Answer to photo quiz: Tunga penetrans

For both patients, considering the characteristics of the lesions, the epidemiological history of travel, and the microscopic study, a diagnosis of tungiasis was made. Tunga penetrans (sand flea) is a hematophagous flea 1 mm in length, whose habitat is warm, dry, sandy soils. This flea is widely distributed in parts of East and West Africa, South America, and the Caribbean and in countries bordering the Indian Ocean. This flea presents a wide range of wild and domestic hosts, humans being an accidental host. Occasionally, tourists from developed countries are diagnosed with tungiais after becoming infected in areas where the disease is endemic...

Thermal and Non-thermal X-Rays from the LMC Super Bubble 30 Dor C

We report on the discovery of thermal and non-thermal X-rays from the shells of the super bubble (SB) 30 Dor C in the Large Magellanic Cloud (LMC). The X-ray morphology is a nearly circular shell with a radius of about 40 pc, which is bright on the northern and western sides. The spectra of the shells are different from region to region. The southern shell shows clear emission lines, and is well fitted with a model of a thin-thermal plasma (kT = 0.21keV) in non-equilibrium ionization (NEI) plus a power-law component. This thermal plasma is located inside of the H alpha emission, which is the outer edge of the shell of the SB. The northern and western sides of the SB are dim in H alpha emission, but are bright in non-thermal (power-law) X-rays with a photon index of 2.1-2.9. The non-thermal X-ray shell traces the outer boundary of the radio shell. These features of thin-thermal and non-thermal X-rays are similar to those of SN 1006, a prototype of synchrotron X-ray shell, but the non-thermal component of 30 Dor C is about ten-times brighter than that of SN 1006. 30 Dor C is the first candidate of an extragalactic SB, in which energetic electrons are accelerating in the shell. The age is much older than that of SN 1006, and hence the particle acceleration time in this SB may be longer than those in normal shell-like SNRs. We found point-like sources associated with some of tight star clusters. The X-ray luminosity and spectrum are consistent with those of young clusters of massive stars. Point-like sources with non-thermal spectra are also found in the SB. These may be background objects (AGNs) or stellar remnants (neutron stars or black holes).Comment: 11 pages, 6 figures, Accepted for publication in ApJ, the paper with full resolution images in http://www-cr.scphys.kyoto-u.ac.jp/member/bamba/Paper/30DorC.pd

Multi-scenario modelling of learning

International audienceDesigning an educational scenario is a sensitive and challenging activity because it is the vector of learning. However, the designed scenario may not correspond to some learners’ characteristics (pace of work, cognitive styles, emotional factors, prerequisite knowledge, …). To personalize the learning task and adapt it gradually to each learner, several scenarios are needed. Adaptation and personalization are difficult because it is necessary on the one hand to know in advance the profiles and on the other hand to produce the multiple scenarios corresponding to these profiles. Our model allows to design many scenarios without knowing the learner profiles beforehand. Furthermore, it offers each learner opportunities to choose a scenario and to change it during their learning process. The model ensures that all announced objectives have enough resources for acquiring knowledge and activities for evaluation

Different femoral rotation with navigated flexion-gap balanced or measured resection in total knee arthroplasty does not lead to different clinical outcomes

PURPOSE: Femoral rotation in total knee arthroplasty (TKA) is hypothesized to vary in the same knee depending on the method used to establish it. METHODS: Thirty-eight patients who underwent TKA surgery using a measured resection technique (RT) were compared with 40 patients who underwent a flexion-gap balancing technique with computer-assisted (for navigation) surgery (FB-CAS) to assess clinical and radiographic alignment differences at two years postoperatively. In 36 of the 40 patients in the FB-CAS group, both methods were used. Intraoperatively, the transepicondylar femoral rotation (TEFR) in reference to the transepicondylar axis was established as the rotation that balanced the flexion gap. Once the TEFR was obtained, an analogous rotation as measured by a posterior reference femoral rotation (PRFR) cutting guide was determined. RESULTS: Femoral component rotation determined by the TEFR and PRFR methods differed in each of the knees. The median TEFR was 0.08°±0.6° (range -¿1.5°, 1.5°), and the median PRFR was 0.06°±2.8° (range -¿6°, 5°). The mean difference in the rotational alignment between the TEFR and PRFR techniques was 0.01° ± 3.1°. The 95% limits of agreement between the mean differences in measurements were between 6.2° external rotation and -¿6.1° internal rotation. At 2 years postoperatively, we found no differences in the radiographic or clinical American Knee Society score between the two groups. CONCLUSION: Rotation of the femoral component in TKA can vary in the same knee depending on the surgical method used to establish it. This variation in femoral rotation is sufficiently small enough to have no apparent effect on the 2-year clinical outcome score.Postprint (author's final draft

Integrating health behavior theory and design elements in serious games.

Background: Internet interventions for improving health and well-being have the potential to reach many people and fill gaps in service provision. Serious gaming interfaces provide opportunities to optimize user adherence and impact. Health interventions based in theory and evidence and tailored to psychological constructs have been found to be more effective to promote behavior change. Defining the design elements which engage users and help them to meet their goals can contribute to better informed serious games. Objective: To elucidate design elements important in SPARX, a serious game for adolescents with depression, from a user-centered perspective. Methods: We proposed a model based on an established theory of health behavior change and practical features of serious game design to organize ideas and rationale. We analyzed data from 5 studies comprising a total of 22 focus groups and 66 semistructured interviews conducted with youth and families in New Zealand and Australia who had viewed or used SPARX. User perceptions of the game were applied to this framework. Results: A coherent framework was established using the three constructs of self-determination theory (SDT), autonomy, competence, and relatedness, to organize user perceptions and design elements within four areas important in design: computer game, accessibility, working alliance, and learning in immersion. User perceptions mapped well to the framework, which may assist developers in understanding the context of user needs. By mapping these elements against the constructs of SDT, we were able to propose a sound theoretical base for the model. Conclusions: This study’s method allowed for the articulation of design elements in a serious game from a user-centered perspective within a coherent overarching framework. The framework can be used to deliberately incorporate serious game design elements that support a user’s sense of autonomy, competence, and relatedness, key constructs which have been found to mediate motivation at all stages of the change process. The resulting model introduces promising avenues for future exploration. Involving users in program design remains an imperative if serious games are to be fit for purpose

Understanding the ongoing learning needs of Australian metropolitan, rural and remote paediatricians: Evaluation of a neurology outreach programme

Aim: The purpose of this study was to evaluate whether a neurology outreach teaching programme delivered via video-teleconferencing (6 × 60 min live sessions every 6–8 weeks) is acceptable, contributes to understanding and meets the neurology learning needs of Australian paediatricians from metropolitan, rural and remote areas. Methods: A sample of six NSW sites that joined the neurology outreach programme between 2017 and 2019 (Arm 1) and six interstate sites from QLD, WA and TAS who commenced the programme in 2020 (Arm 2) participated. A mixed-methods survey explored participants' learning needs and value of the programme. Results: Forty-six participants submitted programme evaluation surveys (26 arm 1, 20 arm 2); 9 were removed due to insufficient data (n = 37). Quantitative and qualitative data showed the programme was acceptable in format, relevant to practice, appropriate for clinician learning needs, and engaging. Clinicians reported improvement in understanding and confidence. Participants felt more connected/less isolated and up-to-date. Participants reported a positive impact from the programme on approach to neurological problems and ensuing consults, and more differentiated and appropriate paediatric neurology referrals. Conclusion: This study validates the live video-teleconference outreach model as an acceptable, effective and important means of providing continuing neurology education for Australian paediatricians

Ejecta, Dust, and Synchrotron Radiation in B0540-69.3: A More Crab-Like Remnant than the Crab

We present near and mid-infrared observations of the pulsar-wind nebula (PWN) B0540-69.3 and its associated supernova remnant made with the {\it Spitzer Space Telescope}. We report detections of the PWN with all four IRAC bands, the 24 $\mu$m band of MIPS, and the Infrared Spectrograph (IRS). We find no evidence of IR emission from the X-ray/radio shell surrounding the PWN resulting from the forward shock of the supernova blast wave. The flux of the PWN itself is dominated by synchrotron emission at shorter (IRAC) wavelengths, with a warm dust component longward of 20 $\mu$m. We show that this dust continuum can be explained by a small amount (\sim 1-3 \times 10^{-3} \msun) of dust at a temperature of $\sim 50-65$ K, heated by the shock wave generated by the PWN being driven into the inner edge of the ejecta. This is evidently dust synthesized in the supernova. We also report the detection of several lines in the spectrum of the PWN, and present kinematic information about the PWN as determined from these lines. Kinematics are consistent with previous optical studies of this object. Line strengths are also broadly consistent with what one expects from optical line strengths. We find that lines arise from slow ($\sim 20$ km s$^{-1}$) shocks driven into oxygen-rich clumps in the shell swept-up by an iron-nickel bubble, which have a density contrast of $\sim 100-200$ relative to the bulk of the ejecta, and that faster shocks ($\sim 250$ km s$^{-1}$) in the hydrogen envelope are required to heat dust grains to observed temperatures. We infer from estimates of heavy-element ejecta abundances that the progenitor star was likely in the range of 20-25 $M_\odot$.Comment: 46 pages, 10 figures, accepted for publication in Ap

Perivascular spaces are associated with tau pathophysiology and synaptic dysfunction in early Alzheimer’s continuum

Background: Perivascular spaces (PVS) have an important role in the elimination of metabolic waste from the brain. It has been hypothesized that the enlargement of PVS (ePVS) could be affected by pathophysiological mechanisms involved in Alzheimer’s disease (AD), such as abnormal levels of CSF biomarkers. However, the relationship between ePVS and these pathophysiological mechanisms remains unknown. Objective: We aimed to investigate the association between ePVS and CSF biomarkers of several pathophysiological mechanisms for AD. We hypothesized that ePVS will be associated to CSF biomarkers early in the AD continuum (i.e., amyloid positive cognitively unimpaired individuals). Besides, we explored associations between ePVS and demographic and cardiovascular risk factors. Methods: The study included 322 middle-aged cognitively unimpaired participants from the ALFA + study, many within the Alzheimer’s continuum. NeuroToolKit and Elecsys® immunoassays were used to measure CSF Aβ42, Aβ40, p-tau and t-tau, NfL, neurogranin, TREM2, YKL40, GFAP, IL6, S100, and α-synuclein. PVS in the basal ganglia (BG) and centrum semiovale (CS) were assessed based on a validated 4-point visual rating scale. Odds ratios were calculated for associations of cardiovascular and AD risk factors with ePVS using logistic and multinomial models adjusted for relevant confounders. Models were stratified by Aβ status (positivity defined as Aβ42/40 < 0.071). Results: The degree of PVS significantly increased with age in both, BG and CS regions independently of cardiovascular risk factors. Higher levels of p-tau, t-tau, and neurogranin were significantly associated with ePVS in the CS of Aβ positive individuals, after accounting for relevant confounders. No associations were detected in the BG neither in Aβ negative participants. Conclusions: Our results support that ePVS in the CS are specifically associated with tau pathophysiology, neurodegeneration, and synaptic dysfunction in asymptomatic stages of the Alzheimer’s continuum

Forskolin-induced Organoid Swelling is Associated with Long-term CF Disease Progression

RATIONALE: Cystic fibrosis (CF) is a monogenic life-shortening disease associated with highly variable individual disease progression which is difficult to predict. Here we assessed the association of forskolin-induced swelling (FIS) of patient-derived organoids (PDO) with long-term CF disease progression in multiple organs and compared FIS with the golden standard biomarker sweat chloride concentration (SCC). METHODS: We retrieved 9-year longitudinal clinical data from the Dutch CF Registry of 173 people with mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Individual CFTR function was defined by FIS, measured as the relative size increase of intestinal organoids after stimulation with 0.8 µM forskolin, quantified as area under the curve (AUC). We used linear mixed effect models and multivariable logistic regression to estimate the association of FIS with long-term FEV1pp decline and development of pancreatic insufficiency, CF-related liver disease and diabetes. Within these models, FIS was compared with SCC. RESULTS: FIS was strongly associated with longitudinal changes of lung function, with an estimated difference in annual FEV1pp decline of 0.32% (95%CI: 0.11%-0.54%; p=0.004) per 1000-points change in AUC. Moreover, increasing FIS levels were associated with lower odds of developing pancreatic insufficiency (adjusted OR: 0.18, 95%CI: 0.07-0.46, p<0.001), CF-related liver disease (adjusted OR: 0.18, 95%CI: 0.06-0.54, p=0.002) and diabetes (adjusted OR: 0.34, 95%CI: 0.12-0.97, p=0.044). These associations were absent for SCC. CONCLUSION: This study exemplifies the prognostic value of a PDO-based biomarker within a clinical setting, which is especially important for people carrying rare CFTR mutations with unclear clinical consequences