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Textural and compositional variations in titanite constrain the roles of magma mixing and hydrothermal alteration in two plutons in central Utah: the Jurassic Notch Peak and the Oligocene Little Cottonwood stocks. In the Notch Peak intrusion, magmatic titanite grains usually have oscillatory zones combined with BSE-bright sector zones, in some cases surrounding simple unzoned cores. These grains are frequently overprinted by hydrothermal titanite with low concentrations of high field strength elements (HFSE). Magmatic titanite has an average δ18O of 6.0‰ and post-magmatic titanite is 6.2‰, as analyzed by SIMS. Average Zr-in-titanite temperatures are also similar, with 718 °C for magmatic and 711 °C for hydrothermal titanite. These observations indicate simple magmatic growth, followed by hydrothermal alteration by magmatic fluids. Titanite in aplite dikes and sills has lower concentrations of all trace elements except F. Many titanite grains in the aplites have late overgrowths of high-Fe titanite. This high-Fe titanite has δ18O of 6‰ and an average Zr-in-titanite temperature of 718 °C and likely precipitated from a last flush of exsolved magmatic water enriched in Cl and Fe. Titanite in the Little Cottonwood stock typically has distinct patchy cores with rounded and embayed ilmenite inclusions. Mafic enclaves have abundant titanite that is similar in texture and δ18O (5.1‰) to titanite in the host (δ18O = 4.9‰), but it has a slightly higher average Zr-in-titanite temperature (731 vs. 717 °C). The patchy cores in the enclaves have the highest average Zr-in-titanite temperature (759 °C) and distinctive REE patterns. The textural and compositional data indicate that a hotter, more reduced, ilmenite-bearing mafic magma mixed into an oxidized felsic magma, destabilizing existing ilmenite and allowing crystallization of titanite. In the granodiorite and in the enclaves, hydrothermal growth of titanite is evidenced by distinct narrow rims as well as anhedral titanite that grew between sheets of chloritized biotite. Secondary hydrothermal titanite typically has lower concentrations of most HFSE, but is relatively enriched in F, Mg, Mo, and U, and it has higher Nb/Ta and lower Th/U ratios. Post-magmatic titanite also has strikingly different REE patterns than magmatic titanite, including the absence of pronounced Eu anomalies and lower REE abundances. These chemical features are controlled by element solubilities in aqueous fluids. In most cases, hydrothermal titanite has δ18O values similar to magmatic titanite, indicating alteration and recrystallization from exsolved magmatic fluids. The involvement of meteoric water with low δ18O is evident locally; individual spots have δ18O as low as 1.7‰ in the Little Cottonwood stock. Titanite compositions and textures provide important insights into the origins of granitic rocks and can be used to distinguish separate batches of magma, gauge the evolution of magmatic rocks, assess mixing processes, and infer compositions of mixing components. Because titanite also forms hydrothermally, it retains hints about the composition, temperature, and oxygen fugacity of the hydrothermal fluids and reveals details about titanite-forming reactions. However, the Al-in-titanite geobarometer does not yield realistic pressures of crystallization and the use of titanite as a geochronometer is compromised by the development of U-rich hydrothermal titanite. [ABSTRACT FROM AUTHOR]

• Presents a novel methodology for simultaneously measuring two-phase flow characteristics and pipe motion. • Utilizes a computer vision algorithm for continuous pipe and liquid monitoring across the entire experimental test section. • Deploys a field scale facility designed to mimic configurations encountered in offshore flowlines. • Analyzes and explains the relationship between two-phase flow parameters (such as superficial velocities and slug characteristics) and pipe response (like pipe displacement amplitude and frequency). One of the governing contributors to offshore structures' (e.g., pipelines and deep-water risers) accumulative long-term fatigue damage is the internal flow-induced vibrations caused by slug flow. Due to the complexity of the numerical modeling of the internal flow and fluid–structure interaction, experimental campaigns are often performed to predict the asset response and provide a benchmark for numerical model validation. In this study, an experimental campaign was conducted which included a unique computer vision data acquisition system and a large-scale facility designed to mimic industry field conditions. This study aims to relate flow parameters to structural response and explain the mechanisms that govern the relationship between both domains. The presented results reveal that the gravitational forces of the fluid dominate the transverse deflections of the pipe and, therefore, the slug liquid holdup, film liquid holdup, and slug length showed strong correlations to pipe deflections. However, centrifugal forces were observed to have significant contributions to pipe deflection for high translational velocity slugs. Additionally, it was found that for most of the test conditions, the primary pipe excitation frequency correlates to the slug frequency. It was discovered that no-slip liquid holdup has a positive correlation to both the magnitude and range of pipe deflection and that increases in superficial gas and liquid velocities led to decreases and increases in pipe deflection, respectively. Furthermore, it was observed that the measured frequency responses of the structure tended to increase with increasing gas velocity until the flow pattern in the pipe began to transition to annular flow. [ABSTRACT FROM AUTHOR]

With the expansion of carrier screening to general preconception and prenatal patient populations, most patients will receive negative results, which we define as indicating <25% risk of having a child with a genetic condition. Because there is limited experience with expanded carrier screening, it is important to understand how receiving negative results affects patients, especially as providers, payers, and policymakers consider whether to offer it. In this mixed‐methods study, we asked preconception patients enrolled in the NextGen study about their expectations and experiences receiving negative expanded carrier screening results. Participants completed surveys at study enrollment (n = 110 women, 51 male partners), after receiving carrier results (n = 100 women, 38 male partners), after receiving secondary findings (n = 98 women, 36 male partners), and 6 months after receiving results (n = 95 women, 28 male partners). We also interviewed a subset of participants 12 to 24 months after receiving results (n = 24 women, 12 male partners). We found minimal negative emotional impact and privacy concerns, increased confidence in reproductive plans, and few changes to health behaviors, although some patients made health decisions based on misunderstandings of their results. These findings suggest that expanded carrier screening causes minimal psychosocial harms, but systems are needed to reduce the risk of misinterpreting results. [ABSTRACT FROM AUTHOR]

This paper examines the state of practice used in the value for money (VfM) analysis of highway projects in the United States. Based on direct contact with public transportation agencies and the search of project websites, seven VfM studies were selected for a comparative analysis. The paper finds that the choice of public sector comparator (PSC) model varied from one study to another, which is driven by agency experience. The risks transferred from employing the public-private partnership (P3) model are closely related to the choice of repayment schemes. Discount rates used in practice are similar across studies despite wide-ranging debates over appropriate rates in the literature. VfM studies show the advantages of agency municipal bonds are reduced when favorable borrowing rates are available to private partners. The paper lastly examines reasons why agencies chose not to deliver projects as P3s based on VfM studies. [ABSTRACT FROM AUTHOR]

Purpose: To compare patient-triggered follow-up (PTFU) for curatively treated colorectal cancer against traditional outpatient follow-up (OPFU).Methods: Questionnaires were mailed at four time points over one-year post-treatment to two prospectively-recruited cohorts: A, patients entering follow-up and receiving OPFU pre-implementation of PTFU; B, patients entering follow-up (FU) and receiving either OPFU (B1) or PTFU (B2) post-implementation of PTFU. Bi-variate tests were used to compare patient characteristics and outcomes eight months after entering follow-up (generic and cancer-specific quality of life (QoL), satisfaction). Regression analysis explored associations between follow-up model and outcomes. Resource implications and costs of models were compared.Results: Patients in Cohort B1 were significantly more likely to have received chemotherapy (p < 0.001), radiotherapy (p < 0.05), and reported poorer QoL (p = 0.001). Having a longstanding co-morbid condition was the most important determinant of QoL (p < 0.001); model of care was not significant. Patients were satisfied with their follow-up care regardless of model. Health service costs were higher in PTFU over the first year CONCLUSIONS: PTFU is acceptable to patients with colorectal cancer and can be considered to be a realistic alternative to OPFU for clinically suitable patients. The initial costs are higher due to provision of a self-management (SM) programme and remote surveillance. Further research is needed to establish long-term outcomes and costs. [ABSTRACT FROM AUTHOR]

The neuropeptides neurokinin B (NKB) and kisspeptin are potent stimulators of gonadotrophinreleasing hormone (GnRH)/luteinsing hormone (LH) secretion and are essential for human fertility. We have recently demonstrated that selective activation of NKB receptors (NK3R) within the retrochiasmatic area (RCh) and the preoptic area (POA) triggers surge-like LH secretion in ovaryintact ewes, whereas blockade of RCh NK3R suppresses oestradiol-induced LH surges in ovariectomised ewes. Although these data suggest that NKB signalling within these regions of the hypothalamus mediates the positive-feedback effects of oestradiol on LH secretion, the pathway through which it stimulates GnRH/LH secretion remains unclear. We proposed that the action of NKB on RCh neurones drives the LH surge by stimulating kisspeptin-induced GnRH secretion. To test this hypothesis, we quantified the activation of the preoptic/hypothalamic populations of kisspeptin neurones in response to POA or RCh administration of senktide by dual-label immunohistochemical detection of kisspeptin and c-Fos (i.e. marker of neuronal activation). We then administered the NK3R agonist, senktide, into the RCh of ewes in the follicular phase of the oestrous cycle and conducted frequent blood sampling during intracerebroventricular infusion of the kisspeptin receptor antagonist Kp-271 or saline. Our results show that the surge-like secretion of LH induced by RCh senktide administration coincided with a dramatic increase in c-Fos expression within arcuate nucleus (ARC) kisspeptin neurones, and was completely blocked by Kp-271 infusion. We substantiate these data with evidence of direct projections of RCh neurones to ARC kisspeptin neurones. Thus, NKB-responsive neurones in the RCh act to stimulate GnRH secretion by inducing kisspeptin release from KNDy neurones. [ABSTRACT FROM AUTHOR]

Anecdotal reports in the press and epidemiological studies suggest that deployment to Iraq and Afghanistan may be associated with respiratory diseases and symptoms in U.S. military personnel and veterans. Exposures during military operations were complex, but virtually all service members were exposed to high levels of respirable, geogenic dust. Inhalation of other dusts has been shown to be associated with adverse health effects, but the pulmonary toxicity of ambient dust from Iraq has not been previously studied. The relative toxicity of Camp Victory dust was evaluated by comparing it to particulate matter from northern Kuwait, a standard U.S. urban dust, and crystalline silica using a single intratracheal instillation in rats. Lung histology, protein levels, and cell counts were evaluated in the bronchoalveolar lavage fluid 1–150 d later. The Iraq dust provoked an early significant, acute inflammatory response. However, the level of inflammation in response to the Iraq dust, U.S. urban dust, and Kuwait dust rapidly declined and was nearly at control levels by the end of the study At later times, animals exposed to the Iraq, U.S. urban, or Kuwait dusts showed increased small airway remodeling and emphysema compared to silica-exposed and control animals without evidence of fibrosis or premalignant changes. The severity and persistence of pulmonary toxicity of these three dusts from the Middle East resemble those of a U.S. urban dust and are less than those of silica. Therefore, Iraq dust exposure is not highly toxic, but similar to other poorly soluble low-toxicity dusts. [ABSTRACT FROM AUTHOR]

The article discusses the management approach in patient with pelvic fractures in prehospital setting. The findings of a consensus meeting on the prehospital management of pelvic injuries are offered. Also highlighted is the importance of adequate training in managing patient's with pelvic fractures.

Objectives To determine dosing alert rates based on prescription order characteristics and identify prescription order risk factors for the occurrence of dosing alerts. Methods A retrospective analysis of inpatient medication orders and dosing alerts occurring during October 2011 and January, April, and July 2012 at a pediatric institution. Prescription orders and alerts were categorized by: medication class, patient age, route of administration, and month of the year. Results There were 228,259 orders during the studied period, with 11,072 alerted orders (4.9%). The most frequently alerted medication class was the non-analgesic central nervous system agent class (14% of alerts). Age, route, medication class, and month all independently affected dosing alert rates. The alert rate was highest for immunosuppressive agents (54%), neonates (6.7%), and orders for rectal administration (9.5%). The alert rate was higher in adult patients receiving their care at a pediatric institution (5.7%) compared to children (4.7%), but after multivariate analysis, pediatric orders had higher odds for an alert (OR 1.1, 95% CI 1.05–1.16). Mercaptopurine had the highest alert rate when categorized by active ingredient (73.9%). Albuterol 2.5 mg/mL continuous aerosol and heparin 1000 units in 0.9% sodium chloride injection solution were the unique medications with the highest alert rates (100.0% and 97.7%, respectively). Conclusions Certain types of prescription orders have a higher risk for causing dosing alerts than others. Patient age, medication class, route of administration, and the month of year can affect dosing alert rates. Design and customization efforts should focus on these medications and prescription order characteristics that increase the risk for dosing alerts. [ABSTRACT FROM AUTHOR]

The article presents a reprint of the article "Pharmacologically assisted laryngeal mask insertion: A consensus statement" by R. Moss and colleagues which appeared in the "Emergency Medicine Journal." It offers information about the technique of pharmacologically-assisted laryngeal mask (PALM) insertion.

Neurokinin B ( NKB) is essential for human reproduction and has been shown to stimulate luteinising hormone ( LH) secretion in several species, including sheep. Ewes express the neurokinin-3 receptor ( NK3R) in the retrochiasmatic area (RCh) and there is one report that placement of senktide, an NK3R agonist, therein stimulates LH secretion that resembles an LH surge in ewes. In the present study, we first confirmed that local administration of senktide to the RCh produced a surge-like increase in LH secretion, and then tested the effects of this agonist in two other areas implicated in the control of LH secretion and where NK3R is found in high abundance: the preoptic area ( POA) and arcuate nucleus ( ARC). Bilateral microimplants containing senktide induced a dramatic surge-like increase in LH when given in the POA similar to that seen with RCh treatment. By contrast, senktide treatment in the ARC resulted in a much smaller but significant increase in LH concentrations suggestive of an effect on tonic secretion. The possible role of POA and RCh NK3R activation in the LH surge was next tested by treating ewes with SB222200, an NK3R antagonist, in each area during an oestradiol-induced LH surge. SB222200 in the RCh, but not in the POA, reduced the LH surge amplitude by approximately 40% compared to controls, indicating that NK3R activation in the former region is essential for full expression of the pre-ovulatory LH surge. Based on these data, we propose that the actions of NKB in the RCh are an important component of the pre-ovulatory LH surge in ewes. [ABSTRACT FROM AUTHOR]

Pseudogenes are duplicated yet defunct copies of functional parent genes. However, some pseudogenes have gained or retained function. In this study, we consider a functional role for the NLRP2-related, higher primate-specific, processed pseudogene NLRP2P, which is closely related to Pyrin-only protein 2 (POP2/PYDC2), a regulator of nuclear factor-κB (NF-κB) and the inflammasome. The NLRP2P open-reading frame on chromosome X has features consistent with a processed pseudogene (retrotransposon), yet encodes a 45-amino-acid, Pyrin-domain-related protein. The open-reading frame of NLRP2P shares 80% identity with POP2 and is under purifying selection across Old World primates. Although widely expressed, NLRP2P messenger RNA is upregulated by lipopolysaccharide in human monocytic cells. Functionally, NLRP2P impairs NF-κB p65 transactivation by reducing activating phosphorylation of RelA/p65. Reminiscent of POP2, NLRP2P reduces production of the NF-κB-dependent cytokines tumor necrosis factor alpha and interleukin (IL)-6 following toll-like receptor stimulation. In contrast to POP2, NLRP2P fails to inhibit the ASC-dependent NLRP3 inflammasome. In addition, beyond regulating cytokine production, NLRP2P has a potential role in cell cycle regulation and cell death. Collectively, our findings suggest that NLRP2P is a resurrected processed pseudogene that regulates NF-κB RelA/p65 activity and thus represents the newest member of the POP family, POP4. [ABSTRACT FROM AUTHOR]

Background: Small vessel childhood primary angiitis of the central nervous system (SV-cPACNS) is a rare disease characterized by inflammation within small vessels such as arterioles or capillaries. Case presentation: We report a case of SV-cPACNS in an 8-year-old boy confirmed by brain biopsy. This patient was also incidentally found to have anti-glial fibrillary acidic protein (GFAP) antibodies in the cerebrospinal fluid (CSF) but had no evidence of antibody-mediated disease on brain biopsy. A literature review highlighted the rarity of SV-cPACNS and found no prior reports of CSF GFAP-associated SV-cPACNS in the pediatric age group. Conclusion: We present the first case of biopsy proven SV-cPACNS vasculitis associated with an incidental finding of CSF GFAP antibodies. The GFAP antibodies are likely a clinically insignificant bystander in this case and possibly in other diseases with CNS inflammation. Further research is needed to determine the clinical significance of newer CSF autoantibodies such as anti-GFAP before they are used for medical decision-making in pediatrics. [ABSTRACT FROM AUTHOR]

Events in Europe in the last year have shown there is a realistic threat to public safety in the UK from shooting, stabbing and bombing incidents. In an interview with BBC on 31 July 2016, the Metropolitan Police Commissioner stated that an attack within UK was a case of ‘when not if’. citizenAID empowers the public to take action to save lives and thereby enhance national resilience. [ABSTRACT FROM AUTHOR]

Background: Short-course antiretroviral therapy (ART) in primary human immunodeficiency virus (HIV) infection may delay disease progression but has not been adequately evaluated.Methods: We randomly assigned adults with primary HIV infection to ART for 48 weeks, ART for 12 weeks, or no ART (standard of care), with treatment initiated within 6 months after seroconversion. The primary end point was a CD4+ count of less than 350 cells per cubic millimeter or long-term ART initiation.Results: A total of 366 participants (60% men) underwent randomization to 48-week ART (123 participants), 12-week ART (120), or standard care (123), with an average follow-up of 4.2 years. The primary end point was reached in 50% of the 48-week ART group, as compared with 61% in each of the 12-week ART and standard-care groups. The average hazard ratio was 0.63 (95% confidence interval [CI], 0.45 to 0.90; P=0.01) for 48-week ART as compared with standard care and was 0.93 (95% CI, 0.67 to 1.29; P=0.67) for 12-week ART as compared with standard care. The proportion of participants who had a CD4+ count of less than 350 cells per cubic millimeter was 28% in the 48-week ART group, 40% in the 12-week group, and 40% in the standard-care group. Corresponding values for long-term ART initiation were 22%, 21%, and 22%. The median time to the primary end point was 65 weeks (95% CI, 17 to 114) longer with 48-week ART than with standard care. Post hoc analysis identified a trend toward a greater interval between ART initiation and the primary end point the closer that ART was initiated to estimated seroconversion (P=0.09), and 48-week ART conferred a reduction in the HIV RNA level of 0.44 log(10) copies per milliliter (95% CI, 0.25 to 0.64) 36 weeks after the completion of short-course therapy. There were no significant between-group differences in the incidence of the acquired immunodeficiency syndrome, death, or serious adverse events.Conclusions: A 48-week course of ART in patients with primary HIV infection delayed disease progression, although not significantly longer than the duration of the treatment. There was no evidence of adverse effects of ART interruption on the clinical outcome. (Funded by the Wellcome Trust; SPARTAC Controlled-Trials.com number, ISRCTN76742797, and EudraCT number, 2004-000446-20.). [ABSTRACT FROM AUTHOR]

Tibial plateau fractures are uncommon injuries of the proximal tibia which vary in severity from minimally displaced stable injuries to high energy complex fractures with significant articular and metaphyseal comminution and severe associated soft tissue injuries. Following initial assessment and appropriate investigation a number of management options are available to the treating surgeon. We discuss the presentation, initial management and investigation as well as outlining the various treatment options with an emphasis on operative treatment. We further discuss the common complications and outcomes following tibial plateau fracture. [ABSTRACT FROM AUTHOR]

Visible light units (LCU) used in routine dentistry to cure light activated materials may become contaminated with oral micro-organisms. This pilot study was designed to investigate whether the fan, handle and base unit mains on/off button areas of three different designs of quartz tungsten halogen LCUs (3M Unitek 2500, Elipar Highlight, Demetron Optilux 401) were effectively disinfected after use in a dental teaching hospital. Over a period of seven days 52 LCUs were swabbed before clinics in the morning and 28 were swabbed again after clinics in the afternoon. Bacterial contamination was detected on approximately 40% (20/52) of units before use and 64% (18/28) after use: few viable organisms were detected on the fan or handle areas, but many were isolated from the mains button, including Staphylococus aureus. These findings highlight the need for greater awareness of the potential risk of contamination of the base unit and compliance with recommendations to clean and disinfect all areas of the units. [ABSTRACT FROM PUBLISHER]

Posterior cruciate ligament (PCL) injuries occur following both high-velocity trauma (motor vehicle collisions) and low-velocity trauma (sporting injuries) with the most common cause being high-velocity trauma resulting in so-called 'dash board injuries'. In majority of the cases, clinical examination will reveal the presence of a PCL tear; however, magnetic resonance imaging remains the imaging modality of choice if the diagnosis is in doubt. For the most part, isolated PCL tears are relatively benign and can be treated conservatively. PCL avulsion injuries or grade III ruptures may require operative intervention. Postoperative rehabilitation is also an important part of the healing process. [ABSTRACT FROM AUTHOR]

Treatment of the 'pilon' fracture provides one of the greatest challenges to orthopaedic surgeons today. The force required to fracture the distal tibia can lead to complex fracture configurations and significant soft tissue compromise that challenge subsequent repair. High complication rates have encouraged extensive research over decades into an operative method that limits the insult to the surrounding soft tissue envelope whilst maintaining the stability of the fixation obtained. Two main techniques of fixation that meet such criteria have evolved more than others namely, open reduction and internal fixation (ORIF two-staged protocol) and external fixation (ankle sparing hybrid fixation). Advances in these techniques have seen a significant reduction in the rate of catastrophic complications such as amputation, osteomyelitis and arthrodesis. The legacy of the pilon fracture, however, is such that it is hard to decide which treatment method is best and indeed severe fractures (AO classification type C2 or 3 or Reudi and Allgower type III) are better treated with primary arthrodesis and even amputation in some cases. Both methods have their drawbacks. A high prevalence of pin tract infections and possibly inadequate reduction may occur in some cases treated with external fixators. There is considerable variability of outcome with the two-staged protocol depending on the patients treated, the judgement and skill of the surgeon operating and risk of soft tissue compromise. The two-staged protocol seems to have a greater following and seems on the surface to get over many typical complications. No one treatment method is best for all fractures; in fact both are equally good for simpler fractures. It is their outcome in treating severe fractures that will determine which of the two methods is best and which could be adequately tested with a randomised controlled trial. [ABSTRACT FROM AUTHOR]

Fractures of the radial head and neck are common injuries that largely result from a fall onto an outstretched hand. They can range from simple injuries amenable to conservative management, to complex injuries requiring operative intervention. Undisplaced and minimally displaced fractures can usually be managed nonoperatively with satisfactory results. Open reduction and internal fixation (ORIF) is generally indicated for significantly displaced or complex fractures, with radial head replacement reserved for cases refractory to ORIF. However, there remains debate regarding optimal treatment of complex radial head fractures and further evidence is required before definitive management guidelines can be produced. [ABSTRACT FROM AUTHOR]

Traumatic hip dislocation occurs during high-energy trauma and is often associated with other life threatening injuries. Dislocation can be anterior or posterior and urgent reduction is mandatory to reduce the risk of a vascular necrosis of the femoral head. Undisplaced femoral neck fractures should be excluded prior to attempted reduction. Various closed reduction techniques have been described and most dislocations can be reduced with a closed technique. Failure to achieve reduction makes open reduction mandatory. This review describes the diagnosis, investigation and management of this complex and challenging injury. [ABSTRACT FROM AUTHOR]

Before attempting to treat ankle fractures it is vital to appreciate the normal functional anatomy of this complex joint. The objectives of treatment, as with all fracture management, are to restore the anatomy and return normal function to the injured joint. This article describes the functional anatomy of the ankle and the epidemiology, assessment and definitive management required for a routine ankle fracture. [ABSTRACT FROM AUTHOR]

A review of the literature underpinning modern triage methodology is presented. The philosophy and history is described prior to a review of triage scoring methodology relevant to modern day practice. The importance of triage is most acute during major incidents and the triage process is highlighted within this framework. Triage has wide-ranging applications throughout medical practice and these are included as part of the discussion. [ABSTRACT FROM AUTHOR]

Acute compartment syndrome of the limb is an orthopaedic surgical emergency. Delay in its recognition and treatment can result in serious morbidity. The aetiology, diagnosis and management of this condition are discussed in this review article. [ABSTRACT FROM AUTHOR]

In the abrupt vertical deceleration that occurs on impact after a free fall, tissue damage is caused by the absorption by the body of the energy accumulated during the free fall. Patients sustain a unique injury pattern that is predicatably different from that seen with other forms of blunt multiple trauma. The present paper reviews the pathophysiology and pattern of injury sustained following free fall. [ABSTRACT FROM AUTHOR]

The article focuses on the need to change the spinal immobilisation practices for prehospital trauma patients. Following the principles of minimal handling with one early movement, the authors don not support routine use of the long spinal board for spinal immobilisation and the transportation of patients.

Background There is now accumulating evidence that matrix metalloproteinases (MMPs), the physiological mediators of matrix deposition and degradation, play an important role in the development of intimal hyperplasia following arterial bypass. This study investigated the effect of marimastat, an orally active specific MMP inhibitor, on neointima formation in cultured human saphenous vein. Methods Segments of human saphenous vein obtained from ten patients undergoing arterial bypass surgery were cultured for 14 days in serum-supplemented RPMI medium (controls) or in control medium supplemented with marimastat at three different concentrations (treatment groups). Following culture, half of each segment was prepared for histological examination and MMPs were extracted from the other half for gelatin zymography. Results Marimastat inhibited neointimal thickening in a concentration-dependent manner; inhibition was significant at 10-5 and 10-6 mol/l (P=0·006). This observation was paralleled by a significant reduction in the levels of MMP-2 and MMP-9 in the tissues. Conclusion Marimastat significantly reduced neointimal thickening in this laboratory model. MMP inhibitors may offer a potential therapeutic strategy in the prevention of intimal hyperplasia. [ABSTRACT FROM AUTHOR]

The course of forty-six consecutive patients were studied for 3½-5 years after renal homotransplantation from related and unrelated donors. Transthoracic thymectomy was performed before transplantation in twenty-four cases; the other twenty-two recipients served as controls. A similar spectrum of donor-recipient lymphocyte antigen compatibility was present in both the test and control series. In both the related and non-related cases, there was no clinical evidence that the patients with thymectomy had either an early or late advantage in terms of survival, reduced drug dosages, or quality of renal functions However, pathologic studies with light and electron microscopy and with immunofluorescence revealed that the homografts in the thymectomized patients had fewer and less severe lesions of the kind that would be expected to limit the functional life time of these organs. [ABSTRACT FROM AUTHOR]

Sanfilippo Syndrome is a rare, pediatric-onset, multi-symptom disorder with no approved treatments. Methods The first study phase resulted in high-priority symptom domains including communication, behavior, adapting, mobility, sleep, eating, and pain. Conclusions Symptoms in Sanfilippo syndrome weighted toward the cognitive domain, but global cognitive measures are broad and may not be adequately sensitive or disease specific to be responsive to subtle but meaningful change in a non-curative therapy. [Extracted from the article]

Aim: To assess current practice in cervical spine clearance across major trauma centres in England and review current guidelines.Materials and Methods: An electronic survey was sent to lead trauma clinicians at 22 major trauma centres in England. This assessed the clinical decision tools used, the choice of initial imaging technique, and the methods used to clear the cervical spine in alert and obtunded patients without focal neurology, and where initial imaging was normal. British Orthopaedic Association Standards for Trauma (BOAST) 2 and Eastern Association for Surgery for Trauma (EAST) guidelines were used as standards.Results: Eighteen out of the 22 (82%) centres responded by completing the survey. Most (71%) centres used the Canadian C-Spine Rule for clearing the cervical spine clinically. Seventy-two percent of centres preferred computed tomography (CT) as the first-line imaging technique, the choice based on age of patient and mechanism of injury. If the initial CT imaging was normal, magnetic resonance imaging (MRI) was performed in 52% of centres to clear the cervical spine, with half of these centres stating that they would discuss further imaging with a radiologist first. The practice across centres was highly variable for the obtunded patient, with most centres preferring continuing immobilisation or MRI to clear the cervical spine, with a small minority removing spinal precautions when a high-quality multidetector CT was normal.Conclusion: Multidetector CT is the preferred initial imaging technique across most major trauma centres in England when blunt cervical spine trauma is suspected. There is widespread reliance on MRI to clear the cervical spine in both alert and obtunded patients, if initial CT imaging is normal and there is no focal neurology on clinical assessment. This calls for greater awareness of the reliability of a high-quality normal multidetector CT examination in clearing the cervical spine in the absence of focal neurology. [ABSTRACT FROM AUTHOR]

To determine the effects of two presynchronization strategies in conjunction with delayed fixed-time artificial insemination (TAI) on pregnancy rates to TAI (PR/AI), 1700 Angus beef heifers at three locations in South Dakota were enrolled in a completely randomized design with a 2 by 2 factorial arrangement of treatments. Within location, all heifers were randomly assigned to one of four treatments: 1) PG54 (n = 434), heifers were administered prostaglandin F 2α (PGF; 25 mg im) 7 d prior [Day −14] to the initiation of the 7-d CO-Synch + controlled internal drug releasing (CIDR) protocol wherein they received gonadotropin-releasing hormone (GnRH; 100 μg im) and a CIDR insert on Day −7, PGF at CIDR removal on Day 0, and a second injection of GnRH concurrently with TAI 54 ± 2 h later; 2) PG72 (n = 426), heifers were exposed to the same treatment as PG54, however, TAI was performed 72 ± 2 h after CIDR removal; 3) PG-CIDR54 (n = 422), same as PG54 but heifers received a CIDR insert on Day −14 rather than Day −7, in addition to PGF administration; 4) PG-CIDR72 (n = 418), same as PG-CIDR54, however, TAI was performed 72 ± 2 h after CIDR removal. Estrus detection patches were applied to all heifers on Day 0 and were evaluated for activation at TAI. Pregnancy was diagnosed via transrectal ultrasonography between 30 and 47 d after TAI. The percentage of heifers exhibiting estrus between Day 0 and TAI was greater (P < 0.01) in the PG72, PG-CIDR54, and PG-CIDR72 treatments compared to the PG54 treatment (78.11, 86.59, and 91.09 vs. 31.05%, respectively). Furthermore, estrus response was greater (P < 0.01) in PG-CIDR72 heifers when compared to PG72. Pregnancy rates to TAI differed among treatments and were greater (P < 0.05) in the PG72 and PG-CIDR54 treatments when compared to PG-CIDR72 (48.8 and 50.4 vs. 38.4%, respectively), and were greater (P = 0.03) in PG-CIDR54 vs. PG54 (43.1%). Moreover, a tendency (P = 0.10) was determined on PR/AI between PG54 and PG72. In conclusion, presynchronization strategies and prolonged exposure to exogenous progesterone have the potential to alter estrus expression and improve fertility in replacement beef heifers. • Delaying TAI to 72 h increased the percentage of heifers exhibiting estrus after presynchronization with prostaglandin F 2α. • Delaying TAI to 72 h in heifers presynchronized with prostaglandin F 2α resulted in a tendency for an increase in PR/AI. • Presynchronization with prostaglandin F 2α and a CIDR insert resulted in an increase in PR/AI when TAI was performed at 54 h. [ABSTRACT FROM AUTHOR]

An abstract of the article "Influence of Age on Participation and Preferences for Education Strategies in a Multi-Component Intervention" by Jessica Li et al. is presented.

Focuses on the influence of Boer War in Kosovo, Servia on the medical developments in the battlefield. Evaluation the medical experience in the battlefield; Impact of war conduct and climate on the healing of gun shot wounds; Inadequacy in the medical preparations on a large-scale war.

Background: The maternal immune system undergoes substantial changes to support healthy pregnancy. Although obesity is a primary driver of inflammation and predictive of perinatal complications, additive effects of pregnancy and obesity on changes in inflammatory processes are not well delineated. Methods: This study examined serum proinflammatory markers interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-α, IL-1β, and C-reactive protein (CRP) during each trimester of pregnancy and 4–6 weeks postpartum among 57 women. Results: Overall, IL-6 showed an increasing trend across pregnancy and significant increase at postpartum. Similarly, TNF-α increased significantly across gestation, with a further increase at postpartum. Both IL-8 and IL-1β showed a U-shaped curve, decreasing from early to later pregnancy, and increasing at postpartum. Finally, serum CRP decreased significantly across pregnancy, with further decreases at postpartum. Maternal obesity predicted higher IL-6 at each study visit. Obese women showed a trend toward elevated serum CRP during pregnancy, and significantly higher levels at postpartum. Discussion: The course of pregnancy and postpartum is characterized by significant changes in serum proinflammatory mediators. Obese women show elevations in serum proinflammatory markers relative to normal weight women during pregnancy and postpartum. Further research is needed to determine the extent to which obesity-induced inflammation affects maternal and fetal health. [ABSTRACT FROM AUTHOR]

Introduction: Hip fractures cause significant morbidity and mortality in the elderly population. There are over 75′000 per year in the UK. Despite this, there has been little research on patients' views and experiences of hip fractures. This was highlighted as an area where further research was required in the NICE guidelines for hip fractures. The aim of this study was to assess patients' experiences of their hip fractures and hip fracture management.Sampling methods: An interview script was created based on recommendations made in the NICE guidance. Approval was gained from the local patient experience team. A 30 minute semi-structured interview was undertaken by a single interviewer who was not involved in the patients care.Results: 15 patients were interviewed with an average age of 81.7 (range 70-94). 13 females and 2 males participated. When asked about their feelings about injuring their hip, most felt resentment and blamed themselves for the injury. When asked if they would make a full recovery, 10 out of 15 thought they would. Only 5 of 15 thought their living circumstances would change. 8 out of 15 thought they would need additional help after discharge and the majority had negative thoughts about this. Returning home and regaining independence were the most important factors highlighted by all those questioned. When asked about the advice they would give to other people who suffered a hip fracture, most made comments such as ‘listen to the advice given’, ‘just get on with it’ and ‘stay positive’.Conclusion: Hip fractures are a major event for an elderly person. Patients do not generally understand the effects that it may have on their life. Returning to their pre-fracture level of mobility and living circumstances following a hip fracture were most important to those interviewed. [ABSTRACT FROM AUTHOR]

Introduction: Hip fractures cause significant morbidity and mortality in the elderly population. There are over 75′000 per year in the UK. Despite this, there has been little research on patients' views and experiences of hip fractures. This was highlighted as an area where further research was required in the NICE guidelines for hip fractures. The aim of this study was to assess patients' experiences of their hip fractures and hip fracture management.Sampling methods: An interview script was created based on recommendations made in the NICE guidance. Approval was gained from the local patient experience team. A 30 minute semi-structured interview was undertaken by a single interviewer who was not involved in the patients care.Results: 15 patients were interviewed with an average age of 81.7 (range 70-94). 13 females and 2 males participated. When asked about their feelings about injuring their hip, most felt resentment and blamed themselves for the injury. When asked if they would make a full recovery, 10 out of 15 thought they would. Only 5 of 15 thought their living circumstances would change. 8 out of 15 thought they would need additional help after discharge and the majority had negative thoughts about this. Returning home and regaining independence were the most important factors highlighted by all those questioned. When asked about the advice they would give to other people who suffered a hip fracture, most made comments such as ‘listen to the advice given’, ‘just get on with it’ and ‘stay positive’.Conclusion: Hip fractures are a major event for an elderly person. Patients do not generally understand the effects that it may have on their life. Returning to their pre-fracture level of mobility and living circumstances following a hip fracture were most important to those interviewed. [ABSTRACT FROM AUTHOR]