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Abstract Chiral intermetallic phases may show unusual chemical and physical properties with nontrivial structure-property relationship. It is therefore of particular interest to study the structural conversion between domains of different handedness. Here, the atomic decoration of the enantiomorph exchange area within single crystal of the Weyl semimetal CoSi is determined by a combination of atomic-resolution scanning transmission electron microscopy imaging, single crystal X-ray diffraction and quantum chemical analysis of atomic interactions. Two-atomic [CoSi] units are shown to be the bonding base for the FeSi-type structure and may be considered as ‘pseudo-molecules’, thinking of molecular organic crystals. Tiny reorganisation of atomic interactions within these units results in the appearance of sequence ‘faults’ in the structure pattern i.e. in a different structural motif in the enantiomorph exchange area, which – contrary to the A and B enantiomorphs of CoSi – contains an inversion centre and allows a local enantiomorph ‘conversion’. Due to the special features of atomic interactions, the reorganisation of multi-atomic bonds leads to slightly higher total energy. This appears within one and the same grain which is prepared by the short distance chemical vapor transport.

Objective: To help inform decisions regarding the equitable implementation of obesity interventions, we examined whether interventions were equitably reaching the most vulnerable communities, identified communities that received fewer interventions than expected, and estimated the effect of ‘dose’ of interventions on obesity prevalence. Methods: We created a database to identify and characterize obesity-related interventions implemented in Los Angeles County from 2005 to 2015 linked to community-level sociodemographic and obesity prevalence data. We ran generalized linear models with a Gamma distribution and log link to determine if interventions were directed toward vulnerable communities and to identify communities that received fewer interventions than expected. We ran fixed-effects models to estimate the association between obesity prevalence and intervention strategy count among preschool-aged children enrolled in the Special Supplemental Nutrition Assistance Program for Women Infants and Children. Results: We found that interventions targeted vulnerable communities with high poverty rates and percentages of minority residents. The small cluster of communities that received fewer interventions than expected tended to have poor socioeconomic profiles. Communities which received more intervention strategies saw greater declines in obesity prevalence (β = -0.023; 95 % CI: −0.031, −0.016). Conclusions: It is important to determine if interventions are equitably reaching vulnerable populations as resources to tackle childhood obesity become available. Evaluating the population impact of multiple interventions implemented simultaneously presents methodological challenges in measuring intervention dose and identifying cost-effective strategies. Addressing these challenges must be an important research priority as community-wide interventions involve multiple intervention strategies to reduce health disparities.

Introduction Households are increasingly studied in population health research as an important context for understanding health and social behaviours and outcomes. Identifying household units of analysis in routinely collected data rather than traditional surveys requires innovative and standardised tools, which do not currently exist. Objectives To design a utility that identifies households at a point in time from pseudonymised Unique Property Reference Numbers (UPRNs) known as Residential Anonymised Linkage Fields (RALFs) assigned to general practitioner (GP) patient addresses in electronic health records (EHRs) in north east London (NEL). Methods Rule-based logic was developed to identify households based on GP registration, address date, and RALF validity. The logic was tested on a use case on the household clustering of childhood weight status, and bias in success of identifying households was examined in the use case cohort and in a full population cohort. Results 92.1% of the use case cohort was assigned a household. The most frequent dominant reason (55.3%) for a household not assigned was that a person had no valid household RALFs available across their patient registration address records. Other reasons are having none or multiple valid household RALFs, or not being alive at the event date. In the use case, children not assigned to a household were more likely to attend schools in City & Hackney and living in the third most deprived quintile of lower super output areas. 88.9% of the population cohort was assigned a household. Patients not assigned to a household were more likely to be aged 18 to 45 years, living in City & Hackney, and living in the second quintile of most deprived lower super output areas. Conclusions We have developed a method for deriving households from primary care EHRs that can be implemented quickly and in real-time, providing timely data to support population health research on households.

Abstract We study the effect of the mirror force on the collision rate due to the energetic electron precipitation into the ionosphere. We solve the motion of individual precipitating electrons with the mirror force, where collisions with neutral gas are computed by the Monte Carlo method. By comparing the results with those without the mirror force, we examine the effect of the mirror force on the altitude profile of the ionization rate. First, we carry out simulations of mono-energetic precipitation of 3 keV electrons whose initial pitch angle is 70 degrees at 400 km at L = 6.45. We find that the collision rate peaks at around 120 km altitude and that the duration of the collision is scattered in time with a delay of about 5 ms compared with the result without mirror force. Next, we perform mono-energetic precipitation of the different energy and pitch angle ranges. Simulation results demonstrate that larger kinetic energy lowers the altitude profiles of the collision rate, consistent with previous studies. We also find that the upward motion of electrons bounced back from their mirror points results in the upward broadening of the altitude profile of the collision rate. Simulation results for electrons with kinetic energies above 100 keV show that a secondary peak of the collision rate is formed near the mirror point. The formation of the secondary peak can be explained by the stagnation of electrons around the mirror point at 130 km altitude, because the relatively long duration of staying in neutral gas increases the number of collisions. Simulation results show that under the precipitation of electrons in the kinetic energy range larger than tens of keV with the pitch angle close to the loss cone, the maximum collision rate in the altitude range lower than 100 km becomes one order of the magnitude smaller. The results of the present study suggest the importance of the mirror force for the precise modeling of ionospheric response due to the energetic electron precipitation caused by the pitch angle scattering through wave–particle interactions. Graphical Abstract

Background: Reports correlating changes in salivary flow rate and amylase with radiation dose to parotid glands and development of salivary dysfunction for Head and Neck cancers (HNC) are lacking. In the current study, an attempt was made at understanding this.Method: This was a prospective study carried out on people newly diagnosed with HNC requiring curative radiotherapy of more than 60 Gy. The salivary flow rate and levels of salivary α-amylase were evaluated before the start of radiation [day 1, before exposure to the first fraction of 2 Gy radiation], after 2 Gy [24 hours after the 1st fraction of 2 Gy, before exposure to 2nd fraction of 2 Gy on day 2 of the treatment], and on the completion of 30 Gy [(15 fraction of 2 Gy), before start of the 16th fraction, at the start of the fourth week on day 22] of radiation and development of salivary dysfunction was evaluated on a weekly basis. The demographic data were subjected to frequency and percentage, while biochemical data were stratified depending on dose to parotids and subjected to unpaired “t-test”. We also employed chi square/Fishers exact test to ascertain changes in the number of patients developing various degrees of salivary dysfunction on a weekly basis. A P value of

Background: Radiation dermatitis is known to be a major side-effect occurring following cancer treatment. We conducted the present study to understand whether salivary lactate dehydrogenase (LDH) could be conducive to predict the development of radiation-dermatitis in the head and neck cancer (HNC) patients undergoing curative radiotherapy (60-70 Gy).Method: This was a prospective study performed on HNC patients requiring curative radiotherapy. Saliva was collected at two points from the willing volunteers. The first time point was prior to the first fraction of 2 Gy radiation and the second one was 24 hours after the first fraction and before exposure to the second fraction. The saliva collected at the both time points were analyzed for the levels of salivary LDH using standard procedure. The patients were provided with the standard care throughout the treatment period and the incidence and severity of radiation dermatitis was noted down using a proforma sheet throughout the 7-week treatment period.Results: The results suggested that with exposure to 2 Gy fraction, there was an increase in the level of salivary LDH (387.11 ± 18.98 IU/L vs. 368. 13 ± 19.56IU/L); this increase was significant (t = 20.06 and P < 0.001). The LDH data was stratified based on the severity of dermatitis [mild (grades 1 and 2) vs. severe (grades 3 and 4)] in accordance to the Radiation Therapy Oncology Group/European Organization for Research and Treatment Cancer (RTOG) grading. The LDH values were subjected to Karl Pearson’s correlation analysis with the grade of dermatitis and the results indicated a P value of 0.019 and R value of 0.24.Conclusion: For the first time, our study revealed that salivary LDH could be a useful marker to understand the development of radiation-induced dermatitis in HNC patients undergoing curative radiotherapy. The most advantageous aspect herewith is that the collection of saliva does not require skilled people or special equipment; it cou ld be done at repeated intervals and without causing any invasive process.

ABSTRACT Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binding antibody (Ab) levels following vaccination or natural infection could be used as a surrogate for immune protection if results of serological assays were standardized to yield quantitative results using an international standard. Using a bead-based serological assay (Luminex xMAP), anti-receptor binding domain (anti-RBD) Ab levels were determined for 1,450 participants enrolled in the Los Angeles Pandemic Surveillance Cohort (LAPSC) study. For 123 participants, SARS-CoV-2 binding antibody unit (BAU) levels were also quantified using WHO standards and then compared to the semiquantitative results. Samples were chosen to represent the range of results and time from vaccination. Antibody levels and decay rates were then compared using unadjusted and adjusted linear regression models. The linear range of the assay used in this study was determined to be 300 to 5,000 mean fluorescence intensity units (MFI). Among the fully vaccinated groups (vaccinated only and vaccinated with past infection), 84.8% had anti-RBD MFI values above the linear range of >5,000 MFI, and 33.8% had values of >15,000 MFI. Among vaccinated participants with past infection (hybrid immunity), 97% had anti-RBD values of >5,000 MFI and 70% (120/171) had anti-RBD values of >15,000 MFI. In the subgroup quantified using the WHO control, BAU levels were significantly higher than the semiquantitative MFI results. In vaccinated participants, Ab decay levels were similar between infected and noninfected groups (P = 0.337). These results demonstrate that accurate quantitation is possible if standardized with an international standard. BAU can then be compared over time or between subjects and would be useful in clinical decision making. IMPORTANCE Accurate quantification of SARS-CoV-2-specific antibodies can be achieved using a universal standard with sample dilution within the linear range. With hybrid immunity being now common, it is critical to use protocols adapted to high Ab levels to standardize serological results. We validated this approach with the Los Angeles Pandemic Surveillance Cohort by comparing the antibody decay rates in vaccinated participants and vaccinated infected participants.

Abstract Background The choice of aortic valve replacement needs to be decided in an interdisciplinary approach and together with the patients and their families regarding the need for re-operation and risks accompanying anticoagulation. We report long-term outcomes after different AVR options. Methods A chart review of patients aged

Lead telluride is an important thermoelectric material but its metal-to-semiconductor transition above 230 °C is not fully understood. Here, atomic-resolution transmission electron microscopy provides structural insights into this transition, explaining the metallic behavior by a dislocation network within the rock salt structure.

Marine sponges of the subclass Keratosa originated on our planet about 900 million years ago and represent evolutionarily ancient and hierarchically structured biological materials. One of them, proteinaceous spongin, is responsible for the formation of 3D structured fibrous skeletons and remains enigmatic with complex chemistry. The objective of this study was to investigate the interaction of spongin with iron ions in a marine environment due to biocorrosion, leading to the occurrence of lepidocrocite. For this purpose, a biomimetic approach for the development of a new lepidocrocite-containing 3D spongin scaffold under laboratory conditions at 24 °C using artificial seawater and iron is described for the first time. This method helps to obtain a new composite as “Iron-Spongin”, which was characterized by infrared spectroscopy and thermogravimetry. Furthermore, sophisticated techniques such as X-ray fluorescence, microscope technique, and X-Ray diffraction were used to determine the structure. This research proposed a corresponding mechanism of lepidocrocite formation, which may be connected with the spongin amino acids functional groups. Moreover, the potential application of the biocomposite as an electrochemical dopamine sensor is proposed. The conducted research not only shows the mechanism or sensor properties of “Iron-spongin” but also opens the door to other applications of these multifunctional materials.

Background: In locally advanced head-and-neck cancers (HNCs), definitive chemoradiation therapy has emerged as the treatment of choice due to the benefit of organ preservation. Radiation therapy is known to cause significant acute and late toxicities when it is used at radical doses. Studies have shown that more severe toxicities such as mucositis were observed in patients who received radiation therapy with concurrent chemotherapy. Incidental radiation exposure to buccal mucosa during radiation therapy for HNCs contributed to acute radiation-induced oral mucositis (RIOM). Objective: The objective of the study was to dosimetrically evaluate the dose received by buccal mucosa in patients with HNC patients undergoing sequential intensity-modulated radiotherapy technique (SEQ-IMRT) and simultaneous integrated boost intensity-modulated radiotherapy technique (SIB-IMRT). Materials and Methods: Forty patients with histologically proven squamous cell carcinoma of head and neck excluding nasopharyngeal and oral cavity cancers, who received radical chemoradiation therapy by SEQ-IMRT or SIB-IMRT were retrospectively analyzed. The total prescribed dose to the planning target volume was 70 Gy delivered in 2 Gy daily fractions in SEQ-IMRT and 66 Gy in 30 fractions in SIB-IMRT. All patients received concurrent weekly injection cisplatin (35 mg/m2). Dosimetric parameters of right and left buccal mucosa (V 15 Gy, V 30 Gy, and V 45 Gy) were recorded and correlated with grades of RIOM and weight loss as per CTCAE v5.0. Results: Mucositis and weight loss were accessed from week 1 to 7 in the SEQ-IMRT arm and week 1–6 for SIB-IMRT arm. Grade 3 mucositis was observed among 2 patients (10%) and 3 (15%) patients in the SIB-IMRT and none in SEQ-IMRT arm. Grade 2 Weight loss was observed among 35% of patients in SIB-IMRT arm and 5% patients in SEQ-IMRT arm. Conclusion: This study assessed the occurrence of several RIOM as predictive factor with respect to dose received to buccal mucosa in HNC patients, except nasopharyngeal and oral cavity cancer. Our data demonstrated relationship between V30 Gy of buccal mucosa and oral mucosal toxicity with associated weight loss in patients with HNCs undergoing radical chemoradiation therapy.

Abstract Actin is a fundamental member of an ancient superfamily of structural intracellular proteins and plays a crucial role in cytoskeleton dynamics, ciliogenesis, phagocytosis, and force generation in both prokaryotes and eukaryotes. It is shown that actin has another function in metazoans: patterning biosilica deposition, a role that has spanned over 500 million years. Species of glass sponges (Hexactinellida) and demosponges (Demospongiae), representatives of the first metazoans, with a broad diversity of skeletal structures with hierarchical architecture unchanged since the late Precambrian, are studied. By etching their skeletons, organic templates dominated by individual F‐actin filaments, including branched fibers and the longest, thickest actin fiber bundles ever reported, are isolated. It is proposed that these actin‐rich filaments are not the primary site of biosilicification, but this highly sophisticated and multi‐scale form of biomineralization in metazoans is ptterned.

BACKGROUND: Welding work is considered to be an occupational hazard and welders are exposed to a range of metal fumes that are toxic to the blood system. Regular inhalation of the welding toxic fumes alters the hematological, antioxidant, and trace element levels and therefore an attempt is made at understanding these changes in the welders. AIM OF THE WORK: In this case–control study, an attempt is made at understanding the general health, hematological, antioxidant, and trace elements status of welders by comparing with age-matched office workers from the same area. MATERIALS AND METHODS: This was a purposive, case–control prospective study and was carried out in healthy volunteers devoid of any chronic or acute systemic ailments in Mangalore, India. The sociodemographic details were collected in a structured questionnaire, while a detailed clinical examination was carried out by the senior clinicians. The blood collected as per the standard laboratory procedure was analyzed for hematological parameters, antioxidant, and trace elements status. The data were subjected to frequency, percentage, and analyzed using the unpaired ttest. P < 0.05 was considered statistically significant. RESULTS: The results suggest that when compared to the controls, the welders showed significantly lower neutrophil count (53.45 ± 6.11 vs. 46.68 ± 6.12; P = 0.0003) and platelet count (267409.1 ± 42329.4 vs. 199142.9 ± 73735.1; P = 0.0002), and significantly higher counts of eosinophils (5.86 ± 4.12 vs. 9.86 ± 2.76; P = 0.0004) and monocytes (2.45 ± 1.63 vs. 4.89 ± 1.17; P < 0.0001). The levels of lipid peroxidation were high (225.73 ± 56.88 vs. 255.82 ± 30.26; P = 0.04), whereas total antioxidant capacity was less (3.00 ± 0.91 vs. 2.16 ± 1.04; P = 0.004) in the welders. When compared to controls, the serum iron (84.09 ± 6.18 vs. 94.46 ± 8.44; P ≤ 0.0001), copper (104.68 ± 40.63 vs. 148.93 ± 34.18; P = 0.0002), and lead (8.53 ± 5.49 vs. 14.18 ± 8.05; P = 0.005) were all significantly high in welders. There was no significant difference in the serum zinc and glutathione levels between the controls and welders. CONCLUSIONS: The results of the study indicate that occupational exposure to welding fumes among welders disturbs the homeostasis of trace elements in systemic circulation and induces oxidative stress.

Introduction Linking places to people is a core element of the UK government's geospatial strategy. Matching patient addresses in electronic health records to their Unique Property Reference Numbers (UPRNs) enables spatial linkage for research, innovation and public benefit. Available algorithms are not transparent or evaluated for use with addresses recorded by health care providers. Objectives To describe and quality assure the open-source deterministic ASSIGN address-matching algorithm applied to general practitioner-recorded patient addresses. Methods Best practice standards were used to report the ASSIGN algorithm match rate, sensitivity and positive predictive value using gold-standard datasets from London and Wales. We applied the ASSIGN algorithm to the recorded addresses of a sample of 1,757,018 patients registered with all general practices in north east London. We examined bias in match results for the study population using multivariable analyses to estimate the likelihood of an address-matched UPRN by demographic, registration, and organisational variables. Results We found a 99.5% and 99.6% match rate with high sensitivity (0.999,0.998) and positive predictive value (0.996,0.998) for the Welsh and London gold standard datasets respectively, and a 98.6% match rate for the study population. The 1.4% of the study population without a UPRN match were more likely to have changed registered address in the last 12 months (match rate: 95.4%), be from a Chinese ethnic background (95.5%), or registered with a general practice using the SystmOne clinical record system (94.4%). Conversely, people registered for more than 6.5 years with their general practitioner were more likely to have a match (99.4%) than those with shorter registration durations. Conclusions ASSIGN is a highly accurate open-source address-matching algorithm with a high match rate and minimal biases when evaluated against a large sample of general practice-recorded patient addresses. ASSIGN has potential to be used in other address-based datasets including those with information relevant to the wider determinants of health.

In the Maasai Steppe, public health and economy are threatened by African Trypanosomiasis, a debilitating and fatal disease to livestock (African Animal Trypanosomiasis -AAT) and humans (Human African Trypanosomiasis-HAT), if not treated. The tsetse fly is the primary vector for both HAT and AAT and climate is an important predictor of their occurrence and the parasites they carry. While understanding tsetse fly distribution is essential for informing vector and disease control strategies, existing distribution maps are old and were based on coarse spatial resolution data, consequently, inaccurately representing vector and disease dynamics necessary to design and implement fit-for-purpose mitigation strategies. Also, the assertion that climate change is altering tsetse fly distribution in Tanzania lacks empirical evidence. Despite tsetse flies posing public health risks and economic hardship, no study has modelled their distributions at a scale needed for local planning. This study used MaxEnt species distribution modelling (SDM) and ecological niche modeling tools to predict potential distribution of three tsetse fly species in Tanzania's Maasai Steppe from current climate information, and project their distributions to midcentury climatic conditions under representative concentration pathways (RCP) 4.5 scenarios. Current climate results predicted that G. m. morsitans, G. pallidipes and G swynnertoni cover 19,225 km2, 7,113 km2 and 32,335 km2 and future prediction indicated that by the year 2050, the habitable area may decrease by up to 23.13%, 12.9% and 22.8% of current habitable area, respectively. This information can serve as a useful predictor of potential HAT and AAT hotspots and inform surveillance strategies. Distribution maps generated by this study can be useful in guiding tsetse fly control managers, and health, livestock and wildlife officers when setting surveys and surveillance programs. The maps can also inform protected area managers of potential encroachment into the protected areas (PAs) due to shrinkage of tsetse fly habitats outside PAs.

BackgroundRapid antigen tests hold much promise for use in the school environment. However, the performance of these tests in non-clinical settings and among one of the main target populations in schools-asymptomatic children-is unclear. To address this gap, we examined the positive and negative concordance between the BinaxNOW™ rapid SARS-CoV-2 antigen assay and an RT-PCR test among children at a community-based Covid-19 testing site.MethodsWe conducted rapid antigen (BinaxNOW™) and oral fluid RT-PCR (Curative Labs) tests on children presenting at a walk-up testing site in Los Angeles County from November 25, 2020 to December 9, 2020. Positive concordance was determined as the fraction of RT-PCR positive participants that were also antigen positive. Negative concordance was determined as the fraction of RT-PCR negative participants that were also antigen negative. Multivariate logistic regression models were used to examine the association between positive or negative concordance and participant age, race-ethnicity, sex at birth, symptoms and Ct values.Results226 children tested positive on RT-PCR; 127 children or 56.2% (95% CI: 49.5% to 62.8%) of these also tested positive on the rapid antigen test. Positive concordance was higher among symptomatic children (64.4%; 95% CI: 53.4% to 74.4%) compared to asymptomatic children (51.1%; 95% CI: 42.5% to 59.7%). Positive concordance was negatively associated with Ct values and was 93.8% (95% CI: 69.8% to 99.8%) for children with Ct values less than or equal to 25. 548 children tested negative on RT-PCR; 539 or 98.4% (95% CI: 96.9% to 99.2%) of these also tested negative on the rapid antigen test. Negative concordance was higher among asymptomatic children.ConclusionsRapid antigen testing can successfully identify most COVID infections in children with viral load levels likely to be infectious. Serial rapid testing may help compensate for limited sensitivity in early infection.

The objective of this study was to use available data on the prevalence of COVID-19 risk factors in subpopulations and epidemic dynamics at the population level to estimate probabilities of severe illness and the case and infection fatality rates (CFR and IFR) stratified across subgroups representing all combinations of the risk factors age, comorbidities, obesity, and smoking status. We focus on the first year of the epidemic in Los Angeles County (LAC) (March 1, 2020-March 1, 2021), spanning three epidemic waves. A relative risk modeling approach was developed to estimate conditional effects from available marginal data. A dynamic stochastic epidemic model was developed to produce time-varying population estimates of epidemic parameters including the transmission and infection observation rate. The epidemic and risk models were integrated to produce estimates of subpopulation-stratified probabilities of disease progression and CFR and IFR for LAC. The probabilities of disease progression and CFR and IFR were found to vary as extensively between age groups as within age categories combined with the presence of absence of other risk factors, suggesting that it is inappropriate to summarize epidemiological parameters for age categories alone, let alone the entire population. The fine-grained subpopulation-stratified estimates of COVID-19 outcomes produced in this study are useful in understanding disparities in the effect of the epidemic on different groups in LAC, and can inform analyses of targeted subpopulation-level policy interventions.

Previous exposition to heparin and protamine in patients undergoing cardiopulmonary bypass and postoperative therapeutic anticoagulation with LMWH may lead to the development of heparin-induced thrombocytopenia (HIT) and/or protamine-induced thrombocytopenia (PIT). This case deals with a rare clinical presentation of circulating IgG antibodies against heparin/platelet factor 4 complexes and heparin/protamine complexes after cardiac surgery. Ensuing purpura and skin necrosis (blisters) at the injection sites of LMWH and clinical symptoms improved rapidly after replacement of LMWH by an alternative anticoagulant. The aim of this report is to draw attention to the several different clinical manifestations of heparin- and/or protamine-induced thrombocytopenia and shows a possible course of treatment and recovery.

Background: Lymphedema arises due to a malfunction of the lymphatic system, leading to extensive tissue swelling. Complete decongestive therapy (CDT), which is a physical therapy lasting for 3 weeks and includes manual lymphatic drainages (MLD), leads to fluid mobilization and increases in plasma volume. Here, we investigated hemodynamic responses induced by these fluid shifts due to CDT and MLD. Methods: Hemodynamic parameters were assessed continuously during a sit-to-stand test (5 min baseline, 5 min of standing, and 5 min of recovery). This intervention was repeated on days 1, 2, 7, 14, and 21 of CDT, before and after MLD. Volume regulatory hormones were assessed in plasma samples. Results: A total number of 13 patients took part in this investigation. Resting diastolic blood pressure significantly decreased over three weeks of CDT (p = 0.048). No changes in baseline values were shown due to MLD. However, MLD led to a significant decrease in heart rate during orthostatic loading over all epochs on therapy day 14, as well as day 21. Volume regulatory hormones did not show changes over lymphedema therapy. Conclusion: We did not observe any signs of orthostatic hypotension at rest, as well as during to CDT, indicating that lymphedema patients do not display an elevated risk of orthostatic intolerance. Although baseline hemodynamics were not affected, MLD has shown to have potential beneficial effects on hemodynamic responses to a sit-to-stand test in patients undergoing lymphedema therapy.

Abstract Background Necrotizing myositis is a rare but life-threatening soft-tissue infection characterized by rapidly spreading inflammation and subsequent necrosis of the affected tissue. The myositis is often caused by toxin-producing, virulent bacteria such as group A β-hemolytic streptococcus and associated with severe systemic toxicity. It is rapidly fatal unless diagnosed promptly and treated aggressively. However, necrotizing myositis is often initially misdiagnosed as a more benign soft-tissue infection as such fulminant, invasive muscle infections are rare with no more than 30 cases reported over the last century. Case presentation We illustrate the case of a 74-year-old male Caucasian initially presenting with a progressing swelling and gradually oncoming pain of the upper right extremity. Rapidly, livid discolorations of the skin, blisters, hypoesthesia and severe pain resistant to analgesics treatment developed accompanied by disruption of the arterial blood flow. Due to a manifest compartment syndrome the patient was admitted to theater for fasciotomy of the arm. After multiple revision surgeries wound closure was achieved using a pedicled, fasciocutaneous parascapular flap and a free, ipsilateral anterolateral thigh flap. Microbiological analysis revealed group A β-hemolytic streptococcus, histology a bacterial interstitial myositis with necrotic muscular fibers. Conclusions A high degree of clinical suspicion is necessary to avert potentially disastrous consequences of necrotizing myositis. Timely diagnosis, broad-spectrum antibiotic therapy, and aggressive surgical debridement of affected tissue are keys to the treatment of this serious, often life-threatening infection.

Nano-scaled thermoelectric materials attract significant interest due to their improved physical properties as compared to bulk materials. Well-shaped nanoparticles such as nano-bars and nano-cubes were observed in the known thermoelectric material PbTe. Their extended two-dimensional nano-layer arrangements form directly in situ through electron-beam treatment in the transmission electron microscope. The experiments show the atomistic depletion mechanism of the initial crystal and the recrystallization of PbTe nanoparticles out of the microparticles due to the local atomic-scale transport via the gas phase beyond a threshold current density of the beam.

Background and Objectives: Snakebite is a common medical emergency requiring immediate medical attention. This study was conducted to understand snakebite cases, with particular attention given to where the lacunae lie in current management so that remedial steps may be undertaken. Materials and Methods: This was a cross-sectional, descriptive study and was carried out in Davangere, Karnataka, India. Snakebite cases (729) were included in the study and all the victims were interviewed using a prestructured questionnaire. Victims were evaluated for the nature of bites, first aid measures, treatment modalities, and treatment outcome. Results: The majority of the snakebite victims were from villages, were farmers, and belonged to the 20-40 years age group. Viper bites were the most frequently reported, and an overwhelming number of victims resorted to first aid measures with tourniquet application at the site. Most victims reached a peripheral health institution (PHI) first following the bite, and a small fraction received only one vial of anti-snake venom (ASV). The longest referral pathway to a tertiary hospital was as follows: Bite-traditional healer- primary health center (PHC)-tertiary hospital; fatality was 2%. Most victims had signs of envenomation and received ASV, of whom 32% administered with ASV had developed hypersensitivity reaction. Conclusion: This study showed that PHCs were inadequate in terms of providing optimal treatment and that measures are needed to upgrade these facilities.

Introduction: An accurate and passive fit of implant framework prosthesis, as well as the successful surgical operation is suggested as one of the critical requirements for long-term implant success. Objective: The purpose of this in vitro study was to evaluate the accuracy of the master cast using open tray impression technique with conventional and novel splinting materials. Methodology: A mandibular reference model with four ADIN implants was done. Ten custom trays were fabricated using the light curable resin sheets. Medium body polyether impression material was used. These trays were randomly divided between the two groups, with five trays in each group. Impression techniques were divided into two groups namely: Group A: Direct impression technique with open tray impression copings splinted with autopolymerizing acrylic resin (GC pattern resin). Group B: Direct impression technique with open tray impression copings splinted with Pro-temp TM 4 (bis-GMA) syringable temporization material. Thus, final impressions were made. Total of 10 master casts were fabricated. Evaluation of casts using Dynascope-Vision Engineering, TESA microhite two- dimension and coordinate measuring machine were used. Results: Statistical comparisons were made using ANOVA test and post-hoc test. Same amount of deviation values obtained with resin splinted and bis-GMA splinted impression copings. Conclusion: The master cast obtained by both the splinting material exhibits no difference from the reference model. So bis-GMA can be used, which is easy to handle, less time consuming, less technique sensitive, rigid, and readily available material in clinics.

Patients with a tracheostomy stoma experience compromised speech and function due to the associated changes in airflow patterns. Rehabilitation of a patient with tracheal stoma is a highly challenging task. The main objective is to design an inexpensive, easily fabricated stomal prosthesis for postlaryngectomy patients who require prolonged tracheotomy. This clinical case report describes a 29-year-old male patient who underwent for tracheotomy 3 months before for respiratory distress following a suicidal attempt. Hence tracheotomy was done, and the patient has been with the tracheostomal tube since surgery for the past 3 months. Laryngoscopy examination reported as restricted bilateral vocal cord movements, and the cords were in the adducted position with minimal glottic chink. No history of difficulty in swallowing. On examination, no scar or ulceration is seen around the stoma. The skin around the stoma is healthy. The patient was referred to the oral and maxillofacial Prosthodontics Department from the Department of ENT. The patient′s old tracheostomal tube was used as the dimensions of the custom made tracheal prosthesis without making a functional impression of the mature stoma. A tracheal button was made with 2 mm polyethylene urethane sheet to maintain the airway patency of the mature stoma. Width and length of the old tracheostomal tube were measured and customized with polyurethane sheet by directly flaming over heat. The finished product was thin, flexible, maintains enhanced tear strength, require no tapes or adhesives and less technique sensitive. These properties of the prosthesis make more advantageous than the commercially available tracheal buttons. The result in this patient was excellent with no postoperative complications. An innovative approach for fabrication of tracheostomal prosthesis was discussed to increase its successful use in tracheostomal patients. The patient′s old tracheostomal tube was used as the dimensions of the custom made tracheal prosthesis without making a functional impression of the mature stoma. The finished product was thin, flexible, maintains enhanced tear strength, require no tapes or adhesives and less technique sensitive. These properties of the prosthesis makes more advantageous than the commercially available tracheal buttons. The result in this patient was excellent with no postoperative complications.

Introduction: Diabetic Retinopathy (DR) is a well-known consequence of long standing and poorly controlled Diabetes Mellitus (DM). Several studies have demonstrated both a qualitative and quantitative reduction in health related quality of life in persons with DR. But no such study has been done in the Indian population. Aim: To assess health related and vision related quality of life in people with DR. Materials and Methods: The present study included two groups of patients with Type 1 and Type 2 diabetes. Cases included 97 patients with DR. The control group (n=26) consisted of diabetic cases with no clinically detectable DR changes. After taking informed consent, health and vision related quality of life was assessed using National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ-25). Demographic information, social history and diabetic history were also obtained from all patients. DR was graded using the Early Treatment Diabetic Retinopathy Study (ETDRS) classification. Results: Of the 97 cases with DR, 42.3% were females. Of the 26 controls, 53.8% were females. The mean±SD age in years of the cases was 55.09±9.56 and controls were 54.12±13.01. The mean±SD of DM in years for the cases was 10.98±5.62 and for controls was 6.69±2.29. There were statistically significant (p

Objective: The aim of this study was to analyze the midterm clinical results of aortic valve replacement with cryopreserved homografts.Materials and Methods: Aortic valve replacement was performed in 40 patients with cryopreserved homograft. The indications were aortic valve endocarditis in 20 patients (50%), truncus arteriosus in 6 patients (15%), and re-stenosis or regurtitation after aortic valve reconstruction in 14 (35%) patients. The valve sizes ranged from 10 to 27mm. A full root replacement technique was used for homograft replacement in all patients.Results: The 30-day postoperative mortality rate was 12.5% (5 patients). There were four late deaths. Only one of them was related to cardiac events. Overall mortality was 22.5%. Thirty-three patients were followed up for 67±26 months. Two patients needed reoperation due to aortic aneurysm caused by endocarditis. The mean transvalvular gradient significantly decreased after valve replacement (p

Introduction of nonstoichiometry to AgSbTe2-based materials is considered to be an effective way to tune thermoelectric properties similarly to extrinsic doping. To prove this postulate, a systematic physicochemical study of the Ag1−xSb1+xTe2+x alloys (0 ≤ x ≤ 0.4) was performed. In order to investigate the influence of the cooling rate after synthesis on phase composition and thermoelectric performance, slowly cooled and quenched Ag1−xSb1+xTe2+x alloys (x = 0; 0.1; 0.17; 0.19; 0.3; 0.4) were prepared. Single-phase material composed of the β phase (NaCl structure type) was obtained for the quenched x = 0.19 sample only. The other alloys must be regarded as multi-phase materials. The cooling rate affects the formation of the phases in the Ag-Sb-Te system and influences mainly electronic properties, carrier mobility and carrier concentration. The extremely low lattice thermal conductivity is an effect of the mosaic nanostructure. The maximal value of the figure of merit ZTmax = 1.2 is observed at 610 K for the slowly cooled multi-phase sample Ag0.9Sb1.1Te2.1. Thermoelectric properties are repeatedly reproducible up to 490 K.

Weakening belief in the concept of free will yields pronounced effects upon social behavior, typically promoting selfish and aggressive over pro-social and helping tendencies. Belief manipulations have furthermore been shown to modulate basic and unconscious processes involved in motor control and self-regulation. Yet, to date, it remains unclear how high-level beliefs can impact such a wide range of behaviors. Here, we tested the hypothesis that priming disbelief in free will diminishes the sense of agency, i.e., the intrinsic sensation of being in control of one’s own actions. To this end, we measured participants’ implicit and explicit self-agency under both anti-free will and control conditions. Priming disbelief in free will reduced implicit but not explicit components of agency. These findings suggest that free will beliefs have a causal impact on the pre-reflective feeling of being in control of one’s actions, and solidify previous proposals that implicit and explicit agency components tap into distinct facets of action awareness.

La sustitución de la válvula aórtica utilizando la propia válvula pulmonar del paciente, el autoinjerto pulmonar, conocida como intervención de Ross, ha visto aumentada su popularidad después de una adopción inicial lenta. Hoy día muchos cirujanos la consideran como intervención de elección en niños y pacientes jóvenes. Sin embargo, hay ciertas dudas sobre el comportamiento y resultados alejados tanto del autoinjerto como del homoinjerto utilizado para la reconstrucción del tracto de salida del ventrículo izquierdo. En esta revisión se efectúa un análisis critico de los aspectos técnicos de la intervención y de sus modificaciones, se repasan los resultados disponibles de series amplias sobre niños y adultos incluyendo nuestros propios resultados y se discuten los problemas clave del procedimiento, el potencial de dilatación del autoinjerto en la circulación sistémica y la durabilidad del homoinjerto en el tracto de salida del ventrículo derecho. Concluimos que la intervención de Ross ofrece una reparación duradera y eficaz en niños y adultos jóvenes.

The solid-state reaction of WO3 with W was studied in order to clarify the phase formation in the binary system W-O around the composition WOx (2.50 ≤ x ≤ 3) during spark plasma sintering (SPS). A new phase “WO2.82” is observed in the range 2.72 ≤ x ≤ 2.90 which might have the composition W12O34. The influence of the composition on the thermoelectric properties was investigated for 2.72 ≤ x ≤ 3. The Seebeck coefficient, electrical conductivity and electronic thermal conductivity are continuously tunable with the oxygen-to-tungsten ratio. The phase formation mainly affects the lattice thermal conductivity κlat which is significantly reduced until 700 K for the sample with the composition x = 2.84, which contains the phases W18O49 and “WO2.82”. In single-phase WO2.90 and multi-phase WOx materials (2.90 ≤ x ≤ 3), which contain crystallographic shear plane phases, a similar reduced κlat is observed only below 560 K and 550 K, respectively. Therefore, the composition range x < 2.90 in which the pentagonal column structural motif is formed might be more suitable for decreasing the lattice thermal conductivity at high temperatures.

To study transmission patterns of Pneumocystis carinii pneumonia (PCP) in persons with AIDS, we evaluated P. carinii isolates from patients in five U.S. cities for variation at two independent genetic loci, the mitochondrial large subunit rRNA and dihydropteroate synthase. Fourteen unique multilocus genotypes were observed in 191 isolates that were examined at both loci. Mixed infections, accounting for 17.8% of cases, were associated with primary PCP. Genotype frequency distribution patterns varied by patients' place of diagnosis but not by place of birth. Genetic variation at the two loci suggests three probable characteristics of transmission: that most cases of PCP do not result from infections acquired early in life, that infections are actively acquired from a relatively common source (humans or the environment), and that humans, while not necessarily involved in direct infection of other humans, are nevertheless important in the transmission cycle of P. carinii f. sp. hominis.

Ideomotor theory states that the formation of anticipatory representations about the perceptual consequences of an action (i.e. action-effect (A-E) binding) provides the functional basis of voluntary action control. A host of studies has demonstrated that A-E binding occurs fast and effortlessly, yet only little is known about cognitive and affective factors that influence this learning process. In the present study, we sought to test whether the motivational value of an action modulates the acquisition of A-E associations. To this end, we associated specific actions with monetary incentives during the acquisition of novel A-E mappings. In a subsequent test phase, the degree of binding was assessed by presenting the former effect stimuli as task-irrelevant response primes in a forced-choice response task in the absence of any reward. Binding, as indexed by response priming through the former action effects, was only found for reward-related A-E mappings. Moreover, the degree to which reward associations modulated the binding strength was predicted by individuals’ trait sensitivity to reward. These observations indicate that the association of actions and their immediate outcomes depends on the motivational value of the action during learning, as well as on the motivational disposition of the individual. On a larger scale, these findings also highlight the link between ideomotor theories and reinforcement-learning theories, providing an interesting perspective for future research on anticipatory regulation of behavior.

IntroductionGestational diabetes and pregnancy-related hypertension can lead to adverse health effects in mothers and infants. We assessed recent trends in the rates of these conditions in Los Angeles County, California.MethodsHospital discharge data were used to identify all women aged 15–54 years who resided in the county, had a singleton delivery from 1991 through 2003, and had gestational diabetes or pregnancy-related hypertension listed as a discharge diagnosis at the time of delivery. The prevalence of each condition was calculated by calendar year, race/ethnicity, and age group. Temporal trends in the rates were assessed by using negative binomial regression models, controlling for race/ethnicity and age. Separate models were run for each racial/ethnic and age group.ResultsThe age-adjusted prevalence of gestational diabetes increased more than threefold (from 14.5 cases per 1000 women in 1991 to 47.9 cases per 1000 in 2003). The age-adjusted prevalence of pregnancy-related hypertension also increased (from 40.5 cases per 1000 in 1991 to 54.4 cases per 1000 in 2003). In the multivariable regression analysis, the annual rate increase for gestational diabetes was 8.3% overall and was highest among Hispanics (9.9%). The annual rate increase for pregnancy-related hypertension was 2.8% overall and was highest among blacks (4.8%).ConclusionThe rates of gestational diabetes and pregnancy-related hypertension are increasing in Los Angeles County. Further research is needed to determine the causes of the observed increases and the growing racial/ethnic disparities in those rates.

We describe a case where the expiratory bacterial filter was completely blocked by a plastic membrane. Significantly increased airway pressures and inability to deliver adequate tidal volume to the patient were experienced. The cause of machine failure could not be identified until a complete preanesthesia machine manual check was performed. All machines and circuits should be checked manually, even with the availability of new and advanced self-tests in machines. Backup ventilation equipments and familiarity with signs of expiratory and inspiratory limb obstruction should not be underestimated.