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Malignant mesothelioma with EWSR1-ATF1 fusion is a rare malignancy described in young adults without asbestos exposure. To the best of our knowledge, outcomes to local and systemic therapies for this subtype of malignant mesothelioma have not been described. This case report describes the clinical course of a 19-year-old man diagnosed with malignant peritoneal mesothelioma with EWSR1-ATF1 fusion localized to the abdomen. His disease followed an aggressive course and resulted in limited survival (18 mo). There was treatment resistance to several lines of conventional local and systemic treatments for peritoneal mesothelioma and biologically targeted MET inhibition with crizotinib. More research is required in this rare subtype of peritoneal mesothelioma.

Coal particles, a typical of organic matter with high carbon content, widely diffused in soil environment due to massive consumption of coal energy for centuries. Even in small amounts presented in soils, coal particles can produce obvious overestimation of soil organic carbon (SOC) and thus increase an uncertainty of soil C sequestration assessment. However, there is a lack of determination methods for distinguishing coal-derived C from SOC. This study takes the Jiaozuo mining area as the study area, which has a history of anthracite mining for more than 100 years and where coal-contaminated soils are widespread. The hyperspectral characteristics of the mine soils were analyzed by collecting coal particles and coal-free soils and then mixing known quantities of the two samples manually. Based on eight spectral mathematical transformation and two spectral feature screening methods (i.e., traditional correlation coefficiencies, and comprehensive competitive adaptive reweighted sampling (CARS)), six inversion models including spectral feature index models (i.e., deviation of arch (IDOA), difference index (ID), ratio index (IR)), and three machine learning models (i.e., partial least squares regression (PLSR), support vector machine (SVM) and random forest (RF)), were established to inversing coal-derived C content. The applicability of the established optimal inversion model was also examined. It was found that in the wavelength range from 350 nm to 2500 nm, the spectral curves of coal particles are obviously different from those of plant-derived organic matter and coal-free soils. Moreover, the spectral reflectance (R) of coal-contaminated soils decreases with increasing coal-derived C content. These findings provide a theoretical basis for the application of hyperspectral remote sensing technology to quantitatively inverse coal-derived C of mine soils. The CARS-extracted feature wavebands of coal-derived C distributed evenly in the wavelength range between 350 nm and 2500 nm, and the number of feature waveband extracted by the CARS was far higher than that by traditional correlation coefficiency methods. After mathematical transformation of R data, the estimated accuracies of coal-derived C content produced by the IDOA, ID and IR inversion models were significantly enhanced, among which, the DI model of 1/R spectral transformation exhibited the highest estimation accuracy. Compared with the traditional index models, the three machine learning models combined with CARS further enhanced estimation accuracy of coal-derived C content. Among the three machine learning models, the 1/R-CARS-RF inversion model produced the highest estimation accuracy, showing \begin{document}$R_{\rm{m}}^2 $\end{document}=0.998, RMSE=0.348, RPD=29.943 for its validation set. The applicability test showed that the 1/R-CARS-RF model exhibited a good applicability for different coal-contaminated soils in the Jiaozuo mining area as observed 1.88% for RMSE and 4.97 for RPD. Therefore, it can be expected that hyperspectral remote sensing technology has a promising application prospect for determining coal-derived C content in mine soils. In addition, this study can provide a methodology support for distinguishing coal-derived C from SOC in mine soils and accurately assessing soil carbon sequestration.

Electric vehicles are having significant priority in transportation including goods, public transport etc. among many technologies in electric vehicle, brushless DC (BLDC) motors operated eclectic drives are mostly used. Speed sensorless control is required to implement for obtaining a best performance. At the same time, a sliding mode controller (SMC) can be able to produce the ultimate response under various conditions. Hence sensorless speed control with SMC of BLDC motor is implemented in this paper to drive the electric vehicle. In order to develop speed sensorless of motor, a model reference adaptive control (MRAC) system is developed. However, obtaining a fastest response is very important in electric vehicle speed control. Hence a TS-Fuzzy model is developed to use in the place of conventional PI controllers. Extensive results are collected for presentation by establishing Hardware – in the – Loop (HIL) with the help of two OPAL-RT devices.

Grid connected renewable energy sources based electric power generation systems are increasing day by day to meet the electrical demand without burning any fossil fuels. Doubly fed induction generators (DFIGs) are widely used in wind turbines due to advantages that they can allow the amplitude and frequency of their output voltages to be maintained at a constant value, no matter the speed of the wind blowing on the wind turbine rotor. Moreover, the DFIG provides a huge possibility to improve network dynamic behavior by using the power electronic converters with sufficient control arrangements. Many different structure and control algorithms can be used for control of power converters. However, conventional controllers cannot perform with full efficiency during rapid changes in wind speed. Hence, Takagi–Sugeno–Kang (TSK) Fuzzy controllers based novel control technique is proposed in this paper for performing many tasks on grid connected DFIG systems. The proposed control scheme is tested under variations of voltage, frequency, wind speed, and reactive power load. To achieve the realistic responses, the Hardware-in the-Loop (HIL) is implemented with the help of OPAL-RT modules for presenting extensive results.

This review article delves into the strategic integration of renewable energy sources within smart cities, emphasizing the role of electric vehicles (EVs) in ensuring stability. Smart cities, at the forefront of sustainable urban development, prioritize energy systems that are both clean and renewable. The integration of various renewable energy resources, including solar, wind, geothermal, hydropower, ocean, and biofuels, into the energy systems of smart cities is explored, considering both technical and economic aspects. The rapid adoption of these technologies provides a foundation for a low-carbon economy, ensuring a cleaner and more sustainable urban environment. However, challenges persist, particularly in optimizing energy systems for renewable integration, stability, operational range, and cost-effectiveness. Additionally, the evolution of smart cities has brought forth advanced energy conservation systems, addressing energy management at both building and city levels. Innovative solutions, such as advanced infrastructure and energy trading strategies in distributed systems, are proposed. The role of EVs in the smart grid is also highlighted, addressing challenges posed by renewable energy’s intermittent output. The potential of EVs to counteract these fluctuations, especially under the vehicle-to-grid (V2G) framework, is discussed, offering insights into future research avenues for a harmonious and sustainable energy ecosystem in smart cities.

STUDY OBJECTIVE: Clerkship directors design and implement educational programs for students. Scholarly productivity is necessary for academic advancement. We define characteristics of emergency medicine clerkship directors and evaluate determinants of scholarly productivity and job satisfaction. METHODS: This is a cross-sectional survey. Clerkship directors for emergency medicine senior rotations completed a confidential online questionnaire. Demographic data were analyzed with descriptive statistics. Scholarly productivity and job satisfaction indices were created for multivariate analysis. RESULTS: One hundred eleven (82%) of 136 directors responded (age 38.9+/-7.0 years; men 72.1%; junior academic rank 72.1%; served as clerkship directors for < or =5 years 77.4%; formal training in education: medical education fellowship 36%, teaching credential 12.7%, emergency medicine subspecialty fellowship 6.3%; support for clerkship director's activities: clinical hours reduction 2.7+/-2.3 weekly; minimal training for clerkship director's role 85.6%; ongoing professional development 40.5%; scholarly productivity: < or =5 peer-reviewed publications 78.4%, grant 28%, textbook chapter 65%; plan to be clerkship director in 5 years 63%; perceived support from supervisor 88%; perceived value from colleagues 81%; perception that clerkship directors is as important as residency director 47.8%). Multivariate regression shows a significant effect of medical education fellowship (P =.013) and subspecialty training (P =.044). Departmental support enhances the effect of medical education (P =.008) or subspecialty (P =.026) fellowships and improves productivity for senior faculty (P =.047). Multivariate regression explaining job satisfaction shows a positive effect of reduced clinical hours (P =.038) and increased faculty development (P =.033). CONCLUSION: Most emergency medicine clerkship directors are junior faculty with minimal release time or training for their positions. [ABSTRACT FROM AUTHOR]

Background: Experimentation confirmed the conclusion that bone allografts, like other tissue and organ allografts, are immunogenic. These immune responses cause resorption of allograft, thus lowering the bone formation capacity of the graft. An attempt has been made in this study to prevent immune reactions and achieve enhanced regeneration of allograft-demineralized freeze-dried bone matrix by incorporating it with an immunosuppressive drug Cyclosporine-A (CsA) in the treatment of human periodontal infrabony defects. Materials and Methods: Fifteen patients showing clinical evidence of almost bilateral infrabony defects requiring bone grafting procedures were selected. In each patient, the infrabony defect of one side of the arch was designated as Group A (control site) and the infrabony defect of the contralateral side of the same arch was designated as Group B (test site). Results: On comparative evaluation of the two groups (by Student t-test), the mean values of reduction in probing depth (P=0.81 NS ) and gain in clinical attachment level (P=1.00 NS ) of Group B were found to be greater than that of Group-A, but the differences were statistically non-significant. The mean linear bone fill (P=0.010 FNx08 ) of Group B was also detected to be higher than that of Group A, and the difference was found to be statistically significant. Conclusion: Increase in linear bone fill in Group B signifies the role of CsA in augmenting the regenerative potential of allograft by eliminating immune reactions.

Objectives: Many a times in clinical periodontology, the decision whether to prescribe prophylactic antibiotics or not , is perplexing.The present study was conducted to compare the bacteremias induced after periodontal flap surgeries with and without prophylactic antibiotics. Materials and Methods: The occurrence of postoperative bacteremia following periodontal flap surgery was studied in 30 patients. On these patients, 30 quadrant wise flap surgeries were carried out without any preoperative prophylactic antibiotics and 30 surgeries carried out after prophylactic administration of amoxycillin preoperatively. A blood sample was taken from each patient at the time of maximum surgical trauma and was cultured for micro-organisms and antibiotic sensitivity. Results: 18 out of 60 blood samples were positive for micro-organisms. There was a significant reduction in post operative bacteremia after amoxycillin prophylaxis (x - 7.96 with P< 0.01) as post operative bacteremia was found in 14 of the non medicated patients as compared to only 4 of the pre medicated patients. The micro-organisms encountered in the study are as follows:- 1) Staphylococcus albus coagulase negative, 2) Klebsiella, 3) Psedomonas aerugenosa, 4) Streptococcus viridans, 5) Alpha hemolytic streptococcus, 6) Neisseria catarrhalis Conclusion: On the basis of the study, it is concluded that the incidence of postoperative bacteremia following periodontal flap surgery is not as high as previously reported. The clinical results show that Amoxicillin is highly effective in reducing postoperative bacteremia in periodontal flap surgery and thus in preventing the possible sequelae (Infective Endocarditis and other systemic maladies) in susceptible patients. However, cefotaxime and cephalexin may prove to be more effective in preventing the same.

Background: Microbial colonization of the barrier membranes used for guided tissue regeneration is inevitable and can lead to delayed healing. Aims: Antimicrobial coating of the membrane with 25% doxycycline paste has been attempted to prevent infection and achieve enhanced regeneration in periodontal infrabony defects. Materials and Methods: Twenty-four patients with 2-walled or 3-walled infrabony defects were selected and randomly divided into two equal groups. Infrabony defects of group A were treated with a biodegradable membrane coated with 25% doxycycline while those of group B were treated with membrane alone. Clinical assessment of probing depth and attachment level and radiographic evaluation of the defect depth was done preoperatively and at 12 and 24 weeks postoperatively. Statistical Analysis: The relative efficacy of the two treatment modalities were evaluated using the paired Student′s t- test and the comparative evaluation between the two groups was done using the independent Student′s t -test. Results: Both the groups exhibited a highly significant reduction in probing depth and gain in clinical attachment level and linear bone fill at the end of 24 weeks. Comparative evaluation between the two study groups revealed a significant reduction in probing depth ( P = 0.016 FNx01 ) and linear bone fill ( P = 0.02 FNx01 ) in group A as compared to group B. Mean gain in attachment level was greater for group A than for group B but the difference was statistically nonsignificant ( P = 0.065 NS ). Conclusions: The results suggest that doxycycline is beneficial in reducing membrane-associated infection and can potentiate regeneration through host modulation.

Abstract Purpose Metallic skin closure staples and vessel ligation clips should be tested at 3-Tesla to characterize MRI issues in order to ensure patient safety. Therefore, metallic surgical implants were assessed at 3-Tesla for magnetic field interactions, MRI-related heating, and artifacts. Methods A skin closure staple (Visistat Skin Stapler, staple, Polytetrafluoroethylene, PTFE, coated 316L/316LVM stainless steel; Teleflex Medical, Durham, NC) and a vessel ligation clip (Hemoclip Traditional, stainless steel; Teleflex Medical, Durham, NC) that represented the largest metallic sizes made from materials with the highest magnetic susceptibilities (i.e., based on material information) among 61 other surgical implants (52 metallic implants, 9 nonmetallic implants) underwent evaluation for magnetic field interactions, MRI-related heating, and artifacts using standardized techniques. MRI-related heating was assessed by placing each implant in a gelled-saline-filled phantom with MRI performed using a transmit/receive RF body coil at an MR system reported, whole body averaged SAR of 2.9-W/kg for 15-min. Artifacts were characterized using T1-weighted, SE and GRE pulse sequences. Results Each surgical implant showed minor magnetic field interactions (20- and 27-degrees, which is acceptable from a safety consideration). Heating was not substantial (highest temperature change, ≤ 1.6°C). Artifacts may create issues if the area of interest is in the same area or close to the respective surgical implant. Conclusions The results demonstrated that it would be acceptable for patients with these metallic surgical implants to undergo MRI at 3-Tesla or less. Because of the materials and dimensions of the surgical implants that underwent testing, these findings pertain to 61 additional similar implants.

Abstract Background Lyme neuroborreliosis (LNB) may present as meningitis, cranial neuropathy, acute radiculoneuropathy or, rarely, as encephalomyelitis. We hypothesized that glia, upon exposure to Borrelia burgdorferi, the Lyme disease agent, produce inflammatory mediators that promote the acute cellular infiltration of early LNB. This inflammatory context could potentiate glial and neuronal apoptosis. Methods We inoculated live B. burgdorferi into the cisterna magna of rhesus macaques and examined the inflammatory changes induced in the central nervous system (CNS), and dorsal root nerves and ganglia (DRG). Results ELISA of the cerebrospinal fluid (CSF) showed elevated IL-6, IL-8, CCL2, and CXCL13 as early as one week post-inoculation, accompanied by primarily lymphocytic and monocytic pleocytosis. In contrast, onset of the acquired immune response, evidenced by anti-B. burgdorferi C6 serum antibodies, was first detectable after 3 weeks post-inoculation. CSF cell pellets and CNS tissues were culture-positive for B. burgdorferi. Histopathology revealed signs of acute LNB: severe multifocal leptomeningitis, radiculitis, and DRG inflammatory lesions. Immunofluorescence staining and confocal microscopy detected B. burgdorferi antigen in the CNS and DRG. IL-6 was observed in astrocytes and neurons in the spinal cord, and in neurons in the DRG of infected animals. CCL2 and CXCL13 were found in microglia as well as in endothelial cells, macrophages and T cells. Importantly, the DRG of infected animals showed significant satellite cell and neuronal apoptosis. Conclusion Our results support the notion that innate responses of glia to B. burgdorferi initiate/mediate the inflammation seen in acute LNB, and show that neuronal apoptosis occurs in this context.

Monogenic syndromes are associated with neurodevelopmental changes that result in cognitive impairments, neurobehavioral phenotypes including autism and attention deficit hyperactivity disorder (ADHD), and seizures. Limited studies and resources are available to make meaningful headway into the underlying molecular mechanisms that result in these symptoms. One such example is DeSanto-Shinawi Syndrome (DESSH), a rare disorder caused by pathogenic variants in the WAC gene. Individuals with DESSH syndrome exhibit a recognizable craniofacial gestalt, developmental delay/intellectual disability, neurobehavioral symptoms that include autism, ADHD, behavioral difficulties and seizures. However, no thorough studies from a vertebrate model exist to understand how these changes occur. To overcome this, we developed both murine and zebrafish Wac/wac deletion mutants and studied whether their phenotypes recapitulate those described in individuals with DESSH syndrome. We show that the two Wac models exhibit craniofacial and behavioral changes, reminiscent of abnormalities found in DESSH syndrome. In addition, each model revealed impacts to GABAergic neurons and further studies showed that the mouse mutants are susceptible to seizures, changes in brain volumes that are different between sexes and relevant behaviors. Finally, we uncovered transcriptional impacts of Wac loss of function that will pave the way for future molecular studies into DESSH. These studies begin to uncover some biological underpinnings of DESSH syndrome and elucidate the biology of Wac, with advantages in each model.

Background: The role of fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in indolent lymphoma has been minimally studied., Objective: This study aims to assess the value of FDG-PET/CT in predicting the prognosis of indolent lymphoma., Methods: We prospectively recruited 42 patients with indolent lymphoma. A total of 2 patients were excluded, and 40 underwent baseline PET/CT and follow-up at various time points. A total of 9 patients were observed only, 7 received 4 doses of rituximab alone, and 24 received chemoimmunotherapy. Metabolic response on follow-up PET/CT was assessed using the maximum standardized uptake value (SUVmax) and Deauville criteria (DC). We aimed to obtain the best SUVmax and DC to predict optimal survival rates, risk stratification, and optimize therapeutic strategies. The mean follow-up from the initial diagnosis was 33.83 months., Results: SUVmax <4.35 at interim PET/CT provided the best discrimination, with a progression-free survival (PFS) of 100% and a median survival time of 106.67 months compared with SUVmax ≥4.35 (P=.04), which had a PFS of 43.8% and a median survival time of 50.17 months. This cutoff was also valuable in predicting overall survival at baseline, that is, 100% overall survival with baseline SUVmax <4.35, versus 58.4% for SUVmax ≥4.35 (P=.13). The overall survival of patients with a baseline DC score <3.0 was 100%, with a median overall survival of 106.67 months., Conclusions: We demonstrated the utility of PET/CT in indolent lymphomas. SUVmax (<4.35 vs ≥4.35) on interim PET/CT performed best in predicting PFS., (©Nawal Faiez AlShehry, Raja Shanker, Syed Ziauddin Ahmed Zaidi, Fahad AlGhmlas, Ibraheem Hussein Motabi, Shahid Iqbal, Ahmad Ali Butt, Hassan AlShehri, Imran Khan Tailor, Syed Yasir Altaf, Mubarak AlGhamdi, Mohammed Marie, Mansour AlFayez, Kamal Al Zahrani, Mohammed Dwaimah, Tahani Al-Halouli, Wafaa Al-Shakweer, Maied Zaher AlShehery, Abdul Rehman Zia Zaidi, Atta Munawar Gill, Belal Mohammed Albtoosh, Musab Ahmed. Originally published in JMIR Formative Research (https://formative.jmir.org), 12.11.2021.)

This study is a qualitative analysis of facilitators and barriers in the dissemination of Family Check-Up (FCU), a U.S.-developed preventive intervention in Sweden. The FCU is inherently culturally flexible because it was designed to be tailored to each family's needs and context, including cultural norms and values. We present the FCU implementation framework (IF) as a conceptual framework for cross-country transport of the FCU and evidence-based programs (EBP) more generally. The FCU IF draws from implementation science literature and involves specifying barriers and facilitators related to implementation drivers (e.g., competency) at each implementation phase and applying these data to inform phase-specific, readiness-building activities for each driver. In addition to driver-related influences, barriers and facilitators specific to the FCU and the collaborative partnership between the U.S. and Swedish purveyors emerged in the data. The partnership's reliance on a hybrid bottom-up, top-down approach that balanced the Swedish purveyor's autonomy and cultural expertise with guidance from the U.S. purveyor facilitated adaptation of the FCU for Sweden. Relying on previously collected data, we also explored similarities and differences in barriers and facilitators to FCU scale-up in the United States versus Sweden. In general, across drivers, the same barriers and facilitators were salient. This study suggests that dissemination of culturally flexible EBPs guided by a dynamic implementation framework can facilitate cross-country transport of EBPs. This study promotes a culture of prevention by highlighting barriers, facilitators, and readiness-building strategies that influence the cross-cultural transportability of EBPs that prevent the onset and escalation of child problem behavior.

Treatment of aromatic N-substituted N-heterocyclic carbenes (NHCs) with trimethyl-gallium and -indium yielded the new Lewis acid-base adducts, IMes·GaMe 3 (1), SIMes·GaMe 3 (2), IPr·GaMe 3 (3), SIPr·GaMe 3 (4), IMes·InMe 3 (5), SIMes·InMe 3 (6), IPr·InMe 3 (7), and SIPr·InMe 3 (8), with all complexes being identified by X-ray diffraction, IR, and multinuclear NMR analyses. Complex stability was found to be largely dependent on the nature of the constituent NHC ligands. Percent buried volume (%V Bur ) and topographic steric map analyses were employed to quantify and elucidate the observed trends. Additionally, a detailed bond snapping energy (BSE) decomposition analysis focusing on both steric and orbital interactions of the M-NHC bond (M = Al, Ga and In) has been performed.

The influence of plant traits on forest fire behaviour has evolutionary, ecological and management implications, but is poorly understood and frequently discounted. We use a process model to quantify that influence and provide validation in a diverse range of eucalypt forests burnt under varying conditions. Measured height of consumption was compared to heights predicted using a surface fuel fire behaviour model, then key aspects of our model were sequentially added to this with and without species-specific information. Our fully specified model had a mean absolute error 3.8 times smaller than the otherwise identical surface fuel model (p < 0.01), and correctly predicted the height of larger (≥1 m) flames 12 times more often (p < 0.001). We conclude that the primary endogenous drivers of fire severity are the species of plants present rather than the surface fuel load, and demonstrate the accuracy and versatility of the model for quantifying this.

Highly active and selective aerobic oxidation of KA-oil to cyclohexanone (precursor for adipic acid and ɛ-caprolactam) has been achieved in high yields using continuous-flow chemistry by utilizing uncapped noble-metal (Au, Pt & Pd) nanoparticle catalysts. These are prepared using a one-step in situ methodology, within three-dimensional porous molecular architectures, to afford robust heterogeneous catalysts. Detailed spectroscopic characterization of the nature of the active sites at the molecular level, coupled with aberration-corrected scanning transmission electron microscopy, reveals that the synthetic methodology and associated activation procedures play a vital role in regulating the morphology, shape and size of the metal nanoparticles. These active centers have a profound influence on the activation of molecular oxygen for selective catalytic oxidations., (© 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Treatment of a series of aromatic NHCs (IMes, SIMes, IPr and SIPr) with trimethylaluminium produced their corresponding Lewis acid-base adducts: IMes·AlMe3 (1), SIMes·AlMe3 (2), IPr·AlMe3 (3), and SIPr·AlMe3 (4). These complexes expand the few known examples of saturated NHC stabilised Group 13 complexes. Furthermore, compounds 1-4 show differential stability depending on the nature of the NHC ligand. Analyses of topographic steric maps and NHC %V(Bur) were used to explain these differences. All the compounds have been fully characterised by multinuclear NMR spectroscopy, IR and single crystal X-ray analysis together with computational studies.

By using platinum nanoparticle catalysts that are generated in situ by extrusion from a porous copper chlorophosphate framework, the role of oxidants in the selective oxidation of benzyl alcohol to benzaldehyde was evaluated, with a view to establishing structure-property relationships. With a detailed study of the kinetic properties of the oxidation reaction, it has been determined that the aerobic oxidation pathways progress with lower levels of product selectivity and higher activation energies (72.4 kJ mol -1 ) than the peroxide-based ones (23.6 kJ mol -1 ); affording valuable insights in the design of solid catalysts for selective oxidation reactions. Furthermore, through the use of X-ray absorption spectroscopy, the effect of calcination temperature on the degree of extrusion and its influence on nanoparticle formation have been evaluated, leading to the establishment of structure-activity correlations between the observed activation energies and the proportion of nanoparticle species generated., (Copyright © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

The frontispiece shows a novel in situ method of generating metal nanoparticles within porous molecular frameworks, thereby affording highly active and selective single-site heterogeneous catalysts for industrially significant aerobic oxidations. The Communication on page 1226 by Robert Raja and Andy Hor et al. highlights the importance of spectroscopic and kinetic studies in establishing structureproperty correlations that are fundamental in the design of sustainable heterogeneous catalysts., (Copyright © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

We measured total and free plasma concentrations of ropivacaine following high-volume, high-dose local infiltration analgesia in 28 patients aged 65 years or over undergoing unilateral total knee arthroplasty. Patients received infiltration of ropivacaine 400 mg followed by infusion at 20 mg.h(-1) through an intra-articular catheter. Total and free plasma levels of ropivacaine were measured at specified time intervals during a 24-h period after tourniquet release. Patients were monitored for symptoms and signs of local anaesthetic toxicity. Total levels of plasma ropivacaine varied from 0.147 to 3.093 μg.ml(-1) (mean (SD) 1.105 (0.518) μg.ml(-1) ). Free levels of plasma ropivaca-ine varied from 0.001 to 0.104 μg.ml(-1) (mean (SD) 0.037 (0.020) μg.ml(-1) ). Six samples had total plasma ropivacaine levels greater the toxic threshold of 2.2 μg.ml(-1) . No samples reached the toxic threshold for free venous ropivacaine concentration. We conclude that the use of high-dose ropivacaine infiltration and catheter infusion for total knee arthroplasty in an elderly population does not result in free plasma ropivacaine levels previously associated with toxicity but that raised total plasma levels may be observed., (© 2015 The Association of Anaesthetists of Great Britain and Ireland.)

The impacts of escalating wildfire in many regions - the lives and homes lost, the expense of suppression and the damage to ecosystem services - necessitate a more sustainable coexistence with wildfire. Climate change and continued development on fire-prone landscapes will only compound current problems. Emerging strategies for managing ecosystems and mitigating risks to human communities provide some hope, although greater recognition of their inherent variation and links is crucial. Without a more integrated framework, fire will never operate as a natural ecosystem process, and the impact on society will continue to grow. A more coordinated approach to risk management and land-use planning in these coupled systems is needed.

We measured total and free plasma concentrations of ropivacaine following high-volume, high-dose local infiltration analgesia in 19 patients aged 65 years or over undergoing unilateral total hip arthroplasty. The patients received 180 ml ropivacaine 0.2% (360 mg), which was injected into the deep and peri-capsular tissues, the gluteal muscles and fascia lata, and the subcutaneous tissues and skin. Patients were monitored for clinical symptoms and signs of systemic local anaesthetic toxicity. Total levels of plasma ropivacaine varied from 0.081 to 1.707 μg.ml(-1) (mean (SD) 0.953 (0.323) μg.ml(-1) ). Free levels of plasma ropivacaine varied from 0.000 to 0.053 μg.ml(-1) (mean (SD) 0.024 (0.011) μg.ml(-1) ). No samples reached the toxic threshold for venous ropivacaine concentration, although four patients exhibited mild symptoms consistent with local anaesthetic toxicity. One patient had episodes of complete heart block on ECG monitoring, but plasma ropivacaine levels were below toxic levels. We conclude that plasma levels for ropivacaine associated with toxicity in a volunteer population (total 2.2 μg.ml(-1) , free 0.15 μg.ml(-1) ) are not reached during local infiltration analgesia for hip arthroplasty in elderly patients., (© 2014 The Association of Anaesthetists of Great Britain and Ireland.)

Environmental disturbance underpins the dynamics and diversity of many of the ecosystems of the world, yet its influence on the patterns and distribution of genetic diversity is poorly appreciated. We argue here that disturbance history may be the major driver that shapes patterns of genetic diversity in many natural populations. We outline how disturbance influences genetic diversity through changes in both selective processes and demographically driven, selectively neutral processes. Our review highlights the opportunities and challenges presented by genetic approaches, such as landscape genomics, for better understanding and predicting the demographic and evolutionary responses of natural populations to disturbance. Developing this understanding is now critical because disturbance regimes are changing rapidly in a human-modified world., (Copyright © 2013 Elsevier Ltd. All rights reserved.)