Carbon monoxide poisoning: novel magnetic resonance imaging pattern in the acute setting

The presentation of carbon monoxide (CO) poisoning is non-specific and highly variable. The diagnosis is made when a compatible history and examination occur in a patient with elevated carboxyhaemoglobin levels. The severity of intoxication is difficult to assess accurately based on laboratory markers alone. Magnetic resonance imaging (MRI) has been shown to have superior sensitivity to computed tomography for the detection of abnormalities post CO poisoning. We report a novel imaging pattern on MRI undertaken in the acute setting in a patient with CO intoxication. We also discuss the management and follow up of patients with CO poisoning

Carbon monoxide poisoning: Novel magnetic resonance imaging pattern in the acute setting

The presentation of carbon monoxide (CO) poisoning is non-specific and highly variable. The diagnosis is made when a compatible history and examination occur in a patient with elevated carboxyhaemoglobin levels. The severity of intoxication is difficult to assess accurately based on laboratory markers alone. Magnetic resonance imaging (MRI) has been shown to have superior sensitivity to computed tomography for the detection of abnormalities post CO poisoning. We report a novel imaging pattern on MRI undertaken in the acute setting in a patient with CO intoxication. We also discuss the management and follow up of patients with CO poisoning

Online cognitive-based intervention for depression: exploring possible circularity in mechanisms of change.

Background. This study investigates possible circularity in mechanisms of change in participants of Master Your Mood (MYM), a cognitive-based, online intervention for young adults with depressive symptoms. A previous study showed that MYM effectively reduced depression and anxiety and strengthened mastery

Predicting consistent foraging ecologies of migrating waterbirds: Using stable isotope and parasite measurements as indicators of landscape use

The emergence of novel human pathogens is frequently linked with zoonotic events and human-wildlife interactions that promote disease transmission. Consequently, surveillance of wildlife populations for candidate diseases that could spread to humans is beneficial, but requires widespread collections of numerous samples. A legitimate means to acquire large sample sizes of waterfowl is through cooperation between researchers and hunters, who also work in concert with natural resource managers, landowners, and agricultural entities -e.g., aquaculture facilities. In addition to understanding the occurrence and spread of parasites and pathogens by birds, these samples can be used to answer questions about the ecology of various waterbird species. Body mass and morphometric data on hunter-donated specimen are useful for understanding bird condition and other dynamics of birds; however, when breast meat is removed prior to the acquisition of specimen weight, samples might not be as desirable. Here, we evaluate the utility of data obtained from a bird species that might be targeted by hunters and subsequently used to learn about their disease dynamics. Lesser Scaup (Aythya affinis) collected at aquaculture facilities were assessed for their stable isotope concentrations and parasites communities to learn about the birds’ foraging ecology. Discriminant analyses designed to classify birds by the aquaculture pond type from which they were collected included isotope data, Principal Components derived from parasite community data of 7 types, and birds’ body mass. We compared these to Double-crested Cormorants (Nannopterum auritum) feeding on catfish and found the two waterbird species exhibited different infracommunities of parasites Furthermore, some scaup demonstrated fish aquaculture pond type fidelity. Bird body mass was an important metric to include in analytical models when all parasite datatypes were not available. However, the combination of stable isotope concentrations and parasite infracommunity data (that includes prevalence, abundance, volume, and energy use) in models resulted in host ecology differentiation equal or better than models where bird body mass was included. Hunter-derived samples should be encouraged as a means for sample acquisition and be considered as an approach for aquaculture-wildlife conflict management as the information that can be obtained through these samples is multifaceted

Robust paths to net greenhouse gas mitigation and negative emissions via advanced biofuels

ACKNOWLEDGEMENTS We thank Dennis Ojima and Daniel L. Sanchez for their encouragement on this topic. The authors gratefully acknowledge partial support as follows: J.L.F., L.R.L., T.L.R., E.A.H.S., and J.J.S., the Sao Paulo Research Foundation (FAPESP grant# 2014/26767-9); J.L.F., L.R.L., K.P., and T.L.R., The Center for Bioenergy Innovation, a U.S. Department of Energy Research Center supported by the Office of Biological and Environmental Research in the DOE Office of Science (grant# DE-AC05-00OR22725); L.R.L., the Sao Paulo Research Foundation, and the Link Foundation; J.L.F. and K.P., USDA/NIFA (grant# 2013-68005-21298 and 2017-67019-26327); T.L.R., USDA/NIFA (grant# 2012-68005-19703); D.S.L. and S.P.L., the Energy Biosciences Institute. Data availability The DayCent model (https://www2.nrel.colostate.edu/projects/daycent/) is freely available upon request. Specification of DayCent model runs and automated model initialization, calibration, scenario simulation, results analysis, and figure generation were implemented in Python 2.7, using the numpy module for data processing and the matplotlib module for figure generation. Analysis code is available in a version-controlled repository (https://github.com/johnlfield/Ecosystem_dynamics). A working copy of the code, all associated DayCent model inputs, and analysis outputs are also available in an online data repository (https://figshare.com/s/4c14ec168bd550db4bad; note this URL is for accessing a private version of the repository, and will eventually be replaced with an updated URL for the public version of the repository, which will only be accessible after the journal-specified embargo date).Peer reviewedPostprintPublisher PD

Evolution of l-DOPA 4,5-dioxygenase activity allows for recurrent specialisation to betalain pigmentation in Caryophyllales

The evolution of l-DOPA 4,5-dioxygenase activity, encoded by the gene DODA, was a key step in the origin of betalain biosynthesis in Caryophyllales. We previously proposed that l-DOPA 4,5-dioxygenase activity evolved via a single Caryophyllales-specific neofunctionalisation event within the DODA gene lineage. However, this neofunctionalisation event has not been confirmed and the DODA gene lineage exhibits numerous gene duplication events, whose evolutionary significance is unclear. To address this, we functionally characterised 23 distinct DODA proteins for l-DOPA 4,5-dioxygenase activity, from four betalain-pigmented and five anthocyanin-pigmented species, representing key evolutionary transitions across Caryophyllales. By mapping these functional data to an updated DODA phylogeny, we then explored the evolution of l-DOPA 4,5-dioxygenase activity. We find that low l-DOPA 4,5-dioxygenase activity is distributed across the DODA gene lineage. In this context, repeated gene duplication events within the DODA gene lineage give rise to polyphyletic occurrences of elevated l-DOPA 4,5-dioxygenase activity, accompanied by convergent shifts in key functional residues and distinct genomic patterns of micro-synteny. In the context of an updated organismal phylogeny and newly inferred pigment reconstructions, we argue that repeated convergent acquisition of elevated l-DOPA 4,5-dioxygenase activity is consistent with recurrent specialisation to betalain synthesis in Caryophyllales. Keywords: Caryophyllales; anthocyanins; betalains; convergent evolution; gene duplication; l-DOPA 4, 5-dioxygenase (DODA); metabolic operon; plant pigments; specialised metabolism

Incidence, nature and causes of avoidable significant harm in primary care in England:retrospective case note review

Objective To estimate the incidence of avoidable significant harm in primary care in England; describe and classify the associated patient safety incidents and generate suggestions to mitigate risks of ameliorable factors contributing to the incidents. Design Retrospective case note review. Patients with significant health problems were identified and clinical judgements were made on avoidability and severity of harm. Factors contributing to avoidable harm were identified and recorded. Setting Primary care. Participants Thirteen general practitioners (GPs) undertook a retrospective case note review of a sample of 14 407 primary care patients registered with 12 randomly selected general practices from three regions in England (total list size: 92 255 patients). Main outcome measures The incidence of significant harm considered at least ‘probably avoidable’ and the nature of the safety incidents. Results The rate of significant harm considered at least probably avoidable was 35.6 (95% CI 23.3 to 48.0) per 100 000 patient-years (57.9, 95% CI 42.2 to 73.7, per 100 000 based on a sensitivity analysis). Overall, 74 cases of avoidable harm were detected, involving 72 patients. Three types of incident accounted for more than 90% of the problems: problems with diagnosis accounted for 45/74 (60.8%) primary incidents, followed by medication-related problems (n=19, 25.7%) and delayed referrals (n=8, 10.8%). In 59 (79.7%) cases, the significant harm could have been identified sooner (n=48) or prevented (n=11) if the GP had taken actions aligned with evidence-based guidelines. Conclusion There is likely to be a substantial burden of avoidable significant harm attributable to primary care in England with diagnostic error accounting for most harms. Based on the contributory factors we found, improvements could be made through more effective implementation of existing information technology, enhanced team coordination and communication, and greater personal and informational continuity of care

Understanding the epidemiology of avoidable significant harm in primary care:Protocol for a retrospective cross-sectional study

Introduction: Most patient safety research has focused on specialist-care settings where there is an appreciation of the frequency and causes of medical errors, and the resulting burden of adverse events. There have, however, been few large-scale robust studies that have investigated the extent and severity of avoidable harm in primary care. To address this, we will conduct a 12-month retrospective cross-sectional study involving case note review of primary care patients. Methods and Analysis: We will conduct electronic searches of general practice (GP) clinical computer systems to identify patients with avoidable significant harm. Up to sixteen general practices from three areas of England (East Midlands, London and the North West) will be recruited based on practice size, to obtain a sample of around 100,000 patients. Our investigations will include an ‘enhanced sample’ of patients with the highest risk of avoidable significant harm. We will estimate the incidence of avoidable significant harm and express this as ‘per 100,000 patients per year’. Univariate and multivariate analysis will be conducted to identify the factors associated with avoidable significant harm. Ethics/Dissemination: The decision regarding participation by general practices in the study is entirely voluntary; the consent to participate may be withdrawn at any time. We will not seek individual patient consent for the retrospective case note review, but if patients respond to publicity about the project and say they do not wish their records to be included we will follow these instructions. We will produce a report for the Department of Health’s Policy Research Programme and several high-quality peer-reviewed publications in scientific journals. The study has been granted a favourable opinion by the East Midlands Nottingham 2 Research Ethics Committee (reference 15/EM/0411) and Confidentiality Advisory Group approval for access to medical records without consent under section 251 of the NHS Act 2006 (reference 15/CAG/0182)

What are the important morbidities associated with paediatric cardiac surgery? A mixed methods study.

OBJECTIVES: Given the current excellent early mortality rates for paediatric cardiac surgery, stakeholders believe that this important safety outcome should be supplemented by a wider range of measures. Our objectives were to prospectively measure the incidence of morbidities following paediatric cardiac surgery and to evaluate their clinical and health-economic impact over 6 months. DESIGN: The design was a prospective, multicentre, multidisciplinary mixed methods study. SETTING: The setting was 5 of the 10 paediatric cardiac surgery centres in the UK with 21 months recruitment. PARTICIPANTS: Included were 3090 paediatric cardiac surgeries, of which 666 patients were recruited to an impact substudy. RESULTS: Families and clinicians prioritised:Acute neurological event, unplanned re-intervention, feeding problems, renal replacement therapy, major adverse events, extracorporeal life support, necrotising enterocolitis, postsurgical infection and prolonged pleural effusion or chylothorax.Among 3090 consecutive surgeries, there were 675 (21.8%) with at least one of these morbidities. Independent risk factors for morbidity included neonatal age, complex heart disease and prolonged cardiopulmonary bypass (p<0.001). Among patients with morbidity, 6-month survival was 88.2% (95% CI 85.4 to 90.6) compared with 99.3% (95% CI 98.9 to 99.6) with none of the morbidities (p<0.001). The impact substudy in 340 children with morbidity and 326 control children with no morbidity indicated that morbidity-related impairment in quality of life improved between 6 weeks and 6 months. When compared with children with no morbidities, those with morbidity experienced a median of 13 (95% CI 10.2 to 15.8, p<0.001) fewer days at home by 6 months, and an adjusted incremental cost of £21 292 (95% CI £17 694 to £32 423, p<0.001). CONCLUSIONS: Evaluation of postoperative morbidity is more complicated than measuring early mortality. However, tracking morbidity after paediatric cardiac surgery over 6 months offers stakeholders important data that are of value to parents and will be useful in driving future quality improvement