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The Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH) trial demonstrated that minimally invasive surgery to treat spontaneous lobar intracerebral hemorrhage (ICH) improved functional outcomes. We aimed to explore current management trends for spontaneous lobar ICH in Canada to assess practice patterns and determine whether further randomized controlled trials are needed to clarify the role of surgical intervention.
Methods:
Neurologists, neurosurgeons, physiatrists and trainees in these specialties were invited to complete a 16-question survey exploring three areas: (1) current management for spontaneous lobar ICH at their institution, (2) perceived influence of ENRICH on their practice and (3) perceived need for additional clinical trial data. Standard descriptive statistics were used to report categorical variables. The χ2 test was used to compare responses across specialties and career stages.
Results:
The survey was sent to 433 physicians, and 101 (23.3%) responded. Sixty-eight percent of participants reported that prior to publication of the ENRICH trial, spontaneous lobar ICH was primarily managed conservatively, with surgery reserved for life-threatening situations. Forty-three percent of participants did not foresee a significant increase in surgical intervention at their institution. Of neurosurgical respondents, 33% remained hesitant to offer surgical intervention beyond lifesaving operations. Only 5% reported routinely using specifically designed technologies to evacuate ICH. Seventy percent reported that another randomized controlled trial comparing nonsurgical to surgical management for spontaneous lobar ICH is needed.
Conclusions:
There is significant practice variability in the management of spontaneous lobar ICH across Canadian institutions, stressing the need for additional clinical trial data to determine the role of surgical intervention.
Despite the global expansion of electronic medical record (EMR) systems and their increased integration with artificial intelligence (AI), their utilization in disaster settings remains limited, and few studies have evaluated their implementation. We aimed to evaluate Fast Electronic Medical Record (fEMR), a novel, mobile EMR designed for resource-limited settings, based on user feedback.
Methods
We examined usage data through October 2022 to categorize the nature of its use for disaster response and determine the number of patients served. We conducted interviews with stakeholders and gathered input from clinicians who had experience using fEMR.
Results
Over eight years, fEMR was employed 60 times in 11 countries across four continents by 14 organizations (universities, non-profits, and disaster response teams). This involved 37,500+ patient encounters in diverse settings including migrant camps at the US-Mexico and Poland-Ukraine borders, mobile health clinics in Kenya and Guatemala, and post-earthquake relief in Haiti. User feedback highlighted adaptability, but suggested hardware and workflow improvements.
Conclusion
EMR systems have the potential to enhance healthcare delivery in humanitarian responses, offer valuable data for planning and preparedness, and support measurement of effectiveness. As a simple, versatile EMR system, fEMR has been deployed to numerous disaster response and low-income settings.
Identifying long-term care facility (LTCF)-exposed inpatients is important for infection control research and practice, but ascertaining LTCF exposure is challenging. Across a large validation study, electronic health record data fields identified 76% of LTCF-exposed patients compared to manual chart review.
Direct numerical simulations (DNSs) of three-dimensional cylindrical release gravity currents in a linearly stratified ambient are presented. The simulations cover a range of stratification strengths $0< S\leq 0.8$ (where $S=(\rho _b^*-\rho _0^*)/(\rho _c^*-\rho _0^*), \rho _b^*, \rho _0^*$ and $\rho _c^*$ are the dimensional density at the bottom of the domain, top of the domain and the dense fluid, respectively) at two different Reynolds numbers. A comparison between the stratified and unstratified cases illustrates the influence of stratification strength on the dynamics of cylindrical gravity currents. Specifically, the front velocity in the slumping phase decreases with increasing stratification strength whereas the duration of the slumping phase increases with increments of $S$. The Froude number calculated in this phase shows a good agreement with models proposed by Ungarish & Huppert (J. Fluid Mech., vol. 458, 2002, pp. 283–301) and Ungarish (J. Fluid Mech., vol. 548, 2006, pp. 49–68), originally developed for planar gravity currents in a stratified ambient. In the inertial phase, the front velocity across cases with different stratification strengths adheres to a power-law scaling with an exponent of $-$1/2. Higher Reynolds numbers led to more frequent lobe splitting and merging, with lobe size diminishing as stratification strength increased. Strong interactions among inner vortex rings occurred during the slumping phase, leading to the early formation of hairpin vortices in weakly stratified cases, while strongly stratified cases exhibited delayed vortex formation and less turbulence.
Frontal ablation, the combination of submarine melting and iceberg calving, changes the geometry of a glacier's terminus, influencing glacier dynamics, the fate of upwelling plumes and the distribution of submarine meltwater input into the ocean. Directly observing frontal ablation and terminus morphology below the waterline is difficult, however, limiting our understanding of these coupled ice–ocean processes. To investigate the evolution of a tidewater glacier's submarine terminus, we combine 3-D multibeam point clouds of the subsurface ice face at LeConte Glacier, Alaska, with concurrent observations of environmental conditions during three field campaigns between 2016 and 2018. We observe terminus morphology that was predominately overcut (52% in August 2016, 63% in May 2017 and 74% in September 2018), accompanied by high multibeam sonar-derived melt rates (4.84 m d−1 in 2016, 1.13 m d−1 in 2017 and 1.85 m d−1 in 2018). We find that periods of high subglacial discharge lead to localized undercut discharge outlets, but adjacent to these outlets the terminus maintains significantly overcut geometry, with an ice ramp that protrudes 75 m into the fjord in 2017 and 125 m in 2018. Our data challenge the assumption that tidewater glacier termini are largely undercut during periods of high submarine melting.
While unobscured and radio-quiet active galactic nuclei are regularly being found at redshifts
$z > 6$
, their obscured and radio-loud counterparts remain elusive. We build upon our successful pilot study, presenting a new sample of low-frequency-selected candidate high-redshift radio galaxies (HzRGs) over a sky area 20 times larger. We have refined our selection technique, in which we select sources with curved radio spectra between 72–231 MHz from the GaLactic and Extragalactic All-sky Murchison Widefield Array (GLEAM) survey. In combination with the requirements that our GLEAM-selected HzRG candidates have compact radio morphologies and be undetected in near-infrared
$K_{\rm s}$
-band imaging from the Visible and Infrared Survey Telescope for Astronomy Kilo-degree Infrared Galaxy (VIKING) survey, we find 51 new candidate HzRGs over a sky area of approximately
$1200\ \mathrm{deg}^2$
. Our sample also includes two sources from the pilot study: the second-most distant radio galaxy currently known, at
$z=5.55$
, with another source potentially at
$z \sim 8$
. We present our refined selection technique and analyse the properties of the sample. We model the broadband radio spectra between 74 MHz and 9 GHz by supplementing the GLEAM data with both publicly available data and new observations from the Australia Telescope Compact Array at 5.5 and 9 GHz. In addition, deep
$K_{\rm s}$
-band imaging from the High-Acuity Widefield K-band Imager (HAWK-I) on the Very Large Telescope and from the Southern Herschel Astrophysical Terahertz Large Area Survey Regions
$K_{\rm s}$
-band Survey (SHARKS) is presented for five sources. We discuss the prospects of finding very distant radio galaxies in our sample, potentially within the epoch of reionisation at
$z \gtrsim 6.5$
.
Infectious mononucleosis is a relatively common acute presentation to the ENT department. There is an expected derangement in the liver function test results in most patients. There is no guidance regarding follow up, and practice varies. This study aimed to evaluate the utility of liver function tests and abdominal ultrasound in infectious mononucleosis.
Methods
This was a retrospective study of all adult patients admitted under ENT with infectious mononucleosis over a five-year period.
Results
A total of 153 patients were included; 80 per cent had abnormal liver function test results at presentation. Around 50 per cent had at least one liver function test assessment following discharge. Median (interquartile range) time to resolution of liver function test results was 32 days (20–50 days); maximum time was 10 months. Six patients had in-patient abdominal ultrasound: all showed a normal liver and biliary tree. No patient developed any liver disease sequelae.
Conclusion
The findings suggest that serial assessment of liver function is not required in immunocompetent adults with subclinical derangement in liver function.
Background: Concern around perceived neurocognitive decline is increasing, leading to increased number of referrals and anxiety for patients. We aimed to explore the likelihood of the “worried well” experiencing neurocognitive decline. Methods: 166 “worried well” patients who attended the Rural and Remote Memory Clinic between 2004 and 2019 were included. Mini Mental Status Examination, Center for Epidemiologic Studies Depression Scale, and Functional Assessment Questionnaire scores were measured and compared at initial assessment and at 1-year follow-up. MMSE scores over time were assessed with a mean follow-up of 2.95 years (SD 2.87). Results: There was no statistically significant difference in MMSE, CESD, or FAQ scores between clinic day and one-year follow-up, and no consistent pattern of MMSE score over time. Of the 166 patients with SCI on initial assessment, nine were eventually given a neurological diagnosis. Conclusions: There is no pattern of neurologic decline observed in the “worried well”. Though the likelihood of a patient with SCI developing a neurological diagnosis is reassuringly low, (9/166), it is not irrelevant. This, along with the benefits of early diagnosis and treatment for dementia, leads us to believe that patients with SCI should still be seen in follow-up at least at the one-year mark.
Through laboratory experiments and numerical simulations, we examine the evolution of buoyant plumes as they are influenced by background rotation in a uniform density ambient fluid. The source Rossby number is sufficiently large that rotation does not directly affect the plume at early times. However, on a time scale of the order of half a rotation period, the plume becomes deflected from the vertical axis. For some experiments and simulations, the deflection persists and the flow precesses about the vertical axis. In other cases, shortly after being deflected, the plume laminarizes near the source to form a near-vertical columnar vortex, which we refer to as a ‘tornado’. Tornado formation occurs in some experiments and not in others even if the source and background rotation parameters are identical. However, their formation is more likely if the plumes are ‘lazy’. Simulations reveal that this is a consequence of the competing dynamics that occurs on comparable time scales. As a consequence of entrainment, vertical vorticity builds up within the plume reducing the Rossby number and suppressing vertical motion at distances progressively closer to the source. Meanwhile, the swirl (the ratio of the azimuthal to vertical flow) around the vicinity of the source increases, which tends to suppress three-dimensional turbulence in the near-source flow. Although the former process ultimately acts to deflect the plume off axis, in some instances, the swirl around the source succeeds in laminarizing the flow, resulting in tornado formation.
Necrotising otitis externa is a progressive infection of the external auditory canal which extends to affect the temporal bone and adjacent structures. Progression of the disease process can result in serious sequelae, including cranial nerve palsies and death. There is currently no formal published treatment guideline.
Objective
This study aimed to integrate current evidence and data from our own retrospective case series in order to develop a guideline to optimise necrotising otitis externa patient management.
Methods
A retrospective review of necrotising otitis externa cases within NHS Lothian, Scotland, between 2013 and 2018, was performed, along with a PubMed review.
Results
Prevalent presenting signs, symptoms and patient demographic data were established. Furthermore, features of cases associated with adverse outcomes were defined. A key feature of the guideline is defining at-risk patients with initial intensive treatment. Investigations and outcomes are assessed and treatment adjusted appropriately.
Conclusion
This multi-departmental approach has facilitated the development of a succinct, systematic guideline for the management of necrotising otitis externa. Initial patient outcomes appear promising.
Ice mélange has been postulated to impact glacier and fjord dynamics through a variety of mechanical and thermodynamic couplings. However, observations of these interactions are very limited. Here, we report on glaciological and oceanographic data that were collected from 2016 to 2017 at LeConte Glacier and Bay, Alaska, and serendipitously captured the formation, flow and break-up of ephemeral ice mélange. Sea ice formed overnight in mid-February. Over the subsequent week, the sea ice and icebergs were compacted by the advancing glacier terminus, after which the ice mélange flowed quasi-statically. The presence of ice mélange coincided with the lowest glacier velocities and frontal ablation rates in our record. In early April, increasing glacier runoff and the formation of a sub-ice-mélange plume began to melt and pull apart the ice mélange. The plume, outgoing tides and large calving events contributed to its break-up, which took place over a week and occurred in pulses. Unlike observations from elsewhere, the loss of ice mélange integrity did not coincide with the onset of seasonal glacier retreat. Our observations provide a challenge to ice mélange models aimed at quantifying the mechanical and thermodynamic couplings between ice mélange, glaciers and fjords.
Depression is a major public health problem in European countries, and health systems need to ensure access to effective psychological and pharmacological treatments. Research suggests that improvements in depression care require “complex interventions” that implement change in several areas simultaneously.
Methods
We describe an observational study of the implementation of a “stepped care” model to provide care for all adults presenting with a new case of depression in a mixed urban-rural area of Scotland with a population of 76,000 people.
A team of 5.2 clinicians provided care for about 1,000 new cases of depression each year. “Guided Self-Help” was the baseline intervention for all patients, supplemented where necessary with pharmacological treatment and Cognitive Behavioural or Interpersonal Therapy.
Service delivery systems were reformed to provide: specialist treatment in primary care settings using primarily non-medical clinicians, comprehensive electronic clinical records, continuous outcome monitoring and intensive investment in staff training and support.
Results
Clinical outcomes (measured by the Personal Health Questionnaire, Social and Work Adjustment Scale and EQ-5D) showed significant improvement despite relatively brief clinician contact (2.5 hours over 4.6 contacts). Savings of more than 50% were made on the antidepressant drug budget. Service user satisfaction ratings were high.
Conclusions
Population needs for depression care can be met using “stepped care” models such as that described above. A randomised controlled study of this approach would be required to fully test the model.
We present a workflow to track icebergs in proglacial fjords using oblique time-lapse photos and the Lucas-Kanade optical flow algorithm. We employ the workflow at LeConte Bay, Alaska, where we ran five time-lapse cameras between April 2016 and September 2017, capturing more than 400 000 photos at frame rates of 0.5–4.0 min−1. Hourly to daily average velocity fields in map coordinates illustrate dynamic currents in the bay, with dominant downfjord velocities (exceeding 0.5 m s−1 intermittently) and several eddies. Comparisons with simultaneous Acoustic Doppler Current Profiler (ADCP) measurements yield best agreement for the uppermost ADCP levels (~ 12 m and above), in line with prevalent small icebergs that trace near-surface currents. Tracking results from multiple cameras compare favorably, although cameras with lower frame rates (0.5 min−1) tend to underestimate high flow speeds. Tests to determine requisite temporal and spatial image resolution confirm the importance of high image frame rates, while spatial resolution is of secondary importance. Application of our procedure to other fjords will be successful if iceberg concentrations are high enough and if the camera frame rates are sufficiently rapid (at least 1 min−1 for conditions similar to LeConte Bay).
Temporal and spatial scarcity of water in semi-arid and seasonal ecosystems often leads to changes in movements and behaviour of large vertebrates, and in the neotropics this dynamic is poorly understood due to logistical and methodological limitations. Here we used camera trapping to elucidate variation in patterns of seasonal use of waterholes and pathways by 10 large-mammal and four large-bird species in the dry forest of north-western Costa Rica. From 2011 to 2015, we deployed trail cameras at 50 locations, including waterholes and three types of pathway (roads, human trails and animal paths). We used Generalized Linear Models to evaluate the effect of location and seasonality on the rates at which independent photographs were taken. We found interacting effects of location and seasonality for the capuchin monkey (Cebus capucinus), the tiger heron (Trigrisoma mexicanum), the white-tailed deer (Odocoileus virginianus) and the tapir (Tapirus bairdii) suggesting that these species were the most influenced by waterholes during the dry season. Comparison of waterhole sites and specific types of pathways (roads, animal paths and human trails) showed that location influenced photo-capture rates of almost all species, suggesting a useful insight to avoid and account for bias in camera trap studies. Furthering our ecological understanding of seasonal water regimes and large vertebrates’ behaviours allow for better understanding of the consequences of climate change on them.
The calving of icebergs accounts for a significant fraction of the mass loss from both the Antarctic and Greenland ice sheets. Iceberg melting affects the water properties impacting sea ice formation, local circulation and biological activity. Laboratory experiments have investigated the effects of the Earth’s rotation on iceberg melting and the possible formation of Taylor columns (TCs) underneath icebergs. It is found that at high Rossby number, $Ro$, when rotation is weak compared to advection, iceberg melting is unaffected by the background rotation. As $Ro$ decreases, the melt rate shows an increasing trend, which is expected to reverse for very low $Ro$. This behaviour is explained by considering the integrated horizontal velocity at the base of the iceberg. For moderate $Ro$, a partial TC is formed and its effective blocking accelerates the flow under the remainder of the iceberg, which increases the melt rate since the melting is proportional to the flow velocity. It is expected that for very low $Ro$ the melt rate decreases because, with the expansion of the TC, the region of flow acceleration occurs away from the base of the iceberg. For low free stream velocity the freshwater produced by the ice melting introduces another dynamical effect. It is observed that there is a threshold free stream velocity below which the melt rate is constant. This is explained with the formation of a gravity current at the base of the iceberg that insulates it from the free flow and controls its melting.
Corundum xenocrysts from alkaline basalt fields differ in characteristics and hence lithospheric origins. Trace element, fluid/melt inclusion and oxygen isotope studies on two eastern Australian corundum deposits are compared to consider their origins. Sapphires from Weldborough, NE Tasmania, are magmatic (high-Ga, av. 200 ppm) and dominated by Fe (av. 3300 ppm) and variable Ti (av. 400 ppm) as chromophores. They contain Cl, Fe, Ga, Ti and CO2-rich fluid inclusions and give δ18O values (5.1–6.2‰) of mantle range. Geochronology on companion zircons suggests several sources (from 290 Ma to 47 Ma) were disrupted by basaltic melts (47 ± 0.6 Ma). Gem corundums from Barrington, New South Wales, also include magmatic sapphires (Ga av. 170 ppm; δ18O (4.6–5.8‰), but with more Fe (av. 9000 ppm) and less Ti (av. 300 ppm) as chromophores. Zircon dating suggests that gem formation preceded and was overlapped by Cenozoic basaltic melt generation (59–4 Ma). In contrast, a metamorphic sapphire-ruby suite (low-Ga, av. 30 ppm) here incorporates greater Cr into the chromophores (up to 2250 ppm). Fluid inclusions are CO2-poor, but melt inclusions suggest some alkaline melt interaction. The δ18O values (5.1–6.2‰) overlap magmatic sapphire values. Interactions at contact zones (T = 780–940°C) between earlier Permian ultramafic bodies and later alkaline fluid activity may explain the formation of rubies.
Uranium-lead isotope dating of two zircon inclusions in sapphires from the Central Province, NSW. gives ages of 35.9 ± 1.9 and 33.7 ± 2.1 million years (Ma). These ages fall within the range of basalt potassium-argon ages of 19 to 38Ma and zircon fission track ages of 2 to 49Ma for the timing of volcanism of the Central Province, NSW. These data, combined with the observation that corundum is found associated with many alkali basaltic provinces, indicate a genetic link between the growth of large corundum crystals and the processes involved in alkali basaltic magma generation. The reported failure of experimental attempts to grow corundum from a corundum-bearing basaltic composition, and more significantly, the abundance of incompatible elements such as U, Th, Zr, Nb and Ta in inclusion minerals indicate that the crystallization process is not simple. Corundum and the other minerals found as its inclusions (zircon, columbite, thorite, uranium pyrochlore, alkali feldspar etc.) could not have crystallized from most basaltic compositions. A more complex process must occur in which crystallization takes place when there are high proportions of incompatible elements and volatiles in the melt. These crystallization products are then carried to the surface by upward movement of later magmas. The extent of this process presumably determines whether a particular basaltic province carries sufficient corundum to be worked into economic concentrations of sapphire.
Alluvial rubies and sapphires are found in palaeodrainage deposits along the Cudgegong-Macquarie River system, central eastern New South Wales, Australia. A pink to red suite contains Cr (up to 0.6 wt.% Cr2O3) as the main chromophore, exceeding Fe (up to 0.5 wt.%Fe2O3). Corrosive etching suggests a prior xenocrystic Mesozoic-Cenozoic basaltic transport, while Cr2O3/Ga2O3 to Fe2O3/TiO2 ratios indicate an original metamorphic source. Syngenetic mineral inclusions include Al-rich diopside, meionite and anatase. The Al-rich diopside (‘fassaite’) contains extremely high Al2O3 (20–21 wt.%). A blue-green suite contains Fe (up to 0.8 wt.% Fe2O3) as a dominant chromophore, while a rare nepheline-anorthoclase composite inclusion supports a magmatic phonolitic origin. The Cudgegong- Macquarie ruby formation is compared with a garnet granulite origin proposed for Thailand rubies and a xenolith of corundum-bearing garnet granulite from Ruby Hill, Bingara, Australia. Clinopyroxenecorundum thermometry suggests the Cudgegong-Macquarie rubies formed at T >1000–1300ºC, a high equilibration T for proposed lithospheric granulites. These rubies form a distinctive suite compared to other rubies from Australian and SE Asian basalt fields, but have some similarities with eastern Thailand rubies.
Inflammation of the mammary gland following bacterial infection, commonly known as mastitis, affects all mammalian species. Although the aetiology and epidemiology of mastitis in the dairy cow are well described, the genetic factors mediating resistance to mammary gland infection are not well known, due in part to the difficulty in obtaining robust phenotypic information from sufficiently large numbers of individuals. To address this problem, an experimental mammary gland infection experiment was undertaken, using a Friesian-Jersey cross breed F2 herd. A total of 604 animals received an intramammary infusion of Streptococcus uberis in one gland, and the clinical response over 13 milkings was used for linkage mapping and genome-wide association analysis. A quantitative trait locus (QTL) was detected on bovine chromosome 11 for clinical mastitis status using micro-satellite and Affymetrix 10 K SNP markers, and then exome and genome sequence data used from the six F1 sires of the experimental animals to examine this region in more detail. A total of 485 sequence variants were typed in the QTL interval, and association mapping using these and an additional 37 986 genome-wide markers from the Illumina SNP50 bovine SNP panel revealed association with markers encompassing the interleukin-1 gene cluster locus. This study highlights a region on bovine chromosome 11, consistent with earlier studies, as conferring resistance to experimentally induced mammary gland infection, and newly prioritises the IL1 gene cluster for further analysis in genetic resistance to mastitis.