Failure to obtain adequate anaesthesia associated with a bifid mandibular canal: a case report

The document attached has been archived with permission from the Australian Dental Association. An external link to the publisher’s copy is included.The inferior alveolar nerve (IAN) block is the most common method for obtaining mandibular anaesthesia in dental practice but it is estimated to have a success rate of only 80 to 85 per cent. Causes of failure include problems with operator technique and anatomical variation between individuals. This case report involves a patient who received IAN blocks on two separate occasions that resulted in only partial anaesthesia of the ipsilateral side of the mandible. Radiographic assessment disclosed the presence of bifid mandibular canals that were present bilaterally and that may have affected the outcomes of the local anaesthetic procedures. Previous studies of bifid mandibular canals are reviewed and suggestions provided that should enable clinicians to differentially diagnose, and then manage, cases where IAN blocks result in inadequate mandibular anaesthesia.K Lew, G Townsen

Extracorporeal life support (ECLS) for pediatric trauma: experience with five cases

Extracorporeal life support (ECLS) was used to treat five pediatric trauma patients (ages 1 to 17 years) with respiratory failure unresponsive to conventional mechanical ventilation. Diagnoses in these patients that resulted in respiratory failure included hydrocarbon aspiration (one patient), multiple trauma with pulmonary contusion (two patients), bronchopleural fistula (one patient), and neardrowning (one patient). Time on ECLS bypass averaged 328 h (range 140–527 h). Physiologic complications included bleeding, cardiac arrest, cardiac tamponade, hypoxemia, and hypotension. Mechanical complications involving the bypass circuit included roller-pump raceway rupture, roller-pump failure, and membrane oxygenator failure. All complications were managed without mortality. Three of the five patients were decannulated from ECLS and survived. Support was terminated in the remaining two due to irreversibility of the pulmonary injury. ECLS may provide life-saving support to pediatric patients with respiratory failure after trauma when conventional means of ventilatory support have failed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47185/1/383_2004_Article_BF00177095.pd

Volcanic Gases:Silent Killers

This is the accepted manuscript. The final version is available at http://link.springer.com/chapter/10.1007%2F11157_2015_14.Volcanic gases are insidious and often overlooked hazards. The effects of volcanic gases on life may be direct, such as asphyxiation, respiratory diseases and skin burns; or indirect, e.g. regional famine caused by the cooling that results from the presence of sulfate aerosols injected into the stratosphere during explosive eruptions. Although accounting for fewer fatalities overall than some other forms of volcanic hazards, history has shown that volcanic gases are implicated frequently in small-scale fatal events in diverse volcanic and geothermal regions. In order to mitigate risks due to volcanic gases, we must identify the challenges. The first relates to the difficulty of monitoring and hazard communication: gas concentrations may be elevated over large areas and may change rapidly with time. Developing alert and early warning systems that will be communicated in a timely fashion to the population is logistically difficult. The second challenge focuses on education and understanding risk. An effective response to warnings requires an educated population and a balanced weighing of conflicting cultural beliefs or economic interests with risk. In the case of gas hazards, this may also mean having the correct personal protection equipment, knowing where to go in case of evacuation and being aware of increased risk under certain sets of meteorological conditions. In this chapter we review several classes of gas hazard, the risks associated with them, potential risk mitigation strategies and ways of communicating risk. We discuss carbon dioxide flows and accumulations, including lake overturn events which have accounted for the greatest number of direct fatalities, the hazards arising from the injection of sulfate aerosol into the troposphere and into the stratosphere. A significant hazard facing the UK and northern Europe is a “Laki”-style eruption in Iceland, which will be associated with increased risk of respiratory illness and mortality due to poor air quality when gases and aerosols are dispersed over Europe. We discuss strategies for preparing for a future Laki style event and implications for society

Genome-wide linkage and association study implicates the 10q26 region as a major genetic contributor to primary nonsyndromic vesicoureteric reflux

Abstract Vesicoureteric reflux (VUR) is the commonest urological anomaly in children. Despite treatment improvements, associated renal lesions – congenital dysplasia, acquired scarring or both – are a common cause of childhood hypertension and renal failure. Primary VUR is familial, with transmission rate and sibling risk both approaching 50%, and appears highly genetically heterogeneous. It is often associated with other developmental anomalies of the urinary tract, emphasising its etiology as a disorder of urogenital tract development. We conducted a genome-wide linkage and association study in three European populations to search for loci predisposing to VUR. Family-based association analysis of 1098 parent-affected-child trios and case/control association analysis of 1147 cases and 3789 controls did not reveal any compelling associations, but parametric linkage analysis of 460 families (1062 affected individuals) under a dominant model identified a single region, on 10q26, that showed strong linkage (HLOD = 4.90; ZLRLOD = 4.39) to VUR. The ~9Mb region contains 69 genes, including some good biological candidates. Resequencing this region in selected individuals did not clearly implicate any gene but FOXI2, FANK1 and GLRX3 remain candidates for further investigation. This, the largest genetic study of VUR to date, highlights the 10q26 region as a major genetic contributor to VUR in European populations

Allometry of the Duration of Flight Feather Molt in Birds

Replacement of flight feathers takes disproportionately more time for large birds than it does for small birds, because feather length increases with body size almost twice as fast as feather growth rate increases

An objective method for the production of isopach maps and implications for the estimation of tephra deposit volumes and their uncertainties

Characterization of explosive volcanic eruptive processes from interpretation of deposits is a key for assessing volcanic hazard and risk, particularly for infrequent large explosive eruptions and those whose deposits are transient in the geological record. While eruption size—determined by measurement and interpretation of tephra fall deposits—is of particular importance, uncertainties for such measurements and volume estimates are rarely presented. Here, tephra volume estimates are derived from isopach maps produced by modeling raw thickness data as cubic B-spline curves under tension. Isopachs are objectively determined in relation to original data and enable limitations in volume estimates from published maps to be investigated. The eruption volumes derived using spline isopachs differ from selected published estimates by 15–40 %, reflecting uncertainties in the volume estimation process. The formalized analysis enables identification of sources of uncertainty; eruptive volume uncertainties (>30 %) are much greater than thickness measurement uncertainties (~10 %). The number of measurements is a key factor in volume estimate uncertainty, regardless of method utilized for isopach production. Deposits processed using the cubic B-spline method are well described by 60 measurements distributed across each deposit; however, this figure is deposit and distribution dependent, increasing for geometrically complex deposits, such as those exhibiting bilobate dispersion. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00445-015-0942-y) contains supplementary material, which is available to authorized users

Exhaled Aerosol Transmission of Pandemic and Seasonal H1N1 Influenza Viruses in the Ferret

Person-to-person transmission of influenza viruses occurs by contact (direct and fomites) and non-contact (droplet and small particle aerosol) routes, but the quantitative dynamics and relative contributions of these routes are incompletely understood. The transmissibility of influenza strains estimated from secondary attack rates in closed human populations is confounded by large variations in population susceptibilities. An experimental method to phenotype strains for transmissibility in an animal model could provide relative efficiencies of transmission. We developed an experimental method to detect exhaled viral aerosol transmission between unanesthetized infected and susceptible ferrets, measured aerosol particle size and number, and quantified the viral genomic RNA in the exhaled aerosol. During brief 3-hour exposures to exhaled viral aerosols in airflow-controlled chambers, three strains of pandemic 2009 H1N1 strains were frequently transmitted to susceptible ferrets. In contrast one seasonal H1N1 strain was not transmitted in spite of higher levels of viral RNA in the exhaled aerosol. Among three pandemic strains, the two strains causing weight loss and illness in the intranasally infected ‘donor’ ferrets were transmitted less efficiently from the donor than the strain causing no detectable illness, suggesting that the mucosal inflammatory response may attenuate viable exhaled virus. Although exhaled viral RNA remained constant, transmission efficiency diminished from day 1 to day 5 after donor infection. Thus, aerosol transmission between ferrets may be dependent on at least four characteristics of virus-host relationships including the level of exhaled virus, infectious particle size, mucosal inflammation, and viral replication efficiency in susceptible mucosa

Early Life Events Carry Over to Influence Pre-Migratory Condition in a Free-Living Songbird

Conditions experienced during development can have long-term consequences for individual success. In migratory songbirds, the proximate mechanisms linking early life events and survival are not well understood because tracking individuals across stages of the annual cycle can be extremely challenging. In this paper, we first use a 13 year dataset to demonstrate a positive relationship between 1st year survival and nestling mass in migratory Savannah sparrows (Passerculus sandwichensis). We also use a brood manipulation experiment to show that nestlings from smaller broods have higher mass in the nest relative to individuals from larger broods. Having established these relationships, we then use three years of field data involving multiple captures of individuals throughout the pre-migratory period and a multi-level path model to examine the hypothesis that conditions during development limit survival during migration by affecting an individual's ability to accumulate sufficient lean tissue and fat mass prior to migration. We found a positive relationship between fat mass during the pre-migratory period (Sept–Oct) and nestling mass and a negative indirect relationship between pre-migratory fat mass and fledging date. Our results provide the first evidence that conditions during development limit survival during migration through their effect on fat stores. These results are particularly important given recent evidence showing that body condition of songbirds at fledging is affected by climate change and anthropogenic changes to landscape structure

Nothing Lasts Forever: Environmental Discourses on the Collapse of Past Societies

The study of the collapse of past societies raises many questions for the theory and practice of archaeology. Interest in collapse extends as well into the natural sciences and environmental and sustainability policy. Despite a range of approaches to collapse, the predominant paradigm is environmental collapse, which I argue obscures recognition of the dynamic role of social processes that lie at the heart of human communities. These environmental discourses, together with confusion over terminology and the concepts of collapse, have created widespread aporia about collapse and resulted in the creation of mixed messages about complex historical and social processes

Divalent Metal Ions Tune the Self-Splicing Reaction of the Yeast Mitochondrial Group II Intron Sc.ai5γ

Group II introns are large ribozymes, consisting of six functionally distinct domains that assemble in the presence of Mg2+ to the active structure catalyzing a variety of reactions. The first step of intron splicing is well characterized by a Michaelis–Menten-type cleavage reaction using a two-piece group II intron: the substrate RNA, the 5′-exon covalently linked to domains 1, 2, and 3, is cleaved upon addition of domain 5 acting as a catalyst. Here we investigate the effect of Ca2+, Mn2+, Ni2+, Zn2+, Cd2+, Pb2+, and [Co(NH3)6]3+ on the first step of splicing of the Saccharomyces cerevisiae mitochondrial group II intron Sc.ai5γ. We find that this group II intron is very sensitive to the presence of divalent metal ions other than Mg2+. For example, the presence of only 5% Ca2+ relative to Mg2+ results in a decrease in the maximal turnover rate k cat by 50%. Ca2+ thereby has a twofold effect: this metal ion interferes initially with folding, but then also competes directly with Mg2+ in the folded state, the latter being indicative of at least one specific Ca2+ binding pocket interfering directly with catalysis. Similar results are obtained with Mn2+, Cd2+, and [Co(NH3)6]3+. Ni2+ is a much more powerful inhibitor and the presence of either Zn2+ or Pb2+ leads to rapid degradation of the RNA. These results show a surprising sensitivity of such a large multidomain RNA on trace amounts of cations other than Mg2+ and raises the question of biological relevance at least in the case of Ca2+