Serum inflammatory markers and amputations in hand osteomyelitis: a retrospective review of 146 cases

Background: The diagnosis of hand osteomyelitis requires correlation of clinical, radiological, and microbiological findings. The role of serum inflammatory markers in diagnosing and prognosticating hand osteomyelitis remains uncertain. We sought to determine the utility of inflammatory markers in the diagnosis and follow-up of hand osteomyelitis, and their ability to predict outcomes, particularly amputation. Methods: We retrospectively reviewed 146 patients diagnosed with hand osteomyelitis and with serum inflammatory marker levels measured after the onset of symptoms and within 14 days either side of diagnosis. Blood results at first presentation including white cell count (WCC), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and C-reactive protein (CRP) were reviewed, and associations with amputations assessed. Follow-up markers taken at 15 to 60 days from diagnosis were analyzed where available. Results: Mean WCC and CRP at diagnosis were 9.2 (SD: 4.6) and 30.2 (SD: 42.4) respectively, compared with 8.2 (SD: 3.9) and 30.2 (SD: 42.4) at follow-up. At diagnosis, sensitivity of CRP was 74%, and WCC was 31%. Each marker had a low positive predictive value for amputation at diagnosis (<29%). A rise in CRP between diagnosis and follow-up was associated with an increased risk of amputation compared with a fall in CRP. The finding that WCC and CRP were both normal at diagnosis had a high negative predictive value against amputation (96%). Conclusion: C-reactive protein has a higher sensitivity than WCC, NLR, and PLR when used as a diagnostic adjunct in hand osteomyelitis. White cell count and CRP both within reference ranges at diagnosis was highly negatively predictive against amputation

The Impact of Same Gender Speed-Mentoring on Women's Perceptions of a Career in Surgery – A Prospective Cohort Study

BACKGROUND: Mentoring is critically important for the personal and professional development of a surgeon. Early career stage mentoring by same-gender role models may help ameliorate the gender imbalance in surgery based on our understanding of barriers for women pursuing surgical careers. A novel method of establishing these relationships is speed mentoring. This study aims to examine the impact of a one-day speed-mentoring session with same gender mentors on a cohort's perceptions of a career in surgery. DESIGN: This prospective pre-post study compared attitudes and perceptions of a career in surgery before and after a speed-mentoring session with female surgeons. Mentees were assigned into groups of 1 or 2 and were paired with a female surgeon for 8 minutes. Each mentee group then rotated to another mentor for the same amount of time and this process continued for a total of twelve sessions. Mentees completed a 19-point questionnaire before and after the speed mentoring intervention. Setting: This multicenter study included participants from across the United Kingdom. PARTICIPANTS: Inclusion criteria were female gender and medical student or foundation year doctor (internship year 1 or 2) status. Three hundred and forty participants participated in the intervention, 191 were included in the analysis. RESULTS: Following intervention, the percentage of participants who agreed that having a family would negatively impact a woman's surgical career progression significantly decreased from 46.6% to 23.0%. The percentage of participants who agreed that an “old boys’ club” attitude exists in surgery also significantly decreased (73.8%-58.1%). The percentage of participants who agreed it was more difficult for a woman to succeed in her surgical career than a man significantly decreased (73.8%-64.9%). One hundred and eighty-three (96%) participants agreed that mentorship is important for career progression and 153 (71.2%) participants stated that they did not have someone who they considered a mentor. CONCLUSIONS: Conducting a speed mentoring program with same-gender role models significantly changed female medical students’ and junior doctors’ perceptions of women in surgery. The results suggest that such programs may be effective tools for facilitating mentor-mentee relationships and could be employed by surgical organizations to encourage a diverse uptake into surgery

Dental metric standards for sex estimation in archaeological populations from Iran

Sex estimation of skeletal remains is one of the major components of forensic identification of unknown individuals. Teeth are a potential source of information on sex and are often recovered in archaeological or forensic contexts due to their post-mortem longevity. Currently there is limited data on dental sexual dimorphism of archaeological populations from Iran. This dissertation represents the first study to provide a dental sex estimation method for Iron Age populations. The current study was conducted on the skeletal remains of 143 adults from two Iron Age populations in close temporal and geographic proximity in the Solduz Valley (West Azerbaijan Province of Iran). 2D and 3D cervical mesiodistal and buccolingual and root volume measurements of maxillary and mandibular teeth were used to investigate the degree of sexual dimorphism in permanent dentition and to assess their applicability in sex estimation. In total 1327, 457, and 480 anterior and posterior teeth were used to collect 2D cervical, 3D cervical, and root volume measurements respectively. 2D cervical measurements were taken using Hillson-Fitzgerald dental calliper and 3D measurements were collected using CT images provided by Open Research Scan Archive (ORSA) - Penn Museum. 3D models of the teeth were created using manual segmentation in the Amira 6.01 software package. Since tooth density largely differs from crown to apex, root segmentation required two threshold levels: the segmentation of the root from the jaw and the segmentation of the crown from the root. Thresholds used for root segmentation were calculated using the half maximum height protocol of Spoor et al. (1993) for each skull, and thresholds used for crown segmentation were set visually for each tooth separately. Data was analysed using discriminant function analysis and posterior probabilities were calculated for all produced formulae where sex was previously assessed from morphological features of pelvis and skull. Bootstrapping was used to account for small sample sizes in the analysis. Statistical analysis was carried out using SPSS 23. The percentage of sexual dimorphism was also used to quantify the amount of sexual dimorphism in the sample. The results showed that incisors and canines were the most sexually dimorphic teeth, providing percentages of correct sex classification between 80% and 100% depending on the measurement used. Root volume measurement was shown to be the most sexually dimorphic variable providing an accuracy of over 90% in all functions. The present study provided the first dental metric standards for sex estimation using odontometric data in Iranian archaeological populations. Dental measurements, particularly root volume measurements, were found to be of value for sex assessment and the method presented here could be a useful tool for establishing accurate demographic data from skeletal remains of the Iron Age from Iran

Local interactions governing the performances of Lithium- and Manganese-rich cathodes

The local structural and electronical transformations occurring along the first charge and discharge cycle of Li- and Mn-rich Li[Li0.2Ni0.16Mn0.56Co0.08]O2 cathode material have been characterized by X-ray absorption spectroscopy at several complementary edges. The irreversible spinel formation, occurring at the expenses of the cycling layered phase during the first charge, is quantified (about 10%) and spatially localized. The local strains induced by the Ni oxidation have been evaluated. They induce the formation of a low spin Mn3+ in the layered structure in parallel to the irreversible formation of the spinel phase in the particles bulk. The charge balance has been quantified for all the elements along the first charging cycle, confirming a reversible oxygen oxidation along the charge. Overall, these quantitative results provide an experimental basis for modeling aimed to control the structure and its evolution, for instance, hindering the spinel formation for the benefit of the material cycle life. © 2021 American Chemical Society

Room temperature ionic liquid (RTIL)-based electrolyte cocktails for safe, high working potential Li-based polymer batteries

In this work, we report novel room temperature ionic liquid (RTIL)-based electrolytes to be used with high-energy cathode, lithium-rich nickel manganese cobalt oxide (Li[Li0.2Mn0.56Ni0.16Co0.08]O2, LiR-NMC) in Li-ion batteries. The physical and electrochemical characteristics of the newly developed materials are thoroughly detailed, also by means of post-cycling electrochemical impedance spectroscopy (EIS) analysis of the resulting lab-scale lithium cells upon long-term, constant-current cycling (>1200 cycles). In addition, an innovative polymer electrolyte is developed encompassing the best performing RTIL-based electrolyte mixture, which is investigated in terms of its physico-chemical features, ion transport and electrochemical behaviour by EIS, cyclic voltammetry and constant-current (galvanostatic) cycling. The polymer electrolyte is obtained via facile, rapid and easily up-scalable UV-induced free radical polymerization (UV curing) technique, being a low-cost and solvent-free approach compared to other existing film formation techniques. The versatile fabrication method along with the use of appropriate materials may turn high-voltage, solid state and ageing resistant batteries into industrial reality in the coming years, as underlined by the excellent electrochemical response of the lithium polymer cell

Synergistic electrolyte additives for enhancing the performance of high-voltage lithium-ion cathodes in half-cells and full-cells

Herein we address the key challenge towards the practical use of high-voltage lithium-ion cathode materials, i.e., the insufficient stability of the electrolyte towards oxidation. The transition metals in such materials, especially nickel, catalyze the decomposition reaction of the electrolyte, ultimately leading to poor cycling stability and rapid fading of the battery. To tackle this challenge, a new combination of electrolyte additives is introduced, targeting stabilized electrode/electrolyte interfaces and interphases for both the anode and cathode. The results show that the synergistic effect of tris(trimethylsilyl) phosphite (TTSPi) and bis(2,2,2-trifluoroethyl) carbonate (TFEC) can significantly improve the performance of cathode half-cells and also of lithium-ion full-cells with a cell voltage higher than 4.5 V. Cells using both TTSPi and TFEC as additives show greatly enhanced cycling stability, increased capacity, and improved coulombic efficiency, which can be even further improved when adding also lithium bis(oxalato)borate. © 2020 Elsevier B.V. • Design of an electrolyte composition for high-voltage cathodes. • Enhanced performance for 5 V cathodes and graphite anodes. • In-depth analysis of the SEI and CEI in half-cells and full-cells. • Synergistic effect of TTSPi and TFEC for high-voltage cathodes and graphite anodes. • Further improvement by adding also LiBOB. © 2020 Elsevier B.V