet. The absorption band between 580 and 440cm-1 in FTIR confirm the formation of hexaferrite. The magnetic properties of the samples changes with Al ion substitution make the material suitable for low density longitudinal and perpendicular magnetic recording.

Validation of the Seegene RV15 multiplex PCR for the detection of influenza A subtypes and influenza B lineages during national influenza surveillance in hospitalized adults.

Background. The Serious Outcomes Surveillance Network of the Canadian Immunization Research Network (CIRN SOS) has been performing active influenza surveillance since 2009 (ClinicalTrials.gov identifier: NCT01517191). Influenza A and B viruses are identified and characterized using real-time reverse-transcriptase polymerase chain reaction (RT-PCR), and multiplex testing has been performed on a subset of patients to identify other respiratory virus aetiologies. Since both methods can identify influenza A and B, a direct comparison was performed.Methods. Validated real-time RT-PCRs from the World Health Organization (WHO) to identify influenza A and B viruses, characterize influenza A viruses into the H1N1 or H3N2 subtypes and describe influenza B viruses belonging to the Yamagata or Victoria lineages. In a subset of patients, the Seeplex RV15 One-Step ACE Detection assay (RV15) kit was also used for the detection of other respiratory viruses.Results. In total, 1111 nasopharyngeal swabs were tested by RV15 and real-time RT-PCRs for influenza A and B identification and characterization. For influenza A, RV15 showed 98.0 % sensitivity, 100 % specificity and 99.7 % accuracy. The performance characteristics of RV15 were similar for influenza A subtypes H1N1 and H3N2. For influenza B, RV15 had 99.2 % sensitivity, 100 % specificity and 99.8 % accuracy, with similar assay performance being shown for both the Yamagata and Victoria lineages.Conclusions. Overall, the detection of circulating subtypes of influenza A and lineages of influenza B by RV15 was similar to detection by real-time RT-PCR. Multiplex testing with RV15 allows for a more comprehensive respiratory virus surveillance in hospitalized adults, without significantly compromising the reliability of influenza A or B virus detection.

Evaluation of lymph node ratio and morphologic patterns of nodal reactive hyperplasia in primary organ malignancy.

BACKGROUND: Lymph node ratio (LNR) in cancer staging is the ratio of nodal metastases (LNM) to total nodes harvested (LNH). Reactive nodal hyperplasia can exhibit morphological patterns I to VI. AIMS: To measure LNR and evaluate it with tumor stage, tumor grade, LN reactive patterns, and LN size. SETTING AND DESIGN: Retrospective, observational study of 100 cancer resections including breast, gastrointestinal (GIT), genitourinary (GUT), and head, face, neck, and thyroid (HFNT). MATERIALS AND METHODS: Total 1463 LNs were reviewed for metastases and reactivity patterns I-VI as per the World Health Organization (WHO) protocol. LNR was calculated from LNM and LNH. STATISTICAL ANALYSIS USED: Association between qualitative variables was assessed by the Chi-square test and Fisher's exact test, those between quantitative variables using the unpaired t-test and Mann-Whitney U test. RESULTS: Mean LNH (23.7) was highest in HFNT and lowest (6.6) in GIT (P = 0.008). Mean LNR was highest (0.29) in breast and least (0.06) in HFNT (P = 0.861). Commonest LN reactive patterns were sinus histiocytosis (60), mixed (48), and follicular hyperplasia (46) (P = 0.000). Maximum cases of breast (59.6%), GUT (53.8%), and HFNT (45%) belonged to stage T2, while GIT (60.0%) to stage T3 (P = 0.000). Maximum well-differentiated cases belonged to HFNT (13, 59.0%), while moderately poorly differentiated cases of breast (38, 55.8% and 7, 70.0%) (P = 0.000). The largest and smallest metastatic LN was 2.4 cm and 0.4 cm (P = 0.009). LNs with thickened capsule showed nodal metastases in 75.7% (P = 0.003871). CONCLUSIONS: LNH and LNR cut-off values show organ-wise variation and need standardization. LNR shows stronger relation with tumor grade than tumor stage. Commonest LN reactive patterns include sinus histiocytosis and follicular hyperplasia. Thickened LN capsule strongly suggests nodal metastases. A longitudinal follow-up is warranted to study prognostic association between LNR and LN reactive pattern.

The Impact of Prior Season Vaccination on Subsequent Influenza Vaccine Effectiveness to Prevent Influenza-related Hospitalizations Over 4 Influenza Seasons in Canada.

BACKGROUND: Recent studies have demonstrated the possibility of negative associations between prior influenza vaccines and subsequent influenza vaccine effectiveness (VE), depending on season and strain. We investigated this association over 4 consecutive influenza seasons (2011-2012 through 2014-2015) in Canada. METHODS: Using a matched test-negative design, laboratory-confirmed influenza cases and matched test-negative controls admitted to hospitals were enrolled. Patients were stratified into 4 groups according to influenza vaccine history (not vaccinated current and prior season [referent], vaccinated prior season only, vaccinated current season only, and vaccinated both current and prior season). Conditional logistic regression was used to estimate VE; prior vaccine impact was assessed each season for overall effect and effect stratified by age (<65 years, ≥65 years) and type/subtype (A/H1N1, A/H3N2, influenza B). RESULTS: Overall, mainly nonsignificant associations were observed. Trends of nonsignificant decreased VE among patients repeatedly vaccinated in both prior and current season relative to the current season only were observed in the A/H3N2-dominant seasons of 2012-2013 and 2014-2015. Conversely, in 2011-2012, during which B viruses circulated, and in 2013-2014, when A/H1N1 circulated, being vaccinated in both seasons tended to result in a high VE in the current season against the dominant circulating subtype. CONCLUSIONS: Prior vaccine impact on subsequent VE among Canadian inpatients was mainly nonsignificant. Even in circumstances where we observed a trend of negative impact, being repeatedly vaccinated was still more effective than not receiving the current season's vaccine. These findings favor continuation of annual influenza vaccination recommendations, particularly in older adults. CLINICAL TRIALS REGISTRATION: NCT01517191.

Oxygen isotope in archaeological bioapatites from India: Implications to climate change and decline of Bronze Age Harappan civilization.

The antiquity and decline of the Bronze Age Harappan civilization in the Indus-Ghaggar-Hakra river valleys is an enigma in archaeology. Weakening of the monsoon after ~5 ka BP (and droughts throughout the Asia) is a strong contender for the Harappan collapse, although controversy exists about the synchroneity of climate change and collapse of civilization. One reason for this controversy is lack of a continuous record of cultural levels and palaeomonsoon change in close proximity. We report a high resolution oxygen isotope (δ(18)O) record of animal teeth-bone phosphates from an archaeological trench itself at Bhirrana, NW India, preserving all cultural levels of this civilization. Bhirrana was part of a high concentration of settlements along the dried up mythical Vedic river valley 'Saraswati', an extension of Ghaggar river in the Thar desert. Isotope and archaeological data suggest that the pre-Harappans started inhabiting this area along the mighty Ghaggar-Hakra rivers fed by intensified monsoon from 9 to 7 ka BP. The monsoon monotonically declined after 7 ka yet the settlements continued to survive from early to mature Harappan time. Our study suggests that other cause like change in subsistence strategy by shifting crop patterns rather than climate change was responsible for Harappan collapse.

Unfolded protein response-induced dysregulation of calcium homeostasis promotes retinal degeneration in rat models of autosomal dominant retinitis pigmentosa.

The molecular mechanism of autosomal dominant retinitis pigmentosa (ADRP) in rats is closely associated with a persistently activated unfolded protein response (UPR). If unchecked, the UPR might trigger apoptosis, leading to photoreceptor death. One of the UPR-activated cellular signaling culminating in apoptotic photoreceptor cell death is linked to an increase in intracellular Ca(2+). Therefore, we validated whether ADRP retinas experience a cytosolic Ca(2+) overload, and whether sustained UPR in the wild-type retina could promote retinal degeneration through Ca(2+)-mediated calpain activation. We performed an ex vivo experiment to measure intracellular Ca(2+) in ADRP retinas as well as to detect the expression levels of proteins that act as Ca(2+) sensors. In separate experiments with the subretinal injection of tunicamycin (UPR inducer) and a mixture of calcium ionophore (A231278) and thapsigargin (SERCA2b inhibitor) we assessed the consequences of a sustained UPR activation and increased intracellular Ca(2+) in the wild-type retina, respectively, by performing scotopic ERG, histological, and western blot analyses. Results of the study revealed that induced UPR in the retina activates calpain-mediated signaling, and increased intracellular Ca(2+) is capable of promoting retinal degeneration. A significant decline in ERG amplitudes at 6 weeks post treatment was associated with photoreceptor cell loss that occurred through calpain-activated CDK5-pJNK-Csp3/7 pathway. Similar calpain activation was found in ADRP rat retinas. A twofold increase in intracellular Ca(2+) and up- and downregulations of ER membrane-associated Ca(2+)-regulated IP3R channels and SERCA2b transporters were detected. Therefore, sustained UPR activation in the ADRP rat retinas could promote retinal degeneration through increased intracellular Ca(2+) and calpain-mediated apoptosis.

Primary mantle cell lymphoma of appendix.

We present a case of immunohistochemically proven primary mantle cell lymphoma of appendix that presented as a mass in right iliac fossa. The usual presentation of gastrointestinal mantle cell lymphoma is in the form of multiple lymphomatous polyposis. Mantle cell lymphoma has a unique immunohistochemistry and genetic abnormality.

UVB-emitting Gd(3+)-activated M2O2S (where M = La, Y) for phototherapy lamp phosphors.

Gd(3+)-activated oxysulphide (M2O2S) may be used to study Photoluminescence (PL) properties with respect to phototherapy. Gd(3+)-activated phosphor materials are widely used for phototherapy lamps. The Gd(3+) ion gives characteristic Narrow-Band (NB) emissions, in particular in the ultraviolet (UV) light region, that are used to treat more than 50 types of skin diseases. In this paper, M2O2S oxysulphide doped with Gd(3+) was synthesized by the solid-state flux fusion method and its down conversion spectral properties were studied as a function of different Gd(3+) concentrations. The sample was characterized by X-ray Diffraction (XRD), Scanning Electron Microscope (SEM), Fourier Transform Infrared Spectroscopy (FT-IR), and PL and the crystal structure was also studied. The lanthanum oxysulphide (La2O2S)-activated Gd(3+) ion showed a sharp emission peak at 314 nm when excited at 275 nm excitation, whereas the yttrium oxysulphide (Y2O2S)-activated Gd(3+) ion showed a sharp emission at 316 nm when excited by 272 nm. The effect of concentration of the Gd(3+) ion on the luminescence properties of M2O2S:Gd(3+) phosphor was also studied. These phosphor materials activated with the Gd(3+) ion may be suitable for phototherapy lamps, which are used to treat many types of skin diseases such as psoriasis, vitiligo, or scleroderma.

An activated unfolded protein response promotes retinal degeneration and triggers an inflammatory response in the mouse retina.

Recent studies on the endoplasmic reticulum stress have shown that the unfolded protein response (UPR) is involved in the pathogenesis of inherited retinal degeneration caused by mutant rhodopsin. However, the main question of whether UPR activation actually triggers retinal degeneration remains to be addressed. Thus, in this study, we created a mouse model for retinal degeneration caused by a persistently activated UPR to assess the physiological and morphological parameters associated with this disease state and to highlight a potential mechanism by which the UPR can promote retinal degeneration. We performed an intraocular injection in C57BL6 mice with a known unfolded protein response (UPR) inducer, tunicamycin (Tn) and examined animals by electroretinography (ERG), spectral domain optical coherence tomography (SD-OCT) and histological analyses. We detected a significant loss of photoreceptor function (over 60%) and retinal structure (35%) 30 days post treatment. Analysis of retinal protein extracts demonstrated a significant upregulation of inflammatory markers including interleukin-1ß (IL-1ß), IL-6, tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1) and IBA1. Similarly, we detected a strong inflammatory response in mice expressing either Ter349Glu or T17M rhodopsin (RHO). These mutant rhodopsin species induce severe retinal degeneration and T17M rhodopsin elicits UPR activation when expressed in mice. RNA and protein analysis revealed a significant upregulation of pro- and anti-inflammatory markers such as IL-1ß, IL-6, p65 nuclear factor kappa B (NF-kB) and MCP-1, as well as activation of F4/80 and IBA1 microglial markers in both the retinas expressing mutant rhodopsins. We then assessed if the Tn-induced inflammatory marker IL-1ß was capable of inducing retinal degeneration by injecting C57BL6 mice with a recombinant IL-1ß. We observed ~19% reduction in ERG a-wave amplitudes and a 29% loss of photoreceptor cells compared with control retinas, suggesting a potential link between pro-inflammatory cytokines and retinal pathophysiological effects. Our work demonstrates that in the context of an established animal model for ocular disease, the persistent activation of the UPR could be responsible for promoting retinal degeneration via the UPR-induced pro-inflammatory cytokine IL-1ß.

Interim estimates of 2013/14 influenza clinical severity and vaccine effectiveness in the prevention of laboratory-confirmed influenza-related hospitalisation, Canada, February 2014.

During the 2013/14 influenza season in Canada, 631 of 654 hospitalisations for laboratory-confirmed influenza enrolled in sentinel hospitals were due to Influenza A. Of the 375 with known subtype, influenza A(H1N1) accounted for 357. Interim unmatched vaccine effectiveness adjusted for age and presence of one or more medical comorbidities was determined by test-negative case-control design to be 58.5% (90% confidence interval (CI): 43.9-69.3%) overall and 57.9% (90% CI: 37.7-71.5) for confirmed influenza A(H1N1).

Applications of pathology-assisted image analysis of immunohistochemistry-based biomarkers in oncology.

Immunohistochemistry-based biomarkers are commonly used to understand target inhibition in key cancer pathways in preclinical models and clinical studies. Automated slide-scanning and advanced high-throughput image analysis software technologies have evolved into a routine methodology for quantitative analysis of immunohistochemistry-based biomarkers. Alongside the traditional pathology H-score based on physical slides, the pathology world is welcoming digital pathology and advanced quantitative image analysis, which have enabled tissue- and cellular-level analysis. An automated workflow was implemented that includes automated staining, slide-scanning, and image analysis methodologies to explore biomarkers involved in 2 cancer targets: Aurora A and NEDD8-activating enzyme (NAE). The 2 workflows highlight the evolution of our immunohistochemistry laboratory and the different needs and requirements of each biological assay. Skin biopsies obtained from MLN8237 (Aurora A inhibitor) phase 1 clinical trials were evaluated for mitotic and apoptotic index, while mitotic index and defects in chromosome alignment and spindles were assessed in tumor biopsies to demonstrate Aurora A inhibition. Additionally, in both preclinical xenograft models and an acute myeloid leukemia phase 1 trial of the NAE inhibitor MLN4924, development of a novel image algorithm enabled measurement of downstream pathway modulation upon NAE inhibition. In the highlighted studies, developing a biomarker strategy based on automated image analysis solutions enabled project teams to confirm target and pathway inhibition and understand downstream outcomes of target inhibition with increased throughput and quantitative accuracy. These case studies demonstrate a strategy that combines a pathologist's expertise with automated image analysis to support oncology drug discovery and development programs.

A randomized comparative trial evaluating the safety and efficacy of liposomal amphotericin B (Fungisome) versus conventional amphotericin B in the empirical treatment of febrile neutropenia in India.

BACKGROUND: In patients with persistent fever and netropenia, amphotericin B is administered empirically for early treatment and prevention of systemic fungal infections. Despite this treatment, there are chances of breakthrough fungal infections and drug is also toxic. MATERIALS AND METHODS: A multicentric, randomized, controlled clinical trial was conducted to compare liposomal amphotericin B two doses with conventional amphotericin B as empirical antifungal therapy. RESULTS: The average body weight of patients was 26.4 ± 14.8 (n=22), 32.9 ± 19.4 (n=23) and 37.9 ± 20.0 (n=20) kg in 1 mg, 3 mg Fungisome (liposomal amphotericin B) and 1 mg/kg/day conventional amphotericin B group, respectively. The mean age was 16.2 ± 13.4, 16.0 ± 10.9 and 22.7 ± 16.2 yrs in 1 and 3 mg/kg/day Fungisome and 1 mg/kg/day conventional AMP B group, respectively. The average duration of treatment with 1 mg and 3 mg/kg/day Fungisome and 1 mg/kg/day conventional amphotericin B was 17 ± 9.8, 16.2 ± 8.3, and 14.7 ± 10.7 days, respectively. The time to resolve fever was 13.3 ± 10.2, 10.9 ± 7.1, 10.1 ± 6.7 days, and for absolute neutrophil count (ANC) to be above 500 cells per microliter, it took 13.4 ± 9.6, 10.6 ± 7.6 and 7.3 ± 3.4 days, respectively. Liposomal formulations were well-tolerated compared to conventional amphotericin B. CONCLUSIONS: This small randomized study showed that the indigenous liposomal formulation Fungisome appears to be equally efficacious and safer than conventional amphotericin B. Also, the lower dose Fungisome (1 mg/kg/day) appears to be equally efficacious and was well-tolerated as compared to higher dose Fungisome (3 mg/kg/day). Treatment cost would be a major factor for limiting use of higher dose of Fungisome.

A method to minimize the global warming and environmental pollution.

There has been continuous increase in the level of CO2 in atmosphere. Therefore, it is essential to develop an economical and convenient process to reduce the concentration of CO2 in the atmosphere. In this study, we have proposed an economical and efficient adsorption method to minimize the environmental CO2. A fluidized bed adsorption column was used, fabricated using cast iron sheet. The low prize pyrolyzed biochar prepared from farming biomass (crushed fine powder) was used as an adsorbent to adsorb CO2 from the mixture of air and CO2 (99.5% air and 0.5% CO2). The experimental observation was taken for the % removal of CO2 from the mixture of air and CO2, development of adsorption isotherm and to study the effect of pressure and inlet gas flow rate on the amount of CO2 adsorbed per kg of biochar. The exhausted (CO2 adsorbed) biochar from the fluidized column was tested as a fertilizer for the wheat crop and it has given near about 10% increase in the height of wheat crop within the first 10 days after sowing the wheat seeds. On the basis of this experimentation, we have proposed a hypothetical method, using above mentioned fluidized bed column and biochar as adsorbent to reduce the CO2 concentration in the highly polluted regions.

Armodafinil versus Modafinil in Patients of Excessive Sleepiness Associated with Shift Work Sleep Disorder: A Randomized Double Blind Multicentric Clinical Trial.

Aim. To compare the efficacy and safety of armodafinil, the R-enantiomer of modafinil, with modafinil in patients of shift work sleep disorder (SWSD). Material and Methods. This was a 12-week, randomized, comparative, double-blind, multicentric, parallel-group study in 211 patients of SWSD, receiving armodafinil (150 mg) or modafinil (200 mg) one hour prior to the night shift. Outcome Measures. Efficacy was assessed by change in stanford sleepiness score (SSS) by at least 2 grades (responder) and global assessment for efficacy. Safety was assessed by incidence of adverse events, change in laboratory parameters, ECG, and global assessment of tolerability. Results. Both modafinil and armodafinil significantly improved sleepiness mean grades as compared to baseline (P < .0001). Responder rates with armodafinil (72.12%) and modafinil (74.29%) were comparable (P = .76). Adverse event incidences were comparable. Conclusion. Armodafinil was found to be safe and effective in the treatment of SWSD in Indian patients. The study did not demonstrate any difference in efficacy and safety of armodafinil 150 mg and modafinil 200 mg.