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Cyclonic vortices that are weaker than tropical storm category can bring heavy precipitation as they propagate across the South China Sea and surrounding countries. Here we investigate the structure and dynamics responsible for the intensification of a Borneo vortex that moved from the north of Borneo across the South China Sea and impacted Vietnam and Thailand in late October 2018. This case study is examined using Met Office Unified Model (MetUM) simulations and a semi-geotriptic (SGT) balance approximation tool. Satellite observations and a MetUM simulation with 4.4 km grid initialised at 12:00 UTC on 21 October 2018 show that the westward-moving vortex is characterised by a coherent maximum in total column water and by a comma-shaped precipitation structure with the heaviest rainfall to the northwest of the circulation centre. The Borneo vortex comprises a low-level cyclonic circulation and a mid-level wave embedded in the background easterly shear flow, which strengthens with height up to around 7 km. Despite being in the tropics at 6∘ N, the low-level vortex and mid-level wave are well represented by SGT balance dynamics. The mid-level wave propagates along a vertical gradient in moist stability, i.e. the product between the specific humidity and the static stability, at 4.5 to 5 km and is characterised by a coherent signature in the potential vorticity, meridional wind, and balanced vertical velocity fields. The vertical motion is dominated by coupling with diabatic heating and is shifted relative to the potential vorticity so that the diabatic wave propagates westwards, relative to the flow, at a rate consistent with prediction from moist semi-geostrophic theory. Initial vortex development at low levels is consistent with baroclinic growth initiated by the mid-level diabatic Rossby wave, which propagates on baroclinic shear flow on the southern flank of a large-scale cold surge.

The fast pace of technological advancements is regarded as one of the global drivers of change. In the telecommunications sector in South Africa, these technological advancements as well as sector transformation pose competitiveness challenges to entrepreneurs. This paper reports an empirical study performed to contribute to the promotion of entrepreneurial competitiveness within the telecommunications sector of the South African economy. From the empirical study, significant relationships proved to exist between the intervening- and independent variables and the dependent variable of this study, namely Perceived Entrepreneurial Competitiveness. The independent variable Infrastructural Change positively influenced both the intervening variable Entrepreneurial Orientation and dependent variable Perceived Entrepreneurial Competitiveness. In the same manner, the independent variables of Regulatory Alignment and Entrepreneurial Mindset did positively influenced Perceived Entrepreneurial Competitiveness within this study. The study found that entrepreneurs can position their businesses more competitively if the factors that impact directly or indirectly on Entrepreneurial Competitiveness in the South African Telecommunications sector are taken in consideration.

Abstract. Background. Male genital form and function may be rendered abnormal by a number of disease processes, with profound associated psychological and functional consequences. The aim of the study is to review our reconstructive experience with cases of genital loss or distortion due to nonmalignant diseases processes and atypical neoplasia. Materials and methods. A retrospective review of a prospectively maintained database was performed to identify reconstructive cases performed from 2018 to 2020 under the care of a single surgeon. Male patients 18 years or older with a disease diagnosis other than squamous cell carcinoma affecting genital form were included. Disease processes, patient factors, surgical techniques, and both functional and cosmetic outcomes were reviewed. Results. Fourteen cases were identified. The patients had a mean age of 52.2 years (range, 21–72 years). Acquired buried penis was present in 8 patients. Etiology of genital abnormality included balanitis xerotica obliterans (n = 6), excess skin loss at circumcision (n = 2), self-injection of petroleum jelly to penile shaft (n = 1), Fournier gangrene (n = 1), hidradenitis suppurativa (n = 1), extramammary Paget disease (n = 1), idiopathic lymphoedema (n = 1), and penoscrotal webbing (n = 1). Reconstructive techniques performed included penile debridement/shaft skin release, scrotectomy, suprapubic apronectomy, and division of penoscrotal webbing, in combination with split-thickness skin grafting where required. A penile implant was inserted in one patient. Reconstructive planning, techniques, and outcomes are described. Conclusions. A variety of reconstructive techniques in andrology can be used to improve the aesthetic and functional outcomes of multiple disease processes affecting the male external genitalia.

The present study had two aims. First, we set out to evaluate the structure of processing speed in children by comparing five alternative models: two conceptual models (a unitary model, a complexity model) and three methodological models (a stimulus material model, an output response model, and a timing modality model). Second, we then used the resulting models to predict multiple types of reading, a highly important developmental outcome, using other well-known predictors as covariates. Participants were 844 children enrolled in third through fifth grade in urban public elementary schools who received 16 measures of processing speed that varied in the above dimensions. A two-factor complexity model that differentiated between simple and complex processing speed was the preferred model and fit the data well. Both types of PS predicted reading fluency, and complex (but not simple) PS predicted single word reading and comprehension. Results offer insight to the structure of processing speed, its relation to closely related concepts (such as executive function), and provide nuance to the understanding of the way processing speed influences reading.

Abstract Background In this “Advancing simulation practice” article, we offer an expose of the involvement of real patients in Objective Structured Clinical Examinations (OSCEs), inviting educators who traditionally involve solely SPs in their summative OSCEs to consider the practice. The need for standardisation in summative assessments can make educators understandably wary to try this, even if the rhetoric to involve real patients is accepted. We offer this as an instance of the tussle between standardisation and validity experienced throughout health professions education. Main text We offer our experience and empirical evidence of this simulation practice, based on an institutional ethnographic examination of the involvement of real patients in summative OSCEs from an undergraduate medical school in the UK. Our critique demonstrates the merits of this approach as an assessment environment closer to the real clinical environments where these soon-to-be doctors interact in a more authentic way with real patients and their illness experiences. We balance this against the extra work required for all involved and suggest the biggest challenge is in the reorientation work required for both Faculty and students who are institutionalised to expect standardisation above all in assessment. Conclusion We advocate for involving real patients in summative OSCEs and hope that readers may feel compelled and empowered to foster this shift in mindset required to introduce this practice into their assessments.

Abstract The calculation of next-to-leading order (NLO) perturbative corrections at fixed operator dimension in Standard Model Effective Field Theory (SMEFT) has been a topic of much recent interest. In this paper we obtain the NLO corrections from dimension-6 operators to the Higgs boson decays h → f f ¯ $$ h\to f\overline{f} $$ , where the fermions f ∈ {μ, τ, c}. This extends previous results for h → b b ¯ $$ h\to b\overline{b} $$ to all phenomenologically relevant Higgs boson decays into fermions, and provides the basis for future precision analyses of these decays within effective field theory. We point out the benefits of studying ratios of decay rates into different fermions in SMEFT, the most surprising of which is enhanced sensitivity to anomalous hγγ and hgg couplings induced by flavor-universal SMEFT operators, especially in scenarios where flavor-dependent Wilson coefficients are constrained by Minimal Flavor Violation.

Prosthetic joint infections (PJIs) are typically caused by Staphylococcus aureus and coagulase-negative Staphylococci species. Corynebacterium species are microorganisms of the human skin and mucous membranes that are often considered contaminants when grown in culture. In the past, Corynebacterium species were often classified as diphtheroids based on growing as gram-positive rods in aerobic environments, but with advances in technology, the identification of Corynebacterium species has improved. Corynebacterium can cause infection, but there are few case reports of orthopaedic infection. We present 3 cases of total hip arthroplasty and 3 cases of total knee arthroplasty PJI caused by Corynebacterium species. We found a high failure rate of surgical treatment of Corynebacterium PJI, defined as reoperation for infection. This information adds to the limited literature on these organisms in total joint arthroplasty PJI.

Abstract Models that aim to capture the interactions between sediment supply, base level and tectonism recorded in fan delta successions in rift basins have not considered the stratigraphic archive preserved in interfan areas; yet interfan stratigraphy can provide a complementary record to the fan delta axes. The exhumed Early–Middle Pleistocene Kerinitis and Selinous fan deltas, in the hangingwall of the Pyrgaki–Mamoussia (P‐M) Fault, Corinth Rift, Greece, offer an ideal laboratory for the assessment of interfan architecture. Furthermore, using the geometry of adjacent present‐day fan deltas, interfans are classified into three end‐members. The classification is based on their lateral separation, which determines the degree of interfingering of topset, foreset and bottomset deposits. Qualitative (facies, stratal geometries, nature of key surfaces) and quantitative (stratigraphic thickness, bedding dip, palaeocurrents, breakpoint trajectories) data were collected in the field and from unmanned aerial vehicle photogrammetry‐based 3D outcrop models of the exhumed fan delta successions. The ancient Kerinitis–Selinous interfan architectures record: (a) initial westward progradation of the Kerinitis fan delta into the interfan area (Phase 1), (b) subsequent progradation of the Selinous fan delta into the interfan area and asymmetric growth of both fan deltas eastward (Phase 2), (c) stratal interfingering of foresets from both systems (Phase 3), and (d) relative base‐level fall, erosion and reworking of sediments into the interfan area (Phases 4 and 5). The Kerinitis–Selinous interfan evolution is linked to initial net subsidence of the P‐M Fault (Phases 1–3) and subsequent net uplift (Phases 4 and 5) resulting from a northward shift in fault activity. The interfan area provides a more complete stratigraphic record than the proximal axial areas of the fan deltas of the early stages of basin uplift, through higher preservation potential and protracted submergence. Therefore, for the most comprehensive insight into basin evolution, interfan analysis should be undertaken in concert with analysis of the fan delta axes.

Abstract We calculate the full set of next-to-leading order (NLO) corrections to h → b b ¯ $$ \overline{b} $$ decay in the dimension-6 Standard Model Effective Field Theory (SMEFT). Our calculation forms the basis for precision studies of this decay mode in effective field theory, providing analytic and numerical results for contributions of the 45 dimension-6 operators appearing at NLO. On the technical side, we discuss several complications in NLO SMEFT computations which have not yet been addressed in the literature. These include subtleties in Higgs-Z mixing, electric charge renormalization, and especially the treatment of tadpoles in SMEFT. In particular, we highlight the role of decoupling relations in eliminating potentially large tadpole corrections to the decay rate in hybrid renormalization schemes which employ the MS ¯ $$ \overline{\mathrm{MS}} $$ scheme for some Standard Model parameters (such as the b-quark mass and electric charge) and the on-shell scheme for others.

Microbiome research has increased dramatically in recent years, driven by advances in technology and significant reductions in the cost of analysis. Such research has unlocked a wealth of data, which has yielded tremendous insight into the nature of the microbial communities, including their interactions and effects, both within a host and in an external environment as part of an ecological community. Understanding the role of microbiota, including their dynamic interactions with their hosts and other microbes, can enable the engineering of new diagnostic techniques and interventional strategies that can be used in a diverse spectrum of fields, spanning from ecology and agriculture to medicine and from forensics to exobiology. From June 19–23 in 2017, the NIH and NSF jointly held an Innovation Lab on Quantitative Approaches to Biomedical Data Science Challenges in our Understanding of the Microbiome. This review is inspired by some of the topics that arose as priority areas from this unique, interactive workshop. The goal of this review is to summarize the Innovation Lab’s findings by introducing the reader to emerging challenges, exciting potential, and current directions in microbiome research. The review is broken into five key topic areas: (1) interactions between microbes and the human body, (2) evolution and ecology of microbes, including the role played by the environment and microbe-microbe interactions, (3) analytical and mathematical methods currently used in microbiome research, (4) leveraging knowledge of microbial composition and interactions to develop engineering solutions, and (5) interventional approaches and engineered microbiota that may be enabled by selectively altering microbial composition. As such, this review seeks to arm the reader with a broad understanding of the priorities and challenges in microbiome research today and provide inspiration for future investigation and multi-disciplinary collaboration.

Abstract Background DNA methylation is a heritable epigenetic mark, enabling stable but reversible gene repression. In mammalian cells, DNA methyltransferases (DNMTs) are responsible for modifying cytosine to 5-methylcytosine (5mC), which can be further oxidized by the TET dioxygenases to ultimately cause DNA demethylation. However, the genome-wide cooperation and functions of these two families of proteins, especially at large under-methylated regions, called canyons, remain largely unknown. Results Here we demonstrate that DNMT3A and TET1 function in a complementary and competitive manner in mouse embryonic stem cells to mediate proper epigenetic landscapes and gene expression. The longer isoform of DNMT3A, DNMT3A1, exhibits significant enrichment at distal promoters and canyon edges, but is excluded from proximal promoters and canyons where TET1 shows prominent binding. Deletion of Tet1 increases DNMT3A1 binding capacity at and around genes with wild-type TET1 binding. However, deletion of Dnmt3a has a minor effect on TET1 binding on chromatin, indicating that TET1 may limit DNA methylation partially by protecting its targets from DNMT3A and establishing boundaries for DNA methylation. Local CpG density may determine their complementary binding patterns and therefore that the methylation landscape is encoded in the DNA sequence. Furthermore, DNMT3A and TET1 impact histone modifications which in turn regulate gene expression. In particular, they regulate Polycomb Repressive Complex 2 (PRC2)-mediated H3K27me3 enrichment to constrain gene expression from bivalent promoters. Conclusions We conclude that DNMT3A and TET1 regulate the epigenome and gene expression at specific targets via their functional interplay.

Focused thoracic ultrasound has become essential in the guidance and direction of pleural interventions to reduce unwanted complications and as a result now forms a crucial component of physician training. Current training standards along with assessment methods vary widely, and are often not robust enough to ensure adequate competence. This review assesses the current state of training and assessment of thoracic ultrasound competence in various settings, allowing comparison with alternative competency based programmes. Future directions for training and assessment of thoracic ultrasound competence are discussed.

Paratesticular soft tissue tumours are remarkably rare entities, with malignant subtypes accounting for approximately 30%. Due to the paucity of cases, a consensus on the best treatment has not yet been reached, presenting a diagnostic and therapeutic challenge for clinicians. Although rare, three such cases presented to the care of our institution serving a population of approximately 400,000 in the space of 13 months. These were three gentlemen, aged 54, 82 and 86 years old, presenting with left sided testicular swellings. Ultrasound in each case confirmed an extratesticular mass. Only the second gentleman complained of associated pain, however he had experienced scrotal trauma in the preceding weeks. Only one patient had suspicions of metastatic disease, with a 9 mm pulmonary nodule on computed tomography. All patients underwent a radical inguinal orchidectomy with high ligation of the spermatic cord, in keeping with best accepted guidelines. Histology confirmed a well-differentiated liposarcoma, a dedifferentiated liposarcoma and a leiomyosarcoma respectively, all high grade. One gentleman returned to theatre for re-excision of margins. Our case series emphasises the need for full multidisciplinary team specialist sarcoma input, as well as radical resection with judicious margins in order to reduce the risk of local recurrence, in the treatment of these rare tumours.

Objectives: Intravenous fluid (IV) therapy is an important component of care for many hospital patients, especially in perioperative and acute care settings. However, errors in fluid composition and dosing can be life-threatening. To achieve competent professional performance, i.e., accurate and fluent, it is vitally important that medical students receive effective training in IV fluid therapy. Methods: In this study, we explored how Precision Teaching (PT), a behaviour analytic teaching method, can enhance outcomes of usual medical education techniques. A total of 178 third-year medical students participated in the study during the IV fluid therapy training week. All students completed a multiple-choice test pre- and post-training. In addition to standard IV fluid therapy teaching, the experimental intervention group (n=83 students) used SAFMEDS (Say All Fast MinuteEvery Day Shuffled) cards approximately 3-5 times per day for 5 days. The other 95 students (control group) received teaching as usual, but did not undergo the additional training. Results: Results show that the SAFMEDS boosted performance of the intervention group on the MCQ by 20 percentage points when compared to the control group. Fluency (accuracy and speed) of performance on SAFMED trials increased markedly during the intervention week and there was evidence that weaker students benefitted in particular. Conclusions: Implications for medical education are outlined.

Direct reprogramming of fibroblasts to neurons induces widespread cellular and transcriptional reconfiguration. Here, we characterized global epigenomic changes during the direct reprogramming of mouse fibroblasts to neurons using whole-genome base-resolution DNA methylation (mC) sequencing. We found that the pioneer transcription factor Ascl1 alone is sufficient for inducing the uniquely neuronal feature of non-CG methylation (mCH), but co-expression of Brn2 and Mytl1 was required to establish a global mCH pattern reminiscent of mature cortical neurons. Ascl1 alone induced promoter CG methylation (mCG) of fibroblast specific genes, while BAM overexpression additionally targets a competing myogenic program and directs a more faithful conversion to neuronal cells. Ascl1 induces local demethylation at its binding sites. Surprisingly, co-expression with Brn2 and Mytl1 inhibited the ability of Ascl1 to induce demethylation, suggesting a contextual regulation of transcription factor - epigenome interaction. Finally, we found that de novo methylation by DNMT3A is required for efficient neuronal reprogramming.