Cerebral venous thrombosis as a complication of intracranial hypotension after lumbar puncture

Background Optic neuritis is recognised by the international classification of headache disorders as a painful cranial nerve lesion. A lumbar puncture may be performed in the investigation of optic neuritis. Postdural puncture headache (PDPH) due to intracranial hypotension is a frequent complication of this procedure. In contrast, cerebral venous thrombosis (CVT) is a rare but potentially fatal complication of dural puncture. A few studies have identified an association between iron deficiency anaemia and venous thrombosis. There are no reports linking CVT with lumbar puncture and iron deficiency anaemia. Methods and results We present a 32-year-old woman with optic neuritis and iron deficiency anaemia complicated by a PDPH and CVT. Conclusion CVT should be considered in a patient with persistent headache, recent lumbar puncture and iron deficiency anaemia. Early recognition and treatment of this condition are vital to avoiding mortality and morbidity

Patients’ experiences of lupus related foot problems : a qualitative investigation

Background: Systemic lupus erythematosus (SLE) can present with a variety of symptoms. Previous research has shown there is a high prevalence of lower limb and foot problems in patients with SLE associated with the musculoskeletal, vascular and neurological changes. Furthermore, there is a high prevalence of infections affecting the feet and a range of common skin and nail problems. However, it is not known how these foot problems impact upon people’s lives. Therefore, we aimed to explore this using a qualitative approach. Method: Following ethical approval, 12 participants were recruited who had a diagnosis of SLE, current and/or past experience of foot problems and were over 18 years in age. Following consent, interviews were carried out with an interpretivist phenomenological approach to both data collection and analysis. Results: Seven themes provide insight into: foot problems and symptoms; the impact of these foot problems and symptoms on activities; disclosure and diagnosis of foot problems; treatment of foot problems and symptoms; perceived barriers to professional foot care; unanswered questions about feet and foot care; and identification of the need for professional foot care and foot care advice. Conclusion: These participants tend to “self-treat” rather than disclose that they may need professional foot care. A lack of focus upon foot health within a medical consultation is attributed to the participant’s belief that it is not within the doctor’s role, even though it is noted to contribute to reduced daily activity. There is a need for feet to be included as a part of patient monitoring and for foot health management to be made accessible for people with SLE

Comparison of dairy cow step activity under different milking schedules

Context. Variations in the number of milkings each day and their timing are becoming increasingly common. How these changes affect cow behaviour is poorly understood. When cows are milked less frequently, their walking to and from the dairy is reduced and their amount of time spent at pasture increases; however, the impact on activity under different milking schedules has not been measured. Aims. The objective of this study was to identify any differences in cow walking activity (steps per hour) among three milking frequencies and three milking schedules of 3-in-2 (milking three times in 2 days), at two stages of lactation (34 and 136 days in milk), over a period of 6 weeks. Time spent eating was assessed to help explain differences in activity within a day. Methods. Data were collected from five groups of 40 cows (n = 200) milked, as follows: once a day (OAD); twice a day (TAD); 3-in-2 (three groups) at intervals of 12–18–18 h, 10–19–19 h, and 8–20–20 h. All cows were fitted with AfiAct pedometers, which recorded steps per hour. Eight cows in each treatment group were also fitted with CowManager SensOor™ ear tags, which recorded minutes per hour spent eating. Key results. Cow steps per hour increased with an increasing milking frequency in both trial periods. When data associated with walking to and from milking were removed, there were still differences in cow step activity. Cows milked OAD took 30% fewer steps than TAD cows. The diurnal pattern of eating time differed between these two trial groups. The effect of milking time among the 3-in-2 trials showed that the shorter the time between the milkings on the day the cows were milked twice, the greater the number of steps per hour. There were graphical eating differences between the 8–20–20 trial group and 12–18–18 trial group on the day that cows were milked twice. Conclusions. We conclude that both the number and timings of milkings affect a cow’s step activity and grazing behaviour. Implications. Farmers should minimise the amount of time cows spend away from the paddock, especially in the afternoon, to minimise any changes to natural behaviour

RAPID COMMUNICATION A RATIONAL APPROACH TO THE DESIGN OF WASTEWATER-FED FISHPONDS

Abstract --A procedure is given for the minimal treatment of wastewater in a 1-day anaerobic pond followed by a 5-day facultative pond prior to discharge into a fishpond. The criterion for the design of the fishpond is a surface loading of total nitrogen of 4 kg N ha "~ d "t. The number of faecal coliforms in the fishpond is then determined; this should be ~, 1000 per 100 ml to ensure that the fish are microbiologically safe for human consumption. Fish (carp and tilapia) yields are of the order of 13 t ha a a-', assuming that the pond is drained and harvested three times a year and that there is a fish loss of 25 percent. Preliminary financial analysis indicates that such a wastewater-fed fishpond system is commercially viable

On acceleration of Krylov-subspace-based Newton and Arnoldi iterations for incompressible CFD: replacing time steppers and generation of initial guess

We propose two techniques aimed at improving the convergence rate of steady state and eigenvalue solvers preconditioned by the inverse Stokes operator and realized via time-stepping. First, we suggest a generalization of the Stokes operator so that the resulting preconditioner operator depends on several parameters and whose action preserves zero divergence and boundary conditions. The parameters can be tuned for each problem to speed up the convergence of a Krylov-subspace-based linear algebra solver. This operator can be inverted by the Uzawa-like algorithm, and does not need a time-stepping. Second, we propose to generate an initial guess of steady flow, leading eigenvalue and eigenvector using orthogonal projection on a divergence-free basis satisfying all boundary conditions. The approach, including the two proposed techniques, is illustrated on the solution of the linear stability problem for laterally heated square and cubic cavities

Motive-demand dynamics creating a social context for students’ learning experiences in a making and design environment

Making and design environments, often referred to as makerspaces, have aroused recent educational interest. These environments typically consist of spaces that support interest-driven engagement in hands-on creative activities with a range of digital artefacts. Although a variety of benefits from participating in making and design activities have been proposed, we currently have limited understanding of students’ learning experiences in makerspaces situated in schools. Following Hedegaards’ conceptualisations, we investigate motive-demand dynamics in students’ social activity in a school-based digital making and design environment, ‘The FUSE Studio’. We highlight our findings via vignettes selected from 65 h of video recordings of 94 students (aged between 9 and 12 years old) carrying out activities; the recordings were collected intermittently from an elective course over one semester. Our study illustrates how the students’ learning experiences were shaped through tension-laden interplay between the motives and demands of their activity situated across personal, relational and institutional contexts. The findings make visible how established ways of working and being at school interacted and came into tension with the students’ motive orientations, thereby limiting and at times transforming the social context of their learning. Our work also demonstrates how the analysis of motive-demand dynamics offers one useful conceptual tool to unpack students’ learning experiences in novel learning environments.Peer reviewe

Anthropometric indices of Gambian children after one or three annual rounds of mass drug administration with azithromycin for trachoma control.

BACKGROUND: Mass drug administration (MDA) with azithromycin, carried out for the control of blinding trachoma, has been linked to reduced mortality in children. While the mechanism behind this reduction is unclear, it may be due, in part, to improved nutritional status via a potential reduction in the community burden of infectious disease. To determine whether MDA with azithromycin improves anthropometric indices at the community level, we measured the heights and weights of children aged 1 to 4 years in communities where one (single MDA arm) or three annual rounds (annual MDA arm) of azithromycin had been distributed. METHODS: Data collection took place three years after treatment in the single MDA arm and one year after the final round of treatment in the annual MDA arm. Mean height-for-age, weight-for-age and weight-for-height z scores were compared between treatment arms. RESULTS: No significant differences in mean height-for-age, weight-for-age or weight-for-height z scores were found between the annual MDA and single MDA arms, nor was there a significant reduction in prevalence of stunting, wasting or underweight between arms. CONCLUSIONS: Our data do not provide evidence that community MDA with azithromycin improved anthropometric outcomes of children in The Gambia. This may suggest reductions in mortality associated with azithromycin MDA are due to a mechanism other than improved nutritional status

P193 USEFUL I: musculoskeletal ultrasound to identify patients with lupus arthritis with better response to therapy

Background In SLE, musculoskeletal manifestations have an impact on quality of life, disability and clinical trial outcomes, but are harder to assess than in RA and PsA. We previously showed that joint swelling lacks sensitivity, specificity and responsiveness compared to ultrasound. USEFUL was a multicentre longitudinal study to determine clinical features predicting ultrasound synovitis and whether patients with ultrasound synovitis respond better to therapy. Methods SLE patients were recruited if the referring physician deemed they had inflammatory pain warranting treatment. Swollen joints were not required. At baseline, physicians recorded the features that led them to diagnose inflammatory pain and features of concurrent fibromyalgia and osteoarthritis. Stable doses of prednisolone (≤5 mg/day), antimalarials or immunosuppressants were allowed. Participants received depomedrone 120 mg IM then were assessed at 0, 2 and 6 weeks for 66/68 swollen and tender joint counts, BILAG-2004, SLEDAI-2K, physician global and MSK-VAS, inflammatory markers, patient pain and disease activity-VAS, HAQ-DI, LupusQoL, ultrasound of hands and wrists (blinded to patient and clinical assessor). An internal pilot determined the primary endpoint: EMS-VAS at 2 weeks (adjusted for baseline) between patients with ultrasound-synovitis vs. normal ultrasound at baseline. Sensitivity analyses adjusted for prednisolone and immunosuppressants. Results 122/133 patients recruited completed all visits. There was significant disagreement between clinical examination and ultrasound. 78/133 had ultrasound synovitis; 68% of these had ≥1 swollen joint. Of 66/133 patients with ≥ 1 swollen joint, 20% had normal ultrasound. Ultrasound-synovitis was more likely with joint swelling, a symmetrical small joint distribution and active serology. Physician-determined EMS, other lupus features or prior response to therapy were not associated. Fibromyalgia or osteoarthritis did not reduce the probability of ultrasound synovitis. In the full analysis set (n=133) there was no difference in EMS VAS at 2 weeks according to ultrasound synovial status as baseline (difference -8 mm, 95% CI -19, 4 mm, p=0.178). 32 patients had fibromyalgia. After excluding these patients, we found a statistically and clinically significantly better clinical response to depomedrone in patients with ultrasound-synovitis at baseline (baseline-adjusted EMS VAS at 2 weeks -12 mm, 95% CI -24, 0 mm, p=0.049). This difference was greater in the treatment-adjusted sensitivity analysis (-12.8 (95% CI -22, -3 mm), p=0.007) and the per-protocol-adjusted sensitivity analysis (-14.8 mm (95% CI -20.8, -8.8 mm), p<0.001). Patient with ultrasound synovitis had higher rates of improvement in the musculoskeletal BILAG-2004 (56% vs. 26%, p=0.09) and SLEDAI-2K (37% vs. 15%, p=0.03). Conclusions In lupus arthritis distribution and serology, but not other features, help identify ultrasound-synovitis. Ultrasound-synovitis was independent of features of fibromyalgia, but fibromyalgia confounded assessment of response. Excluding fibromyalgia, response to therapy was better in patients with abnormal ultrasound compared to normal. Ultrasound should be used to select patients for therapy and clinical trials, especially when there are inflammatory symptoms without swollen joints