Evaluating The Utility Of Spect/ct Imaging Of Angiosome Perfusion In Diabetic Patients With Critical Limb Ischemia

EVALUATING THE UTILITY OF SPECT/CT IMAGING OF ANGIOSOME PERFUSION IN DIABETIC PATIENTS WITH CRITICAL LIMB ISCHEMIA. Jessica L. Buckley, Albert J. Sinusas, Mitchel R. Stacy. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT. Impaired lower extremity perfusion is a hallmark of peripheral arterial disease (PAD) and is particularly problematic in diabetic patients, who suffer from high rates of PAD, ulceration, and lower extremity amputation. The ability to non-invasively detect deficits in microvascular perfusion within vascular territories, or angiosomes, of the feet may provide information related to tissue viability and guide therapeutic interventions. In this study, we sought to apply single photon emission computed tomography (SPECT)/CT imaging to quantify volumetric microvascular perfusion within specific angiosomes containing non-healing foot ulcers in diabetic patients with critical limb ischemia (CLI). Additionally, we sought to assess the value of SPECT/CT perfusion imaging for predicting limb salvage in CLI patients undergoing lower extremity endovascular revascularization. Forty-one diabetic patients (mean age, 66±12 yrs) with non-healing ulcers and nine healthy control subjects (mean age, 50±10 yrs) underwent SPECT/CT imaging of the feet following a resting injection of technetium-99m (99mTc)-tetrofosmin (dose, 550.6 ± 37 Mbq). CT images of diabetic feet were segmented into five angiosomes and used for quantifying relative radiotracer uptake, expressed as standardized uptake values (SUVs). SUVs were assessed for each CLI patient in the angiosome containing the non-healing ulcers, while average whole foot perfusion was assessed for healthy control subjects. Percent change in SPECT SUVs of ulcerated angiosomes was quantified following endovascular revascularization in patients, and 3-, 6-, and 12-month limb salvage outcomes were assessed. SPECT/CT imaging allowed for visualization of perfusion deficits under resting conditions. 99mTc-tetrofosmin SPECT/CT imaging of angiosome foot perfusion demonstrated a significant difference in baseline perfusion values (SUVs) between diabetic patients with CLI and healthy control subjects (p = 0.02). Analysis of baseline SPECT/CT imaging and ankle-brachial index (ABI) measurements in CLI patients and healthy control subjects demonstrated a significant and positive relationship between SPECT/CT angiosome perfusion and ABI (p = 0.01; r = 0.41). Serial evaluation of relative changes in SPECT angiosome foot perfusion following revascularization revealed significant quantitative changes in perfusion after treatment, whereas ABI measurements did not demonstrate significant changes after revascularization. Changes in SPECT/CT-derived angiosome perfusion significantly differed between patients with and patients without amputation in the 3 (p = 0.01), 6 (p = 0.03), and 12 (p = 0.03) months following revascularization. SPECT/CT imaging provides a useful non-invasive tool for evaluating microvascular perfusion within specific angiosomes of the foot under resting conditions. SPECT/CT imaging also allows for serial assessment of sensitive changes in angiosome microvascular perfusion following revascularization that are undetected by ABI. Perfusion imaging with SPECT/CT offers a novel quantitative imaging approach for assessing the efficacy of revascularization strategies targeted at restoring perfusion to non-healing wounds of the foot and may assist with predicting limb salvage outcomes in CLI patients undergoing revascularization. Future application of SPECT/CT perfusion imaging may provide additional value for detection and targeting of ischemic tissue for therapeutic interventions in the PAD patient population

Re-storing the Earth: A Phenomenological Study of Living Sustainably

Living sustainably evokes ideas of lived, bodily engagement with and perception of the earth. Yet, modern ways of thinking and speaking have slowly alienated the earth from consciousness. Using phenomenological methods, the author examines the experience of living sustainably, exploring her own background and the idea of restoring the earth to consciousness, before examining the lives of two students dedicated to living sustainably. Components of upholding the earth, in-volving humanity, perceiving differences in studying and embodying sustainability, and engaging in choices fill the experience of living sustainably

"Backing Away from the Cliff": A Theory of Education for Sustainability in the Postsecondary Classroom

Despite growing efforts for Education for Sustainability (EfS), little empirical research documents EfS in the postsecondary classroom and the ways in which sustainability is defined in these classrooms. The purpose of this study was to provide a theory of EfS in the postsecondary classroom in the United States. I sought to understand how postsecondary educators understand sustainability, how they engage in EfS in the classroom, and what contexts influence their work in EfS. Using a constructivist, grounded theory methodology, I selected three institutions - East State University, Liberal Arts College, and Religious University - for this study given both their diversity of mission and their commitment to EfS. I observed 27 different courses, comprising a total of 67 class meetings, and interviewed a total of 42 individuals, 29 of whom were educators, 11 of whom were students, and 2 who were primarily administrators. Findings revealed that a macro-narrative of sustainability in the classroom concerns (a) the relationship between humanity and the environment, including relationships between communities that are mediated by the environment; (b) the ways in which people come to understand those relationships; and (c) the responsibilities individuals have because of those relationships. Educators described that the term sustainability is complex but also invites dialogue. Variations of EfS in the classroom existed along two continua, one concerning the role of sustainability (whether fundamental or supplemental) and another concerning the teaching framework (practical or theoretical). When used together, these continua created a typology of courses that helped students conceptualize, operationalize, contextualize, or synthesize sustainability. Although variations of EfS existed, a number of pedagogical characteristics were similar in EfS classrooms, including educators' desire to teach beyond content, multiple sources of knowledge, the use of pedagogical partnerships, invitation to conversation among disciplines, and values orientations. These characteristics together demonstrate a path from knowledge to practice in an EfS classroom. Findings provide a theory for understanding sustainability within the context of a postsecondary classroom and possible variations for EfS in the classrooms. They reveal implications for educators - both inside the classroom and within the co-curriculum - as they provide an empirically grounded theory for EfS

Heavy metals contaminating the environment of a progressive supranuclear palsy cluster induce tau accumulation and cell death in cultured neurons

Progressive supranuclear palsy (PSP) is a neurodegenerative disorder characterized by the presence of intracellular aggregates of tau protein and neuronal loss leading to cognitive and motor impairment. Occurrence is mostly sporadic, but rare family clusters have been described. Although the etiopathology of PSP is unknown, mutations in the MAPT/tau gene and exposure to environmental toxins can increase the risk of PSP. Here, we used cell models to investigate the potential neurotoxic effects of heavy metals enriched in a highly industrialized region in France with a cluster of sporadic PSP cases. We found that iPSC-derived iNeurons from a MAPT mutation carrier tend to be more sensitive to cell death induced by chromium (Cr) and nickel (Ni) exposure than an isogenic control line. We hypothesize that genetic variations may predispose to neurodegeneration induced by those heavy metals. Furthermore, using an SH-SY5Y neuroblastoma cell line, we showed that both heavy metals induce cell death by an apoptotic mechanism. Interestingly, Cr and Ni treatments increased total and phosphorylated tau levels in both cell types, implicating Cr and Ni exposure in tau pathology. Overall, this study suggests that chromium and nickel could contribute to the pathophysiology of tauopathies such as PSP by promoting tau accumulation and neuronal cell death

Mad Women: Living with a Label of Borderline Personality Disorder

Throughout history, society has sought to label people who have exhibited behaviour perceived as abnormal. Since the enlightenment, psychiatry has endeavoured to provide explanations for such abnormal behaviours by labelling people with mental health diagnoses. Historically, women have been prime candidates for labelling, accused of witchcraft and subjected to punishment in the Middle Ages, labelled with hysteria and confined in asylums by the Victorians, and more contemporarily, assigned with the borderline personality disorder diagnosis. This critical review seeks to explore the borderline personality disorder diagnosis and examine the implications it has for women who are given this label. Literature suggests that there are many problems with the borderline personality disorder diagnosis, since it is poorly defined and its current system of classification is considered to be failing. This diagnosis is based upon gender-appropriate traits and behaviours and the judgement of these to be abnormal in women who are diagnosed with borderline personality disorder. The criteria for the diagnosis are such that it is considered to be gender-biased and as a result women are more vulnerable to being labelled with borderline personality disorder than men. Borderline personality disorder consists of traits and characteristics which can be destructive and have a severe impact upon the lives of individuals, such as extreme emotional reactions, intense anger, self-harm and unstable relationships. These traits also tend to be associated with negativity and therefore stigmatising attitudes around the diagnosis are prevalent, particularly within mental health services and amongst professionals working within them. Women diagnosed with borderline personality disorder tend to be labelled as untreatable, manipulative, blameworthy, attention-seekers and undeserving of care. This inevitably leads to poor relationships between these women and mental health professionals and can have a damaging impact on their experiences with psychiatric services and the quality of care they receive

Morphological and physiological determinants of local adaptation to climate in Rocky Mountain butterflies

Flight is a central determinant of fitness in butterflies and other insects, but it is restricted to a limited range of body temperatures. To achieve these body temperatures, butterflies use a combination of morphological, behavioural and physiological mechanisms. Here, we used common garden (without direct solar radiation) and reciprocal transplant (full solar radiation) experiments in the field to determine the thermal sensitivity of flight initiation for two species of Colias butterflies along an elevation gradient in the southwestern Rocky Mountains. The mean body temperature for flight initiation in the field was lower (24–26°C) than indicated by previous studies (28–30°C) in these species. There were small but significant differences in thermal sensitivity of flight initiation between species; high-elevation Colias meadii initiated flight at a lower mean body temperature than lower-elevation Colias eriphyle. Morphological differences (in wing melanin and thoracic setae) drive body temperature differences between species and contributed strongly to differences in the time and probability of flight and air temperatures at flight initiation. Our results suggest that differences both in thermal sensitivity (15% contribution) and in morphology (85% contribution) contribute to the differences in flight initiation between the two species in the field. Understanding these differences, which influence flight performance and fitness, aids in forecasting responses to climate change

Naturecultures guidance: steps in our journey

The emergence of cultural landscapes concepts heralded important mindset shifts in heritage practices. These have underpinned development of landscape approaches that recognise larger-scale interactions and the relationships between natural and cultural elements and processes. However, it has become apparent that an enduring nature-culture binary in heritage practices can result in adverse outcomes ‘on the ground’. The ISCCL has provided a forum and a source of global leadership for these issues, including the exploration of the implications of working with naturecultures to achieve conservation outcomes that are effective and inclusive. Naturecultures was coined by Donna Haraway in 2003 to recognise that natural and human environments, including non-human and more-than-human beings (such as spirits, creation ancestors, divinities) are intimately bound or entangled within different places. There is a now a growing desire to move beyond a curious consideration of the conceptual possibilities of naturecultures to implement its meanings in a wide array of everyday heritage management practices. Physically separated by the global pandemic, we are a small group of natural and cultural heritage practitioners and ISCCL members who decided to step briefly away from our organisational and institutional affiliations to connect with each other, reflect on our experiences, and offer guidance to others. This presentation will be our first opportunity to communicate what we’ve been up to, and to share some thoughts that our journey together has afforded. We argue that applying naturecultures in our practices is beneficial for people and places, and can support more effective conservation outcomes. Please join us to think further about these ideas. Français : L\u27émergence des concepts de paysages culturels a annoncé d\u27importants changements de mentalité dans les pratiques patrimoniales. Ceux-ci ont soutenu le développement d\u27approches paysagères qui reconnaissent les interactions à plus grande échelle et les relations entre les éléments et les processus naturels et culturels. Cependant, il est devenu évident qu\u27un binaire nature-culture durable dans les pratiques patrimoniales peut entraîner des résultats négatifs « sur le terrain ». L\u27ISCCL a fourni un forum et une source de leadership mondial pour ces questions, y compris l\u27exploration des implications du travail avec les cultures de la nature pour obtenir des résultats de conservation efficaces et inclusifs. Naturecultures a été inventé par Donna Haraway en 2003 pour reconnaître que les environnements naturels et humains, y compris les êtres non humains et plus qu\u27humains (tels que les esprits, les ancêtres de la création, les divinités) sont intimement liés ou enchevêtrés dans différents endroits. Il y a maintenant un désir croissant d\u27aller au-delà d\u27une curieuse considération des possibilités conceptuelles des cultures de la nature pour mettre en œuvre ses significations dans un large éventail de pratiques quotidiennes de gestion du patrimoine. Physiquement séparés par la pandémie mondiale, nous sommes un petit groupe de praticiens du patrimoine naturel et culturel et de membres de l\u27ISCCL qui ont décidé de s\u27éloigner brièvement de nos affiliations organisationnelles et institutionnelles pour se connecter les uns aux autres, réfléchir à nos expériences et offrir des conseils aux autres. Cette présentation sera notre première occasion de communiquer ce que nous avons fait et de partager quelques réflexions que notre voyage ensemble a permis. Nous soutenons que l\u27application des cultures de la nature dans nos pratiques est bénéfique pour les personnes et les lieux, et peut favoriser des résultats de conservation plus efficaces. Veuillez vous joindre à nous pour approfondir ces idées. Español: La aparición de conceptos de paisajes culturales anunció importantes cambios de mentalidad en las prácticas patrimoniales. Estos han apuntalado el desarrollo de enfoques de paisaje que reconocen interacciones a mayor escala y las relaciones entre elementos y procesos naturales y culturales. Sin embargo, se ha hecho evidente que un binario duradero entre naturaleza y cultura en las prácticas patrimoniales puede dar lugar a resultados adversos sobre el terreno . El ISCCL ha proporcionado un foro y una fuente de liderazgo global para estos temas, incluida la exploración de las implicaciones de trabajar con las culturas de la naturaleza para lograr resultados de conservación que sean efectivos e inclusivos. Naturecultures fue acuñada por Donna Haraway en 2003 para reconocer que los entornos naturales y humanos, incluidos los seres no humanos y más que humanos (como espíritus, antepasados de la creación, divinidades) están íntimamente ligados o enredados en diferentes lugares. Existe ahora un creciente deseo de ir más allá de una consideración curiosa de las posibilidades conceptuales de las culturas de la naturaleza para implementar sus significados en una amplia gama de prácticas cotidianas de gestión del patrimonio. Físicamente separados por la pandemia global, somos un pequeño grupo de practicantes del patrimonio natural y cultural y miembros de ISCCL que decidieron alejarse brevemente de nuestras afiliaciones organizacionales e institucionales para conectarnos unos con otros, reflexionar sobre nuestras experiencias y ofrecer orientación a los demás. Esta presentación será nuestra primera oportunidad para comunicar lo que hemos estado haciendo y compartir algunos pensamientos que nos ha brindado nuestro viaje juntos. Argumentamos que la aplicación de las culturas de la naturaleza en nuestras prácticas es beneficiosa para las personas y los lugares, y puede respaldar resultados de conservación más efectivos. Únase a nosotros para pensar más en estas ideas

Successive Bacterial Colonisation of Pork and its Implications for Forensic Investigations

Aims: Bacteria are considered one of the major driving forces of the mammalian decomposition process and have only recently been recognised as forensic tools. At this point, little is known about their potential use as ‘post-mortem clocks’. This study aimed to establish the proof of concept for using bacterial identification as post-mortem interval (PMI) indicators, using a multi-omics approach. Methods and Results: Pieces of pork were placed in the University’s outdoor facility and surface swabs were taken at regular intervals up to 60 days. Terminal restriction fragment length polymorphism (T-RFLP) of the 16S rDNA was used to identify bacterial taxa. It succeeded in detecting two out of three key contributors involved in decomposition and represents the first study to reveal Vibrionaceae as abundant on decomposing pork. However, a high fraction of present bacterial taxa could not be identified by T-RFLP. Proteomic analyses were also performed at selected time points, and they partially succeeded in the identification of precise strains, subspecies and species of bacteria that colonized the body after different PMIs. Conclusion: T-RFLP is incapable of reliably and fully identifying bacterial taxa, whereas proteomics could help in the identification of specific strains of bacteria. Nevertheless, microbial identification by next generation sequencing might be used as PMI clock in future investigations and in conjunction with information provided by forensic entomologists. Significance and Impact of the Study: To the best of our knowledge, this work represents the first attempt to find a cheaper and easily accessible, culture-independent alternative to high-throughput techniques to establish a ‘microbial clock’, in combination with proteomic strategies to address this issue