Challenges in diagnosing and treating snakebites in a rural population of Tamil Nadu, India: the views of clinicians

Snakebites cause death, disability and economic devastation to their victims, people who live almost exclusively in rural areas. Annually an estimated two million venomous bites cause as many as 100,000 deaths worldwide as well as hundreds of thousands of deformities and amputations. Recent studies suggest that India has the highest incidence of snakebite and associated deaths worldwide. In this study, we interviewed 25 hospital-based clinicians who regularly treat snakebites in Tamil Nadu, India, in order to gauge their opinions and views on the diagnostic tools and treatment methods available at that time, the difficulties encountered in treating snakebites and improvements to snakebite management protocols they deem necessary. Clinicians identified the improvement of community education, training of medical personnel, development of standard treatment protocols and improved medication as priorities for the immediate future

The platelet-surface thiol isomerase enzyme ERp57 modulates platelet function

Background: Thiol isomerases are a family of endoplasmic reticulum enzymes which orchestrate redox-based modifications of protein disulphide bonds. Previous studies have identified important roles for the thiol isomerases PDI and ERp5 in the regulation of normal platelet function. Objectives: Recently, we demonstrated the presence of a further five thiol isomerases at the platelet surface. In this report we aim to report the role of one of these enzymes - ERp57 in the regulation of platelet function. Methods/Results: Using enzyme activity function blocking antibodies, we demonstrate a role for ERp57 in platelet aggregation, dense granule secretion, fibrinogen binding, calcium mobilisation and thrombus formation under arterial conditions. In addition to the effects of ERp57 on isolated platelets, we observe the presence of ERp57 in the developing thrombus in vivo. Furthermore the inhibition of ERp57 function was found to reduce laser-injury induced arterial thrombus formation in a murine model of thrombosis. Conclusions: These data suggest that ERp57 is important for normal platelet function and opens up the possibility that the regulation of platelet function by a range of cell surface thiol isomerases may represent a broad paradigm for the regulation of haemostasis and thrombosis

Mesospheric winds measured by MF radar with full correlation analysis: error properties and impacts on studies of wind variance

The mesosphere is one of the most difficult parts of the atmosphere to sample; it is too high for balloon measurements and too low for in situ satellites. Consequently, there is a reliance on remote sensing (either from the ground or from space) to diagnose this region. Ground-based radars have been used since the second half of the 20th century to probe the dynamics of the mesosphere; medium-frequency (MF) radars provide estimates of the horizontal wind fields and are still used to analyse tidal structures and planetary waves that modulate the meridional and zonal winds. The variance of the winds has traditionally been linked qualitatively to the occurrence of gravity waves. In this paper, the method of wind retrieval (full correlation analysis) employed by MF radars is considered with reference to two systems in Antarctica at different latitude (Halley at 76∘ S and Rothera at 67∘ S). It is shown that the width of the velocity distribution and occurrence of “outliers” is related to the measured levels of anisotropy in the received signal pattern. The magnitude of the error distribution, as represented by the wind variance, varies with both insolation levels and geomagnetic activity. Thus, it is demonstrated that for these two radars the influence of gravity waves may not be the primary mechanism that controls the overall variance

A Study of Competence in Mathematics and Mechanics in an Engineering Curriculum

Professional bodies expect engineers to show competence in both mathematics and engineering topics such as mechanics, using their abilities in both of these to solve problems. Yet within engineering programmes there is a phenomena known as ‘The Mathematics Problem’, with students not demonstrating understanding of the subject. This paper will suggest that students are constructing different concept images in engineering and mathematics, based on their perception of either the use or exchange value for the topics. Using a mixed methods approach, the paper compares ten different types of concept image constructed by students, which suggests that familiar procedural images are preferred in mathematics. In contrast strategic and conceptual images develop for mechanics throughout the years of the programme, implying that different forms of competence are being constructed by students between the two subjects. The paper argues that this difference is attributed to the perceived use-value of mechanics in the career of the engineer, compared to the exchange-value associated with mathematics. Questions are raised about the relevance of current definitions of competence given that some routine mathematical operations previously performed by engineers are now being replaced by technology, in the new world of work

Fragmentation and mechanical performance of tailored nickel-aluminum laminate compacts

The fragmentation of materials is a complex sequence of physical processes in which the kinetic energy is converted into deformation and fracture energy. The incorporation of reactive mixtures adds a third form of energy, chemical energy. The fragmentation and mechanical performance of nickel-aluminum compacts was examined under dynamic conditions using mesostructured powder compacts in which the interfaces between the powders (having initial sizes between 355 and 500 µm) were tailored during the swaging fabrication process. Fragmentation was created in ring samples of this material through explosively driven expansion (generating velocities around 100 m/s) and analyzed through high-speed photography, laser interferometry and soft capture of fragments. Quasi-static and dynamic mechanical testing was conducted to examine the mechanical performance and to provide parameters for the constitutive description. Experimental results are compared with fragmentation theories to characterize the behavior of reactive powders based on the material’s mesostructure by introducing the fracture toughness of the compacts, following the principal elements of the earlier work on tailored aluminum compacts. The fracture toughnesses, which ranged from 0.17 to 0.67 MPa m1/2, are related to the interfacial cohesion between particles and the fragmentation is a direct consequence of these parameters. The mean fragment size is calculated using a modified form of Mott’s theory and successfully compared with experimental results; it ranges from 10 µm to 40 µm. Finite element simulations on Al compacts confirm that the fragmentation increases (smaller fragment sizes) with a decrease in fracture toughness. The methodology developed here can be applied for tailoring the fragmentation of reactive munitions

Ecological connectivity in fragmented agricultural landscapes and the importance of scattered trees and small patches

Background Fragmentation and habitat loss can restrict species movement and reduce connectivity, negatively impacting biodiversity. Characterising the overall connectivity of an area can inform better management of human modified landscapes. Contemporary connectivity modelling methods seldom incorporate fine-scale movement patterns associated with movement between fine-scaled structural connectivity elements such as scattered trees, roadside corridors and small patches of habitat. This study aims to characterise connectivity within the Karuah-Myall catchments, a typical woodland ecosystem that is fragmented by agriculture, using least-cost path analysis and a graph-theoretic approach; it focuses on how fine-scaled vegetation such as scattered trees support connectivity. We mapped scattered (and paddock) trees within this agricultural landscape where the main human modified land use was pasture. We modelled connectivity for a general representative woodland species using an interpatch dispersal distance and gap crossing threshold, and resistance from different land cover types. The gap crossing distance threshold was used to model movement between fine-scaled vegetation features. We compared the least-cost paths modelled with and without scattered trees. Results Our results show that by excluding scattered trees, least-cost paths across the cleared pasture landscape did not reflect the types of movement patterns typically observed from field studies, such as those associated with a foray-search strategy used by small and medium mammals and birds. The modelling also shows that the Karuah-Myall catchments are well connected and provide value to biodiversity beyond the catchment borders, by connecting coastal vegetation to the Great Eastern Ranges national wildlife corridor initiative. Conclusion Connectivity models that exclude fine-scale landscape features such as scattered trees and small, linear patches risk misrepresenting connectivity patterns. Models of regional-scale connectivity can be influenced by the presence or absence of even the smallest features, such as scattered trees

Prevalence, determinants, and clinical associations of high-sensitivity cardiac troponin in patients attending emergency departments

Background: High-sensitivity cardiac troponin assays may improve the diagnosis of myocardial infarction but increase the detection of elevated cardiac troponin in patients without acute coronary syndrome. Methods: In a prospective cohort study, we evaluated the prevalence, determinants, and outcome of patients with elevated cardiac troponin attending the emergency department without suspected acute coronary syndrome. We measured high-sensitivity cardiac troponin in 918 consecutive patients attending the emergency department without suspected acute coronary syndrome who had blood sampling performed by the attending clinician. Elevated high-sensitivity cardiac troponin I was defined as concentrations above the sex-specific 99th percentile threshold. Clinical demographics, physiological measures, and all-cause mortality at 1 year associated with elevated high-sensitivity cardiac troponin concentrations were recorded. Results: Elevated cardiac troponin concentration occurred in 114 (12.4%) patients, of whom 2 (0.2%), 3 (0.3%), and 109 (11.9%) were adjudicated as type 1 myocardial infarction, type 2 myocardial infarction, and myocardial injury, respectively. Elevated troponin concentrations were associated with increasing age, worsening renal function, multimorbidity, and adverse physiology. Across a total of 912 patient-years follow-up, cardiac troponin concentration was a strong predictor of death (hazard ratio [HR] 1.26 per 2-fold increase, 95% confidence interval [CI] 1.06 to 1.49) independent of age, sex, multimorbidity, and adverse physiology. Conclusions: High-sensitivity cardiac troponin concentrations were elevated in 1 in 8 consecutive patients without suspected acute coronary syndrome attending the emergency department and were associated with increasing age, multimorbidity, adverse physiology, and death. Elevated cardiac troponin in unselected patients predominantly reflects myocardial injury rather than myocardial infarction

The Hepatic Compensatory Response to Elevated Systemic Sulfide Promotes Diabetes

Impaired hepatic glucose and lipid metabolism are hallmarks of type 2 diabetes. Increased sulfide production or sulfide donor compounds may beneficially regulate hepatic metabolism. Disposal of sulfide through the sulfide oxidation pathway (SOP) is critical for maintaining sulfide within a safe physiological range. We show that mice lacking the liver- enriched mitochondrial SOP enzyme thiosulfate sulfurtransferase (Tst−/− mice) exhibit high circulating sulfide, increased gluconeogenesis, hypertriglyceridemia, and fatty liver. Unexpectedly, hepatic sulfide levels are normal in Tst−/− mice because of exaggerated induction of sulfide disposal, with associated suppression of global protein persulfidation and nuclear respiratory factor 2 target protein levels. Hepatic proteomic and persulfidomic profiles converge on gluconeogenesis and lipid metabolism, revealing a selective deficit in medium-chain fatty acid oxidation in Tst−/− mice. We reveal a critical role of TST in hepatic metabolism that has implications for sulfide donor strategies in the context of metabolic disease

Rising water temperature in rivers: Ecological impacts and future resilience

Rising water temperatures in rivers due to climate change are already having observable impacts on river ecosystems. Warming water has both direct and indirect impacts on aquatic life, and further aggravates pervasive issues such as eutrophication, pollution, and the spread of disease. Animals can survive higher temperatures through physiological and/or genetic acclimation, behavioral and phenological change, and range shifts to more suitable locations. As such, those animals that are adapted to cool-water regions typically found in high altitudes and latitudes where there are fewer dispersal opportunities are most at risk of future extinction. However, sub-lethal impacts on animal physiology and phenology, body-size, and trophic interactions could have significant population-level effects elsewhere. Rivers are vulnerable to warming because historic management has typically left them exposed to solar radiation through the removal of riparian shade, and hydrologically disconnected longitudinally, laterally, and vertically. The resilience of riverine ecosystems is also limited by anthropogenic simplification of habitats, with implications for the dispersal and resource use of resident organisms. Due to the complex indirect impacts of warming on ecosystems, and the species-specific physiological and behavioral response of organisms to warming, predicting how river ecosystems will change in the future is challenging. Restoring rivers to provide connectivity and heterogeneity of conditions would provide resilience to a range of expected co-occurring pressures, including warming, and should be considered a priority as part of global strategies for climate adaptation and mitigation. This article is categorized under: Science of Water > Water and Environmental Change Water and Life > Nature of Freshwater Ecosystems Water and Life > Stresses and Pressures on Ecosystems

Patient selection for high sensitivity cardiac troponin testing and diagnosis of myocardial infarction: prospective cohort study

Objective: To evaluate how selection of patients for high sensitivity cardiac troponin testing affects the diagnosis of myocardial infarction across different healthcare settings. Design: Prospective study of three independent consecutive patient populations presenting to emergency departments. Setting: Secondary and tertiary care hospitals in the United Kingdom and United States. Participants: High sensitivity cardiac troponin I concentrations were measured in 8500 consecutive patients presenting to emergency departments: unselected patients in the UK (n=1054) and two selected populations of patients in whom troponin testing was requested by the attending clinician in the UK (n=5815) and the US (n=1631). The final diagnosis of type 1 or type 2 myocardial infarction or myocardial injury was independently adjudicated. Main outcome measures: Positive predictive value of an elevated cardiac troponin concentration for a diagnosis of type 1 myocardial infarction. Results: Cardiac troponin concentrations were elevated in 13.7% (144/1054) of unselected patients, with a prevalence of 1.6% (17/1054) for type 1 myocardial infarction and a positive predictive value of 11.8% (95% confidence interval 7.0% to 18.2%). In selected patients, in whom troponin testing was guided by the attending clinician, the prevalence and positive predictive value were 14.5% (843/5815) and 59.7% (57.0% to 62.2%) in the UK and 4.2% (68/1631) and 16.4% (13.0% to 20.3%) in the US. Across both selected patient populations, the positive predictive value was highest in patients with chest pain, with ischaemia on the electrocardiogram, and with a history of ischaemic heart disease. Conclusions: When high sensitivity cardiac troponin testing is performed widely or without previous clinical assessment, elevated troponin concentrations are common and predominantly reflect myocardial injury rather than myocardial infarction. These observations highlight how selection of patients for cardiac troponin testing varies across healthcare settings and markedly influences the positive predictive value for a diagnosis of myocardial infarction