Complications of auricular correction

The risk of complications of auricular correction is underestimated. There is around a 5% risk of early complications (haematoma, infection, fistulae caused by stitches and granulomae, allergic reactions, pressure ulcers, feelings of pain and asymmetry in side comparison) and a 20% risk of late complications (recurrences, telehone ear, excessive edge formation, auricle fitting too closely, narrowing of the auditory canal, keloids and complete collapse of the ear). Deformities are evaluated less critically by patients than by the surgeons, providing they do not concern how the ear is positioned. The causes of complications and deformities are, in the vast majority of cases, incorrect diagnosis and wrong choice of operating procedure. The choice of operating procedure must be adapted to suit the individual ear morphology. Bandaging technique and inspections and, if necessary, early revision are of great importance for the occurence and progress of early complications, in addition to operation techniques. In cases of late complications such as keloids and auricles that are too closely fitting, unfixed full-thickness skin flaps have proved to be the most successful. Large deformities can often only be corrected to a limited degree of satisfaction

WRF‐based dynamical downscaling of ERA5 reanalysis data for High Mountain Asia: Towards a new version of the High Asia Refined analysis

The High Asia Refined analysis (HAR) is a regional atmospheric data set generated by dynamical downscaling of the Final operational global analysis (FNL) using the Weather Research and Forecasting (WRF) model. It has been successfully and widely utilized. A new version (HAR v2) with longer temporal coverage and extended domains is currently under development. ERA5 reanalysis data is used as forcing data. This study aims to find the optimal set‐up for the production of the HAR v2 to provide similar or even better accuracy as the HAR. First, we conducted a sensitivity study, in which different cumulus, microphysics, planetary boundary layer, and land surface model schemes were compared and validated against in situ observations. The technique for order preference by similarity to the ideal solution (TOPSIS) method was applied to identify the best schemes. Snow depth in ERA5 is overestimated in High Mountain Asia (HMA) and causes a cold bias in the WRF output. Therefore, we used Japanese 55‐year Reanalysis (JRA‐55) to correct snow depth initialized from ERA5 based on the linear scaling approach. After applying the best schemes identified by the TOPSIS method and correcting the initial snow depth, the model performance improves. Finally, we applied the improved set‐up for the HAR v2 and computed a one‐year run for 2011. Compared to the HAR, the HAR v2 has a better representation of air temperature at 2 m. It produces slightly higher precipitation amounts, but the spatial distribution of seasonal mean precipitation is closer to observations.BMBF, 03G0878G, Verbundprojekt: CLIENT II - CaTeNA; Klimatische und Tektonische Naturrisiken in Zentralasien; Vorhaben: Klimatische Auslöser von HangrutschungenTU Berlin, Open-Access-Mittel – 202

Emerging Themes from the ESA Symposium Entitled “Pollinator Nutrition: Lessons from Bees at Individual to Landscape Levels”

Pollinator populations are declining (Biesmeijer et al., 2006; Brodschneider et al., 2018; Cameron et al., 2011; Goulson, Lye, & Darvill, 2008; Kulhanek et al., 2017; National Research Council, 2007; Oldroyd, 2007), and both anecdotal and experimental evidence suggest that limited access to high quality forage might play a role (Carvell, Meek, Pywell, Goulson, & Nowakowski, 2007; Deepa et al., 2017; Goulson, Nicholls, Botias, & Rotheray, 2015; Potts et al., 2003, 2010; Vanbergen & The Insect Pollinators Initiative, 2013; Vaudo, Tooker, Grozinger, & Patch, 2015; Woodard, 2017). Multiple researchers are earnestly addressing this topic in a diverse array of insect-pollinator systems. As research continues to be published, increased communication among scientists studying the topic of nutrition is essential for improving pollinator health

A vertically discretised canopy description for ORCHIDEE (SVN r2290) and the modifications to the energy, water and carbon fluxes

Since 70% of global forests are managed and forests impact the global carbon cycle and the energy exchange with the overlying atmosphere, forest management has the potential to mitigate climate change. Yet, none of the land surface models used in Earth system models, and therefore none of today’s predictions of future climate, account for the interactions between climate and forest management. We addressed this gap in modelling capability by developing and parametrizing a version of the land surface model ORCHIDEE to simulate the biogeochemical and biophysical effects of forest management. The most significant changes between the new branch called ORCHIDEE-CAN (SVN r2290) and the trunk version of ORCHIDEE (SVN r2243) are the allometric-based allocation of carbon to leaf, root, wood, fruit and reserve pools; the transmittance, absorbance and reflectance of radiation within the canopy; and the vertical discretisation of the energy budget calculations. In addition, conceptual changes were introduced towards a better process representation for the interaction of radiation with snow, the hydraulic architecture of plants, the representation of forest management and a numerical solution for the photosynthesis formalism of Farquhar, von Caemmerer and Berry. For consistency reasons, these changes were extensively linked throughout the code. Parametrization was revisited after introducing twelve new parameter sets that represent specific tree species or genera rather than a group of often distantly related or even unrelated species, as is the case in widely used plant functional types. Performance of the new model was compared against the trunk and validated against independent spatially explicit data for basal area, tree height, canopy strucure, GPP, albedo and evapotranspiration over Europe. For all tested variables ORCHIDEE-CAN outperformed the trunk regarding its ability to reproduce large-scale spatial patterns as well as their inter-annual variability over Europe. Depending on the data stream, ORCHIDEE-CAN had a 67% to 92% chance to reproduce the spatial and temporal variability of the validation data.JRC.H.5-Land Resources Managemen

Definition of the viral targets of protective HIV-1-specific T cell responses

<p>Abstract</p> <p>Background</p> <p>The efficacy of the CTL component of a future HIV-1 vaccine will depend on the induction of responses with the most potent antiviral activity and broad HLA class I restriction. However, current HIV vaccine designs are largely based on viral sequence alignments only, not incorporating experimental data on T cell function and specificity.</p> <p>Methods</p> <p>Here, 950 untreated HIV-1 clade B or -C infected individuals were tested for responses to sets of 410 overlapping peptides (OLP) spanning the entire HIV-1 proteome. For each OLP, a "protective ratio" (PR) was calculated as the ratio of median viral loads (VL) between OLP non-responders and responders.</p> <p>Results</p> <p>For both clades, there was a negative relationship between the PR and the entropy of the OLP sequence. There was also a significant additive effect of multiple responses to beneficial OLP. Responses to beneficial OLP were of significantly higher functional avidity than responses to non-beneficial OLP. They also had superior in-vitro antiviral activities and, importantly, were at least as predictive of individuals' viral loads than their HLA class I genotypes.</p> <p>Conclusions</p> <p>The data thus identify immunogen sequence candidates for HIV and provide an approach for T cell immunogen design applicable to other viral infections.</p

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Evaluating the performance of land surface model ORCHIDEE-CAN v1.0 on water and energy flux estimation with a single- and multi-layer energy budget scheme

Canopy structure is one of the most important vegetation characteristics for land-atmosphere interactions, as it determines the energy and scalar exchanges between the land surface and the overlying air mass. In this study we evaluated the performance of a newly developed multilayer energy budget in the ORCHIDEE-CAN v1.0 land surface model (Organising Carbon and Hydrology In Dynamic Ecosystems - CANopy), which simulates canopy structure and can be coupled to an atmospheric model using an implicit coupling procedure. We aim to provide a set of accept-able parameter values for a range of forest types. Top-canopy and sub-canopy flux observations from eight sites were collected in order to conduct this evaluation. The sites crossed climate zones from temperate to boreal and the vegetation types included deciduous, evergreen broad-leaved and evergreen needle-leaved forest with a maximum leaf area index (LAI; all-sided) ranging from 3.5 to 7.0. The parametrization approach proposed in this study was based on three selected physical processes - namely the diffusion, advection, and turbulent mixing within the canopy. Short-term sub-canopy observations and long-term surface fluxes were used to calibrate the parameters in the sub-canopy radiation, turbulence, and resistance modules with an automatic tuning process. The multi-layer model was found to capture the dynamics of sub-canopy turbulence, temperature, and energy fluxes. The performance of the new multi-layer model was further compared against the existing single-layer model. Although the multi-layer model simulation results showed few or no improvements to both the nighttime energy balance and energy partitioning during winter compared with a single-layer model simulation, the increased model complexity does provide a more detailed description of the canopy micrometeorology of various forest types. The multi-layer model links to potential future environmental and ecological studies such as the assessment of in-canopy species vulnerability to climate change, the climate effects of disturbance intensities and frequencies, and the consequences of biogenic volatile organic compound (BVOC) emissions from the terrestrial ecosystem.Peer reviewe

Excavating Childhood: Fairytales, Monsters and Abuse Survival in Lynda Barry’s What It Is

This article investigates the excavation of abused childhood in Lynda Barry’s What It Is. Looking at the centrality of childish play, fairy tales and the Gorgon in the protagonist’s effort to cope with maternal abuse, it argues that comics complicate the life narrative and allow the feminist reconfiguration of the monstrous mother of Western psychoanalysis and art