Pseudohypernatremia secondary to trisodium citrate (Citra-LockTM).

Introduction: Hypernatremia is common among hospitalized patients especially in the intensive care units and presents an independent risk factor for mortality. Mild hypernatremia is often asymptomatic but severe hypernatremia causes central nervous system dysfunction with initial non-specific symptoms of encephalopathy that may progress to seizures, coma and death, if left untreated. Severe hypernatremia is a medical emergency and requires emergent medical attention. Materials and methods: A haemodialysis patient who arrived for his scheduled haemodialysis treatment had monthly blood work drawn and was reported to have severe hypernatremia with serum sodium concentration of 183 mmol/L. The possibility of technique or laboratory error was considered and systematically evaluated. Results: The serum sodium measurement using another analyser showed similar value of 182 mmolL. A repeat serum sodium level on a sample drawn 2 h later showed normal value of 139–140 mmol/L. A step-wise evaluation of the complete procedure from blood collection to analysis of the sample revealed this to be spuriously elevated serum sodium concentration secondary to contamination of the sample during sample collection with trisodium citrate, a catheter-lock solution, commonly used in dialysis units to maintain patency of dialysis catheters. Conclusions: Spuriously elevated plasma sodium concentration (pseudohypernatremia) of mild degree is common but severe pseudohypernatremia is rare and the possibility of sample contaminations or laboratory error should be considered. Vigilance is required by both the medical and the laboratory staff to resolve such issues in a timely fashion to avoid unintended consequences

Development and Characterisation of a Gas System and its Associated Slow-Control System for an ATLAS Small-Strip Thin Gap Chamber Testing Facility

A quality assurance and performance qualification laboratory was built at McGill University for the Canadian-made small-strip Thin Gap Chamber (sTGC) muon detectors produced for the 2019-2020 ATLAS experiment muon spectrometer upgrade. The facility uses cosmic rays as a muon source to ionise the quenching gas mixture of pentane and carbon dioxide flowing through the sTGC detector. A gas system was developed and characterised for this purpose, with a simple and efficient gas condenser design utilizing a Peltier thermoelectric cooler (TEC). The gas system was tested to provide the desired 45 vol% pentane concentration. For continuous operations, a state-machine system was implemented with alerting and remote monitoring features to run all cosmic-ray data-acquisition associated slow-control systems, such as high/low voltage, gas system and environmental monitoring, in a safe and continuous mode, even in the absence of an operator.Comment: 23 pages, LaTeX, 14 figures, 4 tables, proof corrections for Journal of Instrumentation (JINST), including corrected Fig. 8b

“How will you construct a pathway system?”: Microanalysis of teacher-child scientific conversations

During the preschool years, children’s question-explanation exchanges with teachers serve as a powerful mechanism for their early STEM knowledge acquisition. Utilizing naturalistic longitudinal classroom data, we examined how such conversations in an inquiry-based preschool classroom change during an extended scientific inquiry unit. We were particularly interested in information-seeking questions (causal, e.g. “How will you construct a pathway?”; fact-based, e.g., “Where’s the marble?”). Videos (n = 18; 14 hours) were collected during a three-week inquiry unit on forces and motion and transcribed in CLAN-CHILDES software at the utterance level. Utterances were coded for delivery (question vs. statement) and content (e.g., fact-based, causal). Although teachers ask more questions than children, we found a significant increase in information-seeking questions during Weeks 2 and 3. We explored the content of information-seeking questions and found that the majority of these questions were asked by teachers, and focused on facts. However, the timing of fact-based and causal questions varied. Whereas more causal questions occurred in earlier weeks, more fact-based questions were asked towards the end of the inquiry. These findings provide insight into how children’s and teacher’s questions develop during an inquiry, informing our understanding of early science learning. Even in an inquiry-learning environment, teachers guide interactions, asking questions to support children’s learning. Children’s information-seeking questions increase during certain weeks, suggesting that providing opportunities to ask questions may allow children to be more active in constructing knowledge. Such findings are important for considering how science questions are naturally embedded in an inquiry-based learning classroom

Does the majority always know best? Young children's flexible trust in majority opinion

Copying the majority is generally an adaptive social learning strategy but the majority does not always know best. Previous work has demonstrated young children's selective uptake of information from a consensus over a lone dissenter. The current study examined children's flexibility in following the majority: do they overextend their reliance on this heuristic to situations where the dissenting individual has privileged knowledge and should be trusted instead? Four- to six- year-olds (N = 103) heard conflicting claims about the identity of hidden drawings from a majority and a dissenter in two between-subject conditions: in one, the dissenter had privileged knowledge over the majority (he drew the pictures); in the other he did not (they were drawn by an absent third party). Overall, children were less likely to trust the majority in the Privileged Dissenter condition. Moreover, 5- and 6- year-olds made majority-based inferences when the dissenter had no privileged knowledge but systematically endorsed the dissenter when he drew the pictures. The current findings suggest that by 5 years, children are able to make an epistemic-based judgment to decide whether or not to follow the majority rather than automatically following the most common view

Incidence and Outcomes of Acute Implant Extrusion Following Anterior Cervical Spine Surgery.

STUDY DESIGN: Multi-institutional retrospective case series of 8887 patients who underwent anterior cervical spine surgery. OBJECTIVE: Anterior decompression from discectomy or corpectomy is not without risk. Surgical morbidity ranges from 9% to 20% and is likely underreported. Little is known of the incidence and effects of rare complications on functional outcomes following anterior spinal surgery. In this retrospective review, we examined implant extrusions (IEs) following anterior cervical fusion. METHODS: A retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were reviewed to identify occurrence of 21 predefined treatment complications. RESULTS: Following anterior cervical fusion, the incidence of IE ranged from 0.0% to 0.8% across 21 institutions with 11 cases reported. All surgeries involved multiple levels, and 7/11 (64%) involved either multilevel corpectomies or hybrid constructs with at least one adjacent discectomy to a corpectomy. In 7/11 (64%) patients, constructs ended with reconstruction or stabilization at C7. Nine patients required surgery for repair and stabilization following IE. Average length of hospital stay after IE was 5.2 days. Only 2 (18%) had residual deficits after reoperation. CONCLUSIONS: IE is a very rare complication after anterior cervical spine surgery often requiring revision. Constructs requiring multilevel reconstruction, especially at the cervicothoracic junction, have a higher risk for failure, and surgeons should proceed with caution in using an anterior-only approach in these demanding cases. Surgeons can expect most patients to regain function after reoperation

Rare Complications of Cervical Spine Surgery: Pseudomeningocoele.

STUDY DESIGN: This study was a retrospective, multicenter cohort study. OBJECTIVES: Rare complications of cervical spine surgery are inherently difficult to investigate. Pseudomeningocoele (PMC), an abnormal collection of cerebrospinal fluid that communicates with the subarachnoid space, is one such complication. In order to evaluate and better understand the incidence, presentation, treatment, and outcome of PMC following cervical spine surgery, we conducted a multicenter study to pool our collective experience. METHODS: This study was a retrospective, multicenter cohort study of patients who underwent cervical spine surgery at any level(s) from C2 to C7, inclusive; were over 18 years of age; and experienced a postoperative PMC. RESULTS: Thirteen patients (0.08%) developed a postoperative PMC, 6 (46.2%) of whom were female. They had an average age of 48.2 years and stayed in hospital a mean of 11.2 days. Three patients were current smokers, 3 previous smokers, 5 had never smoked, and 2 had unknown smoking status. The majority, 10 (76.9%), were associated with posterior surgery, whereas 3 (23.1%) occurred after an anterior procedure. Myelopathy was the most common indication for operations that were complicated by PMC (46%). Seven patients (53%) required a surgical procedure to address the PMC, whereas the remaining 6 were treated conservatively. All PMCs ultimately resolved or were successfully treated with no residual effects. CONCLUSIONS: PMC is a rare complication of cervical surgery with an incidence of less than 0.1%. They prolong hospital stay. PMCs occurred more frequently in association with posterior approaches. Approximately half of PMCs required surgery and all ultimately resolved without residual neurologic or other long-term effects

The Virtual Shop: A new immersive virtual reality environment and scenario for the assessment of everyday memory

Background: Assessing and predicting memory performance in everyday life is a common assignment for neuropsychologists. However, most traditional neuropsychological tasks are not conceived to capture everyday memory performance. New method: The Virtual Shop is a fully immersive task developed to assess memory in a more ecological way than traditional neuropsychological assessments. Two studies were undertaken to assess the feasibility of the Virtual Shop and to appraise its ecological and construct validity. In study 1, 20 younger and 19 older adults completed the Virtual Shop task to evaluate its level of difficulty and the way the participants interacted with the VR material. The construct validity was examined with the contrasted-group method, by comparing the performance of younger and older adults. In study 2, 35 individuals with subjective cognitive decline completed the Virtual Shop task. Performance was correlated with an existing questionnaire evaluating everyday memory in order to appraise its ecological validity. To add further support to its construct validity, performance was correlated with traditional episodic memory and executive tasks. Results: All participants successfully completed the Virtual Shop. The task had an appropriate level of difficulty that helped differentiate younger and older adults, supporting the feasibility and construct validity of the task. Comparison with existing method(s): The performance on the Virtual Shop was significantly and moderately correlated with the performance on the questionnaire and on the traditional memory and executive tasks. Conclusions: Results support the feasibility and both the ecological and construct validity of the Virtual Shop

Vascular contributions to cognitive impairment and dementia: Research consortia that focus on etiology and treatable targets to lessen the burden of dementia worldwide

The research into vascular contributions to cognitive impairment and dementia (VCID) aims to understand the importance of cerebrovascular biology in cognitive decline. Prevention and treatment of VCID is poised to have major impact on dementia-related disease burden and is thus a critical emerging objective in dementia research. This article presents VCID consortia focused on multidisciplinary approaches to identify key pathologic targets and develop diagnostic tools with the goal of bridging the divide between basic research and clinical trials. Members of these multi-institute, multidisciplinary consortia provide a prospective on the history and emerging science of VCID and how VCID consortia can address some of the more complex questions in VCID and drive the field forward. These consortia, and others like them, are uniquely suited to tackle some of the most difficult obstacles in translating research to the clinic