An unusual presentation of cirrhotic pleural effusion in a patient with no ascites: a case report

Pleural effusion that develops in a patient with cirrhosis and portal hypertension, in the absence of cardiopulmonary disease, is termed hepatic hydrothorax. Hepatic hydrothorax very rarely presents in the absence of ascites. Although the exact mechanism is somewhat controversial, pleural effusion occurs when ascitic fluid moves through diaphragmatic defects which are opened up by increased intra-abdominal pressure. We report a case report of cirrhotic pleural effusion in a patient with no clinical or radiographic evidence of ascites and discuss the pathogenesis, diagnosis and management of this condition

Factors influencing the utilization of health facilities for childbirth in a disadvantaged community of Lalitpur, Nepal

Background: In Nepal, half of deliveries take place at home (HMIS 2014), while institutional birth assisted by skilled birth attendants (SBAs) are still infrequent. Objectives: This study explores factors influencing the utilization of health facilities for childbirth in a disadvantaged community of rural Nepal. Method: A qualitative study with two focus groups: mothers-in-law and husbands, and female community health volunteers. 28 semi-structured in-depth interviews were conducted with selected participants 20 mothers and 8 grass-root and policy level stakeholders. Data were analysed by three delays model of conceptual framework. Results: The main reasons for giving birth at home included cultural tradition, lack of awareness about danger signs during pregnancy and childbirth, about importance of skilled birth attendants and lack of knowledge about availability of free 24-hours delivery sites/birthing centers, inability to afford two way transportation costs despite transport incentives provided by government for institutional delivery, fear of episiotomy/surgery/physical abuse and health service provider’s attitude for home delivery. Health facilities were mostly used by women who experienced complications during childbirth Policy Implications: Significant gaps from policy to grass root levels were identified which -suggests that dissemination of information about free delivery must be more effective. The health workers should convincingly inform families about benefits of institutional delivery, especially in marginalized/disadvantaged communities

Non-destructive shadowgraph imaging of ultracold atoms

An imaging system is presented that is capable of far-detuned non-destructive imaging of a Bose-Einstein condensate with the signal proportional to the second spatial derivative of the density. Whilst demonstrated with application to $^{85}\text{Rb}$, the technique generalizes to other atomic species and is shown to be capable of a signal to noise of ${\sim}25$ at $1$GHz detuning with $100$ in-trap images showing no observable heating or atom loss. The technique is also applied to the observation of individual trajectories of stochastic dynamics inaccessible to single shot imaging. Coupled with a fast optical phase lock loop, the system is capable of dynamically switching to resonant absorption imaging during the experiment.Comment: 4 pages, 5 figure

A quantum sensor: simultaneous precision gravimetry and magnetic gradiometry with a Bose-Einstein condensate

A Bose-Einstein condensate is used as an atomic source for a high precision sensor. A $5\times 10^6$ atom F=1 spinor condensate of $^{87}$Rb is released into free fall for up to $750$ms and probed with a Mach-Zehnder atom interferometer based on Bragg transitions. The Bragg interferometer simultaneously addresses the three magnetic states, $\left| m_f=1,0,-1 \right\rangle$, facilitating a simultaneous measurement of the acceleration due to gravity with an asymptotic precision of $2.1\times 10^{-9}$$\Delta$g/g and the magnetic field gradient to a precision $8$pT/m

International variation in invasive care of the elderly with acute coronary syndromes

Aims To explore variations in invasive care of the elderly with acute coronary syndromes across international practice. Methods and results Using combined populations from the SYMPHONY and 2nd SYMPHONY trials, we describe 30-day cardiac catheterization in elderly (≥75 years; n=1794) vs. younger patients (<75 years; n=14 043) after multivariable adjustment and by region of enrolment. The use of cardiac catheterization and revascularization were not protocol-specified. Elderly patients (median age 78 years) were more often female and more frequently had hypertension, diabetes, prior myocardial infarction, and prior coronary bypass surgery. Overall, they underwent less cardiac catheterization than younger patients [53 vs. 63%; adjusted OR 0.53 (0.46, 0.60)]. The absolute rate of cardiac catheterization in the elderly varied from 77% (vs. 91% in younger patients) in the US cohort to 27% (vs. 41% in younger patients) in the non-US cohort. Revascularization of elderly who underwent cardiac catheterization was also higher in US than non-US cohorts (71.3 vs. 53.6%). There was a significant interaction between the patient age and the use of catheterization across US and non-US regions of enrolment, as well as differences in the predictors of catheterization in the elderly. Despite these findings, after adjustment, 90-day rates of death and death or myocardial infarction (MI) were not significantly different in elderly who underwent catheterization compared with those who did not. Conclusion Although older age is universally predictive of lower use of cardiac catheterization, marked variation in catheterization of the elderly exists across international practice. Demonstrated differences in patterns of use suggest a lack of consensus regarding optimal use of an invasive strategy in the elderl

Differential livelihood adaptation to social-ecological change in coastal Bangladesh

Social-ecological changes, brought about by the rapid growth of the aquaculture industry and the increased occurrence of climatic stressors, have significantly affected the livelihoods of coastal communities in Asian mega-deltas. This paper explores the livelihood adaptation responses of households of different wealth classes, the heterogeneous adaptation opportunities, barriers and limits (OBLs) faced by these households and the dynamic ways in which these factors interact to enhance or impede adaptive capacities. A mixed methods approach was used to collect empirical evidence from two villages in coastal Bangladesh. Findings reveal that households’ adaptive capacities largely depend on their wealth status, which not only determine their availability of productive resources, but also empower them to navigate social-ecological change in desirable ways. Households operate within a shared response space, which is shaped by the broader socio-economic and political landscape, as well as their previous decisions that can lock them in to particular pathways. While an adaptive response may be effective for one social group, it may cause negative externalities that can undermine the adaptation options and outcomes of another group. Adaptation OBLs interact in complex ways; the extent to which these OBLs affect different households depend on the specific livelihood activities being considered and the differential values and interests they hold. To ensure more equitable and environmentally sustainable livelihoods in future, policies and programs should aim to expand households’ adaptation space by accounting for the heterogeneous needs and complex interdependencies between response processes of different groups

Single-molecule multiparameter fluorescence spectroscopy reveals directional MutS binding to mismatched bases in DNA

Mismatch repair (MMR) corrects replication errors such as mismatched bases and loops in DNA. The evolutionarily conserved dimeric MMR protein MutS recognizes mismatches by stacking a phenylalanine of one subunit against one base of the mismatched pair. In all crystal structures of G:T mismatch-bound MutS, phenylalanine is stacked against thymine. To explore whether these structures reflect directional mismatch recognition by MutS, we monitored the orientation of Escherichia coli MutS binding to mismatches by FRET and anisotropy with steady state, pre-steady state and single-molecule multiparameter fluorescence measurements in a solution. The results confirm that specifically bound MutS bends DNA at the mismatch. We found additional MutS–mismatch complexes with distinct conformations that may have functional relevance in MMR. The analysis of individual binding events reveal significant bias in MutS orientation on asymmetric mismatches (G:T versus T:G, A:C versus C:A), but not on symmetric mismatches (G:G). When MutS is blocked from binding a mismatch in the preferred orientation by positioning asymmetric mismatches near the ends of linear DNA substrates, its ability to authorize subsequent steps of MMR, such as MutH endonuclease activation, is almost abolished. These findings shed light on prerequisites for MutS interactions with other MMR proteins for repairing the appropriate DNA strand