Renal Infarct After Endovascular Abdominal Aortic Aneurysm Repair: Consider in Back Pain Differential

As hypertension, obesity, and hyperlipidemia become more widespread, the prevalence of abdominal aortic aneurysms (AAA) has also increased.1 Traditionally those with multiple comorbidities – also those with greatest AAA mortality – were considered too high risk for operative repair. In recent decades, however, endovascular abdominal aortic aneurysm repair (EVAR) has become a popular option, especially for high-risk patients. Overall, short-term outcomes are comparable to traditional open repair despite higher patient baseline risk. However, EVAR comes with its own risks, which the emergency physician should be aware of. Here, we present a rare complication of EVAR: device thrombosis with subsequent renal infarct

The staphylococcal QacR multidrug regulator binds a correctly spaced operator as a pair of dimers

Expression of the Staphylococcus aureus plasmid-encoded QacA multidrug transporter is regulated by the divergently encoded QacR repressor protein. To circumvent the formation of disulfide-bonded degradation products, site-directed mutagenesis to replace the two cysteine residues in wild-type QacR was undertaken. Analysis of a resultant cysteineless QacR derivative indicated that it retained full DNA-binding activities in vivo and in vitro and continued to be fully proficient for the mediation of induction of qacA expression in response to a range of structurally dissimilar multidrug transporter substrates. The cysteineless QacR protein was used in cross-linking and dynamic light-scattering experiments to show that its native form was a dimer, whereas gel filtration indicated that four QacR molecules bound per DNA operator site. The addition of inducing compounds led to the dissociation of the four operator-bound QacR molecules from the DNA as dimers. Binding of QacR dimers to DNA was found to be dependent on the correct spacing of the operator half-sites. A revised model proposed for the regulation of qacA expression by QacR features the unusual characteristic of one dimer of the regulatory protein binding to each operator half-site by a process that does not appear to require the prior self-assembly of QacR into tetramers

Vagrancy, Vice, and Victimhood: The Evolution of Homeless Persecution

Through the examination of how urban space is constructed, one can see how the city testifies to the ways that history and memory come to shape human experience and the vocabularies with which it is understood and remembered. This paper will diverge from contemporary discussions of history and memory through an investigation of the roles of affect and social location have in shaping how the city is thought of and remembered differently. It will compare historical constructions of city folk in an attempt to understand the role of hegemonic social, economic, and political conditions in the construction of “history.” This paper draws on the work of affective communication theory, and analyzes how memory is impacted by homeless erasure through the lenses of discourse, spatiality, and performance. This paper will conclude by using Jacques Derrida’s conception of hauntology to prove that affect comes to inform all parts of the memory-making process, and argue that remaining attune to the keenly-felt absences of historical memories often bequeaths entirely new counter-histories of their own

Plant exudates may stabilize or weaken soil depending on species, origin and time

We hypothesized that plant exudates could either gel or disperse soil depending on their chemical characteristics. Barley (Hordeum vulgare L. cv. Optic) and maize (Zea mays L.cv. Freya) root exudates were collected using an aerated hydroponic method and compared to chia (Salvia hispanica L.) seed exudate, a commonly used root exudate analogue. Sandy loam soil passed through a 500-μm mesh was treated with each exudate at a concentrationof 4.6 mg exudate g-1 dry soil. Two sets of soil samples were prepared, One set of treated soil samples was maintained at 4oC to suppress microbial processes. To characterize the effect of decomposition, the second set of samples was incubated at 16C for 2 weeks at – 30 kPa matric potential. Gas chromatography–mass spectrometry (GC–MS) analysis of the exudates found that barley had the largest organic acid content and chia the largest content of sugars (polysaccharide-derived or free), and maize was in between barley and chia. Yield stress of amended soil samples was measured by an oscillatory strain sweep test with a cone plate rheometer. When microbial decomposition was suppressed at 4oC, yield stress increased 20-fold for chia seed exudate and two-fold for maize root exudate compared to the control, whereas for barley root exudate it decreased to half. The yield stress after 2 weeks of incubation compared to soil with suppressed microbial decomposition increased by 85% for barley root exudate, but for chia and maize it decreased to by 87% and 54%, respectively. Barley root exudation might therefore disperse soil and this could facilitate nutrient release. The maize root and chia seed exudates gelled soil, which could create a more stable soil structure around roots or seeds

Meningococcal disease in children in Merseyside, England:a 31 year descriptive study

Meningococcal disease (MCD) is the leading infectious cause of death in early childhood in the United Kingdom, making it a public health priority. MCD most commonly presents as meningococcal meningitis (MM), septicaemia (MS), or as a combination of the two syndromes (MM/MS). We describe the changing epidemiology and clinical presentation of MCD, and explore associations with socioeconomic status and other risk factors. A hospital-based study of children admitted to a tertiary children's centre, Alder Hey Children's Foundation Trust, with MCD, was undertaken between 1977 to 2007 (n = 1157). Demographics, clinical presentations, microbiological confirmation and measures of deprivation were described. The majority of cases occurred in the 1-4 year age group and there was a dramatic fall in serogroup C cases observed with the introduction of the meningococcal C conjugate (MCC) vaccine. The proportion of MS cases increased over the study period, from 11% in the first quarter to 35% in the final quarter. Presentation with MS (compared to MM) and serogroup C disease (compared to serogroup B) were demonstrated to be independent risk factors for mortality, with odds ratios of 3.5 (95% CI 1.18 to 10.08) and 2.18 (95% CI 1.26 to 3.80) respectively. Cases admitted to Alder Hey were from a relatively more deprived population (mean Townsend score 1.25, 95% CI 1.09 to 1.41) than the Merseyside reference population. Our findings represent one of the largest single-centre studies of MCD. The presentation of MS is confirmed to be a risk factor of mortality from MCD. Our study supports the association between social deprivation and MCD

Widespread Treponema pallidum Infection in Nonhuman Primates, Tanzania

We investigated Treponema pallidum infection in 8 nonhuman primate species (289 animals) in Tanzania during 2015–2017. We used a serologic treponemal test to detect antibodies against the bacterium. Infection was further confirmed from tissue samples of skin-ulcerated animals by 3 independent PCRs (polA, tp47, and TP_0619). Our findings indicate that T. pallidum infection is geographically widespread in Tanzania and occurs in several species (olive baboons, yellow baboons, vervet monkeys, and blue monkeys). We found the bacterium at 11 of 14 investigated geographic locations. Anogenital ulceration was the most common clinical manifestation; orofacial lesions also were observed. Molecular data show that nonhuman primates in Tanzania are most likely infected with T. pallidum subsp. pertenue–like strains, which could have implications for human yaws eradication

An incubation perspective on social innovation : the London Hub - a social incubator

In the context of incubators, particularly those that are driven to achieving social objectives, this paper investigates core processes that support the development of social innovation. Social innovation as this paper argues is underpinned by a new form of social collaboration and engagement built upon strong forms of sharing knowledge and learning. Coupled with this is the element of social capital reinforced by entrepreneurship and leadership that promotes sustainability in the community. These factors drive innovative thinking and ways of engaging among stakeholders in order to create new forms of socio-economic impact. Such value-creating activity occurs in firms that operate within incubators involving a wide range of stakeholders who work through networks to co-create and meet social challenges. Through a case study of a social incubator and an incubatee, we demonstrate the core processes that irradiate the argument on social innovation. The contribution of this paper is threefold: firstly, social innovation is an emerging area of research, of which there is a dearth in terms of examining the processes empirically. We address the gap in this field by demonstrating the value of social collaboration and engagement using different innovation models. Secondly, we establish links between social innovation and incubation using the concept of social capital. This allows us to achieve our third contribution: exemplification of a dyadic value-based partnership and collaboration processes between an incubator and an incubatee, through activities driven by social innovation which aim to have social impact. The paper concludes with practice implications and suggests directions for future research

One session of remote ischemic preconditioning does not improve vascular function in acute normobaric and chronic hypobaric hypoxia

Application of repeated short duration bouts of ischemia to the limbs, termed remote ischemic preconditioning (RIPC), is a novel technique that may have protective effects on vascular function during hypoxic exposures. In separate parallel-design studies, at sea-level (SL; n=16), and after 8-12 days at high-altitude (HA; n=12; White Mountain, 3800m), participants underwent either a sham protocol or one session of 4x5 minutes of dual-thigh cuff occlusion with 5-minutes recovery. Brachial artery flow-mediated dilation (FMD; ultrasound), pulmonary artery systolic pressure (PASP; echocardiography), and internal carotid artery flow (ICA; ultrasound) were measured at SL in normoxia and isocapnic hypoxia [end-tidal PO (PETO ) maintained to 50mmHg], and during normal breathing at HA. The hypoxic ventilatory response (HVR) was measured at each location. All measures at SL and HA were obtained at baseline (BL), 1 hour, 24 hours, and 48 hours post-RIPC or sham. At SL, RIPC produced no changes in FMD, PASP, ICA flow, end-tidal gases or HVR in normoxia or hypoxia. At HA, although HVR increased 24 hours post RIPC compared to BL (2.05{plus minus}1.4 vs. 3.21{plus minus}1.2 L•min-1•%SaO2-1, p<0.01), there were no significant differences in FMD, PASP, ICA flow, resting end-tidal gases. Accordingly, a single session of RIPC is insufficient to evoke changes in peripheral, pulmonary, and cerebral vascular function in healthy adults. Although chemosensitivity may increase following RIPC at HA, this did not confer any vascular changes. The utility of a single RIPC session seems unremarkable during acute and chronic hypoxia