Natural disaster alters the adaptive benefits of sociality in a primate

Weather-related disasters can radically alter ecosystems. When disaster-driven ecological damage persists, the selective pressures exerted on individuals can change, eventually leading to phenotypic adjustments. For group-living animals, social relationships are believed to help individuals cope with environmental challenges and may be a critical mechanism enabling adaptation to ecosystems degraded by disasters. Yet, whether natural disasters alter selective pressures on patterns of social interactions and whether group-living animals can, as a result, adaptively change their social relationships remains untested. Here, we leveraged unique data collected on rhesus macaques from 5 years before to 5 years after a category 4 hurricane, leading to persistent deforestation which exacerbated monkeys' exposure to intense heat. In response, macaques increased tolerance for and decreased aggression toward other monkeys, facilitating access to scarce shade critical for thermoregulation. Social tolerance predicted individual survival for 5 years after the hurricane, but not before it, revealing a clear shift in the adaptive function of social relationships in this population. We demonstrate that an extreme climatic event altered selection on sociality and triggered substantial and persistent changes in the social structure of a primate species. Our findings unveil the function and adaptive flexibility of social relationships in degraded ecosystems and identify natural disasters as potential evolutionary drivers of sociality.

One-Sentence Summary

Testard et al. show that a natural disaster altered selection on sociality in group-living primates triggering persistent changes in their social structure.

Diamond preservation in the lithospheric mantle recorded by olivine in kimberlites

The diamond potential of kimberlites is difficult to assess due to several mantle and magmatic processes affecting diamond content. Traditionally, initial evaluations are based on the compositions of mantle-derived minerals (garnet, chromite, clinopyroxene), which allow an assessment of pressure-temperature conditions and lithologies suitable for diamond formation. Here we explore a complementary approach that considers the conditions of diamonds destruction by interaction with melts/fluids (metasomatism). We test the hypothesis that carbonate-rich metasomatism related to kimberlite melt infiltration into the deep lithosphere is detrimental to diamond preservation. Our results show that high diamond grades in kimberlites worldwide are exclusively associated with high-Mg/Fe olivine, which corresponds to mantle lithosphere minimally affected by kimberlite-related metasomatism. Diamond dissolution in strongly metasomatised lithosphere containing low-Mg/Fe olivine provides a causal link to the empirical associations between low diamond grades, abundant Ti-Zr-rich garnets and kimberlites with high Ti and low Mg contents. This finding show-cases olivine geochemistry as a viable tool in diamond exploration.

Surveillance of Mpox Cases Attending Sexual Health Services in England (SOMASS): design, implementation and initial findings from the SOMASS data collection tool, 2022

OBJECTIVES

We aimed to design and implement a data collection tool to support the 2022 mpox (monkeypox) outbreak, and to describe clinical and epidemiological data from individuals with mpox attending sexual health services (SHSs) in England.

METHODS

The UK Health Security Agency and the British Association for Sexual Health and HIV established the Surveillance of Mpox Cases Attending Sexual Health Services in England (SOMASS) system.Descriptive data were collected via a secure web-based data collection tool, completed by SHS clinicians following consultation with individuals with suspected mpox. Data were collected on patient demographics, clinical presentation and severity, exposures and behavioural characteristics.

RESULTS

As of 17 November 2022, 276 SOMASS responses were submitted from 31 SHSs in England.Where recorded, most (245 of 261; 94%) individuals identified as gay, bisexual or men who have sex with men (GBMSM), of whom two-thirds were HIV negative (170 of 257; 66%) and taking HIV pre-exposure prophylaxis (87 of 140; 62%), with a median age of 37 years (IQR: 30-43). Where known, thirty-nine per cent (63 of 161) had a concurrent sexually transmitted infection (STI) at the time of their mpox diagnosis.For 46% of individuals (127 of 276), dermatological lesions were the initial symptom. Lesions were mostly asymmetrical and polymorphic, predominately affecting the genital area and perianal areas.Nine per cent (24 of 276) of individuals were hospitalised. We report an association between receptive anal intercourse among GBMSM and proctitis (27 of 115; 24% vs 7 of 130; 5%; p<0.0001), and the presence of perianal lesions as the primary lesion site (46 of 115; 40% vs 25 of 130; 19%; p=0.0003).

CONCLUSIONS

We demonstrate multidisciplinary and responsive working to develop a robust data collection tool, which improved surveillance and strengthened the knowledge base. The SOMASS tool will allow data collection if mpox resurges in England. The model for developing the tool can be adapted to facilitate the preparedness and response to future STI outbreaks.

Arthrofibrosis in Robotic Total Knee Arthroplasty: An Investigation Into How Robotic Assistance May Contribute to a Tight Knee

INTRODUCTION

Arthrofibrosis after total knee arthroplasty (TKA) can lead to pain and restricted range of motion. Matching native knee kinematics is crucial in avoiding arthrofibrosis postoperatively. However, manual jig-based instruments have demonstrated variability and inaccuracy during primary TKA. Robotic-arm-assisted surgery was developed to increase the precision and accuracy of bone cuts and component alignment. In the literature, limited information on arthrofibrosis after robotic-assisted TKA (RATKA) exists. The purpose of this study was to compare the incidence of arthrofibrosis after manual TKA (mTKA) with RATKA by examining the need for manipulation under anesthesia (MUA) postoperatively and evaluating preoperative and postoperative radiographic parameters.

METHODS

A retrospective analysis of patients who underwent primary TKA from 2019 to 2021 was conducted. Rates of MUA were evaluated and perioperative radiographs were analyzed to determine posterior condylar offset ratio, Insall-Salvati Index, and posterior tibial slope (PTS) in patients who underwent mTKA versus RATKA. Range of motion was recorded for patients who required MUA.

RESULTS

A total of 1234 patients were included, of which 644 underwent mTKA, and 590 underwent RATKA. Thirty-seven RATKA patients compared with 12 mTKA patients required MUA postoperatively (P < 0.0001). A significant decrease in PTS postoperatively was seen in the RATKA (7.10° ± 2.4° preoperatively versus 2.46° ± 1.2° postoperatively), with a mean decrease of the tibial slope of -4.6° ± 2.5° (P < 0.0001). In patients requiring MUA, a larger decrease was seen in the RATKA group when compared with the mTKA group (mean -5.5 ± 2.0 versus -5.3 ± 0.78, P = 0.6585). No significant difference was seen in the posterior condylar offset ratio and Insall-Salvati Index in both groups.

DISCUSSION

When conducting RATKA, it is important to match PTS close to the native tibial slope to decrease the incidence of arthrofibrosis postoperatively, as a decrease in PTS can lead to decreased postoperative knee flexion and poor functional outcomes.

The Extra-Islet Pancreas Supports Autoimmunity in Human Type 1 Diabetes

In autoimmune Type 1 diabetes (T1D), immune cells progressively infiltrate and destroy the islets of Langerhans - islands of endocrine tissue dispersed throughout the pancreas. However, it is unclear how this process, called 'insulitis', develops and progresses within this organ. Here, using highly multiplexed CO-Detection by indEXing (CODEX) tissue imaging and cadaveric pancreas samples from pre-T1D, T1D, and non-T1D donors, we examine pseudotemporal-spatial patterns of insulitis and exocrine inflammation within large pancreatic tissue sections. We identify four sub-states of insulitis characterized by CD8 ⁺ T cells at different stages of activation. We further find that exocrine compartments of pancreatic lobules affected by insulitis have distinct cellularity, suggesting that extra-islet factors may make particular lobules permissive to disease. Finally, we identify "staging areas" - immature tertiary lymphoid structures away from islets where CD8 ⁺ T cells appear to assemble before they navigate to islets. Together, these data implicate the extra-islet pancreas in autoimmune insulitis, greatly expanding the boundaries of T1D pathogenesis.

The perception and utilization of community care services by older persons in the new urban areas of Beijing, China: A cross-sectional study

Background and Aims

In recent years, Beijing, similar to many other large cities in China, has experienced rapid urbanization in many new areas. These have often been locations of population aging but have not had concomitant development of required community care services for older persons. This study aims to understand the perception and utilization of newly developed community care services by the older persons living in this region for providing knowledge to improve the services.

Methods

Applying Andersen's behavior model, this study used binary logistic regression of the factors influencing the perception and utilization of community care services and analyzed data collected by questionnaires to 301 older persons in the new urban areas of Beijing.

Results

Education, income, activities of daily living, instrumental activities of daily living, mental health, and economic needs are statistically significant factors affecting older persons' perception of community care services. Age, perception of community care services, income, neighborhood relationships, mental health, and emotional needs are significant factors affecting older persons' utilization of community care services.

Conclusion

Demographic characteristics, health status, social support, and care needs were significant factors in the perception and utilization of community care services, after controlling for many variables. Improving older persons' perceptions of community care services is likely to promote their access to the services, which should help meet the challenges of rapid population aging in providing community care services to support aging in place in the new urban areas of Beijing, China.

Evaluation of the impact of assistive artificial intelligence on ultrasound scanning for regional anaesthesia

BACKGROUND

Ultrasound-guided regional anaesthesia relies on the visualisation of key landmark, target, and safety structures on ultrasound. However, this can be challenging, particularly for inexperienced practitioners. Artificial intelligence (AI) is increasingly being applied to medical image interpretation, including ultrasound. In this exploratory study, we evaluated ultrasound scanning performance by non-experts in ultrasound-guided regional anaesthesia, with and without the use of an assistive AI device.

METHODS

Twenty-one anaesthetists, all non-experts in ultrasound-guided regional anaesthesia, underwent a standardised teaching session in ultrasound scanning for six peripheral nerve blocks. All then performed a scan for each block; half of the scans were performed with AI assistance and half without. Experts assessed acquisition of the correct block view and correct identification of sono-anatomical structures on each view. Participants reported scan confidence, experts provided a global rating score of scan performance, and scans were timed.

RESULTS

Experts assessed 126 ultrasound scans. Participants acquired the correct block view in 56/62 (90.3%) scans with the device compared with 47/62 (75.1%) without (P=0.031, two data points lost). Correct identification of sono-anatomical structures on the view was 188/212 (88.8%) with the device compared with 161/208 (77.4%) without (P=0.002). There was no significant overall difference in participant confidence, expert global performance score, or scan time.

CONCLUSIONS

Use of an assistive AI device was associated with improved ultrasound image acquisition and interpretation. Such technology holds potential to augment performance of ultrasound scanning for regional anaesthesia by non-experts, potentially expanding patient access to these techniques.

CLINICAL TRIAL REGISTRATION

NCT05156099.

Impact of rapid near-patient STI testing on service delivery outcomes in an integrated sexual health service in the United Kingdom: a controlled interrupted time series study

OBJECTIVES

To evaluate the impact of a new clinic-based rapid sexually transmitted infection testing, diagnosis and treatment service on healthcare delivery and resource needs in an integrated sexual health service.

DESIGN

Controlled interrupted time series study.

SETTING

Two integrated sexual health services (SHS) in UK: Unity Sexual Health in Bristol, UK (intervention site) and Croydon Sexual Health in London (control site).

PARTICIPANTS

Electronic patient records for all 58 418 attendances during the period 1 year before and 1 year after the intervention.

INTERVENTION

Introduction of an in-clinic rapid testing system for gonorrhoea and chlamydia in combination with revised treatment pathways.

OUTCOME MEASURES

Time-to-test notification, staff capacity, cost per episode of care and overall service costs. We also assessed rates of gonorrhoea culture swabs, follow-up attendances and examinations.

RESULTS

Time-to-notification and the rate of gonorrhoea swabs significantly decreased following implementation of the new system. There was no evidence of change in follow-up visits or examination rates for patients seen in clinic related to the new system. Staff capacity in clinics appeared to be maintained across the study period. Overall, the number of episodes per week was unchanged in the intervention site, and the mean cost per episode decreased by 7.5% (95% CI 5.7% to 9.3%).

CONCLUSIONS

The clear improvement in time-to-notification, while maintaining activity at a lower overall cost, suggests that the implementation of clinic-based testing had the intended impact, which bolsters the case for more widespread rollout in sexual health services.

Obinutuzumab as consolidation after chemo-immunotherapy: Results of the UK National Cancer Research Institute phase II/III GALACTIC trial

The GA101 (obinutuzumab) monocLonal Antibody as Consolidation Therapy In chronic lymphocytic leukaemia (CLL) (GALACTIC) was a seamless phase II/III trial designed to test whether consolidation with obinutuzumab is safe and eradicates minimal residual disease (MRD) and, subsequently, whether this leads to prolonged progression-free survival (PFS) in patients with CLL who have recently responded to chemo-immunotherapy. Patients with a response 3-24 months after chemotherapy were assessed for MRD. MRD-positive patients were randomised to receive consolidation therapy with obinutuzumab or no consolidation. The trial closed after the phase II part due to slow recruitment. In all, 48 patients enrolled of whom 19 were MRD negative and were monitored. Of the 29 MRD-positive patients, 14 were randomised to receive consolidation and 15 to no consolidation. At 6 months after randomisation, 10 and 13 consolidated patients achieved MRD negativity by flow cytometry (sensitivity 10-4 ) in bone marrow and peripheral blood respectively. PFS was significantly better in consolidated patients compared to non-consolidated patients (p = 0.001). No difference was observed in PFS, overall survival or duration of MRD negativity when comparing the 10 MRD-negative patients after consolidation with the 19 MRD-negative patients in the monitoring group. Common adverse events in the consolidation arm were thrombocytopenia, infection, and cough. Only 1% of events were infusion-related reactions. This observation provides further evidence that consolidation to achieve MRD negativity improves outcomes in CLL and that obinutuzumab is well tolerated in patients with low levels of disease.

Recommendations for anatomical structures to identify on ultrasound for the performance of intermediate and advanced blocks in ultrasound-guided regional anesthesia

Recent recommendations describe a set of core anatomical structures to identify on ultrasound for the performance of basic blocks in ultrasound-guided regional anesthesia (UGRA). This project aimed to generate consensus recommendations for core structures to identify during the performance of intermediate and advanced blocks. An initial longlist of structures was refined by an international panel of key opinion leaders in UGRA over a three-round Delphi process. All rounds were conducted virtually and anonymously. Blocks were considered twice in each round: for “orientation scanning” (the dynamic process of acquiring the final view) and for “block view” (which visualizes the block site and is maintained for needle insertion/injection). A “strong recommendation” was made if ≥75% of participants rated any structure as “definitely include” in any round. A “weak recommendation” was made if >50% of participants rated it as “definitely include” or “probably include” for all rounds, but the criterion for strong recommendation was never met. Structures which did not meet either criterion were excluded. Forty-one participants were invited and 40 accepted; 38 completed all three rounds. Participants considered the ultrasound scanning for 19 peripheral nerve blocks across all three rounds. Two hundred and seventy-four structures were reviewed for both orientation scanning and block view; a “strong recommendation” was made for 60 structures on orientation scanning and 44 on the block view. A “weak recommendation” was made for 107 and 62 structures, respectively. These recommendations are intended to help standardize teaching and research in UGRA and support widespread and consistent practice.

Ecosystem restoration is integral to humanity's recovery from COVID-19

COVID-19 has devastated global communities and economies. The pandemic has exposed socioeconomic disparities and weaknesses in health systems worldwide. Long-term health effects and economic recovery are major concerns. Ecosystem restoration-ie, the repair of ecosystems that have been degraded-relates directly to tackling the health and socioeconomic burdens of COVID-19, because stable and resilient ecosystems are fundamental determinants of health and socioeconomic stability. Here, we use COVID-19 as a case study, showing how ecosystem restoration can reduce the risk of infection and adverse sequelae and have an integral role in humanity's recovery from COVID-19. The next decade will be crucial for humanity's recovery from COVID-19 and for ecosystem repair. Indeed, in the absence of effective, large-scale restoration, 95% of the Earth's land could be degraded by 2050. The UN Decade on Ecosystem Restoration (2021-30) declaration reflects the growing urgency and scale at which we should repair ecosystems. Importantly, ecosystem restoration could also help to combat the health and socioeconomic issues that are associated with COVID-19, yet it is poorly integrated into current responses to the disease. Ecosystem restoration can be a core public health intervention and assist in COVID-19 recovery if it is closely integrated with socioeconomic, health, and environmental policies.

Matryoshka and disjoint cluster synchronization of networks

The main motivation for this paper is to characterize network synchronizability for the case of cluster synchronization (CS), in an analogous fashion to Barahona and Pecora [Phys. Rev. Lett. 89, 054101 (2002)] for the case of complete synchronization. We find this problem to be substantially more complex than the original one. We distinguish between the two cases of networks with intertwined clusters and no intertwined clusters and between the two cases that the master stability function is negative either in a bounded range or in an unbounded range of its argument. Our proposed definition of cluster synchronizability is based on the synchronizability of each individual cluster within a network. We then attempt to generalize this definition to the entire network. For CS, the synchronous solution for each cluster may be stable, independent of the stability of the other clusters, which results in possibly different ranges in which each cluster synchronizes (isolated CS). For each pair of clusters, we distinguish between three different cases: Matryoshka cluster synchronization (when the range of the stability of the synchronous solution for one cluster is included in that of the other cluster), partially disjoint cluster synchronization (when the ranges of stability of the synchronous solutions partially overlap), and complete disjoint cluster synchronization (when the ranges of stability of the synchronous solutions do not overlap).

Perturbation of the deep-Earth carbon cycle in response to the Cambrian Explosion

Earth's carbon cycle is strongly influenced by subduction of sedimentary material into the mantle. The composition of the sedimentary subduction flux has changed considerably over Earth's history, but the impact of these changes on the mantle carbon cycle is unclear. Here, we show that the carbon isotopes of kimberlite magmas record a fundamental change in their deep-mantle source compositions during the Phanerozoic Eon. The ¹³C/¹²C of kimberlites before ~250 Ma preserves typical mantle values, whereas younger kimberlites exhibit lower and more variable ratios-a switch coincident with a recognized surge in kimberlite magmatism. We attribute these changes to increased deep subduction of organic carbon with low ¹³C/¹²C following the Cambrian Explosion when organic carbon deposition in marine sediments increased significantly. These observations demonstrate that biogeochemical processes at Earth's surface have a profound influence on the deep mantle, revealing an integral link between the deep and shallow carbon cycles.

The redistributive power of cash transfers vs VAT exemptions: A multi-country study

Like high-income countries, low- and middle-income countries (LMICs) offer reduced rates and exemptions on particular goods and services in their value-added tax (VAT) systems. These policies are often motivated by distributional concerns and target items thought to take up a larger share of the budgets of poorer households. This paper explores the effectiveness of such policies in six LMICs. We estimate their impact on tax revenues, inequality and poverty, and compare these effects to existing cash transfer schemes and a hypothetical Universal Transfer (UT) funded by broadening the VAT base. To do so, we use tax-benefit microsimulation models incorporating input-output tables, allowing us to estimate the impact of exemptions on consumer prices due to VAT embedded in supply chains. We show that although preferential VAT rates reduce poverty, they are not well targeted towards poor households overall. Existing cash transfer schemes are better targeted but generally have limited coverage. A UT funded by a broader VAT base would create large net gains for the poorest households, reducing inequality and most measures of extreme poverty in each of the countries studied. Our results suggest that the widespread practice of providing special VAT treatment to certain goods and services is an expensive way of reaching poor households. In principle, expanding the VAT base and social protection schemes in tandem has the potential to both raise tax revenues and reduce poverty. Such reforms therefore warrant consideration for LMICs as they pursue Domestic Revenue Mobilisation and broader development objectives.

Learning Curve of Robotic-Assisted Total Knee Arthroplasty for Non-Fellowship-Trained Orthopedic Surgeons

Background

Total knee arthroplasty (TKA) serves as a reliable treatment option for patients with end-stage arthritis, but patient dissatisfaction rate remains high. With the projected increase in the volume of arthroplasty operations, surgeons have aimed for methods in which to improve the patient outcomes. Robotic-assisted TKA has become increasingly popular. The learning curve for such technology has been investigated, but these prior studies have only been performed by fellowship-trained arthroplasty surgeons. The goal of this study was to investigate the learning curve for non-fellowship-trained orthopedic surgeons to ameliorate any concerns about increased operative time.

Methods

Retrospective analysis of robotic-assisted TKAs and manual TKAs, performed by two non-fellowship-trained orthopedic surgeons, was conducted on a total of 160 patients. For each individual surgeon, the robotic-assisted TKAs were divided into 3 cohorts of 20 consecutive patients. Data from 20 consecutive manual TKAs were also gathered for each surgeon. The mean operative times were compared. Cohorts were then grouped together for both surgeons and compared in a similar fashion.

Results

For surgeon 1, mean operative times were significantly increased for robotic-assisted cohorts compared with those for the manual cohort. For surgeon 2, the first robotic-assisted cohort was significantly longer. However, there were no significant differences for the second and third robotic-assisted cohorts. In the combined surgeon group, there was no significant difference between operative times for the third robotic cohort and the manual cohort.

Conclusion

This study demonstrates that the general orthopedic surgeon in a community hospital may be able to adequately perform robotic-assisted surgery in a similar timeframe to their manual TKA within their first 40 robotic-arm-assisted TKA.

Telephone Consultation in Otorhinolaryngology During the Coronavirus Disease 2019 Pandemic: a Cross-sectional Analysis of Effectiveness and Satisfaction for Patients and Clinicians

The COVID-19 pandemic has necessitated measures to minimise face-to-face interaction. We assessed the efficacy of teleconsultation and patient satisfaction in adult otorhinolaryngology clinic. A prospective review of telephone consultations over 6 months in a single district general hospital was conducted. Data was collected on the characteristics and outcomes of teleconsultations by clinicians, and a questionnaire was sent to patients. Of 304 telephone consultations, 115 were new and 189 were follow-up. Five percent of patients were listed for surgery. The discharge rate was 31%, largely comprising of patients with otorhinolaryngological symptoms. High clinician and patient satisfaction were reported by 90% and 96%, respectively. Telephone consultation was a good one-stop treat and discharge service for a number of otorhinolaryngological complaints such as hearing loss, tinnitus and recurrent tonsillitis. Patient and clinician satisfaction was high. Careful triaging of referrals for telephone consultation can potentially reduce the number of face-to-face clinic appointments.

International consensus on anatomical structures to identify on ultrasound for the performance of basic blocks in ultrasound-guided regional anesthesia

There is no universally agreed set of anatomical structures that must be identified on ultrasound for the performance of ultrasound-guided regional anesthesia (UGRA) techniques. This study aimed to produce standardized recommendations for core (minimum) structures to identify during seven basic blocks. An international consensus was sought through a modified Delphi process. A long-list of anatomical structures was refined through serial review by key opinion leaders in UGRA. All rounds were conducted remotely and anonymously to facilitate equal contribution of each participant. Blocks were considered twice in each round: for "orientation scanning" (the dynamic process of acquiring the final view) and for the "block view" (which visualizes the block site and is maintained for needle insertion/injection). Strong recommendations for inclusion were made if ≥75% of participants rated a structure as "definitely include" in any round. Weak recommendations were made if >50% of participants rated a structure as "definitely include" or "probably include" for all rounds (but the criterion for "strong recommendation" was never met). Thirty-six participants (94.7%) completed all rounds. 128 structures were reviewed; a "strong recommendation" is made for 35 structures on orientation scanning and 28 for the block view. A "weak recommendation" is made for 36 and 20 structures, respectively. This study provides recommendations on the core (minimum) set of anatomical structures to identify during ultrasound scanning for seven basic blocks in UGRA. They are intended to support consistent practice, empower non-experts using basic UGRA techniques, and standardize teaching and research.

Localized Darier disease: three cases of Type 1 segmental mosaicism

Darier disease (DD) is an autosomal dominant acantholytic dermatosis with an estimated prevalence of 1 in 30 000-100 000. A localized form of DD was first described by Kreibich in 1906 and is thought to account for 10% of all cases. A number of clinical variants have been reported including: unilateral, linear, segmental or zosteriform DD. We present a case series of three patients with localized DD.

Facial subcutaneous emphysema in a patient with connective tissue disorder

A 47-year-old woman presented to the emergency department with sudden onset of swelling in her face, which had been triggered by blowing her nose. She had no other symptoms, but was known to have Ehlers-Danlos syndrome. A CT confirmed bilateral subcutaneous facial emphysema attributed to a defect in her left nasal cartilage. The condition was managed conservatively with prophylactic antibiotics and self-resolved within 48 hours. Only eight cases of sudden facial subcutaneous emphysema following nose blowing or sneezing have been found in the English literature and this is the first known case in a patient with a connective tissue disorder. In this case, her condition is suspected to have contributed to her presentation and may be underlying in other similar cases.

Tetherin/BST2, a physiologically and therapeutically relevant regulator of platelet receptor signalling

The reactivity of platelets, which play a key role in the pathogenesis of atherothrombosis, is tightly regulated. The integral membrane protein tetherin/bone marrow stromal antigen-2 (BST-2) regulates membrane organization, altering both lipid and protein distribution within the plasma membrane. Because membrane microdomains have an established role in platelet receptor biology, we sought to characterize the physiological relevance of tetherin/BST-2 in those cells. To characterize the potential importance of tetherin/BST-2 to platelet function, we used tetherin/BST-2-/- murine platelets. In the mice, we found enhanced function and signaling downstream of a subset of membrane microdomain-expressing receptors, including the P2Y12, TP thromboxane, thrombin, and GPVI receptors. Preliminary studies in humans have revealed that treatment with interferon-α (IFN-α), which upregulates platelet tetherin/BST-2 expression, also reduces adenosine diphosphate-stimulated platelet receptor function and reactivity. A more comprehensive understanding of how tetherin/BST-2 negatively regulates receptor function was provided in cell line experiments, where we focused on the therapeutically relevant P2Y12 receptor (P2Y12R). Tetherin/BST-2 expression reduced both P2Y12R activation and trafficking, which was accompanied by reduced receptor lateral mobility specifically within membrane microdomains. In fluorescence lifetime imaging-Förster resonance energy transfer (FLIM-FRET)-based experiments, agonist stimulation reduced basal association between P2Y12R and tetherin/BST-2. Notably, the glycosylphosphatidylinositol (GPI) anchor of tetherin/BST-2 was required for both receptor interaction and observed functional effects. In summary, we established, for the first time, a fundamental role of the ubiquitously expressed protein tetherin/BST-2 in negatively regulating membrane microdomain-expressed platelet receptor function.

Shoulder Joint Position Sense Can Be Reduced by Sensory Reference Frame Transformations

Joint position sense (JPS) is commonly evaluated using an angle replication protocol with vision occluded. However, multiple sources of sensory information are integrated when moving limbs accurately, not just proprioception. The purpose of this study was to examine different availability of vision during an active JPS protocol at the shoulder. Specifically, the effects of four conditions of vision availability were examined for three target shoulder elevation angles (50°, 70° & 90°): vision occluded continuously (P-P); vision available continuously (VP-VP); vision occluded only during target memorization (P-VP); and vision occluded only during target position replication (VP-P). There were 18 participants (M age = 21, SD = 1 years). We used separate repeated ANOVAs to examine the effect of condition and target angle on participants' absolute error (AE, a measure of accuracy) and constant error (CE, a measure of directional bias). We found a significant main effect for condition and angle for both dependent variables (p < 0.01), and follow-up analysis indicated that participants were most accurate in the VP-VP condition and least accurate in the P-VP condition. Further follow-up analysis showed that accuracy improved with higher target elevation angles, consistent with previous research findings. Constant error results were similar, as there was a prominent tendency to overshoot the target. Unsurprisingly, participants performed best at the angle replication protocol with their eyes open. However, while accuracy was reduced when vision was occluded during target memorization, it was restored during target replication. This finding may have indicated an accuracy cost due to introduced noise when transforming sensory information from a proprioceptive reference frame into a visual reference frame.

The use of nanovibration to discover specific and potent bioactive metabolites that stimulate osteogenic differentiation in mesenchymal stem cells

Bioactive metabolites have wide-ranging biological activities and are a potential source of future research and therapeutic tools. Here, we use nanovibrational stimulation to induce osteogenic differentiation of mesenchymal stem cells, in the absence of off-target, nonosteogenic differentiation. We show that this differentiation method, which does not rely on the addition of exogenous growth factors to culture media, provides an artifact-free approach to identifying bioactive metabolites that specifically and potently induce osteogenesis. We first identify a highly specific metabolite, cholesterol sulfate, an endogenous steroid. Next, a screen of other small molecules with a similar steroid scaffold identified fludrocortisone acetate with both specific and highly potent osteogenic-inducing activity. Further, we implicate cytoskeletal contractility as a measure of osteogenic potency and cell stiffness as a measure of specificity. These findings demonstrate that physical principles can be used to identify bioactive metabolites and then enable optimization of metabolite potency can be optimized by examining structure-function relationships.

Walking on Visual Illusions

In nature, sensory and physical characteristics of the environment tend to match; for example, a surface that looks bumpy is bumpy. In human-built environments, they often don't. Here, we report observations from people exploring if mismatch between visual and physical characteristics affected their perceived walking experience. Participants walked across four flat floors, each comprising of a visual illusion: two patterns perceived as alternating 3D "furrows and ridges," the Primrose Field illusion, and a variant of the Cafe Wall illusion as a control pattern without perceived 3D effects. Participants found all patterns intriguing to look at; some describing them as "playful" or "gentle." More than half found some of the patterns uncomfortable to walk on, aversive, affecting walking stability, and occasionally even evoking fear of falling. These experiences raise crucial research questions for the vision sciences into the impact of architectural design on well-being and walkability.

Lessons Learned From Implementing Prospective, Multicountry Mixed-Methods Evaluations for Gavi and the Global Fund

Lessons learned from implementing evaluations for Gavi, the Vaccine Alliance and the Global Fund for AIDS, Tuberculosis, and Malaria can help inform the design and implementation of ongoing or future evaluations of complex interventions. We share 5 lessons distilled from over 7 years of experience implementing evaluations in 7 countries.

Introduction:

As global health programs have become increasingly complex, corresponding evaluations must be designed to assess the full complexity of these programs. Gavi and the Global Fund have commissioned 2 such evaluations to assess the full spectrum of their investments using a prospective mixed-methods approach. We aim to describe lessons learned from implementing these evaluations.

Methods:

This article presents a synthesis of lessons learned based on the Gavi and Global Fund prospective mixed-methods evaluations, with each evaluation considered a case study. The lessons are based on the evaluation team’s experience from over 7 years (2013–2020) implementing these evaluations. The Centers for Disease Control and Prevention Framework for Evaluation in Public Health was used to ground the identification of lessons learned.

Results:

We identified 5 lessons learned that build on existing evaluation best practices and include a mix of practical and conceptual considerations. The lessons cover the importance of (1) including an inception phase to engage stakeholders and inform a relevant, useful evaluation design; (2) aligning on the degree to which the evaluation is embedded in the program implementation; (3) monitoring programmatic, organizational, or contextual changes and adapting the evaluation accordingly; (4) hiring evaluators with mixed-methods expertise and using tools and approaches that facilitate mixing methods; and (5) contextualizing recommendations and clearly communicating their underlying strength of evidence.

Conclusion:

Global health initiatives, particularly those leveraging complex interventions, should consider embedding evaluations to understand how and why the programs are working. These initiatives can learn from the lessons presented here to inform the design and implementation of such evaluations.

Post-discharge needs of Iranian women diagnosed with severe mental illness: A qualitative study

WHAT IS KNOWN ON THE SUBJECT?: A search of common databases indicates the absence of any research focused on the needs of Iranian women diagnosed with severe mental illness post-discharge from an inpatient setting. Moreover, there is a lacuna of information about the unique experiences and needs of persons diagnosed with severe mental illness living in non-Western communities (esp. Middle Eastern communities). WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: This study examined interviews of women diagnosed with severe mental illness receiving treatment at an Iranian inpatient hospital. Three categories of post-discharge needs emerged: support, skill acquisition and information. Support consisted of family, social and health system subcategories. Skill acquisition was comprised of social skills, work skills and self-management skills. Lastly, information distinguished between illness-related information and women's health information. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Findings highlight the need for systemic changes to current care models. Broadly, families should be incorporated into care to improve outcomes and decrease stigma. Regarding mental health nursing, results highlighted the need for additional nursing and occupational therapy interventions to empower families and patients. Nursing practitioners can aid in preparing these patients for employment and public health initiatives to decrease stigma and improve access to care. ABSTRACT: Introduction Understanding the post-discharge needs of patients diagnosed with severe mental illness is critical for improving treatment outcomes. Aim The aim of the present study was to determine the unique post-discharge needs of Iranian women diagnosed with severe mental illness. Method Conventional content analysis was utilized to analyse data gathered via focus group interviews conducted within the psychiatric inpatient unit at Farabi hospital located in Kermanshah, Iran. Participants (N = 42; M age = 40; SD = 6.3 years) had been diagnosed with a severe mental illness, had a history of at least two psychiatric hospitalizations and were awaiting discharge following significant symptom improvement. Results Content analysis extracted three categories of post-discharge needs: support, skill acquisition and information. Support consisted of family, social and health system subcategories. Skill acquisition was comprised of social skills, work skills and self-management skills. Lastly, information distinguished between illness-related information and women's health information. Discussion/Implications for practice Analysis of interview data highlighted the general need for adopting a family-system approach to reduce stigma, increase knowledge and foster skill acquisition. Regarding mental health nursing, results highlighted the unique role of nurses and their capacity to pre-emptively address needs such as aiding in employment. Lastly, findings are contrasted against Western care models.

Longitudinal Trajectory of Exposure to Psychological Interpersonal Violence

Psychological intimate partner violence (P-IPV) refers to verbal abuse from one partner to another and abuse of power or control from one partner to another. To date, no studies have examined the longitudinal course of P-IPV exposure among mothers or the effect that witnessing P-IPV can have on their children. Using latent class growth analysis, the current study identified five trajectory groups with the following intercept and growth characteristics: low stable, low-increasing, moderate-decreasing, high-decreasing, and consistently elevated. Membership in the four groups characterized by higher P-IPV exposure was predicted by maternal race and exposure to physical abuse. The children of mothers in the low-increasing and consistently elevated groups had elevated scores on the Internalizing and Externalizing scales of the Childhood Behavior Checklist. These findings remained after controlling for child sex, race, cumulative trauma exposure, and maternal depression.

Frictions and taxpayer responses: evidence from bunching at personal tax thresholds

We exploit kinks and notches in the UK personal tax schedule over a 40-year period to investigate how taxpayers respond to income tax and social security contributions. At kinks, where the marginal rate rises, we find bunching by company owner-managers and the self-employed, but not those with only employment income. Responses to notches, where the average rate rises, provide compelling evidence that this is because most employees face substantial frictions: fewer than a quarter bunch even where doing so would increase both consumption and leisure. We develop a new approach for identifying selection in who responds and for decomposing responses into hours and wage components. We find that those employees who do bunch at notches are almost exclusively part-time workers, but tend to have lower wages and work more hours than those part-time workers who do not bunch.

Kimberlite genesis from a common carbonate-rich primary melt modified by lithospheric mantle assimilation

Quantifying the compositional evolution of mantle-derived melts from source to surface is fundamental for constraining the nature of primary melts and deep Earth composition. Despite abundant evidence for interaction between carbonate-rich melts, including diamondiferous kimberlites, and mantle wall rocks en route to surface, the effects of this interaction on melt compositions are poorly constrained. Here, we demonstrate a robust linear correlation between the Mg/Si ratios of kimberlites and their entrained mantle components and between Mg/Fe ratios of mantle-derived olivine cores and magmatic olivine rims in kimberlites worldwide. Combined with numerical modeling, these findings indicate that kimberlite melts with highly variable composition were broadly similar before lithosphere assimilation. This implies that kimberlites worldwide originated by partial melting of compositionally similar convective mantle sources under comparable physical conditions. We conclude that mantle assimilation markedly alters the major element composition of carbonate-rich melts and is a major process in the evolution of mantle-derived magmas.

Meningiomas in children

Meningiomas in children are poorly understood because they are rare. Recent reports have provided a more complete description of their incidence, genetics, imaging features, and outcome. In general, meningiomas in children are more likely to be higher grade, present in atypical locations, and have a higher risk of recurrence. The challenges encountered in children with respect to surgical and postoperative management are unique. Improved understanding of pediatric meningiomas, as well as the availability of new surgical, medical, and radiation therapies, creates opportunities to improve outcomes in this unique population.

MIDA boronate allylation – synthesis of ibuprofen

MIDA boronates are among the most useful reagents for the Suzuki–Miyaura reaction. This chemistry typically generates new bonds between two aromatic rings, thereby restricting access to important areas of chemical space. Here we demonstrate the coupling of MIDA boronates to allylic electrophiles, including a new synthesis of the well-known COX inhibitor ibuprofen.

Here we demonstrate the coupling of MIDA boronates to allylic electrophiles, including a new synthesis of the well-known COX inhibitor ibuprofen.

Short-term safety and effectiveness of sugammadex for surgical patients with end-stage renal disease: a two-centre retrospective study

Sugammadex is a novel reversal agent for aminosteroid neuromuscular blocking drugs, especially rocuronium. Given its renal excretion, sugammadex is not recommended for patients with end-stage renal disease; however, reports exist of its use in this group of patients. This two-institutional retrospective observational study aimed to review the safety profile and effectiveness of sugammadex in surgical patients with end-stage renal disease who required pre-operative renal replacement therapy. Adult surgical patients with end-stage renal disease requiring pre-operative renal replacement therapy, who received sugammadex between April 2016 and January 2019, were studied. The primary outcome was the incidence of postoperative tracheal re-intubation within 48 h. The secondary outcome was the incidence of deferred tracheal extubation in the operating theatre. One hundred and fifty-eight patients were identified from 125,653 surgical patients: 48 patients (30%) underwent renal transplantation and 110 (70%) underwent non-renal transplantation procedures. There were 22 instances (14%) of deferred tracheal extubation due to surgical and/or pre-existing medical conditions. Out of the 136 patients who had the tracheal tube removed at the end of the procedure, three patients had their trachea re-intubated within 48 h: two patients developed pulmonary oedema resulting from volume overload; and one patient had worsening sepsis. No incidence of recurrence of neuromuscular blockade was observed. Of note, 24 (18%) patients were found to have incomplete neuromuscular blockade reversal with neostigmine but administration of sugammadex led to successful tracheal extubation. In conclusion, sugammadex appears to be safe and effective in adult patients with end-stage renal disease receiving pre-operative renal replacement therapy.

Kimberlites reveal 2.5-billion-year evolution of a deep, isolated mantle reservoir

The widely accepted paradigm of Earth's geochemical evolution states that the successive extraction of melts from the mantle over the past 4.5 billion years formed the continental crust, and produced at least one complementary melt-depleted reservoir that is now recognized as the upper-mantle source of mid-ocean-ridge basalts¹. However, geochemical modelling and the occurrence of high ³He/⁴He (that is, primordial) signatures in some volcanic rocks suggest that volumes of relatively undifferentiated mantle may reside in deeper, isolated regions². Some basalts from large igneous provinces may provide temporally restricted glimpses of the most primitive parts of the mantle^3,4, but key questions regarding the longevity of such sources on planetary timescales-and whether any survive today-remain unresolved. Kimberlites, small-volume volcanic rocks that are the source of most diamonds, offer rare insights into aspects of the composition of the Earth's deep mantle. The radiogenic isotope ratios of kimberlites of different ages enable us to map the evolution of this domain through time. Here we show that globally distributed kimberlites originate from a single homogeneous reservoir with an isotopic composition that is indicative of a uniform and pristine mantle source, which evolved in isolation over at least 2.5 billion years of Earth history-to our knowledge, the only such reservoir that has been identified to date. Around 200 million years ago, extensive volumes of the same source were perturbed, probably as a result of contamination by exogenic material. The distribution of affected kimberlites suggests that this event may be related to subduction along the margin of the Pangaea supercontinent. These results reveal a long-lived and globally extensive mantle reservoir that underwent subsequent disruption, possibly heralding a marked change to large-scale mantle-mixing regimes. These processes may explain why uncontaminated primordial mantle is so difficult to identify in recent mantle-derived melts.

Interhypothalamic adhesions in endoscopic third ventriculostomy

INTRODUCTION

An interhypothalamic adhesion (IHA) is a gray mater-like band of tissue traversing across the third ventricle anterior to the mammillary bodies and is similar but distinct from an interthalamic adhesion. These rare anatomic anomalies can be detected with magnetic resonance imaging or, incidentally, during endoscopic ventricular surgery.

METHODS

All cases of interhypothalamic adhesions visualized during endoscopic third ventriculotomy (ETV), outside of the myelomeningocele setting, were identified from two institutions. Retrospective chart and imaging reviews were conducted and compared to intraoperative videos and photos for all cases. IHA variables collected included the following size, location, multiplicity, and associated anatomic anomalies.

RESULTS

Four cases of interhypothalamic adhesions were identified during ETV-all of which, either partially or completely, obscured access to the third ventricular floor. The IHAs in our cohort were duplicated in two patients, large (> 3 mm and severely obstructing access to the third ventricular floor) in three patients, and adherent to the floor of the third ventricle in three patients. All four patients had primary absence of the septum pellucidum. Previous reports found associations of IHAs with other congenital, particularly midline, abnormalities. The IHAs in our cohort affected the surgery in three of four cases including misdirecting the ventriculostomy and requiring retraction or division of the IHA. In no case was postoperative pituitary or hypothalamic dysfunction observed.

CONCLUSIONS

Although interhypothalamic adhesions are rare, these anomalies must be recognized as they may hinder access to the third ventricular floor. IHAs may be large, multiple, or adherent to adjacent ventricular structures, they can misdirect or occlude the ventriculostomy or impart risk of bleeding and hypothalamic injury. Techniques for management of IHA include aborting the attempt, re-siting the ventriculostomy, or retracting or dividing the IHA, which enabled technically successful ETV in three of four patients in this series.

Modeling Epidemics in Seed Systems and Landscapes To Guide Management Strategies: The Case of Sweet Potato in Northern Uganda

Seed systems are critical for deployment of improved varieties but also can serve as major conduits for the spread of seedborne pathogens. As in many other epidemic systems, epidemic risk in seed systems often depends on the structure of networks of trade, social interactions, and landscape connectivity. In a case study, we evaluated the structure of an informal sweet potato seed system in the Gulu region of northern Uganda for its vulnerability to the spread of emerging epidemics and its utility for disseminating improved varieties. Seed transaction data were collected by surveying vine sellers weekly during the 2014 growing season. We combined data from these observed seed transactions with estimated dispersal risk based on village-to-village proximity to create a multilayer network or "supranetwork." Both the inverse power law function and negative exponential function, common models for dispersal kernels, were evaluated in a sensitivity analysis/uncertainty quantification across a range of parameters chosen to represent spread based on proximity in the landscape. In a set of simulation experiments, we modeled the introduction of a novel pathogen and evaluated the influence of spread parameters on the selection of villages for surveillance and management. We found that the starting position in the network was critical for epidemic progress and final epidemic outcomes, largely driven by node out-degree. The efficacy of node centrality measures was evaluated for utility in identifying villages in the network to manage and limit disease spread. Node degree often performed as well as other, more complicated centrality measures for the networks where village-to-village spread was modeled by the inverse power law, whereas betweenness centrality was often more effective for negative exponential dispersal. This analysis framework can be applied to provide recommendations for a wide variety of seed systems.[Formula: see text] Copyright © 2019 The Author(s). This is an open access article distributed under the CC BY 4.0 International license.

Making Hard Choices in Local Public Health Spending With a Cost-Benefit Analysis Approach

Background: In 2013, public health moved into Local Authorities, but initial optimism has been overtaken by serious ongoing financial constraints and an uncertain future. Hard choices have become an everyday reality across local authorities and for their public health teams. Assessing the return-on-investment of public health interventions and possessing economic evaluation skills have become more critical than ever before. Methods: Using the New Economy cost-benefits-analysis model developed at the Greater Manchester Combined Authority, we undertook cost benefit analyses of some of our largest areas of commissioned spend in local public health practice to better understand both the public and fiscal returns of our interventions. Results: The cost-benefit analyses indicated considerable variation in the public (economic and social) returns-on-investment for our spend on services purchased as a commissioner with £1.37 to 6.81 returned for every £1 spent, and a fiscal return for every £1 invested of between £0.54 and 1.37. Additionally, the fiscal benefits (reduced service costs) of these public health interventions appear to primarily flow to the NHS, which accounts for about 94% of the fiscal return. Conclusion: While cost-benefit modeling cannot provide a complete picture of "value," it does provide decision-makers with a transparent metric that facilitates a whole-of system discussion on "intervention value" and prevention at scale investments. This approach will support investment strategies when implementing Sustainability and Transformation Partnerships and Integrated Care Systems. However, these tools should be used to support robust decision-making processes, not as a replacement for or a short-circuiting of existing processes.

Expanding Universe Illusion

We present a new induced movement illusion from global expansion or contraction in a triangular region filled with rising or falling textures. Objective global expansion or contraction induces lateral movement in the oblique edges of the triangle. The effects may be due to common and relative movements operating within a single texture.

Force perception at the shoulder after a unilateral suprascapular nerve block

There are two key sources of information that can be used to match forces-the centrally generated sense of effort and afferent signals from mechanical receptors located in peripheral tissues. There is currently no consensus on which source of information is more important for matching forces. The corollary discharge hypothesis argues that subjects match forces using the centrally generated sense of effort. The purpose of this study was to investigate force matching at the shoulder before and after a suprascapular nerve block. The nerve block creates a sensory and muscle force mismatch between sides when matching loads. The torque matching accuracy did not change after the nerve block was administered. Directionally, the torque error was in the direction proposed by the corollary discharge hypothesis. However, the mismatch between deltoid EMG was substantially greater compared to the changes in the torque matching error after the block. The results support that sensory information is used during force matching tasks. However, since the nerve block also created a sensory disruption between sides, it is not clear how sensory information is reweighted following the nerve block and a role for sense of effort is still implicated.

The Dimerisation of Phthalocyanines

In this review, we have shown that the dimerisation of phthalocyanine compounds, notably here the sulphonated aluminium phthalocyanines, is dependent upon concentration, on the medium in which the dye is dissolved, and upon pH. Complex equilibria between various monomer and dimer species are observed as a function of pH, and the probable structures of the dimers elucidated by semi-empirical and ab initio calculations. The formation of a red-shifted dimer leads to the quenching of monomer singlet state in concentrated solution, in reverse micelles, and in lipid vesicles, and this behaviour can account for the fluorescence intensity distributions and decay characteristics of phthalocyanine dyes in living cells as a function of irradiation time.

The influence of socioeconomic status on presentation and outcome of acute kidney injury

AIM

Although socioeconomic background is known to impact on the incidence and progression of chronic kidney disease, its influence of on the presentation and outcome for acute kidney injury is not known and is the subject of this study.

DESIGN

The Welsh National electronic AKI reporting system was used to identify all cases of AKI in patients >18 years of age between March 2015 and November 2017.

METHODS

Socioeconomic classification of patients was derived from the Welsh Index Multiple Deprivation score (WIMD). Patients were grouped according to the WIMD score by their postcode, and the ranked data were categorized into percentiles and correlated with incidence and measures of AKI severity and outcome.

RESULTS

Date was collected on a total of 57 654 patients. Increased deprivation was associated with higher AKI incidence rates, more episodes of AKI per patient and more severe AKI at presentation. In contrast 90-day mortality was highest in the most affluent areas. Mortality in affluent areas was driven by increased patient age. Corrected for age 90-day mortality was higher in areas of increased deprivation.

CONCLUSION

This study highlights that AKI incidence presentation and outcomes are adversely affected by social deprivation. Further studies are required to understand the extent to which these differences reflect patient related factors or regional differences in provision and access to care.

Catalytic Isohypsic-Redox Sequences for the Rapid Generation of Csp3 -Containing Heterocycles

Cross‐coupling reactions catalyzed by transition metals are among the most influential in modern synthetic chemistry. The vast majority of transition‐metal‐catalyzed cross‐couplings rely on a catalytic cycle involving alternating oxidation and reduction of the metal center and are generally limited to forging just one type of new bond per reaction (e.g., the biaryl linkage formed during a Suzuki cross‐coupling). This work presents an Isohypsic‐Redox Sequence (IRS) that uses one metal to effect two catalytic cycles, thereby generating multiple new types of bonds from a single catalyst source. We show that the IRS strategy is amenable to several widely used transformations including the Suzuki–Miyaura coupling, Buchwald–Hartwig amination, and Wacker oxidation. Furthermore, each of these reactions generates value‐added heterocycles with significant sp³‐C (3‐dimensional) content. Our results provide a general framework for generating complex products by using a single metal to fulfill multiple roles. By uniting different combinations of reactions in the isohypsic and redox phases of the process, this type of catalytic multiple bond‐forming platform has the potential for wide applicability in the efficient synthesis of functional organic molecules.