Routine repeat head CT may not be necessary for patients with mild TBI.

Background:Routine repeat cranial CT (RHCT) is standard of care for CT-verified traumatic brain injury (TBI). Despite mixed evidence, those with mild TBI are subject to radiation and expense from serial CT scans. Thus, we investigated the necessity and utility of RHCT for patients with mild TBI. We hypothesized that repeat head CT in these patients would not alter patient care or outcomes. Methods:We retrospectively studied patients suffering from mild TBI (Glasgow Coma Scale (GCS) score 13-15) and treated at the R Adams Cowley Shock Trauma Center from November 2014 through January 2015. The primary outcome was the need for surgical intervention. Outcomes were compared using paired Student's t-test, and stratified by injury on initial CT, GCS change, demographics, and presenting vital signs (mean ± SD). Results:Eighty-five patients met inclusion criteria with an average initial GCS score=14.6±0.57. Our center sees about 2800 patients with TBI per year, or about 230 per month. This includes patients with concussions. This sample represents about 30% of patients with TBI seen during the study period. Ten patients required operation (four based on initial CT and others for worsening GCS, headaches, large unresolving injury). There was progression of injury on repeat CT scan in only two patients that required operation, and this accompanied clinical deterioration. The mean brain Abbreviated Injury Scale (AIS) score was 4.8±0.3 for surgical patients on initial CT scan compared with 3.4±0.6 (P<0.001) for non-surgical patients. Initial CT subdural hematoma size was 1.1±0.6 cm for surgical patients compared with 0.49±0.3 cm (P=0.05) for non-surgical patients. There was no significant difference between intervention groups in terms of other intracranial injuries, demographics, vital signs, or change in GCS. Overall, 75 patients that did not require surgical intervention received RHCT. At $340 per CT,$51 000 was spent on unnecessary imaging ($367 000/year, extrapolated). Discussion:In an environment of increased scrutiny on healthcare expenditures, it is necessary to question dogma and eliminate unnecessary cost. Our data questions the use of routine repeat head CT scans in every patient with anatomic TBI and suggests that clinically stable patients with small injury can simply be followed clinically. Level of evidence:Level III

The Gender Gap in Life Expectancy in Urban and Rural China, 2013–2018

Background: Gender differences in mortality are embedded within mortality transitions. Rural residents generally lag behind their urban counterparts in the transitions. The study objective is to identify major causes of death that drive gender differences in mortality in urban and rural China. Methods: We use age-, gender-, urban-rural- and cause-specific mortality data (2013–2018) derived from the national mortality surveillance system that covered about 24% of the Chinese population. We apply Arriaga's method to decompose age- and cause-specific contributions to the gender gap in life expectancy at birth. Analyses are stratified by urban-rural residence. Results: Women had a higher life expectancy at birth than men in both urban and rural areas. Cancers, cardiovascular disease, external causes, and respiratory disease accounted for more than 90% of the gender gap in both areas during 2013–2018. In urban areas, the gender gap decreased from 5.17 years in 2013–2015 to 4.98 years in 2016–2018. In rural areas, the gender gap stayed rather constant (2013–2015: 5.68 years; 2016–2018: 5.65 years). Traffic accidents, among external causes, contributed the most to decreasing the gender gap (urban: −0.07 years; rural: −0.10 years), especially in the 0–44 age group. However, the decrease in the gender gap was counteracted by an increase in the gender gap attributable to ischemic heart disease (urban: +0.05 years; rural: +0.08 years) and lung cancer (urban: +0.02 years; rural: +0.05 years) in older age groups. The gender gap attributable either to cerebrovascular disease or to chronic lower respiratory disease decreased in urban areas but increased in rural areas. Conclusions: The urban-rural variations in the cause-specific contributions to the gender gap in China suggest the necessity of implementing urban-rural-specific interventions to improve population health and health equity

Complexity of decoupling and time-reversal for n spins with pair-interactions: Arrow of time in quantum control

Well-known Nuclear Magnetic Resonance experiments show that the time evolution according to (truncated) dipole-dipole interactions between n spins can be inverted by simple pulse sequences. Independent of n, the reversed evolution is only two times slower than the original one. Here we consider more general spin-spin couplings with long range. We prove that some are considerably more complex to invert since the number of required time steps and the slow-down of the reversed evolutions are necessarily of the order n. Furthermore, the spins have to be addressed separately. We show for which values of the coupling parameters the phase transition between simple and complex time-reversal schemes occurs.Comment: Completely rewritten, new lower bounds on the number of time steps, applications and references adde

Selective excitation enables encoding and measurement of multiple diffusion parameters in a single experiment

Band selectivity to address specific resonances in a spectrum enables one to encode individual settings for diffusion experiments. In a single experiment, this could include different gradient strengths (enabling coverage of a larger range of diffusion constants), different diffusion delays, or different gradient directions (enabling anisotropic diffusion measurement). In this report, a selective variant of the bipolar pulsed gradient eddy current delay (BPP-LED) experiment, enabling selective encoding of three resonances, was implemented. As proof of principle, the diffusion encoding gradient amplitude was assigned a range dependent on the selected signal, thereby allowing the extraction of the diffusion coefficient for water and a tripeptide (Met-Ala-Ser) with optimal settings in a single experiment

Socioeconomic disparity in adult mortality in India: estimations using the orphanhood method

Background Due to a lack of data, no study has yet documented differences in adult life expectancy in India by education, caste, and religion. Objective To examine disparities in socioeconomic status (SES) in the adult mortality rate (40q30) and life expectancy at age 15 (e15) in India. Data and methods We estimated adult mortality by SES with the orphanhood method to analyze information related to the survival of respondents’ parents. We used data from the India Human Development Survey 2011–2012. SES was measured by education, caste, religion, and income of the either deceased adults or their offspring. Results A consistency analysis between orphanhood estimates and official statistics confirmed the robustness of the estimates. Mortality is higher among adults who are illiterate, belong to deprived castes or tribes, have children with a low level of education, and have a low level of household income. The adult mortality rate varies marginally by religion in India. Life expectancy at 15 (e15) is about 3.50 and 5.7 years shorter for illiterate men and women, respectively, compared with literate men and women. The parameter e15 also varies significantly by educational attainment of offspring. On average, parents of children educated to higher secondary level (and above) gain an extra 3.8–4.6 years of adult life compared to parents of illiterate children. Disparity in e15 by caste and religion is smaller than disparity by education or income. Conclusion The adult mortality burden falls disproportionately on illiterate adults and adults with less educated offspring. Thus, educational disparity in adult mortality appears to be prominent in Indian context. In the absence of adult mortality statistics by SES in India, we recommend that large-scale surveys should continue collecting data to allow indirect techniques to be applied to estimate mortality and life expectancy in the country

A Morpho-molecular Perspective on the Diversity and Evolution of Spumellaria (Radiolaria)

Spumellaria (Radiolaria, Rhizaria) are holoplanktonic amoeboid protists, ubiquitous and abundant in the global ocean. Their silicified skeleton preserves very well in sediments, displaying an excellent fossil record extremely valuable for paleo-environmental reconstruction studies, from where most of their extant diversity and ecology have been inferred. This study represents a comprehensive classification of Spumellaria based on the combination of ribosomal taxonomic marker genes (rDNA) and morphological characteristics. In contrast to established taxonomic knowledge, we demonstrate that symmetry of the skeleton takes more importance than internal structures at high classification ranks. Such reconsideration allows gathering different morphologies with concentric structure and spherical or radial symmetry believed to belong to other Radiolaria orders from the fossil record, as for some Entactinaria families. Our calibrated molecular clock dates the origin of Spumellaria in the middle Cambrian (ca. 515 Ma), among the first radiolarian representatives in the fossil record. This study allows a direct connection between living specimens and extinct morphologies from the Cambrian, bringing both a standpoint for future molecular environmental surveys and a better understanding for paleo-environmental reconstruction analysis. (C) 2021 The Authors. Published by Elsevier GmbHThis work was supported by the IMPEKAB ANR 15-CE02-0011 grant and the Brittany Region ARED C16 1520A01, the Japan Society for Promotion of Science KAKENHI Grant No. K16K0-74750 for N. Suzuki and "the Cooperative Research Project with the Japan Science and Technology Agency (JST) and Centre National de la Recherche Scientifique (CNRS, France) "Morphomolecular Diversity Assessment of Ecologically, Evolutionary, and Geo-logically Relevant Marine Plankton (Radiolaria) ". We are grateful to the CNRS-Sorbonne University ABiMS bioinformatics platform (http://abims.sbroscoff.fr) for providing computational resources. The authors are grateful to the MOOSE observation national network (funded by CNRS-INSU and Research Infrastructure ILICO) which sustain the annual ship-based hydrographic sections in the northwestern Mediterranean Sea (MOOSEGE) , as well as John Dolan for hosting us multiple times at the Laboratoire d'Oceanographie of Villefranche sur Mer. We are greatly thankful to Cedric Berney for the phylogenetic advice and the valuable help on the interpretation of the "symbiotic" clade, as well as Vasily Zlatogursky for his contributions and feed-back on the heliozoan-like organism