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PurposeComputed Tomography Angiography (CTA) is the first line of imaging in the diagnosis of Large Vessel Occlusion (LVO) strokes. We trained and independently validated end-to-end automated deep learning pipelines to predict 3-month outcomes after anterior circulation LVO thrombectomy based on admission CTAs.MethodsWe split a dataset of 591 patients into training/cross-validation (n = 496) and independent test set (n = 95). We trained separate models for outcome prediction based on admission “CTA” images alone, “CTA + Treatment” (including time to thrombectomy and reperfusion success information), and “CTA + Treatment + Clinical” (including admission age, sex, and NIH stroke scale). A binary (favorable) outcome was defined based on a 3-month modified Rankin Scale ≤ 2. The model was trained on our dataset based on the pre-trained ResNet-50 3D Convolutional Neural Network (“MedicalNet”) and included CTA preprocessing steps.ResultsWe generated an ensemble model from the 5-fold cross-validation, and tested it in the independent test cohort, with receiver operating characteristic area under the curve (AUC, 95% confidence interval) of 70 (0.59–0.81) for “CTA,” 0.79 (0.70–0.89) for “CTA + Treatment,” and 0.86 (0.79–0.94) for “CTA + Treatment + Clinical” input models. A “Treatment + Clinical” logistic regression model achieved an AUC of 0.86 (0.79–0.93).ConclusionOur results show the feasibility of an end-to-end automated model to predict outcomes from admission and post-thrombectomy reperfusion success. Such a model can facilitate prognostication in telehealth transfer and when a thorough neurological exam is not feasible due to language barrier or pre-existing morbidities.

Summary: Background: Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures. Methods: This is a prospective multi-centre observational cohort study of adults with CES in the UK. We assessed presentation, investigation, management, and all Core Outcome Set domains up to one year post-operatively using clinician and participant reporting. Univariable and multivariable associations with the Oswestry Disability Index (ODI) and urinary outcomes were investigated. Findings: In 621 participants with CES, catheterisation for urinary retention was required pre-operatively in 31% (191/615). At discharge, only 13% (78/616) required a catheter. Median time to surgery from symptom onset was 3 days (IQR:1–8) with 32% (175/545) undergoing surgery within 48 h. Earlier surgery was associated with catheterisation (OR:2.2, 95%CI:1.5–3.3) but not with admission ODI or radiological compression. In multivariable analyses catheter requirement at discharge was associated with pre-operative catheterisation (OR:10.6, 95%CI:5.8–20.4) and one-year ODI was associated with presentation ODI (r = 0.3, 95%CI:0.2–0.4), but neither outcome was associated with time to surgery or radiological compression. Additional healthcare services were required by 65% (320/490) during one year follow up. Interpretation: Post-operative functional improvement occurred even in those presenting with urinary retention. There was no association between outcomes and time to surgery in this observational study. Significant healthcare needs remained post-operatively. Funding: DCN Endowment Fund funded study administration. Castor EDC provided database use. No other study funding was received.

ABSTRACT The availability of public genomics data has become essential for modern life sciences research, yet the quality, traceability, and curation of these data have significant impacts on a broad range of microbial genomics research. While microbial genome databases such as NCBI’s RefSeq database leverage the scalability of crowd sourcing for growth, genomics data provenance and authenticity of the source materials used to produce data are not strict requirements. Here, we describe the de novo assembly of 1,113 bacterial genome references produced from authenticated materials sourced from the American Type Culture Collection (ATCC), each with full genomics data provenance relating to bioinformatics methods, quality control, and passage history. Comparative genomics analysis of ATCC standard reference genomes (ASRGs) revealed significant issues with regard to NCBI’s RefSeq bacterial genome assemblies related to completeness, mutations, structure, strain metadata, and gaps in traceability to the original biological source materials. Nearly half of RefSeq assemblies lack details on sample source information, sequencing technology, or bioinformatics methods. Deep curation of these records is not within the scope of NCBI’s core mission in supporting open science, which aims to collect sequence records that are submitted by the public. Nonetheless, we propose that gaps in metadata accuracy and data provenance represent an “elephant in the room” for microbial genomics research. Effectively addressing these issues will require raising the level of accountability for data depositors and acknowledging the need for higher expectations of quality among the researchers whose research depends on accurate and attributable reference genome data. IMPORTANCE The traceability of microbial genomics data to authenticated physical biological materials is not a requirement for depositing these data into public genome databases. This creates significant risks for the reliability and data provenance of these important genomics research resources, the impact of which is not well understood. We sought to investigate this by carrying out a comparative genomics study of 1,113 ATCC standard reference genomes (ASRGs) produced by ATCC from authenticated and traceable materials using the latest sequencing technologies. We found widespread discrepancies in genome assembly quality, genetic variability, and the quality and completeness of the associated metadata among hundreds of reference genomes for ATCC strains found in NCBI’s RefSeq database. We present a comparative analysis of de novo-assembled ASRGs, their respective metadata, and variant analysis using RefSeq genomes as a reference. Although assembly quality in RefSeq has generally improved over time, we found that significant quality issues remain, especially as related to genomic data and metadata provenance. Our work highlights the importance of data authentication and provenance for the microbial genomics community, and underscores the risks of ignoring this issue in the future.

Despite the growth rates of photovoltaic solar parks, their potential to alter land surface temperature remains unclear. Yet, resolving temperature impacts is pivotal to understanding the implications for ecosystem function, and the consequences for society due to perturbations to ecosystem service supply and natural capital stores. Here, for the first time, we demonstrate the existence of a solar park land surface temperature cool island effect that extends beyond the solar park boundary, using Landsat satellite imagery. The cool island effect was quantified for two large ground-mounted solar parks, Longyangxia (850 megawatts) in China and Stateline (300 megawatts) in the United States of America, where the effect was confirmed using field-based measurements. At both sites, the cooling extended up to 730 m away from the solar park boundary with localized reductions in LST of up to 2.3 °C. These cool islands could affect large areas of the land surface as solar parks proliferate across the world, with notable positive or negative impacts on ecosystem function. Given the potential implications for ecosystem processes, including carbon feedbacks to climate change and the carbon intensity of the electricity produced, improved understanding of solar park LST impacts is required. Specifically, this knowledge is needed to inform the development of sustainable land use and energy policies considering the rapid growth of solar park developments.

This article discusses Buddhist apologetics in Tibet by examining the formation, revision, and reception of the most renowned literary apologia ever written in defense of the Old School of Tibetan Buddhism: Sokdokpa Lodrö Gyeltsen’s early 17th-century magnum opus the Thunder of Definitive Meaning. It reconstructs in broad strokes the history of the Thunder’s reception from the early 17th century to the present and relates this to details in different versions of the Thunder and its addendum to shed light on the process by which this work was composed and edited. By considering this work’s peculiar context of production and history of reception alongside passages it presents revealing how it was conceived and revised, this analysis aims to prepare the ground for its study and translation. In so doing, this discussion attempts to show how a broadly historical approach can work in tandem with a fine-grained philological approach to yield fresh insights into the production and reception of Buddhist literary works that have important ramifications for their understanding and translation.

Introduction: Despite increasing recognition of atypical femoral fractures (AFFs), there’s conflicting evidence about incidence, aetiology, and short-term outcomes of these injuries. This study reports the incidence of AFFs at our center and compares the early postoperative outcomes against typical femoral fractures (TFFs). Methods: A retrospective observational cohort study of patients presenting to our trauma unit between November 2015 and July 2016 was undertaken. Inclusion criteria required radiologically confirmed proximal femoral fracture, which was then categorized as AFF or TFF. Primary outcome measures included length of stay, discharge destination, and 30-day mortality. Results: Two hundred thirty-nine patients presented to our trauma unit over 9 months with either a fractured neck of femur or proximal femoral fracture. A total of 122 were identified as pertrochanteric, subtrochanteric, or proximal femoral shaft fractures of which 25 (20.5%) displayed atypical radiographic features consistent with AFF. The 2 groups were similar for average age (TFF 85.3 years vs AFF 85.0 years), gender (19% vs 16% male gender), American Society of Anaesthesiology grade (3.0 vs 3.0), cognitive score (abbreviated mental test score = 7.03 vs 7.08), and preinjury place of residence (88.9% vs 92.0% lived in own home). Typical fractures were fixed with either dynamic hip screw or intramedullary nailing, all atypical fractures were fixed with intramedullary nailing. There was no statistical difference between the 2 groups for length of stay (12.8 days vs 14.3 days; P > .05), discharge to preinjury residence (45.1% vs 36%; P > .05), or 30-day mortality (8.1% vs 12%; P > .05). Discussion: In our predominantly geriatric population atypical radiographic features were observed in around 10% of patients presenting with proximal femoral fractures or fractured neck of femur. Previous studies have reported poor outcomes for pain, mobility, and length of stay after AFF. However, we observed no difference in short-term outcome measures when compared to patients with typical proximal femoral fracture patterns at our trauma unit. Conclusion: With modern principles of trauma care outcomes achieved following AFFs may be equivalent to typical femoral fractures in the geriatric population.

This article examines the relationship between the practice and theory of medicine and Buddhism in premodern Tibet. It considers a polemical text composed by the 16th−17th-century Tibetan physician and tantric Buddhist expert Sokdokpa Lodrö Gyeltsen, intending to prove the Buddhist canonical status of the Four Medical Tantras, the foundational text of the Tibetan medical tradition. While presenting and analyzing Sokdokpa’s polemical writing in the context of the broader debate over the Buddhist pedigree of the Four Tantras that took place during his time, this discussion situates Sokdokpa’s reflections on the topic in terms of his broader career as both a practicing physician and a tantric Buddhist ritual and contemplative specialist. It suggests that by virtue of Sokdokpa’s tightly interwoven activities in the spheres of medicine and Buddhism, his contribution to this debate gives voice to a sensibility in which empiricist, historicist, and Buddhist ritual and contemplative inflections intermingle in ways that resist easy disentanglement and classification. In this it argues that Sokdokpa’s reflections form an important counterpoint to the perspectives considered thus far in the scholarly study of this debate. It also questions if Sokdokpa’s style of argumentation might call for a recalibration of how scholars currently construe the roles of tantric Buddhist practice in the appeal by premodern Tibetan physicians to critical and probative criteria.

Este trabalho examina a posição do Inglês como língua internacional em termos de forças políticas e econômicas que contribuíram para a posição dominante do inglês na arena mundial. O trabalho examina a acusação de que o ensino de inglês como segunda língua ou língua estrangeira contribui para o imperialismo lingüístico e cultural e desafia o pressuposto de que os falantes nativos de inglês são necessariamente os melhores professores. Recomenda- se aos profissionais de língua inglesa a adoção de uma filosofia de relativismo pragmático na sua avaliação das necessidades do aprendiz de forma a evitar tendências etnocêntricas em seus currículos.