Tension Empyema Thoracis

Tension empyema is a rare and life threatening complication of pleural space infection requiring emergent drainage to restore cardio-respiratory function. The authors report a case of a 27-yearold male patient with pulmonary tuberculosis, who presented with severe dyspnea, right sided chest pain, and persistent cough. He subsequently developed cardiovascular collapse requiring an emergent right chest tube which drained over 2 liters of pus under pressure. The cardiovascular system stabilized and he subsequently underwent decortication for trapped lung and had an uneventful postoperative stay. Tension empyema should be considered as a differential in young patients without a history of trauma, thoraco-abdominal procedures or thoracic surgery, who present with cough, fever and chest pain, with clinical findings of cardiovascular collapse.Keywords: Tension Empyema, Tuberculosis, Cardiac Arrest, Thoracostomy

Modelling endoplasmic reticulum network maintenance in a plant cell

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record.The endoplasmic reticulum (ER) in plant cells forms a highly dynamic network of complex geometry. ER network morphology and dynamics are influenced by a number of biophysical processes, including filament/tubule tension, viscous forces, Brownian diffusion and interactions with many other organelles and cytoskeletal elements. Previous studies have indicated that ER networks can be thought of as constrained minimal-length networks acted on by a variety of forces that perturb and/or remodel the network. Here, we study two specific biophysical processes involved in remodelling. One is the dynamic relaxation process involving a combination of tubule tension and viscous forces. The other is the rapid creation of cross-connection tubules by direct or indirect interactions with cytoskeletal elements. These processes are able to remodel the ER network: the first reduces network length and complexity while the second increases both. Using live cell imaging of ER network dynamics in tobacco leaf epidermal cells, we examine these processes on ER network dynamics. Away from regions of cytoplasmic streaming, we suggest that the dynamic network structure is a balance between the two processes, and we build an integrative model of the two processes for network remodelling. This model produces quantitatively similar ER networks to those observed in experiments. We use the model to explore the effect of parameter variation on statistical properties of the ER network.This work was funded by a Leverhulme Trust grant (RPG-2015-106)

Words and Deeds: From Incompatibilities to Outcomes in Anti-Government Disputes

Dissidents can choose among different tactics to redress political grievances, yet violent and nonviolent mobilization tend to be studied in isolation. We examine why some countries see the emergence of organized dissident activity over governmental claims, and why in some cases these organizational claims result in civil wars or nonviolent campaigns, while others see no large-scale collective action. We develop a two-stage theoretical framework examining the organized articulation of political grievance and then large-scale violent and nonviolent collective action. We test implications of this framework using new data on governmental incompatibilities in a random sample of 101 states from 1960- 2012. We show that factors such as demography, economic development and civil society have differential effects on these different stages and outcomes of mobilization. We demonstrate that the common finding that anocracies are more prone to civil war primarily stems from such regimes being more prone to see maximalist political demands that could lead to violent mobilization, depending on other factors conducive to creating focused military capacity We find that non-democracy generally promotes nonviolent campaigns as anocracies and autocracies are both more likely to experience claims and more prone to nonviolent campaigns, conditional on claims

Pattern of adult intestinal obstruction at Tenwek hospital, in south-western Kenya

Introduction: acute mechanical intestinal obstruction (IO) is one of the leading causes of surgical admissions in most emergency departments worldwide. The causes of IO vary significantly depending on geographical location. The aim of this study was to identify the etiology, management and outcomes of patients with acute mechanical IO presenting in south-western Kenya. Methods: a 4 year (November 2009–October 2013) retrospective review of all adult patients admitted with acute mechanical IO at Tenwek Hospital in Bomet, Kenya. Results: a total of 303 male and 142 female patients, presented with acute mechanical IO during the study period. Mean patient age was 40.6 years (range 17-91), with peak  incidence in those aged 31-40 years. The foremost signs and symptoms were abdominal pain (89.4%), abdominal tenderness (81.6%), vomiting (78%), abdominal distension (65.4%) and constipation (50.8%). Sigmoid volvulus (25.6%), adhesions (23.1%), small bowel volvulus (21.3%), and ileo-sigmoid knotting (8.5%) were the leading causes of IO. Laparotomy was undertaken in 361 (81.1%) cases, with bowel gangrene noted in 112 (30.4%). The overall morbidity and mortality rates were 15% and 4.5% respectively. Patients with gangrenous bowel at laparotomy had a higher morbidity rate (22.3% vs 9.6%, P=.001), a higher mortality rate (9.8% vs 3.2%, P=.02) and a longer duration of stay (9.9 days vs 7.6 days,  P=.0001) compared to those with viable bowel. Conclusion: the most common causes of IO in this study were sigmoid volvulus, adhesions, small bowel volvulus and ileo-sigmoid knotting. Presence of bowel gangrene was associated with higher morbidity and mortality rates

Efficacy and effectiveness of the combination of sulfadoxine/pyrimethamine and a 3-day course of artesunate for the treatment of uncomplicated falciparum malaria in a refugee settlement in Zambia.

In the Maheba Refugee Settlement, in the clinics supported by Medecins Sans Frontieres, all children aged up to 5 years with a confirmed diagnosis of uncomplicated falciparum malaria are treated with the combination of sulfadoxine/pyrimethamine (SP) and artesunate (AS). We compared the treatment's efficacy and effectiveness. Patients were randomized in order to receive the treatment supervised (efficacy) or unsupervised (effectiveness). Therapeutic response was determined after 28 days of follow up. The difference between recrudescence and re-infection was ascertained by polymerase chain reaction (PCR). We also assessed genetic markers associated to SP resistance (dhfr and dhps). Eighty-five patients received treatment under supervision and 84 received it unsupervised. On day 28, and after PCR adjustment, efficacy was found to be 83.5% (95% CI: 74.1-90.5), and effectiveness 63.4% (95% CI: 52.6-73.3) (P < 0.01). Point mutations on dhfr (108) and dhps (437) were found for 92.0% and 44.2% respectively of the PCR samples analysed. The significant difference in therapeutic response after supervised and unsupervised treatment intake can only be explained by insufficient patient adherence. When implementing new malaria treatment policies, serious investment in ensuring patient adherence is essential to ascertain the effectiveness of the new treatment schedules

Role of Rigid Endoscopic Detorsion in the Management of Sigmoid Volvulus

Introduction: Sigmoid Volvulus (SV) is a common cause of bowel obstruction in Africa, affecting a relatively young and healthy population. There has been little research regarding the use of endoscopic detorsion in the management of SV from East Africa. The aim of this study was to determine the outcome of patients with SV managed by endoscopic detorsion at a single institution over a 9 year period.Methods: A retrospective review of all patients admitted with SV at Tenwek Hospital in Bomet, Kenya from January 2006 to October 2014 was done. Data were collected on demographics, clinical presentation, operative findings, management, and outcome.Results: There were 159 cases with a mean age of 41.1 years (range 15-87). Rigid endoscopic detorsion was attempted in 125 (79%) patients. The success, early recurrence, and mortality rate for rigid endoscopic detorsion was 79%, 6%, and 0% respectively. Eleven (13%, n=99) patients declined surgery after successful endoscopic detorsion, while 87 patients had semi-elective surgery, an average of 3.5 days post detorsion. Sixty patients had emergency surgery, with gangrenous bowel noted in 43 (72%) cases. Patients undergoing emergency surgery had a higher morbidity rate (27% vs. 5%, p=0.0002), and a higher mortality rate (12% vs. 0, p=0.002) compared to those having semi-elective surgery due to the presence of gangrenous bowel.Conclusion: Rigid endoscopic detorsion is appropriate in the initial management of any stable patient with clinical and radiological features suggestive of sigmoid volvulus without features of peritonitis.Keywords: Sigmoid Volvulus, Endoscopic Detorsion, Rigid Sigmoidoscopy, Outcomes

An Optical Counterpart to the Anomalous X-ray Pulsar 4U 0142+61

The energy source of the anomalous X-ray pulsars is not well understood, hence their designation as anomalous. Unlike binary X-ray pulsars, no companions are seen, so the energy cannot be supplied by accretion of matter from a companion star. The loss of rotational energy, which powers radio pulsars, is insufficient to power AXPs. Two models are generally considered: accretion from a large disk left over from the birth process, or decay of a very strong magnetic field (10^15 G) associated with a 'magnetar'. The lack of counterparts at other wavelengths has hampered progress in our understanding of these objects. Here, we present deep optical observations of the field around 4U 0142+61, which is the brightest AXP in X-rays. We find an object with peculiar optical colours at the position of the X-ray source, and argue that it is the optical counterpart. The optical emission is too faint to admit the presence of a large accretion disk, but may be consistent with magnetospheric emission from a magnetar.Comment: 16 pages, 3 figures, accepted by Nature. Press embargo until 1900 hrs London time (GMT) on 6 December 200

Phase-slip induced dissipation in an atomic Bose-Hubbard system

Phase slips play a primary role in dissipation across a wide spectrum of bosonic systems, from determining the critical velocity of superfluid helium to generating resistance in thin superconducting wires. This subject has also inspired much technological interest, largely motivated by applications involving nanoscale superconducting circuit elements, e.g., standards based on quantum phase-slip junctions. While phase slips caused by thermal fluctuations at high temperatures are well understood, controversy remains over the role of phase slips in small-scale superconductors. In solids, problems such as uncontrolled noise sources and disorder complicate the study and application of phase slips. Here we show that phase slips can lead to dissipation for a clean and well-characterized Bose-Hubbard (BH) system by experimentally studying transport using ultra-cold atoms trapped in an optical lattice. In contrast to previous work, we explore a low velocity regime described by the 3D BH model which is not affected by instabilities, and we measure the effect of temperature on the dissipation strength. We show that the damping rate of atomic motion-the analogue of electrical resistance in a solid-in the confining parabolic potential fits well to a model that includes finite damping at zero temperature. The low-temperature behaviour is consistent with the theory of quantum tunnelling of phase slips, while at higher temperatures a cross-over consistent with the transition to thermal activation of phase slips is evident. Motion-induced features reminiscent of vortices and vortex rings associated with phase slips are also observed in time-of-flight imaging.Comment: published in Nature 453, 76 (2008

The rationale and plan for creating a World Antimalarial Resistance Network (WARN)

Drug resistant malaria was a major factor contributing to the failure of a worldwide campaign to eradicate malaria in the last century, and now threatens the large investment being made by the global community in the rollout of effective new drug combinations to replace failed drugs. Four related papers in this issue of Malaria Journal make the case for creating the World Antimalarial Resistance Network (WARN), which will consist of four linked open-access global databases containing clinical, in vitro, molecular and pharmacological data, and networks of reference laboratories that will support these databases and related surveillance activities. WARN will serve as a public resource to guide antimalarial drug treatment and prevention policies and to help confirm and characterize the new emergence of new resistance to antimalarial drugs and to contain its spread