An update on nonoperative management of the spleen in adults

Many patients with blunt splenic injury are considered for nonoperative management and, with proper selection, the success rate is high. This paper aims to provide an update on the treatments and dilemmas of nonoperative management of splenic injuries in adults and to offer suggestions that may improve both consensus and patient outcomes

Carbon flux in supraglacial debris over two ablation seasons at Miage Glacier, Mont Blanc massif, European Alps

The cryosphere plays an important role in the global carbon cycle, but few studies have examined carbon fluxes specifically on debris-covered glaciers. To improve understanding of the magnitude and variability of the atmospheric carbon flux in supraglacial debris, and its environmental controls, near-surface CO2 fluxes and meteorological variables were monitored over thick (0.23 m) and thin (0.04 m) debris at Miage Glacier, European Alps, over two ablation seasons, using an eddy covariance system. The CO2 flux alternates between downward and upward orientation in the day and night, respectively, and is dominated by uptake of CO2 in thick debris (mean flux = 1.58 g CO2 m−2 d−1), whereas flux magnitude is smaller and near net zero on thin debris (mean flux = −0.06 g CO2 m−2 d−1). These values infer a potential drawdown of >150 t CO2 km−2 over an ablation season, and >500 t CO2 (0.5 Gg CO2) for the whole debris-covered zone. The strong correlation of daytime CO2 flux magnitude with debris surface temperature suggests that atmospheric CO2 is consumed in hydrolysis and carbonation reactions at sediment-water interfaces in debris. Incoming shortwave radiation is key in heating debris, generating dilute meltwater, and providing energy for chemical reactions. CO2 drawdown on thin debris increases by an order of magnitude on days following frost events, implying that frost shattering generates fresh reactive sediment, which is rapidly chemically weathered with the onset of ice melting. Net CO2 release in the night, and in the daytime when debris surface temperature is below 7°C, is likely due to respiration by debris microorganisms. The combination of dilute meltwater, high temperature, and reactive mineral surfaces open to the atmosphere, makes supraglacial debris an ideal environment for rock chemical weathering. Debris-covered glaciers could be important to local and regional carbon cycling, and measurement of CO2 fluxes and controlling processes at other sites is warranted

Achieving interoperability through semantics-based technologies: the instant messaging case

The success of pervasive computing depends on the ability to compose a multitude of networked applications dynamically in order to achieve user goals. However, applications from different providers are not able to interoperate due to incompatible interaction protocols or disparate data models. Instant messaging is a representative example of the current situation, where various competing applications keep emerging. To enforce interoperability at runtime and in a non-intrusive manner, mediators are used to perform the necessary translations and coordination between the heterogeneous applications. Nevertheless, the design of mediators requires considerable knowledge about each application as well as a substantial development effort. In this paper we present an approach based on ontology reasoning and model checking in order to generate correct-by-construction mediators automatically. We demonstrate the feasibility of our approach through a prototype tool and show that it synthesises mediators that achieve efficient interoperation of instant messaging applications

Flexible Lipid Bilayers in Implicit Solvent

A minimalist simulation model for lipid bilayers is presented. Each lipid is represented by a flexible chain of beads in implicit solvent. The hydrophobic effect is mimicked through an intermolecular pair potential localized at the ``water''/hydrocarbon tail interface. This potential guarantees realistic interfacial tensions for lipids in a bilayer geometry. Lipids self assemble into bilayer structures that display fluidity and elastic properties consistent with experimental model membrane systems. Varying molecular flexibility allows for tuning of elastic moduli and area/molecule over a range of values seen in experimental systems.Comment: 5 pages, 5 figure

To Sleep, Perchance to Dream: Acute and Chronic Sleep Deprivation in Acute Care Surgeons

Background Acute and chronic sleep deprivation are significantly associated with depressive symptoms and felt to be contributors to the development of burnout. In-house call (IHC) inherently includes frequent periods of disrupted sleep and is common amongst acute care surgeons (ACS). The relationship between IHC and sleep deprivation (SD) amongst ACS has not been previously studied. The goal of this study was to determine prevalence and patterns of SD in ACS. Study Design: A prospective study of ACS with IHC responsibilities from two Level I trauma centers was performed. Participants wore a sleep tracking device continuously over a 3-month period. Data collected included age, gender, schedule of IHC, hours and pattern of each sleep stage (light, slow wave (SWS), and REM), and total hours of sleep. Sleep patterns were analyzed for each night excluding IHC and categorized as normal (N), acute sleep deprivation (ASD), or chronic sleep deprivation (CSD). Results 1421 nights were recorded amongst 17 ACS. (35.3% female; ages 37-65, mean 45.5 years). Excluding IHC, average amount of sleep was 6.54 hours with 64.8% of sleep patterns categorized as ASD or CSD. Average amount of sleep was significantly higher on post-call day 1 (6.96 hours, p=0.0016), but decreased significantly on post-call day 2 (6.33 hours, p=0.0006). Sleep patterns with ASD and CSD peaked on post-call day 2, and returned to baseline on post-call day 3 (p=0.046). Conclusion Sleep patterns consistent with ASD and CSD are common amongst ACS and worsen on post-call day 2. Baseline sleep patterns were not recovered until post-call day 3. Future study is needed to identify factors which impact physiologic recovery after IHC and further elucidate the relationship between SD and burnout

Prostate-specific antigen (PSA) testing of men in UK general practice : a 10-year longitudinal cohort study

OBJECTIVES: Cross-sectional studies suggest that around 6% of men undergo prostate-specific antigen (PSA) testing each year in UK general practice (GP). This longitudinal study aims to determine the cumulative testing pattern of men over a 10-year period and whether this testing can be considered equivalent to screening for prostate cancer (PCa). SETTING, PARTICIPANTS AND OUTCOME MEASURES: Patient-level data on PSA tests, biopsies and PCa diagnoses were obtained from the UK Clinical Practice Research Datalink (CPRD) for the years 2002 to 2011. The cumulative risks of PSA testing and of being diagnosed with PCa were estimated for the 10-year study period. Associations of a man's age, region and index of multiple deprivation with the cumulative risk of PSA testing and PCa diagnosis were investigated. Rates of biopsy and diagnosis, following a high test result, were compared with those from the programme of PSA testing in the Prostate Testing for Cancer and Treatment (ProtecT) study. RESULTS: The 10-year risk of exposure to at least one PSA test in men aged 45 to 69 years in UK GP was 39.2% (95% CI 39.0 to 39.4%). The age-specific risks ranged from 25.2% for men aged 45-49 years to 53.0% for men aged 65-69 years (p for trend <0.001). For those with a PSA level ≥3, a test in UK GP was less likely to result in a biopsy (6%) and/or diagnosis of PCa (15%) compared with ProtecT study participants (85% and 34%, respectively). CONCLUSION: A high proportion of men aged 45-69 years undergo PSA tests in UK GP: 39% over a 10-year period. A high proportion of these tests appear to be for the investigation of lower urinary tract symptoms and not screening for PCa. TRIAL REGISTRATION NUMBER: ISRCTN20141297,NCT02044172

Understanding factors influencing home pregnancy test use among women in western Kenya: A qualitative analysis

BackgroundThere are limited data on home pregnancy test use among women in low-and-middle-income countries. A prior survey found that only 20% of women in western Kenya used a home pregnancy test to confirm their pregnancies before going to antenatal care. This qualitative study aims to understand why women do not use home pregnancy tests in early pregnancy.MethodsFrom April 2021 to July 2021, we interviewed women from four antenatal care clinics in Homa Bay and Siaya counties. We recruited women previously enrolled in the PrEP Implementation for Mothers in Antenatal care (PrIMA) study, a cluster-randomized trial that evaluated the best approaches to implementing PrEP in maternal and child health clinics in Western Kenya (NCT03070600). Interviews were conducted via phone, audio recorded, translated, and transcribed verbatim. We coded and analyzed the transcripts to capture factors influencing women's capability, opportunity, and motivation to use home pregnancy tests.ResultsWe conducted 48 semistructured interviews with women aged 21–42 years. Twenty-seven women did not use a home pregnancy test in their most recent pregnancy. Seventeen of these women reported not using a home pregnancy test before. Lack of knowledge, mistrust in the accuracy of tests, preferring to rely on signs and symptoms of pregnancy or get a test from the health facility, cost, and accessibility were key barriers to home pregnancy test use.ConclusionImproving the uptake of home pregnancy testing during early pregnancy will require efforts to enhance community knowledge of test use and associated benefits and reduce cost burdens by making tests more affordable and accessible

Life in 2.5D: Animal Movement in the Trees

The complex, interconnected, and non-contiguous nature of canopy environments present unique cognitive, locomotor, and sensory challenges to their animal inhabitants. Animal movement through forest canopies is constrained; unlike most aquatic or aerial habitats, the three-dimensional space of a forest canopy is not fully realized or available to the animals within it. Determining how the unique constraints of arboreal habitats shape the ecology and evolution of canopy-dwelling animals is key to fully understanding forest ecosystems. With emerging technologies, there is now the opportunity to quantify and map tree connectivity, and to embed the fine-scale horizontal and vertical position of moving animals into these networks of branching pathways. Integrating detailed multi-dimensional habitat structure and animal movement data will enable us to see the world from the perspective of an arboreal animal. This synthesis will shed light on fundamental aspects of arboreal animals’ cognition and ecology, including how they navigate landscapes of risk and reward and weigh energetic trade-offs, as well as how their environment shapes their spatial cognition and their social dynamics

Estimating encounter location distributions from animal tracking data

1. Ecologists have long been interested in linking individual behaviour with higher level processes. For motile species, this ‘upscaling’ is governed by how well any given movement strategy maximizes encounters with positive factors and minimizes encounters with negative factors. Despite the importance of encounter events for a broad range of ecological processes, encounter theory has not kept pace with developments in animal tracking or movement modelling. Furthermore, existing work has focused primarily on the relationship between animal movement and encounter rates while the relationship between individual movement and the spatial locations of encounter events in the environment has remained conspicuously understudied. 2. Here, we bridge this gap by introducing a method for describing the long-term encounter location probabilities for movement within home ranges, termed the conditional distribution of encounters (CDE). We then derive this distribution, as well as confidence intervals, implement its statistical estimator into open-source software and demonstrate the broad ecological relevance of this distribution. 3. We first use simulated data to show how our estimator provides asymptotically consistent estimates. We then demonstrate the general utility of this method for three simulation-based scenarios that occur routinely in biological systems: (a) a population of individuals with home ranges that overlap with neighbours; (b) a pair of individuals with a hard territorial border between their home ranges; and (c) a predator with a large home range that encompassed the home ranges of multiple prey individuals. Using GPS data from white-faced capuchins Cebus capucinus, tracked on Barro Colorado Island, Panama, and sleepy lizards Tiliqua rugosa, tracked in Bundey, South Australia, we then show how the CDE can be used to estimate the locations of territorial borders, identify key resources, quantify the potential for competitive or predatory interactions and/or identify any changes in behaviour that directly result from location-specific encounter probability. 4. The CDE enables researchers to better understand the dynamics of populations of interacting individuals. Notably, the general estimation framework developed in this work builds straightforwardly off of home range estimation and requires no specialized data collection protocols. This method is now openly available via the ctmm R package