Segond fracture with anterior cruciate ligament tear in an adolescent

The authors report a case of acute knee injury in a 14-year-old teenager. The X-ray showed a so-called Segond’s fracture: a small avulsed bone fragment, elliptical in shape, lying immediately below the external tibial plateau, a few millimeters from the lateral tibial cortex. The fracture site was in the portion of the tibial condyle which is linked to the middle third of the lateral capsule by meniscal tibial fibers. Clinical examination under anesthesia and subsequent arthroscopy revealed a total intrasubstance ACL (anterior cruciate ligament) tear close to the proximal insertion. The authors confirm Segond’s report of a possible association of this avulsion fracture with ACL injuries, even in adolescence

Exploring How Eruption Source Parameters Affect Volcanic Radiative Forcing Using Statistical Emulation

The radiative forcing caused by a volcanic eruption is dependent on several eruption source parameters such as the mass of sulfur dioxide (SO2) emitted, the eruption column height, and the eruption latitude. General circulation models with prognostic aerosol and chemistry schemes can be used to investigate how each parameter influences the volcanic forcing. However, the range of multidimensional parameter space that can be explored is restricted because such simulations are computationally expensive. Here we use statistical emulation to explore the radiative impact of eruptions over a wide covarying range of SO2 emission magnitudes, injection heights, and eruption latitudes based on only 30 simulations. We use the emulators to build response surfaces to visualize and predict the sulfate aerosol e-folding decay time, the stratospheric aerosol optical depth, and net radiative forcing of thousands of different eruptions. We find that the volcanic stratospheric aerosol optical depth and net radiative forcing are primarily determined by the mass of SO2 emitted, but eruption latitude is the most important parameter in determining the sulfate aerosol e-folding decay time. The response surfaces reveal joint effects of the eruption source parameters in influencing the net radiative forcing, such as a stronger influence of injection height for tropical eruptions than high-latitude eruptions. We also demonstrate how the emulated response surfaces can be used to find all combinations of eruption source parameters that produce a particular volcanic response, often revealing multiple solutions

Morphologic adjustments of actively evolving highly curved neck cutoffs

Neck cutoffs and their resultant oxbow lakes are important and prominent features of riverine landscapes. Detailed field-based research focusing on the morphologic evolution of neck cutoffs is currently insufficient to fully characterize cutoff evolution. High-resolution bathymetric data were collected over 3 years for the purpose of determining channel morphology and morphologic change on three actively evolving neck cutoffs. Results indicate the following general trends in morphologic adjustment: (1) a longitudinal bar in the upstream meander limb that develops near the entrance to the abandoned bend; (2) a deep scour hole in the downstream meander limb immediately downstream of the cutoff channel; (3) erosion of the bank opposite the cutoff in the downstream meander limb; (4) a cutoff bar in the downstream meander limb at the junction corner of the cutoff channel and the downstream meander limb; and (5) perching of the exit of the abandoned bend above the cutoff channel due to channel bed incision. The results presented herein were used to develop a conceptual model that depicts the morphologic evolution of highly curving neck cutoffs. The findings of this research are combined with recent analyses of the three-dimensional flow structure through neck cutoffs to provide a mechanistic explanation for the morphodynamics of neck cutoffs. (c) 2019 John Wiley & Sons, Ltd

Vancomycin-resistant Enterococcus faecium sequence type 796 - rapid international dissemination of a new epidemic clone

Background: Vancomycin-resistant Enterococcus faecium (VRE) is a leading cause of hospital-acquired infections. New, presumably better-adapted strains of VRE appear unpredictably; it is uncertain how they spread despite improved infection control. We aimed to investigate the relatedness of a novel sequence type (ST) of vanB E. faecium - ST796 - very near its time of origin from hospitals in three Australian states and New Zealand. Methods: Following near-simultaneous outbreaks of ST796 in multiple institutions, we gathered then tested colonization and bloodstream infection isolates' antimicrobial resistance (AMR) phenotypes, and phylogenomic relationships using whole genome sequencing (WGS). Patient meta-data was explored to trace the spread of ST796. Results: A novel clone of vanB E. faecium (ST796) was first detected at one Australian hospital in late 2011, then in two New Zealand hospitals linked by inter-hospital transfers from separate Melbourne hospitals. ST796 also appeared in hospitals in South Australia and New South Wales and was responsible for at least one major colonization outbreak in a Neonatal Intensive Care Unit without identifiable links between centers. No exceptional AMR was detected in the isolates. While WGS analysis showed very limited diversity at the core genome, consistent with recent emergence of the clone, clustering by institution was observed. Conclusions: Evolution of new E. faecium clones, followed by recognized or unrecognized movement of colonized individuals then rapid intra-institutional cross-transmission best explain the multi-center, multistate and international outbreak we observed

Australian Enterococcal Sepsis Outcome Programme, 2011

From 1 January to 31 December 2011, 29 institutions around Australia participated in the Australian Enterococcal Sepsis Outcome Programme (AESOP). The aim of AESOP 2011 was to determine the proportion of enterococcal bacteraemia isolates in Australia that are antimicrobial resistant, with particular emphasis on susceptibility to ampicillin and the glycopeptides, and to characterise the molecular epidemiology of the Enterococcus faecalis and E. faecium isolates. Of the 1,079 unique episodes of bacteraemia investigated, 95.8% were caused by either E. faecalis (61.0%) or E. faecium (34.8%). Ampicillin resistance was detected in 90.4% of E. faecium but not detected in E. faecalis. Using Clinical and Laboratory Standards Institute breakpoints (CLSI), vancomycin non-susceptibility was reported in 0.6% and 31.4% of E. faecalis and E. faecium respectively and was predominately due to the acquisition of the vanB operon. Approximately 1 in 6 vanB E. faecium isolates however, had an minimum inhibitory concentration at or below the CLSI vancomycin susceptible breakpoint of ≤ 4 mg/L. Overall, 37% of E. faecium harboured vanA or vanB genes. Although molecular typing identified 126 E. faecalis pulsed-field gel electrophoresis (PFGE) pulsotypes, more than 50% belonged to 2 pulsotypes that were isolated across Australia. E. faecium consisted of 73 PFGE pulsotypes from which 43 multilocus sequence types were identified. Almost 90% of the E. faecium were identified as clonal complex 17 clones, of which approximately half were characterised as sequence type 203, which was isolated Australia-wide. In conclusion, the AESOP 2011 has shown that although polyclonal, enterococcal bacteraemias in Australia are frequently caused by ampicillin-resistant vanB E. faecium

An observational prospective study of topical acidified nitrite for killing methicillin-resistant Staphylococcus aureus (MRSA) in contaminated wounds

Background Endogenous nitric oxide (NO) kills bacteria and other organisms as part of the innate immune response. When nitrite is exposed to low pH, NO is generated and has been used as an NO delivery system to treat skin infections. We demonstrated eradication of MRSA carriage from wounds using a topical formulation of citric acid (4.5%) and sodium nitrite (3%) creams co-applied for 5 days to 15 wounds in an observational prospective pilot study of 8 patients. Findings Following treatment with topical citric acid and sodium nitrite, 9 of 15 wounds (60%) and 3 of 8 patients (37%) were cleared of infection. MRSA isolates from these patients were all sensitive to acidified nitrite in vitro compared to methicillin-sensitive S. aureus and a reference strain of MRSA. Conclusions Nitric oxide and acidified nitrite offer a novel therapy for control of MRSA in wounds. Wounds that were not cleared of infection may have been re-contaminated or the bioavailability of acidified nitrite impaired by local factors in the tissue

Defending the 'Negro Race': Lamine Senghor and Black Internationalism in Interwar France

This article examines the career of Lamine Senghor, a Senegalese veteran of the First World War, who emerged in the mid 1920s as the most influential black anti-colonial activist of the period. Senghor combined a communist-inspired critique of empire with an attempt to forge a transnational sense of black identity. Many of the questions facing Senghor remain relevant today: should the black community seek equality through its own independent pressure groups or through strategic alliances with mainstream political parties? And how does one engage with issues of racial (or religious) equality within the terms of the purportedly colour-blind and secular Republic

Chiral Symmetry Breaking and External Fields in the Kuperstein-Sonnenschein Model

A novel holographic model of chiral symmetry breaking has been proposed by Kuperstein and Sonnenschein by embedding non-supersymmetric probe D7 and anti-D7 branes in the Klebanov-Witten background. We study the dynamics of the probe flavours in this model in the presence of finite temperature and a constant electromagnetic field. In keeping with the weakly coupled field theory intuition, we find the magnetic field promotes spontaneous breaking of chiral symmetry whereas the electric field restores it. The former effect is universally known as the "magnetic catalysis" in chiral symmetry breaking. In the presence of an electric field such a condensation is inhibited and a current flows. Thus we are faced with a steady-state situation rather than a system in equilibrium. We conjecture a definition of thermodynamic free energy for this steady-state phase and using this proposal we study the detailed phase structure when both electric and magnetic fields are present in two representative configurations: mutually perpendicular and parallel.Comment: 50 pages, multiple figures, minor typo fixed, references adde

Orientation in high-flying migrant insects in relation to flows: mechanisms and strategies

High-flying insect migrants have been shown to display sophisticated flight orientations that can, for example, maximize distance travelled by exploiting tailwinds, and reduce drift from seasonally optimal directions. Here, we provide a comprehensive overview of the theoretical and empirical evidence for the mechanisms underlying the selection and maintenance of the observed flight headings, and the detection of wind direction and speed, for insects flying hundreds of metres above the ground. Different mechanisms may be used—visual perception of the apparent ground movement or mechanosensory cues maintained by intrinsic features of the wind—depending on circumstances (e.g. day or night migrations). In addition to putative turbulence-induced velocity, acceleration and temperature cues, we present a new mathematical analysis which shows that 'jerks' (the time-derivative of accelerations) can provide indicators of wind direction at altitude. The adaptive benefits of the different orientation strategies are briefly discussed, and we place these new findings for insects within a wider context by comparisons with the latest research on other flying and swimming organisms

Functional limit theorems for random regular graphs

Consider d uniformly random permutation matrices on n labels. Consider the sum of these matrices along with their transposes. The total can be interpreted as the adjacency matrix of a random regular graph of degree 2d on n vertices. We consider limit theorems for various combinatorial and analytical properties of this graph (or the matrix) as n grows to infinity, either when d is kept fixed or grows slowly with n. In a suitable weak convergence framework, we prove that the (finite but growing in length) sequences of the number of short cycles and of cyclically non-backtracking walks converge to distributional limits. We estimate the total variation distance from the limit using Stein's method. As an application of these results we derive limits of linear functionals of the eigenvalues of the adjacency matrix. A key step in this latter derivation is an extension of the Kahn-Szemer\'edi argument for estimating the second largest eigenvalue for all values of d and n.Comment: Added Remark 27. 39 pages. To appear in Probability Theory and Related Field