Rapid Molecular Detection of Rifampicin Resistance Facilitates Early Diagnosis and Treatment of Multi-Drug Resistant Tuberculosis: Case Control Study

Multi-drug resistant tuberculosis (MDR-TB) is a major public health concern since diagnosis is often delayed, increasing the risk of spread to the community and health care workers. Treatment is prolonged, and the total cost of treating a single case is high. Diagnosis has traditionally relied upon clinical suspicion, based on risk factors and culture with sensitivity testing, a process that can take weeks or months. Rapid diagnostic molecular techniques have the potential to shorten the time to commencing appropriate therapy, but have not been put to the test under field conditions.This retrospective case-control study aimed to identify risk factors for MDR-TB, and analyse the impact of testing for rifampicin resistance using RNA polymerase B (rpoB) mutations as a surrogate for MDR-TB. Forty two MDR-TB cases and 84 fully sensitive TB controls were matched by date of diagnosis; and factors including demographics, clinical presentation, microbiology findings, management and outcome were analysed using their medical records. Conventionally recognised risk factors for MDR-TB were absent in almost half (43%) of the cases, and 15% of cases were asymptomatic. A significant number of MDR-TB cases were identified in new entrants to the country. Using rpoB mutation testing, the time to diagnosis of MDR-TB was dramatically shortened by a median of 6 weeks, allowing patients to be commenced on appropriate therapy a median of 51days earlier than those diagnosed by conventional culture and sensitivity testing.MDR-TB is frequently an unexpected finding, may be asymptomatic, and is particularly prevalent among TB infected new entrants to the country. Molecular resistance testing of all acid fast bacilli positive specimens has the potential to rapidly identify MDR-TB patients and commence them on appropriate therapy significantly earlier than by conventional methods

Strong Carbon Features and a Red Early Color in the Underluminous Type Ia SN 2022xkq

We present optical, infrared, ultraviolet, and radio observations of SN 2022xkq, an underluminous fast-declining type Ia supernova (SN Ia) in NGC 1784 ($\mathrm{D}\approx31$ Mpc), from $<1$ to 180 days after explosion. The high-cadence observations of SN 2022xkq, a photometrically transitional and spectroscopically 91bg-like SN Ia, cover the first days and weeks following explosion which are critical to distinguishing between explosion scenarios. The early light curve of SN 2022xkq has a red early color and exhibits a flux excess which is more prominent in redder bands; this is the first time such a feature has been seen in a transitional/91bg-like SN Ia. We also present 92 optical and 19 near-infrared (NIR) spectra, beginning 0.4 days after explosion in the optical and 2.6 days after explosion in the NIR. SN 2022xkq exhibits a long-lived C I 1.0693 $\mu$m feature which persists until 5 days post-maximum. We also detect C II $\lambda$6580 in the pre-maximum optical spectra. These lines are evidence for unburnt carbon that is difficult to reconcile with the double detonation of a sub-Chandrasekhar mass white dwarf. No existing explosion model can fully explain the photometric and spectroscopic dataset of SN 2022xkq, but the considerable breadth of the observations is ideal for furthering our understanding of the processes which produce faint SNe Ia.Comment: 38 pages, 16 figures, accepted for publication in ApJ, the figure 15 input models and synthetic spectra are now available at https://zenodo.org/record/837925

Genetic correlation between amyotrophic lateral sclerosis and schizophrenia

A. Palotie on työryhmän Schizophrenia Working Grp Psychiat jäsen.We have previously shown higher-than-expected rates of schizophrenia in relatives of patients with amyotrophic lateral sclerosis (ALS), suggesting an aetiological relationship between the diseases. Here, we investigate the genetic relationship between ALS and schizophrenia using genome-wide association study data from over 100,000 unique individuals. Using linkage disequilibrium score regression, we estimate the genetic correlation between ALS and schizophrenia to be 14.3% (7.05-21.6; P = 1 x 10(-4)) with schizophrenia polygenic risk scores explaining up to 0.12% of the variance in ALS (P = 8.4 x 10(-7)). A modest increase in comorbidity of ALS and schizophrenia is expected given these findings (odds ratio 1.08-1.26) but this would require very large studies to observe epidemiologically. We identify five potential novel ALS-associated loci using conditional false discovery rate analysis. It is likely that shared neurobiological mechanisms between these two disorders will engender novel hypotheses in future preclinical and clinical studies.Peer reviewe

The Science Performance of JWST as Characterized in Commissioning

This paper characterizes the actual science performance of the James Webb Space Telescope (JWST), as determined from the six month commissioning period. We summarize the performance of the spacecraft, telescope, science instruments, and ground system, with an emphasis on differences from pre-launch expectations. Commissioning has made clear that JWST is fully capable of achieving the discoveries for which it was built. Moreover, almost across the board, the science performance of JWST is better than expected; in most cases, JWST will go deeper faster than expected. The telescope and instrument suite have demonstrated the sensitivity, stability, image quality, and spectral range that are necessary to transform our understanding of the cosmos through observations spanning from near-earth asteroids to the most distant galaxies.Comment: 5th version as accepted to PASP; 31 pages, 18 figures; https://iopscience.iop.org/article/10.1088/1538-3873/acb29

Does three-dimensional technology transfer from the laboratory to the operating theatre with benefits to surgical efficiency and patient safety?

Minimally invasive surgery has evolved over the last century to become a gold standard for many surgical procedures. This relates to the reduction in morbidity associated with large incisions. Patients benefit from reduced surgical trauma and post-operative pain, and a more rapid recovery and return to normal activities. This is at the cost of an increased complexity of technical skill required and therefore steep learning curve, especially related to the loss of the stereopsis of binocular vision, which provides our keenest depth perception in dextrous skills. Technological pioneers have been trying to overcome the loss of stereopsis for the last few decades without success, either from poor image capture or projection technologies. The advent of passive polarising 3D technology in the entertainment industry has paved the way for new visual systems which, in laboratory based experiments, have shown significant benefits to efficiency in tasks with reduced time and error production. These benefits have yet to be proven in true surgery with any validity. This research was undertaken to provide high quality evidence investigating the effect of these 3D visual systems on actual laparoscopic surgery. The aim was to evaluate whether the benefits to surgical efficiency, and potentially patient safety with error reduction, are truly transferrable to the complex environment of an operating theatre. Although the reduction in operative time showed no significance with the primary end point, sub group analysis identified significant benefit in more difficult cases. The study shows that the 3D systems do reduce the operating time and the significant error production, especially gallbladder perforation, in true surgery

Does three-dimensional technology transfer from the laboratory to the operating theatre with benefits to surgical efficiency and patient safety?

Minimally invasive surgery has evolved over the last century to become a gold standard for many surgical procedures. This relates to the reduction in morbidity associated with large incisions. Patients benefit from reduced surgical trauma and post-operative pain, and a more rapid recovery and return to normal activities. This is at the cost of an increased complexity of technical skill required and therefore steep learning curve, especially related to the loss of the stereopsis of binocular vision, which provides our keenest depth perception in dextrous skills. Technological pioneers have been trying to overcome the loss of stereopsis for the last few decades without success, either from poor image capture or projection technologies. The advent of passive polarising 3D technology in the entertainment industry has paved the way for new visual systems which, in laboratory based experiments, have shown significant benefits to efficiency in tasks with reduced time and error production. These benefits have yet to be proven in true surgery with any validity. This research was undertaken to provide high quality evidence investigating the effect of these 3D visual systems on actual laparoscopic surgery. The aim was to evaluate whether the benefits to surgical efficiency, and potentially patient safety with error reduction, are truly transferrable to the complex environment of an operating theatre. Although the reduction in operative time showed no significance with the primary end point, sub group analysis identified significant benefit in more difficult cases. The study shows that the 3D systems do reduce the operating time and the significant error production, especially gallbladder perforation, in true surgery

Colopexy as a treatment option for the management of acute transverse colon volvulus: a case report

INTRODUCTION: Transverse colon volvulus is an uncommon acute surgical presentation associated with a higher rate of mortality than volvulae at other locations along the colon. Surgical resection or correction is the only treatment, and various methods have been described in case report literature to relieve the volvulus and prevent recurrence. CASE PRESENTATION: We present the case of a 25-year-old Caucasian woman who was admitted with a three-day history of abdominal pain, absolute constipation and abdominal distension. Subsequent radiographic and computed tomography imaging revealed right-sided colonic dilatation suggestive of a volvulus. An emergency laparotomy was performed during which the dilated proximal bowel was decompressed and colopexy executed by using the greater omentum to fix the transverse colon at the hepatic and splenic flexures. CONCLUSIONS: Volvulus of the transverse colon is rare but must form part of the clinician's differential diagnosis when encountering a patient with suspected bowel obstruction, especially in younger patients with no previous surgical history. Laparotomy is the treatment of choice and the technique of using the greater omentum as a fixing point for redundant bowel to the lateral abdominal wall is an option that may be considered especially when the bowel appears viable

3D laparoscopy does not reduce operative duration or errors in day-case laparoscopic cholecystectomy: a randomised controlled trial

Background Contemporary 3D platforms have overcome past deficiencies. Available trainee and laboratory studies suggest stereoscopic imaging improves performance but there is little clinical data or studies assessing specialists. We aimed to determine whether stereoscopic (3D) laparoscopic systems reduce operative time and number of intraoperative errors during specialist-performed laparoscopic cholecystectomy (LC). Methods A parallel arm (1:1) randomised controlled trial comparing 2D and 3D passive-polarised laparoscopic systems in day-case LC using was performed. Eleven consultant surgeons that had each performed ˃ 200 LC (including ˃ 10 3D LC) participated. Cases were video recorded and a four-point difficulty grade applied. The primary outcome was overall operative time. Subtask time and the number of intraoperative consequential errors as identified by two blinded assessors using a hierarchical task analysis and the observational clinical human reliability analysis technique formed secondary endpoints. Results 112 patients were randomised. There was no difference in operative time between 2D and 3D LC (23:14 min (± 10:52) vs. 20:17 (± 9:10), absolute difference − 14.6%, p = 0.148) although 3D surgery was significantly quicker in difficulty grade 3 and 4 cases (30:23 min (± 9:24), vs. 18:02 (± 7:56), p ˂ 0.001). No differences in overall error count was seen (total 47, median 1, range 0–4 vs. 45, 1, 0–3, p = 0.62) although there were significantly fewer 3D gallbladder perforations (15 vs. 6, p = 0.034). Conclusion 3D laparoscopy did not reduce overall operative time or error frequency in laparoscopic cholecystectomies performed by specialist surgeons. 3D reduced Calot’s dissection time and operative time in complex cases as well as the incidence of iatrogenic gallbladder perforation (NCT01930344).</p

An ‘unkindness’ of ravens? Measuring prosocial preferences in Corvus corax

In recent years there has been considerable research effort to determine whether other species exhibit prosocial motivations parallel to those of humans; however these studies have focused primarily on primates, and with mixed results. We presented captive ravens with a modified prosocial choice task which aimed to address several criticisms of previous methods by including a stringent pre-training regime and a setup that disentangles motivation to provision a conspecific from motivation to feed next to one. In this task subjects (N=6) received no rewards for themselves but could choose to deliver food rewards to either a conspecific or an empty, inaccessible compartment. Subjects did not demonstrate any prosocial tendencies (i.e., they did not preferentially choose to reward a conspecific over the empty compartment), and instead often ceased pulling on test trials when they received nothing for themselves (up to 70% of 80 trials with a partner present, up to 83% of 40 trials in a non-social control condition). The relationship between the subject and the partner had no influence on the subject’s choices; however subjects were more likely to pull immediately after performing socio-agonistic displays. Our results contribute to a growing body of evidence that despite their sophisticated social cognitive abilities and range of cooperative behaviours exhibited in the wild, un-paired (or unbonded) ravens do not seem to act to benefit conspecifics in the absence of immediate self-gain