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This article examines Hartmut Stegemann’s preliminary proposal that the remains of the beginning handle sheet of 1QHa have survived and provide useful data for reconstructing the scroll. According to Stegemann, this handle sheet supplies critical material evidence that three columns existed before 1QHa 4, the first substantially extant column in the manuscript. The handle sheet was recovered from one of three scrolls, 1QM, 1QIsab, and 1QHa. Each of these possibilities is considered, and a new proposal that the handle sheet belongs to the end of 1QIsab is advanced. The article offers a tentative reconstruction of the handle sheet as part of 1QIsab to demonstrate its material continuity with col. 28 of 1QIsab.

The idea that the quantum world isn't as random as it seems is taboo for many physicists. But could it finally make sense of quantum theory, asks Michael Brooks

Campylobacteriosis is the most commonly notified foodborne disease in New Zealand and poultry meat is the major source for human infection. Carcasses and portions were sampled from key points along primary and secondary processing chains of three New Zealand poultry processors to determine the impact of processing steps on Campylobacter concentrations. Primary processing reduced Campylobacter concentrations on carcasses by almost 6-log; the biggest reduction was achieved by the spinchill, followed by the scald step. Significant plant differences in the degree of Campylobacter reduction were also observed at these steps. The spinchill and final acidified sodium chlorite wash resulted in carcasses with low-to-no levels of Campylobacter regardless of concentrations at prior steps. A similar study was conducted at primary processing for one plant in 2013; significant improvements in Campylobacter mitigation since 2013 were noted. Campylobacter concentrations from final product from secondary processing were higher than concentrations at the end of primary processing. Drumsticks had lower Campylobacter concentrations than other portion types. Skin removal from product did not consistently result in product with lower Campylobacter concentrations. Results identify key areas to target for further reduction of Campylobacter on poultry meat, and provide a benchmark to compare the efficacy of future interventions.

It's been a long time coming, but materials that conduct electricity without losing any of it could finally be emerging from the cold, says Michael Brooks

Background/Aims The COVID-19 pandemic placed patients with rheumatoid arthritis (RA) at increased risk of poor outcomes as a result of their condition, compounded by use of immunosuppressant medication, and higher prevalence of comorbidities. As a consequence, some patients were instructed within the UK to follow strict guidelines to “shield”, severely restricting routine social interactions. This study explored patients’ longitudinal experiences of living with RA during the COVID-19 pandemic. Methods Patients with rheumatoid arthritis, from a community hospital-based rheumatology service, participated in two semi-structured telephone interviews at baseline in autumn 2020 and 2-4 months later. Interviews were recorded and transcribed verbatim. Interpretative phenomenological analysis was undertaken by two members of the research team with input from two patient partners (KR and MB). Results 15 participants (9 females, 10 retired, age range 45-79 years) were interviewed twice. Five themes were identified: i) fear, ii) social wellbeing, iii) physical health, iv) pre-existing self-management of RA as a coping mechanism, and v) vulnerability. The overriding emotion was one of fear of contracting COVID-19, which remained high throughout both interviews. Fear was influenced by patients’ existing knowledge of their RA and medications and the presence of other significant co-morbidities. Further influences on fear included mainstream media reports (increasing reporting of deaths and new variants) and personal knowledge (family and friends who had contracted COVID-19). The impact on social wellbeing became more pronounced as remote communications could not replicate the benefits of physical interaction. Participants reported no impact on their physical health, with increased rest resulting from restricted social interaction perceived to be beneficial. Many participants utilised the resilience they had learned as a result of having RA to cope, including stress management, pacing, and exercise. Being categorised as “clinically extremely vulnerable” led to a reassessment of self-identity, with participants not wanting to be perceived as being weak or helpless. Finally, many participants used lockdown to reflect on and reassess their personal priorities. Conclusion This longitudinal interview study with 15 people with RA highlights that the main impact of the pandemic appeared to be on emotional wellbeing brought about by fear of COVID-19, later compounded by lack of social interaction. In this small study, participants’ physical health was reported to be stable and participants were able to use self-management skills to cope. The realisation of the seriousness of contracting COVID-19 led to feelings of vulnerability and a reassessment of self-identity. The study raises important issues for those providing healthcare to people with RA, including effective communication with awareness of its likely impact, using pre-existing self-management strategies to enhance wellbeing, and recognition of the potential for social isolation and the implications thereof. Disclosure P. Campbell: None. Z. Paskins: None. S. Hider: None. A. Hassell: None. F. Crawford-Manning: None. K. Rule: None. M. Brooks: None. S. Ryan: None.

The prognostic significance of preoperative MRI findings in patients undergoing discectomy is incompletely understood. Identifying the radiological predictors of revision surgery on pre-operative MRI can guide management decisions and potentially prevent multiple surgeries. We included 181 patients who underwent primary lumbar discectomy between 2010 and 2014. All patients were contacted via a short telephone interview to determine if they had revision surgery within 5 years of their index surgery. Preoperative MRI of the lumbosacral spine was evaluated for various radiological factors including type of disc herniation, anatomical location of herniation, direction of herniation, degree of disc degeneration, end plate changes and presence of listhesis. Other potential confounders including age, gender, smoking status and index level of surgery were also recorded. Multivariate model of all radiological predictors and confounders were developed and a step-wise approach was used to remove insignificant variables in order to develop final significant multivariate model. P value of0.05 was considered statistically significant. Patients with retrolisthesis were found to be 2.7 times more likely than the patients without listhesis to require revision surgery (p = 0.019). Patients with foraminal disc herniation were 3.45 times more likely than the patients with paramedian disc herniation to require revision surgery (p = 0.026). Other MRI predictors failed to achieve statistical significance. Based on the data presented patients with retrolisthesis and/or foraminal disc herniation should be counselled on the relatively higher risk of revision surgery when proceeding with discectomy, or alternative options should be considered.

Our best mathematical model of consciousness might imply everything has got it. How seriously should we take that, asks Michael Brooks

The COVID-19 lockdown has had a marked effect on citizen science projects, such as the Southern African Bird Atlas Project, SABAP2. With their mobility severely constrained, most citizen scientists...

External ventricular drain (EVD) associated ventriculitis is a complication of EVD placement associated with significant morbidity and mortality. Gold-standard for EVD associated bacterial ventriculitis diagnosis involves cerebrospinal fluid (CSF) sampling from the EVD with microscopy, culture and sensitivity testing. The ratio of white blood cells to red blood cells has anecdotally been considered a predictive factor in diagnosing EVD associated ventriculitis, however no study has been done demonstrating this.A retrospective cross-sectional study was designed to assess whether the ratio of CSF white blood cells to red blood cells could be used to diagnose EVD associated ventriculitis. Data was collected for all patients undergoing EVD insertion at a major neurosurgical unit in Sydney, Australia. A receiver operator characteristics (ROC) curve was used to determine if this ratio was useful, and Youden's index was calculated to determine the appropriate cut-off point.This sample of n = 157 consecutive patients a total of 29 patients were diagnosed with ventriculitis. The area under the ROC curve was significant (0.706, P 0.001), and Youden's index demonstrated an appropriate cut-off point was a ratio of 1:106.CSF parameters have long been considered predictive of EVD associated ventriculitis. We demonstrated that using a component of routine testing it is possible to accurately predict a ventriculitis diagnosis. As the ratio is used, it enables discrimination in a raised white blood cell count due to local trauma with interventricular bleeding.CSF white blood cell to red blood cell ratio is an appropriate diagnostic test for ventriculitis.

Objectives People with inflammatory arthritis (IA) have an increased incidence of serious illness and mortality, placing them at risk from poor outcomes from COVID-19. This study explored patients’ perceptions of risk from COVID-19 over a longitudinal period of the pandemic. Methods Fifteen adults with inflammatory arthritis attending a NHS rheumatology service, each took part in 3 semi-structured telephone interviews conducted between 16th September 2020 - 29th July 2021. Interpretive phenomenological analysis was undertaken by two researchers and two public contributors. Results Four main themes relating to perceptions of risk from COVID-19 were identified: i) Inflammatory arthritis, medications and co-morbidities, ii) Immediate social environment iii) Health policy communication, and iv) Media influence. Participants recognised that having IA increased their individual risk. Perceptions of risk and associated fear increased during the pandemic, influenced by family/friends who had had COVID-19 and health policy communications. The perceived constant use of negative messages led to many participants disengaging with the media. At the final interviews when the vaccination programme was well established, participants continued to assess the risk and benefits of engaging in activities. Conclusions This study demonstrates the breadth of factors that influenced perceptions of risk in people with an inflammatory arthritis. As health professionals we only have a small sphere of influence over some of these factors, namely health care communications. People with inflammatory arthritis appropriately knew their condition increased their infection risk, but more could be done to consider how and to what extent we involve patients in explaining risk at times of crisis. LAY SUMMARY What does this mean for patients? People with inflammatory arthritis (IA) have an increased risk of serious infection. We interviewed 15 adults with IA, three times, over 7 months during the pandemic to explore how patients interpreted their own risk to COVID-19. We found that people were fearful that COVID-19 could be fatal due to having IA. This fear was heightened by media reports of new variants, seeing family and friends with COVID-19, and receiving letters from the hospital and government confirming their increased risk. Awareness of risk remained high throughout the three interviews which may reflect the lack of evidence, at that time, regarding the exact risk to people with an IA. Our work adds to previous research that individual risk needs to be communicated in such a way that it contains information as to how risk can be reduced without inducing further distress. Patient involvement in how risk can be communicated effectively is required.

Background\ud Putting patients at the heart of everything we do is fundamental to the philosophy of the NHS. It is required to stimulate cultural and transformational change needed to manage the increasing demand on NHS services. Patients as ‘equal partners’ are recommended by NICE, the charitable sector and MSK Best Health Collaboratives but the method to achieve this ambition is less clear.\ud Method\ud A large community Trust in the UK explored opportunities to employ a service user in a Musculoskeletal Interface Service. The Peer Support Worker model (temporary employment for 6 months) was used to facilitate employment. Impact of the role within and external to the Trust, was captured.\ud A facilitated discussion was held with National MSK Leads to highlight how organisations could start, support and scale these opportunities\ud Results\ud The first MSK Peer Support Worker was successfully appointed in January 2021 and became the first Physical Heath Support worker within the Community Trust. A permanent Patient Engagement Champion was secured following the initial 6 months in post.\ud Facilitated discussions with 40 senior MSK Leaders suggested building relationships with others internal and external to the organisation, communicating the purpose, benefits and achievements of the role were important success factors.\ud Discussion\ud Employing a patient with lived experience of MSK health problems can influence processes, pathways and culture within an organisation. MSK leaders are well placed to seek and create opportunities to embed such roles. Care and consideration need to be given to the mentorship and going support for post holders.

While studies have demonstrated an association between preoperative hypoalbuminemia and adverse clinical outcomes, the optimal serum albumin threshold for risk-stratification in the broader surgical population remains poorly defined. We sought define the optimal threshold of preoperative serum albumin concentration for risk-stratification of adverse post-operative outcomes. Using the American College of Surgeons National Surgical Quality Improvement Program Database, we identified 842,672 patients that had undergone a common surgical procedure in one of eight surgical specialties. An optimal serum albumin concentration threshold for risk-stratification was determined using receiver-operating characteristic analysis. Multivariable logistic regression analysis was used to evaluate the odds of adverse surgical events; a priori defined subgroup analyses were performed. A serum albumin threshold of 3.4 g/dL optimally predicted adverse surgical outcomes in the broader cohort. After multivariable analysis, patients with hypoalbuminemia had increased odds of death within 30 days of surgery (odds ratio [OR] 2.01, 95% confidence interval [CI] 1.94–2.08). Hypoalbuminemia was associated with greater odds of primary adverse events among patients with disseminated cancer (OR 2.03, 95% CI 1.88–2.20) compared to patients without disseminated cancer (OR 1.47, 95% CI 1.44–1.51). The standard clinical threshold for hypoalbuminemia is the optimal threshold for preoperative risk assessment.

Entropy's inexorable push towards chaos seems to give structure to the universe, says Michael Brooks. So why can nobody agree on what it is?.

There’s no escaping the laws of physics – even at the movies. Michael Brooks reveals why they’re vital in creating the best possible visual effects

A universe identical to our own could be hiding in plain sight. Michael Brooks steps through the looking glass.

The pole is wandering, and faster than ever. To understand why we must journey to the centre of the Earth, says Michael Brooks

We investigate the factors (“drivers”) that motivated investment in energy efficiency in commercial real estate office buildings over the 2006–2011 and 2012–2017 period, and looking forward from 20...

This paper presents different design considerations of two different packaging approaches for micromodules, namely vertically integrated ferrite substrate based [1] and conventional overmolded side-by-side integration [2]. Production steps, EMI, and thermal considerations are covered in this paper. Two dc-dc converter micromodules with the same specifications are built using both packaging approaches and tested. The vertically integrated micromodule has dimensions of 3.2 X 2.5 X 1.6mm3 while the side-by-side integrated micromodule achieves 2.5 X 2.5 X 1.2mm3 dimensions. Both modules achieve peak efficiency of 87% for 5Vin-to-1.8Vout conversion. Experimental evaluation and market requirements suggest the suitability of vertically integrated micromodule for applications, which require very low noise level (radiated emissions) and excellent thermal derating performance such as data acquisition and measurements. On the other hand, side-by-side integrated micromodules are suitable for applications that require low profile height and have aggressive cost requirements such as consumer electronics, i.e. tablets, smart phones, and laptops.

A cultural change in medicine has placed a renewed focus on the importance of a diverse and inclusive healthcare workforce. The methods employed by anesthesiology departments in pursuit of diversity and inclusion needs to be examined.This study's objective was to assess the frequency of established leadership infrastructures and initiatives that promote diversity and inclusion within academic anesthesiology departments.This was a cross-sectional survey study. The authors emailed an electronic survey to 98 academic anesthesiology departments to assess leadership roles, dissemination platforms and initiatives used to support diversity and inclusion.Academic anesthesiology department in the United States with at least 60 residents.The measure tested was the existence and quantification of leadership roles and initiatives directed at diversity and inclusion efforts at academic anesthesiology departments.The survey response rate was 49.4% (95% CI 39.3-59.6%). While 62.5% (95% CI 47.0-75.8%) of respondents reported having faculty members with a diversity and inclusion role, only 27.5% (95% CI 16.1-42.8%) reported a clearly defined leadership role such as vice-chair or committee chair. Seventy percent of respondents reported initiatives geared towards diversity using multiple platforms to showcase these initiatives.Based on these survey results, many anesthesia departments have developed initiatives to promote their departmental diversity. However, only a minority have established clearly defined leadership roles, which may be critical to enhance departmental success in promoting diversity and inclusion.

Primary scrotal melanoma represents the rarest genitourinary malignancy. We describe the 25th reported case. The 79-year-old patient presented with a rapidly enlarging right cutaneous scrotal mass which after local excision demonstrated pT4b nodular malignant melanoma (BRAF V600E mutation positive). The patient underwent wide local excision of his hemiscrotum and inguinal lymph node dissection demonstrating nodes positive for melanoma (pN2b). Postoperatively, the patient developed a left sided malignant pleural effusion (M1b). Per American Joint Commission Cancer staging, BRAF mutant targeted therapy (dabrafenib) was initiated. This case documents the first instance in which metastatic scrotal melanoma will be treated with oncogene targeted therapy.

Part 1: Teaching Methods and Tools; International audience; This work presents a model for reviewing the risks of institutions teaching cybersecurity. The work is based on efforts in this direction at Regis University and Adams 12 Five Star Schools in Colorado. These two institutions are described in a comparative case study reviewing the following four aspects of addressing risk: policy, adjudication, infrastructure protection, and curricular boundaries. The model is presented in a generalizable framework to facilitate risk analysis across the education of children in public schools, university level education, and professional development programs. This framework is not intended to supplement a traditional threat analysis program and not replace it. In addition to the specialized risks addressed here, institutions teaching cybersecurity are often perceived as potential targets for adversaries because of the schools as a pipeline to cyber defense activities, and because institutions teaching cybersecurity are part of societal long-term cyber defense strategies that confront criminal, nation state, and activist threats.

This paper presents a cost-effective electromagnetic energy harvester (EMEH) based on wire-wound technology. It also shows the energy management system used to convert the EMEH's AC voltage to a DC one. The EH system is self-powered and does not require external sources or pre charge of any of its components and provides maximum power point tracking.

The UK has embarked on a programme of self-testing for coronavirus, but can swabs taken at home be trusted? Michael Brooks reports.

PURPOSE To assess the association of adverse pathology (AP), defined as high-grade (≥ Gleason Grade Group 3) and/or non-organ confined disease, with long-term oncologic outcomes after radical prostatectomy (RP). MATERIALS AND METHODS Using a stratified cohort sampling design, we evaluated the association of AP with the risk of distant metastasis (DM) and prostate cancer-specific mortality (PCSM) up to 20 years after RP in 428 patients treated between 1987 to 2004. Cox regression of cause-specific hazards was used to estimate the absolute risk of both endpoints, with death from other causes treated as a competing risk. Additionally, subgroup analysis in patients with low and/or intermediate-risk disease, who are potentially eligible for active surveillance (AS), was performed. RESULTS Within the cohort sample, 53% of men exhibited AP at time of RP, with median follow up of 15.5 years (IQR 14.6-16.6 years) thereafter. Adverse pathology was highly associated with DM and PCSM in the overall cohort (HR 12.30, 95% confidence interval [CI] 5.30-28.55, and HR 10.03, 95% CI 3.42-29.47, respectively, both P < 0.001). Adverse pathology was also highly associated with DM and PCSM in the low/intermediate-risk subgroup (HR 10.48, 95% CI 4.18-26.28, and 8.60, 95% CI 2.40-30.48, respectively, both P < 0.001). CONCLUSIONS Adverse pathology at the time of RP is highly associated with future development of DM and PCSM. Accurate prediction of AP may thus be useful for individualizing risk-based surveillance and treatment strategies.

Aims Various behavioral impulsivity measures have been developed, yet there has been no recent synthesis and evaluation of available tools. Key to consider is the context for assessment, and whether they can be delivered outside of the laboratory. The aim of this review was to identify and appraise behavioral impulsivity measures, with a secondary objective of identifying measures suitable for real-world delivery (independent of researcher administration). Methods PsycINFO, Embase, Medline and PsycTESTS databases were searched for articles published from 1997 using a behavioral impulsivity measure suitable for adults (PROSPERO: CRD42017057784). Measures assessing response disinhibition, impulsive response initiation, and/or impulsive decision-making were identified, delivery method assessed, and searches undertaken for psychometric properties of tasks. Results Twenty four behavioral impulsivity measures were identified; evidence of adequate reliability and validity was reported for only eight measures. Only six measures did not require computer facilities. Two measures were suitable for pen-and-paper delivery, the Monetary Choice Questionnaire and Probabilistic Discounting Task, both of which index impulsive decision-making. Conclusions Further validation of impulsivity measures is necessary to assist researchers in choosing an appropriate measure for their research setting. Development of behavioral impulsivity measures which can be delivered outside of the laboratory context is a key priority.

Study design Cross sectional study. Purpose To assess the quality of anterior cervical discectomy and fusion (ACDF) videos available on YouTube and identify factors associated with video quality. Overview of literature Patients commonly use the internet as a source of information regarding their surgeries. However, there is currently limited information regarding the quality of online videos about ACDF. Methods A search was performed on YouTube using the phrase 'anterior cervical discectomy and fusion.' The Journal of the American Medical Association (JAMA), DISCERN, and Health on the Net (HON) systems were used to rate the first 50 videos obtained. Information about each video was collected, including number of views, duration since the video was posted, percentage positivity (defined as number of likes the video received, divided by the total number of likes or dislikes of that video), number of comments, and the author of the video. Relationships between video quality and these factors were investigated. Results The average number of views for each video was 96,239. The most common videos were those published by surgeons and those containing patient testimonies. Overall, the video quality was poor, with mean scores of 1.78/5 using the DISCERN criteria, 1.63/4 using the JAMA criteria, and 1.96/8 using the HON criteria. Surgeon authors' videos scored higher than patient testimony videos when reviewed using the HON or JAMA systems. However, no other factors were found to be associated with video quality. Conclusions The quality of ACDF videos on YouTube is low, with the majority of videos produced by unreliable sources. Therefore, these YouTube videos should not be recommended as patient education tools for ACDF.

A strange result from the edge of the universe is messing up our tidy laws of nature, says Michael Brooks

Although it has long been acknowledged that 1QS, 1QSa, and 1QSb are part of the same manuscript, most scholars follow J.T. Milik’s interpretation of the columns of 1QSa and 1QSb as appendices to 1QS. This article examines the circumstances out of which this “appendix hypothesis” emerged, highlights its weaknesses, and takes up Philip Alexander and Géza Vermes’s call to consider the sections of the scroll together by proposing that 1QS-1QSa-1QSb is a composite work that its editor has unified through superscriptions. This study also examines the formatting between 1QS, 1QSa, and 1QSb and the evidence of a recension concerned with introducing the activity of the sons of Zadok and reframing the material for the Maskil throughout the scroll to propose that the heterogeneous and sometimes inconsistent contents are presented by its redactor as a single work rather than three distinct works in a single scroll.

Could one multifaceted particle solve all the deepest problems in physics, asks Michael Brooks

Long-term follow-up is needed to evaluate the impact of short-term cancer research programs on the career trajectories of medical and graduate students. Participation in these programs may be crucial in fostering the next generation of cancer research scientists. This report presents the career outcomes and research productivity of 77 medical and public health students with 25 years of tracking data following their participation in a summer cancer research training program at the University of Alabama at Birmingham (UAB) in 1990-1998. Of 64 summer trainees with contact information, complete survey responses were received from 55 (86.0%) individuals. Over half reported clinical care of cancer patients and 18.2% stated that they were engaged in cancer research. Literature searches confirmed that 23.4% (18/77) of trainees have published cancer research papers. Future studies should explore the optimal timing of short-term post-baccalaureate academic cancer training experiences to identify participant characteristics and institutional factors that influence career choices and determine research productivity.

The Internet is a critical eHealth/eGovernment information source, and the U.S. Department of Veterans Affairs operates the United States’ largest integrated health care system. This case study used machine-based accessibility testing to assess accessibility for 116 VA Medical Center websites, based on U.S. Section 508 standards and international WCAG 2.0 guidelines. While we found accessibility issues on each website analyzed, problems were generally limited. Notable exceptions included PDF accessibility and fixed-text sizes. The study’s results offer implications for practitioners (accessibility problems likely overlooked and ways to check accessibility) and educators, particularly the need to better integrate accessibility into the curriculum.