A Three-dimensional Printed Low-cost Anterior Shoulder Dislocation Model for Ultrasound-guided Injection Training.

Anterior shoulder dislocations are the most common, large joint dislocations that present to the emergency department (ED). Numerous studies support the use of intraarticular local anesthetic injections for the safe, effective, and time-saving reduction of these dislocations. Simulation training is an alternative and effective method for training compared to bedside learning. There are no commercially available ultrasound-compatible shoulder dislocation models. We utilized a three-dimensional (3D) printer to print a model that allows the visualization of the ultrasound anatomy (sonoanatomy) of an anterior shoulder dislocation. We utilized an open-source file of a shoulder, available from embodi3D® (Bellevue, WA, US). After approximating the relative orientation of the humerus to the glenoid fossa in an anterior dislocation, the humerus and scapula model was printed with an Ultimaker-2 Extended+ 3D® (Ultimaker, Cambridge, MA, US) printer using polylactic acid filaments. A 3D model of the external shoulder anatomy of a live human model was then created using Structure Sensor®(Occipital, San Francisco, CA, US), a 3D scanner. We aligned the printed dislocation model of the humerus and scapula within the resultant external shoulder mold. A pourable ballistics gel solution was used to create the final shoulder phantom. The use of simulation in medicine is widespread and growing, given the restrictions on work hours and a renewed focus on patient safety. The adage of see one, do one, teach one is being replaced by deliberate practice. Simulation allows such training to occur in a safe teaching environment. The ballistic gel and polylactic acid structure effectively reproduced the sonoanatomy of an anterior shoulder dislocation. The 3D printed model was effective for practicing an in-plane ultrasound-guided intraarticular joint injection. 3D printing is effective in producing a low-cost, ultrasound-capable model simulating an anterior shoulder dislocation. Future research will determine whether provider confidence and the use of intraarticular anesthesia for the management of shoulder dislocations will improve after utilizing this model

The role of adjuvant in mediating antigen structure and stability

The purpose of this study was to probe the fate of a model antigen, a cysteine-free mutant of bacteriophage T4 lysozyme, to the level of fine structural detail, as a consequence of its interaction with an aluminum (Al)-containing adjuvant. Fluorescence spectroscopy and differential scanning calorimetry were used to compare the thermal stability of the protein in solution versus adsorbed onto an Al-containing adjuvant. Differences in accessible hydrophobic surface areas were investigated using an extrinsic fluorescence probe, 8-Anilino-1-naphthalenesulfonic acid (ANS). As has been observed with other model antigens, the apparent thermal stability of the protein decreased following adsorption onto the adjuvant. ANS spectra suggested that adsorption onto the adjuvant caused an increase in exposure of hydrophobic regions of the protein. Electrostatic interactions drove the adsorption, and disruption of these interactions with high ionic strength buffers facilitated the collection of two-dimensional 15N heteronuclear single quantum coherence nuclear magnetic resonance data of protein released from the adjuvant. Although the altered stability of the adsorbed protein suggested changes to the protein\u27s structure, the fine structure of the desorbed protein was nearly identical to the protein\u27s structure in the adjuvant-free formulation. Thus, the adjuvant-induced changes to the protein that were responsible for the reduced thermal stability were not observed upon desorption. © 2011 Wiley Periodicals, Inc

A Comparison of Homemade Phantoms for Ultrasound Guided Peripheral Intravenous Catheter Insertion

Purpose: Ultrasound (U/S) guided peripheral intravenous catheter (PIV) placement is implemented in clinical settings across the medical field, with evidence supporting the use of point-of-care U/S as a procedural tool to improve patient outcomes. Non-commercial vascular access phantoms made of various materials have been described in published literature and online tutorials; however, there has been no comparison of the models. The primary objective of this study is to determine if non-commercial phantoms are useful for the education of U/S guided PIV placement. Methods: This prospective observational study trialed six unique phantom models: 1) the Amini ballistics gel model, 2) the Morrow ballistics gel model, 3) the University of California San Diego (UCSD) gelatin model, 4) the Rippey chicken model, 5) the Nolting spam model, 6) and the Johnson tofu model. Selected phantoms were assembled through instructions from the source reference. Six U/S fellowship trained Emergency Medicine physicians performed U/S guided PIV placement on each model to evaluate their effectiveness pertaining to phantom haptics, echogenicity properties, and utility for PIV practice. Results/ Conclusion: The Rippey model outperformed other models in this study, doing so with a mid-level cost and minimal preparation time. The Rippey model scored highest on aggregate scores pertaining to haptics, echogenicity, and utility for U/S guided PIV placement and comparability to commercial products. Non-commercial U/S phantoms may represent cost-effective and useful PIV insertion educational tools. Future studies should investigate the utility of these phantoms in teaching USIV to novice learners and direct comparison of non-commercial to commercial phantoms

Connectivity and Nitrate Uptake Potential of Intermittent Streams in the Northeast USA

Non-perennial streams dominate the extent of stream networks worldwide. Intermittent streams can provide ecosystem services to the entire network—including nitrate uptake to alleviate eutrophication of coastal waters—and are threatened by lack of legal protection. We examined 12 intermittent streams in the temperate, humid climate of the Northeast USA. Over 3 years of monitoring, continuous flow was observed a median of 277 d yr−1, with no-flow conditions from early summer into fall. Estimated median discharge was 2.9 L s−1 or 0.36mm d−1. All intermittent streams originated from source wetlands (median area: 0.27 ha) and the median length of the intermittent stream from the source wetland to the downstream perennial stream was 344m. Through regional geospatial analysis with high resolution orthophotography, we estimated that widely available, “high resolution” (1:24,000) hydrography databases (e.g., NHDPlus HR) only displayed 43% of the total number of intermittent streams. Whole-stream gross nitrate-N uptake rates were estimated at six intermittent streams during continuous flow conditions using pulse additions of nitrate and a conservative tracer. These rates displayed high temporal variability (range: no detect to over 6,000mg N m−1 d−1); hot moments were noted in nine of the 65 pulse additions. Whole-stream gross nitrate-N uptake rates were significantly inversely related to discharge, with no measurable rates above 7 L s−1. Temperature was significantly positively correlated with whole-stream gross nitrate-N uptake rates, with more hot moments in the spring. Microbial assays demonstrated that nitrate cycling in intermittent streams are consistent with results from low order, perennial forested streams and highlighted the importance of debris dams and pools—potential locations for transient storage. Our assessment suggests that intermittent streams in our region may annually contribute 24–47% of the flow to perennial streams and potentially remove 4.1 to 80.4 kg nitrate-N km−2 annually. If development in these areas continues, perennial streams are in danger of losing a portion of their headwaters and potential nitrate uptake areas may become nitrate sources to downstream areas. These results argue to manage fluvial systems with a holistic approach that couples intermittent and perennial components

Estimation in a multiplicative mixed model involving a genetic relationship matrix

Genetic models partitioning additive and non-additive genetic effects for populations tested in replicated multi-environment trials (METs) in a plant breeding program have recently been presented in the literature. For these data, the variance model involves the direct product of a large numerator relationship matrix A, and a complex structure for the genotype by environment interaction effects, generally of a factor analytic (FA) form. With MET data, we expect a high correlation in genotype rankings between environments, leading to non-positive definite covariance matrices. Estimation methods for reduced rank models have been derived for the FA formulation with independent genotypes, and we employ these estimation methods for the more complex case involving the numerator relationship matrix. We examine the performance of differing genetic models for MET data with an embedded pedigree structure, and consider the magnitude of the non-additive variance. The capacity of existing software packages to fit these complex models is largely due to the use of the sparse matrix methodology and the average information algorithm. Here, we present an extension to the standard formulation necessary for estimation with a factor analytic structure across multiple environments

Models and metaphors: complexity theory and through-life management in the built environment

Complexity thinking may have both modelling and metaphorical applications in the through-life management of the built environment. These two distinct approaches are examined and compared. In the first instance, some of the sources of complexity in the design, construction and maintenance of the built environment are identified. The metaphorical use of complexity in management thinking and its application in the built environment are briefly examined. This is followed by an exploration of modelling techniques relevant to built environment concerns. Non-linear and complex mathematical techniques such as fuzzy logic, cellular automata and attractors, may be applicable to their analysis. Existing software tools are identified and examples of successful built environment applications of complexity modelling are given. Some issues that arise include the definition of phenomena in a mathematically usable way, the functionality of available software and the possibility of going beyond representational modelling. Further questions arising from the application of complexity thinking are discussed, including the possibilities for confusion that arise from the use of metaphor. The metaphor of a 'commentary machine' is suggested as a possible way forward and it is suggested that an appropriate linguistic analysis can in certain situations reduce perceived complexity

Demodex Blepharitis: A Comprehensive Review of the Disease, Current Management, and Emerging Therapies

Demodex blepharitis is a common disease of the eyelid, affecting approximately 25 million Americans. This article reviews what is known about the mechanisms and impact of Demodex blepharitis, risk factors, signs and symptoms, diagnostic techniques, current management options, and emerging treatments. Demodex mites contribute to blepharitis in several ways: direct mechanical damage, as a vector for bacteria, and by inducing hypersensitivity and inflammation. Risk factors for Demodex blepharitis include increasing age, rosacea, and diabetes. The costs, symptom burden, and psychosocial effects of Demodex blepharitis are considerable. The presence of collarettes is pathognomonic for Demodex blepharitis. Redness, dryness, discomfort, foreign body sensation, lash anomalies, and itching are also hallmarks of the disease. Although a number of oral, topical, eyelid hygiene and device-based options have been used clinically and evaluated in studies for the management of Demodex blepharitis, none have been FDA approved to treat the disease. Recent randomized controlled clinical trials suggest that lotilaner ophthalmic solution, 0.25%, is a topical treatment with the potential to eradicate Demodex mites and eliminate collarettes and eyelid redness for an extended period

Genetic studies of quantitative MCI and AD phenotypes in ADNI: Progress, opportunities, and plans

INTRODUCTION: Genetic data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) have been crucial in advancing the understanding of Alzheimer's disease (AD) pathophysiology. Here, we provide an update on sample collection, scientific progress and opportunities, conceptual issues, and future plans. METHODS: Lymphoblastoid cell lines and DNA and RNA samples from blood have been collected and banked, and data and biosamples have been widely disseminated. To date, APOE genotyping, genome-wide association study (GWAS), and whole exome and whole genome sequencing data have been obtained and disseminated. RESULTS: ADNI genetic data have been downloaded thousands of times, and >300 publications have resulted, including reports of large-scale GWAS by consortia to which ADNI contributed. Many of the first applications of quantitative endophenotype association studies used ADNI data, including some of the earliest GWAS and pathway-based studies of biospecimen and imaging biomarkers, as well as memory and other clinical/cognitive variables. Other contributions include some of the first whole exome and whole genome sequencing data sets and reports in healthy controls, mild cognitive impairment, and AD. DISCUSSION: Numerous genetic susceptibility and protective markers for AD and disease biomarkers have been identified and replicated using ADNI data and have heavily implicated immune, mitochondrial, cell cycle/fate, and other biological processes. Early sequencing studies suggest that rare and structural variants are likely to account for significant additional phenotypic variation. Longitudinal analyses of transcriptomic, proteomic, metabolomic, and epigenomic changes will also further elucidate dynamic processes underlying preclinical and prodromal stages of disease. Integration of this unique collection of multiomics data within a systems biology framework will help to separate truly informative markers of early disease mechanisms and potential novel therapeutic targets from the vast background of less relevant biological processes. Fortunately, a broad swath of the scientific community has accepted this grand challenge

Public preferences for vaccination campaigns in the COVID-19 endemic phase:insights from the VaxPref database

Objective: Despite widespread perceptions that SARS-CoV-2 (COVID-19) is no longer a significant threat, the virus continues to loom, and new variants may require renewed efforts to control its spread. Understanding how individual preferences and attitudes influence vaccination behaviour and policy compliance in light of the endemic phase is crucial in preparation for this scenario. Method: This paper presents descriptive data from a global stated choice survey conducted in 22 countries across 6 different continents between July 2022 and August 2023, and reports the methodological work developed to address the need for comparable data. Results: This study included 50,242 respondents. Findings indicated significant heterogeneity across countries in terms of vaccination status and willingness to accept boosters. Vaccine hesitancy and refusal were driven by lower trust in public health bodies, younger age, and lower educational levels. Refusers and hesitant people reported lower willingness to take risks compared to those fully vaccinated (p&lt;0.05). Lower mental health levels were found for the hesitant cohort (p&lt;0.05). Conclusions: Insights from this database can help public health authorities to gain a new understanding of the vaccine hesitancy phenomenon, support them in managing the transition from the pandemic to the endemic phase, and favour a new stream of research to maximise behavioural response to vaccination programs in preparation of future pandemics.</p

A <i>Herschel</i> and BIMA study of the sequential star formation near the W 48A H II region

We present the results of Herschel HOBYS (Herschel imaging survey of OB Young Stellar objects) photometric mapping combined with Berkeley Illinois Maryland Association (BIMA) observations and additional archival data, and perform an in-depth study of the evolutionary phases of the star-forming clumps in W 48A and their surroundings. Age estimates for the compact sources were derived from bolometric luminosities and envelope masses, which were obtained from the dust continuum emission, and agree within an order of magnitude with age estimates from molecular line and radio data. The clumps in W 48A are linearly aligned by age (east-old to west-young): we find a ultra-compact (UC) H II region, a young stellar object (YSO) with class II methanol maser emission, a YSO with a massive outflow and finally the NH2D prestellar cores from Pillai et al. This remarkable positioning reflects the (star) formation history of the region. We find that it is unlikely that the star formation in the W 48A molecular cloud was triggered by the UC H II region and discuss the Aquila supershell expansion as a major influence on the evolution of W 48A. We conclude that the combination of Herschel continuum data with interferometric molecular line and radio continuum data is important to derive trustworthy age estimates and interpret the origin of large-scale structures through kinematic information