The management of tetanus in adults in an intensive care unit in Southern Vietnam

Background: Tetanus remains common in many low- and middle-income countries (LMICs) yet the evidence base guiding management of this disease is extremely limited, particularly with respect to contemporary management options. Sharing knowledge about practice may facilitate improvement in outcomes elsewhere. Methods: We describe clinical interventions and outcomes of 180 adult patients ≥16 years-old with tetanus enrolled in prospective observational studies at a specialist infectious diseases hospital in Southern Vietnam. Patients were treated according to a holistic management protocol encompassing wound-care, antitoxin, antibiotics, symptom control, airway management, nutrition and de-escalation criteria. Results: Mortality rate in our cohort was 2.8%, with 90 (50%) patients requiring mechanical ventilation for a median 16 [IQR 12-24] days. Median [IQR] duration of ICU stay was 15 [8-23] days. Autonomic nervous system dysfunction occurred in 45 (25%) patients. Hospital acquired infections occurred in 77 (43%) of patients. Conclusion: We report favourable outcomes for patients with tetanus in a single centre LMIC ICU, treated according to a holistic protocol. Nevertheless, many patients required prolonged intensive care support and hospital acquired infections were common

Tracking cortical entrainment in neural activity: auditory processes in human temporal cortex.

A primary objective for cognitive neuroscience is to identify how features of the sensory environment are encoded in neural activity. Current auditory models of loudness perception can be used to make detailed predictions about the neural activity of the cortex as an individual listens to speech. We used two such models (loudness-sones and loudness-phons), varying in their psychophysiological realism, to predict the instantaneous loudness contours produced by 480 isolated words. These two sets of 480 contours were used to search for electrophysiological evidence of loudness processing in whole-brain recordings of electro- and magneto-encephalographic (EMEG) activity, recorded while subjects listened to the words. The technique identified a bilateral sequence of loudness processes, predicted by the more realistic loudness-sones model, that begin in auditory cortex at ~80 ms and subsequently reappear, tracking progressively down the superior temporal sulcus (STS) at lags from 230 to 330 ms. The technique was then extended to search for regions sensitive to the fundamental frequency (F0) of the voiced parts of the speech. It identified a bilateral F0 process in auditory cortex at a lag of ~90 ms, which was not followed by activity in STS. The results suggest that loudness information is being used to guide the analysis of the speech stream as it proceeds beyond auditory cortex down STS toward the temporal pole.This work was supported by an EPSRC grant to William D. Marslen-Wilson and Paula Buttery (EP/F030061/1), an ERC Advanced Grant (Neurolex) to William D. Marslen-Wilson, and by MRC Cognition and Brain Sciences Unit (CBU) funding to William D. Marslen-Wilson (U.1055.04.002.00001.01). Computing resources were provided by the MRC-CBU and the University of Cambridge High Performance Computing Service (http://www.hpc.cam.ac.uk/). Andrew Liu and Phil Woodland helped with the HTK speech recogniser and Russell Thompson with the Matlab code. We thank Asaf Bachrach, Cai Wingfield, Isma Zulfiqar, Alex Woolgar, Jonathan Peelle, Li Su, Caroline Whiting, Olaf Hauk, Matt Davis, Niko Kriegeskorte, Paul Wright, Lorraine Tyler, Rhodri Cusack, Brian Moore, Brian Glasberg, Rik Henson, Howard Bowman, Hideki Kawahara, and Matti Stenroos for invaluable support and suggestions.This is the final published version. The article was originally published in Frontiers in Computational Neuroscience, 10 February 2015 | doi: 10.3389/fncom.2015.0000

Representation of Instantaneous and Short-Term Loudness in the Human Cortex.

Acoustic signals pass through numerous transforms in the auditory system before perceptual attributes such as loudness and pitch are derived. However, relatively little is known as to exactly when these transformations happen, and where, cortically or sub-cortically, they occur. In an effort to examine this, we investigated the latencies and locations of cortical entrainment to two transforms predicted by a model of loudness perception for time-varying sounds: the transforms were instantaneous loudness and short-term loudness, where the latter is hypothesized to be derived from the former and therefore should occur later in time. Entrainment of cortical activity was estimated from electro- and magneto-encephalographic (EMEG) activity, recorded while healthy subjects listened to continuous speech. There was entrainment to instantaneous loudness bilaterally at 45, 100, and 165 ms, in Heschl's gyrus, dorsal lateral sulcus, and Heschl's gyrus, respectively. Entrainment to short-term loudness was found in both the dorsal lateral sulcus and superior temporal sulcus at 275 ms. These results suggest that short-term loudness is derived from instantaneous loudness, and that this derivation occurs after processing in sub-cortical structures.This work was supported by an ERC Advanced Grant (230570, ‘Neurolex’) to WMW, and by MRC Cognition and Brain Sciences Unit (CBU) funding to WMW (U.1055.04.002.00001.01). Computing resources were provided by the MRC-CBU.This is the final version of the article. It first appeared from Frontiers via http://dx.doi.org/10.3389/fnins.2016.0018

Excavations and the afterlife of a professional football stadium, Peel Park, Accrington, Lancashire: towards an archaeology of football

Association football is now a multi-billion dollar global industry whose emergence spans the post-medieval to the modern world. With its professional roots in late 19th-century industrial Lancashire, stadiums built for the professionalization of football first appear in frequency in the North of England. While many historians of sport focus on consumerism and ‘topophilia’ (attachment to place) regarding these local football grounds, archaeological research that has been conducted on the spectator experience suggests status differentiation within them. Our excavations at Peel Park confirm this impression while also showing a significant afterlife to this stadium, particularly through children’s play

Natural killer cells and innate lymphoid cells but not NKT cells are mature in their cytokine production at birth.

Early life is a time of increased susceptibility to infectious diseases and development of allergy. Innate lymphocytes are crucial components of the initiation and regulation of immune responses at mucosal surfaces, but functional differences in innate lymphocytes early in life are not fully described. We aimed to characterise the abundance and function of different innate lymphocyte cell populations in cord blood in comparison to that of adults. Blood was collected from adult donors and umbilical vessels at birth. Multicolour flow cytometry panels were used to identify and characterise lymphocyte populations and their capacity to produce hallmark cytokines. Lymphocytes were more abundant in cord blood compared to adults, however, mucosal-associated invariant T (MAIT) cells and Natural Killer T (NKT)-like cells, were far less abundant. The capacity of NKT-like cells to produce cytokines and their expression of the cytotoxic granule protein granzyme B and the marker of terminal differentiation CD57 were much lower in cord blood than in adults. In contrast, Natural Killer (NK) cells were as abundant in cord blood as in adults, they could produce IFNγ, and their expression of granzyme B was not significantly different to that of adult NK cells, although CD57 expression was lower. All innate lymphoid cell (ILC) subsets were more abundant in cord blood, and ILC1 and ILC2 were capable of production of IFNγ and IL-13, respectively. In conclusion, different innate lymphoid cells differ in both abundance and function in peripheral blood at birth and with important implications for immunity in early life

Modelling with non-stratified chain event graphs

© 2019, Springer Nature Switzerland AG. Chain Event Graphs (CEGs) are recent probabilistic graphical modelling tools that have proved successful in modelling scenarios with context-specific independencies. Although the theory underlying CEGs supports appropriate representation of structural zeroes, the literature so far does not provide an adaptation of the vanilla CEG methods for a real-world application presenting structural zeroes also known as the non-stratified CEG class. To illustrate these methods, we present a non-stratified CEG representing a public health intervention designed to reduce the risk and rate of falling in the elderly. We then compare the CEG model to the more conventional Bayesian Network model when applied to this setting

Improving Access to Psychological Therapies (IAPT) services outcomes for people with learning disabilities: National data 2012-2013 to 2019-2020

Primary care interventions for people with common mental health problems in England are primarily delivered through Improving Access to Psychological Therapies (IAPT) services. One of the priorities for IAPT services is to reduce inequalities in access and outcomes for potentially disadvantaged populations. This paper uses national data from the years 2012-2013 to 2019-2020 to present a comparison of service process and therapy outcomes for people with learning disabilities. Annual data for people with learning disabilities, people with other recorded disabilities and people with no recorded disabilities were extracted from a publicly available, national data source. Data are presented graphically with relative risk calculated for each variable and year, and show a broadly similar pattern of waiting time access for people with learning disabilities and people with no disabilities, and a broadly similar proportion of people with learning disabilities and people with no disabilities who finish treatment. However, people with learning disabilities have poorer clinical outcomes than people with no disabilities. We discuss adaptations to IAPT processes and therapy provision that may further support people with learning disabilities' access to IAPT services. Key learning aims (1) To describe how IAPT services record disabilities, and in particular record whether a person identifies themselves as having a learning disability.1 (2) To explore the differences in processes and therapy outcomes for people with learning disabilities compared with people with no disabilities and people with other disabilities. (3) To understand adaptations to IAPT processes and therapies that may make IAPT services more accessible to people with learning disabilities

Effects of High Temperature on Growth Performance of Pigs

Data related to the biological performance of pigs were collected from various piggeries in Queensland, N.S.W., Victoria and Tasmania. Climatic zones in the above states were defined and the biological performance data were related to various temperature parameters in different climatic zones. There were significant relationships between the growth performance parameters and climatic parameters with a reduction in daily rate of gain, an increase in feed conversion ratio and possibly an increase in backfat depths during the hotter parts of the year. Experiments were conducted under field conditions in central New South wales in various piggeries to determine the effects of a hot climate on biological performance under practical conditions. ... Eight experiments were conducted under laboratory conditions at the University of New England, to study the influence of high ambient temperature on the growth performance of bacon pigs and to try to determine means to ameliorate heat stress. ... Relationships between total heat production per pig per day and respiratory quotient and daily dry matter intake were established. The results indicated that the animals with higher daily dry matter intakes had higher total heat production and respiratory quotient values