bluuebunny/crossref_metadata_2025 huggingface dataset:
Skin and Psychosomatics – Psychodermatology today
Authors: Gieler Uwe , Gieler Tanja , Peters Eva Milena Johanne , Linder Dennis
Published: November 2020

Modern psychodermatology relies on the bio‐psycho‐social disease model in psychosomatics, according to which biological, psychological and social factors (on various levels, from molecules to the biosphere) play a major role in the disease pathogenesis through complex, non‐linear interactions over the entire disease course. It is nowadays experimentally proven that “emotions get into the skin”. Recent research shows close anatomical, physiological and functional connections between skin and nervous system, already known to be ontogenetically related. These connections are reflected in many skin diseases where psychological and somatic etiological factors are closely intertwined. A holistic approach by the physician should do justice to this interdependence; biological, psychological and social factors should be adequately taken into account when taking anamnesis, making a diagnosis and choosing a therapy. The “visibility” of the skin organ bestows dermatology a special position among the various other clinical subjects, and renders a holistic, psychosomatic approach to the patient that is particularly important. The life course belongs also to modern psychodermatological approaches. Based on the modern psychodermatology concept, other corresponding sub‐areas such as psychogastroenterology, psychocardiology etc. have emerged. After the theoretical part of this article, some selected skin diseases are discussed in more detail from the psychosomatic point of view.
Predictive validity of the Hand Assessment for Infants in infants at risk of unilateral cerebral palsy
Authors: Ryll Ulrike C , Krumlinde‐Sundholm Lena , Verhage Cornelia H , Sicola Elisa , Sgandurra Giuseppina , Bastiaenen Caroline HG , Eliasson Ann‐Christin
Published: November 2020

Aim

To evaluate the sensitivity, specificity, and predictive value of the Hand Assessment for Infants (HAI) in identifying infants at risk of being diagnosed with unilateral cerebral palsy (CP), and to determine cut‐off values for this purpose.

Method

A convenience sample of 203 infants (106 females, 97 males) was assessed by the HAI at 3, 6, 9, and 12 months. Sensitivity, specificity, predictive values, and likelihood ratios were calculated using receiver operating characteristic curve analysis. Cut‐off values were derived for different ages. The clinical outcome (unilateral CP yes/no) at 24 months or more served as an external criterion to investigate the predictive validity of HAI.

Results

Half of the infants developed unilateral CP. The area under the curve ranged from 0.77 (95% CI [confidence interval] 0.63–0.91) to 0.95 (95% CI 0.90–1.00) across HAI scales and age intervals. Likewise, sensitivity ranged from 63% to 93%, specificity from 62% to 91%, and accuracy from 73% to 94%.

Interpretation

HAI scores demonstrated overall accuracy that ranged from very good to excellent in predicting unilateral CP in infants at risk aged between 3.5 and 12 months. This accuracy increased with age at assessment and the earliest possible prediction was at 3.5 months of age, when appropriate HAI cut‐off values for different ages were applied.

What this paper adds

The Hand Assessment for Infants (HAI) predicts unilateral cerebral palsy (CP) with high accuracy.

HAI cut‐off values can guide clinical practice for early identification and diagnosis of unilateral CP.
Health literacy of people living with mental illness or substance use disorders: A systematic review
Authors: Degan Tayla J. , Kelly Peter J. , Robinson Laura D. , Deane Frank P. , Smith Anna M.
Published: November 2020

Aim

Health literacy is one's ability to use cognitive and social skills to access, understand and appraise health information. Despite poor health outcomes of people living with mental illness there is limited research assessing their health literacy. This systematic review aims to synthesise research on health literacy rates, conceptualizations, and outcomes of people living with mental illness, including substance use disorders. This will provide insights into how health literacy might be targeted to reduce these health inequities.

Methods

A search of published literature in multiple databases up until February 2019 was conducted. One reviewer screened the titles, abstracts and keywords of identified publications and the eligibility of all full‐text publications were assessed for inclusion along with a second reviewer. Both reviewers independently rated the quality of the included studies.

Results

Fourteen studies were included in the review. Rates and measures of health literacy varied. Low health literacy and health literacy weaknesses were identified. There is a lack of research on the relationship between health literacy and other outcomes, particularly health service engagement.

Conclusion

The review highlights the high rates of low health literacy within this population compared with general populations. Most studies used a functional health literacy measure, despite its limitations, with only a few using multidimensional measures. Overall, there is limited research examining the impact that this populations health literacy has on their recovery and how it affects them over time. The review emphasizes the importance of practitioners assessing and targeting health literacy needs when working with this population.
Contract costs, stakeholder capitalism, and ESG
Authors: Fama Eugene F.
Published: November 2020

Observed contract structures are competitive solutions to the problem of maximizing stakeholder welfare when contracting is costly. Winning contract structures typically set fixed payoffs for most stakeholders, with residual risk borne by shareholders, who then get most of the decision rights. With rising interest in environmental, social, and governance (ESG) issues, there is sentiment for replacing the max shareholder wealth decision rule with max shareholder welfare. This view does not recognize that investors view max welfare in terms of their overall consumption‐investment portfolios. Since firms are not privy to the total ESG exposures of shareholders, max shareholder wealth is the appropriate decision rule.
Metabolic dysfunction and inflammatory disease: the role of stromal fibroblasts
Authors: Farah Hussein , Young Stephen P. , Mauro Claudio , Jones Simon W.
Published: November 2020

Mesenchymal stromal fibroblasts have emerged as key mediators of the inflammatory response and drivers of localised inflammation, in part through their interactions with resident and circulating immune cells at inflammatory sites. As such, they have been implicated in a number of chronic inflammatory conditions as well as in tumour progression through modifying the microenvironment. The connection between metabolic changes and altered phenotype of fibroblasts in inflammatory microenvironments has clear implications for our understanding of how chronic inflammation is regulated and for the development of new anti‐inflammatory therapeutics. In this review, we consider the evidence that changes to fibroblast metabolic state underpin chronic inflammation. We examine recent research on fibroblast metabolism in inflammatory microenvironments and consider their involvement in inflammation, providing insight into the role of fibroblasts and metabolism in mediating inflammatory disease progression namely cancer, arthritis and fibrotic disorders including chronic kidney disease, pulmonary fibrosis, heart disease and liver disease.
Tools to study and target the Siglec–sialic acid axis in cancer
Authors: Läubli Heinz , Kawanishi Kunio , George Vazhappilly Cijo , Matar Rachel , Merheb Maxime , Sarwar Siddiqui Shoib
Published: November 2020

Siglecs are widely expressed on leucocytes and bind to ubiquitously presented glycans containing sialic acids (sialoglycans). Most Siglecs carry an immunoreceptor tyrosine‐based inhibition motif (ITIM) and elicit an inhibitory intracellular signal upon ligand binding. A few Siglec receptors can, however, recruit immunoreceptor tyrosine‐based activation motif (ITAM)‐containing factors, which activate cells. The role of hypersialylation (the enhanced expression of sialoglycans) has recently been explored in cancer progression. Mechanistic studies have shown that hypersialylation on cancer cells can engage inhibitory Siglecs on the surface of immune cells and induce immunosuppression. These recent studies strongly suggest that the Siglec–sialic acid axis can act as a potential target for cancer immunotherapy. Moreover, the use of new tools and techniques is facilitating these studies. In this review, we summarise techniques used to study Siglecs, including different mouse models, monoclonal antibodies, Siglec fusion proteins, and sialoglycan arrays. Furthermore, we discuss the recent major developments in the study of Siglecs in cancer immunosuppression, tools, and techniques used in targeting the Siglec–sialic acid axis and the possibility of clinical intervention.
Examining barriers to timely waitlisting for kidney transplantation for Indigenous Australians in Central Australia
Authors: Tiong Mark K. , Thomas Sajan , Fernandes David K. , Cherian Sajiv
Published: November 2020

Background

Indigenous Australians are disproportionately affected by end stage kidney disease. Despite this, they face significant delays being assessed and waitlisted for kidney transplant.

Aims

To examine the kidney transplant waitlisting process in our region, to compare the workup process between Indigenous Australians and non‐Indigenous patients, and identify major sources of delay.

Methods

We analysed the records of all patients being treated by our service who were on the kidney transplant waitlist between January 2017 and June 2018. Between‐group differences were used to compare the time between commencement of dialysis and completion of each component of assessment. Patients who had more than 1 year between commencement of dialysis and waitlisting were further analysed for major sources of delay.

Results

Twenty‐five patients were included (20 Indigenous Australians and 5 non‐Indigenous). The median time to waitlisting for transplant after commencing dialysis was significantly longer in the Indigenous group (1215 vs 264 days, P = 0.032). Indigenous Australian patients waited longer before commencing the transplant assessment process and before completing dental assessment, tissue typing and review by the transplant nephrologist and surgeon. Five patients (two Indigenous Australians, three non‐Indigenous) were waitlisted within 1 year of commencing dialysis. Among the remaining 20 patients, cardiac and systems issues were the two most common major sources of delay.

Conclusion

Indigenous Australian patients face significant delays accessing the kidney transplant waitlist. Cardiac assessment and systems issues are prominent sources of delay and efforts to address these areas may help to improve equity of access to kidney transplantation.
Incidence, risk factors, and clinical impact of peridevice leak following left atrial appendage closure with the LAmbre device—Data from a prospective multicenter clinical study
Authors: Wang Guangji , Kong Bin , Qin Tianyou , Liu Yu , Huang Congxin , Huang He
Published: November 2020

Background

In the present study, we sought to explore the incidence, risk factors, and clinical impact of peridevice leaks (PDLs), following LAmbre‐assisted left atrial appendage closure (LAAC).

Methods

We performed transesophageal echocardiography (TEE) on patients participating in the LAmbre multicenter study, at Day 1 postimplantation, then at 3 and 12 months to assess PDL, device‐related thrombus, left atrial appendage (LAA) thrombus, and left atrial thrombus. Clinical events were recorded during follow‐up.

Result

A total of 152 patients with atrial fibrillation successfully completed LAAC. At 3 months follow‐up, 123 patients underwent TEE, with 21 (17%) of them presenting PDL. Among the 121 patients who underwent TEE at 12 months follow‐up, 19 (15.7%) presented PDL. Patients with PDL exhibited larger LAA orifice diameters and larger device sizes compared to those in the no leak group. In addition, we found no significant differences in thromboembolic events between patients in the PDL and no leak groups.

Conclusion

LAmbre‐assisted LAA closure resulted in a relatively low PDL occurrence, and its rate decreased over time. In addition, PDL was more prominent in patients with larger LAA orifice diameter and larger device size. However, the condition was not associated with an increased risk for thromboembolic events.
New approaches to skin photodamage histology—Differentiating 'good' versus 'bad' Elastin
Authors: Widgerow Alan D. , Napekoski Karl
Published: November 2020

Background

Photodamage creates changes within the skin layers known as solar elastosis. This presents as fragmentation of collagen and elastin fibers, decreases in the extracellular matrix (ECM) ground substance, as well as hyaluronic acid decrease in the thinning epidermis. Traditional immunohistochemistry (IHC) staining has failed to differentiate degenerated elastin from new elastin fibers generated with various topical strategies.

Aims

A combination of stains that can offer a regenerative narrative distinguishing newly formed collagen and elastin from that of degenerated protein, thus distinguishing “good” vs “bad” elastin.

Methods

A series of stains were explored based on their ability to identify early regenerative changes within epidermal, dermal, and ECM areas to examine consistency of outcomes and reliability.

Results

A combination of Movat, fibrillin, elafin, and versican for elastogenesis and reversal of solar elastosis. CD44 for HA status (mainly epidermal) and Herovici stain for identifying early collagenesis in the ECM provides a comprehensive range of stains for identifying new elastin and collagen

Conclusion

This suggested stain combination appears to offer an ideal collection of stains for identifying regenerative events within the skin layers.
Programmed cell death as a black queen in microbial communities
Authors: Ndhlovu Andrew , Durand Pierre M. , Ramsey Grant
Published: November 2020

Programmed cell death (PCD) in unicellular organisms is in some instances an altruistic trait. When the beneficiaries are clones or close kin, kin selection theory may be used to explain the evolution of the trait, and when the trait evolves in groups of distantly related individuals, group or multilevel selection theory is invoked. In mixed microbial communities, the benefits are also available to unrelated taxa. But the evolutionary ecology of PCD in communities is poorly understood. Few hypotheses have been offered concerning the community role of PCD despite its far‐reaching effects. The hypothesis we consider here is that PCD is a black queen. The Black Queen Hypothesis (BQH) outlines how public goods arising from a leaky function are exploited by other taxa in the community. Black Queen (BQ) traits are essential for community survival, but only some members bear the cost of possessing them, while others lose the trait In addition, BQ traits have been defined in terms of adaptive gene loss, and it is unknown whether this has occurred for PCD. Our conclusion is that PCD fulfils the two most important criteria of a BQ (leakiness and costliness), but that more empirical data are needed for assessing the remaining two criteria. In addition, we hold that for viewing PCD as a BQ, the original BQH needs to include social traits. Thus, despite some empirical and conceptual shortcomings, the BQH provides a helpful avenue for investigating PCD in microbial communities.
A novel 13C pulse‐labelling method to quantify the contribution of rhizodeposits to soil respiration in a grassland exposed to drought and nitrogen addition
Authors: Wang Ruzhen , Bicharanloo Bahareh , Shirvan Milad Bagheri , Cavagnaro Timothy R. , Jiang Yong , Keitel Claudia , Dijkstra Feike A.
Published: November 2020

Rhizodeposition plays an important role in below‐ground carbon (C) cycling. However, quantification of rhizodeposition in intact plant–soil systems has remained elusive due to methodological issues.

We used a 13C‐CO2 pulse‐labelling method to quantify the contribution of rhizodeposition to below‐ground respiration. Intact plant–soil cores were taken from a grassland field, and in half, shoots and roots were removed (unplanted cores). Both unplanted and planted cores were assigned to drought and nitrogen (N) treatments. Afterwards, shoots in planted cores were pulse labelled with 13C‐CO2 and then clipped to determine total below‐ground respiration and its δ13C. Simultaneously, δ13C was measured for the respiration of live roots, soils with rhizodeposits, and unplanted treatments, and used as endmembers with which to determine root respiration and rhizodeposit C decomposition using two‐source mixing models.

Rhizodeposit decomposition accounted for 7–31% of total below‐ground respiration. Drought reduced decomposition of both rhizodeposits and soil organic carbon (SOC), while N addition increased root respiration but not the contribution of rhizodeposit C decomposition to below‐ground respiration.

This study provides a new approach for the partitioning of below‐ground respiration into different sources, and indicates that decomposition of rhizodeposit C is an important component of below‐ground respiration that is sensitive to drought and N addition in grassland ecosystems.
The Arabidopsis leucine‐rich repeat receptor‐like kinase MIK2 is a crucial component of early immune responses to a fungal‐derived elicitor
Authors: Coleman Alexander D. , Maroschek Julian , Raasch Lars , Takken Frank L.W. , Ranf Stefanie , Hückelhoven Ralph
Published: November 2020

Fusarium spp. cause severe economic damage in many crops, exemplified by Panama disease of banana or Fusarium head blight of wheat. Plants sense immunogenic patterns (termed elicitors) at the cell surface to initiate pattern‐triggered immunity (PTI). Knowledge of fungal elicitors and corresponding plant immune‐signaling is incomplete but could yield valuable sources of resistance.

We characterized Arabidopsis thaliana PTI responses to a peptide elicitor fraction present in several Fusarium spp. and employed a forward‐genetic screen using plants containing a cytosolic calcium reporter to isolate fusarium elicitor reduced elicitation (fere) mutants.

We mapped the causal mutation in fere1 to the leucine‐rich repeat receptor‐like kinase MDIS1‐INTERACTING RECEPTOR‐LIKE KINASE 2 (MIK2) and confirmed a crucial role of MIK2 in fungal elicitor perception. MIK2‐dependent elicitor responses depend on known signaling components and transfer of AtMIK2 is sufficient to confer elicitor sensitivity to Nicotiana benthamiana.

Arabidopsis senses Fusarium elicitors by a novel receptor complex at the cell surface that feeds into common PTI pathways. These data increase mechanistic understanding of PTI to Fusarium and place MIK2 at a central position in Arabidopsis elicitor responses.
Sex‐specific Differences in Multisite Pain Presentation among Adults with Lower‐Limb Loss
Authors: Beisheim Emma Haldane , Seth Mayank , Horne John Robert , Hicks Gregory Evan , Pohlig Ryan Todd , Sions Jaclyn Megan
Published: November 2020

Objectives

Multisite pain remains significantly understudied following lower‐limb loss (LLL), especially among females. This study aimed to explore sex‐specific differences in the presentation of multisite pain post LLL. Hypotheses were multisite pain would be more prevalent among females post LLL as compared with males, and female sex would be significantly associated with multisite pain prevalence.

Methods

In this cross‐sectional study, participants answered standardized questions regarding the presence of amputation‐specific (ie, phantom‐limb, residual‐limb) and secondary (ie, contralateral‐limb, low‐back) pain. Multisite pain was defined as pain in ≥ 2 locations. Sex‐specific differences in pain prevalence were evaluated using chi‐square tests (P ≤ 0.050). Using logistic regression, the association between sex and multisite pain was examined after controlling for covariates (age, body mass index, time since amputation, amputation etiology and level).

Results

The sample included 303 adults (33% females) ≥ 1 year post unilateral LLL. More females than males reported pain in the residual limb (53.0% vs. 38.4%), low back (56.0% vs. 39.9%), contralateral knee (37.0% vs. 24.1%), and contralateral hip (25.0% vs. 12.3%;P < 0.050). More females than males were classified as having multisite pain (72.0% vs. 54.7%;P = 0.004). While patterns of multisite pain were similar (ie, pain affected both amputation‐specific and secondary sites) between sexes, being female was independently associated with higher odds of having multisite pain (odds ratio: 2.40, 95% confidence interval: 1.40 to 4.12).

Discussion

Female sex appears to be associated with multisite pain ≥ 1 year after LLL. Future work is needed to identify mechanisms underlying sex‐specific differences in pain presentation and evaluate the impact of sex on pain‐related outcomes post amputation.
Using Visual Feedback Manipulation in Virtual Reality to Influence Pain‐Free Range of Motion in People with Nonspecific Neck Pain
Authors: Kragting Maaike , Schuiling Stefan F. , Voogt Lennard , Pool‐Goudzwaard Annelies L. , Coppieters Michel W.
Published: November 2020

Background

Based on associative learning theories it is hypothesized that pain might be a conditioned response. In people with musculoskeletal pain, the occurrence of movement‐induced pain might be a protective response, influenced by visual cues suggesting that the person is approaching a painful position. This study aimed to determine (1) whether the pain‐free range of motion (ROM) increased and decreased when visual feedback understated or overstated true rotation in people with neck pain and (2) whether this effect was more pronounced if pain was chronic.

Method

People with subacute and chronic nonspecific neck pain wore a VR‐headset and rotated their head to the left and right until the onset of pain. Visual feedback about the amount of movement was either equal, 20% less, or 20% greater than their actual rotation. Maximal pain‐free ROM was measured using the VR‐headset sensors. Data were analyzed using a mixed‐design ANOVA.

Results

There was no effect of visual feedback manipulation on pain‐free ROM (P = 0.13) and no interaction effect between the visual feedback condition and duration of pain (P = 0.86).

Discussion

The inability to influence pain‐free ROM by manipulating visual feedback in people with subacute or chronic neck pain does not support associative learning theories for the perception of neck pain.
Indicators of middle school students' mathematics enjoyment and confidence
Authors: Christensen Rhonda , Knezek Gerald
Published: November 2020

A study involving 916 students spanning grades 5–8 was conducted to investigate indicators that may contribute to enjoyment and confidence in mathematics. For this group of middle school students, mathematics enjoyment, mathematics confidence, and attitudes toward school were found to generally decline across grade levels. Mathematics enjoyment and confidence were also found to differ significantly based upon student preferences for future careers. Gender differences as well as similarities regarding predictors of mathematics enjoyment and confidence were identified. Specifically, the best predictor for end of year mathematics enjoyment for males was beginning of year attitude toward school, while the most significant predictor of end of year enjoyment for females was beginning of year dispositions toward mathematics (semantic perception). A strong relationship between mathematics enjoyment and confidence overall was found, with indications that activities that increase mathematics enjoyment contribute to increased confidence, and also that activities that increase mathematics confidence contribute to increased enjoyment.
Donor‐derived renal allograft mucormycosis in a combined liver and kidney transplantation: Case report and review of the literature
Authors: Thatipelli Sneha , Santoiemma Phillip , Echenique Ignacio A. , Green Richard , Ison Michael G. , Ladner Daniela , Kanwar Yashpal S. , Stosor Valentina
Published: November 2020

Mucormycosis infrequently may present with isolated renal involvement. Among solid organ transplant recipients, renal allograft mucormycosis has been most often associated with medical tourism or transplantation outside of the western world. We report a case of an HIV/HCV co‐infected woman who underwent simultaneous liver and kidney transplantation with a Public Health Service increased risk donor organ. 16 days after transplant, she developed massive hematuria and was found to have renal allograftRhizopusspp. involvement, we surmise to have been from donor‐derived infection. Therapy included nephrectomy, debridement, liposomal amphotericin B, and posaconazole with survival. We reviewed PubMed indexed, English‐language cases of isolated renal mucormycosis in general, in HIV/AIDS, and from donor‐derived renal allograft infections.
Reviewer Acknowledgements
Authors: Smith Robert
Published: November 2020

Journal of Education and Training Studies (JETS) would like to acknowledge the following reviewers for their assistance with peer review of manuscripts for this issue. Many authors, regardless of whether JETS publishes their work, appreciate the helpful feedback provided by the reviewers. Their comments and suggestions were of great help to the authors in improving the quality of their papers. Each of the reviewers listed below returned at least one review for this issue.Reviewers for Volume 8, Number 12Gianpiero Greco, University of Study of Bari, ItalyHassan Shaaban, Atomic energy Authority, EgyptIntakhab Khan, King Abdulaziz University, Saudi ArabiaJohn Cowan, Edinburgh Napier University, UKJohn Mark Asio, Gordon College, PhilippinesJonathan Chitiyo, University of Pittsburgh Bradford, USAKun-Hsi Liao, Taiwan Shoufu University, TaiwanLucy Lugo Mawang, Kenyatta University, KenyaMaría Jesús Fernández, University of Extremadura, SpainMary Sciaraffa, Eastern Kentucky University, USAMatt Varacallo, University of Kentucky, USAMaurizio Sajeva, Pellervo Economic Research PTT, FinlandMeral Seker, Alanya Alaaddin Keykubat University, TurkeyMichail Kalogiannakis, University of Crete, GreeceNiveen M. Zayed, MENA College of Management, JordanRichard H. Martin, Mercer University, USARichard Penny, University of Washington Bothell, USASaadet Korucu Kis, Necmettin Erbakan University, TurkeySamah El-Sakka, Suez University, EgyptShu-wen Lin, Sojo University, JapanThada Jantakoon, Rajabhat Maha Sarakham University, Thailand Robert SmithEditorial AssistantOn behalf of,The Editorial Board of Journal of Education and Training StudiesRedfame Publishing9450 SW Gemini Dr. #99416Beaverton, OR 97008, USAE-mail 1: jets@redfame.comE-mail 2: jets@redfame.orgURL: http://jets.redfame.com
Nicotinic receptor activation induces NMDA receptor independent long‐term potentiation of glutamatergic signalling in hippocampal oriens interneurons
Authors: Nicholson Elizabeth , Kullmann Dimitri M.
Published: November 2020

Key points

Long‐term potentiation of glutamatergic transmission to hippocampal interneurons in stratum oriens does not require NMDA receptors and the induction mechanisms are incompletely understood.

Extracellular stimulation, conventionally used to monitor synaptic strength and induce long‐term potentiation (LTP), does not exclusively recruit glutamatergic axons.

We used optogenetic stimulation of either glutamatergic or cholinergic afferents to probe the relative roles of different signalling mechanisms in LTP induction.

Selective stimulation of cholinergic axons was sufficient to induce LTP, which was prevented by chelating postsynaptic Ca2+ or blocking nicotinic receptors.

The present study adds nicotinic receptors to the list of sources of Ca2+ that induce NMDA receptor independent LTP in hippocampal oriens interneurons.

Many interneurons located in stratum oriens of the rodent hippocampus exhibit a form of long‐term potentiation (LTP) of glutamatergic transmission that does not depend on NMDA receptors for its induction but, instead, requires Ca2+‐permeable AMPA receptors and group I metabotropic glutamate receptors. A role for cholinergic signalling has also been reported. However, electrical stimulation of presynaptic axons, conventionally used to evoke synaptic responses, does not allow the relative roles of glutamatergic and cholinergic synapses in the induction of LTP to be distinguished. Here, we show that repetitive optogenetic stimulation confined to cholinergic axons is sufficient to trigger a lasting potentiation of glutamatergic signalling. This phenomenon shows partial occlusion with LTP induced by electrical stimulation, and is sensitive to postsynaptic Ca2+ chelation and blockers of nicotinic receptors. ACh release from cholinergic axons is thus sufficient to trigger heterosynaptic potentiation of glutamatergic signalling to oriens interneurons in the hippocampus.
A finite element model of the Japanese koto constructed from computed tomography scans
Authors: Coaldrake A. Kimi
Published: November 2020

This paper presents a method for using computed tomography (CT) scan images of a Japanese koto as the basis of a mesh of a finite element model. The CT images gave access to previously inaccessible internal geometry. Images of grain structure and orientation in all three dimensions of the koto's Paulownia wood was important to the model's development. Obtaining the wood's physical properties for the Voigt notation and using curvilinear coordinates to rotate it to account for the grain was also a critical step. Following the model construction, studies were conducted to investigate the koto's fundamental vibrational behavior. First, the model predicted the koto's mode shapes and frequencies. Simulations in the frequency and time domains also identified unreported aspects of the koto's acoustics. Second, five physical experiments were conducted including transducer studies, Chladni patterns, an acoustic camera tests, and the response of the koto when played. The acoustic camera in particular gave insights into the koto's sound radiation. The combined results advance the limited knowledge of the koto including identifying 100 Hz as the first eigenmode and 85 Hz as a major air mode.
Dual support technique for pediatric palatal fracture: 1.5 mm transmucosal titanium plates along with acrylic splint backing
Authors: Kaur Amanjot , Chugh Ankita , Kumar Pravin
Published: November 2020

Surgeons are always in a dilemma for the management of paediatric facial fractures due to distinctive nature of growing facial skeleton. The ultimate treatment goal for paediatric fractures should be as conservative as possible with least invasive surgical approach that will access the fracture and least invasive surgical fixation that will allow stable reduction and will prevent any growth disturbances. We are presenting a case of 4- year old with panfacial fracture managed according to this principle using transmucosal titanium plates with acylic splint for sagittal split of palate.
Guillain-Barré syndrome and COVID-19: association or coincidence
Authors: Gale Aislinn , Sabaretnam Suganya , Lewinsohn Asher
Published: November 2020

COVID-19 is a novel disease best known to cause a cough, fever and respiratory failure. Recently, it has been recognised that COVID-19 may present in multi-systemic ways which can cause diagnostic uncertainty or error.

We present a patient who attended hospital with features of Guillain-Barré syndrome (GBS) before developing clinical and radiological findings of COVID-19. While the authors recognise that neurological complications have been reported following COVID-19 infection, to their knowledge this report describes a unique presentation of GBS without preceding COVID-19 symptoms.

Since these conditions may have considerable overlapping features including respiratory failure and (following prolonged critical care admission) profound weakness, it is possible that one diagnosis may be overlooked. Raising awareness of a possible association between these conditions is important so both are considered allowing appropriate investigations to be arranged to optimise the chance of neurological recovery and survival, while also protecting staff from potentially unrecognised COVID-19.
Neospora caninum: a new class of biopharmaceuticals in the therapeutic arsenal against cancer
Authors: Lantier Louis , Poupée-Beaugé Agathe , di Tommaso Anne , Ducournau Céline , Epardaud Mathieu , Lakhrif Zineb , Germon Stéphanie , Debierre-Grockiego Françoise , Mévélec Marie-Noëlle , Battistoni Arthur , Coënon Loïs , Deluce-Kakwata-Nkor Nora , Velge-Roussel Florence , Beauvillain Céline , Baranek Thomas , Lee Gordon Scott , Kervarrec Thibault , Touzé Antoine , Moiré Nathalie , Dimier-Poisson Isabelle
Published: November 2020

Background

Microorganisms that can be used for their lytic activity against tumor cells as well as inducing or reactivating antitumor immune responses are a relevant part of the available immunotherapy strategies. Viruses, bacteria and even protozoa have been largely explored with success as effective human antitumor agents. To date, only one oncolytic virus—T-VEC—has been approved by the US Food and Drug Administration for use in biological cancer therapy in clinical trials. The goal of our study is to evaluate the potential of a livestock pathogen, the protozoan Neospora caninum, non-pathogenic in humans, as an effective and safe antitumorous agent.

Methods/Results

We demonstrated that the treatment of murine thymoma EG7 by subcutaneous injection of N. caninum tachyzoites either in or remotely from the tumor strongly inhibits tumor development, and often causes their complete eradication. Analysis of immune responses showed that N. caninum had the ability to 1) lyze infected cancer cells, 2) reactivate the immunosuppressed immune cells and 3) activate the systemic immune system by generating a protective antitumor response dependent on natural killer cells, CD8-T cells and associated with a strong interferon (IFN)-γ secretion in the tumor microenvironment. Most importantly, we observed a total clearance of the injected agent in the treated animals: N. caninum exhibited strong anticancer effects without persisting in the organism of treated mice. We also established in vitro and an in vivo non-obese diabetic/severe combined immunodeficiency mouse model that N. caninum infected and induced a strong regression of human Merkel cell carcinoma. Finally, we engineered a N. caninum strain to secrete human interleukin (IL)-15, associated with the alpha-subunit of the IL-15 receptor thus strengthening the immuno-stimulatory properties of N. caninum. Indeed, this NC1-IL15hRec strain induced both proliferation of and IFN-γ secretion by human peripheral blood mononuclear cells, as well as improved efficacy in vivo in the EG7 tumor model.

Conclusion

These results highlight N. caninum as a potential, extremely effective and non-toxic anticancer agent, capable of being engineered to either express at its surface or to secrete biodrugs. Our work has identified the broad clinical possibilities of using N. caninum as an oncolytic protozoan in human medicine.
The management of drowning: a review of current evidence and guidelines
Authors: Castledine B , Phillips S
Published: November 2020

This article provides a review of the treatment of decompression illness (DCI) in the military setting. For those personnel who deliver military healthcare at all levels, there is an overview of the clinical picture, diagnosis and treatment aims when dealing with patients with DCI. The treatment aims are discussed using a situational approach from the perspectives of primary care, pre-hospital care through secondary care and onward to treatment by the diving medicine specialist. With ongoing medical support to worldwide diving operations, this narrative review provides an update in current DCI management for those involved in caring for military divers.
50 years: man and boy in the Royal Naval Medical Service
Authors: Proctor D
Published: November 2020

This article details some of my experiences as part of a 50-year career in or working for the Royal Naval Medical Service (RNMS), that started in 1966 when England last won the World Cup. In such a long career (29 years in uniform and 21 in the Civil Service), I have seen many changes to the RNMS itself and I hope that I can portray these, although with long service comes old age and all the frailties this encompasses. I currently work as a Specialist Instructional Officer in the Institute of Naval Medicine (INM) where I have been for the past 28 years.
Cold water survival – an evidence-based update
Authors: House C
Published: November 2020

Royal Navy (RN) cold water survival advice was historically based on data collated from immersion incident reports during World War II. This evidence-based review highlights the advances in the knowledge and understanding of the risks associated with cold water immersion and how this has been applied to provide up-to-date advice to maximise the chances of survival for passengers on board RN helicopters ditching into water.
The management of gastro-oesophageal reflux disease in the UK Armed Forces
Authors: Perigo O , Khan M
Published: November 2020

Gastro-oesophageal reflux disease (GORD) is a common presentation to primary care and has large direct and indirect effects on the UK economy. The purpose of this review is to highlight the management strategies for GORD among military personnel in primary and secondary care. Particular emphasis is placed on the outcomes from each form of treatment and the possible impact on deployability, in keeping with current UK military medical policy and guidance.
Medical and logistics aspects of the Peninsular War, 1808-1814
Authors: Wardley T , Goacher J , Neep S , Fleet S , White R , Banks A , Dale R , Belcher S , Cooper K , Webber Z , Adamson J
Published: November 2020

Following the failure of the French maritime force at the Battle of Trafalgar, Napoleon sought to dominate Europe through his ‘Continental System’, using large, conscripted, land forces to control nation states and close European ports to British trade. To counter this denial of economic opportunity Britain deployed a large force to the Iberian Peninsula in 1808. Thus ensued the Peninsular War of 1808–14. This article discusses some of the medical advances identified from the war, including force health protection measures, surgical techniques and medical evacuation.
Consideration of the medical care and biomedical support of women and children on Role 2 Afloat maritime contingency operations
Authors: Hillman CM , Horrobin R , Mills S , Mercer S
Published: November 2020

The Royal Navy’s Role 2 Afloat (R2A) capability has now been firmly established in support of United Kingdom (UK) troops on contingency operations such as humanitarian aid and disaster relief operations. This article reviews the current capability of R2A to deliver medical care to children and pregnant women, including the challenges facing the deployed Biomedical Scientist (BMS).
CrossFitter’s knee: patellofemoral chondral injury following high-intensity functional training
Authors: Jackson J , Hart S , Fries CA , Robinson J , Murray J , Wood A M
Published: November 2020

We present a case series of patients with patellofemoral joint (PFJ) chondral injuries presenting as anterior knee pain secondary to participation in high-intensity functional training programmes. We aim to highlight PFJ chondral injuries as a potential complication of military servicemen engaging in high-intensity functional training programmes. This may allow medical staff to identify the injuries early, and highlight this possible injury mechanism to Physical Training staff to help educate participants and mitigate the risk of injury.
Creating a Healthy Ship
Authors: Morrow L , Abrams C , Shaw A
Published: November 2020

In 2015 HMS DUNCAN was chosen as the intervention ship for an Institute of Naval Medicine (INM)-led project entitledSecond Sea Lord (2SL)’s Feeding the Fleet Initiative. During her nine-month maiden deployment on Operation KIPION, a healthy lifestyle intervention was initiated, encompassing executive health, catering services, medical services and physical training. The key enabler of the success of the intervention was the formation of an effective Unit Health Committee. This article presents the lessons identified and provides useful examples from the intervention, which aimed to create a healthy lifestyle culture on board a deployed ship.
1982 Falklands War: An analysis of UK combat injuries and survival
Authors: Penn-Barwell J G , McGuire RA , Rickard RF
Published: November 2020

It is thought likely that the next conflict in which the Naval Service is closely engaged will show greater similarity to the Falklands War (Operation CORPORATE) of 35 years ago than to the recent, prolonged, counter-insurgency operation in Afghanistan (Operation HERRICK). This study uses registry data to examine casualties sustained on Op CORPORATE and compares the injury severity of survivors with that observed on Op HERRICK. Because of their mechanistic consistency, dismounted gunshot wound (GSW) casualties are used as the cohorts for comparison.

This report details the first systematic quantitative analysis of Op CORPORATE casualties. The analysis suggests that, at least amongst those dismounted casualties injured by GSW, more severely injured casualties survived during Op HERRICK than during Op CORPORATE. Allowing for the different operational scenarios and the significant differences in the provision of medical care, it can be concluded that these differences were not as marked as might have been expected and that, overall, survival outcomes approached those seen more recently in Afghanistan.
Managing suspicious skin lesions on deployed operations
Authors: Holland T J , McIntosh S , Smith J J
Published: November 2020

The incidence of skin cancer is rising year on year. The general risk in the military population is low, but a missed lesion may have severe consequences. This paper outlines the key factors to consider when assessing a lesion, risk stratification methods and the challenges of managing suspected malignancy when operating remote from the UK.
Intravascular ultrasound, performed during resuscitative endovascular balloon occlusion of the aorta (REBOA), confirms correct balloon deployment and haemostasis - a potential solution for remote, austere and military settings
Authors: Rees P S C , Buckley A M , Watts S A , Kirkman E
Published: November 2020

Introduction

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is rapidly evolving as an emergency haemorrhage control technique. It has wide potential applicability in remote and austere settings, and following military trauma where prolonged field care might be required. However, rapid confirmation of balloon delivery is a challenge which relies on estimates derived from anatomical measurements or trans-abdominal ultrasound. In addition, confirmation of adequate balloon expansion is difficult. Intravascular ultrasound (IVUS) offers a solution to these two issues, making REBOA a deliverable therapy in the pre-hospital and early hospital settings.

Methods

In an animal model of severe ballistic trauma, following characterisation of the technique, an IVUS-REBOA device was configured, combining a peripheral angioplasty balloon and a digital coronary IVUS catheter. This was introduced via a sheath into the femoral vessel over a conventional angioplasty guide wire.

Results

Real time IVUS imaging allowed confirmation of delivery of the balloon to the aorta, and also demonstrated full apposition once deployed. Furthermore, using ChromaFlo imaging, the device confirmed loss of pulsatile flow in the aorta after deployment, correlating with loss of transduced femoral pressure traces. Post-mortem examination confirmed correct anatomical balloon placement.

For the first time, in a porcine pilot study, we have demonstrated that IVUS-REBOA is feasible and confirms both correct balloon placement and haemostasis. It has potential to offer advantages to REBOA operators especially during the pre-hospital and retrieval phases, and in the early phase of hospital delivered damage control resuscitation at remote locations.
Helping St George: the Royal Naval Medical Service at Zeebrugge, 22-23 April 1918
Authors: Wickenden JVS , Walsh D
Published: November 2020

On the night of 22-23 April 1918, the Zeebrugge Raid, part of Operation Z.O., took place. This historical article gives some context to the raid and its purpose, studies the medical provision for and experience during the raid, and tells the stories of the medical staff involved.
Operation RUMAN: Role 2 Afloat delivering Humanitarian Aid and Disaster Relief operations in the Caribbean
Authors: Matthews J J
Published: November 2020

In the autumn of 2017, two Category 5 hurricanes caused extensive damage in the Caribbean. This resulted in the activation of two Role 2 Afloat (R2A) teams in support of Operation RUMAN, the military response to provide Humanitarian Aid and Disaster Relief (HADR) to the affected area. This paper documents the deployment of the R2A capability during Op RUMAN and outlines the main lessons identified in the delivery of HADR in the maritime environment.
Presentation and management of traumatic pneumothorax in the deployed setting
Authors: Cornell J
Published: November 2020

Pneumothorax is a potentially life-threatening complication of traumatic chest injury. Rapid assessment, recognition and management in the deployed pre-hospital and hospital environment is essential, as complications such as hypoxia and cardiovascular collapse require urgent intervention. This article aims to describe the evidence for presentation, management and occupational aspects of traumatic pneumothorax, which can prevent selection into specialist roles such as diving, submarine service and aviation.
Free Open Access Medical Education (FOAM) and its relevance to military clinicians
Authors: Winstanley M , Henning D , Gurney I
Published: November 2020

Clinicians are expected to regularly update their professional knowledge, and in doing so, they navigate more complex and wide-ranging educational resources, putting greater pressure on their time. Free open-access medical education (FOAM) is an environment led predominantly through social media which enables discussion, education and rapid dissemination of journal articles and other educational material.

The Defence Medical Services have many different employment groups spread across a variety of medical specialties. FOAM can provide benefits to military clinicians in promoting and disseminating the work being done, and in terms of recruitment and education of clinical personnel, both in the firm base and in deployed settings. There are several potential pitfalls among FOAM resources which can be addressed by carefully appraising the resources being used and being aware of the possible biases. This article aims to highlight the possible uses of FOAM within the military as well as some methods to help engage users and ensure they are able to negotiate the hazards of the FOAM world.
Peripheral arterial disease
Authors: Swain C S , Khan M
Published: November 2020

Peripheral arterial disease is traditionally considered a condition that affects an elderly population. Although rare in personnel in the Royal Navy, it has the potential to have a significant impact on individual operational capability. This review article addresses the clinical picture of peripheral arterial disease including examination, the differential diagnoses, and management in the pre-hospital military environment, and makes recommendations regarding referral to specialist care and future deployability.