An unusual cause of subarachnoid haemorrhage in a patient with newly diagnosed neurofibromatosis: a case report

Introduction In this report we discuss an unusual cause of subarachnoid haemorrhage in association with neurofibromatosis. Case presentation A previously fit 55-year-old man developed sudden onset headache with loss of consciousness. He was comatose on admission with no focal neurological signs. Numerous neurofibromas and café-au-lait patches were noted, indicating neurofibromatosis type 1 which had not been previously diagnosed. Computer Tomography brain revealed a grade IV subarachnoid haemorrhage in association with numerous vascular lesions on cerebral angiography. Conclusion A rare cause of subarachnoid haemorrhages was identified and is discussed in detail

Researching Zika in pregnancy:lessons for global preparedness

Our understanding of congenital infections is based on prospective studies of women infected during pregnancy. The EU has funded three consortia to study Zika virus, each including a prospective study of pregnant women. Another multi-centre study has been funded by the US National Institutes of Health. This Personal View describes the study designs required to research Zika virus, and questions whether funding academics in the EU and USA to work with collaborators in outbreak areas is an effective strategy. 3 years after the 2015\u201316 Zika virus outbreaks, these collaborations have taught us little about vertical transmission of the virus. In the time taken to approve funding, agree contracts, secure ethics approval, and equip laboratories, Zika virus had largely disappeared. By contrast, prospective studies based on local surveillance and standard-of-care protocols have already provided valuable data. Threats to fetal and child health pose new challenges for global preparedness requiring support for the design and implementation of locally appropriate protocols. These protocols can answer the key questions earlier than externally designed studies and at lower cost. Local protocols can also provide a framework for recruitment of unexposed controls that are required to study less specific outcomes. Other priorities include accelerated development of non-invasive tests, and longer-term storage of neonatal and antenatal samples to facilitate retrospective reconstruction of cohort studies

Neurodegenerative Disease and the NLRP3 Inflammasome.

The prevalence of neurodegenerative disease has increased significantly in recent years, and with a rapidly aging global population, this trend is expected to continue. These diseases are characterised by a progressive neuronal loss in the brain or peripheral nervous system, and generally involve protein aggregation, as well as metabolic abnormalities and immune dysregulation. Although the vast majority of neurodegeneration is idiopathic, there are many known genetic and environmental triggers. In the past decade, research exploring low-grade systemic inflammation and its impact on the development and progression of neurodegenerative disease has increased. A particular research focus has been whether systemic inflammation arises only as a secondary effect of disease or is also a cause of pathology. The inflammasomes, and more specifically the NLRP3 inflammasome, a crucial component of the innate immune system, is usually activated in response to infection or tissue damage. Dysregulation of the NLRP3 inflammasome has been implicated in the progression of several neurodegenerative disorders, such as Alzheimer's disease, Parkinson's disease, Huntington's disease, amyotrophic lateral sclerosis, and prion diseases. This review aims to summarise current literature on the role of the NLRP3 inflammasome in the pathogenesis of neurodegenerative diseases, and recent work investigating NLRP3 inflammasome inhibition as a potential future therapy

An intelligent interface for integrating climate, hydrology, agriculture, and socioeconomic models

Understanding the interactions between natural processes and human activities poses major challenges as it requires the integration of models and data across disparate disciplines. It typically takes many months and even years to create valid end-to-end simulations as different models need to be configured in consistent ways and generate data that is usable by other models. MINT is a novel framework for model integration that captures extensive knowledge about models and data and aims to automatically compose them together. MINT guides a user to pose a well-formed modeling question, select and configure appropriate models, find and prepare appropriate datasets, compose data and models into end-to-end workflows, run the simulations, and visualize the results. MINT currently includes hydrology, agriculture, and socioeconomic models.Office of the VP for Researc

Geometry of River Networks II: Distributions of Component Size and Number

The structure of a river network may be seen as a discrete set of nested sub-networks built out of individual stream segments. These network components are assigned an integral stream order via a hierarchical and discrete ordering method. Exponential relationships, known as Horton's laws, between stream order and ensemble-averaged quantities pertaining to network components are observed. We extend these observations to incorporate fluctuations and all higher moments by developing functional relationships between distributions. The relationships determined are drawn from a combination of theoretical analysis, analysis of real river networks including the Mississippi, Amazon and Nile, and numerical simulations on a model of directed, random networks. Underlying distributions of stream segment lengths are identified as exponential. Combinations of these distributions form single-humped distributions with exponential tails, the sums of which are in turn shown to give power law distributions of stream lengths. Distributions of basin area and stream segment frequency are also addressed. The calculations identify a single length-scale as a measure of size fluctuations in network components. This article is the second in a series of three addressing the geometry of river networks.Comment: 16 pages, 13 figures, 4 tables, Revtex4, submitted to PR

Analyzing the impact of course structure on electronic textbook use in blended introductory physics courses

We investigate how elements of course structure (i.e., the frequency of assessments as well as the sequencing and weight of course resources) influence the usage patterns of electronic textbooks (e-texts) in introductory physics courses. Specifically, we analyze the access logs of courses at Michigan State University and the Massachusetts Institute of Technology, each of which deploy e-texts as primary or secondary texts in combination with different formative assessments (e.g., embedded reading questions) and different summative assessment (exam) schedules. As such studies are frequently marred by arguments over what constitutes a “meaningful” interaction with a particular page (usually judged by how long the page remains on the screen), we consider a set of different definitions of “meaningful” interactions. We find that course structure has a strong influence on how much of the e-texts students actually read, and when they do so. In particular, courses that deviate strongly from traditional structures, most notably by more frequent exams, show consistently high usage of the materials with far less “cramming” before exams.National Science Foundation (U.S.) (Grant DUE-1044294)Google (Firm

Analyzing the impact of course structure on electronic textbook use in blended introductory physics courses

We investigate how elements of course structure (i.e., the frequency of assessments as well as the sequencing and weight of course resources) influence the usage patterns of electronic textbooks (e-texts) in introductory physics courses. Specifically, we analyze the access logs of courses at Michigan State University and the Massachusetts Institute of Technology, each of which deploy e-texts as primary or secondary texts in combination with different formative assessments (e.g., embedded reading questions) and different summative assessment (exam) schedules. As such studies are frequently marred by arguments over what constitutes a “meaningful” interaction with a particular page (usually judged by how long the page remains on the screen), we consider a set of different definitions of “meaningful” interactions. We find that course structure has a strong influence on how much of the e-texts students actually read, and when they do so. In particular, courses that deviate strongly from traditional structures, most notably by more frequent exams, show consistently high usage of the materials with far less “cramming” before exams.National Science Foundation (U.S.) (Grant DUE-1044294)Google (Firm

CORONA (COre ultRasOund of covid in iNtensive care & Acute medicine) Study : national service evaluation of lung and heart ultrasound in intensive care patients with suspected or proven COVID-19

Background Combined Lung Ultrasound (LUS) and Focused UltraSound for Intensive Care heart (FUSIC Heart - formerly Focused Intensive Care Echocardiography, FICE) can aid diagnosis, risk stratification and management in COVID-19. However, data on its application and results are limited to small studies in varying countries and hospitals. This United Kingdom (UK) national service evaluation study assessed how combined LUS and FUSIC Heart were used in COVID-19 Intensive Care Unit (ICU) patients during the first wave of the pandemic. Method Twelve trusts across the UK registered for this prospective study. LUS and FUSIC Heart data were obtained, using a standardised data set including scoring of abnormalities, between 1st February 2020 to 30th July 2020. The scans were performed by intensivists with FUSIC Lung and Heart competency as a minimum standard. Data was anonymised locally prior to transfer to a central database. Results 372 studies were performed on 265 patients. There was a small but significant relationship between LUS score >8 and 30-day mortality (OR 1.8). Progression of score was associated with an increase in 30-day mortality (OR 1.2). 30-day mortality was increased in patients with right ventricular (RV) dysfunction (49.4% vs 29.2%). Severity of LUS score correlated with RV dysfunction (p < 0.05). Change in management occurred in 65% of patients following a combined scan. Conclusions In COVID-19 patients, there is an association between lung ultrasound score severity, RV dysfunction and mortality identifiable by combined LUS and FUSIC Heart. The use of 12-point LUS scanning resulted in similar risk score to 6-point imaging in the majority of cases. Our findings suggest that serial combined LUS and FUSIC Heart on COVID-19 ICU patients may aid in clinical decision making and prognostication

Concurrent pulmonary zygomycosis and Mycobacterium tuberculosis infection: a case report

A non-smoking 77-year old gentleman of Indian origin was admitted with a 4-month history of intermittent night sweats, haemoptysis and 6 kg of weight loss. CT scan of thorax demonstrated a 2.5 cm mass in the right middle lobe with multiple small nodules within the right lung and confirmed the presence of mediastinal and hilar lymph nodes