Search

Cutaneous collagenous vasculopathy (CCV) is a rare and idiopathic microangiopathy of superficial dermal blood vessels. There have been 75 cases described in the literature to date, not including the current report; however, given its clinical similarity to other primary telangiectasias, it is likely to be underreported and underdiagnosed. Here, we describe the clinical and histological features of 2 patients we newly diagnosed with CCV. Both generally fit the profile of prior cases and confirm previously described associations—they both are older White women, have rashes on their lower extremities, and have conditions and medications that are common among other reported cases. However, both are also somewhat atypical, as Patient 1 had symptomatic CCV and Patient 2 had a papular rash. As such, both cases broaden the spectrum of our current understanding of CCV. We also provide a comprehensive review of all published reports of CCV to date and uncover 2 previously unreported associations: one with visceral malignancy, and the other with hypothyroidism. Whether these association are coincidental is worth investigating in future studies.

To investigate cytokine levels in the tear fluid of patients receiving serial intravitreal injections (IVI) with anti-vascular endothelial growth factor (anti-VEGF) for neovascular age-related macular degeneration (nAMD).

Introduction: Metal-on-metal (MoM) total hip arthroplasty (THA) may cause adverse reactions to metal debris (ARMD). ARMD causing femoral vessel compression with serious complications has been described in case reports, but the rate of compression by ARMD is not known. This study aims to investigate the rate, and quantify the severity, of femoral vessel compression in MoM hips with ARMD lesions.Methods: Patients under surveillance for MoM THA investigated with MRI were studied. In patients with confirmed ARMD, femoral artery (FA) and vein (FV) diameters were measured at the point of maximal compression and compared to contralateral vessels. The primary outcome measure was presence or absence of compression. Cases were then classified by compression ratios. Secondary outcome measures were rates of deep vein thrombosis, revision surgery and time to ARMD from index procedure.Results: MRI scans for 436 patients with MoM THA were screened. Of these, 211/436 (48.4%) showed evidence of ARMD. Measurements were obtained on 133/211 (63.0%) patients. The FV was compressed in 102/133 (76.7%) and FA in 58/133 (43.6%), while 31/133 (23.3%) patients had no compression. In FVs, 42 demonstrated mild compression, 39 moderate and 21 severe. In FAs, none were severely compressed, 6 were moderate and 52 showed mild compression. There were 3 DVT cases, 2 in patients with moderate FV compression and 1 in patients without FV compression. Revision rates were highest in patients with severe FV compression (14/21, 66.7%). The mean time for MRI-diagnosed ARMD from index procedure was 8 years and 1 month (range 11 months–14.5 years).Conclusions: Extra-luminal compression of the femoral vessels was found in >75% of patients with ARMD. Although it is not clear whether revision for femoral vessel compression is required, quantification of FV compression may be useful for surgeons and radiologists considering revision for ARMD.

Mucocele-like lesions (MLLs) of the breast are rare lesions described as dilated, mucin-filled cysts associated with rupture and extracellular mucin in the surrounding stroma. These lesions are of clinical concern because they can coexist with a spectrum of atypical and malignant findings, including atypical ductal hyperplasia, ductal carcinoma in situ, and invasive carcinoma including mucinous carcinoma. Imaging findings of MLLs are nonspecific and varied, although the most common initial finding is that of incidental coarse heterogeneous calcifications on mammography. Occasionally, an asymmetry or mass may be found with or without calcifications, and such MLLs have a higher rate of upgrade to malignancy at excision. Pathology findings are often descriptive given the small sample received from percutaneous biopsy, and the primary consideration is to report any associated atypia, including atypical ductal hyperplasia. There is consensus in the literature that MLLs with atypia on biopsy should undergo excision because of the average reported 17.5% (20/114) upgrade rate to malignancy. The upgrade rate for MLLs without atypia averages 4.1% (14/341). Therefore, imaging surveillance may be a reasonable alternative to excision for MLLs with no atypia on a case-by-case basis. We review MLL imaging findings, pathology findings, and clinical management and present 3 cases from our institution to add to the literature on these rare lesions.

The following are the objectives of this study: (1) Assess the feasibility and acceptability of emailing parent-reported measures of infant health and development after NICU discharge. (2) Examine whether post-discharge questionnaire data helps identify infants most likely to benefit from specialized follow-up care. Parents of 51 infants <32 weeks’ gestation received email questionnaires at 44 weeks postmenstrual age (PMA) and 6 months corrected age (CA). Adverse infant outcomes were assessed in-person at 6 months: (1) Bayley-III cognitive or motor score?<85; (2) weight, length, or head circumference <10th percentile; (3) new referral for medical or developmental services. Questionnaire response was 48 (94%) at 44 weeks PMA and 46 (90%) at 6 months CA. 36 (70%) infants were assessed at 6 months; 72% had at least 1 adverse outcome. Poorer transition home, feeding problems, and special health care needs at 44 weeks PMA predicted adverse outcomes. Feeding problems, maternal depression, and lower infant health-related quality of life at 6 months CA correlated with adverse outcomes. Emailed questionnaires after NICU discharge were feasible to implement and acceptable to families. Repeated post-discharge assessments may help identify infants at heightened health and developmental risk.

Nasal inserts are novel solid, bio-adhesive dosage forms that various methods can prepare. Nasal inserts work on the principle of nasal fluid absorption from the nasal mucosa on administration into the nasal cavity, where it forms gel, avoiding foreign body sensation. They are administered via the nasal route and help to accomplish delayed systemic drug delivery. This investigation aimed to develop lyophilized nasal inserts of diltiazem hydrochloride for the treatment of hypertension using various concentrations of xanthan gum and guar gum. The drug content, surface pH, hydrophilicity studies, water uptake studies, mucoadhesive studies, in vitrodrug release studies, and ex vivopermeation studies of the drug-loaded inserts were carried out. It was further characterized and evaluated by differential scanning calorimetry, scanning electron microscopy, X-ray diffraction studies, histological investigation and stability studies. Lyophilized nasal inserts have advantages over other formulations due to their high-water uptake and mucoadhesion properties. The optimized formulation showed no significant changes in the treated nasal mucosa of the goat, and the stability of the formulation was confirmed by stability studies. The nasal insert containing xanthan gum and guar gum (1:3) is the optimized one because of its high drug content and better drug release when compared to other formulations. In conclusion, the novel nasal inserts of diltiazem hydrochloride could be a better alternative for treating hypertension.

ABSTRACTPerinatal undernutrition stress predisposes several disorders in adult life, which could be programed using nutraceuticals. However, the effect of perinatal undernutrition stress on orexin peptides, brain lipids, and its amelioration by a potent antioxidant (Astaxanthin) needs exploration. The present study focussed on the effect of perinatal undernutrition stress on brain fatty acid levels, Orexin peptides A and B, and its amelioration by Astaxanthin.Twenty-four male Wistar rats (Rattus norvegicus) were allocated to four groups (n = 6) as Normal, Perinatally Undernourished (UN), Astaxanthin treated (AsX, 12mg/kg), and perinatally Undernourished-but-Astaxanthin treated (UNA), and are allowed to grow for 1, 6 and 12 months. The fatty acid and orexin peptides A & B at different brain parts were measured and compared. Orexin peptides were assessed using an ELISA kit. Fatty acid levels were estimated using HP 5890 gas chromatograph. Data were analyzed by ANOVA followed by Tukey’s posthoc test. P < 0.05 was considered significant.The hair cortisol, Orexin-A, and B were significantly increased (p < 0.001) in the UN group compared to normal and were modulated significantly by AsX in the UNA group. Undernutrition stress during the perinatal period altered the lipid profile, Total SFA, Total MUFA, Totaln-3 PUFA, Totaln-6 PUFA,n-3: n-6 PUFA, which Astaxanthin effectively modulated at 6 and 12 months of postnatal life. There was no difference between DHA and AA ratio. These results indicate that nutritional enrichment with Astaxanthin during the perinatal period positively contributes to adult health. Further, the mechanism of regulation of brain chemistry by Astaxanthin is warranted.

Leptocybe invasaFisher & La Salle, 2004 (Hymenoptera: Eulophidae), is a gall wasp that infests EucalyptusL’Hér. (Myrtaceae) species and their crosses in nurseries, orchards and plantations. This pest infests the young plants, coppice shoots and both middle aged and old trees in an ever-increasing number of countries around the world; making it important to record new countries with incidences, as well as new host plants and associated parasitoids of this pest. The objectives of this paper were to record, for the first time, L. invasagalls parasitized by Megastigmussp. (Hymenoptera: Torymidae) on a new host plant, Eucalyptus brassianaS.T. Blake in Indonesia and key biological data from this association. The number of galls was similar between branch parts (petioles, midribs and stems) and branches. The number of emerged adults differed between their species (L. invasaand Megastigmussp.) with a higher number for the pest, but similar between branches. The occurrence of L. invasain Indonesia is alarming as this country is a large producer of paper, pulp and viscose materials from Eucalyptuswood for local and foreign markets. However, its parasitism by Megastigmusopens the possibility to develop biological control programs.

Hip fracture is the most common injury requiring treatment in hospital. Controversy exists regarding the use of antibiotic loaded bone cement in hip fractures treated with hemiarthroplasty. We aimed to compare the rate of deep surgical site infection in patients receiving high-dose dual-antibiotic loaded cement versus standard care single-antibiotic loaded cement.

Purpose: The purpose of this study series, which involves a questionnaire survey and qualitative interviews, was to (a) evaluate patient-reported usefulness of continuous glucose monitor (CGM) hypoglycemia-informing features and (b) identify challenges in using these features (ie, CGM glucose numbers, trend arrows, trend graphs, and hypoglycemia alarms) during hypoglycemia in adults with type 1 diabetes (T1DM).Methods: A cross-sectional questionnaire survey study was conducted with adults who have T1DM and were using CGMs to assess the perceived usefulness of hypoglycemia-informing features. A semistructured interview study with T1DM CGM-using adults and inductive thematic analysis were subsequently performed to identify challenges in using CGM hypoglycemia-informing features to manage hypoglycemia.Results: In the survey study (N = 252), the CGM glucose numbers, trend arrows, trend graphs, and hypoglycemia alarms were found to be very useful by 79%, 70%, 43%, and 64% of participants, respectively. Several challenges in using these features to manage hypoglycemia were identified in the qualitative study (N = 23): (1) hypoglycemia information not fully reliable,; (2) unpredictability of future blood glucose levels, (3) lack of awareness about how information can be used, and (4) disruptions associated with information.Conclusions: Although the majority of T1DM adults found their CGMs’ hypoglycemia-informing features helpful, challenges in optimally using these features persisted. Targeted knowledge and behavioral interventions could improve CGM use to reduce hypoglycemia.

Entropy stabilized oxides (ESOs) are a new class of stable hybrids and single phase metal oxides made from multiple ions with material properties somewhere between the constituent oxides, or occasionally entirely new properties. One of the limitations of ESOs is their energy-intensive fabrication process, which has resulted in slow development and scale-up of new ESOs. In this work, we present a novel energy-efficient ESO synthesis method that uses the ability of carbonaceous materials to heat rapidly in response to radio frequency (RF) fields in 1–200 MHz range. Using carbon fibers and graphene as RF susceptors, synthesis of (Mg0·2Co0·2Ni0·2Cu0·2Zn0.2)O is achieved through RF-initiated combustion synthesis with heating rates of 203 °C/s at 20 W of input power. This method reduces the formation time of ESOs to less than a minute, allowing for much more efficient fabrication. The corresponding morphology and composition of the as-synthesized ESO-carbon fiber and ESO-graphene were studied using extensive spectroscopy and characterization. Additionally, single carbon fibers coated with ESO were tested for tensile strength and modulus; little change in mechanical properties was observed as compared to pristine fibers. This work opens an exciting frontier for the rapid synthesis of ESO-carbon composites using RF heating as a non-contact, rapid, and efficient manufacturing process.

We report the map of 20 reactions that take place during vapor‐phase photochemical dehydrogenation of ethanol on four metal‐doped TiO2(Mn/TiO2, Mn= nanoparticles of Pd, Pt, Au, and Cu) under solar simulated light. The reactions are sensitively affected by the moisture amount and the nature of the carrier gas. To construct the above map, we also used CH3CHO, CH3CO2H, (C2H5O)2CHCH3, and CH3CO2C2H5, respectively, as an independent starting reagent. Amazingly, Mn/TiO2not only serves as photocatalysts but also as thermocatalysts for various reactions that appear in the above map. The reaction is proposed to proceed by a radical mechanism in which photoinduced electron transfer from the valence band to the conduction band of TiO2is the initial step and the subsequent electron injection from organic reactants to the hole in the TiO2valence band. This report also features highly valuable unprecedented reactions, which bear great potential to be commercialized. Twenty reactions that take place during vapor–solid photochemical dehydrogenation of ethanol on metal‐doped TiO2and the map on how they are interconnected are reported. It gives insights into photocatalytic and thermocatalytic dehydrogenation of ethanol and others and helps to develop eco‐friendly processes for the dehydrogenation and oxidative coupling of other alcohols into various products.

ABSTRACTIn global sustainability governance, many actors have emphasised the need for policy integration across the economic, social, and environmental dimensions. In 2015, the United Nations agreed on 17 Sustainable Development Goals (SDGs) to advance such integration. But have international organisations responded to this call, and can we observe any integrative effect of the SDGs? We draw on International Relations theories that incorporate change in their analysis and develop an analytical framework to assess change through the lenses of ideas, norms, and institutions. We use this framework to assess sustainability-oriented change in the International Labour Organisation (ILO). The ILO is traditionally an organisation with a primarily socio-economic mandate and hence an ideal case to study whether the SDGs had any impact after 2015 in strengthening the environmental dimension of sustainability in the ILO’s institutional settings and policy development. We focus on the 2010–2019 period and conduct a systematic qualitative content analysis of primary documentary sources, complemented with expert interviews and data on operational developments. The paper concludes that there is a significant yet instrumental greening trend in the ILO’s approach to sustainable development, but also a bidirectional influence between the ILO and the SDGs.

There is increasing demand for cost-efficient composite materials having higher strength but lower weight. graphene nanoplatelets (GNPs) are novel nanofillers, compatible with most polymer matrices, enhancing overall mechanical properties. Present work was focussed on analysing elastic properties and stresses of GNP-reinforced laminated epoxy nanocomposites, under low graphene contents. Various elastic properties were evaluated by Halpin–Tsai model, for varying GNP volume fractions. Addition of this nano-filler is observed to have significant influence on the elastic properties of laminated nanocomposites. Finite element (FE) analysis was carried out on GNP/epoxy laminated nanocomposites with different lay-ups, for varying GNP volume fractions. Stress variation throughout the laminate thickness was investigated using both FE and classical lamination theory (CLT), considering quasi-isotropic, cross-ply, and unidirectional laminate orientations. Quasi-isotropic laminated nanocomposites may be more effective than cross-ply and unidirectional nanocomposites. FE results for both normal and shear stresses were verified with theoretical results calculated using CLT.

ABSTRACTBumble bees, along other managed honeybee species, provide vital pollination services to a wide range of agricultural and wild plants over the Himalayan range. As a result, it is regarded as one of the most important pollinator species in the Himalayan area. For the first time in our knowledge, we report an assessment of existing and projected habitat suitability distribution of bumble bees in the Great Himalayan National Park Conservation area. Between May 2018 and October 2019, nine species were reported in the region. A maximum entropy (MaxEnt) species distribution model was used to make future forecasts for the year 2050 utilising bioclimatic and biophysical data. The Jackknife test was performed to assess the variables’ contribution to predictive modelling. In the year 2050, Bombus tunicatus, Bombus haemorrhoidalis, Bombus festivusand Bombus asiaticuswill be in more danger, representing the least suitable territory, according to a comparison of the nine species of bumble bees. This loss in species distribution area may result in the extinction of vital wildflower pollinators in the near future.

A facile stamping method was developed to assemble ordered arrays of mesoporous WO3micropillars with uniform sizes, shapes, and lengths on F-doped tin oxide glass. Using this method, a series of WO3heterostructural bilayer photoanodes consisting of an array of m-μm long ordered mesoporous WO3micropillars at the top and the n-μm thick mesoporous WO3plain sheet layer at the bottom (denoted as m/n) were prepared. Among them 2.5/7.5 displayed a steady state photocurrent density of 3.6 mA cm–2at 1.23 V (vs RHE) under AM 1.5 (1 Sun), which is much higher than that of the plain 10-μm thick WO3sheet (2.5 mA cm–2). This phenomenon occurs owing to the following six benefits: increases in charge carrier density, number of photogenerated electron, charge collection rate, thermodynamic feasibility for the vectorial charge transport from the outermost layer of the photoanode to the inner layer, the surface hydrophilicity, and the decrease in charge transfer resistance.

Background Randomised controlled trials (RCTs) often struggle with various aspects of participant recruitment, including engaging clinicians to recruit effectively, and subsequently fail to reach their target sample size. Studies evaluating interventions to improve recruitment aimed specifically at recruiters to the trial are limited in number. The RCTs embedded into the World Hip Trauma Evaluation (WHiTE) cohort study use Trainee Principal Investigators (TPIs) to help manage and drive recruitment at trial sites. No formalised training or support is provided by central trials units to the TPIs. Additionally, trial recruiters receive a generic automated email confirming randomisation to the trial with no other communication to influence or incentivise their behaviour to further recruit. The primary aim of this factorial trial was to evaluate the effectiveness of an educational intervention to TPIs and a positive reinforcement intervention via an email (digital) nudge on increasing recruitment. Secondary aims included feasibility of implementing the interventions and surveying TPIs on the educational package quality of content, delivery and ongoing support.Design This was a multicentre, open, cluster, 2x2 factorial RCT embedded in the WHiTE 8 COPAL RCT, in which research sites were randomised 1:1:1:1 to receive the enhanced TPI package, the digital nudge intervention, both, or neither.Results 1215 patients were recruited to the WHiTE 8 COPAL trial across 20 sites during the SWAT between August 2018 and March 2019. There was a statistically significant interaction between the interventions (IRR 2.09, 95% CI 1.64 to 2.68, p< 0.001). There was a statistically significant benefit on recruitment (IRR 1.23 95% 1.09 to 1.40, p=0.001) from utilizing an enhanced TPI education intervention. The digital nudge intervention had no significant impact on recruitment (IRR 0.89 95% CI 0.79 to 1.01, p=0.07). Within enhanced TPI package sites, the digital nudge had a beneficial effect, while in the standard practice TPI sites it had a detrimental effect. Feasibility analysis showed the median time to site digital nudge and enhanced TPI set up were one day and 17 days, respectively. 353 digital nudges were created taking an average of 12 min to construct, log the activity and then disseminate to recruiters. Median induction time for enhanced TPI was 32 min and 100% of the groups were extremely satisfied with the induction content, delivery and ongoing support.Discussion An education and support programme targeted at surgical TPIs involving a digital education package, 1:1 telephone induction and subsequent support package was effective in increasing recruitment in the first 6 months of trial commencement. There was no evidence for the effectiveness of the digital nudge intervention in isolation, although our results show that when combined with an education programme, it leads to enhanced effectiveness of that programme.

Assessing the effectiveness of activated carbon is essential for the optimal operation of water treatment systems. Traditional evaluation methods, although precise, are typically labor-intensive and require complex equipment This study introduces a novel application of the B.EL.D™ device, utilizing redox potential measurements to gauge the activation level of carbon filters—an approach not previously employed. We hypothesized that redox potential is a reliable indicator of activated carbon's performance, a hypothesis that was rigorously validated through extensive testing against the standard iodine number test (ASTM D4607). Our analysis included both control and operational samples from ongoing water treatment processes over two years, confirming a definitive correlation between redox potential and carbon's adsorptive capacity. The findings demonstrate the potential of our method as a rapid, accurate, and cost-effective alternative to current testing practices. Currently under patent consideration, this study marks a significant advancement towards improving the assessment of activated carbon filters, providing an efficient pathway for water treatment facilities and establishing the foundation for a predictive maintenance model.

The satisfaction with life and, in particular, with treatment in Parkinson’s disease (PD) is understudied. To explore a new 7-item rating tool assessing satisfaction with life and treatment (SLTS-7) in PD. In this cross-sectional, multi-center study, including patients screened for advanced therapies, psychometric characteristics of the SLTS-7 were analyzed. An exploratory factor analysis identified the underlying factorial structure of the SLTS-7. 117 patients were included, and the data quality of the SLTS-7 was excellent (computable data 100%), and acceptability measures satisfied standard criteria. Besides the global assessment (item 1), the exploratory factor analysis produced item 2 (physical satisfaction) as an independent item and two factors among the remaining items: items 3–5 (psycho-social satisfaction), and items 6 and 7 (treatment satisfaction). Cronbach’s alpha was 0.89, indicative of high internal consistency. The SLTS-7 total score correlated moderately with motor symptoms and weakly with non-motor symptoms total scores. SLTS-7 showed the highest correlations with the European Quality of Life with 5 items (EQ-5D) visual analog scale (0.43–0.58, p < 0.01), indicating a moderate convergent validity. The SLTS-7 significantly increased with higher non-motor symptoms burden levels (p = 0.002). Life satisfaction in PD covers three specific aspects, namely physical, psycho-social, and treatment satisfaction. The new SLTS-7 is a valid, reliable, and easy-to-use tool to assess satisfaction with life and treatment in patients with PD screened for advanced therapies. Longitudinal studies analyzing the effect of advanced PD treatment on life and treatment satisfaction are warranted.

Efforts to sustain multi-scalar benefit flows from forests increasingly concentrate on interventions in landscapes. Integrated landscape approaches have emerged as the dominant paradigm among international agencies for reconciling competing land uses. Small and medium forest enterprises receive growing attention for their ability to meet local development aspirations while supporting healthy forest ecosystems. Despite their prevalence in forest sustainability initiatives, landscape approaches and small and medium enterprises have not yet been integrated into a holistic framework. Here, we conceptually integrate the two phenomena using place as a guiding concept. We examined peer-reviewed literature to understand cultural, socio-political, and biophysical attributes and processes that influence outcomes of small and medium forest enterprises. We then held a series of seminars to discuss empirical and theoretical advances in landscape approaches and the role of small and medium forest enterprises. From this, we identified areas of complementarity, where investments might lead to mutual gains for prosperous and sustainable forest landscapes. We propose four overarching synergies between integrated landscape approaches and small and medium forest enterprises: (I) collective organization, decision-making, and action, (II) empowerment, rights, and tenure security, (III) coherent policy and commitment across governance scales, and (IV) managing for multiple functions and values within planetary boundaries. To increase understanding of these synergies in local contexts, researchers and practitioners could share lessons from place-based sustainability science, contributing to learning systems for inclusive benefit flows in forest landscapes.

The article presents letters from queer writers and artists in the U.S. about their life experiences. Artist Amanda Monti of Brooklyn, New York shares her experiences as a hand model and a palm reader. Writer Drew Pham of Brooklyn, New York talks about her dream of having children as a transgender woman.

Supplemental Digital Content is available in the text.Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare, low-grade adnexal neoplasm with predilection for the periorbital skin of older women. Histologically and immunophenotypically, EMPSGC is analogous to another neoplasm with neuroendocrine differentiation, solid papillary carcinoma of the breast. Both lesions are spatially associated with neuroendocrine mucinous adenocarcinomas of the skin and breast, respectively. EMPSGC is ostensibly a precursor of neuroendocrine-type mucinous sweat gland adenocarcinoma (MSC), a lesion of uncertain prognosis. Non-neuroendocrine MSC has been deemed locally aggressive with metastatic potential, and previous works speculated that EMPSGC-associated (neuroendocrine-type) MSC had similar recurrence and metastatic potential with implications for patient follow-up. Only 96 cases of EMPSGC have been reported (12 cases in the largest case series). Herein, we present 63 cases diagnosed as “EMPSGC” in comparison with aggregated results from known published EMPSGC cases. We aim to clarify the clinicopathologic features and prognostic significance of the neuroendocrine differentiation of EMPSGC and its associated adenocarcinoma and to determine the nosological relevance of EMPSGC association in the spectrum of MSC histopathogenesis. Results established an overall female predominance (66.7%) and average presenting age of 64 years. EMPSGC lesions were associated with adjacent MSC in 33.3% of cases. The recurrence rate for neuroendocrine-type MSC was ~21%, less than the reported 30% for non-neuroendocrine MSC. There were no cases of metastasis. EMPSGC and neuroendocrine-type MSC are distinct entities with more indolent behavior than previously reported, supporting a favorable prognosis for patients.

Wild meat has long been a staple of rural communities in West Papua Province, Indonesia. However, development of commercial networks has resulted in wild meat being increasingly transported in from forests to urban areas. This study describes the structure and operation of the wild meat trade chain along the coast of the Bird's Head Peninsula (BHP) of West Papua, including how wild meat flows from forests to urban areas and contributes to local livelihoods across the trade chain. Commercial networks have developed and wild meat is transported from forests to urban areas and contributes to livelihoods along the entire value chain. A survey was conducted on three groups of hunters: “focal respondents” (N = 220), including “participating hunters” (N = 33); “random respondents” (N = 800); and other actors (“intermediaries” [N = 6], “market traders” [N = 3], and “restaurant owners” [N = 4]) involved in the meat trade. Results indicate that hunting for trade is still a secondary livelihood activity, with more than half of our respondents selling hunted wildlife within their home villages. Hunters, intermediaries, market traders, and restaurant owners are involved in longer-distance wild meat trade and their roles are well defined from hunting to trading. The trade in wild meat along the coast of the BHP mirrors patterns found in other parts of the tropics. Market-oriented hunting that is emerging along the coast of the BHP may increase hunters' dependence on trading, which may increase the number of stakeholders involved. Consequently, wild meat harvest rates may be affected as modern techniques are used to increase the efficiency of hunting. Improving local agriculture productivity may be important to boost incomes and reduce the need to supplement income by selling wild meat. Development and conservation efforts should be focused on creating jobs for remote rural communities and to changing the behavior of wild meat purchasers.

PurposeTo estimate the total healthcare cost associated with diabetic retinopathy (DR) in type 2 diabetes in Indonesia and its projection for 2025.MethodsA prevalence-based cost-of-illness model was constructed from previous population-based DR study. Projection for 2025 was derived from estimated diabetes population in 2025. Direct treatment costs of DR were estimated from the perspective of healthcare. Patient perspective costs were obtained from thorough interview including only transportation cost and lost of working days related to treatment. We developed four cost-of-illness models according to DR severity level, DR without necessary treatment, needing laser treatment, laser +intravitreal (IVT) injection and laser + IVT +vitrectomy. All costs were estimated in 2017 US$.ResultsThe healthcare costs of DR in Indonesia were estimated to be $2.4 billion in 2017 and $8.9 billion in 2025. The total cost in 2017 consisted of the cost for no DR and mild–moderate non-proliferative DR (NPDR) requiring eye screening ($25.9 million), severe NPDR or proliferative DR (PDR) requiring laser treatment ($0.25 billion), severe NPDR or PDR requiring both laser and IVT injection ($1.75 billion) and advance level of PDR requiring vitrectomy ($0.44 billion).ConclusionsThe estimated healthcare cost of DR in Indonesia in 2017 was considerably high, nearly 2% of the 2017 national state budget, and projected to increase significantly to more than threefold in 2025. The highest cost may incur for DR requiring both laser and IVT injection. Therefore, public health intervention to delay or prevent severe DR may substantially reduce the healthcare cost of DR in Indonesia.

The aim of the present study was to assess, for the first time to our knowledge, Listeria monocytogenesCFU changes, as well as to determine the transcription of key virulence genes, namely, sigB, prfA, hly, plcA, plcB,inlA, inlB, inlC, inlJ, inlP,and lmo2672after in vitro exposure to human gastric and duodenal aspirates. Furthermore, investigations of the potential correlation between CFU changes and gene regulation with factors influencing gastric (proton pump inhibitor intake and presence of gastric atrophy) and duodenal pH were the secondary study aims. Gastric and duodenal fluids that were collected from 25 individuals undergoing upper gastrointestinal endoscopy were inoculated with L. monocytogenesserotype 4b strain LQC 15257 at 9 log CFU•mL−1and incubated at 37°C for 100 min and 2 h, respectively, with the time corresponding to the actual exposure time to gastric and duodenal fluids in the human gastrointestinal tract. Sampling was performed upon gastric fluid inoculation, after incubation of the inoculated gastric fluids, upon pathogen resuspension in duodenal fluids and after incubation of the inoculated duodenal fluids. L. monocytogenesCFU changes were assessed by colony counting, as well as reverse transcription quantitative PCR by using inlBas a target. Gene transcription was assessed by reverse transcription quantitative PCR. In 56% of the cases, reduction of the pathogen CFU occurred immediately after exposure to gastric aspirate. Upregulation of hlyand inlCwas observed in 52 and 58% of the cases, respectively. On the contrary, no upregulation or downregulation was noticed regarding sigB, prfA, plcA, plcB, inlA, inlB, inlJ,inlP,and lmo2672. In addition, sigBand plcAtranscription was positively and negatively associated, respectively, with an increase of the pH value, and inlAtranscription was negatively associated with the presence of gastric atrophy. Finally, a positive correlation between the transcriptomic responses of plcB, inlA, inlB, inlC, inlJ, inlP,and lmo2672was detected. This study revealed that the CFU of the pathogen was negatively affected after exposure to human gastroduodenal aspirates, as well as significant correlations between the characteristics of the aspirates with the virulence potential of the pathogen.

We present the first low‐temperature thermochronology data from northernmost Ellesmere Island (Canadian Arctic), along with palynological data from Paleogene sediments. Our study area is part of the >2,500‐km‐long Eurekan deformation belt that formed across the High Arctic during the Eocene. The aim of this study is to investigate the exhumation of the Eurekan belt and potential relationships with the opening of the North Atlantic, as well as with environmental changes of the Arctic. Our data show that the Canadian Arctic margin was characterized by stretching and basin formation during the Paleocene. Sediment deposition occurred in a coastal swamp environment under a warm and humid climate that lasted into the early Eocene. Exhumation of northern Ellesmere Island was episodic and was presumably controlled by strike‐slip movements along the De Geer Fracture Zone between Svalbard and Greenland. Enhanced exhumation of northern Ellesmere Island occurred ~66–60 Ma, ~55–48 Ma, 44–38 Ma, and 34–26 Ma. These exhumation periods largely correlate with changes of spreading rates and movement directions of the Norwegian‐Greenland Sea. Main topographic growth along the Eurekan belt was temporally coincident with deposition of ice‐rafted debris off eastern Greenland. We suggest that Eurekan topography growth was an important trigger for glacier formation in Greenland. The cessation of rapid exhumation at ~26 Ma can be explained by continental separation between Greenland and Svalbard, which decoupled northern Ellesmere Island from strike‐slip movements along the De Geer Fracture Zone, eventually leading to the opening of the Fram Strait. Thermochronology data suggest Eocene high‐latitude rapid exhumation and topography formationIntracontinental Eureka Orogeny seems to be controlled by far‐field effects of North Atlantic spreadingRise of the Eureka Belt starts at warm and humid conditions and may have triggered subsequent Arctic glaciation

Since the introduction of autologous platelet-rich plasma (PRP) in medical practice, various studies have documented that implementing PRP can enhance healing and the anti-aging process, employing angiogenesis regeneration due to the multiple growth factors and cytokines involved. Numerous reports have shown promising results with the use of PRP in ovarian treatment, regarding ovarian regeneration and reactivation of folliculogenesis. This case series reports on two women with premature ovarian failure (POF) aged 40 and 27 years, respectively, and one menopausal woman aged 46 years. All patients presented with lack of menstrual cycle for over a year. The women reported previous failed in vitro fertilization (IVF) attempts, and, after rejecting the option of oocyte donation, they opted for the approach of autologous ovarian PRP treatment. Following PRP treatment, the three patients were invited to conceive naturally. The primary outcome was the restoration of menstruation following autologous ovarian PRP treatment, as well as an improvement in hormonal profile, a decrease in follicle-stimulating hormone (FSH) levels, and a concurrent increase in anti-Müllerian hormone (AMH) levels. Further to that, our patients achieved pregnancy through natural conception within 2–6 months following PRP treatment, resulting in currently ongoing complication-free clinical pregnancies – a first report in the literature for menopausal and POF patients. Implementation of PRP should be further investigated through randomized controlled trials (RCTs), as it may hold the key to successful treatment for a certain cohort of patients exploring reproductive treatment options following menopause.

Ultrathin polymeric films may completely change in their surface properties from bacteria loving to bacteria repelling which are essential for creating non-fouling surfaces. The covalent modifications of biodegradable polylactide (PLA) surface with alkyl bromide initiator followed by immobilization of three different types of polymers having potential antibacterial effects, i.e., poly(2-hydroxyethyl methacrylate) (PHEMA), Poly(2-[(methacryloyloxy)ethyl]trimethylammonium chloride) (PMETA) and poly(poly(ethylene glycol) methacrylate) (PPEGMA) were successfully conducted using surface-initiated atom transfer radical polymerization (ATRP) technique. High initiator density (1.72 initiator/nm2) on PLA surface determined by XPS led to the formation of smooth polymer brush as shown by AFM images which were further characterized by FTIR and contact angle measurement. Though linear brush growth was observed irrespective of monomers employed, ‘grafting yield’ was found to be highest for PHEMA brush (22.2 µg cm−2at 6 h) under similar conditions indicating its high activity in the presence of efficient catalytic system. Finally, the antibacterial response of these brushes was evaluated against both gram-positive (Staphylococcus aureus) and gram-negative (Escherichia coli) bacteria and PMETA modified PLA surface was found to exhibit the highest inhibition of bacterial adhesion (> 97% for S.aureus). The novelty lies in the generation of polymer brushes with excellent antibacterial property onto biodegradable polylactide surface. The potential uses of these modified surfaces would include biomedical devices, food packaging, etc.

The various oligomeric states of the M2 isoform of pyruvate kinase (PKM2) were distinguished using native mass spectrometry. The effect of PKM2 concentration on its dimer–tetramer equilibrium was monitored, and a value for the dissociation constant (Kd) of the two species was estimated to be 0.95 µM. Results of binding of fructose-1,6-bisphosphate (FBP) to PKM2 are shown and provide insight into the allosteric mechanism and changes in the oligomerization status of PKM2. The average Kdfor binding of FBP to the PKM2 tetramer was estimated to be 7.5 µM. It is concluded that four molecules of FBP bind to the active PKM2 tetramer whereas binding of FBP to the PKM2 dimer was not observed. It is suggested that either FBP potentiates rapid tetramer formation after binding to apo PKM2 dimers or FBP binds to PKM2 apo tetramers, thus driving the dimer–tetramer equilibrium in the direction of fully FBP-bound tetramer. The binding occurs in a highly positively cooperative manner with a Hill coefficient (n) of 3.

Drug-induced liver injury resulting from herbal and dietary supplement use is increasingly common and underrecognized. We report a case of a 34-year-old male recreational bodybuilder who presented with muscle cramping, fatigue, and diffuse itching in the setting of bodybuilding supplement use. Labs showed cholestatic liver injury, and liver biopsy revealed bland cholestasis and sinusoidal dilation. He was diagnosed with anabolic-androgenic steroid-induced liver injury. He was symptomatically managed with plasmapheresis for debilitating pruritus. This case highlights drug-induced liver injury as a complication of bodybuilding supplement use containing unlabeled anabolic-androgenic steroids. Sports medicine providers should inquire on herbal and dietary supplement use and be aware of potential contaminants.

Emanuela Agni takes issue with comments by usability guru Jakob Nielsen made in Computer Weekly's 9 November issue Jakob Nielsen's controversial ideas are at the centre of a raging battle […]

Native electrospray ionization mass spectrometry (ESI-MS) was applied to analyze the binding of compounds generated during fragment-based drug discovery (FBDD) campaigns against two functionally distinct proteins, the X-linked inhibitor of apoptosis protein (XIAP) and cyclin-dependent kinase 2 (CDK2). Compounds of different molecular weights and a wide range of binding affinities obtained from the hits to leads and lead optimization stages of FBDD campaigns were studied, and their dissociation constants (Kd) were measured by native ESI-MS. We demonstrate that native ESI-MS has the potential to be applied to the stages of an FBDD campaign downstream of primary screening for the detection and quantification of protein–ligand binding. Native ESI-MS was used to derive Kdvalues for compounds binding to XIAP, and the dissociation of the complex between XIAP and a peptide derived from the second mitochondria-derived activator of caspases (SMAC) protein induced by one of the test compounds was also investigated. Affinities of compounds binding to CDK2 gave Kdvalues in the low nanomolar to low millimolar range, and Kdvalues generated by MS and isothermal titration calorimetry (ITC) followed the same trend for both proteins. Practical considerations for the application of native ESI-MS are discussed in detail.

Plants exposed to adverse environmental conditions are invariably compromised in their growth and development. The bZIP class of transcription factors (TF) form a large group among stress signalling components that regulate plant responses towards stress. We identified bZIP TF encoding genes that are expressed differentially in indicarice under stress and here we functionally characterize one such gene, OsbZIP16. Although, OsbZIP16 forms a clade with its orthologous monocot protein sequences, we find in our study that it can impart tolerance to abiotic stress in Arabidopsis. OsbZIP16is expressed strongly upon dehydration, salt and ABA treatment in Oryza sativacv. IR64 seedlings. It localizes in the cell nucleus and the gene product is capable of transcriptional activation, thus providing evidence for its capability as a functional TF. Upon overexpression in Arabidopsis, OsbZIP16oxplants show wild type morphology, however, these plants showed tolerance when subjected to drought stress at vegetative stage and set healthy seeds on recovery. The OsbZIP16oxseedlings showed reduced sensitivity to mannitol, ABA and sodium chloride during germination and also reduced ROS accumulation upon H2O2exposure. Thus, OsbZIP16regulates abiotic stress responses and is also a good candidate gene that can be utilised to impart tolerance in plants under water deficit conditions.

Native electrospray ionization mass spectrometry (ESI-MS) was applied to analyze the binding of compounds generated during fragment-based drug discovery (FBDD) campaigns against two functionally distinct proteins, the X-linked inhibitor of apoptosis protein (XIAP) and cyclin-dependent kinase 2 (CDK2). Compounds of different molecular weights and a wide range of binding affinities obtained from the hits to leads and lead optimization stages of FBDD campaigns were studied, and their dissociation constants (Kd) were measured by native ESI-MS. We demonstrate that native ESI-MS has the potential to be applied to the stages of an FBDD campaign downstream of primary screening for the detection and quantification of protein–ligand binding. Native ESI-MS was used to derive Kdvalues for compounds binding to XIAP, and the dissociation of the complex between XIAP and a peptide derived from the second mitochondria-derived activator of caspases (SMAC) protein induced by one of the test compounds was also investigated. Affinities of compounds binding to CDK2 gave Kdvalues in the low nanomolar to low millimolar range, and Kdvalues generated by MS and isothermal titration calorimetry (ITC) followed the same trend for both proteins. Practical considerations for the application of native ESI-MS are discussed in detail.

ABSTRACTAlthough numerous studies have been conducted in recent years on energy transitions, they have been predominately developed and applied in industrialized countries. It is however important to examine the applicability of transition theories, as they are currently formulated, beyond OECD countries. This paper analyses renewable energy transitions in Africa, using Nigeria as a case study, to elucidate the analytical and methodological challenges that sustainability transition studies are facing in developing countries, particularly rentier states. In doing so, the paper employs the lens of the multi-level perspective (MLP) on socio-technical transitions - a well-established theory that emphasizes the role of ‘niches’, ‘regimes’ and ‘landscapes’ in instituting transitions. Based on a detailed analysis of Nigeria, we argue for a more nuanced enquiry of the construct ‘regime’ that better accounts for the rentier character of the state including the role of political elites and prevalent client-patron relationships. As such, our paper makes an important contribution to the further refinement and enrichment of the MLP by focusing on the political dimensions of energy transitions.

Supplemental Digital Content is available in the text

Recent studies in the field of political science and environmental resource governance suggest that oil-exporting economies have begun to implement fuel subsidy reforms. However, while most studies on this issue focus largely on the broader environmental and economic consequences of fuel subsidy reforms, few have examined specifically the effects on renewable energy transitions. Drawing insights from the literature on political economy and the multi-level perspective on socio-technical transitions, with empirical examples from Nigeria, first this study provides an explanation of which factors triggered fuel reforms on the basis of the interaction between landscape and regime elements and second the effects of such fuel reforms on renewable energy transitions. Findings suggest that landscape factors such as global oil crashes and pressures from international financial organisations played crucial roles in the drive for fuel reforms. Nonetheless, rentier regime members responded to these pressures by adopting institutional, discursive and redistributive measures. Of all three strategies, the institutional strategy was significantly pivotal in the proliferation of renewable energy in Nigeria. This study concludes by discussing lessons learned in shaping a transition away from fossil fuels in Nigeria and rentier countries in general.

Landscape approaches attempt to achieve balance amongst multiple goals over long time periods and to adapt to changing conditions. We review project reports and the literature on integrated landscape approaches, and found a lack of documented studies of their long-term effectiveness. The combination of multiple and potentially changing goals presents problems for the conventional measures of impact. We propose more critical use of theories of change and measures of process and progress to complement the conventional impact assessments. Theories of change make the links between project deliverables, outputs, outcomes, and impacts explicit, and allow a full exploration of the landscape context. Landscape approaches are long-term engagements, but short-term process metrics are needed to confirm that progress is being made in negotiation of goals, meaningful stakeholder engagement, existence of connections to policy processes, and effectiveness of governance. Long-term impact metrics are needed to assess progress on achieving landscapes that deliver multiple societal benefits, including conservation, production, and livelihood benefits. Generic criteria for process are proposed, but impact metrics will be highly situation specific and must be derived from an effective process and a credible theory of change.

Responsive packaging systems can adapt to surrounding environments or react to stimuli in the food and/or regulate transport of encapsulated actives/nutrition in presence of external stimuli. It also converts chemical and biochemical signals into optical, electrical, mechanical signals etc. To allow real time food safety and quality monitoring along with extension of shelf-life of food products. These packaging systems are currently an emerging area in food packaging research and playing an increasingly important part in a diverse range of applications, such as nutrition delivery in controlled fashion, ‘on demand’ active delivery, spoilage indicators etc. This paper gives an overview of recent developments and challenges on the applications of stimuli-responsive materials towards food packaging area. We also highlight the future directions to convert research outcome into commercial products.

Hepatocellular carcinoma (HCC) is the most common primary hepatic malignant neoplasm in adults. Clinically, it tends to present late, and its prognosis historically has been poor, due to limited treatment options at the more advanced stage. A multidisciplinary approach for surveillance and early diagnosis of hepatocellular carcinoma in high-risk populations, combined with advances in surgical and other forms of ablative or chemotherapy, has greatly improved outcomes for patients with this tumor. Liver biopsies for HCC are becoming rare, being performed only for lesions that are atypical on imaging, to avoid the risk of bleeding or of inadvertently seeding the needle tract with HCC. HCC, a tumor of varied appearance, can be diagnostically challenging, particularly on a liver biopsy, due to sampling errors. Although HCC typically occurs on a background of cirrhosis, or advanced fibrosis, it may also arise in the noncirrhotic liver. Well-differentiated HCC may be hard to distinguish from benign lesions in the noncirrhotic liver and premalignant lesions in the cirrhotic liver, whereas a poorly-differentiated neoplasm may be difficult to tell apart from metastases or primary intrahepatic cholangiocarcinoma. Additionally, variant forms of HCC may mimic other neoplasms. This case-based review discusses typical HCC, the increasingly recognized steatohepatitic variant of HCC, the rare scirrhous variant of HCC and the extremely rare and clinically challenging cirrhotomimetic HCC.

Eyes with treatment-naive choroidal melanoma demonstrate parafoveal microvascular ischemia on optical coherence tomography angiography. In subgroup analyses, subretinal fluid and tumor size significantly contribute to microvascular compromise.

AimsMyxofibrosarcomas (MFSs) are malignant soft-tissue sarcomas characteristically presenting as painless slowly growing masses in the extremities. Locally infiltrative growth means that the risk of local recurrence is high. We reviewed our experience to make recommendations about resection strategies and the role of the multidisciplinary team in the management of these tumours.Patients and MethodsPatients with a primary or recurrent MFS who were treated surgically in our unit between 1997 and 2012 were included in the study. Clinical records and imaging were reviewed. A total of 50 patients with a median age of 68.4 years (interquartile range 61.6 to 81.8) were included. There were 35 men; 49 underwent surgery in our unit.ResultsThe lower limb was the most common site (32/50, 64%). The mean size of the tumours was 8.95 cm (1.5 to 27.0); 26 (52%) were French Fédération Nationale des Centres de Lutte Contre le Cancer grade III. A total of 21 (43%) had positive margins after the initial excision; 11 underwent further excision. Histology showed microscopic spread of up to 29 mm beyond macroscopic tumour. Local recurrence occurred in seven patients (14%) at a mean of 21 months (3 to 33) and 15 (30%) developed metastases at a mean of 17 months (3 to 30) post-operatively.ConclusionHigh rates of positive margins and the need for further excision makes this tumour particularly suited to management by multidisciplinary surgical teams. Microscopic tumour can be present up to 29 mm from the macroscopic tumour in fascially-based tumours.Cite this article: Bone Joint J2016;98-B:1682–8.