Staged endovascular repair of an abdominal aortic aneurysm adjacent to a chronic high-flow iliocaval traumatic arteriovenous fistula

Large-vessel chronic traumatic arteriovenous fistulas are a rare complication after trauma. Delayed presentation can consist of one or more features of high-output cardiac failure, pulsatile abdominal mass, bruit, limb ischemia, and venous congestion. We describe a patient with a complex iliocaval fistula secondary to a remote gunshot wound associated with a large 8.5-cm aortic aneurysm. Informed consent of the patient was obtained for publication of the case

Cryptic multicolored lizards in the Polychrus marmoratus Group (Squamata: Sauria: Polychrotidae) and the status of Leiolepis auduboni Hallowell

The Neotropical genus Polychrus contains seven species of arboreal lizards. The type species for the genus is the widespread Polychrus marmoratus. We compared a few populations of P. marmoratus using 16S and COI mitochondrial gene sequences (1,035 bp total) and found several lineages existing under the name Polychrus marmoratus. Working backwards, using morphology we identify Polychrus marmoratus from the Guiana Shield and resurrect the name Leiolepis auduboni Hallowell for the species present in Trinidad, Tobago, and northern Venezuela. The number of species in the genus Polychrus is raised to eight. However, we also discuss evidence for the existence of other cryptic species withi

Effect of pH and heat treatment on viscosity and heat coagulation properties of milk protein concentrate

peer-reviewedThe effect of pH, adjusted using either hydrochloric acid (HCl), citric acid or sodium hydroxide, on calcium ion (Ca2+) activity, and consequent changes in viscosity and heat coagulation time (HCT) of milk protein concentrate (MPC) was investigated. Reducing the pH of MPC dispersions resulted in a reduction in their viscosity, which subsequently increased during heat treatment. The maximum heat stability of MPC was observed at pH 6.7. Reducing the pH of MPC from 6.7 to 6.2 resulted in a significant (P < 0.05) increase in Ca2+ activity, and reduction in HCT. Such changes were more extensive using HCl compared with citric acid. Increasing the pH greater than 6.7 also led to a reduction in HCT but a decrease in Ca2+ activity. These results demonstrate the importance of pH adjustment, and choice of acidulant, on Ca2+ activity, viscosity, and heat coagulation properties of MPC concentrates during processing

Changes in presentations with features potentially indicating cancer in primary care during the COVID-19 pandemic:a retrospective cohort study

OBJECTIVES: To investigate how the COVID-19 pandemic affected the number of people aged 50+ years presenting to primary care with features that could potentially indicate cancer, and to explore how reporting differed by patient characteristics and in face-to-face vs remote consultations. DESIGN, SETTING AND PARTICIPANTS: A retrospective cohort study of general practitioner (GP), nurse and paramedic primary care consultations in 21 practices in South-West England covering 123 947 patients. The models compared potential cancer indicators reported in April–July 2019 with April–July 2020. MAIN OUTCOME MEASURES: Potential indicators of cancer were identified using code lists for symptoms, signs, test results and diagnoses listed in the National Institute for Health and Care Excellence suspected cancer referral guidance (NG12). RESULTS: During April–July 2019, 17% of registered patients aged 50+ years reported a potential cancer indicator in a consultation with a GP or nurse. During April–July 2020, this reduced to 11% (incidence rate ratio (IRR) 0.64, 95% CI 0.62 to 0.67, p<0.001). Reductions in potential cancer indicators were stable across age group, sex, ethnicity, index of multiple deprivation quintile and shielding status, but less marked in patients with mental health conditions than without (IRR 0.75, 95% CI 0.72 to 0.79, interaction p<0.001). Proportions of GP consultations with potential indicators of cancer reduced between 2019 and 2020 for face-to-face consultations (IRR 0.84, 95% CI 0.76 to 0.92, p<0.001) and increased for remote consultations (IRR 1.17, 95% CI 1.07 to 1.29, p=0.001), although it remained lower in remote consulting than face-to-face in April–July 2020. This difference was greater for nurse/paramedic consultations (face-to-face: IRR 0.61, 95% CI 0.44 to 0.83, p=0.002; remote: IRR 1.60, 95% CI 1.10 to 2.333, p=0.014). CONCLUSION: The number of patients consulting with presentations that could potentially indicate cancer reduced during the first wave of the COVID-19 pandemic. Patients should be encouraged to continue contacting primary care for persistent signs and symptoms, and GPs and nurses should be encouraged to probe patients for further information during remote consulting, in the absence of non-verbal cues

Van Allen probes observations of a three-dimensional field line resonance at a plasmaspheric plume

Funding: JKS, KRM, and IJR acknowledge support from NERC Grants NE/P017185/2, NE/V002554/2, and STFC Grants ST/V006320/1, ST/X001008/1. DPH acknowledges NASA Grant 80NSSC20K1324. ANW was funded in part by STFC Grant ST/W001195/1. AWS was supported by NERC Independent Research Fellowship NE/W009129/1.Field Line Resonances (FLRs) are a critical component in Earth's magnetospheric dynamics, associated with the transfer of energy between Ultra Low Frequency waves and local plasma populations. In this study we investigate how the polarisation of FLRs are impacted by cold plasma density distributions during geomagnetic storms. We present an analysis of Van Allen Probe A observations, where the spacecraft traversed a storm time plasmaspheric plume. We show that the polarisation of the FLR is significantly altered at the sharp azimuthal density gradient of the plume boundary, where the polarisation is intermediate with significant poloidal and toroidal components. These signatures are consistent with magnetohydrodynamic modeling results, providing the first observational evidence of a 3D FLR associated with a plume in Earth's magnetosphere. These results demonstrate the importance of cold plasma in controlling wave dynamics in the magnetosphere, and have important implications for wave-particle interactions at a range of energies.Publisher PDFPeer reviewe

The Grizzly, October 18, 1985

Limerick: The Main Objective - Calm • Typesetting Equipment Offers New Experience • Letters: Ex-Rover Responds; Some Housing Needs Help; Reply for Sluggo • Financial Aid Striving to the Top • Search of Success Finds Bravo • Look Out for the Candid Cameras • Sorority Pledging Sees Light Through Tunnel • Field Hockey Battles Tough Competition • Booters Find Easier Times • Ultimate Frisbee is Here • Doleniak: Flying Higher Through the Sky • Grizzlies are Defeated • Campus Security Noteshttps://digitalcommons.ursinus.edu/grizzlynews/1148/thumbnail.jp

Infections in hematopoietic cell transplant recipients: Results from the Organ Transplant Infection Project, a multicenter, prospective, cohort study

Background. Infection is a major cause of morbidity and mortality after allogeneic hematopoietic cell transplantation (HCT). Our object was to better define the epidemiology and outcomes of infections after HCT. Methods. This was a prospective, multicenter cohort study of HCT recipients and conducted from 2006 to 2011. The study included 4 US transplant centers and 444 HCT recipients. Data were prospectively collected for up to 30 months after HCT using a standardized data collection tool. Results. The median age was 53 years, and median follow up was 413 (range, 5-980) days. The most common reason for HCT was hematologic malignancy (87%). The overall crude mortality was 52%. Death was due to underlying disease in 44% cases and infection in 21%. Bacteremia occurred in 231 (52%) cases and occurred early posttransplant (median day 48). Gram-negative bloodstream infections were less frequent than Gram-positive, but it was associated with higher mortality (45% vs 13%, P = .02). Clostridium difficile infection developed in 148 patients (33%) at a median of 27 days post-HCT. There were 53 invasive fungal infections (IFIs) among 48 patients (11%). The median time to IFI was 142 days. Of 155 patients with cytomegalovirus (CMV) infection, 4% had CMV organ involvement. Varicella zoster infection (VZV) occurred in 13 (4%) cases and was disseminated in 2. Infection with respiratory viruses was seen in 49 patients. Pneumocystis jirovecii pneumonia was rare (1%), and there were no documented cases of nocardiosis, toxoplasmosis, endemic mycoses, or mycobacterial infection. This study lacked standardized antifungal and antiviral prophylactic strategies. Conclusions. Infection remains a significant cause of morbidity and mortality after HCT. Bacteremias and C difficile infection are frequent, particularly in the early posttransplant period. The rate of IFI is approximately 10%. Organ involvement with CMV is infrequent, as are serious infections with VZV and herpes simplex virus, likely reflecting improved prevention strategies