Exoticism, Cultural Hybridity, and Subaltern Identity in Three Macanese Novels

Although the novels of Austin Coates, Henrique de Senna Fernandes, and Rodrigo Leal de Carvalho’s depict life in the former Portuguese colony of Macau, their individual perspectives reflect a contrast between literary colonialism and coloniality. A British public servant, Coates perceives Macanese reality through the competing biased eyes of an Englishman resenting Portuguese culture and administration in the colony; Leal de Carvalho, a Portuguese resident of Macau, romantically depicts the social nature of Portuguese colonialism; Senna Fernandes, a native Macanese educated in Portugal, offers his interpretation of the colony’s Eurasian inhabitants vis-à-vis its Chinese population. The aim of this article is to contrast the literary representation of three issues in Coates’s City of Broken Promises, Fernandes’s The Bewitching Braid, and Carvalho’s The Count and his Three Wives: exoticism, cultural hybridity, and subaltern identity

Detección de Dekkera / Ibrettanomyces en Vinos Tintos

Existen en la actualidad diversos métodos empleados para la detección de Dekkera/Brettanomyces con numerosas ventajas pero no exentos de inconvenientes tales como umbrales de detección, diferenciación entre células viables y muertas, carácter no preventivo, falsos positivos, tiempos de espera, evaluación insegura (por olfato humano o visual) y contaminaciones por hongos oportunistas. Con objeto de aportar soluciones a esta problemática se han combinado un medio selectivo-diferencial líquido y técnica HPLC/DAD con objeto de evaluar la “Actividad potencial hidroxicinamato descarboxilasa y vinilfenol reductasa existente en un vino”, mejorando algunos de los aspectos anteriores como la cuantificación de poblaciones pequeñas (1 ufc/50ml), trabajo con volúmenes grandes, y detección únicamente de células viables (verdaderas responsables de la formación de etilfenoles)

Therapeutic Hypothermia in Stroke and Traumatic Brain Injury

Therapeutic hypothermia (TH) is considered to improve survival with favorable neurological outcome in the case of global cerebral ischemia after cardiac arrest and perinatal asphyxia. The efficacy of hypothermia in acute ischemic stroke (AIS) and traumatic brain injury (TBI), however, is not well studied. Induction of TH typically requires a multimodal approach, including the use of both pharmacological agents and physical techniques. To date, clinical outcomes for patients with either AIS or TBI who received TH have yielded conflicting results; thus, no adequate therapeutic consensus has been reached. Nevertheless, it seems that by determining optimal TH parameters and also appropriate applications, cooling therapy still has the potential to become a valuable neuroprotective intervention. Among the various methods for hypothermia induction, intravascular cooling (IVC) may have the most promise in the awake patient in terms of clinical outcomes. Currently, the IVC method has the capability of more rapid target temperature attainment and more precise control of temperature. However, this technique requires expertise in endovascular surgery that can preclude its application in the field and/or in most emergency settings. It is very likely that combining neuroprotective strategies will yield better outcomes than utilizing a single approach

First case of a naturally acquired human infection with Plasmodium cynomolgi

Since 1960, a total of seven species of monkey malaria have been reported as transmissible to man by mosquito bite: Plasmodium cynomolgi, Plasmodium brasilianum, Plasmodium eylesi, Plasmodium knowlesi, Plasmodium inui, Plasmodium schwetzi and Plasmodium simium. With the exception of P. knowlesi, none of the other species has been found to infect humans in nature. In this report, it is described the first known case of a naturally acquired P. cynomolgi malaria in humans.The patient was a 39-year-old woman from a malaria-free area with no previous history of malaria or travel to endemic areas. Initially, malaria was diagnosed and identified as Plasmodium malariae/P. knowlesi by microscopy in the Terengganu State Health Department. Thick and thin blood films stained with 10% Giemsa were performed for microscopy examination. Molecular species identification was performed at the Institute for Medical Research (IMR, Malaysia) and in the Malaria & Emerging Parasitic Diseases Laboratory (MAPELAB, Spain) using different nested PCR methods.Microscopic re-examination in the IMR showed characteristics of Plasmodium vivax and was confirmed by a nested PCR assay developed by Snounou et al. Instead, a different PCR assay plus sequencing performed at the MAPELAB confirmed that the patient was infected with P. cynomolgi and not with P. vivax.This is the first report of human P. cynomolgi infection acquired in a natural way, but there might be more undiagnosed or misdiagnosed cases, since P. cynomolgi is morphologically indistinguishable from P. vivax, and one of the most used PCR methods for malaria infection detection may identify a P. cynomolgi infection as P. vivax.Simian Plasmodium species may routinely infect humans in Southeast Asia. New diagnostic methods are necessary to distinguish between the human and monkey malaria species. Further epidemiological studies, incriminating also the mosquito vector(s), must be performed to know the relevance of cynomolgi malaria and its implication on human public health and in the control of human malaria.The zoonotic malaria cannot be ignored in view of increasing interactions between man and wild animals in the process of urbanization.This work was supported by the Interuniversity Cooperation Programme (AECID grant and A1/035539/11) and IMR/NIH Project NMRR-11-410-9622. THT was financed by a fellowship from the Instituto de Salud Carlos III.S

Red blood cell transfusion in patients with subarachnoid hemorrhage: a multidisciplinary North American survey

Abstract Introduction Anemia is associated with poor outcomes in patients with aneurysmal subarachnoid hemorrhage (SAH). It remains unclear whether this association can be modified with more aggressive use of red blood cell (RBC) transfusions. The degree to which restrictive thresholds have been adopted in neurocritical care patients remains unknown. Methods We performed a survey of North American academic neurointensivists, vascular neurosurgeons and multidisciplinary intensivists who regularly care for patients with SAH to determine hemoglobin (Hb) concentrations which commonly trigger a decision to initiate transfusion. We also assessed minimum and maximum acceptable Hb goals in the context of a clinical trial and how decision-making is influenced by advanced neurological monitoring, clinician characteristics and patient-specific factors. Results The survey was sent to 531 clinicians, of whom 282 (53%) responded. In a hypothetical patient with high-grade SAH (WFNS 4), the mean Hb concentration at which clinicians administered RBCs was 8.19 g/dL (95% CI, 8.07 to 8.30 g/dL). Transfusion practices were comparatively more restrictive in patients with low-grade SAH (mean Hb 7.85 g/dL (95% CI, 7.73 to 7.97 g/dL)) (P < 0.0001) and more liberal in patients with delayed cerebral ischemia (DCI) (mean Hb 8.58 g/dL (95% CI, 8.45 to 8.72 g/dL)) (P < 0.0001). In each setting, there was a broad range of opinions. The majority of respondents expressed a willingness to study a restrictive threshold of ≤8 g/dL (92%) and a liberal goal of ≥10 g/dl (75%); in both cases, the preferred transfusion thresholds were significantly higher for patients with DCI (P < 0.0001). Neurosurgeons expressed higher minimum Hb goals than intensivists, especially for patients with high-grade SAH (β = 0.46, P = 0.003), and were more likely to administer two rather than one unit of RBCs (56% vs. 19%; P < 0.0001). Institutional use of transfusion protocols was associated with more restrictive practices. More senior clinicians preferred higher Hb goals in the context of a clinical trial. Respondents were more likely to transfuse patients with brain tissue oxygen tension values <15 mmHg and lactate-to-pyruvate ratios >40. Conclusions There is widespread variation in the use of RBC transfusions in SAH patients. Practices are heavily influenced by the specific dynamic clinical characteristics of patients and may be further modified by clinician specialty and seniority, the use of protocols and advanced neurological monitoring

Global Incidence of Neurological Manifestations Among Patients Hospitalized With COVID-19-A Report for the GCS-NeuroCOVID Consortium and the ENERGY Consortium.

Importance The COVID-19 pandemic continues to affect millions of people globally, with increasing reports of neurological manifestations but limited data on their incidence and associations with outcome. Objective To determine the neurological phenotypes, incidence, and outcomes among adults hospitalized with COVID-19. Design, Setting, and Participants This cohort study included patients with clinically diagnosed or laboratory-confirmed COVID-19 at 28 centers, representing 13 countries and 4 continents. The study was performed by the Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID) from March 1 to September 30, 2020, and the European Academy of Neurology (EAN) Neuro-COVID Registry (ENERGY) from March to October 2020. Three cohorts were included: (1) the GCS-NeuroCOVID all COVID-19 cohort (n = 3055), which included consecutive hospitalized patients with COVID-19 with and without neurological manifestations; (2) the GCS-NeuroCOVID COVID-19 neurological cohort (n = 475), which comprised consecutive patients hospitalized with COVID-19 who had confirmed neurological manifestations; and (3) the ENERGY cohort (n = 214), which included patients with COVID-19 who received formal neurological consultation. Exposures Clinically diagnosed or laboratory-confirmed COVID-19. Main Outcomes and Measures Neurological phenotypes were classified as self-reported symptoms or neurological signs and/or syndromes assessed by clinical evaluation. Composite incidence was reported for groups with at least 1 neurological manifestation. The main outcome measure was in-hospital mortality. Results Of the 3055 patients in the all COVID-19 cohort, 1742 (57%) were men, and the mean age was 59.9 years (95% CI, 59.3-60.6 years). Of the 475 patients in the COVID-19 neurological cohort, 262 (55%) were men, and the mean age was 62.6 years (95% CI, 61.1-64.1 years). Of the 214 patients in the ENERGY cohort, 133 (62%) were men, and the mean age was 67 years (95% CI, 52-78 years). A total of 3083 of 3743 patients (82%) across cohorts had any neurological manifestation (self-reported neurological symptoms and/or clinically captured neurological sign and/or syndrome). The most common self-reported symptoms included headache (1385 of 3732 patients [37%]) and anosmia or ageusia (977 of 3700 patients [26%]). The most prevalent neurological signs and/or syndromes were acute encephalopathy (1845 of 3740 patients [49%]), coma (649 of 3737 patients [17%]), and stroke (222 of 3737 patients [6%]), while meningitis and/or encephalitis were rare (19 of 3741 patients [0.5%]). Presence of clinically captured neurologic signs and/or syndromes was associated with increased risk of in-hospital death (adjusted odds ratio [aOR], 5.99; 95% CI, 4.33-8.28) after adjusting for study site, age, sex, race, and ethnicity. Presence of preexisting neurological disorders (aOR, 2.23; 95% CI, 1.80-2.75) was associated with increased risk of developing neurological signs and/or syndromes with COVID-19. Conclusions and Relevance In this multicohort study, neurological manifestations were prevalent among patients hospitalized with COVID-19 and were associated with higher in-hospital mortality. Preexisting neurological disorders were associated with increased risk of developing neurological signs and/or syndromes in COVID-19

Stroke Severity Predicted by Aortic Atheroma Detected by Ultra-Fast and Cardiac-Gated Chest Tomography†

Background and Purpose: The presence of aortic atherosclerosis is an independent risk factor for secondary stroke. The present study was designed to have an initial exploration of the correlation between the load and extent of aortic atheroma (AA) and initial stroke severity or clinical outcome 3 months after stroke. Methods: Cardiac-gated chest tomography (CGCT) was used to detect and measure AA in patients with acute ischemic stroke as shown by our group in prior prospective studies and this is part four sub-exploratory study of the same cohort. The National Institute of Health Stroke Scale (NIHSS) was used to assess the initial stroke severity, and the modified Rankin Scale (mRS) was used to assess 3-month outcome. Results: Thirty-two patients underwent CGCT for evaluation of AA, and 21 were found to have AA. AA was more prevalent in patient with NIHSS >6 (14/17 versus 7/15, p-value 0.03). Applying the multiple logistic regression and propensity score adjustment (using the propensity of having AA given the baseline features as covariates) showed a non-significant trend that AA is three times more likely to be associated with NIHSS >6 (p = 0.08, OR 3.08, 95% CI 0.94–13.52). There was no evidence of association of AA with 3-month functional outcome (mRS): 11/14 (78.6%) mRS >1 had AA, and 10/18 (55.5%) of those with mRS ≤1 had AA (p = 0.27). Conclusion: In our current study with limited sample number and exploratory nature, the presence of AA on CGCT with acute ischemic stroke patients may be associated with worse neurological deficit at presentation. There was no evidence of association with 3-month functional outcome using the mRS

A Physiology-Driven Computational Model for Post-Cardiac Arrest Outcome Prediction

Patients resuscitated from cardiac arrest (CA) face a high risk of neurological disability and death, however pragmatic methods are lacking for accurate and reliable prognostication. The aim of this study was to build computational models to predict post-CA outcome by leveraging high-dimensional patient data available early after admission to the intensive care unit (ICU). We hypothesized that model performance could be enhanced by integrating physiological time series (PTS) data and by training machine learning (ML) classifiers. We compared three models integrating features extracted from the electronic health records (EHR) alone, features derived from PTS collected in the first 24hrs after ICU admission (PTS24), and models integrating PTS24 and EHR. Outcomes of interest were survival and neurological outcome at ICU discharge. Combined EHR-PTS24 models had higher discrimination (area under the receiver operating characteristic curve [AUC]) than models which used either EHR or PTS24 alone, for the prediction of survival (AUC 0.85, 0.80 and 0.68 respectively) and neurological outcome (0.87, 0.83 and 0.78). The best ML classifier achieved higher discrimination than the reference logistic regression model (APACHE III) for survival (AUC 0.85 vs 0.70) and neurological outcome prediction (AUC 0.87 vs 0.75). Feature analysis revealed previously unknown factors to be associated with post-CA recovery. Results attest to the effectiveness of ML models for post-CA predictive modeling and suggest that PTS recorded in very early phase after resuscitation encode short-term outcome probabilities.Comment: 51 pages, 7 figures, 4 supplementary figure

Carbon remineralization by small mesopelagic and bathypelagic Stomiiforms in the Northeast Atlantic Ocean

The organic carbon resulting from photosynthesis in the upper ocean is transferred downward through the passive sinking of organic particles, physical mixing of particulate and dissolved organic carbon as well as active flux transported by zooplanktonic and micronektonic migrants. Several meso- and bathypelagic organisms feed in shallower layers during the nighttime and respire, defecate, excrete and die at depth. Recent studies suggest that migrant micronekton transport similar amounts of carbon to migrant zooplankton. However, there is scarce information about biomass and carbon flux by non-migratory species in the mesopelagic and bathypelagic zones. The non-migratory bristlemouth fishes (Cyclothone spp.) and partial migrator (A. hemigymnus) remineralise organic carbon at depth, and knowledge about this process by this fauna is lacking despite them having been referred to as the most abundant vertebrates on Earth. Here we show the vertical distribution of biomass and respiration of non-migratory mesopelagic fishes, during day and night, using the enzymatic activity of the electron transfer system (ETS) as a proxy for respiration rates. The study is focused on five Cyclothone species (C. braueri, C. pseudopallida, C. pallida, C. livida and C. microdon) and Argyropelecus hemigymnus. The samples were taken on a transect from the oceanic upwelling off Northwest Africa (20° N, 20° W) to the south of Iceland (60° N, 20° W). Cyclothone spp. showed, by far, the largest biomass (126.90 ± 86.20 mg C·m⁻²) compared to A. hemigymnus (0.54 ± 0.44 mg C·m⁻²). The highest concentrations of Cyclothone spp. in the water column were observed between 400 and 600 m and from 1000 to 1500 m depths, both during day and night. For the different species analysed, ETS activity did not show significant differences between diurnal and nocturnal periods. The total average specific respiration of Cyclothone spp. (0.02 ± 0.01 d⁻¹) was lower than that observed for A. hemigymnus (0.05±0.02 d⁻¹). The average carbon respiration of Cyclothone spp. was 2.22 ± 0.81 mg C·m⁻²·d⁻¹, while it was much lower for A. hemigymnus (0.04 ± 0.03 mg C·m⁻²·d⁻¹). The respiration of Cyclothone spp. was lower in the bathypelagic than in the mesopelagic zone (0.84 ± 0.48 vs 1.36 ± 1.01 mg C·m⁻²·d⁻¹, respectively). These results, to our knowledge, provide the first account of remineralisation by this community in the meso and bathypelagic zones of the ocean.En prens