A Mechanism for Chronic Filarial Hydrocele with Implications for Its Surgical Repair

Chronic hydrocele is the accumulation of fluid around the testis leading to an increase in the volume of the scrotal contents. Depending on the volume of fluid, hydrocele can be disfiguring and even incapacitating. Chronic hydrocele has multiple etiologies, but irrespective of the cause, surgery is the standard form of treatment and this can be done using different surgical techniques. The prevalence of chronic hydrocele in bancroftian filariasis endemic areas—a parasitic disease transmitted by mosquito—is very high and represents the most common clinical manifestation of bancroftosis, following by swollen legs of lower limbs or lymphedema among women. In Greater Recife, northeastern, Brazil, a bancroftian filariasis endemic area, a pioneering, prospective surgical study proposes a new mechanism for filarial-induced hydrocele and presents evidence that the filarial hydrocele fluid may damage the testis. Thus, based on the findings presented, the authors propose that in bancroftian filariasis endemic areas hydrocele patients should be operated on using a specific surgical technique in order to avoid recurrence of the disease, and consequently, additional damage to the testicle

A clustering of childhood meningococcal disease: a challenge for physicians, press and community.

The Delaware Division of Public Health reported only two cases of documented meningococcal infection in the pediatric population in 1992. As of March 1, 1993, the Morbidity and Mortality Weekly Report indicated only one case of meningococcal disease in the state of Delaware for 1993. However, from the end of February to early April 1993, approximately six weeks, there were seven cases of documented meningococcal infection in the pediatric population that either presented or were transferred to one of the pediatric care facilities in the Wilmington, Delaware area. Notification of these cases to the Delaware Division of Public Health prompted the dispersion of a statewide letter concerning the recognition of the clinical signs of meningitis and the proper prophylaxis for meningococcal exposure

Riemann solvers and undercompressive shocks of convex FPU chains

We consider FPU-type atomic chains with general convex potentials. The naive continuum limit in the hyperbolic space-time scaling is the p-system of mass and momentum conservation. We systematically compare Riemann solutions to the p-system with numerical solutions to discrete Riemann problems in FPU chains, and argue that the latter can be described by modified p-system Riemann solvers. We allow the flux to have a turning point, and observe a third type of elementary wave (conservative shocks) in the atomistic simulations. These waves are heteroclinic travelling waves and correspond to non-classical, undercompressive shocks of the p-system. We analyse such shocks for fluxes with one or more turning points. Depending on the convexity properties of the flux we propose FPU-Riemann solvers. Our numerical simulations confirm that Lax-shocks are replaced by so called dispersive shocks. For convex-concave flux we provide numerical evidence that convex FPU chains follow the p-system in generating conservative shocks that are supersonic. For concave-convex flux, however, the conservative shocks of the p-system are subsonic and do not appear in FPU-Riemann solutions

Effects of cold winters and roost site stability on population development of non-native Asian ring-necked parakeets (Alexandrinus manillensis) in temperate Central Europe – Results of a 16-year census

Asian ring-necked parakeets (Alexandrinus manillensis, formerly Psittacula krameri, hereafter RNP) first bred in Germany in 1969. Since then, RNP numbers increased in all three major German subpopulations (Rhineland, Rhine-Main, Rhine-Neckar) over the period 2003–2018. In the Rhine-Neckar region, the population increased to more than fivefold within only 15 years. Interestingly, there was no significant breeding range expansion of  RNP in the period 2010–2018. In 2018, the total number of RNP in Germany amounted to >16,200 birds. Differences in RNP censuses between years were evident. Surprisingly, cold winters (extreme value, −13.7 °C) and cold weather conditions in the breeding season (coldest month average, −1.36 °C) were not able to explain between-year variation. This finding suggests that in general winter mortality is low – with exceptions for winters 2008/2009 and 2009/2010, and a population-relevant loss of broods is low in our study population. Surprisingly, the social behaviour in terms of spatio-temporal stability of roost sites could well explain positive and negative population trends. Years of spatially stable and regularly used roost sites seem to correlate with increasing population sizes. In contrast, known shifts of RNP among different roost sites or the formations of new roost sites by split are related to population stagnation or a decrease in numbers. Climate change may lead to further range expansion as cities not suitable yet for RNP may become so in the near future.

Scaling Ecosystem Services to Reef Development : Effects of oyster density on nitrogen removal and reef community structure

Eighteen native oyster experimental reefs (16-m2 each) were restored using six oyster densities (0, 10, 25, 50, 100 and 250 adult oysters m-2) with three replicates of each density at each of two sites: one subtidal site in Onancock Creek, Virginia and one intertidal site in Hillcrest Oyster Sanctuary within The Nature Conservancy’s Virginia Coast Reserve. A science-based monitoring program explored quantitative relationships between structural and functional characteristics of these restored reefs. Structural parameters examined included oyster abundance, oyster size/biomass, surface shell volume, reef topographic complexity and sediment characteristics. Functional parameters included denitrification rates and macrofaunal abundance and biomass. Data were collected from the intertidal site during six sampling periods between April 2012 and July 2013 and from the subtidal site in April and June 2012. Relationships between reef structural parameters and functional parameters were complex and variable. As of July 2014, the intertidal reefs continue to serve as a platform for continued studies of the relationships between reef structural and functional characteristics

Prospective Validation of the Emergency Heart Failure Mortality Risk Grade for Acute Heart Failure: The ACUTE Study

Background: Improved risk stratification of acute heart failure in the emergency department may inform physicians\u27 decisions regarding patient admission or early discharge disposition. We aimed to validate the previously-derived Emergency Heart failure Mortality Risk Grade for 7-day (EHMRG7) and 30-day (EHMRG30-ST) mortality. Methods: We conducted a multicenter, prospective validation study of patients with acute heart failure at 9 hospitals. We surveyed physicians for their estimates of 7-day mortality risk, obtained for each patient before knowledge of the model predictions, and compared these with EHMRG7 for discrimination and net reclassification improvement. We also prospectively examined discrimination of the EHMRG30-ST model, which incorporates all components of EHMRG7 as well as the presence of ST-depression on the 12-lead ECG. Results: We recruited 1983 patients seeking emergency department care for acute heart failure. Mortality rates at 7 days in the 5 risk groups (very low, low, intermediate, high, and very high risk) were 0%, 0%, 0.6%, 1.9%, and 3.9%, respectively. At 30 days, the corresponding mortality rates were 0%, 1.9%, 3.9%, 5.9%, and 14.3%. Compared with physician-estimated risk of 7-day mortality (PER7; c-statistic, 0.71; 95% CI, 0.64-0.78) there was improved discrimination with EHMRG7 (c-statistic, 0.81; 95% CI, 0.75-0.87; P=0.022 versus PER7) and with EHMRG7 combined with physicians\u27 estimates (c-statistic, 0.82; 95% CI, 0.76-0.88; P=0.003 versus PER7). Model discrimination increased nonsignificantly by 0.014 (95% CI, -0.009-0.037) when physicians\u27 estimates combined with EHMRG7 were compared with EHMRG7 alone (P=0.242). The c-statistic for EHMRG30-ST alone was 0.77 (95% CI, 0.73-0.81) and 30-day model discrimination increased nonsignificantly by addition of physician-estimated risk to 0.78 (95% CI, 0.73-0.82; P=0.187). Net reclassification improvement with EHMRG7 was 0.763 (95% CI, 0.465-1.062) when assessed continuously and 0.820 (0.560-1.080) using risk categories compared with PER7. Conclusions: A clinical model allowing simultaneous prediction of mortality at both 7 and 30 days identified acute heart failure patients with a low risk of events. Compared with physicians\u27 estimates, our multivariable model was better able to predict 7-day mortality and may guide clinical decisions. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02634762

Feasibility and Effectiveness of Basic Lymphedema Management in Leogane, Haiti, an Area Endemic for Bancroftian Filariasis

Lymphatic filariasis is a parasitic disease that is spread by mosquitoes. In tropical countries where lymphatic filariasis occurs, approximately 14 million people suffer from chronic swelling of the leg, known as lymphedema. Repeated episodes of bacterial skin infection (acute attacks) cause lymphedema to progress to its disfiguring form, elephantiasis. To help achieve the goal of eliminating lymphatic filariasis globally, the World Health Organization recommends basic lymphedema management, which emphasizes hygiene, skin care, exercise, and leg elevation. Its effectiveness in reducing acute attack frequency, as well as the role of compressive bandaging, have not been adequately evaluated in filariasis-endemic areas. Between 1995 and 1998, we studied 175 people with lymphedema of the leg in Leogane, Haiti. During Phase I of the study, when compression bandaging was used to reduce leg volume, the average acute attack rate was 1.56 episodes per year; it was greater in people who were illiterate and those who used compression bandages. After March 1997, when hygiene and skin care were emphasized and bandaging discouraged, acute attack frequency significantly decreased to 0.48 episodes per year. This study highlights the effectiveness of hygiene and skin care, as well as limitations of compressive bandaging, in managing lymphedema in filariasis-endemic areas

Liquid Medication Errors and Dosing Tools: A Randomized Controlled Experiment

Poorly designed labels and packaging are key contributors to medication errors. To identify attributes of labels and dosing tools that could be improved, we examined the extent to which dosing error rates are affected by tool characteristics (ie, type, marking complexity) and discordance between units of measurement on labels and dosing tools; along with differences by health literacy and language