An unusual presentation of erythema multiforme in a paediatric patient

Background: Erythema multiforme (EM) is an acute, vesiculobullous disease of skin and mucous membranes with symptoms ranging from mild to severe. A complex interaction of different factors has been implicated the condition; the majority with a preceding herpes simplex infection. This report describes an unusual presentation of erythema multiforme affecting the lips and oral mucosa of a healthy 7-year-old boy in the form of lip adherence. Case report: Two weeks following eruption of oral ulcerations, a 7-year-old healthy boy developed severe erosive ulceration of both lips, causing complete lip adherence. This was accompanied by marked bilateral submandibular and cervical lymphadenopathy, tremor and sweating. Clinical and laboratory investigations led to a diagnosis of erythema multiforme. The patient was treated initially with gentle application of Vaseline between the lips using cotton buds in an attempt to release lip adhesion, followed by surgical release of the lips under general anaesthesia. Analgesics and topical steroid mouthwash were provided. Follow-up: Seven months later, the patient presented with a recurrence of his EM which included lesions on the skin. The patient was treated with antivirals, topical and systematic steroids to suppress the recurrent attacks of EM. Eighteen months following the initial presentation the patient and parent reported considerable decrease in the frequency, severity and duration of the occurrence of intra-oral ulcers, with no major episode of target lesions on the skin. Conclusion: Erythema multiforme is rare in children, however it should be considered in the differential diagnosis of recurrent erosive oral ulcerative lesions especially when the oral lesions resemble those of primary herpetic gingivostomatitis

Ice nucleation by fertile soil dusts: Relative importance of mineral and biogenic components

Agricultural dust emissions have been estimated to contribute around 20% to the global dust burden. In contrast to dusts from arid source regions, the ice-nucleating abilities of which have been relatively well studied, soil dusts from fertile sources often contain a substantial fraction of organic matter. Using an experimental methodology which is sensitive to a wide range of ice nucleation efficiencies, we have characterised the immersion mode ice-nucleating activities of dusts (d<11 μ m) extracted from fertile soils collected at four locations around England. By controlling droplet sizes, which ranged in volume from 10 to 10 L (concentration=0.02 to 0.1 wt% dust), we have been able to determine the ice nucleation behaviour of soil dust particles at temperatures ranging from 267K (-6°C) down to the homogeneous limit of freezing at about 237K (-36°C). At temperatures above 258K (-15°C) we find that the ice-nucleating activity of soil dusts is diminished by heat treatment or digestion with hydrogen peroxide, suggesting that a major fraction of the ice nuclei stems from biogenic components in the soil. However, below 258 K, we find that the ice active site densities tend towards those expected from the mineral components in the soils, suggesting that the inorganic fraction of soil dusts, in particular the K-feldspar fraction, becomes increasingly important in the initiation of the ice phase at lower temperatures. We conclude that dusts from agricultural activities could contribute significantly to atmospheric IN concentrations, if such dusts exhibit similar activities to those observed in the current laboratory study

Using the theory of planned behaviour as a process evaluation tool in randomised trials of knowledge translation strategies : A case study from UK primary care

Peer reviewedPublisher PD

Living on the edge: predicting invertebrate richness and rarity in disturbance‐prone aquatic–terrestrial ecosystems

Temporal fluctuations in cause the spatial extent of wet and dry habitats to vary in aquatic–terrestrial riverine ecosystems, complicating their biomonitoring. As such, biomonitoring efforts may fail to characterize the species that inhabit such habitats, hampering assessments of their biodiversity and implementation of evidence-informed management strategies. Relationships between the dynamic characteristics of aquatic–terrestrial habitats and their communities are well known. Thus, habitat characteristics may enable estimation of faunal assemblage characteristics such as taxonomic richness, regardless of in-channel water levels. We investigated whether indicators summarizing habitat survey data can predict two metrics representing terrestrial invertebrate assemblages (e.g. taxa richness) in two aquatic–terrestrial habitats: exposed riverine sediments and dry temporary streams. We also compared the performance of unimetric and multimetric habitat indicators in making predictions. In exposed riverine sediments, >88% of predictions were correlated with observed taxa richness and an index of conservation status. Values predicted by exposed riverine sediment samples were correlated with those observed in temporary stream channels with comparable riparian (i.e. largely agricultural) land use, but not those observed in channels with contrasting (i.e. more urban) land use. Unimetric habitat indicators performed similarly to more complex multimetric indicators, with each explaining ≤6% of the variability in taxa richness and the index of conservation status. The different spatial scales at which invertebrates respond to habitat conditions and at which indicators record habitat conditions, and a more comprehensive training dataset that incorporates a full range of habitat conditions (i.e. land use), may improve future predictions. We demonstrate that invertebrate assemblage characteristics can be predicted regardless of in-channel water levels. Agreement between exposed riverine sediment predictions and temporary stream observations suggests that these predictions are transferable among a range of aquatic–terrestrial habitat types, and could thus be widely applied to aid conservation of riverine biodiversity in dynamic aquatic–terrestrial ecosystems

A standardised multi-method survey to enhance characterisation of riparian invertebrate communities

Riparian invertebrate communities are species rich, but variability in sampling methods hampers assessment of their distributions and inference of the quality of their habitats. To reduce this variability, a standardized, multi-method survey protocol was recently developed. Here, riparian beetle community surveys conducted before and after the protocol's introduction were used to evaluate its effectiveness in characterizing communities and in limiting variability among surveys. Use of the standardized protocol reduced variability in sampling effort, and this had a limited effect on estimates of taxonomic richness. Surveys using the protocol captured significantly more species than surveys done before its introduction, evidencing the benefits of standardized multi-method survey protocols. Our study highlights that standardized multi-method survey protocols may enable identification and prioritization of sites requiring management to improve habitat quality. As such, we recommend the integration of such protocols into monitoring programmes, to enhance protection of biodiverse invertebrate communities in vulnerable riparian habitats

High Fidelity Tape Transfer Printing Based On Chemically Induced Adhesive Strength Modulation

Transfer printing, a two-step process (i.e. picking up and printing) for heterogeneous integration, has been widely exploited for the fabrication of functional electronics system. To ensure a reliable process, strong adhesion for picking up and weak or no adhesion for printing are required. However, it is challenging to meet the requirements of switchable stamp adhesion. Here we introduce a simple, high fidelity process, namely tape transfer printing(TTP), enabled by chemically induced dramatic modulation in tape adhesive strength. We describe the working mechanism of the adhesion modulation that governs this process and demonstrate the method by high fidelity tape transfer printing several types of materials and devices, including Si pellets arrays, photodetector arrays, and electromyography (EMG) sensors, from their preparation substrates to various alien substrates. High fidelity tape transfer printing of components onto curvilinear surfaces is also illustrated

Regulation of the Cardiac Na+/K+ ATPase by Phospholemman

Hansraj Dhayan, Rajender Kumar, Andreas Kukol, ‘Regulation of the Cardiac Na+/K+ ATPase by Phospholemman’, in Sajal Chakraborti, Naranjan Dhalla, eds., Regulation of Membrane Na+-K+ ATPase, (Switzerland: Springer, 2016), ISBN 978-3-319-24748-9, eISBN 978-3-319-24750-2.Peer reviewe

Changes in undergraduate student alcohol consumption as they progress through university

BACKGROUND: Unhealthy alcohol use amongst university students is a major public health concern. Although previous studies suggest a raised level of consumption amongst the UK student population there is little consistent information available about the pattern of alcohol consumption as they progress through university. The aim of the current research was to describe drinking patterns of UK full-time undergraduate students as they progress through their degree course. METHOD: Data were collected over three years from 5895 undergraduate students who began their studies in either 2000 or 2001. Longitudinal data (i.e. Years 1–3) were available from 225 students. The remaining 5670 students all responded to at least one of the three surveys (Year 1 n = 2843; Year 2 n = 2219; Year 3 n = 1805). Results: Students reported consuming significantly more units of alcohol per week at Year 1 than at Years 2 or 3 of their degree. Male students reported a higher consumption of units of alcohol than their female peers. When alcohol intake was classified using the Royal College of Physicians guidelines [1] there was no difference between male and females students in terms of the percentage exceeding recommended limits. Compared to those who were low level consumers students who reported drinking above low levels at Year 1 had at least 10 times the odds of continuing to consume above low levels at year 3. Students who reported higher levels of drinking were more likely to report that alcohol had a negative impact on their studies, finances and physical health. Consistent with the reduction in units over time students reported lower levels of negative impact during Year 3 when compared to Year 1. CONCLUSION: The current findings suggest that student alcohol consumption declines over their undergraduate studies; however weekly levels of consumption at Year 3 remain high for a substantial number of students. The persistence of high levels of consumption in a large population of students suggests the need for effective preventative and treatment interventions for all year groups

How the love of muscle can break a heart: Impact of anabolic androgenic steroids on skeletal muscle hypertrophy, metabolic and cardiovascular health.

It is estimated 6.4% of males and 1.6% of females globally use anabolic-androgenic steroids (AAS), mostly for appearance and performance enhancing reasons. In combination with resistance exercise, AAS use increases muscle protein synthesis resulting in skeletal muscle hypertrophy and increased performance. Primarily through binding to the androgen receptor, AAS exert their hypertrophic effects via genomic, non-genomic and anti-catabolic mechanisms. However, chronic AAS use also has a detrimental effect on metabolism ultimately increasing the risk of cardiovascular disease (CVD). Much research has focused on AAS effects on blood lipids and lipoproteins, with abnormal concentrations of these associated with insulin resistance, hypertension and increased visceral adipose tissue (VAT). This clustering of interconnected abnormalities is often referred as metabolic syndrome (MetS). Therefore, the aim of this review is to explore the impact of AAS use on mechanisms of muscle hypertrophy and markers of MetS. AAS use markedly decreases high-density lipoprotein cholesterol (HDL-C) and increases low-density lipoprotein cholesterol (LDL-C). Chronic AAS use also appears to cause higher fasting insulin levels and impaired glucose tolerance and possibly higher levels of VAT; however, research is currently lacking on the effects of AAS use on glucose metabolism. While cessation of AAS use can restore normal lipid levels, it may lead to withdrawal symptoms such as depression and hypogonadism that can increase CVD risk. Research is currently lacking on effective treatments for withdrawal symptoms and further long-term research is warranted on the effects of AAS use on metabolic health in males and females