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Procalcitonin (PCT) is a well-known biomarker that is directly connected to bacterial infection especially when it reaches significantly high levels. It is extremely rare to be witnessed in non-bacterial infections such as viral or parasitic. It may be elevated in other conditions such as trauma and autoimmune diseases. We present a rare case of a young gentleman, who had an extremely high PCT level that appeared to be a result of anaphylaxis due to worm infestation.

The negative impacts of catastrophic fire and explosion accidents due to copper corrosion problems of oil-filled electrical transformers are still in the spotlight due to a lack of effective methods for early fault detection. To address this gap, a condition monitoring (CM) procedure that can detect such problems in the initial stage is proposed in this paper. The suggested CM procedure is based on identified measurable variables, which are the relevant by-products of the corrosion reaction, and utilizes an Early Fault Diagnosis (EFD) model to detect and solve the copper corrosion problems. The EFD model includes a fault trend chart that can track a fault progression during the useful life of transformers. The purpose of this paper is to verify and validate the effectiveness of the suggested CM procedure by an empirical study in a power plant. The result of applying this procedure was early detection of copper corrosion problems in two transformers with suspected copper corrosion propagation from a total of 84. The corrective action was adding an optimized amount of a passivator, an anticorrosion additive, to suppress the corrosion reaction at the correct time. The main conclusion of this study is the importance of early detection of transformer faults to avoid the negative impacts on societal, company, and individual levels.

Fire and explosion accidents of oil-filled electrical transformers are leading to negative impacts, not only on the delivery of energy, but also on workplace health and safety as well as the surrounding environment. Such accidents are still being reported, regardless of applying the regular maintenance strategy in the power plants. The purpose of this paper is to integrate a sustainability perspective into the maintenance strategy. The problem addressed is: how can we approach the relevant cost-effective sustainable maintenance for oil-filled electrical transformers? For this purpose, an empirical study in a power plant in Kuwait was introduced. The first stage was to carry out a sustainability assessment using the ABCD procedure. In this procedure, gaps to approach sustainability were identified and actions prioritized to close these gaps were demonstrated. Applying this procedure yielded an early fault diagnosis (EFD) model for achieving cost-effective sustainable maintenance using a fault trend chart based on a novel numerical method. Implementing this model resulted in an extension of the lifetime of transformers with suspected failure propagation, leading to a deferral of the replacement investment costs. The principal conclusion of this paper is the importance of viewing the maintenance strategy of transformers from a strategic sustainability perspective, in order to approach relevant cost-effective sustainable maintenance.

In Mexico, Triatoma longipennis (Usinger), Triatoma picturata (Usinger), and Triatoma pallidipennis (Stal), primary Chagas disease vector species of the phyllosoma complex, were analyzed by randomly amplified polymorphic DNA (RAPD). Sixteen decametric primers resolved individual profiles not identical, but partially discriminative between species. Analysis based on pairwise presence/absence comparisons between the three species was performed using three primers and two outgroup species Triatoma infestans (Klug) and Triatoma barberi (Usinger). Fifty-three bands in total were scored, although only two bands were constant among the three phyllosoma complex species. Two other bands were constant only for T. longipennis and T. picturata together, and not present in T. pallidipennis. Neighbor Joining tree and the multiple correspondence analysis discriminated T. pallidipennis clearly from the other two species, although there was overlap between T. longipennis and T. picturata. The results indicate a close relationship between the studied species and support the hypothesis of their recent evolution. The suitability of RAPD to discern populations within the species is discussed.

A crisis for a newborn and a new nurse. [ABSTRACT FROM AUTHOR]

Abstract: Numerous publications describe techniques to measure trigonocephaly caused by metopic synostosis, but they are potentially hazardous for use in acquiring longitudinal data. Optical surface scanning technology can safely yield craniometrics but has not established a practical means for measuring objective morphological changes to trigonocephaly during the practical time constraints of a clinical visit. The purpose of this preliminary study was to evaluate a method for safely and repeatedly measuring frontal angle (FA) using technology available at multiple centers providing treatment with cranial remolding orthoses.Optical scans of infants who underwent endoscopic-assisted minimally-invasive craniectomy for repair of metopic synostosis with cranial remolding were retrospectively analyzed. A novel FA measurement technique "FA30" was developed based on repeatable, geometrically-related surface landmarks approximating the glabella and frontotemporali. Results were compared to a control group and categories of non-synostotic deformity. Inter-rater reliability was assessed for pre- and post-treatment scan measurements among separate clinicians.All trigonocephalic subjects (n = 5) had initial FA30 significantly lower than the control group and other cohorts (P < 0.001). During the course of orthotic cranial remolding following surgical release mean FA30 increased from 121.5° to 138.5° (P < 0.001), approaching the control group mean of 144.4°. Intraclass coefficient calculation showed high reliability (intraclass correlation coefficient: 0.993, 95% confidence interval: 0.957-0.998, P < 0.001), which was supported with Bland-Altman analyses of agreement.Optical surface scanning may provide a safe, accurate, and repeatable means to measure FA. Increase in FA30 demonstrates correction of trigonocephaly. The method presented enables expeditious reporting of treatment progress to the infant's surgeon and parents, and has potential for use in optimizing treatment outcomes at multiple centers., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of Mutaz B. Habal, MD.)

Introduction: The purpose of this study is to identify the advancing role of Intraoperative Neurophysiological Monitoring (IONM) in detecting and preventing nerve injuries during shoulder surgery procedures. Methods: We performed a retrospective analysis of IONM data from ten shoulder procedures. The patients consisted of nine females and one male with ages ranging from 67 to 81 years (median: 74 years). IONM modalities utilized were bilateral Somatosensory Evoked Potentials (SSEP), Transcranial Motor Evoked Potentials (TCeMEP), ipsilateral Electromyogram (EMG) from upper extremity muscles and Train of four (TOF) recordings. Results: A decrease in signals was noted in three patients (30%). Only upper SSEP amplitude decreased in one patient; both upper extremity SSEP and TCeMEP decreased in two patients. Only one patient had poor baseline radial nerve SSEP that improved during the surgery. We performed spontaneous EMG (s-EMG) in all ten patients and successfully recorded triggered (t-EMG) in seven patients (71.4%). In one patient, SSEP and TCeMEP did not improve, and the patient woke up with deficits. Conclusions: In this small series, we were able to identify real-time impending nerve injury. The use of IONM alerted and may have prevented intraoperative nerve injury in 30% of the patients in this series. In one patient, SSEP and TCeMEP did not recover even after the intervention due to severe blood loss. The patient woke up with sensory and motor deficits. The utilization of multimodality IONM can be helpful due to signal changes, therefore minimizing the frequency of nerve injury and deficits.

Background: Health care spending is projected to increase throughout the next decade alongside the number of total joint arthroplasties (TJAs) performed. Such growth places significant financial burden on the economic system. To address these concerns, Bundled Payments for Care Improvement (BPCI) is becoming a favorable reimbursement model. The aim of this study is to present the outcomes with BPCI model focused on the post-acute care (PAC) phase and compare the outcomes between years 1 and 2 of implementation., Methods: The Joint Utilization Management Program (JUMP) was implemented in January 2014. Inclusion criteria were Medicare patients undergoing primary unilateral in-patient TJA procedures, outpatient procedures that resulted in an in-hospital admission, and trauma episodes that required TJA. Scorecards monitoring surgeons' performance and tracking length of stay (LOS) in the PAC setting were established. The data generated from these scorecards guided percentage sum-allocation from the total gain-shared sum among the participating providers., Results: A total of 683 JUMP patients were assessed over two years. PAC utilization decreased between 2014 and 2015. The average LOS was longer in year 1 than year 2 (4.50 vs 3.19 days). In-patient rehabilitation (IPR) decreased from 6.45% to 3.22%, with a decrease in IPR average LOS of 1.47 days. The rate of 30-day readmission was lower for JUMP patients in 2015 than 2014 (8.77% vs 10.56%), with day of readmission being earlier (11.91 days vs 13.71 days) in 2014., Conclusion: Under the BPCI program, our experience with the JUMP model demonstrates higher efficiency of care in the PAC setting through reduced LOS, IPR admission rates, and 30-day readmission rate., (Copyright © 2019. Published by Elsevier Inc.)

Reverse shoulder arthroplasty (RSA) has revolutionized treatment of arthritis and rotator cuff insufficiency and is performed using implants with either a medial or a lateral center of rotation. We conducted a study of the outcomes and the effect of surgeon learning after the first 60 consecutive lateral-center-of-rotation RSAs implanted by a single surgeon unaffiliated with the design team for this particular reverse shoulder prosthesis. At minimum 2-year followup, mean improvements in active forward elevation, abduction, and external rotation were 69°, 55°, and 23°, respectively; mean active internal rotation improved significantly as well (P < .001 for all). Mean Simple Shoulder Test (SST) scores improved from 1.8 (range, 0-6) to 6.9 (range, 0-12) (P < .0001), and mean final American Shoulder and Elbow Surgeons score was 72 (range, 27-100). Final radiographs showed scapular notching in 5 shoulders (11%). Gains in SST scores, active forward elevation, and active abduction were lower for the first 15 cases than for the next 45 cases, and 5 of the 8 reoperations were performed after the first 15 cases. Overall improvements in active motion and self-assessed shoulder function in this series are comparable to those previously reported by the design team. Experience with RSA appears to influence efficacy, but the learning curve may not be as steep as previously reported.

Background: A non-articulated plantarflexion resist ankle foot orthosis (AFO), commonly known as a posterior leaf spring AFO, is indicated for patients with motor impairment to the dorsiflexors. The AFO is often custom molded to a patient's lower limb anatomy and fabricated from polypropylene. There are no established guidelines for fabricating this type of AFO with predetermined stiffness of the ankle region for normal walking speeds. Therefore an AFO may not meet the biomechanical needs of the patient., Objectives: Quantify the biomechanical ankle stiffness requirement for an individual with complete dorsiflexor impairment and develop a method for fabricating an AFO with ankle stiffness to meet that requirement., Study Design: Experimental, bench research., Methods: The literature on sagittal biomechanics of non-pathological adults was reviewed to derive the stiffness of the ankle during loading response. Computer models of 144 AFOs were created with geometric variations to account for differences in human anthropometrics. Computer-based finite element analysis was employed to determine the stiffness and safety factor of the models., Results: Stiffness of the AFOs ranged from 0.04 to 1.8 Nm/deg. This ample range is expected to account for the stiffness required for most adults with complete dorsiflexor impairment. At 5° deflection the factor of safety (ratio of strength to stress) ranged from 2.8 to 9.1. A computer program was generated that computes AFO stiffness from user-input variables of AFO geometry. The stiffness is compared to a theoretically appropriate stiffness based on the patient mass. The geometric variables can be modified until there is a close match, resulting in AFO design specification that is appropriate for the patient., Conclusion: Through validation on human subjects, this method may benefit patient outcomes in clinical practice by avoiding the current uncertainty surrounding AFO performance and reducing the labor and time involved in rectifying a custom AFO post-fabrication., Clinical Relevance: This method provides an avenue for improving patient outcomes by avoiding the current uncertainty surrounding non-articulated plantarflexion resist ankle foot orthosis performance. The ability to quantify the biomechanical ankle stiffness requirement for an individual with complete dorsiflexor impairment provides insight into how other AFO types should be designed as well.

To define in vivo interactions of Escherichia coli DNA replication components, extragenic suppressors of a dnaZ(TS) mutant were isolated. A temperature-sensitive dnaZ mutant, which is defective in polymerization, was placed at 39 degrees C to select temperature-insensitive revertants. Some of these revertants also were cold sensitive, a phenotypic property that facilitated study of the suppressor. Mapping of the cold sensitivity indicated that some of the suppressor mutations are intragenic but others are located within the initiation gene, dnaA. The dnaA mutations that suppress the dnaZ(TS) defect are designated dnaA(SUZ, CS). The dnaA(SUZ, CS) strains have a defect in DNA synthesis at low temperature that is typical of an initiation defect. These data suggest that the dnaA product, an initiation factor, interacts in vivo with the dnaZ protein, a polymerization factor.

Suppressors of a temperature-sensitive dnaZ polymerization mutant of Escherichia coli have been identified by selecting temperature-insensitive revertants. Those suppressed strains which concomitantly became cold sensitive were chosen for further study. Intragenic suppressor mutations, which caused cold-sensitive defects in DNA polymerization, were located in dnaZ by transduction with lambda dnaZ+ phages. Extragenic suppressor mutations were mapped within the initiation gene dnaA. These suppressor-containing strains were defective in initiation at low temperature as determined by measurements of DNA synthesis in vivo and in toluene-treated cells. The occurrence of suppressor mutations of dnaZ(Ts) within the dnaA gene is considered evidence that the dnaA and dnaZ products interact in vivo. A second indication of a dnaA-dnaZ protein-protein interaction was provided by the observation that the introduction of additional copies of the dnaZ+ gene into a strain carrying the dnaA suppressor mutation was lethal [whether the strain was dnaZ+ or dnaZ(Ts)].