Child abuse and fabricated or induced illness in the ENT setting: a systematic review

Background Child maltreatment is persistently under-recognised. Given that a third of maltreated children may return with serious or fatal injuries, it is imperative that otolaryngologists who are in frequent contact with children are able to detect maltreatment at first presentation. Objective of review This review aims to identify ENT injuries, signs or symptoms that are indicative of physical abuse or fabricated or induced illness (child maltreatment). Type of review Systematic review. Search strategy An all-language search, developed in Medline Ovid and consisting of 76 key words, was conducted of published and grey literature across 10 databases from inception to July 2015, for primary observational studies involving children aged <18 years. Evaluation method Each relevant article underwent two independent reviews with full critical appraisal, applying strict quality standards. Results Of the 2448 studies identified and screened, 371 underwent full review, resulting in 38 included studies that detailed 122 maltreated children. Pharyngeal perforations (n = 20) were the most frequent abusive ENT injury, predominantly affecting neonates and infants, presenting with dysphagia, drooling, haemoptysis and surgical emphysema. At least 52% of children with abusive pharyngeal injuries had additional co-existent injuries. The majority of ear injuries were inflicted to the external ear (n = 11) and included auricular deformity, abrasions, petechiae, lacerations and burns. Fabricated or induced illness cases presented most commonly with recurrent, unexplained otorrhoea or ENT lesions that failed to heal despite appropriate therapy. Conclusions All clinicians should be familiar with the signs of child maltreatment. Pharyngeal injuries, or injuries to the external ear, presenting in young children without an explicit history of witnessed injury should prompt a child protection referral for full evaluation. Likewise, children who present with recurrent, or apparently intractable symptoms and signs despite appropriate treatment, should raise the possibility of fabricated or induced illness, and discussion with a child protection specialist is advised. Early recognition of possible child maltreatment and instigation of appropriate safeguarding measures are essential to prevent repetition and escalation of injury. This is of paramount importance to otolaryngologists, who have the potential to identify these children in their practice

Sickle Cell Disease Treatment with Arginine Therapy (STArT): Study protocol for a phase 3 randomized controlled trial

BACKGROUND: Despite substantial illness burden and healthcare utilization conferred by pain from vaso-occlusive episodes (VOE) in children with sickle cell disease (SCD), disease-modifying therapies to effectively treat SCD-VOE are lacking. The aim of the Sickle Cell Disease Treatment with Arginine Therapy (STArT) Trial is to provide definitive evidence regarding the efficacy of intravenous arginine as a treatment for acute SCD-VOE among children, adolescents, and young adults. METHODS: STArT is a double-blind, placebo-controlled, randomized, phase 3, multicenter trial of intravenous arginine therapy in 360 children, adolescents, and young adults who present with SCD-VOE. The STArT Trial is being conducted at 10 sites in the USA through the Pediatric Emergency Care Applied Research Network (PECARN). Enrollment began in 2021 and will continue for 5 years. Within 12 h of receiving their first dose of intravenous opioids, enrolled participants are randomized 1:1 to receive either (1) a one-time loading dose of L-arginine (200 mg/kg with a maximum of 20 g) administered intravenously followed by a standard dose of 100 mg/kg (maximum 10 g) three times a day or (2) a one-time placebo loading dose of normal saline followed by normal saline three times per day at equivalent volumes and duration as the study drug. Participants, research staff, and investigators are blinded to the participant\u27s randomization. All clinical care is provided in accordance with the institution-specific standard of care for SCD-VOE based on the 2014 National Heart, Lung, and Blood Institute guidelines. The primary outcome is time to SCD-VOE pain crisis resolution, defined as the time (in hours) from study drug delivery to the last dose of parenteral opioid delivery. Secondary outcomes include total parental opioid use and patient-reported outcomes. In addition, the trial will characterize alterations in the arginine metabolome and mitochondrial function in children with SCD-VOE. DISCUSSION: Building on the foundation of established relationships between emergency medicine providers and hematologists in a multicenter research network to ensure adequate participant accrual, the STArT Trial will provide definitive information about the efficacy of intravenous arginine for the treatment of SCD-VOE for children. TRIAL REGISTRATION: The STArT Trial was registered in ClinicalTrials.gov on April 9, 2021, and enrollment began on June 21, 2021 (NCT04839354)

Efficient Algebraic Two-Level Schwarz Preconditioner for Sparse Matrices

Domain decomposition methods are among the most efficient for solving sparse linear systems of equations. Their effectiveness relies on a judiciously chosen coarse space. Originally introduced and theoretically proved to be efficient for self-adjoint operators, spectral coarse spaces have been proposed in the past few years for indefinite and non-self-adjoint operators. This paper presents a new spectral coarse space that can be constructed in a fully-algebraic way unlike most existing spectral coarse spaces. We present theoretical convergence result for Hermitian positive definite diagonally dominant matrices. Numerical experiments and comparisons against state-of-the-art preconditioners in the multigrid community show that the resulting two-level Schwarz preconditioner is efficient especially for non-self-adjoint operators. Furthermore, in this case, our proposed preconditioner outperforms state-of-the-art preconditioners

Purification of Bioethanol Using Microbubbles Generated by Fluidic Oscillation: A Dynamical Evaporation Model

(Graph Presented) A computational model of a single gas microbubble immersed in a liquid of ethanol-water mixture is developed and solved numerically. This complements earlier binary distillation experiments in which the ethanol-water mixture is stripped by hot air microbubbles achieving around 98% vol. ethanol from the azeotropic mixture. The proposed model has been developed using Galerkin finite element methods to predict the temperature and vapor content of the gas microbubble as a function of its residence time in the liquid phase. This model incorporates a novel rate law that evolves on a time scale related to the internal mixing of microbubbles of 10-3s. The model predictions of a single bubble were shown to be in very good agreement with the existing experimental data, demonstrating that the ratio of ethanol to water in the microbubble regime are higher than the expected ratios that would be consistent with equilibrium theory for all initial bubble temperatures and all liquid ethanol mole fractions considered and within the very short contact times appropriate for thin liquid layers. Our previous experiments showed a decrease in the liquid temperature with decreasing liquid depth in the bubble tank, an increase in the outlet gas temperature with decreasing liquid depth, and an improvement in the stripping efficiency of ethanol upon decreasing the depth of the liquid mixture and increasing the temperature of the air microbubbles, all of which are consistent with the predictions of the computational model

Dietary factors and Type 2 diabetes in the Middle East : what is the evidence for an association? - A systematic review.

This review aims to search and summarise the available evidence on the association between dietary factors and type 2 diabetes mellitus (T2DM) in Middle Eastern populations, where diabetes prevalence is among the highest in the world. Electronic databases were searched; authors, libraries, and research centres in the Middle East were contacted for further studies and unpublished literature. Included studies assessed potential dietary factors for T2DM in Middle Eastern adults. Two reviewers assessed studies independently. Extensive searching yielded 17 studies which met the inclusion criteria for this review. The findings showed that whole-grain intake reduces the risk of T2DM, and potato consumption was positively correlated with T2DM. Vegetables and vegetable oil may play a protective role against T2DM. Dietary patterns that are associated with diabetes were identified, such as Fast Food and Refined Grains patterns. Two studies demonstrated that lifestyle interventions decreased the risk of T2DM. In summary, the identified studies support an association between some dietary factors and T2DM; however, many of the included studies were of poor methodological quality so the findings should be interpreted with caution. The review draws attention to major gaps in current evidence and the need for well-designed studies in this area

Novel cortex lytic enzymes in Bacillus megaterium QM B1551 spores.

Present models for spore germination in Bacillus species include a requirement for either the SleB or CwlJ cortex lytic enzymes to efficiently depolymerise the spore cortex. Previous work has demonstrated that B. megaterium spores may differ to other species in this regard, since sleB cwlJ null mutant spores complemented with the gene in trans for the non-peptidoglycan lysin YpeB can efficiently degrade the cortex. Here, we identify two novel cortex lytic enzymes, encoded at the BMQ_2391 and BMQ_3234 loci, which are essential for cortex hydrolysis in the absence of SleB and CwlJ. Ellipsoid localisation microscopy places the BMQ_3234 protein within the inner-spore coat, a region of the spore that is populated by other cortex lytic enzymes. The findings reinforce the idea that there is a degree of variation in mechanisms of cortex hydrolysis across the Bacillales, raising potential implications for environmental decontamination strategies based upon targeted inactivation of components of the spore germination apparatus.BAR was the recipient of a scholarship from the Sultanate of Oman government. AG was the recipient of a Cambridge Nehru Scholarship and received support from the Raymond and Beverly Sackler Foundation

Climate Change Impacts on Water Resources in the Northeast

This study aims first to summarize the existing body of research related to concerns about water resources, water supply, and potential impacts of natural disasters under a warmer climate in the northeast. In addition, this study seeks to expand prior work by looking at the potential impacts of a changing climate on water quality in the reservoir system