Laser Detection and Imaging Techniques for Surface Examination

A coherent laser probe provides the basis for the recording of complex SAW distributions. Using three or more scans, the surface wave velocity can be deducep with an accuracy of a few parts in 105. Such measurements are sufficiently sensitive to detect small changes in surface characteristics; as an example, results will be presented on the effect of doping a Si surface. It is also possible to improve the accuracy of the basic elastic constants of the material by reference to the velocity characteristic. Of particular importance is the fact that this technique provides evidence on the effective value of these constants close to a surface; it is, therefore potentially useful for surface layer characterisation. Surface defects can be detected by means of scattered waves in both the forward as the reverse directions. In principle, either can be used to image the defect. Using both these components, the defect size and location can be determined with improved accuracy

Outcome of Percutaneous Nephrostomy for the Management of Pyonephrosis

ObjectiveThe aim of this study was to evaluate the efficacy of percutaneous nephrostomy (PCN) drainage for the interim management of pyonephrosis.MethodsNinety-two consecutive patients (29 men, 63 women; mean age, 57 years; range, 23-88) who underwent PCN for the treatment of pyonephrosis from 1996 to 1999 were evaluated retrospectively. The clinical presentation, bacteriology and patient outcomes were analyzed.ResultsThe majority (77%) of patients had underlying obstructing urinary calculi. Other causes of obstruction included strictures (9%), papillary necrosis (7%), pelvi-ureteric junction obstruction (4%) and malignant stricture (3%). The microorganisms cultured were Escherichia coli (30%), Klebsiella (19%), Proteus (8%), Pseudomonas (5%), Enterococcus (5%), and Candida spp (5%). The microorganisms were sensitive to gentamicin (79%), ceftriaxone (71%), cephalexin (54%), nitrofurantoin (40%), cotrimoxazole (35%), nalidixic acid (32%) and ampicillin (29%). Only 30% of bladder urine cultures were positive for microorganisms; the addition of PCN cultures improved this yield to 58%. The antibiotic regimen was revised according to the PCN culture whenever there was a discrepancy. After PCN, 69% of patients underwent minimally invasive procedures as definitive treatment of the obstructing lesion. Only 14% of patients required open surgery. There was low procedure-related morbidity (14%) and low overall mortality (2%).ConclusionsPCN cultures yield important bacteriological information. The procedure is associated with minimal morbidity, facilitates definitive treatment and provides therapeutic benefit. (Asian J Surg 2002;25(3):215-9

Investigating changes within the handling system of the largest semi-captive population of Asian elephants

The current extinction crisis leaves us increasingly reliant on captive populations to maintain vulnerable species. Approximately one third of Asian elephants (Elephas maximus) are living in semi-captive conditions in range countries. Their relationship with humans stretches back millennia, yet elephants have never been fully domesticated. We rely on the expertise of traditional handlers (mahouts) to manage these essentially wild animals, yet this profession may be threatened in the modern day. Here, we study the handling system of semi-captive timber elephants in Myanmar; the largest global semi-captive population (similar to 5 000). We investigate how recent changes in Myanmar may have affected the keeping system and mahout-elephant interactions. Structured interviews investigated changes to mahout attitude and experience over the last two decades, as perceived by those who had worked in the industry for at least 10 years (n=23) and as evaluated in current mahouts (n=210), finding mahouts today are younger (median age 22yrs), less experienced (median experience 3yrs), and change elephants frequently, threatening traditional knowledge transfer. Mahout-elephant interactions manifested as 5 components ('job appreciation'; 'experience is necessary'; 'human-elephant interaction'; 'own knowledge'; 'elephant relationship'), according to Principal Components Analysis. Experienced mahouts and mahouts of bulls and younger elephants were more likely to agree that 'experience is necessary' to be a mahout. Mahouts with difficult elephants scored lower on 'human-elephant interaction' and a mahout's perception of their 'own knowledge' increased with more experience. Our finding of change in terms of mahout experience, age and commitment in the largest semi-captive elephant population suggests need for formal training and assessment of impacts on elephant welfare; these are findings applicable to thousands of elephants under similar management

Handler familiarity helps to improve working performance during novel situations in semi-captive Asian elephants

Working animals spend hours each day in close contact with humans and require training to understand commands and fulfil specific tasks. However, factors driving cooperation between humans and animals are still unclear, and novel situations may present challenges that have been little-studied to-date. We investigated factors driving cooperation between humans and animals in a working context through behavioural experiments with 52 working semi-captive Asian elephants. Human-managed Asian elephants constitute approximately a third of the remaining Asian elephants in the world, the majority of which live in their range countries working alongside traditional handlers. We investigated how the familiarity and experience of the handler as well as the elephant’s age and sex affected their responses when asked to perform a basic task and to cross a novel surface. The results highlighted that when novelty is involved in a working context, an elephant’s relationship length with their handler can affect their cooperation: elephants who had worked with their handler for over a year were more willing to cross the novel surface than those who had a shorter relationship with their handler. Older animals also tended to refuse to walk on the novel surface more but the sex did not affect their responses. Our study contributes much needed knowledge on human-working animal relationships which should be considered when adjusting training methods and working habits.</p

Evaluating the Reliability of Non-Specialist Observers in the Behavioural Assessment of Semi-Captive Asian Elephant Welfare

Recognising stress is an important component in maintaining the welfare of captive animal populations, and behavioural observation provides a rapid and non-invasive method to do this. Despite substantial testing in zoo elephants, there has been relatively little interest in the application of behavioural assessments to the much larger working populations of Asian elephants across Southeast Asia, which are managed by workers possessing a broad range of behavioural knowledge. Here, we developed a new ethogram of potential stress- and work-related behaviour for a semi-captive population of Asian elephants. We then used this to collect observations from video footage of over 100 elephants and evaluated the reliability of behavioural welfare assessments carried out by non-specialist observers. From observations carried out by different raters with no prior experience of elephant research or management, we tested the reliability of observations between-observers, to assess the general inter-observer agreement, and within-observers, to assess the consistency in behaviour identification. The majority of ethogram behaviours were highly reliable both between- and within-observers, suggesting that overall, behaviour was highly objective and could represent easily recognisable markers for behavioural assessments. Finally, we analysed the repeatability of individual elephant behaviour across behavioural contexts, demonstrating the importance of incorporating a personality element in welfare assessments. Our findings highlight the potential of non-expert observers to contribute to the reliable monitoring of Asian elephant welfare across large captive working populations, which may help to both improve elephant wellbeing and safeguard human workers.</p

Gestational diabetes mellitus prevalence in Maela refugee camp on the Thai–Myanmar Border: a clinical report

Background: Individuals in conflict-affected areas rarely get appropriate care for chronic or non-infectious diseases. The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide, and new evidence shows conclusively that the negative effects of hyperglycemia occur even at mild glucose elevations and that these negative effects can be attenuated by treatment. Scientific literature on gestational diabetes in refugee camp settings is critically limited. Methods: A 75 g 2-hour glucose tolerance test was administered to 228 women attending the antenatal care (ANC) clinic in Maela refugee camp on the Thai–Myanmar border. Prevalence of GDM was determined using the HAPO trial cut-offs [≥92 mg/dL (fasting),≥180 (1 hour), and≥153 (2 hour)] and the WHO criteria [≥126 mg/dL (fasting), and 140 mg/dL (2 hour)]. Results: From July 2011 to March 2012, the prevalence of GDM was 10.1% [95% confidence interval (CI): 6.2–14.0] when the cut-off determined by the HAPO trial was applied. Applying the older WHO criteria yielded a prevalence of 6.6% (95% CI 3.3–9.8). Age, parity, and BMI emerged as characteristics that may be significantly associated with GDM in this population. Other risk factors that are commonly used in screening guidelines were not applicable in this diabetes-naïve population. Discussion: The prevalence of GDM is lower in this population compared with other populations, but still complicates 10% of pregnancies. New evidence regarding gestational diabetes raises new dilemmas for healthcare providers in resource-poor settings. Efforts to identify and treat patients at risk for adverse outcomes need to be balanced with awareness of the risks and burdens associated with over diagnosis and unnecessary interventions. Screening approaches based on risk factors or using higher cut-off values may help minimize this burden and identify those most likely to benefit from intervention

An algorithm for differentiating food antigen-related gastrointestinal symptoms

Aim: The aim of this clinical audit was to assess patient-reported outcomes on the effect of dietary intervention, to enhance our understanding of possible treatment options in irritable bowel syndrome (IBS). Background: A large number of food-related gastro-intestinal disorders have been attributed to IBS for decades. Methods: Patient-reported outcomes from the records of 149 IBS patients treated at secondary and tertiary Gastroenterology outpatients in two UK hospitals between January 2014 and July 2016 were audited. Patients all presented with symptoms fulfilling Rome III-IV criteria for IBS had negative coeliac serology and did not have other gastrointestinal (GI) conditions. A modified version of a low FODMAP diet had been recommended (gluten and lactose free diet (G/LFD)) and was implemented for 6 weeks. Outcomes and dietary adherence were recorded during outpatient's consultations. Results: A total of 134 patients complied with the diet optimally. The majority had an improvement rate >70% and continued with the diet. Fifty-three percent became completely or almost asymptomatic, while 27.6% had a poor response to the diet (scoring < 30%) to G/LFD. The improvement was excellent in patients with normal BMI and good in overweight and obese and where BMI <18. Over 50% did not require any follow-up within 12 months. Conclusion: Although it is unclear whether symptoms are triggered by gluten, fructans or lactose, elimination of gluten and lactose proved to be an effective treatment in patients with IBS. Multidisciplinary team management and implementation of detailed nutrition therapy using the audit algorithm might prove to be both cost effective and efficacious a treatment option in IBS

Multicenter Validation of Histopathologic Tumor Regression Grade After Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Carcinoma

Response classification after neoadjuvant chemotherapy in muscle-invasive bladder carcinoma is based on the TNM stage at radical cystectomy. We recently showed that histopathologic tumor regression grades (TRGs) add prognostic information to TNM. Our aim was to validate the prognostic significance of TRG in muscle-invasive bladder cancer in a multicenter setting. We enrolled 389 patients who underwent cisplatin-based chemotherapy before radical cystectomy in 8 centers between 2010 and 2016. Median follow-up was 2.2 years. TRG was determined in radical cystectomy specimens by local pathologists. Central pathology review was conducted in 20% of cases, which were randomly selected. The major response was defined as ≤pT1N0. The remaining patients were grouped into partial responders (≥ypT2N0-3 and TRG 2) and nonresponders (≥ypT2N0-3 and TRG 3). TRG was successfully determined in all cases, and interobserver agreement in central pathology review was high (κ=0.83). After combining TRG and TNM, 47%, 15%, and 38% of patients were major, partial, and nonresponders, respectively. Combination of TRG and TNM showed significant prognostic discrimination of overall survival (major responder: reference; partial responder: hazard ratio 3.5 [95% confidence interval: 1.8-6.8]; nonresponder: hazard ratio 6.1 [95% confidence interval: 3.6-10.3]). This discrimination was superior compared with TNM staging alone, supported by 2 goodness-of-fit criteria (P=0.041). TRG is a simple, reproducible histopathologic measurement of response to neoadjuvant chemotherapy in muscle-invasive bladder cancer. Integrating TRG with TNM staging resulted in significantly better prognostic stratification than TNM staging alone

Opposite Modulation of RAC1 by Mutations in TRIO Is Associated with Distinct, Domain-Specific Neurodevelopmental Disorders

The Rho-guanine nucleotide exchange factor (RhoGEF) TRIO acts as a key regulator of neuronal migration, axonal outgrowth, axon guidance, and synaptogenesis by activating the GTPase RAC1 and modulating actin cytoskeleton remodeling. Pathogenic variants in TRIO are associated with neurodevelopmental diseases, including intellectual disability (ID) and autism spectrum disorders (ASD). Here, we report the largest international cohort of 24 individuals with confirmed pathogenic missense or nonsense variants in TRIO. The nonsense mutations are spread along the TRIO sequence, and affected individuals show variable neurodevelopmental phenotypes. In contrast, missense variants cluster into two mutational hotspots in the TRIO sequence, one in the seventh spectrin repeat and one in the RAC1-activating GEFD1. Although all individuals in this cohort present with developmental delay and a neuro-behavioral phenotype, individuals with a pathogenic variant in the seventh spectrin repeat have a more severe ID associated with macrocephaly than do most individuals with GEFD1 variants, who display milder ID and microcephaly. Functional studies show that the spectrin and GEFD1 variants cause a TRIO-mediated hyper- or hypo-activation of RAC1, respectively, and we observe a striking correlation between RAC1 activation levels and the head size of the affected individuals. In addition, truncations in TRIO GEFD1 in the vertebrate model X. tropicalis induce defects that are concordant with the human phenotype. This work demonstrates distinct clinical and molecular disorders clustering in the GEFD1 and seventh spectrin repeat domains and highlights the importance of tight control of TRIO-RAC1 signaling in neuronal development.<br/