Dislodged Endovascular Heat-Induced Thrombus Resulting in Pulmonary Embolus Following Post-Operative Ultrasound Compression

Introduction: Venous insufficiency and consequent varicose veins are common problems faced by many patients. Fortunately, there are many treatment options available including a minimally invasive method known as radiofrequency ablation (RFA). RFA is not without complications; amongst those are endovascular heat induced thrombosis (EHIT). This rare complication is typically managed conservatively; however, in rare occasions, the thrombus can detach and embolize causing further issues for patients. Case Description: A 48-year-old male underwent an uneventful RFA procedure for a CEAP 4a venous insufficiency. On the post-operative ultrasound venous duplex evaluation, the patient was found to have EHIT type 2 in the right greater saphenous vein extending to the sapheno-femoral junction. During compression and release of the ultrasound probe by the ultrasound technician, the thrombus detached from the venous wall and embolized to a right lung subsegmental branch. Discussion: This case report focuses on the possibility of secondary sequela that may arise from EHIT affecting other organ systems from the RFA procedure, the classification system of EHIT, and management options

A qualitative analysis of advance fee fraud e-mail schemes.

Abstract Criminals utilize the Internet to perpetrate all manner of fraud, with the largest dollar losses attributed to advance fee fraud e-mail messages. These messages come from individuals who claim to need assistance moving a large sum of money out of their country. Individuals who respond to the messages often become victims of fraud and identity theft. Few criminologists have examined this type of fraud, thus this study explores the mechanisms employed by scammers through a qualitative analysis of 412 fraudulent e-mail messages. The findings demonstrate that multiple writing techniques are used to generate responses and information from victims. Half of all the messages also request that the recipient forward their personal information to the sender, thereby enabling identity theft. The implications of this study for law enforcement and computer security are also discussed

Upgrades to the International Space Station Urine Processor Assembly

The ISS Urine Processor Assembly (UPA) began operations in November 2008. Though the UPA has successfully generated distillate from crew urine, several modifications and upgrades have been implemented to improve overall system performance throughout the years. Current and future upgrades to the UPA will continue to focus on improved system performance and reliability, focusing primarily on the Distillation Assembly and upgrades to the UPA vacuum pump. Work towards a flight demonstration experiment of a vacuum pump utilizing scroll pump technologies has also continued forward. The following paper discusses progress on these various concepts, including the implementation of a more reliable drive belt, improved methods for managing condensate in the stationary bowl of the Distillation Assembly, installation of improved centrifuge bearings, implementation of a liquid level sensor, and upgrades to the UPA vacuum pump

Attending Nurse Practitioners in Long-Term Care Homes Evaluation

Introduction In 2014, the Ontario Ministry of Health and Long-Term Care (MOHLTC) announced funding for 75 nurse practitioners (NPs) over three years in long-term care (LTC) homes. This evaluation was approved by ICES’ Applied Health Research Question (AHRQ) team, a portfolio which answers questions from stakeholders having impact on healthcare policy. Objectives and Approach The purpose of this project is to evaluate the impact of the first thirty NPs hired. Changes will be evaluated using key outcome measures of resident care (e.g., early hospital discharge, emergency room bed days) identified through a literature review conducted by the MOHLTC. LTC home residents were identified using all individuals with claims in OHIP during the 2016-17 fiscal year with a location of a LTC home. LTC homes with a hired NP were considered to be cases and all other LTC homes were considered to be controls. Results For part one of this evaluation, case and control LTC homes were stratified by bed size, Case Mix Index, rurality and Local Health Integration Network. Hospitalization records and emergency visits (from Discharge Abstract Database and National Ambulatory Care Reporting System) were determined for LTCH residents 6 months before and after the NP hire date of October 1, 2016. Overall, the rate of hospital admissions (per 100 residents) increased by 3.44% (8.51% to 11.94%) following the NP hire date; whereas, the rate of hospital admissions increased by 2.29% (6.55% to 8.83%) among controls. Following the NP hire date, the rate of emergency department visits also increased by 3.15% among cases (16.62% to 19.77%) in comparison to a 2.31% increase among controls (12.55% to 14.86%). Conclusion/Implications The findings from this evaluation will inform further implementation strategies of the NP program and guide decision-making of future funding opportunities. In summary, the results will inform policies to strengthen care of LTC homes and improve the quality of care of residents

Reduced cognitive deficits after FLASH irradiation of whole mouse brain are associated with less hippocampal dendritic spine loss and neuroinflammation

Aim To evaluate the impact of ultra-rapid FLASH mouse whole brain irradiation on hippocampal dendritic spines and neuroinflammation, factors associated with cognitive impairment after brain irradiation. Methods We administered 30 Gy whole brain irradiation to C57BL6/J mice in sub-second (FLASH) vs. 240 s conventional delivery time keeping all other parameters constant, using a custom configured clinical linac. Ten weeks post-irradiation, we evaluated spatial and non-spatial object recognition using novel object location and object recognition testing. We measured dendritic spine density by tracing Golgi-stained hippocampal neurons and evaluated neuroinflammation by CD68 immunostaining, a marker of activated microglia, and expression of 10 pro-inflammatory cytokines using a multiplex immunoassay. Results At ten weeks post-irradiation, compared to unirradiated controls, conventional delivery time irradiation significantly impaired novel object location and recognition tasks whereas the same dose given in FLASH delivery did not. Conventional delivery time, but not FLASH, was associated with significant loss of dendritic spine density in hippocampal apical dendrites, with a similar non-significant trend in basal dendrites. Conventional delivery time was associated with significantly increased CD68-positive microglia compared to controls whereas FLASH was not. Conventional delivery time was associated with significant increases in 5 of 10 pro-inflammatory cytokines in the hippocampus (and non-significant increases in another 3), whereas FLASH was associated with smaller increases in only 3. Conclusion Reduced cognitive impairment and associated neurodegeneration were observed with FLASH compared to conventional delivery time irradiation, potentially through decreased induction of neuroinflammation, suggesting a promising approach to increasing therapeutic index in radiation therapy of brain tumors

Reorganization of surviving mammal communities after the end-Pleistocene megafaunal extinction

Large mammals are at high risk of extinction globally. To understand the consequences of their demise for community assembly, we tracked community structure through the end- Pleistocene megafaunal extinction in North America.We decomposed the effects of biotic and abiotic factors by analyzing co-occurrence within the mutual ranges of species pairs. Although shifting climate drove an increase in niche overlap, co-occurrence decreased, signaling shifts in biotic interactions. Furthermore, the effect of abiotic factors on cooccurrence remained constant over time while the effect of biotic factors decreased. Biotic factors apparently played a key role in continental-scale community assembly before the extinctions. Specifically, large mammals likely promoted co-occurrence in the Pleistocene, and their loss contributed to the modern assembly pattern in which co-occurrence frequently falls below random expectations. Includes supplementary materials

Reorganization of surviving mammal communities after the end-Pleistocene megafaunal extinction

Large mammals are at high risk of extinction globally. To understand the consequences of their demise for community assembly, we tracked community structure through the end-Pleistocene megafaunal extinction in North America. We decomposed the effects of biotic and abiotic factors by analyzing co-occurrence within the mutual ranges of species pairs. Although shifting climate drove an increase in niche overlap, co-occurrence decreased, signaling shifts in biotic interactions. Furthermore, the effect of abiotic factors on co-occurrence remained constant over time while the effect of biotic factors decreased. Biotic factors apparently played a key role in continental-scale community assembly before the extinctions. Specifically, large mammals likely promoted co-occurrence in the Pleistocene, and their loss contributed to the modern assembly pattern in which co-occurrence frequently falls below random expectations.Peer reviewe

Investigating Biotic Interactions in Deep Time

Recent renewed interest in using fossil data to understand how biotic interactions have shaped the evolution of life is challenging the widely held assumption that long-term climate changes are the primary drivers of biodiversity change. New approaches go beyond traditional richness and co-occurrence studies to explicitly model biotic interactions using data on fossil and modern biodiversity. Important developments in three primary areas of research include analysis of (i) macroevolutionary rates, (ii) the impacts of and recovery from extinction events, and (iii) how humans (Homo sapiens) affected interactions among non-human species. We present multiple lines of evidence for an important and measurable role of biotic interactions in shaping the evolution of communities and lineages on long timescales.Peer reviewe

Late quaternary biotic homogenization of North American mammalian faunas

Biotic homogenization-increasing similarity of species composition among ecological communities-has been linked to anthropogenic processes operating over the last century. Fossil evidence, however, suggests that humans have had impacts on ecosystems for millennia. We quantify biotic homogenization of North American mammalian assemblages during the late Pleistocene through Holocene (similar to 30,000 ybp to recent), a timespan encompassing increased evidence of humans on the landscape (similar to 20,000-14,000 ybp). From similar to 10,000 ybp to recent, assemblages became significantly more homogenous (>100% increase in Jaccard similarity), a pattern that cannot be explained by changes in fossil record sampling. Homogenization was most pronounced among mammals larger than 1 kg and occurred in two phases. The first followed the megafaunal extinction at similar to 10,000 ybp. The second, more rapid phase began during human population growth and early agricultural intensification (similar to 2,000-1,000 ybp). We show that North American ecosystems were homogenizing for millennia, extending human impacts back similar to 10,000 years.Peer reviewe

Late quaternary biotic homogenization of North American mammalian faunas

Biotic homogenization-increasing similarity of species composition among ecological communities-has been linked to anthropogenic processes operating over the last century. Fossil evidence, however, suggests that humans have had impacts on ecosystems for millennia. We quantify biotic homogenization of North American mammalian assemblages during the late Pleistocene through Holocene (similar to 30,000 ybp to recent), a timespan encompassing increased evidence of humans on the landscape (similar to 20,000-14,000 ybp). From similar to 10,000 ybp to recent, assemblages became significantly more homogenous (>100% increase in Jaccard similarity), a pattern that cannot be explained by changes in fossil record sampling. Homogenization was most pronounced among mammals larger than 1 kg and occurred in two phases. The first followed the megafaunal extinction at similar to 10,000 ybp. The second, more rapid phase began during human population growth and early agricultural intensification (similar to 2,000-1,000 ybp). We show that North American ecosystems were homogenizing for millennia, extending human impacts back similar to 10,000 years.Peer reviewe